Intro Voice: Doctor's Kitchen. Recipes, health, lifestyle.
Dr Dean: Studies have shown that kids as young as 12 years old, all this hoopla about ADD and ADHD. ADD ADHD is a real thing. It's a little overstated, over-recorded in US, but it's a real thing. But it's nothing compared to telling people that the kids are still myelinating. They're actually building the brains up to age 20, 21. And you're seeing white matter disease in children because of diet? That by far supersedes any danger of ADD, ADHD of anything else, because you're structurally damaging the brain that early. So we think that people shouldn't just wait till they have memory issues. They shouldn't wait till they have some stroke or vascular disease. They should assume that if we're not eating the healthy food, that you're actually affecting brain early on.
Intro Voice: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests while we discuss the multiple determinants of what allows you to lead your best life.
Dr Rupy: Dementia is the defining disease of our time. In the UK, it is the leading cause of death. Almost a million people suffer with it and one in every 14 people in the population aged over 65. And it's growing. The most common type is Alzheimer's and the treatment, well, there are none. And after decades of research and billions of pounds spent, we have a few drugs that mildly improve symptoms, but nothing close to a cure. And so when I came across lifestyle measures including diet, exercise and community-based interventions that could reduce the risk of getting dementia by 70, 80 or even some people are saying 90%, I had to get Dr Dean and Dr Aisha Sherzai on the pod to talk about their research. They are a unique husband and wife team on the cutting edge of brain science and dedicated to educating people on the simple steps to long-term health and wellness through their work as directors of the Alzheimer's Prevention Program at Loma Linda University Medical Centre with patients as well as through online writing, videos and books at team sherzai.com. Dr Dean Sherzai is a behavioural neurologist and neuroscientist whose entire life has been dedicated to behavioural change models at community and population level. And Dr Aisha Sherzai finished two residencies at Loma Linda University in preventative medicine and neurology. She also holds a master's in advanced sciences from UCSD and completed a fellowship in vascular neurology from Columbia University. Today's podcast is going to cover a number of different things. We talk about how they became interested in brain health and their personal reasons why they go into plant-based eating, the prevalence of dementia in the US and the UK, the brain as a huge energy and oxygen consuming organ and their community-based research. After today's podcast, you're going to learn a lot about creating habit loops and why a plant-forward eating pattern is critical to preventing dementia as well as a whole bunch of other issues as well that we see in medicine. We also talk about specific foods that Team Sherzai call out as helpful for the brain, which you'll come across. You will also learn about the issues around nutritional science and why this information is taking just so long to trickle down into clinical practice that everyone has access to. You'll learn about the main cells involved in brain health, namely the neurons and the glial cells, and just why diet, lifestyle and other factors are becoming top of importance amongst traditional medical communities and why prevention is the cure. We go into a bit of detail about the genes known to play a role in dementia risk and how the bare minimum of those are deterministic. So if you have come across APOE or the other genomic tests that claim to give you risk factors around Alzheimer's, you'll learn about just how much scope there is for lifestyle intervention to prevent disease as well. I'm not saying it's everything, I'm not saying, you know, it's it can make you your brain tip top, but it certainly has a huge impact on your risk. And we also talk about why better brain health supports your immune system and all the other parameters of how you can improve your brain health today for not only prevention, but also improved cognition, improved performance and improved happiness as well. You can find all of this information and more in their new book, The 30-Day Alzheimer's Solution. It is a fantastic resource, as is their previous book, The Alzheimer's Solution. I've learned so much from them and I'm sure you'll find it useful as well. For now, on to the pod. So first of all, thanks so much for making time in the morning to jump on the podcast. I wanted to kick off things because I've been following you guys for a while now. I think your work is wonderful. I wanted to ask how you started becoming interested in the brain and ultimately a plant-based way of living because I understand at least from what I know of Dean, that you weren't really a plant-forward eater.
Dr Dean: Yeah, and not as I said, not even close. I grew up in a family of doctors, Northeast United States, New Jersey, Pittsburgh, those kind of places. As it happens, I always say this, surgeons think they're hunters. So we had a farm for hunting alone and as it happened, thank goodness for the animals, they were horrible hunters. We would always go out the whole day trying to hunt in this huge piece of land and then come back home and go to some shop and get the meat and eat. So it was not even in my mindset to be plant-centred. And I played sports in Pittsburgh, soccer, tennis and everything else. And it was seven meals a day, even beef jerky eating meat. And so it happened about 2002 when I went to Afghanistan where I was asked, I was at NIH at the time doing work in building and experimental therapeutics branch that as esoteric as wonky as you can get. It's the centre of research, the weirdest research you can think of. And I was asked by HHS and World Bank to come to Afghanistan to help rebuild the healthcare system. So I went there and lo and behold in a party, this lovely person comes, sits next to me. Yes, she will, her story is a little different, but we started talking and our first conversation was around our grandparents. And our first conversation was one of those events where my grandfather who was the foundation of the family, he was the Secretary of Education, brilliant, brilliant man, poet, philosopher. He would be in the centre of gathering in this farm where everybody would gather on the weekends. He would be playing chess and on one of those occasions, and he was phenomenal in chess, he forgot how to move the knight. And for those who play chess, knight has this unusual L-shaped move and he forgot and everybody in the family, dozens of grandchildren just in shock, what's going on? And at the time we were young, so we weren't familiar and that was a foundational moment. And that was the moment that actually without knowing so pushed me towards neuro. I didn't go to surgery, general surgery, went to neuro. Aisha experienced the same thing with her grandfather, which was a brilliant Columbia-trained, Hopkins-trained, prime minister of a country who developed Alzheimer's as well.
Dr Aisha: Yeah, my grandfather was one of those individuals who essentially was the hero of the family. Everybody wanted to be him. The way he spoke, the way he talked, the way he interacted with an individual. And to see a person of his stature and his intellect slowly and gradually lose parts of himself left a very deep mark on us as children. And we remember him not remembering his children's names and confusing us with strangers and being scared of us, pushing us away, locking himself into his room. And so that was quite a painful experience for our parents and for us growing up and we were, I was intrigued about learning what really was going on. What is dementia and how is it, how does it take away your self, your your sense of existence? And so going through college, that's how I decided to get into neuroscience. And when I had that first conversation with Dean and the similarity.
Dr Dean: But what made you to sit next to me?
Dr Aisha: Well, of course it was your looks and your charm and this beautiful personality. And it was an amazing time.
Dr Dean: You'll be paid later.
Dr Aisha: He's humble about it, but Dean, he was in the experimental therapeutics branch of the NIH here in the United States. And when he went to the United States, I'm sorry, Afghanistan, he became the prime minister there. He actually changed the healthcare system for the deputy minister. He changed the healthcare system for the department or the Ministry of Health and he created these programs for women's empowerment where this is interesting, he actually recruited about 20,000 girls who were educated up to grade six and he created a nursing program for them, essential, essentially just teaching them very basic healthcare techniques, like how to give ampicillin if somebody has upper respiratory tract infection, how to create oral rehydration solution, or how to tell the difference between spotting and bleeding if a woman is pregnant because the next tertiary care hospital was days away. And so these women became community leaders. And so there was a, there was a paradigm shift in the realm of public health. And so when you see things like that, when you see when you make an impact like that, it's just a phenomenal way of living. And when we came back to the United States, I was there with Doctors Without Borders, just as a medical student volunteering with them in refugee camps. And when we came back here, we went back to neurology. At the time we went to UC San Diego. Dean started his fellowship in neurodegenerative diseases of the brain and I did neuroimaging research in Alzheimer's disease. And it was a, it was a bleak field in Alzheimer's.
Dr Dean: So immediately we were a bit of a risk-takers. UCSD was the number one neuroscience program in the country and after that the path was kind of set. You know how it is when you come from a place like that and NIH, you go to Boston and other, and we said, no, we're going to take a risk. You know, we've done the clinical trials, we've done those poor mice, we sacrificed thousands of them and looking into the hippocampus and it wasn't getting us the result. In fact, hundreds of millions of dollars spent on brain health research and zero treatment. The treatments we have are not curative or even disease modifying. They're just symptomatic. I mean, minimally symptomatic. So we said there's got to be a model of prevention somewhere. So we looked around, our mentor was Elizabeth Barrett-Connor, this powerful woman who had 900 publications and we had Dilip Jeste who was the head of NIMH who had another 900 publications. These are, they looked at prevention. And so we said, you know, we're going to take a risk and look and lo and behold, about 80 miles away is Loma Linda. Loma Linda is the only blue zone. For those people who know about blue zones, these are the healthiest places in the world. And it's the only blue zone in US and it's also the only validated blue zone in the world. They have the largest study, 96,000 people over 50 years. And when we looked at the data, repeatedly, lifestyle, people who lived a certain life lived 12 years more and healthier. We're not talking about months, we're talking about 12 years. And we're like, wait a second, why isn't anybody talking about this? Why are we still giving molecular treatments, which we should, we're not against molecular research, it's incredibly important, but it shouldn't be 100% of the focus. It should be 20%, 30%, the other 70% should be prevention. So I, as usual, I did a cold call to the president of Loma Linda, I said, I want to come and create a brain institute there. And he said, come over. We went, on the way there, our mentor, Dr. Leon Thal, who was the god of neuroscience, said, this is career suicide. And we said, it's a good death. It's worth it. So we went there and started a clinic, started doing research. I was the director of research for all the residents, not just neurology, and the director of research for neuroscience.
Dr Aisha: And I did a residency, dual residency in preventive medicine and neurology, just focusing on preventive neurology.
Dr Dean: So we coined the term preventive neurology, looking at the impact of lifestyle on the prevention of diseases of the brain, neurodegenerative, vascular diseases of the brain.
Dr Aisha: And what we found repeatedly, I mean, without fail, was, you know, there's these food wars, keto, paleo, forget about that. Whatever your food war is, there's no question that more plants work. Whatever you eat, it could be aluminum, sorry, I don't mean to be facetious, it could be, you know, whatever it is, add more plants with it, more greens, and because the data was just overwhelming. We're talking about, Aisha went to Columbia University two years, I had the kids, we would fly back and forth between New York and LA every two weeks. And in the morning she would be in the ICU, at night she would be in the cooking class, she's a culinary artist, and because what we saw repeatedly is food, food, food. And it's the dominant issue, whether it was stroke, California teacher study.
Dr Dean: Yeah, no, just looking at large databases, dietary patterns, populations being followed for a long time, we saw that people who adhere to a healthier diet had lower risk of strokes. One, one population that I work with is a California teacher study, 133,000 people followed for over 20 years. We wanted to find out what Mediterranean diet meant and, you know, everybody thinks that Mediterranean diet is this diet that only exists in the Mediterranean region, but when you look at the dietary structure, you get a high score if you eat fruits, vegetables, legumes, whole grains, nuts and seeds, and you get a lower score if you eat processed foods and sources of saturated fats. So it's a plant-predominant dietary pattern. And that was linked with reduced risk of stroke. So we kind of see this pattern over and over again.
Dr Rupy: I mean, there's so many things that I want to unpack there because one of the things I always find fascinating is when I speak to my colleagues about the fact that I'm interested in nutrition, I'm doing a master's in nutrition, I talk about recipes and all that kind of stuff. It's met with a degree of skepticism that is quite hard to overcome in an initial conversation. It's almost like I always, I have like a set of emails that I send my colleagues afterwards, like, look at this study, look at this study, you know, I get it, nutritional science does have issues, it is, you know, polluted by a number of different biases as a lot of studies are, but it is pretty undeniable when you're looking at the wealth of evidence and combining that with mechanisms that support why this might be happening and the extension on life as well as the prevention of disease to ignore. And so I wonder how you overcome that when you talk to other colleagues about it and perhaps even how you overcame that yourself. I mean, it sounds like it was over a long period of time, but yourself, Dean, you know, being in a field where you're looking at pharmaceuticals, it must have been quite difficult.
Dr Dean: The difficulty is a historical one for each individual physician. I mean, remember, we both did this, four years of college or five years in United States and UK and Europe is a little different, but still that preamble. Then you have four years of medical school, then you have four or five years of residency, then I, we did fellowships and then masters and PhD. I mean, by the time you're out, you're so indoctrinated into a system, which is a great system. I'm not the kind that throws the baby out with the bath water. Medical system has given us the ability to live healthfully into 70, 80 years. And for people who doesn't, they don't appreciate the healthcare system that we have, you know, I was the deputy minister of health in Afghanistan, I did work in Somalia and other places. One out of four children would die before the age of five. One out of six women would die during their pregnancy. We've done amazing things with the modern medical system. So we're not saying that the modern medical system is bad. We're saying now there's time to shift a little bit towards prevention. And in the medical education, there is no prevention. The little cursory talk that says B12 deficiency or vitamin C causes scurvy, those have no effect because people say, oh, I don't see that in the clinic anyway. But reality is that's the dominant issue that comes to us in the clinic after it's too late. Aisha and I live in a place where it's literally the healthiest place in the world. Loma Linda, the Seventh-day Adventist, they live significantly longer and healthier than everybody else. I mean, just that fact should tell people there is something going on that they're doing. It's not genetic because there's a, this is not a genetically specific population. It's actually quite diverse. When you look at the Seventh-day Adventist Hispanics, when you look at the Seventh-day Adventist African-Americans or blacks, and when you look at the Seventh-day Adventist Caucasians, across the board, they live longer and healthier, especially if they live plant-based. But people say, but it's not just the plant-based, they're also faith-based and they're community-driven, they walk. Yes. But when you look at the large database, when you look at the large database, that's the beauty of large data. That's why randomized clinical trials, they have their place. I've done, I've led many of them at NIH and other. But they don't give you long-term data, which is extremely valuable. If I did randomized clinical trial data research in the way that it needs to be, it would be a billion-dollar study, each one of them. So they have a place, but what gives you data is large databases because in large databases you can parse out through statistical models and others, parse out the confounding factors, the things that could be affecting the data and the things that are truly the dominant issues. And when you look at this, whether it's California teacher study, we've been part of that, 133,000, Adventist Health Study, 96,000, the Columbia, Northern Manhattan study, the Women's Health Initiative, all of them that we've been involved in, Framingham study. Yeah. All of them repeatedly, nutrition is the dominant issue.
Dr Aisha: And when you see this information coming at you from different lines of studies, whether it's observational studies, different epidemiological studies, in clinical trials as well, I think, you know, even if there are one or two papers that point towards the other direction, but the majority actually have, you know, pointing more towards a healthful living and nutrition being a very important factor, that's where you move. And that's how science works. There are no absolutes in science. You just look at the majority of the data and see where it points and you follow.
Dr Dean: And with the physicians, as beautifully stated, absolutely. And with the physicians, the second impediment is there is this sense of incredulity, a lack of belief that things can be done because a physician has 15 minutes with a patient in the United States. In that 15 minutes, I'm lucky to listen to the heart, tap the knee in my case, we don't listen to the heart. Who listens to the heart? Neurologists don't listen to that. You don't even have a heart. Nothing from dying. I'm joking. I'm joking. I do the complete exam head to toe in 15 minutes and give a full advice. No, but all of that and then believe that I can say something that can truly change people. Well, they're right. In that 15 minutes, it can't be done. But where it can be done is in the, in the conversations that we can have in the communities. That's why very early on, we went to the communities. We actually lead currently lead the largest community-based brain health initiative in the country. The reason I put the community-based part, my PhD is in community-based participatory research. The community-based part, there are studies out there, the pointer and others that they do clinical work on nutrition and lifestyle. But I think that's contrived. We actually go to the communities, use the resources of the communities, have conversations with the communities, and then bring about lifestyle change in these communities. But when do we have that time in our clinical setting? Or ironically and fortuitously, what you do on in your clinical setting and in the social media and what we do in social media has been more effective than what I've done in a thousand clinic visits.
Dr Aisha: Oh, absolutely.
Dr Dean: Especially if we stand for science, especially if we make the hard conversation, have the hard conversation saying that, you know, this little gimmick thing, lectin is popular, but the science is this and and have the hard conversation. You get bashed, you get pushed down. Without us going fully plant-based, if we had not gone plant-based, the fact that we did the largest study in the country in the world, the fact that we've published papers, the fact that we've, but we said this is the data. Now, how we change individuals or help, not we won't change them. How we create the conversations that they can create environments in their own home is by meeting them where they are, not giving dictations and edicts from up above. Here's a prescription, 20 broccolis. I've said that before. No, I haven't said that. So you have to meet people where they are and everybody's in different stages of journey. And that humility is had when you look at, when I look at myself 20 years ago, where my diet was, you know, meat, processed food, and cupcakes, breakfast, lunch, and dinner, and and a five or six Cokes, you know, soft drinks. Yeah. And and I thought that was healthy because I was running around. So I can't be arrogant about what where people should be. We just have to meet them and and give one tool at a time.
Dr Rupy: I'm really interested in your personal journey there actually because, you know, when I transitioned, the cupcakes.
Dr Dean: Yeah. I'm sorry.
Dr Rupy: I mean, where did the five Cokes come from? I don't know where, yeah, that, I mean, that's pretty shocking. But I mean, you know, that aside, I think it's very difficult for people to change behaviour. And I'm wondering what your personal experience has led to in terms of how you encourage and empower other people to make the changes that you ultimately made as well. And also, you know, you talk about in your in your book about mimicking the savoury tastes and the what you might miss as well from a diet that has a lot more refined products in, sugar sweetened products and and meat products as well. So I wonder how you came across that yourselves.
Dr Aisha: Yeah, I think the first step, and I know you do this all the time too, Rupy, is to find out why. Why is it that someone or some people have a particular type of a habit? Conversations and listening and understanding people's situations helps quite a lot instead of coming from a place where you're trying to, quote unquote, fix things. Being a fixer never works in the realm of behavioural neurology or behaviour in general. So understanding why, finding out patterns of behaviour specifically, going down into the details. I mean, we even have questionnaires and checklists to find out what they do the first thing they wake up in the morning, what they eat, what they have inclinations towards, when they're under stress, what kind of foods do they move towards, and why is it that healthy habits don't happen around them? And then, obviously, it's different for different people. And finding out one element that they can change at a time. Dean always brings his business background into this and creates smart goals, you know, specific, measurable, attainable, relevant and time-bound goals. And that works in many cases because it seems easy. People are busy. The notion that you are working towards a better health is difficult to maintain because sometimes you don't see immediate effects. And especially when it comes to brain health, you don't see better focus and attention, you know, minutes right away. It's not like a cream you put on your skin and you see that your skin is getting moisturized and it looks better. So conversations, education, finding out what works for them, coming from their perspective, and making sure that you earn their trust, that they don't think that you're sitting from a very elitist position, you know, speaking down to them and telling them what to do because you're the know-all. That never works. And so that's why we're very passionate about our healthy minds initiative, which is the non-for-profit organization and everything we do go towards that. And we go out into communities to have conversations and to essentially find out people who can be health ambassadors or brain health ambassadors and speak to individuals and spread this message of hope and empowerment.
Dr Dean: Beautifully. And one of the things about human brain is it's a three-pound organ, two pounds, it's a jello, it's a hard jello. If anybody's ever held a brain in their hand, and I hope that if you did, you are a physician and it wasn't in a condition. Yeah. I would be gruesome if I know, I know. So I'm not speaking to those people. But in general, it's three pounds, 2%, but consumes 25% of your body's energy at any one point. It could even more at times, oxygen as much as 50% at times. It does some of its best work during sleep, which should be a clue. Sleep is extremely important, restorative sleep, we call it. But this brain, this amazing brain needs low energy outputs, low energy behaviours. And another name for low energy behaviours is habits. So we develop these habit loops for computer scientists out there, there are these macro loops. These are programs that set and repeat themselves. Well, that's literally what a habit loop is. It's a macro loop program. And 90% if not more, arbitrary number, I hate arbitrary numbers, but sometimes you have to use them. It stands for a lot. A lot of your behaviour, even your political views are habit loops that are set early on in life. They're connected to other habit loops. That's why they're hard to change because they're interconnected habit loops. Now, these habit loops are, people quote places like the basal ganglia, but it's mostly driven in the basal ganglia, but other places as well. But these habit loops are well ingrained. They were functional, even when they were dysfunctional, they were functional because if they were doing something bad, they were serving some psychological need, a bad psychological need somewhere else. So they were functional. To change that, by the way, all most of your habit loops are set in your teenage years. And I tell people, really, you want to stick to your teenage habits? I have two teenagers at home. I love them. They're phenomenal, but those are not the habit loops you want. So resetting the habit loops is critical. So telling, teaching people instead of all, so I gave some jargon here, but saying, what if I can tell you that we can, we and us two always, we can change habits and habits are critical because they can give you the kind of power that marshals the full capacity of this brain that's got trillions of connections at one times 10 to the 50th processing power, most powerful, more powerful than any supercomputer today, today. And and that's and we just use it to watch Big Brother or some other show, you know, it's it's incredible power. But if we control the habit loops, and the habit loops are changed one small behaviour at a time. In fact, throw away the New Year resolution, throw away the new diet, forget about the name, whatever name you've heard, one habit. A smart, specific, measurable and attainable habit. So let's say that you look at your life and you say, I want to, my diet is not good. That's not helpful. That actually creates more anxiety which pulls you away, you know, the fight or flight. How about you say, you know, sugar, we all agree on sugar. Sugar is bad. That's one thing people don't argue about, but let's say sugar is bad. Okay, first quantify it, truly, because we underestimate how much we consume. How much of the processed sugar you're getting in your canned foods and your packaged foods or added sugar. I'm going to reduce that or in white bread and things like that. I'm going to reduce that by 50%. First, be honest with yourself, is that doable? 50% of and and shouldn't be just elimination. How are you going to replace it with something else that's if not equal, at least satiates that need for a little bit. So, sugar, 50%, and here's the replacement for the next two months. By the way, sugar is as powerful as cocaine. You need two months. 21 days is not going to do it. Two months. So sugar. And once you succeed on that one little, by the way, have a little box where you check it off on a daily basis. You change that one behaviour specifically, measurably, visibly, and after two months, you've actually gone through the withdrawal. Yes, you're going to feel bad first because all change feels bad. All change from high energy, high processed food feel bad because it's taking away that that overdrive. So you're going to feel bad, you're going to feel the withdrawal. And then when you settle to your resting state, even that sugar, what do we get every time? The fog has lifted. So one habit specifically, measurably will change, well, it will be the nidus for the beginning of a pattern, not on diet, not on exercise, but on a control over your habit creation. That's where, you know, we the name of the book is the 30-day Alzheimer's solution, but it's not about, you know, we were uncomfortable. We are uncomfortable with every gimmick from from processed to GMO to but even 30 days, but the 30 days is not going to give you a beginning of a new life by no stretch. But the goal of that 30 days is to get control of habit creation. And knowing that changing diet is not deprivation, it cannot be deprivation, it fails. Changing diet is small incremental successes toward a more variety of beautiful, plentiful, vibrant life that doesn't break your brain, but makes your brain. We say that every food you eat, every meal, either breaks your brain a little bit or makes your brain a little bit. So that's the the habit change pathway that we we undertake.
Dr Rupy: Yeah, I mean, there's so many things that really do speak to me about that. It really does remind me about the TED talk that I was privileged to give in Bristol where we started our culinary medicine program at the medical school there. And I talked about the diet wars and how actually when you look at them, 80% probably agree on things and it's getting rid of processed foods, sugar, poor quality fats, etc, etc. And really what you want to be focusing on are the habits that you can make every single day that compound over time to lead to a healthier diet that you can sustain because the biggest thing that I find, particularly when I talk to people about the way I like to eat is, well, that's completely far removed from the way I eat right now, that's completely unattainable for me. But the way you've explained it in terms of just making one change at a time, I think is is super important and that's exactly how I like to bring it up, particularly in our clinical appointments, which are around eight to 10 minutes in the UK here. We're really, really stretched as well. We're talking about the brain today and I love the way you talked about the brain being, you know, a largely lipid organ, very energy consuming as well. I wonder if you can give us a sort of insight into the degree by which dementia is affecting the population in the US. I know in the UK it's the leading cause of death, about one in 14 people in the UK actually suffer with dementia over the age of 65. It's definitely a growing issue. I'm assuming it's similar in the US.
Dr Aisha: Oh, definitely. It's the, the numbers are very scary. Currently, around 6 million people are living with dementia in the United States. And this, this number is increasing and we think that this is an underestimation of the true numbers because there are a lot of communities and a lot of populations who never report it. And it is considered as a normal part of aging to have memory problems. So we think it's an underestimation. And the numbers, you know, one in, one in 10 over the age of 65 has dementia. And this number actually increases quite a bit until about age 85 where almost 50% of the population have dementia. It is the costliest disease. It's the, the total numbers, the annual cost in 2020 was $305 billion, but that was just the direct cost. There's another $250 billion indirect cost where caregivers and loved ones take care of their family members and they lose a lot of days at work and things of that nature. So it is the costliest disease and in itself it's going to break down our system, forget about healthcare system. So everybody needs to talk about it at this point. And, um, right now, you know, with 400 clinical trials being done, no treatment for it at all, not a single medicine that can actually modify the disease. We have nothing. The couple of medications that are out there in the market, they are only for symptoms and they don't work for a very long time, only months to about a year. And the burden on the patients and on their loved ones is immense and it is projected that by 2050, if we continue to go through this, to this trajectory, the cost is going to be astronomical, $1.3 trillion. And so we all have to talk about this and it has to be a big part of the conversation, whether it's our politics or healthcare system.
Dr Dean: And the important point here is as Aisha pointed out, is that much of it can be prevented. Whereas that concept was controversial just a few years ago. We've been talking about prevention for the last nearly eight to 10 years. And initially when we were talking about this, we wouldn't even get invited to certain conferences. Two years ago, Alzheimer's Association International Conference, 5,000 dementia neurologists from around the world, the plenary talk was prevention is the new cure. Aisha and I were like jumping up and down like, okay, now it's popular.
Dr Aisha: Yeah, the first slide was prevention is the new treatment.
Dr Dean: Yeah.
Dr Aisha: But it took a long time to come to that point.
Dr Dean: Exactly. And even then they said 60% can be prevented. We think that with optimal, optimal is hard, with optimal diet, exercise, stress management, sleep and and and and mental activity, the five pillars that we we've named neuro, N E U R O, nutrition, exercise, unwind, with those five pillars optimally, and again, we say it's hard, up to 90% of dementia, the most costly disease, up to 80 to 90% of strokes, Aisha's specialty, strokes, all and stroke is another the most debilitating of all diseases, can be prevented and there's no question of that. Yet, like you said earlier, it's difficult to sell this in the physical, in the clinical world because what what is required to create the preventive pathway is conversations, listening, time, looking at communities, and how can we do that in eight to 15 minute increments? It's impossible. So now physicians are good people. Let's just say that. We're good people, right? We are good people. We are good people. Yeah. And and we want to be, we want to be, we most of us if not all of us went into this to make a difference. Both of us because of our families, we saw the good they did and everything. And when you hear the kind of things that that you have no access to and and it claims to do massive things, the dissonance it creates inside, you have to create language against dissonance. This is human nature. We have two things, confirmation bias, where we confirm the biases we had before, and creating language to to get rid of the dissonance. So these good physicians that want to do good, hear things that says that your work is not as effective as if you did public health and spoke to people like we do, it creates such dissonance that you have to create language that says, no, that can't be, it's not true. But the data is just overwhelming. The data is not questionable. We've done five reviews now, massive reviews. In fact, actually seven. We just submitted two reviews, comprehensive reviews, one on omega-3 and the developing brain and omega-3 and the aging brain. And repeatedly, repeatedly, the the the breath and the and the force of data that shows that nutrition, especially a clean diet, plant-based diet, the reason I say plant-based because I'm not running away from vegan, I'm not running away from this or that. It's just if we can change the diet of UK, Europe, United States, even 20% to more plant-based, that's 20% or so cost saving in healthcare. We're talking about trillions of dollars. So we can't be dogmatic. Let's move more plant-based. Let's go more cleaner. Let's go less processed. And if you're going to have cupcakes, have healthy cupcakes. So, yeah.
Dr Rupy: Rupy's cupcakes. Yeah. My cupcakes. I'm not, I'm not a very good baker, I'll be honest.
Dr Dean: But you know, this is, I'm glad you brought up these numbers because these are the things that I wanted to ask you about. When you're looking at the magnitude of dementia in the US and the UK, when you're looking at the cost of it as well, and you you have a potential program that has a 90% disease reduction or thereabouts, you know, you'd think healthcare systems would be jumping at the opportunity to employ this by any means necessary because whatever it takes, whether it's medical meals, whether it's personalized nutritionists, whether it's changing the food landscape to to make the right sorts of foods cheaper, we would be employing right now. So there is still a barrier there. Where it's coming from, I'm not too sure. And I think, you know, the fact that you talk about the plenary session starting off with prevention, I think is it's great, but that often takes a long time to trickle down into practice, isn't it?
Dr Rupy: So you have to look at where the impediments are. So the impediments are information, resources, in real estate, it's about location, location, location. In public health, it's access, access, access. Access to information, access to resources, and access to healthcare. Access to information, the healthcare system doesn't have the mechanism or the will to say that we are not doing the thing at the disease. So healthcare system that we have now is fantastic, but it's disease care. We meet patients at the point of disease. Those well checks are really not doing anything. Well, it's doing, you should go to your well checks. I'm not saying, but they're not really designed to do prevention. They're designed to actually check the beginnings of disease. Yeah. So the healthcare system doesn't have access to how to bring the information to the public. That's one impediment. And the culture change is so massive that it's better to ignore it than to meet that culture change. Culture is when language around the concept becomes ubiquitous in populations. So that's the problem. The second access point is, who's funding this? As far as information, let's just take information and research. The funding comes from resources. I was at NIH. We actually doled out the funding, you know, $27 billion was the funding at the time that they gave out. And the only way that a group of scientists would give money to another group of scientists is if you could measure the outcome tangibly. Like the sodium level, no, the glucose level or let's say the hemoglobin A1C level went from 6.4 to 6.2. That's a good study. That's not how public health works. You can't get that kind of measurements. You have to move populations and have different kind of measurements, which means against culture difference and a method of funding difference. So, lo and behold, they said, okay, lifestyle works. Let's give it funding, millions of dollars. And again, now they're bringing patients to clinics to give them dietary advice. My PhD thesis was community-based participatory research. And we looked at African-American communities or black communities, sorry, Hispanic communities and other communities. The possibility of transferring that information to the clinic did not exist. You have to go to the communities, to the faith communities, to the churches, to the to the barber shops and and other places because that's where transfer of information takes place. Now, if I bring that level of complexity, oh my gosh, a whole hoopla. Really? But that's what has to happen. Let me, so the questionnaires that are being applied in research were created in the 1960s, 70s on 50-year-old white men in Boston, the most educated. And now we were applying those in 70-year-old Hispanic women in San Bernardino. And when it didn't connect, we said, oh, it's failure. The failure is not in the person, the failure is not in the process, the failure is in the in the tools we're using from antiquated beliefs, antiquated thoughts, antiquated processes. So what we did in our research, we actually went to the community, it's called CBPR, you sit down with community leaders, it's not unstructured, so people say, oh, but no, it's structured. You give questions and and we got questions that were relevant to that community, we created a questionnaire out of that, then applied the questionnaire and what we got was 180 degrees different from what had been coming to us before. And and that's different in our other study, which is the largest study in San in Beach Cities, where it's an affluent population, it's mostly a Caucasian population, so it's a different kind of community and we got different responses. And the African and black churches, we got different kind of. So the impediment is in in a mindset that comes to us from 1950s, which is this solid box mindset, not the amorphous complexity, beauty of complexity. And and then the other impediment is the sources of funding, which is the research, which says, give me one solid outcome. You know, and it's got to be sodium of this or potassium of this. And human behaviour is not about that one solid number. Now, we can give you numbers that are movable, tangible, operational, but not the way that it worked 50 years ago. So that's where I see the impediment. That's why conversations that you and I and Aisha and at Columbia and others where it's a little uncomfortable, you push people and say, research has to adapt a little.
Dr Dean: Yeah, absolutely. And you touched on lipids there and I wanted to talk about fat in the brain because I think there is a new sort of pervasive idea that because the brain is largely made up of fat, that we can somehow eat tons of fat and it will go straight to our brain. I know you guys both as physicians know that that's not quite what happens and there's no storage capacity for the brain as well, which I think a lot of people need to understand. So what is this delicate relationship between fats in our brain and fats in our diet?
Dr Aisha: Yeah, thank you for bringing this up because it is a big misunderstanding. So yes, the brain is a fatty organ. It has a lot of fat. I think that has been exaggerated. People say it's 70% fat, but when you look at the calculations, that includes the water content as well. So it's much lower than that. But the fat in the brain is all structural fat. So it's a part and parcel of the wall of the cell, the structures of the neurons and the glial cells and the dendrites and the axons. And it's, you know, you don't have storage fat in the brain, which is a brilliant evolutionary concept because imagine what would happen to the brain if we went into starvation mode, right? It would start eating up itself. That doesn't happen. So the only kind of fats that the brain needs on a regular basis are omega-3 fatty acids. And they're small enough to go through the blood-brain barrier. So the blood-brain barrier is a very tight junction and it's like, you know, security guards at the brain that don't really allow a lot of things to go in. That's why, you know, infections and bigger, larger molecules are not allowed to pass through the blood vessels into the brain. And so omega-3 passes through and we need it on a daily basis. But as far as saturated fat is concerned or cholesterol is concerned, it doesn't. The cholesterol that our body produces in the liver is enough to add to the structural organization of the brain and we don't need to consume more of it. As a matter of fact, if we consume too much saturated fat, the very intricate blood vessels, which we have millions and millions of tributaries of these blood vessels in the brain, they get damaged. We have very sensitive layers of endothelium in these arteries that get damaged with too much saturated fats and trans fatty acids. And there was a time when Alzheimer's disease specifically was considered as a disease that essentially was related to abnormal protein deposition in the brain. But we now know that there is a lot of overlap between vascular disease and Alzheimer's too. So the damage to these small little sensitive arteries can actually cause damage to very susceptible areas of the brain, including the hippocampus, which is a part of the brain related to memory encoding, the frontal lobe, and we see these small little tiny strokes without any manifestations like paralysis on one side of the body or loss of speech or blindness. These small vascular damage to the brain actually tends to increase the risk of Alzheimer's disease too. So it's very important from a public health perspective for people to know that you don't need to eat a lot of saturated or fat in general and especially no need for eating saturated fats and trans fatty acids because it can damage the vasculature in the brain.
Dr Dean: One of the things that we are seeing and we're writing something about this now, which is not recorded as a, in the United States, we have these codes that you record the disease, ICD-10 now, it was ICD-9, ICD-10, UK, you have codes as well. There is no code for mild to moderate white matter disease. Nobody records it. Oh, I didn't know that. Yeah, you don't record that. But given that both of us see patients older than 55, almost exclusively, except I see some athletes as well who come from traumatic brain injury. But we see the prevalence of white matter disease ubiquitous. Always. And it's directly related to diet, to their lipid levels or hemoglobin A1C levels. I mean, it's it's crazy. I mean, to know that you're seeing white matter disease, and by the way, if you're seeing little dots, a few of them, it doesn't mean that it's, oh, it's nothing. They say that whenever you see anything on the MRI, multiply it 10,000 times at the molecular level and and throughout the brain because you're not seeing it fully manifest, but it's there. So that to me is the biggest epidemic in the West. A thing that we're not even recording. The thing that's actually behind the fog, the thing that's behind the cognitive decline that starts early, but not to the extent where a person is calling themselves demented or mild cognitive impairment. It's the beginnings of it. So if we can reverse that, and we know we can reverse that through diet and lifestyle, exercise and everything else, we will have done more than any other public health endeavor. But here's the thing.
Dr Rupy: Yeah, absolutely. And you mentioned alcohol. I did want to ask about alcohol. Again, my confirmation bias, I wouldn't mind having a glass of red wine every now and then. But the more I look at it and I also look at it through the lens of society as well and whether I should be recommending any amount of alcohol because of the other consequential effects of alcohol consumption, the fact that it's addictive. I'm coming around to the idea that we shouldn't be having any. Is that, is that something that's in line with yourselves or?
Dr Aisha: Absolutely. We've we've learned quite a bit about alcohol over the years. As you know, there was a time when it was recommended for brain health, but with more and more data and especially with the nuanced information that we're receiving, we now understand that the alcohol component, forget about the resveratrol and all these other nutrients that are available in wine, the alcohol component causes a lot of damage. It's essentially putting our body in a major state of shock, especially the liver and the filters in our body. And we have recently found out that the amount of alcohol needed for brain is essentially zero. You don't need it. And the amount of resveratrol in wine that you would benefit from is, you know, you have to drink a truckload of wine to get the amount of resveratrol that's good for the brain. We also think that the studies that have shown benefit, they essentially, it probably might be because of the conviviality that is associated with with alcohol. You're sitting with your friends and you're in with your, with your tribe and and that's a very strong anxiolytic. And so that's probably not really taken into consideration and it could be a confounding factor. But no, I agree with you. And the way we approach it in communities because it could be a, you know, you lose a lot of friends if you say things like this. So we say, you know, if you've never drunk alcohol, don't start it for brain health. But if you do enjoy, you know, a glass one here, here and there, never more than a glass a day, then I think that should be okay. Of course, in the context of a healthy lifestyle.
Dr Rupy: Yeah, absolutely. Always within that context. And and you the neuro lifestyle, which which you alluded to before, you know, nutrition, exercise, unwinding, restoration, optimizing. I think it's again, a very good sort of perspective, a lens to to look at the brain. And I wanted to sort of close our conversation really talking about the unwind element and how that relates to not only brain health and creativity, but also our immune system and how we can support our innate immune system as well through our thoughts and and other actions that can support unwinding and relaxing.
Dr Dean: Before we get to that, I want to kind of attack some words. Sure. Two words that we we we want to make sure that people, if they don't mind getting rid of from their vocabulary, one is moderation. Moderation is a word we use to get out of doing things. So, yeah, so I mean, I used to eat seven servings of processed meat a day in Pittsburgh. What is moderation for that person? Four servings? Is that any better? The reason moderation doesn't work is because there's no measurable, quantifiable denominator. So why even use it? What we say, identify the optimal. Whether you believe us and we look at our data, always look at the data, see if we're using any trick words like, you know, and of course, you we are completely aligned. And if you believe us, then the optimal is as unprocessed, as whole food, as plant-centered as possible and quantify that. And your job is to move towards that. Forget about moderation, this and that. How am I moving in a measurable way towards that? The benefit of that is not even about food. It's about you feeling a sense of control, which is bigger than food, which is bigger than the next diet plan. So the second word we absolutely abhor, which we think is arrogant, which is a vestige of of the centuries of of, well, let's not make it too bombastic, is the word motivation. Motivation, what is that? It feels like I'm supposed to get up in the morning motivated, raw, raw, arms up in the air, you know. No, throw that away. If you don't feel motivated, it's okay. What creates this feeling of movement forward is small incremental successes. Small measure, which connects to our previous term, doesn't it? Instead of moderation, small incremental successes. Once you create these small incremental successes that you check off, it creates a momentum that is way bigger than any motivation. So just those two words. In fact, out of this book, if you get anything besides her amazing recipes, is those two concepts of empowerment of behaviour change. Instead of these bombastic words that feel like they're empowering because I just listened to this guy talk and he was on stage and he was big guy and he was jumping around and I was so motivated. And then the next morning I'm like, oh my gosh, I'm not like him. Why? And I feel bad. Yeah. No, small incremental successes. Now, stress. We actually divide stress into good stress and bad stress. And that's not a little play on word. It is important because your brain, this, there's a reason why evolution invested all this energy on this three-pound organ. Why? Really, for me to just reproduce? I don't, I think there's more to it. It's information capture. Initially, the information capture was to get away from that tiger or bear. But civilization has given us more information capture tools. And if you're not information capturing throughout life, which is stressful sometimes, good stress, your brain actually decides that, oh, this energy investment at 50 years of age is not worth it. It actually withdraws and pulls back and shrinks. In fact, the number one factor that led to brain shrinkage was lack of cognitive challenge. Now, as much as people think Sudoku and crossword puzzles, which will at some point sue me, both of them, these companies, these big companies. You said a lot of bad things about Sudoku. Yeah, I'm sorry. Sudoku, crossword industrial complex will come after me. But those are great. Those are fine. But we did a meta-analysis in 2018, it was published, looking at cognitive games and MCI patients, which is pre-dementia patients. Mild cognitive impairment patients. And what we found was three factors. Purpose, yes, in science, there wasn't such a term as and I will define that purpose. Complexity and challenge. That's good stress. Bad stress is when you're doing activities that are not clear as far as purpose, doesn't have clear direction, don't have clear timelines and they run on and on and on and they're creating a feeling of tension. That comes to us from evolution, the fight or flight. At the core of our behaviour, and I'm a behaviourist, I'm writing a book on behaviour. At the core of our behaviour is that fight or flight, as much as we think we're so complex and we've read thousand, no, fight or flight. If we can manage that, we have got control over our little universe. Fight or flight, sympathetic, parasympathetic, run everything. Now, that was needed because if the tiger was coming at you, you better focus all your energy away from reproduction, from your immune system, from your digestive system, from your growth system, and focus towards muscle, running, vasoconstriction so you don't bleed and run. That was basically it. And if you look at it that way, you see that anything that creates that tension, short-term, it's good. In fact, we've seen that short-term tension, even that kind of tension we need it. It actually creates resilience. But if that state of feeling persists and persists and persists, it creates profound damage. And in our Western world, or actually in the world in general, we have developed systems where that persistent, unsatisfied, uncomplete discomfort, which creates the sympathetic undertone, persists, which lowers your immunity, lowers your growth, lowers your sex hormones, lowers your thyroid, lowers every system. How? Through what we define as the limbic hypothalamic pituitary axis, as well as the sympathetic. Now, this is cool. Every emotion you feel is translated in your limbic system and frontal lobe to say good or bad. If it's good, it sends a different information to your hypothalamus, which sends the different information to your pituitary. Now, pituitary is hormone central. The tip of your little pinky, that's how big it is. But that little organ has your control of your growth hormone, thyroid, insulin, sexual function, and directly through your adrenal, your immune system, everything is controlled there. So your everyday emotions continually affect your hormonal system, including your immune system. If you have good feeling, sends a different information to your hypothalamus and pituitary, which actually stabilizes all that. So two pathways, sympathetic, parasympathetic, we call it autonomic, and the limbic hypothalamic pituitary system. All coming from your emotions. Now, that's a little daunting because as soon as I say that, people say, oh, even if they don't say it verbally, they feel it. I have no control over that. This is too complicated. Or the next thing is, I'm going to meditate and do mindfulness, which is very important. But there's a little more thing to this. We talk about and in the book we talk about this, how to systematically break this down under your control. Smart goals. Spend some time writing your good stresses, specifically and measurably, and we're not used to this. You'll get better and better at this. And your good stresses specifically and measurably. And work towards reducing, eliminating, and delegating the bad stressors over time, increasing, empowering, and tooling the good stressors. And that's not a pill you take and the next hour you feel better. That's a tool that you develop that makes you permanently better and better and better and better over six months. But that's powerful because by doing that, you actually take control of something that's not been controlled before, your autonomic system. You take control of something that's never been even talked about, which is your limbic hypothalamic pituitary system. But in a functional way with writing. For example, I don't like my job is not specific. We drive to Loma Linda twice a day, two hours, twice a week, two hours, one way or the other. That's terrible. But we do other things in Loma Linda, which is this clinical trial, this thing and seeing patients, those are good. So how do I reduce this over time? And we've, you know, we do telemedicine now. And how do we increase the good ones where we do public speaking and talk and increase that? And our life, which is pretty full, now is a little more controlled, less anxiety, less stress, less inflammation. Yes, those emotions have more profound effect on. And that's how you get control over good and bad stress. And by the way, good stress is things like learning a new musical instrument, learning how to dance. For some of us, it can be more stressful, bad stress to learn how to dance, but we will leave that alone. Yeah, we won't say who. Learning to, learning to play cards with friends. Yeah. Learning a new language, running a team, book clubs, those are things that, or taking classes, you know, those are good stressors that push your brain, but also are the biggest factor for connections of the neurons. So one last point on that. Here is a power. 87 billion neurons, each of them can make two connections or 30,000 connections. And how do we make the connections? Exercise and good stress. That's power. That's that's control.
Dr Rupy: That is power. I mean, I I I love the way that you've mixed in sort of the the logical engineering pathways of the brain and, you know, modeled that on the creativity element as well and why that's so important. And I just, I look at you both and obviously you're both very advanced in in your scientific thinking, but there's there's a lovely blend of like the culinary creativity there and the emotional side as well as the science across you both. So I think it's just a wonderful team that you've got and the book is incredible as well. So I just thought I'd take this moment to to thank you both for your work and I can't wait to support you in all your future endeavors.
Dr Aisha: We love everything you do, everything you stand for, your work, your food, my goodness. And just being connected with you is just a joy. I'm I'm looking forward to speaking with you more, hopefully in the future and coming and probably cooking together.
Dr Dean: And we don't have just passing conversations. No. We have families. You're you're family now.
Dr Rupy: Oh, that's so lovely. We might be annoying now. That's great. Yeah. Oh, that's great. Honestly, I could have chatted to you guys for so much longer. I've got so many other elements and things that I didn't even ask about, but you know, we'll save that for another time. And I I didn't realize that you're writing another book as well. That's amazing. I don't know where you get the time, you guys.
Dr Aisha: So much to say. So much to converse about. It's a beautiful life.
Intro Voice: I really hope you enjoyed that with Dr Dean and Dr Aisha Sherzai. They are just such a unique combination and I loved chatting to them. To summarize our conversation, plant-forward diets are fantastic through the perspective of not just brain health, but also vascular disease, cardiovascular disease, and mood as well. You've learned how creativity has a bidirectional effect on the brain and this is not just about Sudoku or crosswords. Why you don't need to eat a ton of fat to support your brain, but quality fats are essential for your brain and specifically when it comes to omega-3 fatty acids. And you've also learned about the other lifestyle interventions that support brain health. Please do go check out their book. It is a fantastic resource full of all the different things that we've talked about today. It's called The 30-Day Alzheimer's Solution and you will find all the links to the books and their work on the show notes on the podcast page of the doctorskitchen.com. See you here next time.
