Alzheimer’s Can Be Prevented & Reversed: Drs. Dean & Ayesha Sherzai On Optimizing Brain Health

While other major diseases are in decline, deaths from Alzheimer's have increased dramatically in recent decades. In fact, Alzheimer's is currently the 6th (and due to massive under-reporting may be as high as the 3rd ) leading cause of death in the United States. Right now, over 47 million people worldwide currently live with Alzheimer's. By 2050, it's predicted this form of dementia will plague 135.5 million people across the globe. This disease has become so pervasive, chances are you have been directly or indirectly impacted through an afflicted loved one. If so, then you know first hand the devastation it creates. You've seen it's ravaging effects. Perhaps you've even shouldered the immense emotional, financial and social burden it produces — and the hopelessness it provokes. The sad truth is that Alzheimer's is a condition that Western medicine has utterly failed to combat, let alone cure. Simply put, there is no pharmaceutical or surgical treatment to effectively prevent or reverse this savage and cataclysmic condition. But there is hope. Alzheimer's isn't a genetic inevitability. A diagnosis doesn't have to come with a death sentence. In fact, according to this week's guests, 90% of all Alzheimer's cases can be prevented. And for the 10% with a strong genetic risk for cognitive decline, the disease can be delayed for ten to fifteen years. These are not estimates. Nor are they wishful thinking. They are conclusions based on rigorous science performed by neurologists Drs. Dean and Ayesha Sherzai. Co-directors of the Brain Health and Alzheimer's Prevention Program at Loma Linda University Medical Center, Team Sherzai is the dynamic husband and wife duo behind the largest clinical and observational study on Alzheimer's to date as well as the co-authors of The Alzheimer's Solution*, a must-read primer that details their extensive research, chronicles the remarkable results they have experienced working with patients first-hand, and sets forth the first ever comprehensive program to prevent Alzheimer's disease, improve cognitive function, and ultimately optimize long-term brain health. The solution might surprise you. It's not due to a breakthrough in surgical procedures. It's not the result of new pharmaceutical trials. Instead, as far fetched as it may sound, the answer is rooted in fundamental, simple changes in nutrition and lifestyle. Dr. Dean Sherzai, M. D., PhD., completed his medical and neurology residencies at Georgetown University with a subsequent fellowship in neurodegenerative diseases at the National Institutes of Health, followed by a second fellowship in Dementia and Geriatrics at the University of California, San Diego. He also holds two Masters Degrees; in advanced sciences at UCSD and a Masters in public health from Loma Linda University. Finally, he has received a Ph. D. in Healthcare leadership at Loma Linda/Andrews University. Dr. Ayesha Sherzai, M. D., completed her medical residency at Loma Linda University. She subsequently completed a residency in preventive medicine and neurology and thereafter received a fellowship in vascular neurology from Columbia University, and is currently finalizing her PhD in Epidemiology at Loma Linda University. Ayesha also has a culinary degree, giving her a unique understanding of nutrition as a powerful tool for disease prevention. Peace + Plants, Rich Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:06Ayesha Sherzai?

  There are few genes in Alzheimer's disease, maybe less than 5% of the genes that completely determine whether somebody gets Alzheimer's or not. As a matter of fact, if you have those genes, you're definitely going to get it. But even for those, you can push it off for a very long time. For the rest of them, for the 95-plus percent of the genotypes, it's quite clear that what you do in your life, the type of food that you eat, whether you exercise or not, or the level of stress that you have, determine whether you're going to get the disease in your early 60s or in your late 90s.

• 1:44Rich Roll?

  That's Dr. Ayesha Sherzai, along with Dr. Dean Sherzai, this week on the Rich Roll Podcast.

• 2:01Rich Roll?

  The Rich Roll Podcast. Hey everybody, how you guys doing? Greetings. How did it go Thanksgiving? Was it good? Did you guys survive? I hope so. I hope you kept your food intake in check. I hope you resisted the urge to splurge, that you stayed away from the mall on Black Friday and enjoyed your loved ones, all the good things. My name is Rich Roll. This is my podcast. Thanks for dropping by. Today on the show, we're going to dive into a subject that I've been wanting to explore for a very long time. It's an important subject, and that is brain health with a focus on dementia and our quickly growing epidemic of Alzheimer's, which is this devastating disease that's destroying

• 2:44Rich Roll?

  lives at quite an alarming rate. Right now, Alzheimer's is currently the sixth leading cause of death in the United States, and that could be as high as the third leading cause of death due to massive unreporting. Currently, 47 million people worldwide live with Alzheimer's. And what's interesting is that while other major diseases are in decline, deaths from Alzheimer's have increased radically. By 2050, they're predicting that it's a disease that will afflict 135 million people. And I'd be willing to bet that most of you guys out there listening have been impacted by this disease either directly or indirectly through somebody in your circle that you

• 3:29Rich Roll?

  love. And if you have, then you know how ravaging and devastating it is and how hopeless it can leave you because in truth, it's a condition that Western medicine has really failed to overcome. There is no pharmaceutical or surgical treatment for this, as well as for related diseases like Parkinson's. And the emotional, financial, and social burden of this and related diseases is just immense. Certainly genetics play a role in your risk, but that's hardly the whole story. There is a silver lining. There is hope. And according to today's guests, 90% of Alzheimer's cases can be prevented,

• 4:13Rich Roll?

  and symptomology can even be reversed. And this is not achieved through the latest breakthrough in surgical procedures or new pharmaceutical remedies, but as wild and as far-fetched as it may sound, through something as simple and fundamental as nutrition and lifestyle. To walk us through all of this is the husband and wife duo, Doctors Dean and Ayesha Sherzai, Team Sherzai, as they call themselves. Doctors Dean and Ayesha are the directors of the Alzheimer's Prevention Program at Loma Linda University Medical Center, and are the authors of an amazing new book entitled "The Alzheimer's Solution," which outlines the first comprehensive program

• 4:55Rich Roll?

  for preventing Alzheimer's disease and improving cognitive function, based on this tremendous research that they performed, which involved the largest clinical and observational study of Alzheimer's to date. Dr. Dean Sherzai finished his medical and neurology residencies at Georgetown University, with a subsequent fellowship in neurodegenerative diseases at NIH, the National Institutes of Health, followed by a second fellowship in dementia and geriatrics at the University of California, San Diego. He also holds two master's degrees in advanced sciences at UCSD, and a master's in public health from Loma Linda University. He also has received

• 5:35Rich Roll?

  a PhD in healthcare leadership from Loma Linda/Andrews University. Dr. Ayesha Sherzai completed her medical residency at Loma Linda. She subsequently completed a residency in preventive medicine and neurology, and thereafter received a fellowship in vascular neurology from Columbia University, and is currently finalizing her PhD in epidemiology at Loma Linda. Dr. Ayesha also has a culinary degree, giving her a really unique understanding of nutrition as a powerful tool for disease prevention. These are smart people, and this is a very powerful, important conversation. And of course, as always, there's a few more things I want to say about what is to come, but first.

• 6:26Rich Roll?

  Okay, Team Sherzai. Like I said, this is quite a profound conversation. It's a conversation that I think is going to leave you rethinking everything you thought you knew, not just about Alzheimer's, but about brain health in general and the power of food and lifestyle to heal. Rather than list out the many subjects we cover, I think I'm just going to suggest that you listen keenly to the entire podcast and take notes because this one truly is potentially life-changing. And with that, here is me and Doctors Dean and Ayesha Sherzai.

• 7:07Rich Roll?

  Cool, we ready to go? Yes, we are. Thank you so much for making the trip all the way out here. I'm delighted to talk to you guys. The book that you have written, The Alzheimer Solution, it's super powerful and I have no doubt that it's already helping lots of people and has the potential to really be a healing, curative treatment for so many people. It's an incredible work and I'm just so excited to unpack it with you guys. So, thank you for coming out. Thank you for having me.

• 7:40Ayesha Sherzai?

  Thank you so much for having us.

• 7:41Rich Roll?

  Right, so we met at Rachel's event initially, right? Yes. At Rachel Abrams' event. So, we share Rachel and Doug Abrams as common friends. Doug, I went to college with Doug. Oh, my goodness. Yeah, he was a college classmate of mine. And I've had Doug and Rachel have both been on the podcast about a year ago. So, it comes full circle.

• 8:02Ayesha Sherzai?

  That's amazing.

• 8:03Rich Roll?

  And here we are talking. So, I think maybe the best way to kind of launch into this is perhaps to define our terms a little bit. What do we mean when we're talking about Alzheimer's? And perhaps it would be worth explaining the difference between Alzheimer's and other forms of dementia.

• 8:25Dean Sherzai?

  So Alzheimer's is a fairly new disease in the sense that it's it's beginning to be well-known in our society, especially first-world society. It's not a new disease in the sense as far as a new infection or something of that nature. It's been known for a hundred years or so and defined by Dr. Alzheimer's of all people.

• 8:47Rich Roll?

  It's like 1901 or something like that.

• 8:49Dean Sherzai?

  Yeah, exactly. And but but for longest time, even now, in many communities, they'd call it senility, they call it part of just normal aging. Just today I saw a patient, full-blown Alzheimer's, advanced. The family didn't know that this person had Alzheimer's and all the things they had to do, either to prevent or even now that they have it, to how to deal with it. Alzheimer's is a subcategory of the bigger disease process, which is dementia. Dementia is the big group, which is like cancer and Alzheimer's is a subtype of it. But it's the biggest category. Sixty to seventy percent of all dementias is Alzheimer's. And since 1990s, when first President Reagan was diagnosed, and from

• 9:34Dean Sherzai?

  then on, it became more known and more studied and billions of dollars spent and research in the field.

• 9:42Rich Roll?

  So why, you say it's a relatively new disease. I mean, it's discovered in 1901, and now we're seeing, you know, seeing it at epidemic levels and the growth curve is insane. So what is, you know, why is it a recent disease? Why is it just coming online now and why is it accelerating at such a rapid rate?

• 10:00Dean Sherzai?

  I was, it was a play on words. It's not a new disease in the sense that in the human experience. It's a new disease as far as our understanding of it, its prevalence, its massive growth. I mean, we're talking about every other disease in decline, pretty much every other disease, or death from every other disease in decline. Yet mortality and death from Alzheimer's in just the last 10 years has grown more than eighty percent. Part of that is because we're an aging society. We're doing better with the, yeah, we have more diabetes, we have more obesity, we have more of all these other diseases, but we're surviving them with machines, with surgeries, with these catheters, all these things. We're living past what we would have lived before.

• 10:42Rich Roll?

  We can survive diseases that used to kill us.

• 10:45Dean Sherzai?

  Absolutely. But when it comes to, what's left behind is our brain. At the end of the day, we're left with our brain. And it's the cumulative problems over fifty, sixty years that actually end up in being Alzheimer's at the end, or dementia and general Alzheimer's. And that's where we bring the new kind of conversation that we have to approach it in that sense. We have to approach it as a lifestyle disease. And, and that's why it's so important.

• 11:14Rich Roll?

  Right, and we're gonna, we're gonna work our way towards that, but just to kind of lay a little foundation, when I was going through your book, I mean, the, the statistics are staggering. Six leading cause of death, but perhaps as high as third because it's so under-reported. Two hundred and twenty-six billion dollars are spent in the US to treat this, and it's looking like, or in six hundred and four billion worldwide, it's working its way towards the trillions. By 2050, we're looking at a hundred and thirty-five and a half million people suffering from this disease. I mean, this is something that's, if it's not touching you directly, it's certainly touching you indirectly.

• 11:51Ayesha Sherzai?

  Absolutely. I think it's probably one of the scariest things out there, and you know, you quoted the numbers. And it's so sad that all this research throughout the years by big organizations, whether it's Alzheimer's Association or others, they haven't really done much. There, there's really no medication for this, for this disease. There is this incredible failure rate for, for finding a treatment for Alzheimer's disease, about a ninety-nine point six percent failure rate.

• 12:25Rich Roll?

  It's like insane.

• 12:26Ayesha Sherzai?

  Which is probably one hundred.

• 12:27Rich Roll?

  How can you even call it like a, a medication worth even considering with that level of failure rate?

• 12:32Ayesha Sherzai?

  There is no, there is no treatment for it, and you know, the, the minute number actually are medications that are used for allaying some of the symptoms.

• 12:41Dean Sherzai?

  For a few years.

• 12:42Ayesha Sherzai?

  Yeah, just for a few years. It doesn't work long-term at all, so. And there is, the reason is because everybody's been focusing on one molecule, on one small process, instead of stepping back and looking at the bigger picture and the complexity of the disease.

• 12:57Rich Roll?

  Right.

• 12:58Ayesha Sherzai?

  So, yeah, I think, I think there's a lot to be done in that area.

• 13:00Rich Roll?

  Yeah, I mean, it was basically a death sentence. You would go to your doctor and the doctor would say, "Well, we'll try to make you comfortable and here are some options in terms of places where you can get assistance with your lifestyle, but you're, you're just gonna ride this out and that's it."

• 13:17Ayesha Sherzai?

  Yeah.

• 13:18Rich Roll?

  And we see these pharmaceuticals that are available now, but they really just don't, they're just, they're, they're not effective.

• 13:24Ayesha Sherzai?

  Not at all, not at all. It's so depressing being a neurologist in that field, because, you know, we went through it in the past. A person would come in, we would diagnose them with Alzheimer's disease, or our supervisor, whoever the neurologist was, and the next conversation would be, "You need to get ready to let go of your finances, you need to find a nursing home, you need to bring your family members so that they're aware of how you're going to lose parts of yourself as you move along." And that, that was basically it. There was no-

• 13:58Rich Roll?

  It's like, how do you handle that as a, as a doctor, having to have that conversation over and over and over?

• 14:03Ayesha Sherzai?

  Absolutely.

• 14:04Dean Sherzai?

  It's worse than a death sentence.

• 14:05Rich Roll?

  Devastating.

• 14:06Dean Sherzai?

  For a great majority, they've done studies and, for, for many Americans, it's worse than death, to know that you're having Alzheimer's. And, and the approach from the medical field is actually even worse. You have 20 minutes with a patient.

• 14:20Rich Roll?

  Mm-hmm.

• 14:21Dean Sherzai?

  "Hi, how are you doing? How is it going?" You do the cursory check of the heart, tapping the knee, and then at the, you know, the last five minutes, you have Alzheimer's and this is what you have and this is what you have to do, and here are some pills. And the pills don't change the progression of the disease, they just help you with the symptoms.

• 14:39Dean Sherzai?

  This is a process that's going to increase, accelerate every family. Every family in America will be affected by it either directly or indirectly. And we need to do something to kind of either curb it or have a new approach to it. And what we're doing is actually, whenever we bring this topic, they tell us, but are you blaming the person? It's not about that. It's about giving hope. It's about starting a new process, a new direction. That was the whole goal and came from our experiences in the communities. We live in La Malinda.

• 15:15Rich Roll?

  Right. The story of how you evolved into this perspective for treatment and, you know, prevention is unbelievable, right? Because you're coming, you know, you're hard-nosed scientists, you know, immersed in the scientific method, you know, raised to be doctors in the Western tradition and had your experience with that and then kind of evolved into what you're doing now. But to give it some context, maybe let's explain a little bit of your background. I mean, I know you met in Afghanistan, which that's probably, we could spend two hours on that probably. But I mean, Dean, you were at NIH, yes? And Ayesha, you were, is it Ayesha? How do I say it?

• 15:56Ayesha Sherzai?

  Ayesha.

• 15:57Rich Roll?

  Ayesha. You were at UC San Diego, correct?

• 16:00Ayesha Sherzai?

  Yes.

• 16:00Rich Roll?

  Both practicing neurology?

• 16:02Ayesha Sherzai?

  Absolutely. Yeah, we actually came into this field because we both had grandparents who had dementia, severe dementia. And, you know, they were incredible human beings and they were our heroes. And I remember having my grandfather's picture on my desk throughout my medical school because I wanted to be like him. And I saw how slowly and gradually grandfather lost himself to the point where he didn't recognize his children, didn't recognize any of his grandchildren, and that was just devastating. I saw the pain that my parents went through. And for this brilliant person to slowly and gradually become a child again. So it affected us and we wanted to study neuroscience and the brain and its beauty

• 16:47Ayesha Sherzai?

  and its complexity. But, you know, as you go on through the period of, you know, getting educated in the medical field, you come to a point where you're in a clinic with a dementia patient and there's really nothing you can do about it. And that was just... Depressing.

• 17:02Rich Roll?

  Yeah, well, it's such a powerlessness.

• 17:04Ayesha Sherzai?

  Very, very.

• 17:05Dean Sherzai?

  It's UCSD is at the time with Lyon, it was number one neuroscience program in the country. NIH is NIH and we were, we were actually at UCSD and study after study after study, billions of dollars, a mouse model, it worked on mice, so let's apply it to humans. Again, a failure. That's at least a hundred to three hundred billion dollars, a million dollars per study, you know, and it was just incredibly frustrating. First of all, the mouse, mouse models, fifty, sixty things have worked on mice. Even blueberries work on mice. I mean, I think if you just look at them in the right way, they will work on the mice. Mice do not men make. And after a while, we just said, this is, this is just

• 17:47Dean Sherzai?

  too much. So we decided to look for an alternative. We looked around, Dan Buettner, read about him and his book, and we found out about Loma Linda, and then the rest just followed. But, but that transition was painful and scary.

• 18:03Rich Roll?

  Right.

• 18:04Ayesha Sherzai?

  There were a lot of impediments in the way. Sorry to cut you off.

• 18:06Rich Roll?

  No, please go.

• 18:08Ayesha Sherzai?

  Because, you know, the way you're trained in the medicine world is to look at cause and effect and look at a linear path of how A affects B. How does A influence B and what are some of the other factors that come to it? It's very, very myopic. And the way research is funded by NIH or other governing bodies is just that, to have a linear model of looking at associations and studies after studies after studies have just looked at very small things at a time and not the bigger picture. And we were so excited to see studies from Loma Linda or the Blue Zones coming and showing that there is a different

• 18:47Ayesha Sherzai?

  perspective to look at. There is lifestyle. There is, you know, this complex nature of, of the foods that you eat or whether you exercise or not, and the interactions between these lifestyle factors, they matter. And it was painful because I remember clearly when we were showing interest in doing something of that nature or studying populations.

• 19:12Ayesha Sherzai?

  We were told by our mentors and, you know, some of the prominent people at universities, things like, oh, you're, this is career suicide for you. You do know that there's no future in this. If you decide to leave UCSD and this fabulous, say, for example, a molecular, molecular research that you're doing, and you're going to go and study epidemiology and population studies, nobody's going to fund your research.

• 19:36Rich Roll?

  Right. Yeah, you're breaking ranks with, you know, with, with core tradition, and that's a frightening thing.

• 19:42Ayesha Sherzai?

  It is.

• 19:43Rich Roll?

  And, you know, just to touch on what you said earlier, you know, that is the, by its very nature, the reductive nature of the scientific method, right? And there's reason and rationality for that, and it works in many cases, but it's inherently flawed with respect to some

• 19:59Ayesha Sherzai?

  Agreed.

• 19:59Rich Roll?

  ways of approaching problems, right? Because it's not just one thing. It's a, it's a matrix of an infinite number of cofactors that interrelate in this interplay of things that coalesce to, you know, create this situation. You can't, you can't extract out the one variable, the B12, or the beta-carotene.

• 20:18Dean Sherzai?

  Exactly, exactly.

• 20:19Rich Roll?

  And, and come up with a solution for this.

• 20:22Dean Sherzai?

  Absolutely.

• 20:23Rich Roll?

  So, so that's interesting. So the, so Loma Linda comes onto your radar, and Dan Buettner, in his, you know, amazing books and all the incredible work that he's done, and you decide to pack your bags and head out to the one blue zone in the United States and hang out with the Seventh Day Adventists.

• 20:38Ayesha Sherzai?

  Yes.

• 20:39Dean Sherzai?

  It was, it was a frightening endeavor. I was the director of the Brain Health Center. She did her, she, so we'd said, we're gonna go all out. So she did a preventive medicine residency, a neurology residency, and then with two kids with us, I was in Loma Linda as the director of Brain Health Center, and Ayesha went to Columbia University to study vascular and epidemiology at Columbia University, two years, flying back and forth every two weeks.

• 21:07Ayesha Sherzai?

  Most difficult time ever.

• 21:09Dean Sherzai?

  We're gonna go all out.

• 21:10Rich Roll?

  Wow.

• 21:11Dean Sherzai?

  And study, and at night she would study culinary.

• 21:14Ayesha Sherzai?

  I went to cooking school.

• 21:15Rich Roll?

  Right, I know. Do you did the, you did the Roubaix school?

• 21:18Ayesha Sherzai?

  I did. No, I actually went to Nashville Gourmet Institute. And then went to Ruby. I did the Ruby Online as well.

• 21:25Rich Roll?

  You're just like collecting all kinds of degrees.

• 21:27Ayesha Sherzai?

  It was fun. To be honest with you, I think, you know, I probably would make more difference talking to some of my patients about changing their dietary patterns than just pushing aspirin and statins. I found that useful in so many occasions and just, you know, personalizing lifestyle for them. So I think it was a great decision.

• 21:48Rich Roll?

  And what is the rationale behind getting a degree at Columbia in, what was it, vascular?

• 21:54Ayesha Sherzai?

  Yes, it was vascular neurology and epidemiology. So it was a combined training in stroke, understanding diseases of the brain, especially vascular disease of the brain. And the epidemiology side highlighted prevention and understanding how disease patterns exist in population.

• 22:14Dean Sherzai?

  It was so funny that while she was there in first year, they want to get you into research, molecular research. And she said, no, I'm going to study population research. Said, okay, there's this study in California teacher's study, why don't you look into that data? So she flew to California, collected the data and did that study with Mediterranean diet, plant-based component of it and stroke. And low and behold, she, that paper was highly touted. She won the youngest researcher award for American Heart Association. And the Columbia people all of a sudden turned around, oh, so everybody was excited. So she was the youngest plenary speaker in the American Heart Association.

• 22:52Ayesha Sherzai?

  It was.

• 22:52Dean Sherzai?

  Talking about lifestyle and stroke. So the very thing that they thought that would not really make amount to anything, all of a sudden turned out to. So every step we've taken, completely non-traditional, has turned out to actually resonate and make a difference. And hers showed that what the more people lived a plant-based lifestyle, closer adherence.

• 23:16Ayesha Sherzai?

  Yes.

• 23:17Dean Sherzai?

  As low as forty-four.

• 23:18Ayesha Sherzai?

  Had low, had about, you know, forty percent lower risk of having strokes.

• 23:23Dean Sherzai?

  Forty percent.

• 23:24Rich Roll?

  Forty percent.

• 23:25Ayesha Sherzai?

  Very, very large population.

• 23:27Rich Roll?

  That's amazing. So when you're in this situation in San Diego, being frustrated with the sort of standard operating procedure of treating these patients with dementia, did you, I mean, were you already looking at lifestyle and getting interested in that and were you sold on that and the plant-based diet and all of that? Or did that come in turn with coming out to Loma Linda and kind of immersing yourself in the way that they are tackling these problems and looking at how people are living in that in that part of the world?

• 23:59Dean Sherzai?

  Yeah, as a scientist, you want to make sure that your personal biases do not bias your science.

• 24:05Rich Roll?

  Right, that's kind of what I'm getting at.

• 24:07Dean Sherzai?

  Yeah, yeah, I know. And we were already vegetarians for other reasons. We are for ethical reasons and all that. And this came in the middle of Afghanistan, of all places. We decided that we're going.

• 24:23Rich Roll?

  You're a vegetarian in Afghanistan?

• 24:24Dean Sherzai?

  Yes, and that in itself is another book of this slippery slope of, you know, I was the deputy minister of health. I went from NIH to Afghanistan, became the youngest deputy minister, created this whole women's empowerment, but my downfall was that I became vegetarian. Nothing else.

• 24:41Rich Roll?

  That was like political suicide for you?

• 24:43Dean Sherzai?

  Yeah. Almost. Absolutely. But that aside, when we came to Loma Linda, we really, even now, we, for example, some of the things we say is, "Sugar is worse." But we let the science do the talking. As a scientist, you can't let your personal biases direct the science. But the science is just overwhelming. It's not just us. It's, you know, yeah, you get these little blurbs of fat diets here and there, let's do keto, let's do this, let's do that. Plant-based living has been proven over 100 years, thousands of papers, validated papers. It doesn't mean that somebody just did one little paper, five other people repeated it. This has been powerfully shown.

• 25:28Dean Sherzai?

  The Averin's Health Study showed that people who live a certain life, more plant-based, live 10 years longer and healthier than everybody else. In JAMA, not just a regular journal, top journal in the world, it was published, and many other things. Cancer risk is lower and everything else. The only thing that was left to show was brain. So we study the brain and while there, we actually looked at my clinic or our clinic, which we saw thousands of people. And this is at the center of this 70 Adventist community. There's nowhere else for them to go.

• 26:00Rich Roll?

  Right.

• 26:00Dean Sherzai?

  Either they come to me or they just stay home as far as.

• 26:03Rich Roll?

  Yeah, you're looking for candidates to study.

• 26:06Dean Sherzai?

  Yes.

• 26:06Rich Roll?

  And there's nobody to study because there's you go to the gym and everyone's 90 and they're doing pushups.

• 26:11Ayesha Sherzai?

  Absolutely.

• 26:12Dean Sherzai?

  I mean, Dr. Wareham did surgery at 95.

• 26:16Rich Roll?

  It's insane.

• 26:17Dean Sherzai?

  It is. And he's still running around, you know.

• 26:19Rich Roll?

  Is he? Yeah, he's not practicing medicine anymore, right?

• 26:21Ayesha Sherzai?

  No, he retired because he wanted to travel.

• 26:23Rich Roll?

  Right.

• 26:24Ayesha Sherzai?

  Not because he had a tremor or he was feeling tired. He's just an incredible, strong and very, very healthy person.

• 26:31Dean Sherzai?

  I have patients 80 something saying that, you know, I'm running the marathon in LA. Are you joining him? I was like a little embarrassed. I was like, no, not this year. But this is an 80 something year old running a marathon. I mean, that's amazing.

• 26:45Ayesha Sherzai?

  Yes, not unusual to see that on a regular basis.

• 26:47Dean Sherzai?

  Absolutely. So, so this is, and then the clinics were, were people from outside.

• 26:53Rich Roll?

  Right.

• 26:54Dean Sherzai?

  Right beyond 10.

• 26:55Rich Roll?

  So, yeah, so you come to Loma Linda, we're going to study brain health. We need all these people that we can evaluate to create this population study. No one's showing up at the clinic. And ultimately you have to kind of go across the tracks over to San Bernardino where there's a lower socioeconomic class of people and people are suffering terribly there from all manner of lifestyle illnesses.

• 27:17Ayesha Sherzai?

  Absolutely. The disparity is just enormous and the devastation that you see from Alzheimer's disease and other, you know, all the other risk factors for Alzheimer's disease is just incredible. And so, you know, of course, you know, they're the same population, they're living under the same sun and probably the same zip code and they have the same supermarkets and restaurants. So it had to be something else. And that gave us a very good opportunity to compare the populations and study lifestyle and how it affects brain health.

• 27:51Rich Roll?

  It's so crazy. Yeah, like on, over here, you have people in Loma Linda who are living crazy long lives, active lives. And, you know, literally, you know, right next door, you have a population of people who are having an extremely different experience.

• 28:05Ayesha Sherzai?

  That's right.

• 28:06Rich Roll?

  And that's, that's a great place to. Um, began a study, right?

• 28:10Ayesha Sherzai?

  Yes.

• 28:11Rich Roll?

  I mean, that juxtaposition is quite potent.

• 28:13Ayesha Sherzai?

  Dean and I would um go to some of the churches and some of the synagogues in the area to speak about brain health and, you know, how many talks have we done?

• 28:23Dean Sherzai?

  Yeah, over a hundred talks. I say that I've given more talks in churches than some of the ministers. I mean, we, we went to church after church after church in order to draw people because I think it's a great place, you know? Um, and, and they were very willing, the Catholic diocese and everybody to willing to listen, and it was overwhelming.

• 28:40Ayesha Sherzai?

  Yeah, yeah. Most of their male leaders, faith leaders, were not there. It was mostly run by women because they uh would pass away, uh, you know, after, say, for example, age sixty-five. You wouldn't, you would barely find anyone beyond age sixty-five there. And the ones that were there were, you know, had a lot of health issues. So it was quite prominent even without doing any research, just by having conversations with, you know, the, the, the society, the communities, um, that there was this incredible amount of um need for health awareness and disease prevention.

• 29:16Rich Roll?

  Um, so you then spend the better part of the next, like fifteen years studying, studying these people, right?

• 29:24Dean Sherzai?

  Correct, correct, absolutely. I mean, my PhD thesis was on seeing how you can get information into different communities. And this is a little bit of digression, but um, uh, we looked at African-American, Hispanic and Caucasian population, or it's not even, we realize that it's not even the race thing, it's socioeconomic and availability and access. Access is always, access to information, access to right foods and all that. Um, in, in certain populations, this lower socioeconomic, information, knowledge about stroke, about dementia, about all these diseases was nonexistent. It was just disease of aging, just a clump. And access to the kind of foods, the kind of environment to walk, the kind of communities that are actually built around health, the blue zones, was, was not available.

• 30:09Dean Sherzai?

  And, and then most importantly, where they deemed, where they thought that, that information could be given to them, they could be receptive, we had it all wrong. You know, a survey that was created in Boston and Harvard or Harvard and then applied by, you know, sixty year old, fifty year old men to seventy year old Hispanic women doesn't make sense.

• 30:34Rich Roll?

  Yeah.

• 30:35Dean Sherzai?

  So we realized that that's not where you do the training, that's not where you do the education, the clinics, it's in the communities. That's where, actually, that's where this whole book, we created the Community Driven Brain Health or Healthy Minds Initiative. And all the profits from the book will go into building community awareness in different communities throughout the world as far as brain health.

• 30:56Rich Roll?

  So these people start coming into your clinic and the idea was what? Like, we want to understand how all of these people are living, what is contributing to this disease of the brain and start experimenting with protocols to reverse it or prevent it?

• 31:13Dean Sherzai?

  Correct.

• 31:14Rich Roll?

  Is that sort of the master statement behind this?

• 31:17Dean Sherzai?

  That's exactly right.

• 31:18Rich Roll?

  And then what do you start to learn?

• 31:19Dean Sherzai?

  So we collect data on nutrition, exercise, the things that we know, you know. The only thing that we didn't collect was stress, but as far as physical activity, as far as, you know, all these elements, sleep and mental activity, not profound data, just superficial data, just conversational, we collected it. And over and over again, we realized that the people that were healthy, ninety year old, that just had minor memory problem, they were the people that kept their mind active, they walked all the time, they were more plant-based diet, consistently, that was the component. And we realized, so this is, yeah, genetics, put that aside, that cannot be genetics,

• 32:03Dean Sherzai?

  it cannot be driven by genes, it had to be environment. And thousands of patients, so we started applying it. We didn't apply it to Alzheimer's patients, we applied it to people what they call mild cognitive impairment, people who have, who are at risk, very high risk, people who are in mild cognitive impairment, they have a, fifty percent of them go on to develop Alzheimer's. So we applied these changes, small changes, according to what they could do. And even small changes affected their livelihood, their progression. This was miraculous, remarkable. So from there, we decided to do something bigger, and that's where we are now.

• 32:45Rich Roll?

  And when you were seeing those changes, like, how are you quantifying like cognitive degeneration versus improvement?

• 32:52Dean Sherzai?

  So there are measurable metrics. For example, the Mocha and the Mini Mental Status, and then there's these bigger neurocyte batteries, which is two hours where you do really long paper and pencil and find out where people's changes are. Repeatedly, you would see differences in those. There are other measures such as MRIs, which actually you've measured the volume of the brain. And even those, you saw some changes. When it comes to the human brain, what's interesting, it's not the volume. You know, we have 87 billion neurons.

• 33:23Ayesha Sherzai?

  Yes.

• 33:24Dean Sherzai?

  And one quadrillion potential connections. So this machine, what they say, one times 10 to the 50th power, it's not the cells. We could lose a billion cells, of course, not all at once, that would be bad, but sorely we could lose a billion cells. But the rest is what matters.

• 33:40Ayesha Sherzai?

  And that's the concept of cognitive reserve, which is incredibly exciting. And that basically means that it's not the number of cells that determine your cognitive prowess, it's actually the connections. And the exciting thing is, those connections are made and broken on a daily basis. It's up to us what we do to create those connections. And it's like putting money in a bank account for a rainy day. You know, making more connections actually staves off disease, but at the same time builds a better brain, so you feel sharper, better, and, you know, bring forth the full capacity of the brain. And I think, you know, this is the language that we use in our clinic, and this is the

• 34:22Ayesha Sherzai?

  language that we've tried to use in our research as well, to make people understand that it's in their power to actually make it happen in their lives.

• 34:37Rich Roll?

  Yeah, the brain is so mysterious, right? In so many ways. And that idea that, you know, I don't know whether it's apocryphal or to what extent it's true, that we're only using a small portion of it and that we could lose all these cells, but that it's more about how we're using what we have.

• 34:54Dean Sherzai?

  Yeah. They're saying that we use 10%, but actually, we use all of the brain, but we use it incredibly inefficiently. So, a lot of people compare the brain to a muscle. And I say, what a disservice to the brain to compare it to a muscle.

• 35:08Rich Roll?

  Way more complicated.

• 35:10Dean Sherzai?

  Way more powerful and resilient. So, the biggest guy we know, let's say Arnold Schwarzenegger, that's the only one I can think of. There are many others I know. He built his muscle four times the average mass, let's say. So, an average brain, an average neuron, can have a few connections, or as many as 30,000 connections. That's not four times, that's 30,000 connections. So, the idea is, here's a neuron, and of course, this is metaphoric, and here's a memory you're trying to get to. If it's a couple of connections to that piece of memory, one of them at age 70 is severed by a little microvascular infarct, and another one by amyloid plaque, there it is, memory's gone. Of course, I'm making it.

• 35:52Dean Sherzai?

  Imagine there are 30,000 connections to that piece of information. It will never be severed. That's the power that you have by building these connections. And actually, they've done experiments where they can see it grow on a daily basis. That's what we can do on a day.

• 36:08Rich Roll?

  And we understand how to grow those? Like how to strengthen, how to create more of those connections?

• 36:13Dean Sherzai?

  You and I are doing it right now.

• 36:15Rich Roll?

  With the longer we talk, the less likely we are to forget each other?

• 36:18Dean Sherzai?

  Correct. Challenge. So, one of the things, sorry, I'm gonna digress, but one of the things people say, what do I do for brain activities? I said, not Sudoku. I hate Sudoku. If I have to do Sudoku, I'm gonna get dementia. Not that there's anything wrong with Sudoku. If you like it, it's great, but it's not complex. You know, your brain did not evolve by adding numbers to nine. I mean, when did that happen? While we were being chased by saber-toothed tigers? No. Our brain evolved through complexity. So, one of the things we say, you wanna build your brain? Get a group of friends, play cards. The act of me listening to you, having... Sense of your emotions. And that's, brain is being processed. Right.

• 37:01Dean Sherzai?

  So your brain is processing this, your mirror neurons is checking your emotions. And my frontal lobe is processing what you just said. My memory centers goes back and sees what that, what relevance that has. Then comes up with an answer. Then the motor cortex, you've just used the entire brain, plus the emotional component. That's not Sudoku. That's a, that's a complex behavior building connections. So music. Music is, to me is my favorite. Ayesha is a professional singer. I'm, I say I'm the worst guitarist in history of mankind.

• 37:35Ayesha Sherzai?

  He's not.

• 37:36Dean Sherzai?

  But the cacophony I create is, you know, you're listening to your own music. You're playing, which is motor cortex with the fingers. You're memorizing, remembering, recalling some tunes or some notes. So that's your memory centers. You're processing that through how it's supposed to be played. And my case is just simple. And that involves the entire brain plus the emotional component. That's building connections. And in fact, they've done studies, FMRI studies, that have shown that this makes the connections. The taxi driver study, people have heard about this, so let's go to that. The London taxi drive, we just came from London for our book tour and, and I can understand why.

• 38:17Ayesha Sherzai?

  Makes more sense now.

• 38:18Dean Sherzai?

  It makes more sense. Not in the world, in the, in the realm of GPS anymore, but a while ago, if you needed a license, a taxi license, you had to memorize all the streets in London. My goodness. Wow. So the average person doing this study was fifty something. So not a young person. And they all did it. They did studies, volumetric studies, volume of the hippocampus, the memory centers, before they started studying and after. The brain had actually grown after this. Grown in actual volume.

• 38:50Ayesha Sherzai?

  In a relatively short period of time.

• 38:52Dean Sherzai?

  Very, very short period. So that tells you that your brain is active at any age and can grow connections. Of course, the cells didn't grow, although now we know that even they grow to some extent, especially with exercise, with neurotrophic factors and all that. You, you've done a lot of good to your brain with, with exercise. Yeah, I've probably damaged it in many other ways, but. No, there's a reserve, there's plenty of reserve. But, but those connections grow and we see it by volume. So it's wonderful. So it's a book of hope, you know, that you can do something. And it's not even about Alzheimer's. Now, he was like, talk about the dropping, it's about avoiding Alzheimer's.

• 39:35Dean Sherzai?

  It's about resilient, fulfilled, vibrant brain activity late into your eighties, nineties and beyond.

• 39:42Ayesha Sherzai?

  Using the full potential of the brain.

• 39:44Rich Roll?

  Right. So when you begin this journey fifteen some odd years ago, I would imagine, you know, like you kind of alluded to earlier, your colleagues are like, this is clear suicide. What are you doing? You're going to start looking at, you know, lifestyle medicine for this. And so I think it would make sense to kind of explain, or at least talk through some of the myths and the misconceptions about this disease. Particularly this notion that it's a purely genetic situation. Like if you have the gene, this is what's going to happen and there's nothing you can do about it.

• 40:19Ayesha Sherzai?

  Right. That has been the misunderstanding for such a long time. And, you know, there are, there are a few genes in Alzheimer's disease, maybe less than 5% of the genes that, you know, completely determine whether somebody gets Alzheimer's or not. As a matter of fact, if you have those genes, you're definitely going to get it. But even for those, you can push it off for a very long time. For the rest of them, for, you know, the 95 plus percent of the genotypes, it's, it's quite clear that what you do in your life, the type of food that you eat, whether you exercise or not, or the level of stress that you have,

• 40:59Ayesha Sherzai?

  determine whether you're going to get the disease in your early sixties or in your late nineties.

• 41:05Rich Roll?

  Right. So this, as I understand it, this, this gene, the primary gene is the APO.

• 41:12Dean Sherzai?

  E4.

• 41:13Rich Roll?

  E4.

• 41:13Ayesha Sherzai?

  E4, yes.

• 41:15Rich Roll?

  And, and this can be expressed in a variety of ways. Like you either, you have it as like a recessive allele, right? Or you have it as like, I don't know how you describe it.

• 41:26Dean Sherzai?

  Dominant.

• 41:27Rich Roll?

  Dominant.

• 41:27Dean Sherzai?

  Yes.

• 41:28Rich Roll?

  And then if you have it like, what is it, twice over? How did you describe that?

• 41:32Dean Sherzai?

  Yeah, if you, if you get a certain alleles from your mom and dad, which is actually rare, 2% of people, your risk goes up 20 fold. But even. Of those that have the two alleles, only 50% of them get Alzheimer's. So yeah, it increases your risk, but it doesn't mean it's destiny. Genes and Alzheimer's do not make destiny. So Ayesha was talking about the 5% that are very heavily driven. But the other 90 or 90 plus percent are, we know now there are like 30 genes. We'll probably identify further that increase your risk of Alzheimer's and those, plus APOE4. Now, what are these genes? These other genes for the ones that we think we can reverse.

• 42:13Dean Sherzai?

  Now we know that a proportion of them are genes with vascular response. Others are immune response. Others are garbage disposable, meaning that as you gauge, you accumulate this garbage in the cells. And how well is your garbage disposal? And then the APOE4 is lipid and inflammation. So they're lifestyle genes. So these genes give you a range of anywhere between 10 to 30 years. What you do in life decide determines if you're going to get it early on or as late as 90 or beyond.

• 42:45Rich Roll?

  Right, so the magnitude of how these genes are expressed is contingent upon what you're eating and how you're moving and how you're living your life.

• 42:53Ayesha Sherzai?

  Absolutely.

• 42:53Dean Sherzai?

  Completely.

• 42:54Rich Roll?

  And what's interesting, let's get into like the contributing factors before we get into the solution. Cause you kind of broke this down into four categories. We have inflammation, we have oxidation, we have glucose deregulation, and we have lipid dysregulation. Right, so these are the four main things that are driving the expression of this.

• 43:14Ayesha Sherzai?

  Absolutely, absolutely.

• 43:16Rich Roll?

  So when we're talking about inflammation, let's just go through these like seriatum, if we could quickly and explain what these mean.

• 43:23Dean Sherzai?

  Yeah, so inflammation is a normal part of the body.

• 43:25Ayesha Sherzai?

  Yes, it's a constant process that goes on and we have mechanism in place that get rid of them. And Alzheimer's disease and so many other diseases. And that actually shows us the the commonality between,

• 43:37Rich Roll?

  Right.

• 43:37Ayesha Sherzai?

  you know, degenerative diseases of the brain and vascular diseases of the brain and the body.

• 43:41Rich Roll?

  Right, because, sorry, I don't mean to interrupt.

• 43:43Ayesha Sherzai?

  Not at all, please.

• 43:44Rich Roll?

  If you could indulge me, yeah, what's amazing is how much so much of this tracks what we know about heart disease and diabetes. Like, when we're looking at chronic inflammation and the incidence of these diseases, it's like completely overlaps

• 43:58Ayesha Sherzai?

  Absolutely.

• 43:59Rich Roll?

  in the Venn diagram with what you guys are talking about with the brain.

• 44:01Ayesha Sherzai?

  And and that is something that we have been focusing upon. And it was almost a eureka moment for us. We knew it, but the fact that, you know, the processes that are going on in the brain goes on in the body as well. For such a long time, people always, people and scientists specifically, always thought that the brain was a black box. It was a separate organ that had completely different type of physiology. And, you know, the the things that affected the heart, say, for example, the kidneys, the lungs, couldn't affect the brain, but that's not true. It's the same process. We talked about inflammation. You know, there are certain mechanisms that are not working very well. And inflammation builds.

• 44:43Ayesha Sherzai?

  And that's how it starts destroying the brain structure, whether it's the cells, the connections, the supporting structures of the brain. And and the inflammation is actually associated with the other processes, with glucose dysregulation, which is essentially the glucose not being able to used properly by the cells. Lipid dysregulation, where the proper fat cells that create and metabolize cells, they stop working. And then, um, you know, all of them together start, you know, depositing the bad proteins, which is essentially what all the scientists have been focusing on, but not looking at the upstream processes.

• 45:20Dean Sherzai?

  Yeah, so it's it's almost like all these paths lead to one point, the amyloid, which actually starts 20 years, 10 years before. And then everybody just focuses on that endpoint. Uh, we we've made an animation, hopefully coming out soon. It's a it's a it's a little boat. You're in your thirties. In your thirties, you start having some blood pressure.

• 45:39Ayesha Sherzai?

  So the boat is an analogy of a person?

• 45:40Dean Sherzai?

  Or the brain.

• 45:41Ayesha Sherzai?

  Yes.

• 45:42Dean Sherzai?

  And then there's a little hole in the boat. And then there's inflammation because of overwhelming bad food and things of that nature. So that's a crack in the boat. And then oxidative byproducts because of the fact that you had certain trauma or because of head trauma or other things. And so by fifty or forties, the amyloid, which is water, starts seeping in. And the holes are accumulating because of all these other things. And then about sixty or sixty-five, the person is sitting on a boat and they feel the water. But the boat's already one-third full of water.

• 46:18Rich Roll?

  Uh huh.

• 46:18Dean Sherzai?

  And for the last thirty years, all we've been doing, billions of dollars, taking a little cup, trying to get rid of water.

• 46:24Rich Roll?

  Uh huh.

• 46:25Dean Sherzai?

  You could get rid of all of the water, but if you don't address the inflammation, the crack, if you don't address the glucose dysregulation, the boat's still gonna sink. That's the mentality, the concept is wrong because we're looking at it completely in the wrong end. Should be looked at at the lifestyle side.

• 46:44Rich Roll?

  Right. And not only that, not even really looking at it or addressing it until the boat's half-full.

• 46:49Dean Sherzai?

  Exactly.

• 46:50Rich Roll?

  Of water. Like, oh, well, now that you have this thing, it's like, well, actually, this has been building for the last, you know, twenty years.

• 46:56Dean Sherzai?

  Exactly.

• 46:57Rich Roll?

  You know? And it's not any one of these four factors. I mean, these are all interrelated. I mean, if you are chronically inflamed, then you're gonna have problems with oxidation and free radicals and, you know, glucose deregulation leads to insulin resistance. These are all related to the foods that we're eating and how we're living our lives and how we're sleeping or not sleeping and the stress and all of that plays into that. And these are the same four factors that are contributing to diabetes and heart disease.

• 47:23Ayesha Sherzai?

  Absolutely.

• 47:24Dean Sherzai?

  And to make it a little anticlimactic, take the power away from the boat?

• 47:30Dean Sherzai?

  Whatever you knew about heart disease, apply it to brain disease.

• 47:34Rich Roll?

  Right, because when you're talking about amyloid, you're talking about the plaques that the amyloids create in the brain, right? And so, I mean, is it fair to draw an analogy to the plaques that are in our arterial system with heart disease? Is there a rationale in comparing those two? Or is it completely a different?

• 47:50Dean Sherzai?

  It's a different kind of plaque. Amyloid, although you have amyloidosis and other diseases that happen systematically as well, but the amyloid in the brain is a little different. But in reality, it's the same process. The body is overwhelmed because of inflammation, because of oxidation and everything else. So it actually starts making bad proteins, simply. A bad protein in one place is tau, another place is synuclein, another place is amyloid. But it's because it's been overwhelmed by inflammation, glucose dysregulation, lipid dysregulation. It's time for us to just say, the brain is complex, great, but the mechanisms are the same, but just so much more.

• 48:29Dean Sherzai?

  I mean, this little three-pound organ, 25% uses 25% of the body's energy. Of course, it's going to be overwhelmed more.

• 48:38Ayesha Sherzai?

  It makes it one of the most susceptible organs in the body, as well as the most resilient one, because of its activity, because it's always trying to consume so much energy. So whatever we do, we kind of joke about it in our talks, we say, sorry cardiologists, the heart is there to support the brain. But it is so. Whatever we do to it actually affects it first and then the rest of the body.

• 49:00Rich Roll?

  Right. But in the same way that a cardiologist is sort of focused on stents and bypass, they're looking at the end product of this disease. In your field, it's all about amyloid and how do we get rid of this stuff?

• 49:14Ayesha Sherzai?

  Yes.

• 49:15Rich Roll?

  As opposed to looking at the factors that are contributing to the production of it in the first place.

• 49:19Ayesha Sherzai?

  Absolutely.

• 49:20Dean Sherzai?

  We think that actually even exponentially more for the brain. If you take care of your brain, you've taken care of all the body. Because now, this thing that we're trying to create, living mind kind, it's about the mind, mindful living. And so this affects the totality of your body. For a brain, it's something more than that, because here you have emotions as well. You have motivation, you have all this. So one of the elements of our book is not just saying, this is bad. And this is good, but where we have failed people is we just throw it at them without giving them the tools of how to apply it to their life. So mindful living is the unique thing about our book, more than even the science.

• 50:02Ayesha Sherzai?

  And it's a vicious cycle. If you feel good, you know, based on the good neurochemicals being produced appropriately, if you take care of your brain and if you have a healthy mind, that owning that mindfulness in your life and applying it on a regular basis can help you take better care of yourself. So there you go. You have a healthy brain, you have the tools to take care of your heart and the rest of your body.

• 50:30Rich Roll?

  Right, and everything follows.

• 50:31Dean Sherzai?

  And depression. Recently, papers came, several, I mean, whenever, as a science, we don't say a paper came. A paper means nothing. It has to be multiple and validated. Otherwise, every day you say, "Science says this." Who's this Mr. Science that keeps saying these things? You gotta give me more than that. But lots of papers say that one of the major causes of depression, inflammation.

• 50:54Ayesha Sherzai?

  Yeah.

• 50:55Dean Sherzai?

  So it keeps coming back, yet we keep slipping. I call it logic slip. And a lot of times when you have debates, you keep building these logical sequence and you work past the fallacies and everything, and then it slips again. That's what's happening in nutrition and lifestyle and you make the case. I mean, the case for diet has been made over and over again, and then all of a sudden slipping again. Now we know inflammation and all these things actually even affect the depression, anxiety, everything, all of these diseases.

• 51:26Rich Roll?

  Right. You can't extract one thing from the other, right? And it seems like the advent of functional medicine, lifestyle medicine is growing and people are starting to embrace this idea that it's not just one treatment protocol, that we have to kind of look at a person in a holistic way and, you know, treat them.

• 51:49Rich Roll?

  You know, all the way down to, you know, how they how they interact with their family members and at work and what's their relationship with their boss and, you know, all of that stuff is crucial, right, to kind of solving this problem. Well, let's talk a little bit about the path forward in terms of prevention and reversal. Like, you break this down into five categories, right? Nutrition, exercise, unwind, restore, and optimize. So maybe we can spend a little bit more time in unpacking the nutrition part of this in detail.

• 52:21Ayesha Sherzai?

  Yeah, absolutely. It's it's been quite clear, you know, from studies coming from the Adventist Health Study and from the Women's Health Initiative and, you know, decades of data that show that a whole food, which is unprocessed, plant-based diet, low in sugar, seems to be the best dietary pattern for for the brain. And it affects all those processes that we just talked about, lowering inflammation, managing glucose metabolism, managing lipid metabolism, providing the best source of macro and micronutrients for the brain to thrive, to grow, to heal itself. And, you know, study after study shows the same thing over and over again.

• 53:05Ayesha Sherzai?

  And by just looking at populations, you know, the seven-day Adventist population, you rarely see dementia. And the ones that do have dementia either have it very late in life, or they have had other uncontrolled risk factors in their life. And so the idea of nutrition, you know, we try not to tell people to become vegetarians in the clinic, and that it doesn't work that way. And especially for people who have not been vegetarians throughout their lives.

• 53:34Rich Roll?

  Not just gonna hit them with that right over the head, right?

• 53:37Ayesha Sherzai?

  No, it doesn't work that way. And I think... And I think as scientists and as doctors, we failed over and over again because we have this cookie cutter approach for everybody. Just do what I, just do this and you'll become better. It doesn't work that way. It has to be tailored according to their resources, to their likes and dislikes, to what they can own at that moment in their life and move forward with it. So it's making small incremental changes on a daily basis.

• 54:07Dean Sherzai?

  We, one of the talks we gave to one of the African-American churches, afterwards they invited us and it was all women, of course, and wonderful and said, Dr. Cher, it was a wonderful talk.

• 54:18Ayesha Sherzai?

  Yeah, we love you very much.

• 54:19Dean Sherzai?

  We love you so much, but if you expect us to go vegan overnight, it's not gonna happen. I said, no, no, no, that's not the aim. The aim is to work towards, so in the book we said, W T E, W T I, work towards eliminating, work towards increasing. It's small incremental changes.

• 54:35Ayesha Sherzai?

  And, and the, the most interesting thing is, in, in that research project that I conducted in the California Teacher Study, we, we essentially created a statistics to look at adherence levels to a plant-based diet. And every incremental change, every increase in the score of adherence to the best diet lowered risk of stroke, lowered risk of brain diseases. And, you know, to tell people that even if you replace, you know, an unhealthy meal with a small salad, or, or just replacing small, making small changes, actually makes a big difference. And we've seen that in the clinic. And I think that's, that's empowering.

• 55:15Dean Sherzai?

  At the core of this is motivation. And the word motivation is, is a terrible word. And my daughter reminded us how terrible it was. My 10-year-old daughter, they're both, my son is fairly driven, he's 12 years old, and she came, you know, and she's actually very good. She's 10 years old, she's in ninth grade. And she said-

• 55:34Rich Roll?

  Oh, she's in ninth grade? She's 10 years old and in ninth grade?

• 55:38Dean Sherzai?

  And, and our son is already, yeah, no, but, but, all right, she comes and-

• 55:42Rich Roll?

  I gotta know more about that.

• 55:44Dean Sherzai?

  Said mom is all motivated and you're motivated and Alex is motivated. So what's going on?

• 55:50Ayesha Sherzai?

  I don't feel motivated. She told us.

• 55:53Dean Sherzai?

  So I realized, wait a second, what is this motivation thing? Why? What? So because we throw it at children and they if they don't own this big monosyllabic thing, like as if, you know, one of those movies where you're

• 56:04Rich Roll?

  You're Tony Robbins.

• 56:06Dean Sherzai?

  Yeah, exactly. Then you're not doing the right thing. There's something wrong with you. There's no motivation. Motivation is small increments of success in a direction that you've set. That incidentally, your brain and your brain always does this. I'll give you a perfect example of that. You have a blind spot. We can do experiment and we can figure out where your blind spot is. Your brain fills in that space. And hundreds of experiments like that where your brain fills in information, fills in color, fills in knowledge. When somebody is drunk, they confabulate. People say, oh, he's lying. No, your brain is forced to create a story. So this filling in is a natural part of human brain to make itself comfortable.

• 56:48Dean Sherzai?

  So when you have a series of successes in a direction with a vector with a purpose, purpose, purpose is the key. Your brain creates an emotion to it and that emotion has a direction. That's motivation. So we just operationalize motivation. And so if you want to change people's behavior, you don't just throw it at them. In fact, the reason that most of healthcare is a failure because it's sick care. In medicine, we don't learn behavioral modification at all. Four years of college, highly driven people whose mom or dad told them to become a doctor. I've just offended a bunch of people, but for a large percentage.

• 57:24Rich Roll?

  Pretty much true for a lot of people.

• 57:26Dean Sherzai?

  Exactly. And then so it's like study, study biochemistry, this and this, but nothing about lifestyle and all this. And then you have

• 57:32Rich Roll?

  Understanding human behavior and how to relate to another human being.

• 57:36Dean Sherzai?

  No, because they're high, hyper driven people. The rest of the people, you know, medical school, worse. So it's just biochemistry, anatomy, histology, memorization. Then four years of residency. My gosh, that was until recently, that was just going through, you know, military school. So that's 12 years and then fellowship. So you come out as a leader now. You're a doctor, patients come to you. And by the way, 50% of your pay is going to be how to train them and train the patient or teach the patient about lifestyle. Never happens. You don't know. So what do you do? You at the door, you've done the check, you've done the knee thing, you've set.

• 58:10Ayesha Sherzai?

  And and it's how healthcare reimburses you. They reimburse you more on the notes and your examination. And what, five minutes of counseling?

• 58:17Dean Sherzai?

  Yeah.

• 58:18Ayesha Sherzai?

  Not even.

• 58:19Dean Sherzai?

  At the door, you say, by the way, eat healthy. And most of the doctors don't know about what that means. So they've Googled like everybody else. So it's either this gimmick or that gimmick.

• 58:28Ayesha Sherzai?

  Ketogenic diet or paleo and things like that.

• 58:30Dean Sherzai?

  And then the person is left at the door, uh uh uh in the clinic, lost. So they look at this, this is incredible. If I I I want to actually create controversy so that there's conversation. Controversy is great, conversation. What happens is the patient's left, I have blood pressure, I have diabetes, and I know that it's related to my diet. And he said, I have to eat healthy. There's no information. Forget about information. Forget about behavior. They give up on it. Not only do they give up on that, they also give up on their medicines. You've done double damage. It's time to change the conversation towards how you truly empower patients. You go to their communities or in the clinic, give them one behavior. We give one behavior.

• 59:15Ayesha Sherzai?

  Yeah.

• 59:15Dean Sherzai?

  Yeah, we know what sugar is. Cut your sugar. We know what saturated fat is. You eating this much cheese for in a week? How about here's a plant based cheese that you can get from this place. Just change that for a week.

• 59:31Rich Roll?

  Right, something very specific.

• 59:32Dean Sherzai?

  Tangible.

• 59:33Rich Roll?

  And doable that they can that they can master or that they can work on.

• 59:36Ayesha Sherzai?

  Exactly. Something to check off on a regular basis so that it becomes a deep bound habit. And they feel success in doing it. And then we'll have to think about it. And that's when you introduce the next step.

• 59:49Rich Roll?

  Yeah, just get almond milk, not regular milk.

• 59:52Dean Sherzai?

  Right, exactly.

• 59:52Rich Roll?

  Just make that one change.

• 59:53Dean Sherzai?

  One change.

• 59:54Rich Roll?

  You know, getting back to your earlier point, it's a systemic problem. I mean, these doctors are well intentioned. You know, whether they understand nutrition or not, like everybody wants to help their patients. They're under their own pressures, right? They gotta move on to the next person. And you hear time and time again, well, I could tell them to do this or that, but they're not gonna do it. Right? And there's sort of a pessimism, I think, and a condescension that's built into that. But there's also a truth, right? Because if they just tell them to do something, but there's no accountability, and there's no community, and there's no follow-up, and there's no structure in place where, you know, that doctor's office can reach out and check on that person, or they're supposed to come back, and there's a program that they can, where they have support for making this change.

• 1:00:39Rich Roll?

  You know, if that's not available, then they're right. Like, just telling them to do that thing is probably not going to work. So it's bigger than just get involved in the community. It's sort of like, well, how do we create a system where the doctors can be incentivized and taken care of for taking that, you know, step and making that effort?

• 1:00:58Dean Sherzai?

  Absolutely. You hit it right on.

• 1:01:00Ayesha Sherzai?

  Yeah.

• 1:01:00Dean Sherzai?

  Incentivized. I mean, they have to make a living. And not only, forget about living. Doctors are willing to sacrifice their money, their time. But there has to be time allotted and a system created that where even the doctors see their behavior coming to a success. So the doctors are motivated. So the first step in everything is conversation. I think one of the most important things we can do, and it started, it has started.

• 1:01:27Ayesha Sherzai?

  It's already started, yeah.

• 1:01:27Dean Sherzai?

  Is to say, the way we're doing medicine right now is not healthcare. It is important. Sick care is important. When a person comes with an infection, they need a medicine. When a person comes with a blood pressure of 200, you're not gonna say, go eat, you know, this. That's a long-term thing. You have to take your medicine. That's sick care. It's important. But there's another side, which is healthcare, which has to be incentivized. There has to be a mechanism. People can't just rely on goodwill, where I'm gonna go at nights to the clinics, or this or that, or to churches. There has to be a system created where we can prevent. But you know what? That system, when it's created, will reduce the cost of healthcare by 80 to 90% by itself.

• 1:02:09Rich Roll?

  That's a pretty staggering statistic.

• 1:02:11Dean Sherzai?

  Yeah, so we just have to make the choice as a society. And even the choice, you know, we get caught up in the politics of right, left. No, once there's enough information that overwhelms and, and, and everybody sees the benefit in this for their kids. I mean, we don't, this book is not about just Alzheimer's, end of life. I mean, our kids are overwhelmed by sugar. And then we tell them they have ADHD. Well, they might, but a great proportion just have a lot of sugar.

• 1:02:40Rich Roll?

  Yeah, there's no question about that. And also, you know, I want to get back to the nutrition piece in a minute, but you know, what I took away from it is that it's a book about how to live your life now so that you don't have to deal with this. When you're like, if you're, you could read this book as a 20 year old and say, well, I want, I want to take care of my brain. And this is the way to do it because those amyloids and all this sort of stuff that goes into creating, you know, the dementia, Alzheimer's, this is going on all the time, right? So it doesn't just suddenly strike you at age 65, like it's just like heart disease. Like you're working on this your whole life and it has to do with the diet and the lifestyle.

• 1:03:20Ayesha Sherzai?

  Absolutely.

• 1:03:22Rich Roll?

  So on the nutrition piece, so as, just so we're totally clear, as scientists who have, you know, studied this disease for a long time and treated a lot of people, you're sold on the whole food plant-based diet. This is, this is the way to go.

• 1:03:38Ayesha Sherzai?

  Absolutely.

• 1:03:39Dean Sherzai?

  As a scientist, we say to the best of our knowledge today, that to me is the most powerful, the most humble statement in English language. I think forced certainty is the cause of a lot of our conflicts. Science is open to change. I mean, tomorrow they say, if you eat steak, I'm not going to because of other reasons, but I would say, okay. I doubt that it's going to come, come, but to that, right now, the data is just overwhelming. And, and a lot of times in discussions, or any discussion, they fail you by, by falsely

• 1:04:19Dean Sherzai?

  holding you to absolutes, saying, but there's not cause and effect. Science cannot create cause and effect. It can create strong correlations, very strong. Even now, we can't create cause and effect with cigarettes, because you can always talk your way out of it, you know, even if you give people, even if it was ethical. But there's a tremendous amount of data that a whole food, plant-based diet is overwhelmingly protective.

• 1:04:44Ayesha Sherzai?

  Yeah.

• 1:04:44Rich Roll?

  Is there any positive benefit with respect to brain health for, is there any argument that there's something healthy about eating meat when it comes to cognitive health?

• 1:04:58Ayesha Sherzai?

  Well, yeah.

• 1:05:01Rich Roll?

  Go ahead, sorry.

• 1:05:01Ayesha Sherzai?

  So nutrition sciences, you know, has its flaws. And the way we're recording diet right now is through food frequency questionnaires, or diet, food diaries, and things of that nature. And, you know, it has its strengths when you look at the different components of meat, the saturated fats and the animal proteins, you know, whether it's animal studies or human studies, they're not good. I mean, the data, over and over, comes back and shows us that saturated fat actually causes those plaques in the arteries in the brain that supply oxygen and nutrition to the different areas of the brain, and they get clogged when saturated fat is very high in your diet.

• 1:05:38Dean Sherzai?

  Plus inflammation and everything else.

• 1:05:39Ayesha Sherzai?

  Plus inflammation, plus affecting glucose metabolism as well. And on the contrary, so in comparison to, you know, other types of fats, such as polyunsaturated fats and monounsaturated, they're actually beneficial. The most important element of the Mediterranean diet that everybody's been talking about for heart health and for brain health are those, you know, poly and monounsaturated fats, and they come from plants. So, you know, when you look at different, um, different comparisons of whether they're the types of fat that you eat, or the antioxidants that you get from plants, it's, it's quite clear. And you know, when you look at meat, I mean, other than fat and protein, it doesn't have anything, it doesn't have any fiber, and some of the minerals that are there, they're just minimal.

• 1:06:21Ayesha Sherzai?

  So you get more benefit from eating a whole food, plant-based diet.

• 1:06:25Dean Sherzai?

  The two things that they always talk about is protein, and how about lean meat? Okay, so, uh, these are oxymorons, lean meat, because it's the fat, not that you see and you strip away, the cells, and their cell wall have these kind of saturated fats, that's the component that we're talking about. So when they say chicken is lean meat, well, first of all, we're eating three times more chicken than anything else, actually much more, so therefore by volume.

• 1:06:51Ayesha Sherzai?

  It's the main source of cholesterol in our diet.

• 1:06:52Dean Sherzai?

  Chicken's the big problem. It is, it is. But at the same time, the fat is not what you see as white streets, it's what's in the cell walls. The cell wall structure is different, so that's one thing. The second thing, protein, it's as if plants don't have protein. The protein, the majority of protein we get is not in the form of muscle, the majority of protein we get is in the ribosomes and proteins within the cells. So, to say that plants have, don't have protein is, is not understanding the mechanism of the cell. So we have plenty of protein and, uh, within the cell, and then we have other plants that have protein even outside, you know, like beans and others. So those are the two, uh, contradictory things. The one thing, though, that we always talk about, that we, they've seen in vegans, is

• 1:07:35Dean Sherzai?

  lack of B12. B12 and the way it's bound to meat, and he, you know, it's actually much more bioavailable in the meat form, than it is in the plant form. Right. So, anybody who's purely vegan should definitely supplement themselves with B12. Um, and then what we say is, along with B12, everybody, not just vegans, uh, DHA and omega 3 should be, because the synergy between B12 and, and, uh, omega and B, uh, DHA seems to be pretty powerful, more, uh, will be coming out on that. We're big time about synergy of vitamins, not singularity. In other words, like, taking those together to increase the bioavailability of a B12? Correct, exactly. Yeah, I haven't heard that before.

• 1:08:18Dean Sherzai?

  Yeah, not so much that bioavailability, but they seem to work together more in the body. Um, and, and many studies, we did four reviews, which is these, collecting all the papers, and then coming out with what those said, so it's just the most painful kind of research. And on nutrition and Parkinson's, nutrition and stroke and nutrition and dementia. And the thing that stood out the most was synergy.

• 1:08:40Ayesha Sherzai?

  Absolutely. So these micronutrients, whether they're vitamins or minerals, they don't work alone. You know, it's actually the combination and the levels of the different kinds of micronutrients that matter and they synergize each other's availability. So, and that makes sense. And that's why, you know, hundreds of studies on, say, for example, vitamin E and brain health, or vitamin C and Alzheimer's or Parkinson's disease have come back with no results, with no particular correlation and effect. But, and, and when you eat it in a whole form, when you eat it in a, you know, plant form, all of these micronutrients are well balanced and they're bound to other macronutrients, they're bound to the fiber as well,

• 1:09:24Ayesha Sherzai?

  which increases their bioavailability.

• 1:09:33Rich Roll?

  One of the things that you hear is, is that you need healthy fats for brain health. Like the brain needs good fats, right? So that's true, correct? So when we're talking about healthy fats, what are those healthy fats? What are the, you know, we talked a little bit about saturated fat and animal fat, but like, how do we parse the difference between a healthy fat and an unhealthy fat?

• 1:09:57Ayesha Sherzai?

  We say focusing too much on fat or one food product is just...

• 1:10:01Rich Roll?

  I'm getting reductionist now.

• 1:10:02Ayesha Sherzai?

  Yeah, exactly.

• 1:10:04Rich Roll?

  But I mean, that's what you hear. You're like, oh, if you, I've heard that many times, like, oh, to combat Alzheimer's, or if you don't want to get dementia, like you have to make sure you're getting enough of your omega threes and your healthy fats in your diet.

• 1:10:16Ayesha Sherzai?

  Right. I think, I think just focusing on eating unprocessed whole foods, mostly plant, is the best way to go about it because you get your protein, you get your carbohydrates, you get the best types of fat by just eating those normal foods. If we focus too much on one micronutrient and one macronutrient, it doesn't, it doesn't do any...

• 1:10:37Dean Sherzai?

  Eat your olives, eat your avocados and you got your fats.

• 1:10:39Ayesha Sherzai?

  You eat some nuts here and there and you're, you're fine.

• 1:10:42Rich Roll?

  There was much ado about coconut oil recently and the impact on brain health. And you, you were pretty unequivocal in your book about that.

• 1:10:50Dean Sherzai?

  And and you want to we've been attacked by it seems to be clans.

• 1:10:55Ayesha Sherzai?

  Yeah, there's the.

• 1:10:56Rich Roll?

  People are very passionate. No, there's there's certain things that people get really.

• 1:11:00Ayesha Sherzai?

  Yes.

• 1:11:00Rich Roll?

  Very passionate. Get very passionate about.

• 1:11:02Ayesha Sherzai?

  Coconut was one of them. We learned very early.

• 1:11:05Rich Roll?

  Well, it goes back and forth on coconut oil, too. But go ahead. Sorry.

• 1:11:08Ayesha Sherzai?

  Right. No, it it's interesting, because, you know, all of this started with with one study and.

• 1:11:15Dean Sherzai?

  Not steady.

• 1:11:16Ayesha Sherzai?

  One person, one person giving coconut oil to her husband who had Alzheimer's disease.

• 1:11:22Dean Sherzai?

  So no, supposedly had Alzheimer's.

• 1:11:24Ayesha Sherzai?

  Supposedly had Alzheimer's disease and supposedly got better. But then we found out later that he got worse later as well. So we don't know whether it was coconut oil or whatever it was.

• 1:11:32Rich Roll?

  This guy's like patient zero, like for this whole story.

• 1:11:35Ayesha Sherzai?

  Yeah.

• 1:11:35Rich Roll?

  That's like a sociological experiment. Like, how did that happen?

• 1:11:39Dean Sherzai?

  It it happens because people are looking for anecdotes and fallacies. So why are we keep? Why do we keep struggling? Because we're we're our brain is designed to hear stories. And if somebody tells a good story, that's more powerful than a thousand studies.

• 1:11:57Ayesha Sherzai?

  And because the studies don't have stories in them and they're not associated with faces.

• 1:12:01Rich Roll?

  Maybe they should.

• 1:12:03Ayesha Sherzai?

  Yeah, maybe they should.

• 1:12:04Rich Roll?

  Do a little storytelling in in JAMA, right?

• 1:12:06Ayesha Sherzai?

  Probably make a case series. Um, I think I think that would that would actually sit with the population much better, but it's just, you know, you pointed it out. When you like we're storytellers, when you don't associate a cause and an effect with a person or with a a a particular situation, it's very difficult to see it. I mean, the thousands of people that have been studied and you have these phenomenal results. They don't have any faces. They're just numbers and people don't see themselves be a part of that.

• 1:12:36Dean Sherzai?

  Yeah, this this so the study, although there's there were some data, so let's just talk about the science of the um coconut oil. Um, medium chain fatty acids and coconut um oil has been studied in many things and there's some some some signals that people get here and there. Um, there's some evidence to the best of our knowledge today that the medium chain part, which is about eighty eight percent of the total fat. The other ninety percent is ninety to ninety two percent is saturated fat. But the medium chain, when people have looked at that, seems to have some benefit. And even that has to be reproduced and shown. So we're okay with that. I mean, that's we have no, we have no skin in the game on one side or the other. What works?

• 1:13:21Dean Sherzai?

  And so what we say is, to the best of our knowledge today, with the data, true data, there doesn't seem to be a strong relation between coconut oil and, and, and brain health. The medium chain part, there seems to be some, what we say qualitative and further study does need to be changed, done, and that, that is being done. And we welcome that. But to extrapolate from one case and from few studies, to say that it's beneficial for your, for your brain, don't you think somebody would have shown those cases in a much better way? They would have made millions by now.

• 1:13:53Rich Roll?

  Yeah, but that would require us to actually read, right?

• 1:13:56Dean Sherzai?

  Yes.

• 1:13:57Rich Roll?

  We don't want to do that.

• 1:13:58Dean Sherzai?

  No, no, no, no, no.

• 1:14:00Rich Roll?

  A lot of the, it seemed that a lot of the research that, that, you know, you kind of plow through in the book and has kind of informed your, your, you know, your protocols, some of it comes from looking at the Mediterranean diet, right? Versus like a whole food, plant-based diet, and probably because there's just been more studies on that. I don't know.

• 1:14:20Ayesha Sherzai?

  Right.

• 1:14:21Rich Roll?

  So how does that play out in terms of meat intake and, and also, you know, things like olive oil, processed vegetable oils?

• 1:14:29Ayesha Sherzai?

  What actually has-

• 1:14:30Rich Roll?

  Beyond coconut oil.

• 1:14:31Ayesha Sherzai?

  It actually has helped us. It has actually helped us understand the nuances of plant-based diet and its benefit. Because the way the dietary scoring system, for the lack of better term, is structured is, you know, you, you get positive scores for a plant-based diet. And you get negative scores for sugar, meat, dairy, and things of that nature. So the higher you go on that scale means the more adherent you are to a whole food, plant-based diet. But because this, this Mediterranean diet was structured and it was given a label and it was started in an area where people had the least amount of cardiovascular disease, it just stuck that way.

• 1:15:17Ayesha Sherzai?

  Um. But we now know that, you know, different scientists and different um doctors at different uh universities have actually come up with a better definition of dietary patterns. And there are different statistical processes like factor analysis to see, you know, what dietary pattern stands out in the healthiest population. And um we we see this uh this picture being translated uh in different populations. That a plant-based diet seems to be the healthiest.

• 1:15:43Dean Sherzai?

  And the factor analysis is is looking at what component of this thing is most beneficial. And it's not the fish. Right. It's the plants.

• 1:15:51Ayesha Sherzai?

  Right.

• 1:15:51Dean Sherzai?

  Over and over. It's the beans. It's that that component. So even though it's not completely uh a, let's say, a plant-based diet, but we can actually distill because these are large studies, one hundred forty-four thousand, you know. Um. We can, it's large enough, we can actually then break it down into what component of the diet had the greatest benefit, because this group ate more of this versus this. So we now have enough data from all these big studies to strongly, consistently say that it's the plant-based component of even of the Mediterranean that's most most beneficial. That's interesting. But by far and away, the large culprit here is sugar.

• 1:16:34Dean Sherzai?

  Correct. Correct. And we, even us, I mean, uh, meat is bad, saturated fat is bad. Um. Let me actually take a step back. So let's get back to the disease, diseases of the brain. Um. When it comes to stroke, it's fairly well-known. Stroke is vascular. So it's going to be mostly driven by saturated fat and and sugar then. For Alzheimer's, it's it's it's a catch-all category. In a few years, we will realize that there are many types of Alzheimer's. Those that come to it from vascular side, those that come to it from inflammatory side, those that come from it from other sides, the football players that have been hit multiple times with trauma. Right. That's more inflammation versus those who have lipidous radiation.

• 1:17:19Dean Sherzai?

  So to to talk about that, there are those that are more driven by sugar and glucose disadiation. But there are others, especially the ones with APOE four, that we believe that are driven by sugar and everything and inflammation, but but dominant feature is fat and saturated fat. So it depends which direction. And I say, since we don't know that yet, although we can get a good picture of it, especially in our clinic and others and others. It would behoove us to kind of limit all of those bad things. You know, sugar and saturated fat in steps.

• 1:17:52Rich Roll?

  Right. What about gluten?

• 1:17:55Dean Sherzai?

  I'll leave that to you.

• 1:17:57Rich Roll?

  Yeah.

• 1:17:57Ayesha Sherzai?

  And that was another one that...

• 1:17:59Rich Roll?

  But it didn't seem like, was it, I didn't see it in the book. Did you guys make a decision to not address that?

• 1:18:05Ayesha Sherzai?

  Oh, well, because there really isn't any data that supports the idea that gluten is, you know, causes harm to the brain. There's, you know, probably one or two percent of the population that are sensitive to gluten and they have specific allergies.

• 1:18:20Rich Roll?

  Right, and that creates inflammation.

• 1:18:22Ayesha Sherzai?

  It creates inflammation and it actually has other repercussions in the body. Gut health and skin health and musculoskeletal issues as well. So it's a constellation of problems that people suffer from. For gluten to just affect the brain, there's really no, there's no data that supports that. And, you know, there have been some authors that have actually made a lot of fortune pushing the idea that gluten's bad for you and that you have to stay away from it and that you just have to eat a lot of fat and protein and that's just not true.

• 1:18:53Dean Sherzai?

  Yeah, the important thing is here is, I always say, it's not, the struggles we have as humanity is not truth. Everybody has their truth. It's the weight of the truth. If somebody overstates the weight of a truth, they're creating fallacy. If they're understating it, it's creating fallacy. Is gluten bad for people who have celiac disease? Absolutely, they should avoid it. Is gluten bad for another percentage, which we still don't fully know? I mean, look at this. We don't know something fully, yet we're making these huge public health actions. And I'll tell you where the public health component comes in. Let's say that other group beyond celiac disease is 3%. We don't even know that. Let's say if it's that bad for them, they should be studied, identified, and they should avoid it.

• 1:19:38Dean Sherzai?

  But to say that gluten's bad, which actually what's now the common law or language out there, means that 90% or more have to avoid gluten, which means that with that comes what? They have to avoid, because we don't have a good way of doing that. So...

• 1:19:55Ayesha Sherzai?

  It's a blunt mechanism.

• 1:19:56Dean Sherzai?

  A blunt mechanism. We give up on all...

• 1:19:58Ayesha Sherzai?

  Whole grains.

• 1:19:59Dean Sherzai?

  Whole grains.

• 1:19:59Ayesha Sherzai?

  Yeah.

• 1:20:00Dean Sherzai?

  So, look at weight of truth. This 3% benefited, the 3% that was supposedly gluten sensitive. But the 95% or 90 whatever percent that would have benefited from a whole wheat. And they're going to suffer because of overgeneralization of 3%. That's a common problem in science.

• 1:20:22Rich Roll?

  Yeah, no, I get that. I get that. And I think it gets even more complicated because we've hybridized our wheat. And most of the wheat is, it's so stripped of any of its nutritional value anyway. And it ends up in these packaged foods. I mean, I just know if I eat like crappy pizza crust, like my eyes get puffy. And like, I feel terrible. Like, I'm like, that's not good for me. Like, my research is done. Like, I know, like, I don't know where I fall in the spectrum of gluten sensitivity. But I can tell you straight up that it's creating an inflammatory response in my body. And that can't be good. And I feel terrible.

• 1:20:54Dean Sherzai?

  Absolutely.

• 1:20:55Rich Roll?

  And then I keep eating it.

• 1:20:59Rich Roll?

  So it's like, it's like, well, what is in our wheat? And is it the gluten? Or is it something else about like how we've, you know, kind of, you know, hybridized these foods that are staples? Because at its core, of course, whole grains are great. And now it's almost like if you say, well, you should eat whole grains. People are like, ah, whole grains, like they're afraid of whole grains.

• 1:21:17Dean Sherzai?

  Yeah, so that 3%, 4%, 5%, let's say, is dictating health for the 90%. That would have benefited from whole grain. I mean, if we give up fats, saturated fats, and especially, let's say fats, sugars, and then grains as well, what are we gonna eat?

• 1:21:35Rich Roll?

  Right. People throw up their hands. They get despondent.

• 1:21:37Dean Sherzai?

  Yeah, and that's what I was getting to. One of the things that, not to be a conspiracy theorist or anything like that. One of the ways you fail people is by throwing so much information, false, and play with the weights of truth, that people just finally give up and say, I'm gonna do whatever I have to. And we can't afford that. So you operate with what you know, to the best of our knowledge. And say, I'm fully on board to study coconut oil. But am I going to make public health decisions for general population on that? No, not yet. I'm fully on board to studying gluten. Absolutely. Are we at the apex, at the full knowledge of all of nutrition? Not even close. Not at all.

• 1:22:19Dean Sherzai?

  But what do we make public policy on is with the best data we have right now. Otherwise, you're going to be all over the place and people give up. And then there, and we know that. Diet kills and diet saves. And we, so we have to operate with what we know and leave the rest open to research.

• 1:22:41Rich Roll?

  On the subject of research and diet, what is your perspective on the ketogenic diet? Because this is getting a lot of attention and a lot of press and there's a lot of talk about the impact of being in ketosis in terms of disease prevention and reversal, et cetera. So like, what do you know about it? What is your understanding of it? What's your perspective?

• 1:23:02Ayesha Sherzai?

  So the process of ketosis is essentially a, a period of starvation for the body and for creating alternative fuels that the body can use. And it has been studied specifically, we'll talk about the brain diseases, you know, for certain epilepsy diseases of, of children.

• 1:23:21Dean Sherzai?

  Not all epilepsy.

• 1:23:22Ayesha Sherzai?

  Not, not, there are certain epilepsies and it, it's helpful. It actually makes them have less seizures and it makes them function better in their lives. But usually it's a very short period, a very quick blunt method of controlling seizures in that population. Beyond that, ketosis hasn't been studied in any other disease and it hasn't really generated, you know, a large amount of evidence for us to apply it in public health. For individuals with Alzheimer's disease or cognitive impairment, you know, the, the studies that have actually shown that ketosis or a ketogenic diet is, you know, showing

• 1:24:05Ayesha Sherzai?

  some benefit, they were done in a very small population and the amount of ketosis wasn't measured well and it was studied for a very short period of time. It makes sense when you look at the cellular structure for the ketone bodies to provide fuel for cells that can't use glucose anymore for advanced stages of the disease because the cell structure has been. You know, has been destroyed and there's been a lot of inflammation and dysregulation going on. However, to use this particular technique or this approach for a long term, I mean, we know that down the road, they will have plaques in their arteries if they keep up the ketogenic diet.

• 1:24:47Ayesha Sherzai?

  They will have glucose dysregulation, they will have lipid dysregulation, all these processes that we just talked about, and it causes a lot more inflammation. So it doesn't make sense that this diet would actually work long term.

• 1:24:58Dean Sherzai?

  Um, do people feel good on using it initially? Absolutely, and I'll tell you why. And do people lose weight? Absolutely, because if you're gonna stay away from carbs, let's say, um, you hold about two to three pounds or more of carbs in your muscles. And as that gets burned away, used, and the water that's connected to it, anywhere between six to 10 to 12 pounds of weight is lost. So, wow, I just lost weight? Absolutely, great. Why do you feel good? Because here's a cell that needs glucose, it needs energy. I mean, we talked about how much energy it needs. The usual mechanism or the usual energy source is glucose, the most effective way, the functional energy source.

• 1:25:42Dean Sherzai?

  But in order for glucose to get in, it needs receptors. It's not, it's a very fickle process. It has to find a receptor, and if there's too much sugar in the body, what happens is the cell internalizes the receptor because it's shocked, so now there's, it's swimming in sugar but starving of energy. So it's, it's very difficult process of getting, not difficult, but more complex than, than clear ketone, of getting sugar into the cell. What ketones, it's small molecule, gets right into the cell. So it has, the cell has energy. So what, so people say, I feel better, I feel more awake. Of course you do initially and for a while, but that doesn't mean that long-term benefit is there. Now, let's look at how you achieve ketosis. It's not a natural state.

• 1:26:25Dean Sherzai?

  You have to have this incredible diet that is also high in saturated fat and/or fat and...

• 1:26:30Ayesha Sherzai?

  And very little in carbohydrates, less than 5% of carbohydrates.

• 1:26:34Dean Sherzai?

  Initially, there's even reduction in inflammation with ketone studies. But long-term, it's always about the long game. If people want short game, I'll give you 50 different ways where you will lose weight, cut off your arm. They will actually, they will, they will actually feel better. I have lots of pills out there that'll make you feel better. Long-term gain. Everything we're talking here is about long-term game, the long game. I'm a Pittsburgh Steeler. It's a long game. It has to think about what could truly, how did your body evolve? Did it really evolve in this way? They said they bring paleo. Really? You're going to bring example of people who only lived up to thirty years of age to give me healthcare for me living at eighty years of age? Does that even make sense? And if

• 1:27:19Dean Sherzai?

  you think meat was the way to go, I was a hunter. We had a farm in Virginia with a shotgun. I barely shot anything weekend after weekend. Go chase a rabbit without a gun.

• 1:27:31Rich Roll?

  I can't see, I'm trying to picture you with a shotgun.

• 1:27:33Dean Sherzai?

  That's a long, long time ago. But, but, so the science, the paleo, you know, the anthropology, everything is so wrong. I still say, we're open. Show us the data. Let's not jump ahead of ourselves because it has public health implications. We're just beginning as physicians. We're terrible with this prevention side. We're just beginning to accept some of the things that have been proven to apply behaviorally. Now, all of a sudden, because somebody wants to sell the book of the day, and by the way, you know, plants are poisonous to you, and the first reference is wrong in the book. I mean, so that's why it's

• 1:28:15Rich Roll?

  I think I know what book you're talking about.

• 1:28:18Dean Sherzai?

  But we need to say what works, what has been proven. We're open. Let's apply this. And if anybody brings newer ideas, like eating paint off the wall is going to, you know, give you less Alzheimer's, let's study that. But I would like you to try that first.

• 1:28:35Rich Roll?

  Right. So the research right now is pretty unequivocal. Like adopting a whole food, plant-based diet is gonna have a big impact in a positive way. Are there, if I'm not mistaken, aren't there studies being done now on psychedelics, on brain health and dementia? Is that true?

• 1:28:52Dean Sherzai?

  Marijuana is one of the components of it. Yeah, and all the other components are being studied. And, and, you know, we're excited because for a long time.

• 1:29:05Dean Sherzai?

  Social biases were stopping these powerful drugs from being studied. Again, either this way or this way, we don't know. But a chemical that directly binds to specific receptors is going to have consequences. So that should be studied and then many other drugs should be studied in a very scientific and responsible way.

• 1:29:23Rich Roll?

  Right. All right, so we went through the nutrition part, but there's four other things here in your book, right? We got, I mean, exercise is kind of self, it's self-evident, right?

• 1:29:34Dean Sherzai?

  Not really.

• 1:29:37Rich Roll?

  All right, well, what do you mean by that?

• 1:29:38Dean Sherzai?

  So everybody comes to us and says, what, I walk?

• 1:29:41Ayesha Sherzai?

  I walk around my neighborhood.

• 1:29:42Rich Roll?

  They have an inflated sense of what they're actually doing.

• 1:29:45Ayesha Sherzai?

  I'm active. I walk around my living room and my kitchen all day long. And we tell them, well, that's wonderful, but that's not exercise. That's meditation. You know, walking around the neighborhood may be good for you. You're moving naturally. But for brain health, it has to be strenuous. There has to be some level where you're breaking a sweat and you're not able to finish a sentence when you're speaking. And there's been studies that actually show that in those moments where your strenuous activity comes to that moment where, you know, your heart rate is raised, that's when the chemicals start being released in your blood, whether it's brain-derived neurotrophic factor or others. And those are the ones that make those connections.

• 1:30:29Ayesha Sherzai?

  Those are the ones that increase the size of your hippocampus. As a matter of fact, there was a study a couple of years ago.

• 1:30:35Dean Sherzai?

  Several, actually.

• 1:30:35Ayesha Sherzai?

  Yeah, the one particular one in a large sample of population where they compared individuals who just, you know, did stretching and some Pilates and yogas and the others were working with a physical trainer. And they did strenuous physical activity three to four times a week. And after two years, they had, they literally grew the size of their hippocampus.

• 1:30:58Rich Roll?

  That's crazy.

• 1:30:59Ayesha Sherzai?

  You know, and, and these are individuals who are,

• 1:31:02Rich Roll?

  That's amazing.

• 1:31:03Ayesha Sherzai?

  in their, in their midlife. And that's, I think that's such an incredible empowering, a piece of information for all of us.

• 1:31:12Rich Roll?

  When you're talking about exertion, can we get specific in terms of whether we're, we're talking about aerobic exercise versus anaerobic exercise?

• 1:31:20Dean Sherzai?

  So the, the data is still coming. Some of the data is kind of interesting, exciting and, and kind of throws us for a loop. For example, people with bigger legs had lower dementia.

• 1:31:32Ayesha Sherzai?

  A twin study.

• 1:31:33Rich Roll?

  Really?

• 1:31:34Ayesha Sherzai?

  Twin study.

• 1:31:34Rich Roll?

  Bigger meaning like thicker, like more muscle mass.

• 1:31:39Dean Sherzai?

  More muscle.

• 1:31:39Ayesha Sherzai?

  So the ones who were more active actually had a bigger brain. From the same genetic background.

• 1:31:44Dean Sherzai?

  Yeah, so was it, so in, in research.

• 1:31:46Rich Roll?

  Do they have bigger legs because they're, they're exercising more?

• 1:31:49Dean Sherzai?

  Yeah, exactly.

• 1:31:50Rich Roll?

  It's not just they have.

• 1:31:51Dean Sherzai?

  No, no, no.

• 1:31:52Ayesha Sherzai?

  Muscle mass.

• 1:31:53Dean Sherzai?

  They have same gene, so there has to be something else. But directionality in science is important. Were they healthy, therefore they retain their muscle more or something? But then other studies show that leg strength has correlation with brain, brain health. And it kind of makes sense because your blood gets to your heart. Well, your blood gets to your heart because your legs have, the muscles have to pump the, the veins to get it to the heart, to the brain. So that seems to be, so even anaerobic exercise seems to have relationship with brain, better brain health. But definitely aerobic exercise repeatedly has been shown to, to have tremendous positive effect on the brain. So that's, that's one thing that, that, oh, as much as, what was it? One study was 40%, nearly 40% reduction in the chance of getting Alzheimer's.

• 1:32:38Rich Roll?

  40%?

• 1:32:38Dean Sherzai?

  Yeah, that's, these are not small numbers, 40%.

• 1:32:41Rich Roll?

  Right. But when you're, when you're kind of chagrined at the person who said, well, I walk around the block. I mean, that's kind of a blue zones thing, right? Like it's, it's not about exerting, you know, over exerting yourself. It's just, these are populations of people that are just kind of in slow perpetual motion throughout the day.

• 1:32:59Dean Sherzai?

  So, so it's not one thing. So you, you hit it on a very good, good point. So a lot of people are highly educated yet to get dementia. Or others who have very little education, yet they didn't get dementia because they ate well. And others who didn't, who ate, you know, their diet was okay and their education was okay, but they just did lots of exercise. And others who just had complex jobs. So my grandfather and her grandfather were probably the most brilliant people you can imagine, yet they got Alzheimer's. For them, it was diet and lack of activity and these kind of things. So it's, it's the different contributors. That's why we say it's a whole person component. It's not just diet.

• 1:33:39Rich Roll?

  Right.

• 1:33:39Dean Sherzai?

  It's not just this. It's the being mindful of a life that encompasses all of those things. So the more of those things you do, the more protected you are.

• 1:33:48Rich Roll?

  Mm-hmm.

• 1:33:49Dean Sherzai?

  But even if you do some of them, that gives you a measure of protection.

• 1:33:52Rich Roll?

  Can you exercise too much? Does it become bad? I'm asking for, for a friend.

• 1:34:00Ayesha Sherzai?

  I don't know. I don't know. I, I, I think it like, like Dean said, it just depends on everything else. If too much exercise is causing stress, then you probably, you know, not doing yourself a favor.

• 1:34:11Rich Roll?

  I just wanna make, I don't know if, I just wanna make sure I'm not injuring my brain by running long distances. I'm not banging my head against anything.

• 1:34:18Dean Sherzai?

  That's the thing.

• 1:34:18Ayesha Sherzai?

  Yeah.

• 1:34:19Rich Roll?

  If you do traumatic.

• 1:34:20Ayesha Sherzai?

  Right.

• 1:34:20Dean Sherzai?

  Yeah, no, no.

• 1:34:21Rich Roll?

  It's different.

• 1:34:22Dean Sherzai?

  Your, your balance is probably better than ninety, ninety percent of people. No.

• 1:34:25Ayesha Sherzai?

  Absolutely.

• 1:34:25Dean Sherzai?

  But if you're doing like boxing and that kind of exercises, absolutely, that's doing damage.

• 1:34:30Ayesha Sherzai?

  Or getting hurt on a regular basis, inflammation.

• 1:34:32Dean Sherzai?

  Inflammation.

• 1:34:33Ayesha Sherzai?

  In your legs and in your arms during physical activity, that definitely, you know, uh, causes some level of damage.

• 1:34:40Rich Roll?

  Do you see patients with TBI regularly?

• 1:34:43Dean Sherzai?

  We do.

• 1:34:44Ayesha Sherzai?

  Yes, we do.

• 1:34:45Rich Roll?

  It's interesting how like that's really come, come into the conversation as a real thing and the impact on the NFL and kids playing football and everything, you know?

• 1:34:54Ayesha Sherzai?

  It is, it is, it's quite scary.

• 1:34:56Dean Sherzai?

  We actually are in the process of trying, um, well, it's with the NFL, the retired NFL group, uh, bringing him into our clinic. It hasn't been fine wise or anything, but, but there's no doubt that people who get hit or not even hit to the head, sudden deceleration. You know, this is a bony structure. I mean, if you ever get a skull, you'll actually be, be worried that, you know, there are bony edges there. And the brain is floating in a liquid and it's not even a gelatinous liquid. It's a liquid that easily moves the brain. It's a little more viscous than water, but it still moves easily. So anytime you come to sudden stop, that brain is still moving.

• 1:35:39Dean Sherzai?

  So they say, oh, we created this new helmet and this. How's the helmets going? How is that helmet going to stop the brain from moving within the skull?

• 1:35:48Rich Roll?

  Right.

• 1:35:48Dean Sherzai?

  Yeah. And my son always comes up with these things. What was this? The superhero where the girl is falling at, you know, fast speed and this super picks him up. Nope, there is, she's dead. The brain stopped.

• 1:35:59Ayesha Sherzai?

  It's a lot of fun watching Marvel movies with him, yeah. Brain damage.

• 1:36:03Rich Roll?

  Yeah.

• 1:36:05Rich Roll?

  You're like buzz killing every snare.

• 1:36:07Dean Sherzai?

  No, so repetitive trauma or repetitive deceleration, absolutely. The small bridging veins are going to be cut. The inflammation that builds up, absolutely.

• 1:36:19Ayesha Sherzai?

  And you don't have to lose consciousness necessarily. You get brain damage even, you know, the lack of laws of consciousness.

• 1:36:25Rich Roll?

  And do these five factors of nutrition, exercise, sleep, stress, you know, engagement, all of that? Can those work to, you know, when you have somebody who has TBI, traumatic brain injury? Can these factors work to, you know, prevent the further development of that turning into a more profound dementia or Alzheimer's? Or can it be reversed? Or are those people just, it's about managing it?

• 1:36:52Ayesha Sherzai?

  That's a great question. And that's where the idea of personalization of brain health comes in. So you look at the factors that affects them the most and you address that aggressively. And of course, you know, bringing in the whole comprehensive lifestyle. For example, if somebody has, we'll talk about it later, but if somebody has sleep apnea, you know, they're not sleeping well and there are moments during their sleep where they're not getting oxygen into their brains. You give them blueberries and the healthiest diet in the world and they're not going to benefit from it. So it just depends on what areas need to be attended first.

• 1:37:28Dean Sherzai?

  Yeah. Addressing, that's one, this cookie cutter concept, that's where we go wrong when it comes to brain health. It's complex. Not to perseverate and repeat what you said, but we have, every person comes to this journey of brain aging on their own terms. We have to identify that, that focus, that area that has affected their brain negatively, and that area that they can actually create success. That's where the personalization takes place.

• 1:37:56Rich Roll?

  So unwind, this is the next category, right? And this is about, this is about stress reduction, mindfulness, and specifically meditation. Yes.

• 1:38:09Ayesha Sherzai?

  Yes.

• 1:38:10Dean Sherzai?

  It's not stress reduction.

• 1:38:11Ayesha Sherzai?

  It's identifying your stresses in life. And there's, there's a definition that we use, you know, good stress and bad stress. And it kind of sounds funny, but we do believe that there is actually a thing such as good stress. And, you know, those are the activities that you own, those are the situations that you understand, and you can manage on a regular basis. And it is bound to a purpose in life. And that's necessary because that keeps you challenged, that keeps you on the edge, that keeps you awake, and that keeps you motivated enough to do something about your life to move forward.

• 1:38:51Rich Roll?

  Right, like I'm thinking about, sorry I interrupted you again. But like, I'm thinking about the person who's retired, right? And then suddenly finds himself in the lazy boy chair, bored and unchallenged, right? Is lacking that good stress that leads to, you know, the advancement of, of aging.

• 1:39:07Dean Sherzai?

  In fact, that's the one state that has shown to be the biggest determinant of decline. If a person had a high level job, by the way, the most protective thing, even beyond food and everything, we would love to say food, it's the level of complexity of the job. If they had a complex job that they loved all their life, that was protective even beyond bad food and everything else. I'm not saying that people should just, you know, do that, but, but it's protective. But if they had a high level job and then they retired and they didn't do anything, that determined the highest rate of decline in brain health.

• 1:39:37Rich Roll?

  That's interesting. That's super interesting.

• 1:39:40Dean Sherzai?

  Purpose. Life with purpose.

• 1:39:42Rich Roll?

  Sorry, Ayesha, I interrupted you. I think I where I, where you were.

• 1:39:45Ayesha Sherzai?

  We're flowing, we're flowing. It's a conversation, I love it.

• 1:39:48Rich Roll?

  Yeah, so keeping, keeping yourself stimulated while also reducing the bad kind of stress.

• 1:39:54Ayesha Sherzai?

  Yes, yes. It can literally eat away your brain. I mean, we have studies that show that people who had a rough childhood, whether it was physical or mental abuse, they actually have a higher risk for developing dementia later on in life. And it makes sense when you look at people going through stress. There are specific hormones that are secreted in the brain, cortisol and others, that change the physiology of the brain, that change the amount of blood supply going into the brain. And it actually causes formation of a lot of oxidative byproducts that, you know, reduce those connections, that jeopardize the structure of brain cells.

• 1:40:38Ayesha Sherzai?

  And there's shrinking, there's literal shrinking of the brain during stress. And so identifying what stress is and getting rid of it. And you're not in a magical way. We don't ask people to just sit down and not do anything, but to try to focus on managing our lives and managing and being organized. For example, trying to minimize things and attending to all of them.

• 1:41:04Dean Sherzai?

  The present.

• 1:41:05Ayesha Sherzai?

  That you can, yeah, just being in the present. And that's the best way to go forward.

• 1:41:09Dean Sherzai?

  This is the one chapter that's a little different than the other chapters. We go into why meditation, why mindfulness?

• 1:41:15Ayesha Sherzai?

  Right.

• 1:41:16Dean Sherzai?

  What it does, it actually gives you ability to step back from the moment. We live, people think that urgent living, so living from minute to minute to minute, it increases cortisol levels and all that stuff. The ability to step back, be it consciously or through, gives you a higher view of everything and actually completely reduces those hormones. And they've done a study after, and increases oxytocin levels. Pilsac and his oxytocin.

• 1:41:44Ayesha Sherzai?

  The happy hormone.

• 1:41:45Dean Sherzai?

  The happy hormone, the love hormone. So it increases that. These are important things, the moments that you can actually create, that actually increase the oxytocin and positive hormones and reduce the negative hormones, determine the shrinkage of the brain, literally. So we've instituted this in our household with our children.

• 1:42:04Ayesha Sherzai?

  Yeah.

• 1:42:06Dean Sherzai?

  Sophie, Tan and Alex. And so what we do with them is mindful breathing. And I do this and we do this in lectures.

• 1:42:12Ayesha Sherzai?

  Yes.

• 1:42:13Dean Sherzai?

  We're huge, we did this in the Sinai Temple, 500 people.

• 1:42:17Ayesha Sherzai?

  500 individuals.

• 1:42:18Dean Sherzai?

  I said, "Close your eyes." So they close, I said, something very simple, you'll see it's kind of, so breathe in.

• 1:42:27Dean Sherzai?

  Breathe out, just be aware of that. Breathing in and breathing out. Next, muscles, you know, you know how it is, the muscle relaxation. Then put yourself in a beautiful place. And next, focus on one item. And we did this for 15 seconds.

• 1:42:41Ayesha Sherzai?

  Yes.

• 1:42:41Dean Sherzai?

  I said, open your eyes. And I mean, this incredulous population, the elderly in the churches and the community centers. Every time they say, this was amazing for 15 seconds. So the other day, we do this twice a day with the kids. And my daughter came and said, Dad, my life has changed. And we were like laughing, I said, you have no right to say that. You're 10 years old. But, but, but this is important. And, and, and beach cities, Manhattan, Redondo, they do this in schools.

• 1:43:11Rich Roll?

  Do they really?

• 1:43:11Dean Sherzai?

  Yes.

• 1:43:12Ayesha Sherzai?

  Yes. Mindfulness.

• 1:43:13Dean Sherzai?

  Yeah, we're part of that project. We're actually implementing.

• 1:43:15Rich Roll?

  Is that part of the Blue Zone stuff?

• 1:43:17Dean Sherzai?

  That's it.

• 1:43:18Rich Roll?

  That's down in Redondo?

• 1:43:19Dean Sherzai?

  And now we're involved on the brain health side.

• 1:43:21Rich Roll?

  Oh, wow.

• 1:43:21Dean Sherzai?

  And they've done this way, way before us. Imagine teaching kids to manage stress. What better gift?

• 1:43:28Rich Roll?

  Yeah, that's a beautiful thing.

• 1:43:30Ayesha Sherzai?

  It is.

• 1:43:30Rich Roll?

  And it's really cool, you know, to hear that coming from you guys, from, from the perspective of neurologists, right? Who are like rooted in the hard science.

• 1:43:39Dean Sherzai?

  But you didn't expect that from cardiologists, did you?

• 1:43:41Rich Roll?

  No, yeah, I know. But I mean, I have like, two days ago, I was doing a podcast with Guru Singh, who's like a Kundalini master. He's like, I talked to a lot of guys like that.

• 1:43:51Ayesha Sherzai?

  Yes, it's amazing.

• 1:43:51Rich Roll?

  I can, you know, I expect to hear these sorts of things from them, but like to hear, to hear it come from, you know, hardcore scientists, like it's, it's cool, right? So in that, in that vein, are there studies where you can see the before and after MRIs and kind of really gauge the impact on, on brain health with somebody who is, you know, performing a consistent meditation practice?

• 1:44:15Ayesha Sherzai?

  There hasn't been a lot of studies, but yes, there are studies that have looked at, say, for example, Buddhist monks who meditate on a regular basis. And they have. Um, lower risk of of brain diseases. But I think it's an area that is expanding more and people are very excited about it. And thankfully, we have tools. We have functional MRIs and other MRI sequences that actually goes deep down into the brain to see how meditation affects

• 1:44:40Rich Roll?

  Right.

• 1:44:40Ayesha Sherzai?

  those those cells and connections.

• 1:44:42Dean Sherzai?

  I should did two years or year of research at UCSD, FMRI.

• 1:44:46Ayesha Sherzai?

  Yes.

• 1:44:47Dean Sherzai?

  These are MRIs that actually look at your brain while you're thinking, you're doing things. So they've done all these kind of studies, free will studies and other things that have done with these MRIs.

• 1:44:54Ayesha Sherzai?

  They give you functions like memory cards and things to learn and think about, listen to music, and you see how the brain functions live.

• 1:45:01Dean Sherzai?

  Yeah. So they've done that with meditation and and repeatedly. We know that different parts of brain are brought into function. Um, the brain actually works at a different level. The greater detail has to be worked up as far as how this has to ha- works for your long term health and as far as brain health. Why is it not being done? Because first of all, it's costly. Second of all, you have to get rid of a lot of what science we call confound, other things that could be contributing. So if you bring a Buddhist monk and put him on FMRI and you see brain has changed, then you have to say, well, this guy is doing a lot of other things that are beneficial as well.

• 1:45:36Rich Roll?

  Mm hmm. Right. There's a lot of co-founding factors.

• 1:45:39Dean Sherzai?

  Exactly, exactly.

• 1:45:40Rich Roll?

  Yeah, yeah, yeah. Sleep. Talk about sleep a little bit.

• 1:45:45Dean Sherzai?

  Big, big, big part of our book.

• 1:45:47Ayesha Sherzai?

  It's um, it's something that's not really discussed much. And um, you know, we we lived in Los Angeles and Dean and I joke about this all the time. You know, you, there's always some detox going on, you know, detox of the day, eat this or do that. In our opinion, the best type of detox is actually sleep.

• 1:46:07Rich Roll?

  People talk about that in LA?

• 1:46:07Ayesha Sherzai?

  They do.

• 1:46:09Rich Roll?

  I didn't know.

• 1:46:10Ayesha Sherzai?

  Some people do. And the best detox is just sleep.

• 1:46:14Dean Sherzai?

  Restorative sleep.

• 1:46:15Ayesha Sherzai?

  Yes. So so what does that mean? That means that one is able to go through all the stages of sleep without any interruption. And um, there's been studies where

• 1:46:28Ayesha Sherzai?

  One night of sleep deprivation has increased the amount of amyloid in the brain and the cerebrospinal fluid or the fluid that surrounds the brain exponentially.

• 1:46:39Rich Roll?

  Wow.

• 1:46:40Ayesha Sherzai?

  And inflammation.

• 1:46:41Rich Roll?

  That's just one night.

• 1:46:43Ayesha Sherzai?

  That's just one night of bad sleep.

• 1:46:45Rich Roll?

  For anybody or is that like a function of whether you have the proper gene or disposition to dementia or no?

• 1:46:52Ayesha Sherzai?

  No, no. No, for anybody because those factors were actually taken into consideration during the analysis and that's just incredible and you know they've done studies among night shift workers who have completely challenged their their cycle, their their biology and they seem to not do very well in a lot of memory testing and even among college students, you know, a good night's sleep actually tends to increase their their scores if they studied very hard and if they sleep well, they have higher score compared to those who don't sleep well.

• 1:47:26Rich Roll?

  Who pull an all nighter and cram.

• 1:47:27Ayesha Sherzai?

  Yeah. That doesn't work and and when you look at the physiology, um, you know, sleep is a mechanism where your memory is consolidated or just to put it in simple terms, you know, there are files and folders created in the brain where all of these memories are placed. So it's easier for one to go and retrieve it later and it also gets rid of all the quote unquote garbage that is deposited in the brain during the day. So it's essentially, you know, a garbage cleaning system and it consolidates memory in the brain and it's it's it's a very, very important thing to talk about. And so what are some of the things that affect sleep? Yeah, maybe, you know, not not having the time to go to sleep or a job, but even, you

• 1:48:11Ayesha Sherzai?

  know, things as such as sleep apnea, which is just crazy. Sleep apnea is a disease where you have a number of periods during your sleep where you stop breathing and your brain doesn't get oxygen and in one population, sleep apnea increased the risk of Alzheimer's disease by 70%.

• 1:48:31Rich Roll?

  Wow.

• 1:48:32Ayesha Sherzai?

  70%.

• 1:48:33Rich Roll?

  And how many people suffer from sleep apnea?

• 1:48:36Dean Sherzai?

  Way more than you would expect, especially as as we get older or people are a little overweight or have these other chronic diseases. Sleep apnea is very common finding.

• 1:48:45Ayesha Sherzai?

  It goes unnoticed most of the time because it's, you know, people don't actually say, hey, I snore or I wake up multiple times and I have hard time breathing.

• 1:48:54Dean Sherzai?

  Or I slept eight hours, but I was still tired the whole day.

• 1:48:57Rich Roll?

  I feel terrible.

• 1:48:58Dean Sherzai?

  Exactly, exactly.

• 1:48:59Ayesha Sherzai?

  Exactly, and that's sleep apnea, so.

• 1:49:01Rich Roll?

  So it prevents you from entering that deep restorative phase of sleep.

• 1:49:04Ayesha Sherzai?

  Absolutely, and then the, the other thing about medication, I mean, you know, as physicians, we all, we, we are so quick on giving medication to make sure that, you know, one sleeps. Medications don't help because, yeah, it knocks you out, but again, all of that sleep rhythm and the sleep cycles are, are messed up.

• 1:49:21Rich Roll?

  Yeah, you're not, you're not like going through the proper cycles.

• 1:49:24Ayesha Sherzai?

  Exactly, exactly.

• 1:49:26Rich Roll?

  So many people are on those pills.

• 1:49:28Dean Sherzai?

  Yeah, so these are, again, easy remedies, easy remedies. Do you wanna knock somebody out? I mean, we saw Michael Jackson, I mean, pop a fall.

• 1:49:36Rich Roll?

  Right.

• 1:49:36Dean Sherzai?

  This is a medicine you give for surgery.

• 1:49:39Ayesha Sherzai?

  In ICUs.

• 1:49:40Dean Sherzai?

  In ICUs, so, um, um, you can knock people out, but it doesn't mean they have restorative sleep. Sleep cleans the brain. And when people, another thing that during sleep, if you're not getting good sleep, these microglia, these are the molecules that actually clean up the brain, they start eating way at its own brain, at good brain, or at least the connections, the axons. So, in one paper we wrote and some others, that if you don't get good sleep, the brain starts eating itself.

• 1:50:08Rich Roll?

  What do you mean eating itself?

• 1:50:10Dean Sherzai?

  So microglia are these mo, these cells that actually clean up, they're the cleanup molecules or cells in the brain.

• 1:50:15Ayesha Sherzai?

  Janitor cells.

• 1:50:16Dean Sherzai?

  Janitor cells. And their job is, at night, you have good night's sleep, the connections that are bad connections, it actually goes and eats those connections away, or breaks them up and eats the, and other garbage that's there, it starts eating them up. If you don't have good sleep, they've seen that actually these microglia go and break up good connections in the brain and eat up cells. So it is actually destroying its own brain.

• 1:50:42Rich Roll?

  You're literally cannibalizing yourself.

• 1:50:43Dean Sherzai?

  You're cannibalizing yourself because of lack of sleep. So, sleep is important. Uh, sleep, we don't talk about it because, you know, you just go to sleep, go in the night, you know, in a room and get knocked out. One of the most common problems in our population is sleep problems. And the ones that have good sleep, they think they have good sleep because they're, they're taking medication. So if we could do anything beyond diet and everything, it would be create a sleep center that teaches people simple things, sleep hygiene. You know, we don't recognize that as we get older, we don't digest food as well. That we might not hear it, hear the sound or the gurgling and all that, but you're still, your stomach's working.

• 1:51:26Dean Sherzai?

  So eating an hour before sleep, it doesn't, you're, you're, that's going to keep you awake.

• 1:51:31Ayesha Sherzai?

  And it doesn't necessarily have to be caffeine. It can be anything. Just the process of digestion keeps us awake.

• 1:51:37Rich Roll?

  I do that all the time.

• 1:51:38Dean Sherzai?

  Yeah, I did that. I mean, you read in the book, that was a common thing. And when I stopped that and a couple of other things, my, my sleep became a lot better. Now the book is keeping me up.

• 1:51:51Dean Sherzai?

  That's a different problem.

• 1:51:52Rich Roll?

  You gotta go back to the young one.

• 1:51:54Dean Sherzai?

  The paleo people attack you.

• 1:51:57Rich Roll?

  Are they?

• 1:51:58Dean Sherzai?

  Yeah, I should get so many names.

• 1:52:00Rich Roll?

  Who's attacking you?

• 1:52:02Ayesha Sherzai?

  It's just the cults. Because they don't agree with you, they start attacking you.

• 1:52:08Rich Roll?

  Well, it's, you know, this, this whole diet thing is very tribal. You know, I just watched a video earlier today, our friend Garth Davis, who bravely went on the doctors.

• 1:52:18Dean Sherzai?

  Oh, my God.

• 1:52:19Rich Roll?

  I, I didn't watch it at the time and I, I saw Garth write about what the experience was like for him and his frustration about it. And then Plant Based News, which is a big YouTube channel, like he put together kind of like a whole video where he goes back and forth and does some analysis on it to kind of try to explain what's going on. And, and it just, it's like, wow, this is so emotional on both sides, you know, and, and, and we're so dug in, you know, and, and, you know, these debates where we're putting, you know, the Garths and the Lustigs or whoever it is and pitting them against each other. It's like, it's like dog fighting, you know, and it's like, it's not, it's not leading to a greater understanding.

• 1:53:00Rich Roll?

  It's just creating tribalism in the same way that we're seeing it being played out politically. And, you know, it's. It's a tricky thing. Like, I don't know what the way forward is, but the way that we're kind of navigating it right now doesn't seem to be functioning in a helpful way.

• 1:53:15Ayesha Sherzai?

  I agree.

• 1:53:16Dean Sherzai?

  It's a confirmation bias, one of the biggest problems we have as human beings. Our brain was designed, what they call type one error. If you're running around, let's say, paleolithic time, and you're just worried about survival and reproduction, mostly survival, and there's a bush there, and you look at the bush, and you say, if I do this, and I do the safe thing, it's, you know, walk away, or the tiger's going to attack me, or the saber tooth. Our decision is, is to do what we want to confirm, what we know. So, our brain is designed to confirm the things that we're comfortable with, at any cost. Doesn't

• 1:53:58Dean Sherzai?

  matter how much education you have. In fact, the education just creates language to better that confirmation bias. So, I think that way out, if possible, is to step back and not argue the thing, but the way to the thing. It's almost like philosophy. So, you know, it's, what is the method we're using to come to conclusions? So, the paleo people attacked that, but I have, you know, you had 20 people in your, I have 5,000 people following me. I said, that's appeal to masses. But I have these doctors that said, that's appeal to authority. But, but, you know, this person did this, and that's an anecdote. Appeal to anecdote. The only way we can make the decision is, not absolute cause and effect.

• 1:54:39Dean Sherzai?

  Who has the most data that shows, and the right kind of data, that shows an outcome? Let's follow that for now, and test the rest of them.

• 1:54:47Rich Roll?

  Yeah, I think so. I think that what's so baffling about the whole thing is that everybody's a scientist, right? So, it should be about data and facts, and yet, and we're, and we're expecting it to play out that way, and we're underappreciating some of the things that you just referenced, like the, the level of emotion that goes into this and the confirmation bias on both sides, you know, this gets played out. But it's like, these are the guys who are supposed to be above this. Like, you're not supposed to get emotional about it. It is supposed to be about the data, and it's just more complicated than that, you know?

• 1:55:26Dean Sherzai?

  It is. You're absolutely right.

• 1:55:28Rich Roll?

  All right.

• 1:55:31Rich Roll?

  Optimize. What are we talking about here? This is the fifth pillar in your protocol, your program.

• 1:55:36Ayesha Sherzai?

  That's the fun part. I love the concept of optimization because that's, again, probably the core, um, the core of personalization. Optimizing cognitive activity, what does that mean? Keep yourself on the edge, keep yourself motivated and keep yourself challenged at all times. And, you know, we see brain games and crossword puzzles and Sudoku, which you don't like very much, uh, being thrown to people, but that's, that's not what makes the brain. Um, it has to be something that one can own and it has to be personalized. So, for example, when Dean and I see some patients, we ask them, so what did you do before you got to this point in your life?

• 1:56:21Ayesha Sherzai?

  You know, what, what were your hobbies? Um, and for example, we had, we had, we had a patient who was a car mechanic and he hated his job and he had retired. He was having some cognitive impairment. And, uh, we talked him into getting back into something that he loved and it was making cars. So he just got some cars in his garage and he started fixing them and he felt so much better. And, you know, over, over a couple of years, his, his scores, cognitive scores actually got better. So it has to be something that one can do on a regular basis that brings a lot of fun. And it has to be something that involves all of the domains of the brain, whether it's vision, whether it's hearing, whether it's judgment, decision making. Um, all of these have to come work in concert.

• 1:57:06Dean Sherzai?

  Yeah, getting back to blue zones. So, yeah, they ate well. They walked naturally, so that might have helped and not better than not walking, you know, that's, uh, better than driving all the, everywhere. But the mental activity there is the social activity.

• 1:57:20Rich Roll?

  Right. It's, it's the social engagement, right? That's really at the core of this whole thing.

• 1:57:24Dean Sherzai?

  That's exactly right.

• 1:57:25Rich Roll?

  Yeah.

• 1:57:25Ayesha Sherzai?

  It, it actually maximizes the cognitive activity.

• 1:57:28Rich Roll?

  Right. So if you're not, you, you, you're just sitting alone at home in, in a dark room doing crossword puzzles. That's not, that's not what you're talking about.

• 1:57:35Ayesha Sherzai?

  Right.

• 1:57:36Dean Sherzai?

  Another measure of this engagement was, uh, once a couple of studies came as far as hearing, and we see this often.

• 1:57:41Ayesha Sherzai?

  Yes.

• 1:57:41Dean Sherzai?

  As people get older, as their hearing diminishes, I don't mean deafness, even minimally. There's a correlation between loss of hearing and cognitive capacity. So even if, it's not even social, just ambient noise seems to keep the...

• 1:57:59Rich Roll?

  Oh, because unconsciously, your, your brain is doing things that you're not even aware of.

• 1:58:04Dean Sherzai?

  Exactly. So as you lose hearing, of course, your, your connection with the people goes down. You have a conversation with somebody and you're a millisecond off because of hearing. That's going to make you, without thinking, that, that, that language, you remember I said earlier, you, you come up with, "I don't like this anymore." So they become disengaged from communities, over and over again.

• 1:58:23Ayesha Sherzai?

  Hearing loss is almost a surrogate of loneliness.

• 1:58:25Dean Sherzai?

  It is.

• 1:58:26Ayesha Sherzai?

  It's, it's you being completely disconnected.

• 1:58:29Dean Sherzai?

  Yeah. And, and a 10% increase, that just hearing loss, contributed to 10% of dementias. So, one of the first things we do is check the hearing. I mean, they think they're not having bad hearing, but as we get older, we do.

• 1:58:43Rich Roll?

  The most shocking statistic in your book was the statistic that the spouse of someone with Alzheimer's is 600% more likely to develop the disease. 600%.

• 1:58:59Ayesha Sherzai?

  It's incredible, isn't it?

• 1:59:00Rich Roll?

  And it plays to that social piece, right? I mean, what is going on with that?

• 1:59:04Dean Sherzai?

  Yeah.

• 1:59:04Ayesha Sherzai?

  Well, that is a phenomenal example of, you know, the complexity of the disease. I mean, obviously, it's not genetics that causes it, so it has to be shared environment. You know, after living together, you eat the same thing, you move the same way, you sleep, your sleep patterns are similar, you engage in the community in the same way, obviously. Because, because the, um, the unhealthy environment caused Alzheimer's in one partner, it affects the other one as well.

• 1:59:35Dean Sherzai?

  The stress levels.

• 1:59:35Ayesha Sherzai?

  The stress, of course, yes.

• 1:59:37Dean Sherzai?

  Imagine the stress levels that Ayesha causes in my life.

• 1:59:41Ayesha Sherzai?

  I reduce.

• 1:59:42Dean Sherzai?

  Completely the opposite. She's the anti-inflammation person. No, but.

• 1:59:47Ayesha Sherzai?

  And you're the anti-stress.

• 1:59:48Dean Sherzai?

  No, it's the, it's the shared environment.

• 1:59:51Ayesha Sherzai?

  Absolutely.

• 1:59:51Dean Sherzai?

  I mean, repeatedly, you start eating the same foods. Even though, well, you were a chocolate person and I was a steak and cheese person. But now we're kind of, well, we're plant-based now, but very much the same activity level. We exercise together. Right. Uh, so that's critical. In fact, in my, in our program, we, we encourage people, the husbands and wives or partners, to come together. Because it, it's impossible for us to apply diet change to one person.

• 2:00:17Rich Roll?

  Right.

• 2:00:17Dean Sherzai?

  And the other person's doing whatever they want.

• 2:00:19Rich Roll?

  No.

• 2:00:19Dean Sherzai?

  The household has to change.

• 2:00:20Rich Roll?

  Of course, of course.

• 2:00:22Ayesha Sherzai?

  Makes it a disease of the, of the family. Um, you know, if, if your kitchen is not changed entirely, now obviously there'll be times when you will eat unhealthy food, so.

• 2:00:33Rich Roll?

  Right.

• 2:00:33Ayesha Sherzai?

  We, we once involved, what, how many family members in your clinic?

• 2:00:36Dean Sherzai?

  Fourteen.

• 2:00:37Ayesha Sherzai?

  Yeah, remember like fourteen individuals came to this clinic because they all wanted to invest in this lifestyle and that's how it works.

• 2:00:43Dean Sherzai?

  I love the grandchildren to be involved.

• 2:00:45Ayesha Sherzai?

  Yes.

• 2:00:45Dean Sherzai?

  Because if we want culture change, we know, now know data shows that if you start earlier, they're, the, the teenagers actually change the food in the household more than the other way around. So I had the, the grandchildren there and giving them speech and giving them, you know, kind of coax them into it and say, you have the power to change the family. And, uh, and, and that's a good way to learn empathy where your grandfather is suffering from Alzheimer's.

• 2:01:09Rich Roll?

  Yeah.

• 2:01:09Dean Sherzai?

  And you don't preach empathy, you live it.

• 2:01:13Rich Roll?

  Yeah.

• 2:01:13Dean Sherzai?

  So we love the involvement of the entire family.

• 2:01:16Rich Roll?

  What have been some of the success stories that you've experienced with some of your patients that you've put through this program?

• 2:01:24Dean Sherzai?

  Many, many.

• 2:01:25Ayesha Sherzai?

  Oh my goodness, there, there are many. Um, they've been particularly with this whole comprehensive, um, approach, um, not just diet, not just exercise. I mean, there, there are stories in particular ones as well, but you know, we, um, remember that lady who, um, was a high functioning person, professor, very knowledgeable, and she was stunned that she was, you know, experiencing cognitive impairment. But um we found out that she had sleep apnea. And we found out that she had incredible amount of stress in her job. I mean, there are things that were completely out of her control. So just to identify those, you know, treating her sleep apnea,

• 2:02:09Ayesha Sherzai?

  modifying her diet and for her to look into other venues that were close to her um job and to her, you know, um uh her level of education or qualifications. Um she completely turned around and she actually became an advocate for for brain health.

• 2:02:26Rich Roll?

  Wow, that's amazing.

• 2:02:27Dean Sherzai?

  Yeah, those to me, I like the ones that were. It's not that that magic thing that we find. Sleep apnea is easy. You find that, you correct that, you you see a huge difference. You see people who are on their own diet and they think they're on the right diet and you change that. You definitely see, for example, sugar. First three weeks, four weeks, people have a hard time giving up sugar. I mean, very hard time. By the fifth week, sixth week, they come and say, I feel a fog lifting. So that's not one case.

• 2:02:55Ayesha Sherzai?

  Always talk about.

• 2:02:56Dean Sherzai?

  Multiple cases of this. I mean, over and over again. But the cases I love is that when we applied one little thing here, one little thing here, one little, you know, and each of the domains. And and and of course, you saw the difference. But you see a change in level of motivation. These people become, they want to be your coaches.

• 2:03:14Ayesha Sherzai?

  Yeah.

• 2:03:14Dean Sherzai?

  They want to be your coaches out there.

• 2:03:15Rich Roll?

  That's cool.

• 2:03:16Dean Sherzai?

  Uh so uh that makes medicine completely different than cutting and pilling. You know, giving pills, here's a prescription. It makes it so much more fun.

• 2:03:26Ayesha Sherzai?

  Very fulfilling.

• 2:03:27Rich Roll?

  Um.

• 2:03:30Rich Roll?

  I just lost my train of thought. What was I gonna ask? I had this awesome question.

• 2:03:35Ayesha Sherzai?

  Oh.

• 2:03:36Rich Roll?

  No, one thing, well, it'll come back to me in a minute, but but uh one uh another statistic that I thought was interesting was um. That two thirds of the people that suffer from this are women?

• 2:03:49Ayesha Sherzai?

  Yes.

• 2:03:50Rich Roll?

  And that we don't really know why that's the case. Is that, is that correct?

• 2:03:54Ayesha Sherzai?

  That's true. There are some theories out there that explain some part of, of that picture. So, you know, people have looked at hormones and how, you know, after menopause, the physiology of a woman changes, or the effect of multiple pregnancies on brain health and body health in general. But, you know, one of the strongest and most interesting concept that has surfaced is the fact that the women who have Alzheimer's disease now and have been detected to have cognitive impairment come from a time where they were

• 2:04:33Ayesha Sherzai?

  probably not as challenged as men were, as far as their job is concerned. And the amount of stress that was put on these women was much higher than women now. We've evolved as a society, and so we're trying to find out, you know, what were the differences as far as education levels concerned, as far as cognitive reserve, and as far as the amount of stress and other physiological determinants that made these women have more Alzheimer's now. So it's still, we're still trying to understand it better.

• 2:05:03Rich Roll?

  Yeah.

• 2:05:04Ayesha Sherzai?

  But it's a crazy number, and, you know, more women are suffering.

• 2:05:07Rich Roll?

  Yeah, it's, I was not aware of that. It's crazy.

• 2:05:10Dean Sherzai?

  And then two thirds of caregivers are also women.

• 2:05:13Ayesha Sherzai?

  Yes.

• 2:05:13Dean Sherzai?

  So, and, and, and they suffer from the consequence of taking care of a father or a mother that has...

• 2:05:19Ayesha Sherzai?

  Which puts them at a high risk.

• 2:05:21Rich Roll?

  What is your opinion on people who go and, and get their genetic testing done, the 23 and Me's and all of that, and, you know, come to you and say, "I have the gene", or "I don't have the gene", or what have you?

• 2:05:33Ayesha Sherzai?

  Yeah, that happens a lot.

• 2:05:35Dean Sherzai?

  So, I...

• 2:05:37Dean Sherzai?

  I have two grandparents who had Alzheimer's and you have had and uh but and I forget a lot of things. I lose a lot of things.

• 2:05:43Ayesha Sherzai?

  I can attest to that. He forgets his jackets all the time.

• 2:05:48Dean Sherzai?

  I probably would be much more rapid decline. No, it's so I at this point and and it's evident that's because we're we live the most crazy, love, busy and passionate, loving, you know, lovely life. I mean, but but it's very busy, multiple.

• 2:06:02Ayesha Sherzai?

  A lot of elements.

• 2:06:03Dean Sherzai?

  A lot of elements, very colorful. And um uh but if let's say I take the gene genetic test and I find out that I have APOE four and another APOE four and some other genes. So now I forget my uh something. What do you think I'm gonna do? I'm gonna attribute it to my genes.

• 2:06:20Rich Roll?

  Immediately leap to, oh, this is inherent. It's happening, you know?

• 2:06:24Dean Sherzai?

  And that that's not just me being motivated. So a lot of people say that's good for me because I'm gonna be motivated. No, that's not motivation. That is going to be at a level of stress and anxiety that you that is going to be damaging.

• 2:06:36Ayesha Sherzai?

  It's almost becoming a self fulfilling prophecy. Whatever you do, you attribute it to that. And we've seen people do that all the time.

• 2:06:42Dean Sherzai?

  Exactly. So I say, live as if you have the genes. And let the outcome speak for itself. Because if you find out that you have the genes, the anxiety, because we don't have a cure for the genes at this point. Maybe in a few years with this CRISPR thing and all these genetic uh manipulations that we can do, and it will happen. No matter how many people say this is not natural, it's that's.

• 2:07:03Rich Roll?

  It's definitely gonna happen. It's already happening.

• 2:07:05Dean Sherzai?

  It is. It is. It can leukemia and other diseases and and sickle cell. I mean, we've seen children suffer from sickle cell like.

• 2:07:12Rich Roll?

  Yeah.

• 2:07:12Dean Sherzai?

  I don't wanna see that.

• 2:07:13Rich Roll?

  The forefront of like, what's happening with that right now?

• 2:07:16Dean Sherzai?

  But even with these genes, it will it will happen. But until then, do you wanna live with that kind of anxiety? Every time you forget where your park, your car was parked last night?

• 2:07:27Ayesha Sherzai?

  We walked for such a long time.

• 2:07:30Dean Sherzai?

  So I say, if it's not in the research setting, there's no benefit at this point. Live as if you have the genetic risk. Change your lifestyle because not just for Alzheimer's, that lifestyle is gonna affect your heart, your your immune system, your mood, depression, anxiety. And studies have shown that the best form of treatment of a depression.

• 2:07:51Dean Sherzai?

  Three hundred percent better than any drug out there is exercise.

• 2:07:54Rich Roll?

  Exercise, yeah.

• 2:07:55Dean Sherzai?

  So live it and then let the genes play themselves out.

• 2:07:59Rich Roll?

  Among these, these five factors, nutrition, exercise, sleep, uh, stress management, engagement, is there one that's more important than the other? Is it the interplay of the five? Like if somebody had to, you know, pick one thing to begin with and they're overwhelmed by the five, like what is the most important of all of these to kind of catalyze that journey?

• 2:08:23Ayesha Sherzai?

  I think for the majority is food. Yep, without a doubt, because how could it not be? It's something that we put in our bodies three or four times a day. It's the most important environmental factor for us. It makes or breaks your brain. But then again, it depends on, you know, what are some of the proclivities for Alzheimer's disease or for brain diseases in general and to focus on the one that is the most affected.

• 2:08:48Dean Sherzai?

  I agree with you fully. I mean, let's take the personal thing out. Let's say that we don't find something unique in this person that, that, that we need to address right away. In general, we would say food, definitely. And then the easiest one is exercise. And for me, exercise is not going to the gym. I mean, when I say to people, some of these gyms, you have to get dressed up more than some clubs, you know?

• 2:09:11Ayesha Sherzai?

  That's so tough going to the gym.

• 2:09:13Dean Sherzai?

  Anything that takes away impediment towards exercise. They say, oh, you, you want to exercise? Run to the gym. I said, no, I want a limo to come and pick me up. Nobody does.

• 2:09:22Rich Roll?

  Maybe when you were at Cedar Sinai.

• 2:09:24Dean Sherzai?

  Maybe, yeah. No, we were, we were the directors of the brain health program and we were the only one with a Toyota Sienna that you saw. But, but, but the, the, the most important thing is that it institutes, uh, do something that's proximal and easy. So I say, if I was Secretary of Health and Human Services, I would have connected everybody's TV to a recumbent bike so it wouldn't work unless they're rolling. That would have reduced healthcare

• 2:09:49Rich Roll?

  I like that.

• 2:09:49Dean Sherzai?

  costs significantly. Nobody's gonna do that.

• 2:09:52Ayesha Sherzai?

  Nobody's gonna vote for you.

• 2:09:53Dean Sherzai?

  No, nobody will. It's not a voting position. But, but it is important to bring it to your living space and then whatever else you do extra is fantastic. So for my sixty year olds and fifty year olds, I said, get a little foot pedal exerciser or a recumbent bike, watch your news and then go slow, roll slow.

• 2:10:12Rich Roll?

  Yeah.

• 2:10:12Dean Sherzai?

  You know, two miles an hour, an hour, a mile an hour. And then every few commercials, just rev it up. You've just changed their life.

• 2:10:19Rich Roll?

  Use the commercials to do your intervals.

• 2:10:21Ayesha Sherzai?

  Yes, exactly.

• 2:10:22Dean Sherzai?

  Interval. I mean, how beautiful is that?

• 2:10:24Rich Roll?

  So you're getting the aerobic and the anaerobic.

• 2:10:26Dean Sherzai?

  Exactly. So there's no balance problem because you're sitting. There's no clothing. You know, you can do it naked if you want. I would rather not if they...

• 2:10:35Dean Sherzai?

  They can do it in the privacy of their home. They can read something while doing that. They can watch and learn something on YouTube. So to me, that would be wonderful. And it's cheap. If you can't afford the recumbent bike, get one of those foot pedal exercisers and put it on your beautiful, comfortable seat. So the seat's not uncomfortable. And you just do that. And you've done aerobic, you've done anaerobic, and you know, it's wonderful. That's my easy addition.

• 2:11:02Rich Roll?

  Prescription.

• 2:11:03Dean Sherzai?

  Prescription.

• 2:11:04Rich Roll?

  I think you usually the way that I, we gotta wrap it up, the way that I end conversations when I have doctors on the show is I ask them if they woke up in a parallel universe and found themselves to be the surgeon general, what would be the first order of business? Or what are the policies, the legislation that you would like to see get pushed forward? So we have the bike powering the TVs. We're gonna put that into motion. We're gonna pass that law. What else would you do if you were in that capacity?

• 2:11:39Ayesha Sherzai?

  There are a lot of things. I would probably make every restaurant offer one healthy dish, one heart-healthy dish that has been approved for the brain. I think people need to have choices. A lot of us want to be with friends, want to be with family members, but health doesn't necessarily have to be synonymous with deprivation.

• 2:12:04Dean Sherzai?

  Absolutely. And I would focus on prevention. I would actually create incentivized prevention. So doctors, healthcare systems would have educational programs for what prevention means, first of all, and then incentivize it financially, both at the public health side, which is the community, and in the hospital and clinic side to actually do prevention instead of sick care only. That would be wonderful. And in a way, if you can, if you do the lump payment where this person's life is, let's say, $8,000, and... If, if that actually incentivizes it, meaning that if you keep them out of the hospital, you get more of the money.

• 2:12:45Rich Roll?

  Mm-hmm.

• 2:12:46Dean Sherzai?

  So how do you keep them out of the hospital is teach them how to, how to prevent the disease themselves.

• 2:12:51Rich Roll?

  Yeah, I mean, I think the keys to the kingdom really are in finding a way to revolutionize our healthcare system to prioritize prevention.

• 2:13:00Dean Sherzai?

  Yeah.

• 2:13:01Rich Roll?

  You know, it's like, it's just not set up that way right now. And until we shift focus, we're going to continue down this path that we know is not working.

• 2:13:08Ayesha Sherzai?

  Absolutely, absolutely.

• 2:13:10Rich Roll?

  Well, thank you for doing this and sharing your message. You know, I think as a sort of primary takeaway from your book, I think it's really empowering, you know, because it's basically telling people like, look, you can control this, like, whatever your genetic disposition is, you know, that gene need not be necessarily expressed. And here are the things that you can do that we have seen and that have been proven to maintain your brain health and take, you know, you know, set you up in the best position to avoid having to go down this road, because this really is an epidemic that is just decimating lives everywhere we look. And, and the rate at which it's accelerating is beyond alarming, right?

• 2:13:52Rich Roll?

  So to the extent that we can all, you know, take to heart these measures and start to implement these changes in our lives and try to, you know, serve as a lighthouse or a source of inspiration for our loved ones who we see heading in this direction, I think this is really important work. And I thank you for writing this book and for the work that you do.

• 2:14:12Dean Sherzai?

  Thank you.

• 2:14:13Ayesha Sherzai?

  That's our pleasure. Thank you. You said it beautifully.

• 2:14:16Rich Roll?

  What do you got, what's up, what's next for you guys? Are you writing another book or what are you doing?

• 2:14:20Ayesha Sherzai?

  We are, yes.

• 2:14:21Dean Sherzai?

  We're working on that.

• 2:14:22Ayesha Sherzai?

  We're working on that and really putting in a lot of effort to expand this into different communities, whether it's in San Bernardino or the beach cities, and involving and training community members to take it upon themselves to spread the message.

• 2:14:38Rich Roll?

  Yeah.

• 2:14:39Dean Sherzai?

  And like I said, most of, actually all of the profits go to this foundation. And if anybody wants to partner with us, for us to come there and give workshops on, on lifestyle and prevention, we're willing to pay out of our own pocket to come and fly there and, and help the community build this.

• 2:14:54Rich Roll?

  Oh, that's amazing. Wow. So if somebody's listening to this and they want to take you up on that, how do they get in touch with you?

• 2:14:59Dean Sherzai?

  They, yeah.

• 2:15:00Ayesha Sherzai?

  They can get in touch with us through our website and our social media. We are teamsharesai.com.

• 2:15:06Ayesha Sherzai?

  And we would, we're very responsive. We'd be happy to, you know, set something up with them.

• 2:15:11Rich Roll?

  Right. Team Sherzai, S H E R Z A I dot com.

• 2:15:15Ayesha Sherzai?

  That's correct.

• 2:15:16Rich Roll?

  That's cool. Have you, I know you know Dan Buettner.

• 2:15:19Ayesha Sherzai?

  Yes.

• 2:15:20Rich Roll?

  Have you spoken to him about perhaps collaborating with the work that he's doing with Blue Zones in some kind of official way? Like, it seems like it would be, there's a natural fit.

• 2:15:30Dean Sherzai?

  We have, we have, and we will. And so far, we're actually picking the fruits of, that he's laid down, which is in Beach Cities. We're doing the brain health side of it. But we would love to because I told him several times, we told him that the public health that he's doing is more beneficial than a thousand doctors. Because it makes it so easily palatable. I mean, he shows it in populations. People, you said it. They don't see it in this story format. They're not going to believe it. But he shows the stories in thousands of people in regions. It's wonderful.

• 2:16:03Rich Roll?

  It's unbelievable.

• 2:16:04Ayesha Sherzai?

  Yeah, it is.

• 2:16:05Rich Roll?

  All right. Thanks, you guys.

• 2:16:06Dean Sherzai?

  Thank you.

• 2:16:07Rich Roll?

  So I end the show by saying, peace and plants at the very end. But I thought, since there's two of you, usually I'm just talking to one person. You guys can like, take us out by saying that?

• 2:16:17Dean Sherzai?

  Peace and plants.

• 2:16:19Rich Roll?

  Ah, fantastic. Thanks, you guys. Awesome.

• 2:16:21Ayesha Sherzai?

  Thank you.

• 2:16:22Rich Roll?

  Cool. Thank you. Great.

• 2:16:27Rich Roll?

  Okay, we did it. What'd you guys think? I thought it was pretty incredible. Potentially life-changing, life-saving. Not just for yourself, but for your loved ones. A really important conversation. I hope you took it to heart. If you want to learn more about Doctors Dean and Aisha Sherzai, go to teamsherzai.com, S H E R Z A I. And they're also Team Sherzai on both Twitter and Facebook. And please pick up their new book, The Alzheimer's Solution. Like I said, a really profound work that I think has the potential to save so many lives. We have a full video version of the podcast up on YouTube, youtube.com/richroll. Thank you for all the kind comments we've been getting

• 2:17:10Rich Roll?

  about the move to video. We just eclipsed 50,000 subscribers on that platform, which is great. It's awesome. And we're learning. We're trying to get better. We're trying to find our groove and our unique approach in that medium, on that platform slowly and as we go. As I mentioned in the last episode, I'm currently looking for a new filmmaker, photographer, editor to collaborate with. For a rundown on the exact details and qualifications for the gig, please see the blog post for this episode at richroll.com. And while you're there, please be sure to check out this week's show notes on the episode page. Tons of links to help expand your understanding, your education about brain health and dementia. So please make

• 2:17:54Rich Roll?

  a point of digging in there. If you would like to support this show and my work, share it with your friends and on social media, leave a review on Apple Podcasts. But perhaps the most important thing, hit that subscribe button. It only takes a minute. It helps us so much. It helps raise visibility for the show to get new listeners. So if you're a fan of what I've been doing, but you have not yet subscribed to the show on Apple Podcasts, on iTunes, please do that. Also, thank you to everybody who supports my work on Patreon. I really appreciate that. I'm going to be scheduling a new AMA Ask Me Anything on that platform soon, available only to people who contribute on Patreon. I'll make that announcement on that page. If you want to learn more about my Patreon, click the Patreon banner ad on

• 2:18:37Rich Roll?

  any episode page at richroll.com. Did you guys navigate Thanksgiving okay? Did you stay on track? Or did you go off the program? Did you go off the reservation completely? Come on, you guys. That's the very reason that we created the Plant Power Meal Planner, to avoid all of those pitfalls. This powerful tool that takes all the guesswork out of eating right, maintaining the optimal diet for your health. It's just a dollar 90 a week. In exchange for that, you get access to thousands of amazing plant-based recipes. They're delicious. They're healthy. You get unlimited meal plans and grocery lists. Everything is totally personalized and customized based on your goals, your allergies, your food preferences, your time constraints. You can even scale it up depending upon how

• 2:19:20Rich Roll?

  many people you have in your family. We have an incredible customer support team, experts. These are people with graduate degrees, athletes, parents, and the like who are standing by the ready to answer any question you may have seven days a week. We even have grocery delivery in about 60 metropolitan areas. That means that when you select the recipes that you like, not only will it create a grocery list, so you can take that to the grocery store if you like, it also will integrate through Instacart to have all of those groceries delivered to your home without you even leaving the house. Unbelievable, right? For more information, go to meals.richroll.com or click on Meal Planner on the top menu at richroll.com. If you would like to receive a free semi-weekly email from me, I send one

• 2:20:05Rich Roll?

  out most weeks. It's called Roll Call, five or six, or seven, or four, or eight, things that I stumbled across over the course of the previous week. Usually some articles I read that I thought were informative or enlightening, a product that I'm enjoying, a documentary I watched, a video that I watched. Simple stuff like that. I'm not trying to sell you anything. No affiliate links, just good stuff, no spam ever. So if that sounds interesting to you, you can sign up by providing your email address in any of those email capture windows on my site. I want to thank everybody who helped put on the show today. Jason Camiolo for audio engineering, production, and interstitial music. Shawn Patterson for

• 2:20:44Rich Roll?

  help on graphics. David Zammatt for his video wizardry and theme music, as always, by Analemma. Again, I hope you guys had a great Thanksgiving weekend. We're heading into the holiday season. I hope you guys are sealing your field. You are investing in yourself and in your well-being to help navigate the tricky, treacherous waters that the holiday season always puts up in your windshield. I know it does for me. It always takes a little bit of extra effort and time and diligence to comport myself.

• 2:21:15Rich Roll?

  To be the person that I want to be to kind of navigate, like I said, these treacherous waters. So in any event, I'll be back with you guys soon. Until then, peace, plants. Namaste.