Speaker 1: Medical knowledge now is advancing doubles every seventy three days.
Speaker 1: It's impossible, wow for one doctor or even a team
Speaker 1: of doctors to keep up with everything.
Speaker 2: Prior to joining ATRIA, Doctor David Dotick trained at the
Speaker 2: Mayo Clinic and served on the faculty there for more
Speaker 2: than three decades. At the Mayo Clinic, he founded the
Speaker 2: Neurology Residency Program, the Headache Fellowship Program, the Sports Neurology
Speaker 2: and Concussion Program, the Migraine and Headache Program, and co
Speaker 2: founded the Vascular Neurology Stroke Program. He is a professor
Speaker 2: emeritus at the Mayo Clinic, a consultant for the Mayo
Speaker 2: Clinic International, and a guest professor at the Norwegian University
Speaker 2: of Science and Technology and an affiliate professor at the
Speaker 2: University of Copenhagen. That's a very impressive resume of some
Speaker 2: of your jobs. Doctor David Dodeck is a notable neurologist,
Speaker 2: a prolific researcher, and the founder of multiple programs to
Speaker 2: treat brain injury and disease. In other words, an expert
Speaker 2: on the brain. I wanted to talk to him today
Speaker 2: about brain health because, to paraphrase a quote he shared
Speaker 2: it doesn't help to live longer if the brain isn't
Speaker 2: in good shape. And I think all of us know
Speaker 2: that absolutely inherently, and I know that we all have
Speaker 2: questions about risk factors and warning signs for dementia, stroke
Speaker 2: and other brain diseases. So we will cover all of
Speaker 2: that today. Welcome to my podcast, Doctor Dodeck.
Speaker 1: Martha, it's a thrill to be here.
Speaker 2: Thank you so very very much. Now for clarity, I
Speaker 2: recently enrolled in the ATRIA program. This is and maybe
Speaker 2: doctor Dodeck can just describe it very simply for all
Speaker 2: of you. What is exactly a TRIA?
Speaker 1: Exactly? ATRIA is kind of a preventive healthcare ecosystem that
Speaker 1: seeks to translate science into medicine real time. What I
Speaker 1: mean by that as the Institute of Medicine has estimated
Speaker 1: that it takes about seventeen years for something that's validated
Speaker 1: in research to actually make it to the bedside in
Speaker 1: clinical practice. So we're looking to translate science and technology
Speaker 1: because it's advancing so rapidly real time to prevent, reverse,
Speaker 1: stop or delay the chronic diseases that reduce our longevity,
Speaker 1: you know, chronic diseases right now ninety five percent of
Speaker 1: people over the age of sixty have at least one
Speaker 1: chronic disease, and about eighty percent have at least two.
Speaker 1: And chronic diseases account for seventy five percent of not
Speaker 1: only a health care spend in this country, but seventy
Speaker 1: five percent of the deaths. So if we can stop
Speaker 1: those chronic diseases, we can extend healthy lifespan and importantly
Speaker 1: brain span.
Speaker 2: So what are the top six chronic diseases that you're
Speaker 2: talking about.
Speaker 1: I'm talking about diabetes and other metabolic diseases that may
Speaker 1: be related to diabetes. I'm talking about neurodegenerative disease like
Speaker 1: Alzhema disease, Parkinson's disease, We're talking about cancer. We're talking
Speaker 1: about cardiovascular disease. Those are those are the four one
Speaker 1: biggest ones. And there are other chronic diseases like arthritis,
Speaker 1: which is very common of course. So those are really
Speaker 1: five major chronic diseases that we can do so much
Speaker 1: about today, and so many Americans right now are suffering
Speaker 1: from them. Medical knowledge now is advancing doubles every seventy
Speaker 1: three days. It's impossible, wow, for one doctor or even
Speaker 1: a team of doctors to keep up with everything. So
Speaker 1: it's called like an onion, a core group of internal
Speaker 1: medicine specialists surrounded by specialty pods, and then surround that
Speaker 1: with what we call the Atria Academy of Science and Medicine,
Speaker 1: which you have access to, which we have access to.
Speaker 1: And the people on this are really key opinion leaders
Speaker 1: across many medical and surgical disciplines. And the idea here, Martha,
Speaker 1: is that we can tap them, these experts around the
Speaker 1: world to get current best thinking on whatever issue, topic
Speaker 1: or question that might arise.
Speaker 2: But you have written so many fantastic articles, you have
Speaker 2: done so much research in a variety of very amazing
Speaker 2: medical fields. Do you ever stop to think what's happening to.
Speaker 1: All of us? I do. I stop to think every day.
Speaker 1: But I've never been more excited about the pace of
Speaker 1: medicine and the future of medicine than I am today.
Speaker 1: I'll really great, and I've learned more in the past
Speaker 1: two years than I think I've learned in the past twenty.
Speaker 2: Really, what is that from you? Things that I just think?
Speaker 1: It's the pace with which advances are happening, you know,
Speaker 1: like I said, if medical knowledge is doubling every seventy
Speaker 1: three days. Then you have an insatiable appetite for learning.
Speaker 1: You just can't get enough of it. So, and as
Speaker 1: the chief medical Officer and chief Science Officer, is my
Speaker 1: job to stay abreast of all of the things that
Speaker 1: are happening or as many as I possible.
Speaker 2: How many physicians are affiliated with ATRIAB forty five forty
Speaker 2: full time physicians. You say in us that we can
Speaker 2: transform medical care from sick care to health care and
Speaker 2: be a model that others will evaluate and scale so
Speaker 2: that healthy lifespan is extended for as many people as possible. Yes,
Speaker 2: So I'm a firm believer in that. Yeah, And I
Speaker 2: think that it is so important for us to think
Speaker 2: about living not anti aging, but aging gracefully and healthfully.
Speaker 1: Healthy lifespan, that's what we're talking about. Soever, however many
Speaker 1: years you have, make those years healthy years where you
Speaker 1: can cognitively you have your full cognitive capacity, physical capacity,
Speaker 1: mental health capacity, because it's about happiness, happy happiness span
Speaker 1: as I like to say, play span and brain span.
Speaker 1: So it's keeping pilled people as healthy as possible for
Speaker 1: as long as they live.
Speaker 2: What is the average lifespan today.
Speaker 1: In the United States, it's about seventy seven years. But unfortunately,
Speaker 1: despite the fact that we outpace every OECD country in
Speaker 1: terms of technology, the science and technology in the United
Speaker 1: States is just staggering. What we have here and the physicians,
Speaker 1: the quality of the medicine is remarkable, and yet we're
Speaker 1: falling behind on every metric of health, whether it's infant
Speaker 1: mortality or whether it's lifespan. But right now it's about
Speaker 1: seventy seven years. It's a little bit different in women,
Speaker 1: so it's longer in women, so it's about eighty two years,
Speaker 1: and women about seventy seven, seventy eight in men.
Speaker 2: I like to give people at least some hope and
Speaker 2: some guidance and what they can do to extend that lifespan.
Speaker 2: What is the worst thing a person can do to
Speaker 2: bring on an early demise?
Speaker 1: Not move, not move, not move, So physical movement and
Speaker 1: cognitive exercise. So physical exercise and cognitive exercise, if you
Speaker 1: did nothing else, that is crucial, okay, or brain held
Speaker 1: for heart health and for longevity.
Speaker 2: And what you should not put in your body.
Speaker 1: So I don't put saturated fat in my body. I
Speaker 1: hardly put any alcohol in my body. And I don't
Speaker 1: put red meat in my body. Not that I'm saying
Speaker 1: I don't want anybody to think that red meat is
Speaker 1: necessarily bad, but I just happen not to put red
Speaker 1: meat in my body. So those are perhaps the three
Speaker 1: things I don't put in my body, and I would
Speaker 1: counsel my patients to think about alternatives in their diet.
Speaker 2: I was recently speaking to a doctor from Europe who
Speaker 2: has a list, and top of his list is alcohol. Yeah,
Speaker 2: top above heroin and cocaine.
Speaker 1: Well, alcohol, Martha, according to the World Health Organization, is
Speaker 1: a carcinogen, right, And no amount of alcohol, unfortunately, is good,
Speaker 1: good for you or good for your brain. So as
Speaker 1: a neurologist, if you cannot consume alcohol, that would be
Speaker 1: a good thing. However, risk factors are stackable. So if
Speaker 1: you keep yourself healthy, if you're exercising, and you're following
Speaker 1: a diet that's been shown to reduce the risk of
Speaker 1: cognitive decline in dementia, and you're managing your numbers as
Speaker 1: I like to call it, your blood sugar, your blood cholesterol,
Speaker 1: your blood pressure, you're screening for cancer. Right. If you're
Speaker 1: doing all of those things, if you're doing everything else, right.
Speaker 1: I don't want people to think they came to have
Speaker 1: a glass of wine or a glass of champagne. But
Speaker 1: alcohol to excess is definitely not good for your brain.
Speaker 2: So I've heard that forty five percent of dementia can
Speaker 2: be prevented.
Speaker 1: That's true, and you know the Lancet Commission, which published
Speaker 1: that report just several months ago. It's interesting that back
Speaker 1: in twenty seventeen they said thirty five percent. Four years later,
Speaker 1: it's forty percent. Four years later, like a few months ago,
Speaker 1: it's forty five percent. And they didn't even consider things
Speaker 1: like diet, things like gut health. So what are they saying.
Speaker 1: They have identified these fourteen modifiable risk factors, and it's
Speaker 1: gone from ten to twelve to fourteen. And every time
Speaker 1: they increase by two the number of risk factors you
Speaker 1: should target, it increases by five percent the decrease in dementia.
Speaker 1: So that's powerful when you sit back and think, Okay,
Speaker 1: the United States right now we have about seven million
Speaker 1: people with Alzheimer's disease, but we have close to fifty
Speaker 1: in the early stages at least with the pathology in
Speaker 1: the brain.
Speaker 2: Eighty million.
Speaker 1: Yeah, and they don't know it yet.
Speaker 2: Oh, because our total population here in the United States.
Speaker 1: Is three fifty or somewhere around there, So it's horrifying.
Speaker 1: And you know, we've got fifty million across the globe
Speaker 1: and it accounts for about eight point five trillion dollars.
Speaker 1: So if we can if you imagine if almost half
Speaker 1: of dementia is preventable if you attend to these modifiable
Speaker 1: risk factors, in addition to other risk factors that we
Speaker 1: know are important, like diet, like sleep, like perimenopause and
Speaker 1: how that's managed, like gut health. And I can go on, Wow,
Speaker 1: I guarantee you that in another four years it's not
Speaker 1: going to be forty five percent anymore. It's going to
Speaker 1: be something higher than that. So I'm very optimistic.
Speaker 2: But how can we educate the public to these facts.
Speaker 1: It's going to take just a public a massive public
Speaker 1: awareness campaign. And we've seen how successful they've been in
Speaker 1: the past, whether it's in autism or whether it's in tobacco,
Speaker 1: or whether it's an HIV. We've seen how successful these
Speaker 1: public awareness campaigns in terms of raising awareness. I think
Speaker 1: that's what we have to do here. The American Heart
Speaker 1: Association has done a phenomenal job in raising awareness of
Speaker 1: the risk factors around cardiovascular disease and heart health. We
Speaker 1: have to do the same thing with the brain.
Speaker 2: Given how rapidly research is coming out about how lifestyle
Speaker 2: impacts health. Is there an intervention or a strategy in
Speaker 2: the past two years that you're excited about that isn't
Speaker 2: yet widely distributed to the public.
Speaker 1: We'll just give you an example, Martha. We've been talking
Speaker 1: about diet. So there's this diet called the mind diet,
Speaker 1: which is a combination of the Mediterranean diet and the
Speaker 1: diet to stop hypertension. It's called the mind diet. And
Speaker 1: there are studies that looked at this mind diet showing
Speaker 1: that if you follow this rigor, you drop the risk
Speaker 1: of cognitive decline by about fifty three percent.
Speaker 2: Wow, it's just a diet, right, And what do you think?
Speaker 1: I think it's real. It's the diet that I follow.
Speaker 1: So if you and there's a lot more research to
Speaker 1: be done, but just take that alone. Physical exercise, no question,
Speaker 1: it's the best drug if you will, It's the best
Speaker 1: prescription that I could write. Cognitive exercise. People underestimate the
Speaker 1: power of cognitive exercise. I'll give you an example we
Speaker 1: recommend a program. No disclosure here, no affiliation to brain
Speaker 1: age Q. It's one of a number of platforms that
Speaker 1: challenge you cognitively. It's not like Sudoku or a puzzle
Speaker 1: like that, but it's more it's designed to enhance processing
Speaker 1: speed and memory, et cetera. People who have stuck with
Speaker 1: that reduce the risk of dementia by about twenty nine percent.
Speaker 1: So I could go on and on in terms of
Speaker 1: interventions that I'm excited about, but just some of the
Speaker 1: low hanging fruit are and sleep is another one.
Speaker 2: Now that's my big problem.
Speaker 1: Sleep is a risk factor for so many things, from
Speaker 1: heart disease to dementia, to hypertension, blood high blood pressure.
Speaker 1: It's a serious problem. And many Americans have a problem
Speaker 1: with sleep, and it gets worse as we age.
Speaker 2: I always have. It's horrible.
Speaker 1: And so there are many ways which we can treat
Speaker 1: insomnia and sleep disorders effectively. But sleep is really really important.
Speaker 1: If I if I told you one night of sleep
Speaker 1: deprivation really shuts down your memory organ in your brain,
Speaker 1: the place where you put files, in the place where
Speaker 1: you store files and store memory. Just one night of
Speaker 1: sleep deprivation. Now I'm not a great one to talk.
Speaker 1: But I wear this because I do monitor my sleep,
Speaker 1: and yeah, you're going to hell.
Speaker 2: I should be wearing mine. Say I'm not wearing mine.
Speaker 1: And just tracking how because it's a very powerful motivating factor.
Speaker 1: When I look at my sleep, open showed me.
Speaker 2: The aura ring right, Yes, it's the it's oh, you
Speaker 2: are a right.
Speaker 1: And there are many different types of trackers.
Speaker 2: So it tells you what exactly. It tells you how
Speaker 2: many hours you slept.
Speaker 1: Tell me how many hours you slept, how many how
Speaker 1: much you slept in rem sleep or rapid eyebooment or
Speaker 1: dream sleep if you will, deep sleep, which is really important.
Speaker 1: What's your heart rate and oxygen was during stay?
Speaker 2: You better get my r ring out? Now? What do
Speaker 2: you do for physical exercise?
Speaker 1: I tried to do both aerobic as well as resistance
Speaker 1: training sometimes what we call circuit training, which is both
Speaker 1: at the same time. I think it's really important. Both
Speaker 1: are really very important, and both have been shown unequivocally
Speaker 1: to promote healthy lifespan as well as to promote brain
Speaker 1: span if you will, or cognitive health. So I think
Speaker 1: resistance training is you can either use your body for that,
Speaker 1: like push ups or lunges or free weights or bands,
Speaker 1: but I think resistance training to keep muscle mass because,
Speaker 1: believe it or not, muscle secretes hormones and chemicals that
Speaker 1: are actually important for brain health, so really important, and
Speaker 1: it also prevents frailty over time. Right, So you know,
Speaker 1: resistance training an aerobic training. There was a study done Martha.
Speaker 1: It's called a finger study because there's five fingers and
Speaker 1: it was back about ten eleven years ago. It's a
Speaker 1: landmark study where they took sixty to seventy seven year
Speaker 1: old people who were at risk for dementia but who
Speaker 1: were cognitively normal, and they did five interventions. One was
Speaker 1: just social connectedness, right, just put them in groups or
Speaker 1: just to increase the amount of social interaction they had.
Speaker 1: Another one was managing their risk factors blood pressure, blood sugar,
Speaker 1: blood cholesterols.
Speaker 2: All of that include managing blood pressure. Do you have
Speaker 2: to take blood pressure medicine?
Speaker 1: No, you don't have to take blood pressure medicine. Many do.
Speaker 1: But if you weight is a big one. So if
Speaker 1: you lost weight and if you had a very low
Speaker 1: sodium diet, there are things that you can do like
Speaker 1: that that can keep controlling.
Speaker 2: Your Then environmental pressures. You can't really monitor that.
Speaker 1: No, you can't monitor that, but there are devices now
Speaker 1: where you can actually monitor your blood PRESSU sure, and
Speaker 1: so you can see you at a snapshot over the
Speaker 1: course of a week what your blood pressure has been.
Speaker 1: That is the single most important risk factor for stroke
Speaker 1: and heart attack. And so knowing your number and knowing
Speaker 1: what your numbers should be i e. Less than one
Speaker 1: twenty over eighty and accepting nothing above that is crucial
Speaker 1: for brain health and for heart health. And that's so
Speaker 1: these five fingers people who followed it had a fifty
Speaker 1: percent greater reduction in cognitive decline or the five fingers,
Speaker 1: so vascular risk factors, okay, right, Social connectivity, so physical
Speaker 1: cognitive exercise, nutrition, the diet, so the mind diet was
Speaker 1: it was actually a Norwegian diet. What looks almost identical
Speaker 1: to the mind diet, So diet, physical cognitive exercise, managing.
Speaker 2: Those already looks up mind diet.
Speaker 1: So those five things, just those alone made a dramatic
Speaker 1: difference over the course of just two years and reducing
Speaker 1: the risk of cognitive decline and dementsion.
Speaker 2: YEA, how much does the role of genetics play when
Speaker 2: it comes to dementia and other neurological conditions.
Speaker 1: It plays a role, but you know, the sort of
Speaker 1: rule of thumb, Martha, and there's no real science behind this,
Speaker 1: but by and large it's true. Eighty percent of brain
Speaker 1: health and eighty percent of longevity is lifestyle. It is
Speaker 1: maybe twenty percent is genes. But you know, there's this
Speaker 1: phenomenon known as the gene environment interaction. So if you
Speaker 1: don't sleep, if you don't manage those risk factors, if
Speaker 1: you don't move, if you're exposed to toxicans in the environment,
Speaker 1: if you smoke, if you drink a lot of alcohol,
Speaker 1: you change the expression of genes, so you might turn on,
Speaker 1: for example, like bad sleep will turn on genes that
Speaker 1: increase the risk for cancer or cardiovas heart disease and
Speaker 1: decrease the expression of genes that are responsible for your
Speaker 1: immune system. So there's a powerful role between the environment
Speaker 1: in which genes are expressed. Is there some really exciting
Speaker 1: work being done now that there are some genetic risk
Speaker 1: factors for Alzheimer's disease, But some of these new targets
Speaker 1: that are being tested, these druggable targets as we talk about,
Speaker 1: that may find their way into clinical practice in the
Speaker 1: not too distant future completely neutralize, at least in animals,
Speaker 1: the effect of bad genes. So genes, yeah, important, responsible
Speaker 1: for about twenty percent of lifespan and brain span, if
Speaker 1: you will. But how you live your life has a
Speaker 1: powerful influence on whether those genes, those bad genes will
Speaker 1: actually be expressed versus the good genes that you want expressed.
Speaker 2: I've read that women are at higher risk for dementia
Speaker 2: than men. Is that's true?
Speaker 1: That is true?
Speaker 2: Why?
Speaker 1: Good question. We think it has a lot to do
Speaker 1: with hormones, particularly during that periman apostle phase where there
Speaker 1: is kind of a precipitous drop in estrogen. So hormones
Speaker 1: definitely play role. They're estrogen and progesterone receptors all over
Speaker 1: the brain, so I think you know there's a hormonal
Speaker 1: influence to this. There may be other risks as well.
Speaker 1: Hormone therapy is important to at least have a conversation
Speaker 1: with your doctor if you're in early in the early
Speaker 1: perimid apostle phase, because estrogen may be protective for the brain,
Speaker 1: so it's important. There as a lot of nuances there,
Speaker 1: but it's important to at least have that conversation with
Speaker 1: your doctor. Women are also at a higher risk of
Speaker 1: other diseases that may affect the brain, like diabetes, like
Speaker 1: heart disease. So all of these things. You can think, Martha,
Speaker 1: of the our health as a house. The brain sits somewhere,
Speaker 1: the heart sits in another house, but they're all connected,
Speaker 1: and so if one organ is sick, it makes the
Speaker 1: whole house sick. If one room is sick, it makes
Speaker 1: the whole house sick. So I think because women are
Speaker 1: at a higher risk for many of the diseases that
Speaker 1: affect the brain, and they go through these fluctures, you know,
Speaker 1: hormonal stages during their life, I think that's partly why
Speaker 1: they're at an increase risk.
Speaker 2: I had a very good doctor long time ago who
Speaker 2: put me on an estrogen and I've been on it
Speaker 2: for but sixty years or something, and I think it
Speaker 2: served me well. Yes, because good skin, good hair, good.
Speaker 2: My brain's pretty good. I think, if I'm interested in
Speaker 2: brain health and not an ATREAM member, what simple tests
Speaker 2: should I ask my doctor to check for during my
Speaker 2: annual checkup?
Speaker 1: He or she should do a cognitive health examination. So
Speaker 1: where are you? What is your baseline? It's not done today.
Speaker 2: Oh it isn't.
Speaker 1: When you go in for your annual physical they don't
Speaker 1: really test your brain health.
Speaker 2: No, they do not.
Speaker 1: They take a chest X ray. They might do it.
Speaker 2: But who would you go to for that? To a neurologist.
Speaker 1: You would go to a neurologist. But also you should
Speaker 1: be able to go to a primary care physician as well.
Speaker 1: So just like you know route there's routine screening for
Speaker 1: heart health, and you know blood pressure and blood glucose,
Speaker 1: the should be routine root teen screening for brain health.
Speaker 1: So that includes maybe some certainly a cognitive test of
Speaker 1: the brain. Right now, we might as well talk about it.
Speaker 1: There are a couple of blood tests right now that
Speaker 1: will actually tell us what the health of the brain
Speaker 1: actually is. Oh wow, So in the future Martha was
Speaker 1: working on that. Oh, there are lots of pharmaceutical companies
Speaker 1: working on that. They are a scientists working on that,
Speaker 1: and a couple are commercially available right now. So, as
Speaker 1: we alluded to earlier, Alzheimer's disease and other nerod degenerator
Speaker 1: diseases begin years to decades before they actually show up
Speaker 1: as symptoms. And imagine a future where when you go
Speaker 1: in and get your blood drawn and you get a
Speaker 1: you know, a blood count done, and you know, you
Speaker 1: get a cholesterol test. Imagine if you've got a test
Speaker 1: for the brain. Yeah, I would love that that determined
Speaker 1: your brain health and that provided you with the opportunity
Speaker 1: to intervene early and maybe never develop the actual disease.
Speaker 1: I think that's the future and that's what.
Speaker 2: We're I went to that laboratory is famous laboratory in Iceland.
Speaker 2: Do you know about that laboratory that reads your genome? Oh? Yes, yes,
Speaker 2: So I did that, oh twenty years of seacode. Yes, yes, seacode,
Speaker 2: and I went through the whole test. They test you
Speaker 2: against the Icelandic population, which is a very protected and
Speaker 2: very small population that I had really no propensity for
Speaker 2: any life threatening diseases in my genome except for maybe obesity.
Speaker 2: So I felt really good about it, But I wish
Speaker 2: I could have that again. Where are there places in
Speaker 2: America now that are reading your genome like that?
Speaker 1: Absolutely, we do it, and we do on every member
Speaker 1: at ATRIA. We do full genome sequencing good as well
Speaker 1: as what we call polygenic risk scoring, because not all
Speaker 1: diseases are due to a single gene or a mutation
Speaker 1: a single gene. They're due to variations in multiple genes,
Speaker 1: So we test people for that to see what diseases
Speaker 1: they're at risk for. We do something called pharmaco genomics,
Speaker 1: which means that we test the genes that are responsible
Speaker 1: for enzymes and proteins in the body that metabolize drugs. So,
Speaker 1: do you know that there are more than three hundred
Speaker 1: drugs common drugs that your genes will determine how you
Speaker 1: metabolize those drugs, or even if then you know that
Speaker 1: now three hundred over three. So we do that testing
Speaker 1: because before I put you on an antibiotic or a statin,
Speaker 1: or an antidepressant or many many other medications, we want
Speaker 1: to know whether and how effectively you metabolize those drugs.
Speaker 1: So we do that, and then we do something where
Speaker 1: we look at about one hundred and sixty seven actionable genes.
Speaker 1: It's one thing to look at the entire thousands of
Speaker 1: genes in the genome. It's another thing to look at
Speaker 1: those for which we need to know the answer as
Speaker 1: to whether you have it or not, because it changes
Speaker 1: the way we surveil you and treat you and treat you.
Speaker 1: So we do that as well. I'll give you. There
Speaker 1: was a recent study in a place where they do
Speaker 1: whole genomes. When singing do all these genetic tests like
Speaker 1: I talked about, forty percent of the people had an
Speaker 1: actionable gene that changed the way they were managed, treated,
Speaker 1: or surveilled. Oh great, Yeah, so it's really important.
Speaker 2: So medicine is becoming more complex and yet more clearer
Speaker 2: and more precise and precise. Yeah, I mean, we can
Speaker 2: preventive medicine right now can be done with such precision,
Speaker 2: molecular precision. It's staggering actually and exciting. Now, what about
Speaker 2: prescribing drugs. I'm terrible about taking drugs. I don't like
Speaker 2: taking things. I don't know why, but I've never I
Speaker 2: just don't like it.
Speaker 1: When it comes to medications. Let's say, when I tell
Speaker 1: people they really need to know their numbers. And when
Speaker 1: I say that, I mean, you really need to know
Speaker 1: how well you're disposing glucose blood sugar. You really need
Speaker 1: to know that. They call Alzheimer's type three diabetes for
Speaker 1: a reason. Oh right, So when we develop insulin resistance
Speaker 1: in our body. Insulin is the drug that takes care
Speaker 1: of glucose and sugar in the body. We really need
Speaker 1: to know and really aggressively manage blood sugar. So knowing
Speaker 1: what your insulin is, knowing what your A one C is,
Speaker 1: and there's been good public awareness campaigns around that is
Speaker 1: really important. Not only that, though, you got to know
Speaker 1: what the target is. So I saw a patient today
Speaker 1: today before coming here, who I saw eight months ago
Speaker 1: whose A one C was six point one, not in
Speaker 1: the diabetic range, certainly in the pre diabetic range and
Speaker 1: unacceptably high in my opinion. So he told me today
Speaker 1: and he was very proud that the lifestyle measures, just
Speaker 1: the lifestyle measures that we instituted, brought his A one
Speaker 1: C down to five point one. Oh, that's great, whole point,
Speaker 1: which is fantastic. That's a lot actually in the normal range.
Speaker 1: So knowing your numbers like blood pressure, blood sugar, blood lipids.
Speaker 1: In the United States right now, there are anywhere between
Speaker 1: one hundred and twenty five to one hundred and fifty
Speaker 1: million with each of those diseases obesity, diabetes, pre diabetes,
Speaker 1: hYP tension, or high cholesterol. And unfortunately, less than one
Speaker 1: in four Americans move enough, get enough exercise, less than
Speaker 1: one in four actually have their high blood pressure managed.
Speaker 1: One and four one and four. So if we just
Speaker 1: that's low hanging fruit, if we just got that right,
Speaker 1: imagine how healthy we would be, and imagine how we
Speaker 1: could extend healthy lifespan.
Speaker 2: And how can we help people do that? Is it
Speaker 2: the hospitals? Is it the how do you get people
Speaker 2: to get that care? I mean, I recently had someone
Speaker 2: who works for me hurt his back. That was four
Speaker 2: weeks ago. Yeah, he really hurt his back. It wasn't
Speaker 2: it wasn't. It's not a joke. He couldn't move. It
Speaker 2: took a month for him to get an MRI with
Speaker 2: the healthcare that he has. Yeah, and pretty terrible.
Speaker 1: Access is a big thing, it is. It's a big thing.
Speaker 1: So access to care is a problem in this country.
Speaker 1: And if you don't have access to care, it's difficult
Speaker 1: for you to know your numbers, and it's difficult for
Speaker 1: you to get expert advice on how to best manage
Speaker 1: those numbers. Having said that, one of the things that
Speaker 1: we're committed to doing is developing modern a book of
Speaker 1: modern medicine made up of clinical protocols that focus on
Speaker 1: each of these things, in addition to fifty other things.
Speaker 1: It has to be very simple, has to be simple.
Speaker 1: It has to be like five pages, and it has
Speaker 1: to be digestible and accessible so that people.
Speaker 2: Can It should be on billboards everywhere.
Speaker 1: Absolutely, no, it should.
Speaker 2: I believe in that so much education and teaching can
Speaker 2: be simplified, not too simple, but simple enough for everybody
Speaker 2: to understand.
Speaker 1: Absolutely. So making this freely available to the public and
Speaker 1: to the medical community will empower physicians, but all also
Speaker 1: empower people.
Speaker 2: Are you working on that? Doctor Dodeck has written how
Speaker 2: many books? Sixteen books or so and varying subjects. You've
Speaker 2: also written nine hundreds to one thousand fantastic articles on
Speaker 2: all kinds of medical subjects. I mean, you're have been
Speaker 2: so prolific. But what get this book out?
Speaker 1: So this is my passion right now. That's book of
Speaker 1: modern medicine.
Speaker 2: That would be so great.
Speaker 1: And make that available to people in a way that
Speaker 1: that it's accessible to them and they can understand it
Speaker 1: and it empowers them to take this mad take matters.
Speaker 2: Into their ouide book.
Speaker 1: Yeah, exactly, a playbook. It's a ways for your health,
Speaker 1: if you will.
Speaker 2: That would be so great. Yeah, okay, I'm looking forward
Speaker 2: to that. What foods contribute most to brain health? Well?
Speaker 1: You know this mind diet that I talked about now,
Speaker 1: Basically it's made up of healthy oils like olive oil
Speaker 1: for example. It's made up of legumes and beans, green
Speaker 1: leafy vegetables. Berries, not so much all fruit. We used
Speaker 1: to say fruit, but it's more berries, especially blueberries, nuts,
Speaker 1: certain nuts like almonds and walnuts. Chicken and poultry is
Speaker 1: actually on that mind diet as well. Those are the
Speaker 1: main things on that mind diet. And as fish, definitely
Speaker 1: fish because omega threes really important for the brain. Most Americans,
Speaker 1: the vast majority of omega Americans are low and deficient
Speaker 1: in omega threes because they just simply can't get enough
Speaker 1: in their diet, unlike if you live in Japan, where
Speaker 1: most of them are, you know, not deficient invite in
Speaker 1: omega three. So if you're if you're deficient in omega threes,
Speaker 1: that's where supplementation can be helpful to get your omega
Speaker 1: three index. We call it up to a level that
Speaker 1: protects your brain and protects your body.
Speaker 2: At what age your human brains start to decline? Is
Speaker 2: there an age or an approximate age, or is it
Speaker 2: declining the minute you're born? Well no, not really, You're
Speaker 2: getting old the minute you're born.
Speaker 1: You know, the human brain really doesn't fully mature until
Speaker 1: early twenties, maybe mid twenties, right, and it's not downhill
Speaker 1: from there. But I will say that brain health as
Speaker 1: well as longevity in general, is recursive. What I mean
Speaker 1: by that is, when you're sixty years old, how healthy
Speaker 1: my body and brain is depended what I did when
Speaker 1: I was in my fifties. And when I'm in my fifties,
Speaker 1: the health of my brain depends on how healthy I
Speaker 1: was in my forties. So you can't go back. Well,
Speaker 1: you can stop, and you can attenuate the progression. But
Speaker 1: it's what when I talk to young people, it's hard
Speaker 1: to compel young people when you say, when you start
Speaker 1: talking about dimension Alzheimer's disease, no thirty year old is
Speaker 1: thinking about what happens when they're seventy or eighty. However,
Speaker 1: what I do tell them and what does compel them
Speaker 1: is who doesn't want a cognitive edge? Who doesn't want
Speaker 1: to be thinking faster, storing more information, having that edge,
Speaker 1: whether it's in their job or in their daily lives.
Speaker 1: And we can do that today. We can enhance cognitive performance.
Speaker 1: And when we're enhancing cognitive performance. Well, ultimately at the
Speaker 1: age of sixty, you'll enter your sixties with a much
Speaker 1: healthier brain. So brain health is recursive in how we
Speaker 1: treat our brain when we're thirty five has a profound
Speaker 1: impact on what happens when you're sixty five and eighty five.
Speaker 1: What's the difference between dementia and natural aging forgetfulness? Well,
Speaker 1: dementia is of course forgetfulness, but it affects activities of
Speaker 1: daily living. You're functionally impaired, whether that's your job or
Speaker 1: whether that's simple activities of daily living. Forgetfulness. You know,
Speaker 1: we all forget things from time to time. I probably
Speaker 1: forgot many things on my walk down here, but I'm
Speaker 1: still able to function and perform in my job and
Speaker 1: in my social life and in my daily life. So
Speaker 1: dementia is what is not is forgetfulness, and it's also
Speaker 1: other cognitive domains like processing speed and executive function, the
Speaker 1: ability to plan and make decisions and solve problems, and
Speaker 1: that starts to impede and affect your job pformance, and
Speaker 1: your ability to actually be socially engaged, in active and
Speaker 1: just care for yourself. That's the difference between dementia and
Speaker 1: just benign forgetfulness.
Speaker 2: Is it true that the brain cleans itself when they
Speaker 2: when it sleeps?
Speaker 1: It is true. One thing I wanted to say is
Speaker 1: we actually, I think one of the things we'll look
Speaker 1: back at, Martha in the future, the fact that we
Speaker 1: treat forgetfulness or cognitive decline as an inevitable consequence of aging.
Speaker 1: I think it's just a failure of our imagination. So
Speaker 1: I really do think that we can keep our brains
Speaker 1: healthy and never outlive our brain sleep. One of the
Speaker 1: real mechanisms by which we think sleep is good for
Speaker 1: the brain, and why sleep deprivation is bad for the
Speaker 1: brain and can lead to dementia, is that when we sleep,
Speaker 1: we open up these channels in the brain and it
Speaker 1: clears out all the toxins and proteins that are released
Speaker 1: during the day. So it does, it's really it does
Speaker 1: form a real function, a housekeeping function in the brain.
Speaker 1: And when you don't sleep, you don't remove all that debris.
Speaker 1: And when that debris settles in, that's not healthy for
Speaker 1: cells in the brain.
Speaker 2: It's crowding.
Speaker 1: It's crowding, and proteins start to clump and misfold and starts,
Speaker 1: and that's toxic. That's deadly to cells.
Speaker 2: Remember you have to clean your house.
Speaker 1: Seven eleven eleven, seven hours and eleven minutes. I got
Speaker 1: to sleep at least seven to eight hours a night.
Speaker 2: And how do you exercise the brain? You talk about exercising,
Speaker 2: I mean for physical exercising, we know, but what about
Speaker 2: the brain exercise? Or what kind of games are really good?
Speaker 2: What kind of thinking is good? Reading?
Speaker 1: Well, certainly reading and Sudoku and all of these different
Speaker 1: puzzles keeps the brain cognitively engaged, but real.
Speaker 2: Which game do you play? What game do you play?
Speaker 1: I use brain HQ, which is what we recommend because
Speaker 1: it's been shown actually to be the best, the best.
Speaker 1: And you know this is the one where I said
Speaker 1: it reduces the risk of dementia by maybe thirty percent
Speaker 1: if you adhere to it. So like twenty to thirty
Speaker 1: minutes a day, that's nice.
Speaker 2: Should I give that to my twelve year old grandson too,
Speaker 2: whose brain is so alive?
Speaker 1: He would love it because it's kind of a game
Speaker 1: and you get better over time and you watch.
Speaker 2: Yourself O the brain HQ. It's online, Yes, oh we were,
Speaker 2: And it says to your IQ it doesn't.
Speaker 1: Test your IC but It measures your processing speed and your.
Speaker 2: Working There's something that was I took it on an
Speaker 2: airplane and then I gave it to him and we
Speaker 2: were competing against each other with for IQ and it
Speaker 2: was so much fun.
Speaker 1: Yeh.
Speaker 2: And he and I just he and I were doing
Speaker 2: very well together.
Speaker 1: Well there you go.
Speaker 2: Yeah, so I was. I was very pleased that I
Speaker 2: was not falling too far behind. But it's so fun
Speaker 2: to do those games. I mean, well, that's one thing
Speaker 2: that I have when I wake up at five o'clock
Speaker 2: or four o'clock. I drew all the stupid puzzles in
Speaker 2: the New York Times. That's okay, right, absolutely, But it's
Speaker 2: taking away from my sleep.
Speaker 1: Well, it's taking away from your sleep. You gotta It's
Speaker 1: all about balance. It's all about balance. I will tell
Speaker 1: you that doing wordal and three is good. Doing wordle
Speaker 1: in three is great.
Speaker 2: You don't know what I'm talking about. Triwordal. It's a silly,
Speaker 2: intense game.
Speaker 1: I'm very proud of myself when I get it in three.
Speaker 1: That usually doesn't happen. But you know, some of the
Speaker 1: other really beneficial cognitive exercises that I tell people to do,
Speaker 1: learn a new language, or take up a musical instrument.
Speaker 1: When you challenge the brain with novel exercise like that,
Speaker 1: that's really really good.
Speaker 2: Okay, that's a very good idea.
Speaker 1: Yeah.
Speaker 2: I have my piano sitting by itself in a room.
Speaker 2: It should be used absolutely. Okay. Well, I also do gardening,
Speaker 2: which is also I think very good for very therapeutic.
Speaker 2: It is, yeah, and it's you can learn a lot.
Speaker 2: I mean I learned so much in a couple hours
Speaker 2: of gardening. Yeah, because I tried to learn the names
Speaker 2: of the plants. I study each plant, and I think
Speaker 2: that's good for people absolutely, And you know, growing things,
Speaker 2: nurturing things, all of that is healthy and good.
Speaker 1: And being around nature like that, being around green is
Speaker 1: a very beneficial thing. Why, which is why I try
Speaker 1: to get in the park as often as possible.
Speaker 2: And I read that rumination is one of the worst
Speaker 2: things for the brain. It's rumination and what is it
Speaker 2: doing to us?
Speaker 1: You know, there's this area in the brain called the
Speaker 1: default mode network because we default to.
Speaker 2: It m N DMN DM.
Speaker 1: Mode network DMN, and this default mode network is particularly
Speaker 1: active in people who ruminate, in people who are depressed,
Speaker 1: and so it's.
Speaker 2: Rumination is not chewing your cut thinking about the same
Speaker 2: thing over and over again, isn't it? Isn't that what
Speaker 2: it is? So why did he go away? Why did
Speaker 2: he go did? Why did we break up? Don't think
Speaker 2: about it? That's what I show people all the time.
Speaker 2: Just don't think about those things.
Speaker 1: Don't never, never have any regrets. Everything happens for a reason.
Speaker 1: So I try not to have any regrets because whatever
Speaker 1: I've done or whatever I've said, you know, it happened.
Speaker 1: I can't have any regrets over something that's in the past. Yeah,
Speaker 1: So don't ruminate about it because it's not going to
Speaker 1: change it.
Speaker 2: You can feel sorry, but you don't have to think
Speaker 2: about it.
Speaker 1: Yeah.
Speaker 2: Right, that's how I feel. I think that's very good
Speaker 2: for oneself.
Speaker 1: Stress is bad for one's brain. Martha.
Speaker 2: I was getting vitiligo when I was going through my divorce.
Speaker 2: I was losing pigment in my skin, and I went
Speaker 2: to a Brazilian friend of mine said, oh, go to
Speaker 2: see this witch doctor in sal Polo, Brazil. So I went.
Speaker 2: I flew all the way to salth Paulo, Brazil, and
Speaker 2: then had to drive up into the mountains and stand
Speaker 2: in line. There's a line like a mile long of
Speaker 2: people waiting to see this doctor, witch doctor. And when
Speaker 2: I told her, and she turned out to be like
Speaker 2: a like a Japanese lady who had been living there
Speaker 2: for many years. And she looked at me and she said,
Speaker 2: what's your problem? And I said stress. She said, in
Speaker 2: my language, we do not have a word for stress.
Speaker 1: Interesting, yeah, and she.
Speaker 2: But she understood that stress was called seeing this discoloration
Speaker 2: of my skin, and and it went away after the
Speaker 2: stress was alleviated, you know. But it was so interesting
Speaker 2: that that that can it can do that to you.
Speaker 2: It's a horrible thing stress.
Speaker 1: There's a thousand different physiological reactions in the body to stress.
Speaker 1: So one of the things we always recommend is mindfulness meditation.
Speaker 1: It can be very effective for sleep. There are devices
Speaker 1: that we call them biofeedback devices. One in particular will
Speaker 1: actually when your mind, it uses EEG sensors on the head,
Speaker 1: and when your mind is at rest, it will play
Speaker 1: soundscapes that are pleasant. But when your mind is distressed
Speaker 1: or stressed, it will play louder clouds thunder right, And
Speaker 1: so what you do.
Speaker 2: Is try to put them on your head.
Speaker 1: Yeah, you try to calm your environment, right, have to
Speaker 1: get those. We'll talk about it when you come.
Speaker 2: What happens to your brain when you're having a stroke.
Speaker 1: Well, it depends. There are two different types of stroke.
Speaker 1: One is where you block a blood vessel in the
Speaker 1: brain and that part of the brain no longer is
Speaker 1: receiving that blood supply, the oxygen, the nutrients that keep
Speaker 1: it alive.
Speaker 2: That's permittent or it can be temporary.
Speaker 1: It can be temporary, and we have treatments now that
Speaker 1: can unblock that and rescue the brain, which is fantastic.
Speaker 1: There's another that accounts for about eighty five percent of stroke.
Speaker 1: A fifteen percent of stroke is when there's a hemorrhage.
Speaker 1: We're bleeding into the brain as an aneurysm. It could
Speaker 1: be from an aneurysm. Sometimes it's from the most common
Speaker 1: cause of hemorrhage into the brain is high blood pressure,
Speaker 1: So not only does it cause hemorrhaging into the brain,
Speaker 1: but it also blocks blood vessels high blood pressure, which
Speaker 1: is why the number one respector for stroke. So those
Speaker 1: are the two different types of stroke. Blockage from a
Speaker 1: blood clot which is much more common, but sometimes hemorrhage
Speaker 1: into the brain from an aneurysm, from a malformation or
Speaker 1: sometimes from just high blood pressure.
Speaker 2: So best things for preventing a.
Speaker 1: Stroke, best thing for preventing a stroke is to keep
Speaker 1: those blood vessels open and healthy and keep that blood
Speaker 1: pressure down right. And sometimes we do screening evaluations where
Speaker 1: we you know, about three percent of people walking outside
Speaker 1: right now, if we walked outside on forty eighth street,
Speaker 1: three percent have an aneurysm. They don't know it, don't
Speaker 1: know it. Wouldn't it be good to know that and
Speaker 1: to monitor that and to intervene when necessary before it ruptures.
Speaker 1: So managing risk factors again, I'll go back to blood pressure,
Speaker 1: blood sugar. Because we have we have big blood vessels.
Speaker 1: Think of the arteries that go to the brain, Martha,
Speaker 1: like a tree. We have a big trunk that goes
Speaker 1: up the neck. We have got four of them, and
Speaker 1: then each of those branch off into smaller and smaller branches.
Speaker 1: Imagine if I told you the tiny blood vessels that
Speaker 1: supply every square millimeter of your brain are supplied by
Speaker 1: a blood vessel the width of a hair in your head,
Speaker 1: and we've got about four under miles of them, and
Speaker 1: we need to keep them open.
Speaker 2: Wow.
Speaker 1: So managing blood pressure, blood sugar, blood, colesterol really important.
Speaker 2: What is the medicine that you talk about t PA
Speaker 2: and how does it work after a stroke?
Speaker 1: So TPA is tissue plasmiagen activator. It's a clockbuster. So
Speaker 1: when someone's having a stroke and they get to medical
Speaker 1: attention quickly enough, we can do test to see which
Speaker 1: blood vessel is blocked and give that patient that clockbuster.
Speaker 1: It revolutionize the treatment of stroke. The first applied it
Speaker 1: can be applied intravenously, so just just through the vein
Speaker 1: you put iv in and give it intravenously, or for
Speaker 1: some people we can actually go in with a catheter
Speaker 1: usually through the groin, not a major surgery, go up
Speaker 1: to the clot and actually retrieve it, or give some
Speaker 1: blood dinner there, or give that TPA, or there are
Speaker 1: other types of clotbusters now where we dissolve that clot.
Speaker 1: So the dissolving of the clot or the pulling out
Speaker 1: of the clot has really transformed the whole field of stroke.
Speaker 1: But the better thing is there are eight hundred thousand.
Speaker 1: When I was in training back more than thirty years ago,
Speaker 1: I was told there are eight hundred thousand strokes every
Speaker 1: year in the United States. And eighty percent of them
Speaker 1: are preventable. Guess how many strokes are in the United States?
Speaker 1: Still eight hundred thousand and even more of them are
Speaker 1: preventable with all the different treatments and knowledge we have now.
Speaker 2: And so what's happening.
Speaker 1: They're not being addressed.
Speaker 2: Oh you know, the doctors are missing them.
Speaker 1: Not necessarily missing them. But again it's regarding access to care,
Speaker 1: and we're not focusing enough on managing them aggressively. Like
Speaker 1: why would one in four people with high blood pressure
Speaker 1: in the United States not haven't managed, Like we're talking
Speaker 1: like fifty percent of the population Martha, that is high
Speaker 1: blood pressure, less than one and four haven't managed.
Speaker 2: It's worriesome.
Speaker 1: But nowadays with digital in our digital environment in which
Speaker 1: we live, where wearables and sensors that we have on
Speaker 1: our body right now can measure and monitor blood pressure.
Speaker 2: But the oral ring doesn't you not yet.
Speaker 1: Not yet. But there are other devices that are becoming.
Speaker 2: What's the best blood pressure device for people?
Speaker 1: Well, blood pressure device is an actual blood pressure cuff.
Speaker 1: But I can tell you that there are devices that
Speaker 1: have become available even recently where you can actually do
Speaker 1: a selfie on your phone and it will measure your
Speaker 1: blood pressure and actually take an EKG.
Speaker 2: Okay, you know what. I love this.
Speaker 1: So imagine most we can't send blood pressure cuffs to
Speaker 1: everybody around planet Earth, but most everybody has a cell phone.
Speaker 1: Can you imagine in seconds getting your blood pressure just
Speaker 1: by taking a cell phone. So that's the future.
Speaker 2: How does that work?
Speaker 1: Well, I guess it's proprietary technology, but this company is
Speaker 1: doing that. Well, there's a company in Canada that's doing that,
Speaker 1: and there are other companies as well. I mean Apple's
Speaker 1: developing this kind of technology. There's one called ai z
Speaker 1: Tech that's developing this technology. So the future look very
Speaker 1: bright in terms of empowering people to be able to
Speaker 1: monitor and measure their own risk factors and take control
Speaker 1: of them. That's where that Book of Modern Medicine is
Speaker 1: going to come in real handy, Martha.
Speaker 2: Yeah, this is to educate, to educate and inform. Yes,
Speaker 2: that is your duty, doctor Joe Dick.
Speaker 1: I'm up for it. I'm up for it immediately.
Speaker 2: What's the number one piece of advice that you would
Speaker 2: like to impart to our listeners today on this podcast
Speaker 2: that will really help guide them?
Speaker 1: How about this? How about a before c a comes
Speaker 1: before C as activities, sleep, movement, diet. Right, those those things.
Speaker 1: B is blood pressure, blood sugar, body fat, and blood cholesterol.
Speaker 1: Those are the bees. Those are the four bees, and
Speaker 1: C is cancer screening. So it's a before C.
Speaker 2: Oh. Great, well, thank you so much. I think this
Speaker 2: will open a lot of people's minds to better care
Speaker 2: for themselves, which we all hope for. We want everybody
Speaker 2: to take good care of themselves. And thank you for
Speaker 2: sharing your vast knowledge with us today.
Speaker 1: It's really great, Martha. Thank you so much for having
Speaker 1: me here. It's been a pleasure in a thrill