Robert Lufkin 00:00
Welcome to the health longevity secrets show and I'm your host, Dr. Robert Lufkin. It's exciting that more and more programs are becoming available to treat and yes even prevent Alzheimer's disease. Today we speak with two of the pioneers in this area about the program that they have. Dr. Dean Sherzai is co director of the Alzheimer's prevention program at Loma Linda University. Dean trained in neurology at Georgetown University School of Medicine and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health, and UC San Diego. He also holds a PhD in healthcare leadership. Dr. Aisha Sherzai, is a neurologist and co director of the Alzheimer's prevention program at Loma Linda University, where she leads the lifestyle program for the prevention of neurological diseases. She completed a dual training in preventative medicine and neurology at Loma Linda University and a fellowship in vascular neurology, and after demonology at Columbia University, she is also a trained plant based culinary artist. And now, doctors Dean and Aisha Sherzai. Hey, Dean, welcome to the show.
Dean Sherzai 01:16
Thank you so much. It's wonderful to be here and to be connected, you're doing amazing work and love to be part of the community.
Robert Lufkin 01:25
I'm, I've been so looking forward to this day. I'm a big fan of your book that una show wrote on the Alzheimer's solution. I also follow your podcast that brain health Revolution podcast. And we'll put that in the show notes. And we could talk about that a little later in the show as well. But one thing I'm excited about, I think you and I share a common vision of educating people to the possibilities of preventing Alzheimer's disease through lifestyle and other changes and, and in in the program we hear we're hearing from many speakers with in some of them vary on the particular implementation of the lifestyle choices. But I think the important consensus is now that experts are agreeing that lifestyle matters and can have a significant effect in preventing this this challenging disease. So before before we dive into that, maybe we could just take a moment and you could tell us a little bit about how you came to be so interested in this fascinating area.
Dean Sherzai 02:37
So usually, it's my wife and I we're both here talking. She has she had another commitment, but she will she's part of this community always. We met. I did my work at Georgetown University. And, and then I did two years of fellowship at NIH, doing some really wonky research and building 10 Where you put in BDNF and GDnf into the brain stems and enter the basal ganglia and, and all kinds of clinical trials. In 2002, I was asked to go to Afghanistan for a short stint to help reconstruct the country that turned into a three year project I, I helped to reconstruct the healthcare system. And that's where my wife went, gone back with Doctors Without Borders. We met in a conversation. And 20 years later, we see that that whole thing kind of unraveled, but but our conversation was about our grandparents, both of us had two amazing probably the most brilliant people we've ever met, who had Alzheimer's and end of life. And we saw these people were proud of their mind, their, their capacity, their their relationship with the world, just start losing bits and pieces of themselves in front of the world, which was the most demoralizing thing to see specially in retrospect, especially now knowing the disease, but even then, I felt it. One of the stories I give is, I remember we my my uncle's are all surgeons, I'm the only neurologist because whenever the all the doctors would get together, they have talked about the brain. So I got interested then. And we would go to this hunting lodge. And thank goodness for the animals. Surgeons make terrible hunters, we almost never got anything. And we would then we would gather in the house in the middle of this huge farm that we'd go to on the weekends. And my grandfather would be at the center and he would be playing chess, this is in Frederick, Maryland, or Virginia when and we would be sitting there and he would be playing chess with everybody and he was so brilliant that everybody was on one side you and he would beat everybody. But this one time. I remember him saying all of a sudden pausing and I remember that vacant look and saying how do you move that piece and it was a night for those who play chess. They know that night is a little quirky, moved And and that just took everybody by surprise a shocking man and, and that moment we saw then from there on small incremental losses of self. And that was devastating. And I went through medical school and everything and never knowing why I'm going that direction. In retrospect, oh, that was the driving factor. For my wife, it was the same thing. Her grandfather, brilliant, brilliant man, same kind of a situation. And we see this over and over again, from household to household, we have 6 million Americans right now suffering from Alzheimer's, that's Alzheimer's. Dementia is the umbrella category. Dementia is when your cognitive cognition is affected to the point where you can't do one of your daily activities, such as driving or finances or cooking, it's affected, that's dementia, but that's umbrella category. But there are many types of dementia is Alzheimer's, the biggest category 60 to 70% of all dementia is Alzheimer's. It's the fastest growing epidemic in America. And in the Western world, for that matter. It's number one cause of mortality, morbidity in UK, number one in Japan, and a lot of Europe, and number three in us and is growing fast. And up to now, the only approach we've had to it was pharmaceutical as if we could actually target a molecule and get rid of the disease. After hundreds of billions of dollars of spending, we have zero success. In fact, even the latest drug that was approved by FDA, which is very controversial, because the effect was overrated over overstated. And now it's being challenged. We have nothing yet. When we my wife and I, when we came back, we looked into the data, we started doing research, we went to UCSD, which was the number one neuroscience program in the country at a time we started working there. And from there to Loma Linda, which is the only Blue Zone or healthiest places in the world to study those relationship. And what we saw over and over was that there's an alternative path. There's an alternative way to do this, other than just using one pill to get rid of the disease, which hasn't worked. There is evidence for prevention. There's profound evidence for prevention. And that just excited us so much that we left everything and and some of our mentors said this is suicide going, you know, from UCSD, you could pick your especially in neuroscience, you could pick your spot, we said, we want to study prevention, and that's where we are. And that's what we've been doing for the last 15 years.
Robert Lufkin 07:36
And it's fascinating, I think we we all come from you and I come from a in Asia come from a traditional medical background, from medical schools and that sort of thing where where we studied individual diseases and and the system has become effective more or less at treating things with with drugs or surgery or in few cases, radiation therapy, but they're we're always looking for a pill or a fifth or something. And and basically every chronic disease that we've encountered, you know, obesity, diabetes, heart attacks, stroke, even in cancers, there's there's always been something that that worked a little bit at least. But what is it about Alzheimer's? You know, as you pointed out, and what is it about this disease that it's caught? You know, we've had the greatest minds, the greatest medical minds in the world have been applying themselves to this with essentially, as you say, unlimited financial resources, billions of dollars spent on developing drugs. And like you say, as far as any kind of treatment that's effective, we failed. So why, why is what is it about Alzheimer's
Dean Sherzai 08:53
so often? Just because a large group of people very, very intelligent people are working on something doesn't mean that you're, you're hitting the right target. Our living room is pretty unique. Actually, our dining room is not a dining room. It's a whiteboard that all the walls are painted white. So I have two kids 16 year old and a 14 year old, and they're writing on the walls and there's a ping pong table and now we just got darts and dartboard and plastic rubberband, but I'm so talking about precision and accuracy. You can be very precise but not accurate. You could be hitting the same little spot very effectively because you have incredible tools. But then the spot you're hitting is not the bullseye. That's what we've been doing. We've been we've been working on eliminating amyloid and tau which is important. By the way I'm going to take a step back the way we approach lifestyle medicine is not like a lot of lifestyle. Doc's are these the functional Doc's that say, you know throw the baby out with the bathwater. Oh, All of medicine is bad and pharmaceuticals don't work and cholesterol lowering medicine. No, that's, that's wrong. They work they have their place. And molecular research definitely has its place. But what we've missed is 80% of medicine, which is prevention, I'm using that arbitrarily, but it's pretty close and significant is prevention. And we have not focused on that. And what that does is, when you're working on the acute on the molecular, a lot of times you're missing the bullseye, you're very accurate. And we had these antibodies that eliminated amyloid, which is this protein that's associated with Alzheimer's, and tau, we we enzyme and we use enzymes to get rid of it, we use them nutrients to get rid of it, we, we use the antibodies to get rid of it, we even use Soundwave and LightWave. And all you know how we get quirky, it's not when we get really on the edge, it's sound waves and, and helmets and all kinds of stuff. We use everything and hundreds of billions of dollars, and we get rid of it. And they work but never got rid of disease because that's not for the majority. It's not the cause of the disease. It's an outcome. It's a process. It's an intermediary. The disease is a long term disease is long term cumulative damage, which the healthcare system or research system is not designed to take on. The research system is designed to take on one molecule for a short period of time, because even that's going to cost millions, right? Do you expect to take on a chronic disease of 2030 years with multiple variables, that's going to cause trillions. So the research system at NIH or National Science Foundation or others are not in a position to take on these kinds of chronic diseases. Now, with Alzheimer's, there are those types where genes determine outcome, like Huntington's disease, and Huntington's disease, it's 100%. If you have this abnormality on chromosome four, sadly, we know the person is going to get it. And in fact, by how many repeats of that molecule, we know when they're going to get it. That's how predictive it is. It's genetically driven 100%, we say it's 100% penetrates. In Alzheimer's, there are Alzheimer's cases that are like that driven 100% by genes. But guess what they constitute 3% of all Alzheimer's. Those genes are preset on one personnel and to an ATP 3% of Alzheimers. The rest of Alzheimer's is the interplay of genes and genetic risk and environment and lifestyle. And now we have plenty of evidence that lifestyle as a bigger factor than anything else, by far, that by looking at people who had certain genes, and yet they lived certain lifestyles, and they did not get the disease. And we have repeats of those studies. So the problem has been that we haven't looked at the chronic long term cumulative effect. And when you look at it that way, you see four processes as the down downstream, or upstream causal phenomenon. It's inflammation, lifelong inflammation, oxidation, glucose dysregulation, and lipid dysregulation. And that's, there's other things as well, but those are the main four drivers. And for brain, there's 1/5. One, how much you've used your brain, how much you've pushed your brain that creates resilience that creates connectivity, those five factors. Now what affects those five factors? Very simple. It's not a drug or anything. It's nutrition, exercise, stress, sleep, profoundly important. And mental activity. That's it, those are the drivers if we kind of focus on that on, on creating a platform where you know what, the most healthy, and we, you know, way to approach those five factors for you, for your family, for your community, is then we will have changed healthcare completely overnight. And we are not even close to that even now. Even in lifestyle medicine doctors who just found out about Alzheimer's and lifestyle, they're doing these clinical trials, 100 people six months and this is not only ciliates, it's it's it's harmful you might get a you might get a signal you're gonna find a signal because you're putting a million dollars into this this study. But it doesn't mean it's real. But if you look at long term studies, oh my goodness. When we first landed in Loma Linda one of their studies in 1993. Ballpark by Paul Graham was looking at people who ate meat, all meats and no meat and control from multiple variables and and what they saw was literally two times greater risk of Alzheimer's and those who ate meat Just looking at that component two times, of course. Now with epidemiological, I have a master's in FTM epidemiology. I know the limitations and all that. And I know that the talk show hosts, they love saying epidemiology is not science. Well, it is science, it's a great science. There are different kinds of Sciences. But the epidemiological data is just so powerful that it cannot be just brushed off by by saying, it's not causality. You cannot determine causality in science, in reality, not even in physics. But you can create incredible correlation that's as good as causality. And so that was there. And then we saw other studies by by in California Teachers study and in the Harvard Framingham study, not directly, that the effect of nutrition was so profound, that's just nutrition,
Robert Lufkin 15:53
clicking on causality so that you know, the classic thing controlled, prospective randomized clinical trial, would you accept that causality or that still getting a stronger association
Dean Sherzai 16:07
and a strong association? Because there's no way I mean, if anybody's done logistic regression, there's the outcome variable you're checking. If you're doing a ANOVA, or men over or something else, you can have multiple outcomes. And then you have the left side of the formula, and how big your left side of formula is, is how accurate you are. And you think, Oh, I have five variables, age, gender, education, all that good. No, there's no way that you know, all the possibilities of other variables there. So there's no way you can absolutely determine causality. And then there's another problem with with randomized clinical trials, even double blind or triple blind, where even the pharmacy doesn't know. There's, there's a problem there short term. Short term does not mean positive effect long term. There are many, many studies where short term they show positive effect, but long term, they have negative effect. I would venture to say that there's evidence that when we're talking about ketogenic diet, there's no study past six months, no site, I mean, no legitimate study. Yeah, you're going to get three people to do ketogenic diet. First of all, if anybody talks about ketogenic diet, please come to a Keto ward in neurology department, and see how a true ketogenic diet is, how difficult it is, and how impossible it is to maintain it long term. And here's the third factor, because I'm a public health person, how impossible it is to apply that to populations. I mean, if we're going to talk about things, we must also talk about how applicable it is for larger populations, not just a population that has the money to buy the little kits in, in Beverly Hills. It has to be applicable for general, bigger populations. So with that said,
Robert Lufkin 17:51
Just one question on that. So is the problem with ketogenic diets, like, in practicality, is that? I mean, if it seems like if you just reduce carbohydrates, people would go into ketosis, right? If they would reduce the carbohydrates in their diet, if they select foods that could be plant based, it could be animal based. Yeah, it doesn't really matter. But but just the the energy balance on the ketosis that people wouldn't be able to wouldn't if, if they just eliminate carbs, it seems like that would not eliminate, of course, but just lower the carbohydrate intake, they would go into ketosis, right? They don't have to fast they don't have to do anything, right?
Dean Sherzai 18:35
No, actually, it's a little more difficult than that. So the key or the carbohydrate has to be reduced significantly. I mean, compared to what we as Americans eat, it's significant. And then and then you need another source of energy, don't you protein is not your primary source, and DNA or nucleic acid. So you have four macros, right? The nucleic acids, your DNA is not going to be your energy source, you don't, you definitely don't want that. The protein is not going to be your primary energy source. So there's two left fat or carbs. So if you're reducing carbs, you're going to have to increase what fats there's no other way to otherwise starvation. So if you're going to increase fats, let's say that you do get energy from that. Fats are the number one source of oxidative byproducts, fats, especially saturated fats, let's not let's let me be a little more accurate I saturated fats are a major source of inflammatory byproducts in the body. All Ward studies, if you look at the word studies, and H word studies, inflammation as a downstream product of that, so yes, initially, you even fix the insulin resistance. I know that keto studies have shown that they help with insulin resistance. And they've shown that in cognitive studies, although the outcomes have been incredibly weak. There's a little bit of signal after six months that I'll give that. But where's the long term studies that a keto diet has reversed Alzheimer's has even prevented Alzheimer's or prevented cognitive decline long term over one year, two years, three years, four years, five years. None. Zero studies. I mean, if you look at the latest meta analyses, by the way, those meta allowances were not the best of meta analysis. But let's just say, so there is a problem that by the way, I'm completely open to all directions of science. If they tomorrow, come back and say, here's a ketogenic diet that reverses Alzheimer's perfectly and, and we can actually achieve it at population of there's no, I don't have a horse, other than outcomes. But I definitely want to make sure that the trends of the week do not make science of them of the year. And that's what happens with us a lot of times, the Joe Rogan's of the world, seem to be bigger drivers of science than the scientists that and Rush University and and, and UCLA and other places. So it's critical that we approach it that way, and be open to it. I mean, I still say that if we should continue doing studies on keto, both plant based or non plant based, it doesn't matter. And see if there you can get a signal a true signal, a meaningful signal that that's been shown to be now and then the second step is sustainability. But as far as the coming back to our original point, lifestyles effect on on brain health, we there's no doubt now we were one of the first people to say that there's a possibility of preventing Alzheimer's. And there was such a hoopla that we got significant pushback. Then, a few years ago, an American and Alzheimer's Association International Conference, the first plant the plenary talk was prevention is the new treatment, which was oh my goodness, okay, so we are we're there now. So but still, the controversy is some people say 30% of Alzheimer's can be prevented. Some people say 60%, we say under optimal conditions for a protracted period of time as much as 90%. But ours is, here's being a true scientist. I'm hoping that I keep myself accountable. That's an extrapolation. Fairly accurate extrapolation. But still extrapolation. But the data as far as prevention is no longer questionable. Now, the question is, how do we apply it to different communities? What do we agree upon? I mean, even now, with nutrition, there's controversy. Ironically, with exercise, there's no controversy. You don't get many people saying, Oh, don't exercise that's as good as exercising. You don't people that hear people saying, oh, no, sleep is as good as sleep. But when it comes to food, I wonder why there is such profound controversy being made every single day. Isn't that
Robert Lufkin 22:51
crazy? I mean, at least, at least, at least we're having the conversation about, about lifestyle, preventing Alzheimer's so people are waking up to it and and just touching my back on what you said before preventing not only Alzheimer's disease, but the factors, you mentioned inflammation, those things. They're also now being identified as risk factors or drivers for heart disease for stroke for certain cancers, and even longevity genes that you know, are they all tie back into this? So this lifestyle thing will have many benefits beyond potentially lowering your risk for Alzheimer's disease? It's It's amazing. The epigenetics,
Dean Sherzai 23:35
we're doing a meta analysis not done sorry, not meta lens, a comprehensive review on on the epigenetics of not just dementia, but neurological diseases. And what's interesting is that whether it's methylation, or glycosylation, or all these processes that affect the gene expression, right? They're all the same. It's glucose dysregulation, lipid dysregulation inflammation. So it's wonderful. The one caveat or added thing for brain is the cognitive activity, the amount of cognitive activity and Iraq and I would say that sleep is literally for the brain. Yeah, it affects other organs as well. But sleep was created for the purposes of this incredibly overpowered and overwhelmed Oregon three pounds 2% of our body's weight yet consuming 25% of our body's energy. I didn't want any one point. It needed sleep. It needed and we'll talk about that. Why, why that's Yeah,
Robert Lufkin 24:38
yeah. No, that's, that. That's great. And it's, and I mean, the one thing on nutrition that, at least I'm hearing from the people we were speaking to is that they may disagree whether it's, you know, high fat, low fat, high carb, low carb or different things about The content of it but one thing it seems like everybody agrees on is that sugar, refined carbohydrates should be avoided no matter what, what your dietary plan is, everyone seems to agree on that sort of like the exercise thing. Exercise is good and nobody disagree. Nobody's saying we should eat sugar except, you know, maybe the sugar lobby,
Dean Sherzai 25:23
that kind of sugar should be avoided. Process, carbs process should be avoided. We say we add to that a saturated fat. Yeah, there's a big fight there whenever the one fight is the fat, isn't it? Which comes with meat, cheese and butter and all of that stuff? And and, and, and we say the reason I mean, even if you don't agree with the fat, which is actually what we say is what bewilders us as if there's so much data on this side. Why is there so much resistance? At least there should be questioning, and then you realize that confirmation bias is the most powerful driving force in human existence. So therefore, my favorite statement or who was it said? People love hearing good news about their bad habits. Yeah,
Robert Lufkin 26:16
exactly. Right. You find something that confirms what they want, for sure. But yeah, that it's it's so fascinating, the way that that we're seeing these, these effects now, I always wonder, I always asked myself, that, coming from mainstream medicine, why are so many of our colleagues, so reluctant to consider much less embrace lifestyle changes in the power of treating their patients? Why why are we Why is there so much resistance here?
Dean Sherzai 26:48
I think it's, it's, so we have our egos I'm a neural behavior, as saw here comes from psychiatry. Sorry about that. But our egos are so bound to our, to what we do that this ship that that's huge ship, that is medicine, you know, four years of college, five years, you know, four or five years of college, four years of medical school, four to seven years of residency, a lot of people like me that three fellowships, then, you know, masters, PhD, you by the time you're done, it's like 20 years of investment in this ship. This ship that never talks about lifestyle, the closest you come to lifestyle is oh B 12 deficiency, or scurvy, or, you know, these kinds of things. That's not lifestyle medicine, that's just saying avoiding deficiencies states cause those things but no, no talk about lifestyle medicine. Definitely no talk about behavioral approaches to lifestyle, medicine, none. And then somebody comes or group of people come and say, oh, wait a second, there's something more important outside of that, that and these are not bad doctors. We're not bad doc. We weren't bad doctors. But it's just that it becomes such a disheartening thing to know that you've built this ship, yet, it doesn't even come close to painting, you know, or showing the bigger picture it then what you do is either so the natural way that people actually disregard things as you make fun of it. You, you you, you belittle it, and you ignore it. But reality with truth, there's a video by Steven Pinker. So it's about reason is a brilliant, brilliant video, one of my favorite philosophy videos, but as Steven Pinker people should go look at that, once truth manifests once it's truly manifest. Yeah, it's pushed back relegated, disregarded, but eventually it comes to the surface. So now we know lifestyle medicine, prevention is a reality, a massive reality. We're finding nuances, we're actually approaching the next stage which is translation. Okay, we already agree it's, it's for food. Anything you do different from what you're doing now, as standard American diet, the SAD diet is good. So we're not an all or none phenomenon. But we're also don't like the concept of we my two words that we hate. One is motivation. It's a very arrogant, yet not mathematical term. I can't, I can't operationalize thing around motivation. There's no denominator, there's no numerator. There's nothing I can mathematically change from day to day. If I wake up one morning and I'm not motivated. What do I do? I just say be motivated. That's not reasonable, especially if, if you're overwhelmed if you have depression. So instead of motivation is systematic, measurable, achievable, goals towards a direction and the optimal is known, but that's not your goal. Your goal is the next step that you need to take that's measurable and achievable. And beauty of that is when you do it, and it's measurable and you achieve it and you check off that that box proverbial reel that sets off your dopamine pathway, the reward pathway, the behavior pathway, the habit pathway. And that becomes not just a little motivation of the moment, it becomes personality over time. That's the beauty of doing it that way mathematically. The second word I hate is moderation. Moderation is a word usually men used to get out of doing things. I grew up in Pittsburgh, I played soccer, tennis, football, you name it. I ate meat seven times a day. Plus beef jerky in the middle. So for me, what is moderation four times a day? Is that any better? Or if I had a bottle of cyanide in a day, what is moderation half a bottle. Moderation doesn't make sense, for multiple reasons. Because it's not again, measurable, meaningful, it's demotivating. Because you always, your goal is, let's say losing weight. But that never should be the goal. But but let's say if that is the case, and then you say moderation, and you keep failing, because there's nothing tangible, measurable to achieve. So instead of moderation, no, my next step is to reduce sugar. First of all, I have to know how much truly am I getting of sugar, right? Because none of us really know, because it's not just added sugar as to how much am I getting, and in a smart way, reduce it, what a smart way, specific for ask for specific M for measurable. A for achievable, are for relevant to Mirei or goal and t time bound. So I'm going to reduce sugar, it's specific, I know what what were what it is and where it is. Measurable by 50%. achievable. Yeah, I can do that. I'm not going to do everything else, I'm not going to change it all, I'm not going to change my whole life, you're not going to go vegan, or paleo or this or that overnight, forever achievable. Relevant, yes, it's relevant to my goal to be healthier, and time bound for the next two months. By the way, sugar addiction is not going to be kicked in 21 days, I don't know where people got this 21 day thing, it's going to take a while sugar addiction is a powerful addiction. So in order to get rid of it to change your taste buds, which takes up it takes at least two to three months. And once you do that, you maintain that you go to the next SMART goal, I'm going to reduce my butter intake, if that is the thing for you, by 50%. And then 100%, three months later, and so on as you're doing that you're not reliant on a morphus failure based model such as motivation and moderation. You're basing it on measurable, meaningful, tangible, dopamine boosting behaviors.
Robert Lufkin 32:43
Yeah, I agree. That's a great approach. It's not just setting the goal for lifestyle, but actually having a method that works that the people can do and, and you you have a great program out there both both locally and I think it's available online, but it reading in your book, if you use a beautiful mnemonic for it, it's called neuro that and he you are Oh, that that allows you to approach the lifestyle categories that need to be addressed. Maybe you could just walk us through that and tell us more
Dean Sherzai 33:19
nutrition. By the way, all the elements in neuro are amenable to change over time, some our favorite thing in our houses to the best of our knowledge today. I think it's the only humble term in language. Everybody else pretense of humility, science lives it by saying to the best of our knowledge today, and and what that means is that if it changes, that's not a weakness of science, that's a strength of science. I mean, we've built airplanes by not absolute knowledge, the concept of building fly you're building the plane while you're flying it as humanity we literally did that, you know, from the buy wing plane to a single engine to now rockets that go 4000 miles an hour. So to the best of our knowledge today and, and we say strong data, that for nutrition and nutrition, its whole food plant based. Now again, your next step is not that hopefully plant based is basically healthy vegan. Not vegan vegan can be very unhealthy french fries are vegan and hohos are being I mean, you name it, the coke is vegan. So it's it's a whole food plant based, as close as you can, but you should take the next one step for the next three months. That's it and then measurably change yourself. So that's nutrition and the data on that as far as cholesterol as far as fat as far as sugar is just profound as and saturated fat. And with nutrition as far as vitamins to the best of our knowledge today. We did the analysis. We did a reviews we just submitted two papers to comprehensive reviews, one on omega three and the developing brain and one are Omega three and the aging brain You don't need vitamin supplements, but be extra aware of vitamin B 12. Everybody, not just vegans or this or that everybody because 41% of Americans have vitamin B 12 deficiency, and B 12 is very important. So what do I mean by being aware of it, either eat fortified foods that have B 12. Take a bite B 12 supplement because it's also water soluble doesn't harm or more appropriate at least get your doctor to check your b 12 level on a regular basis. And then go from there. If it's on the lower side, supplementary, more fortified foods. And the other vitamins, there's no data vitamin D be a little more aware. Again, larger percentage of people have vitamin D deficiency than we thought. Sunlight is helpful, but also foods that have fortified it. So vitamin D and vitamin B 12 have profound effect on your central nervous system profound effect even beyond central nervous from on your blood and everything else but specially central nervous system. So be aware of those two. And if you need to supplement Yeah, that's fine. But I'm not saying that's your first step. The other thing we found is that and for this we don't have strong evidence but there are trends and given that the only fat that the brain needs and that's the only fat that the brain needs. You know nowadays we hear this thing Oh, the brain has lots of fats are made of fat, therefore it needs fat. No, wrong wrong, completely wrong. It doesn't get through your blood blood brain barrier. It actually destroys and damages your blood brain barrier. It affects your and Ophelia lining. We know the oxidation we know what it does to mitochondria. So no, no, not fat. And by the way, your brain doesn't have storage fat. It's not like your stomach. There's no storage in your brain. It makes it so plenty of cholesterol, everything else from your liver and everything else. The only fat it needs his omega threes, EPA DHA. Be aware of your intake. If you're eating fish, there's evidence that fish is good. We don't eat fish for multiple reasons. But I can't with good conscience. I can't say that there's no evidence that good fish, especially fatty fish, salmon or no not tuna, avoid tuna. But salmon and all those smaller fish are good fatty fish are good. But we worried that because fish are concentrators, and we inconsistently. Check only two toxins, maybe three Mercury lead, and the other 3000 toxins that have been added to our bonus than we never check. I worry in long term there might be harm. And the only benefit of fish appears to be from its Omega three content. So if you're going to take a supplement, take a supplement, and we take supplements. We don't push any supplements, I don't care what you take, we never worked with any companies that even come close to to make you know because we want to stay keep the science clean from the marketing side of things. So yeah, Omega three is important for both the developing brain. By the way, that's when the brain is developed developing the fastest from pre birth up to age 21, your brain still developing 20s, early 20s. And then the aging brain. And it's up to you to determine when you think the aging brain is but the data shows anything above 45 to 50. You might need omega threes to help. So we take supplements, Omega three samples. So that's basically it beyond that there's no evidence co q 10. And this or that or none of that stuff is evident. So that's nutrition. For exercise. There's plenty of data that exercise is probably more effective for the brain than any other organ. Yes, the brain is the most vascular organ. So we know that exercise provides a more consistent higher volume of blood to the brain, because your brain needs constant blood supply. And as we get older, especially as we get older, and the blood supply of the micro vasculature be continuous and the most effective way to get blood to all of the brain and keep the what they call angiogenesis. Growth of vessels going is through exercise. The other thing exercise does is increases your BDNF, which is important for connectivity of neurons, by tenfold every time you exercise and by the way that's sustained. So it's so
Robert Lufkin 39:21
that just for the audience have BDNF brain derived neurotrophic factor we've talked about before, but that's that can actually show cause the amygdala to increase in size on the MRI scans on follow up scans with BDNF activation.
Dean Sherzai 39:36
Any age. Yeah, yeah, it's bewildering. I mean, the the Harvard study showed that it brisk walk Framingham a brisk walk 25 minutes a day consistently reduce your chance of Alzheimer's by 45%. Wow, we have people selling pills on TV that haven't shown 1% Their whole data is Is 10 people. And when nobody's seen those 10 people or 100 people, there's no data. Exercise reduces. And we think when we start our program, we start with exercise. And here's the exercise program we start with a morning brisk walk is the best thing you can do in life. Why? It resets your melatonin cortisol pathways, which means you're going to sleep better at night, and you're going to be more energetic throughout the day. Because of that, it resets your meta metabolism in the morning. It I mean, as far as your mood vitamin D, as far as exercise BDNF early in the morning, if you can do anything, start with that. And here's the other part that's beneficial that exercise, whereas the reward or the dopamine release, and better sleep is not gained immediately. The dopamine and release for exercise is immediate, because you said you were going to walk 25 minutes I got down there, it is a check. And you feel better. So that's the chord the beginning the night is the inception of any lifestyle program. If you can do it, I know that some people have physical limitations, there are other things you can do. But morning brisk walk is where you start. And by the way, that also gets you into eating better sleeping, better stress management and everything. Success critical. And the types of exercise. Threefold, aerobic exercise critical. By the way, when people come to me and say, Oh, Doc, I'm fine. I walk the neighborhood, I do gardening, that's great. That's meditation. When we say exercise, you got to get short of breath. You don't have to count your pulse and subtract your age and all of that stuff. No, you just have to get short of breath where you have difficulty finishing a sentence. Of course, under your doctor's supervision, making sure you don't have heart problems and all that. The second type of exercise which is profoundly important, shocking to us was like strength. leg strength is associated with brain size. Now that data needs to be better clarified, but there's plenty data already. And I don't mean put weights on your shoulder and do squats, just mini squats, or biking or you know, walking the stairs. Bigger legs, bigger, bigger brains. Absolutely. And also, if you're older, we know that my number one reason for emergency room visit falls, the thing that stops falls more than anything else is better, stronger legs, so stronger legs are important. And the third is created life or on your home where you're not sedentary for long periods. You're standing up you're watching a show stand up and watch your show do a little foot pedal exerciser. And you know eat around a an island standing up. You don't have to be traditional stand up more standing up the better. So that's that's important and more walking and stretching and all that. Unwind stress management, I need to manage the time here. A stress is very important. And here's the surprising thing. There's good stress and bad stress. Good stress is the kind of stress that actually is the very purpose of the brain. Why would you be using 25% of the body's energy and putting your brain and your body at risk by sleeping to rejuvenate the brain. Because the brain wants to be challenged wants to think wants to solve problems. And if it's not doing that it shrinks. In fact, the number one reason for shrinkage of the brain is when people don't use their brain either throughout life the biggest risk factor of dementia just recent data was when people had lower education level or didn't challenge the brain throughout life. The biggest risk factor I would have liked it to be food or this or known as brain activity. So challenge your brain throughout life if you retire don't retire just rewire. Find a new hobby that challenge your visual spatial attention memory push yourself around your passions before you have to take classes like histology which I hated. Now I can take you know pottery class or you know guitar class or dance class are those challenge your brain and they grow your brain exercise and mental activity grows. So that's positive stress. Negative stress is the kind of activities behaviors and thoughts that are not driven by your purpose don't have a clear direction don't have clear victories they're just going on and on and on tension is building on and on and on the survivor you know the the sympathetic system is on at a low grade level. So that's actually shrinking the brain. So if you have bad stressors identified them specifically remember SMART goals and then delegate reduce and eliminate them over time because those bad stressors can significantly shrink your brain but we just live with them as if all don't worry I'm I'm okay with it. If you're not identifying specifically, reduce eliminated delegate, and where you can't do that, find the language that finds a purpose for them. And then we'll and then focus on the positive stress. Sleep our restorative sleep not just sleep ours for restorative sleep neuro ours for starters, that means seven to eight hours of sleep Sleep where you're going through those phases of sleep four to five times, that means spend money not on some spa, make your bedroom your spa, no light. And when you do turn on the light at night, it should be red light or low light, not blue light or bright light, because it's going to turn on the circadian clock. Work on eliminating sound in your room sound proofing, or if you have running thoughts have white noise, that that's compatible to you. Lower temperature in the room helps. And and then and so start investing on sleep because sleep is profoundly important. That's where your brain reorganizes we recategorize his memories for long term. And that's where the brain actually cleanses itself significantly. And when people don't get good sleep on a chronic basis, their brains shrink because the glial cells the support or Janner cells, when they don't sleep, they start eating way the good brace. So sleep is that important. And then last one, optimize is what I talked about, which is positive stress. Make your life around purposes, find purposes that really give you joy, but also challenge you and push you. Because if it's repetitive, it's not pushing you. So fine, learn new musical instrument, learn a new group, learn book clubs, or find book clubs to join, lead and a non for profits, multiple things that challenge your brand, take classes that you always wanted. And that pushes you so much that that's the number one variable to connecting the brain. Now what does that mean, you have 87 billion neurons, each of them can make a couple of connections, or as many as 30,000 connections per neuron. And what determines that connection is mental activity. We did a meta analysis with the deal of Jesse I call them the most powerful scientists there is a reason Stein aging Institute, he was the head of NIH, neuro psychiatric division. And what we found successful cognitive aging had to do basically around this, find your purpose and push your brain and that creates redundancy of connectivity at a 30,000 fold, nothing can come close to that. So that's it, that's that's free, all of that is free. You don't have to worry worry about whole food plant base, that's, that's free. By the way, people who say it's expensive, it's not potatoes, and beans and greens are not expensive. So we just have to be organized. Exercise is free. Stress Management is free. Sleep is free, and mental activities free. Those five things will have so much power to not just help you avoid Alzheimer's and stroke and dementia and heart disease, all that, but continually grow your brain capacity throughout life to continually grow your focus throughout life. And by doing so, you don't have to pay anybody, including us.
Robert Lufkin 48:01
Yeah, that's such a beautiful concept of those ideas there. And, and not to be cynical, but that may be the problem that that this doesn't cost more so so big drug companies and you know, special interests that make a lot of money producing insulin or other things. My you know, you could write an insulin prescription in a minute, but it takes, you know, 20 minutes to explain a lifestyle program or longer to a patient and the healthcare system needs to need to adjust to that because it's this is really much more cost effective. And ultimately, it's better for better for the patient. Now. Your program is available both on site if people are in the Loma Linda area they come but they can also do it online. I understand. That's right.
Dean Sherzai 48:52
Absolutely. We you can find us on social media as shares AI MD. You can see my name there or with the brain health revolution, the brain health revolution on social media, but we have a community, the brain health revolution on mighty networks.co. If you go there, look for brain health revolution. We were helping, we're very proud that we actually won the National Academy of Medicine, innovative award for our research our work in the communities. Now we want to build this capacity within communities throughout the world, in fact, it's the biggest brain health initiative in the world and in many ways, and would love you guys to be involved and to spread it in your communities because I think this will have the most profound effect on public health more than anything else.
Robert Lufkin 49:43
Yeah, that that's beautiful. We're going to link to all those in the show notes as well so people could access them and we'll have some additional information on that. But Dean, I want to thank you so much for taking an hour today and spending time with us and telling us about the the beautiful work that you are doing there.
Dean Sherzai 50:01
Thank you so much. It's wonderful, wonderful to be connected to you and I think we're close by so we're about 60 miles apart. Looking forward
Robert Lufkin 50:09
to getting together so much.
Unkown Speaker: 50:11
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