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Brain Body Reset
Beyond the diagnosis and symptoms, there's a path to feeling better. Dive into the world of brain-body connection and learn how to optimize your health.
Brain Body Reset
Vascular Dementia- Practical Guide To Controlling Your Future
Is vascular dementia inevitable, or can you prevent it before it starts? In this solo episode, Dr. Zimmerman challenges conventional thinking about aging and cognitive decline. He lays out a powerful, proactive approach to preventing one of the most common—but overlooked—forms of dementia.
🔑 Key Takeaways:
- Vascular dementia is often preventable, but early action is crucial—changes can begin 10–20 years before symptoms appear.
- Silent warning signs like elevated blood sugar, insulin, homocysteine, and inflammation are red flags long before memory loss starts.
- Critical lab tests and imaging, including fasting insulin, hemoglobin A1C, coronary calcium scores, and MRI scans, are underutilized tools for early detection.
- Lifestyle factors like poor sleep, stress, ultra-processed foods, and lack of exercise compound your risk—but also offer the biggest opportunities for change.
- You have more control than you think. Empowerment, consistency, and the right data—not just genetics—are the foundation for long-term brain health.
Vascular dementia, is this something that's just going to happen to you if it does? Or is this something that you can actually control? Now, a lot of people, when they think about dementia, they think this is just something that's going to happen to them as they age. And if they happen to have a family member who's been diagnosed with dementia, then they believe that their risk is going to be substantially higher than someone who doesn't have it. There's a lot of thoughts that there's genetic components to this. But what I want to do is we're going to walk through a framework for preventing vascular dementia. Personally, I believe that most cases of vascular dementia are completely preventable. But it's not so simple as saying, oh, I don't want to have vascular dementia. You know, I'm going to be okay. First, before we really get into what you can do, there was some new research that came out that estimated that upwards of forty four percent cases of dementia by the time someone hits years of eighty years old are related to poor vascular health. When we look at dementia, first, let's establish that dementia is an overarching category. Now within dementia, there are subcategories. So you have Alzheimer's disease, which is the most common form of dementia. The next most common type of dementia is vascular dementia. You also have things such as frontotemporal dementia, Lewy body dementia, which we're not going to go into those as we are focusing on vascular dementia. Now, most people when they have or are worried about dementia, they often don't really worry about it until they start experiencing a lot of the symptoms of dementia. So what are some of the things that you may notice when you have dementia? Well, it's not the routine minimal stuff, right? We're talking about more impactful stuff, right? Problems with performing tasks such as paying bills, Maybe you're getting confused and getting lost when you're driving around. If you get instructions and you're asked to do two to three things, two to three never happens. You only get the first thing done. You may have changes in the mood, may have depression or anxiety, even though you haven't had it any other point in life. Maybe you have hallucinations or delusions, seeing stuff that's not there. Now, if you wait for these things to happen, you're much further along than you should be. And the likelihood you're going to get the help you want, it's going to be a lot less. But if you have some of the early warning signs, such as misplacing things, maybe you're walking to a room more frequently and being like, huh, what was I doing there? Or I'm misplacing my keys or my phone more than I've done in the past. Maybe you find when you go grocery shopping, you have to write down a lot more things than you previously did. Also, maybe starting a little struggle with word finding, a little bit of memory issues. Now, when we talk about memory, it's super important that we realize most people with any type of dementia, they are going to maintain their long-term memory. They're going to be very, very sharp when you ask about things from their teenage years, early adult years, they tend to do really, really well. But when you look at most recent within the past couple of years, they're not going to do so well. Now, I understand a lot of you are like, but I struggle with finding words in conversations. I zone out. My concentration's not as good. Does that mean I'm going to get dementia, specifically vascular dementia or Alzheimer's? And the answer is no, but I need you to think about it this way. It is a continuum. It increases the likelihood. So you can either say, all right, I'm in my forties, my fifties. Here's what I'm noticing. I don't think I'm at risk of dementia. I'm going to ignore it. Or you can say, well, while I hope it's not dementia and I could say it's not, I also want to make sure that I'm attacking as if it is because one, you're waiting for it to happen to you. The other, you're saying, I don't want it to happen to me. And there's a big, big difference because when we look at the research, most people start showing physiological changes within their brain. ten to twenty years before they are ever going to get diagnosed so your physiological changes occur before your symptoms will ever show up so before you get confused you are getting lost before you really struggle and you're asking the same question time and time again to a family member if you wait for that once again this has been going on for at least ten if not twenty years so we've got to be proactive So how do we go about being proactive and actually preventing vascular dementia? So as we established, vascular dementia is the second most common type of dementia, followed by Alzheimer's. When we look at this, there are some of those things, okay, well, this can increase your likelihood of dementia, vascular, but let's just go super general at this moment. Anything that increases cardiovascular disease is going to increase your likelihood of getting vascular dementia. So I get a lot of people that I'm treating. They'll come in with active dementia. In reality, the best point to have started would have been ten to twenty years in advance. And I personally believe we can prevent a lot of it from ever occurring based upon different people's life expectancy. But. You don't want to wait, once again, until you're that bad. Please, please do not wait. It's going to be too late. Now, when we think about cardiovascular health, hypertension is known as the silent killer. And really most forms of cardiovascular disease are known as the silent killer. Because you don't feel worse because your blood pressure goes from one ten to one twenty six to one thirty two to one thirty four. You don't really feel any worse and you don't feel any worse either when your heart starts remodeling. your ejection fraction so your ability to kick stuff out of your heart and to pump it through the circulation you also don't feel any worse when that starts changing which is why it's so dangerous because in our society we're so conditioned to saying I'm not going to get care I'm not going to do anything until we basically have a significant symptom burden that's impacting our life But if you view your health like you do a car, this would be your check engine light. This would be your, hey, your gas is almost running out, right? It's telling you in advance of what's going to happen if you don't do anything about it. But once again, you don't notice your car is having issues, right? When you have a quarter of a tank left. It drives no differently when you have a quarter of a tank or a half tank. But it does drive substantially differently when you hit zero. It doesn't go. So this is why looking at the way you're functioning is actually kind of dangerous because we say, oh, but I'm doing okay. I'm doing okay. So what are some of those things that we can check in labs through imaging that's going to tell us, A warning sign is on and we need to do stuff about it. Now, there's a lot of different things here, but I want it to be usable for you, okay? There's a lot of minutia and weeds that we can go, but once again, I wanna best serve you and talk about the things that you can really do. So what are some of those things that we know contribute to cardiovascular disease? We're gonna start at metabolic health. So it's very well known that if you have diabetes, or obesity, your rate of vascular dementia is going to be a lot higher than those who don't have it. Now, don't wait till you become diabetic. So what are markers that you should look at? Well, fasting glucose. Now, when you look at a fasting glucose, your lab is often going to say lab range is anywhere from seventy, seventy five up to one hundred or one hundred and five. In reality, fasting blood sugar, you really want it in the eighties. So even being in the mid nineties is still going to increase your likelihood of cardiovascular disease. So we don't want to live just within a standard lab realm, because if you're not aware, Here's how lab values are actually calculated. They do a certain amount of labs of the general population. They do a mathematical equation and say, basically, ninety seven percent of the population lives within this. This is our normal range. Well, if you've been to any grocery store, you realize that. Ninety-five percent of the population is definitely not healthy, right? They're not what we would look at and consider as healthy. So we shouldn't consider those labs to be healthy either. And this is where we want to really refine it and bring it in more. Next, going along with fasting blood sugar, and it should be noted, I'm okay if people get this marker when they're not truly fasting, because by about three hours after eating, your blood sugar level should be back to a fasting level. If not, that's telling us we're probably having some issues. Okay. You don't need to wait for a ten hour fast for you to be elevated because once again, that's ten hours without food. That's way too long. Your body should have handled it hours before then. Now fasting blood sugar does change a bit more. So a more stable market you can use called hemoglobin A-C. A lot of people are not getting this test performed until they're diabetic or there's strong suspicions they are. But this is more of a measure of damage to your blood cell as a result of sugar. The higher the number, the worse it is. When you look at most labs, five point seven to six point four is going to be prediabetes. Six point five and above is diabetes. Realistically, the lower the number, the better. So we don't want to celebrate because we're at a five six. A five zero is going to have substantially better benefits in reducing their likelihood of vascular dementia or cardiovascular disease than a five six. It's just the way it is. The lower, the better on this one, okay? There's no, oh, well, I'm normal. It's okay, okay? That is not a realm you want to really live in. Next. Next. Insulin. Okay. So going along with Blutcher, you got to look at your insulin response. Know what your fasting insulin is. My average patient has never had their fasting insulin performed before they come in. So where's it at? Lab ranges upwards of twenty, twenty one, twenty two. You really want it to be less than eight or seven. I've even heard people say lower than that, but really eight is a good number to have your fasting insulin underneath. Now there's another marker that goes along with insulin called C-peptide. C-peptide is a better acting marker for your insulin response. It's more stable. This lab range is typically under three point five or four. Personally, I like it underneath about two and a half. Same thing, kind of the lower, the better. We do not want impaired insulin responses because the more insulin we have to dump, the harder it is to manage our blood sugar, the more likely we have issues. Now to go along with this kind of an indirect measure that many of you are having performed, and I don't know if it's being talked with you about, it's when you have your lipid panel, right? They're doing your total cholesterol, LDL, your HDL. One of the markers they are doing is called your triglycerides. So any excess sugar you have floating around your body will store in the form of a fat known as a triglyceride. Lab range for this is upwards of a hundred and fifty. I don't like it anywhere near that. I've heard some experts who like it under eighty. I tend to tell patients seventy five. Once again, lab ranges are dangerous in a lot of these things because you flirt with danger and things can progress over time. So we definitely don't want that to occur. So where are your triglycerides at? Make sure they are in a good spot. So those are the foundational ones, right? Those are really cheap. They're easy to do and not everyone does it. Now, the next step of things we want to look at also in blood work is going to be what's called homocysteine. So homocysteine is essentially this amino acid, okay? It's methionine and cysteine. Now, your body has to break down homocysteine using methylated B vitamins. This is where a lot of people are talking about MTHFR genes. Now, don't get me going on that because homocysteine is a better measure of seeing how well you are methylating than just getting the gene itself. Having the gene genetic snip doesn't necessarily mean there is an issue. It just means there is a tendency to an issue. When we look at homocysteine levels, the labs, depending on the company that does it, it's going to range quite a bit. I've seen labs that say under ten. I've seen labs that say under fifteen. Personally, I like anywhere from about five to an eight. But when you look at the international consensus on homocysteine, it is well known that anything at eleven or higher is a causative factor for dementia, specifically vascular dementia. Other research does suggest that ten absolutely does it too. But once again, the universal consensus is eleven. And the average person is never going to have their homocysteine looked at until after they've had a stroke. So this is really, really bad because just like If your blood sugar goes up for a day or two, you're not going to have issues and damage from your blood sugar that's really going to impact you long-term. Homocysteine is very much the same. If it's just temporarily elevated for a day or two, it doesn't do a lot of issues. But what happens when you go twenty to thirty years with a homocysteine level of let's just say thirteen, that slowly has been doing damage to your vascular walls. And now all of a sudden, it increases your risk of heart disease and vascular dementia, right? This is something that could have been dealt with pretty easily, actually. But because it's not something routinely ran in healthcare, you now have this risk factor that should have been dealt with that never was. So, I hope you're getting a point that there's a lot that you can do, and we're going to keep going a bit further. Now, sex hormones also play a role in vascular health. Testosterone and estrogen, specifically progesterone to a lesser extent. So hormones definitely play a role in female health with reducing their likelihood of cardiovascular disease. Even in guys, it definitely helps too. I know some of you are still like, oh, but there used to be labels that said testosterone increased the risk of cardiovascular disease. They removed those labels because there was never any true research that supported it. That was just something that was really ran with. So having good hormonal health absolutely does play a role in reducing your risk of cardiovascular disease. then the last blood marker that I want to talk about is something called high sensitivity c-reactive protein you will typically see this gets correlated with cardiovascular disease increasing the risk it's actually more of a generic marker but the higher your c-reactive protein is the more likely you've got inflammation going on in the body inflammation in the body hey guess what it's floating around your bloodstream it's going to increase the likelihood of having issues there with cardiovascular disease. And once again, anything with cardiovascular disease does increase your risk of vascular dementia, which once again, I believe is preventable for most people, but it does start in your thirties, your forties and fifties. Do not wait till your seventies and you're having issues to try to do something about it. It is way harder at that point in time because there's a window of opportunity and and you're really missing the window it's just like if your house catches on fire are you going to save more belongings if you see a little flame and you put it out or if you wait for it to be eighty percent engulfed well obviously if you see it early you put it out you're gonna save way more of your belongings same thing is true when we look at vascular dementia now another set of labs that you may want to consider are stool tests So there's a lot of research. If you go to PubMed, you go to Google and you start typing in gut microbiome and brain, gut microbiome and dementia, gut microbiome and metabolic health, gut microbiome and hypertension, right? There's a lot of research that has been coming out over the years because a lot of our immune system is influenced by the health of our gut. We also know the diversity of our gut microbiome is going to impact byproducts that are produced. So there's metabolites. Now, some of these metabolites are very, very healthy for us, such as butyrate, which is a short chain fatty acid, does a good job of helping with the immune system. But on the other side, you get inflammatory byproducts. For example, one of them is known as lipopolysaccharide. This is going to create a lot of issues for people. So getting a good comprehensive stool analysis can absolutely be important in helping to prevent vascular dementia. Now, I do want to offer a word of caution. When most people think about getting a stool test, they think, well, I don't have constipation or diarrhea. So therefore my gut microbiome should be perfectly healthy. This is not true. Okay. This is not true one bit. You don't need constipation or diarrhea to have altered gut microbiome. Having cardiovascular disease can do it. Having brain fog, chronic fatigue. autoimmunity, headaches, migraines, all of those things can be impacted by the health of your gut microbiome. Now, yes, you could probably do some generic things, right? Maybe take some probiotics, maybe do some gut cleanses, but it's going to be generic. You can be much more specific when you're using good quality probiotics. microbiome tests to really look at your stool so we've got blood tests we've got stool testing that's important when trying to prevent vascular dementia now another set of tests that a lot of people aren't getting and it's because insurance doesn't cover it but it's actually pretty affordable it's what's called a coronary artery calcium score so what this is it's a ct scan that looks at the amount of buildup and the walls of your coronary arteries because if you have buildup of plaque in your coronary arteries and your brain is full of blood vessels do you not believe that there's probably a higher likelihood that you're also going to have blood vessel disease within your brain and the answer is absolutely so I'm a big fan of people starting at the age of about thirty getting a coronary artery calcium score to know where they're at, because once again, cardiovascular disease is the silent killer. And if you have hypertension, if you end up needing a stent, you have a bypass, you have a heart attack, you end up having a stroke because of cardiovascular issues, your risk of vascular dementia is higher than someone who does not have those issues. And you need to know where you stand because as we talked about with symptoms and warning signs, If you wait for symptoms to get bad enough, for many people, the first symptom of a heart attack is a heart attack. They didn't get, oh, here was your year notice before it happened. But if you use imaging that, right, depending on where you live, you can know the health of your blood vessels within your heart. Now, that's not the only imaging. So, I do get a lot of people who come in with memory issues and they've had MRIs, sometimes CTs as well, but they'll have MRIs to see if that explains their memory issues that they're having. Now, there's a common finding that you will see in imaging. You'll see small, you'll see white matter hyperintensities. You'll also see chronic small vessel disease, chronic small, you know, like likely due to chronic microvascular ischemia. Unfortunately, because they're so used to seeing this as people get older, my average patient who has this on their imaging report, they don't even get told about it. They just go, hey, your imaging looks normal. You didn't have a stroke. There was no bleed. You don't have a tumor. Things are okay. But there is a lot of them that actually have moderate to severe vascular disease in their brain. If you have vascular disease in your brain, you're not going to be delivering as many nutrients and oxygen and blood to your tissues as you need to. And if you don't deliver what it needs, those areas get injured and they're not going to perform as well as they should. So if you have someone, a neurologist or whoever is usually running the imaging, make sure to read your report. Because once again, nine out of ten times, people are never told it. in what they report to me. Maybe they get told and they don't remember, but most of them are like, I had no clue. They just told me my imaging was normal. So please make sure that you really get an idea on that side. Okay. So we've talked about blood work. We've talked about stool testing. We've talked about heart scans. We've talked about brain imaging and what that shows. Now, the other test that you should have done is A sleep study. One of the most common undiagnosed causes of cardiovascular disease, hypertension, and other things like that is going to be obstructive sleep apnea. Yes, if you have obesity, your likelihood of having obstructive sleep apnea is going to be higher, but you can also have obstructive sleep apnea even if you are of a normal weight. And if you do have it, your risk of anything cardiovascular does go up. So it's definitely worth getting that study because if you have it, there are things that you can do to treat it. As you treat it, you are going to significantly improve everything else because no matter what you try to do with supplements or medications, if you do have sleep apnea, it's going to be harder than it should be to get everything else under control. So make sure you're getting that looked at and evaluated. Because sleep is a make or break. Because what you may not know is your brain has a waste removal system known as your lymphatic system. So in the body, it's called lymphatic. But in the brain, it's lymphatic. This is a system that removes toxins. When you remove toxins, the inflammation level in your brain does go down. But if you don't get it down and it stays inflamed, well, when we look at vascular dementia and other types of dementia, Chronic neuroinflammation is what ultimately drives a neuroinflammatory neurodegenerative process. So getting that down, making sure you're sleeping really well is critically important. Now going right along with sleep, it's going to be physical exercise. Physical exercise is super important to maintaining cardiovascular health. As you maintain cardiovascular health, you do also reduce your likelihood of of vascular dementia. Cardiovascular fitness and physical exercise is one of the best research things in preventing dementia of any type. And at the end of the day, when we talk about preventing dementia, it's about stacking the deck in your favor. There's likely not going to be one thing that if you do it, it's going to prevent you from getting dementia. Okay. But there's going to be a group of things that when you do it consistently over time, you are going to significantly stack the deck in your favor and you are going to reduce that risk. So we're not looking for the home run hit with any one thing. We're saying, what are these things that we add them together? So right, sleep, physical exercise. Next, since we've already talked about gut microbiome, well, You can be targeted with supplements based upon what your stool showed. But also there's been a lot of research coming out about the impact of ultra-processed food on our gut microbiome, impacting the likelihood of diabetes. So if you are eating ultra-processed foods, right, you find you're doing a lot of things that need to be heated up in the oven, toaster oven, air fryer, microwave, it's already pre-packaged, that's in general going to increase your risk. So you really want to get that down And I'm more of a big fan of, look, lots of good veggies, probably half your plate. Then another thirty five percent of the plate being good fat and protein. Right. Grass fed beef, wild caught fish. Maybe you have some avocado, maybe you have some berries. Right. But kind of lower end on the carb, a lot more veggie, good fibers. And ultimately, the good fiber your gut microbiome uses to feed itself, diversify and to be healthier. But also because you're not getting a lot of processed foods and everything else. We started off by talking about blood sugar and insulin. So you also reduce your likelihood of developing insulin resistance. You also reduce your likelihood of developing diabetes and other things like that. And this is going to play a big role in keeping your weight good. And once again, reducing your risk. So. we've covered a lot up to this point on testing and things that can be done now homocysteine as we talked about you just got to know your level right maybe you don't need anything for it but if you do methylated b vitamins okay such as methyl tetrahydrofolate um methylcobalamin can definitely help with getting things to a better spot so but check know where you are at you can only really do things when you know where you're at, okay? If you don't know where you're at, we're really guessing and we need to be more strategic about this. And then you've got to look at this from a consistency perspective, right? We're not doing this for days or weeks. We're doing this for years. So we maintain the health we want. So that way, when we get older, our kids and our grandkids, we remember. It's so sad watching people come in and they don't know who brought them in to the office and they haven't known for five years or they have grandkids and they're like, I don't know their names, but they can tell them everything about when they were fifteen years old. This is hurts people a lot. OK. Now. You can control so much of this, and I want you to think about the foundational stuff. How do you eat? How do you sleep? How do you stress? How do you exercise and how do you socialize? Because Those are critically important. And I do want to talk about stress. Stress kind of gets downplayed. It's like, oh, but everyone's stressed. Everyone's got it. But when you look at some of the models of depression, for example, stress in our body is from a variety of different things. Maybe your stress is from the foods you're eating. Maybe it's from an infection. Maybe it's due to, right, emotional stressor or a physical stressor. Our body is going to respond differently based upon the type of stress that is present. But neurologically, our immune system there, underneath the microglial cells, it does not know the difference. It just says, boom, stress, okay, we're going to trigger the immune response and nothing good is going to happen. So it does not know the difference. So chronic stress absolutely does change the immune system in our brain. And it's known to lead to shrinkage or atrophy of parts of our brain response for learning and memory, such as our hippocampus. and plays a role as well. We also do know that stress does play a negative role with cardiovascular disease. So you have all these things that are really playing a role that need to be addressed. One of the last things it's whenever we look at the labs, we look at the blood sugar and the insulin. We really want these stable. Okay. You don't want to go from super low to super high. You want to live within a range. right think about like if you're hanging out with someone do you want to hang out with someone who is super depressed and then they get super manic and then they go super depressed right and you're just like oh my gosh what's going on with this person they are all over the place like I don't know what's going to happen here same thing's kind of true when our blood sugar and insulin is going all over the place right oh it's ramping up way too high now our insulin's got a spike Well, insulin is more than just blood sugar. Insulin is actually a signaling molecule within our brain. And so now all of a sudden you develop insulin resistance within your brain, which also leads to cognitive issues, memory issues, depression, anxiety, and other things like that. So we really don't want these to fluctuate a lot. But at the end of the day, these are the pillars that we've covered, right? that can help you reduce your likelihood of getting vascular dementia because it is the second most common type and it is going up but it's going up because of the choices and the behaviors that we are doing on a daily basis once again because of the choices and behaviors we're doing on a daily basis now are there maybe a few things that are kind of out of our control More or less, yes, right? There's a lot of pollution that we know impacts things, which we can't really do a lot of. But if you stack the deck in your favor, then usually the things that you can control will outweigh what you can't control. But we have to get back to where we are empowered. You are an empowered individual. You have what you need to take control of your life. You don't always wait to go in to see a doctor and then say, doc, tell me everything I need to do. in the version of a pill. It's a, doc, I don't have the experience in the Serena. What can I do and execute that will then change my future? Because vascular dementia is not something that people have to get. In general, I do believe it's a choice. So I hope you found this useful. If you have other topics you'd like me to cover, because on this channel and on this podcast, I do some of these where I'm by myself. I do others where I bring in experts in the field, medical doctors, DOs, chiropractors, and other experts in certain arenas to talk about anything that impacts brain health. And that ranges from POTS to migraines to other forms of dementia, concussions, and many other things like that. Hope you enjoy.