Transcript of #1 Neurologists: What You Can Do to Prevent Alzheimer's & Dementia New

Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. I got to tell you, today you and I are going to talk about a topic that gets me choked up because it's that important, and it hits home for both you and me because right now you have somebody in your life who is either experiencing cognitive decline Or they're in the early stages of dementia. They may not even know it. Or you have somebody in your family who's already been diagnosed or died from Alzheimer's. And this topic makes me emotional because it's something that you and me and everyone is dealing with in their families. And when you do, it can be so draining and heavy of a topic. That's why I called in two of the world's top medical experts, neurologists who are the leading researchers on Alzheimer's, dementia, and cognitive decline, to give us both a very specific plan that we can share with our families. A plan that can slow down, pause, and even prevent dementia. And they're so excited to teach you that your brain health It isn't just up to your genetics. It's a product of how you live your life every day.

And I really want you to listen because the conversation today is about what you can do. And our experts are going to tell you there is so much you and your family can do. There's so much good news. There's incredible research. It's not too late and it's never too early to start taking better care of your brain. You're going to learn about things that you can do right now that are all based on research. They are free. You can do them today. In fact, you can do them while you're listening. That can boost your chance of not getting dementia by 53%. These neurologists are going to discuss 5 specific and simple things that you and your loved ones should focus on that will either slow down, pause, and even reverse brain decline. This is such an extraordinary conversation. I'm so glad that you're here because these two experts will tell you whether you're 8 years old or you're 88 years old, it will work because the recommendations are based on extensive research and it could add years, maybe even decades to your life. You know, for the past 2 years, I have been using work and a busy schedule as my number one excuse to not put my health first.

I bet you can relate. Even when I was being consistent with the gym or I was squeezing in workouts, I was seeing little to no change. Why? Because I didn't change my diet. Well, now that I understand all the research from the experts on this podcast, I see how critical protein is for me. And based on what my doctor is recommending, a daily goal of 125 grams of protein per day, I can't get there on meal prep alone. I needed something on the go that tastes great. It doesn't sit in my stomach like a brick. That's why I co-founded Pure Genius Protein and developed this product with a team of doctors, some of your favorite world-renowned experts. Pure Genius Protein shots are 100 calories, zero sugar, zero fat, No artificial flavors or sweeteners, no dyes, just delicious. And this week, save 20% on your first order at puregeniusprotein.com when you use code MEL. Plus, there's a 30-day money-back guarantee. Cheers to your health. Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. I am so excited that you're here. I am thrilled. Thrilled about our experts today. It's such an honor to be together and to spend this time with you.

And if you're a new listener, I just want to take a moment and welcome you to the Mel Robbins Podcast family. I am grateful that you're here. The conversation today is so important, and I'm glad that you're listening not only for yourself, but I hope you will share this with everyone in your family, because what you're about to learn is going to give you hope And based on the research that you're about to hear, it could add years, even a decade to your life. It's gonna make your brain healthier. And everything that our medical experts will recommend is free. Today we are talking about memory, dementia, and the brain health framework you need with two of the most respected voices, researchers, and medical experts in brain health, Dementia and Alzheimer's Prevention. Dr. Ayesha Sherzai and Dr. Dean Sherzai are here today. They are board-certified neurologists trained in the treatment of Alzheimer's disease, dementia, and cognitive decline. They have spent decades studying neurodegenerative diseases. They are also a married couple who have trained and worked at some of the most prestigious academic institutions in the world, including Georgetown, Columbia, and the NIH. They both currently work at Charles R.

Drew University of Medicine and Science, where Dr. Dean is the Executive Director of Clinical Research and the Director of Community Corps, and Dr. Ayesha is a Professor of Neuroscience and Director of the INSPIRE Research Program. They are the former co-directors of the Brain Health and Alzheimer's Prevention Program at Loma Linda University where they studied the healthiest people in America, the Loma Linda Seventh-day Adventist population, and also co-directed the brain health and Alzheimer's prevention programs at Cedars-Sinai Hospital. They are also the authors of the bestselling book The Alzheimer's Solution. Please help me welcome Drs. Ayesha and Dean Shirzai to the Mel Robbins Podcast.

It's so wonderful to be here, Mel. Thank you.

Thank you so much.

Thank you for jumping on a plane. Thank you for taking time out of your busy schedule to fly across country and be here with us in Boston. We are so excited to have you here, and I wanna start by having you speak to me and the person that's with us. What could be different about my life or the life of people that I love based on everything you're about to teach us today?

Uh, I'll tell you that this is the most important, uh, system that we're talking about, the brain. This little brain.

Oh, and he's picking up a brain already. Dr. Dean's got a brain in his hands.

This brain that's supposed to be 3 pounds, 2% of your body's weight, consumes 25% of your body's energy, as much as 40% of your oxygen at times. This brain is constantly working. It has 86 billion neurons, over 1 trillion potential connections. It's the most active organ in your body and arguably the most active and adaptive organ in biology. What does that tell you? It's the change organ. And here's the most important part. The change part is in your hand, whether you're 9 years old or 90 years old.

This is an important topic that we need to talk about. And when the listener leaves this conversation, we want them to feel empowered to take care of themselves. Nothing magical around it, with things that are easily around them, things that they can start today.

Beautiful. So, Dr. Ayesha, I want to stay right there for a second because I think if you're my age, 57, or you're 60 or 70, you're thinking about dementia, you're thinking about memory loss. You may have somebody in your family that has been diagnosed with Alzheimer's. But if the person that's listening right now is in high school or their 20s or their 30s, What could change about their life and why is it critical that they listen to this episode and share it with people that they care about?

That's such an important question. When the word dementia comes about, you know, we always think that that's a point, that's a diagnosis that happens later on in life. But when you actually look at brain health, it's like a spectrum. You kind of build your brain and if you don't take care of it, the wear and tear will accumulate over a period of time. And a time will come when kind of that damage is irreversible. And I'm not trying to scare the listener.

Well, I don't mind if you scare us because I think we need to hear the truth, 'cause I think most of us start thinking about dementia when we get to midlife, or if we have a family member that gets diagnosed, or we start to feel concerned about it. But you are here to tell us the facts based on research and your medical expertise, which is that this starts way earlier.

It does, it does. And I'm glad that you put it that way, and I'm glad that we're talking about it because, you know, as a neurologist, I sit in my clinic and I have a schedule day packed with people coming in with problems with their memory. And then my job is to kind of diagnose them with dementia. And that is a stage where the damage is so profound and so, conspicuous that there's not much one can do. There is a lot you can do at that stage as well. But how wonderful it would be for us to actually start taking care of our brain early on. So if we were in our 20s or 30s, things like going to sleep on time, waking up on time, making sure we exercise, making sure that we take care of our stress, which is really ravaging our brain, making sure we eat well and have a dietary pattern that we like continuing for a long time, those things matter. Matter and they make a huge difference for our brain.

I would love to just ask you both, what is dementia?

Hmm. Yeah, so dementia is an umbrella category. It's a definition of a condition where your cognition and your memory affects your daily activities. And there are many different types of dementia. 60 to 70% of dementias are Alzheimer's dementia. So it's the most prominent type of dementia. That's why the word Alzheimer's is used synonymously with dementia. It's actually a type of dementia. Another type of dementia is vascular dementia, when the blood vessels in the brain are damaged. And then there are other smaller ones like frontotemporal lobe dementia, Huntington's disease, Parkinson's dementia, Lewy body dementia. And most of them essentially impact the way you think, your memory, your decision-making, your processing speed. And it's something that doesn't start right away, like we were saying it earlier. It's accumulative damage in the brain that causes causes this condition. There are multiple different types of protein. One is called amyloid beta protein, another one is called tau. And what happens is over time, they start damaging the inside of brain cells, on the outside of the brain cells. And there are different ways of actually looking at the brain to understand what kind of dementia people have.

Dr. Dean, you know, after reading your bestseller that you two wrote together, "The Alzheimer's Solution," I'll tell you what caught me was at the top, Radically reduces risk of Alzheimer's disease by 90%. One of the things that I realized is that brain health is just one of those things that you don't even think about until it feels like it's too late. Is it ever too late to consider your brain health?

I wanna approach this carefully because, uh, there are cases where it is too late, and that's where advanced Alzheimer's. There's a lot of people that are actually making money off of people's fears, and this is the biggest fear. Uh, when a person has Alzheimer's, or the family and the patient are desperate, and guess what? When there's desperation, people go after that desperation. And I want to make sure that people understand that there is no way to reverse advanced Alzheimer's at this point. You can slow it down. You can work on quality of life, which is as important. Helping families with their journey. Ayesha and I sit down with the families for hours telling them what they're about to face, what to do, and most importantly, how to give this person that's going through its battle quality of care and don't fall for the gimmick of the day. But for the great majority of those that have pre-Alzheimer's or early dementia or MCI, which is right before dementia, a significant portion of those, that population can be helped to prevent or delay significantly. And that's incredibly important. If we, if we can do that even at 60%, which is the number that's been proven, what we— when we say 90%, we are extrapolating.

I'm always careful not to separate science from extrapolation, but even 60%, we're talking about millions and millions of people whose lives will be changed. And that's very important. And I want the people there to know that every family now has somebody that has Alzheimer's or demen— or some other type of dementia. And all of those can be affected if we get it early enough.

I love that you can pause or slow it down. You also use this phrase MCI that happens before dementia, and I felt myself lean in. What is MCI?

MCI stands for mild cognitive impairment, and this is where a person is having significant memory issues, significant focus issues. But, but everybody has that. So as soon as I say that, people get scared. No, significant to the point that it's really to some extent affecting their daily activities. They can still drive, they can still do their finances, but themselves and the family is noticing that this is a little different than the past.

And give me a couple examples of what might be MCI. And 'cause I think we've all, like, I love that you said every one of us has somebody in our family Yes. That is diagnosed with dementia or careening right into it. And I think we've all been at that point, whether you're talking about your grandparents or your parents, where you're like, well, they're just kind of losing it. They're not really themselves anymore. They're slowing— like, there are ways we talk about it. But could you give a couple examples of just like what you might see in this MCI stage or super early stage?

So let me tell you what's normal.

Okay.

You're going to the kitchen. And halfway there, you forgot what you were trying to do, right?

Yes.

That happens daily because memory is focus. And I'll talk about that. Focus is the gatekeeper. Focus is the currency. So as you get older, you have lots of things affecting your focus. There's a little pain in your knee, the work, the podcast, the people calling, the problem with the in-laws or family members in good way. Now, I don't mean anything bad. But all of these things are in the back of the mind.

Yes.

Those are interferences. So of course, when you are trying to go to the kitchen, you're supposed to first encode that memory before you go. And it, when you're younger, it happens naturally. When you're older, there's all this piece of information interfering, so you never put it in the right file folder. You go there and you try to grab, it's not there. That's normal.

Okay.

But if it happens every day, every minute, there's something going. If you're forgetting closer family members' names, not just once or twice, but on a daily basis, there's something wrong. So then even that, it's not necessarily dementia. It's something to be addressed. Go to a neurologist, get it evaluated. They'll do imaging, they'll do blood tests. They will do to make sure that's not B12 deficiency or thyroid disorder or something of that nature that's quickly reversible. And they can figure out this is what the stage you're in. And we can really influence it significantly.

And the reason is because what you're about to teach us is there are evidence and research-backed things that you can start doing right now that slow or pause the onset of things getting worse.

Absolutely.

That's really hopeful.

It's incredible. And, and for those that don't have this, start now because it's not just about pausing. How about growing your brain as you get older? We literally see brains grow on MRIs. People who do X, Y, and Z, the things that we are about to speak about. They grow their brains well into their 80s, 90s, and beyond because the brain is that active, that, that has that much capacity to grow. And it's incredibly hopeful.

Oh, Dr. Dean, do you believe that our overall brain health as a society is getting worse?

In many ways, yes. The reason it, it feels like it's getting worse, and it is, the numbers are there, uh, it's not necessarily dementia increasing, but that, that risk is increasing as well. It's because we have so much more happening to us, to our brain, to our focus, Our focus, as I said, is the gatekeeper. It's the currency of our consciousness. So the way you spend that currency matters. I want everybody in the audience to recognize that you have to be aware of your focus and where it's being spent. And in a world where your focus is being stolen systematically through the social media systems and machinery that tries to pull your focus, We, we, we have to be careful because if your focus is 3, 3 seconds at a time, yes, you're never going to get to better memory because without a focus that goes deeper, memory doesn't happen. Without a focus that goes deeper, deep thinking and executive function doesn't happen. Without a focus that can go deeper and sustain, your emotional stability actually is flipped to an urgency living, which is this, this fight or flight state. Which is incredibly disruptive. So it starts with that world we live in, which is constant attack on your focus.

What do you think the most common habit that you both see is that's harming people's, like, brain function and we may not even realize it?

I'm making a generalized statement, but something that I see quite often is stress. And we define stress in different ways in our lives. But stress is such a powerful contributor to cognitive decline.

Why is that contributing to cognitive decline, Dr. Ayesha?

Yeah, so, so it essentially changes your biology. You know, when people are under stress, and I have to say bad stress because there is such a thing as good stress, and we'll talk about that later. When people are experiencing bad stress, your body starts creating specific neurochemicals and hormones that don't allow information to be stored in your brain. Well, you basically are kind of closing all the gates for creativity, for memory, for processing information, and you're in this constant fight or flight situation where your heart rate is up and you're chronically going through biological shifts in your body. Inflammation goes up, oxidative damage goes up. Even if you're quiet, if even if it's not really showing on the surface, on the inside, stress literally eats up your brain. As a matter of fact, there have been some studies that showed that when people are under chronic stress, they actually have smaller brains. There's a part of the brain called the hippocampus, and the hippocampus is responsible for many things, but the primary function of hippocampus is encoding memory. That shrinks when people are under chronic stress and cortisol is up. So it affects your brain, it affects your heart, it affects your arteries, and it's really important for people to kind of take it take an account of what their bad stressors are and do something about it.

Is this why, if you just think personally, and as you're listening or watching right now, think to a moment in your life where you were under so much pressure, is this why those periods of your life, you sometimes look back on them later and you're like, I don't even remember what was going on because my life was so stressful?

Absolutely. Stress basically is fight or flight. So you have these two primal states, fight or flight and reproduce and, um, and build, which is the parasympathetic system and sympathetic system. These two systems are the primary driving force of the brain. When you're in constant stress, you're in fight or flight. Fight or flight means your GI system shuts down, your growth hormones shut down, your cortisol goes up, your bones actually starts resorbing and not building. Every system you can think of, including immune system, sexual activity, everything closes. And in during that state, your frontal lobe closes because you are not worried about thinking your way out of the grip of a tiger. You're just running. It's a, it's fighting the tiger. And if you're fighting the tiger constantly, none of the growth states matter. And the brain knows, and the body knows that, shuts them down. So chronic stress is that, that bad. And then the second part, secondary part of that is when you're in constant stress, nobody is going to be able to stick to a very disciplined, uh, nutritional program because you're going to go to survival nutrition, which is eating the bad food just to get the calories, right?

You're not going to be doing exercise. It's about doing what makes you just comfortable. You're not going to sleep well. What's the number one factor that affects sleep? Stress. Mental activity, your frontal lobe closes, everywhere else closes except the limbic emotional brain. Stress is that destructive, both within the body in general, the brain, and with habits.

You know, one of the things that, um, I love about your work is not only the fact that you're doing research and you're in these big clinical practices, but you're also in community outreach programs. You've built the largest brain outreach program in communities nationwide, which means you're seeing people of all different ages. Because I think probably if you looked at the data, you got more people going into hospitals for screenings that are older. But I'm curious, how young are you both starting to see the effects of cognitive decline in brain health in people?

I love that you said cognitive decline because I have to be, be honest, We don't see dementia earlier because then that's later on, but cognitive decline, definitely. And we're seeing quite a few in the communities right now. We're in community churches and we thought that we're going to see people in their 60s, 70s, or later. We're seeing people in their 40s come to us and saying they're having cognitive decline. And when we test them, we detect the cognitive decline.

Wow.

Now, that doesn't mean that they have dementia. That might make them at risk for dementia down the stream, but we know that they're having these cognitive issues early on. And, and at the same time, it's incredibly positive because we catch it early in, in the hospital and clinic because hospitals and clinics are fantastic, but they're fantastic for sick care, which means you see people at the point of disease. Once they have dementia, once they've had stroke, once they've had heart attack. You see people way earlier in the communities when they haven't had that yet, but they're seeing the beginnings of it. Or if we detect the beginnings, that's the powerful work in the community.

I love that. You know, one other thing that I read in your book, Dr. Ayesha, is that there are 7 stages to dementia. You've already taught us that Alzheimer's is a slice of dementia, even though they seem to be used interchangeably. And that we can be in the first stage, so preclinical stage, 20 years or longer. And I want to read to you from your best-selling book, The Alzheimer's Solution. This is on page 61. A person in stage 1 has no impairment, no memory disorder, or cognitive deficits, though— I'm going to say this word wrong, but amyloid?

Yes.

Okay, I said that right. Okay, said it right. Amyloid plaques and tau tangles may be accumulating in the brain. Alzheimer's and other dementias begin to form years and often decades before they manifest. There may also be inflammation, vascular changes, and atrophy in certain parts of the brain, but not enough to cause symptoms, and this first of the 7 stages of dementia can last 20 years or longer. Hmm.

Yeah, that sounds scary, doesn't it?

Yes. I'm, I'm like, am I already in it? Like, probably, but—

I think it kind of ties back to what I was saying earlier. I think if we think about brain health as a spectrum and not something as like healthy versus non-healthy, Yes. It will make sense.

Now, are we all gonna get dementia?

No, that's the whole point of having this conversation, right? Okay. What we do is throughout our life, you're either living a life that is taking care of that magnificent organ or you're contributing to its damage. If you're doing things that are damaging to that brain, if you kind of like think about it, it's like a wear and tear. Beautiful machine, right? You have to oil it, you have to keep it away from moisture, you have to make sure that it's not exposed directly to the sun, you have to make sure that you keep it clean, right? Like, I just got myself a Cuisinart, like that's, you know, that mixer stand, and it requires a little bit of maintenance. I don't know why I'm bringing that analogy, but—

'Cause it's a pain in the rear end to clean, that's why.

Right, yeah. If you kind of just let it be, then it's going to not work properly. Same goes for the brain. You really have to put in the work to take care of it. And so if we don't, even if we're in our 20s and 30s, like we were saying earlier, a bad night's sleep, not eating well, choosing a sedentary life, having poor relationships that is constantly creating stress in our life, not really pushing ourselves to learn something new, to experience something new and be creative, What happens is your brain starts accumulating these bad proteins that you just talked about, amyloid beta protein and tau tangle. And after a while, that damage really shows itself. Like when we actually do MRI imaging of our patient's brain, right? You can actually see white spots. We call it white matter disease. And that could be related to bad blood pressure. It could be related to high cholesterol. It could be related to loneliness and social withdrawal. Not treating sleep apnea, and not living a healthy lifestyle. So you can actually be in that stage for decades before the first symptom of like forgetfulness comes about. That's what we meant in the book.

Now, if you've had concussion damage, 'cause I keep thinking about the fact that so many people listen to this podcast within families, does that put you at greater risk for developing dementia or any cognitive decline later in life?

It does. It does. And, but there are different degrees. If people had a significant head trauma, of course, the risk goes higher.

Yes.

Or if you had multiple smaller head traumas, again, same thing. So I want people to know that head trauma is a major contributor, and we have to take life with that in mind. We took it for granted that the brain was going to be fine because it's inside that bony skull. That bony skull has ridges, and the fluid that covers the brain is not viscous. So it's not, you know, slow motion, doesn't slow down. It's literally bouncing off the bone. It's— so we have to be careful with the activities we're involved in. I'm sadly even— I played soccer, I'm sure I've stuck to tennis. Even soccer players that do multiple headers, they've seen that that actually affects the brain. And activities like boxing and traumatic brain injuries absolutely contribute to that. Now, the good news is if it's a few head traumas, like the things that Aisha just said, a few things that happen during a youth, we can reverse that. The good things that you do can significantly offset the bad things. I would rather that people don't do the bad things because we don't know when you'll be overwhelmed, but the two are, has to be taken into consideration.

I wanted to add something.

Yes, please.

And I think this is really important and people might find it useful. When we expose our brain to something that could potentially harm it, we don't feel it when we're younger. We actually don't have any pain receptors in our brain.

You don't?

We don't. So that's why, I don't know if you've actually seen these neurosurgery videos where, you know, they have somebody's skull open up and they have their eyes open and they just kind of poke at the brain and the person is playing the violin to see which part of the brain they're touching. The brain itself doesn't have any pain receptors. The coverings do. But my point here is the brain has so much reserve and capacity to kind of make up for a deficit earlier in our life.

Yeah.

So you actually don't feel it. One of the reasons why people don't care about their brain health is like, even if they drink too much, even if they miss many nights of sleep, they're fine, right? They don't feel it. Had it been your skin, if you keep on slapping your skin, you're gonna get a bruise. You're gonna be able to like, Oh gosh, I see it, I see the damage. But we don't see or feel the damage to our brain because it has such resilience, a very, very quote unquote plastic organ. It makes up for those deficits, but the damage is happening unfortunately.

Well, I love that you said that, and here's why. Because common sense, I think we all know, if you're smoking, you're damaging your lungs. If you're eating ultra-processed food, you're damaging your GI tract and some of your other organs. If you are sedentary, you're not doing a lot for your overall health and your muscles. And what I'm gathering from this conversation, and also from the lifestyle interventions you're about to talk about that are within all of our reach to be able to take better care of ourselves and our brains, that just like smoking damages your lungs, it's damaging your brain. Just like alcohol is damaging your liver and you may feel the hangover in your body, It's damaging your brain. And just thinking about it holistically, that this organ that is literally what's keeping you alive is affected by everything you do, but we're not thinking about it. And that's why this is so important.

Incredibly well said. And I would go as far as say you probably affect the brain more because remember, really, it's a 3-pound organ. But it consumes 25% of your body's energy. It, it is the most vascular organ. You would think that the heart is the most vascular. The brain is the most vascular organ in the body. So we're talking about smoking. So smoking affects the lungs. The vasculature of the brain is affected significantly more because there's more of it. When blood pressure affects the, the peripheral organs, the brain is profoundly more affected because of the vasculature. When you're having alcohol, it directly kills neurons. And so more than killing neurons, affects the connections between neurons and affects sleep and everything else. So we usually say if you take care of your brain, you've more than taken care of the rest of the body because the brain's demands are— it's resilient, but its demands are tremendous.

Thank you for saying that. I'm so grateful that you're here. I'm also grateful for our sponsors. So I wanna take a pause so we can give our sponsors a chance to shine. I also wanna give you a chance to share this episode with your family because everybody in your family deserves this life-saving information. And don't go anywhere. We have so much more to dig into with Dr. Ayesha and Dr. Dean when we return. Stay with me. Welcome back, it's your friend Mel Robbins. Today you and I are here with two world-renowned neurologists, Dr. Ayesha and Dr. Dean Shirzai. We're talking about memory, dementia, and the brain health framework that you need, and exciting new research and a protocol that can help you slow down, pause, and even reverse brain decline. All right, let's just jump right back in. My next question is, Dr. Dean, how much control do people have over their cognitive future?

More than any other organ. Your brain is at your control. It's, it's there to answer to you constantly. Your brain is growing constantly and is growing in relation to what you do to it. And it's also shrinking in relation to what you do to it.

Oh, I don't like that. When you said shrinking, it made me feel bad because you know what made me think about? It's like, If I— this may be too much information, but, but, you know, you think about hydration. We all need water. If I go to the bathroom and I see that the urine's a certain color, I'm like, oh, I'm like not hydrated. But I'm not thinking that my brain needs water. And if I'm not hydrated, my brain's shrinking a little bit. And I think that's a really compelling thing to think about.

It is. It's beautifully stated. And it's compelling because it's visual, but it's even more real for the brain. So nutrition, sleep, and, and stress management creates the environment for the brain to grow or shrink. The two things that grow the brain, and, and by grow I mean connections between neurons. Your neurons can have two connections.

Oh, they're pulling out a visual. I'm excited to see this. Okay, let me describe this for, for the person who's listening. They're holding up just a kind of a whiteboard and you've got two blue dots on either end, and then they're connected, these two blue dots, by just 2 red screens.

Yes. And the screens, the blue dots, the blue things are imaginary. It's the neurons.

Okay. So the blue dots are neurons.

And the connections are the axonal connections between the neurons.

What are they called?

Axonal connections.

Axonal connections.

That's how they communicate with each other. That's how we actually think. It's the communication between neurons.

Got it. Now, do I need the red? Do I need the neurons to be connected in order for my brain to grow?

Oh, absolutely. In order for your brain to even survive.

So brain health requires your neurons to be able to connect to each other.

Yes, and these connections can be made at any stage of our life. That's the cool thing about it, you know? We may not be able to grow many brain cells, but we can make so many connections between the brain cells that we already have. Each cell can make as little as 1 or 2 connections or as many as 30,000 connections.

Depending on how you take care of it. Hold on, you're holding scissors, so I don't know what you're about to do.

Well, this is, this is what happens. If you haven't eaten well, if you haven't challenged your brain, if you haven't exercised, your neurons are connected, a couple of connections, right? Yeah. Couple of axons. And one night you had too much alcohol and one of the strings is cut, right?

Oh my gosh. He just, it was so sad. He just, so if you're listening, he just cut one of the strings and now these two neurons are hanging on by one thread.

Yeah. And then another day you were, you know, you were just walking or you play, were playing sport and you had a head injury. And the other—

Oh my God, they're not connected anymore.

They're not connected. And not only are they not connected, and most of the time they never connected. And that's it. It's gone.

Now, that's so depressing.

It is. But here's the—

Is that what you mean by you're shrinking your own brain?

Right.

Because you're killing the connections between the neurons.

Absolutely.

Okay. They've got another visual. Let me, let me explain this to the person who's listening. So now they're holding up a second visual. It's again, two neurons, but this time instead of two strings, there's like tons and tons and tons and tons and tons and tons of strings connecting them.

Correct. And this is not even a good representation. This is probably 50 connections. We're talking about 30,000. 30,000. Now, this is one neuron and then connected to another neuron. Now, this is because this person has kept their brain active. They've challenged themselves, they've exercised, they've kept, you know, good nutrition and all of that.

And so, so you, by doing that, have created the conditions for the neurons in your brain to grow and connect and communicate with each other, which increases the health of your brain.

And thousands of studies have shown this too. Imaging studies to pathology studies that people that have challenged itself, that have kept their brain healthy, have way more connections. Now, this brain, let's say the same thing as the previous one. One night they drank and one of the strings got cut, right?

Okay. I still don't like— I don't like it when you cut it because I feel my brain going, don't do that.

Yeah. One brain. And then another day, They had head trauma. Another one broke. Guess what? Oh, still all the rest of the connections are there, right? Let's see a bunch of other things happen.

Now he's cutting a lot. There's a lot of strings hanging down, but you still have the connection between the two.

And here's the beautiful part. Not only are those connections continuing to work, the fact that they're connected actually later on allows these two knots to make further connections again. That's the incredible story. That's the incredible hopeful story. By the way, those connections can be made at 80, 90, even 100 years of age.

Now, if you have dementia, can you continue to make connections?

Yes, you can. You can. But the thing is, if you have advanced dementia, by then the mechanism of destruction through tau and amyloid is so profound that it's difficult to reverse. But I think you can slow it down.

The really important thing about this visual, and it's so powerful, is that as long as you don't destroy it all—

yes—

and the neurons stay connected through the lifestyle and research-backed things that you're going to tell us to focus on, you can help your neurons in your brain make more connections, even if you've done some damage earlier in your life.

That's a very empowering statement, and we see it clinically in our patients. Say, for example, if someone has had a mild stroke or if they've had traumatic brain injury. In stroke, what happens is some of your brain cells die and they never come back. But with physical therapy, with a healthy lifestyle, with cognitive therapy, you can actually strengthen the connections between the cells that are already there. And sometimes they can take over the function of the cells that are lost. It's so wonderful to actually see people recover even after major injuries or major strokes when they start living a healthy life and implement these lifestyle factors.

Can you bring that visual back real quick? 'Cause I wanna ask you a question related to stress and the visual that has a bunch of different connections. So let's say you've been taking very good care of yourself, but now you're in a caregiver role. And you talked about the fact that, you know, Dr. Ayesha, when you were talking about the things that create damage to your brain health, one of the biggest ones is stress and chronic stress. And we now know that caregiving is its own form of chronic stress. And I was startled reading your bestselling book, The Alzheimer's Solution, page 46. Partners of those who develop dementia have a 600% greater risk of developing the disease themselves compared to the general matched population. And this isn't attributable solely to stress, that shared lifestyle risks are also a major factor in the health outcomes of long-term couples. I'd love to have you just grab the scissors and just show us kind of like how stress and caregiving really can break apart these connections and neurons because you're not— you're, you're so focused on somebody else, you stop taking care of yourself.

So when caregivers are under tremendous stress, let's say their cortisol level is high, that kind of cuts off 2 or 3 different connections between cells. Let's say, for example, they don't get a good night's sleep. We know how common that is among caregivers. Your brain didn't get enough time to cleanse itself and to function properly. Let's say 4 or 5 other connections got cut off. Let's say you don't have time to walk or to exercise. Forget about it. You have some other connections cut off. Let's say you never really get time to do something creative because you're just stuck in this constant mundane lifestyle of doing something over and over again. Creativity doesn't allow for your brain to grow at all. And then on top of that, just the sadness and this pressure of taking care of another person, the guilt that comes with it, the shame that comes with it, all of that actually just severs the beautiful connection between brain cells, and that's what puts people at a high risk. The other thing is when you live with someone who has Alzheimer's disease or some sort of dementia, lifestyle matters too. So you kind of share the same environment too.

You kind of eat the same foods that they do. Let's say, for example, if they were not eating healthy food.

Yes.

There you go.

Wow.

Connection severed. They were not really into exercising. There you go. You kind of follow that pattern. And as you can see, there's accumulation of all of these risk factors on top of the stress that you're experiencing, and caregivers suffer a lot.

I am so grateful that you brought this visual example. And if you're listening, what just happened is every time Dr. Ayesha talked about those very real circumstances that caregivers are experiencing, she was cutting one of the strings that connected the neurons in your brain. And it was extremely compelling and dramatic to see the connections and the strings hanging down because this This is the first visual example that I've ever experienced that really demonstrates to you as a caregiver why taking care of yourself, getting sleep, eating right, staying connected to friends, that, you know, you hear the adage, put your oxygen mask on. It does matter because while you're caregiving, if you don't take care of yourself, your brain is shrinking. And there are things that you can do to stop that from happening or to build more neurons back if you've been in a period of caregiving and now you're coming out of it so that you can. But this to me raises the stakes in why the interventions we're about to talk about matter so much.

One other point that I have to make here.

Yes.

A large percentage of population, your population, is women.

Yes.

Two-thirds of all caregivers are women, and two-thirds of all Alzheimer's patients and dementia patients are women. And, and they're usually caregivers when they're midlife, they're, they're going through menopause and everything else. That's not a sad thing. Here's the positive part of that. If they just are aware of that fact and they do one or two positive, you know, behaviors and activities in their life. That is a significant change in risk factor. So for women especially, they should know majority of the women that we deal with are, you know, they're taking care of their children and their mother, and then they're going through their 40s and 50s, like you said, as estrogen drops in your hormonal system and the expectations that are put on you from, on this is from the society.

All of that takes a toll.

Thank you so much for explaining that. I really get it. And I know as you're listening, you're getting it too. And I also know there's people in your life that you need to share this with. I'm thinking about my best friend from childhood, and her dad is going through cognitive decline. I'm sending this to her right now. There's somebody in your life that's caring for an aging parent, that has a spouse that has been diagnosed, or that's in the early stages of cognitive decline. This is such a life-changing resource, so please take a moment and send this to somebody that you care about, whether it's your parents your aunt who's not taking her health seriously, somebody that you care about at work that's caregiving for somebody with memory issues. Even send it to the young people in your life and let them know it's never too early to start caring about your brain health. And what we're learning today is it truly matters. All righty, don't go anywhere. We have so much more to dig into when we return. Stay with me. Welcome back, it's your friend Mel Robbins. Today you and I are here with neurologists Dr. Ayesha and Dr. Dean Shirzai talking everything memory, dementia, and brain health.

We're learning about exciting research and a framework that they recommend to their patients that can pause, slow down, even reverse dementia. There is so much more I want to dig into, so let's just jump right back in. Well, I really appreciate your work because you have simplified the things that we need to focus on down to 5 things. Dr. Ayesha, it's a word, neuro, N-E-U-R-O. Can you walk us through the 5 things that we should focus on and If you're a caregiver, ladies, wake up. Like, this is what we need to do to keep our brains healthy.

Thank you for bringing that up, Mel. We kind of kept it simple for our patients and our community members to remember these 5 pillars because they make a huge difference. So N stands for nutrition. It's not about superfoods. It's about what kind of dietary pattern you choose. And I'd be happy to talk about it later. E is for exercise. Moving. Movement is life. It's connected deeply to how we feel about ourselves and how our brain grows. U is for Unwind, which is stress management. Reducing bad stress, increasing your good stress. R stands for Restorative Sleep, which basically means the deep kind of restoring sleep that cleanses your brain and makes it ready to memorize and be creative. And O stands for Optimizing Cognitive Activity. Doing specific kind of activities, living a meaningful and a purposeful life, and engaging with your, with your environment and your social life so that you can grow the brain.

So, doctors, you're saying all we have to do is focus on better nutrition, moving our bodies, unwinding, meaning just address some of the big stressors in your life, mindfulness, Deeper rest, prioritizing sleep, and then optimizing some of the cognitive functioning in terms of just learning something or engaging in things that expand the way that you think. That's all we need to do to take better care of our brains.

These are the core lifestyle measures that you can address. And yes, you can take care of your brain.

This is how we can pause the onset of dementia.

Let's put it this way. Take nutrition alone. If you eat that nutrition that's healthy and it's simple, it's not any— you don't have to buy anything from anybody. These are simple things from any grocery store. We, we work in Crenshaw, we work in, in, in Central LA, things that you can find anywhere. The studies have shown, my study, that just good nutrition reduces your chance of Alzheimer's by 53%.

53%.

Your brain is incredibly forgiving and resilient. And I mean that in a physiological sense, because this brain doesn't hold guilt or memories of, of a blame or what did you do? It, it recognizes the thing that's in front of it. So if you put the right thing in front of it, it literally overnight changes.

It's sort of like a plant. So you might have a sad plant in the corner, but if you give it a little sun and some water, it'll perk right up. Is that what you're saying?

That's the perfect analogy.

Now, Dr. Dean, before we go deeper into each one of these habits, because once you said 53%, Like, like that, that was incredible just talking about nutrition. Can you share more about why each one of these 5 habits matter so much for your brain health?

Uh, absolutely. Because they're cumulative. At the, at the same time, you could do 1 or 2 of them and you would still benefit. But if you do several of them, and there's, there's a study that actually shows this, when people did 1 or 2 of these habits, they reduced their chance of Alzheimer's by 30% or so when they did did 4 of them, they actually reduced it by 60%.

60% reduction.

Yes.

By following these 5 simple habits.

Correct. And it's powerful because it's cumulative. So if you, uh, do just walking, we're not talking about some kind of marathon running, just daily walk, you've reduced your chance significantly. In fact, one Harvard study showed that if people walked brisk walk 25 minutes a day, Just a brisk walk, 25 minutes a day. They reduced their chance of Alzheimer's by 40%.

Wait, hold on a second.

Yes. Yes.

I mean, that just sounds honestly insane that you could reduce your risk of Alzheimer's by 40% by taking a 25-minute brisk walk. How many days? Just every day?

5 days a week.

Well, and so— and if you're listening to this podcast and walking right now, you're doing a twofer. You're not only learning but you're also doing something that improves your brain health. You know what else is cool about that? It's free.

It's free. You're right, absolutely. And whenever we talk to our patients, we try to create this picture of you accumulating these coins or, you know, like creating a brain bank account. And we actually have a model here that if you wanna pull out the marbles. So basically have two jars in front of us.

Okay, great. So we've got— so if you're listening, I want to tell you right now what's happening. There are two big Mason jars, and one of the jars is about half full of clear marbles. And the second jar only has like a little bit of marbles. So I'm just going to take a guess that the person on the right that has just a few marbles in there partied a lot, didn't get a lot of sleep, has had a lot of concussions, and is caring for people. And so it feels like a lot of the connections between the neurons have been destroyed. No judgment. No judgment.

No, no, never.

Yes, the one on the left is about half full with marbles. This is somebody that's eating better and that kind of stuff.

So the jar that has less marbles is someone who really didn't invest in their brain health too.

Okay.

So say for example, they didn't take that dietary pattern seriously or they didn't take sleep seriously. So they really don't have a lot to lose over here. And say for example, if they have one night of bad sleep, I'm going to start pouring the marble out of the jars. Now you have less, right? And then let's say, for example, another time they just decided to kind of just let go and just eat a lot of, you know, unhealthy food, junk food, and not really getting all those blueberries and good fats in there. And then whoop, we're going to lose some more marbles here. And now you're left with very little. Now, the person who has actually invested in their brain and they've accumulated all of this positive energy and protection for their brain, let's say something bad happens to them. Even if they actually start having, say for example, they've had a small little brain injury, they're gonna lose a little bit of marble here, but guess what? They still have a lot there. Yeah. They're really not going to run out of that. Cumulative benefits for their brain health. So this is essentially a concept of cognitive reserve.

Oh, I got it. So the more you focus on these 5 lifestyle changes that we're gonna unpack for you, the more you're investing for the future so that if something happens, caregiving for a couple years, if something happens, you have a reserve reserve of healthy deposits in your brain to get you through it. Now, does the opposite also work? You haven't been good, you're now listening to this or watching this, and you're like, uh-oh. Because I know that this is an episode that so many of you are going to be sharing with your parents and your grandparents and your brothers and your sisters, and you may have received this in the family group text chain, and now you're listening thinking, oh my God, I'm screwed, what am I going to do? Does it work the opposite, meaning every night's sleep, you're now starting to deposit.

Okay, that's a beautiful segue. The reality is, let's say you're 50 years old or 60 years old and you have this little reserve, you can say, but now you start with nutrition and you're eating a very healthy nutrition. You remember, 53%, we are talking significantly first. Now you're walking every morning and doing some leg exercise as well. We'll get to that. Now you have all of this. Now these marvels are coming out of the brain.

That's good because it's spilling over. Good health.

Now you're actually managing your stress, and, and then you're sleeping better. And now also you're challenging your brain, you're creating relationships, you're socially active, you're doing creative stuff. That's a full bank account in your 60s.

You know what else I loved about this is that we've all seen those videos online of grandmothers and grandfathers at the gym pumping weights to prove that if you start at any age, your muscles can respond. And what I love about this visual is that even if you're listening right now and you have not done a good job of taking care of yourself, you can start today and it will make an enormous difference in your brain health and how you feel. And more importantly, what you're saying is based on the research, we're going to go through each one of these 5 things that you want us to focus on. You can pause dementia, you can slow it down, you can protect yourself from getting it the earlier you start.

Absolutely. It kind of ties back to that question you asked about why should people worry about their brain health in their 20s and 30s. This is why.

Well, and I also love this because there's so much noise out there about longevity and people injecting themselves in this thing and that thing and the other thing and like all this crazy weird stuff. And you're just saying, hey, there are 5 things that based on all of the research, based on all of your expertise, this makes a significant difference. One of the things that I think is super cool about you is that during your neurology training at Columbia University, you became a professionally trained chef.

I did.

Why?

Because I spent a lot of time in my clinic talking to my patients about nutrition, and I felt so disempowering to kind of just pat them on the back and say, eat healthy. What does that even mean? Eat healthy. It means different things for different people. Or, you know, I always took pride in being very evidence-based, and I would bring up mind diet or Mediterranean diet. But what does Mediterranean diet mean for someone who lives in Crenshaw, Los Angeles, California? And so I thought, no, I think I need to know this better, because at the end of the day, it's you in your kitchen, it's you in front of your fridge making decisions about what to put in your body. And if I'm not specific, and if I'm not empowering, I'm not doing anything. So I'd be in the ICU in the mornings, at Columbia Presbyterian. And then, you know, right after work at 7:00 PM in my scrubs, I would run down to, you know, the cooking school in New York City. And I got my degree in 2 years, and I've been teaching my patients and my communities how to cook.

So let's put us right at that spot that we all plan what we're eating, which is standing in front of the fridge with the doors open. Yeah. Or standing in front of the cupboard with the door open. What do you want us to have in our fridge or our cupboards in terms of the options and what we should focus on for better brain health?

So when you look at the different studies that have been done, the, that, that show what kind of foods matter for brain health, it's not, you know, one or two foods that stand out. It's not a superfood of the day because we all hear that in infomercials and, you know, people stock up on certain things. Specific foods. It's the kind of dietary pattern that you have, the different types of food that you eat. And whether it's the Mind Diet or Mediterranean Diet or all these dietary patterns that have been studied extensively, it's a variation of the same theme. They're mostly plants. So you have your greens, leafy green vegetables. You have your cruciferous vegetables like broccoli, cabbage, cauliflower. You have nuts like walnuts and almonds. You have seeds like flaxseeds and chia seed. You have legumes, which are phenomenal, beans, lentils, tofu, tempeh. Then you have coffee and tea that are so potent in their anti-inflammatory compounds. You have spices that give flavor and have anti-inflammatory effect. All of this, if it's in your bowl, if it's just soup, or if it's a sandwich, they're great. And like we were saying, studies have shown that people who eat a healthy dietary pattern, MIND diet, they reduce their risk of Alzheimer's disease by 53%.

But even if you actually take some foods that stand out. Like, for example, studies have shown that people who add 1 serving of leafy green vegetables like spinach or kale or collard greens to their diet, right? It could be raw, cooked, frozen, whatever. If they ate that on a regular basis, they had a brain that was 11 years younger.

What? What?

Yeah.

Just 1 lame spinach or kale or collard green salad?

Just open the bag. Fistful of spinach, put it in your soup, or just toss some olive oil and some lemon on it and just eat it. And your brain looks 11 years younger. It looks good on neuroimaging and it functions better as well. How wonderful is that? Just greens. Even if somebody is listening to this podcast and the only thing that they take out of this episode is just eating leafy green vegetables, I've done my job.

I think that's extraordinary.

It really is extraordinary. And then you add other things on top of it, like, for example, if you eat beans on a regular basis. They have so much fiber, they have complex carbohydrates. Everybody's scared of carbs, but complex carbohydrates are important for you. Your brain runs on glucose, and you, if you give it the right kind of carbohydrate, it functions beautifully. So when you eat lentils and beans, they provide protein, they provide complex carbohydrates. It's good for your brain, it's good for your gut. It actually manages your insulin levels, your glucose levels, because at the end of the day, there are 4 things that start impacting your brain health when it comes to nutrition. Inflammation, oxidation, glucose or sugar dysregulation, like prediabetes and diabetes, and then lipid dysregulation or fat dysregulation, which means bad cholesterol, too high LDL. All of this kind of starts damaging the brain. And what you eat impacts all 4 of these things. So I would love for the person who's listening to make sure they're having some green leafy vegetables, to make sure that they're having some nuts nuts or seeds, maybe they can put it in a jar on their counter, add some walnuts to your oats.

For them to eat whole grains like oats, brown rice, let's say quinoa. For them to actually have some anti-inflammatories in the form of blueberries and strawberries and raspberries because these are potent compounds that cross the blood-brain barrier and they actually fix the inflammatory changes and the oxidative damage in the brain. For them to drink some coffee if they can handle it or some green tea. And, you know, I know it sounds cliché, but when they say eat the rainbow, there's something to it. These colored compounds, the fruits and vegetables that you eat, they really provide the right kind of an environment for your brain to grow and thrive.

I also love that kind of cliché thing, but it's really true, to just shop the perimeter of the grocery store because that's where the vegetables and the meats and the fish and all the good stuff are. So, Dr. Dean, let's move on to exercise because You have said, well, both of you have said that your legs protect your memory.

I don't want to compare exercise to any other of the neurofactors, but we're beginning to believe that exercise is central. You have to move. You have to create a life of movement because when you move, both aerobic and anaerobic, both exercises that make you tired and exercises that strengthen your muscles, both are now found to be critically important. When you move, believe it or not, it's the number one factor that affects your emotions, whether it's anxiety, depression. It's, it's incredibly potent. I'm not saying as a replacement for medications, but as a powerful adjunct, it's incredibly important. But on the brain itself, when you move, it creates chemicals such as BDNF, GDNF, and VEGF. These are growth factors. That grow the vasculature, that grow the connections between neurons. They're incredibly powerful. When you move, it's the biggest pump in your body. It's not your heart, it's your legs. Legs push the blood to the, to the brain. So they've done studies that people who moved regularly had better blood flow to the brain. When you move, it actually helps with the cleansing of the brain later on because your lymphatic system which is the cleansing mechanism, works better.

The list goes on and on and on. I don't care if you're going to be— nowadays it's popular to say zone 1 and zone this or that. Forget about that. Do a brisk walk. The zone stuff is for people to sell their programs. Eat salad, greens, and walk a brisk walk 20 to 25 minutes a day. That's nothing extraordinary, but it's It's extraordinary as far as what it does for your brain. Now, the strengthening strength exercises are even more powerful, especially leg exercises. When I was younger, even when you and I worked out, it said don't skip leg day. I hated leg day, but leg days are important. Let's start from the other end of the life spectrum. When you're older, the number one reason that people end up in emergency room is falls. In fact, we lost our healthy, incredibly healthy grandma, Aisha's mom, just recently within the last month because of a fall. We lost my mom originally because of a fall and injury, and then COVID was a subsequent factor. But falls are incredibly common. Guess what stops falls? Leg strength. Now let's get a little closer. At a younger age, leg strength builds brain volume.

What does that mean?

It grows your brain. So there's a study, there's a twin study, and there's no better studies than twins because genetically they're identical. So it's not genetics, right? Often even environmentally they're the same, right? Often they did studies in MCI patients, mild cognitive impairment, pre-dementia, seeing there's a control group. One sibling did leg sprint, the other one did stretching. Not that stretching is bad, but compared to leg strength, they looked at the percentage of MCIs that went on to develop dementia. Those that did leg strengthening exercises reduced their chance of Alzheimer's by 47%, actually 47%. Leg strength.

Hold on. I just wanna make sure that as you're watching or listening, that you really got what Dr. Dean just said to you. So, so far, and this makes sense, that your legs are critically important because they're an even bigger pump of blood than your heart. And when you have good leg strength, when you go for a walk, 25-minute brisk walk, 5 days a week, you reduce your risk for Alzheimer's by how much?

So the siblings who exercise and had stronger legs, 47% of them actually had normal memory testing after that period. And it wasn't even extensive. It was just a 6-month study, and they exercised for about 30 to 45 minutes, and they were doing things like resistance training, leg press, lunges, and squat.

How many days a week do I have to do this?

3 or 4 times a week.

That's it?

Yeah.

Like, why wouldn't you do this if you knew that you decreased your risk for Alzheimer's significantly, and if you have any type of mild cognitive impairment, the study is showing that you might actually reverse it.

Yeah.

Well, then that's—

I'm saying like as a whisper, I'm like, really?

Yes.

Yeah. The speakers in our hands just yelling at the top of our lungs to say this is such a wonderful way of taking care of your—

and even if you're 80, even if you're 90.

Yes. You don't have to do leg presses with weights on your shoulder. I tell people, do mini squats. You're, you're watching your favorite show. Make, make that your leg day. Uh, you stand up, your couch is behind you. Don't go all the way 90 degrees, go 60 degrees and do a few of those. Write it down. And even if you fall, you find falling on your couch, but you've started. You've started in a place, not a gym where you have to get all dressed up, in your own home in front of your favorite show. You just did 10 squats.

Or if you're waiting for your microwave, if you're warming something up, instead of just like standing there, just hold onto something and do some mini squats for 60 seconds and you'll see the benefits. It's as simple as that.

This is incredible. Dr. Dean, let's move on to the third one. We've done nutrition, we've done exercise. The next one is unwind, and it's about the intentional effort to de-stress.

Correct. There's a reason why U is in the middle of neuro. As I said earlier, stress management is central. But here's the thing, there's good stress and bad stress, and good stress is critical. There's a reason that you have 86 billion neurons and a quadrillion connections. If it was reproduction and getting food, you would stop at, as a bacteria, they do a great job. They get food and they reproduce. It's for more than that. That brain demands good stress.

Yes.

It needs to be challenged. In fact, studies have shown that people who are very mentally active and then they retired and then for the next 2 years they didn't do anything, guess what? The steepest decline then.

But we've seen it. Yeah. Like you've probably seen your parents retire or somebody in your family retire and they were active and alive and interested and engaged. And then 2 years later it's like, who are you?

Yes. But the ones that maintain the level, the same level of activity, but maybe around things that they always wanted to, right? They maintain the cognitive capacity.

So about though, the unwind, why is it important to really take minimizing the bad stress, the constant pressure, the negative self-talk, the endless perfectionism and the to-do list, the things that we do that we may be able to dial down? Why is unwinding that stress really important and how do we do it for brain health?

Because stress used to be a one-time thing or less frequent, right? There, a tiger was after you, right? You either died or stressed, right? So, or both. And then now in the modern world, every single system in your body is affected because when you're under stress, your body is telling you, I don't have time, enough energy to spend on this, this, and this. These are luxury states. My entire focus is going to be on survival.

Yes.

And everything shuts down. That's why people in chronic stress have higher degrees of cancers. Immune system is lower, right? So that's why it's critical to address stress centrally.

And how do you recommend when it comes to brain health, Dr. Dean, what is one important thing that somebody should really start to think about or to do in their life for better brain health when it comes to stress?

Very, very non-neurological way. Make lists.

Okay.

Identify bad stressors in your life, meaning activities, behaviors, and thoughts that are not driven by your purpose, that are external to your purpose, that don't have good timelines, that are just taking over your life and you have no control over them. Literally write them down specifically. The other side of the paper, write the good stressors, the activities that you would want to do or you're doing that have meaning for you. That have purpose, that are well-defined, that have clear timelines of victory. Write those down specifically. And your life purpose should be reducing, eliminating, and delegating the negative stress, increasing, empowering, and tooling and strategizing towards good stress.

But I love the fact that you're talking about lists because you're right, we do tend to manage it all in our minds. And we began this conversation by you saying, that we are living in a moment in time when there's so much bombarding you that your speed of retrieval for what matters is slowing down because you have to wade through all this junk that the world is throwing at your brain. And so making the list forces you to get on paper what's actually going on in your life. If you really get intentional around dialing down the stress, what are the implications for slowing down dementia or growing a better brain? Like what happens? Happens?

Uh, purpose. Good stress is activities, behaviors, and thoughts that are driven by your purpose. Let's just take that one component.

Yes.

Studies have showed that people that were purpose-driven have significant better brain health. I wanna make sure that I, uh, demystify the word purpose. In my case, purpose is neurologic. Purpose has direction. Purpose is a well-defined thing that I'm going towards. When a life has got that kind of vector, that kind of direction, that kind of power pulling it, and you've organized it well, it is the ultimate in good stress.

And it makes sense because, you know, if you think about when you get in a rut in your life where you're just in a period where everything is work, where everything is taking care of other people, and then you start slipping into these habits where you're wasting hours every day on social media and just doing dumb things that actually kind of stress you out and make you depressed, you start to tell yourself, well, I don't have time to volunteer at hospice, I don't have time to to church or synagogue or mosque this weekend. I don't have time to work in the community garden. And the list and getting everything going on in your life and crossing off some stressors also opens up space for you to find a Thursday night to go back to book club. And, you know, I kind of think about this like, do you have something you're looking forward to every week? And that direction is really important, you're saying, for your brain health.

Yes.

Dr. Ayesha, let's talk about our rest. How can the person listening improve the quality of their sleep?

It's so important, and I feel like a hypocrite right now talking to you about restorative sleep because I flew in from Los Angeles last night and I haven't had a good night's sleep, but I'm caffeinated. Sleep is something we don't talk about enough, and it's always an afterthought, isn't it? It's like, oh, I'll sleep later. It's as if you're taking away time from such a precious resource staying and you're being selfish to go to sleep. But sleep is a time when your brain actually does its most important task. Two things happen when we sleep. The first thing that happens is you actually start cleansing your brain. There's a very elegant system that gets activated when we go to the deeper stages of sleep. It's called the glymphatic system, and it is made of a type of a fluid that literally washes your brain and gets rid of the debris. And there are very specialized cells. They're these tiny cells called microglia. These are the janitor cells of your brain. They get activated. You know how when you're in a building and during the day there's business and people come and go, there's a pile of trash that accumulates in the trash cans.

This janitorial system, you know, comes into the building and then it cleans up. So when you come back the next day, everything is spotless and clean and it smells great. That's exactly what happens when we go to sleep. Your brain gets rid of all of this debris, the amyloid beta protein that has been associated with Alzheimer's disease, the tau tangles, and so many other things, they get washed away. The second thing that happens is your memories get organized from short-term to long-term memory. You know how during the day when you come up with ideas, you write them, you scribble them, you were scribbling on some papers in the corners, and you probably have some Post-it notes in your computer in your office. What happens is when we go to sleep, all of this information gets beautifully written into a nice Word document. It goes into the right file and then the folder and then the cabinet. I'm giving examples so you know where it is the next day. You're not like thinking about like, oh, what was that thought that I had? Where did I put it? Oh, it's neatly in the right file folder cabinet.

I can retrieve that. That's what happens in our brain. The defragging system of the brain actually gets gets activated during deeper stages. So when we don't sleep, when we don't get at least 7 to 8 hours of deep sleep, when we don't hit those deeper stages of sleep where this process gets activated, when we keep waking up over and over again because we have to go to the bathroom, or if we have sleep apnea, or if we have restless leg syndrome, or if we're worrying constantly and we keep waking up because of that, all of this byproducts, these byproducts, they accumulate in the brain. And over a long period of time, they've seen that people who have major sleep disorders, chronic disorders, they are at a higher risk of developing Alzheimer's disease and dementia.

Well, it makes perfect sense. And it also ties back to what you were talking about earlier about the speed of recovery, that if you're not getting a deep, restful night's sleep and you can't, go through that phase where the brain cleans out the garbage, you're having to sift through it all day long. And you also aren't filing away anything that happened into long-term memory. Is there any recommendation that you have for your patients in terms of like just one thing that you could do starting tonight that might help you get a better night's sleep?

There's so many things that you hear on the internet about sleep. One thing that is that's extremely helpful and it has been validated by sleep specialists and scientists is choosing to wake up the same day every day. Just set a time to wake up the same time every single day.

Why?

Because say, for example, if you decide to wake up at 7 in the morning or 6 in the morning, even if you haven't had enough sleep the night before that, you're going to slowly and gradually fix that. Your body will need to sleep more. And so you don't have to like, assign a time to go to bed, just wake up at the same time. There's so many other things as well, and it's dependent on the person as well. So for example, going for a walk first thing in the morning, it resets your circadian rhythm. It actually exposes you to sunlight. It gets you to exercise a little bit more, so you kind of get tired during the day to go to sleep. And then there's some environmental factors as well. Making sure that your room is dark, making sure that your bedroom is only for sex and sleep, and it's not living room or a dining room or a social gathering place. That it's cool, that it's not noisy. All of these environmental factors make us, and then for stress management, that in itself is a huge topic, but cognitive behavioral therapy for insomnia works really well.

This is something that people can get help from with a psychologist or a sleep specialist, and it kind of helps you shut down that noise that is associated with stress.

What I love about the walk first thing in the morning in terms of resetting your circadian rhythm is it's a twofer. See, I like to bundle things. If you do a 25-minute brisk walk first thing, we reset the circadian rhythm and we reduce our risk by 45% for Alzheimer's based on the research. See, I'm listening.

You got it.

Let's talk about the final recommendation of the 5 things in neuro, and that is O, optimize.

Optimize is good stress, and it is critical. Your brain wants to be challenged. Your brain wants to be creative. The ultimate byproduct, the ultimate purpose and direction of brain is creativity. Creativity is central, and creativity means pushing the brain to do new things. And study after study shows that people who kept their brain active late in life actually grew their brain. There are some really cool studies, two studies. One is the Nun Study. The Nun Study is a, several hundred nuns dedicated their their body, their brain, their tissue, their blood cells, and their diaries to science. And after they passed away, their brains were autopsied and analyzed. And they saw that some of the nuns, they all did pretty much the same thing. Some of the nuns, despite having significant pathology, lots of shrinkage, lots of little amyloid and tau, as well as a little microvasculature, they were normal during life. Another group that had very minimal pathology, a pretty full brain, and they had Alzheimer's right before death. And it wasn't genetics. So what's going on? Why is this group that has so much pathology yet normal? This group that has minimal pathology and already succumbed to Alzheimer's.

After doing much of the work as far as genetics and study and blood tests and everything else, they looked at their diaries. The group that had had significant pathology yet was protected, their diaries demonstrated incredibly complex language. They had greater vocabulary.

What does that tell you?

Idea density. That means they challenged their brain. They learned more. They pushed themselves to study more, to learn more, to have more vocabulary. Idea density is a lovely, lovely concept. I said, if I, I'm a terrible guitarist, but if I ever have a band, I'm gonna call it Idea Density. Which is gonna be even worse. But nonetheless, it's an incredible concept. The group that succumbed in spite of normal had much less sophisticated vocabulary, had challenged their brain much less.

So what are the top recommendations of things that you can do to challenge your brain? Because I'm, I'm sitting here thinking about some of the people in my life who are like always doing Sudoku or the crossword puzzle or passing Wordle. Like, are we doing word games? Are we reading? Are we learning new Are we learning languages? Like, what is the biggest bang for the buck in terms of keeping your mind active and optimizing the brain's natural desire to create, to grow, to learn?

E, all of the above. But, but reality is, um, the more complex the better. We did a meta-analysis. We write papers. We, we, we did a meta-analysis, uh, a couple of years ago looking at everybody else's papers who gave it to us. And we've looked at the bigger data. And we saw that 3 things matter: complexity, purpose, and challenge. And what does that mean? Activities that have a purpose for you and have complexity, meaning multi-domains, and you're pushing yourself are by far the best.

Does that mean we could be doing a puzzle as a family?

Those are great, but learning a musical instrument. So when you're learning guitar, you're reading the notes. Yes. It's your language centers.

Okay.

You're processing it. It's your, uh, prefrontal lobe. You're visually processing it, your occipital lobe, you're actually being creative, it's your parietal lobe, you're emotionally involved. If they're listening to me, it's bad negative emotion, but for me it's good emotions. You're emotionally involved, it's your limbic system, and you're dextrous, it's your motor cortex. It's the entire brain being active at the same time. And that's complexity. It's purpose because I love the music. And what you do is if for a couple of weeks you learned a Beatles song that has 4 chords, next week do 5 chords. That's pushing yourself forward. If you're learning dancing, if it's a 3-step dance, next week do 5-step dance. So real life activities are much more meaningful because they serve your purpose.

Wow. Anything else that counts? Reading books, book clubs, staying active? 'Cause I know people are gonna be like, well, how do I engage my brain? I'm 70, I'm 80, I'm this, I'm the other thing.

All of those, all of those have complexity in them, right?

Right.

So, but, but if you're reading, read, recite, and rewrite, that gives another level of complexity. So you just read a book, not a whole book, but a chapter. Now think about it, process it, rethink it, and rewrite it. That brings the entire brain into effect. Uh, if you're book clubs, amazing, because now you're social.

Yes.

So it's the social interaction, the conversation, the thinking, the processing. There's an incredible thing about dual task. So for example, if you're on a treadmill, people that exercise on a treadmill and then they listen to a Mel Robbins, uh, podcast, which everybody should do, they actually did significantly better than just exercise alone.

So you get a twofer if you're walking on a treadmill and you're listening to a podcast because you're expanding your mind and it makes you think about new things and you're moving your legs, which we now know your legs pump all this blood to your brain and it's one of the most important things you can be doing when you're exercising.

Not only is more blood going to the brain, BDNF, brain-derived neurotrophic factor, that grows the brain, is also being pumped at a time that you're learning something. So it's more than two for it. Yeah. So it's critical that we do these kind of things. And basically anything you're doing, it— doing it a little more complex, if you're gonna do it in social setting, even better. That's your brain-growing activity.

Well, the thing that I'm so excited about is that it's never too early. It's never too late. I love that your brain isn't judging you. Your brain is like a plant wilting in the corner. It needs some water. It needs some sunlight. It needs new proper nutrition, exercise. It needs you to manage your stress a little better, get a good night's sleep, and to be engaging it in ways that you can learn and create. And those things alone significantly improve your brain health. It pauses dementia. It can slow it down if you're already there. These are things the people that you love and that you can start doing right now. I have learned so much from the two of you. It is so cool what you're doing. Dr. Dean, Dr. Ayesha, what are your parting words?

20 years from now, you're not going to remember this conversation, but your brain is going to remember the changes that you're going to make today and tomorrow. And that's what matters. It could be a walk. It could be joining a book club. It could be joining your children or your grandchildren to play games once or twice a week. Those things will determine how you are going to be you in this beautiful story of your life. And your 75, 85, 95, 105-year-old will thank you.

Beautiful. I don't know if I can top that, but I'll—

You'll contribute to it. Yes, exactly.

A cathedral was not built right away. It was one brick at a time. People forget that because they think it's not enough. It is enough. When you're standing in front of TV during your favorite show and at the beginning just standing and making small steps in place, that is profoundly powerful for multiple reasons. One is your reward system, which is built on dopamine, is both reward and movement. There's a reason why dopamine affects both of those. Now you've created the foundation, the first brick that everything else can be built on. That's as powerful as the entire building. You've just started. Just do that every day. If you just add one serving of greens a day, that's, that's not a brick, that's a wall. That is a wall.

A wall of a fort.

Now you see. That the cathedral— these are cathedrals you're building with small, simple, incredible bricks of daily activity that will change your life, your family's life. When they talk about genetic, it's not genetics, it's shared habits. You just change your children's habits and your parents' habits. You've just built cathedrals in your communities. That's our purpose in life.

Well, Dr. Dean, Dr. Ayesha, Ladies and gentlemen, the Shirsais are here. It is a real privilege in life to be in the presence of someone's genius. And it's so moving to see your passion and the gift that you have for boiling all of this down in both a simple way and in an urgent way. I believe you when you say that there are so many small things we can start doing and our loved ones can start doing right now that will forever change your brain health. And you have taught me so much today. I'm sharing this not only with my family group chat with Chris and the three, you know, adult kids, but the larger ones with cousins and aunts and uncles, because everybody deserves this information and research and these simple recommendations and the reasons why they matter so much. It's literally your life and you've just put the power back in our hands to improve it. So thank you. Thank you. Thank you for the work that you're doing. And thank you for flying all the way here and spending this time with us to help us improve our lives. And I want to thank you.

Thank you for making the time to listen to something that 1,000% is going to improve your life and the life of absolutely everybody that you love, that you share this with. I am convinced that the way that you take care of your brain is going to determine how you feel in your life. I learned so much. I know you did too. I want to thank you for listening and watching all the way to the end. I also want to thank you for sharing this generously because we all deserve to have access to this information and the reasons why the things that these amazing doctors are recommending are going to work. And in case no one else tells you today, I wanted to be sure to tell you that I love you and I believe in you and I believe in your ability to create a better life and paying attention to and taking your brain health seriously. There is no doubt based on the research and everything you learned today that that is the way you create a better life. All righty. I will see you in the very next episode. I'm going to welcome you in the moment you hit play.

That will either slow down, pause, or even reverse— that will— that will either slow down, pause, and even reverse brain decline. What you're about to— hold on a second. Do we want to do the— and everything that the two medical experts that you're going to meet are going to recommend. They have spent decades studying neurodegenerative disease. Oh, my God. Dear God. Okay, here we go. They are also a married couple who have trained and worked at some of the most prestigious agate— prestigious. Okay. I'm so grateful that you're here. I'm also grateful for our sponsors. So I want to take a pause so we can give our chance— exciting new research and a protocol that can help you slow down, pause, and even reverse brain— brain decline. Even reverse brain decline. Well done, you two. Wow. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional.

Got it? Good. I'll see you in the next episode.

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