Building Your Brain Retirement Fund

Breaking news . The wait is over now . Waiting for summer? Over. Waiting while charging your electric car? Ultra fast, over . Turn up summer energy. Discover charging in minutes all across Europe , and for even more summer energy, stream the new Ionity remix by Elderbrook on Spotify now. Ionity , charge faster, enjoy more . Speaking of healthy food, what's the healthiest food or diet that you can eat for your brain? The Mediterranean diet has the strongest data for reducing risk of stroke, reducing risk of heart attacks, reducing risk of Alzheimer's reduced by a lot . The people with a Mediterranean diet have a brain that's up to eighteen years younger compared to people who did not eat the Mediterranean diet. The Mediterranean diet is fruits, vegetables, whole foods. Whole foods, you know, exhibition olive oil oil, some fish. And it, to me, it happens to be the one that's most studied in these scenarios. I think you're right. It's almost studied. It doesn't mean it's the best diet. So if you are from China and usually have lots of fruits and vegetables anyway , then that's good. It doesn't have to be Mediterranean. All Mediterranean means is that it's a healthy food. It's whole food that has really good marketing behind it. Yeah. Welcome to the Checkup podcast. My guest today is Dr. Majid Fatuhi, world renowned neurologist and adjunct professor at Johns Hopkins, who's redefining how we think about aging, intelligence, and brain health. In his new book The Invincible Brain, Dr. Fatuhi shares remarkable insights he's gleaned over decades of research into conditions like Alzheimer's. We dove deep into tips on how to reduce your risk of contracting the disease and how to improve your overall memory and brain health. We also discussed the faulty promises of genetic testing and full body MRIs, what diet changes can actually make a difference in your life, and the reality of taking an IQ test, please help me in welcoming Dr. Fatuhi to the checkup podcast. Doctor, I'm really excited to have you on to chat about the brain. And this is a topic that I have a lot of interest in personally brain gets hit sometimes , I do a little bit of boxing on the side and I worry about how that's going to impact my brain . I've also seen that as we become older as a society because we've solved acute disease and we've had so many improvements in treating acute disease that as we're living longer , we're moving into the era of more chronic disease states, one of which a large one being brain disease . So you being a person that's been able to fight back against that gets me really excited . So very excited to chat with you on the topic . What got you interested, even like going back to study the brain. Why was that of interest to you? I became interested in studying the brain when I was seven years old, eighty years old. My father told me the story of a young girl who was born without arms . And out of necessity she had learned to use her toes to paint or to open doors or to cook . And he said, Megit, look at this young woman . She's doing everything with her toes , which is something you think would be never possible . So our brain has a lot of power and capacity that we usually don't use it. You can do anything. You can get a PhD, you can get an MD, you can be an author, you can change the world . And people who have changed the world were regular kids one day . They were not born as like geniuses. You know, they were like regular kids like you . So ever since I was a kid, I was really interested in the brain and actually wrote a book when I was fourteen years old. Wow about how to become successful in life What was the title of that book? Exactly that. Get rich . No hard to book successful, not necessarily be rich, but I know I talk about Thomas Edison, Matt Montgandy, John F. Kennedy. Wow, okay. You've already studied them by age fourteen. Yeah, yeah, I became interested in how different people had achieved remarkable things. How did they do it ? And I realized some common themes, which of course, you know, people know very well these days and persistence, setting goals, having purpose , feel passionate and all that. And then when I went to medical school at Harvard, I became even more interested in neurology and I did my residency neurology at Johns Hopkins, and I was seeing patients who were diagnosed with Alzheimer's disease. But when I examined them more closely, I realized that often they had many treatable symptoms , but those symptoms were not acknowledged as a part of what caused them to have dementia So for example , we now know that things like sleep apnea, insomnia, poor diet , stress , all of those things can shrink the brain. We know that for a fact in a dose dependent way . And so I had many patients who had all these conditions and have cognitive decline and were diagnosed with Alzheimer's disease. And I thought, this doesn't add up. They have six causes for their cognitive decline, all those medical conditions, obesity, diabetes, depression, all these things . And they're diagnosed with Alzheimer's. Alzheimer's we think of plaques and tangles , these proteins that tangle up and they form like gum like pieces that trigger inflammation and cause brain atrophy. So then I became really interested to educate the world that, hey, what we call Alzheimer's is often overdiagnosis that Alzheimer's is not a single entity. It's a super problems. So I wrote my first book actually when I was a resident aturolog Ne y at Johns Hopkins, I took two weeks off and I just sat one chapter a day and I finished it . It was called a memory cure. And that book was met with much criticism from my colleagues in academia because they thought, well who are you to talk about preventing Alzheimer's disease? We can't prevent Alzheimer's disease. I argued that if you prevent and treat the reversible components , then you can reduce the load of pathology in the brain so you can slow the rate of decline. That concept is now well accepted. That concept is not something that anyone would question or argue. What were they concerned about that you were giving false promise or something ? Because even in two thousand two , people thought if you have Alzheimer's disease, you have Alzheimer's disease . And there's nothing that you could do to slow the progress or prevent it. Back then we still were thinking plaques and tangles are the primary causes and these other things like vascular problems , inflammation, reduced rinsing of the brain at night. Those are like a little side things. The main things are these plaques and tangles . And over the past thirty years, we've come to appreciate that no , every person's brain contains many components of all these things I just had mentioned . And yes, if we address those other things , then there will be changes in cognitive function. And you know what? In twenty ten , I started my own neurology practice. I felt like at the time I was an assistant professor of neurology at Hopkins and it was very difficult to get a whole thing going on at Hopkins. So I started my own neurology practice and I put together a twelve week program. I argue that if it's true that exercise improves the brain, grows the brain, if meditarian diet reduces blacks and tangles , if meditation improves blood flow and grows the brain . If all those things are true, and if it's true that if you treat the treatable components, like if you treat the sleep apnea and insomnia and depression and all the other things that patients have, if you do all of them at once, you should see significant benefits in a short period of time. So I started a nine month program , which I called brain fitness program back then twenty twelve, twenty thirteen . And I've had Hopkins react to you opening your own practice? Doing this? No, they were like, no, I mean, I had Hopkins a big place. And sure. I had my colleagues. And you know, many people thought that maybe I'm doing the right things and there was no heartfailing to say. Was Hopkins not doing that kind of work about getting people focused on their sleep, on their fitness on their diet? Yes, I think. Was this a blind spot of the industry? I think I think that , you know, are things in science that are fashionable . For example, these days it's very fashionable to talk about longevity. Longevity has always been a main topic for for centuries for forever . But in the past ten years , there's been a lot more conferences, a lot more you think that is? I think generally people like you mentioned, a lot of acute things are being managed and now people thinking about long term . So back then in twenty twelve, twenty thirteen when I started my program , I saw patients in their sixties and seventies who are typical older adult, they're sitting doing crossword puzzles. They forget things. They're not going outside as much because they keep forgetting things. They repeat themselves sometimes. A condition would call mild cognitive impairment. And when I started to do my program, which I just told you, to reduce the bad things and have brain coaches who help them improve the good things . And I saw that patients got better a lot sooner than I expected. So instead of not yeah, so I thought, you know, people were getting better in like four months, three months. So at first it was nine months, then I made it six months. And I thought, you know, these people are getting better sooner. So I made it three months. And I said, they're still getting better. I made it six weeks and it wasn't enough. So I found by trial and error that if I bring my patients to my brain center, meet with them twice a week and our brain coaches were like enthusiastic cheerleaders. They would say, Hey, Mr. Smith, how you doing? Tell me how much did you walk yesterday? Ten minutes . Awesome, good job. You know, that sugar you're eating is not good for you. Can you please cut that back? I mean, maybe we can half half as much as the sugar stuff so be bad for you . So my brain coaches talk to our patients about all the elements that shrink their brain and all the elements that grow their brain. I had them read my book. I had written the second book by then boost your brain in twenty twelve, which was about all the factors that shrink or grow the brain. So I had my brain coaches read the book and pass a test, a three hour test to make sure they really understood all those things . And so we saw that patients were getting better in three months, twice a week, ninety minutes, they were getting better. How are you judging their improvements? Uh huh . We decided to obtain objective improvements because everybody said they felt better. You know, the family members would come to me and say, Oh, I can't believe my spouse is the same person. He couldn't remember five things. I told him to go shopping and now he memorizes twenty words. I can't believe this. We obtained objective cognitive tests which were administered through computer programs. So it wasn't like it was our people doing it. It was less chance of bias. Third party . And it was computer based, so we couldn't really manipulate change. It was an objective third party cognitive test. And many of the studies that I had read talked about how you can grow the part of your brain that's important for memory called hippocampus. Hippocampus is the sides of your thumb. You got one on the right, one on the left and this is the part of the brain that's critical for learning new things . And this part of the brain shrinks with Alzheimer's. And so I decided to do quantitative MRIs on my patients . And guess what ? We saw that half the patients had increased in the volume of their recampus between one percent to three percent. Half of them did not. Half of them still declined, probably declin ed less than they would have been otherwise. But it was a busy routines can make it hard to focus on your health goals, but Med Express offers a simple way to explore weight management treatment online. Complete our Shore Eligibility Consult ation with no need for face to face appointments or travel. If eligible, treatment is delivered discreetly, with UK registered clinicians offering support along the way. Visit medxpress. co. uk slash podcast to get started today. This isn't just microscopic. You're seeing this microphone and that's the thing that was amazing. To me, I was pleasantly surprised. And let me tell you what made me start my own program. Like it was a big leap to leave my cushy job, you know, like, you know, you're a professor, you teach, you see patients, it's very comfortable. I don't like money. I don't like business . I know studying my own practice was a big undertaking. Yeah. I had to get out of my comfort zone to do that. But there was one study that really convinced me to do it . And this study was done in a group of thirty or forty patients and they wanted to know if exercise can grow the size of a campus . And so they had a control group that played football, something that doesn't require too much effort and another group that did cycling . They did four times a week, forty five minutes to an hour of vigorous cycling . And what was interesting about that study is that all of the control groups did not have any change, but all of the active groups, all the individuals who exercise who did the cycling grew the size of a campus. Not half of them, all of them . And I thought if exercise alone can grow the size of a campus . O coursef if you, combine it with diet, improving sleep, you know, meditating all other things, you will definitely see results. So what I did my own MRIs on patients and they improved, I was in cloud nine. I never forget aerodiologist called me. This was Baltimore. Eradiologist called me. He said, I've noticed a bunch of your patients are coming back and have me do quantitative MRIs. And the size of your campus is getting bigger. What are you doing? Because this is unheard of unheard of that what's happening that the volume is expanding, is there new synapses forming, neuron regenerated? What's happening? Yes . There are four things that happen that grows the brain. Number one is increased blood vessels. When you stimulate your brain with exercise particularly, but these other things that are called five pillars of brain health, you increase the number of blood vessels. You increase the number of synapses, you increase the number of connections , and you increase the overall capacity of the brain. So more synapses , more connections , more blood vessels and more neurons, four things, neurogenes is. So part of the brainflow memory hippocampus is capable of to generate new neurons at any age . So those four elements accounts for that three to five millimeter increase in volume that we see near campus. What changed? Because I believe in my education, maybe it was pre med, not med school , there was the notion that the brain does not regenerate. Neurons do not regenerate. It's unlike your liver. That was the joke that all the classmates made. Where is the state of research now when it comes to brain regenerating itself? It's compelling evidence that a human brain is capable of generating new neurons at any age in Dappy campus, not all over the brain, only in AP campus, mainly in Deppie campus or some other parts of the brain . And the research started animals . There was a professor Fred Gage who put mice in two groups, one group was put in a cage with a running wheel and another group was placed in a cage without a running wheel. And he saw that the animals which were in the cage with a running wheel and actually, you know, exercise for a few hours over daily over a matter of I think it was six weeks or two months had larger every campus and then when they sliced it and looked under their microscope and they stain these sections for new neurons. They saw new neurons . And then they stained it for components of neurons that are important for synapses. In other words, these are not immature, premature stem cells, these were mature neurons. And then they stained them for with antibodies to actually see the dendrites and growth. So that was established. But then the question became does this happen in humans . And they did a very interesting study which I probably couldn't do these days is that there was a group of people in Sweden and I think it was Sweden or somewhere in Northern Europe . And they had cancer and were going to die soon. So the researchers went to them and said, listen, you know, we're doing this research and we want to see if the campus generates new neurons. Do you mind if I give you something? If you pass away, then we want to slice to your brain and they agreed and they saw that even in this group of patients patients with cancer who are dying that the hippocampus was generating new neurons. And more recently, you know, there's a research there are surgical procedures for treatment epilepsy so doctors surgeons can go inside the campus and take some part out as a part of treatment for epilepsy. And when they look under the microscope, they see evidence of new neurons . So now we have compelling evidence that apocampus can generate new neurons at any age and we know that there are a few things that can generate this process of neurogenesis and exercise the number one on that list . Anyway, going back to the story of my twelve week program , I published that result that Hippocampus grows with the twelve week program in the journal of Prevention of Alzheimer's Disease. And as I provided this program for more patients, there were other patients who said, well, can we join this program? You know, had concussion, has it gotten better? And I thought, you know what? Let's try it. And so I put a group of patients with pers istent post concussion syndrome. Not the concussion patient who gets better a week later. These are patients who three, six months later a year later, they still can't function . And we saw that eighty percent of patients with persistent post concussion syndrome had objective improvements in the cognitive test, not just I feel better, which most of them did , objective improvements. And then I provide this program for teenagers and adults at ADHD and again, eighty percent of patients improved. So there's one thing very clear. There's a concept called neuroplasticity , which means our brain has the capacity to change and grow at any age . And if you take care of the negative things that usually shrink your brain, poor diet, poor sleep, seditary lifestyle, all those things that shrink the brain. If you avoid those and if you replace them with exercise , brain training , meditation, optimal sleep, that you can see results in a matter of weeks, not months or years, in a matter of weeks. So as I was doing these things , my program became busier and busier at an office in Northern Virginia. We had twenty five brain coaches . And we became so busy that my office was open seven days a week from eight AM to eight PM . And it was like incredible to see people come from all corners of the country. We have people from Arizona, Connecticut, Florida, they would come for the twelve week program. They would actually stay in hot ael near our office and doing this. And that's when I thought, you know what? This is too good to be offered just for a small group of people in Northern Virginia. This is something that can change the lives of a lot of people around the world . And the thing is that in parallel to all the things I've been doing , other people have been doing the similar things. What I did back then it was novel in twenty twelve, the idea of having a multi model life style infection program was a new thing. But since then , there have been at least a hundred studies . I mean, every combination has been tried. And you know what's so interesting . Recently, as you may know, there is new drugs for Alzheimer's disease. You know, there are antibodies that target amyloid in the brain and they reduce amyloid in the brain by by like thirty five percent or twenty seven percent . And there's a modest slowing of cognitive decline in this patient population. So instead of going down by nine point, they go by down by four points. They still go down , but less slow. So then I wanted to know if these multimodal life interventions can have similar effect as these drugs using the same outcome measures. So these studies usually use something called ADASCOG, which is a paper and pencil, it is a computer based program. It takes about, I think, forty five minutes an hour to do it. It asked for memory, orientation, doing things . It's a cognitive test . And there were at least five studies I found which were placebo controlled, randomized controlled trial using the same population as the population that drug companies used, you know, patients in their sixties, seventies, early eighties, maybe who have early stages of Alzheimer's disease or this condition called mild cognitive impairment and they use the same test. Guess what ? The studies that used the multimodal lifestyle interventions, diet, exercise, brain training and so forth had more benefits than these drugs. These drugs slowed the rate of cognitive decline. These interventions improve cognitive function. And then they usually talk about the drug companies talk about the twenty seven percent change between the control group intervention group and there's a Dynamap is like thirty five percent. When you look at multimodal lifestyle interventions, it's two hundred percent to four hundred percent . Yes . It's incredible. numbers The are amazing . And I'm curious twofold about those medications. I know that from when they initially were announced, they've been a little bit of a letdown for the pharmac ies in the sense that patients find them expensive, inaccessible, don't see the benef it from the small amounts that they could benefit from them as opposed to doing lifestyle changes . Second , there's been some talk in the imaging community, the neuroimaging community about how has the Amyloid hypothesis been thrown under some scrutiny lately? Have you seen that? What are your thoughts on the issue? Yes. With manipulated images and so forth. I don't think it's necessary to talk about a few papers which we manipulated . I think that was not a good thing they did. However, there are thousands of studies . And so I don't think it was a one paper that manipulated the data, which resulted in all the things they've done. I think in general people want a quick result. In general, people , especially Americans, want a quick result, a quick cure for every problem . And fortunately, in the scientific community, many of my colleagues have focused on plaques and tangles. They see the world as plaques and tangles with a little bit of other things . They have not come to appreciate that an eighty year old brain has a super problems. There's inflammation, there's blood flow problem, and there's difficulty with rinsing of the brain. Those three things . And plaques and tangles are a part of this picture . And so if this is really true , then if you just treat the amyloid plaques, you only removed at best twenty percent of problem. So you should not see great results. And this is exactly what has happened. See, the amyloid cascade hypothesis talks about how this amyloid somehow triggers the formation of tau , which is the next level of these aggregates . And then once you have tau, then everything is over. And it's true in early onset Alzheimer's disease. If you have a fifty five year old who has plaques and tangles and nothing else, that's what happens to them. They usually have nothing else, plague and tangles, destroys the brain and they develop dementia and their miserable life. People in their eighties , late seventies and eighties have super problems and plaques and tangles are a small portion of that. So in them t,argeting the amyloid will produce very little results, which is exactly what we've seen . And I think more and more are coming to appreciate that we need a multimodal intervention because what we call Alzheimer's disease is a multi mortal multifactorial condition. Now , one of my pets views we overdiagnose Alzheimer's disease. We put the label of Alzheimer's disease on many people who have only part of the soup . I wish we would call people as having cognitive impairment. You have mild cognitive impairment, you have moderate cognitive impairment, and you have severe cognitive impairment. We wouldn't label it as the cause. When you say somebody has Alzheimer's disease, you're implying the plaques and tangles that triggered all the problems . But if you say somebody has cognitive decline, then you're more prone to look for causes. And I think as a primary care physician , you need to know that when somebody comes in with cognitive decline, let's say you have a seventy eight year old who comes to see you, they're for getting names, they have missed some appointments , they're not as social as they used to be . They're confused at times . You shouldn't jump to the diagnosis of Alzheimer's disease. You do cognit testing, their memory is not good. Unfortunately, a lot of doctors, when they see that result, especially if they order these new biomarkers that look for plaques and tangles, they say, well, you have Alzheimer's disease . But the answer is no . They have flats and tankles, but they have these other things that are treatable . So let's think of other things that are treatable. Do you have depression? Yes or no. Depression is treatable. I mean, especially in the elderly, a small dose of SSRIs can actually help. If you put them in a social environment where they can be useful, you put them in a church and say, why don't you join this community this club, this community, in the church, why don't you become a volunteer in the local museum or local elementary school? If you do those things, they perk up and that's what I see in my practice. Patient after patient after patient it would come up. I would do this little things that will regain their confidence and they will do more. And it's not just me. Again, I don't want to pretend like I've solved the problem of Alzheimer's dis in the world. There's a study that was done in Japan , they look at all the people who were diagnosed with MCI. Everybody is MCI. They looked at it a year later. thirty percent of that population had reverted to normal. And those are patients who had done social activities , they had done more exercise . So usually twenty percent ten percent to twenty percent of people who get a diagnosed MCI spontaneously revert to normal because life circumstances can affect your brain function . The internet is coaching our kids. When boys hear that on repeat, it shapes how they see themselves. We can't leave it to those voices. We have to be louder together with E , we need to coach them, guide them, back them. Building our boys up every chance we get. Be yourself, back your mates. Confidence comes from a game. As proud Hartner, the England teams, EE has support and guidance to help build all our boys up on and off the pitch. Search E S boys. I'm curious from the primary care state of things because I try and be very holistic and not think about one organ or one dise ase condition . So the things that you're doing in these brain fitness programs, brain coaching programs , I'm preaching to my patients whether they're seventy five years old with mild cognitive impairment or they're twenty five years old with pre diabetes, right? Because I'm going to try and treat their depression, I'm going to try and treat their blood flow, their exercise, their diet. I'm trying to get that instilled early on in my patients . And in every physical I'm trying to push that in because I'm trying to think about prevention. In fact, you mentioned how society has this new obsession with longevity doctors and longevity specialists. I actually find that hilarious because I think every doctor with one exception is a longevity doctor and that's hospice doctors because they're the one doctor that's probably not thinking about longevity . And that's not their fault, but we're all trying to make our patients live a longer and a higher quality of life . But when I think about the struggles that I have with my patients in terms of getting them, like I get them diagnosed with sleep apne a, getting them to wear their CPAP , patients that desperately would benefit from exercise from a metabolic standpoint of their heart, their brain, every organ in their body . Even depression gets better with exercise . Patients who have depression either can't access mental health services or feel a stigma to those services or medications. So I'm curious what makes your brain fitness program so successful that almost everyone seems to buy in so well . I think part of it was what happened in our waiting room . People would come in, the new patients would come in and they would talk with other patients who were halfway in the program with their finishing program and they would tell these other patients it's incredible . You will love this . Also we had very good reviews. I mean, I had more than three hundred reviews on like Google Reviews and it was five out of five for every patient. Patient after patient said things like you changed my life. This is the best thing ever. There was not a single bad review, not a single bad review over all these fifteen years that I provided the program. Not on ce, not even once. You know, you're a doctor, you know that there was always someone who was unhappy about something . And not only they were not unhappy, people always said the good things. I think so when people saw that it's possible, I think the problem is that most people don't realize that these five pillars of brain health , exercise, sleep , diet, stress reduction, and brain training, these five pillars of brain health are simple, but powerful. People always think that if it's something powerful , it must be expensive, it must be some kind of injection, it must be like a difficult protocol . But the truth of the matter is these are simple and powerful . That they do make a difference in people's lives and that you can see results in a matter of weeks, not years . You know? And so I think those are the elements. If people see that's going to happen , a lot of people can't believe that, you know, everybody says diet and exercise since when diet and exercise can change things . But if you do it and not only diet and exercise but this five pillars of brain health, you will see you will see significant improvements. The other thing I hope will become a trend is once a few people start doing it and they write about it on social media and it becomes a thing and everybody else does it. Let me give you an interesting story . In nineteen fifties, there was no evidence that exercise good for you . In fact, if somebody had a heart attack or something, the prescription rest . And they would point to a few people who had died with marathon or marathon who had died as maybe it's not a good thing . And so in nineteen fifties, nineteen sixties, there were a few cardiolog ists who said, you know, exercise is good. And the reason was a Harvard study that showed if you look at bus drivers and bus conductors and monitored them over ten years , the bus conductors that move up and down in and out of the bus are far less likely to get heart attacks than the bus drivers which were sitting all the time . And that was one of the first studies that made people realize maybe exercise is a good thing . And I think it was Dr. White , who was the cardiologist for I think Roosevelt, who said, You know what? Exercise is good for you . And this was a shock . In nineteen sixty's or nineteen seventies, there was an article in New York Times A few cardiologists believe exercise is good for you. This was a tit ch article . No, it's funny hearing it now . I know . I know . So it was a paradigm shift. It took obviously thirty years before we see a gym in every corner . That's where we are with realizing that brain training , feeding the brain the right things, making sure that you sleep so that the cleansing happens the brain, these things will one day become so obvious that will be programs left and right . I am certain that they will happen. Why aren't they happening now you think? I mean, we have such great data already . Well, it takes a while. I think a medical strategy takes how long did it take for smoking secession to happen in the United States ? You know, smoking was very common in nineteen sixties and seventies. It took twenty thirty years until these days there's no smoking restaurant s or public places and usually it takes a person an event , something that turns the clock and turns the no everybody does that. I think once it becomes what everybody else does, then it becomes acceptable. You know, most ideas start with, oh, that's nonsense. Or some people then after a while say, well, there may be some tooth in it. After a while they say, there's really good truth in it. And then after a while they say, Well, it's obvious , you know, a lot of new ideas. Where do you think we are on this? We are the one stage before it's obvious. I think we are in that stage drill,' theres good data . There's good data. There's some good suggestion. I mean, part of your problem is like it's too good to be true. That's part of your problem. I feel like that's not the problem. And I'm curious what you think about my opinion when I tell my patients these things , they say it's obvious , but it's hard for them to change their behavior and it's hard for me to modify their behavior because I don't have a brain fitness program active in my hospital where I can get them involved in it , or their life situation doesn't allow them to get involved in it . So to me, it's the motivating factor. In fact, I just did a debate against individuals who support the current Maha movement. I don't know if you're familiar with it, the RFK's movement to make America healthy . And they say that they're sick and tired of the fact that America has this chronic health disease burden and it's so high and we in healthcare keep trying to medicalize it when the solution is simple. The brain fitness program basically is what they're saying. And I agree and I see so much value from getting people moving, exercising , eating well, sleeping well , but I have such a hard time getting my patients to change their behaviors. And that's why when like a new medication like these GLP ones come about , which is really a behavior modification medication more than it is anything else . That's a big change that we can make in our patients' lives, but then they become subjugated to taking the medication forever . So to me, it's less at the pati ents don't believe it's obvious. They know that they would get healthier if they exercise, if they sleep well, they quit their bad habits, smoking, excess drinking, et cetera . But it's the lack of motivation or behavior change that I struggle with the most. I don't know from a neurological perspective if you have some insight into that. Yeah, you're absolutely right. And I think that's why our brain coaches were such a critical component of our success because these were young employees who had a background in psychology or social work and I had a protocol for them that you know we personalize a program. Not everybody needs to work on the five pillars of brain health at the same time. Right. So for example, you may be fit already and you may be eating, you may be eating well and you may benefit from some meditation. Like slow breathing , just breathing slowly for five minutes, ten minutes can actually change the activity in the brain. I think the key is to reduce the five pillars of brain health to two pillars of brain health for someone and say, okay, you need to work on these things for the next four weeks , set a goal and come back. So in my book, I try to help people personalize the program so they can do it. I'm also working on an app to help people to incorporate these things. I've talked with some healthcare systems and they would like to do it, but the brain coaching is not covered . It's not a code is no code. Yeah that's that whole thing of our healthcare system is the worst part of our healthcare system. That plus the mental health aspect, I think is the worst because everyone wants to blame doctors for not being prevent ive enough in terms of improving longevity, but it's not up to us if I wish my patients can afford to do a program like that, but if their insurance won't cover it, they're likely not going to do it . So that's where the investment need s to happen from a system wide perspective, and I feel like these touch points that they had with the brain coaches , that's carry so much value . I remember when I was a resident, we had to do a quality improvement project . And the one that I chose to do was exercising with my patients who were previously sedentary to see if it would motivate them after they finish the program. Because obviously when they're coming in to see me twice a week to exercise, they're excited because they get to see their doctor more, they're doing something new under very careful guidance. The question is what would happen six months after the program was over ? And the majority of them incorporated some level of physical activity. It wasn't a huge win. Obviously I'm a resident, two other residents doing a small project . I'm curious what your outcomes were after the twelve weeks. What was the success rate moving forward? Yes, I did exactly that. So I looked at patients at three months and six months and not only talked with them, we did objective testing . So when patients finished the program , three months later they would come. It was just a checkup, say how are they doing? And they did cognitive testing, and I would talk with them. And then they did a six month . And it was always , I mean , I can't think of any patient who came back who told me I stopped doing things. Maybe the patients who didn't make the appointment are the ones who didn't care about selection. But the ones who showed up did tell me that they had kept up with the exercises and things like that. For one thing, once you get to a new level of mental fitness, it's self motivating. That alone becomes a reward. And the other thing is that they form habits. So for example, they would not eat junk food again. Once you start not touching junk food and that becomes a habit, then it's a habit. Next time you see it, like I hardly ever eat french fries or don't I never eat a donut. You can't force me to eat a donut . And once they know people see the results and that becomes a habit, then they don't have to think about it. It's not a question. Like you become into a routine that on Monday, Wednesday, Friday, I'm going to exercise. It's like brushing your teeth. There's nothing to think about . And the other thing we did is that, you know, one of the patients I was seeing who did a program and then three months later her brain had grown. A year later she actually came back to me and said Dr. Friday can get one more MRI. I'm just curious. You know, her brain had actually improved eight percent, which was the largest we ever saw. Usually it's one to three percent, which is equivalent to the brain that's about one to three years younger in twelve weeks . And she had kept everything and then she came a year later and her brain had grown one more percent on her own . We didn't do repeat MRIs on our patients because it was hard to justify from an insurance point of view. Yeah. But I think if the insurance companies realized that these programs will save them money , they would pay for it. Yeah. I mean, Medicare doesn't pay for it either. It's interesting to me that there is no code for brain rehabilitation unless somebody has a stroke or a concussion. There's no code that we could use to charge Medicare for improving people. There are some codes for lifestyle modifications and there are modest payments . But you know this as you see patients is that these interventions are simple but powerful, very powerful. And in the long run, the health systems will the insurance companies would actually save money because if you don't get the heart attack, if you don't get the stroke, you can save money . Yeah, I talked to Dr. Sanji Gupta about this, I believe, in changing our rules, actually may have been Ezekiel Emmanuel , about changing the rules for insurers, because they don't cover the same patient for an extended period of time, usually people swap in and out of coverages throughout their life . They don't have to think about prevention because they're thinking about saving money today. But if you create some sort of rule that when someone signs up in year one, they don't have to re enroll for five more years or ten more years. Now they're going to start thinking about prevention of trying to keep that person healthy. And the incentives shift in that point. So I thought that would be really cool because I think about all the negative things people say about doctors, oh, you guys just think about disease . Well, I see why they're saying that because I can write a prescription for my patient to get physical therapy if they sprain their calf muscle, but I can get them physical therapy when they're pre diabetic, which is a way bigger issue, will carry so much more benefit, and yet if I write prediabetes as the reason I want them to exercise with the therapist, denied . Make it make sense, right? I think this is what will change in ten to fifteen years. That's where I think will change because it's so obvious. It's a no brainer , this is obvious. And I think you and you know, I think thousands , if not tens of thousands of other physicians feel the same way . And I think there will be enough of an incentive for insurance companies or at least Medicare to change their attitude toward encouraging patients to participate in programs and pay for them. Yeah, that's a big value that I feel like we're missing out on as a society. Just because I feel the only patients that get it are ones who are highly motivated that seek it out. I'm curious actually for your research and your practice that you started, where did those patients come from? Were they pre selected in that they came or you just had the patients that you had how to do? Yeah, any patients who came through the door, we offered a program too. But they were you said that they were coming from different states and states they were pretty excited about it. Yeah, I think I think initially I didn't have any patients. When I started programming, you know, I had like five patients a day and you know, when I talk about these things , they were skeptical and then as the program evolved and became more structured , they saw more results, there were more patient reviews online and then more patients came. So it grew down a group. Yeah, I had patients from Boston, Florida, like I said, Arizona, Connecticut, everywhere. Any missteps when you started it that you learned from in starting that journey, whether it was creating the program , patient motivation wise, anything that you learned in those beginning stages? I think I learned to make it more structured . You know, initially we would tell people to you to exercise , but then I realized that every person has different level of fitness and we can't say the same thing to everyone. So I decided to do what's called VO two max testing. Are you familiar with it? Yes. Yeah. So I actually bought stationary bike to do fitness testing in my neurology office. And I remember the rep who brought the machine, he said, I'm never sold one of these machines to a neurologist. What are you doing here? And you know the VO two max , the measure of your fitness is perhaps a single most important determinant of whether you're going to stay healthy for a long time, whether you're going to stay sharp or get demented. That one measure , the BOT two max, the measure of your fitness is more important than anything else . So I would do a fitness testing on my patients. And I think one of the things I helped my patients that I showed them data. I would actually bring up the papers on my computer screen. I said, look at this number. This is your VO two max and people who have a higher VO two max have a larger hippocampus, they have better memory and they reduces risk of Alzheimer's disease. You're here. You want to go there . And I think that that motivated them to see that it's not just Oh, just exercise and you know, trust me, you'll be good. Right. And then the other thing we did was with for example with HRV biofeedback, we would measure the HRV at baseline and it would provide them the HRV biofeedback so they can see objectively how they improve. What does that look like? So patients can or viewers can visualize what that means HTRB let's stay together . Are you for it? Yeah. All right, just sit up at a little straight. So what we're going to do, let me tell you the science of it and then we'll do it together. So the idea is that when you're sitting down breathing , your heart rate changes just a little bit. Your heart is if it's sixty per minute , it doesn't beat one every second. It's like one point one nine, one point two, nine eight. It's a little variability in your heart rate. And that heart rate variability turns out to be a good thing. It means that there's a lot of elasticity in your sympathetic and parasympathetic nervous system. It's a good thing. So if your heart rate changes from being adaptable, flexible is an adaptable, flexible thing . And it turns out that if you increase that period of the variability that it stimulates the vagus nerve from your heart goes to your brain and that sets your mind at a common level. It reduces cortisol level and that's good for your brain. It also improves blood flow to your brain . So how do you increase your heart rate viability? It turns out that the best way to do that is just to sit there and breathe slowly. What I do is a count of six through six, which we'll do in a minute. So when you do that slow breathing , you can just see on this screen the heart rate viability improves. And there are biofeedback tools that you can find on internet. For example, that when HIV improves, there's a balloon that goes up in the air. So that provides feedback for you so you stick with it . So here's what we're going to do. So we're going to breathe in with a kind of six. We're gonna hold for a count of three, and we're gonna breathe out for a count of six, and we're gonna do that for three cycles. Don't fall asleep on me, okay? Okay . That might get so relaxed that you just lose it. Okay, here go, here we go. So I do it and you breathe out one two three four five six . Hold one , two three breathe out one , two , three four , five , six . Now we're gonna take a deep breath in one , two , three four five, six, hold one , two , three , and breathe out one , two three four , five , six , breathe in one , two , three , four , five, six , hold one , two , three , without one , two , three , four , five, six . Get the new fix and fall tariff from British gas, where prices can only slide down . If energy prices climb up, no worries, you'll be fixed for two years, but if later the market falls, so will your tariff. A win win? Sorted automatically by us . Price cap taken care of. Fix your prices today . Search British Gas Fix and Fall. TC's Eligibility and Limitation supply price review based on the offen price capture twelve months. See, British co slash verify for more. Are you one of those media strategy people clicking through slides, scrolling spreadsheets? Yes. Good. This is for you. Because on Spotify, there's an audience that's different, locked in, loyal, invested . They're called fans. Fans don't just listen to music, they feel seen by it, like it belongs to them. So when your brand shows up on Spotify, that's who you're talking to. And you're right next to artists like me, Lizo. So, are you ready to talk to fans? Spotify advertising. You're among fans. Now, it's amazing. When I do that, I actually filmed Commer myself. Yeah . And just we did it three circles . Now imagine you just do this for ten minutes. Actually just two minutes. During the day, if you're a busy day, just two minutes or five minutes. Ideally five minutes, but I'm in two minutes . And the thing is that it's one of those examples of things that are simple , but powerful . This breathing intervention reduces stroke risk, reduces heart attack ris,k, improves mood, reduces depression and longevity. There are so many studies of this breathing exercise. You're not meditating. You're not repeating a mantra, although that will be like a plus sign on top of everything else. You're just breathing, just breathing . And I talk about hacks. I mean, I don't like to talk to this kind of lingo, but it's a hack because it's simple. It doesn't cost anything. You don't have to buy any equipment. You could get there apps you can get like a Calm app, that's a free app that helps you with this breathing exercise . But the benefits are incredible. There was a study that showed heart rate heart rate viability training by feedback improves depression. So they had a control group and a depressed group . And no , they were the depressed group of both groups, one group got heart rate variability, the other group just sat there relaxed . And then the group that received hard rate variability after three months had better scores on mood . Then they said, Okay, you guys go home. Don't do any r heateart variability training, come back three months later. Three months later , where they had not done heart rate viability for three months , they still had a last day. They still had benefits . Yeah , it's incredible. Like, you know, a lot of people talk about drugs if they were a drug that would be so powerful , so many people would buy it. Yeah. I mean, it's incredible why it's so hard to get people to make a behavior change when there's so much value in I think people need to have a moment. This is what I did with my patients. See, one of the things I did with my patients actually enjoyed was to get to know them. So when I started seeing patients, I wanted to say what brings you here. So how you doing? What do you do? You have kids? They have pets. I will hear about their pets and the kids and the grandkids . I would get to know them. That's unusual for a special No, I have an hour with my patients. And the thing I is knew what I I was doing. didn't have to, you know, I've done the same thing thousands of times. So it's not like it's a rush. And I allowed one hour. I mean , I could have done it twenty minutes. But I thought if I wanted to see results, the patient needs to trust me and the patient needs to have an aha moment . So I would establish and I learned a lot through those simple conversations. I would learn about their what kind of date they usually have , what their environment's like. I learned a lot from those simple conversations. In fact, perhaps more so than a lot of formal things we do in medicine . And then I would hear them out like what do they think is causing their memory problems? Because everybody comes in thinking that Alzheimer's obviously . And then I would hear them out, I would hear as what they think is going on. And then I would talk with them. I would again, I have so many studies on my computer, I would just say, listen, here's what stress anxiety does to your brain. When you stress out, you have higher cortisol levels. The higher the cortisol levels, the more you shrinks . And it's not like you know, it's anything else. It's very simple. It's very simple. Cortisol levels, chronic high stress. I mean, it's okay to be stressed if a car accident, there's a leak in the basement, there are financial problems in that stress. Yes. But if you stress every day all the time, you have higher cortisol levels, cortisol is toxic to the hippocampus . And so you really want to epic shrinks, and the more hip strinks, the more likely you get Alzheimer's. What we call Alzheimer's is basically shrinkage of hypocampus and the cortex . And so when I saw that, there was a collection of silence and there was oh my god, really? And that's what I think the magic happened. That aha moment . And the thing is that the aha moment is different for different people . And some people need a little bit of conversation. Some people need a lot of conversation. And a lot of there's misconception. You have to sort of listen here and iron out the misconceptions with data. I think once people see the data and they believe it in their heart of hearts , that's when the magic happened. A lot of times patients who left to my office to make appointments, they would say the nicest thing about me to my staff . Just the first visit . The first visit would be like a life changing appointment for a lot of them. And I realized that if I wanted to program to be successful, I couldn't cut that shorter. Because I had so many patients. There were so many patients in my waiting list. It would have been easier if I just cut in half an hour and just move on . But I felt like if I spent enough time with patients and they had that aha moment, they were going to stick with it . They were going to stick with the program. Investing that alliance was valuable. Yes. And they had to learn what we were doing, the shrinking of the brain, the growing of the brain. We had a lot of pamphlets about, you know, things that shrink your brain, things that grow your brain. And of course, my brain coaches were enforce it as well. Yeah . Yeah , that's really interesting because I want to get better at that in terms of not necessarily the alliance. I think we do a pretty good job of that when we have the time in family medicine, but more so getting people excited about it , because I spend a lot of time studying the psychology of influence, especially given the work that I do on social media. It's being an influencer, right ? So I've seen how the psychology of influence can actually work against patients where when you're selling them something , a miracle product , a miracle program that is very expensive that they can't afford, a lot of times they view that as more effective simply because it costs more. Like if you market a product that's more expensive, they assume it's better. Exactly. Whereas this is simple, it's not expensive. People think they need a gym membership where I can design a body weight program for them of doing squats, push ups and maybe pull ups at most . And yet the buy in is very, very hard to get these days with people being busier , being distracted by activities that are not necessarily healthy, that are very addictive . Foods that are ultra processed that are tasty and easy, that oftentimes aren't the most nutritious . Anxiety's keeping up people at night . When they are depressed, they're feeling low motivation levels as is to even shower, let alone exercise . So there's a lot of things working against us in the primary care space. I'm optimistic though. I think it's going to change. I think for one thing, I think if we go to a gym these days, you see a lot more older adults . If you go to a gym, it's not uncommon to see people their seventies or eighties. And I think that people have caught on that exercise is really important for longevity . So we see more older people in gyms than we used to. Now I was I did triathlon a couple years ago and I was so proud of myself. I had done the one mile swim ming and I had done twenty six miles of biking and I was doing my eight miles of running. And it was toward the end and I was so proud of myself to finish. And I was going, I saw this older gentleman who was clearly in his eighties was asking me, I said, wait a minute, I'm not gonna let that happen . But I think it is the case that a lot of people who are getting older to realize that they can get better if they stick with it. You know, there was a gentleman who's one hundred and five who did a marathon and in Toronto Mr. Sink and they interviewed him saying how have I been doing marathons? As though in his eighties, his wife died and he was sad so he went for runs. And he enjoyed the running and he just ran more and more and more. And now he's a marathon runner and he does the marathon every year . And I think more and more people are catching on. And you know, in the Western European countries , more and more people are doing all the things we talk about. I was in Netherland a couple years ago and you see everybody on bikes and don't see any junk food places around the city. People are very conscious of their environment . And studies have shown that the incidence of Alzheimer's disease is actually decreasing in Western Europe countries like Netherland and Sweden , Denmark and places like that , because people are realizing that these things do make a difference in the long term. And I think that's what's going to happen in the United States. And part of the United States, this is happening . You know, about Framingham study, sure . So one of my colleagues did a study of looking at people who have been a part of the Framingham study. And you know, as a part of Framing Study, so many people have had brain MRIs blood pressure testing and cognitive testing and everything else. And so he looked at the brains of these individuals born nineteen thirties, forties, fifties, sixties and sixties in that group . And then he looked at the size of the brain of people born in these different decades . And he saw that with every generation, their brain is slightly larger . In fact, between the first decade and fourth decade, you know, nineteen thirties, nineteen sixties, fifties, there was a six percent larger campa volume in the newer generation. So the newer generation elderly , at least in Massachusetts where the Framingham study was done , people are exercising more, they have better education . They're doing something right. The incident of Alzheimer's disease is going down even though people are living longer . And I think that's what's going to happen in the United States. I think ten years from now, twenty years from now, people are going to look back and say , how did we miss it? It was so obvious. How did we miss it . I see a lot of this happening discordinately, so with different populations differently. So I work at a community health center, so the people I take care of a lot of times either aren't privy or don't participate in this type of fitness and health curiosity. So I do see what you're talking about, the one hundred five year olds running marathons . I don't know if that's representative of the larger portion of the population because if you see the numbers of who's pre diabetic, who's morbidly obese , now from an overweight obese category BMI wise, we're over fifty percent . So I'm hoping the success is in the upper part of the United States, meaning upper ranges starts translating to across the board . I'm also curious for those who are health, curious, health conscious, they're already eating a decent diet. They exercise regularly, they think about their mental health, they try and sleep well. For those people , what is something they can do to improve their chances of to decrease their chances of developing Alzheimer's. Yes . In my book, I have a list of forty questions that I check for all the reversible causes of cognitive decline and brain aging. For example, hearing loss, vision loss , working too much , concussions . And so there's a list of forty things that people can check to find out, well, if I'm doing anything like what are the issues, high blood pressure, diabetes, obesity, those are the obvious ones. So I think that's one way to look at all the possible things that can increase risk of dementia . And that way people can figure out what the problem is. So the I mean, you may probably have heard of this state. It was published in Lancet by an international group of scientists that showed that forty five percent of dementia cases in the world can be prevented by addressing fourteen things . Now, imagine forty five percent of dementia cases in the world can be prevent ed by fourteen things. And those fourteen things are the things we just talked about, the hearing loss, the air pollution , poor diet. And they didn't even include sleep. I think there were not enough randomiz ed enough data, but that's an obvious one. If you have poor sleep or you have sleep apnea, that's just another factor. So I think every person is different and and many medical conditions and environmental conditions can cause it. And if you go through them one by one, you can pick five that are contributing. And if we can limit them to like three or five, then it can address them . But one thing you said earlier, which I like to elaborate and actually totally agree with you is the cost of food is so much cheaper to buy a sandwich with french fries and a sugary soda than to get one pound of grapes or one pound of blueberries. And that's unfortunate. That's really unfortunate. Yeah. Yeah, fresh produce is tough to get also the ease of eating a sandwich versus using silverware cutery. So I see people make that choice all day long during a busy job . They run and get a bagel or something. Yeah , not very nutritious . What are, you know, with all your years of research, what are the most toxic habits that people have for their brains? Stress . Because stress is interesting because stress can sometimes be valuable, especially in acute setting. But are you talking about chronic stress? I'm talking about excessive daily stress when it's not necessary. There's a level of stress that's good for you. It's called US EU SDR U stress. So for example, if you're stressing out about a deadline, if you're stressing about finishing a job right , or if you're stressing about finishing a project that you have and there's definitely going on . That's good stress. It sort of primes you to have more attention and to do more and that's healthy. I think when you exercise clearly you put your body through stress and that's called a good stress. The bad stress is where everything is an emergency . Like you are late for work every day , dealing with the sposs or coworkers is always stressful, dealing with children is always anger related , angry interactions with children . You're frustrated with the economy, you're frustrated with the government, you're frustrated with everything. You're just upset all the time . And I think that is really bad for you because your stress response is meant to kick in when there is an emergency . You don't want to have that all the time . When you're constantly stressed, your cortisol and adrenaline level is higher, your heart rate is being faster, your heart rate variability is lower. You're more prone to get strokes, heart attacks, dementia is horrible, horrible. And the thing is it boils down to your mindset and the solution is so simple . The solution is a change in mindset. Now a lot of people say, What are you talking about? You know, the traffic is horrible. I spend an hour in traffic . Well , if there's traffic one hour every day , that's called life . You choose to go somewhere else, you choose to live earlier, instead of complaining about the same thing every day, change it . The other big thing is expectations because we expect something , we get disappointed and that gap determines how frustrated we are. So if your expectation is that coworkers do their job right and that you cooperate with them and everybody else is doing right and everything goes smoothly, then you're happy. But reality is people have different lives. We have different priorities. Some people have married problems, some people have problems with children, some people have addiction, some people have different childhood education, childhood , we have, you know, lifestyle. And so we can't expect everybody to just be perfect, assuming you're perf ect. And let's not talk about the fact that you may not be perfect after all . So I think if you reduce your expectation , and this is not Oh, come on, you can't do that. Yes, you can . You're not saying reduce your expectations, like live a lower quality of life. No . Work on yourself instead of forcing other people to do what you want them to do . That's the difference. And that's doable. You know , people, for example, worry about they say the same thing over and over again. Only if my wife or my husband did this , as if the whole life would be totally different if the spouse did correctly. And you know, face it. You're not perfect. Why should they be perfect ? And why not work on yourself? Why not let people do what they want to do? You do what's right and if they do the right thing, great. And if they don't , well , it's too bad for them. You know, we were talking about behavior modifications . I mean, you can also call it manipulation . If your spouse likes flowers or if your spouse likes compliments , maybe you can try to compliment them or buy gift and see what happens. Don't complain . To me, complaining means you failed . When you complain about things , I'm sorry to say it's on you. Like somebody's choin gets on your nerve . It's not on them, it's on you . You are interpreting their chewing a person loudly as inappropriate and it's making you angry. But it's your choice to get angry or not angry . What if you just get up and go somewhere else? What if you smile and talk to them so they smile chewing? I mean, think of something creative to do. Don't complain. Have you noticed the shift in our society with this focus ? For the negative? I think unfortunately , especially in this part of the world and I travel a lot . I mean, I've been to forty countries and I give lectures everywhere and so I get to see a lot of different cultures. I think when I come to this part of the world , I feel like a lot of people have a sense of entitlement , like tend to be rude with people in customer service. Like if you go to the airport and things are not right. And I think the people who lose are the people who get angry , not the people who are the subject of anger, although they're frustrated too. Yeah. Well, it becomes a never ending cycle because what do they say? Hurt people, hurt people. So yeah, the more you get I think the mindset is the single most important thing for having a happy life. . Yeah, thinking about your response to all this outside stimuli as opposed to the stimuli , right? Because you're always going to have challenges or things that are set to you. Here's ha moment that I like a lot of your listeners to think about . There's no such thing as reality . You see the things around you and your brain interprets them them and then that's the reality you formed based on what you saw . And if you put five people next to each other , each person will create a different reality like you go to the airport , it's crowded and you know there's a big lineup. You can interpret that many different ways. You can interpret what it chaos. What are not organized? You can think like, it's a good thing. The economy must be good. So many people are out there. It's a good thing, you know? It's like you can interpret everything so differently . And that should give you some degree of humility that don't get too excited about this. This is not reality. The reality is what you create in your brain . It's not what's actually happening. Our eyes convert what we see as facts what happens in the brain. And of course, you know, just watch the news. I mean, unfortunately what happens in the news and how people interpret it so differently and you can't blame them , you know, if they have brought up with certain way of looking at things, let me give you an example . I once had gone skiing South Lake City and I was alone. I decided to go skiing alone for just fun of it. And then we came back and there was a little jacuzzi and the condominium was staying and there were a bunch of people. And it was this gentleman who was just talking with other people and he was saying, you know, God helps me every hour . Every hour God helps me . And God is helping me to do things and make me happy every hour. Look at you . God put you here so I can have this conversation and enjoy myself. God allowed me to come to be able to come to skiing. God allowed me to have enough money to come to this nice condominium . And every hour God is helping me . He may be right , but I realized that in his view , every hour he's looking for the evidence that God is helping him . And there's no doubt in his mind that it's what's happening . In fairness, he may be right . I can't argue that it's not right , but you could also have the same view about so many other things about the generalizations that you make. So if you change that point of view and decide that, you know, I live in a beautiful world . Life is not fair . Who said life is fair? I'm going to take owners of my problems . I'm not going to affect other people , and I'm not trying to control other people. I'm going to try to control my life. And I'm going to try to improve my fitness and instead of arguing about what people haven't done their job, I'm just going to do more of my job . It may be a little extreme because people argue, well, that's not fair , but which way are you happy ? You're happier if you work on yourself , expect the least and be happy with anything more than the least. And those things make a difference in your brain function. See, your everyday habits can either shrink your brain or grow your brain . If you smoke , if you eat sugary food, if you stress too much, if you spend most of your time at night scrolling and not sleeping enough, every one of those habits shrink your brain by just a millimeter a little bit . If you exercise, if you smile more often , if you challenge your brain, do those fibulars of brain health, every one of those can change your brain by millimeter every day. And we know for a fact that people who do these things over the years have either healthy, strong brain or sort of a normal aging brain. And last latest in neuroscience field. Based on the concept of neuroplasticity, we know that aging does not have to be necessarily continuous decline . Aging does not mean that your brain will shrink automatically . What will shrink your brain is if you have poor habits, sedentary lifestyle, you don't sleep enough, you drink a lot of beer, you watch TV all the time, you don't do anything exciting to your brain. If that's what aging is, your brain will shrink . But if you do all the opposites, every day your brain is much larger . And I'm confident that people can become what I call a brain superager. A brain superager is someone who's healthy, sharp and well under their eighties . So my goal is to be ninety years old , sharp and independent. I'm sixty three now. And based on all the things I know , I think there's like a ninety five percent chance I'll get there. What's the highest lifespan for the human brain? I think the lifespan is something in nineties . Why nineties? What happens after nineties? That's a very good question. I think this is called program cell death . All species have a finite lifespan , cockroaches, fish, birds. Well, Brian Johnson would disagree with you. I don't know. Well, who is I know about Brian Johnson and I'm curious I'm curious to see what happens to him . Are you know what's going to happen if yeah yeah so I think that there's the program sell bath. Of course, there's a telomeres shrinking that happens with aging and at some point the telomeres gets too short to maintain and everything falls apart. And the other thing that happens is the mitochondria. Mitochondria, as you know, important for generating ATP energy in the cells. And as the number of mitochondria goes down , then things start to fall apart. So I think it's a natural process for people to die. And I think it's fine. I'm ready to die when time comes. I don't fear it because my goal is to live a happy life and then die and get over with. I do not plan to have this gradual decline over the years . And if there are people who think that as they grow older , they just everything goes downhill and it's a downhill process , then they need to rethink that mistaken idea because I think midlife, especially should be a new child. That's what Shakespeare said Mid,life is a new childhood. This is when , you know, you are where you are in life, you have a job, you have family, you have what you want to do . And you can actually build stronger brain every year or at least avoid that decline that happens if you slow down . See people slow down and things fall apart. I was with some friends not too long ago and he's in his sixties seven sixties. What do you expect ? I said, What are you talking about? I'm my sixties . I mean, I bike for a hundred miles, I swim, I do things, I'm always active. What is it I want to do that I can't do. But if you keep telling yourself, I know my joints are falling apart. I'm getting old. No, if your joints are hurting , if it's arthritis, treat it. If it's something else, treat it. And also if you exercise , you have more muscles that protect your joints and you have less joint problem. If you have whatever it is, there's some decline let's say five percent and that's fine. You may be slower in thinking by five percent, but what's the rush ? So you're five percent slower. I mean, you're not doing quantum physics and on a rush to be able to like that five seconds make a difference people need to have a positive outlook about aging. That's my message. Don't look at aging as a downhill course . Look at aging as something you look forward to that you're excited to. Like, I look forward to being seventy and show off how I can do everything , you know? It sounds like you're very focused on living a very balanced homeostatic lifestyle to live to the top of your potential. There exist this world that I have spoken negatively about that is very focused on hyperopimization . And a lot of that comes from these hormone clinics that are promising infusions of hormones and supplements . What's your take on that longevity world where they are almost outpacing the speed of research themselves? Yes, I don't agree with them. I know for example there are many peptides that are recommended for longevity and I know that 's recommended is you're using that term very loosely. Yeah, like you know, if you watch social media, I guess it's not recommended by physicians. There are people who are on a podcast who talks about these things . And then I know that for some cryptine is something that people recommend and I'm not a fan of these supplements or these interventions that are beyond healthy living. You know, when I go to Europe , for example, I walk in a small town, village in Greece. Nobody's doing anything exotic. You know, they're older, they're sitting around, they're playing cards or they're doing something together, laughing, they're going hiking . And you know, you see a lot of older people in Tibet and a lot of places, they're not doing any exotic supplements. They're living life. And I think you mean they're not doing NAD infusions on the mountains up. They're not doing a infusion on the mountain. No. And I think is that our body generates BDNF , brain drive neurotrophic factor, which is a neuroprotective compound that keeps your brain healthy . So if you can generate your own BDNF with exercise, why would you want to go get an infusion for an hour and then an hour a week later a month later . But then you know a month later or a certain period of time you have to keep getting these things. Why not generate your own? And why do you need that extra ? Why do you need that extra ? Yeah. I mean, I think I think we go back to the mindset . You need to be happy. You need to find a happy place for yourself and a happy place is not with Botox and all this peptides and exotic infusions is being happy with yourself to enjoy life. Is there anyone who's doing anything revolutionary in the neuroscience space that you're excited about ? Or is it just back to the basic principles that you've talked about? I think what's revolutionary are these multi moderal lifestyle interventions which have shown incredible results in reducing the early stages of Alzheimer's disease . See, we always talk about preventing Alzheimer's disease. I have been talking about preventing Alzheimer's disease for thirty years. I always believe that if you do all those things we talk about, you reduce your risk to get to the point of confusion to the point where you're not sure what year it is or things like that. And what's exciting to me is that these multi modal lifestyle interventions, which are randomized control trials. It's hard to do randomized control trials , show these interventions that are so simple are able to reduce the amyloid level in the brain. See, there are three things that we talk about other than amyloid. There's inflammation, there's reduced blood flow, and there's reduced cleansing of the brain, reduced cleaning of the brain. Those three processes can shrink the brain and then you have plaques and tangles, which are the markers of Alzheimer's disease . But mostly these days are biomarkers are available. We don't have a biomarker for a simple biomarker for blood flow. We don't have a simple biomarker for inflammation. We don't have a simple biomarker for this brain cleaning that happens at night. But the markets that we have, this amyloid plaques, amyloid levels, are something we can measure. And so when I say that you have patients with a diagnosed of early stage Alzheimer's disease who do the programs and then the amnulot level in the brain goes down, a lot more so than other things . That to me is revolutionary. Yeah . We are for the first time reversing what we call Azhamism. Illumination presents minions and monsters . You want to make a monster movie? Competitor her. And what are you going to use for your monster? On july first , I know the perfect monster for your movie. Just try not to look too delicious. Quick question. I want to eat one of these funny looking yellow guys, is that okay? Minions and monsters in cinemas Wednesday July one. Book tickets now. What are you what's your take? And I'll tell you mine on genetic tests that try and predict whether or not someone has proclivity or a higher chance of developing Alzheimer's . Recently, a famous movie star, Chris Hemsworth went on a TV show and got tested, found out he's high risk, and now he's very worried about it, and he's making all these lifestyle changes. To me, I'm not a big fan of recommending these tests generally, perhaps case by case it's going to be different because I feel it implants this fear that is not very changeable with the exact opposite, it is changeable through lifestyle changes. But to me, do those lifestyle changes without knowing the risk. I'm curious what your thoughts on the matter are. A hundred percent agree with you. So I don't recommend tests. The test that people talk about is called Apolliprotein E four . This gene comes in three variations, four, two, three, and four. People have AP OE version version seem to be less likely to develop Alzheimer's disease. People have AP variation are more likely to get Alzheimer's disease. And the difference is a matter of six years or eight years or ten years. So if you have four , you may develop it at age seventy two. If you have two two , you may develop it at age eight five . That's what the data shows. What people don't talk about is that there are multiple other genes that we haven't discovered yet. So just not everybody has API four or even AP four develop Alzheimer's disease during their lifetime. Not everybody does . And people have API four who exercise regularly have the same level of amyloid as people at AP four two. In other words, exercise negates the effects of the gene . So two things. Number one , there are at least ten genes involved in longevity and brain functions at least at the minimum. A point four is just one of them . We haven't discovered so many other ones. So it's incomplete information . Let me give a little story A patient came to see me from Florida . Her name is Jean Carper. She made a documentary and talked about this thing so I can tell her name. So Jean Carper was told that she has APO four gene and that she is going to develop Alzheimer's disease. Now she used to be a CNN reporter. So she did an investigative reporting and to her credit, she talked with a lot of prom inent experts in the country about this . And then she had read some of my papers. So she came from Kivest. She flew all the way to Baltimore to see me. When I talked with her, she gave me the story ,, ye Iah was told I have four, I'm going to get Alzheimer's disease. What can I do? So I talked to her and I gave her a list of fifteen things. She remembered twelve of the fifteen things, which is incredible. Back then she was eighty two . And then I did a fitness testing on her because I had fitness testing in my office. She did really well. And I said, Jane, you don't have Alzheimer's disease, and you're very unlikely to develop it. Giving how well your brain is working is extremely unlikely that in ten years abroad abrupt fall . And so she actually videotaped me and she made a documentary called Monster in the Mind Talking about Alzheimer's Disease and actually a significant portion of it toward end is talking with me. But I've stayed with her. She invited me to go visit her in QS. I went. And now she's ninety three years old. She's still doing she lives by herself. She actually had an art exhib ition recently and I talked to her. She's as lively as ever . So the point is this , yes, she did have a PF four, but she probably has a lot of other good genes and she has the best lifestyle. So I don't recommend AP four testing because just like you said, I'm gonna do everything myself irrespective of it. Irrespective and I don't want the nagging thing in the back of my mind. Now there are people who say no, I want to know . If you're prepared to deal with this idea that I have an Alzheimer's gene in my brain and you're comfortable with that, then fine. But I feel much better not to do that test because I know my lifestyle dimensions are the best things I'm going to do either way . So why add that extra anxiety? And it's a cost in a day and age where people's financial budgets for healthcare is lower I think should not be allowed to be tested. You think it shouldn't even be allowed? No, because it doesn't give a full story . I find it very well, they probably write a disclaimer that it's write a disclaimer. Of course these days can't get these things for you can buy them on internet. And I think that's irresponsible to provide these tests which can have profound implications for a naive person who just buys a test and And they're trying to sell them and get the gets the, you know, the little comment that this is more commonly seen Alzheimer's disease. It is true. It's commonly seen in Alzheimer's disease, but it's a whole lot of information that is not provided. And they already made the five hundred dollars, whatever it is they made . And I think that's irresponsible and it should not be available to general. It should that best be available only talking to a physician who can provide counseling for you. And data privacy, who knows who owns that data now, especially with companies being bought out? I know twenty three and me. Yeah, yeah. So we did actually a video on twenty three and me covering all this before that happened. So it was interesting to see it like we told the future in that regard. I've even seen some of these genetic tests even outside of the health brain health space make statements like you're very low risk for developing type two diabetes . So what now go eat skittles? Like what is the to me, again, because I function in primary care, there's so many tests I can order. If my test that I'm ordering is not going to provide information that's going to change management. There's no need to order the test. Exactly. That's exactly your point. But that's lost. If the test is lost, it's not going to change the management, you shouldn't get it. Yeah. That doesn't exist in okay, so I'm wrong. That exists in healthcare, but that notion in wealthy individuals, they don't believe in that . I don't know why. They want too much control. I think people want to be proactive. I mean, there are people who get a whole body MRIs curious your thoughts on that as well? No, because what happens is what happens is that you're going to get a little this here, a little that there and then that requires a lot more testing and biopsies and everything else . I think the risks of complications with the results that come in the incidental findings is more than than whatever potential whatever potential benefit. I mean, it's extremely unlikely that you're going to catch a pancreatic cancer . I mean, you do MRIs every year. You're going to do every month. I mean, yeah, at some point you have to have very un acomfortable conversation with the CEO of Pernuvo sitting across for me in that same way. And I don't I understand where the fear is coming from that people have and they do a very good job through marketing of instilling that fear and the hope of being able to catch something , but it's not honest about what is actually found most of the time, what's missed most of the time . And it provides this conversation where it seems like people believe that I don't want to find things in them when in reality they're getting worse care even though they're spending more money on it, which is weird to say. I think it's fair enough to do things that are recommended by national organizations. Like you want to get a pep smear, you get a colonoscopy, you want to, you know, do a baseline cardiac evaluation . I think those are the common sense things that been accepted by the medical community as standard protocols. I think that's fair , but to do random testing. And there are some companies that check your gut biome, biome, and then they tell you eat more f iber. Yeah. I can tell you that for free. I got you don't need to do it. So yeah, it's ridiculous. It's just it's a hyper monetized world of healthcare. I know because the average person that's spending the money on it has incomplete knowledge and they have a fear of being sick and they have the hope that someone with money can give them the answer and it just can't and they don't want to believe that. So best investment people can make in their future is to reevaluate their mindset . I think people who have a healthy, positive mindset have such a better life experi ence . If you feel life is good, you wake up in the morning, think today is going to be a great day . And then you look for good opportunities and you're kind to people and you enjoy your day and then you go exercise, you feel, oh my God, I feel wonderful that I exercise . You go home, eat a healthy meal and you know you, do in the evening, the things you like, whether you take a dance class or you do something fun with the family or you learn something new, whatever it is. And you go to sleep thinking, you know, life is great. I had a wonderful day today and I'm so lucky to have the life I have , that is priceless. No money can buy that . You can't pay for that . And it's easy. It's not difficult. I think what it requires is to pause and say , What if I tried that for a day? Just a day . And if just a day, just one day and see how much of a difference it will make on your experience of life . An experience of life is not just how you feel, it changes your physiology. Your sympathetic and parasympathetic nervous system are constantly being alternating . People who have a lot of anxiety about, oh, what did the test show? What's happened? I'm late, I'm not good. Why is everything going wrong in my life ? They actually increase cortisol. They have more sympathetic drop, they have small heart rate viability . And these are the people who are more prone to strokes and heart attacks . And simple , inexpensive mindset can really give you a better quality of life and help you live a longer life. And you know, one of the things I find interesting is that we talk about longevity a lot, but we don't talk about quality of life . You know, I think it was Kennedy who said we just don't want to add years to our life. We want to add life to our years . I think we really want to focus on the quality of the years. You don't want to live to age ninety and be stressed out all the time. Yeah . And I think to add quality to your years , you need to work on your mindset. If you have that mindset, great, enjoy it. If you don't , realize it doesn't take therapy , it doesn't take expensive things. It takes five minutes of you writing down what are things that are important to you? What do you find passionate? What do you find meaningful? What are you passionate about ? Write those things down and tell yourself like I want to be X, Y and Z. These are the things I like about my life. These are the things I don't like about my life. Try to remove, eliminate, reduce those things you don't like, and spend more time on things you do like. And get tell yourself, I'm going to have a good life . It's not that complicated. I mean, that is like we were talking about hacks. That's the biggest hack. Yeah , that you change your mindset and all of a sudden you see the world to a different lens , I actually envied that guy. Remember the guy I told you in the jacuzzi in Salt Lake City ? I mean, he's living life. He's living life. I mean, with a lot of gratitude, gratitude to the antidote. And you know, I don't know if it's right or not, but he definitely I mean, he was actually getting annoying to me because he said God put you here so that I can talk with you and enjoy thised conversation. And I realized, well, I can't get annoyed because if I get annoyed, that's on me. So I'm not gonna go there . And I actually envied him for a moment. I said , He's just living life. I mean, that's extreme. I think it's possible to enjoy every day of life and knowing that if you have that kind of mindset, you're more likely to go through life with ease . So you don't want to be confrontational with ex ercise, with diet choices . You want to be moving through life with ease . So you don't want to fight the fact that you're eating a food that's healthy but you don't like. Or choose a food that is tasty and healthy. And there's a lot of options. Speaking of healthy food, what's the healthiest food or diet that you can eat for your brain? There's one big rule for me , which is the number one thing I recommend to my patients is don't eat junk food, period . None, zero, absolutely nothing. Because as you mentioned earlier, this is high ly processed food is really not food. It's a bunch of chemicals with some spices on top. And it's the spices that people like and they don't know what they're eating. It's not really food. And if you eat junk food and that's all you do, you're more than seventy percent in what's good for the brain . If you don't eat sugary food and things in high intrans fat, highly processed food, which we're surrounded with , you're good to go. You eat whatever else you want . Now, if you want to go one step further, say, okay, fine. I've cut back on jackfood. What's good for you? There are a few things that I know for good for you. Again, the principles are increased blood flow, red uce inflammation, improve the cleaning the habits in the brain, the cleansing habits in the brain . So one of my few favorite foods are blueberries. Blueberries are a really dense source of nutrients, antioxidants and the increased loads of BDNF in the brain. So that's good. The other thing I like is pomegranate and the pomegranates are known to increase blood flow in the brain. And dark chocolate actually is surprisingly good. I mean, usually people think if something is good for you, it's not tasty, but dark chocolate cocoa is good for you. You want a dark chocolate that increases blood flow to the brain and that's been shown to increase blood flow in the brain. So these are some of the food that I like, but in general fruits and vegetables , legumes , some meat , not so much red meat, but chicken fish. I eat steak once a week maybe on average . I try eating chicken or fish more often . So the point and the secret is every food has a collection of vitamins and minerals . Whatever you eat that's natural, has some zinc and some other chemicals, nutrients and vitamins are good for you. There's no one particular diet. The Mediterranean diet has the strongest data for reducing risk of stroke, reducing risk of heart attacks, reducing risk of Alzheimer's, reduced by a lot. One study showed that if you monitor people for twenty or thirty years until they die and then you look at their brain after they passed away, you measure the amounts of plaques and tangles, not all the other things we talked, just of plaques and tangles. And compare the brain s of these people who usually ate a Mediterranean diet and these people who didn't eat the Mediterranean diet . The people with a Mediterranean diet have a brain that's up to eighteen years younger compared to people who did not eat a Mediterranean diet. So we know for a fact that a Mediterranean diet is particularly good for you. Now, the Mediterranean diet is fruits, vegetables, whole foods, you know, whole foods, you know, exhibition olive oil, some fish . And it to me it happens to be the one that's most studied in these scenarios. I think you're right. It's almost studied. It doesn't mean it's the best diet . So if you are from China and you usually have lots of fruits and vegetables anyway, then that's good. It doesn't have the Mediterranean. All Mediterranean means is that it's a healthy food. Yeah. It's whole food that has really good marketing behind it. Yeah ., Yeah ye.ah So and I think part of it is a Mediterranean lifestyle too . Right. Like you Mingo, like imagine Italian Lygi It's an Italian family all sitting around eating and they don't eat large port ions. And that's the other thing. You want to have small portions. You don't have to eat. Like I eat breakfast , you know, some oatmeal, some blueberries, something. And then I usually skip lunch. I usually have just a small bowl yogurt for lunch and then I have a meal around five, six o'clock for dinner and I find that's enough. I don't need to eat a lot . So quantity matters and quality matters. And the basic principle is if you don't eat junk food, you're good. Where do you see the future? Where are we going? Where are we going to be in ten years ? I'm optimistic . I'm optimistic. I'm waiting for that turning of the trends. See, people follow a trend . Like it's a trend to do something and everybody does it As I mentioned, we're in that stage like forty years ago, Alzheimer's a disease . You only find the amyloid cure, you're done . Then there was some question, oh maybe there's something we could do. Maybe it's not all that . And you know, now it's like, oh my God, there's so much data. Not everybody knows about this, but there is a lot of data. The amount of data that is available for all the things I talked about beyond compelling . It's like, how could we not why isn't everybody doing this? A lot of my brain coaches will come to me doctor D. Why is this not the prime news in CNN and everywhere else? Why is this not everywhere? And sometimes I feel like going on rooftops and say people this is your roof. You can't reverse Alzheimer's disease. You don't know aging doesn't have to be declined. Your brain has malleability, your brain can change. Your future is bright, you don't have to necessarily get frail as you get older. Come on guys . And I think ten, twenty years from now , people are going to look back and say , what were they thinking ? Like why we're not doing these things ? And there will be special programs for brain fitness programs everywhere. Like you go, every city you go , and every other block there's a gym. There's so many gyms everywhere . And this was not the case in nineteen fifties, nineteen sixties, and nineteen seventies. It was not the case. Well, the question are people going now . Because I know a lot of people are signed up for gyms. I don't know if they're using them. You're right. Good point. But I think more people at least are going Yeah, thinking about it and are opening their minds to it. You know what I forgot to ask you our IQ tests BS ? Yes . Why? They are BS because our brain can have different cognitive capacities. There's a part of our brain called the cortex, which is the outer layer of the brain . And it is the hippocampus which is the size of your thumb. You have one on the right, one on the left . The cortex and hippocampus together mediate your higher cognitive abilities , how to read, write, type, drive, do your taxes, do a podcast , plan your days. These are called higher brain functions . And they all emanate from networks of connections between different parts of the cortex and the campus. Got it? Okay . So historically , people have been talking about IQ tests, which measure only a handful of your cognitive abilities logic, processing speed , mathematics , literature or comprehension, special , special reasoning, very few . They do not test the whole spectrum of cognitive functions that a person can have. For example, to do a podcast, it takes a lot of intelligent. Like why isn't everyone's podcast as successful as yours? You've done something right . If you're a good dancer, if you're doing this performances on ice , you know , that people do, if you're a good chef, if you're a good comedian , you are intelligent in those areas . Who's there to say that being good with math and logic is better than being good with doing all these other cognitive abilities . And I think this is not a benign distinction I've seen I won't say thousands, but really thousands of patients who come to see me and they always assume that other people are sm arter because they think that other people have better memory , other people can think better, other people have better scores and IQ tests, and you don't appreciate that they themselves are so intelligent and there are other people who envy them because your cognitive capacity comes from networks of connections between different parts of your cortex and your hippocampus. So for example, you have a network for language. And some people are using that network and they can improve on it. That's the beauty of the brain. You can acquire any form of intelligence . So we have, you know, you speak English, let's say, but that's one little part of the network, but you can modify the network and improve on it . So now you can have, you know, you can speak two languages . And so another network would be for memory, another network is for attention to sustain your attention. Another network is for executive function for you to sequence things and get things done. And of course it's a network for doing nothing like anidol where you just sit there and you don't do nothing. That's a network itself. So it's a background network. So there are two types of intelligence . Innate intelligence and acquired intelligence. It is true that everybody is born with some kind of cognitive function that comes easy to them. Like some people are naturally good at playing the music, playing their piano for example. They don't really need some instructions , they somehow just play it . Somehow some people learn languages easily. Like I know five, six languages, and I find it comes easy to me. I don't have to work as hard . And other people are very good with numbers. They don't try hard. They're just generally good with numbers. And that's the thing . They have some innate talents they're born with. It's just back like the factory that comes that generates that brain. It comes with pre assembled networks that are in some areas better . But here's the thing, our brain has the capacity to acquire any other form of intelligence. Let's say I want to become a good cook. Let's say I want to become a good accountant. I have the brain wiring to get good at it. If I spend ten thousand hours on anything, I'll get good at it. If I can spend ten thousand hours on accounting and doing taxes , I'll be one of the best tax accountants ever. And so this is what people miss. They assume that IQ tests determine intelligence . They probably don't do well on those IQ test s, therefore they're not intelligent, therefore they're not smart, therefore they can't be successful in life . And that's unfortunate tragedy that these companies that market and sell the IQ test and the general public assumes that if you do well on those tests you're good at it. Like yeah, take a quarterback. You know, watch football these days and these quarterbacks are able to send the ball fifty yards away just within inches of two to the other. And the thing is that they send the ball where the wide receiver will be, not where the wide receiver is right and they see that three other people, three other players from other team are going to them, they send it within inches of where the ball's supposed to be. That is intelligence, but we never think of that as intelligence. So bottom line is this intelligence emanates from the functions of cortex in a decampus. Cortex is a mosaic of areas that are covered the whole brain like a blanket. And the campus is in the middle and either side . And there are millions of connections, the networks, like you see the networks you see on like airline connections, the networks . So there's so many networks. And each networ k does something language, attention, executive function, math, other things . And these people are born with certain of these networks that are already pretty good to begin with , but we can form new ones. I mean form new networks. We grow our brain. There are at least fifty studies. I teach a course called Advances in Neuroplasticity and its Applications in Neurology Jo athns Hopkins . And I spent twenty six hours about all the things that shrink and grow the brain. And one of them is how different forms of cognitive stimulation, different types of brain training, can grow the size of cortex and a campus and make these networks more sophisticated. So is a bigger brain a better brain? A bigger brain is a better brain. Especially when it comes to cortex and the campus. So if you do things that increase the size of the cortex every campus, the five pillars of brain health exercise , sleep , nutrition, mindset, brain training. These five pillars of brain health have been shown individually to increase the size of the cortex and hippocampus by a lot. So every day if you do a little bit of this five things , you have a trajectory of having healthy brain. And if you do the five negative ones, sedentary lifestyle, a junk diet, poorer sleep , stressed out lifestyle, and never challenge your brain , then your brain increases inflammation , it reduces blood flow and a cleaning that happens at night with sleep doesn't happen. So you have two sets of choices and each one of them will take your brain in this trajectory or that trajectory . So if you do the things that help to grow your brain, you have a larger brain reserve . You increase resilience to your brain. I call my book the Invincible Brain , meaning that if you do all this thing I just told you, you make your brain invincible. You make your brain more resistant to anything bad that can happen to your brain. And so you know, sometimes I talk to it as if it's a retirement plan. If you do everything so many things that I just talked about, the five pillars of brain health, you have a larger brain retirement fund. So when you get to your seventies and eighties unless these plaques and tangles come out of nowhere , you will be able to still function . People need to know that it is possible to have Alzheimer's disease in your brain and have no symptoms if your brain is healthy and strong otherwise . That's a well established fact For example, the Nun's study showed that these elderly women in their eighties had busy lives. They were teaching others. They were doing community work, they were crocheting and driving . And many of them who died had loads and loads of these plaques and tangles . And Dr. Snowden and other colleagues were puzzled like, do you have Alzheimer's in your brain? Why aren't you having symptoms ? And the secret was