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one interesting study looked at 42 000
men 48 000 women followed them for eight
years
those who had the highest level of uric
acid had a 16 increased risk of
all-cause mortality cardiovascular
mortality
38 why might that be let's say that diet
is
one of the biggest players and I think
perhaps the most important
so love means lower uric values and it's
the diet that we constructed that can be
um use as a lens through which you could
look at your dietary preferences or your
dietary Dogma if you will whether it's
keto vegan paleo all of those diets and
others can be adapted to be more
conducive to lowering your uric acid
values it means as things that we've
talked about
being very cognizant of purines of
alcohol specific types of alcohol and
certainly when you recognize that 70
percent of the manufactured Foods in
America today in other words if it has a
bar code and it's in the grocery store
it has added sweetener 70 do and by and
large that comes from high fructose
there's the villain corn syrup that we
subsidize to the tune of 500 billion
dollars a year
so um
it's time to call that out
I wrote a an op-ed it was an open letter
to President Biden February 21st of this
year with Dr Casey means uh saying that
you know these um uh nutrition
recommendations that last for five years
for the United States that are put up by
the USDA allow uh indicate that 10
percent of our daily calories coming
from sugar is okay
the I wouldn't say there's no science
that would support that but 99 of the
science uh that was provided to the
Review Committee for that Dogma or that
Doctrine
so that's way too much that six percent
should come or less from sugar so our
Hope was that we could get some new
language that would rewrite you know
that uh that five-year recommendation
but how many people do you think steer
by the recommendation
a lot really oh my gosh like people
actually pick up the box in the military
no no I'm talking about in terms of of
government influence that the military
and schools and federal uh food programs
they say 10 they you know then they're
therefore these foods that are
manufactured they have all this added
sugar fair game oof
that's and what does that do it creates
the very illnesses that are bankrupting
our Health Care system so that don't
make no sense to me so uh I'm guessing
that that hasn't been adopted that we're
still at 10
um so we've got sugar hiding everywhere
what are things that are high in purines
that we should be paying attention to
um like one one thing I definitely want
to talk about is red meat
um but where else are we going to find
like if we know that DNA and RNA is in
everything then I I don't even
understand to be honest how some things
are higher or lower but it has to do
with the cellularity and the
concentration the more cells it has as
opposed to other things give me a dense
Cellular One dense Cellular One be a
like a small fish like a sardine or an
anchovy is more really dense
well let's just say with it meat or in
our products for one second we'll get to
that in a second as opposed to chicken
or really just the space between the
cells the space between it's that
density it's the uh the real cellularity
of uh organ meat for example liver and
kidney very high in purines so they will
they're directly involved in their
metabolism breakdown of the DNA and RNA
then to make uric acid but it doesn't
necessarily mean
as we segue to fruits and vegetables
that all foods that are high in purines
are going to raise uric acid so that's a
bit of a disconnect that we finally have
massaged into being meaningful because
for years well for years it was foods
high in purines if you have gout stay
away from them because we know purines
make uric acid we know high in uric acid
is the cause of gout what what is gout
so gout is the
extracellular crystallization of uric
acid where uric acid is so high that it
finally precipitates out it's like
um making rock candy you've ever made
rock candy in the day all right well how
do you make rock candy is
um you have a solution of sugar and you
heat it and it because it's hot you can
dilute more sugar and then as it cools
if you have a thread in there it'll
crystallize on the thread and you pull
it out and you've got rock candy I mean
you're eating sugar there's nothing else
there right anyway so things precipitate
out when their concentration is really
high I've seen it like on people's
elbows and stuff it's toes crazy and it
crystallized why it picks the great
break through the skin can they can open
up and be hugely painful in fact you
know we humans are not the only animals
at risk for that other animals that have
high uric acid like reptiles and birds
uh
T-Rex sued the T-Rex had uh gout in her
fossilized skeleton but wait in in such
a natural environment how are they
ending up getting out they're just
eating things that are too they're
eating other lizards and they're just
too high in in who can say I mean I
don't think we know exactly what T-Rex
ate but you know it looks based upon
teeth and short digestive tract that
they ate meat you know they were these
you know prototypic carnivores and as
such were at higher risk for gout segues
back to us as humans so it doesn't mean
that people who eat a lot of meat are
necessarily going to get gout and may
not even have a high level of uric acid
but it takes us to a place it really
depends on the person so therefore you
want to check your uric acid but here's
how do you check your uric acid it's a
blood test and over-the-counter yes
that's the good news but most people
have already had their uric acid checked
it's part of your annual blood test and
and you could call your doctor and say
what's my uric acid and she or he would
say well it's either normal or not if
it's above seven it's abnormal it's out
of the normal range and below seven
you're in the clear but understand Tom
this is only in the context of gout not
metabolic health
so for metabolic Health we want it not
in the normal range in the Optimal
Health which is range 5.5 or lower okay
that's what the Research indicates is
the cutoff in terms of cardio metabolic
issues so having higher uric acid levels
one interesting study published in 2009
looked at 42 000 men 48 000 women
followed them for eight years
those who had the highest level of uric
acid had a 16 increased risk of
all-cause mortality becoming a dead
person for any reason whatsoever that's
what the term means cardiovascular
mortality
38 percent why might that be we talked
about nitric oxide we talked about blood
flow we talked about inflammation of the
arteries for example stroke risk death
from stroke 35 increased risk and here's
an interesting part of that study I
thought
for people looking at their values for
every point of uric acid elevation over
seven
all-cause mortality increased 8 to 13 oh
God so at eight at nine at ten you know
you see people with a uric acid level of
11. oh that's a big big study the other
thing the study showed which I thought
was really quite interesting
They concluded that one-fourth of all
type 2 diabetes was a consequence of
elevated uric acid what
okay so hold on let's the the cause
thing I want to really put a fine point
on that so
uh the cause of type 2 diabetes is the
over consumption of sugar I would assume
which leads to elevation in uric acid
not that the elevation of uric acid is
the cause of type 2 type 2 diabetes or
are you saying no no that's exactly
what's happening if you over consume the
sugar but it was handled appropriately
and I could artificially depress your
uric acid you actually wouldn't end up
with type 2 diabetes that study has
actually been done in both rodents and
in humans and here's how the study
worked
uh Dr Richard Johnson University of
Colorado uh who I dedicated the book to
uh did research with laboratory right
animals rats if you want to make them
diabetic and hypertensive you give them
fructose you put fructose at their
drinking water
and if you leave them alone they develop
these problems and they gain weight if
you give them a drug which is a gout
drug called allopurinol they still drink
the fructose but now you've done what
you've blocked uric acid production they
don't get these metabolics that go do
they urinated out uh it actually it's
metabolized into other things you know
normally if we have a functioning
uricase enzyme we will then metabolize
uric acid into another product called
alantoin but in this case they uh it
simply gets recycled and is used as a
building block for other things even DNA
and RNA so it can re it can go into
those those pools he did the study in
humans as well
he gave them high fructose diet and gave
them this medication called allopurinol
which blocks uric acid production and lo
and behold had the same effect so my
point is that it's that's the the study
that you wanted to know because you're
saying I'm eating a lot of fructose if I
don't make uric acid I'm good now I'm
not suggesting therefore eat a lot of
fructose I'll tell you something even
more exciting
the first enzyme in the metabolism of
fructose is called fructokinase
you're and that takes It ultimately down
to uric acid uric acid feeds back and
you would think would then would shut
off fructokinase it actually enhances
fructokinase activity this becomes a
feed forward process which is what you'd
want if you're going to get ready to
starve
there are now uh drug there's one drug
company and that is working on a drug to
block
fructokinase so we don't metabolize
fructose where it goes is anyone's guess
but it's not going to go on to form uric
acid so that's going to be could be a
powerful tool in terms of obesity so let
me finish one other thought and that is
I'm certainly not suggesting that people
then take a gout drug
but I will say that there are several
bioflavonoids that act in a similar way
to inhibit the final step enzyme for the
production of uric acid for example
quercetin quercin works just like
Allopurinol
um uh ludiolin is another bioflavonoid
that works as well as in one study
allopurinol to block uric acid
production so to get back to an earlier
question then so you follow your uric
acid at home with a home monitor that
you can buy on Amazon much as you might
follow your own blood sugar I did not
expect that answer about I honestly
thought you misspoke in terms of
causation of type oh it is causation
because it was a survival mechanism we
wanted we needed to become diabetic what
we had to become diabetic to raise our
blood sugar to power the brain
so insulin resistance
why would that need to be true if we can
pull the energy out of our fat stores
use it even as ketones the brain can
metabolize ketones I know it prefers
glucose but why would we have to because
it seems so transient we can't store it
in the bloodstream long enough for that
to be meaningful right I mean isn't that
the whole idea behind fat storage is
it's a much more it is you know uh you
have to consider that these are not
animals that are getting fat they're
just getting a little bit fatter than
the neighbor who doesn't have that
genetic issue to have the uricase so
it's not like these primate in our
primate ancestors were getting fat and
laying around with big rolls of fat they
just had a tiny bit more fat so their
ability to tap into that fat source and
and then create Ketone bodies to power
their brains was something they had but
only as long as they had the fat
reserves ultimately
they would need the ability to also
provide glucose at least in the short
run to their brains by virtue of being a
little bit insulin resistant so let me
let me pull on diabetic yeah but at
least a little bit more insulin
resistant to raise that blood sugar to
power that brain okay so let me say it
in a different way that every year
in winter
we had a cycle get triggered where we
would become slightly diabetic
meaning that our body
made it harder uric acid made it harder
for the normal mechanisms to pull the
blood sugar out of the bloodstream and
store it away exactly which meant that
it was available in circulating Supply
we ran hot if you will of just there was
slightly elevated levels of sugar in our
blood and it becomes sort of a second
storage location in fact is it the only
storage location for sugar you can store
some in your liver right you can store
some of your muscles but it doesn't come
back out into circulating Supply right
and you could store some in your kidney
interesting that one you mentioned
earlier but I'd never heard that before
yes so if we get all these sort of
little nooks and crannies where we are
now storing sugar for that period of the
year and then presumably we would come
back out of that as we got out of the
fruit season we made it through the
winter and now things would
theoretically normalize
that's right but remember that
we can with that blood sugar we can then
trigger the manufacturing again of
fructose
even though we haven't consumed fructose
we can manufacture it from fat or from
are we gonna have to break down wheat
from sugar from glucose itself I think
that what that fructose is doing is in
keeping this whole Cascade alive where
we're it's not just making fat but
locking it up storing it keeping it you
know guarding it it's precious because
that's at the end of the day that's our
last fuel source you know you're going
to go through your glycogen ultimately
if you have no food whatsoever the other
thing interestingly is
as we metabolize fat as any animal
metabolizes fat we make water
so this is a powerful hedge against
dehydration as well we make one gram of
water for every gram of fat that we
metabolize you know it's a pretty
interesting concept that it's a it's a
hedge against dehydration as well I mean
you know whales don't drink water they
make their own water from the fat that's
why they're so one of the reasons
they're so fat you know and animals that
live in the desert when there is fruit
available they'll eat that fruit make
fat as a storage Depot from which their
bodies will make water
whoa
this is far more interesting than
I would have thought it's a it's a
really fascinating mechanism I've never
heard anybody talk about this before
um okay I want to talk about red meat so
I eat a lot of red meat I've never
tested my uric acid levels so I'll be
very curious to get one of these I'm
going to send you one that would be
amazing I will send you one
and I ask because I feel amazing
and I though don't know if I'm killing
myself slowly so I every time I go to
like get off of red meat and eat higher
vegetable diet because I do eat
vegetables
um
I don't feel as good and I could just be
doing it poorly I'm fully
um open to that but I am super curious
is it all red meat
why do we have to worry about red meat
like what's the the knock-on effect as
it relates to were there many things to
talk about as it relates to eating red
meat that you've had other people talk
about and I I want to focus on in the
context of uric acid I eat red meat
myself and you want to be sure you're
eating Quality Meat and if you eat
poultry and certainly if you eat fish
but that said it's not uh beyond the
quality then it would be a quantity
issue now you may through your
metabolism uh be able to tolerate more
red meat or other animal products but
you would want to know your uric acid
level so it it's as you would know how
much you could tolerate in terms of
carbs by virtue of using your continuous
glucose monitor this is yet another
biofeedback mechanism whereby you're
going to understand
how your diet is influencing your uric
acid level by virtue of how much meat
you consume so yes certain meats are
worse than others the organ Meats the
smaller fish Etc and
but it's beyond purines I mean there are
other things to consider that you've
already considered that said there are
vegetables certain vegetables that are
fairly high in purines the cruciferous
vegetable for example but again they are
buffered by the fiber content by the
bioflavonoids like I mentioned quercetin
red onions really high in in question a
great food onions and the crucifix to
help lower uric acid and the vitamin C
part of that equation as well so I'm
sorry how do those lower uric acid well
the vitamin c does so because it
enhances uric acid excretion from the
kidney the quercetin
and other bioflavonoids act like the
uric acid lowering drug they act like
they allopurinol enzyme the final enzyme
the xanthine oxidates if you will that
is involved in creating the uric acid
and then again the fiber in vegetables
if because they will contain some
fructose slows the release of that
fructose into your bodies you don't get
like you would get from drinking a glass
of fruit juice bad idea
so one in the book you talk more than
just about food you talk about getting
out into nature and things like that so
paint a picture for me of the ideal life
I know we're trying to match back to our
genetics and what that looks like why
does going outside matter
what is the ideal diet and I assume it's
going to be different for everybody and
do we just nearby glucose and uric acid
or is there some other I mean there are
a lot of things we look at in trying to
cultivate what is that perfect diet for
Tom and I think to embrace Embrace that
notion is really very helpful
um the you know one size fits all it
just is is really inappropriate your
heritage is different uh your
preferences are different there are some
broad Strokes we know that manufactured
Foods foods that contain added sugars
Etc are things to be avoid
uh but you know the nuances that you
could look at in terms of how is this
playing out in my body I think are
really quite valuable hence the value of
continuous glucose monitoring of knowing
your uric acid levels of you know
looking at other parameters that that
might be influenced by not just that but
your other lifestyle interventions by
knowing how well uh how well and how
long you are sleeping these are all
extremely valuable inputs for every
individual to know and and clearly you
know what's going to be best for you
will be somewhat different than for me
so for people that come out and say you
know everybody's got to eat this
particular way or it's your blood type
or whatever it may be I think to be fair
uh in this day and age we know that
people are different but
I will say that it's quite clear that
100 of humans alive today or who have
ever lived have this genetic issue with
the eurocase enzyme cannot break down
uric acid and therefore the uric acid
levels of humans is four to five times
higher than other mammals except for
primates number one and number two that
uric acid levels are climbing in
lockstep with fructose consumption in
the 1920s average uric acid level in
Americans was about 3.5 it's now six so
we're seeing this happen as expected
once you understand you know where the
uric acid is coming no such thing as too
low
it's a really good question there is
some suggestion that uric acid because
it might act as an antioxidant to some
degree would be threatening if it was
really low but I think when we see a
correlation uh for example in elderly
people with very very low Uric acids and
risk for degenerative conditions it's
probably because uh it's a an effect not
the cause meaning they're already sick
and cachetic they've lost muscle mass
because they have no more muscle mass
they're not able to keep their uric acid
levels up because they're not breaking
down any more muscle which would
Liberate the purines so you know this is
all about then looking at those dietary
tweaks as your uric acid levels uh are
examined over time to keep your uric
acid level in check and the ultimate
goal
of the book is that missing link that so
many people with
borderline diabetes or Frank diabetes
mild elevation of blood sugar or can't
lose that last 20 pounds and they're
doing everything they possibly can darn
it I'm doing everything I can there's
got to be something else this may be
that something else maybe that Missing
Link and um
truthfully as we've described it it's
not going to be that hard to get your
uric acid level back where it needs to
be and we're going to do it just by
changing our diet we're going to stop
eating fructose
and Japan is leading the charge they are
intervening with patients who have
metabolic conditions to lower their uric
acid America isn't doing that yet
they're targeting uric acid only if you
have gout
um the notion of what we call
asymptomatic hyperuricemia means you
have a very high uric acid but you don't
have gout so you don't have any symptoms
no you're at Great risk for death from
cardio metabolic conditions that's what
the research is telling us you have a
dramatic increased risk for Alzheimer's
and Dementia in general so they're kind
of leading the charge to the extent that
Japan is now producing
no purine beer beer that has zero
purines to help you with your uric acid
way ahead on this yeah they are well you
know we in America tend to think we're
you know we're leading the charge and in
so many areas you know renewable energy
so many areas we see when you look at
what the rest of the world is doing we
can learn from from the rest of the
world and as it relates to uric acid
which is a global problem we see that
other even turkey I mean other countries
are really moving ahead and recognizing
that
when you have this information it is the
harbinger for future metabolic issues
and it's predictive high uric acid is
predictive of hypertension of insulin
resistance elevated butcher therefore
diabetes inflammation oxidative stress
all of those mechanisms that underlie
the things that you don't want to get so
you know John Kennedy said that the time
to fix a roof is when the sun is shining
and you know that's the hope with uh
it's not the end all but it's it's going
to be a powerful addition to our toolbox
yes keeping blood sugar under control
yes getting adequate exercise watching
what you eat controlling your stress
getting enough sleep wearing a wearable
device to look at your sleep
all these things are really important
this um
is now going to be looked at as a
strategic metabolic marker right there
with blood sugar and blood pressure and
and serum lipids I think you're going to
see uric acid very soon being on par
with those uric acid volatile so when I
think about wearing a continuous glucose
monitor the fun is that it's moving
around right so if I have not as
volatile as moment-to-moment blood sugar
measurements but it'll change within a
day and you know it'll go up if you
exercise in a way that you're not used
to and therefore break down a lot of
muscle fiber that will transiently raise
your uric acid level as will fasting in
the short run fasting will raise it
we'll raise it as well being in deep
ketosis why why would it raise it
because you're catabolic you're breaking
down your tissue so liberating
experience theoretically it's supposed
to be muscle sparing you even mentioned
that in the book right so if it's muscle
sparing
is it the release of fat well it is
mostly in when you get to the point that
you start breaking down muscle the truth
is hitting your career goals is not easy
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description alright my friend back to
today's episode
so it's mostly the breaking down of
muscle but also to some degree other
cellular components that will Liberate
the the nucleus of the cell therefore
spill out the nucleic acids the DNA and
the RNA that will be broken down into
purines
thing to think about in terms of fasting
is even if it's an intermittent fast
that you will transiently raise your
uric acid level when it's done your net
positive in a better place
365 days a year in terms of time
restricted eating yes okay there's not a
huge amount of data the studies look at
more of the people who will Fast for a
day or two or three or even longer but
uh that ultimately the time restricted
eating is so beneficial for your
metabolism that we included a chapter in
the book on that notion I mean we've
known that for a couple of years in Dr
satsen Panda even recently has indicated
that this time restricted eating is one
of the most powerful things we can do to
improve our metabolism so we're all in
on that we talk about continuous glucose
monitoring as well
it's all about gaining this information
and then when you have it
having somebody tell you okay what
should I do with this information on
staff we have a vegan and I once watched
him gain an entire package of
blackberries and as he was doing it I
could feel my blood sugar rising and I
was like there's no way this kid's gonna
die like he is he's too good at his job
for me to let him die so I'm like you
have to go get your levels checked and
he did and they'll they fall with when
in what I would consider normal ranges
so I want to know if I'm delusional on
that if they're just as that much
genetic variability because that would
have spiked I know because I take my
blood sugar levels quite frequently that
would have spiked me to over 100 for
sure it may have pushed me closer to
like 120 to have you can't imagine how
many blackberries he ate
um but his his H A1C level was 5.1
and he eats like that all the time
so well three things come to mind first
I I want it not to be missed that our
time together may have compelled you to
engage in aerobic exercise that
that's great I mean that is huge and uh
you know what compelled me was the
science the data
my personal risk for Alzheimer's having
lost my father to that disease and then
just understanding how pervasive and
preventable the situation is but uh if
if you've changed your exercise routine
based upon our time together then I'm
grateful that it came out here that's
great next point on both uh the ideal uh
being in the normal range you brought up
that term and I I just really recoil at
the notion of a normal range because
Normal really by definition is average
it's you know whatever the number is a
thousand samples and then one standard
deviation on either side the normal
range and that doesn't work uh in terms
of my messaging I want optimal so
a normal range of vitamin D between 30
and 100 so a patient will say well my
level's in the normal range doc I'm at
31. there's a term for that it means it
is that sucks not that I use it that
often but it really does we need optimal
well then you know I'm good enough
normal range is not where we are we want
Tip Top and so as it relates to
hemoglobin A1c tempering my next
commentary with the notion of the
U-shaped curve I would say a range would
be between let's say five to maybe about
5.3 5.4 now
to get to your third point of your
friend who's eating a lot of berries
first of all uh it's a lot of sugar it's
a lot of fruit sugar called fructose
which has almost no effect on insulin as
you know there is glucose in there and
ultimately he will to some degree
glycate he'll bind his blood sugar to
protein in the case of hemoglobin A1c
hemoglobin and ultimately will increase
that activity and it'll be measurable
but you say he does it all the time he's
eating whole fruit with fiber to help
offset the blood sugar Spike so I think
you have to look at many things in terms
of looking at an N of one
what did his A1C turn out to be based
upon what you've observed there are a
lot of variables here we don't know his
what his microbiome looks like for
example I think a vegan diet can be a
very salubrious approach however with
certain caveats you're not going to have
great sources of vitamin D B12 fat you
know a lot of vegans don't get enough
dietary fat and it's a huge huge issue
yeah it's interesting when I heard this
story I was like whoa that you you did a
fecal matter transplant with a child
that was suffering from pronounced
autism
I while I have certainly heard the
through line of hey C-sections lead to a
microbiome that's wildly disrupted which
increases the potential of somebody
developing autism I certainly had never
heard of using a fecal metal transplant
to reduce some of the symptoms of that
one walk us through that story which I
think is utterly fascinating and two I'd
love to hear what the pushback is on
that where you think fecal matter
transplants are in terms of efficacy in
terms of safety and I'll say that
knowing that or you should know that I'm
sitting here waiting for the answer
because my wife has struggled profoundly
with antibiotic induced microbiome
disruption and if I thought that that
was going to work I would do it
immediately but I'm worried about the
safety well let's address the safety
first I think with a properly screened
donor
that is negligible I mean it is the
treatment of choice uh being carried out
at more than 100 hospitals in America
today for another disruption of the
bowel Flora called Clostridium difficile
or C diff the standard of care treatment
using antibiotics is has an efficacy of
approximately 28 percent fmt
fecal microbial transplant has an
efficacy without recurrence north of 96
percent whoa
think about it I mean the the reason
that people get C diff in the first
place is from antibiotic exposure
frequently other drugs can do it as well
and they're treating that the mainstream
approach is to treat it with further
antibiotic you talk about fighting fire
with fire but fmt now has really become
a national uh
well-accepted approach to treating
acetam so I wouldn't be concerned in the
least with respect to safety of that
procedure provided the donor is screened
so a woman arrived in my office with her
child and
um
I observed him uh that he couldn't make
eye contact and he was repetitive motion
you know very characteristic autistic
child and I asked her how did you come
to see me today and I think as I recall
she was from
um Mississippi
and she she said you know I need to tell
you the story how it all happened she
was in the parking lot of a grocery
store
and she couldn't get her child out of
the car
and next to her was parked a gentleman
in a truck and he apparently apologized
to her and said uh that he didn't mean
to get and get involved in this but
maybe you ought to take him down to
Florida to see me of all you know and uh
and she asked him why and apparently I'd
helped somebody in his family so she
comes to see me with her son and it was
right then
that I was deeply immersed in the
literature that was revealing that these
kids have a profound disruption of their
gut bacteria I mean it's almost like an
Autism fingerprint and this was many
years several years ago that we see very
powerful correlations between these uh
patterns of gut bacteria and the
manifestation of autism that we see
children who are born by C-section you
alluded to that earlier have an
increased risk of autism and that
C-sections disrupt their microbiome one
researcher clinician actually a Dr
Feingold actually was treating autistic
children using Vancomycin to help re an
antibiotic to re-establish some balance
and was getting good results
so I said let's at least start with some
probiotic enemas I instructed her how to
give her child probiotics from the
health food store putting him in an
enema and administering them he improved
he uh doesn't sound like a big deal but
he was able to tie his shoes for the
first time in his life and he was able
to spend the night out at a friend's
house
I may I mean those are major landmarks
they don't seem like much but they were
as we continued to work with him he
plateaued maintained his improvements
but it was not continuing to get where
she wanted and I said well we ought to
consider fecal microbial transplant what
is that identifying a healthy donor
taking the fecal material and
transplanting it into your son's colon
she identified a healthy 12 year old
girl
and I got on the phone with her and I
said I know it sounds really strange and
it's way out there but we just need to
do this and she said if it'll help him
I'm in well and she did and he began
fmts his mother did them at home
and
um
I was getting ready to give a talk in
Germany
his mother sent me a link to a video of
this kid
presenting a
book report at school on Benjamin
Franklin
and I I got like that getting ready to
give my lecture like I'm getting right
now it took the wind out of my sails I
just couldn't believe it and he's now at
regular school at uh in the top 10
percent of his class he was always
bright but he had this inflammation in
the way it was cognitive performance you
know it's like listening to a
FM radio station in a lightning storm it
was always there so
um you know that was one of the uh
things that we did that was certainly
disruptive and eccentric
um since then the University of Arizona
did an Interventional trial on 20
autistic children demonstrated profound
Improvement in these kids where nothing
has helped them ever in collaboration
with researchers from Harvard validating
the notion of fecal microbial transplant
as a treatment for autism we know that
we can measure the permeability of the
gut
by looking at levels of something called
LPS lipopolysaccharide it's a
chemical that enshrouds the gut many of
the gut bacteria if the gut lining is
leaky
for whatever reason typically because of
disruption of the gut microbiome
then we can measure that LPS in the
bloodstream where it doesn't belong
we see dramatic elevations of this LPS
meaning inflammation and breakdown of
the gut lining in Alzheimer's autism
major depression and even Lou Gehrig's
disease
my point is that we focus on the brain
when there's a heck of a lot going on in
the gut that we're just beginning to
unravel the beginning of our time
together you challenge me you say well
what does a future look like and really
as we understand this relationship
between the gut and the Brain we've got
we've we've moved to a new stadium and
there are new rules written because as a
neurologist I have had traditionally
very few tools in the toolbox it was
very much an Adios diagnose and adios
situation it doesn't really help anybody
to go to the neurologist's office and he
or she comes up with a very exotic name
or something not as exotic like
Alzheimer's is a word that has
incredible
gravitas in a negative way when family
members hear that and we have no
treatment
and yet it's preventable
and um it's like John Kennedy said in
his inauguration that the time to fix
the roof is when the sun is shining and
you know that really has been you know a
fundamental aphorism for me that to
prevent these situations for which we
have no treatment is the call to action
and uh there's no doubt that to a
significant degree this epidemic is
preventable and that's the message that
we want to shout out because
we are inculcated with the mentality
that we should live our lives however we
choose and come what may there'll be a
treatment right eat crap and we'll give
you a diabetes pill to get your A1C
below seven what kind of goal is that
but the reality is
treating your diabetes to lower your
blood sugar has other Downstream effects
that may not be good lowering your
cholesterol level with a Statin drug may
not be the best thing to do and you're
deeper on that I've heard you talk about
that statins effect on insulin receptors
which was what put it on my radar that
there are potentially other issues or
other things that insulin is doing
because I always just thought of it as
the you know taking the blood sugar out
and putting it in the cell let me see if
I can connect those two the notion of
diabetes and and statin drugs for
example and why I'm really so seemingly
dialed in on Diabetes because if you
become a type 2 diabetic which is by and
large a choice you have quadrupled your
risk for Alzheimer's did I say a disease
for which there isn't a treatment yeah
so that's why you don't want to become a
type 2 diabetic
in the Journal of the American Medical
Association in 2012
was the publication of a study called
the women's uh women's collaborative
study and it involved 150
000 women
and demonstrated that those women taking
a Statin drug
had an increased risk of developing type
2 diabetes by 71 percent whoa in men
according to a more recent study 2015
Journal is diabetologia their risk has
increased about 46 percent
taking a Statin drug that's ostensibly
the good thing to do for your heart is
actually associated with a significant
increased risk
for another situation for which guess
what we've got another pill for you so
now you're on your Statin and we're
going to add in your diabetes pills uh
so this is diabetes that did I say
quadruple is your risk for Alzheimer's a
disease for which there is no treatment
so we connect these dots and this is the
information that people need to know
before they capriciously acquiesce to
taking that drug because my doctor said
my cholesterol level is too high and
truthfully I mean I think we all well
understand that it is a
a pathway of this cholesterol number
gets me to write that prescription for
this patient and I'll explain that well
high cholesterol is going to give you a
massive heart attack well that isn't
true that at least 50 percent of
myocardial infarctions in America today
occur in people with normal so-called
normal cholesterol levels beyond that
we have this idea of what is called the
Statin brain we're taking a satin drug
is associated with cognitive issues
memory issues and this is called out on
the the bottle of medicine that this
drug can affect memory why so well
your brain loves cholesterol it's a very
important fat as a lining of your brain
cells it acts as a brain antioxidant and
equally important is the notion that we
talked about vitamin D and how
critically important that is in your
entire body that there are more than 900
receptors in your body for vitamin D
that's how pervasive its actions are and
most of those are in the brain where
does it come from vitamin D Oh Come From
the Sun the sunlight shining on your
naked body changes a chemical into
Vitamin D what is the chemical it's
cholesterol
I actually did not know that well
cholesterol is from which we make
vitamin D as it is from which we make
testosterone and progesterone and
estrogen and cortisol so this
vilification of cholesterol is very much
off base
but you got to give somebody credit it
sure paved the way for the notion that
it's bad and that if you eat eggs your
children will be born naked or some or a
horrible thing will happen and that we
should lower cholesterol to incredibly
low levels the lower the better
so the notion of the U-shaped curve has
yet to find its way to that level of
pharmacology understanding that we need
our cholesterol we love our cholesterol
the issue
that relates to risk for coronary heart
disease is unrelated to cholesterol
cholesterol shows up
when the coronary arteries are inflamed
it shows up to heal the coronary
arteries it's why would a person dies of
heart attack and you section their
coronary arteries you look at under the
microscope you'll see cholesterol is
there it's trying to heal this
inflammation it's like blaming the
firemen because they're on scene blaming
the firemen because they're there at the
Fire doesn't work that way
it has a lot to do with
not the number of LDL it's value but
whether it's been damaged or not
oxidized or not or bound to sugar
how do you check that you have your
doctor check a glycated LDL or oxidized
LDL and maybe your doctor is going to go
well I'm not sure I've heard of that or
that our lab will do we'll do that in
which case you need to move on
because that's what is very clearly
correlated to risk for coronary artery
disease the oxidized level of LDL which
is directly related to blood sugar we're
back where we started
yeah which I don't think in this
interview we've um really put our finger
on the what I'm sure most people know
but I think it work is worth saying what
are the lifestyle choices that are
causing this Cascade of essentially
inflammation
mostly food
and that should be empowering meaning
you can break the cycle so inflammation
is what Alzheimer's is Alzheimer's
coronary art disease Parkinson's disease
autism diabetes cancer these are
inflammatory diseases the brain and the
Alzheimer's patient is virtually on fire
with inflammation the word comes from
the Latin in flamari meaning fire and
inflamed uh so our lifestyle choices by
having higher levels of blood sugar
bind to our proteins called glycation
that's what A1C measures when we bind
sugar because it's always elevated to
our proteins that challenges our immune
system and the immune system says
something's going on here and that
increases the production of these
chemicals called the cytokines that
mediate inflammation there's a very
interesting study that was published in
the journal neurology back in 2014 and
this is a study that looked at a group
of individuals and a couple several
decades ago and did a simple blood test
measuring inflammatory markers
follow these individuals for 24 years
and it found that those individuals who
24 years ago had the highest level of
inflammation in terms of their blood
markers had a dramatic decrease in the
size of their brains and at the time
they came back to get reevaluated had
poor memory function
we know that there is a very powerful
correlation between markers of
inflammation in the blood and
Alzheimer's disease so it's very clear
that we've got to do everything we can
to reduce inflammation and that brings
us back to the gut because the lining of
the gut
that one cell lining that separates
stuff in the gut from the rest of your
body is the gatekeeper basically for
inflammation in your body whenever we
threaten the gut lining and that
chemical LPS and other things gets in
and challenges our immune system we amp
up inflammation and that sets the stage
for every bad chronic disease that you
don't want to get
and when the World Health Organization
is now telling us
that chronic inflammatory degenerative
conditions are the number one cause of
death on planet Earth
we've got to pay attention to that
metric because
it's something over which we have
control based upon our lifestyle choices
like the foods we eat we want to eat
Much More primitively Much More locally
and and as such reduce inflammation what
is up my friend Tom bilyu here and I
have a big question to ask you how would
you rate your level of personal
discipline on a scale of one to ten if
your answer is anything less than a ten
I've got something cool for you and let
me tell you right now discipline by its
very nature means compelling yourself to
do difficult things that are stressful
boring which is what kills most people
or possibly scary or even painful now
here is the thing achieving huge goals
and stretching to reach your potential
requires you to do those challenging
stressful things and to stick with them
even when it gets boring and it will get
boring building your levels of personal
discipline is not easy but let me tell
you it pays off in fact I will tell you
you're never going to achieve anything
meaningful unless you develop discipline
right I've just released a class from
Impact Theory university called how to
build Ironclad discipline that teaches
you the process of building yourself up
in this area so that you can push
yourself to do the hard things that
greatness is going to require of you
right click the link on the screen
register for this class right now and
let's get to work I will see you inside
this Workshop from Impact Theory
University until then my friends be
legendary peace out
what an article when you were 16 or a
letter to the editor in the paper I
guess is a more accurate way of saying
it I don't have to remember this but
came across it in my research and it
basically said speaking of you know
Western lifestyle it basically said uh
we're all sort of running this
experiment and we're each contributing
to
um seeing whose lungs can evolve to
handle pollution and I don't think that
spending uh Sunday at the beach or going
on a week trip to the mountains is going
to be enough and basically intimating
that our current lifestyle is so far
removed from what we've evolved to
handle that there's a just a fundamental
problem and before we started rolling
you and I were talking about
um the your notion of brainwash the new
book that you're working on and I just
want to hear a little bit about that
about you know what are some of the
things that are happening
um from a lifestyle perspective at a
broader level than what we've just been
talking about you know just what we eat
but what we're engaging with
um you know negativity and how that
influences the brain and you know the
way that media is presented and the
kinds of influences that they're having
like what are you finding as you look
more deeply at that
I think that there is a lot of
traction of the the Paleo ideology but
at its core the notion of paleo is one
that says let's get back to sending the
right signals to our genome which is
hasn't changed in let's say 70 000 years
fundamentally and it gets gets back to
our original conversation we started
today about
how are lifestyle choices are
interpreted by our genome how our food
beyond the macronutrient content is
actually information sending up-to-date
signals as to our environment to our
genome so that our genome can then in
kind respond to maintain our health by
responding to the signals to that it
receives our Evolution cannot keep up
with the environment to which we are
exposed and the environment to which we
choose to expose ourselves
so the idea that we can change that by
going back and trying to think about
what it was that our ancestors
Lifestyles must have been like and
therefore cause our genome to express
genes for longevity
reduction of inflammation in
stabilization of immunity is I think
really very very important so I think
that you know this is really becoming an
area of great interest for a lot of
people it's you know instead of trying
to patch up these problems I think the
idea of letting our genes keep us
healthy is really
um
it's it's it's kindness It's really
about about reconnecting to that
incredibly beautiful gift that we've
received from all who have come before
us and it's very instructive to
recognize
that the genes of our gut bacteria are
influencing our genome expression that
those little critters that live within
us are moment to moment changing our
gene expression there's a very
interesting piece of this puzzle that
was just solved for me last month in a
journal cell host and microbe the
researcher's name is Yun Tang the Eng
for University of Louisville and he gave
us information about
the idea that plant cells contain RNA we
know that who didn't know that and that
they are able when we digest plant cells
that
microsomes that then are extruded from
plant cells called exosomes that contain
plant RNA work their way into our gut
bacteria and change the expression of
the genetic material of our gut bacteria
so food is running the show plant food
is changing the expression of our
bacteria
genome that leads to three important
things as it relates to our gut bacteria
it changes their rates of multiplication
it changes the metabolic products that
they produce like vitamins and
neurotransmitters and it changes their
location in the gut hopefully closer to
the gut lining so they can help us keep
that intact
so that was a very intriguing
couple of dots to connect therefore our
food is changing our gene expression and
we should think about that you know we
say when a woman is pregnant she has to
be careful because now she's eating for
two or well Tom you're eating for 100
trillion right now this morning before
we came here
I was having breakfast at the hotel and
uh the the women next to me one woman
was uh had uh skim milk in her coffee
because we don't want dietary fat and to
which she put several uh Pink packets of
sweetener which the research shows is
profoundly damaging to the microbiome
associated with a profound increased
risk of obesity in a French study of
tens of thousands of it was 70 000 women
and also dramatically increases your
risk for avoiding sugar in the first
place type 2 diabetes her brain has been
hijacked by media that would let us
believe that this is the right choice
but that media doesn't have her health
at the core of their interest what that
media has it is their end up bottom line
right and she is simply upon on that
chessboard being manipulated that is the
focus of this new work call called brain
brainwashed we're trying to wash
people's brain and push the reset button
and really call out all the ways that
day to day
our lifestyle choices are being
manipulated you know learning that all
of our online
areas that we explore are being
leveraged to create advertising that's
appealing to us that's not telling me
something that your audience is
certainly aware of but it has Health
consequences it's not just that you
happen to buy you know the latest pair
of glasses or a shirt it has to do with
your health like this woman this morning
choosing this artificial sweetener and I
will say that we had a premise for the
book about calling out how our brains
are influenced and beyond that how
reconnecting with nature how dietary
changes how meditation how various
things can help undo what's been done
how we can harness this notion of
neuroplasticity
we talked about earlier by having higher
levels of bdnf to then allow the good
Pathways to stick
allowing us to connect back to the
prefrontal cortex and act in a more
empathetic way in a more compassionate
way in a way that recognizes that
our decisions today are going to affect
what happens tomorrow
the notion that we can do that is is a
heck of a gift that we need to raise
awareness of especially these days when
impulsivity and narcissism seems to be
you know the way things are done today
and we've certainly got to pay attention
to what what will tomorrow bring how
will our actions today affect ourselves
tomorrow and affect the world tomorrow
so um
the Dalai Lama said that if you want to
be happy
practice compassion
and if you want others to be happy
practice compassion
so in a very real sense what we choose
to do
rewires our brain and changes our
thinking
what I'm saying is that we presuppose
that our thoughts determine our actions
but in a very real sense our actions
determine our thoughts
yeah let that sink in
I was running one day and I was
listening to a podcast from Peter attia
and he interviewed Dr Richard Johnson
University of Colorado
and
explored this topic that uric acid is a
central player in our metabolic Health
it's far more than you know the dead end
metabolic product of fructose that has a
role to play again in gout
and for me everything's about metabolism
because when we're deranged in our
metabolic lives it sets the stage for
all the bad things you don't want to get
Alzheimer's heart disease diabetes
obesity cancer so this becomes a very
powerful tool and I couldn't really fast
what makes you think that all of those
things were metabolic they're born of
metabolic disturbances
well they are I mean their their
underpinning is inflammation and
inflammation has its Genesis in
Disturbed metabolism so these are all
inflammatory uh conditions we've talked
about that before that Alzheimer's is
basically an inflammatory condition that
you know people are now becoming aware
of inflammation in the world of covid
getting this thing called the the
cytokine storm whereby suddenly
inflammatory chemicals are produced in
excess throughout the body and people
have problems with their brains and
their lungs Etc
but in the same force in a lower level
acting over a longer period of time
could be let's say the cytokine drizzle
and is equally as devastating to the
body so and the cytokine drizzle is a
response to eating pro-inflammatory
Foods not just eating pro-inflammatory
foods but anything uh the answer is yes
but not just anything that increases
inflammation not getting enough sleep
engaged in stressful activities a
disturbed gut bacteria set in the state
that's a powerful source of inflammation
in human physiology
leakiness of the gut lining for example
dramatically amplifies inflammation so a
lot of roads lead to the realm of
inflammation and set the stage for
things like Alzheimer's and coronary
artery disease and because of that
it's the reason that a monotherapy or a
one drug approach to alzheimer's for
example uh is beyond myopic it's never
going to work when we have what Dr Dale
bredesen has described as 36 possible
inroads into why your brain isn't
working with respect to alzheimer's uric
acid now being one of those that the
idea of targeting one thing this beta
amyloid protein
you know uh we'll we'll forgive them for
they know not what they do
so all right we hear about uric acid
what was like the key Insight that made
you go whoa there's really something
here because you've moved super quickly
into getting a book out you said you
want to make sure that this wasn't one
of those things that languished for 20
years and you know took all that time to
work its way into the medical
establishment what was the key Insight
that made you go whoa this is a real
linchpin in the understanding of
metabolic Health the urgency on my part
once I figured out how important it is
or realized how important it is the
urgency is that our metabolic Health
globally is in a terrible place
I mean a third of American adults has
hypertension a 10 of of kids age 12 to
18 has hypertension that's crazy it is
uh 50 of adult Americans will be obese
by the year 2030 not just overweight but
obese so we are you know our life
expectancy is declining is it uh that
it's actually declining oh it's
declining dramatically
before covet it began so people say well
because of covet people are dying
earlier uh and you know the truth of the
matter is that this metabolic
derangement bodes for a much worse
outcome as it relates to covet they're
tracking that like yeah it's been
published yeah measure uric acid at
admission and it predicts to some degree
who's going to end up in the ICU who's
going to end up on a vet and who's going
to die now that we recognize uric acid
and its role in disturbing metabolism
and its role in inflammation and its
role in increasing what is called
oxidative stress the damaging effects of
free radicals it was looked at and lo
and behold look what they're finding
what is uric acid like what what is it
what triggers the unhealthy elevation so
uric acid is a very simple chemical and
it is the end product of the metabolism
in the human body and
the bodies of other animals of only
three things alcohol something called
purines which are the breakdown products
of DNA and RNA and by Far and Away
fructose
so to me
we've known that fructose is a demon for
a long long time and you in 1970 it was
published in the Journal of the Lancet
that fructose is a player it is a big
player and yet
we were told that because fructose
doesn't cause insulin to be secreted and
doesn't need insulin to be metabolized
therefore it was a safer sugar and you
know we recognize how industry was able
to manipulate that messaging and how
everybody fell for it but if insulin
really is like one of these high risk
factors and fructose doesn't require
insulin
why isn't it that is the well I'd say
million dollar question that's the 500
billion dollar question that's how much
we subsidize the growth of corn to make
high fructose corn syrup today
with that as a premise that look it
should be safe because it doesn't need
insulin to be metabolized it is a
powerful threat as it relates to type 2
diabetes because it stimulates a couple
of things number one is gluconeogenesis
the creation of glucose in your body de
novo in the liver and uric acid enhances
that process and it causes what is
called insulin resistance meaning that
insulin doesn't work as well in your
body through a number of mechanisms so
that's the dirty secret of fructose that
the industry didn't want us to know
about now it's been called out so
fructose can only be metabolized in the
liver
why as it turns out it can be
metabolized in various other tissues in
the body even including the brain we
learned about the liver but even the
kidney can metabolize fructose so the
the story you know everyone everything's
been compartmentalized but now we know
that it's a lot a lot bigger story we
know that glucose can become fructose
high glucose levels especially when
blood turn into can be fructose through
the use through the body's use of a an
enzyme called Aldos Redux reductase that
is enhanced when serum sodium is higher
so higher levels of salt leads the body
to know that it is in it's getting ready
for famine or water restriction make
more salt it actually create we retain
more salt and we make fructose out of
glucose fructose is the signal then that
prepares us for not having any food
which is really quite intriguing so
fructose found in nature I would assume
primarily in Fruit right so fructose
fruit sugar that's where it comes so
what is it about the natural appearance
of fruit that warns because fruits
what's Spring right or so it's fruits
fall late summer and that's what happens
when you live in L.A late summer and
early uh fall that's kind of right so
it's like hey it's really for our
ancestors I mean now you have fruit 360.
right like I literally have no idea yeah
so but traditionally it is the late
summer and early fall when the wild
blueberries would ripen and our
proclivity to finding sweet things a
survival mechanism deep in your brain
and the brain of every human walking the
planet makes us gravitate towards sweet
we we consume fructose and that triggers
a powerful mechanism in our bodies to
make fat to store fat to lock it up to
make more blood sugar to power our
brains to raise our blood our blood
pressure
so these are powerful survival
mechanisms that happened you know
probably 14 to 17 million years ago when
in the middle myosin period when the
world cooled and for our primate
ancestors that was a survival pressure
and those who had mutations in the genes
that have to do with uric acid made more
uric acid which alerted their bodies to
make more fat now those are the only
only primates that survived they passed
it on to you and me and to every human
such that when we are exposed to
fructose it's telling our bodies get
ready four times of food scarcity um
so the idea of
higher blood sugar and insulin
resistance and all those terrible
metabolic things that we're doing our
damnedest right now to Target
those were wonderful adaptations for us
for more than 99 of our time on this
planet what's happened is now we still
have the old genome
but we've challenged it with a new
environment that is rich in fructose
that is more sedentary we're not doing
as much we're not sleeping as well or
restoratively and and therefore uric
acid is increasing and worsening our
metabolism and leading to this host of
diseases that we talked about what's
your take on fruit itself like is that
to be avoided or that's a million dollar
question so
fruit is a is on the table because of
the fiber content fiber bioflavonoids
and importantly vitamin C so vitamin C
uh dramatically helps with your
excretion of uric acid so your net
negative in terms of uric acid by eating
an apple a day by eating a couple of
apples a day a handful of grapes and
certain fruits are actually associated
with lowering your uric acid like tart
cherries hence the O in the book cover
CDO I do indeed it's the falling Cherry
nicely done so okay so we're in taking
all of this excess fructose used to be
good for us now it's becoming a problem
uh the end of that metabolic train is
uric acid uric acid used to be or it has
a role but not in the elevated levels
that we're talking about now
uric acid is in these elevated levels is
causing inflammation is there anything
else going on or is it simply this
oh no it's there's a lot going on and
let's double click on something I think
is really interesting these would be
some news that happened today
one of the things that uric acid does it
inhibits nitric oxide now not to be too
technical but we need nitric oxide
for many reasons two of which are it
allows blood vessels to open up
improving blood supply
when there's not enough nitric oxide
there's not enough blood supply
it also facilitates how insulin Works to
keep our blood sugar in check
and not having function of nitric oxide
compromises blood supply and compromises
how insulin works so our blood sugar
will go up the reason I say that is
there are drugs that increase nitric
oxide
one of them is Viagra as an as a matter
of fact there's a time and a place when
you a person might need not you a person
might need more blood supply for
erectile dysfunction
uh and a study was published this
morning
showing
that people who take men who take Viagra
It's associated with a 70 reduction in
risk for Alzheimer's
can you imagine and this is not the
first study
more blood supply to the brain also a
reduction in the formation of what's
called Tau protein in the brain but
think about it that might well explain
why elevation of uric acid is associated
with an 80 increased risk of dementia a
55 increased risk of Alzheimer's
specifically and a 165 percent increased
risk of vascular dementia because it's
actually lowering our no
it is lowering the functionality of
nitric oxide okay so we have the nitric
oxide in the system but it's unable to
do its thing because the elevated
presence of uric acid and important I
think a lot of people get the nitric
oxide blood supply
relationship but the the the tying
nitric oxide into how insulin works is a
relatively new idea
so uh you know that's been demonstrated
in animals and then in humans that you
know that's an important function that's
compromised by uric acid so yes we
talked about inflammation cytokine storm
cytokine dribble this nitric oxide story
is actually very important as well how
does it interface with insulin because
we need nitric oxide for two things
how insulin is able to get through the
blood vessel into to then Target the
insulin receptor and then how it's able
to bring blood sugar into the cell doing
its job to help lower blood sugar so the
funny vasodilation to pull down you need
that's how insulin makes its way through
the blood vessel to get to the muscle
and or liver cells to do its job in
terms of the sequestration of blood
sugar if you will for the formation of
of glycogen okay so that would predict
then if the elevated levels of uric acid
cause my vasculature to be too
constricted now I basically am leaving
the glucose in my bloodstream I'm
probably then going to secrete more and
more insulin trying desperately to get
it out because the mechanisms don't
realize that this isn't a lack of
insulin problem this is a vasodilation
problem I'm too constricted I can't get
out I can't reach the muscle cell I
can't reach the fat cells uh that's
really interesting it's really
interesting it's a big problem because
that leads to insulin resistance insulin
doesn't do its job and you know insulin
resistance is devastating for the brain
why well the brain requires glucose so
we can understand from that perspective
but insulin is a powerful trophic
hormone for the brain it nurtures brain
cells if you want to grow brain cells in
a in a Petri dish let's say you nurture
them with insulin and that's how they
grow so you know insulin has far more
important roles you know beyond just its
role in regulating blood sugar so
insulin permits
the glucose receptors at the blood-brain
barrier to allow glucose to get into the
brain to power the brain cells if you
will so it's a very big story so
why might this be why would your what
would be the upside of having uric acid
create insulin resistance and therefore
cause blood sugar to go up why because
when you're starving it'll help power
your brain
because you know we're not the fastest
we're not the strongest but we have a
big brain in relation to our bodies so
that's been our Ace in the whole it's
been our high card that we can play
during times of
you know either starvation or predation
so we need our brains to keep us able to
get food and to keep us from becoming
food and that's not a real concern these
days right but in the day we needed to
make sure we didn't get eaten
one of the chapters in the book is
called survival of the fattest I assume
this is what we're talking about yeah
and it's not like our Prime ancestors
were got fat and we're you know we're
lying around being fat they just had a
little bit a little Edge that superpower
a little extra body fat so that you know
for that extended period of time when
there wasn't food they would be the ones
to survive they were able to lay down
that fat and survive because they had a
mutation in this Gene what the uracase
genes so they couldn't break down uric
acid their uric acid levels would go up
trigger their fat production and they
would survive
help me understand that mechanism in
light of what we just walked through so
elevated uric acid constriction of the
blood vessels the glucose stays in the
system how is it getting me to lay down
the fat if the glucose molecule or the
insulin molecule is having a hard time
getting the glucose molecule into the
cell other mechanisms so we only cover
two so far the next would be oxidative
stress so elevated uric acid profoundly
increases what is called oxidative
stress when mitochondria in the cell are
exposed to higher levels of oxygen
stress they are less functional and that
triggers that's one of those stresses in
the body that triggers fat production
and that becomes a really interesting
story that we didn't cover specifically
in the book
but I think it's fascinating nonetheless
because it's similar and that is why do
we as human beings
not make vitamin C I mean you know
that's a fact we've you've talked about
it before and I I think we have to talk
about that because it's not as well it
sucks to be human we don't make vitamin
C you got to make sure you're not a
limey and you eat enough lunch you don't
get scurvy so that your teeth don't fall
out and your kids aren't born naked or
whatever happens when you have it right
well I think it's interesting because
um
this oxidative stress triggers fat
production which was a good thing
it's again fat production a good thing
being coming a little fatter is a good
thing yes in the through the lens of our
history of being primates or even
hunter-gatherers and increasing
oxidative stress by not having vitamin C
would have been looked at looked upon as
being a good thing through that lens
again and what also cause us to then
seek out the fruit those who would seek
out the fruit would survive get enough
vitamin C to survive during times of
food scarcity
Okay so
now as we take this into a modern
context
um we know that it served us for a while
but now we're getting we have so much
fructose coming into the diet our levels
are going up so high we're constricting
the blood vessels going back to what you
said about
um Viagra like that just that if that
ends up holding I mean that's like a
miracle drug a 70 decrease in the
likelihood of Alzheimer's is crazy
I would take a five percent decrease in
Alzheimer's risk and I think it's fair
to say that you know getting your
metabolic house in order is a powerful
way to decrease your Alzheimer's risk we
know that to be true we know if you're a
type 2 diabetic you've quadrupled your
risk for that disease Alzheimer's for
which there is no medical treatment as
you and I have this conversation right
now despite the exciting news of several
months ago of a new miracle drug that
gets you know that that limits beta
amyloid uh what happened with that was
really quite um encouraging you know it
was resoundly rejected by the neurology
world and rightfully so because it
doesn't work we don't have a drug to
prevent that disease and yet we really
understand where it's coming from it's
coming from Disturbed metabolism
it's been said that Alzheimer's is not
generally a genetic disease and I would
until recently have agreed with that
saying that yeah about four percent of
Alzheimer's have familial type
Alzheimer's disease you know there are
populations around the world South
America for example where it runs quite
strongly in families
I would tell you now that it's probably
a hundred percent genetic
as is type 2 diabetes I would say it's
genetic and you're looking at me saying
where are you going to go with this and
let me go let me let me play it out
because as I've mentioned earlier
what we're seeing now are these
metabolic derangements that underlie
these diseases that represent
a disconnect between evolution and
environment
so we have this genome
that's coding for our survival
in the context of a different
environment
now that we're challenging that genome
with a new set of circumstances a new
context looking at it through a
different lens if you will it's
expressing genes that are Paving the way
for our metabolic Decline and setting
the stage for the very things we don't
want to get
and I have to tell you that language is
something that came to me I think the
night before last as I was just lying in
bed thinking about this stuff that it is
absolutely a genetic uh disease in that
context of the mismatch and
we're living then with physiology and
and a body a machine that is uh you know
mismatched with our current environment
it's outdated machinery and I I realized
before I wrote drop acid that I had
written about that topic a half century
ago
and I wrote a an op-ed in the Miami
Herald about what about us living today
with the outdated Machinery that is more
suited to the environment of our
ancestors
and uh I I saved it I was 16 years old
when I wrote that article I saved it I
put it in the book and um
that's the issue is that it's the
foundation of the Paleo movement let's
try to recapitulate the environment of
our of our ancestors both just in terms
of other activities sleep and exercise
physical activity stress but mostly the
foods that we eat if we can
emulate what our our genome expects will
have better health we said five years
ago uh maybe you should not stop eating
gluten and cut back on your carbs and
eat more dare I say fat
and boy did people's feathers get
ruffled with that so I found that it
felt good to be disruptive and
challenged the status quo Ronald Reagan
said that status quo is a Latin term for
the mess we're in and I think that what
I foresee
is that we are going to see a virtual
explosion in the ability to harness big
data and moving forward manipulate that
data using artificial intelligence to
really be far more specific about making
recommendations for Tom what do you need
based upon who you are what does your
genome look like what does your
microbiome look like what are your
lifestyle choices today where do you
live geographically what's available to
you and therefore be very specific
individually in terms of what your needs
are what's really important I think is
we are now seeing unexpectedly
the ability to leverage personalized
medicine Biometrics to the larger
audience you know which it kind of gets
back to the idea of looking at the few
to extrapolate to the many I mean that's
how drug trials work for example we know
that at most three percent of people are
ever sampled and utilized data wise to
make recommendations for the remaining
97 in terms of a drug and yet now with
this ability to Crunch this data and
move forward I think we're going to
really understand the larger the bigger
Strokes that you know frankly we know
that not everybody today and certainly
moving forward is going to be available
to participate in specific personalized
medicine but I think we're going to
learn what really has traction with
respect to the broad strokes and what do
you think people should be tracking now
like what's a meaningful should I be
wearing an aura ring or a constant
glucose monitor like what are what are
the data points now that that you
collect or that you recommend that
people collect well it's a good question
because you know as you well know there
are so there's such incredible
availability right now to look at
changes in your microbiome on almost a
daily basis for example certainly your
genome is a great place to start that
doesn't change or does it we in reality
we know that our day-to-day lifestyle
choices are hugely influential on the
expression of your life code that we
thought was really locked up in a glass
case and we now recognize absolutely is
not so I think that to start with we
should all understand our genomes
whether it's 23andMe or any other
service that's out there it's not just
getting your genome sequence but then
manipulating that data to understand
what your current needs are before you
even begin tracking As you move forward
how do we manipulate it I've actually
heard somebody say that before yeah
there are several online sites that are
available to upload your 23andMe data
you just drag the file and drop it into
various sites Dr Ben Lynch author of a
book called dirty jeans has a terrific
site and from that you learn not just
what your genome says but more
importantly what does it mean I learned
some things about myself that I never
knew that did change my lifestyle
choices to some small degree one thing I
learned is that
I Tom am a poor methylator what does it
mean it means that I have not the most
favorable genes in a pathway called
MTHFR along with about 20 to 22 percent
of Americans people need to know that
what's the impact of that like if you
were not to address it right the outcome
so one of the most common things that we
see with people who are poor methylators
is uh for example that my homocysteine
level can go up and why is that an issue
well homocysteine is a powerful risk
factor for Alzheimer's so it really
takes us away from the notion of
Alzheimer's being a genetic issue either
you have the Alzheimer's gene or you
don't to alzheimer's being related to
modifiable Lifestyle factors now other
things that are important I think people
should be following
their homocysteine level as mentioned
vitamin D level I think knowing your
fasting glucose level on a pretty
regular basis whether you have an
onboard a glucometer or not I think to
me I I find that to be a little bit of
an Overkill I think you can get a good
sense if you measure your blood sugar
maybe once or twice a week with a finger
stick I think you should know your
Ketone levels your hemoglobin A1c or
so-called average blood sugar I think is
hugely important what do you think is a
good number there
well I've learned in the few years that
I've been at this that um
you know I'm the kind of guy and I I
think you probably are too uh who says
well some is good more is better but in
terms of medicine uh it's not always the
case that a lower insulin level a lower
hemoglobin A1c or a lower blood sugar is
necessarily better for you I mean I five
years ago popularized the idea that
we really have to get our insulin levels
low because it would be a an indication
that we were eating less carbs having
less blood sugar elevations and B it
would ultimately help restrict our risk
for developing insulin resistance uh and
now we see Publications that at the very
lowest ranges of insulin there is
actually at least in women and increased
risk risk a profoundly increased risk of
becoming demented
uh and is it the same risk so they see
it on the low end do they see that same
risk then on the high end well the the
risk on the low end and again this is
just in women but that's very important
since you know two out of every three
Alzheimer's patients is uh are women but
it's important uh that at the lowest
range the risk was increased about 2.38
X at the high range it was increased
about 1.7 x so they're actually worse
off if they're two really really low
interesting how would you depress your
insulin that low well I think this gets
to the point of uh gene expression I
think people have certain what we call
polymorphisms of genes that might not
code for adequate insulin activity so a
plus being of course on an extremely low
sugar low carbohydrate diet so it gets
to again back to dare I say The Sweet
Spot it's a terrible misnomer I think as
it relates to blood sugar and our diets
we shouldn't opt for The Sweet Spot but
uh you know it it's it's relevant for us
to understand in the context of this
discussion
that as we get together and talk about
this
we have no treatment uh for Alzheimer's
none nothing works nothing reduces the
uh the rate at which people Decline and
to me it's very compelling that last
month the Journal of the American
Medical Association put out a study by
Dr Richard Kennedy which was actually a
meta-analysis of some of the the top 10
best evaluations of the efficacy of
so-called Alzheimer's drugs though there
is no drug that works yet Alzheimer's
drugs uh you know are selling at the
rate of close to a billion dollars in
our country annually we've known that
they don't work but what was published
last month was really quite compelling
by the Journal of the American Medical
Association not only do the drugs not
work
but they speed the cognitive decline of
patients who are taking them what are
they attacking what's the the notion
behind the drug must be something that
it what well there are two drugs
none of the drugs are involved in in
dealing with beta amyloid the first
class of drugs representing the Lion
Share about 76 percent are what are
called cholinesterase Inhibitors and
these are drugs like Aricept or
donepezil that inhibit an enzyme that
degrades a neurotransmitter called
acetylcholine because it was noted
decades ago that the Alzheimer's brain
is a brain that is low in acetylcholine
and the Very simplistic approach would
be hey we can bump up acetylcholine
that'll be a good thing and it'll help
people well it never has shown any
efficacy and yet
it receives FDA approval another story
for another time but now it's not just
that it doesn't work but it's hastening
cognitive decline in the very people who
can't afford that and you think of the
families who have Dad or Mom or husband
or wife on these drugs and they're
actually making people worse it's like
giving somebody a treatment for their
diabetes that is raising their blood
sugar and you bring up the idea of
getting rid of plaque it's been noted
since the the naming of Alzheimer's
disease after Dr Alois Alzheimer who
first described the pathology of what
this looked like in the brain of a woman
dying of that disease that now Bears his
name
and the plaques were noted then and
since that time scientists and
clinicians alike have really focused on
the plaque as being the thing we've got
to get rid of
and it turns out that
researchers like Dr Rudolf tansy at
Harvard have made it very clear that the
plaque is the response to the problem
not the cause of the problem the plaque
is what we call an anti-microbial
peptide and it's the brain's way of
responding to perhaps infectious agents
like herpes simplex virus or chlamydia
infection so you know it is said that
the enemy of my enemy is my friend we
need to embrace beta amyloid as being
there for a very important reason when
we rid the brain of beta amyloid as has
been tried in clinical study after
clinical trial
patients decline much more quickly that
might underlie why Pfizer in February of
this year said no more we're just not
going to pursue the notion of an
Alzheimer's drug anymore we've got to
leave the beta amyloid alone there was a
move a couple of years ago for the FDA
to approve
brain scans that would measure the
amount of beta amyloid load in a patient
as a way of being diagnostic do you have
Alzheimer's or are you on the way to
that and they didn't prove it because
they realize that people can have a head
full of beta amyloid and be cognitively
perfectly intact whereas others with
very little beta amyloid actually would
demonstrate the clinical manifestations
of Alzheimer's disease so looking at you
said that okay Pfizer's pulled out
they're no longer making Alzheimer's
drugs but the one thing that is
recognized to help is exercise we know
that exercise has a sort of what all
call a real-time effect on blood sugar
and you're the first person that I've
heard anyway talk about the knock-on
effect of insulin doing more than just
shuttling blood sugar out of your cells
what are the the factors you think that
are at play here and what are the
behaviors that we should take to make
sure that we Stave off dementia as long
as humanly possible what a concept what
a concept that this disease affecting
5.4 million Americans 40 million people
globally costing us a trillion dollars
higher than the market values of Apple
or Google
predicted to Triple by the year 2050
that our lifestyle choices can be
leveraged to reduce our risk that will
affect 50 percent of people age 85 or
older the flip of a coin
so in that uh through that lens let's go
back to where we were the the value of
exercise
and I'd say uh your points about insulin
sensitivity are well taken very
important keeping blood sugar down uh
enhancing the sensitivity of the insulin
receptor I want to come back to that
because I think
um
I'm seeing a big elephant in the room
that we need to talk about and that is
that physical exercise
changes your gene expression you were
able to change the expression of this
previously thought to be immutable life
code for the better and lead to the
expression of what we call a trophic
hormone or growth hormone for the brain
bdnf brain derived neurotrophic Factor
uh there are many things you could do to
amp up bdnf you can use a turmeric in
your cooking take a DHA supplement even
CBD has been demonstrated recently to
increase uh bdnf but the most important
thing you need to buy to improve your
bdnf is a new pair of running shoes
because aerobic exercise
is able to manipulate the expression of
his bdn efforts why specifically aerobic
well to a lesser degree resistance
exercise as well but I'm simply telling
people 20 minutes a day five days a week
hopefully more
at a heart rate value of 180 minus your
age as a target of course consult your
health care practitioner but what a
powerful way to reduce your risk for
dementia how can I connect those dots
and make that statement to you as we sit
here well the Journal of the American
Medical Association has wonderfully
correlated Baseline bdnf levels with
future risk for dementia you want to
have more of this chemical that does two
important things
it increases the growth of new brain
cells in your brain's Memory Center
which is a powerful Target for
Alzheimer's and it also increases the
connection of brain cells one to the
other a process called
neuroplasticity that we can
actually allow our brains to take
advantage of the experiences that we
then choose to pursue to build a better
brain and that is is the bdnf a building
block of that or no it is not it's a
signaling model it is a signaling
molecule I mean our brain cells want to
connect to each other and our lifestyle
choices that are highly stressful that
are deprived of restorative sleep that
are higher in sugar in terms of diet
that are overall stressful increase
cortisol for example that inhibits the
growth of new brain cells actually
compromises our brain cell population in
the very areas that we need the most
like the memory Center the hippocampus
so we can we can reverse that we can tip
to scales in our favor and say I'm not
going to continue losing brain cells I'm
actually going to repopulate my memory
center with new brain cells that study
was done out here at UCLA in
collaboration with researchers at
University of Pittsburgh led by a Dr
Erickson demonstrating two groups of
people a hundred people in each group
one group stretched for a period of a
year the other group was involved in
aerobics they found that those who
stretched had lower levels of bdnf
declining memory function and shrinkage
on very sophisticated brain scans in
terms of their hip campus size which is
the let's pause it because I want to
walk through this and make sure that I
understand that yeah this is incredible
and potentially very useful but I want
to make sure that I understand the
sequence of events right okay so first
of all does bdmf trigger the regrowth of
brain cells across the brain or just the
hippocampus good point we used to say
the brain doesn't grow new brain cells
end of story right I mean you're
probably too young to know that well
that's what I was taught when I was in
medical school we were told that uh your
brain grow Max is out at about age 18
and every beer you drink after that it's
40 000 brain cells or whatever the magic
number was for whatever reason I don't
remember that but
um how incredible that uh in your 90s
you were still growing new brain cells
you have this gift of regrowth of
neurogenesis it's a choice you can make
you can make it today after watching
this podcast by dragging those sneakers
out and if only going to the mailboxes
as far as you can go then have at it
tomorrow you'll do that twice and the
sequence is you're doing the exercise
the exercise of creating bdnf bdnf is
then triggering hippocampal cell growth
hippocampal yes but beyond that another
area too called the subventricular layer
of the What's called the pendama in the
layer of cells that underlies those
fluid-filled compartments that you see
when you look at a brain scan but for
our purposes
the
synaptoplasticity and the
neuroplasticity the connection of brain
cells happens throughout the brain
um we also depend on a process called
synaptic pruning what does that mean it
means that also for brain function we
have to have the ability as we are in
our childhood and Adolescence to cut
back on the number of connections that
we have in order to kind of refine the
the computer to make it work at its
optimal level so which it's doing I'm
assuming based on repetition what you do
the most is going to get the most
connections it's going to get the most
the highest degree of insulation exactly
all of that neurons that fire together
will wire together and those that don't
will atrophy will fall off the tree and
so you're saying that that process the
firing together and wiring together is
one repetition two you get the bdnf if
you're exercising that washes the brain
in some way signals to them hey to in
some way that makes them more active
more likely to connect so what is the
advantage then the
evolutionarily coded or selected
advantage that exercising people
should have higher levels of bdnf and
ultimately let's just say be more
able to survive and cognitively
Superior in evolutionary terms right and
I guess it's the people who were healthy
enough to hunt and gather and to lead
you know the Expeditions in our
Paleolithic times so these individuals
and I've never thought this before just
was having a bit of a free association
while you're talking these are our
ancestors and evolutionarily they were
selected because they were
leading the group
so uh we can play upon that now that we
understand that
biotech companies decades now to figure
out
well Mother Nature's already because
stem cells
continuously regenerating ourselves and
those Inside Out repairing problems you
know there's a road crew inside our body
and so you're saying that right here
is one repetition two you get the bdnf
if you're exercising that washes the
brain in some way signals to them hey to
in some way that makes them more active
more likely to connect so what is the
advantage then the um evolutionarily
coded or selected advantage that
exercising people
should have higher levels of bdnf and
ultimately let's just say be more able
to survive and cognitively
Superior in evolutionary terms right and
I guess it's the people who were healthy
enough to hunt and gather and to lead uh
you know the Expeditions in our
Paleolithic times so these individuals
and I've never thought this before just
was having a bit of a free association
while you're talking these are our
ancestors and evolutionarily they were
selected because they were
leading the group
so uh we can play upon that now that we
understand that
biotech companies have been trying for
decades now to figure out how to inject
stem cells while Mother Nature's already
beat them to it because stem cells are
present in our body as a defense and
we're continuously regenerating
ourselves from the inside out repairing
problems you know there's a road crew
inside our body uh yours and mine right
here right now that are fixing things
that are invisible to us