Kind: captions
Language: en
Alzheimer's disease right now people
don't think they know what causes it we
don't think it's at all reversible some
people don't even know what the early
signs look like
what say you Dale bredesen to that
assertation well first of all let's put
it in perspective over a million people
have died from covid-19 and about 45
million of the currently living
Americans will die of Alzheimer's
disease so it dwarfs the covid-19
pandemic it's just a little slower as
you know but the reality is we're told
all the time there's you know we don't
know what causes it there's nothing you
can do about it we published a trial
just a few months ago in the Journal of
Alzheimer's disease in which 84 percent
of the people actually got better so we
understand it don't rush past that 84 of
people actually had a reversal of
symptoms a reversal of cognitive decline
which we were the first to publish way
back in 2014 and then we finally got
were allowed to do the trial tremendous
results and we not only saw are
improvements in their cognitive testing
but we also saw improvements in their
MRIs so they actually had larger gray
matter volumes and their hippocampal
volumes which decline even with normal
aging declined less than with even
normal aging so this has not been widely
recognized sorry that was going to skim
over my brain for a second yeah so with
the protocol that we're going to go into
here people decline less than normal
aging so forget the fact that they're
there because they have early signs of
dementia but they're you can actually
slow even normal aging down yes okay so
um Richard we'll get into I think the
punch line that you call the switch
which is a metabolic pathway that's
really fascinating it's been coming up a
lot in my life recently but first just
to orient people to alzheimer's I know a
lot of people are going to be coming to
this video because they're terrified of
it yeah they may have already been
touched by it they have somebody in
their life so speaking for myself my
wife's grandmother died of Alzheimer's
it is terrifying up close and the
thought of like oh hey I forgot where my
keys are do I have Alzheimer's you know
what I mean like Orient people around
that what are realistic early signs that
people can look out for and then we'll
dive into how we start undoing this how
we can reverse that Trend yeah yeah so
the reality is my generation uh the
old-timers now is the last generation
that should fear Alzheimer's it is
literally becoming optional and here's
why I say that if everybody as they get
to 40 to 45 years of age or or so would
simply get evaluated and get on active
prevention then we could prevent this in
nearly all people what does evaluation
look like and the evaluation looks like
three things so what we call a
cognoscopy just like we all know right
when you turn 50 what do you get you get
a colonoscopy could be well when you're
45 40 to 45 area you should get a
cognoscopy and that's three things
number one a series of blood tests and
they're going to be related to what
Rick's expertise what's happening with
your glucose and your fructose what's
happening with your inflammatory
Pathways all the things that Rick's
research touches on fits beautifully
with our theory of what's driving
Alzheimer's disease so you get really
fast breakdown for us what what would be
a short list of things that we're going
to look for In The Blood what do we care
about
well you know from my standpoint it
would be things like insulin resistance
uh measuring uh your plasma glucose or
your fasting glucose level and your a
thing called the Homa test which looks
for insulin resistance
um we'd be looking for features of
metabolic syndrome uh you know do you
have fatty liver do you have like all of
this stuff is Downstream of glucose
right well no they kind of go together
with the glucose I wouldn't say they're
Downstream I would say they're all
occurring at the same time so features
of metabolic syndrome which is obesity
diabetes insulin resistance all these
are risk factors for Alzheimer's
um and uh and diet there's certain diet
foods you know so food's very high in
sugar are associated with an increased
risk for Alzheimer's I'm not saying that
you can't eat sugar I don't want to
demonize it but um I do well so I'm
curious why don't you want to be
demonized sugar well I mean you know
so it's true that sugar is probably we'd
probably do better without it but um so
many people uh you know there's so many
foods that have sugar it's very hard to
completely eliminate it from the diet so
the practicality of unless you go like
on a keto diet it may be hard to
actually
not eat some sugar so so it's really uh
excessive sugar that's the biggest
problem I mean like soft drinks yes we
we can demonize soft drinks I agree with
you people should not be drinking soft
drinks but um you know uh you know it's
very hard to you know even vegetables
have will have some sugar in them and
um you know so I I'm not saying that you
shouldn't eat any sugar but but sugar
and high fructose corn syrup are two
major culprits that probably have a role
in the cause of Alzheimer's okay I want
to push on something that
um I said which is
that this is quote-unquote Downstream of
glucose so Downstream may not be the
right word but everything that you've
listed to my Layman's understanding is
going to be directly related to the
amount of glucose that you consume and
you're being very delicate which may be
the Y stance maybe I'm the fool in this
discussion but all of this stuff is
going to be related to the amount of
glucose that you're in taking to to my
estimation is that an uncomfortable
assertion no I think you're right
actually I'm going to agree with you
that
um so there's there's a couple things
the first thing is that yes obesity
diabetes metabolic syndrome these are
all risk factors for Alzheimer's when we
get to diet
sugar and high fructose corn syrup are
clearly risk factors for Alzheimer's but
so are carbs and so are so is glucose
but carbs and glucose to my Layman's
brain are one and the same if I eat
carbs I'm going to minus fiber I'm going
to have a glucose response in the blood
and as somebody who wears a continuous
glucose monitor a lot I am startled by
things like carrots that will Spike my
blood sugar as if I've eaten maybe not a
donut but it's kind of it's scary how
close the response is well you're right
there's a range with carbs you with some
carbs you know especially if they have a
lot of fiber they don't raise the
glucose as much if you have a glucose
monitor versus a donut and so there is
this kind of scale so the the ones the
foods that particularly Drive glucose up
in the blood are things like bread rice
potatoes cereal you know potato chips
near the top and anything that raises
the glucose up
anything that raises that glucose up
will
um get you into trouble according to our
work on uh that could increase your risk
for Alzheimer's okay so going back to
the cognoscopy so we've got the blood
work just went into some detail I think
you said there were three things so that
was one what are the other two and then
the blood work you also want to look at
inflammatory status so that what do you
check for yeah check for hscrp
hscrp I've never heard of it so that's
high sensitivity C-reactive protein this
is a pentameric protein five of them
together that come out of your liver
when you have exposure to various
pathogens and immunological things
so that's critical and in fact if you
look at Alzheimer's as a disease what is
it what is Alzheimer's you know it's
just a name
the the big finding is it is related to
two major things number one is your
innate immune system so this is the
evolutionarily older part of your immune
system that is a relatively non-specific
phenomenon where it's saying something's
wrong things are bad I've got to go into
in an inflammatory process and
ultimately hand off to the Adaptive
system that now is more specific
these are where the toll-like receptors
and things like that come into play it's
recognizing something's wrong and
amyloid is part of that so the stuff
that collects in your brain over the
years when you get Alzheimer's is there
because you are responding to insults
and then the denominator of this is
energetics so as your energy is dropping
again coming back to the the fructose
story which is why it fits so well with
Rick's research
you're coming back to that and it's
cerebral blood flow and it's your
oxygenation which is why people who have
sleep apnea are at increased risk these
are things I'm checking for in the
cognosis exactly so you're looking at
these pieces so you want to know your
pathogen status is your oral microbiome
full of P gingivalis which is a specific
bacterium which gets into your brain by
the way and your brain responds to that
insult by making what's looked years
down the road is Alzheimer's disease so
it's those two big issues we want to
know so we want to know your
inflammatory status we want to know your
vascular status which is why standard
lipid panels things like that
that's the cognosity that's part one The
Blood Part Two is simple online
cognitive assessment you can do that in
about 25 minutes and it's going to test
your memory your executive function your
processing speed things like that
two-thirds of the people who are heading
for Alzheimer's the first thing that
goes is new memory
so it's laying down of memory as you
know people will say uh you know hey
where are we going tomorrow oh we're
going to you know and and Jody's and
then 10 minutes later they'll say hey
where are we going tomorrow and they're
like yeah we're going to Aunt Jodi's as
I told you 10 minutes ago that's and
that's the kind of common early thing
but then there's we call that the
amnestic presentation
about one-third of people present with
the non amnestic presentation and that's
typically executive function planning
problems with calculating having trouble
figuring out a tip for the first time
things like that having trouble working
your iPhone or a new iPad or things like
that these are all kind of typical of
the non-amnistic presentation these are
more by the way more parietal lobe
functions instead of the usual temporal
lobe functions which are more on the on
the amnestic side
so those are the things that typically
come up and you can pick those up early
with an online cognitive assessment and
then the third part is MRI with
volumetrics you want to if you have
symptoms or if you're doing poorly on
the testing then you want to make sure
to include an MRI and not just a
classical MRI you want to make sure to
get volumetrics so you're looking at the
size of your temporal lobe the size of
your hippocampus the size of your
parietal lobe how does it match up with
other people of your age
okay so there are predictable shrinkage
for lack of a better word that we would
expect to see in certain regions of the
brain based on your age and so if you
see something that's outpacing your age
then now we've got a problem exactly
okay so I would like to add something
here so um you know when he talks about
the cognoscopy when Dale does
um I I can point out how this sort of
fits in with Alzheimer's in general so
you know originally when people think
about Alzheimer's they think of amyloid
plaques they think of these Tau protein
neurofibrillary Tangles these are
characteristic histologic findings if
you actually like do an autopsy on a
patient with Alzheimer's the brain
shrinks there's neuronal death and
there's these classic findings and
that's why for Years everybody was
calling this a disease of amyloid
plaques we're going to treat those
amyloid plaques we're going to try to uh
either dissolve them or prevent them and
all these treatments came out and most
of them don't do very much they you know
there are some that may have a little
bit of benefit but we're not really
winning the we're not winning the war
and so so that made people look for the
next level you know what maybe it's not
the amyloid plaques maybe it's something
that occurs before that and I just want
to point out that Dale's cognoscopy
testing is looking for those things that
are occurring early and there's really
three basic areas which we just talked
about one is metabolic do they have
insulin resistance is are they
overweight are they eating the foods
that we know are not healthy for you
like high glycemic carbs a lot of carbs
a lot of sugar a lot of salt that's also
associated with so one is metabolic and
then the SEC and insulin resistance and
high glucose is a major part of because
in the brain of patients with
Alzheimer's one of the earliest changes
is insulin resistance of the brain how
do you test for that
well I I know how to do it in a in a
mouse is it destructive though like yeah
so what happens is the brain
um the regions of the brain that uh
require that use insulin to help take up
glucose okay so insulin is a hormone
that helps cells take up glucoses of
fuel and the classic insulin sensitive
tissue is the scallop muscle and the
Scala muscle uses insulin to help bring
take glucose into the muscle to give it
fuel
in the brain the we we used to think the
brain was largely uh insulin insensitive
uh you know glucose can go into the
brain freely without insulin well it
turns out that's not true there are
regions in the brain that like that re
that use insulin to help bring in the
glucose and those areas become resistant
to insulin
in early Alzheimer's and so you can do
things like pet scanning and things like
that to look for glucose uh utilization
and if there's an impairment in glucose
utilization in other words the brain's
not metabolizing the glucose well you
can actually measure it and um and so so
metabolic is one of these three
characteristics that you're looking at
and the other two just real quickly is
the second one is inflammation and
systemic inflammation is now known to be
a major risk factor for heart disease
Paul ritger brilliant scientists at
Harvard has done all these work where he
measures C-reactive protein this is the
same test you're doing the hscrp if it's
more than three normal is like less than
one if it's over three it means that you
have inflammation
you have systemic inflammation you may
not have a fever your why count may be
normal you may feel fine but there's low
grade inflammation in your body and
that's also seen frequently in people
with metabolic syndrome so the CRP is
like the perfect test uh Paul Ricker
believes that everyone should have that
test done if you have an elevation in
CRP it increases your risk for heart
disease it increases your risk for um
for hypertension it increases your risk
for kidney disease and I believe it's
inflammation is well we know that
inflammation in the brain is one of
those early findings of Alzheimer's and
I'm I don't know for sure but I think
C-reactive protein has it been looked at
for as a risk factor for Alzheimer's
yeah yeah and it is so yeah anything
with increasing inflammation yeah so so
that in the cognoscopy score that Dale's
using he's looking for inflammation
which because we know inflammation in
the brain is an early finding he's
looking for metabolic changes like
insulin resistance because we know
insulin resistance in the brain is is
occurring and the other one is energy
status
energy there's there's really two kinds
of energy there's the energy that we we
actively make and we're using it so that
I can talk to you and you can talk to me
and we can if I need to escape I'll run
out that's how that doesn't become
necessary myself but but that that
energy is ATP that is the currency that
is what uh our bodies make and uses as
uh the way we we use energy we use ATP
and that's the active energy but there's
also stored energy and stored energy is
fat you know and um and so when you eat
food which is a calorie Source we make
energy and some of it is ATP and some of
it is
fat fat and you know typically we try to
refill our ATP and then the extra goes
to fat and and this is how normally it
works and so uh we usually have good ATP
levels but what has been discovered in
Alzheimer's is that ATP levels the
energy and the neurons in neurons is is
low
early on you can show it drop in ATP and
it gets worse as Alzheimer's progresses
so our brains don't you know the neurons
do not they're not taking glucose up as
well
which is the fuel and they're not making
as much ATP so the brain goes into a low
energy state
exactly and Tom you mentioned earlier
you know how do you check in a human if
you've got insulin resistance in the
brain as Rick was saying and some very
nice work from Professor Ed getzel out
of UC San Francisco showing that if you
look at neural exosomes you can
literally look at tiny fragments of
cells these are about 100 nanometers
little fragments of cells that break off
from cells throughout your body in the
brain these actually traffic through the
blood you can isolate them and you can
actually measure the insulin resistance
he's published this 50 years ago blood
test you can do it in a blood test now
the this has been a research tool it is
it's coming online but it's not yet
commercially available but you can so I
can't go to my doctor yet you can't go
to your doctor yet and ask for that but
it's coming
pet scans yeah and so one way to do that
exactly and it goes exactly with what
Rick was saying what is the signature
for Alzheimer's when we as neurologists
look at a brain you see temporal and
parietal reduced glucose utilization and
so you know it fits perfectly with this
notion that you are dealing with an
insulin resistant State and the brain is
simply not using this but it's also
interestingly not using the only other
fuel it can use which is ketones
so you have a real Energy emergency
State when you have cognitive decline
you're not able to use the glucose
because of the insulin resistance you
you actually can look at differences in
signaling but you're also not able to
produce and utilize ketones because one
of the things that prevents you from
making ketones is a high insulin level
so it's going to worst in both worlds
yeah okay so uh let's recap where we are
because I think that this is really
important and I think this is going to
take us into now needing to talk about
the switch and what's actually going on
here
okay so as somebody who for a very long
time I had I was hyper inflamed I
probably I didn't understand that I
always thought it was kind of funny but
you could take your fingernail and write
your name in my skin and my skin would
just welt up and my dad had the same
thing and I obviously didn't realize hey
this means you're gonna die young uh was
not that sharp unfortunately and as I
got older though and I didn't put two
and two together I started having
chronic wrist pain and I had burn marks
on the back of my hands for years
because I was icing them so often that
it was like leaving this little burn
mark and I then met Peter attia and Don
degasino and they said oh dude you've
got to be eating fat like this is crazy
because I was doing what I'd Now call
rabbit starvation
basically the vast majority of my
calories were coming from protein I was
in taking as little fat as humanly
possible because fat makes you fat right
so I was convinced uh and I already I'd
gone low carb years before that
so I thought well I'm low carb my diet
is clean like I couldn't like I assumed
my wrists were like a genetic problem
and when they said hey you need to try
going to being able to be metabolically
flexible and produce ketones uh so try a
high fat diet and stay low carb but
actually go moderate protein as well
let's see now I hated it because I got
keto flu I did not do it well but my
wrist pain went away in like three days
did you measure your uric acid I didn't
I don't think I'd heard of uric acid at
that point unfortunately yeah because a
very high protein diet can raise uric
acid now normally we don't think of the
uric acid as being that much of a
problem but
um in when you're on a keto diet or when
you're on a low carb diet but it can
when it gets high enough it can cause
inflammation like big time and it can
cause gout yeah and uh but it can
represent like with wrist pain knee pain
ankle pain before without having a
complete uh
inflamed attack because when you're on a
keto diet or low carb diet you're
there's a the ketones actually suppress
inflammation to some extent so you can
have kind of like a pseudo you know you
have gout but I mean you have a high
uric acid and you may have problems with
it but you may not actually manifest
full gout because the ketones are
anti-inflammatory okay so let me press
on that so are you saying that by being
on a ketogenic diet which I will Define
as a diet that elicits a 0.5 millimol or
or higher Ketone distribution in the
bloodstream
so you're on a diet that produces that I
could still be high in uric acid yeah so
ketones actually so there's this really
interesting aspect so uric acid is
generated from sugar you know eating
fructose which is like in table sugar
and it's also in high fructose corn
syrup so you can get a high uric acid
from eating carbs you know that contain
fructose
but you can also make uric acid from
protein and um and it's not as much of a
problem if you're on a low carb diet
because one of the things your acid does
is it acts to convert glucose to
fructose it's like a it it can generate
fructose in your body but if I didn't
realize until research you're on a low
carb diet you don't have that much
glucose around to convert to fructose so
the uric acid
you know isn't quite as dangerous in a
person on a low carb diet it can often
go up though to eight or nine or even
higher but there are many cases of
people on low carb diet who will develop
gout interestingly the you know it's not
usually as a serious an attack of gout
as you know and when a person's on a
normal diet with carbs and stuff and
that's because the ketones are
anti-inflammatory if you had to Ballpark
me how many
um grams of protein so I'm about 185
pounds how many grams of protein would I
have to eat to be in that state because
my gut instinct and you gentlemen are
going to strike me dead if I'm wrong
here but my gut instinct is you could
never eat enough protein to be
considered high protein and stay
ketogenic like you'll get kicked out if
I eat too much protein I'm boom I'm out
of ketosis yeah because the protein some
of it gets converted to glucose yeah so
am I crazy or is is my vision of high
protein like so ultra high as to be
nonsensical so so it turns out that the
when you're on a ketogenic diet the uric
acid goes up for two reasons one is the
high protein but the other is the
ketones actually block the excretion of
uric acid so they it goes up from both
unfortunately so it's very very common
for people on a keto diet to have
um you know a uric acid of seven or
eight or nine whoa but then over uh
several months it will tend to come down
it will tend to come down do you
consider a ketogenic diet how healthy or
unhealthy I think that in general
they're fantastic diets even though uric
acid can get that yeah so this has been
the Paradox because uric acid does go up
and so for people that don't know about
uric acid give them a quick primer
because I'm reacting like it's the
devil's Brew so give people a quick
primer I think of uric acid as bad part
because of your work so uh give people a
primer on what uric acid does yes
so uric acid is a substance that's in
everybody's blood we all make uric acid
from when we break down energy or uh
when we break down DNA or RNA it's
basically nucleic acids when they get
broken down they make uric acid and then
we have to excrete it humans have to
excrete the uric acid through the kidney
or the gut other animals actually can
degrade uric acid because they have an
enzyme but we lost that enzyme 15
million years ago and we had a mutation
and I think it's actually plays a role
in some of the problems we have today
but but anyway that as a result uric
acid tends to be higher in humans
because we don't degrade it and we have
to excrete it through the gutter or the
kidneys so like a uric acid and a mouse
or you know maybe a level of one and the
normal level in a human is around five
so we have a much higher level and when
you go on Western diet it actually goes
from about three on a hundred gatherer
diet to about five on a western diet and
then when it gets to seven which is when
you start eating a lot of sugar
shrimp and beer you know this
sounds good to something wrong
shrimp and beer it's quite the uh but
anyway when you start eating a lot of
foods that can make uric acid then what
happens is you're because we don't
degrade it it can get up to seven or
higher and when it once it gets up to
over seven it can cause the disease gout
and gout is this really painful disease
it affects maybe nine million people in
the U.S and it's an arthritis and it it
usually causes red hot tender joints and
systemic inflammation the C-reactive
protein goes up
um you know you can have a low-grade
fever during attack and even after the
attack most people with high uric acid
show evidence of systemic inflammation
there C-reactive proteins frequently
High it stays High and the reason is
because these are tax are from crystals
of uric acid that the deposit in the
joints and they don't really go away so
the attack goes away but the crystals
are still there and they cause this
low-grade inflammation Reese recently we
discovered that they can also deposit in
the blood vessels and there's now there
was a paper in Jama showing that like 70
percent of people with gout have some
urate crystals in their aorta or their
coronaries and it correlates with
increased risk for heart disease so Paul
ritger has been saying you know
inflammation is a major cause of heart
disease and the truth is that high uric
acid can cause inflammation and a p even
when you're even when you don't have an
attack of gout and so uh and and but but
what's interesting is if you go on a
keto diet you uh so a lot of fruit a lot
of uric acid comes from the sugar from
fructose and uric acid actually
amplifies is made when you metabolize
fructose you make uric acid but then
uric acid helps convert glucose to
fructose in the body so it's like a
cycle a vicious cycle so when you go on
a low carb diet you break that cycle to
some extent because you're not eating so
much carbs but you the problem is
ketones block the excretion of uric acid
so your uric acid can still go up so a
real problem is that you know high uric
acid you know is associated with heart
disease It's associated with obesity and
diabetes uh and but the the complicating
factor is that um
keto diets which generally helps block
obesity and diabetes can still raise
uric acid so the question is can you say
that ketones block the secretion of uric
acid so how how is it going up if
ketones are blocking it
uh so ketones black the excretion of
uric acid and the tubules of the kidney
so you can't get rid of the uric acid so
it goes up in the blood oh oh I see what
you're saying it stops us from getting
it out yes exactly from getting it out
and so and and it usually only lasts you
know for the first few months but there
are some people who continue to have a
high uric acid and and when you say that
you had evidence of inflammation high
uric acid causes inflammation it causes
pain in the wrist so I was just thinking
that maybe you were one of those people
who had a uric acid of nine on that diet
and the the issue is though is remember
the key the ketogenic diet is what
caused my inflammation to go away right
so so I had it during my rabbit
starvation okay so ketones are
anti-inflammatory so uh several people
that I've collaborated with are looking
at you know for example Ben bickman
maybe you've interviewed him yeah so
Ben's uh doing some studies to show that
when the uric acid goes up on a keto
diet that it's fairly innocent because
uh the ketones are anti-inflammatory and
can block the pro-inflammatory effects
of uric acid so uric acid is mainly this
thing that causes inflammation
and um and you know ketones block
inflammation so it's it's sort of like
the way to stop it so your uric acid can
go up if you're on a keto diet you may
not suffer from the inflammatory effects
of uric acid
uh so so that's what we're thinking but
there are many cases of people who still
get attacks of gout on a on a low carb
diet I actually I don't know so much
about a keto diet but so that you know
it's a balance of a good guy the ketones
and a bad guy the uric acid and so which
one dominates could could be important
but in general a low carb diet and a
keto diet are are diets I recommend in
general aggressively critical
distinction here so many people get this
wrong a keto diet versus a plant-rich
keto diet it makes all the difference so
for brain health you want a plant-rich
ketogenic diet with appropriate periods
of fasting so you want to get the
ketones up you want to have the low carb
diet but you don't want to have just a
pure meat diet why is that so I'm ultra
high I get most of my calories from meat
so if you're gonna so change my life
right now I want to hear about it so
what what is the difference how how does
it work mechanistically let's change
your future for the better absolutely so
first of all as you probably know there
are now increasing reports coming back
from people because of this carnivorous
approach with ketones who are end up
ending up with vascular disease and
ending up with heart attacks and strokes
so controversial or like when you go and
talk to somebody who's hardcore uh
carnivore uh obviously they paint a very
Rosy picture I will say anecdotally and
yes I understand the limitations of
anecdotes but anecdotally every time
I've tried to go primarily plant-based I
don't feel good so now I've never looked
at oh maybe I'm just doing it wrong
maybe I just need to supplement but I'm
always skeptical of anything where I
have to supplement to get where I need
to be yeah so what is happening when I
intake meat what's happening or if it's
no meat isn't an additive problem it's
you're missing something what am I
missing or vice I think it's a good
point the the pure carnivore diet where
that really works well is for people who
have a tremendous amount of inflammation
and whether it's related to the lectins
that Steve gundry likes to talk about or
whether it's related to something else
that you're responding to you know
that's person of you know that's
personal uh it may be different for each
person but if you look for example at
apoe4.info this is 3 500 people who are
apoe4 positive this is a common risk
factor for Alzheimer's disease about 75
millionflammatory do we know yes because
well for other reasons as well it
doesn't allow you to get rid of amyloid
as well but yes the the predominant
issue there is it is and of course as
Rick will tell you it also has to do
with fructose but it is a
pro-inflammatory gene it is at the
primordial apoe and it's interesting
because it was different in our uh in
our ancestors so that the simeons as we
became the the hominids between five and
seven million years ago
the initial was we were all apoe4
homozygous for 96 percent of hominid
Evolution we've all been apoe44 which
today confers about a 70 lifetime risk
for Alzheimer's it's the major it's the
dominant way we've got 75 million who
have a single copy in this country we've
got about 2 million uh sorry about about
almost 7 million two percent of the
population in other words that has uh
two copies and they're at very high risk
for Alzheimer's disease and so the the
the point here is that they have to be
careful about a carnivorous diet because
they tend to jump up their their LDL
particle numbers they tend to jump up
their triglyceride to HDL ratios and
they're at high risk for heart attacks
and strokes now again if you're going
after inflammation and you don't have
issues with your vascular status then
it's probably fine to have a carnivorous
diet but for most people and certainly
for Alzheimer's disease the
phytonutrients just take one of many
polyphenols alone High polyphenol
associated with lower Alzheimer's
disease take the risk you know we've all
heard so much about lecanumab which was
supposed to be this miracle drug it's
it's the only really the only one of the
anti-amyloid antibodies that seem to
have an effect what it doesn't make you
better it doesn't keep you the same it
slows your decline in Alzheimer's in the
early stages by 27 percent
now what does better than that bill
multi-billion dollar drug extra virgin
olive oil alone did better than
lecanumab can I add that to a high meat
diet
and get the same effect you can
certainly add it to a high meat diet but
you have to remember that you're missing
the polyphenols you're missing the
phytonutrients you're missing the high
fiber now what do you do for fiber
well so I do eat vegetables it's just
that I would say 65 to 70 of my calories
come from uh eggs and animal protein I
guess that is animal protein uh meat and
then the remaining 30 to 35 is vegetable
matter okay so at least you're you're
staying away from the high carb which is
great I don't touch carbs my diet is
very what I call clean I'm always
looking to improve but so I eat a lot of
eggs I eat a lot of red meat I eat a lot
of
um pork I eat a lot of fish
um
beef I never say that so those are the
like my Mainstays and then I cycle
through maybe 10 different vegetables
okay
um and lots of extra what are your
Ketone levels Lots uh I'm not on a
ketogenic diet now so I can feel though
when I click in probably I could tell
you if I hit .7 I might miss a 0.5 but
I'm so because I intermittent fast a lot
yeah uh and I tracked religiously my
intermittent fasting over an 18 month
period and it came out to be about 17
and a half hours and that includes
weekends holidays everything just over
the the whole time about 17 and a half
hours so I mean some days I'm going 19
20 hours right uh so at that point I'm
going to kick over to ketosis uh so I'd
be at a
0.5.75 somewhere in there and I can feel
that so I would say right now I can tell
you I'm not in ketosis uh just because
it's a weekday so I probably only did 16
17 hours Great point and okay and do you
know your apoe status I don't so this is
in fact I want to ask you more about
this so if for however much of our
evolutionary past we were double apoe4
yeah and 96 as well so what has changed
now is it diet is it some other genetic
mutation that makes apoe for or is it
that we live longer that makes that such
a problem why aren't monkeys having an
issue with this so interesting monkeys
have a different apoe and they're so
there were multiple mutations between
the chimp for example between between
our common ancestor and the first
hominids and so we picked up a specific
mutation
which is an Arginine actually instead of
a threonine and you have a what uh what
Professor Robert Maley who discovered
apoe has termed uh a a domain
interaction so if you have apoe4
your apoe looks like columns on a house
basically it's held together because you
have a positive charge interacting with
a negative charge however then just
about 220 000 years ago so relatively
recently in terms of overall Evolution
apoe 3 appeared and then just 80 000
years ago apoe 2 appeared and these are
less pro-inflammatory so guess what
you're not as good at fighting off you
know you eat raw meat that's got
microbes in it you're not going to be as
good at fighting off the infections with
an apoe3 exactly and also you don't do
as well with starvation again comes back
to Rick's work with with fructose and
with this approach that you're taking in
periods of starvation but it gives them
less inflammation so that they tend to
live a few years longer and they have a
much lower likelihood of Alzheimer's
disease and what's changed is the way we
live what's changed is what works
exposed to in our homes with with mold
and mycotoxins the sugar that we're
eating just that the just you know
Rick's research these are the things
that have changed we are we are not uh
we don't have the same sort of uh intake
of plants we we do have a lot more
carnivory so all these things have have
changed and that's why you know you may
be in perfect shape and you can
certainly check that out with a
cognoscopy see where you stand with your
metabolism with your vascular status and
I don't know if you've looked at your
carotids or you've looked at here but
it's been seven or eight years yeah so
so you know if your vessels are looking
good
um and and you've probably seen these
pre-nuvo scans you can look now your
whole body to see if you have any early
tumors you can look to see whether you
have uh early changes with your
microvascular status in your brain these
are good things to know um
okay so uh we have inflammation
obviously playing a huge role your diet
is really uh particular what I want to
start getting into now let's bring it
all together with the switch why this
matters how it ties to uh Alzheimer's so
what is the switch yes so the switch
refers to a biologic change in which uh
an animal suddenly starts to gain weight
uh become insulin resistant and develop
features of metabolic syndrome it's it's
an actual biologic change so normally
animals try to maintain their weight at
a you know regular weight if you feed
them extra food if you put a tube down
their mouth and force feed them and then
you take the tube off they'll go right
back to their normal weight if you fast
them for two months and then you stop
fasting them they'll go right back to
the weight they should be at that time
of the year I mean it's amazing animals
regulate their weight beautifully and we
probably did two but we're not doing it
now and the when we were trying to
figure out you know what this what what
triggers this change and you know it's
most noticeable
and like animals that are preparing for
uh hibernation or for a long distance
migration you know the bear will
maintain its weight during the summer uh
you know can eat more one day you'll eat
less the next day you know it just
maintains itself and then about eight
weeks before it hibernates suddenly it
changes its Behavior it gets hungry all
the time thirsty it starts foraging for
food it becomes insulin resistant it
starts eating a lot more than it
normally does it can gain 10 pounds a
day whoa yeah it they have a contest to
take a picture of the fattest bear on
the internet and in the fall because
they get really really fat these
hibernating bears before they hibernate
they they want to put on that fat and
then when they hibernate they will not
eat you know they'll go to sleep and
they'll not eat for like six months they
won't drink water and they use that fat
to produce energy that they they live
off their fat so fat is a good thing in
nature you know my book nature wants us
to be fat you know talks about this but
but the fat they when they break down
the fat it isn't just the energy that's
produced uh the ATP but the the fat also
produces water so when you break down
fat you're producing water so so uh this
switch is this switch going from a point
where you're regulating your weight till
suddenly you're gaining weight and it
was all meant to be a survival mechanism
to help the animal uh in preparation for
a time when there may not be food around
and so the question is you know what
triggers that switch and it turned out
you know from our work we we're
convinced that the major trigger is
fructose and fructose is a sugar uh it's
in
fruit and honey which we think of as
healthy but it's also in table sugar
it's in high fructose corn syrup and
table sugar half of the table sugar is
fructose and half is glucose and we eat
a ton of sugar and we eat a ton of high
fructose corn syrup so we get a lot of
our fructose from added sugars maybe 15
of the average American diet is sugars
but these uh the the we also can make
fructose as I mentioned earlier
and we can make it in every organ
including the brain and the thesis for
what causes Alzheimer's is that it's
fructose production in the brain that's
causing Alzheimer's and you make
fructose
from glucose that's the only way you can
only make fructose from glucose so when
you're in a high carb diet you're making
fructose all the time and especially
high glycemic carbs because uh when the
blood glucose goes up that really
converts that triggers the conversion to
fructose you got more substrate you know
to convert the glucose to fructosis
there's more glucose there's going to be
more fructose meat and the and salt
turns out to activate that conversion as
well so it turns out that salt can
increase fructose production and red
meats have been Associated these Umami
foods they can help convert the glucose
to fructose and so red meats salt why
red meat because they contain purines
that raise the uric acid and the uric
acid can help convert glucose to
fructose so you got you got you got two
major mechanisms you so the when you
make fructose you make it from glucose
so high carb diets are
you know a big way to get it but then
salt and red meat uh can trigger the
conversion of glucose to fructose now
I'm going to answer uh you know your
question is red meats okay for you
uh and you're not you're not on a high
carb diet so
you know red meats are associated with
Alzheimer's red there are a couple
papers that show increase red meat
intake is associated with Alzheimer's
that's scary for people who are on a
carnivore diet but it may not be true
for people on a carnivore diet because
we according to our work it's the
fructose that causes the problem in the
brain it's not the red meat and the red
meat makes uric acid
which may not work very well to convert
glucose to fructose in a low carb diet
because you don't have a lot of glucose
around now if you're eating a lot of
protein where you where you're making
enough glucose maybe that becomes a
problem but but in general
um you know this might answer your
question this issue of you know is red
meat bad plant products are probably
probably better in general for you know
on the regular diet
but if you're on a carnivore diet you're
not eating a lot of carbs
you may not have that it's conceivable
you may not have that problem probably
don't very interesting and if I remember
right salt is the same way yeah so if
you're eating a lot of salt right and
you have glucose in your system then
that's going to be converted but if you
have salt but no glucose then the odds
are it won't yes
absolutely that's why salted french
fries and salted pretzels and salted
potato chips are so bad because the
carbs the potato chips gives you the
glucose the pretzels give you the
glucose
but the salt helps convert that glucose
to fructose and it will do it in the
brain we have given high salt diets to
animals and we can show an increase in
fructose production in the brain
so and um and there's a
a Dr Sherwin at Yale who gave glucose
and just infused glucose in people
and if he brings the blood glucose up we
know it gets converted to fructose and
he showed in people that it that a brain
fructose levels go up you can just see
it like after about 40 minutes an hour
the fructose levels start going up in
the brain that is scary because uh our
work suggests that that is could drive
Alzheimer's it's not been known for a
long time that diabetes increases the
risk for Alzheimer's but you know if you
do if you can control your diabetes Well
and keep that blood sugar low you're
going to reduce your risk significantly
it's I don't think it's diabetes that
causes uh you know Alzheimer's uh but it
the high glucose converts to fructose
and I'm just going to say one thing here
when you talk about Alzheimer's that's
critical you're also talking about
mental performance so the things that we
do to prevent you from getting
Alzheimer's make you sharper there's no
so it's not you're not just talking to
people worried about Alzheimer's and
then the other the third piece of this
is that you're also talking about people
who've had covid-19 where you know that
so many people get get brain fog and it
turns out unfortunately that many of the
mechanisms are in parallel and it's
already been shown that people who
developed covid-19 are at increased risk
for developing Alzheimer's whoa so the
things that you're talking about today
are for people worried about Alzheimer's
or for people who want to think better
on a day-to-day basis and for people
who've had covid and want to make sure
that their brain fog doesn't ultimately
slip into degeneration so this is a
widely applicable situation you're
talking about here
okay that's super terrifying yeah and I
think that you've found in your studies
that insulin resistance is a major risk
factor for Alzheimer's and counts for
maybe half of the patients are very
common of course metabolic syndrome
there are about 80 million Americans or
so who have metabolic syndrome it's
incredibly common and that includes
insulin resistance so it's just what
you're saying the way we live the things
we're exposed to the foods the ultra
processed foods that we're eating these
are these are all what are colluding to
give us such a common way to die through
Alzheimer's about 15 percent of the
population dies from Alzheimer's and as
I said no idea it was that high yeah so
the fact of the matter is it's it should
be optional and for your generation you
know the the most the vast majority of
people should be able to avoid this
problem through the very things that
you're talking about today um
so that brings us to fructose uh we know
we're eating a ton of it we know we're
converting a ton of it given the things
that you just taught us
um
Thai fructose for me to the bear it
certainly was between the lines and what
you said but I'd love for you to make it
explicit the the idea of a yearly cycle
for anybody that's ever heard like I eat
fruit but only in season I was always
like what the what does that mean yeah
so walk us through that so so you know
we we think of fruits as healthy and in
many respects they are healthy and I
recommend fruits but if you eat a ton of
fruit and I mean a ton
you can get a lot of fructose that way
so fructose is the sugar in fruit and
bears in the fall will start eating
thousands of berries and they'll they
they love honey too and they search it
out but they it's mainly berries that
they eat they can eat 10 000 berries in
a 24-hour period people have counted the
seeds in the scat and
um anyway when you eat that much
fructose you can activate the switch and
it's not the fructose that makes you fat
it's that fructose makes you hungry and
fructose then you then and it causes a
thing called leptin resistance where you
can't control your appetite
and so so I know there's a but in the
paper you guys break them all out so
you've got hunger you've got leptin
resistance yep foraging
stimulates foraging uh so fructose does
is that different than hunger yeah so
hunger is you you're searching I mean
hungry as you you want to eat but
foraging is the process of going out and
searching for the food we'll talk about
foraging in a bit because it's it's the
key
it's the key uh uh Insight that led to
this hypothesis hmm and see that coming
okay so hunger leptin resistance
foraging uh it's also decreasing your
ATP production
yeah so what what happens so to break
down the switch
the first thing is it stimulates hunger
and thirst
both
and it stimulates foraging where you
have to go out and and search for food
it also stimulates uh food intake and
actually it uh it it's it's
blocks satiety this feeling that of
fullness so that you keep eating that's
the leptin resistance yes
so you eat more than you should it
blocks the break in within the cell it
has this unbelievable trick that it does
and the trick it does
is that it lowers the ATP you're eating
calories you think your ATP levels
should go up
but remember energy is both stored
energy and active energy and what it
does is it stuns the mitochondria the
mitochondria the energy factories that
make ATP
so they turn the mitochondria down
and ATP production by the mitochondria
goes down
so where does the energy go it has to go
to the stored energy which is fat
and it blocks the breaking down effect
to replace the ATP so the ATP levels
stay low for quite a while like if you
drink a soft drink I can do an NMR of
your liver and your ATP levels are going
to fall and they're going to stay low
for for a while until they eventually
recover and during that time you'll you
know it stimulates hunger foraging and
and it's blocking the the oxidation of
the the breaking down of the fat so the
fat accumulates calories are going into
the fat but you're not breaking it down
so the fat stores go up
ATP levels stay low the 18 low ATP
levels are like this alarm signal hey I
don't have enough energy
I'm a in a low energy state I'm going to
eat more
because my my bodies tell me that I'm in
a low energy state
and so uh your blood pressure goes up to
help maintain circulation pressures go
up in the kidney to help facilitate
excretion because it thinks that you're
under attack I'm under attack and that's
what fructose does it's the only
nutrient the only nutrient that lowers
ATP in a cell
all the other nutrients do
increase the ATP but glucose is still a
culprit you're right because what
happens is when you eat fructose very
little gets to the brain
but fructose stimulate fructose and
glucose either of them stimulate
fructose production in the brain so
although if I label a fructose molecule
in this sugar and I eat it most of it
gets removed by the liver
and the gut
and the circulation very little of it
gets to the brain this was you know the
Trap how yet fructose production goes up
in the brain when you eat sugar and it's
from both the glucose and the fructose
and the glucose is the more important
one I think actually I don't know which
ones they're probably both equal