The Fastest Way to Get Alzheimer’s (Most People Do This Daily) | Dr. Dale Bredesen

1. 0:00 – 3:24

   Alzheimer’s “survivors” and the evidence for cognitive reversal

   1. RCDr. Rangan Chatterjee0:00

      In your latest book, The Ageless Brain, you write something that I think some people will regard as a little bit provocative. Okay?

   2. DBDr. Dale Bredesen0:10

      Yeah.

   3. RCDr. Rangan Chatterjee0:10

      You write this, "I've often noted that everyone knows a cancer survivor, but no one knows an Alzheimer's one. But let me tell you a secret, I do. In fact, I know many of them."

   4. DBDr. Dale Bredesen0:26

      Yeah. Not only do I know many of them, um, they have started their own group. Um, and in fact, there is a group called the Alzheimer's Survivor Foundation, which is a nonprofit, which is, uh, putting the word out. These are people who themselves have survived, improved their cognition, and sustained the improvement. The first patient I treated was in 2012. She's still doing well. She's just turned 81, and she's actually walking from the Pacific Ocean to the Atlantic Ocean to raise awareness that cognitive decline can be improved, and she's actually about two-thirds of the way. She's currently in Louisiana. She expects to hit the Atlantic Ocean in November. A truly remarkable woman. Uh, but there are many others now. Uh, and these people have another group, which is a support group, so that they can continue on the overall protocol, continue to optimize things. And you know, as you well know, with functional medicine, we see things that haven't been seen before. Reversing diabetes, people who have lupus. Our own daughter had early lupus and had -- no longer has lupus. She turned out to have a very leaky gut and had reasons for her autoimmunity, which are no longer present. Um, we see people improve in their cardiovascular status, uh, and so forth and so on. And so the problem is when you see this paradigm shift in diseases that we all as physicians were taught were untreatable or poorly treatable, it, it is difficult because you have to say, "Look, here's what we're actually seeing." And yet the doctors who haven't seen it yet understandably are skeptical. So there's been a lot of skepticism even while data are being published. We have, uh, two different proof of concept trials that have been published, one from our group, one from another group, and now we're just finishing up a randomized controlled trial at six sites around the US and we already-- because we've got 95% of the data in already, we can already calculate the treatment effect in that group and compared to the control group. So we have a huge treatment effect, which is actually 8.5 times the effect of the US POINTER trial, 6.5 times the effect of Leqembi, and 3.5 times the effect of Kisunla. So this is far better than anything that has been looked at and published previously. And yes, you're going to have people be skeptical until they see it for themselves.

   5. RCDr. Rangan Chatterjee3:07

      Yeah. Dale, you mentioned a lot there, including the new research that's coming out.

   6. DBDr. Dale Bredesen3:12

      Yes.

   7. RCDr. Rangan Chatterjee3:13

      And we're, we're gonna try and get through to everything in this conversation, but I wanna take things step by step. So let's just kind of break this down from the top, okay?

   8. DBDr. Dale Bredesen3:23

      Yeah.

2. 3:24 – 7:32

   Why waiting for dementia is the biggest mistake: the 4-phase Alzheimer’s timeline

   1. RCDr. Rangan Chatterjee3:24

      So for many years, Dale, it has been assumed that Alzheimer's is, for many people, an inevitable part of aging, and also-

   2. DBDr. Dale Bredesen3:37

      Mm-hmm

   3. RCDr. Rangan Chatterjee3:37

      ... if and when it happens, there's nothing you can do about it. Okay? So that's a belief that I still think unfortunately exists out there, um, and you're saying that's simply not true, right?

   4. DBDr. Dale Bredesen3:52

      Exactly, yes. And in fact, as we now understand this better, we can see exactly why that has happened. And, and let me just state for one moment that part of the problem here is when you wait for the dementia phase, which is the fourth and final phase, of course it's more difficult. It's, it's as if you said, "We're not gonna call it cancer until it's widely spread throughout your body. Okay, what do we do to cure cancer?" Well, the best thing we can do to cure cancer is to prevent it to begin with or treat it very early on. So when you develop Alzheimer's disease, you go through four phases, and Alzheimer's is a pathology. The first phase, you're entirely asymptomatic, and you can already begin to pick up markers, biochemical markers such as phosphotal, that will tell you, yes, you're in the early throes of this, just like you would pick up insulin resistance as you're headed for type 2 diabetes. Same idea. The second phase is called SCI, subjective cognitive impairment, and that lasts on average ten years. What that means is you know that something's not quite right, but you're still able to pass the normal cognitive test. You still score well on cognitive testing. The third phase is MCI, mild cognitive impairment, where by definition, you're now scoring abnormally on cognitive tests, but you still are able to perform your activities of daily living, so you don't have dementia yet. The fourth and final phase is dementia. Nobody should wait that long anymore. We have fantastic early tests. We have the ability to reverse the cognitive decline, especially in the early stages. No surprise, the more you wait, the more difficult and less complete the outcome tends to be. But we do have people now, as I mentioned earlier, uh, who are, you know, 13 years. We started in, uh, 2012, so 13 and a half years is the, the first patient, um, and she's still doing very, very well. Now, she didn't wait until she was in late stage dementia, thankfully, and the ones that we are improving in our trial are in the MCI and early dementia phase, very much the same as in the drug trials.

   5. RCDr. Rangan Chatterjee6:07

      Yeah, this is, this is, this is amazing, Dale. Right? So you mentioned these four phases, okay? So-I just wanna make sure we've landed this point. So people who listen to my show regularly will know this idea that in modern medicine we tend to get involved quite late. We often wait for-

   6. DBDr. Dale Bredesen6:25

      Yeah

   7. RCDr. Rangan Chatterjee6:25

      ... symptoms and disease before we start treating you. Type 2 diabetes being a classic example whereby you may have been living with insulin resistance for maybe 10 years before you get a diagnosis, but we, we say, "Oh, your tests are normal, your labs are normal," until your HbA1c, the average marker of your blood sugar, tips into the diabetic range. At that point we say, "Hey, you've got type 2 diabetes, let's treat you." So I think listeners to my show are familiar with that concept, and what you're now saying, Dale, is that Alzheimer's dementia follows the same type of process, right? And actually we're getting involved in stage four, but actually you're saying your work is helping people in stage three and early stage four. But what's really exciting is that there are these two stages before that, asymptomatic and then subjective cognitive impairment, which lasts up to 10 years, that second phase, right?

   8. DBDr. Dale Bredesen7:31

      Yeah.

3. 7:32 – 9:52

   Catching stage 1 early: blood biomarkers, scans, and what to test over time

   1. RCDr. Rangan Chatterjee7:32

      What a window of opportunity. So let's just go back to, to stage one then. Asymptomatic. Because I think a lot of people aren't even aware of this. How on earth can we pick things up in stage one?

   2. DBDr. Dale Bredesen7:46

      Yeah. So there are a number of ways now. You can pick it up with abnormal blood testing now. A- as you know, just within this past year, phospho-tau, Abeta 42 to 40 ratio, GFAP and NfL have emerged as simple blood-based biomarkers. So I had mine checked just a couple of months ago at my kitchen table. You can get your blood drawn very simply and see whether you have this. We, we have a set of tests we call, we call Brain Scan, but it's a, a simple idea. You can get phospho-tau at many, many different laboratories and there are some very sensitive ones, um, that can look to see, "Okay, Rangan, are you in the earliest stages or not?" And you know, people say, "Well, I don't wanna hear the A word. I don't want to know where I stand." But this is no different than knowing that you've got early insulin resistance, and down the road you could develop type 2 diabetes. The earlier you find out, the better. Now secondly, you can also have a spinal tap. That's been known for years, but who wants a spinal tap and do, do that every few years? You could also do a PET scan, an amyloid PET scan or an FDG PET scan or a tau PET scan, any of those. Uh, you can also do something called ASL. This is a MRI approach, arterial spin labeling, which is very sensitive. We're looking at slight changes in blood flow in specific regions of the brain that correlate with Alzheimer's disease. So there are lots of ways for people to find, and the easiest is the blood-based biomarkers. And my argument, and I mention it in the book, every five years, check your markers just like you'd check for insulin resistance. Don't allow yourself to get to that fourth phase. And I should mention, in the first two phases, we don't see people, when we treat those, we don't see people progress. They do well. So the people who are asymptomatic, we've never had someone treated optimally who then goes on to develop dementia.

   3. RCDr. Rangan Chatterjee9:43

      Yeah.

   4. DBDr. Dale Bredesen9:43

      With SCI, virtually 100% of these people improve and stay improved. So again, early, it's the, that's the key.

4. 9:52 – 13:34

   Genetics isn’t destiny: why knowing ApoE status matters

   1. RCDr. Rangan Chatterjee9:52

      This is really exciting. Okay. So, Dale, one of the other prevailing ideas out there, and it was certainly there when I was at medical school, or certainly as a junior doctor, the school of thought was there's no point checking because if you find out you've got the genes that increase your risk of dementia, what on earth are you gonna do about it? So instead of living with that weight behind you your entire life, why not enjoy your life and actually-

   2. DBDr. Dale Bredesen10:20

      Yeah

   3. RCDr. Rangan Chatterjee10:20

      ... get the best out of life that you can before fate delivers its, you know, its harsh blow or however you wanna look at it. But essentially what you're saying is that belief system is there because people think and thought that you can't do anything about it. If you change that belief, if suddenly it's like, wait a minute, there is so many things we can do. A lot of them are quite simple actually. We'll get to all of the practical things shortly.

   4. DBDr. Dale Bredesen10:51

      Mm.

   5. RCDr. Rangan Chatterjee10:51

      If you know that there are things that you can do about it, well, the early testing then has huge value because if you're starting to move up that continuum-

   6. DBDr. Dale Bredesen11:01

      Yeah

   7. RCDr. Rangan Chatterjee11:01

      ... you can do something about it. You can go, "Wait a minute, I'm not gonna wait 30 years now until I get Alzheimer's like my mom or like my auntie or my uncle," whatever it might be, it's, it could be the extra bit of motivation someone needs in their 30s and 40s to start making changes to their lifestyle.

   8. DBDr. Dale Bredesen11:19

      That's exactly right, and that is, I think, one of the most important points because just what you said, because there has been nothing that can be done, and the belief by many is that that's still the case. Everything has been backward, and so this is what we are trying to fix. They say, "Don't check your genetics because nothing can be done. Don't check to see where you stand. Don't check to see until late. If you've got problems, it's probably not Alzheimer's. If it gets worse, come in." And I've seen so many people went into the doctor year after year and they said, "Well, you're not that bad yet. Come back next year." And then finally they come back and say, "Well, now, yes, you are bad, and there's nothing we can do about it." This is really sad to see, and it no longer has to be the case. So now we need to change everything. Yes, you need to check your genetics. Everybody should know their genetics if they're 35 years of age or older.Yes, you should check your status. What is your p-tau? What is your Aβ42 to 40 ratio if you're 35 years or over? And I recommend checking it every five years so that you can see things coming. You know, I've said to my wife, who, who's a huge fan of yours, uh, Dr. Lachine, uh, I've said to her, "You know, uh, Alzheimer's is becoming optional. If you just check it early, if you just look, you don't have to allow this to progress until that third and fourth phase." And she says, "No, that's too radical. You cannot say that." Well, the reality, that's what the data show. If we check early, if we use the appropriate tests, if we get on the appropriate therapeutic, uh, early on, um, there's no need to progress to that final stage of dementia. And that is what doctors have not recognized yet, have not admitted yet, despite the fact that, in fact, publication after publication is showing exactly that. Just as things like, well, look what Pap smear did for cervical cancer, from a highly, a, a disease with high morbidity and mortality to a disease with very little morbidity and mortality. That's what's happened. Look what happened with pre-diabetes. The same thing is now happening with cognitive decline, and we need to recognize that and act on it.

5. 13:34 – 16:25

   Training and implementation gap: why outcomes vary by clinic and clinician

   1. RCDr. Rangan Chatterjee13:34

      Yeah. It's ... I'm just trying to think through this issue and really trying to get my head round why there is such a difference between where the scientific literature is and where current clinical practice is, because that gap is widening all the time, Dale. It's, it's really frustrating on many levels, isn't it?

   2. DBDr. Dale Bredesen14:02

      It's very frustrating. I, I completely agree with you. Now, as you know, Rangan, we, we've now trained over 2,000 physicians in 10 different countries and all over the U.S. and yet the standard of care does not include this approach, and therefore, there are many people who are declining needlessly. Now, when we've looked at our clinical trials, in our first trial, 84% of people improved, and that's even at the stage three and early stage four, as I mentioned earlier. Um, in general practice, we're finding it's more like 50%. Of course, the, the more you've got people who are really up to snuff, the g- more you've got a wonderfully trained team, the better your outcomes are, and of course, the earlier you start.

   3. RCDr. Rangan Chatterjee14:45

      You said general practice. What does that mean?

   4. DBDr. Dale Bredesen14:48

      So in other words, when we look ... So we, we've looked within a trial itself, but then what we've done is we've also collected the data through Apollo Health, which has been, which has worked with me on the algorithms, and we've collected the data from all the different trained doctors. And when we look at those data, we don't see the 84% of people improving. We see about 50% of the people improving. And w- the other thing that's happened is quite interesting. In our current trial, we have six different sites, as I mentioned earlier. Four of the sites are getting spectacular improvements, people going, you know, from a MoCA of 18 to a perfect 30, you know, dramatic improvements. The other two sites, we're not seeing improvement. And in one case, it turned out the doctor had relegated the cases to, uh, to an underling physician who hadn't had the training.

   5. RCDr. Rangan Chatterjee15:41

      Yeah.

   6. DBDr. Dale Bredesen15:41

      So this, doing this, as you know yourself, is much more like surgery than prescription pad medicine. It's not a simple, "I just write a prescription and then, then that's all-

   7. RCDr. Rangan Chatterjee15:51

      Yeah

   8. DBDr. Dale Bredesen15:51

      ... that's all I need to do." It is being a psychologist, getting people to do the appropriate things, convincing the family that they need to do this-

   9. RCDr. Rangan Chatterjee16:00

      Yeah

   10. DBDr. Dale Bredesen16:00

       ... knowing what are the critical pieces. As you mentioned earlier, there are dozens of things that contribute to this, and so for each person, there's a different rate-limiting step. For some people, it's a chronic infection. For some people, it's changes in the oral microbiome. For some, it's sleep apnea, and on and on down the list. So identifying and addressing those critical pieces is important for getting the best outcomes.

6. 16:25 – 23:31

   Measuring cognitive change: MoCA, what scores mean, and real-world turnarounds

   1. RCDr. Rangan Chatterjee16:25

      Yeah. Okay. Um, you mentioned MoCA score there in 18 to 30.

   2. DBDr. Dale Bredesen16:31

      Yes.

   3. RCDr. Rangan Chatterjee16:31

      For, for people who've never heard of that term, what is MoCA and, you know, what is the relevance of going from 18 to 30?

   4. DBDr. Dale Bredesen16:41

      Great point. So MoCA means Montreal Cognitive Assessment. It's a simple, about 12-minute or so, uh, a cognitive assessment of patients, and of course, we can do much better with more sensitive tests. So the one we use is called CNS Vital Signs, and there are many others, many cognitive tests and neuropsychological assessments. But a MoCA is a quick way that people look to see where do you stand. Now, a n- normalcy will be typically from 26 to 30. I- in reality, most people who are already down to 26 probably do have some ear- early disease.

   5. RCDr. Rangan Chatterjee17:17

      W- would you, would you expect someone like me to have a 30, for example?

   6. DBDr. Dale Bredesen17:21

      Yes. You, you might get a 29 or a 30. If you didn't sleep last night, you might forget one of the-

   7. RCDr. Rangan Chatterjee17:26

      Okay

   8. DBDr. Dale Bredesen17:26

      ... so five of the points are for, for memory. Um, you might miss one of the memory points if you had no sleep the last couple nights. But yes, 29 or 30.

   9. RCDr. Rangan Chatterjee17:33

      Got it. So 29, 30 is what you wanna see. Okay.

   10. DBDr. Dale Bredesen17:35

       Yeah.

   11. RCDr. Rangan Chatterjee17:35

       And if someone's down at 18, what, what does that mean?

   12. DBDr. Dale Bredesen17:39

       So 18 is associated with that fourth and final stage. So in typically the-

   13. RCDr. Rangan Chatterjee17:43

       Wow

   14. DBDr. Dale Bredesen17:43

       ... the MC, the, the SCI people are still gonna score that 26 to 30. The, uh, MCI people are typically scoring 25 down to around 20, and it depends, again, a little bit on when you start to lose your activities of daily living. When you're down into the teens, then that is dementia. So these are people who had early stage dementia who nevertheless were able to score a perfect 30 after treatment.

   15. RCDr. Rangan Chatterjee18:11

       Okay. Okay. Dale, I have to stop you there. That, that is ... I just wanna emphasize what you just said, right? So-You know I'm passionate about this, Dale, right?

   16. DBDr. Dale Bredesen18:19

       Yeah.

   17. RCDr. Rangan Chatterjee18:19

       I really want the ... I want everyone listening to really understand how profound what you're saying is compared to what has been believed around dementia, and in particular Alzheimer's dementia, for, for decades now. You're saying that these four stages, stage one, asymptomatic, okay?

   18. DBDr. Dale Bredesen18:40

       Yes.

   19. RCDr. Rangan Chatterjee18:40

       So you don't have symptoms by definition, but you're saying even then you can pick up some markers, some blood markers. And we'll go into those in detail a bit later.

   20. DBDr. Dale Bredesen18:49

       Yeah.

   21. RCDr. Rangan Chatterjee18:49

       The second stage, subjective cognitive impairment, which can last up to 10 years. But, you know, these are things where people are not being identified. I- I- In SCI, they're going to their doctor maybe saying, "I'm sort of ... You know, I can't find my keys. You know, I can't quite remember things."

   22. DBDr. Dale Bredesen19:05

       Yes.

   23. RCDr. Rangan Chatterjee19:05

       But that can last 10 years. Stage three, mild cognitive impairment, where you are scoring abnormally on this MoCA score, but you can still engage in activities of daily living, shower yourself-

   24. DBDr. Dale Bredesen19:18

       Mm

   25. RCDr. Rangan Chatterjee19:18

       ... go to the toilet-

   26. DBDr. Dale Bredesen19:19

       Mm

   27. RCDr. Rangan Chatterjee19:19

       ... whatever it might be. And then stage four, dementia. You're basically saying that there's many cases where they've gone from 18, which is, you know, a significant impairment in your cognitive function-

   28. DBDr. Dale Bredesen19:32

       Yes

   29. RCDr. Rangan Chatterjee19:32

       ... all the way back to 30.

   30. DBDr. Dale Bredesen19:35

       Yeah. I'm not saying many cases, I'm saying we see it repeatedly.
7. 23:31 – 32:47

   ApoE4 as evolutionary ‘mismatch’: helpful in high-infection settings, harmful in the West

   1. RCDr. Rangan Chatterjee23:31

      Yeah. Let's go back to genetics for a second. We've mentioned-

   2. DBDr. Dale Bredesen23:35

      Yeah

   3. RCDr. Rangan Chatterjee23:35

      ... ApoE. People have heard ApoE4, ApoE3.

   4. DBDr. Dale Bredesen23:39

      Mm.

   5. RCDr. Rangan Chatterjee23:39

      Um, can you just take us through genetics, what they actually mean, and why you think it's important that we all know our own genotype with respect to this?

   6. DBDr. Dale Bredesen23:50

      Yeah. So as I mentioned earlier, everybody should know their genotype. There are actually about 100 different genes that increase your risk or decrease your risk for developing Alzheimer's disease, but as you mentioned, ApoE4, so the, uh, apolipoprotein E, which is a fat-carrying protein, uh, is the one that's the most common, and it's the most important genetic risk factor for cognitive decline. Now, if you have zero copies, so for example, I checked myself, I'm an ApoE33, which is kind of vanilla. It's the common one. Three-quarters of the population is ApoE4 negative. My risk throughout my lifetime is about 9%. It's not zero, but it's not terribly high.

   7. RCDr. Rangan Chatterjee24:34

      Is that 9% based upon-Current modern lifestyles

   8. DBDr. Dale Bredesen24:39

      Yes

   9. RCDr. Rangan Chatterjee24:39

      Yeah. 'Cause I think that's a key point. If you weren't proactive about your health-

   10. DBDr. Dale Bredesen24:43

       Yes

   11. RCDr. Rangan Chatterjee24:43

       ... and your brain, if you just lived as most people live, if you're an ApoE33, it's only 9% risk of getting Alzheimer's.

   12. DBDr. Dale Bredesen24:53

       That is correct. And, and it is important to point out that when all these, these numbers have been collected, uh, with epidemiological studies that have had people doing, you know, old-fashioned, uh, lifestyles and those sorts-

   13. RCDr. Rangan Chatterjee25:06

       Yeah

   14. DBDr. Dale Bredesen25:06

       ... of things, and not being treated appropriately. Then, you know, our hope is, of course, to get this as close to zero as possible. Now, if you have a single copy, and that's one quarter of the population. So here in the U.S., about 75 million people have a single copy. Most don't know it, unfortunately, until they get symptoms. Your risk, lifetime risk is about 30% that you will develop Alzheimer's disease. And if you have two copies, you are homozygous for ApoE4, and that's about seven million Americans, then your lifetime risk is about 90%. Most likely you will develop Alzheimer's disease. And therefore, we'd like everyone to know and everyone to get on active prevention so that they reduce that 90% as close to zero as possible. I wanna add one thing. We've just documented to, which again I believe is the first, where someone who's ApoE44, this is a 67-year-old man, ApoE44, already had MCI. He's been treated for the last few years on the protocol. He's done very well. His ASL, so his symptoms have improved, but what's striking is his ASL, this arterial spin labeling, very sensitive test for Alzheimer's, highly abnormal in the past. As of this year, it is completely normal, a completely normal ASL. So that was so striking to see. I hope to see that many more times.

   15. RCDr. Rangan Chatterjee26:42

       Yeah. Th- this is amazing, Dale. That case in particular is fascinating given what you've just said. So ApoE44, so you have two copies. There's a 90% risk of getting Alzheimer's, hence the belief, don't get your testing done because you don't want to live knowing that there's only a one in 10 chance you're not gonna get this condition. That was based on old science. The new science says, "No, no, no. It's even more important to know if you're ApoE44 because you need to get in the cognition game early." So that chap was already at stage three, right?

   16. DBDr. Dale Bredesen27:21

       Yeah.

   17. RCDr. Rangan Chatterjee27:21

       Symptoms get better and brain scan gets better. Utterly remarkable. I'm pretty sure, Dale, when I first met you, you told me that ApoE44 increases your risk of dementia in the West. But did you say, did you say to me that maybe in Africa and in different environments, it lowered your risk and it was all to do with, you know, infection risk and the terrain? You know, c- could you remind me what you told me?

   18. DBDr. Dale Bredesen27:50

       Yeah. So the point was that ApoE4 turns out it's not just, you know, the, the butcher who carries your fat. Um, it is also your senator who's making the laws of the land. That is to say it's a transcription factor. It is a transcriptional repressor. So it actually changes the programming in your cells toward being more pro-inflammatory, and this is actually, this appeared w- with the, with evolution as we went from the simians, which do not have ApoE4, they have an, a, a chimp version of ApoE, to the hominids, where there is now ApoE4 was the primordial ApoE. In fact, for 96% of our evolution as hominids, ApoE4 has been the only one. ApoE3 just appeared 220,000 years ago in our evolution, and ApoE2 just appeared about 80,000 years ago.

   19. RCDr. Rangan Chatterjee28:46

       Wow.

   20. DBDr. Dale Bredesen28:46

       So in fact, these pro, this pro-inflammatory effect, if you are a Tsimane in Bolivia, you actually do better if you're ApoE4 positive.

   21. RCDr. Rangan Chatterjee28:57

       Hmm.

   22. DBDr. Dale Bredesen28:57

       You've got that ability, for example, to eat uncooked food full of microbes.

   23. RCDr. Rangan Chatterjee29:02

       Yeah.

   24. DBDr. Dale Bredesen29:02

       If you're going to puncture your, uh, feet with, and you have a wound, then you're gonna do better as an ApoE4. If you go for periods of starvation, you're going to do better as an ApoE4. But in the first world, where we don't typically have those problems, at least they're not lifespan limiting, then in fact you have that pro-inflammatory state which does give you a slightly shortened lifespan, a shortened brain span. And so we can do something about that.

   25. RCDr. Rangan Chatterjee29:30

       Yeah.

   26. DBDr. Dale Bredesen29:30

       Understanding what's going on, now we can do something about that.

   27. RCDr. Rangan Chatterjee29:33

       Yeah. It, it's so thought-provoking thinking about that, right? That for the bulk of our evolution, we had ApoE4, and it actually helped us. In an environment-

   28. DBDr. Dale Bredesen29:43

       Yes

   29. RCDr. Rangan Chatterjee29:43

       ... where there's infection risk everywhere, where we-

   30. DBDr. Dale Bredesen29:46

       Yep
8. 32:47 – 41:36

   Systems biology and the ‘36 holes in the roof’ model: why one drug isn’t enough

   1. RCDr. Rangan Chatterjee32:47

      and canister with your first subscription, go to drinkag1.com/livemore. Okay, I wanna get to the three big buckets which cause Alzheimer's, so energetics, inflammation, and toxins.

   2. DBDr. Dale Bredesen33:06

      Right.

   3. RCDr. Rangan Chatterjee33:07

      I wanna get to the treatment strategies, you know, the seven basics and the two specifics.

   4. DBDr. Dale Bredesen33:13

      Yeah, yeah.

   5. RCDr. Rangan Chatterjee33:13

      Before we do that, though, I just wanna really make sure we've addressed this key point, uh, which I think we both tried to address at the start, which is that the way you manage this complex disease is by addressing multiple factors. So, and, and I know this is one of the problems you had initially when you submitted your first trial for publication.

   6. DBDr. Dale Bredesen33:41

      Mm-hmm.

   7. RCDr. Rangan Chatterjee33:41

      I think they came back to you and said, "Yeah, Professor Bredesen, this is, this is great, but you've changed more than one thing," right?

   8. DBDr. Dale Bredesen33:47

      Yeah.

   9. RCDr. Rangan Chatterjee33:47

      'Cause I think you changed three or four things in that trial from recollection, and this is the kind of paradigm shift that's required in our profession and with the public to really ... for, for them to really understand just why your work is working so well. It isn't a case of, "You have Alzheimer's. Let's just change this one. Let's try this drug. Does it work? Does it not?" And I think one of the best ways of describing it is your 36 holes in the roof analogy, which, which-

   10. DBDr. Dale Bredesen34:17

       Yeah

   11. RCDr. Rangan Chatterjee34:17

       ... I always thought was beautiful. So can you just speak to that? Because I still don't think the public and our profession really have made that paradigm shift yet in how they look at disease.

   12. DBDr. Dale Bredesen34:30

       Yeah, this is a really good point. So of course we're all trained that if you're going to go out and do a, a scientific experiment or a clinical trial, you change one variable. So you have one group that doesn't have the variable, one group that does have the variable. You compare them and say, "Aha, this is what that variable did." Okay, that works great if you have a system that is a simple linear system, but now we're looking at network function. The brain is complicated. You have about 500 trillion synapses there. We're now saying that the supply is not meeting the demand, so we'd better determine all the things that are reducing the supply and all the things that are increasing the demand. Just as you were saying, various inflammatory processes and toxic processes and energetic processes. We better identify those and address them, and so we're now looking at network. It's a little bit like, Rangan, if you took your car in and you said, "Hey, my car just stopped. I have no idea why." Um, it could be that you've got ... you've run out of gas. It could be that you had some ... you know, you lost your oil, and it's just a, a ... you've got a problem there. It could be that you've got problems with your transmission. All sorts of things. So if, if everyone said, "Well, what we do when a car comes in that's not working is we just fill it up with gas," and some of the cars start working again. Yeah, some of them do.

   13. RCDr. Rangan Chatterjee35:54

       [laughs]

   14. DBDr. Dale Bredesen35:54

       But most of them don't. So you've got to look at all the different possibilities, and what we find is, as you know, some people it's more that they're, they have a pro-inflammatory state. For some people, they've had a lot of toxic exposure. Interestingly, in almost no one is it one thing. They usually have some metabolic problems. They often have l- uh, gut damage that you have spoken so eloquently about over the years. Um, they've got chronic infections. Uh, we'll find people, for example, uh, who have, you know, P. gingivalis, a change in their, uh, oral microbiome with some periodontitis, which has been associated. Some people, they've had a lot of exposure to air pollution. Um, just on and on and on. Sleep apnea, a very common one, and people ... It, it's been pointed out that about 80% of sleep apnea goes undiagnosed.And so with all the many things that that increases risk for hypertension and cardiac disease and all this sort of stuff, it also increases risk for cognitive decline. So what we do then is, with each person, we're going to look at your network, look at all the different things that, uh, contribute to it, and then we're going to optimize each of those. We want to improve the energetics, reduce these inflammatory, uh, uh, inducers, these inflammatory, uh, markers. We wanna reduce the toxin exposure. We see it all the time. By the way, just recently, uh, Bill Shaw, who's the one who started GPL Toxic- Toxicologist m- many years ago, uh, pointed out... He looked at our first trial, uh, with just some data mining, and showed that the, the, uh, the mean of the ochratoxin A in the... So that's wh- this is a toxin from mold species, was 50 times higher, actually it was the median in his case, was 50 times higher than normal background. So these were people who had a very much of a high exposure to these particular biotoxins.

   15. RCDr. Rangan Chatterjee37:53

       Yeah.

   16. DBDr. Dale Bredesen37:53

       And by the way, those particular ones, ochratoxin A, that particular one happens to target the hippocampus of all places, the very area that is often abnormal in Alzheimer's disease. So you've gotta look and you've got to address those things to get the best outcomes.

   17. RCDr. Rangan Chatterjee38:09

       Yeah. And I think a key point there is that sometimes people will say things like, "Oh, I tried that, it didn't work."

   18. DBDr. Dale Bredesen38:17

       Yeah.

   19. RCDr. Rangan Chatterjee38:18

       But actually that is, even that statement is misinformed. Not willingly misinformed-

   20. DBDr. Dale Bredesen38:24

       Mm

   21. RCDr. Rangan Chatterjee38:24

       ... but unknowingly misinformed. Because it's not like, "Oh, I tried that one thing, it didn't work."

   22. DBDr. Dale Bredesen38:31

       Right.

   23. RCDr. Rangan Chatterjee38:31

       Um, "Let me try something else now." Um, it's like, no, no, hold on. Maybe that thing that you tried was 12% of it, right?

   24. DBDr. Dale Bredesen38:39

       Mm.

   25. RCDr. Rangan Chatterjee38:39

       And maybe you need to do something else that's another 7% of it. I know it's not linear like that, right? The body doesn't work-

   26. DBDr. Dale Bredesen38:44

       Right

   27. RCDr. Rangan Chatterjee38:44

       ... like that. But, you know, one of the things I always remember about this analogy that you used, you know, there's 36 holes in the roof. A pharmaceutical might address one of those holes, but what about the other 35?

   28. DBDr. Dale Bredesen38:55

       Right.

   29. RCDr. Rangan Chatterjee38:55

       The other thing you said, which I think is really empowering, is that even if there are 36 different causes, you probably don't need to address all 36. You just need to address enough, maybe that's six, maybe it's seven-

   30. DBDr. Dale Bredesen39:09

       Mm
9. 41:36 – 52:27

   The 3 major buckets driving Alzheimer’s risk: energetics, inflammation, toxins

   1. RCDr. Rangan Chatterjee41:36

      ... for people to think. Could you just go through those three buckets and explain top line what they mean?

   2. DBDr. Dale Bredesen41:43

      Yeah. So there are three, as you mentioned, three major groups of things that contribute to this cognitive decline. The first one is energetics. So you need appropriate blood flow. You need appropriate, uh, oxygenation. You need appropriate mitochondrial function. You need enough support, uh, energetically to make that brain work with all its 500 trillion synapses. So w- we, so no surprise, we can, you can pick out the things that affect that. People with sleep apnea, that's no longer working correctly. People with reduced blood flow, people who are not exercising, people who are, who have some degree of vascular disease, that is reducing the support. People with any sort of mitochondrial damage over the years from various, you know, mitochondrial toxins that people have ingested or been exposed to. Biotoxins are-... common causes of reduced mitochondrial function. Um, and by the way, you know, we, we saw this in the trial that, um, some of the people who were in the control group, because their doctors knew, "Oh, wait a minute, they're on this trial, I'm gonna look for some of these things," there was a lot of cheating going on in the control group. [laughs] So we had ... This, understandably, people say, "Hey, I, you know, I don't, I don't wanna be part of the control group. I wanna do the best I can." And so for example, one of them found out during the, the, during the time, "Oh, wait a minute. I, I, I do have sleep apnea after all."

   3. RCDr. Rangan Chatterjee43:08

      [laughs]

   4. DBDr. Dale Bredesen43:08

      "I'm gonna treat my sleep apnea." And boom, j- just that alone helped the person get some degree of improvement. You can see then optimizing these things, um, is gonna be even better. So energetics, that's the first big bucket, and anything that affects that, as I said, you know, vascular disease, sleep apnea, mitochondrial dysfunction, any of these things will change that. The second big bucket is anything that produces systemic inflammation. And as you know, a very common one is metabolic syndrome. There are about 100 million Americans who have metabolic syndrome, where they've got, you know, in- increased insulin resistance, dyslipidemia, the, kind of the classics, often some extra weight, hypertension. This, this runs together as part of metabolic dysfunction. And one of the things that is included there is a pro-inflammatory state, and this is a common, common contributor. In fact, if you have metabolic syndrome, you have a several-fold increase in your risk for cognitive decline associated with Alzheimer's disease. So th- th- ... So lots of re- ways that you can get systemic inflammation. We see it all the time with tick-borne illnesses, Borrelia, Babesia, Bartonella, Ehrlichia, Anaplasma. Any of the tick-borne illnesses increase your risk for inflammation. Uh, changes in oral microbiome, as I mentioned earlier, another one. Leaky gut that you talked about so nicely years ago, uh, at our course, uh, th- that's another one. So that's the second big bucket. You've gotta look for those. You've got to address them. And then the third big bucket, as you mentioned, is anything that is giving you exposure to toxins, and they come in three different types. There's the inorganics, and there's a lot of evidence now that air pollution increases your risk. So here in California, the California fires, a big issue for us. We are, during those times, um, uh, breathing in air, um, that is actually potentially damaging to our cognition, and there's actually now-

   5. RCDr. Rangan Chatterjee45:16

      Mm

   6. DBDr. Dale Bredesen45:16

      ... a fair amount of research on this, especially the so-called PM2.5, the small-

   7. RCDr. Rangan Chatterjee45:21

      Yeah

   8. DBDr. Dale Bredesen45:21

      ... particulate matter that's associated with cognitive decline. Uh, so th- it's those, and mercury is another big one. Um, interestingly, at the heart of Alzheimer's, this APP, amyloid precursor protein, which is the parent of the amyloid that we associate with Alzheimer's, it's amazing because it is a- at a nodal site for toxicity. It interacts with multiple metals, for example. It interacts with copper and zinc and, and iron and things like that. Um, and actually Professor Ashley Bush, uh, from, uh, Australia, uh, has done beautiful work over the years looking at the relationship between APP and amyloid and metals. Um, then you've got also things, uh, like, like the, the second group, which is of the three here. So the, so the toxins are inorganics, organics, uh, and this is toluene, benzene, glyphosate, things like that. And of course the big one everyone's concerned about currently is microplastics. And there's no question now from the data that microplastics accumulate in the brain more so than the liver or kidney, that they are associated. People who have high degrees of microplastics in their brain have an increased risk for cognitive decline. What's not yet clear is what's cause and effect, whether it's associated but not causal, or whether it's actually causal, or both. Uh, so that's, that's the organic set. And then the third group within the toxins, uh, is the biotoxins, so things like trichothecenes. I mentioned ochratoxin A earlier, uh, and, uh, gliotoxin and things like this that we're getting typically from mold species. So again, people will say, "Oh, come on, molds are everywhere." Yes, they are, but there are some people who are particularly sensitive to them who get this chronic inflammatory state and have damage from their mycotoxins. It's a common contributor-

   9. RCDr. Rangan Chatterjee47:20

      Yeah

   10. DBDr. Dale Bredesen47:20

       ... to cognitive decline.

   11. RCDr. Rangan Chatterjee47:22

       Yeah. Thank you. So [sighs] it, it's funny hearing that, I imagine is going to be quite scary for a lot of people because what you basically just outlined is the bulk of the problems in the modern world when it comes to health [laughs]

   12. DBDr. Dale Bredesen47:40

       Yeah.

   13. RCDr. Rangan Chatterjee47:40

       Right?

   14. DBDr. Dale Bredesen47:40

       Yeah.

   15. RCDr. Rangan Chatterjee47:41

       And we know from the data just how many people are sick these days and are struggling with a variety of, of these sort of conditions that you just mentioned. And although you're mentioning them through the lens of brain health and cognition and Alzheimer's, I mean, the truth is [laughs] if you address those three big buckets, you're not just gonna improve your brain, you're gonna improve virtually every other aspects of your health as well, right? The, it seems like the brain is almost the, the end organ, you know, the, the, the sort of-

   16. DBDr. Dale Bredesen48:16

       Yeah

   17. RCDr. Rangan Chatterjee48:16

       ... final organ to fall. You know, we get, we get those ... We used to get those diagnoses in our-

   18. DBDr. Dale Bredesen48:22

       Mm-hmm

   19. RCDr. Rangan Chatterjee48:22

       ... 70s, our 80s, maybe- and I know that's coming back to 60s and 50s now, right? It's as if the rest of the body can just about tolerate it and put up with it. The brain's just about holding on until it can no longer hold on. Um, you know, inflammation, sleep problems, mitochondrial damage, uh, oral microbiome issues, leaky gut and gut health issues-

   20. DBDr. Dale Bredesen48:47

       Yeah

   21. RCDr. Rangan Chatterjee48:47

       ... mold, air pollution, these are all things that many of us are being exposed to or struggle with.This is gonna get very empowering because you're gonna show us shortly just how much there is that we can do to help with these things, right? Um, but I just wanna tie in genetics just for a minute here. You mentioned the genetics of ApoE before-

   22. DBDr. Dale Bredesen49:13

       Yes

   23. RCDr. Rangan Chatterjee49:13

       ... and how important it is in your view that people understand it so they can take appropriate action early. But let's just say toxins, for example. You just mentioned mold, right? Um, or even things like air pollution and microplastics. Genetics plays a role here as well because I think we are living in an increasingly toxic world.

   24. DBDr. Dale Bredesen49:36

       Yeah.

   25. RCDr. Rangan Chatterjee49:36

       But the truth is, some people genetically I think are better able to deal with these toxins than others. Some of us just aren't very good with detoxifying these toxins from our environment. So are there any... First of all, do you agree with that? And secondly, if you do, are there any specific genetic tests that you recommend where we can actually determine what is our detoxification status?

   26. DBDr. Dale Bredesen50:00

       Yeah.

   27. RCDr. Rangan Chatterjee50:00

       And do we need extra work here compared to someone who perhaps doesn't have the same genetics as we do?

   28. DBDr. Dale Bredesen50:06

       There's no question. We see it again and again and again. For example, you'll often see a husband and wife living together in a home that turns out to have a high degree of mycotoxins, and the husband or wife will become demented. The other one will not, and so they'll say, "Well, how can this be something that's in our home-

   29. RCDr. Rangan Chatterjee50:25

       Mm-hmm

   30. DBDr. Dale Bredesen50:25

       ... because we both live here?" Well, it turns out that genetically, for example, the one who's got the dementia has a null mutation in the GSTM1 gene, as an example.
10. 52:27 – 1:05:27

    The 7 basics for brain span: diet, movement, sleep, stress, training, detox, supplements

    1. RCDr. Rangan Chatterjee52:27

       Yeah. Thank you for that overview. I mean, part of me really wants to go deeper into energetics, inflammation, and toxins, but I think we just hold it there at the moment and move into treatments. If we've got time, we'll, we'll go a bit deeper into each one of those three, or we'll save it for a part two conversation 'cause I wanna make sure in this conversation, Dale, that everyone listening understands first of all that Alzheimer's can... There is something you can do about Alzheimer's, that earlier-

    2. DBDr. Dale Bredesen52:57

       Yeah

    3. RCDr. Rangan Chatterjee52:57

       ... you start picking this stuff up, the more you can do. But even if you've already got a diagnosis, there may well be things that you can do. I don't know what's really interesting, you've written multiple books. This new one, The Ageless Brain: How to Sharpen and Protect Your Mind for a Lifetime, is absolutely fantastic, Dale, and, and what I love about it the most is that, A, it's really clear, it's very well-written, but I think for someone like me in my 40s, I can read that and go, I know exactly what I need to do, what I need to test, and what I need to do if I wanna ensure as much as I possibly can that in a few decades' time my brain is still functioning as well as it could do, right? It's, it's, it's that... It's not a doom and gloom book. It's a book that's saying, "Hey, listen, I don't care how old you are, these are the core things you need to do if you want your brain to function as well as it can for the duration of your life," which I'm pretty sure everyone listening to this wants, right? So thank you for writing it, Dale.

    4. DBDr. Dale Bredesen54:06

       Yeah.

    5. RCDr. Rangan Chatterjee54:06

       I, I think it's a, it's, it's a gift to people who, who take the time to read it. In that book, you go through the kinda seven basics and then the two specifics that you want everyone to be thinking about. So would it be okay for you to sorta take us through all that? So yes, this works, I think. I- is it fair to say before you do this that if you're in stage three or stage four, so stage four being you have dementia-

    6. DBDr. Dale Bredesen54:34

       Right

    7. RCDr. Rangan Chatterjee54:34

       ... you wanna be doing these things, but you may need to do extra as well?

    8. DBDr. Dale Bredesen54:38

       Exactly.

    9. RCDr. Rangan Chatterjee54:39

       Whereas if you're in stage one or stage two, if you get dialed in on these seven things, you can make sure you never end up at three or four. I- is that a way of framing it before you go through it?

    10. DBDr. Dale Bredesen54:50

        Yeah, exactly. So this is what the book is about, having a brain span that is l- as long as your lifespan.So, you know, it is so sad, as, as you well know, someone may live to eighty or ninety or, or beyond, um, but their brain span may only be until they're fifty or sixty. Uh, and you mentioned earlier, y-you know, we used to think of this as an, uh, old-timer's disease, you know, sixties, seventies, eighties, nineties. Now that we know what to look for biochemically, uh, you can see changes in the twenties. That's the, that's the surprise. This is not a disease of old people. It's a disease that is diagnosed when you're old, often, uh, but it can start in your twenties and thirties. And so we wanna look early, we wanna treat early. And then just as you said, you start early, it's very easy. Th- th-- You know, this is an easy thing to do. It's the way. Uh, you know, imagine that your oncologist said to you, "Well, Rangan, you know, don't bother to get a chest X-ray, don't bother to, to lo-- don't bother to get a colonoscopy. We only look at things, um, when you've got widely metastatic cancer." You would fire your oncologist. Um, why are we insisting on this in Alzheimer's disease? Well, let's do, let's do the same thing that's been done with cancer and with diabetes and pre-diabetes. Let's look early on. Let's make sure that you never have to progress to get that final stage. That, that's been one of the biggest problems. So as you said, the-- when, when we do this, there are the seven basics that everybody can do. This is optimizing your systemic function so that you have a brain span that is equal to your lifespan, which is hopefully a nice long and happy lifespan. So those are diet, exercise, sleep, stress, brain training, detox, and some targeted supplements. Those are the simple, basic things we can all do. We wanna optimize those things because, again, we're dealing with a network insufficiency. We're gonna bring that network up to snuff. We're gonna quit putting so much drag on it with all the inflammation and the toxicity. So for the diet, the one that has worked best, as you mentioned earlier, is called Ketoflex twelve three. Um, it is a plant-rich. Plants are critical for detox and critical for better lipid profiles and better glycemic profiles, phytonutrient, you know, on and on and on, as you well know. Uh, and so plant-rich, mildly ketogenic diet. We do want, we want metabolic flexibility. As you know, the brain is like a Prius. It can either funct-- Just two things, it functions on glucose, it functions on ketones. You should be able to go seamlessly back and forth. For most of the people that we see who have cognitive complaints, they've lost both. They are now insulin resistant, and they're not capable of making ketones because when your insulin is high, you have insulin resistance, it prevents you from making the ketones. So you've got the worst of both worlds. You know, your brain is sputtering. We want to return both of those, so you're able to utilize glucose, you're able to utilize ketones, and you can go back and forth. The second one is exercise. It's amazing how, uh, how functional, how helpful exercise is, um, and probably the best data on so-called HIIT, high intensity, but if you just combine strength training with aerobics, you get the better blood flow, you get a better insulin sensitivity, you do much better overall. And people will even tell me, "When I do my exercise, I notice I'm sharper than the days when I'm skipping the exercise." Um, very interesting. And of course, people support that even some people have gotten very interested, as you know, in creatine, which supports that, uh, supports those energetics, supports that, uh, the, the, uh, exercise that you're doing, the strength training that you're doing, and has been helpful for cognition. Um, and then the third one is sleep, and it's really underappreciated. So I check my sleep every morning. You know, how much total sleep? We wanna target at least seven hours. How much REM sleep? We wanna target at least ninety minutes. How much deep sleep? We wanna target at least sixty minutes, and by the way, that's particularly important for people who are detoxing. Um, and then, um, what is your SpO2? You wanna make sure that you're ninety-four percent oxygen saturated or above. And with these wearables that everyone's using today, it's simple. You can check and see your status, check and see how you did. Wearables are going to help us for these chronic complex diseases. So that was the third one, sleep. And make sure you don't have sleep apnea. Sleep apnea is a very common contributor to cognitive decline. And then the fourth one is stress, and you mentioned this earlier. Um, you can f- you can trace the molecular pathways from stress to Alzheimer's disease. It is a common contributor. And by the way, one of the things that switches you from connection to protection is stress. So just having that c- that, you know, chronic on... It's not-- The people who have acute stress with resolution are not at the increased risk that the people who have the chronic unremitting stress.

    11. SPSpeaker1:00:08

        Yeah.

    12. DBDr. Dale Bredesen1:00:08

        That's the big problem. We were not meant evolutionarily to handle that. The fifth one then, um, is brain training. And of course, Professor Mike Merzenich, the father of brain training and the one who started Posit Neuroscience and BrainHQ, uh, that has done a great job with that, and they've done, you know, numerous things. And recently, by the way, they have shown, that team has shown that you can e-even see improvements in neurochemistry, in cholinergic markers in the brain through PET scanning just by doing brain training. So the brain training, very helpful, no question about it. But, you know, you don't want to stimulate that brain if you're not supporting it. So we always recommend start by supporting the brain, then start stimulating it. And there are other stimulations, not just brain training. There are things like light stimulation, sound stimulation, you know, microcurrent, all these sorts of things, magnet- magnetic stimulation. These are all ways to get your brain stimulated. When you've got-- When you're already in a good support system, that's great. Then the next one... is detox. And we talked a little bit about the toxicity before, so important. So just some basic detox things. Saunas, the famous study out of Finland that showed that people who were doing five or six saunas per week had a much lower likelihood of developing Alzheimer's than people that were just doing one or two. Uh, and interestingly, in Finland, not too many people are doing zero saunas per week. So, uh, whereas of course in the U.S. that's the most common. So again, detoxing, getting out there, sweating, getting rid of the toxins in the sweat, you know, breathing these out with s- with exercise, having optimal gut function, high f- uh, fiber diet, which is one of the reasons fiber is actually so incredibly important, both soluble and insoluble, optimizing your gut microbiome, so important, these things. And of course, filter- you know, good healthy water. All of these things are critical for optimal detox, and that does definitely make a difference. And then the final one is some targeted supplements. And yeah, if you are low in vitamin B12, uh, if you are high... In fact, the best studies on homocysteine came out of the UK-

    13. RCDr. Rangan Chatterjee1:02:26

        Yeah

    14. DBDr. Dale Bredesen1:02:26

        ... showing that there was li- literally a linear correlation. As your homocysteine goes up higher and higher, your risk for, for loss of brain volume goes up, and in fact that they could show that they could stop that dead in its tracks just by giving support with B12, folate, um, and, uh, B6. And we typically use, you know, active, typically methylfolate, methyl B12 and P5P, uh, pyridoxal 5'-phosphate. Um, and then some people will need to add some trimethylglycine, but for most people they don't. As shown in these beautiful UK studies, you wanna see your homocysteine down at below seven. Um, so many people are walking around, uh, 13, 14, 15, 20, things like that. Um, this is associated with atrophy of your brain, and so we wanna do... So there, there's one example of, uh, supplements. As I'm, I'm sure you've seen the recent paper out of Harvard on lithium, and now those were only animal studies, but people have known for years that lithium is important for optimal mental function. And so, uh, taking some typically five or 10 milligrams of lithium orotate has been helpful for many people. Knowing your vitamin D level, very important, and again, multiple studies showing both low vitamin D associated with more cognitive decline and mutations in the vitamin D receptor associated with cognitive decline. Um, so there are many of these things.

    15. RCDr. Rangan Chatterjee1:04:01

        Yeah.

    16. DBDr. Dale Bredesen1:04:01

        I happen to like the resolvins as an example. This also, this came from Charles Searhan's, uh, Professor Charles Searhan's work, which again reduces inflammation, helps you to resolve the inflammation. So the armamentarium to prevent and reverse cognitive decline has grown by leaps and bounds in the last decade.

    17. RCDr. Rangan Chatterjee1:04:24

        Yeah. Thank you. It's, it's incredible because what's really interesting is that the first four out of the seven are, I guess, what I've called the four pillars of health for many years-

    18. DBDr. Dale Bredesen1:04:38

        Right, right

    19. RCDr. Rangan Chatterjee1:04:38

        ... food, movement, sleep, and relaxation, okay? So-

    20. DBDr. Dale Bredesen1:04:42

        Yeah

    21. RCDr. Rangan Chatterjee1:04:43

        ... everyone listening, especially regular listeners to my podcast, will be hearing about those four pillars from a variety of different experts around a variety of different diseases, around a variety of different health outcomes-

    22. DBDr. Dale Bredesen1:04:56

        Yeah

    23. RCDr. Rangan Chatterjee1:04:56

        ... right?

    24. DBDr. Dale Bredesen1:04:57

        Right.

    25. RCDr. Rangan Chatterjee1:04:58

        It is gonna be very hard for you to live a vibrant, energetic, disease-free life if you don't pay attention to food, movement, sleep, and relaxation, okay?

    26. DBDr. Dale Bredesen1:05:09

        Yeah.

    27. RCDr. Rangan Chatterjee1:05:09

        So I never get tired of hammering home that point. Those four pillars are really, really important, and of course, with respect to the brain, you've added on three things, brain training, regular detoxification, and finally targeted supplementation, okay? So those are the seven-

    28. DBDr. Dale Bredesen1:05:27

        Mm-hmm

11. 1:05:27 – 1:18:51

    Ketoflex 12/3 in practice: fasting windows, ketone targets, CGMs, and exogenous ketones

    1. RCDr. Rangan Chatterjee1:05:27

       ... which I think frankly, whether we're worried about dementia or not, paying attention to those seven things is gonna be good for your overall health anyway. But let's just go through them sequentially. You have put a bit of detail there for us, but number one, it's a plant rich ket- uh, you know, mild ketogenic diets, okay? Which you call Ketoflex 12/3.

    2. DBDr. Dale Bredesen1:05:52

       Right, right.

    3. RCDr. Rangan Chatterjee1:05:54

       So you said the plants are really important because they help with gut health, they help you with detoxification. You know, all the phytochemicals in those plants can be very helpful for your brain. I think in the book, I was reading The Age of Sprain this morning, I'm pretty sure you were talking about one of the benefits of plants is the fact that our brain is very susceptible to oxidation because of how many lipids, how, how much-

    4. DBDr. Dale Bredesen1:06:22

       Yeah

    5. RCDr. Rangan Chatterjee1:06:22

       ... fat is in the brain. And I think you made the case that plants are antioxidants and they help-

    6. DBDr. Dale Bredesen1:06:29

       Right

    7. RCDr. Rangan Chatterjee1:06:29

       ... reduce this. Um, am I, am I recalling it correctly from your book, Dale?

    8. DBDr. Dale Bredesen1:06:33

       Yeah, and that's one of the many benefits as you indicated. Um, so for, as you know, just polyphenols alone, one of the many, many, many phytonutrients, um, has turned out to enhance cognition. Um, and yes, there, there's antioxidant effects of these. So there are multiple mechanisms by which plants... And by the way, they improve your glycemic status as well.

    9. RCDr. Rangan Chatterjee1:06:56

       Yeah.

    10. DBDr. Dale Bredesen1:06:56

        So they are gonna help you prevent yourself from getting type 2 diabetes. Um, they, they increase your, uh, your glutathione, your ability to detoxify.

    11. RCDr. Rangan Chatterjee1:07:08

        Yeah.

    12. DBDr. Dale Bredesen1:07:08

        Um, sulforaphanes have really emerged as being very helpful. So there's no question for many reason these, these plant rich, mildly ketogenic diets have done the best when it comes-

    13. RCDr. Rangan Chatterjee1:07:20

        Yeah

    14. DBDr. Dale Bredesen1:07:20

        ... to cognitive decline and supporting cognition.

    15. RCDr. Rangan Chatterjee1:07:23

        And, and what does this, what does it mean Ketoflex 12 stroke 3? What does the 12 stroke 3 mean?

    16. DBDr. Dale Bredesen1:07:28

        Yeah. The, yeah, the 12 stroke 3 means that you wanna have at least 12 hours between finishing the last meal at the end of the day and beginning the next one. So in other words, you don't wanna eat right up until bedtime, then sleep for, you know, heaven forbid, four or five hours, although we hear it all the time. Wake up and then down a, a high carb meal. That, that is not good for your brain. You wanna finish... You know, if you finish eating at 7:00 PM, you don't wanna start eating again before 7:00 AM. You wanna give your time, your brain some chance to cleanse itself, and of course, there's been a lot of work over the last several years on that whole process.Uh, the so-called glymphatic system. Um, you wanna be able to cleanse these various, you know, damaged molecular species that occur during the day that are- occur with the various insults. Um, and then you wanna pick up in the morning, uh, and so give yourself some time. Now, some people will go even longer. Be careful. We don't want for... What we see is there are people who are very frail at the beginning. They don't have much of... They cannot get into ketosis very easily. They don't have any fat to burn. Going for too much fasting makes them worse, not better. We have other people where they're overweight, they've got plenty of adipose to burn, they can get into ketosis pretty easily. Having some fasting really helps them, and it reduces their inflammation. So again, it's not one size fits all. You have to look at what's optimal for each person. So 12 hours of fasting, and then slash three because you don't wanna eat for three hours before going to bed. You don't wanna go to bed with a full stomach, especially a high carb. One thing that happens, of course, your insulin will stay high. Um, your growth hormone will stay low as long as you've got that, and then you've got, uh, y- you'll wake up, often we see this all the time, when people check their glucose, for example, with the CGMs that have become so popular, continuous glucose monitoring, they'll say, "Oh, I finally understand. I wake up at 3:30 or 4:00 in the morning, and my heart's pounding. I might be sweaty." It's like, yes, you're hypoglycemic. And they'll come-

    17. RCDr. Rangan Chatterjee1:09:34

        Yeah

    18. DBDr. Dale Bredesen1:09:34

        ... and they'll look, and they, you know, their, their glucose will be 42, so they're way down. So you wanna have a smoo- you wanna smoothen that curve, um, and that's why this plant-rich, mildly ketogenic diet to smooth that glucose curve and to hel- have you, uh, help you to sleep through the night.

    19. RCDr. Rangan Chatterjee1:09:52

        Yeah. When you say mildly ketogenic, um, that's obviously, you know, mildly is, is quite a subjective term, isn't it? Um, are we talking low carb here, basically? On- once someone is having, once someone has got to the point where their brain energetics are not working so well, where they're, where they're displaying symptoms, um, have you found... You know, low carb's an interesting term because to someone, 150 grams of carbs a day is low carb. To someone else, it's 25 grams a day, right?

    20. DBDr. Dale Bredesen1:10:26

        Yeah.

    21. RCDr. Rangan Chatterjee1:10:26

        So it's very hard to know but, what someone means when they say that. But have you found, for example, with some patients, you have to actually give carb limits, like, you know, no more than 50 grams a day to make sure that you are hitting ketosis? Or, you know, he- he- help us understand that.

    22. DBDr. Dale Bredesen1:10:44

        Well, let's put some numbers on it. So when I say, when I say mildly ketogenic, um, work- with people who already have any symptoms, we see the best results when they get to at least to 1.0 millimolar beta-hydroxybutyrate. So you can check them on your finger-

    23. RCDr. Rangan Chatterjee1:11:00

        Yeah

    24. DBDr. Dale Bredesen1:11:00

        ... check your ketones, and there will be continuous ketone monitoring, I'm told, within the next few years, which will be exciting. But meanwhile, you can check your ketones, and you can a- also, uh, as a first order approximation, do it with a breathalyzer or look in the urine, although the blood's always more accurate, uh, and, and is the best way to do it. We wanna see you at 1.0, uh, to 2.0, in that range. That's mildly ketogenic. Um, for people who, you know, when they're looking at neonatal seizures, they're looking at six to eight millimolar-

    25. RCDr. Rangan Chatterjee1:11:31

        Right

    26. DBDr. Dale Bredesen1:11:31

        ... beta-hydroxybutyrate for this truly ketogenic diet. This is mildly ketogenic diet. One, two. We see people who get to two and a half or three even. That's mildly ketogenic. If you're asymptomatic, you have no symptoms and you're just looking at prevention, no problem. Get to .7, .8, .9. You don't need to get quite as high. But once you get the symptoms-

    27. RCDr. Rangan Chatterjee1:11:52

        Yeah

    28. DBDr. Dale Bredesen1:11:52

        ... you wanna get, and we see the best results. Now, Professor Stephen Cunnane from Canada-

    29. RCDr. Rangan Chatterjee1:11:56

        Yeah

    30. DBDr. Dale Bredesen1:11:56

        ... has done studies where he's just taken people with MCI, so they're already in that third stage, just given them exogenous ketones. That alone has improved those. And of course, as you know, uh, Dr. Mary Newport has done some beautiful work with, uh, just with using coconut oil, uh, showing that you can get some improvements, a, a way to give yourself exogenous ketones. So that's, those are the numbers we're looking for.
12. 1:18:51 – 1:30:25

    Brain stimulation, music, joy, and sensory inputs: supporting the network before taxing it

    1. RCDr. Rangan Chatterjee1:18:51

       What about red light therapy? Do we, do we know what that can do for the brain?

    2. DBDr. Dale Bredesen1:18:56

       Oh, absolutely, and that's been used. Uh, Vielight is one of the ones, for example. Neuronic is another group that is getting very good results with this. Vielight's done an, an, uh, you know, a number of-

    3. RCDr. Rangan Chatterjee1:19:04

       What is it? Is Vielight red... Is it a company that uses red lights, or is it a specific type of light?

    4. DBDr. Dale Bredesen1:19:09

       Yes, it's, yeah, V-I-E-L-I-G-H-T. Yeah, Vielight. It's a company, and this work came out of MIT originally, uh, with a Professor Li-Huei Tsai, um, and has w- been adapted for this. So, um, dr- typically this driving, um, at a gamma frequency, which is about 40 cycles per second, seems to be what helps to stimulate the brain to do best in terms of its memory. Again, you don't want to stimulate it too much until you've supported it. I mean, that just makes sen- again, it's like, you know, before you put oil in your car, trying to drive it 100 miles an hour. Yeah, you don't, you don't wanna do that. You wanna make sure that other things are set first, and then you wanna drive it.

    5. RCDr. Rangan Chatterjee1:19:48

       Yeah, that, that's a key point. In, in the chapter on brain training, which is one of my favorite chapters actually in the book, um, you specifically mention that. So I think it's a really key point, like the order sometimes matters.

    6. DBDr. Dale Bredesen1:20:00

       Yes.

    7. RCDr. Rangan Chatterjee1:20:00

       Um, and, and you were hypothesizing that sometimes brain training doesn't show an ef- certain types don't show an effect in the research, but s- others do. And you were hypothesizing that, uh, in fact, I wrote it down. You said, you know, you believe that once neurodegeneration has begun, the added cognitive demand from brain training may further tax a-... distressed brain unless the support is increased or the demand reduced. And I, and I really love that nuance there, this idea that brain training is gonna be really good for your brain, but it depends on where your brain is at, right? So let's get the brain as good as we can with nutrients, with diets, with supplements, and then let's add in the brain training. It, yeah, yeah-

    8. DBDr. Dale Bredesen1:20:54

       Yeah

    9. RCDr. Rangan Chatterjee1:20:54

       ... I thought that was a really interesting point. BON CHARGE are a wellness brand that have a fantastic range of products designed to help you feel better, live better, and sleep better. From blue light glasses to red light therapy devices and beyond, BON CHARGE make it really easy for you to prioritize your wellness at home. And I myself have been using many of their products for well over five years now. One of my current favorites is their Demi Red Light Therapy device. I've been following the research on red light therapy for many years, and the potential benefits include enhanced recovery, better skin, improved eye health, and also improved sleep. Now, since I got this panel, I've been sitting in front of it for about 10 minutes every morning whilst reading and 10 minutes every evening, and I'm definitely finding that I feel more relaxed. I'm falling asleep much faster, and overall, I would say I've had a big increase in energy. To get 20% off all of their products, go to boncharge.com/livemore. I've been drinking Ketone-IQ for about 12 months now when I need to focus and get dialed in before a podcast recording or a writing session, and also before I work out or go for a run. And honestly, I've been really impressed not only how it makes me feel and perform, but also with its taste. Whether you're trying to focus on an important project, stay clear-headed throughout the day, or juggle multiple things on your to-do list, Ketone-IQ delivers clean brain fuel that helps you think sharper, longer, and smoother. It's backed by science and trusted by athletes and high performers all over the world. So if you're looking to push yourself harder, recover faster, and feel sharper under pressure, then why not visit ketone.com/livemore for 30% off your subscription order, plus receive a free gift with your second shipment. And if you're in the U.S., you can find Ketone-IQ at Target stores nationwide and get your first shot completely free.

    10. DBDr. Dale Bredesen1:23:12

        So imagine that you said, "Hey, you know, I've been malnourished for two years now, so I've got very little muscle left. So I'm gonna go out and start working out with weights like crazy, uh, while I'm still malnourished." It makes no sense.

    11. RCDr. Rangan Chatterjee1:23:24

        Yeah.

    12. DBDr. Dale Bredesen1:23:25

        So you've gotta have that supply side to, to slowly increase that. The, and the other thing it means there is don't go crazy with the demand. Don't make it so that you're stressed out. Uh, as you know, it's been found more and more, people who are overtaxing their muscles, people who are running, you know, too many marathons, uh, can really have some joint problems, uh, over the years. So, you know, make it so that it's physiologically appropriate.

    13. RCDr. Rangan Chatterjee1:23:51

        Yeah. Um, you mentioned when you were talking about stimulation there, you mentioned light and music.

    14. DBDr. Dale Bredesen1:23:58

        Yeah.

    15. RCDr. Rangan Chatterjee1:23:58

        And I don't know if it's your work or was it Rudy Tanzi's work? I can't remember. What are, what is... Where are we up to with, um, the impacts of music on our brains?

    16. DBDr. Dale Bredesen1:24:11

        Yeah. Yeah, this is such an interesting point, and, and there was a wonderful, uh, wonderful film, documentary film a few years ago called Alive Inside, where they were showing that specifically music from your era when you are, you know, you've got re- memories in there from music of when you were in your teens and 20s and a youth and enjoying it out, you know, partying and dancing and all these sorts of things. And playing that music would activate the nucleus accumbens and give some joy and give some dopamine and that sort of thing. Um, now interestingly, at that time, that alone did not seem to improve cognition. Since then, there's been another study that suggests that, yes, you even get some cognitive benefit. But overall, as part of improving your physiology, um, music and joy, joy has turned out to be much more important than I ever thought as a scientist-

    17. RCDr. Rangan Chatterjee1:25:03

        Mm.

    18. DBDr. Dale Bredesen1:25:03

        I ever thought it was gonna be. Um, there, you know, there really is a biochemistry to joy. And so for people to get out and enjoy their social interactions and, you know, of course, social interactions are, are shown again and again and again to be important. Um, we've had a couple people mention recently that they, it's a, a woman and man. When the man leaves and goes on trips, the woman actually declines. When they come back and they have good time together, the woman gets better again.

    19. RCDr. Rangan Chatterjee1:25:32

        [laughs]

    20. DBDr. Dale Bredesen1:25:32

        And she goes up and down depending on whether the travel is on or whether they're happy together. Um, music is a classic one, of course. Um, dancing, uh, you know, hiking, all the things that people love, uh, really do make a difference. Again, and of course, reducing your stress. It's basically giving positive feedback to your neural network to say, "Yes, we are on the right track." It's the reason, you know, you have negatives with the nocebo effect.

    21. RCDr. Rangan Chatterjee1:26:00

        Yeah.

    22. DBDr. Dale Bredesen1:26:00

        You know, you're constantly getting that feedback. Is this something that's good for me-

    23. RCDr. Rangan Chatterjee1:26:05

        Yeah

    24. DBDr. Dale Bredesen1:26:05

        ... supporting what I'm doing or not?

    25. RCDr. Rangan Chatterjee1:26:09

        One of the things, uh, you also talk about, Dale, is the importance of addressing when our senses start to go. So, you know, your hearing, for example-

    26. DBDr. Dale Bredesen1:26:18

        Yes

    27. RCDr. Rangan Chatterjee1:26:18

        ... right? So once you start to lose hearing, it's important you address that. But I, I'm fascinated, yes, for the audience, what that means, but also on a personal level-I've got a bit of, uh, sensory neural deafness in my right ear-

    28. DBDr. Dale Bredesen1:26:36

        Mm

    29. RCDr. Rangan Chatterjee1:26:36

        ... um, from essentially being a music fanatic in my teenage years and my 20s-

    30. DBDr. Dale Bredesen1:26:41

        Mm
13. 1:30:25 – 1:55:34

    Your ‘brain check-up’: MyCQ test, biomarker panel meanings, and what to do next

    1. RCDr. Rangan Chatterjee1:30:25

       Yeah. No, I love that. Dale, you mentioned before about biomarkers that we can check.

    2. DBDr. Dale Bredesen1:30:32

       Yes.

    3. RCDr. Rangan Chatterjee1:30:32

       I wanna go into that in just a moment, but something I've been thinking about recently is what are the key biomarkers that people need to look at throughout their life? This goes beyond brain health, okay?

    4. DBDr. Dale Bredesen1:30:46

       Mm-hmm. Yeah.

    5. RCDr. Rangan Chatterjee1:30:46

       Brain health is a part of it, but I was looking at it through the lens of metabolic health, because of course, if you have exceptional metabolic health throughout your life, you are gonna dramatically reduce the likelihood of getting any chronic disease, let alone dementia, any chronic disease, right? So, um, I guess my question to you as one of the world's leading experts in Alzheimer's dementia is, if there were some biomarkers, let, let's say, for example, let's just pick five. So HbA1c, which is your average blood sugar-

    6. DBDr. Dale Bredesen1:31:20

       Mm

    7. RCDr. Rangan Chatterjee1:31:20

       ... insulin, which, you know, fasting insulin, which-

    8. DBDr. Dale Bredesen1:31:23

       Yeah

    9. RCDr. Rangan Chatterjee1:31:23

       ... you know, is a very, very important biomarker, which unfortunately, you know, people in the UK don't have easy access to on the NHS. Homocysteine, which you mentioned before, and how you want that under seven. Um, high-sensitivity CRP, a marker of inflammation.

    10. DBDr. Dale Bredesen1:31:39

        Yeah.

    11. RCDr. Rangan Chatterjee1:31:39

        Um, I don't know. You know, uh, I mean, there's all kinds of different ones.

    12. DBDr. Dale Bredesen1:31:44

        Apo-

    13. RCDr. Rangan Chatterjee1:31:45

        Like ApoB or triglycerides-

    14. DBDr. Dale Bredesen1:31:47

        ApoB. Oh

    15. RCDr. Rangan Chatterjee1:31:47

        ... right?

    16. DBDr. Dale Bredesen1:31:47

        Yeah.

    17. RCDr. Rangan Chatterjee1:31:48

        Let, let, let's say those five or six biomarkers that you could identify, which we can, what is optimal? And if someone from the age of 20 all the way to 80 made sure they checked them regularly, and they stayed in the optimal range for decades, what do you think that would do to their risk of getting dementia?

    18. DBDr. Dale Bredesen1:32:14

        There's no question, and it's been shown repeatedly that it would reduce their risk. However, it would not reduce it to zero. As we talked about earlier, they may have some genetic mutations that they're unaware of. Um, they may have a, you know, pro-inflammatory state. They may have exposure to mycotoxins, for example. All these things are important. They may develop sleep apnea. So it will heal their, their biochemical status. So we think in terms of two different sets of tests. There's one that says, where do I stand today?And you alluded to that earlier, that's the p-tau and the GFAP and tau. Where do I stand today with my brain status? And then there's another that says, where am I headed? And these are the ones you were just talking about. Where am I headed? What, what does my future look like? And you do wanna know your inflammatory status. You do wanna know your glycemic status and, you know, in fact, we're getting better and better, of course, with earlier and earlier and more and more sensitive tests. And by the way, this is where p-tau is headed. There is a super p-tau 217 coming out around the end of this year that will give us even earlier looks so that we can really help people early on, even earlier, and make sure that they-

    19. RCDr. Rangan Chatterjee1:33:31

        Yeah

    20. DBDr. Dale Bredesen1:33:31

        ... don't progress. But to, to, to reply to your point, it will reduce their risk, absolutely. That, that's clear. But it will not reduce it to zero, so therefore you still wanna see where you stand every five years, and you wanna make sure that you, if you start having problems, okay, something different than what you're addressing has come up, so go in and get those things evaluated. We find this all the time, and I mentioned Dr. Toups earlier. She had a patient just recently. Um, she'd done all the basics. She said, "Hmm, somehow this patient's not responding yet, so I need to look further." She did a cone beam CT to look at oral abscesses and found an occult abscess. When she treated that-

    21. RCDr. Rangan Chatterjee1:34:12

        Wow

    22. DBDr. Dale Bredesen1:34:12

        ... the person got better.

    23. RCDr. Rangan Chatterjee1:34:13

        Gee.

    24. DBDr. Dale Bredesen1:34:14

        So again, you've gotta look. You've gotta find what's driving the problem, and you've got to address it.

    25. RCDr. Rangan Chatterjee1:34:19

        Yeah. In terms of, then, someone who's been listening to this podcast, or they just stumbled across this video on YouTube, Dale, and is still watching, right, and is thinking, "Wow, I didn't know any of this. This is brand-new information for me." Let's say they're-

    26. DBDr. Dale Bredesen1:34:35

        Mm

    27. RCDr. Rangan Chatterjee1:34:35

        ... you know, they don't have symptoms. Maybe they're in their 20s, their 30s, their 40s, their 50s, whatever it might be, and they're like, "Okay, I want to now do something straight after this podcast. I wanna take action to see where I'm currently at." I think I've heard you talk about three things to do. Is it MyCQ Test, bloods, and a cognoscopy? You know, w- well, or, or for that person who wants to do something immediately-

    28. DBDr. Dale Bredesen1:35:02

        Yeah

    29. RCDr. Rangan Chatterjee1:35:02

        ... to assess things, what, what, what can they do, basically?

    30. DBDr. Dale Bredesen1:35:07

        Yeah. The easiest thing to do is, is buy the original book, uh, The End of Alzheimer's. Just take a look at why we're doing-
14. 1:55:34 – 2:00:36

    Closing guidance: don’t panic—measure, intervene early, and find well-trained help

    1. RCDr. Rangan Chatterjee1:55:34

       Okay, Dale, just to finish off then. If there's someone who has been listening, right, and they're super interested in what we were talking about, and they're thinking, "Dale, look, I, I'm, I'm really worried. Um, I've cared for my mother for years. She had Alzheimer's."

    2. DBDr. Dale Bredesen1:55:55

       Yeah.

    3. RCDr. Rangan Chatterjee1:55:56

       "I'm scared I'm gonna go the same way as her. Can you help me?" What would you say to her?

    4. DBDr. Dale Bredesen1:56:03

       Yeah. So what I tell everyone, and the same thing for people who come back with a high p-tau, take a deep breath first. It's gonna be okay. We're, we're not living in the caveman era anymore. Now we understand that there are things that can be done. So please just, uh, you know, you're ... We're gonna make sure that you get, for, you know, many, many years to come, that you do well. So please get evaluated. Start, as I said, start to see where you stand today and then where you're headed. So yes, you'll have to have a few blood tests. You'll have to look to see what's actually going on. If you've already got symptoms, you're also gonna wanna have an MRI. But the bottom line is th- this is just like what happened, as I said earlier, with Pap smears and looking at PSAs for prostates and looking at chest x-rays and looking at fasting insulin. We're now in a modern era where we can look at these things, we can tell where you stand, and we can do something about it in the vast majority of people. So please don't worry, but also please don't run and hide. Don't, don't stick your head in the sand.

    5. RCDr. Rangan Chatterjee1:57:07

       Yeah.

    6. DBDr. Dale Bredesen1:57:08

       Uh, because getting active is the s- is the smartest thing you can do.

    7. RCDr. Rangan Chatterjee1:57:11

       Yeah. That's, it's lovely advice. Very, very empowering. It's kind of very honest, very direct, but also very empowering. There's something people can do if they-

    8. DBDr. Dale Bredesen1:57:21

       Yeah

    9. RCDr. Rangan Chatterjee1:57:21

       ... get the data. And for people who want to-Um, work with doctors who you've trained or use your specific protocol, um, where would you direct them online? I mean, you mentioned Recode and Precodes.

    10. DBDr. Dale Bredesen1:57:35

        Yeah.

    11. RCDr. Rangan Chatterjee1:57:35

        You mentioned Apollo Health. I know you're involved with creating this Personalized Brain Institutes-

    12. DBDr. Dale Bredesen1:57:40

        Right

    13. RCDr. Rangan Chatterjee1:57:40

        ... in Santa Monica, but, you know, for people all around the world who wanna learn more, yes, they can get your books, but where are these-

    14. DBDr. Dale Bredesen1:57:47

        Yeah

    15. RCDr. Rangan Chatterjee1:57:47

        ... where are the doctors that they can find to help them?

    16. DBDr. Dale Bredesen1:57:49

        So it's very simple. If you go to mycqtest.com, that will direct you. So if you do well on that, it'll direct you to more on the prevention side, and if you don't do as well, it will direct you to the treatment side. The doctors are, will be included in there, so if you ha- if you go onto... You can either go to mycqtest or you can go to drbredesen.com, um, and you can... and, and it will give you a list of the people that we have trained that are doing this. Now, important to say, as I mentioned earlier, there are some doctors that are getting better results, and there are some doctors that are getting not as good results. So talk to the doctor that you choose. "Can you tell me some people you know? Can you-- Have you published anything? Have you shown anything? Can you, can you at least give me, uh, some examples of people that have improved? Or have me talk to, uh, uh, one or two of the people that have improved so that I can get a good idea," because I think that's an important thing. People will say, "Well, yeah, we do this, uh, but we do it my way, and I do a little of this and a little of that," and they're not getting particularly good results. So make sure that you have someone who's doing well.

    17. RCDr. Rangan Chatterjee1:58:53

        Yeah. Dale, I just wanna say thank you. I appreciate the time you've given me today. Um, I also appreciate you as a human, honestly. You know, I've-

    18. DBDr. Dale Bredesen1:59:03

        Thank you

    19. RCDr. Rangan Chatterjee1:59:03

        ... I've, um, been very lucky to know you personally, um, as a friend for many years now. I think the work you are doing is literally incredible. I know you've faced a lot of pushback throughout your career.

    20. DBDr. Dale Bredesen1:59:18

        Mm.

    21. RCDr. Rangan Chatterjee1:59:18

        But what you're offering the world is a paradigm shift in how we look at this debilitating condition that has had such a horrible impact on so many different families. So I wanna acknowledge you. I wanna say thank you to you. I think it is such important work. Keep going. You are so fit and well in your 70s. I hope we're still podcasting together in your mid-80s and your mid-90s.

    22. DBDr. Dale Bredesen1:59:43

        [laughs]

    23. RCDr. Rangan Chatterjee1:59:44

        Right? So we're gonna keep improving. The new book is The Ageless Brain: How to Sharpen and Protect Your Mind for a Lifetime. I would highly recommend it to anyone. Doesn't matter where you are in life. If you wanna improve the health of your brain, this book has got something in it for you. Uh, and Dale, I, as I said before, the-- I see this as a part one, and I'm very hopeful in the next few months we can get a part two in and go a little bit deeper. So yeah. Thank you so much for coming on the show, and I can't wait till next time, Dale.

    24. DBDr. Dale Bredesen2:00:14

        Thanks so much, Rangan. Great to talk to you. I look forward to talking to you again.

    25. RCDr. Rangan Chatterjee2:00:19

        If you enjoyed that conversation, then I think you are really going to enjoy this one.

    26. DBDr. Dale Bredesen2:00:24

        After somebody has done a ketogenic diet, many of their cells in their body and brain actually have more healthy mitochondria than they did before they started the diet.

Episode duration: 2:00:37