Become an Alzheimer’s Survivor: Dr. Richard Isaacson’s Breakthrough Approach

47 million Americans are going to get dementia if we don't do something about it. People think of dementia in neurodegenerative disease as an older person's disease and it's not. Wow. We can detect changes in the brain decades before a person is going to develop dementia. We spent two trillion dollars over 400 studies in 99% failed. So we're thinking about this wrong. Dr. Richard Isaacson is a leading preventive neurologist and he's dedicated to the prevention of Alzheimer's disease. He was the founder and former director of the Alzheimer's Prevention Clinic at Wild Cornel Medical School. He now serves as the director of research at the Institute for Neurodegenerative Diseases. He heads the NIH-funded retain your brain program about retraining your brain and retaining your brain by doing specific practices that help you preserve your cognitive function. Take us down this sort of this framework of our current thinking and why it's flawed in the traditional neurological field and how you come to understand when you take a different approach. 45% of cases of dementia may be preventable. When someone comes into your office what are you looking at? What are you testing? We do this all now digitally. It's free. People can go right now and get an assessment and like learn about themselves and get automated brain health preventative care, preventive neurology care. How do you approach diet with all this? Women that have increased waste circumference are at a 39% higher risk of dementia. Two more things I want to cover before we close out. What about pharmacologic interventions because drugs have a role and also what about brain exercises? As you know I'm always talking about how central the gut is to living a long healthy life. A high quality probiotic is one of the most important things you can do for your gut which is why I have been recommending seeds DS01 daily symbiotic. I've reviewed hundreds of probiotics over the years but DS01 is the one I personally trust daily. Seeds DS01 combines 24 probiotic strains with a pomegranate based prebiotic for benefits well beyond digestion. Easing bloating, supporting immune function, strengthening the gut barrier, promoting clear glowing skin and even reducing visible signs of aging. Its patented capsule and capsule design ensures these probiotics actually make it to the colon alive where they have the most impact. That's why I joined seeds clinical board and why I recommend DS01 as part of any daily routine. Seed is offering my community 20% off your first month at seed.com slash hymen with the code 20hymen. Get yours today. Did you know most so-called health bars today have as much sugar as a candy bar? Most are made with refined sugar, artificial sweeteners, low quality protein and other ingredients that can spike your blood sugar, cause bloating and deliver very little nutritional value. That's why I recommend Paleo Valley Superfood Bars. They're made with eight plus organic superfoods and grass fed bone broth protein, which supports your gut joints and skin while giving you clean sustained energy. These bars are nutrient dense, protein rich and completely free from junk, a snack you can actually feel good about. They come in four delicious year-round flavors dark chocolate chip, apple cinnamon, lemon meringue and red velvet cake. And right now their pumpkin spice superfood bar is back for a limited time. It's seasonal, delicious and packed with clean ingredients. I keep these bars on hand for myself and recommend them to my patients. They're perfect for when hunger strikes and you need a snack that fuels your body, not spikes it. Head to paleo valley.com slash hymen for 15% off your first purchase and try them today. Well Richard, welcome back to the Dr. Hymen show. We had a few years ago a chance to do this over COVID. That was a long time ago and you have been a man on a mission. Things are very different. It's only been five years but again there's a lot more to tell about this whole topic of neurodegenerative diseases which is a crippling problem. It's the most expensive condition as Alzheimer's, more than heart disease, cancer, diabetes because of the long-term care and issues we have with it. The entire research enterprise pretty much failed to get an answer. There's a lot of sort of drugs that really don't work and if they work they're like extended, you know, your nursing free home time by three months is a big win and the drugs cost a fortune and you know we spent $2 trillion over 400 studies and 99% failed. So we're thinking about this wrong or 100% thinking about this problem wrong and so I want to sort of share a little bit about for you what is sort of the current thinking that's flawed and how should we be thinking about this from a both prevention and treatment perspective because no one is an Alzheimer's survivor, right? I mean there's cancer survivors, there's heart attack survivors but we don't really hear about this but there are and I've certainly had them in my practice and I know other doctors who are working in this field on the fringes are doing this but you came from Cornell, you're an academic, you're trained at Harvard in neurology, you've got the street cres and you've come at the same thing that I came at decades ago. Tomatoes getting thrown at us. Yeah, I mean you know, what do they say? You know the pioneers always have arrows in their backs, right? I'm still bloodied and bruised. So take us down here, you know, this sort of this framework of our current thinking and why it's flawed in the traditional neurological field and how you come to understand we need to take a different approach and even a concept that isn't really well accepted which is that you can actually prevent Alzheimer's. So you know, we don't live in a healthcare system, we live in a sick care system. The medical system is really positioned on treating disease and what does disease mean? Well disease means to most doctors a symptom, a problem, memory loss, dementia, treat then but any chronic disease related to aging, heart disease, Alzheimer's disease, Parkinson's disease, dementia with Lewy bodies, these are diseases that start decades silently in the body and brain and that's when we need to do something. So I had this crazy idea, oh Alzheimer's prevention clinic, you can't start, you can't use Alzheimer's and prevention in the same sentence, that's cookie talk and this was like over 15 years ago and what I wanted to do was not just treat people with cognitive decline and treat people with early dementia but I wanted to see their family members and treat their family members and in 2009 I got kind of taken away in a hallway saying Isaac, you got four family members with the disease, what do you, can we do anything to prevent, like what should I do as a son of a patient of mine? And we spent 45 minutes in the hallway discussing what he and I could possibly do and then next week I saw a sister as a patient and that was the first Alzheimer's prevention consult in the United States that I did and that kind of changed everything to me and to me we're thinking about things wrong, we're doing things all wrong and people think of dementia and neurodegenerative disease as an older person's disease and it's not. We used to joke called old-timers disease. I get it because we see people with dementia and they're older, right? But these diseases start silently in people's 30s, 40s and 50s and 60s and 70s, decades before symptoms and there are 47 million Americans and hundreds of millions of people globally that have these pathologic features, these blood markers that you can now check and these, you know, some cognitive assessments that you could do from the comfort of your own cell phone, we can detect changes in the brain decades before a person is going to develop dementia. So let's go then, let's do it then, let's see the person then but our healthcare system is like so broken that like I can't see a person to try to prevent dementia or reduce risk for Alzheimer's or reduce risk for Lewy body disease or dementia because there's no billing codes for it. I can treat someone with a disease after you have a heart attack or a stroke or dementia but we don't get paid for it because again I don't want to belabor this but our whole healthcare system is broken. So to me we just got to get ahead of things and the evidence, you know, the totality of evidence is overwhelming that we can do something and last time we talked I feel like I was doing cool stuff back then and now it's just totally different like the objective markers like the proof is in the pudding like we're able to do things today that are just like science fiction even five, 10 or 15 years ago so yeah I'm excited about the progress but you know it's hard to keep pushing things forward. It is you know and then you talk about the 47 million Americans, forget globally, 47 million Americans are going to get dementia if we don't do something about it and yet there is nobody pretty much besides you and a few others who are actually thinking this way. I did the math and if we left leave this unchecked the bill for Americans over the next 30 years is going to be 18 trillion dollars. That's basically the amount of our annual GDP one year. It's a huge amount of money and what you're saying is that it's really preventable. Now I want to kind of harken back to the flawed paradigm because in medicine we have this idea that you have a single disease Alzheimer's that's caused by a single pathway amyloid deposition which is this gunk. The gunk suck and in layman's term gunk's up the brain and makes it not work but it's really the body's band-aid where there's inflammation and we've tried to find anti-amyloid drugs for decades and we spent two trillion dollars let's say like I said 400 plus studies and massive failure. Why is that failed and what's wrong with that thinking and why should we look at a different framework that looks at each Alzheimer's patient differently. You say if you've seen one patient with Alzheimer's you're seeing one patient with Alzheimer's right? You took the words in the sentence right out of my mouth. I'm a clinician right I'm a doctor I see patients I talk to patients patients are my petri dish I don't study mice I don't I don't do basic science stuff you know over my head you're an old-time family doctor I'm an old-time neurologist you know carrying the bag and oh I'm calling myself old too so it's a we're all hippies we're all deadheads in the room so you know we're old in a good sense of the word but when you think about neurological disease and brain disease and what I was taught in medical school was like Alzheimer's is like this protein called amyloid and amyloid like you said is a sticky protein that builds up in the brain of a person with Alzheimer's and when you look at the brain of a person with Alzheimer's there's amyloid in it okay but like why are there up to a third of people that have amyloid in their brain but didn't have dementia well that's interesting well how does that make sense and then in the textbooks I remember I remember the graph and the amyloid goes first and then the tau protein the other next protein then brain inflammation and neurodegeneration brain cell death and those were the that was it that's how Alzheimer's work but that's not how it works in the clinic I'm a clinician I look at the patients you know that model of amyloid then tau then brain inflammation the neurodegeneration yeah that happens but in a recent study journal neurology it was like a third of the time that was the trajectory but all the textbooks say that's how it is the medical students are so to me there's buckets and different people present different ways and the way that I view Alzheimer's and I also the way I view neurodegenerative disease as a whole is it's very heterogeneous there are so many different types and manifestations and and even though this if the end symptomatology and the diagnosis is the same each of these patients might have different causes they need different treatment yeah you can take different roads to Alzheimer's you know women you know for example Mrs Smith she may be you know perimenopause the estrogen is dropping she may have a variant genetic variant called apoE which we could talk about apoE4 and you have the apoE4 and the estrogen drops well Mrs Smith she's going to need therapies A, B and C but Mr Jones he's totally different you know he doesn't have the gene he's different he has a big belly as a belly size that's larger the memory center in the brain gets smaller he needs a kind of more metabolic health and a different plan he's going to need therapies X, Y and C the bigger your belly the smaller your brain that's small the memory center exactly and there's lots of things we can do about it so you know different people need different paths and you know our medical system is broken I've said that a couple times but you know it one size fits all is is not how this works and we need to take a one size fits one approach and we call this N of one medicine and and the NIH has actually declared this is one of the most important and actually predictive forms of research and they're funding some N of one research trials but it still hasn't kind of permeated the funding really it hasn't permeated the thinking at all no and you know this is what you call it is precision neurology precision prevention that's exactly right precision or personalized it's it's not one's high spirits all taking this individualized approach it's you know he people hear the term precision medicine oh that's that's fancy expensive tests and no actually it's just like talking to the person and figuring out what road they may be on and whether it's doing a genetic test or doing some blood markers which you know the cost has come down doing cognitive assessments we do this all now digitally we'll and it's free people can go right now and get an assessment and like learn about themselves and get you know a way to like have automated brain health preventative care preventive neurology care and doctors just don't realize and it's not doctor's fault like in medical school I was taught one thing and then the fields change and the fields change so much in five years so so to me you've seen one person you've seen one person with with Alzheimer's and what we've done recently is now not just studied people with at risk of Alzheimer's disease my brother's a Parkinson's specialist my brother's brother-in-law's a Parkinson's specialist my brother's son is a Parkinson's specialist so I got the Parkinson's movement disorders then covered on one side of the family and and we bring everyone into the same research database or research cohort which is a research group we have kind of called a bio RAN study the the bio repository for Alzheimer's and neurodegenerative diseases and when you start putting these people that have similar ish diseases in the same group and look at the signatures the biological signatures they need to be studied together how many times have I thought someone has like Alzheimer's ish they have a different protein or a different pathology where someone has a diagnosis of Parkinson's it's oh wait a minute something a little different you have to study these things together and there's so a lot of common mechanisms it's inflammation it's oxidative stress it's mitochondrial dysfunction these are universal things that happen we talk about in functional medicine all the time that are fundamental to understanding and the question is why and you've been asking why it's not all we do in medicine we say okay what disease you have what drug do I give now why do you have this and how are you different from everybody else who has this and what do you need differently in terms of diagnostics and treatment it'll help you get better yeah and what are we gonna do about it exactly there was an old saying that neurologists don't treat disease we admire it adios and diagnosing no not not anymore yeah that's that's an old neurology saying adios and diagnose diagnose and adios meaning meaning you make the diagnosis and there's nothing you can do about it yeah and that's just that's just plain wrong and you know with with four family members with Alzheimer's disease and like and just seeing the suffering and that's not okay and I don't care if it's a if you have four family members yeah oh yeah oh yeah and I've seen this I mean I haven't family member with some Parkinson's like syndrome that I still can't understand despite having like hundreds of blood tests that we're developing to try to figure it out like it and it makes me sad and and it just motivates me to just keep going and there's so much confusion out there but it's it's it's all about one thing what road could a person be on if it's evidence-based and safe let's go do something about it and we can't do can't be like tricked into thinking oh you have to do a randomized controlled double blind study where everyone gets you know one group they get one treatment and other group they get a placebo like no different people need different treatments so we've kind of turned the paradigm the research paradigm on its head I believe and we use that person as their own control just like you said this n of one paradigm we're following over 250 people over the last five years and each person's getting their own different plan and then what we do is we then group them together and we say okay the people that got the multimodal lifestyle interventions of specific vitamins and supplements that's one group then you have okay well some people take drugs and they have specific medical conditions and those people get that and then we have a group that has the anti-amoled drugs that you mentioned and then we map them all out together and we group them together and that's real-world evidence to show look what's working look what's not and we're helping the individual people and if we just put everyone on an anti-amoled drug or for everyone on you know one of the GLP one the weight loss drugs or just put everyone just on exercise it ain't gonna work so that's the style of research we do and the style of research we do isn't like funded well and it's not like recognized the way it should be well I agree I mean I think what the challenge is is that in each person there are different causes and you have to map them out and if you give person a drug or a supplement that they don't need it's not going to do anything so I always say if you don't have vitamin D deficiency giving vitamin D isn't going to do anything if you don't have insulin resistance giving a GLP one drug probably isn't going to do anything so you've got to customize the treatments one of the failures of medicine is and is you know we have a a rule in functional medicine called the tack girls we talked about last night at dinner if you're standing on attack it takes a lot of asterisks make it feel better so something's in your system is bothering you it's irritating and you mentioned a case for example some of that of herpes lesion on their lips and a herpes virus which is linked to alzheimer's in some cases so the end pathway is the same it's inflammation it's damage the brain and family deposition that's just a reaction to various insults the insults could be toxins they could be allergens they could be crappy diet they could be too much sugar they could be alcohol it could be mole they could be um other factors that they don't have that they need like deficiencies of vitamin d or omega-3s and various things that that all play a role in keeping your brain healthy and so if you don't actually map out what that particular person's individual issues are then you're not going to be able to customize the treatments and personalize it in a way and and what you're doing is so radical because most physicians are focused and trained on diagnosing a disease and then finding that single pathway that explains the disease and that single drug that will fix the problem and that worked for infections so I mean with louis pestre we got the bacteria we saw there's this pneumococcal bacteria oh that causes pneumococcal pneumonia that single disease oh it's treated with a single drug penicillin it's a miracle and yeah it was a miracle and even with infections like covid we saw the host matters if you're an older person or you have chronic disease you're obese you're more likely to die if covid even the same virus so it's not just the virus but what happens is in in that model we basically treated all chronic diseases in the same way which is a massive failure because chronic diseases are complicated and they have multiple causes even if you have the same diagnosis if you have for example diabetes or heart disease or cancer or alzheimer's or parkinson's it may be different causes even if you have the same diagnosis and that's what you're that's what you're kind of coming up with and and then you're having to do investigations to figure that out and then you're doing diagnostics to help you map that out into the blood testing and you call these new blood biomarkers for dementia which is I want want to talk about a minute and imaging brain imaging and then you start to treat these people individually and you see remarkable changes in lowering of these biomarkers of dementia improvements in brain function and improvements in their subjective function and their objective neurocognitive tests which measure you know their brain function and these are things that are real heresy because you don't get any neurology they're biber burst the effects of alzheimer's they're going to just laugh in your face I always stress the importance of breathing to my patients and not just for survival November is lung cancer awareness month and let's remember that the lungs are more than just your breath they fuel your brain your muscles and every organ system with oxygen while filtering out harmful particles and when your lungs are healthy each breath also supports balance in the body now the most efficient way to assess your overall lung health was the Ezra heart and lung CT scan which is available at an additional cost to function members it's a low dose CT scan that's of your chest that looks for lung cancer pulmonary nodules emphysema and more and the best part it only takes three minutes you can breathe easier knowing that function gives you access to a full picture of your health not just a snapshot with function you can access over 100 lab tests from heart and hormones toxins inflammation and stress and you can also access MRI scans and an additional cost and it's all tracked in one secure place over time it's in your 360 view to see what's happening in your body you can learn more and join at function health.com slash mark and use the code hyman 100 to get a hundred dollars towards your membership but that's only for the first thousand people this week after my recent back surgery I was on the hunt for recovery tools that actually work and I kept coming back to the bond charge infrared PEMF mat it's now part of my daily routine this device combines two powerful therapies infrared heat which boosts circulation and reduces inflammation and PEMF which helps stimulate cellular repair and relieve deep muscle tension whether I'm recovering after physical therapy or decompressing at the end of the day this mat has been a game changer all I do is lie down and let it do the work I feel the difference in my joints my energy and especially my sleep I'm waking up feeling more mobile and less stiff and ready to go if you're dealing with chronic pain back issues or just want to support faster recovery and longevity I can't recommend this enough go to bondcharge.com and use code DR mark for 15 off that's b-o-n-c-h-a-r-g-e.com code DR mark the tools that we have are not tools that are radically expensive are radically unobtainable it's just having the wherewithal to try to do something about it and you know when we identify that a person is at high risk due to a gene or otherwise and the person starts adopting changes you know we now have the tools to to truly you know in my opinion definitively show that the things we tell people to do are getting people off the road to dementia they may have amyloid in their blood or they may have some cognitive glitches they may have some symptoms that are still early but they can go about all of their you know usual daily lives and to me I don't care if it's a vitamin a drug or a supplement if there's evidence and it's safe I don't care what the treatment is right like yes I'd rather people you know food is medicine I couldn't couldn't couldn't say that enough times and you know I and I wasn't trained that way I was I was not trained in medical school I didn't learn about that stuff and residency I didn't learn about that stuff but I don't care what it is just just just try it and then just recheck markers and whether the markers are blood markers cognitive assessment markers which again it's easy to do now or brain volume markers and then some of the slides that I sent you not yet fully published and I mean people's brains are growing like that's like that's heresy that doesn't make sense and I'll be honest a decade ago or 20 years ago I would say that's not true or BS but but I see it and when everything is going in the right way when everything about his everything improves you know that's that's evidence for me yeah that's true I mean I think your your your gathering data that is really solid what I want to sort of dive into now is is this idea of you know this this sort of early intervention and assessment we do it for a lot of things cholesterol we check cholesterol cholesterol is a risk factor for heart disease it doesn't necessarily cause heart disease there's other blood biomarkers we test the function that are also very big risk factors like lipoprotein little languages genetic so you can actually map person's trajectory by knowing their biomarkers we do the same thing for metabolic health we can measure glucose or insulin or a1c and see the trajectory of it going up before they get diabetes so this is there's a there's a proxy for this in medicine but with dementia we don't really do that and what's really remarkable about your work is that you're you're not just doing neurocognitive assessments you're not just measuring normal things like omega-3 fats or vitamin D or blood sugar cholesterol or blood pressure which are all important have to be managed if you're going to reduce risk but you're you're finding that these particular blood biomarkers these you're developing new tests that are from protein signatures expressed in people early decades and decades before they even forget their keys for the first time I'd love you to sort of break down some of the things that we're looking at now that are blood biomarkers and at function health we basically have a blood biomarker panel that helps identify that risk including apoE4 testing and apoE testing which is a gene for risk for Alzheimer's looking at p-tow 217 which is another marker AD4240 which is amyloid biomarkers but you're going way deeper than that yeah so you know when it comes to blood testing for Alzheimer's and by the way five years ago whenever we last spoke on the podcast like never in a million years whether it was two years five years ago ten years ago 20 never in a million years did I would have ever pictured myself having a lab in Boca Raton Florida developing there's a lot of Alzheimer's disease that's what they call it and they should be called something else joke Bruce Ames who's a very famous scientist said an epidemiology which is population studies he says if you did a study of population in Miami everybody be born Hispanic and die Jewish I can I can say that that's true from the evidence I've seen we had to create a lab we had to go deep on the blood test like I I'm not a basic science guy like I never like centrifuging blood and and developing at-home testing using different devices and you know developing starting with a panel of say a thousand and now coming we're down hey we're down to 150 tests and we're getting it down and in my goal and our goal at you know at IND and elsewhere we are trying to develop what will one day be termed the cholesterol test for the brain and you know if we're talking baseball analogies we're still in the first inning in my opinion of a nine inning you know baseball game where the tests we use now I think are good in certain ways and I think can be helpful for example if a person has symptoms and the doctor and the person with symptoms is wondering are those symptoms from Alzheimer's disease then then yeah there's this the p tau 217 test is a very good test it's not a perfect test but it's a good test but we're just just taking things with a very different lens and we're looking at people ages 21 and up to understand what the signature of proteins should be what is the normal values of these proteins because when you start doing a regular cholesterol test to prevent a heart attack or stroke and you start doing those tests in people's say 60 or 70 and above that's oftentimes a lot of times too late the cholesterol test for the brain I envision a day where people are going to come to the office and I hope that you know our work will will help you know inform this but people in their 20s and 30s and 40s and 50s and 60s and 70s and beyond before they have symptoms we'll get this panel of tests and we're just starting to like I think the we're in the black and white television phase I think we're we're now in the color television phase where I can kind of see what the five to seven maybe ten markers will be and we can track these tests and we can do it in a way that we can you know lower cost improve increase access yeah and then give people digital tools to like help interpret it and give that person care so what we what we believe is that we need to look earlier and we need to look more deeply yeah and we need to look at other markers and then the other problem is that some of these markers that may be positive uh oh got a positive Alzheimer's blood test what if the person had a virus that morning what if the person got a blood draw in the afternoon rather than the morning you know these are things and and what is a normal value for someone in their 20s or 30s versus someone in their 40s or 50s versus someone in their 60s like what are the reference ranges the reference ranges and and you know most of the research that's been done are people with dementia people age 55 or 60 and above and we need to start earlier so the focus of our research is to to figure out what is this cholesterol test for the brain going to be. Me these tests we want to talk a little bit about them in detail they're the way I think about them is they're they're kind of early warning signs they're not necessarily the cause but they're they're the things we can look at that are resulting from causes that drive those biomarkers to be abnormal. Yes to me the word is biomarker it's a biomarker it's a marker of a biological condition or disease amyloid to me does not cause Alzheimer's disease I've just never felt that way why are there people without amyloid that have like clinical meaning like you know talk to the patient looks like they have Alzheimer's they don't have amyloid oh I wonder what I guess amyloid didn't cause Alzheimer's in that person but by definition you have to have amyloid to have Alzheimer's like our instruction manuals are like totally wrong. Rudy Tansy who's a friend of OrthoR is an amazing guy who's an Alzheimer's researcher. We just said amazing guy like in unison so I hope he hears that and he's a deadhead so like. He's a cool dude and he discovered a Nobel Prize quality science on the very unique early Alzheimer's genes through lucid dreaming if that tells you anything about the guy. He you know he said that there are patients who have brains full of amyloid but die old cognitively intact meaning normal and he said what's unique about these people and I'll do here a perspective is that they have certain genetic variations in their immune system that don't mount an inflammatory response so as far as I understand the literature Alzheimer's the end result is the end result of an inflammatory process in the brain and there are many things that can cause inflammation from infections to toxins to diet to pre-diabetes or diabetes to a mold to you know Lyme disease I mean Chris Christofferson had quote dementia in Alzheimer's but he had Lyme disease and he got treated with antibiotics and it's dementia in a way so I think we have to think more about what the underlying pathology is which is inflammation and then why is there inflammation and then hunt down the sources and the cause of inflammation and remove those and that will lower I might lower these blood biomarkers that are around even a few years ago they weren't really available these things like p-tow 217 or amyloid biomarkers like a AB 4240 other p-tows like 181, 231 neurofilm and life change which is more for brain damage or something called glial fibrillary acidic protein or GFAP and beta synuclein which you're actually developing the test for so there's all these novel biomarkers that are going to be available clinically probably in the not too distant future where you can go get a blood test and you can say gee you know where are my levels you know it's like is my blood sugar high is my cholesterol high is my blood pressure high and those are risk factors and then these that tell you that you need to do something and the question is how do you figure out what to do in each individual if you're treating everybody as an end of one or as a precision medicine or personalized medicine what's the actual clinical work up what are you looking for and then how do you identify the targets and what are you doing for those targets that you find the way that I do it in my in our research program in clinical practice what I would call it the ABCD and E of Alzheimer's and neurodegenerative disease prevention okay ABCD and E and then when someone can't access a doctor or can't get into a research trial we have you know five sites in the US and in the United States and Canada and if you can't access one of those sites and if you can't see a preventive neurologist then we do it through software and I'll explain how that is and we got funded by the National Institute of Health we conducted a very very large almost a thousand person NIH funded randomized controlled trial that showed that free software online you go into the website retainyourbrain.com it's all free retainyourbrain.com retainyourbrain.com if there is anyone out there with a brain that wants to like wait I have a brain I think you I think you do you definitely have a brain it's it's uh you you have a very robust brain it's functioning checkmark neurologist approved I'm going to give the cliff notes version I'm in the ABCD's these but if there's anyone out there like we just spent six years developing and this was before AI was cool we just developed we put my brain and you know a virtual neurologist in your pocket and retainyourbrain.com it's available by web tablet cell phone whatever it's all free and you can get access to this type of education and and and you know does a risk assessment it can do cognitive games and I feel like games whatever and then the software will tell you what to do mostly based on your history you're not necessarily doing blood work or baby steps yeah in time in time but but right now it's it's it's all it's all inaccessible and there's you know no cost and and you know doing the blood test would just add another layer that that's amazing but right now clinically that's what we do and from a research perspective we do use the blood test for sure so so that retainyourbrain which is what we all want to do is retainyourbrain.com is a platform that you develop that basically is downloaded that you're thinking into a system that allows you to assess people identify their individual issues that make specific personalized recommendations that they can implement even without a whole bunch of diagnostics and it's free so everybody should go check that out and do it and if you have family history of any of these neurodegenerative diseases or you're worried about getting it get on and it's free now what I'm talking about is when someone comes into your office or you're part of this 250% research study how deep do you go what are you looking at what are you testing oh we go really deep yeah tell us what you're because I think this is important because people don't know what to look for and I think there may be many physicians listening to this podcast hopefully there's some philanthropists who have family members with these diseases who are going to listen to this and go wait a minute this is a place where I can make a huge impact that is being neglected by the outdated medical research establishment and the antiquated thinking about a reductionist model of disease and the fear of doing too many things at once in a patient it's like you know I think that's that's the joke is like you have to treat everything right if you have low vitamin D or low omega-3s or you have pre-diabetes or you have heavy metals or you have mold or whatever you're finding or you have high cholesterol you've got to treat all those things you can't just treat one thing but that's what we do in traditional medicine. The ABCD and E of Alzheimer's and neurodegenerative disease risk factor risk reduction prevention management is a paradigm that we published on it nature mental health on January 2024 was the last time we kind of updated the paradigm and it's all again doctors out there listening any healthcare providers you can read the paper but the A is simple it's anthropometrics so what does A stand for anthropometrics is body composition body fat muscle mass I also kind of throw bone density in there yeah bone density grip strength also an important proxy for that so well as you go through some of the kind of have you go through and spend once in a while sure and and by the way I'm going to talk about things and people are going to be like wait what what is this guy to he's a neurologist why isn't he talking about belly fat yeah so so I believe and and you know you wrote a paper on this I think back in 2007 about how like our brain disease is really like body and I'm paraphrasing I don't remember what the title was but it's a disease of the brain or a body disorder that affects the brain so I believe Alzheimer's and and I mean this is gonna sound like heresy but I believe neurodegenerative disease many times or most times those are big statements are medical conditions that have secondary negative effects on the brain so just like when a person has diabetes the sign of end organ damage is kidney failure or tingling and numbness in the toes or something called macular generation where people lose vision you know because of diabetes I believe medical conditions the neck and below things affect the brain when I got the heresy because most neurologists stop looking at anything below the neck yeah and I'm I'm like I'm an old-time family doctor like I'm an intro you know I I feel like I practice a one-third internal medicine one-third preventive cardiology and one-third you know preventive neurology which is a field that you know you just barely exist so so what I'm gonna talk about now is going to be very medical so and I'm glad I'm with you because you can you can translate it so so a anthropometrics again but it's a fancy long term and I couldn't use b because body composition is the next letter but everyone needs to know their numbers belly fat especially as belly size gets larger the memory center in the brain gets smaller women that have increased waist circumference okay visceral fat meaning fat around their their body organs women are at a 39% higher risk of dementia wow that have fat around their visceral organs and belly fat and you know what happens to women during the perimenopause transition it gets really really really hard to lose belly fat yeah and there are things that we can do to change that so so we track all these things and we use belly fat muscle mass you know people lose one percent of muscle mass per year I mean like like people like muscle mass is not easy to build and and doctors don't focus on like why are people talking about weight like stop talking about weight body composition talk about body comp- everyone needs these scales okay there are a couple hundred dollars but you know everyone needs to know their body fat we want to lose fat we want to gain muscle we want to put on muscle we want to lose body fat a lot of people take these you know weight loss drugs okay they have some really interesting features maybe too high a dose we'll talk about like the GLP1 drugs yeah the GLP1 drugs but we shouldn't be tracking weight I don't want to hear about someone's weight I want to hear about body fat body composition and muscle and muscle and bone density which is really critical so the A all of these things and anthropometrics are brain markers so we track those the B so measuring your belly fat is a brain marker is what you're saying 100% yeah muscle mass you know and and belly fat absolutely critical risk factors to to prevent cognitive decline dementia in Lewy body dementia Parkinson's these are all metabolic factors that actually do influence these diseases they're all connected they're all connected so what's B B is blood based biomarkers and what do I mean by blood based biomarkers I don't just mean the brain markers I mean cholesterol markers I mean inflammatory markers markers of inflammation nutritional markers metabolic markers and then a bunch of hormones metabolic markers mean like looking at blood sugar insulin so fasting blood sugar fasting insulin you know there's a lot of us may have heard of something called a hemoglobin a1c or like consolidated hemoglobin or HBA1c and you know people say oh above 5.7 is pre diabetes and 6.5 or whatever is is diabetes M metabolism memory if you want to have memory decline don't mind your metabolic risk factors like metabolism and memory is so critical because they even call Alzheimer's type 3 diabetes right it's Alzheimer's diabetes of the brain yep and there's a lot a lot of overlap with the with the with the pathophysiology which is a big word for you know potentially why these disease happen and and metabolic health um you know if you want to fast forward cognitive decline we don't want to do that you know high cholesterol high blood sugar high blood pressure these are all things that can you know fast forward cognitive decline and also the cholesterol is really complicated I'm not sure how much time we have to get dive into this but like there's good cholesterol there's bad cholesterol like HDL that's the good stuff right well maybe not it's a little confusing there's there's a lot of confusing stuff with with cholesterol and it is and it's unfortunately Richard most doctors even cardiologists don't fully assess cardiovascular I literally just got an email from a friend of mine who's a doctor at Mass General's an internist who's very well educated in the top of his field Harvard at Harvard his wife did function health and found she had a lipoprotein A of 500 which is a no one's ever checked which she said no one's ever he's like I the her doctor wouldn't check it I wouldn't check it and now we did a full cardiac workup we can actually manage her risk and look differently at her health and and at function health we do these very deep biomarkers for cardiovascular risk that are far just beyond a regular cholesterol panel like the ApoB which never gets checked hyperprotein A particle size we look at function of HDL you said HDL not all the same some goes the good isn't just all good and the bad isn't all just bad it's a it's kind of a false false framework and and so we're able to get the nuances of what's happening and we look at insulin which again is never tested so a lot of things you're talking about are things that now people can access for a very low cost and the accessibility is critical and you know in 2007 was the first time that I ever had these markers checked in me and that's like almost 20 years ago and I got my first calcium score 20 years ago thank you Dr Agaton it was one of my old mentors like I mean I I got thrown into this because I had mentors and people that thought differently thought in a contrarian way you know Dr. Agaton for example the calcium score I think he invented that and like I don't know 89 90 and it became part of the guidelines the physician you know consensus guidelines in 2018 it took 30 years to make you know the guidelines that like you know okay if you have high cholesterol maybe we should look at the heart to see if there's you know plaque and you know by the way you can have like just the way you can have amyloid but no Alzheimer's you know extremely abnormal cholesterol and clean arteries and I have patients like that I'm like wow your LPA is high your ApoB is high or your particle number is high your particle size is small I mean it's a whistle yeah clean as a whistle and and that's the thing like and this is precision medicine and personalized care so so anyway we look at all these markers and we look at ApoB we look at LP little a we look at H we look at LDO we look at particle size I mean if you have to choose one like I choose ApoB is a good proxy we always check LP little a we look at markers of absorpting is someone you know if someone has high cholesterol instead of just throwing them on a drug that you know you know in the grand scheme of things may work for 70 or 80 percent of the population what if you're in that 20 or 30 percent where you're not the right person and I think you and I whatever we may be I have a different version of my cholesterol is not high it's just borderline but I'm an over absorber of the cholesterol that I eat in my food in my stomach I don't overproduce cholesterol so I don't need a drug that would like statin right statin drug that's not the right drug for me generic drug calls it a zetamide it's a plant sterol inhibitor that's the right drug for me because I've had that checks in 2007 and right now I'm able to control it without a drug but if I need a drug one day that's that's the one I would choose basically also called Zeti but it's interesting because you know you know I have genetics and I've done my cardiovascular genetics and I have a very strong family history of heart disease and I'm a hyper absorber and when I actually started taking this drug it was like a drop like a like a stone because you had the right drug for you but it's not that it's not the cluster I was eating from eggs it's the cholesterol that's produced by your liver and bile it's excreted in your bile that gets reabsorbed that you kind of have to manage this is for people that are listening you may say oh my what is like how do I get these tests like it will be available all this stuff and some of this is available now all this will be talked about just now it's all of the L3 function help for $499 and there's add-ons for cardiovascular you also are going deep run blood by markers I want to stay on the B because because you are looking at additional things that in addition we offer as add-ons like a function but p tau and amyloid and apo E and neuroflimid light chain other things but you're going even deeper into these this stuff we're doing like you know we're we're developing blood tests like that that's our goal and some of these tests are like not anywhere on the market yet and there'll be you know at least two years before you know I believe that we have a potential test that like if someone is worried about taking a statin for example and they want to know are they the person that probably shouldn't take a statin because it may or may not hurt x y or z we're working on a blood test to figure that out like it by the way I can't believe I'm saying this like this is not me I'm not like that guy I'm a clinical guy but I had to do this because no one else is going to do it and if for some patients with dementia taking a satin maybe a bad thing yeah and and you need to track everything and you got to figure out which drug is the right drug for the right person and you know we're we're working on this through ind.org which is our nonprofit on that's the institute for neurodegenerative diseases right yeah but iind.org and people can learn about all this stuff and we have so much education you know all for free online and we're trying to develop these these tests and we're trying to like you know figure this stuff out and um you know when it comes to brain markers I think again the markers that are out now are good and I'm glad they're here but there is so much nuance and so much confusion and you know my worry is is that someone may get a test and then it's it's positive but it's not really positive because of a variety of reasons so like the take home here is what we're doing is we're doing like for example ratios where we divide this by divide this we take this marker that marker and that marker and we put it in a formula and and that is the type of stuff that's not you know I wouldn't say it's available yet it's coming soon um but to me when a person does not have symptoms of cognitive decline and wants to understand their risk I believe that the current tests available are good but we need more we need more higher fidelity I believe that where if our work keeps moving at the rate it's going within a year or less maybe a year and a half we're just going to be able to ramp up that fidelity to make these blood tests more accurate more accessible more meaningful and it can help guide us to say when that person changes their exercise routine or changes their diet or starts on a glp1 drug because their doctor said they were overweight and they had a little diabetes and they want well then we're going to track these markers and we can then show is there a ground truth is there you know and using that person as their end of one control can treating risk factors for cognitive decline actually impact in a positive way brain biomarkers of disease and we're getting really close so between indy.org allslabs.org is one of the arms that we're investing a lot of money to try to figure this out and develop these blood tests and and then honestly once you have access to the testing and you have access and will you be able to include your lab tests in that if you put that in his data yeah I mean in time we're you know for people without symptoms for the panel that we want to deploy I feel that we're not there just yet but that's that's the future but you could even you could have them check their blood pressure you could have them do a body composition and they do that their cholesterol or their insulin type that all or they the heavy metals of the vitamin D or whatever you can add all that data into retrain your brain now can you do that well so yes so for example that one of the key things about retain your brain is there's you know there's tens of millions of people out there that have a gene called apoE4 so having one you know 25% of the population 25% of the people listening today has one or more copies of a gene called apoE4 the four variants you get one from mom one from dad a two three or four you and I have both been tested for this we know lots of people that have been tested about one percent of the population has two copies of before and honestly one of the key drivers of why we created this free you know automated software is because when someone has an apoE4 variant they're scared right and they can type in what their gene what are they they got tested through 23 a year find that it's like oh shoot I don't want to know I don't want to test it and doctors say we don't test it because nothing you do about it so don't don't make sure you don't test it and that's wrong that's entirely wrong because you know if you have an apoE4 variant I'm going to tell you to do all these different things and if you don't have an apoE4 I'm going to tell you different things and if you have two copies of the apoE4 variant which is again one percent of the population doesn't mean you're going to get Alzheimer's but you may be at higher risk so I'm going to tell you to do these things that our research for the last you know 15 years has studied to show may be effective and then the software you type in that you have the apoE4 variant and it's going to tell you you know what you can do to reduce your risk so it's it's more personalized it's more personalized you had to help manage risk factors for Alzheimer's disease. So let's go short there's a bunch of blood tests that are available now that you're already measuring that are easily accessible through your doctor or well they might not order but then function health for $490 and things like your blood sugar insulin you know cholesterol particle size lpa apoB all the nutrients omega 3 all that we we can get that now but there's another layer that you're doing that you're developing your lab that are new biomarkers that are specific for neurodegenerative diseases that we can measure and then are lowered or changed or improved by doing various interventions that are specific to that person. Yep. So it's not like there's one thing you do to fix all that it's a whole bunch of things you do. Exactly and we while we are just starting to scratch the surface and we're in the first inning of a nine inning baseball game the fidelity and the accuracy I'm telling you in 2026 and 2027 these are going to be amazing years because my belief my hypothesis right now is that you mark are going to need these five tests to track over time me I'm different I'm going to need these four tests and a woman especially during the perimenopause transition two out of three brains affected by Alzheimer's these are women's brains and we got to do something about that a woman may need six different blood tests that we follow and we track and then they make a change or they take hormone replacement therapy or they do something and then those six markers improve and then we know we're on the right track so I think we are within maybe 18 months away or less from having this this roadmap clear. The holiday season is upon us and between parties family and everything else your body deserves a break sun lightens infrared saunas are the perfect way to give it exactly that their advanced infrared technology heats you gently helping you detox relax sore muscles and even support a healthy immune system imagine taking just 30 minutes to yourself sweating out stress boosting energy and coming out feeling renewed and here's the kicker starting now means you can ride into the new year feeling healthier and more energized than ever whether it's daily wellness stress relief improved circulation or more balanced hormones sun lighten has got you covered they make it safe simple and incredibly soothing experience the sauna everyone's talking about your body and mind well thank you head over to sun lighten.com and save up to $1400 or more this holiday season with Cote Hyman one of the most important things you can do for your long term health is build and maintain muscle muscle isn't just about appearance as a doctor I can tell you that it's absolutely critical for metabolism resilience and healthy aging studies show that maintaining your muscle as you age can lower your risk of death from any cause and help you stay strong energetic and thriving at every stage of life and to do that you need high quality protein protein is made up of amino acids the raw materials your body uses to create muscle bone skin and other tissues but not all proteins provide the same balance of essential amino acids the ones your body can't make on their own that's why it's so important to get the right building blocks in the right amounts perfect amino is designed to provide those essential amino acids in an easily absorbable form giving your body the nutrients it needs to optimize lean muscle and support overall health it's the reason I take perfect amino every day check it out at bodyhealth.com and use code hyman 20 for 20% off your first order and we can go a lot more into the blood bone conditions I think I think there's ones that were even not looking oh so many nettles like tick infections like mold exposure and I I've only talked about kind of some of the traditional ones but like these inflammatory markers that we're looking at and the immune you mentioned Dr. Tansy earlier I mean a third of our markers are focused on the immune system and inflammation like and we're I'm a neurologist right we're supposed to be talking about brain proteins no we look at inflammatory markers we look at Cascades we look at interleukins we look at CCLs we look at TNF alpha we look at so many things and then if someone oh interleukin those are all blood tests for inflammation exactly yeah in our in our multimodal panel you know we have this guy who he has psoriasis and it's mild psoriasis okay it's mild psoriasis he can deal with it he doesn't want to take a drug or change his diet or do whatever because it doesn't bother him it's fine you know well this guy also has an ApoE4 variant okay and this guy's 49 years old you know I go to the inflammation on this person so wait a minute I look at the panel and I say but but call him Bob Bob um hey bud you got an ApoE4 you got a interleukin 17a which is a inflammatory marker that's elevated in people with psoriasis and bud you're amyloids uh higher than it should be for a 49 year old no tau okay checkmark okay nothing nothing too worrisome but the train's gonna go off the tracks if you don't do something and then you change your diet this guy also had high cholesterol he wasn't treating started Zetia Zetamide because he was an over absorber of cholesterol not not a statin he was afraid of statins okay didn't need a statin anyway uh and omega-3 fatty acids there's omega-3 fatty acids were in the toilet and he's like oh I don't really like fish I'm like yeah and take the capturing and sardines and sardines are abacus and tuna's high in mercury but like in a wild salmon at least once a week but wild salmon has all sorts of stuff in it too um so you take certain supplements that are high quality and everything improved the interleukins came down the his inflammation came down his psoriasis gets better the amyloid comes to like everything about is everything improves through some mild changes that were personalized for him right and and that's that's the key these we could talk about blood biomarkers I mean what you're saying just to be honest with you is heresy I was literally talking to one of the key funders of Alzheimer's research in the world and he looked at me straight in the eye said there's no way and proof that you can lower these biomarkers of Alzheimer's it's not been done it's never been done you can't grow brain you can't lower these biomarkers we're going to try to find a drug that's going to fix it and I'm just thinking to myself no actually I've seen these things change you've seen these things change and that's what's so exciting because you can now start to intervene with multiple different approaches and actually start to change those biomarkers that are risk factors for or indicators of damage that's happening at a subclinical pre-symptomatic level but it's still happening and it's like it's like the bogal loser heart study where they looked at fatty streaks and the arteries of teenagers who are eating crappy diets Louisiana they were prelude to heart disease that they were going to get their 30s and 40s but we could see it in their teens. In May of 2024 there was a CNN documentary that came out and Dr Sanjay Gupta came down you know Sanjay and you know he actually joined joined my research study and it's been really great to get to know him better through that you know I've known him for a long time and this guy named Simon was profiled in this documentary and documentaries are interesting because you know they send a film crew and you get they get to know people and they see people for years and they get to know them and and if that guy that doesn't believe that the stuff that I'm doing and our team is doing is possible he thinks it's it's it's heresy he thinks it's not real well Simon was followed for years and we have his brain on the same MRI the same magnet the same software we have it in 2022 we have an image in 2024 and we have an image in 2025 and Simon is an ApoE 4-4 he's got two little kids okay he's in his early 50s now mid 50s got that's ApoE 4 is the high-risk ApoE 4 he's got me so his name and he's been totally public since he's obviously been in the documentary if someone out there is listening to this and doesn't think this is possible like I should call Simon right now well we're gonna link to the documentary in the show notes everybody we're gonna link to all your studies all your research all your websites it's all there it's all there like this there's now you've seen the scientific slides because I sent them to you but the brain volumes grew and then a year later his brain grew again his amyloid and tau at the first at the the documentary stage his amyloid improved his his amyloid actually normalized his tau was still a little bit there it's gone everything amyloid and tau are gone his symptoms are improved even though he still is doing great and he has some subjective symptoms his brain grew twice this is all real so just just for everybody listening this doesn't happen right brains don't grow they just atrophy as you age that's orthodoxy and what you're challenging is a paradigm is so stuck but you're seeing objective evidence and you're not the only one I mean there's others like Delbradis and others who's been on the podcast who've shown that you can increase the size of the hippocampus the memory center of the brain you can increase the the brain itself and and reduce the atrophy and and that leads to changes in cognitive function and improvement in outcomes we have a saying that we say it a lot promise not to over promise and we're we're cautious and we want to like undersell just to be extra safe because we need to like really prove that this works but my gosh I mean when you see it once you're like wow when you see it twice you're like wow and now I've seen it so many times I'm still like wow right because I'm in awe it's a miracle because compared to what we were trained in in medical school it just doesn't happen but I'm still I try to be conservative about it because if I get too excited about it people won't believe it but the story after story after story is there take us through some of the kinds of ways and the things that you're finding and the treatments that you're doing that are part of the cocktail of things that are available sure so actually so let me finish on the ABCD and E first real real quick the C is cognitive testing and and again like a lot of people don't want to do cognitive testing a lot of people in our research don't want to do it if someone you know wants to you know you know we try to make cognitive activities we call them cognitive activities at retainyourbrain.com you join you get to know yourself you can you know track or you know assess or whatever word you want to use with these cognitive we call them you know activities because they seem less you know worrisome but we do track cognitive function in in our ABCD and E model D is DNA we do look at some genetics especially the ApoE4 variant which is super super super important to personalize care not to deduct or to do sorry if you're going to get Alzheimer's but it does help personalize care and the E and the ABCD and E is emotional and social support and health and and you know stress management staying socially engaged having a meaningful life mindfulness based stress reduction is something that we you know advocate for you know learning new things the E is something we really really really take seriously and we have to focus on the biological the cognitive and the psychosocial in order to get people off the road to neurodegenerative disease and you're talking about these social connections and relationships and having meaning and purpose and connection and belonging and and it even speaks to you know how things like hearing loss or visual loss will actually cause people to withdraw from these social connections which actually accelerates dementia. Yeah 45% of cases of dementia may be preventable if that person does everything right and 45% to me is a very conservative number I think that number is going to be you know from a you know evidence-based way and the next big study to come out it's going to be 50% or 60% or whatever magic number it's going to be but the the majority of cases in my opinion of dementia may be preventable if that person does everything right and we get ahead of things before symptoms and in that 45% the Lancet 2024 paper 8% of cases of dementia are attributable to the modifiable risk factor of hearing loss 8% and now whether you have hearing aids if you can't hear this yeah yeah and you're age 50 and above or whatever word whatever age you want to use get a hearing screen you don't have to I mean you should you know go to an audiologist and see a doctor obviously if you can but but you could do this on your headphones now you could do it on a computer you can get a hearing screen and people that have hearing challenges you know my mom I fought with my mom about this like for for for years like we're hearing aid you'll be more engaged it may help prevent dementia you know that's that's that's not a pill that's not a dietary change it's just have a hearing vision loss there's so many things that we can do to to screen and intravena so so again going back to like what what are the things that you're actually specifically using and how do you kind of customize the treatments and what is a what is a cocktail what are the cocktail of therapies and what are the what's the what besides the things we already talked about you know that are sort of easy to measure what are the kind of things that we should be testing for and looking for and what are the kind of interventions that seem to be promising so um you know in our in our 2019 paper where we showed really back then like for the first time that through multimodal meaning multiple therapies at once that we personalized or the title of the paper was individualized clinical management of people at risk for Alzheimer's disease something like that when you individualized treatments on average back in our 2019 paper people got 21 different interventions so if there's someone out there listening that wants a magic pill or wants to do one thing or two things um I'm sorry to say but it's it's it's not like one or two things can do this because Alzheimer's and neurodegenerative disease is that they're complicated right any chronic disease of aging right diabetes can you take a magic pill to prevent or cure diabetes no can you eat a magic blueberry I love blueberries I think blueberries are great right well you can't eat a magic blueberry and prevent your cure diabetes or Alzheimer's or whatever the people that did the best were people that followed greater than 60 of the recommendations so if we gave 21 on average if you followed greater than 60 people did better people with mild cognitive impairment the earliest symptomatic phase of Alzheimer's actually had improvements in cognition like again heresy that hadn't been jone like that so this is symptomatic early dimension symptomatic well to both we had two groups we had the the early treatment group and the prevention group and I think that the the take home for people listening is that there are so many things you can do I'm going to go through those in a second on average we gave 21 different things oh that sounds like a lot the people that had early cognitive symptoms needed to follow greater than 60 in order to have an impact on their cognitive function Benjamin frankly and now it's a prevention where the powder cure 100 100 100 percent agree with that but the people before they had symptoms whether they followed greater than 60 percent or less than 60 percent of the recommendations they still had cognitive optimization their cognition improved at 18 months in our 2019 study so the earlier you are the less you have to do to move the needle the later you are the more you have to do to move the needle so so that was our 2019 paper and I think that was you know really critical what are those 21 things on average well those are average in our whole universe of things we've probably recommended right around 50 different things across all of the you know thousand plus people that we've seen but the the two kind of categories that I put it on are in our I would say non pharmacologic and then pharmacologic and in the non pharmacological bucket you know for example extra is non drug yeah non drug so non drug and you know in the pharmacological bucket I mean I guess you could I don't know where to put the vitamins and supplements because those are like really important and critical but like wherever you want to put those exercise on a regular basis is by far the number one thing a person can do to reduce their risk of cognitive decline you know if you put mice on a treadmill their amyloid can go down and most people don't realize like I have people say oh there's these new anti-amyloid drugs I want an anti-amyloid drugs that'll fix me right well they're expensive they have side effects there's a whole thing and I do believe in them in the right person at the right dose for the right duration of time but if someone out there today wants to reduce the amyloid in their blood and in their brain tomorrow they should start on an exercise program that's approved by their physician and and and targets the thing that need they need to target and there's major papers published within JAMA like just walking prevents house time yeah I mean anything is better than nothing and and you know someone who's sedentary I'd rather they walk I think walking is physical activity and physical activity is better than nothing but to me physical exercise especially when we get past a certain age we need to be mindful and we need to be intentional about how we do this so if a person is going to say well I'm going to go walk three times a week and I'm going to prevent Alzheimer's well not if you have excess belly fat and not if you have if you're undermuscled so someone that wants to use exercise as a primary lever to pull needs to figure out well what are they trying to do so for for example if someone needs to lose belly fat you know walking slowly is probably not going to be enough you need to get into a higher you know what we call zone two or steady state cardio where the heart rate goes to 60 to 65 percent of of you know the person's maximum the best way to kind of approximate that if someone wants to get into fat burning mode is where they can still have a conversation with someone but the person that they're talking to can hear that they're a little bit short of breath they can hear that they're exercising but they can still carry on a conversation to me that's in the zone two and you need to get I would say at least 40 45 60 minutes of of that and walking alone may not be able to do it but fast walking sometimes with a weighted vest or up and down hills like that that could be a way to get in Austin there are a lot of hills so in Austin it may be very easy to get into zone two to get into the fat burning mode but that's a way to do it and for people that are fit and their doctors say okay doing fasted walking fast walking with a weighted vest early in the mornings before they've you know had any maybe maybe black coffee but if you don't have any carbohydrates in the system you may be able to burn fat even more efficiently but again some people you know shouldn't start like that but the belly fat you know you're not going to fix it by doing crunches or ab exercises it's basically sugar and starch that are driving and if you cut out sugar and starch which is driving metabolic disease which is a big part of Alzheimer's you're going to fix it quickly incredibly and and I think you know if you're trying to just lose body fat but not realizing that if a person has a lot of muscle they're more metabolically active and they can break down show them break down whatever you need to build muscle mass people should be doing strength training at least twice a week you know depending on their individual situation someone is trying to lose body fat they should be doing zone two you know fast walking with a weighted vest you know three times a week for 45 to 60 minutes so exercise is not just like you know going for a walk is better than sitting on the couch but being intentional about your physical activity and physical exercise routine is what it takes to really have an impact on brain health so exercise is one of the interventions diet let's talk about nutrition yeah there's a there's the mind diet which is Mediterranean and you know like the way I think about it is is is you know if food is medicine what's the drug what's the dose what's the duration right and I think yes the mind diet which is a sort of modified Mediterranean diet lots of omega-3 fats and anti-inflammatory foods great but there's there's different levels that you can push on the gas pedal to get more effect I had a patient once who had MCI malcog and pyramid she had a whole bunch of problems the 21 things and we fixed all the thyroid was off she's heavy metals she was pre-diabetic she had methylation issues and high home assisting she had low omega-3 fats I mean just the list went on and on and we fixed everything and her cognitive function dramatically improved and then after like three or four years she started noticing a little bit of the dwindling and I said geez why don't we try a ketogenic diet because I've been reading about ketogenic diets and changing the metabolism of the brain by cutting out all sugar and starch and carbohydrates pretty much and eating 75 fat and we did it in the the lights came back on and I was like holy cow so again how do you approach diet with all this yeah well so you know nutrition and dietary patterns versus single or multiple nutrients like this is a this is a long topic and you and I both have written books about this and we could talk about this probably for an hour but to me different diets you know we're not in the realm yet where precision nutrition is like easy off the shelf straightforward but different people I believe need to follow different dietary patterns and and I too back in I think 2007 was the first time that I put someone on a ketogenic diet and and saw something that I just did not think was possible but then I've had other people where I put on ketogenic diets and like things kind of went the wrong way and and to me you know it's we're not we're gonna get there very soon where one day we'll have you know whether it's a blood test or a genetic test or something where we could put into a computer and the computer will spit out exactly what the person could eat and until until we get to that time I think you think about the big bucket so the Mediterranean style diet fatty fish brain healthy fats omega 3 fatty acids especially people with one or more copies of the apo E4 gene like we have to have enough omega 3 brain healthy fats otherwise people will have cognitive decline in the synapses because a lot of your brain is made up of DHA which is 60% as far as I remember which is and in DHA and EPA are the two most brain healthy fats and DHA is especially important for people with one or more copies of the apo E4 variant so brain healthy fats um that's poofas polyunsaturated fat then you have mono unsaturated fats mono unsaturated fats like if you want to drink olive oil like an ounce or two a day and your doctor says okay that's like anti-tow protein like that is good for but it's got to be good olive oil it's got to be it's got to be bitter and burn the back of your tongue otherwise it doesn't have the polyphenols exactly and 60% one study I read of the alcohol of the uh of the uh of the olive oil out there is corrupt exactly so you know getting quality olive oil um like literally taking a shot of it one or two shots a day or pouring it on everything um you know I have olive oil stashed in different parts of the house and just pour it on pour it on whatever I can get of them because I need and if it burns the mouth yep that's exactly the the proxy has a taste to it so um avocados olive oil fatty fish brain healthy fats are like so critical um green leafy vegetables so you know berries you know half a cup of strawberries or blueberries two to three times a week nurses health study published over a decade ago showed you could delay cognitive decline just by eating berries on a regular basis by two years just from one intervention that's why I gave you a berry shake this morning you did it was good with that with goat milk whey which was a first for me so I appreciate it which is uh really nutritious and actually tasted really good um so you know green leafy vegetables high antioxidants um people should be eating mostly plant-based um you know I would call plant rich yeah plant rich yeah plant rich plant rich and you know there's totally different because plant-based is vegan yeah that might be problematic for people who want to build muscle mostly plant rich okay yeah that's a better and I wouldn't maybe yeah I don't know the exact terminology but you know and then like meat is all not created equal like like red meat grass fed beef is totally different than other beef that isn't you know whatever so I think people need to eat you know where they feel comfortable with whether ethically or otherwise they need to get protein levels whether it's through whey protein through goat or whey protein through regular milk from cows I think each person needs their own individual kind of um thing and some people may be more sensitive to one thing versus the other and there's lots of different and I saw you putting like cocoa polyphenols in your oh yeah I travel I travel with uh dark cocoa powder which is completely ridiculous but I never leave home without my dark cocoa powder um and yeah I have I have coffee in the morning with dark cocoa powder because to me I actually caffeinated coffee I think is brain healthy and has been shown to have better brain outcomes dark cocoa powder um again it has to be like pure and not have the heavy metals in it and things like that but um dark cocoa powder can help with insulin regulation blood pressure control and has shown to be beneficial for for brain health too so Richard I was going to start this morning with a mocha I do a mocha for your a mocha for your memory in the morning and as funny as mocha is actually one of the names for a test we use the montanol cognitive assessment test which is actually something you can actually do at home and something you download on the internet and it's a pretty good way of tracking your your brain health exactly yeah we don't want people to do it too much at home because then they practice and the doctor see the doctor and they memorize the test but I don't disagree yeah for you for sure there definitely ways to track track so fatty fatty foods omega 3 fats monosodium fats berries leafy greens you know nuts nuts and seeds um doesn't see a balance in the omega 6 with omega 3s there's so much um nuance with nutrition but I think that's it um also the elf diet what's that oh my eating moss in the Arctic circle I just I just stuck Dr. Mark Hyman on a dietary pattern that he's never heard of well this is this is a great day I'm never going to forget this day the elf diet eat less food oh eat less food yeah yeah like Michael Paul these food not too much mostly plants right yeah so just less like people just eat so much in excess like it's it's crazy and you know there was a study out of mayo that showed that people that ate like I think the cutoff was like 2100 calories a day less than 2100 or more um have you know delayed cognitive decline and and again this is like imprecise to the okinawa principle right eat harihachi boo which is eat percent percent full exactly harihachi boo that's exactly it so the take home here is though if you're trying to gain muscle well you better eat sufficient protein and and calories because you need both carbs and protein to build muscle and you don't want to like just you know starve yourself and there's good carbs and bad carbs and know the difference um that's really key berries and leafy greens are carbs yeah exactly yeah and you know some whole grains in moderation I think are okay but but not if a person's not active you know so so anyway uh yeah nutrition is you know tricky you know vitamins we we talked about um you know mega three fatty acids but vitamin d especially people with one or more copies of the 8.4 variant um we check vitamin d and just like you mentioned earlier we don't just tell everyone to take vitamin d but I think the statistic in miami as a as an example 60 of the people in miami even with sun exposure are deficient in vitamin d so we check vitamin d and we have to be naked between 10 and 2 in the uh and then morning 2 in the afternoon for 20 minutes and if you're not you're not going to get a vitamin d if you're if you're if you're lifeguard you will but otherwise forget it exactly if you're sunscreen now people are indoors and yeah you know I usually tell people you need 15 minutes of 12 to 15 minutes between the hours of 11 and 1 to try to split the difference I don't want to you know it's it's hard to know for sure but um you know we we check vitamin d and supplement if needed um we also talk a lot about b complex vitamins and b complex vitamins again are not something that's one size fits everyone um the viticog study which was published over a decade ago showed that when people had a marker in their blood called homocysteine if homocysteine is high the people that took b complex vitamins b12 folic acid and a tiny little bit of b6 those people not only um did they have slightly improved memory function on cognitive testing but those people actually also had slower shrinkage of the memory sorry of the of the of the total shrinkage of the total brain size so yeah I think it was a paper published in the year it was going jam or in newland's rinnelli redbird if your homocysteine was over 14 you're 50 percent more likely to eat Alzheimer's or dementia and that's again something we tested function health and also methylmalonic acid which is a marker b12 function and I I remember a patient who came to me who was you know a very uh successful business woman was on multiple boards she was in her early 80s and she's like I got diagnosed with mci mild cognitive impairment early dementia and she was pretty upset and I'm like well I don't know let's see what we find and she had extremely high homocysteine and high methylmalonic acid which is a marker b12 which are better probably better than measuring folate and b12 in the blood probably had a double mth of army she did she had the genetics that made her having trouble with her metaballot pathways yeah and she was older and probably not absorbing b12 which is common as you get older you get less stomach acid and so on and so forth there are people that get acid blockers they don't get I mean that's what that made me crazy I mean there's the third most leading prescribed drugs after statins and psychiatric drugs is the acid blocking drugs which are now over the counter and they they're they're dangerous to take long term fine short term but long term and so I I I said I found this and I gave her a b12 shots and I gave her high doses of methyl folate and some b6 some of these methylated nutrients and completely cured her mci now it's not that everybody with mci or pre-dementia has that problem it's just that she had that problem and then a number of years later probably five years later I got a call from her and I thought oh she's probably going downhill and I'm a little worried about her and I saw her my schedule and I'm like what's going on she's well I'm going for a trek in Bhutan she's 85 and I want to know what I should be doing to prepare and take and blah blah blah like okay great amazing yeah what else supplements what other supplements vitamin D fish oil the b vitamins yeah I mean turmeric I think you know curcumin the active ingritten curry I think in certain people especially with elevated amyloid levels in the blood you know we usually we sometimes use this and I think in terms of like the the big picture those are like the one size fits many ones but I mean the list just I mean this is really long so I mean there's there's definitely other things people can do but but the take home here is you know we check it in the blood we do the history and then we personalize the plant for them so I think nutrition is is really nutrition exercise are like critical critical levers and you know in our research study that we presented data that I can talk about because we presented this at the 2025 Alzheimer's Association International Conference in July 2025 and we showed that when you looked at I'll talk about different interventions in a moment but if you look at multimodal lifestyle intervention that included exercise nutrition vitamins supplements sleep sleep sleep stress management stress management keeping the brain engaged learning social connection yep seeing a doctor on a regular basis to make sure their blood pressure cholesterol you know blood sugar is all modified and in an optimal range for specifically for them when you when you put all those together but no drugs if you look at the groupings of the categories of the people we followed so intensive lifestyle intervention intensive lifestyle intervention of all the interventions that we tried move the needle the most more than any of these billion dollar ramuloid drug studies you know in our in our study that we've you know this has been fully published but I can talk about it because we present an abstract form there are people that for example took glp1 drugs and glp1 drugs are tricky because you know I believe that too high a dose if you're not even right and doing the right thing you can you know lose muscle and have all the things lower dose you know I'm more of like the micro dose crew when it comes to glp1s glp1s positive effect on biomarkers you know in my opinion based on the our results you know impressive results when used in the right person at the right dose for the right duration of time well they improve metabolic health which and there's many rows to roam to do that right if you have radically improve your diet I mean I mean before glp1s were on the market I was reversing diabetes getting people lose 200 pounds 100 pounds 150 pounds you you can do it it's just it's just and I think my guess is that they would do a head dead comparison of glp1s and the same diet that you would eat if you were on glp1s there would be no difference in any of the biology that's my point so while multimodal treatments you know I would say work the best the other categories that worked exceptionally well that meaning exceptionally well to me means statistically significant improvements in a variety of pathologic proteins that are associated with neurodegenerative disease so you're testing not guessing we test everything let me try these 20 things and let's cross our fingers and maybe do a like a sort of semi semi subjective objective test which is a bunch of questions you're actually looking at blood tests to show changes try one thing we repeat it we don't try 10 things that well for multimodal interventions we try a group and then if we're going to try a drug we're going to recheck the 150 biomarker proteins we check the proteins on different machines in duplicates every blood tests we do we run twice this is not normal this is not cost effective we do it anyway because we care about quality not about anything else but and and we just try to do things as as as rigorous as humanly possible and what we show is that when we do these tests we call these N1 studies we'll try a glp1 and we'll check we'll try hormone replacement therapy like hormone replacement therapy bioidentical hormones for women during the paramedic post transition in the right woman at the right dose the women in our in our little hormone replacement therapy group believe it or not the age ranges from 42 to 67 we have multiple women that have actually started on hormone replacement therapy with approval and agreement by the gy n and the primary care doctor in our in our team we've had uh i'll just say what i feel like i should say amazing success with using hormone replacement therapy and and when that rapid drop of estrogen comes in a genetically susceptible woman you know we did this whole women's uh brain imaging study at cornel and spent you know millions and millions of dollars on this women that had you know hormone replacement therapy on board had better brain volumes and less amyloid but it had never really been proven in a in a study that you could use a hormone replacement therapy and then there's a that women's health study that used like synthetic hormones and horse urine derived whatever like when you use a bioidentical patch and you use progesterone and we talk to the gy n and we talk to the doctors hormone replacement therapy during the paramedic post transition has helped improve brain biomarkers associated with Alzheimer's and neurodegenerative disease risk it's been striking so this is more than just what has been done before which is population-based studies which can't really directly look at cause and effect you're actually looking at blood biomarkers that change and improve the blood biomarkers that are associated with neurodegenerative disease that's a big deal and the other thing i wanted to say is that the consensus most of that i've heard is that it's it's important to start right away after your menopausal transition but what i hear you saying is that you can actually start it later what end early i want to start both both i see yes start early does that mean every woman should be on hormone replacement therapy like what what are the implications here yeah this is these are these are really it you know and by the way why hasn't this been better studied why are we the only group to my knowledge like because we are misogynistic research infrastructure like it's it's just so it's demoralizing it's just so wrong that women are taught that like oh you're having night sweats oh oh you don't feel good oh you're having brain fog oh okay sorry you know we'll see you back in six months perimenopause is a neurological disease like you're just gonna have a woman suffer these are these are symptoms that are treated oh go change the temperature in your room and maybe you'll sweat less or maybe change your sheets get better sheets like like no this is a medical condition like really or like you know the cooling thing like okay you are awaited like fine okay treat the problem and what we've shown is that you know through ridiculous amounts of time effort money spent and research which needs to be quadrupled or probably increased even much more than that we've shown that when we use hormone replacement therapy and the right woman at the right dose the right duration in collaboration with the multidisciplinary team when we start seeing the estrogen drop even if the symptoms are very mild you get the estrogen back up the tau starts coming down even though the tau wasn't elevated to a degree where we're like uh oh sky is falling but the tau is higher than it should be in that woman who's 47 years old and this whole concept of like you know uh it's normal well no optimal is where we want a brain protein normal a little borderline a little high like no in order to have the most benefit we need to make these incremental changes and hormone replacement therapy during the perimenopause transition to me is one of the most impactful tools that we can use to reduce the risk of cognitive decline to mention Alzheimer's disease in women and and I think you know it's tricky I think there's risks and benefits with every one of these decisions but um you know I've just seen too many women suffer and it's just not fair so they're symptomatic or if you if you do evaluations you have a higher risk based on your Alzheimer's risk score which you've developed then maybe it's a good idea but even if you're not well I think if you're symptomatic it's like like how could you not I think it's like you know it's unethical not to try to figure out how to in our cohort we track estrogen estradiol levels and other hormone levels um you know I mean women 21 and above we also this is crazy but like you know this hasn't been done before to my knowledge we do multiple blood draws through the menstrual cycle to try to figure out like as estrogen and progesterone change during the cycle guess what p tau 217 changes and these other markers change too how has this never been done before so we have women we have like vault thank you thank you I'm not going to say their their code numbers in our research study they get six blood draws on day one on day three on day seven like we get six blood draws during the menstrual cycle we're just trying to figure out like what should the p tau be at what depending on what day the blood was drawn we need to correct for what the tau level should be based on where the estrogen and progesterone is like these are things that just haven't been figured out yet and these are the types of questions we're asking and these are the types of things that need to be figured out and when you take this approach precision personalized individualized approach we've seen women in their early 40s like 42 is the earliest we've started where we've seen the estrogen going down and we've seen the amyloid going up well maybe they're a little symptomatic but it's not really bothering them but we're going to start on low dose hormone replacement therapy if everyone is in agreement and guess what she feels better her cholesterol comes down that's interesting her amyloid is improving even though it wasn't abnormal and this is really the key like we have to personalize these therapies and we have to you know you also just monitor for a change we've been monitoring these women for so long we see the change and then you intervene and so to me it's if symptomatic like please talk to your doctor and if your doctor says tough it out like go to another doctor if you're pre symptomatic follow it closely I think women pre menopause perimenopause should should probably get checked every six to 12 months for these brain biomarkers and hormones so essentially what you're saying is if you're symptomatic don't suffer and if you're not symptomatic and you have a lot of risk factors and some of these blood biomarkers that were emerging or abnormal then it's better get out early even if you're not symptomatic I believe that specifically in people that are at the highest women that are in the highest risk category which are a before positive especially women with two copies of the a before variants some of the most striking improvements actually one one woman is actually lives in Austin one woman is in California I mean I know these cases like you know the back of my mind like I like you just start and you see everything improve this this is honestly Richard why we co-founded function and and I don't mean to kind of oversell it here but these tests are not things that your doctor likes to order or often will order and for very low cost we've dramatically reduced the cost you can get all these biomarkers including a before and some of these brain biomarkers and then you can kind of start to decide what to do and and take control of your own health I want to ask you about guys because two thirds are women but then one third is guys do guys benefit from hormone replacement therapy in terms of testosterone great question I think the literature has been I would say the literature has been not conclusive is how I would answer this question it doesn't mean it helps or hurt it's just the litter the evidence has not been sufficient for I would say the vast majority of the times that I've looked into the data I would say more recently you know I would say it's more likely than not but not a certainty that using hormone replacement in men specifically testosterone in the right man at the right dose for the right duration that's whole different different discussion and like which types and how many times a week and what version and is the cream or is it inject like there's a lot of confusion here a lot of confusion and then what else is going on like what other hormones because sometimes when people use testosterone they're also doing like five other things what I would say is if hormone replacement is used judiciously in men and the person is putting in the work exercising and trying to build muscle mass in addition to taking you know lower and I mean some of these testosterone levels I see are just like really really high and like a lot of these a lot of the doctors I've spoken to who specialize in this like are not bothered by this in any way shape or form and I'm just like just now you want a physiological level because then your estrogen levels will go up because you convert testosterone estrogen and then you start having sex you know libido issues and other issues that are it's like it's it has to be done right exactly so so so with all of these caveats I would say at this moment today I don't have a definitive answer but I would say it is more likely than not that when testosterone replacement therapy is used cautiously and judiciously there is a beneficial brain effect I'm talking very carefully and generically because is it truly Alzheimer's protective vascular protective cognitive health protective for a reason other than like maybe age related cognitive decline I don't fully understand the pathological um productivity of testosterone but there's something that is protective cognitively I'm just not sure if it's strictly Alzheimer's pathologies it's kind of the motivation hormone right and when people drop off in motivation they withdraw from life they stop doing the things they want they might not want to exercise as much it's kind of like a dirty cascade okay so we've got we've got nutrition we've got exercise we've got certain supplements can be helpful we've got hormone therapy you know you didn't really say a lot about sleep but I think that's another pillar and correcting sleep disturbances and also sleep apnea but also even being careful of sleep drugs the benzos or valium or that category xanax adavan those those drugs are commonly used and they do have impairment functions in the brain so you have to be careful with sleep yeah sleep I mean we could spend probably a whole podcast just on sleep give me a couple of minutes yeah so so you know everyone out there um has to make a plan for sleep you know you could be burning the candle at both ends pushing pushing pushing sleeping five six hours a night if you're exercising doing everything right from an exercise and nutrition perspective but not getting adequate sleep you will not have adequate brain health it's not going to happen so everyone out there needs to prioritize and make a plan for sleep I have people where the only thing they changed after I've read them the riot act was their sleep patterns the only thing they've changed and the impact on their brain biomarkers like objective blood test every I mean objective cardiovascular tests I wear all these trackers we track everything in all of our patients I mean the only this is this is like crazy but the only thing that changed in an otherwise optimized person if you get sleep right the amyloid can come down the cognition can improve sleep is so critical um you know it's not just about you know getting what's the magic you know in our study we did a study on this we tried to figure out like what's the optimal sleep and like 7-11 that's how I remember it like 7-11 7 hours and 11 minutes the people that slept more than that did better cognitively the people that did less but 7 hours and 48 minutes last night great that's that's good and you know obviously you know it depends on the sleep quality and deep sleep is restorative sleep that's when the trash gets taken out the amyloid gets you know taken out in the garbage um you know REM sleep is when short-term memories are consolidated or really formed into long-term memories so there's sleep quality and there's sweet sleep quantity and the number one way to get more sleep quality is to sleep longer to have more REM and more deep sleep like that's a cheat code um you know to me you know actually retain your brain dot com is the actually I'm in a routine right now routine your brain does is gives a person suggestions and as I'm holding my coffee I don't know what time it's 11 or 12 12 in the afternoon I am not allowed to drink coffee after 11 p.m based on my time's up time's up you know because um you know caffeine lasts for five six hours the half-life so if I'm drinking coffee at two or three or four o'clock in the afternoon I still have caffeine in my system as I'm going to bed so to me um you know taking a making a plan for sleep you know sleeping in a dark room like if there's a little bit of like light coming in from the window just plugs and eye shades yeah exactly um weighted blankets some people really like those like um you know for cooling temperature like like cold rooms and heavy blankets cold rooms and heavy blankets yes you heard of here first I mean these are like really easy things that people can do the other thing is in fact I'm reinstalling my air conditioning while you're here because it's an older house and it needs updating and it wasn't cooling down when I put it at 65 it was like in the 70 I'm like that's not good enough yep I agree um you know my other routine that I got uh the the brain healthy habit that the software recommend because you know I typed in the thing like what are my issues and it said sleep is my issue so it's been telling me to help you know make my sleep better and put electronics to bed was the brain healthy habit that was recommended to me well what does that mean every night at 9 30 p.m my alarm goes off as a reminder that says power down your electronics so at 9 30 I try to wrap up and by 10 I try to put you know like our biology wasn't meant to have two cell phones like like this you know at all times with the light and whatever else and there's my there's my there's my Grateful Dead Bear got the Bobby and the Wolf Brothers show a couple years ago for those who don't know what he's talking about it's Grateful Dad and Bob Weir and his his band called the Wolf Brothers I was waiting online to get into the show someone miracle me with that so too many inside jokes yeah but but like why are we on our cell phones right before bed like that causes rumination if you want to fast forward brain aging worry worry about everything like that will make rumination or worry is the number one thing that basically fast forwards cognitive decline two more things that want to cover before we close out got sleep got attrition exercise we got supplements we've got hormones and you mentioned there like 50 different choices so there's a lot of things and people can look at your research we only tell your papers all the media on you people can learn more that there are you know two other pieces one is is what about pharmacologic interventions because drugs have a role and kind of one of the one of the star players here and and and also like what about brain exercises like brain games or any language so those are two things we need to talk about but I think they're key pieces of keeping and retaining your brain I'm equal opportunity I got I got no skin in this game I take no you know funding from pharmaceutical companies any anything like that I'm equal opportunity if it's a drug a vitamin a supplement and it's relatively safe and I would be willing to take it myself or give it to a family member it is on my list of potential intervention so I'm not pro work on anything I'm pro evidence and I'm pro safety that's all I am in our research study that we presented in July 2025 at the international Alzheimer's conference paper is getting ready to be published not going to be published yet it's going to take these papers take you know years and years and years to publish the general categories of drugs that worked the best and when we talked about hormone replacement therapy and we talked about glp ones and those drugs drug categories worked honestly amazingly well like it's just it's just I was I was floored by it there are three other drug categories that people have heard of many people are probably taking and then there's one drug category that is more specific for Alzheimer's so the next four categories that I can talk about briefly are cholesterol treatments and those are two statins as a category and I'll explain the nuance there and then is that a my board Zedia which is a plant sterol inhibitor and we've broken out groups into statin use versus Zedia use that's the the brand name but it's all generic now and then the other categories were I think this was in the paper SSRIs selective serotonin reuptake inhibitors and then the final category was anti amylade drugs so these are drugs that we've studied and these are things that we've studied in our cohort you're also talking about glp ones too are part of the oh yeah yeah oh glp yeah glp ones and hormone replacement therapy are definite check checkmarks and I would say in our in our study multimodal interventions work the best glp ones and hormone replacement therapy I would say work the next best and then there's these four other categories which we studied and across a variety of biomarkers but maybe not as like not homerun grand slam there were statistically significant improvements across select blood biomarkers the basic what you're saying is the basics work better than these fancy drugs that we've been billion dollars researching and have shown very incremental benefit yeah and they're not like zero but they're yeah and they may be additive to an overall package of intrusion true and in the right person at the right dose um is that a my the plant sterol inhibitor I I never in a million years would I have like ever said that I would be saying something like this but you know we're developing these blood tests and you know we talked a lot about Alzheimer's today but alpha synuclein alpha synuclein is the pathologic protein that that builds up in the brain of a person with Parkinson's disease and Lewy body dementia like we are working on these blood test like this is crazy never in a trillion years like what I've ever regardless of my family my brother my brother's son my brother's brother-in-law like like we see these drops in alpha synuclein protein using some of these things and is a park and survive the violence so I don't fully know what this means yet but what I would say is the cholesterol drugs in the right person at the right dose in the right duration um you know your mileage may vary um work and it's improving what I believe to be brain health risk and brain health outcomes statin let's talk about statins the people that start on statins in our cohort are not your typical you know crestor resuva statin 20 milligrams like the amount of people I see on high dose statins it like just blows my mind 85% of the cholesterol lowering effect of resuva statin or crestor comes at five milligrams of the dose so you get 80% of the benefit at the lowest dose yep and no one knows this and like and I think that's correct I mean that's what I've read and that's what I've been taught but like if the majority of the effect come at low dose like why do we keep like to get an extra five or 10 benefit when you like keep pushing and pushing and pushing these doses that are just like really high to me when those cause mitochondrial injury and that is important in keeping your brain healthy is having healthy mitochondria yeah and and you know the the side effects go up and across you know a variety of ways in our cohort lower dose statins in the right person that are biologically attuned to respond to statins meaning when we do the blood test it says you should take a statin because it's you're an over producer of statin genetically or biologically so lower dose statins um do show brain positive effects on our research but you guys are throwing in everybody you're doing tests that say oh you're somebody who produces more cholesterol so you and I don't so statins wouldn't be good and even I have the gene that makes it me have myopathy or muscle damage if I take a statin I have that gene I tested it so it stands are not good for me and they also cause mitochondrial damage and if you do the test this helps you personalize or pre-precision approaches you're going to get a better effect with less side effects and and there's a friend of mine David Faganbaum who created a company called ebikure which is about using drugs that have mechanism of action for diseases for which they were not developed right so what you're talking about is zetamide or zettia it works for Alzheimer's but it was a cholesterol drug but it has an effect that maybe we don't even understand why but it's working on some pathway that's independent of just the cholesterol lowering because it's not just about lowering cholesterol because you could actually lower cholesterol just as much with another drug but not see the same benefit exactly and and and you know these are again these are catching on you are you're catching on you've been to this rodeo before so so anyway I would say cholesterol drugs when used in the right person at the right dose for the right duration of time are protective against dementia and Alzheimer's pathology and maybe even Louis Boddy in Parkinson's but I want to be really conservative not fully published yet like we're we're just we're just learning SSRI selective serotonin reuptake inhibitors and pros and again so in our cohort does that category of drugs actually we have zero people in our cohort on prozac the only people in our cohort that are on SSRIs I think this is because esatallopram or lexapro it's all generic now esatallopram has been shown of all the SSRIs and a study that came out in neurology like a few years ago to have the best you know lowering or attenuation effects on amyloid so in our little group you know we have a group of preventive neurologists preventive cardiologists preventive medicine specialists internal medicine doctors that treat the patients in their own individual clinics and whatever and then they're in our research study and we track the biomarkers we all have gotten the memo that esatallopram I'm going to sound like a broken record at a pretty low dose you know we have a guy now on five milligrams I almost never go I mean I don't usually go high and by the way we're not treating you know you know I'm not a I'm not a psychiatrist I we're you know mild depression versus major depression those things I'm not going to get into the nuance but the majority of people in our cohort that are on SSRIs are on esatallopram or lexapro five milligrams I would say on average and in our cohort it's a small small group but we also saw some but not I would say slam dunk robust effects from low dose esatallopram low dose lexapro so this is really important I just want to say step back because we kind of have to wrap up but I think I think that you know for those of you listening who have a family history or who are suffering from memory loss or are concerned about getting it you know what you're saying Richard Dr. Isaacson is that for the first time in history we're actually able to do preventive neurology around neurodegenerative diseases and that you can actually slow or even reverse the changes that happen that are measurable by new and innovative blood biomarkers that you're developing and that are ones that already available and are available and you're seeing change in brain structure growing brains and the function of brains improvement and cognition and you're not using the old paradigm of a single drug for a single disease using over 50 different things that you pick from depending on how you want to personalize the treatment that if you see one person with Alzheimer's you've seen one person with Alzheimer's and that this field is changing radically in such a way that will actually be able to help us avert this catastrophe of 47 million people who are in the pre-symptomatic stage of Alzheimer's that are measurable by these blood biomarkers that are going to cost us $18 trillion over the next three years. This is revolutionary and if anybody's listening who cares about this issue who wants to help and again I have no affiliation with you other than being your friend and having a bond over the grateful dead, following your work for years. This is where the money needs to go. This is where the philanthropic dollars need to go. This is where NIH funding needs to go if you're listening, Jay Bhattacharya. This is the future because it's what I have seen over 30 years in the practice of functional medicine from a very amateur scientific perspective. I'm not a researcher. I'll have done some research studies. It's what I wrote about in my book The Ultramind Solution 15 years ago or more than 15 years ago now and I think we're at this transitional moment in history where for the first time we're getting a handle on this horrific condition. You know, yeah, you get a heart attack, okay, you have chest pain, you get a bypass, you get a new heart transplant, you're still you. When you get Alzheimer's, you lose you. You lose your family members. It's a catastrophic disease and everybody's terrified of getting it and nobody should be afraid of doing the diagnostic test to figure it out. And now at Ezra, which is a company we bought with Function, we actually can do brain imaging and we can do quantitative brain imaging, which is a more advanced service we offer, but we can actually start to track these things over time. And so you can begin to do these things. You can go to retainyourbrain.com and start to kind of get ahead of the game. So Richard, I just want to say thank you for what you've done. Thank you for the insights, for the aha moments you had in the hallway with that guy with a picture of dementia. We never know how we get doing what we're doing, but I hope that your work continues. I hope that you get it funded not to 10 or 20 million dollars, but we need a billion dollars. We've spent so many billions of dollars and wasted them. This is an area that needs real serious funding because what you're seeing is real. It's not quackery. It's not heresy. Well, it kind of is heresy, but it's actually a valid scientifically and we need to get behind it. So thank you for everything you've done. Thank you for what you're doing. You're leading the pack for the rest of us and I just appreciate everything you are and everything you're doing. So thanks for being on the podcast. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the ultra wellness center at ultra wellness center dot com and request to become a patient. It's important to have someone in your corner who is a trained licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.