How To Optimize Brain Health For Longevity

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman: (00:10) Today we're going to discuss one of my favorite topics, brain health. Now, when you ask most people what they fear when it comes to aging, pretty much everyone says the same, they're scared of losing their executive function, their ability to think, and remember, their ability to focus and stay energized. In short, they're afraid of losing their minds. We can get a new knee, even a new heart or kidney, but we cannot get a new brain. Well at least not yet. Dr. Mark Hyman: (00:37) When we talk about healthy aging, we have to discuss brain health. Currently one in three seniors dies with Alzheimer's or dementia. Over five million Americans are struggling with Alzheimer's and changes can be found in your brain sometimes 20, 30, or 40 years before a diagnosis of dementia occurs. This means that we have a lot of time to heal our brains before we get into trouble. Dr. Mark Hyman: (01:02) Now most of us know we can prevent heart disease by living a healthier lifestyle. But are you aware that the same is true of our brains? Not many people are talking about how to live a brain healthy life. Now remember that unified theory of aging, the problem of insulin resistance caused by too much starch and sugar. Well it applies to the brain too. In fact, scientists now refer to Alzheimer's as type three diabetes or diabetes of the brain. We know that diabetics have four times the risk of getting dementia and that even pre-diabetes can lead to pre-dementia. Dr. Mark Hyman: (01:39) Researchers are exploring, and I have seen in my own patients, the benefits of diet change in dementia, especially very low carbohydrate ketogenic diets, that's mostly fat and very low carbs. Amazing new studies show that aggressive lifestyle treatment and addressing underlying chronic issues like diabetes, high blood pressure and nutritional deficiencies can actually slow and even reverse memory loss in people who already have early dementia. Dr. Mark Hyman: (02:08) And remember, an ounce of prevention is worth a pound of cure. So starting early is really key. My youngest brain patient is nine years old. She's fine now, but has a high risk of dementia, which I'm sure we can prevent by starting early to optimize her health and her brain. Dr. Mark Hyman: (02:27) Now memory loss is just one of the many challenges we see when it comes to declining brain health. Others include anxiety, depression, personality disorders, eating disorders, addictions, obsessive compulsive disorder, attention deficit disorder, and lots more. I believe that our brain is our most important and powerful organ. It's a three pound universe sitting at the top of our body that dictates our choices, that gives you personality, that allows you to fully engage in life. In my last docuseries, Broken Brain, I discussed a key insight that most people still don't seem to understand. And that insight is that your brain is an organ that's connected to everything else happening in your body. Fixing your brain starts with fixing your body. You have to optimize all the inputs and take out all the bad influences or bad information going into the system. I truly believe that the brain is resilient. It can recover and it can heal when given the right conditions. I've seen it over and over in thousands of my patients and the brain science backs this up. Dr. George Papanicolaou: (03:37) Brain health is a really important topic. It comes up in almost every conversation with my patients, and dementia seems to be the fear. Most of all my patients, somewhere in their list of complaints is going to mention something about memory loss or forgetfulness. And they start to worry, is this the beginning of Alzheimer's dementia? Quite honestly, they should worry. But not because they're having some lapses in memory or forgetfulness, but because science is showing us that you can begin the process of developing Alzheimer's dementia 20 to 30 years before you wake up one morning, forgetting your wife's name. It's important when you're young to start thinking about your brain health. You might not want to, you might not think you have to because you're young. But as I said before, you need to start thinking about brain health before it's too late and changes begin. Dr. George Papanicolaou: (04:31) But what is happening in your brain when you're 30 and 40? You're maturing, you're probably starting to feel mature and really getting a good grasp of who you are. Well that's because the brain is still developing, believe it or not. And there are different parts of the brain that are now becoming interconnected. And as those connections occur, you're getting more self-regulation, more self-control and more awareness of your emotions. At the same time, your brain is still putting down myelin on your neurons. Myelin is an insulation that allows those neurons to fire and move information very fast. And the more myelin you have on your neurons, the faster you're going to be able to think. And it's still happening at quite a rapid clip. It starts to level off by the time you're in your forties or middle age. But in your thirties and forties, you're still laying down a lot of myelin. Dr. George Papanicolaou: (05:26) Interestingly enough, in my practice, I do have a lot of 30 and 40 year olds beginning to complain of slower cognition, some brain fog, and even some memory lapses that they hadn't had before. I think it has a lot to do with stress. Greater college debt, waiting to get married in your thirties, maybe even starting a family while you're trying to get a foothold on your career, or a confluence of events that just didn't exist a generation ago. The first place to start in building brain power and avoiding early cognitive decline is building stress resilience. We all have stress, it's everywhere. But it's not meant to be chronic. It's really meant to last for seconds. Dr. George Papanicolaou: (06:13) The bearer lion jumps out of the weeds. All of a sudden, you start to run. Your adrenal glands have pumped out cortisol followed by norepinephrine. Now your vision narrows, your heart's pumping faster, your muscles are stronger than they were seconds before. Now you either get eaten or you get an opportunity to pass your genes on to the next generation. But it happens in seconds. When we're under chronic stress with marriages and work and kids and illness, and it's constant, our cortisol levels are going to be elevated. And that elevation in cortisol leads to problems that will result in early cognitive decline. High levels of cortisol actually have a huge impact on the hippocampus. It will cause dysfunction and shrinking of the hippocampus, and that's where you retain and form memories. Elevated levels of cortisol also impact the prefrontal cortex, and that's where you do your executive function, organization and critical thinking. When the cortisol is too high, you're going to see difficulties in those areas of your brain function. Dr. George Papanicolaou: (07:24) High levels of cortisol will decrease a hormone called Klotho. Klotho regulates the aging process. It also provides your brain with resilience against toxins, many of which can lead to Alzheimer's dementia. A really important study, done at UCLA in 2015, looked at long-term meditators, comparing them to those that didn't meditate at all. And they found that long-term meditators, people that have been meditating at least 20 years, had far greater volume of gray matter in their brain. Dr. George Papanicolaou: (07:57) Other studies have shown with just three months of meditation, you see structural changes in the brain that impact function. The corpus callosum, which is the band of neurons that connect the right to left brain, actually gets thicker. That allows for the right and left brand to communicate and enhance your creativity. You also see an increase in size of the hippocampus, that part of the brain that's responsible for retaining memory, consolidating it and maintaining it. And you also will see a shrinking in the size of the amygdala. The amygdala is responsible for regulating fear, anger, and anxiety. So meditation has these great benefits that you can see in a very short period of time. Dr. Todd LePine: (08:43) We do tests at The UltraWellness Center that look at the risk factors for people with neurodegenerative conditions like Alzheimer's, people with mood conditions and people addiction issues. And what you see in this particular genetic analysis, which we use, called DNA Mind, it looks at these markers related to oxidative stress, inflammation, and brain-derived neurotrophic factor, BDNF. When you have imbalances there and you've inherited these tendencies, it pushes your risk level up for developing neurodegenerative conditions. So it helps you to sort of preempt it. Again, just because you have the genes does not mean you're going to get it. But you may find that you are at much higher risk than your brother or your sister or your friend, and that's really where you get preemptive medicine. Dr. Todd LePine: (09:36) The earlier you catch neurodegenerative conditions, the better. It's a little bit sad because sometimes I will see patients here who have been having their either Parkinson's symptoms or their Alzheimer's symptoms for 10 plus years, and then finally they find us here. And it's a lot harder to treat those conditions once they're more advanced because you have more destruction. It's sort of like if a building's on fire and it's been on fire for five hours versus five minutes, you can put out the fire a lot earlier. Dr. Todd LePine: (10:07) So I have seen a lot of patients who have come to me and they're having problems with cognition, you can call it brain fog or forgetting. And when you clean up their diet, get them off of inflammatory foods, sugar, gluten, dairy are the big ones, any of the artificial foods. Specifically, one of the things I always like to emphasize to my patients is artificial sweeteners. Artificial sweeteners are ubiquitous. They're everywhere. And the artificial sweeteners are supposed to help you lose weight. And I always tell my patients that I've never seen a person lose weight with diet soda, but I've seen a lot of patients gain weight with diet soda. Dr. Todd LePine: (10:47) And these also disrupt the gut microbiome. And then also food additives like food emulsifiers can lead to leaky gut, which in turn can affect the brain. So there's definite things that you can do, just nutritional wise and dietary wise, that can improve a person's cognitive function. And I've had some patients who have come in to me, one in particular comes to mind, it was a woman who I saw. She came in with her husband and she was told by her doctor that you've got Alzheimer's and get your affairs in order. And when we did a full workup on the patient, she had a whole host of things. It's like Dr. Bredesen was talking, it's like Alzheimer's is like a roof with 32 holes in it. And there's all different things where the water can leak in. Dr. Todd LePine: (11:35) So you want to look at all of those things. So we look at heavy metals, we look at the oral microbiome, we look at the gut microbiome. We look at the genes that the person has. We look at their oxidative stress levels, we look at their glucose levels, we look at their insulin levels and we look at the whole big picture. And when she came in, she was having problems with conversation, she was having sort of a flat mood. And when we addressed all of those conditions, and it took some time, it was like she awoke, you know the movie awakenings with Robin Williams, it was like she awakened. It was like her brain woke up, that inflammation, that oxidative stress that was happening to her got turned off, the gene processes got turned off, and she was back to being her normal self. She was then able to have conversation, she was able to drive her car, she was able to be independent. It was really quite remarkable, and that was all without medication. Dr. Elizabeth Boham: (12:32) We always focus first on those lifestyle factors because they have a huge impact on your memory. We make sure they're getting good restful sleep and getting enough sleep, making sure they're getting those seven to nine hours a day. We make sure they're moving every day. We know exercise is critical for brain health. We know exercise is a great way to build BDNF, the brain-derived neurotrophic factor. So we make sure they're getting some exercise every day and getting some good strength training too, to improve insulin levels. Dr. Elizabeth Boham: (13:02) We focus on diet of course, because food is medicine. We make sure that they're not getting high levels of sugar. We make sure we're balancing blood sugar. We make sure that they have insulin, good insulin sensitivity, and we make sure that their diet is rich in phytonutrients. We work to manage stress. We know that when we're under stress, our memory doesn't work as well. When our cortisol levels are high, we're not going to remember the answer to that question or that person's name. So having some really good stress management techniques is critical for a well-working memory. Dr. Elizabeth Boham: (13:36) And then we make sure they've got good relationships and networks, make sure that they have good family and friends and interactions in their day. That can have a huge impact on how well somebody's memory works. We then go up into the matrix and look at how all the systems in the body are interrelated. We focus on any sources of inflammation. Sources of inflammation could be anything from your belly fat, too much visceral adiposity that's creating inflammation in the body and hampering memory. And we know that insulin resistance is tied to dementia and an increased risk of Alzheimer's disease, and it's one of the major things we can do to reverse memory loss. We can lower and improve insulin sensitivity, and that can help improve everybody's memory. Dr. Elizabeth Boham: (14:23) So we look for sources of inflammation like coming from the belly fat. We look for sources of inflammation, which could come from underlying infections like chronic infections in the body. Does somebody have chronic Lyme or a chronic viral infection, or do they have a chronic infection which is an imbalance in the good and bad bacteria in their digestive system, or are they getting inflammation because of a chronic infection in their mouth. Really important to pay attention to. We always look at the mitochondria and say, "What can we do to support the mitochondria?" Is somebody taking a statin medication that is damaging their mitochondria's ability to turn their food into energy? So sometimes we look for medications that may be causing damage to the mitochondria or damage to some of the cells in the body. And we also work to support the mitochondria, sometimes with things like CoQ10 or other B vitamins. Dr. Elizabeth Boham: (15:17) We of course, focus on toxins. Toxins are unfortunately a major driver of memory problems, anything from mercury to lead to plastics and other environmental toxins. And so we work to see, are there toxins in somebody's body, and what can we do to lower them or help the body's detoxification system? We make sure that their transport system's working well, that they've got good circulation in the body, that they're able to oxygenate their cells. And then we make sure that their hormones are in good balance. We screen for insulin resistance. And if there is, we work to reverse it. We make sure that their stress hormones are in good balance and their female and male hormones are in good balance. Dr. Elizabeth Boham: (15:59) All of those things are important when you're looking to see what somebody's individual risk for dementia is. I can't forget to mention also the B vitamins and B12. We see lots of B12 deficiency. And so that's important to look for. So I will often do markers like a methylmalonic acid or homocysteine, markers to see if somebody needs more B12 than the average person. And we do see some improvements when we supplement with higher doses of B12 in that situation for somebody's memory. Dr. Mark Hyman: (16:30) So there's a great article that I read years ago, in the Journal of the American Medical Association, called Shifting Thinking in Dementia. And it's had an interesting line in there, which says, "We have categorical misclassification with etiologic imprecision." And what that means is we say someone has memory loss and the reason for the memory loss is they have dementia. That's categorical misclassification. Saying they have dementia doesn't mean anything. It's just the name that we give to people who have memory loss, which is stupid because it doesn't tell you anything about why. And the second part of that sentence is etiologic imprecision. Etiology means cause. We're in precise about the cause. We don't look at the cause. So there's no such thing as dementia, there are dementias, and everybody's different, and we have to treat each person differently. That is going to be the future of medicine. Dr. Mark Hyman: (17:33) And we're hearing about it, precision medicine, precision health, right? But most of that sadly has to do with what we call pharmacogenomics, which is matching the drug to your genes. Great, if the genes that you have make this drug work better with less side effects, it's good to know. But it ain't the answer and it's not what we should be doing, which is true precision health and precision medicine and precision nutrition and personalized nutrition, which is functional medicine. And that is the future. We're not going to call it functional medicine in the future. It's just going to be medicine, right? There are new terms like network medicine, systems medicine. They're all just placeholders because the future is being revealed in the science, and we're seeing it for the first time. It's a massive paradigm shift. Dr. Mark Hyman: (18:22) It's like Einstein theory of relativity, or Newton saying there's gravity. These were big ideas that have just blown people's minds. And they took decades and centuries sometimes to be accepted. Even evolution, as a theory, is still challenged 150 years later, right? Where still people saying, "Nope, didn't happen." So I think this is where we are in medicine today, and if we are humble, if we are willing to look at the facts, if we're willing to change our paradigm, which is hard to do, we're going to see an acceleration in medicine that is going to lead to increased health, increased wellbeing and longevity like we've never seen before. And I'm just so excited to be alive in this moment and I'm glad it happened before I got too old so I can take advantage of it. And that's what this whole docuseries is about. It's giving you the knowledge and the tools to see the future today and make the future of medicine available to you right now. Dr. Mark Hyman: (19:28) Dementagens are things that cause dementia, and we know so much about what damages our brain. They're brain damaging things. And there are some things that are obvious and some things not so obvious. Diet, are inflammatory diet is the number one cause of dementagens. Processed food, sugar starch, lack of protective nutrients. That is number one. Lack of certain things like exercise are also dementagens. Exercise is one the best ways to activate BDNF, which is this miracle grow for your brain. Lack of sleep is a dementagen. At night, your brain has to clean up the garbage and it's got something that's been recently discovered called the glymphatic system. It's like the lymph system of your brain. And unless you sleep and have good quality sleep, you can't get rid of all the metabolic waste. It's one of the most metabolically active, if not the most metabolically active organ in your body, and it has a lot of waste that's produced as a result of that metabolic activity. Well, the way your body cleans it up is this glymphatic system, and it's active at night, which is how you clean up your brain. So sleep is so critical. Dr. Mark Hyman: (20:45) Stress is a dementagen. We know that when your cortisol level is high, your stress hormone, that it literally shrinks your brain. They've seen tumors in animals that produce cortisol causing shrinkage of the memory center in the brain, called the hippocampus. That's what shrinks in dementia. And when they take out the tumor, which lowers the cortisol, the brain grows back. So stress is a dementagen. Toxins are dementagens, environmental toxins, heavy metals, mercury, lead. Mercury is one of the most undiagnosed health risks that we have today in America, that is almost never tested and almost never treated because we never learned about it in medical school. So if we didn't learn about it, it doesn't exist. And I personally had mercury toxicity, which caused my brain to not work very well and made me feel like I was demented, and that's how I learned so much about it. But it's all the environmental toxins, but lead and mercury are among the worst. Dr. Mark Hyman: (21:50) And it's also lack of relationships. That's a dementagen. If you don't have social connections, social interactions, that affects your brain and makes it decline. Lack of meaning and purpose also. These are biologically active factors. They're not just emotional or psychological. They literally have biological impact on the structure and the function of your brain and every other part of your body. Certain foods can be dementagens, that are allergens, like gluten can be a dementagen. Dairy can be a dementagen, depending on your personal reactivity. Your gut microbiome, if it's not healthy in there, and you've got bad bugs growing, which a lot of people do, and you have a leaky gut, that's a dementagen because that inflammation goes throughout your body and causes dementia or loss of brain function. Dr. Mark Hyman: (22:46) So there are all these various factors that are identifiable, measurable, testable, treatable, that literally can take away all the insults that are causing your brain to decline and causing all sorts of problems. May just be brain fog, it may be depression, it may be ADD, and it may be true dementia or early memory loss. These are all things that we can do something about. I see so many people saying, "I don't want to know if I have the Alzheimer's gene because there's nothing you can do about it." Nonsense. We know now, from rigorous research, that aggressive lifestyle interventions, personalization and optimization of certain nutrients can actually slow and even reverse the course of dementia. So we're in a whole new era of thinking about this that's so exciting, and that allows us, through the use of the lens of functional medicine, to diagnose and to treat these dementagens. Dr. Mark Hyman: (23:45) And there's sometimes other things that are not necessarily our lifestyle like infections. If you get Lyme disease or if you have mold exposure, these can also cause brain damage and they're treatable. Now, Kris Kristofferson had dementia, quote, unquote, turned out he had Lyme disease. He was given intravenous antibiotics and his dementia went away, and I've seen many patients like this. So we have to really look deep and dig deep and be medical detectives and figure out what are the dementagens for each person and how do we get rid of them? And then we need the other part of it, which is how do we restore the brain function? How do we create neurogenesis and neuroplasticity? How do we bring in the things that are reparative, regenerative and healing, that actually can help the brain function better? Dr. George Papanicolaou: (24:29) I spent a lot of time talking about lifestyle factors improving brain function, but there's also a very keen interest in nootropics. Nootropics are compounds that increase brain power and function. Nootropics can also be very beneficial in decreasing inflammation and repairing neurons after trauma. But the main focus for most people using nootropics is they want to enhance their brain function. They want more cognitive ability, they want more memory, they want to be able to organize and be more creative because they see that declining. Again, a lot of that may have to do with stress, but people are looking for that benefit. So nootropics can be very helpful for people who are trying to enhance their cognitive abilities. They're also very helpful in the area of dealing with cognitive decline and dementia. Many nootropics can actually show improvements in memory and cognitive function in those disease states. Dr. George Papanicolaou: (25:31) Now most of us, surprisingly or not so surprisingly, very commonly used nootropics. One of the most common nootropic is caffeine. You find it in tea and you find it in coffee. Caffeine can be bad for you if you overdo it, but it is a stimulant that has been shown to improve cognitive function and mental endurance. So the good thing about caffeine is that it gives you access to other neurotransmitters in your brain, like acetylcholine. Acetylcholine is really important in memory and learning, so we want to have a lot of acetylcholine. L-Theanine is another compound that I use that will enhance the effects of caffeine and limit the caffeine induced jitteriness. Studies have shown that the combination of caffeine and L-Theanine actually can help you improve your ability to multitask. And a safe way to get both caffeine and L-Theanine together is to simply drink green tea. Dr. George Papanicolaou: (26:30) A really interesting herbal compound that I use is called Huperzine A. Huperzine A increases the amount of acetylcholine in your brain, which is a neurostimulator and improves cognitive ability. The way Huperzine A works is that it blocks the action of something called acetylcholinesterase. Acetylcholinesterase breaks down acetylcholine. So by blocking that enzyme, you allow levels of acetylcholine to rise. This is actually a target for pharmaceutical companies who are trying to treat Alzheimer's because there are lower levels of acetylcholine in the brain of Alzheimer's patients. But for an average person, using Huperzine can improve cognitive function and speed of task performance. Dr. George Papanicolaou: (27:18) My favorite nootropics are peptide nootropics. So peptides are synthetic proteins that are 50 amino acids or shorter. Peptides are designed to enhance naturally occurring physiologic processes in the body. Specifically in the brain, neuropeptides or nootropic peptides, can increase BDNF. And we know that BDNF increases the number of connections between neurons and speeds up transfer of information. Dr. George Papanicolaou: (27:52) These peptides can also increase nerve growth factor in the brain and the periphery, and therefore have a role to be played post-trauma or other injuries to the brain. The reason why I like peptides a lot is because they have lasting effects and they can change the neurologic structure of your brain, which differs from the temporary effects that you get by just raising chemicals for short period of time with Huperzine A, caffeine or L-Theanine. Dr. George Papanicolaou: (28:19) My favorite of all of the peptide nootropics is Dihexa. Dihexa was developed at the University of Washington. The key thing about Dihexa, it can enhance neurogenesis and synaptogenesis at multiple connecting of neurons, a thousand times more than brain-derived neurotropic factor, or BDNF, which is the natural compound that your brain uses to do that. Dihexa has been shown to improve cognitive function, is shown to improve memory and learning. There's a lot of hope and promise in using it for patients who are having cognitive decline and early stages of dementia. Those research studies are being done now. Dr. George Papanicolaou: (29:07) Cerebrolysin's another nootropic peptide that is much more known about than Dihexa. Cerebrolysin has been shown to have really great benefits post-stroke and post-trauma, like concussion in the brain. It has a neuroprotective effect that is enhanced by its ability to also raise BDNF and nerve growth factor. It can also, because of the enhancement in nerve growth factor, help with peripheral neuropathies. Dr. George Papanicolaou: (29:35) So these are all the nootropics. We have natural compounds and then we have synthetic peptides. They're all really effective in helping to protect the brain, keep it from aging and enhancing brain performance. I do recommend to all my patients, before we start using nootropics, that we really dial in the lifestyle measures. We work on sleep, we work on stress reduction and resilience and we get them exercising. In fact, the first prescription I write for most of my patients who are having anxiety, depression, or memory lapses is one for exercise. I want them exercising at least 20 minutes every day. So remember, if you are going to do nootropics, they are supplements that you can buy. Start them slow, titrate them slowly so that you can make sure that you tolerate them and you don't have any side effects. Dr. Mark Hyman: (30:29) Your entire body and all the core systems in it interact as a single sophisticated symphony. You're one whole person and all the pieces of your biology and your unique genetic code interact with your environment to determine how sick or well you are in this moment. This means your body and your mind are connected as well. The body and the mind are a single dynamic bidirectional system. What you do to one has an enormous impact on the other. I've said it before, and I'll say it again, what you do to your body, you do to your brain and vice versa. Dr. Mark Hyman: (31:05) We know our mind can dramatically influence our health, your thoughts, your beliefs, your attitudes, traumas, life experiences, directly influence your biology. Your cells are literally listening to your thoughts. And the body directly and powerfully influences the brain. Things like nutritional status, hormone imbalances, food allergies, toxins, digestive, immune, or metabolic imbalances, all these influence our mood, behavior, attention, attitude, and memory. We need to honor this bidirectional relationship in order to reclaim our brains and live a life of vitality. Thanks for tuning in and see you next time for episode six.