This Neurologist Shows You How You Can Avoid Cognitive Decline | Dr. Dale Bredesen on Health Theory

And unfortunately, so many of us are literally giving ourselves cognitive decline or simply sub optimal cognition because we are not doing the right thing. Everybody, welcome to another episode of Health Theory. I am here with Dr. Dale Bredesen, who is a world-renowned brain health researcher and the best-selling author of The End of Alzheimer's. Dale, welcome to the show. Thanks so much, Tom. Great to be here. So, I want to dive into something that is extraordinarily important to me, which is cognitive optimization. It's something that I think a lot about and um there are few people that I've seen take the approach that you take. Most people have said for ever, basically, that there is no cure for um cognitive decline and once you're sort of on the backslide, that's just it. There's not a lot that you can do. Um you were so bold as to write a book called The End of Alzheimer's. So, what is it that you know that everybody else doesn't? Yeah, and I should say, you know, that that cognitive optimization now goes very well with prevention of Alzheimer's in the future. So, what we used to think of as, "Hey, you don't have to worry about this until you're in your 60s." No, we should be doing in our teens, 20s, 30s, 40s. Uh we will get better outcomes. We will get, you know, we will get better brain health. We'll get better performance. So, the the goal of my laboratory over the years was to look at what are the the molecular mechanisms that drive the degenerative state. People say Alzheimer's is because of free radicals. It's because of metal binding problems. It's because of misfolded proteins. It's because of prions. It's because, you know, what what have you. And the reality is that people don't understand what it is. So, that's what we set out to look at 30 years ago. And what we found was really surprising. What we found is that at the heart of Alzheimer's is an insufficiency. You literally have a plasticity network in your brain that responds. And again, this is not surprising. If you think about what it takes to make a country work or to make your business work, you have a supply, you have a demand. So, what happens in Alzheimer's, you have a chronic mismatch between the demand and the supply. And there are four big things that affect those. Number one, anything that drives ongoing inflammation. And that can be dentition, so changes in your oral microbiome, changes in your sinus microbiome, gut microbiome, um systemic inflammation, metabolic syndrome, uh P. gingivalis, herpes simplex 1, on and on and on, anything that drives inflammation. Anything that adds toxicity to your brain. And unfortunately, as you know, we are all exposed to toxins like never before. From the California fires to the you know the air pollution that we live with to the processed foods that we are exposed to, you know, on and on and on to you know the water supply and on and on and on. So, those are two the big ones. The third one is trophic support. So, this was actually discovered years ago by Rita Levi-Montalcini who won the Nobel Prize for her work. She discovered the first one which she called the nerve growth factor. These are typically proteins that bind to specific receptors in your brain and essentially say, "Things are good." So, what happens with Alzheimer's is you have this set of things that are suboptimal. And as I said, that can be inflammatory things, it could be toxic things, can be reduced growth factor and trophic support including nutrients and hormones and then energetics and that's a misunderstood one. Many people, here's a simple example of many, you go to sleep at night, you drop your oxygenation. For many people they don't realize this is happening sometimes in their 20s, 30s, 40s. Now you can check this easily. Check it with your Apple Watch, check it, you know, with a better whatever you like or get out or get a sleep study. You should be sitting at 96 to 98% oxygen saturation. people's levels? So when I started researching you, I literally immediately I this is I paused my research and went and bought two oximeters, one for myself and one for my wife. Um and then I started thinking, well, wait a second. What would cause my oxygen levels to drop? Would it be um just sleep apnea or are there other things? Yeah, the most common is sleep apnea. Um and by the way, that happens more in males, more as we get a little older, more as we are a little overweight, which again, a big problem in our country uh in the western world, more as we have inflammation. So systemic inflammation associated with sleep apnea. A lot of people will actually improve their sleep apnea just as they improve their inflammatory status. But there are also other conditions. Uh there's one for example, something called UARS, upper airway resistance syndrome, where you don't actually have apneic episodes, but you are essentially struggling to get enough air through there while you're sleeping. So it's a resistance syndrome. And by because of that, you're now repeatedly making a little bit of adrenaline. Boom, so you're waking up again and again and again. So again, good to know that you're sleeping, that you're getting enough REM sleep, you're getting enough slow wave sleep, you're getting enough deep sleep, and you're getting enough overall sleep. These are all critical features. Again, these are things that we take for granted and unfortunately so many of us are literally giving ourselves cognitive decline or simply sub optimal cognition because we are not doing the right thing. So, I'm going to I'm going to put a mile marker for people and as soon as I heard you say it, I thought, "Oh my god, of course this is the answer." That it's diet, it's lifestyle, it's uh exposure to toxins. It's like a whole bunch of things. I've heard you say before there's no silver bullet, but there's potentially silver buckshot. That if if we deal with all of these different assaults on the brain that are causing the the um insults, the injuries, then you're not going to have the cognitive decline. That it isn't the amyloid plaque to use an analogy, um so many people and this is the part that literally until 2 days ago when I started researching for this, um I hadn't heard anybody say it. I I'd only ever heard amyloid plaque, amyloid plaque, amyloid plaque. And if you think of amyloid plaque as the water that's on the house after a house fire, you're to blame the water would be to fundamentally misunderstand the problem. And you talk like a functional medicine practitioner. So, can you walk us through like just the basic things that people encounter on a daily basis? You you threw out processed food already, but things like mold and you talked about air pollution. Like what are some of the the just everyday insults people are taking? Yeah, so let me just quickly walk through what this disease actually is cuz that's the whole you know, that that's the whole point of this. That when you're stuck back in the idea that the amyloid is causing the the disease itself, it makes no fundamental sense. Then you say, "Well, wait a minute. Amyloid turned out to be an antimicrobial peptide." So, no surprise, it is part of your defense. So, again, your brain is deciding are things good and I'm going to grow and and maintain synapses, or am I under assault from any of these various things that we'll talk about and therefore I have to go into protection mode. I'm going to pull back and say, "Okay, I won't have quite as many synapses, but I'll survive." And that's what's happening as we get a little older and we can begin before you know, 20 years before Alzheimer's, we begin to downsize, unfortunately. Uh this should get into the mechanism of that really fast. So um I like that. It's very clear and I know hippocampal density is one of the things you look at to judge whether somebody is having this problem or not. So what's going on is the brain is permanently staying in the mode of um protect, downsize. And even in old age, should it be alternating between protect and grow? Yes, you should Yeah, you should be able as long as you don't have a lot of inflammation, a lot of toxicity, you got the support from trophic factors, hormones, and nutrients, and you've got support for energetics, your brain should be able to make and maintain synapses. That's why we people say, "Oh, this person's 95 years old, but she's sharp as a tack or he's sharp as a tack." You see this all the time and this is because they've got that appropriate balance. And so you have to have that shrinking, is So obviously, if you don't remove the insult, the injury, um and you said that, you know, trying to treat the symptoms of Alzheimer's would be like trying to repair your house as it's on fire and it it doesn't make sense. I that conjured such a powerful image. But why does it keep shrinking and shrinking and shrinking? Right. So we have We said this about the house on fire for stem cells. The idea was if you're only giving a monotherapy, so you're just taking a situation where you don't know what these things are that are causing you to be in that pullback mode, you're just going to throw some stem cells in there. Yeah, they're going to help transiently, but you're still the house is still burning down and you're trying to now do something. You're trying to rebuild it as it's burning down. So here's the thing. We have this set of things and so chronically, we are shrinking, shrinking as we're on the wrong side of this balance. The supply is being exceeded by the demand. Well, you'll keep downsizing until these until you can meet the demand. So, that's why you need to remove those insults. And as you indicated, there are several common ones. So, let's start with, you know, what are the common things for people that to be insulted by as we are as we are living? Well, we found subtypes of Alzheimer's that tell you are is yours mostly inflammatory, atrophic, glycotoxic, etc. And we can see markers for that in the blood? Yes. You can see markers for those in the blood. So, you can say, "Oh, this person is mostly an inflammatory Alzheimer patient or inflammatory pre-Alzheimer's." And again, pre-diabetes, we recognize more and more, pre-Alzheimer's, incredibly important to if we're going to make Alzheimer's a rare condition, which is exactly what it should be. So, anything that's inflammatory, so we should know how we're doing with our oral microbiome. Do you have a lot of pathogens? Do you have poor dentition? You are at increased risk for cognitive decline if you do. And then, do you have leaky gut? So, again, leaky gut is something that I wasn't taught about in medical school, but turns out to be quite common for many of us. And when you have that, it will contribute to systemic inflammation and therefore increase your risk for cognitive decline. So, these are all parts of type one or inflammatory cognitive decline. And then, type two is atrophic. And so, that's on the supply side where you have reductions. And a typical thing people will have poor thyroid hormone or reduced testosterone or reduced estradiol or reduced vitamin D or increased homocysteine, on and on. So, there's a whole set of things again required to make your brain function well. And I think everybody has that feeling. I have a day where you get up and wow, I'm really on today. Things are going great. And on the other hand, everyone's had days where like, wait a minute, things are just not right today. So, that's another big a big one there. Then, glycotoxic. So, one of the most common contributors in the United States to cognitive decline is insulin resistance. There are about 80 million Americans who have insulin resistance. Many of them go on to have type 2 diabetes, but you don't have to have type 2 diabetes. Insulin is not only the thing that it deals with glucose, of course, it's an energy-related hormone, but it's also quite an important growth factor for brain cells. And so, when we used to grow brain cells in a dish all the time, we would always have to include insulin in their medium to keep them alive and to keep them interacting. Unfortunately, what happens to us is we are exposed to high-carb diets, low-fiber diets, high glycemic loads, and so we put out all this insulin for years, and therefore we do end up developing. You can actually follow the biochemistry of it. IRS1, the signaling molecule downstream from the insulin receptor, has specific phosphorylation sites, multiple. When it is on signaling, the tyrosine phosphorylation is high and the serine threonine phosphorylation is low. When you have insulin resistance, that changes. You have specific sites that that are phosphorylated on serines and threonines, which is literally saying to you, we're turning down the volume here. And so, this is now not giving its appropriate signaling. You have insulin resistance. And you can check Everyone should know their HOMA-IR. This is a simple calculation to tell you whether you have insulin resistance. If you do, you are at increased risk for cognitive decline, and you're probably not as sharp as you should be. So, that's what we call type 1.5 because it's both an atrophic one and an inflammatory one. Of course, the glycation of your proteins, everyone's familiar with hemoglobin A1C, which is what we measure for glycation of these proteins, but there are hundreds of proteins that are non-enzymatically glycated when you have high glucose levels. So, that's another Now, I've heard I've heard um Alzheimer's referred to as type 3 diabetes. Um but researching you, that seems like even that, while probably a pretty big breakthrough compared to people talking just about amyloid plaques, um still feels like a simplification. So, how many total types are there? Um if I remember right, there's five or six. And um can you just for anybody that's taking notes, can you just walk through with like a really simple type one is this, type 1.5, type two, so on. That'd be great. Absolutely. Type one is inflammatory, as I mentioned. Type two is atrophic. Type 1.5 is glycotoxic. Uh and so, and then type three uh is toxic. And there are three types of toxins. The the you're talking about the metallotoxins, the inorganics, the uh organics, uh and the biotoxins, things like mycotoxins. So, that's type three toxic. Type four is vascular. Again, hugely important to get appropriate energy. You need the oxygen. You need the ketosis. You need the blood flow. You need the mitochondrial support. And then type five is traumatic. So, you've got a a history of head injury, especially recurrent head trauma. Not only are you at increased risk for CTE, but also for Alzheimer's disease. Okay, so let's sort of flip the script here. Um we're now thinking like a functional medicine practitioner. We're looking at the holistic approach, like this I think identifying what causes Alzheimer's, cognitive decline, figuring out how to begin to reverse that also tells us how to stay optimal or even, you know, a little beyond to get to my obsession. What does that protocol look like? What are we eating? What are we doing? Are we in the sauna? Are we exercising? We're getting sunlight? Like what are What are the things people can do? Great point. So, I have a book coming out actually in August, which is called The First Survivors of Alzheimer's. And fantastic, seven wonderful stories from seven people who actually developed Alzheimer's, were told you're going to die, you got Alzheimer's. All of them How deep into Alzheimer's were these people? Uh most of them had relatively early stage. Uh we have had some people very late stage who have improved, but what happens is they tend to improve, but they don't get all the way back to normal. So, we That's one of the things we're working on right now. How do we take someone with late stage Alzheimer's and get them all the way back to normal? What we can do is we can get them improve somewhat. For For people with early stage or especially pre-Alzheimer's, we see tremendous improvements. We see people go from Mocha scores of you know 19, which is very impaired. It goes from zero to Mocha's Montreal Cognitive Assessment. So, it's a kind of standard test that's used. And uh everyone should be scoring in the 28 to 30. 30 is a perfect score. And so, we had people down in 19, which is, you know, Alzheimer's disease, who came back to 30. So, very very striking. Uh and and so, yeah, very enthusiastic about that. But, you brought up a good point. In this book, we have a chapter specifically on enhancing normal cognition. So, what are all the things that you can do to get best outcomes? And yes, there's a whole program very much like what we're using to bring people from sub-optimal cognition to optimal cognition. You can start with normal and improve on your cognition. And yes, it has to to with a whole set of things. You're right, detox is part of it. We all have a some degree of exposure to toxicity by the air we're breathing, by the water we're drinking, by the food we're eating. Uh you know, just if you're eating uh mercury-filled seafood, if you're not eating uh grass-fed beef, um if you've got a high-carb diet, if you're eating simple carbs, all of these things are contributing to a less than optimal outcome. So, you're absolutely right. Just getting in that sauna, getting a sweat going, and then using a non-toxic soap like castile to get to go slow through this. This this is something that I've heard you say a lot, and I've never heard of these soaps. Um so, is castile a brand? No, it's it's a type of soap. And the whole idea of this is that they are they help you to get rid of the toxins um without adding more toxins. You don't want a lot of fragrance sauna. The soap's not helping you get rid of toxins, I would assume. Well, no, what happens is the sauna is driving them out. Okay. Just through sweat? Right. And if you don't then wash them away, they will slowly reabsorb. So, you think about it, you know, you want to get rid of toxins by imbibing less, obviously less exposure, less of the eating, less of the breathing, less of the drinking, all that stuff. And by the way, all of us who were in the California fires, you know, had a setback because of that. That's an issue. And we've had patients who were in, for example, the World Trade Center cloud. If you look at everyone in the World Trade Center cloud, just by 2015, 13% of them already had cognitive decline. These are people Oh. Yeah, relatively young. Scary as hell. It really is. Um this being in that Trade Center cloud increased your risk not only for what we've heard about, lung disease and cancers, but also for cognitive decline. Okay, so just by way of example, sorry to I want to keep going slow so that I make sure people can really take this into their lives. Okay, so I'm in the World Trade Center. The problem is forgetting cancer for a second and lung disease which are maybe more obvious, but I'm I'm taking something in, it's getting into my bloodstream, it's crossing the blood-brain barrier, and some mechanism is happening in my brain. I'm guessing the amyloid plaques are actually glomming onto these toxic particles that have made their way into my brain. My brain goes into um survival mode, so I'm not in growth and repair. Just trying to survive. I'm shrinking, shrinking. So, okay, to one, to try to minimize it, I can HEPA filter the life out of my space. Yep. Number two, I've taken in some toxins. I recognize that. So, now I'm doing something to make me sweat. Does Is a sauna and exercise identical, or does a sauna have certain benefits that exercise doesn't, or vice versa? They both have their own benefits, but they both do have sweating as one of their um yes, with with exercise, you're also improving blood flow to your brain. The sauna doesn't do that as much. On the other hand, sauna's dropping your blood pressure. Um actually kind of you know, relaxing the arterial stiffness for a period of time. As some people unfortunately will pass out in saunas, as you know, so be careful about that. But yes, you also want to increase your glutathione. You want also want to Supplementing or diet? There are a couple ways to go. And for many of these things, you can do it with diet. So, as an example, you want to take some sulforaphane, very helpful, and you can get this with broccoli sprouts as an example. And is this for everybody, or only if we're in a uh big environmental toxin moment? Yeah, so that's the that's the exactly the point. We are all living in a toxic world. That's the problem. Human beings are complicated organisms, and we are all exposed to some degree of toxicity. And so we realized that detoxification is not just for sick people. It's also for people who want to be healthier, who want to enjoy a better future with a lower risk of cognitive decline, a lower risk of cancer, a lower risk of chronic illness. And this is something that, you know, we thought about medicine as we do fine and then we get sick and then we take a pill and we're going to be better again, but that's not the way it works. And then when I was on the National Aging Council, there was an epidemiologist who did a very interesting study looking at when on average do US citizens develop their first chronic illness? And the answer was in our 40s. When do citizens of the UK develop their first chronic illness? In their 50s. So we're almost 10 years worse than the UK. We don't think of the UK as being a being a tremendously healthy group, but they are healthier than United States citizens on average. Again, we so we've got that combination of diet, poor exercise, high stress, poor sleep, and without a lot of brain training. That is a recipe. I wrote in the first book the the end of Alzheimer's, a chapter specifically on how to give yourself Alzheimer's. You want to give yourself Alzheimer's, I can help you do that. It's actually pretty easy. You do all these things the opposite of what we're recommending and even though you won't have Alzheimer's on day one, you'll have the biochemistry that leads to it down the road. So you can you know, you can impact yourself a lot by looking at that you know, that whole set of things. All right, let me give myself Alzheimer's real quick and tell me if I got it right or if I'm missing anything. Um I'm going to totally disrupt my sleep. Yep. Um I'm going to avoid sunlight, so no vitamin D. I'm going to take in as much breathable toxin as humanly possible. I'm definitely going to be doing things like smoking or sitting in traffic. Um I am going to I'm going to do pro-inflammatory stuff. So, I'm going to be um lots of carbohydrates, very low fat. I'm going to eat a lot of big seafood. So, things that live for a long time and eat a lot of smaller fish. Um I'm trying to think what the other six there I've I've gotten several of them. Yeah, cheeseburgers, fries, and a Coke. So, lots of sugar, lots of saturated fat, and no fiber. That is a what we call the perfuda trian. So, it's kind of like the Bermuda tria- triangle. This is the perfuda triangle. Um and then so it's giving you this combination. So, you want to have a leaky gut. You want to have a very high stressful job. And the bottom line for the chapter was you want to do what so many of us are doing all the time. That is why 15% of us are dying of Alzheimer's disease because we live in a society and live in such a way and eat in such a way and sleep in such a way and have stress in such a way that we are doing all the things that are pro Alzheimer's. By the way, before we ever get Alzheimer's, many of us will avoid Alzheimer's, but we're still going to have sub-optimal cognition. So, we're not going to do it. And you know, many of us face that, "Oh my god, it's it's the afternoon. I can barely keep my eyes open. I can barely focus. I can barely get my job done. I can't work fast enough." Those sorts of things. Those are all critical. Okay. So, I want to stay on toxicity for a second. Is fiber tied to toxicity or does that have a Absolutely. So, how do you get rid of these toxins? So, what what's happening is you have a dynamic balance. You're exposed to toxins all the time and you are metabolizing them, inactivating them, excreting them all the time. So, what's happening if you're on the wrong side of that balance, you have a bad future. If you're on the right side, you're just getting better all the time. So, as you said, you want to absolutely reduce your exposure. Find out what your home HERMI score is. That's from the EPA. If it's high, get rid of you remediate and get rid of that exposure. Avoid the California fires. Avoid being on the 405, you know, at rush hour and that sort of thing. As you mentioned, HEPA filters, very important. I think, you know, everybody should think about HEPA filters in their home. Cleaner air, no question, very, very good. And then the appropriate urination. So, yeah, filtered water. So many of us are exposed to really low-quality water. So, that's a, you know, that's a huge issue. And, you know, appropriate, you know, urination every day, very, very helpful. High-fiber diets, you're literally moving out these things. So, you've got a couple of ways to do it, right? And then you can you're also sweating them out. And it's different toxins that are being removed by these different mechanisms. And then, of course, you're also breathing them out. So, you want to optimize those things. And then, in your blood flow, you want to have high glutathione levels, high vitamin C levels. So, you want to have the appropriate detoxicans to bind these things up. Now, you mentioned metals. So many of us are exposed to heavy metals. And And Dr. Joe Pizzorno has made a wonderful career as a as a toxicologically oriented physician at looking at how many of us are exposed to too much mercury, too much lead, too much arsenic, too much on the persistent organic pollutants. And we don't realize it. As he points out, it's one of the major players in this increase in type 2 diabetes that has affected so many people in the United States. Yes, part of it is obesity. Part of it is poor diet. But part of it is also is exposure to arsenic, as it turns out. So, getting are we taking arsenic in? Yeah, you're taking arsenic in from several sources. You get it from ground water. That's one of the most important things. So, you can look up what is the water in my area in terms of arsenic, where does it stand? There's certain areas of Utah, for example, very high in arsenic in ground water. And then interestingly, uh a lot of chicken. So, for people who eat a ton of non-organic chicken, beware, check your arsenic level. Rice, another big one. For people who eat a ton of rice, check to see what your arsenic level is because again, it's something you can detox from. And so, you don't want to be keeping that stuff around. It's It can be damaging. It also increases your risk for cancer, by the way. Um and as a group, these things all increase your risk for cognitive decline. So again, you can do So yes, you want to give yourself Alzheimer's, toxicity is part of it. And I can I can help you so that you can give yourself Alzheimer's fairly quickly. It's It's very kind. I'm glad that you can also do the reverse and help me unwind some of this stuff. So, let's talk about um there's a mechanism in the brain that I found very interesting. Basically, a a mechanism by which we're metabolizing and flushing out the um amyloid plaques. That this is part of a process, another one of your balance things. Um what can we do to promote where it's like, "Okay, cool. I had um something cross the blood-brain barrier, whether it's a virus, fungi, whatever, and amyloid plaques went got it. And now, what can I do to make sure that that gets flushed out?" So, one of my colleagues at UCLA, a guy named Milan Fiala, Professor Milan Fiala, a really interesting character. And what this guy showed is that your You have this natural thing where you actually your macrophages and your circulating macrophages, which are your monocytes, you can You can isolate, take a little of your blood, take your monocytes, and then feed them the amyloid, and see how good How good are they at eating the amyloid? And for a normal person, you eat the amyloid, you're taking it up and get rid of getting rid of it pretty quickly. For people who have cognitive decline, they're very slow and it's because they don't this is goes right back to the balance that we talked about before. If you have ongoing inflammation, what your body is saying to you is hey Tom, you've got you've got an insult from these various organisms. So, the last thing you want to do is eat up and get rid of your amyloid because your amyloid has an antimicrobial effect. It is part of your innate immune system by the way. So, we want to leave that amyloid there so that it can continue to kill the bugs. So, if you want to get rid of your amyloid and flush it out, you want to start by having a pristine system in which there isn't systemic inflammation because then your body's cuz you're you're working against yourself as long as you're saying hey, I'm inflamed. I've got these various things from my oral microbiome or sinusitis or what have you in my brain, you're not going to get rid of amyloid. You're going to make more because you're trying to fight those things. So, the first thing to do is shut off the reason for making it, the insults. Second thing to do is to bind it up. And by the way, curcumin binds it up very nicely. So, this is why again many people will actually shave a little turmeric on their food. People from India do this for years and years and it keeps that amyloid low. It helps to remove it. It binds it and helps to remove it. Now again, you don't want to remove it if you've got systemic inflammation going on. But if you have an anti-inflammatory state, you can slowly remove it. Guess how else you remove it? Getting a good night's sleep. Very good to help remove it. And again, other things like excellent exercise. You're getting that blood flow. You're essentially you're doing more exchange than you would otherwise be doing. Supporting it with appropriate oxygenation. Okay, so um let's go real deep on diet here. So, uh I don't know what percentage of the issue you would prescribe to diet, um but my sort of knee-jerk reaction if somebody's like my flight was delayed, I'm like it's your diet. Like I just to me everything comes back. I know I'm oversimplifying, but so much comes back to diet. So you said something that I found really interesting which was think of me so I go hard on meat grass-fed, but still I like my meat and you said to treat meat like a condiment. So I found that very interesting. So what should my diet be and assume I'm willing to do whatever you tell me is optimal. Yeah, and again, you are relatively young. That's great. So when you're young great have a high protein diet no problem. You want to get clean protein of course. So you want to put things in that that had that are cleaner that don't have all the pesticides don't have all the hormones don't have all the heavy stress. You know, many of these animals dying from bacterial infections. So you got that now. So that that you want to avoid that. So you already mentioned you're doing you know, you're you're eating things that are grass-fed beef fantastic. The key here is you want to stay away from high simple carb diets. That is bad for everybody and again, it's an important part of being able to give yourself Alzheimer's optimally. If you really want to give yourself Alzheimer's have plenty of simple carbs. So what you want to have is a high good fats polyunsaturates and monounsaturates. So olive oil so eating avocados you know, eating any sorts of oils even some small amount of saturated fats coconut oil not not even so bad. You don't want to have a ton of linoleic acid. Be careful about the omega-6es. You want to for for most of us the average American diet has about 15 to 1 omega-6 to omega-3. It's unbelievable. So we're basically saying let's give ourselves as much inflammation as we can and as little anti-inflammatory. If we can get it closer to 1:1, 2:1, 3:1, even 4:1, that's Where Where are the big um omega-6s coming in? So, grain-fed beef would have a ton of omega-6. Yeah, you're getting it from You're basically getting it from seed oils, things like that. Um so, you want to be careful about these seed oils that can have you know, that can have Also known as vegetable oil. Yeah, vegetable oil, stuff like that. You know, palm oil, things like that. Um stick with the avocado oil and that sort of thing and the extra virgin olive oil um on the positive side. And to be fair, you do get a lot of omega-6s from nuts. So, you want to have some nuts because they do give you good oils, but you don't want to be going crazy on the nuts because they can give you too much on the inflammatory side. Do I need raw nuts? Can I have roasted, salted? Where are you at? Raw and minimally roasted. Don't roast them to death because you're damaging the oils then and you can you know, you can oxidize the oils. Remember when you know, saturated fats are hard to oxidize because they don't have double bonds, but the unsaturated fats have those double bonds that make them quite susceptible to oxidation. They can go rancid. That's the idea. Uh and so, be careful of rancidity. Okay, so um now let's talk about the meat in that. So, I've heard you say plant-rich. So, I want to have um what percentage like if you were going to ballpark me calories, what what percentage of my calories do I want from plants? Yeah. So, here's the thing. Let's work from the biochemistry side. Here's what Then we'll talk about if you want to end up with perfect brain function, here's what you need to do to do that. Okay, so for good brain function, you want to be able to have some ketosis. So, you want to have a mildly ketotic diet. Do you check your ketones and are you driving yourself into mild ketosis? I I checked my ketones so ferociously for so many years. Even though I don't check them now, I can feel it. Explain to me though why why do I want to be in ketosis at some periods? And you should probably tell people about your keto 12-3 um just so that they get sort of your overall philosophy. And then I promise, I mentioned seafood, we will come back to that. Um but yeah, walk us through the the why of ketosis. Right. So, the thing is that your brain functions it's got to have it's got to have energy. And you get two types. You can either metabolize glucose, or you can metabolize ketones. That's what your mitochondria use in your brain. And good brain function is a lot about energetics, as we talked about before. And by the way, Alzheimer's is a lot about poor energetics. Poor mitochondria, poor evaluation. So, what happens is so many of us we should be metabolically flexible. You should be able to go back and forth. You have some carbs, you metabolize that. The next meal you have a lot of fats, you can you metabolize ketones, which come from the the metabolism of the fats, and you go back and forth. That's where you want to be. For so many of us though, we're purely on the carbs. And so, even beginning in your late 20s, if you're at risk and if you if our APOE4 positive, and let's digress for one moment to talk about APOE. Do you know your APOE status? I don't, but after listening to you, I I am definitely going to get tested. Yeah. So, three-quarters of people in the country are APOE4 negative, which means your lifetime risk for Alzheimer's about 9% or so. About 75 million Americans have one copy of APOE4, so they got it from either their mother or their father, but not both. And they are their risk goes from 9% for their life to 30% for their life. And then 7 million Americans have two copies. They got one from their mother and one from their father, and they are well over 50% more likely that they will get Alzheimer's than that they will avoid it. Well, good. Now we can make sure that nobody gets it again by doing the right things, by checking these things before you get it. Unfortunately, most people don't know. So, when you have APOE, then you have an increased risk for cognitive decline. You have an increased risk for inflammation. And so, you you want to know that in terms of what you're going to be doing optimally. And by the way, it's you know, it's one of the key issues for for seafood. So, improving one of the reasons to to to get you appropriate fats on board. So, those people are specifically should be staying away from a lot of saturated fats. So, all we're trying to do is drive people, get you into ketosis. If you take someone who's APOE4 positive, as an example, by the late 20s, you can see a decreased glucose utilization in the temporal lobe and the parietal lobe. That's the signature of Alzheimer's in many years later, but you're beginning to see the first changes in the late 20s and early 30s. So again, why we suggest Cuz they're so I know enough about APOE4 to ask maybe the right question. So, APOE4 you put in a historical context, really amazing that it actually would have been very beneficial to our long, long ago ancestors who were just coming down out of the trees. They needed a pro-inflammatory state to deal with punctures in their feet, infections, eating raw food, all that. I thought that was a brilliant take that it it's actually disappearing because of the changes in lifestyle, but it actually served a purpose. That I don't know, that made me feel better about it. But that the reason that I begin to get the decrease in uptake of insulin is because I'm in a pro-inflammatory state. Is that what's causing that? Yes, because you have this beginning of loss of utilization and it is related to insulin resistance, pro-inflammatory state. You can bridge that gap and some beautiful work from Dr. Stephen Cunnane showed that you can bridge that energy gap with ketones. So, that's why we want to get you into a mildly ketotic state. And for anyone with cognitive decline, we definitely want to get you into a mildly ketotic state. And that means a low-carb diet. Now, there's nothing again, nothing wrong with appropriate meats and especially, you know, think about you know, fish, especially the smash fish, but the little guys, salmon, mackerel, anchovy, sardines, and herring. Those are the good guys. You don't want the high mercury guys cuz they can they can hurt you. And you want wild-caught fish. Grass-fed beef, nothing wrong with that. If you want to be a vegetarian, fine. If you want to have grass-fed beef, no problem. And it does it'll it'll help you obviously with avoiding you know, avoiding sarcopenia as you get a little older, you know, loss of muscle mass. So, you can get protein you know, you can get your protein through meat, you can get it through vegetables and other things as well. Beans, you know, all sorts of other ways to get it. So, that's So, this this Keto-Flex 12/3 is that you're getting into ketosis, you're having a high-fiber diet, you're having fasting for a minimum of 12 hours. If you're APOE4 positive, 14 to 16 hours is better. If you're APOE4 negative, 12 to 14 is fine. You need that time overnight to get some autophagy, to get your glymphatic system, you're now cleaning things up, and to improve your ketosis. So, all of these things work together to give you the best synaptic maintenance and synaptogenesis. So, that's why Keto-Flex 12/3. Um and the 3 hours is before bed. So, you want to If you don't want to stop eating 5 minutes before you go to bed cuz your insulin will still be high. And And And by the way, have you checked your CGM yet? So, continuous glucose monitoring, another Quantified Self is changing the world. So, for I think all your viewers, um there's so much you can do now that you would wasn't available 10 years ago. Uh between Apple Watch and Oura Ring and Omron for blood pressure and ketosis, you know, the ketone checks, things like Biosense, you can do breathalyzers now. Um you can check your your sleep at night. You can check your microbiome. You can check your genome. I mean, it's it's incredible. So, you really can can fine-tune yourself and improve your health and improve your long-term cognition with all the things that are currently available. Yeah, continuous glucose monitoring is fascinating. And I did that probably for about 6 months and loved it. It It turned eating into sort of a game of, you know, what's going to spike my glucose, what can I do activity-wise to drive it back down. That was really fascinating. I once ate a bowl of ice cream and did about 300 uh body weight squats and actually drove my insulin down lower than before when I ate the ice cream. So, that was really interesting. It was not worth it. 300 air squats is a lot of air squats. Um so, I didn't do that anymore, but um it was that was very very interesting. And yeah, beginning to understand some of these In fact, I would love to know um what are the tests that somebody should be doing with frequency to keep a real handle on their health. So, you've obviously mentioned several already. Uh we talked about oximeter, uh glucose monitoring. Um Um, what are some of the the things that people can do? I won't say where price just doesn't matter, but that are, you know, doesn't have to be free, but is reasonable. And let me ask when you did the CGM, did you drop into hypoglycemia at all? Because that's equally damaging to your brain. You don't want to be spiking too high, but we find that a number of people will wake up in the middle of the night not realizing they have gone into hypoglycemia. And that is damaging to your brain. So, you know, that's again why a high good fats and protein with low carbs will give you that nice smooth curve and you don't get these big spikes and you don't get the big troughs. So, here are the things you want to know. As you were asking what you know, what do you want to know here? Well, again, you want to go back to what are the things that are putting you at risk? And what are the things that are taking away from your best performance? And so, you want to know, first of all, do I have any systemic inflammation? And you can check your HS-CRP. Simple test, easy to do, any doctor can do it in a draw blood. You can, by the way, now do we have a cognoscopy and I made up that word just because everybody realizes when they turn 50 they should have a colonoscopy. Well, for anyone I recommend this for people for their 40th birthday, get a cognoscopy. Check and see where you stand. And again, Where where do we actually get that? mycognoscopy.com. Easy to do, you can do it direct cognoscopy and it's just three things. It's some simple blood tests, it's a simple online cognitive assessment, and then the third part is actually uh is actually optional. If you've got symptoms of cognitive decline, you want to include an MRI with volumetrics, but if you don't have any symptoms, you're doing well, don't worry about it. You don't need to do that third part. So, it's quite simple. Some blood testing and a quick online cognitive assessment. And then, what you want to know is you want to know the very parameters that that going to help giving you best function of your brain. So, as I said, systemic inflammation. You want to know, do you have good dentition? If you want to check, you could there's a test called oral DNA. Easy, it'll tell you whether you have a high amount of the pathogens like P. gingivalis. Those are the guys that end up in your brain and that are causing you to make that amyloid over the years that is affecting your cognition. Um and then you want to know um for example, do you have leaky You mentioned leaky gut. That's a huge issue, very common, and a common contributor to sub-optimal cognition and a sub-optimal metabolism. So, you want to know that. And then you want to know your glucose numbers. And you don't necessarily have to do CGM, although I I think it's helpful, but if you just know your home IR. So, what that means is you're checking your fasting glucose and your fasting insulin. So, some people will have a normal fasting glucose, but they're only able to do that because their fasting insulin is working overtime to keep that glucose in the normal range. Is there a home test for that? Yeah, there's not a home test for fasting insulin yet, unfortunately. Um so, that's a it's a blood test. Again, you can get it you know, you can get it online, but there isn't a simple quantified self sort of thing, a biohacking sort of thing that you can do for that. Um and then you want to know, are you low in specific hormones, nutrients, and growth factors? And so, you want to know your vitamin D as an example. So, we actually created for people in in interested in prevention, we created something called precode. So, if you look up precode, p r e c o d e, it'll give you the ability to get a report and a simple uh test that will do the critical things to know if you are at risk. Things like your vitamin D and your thyroid status. You want to know your homocysteine. Homocysteine is an indicator of your ability to methylate, which is important for a number of things. One of them being your detox. Um and then you want to know your toxicity status. Now, if you want to look at just the things you can do by yourself at home, okay. Again, you can order these tests and and people you can literally have a someone come to your home and draw these for you or you can go to a local center, either way. But if you just want to do it by Quantified Self, then I recommend that people get either an Apple Watch, an Aura Ring, uh something like this. And again, there are so many things you can do. You can uh look at your uh you can look at your microbiome on your own, send that literally send that in. Um you can look at um your blood pressure, check it easily. There's a thing called Omron, which will which will allow you to follow it with your Apple Toolkit. Um and we have we actually have an app now that that looks at all these various things and helps you to follow them along. Uh you can look at your uh you can look at your oxygenation, as I mentioned earlier with Apple Watch and things like that. Then you can also look at your uh at your vascular elasticity um with something that's called I Heart. So you can look you take that and look at your vascular elasticity. And then your heart rate variability. Um and you can see uh you know, how you're doing for your age. And again, you'll you'll notice when you're under a lot of stress when when things are tough, you're going to have a much lower heart rate variability. When you're doing well, and again, you know, as a scientist, I never thought the idea of things like, you know, things like meditation, I thought these things were, you know, worthless. And I have to say, you know, I can't ignore the data. The data show you that these things are actually helpful. Getting that heart rate variability up, getting that stress down, actually turns out to to be surprisingly helpful. Interestingly, as we were developing drugs for Alzheimer's, one of the targets turns out to be CRF1. So, it's this basically your the thing that's causing you to release cortisol, of course cortisol releasing factor, has receptors in your brain. And those receptors are when they're binding, you're getting a pro-Alzheimer's effect. So again, you're affecting cognition by running up your cortisol levels. So, no question things like meditation and good sleep, getting your heart rate variability up, turn out all to be very helpful. And then do you assume that you check your VO2 max as well? I've never Okay, your Apple Watch has that. So, you can see where your VO2 max is. You Yours is probably very high because if you're in good shape, it should be quite high. And of course, it's age-related, but again, keeping yourself in good shape, that's another thing. It's basically telling you are you able to metabolize the oxygen and get yourself appropriate blood flow. And so again, all these things are critical for again, for giving yourself best outcomes and best cognition, by the way. And then I think it's helpful to check glutathione. Some people argue that that's one that you know, most people are going to have a decent level of glutathione. But for people who have toxicity, you have to have some way to determine, you know, do I have a lot of ongoing exposure to toxins? So, I think it's a very helpful thing to do. Check your glutathione level and also check to see if you've got toxins, if you've got heavy metals. That's an easy one to check. That's a blood test. Or you can do it as a urine test. Some people like to do it as a provoked urine test. That's fine. But one way or another, screening for those metals, see where you stand. And then organics. If you've got, you know, very high load of you know of persistent organic pollutants. That's that's important to know. If you've got a you know if you've got high exposure to benzene, toluene. And here's an example we had a person come in a few years ago who was 47 years old with clear cognitive decline and it turned out that what had happened is she had been exposed for years and years to paraffin candle burning. And these things give off high levels of benzene, toluene, even some mercury. And so she had extremely high levels unfortunately of those things from this constant exposure. So again helpful to do that and then look at your look at your micro toxins. And again there's a separate test for those. There's a couple groups. Real Time does this and also GPL both do these urinary micro toxins. If you're low, hallelujah. Don't think about it for a few years. But if you're if you're not realizing that you're exposed to these things, they can give you all sorts of problems including cognitive decline where you go in and the doctor says I don't know why you've got this your cognition is just not very good. Well, that's something that's important to look into. So all of these very very helpful. Man, all of this has been extraordinarily helpful. I have really enjoyed not only our time together but researching you, going through your book. Um very very hopeful the way that you're showing people that you know we really may be living through the last generation that gets Alzheimer's without understanding how to avoid it. And so that is extraordinary and then being able to use this stuff for cognitive optimization is incredible. Where can people find out more about you so that they know when the book is coming out which I believe is later in 2021. What's the best way? Yeah, good point. So the book's the next book the first survivor's of Alzheimer's coming out in August. Thanks for asking about that. And you can get more information at drbredesen.com. Uh or you can go to mycognoscopy.com uh or you can go to Apollo Health. So, we set up a a software company that just that does software for looking at all these different variables cuz again, the future of medicine is for physicians to work with software engineers. So, your generation is going to have much better cognition than my generation because we didn't know about this. And you don't have to worry about Alzheimer's. It really should be a rare disease, and I'm convinced it will be by the time you get to my age, I think this will be a very rare condition. Amazing. Thank you so much. And guys, be sure to go check out everything that he has to offer. It will change your life quite literally at the cellular level. So, my friends, get after it. And speaking of things you should get after if you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. Thank you guys so much for watching and being a part of this community. If you haven't already, be sure to subscribe. 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