The Daria Hamrah Podcast

How to Age-Proof Your Brain and Stay Sharp for Life - with Dr. Majid Fotuhi

• Daria Hamrah • Season 6 • Episode 8

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Most people think memory loss is a downhill slide you can’t stop. We don’t. In this conversation with neurologist and neuroscientist Dr. Majid Fotuhi, we map out a twelve‑week blueprint that measurably improves memory, focus, and even grows hippocampal volume by targeting the real drivers of decline: poor sleep, chronic stress, insulin resistance, hearing loss, inactivity, and hidden medical issues.

Dr. Majid Fotuhi is a pioneering neurologist, neuroscientist, and professor with more than thirty-five years of experience in brain health, memory, neuroplasticity, and the prevention of Alzheimer’s disease. His work bridges research, clinical innovation, and public education.

He earned his PhD in neuroscience from Johns Hopkins University, completed medical training at Harvard Medical School, and returned to Johns Hopkins for his neurology residency. He currently serves as an adjunct professor at Johns Hopkins University.

An author and communicator, Dr. Fotuhi has written several books and is known for making complex science accessible. His excellence in teaching earned him the American Academy of Neurology’s prestigious award. His research has appeared in peer-reviewed journals, been presented at major conferences, and cited widely by scientists worldwide.

Dr. Fotuhi has created a twelve-week program that has helped thousands of patients with memory loss, brain fog, concussion, mild cognitive impairment, and early Alzheimer’s disease. His expertise has been featured by CNN, NBC News, the Today Show, ABC News, The New York Times, The Washington Post, and The Times (London).


We start by clarifying what mild cognitive impairment is, how it differs from dementia, and why so many cases are preventable. Dr. Fotuhi explains the “type 3 diabetes” model—how decades of sugar spikes and inflammation erode the blood‑brain barrier and starve neurons of a stable environment. Then we get practical. You’ll hear how a personalized “brain portfolio” guides treatment: VO2 max testing to shape exercise, sleep studies and CPAP when needed, targeted brain training that matches deficits, and labs for vitamin D, B12, and omega‑3 status. The results? Early wins in two to three weeks, statistically significant gains at six and twelve, and habits that stick.

We don’t stop at diet and steps. Oral health impacts cognition by limiting whole foods and increasing inflammation; chewing itself engages neural circuits. Hearing loss quietly accelerates decline—hearing aids can move people from mild impairment back to normal. Add a simple, sustainable food approach—ditch ultra‑processed foods, eat vegetables, legumes, fruits, quality proteins, and healthy fats—and consider targeted supplementation with DHA/EPA omega‑3s and corrected D and B12 levels. Along the way, we address why amyloid hogged the spotlight, and point to powerful data: the Lancet’s estimate that 45% of dementia cases are preventable and the American Heart Association’s claim that 80% of strokes can be avoided.

If you want a sharper brain by summer, this is your starting line. Subscribe, share this with someone you love, and leave a review telling us the one habit you’ll change this week. Your future brain will thank you.

Links:

Majid Fotuhi, MD, PhD: https://drfotuhi.com/

https://krieger.jhu.edu/mbi/directory/majid-fotuhi/

https://neurogrow.com/about-us/dr-majid-fotuhi-md-phd/

https://psychology.columbian.gwu.edu/majid-fotuhi


Tweet me @realdrhamrah
IG @drhamrah

Speaker 3:

By the time you're 65, about 1 in 10 people already has dementia. By the time you're in your late 70s, that's closer to 1 in 5. And by 85 and older, up to 1 in 3 of us will have dementia due to Alzheimer's disease. Those aren't abstract numbers, that's your parent, your partner, or even you. Now add this: chronic stress has been shown to shrink the hippocampus, a part of your brain that lets you learn and form new memories. More and more scientists describe Alzheimer's as a form of type 3 diabetes in the brain, driven in part by insulin resistance and decades of sugar spikes and just poor diet. And yet, my guest today has data showing that in just 12 weeks, many of these patients with early cognitive problems not only improve their memory and focus, some actually grow their hippocampus by about 3%. That's like making part of the brain about 3 years younger in 3 months. So the uncomfortable question is this Are we quietly engineering our own future dementia with our stress, sleep, and poor nutrition? Or could we in 12 weeks start to reverse early brain decline? Today we're going to push into that questions with someone who's spent his career on the front lines of dementia and Alzheimer's. So, welcome back to the show. I'm your host, Dr. Daria Hamrah. Today I'm joined by my very good friend and colleague, Dr. Majid Fotuhi, MD PhD, who's a world-renowned neurologist and neuroscientist right around the corner for me. He earned his PhD in neuroscience from Johns Hopkins University and his medical degree from Harvard Medical School. And he's now adjunct professor at the Mind Brain Institute at Johns Hopkins University. He also teaches at George Washington University and Harvard Medical School. Over the past three decades, he has pioneered multidisciplinary brain fitness program that combines a comprehensive brain portfolio assessment with 12 bi-weekly sessions focused on lifestyle optimization and cognitive training. His work shows measurable benefits in patients with memory loss due to aging, concussions, ADHD, and early Alzheimer's. He is the author of several books, including The Upcoming The Invincible Brain, the Clinically Proven Plan to Age-proof Your Brain and Stay Sharp for Life, endorsed by people like Sanjay Gupta, David Perlmutter, and Michael Roizen. Dr. Futui, welcome back. Welcome back to the podcast. It's great to have you here again. I think the last time we talked was, I don't know, it was two or three years ago, I believe, and a lot has happened for both of us during that time. So I want to start right at the deep end with you. So based on everything you've seen in your research and in your clinic, how much of dementia we're seeing today do you believe is actually preventable? Not in theory, but in real people with real lives.

Speaker 1:

First of all, thank you very much for having me on your podcast. I really appreciate it. It's always a pleasure to talk with you. Of course. I think it's hard to put a number on exactly what percentage can be prevented. It has a lot to do with people's lifestyle choices and daily habits. But in my opinion, only 5% of late-life Alzheimer disease is genetic. In other words, only 5% of people can develop it no matter what. 95% of people have a soup of different problems in their brain that has resulted in their cognitive decline, and many of those are reversible and treatable. So in my book, I talk about how, as you said, dietary factors and stress and sleep can each chew away on parts of the brain that are important for memory and cognitive functions. The cortex, which is the outer layer of the brain, and the hippocampus, which is a pair of structures the size of your thumb on either side of the brain. These two structures can shrink or grow with your lifestyle choices. So I think that, you know, about up to 95% can be prevented. And the sooner you start, the sooner you can see results. In my practice, 80% of our patients who were in their 70s improved their brain function. And these were people who had mild cognitive impairment.

Speaker 3:

How do you, for people here listening, they don't understand what mild uh cognitive impairment is? In layman's terms, like if I'm thinking, I'm thinking like that. Mildly compromised, like how what does that exactly mean for the regular person?

Speaker 1:

Mile cognitive impairment is a condition between normal aging and Alzheimer's disease. Someone with my cognitive impairment may repeat himself or herself several times during the day. They may have changes in their personality or their ability to do things, but they remain they remain independent and they they function at the baseline.

Speaker 3:

So that's not when I get out of the house and I realize I forgot my keys, or that's not cognitive impairment.

Speaker 1:

No. That's called age-associated memory impairment. Age associated memory improvement. Those kind of things are a part of life and they happen and they don't necessarily mean anything. But when somebody asks, what are we doing for this, what are we doing this evening? and say, let's say the spouse says we're going to do dinner at a restaurant, and an hour later, what are we doing today? Or are you going to a restaurant this morning? Same questions. And then an hour later, honey, what are we doing this evening? And they have no recollection of having that conversation at all. But the same person may be still buying and selling stocks, getting together with friends, travels, cooks, does everything else. It's just that the memory or some or some brain functions have declined. But the person remains independent. That's the main distinction. So that's what you call the mild cognitive impairment. That's what Once you lose independence, once you can't do the things you used to do, that's the cutoff that we call dementia. And as you said, the most common form of dementia is Alzheimer's disease.

Speaker 3:

And so give me an example for that. So we know that you don't remember the question you asked an hour ago. What's a step further than Yeah.

Speaker 1:

So let's say the person we're just talking about, let's say he keeps asking the same questions, and then one day he's coming home and he gets lost driving to their own home. That's a red flag. That is when it's not normal. It's not, you know, Malcog and Payment usually called MCI. That's when it's not MCI anymore. If you get lost driving in your own neighborhood, that's it. And it happens a lot. You know, somebody goes and then they take the wrong turn. Oh, yeah. Some more totally different. They stop in a gas station, they call the spouse, and she says, Where are you? I don't know. And how do you get there? I don't know. Tell me what's around you. And they say something is totally off. And that's unfortunately something that happens gradually. You know, a person may not be sure if it's a left turn or a right turn here and there, but still get home. As long as they get home, technically, they have not lost their independence. They have they're able to function independently. They can drive to where they're supposed to go. So that's Alzheimer's? When they cut off, when they get when they cross that line where they get lost in their own neighborhood, or you know, if they forget names of daughter or husband or family members, that's what we call the Alzheimer's disease. Now, but different forms of dementia, you know, we can have vascular dementia, frontotemporal dementia, luri dementia, you know, there are whole different forms of dementia. But Alzheimer's is the most common form of dementia. And so these days, Alzheimer's disease is almost used synonymously with dementia in general.

Speaker 3:

So when we look at the numbers now, one in 10 people over the age of 65, and one in three over age of 85, based on some statistics that I looked up, with Alzheimer's dementia, basically have Alzheimer's dementia, you know, so that's pretty sobering. Like after the age of 85, it seems like to me that's the biggest crutch during aging. So if we take those statistics now seriously, what percentage of those cases, in your opinion, didn't have to happen if we had aggressively addressed things like lifestyle and or vascular risk earlier in life? Are we talking like 10%, 30%, 50%, or more?

Speaker 1:

I think only I think to be fair, once you get to your 90s, I think there's some genetic things that happen in people's brains because at some point we all die. I mean, it's not like if you eat healthy and you exercise, you never die. Eventually, as much as you do everything, there are genes and say, okay, time to go, and they kick in. And when they kick in a few years before it, the brain is the first organ to show that we are closing shop. So I think 90s is when, you know, I think the genetic makeup says it's time to go. And the brain is the first organ to show that process. But I think up to 80s, late 80s, I think people can stay functional and and sharp. And I think I think people usually don't have to just decline, decline, decline, decline, decline. They can just live a full life and just die. And so I think I honestly think that up to 80s, only 5% of people would develop dementia no matter what. Let me give you put things in perspective for you. Let's say it's 1940s, and we do a survey, and we find out that 60% of people smoke. Just because 60% of people smoke, it doesn't mean that's normal. That just happens to be the society at that stage. Once upon a time, the average age expectancy was 50s, 60s, even early 1900s. I mean, Dr. Allois Alzheimer's died at age of 53 himself because there were no antibiotics and you know infections. So just because something is happening commonly, it doesn't mean it's normal or it should happen that way. And let me give you some real exciting news, are you? It turns out that in Western European countries and in parts of USA, the incidence of dementia is declining. So you understand that you know, as more and more are living older, older, you should have more higher rates. You should even if it's if the if the if it happens at the same rate, yeah, then at least incidence should stay the same because you have more people. But the incidence is actually going down because in Western European countries like Sweden, Netherlands, more and more people are doing the things we talk about. They eat better, they exercise, you know, many of them quit smoking. And and so the incident of dementia has gone down by 20% in a decade. And in Framingham study, they showed that the incident of dementia has gone down 13%. Here's another really exciting study. This is really exciting. So researchers have been following a large portion of the population in Framingham, which is a city outside Boston, small town. And is that the famous Framingham study that you're referring to? Framingham study, yeah. And so researchers have a lot of information about these people: their blood pressure, their obesity, yeah, cognitive functions, MRIs. And one of my colleagues decided to just look at the MRIs of people at each decade of life. People born in the 1930s, 40s, 50s, 60s, and 70s. It's very easy because they all have MRIs that make it so easy. You just put them in categories. But guess what? They found that with each decade of each each decade that has passed, people in that village, a small town, have bigger cortex and hippocampus each decade. Each decade, the brain, the parts of the brain that usually shrinks with aging has grown. Compared to the So, for example, people born in the 1960s have a bigger brain than people who are born in the 1950s, 1940s, and 1930s. And it's a linear up. So that growth, what does that indicate? Which part of the brain has grown all day? So the cortex and hippocampus are the most important parts of the brain for cognitive functions. These parts of the brain usually shrink by about 1% per year at age 50. So the usual thing is that the brain, on average, and this is a very important thing, on average, the cortex and epicampus decline by 1% per year. So these people, these generation after generation, have not experienced as much atrophy. And so on average, on average, the brain has the brain size, the cortex of the campus, each year has been slightly larger. And I'm curious to look at the results from the next 10 years. So what have they done to achieve that result? I think more and more people are realizing that early childhood education is important. More and more people have stopped smoking.

Speaker 3:

So these this group of the Framingham study, they weren't giving any particular lifestyle recommendation. They just follow them and they let them do whatever they do and then just follow them to see what's happening.

Speaker 1:

You see more and more people in the 70s and 80s who go for a drug in our neighborhood. And you know, I did the triathlon several times in a row. And here I was hopping and puffing in my 60s, trying to finish, get to the finish line, and some lady who clearly was in her 80s passed me. And I was like, come on, man, I'll be doing that.

Speaker 3:

Oh my God. And I realized this- Don't don't tell that, don't go and tell that story to people.

Speaker 1:

No, I happen to be her when I get up to my 80s. So I think that cognitive decline with aging is absolutely preventable. And you know, I have had patients who have done all the right things. Like I had a handful of patients. Well, you said 5% are genetic, right? Exactly. So, for example, I had a patient who was a wonderful lawyer, had been a successful lawyer, exercised, age right, very nice, in good shape, no obesity, nothing. Everything, good, everything about him was. How about stress? I mean, lawyer and stress. Yeah, some stress. But for the most part, he he had done things right. And uh he did have a family history as well. So, but you know, he is such a minority of my patients that I vividly remember him. Everybody else would improve. And he actually remained stable. He he did our program, and he had he he had, you know, we do the mocha scoring, the cognitive scoring, his his mocha score, the cognitive testing score had remained the same. And he I told him, you know, you've done the program for 12 weeks, our program is only three months, you you know, you cannot do things on your own. But he liked coming to our brain center, so he used to come regularly. Uh and so he continued the program like three months, six months. And I think he actually benefited from it because cognitive function, he was someone who would have declined much faster if he had not done the intensive brain training and everything else with it. But everybody else, all my other patients, improved. It was really rare that somebody did not have an improvement in the cognitive functions, and these are people 60s and 70s, and some in their 80s. So I think I think our attitude toward cognitive test um I think that our attitude toward aging and cognitive decline needs to change. We have to realize just as What is it now? What is our attitude now? I think the general attitude with aging is that everything is downhill. Your body fails, your brain fails, and you just fade away and you die. But we know for a fact that people can improve their physical health as they get older. We know that, for example, we can get someone in their 50s and 60s who's totally out of shape and work with them for three to six months and they will be looking great. And as long as they maintain, you know, all the recommendations for good health and exercise regularly, they will stay in good health. Many of my friends, when they're 70s, go to the gym, they do weight lifting, they they play pickleball, they do everything. And you know, in old days, somebody in their 70s was supposed to just sit home, read a newspaper, do crosswork puzzles, maybe, sit by the pool. And they didn't expect a person to, you know, be active in sports or be active in in life in general. They were supposed to just slow down. I think our attitude toward aging needs to change, and we need to believe that we can indeed improve our brain functions from our 50s to our 60s. Our brain has a great degree of plasticity, and it is possible to improve functions. We need to change our mindset and get it.

Speaker 3:

I want to I want to zoom into the the boldest part of your work because that's why I want to literally pick your brain, no pun intended. Because it honestly sounds almost too good to be true at first glance when we hear it, because of what you said, that traditionally how we think of dementia cognitive decline in the context of aging, it's almost like people say, Well, it's kind of like a downhill battle. I'm not gonna fight it, I'm just gonna make the best out of it. Hopefully, I doubt I'll die soon enough so I don't have to worry and be a burden on my family, which is pretty grim and depressing a way to go about the last decades of your life. So, my question is what exactly happens in those 12 weeks? And in which types of patients can you truly say that you reversed early decline if you can talk about reversing decline as opposed to just slowing it? For example, in the case of the lawyer friend of yours. And so can you kind of uh explain that a little bit so for the audience?

Speaker 1:

So uh super problems contribute to cognitive decline with aging. Things like obesity, diabetes, sedentary lifestyle, smoking, too much stress, insomnia, all of these things uh shrink the brain by a little bit, maybe say 5%, 7%, depending on the severity. Obviously, if you have severe sleep apnea, your brain shrinks a lot more than if you have mild sleep apnea. And why is that? Is it due to lack of oxygen or so for each of the main risk factors, there's you know, a common cause is reduced blood flow and inflammation. In the case of sleep apnea, there is hypoxia that happens during the night. So reduced oxygen, which falls multiple times every hour, maybe 40, 50, 60 times an hour, you get to a point of being drowned and you come back up. So no wonder when you wake up in the morning you feel tired and worn out. So there is hypoxia to the brain, there is inflammation, that definitely cytokine levels are higher, and there's increased inflammation in the brain, but it's also hypercoagulability. When people have sleep apnea, the blood clot, the blood becomes more prone to clotting. And the combination of these things contribute to possibility of strokes and vascular disease in the brain. So of the factors I told you, sleep apnea, infnea, stress, obesity, diabetes, entry lifestyle, all of these things chip away in the brain, most of them through reduced blood flow and increased level of inflammation, reduced mitochondrial function, which we'll talk about in a minute. And all of these things are reversible. So if you have someone's sleep apnea and you treat them, the symptoms reverse and there's increased blood flow to the brain, and there's oxygenation in the brain. And studies have shown that if you put somebody on a CPAP machine, the hippocampus grows. You do MRI before treatment, you do MRI after three months, and hippocampus grows by itself. If you don't do anything else, if you just treat someone's sleep apnea successfully, you grow their hippocampus.

Speaker 3:

So you test in your clinic everybody for sleep apnea, I assume?

Speaker 1:

Yes. So we checked, like when I saw a patient, I would do an inventory of all their issues. And so for some people was sleep apnea, for some people it was insomnia, for somebody a lot of them was set into a lifestyle or too much stress. And so each person had different combinations of issues. I will make an inventory of let's say 10 issues and make five of them priority, and then while I would work with them on the health issues, reducing medications, setting up a CPAP machine, you know, working with them to improve their sleep, you know, have them work with the therapist to reduce the stress, my brain coaches would do brain training with the patients. So twice a week, we would do brain games, and we would pick brain games that were fun, like you know, card games or even chess or sudoku. We had a whole room full of brain games. And we would pick brain games, either the ones that increase executive function or the ones that improve processing speed or improve memory, and then we would work with our patients with the games that they needed. So if somebody had memory issues, we'll give them brain games for memory. If they had executive function, we'll have solving puzzle kind of brain games, and if crossing speed will create brain games that require speed.

Speaker 3:

Can you talk about that? Because I heard so many controversies about you know the advantages and benefits of doing memory and brain games in terms of moving the needle in dementia Alzheimer's prevention as compared to lifestyle factors. So many believe now that the brain games are overrated and it's most of the bucket is filled by the lifestyle interventions which you do. Now you do all of it in your clinic, and you have been involved as one of the foremost authorities in all of them. What can you tell us uh about that and to those claims?

Speaker 1:

I think you have to appreciate that what we call dementia or Alzheimer's disease is overall decay and shrinking of cortex and epochampus. And there are things that I would call five pillars of brain health diet, exercise, sleep, stress reduction, and brain training. These five pillars of brain health can contribute to reversing the cognitive decline that happens with aging and to increasing the size of cortex and epochampus. Now, I think it is true that exercise is by far the most effective intervention for growing the size of cortex and epochampus and slowing cognitive decline and reducing risk for Alzheimer's disease. I believe in that. But brain training by itself is quite effective in getting people to have better memory. If you have memory problems, I give you memory training and your memory gets better. Like just you know, I can teach you how to play the piano and you get better at it. You may not necessarily become the best pianist.

Speaker 3:

It even has a world championship, right? This memory, there's a memory world champion.

Speaker 1:

Yes. Actually, no, Nelson Dellas is the current US memory champion, and he's my friend. I've known him for a long time. We met him one of these memory championship uh events. I was a keynote speaker, and he was one of the candidates that he competed, and he actually won. I think it was 2013 or 14. And so he was not necessarily a memory champion in his life. He was a computer science major. And his grandmother died of Alzheimer's disease in France. He became interested in memory and did some memory games and became good at it and won some local championship. And then he enjoyed it, and he did some more games, and he got better at it, and you know, won the state championship and the US memory championship. So he was never born a memory genius or anything. And it's incredible. He memorizes a deck of cards in 45 seconds, and he can memorize 20 decks of cards back to back. I saw it. Is that talent or is it really practice or both? I mean I think I think it's it's intense training. Training? Because he is not a memory champion. I mean, he's not a memory champion.

Speaker 3:

Well, maybe he didn't know he's a memory champion. He had this unsung talent.

Speaker 1:

It's it's I think we all have some innate talents and some acquired talents, but we all can do exceptional things. And think look at people who lose a limb and they get better at using their other limbs. Yeah. Like, you know, there were a couple of the the US Olympic Special Olympic champions who had lost their arms and had learned to do bone arrow with their feet and toes, and they will be right on target using their feet and legs to do that. And you can't say they were born with special.

Speaker 3:

Well, the reason the reason why I'm asking is because we have the people in the spectrum of autism or Asperger's, and you know, they have different abilities of memory and the than the normal person, and you know, that's what I was referring to as you know, there's so many spectrums that we don't know perhaps, or that we do know, but they're mild, moderate, severe, and then the mild ones they kind of go under the radar. And is it could it be maybe that, or you don't think you think it's mostly muscle memory?

Speaker 1:

I think we all have incredible capacity to do wonderful things with our brains. It's without without a doubt in my mind that we all can you know memorize the whole book.

Speaker 3:

I mean, we did with multiple books.

Speaker 1:

Multiple books. I mean and a lot of books. The point to answer your question is yeah, does brain training move the needle? Yes. And I think when somebody has memory problems, if you give them targeted memory training, their memory gets better. Yeah. Because memory is a skill that you can get better at it with practice. So if if you Daria did memory training three hours a day for one year, that's a lot. You you could memorize a deck of cards in a minute. You probably can memorize ten deck of cards. Wow. It's unbelievable. Like you think of it, it's unbelievable. Well, because it's you know, our brain is so malleable. Yeah. That's what I find fascinating in my work dealing with patients and seeing patients turn around. See, I think the most important challenge as we approach aging is the necessity to change our mindset about aging. I a lot of people who came to see me felt that okay, in their 70s. You know, they were brought by their wife. Their wife says, My husband can forget any things, and the guy would say, Well, I'm 70s, what do you expect? And I Think that is the obstacle that we need to overcome. We need to appreciate that our brain has an incredible degree of malleability at any age, and we can always get one notch better. Definitely one notch better. Whether we can get 10 notches better, you know, I can be 100% sure depending on the degree of dedication of a person to intensive training. Like we all can do a marathon. There's no question. We all can run a marathon. You just train. You know, you may somebody get to that point in three months, some people get there at a year, but we all can definitely walk a marathon. So it's definitely doable. You can't say you can't walk 23 miles. You can't walk. Of course you can. And so I think we need to change our attitude toward aging and appreciate that our brain can grow and expand at any age. And we need to believe in that. And with that attitude, we will definitely see results.

Speaker 3:

Well, I think you're bringing up a very good point because I have these conversations with my patients. And I think what you just said about these patients in their 70s or 80s, pretty much they've checked out. And if you look at studies of that look at aging, cognitive decline, uh, or in general, all-cause mortality, like death for any cause. A big part of when you compare the ones that die early versus die later, and when you look at, for example, these blue zones around the world, I think the common denominator there is that most of those elderly they have motivation to live, they have something to look for in their lives. There's they have still something that they're passionate about, and that subconsciously makes them drive and strive to do the things that bring joy and with that then prevent further cognitive decline. And in contrast, there are the ones that, like you said, the narrative is that I'm over 70. What do you expect? It's almost like mentally they've checked out, they don't have anything to look forward to. They're basically waiting in line to die, and they accepted their fate. And no one is there to tell them, hey, you probably have another 10, 15, maybe 20 years to go. So, and you can change that. And I wholeheartedly agree with you. I think when we change the narrative as a society, people will start looking different at aging. Absolutely agree. And and I and and so can you describe now, let's say someone is listening to this podcast and says, Okay, that's fantastic. You've convinced me. I want to do this 12-week thing with Dr. Fatouhi. I want to know what exactly is happening in those 12 weeks, and what happens after the 12 weeks? Meaning, am I done after 12 weeks? I get a certificate, and then I will never get dementia Alzheimer's. Can you walk us through those 12 weeks? What is it that you do or they do, and then after that, what happens when the 12 weeks are over?

Speaker 1:

So the concept behind a 12 weeks brain fitness program that I provide for my patients relies on the multifactorial nature of cognitive decline. In other words, everybody has a different reason or a combination of reasons for having experienced decline in their memory, processing speed, or executive function. And so the first step in in this process is evaluation by me to go through index of 2030 things. So in my book, which is coming up in March, I haven't ever gotten it.

Speaker 3:

Yes, the Invincible Brain, everybody, coming out in March 2026. Yeah.

Speaker 1:

I call it a brain portfolio. And in brain portfolio, I go through a checklist of things. The first thing on the list is your purpose. Why do you want to do this? And what you just said is extremely true, which is if you have a sense of purpose in life, that's a driver that makes you want to live longer. Yeah. That's the that's the incentive to want to be healthy and sharp. And that is the thing that a lot of people don't pay attention to and they don't even consider it. The other thing I have, and I'm just gonna go through this with you, is what are your short-term goals? Like some people want to have better memory, some people want to think faster. So we need to establish what you want to do. Like when you go to a gym, you want to work on your biceps, you want to work work on your core. Like our cognitive abilities arise from our cortex in the campus, and we have the capacity to hone in in specific parts of their brain that we want to work on, just like we can work on different parts of the body. Then I ask them, what percent of your usual baseline are you? If somebody tells me they're 10% of their baseline, it's one thing. If somebody says they're, you know, they're 0%, or somebody says, oh, I'm not I'm only 20% different. So that also gives me an indication of where they are, and it's very subjective. You know, what they you know, some people say I'm 10% of what I used to be 10 years ago. It's hard to believe that you've lost 90% of your cognitive abilities in 10 years. So obviously you're exaggerating. But it's good to know, and I document that. And then I said, Who's your role model? Who do you want to be? Because again, it's just like going to a gym. Do you want to be a you know the hunky guy, or you want to be fit and run fast? And and the thing is, and this is the thing that I think we will be doing in the next generation of medicine, where we can actually sculpt the brain we want, just like the way we can sculpt the body we want. And it's doable, but it's not science fiction, it's totally doable. So, those are the first things we do. Then I ask people 40 questions Do you have kidney problems? Do you have liver problems? Do you have lung problems? We do a review of systems, and this is where I discover things. For example, root causes. Can you run a mile? Can you run two miles? Or or do you smoke? Or how much how much do you drink? How many hours do you sleep? Do you snore? How many complex do you have? How's your sex life? So I go through 40 questions with them. Again, my job is to establish a baseline of where things are and identify a handful of things that we want to target in order to achieve the goal we want, which is the goal that our patient describes he or she wants. So once we do that, I do some blood tests, and I take like B12 level, vitamin D level, omega-3 levels, and there are new Alzheimer's blood tests that I have not used, but those are potential options that I can do for my patients. Then comes the important thing. I do a VO2 max testing. I used to do VO2 max testing. VO2 max is an indication of a person's endurance, it's the maximum amount of oxygen a person can use per minute per body weight. So if you are in your 40s and you are very athletic, your VO2 max would be 50. If you're 20s, it may be 60. If you're 70s, it may be 30s. But there are easy ways to do a testing, and also these days you can go to your phone and find where your VO2 max has been already recorded. Then I may order hearing tests or sleep study or heart uh stress tests. So these are things that help me identify, help no. If somebody's not everybody who snores has sleep apnea, so then then we do we establish whether they have sleep apnea or how bad it is, because it makes a difference, or how many hours they sleep. So every person may get two or three additional tests. Sometimes MRIs, not everybody needs MRI. So then I do two questionnaires, which are neurocognitive questionnaires and neurobehavior questionnaires. There are about 30 questions that say, for example, one of the cognitive neurocognitive questionnaires asks, from one to ten, how bad is your difficulty concentration? So 10 out of 10. How bad do you have difficulty remembering names? How bad are you in navigation trying to find your way around? Two. How how bad is your difficulty with calculations? Eight or three. So everybody has different cognitive functions. Now we're getting to nitty-gritties. And in your behavioral questionnaire asks, how's your mood? Are you irritable? Are you bored? Do you have fatigue? Do you have headaches? Do you get into arguments with people? Well, how's your stress level? That's like our whole population. Well, no, the thing is everybody has the constellation of different things. And I think the key to our success has been identifying specific things for specific individuals. Like, you know, everybody has difficulty with anxiety, everybody has difficulty with stress, everybody has difficulty with sleep, but that's not good enough. We need to know exactly how bad it is. And you know, you may say you have stress, but you're actually not that stressed after all. So how do you measure that, the level like metrically? Yeah. So the you know, as you know, there's no blood test or you know, that's right, beta EEG, quantitative EEG, and that would give us some indication of where Which is uh for the listeners is the measuring your brain waves, getting an idea of your brain waves. And so we could see some people had high levels of beta waves, which are fast waves, and some people had high levels of theta waves, which are the slow waves. So a person who, for example, had depression and had very high levels of the sluggish brain waves, the theta waves, is one thing. Another person who says they had depression, but their delta, theta, beta waves are normal, that was a different thing. That would give me an indication. It wasn't like a black and white test, it would things in perspective for me. So now with this, what I call a brain portfolio, you see how much information I have about each person? Yeah, and these tell me where I'm gonna target my interventions. And because we do a target intervention interventions, we see results because we go after specific things. Like, for example, if somebody said I have you know 10 out of 10 with memory, the brain training that we set up for them would have 30 minutes of memory training. If they said they have difficulty, they're too slow, we'll do processing speed. So so after the initial evaluation, which as you can see was very comprehensive, you know, I spent one hour talking with my patients, I have all these field forms that I would complete for them. Then the program will begin. So that was an assessment step. So then the program begins. They came to Brain Center twice a week and they work with our brain coaches who would have a prescription from me. So this person had lifestyle interventions and brain brain training. So I would say to my brain coaches, you know, this person needs to improve their exercise and they need to reduce the stress on one part, and what kind of brain training they need on the other part. Because I knew from my assessment where the gaps were, and this is the key. I filled in the gaps as opposed to just say, go exercise. I think a lot of people say exercise, eat right, sleep well, don't stress. I mean, that doesn't help. Yeah. Because each person, once you go into detail, has specific issues that need to be addressed. So when they started a program twice a week, they will work with our brain coaches on lifestyle issues and brain training issues. And and we kept track of their progress every week. We had what's called brain health index, a short little questionnaires. And every week I would meet with my brain coaches and we discuss every patient as how they're doing. And I, in parallel to these things, would take care of medical issues. So I'll make sure they get sleep apnea testing and sleep apnea treatment, or if someone has significant anxiety things like this, I would set them up with a social worker, or if I felt like they hadn't exercised in a long time, they may have heart disease, I'll set them up with a cardiologist, or I would just order this stress test myself and just follow up. I tried to own the patient. It was my problem. I didn't just care of everything because I knew I was in charge of the person and I couldn't blame others for dropping the ball. It was, and I would tell that patient, I said, you know, if you were my patient, I said Daria, you're my problem now with pleasure. I'll take care of you, and I'm responsible for everything. If sleep issues, cardiac issues, mood issues, I'm in charge. I get people to help, and if they fail to do their part, ultimately I'm responsible. And that gave people a sense of confidence that it's not like this doc is gonna do this, this doc is gonna do that, and if that doc doesn't do their job, nothing happens. I would tell them, listen, you will get better definitely. Without a question, you will get better. I am telling you, 80% of our patients had a statistically improved statistically significant improvement in objective cognitive testings. We've had we've had three papers published in peer-reviewed journals, and we say it in our clinic all the time. There's no question you will get better. Absolutely. And our brain coaches had seen a lot of success stories, and they were enthusiastic when they saw them. You know, they were very positive because they feel, look, we see this all the time. You're just another one. Like everybody improves here. And this was a shock to our patients. Like, everybody improves. What do you mean everybody improves? These people are 70s. Oh, and then in the waiting room, people would chow each other. And somebody says, Oh, I memorize 100 words. They say, You memorize hundred words? I mean, you're 80 years old. How do you do that? And they would get inspired to then memorize 100 words themselves. And then at six weeks, we will repeat the objective testings, the cognitive testing, and the questionnaires, and they would meet with me. I will go over the progress over six weeks. And, you know, if if they had improved the exercise, but they had not improved the brain training as much. Oh, and they love to come show me how much how many words they memorize. We had like a memorize memory memory trick to show people how to memorize 20 words. So they would memorize 20 words and forward and backwards one week, then they memorize 20 words the next week, and so forth. So it all looked forward to come to see the principal person, like, and and brag the fact that they memorized 40 words or 100 words. And some people then would go on to memorize names of presidents or you know, names of the football players they like. Anyway, at six weeks, I would see what has not improved. Oh, and then we wouldn't wait till six weeks if somebody was not improving. So they said somebody would come one, two, three weeks, they were they had not taken because people started getting better within two, three weeks of they would get the idea, they would get the hang of it, start moving. And if they were not getting they were not starting to move, they wouldn't wait till six weeks. Because we had weekly brain coach meeting, they would tell me such and such has not changed. And then I would meet with them, either formally or informally. Like I said in my writing room, I said, please kind of come here and talk with you. And sometimes I will find out that, for example, they had failed to tell me that they take a medication for sleep that they had somehow forgotten to tell me, or that they had a major conflict with their spouse that they hadn't told me, or you know, they would tell me something that somehow they had not disclosed during my thorough evaluation first summer. Because if somebody goes to the gym regularly, you start saying things in two or three weeks. You start feeling a little better, you still feel like your steps are a little stronger, you feel like that that weight is not as heavy. I mean, things start to weak change after a few weeks. You can't wait six weeks, and so that's why the that's the other thing. We didn't wait till six weeks. But at six weeks, they will come for a formal evaluation, and I would do the test results, I would go over them. Everybody had improved, they were happy about it, and they were even more excited to go back and do four weeks. And then at the end, they would come back and they would, you know, they would have a final set of testing, and I would meet them for a post-program graduation event appointment, and then I would talk to them about how much they improved and how they were they had learned what to do. See, it takes three or four weeks to form a habit, but it takes three or four weeks to start to form a habit. But if you do something regularly, then after 12 weeks, it becomes a habit habit. Like if you start walking regularly, if you start you know not touching junk foods regularly, then it becomes a habit. And then I would see patients three months after, and then six months after. And I always loved those because people had continued to take on new hobbies, they had continued, it's like they're alive again, they're alive again. See you hinted to that. I think people sort of in their mind they kind of die in early 70s and just wait for the actual stopping of breathing. They in their mind they check off. And and when we told them you could do this, you could do that, and then they felt like their legs were stronger, they're walking better, they were feeling better, they had started to do things in their church, they take up new uh volunteering work. They were a new person, full of life, full of going doing things. And I love the part I love the best is when patients came to me and said, Dr. Futui, you changed my life.

unknown:

Dr.

Speaker 1:

Futui, this was the best thing we ever did after done my life. Dr. Futui, why what you do is not available elsewhere? Why have you just need to know why do we have to find you through just other people talking about it? Why is this not standard care? And that's when I decided, you know what? I need to do something beyond just saying, you know, a few thousand patients a year and like you know, 10 patients a day to do things. The things I do don't require special equipment, are readily available, and so why don't I change focus and write my book and start giving public lectures, educating doctors? You know, one of the things I plan to do in the coming years is to work with physician groups to make this program a part of their brain training program, what I call super agent program. I think we need to set a goal to become a superager.

Speaker:

I think you're definitely on path. Like if I had something like I had 90% confidence that would become a super agent, it would be you.

Speaker 3:

No, I love that. I mean, the one analogy you gave comparing the brain to our muscle, and essentially the the brain is a sort of a muscle because you it has the plasticity, it can grow, despite what we learned in medical school, that neurons can't grow, what, 30, 40 years ago? So that is, I think, will completely change the narrative, not just for our society here, I think globally, and uh for context for the audience, like you retired from that clinical practice because you felt like you can't help enough people, and now you're trying to bring that message on and scale that message through education, through authoring books, through academia, etc., which you've always been part of academia, but now you're doing all of that full-time.

Speaker 1:

Yes, and I look forward to doing more of it because as I said, you know, I'm talking to some medical practice groups. And if if I talk with the leaders of medical practice that has a thousand or five thousand patients, or if they have twenty or hundred thousand patients, and if they incorporate this program, something similar to it, into their programs, then I will be able to touch the lives of you know hundreds of thousands of people.

Speaker 3:

100%. And and that's the reason we talked before the podcast about my book, and that was my motivation too. It's it's it's fascinating because I felt I can only make my mark on a few people, but you know, how can we scale the message? And one of the questions I had for you, because just for context, in the past two years I've changed my practice. What you're doing for the brain with all the primary assessment questionnaires, I do for my patients as part of a perioperative optimization, where several months prior to their surgery, I optimized them. But before I know what to optimize, I have to get all the data, all the information on their lifestyle, their personal perception thereof in comparison with actual facts, because there are studies that patients, uh very smart patients, I shouldn't, I think they did a study uh using nutritionists, and they asked them about their diets, and over 80% overreported their diet. And these are nutritionists, meaning they know the science, but we are biased inherently, and we do over-report our sleep, our diet, our exercise level, and sizes of other things. But what in your estimation or in your clinic or in your studies have you seen this over-reporting? And how did you weed through it? How did you assess that? And also a follow-up question on that is during those 12 weeks, how did you deal with non-compliance? In other words, how many patients ended up graduating the 12 weeks, and how many said, Yeah, I don't think this is for me?

Speaker 1:

Yeah, the attrition rate was 7%. Attrition rate seven or seven. Oh, that's low. Only 7% of people did not complete the program of people who started the program. That's pretty good. I think the reason was because when people started the program, they start feeling better within weeks. I mean, the moment they memorized 20 words and they went home and they told their grandchildren they memorized 20 words, they were a new person.

Speaker 3:

I think on top of that is the cohort of patients. The fact that they came to your office, they were already motivated, they were already looking out, looking for alternative ways. So they had that motivation aspect. So I'm not surprised to hear 7%. And you have that cohort of highly motivated patients seeing results within two to three weeks. I mean, they will I would be surprised if they asked you if they can continue the program beyond. Yes, many people did.

Speaker 1:

I think, I think what we told them, and some people did do the program another 12 weeks because we obtained objective test results. So going back to about perception, yeah, it was very interesting that somebody would say, My memory is horrible. And then we do objective testing, and their memory was at a level at 90 percentile for someone in their age group, because we scored the cognitive test results based on their age group every five years. So 63-year-old may say, My memory is horrible, I can't remember anything. And we do testing, the testing shows the memory is a 90 percentile for their age group. So they under-reported, in other words, they underreported their memory. This is average people, it's not educated people. However, you need to know that your memory is not about to fall apart and you're not at the verge of developing Alzheimer's disease. You're still compared to average population, way up there. And I will get you even better because what matters is they're happy, not the numbers. And vice versa. Sometimes people say, you know, my memory is not that bad. It's my you know, I feel like I'm slow. And the memory was like, no, tenth percentile.

Speaker 3:

I think that's a classic, the I think this is a classic phenomenon of the Dunning Kruger effect, where people that are Are you familiar with the Dunning Kruger uh there are two social psychologists they compared confidence and competence, meaning they wanted to see if confidence related to competence, and vice versa. So they saw that people that lack competence, it's it's like a U-shaped curve. So on the left side of the curve, you have the incompetent with high degree of competence, and then as they learn, the confidence level bottoms out. So they're like, oh shoot, there is much more that I need to know. And then as their competence level rises with time, with education, training, and so forth, then their confidence level goes up too. But what they found out is that the highly competent ones that have high confidence, they possess this degree of intellectual humility that makes them under-report their actual competence. And I think that's what could happen with the very highly intellectual people that you meet that under-report their memory. They said, I don't think my memory is as good because their standards are high, the they they're very competent, but they don't go out and boast out, say, Oh yeah, my memory is great, and they're in a tenth percentile. So it's fascinating.

Speaker 1:

You probably see this in your line of work. If somebody comes in and says, My nose is horrible, and this, and you look at the nose and you say, gosh, your nose is great. What are you talking about?

Speaker 3:

Yes. Well, I see that a lot actually because I'm like yourself an educator and teacher. I see that a lot on the fellows and residents that I train and teach, and uh or other people early in their career, they have a high confidence level, but their competence isn't very high. And they're it's a little dangerous, right? Because you will basically omit yourself the opportunity of learning thinking you already know everything. So that way then you're not open to learning something new, and that's very risky. And then as you learn, you realize, oh, there's so much I don't know yet. So I better, you know, humble up a little bit and start um you know, educating myself, and then slowly then the conference level goes up. So I see that a lot in the education department, and that's why you see all these pseudoscientists and influencers on social media, they read a headline, they don't even know they read some abstract of an article, they don't even know how to read a scientific article, and then they complete or they completely misinterpret it, and it's cognitive bias, right? They just use the narrative that fits their belief, and then they go out, they have they get millions of views, they have gazillions of followers, and then they create these movements of the pseudoscience, and then people get confused. So we see the Dunning-Kruger effect full-blown on social media, and I that's why I made it my mission to bring real science and interviewing and having people like you on the podcast, where the recommendations are based on true science and data and not some opinion or fad. But I want to continue more on the lifestyle because I think it's it's important. So a lot of the stuff we're talking about is really fascinating, especially for me personally. But for the audience, I want to give them some actionable and practical advice to go home with where they can start. If they're motivated to change their lifestyle, and if they have something to look out for, maybe they just got a new grandchild, maybe they got remarried at age 70, and now they have something to look forward to. Now they're motivated to improve their lives, their memory, their health. And I want to connect all of this to also metabolism, nutrition, because that's another huge driver that people underestimate. And a lot of people in that age group, they already come with one or more metabolic diseases based on their previous lifestyle, where they didn't know better. I mean, in in our Western society, you know, we don't live in the Mediterranean. So, you know, it's fair to say that we're at age 70 or 60, even, we have already fallen behind. But that doesn't mean we can't. Can we cannot catch up? That doesn't mean now we just have to write it out and cross our fingers, like we discussed as far as the brain. So I want to dive into the one buzzword that has become very popular on social media, where people are increasingly calling Alzheimer's a type 3 diabetes, a brain disease driven in part by insulin resistance. And by now everybody has heard the buzzword insulin resistance, and decades of eating refined sugars, ultra-processed foods, lack of eating whole foods. From your perspective as a neurologist, is my sugar habit literally feeding future dementia? And what do you think is happening in the brain over 10 to 30 years of frequent glucose spikes and ultra-processed foods?

Speaker 1:

Yes. The short answer is yes. I think that poor metabolism and its associated inflammation is a major factor for brain shrinkage. It's absolutely up there. And the sugar spikes that lead to insulin resistance and then to diabetes increase erosion of the blood brain barrier. You know, the blood vessels in the brain have three layers of insulation as compared to, let's say, the blood vessels in your heart and kidney or elsewhere, which have only one layer. The one is the endothelial layer, which is very tight and it doesn't allow the leakage of the material. But in the brain, you have these cells called parasites and these other cells called astrocytes, which provide these extra layers of coverage so that the content of the blood doesn't leak into the brain. When you have a high inflammatory diet, and the inflammation causes erosion of the blood vessels in the brain, the blood content, things like clotting factors, fibrinogen is actually one of the bad ones, and cytokines and other things in the blood that all the electrolytes that may be flowing around leak into the brain. But your brain has a very tight, has a very tightly controlled environment. Inside the brain is a very pristine milieu where everything is controlled. I mean, imagine being inside Pentagon or inside you know vaults of major comp major banks. Fort Knox. And you know, neurons very are very finicky, they're very sensitive. If the calcium level is a little bit high, picograms higher, or if the sodium is picomoles lower, that changes the fire rate. And if, for example, you have too much calcium, the neurons can fire so much to kill themselves. It's called excytotoxicity. So inside the brain, deep inside the brain, the neurons and their supporting cells work together in a very tightly controlled, very tightly regulated environment. There's no room for you know clotting factors and cytokines and red blood cells and like that. So poor diet causes inflammation. Inflammation causes erosion of the blood pain barrier, the content of the blood gets inside the brain, and that causes havoc. That causes wreck problems everywhere inside the brain. The neurons stop fine too much, then the microclean astrocytes actually become reactive, they increase release of free radicals, reactive oxygen species, and that actually worsens the problem. That's adds fuel to the fire, and that part of the brain dies or erodes significantly. Permanently? How much recovery room do we have once that happens? So there we go. So it's called brain reserve. In other words, how much of a brain integrity and capacity have you developed over the years? Let's say you're 45 years old, 50 years old, in these four or five days. Have you been eating right? Have you been sleeping well? Have you done brain training? Have you exercised? If you've done the right things, your brain has a high reserve, which means you can erode 10-20% of it and it's still functioning. But a poorly maintained brain to begin with can't tolerate another 10-20% of damage. And that's that's the difference between a 65-year-old who's doing things and is active and it feels good, it feels good, and you know, another person with the same age who just sits around, has no energy, can't do much. It's the status of their brain, status of their brain health and vitality that determines the level of performance and how happy they feel. See, when people have this, I don't want to call it that way, a dirty brain. The manifestation is you don't have energy for anything, you're not interested in anything, you don't want to do anything, you don't do anything. You watch around, you sit around, watch TV and drink beer, and you know, are grumpy with your family members or friends, or complain about everything, you know. So what goes on in the brain shows up in terms of behavior in day-to-day life.

Speaker 3:

Yeah, I I saw that happening on me, and that's what made me change. I didn't like myself. And about now four years ago, it started happening, and I didn't recognize myself, and I didn't know what it is. My my primary care couldn't tell me, give me the reasons. And then through other avenues, I went down the rabbit hole and I stumbled upon all of this science. And this was for me like an awakening. Now, the question I have for you I know I have done a lot of damage to my brain by virtue of 15 years of medical training, all-nighters, residency, on call, junk food, if any food at all, and all of that food was really ultra-processed. It was basically Cheetos, it was MMs, I mean, it was some candy bars, sodas. I mean, that's how I lived 15 years of my life. Lack of sleep, I would say average four to five hours, and we're talking about an extended period of time, 10-15 years. But then I cleaned my lifestyle up, obviously, once my training was over. But then some of those bad habits I continued even afterwards, meaning eating candy, taking six hours or five or six hours sleeping at night as a badge of honor, boasting that, hey, look at me, I don't even need that much sleep. Uh, because I didn't know all that science. Now, the my question for you is all of that, has that done permanent damage? If so, how what percentage of it? And in the past four years where I really cleaned up my act, can that repair all the damage or not really? And how how how do we know that?

Speaker 1:

Well, I think I think after two, three years the brain goes back to a healthy status. I know, for example, that if somebody smokes a lifetime and their lungs are filled with this black junk and tart from smoking, if they stop smoking three years later, their lungs is almost as good as near. So you can have a smoked lifetime, 30 years and three years of not smoking and exercising makes your lungs almost as good as near. And that's what I find fascinating about our physiology that we have this internal repair kit that is so efficient and works so well in all our organs. You know, same applies to your muscles. If you haven't done anything for a long time, you go to a gym for six months and you know, you get buffed. They did a study in LLE who were in shape and those who were not in shape, and they saw that the load of mitochondria inside their muscle cells reflected their level of activity. Those ones who had a center lifestyle had low level of mitochondria, and those who were active and exercising had high level of bacteria, high level of mitochondria. And then they put them on an exercise training for either four months or six months, and after that, the levels were the same. In other words, four to six months of training brought the level of mitochondria to the same level of somebody who has been exercising all their life. I think that's not fair, actually.

Speaker:

You know, those work all their life, and and somebody can catch up in six months.

Speaker 3:

I mean, that's that's almost but I think the diff the difference is for the ones that have been doing it all their lives, they already created the habit. It's effortless. If you want to catch up, you better have a compelling reason, otherwise, you're not going to be motivated to follow through, and therefore you can't create a habit. I think that's the advantage of someone that is doing that.

Speaker 1:

And I think once people start doing things for a few months, then that becomes a habit. Once if you get to a uh level of exercise, like I can't imagine not exercising. I I really can't, I it, you know, even if when I travel and there's you know flights after flights and I can't, you know, exercise formally, I still walk a lot, I still I can't imagine a week go by that I wouldn't exercise. It hasn't happened in years where a week went by and I didn't exercise. It's so inside. I mean, I can't. I can't, I'm addicted to it. I totally hear you. But I I think most people do it on a regular basis and they see the results, and also I can also feel like if I travel and I can't like have a meeting after meeting and I have to catch an hour flight after a few days, I can feel the tiredness that I'm not quite fresh as I would otherwise.

Speaker 3:

I want to talk about that because you just said something interesting, because that really speaks of our Western society, modern lifestyle. And I want to pivot into diet a little bit. We often, and you talk about brain foods and diets that are good for your brain, and in you know, one of the very classic and studied actually diets is the Mediterranean food and the the mind diet, the mind study, and so forth. We live in a society, we live in times where what you just said, you know, people work, they travel, we don't get to prepare the ideal Mediterranean diet. So, first I want you was us to uh I want you to tell us what that diet consists of, but then also I want to frame it such that in today's world and society, realistically, only maybe half or a third of our pe our our society is able to consistently maintain this ideal diet. So the other aspect is also you connect diet with gut health and stress and all of that. So it's not just one thing. We already discussed it, it's not just exercise, it's not just diet, it's not just mindfulness, it's a plethora of things, it's a combination, it's a this soup. But talking about diet, first talk to us about what is the ideal diet and what solutions do you have for people that are not able to sustain and maintain that type of ideal diet.

Speaker 1:

I think the diet is actually very simple. It's it's a lot easier than you think it is. The simple rule is this don't eat junk food, period. If you don't eat junk food, I'm happy. I'm fine with it. Don't worry about the details of that Mediterranean diet, don't worry about you know what exactly is contained in that diet. Just don't eat junk food. No candies, no cookies, no muffin, no donut, no french fries, no processed food. So pretty much you're asking us not to eat anything. Well, no. I'm joking. I think I think you have choices to what to buy when you go shopping. You have a choice of buying that box of cookies or not. You have a choice of buying, you know, bagged vegetables or bagged this and that. And and and that's the thing that needs to change. If you do that, I'm happy with it. Yeah. But just so you know what the Mediterranean diet is, Mediterranean diet has an emphasis on fresh fruits, uh, fresh food, fruits, vegetables, legumes are the main features of the Mediterranean diet. And the thing is that you know, you don't have to necessarily eat this food, not that food. Just eat fruits and vegetables and you know, add legumes when you can. And and I I eat a Mediterranean diet, and I think it's pretty simple. I mean, I usually have some oatmeal with maybe a banana and some protein powder because I think it's important to have enough protein in a day. I have a Greek yogurt for lunch and dinner. My lovely wife prepares different dishes different nights. Um I'm lucky in that front. And usually it's uh you know, a mixture of vegetables, and is whether it's chicken breast or fish or sometimes red meat. And and and during the day, I usually have four or five snacks, which are usually fruit. Maybe I have some grapefruit. I love blueberries, oranges, apples, pears, whatever seasonal. That's it.

Speaker 3:

It's not how much attention do you uh put into your macros and particularly your protein intake? Do you pay attention to that?

Speaker 1:

One thing I probably need more of. You know, I have uh two scoops of protein powder in the morning. Well, that's good. Uh sometimes I may have a protein bar after exercising. And at night we do have meat which has protein in it. So I think I probably get 60 grams of protein, 70 grams of protein, and I I think I probably need more.

Speaker 3:

Yeah, I think you could improve there. I mean, one of the things that I underestimated the importance of protein in the context of general diet. One of the things I always thought I was a sweet tooth. I always thought it's almost like since I was a kid, I was labeled as a sweet tooth because I was naturally drawn to sweets and candy. And it's hard not being driven to sweets and candy living in Germany. I mean, arguably in Europe they have the best chocolate. Growing up, I took on that habit. But when I changed my protein intake, when I increased my protein intake, I was around 60 to 80. I took it up to 150 because most recommendations now are one gram of protein per pound of ideal body weight, as opposed to the recommended dose, which is the minimum dose, which is half of that, at which point it's not optimal, but you at least you avoid losing uh muscle mass. But if you want to optimize your system, you need to do one gram per pound of ideal body weight, which for me would be 150. I realized I struggle to take in that much protein with a regular diet. So I like you start my morning with two scoops of protein powder, and so I load up my system in the morning with at least 30 to 40 grams. So I start high, and then the rest I try to eat my proteins as for lunch with uh legumen, lentils, beans, tofu, basically vegetable, protein, can vegetable that contains protein, and then at dinner I have meat, salmon, steak, chicken, and then I get another 30 gram out of that, and then I can hit my 150 throughout the day, and throughout the day I may add a protein snack. So all my snacks are protein, so I focus on that, and then I start my morning early. Since I've been doing that, my craving for sweets have gone to zero. You put a bowl of MM in front of my face, I won't pick a single one. Before I had enough protein, I would finish it. You would have to fight me and take that bowl away from me, and I would chase you, I would hunt you down. And that's the one revelation that really made me appreciate a proper diet that is satiating much more than I thought. And I think one of the main factors of having that satiated feeling is giving your body enough protein where you don't start getting the shakes, where you store don't start getting hungry or hangry in my case, and then craving the dopamine hit that the carbs would give you. And instantly, it was so easy, it didn't require any effort for me to cut out the ultra-processed stuff and the snacks just by giving myself enough protein. Now, in regards to diet, my second question was that well, now that we live in a society because people work, people travel, people have kids, people have stuff to do, and they might not be lucky like me and you, and have a beautiful wife that is a foodie or can prepare great food that is on the same page. Some people don't have a wife, and or some people have a wife but or husband that they're both, you know, uh have busy lives, they have many children, still in in ages where they need to take care of them. They just don't have time to even go shop properly. But I agree with you, I think it starts all by in the grocery store. Which aisle do you go to? But at the end of the day, you still have to have time to prepare that. We often diminish the value of supplementation, of supplements. You know, protein powder is a supplement, a protein bar is a supplement. But when it comes to other supplements like vitamin D, omega-3 fish oils, vitamin B12, folate, all of these supplements that we know over a third of the population are lacking because their nutrition is not optimal. And when people talk about those are just expensive urine, but that at the same time we know a third of our population, especially the older we get, the more malnourished we get. What do you say to those people? And how do you make recommendations when it comes to supplementations for your patients?

Speaker 1:

Okay, step number one is you know, no time is no excuse because your health, your future, your your brain, your heart are essential factors. And if your work is too much and you can't do that, then you need to rethink your life. I I was in France and somebody said, you know, people look down at someone who works too much in the office. It's a reflection of poor time management, is look upon negatively if you work too much. It means you failed to get your job done in a timely manner. And so the first thing we need to do is to change our attitude toward work and the need that we need to kill ourselves, you know, work 16 hours a day to be successful. I think it is possible to be successful working a few hours and be more creative. Or maybe there are periods, maybe a year or two restarting a new business or you're rechanging something. For a period of time, you kill yourself. But it should not be a habit of working like that decade after decade after decade. That's poor time management. Number one. Number two is that, you know, before I was married, I cooked myself. It was very simple. You know, I would go to the grocery store, I would get some chicken and some tomatoes and some mushroom and you know, some onion, and you know, I chopped up the onion and tomatoes and the mushroom, and I fried the chicken with some uh olive oil and added those, and I mean, you know, 15 minutes I would have the food ready. So I think really we need to decide what is our priority, and uh you know, is our health and well-being, you know, secondary to um our work. So that's the thing. And the other thing is that you know, you mentioned you have legumes, or you eat fruits during the day, or you know, you have a pretty pretty healthy diet. Each thing you put in your mouth has a collection of different vitamins. Some of them have high zinc, some of them have high other minerals, and some of them have you know high protein. And I'm really against vitamins and supplements in general because how does a person sitting in a pharmaceutical company or some vitamin-making company know what individual person is lacking?

Speaker 3:

Because I don't think people should just randomly uh shot do a shotgun approach and take supplements. I'm talking about physicians based on patients' lives are kind of like the questionnaire you did, based on their lifestyle, the dietary habit, their sleep, their exercise, and then look at their biomarkers based on an analysis, a comprehensive analysis of that. For example, I started doing that in the past years in my clinic, and 82% of all my patients that have a vitamin D level 30 and below, which is literally at the bottom and then deficient and in some cases insufficient. Well, that needs to be supplemented because I'm sorry, we just don't have the time to spend eight hours a day outside in outdoors to get adequate vitamin D levels as how genetics were programmed as part of the evolution. Because we spend 95 times 95% of our times indoors. They did a study that showed that children spend as much time outdoors as inmates in prisons, and in some cases, even less. Well, of course, they're gonna have vitamin D deficiency, but then we have to yeah, until we change how we live, which is uh a societal rethinking, we need to keep people healthy. So I don't think there's anything wrong with supplementing.

Speaker 1:

So I checked B12 level, vitamin D level, and several other vitamins, and if they were low, I would uh if somebody vitamin D was 10, I would give them 50,000 units prescription of vitamin D. And B12 level was often not so much low, but it was with less than optimal, because the normal level of the B12 is 200 to a thousand, yeah, but someone level 210 is too low. So I in that sense, I did do what you're doing, which is targeted supplementation. The one supplement I recommend.

Speaker 3:

That's what I'm talking about. I'm talking about targeted supplementation.

Speaker 1:

I'm not saying one supplement I give to everyone I take myself is omega-3 fatty acids. Which which forms do you take? Is DHA and EPA? I take DHA, EPA, what a thousand? Total DHA, EPA of a thousand milligrams. I do the same. Yeah. And so that's the only supplement I think. I think people need to know their vitamin D level because if their vitamin D level is 20, is different than if the vitamin level, vitamin D level is 5 or 29. Yeah. If it's 29, they need to take supplements. But if it's five or ten or fifteen, they need prescription dosages. Same goes with B12. Yeah. But omega-3 fatty acid, I think, is very important. I did a research myself and actually published in Nature, and we found that people study we did meta-analysis, and studies have shown that low levels of omega-3 fatty acids are associated with a high level of higher incidence of Alzheimer's disease. Another recent study replicated that prospectively. Our study was a retrospective analysis of published studies, and it's a prospective study that showed omega-3 levels. Omega 3 fatty acid makes a huge difference in brain function. So it's important to make a distinction not to take fish oil because fish oil has you know DHA and EPA and a whole lot of other things, including mercury, but a DHA-EPA is what we need. So sometimes people get fooled by a cheap brand of fish oil, which is a third the price of omega-3 fatty acids. And omega-3 fatty acids that we're talking about are DHA and EPA. So DHA EPA is essential. I take it, my wife take it, my daughters take it.

Speaker 3:

Yeah, I think again, we're not talking about all the supplements on the sky. I think it has to be tested. And a lot of my patients ask me, hey, what supplements do you take? I said, the supplements that I take are specific to my uh status. It's not like, oh, you have to take these supplements because of the because it's a good supplement. Well, what are your levels? Exactly. That's that's you articulated my point beautifully. That's exactly what I mean. So the but the context is this you know, uh my my point was like on paper, we always say just eat healthy Mediterranean diet or just cut out the ultra-processed foods. You know, in reality, let's look at statistics, right? So about one in four to one in three adults over 60 in the US has suboptimal nutritional status. These are facts, right? Because not everybody has the luxury, and a lot of people don't, frankly, don't have the money. They're either malnourished or at clear risk of malnourished. And in high-risk groups, in institutional settings, that number even goes up to 30, 40, even 50 percent. So micronutrient deficiencies are common. I mean, especially in the very old. And uh, there's another caveat to that, and why that is malnutrition and old. I covered it in my previous podcast, which you might actually find fascinating. And I'm really curious to know, to see if you have heard about it, because it was a recent publication in The Lancet by a group out of Tufts, whom I interviewed on my last last podcast. Now, you layer that uh what we just discussed. Many older adults can't chew properly. You know, like I'm an old maxillofacial surgeon, I deal with patients that come in with you know atrophy of the uh jaws because they've lost their teeth many years ago, and they can't chew because they can't get teeth. So we end up in this vicious cycle, right? Poor dentition, poor chewing, poor diet, hidden malnutrition, and then more brain vulnerability. Okay, so yet when patients try to close the gap with supplements, you know, first of all, a lot of doctors don't check for these micronutrients like me and you do. I know that because we see the same patients. And I always ask myself, how come their doctor doesn't change for micronutrient deficiencies? Because it's very cheap and easy to treat, but rather they dismiss it as expensive urine. So as if everyone is already eating perfect Mediterranean diet, right? So given the data that a third of older adults are undernourished or at clear risk, and many can't practically follow the ideal diet because of oral, social, or financial limitations. I think we gotta reframe the conversation about supplements is such that me and you just did, and we have been doing in our practice. And so the uh study was interesting that showed the number of the teeth that you have in your mouth is correlated to your all cause mortality. And they published it in The Lancet. The cutoff was if you have less than or you have more than 10 teeth missing, which is you know a little less than half your dentition, your all cause mortality goes up by 50%. Why is that? And your risk of diabetes goes up. Right? So here's the causality in all of this. When you don't have teeth, you can't eat a lot of the foods, a lot of whole foods, a lot of the foods that are good for you, because you can't chew. So automatically you pick foods that you don't have to chew much, and much of that food is ultra-processed foods. So I I'm curious to see if that's something that you have considered. And if not, do you think you are going to consider now evaluating patients and bringing that as perhaps a fifth uh sixth pillar? How many pillars did you have? Five as a sixth pillar into consideration and discuss these issues of uh oral health with the oral surgery community and the dental community so that we can properly equip these patients so that they can eat the foods that help their brain.

Speaker 1:

I totally agree with everything you just said. It's unfortunate that good food is so much more expensive than junk food. It's so sad. Because you know, if you want to buy a pound of grapes, it's more expensive than like two big mags, you know. Yeah. And uh it's really surprising that you know, if you want to buy blueberries, you just have to buy it like a small little cup, you know, and then you go to these fast food restaurants and they give you the full meal that fills you up. And people have financial problems obviously have no choice but to eat because they need food, they need quantity, they need to fill their stomach. And that's unfortunate. And I think people like that have definitely need to consider supplementation beyond what we're just talking about, because they are naturally deficient in light things, and older people may also have less access to cooking and and preparing meals and and and just obtaining the ingredients may be a challenge. And I think it was very interesting that you just said I I actually didn't know about that study that yeah, it was just recently published. Yeah.

Speaker 3:

So But it's something that we in our field have known all along.

Speaker 1:

Yeah, yeah. People who have poor dentition and poor gum health have twice the risk of developing Alzheimer's disease. Wow. Um, and and some people who really dwell on oral health as a major factor for brain health. And the idea is that if you have poor gum health, especially the bacteria that usually live in your mouth and they belong to your mouth as a part of their oral macrobata. It's they don't belong in the in the in the blood and definitely don't belong in the brain. And so the argument is that the erosion of those blood vessels allows this bacteria to seep in to the blood, and some of them eventually find their way inside the blood vessels in the brain, or they can cause blood clots. There's increased formation of blood, it just covers stroke, which is what you alluded to is the leakage into through the blood into the cloud. One is erosion of blood vessels because of inflammation, and the second thing is formation of blood clots. And so people who have poor oral health are at higher risk of developing strokes because of formation of blood clots. And so I think oral health is definitely on top of a list of things to consider for treatment, and I think it's an example of how we need to pay attention to all the details. Similar issues with hearing, see, a lot of older adults have hearing problems, and everything you said about the mouth applies to the ear because people who have poor hearing are far more likely to develop Alzheimer's disease. And a recent study, a placebo control study, showed that if you provide hearing aid to elderly who have hearing loss and have MCI, you revert them to normal. It's like it's like an effective drug that would uh convert someone from MCI to normal is a hearing aid. Because it because it stimulates the brain? It's because when you don't when you don't hear well, you don't process information, you don't engage in information, you don't process it. The information is not coming in, you just disregard it. You get used to just checking out hearing it. And same goes with oral health. And you know, it just is so common, people take it for granted. But if you don't get the nutrients and if you you can't chew things, you just eat software.

Speaker 3:

Well, interesting about the chewing, they monitored on the MRI as the patients are chewing, the part of the MRI showed activation of the brain just by mastic through mastication. Yeah. So the so they they actually recommended and they did a study where they showed that if you, for example, chew gum before you want to memorize something, or let's say you just read something and you you you want to make sure that you remember most of it, when you chew gum, because your brain gets more active, you you will have uh uh improved memory function of that. And so it's fascinating to think of how external factors, hearing, seeing, chewing, talking, uh listening to music through activation of your brain can improve upon this plasticity that you talked about. And and so that's something it's fascinating.

Speaker 2:

Just chewing, chew gum.

Speaker 1:

I think our brain is like a muscle, the more you use it, the stronger it gets. And one way to use it is to apply information, and that's why hearing or vision loss can affect the brain. I must say I hadn't heard about chewing part. Yeah, it is. They they did an MRI analysis of chewing, and it just lights up. Related, although I don't know how to explain it, is that one study showed that people have a smaller temporalis muscle, have a smaller brain. So why do they have a small temporalis muscle? Probably because they're not chewing. I mean, I don't know. I'm just I think in that study they found a correlation between a smaller temporalis muscle and a smaller mass of muscles to understand. In general, yeah. In general. I don't know why the two correlate, but they do. In any case, I think the bottom line is in evaluating you know, a lot of people get older, have a lot of little problems. A study published in Lancet in 2024 showed that 45% of dementia cases in the world can be prevented through 14 different interventions or addressing 14 treatable conditions. And this was a major publication in Lancet. It's one of the most commonly cited papers. This is not like my program where somebody came in and did, you know, diet, exercise, brain training, everything, like with the way we did it. They just looked at epidemiological studies to determine what factors contribute to dementia and the burden, how much of a how much of how much they attribute to cognitive decline and dementia in the world. And so they found things like uh diet, stress, centered lifestyle, hearing loss, vision loss, high cholesterol, a lot of common medical issues we see on our patients contribute to dementia. And if those issues addressed without doing anything additional, without doing brain training, without like necessarily doing anything extra, if you just address the treatable medical conditions that need to be treated anyway, hypertension is one of them. 45% of dementia cases in the world could be prevented. Just think of it.

Speaker 3:

Unbelievable. And how many billions of dollars? What we've spent a billion dollars on treating amyloid plaques and tar and and and and all these Alzheimer research for researching medication to treat Alzheimer's, where the problem 95% of the time is the root cause that, like you said, 50% can be treated. So, do you think we've wasted a lot of time, money, and resources and just advanced some scientists' careers by researching Alzheimer's, where most of the research uh has been going towards treatment rather than prevention?

Speaker 1:

I think a lot of people who do research are honest, sincere people doing research. I think amyloid has gotten more of its share of attention than all the other contributing factors. Why do you think the question is why? I think I think the question part of it is because people want a drug for everything. And if we talk about high blood pressure and cholesterol and stress and poor diet being a factor, that's not something you can make a drug for and treat it. A lot of uh from school companies and researchers falsely have believed that if they s just stop the amyloid, they cure the Alzheimer's disease. First of all, I think Alzheimer's disease is not a good name for the cognitive decline that happens with aging. See, in the brain, you have plaques and tangles, which are hallmark of Alzheimer's disease. However, you get Alzheimer's because your brain shrinks due to a dozen reasons, the super problems. And plaques and tangles are the two of the super problems. And so you're naming the whole brain problem after one feature. And I wrote an article about this in 2009 about how we need to reconsider and call Alzheimer's disease, you know, mild cognitive impairment, moderate cognitive impairment, and severe cognitive impairment. Because if you call it severe cognitive impairment, you don't blame it on one or two factors. You're you're just saying you have heart failure. So if somebody has heart failure, you don't call it amyloid problems. There are people who have too much amyloid and experience heart failure. That is true.

Speaker 3:

But that's not the call, yeah.

Speaker 1:

Because that you don't call it.

Speaker 3:

Yeah, amyloid is the symptom, is is the smoke.

Speaker 1:

The fire is elsewhere. So I think the problem is this that amyloid has gotten more of its share of attention in the past two, three decades. But it has not always been like that. Things change every 40-50 years. In the 1950s, blood vessels were a problem. They was called hardening the arteries. What we call Alzheimer's now used to be called hardening the arteries. And you know, 50 years from now, people probably would look at something else. And I think it's human nature to just follow the leader. And sometimes a group of people become particularly powerful and they set the tone for who gets these grant approvals. So if you have a grant application for Alzheimer's disease and you talk amyloid, you're a lot more likely to get funding than if you work on some protein unrelated to amyloid.

Speaker 3:

I think a lot of our research is guided because of what you just said. And until that changes, we will be chasing our tails for decades, spending billions of dollars in resources where a lot of people make a lot of money, they make careers for themselves, but the consumer does not benefit from it. The patient doesn't benefit from it. And I wish we had in the medical profession more of the fatohis and the people that actually treat and look for the root cause and make a huge impact. I mean, the numbers that you were saying, they are mind-blowing. And I I I know because I talk to colleagues, I'm pretty sure that majority is not aware of that. And yet you have spent what three decades of your career just doing that in your backyard, and now you're going out and trying to shift the paradigm after three decades of failed Alzheimer's research. I think once our system changes in how we fund research, then we can advance medicine much faster than we already have been, and not rest on our laurels.

Speaker 1:

Now, here's one more interesting statistics, which is fully confirmed multiple times. Uh, stroke is the number one cause of disability in the United States, and it's the second leading cause of death in the world. And 80% of strokes can be prevented. 80%. Yeah. Just think of it. And and of course, strokes or reduced blood flow to the brain is a major contributor to cognitive decline and what we call Alzheimer's disease. And so an 80% reduction in stroke would be a huge reduction in Alzheimer's. And it's it's by American Heart Association. This is not just somebody just making this up. It's reported year after year after year. Is it 80%, 80% of strokes in the world can be prevented through treating the modifiable factors like as hypertension, stroke, I mean hypertension, obesity, diabetes, centered lifestyle. These factors, not smoking, all these factors can prevent the number of strokes, 80% of strokes, and stroke is the number one cause of disability, number one cause of disability in the United States. And you can reduce by 80%. I know. And why hasn't it happened? Because a stroke doesn't have an amyloid, the stroke doesn't have one type. Think that we can medicate, yeah. Yeah. Stroke requires exercise, weight loss, you know, poor, you know, healthy diet, active.

Speaker 3:

Well, think of the financial burden alone. The financial burden that it carries with it once a patient has stroke and survives a stroke, similar to people with severe cognitive decline. I'm not calling it Alzheimer's, I've learned, so I'm a good student, with severe cognitive decline, CDI, that simply the financial burden on our society that it imposes, if you know, from both a health perspective for the patients, the social aspect of it, and then the financial aspect of it for our society. I hope that that changes. I hope that through social media, through podcasts, and so where we're not relying on certain groups where there's groupthink involved or there's hidden agendas, we're not relying on traditional media to maybe put it on the evening news. Through podcasts, through social media, we can spread. So and I believe, and at the very beginning of our podcast, you said something that you said in the past decade, the number of Alzheimer's has gone down. I believe it is because of the easier and faster spread of information because of the internet, that more people have access to information, good or bad, at scale, where they can make their own decisions based on their own research, questioning their doctors, asking the right questions, and moving the needle in their own health department. And I think that our technological advancement has a huge thing to do with that, because otherwise I can't explain it. And this there has been, you've probably noticed it in the past five years alone, since COVID, this huge health and longevity movement that is part of that. People were sitting thinking, oh well, I guess we're dying of COVID, but the people that are dying of COVID are the unhealthy people. So, hmm, let me put two and two together. If I get healthier, I have a lesser chance of dying of COVID. How can I get healthier? And all of a sudden, people have become more aware about become more health conscious, and they have their health IQ has risen. And I think that in part has to do with it. And I'm very optimistic about the future, and I'm very optimistic that I feel the cat's out of the bag, and it's gonna be a big change is coming in the next decade, and I'm I'm really excited about that. So thank you so much, Majeed. We have almost covered everything I wanted to cover, but the good news is that what I've learned today is that we're not prisoners of our genetics. The uncomfortable truth is our future brain is being built right now in our 40s, 50s, 60s, with every decision we make about movement, food, sleep, stress, and how we challenge our minds. So, Dr. Fatui, thank you so much for sharing your science, uh your clinical experience, and your hope uh with us today. I can wait uh for people to I can't wait for people to read your new book, The Invincible Brain, including myself, and start applying these tools to their own lives and hopefully you can change millions of lives uh and uh their practices for the professionals out there, for our colleagues that are listening. So, for everyone listening, if this episode resonated with you, please, please, please share it with a friend, parent, or a patient who needs to hear that decline is not inevitable. I'm Dr. Daria Hamra. Thanks for listening, and I'll see you in the next episode. Thank you. Thanks, Darya.