 So on this podcast, we're going to talk about something that I think is on everyone's mind and that is brain health. And here's the good news. For you folks who are worried about whether you carry the apoE4 gene, the Alzheimer's gene, it is not your fate. And I'm going to give you some tips on keeping that gene turned off. So first question that everybody wants to know because it's in the news and I talk a lot about it, the apoE4 gene. So the apoE gene makes you make a lipoprotein that carries cholesterol around your body. There are different ones of these genes and different ones of these lipoproteins. The one that gets everybody's attention is the apoE4 gene. Now why it gets everybody's attention is about 30% of us carry either a single copy of this four, you're called three fours, or a double copy of this four and you're called four fours. About 25%, 28% of us carry three four, the other 2% carry four four. Now everybody goes, well, that's called the Alzheimer's gene and it is because it's the only recognized gene that correlates with an increased risk of developing Alzheimer's dementia. Now I might add that Alzheimer's dementia is different from other forms of dementia. There's such a thing as vascular dementia that I'll talk about as we go along. Okay, so what is the risk? So people who carry the single copy of the four have about a eight or actually about a double the risk chance of developing Alzheimer's than if you didn't have that. The folks who carry the four four have an actual eight times risk of developing Alzheimer's. So that's a real deal. Recently, there's been a study looking at early onset Alzheimer's. These are people who get Alzheimer's before the age of 60. And interestingly enough, only about 10% of those people had the apoE4 gene. So the point of that study is that the vast majority of people who got early onset Alzheimer's, it wasn't the gene that did it. So you're sitting around going, well, should I have my apoE4, my, my apoE status checked? 23andMe does it. Their genetic testing services do it. You can actually have it checked for in any of your doctor's offices say, hi, I want my apoE status checked. It never changes. You either have that gene or you don't. So you're not going to recheck and say, oh, good, it's gone. The point of all this is there are modifiable things you can do to make sure that gene isn't as mischievous as most of us fear. So when you carry the apoE4 gene, and I got interested in this because people who carry the apoE4 gene have increased heart disease, have increased coronary artery blockage. And we now know that the process that causes the coronary artery blockage is the same process that contributes to Alzheimer's in the brain. And that is with this gene, you guys unfortunately don't carry cholesterol properly in and out of your brain. Even or not, your brain cells need cholesterol. It's a critical component of our brain. But unlike, quote, 75% of the population, if you carry the 4, this little carrier, I like to think of it as a subway. And the subway, apoE4, is carrying cholesterol into your brain and cholesterol gets off the subway, goes to your brain cells, goes to work, and then believe it or not, whatever cholesterol isn't needed at the end of the day gets back on the subway, the apoE4 carrier, and leaves. That's how things should normally work, kind of getting on and getting off this carrier. What happens if you make this apo lipoprotein 4, cholesterol gets off just fine, gets out of the subway, goes to work, but then when it wants to get back on, get out of the cell, the subway is full, the doors are closed, and so cholesterol actually builds up in the cell where it does its damage. So that's why study after study after study shows that lowering small dense LDL, and you can have this measured in any doctor's office, is very, very important for people who carry the 4 apoE. It's not so important if you got a normal subway system. So and you've heard me talk, the cholesterol in and of itself is not dangerous, but if you carry this malfunctioning subway system, it behooves you to keep that portion of cholesterol low. So how do we do that? Studies show that saturated fats, particularly animal saturated fats, are the mischief maker in apoE4s. So sorry about that, that means limiting the amount of cheeses you eat, limiting the amount of animal fats that you eat, like bacon for instance, limiting the amount of other long chain saturated fats such as is in coconut oil. Now there is another saturated fat that is a medium chain saturated fat that's called MCT oil, medium chain triglycerides. At least in my studies, it does not seem to increase these small dense LDLs, but I can guarantee you that it does, that saturated fats like coconut oil will. Let me give you a classic example that I share with all my patients. I have a young man, incredible young man, who carries the apoE4 and his father actually has early onset Alzheimer's. So obviously he's very concerned about this. And whenever we test him, he makes a lot of what are called small dense LDLs. And every time I would see him, I said, look, you know, and he loves cheese. He said, we got to get cheese out of your diet. I'm sorry. And he said, no, I love cheese. I said, well, I tell you what, let's do an experiment. Two weeks before the test, I want you to give up cheese and we'll draw your blood and see what happens. So he does. We draw his blood, his small dense LDLs, which are really high, drop to normal. And he's looking at his results and he looks up at me, he says, it's the cheese. And I said, yeah, he says, well, this is great news. I said, oh, thank goodness, you get it. He says, no, you don't get it. I can eat all the cheese I want two weeks before the blood test. I'll stop eating cheese. You'll never know. And no, his body won't know because we know that cheese in him is producing a problem in his brain. He's not feeling it now because he's in his forties. But believe me, every study shows that if you have the four, you don't have to stop it, but you have to limit the amounts of saturated fats in your diet. And you'll see, and I see this in all my patients, those small dense LDLs just drop to beautifully low levels, and that's what you want if you have the four. Now the other question I get is, I don't want to know I have that gene because I'll just be freaking out that the next time I put my cell phone in the freezer, that means I have Alzheimer's. And that's not true at all. We know that this is completely preventable if you carry the four as long as you do these tricks. For instance, I love to talk about this gentleman who was brought to me by his family when he was about 90 years of age. He runs his company as three daughters and they said, look, dad is sharp as a tack. We want to keep him as owning the company. We don't want to take over. Can you help us? Well, he carries the four. So he's now, he'll turn 98, actually in a couple months. He still runs the company. We dramatically drop the amount of small dense LDLs in him. He's happy as a clam. He's smart as a whip. He does not have Alzheimer's. And so you can do this at any time in your life. The other important thing is that you can, if you don't have those subway cars full, actually begin to do what's called reverse cholesterol transport. So please get the APOE4 tested for a third of us, 30% of people carry it. And there's something you can do about it. Now I think that discussion should actually make it clear that genes, even that gene, does not determine your fate. And like I talk about in the longevity paradox, there was a beautiful article published in Gut in 2018 that actually showed that family history genes has only about a 10% or less effect on your fate, on your longevity, on your diseases than environmental factors and the food you eat and the gut microbiome that you have as well as your oral microbiome. And I'm going to go into that in just a second. So if our genes only have about a 10% effect, that means that our lifestyle, the things that I talk about every day, is where you're going to make the individual difference on your health, but also on your brain health. And so that's the great news. Your parent getting dementia or your parent getting coronary artery disease or your parent getting diabetes or even your parent getting cancer is not your fate as long as you don't eat like your parents. So when I take a family history, all I want to know is if you're eating like your parents ate and then they got something, that's where we have to intervene because their fate does not have to be your fate. And that's the exciting thing about the longevity paradox. You can control almost everything that's going to happen to you with food and appropriate supplements. So I have a whole section in the longevity paradox about the importance of exercise and particularly exercise in women who want to have good brain health. It's a shocking study, but so exciting. I just keep mentioning it all the time. This study looked at humans, human women, women who engaged in a regular exercise program. And that can be as simple as walking the dog for a mile twice a day. It can be as simple as yoga, as Pilates, as believe it or not Tai Chi, or something as vigorous as running or weeding a garden, believe it or not, weeding a garden is hard work. Women who regularly engaged in exercise throughout their lives had a 90% reduction in developing Alzheimer's disease compared to women who did not regularly exercise. Now even if they got Alzheimer's disease, that Alzheimer's disease occurred 11 years later than the group who did not exercise. Now just let that sink in. If we had a drug that was 90% effective in stopping Alzheimer's disease, how much would you pay for that? And this drug is free. And even if you were going to get Alzheimer's, getting Alzheimer's at 80 is a whole lot different than getting Alzheimer's at 91. You got another 11 great years that most of us actually look forward to in our 80s rather than sitting in a chronic care facility, not knowing our loved ones' names. So exercise is so, so important in this process. The other thing that exercise does that I talk about in the longevity paradox is that exercise probably does this by changing the bacteria in your gut to a more friendly bacteria. Dr. Dale Bredesen who wrote The End of Alzheimer's and I love to talk about this. Most people have heard of amyloid plaque and tau proteins in Alzheimer's. What most people don't realize is that that amyloid plaque comes from bacteria in the gut. It doesn't come from the brain. And that amyloid plaque, if you have a leaky gut, leaks out of the gut, goes to your brain and there it actually stimulates the production of more amyloid plaque. So if you don't have gut bacteria that are making amyloid plaque and you don't have a leaky gut, by definition you can't get the amyloid to go to your brain. Same way with Parkinson's. We now know that Parkinson's is actually caused by number one a leaky gut, but more importantly a second new paper has confirmed that lectins climb the large nerve that goes to our gut called the vagus nerve up to the brain to the area that controls movement called the substantia nigra and cause Parkinson's. And most people have heard of a herbicide called periquot. Believe it or not it's banned all over the world, interestingly enough it's still not permanently banned in the United States and this recent paper showed that periquot climbs on to lectins and goes to our brain. And we've known for many, many years that periquot causes Parkinson's and we now know how it gets there and that's via lectins. So these are steps that you can take for great brain health. And I'll say it again and I'll say it every day, lectins are the major cause of leaky gut in almost all of us. So getting major lectins out of your life is one of the major ways to protect your brain. Now brain boosting also is important in terms of your oral microbiome. Believe it or not you've got a bunch of bugs in your mouth and we're now sadly discovering that mouth health, that gum health may be even more important for your brain health than any of us would have suspected. There are two scary new papers that show that if you look at plaques from people who have died with Alzheimer's disease, every one of those plaques will have a bacteria from the mouth called P. gingivalis present in those plaques. Now think about this. The mouth and the nose are right next to the brain. They're the closest to your brain of any structure. And those bacteria in your mouth, if you have gum disease or what I call leaky mouth, get right through your bloodstream and have a direct shot into your brain. So that's all the more critical. If your dentist tells you, oh you've got deep pockets or you've got gingivitis, this is actually a cause for alarm that these guys are leaking into your bloodstream and getting into your brain. And there they actually cause inflammation, which is the cause of all dimension from whatever source. So more and more important we have to realize, number one, mouth washes kill bacteria in your mouth. We actually have to have a friendly oral microbiome to actually keep your gums and mouth safe. The other thing that I talk about in the plant paradox is that mouthwash users kill off bacteria that actually make a compound called nitric oxide which dilates your blood vessels. And believe me, we want our blood vessels to dilate to get blood into our brain. So skip the mouthwash. One of the best breath fresheners there is is parsley. So parsley usually comes on your plate when you order something. After you eat chew the parsley, it's one of the best breath fresheners there is. And particularly fond of either coconut oil pulling or better yet, olive oil pulling. It will actually change your microbiome. And here's a tip from Penny, please floss at least once a day. She does it twice a day. I can only bring myself to do it every other day. I admit I've even done a study on myself and others every other day flossing. Get yourself to floss. It will change the way bacteria have of getting into your bloodstream. It will stop them in their tracks and it's a study I published in the Journal of the American Heart Association. The other scary study, people have strokes and they're caused by emboli. And most of these emboli come out of our carotid arteries, these two great big arteries that go to our brain. This study in humans found that another oral bacteria called strep viridans was present in the emboli in these people who had strokes. This was by a same group that also confirmed that people with coronary artery disease have strep viridans in the plaques in their coronary arteries. This goes along with my theory and other people's theory that atherosclerosis, hardening of the arteries, plaque in blood vessels is actually an inflammatory process and that bacteria are capable of initiating this inflammatory process. So not only do you not want to have leaky gut, but you don't want to have leaky mouth. So make sure when you go to the dentist that they are doing probing of your gums and if you start getting threes or fours or beyond that ought to pull it off the air raid sirens that you got leaky mouth and these bacteria are actually getting into you and your brain. So please, I talk about taking care of our gut, but it's equally as important to take care of the bugs that are in our mouth. Speaking of taking care of our brain in another way, I mentioned earlier that meditation is incredibly useful. There are actual studies that show that meditation, however you choose to do it and we've had a number of experts on the Dr. Gundry podcast that explain different ways of performing meditation and I think they're all great because some people like myself who have monkey brain absolutely positively cannot quiet our brains, but we've had some experts tell us, no, no, no, you don't have to quiet your brain at all. I just want you to have a quiet time. I actually meditated during heart surgery. I now meditate during my jog with the dogs. However you choose to do it, whether it's a quiet time, you can meditate laying down in bed, just do it. Meditation changes your gut bacteria for the better and very good studies in memory show that people who meditate on a regular basis have improved memory versus controls who were not taught to meditate. So take the time, look at some of our podcasts, there's some great books, there's some great self-help ways of making meditation a part of your everyday life and it does not take a room where you lock yourself up for half an hour and make your mind go blank. That's not what you have to do. Now it's time for my favorite part of the show, the audience question. Luminary 27 on Instagram. I read your recent interview with Goop and you seem to be a fan of cassava. There is information out there saying cassava is poisonous and less cooked and I'm so confused. If lectins are harmful, how is the cassava exempt from your list? Well so far I don't know of a human being who eats raw cassava. Remember plant tubers are protected by the plant with poisons, toxins. They don't want insects from eating their tubers and so they have a protective system. We as humans after fire was discovered or we bumped into it probably about 150,000 years ago dramatically changed because fire, heat destroys the toxins in tubers and there's very good evidence that you and I are what we are today, thanks to fire allowing us to eat tubers. So you can have all the cassava you want as long as it's cooked and quite frankly a cassava flour is cooked, cassava chips are cooked. Now I have another podcast that says be careful it's still a starch even though it's a resistant starch and you can't have 12 bags of cassava chips every day. You can't have 14 cassava flour tortillas every day. It is not a health food in that way but cooking destroys these lectins and these toxins. So have your cassava but that's a great question. So thanks for bringing that up. Okay so that's it on brain health today. A lot of subject area, I hope that helped you guys particularly with the apoE4 gene. It is not your fate and that's the great news. I want you to be that 98 year old guy who's still running their company and running it very well I might add. Before you go I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher or wherever you get your podcasts because I'm Dr. Gundry and I'm always looking out for you.