What are the actions we can take to maintain our long-term brain health? This week, we discuss this and more with Dr. Marc Milstein, author of The Age-Proof Brain. It turns out that even small behavioral changes, like eating less processed food and regularly challenging yourself with activities like playing an instrument, will support overall brain fitness and neuroplasticity. Furthermore, Dr. Marc also breaks down the surprising link between gut and brain health.
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Key Moments:
“Anything that is processed is likely to feed bad bacteria. These bacteria have been around much longer than us, and so the things that they like to eat are the things that were around much longer than us, long before we got here, and the bad bacteria tend to feed on the things that we created.”
“There’s definitely foods that are great for brain health, but it’s really about variety and we really have evidence that it’s a synergistic relationship. It’s not one food item that is just like this brain-boosting magic food. It’s how the foods work together; and that’s why we believe that supplements can be beneficial but they’re not, in many cases, as beneficial as dietary changes, because what’s in the food works together with other nutrients.”
“So, what we see is that it’s not about this stress-free lifestyle. Our brain is like a car, I like to say, and if you don’t drive it, it falls apart, and if you over-drive it, it falls apart. Stress is a burst of cortisol. Say, I want to get something done. There’s a challenge; I want to tackle something. All those moments of stress are actually good for our brain because they release cortisol and there’s a part of our brain called the hippocampus which is really important for memory, and a squirt of cortisol in a moment of stress actually helps the hippocampus stay strong.”
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Transcript
Speaker 1: 8:20
So you have a book out called the Age-Proof Brain–something that I hope I have and doesn’t everybody and we’re going to talk a little bit about the relationship between the gut and the brain and sort of how to keep these things in sync. Maybe. First tell us a little bit about your background.
Speaker 2: 8:34
Yeah, definitely so. I am a research scientist by training, so I have a doctorate in biological chemistry from UCLA, and so I really specialize in taking research and trying to make it usable, understandable, actionable, trying to dispel a lot of the noise out there. We have a lot of information but a lot of misinformation, so I spend a lot of time trying to get to the heart of what are the things that we can do, things that are simple, actionable, sustainable, that can protect our brain short-term and long-term. And I focus not only on day-to-day brain health, so memory-focused productivity, but really I focus a lot about how do we take these tips to lower risk for things like Alzheimer’s and dementia, because we now clearly understand there’s things that we can do to protect our brain short-term and long-term, and there’s this dual benefit that the same things that protect your brain in the long term can also just make you feel good today.
Speaker 1: 9:28
So you mentioned risk factors for Alzheimer’s dementia. What are you identifying there?
Speaker 2: 9:33
Well, there’s quite a few that we’ve identified and we think of them now as straws on a camel’s back, and it’s not just one thing, but in almost all cases it’s the accumulation of these factors. And since we’ve identified these factors, we just want to think about the things we can control to take those straws off the camel’s back. So there are things like optimizing our sleep is a key factor. What we’re eating. Gut-brain connection. Stress plays a role managing stress, embracing some stress, but taking a break from stress as well. Some environmental factors play a role and a big thing is, besides socialization, learning new things is really some underlying conditions. So things that you might not think are connected, but they are very much connected and if we can treat those underlying conditions, we can protect the brain. It’s actually quite a few of them, but just one to think about is sleep apnea, for example, significantly raises the risk of memory loss because it’s so disruptive to sleep. But if we treat the sleep apnea, we see pretty clearly that it is protective to the brain, that we can actually reverse damage done to the brain. We can protect the brain. So it’s really about overall lifestyle factors, but also just being on top of these underlying conditions that are common that are often either overlooked or mistreated or not treated effectively. That can really protect your brain, short-term and long-term.
Speaker 1: 10:53
I want to make a note on sleep apnea. I think some people think of sleep apnea as just this sort of lifestyle irritation. Yeah, it’s a really serious and potentially fatal thing. I lost somebody last year who essentially to sleep apnea, their heart just stopped, and I think that whenever I hear, as soon as I hear that, I tell people right away like medical treatment immediately. You need to. This needs to be dealt with. Yeah, I love how you keep it really simple too. There are these really and I think we’re on the same page on that that we all love like investigating the exotics out there, but so much of this just comes down to sleep. How are you seeing about the intersection of cardiovascular health and brain health? Yeah, that’s a big one.
Speaker 2: 11:43
Quite a bit on that. That’s a big one, and actually there’s a whole chapter on my book on heart health, heart-brain connection. I like to think about it this way that if you could take the vessels and the veins just in your body and you could lay them out end to end, they would go around the earth more than twice. And I like to think of it that we need to keep those vessels and veins healthy, clear, because even little dips in oxygen that’s delivered through those vessels to our brain can have an impact on memory that day and years from now. And so we’re seeing that a lot of our memory issues that we see are actually rooted in issues with blood pressure, issues with AFib, issues with cholesterol, heart health and it’s another avenue where we have really good treatments for heart health. So we just want to really take advantage of these avenues that we can use to protect the brain. And just one other quick tip is that we actually see these really interesting studies that show that even our blood pressure even decades before we’d ever see a symptom, it can be a root cause. So we know blood pressure is important, but starting to think of it as a brain health tool and knowing what your blood pressure is, and studies are suggesting that having the number around 110 over 70 is a good thing to consider and think about. And again, we have so many good treatments for blood pressure and heart health that we just want to take advantage, because they’re just avenues to protect the brain.
Speaker 1: 13:01
That’s another one that is sort of like one of my bugbearers. The high blood pressure is just so corrosive, it’s so bad on everything. Yeah, you know, as you’re speaking about this, I had a discussion with someone with a lot of scientific knowledge and he prescribes for himself. He takes four. What is it? I think he takes four milligrams of Cyanolus every day, particularly for brain health protection, so it’s an erectile dysfunction medication, but it deals with vasodilation, which I thought was sort of interesting.
Speaker 2: 13:35
Yeah, there is actually some evidence that those medications might be brain protective for that very reason. You know we’re not at the point where we would say that everybody needs to start taking those medications, but it’s on the radar of. It highlights the importance of brain health and vascular health connection and how we want to be treating these areas and talking to one’s doctor about which ways to do that. And interesting to keep our eye on that research to say is there’s something that’s already available that could be repurposed in a way that could be beneficial.
Speaker 1: 14:05
Yeah, I’m not. I’m not encouraging people to do this.
Speaker 2: 14:07
I’m just mentioning that.
Speaker 1: 14:08
Yeah, it’s interesting to see the connection. Somebody with some knowledge told me that, yeah, let’s talk about the gut and the brain. Yeah, we hear this a lot. The gut brain connection. Yeah, bad gut, that brain. Could you lay that out for us a little bit? What’s the mechanism there? How do these two things interact?
Speaker 2: 14:25
Yeah, it’s really fascinating and it’s it’s a piece of the puzzle, it’s not the whole puzzle. So we want to be careful because there’s definitely marketing in this area that’s jumping ahead of the science. But there is absolutely some fascinating, impactful connections between our gut and our brain. That some things we were still learning about and we don’t know. But, just to put it in perspective, what we realize is that what’s happening in our gut is impacting our brain and it’s impacting how we feel, our mood, the way that we’re thinking can even impact things like our personality, and so the connection is that a big part of it, something to consider, is that there is bacteria in your gut and there’s really good bacteria or bad bacteria, and it’s definitely more complicated than just simply good or simply bad. But the idea is is that good bacteria can release what we would call like factors or certain chemicals that actually get into our bloodstream, travel to the brain and can impact our mood, our stress levels, how our brain functions. And, on the other hand, there’s bad bacteria and those bad bacteria can release what we call. More things like that are inflammatory and inflammation. I like to think of it like a fire, and a fire can release smoke, and these factors travel, just like smoke does, through our intestine into our bloodstream and they can essentially cause damage to the brain. So if we would think about like you know, you wouldn’t want smoke in your home or you wouldn’t want to fire in your house. Well, you don’t want those things in your brain too, because what they do is they actually send confusing signals to something that’s already residing in our brain called a microglia, and something just to think about is something that’s really interesting is that these microglia are these cells in our brain that eat up really just waste, trash and toxins and keep our brain youthful and keep our brain essentially clean, because our brain can actually fill up with waste. And these microglia, we want them to eat up the garbage, but what can happen is is they get confused and they start, instead of eating the garbage, they eat healthy brain cells. So the question becomes how do they get confused? Well, one of the ways they get confused is they are listening to signals coming from the gut, and if the signals coming from the gut are from inflammatory signals, we call it the smoke signals, these inflammatory molecules. They confuse the microglia into going to attack mode. So we start to connect the dots and put the pieces together, that what’s happening in our brain can be essentially listening to what’s happening in our gut and reacting to it. So we want to take care of our gut, to take care of our brain. So I don’t know if that was too much information or if that was not enough, but that’s kind of a breakdown of what’s happening, a piece of what’s happening in that connection.
Speaker 1: 16:51
I want to go to the bad bacteria. Yeah, this whole gut thing. I just find it’s so like beyond complex. Yeah, and is what we’re talking about here? Bacteria in its wrong place, so bacteria from the large intestine, say, going into the small intestine Is that what we’re talking about, or something that’s invasive, that we’ve eaten, that’s gone in there?
Speaker 2: 17:12
Yeah, that’s what there’s. Two, two key things to think about. One is exactly what you’re saying, which is that there is such thing as good bacteria that’s in the wrong place and now it becomes bad bacteria, and so what you’re referring to is often called SIBO, which is this idea that bacteria that is doing its job in the large intestine for reasons that are, you know, we don’t completely understand, but we have some ideas can travel up into the small intestine, and that bacteria can release, essentially, factors that are very cause a lot of pain and discomfort in the small intestine, where that bacteria would not be as disturbing and might be beneficial in the large intestine. Now located in the small intestine can be quite painful and intrusive. That’s one aspect. And then there’s also bacteria that, on its own, is this types of species that we’re still figuring out, but there are many different species of bacteria. Some of them feed off of certain types of food and they seem to be more apt to release inflammatory molecules, and we call these more bad bacteria, and so we tend to see that the good bacteria, they tend to eat fiber, they tend to eat whole natural foods, and that’s where the diet plays a big role in this, whereas the bad bacteria they tend to feed off of processed foods, you know, added sugar, and when they populate or they grow they become more likely to release more of these factors that can be damaging. So there is this ecosystem in our gut between good and bad. We’re not saying it has to all be good, but we definitely want more good than bad, and good in the right places, not in the wrong places.
Speaker 1: 18:53
So many questions. There’s certain sort of like artificial sweeteners. Yeah, is there a relationship between bad bacteria and artificial sweeteners? I’ve heard this. I don’t know if that’s true.
Speaker 2: 19:05
So the science is mixed. There is evidence, especially in some animal studies, that artificial sweeteners can cause growth of bad bacteria. What we don’t clearly understand is how much of this artificial sugar would someone have to intake? You know, correlating from an animal study to a human study, these things can be challenging to understand in humans. So really, the take home message is is that if somebody is concerned about their gut health and or they’re having issues, it’s on the list of things to really consider minimizing or eliminating for a variety of reasons. I mean, again, we don’t have clear data on it, but it’s on the list of things to say. If somebody’s struggling with their gut health, it’s something we want to look at and say how much is this person taking in? This is something that we are concerned could be feeding bad bacteria. Anything that is processed is likely to feed bad bacteria, the bacteria. These bacteria have been around much longer than us, and so the things that they like to eat are the things that were around much longer than us, much before we got here, and the bad bacteria tend to feed on the things that we created. And so it’s pretty much trying to think about minimizing those processed, manufactured ingredients as something is just a very simple takeaway from something that is, you know, still, something we’re trying to figure out is something that is complex.
Speaker 1: 20:30
Are there tests for the like what? What’s going on in your small intestine, like, how would you do that?
Speaker 2: 20:38
So, yeah, another area where a gastroenterologist would be very helpful, but we want to be careful of marketing, like you know, sending, you know, ordering kits at home and things like that. Although that’s on the horizon and that’s that is something that is in some cases usable under the care of a gastroenterologist want to be really careful of this, like 23 and me, or genetic analysis version of gut bacteria, just because, although it’s, it could be, you know, entertaining and informative in terms of learning about your gut, to really make like clinical decisions and dietary decisions based on that information is problematic, just because we don’t really know the quality of those tests. There’s not that much oversight. How accurate is the handling of what’s being tested? On the other hand, there are some tests that can look for bacterial overgrowth that can be done from home, that can be ordered by a gastroenterologist, and that’s really amazing because it used to be somebody had to go and go do a breath test in a doctor’s office and now there are some kits that can be done at home and be sent in through the mail and can be very informative. So really the take home is that these kids, that these kits can be utilized under a doctor’s prescription but just mailing away for something. Just be careful of making any concrete decisions from that. Those types of kits.
Speaker 1: 21:56
I feel like I’m really going to go down a rabbit hole here. But what controls the bacteria from the large intestine going in, like you mentioned, sibo? What happens there? What’s the control that keeps it from not doing not getting into the small intestine and what’s the fail?
Speaker 2: 22:13
Yeah, it’s like several things. So that’s a good question. So some things is just an anatomical. Sometimes somebody has a surgery and they have a surgery connection point between they’ve had some sort of intestinal surgery and the anatomy is either dramatically or slightly changed and that change in anatomy can cause a higher risk of bacteria traveling upwards. Sometimes somebody is born with a slight anatomical change, a variation that is more likely to have this bacteria travel. Sometimes it’s the environment of the small intestine could be a virus, a bacteria, another type of bacteria that has altered the pH or the composition in the small intestine or large intestine that is causing that bacteria to travel. So usually the small intestine is not hospitable to those types of bacteria that live in the large intestine. There’s pH differences, there’s enzymes there. It’s not somewhere that the bacteria really wants to live. But sometimes a virus that somebody gets or a bacteria, another type of bacteria, can cause an infection or an inflammatory response that alters the composition of the small intestine, which allows the bacteria to move there and thrive in that environment, which it shouldn’t be. So those are two key reasons that we see. There’s others as well, but it’s not supposed to happen. But it can happen and it’s something that can be really challenging in terms of symptoms. For people, it can be extremely uncomfortable, so it’s something people definitely want to be treated for. It can be a challenge to treat, but there are effective treatments for it and it’s something people want to be aware of.
Speaker 1: 23:43
Interesting.
Speaker 2: 23:44
I know we’re here to talk about brains, but yeah, well, the gut and the brain are connected, so we can keep talking about the gut Talk to me about some of these simple things.
Speaker 1: 23:55
What are some of the things like? If you were to tell someone, what are the things that you need to be doing to keep your memory intact, to really look out? I read a thing in the paper this morning about how in Western nations, rates of dementia, alzheimer’s, are actually falling. They were assumed to accelerate, but they seem to be falling because we’re cardiovascularly taking better care of ourselves, I guess. What are the things that you would suggest for people to be doing?
Speaker 2: 24:22
Well, simple, simple things would be If we keep going with the gut as an avenue for brain health. I would say that diet is complex, it’s individualized, but one really simple thing to do, or two simple things to do, is just being really mindful or aware of what you’re eating, in terms of two key things. One is I always like to think about this museum. I was in in Chicago, the Science Museum, and they have a Twinkie there that they unwrapped like a decade ago and it looks delicious, looks like you could eat it today and it would taste fine. That’s what we’re worried about. The foods that never spoil. It’s the additives, the preservatives, the ultra-processed ingredients and they get into the gut and they can cause inflammation or essentially a fire to spread to the brain and we can really conceptualize and visualize how a fire in the brain is devastating to memory or just brain function. So next time you’re eating something, if it’s packaged, just looking at the ingredients, taking that extra step and saying can I pronounce these ingredients? Is this a chemistry experiment gone wrong or is this like? Is this food, if it’s in that category, opt for something else? Most of the time, just think about minimizing the ultra-processed ingredients. That small tip goes a really long way and a lot of the things that we eat. Oftentimes there’s choices in the grocery store or online. You flip it over and you’re like, oh, this version of this item has a lot of ingredients I can’t pronounce and this version does not, and that simple change can be highly impactful for gut health and brain health. And then the other thing is that people always say what are the magic foods? There’s definitely foods that are great for brain health, but it’s really about variety and we really have evidence that it’s a synergistic relationship. It’s not one food item that is just like this brain-boosting magic food. It’s how the foods work together and that’s why we believe that supplements can be beneficial, but they’re not in many cases as beneficial as dietary changes, because what’s in the food works together with other nutrients. And so if you just think of your plate and your variety of colorful fruits and vegetables, like handfuls at most meals, like eating they say, eat a rainbow that simple tip of just like it’s varieties of colors, that because those colors are actually anti-inflammatory molecules and they help put the fire out, and it’s how they work together, not just a singular ingredient that we believe is more beneficial. So diet. We could go on and on spend hours talking about it, but that one simple or those two simple things can go a really long way for brain health.
Speaker 1: 26:58
I know you took the super-aged quiz and you’re an owl. I’m also an owl. We’re the sort of people that like to read all this science. Others aren’t like us, it’s okay, so we keep it simple. What in terms of physicality, in terms of movement, what do people want to be thinking about?
Speaker 2: 27:18
So, interestingly, the threshold for the amount of movement we need is not as much as we once thought. But we want to be doing a lot of movement, but we realize that we don’t need to do as much as we once thought, which is motivating for people who are struggling to be active. And so a couple of things to think about, as there’s. A study came out, I think, last week, where it was really interesting because they had a study where they had 25,000 people in the study wearing these fitness trackers, and the fitness trackers are starting to give us some interesting data and what they see is that they’re calling it incidental movement. So there’s such thing as I’m gonna go do a chore, I’m gonna go mop the floor, I’m gonna park a little farther from the grocery store, I’m gonna walk around my office, I’m gonna take a flight of stairs and these little bursts of activity two, three minutes a day 30 seconds is not as good as a minute and a minute is not as good as two minutes, but somewhere between two and three minutes of a burst of activity throughout the day a couple times had a significant impact on heart health, and we talked earlier that heart health is critically important for brain health. So what we think about is just trying to build into our day these little moments of I’m gonna park a little farther from my errand or I’m gonna set a timer if I’m at my desk and I’m gonna just take a quick walk outside and go up and down a flight of stairs, and these little bursts of movement are really important. And then, if we think about a bigger thing to think about, or a little bit more, is just walking 30 minutes a day in total has been shown to lower the risk of dementia or memory loss by about 60%, and we understand the science more behind why that is. There’s a couple factors of certain things were released in the brain when we walked that are good for memory, like BDNF, these growth factors. We know that walking and memory are tied together. So beyond those things is great, and I know you were mentioning before that you’re training and that’s all that’s fantastic. But to get to a threshold of some really good protection is not as much as we once thought. So we just wanna encourage getting there, and then beyond that is great too.
Speaker 1: 29:19
I see in the background here what looks like a piano. Is that? Right, yes, it is yeah, and I had someone on the show maybe last year, the year before that, and we were talking about music not just listening to music, but the playing of music and it’s really dramatic effect on the brain, especially learning something new.
Speaker 2: 29:44
Yeah, yeah. So learning something new is one of the most important things we can do for long-term and short-term brain health. And so when we learn new things, we’re not only making new connections in our brain, which, as we get a little bit older, we can be losing some connection. So I like to think of it like a bank account If you’re putting in deposits, you don’t notice the withdrawals as much. So we just wanna learn new things and make new connections. And a musical instrument is, at its essence, learning new things, but it’s also a full brain workout. And so, if we think of the brain, if you went to the gym you wouldn’t just do curls, because after a while that would look not so good, but you wanna be doing different muscle groups and different types of activity throughout the week. Some days you’re doing some, maybe a hip workout, the other day you’re doing some cardio, mild cardio, or you’re doing weight training, the mix, same thing with the brain. And so when we think about, it’s not just crossword puzzles and brain games, it really is just picking an activity that works out multiple parts of the brain, and music does that. It’s physical. You have to move to play the instrument, you have to learn new things. It’s often social, it’s stress relief, it involves rhythm and all these parts of the brain are like different parts of the body and you’re exercising them when you’re playing music. So music is a fun and really usable strategy for brain health.
Speaker 1: 31:05
I think we share a similar philosophy on stress. Zero stress is not such a great thing. Could you talk a little bit about that?
Speaker 2: 31:15
Yeah, yeah. So that’s what we see is that it’s not about this stress-free lifestyle. Our brain is like a car, I like to say, and if you don’t drive it, it falls apart, and if you over drive it, it falls apart, and Stress is cortisol and a burst of cortisol. Like you know, I want to get something done. There’s a challenge, I want to tackle something. I want to do a little bit of traffic. All those moments of stress are actually good for our brain because they release cortisol and there’s a part of our brain called the hippocampus which is really important for memory, and a Squirt of cortisol or a moment of stress actually helps the hippocampus say strong. And if you think about it, if you’re a little bit stressed out, you’re you’re, you’re in the game, like you’re, you’re doing things that are keeping your memory strong. Now the problem is is that we live in a world where there’s just too much stress and it’s happening, it from every possible direction. It’s in the news, it’s in our personal lives or professional lives. So just finding moments To take a break from stress, so stress becomes more acute instead of chronic, and it’s not too much too often, that’s just. That’s that magic sweet spot for brain health, want stress, just want to take a break.
Speaker 1: 32:19
That’s right, I’m glad that you you’ve laid that out. I get a little bit of shade about this. There’s a huge difference between chronic stress and acute stress. And physical activity is an acute stress. Learning an instrument is actually really stressful. It’s hard, yeah, but this is an acute stress. That, that’s, that goes away. The chronic stress, that’s the no, that’s. We don’t want that. We need to deal with that.
Speaker 2: 32:43
Yeah, right right, yeah, too much too often. And another thing is we’re seeing as its perspective. So if you feel like the stress is manageable and you are managing it, it’s not nearly as toxic than if somebody with the same stresses is feeling like it’s overwhelming and unmanageable. So we want to be empathetic to Everyone responds to stress differently, but learning tools to find ways to make it man and is that?
Speaker 1: 33:07
What you’re describing is that like a sense of agency over one’s life, because I’ve heard something also about that like stress in terms of if I feel I can have an impact on Whatever’s going on, that’s one thing. If I feel I’m powerless in the situation, that’s a different thing.
Speaker 2: 33:24
Yeah. So feeling of control Is a big part of it, feeling that there’s a purpose to you know, to my two things that I’m stressed about. I’m learning from it. You know I will take a break from it, but I’m learning from it or I’m helping someone else through this process. Those are mindsets that we realize have an impact on how stress is managed and thus that impacts our brain health too. So stress is very much related to, you know, it’s not just how you feel. It’s impacting your immune system, inflammation. It relates to how your gut is working. So there’s the biochemistry behind the stress response, not just, you know, I want to be happy because I want to be happy. It’s actually related to how your body and brain are functioning.
Speaker 1: 34:06
Yes, I often tell people total comfort leads to total decay. Right, that’s a good one. We’re designed to work hard, we humans, and you turn all that off things, we we become untethered at best. Right, tell us a little bit about what you’re seeing in terms of Any new developments out there in, in the worlds of, you know, brain health. What are the things that are coming your way?
Speaker 2: 34:30
Well, I think it’s a combination of what we’re talking about and realizing that these things are really Rooted in science, they’re valid and they’re helpful because just a couple years ago, really, the mantra was we don’t know, there’s nothing we can do, and like that’s pretty much what it was and and I see that’s pretty much what it was and I still, when I go out and speak to people, I’m it’s. It’s amazing how many people are still in that mindset. You know it’s. People aren’t Engaged in the information that they’re. They still are of the mindset, mindset of oh, I thought there’s nothing I can do or it’s just my destiny to lose my, to lose memory. Because, you know, I had it’s, I saw it in my family and so really Making it, making us all aware that there are things that we can do. We are not destined, in the vast majority of cases, to have significant memory loss, so that’s a big jump forward in just getting that message out and Making people aware that there’s more control here than we ever thought. Combining that with starting now, not waiting at any age. Thinking about you know that the roots of memory loss can take place 10, 20, 30, 40 years before we’d see symptoms, and so we want to prioritize these activities now and not be overwhelmed by them, but just be additive to our life in because many of the things we talk about are fun, you know, socializing, eating well, you’re playing music, traveling all these things are playing sports. They’re all fun and so we just want to. Part of stress management is giving ourselves permission to do these things, um and and and valuing them and and realizing that they’re important for our short-term and long-term brain health. So the lifestyle part is really important. And then, on the other hand, thinking about preventative, proactive medicine, and so we touched upon this idea of sleep apnea. You know, be on top of inflammation there’s some blood tests that people can, that are very mainstream, that people can take, take advantage of. Be on top of heart health, and just saying that my overall health is going to be impacting my memory. Um, we talked about blood pressure. Um, gingivitis is something that raises the risk of Alzheimer’s if it’s not treated because it’s inflammatory. So we putting together all these pieces and saying we want to. We want to be proactive in our lifestyle, be proactive with in terms of um, being on top of any underlying issues and then keeping our eye on therapeutics and realizing that things are, you know, things are on the horizon. We don’t have anything right now where we would say that it is like we don’t have a magic pill. And we might not have a magic pill, but we are starting to be aware that if we can combine things like treating inflammation, being on top of diabetes, treating our heart health and there are some advances in the last year in terms of some Um medications that can be used we believe that can be helpful in treating Alzheimer’s. So that is, they’re not perfect, they have side effects, they’re expensive, but they’re in. It’s a step forward. So being aware that combining these three areas of preventative medicine lifestyle and keeping our eye on the therapeutics and using them when necessary Is providing us a lot of hope moving forward.
Speaker 1: 37:30
Um, you mentioned diabetes. Let’s um, let’s touch on um blood glucose, insulin, inflammation and brain health. Talk to me a little bit about that.
Speaker 2: 37:40
Well, what we know? That diabetes, if it’s not treated, is one of our single greatest risk factors for Alzheimer’s. It’s in in some studies it’s the second greatest risk factor besides age. It raises the risk of Alzheimer’s by about 65 percent. Now, if you treat the diabetes effectively, that risk in most cases goes away, and in some cases, people who are effectively treated for diabetes Are more protected against Alzheimer’s. There’s actually evidence for that, and what we believe is that these Two conditions are linked mechanistically in some ways, and so what we realize is that Alzheimer’s memory loss is not one thing, but a piece of what can be happening besides inflammation, besides blood flow to the brain, besides specific build-ups of waste or toxins in the brain, is also the way the brain utilizes sugar, the way it metabolizes sugar. So sugar is a fuel source to the brain, and if that’s not functioning properly, like it Doesn’t in diabetes, that’s impacting how the brain works. We also realize that the brain’s ability to remove waste and trash from the brain Um is something that, in fact, impacts how it ages. So as we get a little bit older, the brain becomes less efficient at removing waste, and so, just to put this in perspective, your brain’s about three pounds and every year it makes about five pounds of waste, trash, toxins. It’s just leftover chemical reactions, it’s just just part of being alive, and sleep is something that helps remove waste and trash from the brain. Learning new things helps remove waste and trash from the brain. But also diabetes interferes with the brain’s ability to remove waste and it can cause a buildup of waste in the brain which can prematurely age the brain and have a negative impact on its functions. We start to see that there’s a strong mechanism, mechanistic link here, that when diabetes is treated there’s essentially an enzyme in the brain that helps remove trash and waste. But it has another function and that’s involved in diabetes. So if it’s being overused in taxed in diabetes, it’s not doing its job to help remove waste. So we start to realize that these numbers of these elevated risk for people who don’t have a full entry to diabetes. We see the underlying science there. But the positive all this is beyond top of blood sugar. You know, once or twice a year get a blood test, you know him. A go in a, one C, c word is treated. Even pre diabetes can raise the risk of Issues with brain health. Insulin resistance, which is like pre pre diabetes can have an impact on depression, raise the risk for issues with with brain health. So we don’t want to take these things lightly again, we have great treatments for them, so we want to take advantage.
Speaker 1: 40:10
Yes, they’re very much brought that up, that we’re not just talking full blown diabetes. I’ve seen some data on the intersection of obesity and Alzheimer’s dementia, which I’m guessing is also related to metabolic health and insulin resistance and probably, you know, sugar spikes in the blood. Is that something you’ve seen?
Speaker 2: 40:34
Yeah, definitely. So. We are concerned about obesity in terms of its impacts and raising the risk for diabetes, it’s increasing risk for inflammation, as well its impacts on heart health. So we want to be on top of and treating obesity and taking it also seriously as a as a brain health as an issue with brain health as well as came to mind.
Speaker 1: 40:56
But was epic out there? It’s gonna be interesting to see how this plays out. Was epic and brain health? We had somebody on once a little while ago and it was epic. Maybe the fen fen of its time or it may be this amazing thing it’s. I think it’s really too soon to tell, but I have some strong opinions on it. For people who are like they’re going on a bikini vacation versus somebody who’s morbidly obese, I think it’s a lifesaver right right.
Speaker 2: 41:21
Yeah, I agree, and and yeah, it’s too soon to tell in terms of brain health, but it the bigger picture is. What we’re talking about is that we want to be treating obesity using those medications correctly and appropriately and being aware that there’s a connection there.
Speaker 1: 41:37
People talk about the brain gut connection and we’ve talked about it going one way which is gut to brain. How does brain?
Speaker 2: 41:45
talk to gut. Yeah, it’s interesting because we’re all we grew up or we’ve heard. If you have butterflies in your stomach, then that could be impacting your, your nerve, how you’re feeling, and butterflies is just nervousness in your stomach, of course, but the idea is that if you are feeling stressed out or worried and it’s beyond acute and it’s something that becomes chronic, well that chronic release of cortisol Doesn’t just impact your brain, but that cortisol is actually released in abundance in the gut. If we’re, you know, chronically stressed out, and cortisol will impact what types of bacteria grow in the gut, and it turns out that too much cortisol will change the environment of the gut to grow what we call the bad bacteria, which can lead to inflammation, which now cycles back on the brain. So not only is it a two way street, but it’s a bit of a loop, and so what we realize is that it’s actually very hopeful because we now know that we can treat issues with the gut through the brain. Not that it’s the only treatment, but if somebody is having an issue with their gut, we would say let’s put on the list of things that we want to consider stress management techniques, mindfulness, and if somebody has any issues with brain health, we would put on the list. Let’s also be aware of what we’re eating and talk about gut health, because it’s another avenue that we can leverage to protect our brain. So it’s not that these are the only solutions in either direction and it’s not going to. You know, it’s not a magic solution to just treat all brain issues through the gut or all gut issues through the brain, but it’s something we can use and leverage as we understand this connection and give people better treatments and more options to feel better, so that that is very helpful as we understand the science.
Speaker 1: 43:22
Last question. So there’s this idea that one needs to, you know, sort of stop eating three hours before one goes to bed, and I have heard that this is somehow related to melatonin and the pancreas, so your pancreas sort of shuts down into certain point because of melatonin and this causes problems, because people oftentimes, I’ve heard, if you know, they sort of wake up in the night with all this like this bad digestion problems that they don’t have during the day. Help me out on this.
Speaker 2: 43:56
Well, there’s definitely something to be said for not eating too close to bed, for a variety of reasons, that our brain will and body will prioritize digestion over sleep. So, if the food is heavy, if it has those processed ingredients, if it’s too spicy, if someone’s not you know, not somebody who loves spicy food or tolerates it all those things can be disruptive to sleep. On the other hand, we want to think about that. If we’re starving, that can also have a negative impact on our ability to sleep as well. And what we see is that the ability to fall asleep and we don’t have to sleep through the night in the sense that you know, I know you’ve talked a lot about us sleep on your, on the podcast, but we don’t have to wake up. It’s okay to wake up, is what I’m saying? We sleep in cycles and we do wake up and it’s okay. We don’t have to panic if we wake up, but when we wake up, we have trouble getting back to sleep. One of the issues there is that we see there could be a spike or a plummeting of blood sugar, and so what we’re eating before bed is as critical as when we’re eating it, and the three hour rule might work for some people and if people find that effective, that’s within reason. But there are some people who might say you know, I need to have a healthy snack before bed and as long as it’s not interfering with digestion, that’s reasonable as well. And so, thinking about you know, whole natural peanut butter or things like that, like a cottage cheese, is someone’s not lactose intolerant? But things that are like a healthy protein with a really healthy carb and a small snack can also be helpful to help people sleep. So it’s finding that balance where sometimes with these you know hard and fast rules, it tends to be a little bit more individualized that some people can’t get. It can be fine benefit in a healthy small snack before bed and other people are like you know what? I need to cut it off a few hours ahead, and both can be reasonable strategies. But the idea is that we do want to be thinking about not eating throughout the night. That’s something that we do see is that our brain and body do not do well in terms of metabolizing food at two or three in the morning. So really prioritizing our nutrient intake during the day as opposed to like I’m going to get that midnight snack or that two in the morning snack.
Speaker 1: 46:00
That’s what we see clearly is not one of those that a little bit of almond butter, like about a half hour before, because otherwise I’ll just like wake up at three. Yeah, I’m starving.
Speaker 2: 46:11
But also, I think, if and I’m the same way if you’re doing a lot of especially on days I’m doing a lot of exercise, like you oftentimes need that little bit of healthy protein or healthy carb combo to sleep through the night, to, at least you know, sustain.
Speaker 1: 46:23
Dr Mark Milstein. Your book is the age proof brain, which is something I think we all want. I think we should all aim for this, with some awesome suggestions in there. Is there anything you want to leave our people with today?
Speaker 2: 46:34
Well, first of all, thank you for having me on and thank you for spreading this, all all these great tips you know, through all your episodes. It’s so appreciated. I would just say that, not to feel overwhelmed and to feel that we can integrate small steps that have a big impact for brain health, we want to put them together because we know it isn’t just one thing. So you know, if somebody says I’m good because I’m doing crossword puzzles or I’m good because I’m, you know, taking a walk, it is beyond one thing. We actually do have evidence that when you put these things together, they’re more impactful in terms of lowering the risk of memory loss. So, just thinking about our day and saying I’m going to find little moments here and there, not necessarily to take things away, but to add things in, because I think we’re all a little bit tired of people taking things away from us in terms of health. So let’s say let’s focus also on adding things in, like getting outside for that walk in nature, learning something you’ve always wanted to learn and love to learn, passing some of this off to your doctor and just saying you know, I want to be on top of my health and brain health now and years from now. And being social, having fun, playing sports, playing music, realizing it even in stressful times. These things can fall to the bottom of our to-do list, but we want to give ourselves permission to do them because they’re just so critically important.
Speaker 1: 47:49
Yeah, it’s not all about like removing stuff, let’s add more good stuff, right.
Speaker 2: 47:54
It’s not a much better idea. Yeah right, it’s great to have you on.
