Your Brain On... Cheese

Welcome to Your Brain On Podcast with your hosts, Drs. Aisha and Dean Sherzai. We're so excited to be back after a break. It was a memorable break. We had a remarkable year last year. Lots of good and bad things, but this year is going to be absolutely amazing. We have some incredible topics ahead of us. Yes, the year was packed and we had our ups and downs, but we are energized to be back and be connected with you all. today's conversation revolves around an interesting nutrition related topic which is does cheese and cream protect your brain from alzheimer's disease pretty interesting topic yes it is and so this was published in a high-ranked journal the journal of neurology we call it the green journal in you know our field it's a very reputable journal with a good peer review process and the paper was published at the end of December around Christmas time and it just blew up. It became viral and we saw these headlines all over including BBC, CNN, New York Times, KTLA. Everyone was talking about it. And it was essentially not even a question. It was a statement that high-fat cheese and high-fat dairy products including cream can't prevent dementia based on this research which was interesting. What did you feel when you saw those headlines? I'm always thrown aback when in the face of decades of information, a new piece of information that comes that's completely contrary. I'm one that actually is very open to paradoxes, to altered states of data, altered realities of looking at things at completely different perspectives. That's the whole concepts that we as a family have grown around. Science is changing in the face of new data. You also have to be somewhat incredulous because science doesn't work with a sudden jolt. Science is patterns. Science is directions. In general, yes, somebody can come up with a quantum theory for the first time and things of that nature. But in slow sciences like nutrition and psychology, patterns matter more than the sudden discoveries. So you always have to be incredulous. you always have to be open to looking at the data and see what was it that demonstrated this kind of a finding, which is in the face of decades of contrary data. Yeah. And whenever some, you know, there's a headline about a food or one vitamin or one micronutrient protecting the brain or damaging the brain, I always find it almost comical because we now know from lots of research that we don't eat one food. We eat multiple different foods and it's the interaction between them that matters. And one food driving such a strong relationship, I was like, OK, let's just hold on. Let's look at the entire thing. But at the same time, though, I mean, we have to be very aware of our own biases. One thing that is critical for all of us in society to incorporate into our, I'm afraid of the word inculcate because I've used it so much, embed, instill into our consciousness is looking at the data as much as you can be devoid of bias. Now, the reason I say that is because we don't eat cheese. And we haven't eaten cheese in a while. Animal, dairy-based cheese. Exactly. Exactly. But even within plant-based cheese, we try to go very healthy. Oh, I make it, remember. Exactly, you make it. The homemade cheeses. Healthy as far as what we consider, which is saturated fat, low saturated fat. Once in a while when we go out to eat a veggie burger, maybe a melted veggie cheese or a plant-based cheese, it's not that bad. I'm the only one that stays clean and I'm having the lettuce and the tomatoes. You guys are just porking out. Junk foodies. But reality is that we have to be aware of our biases. If there's anything that I want us as a society to incorporate is to make sure that we don't do. The statement is people love hearing good news about their bad habits. And habits are not like children. You can't just throw love at them and hope for them to change. You throw love at bad habits, they become worse. Sometimes with children it's the same. But in general, you have to be very aware of your biases. And that's what we should all start with. So with that said, we wanted to kind of check ourselves. And we're open to changing our views and changing mine. So we went into it full force. I'm actually really glad that you talked about this at the beginning of this conversation, even though it's not in our bullet-pointed notes or anything like that. What bullet-pointed notes? I have one right here on my laptop. But I'm really glad that you brought that up because that's important. And every conversation, especially when it comes to nutrition, should be couched in what our biases are, how we look at things, and how we hold ourselves accountable, and how we want the audience to hold us accountable. If we go astray, we should always use an evidence-based approach, look at the data. And that's exactly what we're going to do today. And the strength of the data, the design of the study, and validity of the design. And the weakness of the study. And the weakness of the study. Right. And as I've said many times, I'm in charge of clinical research at the university, and I have lots of students that are working with me. And what is the one thing I always say? When you're writing a paper and submitting it for a review for acceptance, if you can write your own limitation sections better than any reviewer, that paper is going to get accepted. So tear apart your own paper. Find all the potential flaws. Then the reviewer says, oh, my goodness, this person is so unbiased that if they tore up their own paper better than I could ever do, then it must be good. And that's the approach we should take because the objective is not finding our comforts or finding relief for our comforts or finding support for our biases. The objective for us as a society, and you're going to hear this repeatedly, exhaustively, because we are at a time in history where people play with information. And the only recourse we have as a society is to gather together around not outcomes that we have already put ourselves into camps, but around how we reach truth. And the how of it is so critical. The how of it is systematic. It's scientific methodology that have been well proven and we can all follow in steps of strength. And if we all play that game, nobody can manipulate the outcome with emotional statements or with the marketing techniques. So with that said, let's go into this paper. Beautiful. All right. So this was, and I'm just pulling up my notes here to take a look at the paper and make sure that we give you guys a very thorough understanding of what this paper is about. Like I said, it was published in the Journal of Neurology, and the authors were a combination of different authors, but mainly from a university in Sweden. And it was a long-term health study. It's a prospective observational study, which means that they started looking at a big group of people a long time ago, and they just followed them to see how the association of eating dairy products, specifically they looked at all of dairy, How does it end up as far as its association with Alzheimer's disease is concerned? There's retrospective studies and prospective studies. We've done a lot of papers on both versions. So retrospective is a lot more accessible to all of us. All the data that's been collected on patients going backwards 5, 10, 20, 30 years. And there are different databases that have different level of information and robustness. And those are valuable because you can look back and see this relationship can be found. And you can do it in a way where you can reduce the bias. So retrospective studies are valuable. They are not the ultimate. They are not the gold standard, as in results found by looking at retrospective studies can't be used as a standard of care going forward. But they are great strength. They give great strength towards a direction of belief, scientific belief. Yes, science is also a system of belief. by the system of belief that's justifiable, repeatable, and all of the other variables that we talk about. Prospective is a little stronger because you're going forward, identifying your population. So you're not just collecting anything that came willy-nilly. That's a scientific term, willy-nilly. Yeah. Identifying your population, usually within a certain age group. So you already have some measure of control and following them forward to see all the things that have happened to them going forward. Sometimes you intervene. That's an interventional perspective. But sometimes you observe. Yeah. And like you said, I think it's very important for people to know that these observational studies are very useful because we have some people who say that epidemiology is just they poo the whole genre of research, but some of the most important nutritional information that we have right now that has helped us shape our understanding of how food impacts our health and disease outcomes come from epidemiological observational studies. The strength, the robustness matters. When your epidemiological study is large, 10,000, 20,000, 30,000 large, that's incredible, powerful data. Even case studies, anecdotes. If you have 7 billion anecdotes pointing in the same direction, that's no longer anecdote. So the strength of the given epidemiological study data is important. Absolutely. All right. So this was a long-term prospective observational study that happened in Sweden. And I'm looking at my notes. The cohort was called the Malmo Diet and Cancer Study. So they basically followed 27,670 people over 25 years. And the mean age of the participant was about 58 years old when the study started. And everybody filled out a detailed survey. So they gave them some questionnaires and they interviewed them about what they ate. And they also included a seven-day food diary. And then the researchers tracked them and found out who developed dementia, who developed the different types of Alzheimer's dementia versus vascular dementia after 25 years. And a one-time interview, and then there was nothing. And then they basically followed them for 25 years and looked for who developed dementia, whether it was Alzheimer's or vascular dementia. So you tell me there was no questionnaire in the middle and no dietary and lifestyle questionnaire at the end. No. And so one of the things that in nutrition research that comes up and it can be a potential issue with the kind of nutrition studies that we have so far Hopefully they change in the future with technology and better data capture. But asking someone years ago what they ate and then following them after 25 years and see what the relationship of diet and the disease outcome is, that kind of is problematic. Very problematic. What did you eat 25 years ago? 25 years ago. Gosh, we've changed quite a bit. That's like before you and I got married. What was I eating? Yeah, basically a lot of animal products. Animal products, yes. So that's an issue. I just want to flag that. And what did they find out? So they found out that people who ate more than 50 grams of high-fat cheese per day, that's two slices of cheese or a small wedge of cheddar, brie, gouda, you know, those hard cheeses, had a 13% lower risk of developing dementia. And those who had 20 grams or more of high fat cream daily, which is about one and a half tablespoon, also had a lower risk of developing dementia. And then they looked at low fat dairy product. Those who consumed low fat dairy products like yogurt or skim milk or low fat cheeses like cottage cheese and things like that, they did not have the same effect. So basically, that was it. This was the highlight of the study that was just blown up into all of the news channels. And everybody just picked that and ran with it. Influencers saying, oh, yay, start eating cheese. I have a question. Cream in your coffee. Yes. The original population, the control group in this case, which is the low fat, they literally had low fat cheeses or the baseline group had a lower amount of cheese. and the group that actually showed response had a higher amount of cheese. Because the act of reducing your cheese specifically and reducing your cream specifically has some unique characteristics, right? There are particular kind of people have reduced amount of fat, fatty cheese or fatty cream, as opposed to those that have the baseline amount of fatty cheese and fatty cream. We have that kind of data as far as the socioeconomic, education, all of that. So that's a really good question because in the supplemental data, when they looked at people who had cardiovascular diseases, so say, for example, if at baseline, when they removed people who had diabetes, who had heart disease, who had high blood pressure, which they typically are very careful with the amount of fat that they eat, when they removed that population and they kept the study population very clean and healthy, the association of cheese disappeared. Oh, wow. Okay. So when the whole data, when the sick people were there as well, there was an association? Yes. So when there were sick people, there was an association. But when the sick people were removed and it was all healthy, basically that strength of cheese was not there anymore. It didn't really make a difference as far as dementia outcome is concerned, which tells you that basically what we're seeing could potentially be a healthy user bias. One of the things that the headlines didn't tell us was just because people ate more cheese and had less dementia didn't mean that cheese was the reason for it. And you see that in the supplemental data. Typically, when a large study like this is published, when they characterize the population for us and then they show you all of the raw data, they're usually not placed in the main body of the paper. A lot of the papers have another PDF document that is not as pretty as the paper, and it has all of the raw data. And it's usually published right next to it on the same paper. You just have to look for it, scroll down. It's like this tiny little thing in the corner, and you have to download it to take a look at it. People rarely take a look at it, and there have been some mentions of the supplemental data in the paper as well. So we did when we looked at it. What we found was really interesting, and I think that's a really great thing to have access to the raw supplemental data. Absolutely. So they did some supplemental analyses, and I'm actually going to just read a couple of things that we found out. When you look at the supplementary data, the picture changes completely. When they excluded people who already had conditions like diabetes and heart disease, the apparent benefit of cheese became smaller. Really small. To the point of insignificance? It was marginally insignificant, and I can actually pull up the hazard ratios to show you. And then when they removed people who had developed dementia earlier, so nobody had dementia when they started the study. But say, for example, in the first five years, if anybody developed dementia, when they removed that and looked at the analysis, suggesting that the disease was underway, the effect actually weakened again. So getting rid of people with cardiovascular disease weakened that relationship. Getting rid of dementia patients that had developed their symptoms within the first five years weakened the relationship. And then when they looked at only people with overall healthy diet, because they did check healthy dietary pattern, cheese provided no benefit whatsoever. So it became almost a neutral component in that dietary pattern. And all of this is really important because it tells us that the apparent association depended on people's underlying lifestyle and their health and not the cheese. Really, really a very important point that was not discussed in the paper at all. It's a massive confound that is easily understandable by researchers. This is a little bit worrisome that why wouldn't the legitimate researchers at least speak to this? Absolutely. The statement or the conclusion that I came up with was that cheese wasn't independently protective. It was a marker of good health and good lifestyle. That is a very important thing for people to know. I want to kind of emphasize this further. Again, this is about all of us learning epidemiology and how to look at data. If there's anything that should be taught in high school, it's two things. Epidemiology, which they're trying to denigrate and reduce and make insignificant. It's about how to look at the world around us, how to look at the data and the relationships of data around us. And then, of course, statistics. Everybody should become familiar with these things. And if we do, then we can really not be fooled by biases, by confounders. As people go towards sickness, their diet changes years before. That's why getting one dietary questionnaire at the beginning and nothing going forward means absolutely nothing in many ways. Or at least just say that the relationship is kind of weak because we only checked it one time. Don't make a headline out of it. Exactly. I wish the weight of the interaction between diet and dementia was further elaborated up front instead of doing not a very strong study, but then making a gigantic statement about it on news channels. That's my problem. Let's move on to some of the other things that the paper actually showed. The researchers looked at genetics. So they looked at the APOE4 status and people who had the APOE4 gene, which increases the risk for Alzheimer's disease, didn't really benefit from eating cheese or cream. So if someone has a family history of Alzheimer's disease, the study actually does not give you any reason to start eating cream and cheese, which is an important point. Now, the APOE4 point is critical. In Alzheimer's disease, in fact, many of the treatments that work on Alzheimer's, as far as even symptoms, we don't have a good treatment, but as far as symptoms, they pivot around APOE4. If people have APOE4, they respond differently than those who don't. When it comes to vascular risk, same thing. APOE4-driven Alzheimer's disease is very different than non-APOE4-driven Alzheimer's disease. And that pivot point tells you a lot because a person with APOE4 is not affected by the treatment. That means Alzheimer's or purely APOE4 or amyloid-driven Alzheimer's is not affected by it. Then it has to do something with vascular risk factors, and it has to do with a person's lifestyle throughout their life. That's another confound that was not discussed. And going back to the impact of eating cheese and cream and Alzheimer's disease, look at the statistics, Dean, the hazard ratios, breaking it down into more understandable terminologies. Over the 25-year follow-up period, about 11 to 12 out of every 100 people in this study developed dementia. In the group that was eating the most high-fat cheese, that number dropped to about 10 to 11 per 100. The impact was tiny. Here we're talking about absolute risk reduction and relative risk reduction. The absolute risk reduction was very small. It's like when people said certain medications would come and pharmaceutical companies would say there was a 33% reduction in risk. And then when you looked at the data, it actually went from three to two. The absolute cases out of 100. Yes. So the absolute risk reduction was 1%. The relative risk reduction was 33%. Correct. So that matters. Just wanted to highlight that that was a very small change. So in this one, the absolute risk reduction was 1%. We're talking about, in real world term, one fewer case of dementia per 100 people over 25 years. Yes. And that's before we take all the other confounders into consideration. Exactly. So I had the pleasure of speaking with Dr. Emily Sonestad, who is the lead author of this paper. She was very kind. and she spoke with me about the paper, and I posed some of the questions. Here's our conversation now. Dr. Stanistat, thank you so much for joining me today. As I was saying, this conversation is going to revolve around your recent, very exciting paper about the consumption of dairy products and Alzheimer's disease. Your study got a lot of attention globally, and it's rare to see cheese and dementia in the same headline. I wanted to ask you, what drew you to explore this question of looking at dairy products and cognitive health in general? Yeah, so I have been interested in dairy consumption for a long time. So my main focus has been on cardiovascular disease previously. I have a background in nutrition, but I have specialized in cardiovascular disease. And now we started to collaborate with dementia researchers. So it was quite natural to also look into dairy consumption and risk of dementia in the same cohort that I have been using for a long time. Yeah, absolutely. In your own words, if you don't mind, explain to our amazing audience, what were the findings of the paper that you looked at? I read your paper back and forth but it would be wonderful to hear your take on it as well Yeah so it a prospective cohort study and we looked into different dairy products The main finding was that it was the high fat cheese and also cream that showed protective association for the risk of dementia. It's a long-term study, so it's 25-year follow-up. We also looked into whether the genetic variant, APOE, modified the association. And it's also interesting that we saw association with among those that didn't have this risk elite also that high fat cheese showed a protective association. Yeah, I saw that the link was lower for especially for vascular dementia, which basically means that people who consumed high fat dairy products, specifically hard cheeses and cream, had lower risk of vascular dementia. Is that correct? Yes, that's correct. So we also looked into specific subtypes of dementia and a stronger association with vascular dementia. I guess the one thing that kind of was a bit interesting in this pattern is we keep hearing from other large prospective studies that have been validated over time, whether it's the Framingham Heart Study or the Northern Manhattan Study, large cohort studies in the United States that have followed a large number of people for a very long time, decades, sometimes even three or four decades. There's a very strong association between consumption of saturated fats than sometimes high-fat dairy products like cheese and cream. They usually come with high saturated fatty acids and increased risk of neurological diseases, specifically stroke. And now there's a very close relationship between Alzheimer's disease and consumption of saturated fats as well, to the point where just a few months ago, actually last year, the Lancet Commission for Dementia Prevention, which is a large body that puts out a report every three, four years, they included high LDL cholesterol as one of the modifiable risk factors for Alzheimer's disease. I was wondering what your thoughts on with regards to that relationship. Saturated fat increases the risk of heart disease, stroke, and dementia, but in this paper, it showed that people who consume higher saturated fatty acids and dairy products tend to have lower risk of vascular dimension Alzheimer's disease. I think I had an interest in sources of saturated fat. From previous research, it seems that dairy consumption or saturated fat or those sources, we don't see the same association with cardiovascular disease. For example, meat. Some studies have even shown protective association with cheese for cardiovascular disease. And that has been shown in other studies, including the US. It's very interesting that it might differ depending on the sources of saturated fat. And that's why I do think it's important to look into different food sources. Like cheese is not just fat, it's so much more. So yes, it's important to look at them separately. Definitely. I think it's really important for us to kind of break down the different components in high-fat dairy products to see which element is the one driving the benefit and which element is neutral and which element is harmful, right? Because in spite of having some harmful components in our dietary pattern, people live longer and they do well. So I agree with you. I think we need to, it's an exciting area to study more. Speaking of the paper and the analysis itself too, I noticed, and especially in the supplementary document, that the association seems to weaken when you adjust for overall health, and especially in one of the analyses included in the supplemental data, when you exclude early dementia cases, that association seemed to weaken. Was that part of the reason why, in your statement, you've emphasized that this was not a causal finding? I think, so in the cohort, there were no dementia cases and baselined. What we did was that we excluded those with cardiovascular disease and diabetes at baseline. I'm not sure if it was weakened. I don't remember all the analysis. We did quite many analysis to look at if the analysis were robust. Sure. I was specifically referring to the sensitivity analysis that you had included in the supplementary data. And I'm actually looking at my notes. There were a couple of tables and specifically in the supplementary table, E7, you basically looked at the participants with no major chronic diseases at baseline. So people did not have any diabetes, stroke, cancer, cardiovascular disease. And if you look at the row for high fat cheeses in that table, you'll see that the hazard ratio drops closer to one and it loses its statistical significance. And same goes with the high fat cream as well, which basically told me that in this healthier subgroup, the protective association of cheese is essentially gone. And that could suggest that initial effect may be partly because of those who ate more cheese also were healthier. And I think that kind of shines some light on the fact that people who have access to cheese might actually have access to better health resources as well. Could that be one of the elements where we actually saw that people consuming cheese had lower risk of dementia because of better health in general or better access to health. I'm just wondering what your thoughts are on that. Yeah, so we saw that those consuming a lot of cheese, they had lower level of people with cardiovascular disease, type 2 diabetes in that group. So they seem to be healthier in that case. But yes, and the association would weaken, still statistically significant when they excluded the prevalent cases, but it is very complex to really say, yeah. So that's why we did all those sensitivity analysis. Absolutely. And then when you look at the genetics as well, in the paper, you mentioned the supplementary data when the participants were split into APOE4 carriers and then APOE4 non-carriers. The association between cheese and dementia risk was not significant in carriers of APOE4, which is the group most genetically at risk for Alzheimer's disease. And that's a very important point because basically it suggests that the mechanism more related to vascular health rather than Alzheimer's pathology, which you do mention in the paper. Again, consumption of saturated fat has been associated with increased risk of vascular dementia and Alzheimer's disease. And then this paper flipped it around and said, no, it's actually protective. I wonder what the next steps are. What are you guys looking at to figure out what are some of the things that showed that reverse relationship compared to what we have studied so far? Yeah, so I think next step where we're planning to try to replicate this, we will see if we can see the same association in other cohorts, mainly in Sweden. But I would love to see more studies in US, for example, where cheese consumption might be related to other health behaviors. I think in Sweden, maybe we eat cheese in another way. So I think it's so important that we try to investigate this in other population. That's the first step. But then if we can replicate it, if it's something, then we will have to look into why. Most definitely. Absolutely. It's a very exciting field and we're very excited to learn more about it. Typically the dietary guidelines and when you look at different dietary patterns, specifically the Mediterranean diet pattern or the MIND dietary pattern that has been studied quite extensively in different populations, they all propose a diet that is lower in saturated fatty acids. So low-fat dairy products seems to be healthier than high-fat dairy products. Now that we're actually looking at this association, it would definitely require some rigorous research to find out whether it's a component of the dairy that was helpful versus the saturated fats. I know I keep on harping about that, but it's your paper. I think it's really important for us to interpret the headlines because it's basically suggesting everything that was not suggested in the previous data and the previous dietary guidelines as well. And I was interested in talking to you because when I looked at the supplementary data, I thought, and I may have been mistaken, in the supplementary data, you excluded dementia cases in the first five years, and the hazard ratio for high fat cheeses weakened. So I thought, okay, maybe in the main body of the paper, when you presented it, the dementia cases were included, but in the supplementary, you excluded, and that's why the relationship changed. Did I get that wrong? We excluded those 10 years of the baseline. So trying to get rid of those, maybe, yeah, like getting diagnosis for dementia, it might take some year. And it's actually, it's, I don't know, it's still, I think it's even stronger when we excluded those. It didn't weaken excluding them. So that might be, yeah, trying to get rid of, or trying to handle it, that it might be that someone that already had dementia at baseline or within the couple of years after to exclude them. So that's one sensitive analysis. I see. Okay. And then as far as the APOE status relationship is concerned, so there was really no benefit for APOE4 carriers. So the genetic interaction basically was suggested that if someone has a family history of Alzheimer's disease, which connotes APOE4 carriers, they probably will not see any benefit from eating high-fat dairy products. Is that correct? Yeah, it might be that the genetic components is so strong. So this is for the cases where it's more lifestyle related. Amazing. As a scientist, how would you communicate nuance with the public, especially given that the whole goal is to help society understand what kind of foods they need to consume to improve their brain health and to prevent devastating diseases like Alzheimer's disease and stroke and vascular dementia, given that your paper showed that high-fat dairy cheeses could be preventive. And I know I loved your language. Your language is very nuanced in news outlets. Everybody was running to the shelf to start eating high-fat dairy products, but you said, no, this is an observational study and we need to study it furthermore. I would love to hear it in in your own words what would be your general message about the results of this paper to the public as they try to understand how they need to improve their dietary patterns for their brain health I would not recommend people to start eating more cheese based on these findings. It's more, yes, it's an observation that in a dietary pattern, healthy dietary pattern, cheese can be a part of it. So you don't have to exclude it. based on the MIND diet, it should be avoided, which I think we need more evidence to say that it should be avoided. And now we see that it could be the opposite or at least not detrimental association. But this is one study, although there are some studies that have seen similar associations. But to come up with recommendations, I've been part of the Nordic Nutrition Recommendation. So I know all the work that you have to have quite strong evidence to change the dietary recommendations and guidelines. When the neurology, the journal, wanted to have a press release and I thought, oh, how will we communicate this? Like trying to really answer it in a moderate way, but it's so difficult to get all the nuance how research works. I can imagine how difficult that can be because as a scientist, you're responsible for the kind of language that you use. I've written papers as well and you very well know how important it is to expand on the limitations of any papers. You always put the limitations in the discussion, and in the discussion you take a very nuanced approach, and you always couch every statement by saying there's more research that needs to be done for us to understand this interaction. So I really appreciate it. I'm very concerned, though, on the other side about the public narrative that is being shaped with the viral headlines about this, and especially because saturated fatty acids and our dietary patterns have been associated with the number one killer in the United States, which is heart disease. And the entire goal is to reduce saturated fat consumption as much as possible. And so the way the conversation is shaping and how people are taking this information and posting it on their social media and talking about it is like, oh, everybody told us to stop eating cheese and now cheese is great for you. So let's go ahead and start eating cheese again. That could potentially be dangerous because this is one paper that saw a different association and now we have to wait for better data to come out to understand that nuance and not really necessarily change the guidelines that have been trying to lower the risk of heart disease and Alzheimer's and stroke. Yeah, good. I'm glad you agree. What are some of the next steps of looking into this? What are you and your colleagues interested in looking at moving forward? Are there different ways of looking at the data? Are you recruiting any more members? What's the next plan? Yeah, so we are have some studies in the same population, same cohort. I'm also very interested in added sugar and different sources of added sugar, like if there's a beverage or not, and chocolate and so on. So we have one paper submitted on that. And also interested in, I think, specific meats. I think it's very interesting because I've been in the cardiovascular field and now moving into dementia. I think it's a very, yeah, it's a super interesting field. Oh, absolutely. And there's a lot of overlap between the risk factors between cardiovascular disease and Alzheimer's. Like you said, eloquently, they used to be completely separate. But now we're actually seeing that a lot of pathological changes that happen in the brain, even amyloid deposition has a very strong vascular origin and with the genetics like the APOE4 affecting how cholesterol is metabolized in the body. It's really interesting to look at these small little elements in our lifestyle. If I had to ask you to speak with the public right now, because I know a lot of our lovely audience are interested to hear from you. They've seen the headlines, they've seen the virality of your paper, and here you are, the amazing researcher who actually put out that research. What would you tell them about those viral headlines? Yeah, to take a step back and think about what do we know about protection for dementia, keeping the weight, the blood pressure, the blood lipids, and no smoking and exercise, of course. So there is a lot of things and it's everything in your lifestyle. I would say don't focus on one particular thing. It's so important to have a healthy diet. Cheese can be part of it, but it shouldn't take a major part. I think that's beautiful. And you've spoken like a true scientist, looking at the bigger picture rather than one element at a time. That's basically all my questions. I wish you the best of luck. And I'm so grateful to you for your time, for your interest in science, for looking into these things that gives us great answers and good directions of how we can take care of our brain health. As a physician who works in the clinic with dementia patients and with the number of dementia cases around the world, and especially in the United States, it's a pretty devastating disease and people are hurting a lot. And so thank you so much from the bottom of my heart for taking the time to explain and also for looking into these elements to help societies live longer and healthier lives. Thank you so much. So I'm really grateful for her time and for her expertise. I think I could have done a better job. I think I didn't really push her a little bit, especially at that part where I talked about the supplementary data and the analyses. You did a great job. You're just too nice. I recognized quickly after posing that question that she didn't really, wasn't ready to go there. Out of respect, I didn't push too hard. And this wasn't a confrontational conversation. The most important thing that we should worry about is why is it that headlines just become viral and a lot of people don't ask detailed questions? It's not their fault. I mean, I'm not saying it's the public's fault. And to be honest with you, the journals and the peer review system is making it even more difficult for them. Like Journal of Neurology is excellent. Yes. And something like this published there, we're like, okay, this is probably a really good piece of data. But here it is. We just broke it down and we looked at the supplementary data and these flaws were never discussed. I think I'm going to impugn Journal of Neurology and some other journals as we know they want to get acknowledged as well more and more. It's become a financial gain of some sorts because that piece of news just took over the world. And so everybody went to Journal of Neurology. Everybody started talking about the journal article, of course, by extension, the journal. I don't see any other way that this kind of data could have slipped through, especially in a scientific journal with high impact. You have a great point there. But just to kind of like step back from this paper and look at the broader data over decades, we've known that saturated fats that usually come from dairy products and from animal products have been associated with increased risk of Alzheimer's disease, vascular dementia, and even Parkinson's disease. Whether it's the Northern Manhattan study, whether it's the Framingham study, whether it's the Kaiser Permanente Northern California study, we've known over and over again, we've seen this pattern repeat itself that dietary patterns that are high in saturated fat can increase the risk of the said neurological conditions that I mentioned earlier. As far as the message is concerned, public health message is reduce your saturated fats as much as possible. And typically we want it to be less than 10%, ideally less than 7%. But if we keep on adding these high-fat dairy products, you're definitely going to raise it above 10%. Correct, correct. Absolutely. And I think that this was a—I'm not worried so much about bad science coming out or bad interpretation of science. because every occasion is an opportunity to learn how to look at data. Every occasion is an opportunity to look at the relationship between data and real life and get into discussions that elucidate. So I want everybody to challenge any piece of data, and especially your own biases. And that's the only way that us as a society will overcome this deluge of false science an interpretation that if not countered by good science, it's going to be pretty damaging. Yeah, very true. I am committed to following the full body of science, not just the slice that gets the most attention. Please make sure that you reduce your saturated fat intake as much as possible. Fats are great. You know, the type of fat matters. So polyunsaturated fatty acids that come from things like nuts and seeds and avocados and extra virgin olive oil or any other vegetable oil is great for you. Reduction of saturated fats that come from red meat, high fat dairy products, and even coconut and palm oil, if you can reduce it as much as possible, that's great. Absolutely. And when it comes to dairy, not all dairy is the same, right? Exactly. So yes, not all dairy products are the same. And in multiple studies, when they've looked at low fat dairy products, it's usually replacing something that is more harmful. So whether it's reducing either red meat or something that has more saturated fats. And compared to those, dairy products seem to be helpful. Absolutely. So we get some work to do, but the work starts with all of us looking at the data and learning how to look at the data and looking at our own biases and challenging thought processes with scientific method. And I would say if there is a statement that's contradictory to what we've known for a very, very long time, instead of jumping on that bandwagon because it serves our purpose. Everybody loves cheese. Instead of just owning that, maybe we should just pause and say, okay, just show me the data, what's going on. We don't expect everybody to be able to read the supplemental data. That's impossible. But at least pausing and not sharing and not making it go viral is something that we all can do as a public. All right. I hope this episode was helpful. I truly enjoyed it. Thank you so much for listening. This has been Your Brain On Podcast. And we have been your hosts, Drs. Dean and Aisha Shirzai. Until next time, thank you so much. Can we still say cheese when we take photos? Yeah, of course we can. Yes. Ready? One, two, three. Cheese. Okay. That's as corny. That's as cheesy as it gets. I'm not sure if we're going to keep it. Okay, whatever. It's as cheesy as it gets. Yeah. Thank you