The Profound Effect of Lifestyle in Optimizing Brain Health and Avoiding Alzheimer's

thank you so much hello everyone can you hear me well it's a pleasure to be here we're grateful to Steve for inviting us here to talk to you about a topic that we're both very passionate about brain health in general but specifically Alzheimer's disease we both had two grandparents each who suffered from Alzheimer's disease and we saw them slowly and gradually lose parts of themselves to the point where they couldn't recognize their children and their grandchildren and I remember as a teenager I made a vow that I wanted to understand the brain better and to do something about it and the same thing goes for Verdean so thank you so much for having us here to talk to you about what we do in our clinics and our hospitals and our research on Alzheimer's disease hi everyone I'm Dean after that disclaimer by Steve I think you should just not listen to me period no I'm just kidding mmm but it is the most important talk you'll ever hear it's kind of self-serving but I'll start that way it's about the brain it's the most important organ in the body that goes without saying but for centuries we actually ignored the brain and we because we thought it was too complex so everything was attributed to other body organs such as the heart you know find it in your heart no you won't find it in your heart you'll find it in your limbic system it's all in the brain this incredible brain is the subject of the 21st century it's the focus of all research and 21st century majority of the research and this incredible organ is only three pounds and it's 2% of body's weight but it consumes 25% of body's energy there lies the problem this brain was not expected to survive to 80 90 and beyond the brain was supposed to live to 30 or so you know run around try to find the mate run away from the saber-tooth and die not always in that order but happen people live to 30 40 and didn't live much past that but then Fleming and others and their revolution of antibiotics and surgery and everything else really revolutionized survival if you look at this statistic before they before 1940s it's completely different from now the diseases have changed now we're dealing with chronic disease of aging and none of the the Quadra diseases is more profound not a more overwhelming that the ones that deal with the brain why because this brain is working 24 hours a day whereas the rest of the body actually rests at night it does some of its best work at night and while get we will get to that this brain is overwhelmed continuously working in feverish pace remember 25 percent of the energy is used by this brain so it's overwhelmed all the traumas all the vascular immunological endocrine traumas that accumulate throughout a lifetime affects the brain most by far exponentially mmm that's why we say if you take care of the brain you've taken care of all of the body in there also lies the solution you saw that we there are 87 billion neurons and nearly 1 quadrillion quite connections that's where the protection lies I'll give you a clue at the beginning that way you're gonna have to hold until the end to listen to the secret of how you protect this brain and there are examples of people living living well into their 80s 90s and beyond that have aged successfully we have to be aware of that because right now the fastest-growing population in America are those over age of 85 the second fastest is those 6500 above the pyramid of aging which was mostly at the bottom 30s and 20s now it's turning upside down and that's a good thing we are aging and we're aging successfully currently we have 80,000 centenarians in the United States that number is supposed to go up to 600,000 by 2050 if there's no further cures and cancer or heart disease or anything else and we know there will be so we're getting to be an aging society yeah that's a good thing examples are there doctor Wareham the gentleman on the on the right just passed away a month ago he he lived to a ripe old age of 104 and was fully active till the near end he actually was a cardiothoracic surgeon where we work at Loma Linda University by the way we picked Loma Linda University from the institution's you you you heard about because we were sick of hearing about these clinical trials at molecular level and we wanted to see the same kind of lifestyle success that people saw in heart disease and diabetes can be seen in Alzheimer's and we saw that and I'm gonna tell the story there dr. Wareham did open to closed surgeries up to age 95 he was still rated number one surgeon in loma linda and he retired at 95 because he wanted to travel and even thereafter he was fully active walking feverish pace at you know at 3 miles a day fully mentally active you've seen him on CNN and many other shows as bright as anybody you can imagine but there we have many other examples of that you know a lot of jane goodall a linus pauling picasso and many others aldo picasso who you wouldn't know if it was book good or bad later in the life but but I'm joking I'm I'm an artist a fan but many people who have thrived as they aged and that's where our challenges but the big challenge is dementia the tsunami the Avalanche whatever euphemism you want to use that's the big challenge this dementia by dead is the big categories the umbrella category Alzheimer's is a subtype of dementia dementia is when you're having cognitive deficits to the extent where it's affecting your daily activities that's it that's a one two definition of dementia you can't do your finances you can't do your or you can't do your driving or any of those it's dementia all timers constitutes 60 to 70% of all dimensions but there are many other types vascular dementia Lewy body dementia Parkinson's dementia frontotemporal lobe dementia and many others but underlying all of these there might be some differences but lifestyle as a major component now Alzheimer's is the fastest growing epidemic right now in the United States 5.8 million this should be changed 5.8 million people suffer from Alzheimer's every 66 seconds somebody's being diagnosed with Alzheimer's and actually that's an under diagnosis understand because a great majority of people who have the Alzheimer's of dementia are never reported especially in certain populations it's the third leading cause of mortality and morbidity in us number one in UK number one in Japan number one and many other first developed nations and will be number one in us it is growing at an incredible pace whereas we're succeeding in surviving other chronic diseases such as diabetes and heart disease the prevalence is increasing but we're surviving them mortality from Alzheimer's alone has gone up by a hundred and twenty five percent twenty three percent over the last 15 years and that curve will increase exponentially one in ten people over the age of 65 have diagnosis of dementia that number doubles every decade until at eighty-five where 50% forty seven percent to be specific percent of population have a diagnosis of dementia but that's not a foregone conclusion that's with how we're approaching the disease right now we believe that number can be significantly curtailed and affected if we take a different approach there are some disparities as well women suffer more from dementia and Alzheimer's one in six women get a diagnosis of Alzheimer's in their lifetime one in eleven men African Americans have a four times greater proclivity but the number is actually worse than that because it's not reported as well Hispanics anywhere between two to seven two point seven to three times greater prevalence there are different populations that suffer differently and you see the numbers change and I'll get to those studies as well the cost is absolutely bewildering the direct cost of Alzheimer's 259 billion dollars the indirect cost is another 240 billion now compare that to the second costliest disease heart disease 120 billion third costliest disease all of Kin's cancers combined 70 billion sorry 60 billion you can see that tremendous burden that this disease has on our system not just financially but socially as well one statistics that I have to tell you here is that the caregivers if their age matched they suffer they die 60% faster than the patient the families are absolutely overwhelmed and we must address this this cost is expected to grow exponentially by 2040 to 2050 the cost is expected to be anywhere between 2 to 3 trillion dollars if you are worried if your what other political affiliation you have this must be a priority because this by itself will collapse the healthcare system and the system in general so why are we not addressing it or are we addressing it well we are dressing it in a completely myopic way because of a myth the myth is that we can't prevent Alzheimer's and don't think that medicine and science doesn't have a blind spot it does not as much as people think I'm not one of those conspiracy theories that says this or that of AXYZ no vaccines I'm gonna say that right here whoever but there are blind spots why because the research system is set up in a way where a scientist can get their grant what they call ro1 or whatever grant if they focus on one molecule and that molecular approach has pulled us so far out that we've been spending hundreds of billions of dollars on dozens and dozens of studies on two molecules and lots of poor mice those poor mice amyloid and protein amyloid and tau these are proteins that accumulate and in Alzheimer's we've known this since the time of Eloise L saw marks 100 years ago and we've been chasing this molecule we've been cutting it burning it blocking it whatever we could and after billions of dollars of spending and hundreds of mouse models we have succeeded 0% not a single drug that has disease modified or stopped at the drive-in Alzheimer's we have symptomatic drugs like I like aricept and namenda and others but they're asymptomatic they don't do anything to the curve of the disease and we still do the same thing that has failed over and over again at billions and billions of dollars of cost the second myth is that it's a genetic disease yes it's a genetic disease everything is genetic where genetic beings there's a genetic code in every cell in your body but different diseases have different genetic relationship if you have a Huntington's disease if your man your son will get all Huntington's and depending on how many CAG repeats are there on chromosome 4 it will tell you exactly how fast how aggressively the disease will be that's a genetically driven disease disease but for majority of chronic diseases of aging especially brain diseases it's not one gene it's multiple genes and those genes don't create disease they create a risk spectrum so there are certain genes that really push Alzheimer's those three genes are the core pups those three genes at the corner priests inulin one priest NL and two and a PP there are genes that if you have those genes or any of those genes you will get the disease during your lifetime but nobody here will have anything like that because you see that in in populations like in South America where you land and you see entire populations in their 40s and 50s that have it nobody in the United States not many will have that and guess how my what percentage of Alzheimer's patients are affected by those genes three to five percent so what about the other 95% 95% are these genes so what are those genes the one that everybody knows about is a poly for how many people I've heard about a pony for gene yeah so if you have 18.4 gene your risk goes up four times roughly if you have two one from each parent you your risk goes up anywhere between 12 to 20 times so if you have two genes you should get the disease right no 50% of people with two genes don't get the disease what happened lifestyle there are studies in Nigeria where the prevalence of that gene was much higher in the United States about two percent of people have two genes but Nigeria was much higher but yet early on the prevalence of Alzheimer's was much lower so what happened why didn't the gene increase the prevalence lifestyle but as affluence paradox is coming and taking over places like India and China and Japan and in United and Nigeria the prevalence is going up why lifestyle and what what's the first thing that comes with affluence in these countries you'd meet yeah people who think they're affluent they think they should have me and so a pointee for what is a 24 it's a lipid transporter gene while protein product other things as well inflammation about lipid fat transport there are three kinds of them 0.2 0.3 and 8.4 if you have a pointy – you really have good genes there are really good transporters your risk of the Alzheimer is actually much lower if you have a 43 it's a wash if you have a pointee for your risk goes higher doesn't that make sense it's a lipid transporter that doesn't do its good job well so your risk goes higher so if you have a lipid transport problems what do you do lower the amount of lipids just the first clue into the whole talk so there is the biggest clue they're 8.4 what about these other genes well these other genes are not Alzheimer's genes they never are they're body's response genes vascular response genes immune response genes garbage-disposal genes are what they call lysosomal storage eenz what does that mean vascular response means if you have good genes are in against vascular response if there's vascular trauma throughout life blood pressure going up you have good genes your body has good response so it can respond well but if you have bad ones even a small vascular response is going to be poor immune response if you have bad immune response you know throughout life you the longer you live you will have episodes of immune challenge right inflammation you know infections things about that danger if your body's response is not good it's not proper you're going to have higher risk of Alzheimer's so if you have good response then you be more resilient garbage disposal your body's ability to get rid of waste at cellular level so if you have good response you'll respond no matter what if you have bad genes you will not be able to respond against garbage disposal so if you are if you were having bad genes when it comes to garden waste disposal what do you do don't create as much waste there's a comedian Red Skelton I'm aging myself I mean wait she's way younger than me I'm he said doctor it hurts when I do this don't do this you know don't do that so doctor I have bad genes against garbage disposal so therefore don't consume garbage to be simplified doctor I have bad genes against inflammation don't create inflammation as much as you think it's your knees or your affections that create inflammation the more constant form of source of inflammation is food the most more constant source of oxidation is food it's a chronic source so we have to address it in that way so all these genes our body's response genes lifestyle what about those three genes again let's go back to that so a pee pee is a transmembrane protein that's coded on chromosome 21 down syndromes patients who pay people who have down syndromes have three chromosome 21 so they have access of a PP so that means that there are a higher risk of Alzheimer's so a Down syndrome patient person who lives in their 50s almost invariably they always get Alzheimer's and their disease starts much earlier so that means that it's a foregone conclusion if you have down syndrome you're going to get Alzheimer's right so we had the fortune of doing research on NIH data that look at the enlarged population of Down's syndrome patient and their patients and also looked at proxies for lifestyle markers for lifestyle one of those blood pressure cholesterol diabetes which is very common in those individuals and guess what if the blood pressure cholesterol and diabetes was well controlled guess what happened even in these individuals the disease was pushed back so even in the genetic model of Alzheimer's lifestyles in effect there is no controversy what we're saying is not a belief it's data driven I don't go over all the data she's much better with the data so so it's a lifestyle component so it's critical that we actually take genetics in that perspective another thing that I want to talk about genes is invariably somebody in the crowd will ask me how will I know if I have genes and should I do a genetic test I said no you shouldn't do a genetic test because if we don't have a gene that we can actually target an effect so if you have a genetic test and you know you have the gene then what so if I have I have two grandparents who died from Alzheimer's brilliant people died from Alzheimer's and I lose everything in fact even coming here I forgot my backpack yes so up to now I don't know my genes guess what I attributed that to I'm busy I've you know I have two clinics community-based a program to children a dog mother-in-law mother lots of stuff but the moment I know that I have a pony for gene guess what's gonna happen every time we're gonna attribute it to that it becomes a self-fulfilling prophecy and when I we talk about stress then you'll know the effect of stress on it so until there is a genetic treatment why no in fact due to this assume you have bad genes and live as though you have bad genes and do the things necessary to affect the genes instead of you know the genes then what go in a corner and salt it's ridiculous the approach that that that's being taken by the way at the end of the stuff you'll realize that we have nothing to sell because everything that you need to do has to do with your living where you at your home and your community nothing you have to buy from anybody and in fact all the profits from our book goes to our healthy minds initiative movement to go to every community and do one thing raise awareness about the power of the community on their own health that's it we're not talking about convinced we're not against conventional medicine it's phenomenal they did back surgery on me I'm walking and all that there's a place for conventional medicine but that's sick care we call our clinic in our Hospital sicker health care is in your home your community and your work and it has to be there so it's it's it's important to start understanding where you could make the most difference now as the poet says the low of the road less traveled is the green one he didn't have the green one again but I added that as we at this time majority of us are going to start decline experiencing declining cognition maybe we're not even experiencing but it's happening in our 20s and 30s in fact there's the loss of cells neuron starts very early in our 20s and 30s that's pretty sad your 20s were your peak Wow and and then it starts going down further that's okay cells number of neurons is not that big a deal with 87 billion neurons when people say we use 10% of our body the 10% of our brain they're wrong we use it we use a hundred percent of our brain but only at one percent efficiency so we're not using the total power of this brain besides the 87 billion we have all these connections where the power lies and I'll get to that so don't worry about the burner on loss but if we don't do the necessary things early on it's gonna become MCI which is mild cognitive impairment and then from there 60% of mild cognitive impairment patients go on to develop dementia but if you start chain making the changes in your home your community's early on not only will you hold back dementia and stroke but you will have continued brain growth don't get me wrong there are some changes that happen with aging no matter what miniscule slowing in speed of processing miniscule slowing and retrieval and coding but that's in microseconds it would not affect anybody if there's no disease what you gain with aging is vocabulary context and three-dimensional thinking they used to call that wisdom but it's not that popular anymore we call a three dimensional thinking that's exponentially more than anything that we would law lose so exponentially more there are there any 18 year olds here no good so right around here I say if you had a 18 year old child or you well you're all warned 18 year old just think back compare that eighteen year old to a 60 year old they're not even same species and I have a 14 year old brilliant who's 13 went to college not the same species as mine as my mother the level of three-dimensional thinking is so much different from a child – you know to turn a dog so that's what we have to look forward to a different paradigm of thinking and maintaining that okay that was the positive two years ago when our book came out we were asked because it was published but here at Harper and and UK and Australia and other places by a Simon & Schuster they asked us to come to London to give a talk at BBC Breakfast which is the biggest show in the world we got so excited because right before was not because of the BBC breakfast because they said Abba would be speaking right before you so we got very excited about that I don't know if anybody knows AB me and so we we went there the way there two years ago Alzheimer's Association called them or equivalent of our London said they're too controversial they're saying that lifestyle can affect Alzheimer's and she will show you the data from ten years on and because of myopic the view of the world that they have so they cut our show from forty five minutes to ten minutes but we have about ten minutes with Abbas so that was good but but the all jokes aside we were disappointed this year in Alzheimer's international conference the plenary talk was lifestyle affecting dementia the biggest statement was prevention is the new treatment I was like my gosh you were two years too late you know you you messed up our show and and and you're spending twenty million dollars in lifestyle of course they're gonna blow it they're gonna do it badly because they don't know how to do it they're gonna and AARP is putting sixty million dollars into lifestyle and brain oh so now we're coming to this the realm and we don't care because to us all that matters is that individuals populations and families are against some control over this disease so what do you think is the problem with Alzheimer's dementia or any of these chronic diseases of brain aging for processes roughly glucose this regulation here if you if you take this note this is actually the basis of most biochemical processes in the in the body but specially the brain glucose this regulation lipid this regulation oxidation and inflammation now they're not separate this is a closed system when one happens the rest happen as well but sometimes people come to this disease from one direction more other times other direction when people have diabetes they come from glucose this regulation pathway more if they have cholesterol and she will tell you about that data they will come from that direction and we now deal with retired NFL players there that have found us and they come from inflammation more although inflammation is the common path for most of these but in that population in head trauma and traumatic brain injury inflammation is the first driver so these are the pathways right so what's the solution to this the solution is that how do you effect inflammation who hosts this regulation lipid this regulation oxidation through lifestyle nutrition exercise stress management and sleep the fifth one is mental activity that's separate but those five so we came with this acronym neuro an EU ro and it's for nutrition he is for exercise U is for unwind which is not which is stress management which he doesn't mean get rid of stress actually completely opposite increase your stress your good stress you know that's a very important part that I want to talk to you about R is for restorative sleep not just sleep if you're getting knocked out with medication it doesn't mean you're getting a restorative sleep and sleep is immensely important and I'll give a talk on that but so restorative sleep you have to go through those phases of sleep and oh the most important one is optimizing mental and social activity and I'll tell you though the immense importance and the protective effect of that so those five and if you do this we say that ninety percent of Alzheimer's can be pushed beyond normal age and that's not controversial statement so we'll start with the first one nutrition I shall talk about this her area of research is this and thank you okay let's talk about nutrition so as researchers I always get excited about data and I think every statement has to be supported with data and we don't have a lot of time with you guys I could spend days with you just showing you the data that supports the importance of nutrition and brain health but we picked a couple of papers some really relevant papers to show you you know what kind of diet actually affects brain health and prevents Alzheimer's disease and I think it's important for us to be database first of all and discuss this on a regular basis because there's a lot of noise and clutter and confusion out there everybody's coming up with a diet of the day and you know the vitamin of the day but that is not so so unfortunately this is what our diet looks like it's highly processed mostly animal protein and animal fat based and has a lot of processed sugar and we want to change it to something like this a whole food mostly plant-based diet now let's go over some of the data this paper that was published back in 2002 actually showed the effect of vascular risk for markers you know things like blood pressure and cholesterol on brain health about one thousand four hundred and fifty participants who were 65 to 79 years of age were studied and these individuals had a pony for a pony for is a genetic marker for Alzheimer's disease and was found that people who had April F or they had a higher risk for developing Alzheimer's disease almost two folds so they all went up by two fold however if these individuals had high cholesterol and high blood pressure during their midlife those markers actually increased their risk for Alzheimer's disease more than what the genes did vascular risk markers are actually a higher risk for Alzheimer's disease compared to genes this study that came from Rush University the chicago health and aging project it was a longitudinal study which means that people were followed for many years 2,500 older adults and it was found that people who consumed higher amounts of saturated fats that are derived from animals and trans fats which are found in junk processed foods over a period of six years actually had a higher risk of developing Alzheimer's disease compared to those who ate fats that were derived from plants think of nuts and seeds and avocados this study the Adventist Health Study from where we cut from Loma Linda and Southern California back in 1993 dr. paul geum a researcher was interested in finding out the incidence of dementia in the Adventist population now the addresses have 50% vegetarians and 50% omnivores people who eat meat he wanted to know you know what was what was Alzheimer's incidents like in that population and he found out in a group of about 3,000 individuals in that study that people who ate meat including those who ate poultry and fish had twice the risk of developing Alzheimer's disease compared to vegetarians this study the Kaiser Permanente Northern California group in about 10,000 individuals they found out that people who had high cholesterol during their midlife had a 57 percent higher risk of developing Alzheimer's disease and even borderline high cholesterol increased their risk by 23% so you know there are a lot of people who go on with not really bothering too much about lowering their cholesterol level because it's you know not that high it's just kind of in the middle region know it's important to lower your cholesterol as much as possible especially during midlife the vascular risk factors in midlife seem to have a higher association with development of Alzheimer's disease later on this study in the women's health study from Harvard University 6,000 women followed for four years higher saturated fat intake was associated with a poor trajectory of cognition which means that they had a faster decline in their cognition compared to those who consumed fats from plants and when they did imaging studies of these women people who or the women who had the lowest intake of saturated fats actually had a better looking brain their brains looked younger and they did much better in neuropsychological testing their brain function was that of a woman 6 years younger this study I had the privilege of working with my mentors at Columbia University and it was found that people who ate a plant-based diet which negates sources of saturated fats they had a lower risk of cognitive decline over a span of 6 years compared to those who ate a standard American diet or a sad diet Rush University memory and Ageing project same pattern do you guys see the pattern here so the the scientists at Rush University were interested in the mine diet anybody heard of the mine diet great so the mine diet is I'm hybrid of Mediterranean diet and – diet – diet is one that is high in plants and low in in in salt and sodium and Mediterranean diet I'll explain about what that means later on do you know essentially a diet that is high in unprocessed plant foods it's not fish and cheese and wine and you know some Mediterranean music on the lake we'll talk about that later so people who adhered to a mined diet had a lower risk of Alzheimer's disease by 53% crazy numbers listen it's so amazing and even moderate adherence to a mine diet reduced their risk by 23% and people who were adherent to this die who had the highest adherence actually had a cognitive function equivalent to a person who was seven and a half years younger so functionally their brains were better and they had reduced risk of disease – now I was intrigued by the concept of Mediterranean diets I wanted to know what it was because we hear it a lot don't we everybody's heard about the Mediterranean diet haven't we you see it on the news you see it on magazines everybody wants to go to the Mediterranean region and eat Mediterranean diet by the way it's not like that anymore it used to be unfortunately it's not like that it's been westernized so I had the opportunity to work with this large date of us about a hundred and thirty three thousand women that were followed for about 25 years the California Teachers study and what I did was to find out you know what is the association between Mediterranean diet and incidence of stroke and when you break down the Mediterranean diet score this is what it looks like you know it's you get a high score if you eat vegetables fruits whole grains nuts and seeds legumes and omega fats omega-3 fatty acids not necessarily fish but omega-3 fatty acids it could be derived from plant still and you get a low score if you eat meat poultry and dairy and what are those those are sources of saturated fats right here and what I found was incredible every step of getting closer to a Mediterranean diet lured the risk of stroke and we all know now that people who tend to have stroke have a higher risk for Alzheimer's disease and vascular dementia as well and it was interesting because it was not an all-or-none phenomenon either you eat a Mediterranean diet or you don't know every step of getting closer to that optimal diet which is essentially a whole food plant-based diet made a big difference in lowering stroke risks by 44% and this is just diet we didn't even we adjust it for exercise we adjusted for education levels for stress and things of that nature just diet on its own what medication do we know that shows us numbers like that nothing there is no mathematic Asian let's talk about supplements you know Dean and I work in a clinic we used to work at Beverly Hills where people would come with bags and bags of vitamins and minerals and so on and so forth and they would ask us you know so what about what about this vitamin what about this blue jellyfish thingy that I saw on you know infomercial last night for brain health and most of the randomized control trials on nutritional supplements for Alzheimer's disease prevention have been inconclusive except for three number one is vitamin b12 level vitamin b12 level has to be replaced in deficiency States and it has been associated with better brain health the second one is DHA omega-3 fatty acids but we always say skip the middle fish because fish comes with a lot of junk and a lot of toxins so it's always best to go to the source which is algae so an algae based DHA is important for a brain health and the third one that is relatively new is turmeric and we actually did clinical trials and we wanted to study the amount of amyloid in the brain at cedars-sinai in Los Angeles to see know the amount of amyloid through the retina and when people were given high doses of turmeric it actually bound to that amyloid protein and there's research that shows that the amyloid load and the brain actually is lowered when people take curcumin on a regular basis curcumin is a part of turmeric there's so many different compounds in turmeric but curcumin has been studied so it looks very promising and we per said it's a very potent anti-inflammatory the rest of them they're inconclusive we don't have any data that shows that any other vitamin is good for the brain and we always say why don't you just get all of your vitamins from Whole Foods it's much better because it's the synergy between these vitamins and these nutrients that make a difference there was a study that was released a couple of years ago and they found out that vitamin b12 and omega-3 fatty acids the DHA actually work in synergy to show its benefit for brain health if one is alone the other one is high or vice versa they don't work as well so the body recognizes it in whole food forms are you okay sir I'm sorry about that all right let's talk about fish I mean we always hear you know fish is great for brain health fit fish has great fatty fatty acids that are necessary breeding how I wanted to start that the this conversation by saying that whenever fish is studied in different studies it's always in comparison to something you always compare what you eat now to what the nation eats you know unfortunately we'd a standard American diet which is mostly processed so fish which is lower in saturated fat compared to say red and meat or chicken always seems to be better but if you compare fish to lentils which hasn't really been studied at all I don't think you're going to see any benefits it's the whole food plant-based diet that you know it's way better than all of these animal sources and most the studies actually haven't shown any benefit for cognitive function with the fish consumption or even with omega-3 supplementation and studies among healthy older adults people who have lower omega-3 fatty says it's important for them to be replaced and we all know that fish and you know of the animals in the oceans have been contaminated with Mercury and PCB and there's there's so many publication about that here and there these are neurotoxic we don't go to our doctors to get checked for these toxins except for maybe mercury and lead but they're you know thousands and thousands of other chemicals in the ocean that we never ever check so skip the metal fish it's important to get an algae based DHA and EPA supplementation and to get our nutrition from plant-based sources this is a paper that Dean and I published a few years ago about about demand dementia and diabetes relationship now and anybody heard of Alzheimer's being a type 3 diabetes I mean okay that's interesting that a lot of you have heard it and I think it's a misnomer in yes diabetes or glucose dysregulation is a path for Alzheimer's disease development but it's not the only one it's just one part of the picture and in this paper we found out that people who have diabetes they actually have a higher risk for Alzheimer's disease but in this paper that was published a couple of years ago we found out that people who don't even have a diagnosis of diabetes but they have consistently high glucose levels you know which is a lot of us because of processed foods because of you know the instant you know rush of sugar that we see everywhere and a consumption of sugary foods that actually raises our insulin and we get insulin resistance so insulin resistance has been associated with cognitive decline as well so one shouldn't wait for us to have a diagnosis of diabetes to be careful it's important to pay attention to insulin resistance and what causes insulin resistance mostly saturated fats and processed foods all right and so to kind of come to a conclusion of what an ideal diet for the brain looks like it's a whole food plant-based diet and one should work towards elimination of meat poultry and dairy now we believe in progress sometimes these statements seem harsh especially when we actually work half a day in a in a community clinic where you know people mostly don't have any access to health care they don't have health insurance and for us to go there and ask people to become you know hopeful plan based overnight that's not going to happen they're people who don't even know what beans are you know and they live off a fast food because they're so busy raising a family so as far as progress is concerned find out where you are today and go towards the next step of that optimal diet I think that's the most important message that we have to give to communities specific consumption of certain foods are great for the brain what are they greens berries and beans greens because they're an incredible source of anti-inflammatory compounds berries as well and beans have complex resistant starches that are great source of energy protein and they also keep sugar in your gut they have what we call the second meal effect say for example you ate a bean burrito in the morning which is fabulous but then something happened by accident you had a doughnut we're not gonna go into the detail of it now the beans and the burrito actually keeps the sugar in the doughnut inside your gut and it doesn't let it go into your circulation to cause a sugar spike where your brain just goes haywire and it causes inflammation so eating beans on a regular basis is one of the best things we can do for our brain and if we look at the blue zones in the world these are areas that have the longest living populations who have the least amount of disease including dementia one of the most important factors in the diet is beans all right so in everyday meal would look like something you guys had for lunch today green leafy vegetables cruciferous vegetables other vegetables berries nuts and seeds beans and lentils whole grains herbs and spices tea and coffee and then working towards eliminating sugar and when I say sugar sugar not in fruit because because that has actually bound with so many vitamins and nutrients and fiber this sugar is the white sugar that you know we see everywhere and in pastries and sweets cheese and dairy because there are very high source of saturated and extracted plant oils especially tropical ones coconut oil and palm oil because there are more than 90 percent saturated fats it clogs the artery the same way that saturated fats from animal products are concerned so in summary whole food plant-based diet prevents neurodegenerative diseases of the brain and neurovascular diseases as well like stroke saturated fats are associated with insulin resistance and inflammation and sugar consumption you know pure processed sugar is associated with inflammation in the brain and Dean will talk about exercise I don't know if the clapping is for you or for me but I'll take it for me yeah it's for you it's for you okay so exercise exercise is important we all know this but let me tell you how important whereas nutrition sleep and stress management increased the environment for the brain to grow exercise and mental activity actually grow the brain actually allow those neurons to connect and it's it's critical that we act and incorporate this into our daily life there have been many studies many many as I just said if we would have put all the papers into this talk you would be here till tomorrow in fact one of the things that we found when we published a book Harper kept coming back and saying you have to cut down on the citations you have to cut down on citation so we had to put about 300 of them in the website for people to check in the website because they said if the book is I didn't we didn't even know this if the book has passed a certain thickness there's an eye test that people walk by the book so we had to cut down on the citation I didn't things I didn't know before but for exercise their profound amount of data of the effect of exercise on brain framing a Framingham longitudinal study one of the longest most valid studies in the country daily brisk walk my favorite form of exercise daily brisk walk so you none of you have an excuse daily brisk while some but who can reduce your chance of developing Alzheimer's by 40% this has been repeated in several studies so a daily brisk walk why do I say brisk walk I'm not a big fan of running and and some of the traumatic exercises but a walk biking you know a treadmill or even a recumbent bike is my favorite form of exercise if I was Secretary of Health and Human Services which I would be fired the next day for this edict I would connect every TV to a recumbent bike so nobody's TV would be working unless they're moving the bike yeah you're clapping now you wouldn't be clapping the day after her I know that all these letters would be going out so other studies physical activity and risk of cognitive decline a meta-analysis of prospective studies 2010 34,000 people high level of physical activity reduced your cognitive decline by 38% even moderate exercise reduced it by 35 percent or so that's remarkable when have you heard about the fact that I'm gonna repeat this that cognitive kind of dementia can be prevented if all these papers exist that independently exercise as this not small studies Framingham how health study Adventist Health Study California Teachers study these humongous studies retrospective and perspective that show this why is nobody talking about it you know why because there's no money made from kale broccoli and potatoes there's no money who made from brisk walk literally so this is this is not conspiracy nobody's doing that but it's not a sexy that's where I come in I read so I so physical activity in elderlies associated would improve executive function and processing speed processing speed is something that's affected as we get older not a lot like I said if you avoid pathology its miniscule you won't notice it but exercise reduced the decline in cognitive function especially dementia and specifically executive by sixty percent that's remarkable exercise and memory decline again other studies that show the same thing flow of blood to the frontal lobe it effects blood flow to the frontal lobe it affects glucose metabolism it affects even lipid metabolism in your body but also in your brain as well so in many different ways it affects the brain in a positive way BDNF brain-derived neurotrophic factor when I was when I was at NIH one of the studies we did at that time this is 2001 was we there was a neuro degenerative patient we put BDNF AG DNF into the brain through these pumps to look at the you know regrowth of neurons and all of that didn't work hasn't worked how many years later you know what increases BDNF exercise significantly this is so the instead of putting a pump into your brain go for a brisk walk effective a c-reactive protein inflammatory markers the one factor that reduces inflammatory markers better than anything else is exercise the one factor that increases your good cholesterol HDL exercise so we don't need to go into men study after study 47 percent 50 percent reduction in cognitive decline so it next question is what kind of exercise here I introduce my favorite statement in English language it's the only language I know so in language it's to the best of our knowledge today there seems to be a need for certainty and in those searching the internet or dr. Google that somebody must say that this is going to stop this or 100% data or they say oh it's the retrospective study and so on and so forth No so the best of our knowledge means that there's enough data that gives us a profound amount of certainty for a given direction and beauty of Sciences it's not absolute it's open to reach a challenge but it's good enough and look what we've with that the plane we came in was along those lines you know to the best of our knowledge this is how aerodynamics works to the best of our knowledge this is how you create food it's the best our knowledge this is so I'm emphasizing that as part of what we do as myth-busting and science there's a lot of noise out there this Kido July that South Beach diet and all these these are all confirmation biases but the data profound data shows that exercise there are three types that are effective first of all every time a patient comes to us as I say you have to exercise how I do I've plenty of exercise don't even worry about me I said what do you do I walk the neighborhood I garden you know I walked the dog I said those are fantastic but those are just meditation aerobic exercise more than you thought so that brisk walk it should get you tired you don't have to you know count your pulse and subtract your agent of that if you have difficulty finishing your sentence that's good aerobic exercise and how much work your way towards that's another phrase we use we're not absolutist we're not binary work your way towards and small increments of work 25 to 30 minutes of significant arabic exercise four to five days a week if you haven't done that kind of exercise in years start with five minutes of brisk walking and that's it for two months you didn't get to this point over weeks don't try to get out of it over weeks so you should be getting to 25 minutes for 30 minutes of brisk walking 45 days a week over six months to eight months period and then it will be a successful behavior new your resolutions don't work the second thing is even if you've worked out or exercised half an hour but yet you sat for eight hours studies show that that negated that benefit there's nothing as bad as recumbent C just sitting in one spot right now everybody wants to get up now yeah but no you've been working out the whole time I'm seeing that that's good but yes yes so move throughout the day every hour get up you know all of these smartphones or watches have these the bells that get you know after an hour rings get up stretch walk to the kitchen well maybe not the kitchen to the bathroom in other places so walk often third was a surprising one initially we had to question it because in science there's directionality because so a causation does not a correlation does not cause they should make what does that mean means that the direction might be the opposite direction but what we found not asked others as well that Lake strength was associated with brain health bigger brains break your legs bigger brain so we thought maybe the people are healthier their brains are healthier therefore their legs are healthier no actually the other way was true as well people who worked out their legs actually developed better brain health and it makes sense the biggest pump in your body is not your heart it's your legs the veins in your legs or don't they don't have muscle something has to press them to get the blood up what is that it's the lake muscles so it's a vessel so that means more blood to the brain the biggest source of metabolism or homeostasis of metabolism is legs so bigger legs better better management of glucose of all of these things and thirdly bigger legs mean meant more exercise more stability less Falls all of those things that actually get people who are older into the hospitals and more BDNF for the brain so if you're getting up if you don't have knee problems little mini squats you know biking that recumbent bike and TV thing actually it works so get those legs strong because just the other variable that I spoke about which is fall risk goes down significantly so those three things as far as exercise is concerned the next thing is stress and stress is a very very important factor now stress does many things one is it shrinks the brain it actually creates significant damage to the prefrontal cortex and stress actually affects all your hormone illogical systems let me tell you how so your limbic system is the oldest one of the oldest part of the brain it's the emotional brain the limbic systems job is to part of it is memory but bigger part is emotional interpretation your limbic system interprets a piece of act now remember it's your interpretation the same act could be stressful for one person but pleasant for the other person so there's an interpretive component to that so this person interprets this behavior and deems it stressful the message goes to the hypothalamus and there's a direct path for the hypothalamus then to the pituitary and those of you who know physiology pituitary is the center of all hormonal and occur in every aspect of your body your thyroid gland is controlled from that your insulin is controlled from there your growth hormone is controlled everything immune system is control for that so the interpretation that takes place in your limbic system goes to the epithalamus to the pituitary and what's release is dependent on how you've interpreted it so good stress and bad stress are important initially we felt very uncomfortable but there's because scientists stress and stress interpretation seems like a soft concept but it's not it's the brain so where do we start I'll get past this lots of studies that show stress reduces BDNF reduces the size of the hippocampus affects that part of the brain that are associated with attention actually shrinks those parts of the brain and and studies like for meditation that have shown to actually increase attention and even increase your ability to to attend and memorize we know all of these studies so how do you start the process forward interpreting in our household m-mom we always tell the story my mother was a politician and she was very what those prim and proper the gloves and the chandeliers and all that she comes to two neurologists home where there's a whiteboard in every room including a 8 foot by 6 foot whiteboard in our bedroom she almost has a seizure and but whiteboards are important because we get up and write down one of the things we do without to kids as well good stress and bad stress specifically this is good stress for me this is bad stressful and identify your stress love life times people go through life without ever addressing or identifying the most important thing what is increasing your stress and what's actually good stress now let me tell you what good stress is so good stress is the kind of stress and the most important thing when I get to optimize I'll tell you this is good stress good stress is the kind of stresses earned by your purpose has a direction it's time bound it's you can see the light at the end of the tunnel and that's not a train coming at you and it's it's it's well circumscribed behavior that you have instituted that's purpose that's critical without that nothing else works so that's good stress and support for you to define that increase it throughout life whiteboards and and bad stress is the opposite you're doing something repetitive that's not yours that doesn't seem to have an end and increases stress and then your limbic system interprets it and as bad and all those chemical changes that you think that we talked about happen and that's why the brain shrinks that's why the thyroid gland is affected by stress that's why you grow through hormone is affected by stress these studies are all out there so perception is critical and we talked about bad stress and define you're bad stress and get and try to reduce it so some steps towards stress management not stress reduction stress management identify the stressors we said that stop multitasking there is no such thing as multitasking and when I say this people say oh it's not a big deal it is a huge deal multitasking is part of our DNA in and in this culture I'm in New York City for god sakes it's there is no such thing as multitasking it's doing multiple things badly and creating urgency and redundancy and urgency and that creates a subclinical stress level that accumulates in your body so it's critical to eliminate that it doesn't mean you don't do multiple things my goodness we do multiple things but everything should be in silos you know in their own in their own weight third is first things first prioritize so it's these are all management tools aren't they but that has to be where we start and fourthly as a separate thing meditate whatever that means to you by the way for us meditation doesn't mean sitting in a corner and crossing legs and all that I respect that I love that that's not me as you could have guessed for me it's walking exercising and just to walk with a cadence with them with with a you know count but and with our kids we do mindful meditating where you sit and you teach them how to breathe in and out cleansing and then focusing on that and initially when I was at NIH I would make fun of this I truly would but and I'm still making fun of some of the things but not this this is profound imagine kids being aware of their emotions being aware of their stress levels and managing that one did I teach ed in school so that's a critical thing and by the way just three minutes twice a day because once you become good at it then you can actually take that sense into your day and more importantly everybody says I can't meditate because I can lose focus no that act of losing focus is actually the best part if at first you can only focus on your breath for five seconds that's fine your job is now to move it to seven seconds then to nine seconds then to 10 seconds and that act actually rebuilds the focus centers of the brain let me tell you about the focus centers of the brain the first part of the brain that's affected as we age is not your memory centers you know where it is your focus centers so if you want to and the first part of the brain that's significantly affected in Alzheimer's is the focus centers and thirdly the good news it's the part of the brain that you could affect you can improve so that's the benefit of meditation mindfulness or whatever you're doing that can create that focus and relaxation sleep so I shall speak about sleep let's talk about sleep who sleeps like that anymore now but I just love that picture that's why I put it there okay sleep sleep is the most important time of the day that sounds funny because we're completely unaware of what's happening but it is the most important time of the day for the brain remember when Dean said the brain is the most active organ in the body it consumes 25% of your body's energy constantly it's always a way we sleep but the brain continuously work so because it's a very active organ it produces a lot of waste products it is under a lot of pressure it actually is continuously trying to process things so it needs a process to get rid of all the garbage material and to restore and when does that happen during sleep now it's that the most important thing to remember about sleep is to functions when we sleep two things happen the first thing that happens is consolidation of memory which means that all of the information that we're gathering during the day say you know I've been I've been up since 7:00 in the morning and I've been talking to a lot of you and I've been trying to remember names I've been learning new things I've been looking at all these beautiful books out here all of that information just goes and lies on a notepad of some sort okay just like scribbles when I sleep all of that information goes into a metaphorical file folder and cabinet so that it's easier for me to retrieve it tomorrow and the day after or later on so the information is consolidated during sleep now when people don't sleep that information doesn't go into the file folder in cabinets and it's lost and that's why a lot of people have memory problems short-term memory recall problem solving issues making good decisions in judgment if they have sleep deprivation shift workers like nurses who work in the ICU or cops or people who are they basically challenging their circadian rhythm they experience a lot of cognitive impairment and in this particular study they showed that long-term nightshift workers who actually have disruption of their sleep cycle which suppresses their melatonin production were at a higher risk of cognitive impairment this study actually showed that sleep deprivation causes microglia which are brain cells they're called the janitor cells to go nuts so this is a second function of sleep the first one was memory consolidation the second one is detoxification the brain detoxifies itself during sleep we have microglia small little janitor cells that go and start eating away at the broken parts of the brain you know the damaged parts of the brain but when we don't sleep and during chronic sleep deprivation these cells actually start eating away at the healthy parts of the brain and that's why chronic sleep deprivation has been associated with a smaller sized brain the brain actually shrinks with sleep deprivation and that's what this study actually showed obstructive sleep apnea any disorder that disrupts the architecture of sleep such as sleep apnea puts us at an increased risk for Alzheimer's disease in a study at Florida University they found out among 13,000 participants that sleep apnea increased the risk of Alzheimer's by 70% and Nina and I are actually studying that in another large nationwide sample where we found out that when people have sleep apnea but they were diagnosed early on and they started using CPAP machine they were able to lower their risk of Alzheimer's so treatment made a big difference sleep apnea is an epidemic not only does it affect brain health it actually increases the risk for myocardial infarction heart attacks for diabetes eating patterns behaviors depression mood so identification of sleep apnea is critical and again you know people ask us what about medication if I can't sleep or is it okay if I take medication that eye doctors give and we say yes it's okay short-term medications are fine because it's important for people to feel rested but medication is not a long-term solution the long-term solution is always things like cognitive behavioral therapy or sleep hygiene mechanisms that need to be instituted as soon as possible remember people quit on cognitive behavioral therapy and sleep hygiene sleep hygiene is another long talk which essentially means you know identification of environmental factors that make you sleep better your bedroom should be like a spa it literally should be like a spa it's the best place where your brain detoxifies itself so finding out the right temperature of what temperature is perfect for you even bet she's neck pillow mattress comfort what you eat before sleep making sure you don't eat food right before going to bed because as we grow older you know regardless of the type of food we eat the food digestion slows down and the process of digestion actually keeps us awake and the food that we revs us up and people can't sleep and then cognitive behavioral therapy for running thoughts you know not being able to shut down your mind what do you do you know having things like a small little notebook on your nightstand to write down everything or maybe in that white whiteboard that Dean was talking about to kind of getting things off of your mind and transferring it to something else to calm your mind down mindful breathing all of these are parts of sleep hygiene so we cannot emphasize how important sleep is and especially making sure that one goes through each and every stage of sleep because those are responsible for memory consolidation and detoxification so in summary sleep apnea identification is critically important because it raises risk for Alzheimer's disease it cleanses the brain and it consolidates memory and all of these have to be done at the same time Dean by the way we're not sponsored by bad Metro mattresses or whiteboards so yeah yeah so the next thing is optimizing mental activity as much as we would like to say nutrition is the most important thing or exercises because our research is exercise nutrition and all these other factor mental activities by far the most important because of those connections the cognitive reserve we talked about their each neuron 87 billion neurons each neuron can make a couple of connections or 30,000 connections the analogy I give is it's obviously a false analogy but it's a pic you can it helps you picture it here's a piece of memory and you're trying to get to it there are two connections axons connected to that piece of memory at 20 you did something in a bad night's sleep or or a good night or whatever that that that one is severed at 30 you had a your head bumped into something and this one was severed it's more complex than that what happens that memory gone forever now imagine 30 thousand connections to that what's gonna get rid of that memory nothing I mean short of a huge stroke nothing that's where the resilience comes in and there are many studies that have actually shown this so the this is the part that I want everybody to focus on there are many many studies and I think our studies and here as well the London taxi drivers study who knows about this study there so it's a very interesting study by the way this is pre GPS this is when I was driving probably for Domino's and trying to make money for my college and it's it was difficult back then anybody who knew they had these books you say je7 and you would find the place you can't imagine how many people got free pizza is because of my driving and directions and and and DC in Virginia Fairfax but but nonetheless it was very complex now take that go to London and if anybody's been in London it's horrendous it's not like Chicago Rush Street you know there's a it's much more chaotic and and more importantly and what it is is at that time they had to memorize the taxi drivers for the test every street every number I mean that's incredibly complex and the test was pretty complicated they had to take it so they said let's do this test we do neuropsych testing beforehand imaging and volume metrics beforehand and after the study period those who passed and they looked at the brains of those who passed before and after these are not twenty year olds these are people in their 50s and and around that age average and guess what they saw that their brains actually grew so we thought that your brain is supposed to shrink after the twenties right there especially their hippocampus the part of the memory associated memory actually grew now let me tell you a growth to see the growth on MRI volumetrics it's significant their brains actually grew from just studying for the taxi driver thing so that's remarkable and they did much better in neuropsychological testing after that study period than before and that was just one event one period of studying imagine if you're doing that throughout life or you're doing it for a protracted period of time any occupational complexity is another thing the most protective factor for brain health is Occupational complexity the more complex your job the more protected you are by far more than any other variable for the brain is Occupational complexity so we did this is our study we did a meta-analysis and then anybody who's done research they know how how painful meta analyses are first of all they you have to collect everybody else who's done the research on the field they have to respect you enough to give you the data a lot of times you have to beg but you get it and then you have to combine that statistics and the data together in a certain way and run the data so we did this study on cognitive texercise ah's and MCI mild cognitive impairment patients and what we found was the most important thing is complexity and I'll tell you what complexity means to me work around your weaknesses so as you if you're getting older and if you're having difficulty with memory you memory games there are three kinds of basic memory concepts verbal visual spatial and procedural do the kind of activities that challenge that if it's executive function do things that were makes you think makes you solve problems executive problems and so complexity is the key so out of that study we came up with three concepts at the core of Brett building the brain at the Sun of that is where you're supposed to live at that target complexity what is complexity mean complexity means activities that activate multiple parts of your brain and that's not Sudoku for those Sudoku fans out there know I continue with your Sudoku that's fine but I'm talking about much more complex behaviors learning a musical instrument or if you're already playing a musical and learning new songs learning to dance learning to manage a you know a job volunteering learning different languages building things that's complexity you know we had a patient that via veteran who was having significant problem with his memory it was sixty-five tremendous and he also had some depression and he also some anxiety and was and when he was young prior to going to the military he was he loved fixing cars loved fixing cars then went to the military and when he came out he started working for a big company I can't name it and he they made him do the same thing in a cars so we thought cars alright that's good but he was doing the same thing over and over again muffler muffler muffler muffler and at 65 he was just besides himself he came to me I said I think it's time to retire we gave him some advice he was gone for six months came back we did the testing back to normal cognitively emotionally in every sense and his cognition was quite down back to normal so I said what did you do did you change your diet no sorry I didn't change my dad did you exercise no what did you do this guy who hated his job with the car dealership right what car fixing right that's what he was doing he went back to his home started fixing cars in his garage why he did it in his own terms he did the way he wanted to do it he loved every aspect of it and that changed everything so complex activities like that that was more executive function playing a musical instrument I shows an amazing singer along with my daughter I'm the worst musician in history of mankind I play guitar for 30 years I've I think gone one song stairway to heaven but I'm on the I'm on third stairway staircase not past that it's terrible but I love it because it's the it's the act it's the repetition let's take music playing a guitar when you're playing your instrument you want reading the notes that's your left parietal that's your language centers your Wernicke's and Broca's being challenged you're processing it it's your frontal lobe you're being creative it's your right parietal lobe you're visually processing it it's your occipital lobe you're emotionally processing it's our motor cortex cerebellum with coordination and emotionally processing it because you're emotionally involved that's the entire brain that's no Sudoku that's a brain on fire you can see how a complex behavior like that can build a brain so you don't have to buy another gimmick you don't have to follow a little dot on a screen because somebody said that you need to follow these dots get involved social activity my mother is gonna be very mad if she sees some of these so my mother was all into this chess champion there's there's that all of a sudden now she's 83 every night there's a gathering in her home with her age matched women and they're playing cards for quarters first of all I told her that's illegal but she didn't care but look at that so people playing cards the act of learning how cards are played processing that the conversations sometimes cheating that takes a lot of your activity that's mental activity not Sudoku not sitting in a corner social activity volunteering learning to that dance even adds the the coordination component you got to see my dancing that's even worse than my guitar so that's mental activity this is not joke this is not I if I had to do one thing at a community levels would be to involve communities into other into groups get them involved in other activities with other people give them a purpose beyond self and in the community that's by far the most effective way that you can actually maintain the cognition there earlier the better by the way challenge means if you're doing something complex but it's repetitive it's not good for the brain because it's repetitive so you only know where the next challenge is if you've picked up the guitar you know three chords now it's time for the fourth chord if you're dancing and all you know is three moves it's time for the third fourth move if you're learning languages like French like I did in high school and you only knew 20 words to go to a restaurant and for dating or whatever it's time to go beyond that you know the how to maneuver through a move instead of the café's move the next challenge yourself and only you know that a computer is not gonna tell you that only you know that so do real life stuff the third and the most important one comes to positive stress purpose if that activity does not serve some kind of purpose it becomes stressful and I don't mean purpose being something like saving the rainforest although that would be good but it would be simple things my purpose is I want to learn to play a few songs on the guitar that's a good purpose my purpose is chop some people in my neighborhood but that kind of a direction or vector is what will help us with mental activity so complexity challenge and purpose are central and and we talked about all of those and then habits very quickly bad habits we don't talk about justice science we just throw this at you we've created failure which is what doctors always do doctors are never taught two very important things one is lifestyle which is prevention because it's disease model it's not prevention model it's not it's sick care it's not health care the second they're not second thing they're not thought about is behavior modification just do it I did it incredible arrogance everybody's got their own journey but this is what you do pick one specific behavior this acronym is my favorite it's very childish very early in business or smart goals how many people here know about SMART goals yes specific measurable attainable relevant and time-bound I'm going to be healthy this year what's that mean you're probably going to end up less healthy because of that kind of a goal I'm gonna lose weight what is that mean you're gonna probably gain weighting because of that new year new your resolution I'm going to reduce sugar levels by 50% over the next six weeks is it specific sugar is it measurable 50% is it attainable I think I can reduce it by 50% is it relevant to the bigger goal of health yes because that's pulls you that's that that's the motivation is a time bound six weeks only do that you didn't get to the house unhealthy state overnight don't try to get out of it overnight and when you do this you actually rebuild habits now let me tell you about habits our brain the one percentile that we use is all repetitive behavior habits even when you think you're thinking you're actually using what they call habit loops why because that's a lower energy state thinking outside of the box is high energy State so your brain wants to be in the lower energy State so habits are critical but guess when you developed all these habits during your teenage life you really want to live with your teenage habits so it's time to reprogram them but one habit at a time and when you do so you actually recreate pathways in your basal ganglia and after you create recreates several of them that becomes a highway where habits become a norm habit building but take one habit at a time here's my least favorite word in English language the second least favorite is moderation which is basically a doorway to failure anybody wants to fail their diet oh I'm doing it in moderation what does that mean so let's forget about that but my least favorite as motivation anybody who says you just gotta be motivated they're saying that I'm motivated and you're a loser means nothing so motivation is actually a physiological process that I've defined I gave a talk on this in the Harvard Business School when you have a smart goal in front of you smart specific measure and you take you only know what the steps should be steps that are achievable and successful your brain is a success seeking machine then the next function of the brain is language but it has two broad language terms I like it I don't like it so as you make these successes slowly after a while not 21 days I know everybody's doing a 21 date something depends on the behavior you know you're not going to give up corny to cocaine in 21 days I'm not saying anybody here is doing that but or you're not going to give up sugar for 21 21 days and finish aliy in fact you're going to feel worse everybody said oh this is terrible it's failing me yeah because you're having withdrawals sugar is addictive but then after a couple of months depending on the person and their proclivity some of them well some of us have more sugar addiction in the past yeah but it's gonna take you longer but that's success as you build that success initially pain but after a while your brain comes up with this emotion I like it I like it that has a vector that has a direction that's motivation there is the that's where behavior change can take place specific goals successes and then stick to one behavior then add another behavior and maybe next time it's cheese find replacement cheese that have low fat low cholesterol and then maybe exercise start with five minutes of brisk walk that's it so that's critical that we we start that way our work is in the community we have a clinic Alzheimer's Prevention Program we also have the biggest research program in the country at the beach cities Manhattan Beach Redondo Beach Hermosa Beach where the entire community is doing brain health initiative and 1,700 people in this study and and all our profits from our books and other things go to our healthy minds initiative to raise awareness about the power of the community to take care of itself and we have several other places that we're doing this this is our book and that's us and you can connect to us social media we'd be happy to connect with you through our website team shares if you go to our website we actually have a free brain health assessment test available where you can take a test finding out where you are in your journey towards better brain health and you can fill out the questions to get information on nutrition exercise stress management restorative sleep and optimization thank you so much for your attention we really appreciate being here you


  1. 2:15 your full of shit. Do you homework. People lived to an old age if they survived first couple of years. My granny didn't know about Fleming, vaccination, antibiotic, live till 94

  2. I got the info from a video of a doctor talking on

  3. I am really pleased I have found all this good advice Thank you.But why haven't you mentioned that statins cause Alzheimers (and also diabetes)It's important as so many people in the world take them

  4. People who were taking statins for "bad" colesterol get dementia and Alzheimer.

  5. This is BS, he talks only about money, snd he can hardly walk and talk, has no condition.

  6. Did Dean mean both his parents had alzheimers. That is the same as me, let agree not to get tested it would make lots of worry about the results, better to live well.

  7. awful whiney voice she has. v unfortunate

  8. Both are brilliant here as always, but Dean is really funny, in a good way.

  9. Team Sherzai, my favorite! They always introduce me to (well-designed) scientific studies to geek out on so I'm always seeking out talks or podcasts they're in. 💯👌

  10. Good info and well researched. If you want to refute their (science based) views then list the – peer reviewed and well designed – studies to back it up. All I see here are opinions.

  11. I am.sorry but I lost interest when he said he was in favor of vaccines. Doesn't he know that the elderly population has a high concentration of Alluminum accumulation in the brain, and there are studies that proof vaccines are one of thw biggest environmental causes

  12. Coconut oil clogs arteries,and they are giving away beach front properties in Montana*

  13. There is evidence that coconut oil can actually reverse Alzheimer's Disease and Lewy Body Dementia. Some people have also had success using certain essential oils. Why haven't you mentioned this?


  15. Dean, please take your Blinders off, you may have a specialized skill but you don't know crap about the reality of our situation and the Real Conspiracies to reduce the world population like Agenda 21, Agenda 2030, Georgia Guide Stones, Geoengineering, Toxic Fluoride, Endocrine Hormone Disruptor's in processed foods, Toxic Pharmaceutical Poison's, GMO's, Herbicides and Pesticides, the many Toxic Chemicals in furniture and clothing, 5G, Cell Towers, Cell phones, WIFI, LED lighting, and microwave and Electro Magnetic waves and the list goes on and on…..

  16. Lyme are in Pandemic Stages in the WORLD for over 20 years. The number of patients who commit suicides: 1) Lyme 2) AIDS 3) Cancer.
    A watched a brilliant doctor from New York who had met with a woman diagnosed with Alzheimer’s. He immediately completed a Lyme disease test. It was POSITIVE! She began treatment and is WELL!!

  17. There have been studies in several universities where 4 out of 5 Alzheimer’s patients tested positive …….. another study demonstrated 5 out of 5 patients tested positive to LYME DISEASE!!! Contact IGenix and have a test sent to home!!! WHAT CAN IT HURT!!!

  18. while it may be repetitive i may watch this valuable vid a second time.
    1:01:21 losing the 'mind weeds'…suzuki's 'zen mind, beginners mind'. great book.

  19. What impact are the anti-lipid drugs like simvastatin, lipitor, etc? Do these drugs decrease risk significantly?

  20. Very Nice!
    Love Fom New York!
    Very Nice!

  21. their book is fantastic! must read

  22. If this Speaker does not address solar radiation management SRM / solar aerosol Geoengineering SAG, He has no credibility. This is one of the most important factors in nano particulates heavy metals being dispersed illegally in large scale public testing programs to reduce incoming solar radiation. This is big business And the oxides of Metal And sulfates Pose serious health risks mentally and physically. We are in an open experiment This must be addressed as part of the equation.

  23. You seem to have a command of the topic but even though you didn’t quite enunciate the assertion “vaccines wor…I’ll say that right now”, you cast a shadow on your credibility.

    Just the suggestions that you believe they work means you have not looked at the data objectively, if at all.

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