Dr. Fatuhi: Episode Link
Book: The Invincible Brain
Transcript:
Colleen: Welcome back, everybody. We are thrilled to have on Dr. Majid Fotuhi today. Welcome.
Dr. Fothui: Thanks very much for having me on your podcast.
Colleen: Well, you know, as I mentioned off air, Bridgett’s father-in-law has Alzheimer’s, my mother has dementia, and I think The Invincible Brain is kind of like an off-ramp on this journey that people assume, if you have a family member that has a cognitive issue you are kind of in a fait accompli, that’s your journey and your book is saying absolutely not. So it’s very refreshing to have that understanding that maybe this is not a doomsday. You’ve been researching gosh, 30 plus years, 40 plus years and you really find that life style is highly indicative of whether we will have cognitive decline as we get older.
Dr. Fotuhi: Absolutely. There are many things we could do to reduce our risk of cognitive decline with aging. I think it’s helpful to look back at history, about how things were done before and how things have changed now. For example, about 60, 70 years ago, many people did not take care of their teeth. And when they got to their 70s and 80s, almosthalf the population had dentures. These days, you don’t see that very often. It is because people realize that there are simple things they could do to take care of their teeth every day, and as a result, they can keep their teeth as they get older. The same applies in your brain. If you do certain things every day to take care of your brain, your brain will be bright and helpful and shiny as well. Your brain is a tissue. It’s an organ. It’s not like a computer that gets old and rusty with aging. It’s an organ. It’s like a garden. You take care of it and it will look beautiful and it will blossom. And if you ignore it and don’t take care of it, then it will not look good. What people don’t appreciate is that they can take care of their brain just like they would take care of a garden.
Bridgett: Right. What was so refreshing when reading your book was that you can always learn new things. And so many people use this excuse, I’m too old, or you can’t teach an old dog new tricks. Can you talk about why you always have the capacity to be a learner?
Dr. Fotuhi: Exactly. Actually, Bridget, you know, a researcher, Dr. Cotman, did that exact study. He took a bunch of old dogs and a bunch of new dogs. And then they provided different interventions for the old dogs. One group just got nutrition. One group got nutrition and brain training. And the third one got nutrition, brain training and exercise. And these dogs, these old dogs, after three months performed better than the young puppies. And after six months, they outperformed the younger dogs. So this expression, that you cannot teach old dogs new tricks is absolutely wrong. The other thing that’s very wrong is to say dementia runs in my family and that it is what it is. We know that late life Alzheimer’s disease has a small genetic component. If your parents develop dementia, Alzheimer’s disease in their 80s, your risk is 2% more. So on average, let’s say someone at age 80 has two to three percent risk of developing Alzheimer’s disease. If they have a parent with Alzheimer’s disease, their risk would be five percent or six percent. Now, what people say, they say your risk is doubled. Well, double the two is four, which means there’s a 95 percent chance that you will be fine. And to put this in perspective, having a family member with late life Alzheimer’s disease, it’s just as bad as poor sleep. It’s just as bad as obesity. It’s just as bad as having uncontrolled diabetes or high blood pressure. It’s just as bad as having stress. In fact, if you have all these other things I just mentioned, your risk is 16-fold higher. So you’re 2% or 3%, then if it’s 3%, it’s 48% now if you have these risk factors. Whereas if you just have a family member, your risk has gone from like 3% to 6%. These are the things that people need to appreciate. Lifestyle choices are more important than the genes you have for late-life Alzheimer’s disease. It’s different for early onset Alzheimer’s disease, which unfortunately does have a strong genetic component. And even then, people can delay the onset of Alzheimer’s disease.
I think more than 90% of late-life Alzheimer’s disease can be prevented. I definitely plan to reach the age of 90 and be sharp and independent because I know it is possible. I’m going to take care of my teeth. I’m going to take care of my heart. I will take care of my brain. And it turns out that most of the things that I have to do for my brain are the same things for my heart anyway.
And those same things are good for my liver and my kidney and my muscles and my bone and my hair and my skin anyway. So there are only a few things that I have to do that are specific for my brain health, which is brain training. What I call five pillars of brain health are 1.exercise, 2.optimal sleep, 3. nutrition, 4.stress reduction, and 5.brain training. And the first four are good for your skin. If you’re in your 50s and you want to have a beautiful skin,
You need to exercise. You need to sleep well. You need to make sure you have a food that’s low inflammatory diet. And you need to reduce stress. And those are the things that are going to keep your skin healthy. And they happen to be the same things that keep your heart healthy. And they’re the same things that keep your brain healthy. So these are no-brainers. You’ve got to do that.
Colleen: I was curious because we have spoken to a lot of experts that deal in hormones. And for women, I believe the statistics are 2/3 of dementia patients are now women. What do you believe the role of hormones play in dementia?
Dr. Fotuhi: Estrogen is neuroprotective, which means that women have an advantage of having estrogen, which helps with their…
keeping their brain healthier. And they lose that advantage during menopause. However, the fact that they have memory problems during menopause has to do with the fluctuations in hormone levels and not necessarily an absolute drop in estrogen level. Most women regain their cognitive abilities after the fluctuations of hormones are settled after menopause. Now, it is still debatable as to why women are more likely to get Alzheimer’s disease. One answer has been, well, women live longer. They don’t usually have as much high blood pressure or muscular risk factors than men do, and they live longer. And the longer you live, the more likely it is that you may develop Alzheimer’s disease. Another theory, which I think is a strong theory, is that women have a very strong immune response. Women’s immune response on average is better than men’s immune response. And that’s one reason that autoimmune conditions, conditions in which your own immune system attack yourself, is more common in women than it is in men. So one theory is that the strong immune system that women have triggers and worsens the problems in the brain that are initiated with these blocks and tangles, which are the collections of proteins that are toxic.
So the story goes that, you know, men and women have plaques and tangles in their brain. Women’s brains are better in attacking anything outside the brain. That’s the things that are not good for the brain. But that inflammatory response, that bringing of this force to kill the plaques and tangles actually causes problems for the innocent bystanders in the brain. And that may be the reason.
I think it’s probably 80% has to do with the fact that women live longer and 20% with the fact that they have a stronger immune system. However, this is a very active area of research and nobody knows the answer for sure.
Bridgett: Yeah, I mean, that is a big thing with us too. And a lot of women debate whether or not they should go on hormones or not, should take menopause therapy or do you have any thoughts on that? Do you feel that might help with the risks of cognitive decline.
Dr. Fotuhi: I’m in favor of women receiving hormone replacement therapy for two or three years during the menopause. That’s what I would do if I were a woman and had hormonal fluctuations. The studies have provided convincing evidence that taking two or three years of hormone replacement therapy reduces cognitive decline decades later.
Also, studies have shown that starting hormone replacement therapy in your 70s is not helpful. It’s only helpful during that window when women have hormonal fluctuations. Again, we need to be mindful of the fact that these are ongoing clinical trials and research. And our recommendations may change 10 years from now. 20 years ago, hormone replacement therapy was a standard protocol. Let me give you a little story. I wrote my first book in 2002. And back then, hormone replacement therapy was strongly recommended to everyone. And in my book, I had three or four pages about the benefits of hormone replacement therapy. And as my book was about to go to print, the study came out that women who have taken hormone replacement therapy were more likely to have strokes and dementia. And, you know, later it turned out that that study had flaws. But because it was such a major study, I had to delete those pages, but we couldn’t just delete it because we had to have same page numbers. So I had to come up with some new information to put on those two, three pages to fill those pages and sort of soften the recommendation for hormone replacement therapy. So, you know, recommendations may change over time, but based on all the things I’ve seen in the past 30 or 40 years, I think that hormone replacement therapy in women who do not have a history of cancer or family history of cancer, it’s excellent. I would definitely do it myself.
Colleen: The role of neuroplasticity you talk about in the book, and I think that’s fascinating. Can you talk a little bit about what neuroplasticity is and how it’s beneficial in our brain?
Dr. Fotuhi: Neuroplasticity means that your brain has the capacity to change and rewire itself at any age.
One of the things that fascinated me about the brain was when my father talked to me about how there is no limit in what our brain can do.
Back then, I was seven or eight years old. And he kept saying, now look around you. Look at people who had stroke or concussion and recovered. Look at people who don’t have arms and have learned to do things with their legs. Their brain has so much capacity to do things at any age. And so you should take advantage of that and learn five languages, get an MD, get a PhD. Just do things with your brain. There’s no limit. You can’t fill it up.
And that’s when I became fascinated. And I’ve been teaching about that and doing research about that all my career. I actually teach a course at Johns Hopkins titled Advances in Neuroplasticity and Its Applications in Neurology. I give 26 hours of lectures about how diet, exercise, sleep, brain training, stress, meditation, pollutions, hearing issues, vision issues, all the many things that can affect the brain every day. And so the bottom line is this, your daily habits can make a difference in your brain a little bit every day. Now, if you do more of the good things for your brain every day, the benefits compound over time and you increase your brain reserve such that when you get to your 70s and 80s, you have a big brain fund. You have a big financial asset that you have accumulated over all these decades. However, if every day you do things that chip away on your brain and shrink your brain, like too much stress, poor sleep, sedentary lifestyle, eating junk food, they chip away on your brain at a microscopic level every day. And if you do have the same lifestyle over time, your brain gets smaller and smaller. This is not just theory.
Hundreds of studies have shown that poor lifestyle choices shrink the brain so much so you can see it on brain MRIs. So, for example, people who sleep fewer than six hours a night for two years, the brain is okay. You can’t see measurable differences. However, if they’ve had it for 10, 15, or 20 years, the brain, especially the part of the brain from memory called hippocampus, which is usually the size of your thumb, becomes half its original size.
If you add poor diet and a sedintary lifestyle, then it can be smaller and smaller. And that’s when people lose their marbles and become demented. You know, dementia doesn’t happen out of nowhere. Dementia is happening because of risk factors. Having a family member is a small risk factor for late-life Alzheimer’s disease.
All the other things I just talked to you are either risk factors or protective factors. And that’s why I think it is possible to reach the age of 90 and be sharp and independent. Because if you do all the things that keep growing your brain, your brain will be very healthy and very strong. Just like I mentioned earlier, you take care of your teeth every day, there’s no reason that you lose your teeth when you get to your 70s and 80s. And the same applies to your brain.
Bridgett: And you do, you have some great examples in the book. I mean, your example about the reserve it’s like living paycheck to paycheck. And then if a disaster strikes, you have nothing left in your reserves. So then when you apply that to your body and your brain and what is happening, it really made sense. And you had some great examples too, about if you had a blood test done, like I did with 23 and Me. It told me I had one marker for late onset Alzheimer’s.
But when you read a book like yours and you just think there are so many things that I can do to make sure that that never happens. And you had an example of a woman that had this done as well. Could you talk about that? She’s in her 90s now.
Dr. Fotuhi: Yes. So there’s a genetic test for apolipoprotein E that’s associated with a high.
risk of developing Alzheimer’s disease. However, you have to realize increased probability does not mean you will get the disease. Unfortunately, when people open up the results and they see that they have a gene for Alzheimer’s disease, they don’t hear anything else. They just hear they have a gene for Alzheimer’s disease and that they will get the Alzheimer’s disease itself, which is unfortunate.
Just doing exercise itself can neutralize the effects of this bad gene. Now, one patient I talk about in the book, who’s actually my dear friend now, and she has given permission to talk about this in public, and she did a documentary about it herself, actually, is Jean Carper. She was in her early 80s when she came to see me in 2012.
And she had seen my publications and she flew from Key West, Florida to Baltimore to see me at Johns Hopkins. When I did my evaluations of her, I was so impressed. She was like 80 something and her brain performance was like someone in their 50s or 60s. And I give her a list of 12 things to remember. I think she remembered like eight, which is above the expected level for age.
I said, Jean, honey, you don’t have Alzheimer’s disease. What are you talking about? You’re sharper than most people. You may have a gene that increases the probability of Alzheimer’s disease, but you probably have 10 genes that are neuroprotective. But we don’t know what those genes are, and we haven’t tested you for those. So on balance, you have one bad gene, but you also may have good genes. And she has a lifestyle that is consistent with my five pillars of brain health. She’s very active.
She’s eating healthy. She has low stress. She’s always learning things. And to her credit, she put together a beautiful documentary, and she interviewed the top 20 experts in the country. She went all around the country, and she did professional recordings, and she put a documentary called The Monster in the Mind, talking about Alzheimer’s disease.
And it was incredible, an incredible documentary. It’s available on YouTube. You can watch it. And she actually has, you know, clips of my interview with her. So the bottom line, she’s now 93, 94. I talked to her recently. She has an art exhibit in Key West. And she’s full of life like she was back then. And she’s independent. She has her place.
And she’s living life to the fullest.
Bridgett: Yeah. You know, when you had your list of role model things, I was like, she’s a role model. I mean, she’s a role model.
Dr. Fotuhi: I want people to appreciate that it is possible to have a sharp and brilliant brain at any age. And they should not say,” ah, I’m in my 60s. What do you expect? Or I’m in my 70s. I can’t do this.” The moment you have that attitude, you challenge your brain less. And the less you activate your brain, the more it shrinks. Your brain is like a muscle. The more you use it, the stronger it gets. The less you use it, the more it atrophies. So work on your brain. Visualize your brain. I always tell people, try to have a beautiful brain.
And there’s no Botox for the brain. But there are lots of things it could do to make your brain healthy. I’ve seen at least dozens of brains, real-life brains. When I did my rotations in neuropathology for three months, that’s what we did every day. Chop brains, look at a microscope. Somebody had died of cognitive decline. Did they have Alzheimer’s disease in their brain or not? Stroke, MS, different things. And we would take the brain out of the skull, put it in formaldehyde, and chop it and look at it, look on the microscope. And the one thing I always remembered was the way the brain looked. It was a reflection of how the brain had functioned in life when a person was alive. Some brains, even in their 80s, still look pretty. They look vibrant, shiny colors, beautiful. And the brains, some other brains look…
dark and dusty and dried up like a walnut and stiff. And the blood vessels were like little pipes. They had little malleability. And I didn’t have to know the brain, that person’s history to know they were not doing well before they died. And what determines if your brain is healthy, beautiful, shiny, or crippled, dusty, dry, and hard has to do with your lifestyle choices.
And all the things we know from smoking, diabetes, high blood pressure, too much stress, poor sleep, sleep apnea, all those things, you know, make the brain dustier, darker, smaller, harder. And the more of them you do, I want to use the word earthly, but it’s not a pretty scene. I have held real brains in my hand and it’s not a pretty scene.
I wish I could have a program where people can visualize the brain and see how beautiful it looks. Because it is a beautiful thing. The brain is a beautiful thing. And neurons are so beautiful. I mean, I’ve seen millions of neurons on the microscope. And these neurons have like a cell body and have a tall, long tail.
You know, it’s like 50,000 times the size of the cell body, the long tail, and they have millions of little branches. All these branches are filled with little spots where the synapses are. It’s a beautiful thing. And then this beautiful thing can look half as beautiful in people who have high sugar diet. You know, studies in animals have shown that
uh if you put an animal in four weeks of high sugar diet and then look at the neurons before and after the healthy neurons have this beautiful cell body, millions of little spots where the synapses are a long tail with branches of a tree and the high sugar ones have has half as many spots they look shoveled at this at the cellular level. Of course, the same applies to the whole thing. When researchers want to generate a model of aging in animals, you just put them on a high sugar diet. Imagine that. If they want to create a model of aging with poor joint health, brain health, eye problems. If they want to generate a model of aging animal quickly.
You just put them on a high sugar diet for 12 weeks. And those animals brain becomes the same as an animal brain that’s like, you know, 20 years older.
Colleen: Can you talk a little bit about gray matter and white matter in the brain? Because I think that’s something people say, oh, they found white matter in an MRI or something. And how that plays, if it does play a role in brain health.
Dr. Fotuhi: The outer layer of the brain is called the cortex, like a blanket that covers all our brain areas. And then inside the brain, there are nuclei or structures that are filled with cells. You know, I do this teaching at Hopkins and other places. I take two apples and two pears and two bananas and a bowl. And I put those in the middle and I named the different organs inside the brain, different brain structures.
The bowl on top to talk about the cortex and these other structures. I have two cucumbers for hippocampus, and I told you the size of thumb, one on the right, one on the left. So I put all of them, they name all of them, and I put the bowl on top. So these brain structures are high in density of cells. However, the cortex has connections with these deeper brain structures through fiber bundles. They’re like little ropes that connect specific parts of the cortex to a specific part of these brain structures deeper in the brain. And of course, some of these structures have connections with themselves. The fiber bundles, the ropes, are called the white matter.
And the cell-dense areas, the cortex and the other brain structures, are called gray matter. Because they have more cells, if you look at them, they could look grayish. And the fiber bundles have this sheet of protection insulation called myelin that has a glossy whiter color. It’s called white matter. Now, what happens is that the gray matter is on top.
And a white matter is like bridges that connects the cortex and the subcortical areas. Now, sometimes on MRIs, they say that somebody has a white matter disease. And this means that the connections are damaged. And sometimes they see problems with gray matter. The gray matter is smaller. And that’s because the cortex and other brain structures have become smaller.
You can do something about it right now.
Bridgett: Let’s say you had an MRI and it’s telling you things don’t look great, but there are things that you could do. Like if I went in at 58 years old, I’m 58 years old. And let’s say somebody said that I don’t have to just resign my life to, well, this is it. I can do things about that. Could you share some things that I could do?
Dr. Fotuhi: The point is that your brain has neuroplasticity, your brain has malleability. You can change your brain structure at any age with lifestyle interventions. For example, drugs can really shivel the brain by a lot quickly. Things like cocaine can literally shrink the brain quickly. And high sugar can do that. And exercise can grow the brain. MRI studies have shown, for example, that if you exercise even for three months, you can see measurable differences in the size of the hippocampus, so much so you can see with naked eye on a brain MRI. So you get an MRI, you made the bowl, and you can see the two little cucumbers, and then you ask people to do 45 minutes of intense cycling three times a week, and you do another group that just plays football.
Because they’re active too, but not to the same level as intense cycling. And then you do MRIs at the beginning and you do MRIs three months later. Not three years later, three months later. And then you do MRIs before and after. And because hippocampus is such a structure with clear boundaries, you can actually measure it. And you can see with naked eye. I have pictures of that in my class. I show it to students. I say, this is MRI and this is MRI. Here’s hippocampus and here’s hippocampus. Which one is bigger?
And the whole class points to the one from the hippocampus of people who had exercised. And so this is what I find exciting. And this is what I talk about a lot in my book, The Invincible Brain, of how your daily choices can have a huge impact on your brain in a short amount of time. You know, I have a 12-week program because the things I do for my patients can produce remarkable results for patients in 12 weeks.
Colleen: And you talk about memory, that there are key steps to creating and retaining memories. And as someone who absolutely fails the names test, which you talk about in the book, I found that really helpful. The tricks you give are tips on how to remember things like names. But the key steps you talk about are acquisition, consolidation, storage, and retrieval. Can you break those down for us?
Dr. Fotuhi: Yes. First of all, I think the mistake people make is to say, I’m not good with names. You kind of just did it.
Colleen: Oh, yeah, absolutely.
Dr. Fotuhi: And I think people need to stop doing that. I hope this is the last time you ever say that.
Colleen: Me too.
Dr. Fotuhi: Because if I gave you $10,000 for every name you remembered, I don’t think you would see someone and say, I can’t remember the name.
Imagine I have a stack of $100 bills and I’m going to say, please go to that room and memorize Dr. Fatouhi’s name. It’s not the easiest name. And you come back. You say it’s M-A-J-I-D-F-O-T-U-H-I Majid Fatouhi. Boom. Here, you get $10,000. You will not say I’m not good at it. And I think the people often make the mistake of thinking that they just have to remember the name because they heard it once and they don’t remember it, therefore there must be a problem. When I give lectures in large audiences around the world, I’ve been to 40 countries. I often ask people, “how many of you have difficulty remembering names?’ And more than 90% of the audience, of all sizes, sometimes there are 20, sometimes there are like 5,000 people, 90% raise their hands. Is it possible that 90% of the population has a disease? No. But the 90% of the population has this “I believe that they must remember names just because they heard it once.” Our brain is good at remembering things that are emotional. Like if I were King of England or someone, a royalty, and you would talk with me, chances are you’d remember my name very easily as opposed to, you know, someone that deserves just a book and is an author.
Or you remember the day that you got married or when you had a baby or when you finished high school or your graduation. You really remember things easily that are emotional. And it’s a good system to have. You don’t want to remember every lunch you ever had, every dress you ever wore, every person you ever meet. That’s not practical. Our brain is designed to remember things that are important to our survival, important to our daily lives and most things aren’t. So the system is actually a good system. There’s nothing wrong with that system and so if you go to a party and you meet 20 people and most likely you know you will not see them again, there’s no physiological reason for us to remember those names, however, we have the capacity to remember their names just like we have the capacity to play the piano or we learn how to make a beautiful
painting or to cook a delicious meal. These are all skills that we can get better at with practice. So please, don’t you ever say I’m not good with names. I am good with names. It’s a self-fulfilling prophecy. People say I’m not good with names. Then they see someone.
They don’t remember the names because they just heard it once and it’s gone. And they’re not lying. And they consider it a failure. It’s not a failure. It’s a normal physiological process for us to only remember things that are emotional, things that are really important. So then our brain, you know, usually we hear the information, register the information, then we consolidate it in part of our brain called the hippocampus. That’s where the information gets consolidated. And then the information is sent to our cortex for storage. So the place where information is consolidated is different than a place the information is stored. It’s like a librarian that you know gets a lot of books and journals and decides which one goes to the trash and which one needs to store but the storage is in some places other than where the librarian sits. Now, when we meet someone we need to go through that process and make sure that the information gets consolidated. That’s an important process. The important step. So let’s talk about how to memorize names. I think it’s a practical thing. I have a mnemonic called N-A-M-E, name, for helping people remember how to memorize names. N stands for notice. If you see someone like me, notice something about me.
Like you may notice, for example, that I may have a little accent or that my eyebrow may be a little thicker or something about me. Just remember something. Notice something about me because you want to make that emotional connection. You need something about me that’s unique to me that’s different from Ricardo Edwards or John McIntosh or somebody. Something about me. You notice something before you talk.
You want to zoom your attention to me. You want to acquire information. So then is when you ask, so what’s your name? Like you introduce yourself. “My name is Colleen. And what is your name?”,and I say “Majid Fatouhi.” Now, people say their names usually quickly because they’ve said it millions of times. And they move on. They don’t say it’s Majid Fatouhi. No. Say, hi, my name is Majid Fatouhi. How are you doing? And so what you need to do is to ask.
And don’t even expect to remember the name when they say it the first time because they say it too quickly anyway. So the next step is Memorize. This is when you ask the name again, You say, ‘please tell me your name again.” “Is it Majid” or how do you pronounce it? “And don’t worry about asking people to clarify their name because it shows that you’re interested in them.
It shows that you’re respectful, that you want to pronounce the name correctly. And it’s a compliment. So don’t worry about asking someone, especially if their name is not exactly Colleen or Bridgett. You know, you just ask them, no problem. And so when they say it, you want to say it back. There’s something called muscle memory. Our jaw needs to get comfortable by saying the name. So you want to say it during the conversation. Say, “Majid, where do you live?”
Or “Dr. Futuhi, what do you teach?” Just say it. Because if you’re hesitant what the name is, you haven’t really consolidated the information. You need to ask a question, and then when they say it, you want to consolidate it. So if somebody says, what is that guy’s name? You say with confidence, “it’s Majid Futuhi.”
You noticed, you asked, and you didn’t memorize. The memorization step is when you go back and forth with the person. So the last step is the most important step. Let’s say we’ve talked for 10 minutes, you repeated my name a few times, and now you look at me and you have no clue what my name is. Because you got distracted, there was other things going on, there were people coming and going, we talk about different things, your name is not a common name, and it’s totally gone. And again, that’s a physiological thing because, you know, I hope to see you again, but chances are, you know, in the near future, we won’t see each other. We live in different cities. And so no worries. And this is the important part is Ensure, which means you want to ensure you remember the name at the very end of conversation. And so you ask them to tell you their name again. So you say, “I know you told me your name. Please say it again.”
“Or is it Majid or Michael? “And then you say “Majid,” and this is when you really say, thank you, Majid, and we really make a point of it. This is the step where people don’t really do right. They talk to someone, they have the name during the conversation, they got distracted, and now they don’t remember it. So you want to end by knowing their name in order to have it in your storage areas. You want to make sure that the librarian really did put the journal or the book in the bookshelf, and that’s how you know it at the end. I recommend you practice this next time you’re in a social gathering. Give yourself a challenge of memorizing three names. Just tell yourself, I’m going to get $10,000 for each name. I’m going to memorize three names. Can I remember three names? Of course I can memorize three names.
And then see a person with a mission. See, when I have to remember names, I look at the person with a mission. I’m not just there chit-chatting. I’m there with a mission. My mission is to get that person’s name a thousand times, a thousand percent correctly. So I’m there with a mission. So I notice the name. I ask the name. I memorize it. At the end, I ensure that I know it.
And I do this all the time. I’ve gotten really good at it. I teach classes, usually 50 students. I usually memorize names by first and second class. Now, if it’s a reception where people come for mingling and then I give a talk and have half an hour, during that half an hour, I usually memorize 50, 70 names. And I’ve gotten good at it because I’ve practiced a lot. And I think this is not a unique talent. This is something that everybody can do.
And the most important step is your attitude. Don’t say I’m not good with names. Don’t call it a failure. Just say, I’m going to impress people. And the thing, you know what happens is, let’s say you memorize someone once or twice. You see them again in the street or somewhere else. Say, “hi, Janet, or hi, Michael, or hi, Dr. Futui.” And they say, wow, call and remember my name. wow, she’s good at this. And then you get a reputation for being the one person who is good at remembering names. And from there on, you will be the one with, oh, my God, she has incredible memory for names. Same person.
Bridgett: Yeah. And, you know, we’ve met people like that. I always heard Mr. Rogers could do that. People that met him, that he was really good at doing that. I used to live in Pittsburgh where he lived. And I have a tennis instructor who can do this.
We’ll just do clinics and we’ll just show up for the first time and he’ll go through the names and he’ll know everybody’s name. You know, we’re brand new. We haven’t met each other. We’re 10 people at a clinic and he knows all of our names, And I wanted to talk to you about your brain fitness program. Can you talk a little bit about that?
Dr. Fotuhi: When I reviewed the studies that showed that simple things like exercise can make a huge in the brain in 12 weeks, I decided to put a program together that can actually apply to patients in real life. Most studies have been done in universities. They were not done in the local neurology office. And, you know, it’s not always easy to replicate what scientists see in an artificial academic environment versus a real neurology practice.
I wanted to know for real if it does make a difference in people’s lives if I control their risk factors and if I provided them with those five pillars of brain health. In 2012, I put the program together with a few elderly patients in their 70s and early 80s, and I expected that it would take them nine months to really have significant difference. After all, they were older. And what I found striking was how quickly they improved. So I decided to make the program six months, and then I made the program three months, and it was still working. I made it six weeks, and it wasn’t enough.
So I realized that 12 weeks was a sweet spot for expecting to see remarkable results in older adults with mild cognitive impairment, which is the stage between normal and Alzheimer’s disease. I published the results of my studies of 129 elderly who had improved in the journal of prevention of Alzheimer’s disease. 84% of our patients improved their cognitive functions.
The MRI showed that more than half of them increased the size of the hippocampus by one to three percent, which is equivalent to the brain that’s one to three years younger. And after that, I continued to provide the program for my patients that also had concussion or had brain fog or they had memory loss for various reasons. And the same principle applied to them as well.
I published those results in the Journal of Alzheimer’s Disease Reports in 2023. And I realized that this is really helpful for people of all ages with all sorts of neurological problems. And I felt like I really need to provide this for people everywhere, which is why I wrote this book, The Invincible Brain.
Colleen: And, you know, the chapter four, which talks about your brain fitness program is very comprehensive. And one of the questions I had is you talk a lot about the VO2 max.
When you talk about the importance of exercise, what is the balance between cardio and strength? Like what should we be more focused on for brain health?
Dr. Fotuhi: Ideally, you want to do a combination of aerobic exercise and weight training. Aerobic exercise is very helpful for increasing your VO2 max, which is the maximum amount of oxygen your body can use per minute. And when you are fit,
your vo2 max is higher and higher vo2 max is associated with better memory a low risk of alzheimer’s disease, larger hippocampus, better overall brain performance. VO2 max is the most important indicator of your overall fitness and overall your brain performance in the short term and in the long term. And in order to increase your VO2 max, you really need to have aerobic exercise. Many studies have shown that muscle mass is also important for your brain health because muscles release things that are called myokines.
These are hormones released by the muscle. And one of them is BDNF, Brain Drive Neurotrophic Factor, which is really important for your brain health. And so what I usually do is, I exercise three or four times a week. I do one hour of stationary bike on a Peloton and 45 minutes of weight training. I know many people may not have the time to do that. So I recommend that you do three hours of exercise. You can do 45 minutes of aerobic exercise and 15 minutes of weight training. However, you can also do weight training that’s also aerobic. If you do low weight and you do multiple sets, and if you do it back to back to the point of getting huffing and puffing, then you’ve combined the two. You’ve gotten your weight training and you’ve gotten your aerobic at the same time.
Colleen: You also talk about the importance of the Mediterranean diet. You know, you talk about the importance of diet overall, healthy diet, but you recommend the Mediterranean diet. Why do you do that?
Dr. Fotuhi: When it comes to diet, there are two principles. Principle number one, which I think is more important than principle number two, is don’t eat junk food. Food that are high in processed food and trans fats and sugary food are really bad for the brain. They increase inflammation, reduce blood flow and interfere with the natural cleaning that happens in the brain, so junk food is horrible for your brain. Junk food ages your brain. Each of those three things I told you by itself is bad for the brain. The processed food, trans fats and sugary food and if you combine all of them then your brain size will be smaller.
The second principle is eat a heart healthy diet. The Mediterranean diet has the most data for prevention of Alzheimer’s disease. However, that does not mean that this is the only diet that’s good for you. If you’re vegan, if you like keto diet, if you’re on some Asian diet or South American diet, as long as you don’t have junk food, you’re getting plenty of natural resources of food that are good for you. Now, the military training diet is incredible because research has shown that people who eat a military training diet on a regular basis have a brain that’s up to 18 years younger when it comes to footprints of Alzheimer’s disease. 18 years younger. And this is what I eat. I usually eat fruits and vegetables. Leafy green vegetables are really good. Blueberries are really good.
Pomegranate is really good. These are natural. Fruits and vegetables that are readily available. You don’t find me eating junk food ever. Like I never eat a donut. Never. Sometimes I see a french fry and I must say, I’m just, you know, I like that salty taste. So I have one or two pieces, you know, you know, sometimes you have this beautiful, delicious looking desserts that are really tempting. And I have like one spoonful or maybe two spoonful. I rarely sit down and have a whole cheesecake. I don’t remember the last time I had a cheesecake or a cookie or a bag of chips. I may have one piece of chips because I know these things are really not “food food.” You know, they are processed food.
They’re like the mishmash of a whole lot of chemicals with some spices on top. It’s the spices that people enjoy, not the junk that’s inside. And that junk is really bad for the brain. People don’t appreciate that food that’s pro-inflammatory shrinks the brain. See, these are the things that I hope people will appreciate in the next five to 10 years.
Let me give you something else to put things in perspective. In 1950s, doctors, cardiologists believed that your heart can only pump so many times in a lifetime. So you don’t want to exercise too much because then you run out of how many times your heart would pump. And if somebody had heart disease, they were told to take it easy and rest.
And it was 1950s, 1960s that people started saying, maybe exercise is good. One study showed that if you compare the bus conductors and bus drivers in England, you will see that the bus drivers had more heart disease than the bus conductors who went up and down the stairs and in and out of the bus. So they said maybe there’s something good about being active. And then there’s a Framingham’s study that showed that exercise may be helpful for men, but not for women. And so they were starting to see some signal that maybe exercise is not that bad at all. In the 1970s, there was an article in the New York Times with the title,” Some Cardiologists Believe Exercise May Be Good for your Heart. It was so controversial that some cardiologists are saying,
“you need to exercise.” And of course, these days, we take it for granted that exercise is good for you. The gyms are filled with people of all ages. Everybody’s walking around. Everybody’s having a Fitbit or some kind of measure of how much they’re walking and so on. I think that people 20, 30 years from now look back at us and say, my God, they were eating that food. They were eating that stuff. But how was that legal?
Bridgett: I mean, you think about, yeah, like what inflammation just sounds like it’s just so bad for everything. And you can put those same spices on green beans
Colleen: cookie and green beans. I don’t know.
Bridgett: When you put spices, spices make a difference, but they make a difference in some of those foods.
You also stress the importance of sleep and you share in there things about the importance of sleep because that is so difficult, especially women for people in general in our time of life. Sleep can become so disruptive. Night sweats, things happen. If you don’t mind sharing a little bit about just the importance of sleep.
Dr. Fotuhi: Yes, during sleep, our brain goes to a natural cleaning and rinsing process, especially doing deep sleep. And so when people don’t get enough sleep, this junk material that usually cleared out our brain accumulates. Imagine if the trash collection doesn’t happen in New York for a week. Imagine the mess that will create in the city. And now imagine what happens to your brain if the natural cleaning and rinsing in the brain has been reduced by, let’s say, 30 to 40%, which is what would happen if somebody gets half as much regular sleep as they usually need. So sleep is critically important for brain function, and the proteins associated with Alzheimer’s disease called amyloid is one of those things that gets cleared with the rinsing process.
And so when that doesn’t happen, people have more amyloid in the brain, which means they have more Alzheimer’s disease in the brain. So if you want to get Alzheimer’s disease, you sleep fewer than six hours a night.
Bridgett: You know, and I think about my father-in-law, he used to brag about how little he slept. He used to come down, well, I got up early today and I didn’t go to bed till late.:He would say that because he did exercise. He wasn’t a horrible eater, but he wasn’t a great eater either.
He slept horribly because we just are trying to figure out why did this happen? What’s going on with him? But that is so important to I think back to his sleep patterns and how terrible those were. And if you don’t mind sharing just again, your five pillars just for our listeners, those five pillars.
Dr. Fothi: Based on my 30 years of studies, I have listed what I consider to be five.
most important thing for brain health. There are other things are important for brain health but the five most important things are fitness you want to be in good physical shape exercise three hours a week walk as much as you can every day sleep seven hours a night and if you sleep a few if you miss a few nights to sleep it’s okay but make sure you make a sleep a priority and that you have a regular sleep time
Then is nutrition. Don’t eat junk food. Period. Ever. Ever. Just eat healthy food and resist the temptation of eating junk food. You know, have a little bit if you have to. Manage your stress as much as possible. Our lives are stressful these days, but you create your own stress most of the time.
Take responsibility for your problems, own your problems and reduce expectation for other people and realize stress is toxic for the brain. And then use your brain as much as possible. Your brain is like a muscle. The more you use it, the stronger it gets.
Colleen: Dr. Fatui, thank you so much for coming on your book. We’ll make sure the link is in the show notes, but congratulations on it. And it’s just such a great resource for, you know, our
For every generation, but especially for our generation right now as sandwich generation that are taking care of a lot of their parents who have cognitive decline and are afraid that it could happen to them. So this book gives us kind of that, like I said in the beginning, an off-ramp to resources and taking control back. Thank you so much.
Dr. Fothai: Yes, my pleasure. My book is The Invincible Brain. I really think it is possible to build a resilient, invincible brain. And if people want to reach me, they can just search for The Invincible Brain. I’m on Instagram and LinkedIn and also have a website, drfotuhi.com. D-R-F-O-T-U-H-I.com.
Colleen: Thank you so much for that. And we’ll make sure that it’s all in our show notes, all the links. Thank you.
Dr Fotuhi: Thank you very much. Bye-bye.