November 6, 2024 • 44 mins
Dr. David Dodick is a notable neurologist and the Chief Science and Medical Officer of Atria. He joins Martha to discuss the latest research about lifestyle interventions that help reduce cognitive decline, actionable ways to optimize your brain health, and when to be worried. He also shares tips for stroke prevention and explains why sleep is really the most important thing you can do for the body.
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Speaker 1 (00:00):
Medical knowledge now is advancing doubles every seventy three days.
It's impossible, wow for one doctor or even a team
of doctors to keep up with everything.
Speaker 2 (00:14):
Prior to joining ATRIA, Doctor David Dotick trained at the
Mayo Clinic and served on the faculty there for more
than three decades. At the Mayo Clinic, he founded the
Neurology Residency Program, the Headache Fellowship Program, the Sports Neurology
and Concussion Program, the Migraine and Headache Program, and co
founded the Vascular Neurology Stroke Program. He is a professor
(00:38):
emeritus at the Mayo Clinic, a consultant for the Mayo
Clinic International, and a guest professor at the Norwegian University
of Science and Technology and an affiliate professor at the
University of Copenhagen. That's a very impressive resume of some
of your jobs. Doctor David Dodeck is a notable neurologist,
(01:00):
a prolific researcher, and the founder of multiple programs to
treat brain injury and disease. In other words, an expert
on the brain. I wanted to talk to him today
about brain health because, to paraphrase a quote he shared
it doesn't help to live longer if the brain isn't
in good shape. And I think all of us know
(01:21):
that absolutely inherently, and I know that we all have
questions about risk factors and warning signs for dementia, stroke
and other brain diseases. So we will cover all of
that today. Welcome to my podcast, Doctor Dodeck.
Speaker 1 (01:35):
Martha, it's a thrill to be here.
Speaker 2 (01:36):
Thank you so very very much. Now for clarity, I
recently enrolled in the ATRIA program. This is and maybe
doctor Dodeck can just describe it very simply for all
of you. What is exactly a TRIA?
Speaker 1 (01:51):
Exactly? ATRIA is kind of a preventive healthcare ecosystem that
seeks to translate science into medicine real time. What I
mean by that as the Institute of Medicine has estimated
that it takes about seventeen years for something that's validated
in research to actually make it to the bedside in
clinical practice. So we're looking to translate science and technology
(02:12):
because it's advancing so rapidly real time to prevent, reverse,
stop or delay the chronic diseases that reduce our longevity,
you know, chronic diseases right now ninety five percent of
people over the age of sixty have at least one
chronic disease, and about eighty percent have at least two.
(02:35):
And chronic diseases account for seventy five percent of not
only a health care spend in this country, but seventy
five percent of the deaths. So if we can stop
those chronic diseases, we can extend healthy lifespan and importantly
brain span.
Speaker 2 (02:48):
So what are the top six chronic diseases that you're
talking about.
Speaker 1 (02:52):
I'm talking about diabetes and other metabolic diseases that may
be related to diabetes. I'm talking about neurodegenerative disease like
Alzhema disease, Parkinson's disease, We're talking about cancer. We're talking
about cardiovascular disease. Those are those are the four one
biggest ones. And there are other chronic diseases like arthritis,
which is very common of course. So those are really
(03:15):
five major chronic diseases that we can do so much
about today, and so many Americans right now are suffering
from them. Medical knowledge now is advancing doubles every seventy
three days. It's impossible, wow, for one doctor or even
a team of doctors to keep up with everything. So
it's called like an onion, a core group of internal
medicine specialists surrounded by specialty pods, and then surround that
(03:38):
with what we call the Atria Academy of Science and Medicine,
which you have access to, which we have access to.
And the people on this are really key opinion leaders
across many medical and surgical disciplines. And the idea here, Martha,
is that we can tap them, these experts around the
world to get current best thinking on whatever issue, topic
(03:58):
or question that might arise.
Speaker 2 (04:00):
But you have written so many fantastic articles, you have
done so much research in a variety of very amazing
medical fields. Do you ever stop to think what's happening to.
Speaker 1 (04:13):
All of us? I do. I stop to think every day.
But I've never been more excited about the pace of
medicine and the future of medicine than I am today.
I'll really great, and I've learned more in the past
two years than I think I've learned in the past twenty.
Speaker 2 (04:28):
Really, what is that from you? Things that I just think?
Speaker 1 (04:31):
It's the pace with which advances are happening, you know,
like I said, if medical knowledge is doubling every seventy
three days. Then you have an insatiable appetite for learning.
You just can't get enough of it. So, and as
the chief medical Officer and chief Science Officer, is my
job to stay abreast of all of the things that
are happening or as many as I possible.
Speaker 2 (04:50):
How many physicians are affiliated with ATRIAB forty five forty
full time physicians. You say in us that we can
transform medical care from sick care to health care and
be a model that others will evaluate and scale so
that healthy lifespan is extended for as many people as possible. Yes,
(05:10):
So I'm a firm believer in that. Yeah, And I
think that it is so important for us to think
about living not anti aging, but aging gracefully and healthfully.
Speaker 1 (05:22):
Healthy lifespan, that's what we're talking about. Soever, however many
years you have, make those years healthy years where you
can cognitively you have your full cognitive capacity, physical capacity,
mental health capacity, because it's about happiness, happy happiness span
as I like to say, play span and brain span.
So it's keeping pilled people as healthy as possible for
(05:44):
as long as they live.
Speaker 2 (05:45):
What is the average lifespan today.
Speaker 1 (05:48):
In the United States, it's about seventy seven years. But unfortunately,
despite the fact that we outpace every OECD country in
terms of technology, the science and technology in the United
States is just staggering. What we have here and the physicians,
the quality of the medicine is remarkable, and yet we're
falling behind on every metric of health, whether it's infant
(06:11):
mortality or whether it's lifespan. But right now it's about
seventy seven years. It's a little bit different in women,
so it's longer in women, so it's about eighty two years,
and women about seventy seven, seventy eight in men.
Speaker 2 (06:22):
I like to give people at least some hope and
some guidance and what they can do to extend that lifespan.
What is the worst thing a person can do to
bring on an early demise?
Speaker 1 (06:35):
Not move, not move, not move, So physical movement and
cognitive exercise. So physical exercise and cognitive exercise, if you
did nothing else, that is crucial, okay, or brain held
for heart health and for longevity.
Speaker 2 (06:49):
And what you should not put in your body.
Speaker 1 (06:52):
So I don't put saturated fat in my body. I
hardly put any alcohol in my body. And I don't
put red meat in my body. Not that I'm saying
I don't want anybody to think that red meat is
necessarily bad, but I just happen not to put red
meat in my body. So those are perhaps the three
things I don't put in my body, and I would
(07:14):
counsel my patients to think about alternatives in their diet.
Speaker 2 (07:19):
I was recently speaking to a doctor from Europe who
has a list, and top of his list is alcohol. Yeah,
top above heroin and cocaine.
Speaker 1 (07:30):
Well, alcohol, Martha, according to the World Health Organization, is
a carcinogen, right, And no amount of alcohol, unfortunately, is good,
good for you or good for your brain. So as
a neurologist, if you cannot consume alcohol, that would be
a good thing. However, risk factors are stackable. So if
you keep yourself healthy, if you're exercising, and you're following
(07:52):
a diet that's been shown to reduce the risk of
cognitive decline in dementia, and you're managing your numbers as
I like to call it, your blood sugar, your blood cholesterol,
your blood pressure, you're screening for cancer. Right. If you're
doing all of those things, if you're doing everything else, right.
I don't want people to think they came to have
a glass of wine or a glass of champagne. But
(08:13):
alcohol to excess is definitely not good for your brain.
Speaker 2 (08:17):
So I've heard that forty five percent of dementia can
be prevented.
Speaker 1 (08:22):
That's true, and you know the Lancet Commission, which published
that report just several months ago. It's interesting that back
in twenty seventeen they said thirty five percent. Four years later,
it's forty percent. Four years later, like a few months ago,
it's forty five percent. And they didn't even consider things
like diet, things like gut health. So what are they saying.
(08:43):
They have identified these fourteen modifiable risk factors, and it's
gone from ten to twelve to fourteen. And every time
they increase by two the number of risk factors you
should target, it increases by five percent the decrease in dementia.
So that's powerful when you sit back and think, Okay,
the United States right now we have about seven million
people with Alzheimer's disease, but we have close to fifty
(09:06):
in the early stages at least with the pathology in
the brain.
Speaker 2 (09:08):
Eighty million.
Speaker 1 (09:09):
Yeah, and they don't know it yet.
Speaker 2 (09:10):
Oh, because our total population here in the United States.
Speaker 1 (09:14):
Is three fifty or somewhere around there, So it's horrifying.
And you know, we've got fifty million across the globe
and it accounts for about eight point five trillion dollars.
So if we can if you imagine if almost half
of dementia is preventable if you attend to these modifiable
risk factors, in addition to other risk factors that we
(09:34):
know are important, like diet, like sleep, like perimenopause and
how that's managed, like gut health. And I can go on, Wow,
I guarantee you that in another four years it's not
going to be forty five percent anymore. It's going to
be something higher than that. So I'm very optimistic.
Speaker 2 (09:51):
But how can we educate the public to these facts.
Speaker 1 (09:54):
It's going to take just a public a massive public
awareness campaign. And we've seen how successful they've been in
the past, whether it's in autism or whether it's in tobacco,
or whether it's an HIV. We've seen how successful these
public awareness campaigns in terms of raising awareness. I think
that's what we have to do here. The American Heart
Association has done a phenomenal job in raising awareness of
(10:15):
the risk factors around cardiovascular disease and heart health. We
have to do the same thing with the brain.
Speaker 2 (10:31):
Given how rapidly research is coming out about how lifestyle
impacts health. Is there an intervention or a strategy in
the past two years that you're excited about that isn't
yet widely distributed to the public.
Speaker 1 (10:43):
We'll just give you an example, Martha. We've been talking
about diet. So there's this diet called the mind diet,
which is a combination of the Mediterranean diet and the
diet to stop hypertension. It's called the mind diet. And
there are studies that looked at this mind diet showing
that if you follow this rigor, you drop the risk
of cognitive decline by about fifty three percent.
Speaker 2 (11:03):
Wow, it's just a diet, right, And what do you think?
Speaker 1 (11:07):
I think it's real. It's the diet that I follow.
So if you and there's a lot more research to
be done, but just take that alone. Physical exercise, no question,
it's the best drug if you will, It's the best
prescription that I could write. Cognitive exercise. People underestimate the
power of cognitive exercise. I'll give you an example we
(11:28):
recommend a program. No disclosure here, no affiliation to brain
age Q. It's one of a number of platforms that
challenge you cognitively. It's not like Sudoku or a puzzle
like that, but it's more it's designed to enhance processing
speed and memory, et cetera. People who have stuck with
(11:49):
that reduce the risk of dementia by about twenty nine percent.
So I could go on and on in terms of
interventions that I'm excited about, but just some of the
low hanging fruit are and sleep is another one.
Speaker 2 (12:00):
Now that's my big problem.
Speaker 1 (12:02):
Sleep is a risk factor for so many things, from
heart disease to dementia, to hypertension, blood high blood pressure.
It's a serious problem. And many Americans have a problem
with sleep, and it gets worse as we age.
Speaker 2 (12:15):
I always have. It's horrible.
Speaker 1 (12:17):
And so there are many ways which we can treat
insomnia and sleep disorders effectively. But sleep is really really important.
If I if I told you one night of sleep
deprivation really shuts down your memory organ in your brain,
the place where you put files, in the place where
you store files and store memory. Just one night of
sleep deprivation. Now I'm not a great one to talk.
(12:40):
But I wear this because I do monitor my sleep,
and yeah, you're going to hell.
Speaker 2 (12:44):
I should be wearing mine. Say I'm not wearing mine.
Speaker 1 (12:46):
And just tracking how because it's a very powerful motivating factor.
When I look at my sleep, open showed me.
Speaker 2 (12:53):
The aura ring right, Yes, it's the it's oh, you
are a right.
Speaker 1 (12:59):
And there are many different types of trackers.
Speaker 2 (13:02):
So it tells you what exactly. It tells you how
many hours you slept.
Speaker 1 (13:05):
Tell me how many hours you slept, how many how
much you slept in rem sleep or rapid eyebooment or
dream sleep if you will, deep sleep, which is really important.
What's your heart rate and oxygen was during stay?
Speaker 2 (13:17):
You better get my r ring out? Now? What do
you do for physical exercise?
Speaker 1 (13:22):
I tried to do both aerobic as well as resistance
training sometimes what we call circuit training, which is both
at the same time. I think it's really important. Both
are really very important, and both have been shown unequivocally
to promote healthy lifespan as well as to promote brain
span if you will, or cognitive health. So I think
resistance training is you can either use your body for that,
(13:43):
like push ups or lunges or free weights or bands,
but I think resistance training to keep muscle mass because,
believe it or not, muscle secretes hormones and chemicals that
are actually important for brain health, so really important, and
it also prevents frailty over time. Right, So you know,
resistance training an aerobic training. There was a study done Martha.
(14:04):
It's called a finger study because there's five fingers and
it was back about ten eleven years ago. It's a
landmark study where they took sixty to seventy seven year
old people who were at risk for dementia but who
were cognitively normal, and they did five interventions. One was
just social connectedness, right, just put them in groups or
(14:25):
just to increase the amount of social interaction they had.
Another one was managing their risk factors blood pressure, blood sugar,
blood cholesterols.
Speaker 2 (14:35):
All of that include managing blood pressure. Do you have
to take blood pressure medicine?
Speaker 1 (14:39):
No, you don't have to take blood pressure medicine. Many do.
But if you weight is a big one. So if
you lost weight and if you had a very low
sodium diet, there are things that you can do like
that that can keep controlling.
Speaker 2 (14:52):
Your Then environmental pressures. You can't really monitor that.
Speaker 1 (14:56):
No, you can't monitor that, but there are devices now
where you can actually monitor your blood PRESSU sure, and
so you can see you at a snapshot over the
course of a week what your blood pressure has been.
That is the single most important risk factor for stroke
and heart attack. And so knowing your number and knowing
what your numbers should be i e. Less than one
twenty over eighty and accepting nothing above that is crucial
(15:18):
for brain health and for heart health. And that's so
these five fingers people who followed it had a fifty
percent greater reduction in cognitive decline or the five fingers,
so vascular risk factors, okay, right, Social connectivity, so physical
cognitive exercise, nutrition, the diet, so the mind diet was
(15:40):
it was actually a Norwegian diet. What looks almost identical
to the mind diet, So diet, physical cognitive exercise, managing.
Speaker 2 (15:46):
Those already looks up mind diet.
Speaker 1 (15:49):
So those five things, just those alone made a dramatic
difference over the course of just two years and reducing
the risk of cognitive decline and dementsion.
Speaker 2 (16:00):
YEA, how much does the role of genetics play when
it comes to dementia and other neurological conditions.
Speaker 1 (16:06):
It plays a role, but you know, the sort of
rule of thumb, Martha, and there's no real science behind this,
but by and large it's true. Eighty percent of brain
health and eighty percent of longevity is lifestyle. It is
maybe twenty percent is genes. But you know, there's this
phenomenon known as the gene environment interaction. So if you
(16:30):
don't sleep, if you don't manage those risk factors, if
you don't move, if you're exposed to toxicans in the environment,
if you smoke, if you drink a lot of alcohol,
you change the expression of genes, so you might turn on,
for example, like bad sleep will turn on genes that
increase the risk for cancer or cardiovas heart disease and
(16:53):
decrease the expression of genes that are responsible for your
immune system. So there's a powerful role between the environment
in which genes are expressed. Is there some really exciting
work being done now that there are some genetic risk
factors for Alzheimer's disease, But some of these new targets
(17:13):
that are being tested, these druggable targets as we talk about,
that may find their way into clinical practice in the
not too distant future completely neutralize, at least in animals,
the effect of bad genes. So genes, yeah, important, responsible
for about twenty percent of lifespan and brain span, if
you will. But how you live your life has a
(17:34):
powerful influence on whether those genes, those bad genes will
actually be expressed versus the good genes that you want expressed.
Speaker 2 (17:41):
I've read that women are at higher risk for dementia
than men. Is that's true?
Speaker 1 (17:46):
That is true?
Speaker 2 (17:47):
Why?
Speaker 1 (17:48):
Good question. We think it has a lot to do
with hormones, particularly during that periman apostle phase where there
is kind of a precipitous drop in estrogen. So hormones
definitely play role. They're estrogen and progesterone receptors all over
the brain, so I think you know there's a hormonal
influence to this. There may be other risks as well.
(18:09):
Hormone therapy is important to at least have a conversation
with your doctor if you're in early in the early
perimid apostle phase, because estrogen may be protective for the brain,
so it's important. There as a lot of nuances there,
but it's important to at least have that conversation with
your doctor. Women are also at a higher risk of
other diseases that may affect the brain, like diabetes, like
(18:31):
heart disease. So all of these things. You can think, Martha,
of the our health as a house. The brain sits somewhere,
the heart sits in another house, but they're all connected,
and so if one organ is sick, it makes the
whole house sick. If one room is sick, it makes
the whole house sick. So I think because women are
at a higher risk for many of the diseases that
(18:52):
affect the brain, and they go through these fluctures, you know,
hormonal stages during their life, I think that's partly why
they're at an increase risk.
Speaker 2 (19:01):
I had a very good doctor long time ago who
put me on an estrogen and I've been on it
for but sixty years or something, and I think it
served me well. Yes, because good skin, good hair, good.
My brain's pretty good. I think, if I'm interested in
(19:21):
brain health and not an ATREAM member, what simple tests
should I ask my doctor to check for during my
annual checkup?
Speaker 1 (19:29):
He or she should do a cognitive health examination. So
where are you? What is your baseline? It's not done today.
Speaker 2 (19:36):
Oh it isn't.
Speaker 1 (19:37):
When you go in for your annual physical they don't
really test your brain health.
Speaker 2 (19:41):
No, they do not.
Speaker 1 (19:42):
They take a chest X ray. They might do it.
Speaker 2 (19:44):
But who would you go to for that? To a neurologist.
Speaker 1 (19:47):
You would go to a neurologist. But also you should
be able to go to a primary care physician as well.
So just like you know route there's routine screening for
heart health, and you know blood pressure and blood glucose,
the should be routine root teen screening for brain health.
So that includes maybe some certainly a cognitive test of
the brain. Right now, we might as well talk about it.
(20:09):
There are a couple of blood tests right now that
will actually tell us what the health of the brain
actually is. Oh wow, So in the future Martha was
working on that. Oh, there are lots of pharmaceutical companies
working on that. They are a scientists working on that,
and a couple are commercially available right now. So, as
we alluded to earlier, Alzheimer's disease and other nerod degenerator
(20:32):
diseases begin years to decades before they actually show up
as symptoms. And imagine a future where when you go
in and get your blood drawn and you get a
you know, a blood count done, and you know, you
get a cholesterol test. Imagine if you've got a test
for the brain. Yeah, I would love that that determined
your brain health and that provided you with the opportunity
to intervene early and maybe never develop the actual disease.
(20:56):
I think that's the future and that's what.
Speaker 2 (20:58):
We're I went to that laboratory is famous laboratory in Iceland.
Do you know about that laboratory that reads your genome? Oh? Yes, yes,
So I did that, oh twenty years of seacode. Yes, yes, seacode,
and I went through the whole test. They test you
against the Icelandic population, which is a very protected and
(21:20):
very small population that I had really no propensity for
any life threatening diseases in my genome except for maybe obesity.
So I felt really good about it, But I wish
I could have that again. Where are there places in
America now that are reading your genome like that?
Speaker 1 (21:38):
Absolutely, we do it, and we do on every member
at ATRIA. We do full genome sequencing good as well
as what we call polygenic risk scoring, because not all
diseases are due to a single gene or a mutation
a single gene. They're due to variations in multiple genes,
So we test people for that to see what diseases
they're at risk for. We do something called pharmaco genomics,
(22:01):
which means that we test the genes that are responsible
for enzymes and proteins in the body that metabolize drugs. So,
do you know that there are more than three hundred
drugs common drugs that your genes will determine how you
metabolize those drugs, or even if then you know that
now three hundred over three. So we do that testing
(22:22):
because before I put you on an antibiotic or a statin,
or an antidepressant or many many other medications, we want
to know whether and how effectively you metabolize those drugs.
So we do that, and then we do something where
we look at about one hundred and sixty seven actionable genes.
It's one thing to look at the entire thousands of
genes in the genome. It's another thing to look at
(22:44):
those for which we need to know the answer as
to whether you have it or not, because it changes
the way we surveil you and treat you and treat you.
So we do that as well. I'll give you. There
was a recent study in a place where they do
whole genomes. When singing do all these genetic tests like
I talked about, forty percent of the people had an
(23:05):
actionable gene that changed the way they were managed, treated,
or surveilled. Oh great, Yeah, so it's really important.
Speaker 2 (23:12):
So medicine is becoming more complex and yet more clearer
and more precise and precise. Yeah, I mean, we can
preventive medicine right now can be done with such precision,
molecular precision. It's staggering actually and exciting. Now, what about
prescribing drugs. I'm terrible about taking drugs. I don't like
(23:33):
taking things. I don't know why, but I've never I
just don't like it.
Speaker 1 (23:37):
When it comes to medications. Let's say, when I tell
people they really need to know their numbers. And when
I say that, I mean, you really need to know
how well you're disposing glucose blood sugar. You really need
to know that. They call Alzheimer's type three diabetes for
a reason. Oh right, So when we develop insulin resistance
in our body. Insulin is the drug that takes care
(23:59):
of glucose and sugar in the body. We really need
to know and really aggressively manage blood sugar. So knowing
what your insulin is, knowing what your A one C is,
and there's been good public awareness campaigns around that is
really important. Not only that, though, you got to know
what the target is. So I saw a patient today
today before coming here, who I saw eight months ago
(24:22):
whose A one C was six point one, not in
the diabetic range, certainly in the pre diabetic range and
unacceptably high in my opinion. So he told me today
and he was very proud that the lifestyle measures, just
the lifestyle measures that we instituted, brought his A one
C down to five point one. Oh, that's great, whole point,
which is fantastic. That's a lot actually in the normal range.
(24:45):
So knowing your numbers like blood pressure, blood sugar, blood lipids.
In the United States right now, there are anywhere between
one hundred and twenty five to one hundred and fifty
million with each of those diseases obesity, diabetes, pre diabetes,
hYP tension, or high cholesterol. And unfortunately, less than one
in four Americans move enough, get enough exercise, less than
(25:09):
one in four actually have their high blood pressure managed.
One and four one and four. So if we just
that's low hanging fruit, if we just got that right,
imagine how healthy we would be, and imagine how we
could extend healthy lifespan.
Speaker 2 (25:23):
And how can we help people do that? Is it
the hospitals? Is it the how do you get people
to get that care? I mean, I recently had someone
who works for me hurt his back. That was four
weeks ago. Yeah, he really hurt his back. It wasn't
it wasn't. It's not a joke. He couldn't move. It
took a month for him to get an MRI with
(25:44):
the healthcare that he has. Yeah, and pretty terrible.
Speaker 1 (25:48):
Access is a big thing, it is. It's a big thing.
So access to care is a problem in this country.
And if you don't have access to care, it's difficult
for you to know your numbers, and it's difficult for
you to get expert advice on how to best manage
those numbers. Having said that, one of the things that
we're committed to doing is developing modern a book of
(26:10):
modern medicine made up of clinical protocols that focus on
each of these things, in addition to fifty other things.
It has to be very simple, has to be simple.
It has to be like five pages, and it has
to be digestible and accessible so that people.
Speaker 2 (26:24):
Can It should be on billboards everywhere.
Speaker 1 (26:25):
Absolutely, no, it should.
Speaker 2 (26:27):
I believe in that so much education and teaching can
be simplified, not too simple, but simple enough for everybody
to understand.
Speaker 1 (26:35):
Absolutely. So making this freely available to the public and
to the medical community will empower physicians, but all also
empower people.
Speaker 2 (26:44):
Are you working on that? Doctor Dodeck has written how
many books? Sixteen books or so and varying subjects. You've
also written nine hundreds to one thousand fantastic articles on
all kinds of medical subjects. I mean, you're have been
so prolific. But what get this book out?
Speaker 1 (27:03):
So this is my passion right now. That's book of
modern medicine.
Speaker 2 (27:05):
That would be so great.
Speaker 1 (27:06):
And make that available to people in a way that
that it's accessible to them and they can understand it
and it empowers them to take this mad take matters.
Speaker 2 (27:14):
Into their ouide book.
Speaker 1 (27:15):
Yeah, exactly, a playbook. It's a ways for your health,
if you will.
Speaker 2 (27:19):
That would be so great. Yeah, okay, I'm looking forward
to that. What foods contribute most to brain health? Well?
Speaker 1 (27:36):
You know this mind diet that I talked about now,
Basically it's made up of healthy oils like olive oil
for example. It's made up of legumes and beans, green
leafy vegetables. Berries, not so much all fruit. We used
to say fruit, but it's more berries, especially blueberries, nuts,
certain nuts like almonds and walnuts. Chicken and poultry is
(27:59):
actually on that mind diet as well. Those are the
main things on that mind diet. And as fish, definitely
fish because omega threes really important for the brain. Most Americans,
the vast majority of omega Americans are low and deficient
in omega threes because they just simply can't get enough
in their diet, unlike if you live in Japan, where
(28:21):
most of them are, you know, not deficient invite in
omega three. So if you're if you're deficient in omega threes,
that's where supplementation can be helpful to get your omega
three index. We call it up to a level that
protects your brain and protects your body.
Speaker 2 (28:38):
At what age your human brains start to decline? Is
there an age or an approximate age, or is it
declining the minute you're born? Well no, not really, You're
getting old the minute you're born.
Speaker 1 (28:50):
You know, the human brain really doesn't fully mature until
early twenties, maybe mid twenties, right, and it's not downhill
from there. But I will say that brain health as
well as longevity in general, is recursive. What I mean
by that is, when you're sixty years old, how healthy
(29:11):
my body and brain is depended what I did when
I was in my fifties. And when I'm in my fifties,
the health of my brain depends on how healthy I
was in my forties. So you can't go back. Well,
you can stop, and you can attenuate the progression. But
it's what when I talk to young people, it's hard
to compel young people when you say, when you start
(29:33):
talking about dimension Alzheimer's disease, no thirty year old is
thinking about what happens when they're seventy or eighty. However,
what I do tell them and what does compel them
is who doesn't want a cognitive edge? Who doesn't want
to be thinking faster, storing more information, having that edge,
whether it's in their job or in their daily lives.
And we can do that today. We can enhance cognitive performance.
(29:55):
And when we're enhancing cognitive performance. Well, ultimately at the
age of sixty, you'll enter your sixties with a much
healthier brain. So brain health is recursive in how we
treat our brain when we're thirty five has a profound
impact on what happens when you're sixty five and eighty five.
What's the difference between dementia and natural aging forgetfulness? Well,
(30:18):
dementia is of course forgetfulness, but it affects activities of
daily living. You're functionally impaired, whether that's your job or
whether that's simple activities of daily living. Forgetfulness. You know,
we all forget things from time to time. I probably
forgot many things on my walk down here, but I'm
(30:39):
still able to function and perform in my job and
in my social life and in my daily life. So
dementia is what is not is forgetfulness, and it's also
other cognitive domains like processing speed and executive function, the
ability to plan and make decisions and solve problems, and
that starts to impede and affect your job pformance, and
(31:00):
your ability to actually be socially engaged, in active and
just care for yourself. That's the difference between dementia and
just benign forgetfulness.
Speaker 2 (31:09):
Is it true that the brain cleans itself when they
when it sleeps?
Speaker 1 (31:13):
It is true. One thing I wanted to say is
we actually, I think one of the things we'll look
back at, Martha in the future, the fact that we
treat forgetfulness or cognitive decline as an inevitable consequence of aging.
I think it's just a failure of our imagination. So
I really do think that we can keep our brains
(31:33):
healthy and never outlive our brain sleep. One of the
real mechanisms by which we think sleep is good for
the brain, and why sleep deprivation is bad for the
brain and can lead to dementia, is that when we sleep,
we open up these channels in the brain and it
clears out all the toxins and proteins that are released
(31:56):
during the day. So it does, it's really it does
form a real function, a housekeeping function in the brain.
And when you don't sleep, you don't remove all that debris.
And when that debris settles in, that's not healthy for
cells in the brain.
Speaker 2 (32:09):
It's crowding.
Speaker 1 (32:10):
It's crowding, and proteins start to clump and misfold and starts,
and that's toxic. That's deadly to cells.
Speaker 2 (32:18):
Remember you have to clean your house.
Speaker 1 (32:21):
Seven eleven eleven, seven hours and eleven minutes. I got
to sleep at least seven to eight hours a night.
Speaker 2 (32:27):
And how do you exercise the brain? You talk about exercising,
I mean for physical exercising, we know, but what about
the brain exercise? Or what kind of games are really good?
What kind of thinking is good? Reading?
Speaker 1 (32:41):
Well, certainly reading and Sudoku and all of these different
puzzles keeps the brain cognitively engaged, but real.
Speaker 2 (32:49):
Which game do you play? What game do you play?
Speaker 1 (32:51):
I use brain HQ, which is what we recommend because
it's been shown actually to be the best, the best.
And you know this is the one where I said
it reduces the risk of dementia by maybe thirty percent
if you adhere to it. So like twenty to thirty
minutes a day, that's nice.
Speaker 2 (33:07):
Should I give that to my twelve year old grandson too,
whose brain is so alive?
Speaker 1 (33:10):
He would love it because it's kind of a game
and you get better over time and you watch.
Speaker 2 (33:14):
Yourself O the brain HQ. It's online, Yes, oh we were,
And it says to your IQ it doesn't.
Speaker 1 (33:19):
Test your IC but It measures your processing speed and your.
Speaker 2 (33:22):
Working There's something that was I took it on an
airplane and then I gave it to him and we
were competing against each other with for IQ and it
was so much fun.
Speaker 1 (33:31):
Yeh.
Speaker 2 (33:32):
And he and I just he and I were doing
very well together.
Speaker 1 (33:35):
Well there you go.
Speaker 2 (33:35):
Yeah, so I was. I was very pleased that I
was not falling too far behind. But it's so fun
to do those games. I mean, well, that's one thing
that I have when I wake up at five o'clock
or four o'clock. I drew all the stupid puzzles in
the New York Times. That's okay, right, absolutely, But it's
taking away from my sleep.
Speaker 1 (33:53):
Well, it's taking away from your sleep. You gotta It's
all about balance. It's all about balance. I will tell
you that doing wordal and three is good. Doing wordle
in three is great.
Speaker 2 (34:04):
You don't know what I'm talking about. Triwordal. It's a silly,
intense game.
Speaker 1 (34:09):
I'm very proud of myself when I get it in three.
That usually doesn't happen. But you know, some of the
other really beneficial cognitive exercises that I tell people to do,
learn a new language, or take up a musical instrument.
When you challenge the brain with novel exercise like that,
that's really really good.
Speaker 2 (34:25):
Okay, that's a very good idea.
Speaker 1 (34:27):
Yeah.
Speaker 2 (34:27):
I have my piano sitting by itself in a room.
It should be used absolutely. Okay. Well, I also do gardening,
which is also I think very good for very therapeutic.
It is, yeah, and it's you can learn a lot.
I mean I learned so much in a couple hours
of gardening. Yeah, because I tried to learn the names
of the plants. I study each plant, and I think
(34:50):
that's good for people absolutely, And you know, growing things,
nurturing things, all of that is healthy and good.
Speaker 1 (34:55):
And being around nature like that, being around green is
a very beneficial thing. Why, which is why I try
to get in the park as often as possible.
Speaker 2 (35:03):
And I read that rumination is one of the worst
things for the brain. It's rumination and what is it
doing to us?
Speaker 1 (35:12):
You know, there's this area in the brain called the
default mode network because we default to.
Speaker 2 (35:18):
It m N DMN DM.
Speaker 1 (35:21):
Mode network DMN, and this default mode network is particularly
active in people who ruminate, in people who are depressed,
and so it's.
Speaker 2 (35:34):
Rumination is not chewing your cut thinking about the same
thing over and over again, isn't it? Isn't that what
it is? So why did he go away? Why did
he go did? Why did we break up? Don't think
about it? That's what I show people all the time.
Just don't think about those things.
Speaker 1 (35:51):
Don't never, never have any regrets. Everything happens for a reason.
So I try not to have any regrets because whatever
I've done or whatever I've said, you know, it happened.
I can't have any regrets over something that's in the past. Yeah,
So don't ruminate about it because it's not going to
change it.
Speaker 2 (36:08):
You can feel sorry, but you don't have to think
about it.
Speaker 1 (36:09):
Yeah.
Speaker 2 (36:10):
Right, that's how I feel. I think that's very good
for oneself.
Speaker 1 (36:14):
Stress is bad for one's brain. Martha.
Speaker 2 (36:16):
I was getting vitiligo when I was going through my divorce.
I was losing pigment in my skin, and I went
to a Brazilian friend of mine said, oh, go to
see this witch doctor in sal Polo, Brazil. So I went.
I flew all the way to salth Paulo, Brazil, and
then had to drive up into the mountains and stand
in line. There's a line like a mile long of
people waiting to see this doctor, witch doctor. And when
(36:40):
I told her, and she turned out to be like
a like a Japanese lady who had been living there
for many years. And she looked at me and she said,
what's your problem? And I said stress. She said, in
my language, we do not have a word for stress.
Speaker 1 (36:54):
Interesting, yeah, and she.
Speaker 2 (36:57):
But she understood that stress was called seeing this discoloration
of my skin, and and it went away after the
stress was alleviated, you know. But it was so interesting
that that that can it can do that to you.
It's a horrible thing stress.
Speaker 1 (37:13):
There's a thousand different physiological reactions in the body to stress.
So one of the things we always recommend is mindfulness meditation.
It can be very effective for sleep. There are devices
that we call them biofeedback devices. One in particular will
actually when your mind, it uses EEG sensors on the head,
and when your mind is at rest, it will play
(37:34):
soundscapes that are pleasant. But when your mind is distressed
or stressed, it will play louder clouds thunder right, And
so what you do.
Speaker 2 (37:45):
Is try to put them on your head.
Speaker 1 (37:47):
Yeah, you try to calm your environment, right, have to
get those. We'll talk about it when you come.
Speaker 2 (37:53):
What happens to your brain when you're having a stroke.
Speaker 1 (37:56):
Well, it depends. There are two different types of stroke.
One is where you block a blood vessel in the
brain and that part of the brain no longer is
receiving that blood supply, the oxygen, the nutrients that keep
it alive.
Speaker 2 (38:07):
That's permittent or it can be temporary.
Speaker 1 (38:10):
It can be temporary, and we have treatments now that
can unblock that and rescue the brain, which is fantastic.
There's another that accounts for about eighty five percent of stroke.
A fifteen percent of stroke is when there's a hemorrhage.
We're bleeding into the brain as an aneurysm. It could
be from an aneurysm. Sometimes it's from the most common
cause of hemorrhage into the brain is high blood pressure,
(38:36):
So not only does it cause hemorrhaging into the brain,
but it also blocks blood vessels high blood pressure, which
is why the number one respector for stroke. So those
are the two different types of stroke. Blockage from a
blood clot which is much more common, but sometimes hemorrhage
into the brain from an aneurysm, from a malformation or
sometimes from just high blood pressure.
Speaker 2 (38:55):
So best things for preventing a.
Speaker 1 (38:57):
Stroke, best thing for preventing a stroke is to keep
those blood vessels open and healthy and keep that blood
pressure down right. And sometimes we do screening evaluations where
we you know, about three percent of people walking outside
right now, if we walked outside on forty eighth street,
three percent have an aneurysm. They don't know it, don't
(39:18):
know it. Wouldn't it be good to know that and
to monitor that and to intervene when necessary before it ruptures.
So managing risk factors again, I'll go back to blood pressure,
blood sugar. Because we have we have big blood vessels.
Think of the arteries that go to the brain, Martha,
like a tree. We have a big trunk that goes
up the neck. We have got four of them, and
(39:39):
then each of those branch off into smaller and smaller branches.
Imagine if I told you the tiny blood vessels that
supply every square millimeter of your brain are supplied by
a blood vessel the width of a hair in your head,
and we've got about four under miles of them, and
we need to keep them open.
Speaker 2 (39:54):
Wow.
Speaker 1 (39:55):
So managing blood pressure, blood sugar, blood, colesterol really important.
Speaker 2 (40:00):
What is the medicine that you talk about t PA
and how does it work after a stroke?
Speaker 1 (40:06):
So TPA is tissue plasmiagen activator. It's a clockbuster. So
when someone's having a stroke and they get to medical
attention quickly enough, we can do test to see which
blood vessel is blocked and give that patient that clockbuster.
It revolutionize the treatment of stroke. The first applied it
(40:26):
can be applied intravenously, so just just through the vein
you put iv in and give it intravenously, or for
some people we can actually go in with a catheter
usually through the groin, not a major surgery, go up
to the clot and actually retrieve it, or give some
(40:47):
blood dinner there, or give that TPA, or there are
other types of clotbusters now where we dissolve that clot.
So the dissolving of the clot or the pulling out
of the clot has really transformed the whole field of stroke.
But the better thing is there are eight hundred thousand.
When I was in training back more than thirty years ago,
(41:08):
I was told there are eight hundred thousand strokes every
year in the United States. And eighty percent of them
are preventable. Guess how many strokes are in the United States?
Still eight hundred thousand and even more of them are
preventable with all the different treatments and knowledge we have now.
Speaker 2 (41:23):
And so what's happening.
Speaker 1 (41:24):
They're not being addressed.
Speaker 2 (41:26):
Oh you know, the doctors are missing them.
Speaker 1 (41:29):
Not necessarily missing them. But again it's regarding access to care,
and we're not focusing enough on managing them aggressively. Like
why would one in four people with high blood pressure
in the United States not haven't managed, Like we're talking
like fifty percent of the population Martha, that is high
blood pressure, less than one and four haven't managed.
Speaker 2 (41:48):
It's worriesome.
Speaker 1 (41:49):
But nowadays with digital in our digital environment in which
we live, where wearables and sensors that we have on
our body right now can measure and monitor blood pressure.
Speaker 2 (42:00):
But the oral ring doesn't you not yet.
Speaker 1 (42:02):
Not yet. But there are other devices that are becoming.
Speaker 2 (42:05):
What's the best blood pressure device for people?
Speaker 1 (42:08):
Well, blood pressure device is an actual blood pressure cuff.
But I can tell you that there are devices that
have become available even recently where you can actually do
a selfie on your phone and it will measure your
blood pressure and actually take an EKG.
Speaker 2 (42:24):
Okay, you know what. I love this.
Speaker 1 (42:27):
So imagine most we can't send blood pressure cuffs to
everybody around planet Earth, but most everybody has a cell phone.
Can you imagine in seconds getting your blood pressure just
by taking a cell phone. So that's the future.
Speaker 2 (42:41):
How does that work?
Speaker 1 (42:43):
Well, I guess it's proprietary technology, but this company is
doing that. Well, there's a company in Canada that's doing that,
and there are other companies as well. I mean Apple's
developing this kind of technology. There's one called ai z
Tech that's developing this technology. So the future look very
bright in terms of empowering people to be able to
(43:03):
monitor and measure their own risk factors and take control
of them. That's where that Book of Modern Medicine is
going to come in real handy, Martha.
Speaker 2 (43:11):
Yeah, this is to educate, to educate and inform. Yes,
that is your duty, doctor Joe Dick.
Speaker 1 (43:17):
I'm up for it. I'm up for it immediately.
Speaker 2 (43:21):
What's the number one piece of advice that you would
like to impart to our listeners today on this podcast
that will really help guide them?
Speaker 1 (43:31):
How about this? How about a before c a comes
before C as activities, sleep, movement, diet. Right, those those things.
B is blood pressure, blood sugar, body fat, and blood cholesterol.
Those are the bees. Those are the four bees, and
C is cancer screening. So it's a before C.
Speaker 2 (43:54):
Oh. Great, well, thank you so much. I think this
will open a lot of people's minds to better care
for themselves, which we all hope for. We want everybody
to take good care of themselves. And thank you for
sharing your vast knowledge with us today.
Speaker 1 (44:09):
It's really great, Martha. Thank you so much for having
me here. It's been a pleasure in a thrill
Medical knowledge now is advancing doubles every seventy three days.
It's impossible, wow for one doctor or even a team
of doctors to keep up with everything.
Speaker 2 (00:14):
Prior to joining ATRIA, Doctor David Dotick trained at the
Mayo Clinic and served on the faculty there for more
than three decades. At the Mayo Clinic, he founded the
Neurology Residency Program, the Headache Fellowship Program, the Sports Neurology
and Concussion Program, the Migraine and Headache Program, and co
founded the Vascular Neurology Stroke Program. He is a professor
(00:38):
emeritus at the Mayo Clinic, a consultant for the Mayo
Clinic International, and a guest professor at the Norwegian University
of Science and Technology and an affiliate professor at the
University of Copenhagen. That's a very impressive resume of some
of your jobs. Doctor David Dodeck is a notable neurologist,
(01:00):
a prolific researcher, and the founder of multiple programs to
treat brain injury and disease. In other words, an expert
on the brain. I wanted to talk to him today
about brain health because, to paraphrase a quote he shared
it doesn't help to live longer if the brain isn't
in good shape. And I think all of us know
(01:21):
that absolutely inherently, and I know that we all have
questions about risk factors and warning signs for dementia, stroke
and other brain diseases. So we will cover all of
that today. Welcome to my podcast, Doctor Dodeck.
Speaker 1 (01:35):
Martha, it's a thrill to be here.
Speaker 2 (01:36):
Thank you so very very much. Now for clarity, I
recently enrolled in the ATRIA program. This is and maybe
doctor Dodeck can just describe it very simply for all
of you. What is exactly a TRIA?
Speaker 1 (01:51):
Exactly? ATRIA is kind of a preventive healthcare ecosystem that
seeks to translate science into medicine real time. What I
mean by that as the Institute of Medicine has estimated
that it takes about seventeen years for something that's validated
in research to actually make it to the bedside in
clinical practice. So we're looking to translate science and technology
(02:12):
because it's advancing so rapidly real time to prevent, reverse,
stop or delay the chronic diseases that reduce our longevity,
you know, chronic diseases right now ninety five percent of
people over the age of sixty have at least one
chronic disease, and about eighty percent have at least two.
(02:35):
And chronic diseases account for seventy five percent of not
only a health care spend in this country, but seventy
five percent of the deaths. So if we can stop
those chronic diseases, we can extend healthy lifespan and importantly
brain span.
Speaker 2 (02:48):
So what are the top six chronic diseases that you're
talking about.
Speaker 1 (02:52):
I'm talking about diabetes and other metabolic diseases that may
be related to diabetes. I'm talking about neurodegenerative disease like
Alzhema disease, Parkinson's disease, We're talking about cancer. We're talking
about cardiovascular disease. Those are those are the four one
biggest ones. And there are other chronic diseases like arthritis,
which is very common of course. So those are really
(03:15):
five major chronic diseases that we can do so much
about today, and so many Americans right now are suffering
from them. Medical knowledge now is advancing doubles every seventy
three days. It's impossible, wow, for one doctor or even
a team of doctors to keep up with everything. So
it's called like an onion, a core group of internal
medicine specialists surrounded by specialty pods, and then surround that
(03:38):
with what we call the Atria Academy of Science and Medicine,
which you have access to, which we have access to.
And the people on this are really key opinion leaders
across many medical and surgical disciplines. And the idea here, Martha,
is that we can tap them, these experts around the
world to get current best thinking on whatever issue, topic
(03:58):
or question that might arise.
Speaker 2 (04:00):
But you have written so many fantastic articles, you have
done so much research in a variety of very amazing
medical fields. Do you ever stop to think what's happening to.
Speaker 1 (04:13):
All of us? I do. I stop to think every day.
But I've never been more excited about the pace of
medicine and the future of medicine than I am today.
I'll really great, and I've learned more in the past
two years than I think I've learned in the past twenty.
Speaker 2 (04:28):
Really, what is that from you? Things that I just think?
Speaker 1 (04:31):
It's the pace with which advances are happening, you know,
like I said, if medical knowledge is doubling every seventy
three days. Then you have an insatiable appetite for learning.
You just can't get enough of it. So, and as
the chief medical Officer and chief Science Officer, is my
job to stay abreast of all of the things that
are happening or as many as I possible.
Speaker 2 (04:50):
How many physicians are affiliated with ATRIAB forty five forty
full time physicians. You say in us that we can
transform medical care from sick care to health care and
be a model that others will evaluate and scale so
that healthy lifespan is extended for as many people as possible. Yes,
(05:10):
So I'm a firm believer in that. Yeah, And I
think that it is so important for us to think
about living not anti aging, but aging gracefully and healthfully.
Speaker 1 (05:22):
Healthy lifespan, that's what we're talking about. Soever, however many
years you have, make those years healthy years where you
can cognitively you have your full cognitive capacity, physical capacity,
mental health capacity, because it's about happiness, happy happiness span
as I like to say, play span and brain span.
So it's keeping pilled people as healthy as possible for
(05:44):
as long as they live.
Speaker 2 (05:45):
What is the average lifespan today.
Speaker 1 (05:48):
In the United States, it's about seventy seven years. But unfortunately,
despite the fact that we outpace every OECD country in
terms of technology, the science and technology in the United
States is just staggering. What we have here and the physicians,
the quality of the medicine is remarkable, and yet we're
falling behind on every metric of health, whether it's infant
(06:11):
mortality or whether it's lifespan. But right now it's about
seventy seven years. It's a little bit different in women,
so it's longer in women, so it's about eighty two years,
and women about seventy seven, seventy eight in men.
Speaker 2 (06:22):
I like to give people at least some hope and
some guidance and what they can do to extend that lifespan.
What is the worst thing a person can do to
bring on an early demise?
Speaker 1 (06:35):
Not move, not move, not move, So physical movement and
cognitive exercise. So physical exercise and cognitive exercise, if you
did nothing else, that is crucial, okay, or brain held
for heart health and for longevity.
Speaker 2 (06:49):
And what you should not put in your body.
Speaker 1 (06:52):
So I don't put saturated fat in my body. I
hardly put any alcohol in my body. And I don't
put red meat in my body. Not that I'm saying
I don't want anybody to think that red meat is
necessarily bad, but I just happen not to put red
meat in my body. So those are perhaps the three
things I don't put in my body, and I would
(07:14):
counsel my patients to think about alternatives in their diet.
Speaker 2 (07:19):
I was recently speaking to a doctor from Europe who
has a list, and top of his list is alcohol. Yeah,
top above heroin and cocaine.
Speaker 1 (07:30):
Well, alcohol, Martha, according to the World Health Organization, is
a carcinogen, right, And no amount of alcohol, unfortunately, is good,
good for you or good for your brain. So as
a neurologist, if you cannot consume alcohol, that would be
a good thing. However, risk factors are stackable. So if
you keep yourself healthy, if you're exercising, and you're following
(07:52):
a diet that's been shown to reduce the risk of
cognitive decline in dementia, and you're managing your numbers as
I like to call it, your blood sugar, your blood cholesterol,
your blood pressure, you're screening for cancer. Right. If you're
doing all of those things, if you're doing everything else, right.
I don't want people to think they came to have
a glass of wine or a glass of champagne. But
(08:13):
alcohol to excess is definitely not good for your brain.
Speaker 2 (08:17):
So I've heard that forty five percent of dementia can
be prevented.
Speaker 1 (08:22):
That's true, and you know the Lancet Commission, which published
that report just several months ago. It's interesting that back
in twenty seventeen they said thirty five percent. Four years later,
it's forty percent. Four years later, like a few months ago,
it's forty five percent. And they didn't even consider things
like diet, things like gut health. So what are they saying.
(08:43):
They have identified these fourteen modifiable risk factors, and it's
gone from ten to twelve to fourteen. And every time
they increase by two the number of risk factors you
should target, it increases by five percent the decrease in dementia.
So that's powerful when you sit back and think, Okay,
the United States right now we have about seven million
people with Alzheimer's disease, but we have close to fifty
(09:06):
in the early stages at least with the pathology in
the brain.
Speaker 2 (09:08):
Eighty million.
Speaker 1 (09:09):
Yeah, and they don't know it yet.
Speaker 2 (09:10):
Oh, because our total population here in the United States.
Speaker 1 (09:14):
Is three fifty or somewhere around there, So it's horrifying.
And you know, we've got fifty million across the globe
and it accounts for about eight point five trillion dollars.
So if we can if you imagine if almost half
of dementia is preventable if you attend to these modifiable
risk factors, in addition to other risk factors that we
(09:34):
know are important, like diet, like sleep, like perimenopause and
how that's managed, like gut health. And I can go on, Wow,
I guarantee you that in another four years it's not
going to be forty five percent anymore. It's going to
be something higher than that. So I'm very optimistic.
Speaker 2 (09:51):
But how can we educate the public to these facts.
Speaker 1 (09:54):
It's going to take just a public a massive public
awareness campaign. And we've seen how successful they've been in
the past, whether it's in autism or whether it's in tobacco,
or whether it's an HIV. We've seen how successful these
public awareness campaigns in terms of raising awareness. I think
that's what we have to do here. The American Heart
Association has done a phenomenal job in raising awareness of
(10:15):
the risk factors around cardiovascular disease and heart health. We
have to do the same thing with the brain.
Speaker 2 (10:31):
Given how rapidly research is coming out about how lifestyle
impacts health. Is there an intervention or a strategy in
the past two years that you're excited about that isn't
yet widely distributed to the public.
Speaker 1 (10:43):
We'll just give you an example, Martha. We've been talking
about diet. So there's this diet called the mind diet,
which is a combination of the Mediterranean diet and the
diet to stop hypertension. It's called the mind diet. And
there are studies that looked at this mind diet showing
that if you follow this rigor, you drop the risk
of cognitive decline by about fifty three percent.
Speaker 2 (11:03):
Wow, it's just a diet, right, And what do you think?
Speaker 1 (11:07):
I think it's real. It's the diet that I follow.
So if you and there's a lot more research to
be done, but just take that alone. Physical exercise, no question,
it's the best drug if you will, It's the best
prescription that I could write. Cognitive exercise. People underestimate the
power of cognitive exercise. I'll give you an example we
(11:28):
recommend a program. No disclosure here, no affiliation to brain
age Q. It's one of a number of platforms that
challenge you cognitively. It's not like Sudoku or a puzzle
like that, but it's more it's designed to enhance processing
speed and memory, et cetera. People who have stuck with
(11:49):
that reduce the risk of dementia by about twenty nine percent.
So I could go on and on in terms of
interventions that I'm excited about, but just some of the
low hanging fruit are and sleep is another one.
Speaker 2 (12:00):
Now that's my big problem.
Speaker 1 (12:02):
Sleep is a risk factor for so many things, from
heart disease to dementia, to hypertension, blood high blood pressure.
It's a serious problem. And many Americans have a problem
with sleep, and it gets worse as we age.
Speaker 2 (12:15):
I always have. It's horrible.
Speaker 1 (12:17):
And so there are many ways which we can treat
insomnia and sleep disorders effectively. But sleep is really really important.
If I if I told you one night of sleep
deprivation really shuts down your memory organ in your brain,
the place where you put files, in the place where
you store files and store memory. Just one night of
sleep deprivation. Now I'm not a great one to talk.
(12:40):
But I wear this because I do monitor my sleep,
and yeah, you're going to hell.
Speaker 2 (12:44):
I should be wearing mine. Say I'm not wearing mine.
Speaker 1 (12:46):
And just tracking how because it's a very powerful motivating factor.
When I look at my sleep, open showed me.
Speaker 2 (12:53):
The aura ring right, Yes, it's the it's oh, you
are a right.
Speaker 1 (12:59):
And there are many different types of trackers.
Speaker 2 (13:02):
So it tells you what exactly. It tells you how
many hours you slept.
Speaker 1 (13:05):
Tell me how many hours you slept, how many how
much you slept in rem sleep or rapid eyebooment or
dream sleep if you will, deep sleep, which is really important.
What's your heart rate and oxygen was during stay?
Speaker 2 (13:17):
You better get my r ring out? Now? What do
you do for physical exercise?
Speaker 1 (13:22):
I tried to do both aerobic as well as resistance
training sometimes what we call circuit training, which is both
at the same time. I think it's really important. Both
are really very important, and both have been shown unequivocally
to promote healthy lifespan as well as to promote brain
span if you will, or cognitive health. So I think
resistance training is you can either use your body for that,
(13:43):
like push ups or lunges or free weights or bands,
but I think resistance training to keep muscle mass because,
believe it or not, muscle secretes hormones and chemicals that
are actually important for brain health, so really important, and
it also prevents frailty over time. Right, So you know,
resistance training an aerobic training. There was a study done Martha.
(14:04):
It's called a finger study because there's five fingers and
it was back about ten eleven years ago. It's a
landmark study where they took sixty to seventy seven year
old people who were at risk for dementia but who
were cognitively normal, and they did five interventions. One was
just social connectedness, right, just put them in groups or
(14:25):
just to increase the amount of social interaction they had.
Another one was managing their risk factors blood pressure, blood sugar,
blood cholesterols.
Speaker 2 (14:35):
All of that include managing blood pressure. Do you have
to take blood pressure medicine?
Speaker 1 (14:39):
No, you don't have to take blood pressure medicine. Many do.
But if you weight is a big one. So if
you lost weight and if you had a very low
sodium diet, there are things that you can do like
that that can keep controlling.
Speaker 2 (14:52):
Your Then environmental pressures. You can't really monitor that.
Speaker 1 (14:56):
No, you can't monitor that, but there are devices now
where you can actually monitor your blood PRESSU sure, and
so you can see you at a snapshot over the
course of a week what your blood pressure has been.
That is the single most important risk factor for stroke
and heart attack. And so knowing your number and knowing
what your numbers should be i e. Less than one
twenty over eighty and accepting nothing above that is crucial
(15:18):
for brain health and for heart health. And that's so
these five fingers people who followed it had a fifty
percent greater reduction in cognitive decline or the five fingers,
so vascular risk factors, okay, right, Social connectivity, so physical
cognitive exercise, nutrition, the diet, so the mind diet was
(15:40):
it was actually a Norwegian diet. What looks almost identical
to the mind diet, So diet, physical cognitive exercise, managing.
Speaker 2 (15:46):
Those already looks up mind diet.
Speaker 1 (15:49):
So those five things, just those alone made a dramatic
difference over the course of just two years and reducing
the risk of cognitive decline and dementsion.
Speaker 2 (16:00):
YEA, how much does the role of genetics play when
it comes to dementia and other neurological conditions.
Speaker 1 (16:06):
It plays a role, but you know, the sort of
rule of thumb, Martha, and there's no real science behind this,
but by and large it's true. Eighty percent of brain
health and eighty percent of longevity is lifestyle. It is
maybe twenty percent is genes. But you know, there's this
phenomenon known as the gene environment interaction. So if you
(16:30):
don't sleep, if you don't manage those risk factors, if
you don't move, if you're exposed to toxicans in the environment,
if you smoke, if you drink a lot of alcohol,
you change the expression of genes, so you might turn on,
for example, like bad sleep will turn on genes that
increase the risk for cancer or cardiovas heart disease and
(16:53):
decrease the expression of genes that are responsible for your
immune system. So there's a powerful role between the environment
in which genes are expressed. Is there some really exciting
work being done now that there are some genetic risk
factors for Alzheimer's disease, But some of these new targets
(17:13):
that are being tested, these druggable targets as we talk about,
that may find their way into clinical practice in the
not too distant future completely neutralize, at least in animals,
the effect of bad genes. So genes, yeah, important, responsible
for about twenty percent of lifespan and brain span, if
you will. But how you live your life has a
(17:34):
powerful influence on whether those genes, those bad genes will
actually be expressed versus the good genes that you want expressed.
Speaker 2 (17:41):
I've read that women are at higher risk for dementia
than men. Is that's true?
Speaker 1 (17:46):
That is true?
Speaker 2 (17:47):
Why?
Speaker 1 (17:48):
Good question. We think it has a lot to do
with hormones, particularly during that periman apostle phase where there
is kind of a precipitous drop in estrogen. So hormones
definitely play role. They're estrogen and progesterone receptors all over
the brain, so I think you know there's a hormonal
influence to this. There may be other risks as well.
(18:09):
Hormone therapy is important to at least have a conversation
with your doctor if you're in early in the early
perimid apostle phase, because estrogen may be protective for the brain,
so it's important. There as a lot of nuances there,
but it's important to at least have that conversation with
your doctor. Women are also at a higher risk of
other diseases that may affect the brain, like diabetes, like
(18:31):
heart disease. So all of these things. You can think, Martha,
of the our health as a house. The brain sits somewhere,
the heart sits in another house, but they're all connected,
and so if one organ is sick, it makes the
whole house sick. If one room is sick, it makes
the whole house sick. So I think because women are
at a higher risk for many of the diseases that
(18:52):
affect the brain, and they go through these fluctures, you know,
hormonal stages during their life, I think that's partly why
they're at an increase risk.
Speaker 2 (19:01):
I had a very good doctor long time ago who
put me on an estrogen and I've been on it
for but sixty years or something, and I think it
served me well. Yes, because good skin, good hair, good.
My brain's pretty good. I think, if I'm interested in
(19:21):
brain health and not an ATREAM member, what simple tests
should I ask my doctor to check for during my
annual checkup?
Speaker 1 (19:29):
He or she should do a cognitive health examination. So
where are you? What is your baseline? It's not done today.
Speaker 2 (19:36):
Oh it isn't.
Speaker 1 (19:37):
When you go in for your annual physical they don't
really test your brain health.
Speaker 2 (19:41):
No, they do not.
Speaker 1 (19:42):
They take a chest X ray. They might do it.
Speaker 2 (19:44):
But who would you go to for that? To a neurologist.
Speaker 1 (19:47):
You would go to a neurologist. But also you should
be able to go to a primary care physician as well.
So just like you know route there's routine screening for
heart health, and you know blood pressure and blood glucose,
the should be routine root teen screening for brain health.
So that includes maybe some certainly a cognitive test of
the brain. Right now, we might as well talk about it.
(20:09):
There are a couple of blood tests right now that
will actually tell us what the health of the brain
actually is. Oh wow, So in the future Martha was
working on that. Oh, there are lots of pharmaceutical companies
working on that. They are a scientists working on that,
and a couple are commercially available right now. So, as
we alluded to earlier, Alzheimer's disease and other nerod degenerator
(20:32):
diseases begin years to decades before they actually show up
as symptoms. And imagine a future where when you go
in and get your blood drawn and you get a
you know, a blood count done, and you know, you
get a cholesterol test. Imagine if you've got a test
for the brain. Yeah, I would love that that determined
your brain health and that provided you with the opportunity
to intervene early and maybe never develop the actual disease.
(20:56):
I think that's the future and that's what.
Speaker 2 (20:58):
We're I went to that laboratory is famous laboratory in Iceland.
Do you know about that laboratory that reads your genome? Oh? Yes, yes,
So I did that, oh twenty years of seacode. Yes, yes, seacode,
and I went through the whole test. They test you
against the Icelandic population, which is a very protected and
(21:20):
very small population that I had really no propensity for
any life threatening diseases in my genome except for maybe obesity.
So I felt really good about it, But I wish
I could have that again. Where are there places in
America now that are reading your genome like that?
Speaker 1 (21:38):
Absolutely, we do it, and we do on every member
at ATRIA. We do full genome sequencing good as well
as what we call polygenic risk scoring, because not all
diseases are due to a single gene or a mutation
a single gene. They're due to variations in multiple genes,
So we test people for that to see what diseases
they're at risk for. We do something called pharmaco genomics,
(22:01):
which means that we test the genes that are responsible
for enzymes and proteins in the body that metabolize drugs. So,
do you know that there are more than three hundred
drugs common drugs that your genes will determine how you
metabolize those drugs, or even if then you know that
now three hundred over three. So we do that testing
(22:22):
because before I put you on an antibiotic or a statin,
or an antidepressant or many many other medications, we want
to know whether and how effectively you metabolize those drugs.
So we do that, and then we do something where
we look at about one hundred and sixty seven actionable genes.
It's one thing to look at the entire thousands of
genes in the genome. It's another thing to look at
(22:44):
those for which we need to know the answer as
to whether you have it or not, because it changes
the way we surveil you and treat you and treat you.
So we do that as well. I'll give you. There
was a recent study in a place where they do
whole genomes. When singing do all these genetic tests like
I talked about, forty percent of the people had an
(23:05):
actionable gene that changed the way they were managed, treated,
or surveilled. Oh great, Yeah, so it's really important.
Speaker 2 (23:12):
So medicine is becoming more complex and yet more clearer
and more precise and precise. Yeah, I mean, we can
preventive medicine right now can be done with such precision,
molecular precision. It's staggering actually and exciting. Now, what about
prescribing drugs. I'm terrible about taking drugs. I don't like
(23:33):
taking things. I don't know why, but I've never I
just don't like it.
Speaker 1 (23:37):
When it comes to medications. Let's say, when I tell
people they really need to know their numbers. And when
I say that, I mean, you really need to know
how well you're disposing glucose blood sugar. You really need
to know that. They call Alzheimer's type three diabetes for
a reason. Oh right, So when we develop insulin resistance
in our body. Insulin is the drug that takes care
(23:59):
of glucose and sugar in the body. We really need
to know and really aggressively manage blood sugar. So knowing
what your insulin is, knowing what your A one C is,
and there's been good public awareness campaigns around that is
really important. Not only that, though, you got to know
what the target is. So I saw a patient today
today before coming here, who I saw eight months ago
(24:22):
whose A one C was six point one, not in
the diabetic range, certainly in the pre diabetic range and
unacceptably high in my opinion. So he told me today
and he was very proud that the lifestyle measures, just
the lifestyle measures that we instituted, brought his A one
C down to five point one. Oh, that's great, whole point,
which is fantastic. That's a lot actually in the normal range.
(24:45):
So knowing your numbers like blood pressure, blood sugar, blood lipids.
In the United States right now, there are anywhere between
one hundred and twenty five to one hundred and fifty
million with each of those diseases obesity, diabetes, pre diabetes,
hYP tension, or high cholesterol. And unfortunately, less than one
in four Americans move enough, get enough exercise, less than
(25:09):
one in four actually have their high blood pressure managed.
One and four one and four. So if we just
that's low hanging fruit, if we just got that right,
imagine how healthy we would be, and imagine how we
could extend healthy lifespan.
Speaker 2 (25:23):
And how can we help people do that? Is it
the hospitals? Is it the how do you get people
to get that care? I mean, I recently had someone
who works for me hurt his back. That was four
weeks ago. Yeah, he really hurt his back. It wasn't
it wasn't. It's not a joke. He couldn't move. It
took a month for him to get an MRI with
(25:44):
the healthcare that he has. Yeah, and pretty terrible.
Speaker 1 (25:48):
Access is a big thing, it is. It's a big thing.
So access to care is a problem in this country.
And if you don't have access to care, it's difficult
for you to know your numbers, and it's difficult for
you to get expert advice on how to best manage
those numbers. Having said that, one of the things that
we're committed to doing is developing modern a book of
(26:10):
modern medicine made up of clinical protocols that focus on
each of these things, in addition to fifty other things.
It has to be very simple, has to be simple.
It has to be like five pages, and it has
to be digestible and accessible so that people.
Speaker 2 (26:24):
Can It should be on billboards everywhere.
Speaker 1 (26:25):
Absolutely, no, it should.
Speaker 2 (26:27):
I believe in that so much education and teaching can
be simplified, not too simple, but simple enough for everybody
to understand.
Speaker 1 (26:35):
Absolutely. So making this freely available to the public and
to the medical community will empower physicians, but all also
empower people.
Speaker 2 (26:44):
Are you working on that? Doctor Dodeck has written how
many books? Sixteen books or so and varying subjects. You've
also written nine hundreds to one thousand fantastic articles on
all kinds of medical subjects. I mean, you're have been
so prolific. But what get this book out?
Speaker 1 (27:03):
So this is my passion right now. That's book of
modern medicine.
Speaker 2 (27:05):
That would be so great.
Speaker 1 (27:06):
And make that available to people in a way that
that it's accessible to them and they can understand it
and it empowers them to take this mad take matters.
Speaker 2 (27:14):
Into their ouide book.
Speaker 1 (27:15):
Yeah, exactly, a playbook. It's a ways for your health,
if you will.
Speaker 2 (27:19):
That would be so great. Yeah, okay, I'm looking forward
to that. What foods contribute most to brain health? Well?
Speaker 1 (27:36):
You know this mind diet that I talked about now,
Basically it's made up of healthy oils like olive oil
for example. It's made up of legumes and beans, green
leafy vegetables. Berries, not so much all fruit. We used
to say fruit, but it's more berries, especially blueberries, nuts,
certain nuts like almonds and walnuts. Chicken and poultry is
(27:59):
actually on that mind diet as well. Those are the
main things on that mind diet. And as fish, definitely
fish because omega threes really important for the brain. Most Americans,
the vast majority of omega Americans are low and deficient
in omega threes because they just simply can't get enough
in their diet, unlike if you live in Japan, where
(28:21):
most of them are, you know, not deficient invite in
omega three. So if you're if you're deficient in omega threes,
that's where supplementation can be helpful to get your omega
three index. We call it up to a level that
protects your brain and protects your body.
Speaker 2 (28:38):
At what age your human brains start to decline? Is
there an age or an approximate age, or is it
declining the minute you're born? Well no, not really, You're
getting old the minute you're born.
Speaker 1 (28:50):
You know, the human brain really doesn't fully mature until
early twenties, maybe mid twenties, right, and it's not downhill
from there. But I will say that brain health as
well as longevity in general, is recursive. What I mean
by that is, when you're sixty years old, how healthy
(29:11):
my body and brain is depended what I did when
I was in my fifties. And when I'm in my fifties,
the health of my brain depends on how healthy I
was in my forties. So you can't go back. Well,
you can stop, and you can attenuate the progression. But
it's what when I talk to young people, it's hard
to compel young people when you say, when you start
(29:33):
talking about dimension Alzheimer's disease, no thirty year old is
thinking about what happens when they're seventy or eighty. However,
what I do tell them and what does compel them
is who doesn't want a cognitive edge? Who doesn't want
to be thinking faster, storing more information, having that edge,
whether it's in their job or in their daily lives.
And we can do that today. We can enhance cognitive performance.
(29:55):
And when we're enhancing cognitive performance. Well, ultimately at the
age of sixty, you'll enter your sixties with a much
healthier brain. So brain health is recursive in how we
treat our brain when we're thirty five has a profound
impact on what happens when you're sixty five and eighty five.
What's the difference between dementia and natural aging forgetfulness? Well,
(30:18):
dementia is of course forgetfulness, but it affects activities of
daily living. You're functionally impaired, whether that's your job or
whether that's simple activities of daily living. Forgetfulness. You know,
we all forget things from time to time. I probably
forgot many things on my walk down here, but I'm
(30:39):
still able to function and perform in my job and
in my social life and in my daily life. So
dementia is what is not is forgetfulness, and it's also
other cognitive domains like processing speed and executive function, the
ability to plan and make decisions and solve problems, and
that starts to impede and affect your job pformance, and
(31:00):
your ability to actually be socially engaged, in active and
just care for yourself. That's the difference between dementia and
just benign forgetfulness.
Speaker 2 (31:09):
Is it true that the brain cleans itself when they
when it sleeps?
Speaker 1 (31:13):
It is true. One thing I wanted to say is
we actually, I think one of the things we'll look
back at, Martha in the future, the fact that we
treat forgetfulness or cognitive decline as an inevitable consequence of aging.
I think it's just a failure of our imagination. So
I really do think that we can keep our brains
(31:33):
healthy and never outlive our brain sleep. One of the
real mechanisms by which we think sleep is good for
the brain, and why sleep deprivation is bad for the
brain and can lead to dementia, is that when we sleep,
we open up these channels in the brain and it
clears out all the toxins and proteins that are released
(31:56):
during the day. So it does, it's really it does
form a real function, a housekeeping function in the brain.
And when you don't sleep, you don't remove all that debris.
And when that debris settles in, that's not healthy for
cells in the brain.
Speaker 2 (32:09):
It's crowding.
Speaker 1 (32:10):
It's crowding, and proteins start to clump and misfold and starts,
and that's toxic. That's deadly to cells.
Speaker 2 (32:18):
Remember you have to clean your house.
Speaker 1 (32:21):
Seven eleven eleven, seven hours and eleven minutes. I got
to sleep at least seven to eight hours a night.
Speaker 2 (32:27):
And how do you exercise the brain? You talk about exercising,
I mean for physical exercising, we know, but what about
the brain exercise? Or what kind of games are really good?
What kind of thinking is good? Reading?
Speaker 1 (32:41):
Well, certainly reading and Sudoku and all of these different
puzzles keeps the brain cognitively engaged, but real.
Speaker 2 (32:49):
Which game do you play? What game do you play?
Speaker 1 (32:51):
I use brain HQ, which is what we recommend because
it's been shown actually to be the best, the best.
And you know this is the one where I said
it reduces the risk of dementia by maybe thirty percent
if you adhere to it. So like twenty to thirty
minutes a day, that's nice.
Speaker 2 (33:07):
Should I give that to my twelve year old grandson too,
whose brain is so alive?
Speaker 1 (33:10):
He would love it because it's kind of a game
and you get better over time and you watch.
Speaker 2 (33:14):
Yourself O the brain HQ. It's online, Yes, oh we were,
And it says to your IQ it doesn't.
Speaker 1 (33:19):
Test your IC but It measures your processing speed and your.
Speaker 2 (33:22):
Working There's something that was I took it on an
airplane and then I gave it to him and we
were competing against each other with for IQ and it
was so much fun.
Speaker 1 (33:31):
Yeh.
Speaker 2 (33:32):
And he and I just he and I were doing
very well together.
Speaker 1 (33:35):
Well there you go.
Speaker 2 (33:35):
Yeah, so I was. I was very pleased that I
was not falling too far behind. But it's so fun
to do those games. I mean, well, that's one thing
that I have when I wake up at five o'clock
or four o'clock. I drew all the stupid puzzles in
the New York Times. That's okay, right, absolutely, But it's
taking away from my sleep.
Speaker 1 (33:53):
Well, it's taking away from your sleep. You gotta It's
all about balance. It's all about balance. I will tell
you that doing wordal and three is good. Doing wordle
in three is great.
Speaker 2 (34:04):
You don't know what I'm talking about. Triwordal. It's a silly,
intense game.
Speaker 1 (34:09):
I'm very proud of myself when I get it in three.
That usually doesn't happen. But you know, some of the
other really beneficial cognitive exercises that I tell people to do,
learn a new language, or take up a musical instrument.
When you challenge the brain with novel exercise like that,
that's really really good.
Speaker 2 (34:25):
Okay, that's a very good idea.
Speaker 1 (34:27):
Yeah.
Speaker 2 (34:27):
I have my piano sitting by itself in a room.
It should be used absolutely. Okay. Well, I also do gardening,
which is also I think very good for very therapeutic.
It is, yeah, and it's you can learn a lot.
I mean I learned so much in a couple hours
of gardening. Yeah, because I tried to learn the names
of the plants. I study each plant, and I think
(34:50):
that's good for people absolutely, And you know, growing things,
nurturing things, all of that is healthy and good.
Speaker 1 (34:55):
And being around nature like that, being around green is
a very beneficial thing. Why, which is why I try
to get in the park as often as possible.
Speaker 2 (35:03):
And I read that rumination is one of the worst
things for the brain. It's rumination and what is it
doing to us?
Speaker 1 (35:12):
You know, there's this area in the brain called the
default mode network because we default to.
Speaker 2 (35:18):
It m N DMN DM.
Speaker 1 (35:21):
Mode network DMN, and this default mode network is particularly
active in people who ruminate, in people who are depressed,
and so it's.
Speaker 2 (35:34):
Rumination is not chewing your cut thinking about the same
thing over and over again, isn't it? Isn't that what
it is? So why did he go away? Why did
he go did? Why did we break up? Don't think
about it? That's what I show people all the time.
Just don't think about those things.
Speaker 1 (35:51):
Don't never, never have any regrets. Everything happens for a reason.
So I try not to have any regrets because whatever
I've done or whatever I've said, you know, it happened.
I can't have any regrets over something that's in the past. Yeah,
So don't ruminate about it because it's not going to
change it.
Speaker 2 (36:08):
You can feel sorry, but you don't have to think
about it.
Speaker 1 (36:09):
Yeah.
Speaker 2 (36:10):
Right, that's how I feel. I think that's very good
for oneself.
Speaker 1 (36:14):
Stress is bad for one's brain. Martha.
Speaker 2 (36:16):
I was getting vitiligo when I was going through my divorce.
I was losing pigment in my skin, and I went
to a Brazilian friend of mine said, oh, go to
see this witch doctor in sal Polo, Brazil. So I went.
I flew all the way to salth Paulo, Brazil, and
then had to drive up into the mountains and stand
in line. There's a line like a mile long of
people waiting to see this doctor, witch doctor. And when
(36:40):
I told her, and she turned out to be like
a like a Japanese lady who had been living there
for many years. And she looked at me and she said,
what's your problem? And I said stress. She said, in
my language, we do not have a word for stress.
Speaker 1 (36:54):
Interesting, yeah, and she.
Speaker 2 (36:57):
But she understood that stress was called seeing this discoloration
of my skin, and and it went away after the
stress was alleviated, you know. But it was so interesting
that that that can it can do that to you.
It's a horrible thing stress.
Speaker 1 (37:13):
There's a thousand different physiological reactions in the body to stress.
So one of the things we always recommend is mindfulness meditation.
It can be very effective for sleep. There are devices
that we call them biofeedback devices. One in particular will
actually when your mind, it uses EEG sensors on the head,
and when your mind is at rest, it will play
(37:34):
soundscapes that are pleasant. But when your mind is distressed
or stressed, it will play louder clouds thunder right, And
so what you do.
Speaker 2 (37:45):
Is try to put them on your head.
Speaker 1 (37:47):
Yeah, you try to calm your environment, right, have to
get those. We'll talk about it when you come.
Speaker 2 (37:53):
What happens to your brain when you're having a stroke.
Speaker 1 (37:56):
Well, it depends. There are two different types of stroke.
One is where you block a blood vessel in the
brain and that part of the brain no longer is
receiving that blood supply, the oxygen, the nutrients that keep
it alive.
Speaker 2 (38:07):
That's permittent or it can be temporary.
Speaker 1 (38:10):
It can be temporary, and we have treatments now that
can unblock that and rescue the brain, which is fantastic.
There's another that accounts for about eighty five percent of stroke.
A fifteen percent of stroke is when there's a hemorrhage.
We're bleeding into the brain as an aneurysm. It could
be from an aneurysm. Sometimes it's from the most common
cause of hemorrhage into the brain is high blood pressure,
(38:36):
So not only does it cause hemorrhaging into the brain,
but it also blocks blood vessels high blood pressure, which
is why the number one respector for stroke. So those
are the two different types of stroke. Blockage from a
blood clot which is much more common, but sometimes hemorrhage
into the brain from an aneurysm, from a malformation or
sometimes from just high blood pressure.
Speaker 2 (38:55):
So best things for preventing a.
Speaker 1 (38:57):
Stroke, best thing for preventing a stroke is to keep
those blood vessels open and healthy and keep that blood
pressure down right. And sometimes we do screening evaluations where
we you know, about three percent of people walking outside
right now, if we walked outside on forty eighth street,
three percent have an aneurysm. They don't know it, don't
(39:18):
know it. Wouldn't it be good to know that and
to monitor that and to intervene when necessary before it ruptures.
So managing risk factors again, I'll go back to blood pressure,
blood sugar. Because we have we have big blood vessels.
Think of the arteries that go to the brain, Martha,
like a tree. We have a big trunk that goes
up the neck. We have got four of them, and
(39:39):
then each of those branch off into smaller and smaller branches.
Imagine if I told you the tiny blood vessels that
supply every square millimeter of your brain are supplied by
a blood vessel the width of a hair in your head,
and we've got about four under miles of them, and
we need to keep them open.
Speaker 2 (39:54):
Wow.
Speaker 1 (39:55):
So managing blood pressure, blood sugar, blood, colesterol really important.
Speaker 2 (40:00):
What is the medicine that you talk about t PA
and how does it work after a stroke?
Speaker 1 (40:06):
So TPA is tissue plasmiagen activator. It's a clockbuster. So
when someone's having a stroke and they get to medical
attention quickly enough, we can do test to see which
blood vessel is blocked and give that patient that clockbuster.
It revolutionize the treatment of stroke. The first applied it
(40:26):
can be applied intravenously, so just just through the vein
you put iv in and give it intravenously, or for
some people we can actually go in with a catheter
usually through the groin, not a major surgery, go up
to the clot and actually retrieve it, or give some
(40:47):
blood dinner there, or give that TPA, or there are
other types of clotbusters now where we dissolve that clot.
So the dissolving of the clot or the pulling out
of the clot has really transformed the whole field of stroke.
But the better thing is there are eight hundred thousand.
When I was in training back more than thirty years ago,
(41:08):
I was told there are eight hundred thousand strokes every
year in the United States. And eighty percent of them
are preventable. Guess how many strokes are in the United States?
Still eight hundred thousand and even more of them are
preventable with all the different treatments and knowledge we have now.
Speaker 2 (41:23):
And so what's happening.
Speaker 1 (41:24):
They're not being addressed.
Speaker 2 (41:26):
Oh you know, the doctors are missing them.
Speaker 1 (41:29):
Not necessarily missing them. But again it's regarding access to care,
and we're not focusing enough on managing them aggressively. Like
why would one in four people with high blood pressure
in the United States not haven't managed, Like we're talking
like fifty percent of the population Martha, that is high
blood pressure, less than one and four haven't managed.
Speaker 2 (41:48):
It's worriesome.
Speaker 1 (41:49):
But nowadays with digital in our digital environment in which
we live, where wearables and sensors that we have on
our body right now can measure and monitor blood pressure.
Speaker 2 (42:00):
But the oral ring doesn't you not yet.
Speaker 1 (42:02):
Not yet. But there are other devices that are becoming.
Speaker 2 (42:05):
What's the best blood pressure device for people?
Speaker 1 (42:08):
Well, blood pressure device is an actual blood pressure cuff.
But I can tell you that there are devices that
have become available even recently where you can actually do
a selfie on your phone and it will measure your
blood pressure and actually take an EKG.
Speaker 2 (42:24):
Okay, you know what. I love this.
Speaker 1 (42:27):
So imagine most we can't send blood pressure cuffs to
everybody around planet Earth, but most everybody has a cell phone.
Can you imagine in seconds getting your blood pressure just
by taking a cell phone. So that's the future.
Speaker 2 (42:41):
How does that work?
Speaker 1 (42:43):
Well, I guess it's proprietary technology, but this company is
doing that. Well, there's a company in Canada that's doing that,
and there are other companies as well. I mean Apple's
developing this kind of technology. There's one called ai z
Tech that's developing this technology. So the future look very
bright in terms of empowering people to be able to
(43:03):
monitor and measure their own risk factors and take control
of them. That's where that Book of Modern Medicine is
going to come in real handy, Martha.
Speaker 2 (43:11):
Yeah, this is to educate, to educate and inform. Yes,
that is your duty, doctor Joe Dick.
Speaker 1 (43:17):
I'm up for it. I'm up for it immediately.
Speaker 2 (43:21):
What's the number one piece of advice that you would
like to impart to our listeners today on this podcast
that will really help guide them?
Speaker 1 (43:31):
How about this? How about a before c a comes
before C as activities, sleep, movement, diet. Right, those those things.
B is blood pressure, blood sugar, body fat, and blood cholesterol.
Those are the bees. Those are the four bees, and
C is cancer screening. So it's a before C.
Speaker 2 (43:54):
Oh. Great, well, thank you so much. I think this
will open a lot of people's minds to better care
for themselves, which we all hope for. We want everybody
to take good care of themselves. And thank you for
sharing your vast knowledge with us today.
Speaker 1 (44:09):
It's really great, Martha. Thank you so much for having
me here. It's been a pleasure in a thrill
Host
Martha Stewart
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