Optimize Your Brain: Team Sherzai On Fighting Cognitive Decline With Nutrition & Lifestyle

Alzheimer’s isn’t a genetic inevitability. A diagnosis need not come with a death sentence. In fact, many things can be done to prevent & ameliorate cognitive decline. So let’s talk about it. Today we dive deep into brain health. More specifically, how you can maintain and optimize your cognitive functionality and take an insurance policy out against succumbing to neurodegenerative diseases like Alzheimer’s. Our guides for this exploration are husband and wife neurology duo Drs. Dean and Ayesha Sherzai, returning for a second turn on the podcast (if you missed it, RRP #330 is a must-listen). Affectionately known as Team Sherzai, Ayesha & Dean are the highly credentialed co-directors of the Brain Health and Alzheimer’s Prevention Program at Loma Linda University Medical Center, where they study all things brain health, with a particular focus on lifestyle interventions to prevent cognitive decline and neurodegeneration. Because Alzheimer’s currently afflicts over 40 million people worldwide, I’m willing to bet most of you are directly or indirectly impacted by this affliction. The bad news is that there is currently no cure for Alzheimer’s. And incidence is predicted to triple by 2050. What most don’t realize, however, is that 90% of Alzheimer’s cases can be prevented. In fact, through simple diet and lifestyle changes, the Sherzai’s have experienced remarkable success in both preventing and significantly reversing the symptoms of Alzheimer’s, dementia and cognitive decline in many of their patients, adding vibrant years to their lives. The science behind dementia, the non-interventional means to optimize brain health, and the many strategies to prevent cognitive decline are robustly explored in The Alzheimer’s Solution (the focus of our first podcast) and the Sherzai’s latest book, The 30-Day Alzheimer’s Solution. The solution might surprise you. It’s not due to a breakthrough in surgical procedures. It’s not the result of new pharmaceutical trials. It’s about food. Exercise. Restorative sleep. Community. And maintaining a life of purpose. FULL BLOG & SHOW NOTES: bit.ly/richroll589 YouTube: bit.ly/teamsherzai589 Break out a pen and paper because this one is dense, in-depth and potentially life-altering. 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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• 1:05Ayesha Sherzai?

  When you look at the factors that stand out that contribute to better brain health, it's nutrition, it's exercise, it's stress, it's sleep, and the one that we added is cognitive activity. So when we wrote the first book, we came with this acronym, NEURO. N is for nutrition, E is for exercise, U is for unwind, which is stress management. Not just getting rid of stress, but increasing good stress and getting rid of bad stress. And R is for restorative sleep, deep restorative sleep that helps cleanse the brain and has its own function, and optimization of cognitive activity.

• 1:44Speaker 02

  One of the things that actually gets people to the dementia stage fastest is what they did throughout their life as far as cognitive activity and challenge. That's profoundly important. Sleep, we're talking about a restorative sleep where people go through the four phases of sleep, four to five times a night, deeply. So sleep and investing in sleep is profoundly important. And then there's optimization, which is challenging mental activity. So all of it has to be done and all of them have to be done together. And if it's not just a diet du jour, and if it's lifestyle, and especially if it's lived lifestyle, which is what we're trying to do in communities, we're talking about 90% reduction in Alzheimer's, dementia, stroke, without any biohacking or vitamin

• 2:28Speaker 02

  du jour, or any of that stuff, with regular things you have in your environment. I am Dr. Dean Sherzai.

• 2:35Ayesha Sherzai?

  I'm Dr. Aisha Sherzai, and together we are Sherzai M.D., and this is the Rich Roll Podcast.

• 2:52Rich Roll?

  The Rich Roll Podcast. Hey, everybody. How you guys doing? Welcome to the podcast. My guest today, very exciting, our husband and wife neurology team, Doctors Dean and Aisha Sherzai. Together, this highly credentialed duo are co-directors of the Alzheimer's Prevention Program at Loma Linda University, where they study all things brain health with a particular focus on lifestyle interventions to prevent cognitive decline and neurodegeneration. Here's the thing, chances are, there's somebody in your life who's impacted by Alzheimer's because it's a disease that is exploding right now, currently afflicting well over

• 3:36Rich Roll?

  40 million people worldwide, with incidents actually predicted to triple by 2050, which is very alarming. And although there currently is no cure, what most people don't realize is that Alzheimer's is not a genetic inevitability. It doesn't need to be a death sentence. And in fact, 90% of all Alzheimer's cases can be prevented. And so what distinguishes the Shersis from their colleagues is this unique focus that they have on prevention. And they've had pretty remarkable success, significantly reversing cognitive decline and adding vibrant

• 4:19Rich Roll?

  years to many of their patients' lives. The Shersis first graced the podcast a couple of years ago, that was episode 330, to talk about their first book, The Alzheimer's Solution. And today, they returned to bring us up to speed on the latest science on brain health. To discuss their new book, The 30 Day Alzheimer's Solution. And of course, to provide you with the information, the tools, the nutrition and the lifestyle prescriptions that you need to optimize your cognitive functionality and hopefully sidestep the neurodegenerative diseases that begin much earlier in life than most people imagine and ultimately and devastatingly afflict far too many.

• 5:04Rich Roll?

  This one is powerful. It's potentially life changing and it's all coming up in a few. But first.

• 5:18Rich Roll?

  Okay, Team Sherzai. So you guys are going to want to break out a pen and paper because this one is quite dense. It's in depth. It's powerful. Like I said, it's potentially life altering. It's an amazing conversation that I think is going to provide you everything you need to know about optimizing brain health, preventing cognitive decline and how to avoid the grip of Alzheimer's. I should also mention that if you enjoy this conversation, then check out their podcast, Brain Health and Beyond, which is available on all the podcast platforms. Okay, let's get into it.

• 5:55Rich Roll?

  What is it about age or maybe neurology that makes people set in their ways as they get older? It is a weird thing, right?

• 6:05Ayesha Sherzai?

  It really is.

• 6:06Rich Roll?

  It becomes more difficult to entertain new ideas.

• 6:10Ayesha Sherzai?

  Yeah, I think it varies from person to person. But in my experience, it's just comfort. You know, when, once you set a path and you're comfortable with it, your brain doesn't really allow you to change that path. It's like walking on a snow track. It's so deeply set and the walls are so solid that it's difficult for you to actually make a new path again.

• 6:30Rich Roll?

  New grooves, right.

• 6:31Ayesha Sherzai?

  And it requires a lot of reflection and judgment and being okay to make mistakes and the discomfort in being uncomfortable, the comfort in being uncomfortable.

• 6:43Rich Roll?

  Right, right, right.

• 6:43Ayesha Sherzai?

  That can help you set new ways.

• 6:44Rich Roll?

  Yeah.

• 6:45Ayesha Sherzai?

  I don't know what you want to say about that.

• 6:46Rich Roll?

  It does seem like that becomes much more of a challenge.

• 6:50Speaker 02

  It does, it does. We, the whole idea of change is not normal.

• 6:57Speaker 02

  I'm talking about chronic change. Acute change, we're good at it because in acute change, we had to for millions of years. There's a tree, there's a lion, you know, I better make change in my decision making. I'm not gonna go down this path. Long-term change, we're not designed for that. We're not, our brains are not designed for long-term change. That's a completely different mechanism. And if we, and if we don't address that, I mean, to be honest, I know that this is not biblical, our political stances, everything is around this concept of being okay with change. I always say about 5% of population is future seekers, the other 95% is past protectors. And you have to be past protector in many ways because past protection has worked.

• 7:41Speaker 02

  Whatever has gotten you here is you depending on the past patterns, right? But all the change in the, in society, in the world around us is by those 5% or whatever, I'm using arbitrary number, that are comfortable, this is weird people, comfortable with change? With the unknown, the 360 degrees of unknown, you're willing to go there? And yet this house that's comfortable, you're willing to leave it to go to the next place? That's an unusual concept, which comes with the frontal lobe, but, but that's why as we get older, we become more set on all the strings that connects us to the past. You want us to sever, sever, sever, sever, sever, to go to a new path that is unknown at a time where I'm already vulnerable?

• 8:24Rich Roll?

  Yeah.

• 8:24Speaker 02

  That's too much risk.

• 8:25Rich Roll?

  Yeah, yeah. Is there a genetic piece to that? When you look at that 5%, can you isolate out what it is that distinguishes them neurologically from their years?

• 8:36Speaker 02

  You can tell very early. You can tell, there, there's a genetic component or environmental component. The genetic anxiety is the decor of all this stuff. Or a term that is like anxiety. We're using anxiety as a juxtap, as a word that's, as a filler, but it's a little more than that.

• 8:52Speaker 02

  Our ability to deal with the world around us, for the most part, at the beginning is genetically. You can see the children, we have two children.

• 9:02Rich Roll?

  Trust me, we're gonna talk about them. But go ahead.

• 9:04Speaker 02

  But they're very precocious, incredibly, but very-

• 9:08Rich Roll?

  That's an understatement of the century. No, go ahead.

• 9:10Speaker 02

  Very different, though. Very different. Alex is, you could see when you were... And I'm not putting him down because this is not a weakness. This is just our preclivities. We can change them. When you put him on the sand when he was six months old, you saw him do this. He hated sand? Sophie would crawl to the ocean. I mean, right away. I mean, that's a threat. Why are you not threatened by the very thing you're supposed to be threatened by? No threat. So that threat aversion versus not threat aversion, part of it is intrinsically ingrained in us. Part of it is, actually, data shows, part of it is actually programmed. How your mother reacts to anxiety-provoking moments, mother, because the mother's there all the time.

• 9:54Speaker 02

  Whoever you're around the most, and how they react, no. How they promote challenging situations, an anxiety-provoking situation, how they react with it, and how they deal with it is the... Forget about leadership masters. I got a PhD in leadership. Forget about that. Ends and starts there.

• 10:14Rich Roll?

  Yeah.

• 10:14Speaker 02

  You create situations that are a little bit anxiety-provoking. You fail, nothing. Oh, my parents didn't react badly. You succeed, great. How you react and how those microenvironments of threat aversion, threat response, threat creation and response is the foundation of all leadership.

• 10:35Rich Roll?

  Yeah, I would think from an environmental perspective, or I mean, an evolutionary perspective, that, you know, maintaining your membership and good standing with your community is paramount, right? So if that community is welcoming to people who push the boundaries and try new things, that's one thing. But if that sort of thinking outside the box is gonna alienate you, then...

• 11:02Rich Roll?

  There's going to be some pushback, right? There's a disincentive that's butting up against somebody's willingness to entertain new ideas or try new things.

• 11:11Ayesha Sherzai?

  Yeah, absolutely.

• 11:12Speaker 02

  Always. And the culture that's been set in place that creates an aversion to change. The language, the micro languages, anything that somebody brings that is a little threatening to the status quo, you have things that are, oh, this is arrogant. The word arrogant to push away people who have new ideas is universal.

• 11:34Ayesha Sherzai?

  It's such a ubiquitous silencing technique.

• 11:37Speaker 02

  Yes.

• 11:38Ayesha Sherzai?

  And when you look at when you look at the main reason why people are not willing to change is the fear of being ostracized, like you said. Nobody wants to get out of that comfortable zone because it's really difficult to be alone in your way of life, in your new methodology, in your new habits. And that's the first step that people have to challenge themselves to take over.

• 12:03Rich Roll?

  Right. Given that, though, it's interesting that most environments are not really that permissive when it comes to free thinking and creative expression. Most are pretty regimented around what's okay and what's not. But it would seem like we should be more encouraging to that permissive environment. And why are we not able to kind of make that more the case as opposed to the slim 5% or whatever it is?

• 12:33Ayesha Sherzai?

  Yeah.

• 12:33Speaker 02

  Well, we met in Afghanistan with Taliban around us. Yet that same mentality exists here in the medical community. And by the way, this is me not bashing the medical community.

• 12:48Rich Roll?

  Right, be careful.

• 12:48Speaker 02

  No, no, no.

• 12:49Ayesha Sherzai?

  No, we love the medical. We're part of them.

• 12:52Rich Roll?

  You're not comparing the medical community here to the Taliban.

• 12:55Speaker 02

  No, no, no.

• 12:56Ayesha Sherzai?

  No, not at all.

• 12:57Speaker 02

  Just their mentality, that's all. No, I'm just kidding. No, but the stagnant...

• 13:03Speaker 02

  Comfort with the status quo.

• 13:05Rich Roll?

  Right.

• 13:06Speaker 02

  Is the same thing. I mean, the hallways of your limbic system are the same. You might have put in better clothes and better beards and, you know, my beard was shaving a little better here than that. But if the mentality is, I must maintain, it's not always overt. I must maintain the status. And I don't know even why, because that it makes me uncomfortable. It's the same.

• 13:26Rich Roll?

  Yeah.

• 13:27Speaker 02

  I mean, I, in 2002, before we met, two months earlier, I'm at NIH Experimental Therapeutics Branch. That's as wonky, as experimental as it gets. Speaking with Nobel Prize winners. Two months later, I'm in Afghanistan, speaking with Taliban leaders. Both places trying to bring change. And I can promise you, the, the, the language was much more sophisticated, but the blockades were the same. Protection of the status quo. That's why, I mean, when we, we talk about dementia, we talk about stroke, we talk about mental health. Even now, the repetition of the same patterns over and over again, and now some other studies are starting with clinical trial with 100 people, 50 people, six months. We're done. We know it works.

• 14:13Speaker 02

  We're whole food plant-based. But reality is, if you go 20% better than what the standard American diet is, you'll do 20% better in your healthcare. What does that mean? That means in Alzheimer's, that's $80 billion saved per year.

• 14:33Rich Roll?

  Right, right. Well, it's been a couple of years since you guys have been on the show. And in that intervening period of time, have you found that the sort of conventional medical community has been a little bit more embracing of you than in years past, given the success that you're having and the results that you're seeing in your patients? Or what does that look like right now?

• 14:53Ayesha Sherzai?

  They have. We are seeing a lot of.

• 14:58Ayesha Sherzai?

  Open-mindedness to the idea that lifestyle works, that it's important, that it should be a part and parcel of the bigger conversation about health and wellness in general. And, you know, everywhere we go to the conferences, medical conferences, and it was always focused on molecular research, which is very important. But lately, there's been a lot of conversation about the importance of community-based research and lifestyle and addressing our environments, which is wonderful. So, yes, they are very welcoming, and I'm very encouraged to see that. Still contrived, still not as intensive as it needs to be. I think there's a lot of need for improvement, for better communication.

• 15:43Ayesha Sherzai?

  And that's what Dean and I have been working on, reaching out into the communities to see what fits there. Because the cookie cutter model of something that fits, say, for example, you know, 50 to 60-year-old Bostonian white men wouldn't really be applicable in San Bernardino in a Hispanic community, for example. So finding out specifically what is applicable, what works long-term, and what people can accept is the part that we are working on.

• 16:12Rich Roll?

  Right. So many things I want to get into with you guys. First of all, thank you for coming.

• 16:18Ayesha Sherzai?

  It's our pleasure. Thank you for having us.

• 16:20Rich Roll?

  It's really nice to see you guys. I'm delighted that you're here today. We're going to pick things up where we last left off with them a couple of years ago. But I got to get this out of the way first. I got to talk about your kids because I'm obsessed with how accomplished these two young people are. You've got your son, Alex. Is he 15 now?

• 16:43Ayesha Sherzai?

  He's 15, yes.

• 16:43Rich Roll?

  He's in college, right? Sophia is... How old is she?

• 16:47Ayesha Sherzai?

  13, yes.

• 16:49Rich Roll?

  They've written this book, Walk Like an Elephant, which is all about protecting wild elephants from poachers. But just to give listeners or viewers a sense of what's going on here, Alex mastered calculus at eight, correct? That's right. He wrote this book. He completed high school at 10 with a SAT in the 90th percentile. He's the youngest person to have his research abstract be accepted to an international neuroscience conference. True or false?

• 17:20Speaker 02

  Yes, absolutely.

• 17:21Rich Roll?

  True. He's a pianist. He's a composer. Meanwhile, Sophia was reading fluently at two and a half.

• 17:28Ayesha Sherzai?

  She was, yes.

• 17:29Rich Roll?

  Good lord. And she co-wrote this book when she was eight. She finished high school when she was 10 with a 90th percentile on the PSAT and has been a speaker at Science LA in 2017 and 2018.

• 17:44Ayesha Sherzai?

  That's right.

• 17:45Rich Roll?

  All right. So I don't even know where to begin with this, but as neurologists, you're doing something right here. Like, how do you account for this? There's a nurture aspect to this. There's a nature aspect to this. I mean, this is extraordinary. I've never heard of two young people in the same house excelling at such a level in terms of their brain health, which is what you guys are all about. So help me understand what's going on. And congratulations, by the way.

• 18:15Ayesha Sherzai?

  That's very kind of you.

• 18:16Rich Roll?

  I'm feeling very insecure as a parent.

• 18:17Ayesha Sherzai?

  Thank you so much. No, not at all.

• 18:21Speaker 02

  The most important thing is... So I'm sorry if you...

• 18:25Ayesha Sherzai?

  No, no.

• 18:25Speaker 02

  The mother should... She's actually the reason.

• 18:27Ayesha Sherzai?

  No, no, not at all. No, I think it's teamwork. And I think I just want to say something first.

• 18:32Speaker 02

  Yeah, of course.

• 18:34Ayesha Sherzai?

  You know, there are a lot of times... It's tough to talk about your children because it's a work in progress. I always tell my friends, ask me in five years after they go through their teenage years. But I'm just really proud of their accomplishments. And I don't really consider them as mine. They're just these amazing individuals. And I... We feel like we're their guardians. And it's been such an amazing process of self-correction and reflection. Earlier, Dean was talking about the importance of anxiety management during childhood. And... No matter how many books you read, no matter what scientific papers you read about and how much you know about how the brain works, when it comes to the application of

• 19:14Ayesha Sherzai?

  that knowledge, it's a whole new experience. So it's been a growing period for both of us as well while raising these kids.

• 19:23Speaker 02

  It's a challenge even now. I mean, expectations, as I say sometimes bombastically that the secret to life is management of expectations, but it's micro-expectations, minute by minute expectations. So early on, it wasn't about them following a curriculum, throwing things in front of them. I mean, the shower curtain was the periodic table and the wall was the map. And so throwing in front of them and seeing which proclivities. And then you build around that and build around that, small, micro, almost like Skinner's reinforcements. So you saw a little bit of improvement here or attention, and then you moved it along, more moved it along. And then before you knew it, I mean, Alex

• 20:06Speaker 02

  had, so one of his proclivities early on was, and it doesn't matter what it is, if you find that little night, it just grows, was memorizing capitals. So by two and a half, three, he had memorized, and we have video, memorized all of the world's capitals, all the states' capitals. And I couldn't even, I'm terrible.

• 20:25Ayesha Sherzai?

  Antonanarivo, remember?

• 20:28Speaker 02

  Yeah. So, I mean, you would show him a shape and he would say, oh, this is this country in the cap.

• 20:33Ayesha Sherzai?

  I remember when we used to go to a restaurant and, you know, they would bring some chips and salsa or some bread. And he would take a chip and bite it off and then he would look at it, oh, Mali. I was like, who's Mali, honey? No, country Mali. And he would just take another bite, like, look, Kenya. He was just like a visual learner. It was so amazing to see him absorb all this information.

• 20:56Speaker 02

  Again, work in progress. We have the teenage periods where they get, you know, the frontal lobe, we tell them, there it is, there's the emotional brain taking over. But reality is, I think, and it's not because of us, or, I mean, the potential of human brain, I mean, 87 billion neurons.

• 21:16Speaker 02

  We're talking about each of them making a couple of connections or fifteen thousand to thirty thousand connections. One quadrillion connections. One times ten to the fiftieth power. Now, the answer to that is not sit down and memorize. That's, that's the worst thing. You, you narrow the funnel to a point. Yeah, you push through that funnel. They'll get through, they'll get to the college, maybe even Ivy League, but you've just killed all the three hundred sixty degrees of potential and creativity. The answer, I think, and we might be wrong, is throwing and systematically seeing where the proclivities and reinforcing. Proclivities takes a lot of work, but the human brain is absolutely remarkable, which speaks to both ends of the spectrum.

• 22:02Speaker 02

  From aging brain, which we are actually under, we're, we're dealing, we keep talking about avoiding disease. I'm talking about profound growth of cognitive capacity well into our sixties, seventies, eighties and beyond. And then for children, the brain is growing so fast. And the best argument on internet is, oh, are they choline deficient because they're not getting, you know, eggs or something? Are you kidding?

• 22:28Rich Roll?

  Right. So, did you, did you guys homeschool your kids? Or how did you navigate the educational system to prevent them from, you know, the best parts of them getting hammered out?

• 22:40Ayesha Sherzai?

  It was challenging, especially because when I was, when I had Sophie, I had just started my residency program. So it was a very intense time. And we explored different schools, different systems. They did very well initially for a few years in the Montessori system, which was kind of aligned with what we wanted them to be exposed to, you know, thrown in an environment to see what works for them and have, have the option of absorbing oneself in one subject at a time, rather than, you know, having a couple of hours each and every subject every day. Just the mind doesn't really work that way.

• 23:19Ayesha Sherzai?

  And after a while, we saw that the...

• 23:23Ayesha Sherzai?

  The speed with which they were learning was probably inhibiting them to be creative in that environment. And there were a couple of stories where, you know, the kids didn't feel very comfortable expressing their creativity and their knowledge because of the peer pressure, because of just the general setting. And when we realized that, I think Dean is fearless, and he's way more fearless than I am, he said, no, I think we should withdraw right now and we should create an environment for them at home. And we were traveling quite a bit, too. I was, I actually got into a fellowship program at Columbia University, so I was going back and forth between home and New York. And we wanted the kids to have a constant creative environment. And so we homeschooled them.

• 24:06Ayesha Sherzai?

  And my mother helped, his mother helped, we had a really good system going. And before we knew it, the kids were, and this is not just, you know, bragging about them, it was just an amazing example of how the brain works, where they would just, you know, go deep into a subject and progress so much into it, that a point came where we weren't able to help them with their homework anymore. For example, Alex went to algebra and then went to calculus. Sophie was so far in linguistics, we were just amazed. And so we quickly understood that the conventional model doesn't help at all. And they took their SATs and they did very, very well.

• 24:51Ayesha Sherzai?

  And we were seeking for a program to keep them busy.

• 24:54Rich Roll?

  How old were they when they did the SATs?

• 24:55Ayesha Sherzai?

  They were 10. They both, they both did, I remember we, we went to the, was it the Beverly Hills?

• 25:04Rich Roll?

  Beverly Hills High School.

• 25:06Ayesha Sherzai?

  Beverly Hills High School. We were living in Beverly Hills in Los Angeles then. And a day before the exam, we took Alex up the stairs and we went to the hallway, because he was little. And we wanted him to see the environment and visualize and sit on the chair. And we were just waiting in the hallway for him. And we were so scared, you know, we hoped that he doesn't feel uncomfortable. And I remember the chair was so tall for him that he decided to stand and write on the chair. But all in all, he just aced it. And it was wonderful.

• 25:37Rich Roll?

  I feel bad for the kids that were flanking him on each side, a 10-year-old taking the test next to them.

• 25:46Speaker 02

  The thing is, I mean, it's not about so much them getting high school at 10. Or it's about our, it's not even about school or college. I mean, I think we're the only parents, although they're in Cal State LA right now, has a special program called EEP. We tell them, you know, if you drop out of college, doesn't matter to us. I mean, for somebody, you know, my cousins say that we have more degrees than a thermostat. It was useless, all of them. It's not about that. It's about creativity. It's about this incredible potential of the brain being, often, college, and I might get pushed back on this, actually kills creativity.

• 26:27Speaker 02

  These narrow hallways of thought can absolutely demolish creativity. So it's not even about high school finish, finishing your high school early or college.

• 26:36Ayesha Sherzai?

  Or grades for that matter.

• 26:37Speaker 02

  What can you do to bring this incredible potential of the brain to its full fruition? That's the goal.

• 26:43Rich Roll?

  Yeah, and creating a love of learning, lifelong learning. And there is something, to touch on something you said a second ago, Aisha, about depth versus breadth, like the idea of taking one subject and just immersing yourself in it and going all the way to the end, right? And learning it as you go, where you're, it's so, it's so 360 degrees that you really learn it, as opposed to catching the major concepts and then constantly switching gears in between subjects and really just hitting the surface level of everything to check a box on a test.

• 27:20Ayesha Sherzai?

  Yeah, absolutely. We've witnessed it firsthand with the kids, where whatever subject it was, we would just allow them to immerse themselves in that subject, and it becomes a part and parcel of your fiber eventually. I remember when Sophie was into social sciences, she was into social sciences for three months straight, and then we went to, where did we go? We went to Santa Barbara to show her the missions, and she was learning about the California missions, and the history of Spain, and how they came to the Americas. And it was just three months of complete immersive experience into that. And I think

• 28:01Ayesha Sherzai?

  It really becomes a part of your experience as a person.

• 28:07Rich Roll?

  Right, yeah, you're not going to forget that.

• 28:08Ayesha Sherzai?

  No, not at all.

• 28:10Rich Roll?

  Amazing.

• 28:10Ayesha Sherzai?

  Yeah.

• 28:11Rich Roll?

  All right, well, I think it would be worth taking a few moments to just share a little bit about what you do and your experience. I mean, as I said earlier, you were on the show a couple of years ago, but there's a lot of new listeners and viewers. And I think it would be helpful in terms of contextualizing everything that we're going to talk about.

• 28:32Ayesha Sherzai?

  Yeah, absolutely. So we're both neurologists, husband and wife. We initially started in this field, in this, in this journey, because we were affected by an experience with our grandparents, who went through Alzheimer's disease and they experienced it. And I remember the first conversation Dean and I had, we met in Afghanistan, by the way, when he was there from the World Bank, changing the healthcare system in that country. And I was in medical school and I volunteered with Doctors Without Borders. And because I'm a polyglot, I speak many languages.

• 29:15Ayesha Sherzai?

  They would hire me and have me go to the harems in different villages to talk to women about healthcare and childcare and prevention, so on and so forth. So we met at a party and the first conversation we had was about our grandparents and he has-

• 29:32Rich Roll?

  She came, sat next to me. Right, this is a very cinematic meet cute out of like a rom-com, right?

• 29:40Ayesha Sherzai?

  I'll tell you the true version. No, but I was, I was amazed at him with all the amazing community work that he was doing, which is a whole another story. And we talked about our grandparents and we were just so amazed at how-

• 29:59Ayesha Sherzai?

  These incredible human beings are heroes. Intelligent, just amazing humans, lost parts and parcels of themselves to the point where they couldn't recognize their children, they couldn't recognize their grandchildren. And these giants of human beings were just limited to nothingness. And we wanted to study it. We actually went into the field thinking that hopefully we'll be a part of finding a treatment for diseases of the brain like dementia and Alzheimer's. And it just kind of started from there.

• 30:32Speaker 02

  Absolutely. The first meeting, we talked about that and we were kind of blown away that these people with this kind of mind capacity would actually succumb to Alzheimer's. And so we came back to UCSD, which was the main dementia, number one neuroscience program with Leon Thal, who was a giant, and we worked in his clinic and his lab. I actually did some amazing work with the FMRI's and published there. And quickly we realized that study after study after study is failing. The mouse models would work, those poor mice, thousands upon thousands, you know, you throw blueberry at mice, they will get better. I mean, every day you see a publication, you know, this drug worked, and then when you look, it's a mouse model.

• 31:17Speaker 02

  It never translates to humans. So around the same time, we looked at some other people's work and said, we got to find a different path. And we had a conversation, we are risk takers, and we said, we're going to go to Loma Linda because most of the lifestyle stuff that were coming to us, the work that Elizabeth Barrett Conner and others were doing, which we were working with, was congruent with Loma Linda, which is a Seventh-day Adventist institution where they've shown lifestyle has profound effect on brain health. So it was 60 miles away or 80 miles away. We called, like a cold call, the dean of the university, I said, you know, I'm coming from UCSD, can I start a brain center here? And so absolutely, we went in and started a brain health institute.

• 32:03Speaker 02

  I should have double fellowship, double residency, preventive and neurology.

• 32:06Ayesha Sherzai?

  Yeah, I went to preventive medicines. I think you and I coined the term preventive neurology. And that's what our focus has been, prevention of neurological diseases.

• 32:16Speaker 02

  And what we found was remarkable here. So here in Loma Linda, not Loma Linda, the Seventh Day Adventist part of Loma, which is about the third of the population, you have the healthiest people in the world. There's no question of that. The data is fairly clear. Nobody's contesting that fact. Five miles away, across 10, you have San Bernardino, one of the unhealthiest places. So it's not environment, it's not even socioeconomic and racial, there's a little bit of socioeconomic. It is the most important thing in public health, access. Access to information, access to resources, access to healthcare. There's a huge disparity. Whereas Seventh Day Adventists are health-centered from the religion perspective and everything. In San Bernardino, we work in free clinic, even now, half a day a week, we work there.

• 33:01Speaker 02

  Forty-year-olds with stroke, by the dozens, we see.

• 33:05Ayesha Sherzai?

  Right.

• 33:06Speaker 02

  I mean, that much disparity. So we started shifting and working and doing research, quite a bit of publication, and we realized that Alzheimer's, stroke, dementias can be prevented. And initially, when we came out, like 10 years ago, incredible pushback.

• 33:25Speaker 02

  Whereas two years ago, we were at an Alzheimer's International Conference, and the big plenary talk, big sign was, prevention is the new treatment.

• 33:33Ayesha Sherzai?

  It was amazing.

• 33:34Rich Roll?

  That's amazing.

• 33:35Ayesha Sherzai?

  Yeah. I don't think we ever high-fived in a conference, but we were just so happy that finally they're recognizing the importance of lifestyle.

• 33:42Rich Roll?

  How many practitioners are there in neurology right now that have a preventive focus?

• 33:49Ayesha Sherzai?

  Goodness, I don't know of many.

• 33:52Speaker 02

  We don't know.

• 33:53Rich Roll?

  Preventive neurology.

• 33:54Ayesha Sherzai?

  I don't. Hopefully, there's going to be more.

• 33:56Rich Roll?

  Just you guys.

• 33:57Ayesha Sherzai?

  Hopefully, there's going to be more.

• 33:58Rich Roll?

  Big speech from somebody, but not so many people doing it other than you guys. And it is interesting, like, when you started, it was considered career suicide.

• 34:06Ayesha Sherzai?

  It was.

• 34:07Rich Roll?

  And to, you know, plant your roots in Loma Linda, which, you know, for people who don't know, that's one of the blue zones, people live very long there, they tend to have happier, more fulfilling lives, and that's attributable to their faith community.

• 34:21Rich Roll?

  Their fidelity to healthy lifestyle, exercise, predominantly a plant-based diet there for the most part. All of these things contributing to not only living longer, but as you immediately begin to see better, better brain health. And what makes it so amazing, almost like this perfect Petri dish for the studies that you do, is that disparity. Because the community just outside, you know, the sort of boundaries of, of that Seventh Day Adventist community is, you know, an impoverished, lower socioeconomic situation of people that don't have access to all of those things. I just repeated everything you said. No, no. But that makes for, you know, a ripe environment

• 35:06Rich Roll?

  for doing the kind of work that you do to kind of A/B test these populations.

• 35:12Ayesha Sherzai?

  Absolutely. I think we've learned so much about this concept. And one of the things that stands out is, is all about access. Access not only to, to healthy factors, healthy lifestyle factors, whether it's food and opportunity to move naturally, or stress management, so on and so forth, but access to information and access to resources to apply that in their lives. To have health as a part of your language every single day, where you see left and right and front, behind you, there's health everywhere. That is what differentiates between two communities. You know, when, when the Seventh Day Adventists,

• 35:57Ayesha Sherzai?

  like Dean said, it's a part of their religion when they walk, when they speak, when they wake up in the morning, when they go to bed, when they interact. The, the core structure behind their action is, the outcome is, is good health. The outcome is preservation of the mind and the body. But when you veer away five miles across Highway 10 into San Bernardino, it's almost as if people are completely blind to that concept, that it is possible for them to be the best versions of themselves. And you see this, their life just moving forward like automatons, not really aware of how bad their lifestyle factors are and how destructive it can be to their health.

• 36:42Rich Roll?

  And it's not a judgment. I mean, we want to make sure that we...

• 36:46Speaker 02

  It's it's situation. I mean, all of us get caught up in the in the cycle, especially when when you have to work continuously. The closest healthy food resources 20 miles away.

• 36:57Rich Roll?

  Right.

• 36:57Speaker 02

  And so it's so with that in mind, initially, we went to Cedar Sinai as the directors of Brain Health Program there, prevention. And and then an opportunity arose where in beach cities, which is Manhattan Beach, Redondo Beach, Hermos Beach, they had this program that Dan Buettner, our friend Dan, had started.

• 37:17Rich Roll?

  Yeah, it's one of Redondo's one of the blue zone cities.

• 37:20Ayesha Sherzai?

  That's right.

• 37:20Speaker 02

  Yes, it created Blue Zone. And they had done such an amazing job as far as making it a lived concept, that they offered us the the option of coming there and creating an initiative, Brain Health Initiative, and also the largest research protocol in the country, community-based. So we left everything, again, risk-taking. Who leaves Cedar Sinai one day of clinic for Hollywood?

• 37:43Rich Roll?

  You're insane.

• 37:44Speaker 02

  Yeah. But it's been so since the two years that we talked, we've been actually growing that program. It is there are there are other studies like Pointer and others that are doing clinical research on lifestyle and and brain health. But it's again, more of a laboratory kind of a thing. This is a lived concept. I think we don't need to. We don't need to recreate whether, you know, what is it, broccoli works versus, you know, beef jerky. We know.

• 38:11Ayesha Sherzai?

  Yeah, I think I think we know that already. Yeah, there's enough information.

• 38:15Rich Roll?

  I don't know. There's some people that are confused about that.

• 38:18Speaker 02

  Yeah, there's always going to be noise. There's always going to be people who are going to say the earth is flat. We'll leave them at that. You know, they can they can go to the edge. But but it's it's critical that we move on and apply it not to these contrived clinical trials of 100 people over six months or a year, to real communities. So we're doing three of the largest projects in the country, but it's a lived model of brain health and collecting data and collecting brain health and information.

• 38:45Ayesha Sherzai?

  Yeah, and we're really excited about that because I think one of the things that One of the things that failed in most studies is, again, not understanding what works at an individual level and at the community level. I think if we find out specifically what the limitations and what the strengths are in any community, and then find resources around them in their environment that would help them create a vector towards better health, that's the key. And it has to be long enough where they have support, where they have contact with

• 39:27Ayesha Sherzai?

  the human experience of speaking with someone else, or being around a supportive group to acclimate to that new healthful environment. It sticks. Otherwise, it's just me giving someone a brochure and say broccoli is good for them.

• 39:43Rich Roll?

  Right, right. I mean, that's a play right out of Dan Buettner's playbook, which is you have to create the environment that's conducive to the healthy choice. So then it becomes rote, as opposed to some sort of burden or something that somebody has to think about in order to do, right? It's just there in front of them, and the resources of the community are pushing you into the correct lane.

• 40:07Ayesha Sherzai?

  Right, right. And especially for a condition like cognitive decline, which is tremendous. It's scary. Everybody talks about Alzheimer's and dementia as if it's a disease that just starts at one point. You are diagnosed with Alzheimer's disease there. That's it. That's not the start. Right before that, decades earlier, there is a continuous cognitive decline that people experience. And Dean and I go to different communities for talks and before all this pandemic. When you go into communities where their health literacy is low, or for example, they haven't had any resources, you actually experience the cognitive decline when speaking with individuals

• 40:49Ayesha Sherzai?

  in their 50s and 60s, before they even are diagnosed with Alzheimer's disease. And it's scary, and the numbers are scary. And we never address that. And it's not just brain health. You hear about brain health all the time. You read great books. But it's that self that is under attack. It's that us. It's that us-ness. It's the sense of... Being aware and being present and being able to experience life. That is, we're being robbed of that. You hear brain fog, you hear memory problems, but not being able to be present for each and

• 41:34Ayesha Sherzai?

  every moment in your life, that's what's taken away from people and that's scary. And if we have a way of making people attuned, where we alarm them to listen, there is something that you can do, where you don't have to go through this. I think that would be a great opportunity and it's a great gift for us to be able to serve people that way.

• 41:54Rich Roll?

  Right. So, conventional medical wisdom, at least until recently, is or was that Alzheimer's is something that is going to be visited upon many, many people when they reach, I don't know, late 60s, 70s, something like that. It's basically a genetic predisposition. In more cases than not, it's a death sentence, there's not much we can do about it, we can't cure it, we can't prevent it, we can kind of maybe manage it with some drugs, but really there isn't much that we can do. And we're working on a cure, but we aren't very close. So, how much of that is accurate and where does your work fit in to kind of upend that

• 42:39Rich Roll?

  paradigm?

• 42:40Speaker 02

  So, the genetic component, let's start with that. We know the genes that are involved in Alzheimer's. With new techniques like GWAS analysis and others, where you take large populations who have Alzheimer's and those that don't, you look at the genetic differences, we know about more than 30 genes that are involved in Alzheimer's. Of all Alzheimer's cases, the percentage that's driven by genes, 100% driven by genes, meaning that if they have these genes, they'll get it. And in genetic terms, it's called 100% penetrance, like Huntington's disease. If a person has the Huntington gene on that chromosome four, they'll get it.

• 43:20Speaker 02

  But the percentage of Alzheimer's cases that are like that is only up to 3%. The other 97% are affected by genes, but they're only risk genes, meaning that those genes increase your risk, but they're not a foregone conclusion. It doesn't mean that you'll get it. The next highest risk gene is APOE4.

• 43:45Speaker 02

  About 2% of population has APOE4, is APOE4 positive. So if you have one of those genes coming from one parent, your risk goes up four times. If you have two, one from each parent, about 12 times. That number varies, but roughly, those are the numbers. So even if you have two genes, fully loaded with these bad genes, 50% of people get the disease. The other 50% don't get it. Why? And when you look at the data coming from Nigeria, where the population had higher proclivity for APOE, when they came to US, the disease went up. When you look at the studies that came from UK, which lifestyle increased your risk six times, even in lieu of APOE4, you realize, even with the higher genetic risk of APOE4,

• 44:30Speaker 02

  lifestyle is a way bigger factor, by far. So all of the genes involved in Alzheimer's, except for those 3% or three genes, are all our lifestyle genes. How your lifestyle affects those genes, which means you have control over it. Even the most benign studies, the ones that had minimal effect, the MIND study and others. MIND study just looked at diet, very well-done study. Just a diet adjustment reduced your risk of Alzheimer's by 53%.

• 45:05Rich Roll?

  Wow.

• 45:06Speaker 02

  And that was a watered-down version of the diet we think is optimal.

• 45:12Rich Roll?

  And how long would you need to be eating in that certain way leading up to it?

• 45:18Speaker 02

  It varies from person to person, their background, other things like if they had multiple head traumas, childbirth, like multiple variables. But in reality, if you're on that diet for several years, you continually reduce your risk. Like smoking, if you've smoked all your life and if you come off of smoking, come off of that bacon, come off of that, you know, well, then the more years you pass, I believe in smoking, it's after five years. Five to seven years, yes. Five to seven years, you're back to baseline. Right. Meaning that you're back to the lowest risk factor. So the longer you stay on a healthy lifestyle, which is exercise and all the things that we say, and especially if you do all of them. The reason I say all of them, coming back to our grandparents,

• 46:03Speaker 02

  one of the elements is cognitive reserve, or what the term you and I love, idea density. You know, we say that if we have a musical band that's going to be called Idea Density. They had Idea Density, yes. It's a great, great concept. They both, both our grandparents had immense idea density. And philosophers think, but they succumbed to Alzheimer's. Why? The other elements weren't taken care of. They had diabetes, cholesterol, high blood pressure, horrible food.

• 46:32Ayesha Sherzai?

  Quite sedentary, bad food.

• 46:33Speaker 02

  Didn't exercise. Philosophers are not supposed to exercise for some reason. But, so you have to do all of it.

• 46:39Rich Roll?

  Right.

• 46:48Rich Roll?

  So we're going to get into these lifestyle interventions. But before we do that, let's talk about the brain more generally. We sort of think of the brain as this mysterious black box that is unknowable and something that sits outside of our body, right? Like, there's our body and then there's our brain. And these things don't really overlap. But in truth, brain health is really, it's about vascular health in the same way that heart health is, right? Like, we're dealing with, I don't know how many zillions of, you know, arteries that are going into the brain, you know, putting things into your brain and taking them out, et cetera.

• 47:33Rich Roll?

  And when you think about, you know, heart disease, we all know we're trying to not have plaque in our arteries and keep those pipes running clean. And brain health is really not that different, is it?

• 47:46Ayesha Sherzai?

  That's very true. You put it beautifully. When you look at the brain, it's about three pounds, like jello. It's like hard jello when you hold it in your hands. And it's about 2% of your body's energy. And when you look at the Tissues and the vessels, they're the same vessels that are in your heart and in your kidney and your body. I'm a vascular neurologist, so I teach a lot of anatomy to medical students and residents about the vasculature of the brain. But basically, you know, you have arteries shooting from your heart, going through the neck. There's two major ones in the front, the carotid arteries and the vertebral arteries. And these are the major vessels that take blood to your brain. And there's just branching of these arteries and somebody actually calculated this.

• 48:27Ayesha Sherzai?

  But if you put the vessels in your brain, end to end, it would span about 400 miles. So just imagine all these tiny hairline arteries taking in oxygen and nutrients to these susceptible areas of the brain for this incredible organ to function. And at any moment, our brain, as little and as small as it is, it can consume up to 25% of the body's energy. So just imagine the amount of work that it does. And if we don't address vascular health and if we don't really take care of it, it will succumb to disease. You know, we always say, and our cardiologists don't really like that, but we say the rest of the body is there to carry the brain.

• 49:13Ayesha Sherzai?

  And it essentially comes down to the same pathological processes that affect the brain that also affects the heart, the kidneys and the other systems as well.

• 49:21Speaker 02

  In fact, recently, there was a publication by Dr. Hacinski from Canada. And he summarized the concepts, but the vascular factors actually predate, you know, the popular thing that we hear amyloid plaque and vascular pathology predates those things. With the newer tools, with newer, more sophisticated MRIs, you can see 20 years earlier when somebody starts having some pathology. And the microvascular disease started way earlier. So if we take that into consideration, that in your 20s, 30s, 40s, you know, the things you do isn't going to just avoid Alzheimer's. And we think absolutely for a great majority, 90% plus, you can avoid Alzheimer's.

• 50:05Speaker 02

  But more importantly, sustain cognitive capacity and grow cognitive capacity.

• 50:13Speaker 02

  We we know that our we don't use the full potential of the brain. And in fact, as we get older, one of the areas that's affected the most is focus. For two reasons. One is the focus center shrinks, as well as the fact that we are overwhelmed. Multitasking, which we say, there's no such thing as multitasking. It's doing multiple things badly.

• 50:31Rich Roll?

  Right.

• 50:32Speaker 02

  It just accumulates and accumulates. But if you manage and control focus, you can actually grow your cognitive capacity as you get older. That's our goal, because if you do that, if we've addressed the, this is critical. If we address the vascular factors and the fact that we can grow the brain, we can hit all these communities that are now devastated with cognitive decline. And we see them all the time.

• 50:56Rich Roll?

  Right. So neuroplasticity then becomes a function of vascular health.

• 51:02Speaker 02

  Absolutely.

• 51:02Rich Roll?

  Yeah. Super interesting. When we think of, again, back to the the kind of heart analogy, we think of plaque buildup in terms of deteriorating heart health. With with brain health, it's amyloid plaque, right? Which is different, but kind of the same, like it's blocking these passageways. And that's ultimately what leads to stroke. Is that right?

• 51:28Speaker 02

  Correct. So no, with stroke, it's it's atherosclerotic plaques. It's different. Amyloid actually accumulates outside of the neurons and stops the communication between the neurons. So it's a little different.

• 51:41Rich Roll?

  In between the neurons.

• 51:42Speaker 02

  In between neurons.

• 51:42Rich Roll?

  Right. Okay.

• 51:43Speaker 02

  The neurofibrillary tangles, which is the tau, is inside the cells. There are two things happen. One is the amyloid plaques and the neurofibrillary tangles. They're connected in many ways. We are learning more and more. The neurofibrillary tangles are really interesting. There are these scaffoldings that hold the microtubules inside the cell steady. The microtubules are, it's it's almost like we're doing, we just got the Oculus and we I was doing the, and it's a crazy thing. We're doing the the roller coaster thing. And you see this roller coaster throughout the planet go. And the microtubules are these pipelines throughout the cell for transport, for structure and everything. And the tau molecules hold them together.

• 52:27Speaker 02

  All of a sudden, they get phosphorylated and they come off. And then you see these scaffoldings fall apart and clog together.

• 52:35Speaker 02

  So for many years, we've thought that that's a separate process. It's a genetic proclivity, and there is. There are those 3% variety. But we know that inflammation also attributes to that. Multiple traumas to the head, infections, multiple pathways to trauma, oral hygiene and all of that, as well as vascular factors. So, wait a second. So if vascular factors and inflammatory factors are contributing to even those tau and amyloid co-factors, we have control over those.

• 53:07Rich Roll?

  Right, right. Yeah, so that's amazing. Like, just the realization that we do have some domain over this thing that we've always kind of thought of as just looming out in the distance, and it's either gonna happen or it's not gonna happen.

• 53:23Ayesha Sherzai?

  Oh, absolutely. Just understanding that our day-to-day habits affect those small little arteries in our brain. You know, when you have sustained damage to the arteries, or sustained attack, let's just say, you know, an attack to the system. So the body and the brain especially is constantly trying to revert any damage. You know, we have damage control mode and we have a thrive mode. And the goal is to be more in the thrive mode rather than damage control. And the damage comes from, say, for example, vascular damage comes from sustained high blood pressure. You know, blood pressure is one of the most important risk factors for so many chronic

• 54:08Ayesha Sherzai?

  diseases that we're dealing with. When we have uncontrolled blood pressure, the small blood vessels in our brains, they essentially collapse on themselves. And on MRIs, what we see is these patterns called white matter disease. White matter disease is when there is damage to the blood vessels, and so those parts of the brain are inflamed, or they don't really function very well. A lot of times, they were called nonspecific white matter disease, but we're actually learning more and more about them. And they have been correlated with cognitive decline. They've been correlated with strokes. And we know that lifestyle factors can can really alter them, can change them. Diabetes is another risk factor. Damage to the inner linings of the arteries can cause damage. And you know, there are parts of the brain that require, well, all parts of the brain,

• 54:51Ayesha Sherzai?

  but specifically the ones that are responsible for, say, for example, encoding memory, the hippocampi, or the frontal lobe, where the judgment sits, or or the emotion centers. When they, when the damage, when the blood vessels are damaged in these areas, we really can't function anymore. And that's when you see cognitive decline.

• 55:08Rich Roll?

  Hmm. It's interesting with blood pressure. You know, that's something that you get checked. You know, I don't know. We want, I mean, when you're younger, barely ever, when you go to the doctor for your checkup. But it feels like something that should be monitored much more regularly and closely.

• 55:23Ayesha Sherzai?

  Absolutely, absolutely. Because it's variability in high blood pressure that matters as well. And I'm so excited about, you know, new technology coming up, whether it's, you know, the watches or, you know, any wearable devices that can give just a quick update on how someone is doing, a live update.

• 55:43Rich Roll?

  Right.

• 55:43Ayesha Sherzai?

  I think that's the most important thing. You can't really wait for every three months or every year to get your blood pressure checked. We see people in their 40s and 50s coming in with extremely high blood pressure. And we have to like treat it rapidly with medication to prevent strokes and damage to their body. It's quite ubiquitous.

• 56:01Rich Roll?

  Before we get into the the lifestyle interventions, I want to talk about this neuro paradigm that you guys have come up with. Perhaps it would be good to differentiate between cognitive decline, dementia, Alzheimer's, and strokes. Like, let's, let's get clear on like the different, what the difference between all of these things.

• 56:22Ayesha Sherzai?

  Terminology.

• 56:23Rich Roll?

  Yeah.

• 56:23Speaker 02

  So dementia is the umbrella category. And dementia is, and then the rough definition of it is when a person is having cognitive decline to the extent where they can't do some of their activities they could do before. Not because of physical limitation, because of cognitive limitation, be it memory or processing capacity or things of that nature. For example, if they could drive before, now they're having difficulty driving because they can't think their way through the directions. They could take care of their medications, they can't take care of their medications now. If they were doing the finances, they can't take care of the finances. You have to be careful there because as we get older. Without knowing, you kind of pass off your activities to others.

• 57:06Speaker 02

  And when you've asked the family, oh, I don't know, I don't see a difference. But what happened is, over time, that that responsibility was passed on. But when you truly check them, they have had loss of capacity. That's dementia. It's an umbrella category. Alzheimer's is a subtype of that dementia. It's a major one. Sixty to seventy percent of all Alzheimer's, uh, dementias is Alzheimer's. But there are other types of dementia, such as frontotemporal lobe dementia, Lewy body dementia, vascular dementia, Parkinson's dementia, and many others, Huntington's dementia. But Alzheimer's is the biggest one. They manifest differently, and the causes are somewhat different, although we think that all of them are affected to different degrees by lifestyle.

• 57:48Speaker 02

  Some of them are more genetically driven. Like, frontotemporal lobe dementia is more genetically driven. That dementia is early in life. Sometimes it affects language. So, like, primary progressive aphasia, the person is, can think, but their language is affected disproportionately early on. Lewy body dementia is more movement and hallucinations and visual spatial changes. And it's a different pathway. It's a synuclein body. It's a different kind of protein. Alzheimer's, and this is something that everybody's familiar with. I'm gonna say it, but I wanna state it ahead of time. Don't be scared. We all have some of this. Where short-term memory, early on, is disproportionately affected compared to long-term memory. So, a lot of, especially men, they say, oh, I'm fine. Dean, I'm fine.

• 58:32Speaker 02

  I can remember fifty years back when I was in, you know, and, but I just, you know, I'm having difficulty with breakfast. Well, that's what's happening. Right. The short-term memory, which is in the hippocampus, is affected disproportionately. And it's the fastest-growing epidemic, well, outside of COVID. Now, in the West, we're talking about about six million individuals in US.

• 58:54Speaker 02

  35 million worldwide and this number, we have to read, we have to change the number every time we talk.

• 58:59Ayesha Sherzai?

  Yeah, every time we have a PowerPoint presentation, we have to change these numbers, unfortunately.

• 59:03Rich Roll?

  I read recently 47 million people worldwide.

• 59:06Speaker 02

  Worldwide, yes. So we have to change it again.

• 59:08Rich Roll?

  Yeah, and, and, and estimates are that it's projected to triple by 2050.

• 59:14Ayesha Sherzai?

  Yes, yes.

• 59:15Speaker 02

  And, and the

• 59:16Rich Roll?

  So, everybody's gonna be impacted.

• 59:18Speaker 02

  Everybody. In fact, even now, if you, if you ask families, I did my PhD thesis around community-based participatory research and the, and the minority populations, and, and those populations or in low-income populations, every family's been affected, but they haven't called it dementia or Alzheimer's. That's, that's how ubiquitous it is already. Now, the numbers as far as cost is even, I mean, the human component is incredibly bad because it's affecting everybody and, and we'll talk about what, what COVID did this, and the tsunami. They, this population was the most affected population in the world, the Alzheimer's population.

• 1:00:01Speaker 02

  But the cost, the second costliest disease is heart disease at 120 billion, cancers 70 billion combined. Alzheimer's, direct cost 305 billion, indirect cost 240 billion right now. And it's climbing up to 1.1 to 3 trillion dollars, directed and direct, by 2050, which will collapse our system altogether.

• 1:00:25Rich Roll?

  Yeah, the system's already broken, it can't bear that kind of load. But is that, is that excessive cost attributable to the slow burn nature of this and the extent to which kind of live-in care is required for these people to live their lives? Or where's all that money going?

• 1:00:40Speaker 02

  It's sad. It's, it's going, well, the direct cost is going to Medicare medications, which really don't do much. Not even the pharmaceutical companies claim that Aresceptin and Amenda reverse or slow down the disease. It doesn't. They're just symptomatic. The disease is continuing, it's just doing a little bit of help with the symptomatic. But a lot of money spent there and care, nursing home and others. The indirect cost is you should see the people, the families that can afford it the least have to stay home to take care of their loved ones, which means hours lost, work lost, and all of that that happens with it.

• 1:01:15Rich Roll?

  Right, right, devastating. And on top of that, we have COVID right now, and COVID is really drastically impacting the Alzheimer's community, right? Like I saw on Twitter like two days ago, there was a Barron's article about this that was like trending, you know, that what does the future of Alzheimer's look like? And I know that you guys have spoken about this. What is it about COVID that's disproportionately impacting the Alzheimer's community in such a, in such a bad way?

• 1:01:44Ayesha Sherzai?

  It's a multifactorial, like Dean said, I mean, the numbers are scary. We were, we were actually reading an article the other day, and Alzheimer's patients are dying faster, not because of the infection or COVID-related consequences, but because of their disease. I think the number was 16% higher rate of mortality in that population. And it has to do with loneliness, disconnection.

• 1:02:14Rich Roll?

  The isolation.

• 1:02:15Ayesha Sherzai?

  Isolation from human experience. And, you know, the brain is hungry for information and for connection. And when that withers away, when that's withdrawn, you see patients succumb to Alzheimer's disease. And there are so many stories that we could tell you from our clinic and just talking with some of the caregivers where these lovely patients are completely isolated in a nursing home, and they don't see their children or their loved ones. And the mind is such where if they don't get that conversation, even a phone call or, you know, it's a mundane conversation about food or clothes or just a normal walk in

• 1:02:59Ayesha Sherzai?

  the park, the, the, the, basically, the brain just completely withdraws and withers away. And there's profound changes in, a decline. And their cognition to the point where they forget to do their basic activities of daily living, they forget to eat, they forget to take care of themselves and slowly and gradually that that causes disease and death. And we've seen that so many times, unfortunately, more than we would wish to see.

• 1:03:29Speaker 02

  And this is a population that's most vulnerable.

• 1:03:32Ayesha Sherzai?

  Right, right.

• 1:03:33Speaker 02

  Anxiety, I say, you and I, Aisha and I, we treat anxiety more than we treat the memory component, because it's a quality of life issue, isn't it? I mean, and and and patients with Alzheimer's, anxiety is ubiquitous and rapidly growing. I I and I give analogy like, and it's not, and a patient with Alzheimer's initially feels like they're in their basement, now living in their basement, not really, but that that discomfort, then in the neighbor's home, then in a different city, then a different country, then ultimately in Mars with Martians coming, because nobody's familiar. That anxiety, compounded with loneliness, with isolation,

• 1:04:12Speaker 02

  with separation, is what forces the brain to actually collapse upon itself. We think that the main, the reason for the greater mortality is not so much that because they were in closed environments, therefore they suffered from Alzheimer, from COVID, but because of the greater loneliness in the population that could afford that the least.

• 1:04:31Rich Roll?

  Yeah, I mean, I've had some personal experience with with people that are are suffering from Alzheimer's. And my sense, and this is just purely like anecdotal, is, well, first of all, you can, you can read the anxiety coming a million miles away. Like, you can tell these people are not settled in in who they are, that there's some confusion. And what I see more often than not is almost like a veneer of of denial, or or an effort to like comport themselves as if they know what's going on, like out of fear that somebody might know that something's amiss or awry. And I'm often left wondering, like, what is

• 1:05:10Rich Roll?

  the level of self-awareness that this person, this patient, has about the nature of their condition? Like, are they aware that they're suffering and they're actively trying to put up a front? Or is this something that just occurs with this disease? Like, what is their interior experience of what's happening?

• 1:05:29Speaker 02

  It's tough to know, because it varies. But it's the fight or flight, isn't it? So I mean, I've seen this repeatedly. Your your autonomic

• 1:05:38Speaker 02

  Manifestation in behavior is fight or flight. And my grandmother was a powerful woman. And I actually, in the last years of her life, I actually shared the room with her. And being a stupid teenager, I didn't appreciate that that that experience, which was profound and important, and I should have been more aware. But but that's she, this person that would face you, would talk to you with clear language, because she was, she knew that that in order to be in a world of men, she had learned very early on to be very succinct and clear. She started turning away from the world. So the withdrawal. So you see a lot of people just withdrawing, not being as involved. And in her case, she actually turned around towards the wall.

• 1:06:22Speaker 02

  She would actually start facing the wall. That's a withdrawal. The others push away, the fight. And and it's not, not often, it's not a conscious awareness that something is wrong. It's a discomfort that manifests in those two outcomes. And and if people are aware of that, then you realize that, and that's why a lot of bad interpersonal relationships early on, because people don't know that the Alzheimer's is coming, and the manifestation is this behavior, and all and and turns out really bad. And with my grandmother, it was that. It was the withdrawal. But a lot of people actually didn't have this pushback.

• 1:07:01Rich Roll?

  Right.

• 1:07:02Speaker 02

  Pushback, which is the discomfort, discomfort, something is wrong, and the only tool I have is pushing back.

• 1:07:07Rich Roll?

  Right. Get away and let me, leave me be, right? And what is the appropriate response? Like, I'm sure you've seen all kinds of different dynamics with how people interact with somebody who's suffering. Is there, have you come upon an appropriate kind of way of interacting with somebody who's in this space that's more productive than other ways?

• 1:07:30Ayesha Sherzai?

  Yeah, I think, again, it varies. It depends on the history that the caregiver has had with the patient, the individual with Alzheimer's, and the support structure that they have. But I think one of the most helpful things that I have had experience with my patients and training the caregivers to take care of them is to let them know that it's very important to differentiate between the individual and the disease. They're two separate things and entities. And that actually makes everything fall in place. Because if, say for example,

• 1:08:14Ayesha Sherzai?

  Sally is someone who has Alzheimer's disease, and Sally used to be an amazing human being, had her own job, raised a family, fantastic in the community. She sang, she was part of her church, so on and so forth. Then slowly, she started forgetting things and now she can't do any of those things. So the family and the caregiver should make sure that they remind her of who she was and who she is. Those stories of the things that she did are essentially her medicine and a reminder of who she is and how she's contributed to this world. And the symptoms of forgetfulness, of making mistakes, of saying strange, inappropriate things or acts that are inappropriate, that's the disease, that's not her.

• 1:08:59Ayesha Sherzai?

  And that resolves some of the anxiety within the patient, with the caregiver. Caregivers tend to have this need to fix things. We always want to fix people. We want to fix patients. There's no need to fix anything. And somehow, when you differentiate the two, then that desire to fix goes away and you just focus on the beautiful stories and the memories that that patient has already had and focusing on the moment.

• 1:09:29Speaker 02

  Beautiful.

• 1:09:30Ayesha Sherzai?

  And Dean actually has this beautiful, I love that thing that you do with, yeah, the Islands of Consciousness.

• 1:09:37Speaker 02

  So my attempt at defining consciousness, if there is such a thing, is there are Islands of Consciousness. So the first island is when you're three years old or so and you become aware of yourself as separate from the universe, from the world. And then there's the island of the mother and the island of the father and the island of the family and Islands of Job and so on and so forth. Some of them are more powerful than others. That's why the most lovely thing you see is when a husband has dementia and they don't recognize anything and then the wife comes in and you see this. It's almost as if the greatest party in the universe just opened up doors. You know, because that island, that this wife is still the island, that central island that's connected.

• 1:10:21Speaker 02

  So keeping those islands connected early on with cognitive decline is critical. Getting rid of the damage, which is the food and exercise, and also building connections, those billions of connections that we can't create. So we can keep the tethers into the different islands. That's why people remember long term better than short term. So one of the things we can do to stabilize, at least for a while, is have 20 great stories from the past. That you've lived those experiences when you went to some island as a family or some, you know, some resort or somewhere. And you had that enjoyment and he or she remembers it. Build on that, you know, even embellish it more, you know. And you have those 20 stories.

• 1:11:06Speaker 02

  The greatest anxiety reducing tool that I've ever given my patients had nothing to do with a prescription, although I write this in prescription, actually. Is build those 20 stories and whenever you see the first signs of anxiety, throw that in. That long term island, that big island takes over. And I've never seen anything like that where the conversation just goes there and the anxiety just rests.

• 1:11:27Ayesha Sherzai?

  Yeah.

• 1:11:28Speaker 02

  And you build on those islands, especially early on. Build on those islands of memory and connect them further on. And that becomes your best anxiety reducer. You know what's another great island? Which actually passes way beyond the loss of language. Music. Repeatedly, we've seen where this person can no longer connect with anybody. And now they can't even remember their partner. You put that one piece of music from the 40s or 30s that they loved. And then you see them just moving their fingers to the music and just calming down. So you can build around those islands for the people, for the individuals that are more advanced. For those who haven't developed Alzheimer's.

• 1:12:11Speaker 02

  Is building those connections so that the islands can keep connected. That's where the ultimate consciousness, we believe that consciousness as we define it, is when multiple of these islands are connected. So you can see a meta version of yourself within all these islands.

• 1:12:26Rich Roll?

  So you use those stories to create a lattice work or like a matrix that forms the underpinnings of identity and that gets rooted in the person.

• 1:12:35Speaker 02

  This is not fair.

• 1:12:36Ayesha Sherzai?

  All I'm doing is repeating what you said.

• 1:12:38Rich Roll?

  No, but you do it so much better than that.

• 1:12:41Ayesha Sherzai?

  That's beautifully put. Absolutely.

• 1:12:43Rich Roll?

  Well, nobody, nobody wants to befall this fate, right? And, and you know, when we're young and vital, we think we're bulletproof and this is never going to happen. But these diseases start to take root early in our lives. We don't see the symptoms for many years. So it's all about these habits that we form around diet and lifestyle. So set us up with this, this paradigm that you guys have come up with. And we can walk through some of these habits that you guys have realized have been extremely helpful in managing symptoms and preventing people from headed down this path.

• 1:13:21Ayesha Sherzai?

  Sure. So not to go into the depth and details of the science, which we could do, and we probably will spend some hours just going into it. But when you look at the basis of the pathology that takes place in the brain and the body for that, for that matter is, you know, just a few processes. These are inflammatory processes, oxidation, abnormalities in metabolism of glucose or energy and abnormalities in the metabolism of lipid. These are the four main pathways that cause damage to the vasculature, the blood vessels in the brain. And it causes damage to the neurons and the neural connections as well. And when you look at the mechanism of how these come about,

• 1:14:04Ayesha Sherzai?

  they're very closely linked to your lifestyle. So it has to do with food, with the way you move and exercise, with stress management, with sleep. My goodness, sleep, such an important part of our day. And also how we connect socially, emotionally. To our communities and whether it's, you know, studies coming from, say, for example, in Columbia University, where I trained from the Northern Manhattan Study, or from the Rush University Studies, or from the Adventist Health Study, different studies from around the world. When you look at the factors that stand out that contribute to better brain health, it's nutrition, it's exercise, it's stress, it's sleep,

• 1:14:49Ayesha Sherzai?

  and the one that we added is cognitive activity.

• 1:14:52Rich Roll?

  That's the O, the optimization.

• 1:14:54Ayesha Sherzai?

  That's right. So when we wrote the first book, we came with this acronym, NEURO. N E U R O. Of course, it's self-explanatory and it was good because we're neurologists and helped us a lot too.

• 1:15:06Rich Roll?

  It all came together.

• 1:15:07Ayesha Sherzai?

  It came together and, you know, N is for nutrition, E is for exercise, U is for unwind, which is stress management, not just getting rid of stress, but increasing good stress and getting rid of bad stress. And R is for restorative sleep, deep restorative sleep that helps cleanse the brain and has its own function, and optimization of cognitive activity.

• 1:15:28Rich Roll?

  Right. Some of these, if not all of them, feel like common sense. And yet also, I mean, I think the nutrition piece, everybody knows you gotta, if you want to take care of your body, you gotta eat right, right? Sleep, exercise, challenging yourself mentally, being in a community of people that you're connected to. These are all things that we, we kind of intuitively know are good for our health. The nutrition piece, would you say that's, is there one that stands out as more important than the others, or do these all just work? Obviously, this is a holistic thing, so they're all interconnected. But if you had to pick one, is that even possible?

• 1:16:09Ayesha Sherzai?

  I don't think it's fair.

• 1:16:10Rich Roll?

  I guess if you don't sleep at all and you eat a perfect diet, it's not gonna matter.

• 1:16:14Ayesha Sherzai?

  No, I think it's the multifaceted nature of this that actually makes a big difference. And when you look at different communities and individuals as well, you know, they're they might excel in one thing, but they might be falling behind on others. And I mean, it's understandable. We can't really control everything, but all of them are important. What would you say?

• 1:16:32Speaker 02

  No, I fully agree with you. I think all of it has to be done. And it's incredibly empowering to know that because every time we say that somebody says, oh, my, you know, my friend did all of it, but no, none of us did all of it. And we're talking about living a, let's, I'm not, the food part is pretty specific. I mean, not, we don't have that many communities that lived in the way that we were talking about. And we'll talk about it, you know, as far as whole food, whole food, plant-based. We're talking about exercise, significant exercise. We're not talking about whenever we talk to our patients, oh, I got Dean, I'm fine. I do the gardening, I do the walking, no.

• 1:17:07Ayesha Sherzai?

  Or for example, my patients, when they say, I'm walking all day long from my living room to the kitchen, back to the living room. That's not exercise.

• 1:17:15Speaker 02

  It's gotta be significant amount of exercise. And then a stress management, it's not about just getting rid of bad stress. By the way, we, none of us are doing that well. And it's not just because you meditate it. Meditation is phenomenal, but it's gotta be an all-day, but also about good stress. One of the things that actually gets people to the dementia stage fastest is what they did throughout their life as far as cognitive activity and challenge. That's profoundly important. Sleep, none of us do sleep well, just because we took some medicine. We're talking about restorative sleep where people go through the circadian, you know, the four phases of sleep, four to five times a night deeply. We invest in incredible resorts. We've been invited to different venues.

• 1:17:57Speaker 02

  I say, take that money and, well, I'm not gonna tell, put it in a, in your bedroom. There's a reason why we're knocked out. Evolutionarily, how would it make sense that you're subject to being mauled by bears and lions for one-third of your life? Unless it was that important. So sleep and investing in sleep is profoundly important. We study, we're doing the largest one with the sleep study is, shows that 70% increased risk of dementia for those who have bad sleep. And then there's optimization, which is challenging mental activity. If you think you retire and you can go lie down on the beach, that's great for a few months. But if you continue, that's going to be the fastest point of decline for cognition. Because if this brain

• 1:18:43Speaker 02

  Which is consuming 25% of your body's weight and realizes, oh, I'm not being used, especially at a time where you're aging. You know what it will do? It will actually shrink more rapidly. So all of it has to be done and all of them have to be done together. But the beauty is if they're done and if it's not just a diet de jour or the new resolution run or walk and if it's lifestyle and especially if it's lived lifestyle, which is what we're trying to do in communities, we're talking about 90% reduction in Alzheimer's, dementia, stroke, without any biohacking or vitamin de jour or any of that stuff, with regular things you have in your, you know, in your environment.

• 1:19:24Ayesha Sherzai?

  And I think one of the focus of our study, which is, you know, the largest community-based study in the country now in beach cities is the applicability of this knowledge. I think we have tremendous amount of information about the kind of diet and the kind of exercises that are good for the brain, even stress management, so on and so forth. But what we haven't really focused and what I don't see much of is bridging that gap between the knowledge that we have, the incredible amount of information that we have, and how people apply it at their homes.

• 1:19:59Rich Roll?

  That's always the trick.

• 1:20:00Ayesha Sherzai?

  It really is. It really is. And so I think more focus needs to go towards that, the translation of all this amount of information we have.

• 1:20:11Rich Roll?

  And people aren't very good at estimating or calibrating, you know, how they, how they're adhering to any of these things anyway. Most people tell you, I exercise, like you were saying, like I exercise or, you know, I eat, I eat pretty good, like, you know, everything in moderation. And, you know, these things are divorced from reality more often than not.

• 1:20:30Ayesha Sherzai?

  Yeah, absolutely.

• 1:20:31Speaker 02

  My two least favored words in language is motivation.

• 1:20:36Speaker 02

  And moderation. Motivation is a top-down word that has no denominator. What is that? It's almost like puts pressure on kids. Like, if I don't have it all the time, something's wrong with me. I don't have motivation all day.

• 1:20:49Rich Roll?

  Yeah.

• 1:20:49Speaker 02

  I, it's, so it's important to operationalize motivation in small successive successes that get you that little dopamine and serotonin release. So it's not about the goal. It's not about a, it's about the process. If it's not reduced to process that's in your lived life and you don't enjoy that process, and even if you achieve the goal, it then becomes anticlimactic. Okay, I just did this. Now what? Oh, I fall down to the baseline. So we have to create environments where the process is the thing in itself. Don't want to sound like those philosophers. The thing in itself is the process, not the goal, not the diet, not that. So that's where the change has to happen. And then the other word is moderation.

• 1:21:34Speaker 02

  Moderation is a word people use to get out of doing things. Let's be honest, you know? As soon as you say, oh, Dean, it's all about moderation. But you just had four steaks. Where's the, what, what part of moderation? I'm not judging people. But, but we have to say, this is the optimal that we know to the best of our knowledge today. And that's where the humility of science comes. And we, you know, people say, but Dean, you just changed your perspective on all of oil. Yeah, because it's not about me. It's not even, it's not even about neuro. You can throw away neuro. It's whatever science gives us. And it might not be perfect, but it's a methodology that's changeable with, not with people's ideas, but with a process.

• 1:22:16Speaker 02

  And, and if it changes tomorrow, my ego's not affected. So we have to kind of move that. And if we do that, I think we, we can, we can really address this, this calamity, which is cognitive decline. Yeah. Uh, which is affecting every community we're seeing.

• 1:22:42Rich Roll?

  So let's dive into the nutrition piece. Whole food, plant-based diet is your preferred protocol here. So of all the, you know, the, within the acronym NRO, perhaps that might be the most controversial for, you know, for the average person to get their head around. So how did you arrive at this being, you know, the diet that you're recommending?

• 1:23:06Ayesha Sherzai?

  Right. So when you look at the different epidemiological studies and even clinical trials on diet and brain health, the elements that stand out, they're all plants. Whether it's studies coming from Northern Manhattan Study, or Adventist Study, and all these other epidemiological studies that I mentioned earlier, the foods that have the most anti-inflammatory agents, that have antioxidants, that have a proper synergistic combination of micronutrients and macronutrients happen to be plants. And, you know, as much as we try to stay away from calling foods "superfoods" or, you

• 1:23:50Ayesha Sherzai?

  know, "good foods and bad foods," there are some that seem to be more beneficial and there are some that seem to be harmful. And so when you, and I've had the opportunity and the privilege to work with some databases, the California Teacher Study, and what I did was I studied how the Mediterranean diet, which everybody talks about, is structured and made. And when you look at the Mediterranean diet, or the Mayan diet, again, the food that come on top are vegetables and plants. There are fruits, and legumes, and nuts, and seeds, and whole grains, unadulterated, plant-based foods.

• 1:24:28Ayesha Sherzai?

  The more of these people consume in different communities, the less stroke they have, the less Alzheimer's disease they have, the less chronic diseases of aging they have. And they've been associated with vascular risk factors like high blood pressure, high cholesterol, diabetes. So lower of these tend to actually improve brain health. Now, I know that there's a lot of noise out there and there are different dietary patterns. And you know, there's always this, this, this fight. There's a lot of diet wars going on. But when you look at the science and the mechanism, it always comes towards plants. And it's, it's a spectrum, right? So how much do you want to stay? How long and how much do you want to stick to the healthier foods? That's what determines better brain health.

• 1:25:15Rich Roll?

  When I hear Mediterranean diet, I'm always befuddled because I'm not sure whether that's, they're, they're referring to, you know, a robust, you know, panoply of fruits and vegetables and nuts, seeds and legumes, or we're talking about wine and cheese and olive oil. Like, is, is, as somebody, like, at least in the scientific context, when you're doing these kinds of studies, like, how do they define that?

• 1:25:42Ayesha Sherzai?

  Oh, it's, it's not that difficult, actually. So there's, there are different processes and there are mechanisms in statistics and in science where you do factor analysis and you see what food stands out. And that's one of the things that we are actually doing in one of our studies to see, you know, what is the effect of specific foods on brain health? And yeah, wine, cheese, pasta. When you see the Mediterranean diet advertisement on the magazine, so, you know, pretty lady sitting next to a lake drinking wine. But it's not that. It's actually, it's actually the foods that are unprocessed and plant-based that seem to stand out. But again, you know, even, even science has its flaws. And there are some studies and some study that we were actually reading about a couple of days ago just came,

• 1:26:26Ayesha Sherzai?

  and it was published in a reputable journal saying that, Cheese, daily consumption of lamb, and up to a bottle of wine seem to reduce the risk for Alzheimer's disease. And that plants were actually bad for you. So it's just this manipulation of data.

• 1:26:44Rich Roll?

  Compared to what? Like, how was that study set up?

• 1:26:47Speaker 02

  The study was well-designed. The source of funding is questionable, so we won't go there. But so it speaks to how science can be manipulated. Even in the right environments, it can be manipulated. Depends on what variables you throw into the formula, right? If you don't take into consideration the socioeconomic status. I mean, who eats cheese, wine, and lamb? Higher socioeconomic population, which means that they probably took care of themselves. And who did you compare against? People who had very low socioeconomic, and therefore they had low resources, that they actually had other vascular risk factors and other things. So data can be manipulated. But the massive, massive body of evidence, and California teacher's study, Aisha actually was the main author of this.

• 1:27:32Speaker 02

  133,000 people over 20 years. Averitas Health Study, 97,000 people over 50 years. We're talking about the Harvard Study and Women's Health Study, large studies. The massive data shows, Rush Study, same thing, a large study, that the dominant things that are helpful are the plants and vegetables and less-processed food. So at the minimum, if people want to do something towards health, and if they don't even agree, or they can't make the changes, which I, then they should reduce the processed food. You know, we know that even among the meats, which if you go from beef jerky towards fish, you're more healthy. So we actually say, you know, we are plant-based,

• 1:28:17Speaker 02

  and we think that that's the best. Even plant-based, we don't say vegan, because vegan can be unhealthy.

• 1:28:23Rich Roll?

  Right, that's like saying Mediterranean diet can mean many different things.

• 1:28:26Speaker 02

  Exactly. We say, plant-based but thought out, planned. For example, that we are now pushing a little bit more olive oil. And even there, quantitatively less on the less side, because we think it can help with both consumption of the food, as well as absorption of vitamins. And also, the data shows that we were just at the end of a big review. We, as far as supplements, we don't push a lot of supplements. But for certain populations... Developing brain and aging brain and those who are going through pregnancy, omega threes, whatever your source, seem to be, there's trend against science that there might be need for it. So there's data, you go with the data, we do, but it looks

• 1:29:08Speaker 02

  like the whole food plant-based diet seems to be by far most beneficial because of two reasons. It gets rid of the processed and all the negative elements, the vascular stimuli, the inflammatory products, and also gives you all the nutrients you ever need. All the deficiencies that you hear in the media, iodine deficiency or B12 deficiency, either they're not real, or they can be easily mitigated while retaining all the benefit. That's why the diet has been shown repeatedly to be beneficial.

• 1:29:37Rich Roll?

  Right. Well, let's dive into that a little bit more deeply, and maybe we could start with fish. I mean, you hear all the time, especially in the context of brain health, like, oh, fish is good for brain health. And, you know, there are studies that say fish is part of a healthy diet. Typically, those studies tend to be using fish as a comparison to beef and chicken, so it's not being compared to a whole food plant-based diet. But is it possible to maintain appropriate brain health without fish? What is it in fish that this is referring to? And if we're gonna take fish off the plate, you know, what do we need to make sure that we're taking in, that we're pushing all the right buttons?

• 1:30:19Ayesha Sherzai?

  Yeah, I think that's a very important question. And you're right, fish has always been compared to consumption of meat and chicken and other animal proteins. And so it seems to be better. And the reason being, it has lower saturated fat content, which saturated fat is a major, major reason for damage for arteries in the brain and our bodies, and especially causing inflammatory changes in the brain and insulin resistance on and so forth. So there's a whole cascade that has been associated with saturated fats. And, you know, from a public health perspective, there's consensus that lowering the content of saturated fat in our diet is very important for better brain health. So that's one aspect of consumption of fish.

• 1:31:02Ayesha Sherzai?

  But you're right, there has been no study to show that compared to a healthy, whole food, plant-based diet, fish, a diet that contains fish is better. We don't have that information as of yet.

• 1:31:14Rich Roll?

  We don't have it either way.

• 1:31:15Ayesha Sherzai?

  Right, we don't have it either way. We are concerned about animal proteins being a biomagnifier. You know, animals tend to retain elements that are, they're surrounded within their environment. So, you know, all the lead and the mercury and other organic compounds that we're dumping into the oceans, unfortunately nowadays, they get concentrated in the, in the flesh of these marine animals. And if people consume fish, they consume those elements as well. And we believe that that could be a, an important factor for brain diseases. And we think that a well-managed, whole food, plant-based diet eliminates that risk.

• 1:31:59Ayesha Sherzai?

  And that we can get the omega-3 fatty acids that are, that come from marine animals with a plant-based diet if we take supplements, say, for example, at specific times during our life when our body needs it. So as a child, when a child is growing, or for example, when a woman is pregnant, or for example, when somebody's at a higher risk for developing mild cognitive impairment, supplement with omega-3 fatty acids derived from marine algae, which doesn't really absorb much of those, the elements or the trace minerals, could be very helpful. So we believe that one can actually have a very good diet and healthy diet without it.

• 1:32:39Rich Roll?

  The idea being that everything that you would get in a fish oil supplement, for example, you can get in an algae-based supplement, you're just getting it lower on the food chain. You're, you're basically taking what the fish would filter through, through its body and, and supplementing it in a condensed form.

• 1:32:57Ayesha Sherzai?

  Exactly. The fish actually get the omega-3s from the marine algae.

• 1:33:01Rich Roll?

  So what you hear a lot of, and I'm interested in, in how you're thinking about this, is that

• 1:33:08Rich Roll?

  Given the importance of omega-3, that there is something about plant-based omega-3s that aren't as bioavailable, or aren't converted in the proper way that they are when they're found in animal foods. Hence, why you should be taking fish oil, or these other things. And I know you did a whole podcast with our mutual friend, Simon Hill. You've done many podcasts with him on his wonderful Plant-Proof Podcast. But you did like, a whole episode on omega-3s. So, we're not gonna spend 2 hours on omega-3s, but like, I do wanna get this right.

• 1:33:42Speaker 02

  Sure, sure. Yeah. So, we don't know the total picture. I mean, this is, the humility of science is to say, "This is how much I know, this is what we don't know." And I, we hate this battles, about absoluteness, absolutely not needed, or absolutely needed. We don't, we don't have that much. So, we did the complete review, 2 papers. One on developing brain in omega, and the aging brain. And even there, we didn't have conclusive evidence. But there are trends, especially in populations that are more vulnerable, the trends are saying repeatedly, especially if the studies were done better, and more, that there seems to be need for omega-3. Given the risk factor, although there's some people talking about

• 1:34:24Speaker 02

  prostate cancer, all those studies are weak, and the data is weak so far. But especially in populations that are vulnerable, the cost benefit for us, it appears to be on the side of using it. Not for everybody. I think if you're a young man, or young woman, in your 30s and 40s, if you wanna take supplements, that's fine. But I, we think that there's enough data, that if you have enough chia, and flaxseed, and you know, a walnut, that you can, you can do fine with it. But for a person that's pregnant, especially going from plant-based omega-3, for developing brains, where it's doubling every, you know, other week, in size and numbers, and the one thing you need for brain development, that can't produce, is DHA and omegas, we think that's definitely needed. And for a brain

• 1:35:08Speaker 02

  that's under attack, from vascular reasons, inflammatory reasons, when it's aging, we think it's needed. The cost benefit actually speaks to it. The studies that are, that would be there, that would be conclusive, have not been done. But having looked at the breadth of data, when we did this research, we think the trends speak towards benefit.

• 1:35:29Rich Roll?

  And speak to this this conversion issue. When we're talking about omega threes, we're talking about DHA, ALA,

• 1:35:38Speaker 02

  EPA.

• 1:35:39Rich Roll?

  It all gets very confusing very quickly here. But the idea is that, yeah, when you're taking those in on a plant based diet, they're not converting in the right proportions, or you're losing out on some bioavailability here, and it just doesn't work out.

• 1:35:54Ayesha Sherzai?

  Yeah.

• 1:35:54Speaker 02

  First of all, I think we I've never heard this, but I thought about it the other day. I was like, wait a second. Why are we worried so much about conversion? Do we have enough or not? For example, nothing in our body gets converted at 100%. We don't have 100% bioavailability for anything. Unless you inject it into the artery, you don't have bioavailability 100% for anything. Much of what's actually ultimately bioavailable is in the lower teens, lower 20s. I mean, you eat it, it gets consumed. A lot of it just gets, you know, thrown out with the with the rest of it. And then whatever is bioavailable. With ALA, the percentage varies. Some people say 5%, some people say 8%. Others say up to it's not about what they say. Studies show up to 12% or more. But that's plenty.

• 1:36:38Speaker 02

  If you have one or two tablespoons or teaspoons of, you know, chia, which has it's a great food, chia or flaxseed or hemp. One of the few foods where the omega three ratio compared to omega six is higher.

• 1:36:52Rich Roll?

  Right.

• 1:36:52Speaker 02

  You don't even have that in animal food. So you have much higher absorption of ALA. Now, the conversion of that to EPA and DHA is slower, but you can still get plenty. The problem is when you need more. We think that when your brain, which actually incorporates rapidly DHA, might not be getting enough with just those sources.

• 1:37:15Rich Roll?

  And is there some idea that if you're beginning to experience cognitive decline, or if you're at particular risk for that, that supplementing with omega threes is a good idea?

• 1:37:26Speaker 02

  Yeah, I mean, the studies that were actually the strongest were in the MCI's or mild cognitive impairment.

• 1:37:30Ayesha Sherzai?

  Yeah, there was even slowing of the progression of MCI and even reversal some of the symptoms of patients who had MCI that took supplements and high doses of supplement that worked well for them. So yes, we do have evidence for that.

• 1:37:43Speaker 02

  But we also want to couch this by saying better studies need to be done.

• 1:37:47Rich Roll?

  Right.

• 1:37:48Speaker 02

  Lack of better studies does not negate trend and risk benefit analysis, given that this is the most important, one of the most important micronutrients in the body, DHA.

• 1:37:59Rich Roll?

  Mm-hmm. Well, the omega-6, omega-3 ratio thing is super interesting because sort of if you look back 50 years, our ratio of 6 to 3 was very different than it is now because we didn't have this proliferation of processed foods that are so high in omega-6. So now we're all taking in tons of omega-6, not enough omega-3. And so how much of our omega-3 intake or supplementation, how much of that is to kind of calibrate that ratio versus what we need independent of omega-6? In other words, if we're eating tons of omega-6, it seems to follow that we would then need to take in more omega-3 to create that correct ratio.

• 1:38:42Speaker 02

  There's a bigger problem, which speaks to why we have to go whole plant-based. So if you're eating omega-6, the pathway of conversion of DHA/ EPA is actually a great limiting step. So if you're having more omega-6s, you actually convert the omega-6. You can't get enough DHA conversion. So one of the things you have to do is reduce the omega-6 conversion as well because the same enzyme that actually does the conversion is limited by both of them. If you have more omega-6, it stops, it becomes the rate-limiting step.

• 1:39:15Ayesha Sherzai?

  Of conversion of ALA to DHA.

• 1:39:17Speaker 02

  Correct. So it's critical that not just to increase omega-3s, ALA and others, but also reduce omega-6 resources. And what are those sources? All the foods that have increased in the last, actually, 70, 80 years, which are the processed meats and cheeses and butters and actually all processed foods that are out there have profound amounts of, we're talking about some foods have 4,000 to 8,000 as much omega-6 to omega-3. We weren't like that.

• 1:39:47Rich Roll?

  So you'll never be able to correct that ratio. The only way is to eliminate those foods. And by going whole food plant based, you're getting rid of a lot of those nasty omega sixes that you don't want.

• 1:39:57Speaker 02

  And the benefit is exponential. You're reducing the harm fast, rapidly. And this rate limiting inflammatory. And so let's talk about omega six, omega three quickly. So these are not unnatural pathways. Your body needs omega six. Your body needs omega three. One, and of course, that's simplification. But omega six is the pro-inflammatory, pro-coagulation pathway. You need clotting, and you need inflammation. And omega three is the opposite. As it happens, that as we get older, we need more anti-inflammatory because it becomes a chronic process of inflammation, which we have to counter.

• 1:40:36Rich Roll?

  Right.

• 1:40:37Speaker 02

  And actually baseline higher than normal. And the fact that our diets have changed. So now we have much more pro-inflammatory, pro-coagulation. That's why we have more strokes. That's why we have more inflammatory diseases, including autoimmune diseases. So if you don't lower the inflammatory pathway, you can pump this up.

• 1:40:55Rich Roll?

  It doesn't matter.

• 1:40:56Speaker 02

  First of all, it won't go through. It doesn't matter.

• 1:40:58Rich Roll?

  Right. All right, let me throw this one at you. The brain is made up of fat. It thus needs lots of fat in the diet, saturated fat, and also cholesterol.

• 1:41:11Ayesha Sherzai?

  That drives me crazy.

• 1:41:12Rich Roll?

  I hear this one a lot. So walk us through this one.

• 1:41:17Ayesha Sherzai?

  That drives me crazy. But I think if you look at the structure of the brain, yes, the brain is made out of a lot of fat. The numbers vary. They say, you know, 60%, 70% fat. But that calculation doesn't really separate the amount of fluids that are in the brain too. So it's actually less than 60%. But we'll leave that alone. The important thing to remember is that fats actually don't cross. Big molecules of fat, like cholesterol and saturated fats, they actually can't cross through the blood-brain barrier, which are these tight junctions between cells in the endothelium of the That allow specific things to go in and specific things to come out.

• 1:42:01Ayesha Sherzai?

  So the fat that is in the brain is structural fat. The only fats that are needed by the fat on a daily basis, by the brain, by the, on a daily basis, are omega-3 fatty acids. And those are small enough to actually go, be used, and that's basically it. The rest is just structural fat and it's maintained by all the other micronutrients and by all the other food elements that we consume. So we don't need cholesterol for our brain to maintain its function at all.

• 1:42:33Speaker 02

  Even under the worst circumstances, your liver and your body makes enough of the rest of the fat for the brain if it needs it.

• 1:42:39Ayesha Sherzai?

  Agreed.

• 1:42:39Speaker 02

  It's not a problem, and the brain as well.

• 1:42:41Ayesha Sherzai?

  Any access actually just gets metabolized or they sit on your arteries and they start the process of just plaque formation, unfortunately.

• 1:42:48Rich Roll?

  Uh huh. So nothing to that one?

• 1:42:50Ayesha Sherzai?

  No, not at all.

• 1:42:51Rich Roll?

  Right. And, and talk about saturated fat more broadly in terms of, of brain health. I mean, we are, look, there are these crazy diet wars going on right now. Everybody's, you know, planting their flag in various corners of the internet. We've got the carnivores and we've got the keto people. And, you know, you will, I see this all the time, like keto people will say, you know, I adopted a ketogenic diet, I can focus better, my brain is working better, I'm able to work longer in a more productive way than I was able to previously. Of course, that's anecdotal, but there's a lot of people who feel pretty strongly about this. So speak, speak of this a little bit.

• 1:43:30Speaker 02

  I, I think that they do feel more focused and I believe them. I think that short term, they actually do better cognitively. Not better than any other diet, but they do better than what their baseline would have been. And that's why, but, but long term, there's no data. I mean, if you look at ketogenic diet data, there's nothing more than six months, nothing meaningful longer than six months. Ketogenic diet came from our field, neurology, where children with a particular type of seizure, which were not controlled by multiple medications, they were put in a shock state to control seizures.

• 1:44:10Speaker 02

  Why would we think that that's representative of a brain that's not undergoing shock? They're putting, they're changing the acidic state of the brain so that the seizure is stopped? That's not representative. And then the other thing is, how long, how, how long can you maintain that under normal circumstances? These children were kept in special wards or with special diets, maintaining a ketogenic diet, a true ketogenic diet. And I can tell you-

• 1:44:39Rich Roll?

  It's a lot harder than maintaining a whole food, plant-based diet.

• 1:44:41Speaker 02

  It's crazy difficult.

• 1:44:42Ayesha Sherzai?

  Yeah, it's very difficult.

• 1:44:43Speaker 02

  Most of the people that said, they say that they have, they're on ketogenic diet, they, they've never achieved keto, ketosis. They're just eating more meat. And that, that they call that ketogenic diet. It's much harder than that. So, short-term, they do better, they do very well with glucose and insulin resistance. They do well as far as focus and they do, even do some better with, with certain cognitive testing, which has been done, short-term. But nothing has been shown long-term. There are no populations that have lived this life that can give you long-term benefit. The one population, which is these seizure patients, have had many multiple medical problems, side effects as a result of it. So, we are open, we're absolutely open, because there are, there are plant-based versions

• 1:45:28Speaker 02

  of ketogenic diet. So, we're open to see if, long-term, anybody can show evidence, but nothing so far.

• 1:45:34Rich Roll?

  Right. But the brain runs on glucose.

• 1:45:36Speaker 02

  Brain runs on glucose.

• 1:45:37Rich Roll?

  Right? And so, on a ketogenic diet, you're depriving it of glucose and it's being forced to run on ketones.

• 1:45:45Speaker 02

  Correct.

• 1:45:46Rich Roll?

  Correct? So, is there some scientific sensibility of how the brain functions on ketones versus glucose?

• 1:45:52Speaker 02

  Well, the analogy, you want to tell them the analogy?

• 1:45:55Ayesha Sherzai?

  Well, go ahead, you tell your analogy.

• 1:45:56Speaker 02

  I'll let you tell this.

• 1:45:57Ayesha Sherzai?

  I'll, I'll do the nicer part.

• 1:45:58Speaker 02

  Okay. I, I, I call ketogenic diet, as of now, it might be pejorative, but almost like a cheating on, on your wife kind of a thing. So-

• 1:46:10Rich Roll?

  How dare you?

• 1:46:12Speaker 02

  I know, I mean, terrible. But, so, glucose is the main molecule that cell requires.

• 1:46:19Ayesha Sherzai?

  Preferred fuel.

• 1:46:21Speaker 02

  Preferred fuel. We did a study in Haynes, one of the largest databases, looking at even insulin resistance, not the diabetics. We took them out and looked at insulin, they had lower cognitive state. So, insulin resistance is what we're looking at. If you have too much glucose with food that rapidly rises glucose, what happens is the cell notices that there's too much of this. And actually, the receptors go in. So it's the analogy I give is like somebody's coming as a suitor for your son or daughter. And they knock at the door and there are too many people. The door just closes, it comes out. And but if it's accepted, if it's the right amount of glucose,

• 1:47:04Speaker 02

  the door opens, then it has to go to the father, to the mother. This is an old fashioned story. Right. But it's okay. And uncle, and there's a huge family there that you have to go. Glucose has to do a lot of work to ultimately get to the mitochondria. Imagine what mitochondria is. So it has a lot of work to do. Six, seven, 10 cycles of processing. First of all, it actually has to get through the blood brain barrier, through an active transport, a lot of work. And that is designed to be like that. It's evolutionary designed to go through this hard work for glucose to get into the cell and be functional. Because that's how it manages it long term. Now, let's look at keto bodies, ketone bodies. They're small molecules.

• 1:47:49Speaker 02

  They're cheating. They're going right through the window and right into the mitochondria, skipping all the steps.

• 1:47:54Rich Roll?

  Yeah, don't have to deal with dad and crazy uncle.

• 1:47:58Speaker 02

  Initially, a lot of energy, a lot of fun, a lot of other stuff. This analogy always goes awry. But long term, it's, you know, you feel so ketone bodies might work short term because it's a quick burst.

• 1:48:13Ayesha Sherzai?

  Right.

• 1:48:13Speaker 02

  Even for the mitochondria. But where does in the biochemistry textbooks or any biochemical process, does it say that doing the quick thing in the biochemical processes is long term benefit? From my reading and Aisha's reading and our research and molecular pathways, there's no evidence that anything that's short term like that is going to be beneficial long term.

• 1:48:37Ayesha Sherzai?

  Like you said, it's under a shock state. So, you know, and most of the studies that have been done on ketone bodies have been done in individuals who have had advanced Alzheimer's disease. And at that stage, there's a lot of damage that has already been done. There's the structural damage, vascular damage. And so ketone bodies act as an alternative fuel. Right, so the cells probably don't have the opportunity to use glucose as a fuel, but ketones that don't require all these steps that Dean mentioned, you know, they don't have to go through it and they go right into the cell. And initially, there may be some improvement in their cognitive skills and in their neuropsychological scores. But

• 1:49:21Ayesha Sherzai?

  long term, I think the only study that we have is a feasibility study that was less than six months, and that's basically it. So we don't have any long term results. And if we do, I'll be excited to actually read about it and because it sounds very promising. We just don't have the data yet.

• 1:49:36Rich Roll?

  Is it not an emergency state for the body? It's like a survival mechanism that evolved over millennia to keep a human being alive if they were deprived of food for a certain period of time, right? So in that sense, your physiology is in crisis. Is there a downstream impact on your neurological functioning? Like, are you in a, you know, sort of sympathetic nervous system state of high alert when that's going on?

• 1:50:10Ayesha Sherzai?

  Right.

• 1:50:11Speaker 02

  We think so. We think, I think it's a survival state. That's why survival states are short term states. That's why, I mean, when we talk about stress, it's a short term beneficial state that now has become chronic.

• 1:50:24Rich Roll?

  Right.

• 1:50:25Speaker 02

  We keep missing the evolutionary flaw here. We keep addressing what's short term benefit and think that that's long term benefit. It's not. So we think that at least biochemically, even evidentially, I mean, we're looking at evidence from all the studies. There's no evidence at this point that this is a magical cure for dementia or Alzheimer's or any of these things. It's just a short term survival. That long term, we think has consequences.

• 1:50:52Rich Roll?

  Right. Rather than climbing in the window, how about this analogy? It's sort of like pulling an all nighter and you can, you're gonna, you're gonna get away with the grade on the test, but a month later, you're not going to remember anything.

• 1:51:03Speaker 02

  I can say that story much better than my story.

• 1:51:06Rich Roll?

  So, so let's look at the foods that that are beneficial. Like when you look at the the plant kingdom, what stands out? You know, I know we want to stay away from quote unquote, superfoods, but some foods are better than others. Like, what should people focus on who are trying to enhance their brain health?

• 1:51:27Ayesha Sherzai?

  Yeah, I think if if I had to give a quick version of of what's out there as far as data is concerned, consumption of green leafy vegetables, for example, seems to be very helpful. And it's like unanimous results that you see across different studies. Berries, such as blueberries and strawberries, they stand out, whether it's the mine diet or the Mediterranean diet, or even in the Adventist Health Study, because these are foods that have the highest amount of antiinflammatories. Spices like turmeric, we actually wrote a paper when we were in Cedar Sinai, where we gave our patients high doses of turmeric. And turmeric seems to have the curcumin part of it. It's a very potent antiinflammatory. And it seems to bind with amyloid,

• 1:52:10Ayesha Sherzai?

  which is the bad protein associated with Alzheimer's disease. And it it removes it.

• 1:52:14Rich Roll?

  Oh, wow.

• 1:52:15Ayesha Sherzai?

  And we measured the amount of amyloid, the amyloid load in retina. And after giving them high amounts of turmeric, we actually saw the turmeric binding to the amyloid in the retina, which is really, really interesting. And we're learning more about it as we speak. And yeah, so high fiber, green leafy vegetables and berries and spices, especially turmeric, seems to be on the top.

• 1:52:39Rich Roll?

  Chian flaxseed.

• 1:52:41Ayesha Sherzai?

  Chian flaxseed, which are amazing sources of plant based omega-3 fatty acids, hemp seeds, nuts like walnuts, whole grains. They seem to have the right kind of micronutrients, whether it's thiamine or riboflavin or folic acid, bound beautifully synergistically, supporting each other's absorbance and bioavailability. They all tend to reduce the risk for Alzheimer's disease. And we have studies that have looked at individual foods and risk of Alzheimer's disease and the combination thereof, too.

• 1:53:12Rich Roll?

  Are there any plant foods to avoid?

• 1:53:15Ayesha Sherzai?

  I would say the plant foods to avoid seems to be coconut oil. I know that that again is a controversial area and a lot of people are just, yeah.

• 1:53:23Rich Roll?

  A lot of people are getting mad right now.

• 1:53:25Ayesha Sherzai?

  I know, I'm sorry, but you know, I love coconut.

• 1:53:28Rich Roll?

  Well, that used to be the thing, coconut oil for brain health.

• 1:53:30Ayesha Sherzai?

  Yeah, I know, and unfortunately, the data was pretty flawed when it came out. It was based on a couple of case studies. And as it happened, somebody gave their loved ones coconut oil and they seemed to improve. But then there was no long term follow up. But coconut oil, and I'm happy to say that there's consensus on it. And you know, as a scientist, I want to look at different sources of data, whether it's clinical trials, whether it's epidemiological, whether it's case series. And there's consensus between different scientists and doctors and physicians that coconut oil seems to increase our bad cholesterol LDL, which can result into vascular damage. And the reason being is because coconut oil is one of the few plant oils

• 1:54:15Ayesha Sherzai?

  that is more than 90% saturated fat, and so is palm oil.

• 1:54:18Speaker 02

  And the little nuance to that is the MCT, medium chain triglycerides, that has to be studied and we're open to that. I mean, we think that if that's, those studies come back and show some benefit, we would be more than happy because we need any, anything that's out there that's going to help. So far, no data, no tangible data.

• 1:54:39Rich Roll?

  But with coconut oil, doesn't that, that LDL saturated fat component, isn't it fairly easily converted to like linoleic acid, which makes it more available as an energy source as opposed to being stored?

• 1:54:52Speaker 02

  It could, but reality is that that number, so that's a mechanism. Actually, that mechanism exists for a lot of saturated fats. But reality is that when the studies are done over and over again, what they see is when people consume coconut oil, it is actually the astrogenic and inflammatory component that predominates.

• 1:55:10Rich Roll?

  Interesting. It is a processed food anyway. So in the context of talking about whole food, plant based diet, it's not even really part of that conversation anyway. But you did shift gears with olive oil to some regard.

• 1:55:22Speaker 02

  Here's, talk about controversial.

• 1:55:24Rich Roll?

  Yeah.

• 1:55:25Speaker 02

  We were actually ostracized by some communities for this, which I'd never thought that-

• 1:55:28Rich Roll?

  There's a heated debate going on.

• 1:55:29Speaker 02

  Yes.

• 1:55:30Rich Roll?

  Yeah, people are very strong opinions about this.

• 1:55:33Speaker 02

  It's so funny, you know, we worked in Afghanistan and were ostracized by Taliban. So some plant-based people ostracizing us doesn't scare us too much. But yeah, so please ostracize us away.

• 1:55:44Rich Roll?

  They're not as well armed.

• 1:55:46Speaker 02

  Not as well armed. And so much lovelier people, anyway. So, the reality is, we're open to data. It's not about dogma. There are a couple of lines of argument. And it's not always because we looked at Mediterranean diet. We're actually in the middle of doing a meta-analysis. The data is, again, trend. And nutrition data is tough. So you have to go with trends and multiple domains of trends. And it appears that some, and here's another controversial term, some, olive oil seems to help with cognition, seems to help with health in general, and specifically, you know, extra virgin olive oil. And then the quantity is controversial, how much. We think that there is a point of excess.

• 1:56:29Speaker 02

  So we say, use as minimal as possible, just to help with both digestion and with food. But we just wanted to open up the realm, even though we might make people angry. That's okay, that's our life. But if its data shows this way, we gotta start talking about it. And at the same time, when we go to these churches and faith communities, which we, another one of our projects is a women-centered faith-based community, a brain initiative in African-American churches, where-

• 1:57:03Rich Roll?

  Disproportionately impacted by Alzheimer's.

• 1:57:06Speaker 02

  And also, more importantly, as Aisha's finished getting her PhD in women's leadership, focusing on women and health is the most effective-

• 1:57:16Speaker 02

  Money spent in health. So if you're going to change, bring a brain initiative, it should be around women. So especially African American women or black women and their communities. But we see, and if we go to these communities and Hispanic communities and other communities in Appalachia or Pittsburgh where I come from and say, no meat, no cheese, no butter, no salt, no sugar, no fat, no oil, no dean.

• 1:57:41Rich Roll?

  Right. Yeah, you're gonna have a little bit of an adherence problem.

• 1:57:45Speaker 02

  Absolutely. Now, that doesn't speak to the science, and I spoke already to the science that there seems to be some trend that that's all of oil is fine, especially cardiovascular data. But it does speak also to compliance. And since we work in the communities and we're not doing contrived 100% studies in a lab, we think that's as important.

• 1:58:09Rich Roll?

  Well, compliance is everything. If you don't have compliance, it doesn't matter.

• 1:58:12Speaker 02

  Exactly.

• 1:58:13Rich Roll?

  But you have to be careful, right? Because you don't want to veer too far towards compliance. Then you're the practitioner who's like, I'm not going to tell them about lifestyle because they're not going to do it.

• 1:58:22Speaker 02

  Exactly, exactly. It's a balancing act. So we say, what's the optimal? Especially people who have, so complexity is, you know, somebody said, I think somebody we know, said that the entire problem we have in this world is, I think that cat is about people not being comfortable with complexity. There's a complexity in this. And the complexity is, we have to worry about adherence, but at the same time, we have to say what the truth is. And here's another layer of complexity. If somebody has a four vessel disease, we say, go all the way, no fat, because the data is there. That if you have four vessel arterial disease, you might as well go all the way as opposed to, you know. So there's a bit of complexity there.

• 1:59:04Rich Roll?

  Right. If people don't like that.

• 1:59:07Speaker 02

  I know, I know. I'm sorry.

• 1:59:10Rich Roll?

  The truth will set you free. You have to be able to make room for nuance now more than ever. Things are so crazy out there. And the only way to do that is to have. You know, conversations like this, it's not going to happen on Twitter. And it's tricky and it's, and it's, people's identities are wrapped up in these ideas. And people don't like to be challenged with that because it threatens like, it's almost like cognitive decline. Like you're, you're like, my sense of who I am is being pulled out from underneath me. And emotionally, it's very difficult.

• 1:59:41Ayesha Sherzai?

  Right.

• 1:59:44Speaker 02

  One of the people we admire greatly, we're not going to name names, don't worry. Actually said they would not endorse our book, even though we are in the communities by the thousands, helping thousands of people with a whole food, plant-based diet, just because we say add a little bit of olive oil.

• 2:00:02Rich Roll?

  Yeah, everything gets more and more specialized. It used to just be vegetarianism, and then it's a vegan in vegetarianism. And then within those categories, there's, there's, you know, more and more silos until there's just one person left.

• 2:00:18Rich Roll?

  And nobody can talk, everybody's got their own news feed, you know? And we can't communicate with each other anymore. I mean, that's where this has headed.

• 2:00:25Ayesha Sherzai?

  It's sad.

• 2:00:26Speaker 02

  It is.

• 2:00:28Rich Roll?

  Aisha, how many PhDs do you need?

• 2:00:31Ayesha Sherzai?

  No, I, I'm just, I'm, I feel so lucky. Well, first of all, I have this amazing partner that, you know, just allows me to, to experience life in its fullest. And, um, you know, having, so I have a master's in clinical research and I went to medical school. And I've worked in clinics and I got a fellowship in vascular neurology. But the more I, the more I am in this, in this field, I realize that if we don't focus on the human component, it's meaningless, meaningless.

• 2:01:13Ayesha Sherzai?

  And having had the privilege of working in the communities, meaning going there, sitting down with them, listening to them, working in the community clinic where you have these lovely people coming in and telling you like, doc, I know, I know this is important. I just can't do it right now. I just can't do it because of this, this, this, this. You can't really talk to a...

• 2:01:36Ayesha Sherzai?

  A woman who has two jobs, is divorced, has four or five children to take care of, has a parent with dementia that she takes care of, has tremendous amount of stress because of the situation in the world, and tell them, you know, just meditate every day. Meditation is really good for your brain. That is such an elitist statement. That is such a flawed approach to health. And so what do you do to make yourself available? And what do you do to create an environment in their communities where they can have access to health and wellness in their comfort zones? And so having worked with different individuals,

• 2:02:18Ayesha Sherzai?

  and especially in the faith-based communities, the one thing Dean and I have noticed, and this actually comes from our work in Afghanistan as well, where we've noticed that if we invest in the women in those communities, you've actually invested in the families and in the communities. Because women are the best representatives of that unit in the community. And when you look at different models of success in the world, one of them that came from Dr. Yunus, who was the Nobel Peace Prize laureate. He's the father of micro credits, where he, you know, essentially helped women and their small businesses.

• 2:03:02Ayesha Sherzai?

  And he made some profound statements. He said, "When you help women, you actually help families and you help change that society." Because, no disrespect to men, I love you guys, but women know how to invest in their families and in their units. And so I'm pursuing this PhD in women's leadership because we believe that if women are ambassadors of brain health and mental health, I think it's a game changer. And we've seen that. We've seen that in Afghanistan. And Dean doesn't talk about that. But, you know, one of the things that is so, such a profound story in our life was when, I'm going to say that story for you. When he was working for the World Bank,

• 2:03:47Ayesha Sherzai?

  he was in Afghanistan, and he was running the Ministry of Health. One of the challenges was to make health available for all these provinces and villages that were away from the capital, and there are not a lot of hospitals there. I think we learned more about public health there than any course at Columbia, than any course at NIH and UCSD and Loma Linda University combined together. So knowing the politics and the bureaucracy, what Dean did was essentially a social jujitsu,

• 2:04:25Ayesha Sherzai?

  where he trained, he created the establishment to train 20,000 girls who were, you know, went to school up to sixth grade, because after that, they usually, there's no education available for girls in the provinces. And so he took sixth grade educated girls, and he wanted to train them in just basic healthcare. How to give empicillin when somebody has upper respiratory infection, how to create oral rehydration solution, which is, you know, one liter of boiling water, one fist of sugar, and a pinch of salt, because one in five of it, children under the age of five die from easily preventable diarrhea in those countries.

• 2:05:08Ayesha Sherzai?

  And to give them that oral rehydration solution, you've actually saved a life. Or to tell the difference between spotting and bleeding in a pregnant woman, because the hospital ride is about five days on a donkey, right? Right? So just basic things. And so there was a lot of pushback initially about this project. They said, nope, you're not going to take our girls and educate them. This is against our faith, against our culture and tradition. And Dean said, no, no, no, no, this is, you know, this is going to be done in your, in your communities and in your villages. And so they accepted it. And that was a beautiful move, because they...

• 2:05:46Ayesha Sherzai?

  Created mud huts, clinics for these girls in a very prominent place with a flag on it. And it was just a very basic place with a chair and a table and maybe a bed sheet as a curtain, with a small little bed for the midwife or the nurses, nurses and midwife program, to examine patients. And guess who would get sick after a few days? The men would get sick too, right? And there would be that girl, and she would be the community doctor.

• 2:06:18Rich Roll?

  Uh huh.

• 2:06:18Ayesha Sherzai?

  And suddenly you've completely flipped the relationships.

• 2:06:21Rich Roll?

  Yeah, that just fucks up their whole mindset of the whole thing.

• 2:06:25Speaker 02

  So the jujitsu here is you don't have to confront cultural paradigms. You jujitsu around it.

• 2:06:31Rich Roll?

  Mm hmm.

• 2:06:32Speaker 02

  And with most of healthcare, thank you so much for telling that story.

• 2:06:36Rich Roll?

  That's amazing, by the way, like incredible.

• 2:06:38Speaker 02

  We wrote a paper together.

• 2:06:40Ayesha Sherzai?

  Yeah, it's actually in Lancet.

• 2:06:41Rich Roll?

  Oh wow.

• 2:06:42Speaker 02

  How to apply it to other communities.

• 2:06:43Ayesha Sherzai?

  Right.

• 2:06:44Speaker 02

  And if we do that, not so much jujitsu, but use the resources of a community to build this paradigm around women.

• 2:06:53Speaker 02

  I mean, your wife, the power, we know.

• 2:06:56Ayesha Sherzai?

  What a human she is.

• 2:06:58Speaker 02

  And also they're the leaders. And even in those Taliban infested places, yeah, they do all the yelling and jumping around, the men do. But who runs the households?

• 2:07:08Rich Roll?

  Right, they're making the decisions about.

• 2:07:09Speaker 02

  They're making decisions.

• 2:07:10Rich Roll?

  What people are doing, what they're eating.

• 2:07:12Speaker 02

  Women are the leaders. Women are actually the leaders. And we can build a whole healthcare system, brain health initiative around women. So that's been our work for the last two and a half years.

• 2:07:21Ayesha Sherzai?

  Right.

• 2:07:21Rich Roll?

  Yeah, so applying that template, you know, here in the United States, going into these communities, trying to pull some, you know, tweaked version of that jujitsu maneuver to, you know, empower these women, enlist them in this cause and in turn have them help create structures that trickle down.

• 2:07:42Rich Roll?

  Into their families.

• 2:07:42Ayesha Sherzai?

  Right, absolutely.

• 2:07:43Rich Roll?

  Beautiful.

• 2:07:44Ayesha Sherzai?

  Yeah, so that's the goal. And it's been an amazing journey, just, you know, experiencing that firsthand to see how wonderful of a communicator a woman can be and how easy it is for others to listen to a woman who is a sister, a mother, an individual in the community, coming from a very empathic and a loving place, but at the same time, from a very powerful place. I'm just so excited to be in that area.

• 2:08:13Rich Roll?

  Yeah, there's no bounds to the upside of that, I think.

• 2:08:18Ayesha Sherzai?

  That's right.

• 2:08:19Rich Roll?

  Well, let's talk about the new book. I mean, you guys wrote this amazing book, The Alzheimer's Solution, that came out a couple of years ago. That's what brought you onto the show back then, which is basically an incredible primer on all the research that you've done, case studies, your work with your patients in terms of implementing lifestyle interference to interrupt this brain dementia issue that is mushroom clouding in our society. But the new book, The 30 Day Alzheimer's Solution, right, is more of a tactile, like, very easy to use guide for how to kind of, you know, implement these tools into your daily life

• 2:09:04Rich Roll?

  using this neuro paradigm of... It's basically mostly nutrition focused. You talk about the other stuff, but it takes you through a program. It gives you kind of tools for how to make these changes in your life. And then you have all of these beautiful recipes to try to make it as appealing and delicious and easy for people to do as possible. So it's great. I love it. My only complaint is that it was a digital version, and I don't have the book yet, but it's coming out soon. So talk a little bit about why you decided to write this book and what your, you know, plan for it is.

• 2:09:40Ayesha Sherzai?

  Thanks, Rich. That's very kind of you. And we'll definitely get you a copy. I think the pandemic slowed down everything, but... We're very proud of it. It was it was difficult to put our experiences in a way where it's translational and palatable, part of the pun. But we wanted to focus in on the how part of brain health. You know, the first book was essentially the why and a lot of science, but the applicability part has been expanded in this book. And, you know, the title, The Thirty Day, was a little uncomfortable initially. What does that even mean? Does it mean that in 30 days, I'm going to have the best brain? No, but I think it's a 30 day journey or a plan towards that direction.

• 2:10:23Ayesha Sherzai?

  And we're just really excited. And I think one of the reasons I went to cooking school after going to fellowship was just because of that, that the passion that I have for application of all the science and knowledge that we have already.

• 2:10:38Speaker 02

  One of the key things in behavior change is process. A lot of times, people get focused on goals, and goals fail us because once you reach, as I said, you feel anticlimactic and then what? It's process that's important. Systems have to be established. So the 30 days is attempting, and I never want to do hyperbole, is attempting to create an environment for systems. In fact, we, with the book, for those who sign up early, this is a marketing tool, but they get a... You get all kinds of bells and whistles when I saw that. My goodness, I never thought that at NIH I would be doing this stuff. But in any case. You've turned into a marketer.

• 2:11:22Speaker 02

  But nonetheless, but it is actually, I think it's helpful. We are giving people, by the way, it's, we said, if you buy the book early, you get access, but it's actually on our system. You don't have to buy the book. You can get access to a 30 day course that starts at 1st of April up to the end, where we have sleep doctors, stress doctors, nutritionists, lots of data and equipment and cooking sessions and courses, where I should, that's for free, by the way, takes them with the book through this process for a month, not with the hopes that at the end, they come out completely... Different, but for them to be familiar with possibilities of where the changes, the micro-changes can take place.

• 2:12:06Speaker 02

  You've spoken to an amazing, the Atomic Habits.

• 2:12:11Rich Roll?

  James Clear.

• 2:12:12Speaker 02

  I love the book. I mean, I've read a lot of books. It's those little incremental successes that change into habits, which change into then culture. So this month is about going through this process with brain and mind. Sorry, there's another one that came out, that actually takes them through. And hopefully, by the end of it, they have enough of these little micro habits that becomes a process, individualized habits.

• 2:12:39Rich Roll?

  Yeah. Yeah, I like how you broke it all down. And you didn't sugarcoat it either. You're like, look, this is gonna be hard. If you're gonna get off cheese, it's gonna be uncomfortable. Like, you're not trying to say it's all gonna be awesome all the time. Like, it's, you know, making any kind of change is difficult, and this is no different. But what you find on the other side is worth it. And you give the right amount of encouragement, and you couch motivation in the right context, and I appreciated that as well. But you paint with a broad brush so that, you know, anybody could pick this up and, you know, get their head around what the right path is.

• 2:13:16Ayesha Sherzai?

  That was the goal. That was the goal for, we basically wrote this for our caregivers and the patients and everybody that's been touched by Alzheimer's. And I know the cover says Alzheimer's, but it's essentially brain health in general and cognitive decline, which a lot more people are experiencing.

• 2:13:33Rich Roll?

  Yeah, I mean, it's really hard to appeal to a young person to make changes in their life because they might get Alzheimer's. Like, that's, talk about a motivation problem. But if you, if you instead rephrase it as cognitive enhancement, or, you know, some sort of, you know, brain hack or something like that, then suddenly you get... Young people's attention.

• 2:13:55Speaker 02

  Absolutely.

• 2:13:55Rich Roll?

  You get them interested in taking care of their brains so that they don't fall prey to this later in life.

• 2:14:00Ayesha Sherzai?

  Absolutely, yeah. I think it's important to say it that way.

• 2:14:03Speaker 02

  Right. And for us, we have the Healthy Minds Initiative, which is a non-for-profit, where our goal is, hopefully, that we can promulgate and spread this concept of coaching, women-centered coaching, throughout the country. And whatever comes out of this book goes towards that effort. Whoever wants to help us out goes towards that effort. And I think it's a worthwhile endeavor with I Shen the lead and I'm the driver.

• 2:14:31Ayesha Sherzai?

  We're a team.

• 2:14:32Rich Roll?

  Wow. So all proceeds from the book go to the nonprofit?

• 2:14:35Speaker 02

  All of it.

• 2:14:35Rich Roll?

  Fantastic.

• 2:14:36Speaker 02

  All the profits.

• 2:14:37Rich Roll?

  Yeah. And that nonprofit, Healthy Minds Initiative, is very involved in what you're doing in Redondo, where you live right now. But the idea, much like Blue Zones, is to kind of scale this and model it for other cities and communities?

• 2:14:52Speaker 02

  Absolutely.

• 2:14:53Ayesha Sherzai?

  Yeah, that's right. The Beach Cities Health District is where our flagship Healthy Minds Initiative study is going on. We have one in Arizona, in South Carolina, and we're expanding it in other states as well. And we're basically training coaches who can be brain health representatives and ambassadors in their community and just move it forward.

• 2:15:14Rich Roll?

  Right. Awesome. Well, we got to land this plane, but I got two more things I want to ask you before I let you go. The first is, obviously, there's so much more research that needs to get done in terms of brain health and also nutrition and how lifestyle impacts brain health. What is, if you had your druthers, like what is the study that you would set up? Like, what is the big study that's missing right now? Like, forget about cost, just how would you do it? What would it look at?

• 2:15:45Speaker 02

  First of all, it would be a little longer term. It would be at least three to five years. And it would actually have imaging and it would be community-based. That seems contradictory, like this technology, but it would be community-based. Because if, just like mouse models that work, you know, 400 mouse models for Alzheimer's worked, zero worked on humans. The same way, these little contrived 100%, 200% studies on six months, seven months, means nothing. If we don't do it in larger populations and we don't get good markers of cognition, which is neuropsychological testing, biomarkers and imaging that shows this change over time, it's meaningless.

• 2:16:26Speaker 02

  Because you will get, every diet will come up with a paper saying, "Look at my study, six months, look at my study." There will be many of them, documentaries and everything put together. But we need a larger study going forward. So, we're doing the data capture in our national, we'll take care of the funding there. We don't have the funding for imaging, we don't have the funding for blood tests, and the regular funding sources don't seem to get it. They're not adjusting, saying, "Look, we'll take care of the educational component, we'll take care of the resources, the technology, we'll take care of all of that." But we need some help with the biomarkers and imaging component, and we can have the best study for cognition. And then we will have studies that we'll look at, because it's a large population,

• 2:17:11Speaker 02

  we'll know data on ketogenic, we'll know data on plant-based, whole food, we will know data on omnivore, or even pescatarian. That would be the optimal study that would be out there.

• 2:17:22Rich Roll?

  So essentially, a massive population study, community-based study, where people would be self-reporting, or?

• 2:17:30Speaker 02

  We have the methods of collecting data, not on a once-a-year basis, where the food frequency questions are, but actually on a monthly or weekly basis, we have the tools now. We're actually using that in beach cities, using iPads and computers. We can collect the data as far as that's concerned. We have the tools as far as collecting sophisticated cognitive information on the computers, and we'll take care of all of that. So those two big components, and as far as teaching them using Zoom, for us Zoom was now, actually yesterday, we had a Zoom session with our teaching population of over 100 people. So that's even taken care of. We'll take care of the education component on a weekly basis and the coaching training. The only thing is needed is that biomarker funding that would really help us out because there's bigger costs we've

• 2:18:15Speaker 02

  taken care of.

• 2:18:18Rich Roll?

  Okay, last question. I can't remember whether I asked you guys this last time you were here. If I did, I'm gonna ask you again. I don't remember what you said anyway. If you woke up tomorrow and realized you'd been appointed as Surgeon General of the United States.

• 2:18:35Ayesha Sherzai?

  Oh goodness.

• 2:18:36Rich Roll?

  And given the kind of metastasizing Alzheimer's problem, like this apocalyptic number of people tripling by 2050, what kind of policies would you try to implement? Or legislative changes would you be thinking about that could move us in the right direction as a nation?

• 2:19:00Ayesha Sherzai?

  That's a tough one. You wanna go first?

• 2:19:02Speaker 02

  Okay.

• 2:19:03Ayesha Sherzai?

  Well, I would say more resources for communities about managing their lifestyle. I think most of the funding goes into very specific molecular datas. I think lessons being focused on individuals and the communities, and that's where I would focus, whether it's changing lifestyle with behavior models, whether it's nutrition education, whether it's exercise education, and fitting it according to their resources. That would be the place to focus on.

• 2:19:42Speaker 02

  I fully agree.

• 2:19:44Rich Roll?

  Yeah.

• 2:19:44Speaker 02

  I mean, we were talking about, we talked about mind diet at one point, which is not an optimal diet. Even the people, the main PI passed away recently.

• 2:19:53Ayesha Sherzai?

  Martha Morris.

• 2:19:53Speaker 02

  Martha Morris. And even she said it's not the optimal diet. But yet 53% reduction in Alzheimer's. And I'm sure that the same number would apply if not more for stroke and everything with this mind diet. So why wouldn't we invest at all in this kind of an approach? And especially in the community-based model. So I would, I fully agree with Aisha, that would be the investment.

• 2:20:15Rich Roll?

  Yeah, it seems like more local-based medicine, an overhaul of healthcare to re, you know, sort of reconfigure it around prevention.

• 2:20:29Ayesha Sherzai?

  Right.

• 2:20:29Rich Roll?

  As opposed to diagnosis and prescribing people.

• 2:20:32Ayesha Sherzai?

  Absolutely.

• 2:20:33Rich Roll?

  But yeah, we need a lot of changes, don't we?

• 2:20:36Ayesha Sherzai?

  We do.

• 2:20:37Rich Roll?

  But you guys are playing a huge role in reversing this tide. And I really appreciate the work that you're doing. You're truly saving, saving lives and it's admirable and I wish you all the best. It's amazing what you guys are doing.

• 2:20:50Speaker 02

  Thank you.

• 2:20:51Ayesha Sherzai?

  Thank you for helping us disperse the message. I mean, this is, this is truly important.

• 2:20:55Rich Roll?

  Anything to help you guys out, anytime, reach out. Thank you, that was amazing. Appreciate you guys.

• 2:21:01Ayesha Sherzai?

  Appreciate you.

• 2:21:02Rich Roll?

  The new book is called The 30 Day Alzheimer's Solution.

• 2:21:06Ayesha Sherzai?

  That's right.

• 2:21:06Rich Roll?

  It's available March 23rd.

• 2:21:08Ayesha Sherzai?

  Correct.

• 2:21:09Rich Roll?

  That's pub date, right?

• 2:21:10Ayesha Sherzai?

  Yes, it is.

• 2:21:11Rich Roll?

  Practical guide to help you wrap your head around everything that we talked about today and more importantly, implement those changes into your life. If you want to dive deep into the science and geek out on all of that, I would highly recommend picking up The Alzheimer's Solution, their first book. It's amazing. You can find these guys at Team Sherzai on the internets.

• 2:21:30Ayesha Sherzai?

  That's right.

• 2:21:31Rich Roll?

  And anything else, anywhere else to point people? Is there a website for your nonprofit if people want to learn more about that?

• 2:21:37Ayesha Sherzai?

  HealthyMindsInitiative.org, yes. HealthyMindsInitiative.org and they can contact us and if they're interested in volunteering or having us come to their communities, we'd be happy to do that.

• 2:21:47Rich Roll?

  Awesome. All right, and you guys are welcome here anytime.

• 2:21:50Ayesha Sherzai?

  Thank you.

• 2:21:51Rich Roll?

  Come back and talk to me again, okay?

• 2:21:52Ayesha Sherzai?

  Thank you.

• 2:21:53Speaker 02

  Thank you so much. Thank you.

• 2:21:55Rich Roll?

  Peace.

• 2:21:56Ayesha Sherzai?

  Peace.

• 2:21:57Rich Roll?

  Platts.

• 2:21:59Rich Roll?

  Thanks for listening, everybody. For links and resources related to everything discussed today, visit the show notes on the episode page at richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube. Sharing the show or your favorite episode with friends or on social media is, of course, always appreciated. And finally, for podcast updates, special offers on books, the meal planner, and other subjects, subscribe to our newsletter, which you can find on the footer of any page on richroll.com. Today's show was produced and engineered by Jason Camiolo. The video edition of the podcast was created by Blake Curtis, portraits by Ally Rogers and Davy

• 2:22:44Rich Roll?

  Greenberg, graphic elements courtesy of Jessica Miranda, copywriting by Georgia Whaley, and our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. You can find me at richroll.com or on Instagram and Twitter, @richroll. I appreciate the love. I love the support. I don't take your attention for granted. Thank you for listening. See you back here soon. Peace. Plants. Namaste.