Brain Fitness: Reversing Cognitive Decline And Improving Brain Function - Transcript

Introduction: Coming up on this episode of the Doctor's Pharmacy,

Dr. Majid Fotuhi: Your brain is a tissue is an organ. Just like your skin, just like your heart. And you can do things to heal it and make it healthier.

Dr. Mark Hyman: Welcome to Doctor's Farmacy. I'm Dr. Mark Hyman. That's farmacy with an F, a place for conversations that matter. And if you care about your brain and you want to know how to make your brain better, or if you feel like you got brain fog or memory loss or ADD or you can't focus, there's a reason and there's also a way out. And we're going to talk about that today with one of the world's experts on brain fitness. Something that maybe most of us don't think about. We go to the gym for our body and our muscles and our heart, but how do we actually create a program or a way of living or engage in practices that optimize our brain, that protect our brain, that prevent it from depression, and, and dementia. So we have an amazing guest today, friend of mine, Dr. Majid Fotuhi, a neurologist with expertise in the field of memory, concussion and successful aging. I love that. Successful aging. Through his 30 years of teaching and clinical work in neuroscience research at Harvard Medical School in Johns Hopkins, he's developed a multi disciplinary program for helping people of all ages to improve their memory and their attention, which we all need because this is like a distracted world. He created an innovative brain fitness program, exactly what I was talking about that addresses lifestyle factors, cognitive stimulation and other things. And he's published the results of this successful program for patients with memory loss, with aging concussions and adhd in several scientific journals. And three books including Boost Your Brain, the New Art and Science Behind Enhanced Brain Performance. He received his doctorate in Neuroscience from Johns Hopkins and his medical degree from Harvard Medical School, and he serves as an adjunct professor at George Washington University. Welcome, Majid. Good to see you again.

Dr. Majid Fotuhi: Thanks very much for having me on your show, mark. It's so nice to see you.

Dr. Mark Hyman: Yeah. Well, we first met when you came to Cleveland Clinic to do a presentation at one of our innovation summits, and we talked about the sort of revolution in brain science that's happening right now. And I think most people have kind of heard about how we can help our brains but don't really have a clear understanding. We know for our heart, for example, we need to eat healthy and to exercise and to make sure we don't smoke and don't have high blood pressure and control our blood sugar and diabetes. But most of us have really never thought about how do we optimize our brain function. And it's the most important part of our anatomy. I mean, obviously you talk to any specialist, they think their organs the best part, but the truth is that the brain without that we're not us. And as it declines and as we have various insults to it from our modern world and stress and toxins and our diet and so many other things, our brains tend to not function as well.

Dr. Mark Hyman: And many people walk around with brain fog, with trouble concentrating, with paying attention, and even with significant memory loss. So you really pioneered a whole approach to rethinking how we take care of our brains. And I'd love you to sort of share as a neuroscientist how you first came upon this because typically as doctors we're trained to essentially just treat and treat right? We basically, we have a terrible thing we say, but we say we treat 'em and treat 'em, basically give them the medication or the treatment and not really figure out how to get people healthy, but just treat the disease or in neurology. The other thing we often say is diagnose an adios, right? We diagnose someone, okay, you have parkinson's, you have dementia, you have ADD, you have this. And we basically say goodbye because there's nothing much we can do about fixing the brain.

Dr. Mark Hyman: But the truth is there's a lot we know. And I created a broken brain documentary a number of years ago that many of you can watch online. It's part of our Dr. Hyman plus community. And I think there's other ways to access it well, but it's really a map of a different way of thinking about the brain and how we can optimize our brain function. So let's kind of jump right in. One of the things we're seeing is this rapid explosion in dementia in America and globally, I think six or 6 million or so are living with Alzheimer's now it's projected up to 14 million in a decade or two, and the cost is half a trillion dollars a year to America. This is a massive cost because of the cost of taking care of these patients. It's the number one costly disease. And yet there are no real therapies for this or no real therapies that conventional doctors actually will recommend other than drugs which don't really work. There's been $2 billion plus spent over foreign studies and not a single drug really has any real impact. Maybe they mitigate things a little bit. Maybe they delay your admission to nursing home for a couple of months, that's a successful study. So I think we really, really need to rethink this whole approach. So what are the top things that people can do today to prevent cognitive decline and to optimize their brain function? What would be your highlights? And then we're going to kind of dive into all of it.

Dr. Majid Fotuhi: I think it will help for me to explain how I got to where I am now. I've been able to help a lot of people with brain fog or brain dysfunction, memory loss attention. And we have seen remarkable results in the program that I have developed and is actually available on my website. But lemme just tell you how, ask me how I got to this point. When I was in Harvard Medical School, I became really interested in brain and what happens to our brain with aging. And when I went to do my residency in neurology at Johns Hopkins as a part-time job, I work in the Alzheimer's Disease Research Center Center. My job was to just see these patients who come every year and for us to monitor their progress longitudinal study, looking at people for 30, 40 years that would come every year. We did questionnaires, testing, mris and so forth.

Dr. Majid Fotuhi: And I was curious that many of them who came with the diagnosis of alzheimer's disease had diabetes, hypertension, sleep apnea, the things I knew would cause memory loss. And I was wondering, well, why do we call these people as having alzheimer's disease? They don't have alzheimer's disease that have vascular cognitive impairment. So I digged in to see where do people talk about these things? And back then it was 19 ninety-seven 19 ninety-nine. There wasn't much. And I was surprised. I said, well, this is so obvious. I wrote some articles about how we are over diagnosing alzheimer's. And then I wrote a book about this and it's called the Memory Cure. And in it I explained that a lot of things we call alzheimer's is not really a single disease. There's a of different things happening. Over time, your blood vessels shrink and become hardened. Dementia used to be called hardening the arteries. And I remember from my medical school days when I actually held brains of people who died and those who have vascular risk factors had very crunchy arteries. You can actually,

Dr. Mark Hyman: Wow.

Dr. Majid Fotuhi: Yeah, such vision. I never forget that I would hold their blood vessels and they were hard like little pipes there. A healthy person's blood vessels are more malleable. I can move them around. And that book actually did pretty very well considering that I was just the resident and fellow. I was very happy. And I continued to work at Alzheimer's Disease Research Center and I was an assistant professor of neurology at Johns Hopkins. I signed a hospital, I opened a Center for Memory and Brain Health back in 2002, 2004. The idea that you could do things to improve your brain health was still quite new. It was quite obvious. And I can see sometimes you're frustrated about the fact that people don't know how important food is. And if we take care of people's diet, we can have such a huge impact on our country's healthcare and economy and it's frustrating. Come on guys, this is so obvious.

Dr. Mark Hyman: Yeah.

Dr. Majid Fotuhi: So I did that. I wrote several articles. I published an article, nature Abuse Neurology, about how we have changing perspective about alzheimer's. It's not just plaques and tangles. There's a lot more to it. I wrote, and then meanwhile I was following the literature and some recent studies at the time, 2005 showed that you can actually grow your brain. You exercise, you grow your brain, you increase neurogenesis. I was just amazed. I said, you've

Dr. Mark Hyman: Got new brain cells,

Dr. Majid Fotuhi: New brain cells. And then I read that meditation can grow your brain. And I thought, really? You just sitting there breathing slowly, meditating for like 15, 20 minutes for six months. You have anatomical changes in the brain. There's one thing for you to feel better is one thing to change the level of transmitters in the brain is another thing to grow the brain. To the extent you can see on an mri, it's not microscopic, it's macroscopic. And then I was just blown away by the fact that an otherwise healthy person, we don't have to work with a diseased person and otherwise healthy person can grow his or her brain. And the hippocampus, which is the memory center of the brain, is a part that grows the most. Hippocampus is the size of your thumb. You have one on the right, one on the left, and this part of the brain is ground zero for learning and memory.

Dr. Majid Fotuhi: And this part of the brain shrinks by about 0.5% per year after age 50 on average. But there are things you can do to grow it by a lot. And as I will explain to you in a minute, we did it for our 12 week program. On average, people grew their hippocampus by 3%, which is the equivalent of six years younger in brain age within three months. So then I wrote another public paper and I published in Nature Reviews Neurology, which as you know is a very prestigious journal. And one thing I remember from back then, I think it was 2009 when I wrote that public paper. I send it for reviews. And when you send paper for reviews, usually one likes it, one doesn't like it and one is in middle. When I sent that review article, I got three very positive feedbacks like these people said, yeah, he's right, this is right. And yet nobody else was talking about these things. And to me it was surprising that my neurology colleagues are too busy doing the same old things. Do Dmt, MRI read, prescription Go where we need to hit the pause button and say, wait a minute, what we call alzheimer's. It's really not alzheimer's the soup of problems and then

Dr. Mark Hyman: A soup of problems. I really like that it's a soup of problems. And I think I just want to say something really important here. In traditional medicine, the diagnosis is king. Once you meet these criteria for a bunch of symptoms, we say, oh, we know what's wrong with you. You have got alzheimer's. But the truth is alzheimer's is the name of people of the thing that happens, that people have certain symptoms, you have memory loss and so forth. So it's not actually the cause Alzheimer's cause your memory loss. Something is going on in your brain. And so there's many, many causes and many different people will have different causes for their dementia.

Dr. Majid Fotuhi: Yeah, it's interesting that Dr. Alzheimer's in, so our alzheimer's in a production shirts that talked about aging and dementia in people is because of multiple factors. He never said, I've discovered a disease. He just said, Hey, I saw these few cases. They have these unusual abnormalities. I dunno what they are, but the chairman of his department at the time wanted to make his department look better. It was berlin versus Prague back then, and he called it an alzheimer's disease. So he himself, he himself, I have a quotations that says that the convolution of the brain is because of multiple reasons. But anyway, as I went along, I decided to start my own brain center and provide all the things that I know, grow the brain for our patients and teach them, educate 'em about all the things they're not supposed to do. Because if you can stop the things that shrink your brain and do more things that grow your brain, then you're good. And if you understand why things are the way they are, you'll continue that lifestyle for the rest of your life, which means you change your trajectory from getting demented at 75 or 79 or 82 to no 95 because a lot of people,

Dr. Mark Hyman: Five,

Dr. Majid Fotuhi: Exactly 105 things that you do actually affect telomeres. The same things that are good for the brain are also good for epigenetics and genes as you know. So then I study this program and I published a paper in 2006 when I came to Cleveland clinic. At the time, I had finished the paper and it got published 2006 in the Journal of Permission of Alzheimer's Disease where we provide this 12 week program which had three elements. It was an element of lifestyle modification, all the things you tell people to do, and had an element of brain training. And we provided targeted brain training for people. So somebody had memory loss, we provided with memory training if they were slow to think. We challenged their processing speed with games, all fun games. And we provided biofeedback a form of biofeedback called neurofeedback and other forms like hrb biofeedback.

Dr. Majid Fotuhi: And we saw that people who came to our clinic twice a week for 90 minutes at a time over a period of 12 weeks had improved their memory. A lot of the drugs you talk about, these are people who are like sixties and seventies in some eighties. Most interventions that are done for these drug trials look at their rate of slowing change in rate of decline. Not that people get better is that they help a certain percentage of patients get worse, slower. They don't actually help patients get better from zero instead minus eight, they go to minus five, but nobody goes plus two. In our program, 84% of patients had mci mild cognitive impairment, which is a stage between normal and adults with alzheimer's disease got better. They had objective improvements in the cognitive tests. So I was encouraged with that. And then I thought, and by the

Dr. Mark Hyman: Way, just to stop you there for a minute, yeah, okay. There's really no drug that has ever shown reversal or improvement in the treatment of dementia. There is no drug. There has been a trial called the FINGER trial, which is a large clinical intervention that looked at aggressive lifestyle intervention, optimizing person's health with diet, exercise, sleep, et cetera, aggressively treating all the risk factors, blood sugar, blood pressure. And they saw not only a slowing, not only a stopping, but actually a reversal of cognitive decline in these patients who already had early memory loss. So this is really important for people to understand that you can go to the doctor, but they're not going to be able to give you anything that's going to address your memory. You have to do the things that Majid is talking about, which is essentially addressing brain fitness.

Dr. Majid Fotuhi: Absolutely. And the person who runs that program, Mia Givipelto, is a friend of mine. We've been talking about how people got things wrong since late-nineteen eighties when we were in the ALZHEIMER'S conference. And we see each other every year at the ALZHEIMER'S conference. And I'm so proud of her for putting this large program and this program, this finger concoct trial is done in Denmark and Sweden where people already have a good lifestyle. They will not in a place where obesity is everywhere and people have poor diet, these people on average eat well and exercise and are healthy on average person. So to provide a program to make them better and see results is really remarkable. If you do that program in a small town where people are obese and a sleep apnea is common and smoking is common, drinking is common, you would see much, much more robust results.

Dr. Majid Fotuhi: And my program is very similar to hers except that the difference between my study and her study is that we provided this in a real-life clinical setting. This is not a clinical trial in an academic center where people come to the center for the purpose of clinical trial. This is a real-life neurology practice where average person shows up and we provide this treatment for them. And the only exclusion criteria was that at the time they start, they wouldn't have schizophrenia or dementia when they start. They could have mci, they could have memory loss, they could have everything else, but they didn't have a major psychiatric disorder. And I saw a few people just because of neurology practice, people show up. So the other thing we did, which was really fascinating to me, I mean I knew that my program would work, but we did mris and half of our patients had a growth in the volume of their hippocampus as I had expected. I knew it would happen, but the fact that it actually happened for real, I remember the day I saw the R mri, I was just jumping up and down, oh my God, we did this. And one of our patients,

Dr. Mark Hyman: What he just said, was nothing short of revolutionary. The hippocampus is the part of the brain that's the memory center. It shrinks often as we age and it's very shrunken in people with memory loss. We've never seen anything that actually makes it bigger or grow. And now this is what Dr. Fatouye is talking about, which is this incredible science that allows us to intervene with people and actually help them not only slow and prevent the disease, but actually potentially even reverse all sorts of brain disorder.

Dr. Majid Fotuhi: And Mark, if a drug had done this, it would be bigger than vaccines for covid. If a drug had done half of this, a third of it, a 10th

Dr. Mark Hyman: Of it,

Dr. Majid Fotuhi: The drug had done a 10th of what we did, which is just improve people's cognitive performances or objective testings, never mind that actually grows the brain. And by the way, all the drugs that are current drugs for alzheimer's disease all shrink the brain. And this is something that people need to figure out what happens. Anyway, so back it was 2007, 2008, I was so excited I was providing this program, but since I had a neurology practice, I would also get patients who had concussion or other things. And some people have persistent concussion symptoms, something called post-concussive syndrome. And these are people who have had headaches or memory problems. They can't work, they can't think. They have irritability for months to years and they've seen multiple doctors and nothing has worked. I had some of those patients and I put them in the program and I saw that our program worked for them as well.

Dr. Majid Fotuhi: The reason I think the program was so successful is that we had a multidisciplinary intervention. We didn't just say, here's a prescription for your memory or your day. I actually took the time to do an inventory of all their problems. And then we addressed them. We addressed their memory, I mean their sleep, their anxiety, the inability with non-medication interventions, things like meditation, counseling, exercise, diet, stress reduction. And we saw again about 80% of patients improved. We did objective testing, which is standardized neurocognitive evaluation, and we did a series of four or five questionnaires. We did like a pittsburgh insomnia assessment. We did upwards for sleep apnea, we did back anxiety, we did back depression scales, and we did my own questionnaires for brain fitness and multiple questions.

Dr. Mark Hyman: And these are standardized, legitimate peer-reviewed, validated metrics for looking at mood, brain function, so forth. So it's not like it, Hey, I think my memory was better. It's literally how we measure success in science.

Dr. Majid Fotuhi: And we used validated standardized tests and I felt that I needed to do my own. So I made three questionnaires, and one of the things that we found is that the questionnaires I developed for brain fitness paralleled with the results we saw in the standardized. And so this study also validated my questionnaires because we saw results in our own patient population. It was exciting. We published that in Journal of Rehabilitation in 2020. And again, being a neurologist, I saw patients who would come for attention problems. I had many patients with adhd, whether they were teenagers, kids or adults or people in their forties, fifties. The one thing I learned, and you referred to this earlier, is that we put a label on, people say you have adhd, but it's not like cancer where you look at the mutation and you say you have colon cancer Because of this, these diagnoses are based on a group of experts sitting together making a list of criteria and then calling it this and that. There's nothing absolute about adhd. It's just group of experts coming together and deciding this five out of nine here, five out of nine here, and you put a label on people. A lot of times people have attention deficit disorder in my practice had poorly treated or untreated sleep apnea. Yes, they had attention problems and they did say yes to all the questions, but the real problem was sleep apnea, which

Dr. Mark Hyman: Yeah, I think this is such an important point because people don't understand how screwed up medicine is. And most of the diagnoses we have are really just description of symptoms and don't tell you cause. So when you say, I have depression, or I have adhd or I have alzheimer's or dementia, it's like saying about a headache. Why do you have a headache? Did someone hit you in the head with a hammer? Did you not sleep? Did you eat gluten? Are you having a hangover because you drank too much last night? Do you have a brain tumor? Do you have an aneurysm? There's a million reasons why you could have a headache. And headache is just means my head hurts, right? And so the same thing with depression or ADH adhd or dementia. We have to really start to look at personalization of healthcare and the individualization of our treatments that address the root cause or causes.

Dr. Mark Hyman: And what you do is really radical, which is what we call a multimodal set of interventions. Typically, doctors and science is all about the one thing, one drug for one disease, trying to find that magic bullet, right? The silver bullet that's going to fix it. And that's what most drug research is about. What you're talking about is doing all the things we need to help our brain. We need the right diet, we need exercise, we need sleep, we need stress reduction. We need all sorts of different things that we're going to talk about that actually help to optimize your brain function and address the root causes. So we really have to start to get this paradigm shift that's happening. And it's not just sort of on the margins of medicine, this is in peer review journals, but you're right, if this was a drug, it would be the biggest blockbuster. It would be bigger than Viagra or bigger than Ozempic or any other drug because it's basically doing something that nothing else can do about a disease that is devastating our society.

Dr. Majid Fotuhi: Absolutely. I think the key word you said is paradigm shift. We need a paradigm shift in looking at patients with comorbid memory loss and realizing that it's not just the plexus and tangles, and as you mentioned, there'll be several hundred clinical trials on eliminating amyloid and we still don't have a cure. Yes. The newest drug that was presented in alzheimer's conference does seem to have a slowing of the worsening. One of my colleagues said, yeah, it's great. You get a drug that's going to help you stay in that confused state for a longer period of time.

Dr. Mark Hyman: And by the way, it's like $50,000 a year or more

Dr. Majid Fotuhi: And increase risk of death as one of the side effects. But anyway,

Dr. Mark Hyman: I'll, oh, by the way, yes,

Dr. Majid Fotuhi: Yes. So in 2020 when I did that and patients with adhd or Adhd came to see me, whether they were teenagers or adults, we provide this program and we saw again about 80%. This was like our sweet spot. And so I just published a paper in the Journal of Alzheimer's Disease Reports in June of this year where we looked at three groups of patients who completed this program. It's a 12 week program where people get a full assessment by the beginning, cognitive testing, blood tests and questionnaires. They go to our program twice a week for 12 weeks, and then we see the testing results at the end. We check them every week, but then we do formal evaluation at the end. And the thing that was interesting to me is that we saw similar results in three groups of patients with three different labels and both cognitive tests and responses questionnaires shows dramatic improvements.

Dr. Majid Fotuhi: And to me it shows that if you improve the biology of the brain, your cognitive performance improves. And so the question is not for us to put a label on patients and say, you have this and that. The challenge for us is to figure out why aren't you paying attention? For some people sleep apnea, for some people headaches, some people have so much headaches that they can't pay attention, they're tired, they're irritable because they're frustrated, they're driving, wears them out, they can't sleep at night, they're sleep deprived. The headache is worse. They get into fights and they can't think it straight. Well, listen, they can't think of straight. It's not because they have alzheimer's or they have adhd. It's because their migraine is not completely treated. And the other thing I find fascinating is that we do four things for our patients overall until the principal diet, exercise, sleep, and a stress reduction. These four things seem to help these group of patients with different presenting symptoms. The other thing I found interesting was people,

Dr. Mark Hyman: Do you also use supplements or anything like that?

Dr. Majid Fotuhi: Yes, I recommend omega fatty acids. Again, I published this study myself in Nature early 2000 where I reviewed, I did a meta-analysis and I found that people who had high levels of omega fatty acids were less likely to get cognitive impairment and alzheimer's disease. So I recommend it to people, I take it myself. But in people who do like to take multivitamins or other things, have no objection, but the one that is a part of the program, we recommend mediterranean diet and supplements. And I totally like your idea of a diet. You don't have to be fully vegetarian or fully a carnivore. You can have it mixed. And as long as you stay away from processed food and you have a diversity of things you eat and the fruits of vegetables and a common sense, good diet is really what I recommend. And surprisingly, not too many people do that. The thing I found interesting is that when I sat down with patients, I always spend an hour in the first visit with patients where I would educate them. Now I have pictures of the brain shrinking. The bigger the belly, the smaller the campus, the more stress, the smaller you campus. And how,

Dr. Mark Hyman: Wait, wait. I just want to emphasize what you just said. The bigger your belly, the smaller your brain, the bigger your belly, the smaller your brain. Can you kind of unpack that for a minute because that's a big statement and because so many people have a big belly or even a little big belly, you don't have to have a giant belly. It could just be like a little extra poochiness in there and that's going to have an impact on your brain.

Dr. Majid Fotuhi: So this finding was first published in 2006, and I have a slide that shows correlation. If you kept body mass index and the size of the campus, it goes down the bigger the belly on average. Now, there are some people who do have a big belly, but hippocampus is good and there are some people whose belly is small, but hippocampus is not good. And I think that emphasize the importance of multifactorial basis of this. So if somebody has a big belly, but that person does exercise and does use his or her brain all the time is not stressed, that person may be better off as somebody who's thin but stressed out, doesn't sleep and has a poor diet and so forth. But on average, there's a very clear relationship between the size of the belly and the size of the campus. And now this year at the Alzheimer's conference in Amsterdam, which I attended myself, it was an article by my colleague Dr.

Dr. Majid Fotuhi: Raji that showed if you do mris of body, mris of people and look at their visceral fat, you can see a direct correlation between the visceral fat and the size of the brain overall and particularly the size of hippocampus. So in few studies, you just do a gross evaluation of being overweight body mass index, which is not perfect. But in this study of 10,000 people, they saw that there was a correlation between measurement, exact measurement of visceral fat and the size of the brain, and they put something to side by side and you would think this person has alzheimer's disease. This is a normal person. And the degree of shrinkage in obese people unfortunately is sad. And when I showed these kind of things to my patients, they would definitely think twice to eat the kind of date before. And the thing is that I feel bad for people who overweight because they didn't choose to be overweight or obese.

Dr. Majid Fotuhi: They just say, look, in the two years I want to be 200 pounds heavier. I teach about these things university for my students. And I explain to them that this process is slow. First you have this sugary food and it spikes your insulin levels, and then you have hyperglycemia afterwards. So you are tired and hungry, so eat more. And that extra food that you eat, especially if it's kind of soda or cookies or things that are not good for you, high in trans fats and high in sugar, that contributes to more of these can packed in your fat tissue. And then you still have not enough glucose for your eyes and your brain, your nerves. And this process is sort of a gradual vicious cycle that gets you. And the other thing that happens is that it worsens your brain and the cognitive part of your brain decides how much you eat.

Dr. Majid Fotuhi: So you've had your meal, you say, okay, I had enough. You stop because your stomach is stretched and you have to stop. But you see a tiramisu and you say, look, I have to eat this, and that's your reward system. And then your cognitive part says, no, we've had enough. We should stop. So there's a usual balance and people usually maintain a balance of their cognitive and their emotional decision making or how much to eat. But one thing that happens is that when you eat too much, this system breaks down. And if the worst system shuts down the frontal lobe, then when you see the food, you just forget about thinking about it, you become blind. The whole idea that you've had enough. So I feel bad for people who are overweight or obese, and I sympathize with them, but I also explained to them that it's doable for them to lose weight and it's never too late. So anyway, in our program we did diet, exercise, sleep and stress reduction, and we saw remarkable results because I think what we do is that we improve the biology of the brain. We do the investigative work at the beginning to find the five or six causes for a person's suboptimal cognitive function because their brain is not healthy. And then focus on those things in a personalized individualized program within 10 to 12 weeks.

Dr. Mark Hyman: So what are those five or six causes? What are the things that are causing our brains to not,

Dr. Majid Fotuhi: Yeah, the common culprits are poor sleep. Some people have difficulty falling asleep. Some people have difficulty staying asleep. And unfortunately a lot of people think, well, sleep problems are common and just I tell about sleep problems like everybody else does, but that's not true. Sleep problems are totally treatable. The other part is sleep apnea. When people sleep is fragmented because they snore wake up, sometimes they wake up 40 times or 60 times in an hour and it's terrible. They don't know because they're still knocked out. But when they wake up in the morning, they're tired and they're foggy. Another thing is sedentary lifestyle, poor diet and too much stress, too much anxiety. These are the common culprits. And of course, when I do blood tests, I do see vitamin D deficiency quite often. And after that I see low b-twelve levels,

Dr. Mark Hyman: Low b-twelve elevated homocysteine, which is full a b-six. Those

Dr. Majid Fotuhi: Are the common things I see. It's interesting to me that people who come to me and they're told with other doctors or they think themselves, they have alzheimer's disease, they have bread and butter conditions, they just have multiple of them at the same time.

Dr. Mark Hyman: Yeah, that's right. You have to treat everything.

Dr. Majid Fotuhi: They see a therapist, a therapist talks to them about you should settle things. Or they see depression in the csi countries who prescribe the medication for them. Then they go to cardiologists because of their obesity. And a cardiologists prescribe medications for their high blood pressure and they may have sleep problems. They see a sleep specialist who tells them about sleep hygiene and may prescribe a medication for them. And so they have a whole bunch of medicines and they feel horrible. And what needs to be done is for them to take fewer medicines and do the things that increase blood flow to the brain that rejuvenate your brain. You saw your podcasts, you talk about the garden we have inside us. I think that's a great analogy because we have also a garden here, and I think this is everybody's biased about which is the most important organ body.

Dr. Majid Fotuhi: But as a neurologist, I tend to think that the garden here, and when you garden, you flower your tomato plant and three weeks later you see a tomato, or two months later you see a bunch of tomatoes. And it's so rewarding because it wasn't there and it's there and it's definitely because you took care of it. And what I see, my neurology practice is equally rewarding because we see these people who are tired and worn out on hopeless, and they're just frustrated with things and they say, listen, we can do this for you. We've done it before. We have about 80% success rate. You will get better. And we go through this program with them and at the other end, they come back, they're dressing nicely, their skin glows, they're sitting upright. And I love it. That's the joy of my practice to see these people who look like a wreck. And not six months later, not a year later, six weeks later, they have some improvement and by 12 weeks,

Dr. Mark Hyman: No, it's true. It's amazing how just 12 weeks can reverse off a lifetime of insults. And I think what you're saying is that there's so many different factors that can cause brain dysfunction. You mentioned a number of them, but in my practice as a functional medicine doctor, I see even more things, whether it's heavy metal toxicity, lyme disease or tick infections, mold exposure, leaky gut inflammation from the microbiome, gluten sensitivity, and the list goes on. So really it requires a very deep dive. And what's quite amazing about your program is that you do just the basic stuff with a little bit of tuning up here and there and you still get remarkable results. And it's just so powerful and there's so many other things you can stack onto that that now we're learning can help the brain, whether it's hyperbaric oxygen therapy or things like nad and there's a lot of stuff that's actually emerging that can probably even accelerate your results, I would imagine. Yes,

Dr. Majid Fotuhi: I did check for lyme disease in many of my patients, and I did not check for mold in all my patients. I would listen to hear a correlation, and I think you see a lot more of those kind of patients than I did. People who have this hyperinflammatory state, they have this tired look in their faces. They just come again. I've seen patients for twenty-five years now. I get a feel for what this person's issues are. And of course we do testing and every once in a while I get results I don't expect. But people who just have this totally worn out face and they're just sitting there barely talking, they're frustrated because they've seen so many doctors. And I do find that those kind of patients I ask about mold exposure or when did the symptoms begin? They were fine until twenty-five and late twenties started. There's something new that happened to them. And so I do have a panel that I do level two for patients who didn't get better with my initial intervention.

Dr. Mark Hyman: And what do you do with that? What's level two?

Dr. Majid Fotuhi: Oh, so these are kind things I just said. Check for mold, dig deeper for possible infections, check inflammatory markers. And I didn't get mris for everybody. I would get mris for them. A lot of our patients had an eeg. We look at their brain's electrical activity. And that was very helpful for me because somebody sitting in front of me and the eeg was all blue. We used the color coding where red and yellow was hyperactivity, green was normal, and blue was lower level activity in different brain regions. So they were sitting in front of me and look at their eeg, it's all blue. And I think, wow, that's abnormal. And then I would ask them, I would say if somebody came to memory problems, the eeg was normal and somebody would come with the same degree of memory problem, but the eeg was blue, I would wonder what's wrong with this second person?

Dr. Majid Fotuhi: What's wrong with them? And that's where I find that they would have other things going on with them. And I think I say my program's 80% success, and I think that 20% and a hundred percent patients get better. Nobody comes and says, oh, I didn't see any improvement. Everybody who comes there gets better. And we have glowing remarks, reviews on Google reviews that people say, I changed our life, this and that. The 20% are people who did not statistically significant results on their objective testing. That's the 20% that's not there. But pretty much everybody, and that's a no brainer. Obviously if you get somebody who has an exercise and you get them to tweak their sleep so that they sleep better and change their mindset, I think one of the things I did for my patients, it was to help them change their mindset that yes, we're going to do this. Yes, I've had these problems for 10 years, 20 years, but brain is very malleable and your brain is a tissue is an organ just like your skin, just like your heart. And you can do things to heal it and make it healthier. And those things happen to be the same things that are good for your skin and they're things for prostate and for your eyes,

Dr. Mark Hyman: Right? It's not like there's one lifestyle that's good for your brain, but not good for your heart or for cancer or for your immune system. Exactly.

Dr. Majid Fotuhi: Yeah. You do have to tweak some things for your skin versus your heart versus your hair versus your teeth. But the overall interventions that are good for the brain are good for prostate. I was watching a documentary once about prostate cancer and things you could do to reduce prostate cancer. And a person talking was talking about pecsyslopide and diet and omega fatty acids and meditation. I said, wait a minute. I tell this to my patients and you telling Exactly,

Dr. Mark Hyman: Exactly. It's actually just one human body and everything is actually designed to work well. And what we often do is do all the things that make it not work well. And by doing the basic foundational things of diet, exercise, managing, sleep and stress, just as foundationally and maybe a few supplements, it can have a profound effect on so many people. And it's more powerful than most medications. We have to treat disease, and yet it's not being applied. And that's what's so great about your work and you're not the only one. I mean, there's many others in the neurology space like Richard Isaacson from Cornell who published data that was really compelling about the same approach, which is a kind of multimodal intervention approach based on addressing the particular findings in each patient on a personalized way. Dale Bredesen does the same thing. He wrote a book called The End of Alzheimer's.

Dr. Mark Hyman: He was a cleveland clinic with us on stage when we did our presentation. And so I think that there's a zeitgeist change, and I think we're kind of still stuck a little bit in the whole amyloid hypothesis or in the chemical imbalance hypothesis for depression. And it's really, it breaks my heart. I have a very close friend whose mother is very severely depressed and there she's on a pile of medications and she's a zombie and really not better. And I'm like, wait a minute, depression's just a symptom. It's not a cause. Let's figure out what's causing the depression and let's get her better. And I think we have now the tools, and I wrote a book, gosh, I don't know, 2009 was published, so I probably wrote it in 2007 called the Ultramind Solution, where I really mapped out a lot of this and I didn't have chapters on Parkinson's.

Dr. Mark Hyman: I mean, I didn't write chapters on parkinson's or dementia or depression or anxiety or bipolar or schizophrenia didn't write or autism. I didn't write chapters on all these different problems because they all have common root causes. So I talked about how do we optimize our biological systems? How do we optimize our biological networks and tune things up and remove the things that are causing damage to the brain and add the things in that are actually helping keep the brain healthy. And so that's what you've done and it's really remarkable. Your work is, listen, I'm a practicing physician, haven't published that must research, but you've been publishing research and designing programs and working at academic centers, and I think this is exciting. I'm wondering what your colleagues think. They go, oh, but gee, that's nice, but let's do real medicine or what are they saying to you?

Dr. Majid Fotuhi: I tell you just said there are standard neurologists who are skeptical of these things. And one of the question I get is that you don't have a placebo arm in the studies. The one good thing about the finger study, I give credit to Miya Kibipelto for doing that, is that they do have, first of all, they have a large clinical trial and they have a controlled trial where people just do the same as usual, which as I mentioned for European countries, it's pretty high. But I feel like as a neurologist, how could I have a placebo for my study? Like I teach this meditation, I tell people to do diet changes, sleep changes, improvements, and it's hard to really do a control trial for these things. And the other things that some things are so obvious, as I mentioned, no brainers. If you improve exercise, you have increased blood flow your brain, that's a good thing. You really need, I mean, at some point things have been done so many times that are obvious. And I feel like the fact that I took a bunch of things that have been shown by hundreds if not thousands of our studies that are good for the brain and combined them to one program,

Dr. Majid Fotuhi: It's obvious. Why are you arguing with that? What is the I?

Dr. Mark Hyman: You know why? It's like we're stuck in this old paradigm where if we want to prove something, we have to just do one thing. Okay, we want to know if exercise are good for the brain. Just change that one variable. Get people to exercise, but don't change your diet. Don't get them to sleep better. Don't with stress. Don't make sure their vitamin D levels are okay and their mercury levels are low and their thyroid is good. Just do one thing or let's just do meditation and see if that works. And nobody understands that the body is a system and you have to do everything. You can't just do one thing, you have to tune all the dials. It's like if you want to just sort of grow a plant, I always say this analogy, but you can't just put it in the soil and have no light and no water or you can't have no soil and light and water and you need all the things, ingredients you need for health.

Dr. Majid Fotuhi: That's an excellent analogy that you need. And the reason is, I guess it goes back to dogma that if you have memory problems, you have alzheimer's disease, the spinal drug, if you have attention problems, you have attention deficit disorder. And we put a label as if we know what caused it. And then how could you come up with a simple intervention when we know that most people's symptoms are because of multiple issues that is well established, are rarely had a patient. I mean, I think that early onset alzheimer's disease is a disease. It's a unified bad thing that happens to people. And it's not because they didn't have good lifestyle. It's somebody at 52 cannot operate their microwave, cannot drive, cannot do reading or do simple things. They have a disease, they have, some of them have the genes that increase amyloid. And that is a disease.

Dr. Majid Fotuhi: And I don't argue with that. But once you go to your seventies and eighties, only 12% of people have mostly amyloid and nothing else. And multiple studies have shown that. Multiple studies, one in honolulu, one in Chicago, several studies have shown that if you look at thousands of people who participate in this longitudinal studies similar to the one I did at Hopkins, and you chop the brain and look at it 10 to 15% of the time, you find only one thing. 85% of the time is a super problems. There's some amyloid, there's some mastocardial impairment. There may be even some synuclein that you see in parkinson's disease. And this increased inflammation, huge amount of inflammation. So an average 75 year old has at least four things in their brain that accounts for their memory or attention problems. So it's how could you expect that one drug work?

Dr. Majid Fotuhi: And I think one reason the clinical trials fail over time is because different people have different issues. And I think one thing they've done recently that has increased the yield for the anti amyloid is that they do an amyloid PET scan and they seek out a small minority of people who have mostly amyloid in their brain. This is the minority, and they give drugs that reduces the amyloid and they see a slow reduction in the rate of worsening. And so they think if amyloid was everything, then they should be cured anyway. These studies, they do show complete clearance of amyloid, yet the persons are a little less worse. If amyloid was culprit, you cleared the brain. They have this impressive before and after slides that show the newest anti amyloid drugs clear. There's the brain doesn't have any more red on it. But if the brain is free of amyloid, why is it that the person is less worse? Why is the person not better if amyloid

Dr. Mark Hyman: A culprit? Well, rudy tanzi from harvard talks about patients, for example, have brains full of amyloid, but on autopsy when they see em autopsy, but they have no inflammation, they have some weird gene that prevents them from having inflammation and with no inflammation, there's no alzheimer's. And they have perfect cognition at the time of death even though their brains were full of amyloid. So it sort of

Dr. Majid Fotuhi: Alzheimer's goes with stages one to six and are, there are several reports actually that there are people who have stage six alzheimer's in their brain, and yet in life they did not have memory problem. They did not have any reported problems. They just had a life and they did not act or appear to have dementia. That's possible. So I think amyloid is a particular thing on the side. I would never have any of my family members try these medications that are recently approved by Fda. I think fda approving it is a mistake because they don't make the patients better. These medications are expensive. That's fine. I mean these drug companies do spend billions of dollars making these things. So let them have some money, that's fine. But the thing is they're hardly effective. The effect side is small. And also they have high side effects and increase fatality and they have infusions. It's not like a supplement you take.

Dr. Mark Hyman: Yeah, no, it's super expensive too. It's really,

Dr. Majid Fotuhi: Yeah. So I think the principles that apply to the brain are the same things that apply to skin and the heart and the bones and eyes. And they are well established. Nobody would argue, I don't think this day and age, anybody would argue with you that eating a healthy diet is good for you. I don't think anybody would say, well, wait a minute, I beg to differ. Nobody says that. I don't remember anybody said, I don't think that it's playful. I think everybody unanimously agrees that a healthy diet is good for you and everybody agrees that exercise is good for you. Everybody agrees sleep is good for you, and everybody agrees that stress reduction is good for you. So there is unanimity on the fact that this four things are good for you. And I think what we did is that we said, okay, let's coach people to incorporate these four things in their lives.

Dr. Majid Fotuhi: Because if you are already tired, if you already have brain fog, you can't organize your days and your schedule to have some time for exercise to have a better choice of what you eat. And to do meditation, you just are overwhelmed already with your job and your kids and driving and everything else. So our brain coaches were like cheerleaders. I said, look, Ms. Smith, we are going to do this. We're going to walk five minutes a day, just five minutes. We're not asking too much until next week, next minute, no, please walk 10 minutes a day. And by the way, just cut french fries from your diet. We don't ask you to totally change your diet, the other junk food, but just cut one thing. And the third week, I mean, and the thing was when people made those minor changes, even with those minor changes, they would see results in their own day-to-day life.

Dr. Majid Fotuhi: They say, oh, I had difficulty memorizing phone numbers and now I actually can see, I dunno, I dunno what you did or just the coincidence. And then in week four you say, they would actually have seen some improvement. And by week four they would say, look, how about walking half an hour three times a week and then really donate junk food? Don't change everything else. Just don't say no to cookies and no french fries and try to get your food from farmer's market as much as you can. I love this pharmacy with an F that you put. And so by six weeks when people came back, we had shown them some meditation little by little, but that's not easy. And I think I give credit to my brain coaches who are so patient in dealing with our patients, and we had very small attrition rate. We only had only 7% of attrition, which is 93% of people who came through the program. It's a 12 week program and twice a week, very few people dropped out the program and people dropped out that

Dr. Mark Hyman: Is this something that you have to come see you or can this be done online? Do you have a program online?

Dr. Majid Fotuhi: Yeah, we have it on my website and I outline the questionnaires that people need to do. And

Dr. Mark Hyman: We'll put all this in the show notes so everybody can kind of track

Dr. Majid Fotuhi: That. Sure. And the interventions that we do for our patients are available. I think what would help people who want to do this on their own is to have a partner, whether it's a spouse, their best friend, someone who would partner with them, and they would do it together because they can encourage each other and they have someone of accountability. I think the most difficult challenge was the first two, three weeks when people had to break away

Dr. Mark Hyman: A behavior change.

Dr. Majid Fotuhi: Yes, people have routines. People have a routine for what they eat in the morning, what they ate for lunch, what they ate for dinner, what they do. And those routines need to change. But once the routines change, that's how it is from now on. You don't have to think about it anymore. Once you have a routine of just eating fruits and vegetables and legumes and high fiber, it becomes just a common way of looking at things. You don't have to think about it anymore.

Dr. Mark Hyman: Yeah, I mean it does take, there's a lot of science around habit change, behavior change. There's a lot of supports. There's coaching programs. Vita Health is a great one where you can get support or just getting your friend or your spouse or your partner or your kid or somebody to do it with you makes a huge difference. And I think there's books like Atomic Habits and there's no lack of resources, but it does require just setting the conditions up for success. If all you have in your house is junk food, then that's what you're going to eat. I mean, I was listen to a podcast the other day with Bill Maher and he was talking about how he doesn't, what's going on obesity in America and the challenges and problems with it. And he understands. He says what it's like to be hungry, and he smokes pot and he gets the munchies, but he says he makes sure in his house he doesn't have any crap so that when he gets the munchies, all he can eat is nuts or something like that.

Dr. Mark Hyman: And not get into trouble eating a bag of cookies. So it's really making your home environment safe, setting things up for success. I have that in my kitchen. I have on my counter all my smoothie ingredients out, all my supplements that I want to take all bagged up and little baggies so I don't have to go sort throughout the bottle all day. I have my workout station in my house where I have my bands and all the little things I use, I have everything set up so that it's not a huge effort or friction to actually do what is good for me. And I think that's really important for people to understand that you have to make it automatic and easy. And once you build those habits and structures in your life, it's not something you have to think about. I don't really think about it.

Dr. Mark Hyman: It takes me five minutes. I do it. Not a big deal. So I feel like what you're really sharing with people is a revolutionary idea, majid, that actually our brains are fixable. That we often have broken brains, as I say, and we have this sort of dysfunctions that are treatable, that are based on modifiable causes. And I'd like you to sort of unpack a little bit. We know, for example, for heart disease that what are the modifiable risk factors? Your cholesterol, your blood sugar, smoking exercise, making sure you're sleep apnea. There's things we know that make a huge difference in preventing heart disease. And there's been billions and billions of dollars spent on teaching people that, on educating people that on teaching doctors about it. But doctors are clueless when it comes to how to fix the brain and what we can do and what are the modifiable risk factors. So can you talk about what those are and what we need to be thinking about and how we start to sort through own personal history as well as our patients, as doctors to really understand what are those modifiable risk factors.

Dr. Majid Fotuhi: I think one easy way to think of it is the things that are good for the heart are good brain, and many of the risk factors, the modified risk factors that apply to the heart, apply exactly to the brain as well. For example, stress affects the heart and affects the brain. Poor diet affects the heart, affects the brain, and poor sleep affects the heart and affects the brain. And the one thing that is different here is a degree of cognitive challenges that you put yourself up for. A lot of people retire, stop using their brain as much and that accelerates their cognitive decline. And brain training doesn't have to be using apps that you sit down and play chess or play memory games. I think one thing that can be done is for people to explore the world around them, have a sense of curiosity, a sense of trying to learn something new. For example, a person can try to learn a new language or try to take a class for pottery, took a class for dancing. Things that require multi-sensory involvement are actually better for the brain than compared to those that are just sit down. So

Dr. Mark Hyman: Like playing tennis, I started tennis when I was 45, and so it's not easy for me. I have to really think about it. And I was working on my back end yesterday, and it's like you're kind of creating new pathways and it's constantly challenging. It's in multiple directions, so I really love that. Yeah,

Dr. Majid Fotuhi: My brother Omid Fatihi is a psychologist and he told me something, it's really interesting, and he said, you need to look forward to failing. A lot of people don't try new things. They say, I'm not good at it. You need to say, look, I'm going to enjoy failing the next hobby or challenge that I pick and go for it. Go play tennis. Mess up your back end and laugh about it. Say, see, I did it. And because a lot of people have this barrier to learning new things because they feel intimidated because they're not good at it. A lot of older people may not feel comfortable with all the IT progress we've made in terms of the different gadgets on the phones and different gadgets to adjust the temperature in the house from removal to all these things. These days we have so much electronics all around us and there is still some elderly who still have those phones.

Dr. Majid Fotuhi: They don't want to try a new phone because they feel uncomfortable with trying it. So I think a good way to do things is what my brother Omid said is, look forward to failing. Try new things. And if you fail, say, see, I did it and keep doing it. And as your brain gets better the more you do it. One of the codes that I always share with my students and my patients is that practice makes cortex that accounts for all your cognitive abilities. Whether you do your taxes, type your email, have a conversation with colleagues, everything you do is your cortex, which is like a blanket on top of the brain. So different parts of the brain cortex have different functions. And what happens is that when you do things that challenge that particular part of the brain, that part of the brain grows.

Dr. Majid Fotuhi: So for example, let's say you decide to do a lot of math exercises or you decide to learn a new musical instrument. The parts of the cortex that are involved in doing that task grow just like your muscles grow. And the more brain you have, the more brain reserve you'll have when you get to your eighties and nineties. So hippocampus is part of brain for memory and is the size of your thumb and sits inside your temporal lobe like this inside it. But all these other cortical areas are important for your abilities to do the things you do every day. And the more cortex hippocampus you have, the more functional you'll be in the future. And so for example, one study showed that if you learn to play golf, the parts of the brain that are important for hand-eye coordination and planning, the movements literally grow. They did mris at the beginning of this seventy-two hour golf lesson. And then after that and they compare mris and parts of the frontal lobe actually grow. So I think the growing the brain is easy, it requires a good blood flow to the brain, got good nutrition, low levels of stress, but brain training does make a difference. Well

Dr. Mark Hyman: Talk about that. What is brainer size? We talk about exercise. What's brainer size? How do we exercise our brains? It's not something we think about. We know how to lift weights. We know how to go for a run, but nobody talks about that.

Dr. Majid Fotuhi: Yeah. Let me explain one thing and then I'll answer that question. We're talking before that people say, oh, this intervention didn't work. It's because it was an isolated intervention and a patient has multiple issues and that's why that isolated intervention didn't work. Whether or not brain training is good for you, it's controversial. Some people say studies show that people played chess or did these brain games did not have any difference in the outcome two years later, eight years later. Well, I think the problem is that you can't do one intervention and see results on outcome like whether or not you're demented because if this intervention helps something five, 10% and the cutoff you've set up to see results require 80% or 60%, you did have results, but you failed to capture that result. And the other thing is that if you do that and somebody who exercise and do other things, then you'll see results with your cutoff. So if you have sleep apnea centered lifestyle and poor diet and you just sit home and just do these brain games on your phone, don't expect that six months later you feel like so much sharper,

Dr. Mark Hyman: Right?

Dr. Majid Fotuhi: Sleep apnea is your enemy and you can't just do brain games and expect that six months later. So I want people to appreciate that you need to put things in the context of a personalized multi-modal intervention. In our program, we provided coaching for diet, exercise, sleep, and stress reduction. And this was all in the category of lifestyle modifications. And then we had a category of brain training and then we had to category biofeedback. So brain training does work. Of course it works. Again, it's one of those things that are so obvious. There are at least several hundred if not thousands of studies that if shown that if you do something that part of the brain grows, and clearly the more brain you have, the less likely you get demented. That's true. So no-brainer. The thing to do is to realize that

Dr. Mark Hyman: No, it should be called a brainer, not a no-brainer. I think

Dr. Majid Fotuhi: You know that if you do, let's say a brain game that requires memory, don't expect that your processing speed or your executive function may improve. See, brain has different areas, different networks, and if you work on your biceps, don't expect your quads to be stronger. There is some subdivision of functions in the brain, and so don't expect that you do something on these,

Dr. Mark Hyman: But there's ways to work the whole brain, right, with these programs.

Dr. Majid Fotuhi: So the things to do what I recommend to people is to do things that are body engaging. If you learn to play tennis, you keep track of scores, you learn how to do different things, and then if you really want to good at it, you watch some videos, you have an instructor to teach you and then do a variety of things like for a while, do that and then try pottery and get a feel for texture and how much to do. And then

Dr. Mark Hyman: I learned surfing at 61 years old, so it's never too late.

Dr. Majid Fotuhi: Yeah, I think the idea of enjoy sailing is to try it a lot of and have fun with it. It's okay if you fail, you need to fail multiple times.

Dr. Mark Hyman: Well, I definitely fell off the surfboard a lot, but I'm doing better now. Exactly.

Dr. Majid Fotuhi: Exactly.

Dr. Mark Hyman: I was told I'm intermediate. I was told by my surfing instructor that I'm intermediate now, which is good. Good

Dr. Majid Fotuhi: For you. That's awesome. That's the way to do it. Look watching. And there are books for things like how to memorize a deck of cards or memorize hundred words. We did that for our patients where we showed them how to memorize a hundred words, and most of our patients did it. A lot of people say, no way, Dr. Patu, I can't do this. Then you

Dr. Mark Hyman: Can memorize cards. You can go to Las Vegas and make a lot of money. Well, this is incredible. I can't emphasize enough for people to understand that we're in a revolution in brain science right now, that we're in a moment where people like Majeed and Dr and Dale Bredesen, others are really pioneering work that's helping us to rethink our approach to brain health. Dr. Eamon also has been involved in this work, and I think we need to take it seriously. Our brains are our most precious possession. It's who we are. It's our identity. It's how we basically go through the world. And if we actually lose our brains, you can get a heart transplant. You can't get a brain transplant. So it's really important to take care of the work that Dr. Patu is doing. It's dr D-R-F-O-U-T-U-H You can learn about his brain fitness program there.

Dr. Mark Hyman: You can actually take the brain questionnaire. I did that this morning and I scored very good to Excellent. I'm very happy about that. And you can take that too and encourage you to check out his books and learn more about his work, his books, the memory, or Boost Your Brain. They're awesome. And if you know anybody who might benefit from listening to this podcast, you can do a great job for us by sharing it with them on social media. Also, leave a comment, have you help to understand your brain and optimize your brain function. We'd love to know tips from you and subscribe wherever you get your podcast. And we'll see you next week on The Doctor's Farmacy.

Closing: 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 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 and search their Find a Practitioner database. It's important 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.