Dementia is Preventable with Dr. Majid Fotuhi: Rational Wellness Podcast 450

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Dementia is Preventable with Dr. Majid Fotuhi and host Dr. Ben Weitz.  

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

 

Podcast Highlights

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Dr. Majid Fotuhi is a board certified neurologist, neuropsychiatrist, and the author of the new book, The Invincible Brain.  His website is Dr.Fotuhi.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

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Podcast Transcript

 

Dr. Weitz:  If you’re looking for clinical useful insights, not wellness hype, then you’re in the right place. Welcome to the Rational Wellness Podcast, a podcast for functional and integrative practitioners who wanna practice with greater clarity and precision. I am Dr. Ben Weitz, and each week I sit down with the leading clinicians, researchers, and lab innovators to explore the science lab testing and clinical reasoning behind modern root cause medicine.  This is a show focused on practical evidence-informed insights that you can actually use in patient care. Please subscribe to the Rational Wellness Podcast on Apple, Spotify, or YouTube. Tell your friends and colleagues and if you could give us a five star ratings and review, we would certainly appreciate it.  Finally, to access the show notes and the transcript, go to my website, drweitz.com.

Today on the Rational Wellness Podcast, we’re diving into a hopeful and empowering conversation about brain health with our guest Dr. Majid Fatuhi. Dr. Fatuhi is a board certified neurologist, neuropsych, psychiatrist, and the author of the new book, the Invincible Brain.  Dr. Fatuhi has spent decades using advanced brain imaging, neuroplasticity research, and lifestyle based interventions to help people, not just slow cognitive decline, but actually reverse it. In this episode, we’re gonna challenge the idea that memory loss is inevitable. Talk about why Alzheimer’s disease is sometimes misdiagnosed and explore how sleep, stress, exercise, nutrition can reshape the brain.  If you’ve ever worried about your memory, brain fog focus or long-term cognitive health, this is an episode you don’t want to miss. Dr. Fatuhi, thank you so much for joining us.

Dr. Fotuhi: It’s my pleasure. Thanks for inviting me.

Dr. Weitz: So what did you mean by the title of your book, The Invincible Brain?  Is the Brain Invincible?

Dr. Fotuhi: I think there are many things we can do to make our brain resilient against the effects of aging. Many people assume that just because they get older, everything falls apart and that the memory will fade and that they just gradually become demented. Their brain has a high degree of resilience, and there are many ways that they can make their brain invincible and stay sharp for decades to come.

Dr. Weitz: Right. For years they used to say you have all the brain cells, you’re gonna have all the neurons you’re gonna have by a certain age, and once you get older you just lose neurons. And we’ve learned that throughout your life, you’re continually making new neurons, making new neuronal connections, especially if you do the right things.

Dr. Fotuhi: Absolutely. We used to think that people die with [00:03:00] as many neurons as they were born with, or they’ll just keep losing neurons when they get older. But research has shown that human beings are capable of generating new neurons in the memory part of the brain called the hippocampus. And this neurogenesis can happen at any age.  This is something that has been, that has been shown in animal studies for a long time. But in recent years, human studies have shown the birth of new neurons in hippocampus at any age.

Dr. Weitz: So what are the most powerful mechanisms that drive this neurogenesis? Okay.

Dr. Fotuhi: There are several things people can do to increase neurogenesis in their hippocampus.  The best way to do that is exercise. I’m baffled as to why physical exercise will have anything with the brain and generating new neurons in the brain. But we know for a fact that when people increase their fitness, [00:04:00] they create more neurons in their brain, and the mechanism may be the degeneration of BDNF.  When you exercise, you increase levels of BDNF in your muscles. BDNF is an example of a myokine hormones released from muscles. And A-B-D-N-F has a nurturing mechanism in the brain, and it can help with both a generation of new neurons and maturation of new neurons. So these stem cells can actually turn into mature, high functioning neurons.  And when you exercise you, yeah, go ahead. When you exercise, you increase blood flow to the brain and you reduce inflammation, both of which can also provide an environment for new neurons to grow and blossom.

Dr. Weitz: Are there certain forms of exercise you think are most effective for brain health?

Dr. Fotuhi: That’s a difficult question to answer because there’s mixed results.  We definitely know that when you increase your VO O2 max, when you increase your stamina, you increase the number of mitochondria. Everywhere in the body and in your brain. And when you have more mitochondria, you have more a TP, which has, which means there’s more energy for brain cells to work. So I think as long as you’re getting to the point of puffing and puffing, you’ll create new neurons.  I usually do a combination of both. I usually do like an hour of stationary bike, 45 minutes, myself, weightlifting. I don’t think it’s a good idea to just focus on one and not the other. The benefits seem to be complimentary. You definitely want muscle. It’s amazing that muscle mass actually helps with the health of the brain cells.  And I, it’s definitely the case that if you can maintain cardiovascular stamina and you increase more blood flow through the brain, that your brain also functions well. So ideally you wanna have a combination of both.

Dr. Weitz: As we age, we know the loss of muscle is a major [00:06:00] factor. Weaker muscles leads to falls, leads to shortness of life.  There’s people in nursing homes that can’t get outta bed simply because of sarcopenia. So, you know, if you want to keep the the housing of the brain working, then you need to keep your muscles up as you age if you wanna live a longer, healthier life.

Dr. Fotuhi: Definitely, definitely. So many studies have shown a direct link with between the muscle mass and brain health,

Dr. Weitz: and

Dr. Fotuhi: in your, when, when you have muscle atrophy, that’s the beginning of the end.  When your muscle starts to shrink sarcopenia, then the there will be start the process of shrinking that happens in the brain.

Dr. Weitz: And there’s something about. Novel activity that stimulates the brain too, right? Like doing something different in a different way that forces you to think and coordinate that has a, a beneficial effect on brain.

Right?

Dr. Fotuhi: [00:07:00] Exactly. The similarities between brain and and muscles is amazing. Just like if you wanna build muscles, you have to feel a little pain. You know, they say no pain, no gain. Same applies to your brain. You want to feel a little frustrated. You need to find something that’s a little challenging, not so challenging that you just give up and can’t do it, but challenging enough that you can push yourself and the moment that you feel, oh, I can’t get it, that’s the moment that the new synapses are born.  Just like when you do lift heavier weights than you can usually handle, you get new muscle fibers. Same applies in your brain, and so you want to challenge your brain as much as possible and make, do things that are a little outside your comfort zone. Your brain is like your muscle. The more you use it, the stronger it gets.

Dr. Weitz: My latest challenge is trying to push my rating on chess.com up, and that can be very frustrating. 

Dr. Fotuhi: Yeah, so the moment that you’re frustrated is the moment that there are things that are happening in your brain, so you should welcome that. So if you’re not frustrated, if it’s too easy, then you’re not really challenging yourself.  You like, I like to learn, you know, I know several languages, including French, so I try to, you know, practice French for a few minutes every day as much as possible. And you know, I play Sudoku and I try to go to the next level. So I always try to push just one notch.

Dr. Weitz: And there’s specific brain exercises too.  People have developed programs that you can do on a computer that measure which parts of the brain need more work and can give you specific exercises to help with short-term memory or long-term memory or different aspects of cognitive health.

Dr. Fotuhi: Absolutely. Just like when you go to a gym and you can choose to work on your biceps or [00:09:00] triceps, or you can work on your core or your legs, you can choose which part of the brain you want to strengthen.  You can work on your memory, your attention, your concentration. Your executive function, your processing speed, your problem solving. There is a many of things that you can work on. And when you do these brain game apps, they give you options. They give you options. They wanna work on your memory, on your processing, speed on your attention, and you pick whichever area of the brain that you want to work on.  And if you keep working on it, you’ll find that they will get easier and that you can advance in those brain games.

Dr. Weitz: Do you have a favorite brain game app that you like? 

Dr. Fotuhi: I actually like Lumosity. I think the the interaction and the games they have are well explained and they’re inviting. There are also few other ones.  There’s BrainHQ. 

Dr. Weitz: Yeah.

Dr. Fotuhi: Elevate and Peak. And I think the best way to challenge your brain is to do a hobby that you enjoy, like if you learn how to fish, if you learn how to dance, if you learn how to crochet, if you learn how to improve your photography skills, all of those things are learning.  You don’t have to necessarily sit in front of a computer and do these brain games.  The advantage of those brain games and apps is that you could be selective. You can pick area of attention versus concentration versus memory and so forth, but you know, you wanna have fun doing it. So I recommend doing something you enjoy. Like I enjoy dancing and when I take dance lessons I have to keep track of the steps.  You know, it involves attention to which step comes which after which step, and also have to be mindful of my body, of my partner’s body. [00:11:00] And this is also exercise, so my recommendation is to pick something you enjoy and that will mean that you’re more likely to continue doing it if you dread doing this kind of brain camps.  Don’t, don’t waste your time. Pick something you like. In my book, I have a list of like 50 things that you can consider doing in terms of brainstorming to find something that you enjoy. Same goes with the exercise. You need to pick an exercise you actually enjoy. If you don’t like running, don’t go running.  You know, go rowing or swimming. You don’t like swimming, you don’t like those kind of things. Go for a hike. You go rock climbing, go, you know, play ping pong, play tennis, play pickleball. Pick something you actually enjoy and that will help you stick with it. And the same applies to brain games and brain challenges.  Pick brain challenging things that you actually enjoy

Dr. Weitz:  When it comes to dementia and brain decline, the most common condition we always hear about is Alzheimer’s. But you say that Alzheimer’s is frequently over-diagnosed. Can you explain why that is?

Dr. Fotuhi: Yes. That is a major public health issue we have these days, and that’s an over-diagnosed of Alzheimer’s disease.  See, there are two sets of things that happens in the brain with aging. There are these things called amyloid plaques. T tangles, these proteins aggregate and when they aggregate they, they become like a piece of gum and that causes inflammation and that causes brain shrinkage. With early onset Alzheimer’s disease patients have mostly these plaques and tangles, which shrinks their brain and makes them become demented.  But in late life, Alzheimer’s disease, the most common form of. Alzheimer’s disease patients have two ba basket of things, these plaques and tangles as well as inflammation, reduce blood [00:13:00] flow and reduce the natural rinsing and cleaning that happens in the brain. These things can also cause what’s called as a leaky brain.  The blood vessels can erode and the content that the blood can actually seep into the brain tissue, which is a horrible thing for neurons. Neurons are very sensitive and they can’t tolerate to have like red blood cells and cytokines and things around them. So. If you look at an 80-year-old brain, you see at least seven different pathological things.

You see plaques and tangles, and then you see evidence of a leaky brain. You see evidence of small strokes. You see ev evidence of thickened blood vessels and, and, and narrow blood vessels. And you also see collections of other proteins that are associated with aging. These are things that you see, for example, in Parkinson’s disease called sin clean or Lewy body particles.  And there’s something called TDP 43 and [00:14:00] something other forms of tau. So. An 80 old brain has a whole lot of things. One set of things are plaques and tangles, and another set of things are all these things are just listed. When you go to a doctor and you have cognitive problems, they just label you with this plaques and tangle part of the condition.  They label you with Alzheimer’s disease, but each person is different. Like I may have in my brain at the age of 80, 20% of these plaques and tangles and 80% of these other things. It is never the case that an 80 old has only plaques and tans and nothing else. Never. It just doesn’t happen. In all cases of late life, cognitive decline and, and Alzheimer disease patients have what I call a soup of problems.

However, we’re calling that soup with only those two ingredients, the plaques and tangles. And this is not just a nomenclature problem. When you tell [00:15:00] somebody they have Alzheimer’s disease, you’re implying that they’re doomed to die in a miserable way because there’s no cure for Alzheimer’s disease, and this is the end.  They’re gonna live in a nurse, they’re gonna live and die in a nursing home. But if you call it cognitive decline or cognitive impairment, just call it mild. Moderate or severe cognitive impairment, which is what it is, and then look at the treatable components and treat the treatable components. For example, you know, obesity, diabetes, high blood pressure, insomnia, sleep apnea, poor diet, are all factors that contribute this other bag of things that we were talking about.

And if you address those, you can heal the brain. And I mean this at the most scientific way. I’m not just calling it like a healing mechanisms because I’ve seen it in my own practice. What I did in 2012, 2013, was [00:16:00] after having read all these scientific literature and having published several review articles about how we are over diagnosing Alzheimer’s, I said, listen, if this is really the case and you get a bunch of people in their seventies or early eighties, and you treat the treatable components of their dementia, they should get better.

Right. So this was the hypothesis that I decided to check. I put together this multidisciplinary program that addresses the treatable components and focuses on five pillars of brain health, exercise, sleep, diet, stress reduction, and brain training. And so we had these elderly men and women who came to our clinic twice a week, and they work with our brain coaches who coach them on how to improve their lifestyle.

And also, I treated the treatable components. So if somebody has sleep apnea, I put them in treatment for sleep apnea. It had, if they had [00:17:00] depression, I addressed the depression. If they had high blood pressure, I made sure that it was controlled, had diabetes, I made sure it was controlled. So I worked on the medical part of things and my staff worked on lifestyle things and we did standard.

Validated cognitive testing and brain MRI at the beginning, six weeks and 12 weeks. And what we saw was jaw dropping. These people who were told they have Alzheimer’s disease, they had a condition called mild cognitive impairment, early stage of Alzheimer’s disease, all improved. 84% of them had statistically significant improvements in objective cognitive tests.

It wasn’t that just, just told us they felt, whether they all said that, but when we put them on in front of computers and did testing on them, they had improved. 84% of them had a statistically significant improvements, and the brain MRI showed that more than half of them had [00:18:00] increased the volume of hippocampus by one to 3%, which is equivalent of a brain that’s one to three years younger.

We published those results in the Journal of Prevention of Alzheimer’s Disease, so in short. We do disservice to our elderly men and women who have cognitive decline. We often put the label of Alzheimer’s disease on them and just park them in a nursing home waiting for them to die. And that’s unfortunate because almost like in more than 90% of them have so many treatable components.  And addressing those does make a difference. And people can see results in a matter of weeks to months, not years. We definitely see results in three months, and we definitely see results in six months.

Dr. Weitz: So I wanna stay on this plaque topic. So first I want you to comment on the fact that probably the biggest scandal that we’ve ever seen in medical research has happened in the research related to [00:19:00] amyloid with the falsification of.  Diagrams in, in, in, in the landmark study published in 2006 that showed that Alzheimer’s is caused by amyloid plaque, that they falsified those images.

Dr. Fotuhi: Yes, there were some falsification of data in amyloid research, but to be fair, not all of the amyloid research and amyloid cascade hypothesis was based on those papers which were doctored,

Dr. Weitz: but billions and, and maybe hundreds of billions of dollars of research trying to develop drugs to reduce amyloid as a way to potentially cure Alzheimer’s has gone down that path and basically have been a dismal failure.

Dr. Fotuhi: I think the problem in this field has been an overemphasis on amyloid. It’s not to say that [00:20:00] amyloid has no rule at all. I wouldn’t want to have a range full of amyloid.

Dr. Weitz: Right.

Dr. Fotuhi: I think to put things in perspective, amyloid is similar to cholesterol in cardiovascular disease.

Dr. Weitz: Right, right. 

Dr. Fotuhi:  I agree with that.  If you have high cholesterol, it’s not a good thing. But in order for you to have a heart attack, high cholesterol alone is not the culprit. And some people even question that if cholesterol plays any role at all.

Dr. Weitz: Yes,

Dr. Fotuhi: so, so cholesterol has some role. I wouldn’t want to have high cholesterol levels. Is it, however, in, in order for someone to have a heart attack, they need to have high cholesterol, high blood pressure, diabetes, obesity centered lifestyle, stress, and all that other things too.

Dr. Weitz:  Well, having high cholesterol, the main reason why it’s a problem is if it forms plaque in the artery walls. And in order for the cholesterol to form plaques in the arteries, there has to be inflammation, [00:21:00] oxidation, toxins, et cetera. And, and that’s really one of the keys. And, and same thing with the brain.  We now know that there’s pathogens that enter the brain including microbes and bacteria and viruses, and we have toxins. And that, isn’t it the case that the amyloid is partially a response to trying to actually protect the brain. It has a antimicrobial effect. It has a, a, a, a, a inflammation reduction effect.  And, and it, it. We need to focus on some of these factors that lead to the the problems leading to the amyloid. And if we did that, simply eliminating the amyloid you know, would, it would be a totally different story.

Dr. Fotuhi: You, you’re right, you’re right. Now the, the story amyloid is complicated of fairness.  It’s complicated. I don’t think that, sure, there are [00:22:00] some people, the body’s

Dr. Weitz: complicated,

Dr. Fotuhi: who intentionally are. You know, lying, although I can’t be sure, but I know that amyloid has some physiological roles and like right now I have amyloid in my synapses that have a role in synaptic transmission inside my brain.  And they’re Okay. The problem with amyloid. Oh, and then you know, there’s evidence that amyloid has antimicrobial benefits that its response to problem. Right. It’s not the problem. You know, sometimes when I teach, I talk about how a amyloid, it could be like an ambulances that arrive at the scene of a fire.

And so if you have too many a, if you have too many amyloids, it’s like if you have thousands of ambulances showing up for one fire, then the ambulance becomes a problem itself, even though initially had some beneficial role. And so our fairness. Amyloid is really complicated, but one thing is for sure, it’s not the [00:23:00] simple story that for no reason your amyloid levels go up, you get Alzheimer’s disease and you’re doomed.

That storyline is called the amyloid Cascade Hypothesis that has dominated the field of Alzheimer’s disease for the past 40 years. And unfortunately, it’s not the case. It’s not that simple that you get al amyloid outta nowhere and that causes tau, and then the brain shrinks and you get Alzheimer’s disease and you’re gonna die.

And the solution for that is drugs that reduce amyloid. Now to prove that this hypothesis is not correct. Is that new drugs have been finally successful in reducing amyloid in the brain. I remember in 1980s there was a new drug, like called 15 7 9 2 that had just come to the market to reduce amyloid, and many of the patients who received that drug died of swelling in the brain and, and since then, at least a [00:24:00] hundred clinical trials have looked at the role of amyloid in the brain.

Minimum a hundred. These are randomized controlled trial, and all of them failed. Because there was such determination on behalf of pharmaceutical companies, and I give them credit for that to be so persistent. Finally, two, three drugs showed that patients did not die. And, and if you catch people who have small bleeds early, then you prevent from the bleeding that happens in a lot of patients.

So these days there are new drugs called kinumab and, and umab, which do reduce amyloid. However, even though they eliminate more than 80% of the amyloid in the brain, and I must say, I can’t believe how effective they are, it’s like getting eraser and clean all, all the amyloid in the brain. So if amyloid were the real problem, you would think that the people will perk up and function normally, right?

Dr. Weitz: But the patients don’t get better with these drugs,

Dr. Fotuhi: but the patients don’t get better with drugs, which proves that [00:25:00] amyloid is not the main con culprit. Now patients get less worse. Know, the, the clinical trials showed that, you know, if a person, instead of going down by 10 points right,

Dr. Weitz: they decline at a slower rate.

So slower

Dr. Fotuhi: rate,

Dr. Weitz: they’ll, they’ll spend more time in a nursing home.

Dr. Fotuhi: But, and, and that decline, that the difference is so subtle that neither the patients, nor the caregivers can tell. But to put this in perspective, that have also been randomized controlled trials for patients. We have diagnosed of mild cognitive impairment or early stages of Alzheimer’s disease.  Same patient population that received the drugs. And I actually did the research myself where I compared the benefits of the drugs. Versus the lifestyle programs and the lifestyle intermission programs. And there are five that I found that have done randomized controlled trials and use the same cognitive tests [00:26:00] as the clinical trials for drugs.  So it’s complaining apple to apple. It’s not like complaining different results. They use both something called a cau, a cognitive testing that takes about an hour and was using both of these drugs and the click clinical trials for multimodal lifestyle interventions appear to be far more effective than the drugs.  The drugs slow the rate of decline. These programs that combine diet, exercise, cognitive training actually improve cognitive function. And that’s a big difference. There’s a difference in that patients actually are one notch better. It’s not like they decline, but they decline a little less. They actually improve.  And this all the five clinical trials that use this outcome measure showed the same thing.

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Dr. Weitz:  What do you think about the functional medicine, precision medicine approach of Dr. Bredesen, who’s now been documenting this in research studies? And he has his first he has his first randomized trial that is soon gonna be published using that sort of approach.  And he’s shown both he’s shown a reversal of cognitive decline improvements in MRIs and cognitive testing as well.

Dr. Fotuhi: I saw the results. And I think he’s done a great job of showing the benefits of personalized medicine. [00:29:00] His results are similar to these other randomized controlled trials I told you about, right?  Which is when you do combine diet, exercise, brain training with reducing factors that can contribute to brain declines such as infections and toxins, you do see results. The beauty of our brain is that it’s, this has a high degree of malleability. It’s a beautiful thing. Like our brain is not a computer that just get old and rusty with aging.  Our, our brain’s like a flower, and if you take care of it, it blossoms and you keep maintaining it. It continues to blossom and it doesn’t necessarily decline. If you go from 40 to 50 to 60, you can maintain and grow a beautiful brain, just like you can maintain and grow a beautiful garden. And, and, and the details are important and I think that’s why it’s important to personalize the [00:30:00] intervention.

It’s not enough to tell people, Hey exercise, eat well, and don’t stress that that is. That is true, but every person is unique. For some people diet is a major factor. For some people is sary lifestyle factor, and if somebody has sedentary lifestyle, it’s possible that they have sleep apnea that makes ’em tired.  So they’re a victim. They’re not just lazy, they’re just, they don’t have the energy and they can’t do it. Not that they don’t want to, they just don’t have the energy. Therefore, it’s important to understand individual, patient and personalize interventions for them. That’s why our brain coaching was so successful because we didn’t tell people, okay, you know, follow this five pillar of brain health and come back three months from now.

We worked with them twice a week for six weeks and every week, every time we saw them, we checked on how they had complied with the things they had said. They would, for example, [00:31:00] they would say, walk 15 minutes a day. And so they came back. We asked them, did you walk 15 minutes a day in a nice way?  And we encouraged them to walk 20 minutes the following week. And I think that was the beauty of our program. That was, we were able to use the, the art of behavioral modification to get people to go over the hump. And in our experience, when people started to change, then they will continue to change on their own.  The most difficult part was that initial inertia to get started.

Dr. Weitz: So let’s go through a few of these different lifestyle factors. Why don’t we talk a little bit about diet? And diet is obviously very controversial. It’s like talking about politics, what a healthy diet to one person is an unhealthy diet to someone else.  But what do you think are some of the most important factors in a brain healthy diet?

Dr. Fotuhi: I think there are things that nobody would argue there. There is a large controversial product, [00:32:00] diet, and nutrition definitely. But I think there are three things that every person agrees on. I have never heard anyone challenge what I’m about to say.  Number one is highly processed food are bad for you.

Dr. Weitz: Right?

Dr. Fotuhi: Nobody ever said No, no, no, no, no. That’s wrong. I think there is unanimous agreement that highly processed food is not food. We shouldn’t call ’em food. It is, it’s just agreed is it’s, it’s trash. It’s like getting trash and add spices to it to taste good and then give it to people as food.

Yeah.

Dr. Fotuhi: And I think it is horrible what happens there.

Dr. Weitz: You put the right amount of fat, sugar, and salt, and you hit the bliss point and everybody wants to eat it no matter what’s made of.

Dr. Fotuhi: Exactly. The second thing is that I think everybody agrees that trans fats are bad for you. Things that companies put in like donuts and cookies and things that increase the half life of products staying on shelf for a longer period of time they’re [00:33:00] bad.  And I think there’s nobody who says, you know what? There’s actually some research that shows trans fats are good for you. I think there’s unanimous agreement that trans fats are bad for you, period. And the third thing that is bad for you is things that spike your sugar levels. Things that increase hyperglycemia quickly are bad for you, right?

Again, things like sodas and ice cream and cookies donuts, those things spike your sugar and eventually lead to insulin resistance, and they’re bad for you. So highly processed food, food high in trans fats and sugary food are absolutely bad for you. Now if you just avoid those things, you are free to eat anything else.

You know, my attitude is don’t eat those things and you are free to eat whatever else you do, because I know that the vegan diet has a lot of benefits. You know, it’s reduce of heart attacks [00:34:00] and, and, and it’s really good for you and. I wouldn’t be able to do it because I want to enjoy eating a variety of things.

I’m not a carni, but I do want to eat fish, you know, salmon or eat meat once or twice a week. And I eat you know, salmon once or twice a week and I eat lots of fruits and vegetables. So I follow a medi training diet, but I have nothing against people who really believe in a keto diet like Dr. Bredesen does, and, and recommend it and pursue it. I love eating blueberries and frankly, I don’t wanna live two years extra. If I can have my blueberries, I wanna have quality of life. I wanna enjoy my day-to-day life for years to come. I don’t wanna have just living longer. I wanna have good quality gears and enjoyment of life.  And I believe that if you eliminate those three things I mentioned, there’s not much left to eat, so you’re good to go.

Dr. Weitz: Okay.

Dr. Fotuhi: I think [00:35:00] natural sources are best and, and I know again that there is inflammation associated with some grains and some people are very sensitive to eating grains. I had many patients who had migraine and we eliminated diets and their migraine got better.  I know main neurological conditions, so epilepsy seizures. Patients do really well on a keto diet and, and I know the vegan diet’s good and I haven’t been really convinced with what is the best diet. So the diet that I eat is a Mediterranean diet

Dr. Weitz: and, and really I think. From my perspective in the functional medicine world, you’ve gotta do some testing to see how your body is responding to that diet.  So you might eat a diet that you think is gonna be good for your blood sugar, and maybe in your case it’s not for whatever reason. So I think it’s beneficial if you can follow a, a nutritional approach and then do some testing [00:36:00] to see how it’s working for you.

Dr. Fotuhi: I agree. Yeah. I think doing continuous glucose monitoring is a good idea, right?

I think it’s, it’s eyeopening when you eat something that you think is great for you. Like I love watermelon, I love the taste of it, especially a cold watermelon and a hot summer day. I can finish a whole bowl for you, but little, I knew that we could actually consume my sugar levels quite quickly.

Dr. Weitz: Right.

Dr. Fotuhi: Dammit. I wish I didn’t know.

Dr. Weitz: Yeah, no, that’s a great tool is continuous glucose monitoring.

Dr. Fotuhi: Yeah. Yeah. So I think it’s, I think it’s great if you can work with someone who’s knowledgeable. We need to emphasize personalized medicine, right? We are all unique in our ways. There’s some general things that are good for all of us.  However, we are we are unique in our sensitivity to environment. We are unique in our sensitivity to food, and we are unique in how we respond to our environment. So yeah, ideally [00:37:00] you really need to work with someone who’s really knowledgeable about functional medicine and can help you to optimize your health.

Dr. Weitz: So sleep is super important. We know during sleep, one of the things that happens is that the brain detoxes, it’s through the glymphatic system. So can you talk about the importance of getting good quality sleep for brain health?

Dr. Fotuhi: Sleep is not a passive process. It’s not like you go to sleep and you just wake up and it was just a rest period During sleep.  A lot of dynamic things are going on. The most important though, which is the rinsing and cleaning of the brain. Imagine if the trash will not get collected in New York for a week. What a mess it will be. And our brain is no different. There are billions that there are trillions of chemical processes that happens every day in our brain.  These chemical processes have [00:38:00] byproducts, and these byproducts are things that need to be eliminated and are removed from our brain. It’s like a factory that generates byproducts that needs to be removed and taken away. And this process happens mostly during deep sleep at night. Now, why that is?

We don’t know. There are some hypothesis as to why this rinsing is mostly happening during deep sleep, but it is what it is, and it has been established, you know, it has been shown scientifically to treat the case. So the way it works is that with the position of the arteries in our neck. There are small little arteries in our brain, that little pulsate and around the, the arteries.  This space around it sleeve life is a fluid called CSF. And so which each pulsation is CSF gets pushed, it gets pumped on this side, and it is on the venous side. There’s this cardiovascular space, and then this fluid gets collected from there. So it gets from here and the brain tissue in between [00:39:00] gets the rinse.  With each pulse, and again, this is more effective during deep sleep. So when you don’t get your deep sleep, this process doesn’t happen. The trash accumulates, and when the trash accumulates, it generates more inflammation. And one of the trash that accumulates is the amyloid. And so one of the problems, poor sleep, is high levels of amyloid in the brain.

And research studies have shown that if you have insomnia, which means sleeping further than six hours a night for one or two years, your brain is okay, your brain heals, recovers, and you’re okay. But if you had insomnia for 25 years your brain and especially hippocampus, becomes half its original size and the amlo, those are much higher.

So. It is a no brainer that you must sleep at night. You really need to make a sleep a priority. Unfortunately, a lot of people say, you know, nobody sleeps well. I’m lucky everybody else. [00:40:00] No, you need to make sleep a high priority. The problem with sleep is that you can’t just do it. You know, with exercise you can just get up and go, but if you can’t fall asleep, you can’t really force yourself, and I do not recommend sleeping medications at all.

You need to prepare your mind and put it in the state. Which then you can fall asleep. However, there are many ways you could do it. And these days there’s no shortage of information how to do it. You know, there are things like falling asleep, hygiene, making sure the room is quiet and dark. Make sure that bed is comfortable.  Make sure that there are no other things in the bedroom. The bedroom is quiet. No tv, no exercise machines and read before you go to sleep. Don’t spend too much time on social media. These are some common recommendations. However, if somebody has too much anxiety that prevents ’em from asleep, then they need to address that before they can sleep well.

Dr. Weitz: And, and what is the caution about sleep [00:41:00] medications that affects the way the brain normally works during sleep?

Dr. Fotuhi: Yes. I really, avoid prescribing sleeping medications because they change their architecture of sleep and they’re very habit forming. And the last thing you want is to be addicted to like Ambien or these sleeping medications because you get to a point of not being able to sleep on your own.  I only prescribe these medications maybe for a week, and someone who, for example, had concussion, has not, had, not slept for a long time and they really need to be knocked out for a week or so, I would prescribe it. Other than that, I think herbal T is, is a good thing. You know, it can use melatonin occasionally.  Benadryl occasionally. Magnesium is actually good. Bananas. There’s some things that help, like a bowl of yogurt, cherries. There are some food that can help you get to the mood to fall asleep. Kiwis bananas [00:42:00] and magnesium su supplements also help in general. I think it’s better to do slow breathing exercises, like breathe slowly for 10 minutes and count your breath, or do meditation or read a book.  A good old book. Yeah, it, it, it’s, it really puts you to sleep,

Dr. Weitz: not not on your phone. A paper book.

Dr. Fotuhi: Yeah. Actually. ‘

Dr. Weitz: cause you want to avoid that blue light, right,

Dr. Fotuhi: exactly. Mm-hmm.

Dr. Weitz: Because that inhibits the melatonin secretion.

Dr. Fotuhi: Yes. I think it’s best to read a good old book.

Dr. Weitz: We, we need to bring back book reading for sure.

Dr. Fotuhi: It’s, I think coming back because most more people appreciate the joy of holding a book in your hand and actually flipping through pages.

Dr. Weitz: What do you think about some of the recent blood tests like the p tal two 17 as an indicator of risk of Alzheimer’s?

Dr. Fotuhi: I think they’re very [00:43:00] important part of evaluating someone who has cognitive decline.

And if you have high levels of P til two 17, it’s not a good thing. It is a, it’s a bad, you know, it’s like, you know, do a blood test, you have high cholesterol, you can check your amyloid ratio 42 to 40, and can measure levels of p T two 17. Keeping in mind that these are only giving information about this backup of amyloid.

Plaques and tangles. Right. And they don’t tell you about the bag of all the other things.

Dr. Weitz: Right.

Dr. Fotuhi: And therefore, if you have high level of amyloid in your brain or high tau, it doesn’t mean it’s the end of you. You have to realize that we don’t have markers for these other things we do. For example, the blood the brain.  MRI can show significant atrophy. The MRI can show white heart disease. 

Dr. Weitz:  And this, this is an MRI with volumetrics, correct?

Dr. Fotuhi: And the, the, the MRI with volumetrics can actually give you the size of the hippocampus. And there are also new MRIs that can measure the space, that pre vascular space. When the, when the rinsing doesn’t happen, the fluid backs up in those perivascular spaces.  The, the sleeves that I was telling you about, and you can see the MRI as enlarged spaces. So, and there’s also ultrasound that can be done to measure the velocity. Of the blood flow, which is a measure of,

Dr. Weitz: you mean in, yeah.

Dr. Fotuhi: Mm-hmm. So, so I think having blood tests for amyloid and tau is indication of some part of pathology in your brain, but an incomplete picture.  And, and I think it’s not fair to do the test on people and tell them that you’re gonna get Alzheimer’s disease. There are many people of high levels of amyloid and tau who never develop Alzheimer’s disease. Right. And, and [00:45:00] when you tell that to experts who promote these, they say, well, they, if they live long enough, they will.  Well that doesn’t, that doesn’t work. I mean, you can say they live to 120 years old. They will. But y you know, there was a study called the Nuns Study. The nuns study was to look at elderly women who were living in monasteries and monitor them year after year with cognitive testing and like looking at their lives.

They had all agreed to donate their brain after they passed away so researchers could look at their brain. When researchers looked at their brain, they were shocked because many of the sisters who were fully functioning during their life, even to the very last year of their life, they were driving teaching, course sharing, participating in community activities, had level six Alzheimer’s disease.

The Alzheimer’s grading goes from 1, 2, 3, 4, 5, 6. Six is the worst case. It’s like your brain is ridden with v tangles. It is like the [00:46:00] ultimate case. They had stage six Alzheimer’s pathology in their brain, yet they were living full lives. There was no evidence of problems with them when they were alive.

Even a year before they passed away. But then it says, so why? Why did some of the sisters with such high degree of amyloid and tau did not have symptoms, whereas others did? And so when you look, comparison was that the other group that did have symptoms were the people were the sisters who had other pathology such as small strokes.  So if they had plaque tangles by themselves, they wouldn’t get a stroke. If they had PLA handles and little strokes, then they had symptoms. And I think the same as applying these days. I wouldn’t want to know my tau level, frankly, because it, you know, I, it would add stress to me if I knew my towel levels were high.  I’m already doing everything anyway,

Dr. Weitz: right?

Dr. Fotuhi: So my recommendation and the recommendation to American Academy Neurology is that these tests should be done [00:47:00] only in people who have cognitive deficits. If you’re forgetting your keys and you’re worried about Alzheimer’s disease, you should not do these tests, because if they’re positive, then you’re just gonna have a lot of anxiety for many years to come.

Dr. Weitz: And as far as cognitive testing, which cognitive tests do you prefer? Do you like the moca test? Do you CNS vital signs is, is it better to use a combination of tests?

Dr. Fotuhi: These days, there are at least 50 different versions of cognitive tests. Some cognitive tests are paper and pencil, like the moca or mini mental state examination score.  Others are computer based, like CNS vitals, and some are them. Some of them are half an hour, some of the three hours. Sometimes they can do cognitive testing for two days. I think you need to work with your doctor and find a local place where they do cognitive testing. Usually want a cognitive test that takes at least an hour and to give a [00:48:00] full picture.

These test, these cognitive evaluations measure only certain domains of brain functions. I think it’s important to keep in mind that they measure attention, concentration, processing speed, executive function, problem solving, for example. They do not measure your emotional intelligence. You may be great hands-on person who fixes everything in the garage or in the house and yet would do really poorly.

You could be a very successful businessman. I would do poorly on these tests. And of course, level of education makes a difference. However, these tests, they do give a big picture of where you are with some common cognitive domains. In our practice, we use CNS vitals for a lot of our patients. And it was adequate in combination with me spending an hour talking to the patient.

Lemme tell you, something happened recently. The patient came to see me saying [00:49:00] that. The neurologist told her, the husband is okay. He has only some cognitive problems for his age. He’s 55 years old mechanic. And he had done cognitive testing for four or five hours and had done poorly on it. But the person who did the cognitive testing said that person did not speak English well.

So this could, this was not valid. And the neurologist didn’t actually spend time with the patient, just look at the report. And the bottom said that there are some abnormalities, but they’re not valid because patient does not speak English well. So I saw the patient just, you know, the wife said, could you please see the patient?

And I did. And I, and I asked them like, how, you know, just talk to him a little bit. Asked him to look at my watch and tell me what time it is. He couldn’t tell me. He couldn’t read clock. I said, can you draw a clock and put the hands of a clock to be 7 25? Actually, here it just happened. And, and he couldn’t.  He couldn’t. So I said, listen, why don’t we run, why I drive a circle for you? [00:50:00] And then you can, okay, so here,

Dr. Weitz: and by the way, that’s like, say part of the moca test, right? To be able to do that. Yeah.

Dr. Fotuhi: See, so he, he couldn’t put the 12. He, he didn’t, he just put up to nine 10. And when he looked at it, he realized he didn’t, he couldn’t tell there was something wrong with it.  And I said, okay, well let’s do it again. He did it again. He couldn’t do it. So I put the circle, I said, here, put the hands of a clock. I, I drew the bottom circle for him. He couldn’t and then, and asked him to just five things. I said, listen, I’m gonna give you five things to remember. And I made him a list of five things he couldn’t remember even one.  And a neurologist had seen this patient and told patient, don’t worry about it.

Dr. Weitz: It was

Dr. Fotuhi: just age related. I was shocked. I was just shocked. And so, unfortunately, you know, not everybody takes the time to take care of patients. Cognitive testings is very helpful. I think the standardized cognitive testings are good, but there’s no you know, placement for.[00:51:00]

A neurologist, an expert who would talk to the patient because a person may do poorly because they’re depressed. A person with depression will do poorly on this test. And so you have to put these cognitive tests in the context. I often talk about the similarity of taking care of patients with heart disease versus brain disease.

A cardiologist would obtain a pan of blood test, not just cholesterol. They would check for, you know, they would triglyceride, they would check for LFTs. They look at for kidney function, liver function, thyroid levels, B12, vitamin D, the whole bottom blood test. Then they may recommend a stress test, echocardiogram, and then they talk to you.

They obtain a history like how you do get short of breath when you go up the stairs. How much exercise do you do? Do you smoke? And once they have all this information, then they can tell the patient what the problem is and what the treatment is.

Dr. Weitz: [00:52:00] You’re, you’re talking about the ideal medical exam. And unfortunately in the system we have where, you know doctors are often limited to very short amounts of time with patients we don’t often don’t see such thorough workups.

Dr. Fotuhi: Yes. But I think that’s the way to do it. Yes. I think where we are in the field is that these days these blood tests have become available. So a Dr. May just do the blood test and do some cognitive testing and just tell a person they have Alzheimer’s disease based on those limited. Partial information and you know, recommend that the patient receive these drugs, which is unfortunate because if the treat, if the problem was depression, these drugs are not gonna address the depression.

You know, for example, a a 75-year-old could cogniti problems, will repeat himself is confused sometimes, and they live alone. You put [00:53:00] that same person to live in the house with children and their grandchildren. The same person blossoms the same person all of a sudden remembers things, goes out, laughs fun, has fun.

You know, you take a 75-year-old who has hearing problems and you know, do this, talk with them and you know, they really can’t hear. So they withdraw themselves from social gatherings and they’re alone more often and that limits their brain stimulation. And after a year or two, they may get the diagnosis of mild cognitive impairment.

They give ’em a hearing aid and so many other things reverses. So many things are versus I think it’s a horrible thing that, you know, we don’t have a protocol to address these things. In my book, I have summarized all my experience of 30 years of doing these things into a protocol, but I call a brain portfolio.

I have a list of eight different subsections of things that need to be done in order to have personalized [00:54:00] evaluation. And once people do those things, it becomes clear as to which areas they need to focus on. The most important thing I want people to know is this cognitive decline has many different causes, most of which are treatable.

If you’re forgetting things, if you have repeated yourself often, if you sent an email and then you totally forgot that you had sent an email or you said something in a meeting and somebody said, you said that and you don’t remember having said that, don’t panic. It’s not Alzheimer’s disease. It’s a list of 20 things that could be causing those things, and all of them are treatable.

If you’re a middle-aged person who has these kind of symptoms, you should not be thinking about Alzheimer’s disease as the cause of your problems. You should really look into hopefully working with someone who’s an expert in your field or, you know, read the chapter in my book about all the things that [00:55:00] can potentially cause cognitive decline and have a positive attitude toward it.

The beauty of the brain is that it has a high, if we have malleability, it can change and you can take advantage of that and make your brain to be in good shape.

Dr. Weitz: Can you tell us about a recent case of a patient who did well with your program?

Dr. Fotuhi: Oh, thousands of patients. So one patient was, for example, a seven, 8-year-old retired woman who was brought by her sister.

The sister said, you know, Carol has been sitting at home in front of a tv. In fact, the TV is watching her ’cause she doesn’t do anything for a year, every day. She just sits in front of tv. That’s all she does. She doesn’t talk to anyone. She doesn’t walk anywhere. She just sits there. She can eat. But she doesn’t, doesn’t mention, and the sister wanted me to confirm a diagnosis of Alzheimer’s disease so that she can sell Carol’s house and pay for her to go to the nursing home.

And I thought, wait a minute, why is this lady doing these things? Why is she quiet? Why is she sitting down all the [00:56:00] time? And, and I decided to work with through my evaluation. So it turned out that she had diabetes that was out of control. She had depression. She was, she had back pain and the doctor had given pain medications and she had still had back pain.

So she had received gabapentin, which is very sedating, and benzodiazepines, which are very sedating. And so these medications were really contributing to her lack of movements. That’s why she was sitting all the time. So I tapered medications. I treated her sleep apnea, I treated her diabetes. And she started working with our staff.

I never forget the first day she came, she was this beautiful African American woman wearing a blue suit on a wheelchair. And I remember looking at her, she was like, looking like this. And then by the time she had done the program for six weeks, she was walking to our office by herself. She had stopped being on a wheelchair.

She was walking five, 10 minutes a [00:57:00] day and she was actually talking to people. She was smiling. And she was actually a feisty woman. She was full of life by the time she finished the program, she was looking for a job. She was engaged in her church. She had turnaround, totally turnaround. She was brand new.

That’s brand great to hear

Dr. Weitz: that.

Dr. Fotuhi: Yeah. And then I had done MRI her brain before and after and was significant, increase the volume of her bootcamp. Now, she was very interesting. She came to see me every three months after she finished our program per protocol. So she, three months later, she was actually sad.

I said, what happened? She says, oh, my husband died. And I said, I’m so sorry, you know, and she came back three months later. She was unusually happy. I said, Carol. What’s going on? You’re, you’re, you’re giggling what’s going on says Doc. There was this boy in my high school who I had a crush on, and at the time I didn’t tell him anything because, you know, I was a woman.

I was a girl. And then I got married and he got married. But since my husband [00:58:00] died, I was curious where he was. I looked him up and it turned out that his wife had died. So I called him and he said that he always loved me and he was shy to tell me. So then I decided to get together and they were like teenagers dating each other and she was full of life giggling.

That’s great. Cheerful. And then, and then she said, Dr. Fatuhi, can you do MRI To see what happened to my brain From zero to three months, she has significant increase. She wants to, she wanted to know if the hippocampus had gone back down again. And what the MRI showed was that her hippocampus had grown one more percent since she had finished her program.

Because she was active, she was doing things in the church. She was. Doing everything every, you know, most days she was exercising, eating right. So we published the results of our study that evaluated 129 similar patients with diagnosed of Mocco impairment and we saw that 84% of our patients improved and that the MRI showed that there was a [00:59:00] one to 3% growth in a volume campus in 12 weeks.

Dr. Weitz: That’s great. Okay. So final thoughts and how can people find out about your book or, and your programs?

Dr. Fotuhi: Yes I am on Instagram’s doctor Tuhi, F-O-T-U-H-I. I also post on LinkedIn and X and YouTube. My website is drfotuhi.com. It’s D-R-F-O-T-U-H i.com. And if you search the Invincible Brain, I think many of these things will come up.

I honestly believe that people can make their brain invincible and resilient to the effects of aging, and I really hope that people change their attitude about aging. You know, people need to appreciate that just because they get to their fifties and sixties and seventies, life does not need to be downhill.

You can have a [01:00:00] full life, be happy, do a thousand things and move on with life. It’s true that you may not run as fast as you were in your twenties, you, or that you may not be as quick as when you were in your twenties, but there is no rush. Don’t let that five, seven, 8% decline tell you that you have to stop doing things.

Because if you have that mentality, then you expedite your decline. The less you move, the faster you will decline. The less you move, the less muscle you’ll have and the faster your brain will decline. So have a positive attitude about aging, live life, live life to the fullest, and realize that you can do whatever you want well into your eighties.

Dr. Weitz: That’s great. Thank you, Dr. Fatuhi.

Dr. Fotuhi: My pleasure.

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star readings and review.  As you may know. I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine, and I will talk to everybody next week.