How to Age-Proof Your Brain and Stay Sharp for Life - with Dr. Majid Fotuhi - The Daria Hamrah Podcast

Episode Transcript
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Speaker 3 (00:02):
By the time you're 65, about 1 in 10 people already
has dementia.
By the time you're in your late70s, that's closer to 1 in 5.
And by 85 and older, up to 1 in3 of us will have dementia due
to Alzheimer's disease.
Those aren't abstract numbers,that's your parent, your

(00:25):
partner, or even you.

Now add this (00:26):
chronic stress has been shown to shrink the
hippocampus, a part of yourbrain that lets you learn and
form new memories.
More and more scientistsdescribe Alzheimer's as a form
of type 3 diabetes in the brain,driven in part by insulin
resistance and decades of sugarspikes and just poor diet.

(00:49):
And yet, my guest today hasdata showing that in just 12
weeks, many of these patientswith early cognitive problems
not only improve their memoryand focus, some actually grow
their hippocampus by about 3%.
That's like making part of thebrain about 3 years younger in 3

(01:10):
months.
So the uncomfortable questionis this Are we quietly
engineering our own futuredementia with our stress, sleep,
and poor nutrition?
Or could we in 12 weeks startto reverse early brain decline?
Today we're going to push intothat questions with someone

(01:31):
who's spent his career on thefront lines of dementia and
Alzheimer's.
So, welcome back to the show.
I'm your host, Dr.
Daria Hamrah.
Today I'm joined by my verygood friend and colleague, Dr.
Majid Fotuhi, MD PhD, who's aworld-renowned neurologist and
neuroscientist right around thecorner for me.
He earned his PhD inneuroscience from Johns Hopkins

(01:54):
University and his medicaldegree from Harvard Medical
School.
And he's now adjunct professorat the Mind Brain Institute at
Johns Hopkins University.
He also teaches at GeorgeWashington University and
Harvard Medical School.
Over the past three decades, hehas pioneered multidisciplinary
brain fitness program thatcombines a comprehensive brain

(02:18):
portfolio assessment with 12bi-weekly sessions focused on
lifestyle optimization andcognitive training.
His work shows measurablebenefits in patients with memory
loss due to aging, concussions,ADHD, and early Alzheimer's.
He is the author of severalbooks, including The Upcoming

(02:39):
The Invincible Brain, theClinically Proven Plan to
Age-proof Your Brain and StaySharp for Life, endorsed by
people like Sanjay Gupta, DavidPerlmutter, and Michael Roizen.
Dr.
Futui, welcome back.
Welcome back to the podcast.
It's great to have you hereagain.

(03:01):
I think the last time we talkedwas, I don't know, it was two
or three years ago, I believe,and a lot has happened for both
of us during that time.
So I want to start right at thedeep end with you.
So based on everything you'veseen in your research and in
your clinic, how much ofdementia we're seeing today do

(03:22):
you believe is actuallypreventable?
Not in theory, but in realpeople with real lives.

Speaker 1 (03:30):
First of all, thank you very much for having me on
your podcast.
I really appreciate it.
It's always a pleasure to talkwith you.
Of course.
I think it's hard to put anumber on exactly what
percentage can be prevented.
It has a lot to do withpeople's lifestyle choices and
daily habits.
But in my opinion, only 5% oflate-life Alzheimer disease is

(03:54):
genetic.
In other words, only 5% ofpeople can develop it no matter
what.
95% of people have a soup ofdifferent problems in their
brain that has resulted in theircognitive decline, and many of
those are reversible andtreatable.
So in my book, I talk abouthow, as you said, dietary

(04:16):
factors and stress and sleep caneach chew away on parts of the
brain that are important formemory and cognitive functions.
The cortex, which is the outerlayer of the brain, and the
hippocampus, which is a pair ofstructures the size of your
thumb on either side of thebrain.
These two structures can shrinkor grow with your lifestyle
choices.

(04:37):
So I think that, you know,about up to 95% can be
prevented.
And the sooner you start, thesooner you can see results.
In my practice, 80% of ourpatients who were in their 70s
improved their brain function.
And these were people who hadmild cognitive impairment.

Speaker 3 (04:59):
How do you, for people here listening, they
don't understand what mild uhcognitive impairment is?
In layman's terms, like if I'mthinking, I'm thinking like
that.
Mildly compromised, like howwhat does that exactly mean for
the regular person?

Speaker 1 (05:13):
Mile cognitive impairment is a condition
between normal aging andAlzheimer's disease.
Someone with my cognitiveimpairment may repeat himself or
herself several times duringthe day.
They may have changes in theirpersonality or their ability to
do things, but they remain theyremain independent and they they

(05:37):
function at the baseline.

Speaker 3 (05:38):
So that's not when I get out of the house and I
realize I forgot my keys, orthat's not cognitive impairment.

Speaker 1 (05:46):
No.
That's called age-associatedmemory impairment.
Age associated memoryimprovement.
Those kind of things are a partof life and they happen and
they don't necessarily meananything.
But when somebody asks, whatare we doing for this, what are
we doing this evening?
and say, let's say the spousesays we're going to do dinner at

(06:09):
a restaurant, and an hourlater, what are we doing today?
Or are you going to arestaurant this morning?
Same questions.
And then an hour later, honey,what are we doing this evening?
And they have no recollectionof having that conversation at
all.
But the same person may bestill buying and selling stocks,
getting together with friends,travels, cooks, does everything

(06:32):
else.
It's just that the memory orsome or some brain functions
have declined.
But the person remainsindependent.
That's the main distinction.
So that's what you call themild cognitive impairment.
That's what Once you loseindependence, once you can't do
the things you used to do,that's the cutoff that we call

(06:52):
dementia.
And as you said, the mostcommon form of dementia is
Alzheimer's disease.

Speaker 3 (06:57):
And so give me an example for that.
So we know that you don'tremember the question you asked
an hour ago.
What's a step further thanYeah.

Speaker 1 (07:05):
So let's say the person we're just talking about,
let's say he keeps asking thesame questions, and then one day
he's coming home and he getslost driving to their own home.
That's a red flag.
That is when it's not normal.
It's not, you know, Malcog andPayment usually called MCI.
That's when it's not MCIanymore.

(07:27):
If you get lost driving in yourown neighborhood, that's it.
And it happens a lot.
You know, somebody goes andthen they take the wrong turn.
Oh, yeah.
Some more totally different.
They stop in a gas station,they call the spouse, and she
says, Where are you?
I don't know.
And how do you get there?
I don't know.
Tell me what's around you.

(07:48):
And they say something istotally off.
And that's unfortunatelysomething that happens
gradually.
You know, a person may not besure if it's a left turn or a
right turn here and there, butstill get home.
As long as they get home,technically, they have not lost
their independence.
They have they're able tofunction independently.
They can drive to where they'resupposed to go.

(08:10):
So that's Alzheimer's?
When they cut off, when theyget when they cross that line
where they get lost in their ownneighborhood, or you know, if
they forget names of daughter orhusband or family members,
that's what we call theAlzheimer's disease.
Now, but different forms ofdementia, you know, we can have

(08:32):
vascular dementia,frontotemporal dementia, luri
dementia, you know, there arewhole different forms of
dementia.
But Alzheimer's is the mostcommon form of dementia.
And so these days, Alzheimer'sdisease is almost used
synonymously with dementia ingeneral.

Speaker 3 (08:50):
So when we look at the numbers now, one in 10
people over the age of 65, andone in three over age of 85,
based on some statistics that Ilooked up, with Alzheimer's
dementia, basically haveAlzheimer's dementia, you know,
so that's pretty sobering.
Like after the age of 85, itseems like to me that's the

(09:14):
biggest crutch during aging.
So if we take those statisticsnow seriously, what percentage
of those cases, in your opinion,didn't have to happen if we had
aggressively addressed thingslike lifestyle and or vascular
risk earlier in life?
Are we talking like 10%, 30%,50%, or more?

Speaker 1 (09:37):
I think only I think to be fair, once you get to your
90s, I think there's somegenetic things that happen in
people's brains because at somepoint we all die.
I mean, it's not like if youeat healthy and you exercise,
you never die.
Eventually, as much as you doeverything, there are genes and

(09:58):
say, okay, time to go, and theykick in.
And when they kick in a fewyears before it, the brain is
the first organ to show that weare closing shop.
So I think 90s is when, youknow, I think the genetic makeup
says it's time to go.

(10:20):
And the brain is the firstorgan to show that process.
But I think up to 80s, late80s, I think people can stay
functional and and sharp.
And I think I think peopleusually don't have to just
decline, decline, decline,decline, decline.
They can just live a full lifeand just die.

(10:40):
And so I think I honestly thinkthat up to 80s, only 5% of
people would develop dementia nomatter what.
Let me give you put things inperspective for you.
Let's say it's 1940s, and we doa survey, and we find out that
60% of people smoke.

(11:01):
Just because 60% of peoplesmoke, it doesn't mean that's
normal.
That just happens to be thesociety at that stage.
Once upon a time, the averageage expectancy was 50s, 60s,
even early 1900s.
I mean, Dr.
Allois Alzheimer's died at ageof 53 himself because there were

(11:23):
no antibiotics and you knowinfections.
So just because something ishappening commonly, it doesn't
mean it's normal or it shouldhappen that way.
And let me give you some realexciting news, are you?
It turns out that in WesternEuropean countries and in parts

(11:44):
of USA, the incidence ofdementia is declining.
So you understand that youknow, as more and more are
living older, older, you shouldhave more higher rates.
You should even if it's if theif the if it happens at the same
rate, yeah, then at leastincidence should stay the same
because you have more people.

(12:04):
But the incidence is actuallygoing down because in Western
European countries like Sweden,Netherlands, more and more
people are doing the things wetalk about.
They eat better, they exercise,you know, many of them quit
smoking.
And and so the incident ofdementia has gone down by 20% in

(12:27):
a decade.
And in Framingham study, theyshowed that the incident of
dementia has gone down 13%.
Here's another really excitingstudy.
This is really exciting.
So researchers have beenfollowing a large portion of the
population in Framingham, whichis a city outside Boston, small

(12:48):
town.
And is that the famousFramingham study that you're
referring to?
Framingham study, yeah.
And so researchers have a lotof information about these

people (12:57):
their blood pressure, their obesity, yeah, cognitive
functions, MRIs.
And one of my colleaguesdecided to just look at the MRIs
of people at each decade oflife.
People born in the 1930s, 40s,50s, 60s, and 70s.
It's very easy because they allhave MRIs that make it so easy.

(13:18):
You just put them incategories.
But guess what?
They found that with eachdecade of each each decade that
has passed, people in thatvillage, a small town, have
bigger cortex and hippocampuseach decade.
Each decade, the brain, theparts of the brain that usually
shrinks with aging has grown.

(13:39):
Compared to the So, forexample, people born in the
1960s have a bigger brain thanpeople who are born in the
1950s, 1940s, and 1930s.
And it's a linear up.
So that growth, what does thatindicate?
Which part of the brain hasgrown all day?
So the cortex and hippocampusare the most important parts of

(14:00):
the brain for cognitivefunctions.
These parts of the brainusually shrink by about 1% per
year at age 50.
So the usual thing is that thebrain, on average, and this is a
very important thing, onaverage, the cortex and
epicampus decline by 1% peryear.
So these people, thesegeneration after generation,

(14:25):
have not experienced as muchatrophy.
And so on average, on average,the brain has the brain size,
the cortex of the campus, eachyear has been slightly larger.
And I'm curious to look at theresults from the next 10 years.
So what have they done toachieve that result?
I think more and more peopleare realizing that early

(14:46):
childhood education isimportant.
More and more people havestopped smoking.

Speaker 3 (14:51):
So these this group of the Framingham study, they
weren't giving any particularlifestyle recommendation.
They just follow them and theylet them do whatever they do and
then just follow them to seewhat's happening.

Speaker 1 (15:24):
You see more and more people in the 70s and 80s who
go for a drug in ourneighborhood.
And you know, I did thetriathlon several times in a
row.
And here I was hopping andpuffing in my 60s, trying to
finish, get to the finish line,and some lady who clearly was in
her 80s passed me.
And I was like, come on, man,I'll be doing that.

Speaker 3 (15:45):
Oh my God.
And I realized this- Don'tdon't tell that, don't go and
tell that story to people.

Speaker 1 (15:50):
No, I happen to be her when I get up to my 80s.
So I think that cognitivedecline with aging is absolutely
preventable.
And you know, I have hadpatients who have done all the
right things.
Like I had a handful ofpatients.
Well, you said 5% are genetic,right?
Exactly.
So, for example, I had apatient who was a wonderful

(16:12):
lawyer, had been a successfullawyer, exercised, age right,
very nice, in good shape, noobesity, nothing.
Everything, good, everythingabout him was.
How about stress?
I mean, lawyer and stress.
Yeah, some stress.
But for the most part, he hehad done things right.
And uh he did have a familyhistory as well.

(16:33):
So, but you know, he is such aminority of my patients that I
vividly remember him.
Everybody else would improve.
And he actually remainedstable.
He he did our program, and hehad he he had, you know, we do
the mocha scoring, the cognitivescoring, his his mocha score,

(16:54):
the cognitive testing score hadremained the same.
And he I told him, you know,you've done the program for 12
weeks, our program is only threemonths, you you know, you
cannot do things on your own.
But he liked coming to ourbrain center, so he used to come
regularly.
Uh and so he continued theprogram like three months, six
months.
And I think he actuallybenefited from it because

(17:16):
cognitive function, he wassomeone who would have declined
much faster if he had not donethe intensive brain training and
everything else with it.
But everybody else, all myother patients, improved.
It was really rare thatsomebody did not have an
improvement in the cognitivefunctions, and these are people
60s and 70s, and some in their80s.
So I think I think our attitudetoward cognitive test um I

(17:41):
think that our attitude towardaging and cognitive decline
needs to change.
We have to realize just as Whatis it now?
What is our attitude now?
I think the general attitudewith aging is that everything is
downhill.
Your body fails, your brainfails, and you just fade away
and you die.
But we know for a fact thatpeople can improve their

(18:04):
physical health as they getolder.
We know that, for example, wecan get someone in their 50s and
60s who's totally out of shapeand work with them for three to
six months and they will belooking great.
And as long as they maintain,you know, all the
recommendations for good healthand exercise regularly, they
will stay in good health.
Many of my friends, whenthey're 70s, go to the gym, they

(18:26):
do weight lifting, they theyplay pickleball, they do
everything.
And you know, in old days,somebody in their 70s was
supposed to just sit home, reada newspaper, do crosswork
puzzles, maybe, sit by the pool.
And they didn't expect a personto, you know, be active in
sports or be active in in lifein general.

(18:49):
They were supposed to just slowdown.
I think our attitude towardaging needs to change, and we
need to believe that we canindeed improve our brain
functions from our 50s to our60s.
Our brain has a great degree ofplasticity, and it is possible
to improve functions.
We need to change our mindsetand get it.

Speaker 3 (19:10):
I want to I want to zoom into the the boldest part
of your work because that's whyI want to literally pick your
brain, no pun intended.
Because it honestly soundsalmost too good to be true at
first glance when we hear it,because of what you said, that
traditionally how we think ofdementia cognitive decline in

(19:30):
the context of aging, it'salmost like people say, Well,
it's kind of like a downhillbattle.
I'm not gonna fight it, I'mjust gonna make the best out of
it.
Hopefully, I doubt I'll diesoon enough so I don't have to
worry and be a burden on myfamily, which is pretty grim and
depressing a way to go aboutthe last decades of your life.

(19:52):
So, my question is what exactlyhappens in those 12 weeks?
And in which types of patientscan you truly say that you
reversed early decline if youcan talk about reversing decline
as opposed to just slowing it?
For example, in the case of thelawyer friend of yours.

(20:12):
And so can you kind of uhexplain that a little bit so for
the audience?

Speaker 1 (20:18):
So uh super problems contribute to cognitive decline
with aging.
Things like obesity, diabetes,sedentary lifestyle, smoking,
too much stress, insomnia, allof these things uh shrink the
brain by a little bit, maybe say5%, 7%, depending on the

(20:40):
severity.
Obviously, if you have severesleep apnea, your brain shrinks
a lot more than if you have mildsleep apnea.
And why is that?
Is it due to lack of oxygen orso for each of the main risk
factors, there's you know, acommon cause is reduced blood
flow and inflammation.
In the case of sleep apnea,there is hypoxia that happens

(21:04):
during the night.
So reduced oxygen, which fallsmultiple times every hour, maybe
40, 50, 60 times an hour, youget to a point of being drowned
and you come back up.
So no wonder when you wake upin the morning you feel tired
and worn out.
So there is hypoxia to thebrain, there is inflammation,

(21:25):
that definitely cytokine levelsare higher, and there's
increased inflammation in thebrain, but it's also
hypercoagulability.
When people have sleep apnea,the blood clot, the blood
becomes more prone to clotting.
And the combination of thesethings contribute to possibility
of strokes and vascular diseasein the brain.

(21:47):
So of the factors I told you,sleep apnea, infnea, stress,
obesity, diabetes, entrylifestyle, all of these things
chip away in the brain, most ofthem through reduced blood flow
and increased level ofinflammation, reduced
mitochondrial function, whichwe'll talk about in a minute.
And all of these things arereversible.

(22:09):
So if you have someone's sleepapnea and you treat them, the
symptoms reverse and there'sincreased blood flow to the
brain, and there's oxygenationin the brain.
And studies have shown that ifyou put somebody on a CPAP
machine, the hippocampus grows.
You do MRI before treatment,you do MRI after three months,

(22:29):
and hippocampus grows by itself.
If you don't do anything else,if you just treat someone's
sleep apnea successfully, yougrow their hippocampus.

Speaker 3 (22:39):
So you test in your clinic everybody for sleep
apnea, I assume?

Speaker 1 (22:44):
Yes.
So we checked, like when I sawa patient, I would do an
inventory of all their issues.
And so for some people wassleep apnea, for some people it
was insomnia, for somebody a lotof them was set into a
lifestyle or too much stress.
And so each person haddifferent combinations of

(23:05):
issues.
I will make an inventory oflet's say 10 issues and make
five of them priority, and thenwhile I would work with them on
the health issues, reducingmedications, setting up a CPAP
machine, you know, working withthem to improve their sleep, you
know, have them work with thetherapist to reduce the stress,
my brain coaches would do braintraining with the patients.

(23:29):
So twice a week, we would dobrain games, and we would pick
brain games that were fun, likeyou know, card games or even
chess or sudoku.
We had a whole room full ofbrain games.
And we would pick brain games,either the ones that increase
executive function or the onesthat improve processing speed or

(23:51):
improve memory, and then wewould work with our patients
with the games that they needed.
So if somebody had memoryissues, we'll give them brain
games for memory.
If they had executive function,we'll have solving puzzle kind
of brain games, and if crossingspeed will create brain games
that require speed.

Speaker 3 (24:08):
Can you talk about that?
Because I heard so manycontroversies about you know the
advantages and benefits ofdoing memory and brain games in
terms of moving the needle indementia Alzheimer's prevention
as compared to lifestylefactors.
So many believe now that thebrain games are overrated and

(24:32):
it's most of the bucket isfilled by the lifestyle
interventions which you do.
Now you do all of it in yourclinic, and you have been
involved as one of the foremostauthorities in all of them.
What can you tell us uh aboutthat and to those claims?

Speaker 1 (24:51):
I think you have to appreciate that what we call
dementia or Alzheimer's diseaseis overall decay and shrinking
of cortex and epochampus.
And there are things that Iwould call five pillars of brain
health diet, exercise, sleep,stress reduction, and brain

(25:12):
training.
These five pillars of brainhealth can contribute to
reversing the cognitive declinethat happens with aging and to
increasing the size of cortexand epochampus.
Now, I think it is true thatexercise is by far the most
effective intervention forgrowing the size of cortex and

(25:36):
epochampus and slowing cognitivedecline and reducing risk for
I believe in that.
But brain training by itself isquite effective in getting
people to have better memory.
If you have memory problems, Igive you memory training and
your memory gets better.
Like just you know, I can teachyou how to play the piano and
you get better at it.
You may not necessarily becomethe best pianist.

Speaker 3 (25:59):
It even has a world championship, right?
This memory, there's a memoryworld champion.

Speaker 1 (26:04):
Yes.
Actually, no, Nelson Dellas isthe current US memory champion,
and he's my friend.
I've known him for a long time.
We met him one of these memorychampionship uh events.
I was a keynote speaker, and hewas one of the candidates that
he competed, and he actuallywon.
I think it was 2013 or 14.
And so he was not necessarily amemory champion in his life.

(26:26):
He was a computer sciencemajor.
And his grandmother died ofAlzheimer's disease in France.
He became interested in memoryand did some memory games and
became good at it and won somelocal championship.
And then he enjoyed it, and hedid some more games, and he got
better at it, and you know, wonthe state championship and the
US memory championship.

(26:47):
So he was never born a memorygenius or anything.
And it's incredible.
He memorizes a deck of cards in45 seconds, and he can memorize
20 decks of cards back to back.
I saw it.
Is that talent or is it reallypractice or both?
I mean I think I think it'sit's intense training.
Training?

(27:08):
Because he is not a memorychampion.
I mean, he's not a memorychampion.

Speaker 3 (27:11):
Well, maybe he didn't know he's a memory champion.
He had this unsung talent.

Speaker 1 (27:15):
It's it's I think we all have some innate talents and
some acquired talents, but weall can do exceptional things.
And think look at people wholose a limb and they get better
at using their other limbs.
Yeah.
Like, you know, there were acouple of the the US Olympic

(27:36):
Special Olympic champions whohad lost their arms and had
learned to do bone arrow withtheir feet and toes, and they
will be right on target usingtheir feet and legs to do that.
And you can't say they wereborn with special.

Speaker 3 (27:52):
Well, the reason the reason why I'm asking is because
we have the people in thespectrum of autism or
Asperger's, and you know, theyhave different abilities of
memory and the than the normalperson, and you know, that's
what I was referring to as youknow, there's so many spectrums
that we don't know perhaps, orthat we do know, but they're

(28:14):
mild, moderate, severe, and thenthe mild ones they kind of go
under the radar.
And is it could it be maybethat, or you don't think you
think it's mostly muscle memory?

Speaker 1 (28:24):
I think we all have incredible capacity to do
wonderful things with ourbrains.
It's without without a doubt inmy mind that we all can you
know memorize the whole book.

Speaker 3 (28:38):
I mean, we did with multiple books.

Speaker 1 (28:42):
Multiple books.
I mean and a lot of books.
The point to answer yourquestion is yeah, does brain
training move the needle?
Yes.
And I think when somebody hasmemory problems, if you give
them targeted memory training,their memory gets better.
Yeah.
Because memory is a skill thatyou can get better at it with

(29:03):
practice.
So if if you Daria did memorytraining three hours a day for
one year, that's a lot.
You you could memorize a deckof cards in a minute.
You probably can memorize tendeck of cards.
Wow.
It's unbelievable.
Like you think of it, it'sunbelievable.
Well, because it's you know,our brain is so malleable.

(29:26):
Yeah.
That's what I find fascinatingin my work dealing with patients
and seeing patients turnaround.
See, I think the most importantchallenge as we approach aging
is the necessity to change ourmindset about aging.
I a lot of people who came tosee me felt that okay, in their

(29:50):
70s.
You know, they were brought bytheir wife.
Their wife says, My husband canforget any things, and the guy
would say, Well, I'm 70s, whatdo you expect?
And I Think that is theobstacle that we need to
overcome.
We need to appreciate that ourbrain has an incredible degree
of malleability at any age, andwe can always get one notch
better.
Definitely one notch better.

(30:12):
Whether we can get 10 notchesbetter, you know, I can be 100%
sure depending on the degree ofdedication of a person to
intensive training.
Like we all can do a marathon.
There's no question.
We all can run a marathon.
You just train.
You know, you may somebody getto that point in three months,

(30:32):
some people get there at a year,but we all can definitely walk
a marathon.
So it's definitely doable.
You can't say you can't walk 23miles.
You can't walk.
Of course you can.
And so I think we need tochange our attitude toward aging
and appreciate that our braincan grow and expand at any age.
And we need to believe in that.
And with that attitude, we willdefinitely see results.

Speaker 3 (30:54):
Well, I think you're bringing up a very good point
because I have theseconversations with my patients.
And I think what you just saidabout these patients in their
70s or 80s, pretty much they'vechecked out.
And if you look at studies ofthat look at aging, cognitive
decline, uh, or in general,all-cause mortality, like death

(31:17):
for any cause.
A big part of when you comparethe ones that die early versus
die later, and when you look at,for example, these blue zones
around the world, I think thecommon denominator there is that
most of those elderly they havemotivation to live, they have

(31:39):
something to look for in theirlives.
There's they have stillsomething that they're
passionate about, and thatsubconsciously makes them drive
and strive to do the things thatbring joy and with that then
prevent further cognitivedecline.
And in contrast, there are theones that, like you said, the

(32:01):
narrative is that I'm over 70.
What do you expect?
It's almost like mentallythey've checked out, they don't
have anything to look forwardto.
They're basically waiting inline to die, and they accepted
their fate.
And no one is there to tellthem, hey, you probably have
another 10, 15, maybe 20 yearsto go.

(32:23):
So, and you can change that.
And I wholeheartedly agree withyou.
I think when we change thenarrative as a society, people
will start looking different ataging.
Absolutely agree.
And and I and and so can youdescribe now, let's say someone
is listening to this podcast andsays, Okay, that's fantastic.

(32:45):
You've convinced me.
I want to do this 12-week thingwith Dr.
Fatouhi.
I want to know what exactly ishappening in those 12 weeks, and
what happens after the 12weeks?
Meaning, am I done after 12weeks?
I get a certificate, and then Iwill never get dementia
Alzheimer's.
Can you walk us through those12 weeks?

(33:05):
What is it that you do or theydo, and then after that, what
happens when the 12 weeks areover?

Speaker 1 (33:13):
So the concept behind a 12 weeks brain fitness
program that I provide for mypatients relies on the
multifactorial nature ofcognitive decline.
In other words, everybody has adifferent reason or a
combination of reasons forhaving experienced decline in
their memory, processing speed,or executive function.

(33:34):
And so the first step in inthis process is evaluation by me
to go through index of 2030things.
So in my book, which is comingup in March, I haven't ever
gotten it.

Speaker 3 (33:49):
Yes, the Invincible Brain, everybody, coming out in
March 2026.
Yeah.

Speaker 1 (33:58):
I call it a brain portfolio.
And in brain portfolio, I gothrough a checklist of things.
The first thing on the list isyour purpose.
Why do you want to do this?
And what you just said isextremely true, which is if you
have a sense of purpose in life,that's a driver that makes you
want to live longer.

(34:18):
Yeah.
That's the that's the incentiveto want to be healthy and
sharp.
And that is the thing that alot of people don't pay
attention to and they don't evenconsider it.
The other thing I have, and I'mjust gonna go through this with
you, is what are yourshort-term goals?
Like some people want to havebetter memory, some people want
to think faster.
So we need to establish whatyou want to do.

(34:41):
Like when you go to a gym, youwant to work on your biceps, you
want to work work on your core.
Like our cognitive abilitiesarise from our cortex in the
campus, and we have the capacityto hone in in specific parts of
their brain that we want towork on, just like we can work
on different parts of the body.
Then I ask them, what percentof your usual baseline are you?

(35:01):
If somebody tells me they're10% of their baseline, it's one
thing.
If somebody says they're, youknow, they're 0%, or somebody
says, oh, I'm not I'm only 20%different.
So that also gives me anindication of where they are,
and it's very subjective.
You know, what they you know,some people say I'm 10% of what
I used to be 10 years ago.

(35:22):
It's hard to believe thatyou've lost 90% of your
cognitive abilities in 10 years.
So obviously you'reexaggerating.
But it's good to know, and Idocument that.
And then I said, Who's yourrole model?
Who do you want to be?
Because again, it's just likegoing to a gym.
Do you want to be a you knowthe hunky guy, or you want to be

(35:42):
fit and run fast?
And and the thing is, and thisis the thing that I think we
will be doing in the nextgeneration of medicine, where we
can actually sculpt the brainwe want, just like the way we
can sculpt the body we want.
And it's doable, but it's notscience fiction, it's totally

(36:03):
doable.
So, those are the first thingswe do.
Then I ask people 40 questionsDo you have kidney problems?
Do you have liver problems?
Do you have lung problems?
We do a review of systems, andthis is where I discover things.
For example, root causes.
Can you run a mile?

(36:25):
Can you run two miles?
Or or do you smoke?
Or how much how much do youdrink?
How many hours do you sleep?
Do you snore?
How many complex do you have?
How's your sex life?
So I go through 40 questionswith them.
Again, my job is to establish abaseline of where things are
and identify a handful of thingsthat we want to target in order

(36:50):
to achieve the goal we want,which is the goal that our
patient describes he or shewants.
So once we do that, I do someblood tests, and I take like B12
level, vitamin D level, omega-3levels, and there are new
Alzheimer's blood tests that Ihave not used, but those are

(37:13):
potential options that I can dofor my patients.
Then comes the important thing.
I do a VO2 max testing.
I used to do VO2 max testing.
VO2 max is an indication of aperson's endurance, it's the
maximum amount of oxygen aperson can use per minute per
body weight.
So if you are in your 40s andyou are very athletic, your VO2

(37:38):
max would be 50.
If you're 20s, it may be 60.
If you're 70s, it may be 30s.
But there are easy ways to do atesting, and also these days
you can go to your phone andfind where your VO2 max has been
already recorded.
Then I may order hearing testsor sleep study or heart uh

(38:04):
stress tests.
So these are things that helpme identify, help no.
If somebody's not everybody whosnores has sleep apnea, so then
then we do we establish whetherthey have sleep apnea or how
bad it is, because it makes adifference, or how many hours
they sleep.
So every person may get two orthree additional tests.
Sometimes MRIs, not everybodyneeds MRI.

(38:26):
So then I do twoquestionnaires, which are
neurocognitive questionnairesand neurobehavior
questionnaires.
There are about 30 questionsthat say, for example, one of
the cognitive neurocognitivequestionnaires asks, from one to
ten, how bad is your difficultyconcentration?

(38:47):
So 10 out of 10.
How bad do you have difficultyremembering names?
How bad are you in navigationtrying to find your way around?
Two.
How how bad is your difficultywith calculations?
Eight or three.
So everybody has differentcognitive functions.
Now we're getting tonitty-gritties.

(39:09):
And in your behavioralquestionnaire asks, how's your
mood?
Are you irritable?
Are you bored?
Do you have fatigue?
Do you have headaches?
Do you get into arguments withpeople?
Well, how's your stress level?
That's like our wholepopulation.
Well, no, the thing iseverybody has the constellation

(39:30):
of different things.
And I think the key to oursuccess has been identifying
specific things for specificindividuals.
Like, you know, everybody hasdifficulty with anxiety,
everybody has difficulty withstress, everybody has difficulty
with sleep, but that's not goodenough.
We need to know exactly how badit is.
And you know, you may say youhave stress, but you're actually

(39:53):
not that stressed after all.
So how do you measure that, thelevel like metrically?
Yeah.
So the you know, as you know,there's no blood test or you
know, that's right, beta EEG,quantitative EEG, and that would
give us some indication ofwhere Which is uh for the
listeners is the measuring yourbrain waves, getting an idea of

(40:14):
your brain waves.
And so we could see some peoplehad high levels of beta waves,
which are fast waves, and somepeople had high levels of theta
waves, which are the slow waves.
So a person who, for example,had depression and had very high
levels of the sluggish brainwaves, the theta waves, is one
thing.
Another person who says theyhad depression, but their delta,

(40:38):
theta, beta waves are normal,that was a different thing.
That would give me anindication.
It wasn't like a black andwhite test, it would things in
perspective for me.
So now with this, what I call abrain portfolio, you see how
much information I have abouteach person?
Yeah, and these tell me whereI'm gonna target my
interventions.

(40:58):
And because we do a targetintervention interventions, we
see results because we go afterspecific things.
Like, for example, if somebodysaid I have you know 10 out of
10 with memory, the braintraining that we set up for them
would have 30 minutes of memorytraining.
If they said they havedifficulty, they're too slow,

(41:20):
we'll do processing speed.
So so after the initialevaluation, which as you can see
was very comprehensive, youknow, I spent one hour talking
with my patients, I have allthese field forms that I would
complete for them.
Then the program will begin.
So that was an assessment step.
So then the program begins.
They came to Brain Center twicea week and they work with our

(41:43):
brain coaches who would have aprescription from me.
So this person had lifestyleinterventions and brain brain
training.
So I would say to my braincoaches, you know, this person
needs to improve their exerciseand they need to reduce the
stress on one part, and whatkind of brain training they need
on the other part.

(42:04):
Because I knew from myassessment where the gaps were,
and this is the key.
I filled in the gaps as opposedto just say, go exercise.
I think a lot of people sayexercise, eat right, sleep well,
don't stress.
I mean, that doesn't help.
Yeah.
Because each person, once yougo into detail, has specific
issues that need to beaddressed.

(42:25):
So when they started a programtwice a week, they will work
with our brain coaches onlifestyle issues and brain
training issues.
And and we kept track of theirprogress every week.
We had what's called brainhealth index, a short little
questionnaires.
And every week I would meetwith my brain coaches and we
discuss every patient as howthey're doing.

(42:46):
And I, in parallel to thesethings, would take care of
medical issues.
So I'll make sure they getsleep apnea testing and sleep
apnea treatment, or if someonehas significant anxiety things
like this, I would set them upwith a social worker, or if I
felt like they hadn't exercisedin a long time, they may have

(43:08):
heart disease, I'll set them upwith a cardiologist, or I would
just order this stress testmyself and just follow up.
I tried to own the patient.
It was my problem.
I didn't just care ofeverything because I knew I was
in charge of the person and Icouldn't blame others for

(43:28):
dropping the ball.
It was, and I would tell thatpatient, I said, you know, if
you were my patient, I saidDaria, you're my problem now
with pleasure.
I'll take care of you, and I'mresponsible for everything.
If sleep issues, cardiacissues, mood issues, I'm in
charge.
I get people to help, and ifthey fail to do their part,
ultimately I'm responsible.

(43:50):
And that gave people a sense ofconfidence that it's not like
this doc is gonna do this, thisdoc is gonna do that, and if
that doc doesn't do their job,nothing happens.
I would tell them, listen, youwill get better definitely.
Without a question, you willget better.
I am telling you, 80% of ourpatients had a statistically

(44:11):
improved statisticallysignificant improvement in
objective cognitive testings.
We've had we've had threepapers published in
peer-reviewed journals, and wesay it in our clinic all the
time.
There's no question you willget better.
Absolutely.
And our brain coaches had seena lot of success stories, and
they were enthusiastic when theysaw them.

(44:32):
You know, they were verypositive because they feel,
look, we see this all the time.
You're just another one.
Like everybody improves here.
And this was a shock to ourpatients.
Like, everybody improves.
What do you mean everybodyimproves?
These people are 70s.
Oh, and then in the waitingroom, people would chow each
other.
And somebody says, Oh, Imemorize 100 words.
They say, You memorize hundredwords?

(44:52):
I mean, you're 80 years old.
How do you do that?
And they would get inspired tothen memorize 100 words
themselves.
And then at six weeks, we willrepeat the objective testings,
the cognitive testing, and thequestionnaires, and they would
meet with me.
I will go over the progressover six weeks.
And, you know, if if they hadimproved the exercise, but they

(45:15):
had not improved the braintraining as much.
Oh, and they love to come showme how much how many words they
memorize.
We had like a memorize memorymemory trick to show people how
to memorize 20 words.
So they would memorize 20 wordsand forward and backwards one
week, then they memorize 20words the next week, and so
forth.
So it all looked forward tocome to see the principal

(45:38):
person, like, and and brag thefact that they memorized 40
words or 100 words.
And some people then would goon to memorize names of
presidents or you know, names ofthe football players they like.
Anyway, at six weeks, I wouldsee what has not improved.
Oh, and then we wouldn't waittill six weeks if somebody was
not improving.
So they said somebody wouldcome one, two, three weeks, they

(46:01):
were they had not taken becausepeople started getting better
within two, three weeks of theywould get the idea, they would
get the hang of it, startmoving.
And if they were not gettingthey were not starting to move,
they wouldn't wait till sixweeks.
Because we had weekly braincoach meeting, they would tell
me such and such has notchanged.
And then I would meet withthem, either formally or

(46:23):
informally.
Like I said in my writing room,I said, please kind of come
here and talk with you.
And sometimes I will find outthat, for example, they had
failed to tell me that they takea medication for sleep that
they had somehow forgotten totell me, or that they had a
major conflict with their spousethat they hadn't told me, or
you know, they would tell mesomething that somehow they had

(46:46):
not disclosed during my thoroughevaluation first summer.
Because if somebody goes to thegym regularly, you start saying
things in two or three weeks.
You start feeling a littlebetter, you still feel like your
steps are a little stronger,you feel like that that weight
is not as heavy.
I mean, things start to weakchange after a few weeks.

(47:07):
You can't wait six weeks, andso that's why the that's the
other thing.
We didn't wait till six weeks.
But at six weeks, they willcome for a formal evaluation,
and I would do the test results,I would go over them.
Everybody had improved, theywere happy about it, and they
were even more excited to goback and do four weeks.
And then at the end, they wouldcome back and they would, you

(47:29):
know, they would have a finalset of testing, and I would meet
them for a post-programgraduation event appointment,
and then I would talk to themabout how much they improved and
how they were they had learnedwhat to do.
See, it takes three or fourweeks to form a habit, but it
takes three or four weeks tostart to form a habit.
But if you do somethingregularly, then after 12 weeks,

(47:53):
it becomes a habit habit.
Like if you start walkingregularly, if you start you know
not touching junk foodsregularly, then it becomes a
habit.
And then I would see patientsthree months after, and then six
months after.
And I always loved thosebecause people had continued to

(48:13):
take on new hobbies, they hadcontinued, it's like they're
alive again, they're aliveagain.
See you hinted to that.
I think people sort of in theirmind they kind of die in early
70s and just wait for the actualstopping of breathing.
They in their mind they checkoff.
And and when we told them youcould do this, you could do

(48:35):
that, and then they felt liketheir legs were stronger,
they're walking better, theywere feeling better, they had
started to do things in theirchurch, they take up new uh
volunteering work.
They were a new person, full oflife, full of going doing
things.
And I love the part I love thebest is when patients came to me
and said, Dr.
Futui, you changed my life.

unknown (48:56):
Dr.

Speaker 1 (48:56):
Futui, this was the best thing we ever did after
done my life.
Dr.
Futui, why what you do is notavailable elsewhere?
Why have you just need to knowwhy do we have to find you
through just other peopletalking about it?
Why is this not standard care?
And that's when I decided, youknow what?
I need to do something beyondjust saying, you know, a few

(49:20):
thousand patients a year andlike you know, 10 patients a day
to do things.
The things I do don't requirespecial equipment, are readily
available, and so why don't Ichange focus and write my book
and start giving publiclectures, educating doctors?
You know, one of the things Iplan to do in the coming years

(49:41):
is to work with physician groupsto make this program a part of
their brain training program,what I call super agent program.
I think we need to set a goalto become a superager.

Speaker (49:54):
I think you're definitely on path.
Like if I had something like Ihad 90% confidence that would
become a super agent, it wouldbe you.

Speaker 3 (50:01):
No, I love that.
I mean, the one analogy yougave comparing the brain to our
muscle, and essentially the thebrain is a sort of a muscle
because you it has theplasticity, it can grow, despite
what we learned in medicalschool, that neurons can't grow,
what, 30, 40 years ago?
So that is, I think, willcompletely change the narrative,

(50:25):
not just for our society here,I think globally, and uh for
context for the audience, likeyou retired from that clinical
practice because you felt likeyou can't help enough people,
and now you're trying to bringthat message on and scale that
message through education,through authoring books, through

(50:48):
academia, etc., which you'vealways been part of academia,
but now you're doing all of thatfull-time.

Speaker 1 (50:54):
Yes, and I look forward to doing more of it
because as I said, you know, I'mtalking to some medical
practice groups.
And if if I talk with theleaders of medical practice that
has a thousand or five thousandpatients, or if they have
twenty or hundred thousandpatients, and if they
incorporate this program,something similar to it, into

(51:16):
their programs, then I will beable to touch the lives of you
know hundreds of thousands ofpeople.

Speaker 3 (51:22):
100%.
And and that's the reason wetalked before the podcast about
my book, and that was mymotivation too.
It's it's it's fascinatingbecause I felt I can only make
my mark on a few people, but youknow, how can we scale the
message?
And one of the questions I hadfor you, because just for

(51:42):
context, in the past two yearsI've changed my practice.
What you're doing for the brainwith all the primary assessment
questionnaires, I do for mypatients as part of a
perioperative optimization,where several months prior to
their surgery, I optimized them.
But before I know what tooptimize, I have to get all the

(52:04):
data, all the information ontheir lifestyle, their personal
perception thereof in comparisonwith actual facts, because
there are studies that patients,uh very smart patients, I
shouldn't, I think they did astudy uh using nutritionists,
and they asked them about theirdiets, and over 80% overreported

(52:25):
their diet.
And these are nutritionists,meaning they know the science,
but we are biased inherently,and we do over-report our sleep,
our diet, our exercise level,and sizes of other things.
But what in your estimation orin your clinic or in your

(52:47):
studies have you seen thisover-reporting?
And how did you weed throughit?
How did you assess that?
And also a follow-up questionon that is during those 12
weeks, how did you deal withnon-compliance?
In other words, how manypatients ended up graduating the
12 weeks, and how many said,Yeah, I don't think this is for

(53:10):
me?

Speaker 1 (53:11):
Yeah, the attrition rate was 7%.
Attrition rate seven or seven.
Oh, that's low.
Only 7% of people did notcomplete the program of people
who started the program.
That's pretty good.
I think the reason was becausewhen people started the program,
they start feeling betterwithin weeks.
I mean, the moment theymemorized 20 words and they went
home and they told theirgrandchildren they memorized 20

(53:32):
words, they were a new person.

Speaker 3 (53:34):
I think on top of that is the cohort of patients.
The fact that they came to youroffice, they were already
motivated, they were alreadylooking out, looking for
alternative ways.
So they had that motivationaspect.
So I'm not surprised to hear7%.
And you have that cohort ofhighly motivated patients seeing
results within two to threeweeks.

(53:55):
I mean, they will I would besurprised if they asked you if
they can continue the programbeyond.
Yes, many people did.

Speaker 1 (54:03):
I think, I think what we told them, and some people
did do the program another 12weeks because we obtained
objective test results.
So going back to aboutperception, yeah, it was very
interesting that somebody wouldsay, My memory is horrible.
And then we do objectivetesting, and their memory was at

(54:24):
a level at 90 percentile forsomeone in their age group,
because we scored the cognitivetest results based on their age
group every five years.
So 63-year-old may say, Mymemory is horrible, I can't
remember anything.
And we do testing, the testingshows the memory is a 90
percentile for their age group.
So they under-reported, inother words, they underreported

(54:46):
their memory.
This is average people, it'snot educated people.
However, you need to know thatyour memory is not about to fall

(55:09):
apart and you're not at theverge of developing Alzheimer's
disease.
You're still compared toaverage population, way up
there.
And I will get you even betterbecause what matters is they're
happy, not the numbers.
And vice versa.
Sometimes people say, you know,my memory is not that bad.
It's my you know, I feel likeI'm slow.

(55:30):
And the memory was like, no,tenth percentile.

Speaker 3 (55:33):
I think that's a classic, the I think this is a
classic phenomenon of theDunning Kruger effect, where
people that are Are you familiarwith the Dunning Kruger uh
there are two socialpsychologists they compared
confidence and competence,meaning they wanted to see if
confidence related tocompetence, and vice versa.
So they saw that people thatlack competence, it's it's like

(55:56):
a U-shaped curve.
So on the left side of thecurve, you have the incompetent
with high degree of competence,and then as they learn, the
confidence level bottoms out.
So they're like, oh shoot,there is much more that I need
to know.
And then as their competencelevel rises with time, with
education, training, and soforth, then their confidence

(56:19):
level goes up too.
But what they found out is thatthe highly competent ones that
have high confidence, theypossess this degree of
intellectual humility that makesthem under-report their actual
competence.
And I think that's what couldhappen with the very highly
intellectual people that youmeet that under-report their

(56:42):
memory.
They said, I don't think mymemory is as good because their
standards are high, the theythey're very competent, but they
don't go out and boast out,say, Oh yeah, my memory is
great, and they're in a tenthpercentile.
So it's fascinating.

Speaker 1 (56:57):
You probably see this in your line of work.
If somebody comes in and says,My nose is horrible, and this,
and you look at the nose and yousay, gosh, your nose is great.
What are you talking about?

Speaker 3 (57:08):
Yes.
Well, I see that a lot actuallybecause I'm like yourself an
educator and teacher.
I see that a lot on the fellowsand residents that I train and
teach, and uh or other peopleearly in their career, they have
a high confidence level, buttheir competence isn't very
high.
And they're it's a littledangerous, right?
Because you will basically omityourself the opportunity of

(57:33):
learning thinking you alreadyknow everything.
So that way then you're notopen to learning something new,
and that's very risky.
And then as you learn, yourealize, oh, there's so much I
don't know yet.
So I better, you know, humbleup a little bit and start um you
know, educating myself, andthen slowly then the conference

(57:55):
level goes up.
So I see that a lot in theeducation department, and that's
why you see all thesepseudoscientists and influencers
on social media, they read aheadline, they don't even know
they read some abstract of anarticle, they don't even know
how to read a scientificarticle, and then they complete
or they completely misinterpretit, and it's cognitive bias,

(58:17):
right?
They just use the narrativethat fits their belief, and then
they go out, they have they getmillions of views, they have
gazillions of followers, andthen they create these movements
of the pseudoscience, and thenpeople get confused.
So we see the Dunning-Krugereffect full-blown on social
media, and I that's why I madeit my mission to bring real

(58:39):
science and interviewing andhaving people like you on the
podcast, where therecommendations are based on
true science and data and notsome opinion or fad.
But I want to continue more onthe lifestyle because I think
it's it's important.
So a lot of the stuff we'retalking about is really

(59:00):
fascinating, especially for mepersonally.
But for the audience, I want togive them some actionable and
practical advice to go home withwhere they can start.
If they're motivated to changetheir lifestyle, and if they
have something to look out for,maybe they just got a new
grandchild, maybe they gotremarried at age 70, and now

(59:23):
they have something to lookforward to.
Now they're motivated toimprove their lives, their
memory, their health.
And I want to connect all ofthis to also metabolism,
nutrition, because that'sanother huge driver that people
underestimate.
And a lot of people in that agegroup, they already come with
one or more metabolic diseasesbased on their previous

(59:44):
lifestyle, where they didn'tknow better.
I mean, in in our Westernsociety, you know, we don't live
in the Mediterranean.
So, you know, it's fair to saythat we're at age 70 or 60,
even, we have already fallenbehind.
But that doesn't mean we can't.
Can we cannot catch up?
That doesn't mean now we justhave to write it out and cross

(01:00:05):
our fingers, like we discussedas far as the brain.
So I want to dive into the onebuzzword that has become very
popular on social media, wherepeople are increasingly calling
Alzheimer's a type 3 diabetes, abrain disease driven in part by
insulin resistance.

(01:00:26):
And by now everybody has heardthe buzzword insulin resistance,
and decades of eating refinedsugars, ultra-processed foods,
lack of eating whole foods.
From your perspective as aneurologist, is my sugar habit
literally feeding futuredementia?
And what do you think ishappening in the brain over 10

(01:00:48):
to 30 years of frequent glucosespikes and ultra-processed
foods?

Speaker 1 (01:00:54):
Yes.
The short answer is yes.
I think that poor metabolismand its associated inflammation
is a major factor for brainshrinkage.
It's absolutely up there.
And the sugar spikes that leadto insulin resistance and then
to diabetes increase erosion ofthe blood brain barrier.

(01:01:17):
You know, the blood vessels inthe brain have three layers of
insulation as compared to, let'ssay, the blood vessels in your
heart and kidney or elsewhere,which have only one layer.
The one is the endotheliallayer, which is very tight and
it doesn't allow the leakage ofthe material.
But in the brain, you havethese cells called parasites and

(01:01:39):
these other cells calledastrocytes, which provide these
extra layers of coverage so thatthe content of the blood
doesn't leak into the brain.
When you have a highinflammatory diet, and the
inflammation causes erosion ofthe blood vessels in the brain,

(01:02:00):
the blood content, things likeclotting factors, fibrinogen is
actually one of the bad ones,and cytokines and other things
in the blood that all theelectrolytes that may be flowing
around leak into the brain.
But your brain has a verytight, has a very tightly

(01:02:22):
controlled environment.
Inside the brain is a verypristine milieu where everything
is controlled.
I mean, imagine being insidePentagon or inside you know
vaults of major comp majorbanks.
Fort Knox.
And you know, neurons very arevery finicky, they're very

(01:02:45):
sensitive.
If the calcium level is alittle bit high, picograms
higher, or if the sodium ispicomoles lower, that changes
the fire rate.
And if, for example, you havetoo much calcium, the neurons
can fire so much to killthemselves.
It's called excytotoxicity.
So inside the brain, deepinside the brain, the neurons

(01:03:07):
and their supporting cells worktogether in a very tightly
controlled, very tightlyregulated environment.
There's no room for you knowclotting factors and cytokines
and red blood cells and likethat.
So poor diet causesinflammation.
Inflammation causes erosion ofthe blood pain barrier, the

(01:03:27):
content of the blood gets insidethe brain, and that causes
havoc.
That causes wreck problemseverywhere inside the brain.
The neurons stop fine too much,then the microclean astrocytes
actually become reactive, theyincrease release of free
radicals, reactive oxygenspecies, and that actually

(01:03:49):
worsens the problem.
That's adds fuel to the fire,and that part of the brain dies
or erodes significantly.
Permanently?
How much recovery room do wehave once that happens?
So there we go.

(01:04:10):
So it's called brain reserve.
In other words, how much of abrain integrity and capacity
have you developed over theyears?
Let's say you're 45 years old,50 years old, in these four or
five days.
Have you been eating right?
Have you been sleeping well?
Have you done brain training?
Have you exercised?

(01:04:32):
If you've done the rightthings, your brain has a high
reserve, which means you canerode 10-20% of it and it's
still functioning.
But a poorly maintained brainto begin with can't tolerate
another 10-20% of damage.
And that's that's thedifference between a 65-year-old

(01:04:53):
who's doing things and isactive and it feels good, it
feels good, and you know,another person with the same age
who just sits around, has noenergy, can't do much.
It's the status of their brain,status of their brain health
and vitality that determines thelevel of performance and how
happy they feel.
See, when people have this, Idon't want to call it that way,

(01:05:17):
a dirty brain.
The manifestation is you don'thave energy for anything, you're
not interested in anything, youdon't want to do anything, you
don't do anything.
You watch around, you sitaround, watch TV and drink beer,
and you know, are grumpy withyour family members or friends,
or complain about everything,you know.

(01:05:39):
So what goes on in the brainshows up in terms of behavior in
day-to-day life.

Speaker 3 (01:05:45):
Yeah, I I saw that happening on me, and that's what
made me change.
I didn't like myself.
And about now four years ago,it started happening, and I
didn't recognize myself, and Ididn't know what it is.
My my primary care couldn'ttell me, give me the reasons.
And then through other avenues,I went down the rabbit hole and

(01:06:09):
I stumbled upon all of thisscience.
And this was for me like anawakening.
Now, the question I have foryou I know I have done a lot of
damage to my brain by virtue of15 years of medical training,
all-nighters, residency, oncall, junk food, if any food at

(01:06:32):
all, and all of that food wasreally ultra-processed.
It was basically Cheetos, itwas MMs, I mean, it was some
candy bars, sodas.
I mean, that's how I lived 15years of my life.
Lack of sleep, I would sayaverage four to five hours, and
we're talking about an extendedperiod of time, 10-15 years.

(01:06:55):
But then I cleaned my lifestyleup, obviously, once my training
was over.
But then some of those badhabits I continued even
afterwards, meaning eatingcandy, taking six hours or five
or six hours sleeping at nightas a badge of honor, boasting
that, hey, look at me, I don'teven need that much sleep.

(01:07:18):
Uh, because I didn't know allthat science.
Now, the my question for you isall of that, has that done
permanent damage?
If so, how what percentage ofit?
And in the past four yearswhere I really cleaned up my
act, can that repair all thedamage or not really?
And how how how do we knowthat?

Speaker 1 (01:07:41):
Well, I think I think after two, three years the
brain goes back to a healthystatus.
I know, for example, that ifsomebody smokes a lifetime and
their lungs are filled with thisblack junk and tart from
smoking, if they stop smokingthree years later, their lungs

(01:08:03):
is almost as good as near.
So you can have a smokedlifetime, 30 years and three
years of not smoking andexercising makes your lungs
almost as good as near.
And that's what I findfascinating about our physiology
that we have this internalrepair kit that is so efficient

(01:08:24):
and works so well in all ourorgans.
You know, same applies to yourmuscles.
If you haven't done anythingfor a long time, you go to a gym
for six months and you know,you get buffed.
They did a study in LLE whowere in shape and those who were
not in shape, and they saw thatthe load of mitochondria inside

(01:08:47):
their muscle cells reflectedtheir level of activity.
Those ones who had a centerlifestyle had low level of
mitochondria, and those who wereactive and exercising had high
level of bacteria, high level ofmitochondria.
And then they put them on anexercise training for either
four months or six months, andafter that, the levels were the

(01:09:08):
same.
In other words, four to sixmonths of training brought the
level of mitochondria to thesame level of somebody who has
been exercising all their life.
I think that's not fair,actually.

Speaker (01:09:21):
You know, those work all their life, and and somebody
can catch up in six months.

Speaker 3 (01:09:27):
I mean, that's that's almost but I think the diff the
difference is for the ones thathave been doing it all their
lives, they already created thehabit.
It's effortless.
If you want to catch up, youbetter have a compelling reason,
otherwise, you're not going tobe motivated to follow through,
and therefore you can't create ahabit.
I think that's the advantage ofsomeone that is doing that.

Speaker 1 (01:09:46):
And I think once people start doing things for a
few months, then that becomes ahabit.
Once if you get to a uh levelof exercise, like I can't
imagine not exercising.
I I really can't, I it, youknow, even if when I travel and
there's you know flights afterflights and I can't, you know,

(01:10:06):
exercise formally, I still walka lot, I still I can't imagine a
week go by that I wouldn'texercise.
It hasn't happened in yearswhere a week went by and I
didn't exercise.
It's so inside.
I mean, I can't.
I can't, I'm addicted to it.
I totally hear you.
But I I think most people do iton a regular basis and they see

(01:10:26):
the results, and also I canalso feel like if I travel and I
can't like have a meeting aftermeeting and I have to catch an
hour flight after a few days, Ican feel the tiredness that I'm
not quite fresh as I wouldotherwise.

Speaker 3 (01:10:41):
I want to talk about that because you just said
something interesting, becausethat really speaks of our
Western society, modernlifestyle.
And I want to pivot into diet alittle bit.
We often, and you talk aboutbrain foods and diets that are
good for your brain, and in youknow, one of the very classic
and studied actually diets isthe Mediterranean food and the

(01:11:05):
the mind diet, the mind study,and so forth.
We live in a society, we livein times where what you just
said, you know, people work,they travel, we don't get to
prepare the ideal Mediterraneandiet.
So, first I want you was us touh I want you to tell us what
that diet consists of, but thenalso I want to frame it such

(01:11:29):
that in today's world andsociety, realistically, only
maybe half or a third of our peour our society is able to
consistently maintain this idealdiet.
So the other aspect is also youconnect diet with gut health

(01:11:55):
and stress and all of that.
So it's not just one thing.
We already discussed it, it'snot just exercise, it's not just
diet, it's not justmindfulness, it's a plethora of
things, it's a combination, it'sa this soup.
But talking about diet, firsttalk to us about what is the
ideal diet and what solutions doyou have for people that are

(01:12:20):
not able to sustain and maintainthat type of ideal diet.

Speaker 1 (01:12:25):
I think the diet is actually very simple.
It's it's a lot easier than youthink it is.
The simple rule is this don'teat junk food, period.
If you don't eat junk food, I'mhappy.
I'm fine with it.
Don't worry about the detailsof that Mediterranean diet,
don't worry about you know whatexactly is contained in that

(01:12:49):
diet.
Just don't eat junk food.
No candies, no cookies, nomuffin, no donut, no french
fries, no processed food.
So pretty much you're asking usnot to eat anything.
Well, no.
I'm joking.
I think I think you havechoices to what to buy when you
go shopping.
You have a choice of buyingthat box of cookies or not.

(01:13:11):
You have a choice of buying,you know, bagged vegetables or
bagged this and that.
And and and that's the thingthat needs to change.
If you do that, I'm happy withit.
Yeah.
But just so you know what theMediterranean diet is,
Mediterranean diet has anemphasis on fresh fruits, uh,

(01:13:33):
fresh food, fruits, vegetables,legumes are the main features of
the Mediterranean diet.
And the thing is that you know,you don't have to necessarily
eat this food, not that food.
Just eat fruits and vegetablesand you know, add legumes when
you can.

(01:13:53):
And and I I eat a Mediterraneandiet, and I think it's pretty
simple.
I mean, I usually have someoatmeal with maybe a banana and
some protein powder because Ithink it's important to have
enough protein in a day.
I have a Greek yogurt for lunchand dinner.
My lovely wife preparesdifferent dishes different
nights.
Um I'm lucky in that front.

(01:14:14):
And usually it's uh you know, amixture of vegetables, and is
whether it's chicken breast orfish or sometimes red meat.
And and and during the day, Iusually have four or five
snacks, which are usually fruit.
Maybe I have some grapefruit.
I love blueberries, oranges,apples, pears, whatever

(01:14:35):
seasonal.
That's it.

Speaker 3 (01:14:36):
It's not how much attention do you uh put into
your macros and particularlyyour protein intake?
Do you pay attention to that?

Speaker 1 (01:14:45):
One thing I probably need more of.
You know, I have uh two scoopsof protein powder in the
morning.
Well, that's good.
Uh sometimes I may have aprotein bar after exercising.
And at night we do have meatwhich has protein in it.
So I think I probably get 60grams of protein, 70 grams of

(01:15:05):
protein, and I I think Iprobably need more.

Speaker 3 (01:15:07):
Yeah, I think you could improve there.
I mean, one of the things thatI underestimated the importance
of protein in the context ofgeneral diet.
One of the things I alwaysthought I was a sweet tooth.
I always thought it's almostlike since I was a kid, I was
labeled as a sweet tooth becauseI was naturally drawn to sweets

(01:15:31):
and candy.
And it's hard not being drivento sweets and candy living in
Germany.
I mean, arguably in Europe theyhave the best chocolate.
Growing up, I took on thathabit.
But when I changed my proteinintake, when I increased my
protein intake, I was around 60to 80.
I took it up to 150 becausemost recommendations now are one

(01:15:53):
gram of protein per pound ofideal body weight, as opposed to
the recommended dose, which isthe minimum dose, which is half
of that, at which point it's notoptimal, but you at least you
avoid losing uh muscle mass.
But if you want to optimizeyour system, you need to do one
gram per pound of ideal bodyweight, which for me would be

(01:16:15):
150.
I realized I struggle to takein that much protein with a
regular diet.
So I like you start my morningwith two scoops of protein
powder, and so I load up mysystem in the morning with at
least 30 to 40 grams.
So I start high, and then therest I try to eat my proteins as

(01:16:38):
for lunch with uh legumen,lentils, beans, tofu, basically
vegetable, protein, canvegetable that contains protein,
and then at dinner I have meat,salmon, steak, chicken, and
then I get another 30 gram outof that, and then I can hit my

(01:16:59):
150 throughout the day, andthroughout the day I may add a
protein snack.
So all my snacks are protein,so I focus on that, and then I
start my morning early.
Since I've been doing that, mycraving for sweets have gone to
zero.
You put a bowl of MM in frontof my face, I won't pick a
single one.

(01:17:20):
Before I had enough protein, Iwould finish it.
You would have to fight me andtake that bowl away from me, and
I would chase you, I would huntyou down.
And that's the one revelationthat really made me appreciate a
proper diet that is satiatingmuch more than I thought.

(01:17:40):
And I think one of the mainfactors of having that satiated
feeling is giving your bodyenough protein where you don't
start getting the shakes, whereyou store don't start getting
hungry or hangry in my case, andthen craving the dopamine hit
that the carbs would give you.
And instantly, it was so easy,it didn't require any effort for

(01:18:04):
me to cut out theultra-processed stuff and the
snacks just by giving myselfenough protein.
Now, in regards to diet, mysecond question was that well,
now that we live in a societybecause people work, people
travel, people have kids, peoplehave stuff to do, and they
might not be lucky like me andyou, and have a beautiful wife

(01:18:29):
that is a foodie or can preparegreat food that is on the same
page.
Some people don't have a wife,and or some people have a wife
but or husband that they'reboth, you know, uh have busy
lives, they have many children,still in in ages where they need
to take care of them.
They just don't have time toeven go shop properly.

(01:18:49):
But I agree with you, I thinkit starts all by in the grocery
store.
Which aisle do you go to?
But at the end of the day, youstill have to have time to
prepare that.
We often diminish the value ofsupplementation, of supplements.
You know, protein powder is asupplement, a protein bar is a
supplement.
But when it comes to othersupplements like vitamin D,

(01:19:13):
omega-3 fish oils, vitamin B12,folate, all of these supplements
that we know over a third ofthe population are lacking
because their nutrition is notoptimal.
And when people talk aboutthose are just expensive urine,
but that at the same time weknow a third of our population,

(01:19:36):
especially the older we get, themore malnourished we get.
What do you say to thosepeople?
And how do you makerecommendations when it comes to
supplementations for yourpatients?

Speaker 1 (01:19:50):
Okay, step number one is you know, no time is no
excuse because your health, yourfuture, your your brain, your
heart are essential factors.
And if your work is too muchand you can't do that, then you
need to rethink your life.
I I was in France and somebodysaid, you know, people look down

(01:20:15):
at someone who works too muchin the office.
It's a reflection of poor timemanagement, is look upon
negatively if you work too much.
It means you failed to get yourjob done in a timely manner.
And so the first thing we needto do is to change our attitude
toward work and the need that weneed to kill ourselves, you

(01:20:37):
know, work 16 hours a day to besuccessful.
I think it is possible to besuccessful working a few hours
and be more creative.
Or maybe there are periods,maybe a year or two restarting a
new business or you'rerechanging something.
For a period of time, you killyourself.
But it should not be a habit ofworking like that decade after

(01:21:00):
decade after decade.
That's poor time management.
Number one.
Number two is that, you know,before I was married, I cooked
myself.
It was very simple.
You know, I would go to thegrocery store, I would get some
chicken and some tomatoes andsome mushroom and you know, some
onion, and you know, I choppedup the onion and tomatoes and
the mushroom, and I fried thechicken with some uh olive oil

(01:21:24):
and added those, and I mean, youknow, 15 minutes I would have
the food ready.
So I think really we need todecide what is our priority, and
uh you know, is our health andwell-being, you know, secondary
to um our work.
So that's the thing.
And the other thing is that youknow, you mentioned you have

(01:21:47):
legumes, or you eat fruitsduring the day, or you know, you
have a pretty pretty healthydiet.
Each thing you put in yourmouth has a collection of
different vitamins.
Some of them have high zinc,some of them have high other
minerals, and some of them haveyou know high protein.
And I'm really against vitaminsand supplements in general

(01:22:12):
because how does a personsitting in a pharmaceutical
company or some vitamin-makingcompany know what individual
person is lacking?

Speaker 3 (01:22:24):
Because I don't think people should just randomly uh
shot do a shotgun approach andtake supplements.
I'm talking about physiciansbased on patients' lives are
kind of like the questionnaireyou did, based on their
lifestyle, the dietary habit,their sleep, their exercise, and
then look at their biomarkersbased on an analysis, a

(01:22:45):
comprehensive analysis of that.
For example, I started doingthat in the past years in my
clinic, and 82% of all mypatients that have a vitamin D
level 30 and below, which isliterally at the bottom and then
deficient and in some casesinsufficient.
Well, that needs to besupplemented because I'm sorry,

(01:23:07):
we just don't have the time tospend eight hours a day outside
in outdoors to get adequatevitamin D levels as how genetics
were programmed as part of theevolution.
Because we spend 95 times 95%of our times indoors.
They did a study that showedthat children spend as much time

(01:23:27):
outdoors as inmates in prisons,and in some cases, even less.
Well, of course, they're gonnahave vitamin D deficiency, but
then we have to yeah, until wechange how we live, which is uh
a societal rethinking, we needto keep people healthy.
So I don't think there'sanything wrong with

(01:23:50):
supplementing.

Speaker 1 (01:23:52):
So I checked B12 level, vitamin D level, and
several other vitamins, and ifthey were low, I would uh if
somebody vitamin D was 10, Iwould give them 50,000 units
prescription of vitamin D.
And B12 level was often not somuch low, but it was with less

(01:24:13):
than optimal, because the normallevel of the B12 is 200 to a
thousand, yeah, but someonelevel 210 is too low.
So I in that sense, I did dowhat you're doing, which is
targeted supplementation.
The one supplement I recommend.

Speaker 3 (01:24:31):
That's what I'm talking about.
I'm talking about targetedsupplementation.

Speaker 1 (01:24:34):
I'm not saying one supplement I give to everyone I
take myself is omega-3 fattyacids.
Which which forms do you take?
Is DHA and EPA?
I take DHA, EPA, what athousand?
Total DHA, EPA of a thousandmilligrams.
I do the same.
Yeah.
And so that's the onlysupplement I think.
I think people need to knowtheir vitamin D level because if

(01:24:57):
their vitamin D level is 20, isdifferent than if the vitamin
level, vitamin D level is 5 or29.
Yeah.
If it's 29, they need to takesupplements.
But if it's five or ten orfifteen, they need prescription
dosages.
Same goes with B12.
Yeah.
But omega-3 fatty acid, Ithink, is very important.

(01:25:18):
I did a research myself andactually published in Nature,
and we found that people studywe did meta-analysis, and
studies have shown that lowlevels of omega-3 fatty acids
are associated with a high levelof higher incidence of
Another recent study replicatedthat prospectively.

(01:25:39):
Our study was a retrospectiveanalysis of published studies,
and it's a prospective studythat showed omega-3 levels.
Omega 3 fatty acid makes a hugedifference in brain function.
So it's important to make adistinction not to take fish oil
because fish oil has you knowDHA and EPA and a whole lot of

(01:26:05):
other things, including mercury,but a DHA-EPA is what we need.
So sometimes people get fooledby a cheap brand of fish oil,
which is a third the price ofomega-3 fatty acids.
And omega-3 fatty acids thatwe're talking about are DHA and
EPA.

(01:26:25):
So DHA EPA is essential.
I take it, my wife take it, mydaughters take it.

Speaker 3 (01:26:31):
Yeah, I think again, we're not talking about all the
supplements on the sky.
I think it has to be tested.
And a lot of my patients askme, hey, what supplements do you
take?
I said, the supplements that Itake are specific to my uh
status.
It's not like, oh, you have totake these supplements because
of the because it's a goodsupplement.

(01:26:53):
Well, what are your levels?
Exactly.
That's that's you articulatedmy point beautifully.
That's exactly what I mean.
So the but the context is thisyou know, uh my my point was
like on paper, we always sayjust eat healthy Mediterranean
diet or just cut out theultra-processed foods.
You know, in reality, let'slook at statistics, right?
So about one in four to one inthree adults over 60 in the US

(01:27:18):
has suboptimal nutritionalstatus.
These are facts, right?
Because not everybody has theluxury, and a lot of people
don't, frankly, don't have themoney.
They're either malnourished orat clear risk of malnourished.
And in high-risk groups, ininstitutional settings, that
number even goes up to 30, 40,even 50 percent.

(01:27:38):
So micronutrient deficienciesare common.
I mean, especially in the veryold.
And uh, there's another caveatto that, and why that is
malnutrition and old.
I covered it in my previouspodcast, which you might
actually find fascinating.
And I'm really curious to know,to see if you have heard about
it, because it was a recentpublication in The Lancet by a

(01:28:01):
group out of Tufts, whom Iinterviewed on my last last
podcast.
Now, you layer that uh what wejust discussed.
Many older adults can't chewproperly.
You know, like I'm an oldmaxillofacial surgeon, I deal
with patients that come in withyou know atrophy of the uh jaws

(01:28:23):
because they've lost their teethmany years ago, and they can't
chew because they can't getteeth.
So we end up in this viciouscycle, right?
Poor dentition, poor chewing,poor diet, hidden malnutrition,
and then more brainvulnerability.
Okay, so yet when patients tryto close the gap with

(01:28:44):
supplements, you know, first ofall, a lot of doctors don't
check for these micronutrientslike me and you do.
I know that because we see thesame patients.
And I always ask myself, howcome their doctor doesn't change
for micronutrient deficiencies?
Because it's very cheap andeasy to treat, but rather they
dismiss it as expensive urine.
So as if everyone is alreadyeating perfect Mediterranean

(01:29:07):
diet, right?
So given the data that a thirdof older adults are
undernourished or at clear risk,and many can't practically
follow the ideal diet because oforal, social, or financial
limitations.
I think we gotta reframe theconversation about supplements
is such that me and you justdid, and we have been doing in

(01:29:28):
our practice.
And so the uh study wasinteresting that showed the
number of the teeth that youhave in your mouth is correlated
to your all cause mortality.
And they published it in TheLancet.
The cutoff was if you have lessthan or you have more than 10

(01:29:52):
teeth missing, which is you knowa little less than half your
dentition, your all causemortality goes up by 50%.
Why is that?
And your risk of diabetes goesup.
Right?
So here's the causality in allof this.
When you don't have teeth, youcan't eat a lot of the foods, a

(01:30:13):
lot of whole foods, a lot of thefoods that are good for you,
because you can't chew.
So automatically you pick foodsthat you don't have to chew
much, and much of that food isultra-processed foods.
So I I'm curious to see ifthat's something that you have
considered.
And if not, do you think youare going to consider now

(01:30:37):
evaluating patients and bringingthat as perhaps a fifth uh
sixth pillar?
How many pillars did you have?
Five as a sixth pillar intoconsideration and discuss these
issues of uh oral health withthe oral surgery community and
the dental community so that wecan properly equip these

(01:31:00):
patients so that they can eatthe foods that help their brain.

Speaker 1 (01:31:06):
I totally agree with everything you just said.
It's unfortunate that good foodis so much more expensive than
junk food.
It's so sad.
Because you know, if you wantto buy a pound of grapes, it's
more expensive than like two bigmags, you know.
Yeah.
And uh it's really surprisingthat you know, if you want to

(01:31:28):
buy blueberries, you just haveto buy it like a small little
cup, you know, and then you goto these fast food restaurants
and they give you the full mealthat fills you up.
And people have financialproblems obviously have no
choice but to eat because theyneed food, they need quantity,
they need to fill their stomach.
And that's unfortunate.

(01:31:49):
And I think people like thathave definitely need to consider
supplementation beyond whatwe're just talking about,
because they are naturallydeficient in light things, and
older people may also have lessaccess to cooking and and
preparing meals and and and justobtaining the ingredients may

(01:32:10):
be a challenge.
And I think it was veryinteresting that you just said I
I actually didn't know aboutthat study that yeah, it was
just recently published.
Yeah.

Speaker 3 (01:32:20):
So But it's something that we in our field have known
all along.

Speaker 1 (01:32:24):
Yeah, yeah.
People who have poor dentitionand poor gum health have twice
the risk of developingAlzheimer's disease.
Wow.
Um, and and some people whoreally dwell on oral health as a
major factor for brain health.
And the idea is that if youhave poor gum health, especially

(01:32:46):
the bacteria that usually livein your mouth and they belong to
your mouth as a part of theiroral macrobata.
It's they don't belong in thein the in the blood and
definitely don't belong in thebrain.
And so the argument is that theerosion of those blood vessels
allows this bacteria to seep into the blood, and some of them

(01:33:11):
eventually find their way insidethe blood vessels in the brain,
or they can cause blood clots.
There's increased formation ofblood, it just covers stroke,
which is what you alluded to isthe leakage into through the
blood into the cloud.
One is erosion of blood vesselsbecause of inflammation, and
the second thing is formation ofblood clots.
And so people who have poororal health are at higher risk

(01:33:34):
of developing strokes because offormation of blood clots.
And so I think oral health isdefinitely on top of a list of
things to consider fortreatment, and I think it's an
example of how we need to payattention to all the details.
Similar issues with hearing,see, a lot of older adults have

(01:33:55):
hearing problems, and everythingyou said about the mouth
applies to the ear becausepeople who have poor hearing are
far more likely to developAlzheimer's disease.
And a recent study, a placebocontrol study, showed that if
you provide hearing aid toelderly who have hearing loss

(01:34:15):
and have MCI, you revert them tonormal.
It's like it's like aneffective drug that would uh
convert someone from MCI tonormal is a hearing aid.
Because it because itstimulates the brain?
It's because when you don'twhen you don't hear well, you
don't process information, youdon't engage in information, you

(01:34:39):
don't process it.
The information is not comingin, you just disregard it.
You get used to just checkingout hearing it.
And same goes with oral health.
And you know, it just is socommon, people take it for
granted.
But if you don't get thenutrients and if you you can't
chew things, you just eatsoftware.

Speaker 3 (01:34:57):
Well, interesting about the chewing, they
monitored on the MRI as thepatients are chewing, the part
of the MRI showed activation ofthe brain just by mastic through
mastication.
Yeah.
So the so they they actuallyrecommended and they did a study
where they showed that if you,for example, chew gum before you

(01:35:18):
want to memorize something, orlet's say you just read
something and you you you wantto make sure that you remember
most of it, when you chew gum,because your brain gets more
active, you you will have uh uhimproved memory function of
that.
And so it's fascinating tothink of how external factors,

(01:35:41):
hearing, seeing, chewing,talking, uh listening to music
through activation of your braincan improve upon this
plasticity that you talkedabout.
And and so that's somethingit's fascinating.

Speaker 2 (01:35:58):
Just chewing, chew gum.

Speaker 1 (01:36:01):
I think our brain is like a muscle, the more you use
it, the stronger it gets.
And one way to use it is toapply information, and that's
why hearing or vision loss canaffect the brain.
I must say I hadn't heard aboutchewing part.
Yeah, it is.
They they did an MRI analysisof chewing, and it just lights
up.
Related, although I don't knowhow to explain it, is that one

(01:36:24):
study showed that people have asmaller temporalis muscle, have
a smaller brain.
So why do they have a smalltemporalis muscle?
Probably because they're notchewing.
I mean, I don't know.
I'm just I think in that studythey found a correlation between
a smaller temporalis muscle anda smaller mass of muscles to
understand.
In general, yeah.
In general.

(01:36:44):
I don't know why the twocorrelate, but they do.
In any case, I think the bottomline is in evaluating you know,
a lot of people get older, havea lot of little problems.
A study published in Lancet in2024 showed that 45% of dementia
cases in the world can beprevented through 14 different

(01:37:05):
interventions or addressing 14treatable conditions.
And this was a majorpublication in Lancet.
It's one of the most commonlycited papers.
This is not like my programwhere somebody came in and did,
you know, diet, exercise, braintraining, everything, like with
the way we did it.
They just looked atepidemiological studies to

(01:37:27):
determine what factorscontribute to dementia and the
burden, how much of a how muchof how much they attribute to
cognitive decline and dementiain the world.
And so they found things likeuh diet, stress, centered
lifestyle, hearing loss, visionloss, high cholesterol, a lot of

(01:37:49):
common medical issues we see onour patients contribute to
dementia.
And if those issues addressedwithout doing anything
additional, without doing braintraining, without like
necessarily doing anythingextra, if you just address the
treatable medical conditionsthat need to be treated anyway,
hypertension is one of them.
45% of dementia cases in theworld could be prevented.

(01:38:12):
Just think of it.

Speaker 3 (01:38:17):
Unbelievable.
And how many billions ofdollars?
What we've spent a billiondollars on treating amyloid
plaques and tar and and and andall these Alzheimer research for
researching medication to treatAlzheimer's, where the problem
95% of the time is the rootcause that, like you said, 50%

(01:38:38):
can be treated.
So, do you think we've wasted alot of time, money, and
resources and just advanced somescientists' careers by
researching Alzheimer's, wheremost of the research uh has been
going towards treatment ratherthan prevention?

Speaker 1 (01:38:57):
I think a lot of people who do research are
honest, sincere people doingresearch.
I think amyloid has gotten moreof its share of attention than
all the other contributingfactors.
Why do you think the questionis why?
I think I think the questionpart of it is because people

(01:39:20):
want a drug for everything.
And if we talk about high bloodpressure and cholesterol and
stress and poor diet being afactor, that's not something you
can make a drug for and treatit.
A lot of uh from schoolcompanies and researchers
falsely have believed that ifthey s just stop the amyloid,

(01:39:45):
they cure the Alzheimer'sdisease.
First of all, I thinkAlzheimer's disease is not a
good name for the cognitivedecline that happens with aging.
See, in the brain, you haveplaques and tangles, which are
hallmark of Alzheimer's disease.
However, you get Alzheimer'sbecause your brain shrinks due
to a dozen reasons, the superproblems.

(01:40:05):
And plaques and tangles are thetwo of the super problems.
And so you're naming the wholebrain problem after one feature.
And I wrote an article aboutthis in 2009 about how we need
to reconsider and callAlzheimer's disease, you know,
mild cognitive impairment,moderate cognitive impairment,

(01:40:28):
and severe cognitive impairment.
Because if you call it severecognitive impairment, you don't
blame it on one or two factors.
You're you're just saying youhave heart failure.
So if somebody has heartfailure, you don't call it
amyloid problems.
There are people who have toomuch amyloid and experience
heart failure.
That is true.

Speaker 3 (01:40:48):
But that's not the call, yeah.

Speaker 1 (01:40:50):
Because that you don't call it.

Speaker 3 (01:40:51):
Yeah, amyloid is the symptom, is is the smoke.

Speaker 1 (01:40:54):
The fire is elsewhere.
So I think the problem is thisthat amyloid has gotten more of
its share of attention in thepast two, three decades.
But it has not always been likethat.
Things change every 40-50years.
In the 1950s, blood vesselswere a problem.
They was called hardening thearteries.

(01:41:16):
What we call Alzheimer's nowused to be called hardening the
arteries.
And you know, 50 years fromnow, people probably would look
at something else.
And I think it's human natureto just follow the leader.
And sometimes a group of peoplebecome particularly powerful
and they set the tone for whogets these grant approvals.

(01:41:37):
So if you have a grantapplication for Alzheimer's
disease and you talk amyloid,you're a lot more likely to get
funding than if you work on someprotein unrelated to amyloid.

Speaker 3 (01:41:48):
I think a lot of our research is guided because of
what you just said.
And until that changes, we willbe chasing our tails for
decades, spending billions ofdollars in resources where a lot
of people make a lot of money,they make careers for
themselves, but the consumerdoes not benefit from it.
The patient doesn't benefitfrom it.

(01:42:09):
And I wish we had in themedical profession more of the
fatohis and the people thatactually treat and look for the
root cause and make a hugeimpact.
I mean, the numbers that youwere saying, they are
mind-blowing.
And I I I know because I talkto colleagues, I'm pretty sure

(01:42:31):
that majority is not aware ofthat.
And yet you have spent whatthree decades of your career
just doing that in yourbackyard, and now you're going
out and trying to shift theparadigm after three decades of
failed Alzheimer's research.
I think once our system changesin how we fund research, then

(01:42:53):
we can advance medicine muchfaster than we already have
been, and not rest on ourlaurels.

Speaker 1 (01:43:01):
Now, here's one more interesting statistics, which is
fully confirmed multiple times.
Uh, stroke is the number onecause of disability in the
United States, and it's thesecond leading cause of death in
the world.
And 80% of strokes can beprevented.
80%.
Yeah.

(01:43:21):
Just think of it.
And and of course, strokes orreduced blood flow to the brain
is a major contributor tocognitive decline and what we
call Alzheimer's disease.
And so an 80% reduction instroke would be a huge reduction
in Alzheimer's.
And it's it's by American HeartAssociation.

(01:43:43):
This is not just somebody justmaking this up.
It's reported year after yearafter year.
Is it 80%, 80% of strokes inthe world can be prevented
through treating the modifiablefactors like as hypertension,
stroke, I mean hypertension,obesity, diabetes, centered
lifestyle.

(01:44:03):
These factors, not smoking, allthese factors can prevent the
number of strokes, 80% ofstrokes, and stroke is the
number one cause of disability,number one cause of disability
in the United States.
And you can reduce by 80%.
I know.
And why hasn't it happened?
Because a stroke doesn't havean amyloid, the stroke doesn't

(01:44:26):
have one type.
Think that we can medicate,yeah.
Yeah.
Stroke requires exercise,weight loss, you know, poor, you
know, healthy diet, active.

Speaker 3 (01:44:35):
Well, think of the financial burden alone.
The financial burden that itcarries with it once a patient
has stroke and survives astroke, similar to people with
severe cognitive decline.
I'm not calling it Alzheimer's,I've learned, so I'm a good
student, with severe cognitivedecline, CDI, that simply the

(01:44:56):
financial burden on our societythat it imposes, if you know,
from both a health perspectivefor the patients, the social
aspect of it, and then thefinancial aspect of it for our
society.
I hope that that changes.
I hope that through socialmedia, through podcasts, and so

(01:45:17):
where we're not relying oncertain groups where there's
groupthink involved or there'shidden agendas, we're not
relying on traditional media tomaybe put it on the evening
news.
Through podcasts, throughsocial media, we can spread.
So and I believe, and at thevery beginning of our podcast,

(01:45:38):
you said something that you saidin the past decade, the number
of Alzheimer's has gone down.
I believe it is because of theeasier and faster spread of
information because of theinternet, that more people have
access to information, good orbad, at scale, where they can

(01:46:03):
make their own decisions basedon their own research,
questioning their doctors,asking the right questions, and
moving the needle in their ownhealth department.
And I think that ourtechnological advancement has a
huge thing to do with that,because otherwise I can't

(01:46:24):
explain it.
And this there has been, you'veprobably noticed it in the past
five years alone, since COVID,this huge health and longevity
movement that is part of that.
People were sitting thinking,oh well, I guess we're dying of
COVID, but the people that aredying of COVID are the unhealthy
people.
So, hmm, let me put two and twotogether.

(01:46:44):
If I get healthier, I have alesser chance of dying of COVID.
How can I get healthier?
And all of a sudden, peoplehave become more aware about
become more health conscious,and they have their health IQ
has risen.
And I think that in part has todo with it.
And I'm very optimistic aboutthe future, and I'm very
optimistic that I feel the cat'sout of the bag, and it's gonna

(01:47:07):
be a big change is coming in thenext decade, and I'm I'm really
excited about that.
So thank you so much, Majeed.
We have almost coveredeverything I wanted to cover,
but the good news is that whatI've learned today is that we're
not prisoners of our genetics.
The uncomfortable truth is ourfuture brain is being built

(01:47:30):
right now in our 40s, 50s, 60s,with every decision we make
about movement, food, sleep,stress, and how we challenge our
minds.
So, Dr.
Fatui, thank you so much forsharing your science, uh your
clinical experience, and yourhope uh with us today.
I can wait uh for people to Ican't wait for people to read

(01:47:51):
your new book, The InvincibleBrain, including myself, and
start applying these tools totheir own lives and hopefully
you can change millions of livesuh and uh their practices for
the professionals out there, forour colleagues that are
listening.
So, for everyone listening, ifthis episode resonated with you,
please, please, please share itwith a friend, parent, or a

(01:48:14):
patient who needs to hear thatdecline is not inevitable.
I'm Dr.
Daria Hamra.
Thanks for listening, and I'llsee you in the next episode.
Thank you.
Thanks, Darya.

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How to Age-Proof Your Brain and Stay Sharp for Life - with Dr. Majid Fotuhi

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}How to Age-Proof Your Brain and Stay Sharp for Life - with Dr. Majid Fotuhi