28. Dr. David Perlmutter: The Gut Mistake That's Shrinking Your Brain (And How to Avoid It)

How often do you reach for a sugary snack, telling yourself it's just a small indulgence? Or justify skipping your morning walk because you're "too busy"? Here's the truth: your daily habits are either fueling your longevity or quietly sabotaging it. In this episode of Extend, I sit down with Dr. David Perlmutter, a neurologist and five-time New York Times bestselling author known for his groundbreaking work on brain health, inflammation, and metabolic resilience. We dig deep into the connection between blood sugar, brain aging, and chronic disease—and how small, intentional lifestyle changes can make a massive difference in your long-term vitality. You'll learn how excess glucose can erode your cognitive function and why uric acid—a molecule most of us ignore—may be the key to unlocking better metabolic health. We also share practical tips to curb cravings, improve your sleep, and enhance your focus by rebalancing your diet and mindset. Dr. David Perlmutter is a board-certified neurologist, researcher, and advocate for lifestyle interventions that promote cognitive health and resilience. He is the author of bestselling books like Grain Brain and Drop Acid, and he continues to inspire millions with his work on the gut-brain connection. We Also Discuss: (00:00) Connecting Through Conversation and Brain Health Foundations (04:40) Evolutionary Biology's Role in Brain Health (14:21) Neurology Meets Functional Medicine (25:52) Metabolic Health and Its Impact on Brain Wellness (41:28) The Gut-Brain Connection Explained (56:09) Understanding Brain Disease Through Metabolic Health (01:03:34) Exercise as a Pillar for Brain Health (01:23:23) Nutrition, Lifestyle, and the Future of Brain Care Thank You to Our Sponsors: TruNiagen: Whether you are looking to stay sharp, feel more energized or simple age better, go to https://www.truniagen.com/ IFit: If you are looking to elevate your home gym fitness experience with the best in fitness tech, choose IFIT. Go to https://www.ifit.com/ NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Vitaboom: For supplements you can trust and wellness solutions tailored to your health, visit https://vitaboom.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. David Perlmutter: Website: https://drperlmutter.com/ Instagram: https://www.instagram.com/davidperlmutter

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  Have you ever wondered why some people stay sharp, energized, and resilient while others struggle with brain fog, burnout, or even early signs of memory loss? It's not just genetics or luck. It really comes down to the choices we make in our day-to-day. In today's episode, I'm going to sit down with Dr. David Perlmutter. He's a world-renowned neurologist and bestselling author, and we're going to dive deep into what it really takes to protect your brain. And spoiler alert, it all starts with your metabolic health. We're not just talking about avoiding diseases like Alzheimer's and Parkinson's. This is really about small, science-backed changes that can rewire your brain completely for longevity, mental clarity, and resilience. Dr. Perlmutter gives us an exclusive preview

• 1:35Dr. Darshan Shah?

  of his new research, showing how metabolic health could be the key to reversing conditions we once thought were untreatable. If you're ready to stop reacting to health issues and start taking control of your future, this episode is for you. Dr. David Perlmutter is a world expert in neurology. He's authored several books as a New York Times bestselling author and an international speaker, and also a great friend of mine who I've come to rely on for years and years to educate me on the science of neurology. Let's dive in to this episode with Dr. David Perlmutter.

• 2:15Dr. Darshan Shah?

  Dr. Perlmutter, I've so enjoyed getting to know you over the last year or two since we've met.

• 2:20Speaker 01

  Yeah, we're new friends.

• 2:21Dr. Darshan Shah?

  We're new friends.

• 2:22Speaker 01

  Yeah, hasn't been going on that long, but I've enjoyed every minute of it.

• 2:25Dr. Darshan Shah?

  Same, same. You've just been so gracious and a man of many talents. Like, you've surprised me every time I see you and I talk to you. I heard about your amazing boat trips that you take, you're a fisherman, you're an incredible singer, guitarist. Just mind-blowing.

• 2:43Speaker 01

  Blows into my own mind. Well, yeah, we do enjoy our boating. So, you know, at this stage of life, it's really great to be able to dedicate to really reconnecting with just the solemn aspects of being alone and really getting back to nature. It's so helpful.

• 2:58Dr. Darshan Shah?

  It's something that's often ignored in many people's lives until they feel the negative effects of not doing it for years and years and years. And if there's one thing I've learned is that your brain, it's kind of, it kind of waits a long time before it tells you something bad is happening. But you really got to start earlier managing the inputs into your brain.

• 3:21Speaker 01

  Well, then, two thoughts come to mind. That's kind of redundant. Where do your thoughts come to anyway? But, you know, this morning, about 6:30 in the morning, we were at the hotel where we were staying and I was on a yoga mat outside. It was a beautiful sunrise and could still see half the moon or the moon in half phase. And you're right, it's about reconnecting. It really spoke to me about being, embracing me and welcoming me back. So, you're right, though, we tend to distance ourselves. We get on the treadmill and want to accomplish this and that. And it's that reconnection that really is very, very important.

• 3:59Dr. Darshan Shah?

  Really? At what point in your life did you find yourself reconnecting with nature, reconnecting with your soul?

• 4:06Speaker 01

  Well, let me answer that by saying I remember the point that I realized I was not connecting.

• 4:10Dr. Darshan Shah?

  Yeah.

• 4:10Speaker 01

  And I was in the on-call room during my surgery internship, looking out a non-openable window. And I said to another resident, I miss the weather. I missed, you know, I just got really tired of the climate control.

• 4:28Dr. Darshan Shah?

  Right.

• 4:29Speaker 01

  So I vowed that, you know, I was gonna work hard to do my thing for a period of time, but never be in a situation where I was really distant, distant from weather and from experiencing the changes in the weather. Not that I was at that time thinking about how that includes my physiology, which we know it does, but just because it made, it was just so, speaking to me, so much connection and I felt viscerally that it was a good thing.

• 4:53Dr. Darshan Shah?

  That's amazing. I mean, gosh, I'm kind of envious because I, I realized this probably 25 years after medical school and residency, that this disconnection is having negative effects, not just in my physiology, but also in my mentality. And now, of course, I'm getting back into reconnecting with nature, reconnecting with my soul and my purpose. But it, it took me a long time. And so I think, you know, for this podcast, especially for the younger listeners out there, just make it, make it something you think about, I think, is.

• 5:24Speaker 01

  Yeah. I mean, we can even look at the fractal implications of the term you just used, connection and disconnection. You know, from the, the level of being disconnected from the, the goals of our DNA, wanting us to be, have longevity and be healthy, long health span and lifespan, all the way up to the disconnection that we have with the planet and the disconnection that we have from each other. So, you know, we can unpack that for hours and, and look at the nuances of that term. But I, I think the notion of connectivity is something at multiple levels that we need to foster. And I, I suspect we'll talk about that today.

• 5:59Dr. Darshan Shah?

  Yes. I think there's gonna be a major highlight and we'll double click on, on that for sure. So you've had such an incredible career. You've been such a prolific author. I've learned so much from you over the years, especially, you know, my journey in functional medicine only just started. I, I feel relatively young in this field about 10 years ago. By then, you've already had many, eight years ago, many books out. And I've read many of them. And in preparation for this podcast episode, I pulled them off my shelf. And I looked at some of the highlights that I've made. And some of your newer books that you've written with your son are just incredible. And they really speak to kind of our modern day environment. And then I got to thinking like, how much things have changed over the last 50 years in our environment? And just the things that we're exposed to, the inputs into our brain, nutritionally, sleep wise.

• 6:44Dr. Darshan Shah?

  I think a lot has changed in 50 years. And, um, you know, I was born 52 years ago. And obviously I've noticed the change, but I think you have more experience. And you've really looked at it from a lens of how has this affected our brain? And I'd love to talk about that because I think it has a lot to do with evolutionary biology, what we've evolved. What our brains have evolved to be able to deal with versus not. And I would love to hear kind of your journey through the last, you know, 30, 40 years in medicine. And, and kind of how you think our environment have changed and how this affected our brain.

• 7:16Speaker 01

  Well, that's a, that's a broad subject, that's for sure. Uh, I think that, you know, for your audience, my foray into neurology was very much, you know, toeing the line. So I was in a very mainstream neurology practice with two partners and did the night call, did the, you know, the clinic day in and day out. And basically at, at one point, about 10 years into that, a couple of things happened. Our kids were at an age where I just felt like I was not spending enough time with them and really wanted to. I was missing them.

• 7:48Dr. Darshan Shah?

  Told with it.

• 7:49Speaker 01

  Gee, I, I'd say, um, I'd say Austin was probably nine, Rachel was about seven, so they were, uh.

• 7:55Dr. Darshan Shah?

  So my kids are 10 and seven right now.

• 7:57Speaker 01

  There you go.

• 7:57Dr. Darshan Shah?

  And I'm feeling the, I, I really relate to this. Cause I feel that, I feel it deeply in my heart and my soul, so I get it.

• 8:04Speaker 01

  Well, and I remember I was talking to, uh, that I've started to look at things. And I had a dinner with a fellow by the name of Dr. Bernie Siegel. And he was really a trailblazer, I think. He was one of the founders of the American Holistic Medical Association, a Yale trained general surgeon, a terrific guy. Wrote a book called Love Medicine and Miracles. And matter of fact, I spoke to him about a month ago. And he said, Well, you know, I'm now in about himself, I'm now in the meaning part of life. And I think in contrast to what, probably the achievement part of life. And I was thinking, well, gee, what's it gonna take to transition to the meaning part of life? And I think it's the meaning part of life is when you can start to dedicate your thought processes and your energy

• 8:47Speaker 01

  to exploring what's it all about, what is the meaning of life? As opposed to achievement, financial security, raising the family, all those things. So I realized at that point that that will come with time and it eventually did come. But I did realize though that that's not going to be binary, it's going to be gradual. And so here we are 10 years into this practice where I had a revelation, really one day, that I was treating symptoms only. Whether it was Parkinson's, Alzheimer's, headaches, MS, I was treating symptoms and that's it. And I had, we had brought somebody in, a new, after his residency partner. And he jokingly said one day, I'm stamping out disease.

• 9:31Speaker 01

  And you know, I chuckled and I realized as I was driving home, I thought about that statement. No, we're not.

• 9:38Dr. Darshan Shah?

  No.

• 9:38Speaker 01

  We are not attacking disease in the least bit. And I started to broaden that thought process and realized that we don't have, even to this day, Darshan, we do not have any drugs, for example, to treat diabetes or to treat hypertension. We treat the manifestations, we treat the symptoms, we treat the smoke and we ignore the fire. And, and your viewers may be surprised when they hear, whoa, I'm taking a blood pressure pill, I'm taking a diabetes pill, whatever it may be. And what I'm saying is those will lower blood pressure and lower blood sugar, but stop the medication and a day or two later, your blood pressure, blood sugars are going to go up. So you really have not approached treating the underlying problem, you're treating symptoms. And I think to be fair, that there's no field of medicine

• 10:23Speaker 01

  that is more entrenched in this notion of trying to validate the idea that that's good medicine than neurology.

• 10:30Dr. Darshan Shah?

  I agree with you, yeah.

• 10:31Speaker 01

  And I'm not saying there's anything wrong with it, I think it's really very helpful to Provide a medication to a Parkinson's patient, for example, to allow him or her to reduce his or her tremor or rigidity. That's a great thing. But to completely ignore the underlying disease process, which has until quite recently, and we're going to touch upon this because it's absolutely in an area that I know you're interested in. We've had nothing to treat the underlying disease process. You know, and, and years ago, 18, 20 years ago, I began exploring something called glutathione, an antioxidant, in treating the underlying disease process in Parkinson's. And we published our results in the journal Movement Disorders. And we finally were able to reduce people's progression

• 11:15Speaker 01

  on what is called the Unified Parkinson's Disease Rating Scale, a measurement of how good or bad a patient is doing. So that was important for me. And I realized I wasn't going to be able to pull that off in the practice, that several things actually coalesced at the same time. My mentality changed in terms of what I wanted to emphasize. And one other interesting sidelight was, at that point, there were class action lawsuits against the manufacturers of silicone breast implants.

• 11:45Dr. Darshan Shah?

  I remember that whole.

• 11:47Speaker 01

  Because women were getting a host of issues.

• 11:49Dr. Darshan Shah?

  Right.

• 11:50Speaker 01

  And one of the areas in which they were becoming compromised, when they became compromised, was neurological issues. You know, all kinds of neurological issues, even pretty devastating situations. So I became qualified in America as the only board-certified neurologist who was qualified as an expert to testify in the cases of these women. And beyond testifying, I was qualified then to examine them, create a report that they could then use in the class action suit. And as such, my practice began seeing these women, you know, several a day. And interestingly, part of the evaluation on my perspective was a breast exam, as one might expect, to determine,

• 12:34Speaker 01

  does it appear as if the implant has ruptured? Does it appear as if there's lymph, troubles in the lymph nodes, spread of the silicone lymph node? Or reactive changes in the lymph nodes in the armpit, or whatever it was.

• 12:47Dr. Darshan Shah?

  Right.

• 12:47Speaker 01

  And that just was too much for my partners, that a neurologist would be examining women's breasts.

• 12:55Speaker 01

  So it became clear that it was time for Dr. Prometer to move on.

• 12:59Dr. Darshan Shah?

  Wow. Yeah, it's so interesting. I mean, I feel your pain there because I also, when I started my medical career, was in a very traditional practice. And just even thinking outside of the box was, you were ridiculed probably sometimes. You know, they were just like, what are you doing? Or it makes no sense of the traditional people. And it's so, it's so interesting to me how entrenched they get in that mindset, too. It's just mind blowing to me.

• 13:22Speaker 01

  Yeah. And, and you know, you're right. You're thinking outside the box. And that's what makes it exciting. That's for sure.

• 13:27Dr. Darshan Shah?

  Absolutely.

• 13:28Speaker 01

  But as I've said before, that the mission is not to think outside the box and behave outside the box. It's to make the box bigger.

• 13:34Dr. Darshan Shah?

  Yeah.

• 13:34Speaker 01

  It's to really do your best to make it clear that the things that we are doing are valid, are scientifically validated, and are good for people and achieve some positive outcome. And I won't forget that during this period of reflection and trying to chart a new, new course, that my wife and I went to a really cheap hotel that was the only thing available on Sanibel Island. My office manager watched the kids. And I was thinking, I said, I'm gonna leave this practice. And we both were walking down the beach. It's nighttime. And the conclusion was, what's the worst that could happen? That was the question we asked ourselves. How bad could it get? And, you know, you were saying it's hard to make the decision and all that. It was not.

• 14:18Speaker 01

  I've always been one to just leave the skis pointing straight down the mountain. And don't worry about carving and edging. Just go straight down. Let it go. I mean, it's gonna be okay. You know, do, do what you love and good things will follow.

• 14:33Dr. Darshan Shah?

  Mm-hmm.

• 14:34Speaker 01

  So that allowed me to transition and began, you know, I began exploring all kinds of interesting things. Some were valid and, you know, stood the test of time. Some did not. But I absolutely would not have had it any other way because it's been a very, very exciting ride. Continues to be a very exciting ride. And I'm sure for the next several decades, it'll continue to be inspiring, challenging, and hopefully provide, you know, new information for people.

• 15:01Dr. Darshan Shah?

  Yeah, I love it. And, you know, I think as I look through Through the kind of the journey you've taken in your book writing, you addressed an issue that was very timely in that moment. So with Grain Brain, for example, it seemed like, at least to me, from an outsider's perspective, that people were just really confused about the connection between gluten and inflammation and brain health. And the way you broke it down in that book, it really made a lot of sense to me as a physician. And I was appreciative that you were able to tell the story to just the general public as well. So I think you changed a lot of lives. You probably saved a lot of lives as well. And I just wonder, you know, you emphasize the negative effects of gluten on the brain.

• 15:46Dr. Darshan Shah?

  Was the impetus to write that book something that you saw happening in our environment? And specifically with the dietary recommendations of the United States government? Or how did that come about?

• 15:57Speaker 01

  That's a great question. And I will preface that question, the answer to the question, by indicating, so I got out here for your podcast yesterday. I had some free time at the hotel out by the pool. And for the heck of it, I decide, the question I put into ChatGPT 4.0 was, how have the ideas presented in Grain Brain in 2013 stood the test of time? And it was very encouraging, very validating that the ideas, you know, Grain Brain was mostly about the threat to the brain of carbohydrates.

• 16:32Dr. Darshan Shah?

  Right.

• 16:33Speaker 01

  Of which many are related to gluten being wheat-based. And so there's, you know, added threat to the brain in a lot of people, not all people. So it was very encouraging to read that. And it was interesting because I got into the hot tub then. And there was a woman in the hot tub. It turned out she was a writer for New Yorker magazine. And

• 16:56Dr. Darshan Shah?

  Only in LA does that happen.

• 16:57Speaker 01

  Oh, great.

• 16:58Dr. Darshan Shah?

  Or maybe New York.

• 16:58Speaker 01

  And she had The New Yorker right there, which is fun to read, especially the comics and cartoons. She, I said, well, you know, I've written a few things in my day as well. She said, what do you write about? I said, health. Her first question was, you know, I've been reading a lot lately about the impact of sugar on the brain. And there's some relationship between sugar and Alzheimer's. What an idea. You ever heard of that? And, you know, it's just how things go, right? It's how things are set up like that. It's good for you, though, to realize there's something, there's an undercurrent of destiny in life. And when you just take a deep breath and watch it happen, it's pretty exciting. So what was the impetus, to get back to your question, for writing Grain Brain?

• 17:41Speaker 01

  It was at that time I was beginning actually to make a connection between things going on in the gut and the brain. Recognizing that risk for autoimmune conditions, for example, was certainly a lot higher in people who had gut disorders. Well beyond the genetic predisposition, there's something relating, strangely enough, the gut, which lived in Chicago, to the brain that lived in Paris. I mean, how, these things seemingly so disparate, yet relationships were starting to appear. And, you know, certainly, The Talk of the Town, this was on the heels of a book by William Davis called Wheat Belly. The Talk of the Town was really about wheat and gluten. And he was talking about weight loss and inflammation.

• 18:23Speaker 01

  And when you get to the part in Wheat Belly that talks about inflammation, oh, that lights up something for me. Because at that point, we were really understanding that inflammation is kind of a cornerstone mechanism related to brain degeneration. And, you know, since that time, that's been amplified to include mental health disorders as well. But that said, I started connecting dots between the gut, gluten, inflammation, and the brain. And did the research, and that was the genesis of Grain Brain. And it sure pushed a button. I mean, it sure helped, I believe, a lot of people. It got translated into 32 languages around the world. So really, it was a great experience for me, too, to explore that science, to really Start to cultivate a lane for myself.

• 19:08Speaker 01

  And, you know, be pretty much the only individual in that lane for a long time. You know, ultimately joined the Institute for Functional Medicine. And there was a committee of functional medicine neurologists. And I was the president of that committee. The vice president, secretary, and the only member for an awful long time. And then with, you know, with time, Terry Walls came along, other neurologists began to. And when you think about it, functional medicine is the perfect place for a neurologist. But neurology is always, neurology has always been sort of off putting to physicians. Because, for whatever reason, you know, we could talk about it, but, you know, hasn't been something that everybody's gravitated to. But I, I'm always fascinated by it.

• 19:49Dr. Darshan Shah?

  Yeah, you know, I've always been fascinated by the brain, but then going through medical school and then going, going to residency. I just remember thinking, neurology really was just about, you know, figuring out if someone had a stroke. What part of the brain did that stroke occur in, based on their symptoms? And if someone has Alzheimer's or if someone has Parkinson's, what are the medications you can use to treat it? And it was just kind of like this black box up here, right? Not connected to the rest of the body. And so connecting it to the rest of the body, the way functional medicine has and the way you have, has been a complete game changer once you realize it's part of this entire system.

• 20:24Speaker 01

  It is not, uh, you know, separate, it's not disparate. And, you know, the main thing I think that we were trained to do in residency and even in practice is name the problem.

• 20:33Dr. Darshan Shah?

  Right.

• 20:34Speaker 01

  And or determine where it was in the brain, localize it, you know, and, and once high quality scanning came along, that part of the, of the task was taken away from us. And then just naming it, and you know, truthfully, the treatment options have, are, could be spit out on a card. A carry in your pocket and what's the challenge? You know, what's the academic intellectual challenge of doing that? You become an automaton. And that was not fulfilling.

• 21:00Dr. Darshan Shah?

  Right, exactly. And you know, I think the intersection, I have so many thoughts on this, but the intersection between neurology and psychology now as well. I feel as though now that we understand this functional medicine approach to our entire body, that intersection is very much blurred as well. Well, because the same root causes that are causing brain degeneration, Parkinson's disease, et cetera, are the same causes of psychologicalism, things like depression, anxiety, et cetera. Do you agree with that?

• 21:28Speaker 01

  Oh, fully. And I think that, and I know you have an upcoming podcast with Austin Perlmutter, Dr. Perlmutter, our son.

• 21:35Dr. Darshan Shah?

  Yes.

• 21:36Speaker 01

  So, and you know, I'm sure you'll unpack that, but I think it's quite clear that mechanistically, the same things are going on in mental disorders as are, as we see in the degenerative issues. And, you know, in neurology and other aspects of medicine, we have two types of people. We have lumpers and splitters. We have splitters who want to delineate each and every disease and create an understanding of those diseases and their treatment protocols that are very, very unique for not just depression, but this type of depression, whatever the ICD codes look like. There's going to be a unique accepted practice for the treatment of that disorder. As opposed to the lumpers who try to lump everything together and as we're talking about now,

• 22:18Speaker 01

  recognize that underpinning these disorders are mechanistically shared types of biochemistry and pathology. And that's really good because it can be taken beyond the brain. It can ultimately, and as you know, in the work that you're doing, involves the entire body.

• 22:37Dr. Darshan Shah?

  It does, yeah.

• 22:37Speaker 01

  The notion of a heart smart diet, for example, well, what's the effect of the heart smart diet on the brain? The idea is that there is indeed good and bad recommendations from a dietary perspective that are beneficial for the immune system, the heart, the brain, the bones, and all aspects of health, because that's how our physiology works. So people say, well, gee, what are the best things you could be taking for your brain? Well, we've already talked about what's good for your heart, so we could just extrapolate. But that said, so in many ways, what's exciting at this stage of life for me, and I'm glad I haven't gotten a lifetime achievement award, because the moment you get that lifetime achievement award, that's, they put you out to the past.

• 23:18Dr. Darshan Shah?

  You're like, you're done.

• 23:19Speaker 01

  Wait a couple of decades for that. But what's exciting is that There have been a lot of hanging chads in my mind to try to understand things. Sure, we understood that that problems with energy production in the brain are seen in Alzheimer's. We've understood that people with type 2 diabetes have a higher risk for developing Alzheimer's. We've understood that inflammatory markers are higher in the blood and spinal fluid in patients with Alzheimer's than other neurodegenerative conditions. We've understood, more recently, that metabolic issues in general kind of presage the development of brain disorders, degenerative disorders.

• 24:01Speaker 01

  But what's exciting now is, from the lumper perspective, or grouper perspective, not referring to the fish, is that across the spectrum of neurodegenerative conditions, MS, Huntington's, Parkinson's, Alzheimer's, and so many others, these mechanisms are common, are shared. Therefore, it allows us to look upon this shared mechanistic ideology as being a way to cultivate a general plan that's good for everyone to keep their brains healthy on the front end.

• 24:36Dr. Darshan Shah?

  Yeah.

• 24:36Speaker 01

  You mentioned something earlier about, you know, what happens when, you know, the brain starts going bad. And I was about to interject, but I thought that would be rude.

• 24:47Dr. Darshan Shah?

  You can interject anytime.

• 24:48Speaker 01

  No, that's fine. But, you know, what we understand is that when we see the clinical manifestations, even the very earliest manifestations of Alzheimer's, clinically, i.e. memory or executive function dysfunction, memory compromise or executive function compromise, that this is an indication that issues began with that person's brain 20 to 30 years before.

• 25:14Dr. Darshan Shah?

  Right, right.

• 25:14Speaker 01

  That's, if we ended our interview right now, that would be a good bullet point to take home.

• 25:20Dr. Darshan Shah?

  Exactly, that's such a key factor.

• 25:22Speaker 01

  Yeah.

• 25:23Dr. Darshan Shah?

  Our brain is better than any other organ in our body at masking disease.

• 25:28Speaker 01

  Yes.

• 25:29Dr. Darshan Shah?

  And showing us symptoms late. And like you said, if you're gonna take away one thing, put a pin in that. Because what you do today, if you're 20 years old, is affecting your brain until you turn 50, 60, 70, then you'll see the.

• 25:42Speaker 01

  Yeah, and you were leading into that. We were talking about environment, has our environment changed the last 50 years?

• 25:46Dr. Darshan Shah?

  Right.

• 25:46Speaker 01

  Because it seems like people are manifesting.

• 25:48Dr. Darshan Shah?

  Right.

• 25:49Speaker 01

  So there's a big push in the neurology journals and the throwaway journals. The throwaway journals sort of look like they're academic, but they're really kind of advertorials.

• 25:58Dr. Darshan Shah?

  Advertorials, right?

• 26:00Speaker 01

  There's a real push to embrace these, you know, these early biomarkers for Alzheimer's. To detect it early. And great, you know, if you want to talk about it, spend your time looking at that, great. And the next paragraph is, the reason we'd like to have them is because then we can start treatment earlier when we've bio detected it at an earlier stage. Okay, what does that mean? There is no treatment. So what's all the excitement about these biomarkers if there is no meaningful treatment? Which will raise eyebrows amongst your viewers, clearly. Because we're all hearing about these wonderful drugs, a couple of them that have been FDA approved. That target beta amyloid that are really the cat's meow. They're not.

• 26:43Speaker 01

  They're incredibly minimally effective, associated with significant side effects. And we can do better. I think it's great that we're finally turning our attention to at least trying to identify the underlying cause of Alzheimer's. For example, I don't believe, and many, many in the field do not, you know, latch on to the notion that it's the accumulation of beta amyloid. It's certainly going on.

• 27:08Dr. Darshan Shah?

  Yeah.

• 27:08Speaker 01

  And is roughly related to the progression or even risk. But certainly, there are plenty of patients who on specific types of PET scanning of their brains have lots of beta amyloid and are cognitively very intact at 70 and 80 years old. Similarly, we see PET scans of individuals with end-stage Alzheimer's who don't have much accumulation of beta amyloid in the first place. So we have to challenge that notion that that. Is the end all cause. Having said that, the fact that there is at least attention to looking at the underlying cause is, I think, important. But again, we're recognizing now, and when I say we, I mean, you know, really uh, leading edge researchers around the world, that Alzheimer's is a metabolic condition of the brain.

• 27:54Speaker 01

  It's a manifest- manifestation over changes in metabolism over which you and I and every person has control.

• 28:02Dr. Darshan Shah?

  Exactly.

• 28:03Speaker 01

  That's the empowerment part of the mission. That is, that we can rein in our metabolic functionality in our bodies and that reflects what's going on in the brain, because it's part of the body, alluding to what you said earlier. And as such, in that period, twenty to thirty years prior to becoming my age, set ourselves up for a brain that's going to be along for the ride, that's not going to degenerate and, you know, leave us hanging with a neurodegenerative disorder.

• 28:31Dr. Darshan Shah?

  Exactly. And so I think what your big picture, what you're saying is, yes, we have these biomarkers now potentially that can detect Alzheimer's early or inflammation in the brain early. But the treatment is still the same. It's reducing inflammation, it's controlling metabolic disease. It's understanding that, and if you do that, the understanding is, all of these things will be less prevalent in your life. Alzheimer's, Parkinson's, um, even psychological disturbances can be affected by getting your metabolism under control, getting your inflammation under control.

• 29:03Speaker 01

  Yeah, and that has global implications.

• 29:06Dr. Darshan Shah?

  Yeah.

• 29:06Speaker 01

  And there are fifty million people right now globally with Alzheimer's. I think the number's got to be much higher than that.

• 29:13Dr. Darshan Shah?

  Sure, it seems like it's higher.

• 29:14Speaker 01

  People who are not diagnosed and, you know, the statistics show that here in America, uh, our six point seven million Alzheimer's patients, that number will triple by the year twenty fifty. That's not in the distant future. And, and what we're seeing is that the future is coming to us a lot quicker than we had anticipated. Especially as it relates to a lot of things like climate change. You know, we're reaching thresholds that were predicted to happen in, you know, twenty thirty. Well, that's way off in the distance. Well, it's not. And we're, we've crossed those thresholds. already. I think when you look at prevalence of Alzheimer's and very much Parkinson's even more so that those numbers are going up at a rate that's much higher than we had anticipated.

• 29:54Dr. Darshan Shah?

  Absolutely.

• 29:55Speaker 01

  But metabolically, we're going in the wrong direction globally. And, you know, the World Health Organization tells us that the number one cause of death on planet Earth right now as we have our conversation are the chronic degenerative conditions.

• 30:11Dr. Darshan Shah?

  Sure.

• 30:12Speaker 01

  The diabetes, the obesity, the cardiovascular diseases, Alzheimer's disease, and not COVID, not infectious disease, not TB or other transmissible type of issue. Or trauma. It is chronic degenerative disease that's killing most people on the planet. It's horrible, but we can control that. When we get the messaging out that our choices determine whether or not our metabolism is sound or dysfunctional, that can be hugely empowering for the planet. And, you know, interestingly, you were mentioning how I wrote a book with Austin Perlmutter. One of the central ideas that we put forth in the book

• 30:56Speaker 01

  was the relationship between inflammation and metabolic health and our decision-making ability, how we see the world around us. What is our global view? How do we treat?

• 31:08Dr. Darshan Shah?

  Is that brainwash you're discussing?

• 31:10Speaker 01

  Yes.

• 31:10Dr. Darshan Shah?

  That was such a great book, right?

• 31:11Speaker 01

  And when we look around now and see what's going on globally with how people are treating each other, what's going on is, it's devastating. It's a manifestation of where people's mindset is, what is their reality? What are their beliefs?

• 31:27Dr. Darshan Shah?

  Right.

• 31:28Speaker 01

  And, you know, Gandhi said that your beliefs, you know, dictate your thoughts. Your thoughts dictate your words. Your words dictate your actions. Your actions ultimately dictate your destiny. So in a way, beliefs, what you believe, will dictate your destiny. And your mission, and my mission, is to change people's beliefs as it relates to health.

• 31:48Dr. Darshan Shah?

  Yeah.

• 31:48Speaker 01

  To offer up that level of empowerment that what you've been told may not be accurate. And what people have been told is to live their lives however they choose and that modern medicine is going to fix the problem.

• 31:59Dr. Darshan Shah?

  Right.

• 31:59Speaker 01

  I'm not derogating the wonderful advances in modern medicine, especially late laser radiation cancer therapy.

• 32:06Speaker 01

  And metabolic therapy, I might add. We'll have to open that up.

• 32:09Dr. Darshan Shah?

  Yeah.

• 32:09Speaker 01

  But I am saying that by and large, we've got to be the architects of our health destiny. And your mission has been to give people those tools, empower them with the knowledge that, you know, the ball is on their side of the court.

• 32:23Dr. Darshan Shah?

  Absolutely.

• 32:24Speaker 01

  And now you've got to return that serve.

• 32:26Dr. Darshan Shah?

  Yeah. I mean, one of the first things I do, you know, we see a lot of patients here at my clinic, and we measure a bunch of different biomarkers, and everyone wants to know, what do I do with my nutrition? How do I fix my exercise routine, et cetera? What do the tests show? And I'm, and before we go over a single result, the first thing I say is we're going to have a conversation about your mindset. We need to fix how you think about your health in the first place. And so, you know, I refer back to the book, The Age of Scientific Wellness, about how they need to change their mindset into becoming participatory into this entire journey that they're going to be on. Whereas before, I think, like you said, we're all raised in this world that you don't need to participate. You can do whatever you want. Until the, and then let the Western medical care system take care of you when you get diagnosed with a disease.

• 33:10Dr. Darshan Shah?

  Well, we already said this many times, by then it's 30, 40 years into the problem, right?

• 33:18Dr. Darshan Shah?

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• 33:56Dr. Darshan Shah?

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• 34:36Dr. Darshan Shah?

  I wanted to kind of go back to metabolic health because I think that's such an important root cause of disease. In your book, Drop Acid, you mentioned uric acid as one of the indicators or one of the biomarkers that you believe are particularly useful in helping people understand metabolic disease. But was the reason to bring up uric acid a reason to get people to just think about metabolic disease in a global sense? Or is there something special about uric acid that you believe?

• 35:01Speaker 01

  Both. In the form is really, hasn't really been unpacked in any real interview that people have said, was that just your ploy to let people think that, hey, metabolism matters? And here's just an entree to that mentality. And it was.

• 35:16Dr. Darshan Shah?

  Which is, I mean, which is great.

• 35:17Speaker 01

  You bet it was. It was a little bit of subterfuge. You're exactly right.

• 35:21Dr. Darshan Shah?

  But you know, like, the thing is that people never really thought about the metabolism. It was never a topic of conversation, their metabolic health. And so I'm glad you wrote the book.

• 35:29Speaker 01

  Yeah. And, and you know, it gets back to medical wellness, the whole notion that science is going to be here to take care of us and, and we're just waiting for the next medical breakthrough to, you know, to extend our life and health span. But the reality is, you know, we labored through this a little bit in when continuous glucose monitors, for example, became available from physicians. And there was a big debate as to whether individuals should be able to have that type of information. And now we see, you know, widespread availability of, you know, all kinds of blood results, etc., that people can get without medical intervention.

• 36:04Dr. Darshan Shah?

  CGM just became over the counter.

• 36:05Speaker 01

  That's right. But in the earlier stages, which was in recent memory, I mean, we're talking two years ago, there were ongoing debates, for example, in the Journal of the American Medical Association, saying that, you know, if people get this information, number one, they're not going to know what to do with it, as if most mainstream doctors do fully understand glucose metabolism. And number two, it's going to make people neurotic because they're going to have all this data. And my response was, we shouldn't then, with that mentality, allow people to buy a bathroom scale because they shouldn't know their body weight because they're going to become neurotic and not know what to do with that information. I will agree that, you know, people are confused about what to do with that, about what to do. To do with being overweight, but we see what's happened.

• 36:46Speaker 01

  And now people are able to avail themselves of an incredible, incredibly powerful data set related to this continuous glucose monitor that has immeasurable implications in terms of their current and future health. Just knowing not just your spikes of blood sugar after a particular meal or exercise protocol, or lack of sleep, or negative interaction with another individual, whatever it may be, but more importantly, what are the dynamics of that blood sugar? And what is the, what we call the area under the curve? Not just what the blood sugar is from time to time, but how much time is it elevated?

• 37:23Dr. Darshan Shah?

  Right.

• 37:23Speaker 01

  And so, gosh, I think that's an incredibly valuable piece of information. It's breathtaking that people can get that information without having to go through a physician.

• 37:34Dr. Darshan Shah?

  Yeah, and to your point, I have hundreds of peoples on CGMs right now. Not a single person has not known what to do with that information.

• 37:41Speaker 01

  Yeah.

• 37:42Dr. Darshan Shah?

  Every single one of them eats it up. They want to know, they're monitoring, they're noticing things I wouldn't even think about noticing. Like how a walk outside versus a walk inside increases, decreases the area under the curve. Those kinds of things, which are just, you know, you got to trust people to know what to do with the data, especially when it applies to themselves because they are super motivated.

• 38:02Speaker 01

  Yeah, it gets back to what you just said. You tell every patient before you look at the labs, you know, that they need to get in the game.

• 38:09Dr. Darshan Shah?

  Exactly.

• 38:10Speaker 01

  They are, again, the architects of their health destiny. And that level of knowledge is really empowering, so I'm all in.

• 38:17Dr. Darshan Shah?

  Absolutely. Your next book, Brain Maker, was also way ahead of its time. I'll tell you, a deep dive into gut health and how that, and the microbiome, and how that impacts your brain. And I think, you know, the gut has always been another black box of medicine, I would say. I remember going through residency and just thinking, why would I ever want to be a gastroenterologist? All you do is colonoscopies all day long.

• 38:40Speaker 01

  But think back when you did, you did, you know, a colonic resection.

• 38:45Dr. Darshan Shah?

  Yeah.

• 38:45Speaker 01

  Or any surgery on the bowel.

• 38:47Dr. Darshan Shah?

  I did a lot of those, yeah.

• 38:47Speaker 01

  What's the first thing that you did? You sterilized the gut with neomycin or whatever it was.

• 38:52Dr. Darshan Shah?

  Yeah, we would do bowel preps.

• 38:53Speaker 01

  Right, bowel prep. Terrible is the gut because there'd be no implication of that long term. Why worry about it? You know, maybe it was it was good when you're doing the anastomosis to reduce infection rate. But I think that, gosh, it's so clear that we've been so cavalier with antibiotics.

• 39:11Dr. Darshan Shah?

  Absolutely.

• 39:11Speaker 01

  Over time and, you know, the good news is, I think there's a real revelation in the understanding of this relationship between the microbiota and the entire rest of our physiology, both in terms of metabolism and long term health.

• 39:27Dr. Darshan Shah?

  The words gut-brain connection are thrown around a lot. Would you define that to our listeners and kind of how you think of the gut-brain connection?

• 39:36Speaker 01

  Well, I think it's it's interesting that we're having a discussion because there is this kind of revelation that the gut is connected to the brain. Why don't we talk about the gut-heart connection, the gut-bone connection, the gut-mood connection, the gut connection to any function.

• 39:54Dr. Darshan Shah?

  It's all interconnected.

• 39:55Speaker 01

  The fact that we somehow have segregated the body parts, you know, in a sort of Cartesian way, it's time we we recognize that everything is connected to everything else. We talk about, here's a term that you're gonna love, cardiometabolic health. Why are we locking metabolic health into cardio? Why do we not talk about neurometabolic health? Or metabolic health as it relates to immune? Immunometabolism is now an important term. So, again, you know, I think it's doesn't serve us well to think that this is a revolutionary idea that the gut is connected to the brain. And it is, it's physically, it's chemically, it's spiritually connected to the brain,

• 40:40Speaker 01

  and the brain then connected to the gut. You bet, I had a gut feeling about this. That term means a lot. But and the brain-gut connection as well. So, you know, we know that there that's bidirectional, that's for sure. The brain and your thoughts influence what's going on in the gut, the secretion of the hormones. You know, we know that, for example, corticosteroids that your body will create in response to stress Dramatic effect on the functionality of the gut bacteria, their diversity, whether they're able to do good things for you or not, upon which we depend. The chemicals that they produce, the short chain fatty acids, their role in shoring up the barrier, the gut barrier, that when it becomes dysfunctional, sets the stage for Alzheimer's disease.

• 41:25Dr. Darshan Shah?

  Right.

• 41:25Speaker 01

  So this relationship is profound. And beyond being profound, it provides us an incredible opportunity, a new playing field, as it were. That's what Brain Maker was all about, that we have a new playing field to provide us incredible, unthought of opportunities to help people regain and prevent brain issues, regain brain function and help prevent brain disorders. So it was very exciting to write that book. And like you said earlier about brain, brain, there was pushback, you know? And my gosh, the gut-brain connection, how could that? There is no connection. The brain's here, the gut is there. Why would, why would he say that? So.

• 42:04Dr. Darshan Shah?

  And I think, you know, I think when I think about that gut-brain connection, another thing I did in surgery a lot was vagotomies. I can't believe we used to do that. It was the only way to treat like a ulcer in the stomach. And you think of the vagus nerve and the incredible implication, the amount of, the amount of signals going through the nerve, which 90% of the signal, I think, goes from the gut to the brain. And we would just cut that in surgery because we didn't know what the vagus nerve really did, except make.

• 42:30Speaker 01

  Vagotomy and pyloroplasty, that's for sure. But how interesting it is that that highway, bidirectional highway, is bringing unique things from the gut, actual physical things, not just electrical signals are making their way to the brain, like a protein called alpha synuclein that may in fact be stored in the appendix. But this alpha synuclein makes its way to the brain and is thought to be a fundamental player in Parkinson's disease, such that retrospectively, people who underwent that procedure that you performed, vagotomy, ended up having a remarkably lower risk for Parkinson's because the superhighway was closed.

• 43:11Dr. Darshan Shah?

  Interesting. Yeah. That is so, and this is. In the appendix.

• 43:15Speaker 01

  It is thought that a lot of the alpha-synuclein may be stored in the appendix.

• 43:19Dr. Darshan Shah?

  Has there ever been a study of appendectomy?

• 43:22Speaker 01

  There has been, and it looks as if that might be associated with reduced risk of Parkinson's.

• 43:26Dr. Darshan Shah?

  That's so, and it just highlights that how much we don't know.

• 43:30Speaker 01

  Yeah.

• 43:30Dr. Darshan Shah?

  How many chemical signals, how many molecular signals are there that are going all throughout our body? And the connections that are there is just incredible. We keep learning new signals all the time.

• 43:41Speaker 01

  And I have to tell you that over the years, and I think back when I began lecturing on these kind of novel ideas. I thought, wow, we are really connecting dots and we're really gaining, you know, a new frontier of understanding in terms of what's going on. And I realize now that, gosh, there's so much more to understand. That we're not, people say we haven't scratched the surface. We're not even near beginning that process. It's, there's a lot to learn and that, that's again what makes it exciting. But, you know, as it relates to Parkinson's, that's a metabolic condition.

• 44:15Dr. Darshan Shah?

  Right.

• 44:16Speaker 01

  One very large study demonstrated that the risk of Parkinson's in type 2 diabetics is increased by about 46%. What does it tell you? It tells you that there's a metabolic component, that the area of the brain that creates dopamine is one of the most metabolically active parts of the brain. When we threaten metabolism, that's one of the first areas that suffers. Less dopamine produced by the area, the substantia nigra, and then we have these clinical manifestations. It can be induced by metabolic issues, it can be induced by exposure to various environmental toxins. It can be induced, as we saw with Muhammad Ali, by repeated head trauma. You know, there are many entrees to compromising brain metabolism,

• 45:01Speaker 01

  including, that are feed forward, that continue on. We see that with this chronic traumatic encephalomyelopathy that football players get. That once they are, you know, once this process has been started, it continues. And it continues because of the relationship between our metabolism and the brain's immune system. And that is what we call immunometabolism. That's what my next book is all about, that's, which is called Brain Wars. That is. That's the new horizon.

• 45:35Dr. Darshan Shah?

  And I'm so glad you mentioned this because when you said immunometabolism a few minutes ago, early in the conversation, I was like, wait a minute, I haven't heard you use that term yet in any of your books that I've read, but I did see, I think you wrote a blog about this just recently, is that right?

• 45:49Speaker 01

  I did.

• 45:50Dr. Darshan Shah?

  Yeah, and so for people that want more information, we'll link to the blog for sure. But I'm excited to hear that you have a new book coming out on this because it seems to me there is so much new research around the lymphatic system and the immunology of the brain that is so tied into these chronic degenerative neurological diseases. And as humans, we can affect the immunology of our brains by our everyday actions.

• 46:16Speaker 01

  And I think it's important to realize that we have been very myopic as it relates to the term immune system in the brain. I mean, this focuses on a unique population of cells that make up about 10% to 12% of the cells in the brain called the microglial cells. That'll be on the quiz for all of the viewers, but the point is that, you know, we think of immunity, you know, in the context of infectious problems and COVID, I want to have a strong immune system so I can fight off these invading pathogens. But in the brain and even in the body, the immune system is doing a lot more. I mean, in the brain, the immune system is deeply involved, not only in finding viruses and bacteria and components of these viruses and bacteria ridding the brain, but nurturing

• 46:59Speaker 01

  neurons, nurturing synapses, maintaining the integrity of the blood-brain barrier, gobbling up misfolded proteins like beta amyloid. And when this part of the immune system, the microglial cells, transform into another morphology, we call a different phenotype, the very same cell transforms into, it adopts, changes its personality, becomes the evil twin.

• 47:21Dr. Darshan Shah?

  Wow.

• 47:22Speaker 01

  When it becomes the evil twin, then it hastens the death of neurons, it digests away the synapses, the connections between neurons, it destabilizes the blood-brain barrier, it stops engulfing beta amyloid. It's the same cell. And the shift between being the good twin and the evil twin is governed by the metabolism

• 47:44Speaker 01

  Of that cell. So this is, you know, the spotlight example of immunometabolism. It's how the metabolism of that cell, primarily the function of its mitochondria, and how that determines whether it's the good twin that loves us and nurtures our brains and protects us against Alzheimer's, or the evil twin that hastens the brain's decline.

• 48:06Dr. Darshan Shah?

  Oh, this is so interesting.

• 48:08Speaker 01

  That's the war.

• 48:08Dr. Darshan Shah?

  That's the war that's being fought in the brain. And these, in the microglial cells.

• 48:13Speaker 01

  That's right.

• 48:13Dr. Darshan Shah?

  Are the immune cells of the brain. And they have so many functions, as we know, like at night when you sleep, that's what's kind of clearing your brain of toxins. But you're saying that they become the evil twin if their metabolism is not on point.

• 48:26Speaker 01

  And brain metabolism obviously reflects systemic metabolism. And becoming metabolically compromised, let's say you have type 2 diabetes, you know, probably 70 to 80% of Americans now has either prediabetes or diabetes. That's a sobering statistic. But the idea that, you know, our systemic metabolism is affecting our brain's destiny is a lot to embrace.

• 48:50Dr. Darshan Shah?

  It is, it is. Wow, I mean, it's just, I'm so glad you're writing another book about this because I'm incredibly interested to learn more about the microglial.

• 48:57Speaker 01

  It's a good exercise.

• 48:59Dr. Darshan Shah?

  Yes. And you're definitely not getting a lifetime achievement award before the book because we have to wait till after the book.

• 49:05Speaker 01

  Get it ready, then you're gonna, whether I get it or not will depend on the quality of the book, I guess. But, you know, this relationship to metabolism over which we have control, in the context, let's go back to Parkinson's. I mean, I think there's a lot of understanding out there that metabolic health affects the brain in the context of Alzheimer's. Having said that, the notion of it being something at play as it relates to Parkinson's, I think, is a bit of an eyebrow raiser for a lot of people. But, you know, I think back to the spring of this year, in the New England Journal of Medicine, was a fascinating study published that looked at an intervention to improve metabolism in Parkinson's patients.

• 49:48Speaker 01

  We're going to give these patients an intervention that's going to help them with their metabolism, help them with their blood sugar, the way cells use energy, the way they produce various substances based upon their, what they receive. And what they gave these individuals over a one-year period of time, and had a control group as well that did not receive the intervention, was a GLP-1 agonist drug.

• 50:13Speaker 01

  An Ozempic-like drug given to patients with Parkinson's disease.

• 50:19Dr. Darshan Shah?

  Yes.

• 50:20Speaker 01

  Wow. Well, what did it show? The control group had a progressive decline in function as measured on what is called the UPDRS Unified Parkinson's Disease Rating Scale, which is a standardized way that we look at Parkinson's patients in terms of mobility, their ability to carry out their activities, daily living, how much assistance they need, et cetera. That number generally with time goes higher and higher. In the group receiving the GLP-1 agonist drug, Parkinson's was stopped dead in its tracks.

• 50:51Dr. Darshan Shah?

  That's incredible.

• 50:53Speaker 01

  It is.

• 50:53Dr. Darshan Shah?

  And this is a direct relationship to the metabolic health of the brain cells. It's not, you know, people think of semaglutide and the GLPs as a weight loss drug, right? And I'm sure a person's weight has something to do with the positive effects, but this is more of a direct effect of the GLP on the brain. What do you think?

• 51:11Speaker 01

  Uh, okay, that's, okay, I'm glad you, that you turned into a question because as a statement, uh, who knows? I mean, uh, who knows if, uh, weight loss, but they didn't lose a lot of weight. I mean, generally Parkinson's patients are, are a bit on the thin side.

• 51:24Dr. Darshan Shah?

  Right.

• 51:25Speaker 01

  They say there wasn't a massive weight loss in these, a significant weight loss in these individuals. So interesting thought, why you went there probably was because we know that overweight and obesity is associated with significant higher levels, significant higher level of inflammatory chemicals that are measurable in the blood. The, think the tumor necrosis factor alpha, interleukin-1 beta, interleukin-6, et cetera, which we've seen in Parkinson's and Alzheimer's and across the spectrum of the neurodegenerative conditions to varying degrees. But I think when we look at the research that shows a direct effect on mitochondrial function when these drugs are utilized, as was demonstrated in diabetic patients, a significant improvement of mitochondrial function, that's where the money is, by

• 52:09Speaker 01

  the way, that that's more likely the explanation. I mean, Parkinson's disease is a disease of the mitochondria.

• 52:17Speaker 01

  We know that the mitochondria are immediately damaged when the experimental chemicals are given to rodents and primates to cause Parkinson's in them. These are mitochondrial toxins. And therefore, the focus is on upreglet or enhancing the mitochondria, how they work. That's what metabolism is all about. And that's how, it's one of the ways which these GLP-1 agonist drugs work, which probably is responsive for a lot more of their activity peripherally in terms of their improvement in metabolism than is being given credit for.

• 52:52Dr. Darshan Shah?

  That's true.

• 52:53Speaker 01

  So that said, this is a breathtaking result. I want to make very clear to your viewers that I'm not saying that if, you know, mom or dad or you have Parkinson's, go out and start taking Ozempic or other GLP-1 agonists. I will say that that's not what these drugs are approved for, number one. Number two, this was one study, a year-long study. And number three, there was a significant number of side effects in the treatment arm of this study. Around 40% or more had significant gastrointestinal issues, which is not uncommon as with the other GLP-1 agonist drugs as well. Lyroglutide was the one that was used, Victosia is the trade name of the one used in the study.

• 53:35Speaker 01

  And I will indicate where our story gets even more exciting and where we will, you know, tend to take this validation of metabolism, is that this summer, in the Alzheimer's Association International Conference, there was a presentation by a researcher who carried out a similar study on Alzheimer's patients and showed in the three-year study using the same GLP-1 agonist, Lyroglutide, that the rate of loss of brain substance in established Alzheimer's patients, the shrinkage of the brain was reduced in the treatment group by 50%, with a significantly reduced rate of cognitive decline.

• 54:20Speaker 01

  Yes, there were side effects, but there weren't side effects like are being seen with the currently FDA-approved So-called Alzheimer's drugs.

• 54:28Dr. Darshan Shah?

  Right.

• 54:28Speaker 01

  Of brain hemorrhage and brain shrinkage seen in virtually across, virtually across the board in people receiving these drugs that are, that are approved for treating Alzheimer's disease. So, again, my mission in these two examples in our conversation today is not to indicate this is the way we should go moving forward, though it may be. We'll see what we're, what the approval process looks like. But it's to really shine a light on targeting metabolism.

• 54:57Dr. Darshan Shah?

  Absolutely.

• 54:58Speaker 01

  That's what these drugs are doing. And you and I know, and your audience from listening to you, and all your patients know now, that there are a heck of a lot of things out there that we can be doing right now to improve our metabolism, you know, as opposed to injecting ourselves with a drug every day.

• 55:13Dr. Darshan Shah?

  Exactly, exactly. And I think the GLPs are just indicating metabolisms at the root of all of these brain diseases. And so it's just an indicator of mitochondrial health, it's an indicator of metabolic disease as a root cause of these problems. And so if we're focused on metabolic disease, preferably earlier in life, but as I want to highlight too, is never too late to turn things around.

• 55:36Speaker 01

  And it's never too early.

• 55:37Dr. Darshan Shah?

  Yeah, and it's never too early as well. I mean, like, you know, just to highlight on that point, I can't tell you the number of teenagers that we're seeing that have a hemoglobin A1C of 5.7 indicating poor glucose metabolism. And so I, I, I got my kids started very early on understanding metabolic health. In fact, we talk about it at breakfast once in a while, is their metabolism and how they can affect their metabolism positively.

• 55:59Speaker 01

  Some people may think that's strange, but you're looking out for them. My breakfast lessons growing up were, you know, strange neurological diseases. And I remember one, it actually was dinner, my father said, I want to tell you about Marcia fava bignami syndrome. What in the hell is that? I was, well, how old I was, 11 years old. Well, what's that one going to be, Dad? I had to go there because, you know, he dedicated himself to medicine. So I didn't get a heck of a lot of time.

• 56:27Dr. Darshan Shah?

  What type of physician was he?

• 56:28Speaker 01

  Neurosurgery.

• 56:29Dr. Darshan Shah?

  He was also a neurosurgeon.

• 56:30Speaker 01

  Yeah, so I didn't get a lot of time, and so I had to really be on his, his turf. And Marcia fava bignami syndrome, I, there's not one of your viewers, I think, who's, unless they're in, anyway, in the field.

• 56:41Dr. Darshan Shah?

  I don't know, I haven't even heard of that one.

• 56:42Speaker 01

  It's shrinkage of the corpus callosum due to drinking red wine in Italian men.

• 56:48Dr. Darshan Shah?

  Oh, interesting.

• 56:49Speaker 01

  I know, it's way out there, but the point is that, you know, as you're talking metabolism with your kids, I remember, I remember those days.

• 56:56Dr. Darshan Shah?

  Yeah, my, my dad also was a physician. He, he told me all about The Man Who Mistook His Wife For a Hat. Do you remember that book?

• 57:03Speaker 01

  Oliver Sacks.

• 57:04Dr. Darshan Shah?

  Oliver Sacks, yeah. He loved that book and we would talk about that all the time. And then, like you said, the imaging then kind of, I would say pushed that entire kind of diagnostic pathway under the rug a little bit because now you just get an MRI and you can tell what's going on.

• 57:18Speaker 01

  Oh, as far as, yeah, as far as that, but again, I'm buoyed by the notion that there seems to be a bit of a groundswell in neurology.

• 57:26Dr. Darshan Shah?

  There is.

• 57:27Speaker 01

  To look at lifestyle. I mean, those articles are there, those studies are there. They're generally ignored, but you know, in the, even in the throwaway journals. I was reading a throwaway journal last week, I think it was called Neurology Reviews. There's some interesting things. And they were talking about how there are a couple of neurologists who've established themselves on social media and trying to get, you know, information out. Then I, I was reading about, in this article, the number of followers that I have and, and they interviewed me and I had forgotten about the interview and they asked, why do you do it? And I said, because we've got to get this information out and social media is a great tool for getting information out, for empowering people to make better decisions

• 58:09Speaker 01

  in terms of their lifestyle choices. Let me go back to where we were just a moment ago, because there's a thought still hanging. And that is, so these issues are important 20 to 30 years prior to the onset of Alzheimer's. When does the Alzheimer's prevention program begin then? In your twenties, in your thirties, you said teens having higher A1Cs, adolescents, toddlers, newborns, you know, during pregnancy?

• 58:34Dr. Darshan Shah?

  Right, exactly.

• 58:35Speaker 01

  During gestation, during gestation rather. And I would say, yeah, even pre-gestation.

• 58:41Dr. Darshan Shah?

  Sure.

• 58:41Speaker 01

  You know, I did an interview yesterday on a podcast, we were talking about the method of birth and the implications of whether a, a child is brought into this world via vaginal delivery or cesarean section and the implications that that has on that child's brain. Health.

• 58:58Dr. Darshan Shah?

  Right.

• 58:59Speaker 01

  And immune function based upon the whether that child is anointed with specific bacteria and viruses by passing through the birth canal or is delivered by C-section and is exposed to those organisms on the surgeon's gloves at the time of birth, knowing that mother did receive a blast of IV antibiotics prior to the C-section. Again, I'm not saying C-sections are are a bad thing. They're life-saving, valuable tool, but I believe a little bit overdone. And I think the discussion with soon-to-be parents is needs to go further than the length of the C-section scar, that having a C-section may indeed have lifelong implication for that individual in terms of his or her immune function and even brain function.

• 59:43Dr. Darshan Shah?

  Yeah, absolutely. In fact, a lot of women, when they ask me about what method of delivery and the, you know, a lot of people, especially here in LA, I think a C-section is preferred now as a method of delivery and they do scheduled C-sections a lot of

• 59:57Speaker 01

  Right.

• 59:57Dr. Darshan Shah?

  Time.

• 59:57Speaker 01

  Convenient.

• 59:58Dr. Darshan Shah?

  Convenience, right. It's all about convenience, timing, and actually, the OB-GYNs actually prefer it now, too, because it's less stressful for them to do a C-section than to deal with a breach birth or a birth issue. And so it's it's kind of interesting to see how things have gone with modern medicine. But we always talk about doing a vaginal wipe of the baby to at least get the vaginal microflora to the baby, because a lot, like you said, this, the mothers getting C-sections are getting a dose of antibiotics and the the baby is not exposed to the vaginal canal at all. And so that's one of the ways

• 1:00:28Speaker 01

  You you ought to restate that.

• 1:00:30Dr. Darshan Shah?

  Yeah.

• 1:00:31Speaker 01

  You know, because that's really very, very important.

• 1:00:34Dr. Darshan Shah?

  Yes.

• 1:00:34Speaker 01

  That is something that is almost unknown. I wrote about it in Brainmaker. But what you just said is really quite profound. That's research from NYU, Maria Dominguez-Lopez Bello, I think is her name. And she said, if we're delivering babies via C-section, we'll put a swab in the birth canal ahead of time, keep it warm and moist, and then when the baby's delivered, we'll swab his or her face, mouth, nose, ears, eyes with this, these bacteria.

• 1:01:01Dr. Darshan Shah?

  Right.

• 1:01:01Speaker 01

  Inoculate that child for a healthier microbiome.

• 1:01:04Dr. Darshan Shah?

  Right.

• 1:01:04Speaker 01

  Because when it doesn't happen, and the microbiome Is formed from the other bacteria, you know, after a period of time, eighteen months or so, there's pretty minimal difference between the two. But we do know that rates for autoimmune conditions like type one diabetes and celiac disease are significantly higher in C-section children. That's science. And why is it happening? Is it just, uh, is, what is the correlation? Is it causative? Well, we have a really profound mechanism. Now that we understand the role that the gut bacteria and other organisms are playing in the regulating what's called the set point of the immune system. Not enough immunity or at risk for disease of the infectious type, too much immunity, very simplified.

• 1:01:48Speaker 01

  You react against your own body. We have an autoimmune condition. So that set point is really fundamentally important for keeping us in the Goldilocks zone, in the sweet spot. And, you know, so many of the perturbations of our gut bacteria that we are exposed to these days, primarily the foods that we eat, but the antibiotics and other medications we receive, change the diversity and function of these bacteria and the immune system functions. And as a consequence, the brain is compromised.

• 1:02:16Dr. Darshan Shah?

  Exactly. And it's, you know, it's profound research, like you said, and it's incredible how slow research actually makes its way into mainstream practice. And so doing what you do on social media and also on, on podcasts and just spreading the word. Hopefully more doctors are also listening to your podcast, this podcast, and they're learning these things because the research is there. I mean, it is definitely there and it's not woo woo science. And this, these are some of the practices we should be following. You know, there's this big push in medicine that I've heard ever since I was in medical school called standard of care, right?

• 1:02:48Speaker 01

  Yeah.

• 1:02:49Dr. Darshan Shah?

  The problem with standard of care is it gets locked in and then it's not changed for twenty to thirty years at many institutions, when it should be.

• 1:02:56Speaker 01

  Yeah, there was a word that people used to describe what I was in. They said, oh, what Dr. Perlmutter does is, is unconventional. And, uh, you know, he's, he's breaking with tradition, breaking with tradition. And I, I thought, well, tradition sort of connotes longstanding.

• 1:03:16Speaker 01

  And this, this idea of segregating body parts and targeting disease and not nurturing wellness is really brand new. I mean, you know, those involved in healthcare have always tried to nurture health until quite recently. You know, and again, the medical aspect of, of health is, the scientific aspect viewpoint on health in many ways is exciting and wonderful, but in other ways, kind of locks us into being reactive, not proactive.

• 1:03:43Dr. Darshan Shah?

  Right, right, absolutely.

• 1:03:48Dr. Darshan Shah?

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• 1:04:28Dr. Darshan Shah?

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• 1:04:47Dr. Darshan Shah?

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• 1:05:28Dr. Darshan Shah?

  and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to vitaboom.com and check it out.

• 1:05:39Dr. Darshan Shah?

  I wanted to spend a little bit of time for the listeners. One of the big things I love to talk about in this podcast is a Pareto Principle. The 20% of the information that makes 80% of the difference. Because I think people get really overwhelmed with the massive amount of information that they hear, that they're getting presented by. And, you know, I don't know if you agree, but I think that there's some big wins that you can have. And you detail this in another one of your books, The Grain Brain Whole Life Plan. And I would love to just kind of hear from you, your current thought process around, what are the big wins in brain health right now? If you were to, if someone were to ask you, what are the top five things that I can do right now to live a brain healthy lifestyle? What would you recommend to people?

• 1:06:22Speaker 01

  Exercise would be probably, you know, as well as nutrition, but underrated and a powerful lever to pull. And we can spend some time talking about that, but.

• 1:06:35Dr. Darshan Shah?

  Please, yeah.

• 1:06:35Speaker 01

  Well.

• 1:06:36Dr. Darshan Shah?

  And specifically, what type of exercise and how much?

• 1:06:40Speaker 01

  Well, we know that muscles that are what come into play when you're exercising are actually endocrine glands. They are secreting a variety of chemicals, catepsin B, resin, BDNF, that have effects throughout the body, not the least of which are affecting the brain. And therefore, if you want to have chemicals that are good for the brain, you can produce them by activating this endocrine gland. An endocrine gland is an organ in the body that has, that creates messengers that affect the function of another part of the body. The thyroid gland creates thyroid hormone that has an effect on the muscles, on the heart and the brain, et cetera. So people understand what an endocrine gland is. To conceive of muscles being an endocrine gland is a bit of a stretch, but that's what's

• 1:07:26Speaker 01

  going on. And the, you know, textbooks are written that describe the effects of exercise and the chemicals it creates on the brain. It's there, it's low hanging fruit, it's for everyone, but you have to buy something, some very expensive piece of machinery. And this is the pitch for everybody. A new pair of, I used to call them sneakers, but what do you call them now? I don't know.

• 1:07:48Dr. Darshan Shah?

  Trainers.

• 1:07:49Speaker 01

  You know, you don't need to be equipment heavy and have a, you know, expensive gym membership and a personal trainer. Just get out and walk. Get your heart rate up. We often try to delineate between what we call resistance exercise, which means basically straining a muscle as opposed to aerobic exercise, which is more cardiovascular, which is getting your heart rate up. I think that we can look at some broad stroke recommendations in terms of your heart rate, which you can metrize based on wearing your Apple Watch or Fitbit or whatever you choose, but start to get to know that along with your blood, a glucose level, and maybe even parameters related to sleep. But get your heart rate up for 20 minutes of a period of time. And what should the target heart rate be?

• 1:08:33Speaker 01

  I can't make a general recommendation. This is very personalized approach. But as a really broad, general view, but consult your physician, 180 minus your age. That's a ballpark. It might be a lower number if you're on a medication like a beta blocker. It might be a higher number if you're really in good shape. But just as a starting place, and everybody can start today.

• 1:08:55Dr. Darshan Shah?

  Yes.

• 1:08:55Speaker 01

  If you make it a rule to walk to the mailbox and turn around and come back to your house every day, tomorrow do it twice. If you can do it, you could likely do it twice. There's got to be something that you can do. And if there is, probably a little bit more.

• 1:09:10Dr. Darshan Shah?

  Right.

• 1:09:11Speaker 01

  So this is a tonic. This is a brain tonic. It's creating what's getting a lot of attention and has for the past 15 years, BDNF, brain-derived neurotrophic hormone factor. And this is a chemical that is what we call a trophic factor that just does wonderful things for neurons and synapses and stimulates the growth of new brain cells. I mean, who knew? And when I was in medical school, if you would have said, yes, there's a factor that, well, you would have said even that the brain grows new brain cells, I would have been kicked out of med school.

• 1:09:44Dr. Darshan Shah?

  Right, right.

• 1:09:45Speaker 01

  So, you know, it took a long time for it. We knew, we saw it in rodents, we saw it in primates. But the idea that humans could grow new brain cells was really just very countercultural at the time, really broke with tradition.

• 1:09:56Dr. Darshan Shah?

  Right.

• 1:09:57Speaker 01

  That was the term they used about me. It's non-traditional.

• 1:09:59Dr. Darshan Shah?

  Non-traditional.

• 1:10:00Speaker 01

  Yeah. What is our tradition? Our tradition is to nurture health. Anyhow, so that's really very important. The next on the list-

• 1:10:07Dr. Darshan Shah?

  So either you're saying- Either getting out there and do some aerobic exercise or strength training.

• 1:10:11Speaker 01

  Both.

• 1:10:12Dr. Darshan Shah?

  And do both.

• 1:10:13Speaker 01

  Yeah, and you know, beyond the brain, there's a lot of other benefits to strength training and mobility, uh, flexibility. And that's the third pillar that often gets ignored, and that is flexibility. The reason I think it's important is that when you're doing flexibility, you're ultimately offloading damage risk. So if you're flexible, you're not gonna as likely hurt yourself, pull a muscle, do this and the other, which then leads you to not exercise because you're injured. So we all get injured doing our sports. And then you're out, you know, you can't be playing pickleball for a week or two because you twisted your ankle. You gotta be careful. So I think the flexibility and the balance part are are really very important.

• 1:10:56Speaker 01

  That's how I start my workout is with flexibility and balance. And then aerobics and then weights or machines. You know, as I'm traveling, most of the hotels don't have a lot of free weights, they have a lot of machines. There's some really good machines these days that are smooth and give you, you know, really great control over the amount of of weight that you're doing, you're using. And I can't then overstate the importance of avoiding what everyone's talking about, this ultra-processed foods. Uh, that, you know, became a thing in the in the mid nineteen sixties when food manufacturers, let me stop there. Food manufacturers, what a term. Manufacturing food, food coming from a factory. What is that?

• 1:11:39Speaker 01

  Anyway, uh, you know, entered the marketplace and the lexicon that these foods are, you know, a good way to spike your blood sugar very quickly, as well as being devoid of important nutrients like fiber, like vitamins and minerals, et cetera. But they're just vacuous as it relates to what they're doing for you nutritionally. And they're a really negative, a profound negative impact on the gut bacteria. We've talked about why that's important. That's not what they need. That's not what your bacterial friends need. They need real food. They need fiber. I I really feel like, you know, fiber should be considered the fourth macronutrient. Can't be because it's a carbohydrate, so falls into that category. And unfortunately, because the carbohydrate people go low carb, they go low fiber.

• 1:12:22Dr. Darshan Shah?

  They do.

• 1:12:22Speaker 01

  Bad mistake. But that said, it's avoiding what foods in you are going to raise your blood sugar. So that might be a different recommendation for you as opposed to me. We are different genetically, we're different physiologically. We know the broad strokes. We know, you know, we know what that meal is that's going to spike our blood sugar, even without a continuous glucose monitor, and that's bad for the brain. So, but again, get a CGM and find out. For me, it was cashews. Who knew?

• 1:12:52Dr. Darshan Shah?

  Yeah.

• 1:12:53Speaker 01

  Cashews did a number on my blood sugar. I wasn't prepared for that, and I repeated it. And sure enough, so go easy on the cashews, go easy on the fruit. The fruit bowl, I ordered a fruit bowl yesterday at our hotel. It was enough for an elephant.

• 1:13:07Dr. Darshan Shah?

  Yeah.

• 1:13:07Speaker 01

  So when I ate, you know, a little bit of it, and then the waiter was really surprised. I didn't want to take it with me. He said, box this up anyway.

• 1:13:15Dr. Darshan Shah?

  The serving sizes are just gotten massive in the last few decades.

• 1:13:19Speaker 01

  It's so true. And otherwise, you feel like you're not getting your money's worth, you know? And the restaurant determines portion size. That's what's on the plate. I should eat the whole thing because, you know, you don't want to leave it. The third thing is to eat more fat. Now, that really sounds counter-cultural, doesn't it? But, you know, to be sure, we're talking about, A, the incredible need for good fat to build a better brain. Your brain by dry weight is 70% fat. You need those good fats, those good omega-3s to structurally and functionally improve your brain. And avoid the bad fats. Maybe another conversation I think people know where to go to learn this information. My website, Dr. Georgia Eats, there's so many out there.

• 1:14:00Speaker 01

  And that, I think, is really important because we're trying to undo the damage done in the 1970s and 80s and beyond that castigated dietary fat. Eat more good fat, get good olive oil. Take it with you to the restaurant. It's strange, I know, but so am I. So that's important. And I think, finally, it is to eat more of a plant-based diet. I am not a vegetarian or vegan. I eat animal products. But have a lot of plants with your meal, and they should be of varying colors to really accentuate your exposure to the good things that are in vegetables, the polyphenols, the bioflavonoids that. So much science has supported as being really helpful for your gut bacteria.

• 1:14:43Speaker 01

  And then secondarily for you and also primarily for you through various mechanisms as well. So those are the pillars.

• 1:14:50Dr. Darshan Shah?

  Big pillars.

• 1:14:51Speaker 01

  Exercise, ultra-processed food avoidance and all the foods that are spiking your blood sugar. Eating good fat and having a colorful plate. When you do that and you load your plate like that, you're going to start to see the word Mediterranean kind of flashing in the background because that's kind of what the Mediterranean diet is really all about, though the term has been bastardized these days. But those are really the things we should focus on.

• 1:15:15Dr. Darshan Shah?

  Yeah, it's one of the most studied diets and it doesn't mean you have to go just start eating Greek food only, but it's just following the pattern of the Mediterranean diet, which is high in vegetables, some good fats, you know, they promote fats from fish and nuts. And then finally, the, um, some well-sourced protein that's not processed. I think if you eat that pattern, not only is it brain healthy, it's healthy for every single system in your body.

• 1:15:39Speaker 01

  Getting back to what we talked about earlier.

• 1:15:40Dr. Darshan Shah?

  Exactly. It's, it's a, it's a combination. And then I think also a couple more things that you, you probably agree with as well is protecting your brain. I think, you know, uh, we talked a little bit earlier about CTE, but it's also important for people that don't play football, I think, get protecting your brain. What are your thoughts around that?

• 1:15:58Speaker 01

  Oh, it's a very good point. And, you know, we think, well, football players are banging their heads all day, you know, especially the linemen and, uh, you know, that's what they do throughout the entire game. And it's these repeated head traumas that cause a problem. Well, you know, one bad head trauma is devastating for your brain. Even if you think you've recovered, a lot of what goes on is irreparable and may even continue to worsen over time. You know, and I think I give a lot of credit to our friend Daniel Amen. Who's really made it clear that the brain is so delicate, as he's demonstrated on his spec scanning, that we've got to do everything to protect our brains. I.e. wear a helmet when you're on your bike.

• 1:16:39Dr. Darshan Shah?

  Sure.

• 1:16:39Speaker 01

  You may be really a, a good bicyclist, uh, or it's just a cruiser bike you're going around the neighborhood, but what about that bad driver or some? Somebody who on their cell phone and makes a mistake, you're the one, they're not gonna care. I mean, I'm not gonna care, they're not gonna suffer any damage because it's just their car. But you're in, you know, you've traumatized your brain. Uh, so I think that that's a point well taken.

• 1:17:01Dr. Darshan Shah?

  Yeah, so long, and like you mentioned earlier, that damage keeps going and going for maybe years. We don't, we didn't even know how long.

• 1:17:08Speaker 01

  Well, how does it, how does that happen?

• 1:17:10Dr. Darshan Shah?

  It's the metabolism, right?

• 1:17:11Speaker 01

  Yeah, so you've wondered.

• 1:17:13Dr. Darshan Shah?

  Right.

• 1:17:13Speaker 01

  Gee, you know, fall asleep at night, why is it then that this continues?

• 1:17:17Dr. Darshan Shah?

  Right.

• 1:17:17Speaker 01

  Why do they get worse with time?

• 1:17:19Dr. Darshan Shah?

  Right.

• 1:17:19Speaker 01

  If you have Parkinson's because you were exposed to an environmental insult and the insult has gone away. Why do you now have a progressive disease?

• 1:17:27Dr. Darshan Shah?

  It's a great question.

• 1:17:28Speaker 01

  It's a great question. I've pondered it for a long time.

• 1:17:30Dr. Darshan Shah?

  No.

• 1:17:31Speaker 01

  And now I understand it.

• 1:17:32Dr. Darshan Shah?

  No, you answered it for me today, actually.

• 1:17:34Speaker 01

  And what happens is that trauma, that environmental exposure, uh, that metabolic issue changes those help, helpful microglial cells, the M2 cells into the evil twin, into the M1 damaging cell. That takes over control and now that's running the show, destabilizing neuronal connections. The synapses leading to neurons to undergo pre-programmed cell death, apoptosis, all the bad things, right? Here's the empowerment part. When you target their metabolism, when you target their mitochondria, you can shift them back to being the good twin and stop the process.

• 1:18:14Speaker 01

  How can I say that? Remember the Parkinson's study that was released in, in the spring of this year? They arrested Parkinson's, a chronic progressive neurodegenerative disorder. That's how it's characterized. It's chronic and it's progressive. It worsens with time. No more.

• 1:18:30Dr. Darshan Shah?

  Yeah, I think it's such an important fact to highlight is all of these diseases that we thought, first of all, they come up as a surprise, Alzheimer's, Parkinson's, people are surprised when they get them. They don't need to be a surprise because you can start working on preventing them 30 years ahead of time. But also there, I think the, um, general mindset of the public is they're not treatable and they are gonna progress. And you'll probably die of this now. And what an incredible time we live in when it's reversal is what we're talking about now.

• 1:19:01Speaker 01

  I'm, you know, flying out here, I'm working on my book and it's only a number of months until I get that word out and I'm

• 1:19:08Dr. Darshan Shah?

  I can't wait.

• 1:19:09Speaker 01

  You know, I was excited about Grain Brain and the other books. I'm just over the top, you know, on this book. And again, I hope that I take my lumps for it. I hope I get the criticism because that's good. It means I've ruffled some feathers and it is absolutely time that people recognize two important concepts. A, that a lot of the stuff is reversible. And B, that they are running the ship. They're determining the outcome of the war that's going on in their brains. That's a thesis I'm really going to amplify and you're going to hear a lot more about it. But it's a time when, you know, being able to take advantage of podcasts, of social media, of the exposure that we are free to express and appear on,

• 1:19:53Speaker 01

  that people can tune into this information and gain a level of empowerment beyond the so-called status quo. Ronald Reagan famously said that status quo is a Latin term that means the mess we're in. It doesn't mean that, but it, you know, we're in a mess as it relates to healthcare and, you know, people like you are showing people there is another way, you know, that some people see things as they are and ask why, and others see things as they can be and say, why not? So it's a good time for people who are looking at these opportunities to really bring about a change in healthcare.

• 1:20:29Dr. Darshan Shah?

  Yeah, I agree with you. I'm incredibly optimistic and I really, truly, from the bottom of my heart, appreciate the work that you've done and are doing because, you know, just getting people to change their mindset about these things is a massive shift in our culture. And then just righting the ship a little bit today, that adds up to, you sailboats a lot, right? You know, if you sail the ship one degree different

• 1:20:52Speaker 01

  Over time.

• 1:20:53Dr. Darshan Shah?

  Over time, it's going to make a massive change. I think that's what's happening right now.

• 1:20:57Speaker 01

  I will probably take that from you and use that. That's good.

• 1:21:00Dr. Darshan Shah?

  Absolutely.

• 1:21:01Speaker 01

  I like that, yeah. I will say, and there's a bit of a flight of idea here. We had dinner at your house.

• 1:21:08Dr. Darshan Shah?

  Yes.

• 1:21:08Speaker 01

  Several months ago, and as we were leaving, we got in the car. I said to my wife about you. He's a really nice guy.

• 1:21:17Dr. Darshan Shah?

  Oh, thank you.

• 1:21:17Speaker 01

  And why I'm bringing it up right now, I don't know, because I'm feeling it, you know? And I really honor your dedication to this. And it's very, it's evident and it's important. And it's great that there are people like you on the team, you know? It's really encouraging.

• 1:21:34Dr. Darshan Shah?

  Thank you. It's, it's a hard road to change how medicine is practiced and how health care is administered in our current environment in America. But it's just so incredibly, just inspirational for me to sit across from you and Casey Means and other people that are just making massive shifts in culture right now. And I think this is the beginning of sailing that ship in the right direction. And we're trying to develop a whole new health care system that's focused on health, not on disease. And I think it's going to happen. I really do. And so with that, I just truly appreciate this and thank you so much for coming.

• 1:22:09Speaker 01

  My pleasure. Thank you so much.

• 1:22:11Dr. Darshan Shah?

  This was a great conversation and I can't wait to do it again with you, to be honest. I hope you'll come back after this next book because I just can't wait to dive deep into that.

• 1:22:19Speaker 01

  Count me in.

• 1:22:20Dr. Darshan Shah?

  Thank you. Thank you so much, Dr. Pearl Mutter.

• 1:22:27Dr. Darshan Shah?

  I hope that episode was as enlightening for you as it was for me. I always learn something new when I talk to Dr. David Pearl Mutter. So here are my top 10 eye-opening takeaways from this episode. Number one, your metabolic health directly impacts your brain health. Your metabolic health, which is basically how your body controls your glucose curve, determines how well your brain functions. Conditions like type 2 diabetes increase your risk of developing neurodegenerative disease like Alzheimer's by up to 60%. This is why it's so important to get your metabolic health in order, utilizing tools like the continuous glucose monitor. Number two, neurodegenerative diseases start decades before you have symptoms. Alzheimer's, Parkinson's, and other brain disorders don't just appear overnight.

• 1:23:10Dr. Darshan Shah?

  Clinical signs show up almost 20 years before the disease has already begun.

• 1:23:16Dr. Darshan Shah?

  This makes early prevention a key. What you do in your twenties and thirties can shape your brain health later in life. Number three, CGMs, continuous glucose monitors are game changers. They're not just for diabetics. They track your blood sugar and this tracking helps you understand how your body reacts to food, exercise, and stress and sleep in real time. Some small but very powerful changes, like just switching from an indoor walk to an outdoor one, can lower your blood glucose spike significantly. Number four, exercise is brain medicine. Your muscles actually act like an endocrine gland and they release powerful chemicals that can stimulate BDNF, which is brain-derived neurotrophic factor. This factor protects your neurons and improves your cognitive function.

• 1:24:02Dr. Darshan Shah?

  Even 20-minute of walking can stimulate the production of these brain fertilizers and they can help ward off neurodegeneration. Number five, your gut controls more than just digestion. The gut-brain connection isn't just a buzzword. Your microbiome influences everything from your mood to your cognitive performance. Number seven, GLP agonists show promise for neurological conditions. Drugs like Ozempic, traditionally used only for diabetes and weight management, may actually play a significant and pivotal role in stabilizing neurologic diseases like Parkinson's and Alzheimer's disease. Number eight, chronic stress can turn your brain's good guys into bad guys.

• 1:24:44Dr. Darshan Shah?

  Microglial cells, the immune cells of the brain, can switch from being protective to actually being disruptive under chronic stress and poor metabolic health. When this happens, they start breaking down your synapses and killing neurons, accelerating your cognitive decline. Number nine, your choices can reverse cognitive decline. Despite popular belief, cognitive decline isn't just a one-way street. Research shows that lifestyle changes, including sleep, a good diet, and consistent exercise, can slow and actually reverse signs of Alzheimer's and Parkinson's. Number 10, ultra-processed foods are fueling your brain inflammation. Foods that spike your blood glucose levels

• 1:25:26Dr. Darshan Shah?

  And are stripped of fiber, nutrients, and antioxidants not only harm your body, they're toxic to your brain. A diet high in sugar, refined sugars especially, and processed foods have been linked to mood disorders, memory problems, and cognitive decline. Those are my top 10 takeaways from this episode. I hope you enjoyed this episode. If you did, please share it with someone who's worried about cognitive decline in their future, or could use some advice around their brain health. And please like and comment as well. Thank you.

• 1:25:59Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode, and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.