 Well, hello everybody and welcome to another episode of Dr. Jill live I'm here with my friend and colleague Dr. Dale Bredesen and if you have not heard of Dr. Bredesen you are missing out but today I Promise you there's going to be some exciting updates and things and Everything to do with Alzheimer's disease preventing and reversing Alzheimer's disease and with cognition So let me give you a brief welcome. Dr. Bredesen. Thank you for coming on today Thank you so much Jill always great to talk to you you too So Dr. Bredesen is an Alzheimer's and neurodegenerative disease researcher and the foremost authority or reversal of cognitive decline For those experiencing Alzheimer's symptoms having spent his career on the forefront of research into the mechanisms of neurodegenerative Disease Dr. Dale Bredesen and his team at the Bredesen lab have discovered effective therapeutics for Alzheimer's disease And yes, you've heard me right often. We think of you know recovering from cancer and recovering from auto immunity, but Rarely have you maybe heard how people can achieve recovery or Improvement with Alzheimer's and today we're going to dive into that these discoveries from Dr. Bredesen have led to the publication of over 200 research papers as well as the development of the Bredesen protocol a Multi-step approach designed to reverse the effects of subjective cognitive impairment mild cognitive impairment and early Alzheimer's disease The protocols offer through two programs. Sorry two programs the precode for prevention and the recode for reversal Dr. Bredesen is also the author of two New York Times bestsellers the end of Alzheimer's the first program to prevent and reverse Cognitive decline and the end of Alzheimer's program again welcome Dr. Bredesen it is so exciting to talk to you and you've got some new stuff We're going to talk about at the end of ways to not only achieve the wellness and reversal of Alzheimer's But some really practical tools your team has been working on to help patients achieve even more. I'm super excited about that For those who don't know you give us just a little backstory on how did you get into this research research and where did this all start? Yeah, you know, so I came through a very very classical sort of training way back in the 1970s and 80s Through Caltech and MIT and and actually spent some time at Harvard on the neurology service there And then UCSF and ultimately becoming a professor at UCLA and the idea was you know as we came through this I realized There's nothing you can do about these neurodegenerative diseases if you have ALS You're going to die if you have front or temporal dementia, you're going to die You know, we just go right down the list. It's the area of greatest biomedical therapeutic failure So I thought at the time, okay I need to go into the lab and start looking at what actually drives these processes And so we spent 30 years as you said we published over 200 papers On what actually drives the problem and the interesting thing is it went against what I had been taught I had been taught that this was about misfolded proteins and it's about prions and it's about Reactive oxygen species and what it turned out is actually much closer to my what my wife who's an integrative physician had told me She said, you know, whatever you guys find it's gonna be have something to do with Sleeping and eating and kind of the basics of life and I said no no no We're gonna find one molecule with one fold We're gonna get a drug that goes against that fold everything's gonna be great It didn't turn out to work that way So what we found interestingly is that Alzheimer's disease is a network insufficiency You have this beautiful network these amazing you know about 500 trillion synapses in your brain and You have a supply and a demand and you have all sorts of you need trophic support and you need Blood flow and you need oxygenation and you need glucose and ketones and metabolic flexibility and all these things And of course as you have really point out with such an expert approach toxins you're exposed to things like biotoxins these things are Absolutely crucial. So we realized that okay There's this network and you have to identify the areas of the network that are failing And then you have to address those and you want to address the things that are actually causing the problem Sure downstream. It's fine. If you need a drug to change the processing of a pp for example fine But the idea of using that as a monotherapy Simply has not worked and you know Jill one of the most interesting and telling things that's come out is the downstream look So people who went on erycep or nemenda did worse in the long run than going on nothing The people who went on the anti amyloid antibodies Like Lacanumab and things like that have more rapid brain atrophy than people who don't so these things are short term Not very good solutions with lots of side effects and huge costs That lead to worse outcomes in the long run But when you actually go upstream and you look at the various things and you fix the network These people do and I'm actually writing a paper now on people who got improvements that were over Five years. We have people ten and eleven years who have kept their improvement all that time something that's unheard of With typical pharmaceutical treatments So I love how you describe that because you know We all go into medicine and we love the idea of a blockbuster drug that could save the lives of hundreds of thousands of people But the truth is it's a lot more complex than that. You just did a brilliant job of describing Like you originally put out the research and you talked about the holes in the roof, right? There's 30 plus more and the difficulty is it's not just a one drug one solution and Unfortunately, it's a lot of hard work But you've put together a lot of the program to assist and help people So what can if someone's at home and they're you know 50 in their fifties, which is very early for Onset, but we're seeing more and more people younger people. How could they start? What would you recommend? I know you have something called the Cogniz screen is a cognoscope, right? Cognoscopy So we're saying, you know, just like colonoscopy You should have a cognoscopy if you're 40 or over and we should all do that But you brought up something really important here, you know when I was training We thought of Alzheimer's as a disease of your 60s 70s 80s and 90s It's turned out to be a disease of your 30s 40s 50s and 60s that just gets diagnosed 20 to 30 years later and so these changes are actually happening quite early on and that what people Can do start by recognizing this is actually as you said it's complex, but it boils down to two simple things Number one is energetics. Do you have enough? Are you getting enough blood flow? Oxygenation mitochondrial function ketones glucose those things and the second one is ongoing Inflammation do you have a change in your oral microbiome? Do you have exposure to mycotoxins as you pointed out all these things? These are the two big things and so actually there is a lot you can do and you said something really important We're seeing people younger and younger that's been published by epidemiologists The biggest increases are in people in their 40s and 50s and when I was training I've asked a few of my neurological colleagues Did we ever see way back in the 1980s when I was training as a neurologist? Did we ever see people in their 50s with Alzheimer's and the answer was no We never saw that one of the most common things that I hear about now 52 year old woman who is and it's more females because it seems Of this osteoclastic surge or burst that you go through it's really been tough because the Toxins as you know that you're exposed to Seem to take a bump at the time when there's this beginning of this osteoclastic burst So you have that mercury exposure that wasn't so bad when you were sequestering it You know it does happen in andropause as well But it seems to be more common with with perimenopause and menopause So I think what people can do today Get a cognoscopy check out see where you stand and start doing some of the basics and we think of as you know seven basics diet exercise sleep stress brain training some detox and some Targeted supplements those are the basics and I think in a long in the long run What we will hopefully have is a public health program where everybody does some basics And then the people who fall through the cracks who have who actually get past that okay They will then have a more extensive evaluation more extensive treatment and then a few of those people will still go through They'll have to have a still more extensive as you know Some of these people can be very very difficult to Reverse and yet you see it again and again when you do the right things you see people get better and most importantly you see them stay better Yes, and I loved we talked about in the beginning here the subjective cognitive impairment Which could happen as early as late 30s and mild cognitive impairment and then the early Alzheimer's disease I also noticed you're you're really framing this if we have some with very severe or moderate Alzheimer's It's at least in my experience and assuming with yours. It's a lot harder to treat and reverse those patients, right? So we're actually wanting people to say where am I at even if I'm in my late 30s or early 40s So describe briefly for those listening who'd maybe don't know what those categories are what that looks like the subjective cognitive The mild and the early and then let's talk about what people can do if they're just a little concerned or they have a family history Where can people start and this is a great point and it's a common also misconception that you know This is all Alzheimer's, but as of course Alzheimer's is just a pathology But as you say you end up with a dementia so there you go through four phases when you develop Alzheimer related dementia Phase one you are asymptomatic So you go through some period and you can already show sometimes in your 20s and 30s even you can begin to show changes in pet scans and changes in Final fluid now who wants a spinal tab every year? I don't so the good news is there is a big break Through now with blood testing so you can now get phospho tau 181 Which we should all if you know if you know your blood pressure and your cholesterol You should find out your phospho tau 181 and your 42 to 40 ratio of a beta soon We will also have gfap. It's a research tool still But that'll be that's even more sensitive although it's less specific if your gfap is Normal you're in pretty good shape because you're not heading for Alzheimer's at least at that point So you go through a period that's asymptomatic. That's phase one phase two is what you mentioned SCI subjective cognitive impairment by definition that means you know, there's something not quite right You're not remembering phone numbers the way you used to you may have struggles at work that sort of thing But you're still able to score within the normal range on cognitive tests Now it may be that you're just really smart and so you've lost a lot But you're still able to score in the normal range, but that is sci now the good news SCI is completely reversible We see virtually a hundred percent of those people reverse to normal when they do the right things And it lasts on average 10 years So you have this clear period now the problem is your doctor tells you oh, it's just normal aging Please don't listen to your doctor about that because this is not normal aging You should not be having this sci and at the end of the 10 years What happens is it tends to convert to mci Which is it's too bad that it was named mild cognitive impairment. It's like telling someone don't worry You only have mildly metastatic cancer. It's a relatively late stage of cognitive decline And that lasts for typically several years three to five years each year that you have that There is a five to ten percent chance. You'll convert to full-on dementia During that time what it means is you're now not doing well on the cognitive tests But you're still able to do your activities of daily living When you begin to lose those then by definition you've developed dementia and that typically occurs Right around a mocha score of 19 to 22 right in there So we'd like to catch people when they're up in best would be when they're up 28 29 Still doing very well on their mochas, but they just know they have that sci Then they do absolutely great now the good news We've had people with mocha scores of zero which is end stage dementia where they will improve But they they don't improve to 30. They which is perfect They improve to five or nine or that sort of thing So my hope is we can ultimately understand enough about this disease We can take people from zero to 30 as far as i'm aware. No one has ever done that But that's what we need to understand better It may take the sorts of intranasal peptides you've talked about in the past. It may take stem cells It may take other things But somehow we need to understand that but it's a little bit like at that point Having a collapsed building and say how can we take this now and make it a a perfect building again? We have to figure out how to reconnect those synapses. So those are the four phases you go through got it and uh Testing this out. So where would someone start? Is there do you offer uh mocha online? Or where would people start to get tested if they're like or would they ask their doctor for a riko? Tell us a little bit about say someone's out there listening like oh my my mother or myself or I'm having some issues. I'd like to get screened. Where would they go? Such a great point. And yeah, you can just go mycognoscopy.com and you can actually get blood tests Very easily You can actually you can get a online cognitive assessment Very easy and actually the online cognitive assessments are even more sensitive than mocha So mocha mocha was developed for mci, but it wasn't developed for sci. So it's not very good in that sci range where it has online assessments like cq test and like the cns vital signs and some people like others like cambridge for example, there are other ways to go Brain check. I think it's another one. Um, these are more sensitive than mocha So they can pick up that sci phase which is really nice so that you can get things going and people are often as you know, people are shocked Yeah, uh, we had one person for example who came in even with the mocha who said, you know, this is in my family I think i'm okay, but I better get checked and her mocha was 23, which is fairly late stage mci I like wow and she's done beautifully her mocha is now 30. She did absolutely great doing the right thing So there's a lot you can do by getting started and the earlier you start the better Better off you do as you know and also, you know finding the things that you actually have to address It's very different as you well know Some people, you know, mycotoxins are critical other people. It's metabolic syndrome other people. It's a leaky gut You know other people it's changing their oral microbiome. It's remarkable how different the contributors are Yeah, and hey everybody I just stopped by to let you know that my new book Unexpected finding resilience through functional medicine science and faith is now available for order wherever you purchase books In this book, I share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope And resilience I found along the way This book includes practical advice for things like cancer and crone's disease and other autoimmune conditions Infections like Lyme or Epstein bar and mold and biotoxin related illness What I really hope is that as you read this book you find transformational wisdom for health and healing If you want to get your own copy stop by read unexpected.com There you can also collect your free bonuses So grab your copy today and begin your own Transformational journey through functional medicine in finding resilience Pributors are Yeah, and I love this is really at the core personalized medicine Which is what we all strive to do and what medicine really should There's nothing unusual about this It's kind of how we why we all went into medicine and research to become healers and really understand But we kind of get the idea in at least conventional allopathic medicine There's one diagnosis and one blockbuster drug like we started in the beginning And it's just not that way so it's way more complex But when we get to those root causes that are personalized We see the really miraculous kind of recoveries that should happen in all kinds of facets of not just Alzheimer's and early cognition issues, but other diseases as well Let's briefly jump to the mold topic because as you know, that's near and dear to my heart I've seen people again in their 30s 40s with very significant cognitive impairment because of mold I think one time you said that the early onset dementias You saw around one in three that could be related to biotoxin environment Where would you say now? And would you still agree with that statistic or how often is mold a contributing factor to cognitive impairment? Yeah, and when we were first saying you know somewhere around one and three or so We were thinking the ones where it's the predominant thing as far as being a contributor You know, I asked the the clinicians that I'm working with on the trial We have six absolutely fantastic clinicians. I think you know all of them, you know Dave Bergman and Craig Tonio and and and David Haas and You know in Christine Burke and Anne Hathaway and and cat tubes I'm thrilled to be working with all and they're absolutely fantastic They tell me in their practices more like 70 to 80 percent have at least some contribution From toxicity and it's usually mycotoxins. It's usually these biotoxins. That's scary They're just this is such a common problem. And of course, it's really tough. And as you know better than anyone You've got the spouse saying well, how come I'm doing so well then And then you say well, what about the kids? Well, one's got ADHD and the other one's got a pulmonary problem And the third one's got this a rash and it's like well, hold a minute. You see the pattern here They are being exposed to things So it is it is very tough because this is not even recognized yet The Alzheimer's Association does not recognize Mycotoxins as a cause of Alzheimer's and yet it's one of the most common contributors Yeah, it's usually insidious because if you just ask I always say if I ask patients right flat out Do you have mold in your home 99% will say no because it's hidden behind the wall or floorboard And it really is an ordeal to figure out what's going on and remediate or fix the problem Because often it's uh, it's hidden. It can be expensive So it's hard to get people to go there. But um, once we test and find out that that is an issue I've like you seen now I tend to work with the younger, you know, autoimmune environmentally toxic, um, but Cognition is a key component. I think when we look at mycotoxin studies the number one physical complaint is Impaired memory or cognition so it fits along with that and again This could be someone in their 20s or 30s that doesn't have Early onset dementia, but the cognition is really impaired and even mood and sleep and all of these things that go together Um sleep, let's talk briefly about sleep because I think this is an under Uh talked about topic related to the brain How important is sleep? Um, how does that affect cognition and where do you start with someone who's Having impairment and maybe not sleeping well Yeah, and just just to add to what you just said because I think it's such an important point That there is this phenomenon of younger people having so the typical ones we see with inflammation It's more like in their 60s the atrophic ones. We see who just don't have the hormonal and nutrient support They're typically in their 70s But the ones who come in with the biotoxins are typically in their 40s and 50s And they do look different when I first realized this Uh, you know, I was way behind you on this realizing wait a minute. Hey, there's something going on here It was because there was a group of people who didn't respond to our original approach of let's optimize their hormones and let's optimize Their nutrients and let's decrease their inflammation. There was this other group and you're right. They are younger They are and this is by the way, as I mentioned the epidemiologists are telling us That's what's on the rise the 40 somethings and 50 somethings hugely on the rise They're younger and they look different They less often have pure memory problems. It's more about executive functions. So I think of non-amnestic presentations versus amnestic is classical Alzheimer's But then there's this non-amnestic, which is very much what you're dealing with often now Yes, some of them have memory problems for sure, especially the apo E4s But often you'll see apo E4 negative who's having trouble at work They just can't figure out that new iPhone and they just can't get things together They can't calculate. They can't make tips. They can't write grants They can't do all the things that they were doing before they often have trouble with vision I was going to ask you about posterior cortical atrophy and primary progressive aphasia two of the classic presentations of Alzheimer's that are non-amnestic And the piece and they're both turning out to be toxin related problems And actually I was just talking yesterday to to Kerry Mills Rutland who is a health coach who's doing a great job up in New York City And seeing some of these people who have posterior cortical atrophy Presenting with these visual changes going to an ophthalmologist and saying no, no, this is not an eye problem This is a brain problem And it's interesting. They are turning out to be people who have some toxicity So we're trying to understand what drives you to have that presentation of Alzheimer's as opposed to a different presentation of Alzheimer's and and they often have depression as you know They often have HPA access dysfunction They often are exquisitely sensitive to stress. They go on an all night flight and they're a mess They often respond quite well to BHRT for example So they really look like a different group now my big worry is we've got all these people who've had COVID They're all the setup for 10 15 20 years down the road of having these same sorts of cognitive problems So I think that that is an important thing for people to recognize and to get them on Optimal treatment just as you do in your practice So you mentioned sleep somebody well, let me let you respond to that because I think that this is a such an important and under recognized area No, actually, and I want to go on a tangent We'll come back to sleep in a moment because this is so critical what you've just said Because I know listeners out there going yeah, I don't feel like I'm quite myself And especially I love that you mentioned COVID because what we're seeing is vascular issues are So prominently if people had multiple episodes of COVID even one episode But I see so many things related to hypercoagulability blood viscosity and even looking at and this is Absolutely important for the brain no matter what your age because probably the number one thing for proper brain function is Blood flow to the brain, right? I love that you mentioned that because I think people are post COVID having these long COVID kinds of symptoms and a huge proportion of that is This fuzzy term called brain fog, which is just they can't do what they used to be able to do Like you said they maybe can't executive function Would that be the bucket you'd put it into as far as how to describe? The impairment as far as planning and organizing and doing tasks and understanding and again Organizing yeah, exactly right And you brought up a really important point, which is this change in coagulability and my colleague and co-author Dr. Alexi Karakin with whom I've worked for many years pointed out something very interesting That when you look at where does amyloid come from it is part of the innate immune system We understand that but his point was it's really part of the innate immune system's memory So once you've been exposed to something you have a heightened response You're and that's basically what Alzheimer's is this heightened response. That's why apo e4 heightened response to these various Pathogens and insults. Well, what happens is the amyloid is part of a response Which lives as the memory in three locations. It lives in your bone marrow It lives in your endothelial cells and it lives in your tissue macrophages, which are of course the micro glia in the brain So because it lives in the endothelial cells You lose the ability for this normal laminar flow and this nice Flow where you're not having micro thrombi. You get covid or you're now heading for Alzheimer's You've now changed your your innate memory and you're now in a hyper coagulable state And so just as you said with covid you see these multiple micro thrombi Which is why a lot of people like to treat it with natokinase And so you want to get rid of that and we've had a number of people in the clinical trials where the big problem was hyper coagulability And so this is I think a huge and under recognized area Both for long covid and for Alzheimer's and you know and various steps along the way sci and mci On the way to dementia. These are huge and important issues that should be addressed therapeutically You just described it so eloquently because at the core it's endothelial dysfunction and damage And interesting because we've known for years that nitric oxide is produced on the endothelium Which is a vasodilator and when you mention women all of a sudden in this postmenopause or perimenopause time frame that really shifts That's one of the things I think it's at age of 40 We have 50 production of nitric oxide of that when we were young and then at 60 it's 15% production and this is all an endothelial derived thing that opens up blood vessels and gets blood flow So not only do we have our age instigating decrease in nitric oxide production? But then we have things like viruses like covid was a big one But other infections that cause endothelial inflammation and damage And I love that you're thinking along that lines because like I said I probably the biggest thing that I'm seeing now on all realms in all ages is if you had covid what that's doing to blood flow blood viscosity endothelial lining You mentioned nano kinase lumbarokinase is amazing Are you using pycnogenal as part of the main protocol for yes? Yeah, and what about nitric oxide precursors? Do you have a favorite one for nitric oxide precursors? Let's see neo 40 and berkeley life. I really love berkeley life lately. It's the ones I've been using. Yeah Yeah, we've been using a neo 40 in the past. That's a great point And interestingly this is a little point you probably knew this but it was fascinating when I found out We convert the nitrates in our food like beets and turnips and leafy greens into and in our microbes in our mouth So when you use those really heavy-duty mouth washes, you're actually decreasing your ability to produce nitric oxide in the body I didn't know that so I've been telling you don't use mouthwash If you want that good nitric oxide, which is that's a great point And it's also why we like things like checking your oral dna Seeing what your oral microbiome is doing and then using things like dental siden And oral probiotics to optimize. I do think you know optimizing your oral microbiome very important Yes, because it's so close and even in sinuses when we get mold inhalation As you know, you can probably describe them far more eloquently than me But it's so close with that and we used to think there was no permeability there, right? But as we have infections and issues in our sinuses in our mouth It's so close that we do have some transfer across the blood brain barrier Any thoughts on that real quickly before we move to sleep with like sinuses If there's an issue mouth of this issue, why is that important to the brain? It's such a good point You know, it's it's been interesting to me that you look at Alzheimer's It is largely a face related brain problem So as you said, it's your sinuses and it is your your lips your herpes simplex here You're changing your oral microbiome your chronic sinusitis even hhv 6a probably coming in through your sinuses We had a person recently with a big fungus ball in his sinuses That had been there and been missed for a couple of years. So yes, I agree with you now There's a great one of the most Most interesting experiments I read in the last couple years was where the group was looking to say, okay We all know about the blood brain barrier. It's supposed to exclude all these things We're going to put candida into the bloodstream and see how many weeks The blood brain barrier could exclude it. The answer was a couple of minutes. That's it So when you have candida in your bloodstream, it gains access to your brain within minutes And so whatever this blood brain barrier is, yeah, great for holding out certain chemicals But in fact, there's a lot of there are a lot of things that seem to be able to get across there And of course we find what, you know, what do the neuropathologists tell us p. Gingivalis t denticola p intermediate They're all in your brain. These things are there and of course There's a more and more interest in these things being causing, you know, atherosclerosis and causing distal cancers and things like that So I think that this idea that you've got a microbiome and it's kind of right Stuck in that area that is going we've got what I think of as the medical I'm thinking more and more of us is like the medical internet The internet, you know developed by DARPA back in the 60s, you know allowed us all this communication Well, now we're realizing that that there's a medical internet You've got things connecting between your, you know, your brain and your in your gut and your mouth and your sinuses and all all over the body You've got this amazing flow And you know that that can be bad or that can be good So important and I love that we talked about sinuses mouth all the importance. Let's go back to sleep Of the importance of sleep and if people aren't sleeping first of all, is that the chicken or the egg is part of Alzheimer's Impairment in sleep and circadian rhythm or is it that impairment and lack of proper sleep is leading to cognitive dysfunction? That's a good point, you know, and this is where So much of biology I think wants to have things be linear and simple Uh, I remember years ago two experts were fighting about whether it was bad for your brain to have too much Cortisol or too little cortisol. Well, of course both You know, there's a sweet spot for all these things And so it's the same way with these things where, you know Poor sleep begets more Alzheimer's all-timers begets more poor sleep. So unfortunately these are feedbacks That are unfortunately positive. I think of these as prionic loops Where something begets more of itself and unfortunately, do you see that again and again and again? And it's really the nature of the signaling pathways in your brain Because we think a lot about homeostasis But what we forget is when you have a multi-goal outcome as with blood clotting or as with learning You're trying to go from one part to another. So you're basically having a molecular switch Oh, okay, make this synapse stronger right now quickly or make a blood clot because you're going to die if you don't do that So what you have is a feed forward and unfortunately just as you were indicating, you know, the same thing happens That's not really a chicken and egg. It's kind of both So unfortunately, you're right Alzheimer's does interfere with sleep and on the other hand poor sleep enhances your risk for Alzheimer's disease And there's more and more on this and I worry a lot about the people who have low sp o2 There was an interesting paper a few years ago where they showed that if you just look at the mean sp o2 for the night It correlates very nicely with the size of your hippocampus and other nuclei within your brain So if you're sleeping and you're you know, your average of sp o2 is down you 89 or 90 Instead of where it should be, you know, 96 or 97 you are hurting yourself. That's you're not giving yourself the best chance So absolutely you got to make sure the person doesn't have upper airway resistance syndrome And you're pouring out the adrenaline you want to make sure they don't have sleep apnea So common and unfortunately so under diagnosed and so treatable Yeah, so let me be clear if work up for sleep apnea is part of the cognition assessment my other thought is as we Try to treat this a lot of the treatments like hypnotics or Anti histamines have an effect on cognition So if you were to give someone something to help them sleep, would you go with more natural first? Where would you go with that and what would you say to avoid if you are experiencing cognitive impairment? Yes, this is a really good point and there are all sorts of things that can can exacerbate this So yes, you want to avoid things that change your sleep pattern You absolutely want to avoid anti histamines if you can you want to avoid anti cholinergics You want to avoid just as you said the sedatives you want to avoid the the various benzodiazepines These are all things that increase very clearly increase your risk for cognitive decline So what you want to do is look at what's holding it back By the way, a lot as you well know a lot of times it's low progesterone And so the progesterone is helpful for your parasympathetic system and helps you sleep So having if you if possible having a normal level of progesterone very helpful Melatonin and just as with nitric oxide the melatonin is declining as we get a little older It is a normal product. So having and you don't want to take tons of it But having small amounts of melatonin You know half a milligram one milligram typical some people like three milligrams But you know that kind of a general order and I recognize some people use a hundred milligrams for other reasons It does have anti tumor effects. It does have anti covid effects and things like that That's something separate, but for sleep, you know small amounts Things like l-theanine You know relaxing We know we just saw last few days people talking about lavender sheets and these various Inhalants that actually improve normal cognition, which is great. And that's one of my arguments What we do for preventing Alzheimer's also enhances normal cognition So there's no need to wait until you're having problems You're going to improve your normal cognition as well So there are so many ways to go after this Just good sleep hygiene and I know I'm guilty of this myself Working on emails late at night working and writing something and then boom It's time to go to bed like no, that's not a good way to do it You want to have some good, you know get your blue blockers on you want to kind of fade So I'd be interested in your approach How do you get people to kind of fade into sleep so that they get an optimal sleep? Because I do think that is so important Especially at least an hour of deep sleep and at least an hour and a half of REM and at least seven hours of total sleep Yeah, gosh, I love talking about this because I am I love sleep and I think that's one thing I do well I think routine is so key because our body gets in these rhythms and even subconsciously if for me I take an absence all bath in the evening and actually heating up the body so it can cool down There's a temperature association with good sleep. So I think optimal temperatures below 68 degrees in your home for optimal sleep I think even lower than that might be optimal for our bodies according to the study in the 60s Somewhere is the optimal but our body if we heat if we take a hot shower or a hot bath It actually tends to allow us to cool down afterwards It stimulates those thermal regulation system and having the body cool down So basically morning we wake up the cortisol rises and we get that bright light exposure And that actually will help you sleep at night So I within five minutes of waking up either go get the sunshine water my flowers or I go I have a bright light just to so on the dark days of winter I turn on that bright light because that bright light in our retina before our coffee actually stimulates the rise of cortisol which of course helps and then our body temperature goes up telling us it's time for waking up Then at night we want our body temperature to lower and want no blue lights Like you said all screens have blue lights So you can get now apps and things to convert that you can get blue blockers where you wear that And then I found my deep sleep is best between you know, whenever I go to bed 9 10 11 and Midnight or one and my REM is always best from like 2 a.m. To 6 a.m So if I skimp on the sleep either way, I will see it and pinch on my deep early hours and my REM PMF I really like for the deep sleep I try that that low level like schuman frequency 7 or 8 hertz and I feel like that's a really good thing for And I'd love to ask you what are the things because we talked about all these really basics Which is where you start but red light and PMF and some of these other electromagnetic frequencies and things Have you found any evidence-based usage of these with cognition or lasers or what are the top Two or three or four things that you think really have promise as far as Yeah, that's a great point. You know I've been mainly interested in you know, what are the mechanisms? What is this drive and we're now, you know, by the way trying to make now Adapt these for ALS and adapt them for frontal temporal dementia Can we use the same principles? But understanding that each of these has its own unique biochemistry and genetics So I think that you know the future for all of us is to be able to prevent and reverse all of these different neurodegenerative diseases Especially the earlier the better and part of that has come out is some form of stimulation Now what is best? I tend to like the red light because it actually there's a lot of data on it and there's a lot of You know, it actually has the appropriate wavelength for example for cytochrome c for stimulation So I like that approach Interestingly, as you know 40 hertz has come back again and again and again on all the studies as being For some reason, whether it's 40 hertz sound or 40 hertz light whatever it is light stimulation And then of course mert and dr. Geraldine brosfield has done a really nice job with her looking looking at mert with her patients So a magnetic form of stimulation. There's of course microcurrent There are now, you know sound experiments I tend to like the you know the the light the photo biomodulation just because there are more data I think on this right now than others But all of these represents some form of stimulation and again, you know, you if you're going to work out with weights You better have good nutrition So you want to have all the other things working and then to have this mild stimulation You don't want to overdo it because you don't want to crash the system But appropriate stimulation does seem to be very helpful time after time I love how you frame that because I think it is so important people get all these bells and whistles on expensive devices And the companies are trying to sell us even as physicians, right? They're trying to get us to buy the next $20,000 device for our patients and it's really not those things can be helpful Yes, but it absolutely has to start with the foundational stuff that we first talked about So this would be a good time to talk about diet. We haven't talked about diet yet And I know you have an incredible new program that you're releasing soon I want to hear about that and what you share But tell us about diet first as far as what are people looking for if they have cognitive impairment Where do you start with diet? Such a good point. Yeah, so, you know, and I am not a nutritionist So I'm sure I know far less about this than than most people listening I'm simply interested in what is the neurochemistry that makes your synapses function because this is loss of functional synapses when you are Developing cognitive decline. So it turns out that you have to have all the things we've been talking about You have to have the appropriate energetics. You have to have the appropriate Trophic factors. I was really surprised to see Beautiful work coming out of emery looking at the biology of bdnf versus the biology of app And these things are just intimately related They have similar proteases that are involved with these things. It's amazing So this is part of your normal neuroplastic chemistry And so all of these things are you know are working together When you're actually trying to make people do better. So the common thing as you know people will say Okay, dr. Jill, this is great, but it's just too complicated. It's hard for me. I don't know where to go I don't know what to buy You know, this is why we put out the second book to try to be more specific But then people said I just it's too much So one of the most common things is can you just give me something that does the right thing to help me out? And yes, you have to hit Several things you have to hit the ability to be metabolically flexible So you've got to be able to make glucose and make ketones You got to get that plant rich mildly ketogenic high fiber You know good microbiome heal the gut all these things, you know, heal the gut and heal the blood brain barrier These are all coming together And so the you what works best is a plant rich and there are lots of ways that people have done this But what has worked best is a plant rich mildly ketogenic diet with appropriate periods of fasting now You have to be careful people are often frail you don't want to fast them too long But you don't want to have no fast either. So you want to have some time for autophagy you want to have some time for your appropriate cleansing of the brain Uh, you know with your lymphatics So you want to do all these things that are appropriate and so Actually, julie g who is a apo e four four patient who's done very very well for over 10 years now I've been a real activist and citizen scientist. She and and actually my wife dr. Aida lashin Got together and worked with nutrition for longevity. This was the company founded By vulture dr. Volter Longo and also jennifer maynard And spent months and months and months getting okay. How can you deliver to people make it really easy? Boom you bring in meals for it's typically for monday through friday Uh, and how can you do that to make it really easy and to make it appropriately organic and appropriately? Pastured and appropriately wild caught fish and all the things that make it so that you hit all the the right places For your synapses and so they now have this and it's uh, it's under keto flex So if you just look at keto f l e x one two three dot com keto flex dot com keto flex one two three Because it's a keto flex 12 three approach now. As you know, there are other diets that people have used But they don't tend to get you they don't hit some of the biochemical parameters They don't get you into ketosis at the appropriate time. Some of them don't have enough of the appropriate nutrients So this is the one that actually biochemically works the best for cognition and there are many people who've been using it Who are you know living proof and i'd say i'd start with julie who's been doing this sort of thing for many many years So yes, please check it out. I've eaten them myself and they definitely improved my ketosis They definitely are very very helpful and I give credit to nutrition for longevity for making them delicious Oh, this is amazing because it's one of the most practical things that people even my patients that maybe aren't Cognitively impaired have trouble with what do we eat? How do we eat? Well, and it's I think it's more and more complex And what I love about the program and I've been a fan of this for Almost a decade now and how long it's been but The plants are so crucial and sometimes you hear keto and people are just eating bacon and butter You know and it's like waiting in a no right and you and I totally agree on this But I I think that's so crucial for people to know you can be ketogenic or mildly ketogenic as you put it And still have plant-based diet and there's like this this really really important place where they meet And I really feel like this is a foundation if you've had cancer of course the cognition but this place where you're getting fibrous Nutrient dense foods, but also Metabolic flexibility is really where we're landing on for not only cognition, but many other diseases Absolutely, you know and you mentioned earlier we were talking about the The nature of the of the native immune system and where the memory is so what happens is you can become hyperactive Interestingly and it fits beautifully with this if you eat saturated fats You go up like this and so now you are in a more pro inflammatory state on the other hand if you're eating omega 3s You're coming down. Interestingly if you have adverse childhood experiences, you're going back up So anything that's causing stress is resetting that system to this more pro inflammatory state And we discovered in the lab and published almost a decade ago now That apo e4 does that itself So you've got to essentially counter that with appropriate things like omega 3s and things like and curcumin and appropriate things like that And speaking of curcumin I should ask you have you seen this stuff recently on curcumin being adulterated with lead chromate because of the yellow color Oh, you know, I have yes. Yes It is like some of these things who are like oh goodness We're trying to get even like kale and these wonderful leafy greens are used to pull thallium from the soil So now some of these green juices if you're not careful for a source and it can be organic It has this loads of cadmium and thallium and you're right. It really is scary of whatever Last little thing to before I let you go apo e4. This is a big fear thing for people who have it or know they have it Maybe if you're listening out there, you don't even know What's the prognosis for apo e4 force and basically tell us what it is and then what would you do differently for them? And what would their risk be for cognitive decline? Yeah, great point. And you know things are changing dramatically because you can now check someone's P tail 181 everyone should know that you can check their a beta 4240 ratio and soon gfap So here's the thing if you have no copies of apo e4 and that's three quarters of the population Most being three threes some two threes Your lifetime risk for Alzheimer's is about nine percent. It's not zero, but it's not too high If you have a single copy and that's 75 million americans and everybody should know it Your risk is 30 percent. Please get on some prevention. You don't have to get this the biggest message for today is Alzheimer's is now optional. Nobody needs to get this problem So that's 75 million americans. Please find out. Please get on active prevention There are lots of you know great things to do if you have two copies and that's about seven million americans Unfortunately, the vast majority don't know it your risk is up more like 70 percent Most likely you will develop Alzheimer's disease. And so again, you don't have to please get on active prevention Now, what does that mean? That means get a Cognoscopy get on the personalized part as dr. Jill was mentioning earlier. This is all about personalized medicine That is the future and that's the present now as well But yes, you start with the basics the diet exercise sleep stress all the things we've been talking about And most people are going to do just fine with that But find out if you have chronic infection that's undiagnosed you can get that treated I mean again, you know lime disease such a common issue So many people have it don't realize of course long covid is now emerging as a big issue For people's cognition for the future find out if you've got exposure in your home to mycotoxins find out Even if you're not having symptoms yet, you are at risk for symptoms down the road Get on an appropriate diet Do a do a a week or two of Of keto flex 12 3 through n4l one of these groups. It's it's a good idea get yourself in an optimal state Performance is closely related to risk So you get yourself in an optimal state do these sorts of things and you'll you can lower your risk dramatically We haven't seen a single person yet and I asked all the doctors I talked to have you ever seen anyone Who started when they were asymptomatic did the right things for prevention and still develop dementia? I haven't seen one yet. I haven't heard of one yet There will be some it's on down the road But at least what what you can say is it's it's very uncommon Yeah Tremendous, thank you for the tireless efforts and work that you bring to the world dr Bredesen you are just a gift to humanity and a gift to so many Including myself as a as a fellow doctor that that looks to you for guidance and wisdom and research And we are so grateful both the patients and the doctors Let's just leave everybody with where they can find you and repeat the keto flex and then your own recode Where can people find more information about this? Yeah, thank you so much. I really appreciate that and thank you dr Jill for all the great stuff you've been doing of course I'm always hearing about Wonderful wonderful patient stories of people who've come to you and had such dramatic improvements So thank you for all your great work over the years and of course your education and teaching for all of us So where people can find facebook dr. Dale Bredesen You know also on twitter also on instagram And then please be aware of the new randomized controlled trial You can see evanthea dementia reversal trial evanthea is e-v-a-n-t-h-e-a That actually came from the mother Of of our of our the donor who supported this work very very kind dr Are very kind to support the doctors diana mary and we're grateful to her And so please please check that out, especially if you're in one of those six areas that i mentioned before And so please take a look at this and again Get a cognoscopy you can look at my cognoscopy.com. You can also look at keto flex k e t o f l e x one two three Dot com for the meal deliveries easy delicious great stuff to have Perfect and wherever you're listening. I am putting these websites in you'll be able to see them and link to them So if you didn't get that down just come back to the landing page. You can put all the links in dr. Bredesen Thank you so much. I so appreciate it for all your work Thank you, dr. Jill. Thanks. Great talking to you as always you too