WEBVTT

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What has changed over the last 10 years in imaging the brain?

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When I see a scan on a patient, it tells me your past in a one scan.

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And if we have an opportunity to get a second scan, then I can tell you what your future looks like.

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One day I put up a scan and I said, OK, this guy's probably between 50 and 60.

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And I looked at the age.

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He was 78 years old.

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And I said, wow, this guy is doing something right.

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Dr. Mistry.

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Louisa, neuroimaging is very exciting.

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Probably I have around 300,000 plus exams under my belt.

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So over the past 20 years, I've developed protocols where I feel that it can really help us age more healthier.

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You are utilizing AI in neuroimaging.

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I want to know what AI can do.

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This is volumetric MRI.

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This is the AI going in and outlining these areas in a precise manner.

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I looked at a patient, she was in their fifties.

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She was forgetting things.

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She had had an MRI that was normal.

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So we said, let's come back in a year.

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And her hippocampal volume loss was 2.2%.

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Oh my gosh.

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Which if I was doing the measurements, I would never pick up.

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I'm Louise Nicola and this is The Neural Experience.

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Dr. Mistry, you've spent most of your life as a medical doctor, right?

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You're doing what you were trained to do when you take a brain scan, let's just say an MRI, you scan it, you look at the results and then you report it.

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What has changed over the last 10 years when it comes to what you've found in imaging the brain?

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Louisa, neuroimaging is very exciting.

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And I say that when I see a scan on a patient

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It tells me what you've done up to this point.

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It really tells me your past in sort of a one scan.

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And the reason I say that is that on neuroimaging, not only are we seeing brain volume, but also the health of your calvarium in terms of your bone health, in terms of your vasculature.

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So it gives us a nice snapshot.

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And if we have an opportunity to get a second scan where we have, let's say, one ear in between and something like a volumetric MRI, then I can tell you what your future looks like because then I know your cognitive degeneration happens.

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trajectory?

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What does your curve look like?

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You know, when you draw a line, the slope of the line, we need two points.

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So as soon as we have two points, it gives us an idea, where is this patient going?

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And I believe that information is absolutely invaluable.

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And when I first started in radiology, here I am in a radiology resident, you know, I'm so excited.

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I've read all these anatomy books and

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And I started looking at these scans and I started seeing 30 and 40 year olds having brains and brain volumes of 50 year olds, 60 year olds.

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And I said, wow, that's not what I learned in my books.

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And.

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And I started asking the guy and I would ask my attendings, I would say, is this normal?

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Like, it should be, isn't this like, shouldn't we be questioning this?

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Shouldn't we be reporting this?

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And, you know, we would read them out as no acute disease, you know, and which is a cute term, but it doesn't say anything else.

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And so this started this questioning journey.

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And so for the past 20 years, I would say probably I have around 300,000 plus exams under my belt.

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I started seeing patterns of what makes people age, particularly what makes their brain age.

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And usually when I put up a scan, while just looking at the scan, I can usually tell the age of the patient, right?

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So I usually don't even look at their age.

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I just put up the scan and I say, okay, I know that guy's 50, that guy's 60.

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But what surprised me and, you know, the aha moment here,

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was one day I put up a scan and I said, okay, this guy's probably between 50 and 60.

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And I looked at the age and he was 78 years old.

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And I said, wow.

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I said, this guy is doing something right.

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And I looked at the history and tried to find out.

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And he was a farmer, living a very, very natural lifestyle and things like that.

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And then that just begged the question that, what can we learn from these outliers that we can apply?

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And that started this quest.

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So over the past 20 years, I've developed protocols, put in, you know, several buckets where I feel that these interventions can really help us age more healthier.

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Oh my gosh.

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I love this because it's the same.

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It's almost identical to the story that I had when I was doing EEG scans and picking up on mild cognitive impairment.

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And, you know, I haven't, I don't have, you know, 300,000, I've probably got around, I know 20,000 scans under my belt, where I was tasked with the mission of just pick, like scanning all these brains and detecting MCI.

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And I couldn't understand why,

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most of these patients were women.

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And that started my questioning journey.

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But I think before we move on, I think it'd be good to actually talk about what scans we're talking about because there's so many different brain scans, right?

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And you're specifically talking about an MRI.

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But when we talk about brain scans clinically, we can check the functionality of the brain, which is an EEG.

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We can do an fMRI.

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But what does the MRI actually show?

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So when we talk about brain scans, like you said, there are many different types of scans.

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And besides the ones you mentioned, we can do a CAT scan of the head, either without or with contrast.

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We can do an MRI of the brain.

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More recently, with AI tools, what we're able to do is what is known as volumetric MRI, which is a thin-section MRI.

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And...

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What the AI software is able to do is take those thin sections and measure the volume of the key components in the brain that are important for different functions.

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You know, for example, the hippocampal formation related to memory.

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the cerebellum related balance, right?

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The motor cortex, the sensory cortex, which is related to other pathologies.

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So what we're able to do now, and it's an exciting time in history, is that we have this technology to pick up subtle changes in these balance,

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brain volumes that we could never do before.

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And with we cannot do with the human eye, but AI, when it's under the proper supervision, there's a lot of quality control that goes into this.

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It's just not all automated.

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There's a lot of input from our end and what we're doing.

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But when it's done correctly and it's in the right hands,

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you get tremendous information.

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And when you do it serially, you can figure out this curve or this slope of neurodegeneration.

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Oh my God, that's beautiful because you can actually, so what you're saying is we can go into, like you said, certain parts of the brain, like the hippocampus, which is what I speak about a lot.

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And you can measure, when you say measure the trajectory of its atrophy or trajectory of its change, isn't that, don't you have to do that over a given time, like every six months just to see the rate of change?

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So we can see some change over six months, preferably a year.

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Okay.

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But even then, you know, a year,

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One year is not a long time.

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And when if you look at traditionally where people used to just eyeball the scan and take some rough measurements, there is no way you had the precision or sensitivity to even notice any change.

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We are now able to pick up changes in like one to two percent range, which is phenomenal.

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And that's where we want to be because I can then figure out the trajectory and we can see that are the interventions working?

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Does that person need to be more aggressive in terms of their lifestyle modifications?

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And so it's just giving us these fantastic tools to work with.

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Okay, so what we're going to do is I want you to take this brain.

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This is Zoe.

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And I want you to explain to us the car analogy that you use to describe the brain.

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And you've described it to me before.

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Here you go.

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So, Louise, I do this on stage and for my residents.

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And I believe that when we talk about our central nervous system, most people just point to their brain.

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Yeah.

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You know, and rightfully so, because that's sort of the epicenter of central nervous system or main control center.

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But I like to use a car analogy.

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Right.

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And I say that we are all a finely tuned F1 automobile, right?

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And so the first piece of this, even before we can talk about the brain here,

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I believe the first piece we need to address is the fuel system and the fuel pump that supplies this thing.

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And so if you think of ourselves as a car, the first thing is you could have a beautiful car.

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You have a 700 horsepower Ferrari, but if it has no fuel or a leaky fuel system,

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There's no point.

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It doesn't matter how much horsepower it has.

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And hence the fuel system in our car is our cardiovascular system, right?

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The fuel pump is the heart.

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And what's exciting about this, and we're at a time that now we've understood that

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The heart is not a static, right?

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It's malleable.

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It has plasticity.

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We can train the heart.

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And we talk about the Norwegian 4x4 protocol in being able to train the heart, change the myocardium and optimize the myocardium.

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So exciting times.

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There is something I see over and over again with the women I work with.

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They're doing everything right.

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Training, eating well, optimizing sleep, and they still feel off.

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Low energy, brain fog, mood fluctuations.

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And a lot of the time it comes back to something really simple.

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They're evidently deficient in key nutrients such as iron, folate, zinc, zinc.

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vitamin D, B vitamins, especially if they're menstruating.

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And most supplements just don't account for that.

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They're built on male default models or they chase symptoms instead of fixing the foundation.

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That's why I started using Daily Basis.

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It's a cycle aligned multivitamin powder.

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Two formulas, one vitamin,

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one for each phase of your cycle.

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Replenish in the first half, especially around your period, to restore what you're losing, and balance in the second half to support mood, inflammation, and gut health.

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It's one stick a day.

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You mix it with water.

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That's it.

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For me, the biggest shift has been consistency in how I feel, more stable energy in the first half of my cycle, and in the second half, better focus, better mood, and I'm sleeping better.

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Yeah.

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It's foundational, not a stack, not a quick fix.

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Just one thing a day that covers what most people are missing.

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They're doing a really special offer for the Neuro Experience audience.

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You can use code Neuro for 50% off your first month.

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That is code Neuro for 50% off.

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The link is below in the show notes.

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Did you know that the heart actually has around 40,000 neurons?

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There is an institute called HeartMath, right?

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And they talk about the heart-brain axis.

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Oh, it's amazing.

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And where you talk about heart coherence leading to brain coherence and this whole science coming out of that and phenomenal, phenomenal research coming out of there.

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But going back to our analogy, so we have our fuel pump, which is our heart, and then the fuel system, which is the fuel lines, which is our arteries.

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Interestingly, the arteries, the endothelium of the arteries is also a live system.

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Just as the heart is also constantly evolving.

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the arteries, the endothelial wall is a live system.

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That means your daily lifestyle changes, your movement, everything you do, your HIIT training, the four by four, it changes the endothelium as well.

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So this becomes a huge issue because you may have a great engine or a great brain, but if the fuel system is not there, if your arterial network and your endothelial health is not there, that's when you run into issues with strokes,

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improper perfusion of the brain.

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So that's the first step, is optimizing the fuel system.

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Okay, the second part is the engine.

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Okay, and that's the physical engine block or the brain itself.

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And there are many components we can talk about here, but...

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However, the key components is one is the overall brain volume.

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And so we talk about the total brain volume, which is important because it gives us an idea of how people are aging.

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The second.

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The second aspect is different parts of the brain that have to do with different functions, right?

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We know that the motor cortex and the sensory cortex are important.

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And so we want to know the volume there.

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Beyond that, two other components that are critical.

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is you can even split that and share the hippocampus if we can split it let's see if we can do that but is going to be a hippocampal is uh in the in the medial part of our temporal lobe so we have four lobes the frontal parietal temporal um and then we have the uh cerebellum and the occipital lobes the medial part of our temporal lobe okay that is somewhere in here actually um

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is this area called the hippocampal formation, which is our memory center.

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The volume of that is something that we can track and assess neurodegenerative disease, okay?

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And the other piece that's important is this green area here, this is our cerebellum, which has to do with coordination and balance, okay?

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That's important too, because certain disease processes, certain drugs impact the cerebellum directly and cause cerebellar atrophy.

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Okay.

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So we have our fuel system.

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We have our engine.

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What's important is it's not just about the engine, but it's also about the engine output or the horsepower.

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Mm-hmm.

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So we talk about networks in the brain.

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So you may have a great engine block, a great brain, but it doesn't tell us about the networks inside.

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And so when we look at functional MRI, that is another form of MRI, which tells us how those individuals networks function and are activated.

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And so that's important.

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You may have a great engine,

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You may have a 700 horsepower engine, but it's only putting out 400 horsepower because internally the efficiency is not there.

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And the last piece is how this engine transmits everything to the rest of the body.

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Okay.

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We talk about our nerve root tracks.

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That's our transmission.

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Okay.

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Our drive shaft, the main track is our corticospinal track, is basically the motor cortex communicating with the rest of the body.

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That's how we move things, right?

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but then there are tracks that lead up that bring sensory information.

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Then there are tracks within our system that communicate from the anterior part of the brain to the posterior part of the brain, between the brain.

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And so all these play a role in the transmission of the brain.

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So when we look at it this way, it gives us a much more of a cohesive, much more of a holistic framework of thinking about the nervous system.

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Oh, wow.

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I loved that analogy.

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And there's so many questions, especially as it relates to the blood vessels, because you mentioned it's the most vascular rich organ in the entire body.

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And it's made up of, you've got capillaries, which is the one cell thick little blood vessels.

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You've got the arteries, which have muscles around them, and then you've got the veins.

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So we're going to get into that.

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But before we do, I want to talk about

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what we're here to talk about, which is neurodegeneration.

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And how do we pick up on early signs of neurodegeneration, specifically Alzheimer's disease?

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And something that I've pounded to the audience is that Alzheimer's disease is not a one-time stamp when you are 70, 75 years old.

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You don't just get that diagnosis.

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It is generally when you get the

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or let's just say any of the dementias, we know that it has been going on and going on for about 20 years.

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20 years prior to that diagnosis, or maybe even 30 years prior to that diagnosis, is the starting point of your neurodegenerative journey, which is unfortunate.

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And we'll talk about this landmark study, clinical and biomarker changes in

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dominantly inherited Alzheimer's disease.

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So these are basically, this was a New England Journal of Medicine study, which basically showed in 2012, the evidence to neurodegeneration, meaning like here are the biomarkers that we can detect 20 years prior to you getting a diagnosis.

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So why don't you give us a bit of an overview of what is Alzheimer's disease in your perspective?

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And how do we pick up on early signs of it?

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So, Louisa, you know, apart from a lot of the content that, you know, you talk about in terms of cognitive testing and whatnot that's used for Alzheimer's, right?

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From my perspective as a neuroimager, what are tools we have to pick up early changes in terms of this neurodegeneration, right?

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As we know, Alzheimer's, there are many different forms of Alzheimer's, right?

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We have Alzheimer's, we have also like vascular related dementia, okay?

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So when we talk about Alzheimer's specifically, we know that there are certain proteins that are involved, like beta amyloid and tau.

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And so part of the imaging approach to this has been is that can we pick up these changes early and what can we do and what are the tools that we have?

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So this is one of the scans that is used.

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And this is what is known as a beta.

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It's a amyloid PET scan.

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And basically, it's a PET marker.

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And so what PET is positron emission tomography.

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And basically, it's a substance that's injected, you know, in your vein.

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And it collects and is avid for that beta amyloid protein.

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Now, there are also scans like this for tau, but more common is the beta amyloid.

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Now, what's interesting is there is, this is the normal size.

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And you can see there is some normal physiologic uptake in the white matter.

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Okay.

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And on the right side, we see an Alzheimer's patient where you see all this red area is this abnormal uptake of this beta amyloid tag.

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One of the best ways to improve brain energy metabolism is to make sure that you have adequate ketones circulating in your body.

244
00:20:34.918 --> 00:20:38.359
This is why I ingest ketone IQ.

245
00:20:38.599 --> 00:20:39.760
I'm obsessed with ketones.

246
00:20:39.940 --> 00:20:45.942
They're one of the brain's most efficient energy sources, especially as we age and glucose handling changes.

247
00:20:46.202 --> 00:20:59.746
I use it for deep work or for long days when I want to focus without caffeine or crashes, but I also use it just in my day-to-day to make sure that I am neurologically adequately fueled.

248
00:20:59.806 --> 00:21:01.327
If you haven't tried ketones,

249
00:21:01.727 --> 00:21:02.268
You must.

250
00:21:02.608 --> 00:21:03.749
These ones taste great.

251
00:21:03.849 --> 00:21:12.698
And you can get 30% off your subscription at ketone.com slash neuro plus get a free gift with your second shipment.

252
00:21:12.838 --> 00:21:20.325
So, so when I'm looking at this brain, um, I'm looking, so the, the one on the left where it says normal, what does the plus six mean?

253
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Yeah.

254
00:21:20.937 --> 00:21:31.925
So those are just sort of like image parameters and that has to do with just like the kind of like settings there, I wouldn't worry about that, yeah.

255
00:21:32.105 --> 00:21:36.969
So that brain doesn't have, the normal one doesn't have too much amyloid in it.

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Right.

257
00:21:37.589 --> 00:21:41.251
There is always some little bit of physiologic uptake in the white matter.

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You know, that's that's expected.

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And but you can see in the cortex of the brain, which is the most important.

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That's where the gray matter is right.

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There is not a whole lot of amyloid accumulation.

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So the red part is where the amyloid density is.

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Right.

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So on the right side, we see all this activity in the cortex of the brain, in the frontal lobes here, in the parietal lobes.

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And so what we've seen in terms of assessing and picking these changes up early, that even biopsies have shown that even in cadavers where even in 30-year-olds, we've seen amyloid plaque.

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In a 30-year-old?

267
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In a 30-year-old.

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How is that possible?

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Well, we know that amyloid is basically, our brain is flushing out amyloid every night, right?

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Like through the glymphatic system, right?

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But if that is process impaired,

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you're not sleeping enough, you're stressed, you're under, you know, tremendous trauma, or, you know, and you're in a low socioeconomic area where, you know, kind of you don't have access to kind of proper nutrition and whatnot, then this degenerative process can start early.

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And we know that our brain matures between 25 to 30.

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But then after that is how are you maintaining that nervous system?

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And if the lifestyle factors and all these other issues that we talk about are not optimal, this deposition can start as early as in your late 20s to 30s.

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And also CTE, like concussions at a young age, can obviously impair the clearance of amyloid 2.

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Absolutely.

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Okay.

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00:23:31.883 --> 00:23:37.547
So I want to get onto AI and I want to know what AI can do.

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00:23:37.627 --> 00:23:41.329
Now we're living in this world as 2026, AI is everywhere.

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And a lot of people just think that AI is chat GPT, but you are utilizing AI in neuroimaging.

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And I think it's just the start, right?

283
00:23:50.735 --> 00:23:52.776
I think AI is going to be phenomenal.

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There's an AI tool that you use to measure changes in the memory center of the brain, which we mentioned the hippocampus and the,

285
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I want to see you've brought something in.

286
00:24:02.116 --> 00:24:04.637
So what can AI do in this aspect?

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00:24:04.978 --> 00:24:17.824
So, Louisa, AI from my perspective as a neuro-imager is a great augment to who we are as a physician.

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You know, we're using AI technology in many different ways, not just imaging.

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And, you know, for example, a lot of physicians, you know, before, if you go five years ago, would, uh, or you would step into a room and because of billing and whatnot, would be so busy typing everything because they had to, you know, put in all the notes and everything like that to submit for reimbursements.

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Now, a lot of them can walk into a room.

291
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You have AI in the back, listening, charting and everything like that.

292
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Now they can be more human.

293
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You know, from my perspective, AI is allowing doctors to be more human.

294
00:24:54.837 --> 00:24:58.020
And I think that's a big perspective shift.

295
00:24:58.641 --> 00:25:05.147
Instead of us being afraid of AI replacing us, I believe it augments us as physicians.

296
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As far as imaging is concerned, we're able to do things with AI and offer imaging services with AI that we could never do before.

297
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And so one of them is what I'm going to show right now.

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So this is what is known as a volumetric MRI.

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Basically, what that is, is a thin section MRI.

300
00:25:28.360 --> 00:25:31.902
Now, this is what we call a coronal section.

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It is basically taking a slice of our brain

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in the coronal plane.

303
00:25:36.886 --> 00:25:41.149
And what we're seeing here is all these color coded areas.

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This is the AI going in, identifying these areas and outlining them in a precise manner so that it can take volumes.

305
00:25:53.040 --> 00:26:01.487
So not only of the cerebral cortex, the central gray nuclei, which are like the or what we call our basal ganglia areas,

306
00:26:03.130 --> 00:26:09.091
And more importantly, there are structures we measure that have to do with memory.

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00:26:10.132 --> 00:26:13.512
And so this is what is known as a neural quant scan.

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00:26:13.532 --> 00:26:15.353
That's one of the vendors that we use.

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00:26:16.393 --> 00:26:20.514
And what they do is they, again, map all these areas.

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But one of the key areas that is mapped here is the hippocampal formation.

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And that's what's in the yellow here.

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00:26:28.116 --> 00:26:30.676
I can see one of them is filling out the spaces.

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And the other one, there's a lot of space there.

314
00:26:33.399 --> 00:26:33.660
Right.

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00:26:33.760 --> 00:26:37.034
So the left one in the healthy brain you can see is a...

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00:26:38.807 --> 00:26:41.048
robust hippocampal formation.

317
00:26:41.448 --> 00:26:42.888
It's maintained its volume.

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00:26:43.628 --> 00:26:56.112
The black area next to it, which is where the cerebrospinal fluid is in the ventricle, there's just minimal space there, and it's kind of that temporal horn that's in that area is small in the way it should be.

319
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Now, let's go over into the right side.

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This is an Alzheimer's patient.

321
00:27:00.293 --> 00:27:07.475
That same hippocampal formation, and this is kind of like an exaggerated view, but that same hippocampal formation, you can see, is much smaller.

322
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It's taking up less space.

323
00:27:10.157 --> 00:27:10.497
Okay.

324
00:27:10.858 --> 00:27:14.962
So it equates to less kind of memory function in this individual.

325
00:27:15.542 --> 00:27:21.868
And then the space that was there is now taken up by the dilatation of that ventricle in that area.

326
00:27:21.908 --> 00:27:24.751
And the fourth ventricle, it's very like you can see how big it is.

327
00:27:25.091 --> 00:27:26.473
Even look at these ventricles up here.

328
00:27:26.833 --> 00:27:47.525
and then the other ventricles are large as well because of the overall loss of brain volume in the total loss of brain volume as well so what's interesting uh louisa is that we are once we get serial scans we are able to pick up minute differences in volume of the hippocampus

329
00:27:48.045 --> 00:28:03.182
okay so like i said when we have one study it tells me what you've been doing up to this point your you know but having two or more studies tells me your trajectory where you're going the normal hippocampal

330
00:28:04.203 --> 00:28:04.744
atrophy.

331
00:28:05.384 --> 00:28:07.085
Okay, there are many different numbers.

332
00:28:07.185 --> 00:28:08.426
Some people say 0.5%.

333
00:28:08.486 --> 00:28:09.187
Some people say 1%.

334
00:28:09.207 --> 00:28:09.367
Yearly.

335
00:28:09.387 --> 00:28:09.567
Yearly.

336
00:28:09.587 --> 00:28:09.947
1.5%, 1%, 1.5%.

337
00:28:09.967 --> 00:28:13.089
Those are the different numbers depending on our standards, actually, for the studies we do.

338
00:28:20.965 --> 00:28:22.546
Our thresholds are a lot lower.

339
00:28:23.047 --> 00:28:23.367
Okay.

340
00:28:24.168 --> 00:28:28.551
But what we see is that, I'll give you an example.

341
00:28:29.072 --> 00:28:34.656
Just yesterday, okay, I looked at a patient and she, it was in their 50s.

342
00:28:36.058 --> 00:28:40.141
She had a scan in 2025 because she had, she was forgetting things.

343
00:28:40.181 --> 00:28:41.242
She had issues with memory.

344
00:28:41.282 --> 00:28:43.283
She has a family history of dementia.

345
00:28:43.323 --> 00:28:43.464
Mm-hmm.

346
00:28:44.264 --> 00:28:49.545
And she requested her neurologist said, I need the scan.

347
00:28:49.786 --> 00:28:52.926
OK, she had had an MRI that was normal.

348
00:28:53.306 --> 00:28:57.728
OK, because the MRI, the normal MRI really doesn't do any volumetric imaging.

349
00:28:57.828 --> 00:28:58.748
Nothing is wrong with her.

350
00:28:58.768 --> 00:29:01.749
Nothing is wrong with her brain and kind of like a general MRI sense.

351
00:29:01.809 --> 00:29:04.309
OK, she doesn't have strokes, doesn't have anything like that.

352
00:29:05.850 --> 00:29:09.411
She gets the volumetric scan, her hippocampal volume.

353
00:29:10.451 --> 00:29:15.412
That's the yellow area that we talked about here was in the lower limits of normal.

354
00:29:15.792 --> 00:29:16.252
Okay.

355
00:29:16.332 --> 00:29:16.912
Still normal.

356
00:29:17.072 --> 00:29:18.953
This is based on a normative database.

357
00:29:19.113 --> 00:29:20.453
This is on a normative database.

358
00:29:20.473 --> 00:29:21.233
Do you use Loretta?

359
00:29:21.833 --> 00:29:23.254
What's your normative database?

360
00:29:23.454 --> 00:29:25.034
We use multiple ones.

361
00:29:25.094 --> 00:29:27.275
I'm not sure if we use Loretta specifically.

362
00:29:27.495 --> 00:29:27.855
Okay.

363
00:29:28.215 --> 00:29:38.237
I know that NeuroQuant uses several different databases, you know, and so, but NeuroQuant is the vendor that we use.

364
00:29:38.357 --> 00:29:38.597
Yeah.

365
00:29:40.190 --> 00:29:44.474
So her hippocampal volume was in the lower limits of normal.

366
00:29:45.475 --> 00:29:51.740
And we said, okay, you know, for everything that counts, that's a normal study.

367
00:29:51.860 --> 00:29:55.003
And she could have, we could say, go home and, you know, it's a normal scan.

368
00:29:55.383 --> 00:30:01.628
But we said, you know what, because she's complaining and let's just be more diligent about this.

369
00:30:02.069 --> 00:30:03.650
So we said, let's come back in a year.

370
00:30:03.910 --> 00:30:05.792
And so she, yesterday, she had come back.

371
00:30:06.392 --> 00:30:13.715
And her hippocampal volume loss from 2025 to 2026 was 2.2%.

372
00:30:13.855 --> 00:30:16.776
Oh my gosh.

373
00:30:17.977 --> 00:30:22.739
That's a change which if I was doing the measurements, I would never pick up.

374
00:30:22.859 --> 00:30:24.480
It looks almost identical.

375
00:30:24.500 --> 00:30:24.820
Of course.

376
00:30:24.920 --> 00:30:25.460
Identical.

377
00:30:25.680 --> 00:30:25.960
Okay.

378
00:30:26.220 --> 00:30:29.162
Identical in terms of just us looking at it.

379
00:30:29.442 --> 00:30:35.024
But the AI, when we did the numbers, and again, there's a lot of quality control going into this because we want to make sure that

380
00:30:35.264 --> 00:30:39.487
The scan is not artificially giving us a false positive and whatnot.

381
00:30:39.867 --> 00:30:41.628
We're checking for all that.

382
00:30:41.668 --> 00:30:41.828
Okay.

383
00:30:41.868 --> 00:30:46.391
And that's why I would say that you don't just let AI do the processing and get an output.

384
00:30:46.811 --> 00:30:48.952
It requires us to be very diligent.

385
00:30:49.412 --> 00:30:51.674
But controlling for everything.

386
00:30:52.094 --> 00:30:55.176
She had a 2.2% loss of volume.

387
00:30:55.396 --> 00:30:55.676
Okay.

388
00:30:56.016 --> 00:30:56.257
Now...

389
00:30:57.317 --> 00:31:05.083
Depending on what the normal rate of decline you use, let's say 0.5% or 1%, that's still advanced.

390
00:31:05.123 --> 00:31:06.043
In her 50s.

391
00:31:06.063 --> 00:31:07.685
In her 50s, that's still advanced.

392
00:31:07.945 --> 00:31:08.265
Okay.

393
00:31:08.905 --> 00:31:10.306
So normal scan.

394
00:31:10.426 --> 00:31:12.028
She still has a normal scan.

395
00:31:12.468 --> 00:31:13.589
Two normal scans.

396
00:31:13.989 --> 00:31:16.871
But her rate of decline is very abnormal.

397
00:31:17.792 --> 00:31:20.934
And so now she has an opportunity.

398
00:31:21.134 --> 00:31:21.434
Yeah.

399
00:31:21.634 --> 00:31:21.955
Okay.

400
00:31:22.135 --> 00:31:23.276
To be very aggressive.

401
00:31:23.296 --> 00:31:23.936
Okay.

402
00:31:24.156 --> 00:31:24.416
Okay.

403
00:31:24.456 --> 00:31:26.458
And then we that's what we put in the report.

404
00:31:26.698 --> 00:31:33.044
We said, look, it's a normal scan, but the rate of decline is clearly abnormal.

405
00:31:33.385 --> 00:31:33.605
Okay.

406
00:31:34.065 --> 00:31:34.826
Hence the value.

407
00:31:35.258 --> 00:31:40.760
One of the simplest longevity upgrades is reducing daily toxin exposure.

408
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That's why I switched to Caraway because their ceramic cookware is non-toxic because it has no PFAS, no forever chemicals.

409
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And I use it every single day.

410
00:31:51.303 --> 00:31:54.645
It's one of those quiet changes that adds up over time.

411
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412
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413
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414
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416
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Let's talk about longevity because I think there is a misunderstanding.

417
00:32:16.680 --> 00:32:18.641
Longevity isn't about living longer.

418
00:32:18.761 --> 00:32:23.065
It's about living better and having the energy to actually do it.

419
00:32:23.085 --> 00:32:28.950
And one thing I've noticed on my journey is that health is fragmented.

420
00:32:29.290 --> 00:32:34.696
I mean, you've got different doctors, different labs, different apps, but no one's actually looking at the full picture.

421
00:32:35.256 --> 00:32:37.739
That is where Kinsin comes in.

422
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It is a platform built specifically for women that connects your medical records, labs, and wearable data in one place.

423
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424
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So your provider can actually see what's going on.

425
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And from there...

426
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427
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The biggest thing that stood out for me is when you go on their website, they have a quiz.

428
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429
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430
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431
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If you want to have a look at their things that they've got on offer, meanwhile, I just want you to know I am personally taking their glutathione from them.

434
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435
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439
00:34:01.328 --> 00:34:04.670
Now this rate of decline could be for a number of different factors.

440
00:34:04.710 --> 00:34:11.773
You know, we can think, well, you said she's got a family history, so maybe does she possess any of the genetic risk factors?

441
00:34:11.833 --> 00:34:15.214
Maybe APOE4, that's probably aiding in the atrophy.

442
00:34:16.035 --> 00:34:17.175
Let's look at her lifestyle.

443
00:34:17.195 --> 00:34:21.517
We have to figure out why she's atrophying, but I want to bring up something.

444
00:34:21.537 --> 00:34:22.318
You said 2.2%, right?

445
00:34:22.338 --> 00:34:26.500
Now we're gonna bring up my most favorite study ever,

446
00:34:27.160 --> 00:34:32.650
which is a 2011 study, 2010 actually, Erickson et al.

447
00:34:33.251 --> 00:34:36.377
I've brought it up probably every single podcast I've done.

448
00:34:37.562 --> 00:34:41.603
Exercise training increases size of hippocampus and improves memory.

449
00:34:41.963 --> 00:34:54.587
We have seen with this phenomenal study that just by exercising at minimum 30 minutes a day, you can grow the hippocampus by 2%, the volume of the hippocampus.

450
00:34:54.607 --> 00:34:59.849
So one of the interventions that this woman can get into is exercising, literally.

451
00:35:00.427 --> 00:35:00.887
Absolutely.

452
00:35:01.028 --> 00:35:02.329
I love that study, Louisa, too.

453
00:35:02.749 --> 00:35:10.195
And one of the key drivers here is a part, remember we talked about that four-part CAR model, okay?

454
00:35:10.655 --> 00:35:22.264
Apart from exercising, not only influencing the heart health and the endothelial health, it also aids in BDNF increase, right?

455
00:35:22.384 --> 00:35:26.728
Which is then increasing the volume of that hippocampus, you know?

456
00:35:27.028 --> 00:35:35.730
I want to understand this woman a bit more because not everyone is getting these MRIs with the AI.

457
00:35:35.950 --> 00:35:39.571
Most people actually don't even get an MRI, to be honest, right?

458
00:35:39.991 --> 00:35:46.313
I think in the US, if you've got a, let's just say a migraine, five migraines in a given week, okay, great.

459
00:35:46.333 --> 00:35:48.914
You qualify for an MRI, but how many people are actually going in?

460
00:35:50.014 --> 00:35:57.242
at 52 years old complaining of, you know, short-term memory loss, because honestly, sometimes I'm not 52.

461
00:35:57.482 --> 00:35:58.143
I'm in my thirties.

462
00:35:58.223 --> 00:36:06.511
I get short-term memory loss, albeit it might be because of sleep deprivation, hydration, or stress, but I'm not walking in saying, Hey, can I have an MRI?

463
00:36:07.212 --> 00:36:07.532
And so-

464
00:36:08.306 --> 00:36:13.732
People are not even going in to get an MRI, let alone getting an MRI with volumetrics.

465
00:36:13.973 --> 00:36:15.775
So there's a problem here.

466
00:36:15.795 --> 00:36:17.477
There's a disconnect in the healthcare system.

467
00:36:17.497 --> 00:36:25.546
And I think that that's where a lot of this education is required, that people need to be aware that there are AI tools available.

468
00:36:26.647 --> 00:36:34.553
I think we need people to take a comprehensive, proactive approach to this problem.

469
00:36:34.773 --> 00:36:36.694
And as you know, it's a huge issue.

470
00:36:36.834 --> 00:36:39.596
Dementia is a huge issue.

471
00:36:40.237 --> 00:36:48.603
But you don't want to wait till you have that diagnosis when things don't feel right, like as to this woman.

472
00:36:49.223 --> 00:36:49.443
Right.

473
00:36:49.724 --> 00:36:51.186
She was very proactive about it.

474
00:36:51.206 --> 00:36:52.728
She said, I have a family history.

475
00:36:53.288 --> 00:37:00.818
I I want to be tested, you know, with not just an MRI, but something that's more precise.

476
00:37:01.418 --> 00:37:05.263
And she, I guess, heard about the scan and she requested her neurologist to order it.

477
00:37:05.924 --> 00:37:06.144
So.

478
00:37:07.465 --> 00:37:15.109
For people listening to this out there, I would say that if this applies to you, that is a conversation you can have with your physician.

479
00:37:15.169 --> 00:37:20.612
And if it requires you to get a consult with a neurologist, have this conversation, have a discussion.

480
00:37:21.272 --> 00:37:27.515
And if it's something that makes sense, maybe you want to get a baseline volumetric MRI.

481
00:37:28.215 --> 00:37:33.138
So let's just say they get the baseline volumetric MRI and they're atrophying.

482
00:37:33.956 --> 00:37:34.197
right?

483
00:37:35.038 --> 00:37:40.429
In different areas of the brain, it can be multiple different points at a rate of 2%.

484
00:37:40.930 --> 00:37:41.912
What does somebody do?

485
00:37:41.932 --> 00:37:41.992
So,

486
00:37:44.398 --> 00:37:46.900
hence I mentioned that four part model.

487
00:37:47.460 --> 00:37:50.162
I think you have to address all those components.

488
00:37:50.202 --> 00:37:50.442
Yeah.

489
00:37:50.462 --> 00:37:50.782
Okay.

490
00:37:51.123 --> 00:37:52.444
We talked about heart health.

491
00:37:52.464 --> 00:38:05.512
We talked about endothelial health, you know, and then we get into mechanisms that improve your BDNF and then your brain volumes.

492
00:38:05.613 --> 00:38:05.833
Right.

493
00:38:06.313 --> 00:38:08.434
Apart from exercise, we know that

494
00:38:09.315 --> 00:38:13.297
even things like meditation, mindfulness, okay?

495
00:38:13.537 --> 00:38:29.145
And all the research like Eric Davidson and the colleagues have done talks about how all of those factors also play into increased BDNF levels and increasing brain volumes.

496
00:38:29.345 --> 00:38:38.049
So these are all things that come into play, but I would say you have to address this as a four-part model and be comprehensive about this.

497
00:38:39.121 --> 00:38:49.429
So you've mentioned something as well, by the way, on that, I think, you know, I've, I've spoken a lot on various different podcasts around, like, how do we improve the health of your brain from lifestyle factors alone?

498
00:38:49.509 --> 00:38:56.235
You know, you want to be sleeping well, obviously you want to be exercising, as we mentioned diet, which we can control for.

499
00:38:56.695 --> 00:39:04.802
And then, um, you said earlier in the podcast medications that are actually atrophying the cerebellum.

500
00:39:05.469 --> 00:39:09.611
Not a lot of people think about medications that are actually damaging their brain.

501
00:39:10.131 --> 00:39:20.634
So there's a whole list of medications, but the ones that stand out the most are certain seizure-related medications.

502
00:39:20.975 --> 00:39:22.275
Keppra?

503
00:39:22.355 --> 00:39:23.435
Yes.

504
00:39:23.716 --> 00:39:24.776
And Dilantin.

505
00:39:25.476 --> 00:39:26.937
And so...

506
00:39:28.037 --> 00:39:40.586
It's a tough situation because these people need that medication to control the seizures, but then the medication itself is leading to atrophy, particularly cerebellar atrophy.

507
00:39:41.647 --> 00:39:43.608
So it's a fine balance.

508
00:39:44.249 --> 00:39:48.092
Okay, so let's just say somebody in their 30s are on Keppra.

509
00:39:48.532 --> 00:39:49.973
My father's on Keppra, by the way.

510
00:39:51.754 --> 00:39:53.836
And what would they notice?

511
00:39:53.856 --> 00:39:56.178
What type of changes would they notice in themselves?

512
00:39:57.185 --> 00:40:00.810
So one is that it depends on their cognitive reserve.

513
00:40:00.850 --> 00:40:07.339
You know, when people are in their 30s and 40s, they may not see any changes, right?

514
00:40:07.539 --> 00:40:12.886
But beyond that, you know, you start seeing changes in sort of coordination, right?

515
00:40:12.986 --> 00:40:15.487
Okay, you maybe miss a step.

516
00:40:15.527 --> 00:40:18.549
You have coordination, you know, climbing up a stairway.

517
00:40:19.910 --> 00:40:27.333
And so this loss of balance, loss of coordination, that's where the cerebellum, you know, really functions.

518
00:40:27.393 --> 00:40:34.637
Once you start seeing that, then you wanna do more formal testing to see if this is a truly a cerebellar issue.

519
00:40:35.998 --> 00:40:43.582
Okay, I want to talk now about the vascular piece and a prevention window because you measure intimal thickness, which is what you've mentioned.

520
00:40:43.922 --> 00:40:44.842
Okay, intimal thickness.

521
00:40:44.982 --> 00:40:47.544
Essentially, how well blood is getting to the brain.

522
00:40:47.944 --> 00:40:49.605
Nobody has heard of this before.

523
00:40:50.325 --> 00:40:51.766
Can you talk to me more about what that is?

524
00:40:52.146 --> 00:40:55.768
So this is our fuel pump and fuel system aspect, right?

525
00:40:55.788 --> 00:40:57.729
Like that first aspect we talked about, right?

526
00:40:58.710 --> 00:41:00.631
And I want to show this picture.

527
00:41:01.071 --> 00:41:02.132
Oh, I love this.

528
00:41:02.212 --> 00:41:04.734
It kind of the jugular vein.

529
00:41:04.874 --> 00:41:09.898
And so again, like so for most people looking at this need some orientation.

530
00:41:09.918 --> 00:41:14.821
So basically this is an ultrasound and the probe is placed on the neck.

531
00:41:15.222 --> 00:41:15.582
Okay.

532
00:41:16.283 --> 00:41:20.005
And so this is the outside of the neck and we're going more deeper.

533
00:41:20.165 --> 00:41:23.348
So this is sort of like your skin and subcutaneous tissue.

534
00:41:23.788 --> 00:41:25.970
And this is a jugular vein that is in your neck.

535
00:41:26.070 --> 00:41:29.973
And deep to that jugular vein is our carotid artery.

536
00:41:30.813 --> 00:41:34.015
And you can see the carotid artery has this wall, okay?

537
00:41:34.135 --> 00:41:41.380
And so the wall of the carotid artery, when you go from the inside out, there is this intima layer and then the media layer.

538
00:41:41.640 --> 00:41:53.487
When we do this in a very specific way and with a specific transducer, we call that CIMT scan, which is carotid intima medial thickness scanning.

539
00:41:54.407 --> 00:41:56.028
What is interesting is that...

540
00:41:57.990 --> 00:42:08.863
You know, we talked about that other study where we start seeing amyloid deposition early, okay, almost in late 20s to 30s, depending on lifestyle.

541
00:42:09.865 --> 00:42:15.932
The vascular endothelial changes, they have traced it back almost in the teens, right?

542
00:42:16.673 --> 00:42:23.723
that depending on how your lifestyle was, even in your teens, you can start seeing these intimal changes, okay?

543
00:42:24.384 --> 00:42:28.571
So it even precedes the brain changes.

544
00:42:28.871 --> 00:42:31.615
And that's why I'm so passionate

545
00:42:31.615 --> 00:42:37.158
passionate about this because I think that this is a such an opportunity because it's such a inexpensive scan.

546
00:42:37.498 --> 00:42:37.778
Okay.

547
00:42:38.018 --> 00:42:41.560
For somebody to get a CIMT scan, but it gives you an idea.

548
00:42:41.680 --> 00:42:45.381
And what we're able to do with AI is measure the thickness of this wall.

549
00:42:45.662 --> 00:42:50.144
And it tells us the health of the endothelial lining.

550
00:42:50.764 --> 00:42:59.048
which is very, very key because it will, when you know the health of your endothelial lining, it gives you a chance to intervene.

551
00:42:59.248 --> 00:43:11.793
And particularly if you get serial scans, it tells you if your CIMT numbers, if your intima medial thickening is increasing or decreasing, is your lifestyle interventions working?

552
00:43:11.853 --> 00:43:15.655
If you're doing a four by four, are you making changes or are you know,

553
00:43:16.676 --> 00:43:21.522
So if you're going in the wrong direction, you need to be more aggressive about this.

554
00:43:21.883 --> 00:43:32.336
But it's a relatively easy scan, painless, people can get it, and gives you a great picture and gives you a chance to be proactive.

555
00:43:32.662 --> 00:43:38.006
It's like getting the carotid artery scanned and just seeing if there's any plaque in there.

556
00:43:38.046 --> 00:43:39.107
But it's not just plaque.

557
00:43:39.347 --> 00:43:46.413
You know, you can have, it's interesting because, you know, when I was a radiology resident, we could scan ourselves, you know, and I used to take pictures.

558
00:43:46.493 --> 00:43:51.197
And when I was seeing my doctor, who's sort of a longevity physician, I said, oh, I have clean carotids.

559
00:43:52.738 --> 00:43:57.541
And he would say, no, we need to do a CIMT scan because a clean carotid doesn't mean anything.

560
00:43:57.561 --> 00:44:03.625
We need to know the thickness because that's what's going to tell us where you stand in terms of your endothelial health.

561
00:44:04.366 --> 00:44:05.767
And so I said, oh, OK, I see.

562
00:44:05.847 --> 00:44:06.607
I see what you're saying.

563
00:44:06.627 --> 00:44:09.469
And at that time, I didn't pay much attention.

564
00:44:09.489 --> 00:44:11.511
When I looked into the research, I'm like, he's right.

565
00:44:12.011 --> 00:44:12.431
He's right.

566
00:44:12.471 --> 00:44:16.134
We can actually the thickness tells us a lot about our vascular health.

567
00:44:16.498 --> 00:44:24.861
Have you heard about jugular vein stenosis from poor posture, which is limiting the amount of blood flow to the brain?

568
00:44:26.521 --> 00:44:27.282
What do you think about this?

569
00:44:27.302 --> 00:44:28.982
I don't know if it's actually a real thing.

570
00:44:29.582 --> 00:44:34.364
So jugular vein stenosis from poor posture.

571
00:44:35.284 --> 00:44:39.446
I know poor posture can lead to many different things in our body.

572
00:44:41.053 --> 00:44:48.919
The jugular vein though is very, very malleable in terms of even when it's- Like we're talking here, if everyone's watching.

573
00:44:48.940 --> 00:44:49.040
Yep.

574
00:44:49.460 --> 00:44:51.662
Yeah, with Zoe at the back around here, right?

575
00:44:52.686 --> 00:44:55.969
So the jugular veins runs alongside our neck here.

576
00:44:56.529 --> 00:45:03.194
You know, the jugular vein, even if you narrow it down, it still has a pretty good flow within it.

577
00:45:03.735 --> 00:45:11.260
So to change your posture to a degree that it kind of impedes flow in your jugular vein, it's hard to say.

578
00:45:11.380 --> 00:45:14.563
I have not heard any specific studies regarding that, you know.

579
00:45:14.843 --> 00:45:21.666
It was a popular influencer with no medical training whatsoever who's trying to sell a $100,000 program.

580
00:45:21.766 --> 00:45:21.986
Okay.

581
00:45:22.226 --> 00:45:22.646
Yeah.

582
00:45:22.746 --> 00:45:23.747
All right.

583
00:45:23.787 --> 00:45:24.547
Brian Johnson.

584
00:45:24.647 --> 00:45:35.591
And he did this huge Instagram reel saying, you know, guys, I fixed my posture, which improved my jugular vein because I was getting, you know, less blood flow to the brain.

585
00:45:35.611 --> 00:45:36.832
And now I don't have any headaches.

586
00:45:36.872 --> 00:45:37.252
And I thought...

587
00:45:37.732 --> 00:45:38.532
What the hell?

588
00:45:38.852 --> 00:45:43.974
One of the things we see is something called Eagle's syndrome.

589
00:45:44.334 --> 00:45:50.615
So there is a Eagle's syndrome, and there is a specific kind of ligament that calcifies.

590
00:45:51.115 --> 00:45:54.636
And what it does is narrows down that jugular vein, okay?

591
00:45:55.056 --> 00:46:05.479
But even when people have that type of changes where their jugular vein is pinched because of that ligament in their neck, even then with those patients,

592
00:46:05.879 --> 00:46:13.402
When we look at the kind of intracerebral flow, we don't see any changes, even when they have severe stenosis of the jugular veins.

593
00:46:13.442 --> 00:46:23.385
So I would say that if that's not doing it, you know, some postural changes, I'm not sure how much impact it's going to have on your cerebral blood flow.

594
00:46:23.743 --> 00:46:30.706
Oh, you know, the people that you said that came in and they are 30 years old, but they've got 50 year old brains, right?

595
00:46:31.466 --> 00:46:40.671
Or let's take, for example, a, um, the 50 year old comes in and she or he does the scan and you can see a lot of atrophy.

596
00:46:41.711 --> 00:46:48.837
When you look at this, right, how much do you take cholesterol into perspective here?

597
00:46:49.097 --> 00:46:57.924
Because when it comes to cholesterol and looking at your lipid panel, you can go to your doctor and he'll give you a lipid panel, which tests, you know, triglycerides, HDL, LDL.

598
00:46:57.944 --> 00:47:01.366
Maybe if you're really special, you'll get something called an ApoB.

599
00:47:02.447 --> 00:47:05.471
There is so much happening now on social media, right?

600
00:47:05.491 --> 00:47:13.419
There's a huge divide between the people who think that having a high LDL does not matter when it comes to brain health.

601
00:47:13.460 --> 00:47:20.087
And I think for all cause dementia and for Alzheimer's disease specifically, you want to maintain brain.

602
00:47:21.088 --> 00:47:22.869
You know, low lipid levels.

603
00:47:23.129 --> 00:47:36.477
There's, you know, multiple studies that have actually been shown to say if you can have an LDL less than, you know, which is really remarkable, less than 60, but it doesn't have to be, less than 80, that's, you know, indicative of good long-term brain health.

604
00:47:36.757 --> 00:47:39.878
as well with an ApoB of less than 90, right?

605
00:47:39.898 --> 00:47:50.102
Because once we reach higher, you know, LDL levels and ApoB, we can start to, you know, maybe interfere with how the brain's functioning and clogging up the arteries in the brain.

606
00:47:50.182 --> 00:47:56.684
So when you look at these people, do you cross-reference them with their lipid panels at all?

607
00:47:57.068 --> 00:48:01.650
The fuel system or the cardiovascular system, I think that is step one.

608
00:48:02.410 --> 00:48:12.475
And it's so vital because, you know, part of maintaining this brain health is reducing your risk of stroke.

609
00:48:12.995 --> 00:48:13.295
Okay.

610
00:48:13.955 --> 00:48:19.057
And so cardiovascular health mirrors your brain health.

611
00:48:19.758 --> 00:48:19.958
Right.

612
00:48:20.994 --> 00:48:26.497
So maintaining that endothelial health, the health of your arteries, so vital.

613
00:48:27.177 --> 00:48:32.940
And part of that, you know, we talked about this kind of intima medial thickening, okay?

614
00:48:33.000 --> 00:48:38.222
Because one is that it's so important to reduce your risk of stroke, okay?

615
00:48:38.842 --> 00:48:43.465
But at the same time, when you do that, you're also improving your...

616
00:48:44.325 --> 00:48:45.906
brain health at the same time.

617
00:48:46.686 --> 00:48:57.471
And as far as lipid control, I believe is absolutely key, you know, and I think that everyone should do whatever it takes to get the lipids under control.

618
00:48:57.851 --> 00:48:58.152
Okay.

619
00:48:58.532 --> 00:49:06.355
Now, whether you become super aggressive, try to get it under your LDL under 70 or 80, that's, I think, up to individuals.

620
00:49:06.776 --> 00:49:07.516
But I think that

621
00:49:07.916 --> 00:49:14.951
Certainly if your numbers are out of range and you have a family history of heart disease, okay?

622
00:49:15.552 --> 00:49:17.035
I know the argument is that

623
00:49:18.417 --> 00:49:38.443
the high LDL doesn't necessarily mean it's a bad thing if that LDL is not oxidized, but on the overall, okay, when people have high LDL, they're also not the most healthy individuals, which means they have a high level of inflammation.

624
00:49:38.803 --> 00:49:45.505
So along with that elevated LDL, they do also have inflammation, and that's a bad recipe there.

625
00:49:45.805 --> 00:49:50.728
because you have increased LDL, you have high level of inflammation, you're gonna have high levels of oxidized LDL.

626
00:49:51.209 --> 00:49:59.094
Then you set up this scenario where you're gonna have accumulation in your vessels.

627
00:49:59.474 --> 00:50:01.476
And how do you feel about statins?

628
00:50:02.950 --> 00:50:04.971
So it's interesting.

629
00:50:05.531 --> 00:50:12.313
I would say if you asked me this question 10 years ago, I would say stay away, stay away.

630
00:50:12.573 --> 00:50:12.773
Right.

631
00:50:13.553 --> 00:50:21.175
And but what I've found is that in scenarios where people have a strong family history,

632
00:50:21.695 --> 00:50:24.936
okay, that I think statins do play a role.

633
00:50:25.336 --> 00:50:41.139
And apart from that, what I've seen that is that low-grade, low-level statins play a role in this vessel wall inflammation, which is it.

634
00:50:41.199 --> 00:50:42.760
So, there are a lot of studies on there.

635
00:50:43.420 --> 00:50:44.200
And so, even if

636
00:50:45.185 --> 00:51:01.631
you are not taking statins for to specifically being aggressive with statins to lower your overall particle number and LDL number, just from decreasing the vessel wall inflammation by taking a low dose statin.

637
00:51:02.531 --> 00:51:05.012
I believe there is some some role there.

638
00:51:05.872 --> 00:51:11.036
I am very much on the bandwagon of statins are preventative.

639
00:51:11.056 --> 00:51:13.538
They don't affect you in the slightest.

640
00:51:13.558 --> 00:51:23.344
We've seen a 30% reduction in some really wonderful research and studies to show a 30% reduction in Alzheimer's disease from statin use.

641
00:51:23.364 --> 00:51:26.887
So I don't know why there's so much controversy around it.

642
00:51:26.907 --> 00:51:27.988
Yeah.

643
00:51:28.768 --> 00:51:28.988
Okay.

644
00:51:29.008 --> 00:51:45.744
So moving on, have you seen an intervention window where, and you've tracked this, where somebody comes in and they're at a certain age and you see certain areas of their brain from the MRI with volumetrics, they go through, they complete an intervention, they come back and you've seen changes in that?

645
00:51:46.910 --> 00:51:48.191
That's a great question, Louisa.

646
00:51:48.652 --> 00:52:00.462
And so what you're asking is that after people have positive interventions in terms of lifestyle, let's say better sleep and whatnot, have we seen a increase in the brain volumes?

647
00:52:00.822 --> 00:52:01.142
Okay.

648
00:52:01.903 --> 00:52:04.606
And so a lot of these patients who...

649
00:52:05.286 --> 00:52:08.527
having these sort of follow-ups with lifestyle changes.

650
00:52:08.547 --> 00:52:15.389
A lot of them go to kind of these more lifestyle centers and longevity centers.

651
00:52:15.629 --> 00:52:18.130
And so they're getting these elective scans, right?

652
00:52:18.210 --> 00:52:20.831
And so not all of those patients are coming to us.

653
00:52:21.411 --> 00:52:29.114
But what I can say is that from the patients that we've seen in terms of like who are working with neurologists who are coming to us for those referrals...

654
00:52:30.613 --> 00:52:42.041
We've seen patients that initially had the rate of neurodegeneration of, let's say, like that other patient, like 2.2% or 2% or 3%.

655
00:52:42.582 --> 00:52:50.768
And they have, with lifestyle changes and, you know, lipid control, as we just talked about, have leveled off.

656
00:52:51.248 --> 00:52:54.111
their rate of neurodegeneration.

657
00:52:54.352 --> 00:53:03.582
Maybe so from year to year, maybe there is no change in their brain volume, which I think it's a big achievement.

658
00:53:03.742 --> 00:53:05.123
Think about it, because if your brain...

659
00:53:06.249 --> 00:53:19.556
If your normal rate of decline is, let's say, a point, a point five percent or one percent and you have zero change, that means you've done something to maintain that brain volume from year one to year two.

660
00:53:20.136 --> 00:53:32.962
You know, so we have seen that that when patients have become aggressive, that they have maintained their volume from year to year and that initial drop, they have flattened that curve.

661
00:53:33.322 --> 00:53:34.463
So that is very encouraging.

662
00:53:35.283 --> 00:53:40.466
I really love that because I'm telling people interventions are all that matter, right?

663
00:53:40.486 --> 00:53:41.627
There is nothing that you can do.

664
00:53:41.647 --> 00:53:43.608
There is no cure for Alzheimer's disease.

665
00:53:45.168 --> 00:53:46.609
But there are medications actually.

666
00:53:46.649 --> 00:53:53.933
So if you are, which I still don't, I don't promote either, but let's say you do have mild cognitive impairment.

667
00:53:54.853 --> 00:53:56.093
the pre-dementia state.

668
00:53:56.893 --> 00:54:00.194
And I always say that you're on this trajectory, right?

669
00:54:00.434 --> 00:54:14.477
So now you've been given, you're on the treadmill, you've been given the MCI diagnosis, which means that maybe Alzheimer's disease is going to come knocking on the door in 20 years, but we can make it knock on the door in 30 years, right?

670
00:54:14.517 --> 00:54:16.298
Just by slowing the progression.

671
00:54:17.238 --> 00:54:17.758
How...

672
00:54:18.678 --> 00:54:21.001
What role does medications play?

673
00:54:21.061 --> 00:54:30.993
Specifically, these IV medications, lakanamab, aducanamab, like all of these monoclonal antibodies that you go in, it's an IV infusion.

674
00:54:31.794 --> 00:54:33.816
What are they actually doing in the brain?

675
00:54:33.837 --> 00:54:33.937
Yeah.

676
00:54:35.420 --> 00:54:48.468
So a lot of these antibodies are targeted towards, and there's a lot of research going on, and targeting this beta amyloid that we talked about, right?

677
00:54:48.488 --> 00:54:53.551
So we know that the beta amyloid correlates with increased rate of neurodegeneration.

678
00:54:54.271 --> 00:55:02.316
And so we talked about it, we showed that scan where it kind of like that beta amyloid kind of deposits in that periphery of the brain.

679
00:55:02.716 --> 00:55:04.057
And what's interesting is that,

680
00:55:05.323 --> 00:55:15.172
The beta amyloid not only plays a role in kind of like the neurodegeneration, but also impacts the blood vessels in that area.

681
00:55:15.632 --> 00:55:27.703
And that is one thing also that we see imaging-wise is that not only do we see the cortical volume loss, but we see the vessels there being impacted.

682
00:55:28.263 --> 00:55:42.412
And so a lot of times there is a term we call amyloid angiopathy, where the beta amyloid causes the blood vessels to degenerate and creates this amyloid angiopathy.

683
00:55:42.432 --> 00:55:51.358
And so these patients wind up getting these microbleeds and all over their cortex from that amyloid deposition.

684
00:55:52.218 --> 00:55:59.781
And so micro hemorrhages, micro hemorrhages, and on our scan, they look like these little dots that are all spread.

685
00:55:59.881 --> 00:56:00.161
Okay.

686
00:56:00.301 --> 00:56:18.847
And one of the risk factors is that eventually you get enough of a conglomeration of this beta amyloid and this amyloid angiopathy changes in the cortex, that it ultimately can lead to a a focal parenchymal hemorrhage or a massive hemorrhage.

687
00:56:18.967 --> 00:56:20.348
And that can be very devastating.

688
00:56:20.928 --> 00:56:21.108
So

689
00:56:23.160 --> 00:56:28.362
This protein deposition, you know, it is an issue, okay?

690
00:56:28.562 --> 00:56:32.243
And so not only from neuronal loss, but from vascular changes.

691
00:56:32.683 --> 00:56:40.045
And so a lot of this work with this antibodies is trying to curtail or control those effects.

692
00:56:40.947 --> 00:56:48.509
Yeah, I think, um, uh, I, I don't think that they are, I just, you know, let's not get there in the first place.

693
00:56:48.549 --> 00:56:52.369
Let's not get to the position where you have to think about that.

694
00:56:53.129 --> 00:57:01.191
Uh, let's start intervening in our twenties, definitely intervening in your thirties and forties with all of the lifestyle interventions that we've mentioned.

695
00:57:01.371 --> 00:57:01.611
Right.

696
00:57:01.631 --> 00:57:02.691
So you don't have to get to that spot.

697
00:57:04.932 --> 00:57:05.852
I have a few more questions.

698
00:57:06.937 --> 00:57:07.778
Someone's listening right now.

699
00:57:07.798 --> 00:57:18.751
They've got a parent who has mild cognitive impairment, or maybe they think they've got Alzheimer's disease and they want to advocate for them and they want to get one of these brain scans.

700
00:57:19.132 --> 00:57:19.693
What do they do?

701
00:57:20.934 --> 00:57:21.655
Louisa, you know,

702
00:57:23.272 --> 00:57:29.634
Every time I talk about this, people always approach me and say, hey, you know, can I come, can I come to you and can you scan me?

703
00:57:29.794 --> 00:57:30.074
You know?

704
00:57:30.874 --> 00:57:40.517
And, um, what I tell them is this, is that on these scans, uh, we just, it's not just the hippocampal formation that we're imaging.

705
00:57:40.637 --> 00:57:41.837
We're imaging the whole brain.

706
00:57:42.418 --> 00:57:48.399
And a lot of times we, we don't just see that one particular area, but we also find like incidental tumors.

707
00:57:48.739 --> 00:57:50.760
We find many things that may need follow up.

708
00:57:50.840 --> 00:57:51.420
Wait a second.

709
00:57:51.440 --> 00:57:53.181
How do you find an incidental tumor?

710
00:57:53.361 --> 00:58:04.685
So, you know, there are sometimes people coming in just for these volumetric scans, but that does not mean that they cannot have other brain tumors, you know, in different parts of the brain.

711
00:58:05.146 --> 00:58:05.526
And so...

712
00:58:06.708 --> 00:58:17.779
Sometimes they're coming in for just this kind of like MCI evaluation or, you know, memory impairment evaluation.

713
00:58:18.740 --> 00:58:28.589
And we'll do the scan and it's actually a brain tumor that was causing edema that was leading to the memory issues, you know.

714
00:58:29.430 --> 00:58:42.275
And so what I tell people is this, is that, you know, you don't want to take that responsibility on yourself to get the scan, meaning that there has to be a...

715
00:58:44.033 --> 00:58:56.101
neurologists or a primary care physician who is ready to back you up or who's taking care of you because, God forbid, you get a scan and there is a tumor there.

716
00:58:57.021 --> 00:58:59.403
Now, who do I call to take care of you?

717
00:58:59.943 --> 00:59:03.525
You know, and that becomes an issue for us.

718
00:59:03.805 --> 00:59:04.125
Okay.

719
00:59:04.686 --> 00:59:07.468
So the best approach is that

720
00:59:08.445 --> 00:59:14.949
you go through, get the evaluations in terms of the cognitive tests, let's say the genetic tests.

721
00:59:15.930 --> 00:59:26.496
And if you can make a case to get this exam, approach your physician, approach your neurologist and say, hey, this is, you know, I would like to get evaluated.

722
00:59:26.877 --> 00:59:31.540
But have somebody that can, one, follow up on that study.

723
00:59:32.100 --> 00:59:36.683
And if need be, act on the hippocampal findings we talked about.

724
00:59:38.424 --> 00:59:39.345
There is a brain tumor.

725
00:59:39.525 --> 00:59:42.727
Then there's somebody there that can, you know, address that as well.

726
00:59:43.087 --> 00:59:44.148
But being proactive.

727
00:59:44.528 --> 00:59:44.728
Yes.

728
00:59:45.048 --> 00:59:45.288
Yes.

729
00:59:45.689 --> 00:59:49.071
And asking for what you want and asking for what you need.

730
00:59:49.711 --> 00:59:50.172
Absolutely.

731
00:59:50.212 --> 00:59:50.432
Yes.

732
00:59:51.492 --> 00:59:51.712
Okay.

733
00:59:51.753 --> 01:00:03.740
So my last question is, of everything you've seen in brain scans over your entire career, what is the one thing that separates the people whose brains age well from the people whose brains age don't?

734
01:00:03.880 --> 01:00:06.422
And why is nobody telling people about this?

735
01:00:06.442 --> 01:00:06.682
Okay.

736
01:00:07.443 --> 01:00:08.043
Great question.

737
01:00:09.744 --> 01:00:13.687
And I'm going to share a very brief personal story about this.

738
01:00:14.927 --> 01:00:25.894
So I would say 10 years ago, you know, doing great in my career, you know, great family, great house, you know, driven,

739
01:00:26.774 --> 01:00:29.395
you know, all brands of cars and everything like that.

740
01:00:29.575 --> 01:00:40.600
And but I would say kind of cognitively or in terms of my mental status, I still had this low grade anxiety.

741
01:00:41.220 --> 01:00:41.360
And

742
01:00:42.701 --> 01:00:43.482
It was bothering me.

743
01:00:43.522 --> 01:00:49.808
I said, you know, outwardly, I have all the trappings of success and everything you can think of.

744
01:00:50.448 --> 01:00:53.531
And that's when, you know, I read this book.

745
01:00:53.892 --> 01:00:56.634
It was it's called Altered Traits.

746
01:00:56.774 --> 01:00:58.816
I don't know if you've heard about that book.

747
01:00:58.836 --> 01:00:59.096
Yeah.

748
01:01:00.177 --> 01:01:12.240
And so you have the clinicians in there and the researchers, you have, they talk about what meditation does to your brain.

749
01:01:12.921 --> 01:01:24.944
And to answer your question, I would say that apart from everything we've talked about, you know, the four part model, you know, kind of the vascular health, brain health, brain function, and then the nerve root tracts.

750
01:01:26.345 --> 01:01:35.696
A key parameter or key determinant of brain health is your, what is your baseline anxiety level?

751
01:01:37.298 --> 01:01:41.724
And right now, you know, at that stage, I would say 10 years ago,

752
01:01:42.825 --> 01:01:48.126
I was playing ping pong between two parts, right?

753
01:01:48.186 --> 01:01:54.948
I was either thinking about some regrets of the past or some anxieties or some anticipation of the future, right?

754
01:01:55.148 --> 01:01:57.889
Just kind of constantly on the go, right?

755
01:01:57.949 --> 01:02:02.490
Thinking about things that didn't go right and then always anticipating things, you know, that are going to happen.

756
01:02:02.550 --> 01:02:05.771
And, you know, even the anticipation, you have a little bit of anxiety about it.

757
01:02:06.211 --> 01:02:10.812
And then what I found out, you know, the research shows that that that chronic level of anxiety,

758
01:02:11.312 --> 01:02:20.781
has been linked to one longevity in terms of your telomere length and whatnot, but that it truly impacts your brain as well.

759
01:02:21.242 --> 01:02:33.053
And these studies on these Tibetan monks showed that these monks had, one, some of the best preservation of brain volumes, one.

760
01:02:33.454 --> 01:02:34.094
Number two...

761
01:02:35.175 --> 01:02:42.320
that in terms of neural circuits, right, they were able to downgrade their sort of stress response.

762
01:02:43.061 --> 01:02:58.672
And so that as they built up their practice, they were able to downgrade their stress response during the day so that their stress network, their amygdala, the parts of the brain that plays a role in reactivity, was downregulated.

763
01:02:59.013 --> 01:03:01.755
And so they actually were living a...

764
01:03:02.555 --> 01:03:06.097
a stress free life where they were more present.

765
01:03:06.137 --> 01:03:11.280
They were not in this kind of mode of regrets of the past or anxieties of the future.

766
01:03:12.061 --> 01:03:13.962
And that got me very intrigued.

767
01:03:14.022 --> 01:03:16.564
And I said, you know, I have to work on myself.

768
01:03:16.904 --> 01:03:26.269
So ten years ago, I really dug deep into this research and I said, you know, I want to I want to see make those changes, you know, real for me.

769
01:03:27.610 --> 01:03:33.157
And so I went on this, I decided to do this eight day silence program.

770
01:03:34.533 --> 01:03:36.113
It's in India, it was in India.

771
01:03:36.554 --> 01:03:40.355
But to do this program, there was this prep that I had to go to.

772
01:03:40.395 --> 01:03:45.036
It was almost a 12 to 18 month prep that is needed to go into this.

773
01:03:45.796 --> 01:03:49.617
And I was, I'm just, you know, I've always been very kind of gung-ho about things.

774
01:03:49.637 --> 01:03:52.498
So I said, you know what, I'm just gonna, whatever it needed, we'll do it.

775
01:03:52.518 --> 01:03:55.279
So in 12 months, I kind of completed all the prerequisites, all that.

776
01:03:55.819 --> 01:04:01.781
And I'm here, qualified, went, go to India, eight days, silence, no cell phones,

777
01:04:02.601 --> 01:04:10.188
no social media, no books, no TV, nothing, no contact with family, just total silence for eight days.

778
01:04:10.888 --> 01:04:15.912
And I tell you what, I would say the first five days, extremely painful.

779
01:04:16.313 --> 01:04:20.957
I could not, I wanted to jump ship right away.

780
01:04:22.599 --> 01:04:37.739
end of the sixth day going into the seventh day this stillness descended in me which i cannot i give in my you know just talking about it the hairs on my uh arms stand up because it was so profound

781
01:04:38.652 --> 01:04:45.638
where I was like, wow, this is the first time I'm experiencing the here and now.

782
01:04:46.919 --> 01:04:53.944
And why I share this story is that I believe that in this day and age, we're under so much noise.

783
01:04:54.324 --> 01:04:59.869
You just watch the news, social media, you know, tracking our own emails and everything like that.

784
01:05:00.269 --> 01:05:07.434
that we're constantly playing this ping pong between regrets of the past, anxieties of the future, anticipation of the future.

785
01:05:07.454 --> 01:05:13.858
How many of us actually remain in the here and now and experience this moment?

786
01:05:13.938 --> 01:05:15.379
You're not experiencing life.

787
01:05:16.623 --> 01:05:23.412
And I came out of those eight days and it reset my level of anxiety.

788
01:05:24.213 --> 01:05:30.601
You know, I just, and I do a maintenance practice now for about 20 minutes in the morning.

789
01:05:31.402 --> 01:05:35.006
And so the overall principle, the takeaway for people is,

790
01:05:36.448 --> 01:05:42.234
And when I speak about this on stage, I said, you have a choice between stillness versus illness.

791
01:05:43.135 --> 01:05:48.220
And when you remain in this state of stillness, you're not reactive.

792
01:05:48.700 --> 01:05:49.962
You can respond.

793
01:05:50.602 --> 01:05:56.628
You have this gap between when somebody tells you something, you have this space, this white space to respond from.

794
01:05:57.349 --> 01:06:02.271
versus if you're in this reactive anxiety mode, you're in illness.

795
01:06:02.851 --> 01:06:04.072
And so the choice is that.

796
01:06:04.532 --> 01:06:16.657
And I think that has been the biggest driver for my health and research has shown that that has helped, you know, in terms of preserving brain volume and preserving, you know, kind of like cognitive health.

797
01:06:17.477 --> 01:06:17.958
Wow.

798
01:06:18.578 --> 01:06:24.782
I don't think I'd ever be able to do a silent retreat, but, you know, meditation is, it's very hard for me.

799
01:06:24.902 --> 01:06:28.204
I've never, I just get up and I go every single morning.

800
01:06:28.324 --> 01:06:30.086
I don't meditate in the morning.

801
01:06:30.186 --> 01:06:31.727
I don't really have any sound.

802
01:06:32.267 --> 01:06:34.449
therapeutic morning rituals.

803
01:06:34.989 --> 01:06:36.531
Would I like to meditate?

804
01:06:36.551 --> 01:06:36.851
Yes.

805
01:06:37.952 --> 01:06:41.035
A form of meditation for me is sitting down.

806
01:06:41.075 --> 01:06:48.882
I do sit in silence, but it's maybe the TV's on, or maybe I'm listening, I don't know, to something else or doing, so I don't know how to explain it.

807
01:06:48.902 --> 01:06:49.022
But

808
01:06:49.542 --> 01:07:00.092
to me to calm my brain down, I have to let it be watching something like maybe like some sort of dumb content, um, right on not dumb content on Instagram, but maybe a TV show that calms me down.

809
01:07:00.572 --> 01:07:12.523
But I always wonder about what meditation is doing because I've just seen a lot of the research taking place now with binaural beats and 40 Hertz binaural beats clearing out amyloid in mouse models.

810
01:07:12.983 --> 01:07:13.824
So I wonder if,

811
01:07:14.945 --> 01:07:33.359
how this plays with brainwave activity, getting it into that, you know, gamma frequency brainwave and how if I can get, if we can get that oscillating at the perfect speed, then can that have better brain coherence and calm down anxiety and clear out amyloid?

812
01:07:33.379 --> 01:07:39.103
I'm not sure, but I'm going to definitely be getting on board with meditation now that you've mentioned that.

813
01:07:39.163 --> 01:07:41.505
And I actually want to read that book, Altered Traits.

814
01:07:41.883 --> 01:07:43.365
Yeah, I think it changed.

815
01:07:43.745 --> 01:07:46.908
It really altered traits.

816
01:07:47.209 --> 01:07:48.951
It really altered my viewpoint.

817
01:07:49.591 --> 01:07:53.255
Because what they said was that it's not about changing your state.

818
01:07:53.916 --> 01:08:00.923
It's about changing your trait, which means it's changing who you are biologically.

819
01:08:00.943 --> 01:08:01.604
Yeah.

820
01:08:01.724 --> 01:08:07.908
And which I think is when I saw that, that I said that this is going to have a permanent change in my system.

821
01:08:08.208 --> 01:08:08.669
And it did.

822
01:08:09.569 --> 01:08:17.655
Even that one week intervention changed who I was fundamentally as a person in terms of being reactive.

823
01:08:18.075 --> 01:08:24.979
And it just gave me this level of stillness where now I just have this gap.

824
01:08:25.440 --> 01:08:26.720
When somebody says something to me,

825
01:08:27.741 --> 01:08:30.564
I am, I just, I don't respond right away.

826
01:08:31.244 --> 01:08:41.653
I just think and I take my time and I just, I just, I sometimes I don't even need to respond, but it gives me the space.

827
01:08:41.974 --> 01:08:48.059
And I think that's huge because we know that lowering that chronic state of anxiety is,

828
01:08:49.883 --> 01:08:57.632
has tremendous value in terms of how we age biologically, in terms of our body age, but also how our brain ages.

829
01:08:58.263 --> 01:09:02.606
It's funny you said that just to close out when you said you don't respond immediately.

830
01:09:02.826 --> 01:09:08.030
I've started using this little thing that locks me out of my phone, right?

831
01:09:08.050 --> 01:09:09.491
Locks me out of my apps.

832
01:09:10.071 --> 01:09:13.693
I didn't realize it can also lock you out of your messages.

833
01:09:14.254 --> 01:09:19.577
And so for a certain period of time, because let me tell you, I've got my, you know, it's my work phone and it's my personal phone.

834
01:09:19.597 --> 01:09:21.759
And I'm in a group text with my closest girlfriends.

835
01:09:21.779 --> 01:09:25.281
And sometimes I open it, there's around 50 texts in there and it gives me anxiety.

836
01:09:25.722 --> 01:09:27.423
So now I lock myself out.

837
01:09:28.023 --> 01:09:30.684
of my phone for several hours per day.

838
01:09:30.964 --> 01:09:31.204
Right.

839
01:09:31.344 --> 01:09:40.327
And I just don't get back to any messages, like, especially right, like right now, but even when I'm not doing anything, if I'm doing mundane tasks and I do have the ability to respond, I just lock myself out of them.

840
01:09:40.727 --> 01:09:44.528
So then I have a moment without getting any text messages.

841
01:09:44.688 --> 01:09:46.649
And it's honestly, it's changed my life.

842
01:09:47.529 --> 01:09:48.269
It's huge.

843
01:09:48.289 --> 01:09:50.030
That white space is so vital.

844
01:09:50.510 --> 01:09:51.090
It's so vital.

845
01:09:51.523 --> 01:09:58.400
Well, Dr. Mistry, thank you for coming on here and showing us your brain scans and teaching us all about MRIs and neuroimaging.

846
01:09:59.634 --> 01:10:00.935
Pleasure being here, Louisa.

847
01:10:01.656 --> 01:10:18.749
I would say with technology advancing, we want to not be a slave to technology, but we want to leverage all this technology and AI technology to really augment who we are as humans.

848
01:10:19.089 --> 01:10:23.072
And I think if we can leverage technology that way, that's the best way forward.