March 12, 2025 • 29 mins
Holistic medicine, alternative medicine, complementary medicine – you may have heard these terms or seen them used online and wondered what they mean. Each term refers to the concept of integrative medicine, a comprehensive approach to healthcare that focuses on treating a person’s mind, body and spirit rather than addressing symptoms or a specific disease through a combination of medical treatments and other evidence-based therapies. By integrating practices like nutrition, mindfulness, supplements and other alternative therapies with traditional care, integrative medicine aims to promote overall wellness, enhance healing and improve quality of life, especially for individuals managing chronic conditions like dementia. Dr. David Rakel, a leader in integrative medicine, joins the podcast to share about how this holistic approach can help people experiencing memory change and how diet, mindset and lifestyle can play a crucial role in supporting brain health.
Guest: David Rakel, MD, professor, chair, University of Wisconsin Department of Family Medicine and Community Health, founder, University of Wisconsin Osher Center for Integrative Health
Show NotesLearn more information about the Healthy Living With Mild Cognitive Impairment (MCI) program and register for upcoming events by visiting our website.
Learn more about Dr. Rakel from his profile on the UW Madison Department of Family Medicine and Community Health website.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Intro (00:03):
I'm Dr. Nathaniel Chin, and you're listening to Dementia Matters,
a podcast about Alzheimer's disease. Dementia Matters is a production of the Wisconsin
Alzheimer's Disease Research Center. Our goal is to educate listeners on the
latest news in Alzheimer's disease research and caregiver strategies. Thanks for joining us.
Dr. Nathaniel Chin (00:26):
Welcome back to Dementia Matters. Today, I'm joined by Dr. David Rakel,
professor and chair of the University of Wisconsin Department of Family Medicine
and Community Health. He's also the founder of the Osher Center for Integrative Health
at UW–Madison and a recipient of the Gold Foundation's Leonard Tow Humanism
in Medicine Award, the school's highest honor for excellence and compassion in care. Today,
(00:48):
Dr. Rakel will be talking about his work in integrative medicine,
as well as giving a preview of his upcoming talk for the Wisconsin ADRC's Healthy Living with Mild
Cognitive Impairment series happening on March 14, 2025. Dr. Rakel, welcome to Dementia Matters.
Dr. David Rakel (01:05):
Thank you, Nate. Good to be with you.
Chin (01:08):
To start, and I will let the audience know, I did get a sneak peek of your presentation, and
we're very excited to be having you on the series. What exactly is salutogenesis? You're going to
talk about it in the series. How does it relate to integrative care? What does it actually involve?
Rakel (01:26):
Yeah, thanks for asking. Integrative medicine initially came from the need to
incorporate other aspects of health and healing into traditional models of care. That was more
of an integration of the best science possible for the challenges that we're facing. It doesn't
really have a goal or an outcome towards it. What we want to do is use salutogenic science—salute,
(01:51):
health, genesis, origins of—to have that as our goal. If we have a population of people and we
have a salutogenic science, that science with inform how that population can be as healthy and
happy as possible and stay out of the hospital on the fewest number of medications needed to
(02:11):
maintain and honor the self-healing capacity of every living being, particularly humans,
is our main focus within dynamic environments in which we all live. Integrative medicine is
the integration of things like nutrition and acupuncture. Salutogenic science is the science
(02:32):
that brings us to a healthier place together, which is different than pathogenesis. Pathos,
to suffer. Genesis, the origins of suffering. Most of our medical education is in that, is disease
and suffering. That's not the outcome we want. We wanna be good at it. We wanna keep finding cures
for dementia and all the different causes of it. We need a better balance between the two. Right
(02:59):
now, we have about a 90 percent balance towards pathogenesis. I would say we need at least a 50-50
balance towards salutogenesis and pathogenesis. It's a tough word. It doesn't roll off the tongue,
but salute is health in Italian. Salud is healthy in Spanish. If I'm going to toast Nate,
(03:19):
I'm going to say “salud!” because to your health, Nate. I want you to be healthy.
Chin (03:24):
Okay. Thank you. That actually makes a lot more sense now, especially the way you ended it.
Frankly, you're just saying there's a balance. We need to be experts in living well, in health
promotion, as well as when disease occurs and how to handle pathogenesis. Frankly, pathogenesis
is a complicated word too. It's just that we've used it so often that it's become common to us.
Rakel (03:44):
Yes.
Chin (03:44):
You're introducing a very important word,
and hopefully it'll become more common to us as we go forward. You did mention integrative medicine,
and you've explained that. For our listeners, can you also explain how integrative medicine is
different and similar to other terms that people might hear in the community, like
alternative medicine and complementary medicine? How do they overlap, and how are they different?
Rakel (04:07):
Sure. I'll give you a little history lesson. The initial word that was used for
this was holistic medicine. I think that's a good word. It really shows how everything is
interconnected. Then there was complementary and alternative medicine, which is not a great word.
Complementary suggests that it doesn't stand on its own two feet, whereas if we're dealing with
(04:28):
metabolic syndrome, nutrition can stand very well. That at one time was considered complementary or
alternative therapy. Alternative is not a good word either because we don't want to replace
something that has good science with something else. We want to use both together. We want to
use the best science possible. I always quote Sir William Osler. He said, this is an art based in
(04:51):
science. The art comes from going into the context of unique human beings. What guides our choices is
that relationship with that other human being. Then science guides the best
therapy possible based on the dialogue, which means running through two people,
(05:13):
that information and context is guided by science, but it's really that relationship and the unique
aspect of that human being. CAM has kind of gone out of favor, and then integrative medicine came
in. Now there's functional medicine. Functional medicine talks about getting at the root cause
at the very early onset of disease and how do we bypass that or reverse it. Really,
(05:39):
I think where this is going is salutogenic science or really how complex systems heal;
health and healing. That's really the goal that we want. It's a different financial goal. This
is where value-based care comes, where we get paid to keep people out of the hospital
instead of just being paid to treat people in the hospital. It's a balance. We want both.
We want the best specialists possible for when people need them. We also need primary care,
(06:06):
interprofessionals working together in communities to keep people healthy so they need less things.
Chin (06:12):
With that in mind, how can integrative medicine help people
who are experiencing memory changes or for those who have crossed that
threshold and now they have a diagnosis of mild cognitive impairment or dementia?
Rakel (06:25):
This is a lot of what we'll talk about on the 14th,
I think it is. We wish we had a silver bullet for dementia. We don't. What works best now in
2025 is silver buckshot. We need to use multiple synergistic therapies together
to have the biggest impact. That's where this integrative salutogenic approach goes. How do
(06:51):
we stack the deck in favor of the best possible outcome? Ideally, that would be prevention. Next,
it's how can we maybe reverse the disease if possible? Then next, how do we reduce the
speed of progression? Then how do we enhance quality of life? That's always the goal.
Chin (07:09):
What is your approach to nutrition and dementia risk? I start with this, of course,
because of this investment in salutogenesis. I think food is really, really important,
as our listeners know. In your answer, I'm hoping you can cover some about alcohol,
ultra-processed foods, even a little bit about red meat, and my personal favorite,
(07:31):
or at least I should say what I ask my patients to get rid of, soda.
Rakel (07:35):
Soda. Yeah. Good. We could spend hours on all of those. Let me just simplify it as much as
possible. You can avoid reading all the nutrition books of the world with this. It's a paraphrase
off of Michael Pollan. Eat multicolored whole foods that were recently alive with people you
(07:55):
love. Why do I say that? Multicolored whole foods—we have a multivitamin, and it's called
plants. The different-colored plants give us the nutrients that we need to be healthy. That has
fiber. Fiber slows down the absorption of sugar and establishes a healthy environment for our
microbiome. Then eat with people we love. We digest food when we're more relaxed. When we
(08:21):
stress eat, that increases the sympathetic tone and actually shunts blood away from our digestive
system. Then we have the social support with that. There are so many things around that that help.
If we just look at the evidence, there's been grade A, top-tier level evidence showing that
a plant-forward Mediterranean-DASH type diet—those two combined are considered the MIND diet—where we
(08:47):
take the benefits of a low-salt DASH diet that lowers blood pressure and a Mediterranean diet
that's rich in fiber, whole grains, plants, fish, olive oil. It's low in the three most inflammatory
foods, which are excess sugar, red meat and excessive dairy. Then I'll add processed foods
(09:09):
in there. Processed meat is probably the worst, but let's go to soda because there's a whole
array of concerns with non-nutritive sweeteners, which soda often has. Let's put the high-sugar
soda over there, but I will give you this data point. Most naturally sweetened sodas have
(09:29):
35 grams of added sugar. One teaspoon equals five grams. That's seven teaspoons of sugar in
one soda that's naturally sweetened. Now let's look at some of the science that's evolving for
non-nutritive sweeteners. Aspartame, for example, actually breaks down the blood-brain barrier. We
(09:51):
really need that part of our brain to work well to separate the blood system from the brain system.
Aspartame gets converted to formaldehyde, and formaldehyde starts to deteriorate that really
important barrier between our blood and our brain. We're also learning that a lot of these
(10:13):
non-nutritive sweeteners have erythritol in them. Erythritol increases thrombotic
risk and increases the risk of stroke. We'll share some research at our conference about
the higher risk of stroke and degenerative brain disease with a lot of heavy use. I'm
(10:34):
going to say this—heavy use, not light use, but heavy use of non-nutritive sweeteners. These
are being put in all aspects of our nutrition now, not only sodas but also processed foods.
Chin (10:49):
Well, in your answer, you were very careful to use the word excessive—excessive red meat,
excessive certain foods. Are you implying, though, that—and
this is really what the MIND diet does say to some degree—one serving a week of red meat is
okay. It's okay to have some, just not a lot? Is that what you're saying as well?
Rakel (11:11):
Yes, very much so. Moderation is the key. I love to have a really good steak once in a while,
but I don't have one even three times a week.That's probably too much. Then the
processed meat. Processed meats are injected with nitrosamines. Nitrosamines–nitrates–dilate
(11:33):
our blood vessels, but amines, when we combine amines with nitrous, it's oncogenic,
and it significantly increases the risk of many cancers. The reason we inject processed
meats with nitrates is that they dilate the blood vessels, so you retain more hemoglobin,
so it maintains a little pink color when we eat it. It doesn't look like the cadavers that
(11:54):
we had in medical school. It's just not very appetizing. There are a lot of these chemicals
that are injected into processed foods that we're learning have a lot of danger to them.
Chin (12:06):
I'm not expecting you to give us a long answer on this,
but the field in alcohol use is really evolving, especially coming from the UK Biobank, showing
that any alcohol is not necessarily good for us. It just depends on the outcome you're looking at,
whether it's cognition or cancer. Do you have a particular thought when you talk
to your patients who are drinking, even if it is a moderate amount?
Rakel (12:30):
Absolutely. You mentioned the UK Biobank, which actually we're going to go over a little
summary of all the evidence from the UK Biobank that has come out. It's the largest number of
MRIs of any study. I think there are like eight hundred and some MRIs where they followed people
over time. This is in the United Kingdom, and they like to have their pints of beer in the
(12:54):
United Kingdom. The key was that the significant loss of gray matter volume really hit a tipping
point after about one pint of beer or eight grams of alcohol, which is about one mixed drink a day.
The mantra I like to tell people is, have a pint with your friends and then go home. You'll get
(13:18):
the social support from your friends and then have a little less alcohol. That is the tipping point
for atrophy of the brain. Remember, the American Cancer Association now, for cancer reduction—no
alcohol. That's the recommendation. For heart disease, a little is okay. Maybe for the brain,
who knows? Too much is actually concerning for increasing the gray matter loss of the brain.
Chin (13:45):
In addition to food, there is the timing of food. I know you'll speak to this on March 14th,
but what do you think of intermittent fasting or time-restricted eating,
however you want to phrase it?
Rakel (13:56):
Yeah, I think the more politically-correct term, as you mentioned, is time-restricted eating,
but it's the same thing as intermittent fasting. This is the oldest therapy known to humans. We've
been recommending fasting for thousands of years and now we have some good science to back it up.
(14:17):
The main thing for loss of brain matter is that when we fast, we stimulate ketogenesis,
which is really good for treating diabetes and helping maintain weight. That ketogenesis also
stimulates the brain neurotrophic factor, which is the protein that stimulates the growth of
(14:40):
the brain. Really promising evidence for calorie restriction, intermittent fasting, time-restricted
eating—the minimal amount. Also, this is easier than a ketogenic diet. It's easier to say, okay,
I need at least twelve hours of not eating to have a benefit. The ideal is sixteen hours,
(15:01):
but at least twelve hours—I can do that every night from 7pm to 7 am,
I cannot eat. The benefit there is the eating before bed, because if I eat a bunch before bed,
it goes right to storage because I'm just going to lie there for the next seven or eight hours.
We really reduce that eating in that downtime before bed. That’s a really important time
(15:24):
frame to avoid eating. Even better is if you can extend that to sixteen hours, and that's
where the evidence really shows benefit. You just reduce your eating time to eight hours in a day,
which people can do generally. If you want to take one day off a week to not do it, that's fine,
but the evidence seems to accumulate over time for time-restricted eating.
Chin (15:50):
What is the role of supplements? So when you're in the clinic, how do you
approach patients who either ask about them or you find that they're taking many of them?
Rakel (16:01):
Yeah, it's a challenge. I think where maybe this field of integrative medicine and
functional medicine has not really helped much is that, in Western medicine, we prescribe a
lot of drugs. In integrative and functional medicine, the supplement is the drug, and
(16:21):
it's not really helping us get to a better place together. That's why nutrition, I think, is so
important. If we're really eating well, we don't need many supplements. We also want to look at how
some of these nutrients might help with dementia or help reduce the risk of dementia. The key is:
why are we taking that supplement? What's the evidence behind it? Why do you feel it's helpful?
(16:46):
Let's take Prevagen, for example. I saw so many commercials for Prevagen, and I thought, "There
must be some science behind Prevagen." I did a PubMed search, and there's very little—almost
no evidence. What does the marketing do? It tells the power of a story. Even if there's
no science behind it, there's a market behind it. I almost feel bad saying this because
(17:11):
someone might be benefiting from Prevagen, and just me saying that there's no science
showing a benefit might actually reduce its effect. We have to really understand why
we're doing it. I think there are some key ones, like essential fatty acids. The brain uses DHA;
all fish oil is a combination of DHA and EPA. Breast milk is full of DHA because it's
(17:36):
structural. EPA is more functional. EPA reduces inflammation. We want both of those things for
brain health. We don't have really good data to say taking so much fish oil helps down the
road. There's other benefits of incorporating these essential fatty acids in regards to,
again, mixed evidence, but heart disease and other things. That's one that I won't take people off,
(18:01):
and maybe we are having a benefit at reducing inflammation and improving metabolic dysfunction.
There's a term that type three diabetes is now diabetes of the brain, and we're starting to
correlate how higher risk someone is for dementia when they have type two diabetes
(18:23):
because of this inflammation of the brain and how that can deteriorate that blood-brain barrier.
Keeping diabetes under good control is one of the best things that we can do. Blood pressure
management is one of the best things. If there are supplements that help us do that, great. I have
some people coming in with polypharmacy—I call it polysupplements—and, why are you taking that?
(18:47):
That's my main question. A lot of times, after we go through the list, we can often remove quite a
few and really focus more on the nutrition. People need hope. They need something that gives them
some control over the outcome of their health, and we want to stack the deck in that favor.
Chin (19:07):
I think that's a really good point too, though, that people want hope and they
want to try whatever they can. I always remind patients that supplements are not
FDA-regulated. You have to be careful of what you are putting in your body because
no one is really checking what's in that tablet or that capsule in a supplement.
Rakel (19:26):
I always follow—I get a little cynical as I get older—but always follow the money. The DSHEA
Act, the Dietary Supplements and Health Education Act, was supported by Warren Hatch, a senator out
of Utah, where the most supplement companies are in the world. All supplements can say,
(19:47):
"This supports immunity," but it can't say, "It treats pneumonia." With that DSHEA Act,
we don't really know what the ingredients are because we do have some stamps on the label,
like the GMP stamp–good manufacturing processes–mean that it was made in a factory that
(20:09):
says this is what it is, but it could be sawdust, and it could get the GMP stamp. It doesn't say
that this is flavonoids or fish oil. It says that what they say is in there is in there, and it was
made in a factory that has a good manufacturing process. Buyer beware with these things.
Chin (20:33):
How do you approach mental health? We know how important mental health is to
thinking ability, just the whole body, and specifically anxiety, depression and stress.
Rakel (20:43):
Yeah, we have this thing called pseudodementia. When people get really
anxious or stressed, it can actually mimic dementia because when our mind is multitasking
and we're stressed and we're depressed, it's hard to form new memory. We always want to treat that
first. That's also a really important piece of longevity and function of the brain. One of my
(21:07):
things I love to talk about is the science of perception and really how you see it makes it
matter. Let me break that down. How you see it makes it matter. Isn't it fascinating,
Nate, that a non-physical perception—I see something in my world, non-physical—it comes
through my perception, connects to all the wiring that's already in my brain, and that creates a
(21:32):
neuropeptide? Out of thin air, we develop a neuropeptide through our eyes that triggers
a whole cascade of events that can trigger improvement in immunity, cognitive function,
or worsening of all those things. How you see it matters and actually makes it matter. It takes all
(21:53):
this potential energy, and how I see it collapses it into a particle—a neuropeptide. Don't you feel
like you want to see things as more loving and optimistic and with gratitude rather than—I mean,
in this day and age, it's harder than ever. I have to take a "news holiday," which is
a good strategy. How do I fill my perception with positive things? The prosocial emotions
(22:22):
are gratitude, compassion and awe. It's hard to be focused on your own ego when you're in
those three states. How do we enhance that perception of those positive, non-egocentric
emotions to bring us closer together as a community? That all starts with how you see it,
(22:43):
and that's such an important thing to learn. The earlier we can teach that to our kids, the better.
Chin (22:50):
Well, that really fits into my next question,
which is the role of gratitude or optimism and even the sense of purpose. I think that
matters a great deal after a person retires. We see this, of course,
in the field of geriatrics. People can lose a sense of purpose. How do you approach
individuals with mental health questions or just stress in general? How do you incorporate that?
(23:12):
How do you explain to someone, well, we need to bring in more gratitude or optimism or purpose?
Rakel (23:18):
First thing, Nate, I think, is the questions we ask people. You mentioned going
into retirement, and when people lose that purpose, actually, their risk of premature
death goes up two and a half times when we don't have something to wake up in the morning to live
for. When we were asked to come into the VA, the largest health system in America–the Veterans
(23:40):
Health Association–and change the conversation from "What's wrong with you?" to "What's right
with you?" That alone—if I look at Nate and say, "Boy, Nate, you've got this tremendous ability.
You're dealing with this challenging condition, but how do we pull the health out of you as much
as possible?"—then I have to ask you a different question. The question that we asked was, "What
(24:03):
do you want your health for? Why do you want to be healthy?" Because health, generally, if we catch
it early enough, is much more about what we do than what we take. By far, the evidence is so much
more powerful for healthy behaviors rather than the Aricept that we use to treat the dementia once
it occurs. If we can really work as far upstream and really ask people, "Why do you want to eat
(24:27):
better? Why do you want to forgive your neighbor? Why do you want to go exercise your mind and your
body?" I'm not gonna be the one making those choices—you are. How do we create an environment
where you can be successful, and what do you need? It's really this whole salutogenic science is
really going into the patient's goals and not our goals. Often in Western healthcare, "You need what
(24:54):
I know," right? That's a dangerous projection that often people don't want to hear. How do
we get into that dialogue of "What do you need?" and "How can my expertise help you achieve it?"
Chin (25:05):
That's fascinating, Dave. To end today, I always like to ask a personal question. What's
the most important brain health practice you're engaging in right now? I recognize it can always
change depending on the time. What's one activity you're also working to improve?
Rakel (25:22):
I'll start with that latest one, what I want to grow. One of my favorite mantras,
Nate, is that to which you give attention grows. If I want to build up my bicep, I’ve got to do
the curls. I have two grandchildren, Leo, who is six months, and Willa, who's nineteen months now.
That's what I want to give attention to. It gives me joy. I see them do funny things that you do
(25:50):
and non-politically correct things they say, and it's so much fun just being with them. When we do
reminiscence therapy with people with depression, I love doing that! We go back into a time where
they really had meaningful memories, and it's usually in the distant past. I say, "Tell me
(26:10):
about that book you wrote when you were thirty," and they tell me about it and their recollection
is really good. If I develop dementia down the road, I want to make sure that I'm investing
in those things that are most meaningful to me. At this time in my life, they're my grandkids,
my kids, and my wife and everybody else as well. That's what I'm trying to do, and do all the other
(26:36):
things like exercise. I like to ride my bike. I grew up in Iowa. Meat and potatoes was everything
that we ate. After you start to actually change your nutrition, you start to crave it,
and it takes about six months. Just be patient with yourself, but you have to actually start
(27:00):
to choose those different foods. Anyways, thanks for asking. How about you, Nate? What do you do?
Chin (27:06):
I actually think sleep is incredibly important because it
allows me to do the other things, and I have two little ones. I don't get a lot of sleep,
so I put a lot of my attention into trying to create good sleep hygiene and wake up at the
right time and go to bed early enough. That's what I work on. Then, I like to exercise. It's
(27:27):
a good way of de-stressing for me. Thank you for asking, Dave. I appreciate that.
Rakel (27:32):
That sleep, that circadian rhythm, is so important. When your kids were young,
I bet even if you wanted to, you couldn't. (Laughs)
Chin (27:41):
Absolutely right. (Laughs) Well, with that, Dave, I'd like to thank you
for being on this podcast. For those listening, I'm really excited to have
you on March 14th on the Healthy Living with Mild Cognitive Impairment . For those listening,
if you want to hear more from Dr. Rakel about integrative medicine, how it can benefit brain
(28:01):
health, and the tools to encourage motivation on your personalized pathway to wellness,
please join us for the first Healthy Living with Mild Cognitive Impairment education program of
2025. This is a quarterly series. It will take place on Friday, March 14th, from 9:30 to 11:30
Central Time, both virtually over Zoom and we do have eight community host sites across Wisconsin.
(28:24):
Find out more details and information on how to register at adrc.wisc.edu/mci. Thanks again, Dave.
Rakel (28:33):
Thanks, Nate. I enjoyed talking with you.
Outro (28:36):
Thank you for listening to Dementia Matters. Follow us on Apple Podcasts,
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(28:57):
gift to the Dementia Matters Fund through the UW Initiative to End Alzheimer's. All donations go
toward outreach and production. Donate at the link in the description. Dementia Matters is
brought to you by the Wisconsin Alzheimer's Disease Research Center at the University
of Wisconsin-Madison. It receives funding from private, university, state and national sources,
(29:17):
including a grant from the National Institutes on Aging for Alzheimer's Disease Research. This
episode of Dementia Matters was produced by Amy Lambright Murphy and Caoilfhinn Rauwerdink and
edited by Eli Gadbury. Our musical jingle is Cases to Rest by Blue Dot Sessions. To learn
more about the Wisconsin Alzheimer's Disease Research Center, check out our website at
(29:37):
adrc.wisc.edu. That's adrc.wisc.edu and follow us on Facebook and Twitter. If you have any questions
or comments, email us at Dementia Matters at medicine.wisc.edu. Thanks for listening.
I'm Dr. Nathaniel Chin, and you're listening to Dementia Matters,
a podcast about Alzheimer's disease. Dementia Matters is a production of the Wisconsin
Alzheimer's Disease Research Center. Our goal is to educate listeners on the
latest news in Alzheimer's disease research and caregiver strategies. Thanks for joining us.
Dr. Nathaniel Chin (00:26):
Welcome back to Dementia Matters. Today, I'm joined by Dr. David Rakel,
professor and chair of the University of Wisconsin Department of Family Medicine
and Community Health. He's also the founder of the Osher Center for Integrative Health
at UW–Madison and a recipient of the Gold Foundation's Leonard Tow Humanism
in Medicine Award, the school's highest honor for excellence and compassion in care. Today,
(00:48):
Dr. Rakel will be talking about his work in integrative medicine,
as well as giving a preview of his upcoming talk for the Wisconsin ADRC's Healthy Living with Mild
Cognitive Impairment series happening on March 14, 2025. Dr. Rakel, welcome to Dementia Matters.
Dr. David Rakel (01:05):
Thank you, Nate. Good to be with you.
Chin (01:08):
To start, and I will let the audience know, I did get a sneak peek of your presentation, and
we're very excited to be having you on the series. What exactly is salutogenesis? You're going to
talk about it in the series. How does it relate to integrative care? What does it actually involve?
Rakel (01:26):
Yeah, thanks for asking. Integrative medicine initially came from the need to
incorporate other aspects of health and healing into traditional models of care. That was more
of an integration of the best science possible for the challenges that we're facing. It doesn't
really have a goal or an outcome towards it. What we want to do is use salutogenic science—salute,
(01:51):
health, genesis, origins of—to have that as our goal. If we have a population of people and we
have a salutogenic science, that science with inform how that population can be as healthy and
happy as possible and stay out of the hospital on the fewest number of medications needed to
(02:11):
maintain and honor the self-healing capacity of every living being, particularly humans,
is our main focus within dynamic environments in which we all live. Integrative medicine is
the integration of things like nutrition and acupuncture. Salutogenic science is the science
(02:32):
that brings us to a healthier place together, which is different than pathogenesis. Pathos,
to suffer. Genesis, the origins of suffering. Most of our medical education is in that, is disease
and suffering. That's not the outcome we want. We wanna be good at it. We wanna keep finding cures
for dementia and all the different causes of it. We need a better balance between the two. Right
(02:59):
now, we have about a 90 percent balance towards pathogenesis. I would say we need at least a 50-50
balance towards salutogenesis and pathogenesis. It's a tough word. It doesn't roll off the tongue,
but salute is health in Italian. Salud is healthy in Spanish. If I'm going to toast Nate,
(03:19):
I'm going to say “salud!” because to your health, Nate. I want you to be healthy.
Chin (03:24):
Okay. Thank you. That actually makes a lot more sense now, especially the way you ended it.
Frankly, you're just saying there's a balance. We need to be experts in living well, in health
promotion, as well as when disease occurs and how to handle pathogenesis. Frankly, pathogenesis
is a complicated word too. It's just that we've used it so often that it's become common to us.
Rakel (03:44):
Yes.
Chin (03:44):
You're introducing a very important word,
and hopefully it'll become more common to us as we go forward. You did mention integrative medicine,
and you've explained that. For our listeners, can you also explain how integrative medicine is
different and similar to other terms that people might hear in the community, like
alternative medicine and complementary medicine? How do they overlap, and how are they different?
Rakel (04:07):
Sure. I'll give you a little history lesson. The initial word that was used for
this was holistic medicine. I think that's a good word. It really shows how everything is
interconnected. Then there was complementary and alternative medicine, which is not a great word.
Complementary suggests that it doesn't stand on its own two feet, whereas if we're dealing with
(04:28):
metabolic syndrome, nutrition can stand very well. That at one time was considered complementary or
alternative therapy. Alternative is not a good word either because we don't want to replace
something that has good science with something else. We want to use both together. We want to
use the best science possible. I always quote Sir William Osler. He said, this is an art based in
(04:51):
science. The art comes from going into the context of unique human beings. What guides our choices is
that relationship with that other human being. Then science guides the best
therapy possible based on the dialogue, which means running through two people,
(05:13):
that information and context is guided by science, but it's really that relationship and the unique
aspect of that human being. CAM has kind of gone out of favor, and then integrative medicine came
in. Now there's functional medicine. Functional medicine talks about getting at the root cause
at the very early onset of disease and how do we bypass that or reverse it. Really,
(05:39):
I think where this is going is salutogenic science or really how complex systems heal;
health and healing. That's really the goal that we want. It's a different financial goal. This
is where value-based care comes, where we get paid to keep people out of the hospital
instead of just being paid to treat people in the hospital. It's a balance. We want both.
We want the best specialists possible for when people need them. We also need primary care,
(06:06):
interprofessionals working together in communities to keep people healthy so they need less things.
Chin (06:12):
With that in mind, how can integrative medicine help people
who are experiencing memory changes or for those who have crossed that
threshold and now they have a diagnosis of mild cognitive impairment or dementia?
Rakel (06:25):
This is a lot of what we'll talk about on the 14th,
I think it is. We wish we had a silver bullet for dementia. We don't. What works best now in
2025 is silver buckshot. We need to use multiple synergistic therapies together
to have the biggest impact. That's where this integrative salutogenic approach goes. How do
(06:51):
we stack the deck in favor of the best possible outcome? Ideally, that would be prevention. Next,
it's how can we maybe reverse the disease if possible? Then next, how do we reduce the
speed of progression? Then how do we enhance quality of life? That's always the goal.
Chin (07:09):
What is your approach to nutrition and dementia risk? I start with this, of course,
because of this investment in salutogenesis. I think food is really, really important,
as our listeners know. In your answer, I'm hoping you can cover some about alcohol,
ultra-processed foods, even a little bit about red meat, and my personal favorite,
(07:31):
or at least I should say what I ask my patients to get rid of, soda.
Rakel (07:35):
Soda. Yeah. Good. We could spend hours on all of those. Let me just simplify it as much as
possible. You can avoid reading all the nutrition books of the world with this. It's a paraphrase
off of Michael Pollan. Eat multicolored whole foods that were recently alive with people you
(07:55):
love. Why do I say that? Multicolored whole foods—we have a multivitamin, and it's called
plants. The different-colored plants give us the nutrients that we need to be healthy. That has
fiber. Fiber slows down the absorption of sugar and establishes a healthy environment for our
microbiome. Then eat with people we love. We digest food when we're more relaxed. When we
(08:21):
stress eat, that increases the sympathetic tone and actually shunts blood away from our digestive
system. Then we have the social support with that. There are so many things around that that help.
If we just look at the evidence, there's been grade A, top-tier level evidence showing that
a plant-forward Mediterranean-DASH type diet—those two combined are considered the MIND diet—where we
(08:47):
take the benefits of a low-salt DASH diet that lowers blood pressure and a Mediterranean diet
that's rich in fiber, whole grains, plants, fish, olive oil. It's low in the three most inflammatory
foods, which are excess sugar, red meat and excessive dairy. Then I'll add processed foods
(09:09):
in there. Processed meat is probably the worst, but let's go to soda because there's a whole
array of concerns with non-nutritive sweeteners, which soda often has. Let's put the high-sugar
soda over there, but I will give you this data point. Most naturally sweetened sodas have
(09:29):
35 grams of added sugar. One teaspoon equals five grams. That's seven teaspoons of sugar in
one soda that's naturally sweetened. Now let's look at some of the science that's evolving for
non-nutritive sweeteners. Aspartame, for example, actually breaks down the blood-brain barrier. We
(09:51):
really need that part of our brain to work well to separate the blood system from the brain system.
Aspartame gets converted to formaldehyde, and formaldehyde starts to deteriorate that really
important barrier between our blood and our brain. We're also learning that a lot of these
(10:13):
non-nutritive sweeteners have erythritol in them. Erythritol increases thrombotic
risk and increases the risk of stroke. We'll share some research at our conference about
the higher risk of stroke and degenerative brain disease with a lot of heavy use. I'm
(10:34):
going to say this—heavy use, not light use, but heavy use of non-nutritive sweeteners. These
are being put in all aspects of our nutrition now, not only sodas but also processed foods.
Chin (10:49):
Well, in your answer, you were very careful to use the word excessive—excessive red meat,
excessive certain foods. Are you implying, though, that—and
this is really what the MIND diet does say to some degree—one serving a week of red meat is
okay. It's okay to have some, just not a lot? Is that what you're saying as well?
Rakel (11:11):
Yes, very much so. Moderation is the key. I love to have a really good steak once in a while,
but I don't have one even three times a week.That's probably too much. Then the
processed meat. Processed meats are injected with nitrosamines. Nitrosamines–nitrates–dilate
(11:33):
our blood vessels, but amines, when we combine amines with nitrous, it's oncogenic,
and it significantly increases the risk of many cancers. The reason we inject processed
meats with nitrates is that they dilate the blood vessels, so you retain more hemoglobin,
so it maintains a little pink color when we eat it. It doesn't look like the cadavers that
(11:54):
we had in medical school. It's just not very appetizing. There are a lot of these chemicals
that are injected into processed foods that we're learning have a lot of danger to them.
Chin (12:06):
I'm not expecting you to give us a long answer on this,
but the field in alcohol use is really evolving, especially coming from the UK Biobank, showing
that any alcohol is not necessarily good for us. It just depends on the outcome you're looking at,
whether it's cognition or cancer. Do you have a particular thought when you talk
to your patients who are drinking, even if it is a moderate amount?
Rakel (12:30):
Absolutely. You mentioned the UK Biobank, which actually we're going to go over a little
summary of all the evidence from the UK Biobank that has come out. It's the largest number of
MRIs of any study. I think there are like eight hundred and some MRIs where they followed people
over time. This is in the United Kingdom, and they like to have their pints of beer in the
(12:54):
United Kingdom. The key was that the significant loss of gray matter volume really hit a tipping
point after about one pint of beer or eight grams of alcohol, which is about one mixed drink a day.
The mantra I like to tell people is, have a pint with your friends and then go home. You'll get
(13:18):
the social support from your friends and then have a little less alcohol. That is the tipping point
for atrophy of the brain. Remember, the American Cancer Association now, for cancer reduction—no
alcohol. That's the recommendation. For heart disease, a little is okay. Maybe for the brain,
who knows? Too much is actually concerning for increasing the gray matter loss of the brain.
Chin (13:45):
In addition to food, there is the timing of food. I know you'll speak to this on March 14th,
but what do you think of intermittent fasting or time-restricted eating,
however you want to phrase it?
Rakel (13:56):
Yeah, I think the more politically-correct term, as you mentioned, is time-restricted eating,
but it's the same thing as intermittent fasting. This is the oldest therapy known to humans. We've
been recommending fasting for thousands of years and now we have some good science to back it up.
(14:17):
The main thing for loss of brain matter is that when we fast, we stimulate ketogenesis,
which is really good for treating diabetes and helping maintain weight. That ketogenesis also
stimulates the brain neurotrophic factor, which is the protein that stimulates the growth of
(14:40):
the brain. Really promising evidence for calorie restriction, intermittent fasting, time-restricted
eating—the minimal amount. Also, this is easier than a ketogenic diet. It's easier to say, okay,
I need at least twelve hours of not eating to have a benefit. The ideal is sixteen hours,
(15:01):
but at least twelve hours—I can do that every night from 7pm to 7 am,
I cannot eat. The benefit there is the eating before bed, because if I eat a bunch before bed,
it goes right to storage because I'm just going to lie there for the next seven or eight hours.
We really reduce that eating in that downtime before bed. That’s a really important time
(15:24):
frame to avoid eating. Even better is if you can extend that to sixteen hours, and that's
where the evidence really shows benefit. You just reduce your eating time to eight hours in a day,
which people can do generally. If you want to take one day off a week to not do it, that's fine,
but the evidence seems to accumulate over time for time-restricted eating.
Chin (15:50):
What is the role of supplements? So when you're in the clinic, how do you
approach patients who either ask about them or you find that they're taking many of them?
Rakel (16:01):
Yeah, it's a challenge. I think where maybe this field of integrative medicine and
functional medicine has not really helped much is that, in Western medicine, we prescribe a
lot of drugs. In integrative and functional medicine, the supplement is the drug, and
(16:21):
it's not really helping us get to a better place together. That's why nutrition, I think, is so
important. If we're really eating well, we don't need many supplements. We also want to look at how
some of these nutrients might help with dementia or help reduce the risk of dementia. The key is:
why are we taking that supplement? What's the evidence behind it? Why do you feel it's helpful?
(16:46):
Let's take Prevagen, for example. I saw so many commercials for Prevagen, and I thought, "There
must be some science behind Prevagen." I did a PubMed search, and there's very little—almost
no evidence. What does the marketing do? It tells the power of a story. Even if there's
no science behind it, there's a market behind it. I almost feel bad saying this because
(17:11):
someone might be benefiting from Prevagen, and just me saying that there's no science
showing a benefit might actually reduce its effect. We have to really understand why
we're doing it. I think there are some key ones, like essential fatty acids. The brain uses DHA;
all fish oil is a combination of DHA and EPA. Breast milk is full of DHA because it's
(17:36):
structural. EPA is more functional. EPA reduces inflammation. We want both of those things for
brain health. We don't have really good data to say taking so much fish oil helps down the
road. There's other benefits of incorporating these essential fatty acids in regards to,
again, mixed evidence, but heart disease and other things. That's one that I won't take people off,
(18:01):
and maybe we are having a benefit at reducing inflammation and improving metabolic dysfunction.
There's a term that type three diabetes is now diabetes of the brain, and we're starting to
correlate how higher risk someone is for dementia when they have type two diabetes
(18:23):
because of this inflammation of the brain and how that can deteriorate that blood-brain barrier.
Keeping diabetes under good control is one of the best things that we can do. Blood pressure
management is one of the best things. If there are supplements that help us do that, great. I have
some people coming in with polypharmacy—I call it polysupplements—and, why are you taking that?
(18:47):
That's my main question. A lot of times, after we go through the list, we can often remove quite a
few and really focus more on the nutrition. People need hope. They need something that gives them
some control over the outcome of their health, and we want to stack the deck in that favor.
Chin (19:07):
I think that's a really good point too, though, that people want hope and they
want to try whatever they can. I always remind patients that supplements are not
FDA-regulated. You have to be careful of what you are putting in your body because
no one is really checking what's in that tablet or that capsule in a supplement.
Rakel (19:26):
I always follow—I get a little cynical as I get older—but always follow the money. The DSHEA
Act, the Dietary Supplements and Health Education Act, was supported by Warren Hatch, a senator out
of Utah, where the most supplement companies are in the world. All supplements can say,
(19:47):
"This supports immunity," but it can't say, "It treats pneumonia." With that DSHEA Act,
we don't really know what the ingredients are because we do have some stamps on the label,
like the GMP stamp–good manufacturing processes–mean that it was made in a factory that
(20:09):
says this is what it is, but it could be sawdust, and it could get the GMP stamp. It doesn't say
that this is flavonoids or fish oil. It says that what they say is in there is in there, and it was
made in a factory that has a good manufacturing process. Buyer beware with these things.
Chin (20:33):
How do you approach mental health? We know how important mental health is to
thinking ability, just the whole body, and specifically anxiety, depression and stress.
Rakel (20:43):
Yeah, we have this thing called pseudodementia. When people get really
anxious or stressed, it can actually mimic dementia because when our mind is multitasking
and we're stressed and we're depressed, it's hard to form new memory. We always want to treat that
first. That's also a really important piece of longevity and function of the brain. One of my
(21:07):
things I love to talk about is the science of perception and really how you see it makes it
matter. Let me break that down. How you see it makes it matter. Isn't it fascinating,
Nate, that a non-physical perception—I see something in my world, non-physical—it comes
through my perception, connects to all the wiring that's already in my brain, and that creates a
(21:32):
neuropeptide? Out of thin air, we develop a neuropeptide through our eyes that triggers
a whole cascade of events that can trigger improvement in immunity, cognitive function,
or worsening of all those things. How you see it matters and actually makes it matter. It takes all
(21:53):
this potential energy, and how I see it collapses it into a particle—a neuropeptide. Don't you feel
like you want to see things as more loving and optimistic and with gratitude rather than—I mean,
in this day and age, it's harder than ever. I have to take a "news holiday," which is
a good strategy. How do I fill my perception with positive things? The prosocial emotions
(22:22):
are gratitude, compassion and awe. It's hard to be focused on your own ego when you're in
those three states. How do we enhance that perception of those positive, non-egocentric
emotions to bring us closer together as a community? That all starts with how you see it,
(22:43):
and that's such an important thing to learn. The earlier we can teach that to our kids, the better.
Chin (22:50):
Well, that really fits into my next question,
which is the role of gratitude or optimism and even the sense of purpose. I think that
matters a great deal after a person retires. We see this, of course,
in the field of geriatrics. People can lose a sense of purpose. How do you approach
individuals with mental health questions or just stress in general? How do you incorporate that?
(23:12):
How do you explain to someone, well, we need to bring in more gratitude or optimism or purpose?
Rakel (23:18):
First thing, Nate, I think, is the questions we ask people. You mentioned going
into retirement, and when people lose that purpose, actually, their risk of premature
death goes up two and a half times when we don't have something to wake up in the morning to live
for. When we were asked to come into the VA, the largest health system in America–the Veterans
(23:40):
Health Association–and change the conversation from "What's wrong with you?" to "What's right
with you?" That alone—if I look at Nate and say, "Boy, Nate, you've got this tremendous ability.
You're dealing with this challenging condition, but how do we pull the health out of you as much
as possible?"—then I have to ask you a different question. The question that we asked was, "What
(24:03):
do you want your health for? Why do you want to be healthy?" Because health, generally, if we catch
it early enough, is much more about what we do than what we take. By far, the evidence is so much
more powerful for healthy behaviors rather than the Aricept that we use to treat the dementia once
it occurs. If we can really work as far upstream and really ask people, "Why do you want to eat
(24:27):
better? Why do you want to forgive your neighbor? Why do you want to go exercise your mind and your
body?" I'm not gonna be the one making those choices—you are. How do we create an environment
where you can be successful, and what do you need? It's really this whole salutogenic science is
really going into the patient's goals and not our goals. Often in Western healthcare, "You need what
(24:54):
I know," right? That's a dangerous projection that often people don't want to hear. How do
we get into that dialogue of "What do you need?" and "How can my expertise help you achieve it?"
Chin (25:05):
That's fascinating, Dave. To end today, I always like to ask a personal question. What's
the most important brain health practice you're engaging in right now? I recognize it can always
change depending on the time. What's one activity you're also working to improve?
Rakel (25:22):
I'll start with that latest one, what I want to grow. One of my favorite mantras,
Nate, is that to which you give attention grows. If I want to build up my bicep, I’ve got to do
the curls. I have two grandchildren, Leo, who is six months, and Willa, who's nineteen months now.
That's what I want to give attention to. It gives me joy. I see them do funny things that you do
(25:50):
and non-politically correct things they say, and it's so much fun just being with them. When we do
reminiscence therapy with people with depression, I love doing that! We go back into a time where
they really had meaningful memories, and it's usually in the distant past. I say, "Tell me
(26:10):
about that book you wrote when you were thirty," and they tell me about it and their recollection
is really good. If I develop dementia down the road, I want to make sure that I'm investing
in those things that are most meaningful to me. At this time in my life, they're my grandkids,
my kids, and my wife and everybody else as well. That's what I'm trying to do, and do all the other
(26:36):
things like exercise. I like to ride my bike. I grew up in Iowa. Meat and potatoes was everything
that we ate. After you start to actually change your nutrition, you start to crave it,
and it takes about six months. Just be patient with yourself, but you have to actually start
(27:00):
to choose those different foods. Anyways, thanks for asking. How about you, Nate? What do you do?
Chin (27:06):
I actually think sleep is incredibly important because it
allows me to do the other things, and I have two little ones. I don't get a lot of sleep,
so I put a lot of my attention into trying to create good sleep hygiene and wake up at the
right time and go to bed early enough. That's what I work on. Then, I like to exercise. It's
(27:27):
a good way of de-stressing for me. Thank you for asking, Dave. I appreciate that.
Rakel (27:32):
That sleep, that circadian rhythm, is so important. When your kids were young,
I bet even if you wanted to, you couldn't. (Laughs)
Chin (27:41):
Absolutely right. (Laughs) Well, with that, Dave, I'd like to thank you
for being on this podcast. For those listening, I'm really excited to have
you on March 14th on the Healthy Living with Mild Cognitive Impairment . For those listening,
if you want to hear more from Dr. Rakel about integrative medicine, how it can benefit brain
(28:01):
health, and the tools to encourage motivation on your personalized pathway to wellness,
please join us for the first Healthy Living with Mild Cognitive Impairment education program of
2025. This is a quarterly series. It will take place on Friday, March 14th, from 9:30 to 11:30
Central Time, both virtually over Zoom and we do have eight community host sites across Wisconsin.
(28:24):
Find out more details and information on how to register at adrc.wisc.edu/mci. Thanks again, Dave.
Rakel (28:33):
Thanks, Nate. I enjoyed talking with you.
Outro (28:36):
Thank you for listening to Dementia Matters. Follow us on Apple Podcasts,
Spotify or wherever you listen. Or tell your smart speaker to play the Dementia Matters
podcast. Please rate us on your favorite podcast app. It helps other people find our show and lets
us know how we're doing. If you enjoy our show and want to support our work, consider making a
(28:57):
gift to the Dementia Matters Fund through the UW Initiative to End Alzheimer's. All donations go
toward outreach and production. Donate at the link in the description. Dementia Matters is
brought to you by the Wisconsin Alzheimer's Disease Research Center at the University
of Wisconsin-Madison. It receives funding from private, university, state and national sources,
(29:17):
including a grant from the National Institutes on Aging for Alzheimer's Disease Research. This
episode of Dementia Matters was produced by Amy Lambright Murphy and Caoilfhinn Rauwerdink and
edited by Eli Gadbury. Our musical jingle is Cases to Rest by Blue Dot Sessions. To learn
more about the Wisconsin Alzheimer's Disease Research Center, check out our website at
(29:37):
adrc.wisc.edu. That's adrc.wisc.edu and follow us on Facebook and Twitter. If you have any questions
or comments, email us at Dementia Matters at medicine.wisc.edu. Thanks for listening.
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