Dr. Kristine Burke, MD
In this episode
In this episode, we’ll be talking about healthy brain aging. As we all know, maintaining our cognitive function is one of the most important factors for a long, healthy, happy life. But is it possible to keep our brains functioning well even into old age? And if so, what options do we have? Our guest in this episode is Dr. Kristine Burke, MD, a functional and precision medicine physician who’s an expert in brain health and longevity and maintaining cognitive function during the aging process.
Also in this episode:
- Dr. Patti Shelton, MD, LongevIQ medical communications officer
- Amir Ginsberg, LongevIQ founder.
Related articles, podcast notes & links
Lifestyle is like the foundation of a house. You cannot create health in any arena of the body without that foundation…Sleep, exercising the body, exercising the mind, the food we eat, environmental toxin exposure, stress management, and our social connections. Those are the foundations literally for all health, and that includes brain health.
– Dr. Kristine Burke, MD
- (0:00:00) Podcast and episode intro, medical disclaimer
- (0:01:52) What causes cognitive decline?
- (0:04:22) Early warning signs of cognitive decline
- (0:05:32) Tests for cognitive decline
- (0:07:59) The 5 pillars of brain longevity and cognitive function (SEEDS)
- (0:14:18) Getting optimal sleep for brain health and longevity
- (0:16:20) Physical activities and movement
- (0:19:07) Brain exercises and tips to challenge the brain
- (0:21:37) Toxins, chemicals, and heavy metals
- (0:25:58) Foods and supplements for brain health
- (0:31:59) Mental, physical and chemical impact of stress
- (0:34:34) When to get started with lifestyle modification?
- (0:35:43) Reversing cognitive decline
- (0:40:28) Loneliness, social connections, meaning, and purpose
- (0:42:20) Meditation and brain health
- (0:44:22) Dementia reversal trial
- (0:48:30) Genetics testing
- (0:52:25) Final thoughts
This podcast episode was edited to improve readability.
Podcast and episode intro, medical disclaimer[00:00:00] Dr. Patti: This is Dr. Patti Shelton, and you are listening to the LongevIQ Podcast. We discuss anti-aging and longevity science and how to benefit from it so we can all live long, healthy, happy lives. Just before we get started, a quick medical disclaimer. This podcast is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease or to provide or replace medical advice. Please use this information to educate yourself as much as possible and share this information with a qualified health practitioner that you trust.
In this episode, we’ll be talking about healthy brain aging. As we all know, maintaining our cognitive function is one of the most important factors for a long, healthy, happy life. But is it possible to keep our brains functioning well even into old age? And if so, what options do we have? Our guest in this episode is Dr. Kristine Burke, MD, a functional and precision medicine physician who’s an expert in brain health and longevity and maintaining cognitive function during the aging process.
Also joining us today, as always, is Amir Ginsberg, the founder of LongevIQ. Welcome Dr. Burke. Thank you so much for joining us today.[00:01:14] Dr. Burke: Thank you so much for having me. Really happy to be back. [00:01:17] Dr. Patti: And we’re really excited to be talking about this topic because it’s something that’s so important when we’re thinking about longevity. Most people want to live a long life and keep their brains functioning the whole time. Many of us have seen elders kind of losing their memories when they get towards the end of life, and we want to prevent that, and you have really a lot of wisdom to share about this topic. [00:01:37] Dr. Burke: I think so. Got a lot of experience in this area for sure. And I’m really happy that you guys are bringing this message because we can have the greatest impact when we do it as prevention or early intervention. So that’s really exciting.
What causes cognitive decline?[00:01:52] Dr. Patti: Let’s start by talking about what we know research-wise about cognitive decline. Do we know what causes it? Is it something that inevitably happens as people age? Or are there things that are triggering this to happen? [00:02:05] Dr. Burke: Well, that could be a whole-hour discussion. There are a few pieces to the puzzle that are important for us to unravel a little bit as we move along.
Number one is that the prevailing wisdom for dementia and, in particular, Alzheimer’s disease has been the amyloid hypothesis. And while there is no doubt that amyloid, which is a protein that gets deposited in the brain and contributes to brain degeneration, there are these two very divergent now schools of thought about how that interplay comes to be. And so, in the conventional thinking and where most of the research and the drug therapeutic development has been focused is on removing amyloid as a causative agent. And what we’ve seen from over 300 drugs that have come up through phase two and many through phase three clinical trials and then failed is that the act of just removing amyloid, at best, and that’s the two most recent drugs that have been approved, which had a very slight improvement in the rate of decline, but no improvement in overall cognitive function, which is what we really want to see. That’s the best-case scenario that we can see when all we focus on is removing the amyloid.
In the functional medicine approach, in the precision medicine approach, we really view the amyloid as more of an effect of the underlying inflammatory chronic infection of these processes that are going on in the brain that then lead to the deposition of amyloid, like as a spackle, if you will, to help heal the wound. And over time, that amyloid deposition becomes really excessive.
And just like many things in the body, some is a good thing because it’s protective, and too much is a bad thing. And that’s really what it looks like is unfolding in the research that we’re working on now.
So then, what are those other root causes? And so many of them are the things that we all focus on in our health and longevity promotion area anyway. So it’s all of the things that we know about our lifestyle interventions, our sleep, exercising the body, exercising the mind, the food that we eat, our environmental toxin exposure, and then our stress management and our social connections. Those are the foundations literally for all health, and that includes brain health.
Early warning signs of cognitive decline[00:04:15] Dr. Patti: Fantastic. And this is what we’ll be spending lots and lots of time talking about today, is how we can optimize those things. Let’s talk a little bit about how we can know whether we’re starting to experience cognitive decline. So let’s say somebody’s in their thirties, forties, or fifties, and they’re like, is this happening to me? How do I know if this process is getting started? And what’s kind of going on with that? Is there any kind of testing, or how would somebody assess how their brain is doing so far? [00:04:40] Dr. Burke: Yeah, that’s a great question. As with many things, there’s definitely a spectrum of effects in this. And so early on, we’ll see things that often get ascribed to aging. You forget why you walked into a room, or you can’t remember where you put your keys. You have to put them in the same place all the time, or you’re constantly searching for your phone. As things progress, maybe it’s a difficult time finding the words that you want to use, or maybe forgetting where you parked your car at the mall and having to wander around the parking lot for a while before you find it.
So these are all early indicators that things are not right anymore. Now, that doesn’t necessarily mean that you have dementia, and it doesn’t necessarily mean that you will progress to dementia or cognitive impairment of some sort, but they’re definitely early warning signs that we should not be ascribing simply to aging and that we should be paying attention to.
Tests for cognitive decline[00:05:32] Dr. Burke: In conventional medicine, we have several different cognitive tests that we can do. The most commonly performed one is called the mini Mental Status Examination (MMSE). Now, that one really is designed to pick up true dementia. So in those early phases, or even some of the more significant phases that aren’t fully into the dementia realm, that’s going to have a very poor sensitivity. It’s going to have a very low detection rate, so performing that test is likely to come out negative or normal.
Then from that, another test was developed called the MOCA test, or the Montreal Cognitive Impairment assessment, which is more accurate at picking up mild cognitive decline. And so it’s a little more sensitive for that.
Then we can move into the realm of some of the computerized-based brain testing. The one that we use in our office and in our dementia reversal trial is called CNS Vital Signs, and that test has a much greater capacity for picking up those small changes, those small differences in how the brain is working because it analyzes multiple domains of brain function, your visual memory, your verbal recall, your executive functioning, which is planning and organization, your motor speed, the processing speed of your brain will be one of the first things that we start to see become abnormal. So the first thing that happens is just everything works more slowly.[00:06:57] Dr. Patti: If somebody’s interested in taking one of those tests, can they access that online on their own? Would they need to come to you or another doctor to access the test? Can they just do it at home? [00:07:08] Dr. Burke: So none of those assessments are at-home accessible, with the possible exception of the CNS vitals. But that does have to be through some type of practitioner relationship because the test does have to be interpreted.
I know that Apollo Health, which is the administrator of Dr. Bredesen’s original Recode protocol, they do offer that CNS vital signs testing as a part of the assessment that they offer, and so that would be one way to potentially have that testing done. We’re working on a way to offer that through our practice so that people can have the option of doing what we like to call a cognoscopy, taking a little peek in a look-see to see how their brain is functioning and what maybe some of the basic things are that we could start to modify to help improve their brain health and their brain health trajectory.
The 5 pillars of brain longevity and cognitive function (SEEDS)[00:07:56] Dr. Patti: Speaking of that, what are the things that somebody can do to help optimize their brain health trajectory? And I know this is a big topic, so maybe start with just a quick overview of the categories, and then we can dive a little more specifically into some of those categories. [00:08:12] Dr. Burke: So we call them the seeds of true health from our practice, which is True Health Center for Functional Medicine. And so that’s an acronym that stands for sleep.
Sleep and the brain’s glymphatic system[00:08:21] Dr. Burke: So, for brain health, we want to be getting seven to eight hours of good quality sleep a night. The last few years we’ve learned a lot about what’s called the glymphatic flow within the brain, and that’s a lymph system that’s in the brain itself that helps us to offload toxins and metabolic byproducts while we sleep.
Sleep is literally our brain washing time. It’s literally the time that we are cleaning out the toxins and the things that the brain has produced during that day’s worth of effort. So sleep is a super important part of that puzzle.
Exercise, meditation, and brain derived neurotrophic factor (BDNF)[00:08:59] Dr. Burke: And then exercise is really important, not just physical exercise for the body, which we know is one of the best ways to promote the production of a hormone called BDNF, which stands for brain derived neurotrophic factor.
That BDNF is literally the signal that we need for the brain to grow new connections. So BDNF is super important to maintaining brain health long term. So physical exercise promotes that. And the other thing that promotes that is meditation. And so that’s part of exercising the mind. We could also slide that into our stress management category because it does both things, but meditation promotes BDNF production as well. So those are key, key components.
Exposure to toxins[00:09:42] Dr. Burke: Then we have our exposure to environmental toxins. And a lot of people think, oh, I don’t really have any chemical exposure, or I eat organic, and you know, I don’t wear perfumes, so I’m good. But we have, over the last probably 80 to 100 years, been exposed to tens of thousands of chemicals that never existed in the history of humans.
So even if you want to be over here and don’t want to ascribe to the fact that those chemicals are potentially health-harming to us. Regardless of that, it’s a tremendous amount of chemical load for our body to have to process. So it creates a high metabolic demand on our liver and then also on our brain. So our environmental toxin exposure is a key part of that. So that’s chemical toxins.
Then we have the biological toxins. So these are things like mycotoxins that are produced by molds, for example or some other types of chronic infections that can produce some toxins in their life cycle or try to compete in their environment. Bacteria will do that, fungus will do that, and molds will do that. So these are all things both inside the body and in our physical environment where we live, or we work, or we spend a lot of time that are going to add to that toxic burden. That’s something we call our exposome. All of those things.
Diet and eating patterns for brain health[00:10:58] Dr. Burke: Then the food that we eat. The last time we chatted, we spoke about promoting healthy aging with foods and what some of those things are that we want to do. So from a prevention perspective, it looks like a paleo Mediterranean or a Pesco Vegetarian (* vegetarian who also consumes fish and seafood) type of diet. Those seem to be the ones that have the best research and seem to have the best outcomes.
We bring in a lot of plants. Plant predominant is always important because of all those different colors in the plants. Eating the rainbow is one of the things we like to talk about. All those different colors have chemical properties. Those phytochemicals are protective to us, just like they are protective to the plant, and that’s why the plants make them. So we have the food piece.
Now, once we’ve moved from our normal state of brain health into more of a cognitive decline era of our life, or even into dementia, that’s when bringing on something like a ketogenic diet can be very helpful because we know that the brain loses that ability to utilize fat as fuel as we get older, probably in large part mostly because of our standard American diet, and not so much because of it’s something inherent in how the brain is programmed to do because we can reverse that by putting somebody on a ketogenic diet. So that’s the progression of the dietary interventions that we like to use.
Stress[00:12:17] Dr. Burke: Then we have stress management. A lot of people like to say, well, I just have a lot of stress in my life, but it’s not things that I can control. It’s stress in my job, or it’s stress for my family, or it’s stress taking care of a loved one with dementia, for example. You can’t change that. But what you absolutely have the power to change is how your body responds to that stress and how that stress chemistry is going to impact your physiology. That’s really what we’re talking about when we’re talking about stress management.
Social connection[00:12:46] Dr. Burke: And then the last piece of our foundational puzzle is the social connection. A friend of mine, Dr. Kat Toups, MD, who’s also the lead investigator in our dementia reversal trial, was speaking recently and said that retirement is actually a risk factor for the development of dementia. And it’s probably for a lot of those reasons, right? Loss of social connection, loss of purpose, maybe loss of meaning in one’s life. But that social connection is really important in generating some of the really important hormones that we use to stimulate the brain connections that we want to maintain.
Hormonal balance and brain health[00:13:21] Dr. Burke: And then not part of our foundational piece, but also stemming from that would be our hormonal balance. And so, hormones are a very important part of maintaining our brain health. We have receptors in the brain for estrogen, testosterone, and thyroid, and all of these hormones that can often decline as we age as well. So maintaining those healthy hormone levels is an important piece too. [00:13:48] Dr. Patti: So much information there. Seeds stands for sleep, exercise, physical and mental, exposure to toxins, diet, and then stress and social connections being the last ‘S.’ And then hormones are another thing to think about that’s not necessarily in that foundation little piece. So let’s maybe break down each one individually a little bit more and give people some tips as to how they can kind of work towards optimizing their brain health over time. So we can just go in order.
Getting optimal sleep for brain health and longevity[00:14:18] Dr. Patti: Let’s start with sleep. How much sleep do people really need to maintain their brain health, and how can they make sure that they’re getting that amount? [00:14:25] Dr. Burke: So what the dementia research shows is that it looks like about seven to eight hours of sleep is optimal for brain health. Some research shows that less than six hours and more than nine hours actually have a negative impact on healthy longevity. And so, the sweet spot for the brain appears to be about seven to eight hours a night. We want that to be in a dark environment, in a dark room, so that we pass through the cycles of sleep that we want to maintain and in the appropriate sleep architecture where we have maybe about 20% of deep sleep, about 25% in REM sleep, and then light sleep interspersed in between there and that stage three and four sleep, that deeper sleep, that’s where that glymphatic lymph flow gets stimulated. That’s where the brain really starts that self-cleaning process.
And so things that are going to interrupt getting into a deep sleep, like alcohol at night before bed. Having the television on in the room, falling asleep with the TV on, and then having it run for hours during the night before you wake up to turn it off. That creates blue light in the room. That’s going to change and alter your sleep architecture. Making sure that we have our exercise at a time in the day when it’s not impacting our ability to go to sleep. Having some time without screen time right before you go to bed, so an hour or so before you go to bed to start having that wind down that doesn’t include screen time. Those are some of the great tips for helping to improve sleep architecture in particular.
And then the most obvious one is just planning enough time to sleep, right? Like if you go to bed too late and you know when you have to wake up that you’re not allowing seven to eight hours to sleep, then you’re never going to get enough. So if we’re losing an hour or two a night, seven to 14 hours a week, that starts to really stack up over weeks, months, and years.
Physical activities and movement[00:16:19] Dr. Patti: Very important. And then the exercise. So there’s both the physical and the mental piece of this. So let’s talk about each of those. How much exercise do we need to keep the brain healthy, and how can we make sure we’re getting that? [00:16:32] Dr. Burke: This is still an area of significant research. There’s a lot of differing data out there. There are studies that show that we need significant amounts of exercise, like 30 to 45 minutes, six days a week, to improve brain health. But there are also studies of cultures with significant longevity without brain degeneration. Some of the blue zones, for example, and some of those cultures just take a walk after dinner. So there’s a pretty wide spectrum of what types of exercise can be beneficial.
We are definitely seeing that high-intensity interval training is a potent stimulator of that BDNF production. So that looks like a good thing to plug into our regimens. The wonderful thing about that is you can do two 15-minute sessions of HIIT a week and get a nice hit of BDNF. So that’s an easy thing for people to incorporate. As we talked last time, my personal approach to exercise is just to do what you will do consistently and do what you enjoy because then you will continue to do it.
And it looks like the most important thing is that we just move the body every day in some way. Some of the things that are restorative, like yoga, for example, or Tai chi, those have very nice overlap with helping to improve brain health because at the same time that we’re moving the body, we’re also asking the body to balance, and we’re working on core, and we’re integrating sometimes sound with movement. Dancing is another one that does a great job of that.
So lots of different ways that we can bring exercise in, but I think the bottom line is we want two to five days a week at a minimum where we are getting good movement in. So at least a half hour of walking more if you can. Strength training can be really important, especially as we age, because we start to lose that lean body mass, and that’s a really important thing for us to maintain for healthy longevity.
So a couple days a week of weight training is really good. What I love about what we’re finding is that there are so many ways we can personalize an exercise regimen that everybody can find and do something they enjoy. It doesn’t have to be just this one thing is the only thing you can do, or you’re not going to get the benefits. That’s really liberating.
Brain exercises and tips to challenge the brain[00:18:54] Dr. Patti: Yes. Individual personalization of your plan. And so that’s the physical exercise piece. What about mental exercise? What would you recommend for people giving their brain its own brain workout? [00:19:06] Dr. Burke: Yeah, exactly. There are a lot of different ways to help keep the brain active. And it does definitely fall into the category of use it or lose it, which I think is one of the reasons why retirement is associated with cognitive decline as well.
One thing is just to keep the mind active and keep challenging your brain to learn new things. There are so many ways that you could do that. You could learn a new language, you could learn a musical instrument, you could learn a new physical activity like dancing, for example, because then we’re integrating the music and the sound and the movement that works all different parts of the brain. So that’s a great way to do it. So those are some things we can do from the physical side.
And then, from a more specific brain training program, there are programs like Lumosity, for example, that was one of the first in class in that area. In our dementia study, we use something called BrainHQ, which has really excellent data on improvement in cognitive performance and how the brain performs, and so that, Utilizes games that the computer analyzes your performance as you’re going and continually increases the difficulty so that there’s always challenge and it also stimulates different ways that the brain has to think.
So we can look at visual processing, or we can do integration of sound and recognition. We can do speed processing, training, and speed, which, as I mentioned earlier, is one of the first things to decline. It’s also the thing that has the most wide-ranging benefit on the brain function overall. So no matter what you’re asking your brain to do, if you can improve the speed at which your brain can process, everything that your brain does is going to work better. So that’s a really great place to focus.
There are also crossword puzzles that have been talked about a lot. Sudoku, that’s another one. Right? So more of a mathematical, more of a word and language. What the research has shown on those is while they are each individually beneficial, you tend to train only that skill. So you don’t get the wide-ranging benefits within the brain that we see with some of the other things I’ve mentioned. So they’re good. It’s great if you enjoy doing those. They definitely have some benefits, but they shouldn’t be the only thing you’re doing.
Toxins, chemicals, and heavy metals[00:21:27] Dr. Patti: Makes a lot of sense. Absolutely. That’s our sleep and our exercise. What about exposure to toxins? And I know this is a huge topic all by itself, but I mean, you mentioned both chemical toxins that we might be taking in and biological toxins. So how can we know if we’re being exposed to those things, and what can we do about it? [00:21:46] Dr. Burke: Well, the answer to the first question is easy. You are. Everyone is being exposed every single day, and then it just comes to what degree, right? So maybe recognizing that some of our hobbies or occupations bring with them particular chemical exposures. For example, somebody who works on stained glass as a hobby has a lot of lead exposure. Somebody who’s a painter by trade has a lot of exposure to volatile organic chemicals in the paint fumes. A firefighter has exposure to all manner of different chemicals from what’s being burned in a home.
We all have furniture in our homes, and every piece of furniture in this country that has upholstery is treated with flame retardants. And as the cushioning breaks down gradually over time, that fine particulate is part of the dust that’s in our home. So that’s part of what’s creating what we call the human cloud, what we experience as we walk through our house, like what we’re exposed to. There are lots of things that are going to create exposure for us. And so I think just assuming that you have exposure is the first step.
Then the things that we talked about in how we want to fortify our bodies with our diet that we’re choosing, the foods that we’re choosing. The same thing is true of all of those things that we want to bring in to help our body to detoxify or offload the chemical burden that we acquire.
So eating lots of things from the cruciferous vegetables group, broccoli, kale, cauliflower, cabbage, and Brussels sprouts, all of those foods are going to help us make glutathione, and that’s our master antioxidant that is intricately involved in getting toxins out of our body. So that’s something we can do as part of our lifestyle interventions.
Taking it to the next level, there are tests that we can do that can evaluate the chemical toxins in our body or that can evaluate the mold-related toxins called mycotoxins in our body. Those would all be accessible through a practitioner that is educated on how to utilize those tests and then what to do with the information once we get it back.
So that’s the next level that we can look at what’s actually going on in the body.
We also have our heavy metal toxins, and so the most common heavy metals that we’re exposed to are going to be lead, mercury, arsenic, and cadmium. Those are the most impactful ones. Anybody in my generation that grew up in the sixties and seventies, when we had lead in everything, lead in the paint, lead in our leaded gasoline, leaded crystal, and we had a lot of lead exposure. So lead gets deposited into our bones. And so as we age and is particularly for women because after we go through menopause, we break down bone faster than men who get to hang on to more of their testosterone and maintain their bone density. But as we break down that bone, we start to liberate that lead from that storage depot. We often find significantly elevated levels of lead in our patients.
We also see mercury from the mercury silver amalgams that a lot of dentists used back in that time. And then also from mercury concentration and magnification in the seafood food chain. Those larger predatory fish that are commonly eaten, like tuna, for example, often have a high level of mercury. And so that’s how we can accumulate mercury in our bodies. Other ways as well, but those are the most common ones. In Northern California, where I live, a significant source of mercury for us is actually in the air because after all of these forest fires that were prone to the trees that have taken in mercury from the old mining days, those trees get burnt and that mercury gets released into the atmosphere. And so that can concentrate mercury into our ambient air. So it’s really fascinating the life cycles of the different chemical toxins and the heavy metal toxins. But those are things that we can test for as well. And then, we can help the body by eliminating the sources of exposure. And then also by helping the body to get rid of them, sometimes even using some chelation, which are medications that will bind more tightly to the metals to help the body get rid of them.
Foods and supplements for brain health[00:25:58] Dr. Patti: You mentioned in the part about toxins that we’re talking about certain foods that can help the body to get rid of these things. What other things might we think about with diet? And especially, I’d love to talk a little bit about intermittent fasting as a potential pathway and a little bit more about keto, which you mentioned earlier. [00:26:17] Dr. Burke: I think intermittent fasting is a great tool for us to use to help up-regulate both the detoxification processes in the body and then also to change the way that we’re burning fuel.
Most of these chemicals are stored in our fatty tissues, so anything that we can do to up-regulate our fat-burning, like fasting, for example, and the ketogenic diet, for example, can also help us to offload toxins.
But there’s a caveat with that as well, because if the body isn’t adequately supplied with the nutrients and antioxidants that it needs to do that biotransformation of converting those chemicals from something that’s only fat-soluble and can’t leave the body into something that’s water soluble and able to leave the body through all of our elimination pathways, which are all water-soluble. That’s sweat, that’s urine, that’s stool. Those are the most common ways that we get rid of things. Those are all water soluble. And so we have to convert those things, and that is a very, very nutrient-dense process, and that’s why what we eat is really important to our ability to be able to detoxify those chemicals.[00:27:26] Amir: As we mentioned, it’s all personalized, but are there universal options for foods and supplements to take for brain health? [00:27:34] Dr. Burke: Boy, that’s a great question, and I think it is a really difficult one to answer. There are so many things out there that can potentially be beneficial, but we can’t take them all.
And so that’s really where that precision approach of identifying what looks to have the most impact for the individual is really helpful. But in general, we know that we need to support the physiologic processes that we’ve been talking about. So we need to have a good supply and quantity of the vitamins and micronutrients that the body needs to function.
We generally also, for brain health, need to have mitochondrial support. So the mitochondria, the little power plants in the cell, are responsible for generating ATP, which is literally like the electrical currency of the body. It’s how the power stays on in the body. And the brain uses an enormous amount of ATP. So having things like acetyl L-carnitine, alpha lipoic acid, magnesium, and omega 3’s, which are really important in brain health. Those are some of the core things that we need to have. I’m probably missing some, but those are what popped to mind immediately as being really important core things that the brain needs to function well.
Then we need our detoxification support. And how much of that we need is going to depend a great deal on the genetics we come equipped with. Because our genetics determine our capacity to offload these toxins to process and offload them. And that can vary in some enzymes genetically by over a thousandfold. You and I could have the exact same chemical toxin exposure, but you’re a thousand times better at getting rid of it than I am. So knowing some of those core genetics, which is also part of the precision medicine approach, can also help us to target what’s likely to be the most beneficial for any individual.
But you’re certainly not going to be harmed by augmenting your antioxidant capacity, both by that rainbow of rich phytonutrients in our vegetables and then also potentially with some antioxidants like the alpha lipoic acid that I mentioned, glutathione, for example. N-acetyl cysteine (NAC) is also a potent stimulant of glutathione production. That can be a less expensive way to support detox.
Broccoli sprouts are a fantastic way to promote glutathione production. They contain something called sulforaphane that’s also concentrated in a supplement that I really love called Avmacol. But there are many others out there from high-quality manufacturers. That’s probably one of the most important things to emphasize. It’s not just what you’re choosing to take from a label; it’s who is manufacturing that and what is their process of evaluating their raw ingredients, testing, and ensuring that the product has what the label says that it has.
I’m sure you’re familiar with the investigation that the New York State Attorney General did, where they evaluated, I think it was upwards of 300 different products that were bought off the shelf at drug stores and health food stores, and they had those supplements analyzed. None of them contained exactly what was on the label, and the variance was anywhere from zero to 300 percent, three times what the label said. It really is the wild west. You don’t know what you’re getting unless you’re buying from a pharmaceutical-grade manufacturer. One that does third-party testing and looks at whether it is contaminated with heavy metals.
A lot of the higher-end supplement manufacturers will have QR codes that can be scanned, where you can see the data analysis sheet. You can see exactly what it contains.
You can see the heavy metals testing. If they don’t have that readily available, you should be able to easily get it from the company itself. And so that’s just an easy way that you can try to make sure that you’re taking something that’s high quality if you’re going to choose something. And yes, that is going to cost a little bit more because you definitely do get what you pay for.
Mental, physical and chemical impact of stress[00:31:44] Dr. Patti: Fantastic. That’s super, super useful. And then what about stress? What types of stress are we talking about? And then what might someone be able to do if they can’t get rid of the source of stress to help themselves be a little bit more resilient and more able to manage it? [00:31:59] Dr. Burke: The way I like to look at stress is that it has three main impacts on us. One is the mental impact. That’s the one that we are most often used to thinking about, where stress just makes us feel overwhelmed. Emotionally underwater. Just really stressed out; that kind of classic emotional response. But not everybody responds to stress that way. Many people deal with very high levels of stress, like high-level executives, for example, and they kind of thrive on that, or so they think because they’re good at managing the mental aspect of how stress impacts us.
Then we have the physical impact of stress, feeling tired, having your mind racing and being sleepless at night, kind of being jittery or shaky. Those physical manifestations of stress.
And then, we have the chemical manifestations of stress. And this is the area that almost nobody thinks about in general because we’re not looking inside at our biochemistry most of the time. So we’re not recognizing the impact that that has. But all of the chemical pathways that get activated with stress, prolonged stress in particular, are going to add to and create inflammation within the body. And anybody listening to this podcast is going to know that inflammation is basically the root of all evil for us, right? It’s the thing that’s at the root cause of degeneration, both physical and mental, and even sometimes spiritual. So, anything that’s driving our stress biochemistry is driving more inflammation. And so we have to look at the impact of stress from all of those areas. So no matter whether you’re someone that thrives on stress or somebody that feels underwater with stress, we have to deal with how the body manages stress and how that gets transformed.
So many of the most common ways we try to work on include meditation and mindfulness practices. We can use apps like the Inner Balance app from HeartMath. HeartMath has been for a couple of decades now performing research on heart rate variability, and that’s an excellent way of measuring how the body is responding to stress and how we are transforming the impact of stress in the body. The greater the heart rate variability, the better that is, and the less impact we have on our physiology. So those are some of the ways that we can look at managing and changing how stress is impacting us physiologically.
When to get started with lifestyle modification?[00:34:28] Dr. Patti: Awesome. So now we have a whole bunch of useful lifestyle things to pay attention to. Is there ever a point in the dementia process where these things will work better. Like do we need to start them early? Is it ever too late to start thinking about these things? Like when somebody’s pretty advanced into dementia, is there just no more point to thinking about it? Or is it always something that’s going to be helpful? [00:34:51] Dr. Burke: Patti, that is such an excellent question. The answer, like many of these things, is complicated, but the easy part is, yes, absolutely. The earlier that we start, the better our outcomes. And the other piece of that is the earlier we begin, the less profound the change has to be. If we incorporate these things into our way of life, they don’t have to be as rigid or intense as they have to be if we end up on this end in dementia and we’re trying to reverse damage to the brain. That’s a much heavier lift. It requires a much more involved and strict process to try to regain what we’ve lost, and it’s so much easier and less intense to just start now and start doing the things that we know are going to help us maintain brain health.
Reversing cognitive decline[00:35:43] Dr. Patti: And do you see evidence that we can reverse the process once it started? Can we regain what’s been lost? [00:35:51] Dr. Burke: We absolutely can. I’m involved in a randomized controlled trial for dementia reversal. We’ve just submitted to the IRB (* Institutional Review Board) and have our preliminary approval. So we’re really excited that we should be able to start enrolling the study in March. And in that study, we’re using a precision medicine approach, which is all of the things that we’ve been talking about, and a lot of different data points within the body and biomarkers within the body that we will be following because we already have published in the Journal of Alzheimer’s Disease, the proof of concept trial with three of the investigators in our study group that were able to show that almost 85, I think it was 83% of the participants had improvement, not just less decline, but improvement in their cognitive function with this precision medicine approach. So we’re really excited to take this forward and, on a larger scale, hopefully, be able to prove the exact same thing. [00:36:51] Dr. Patti: Such a good message of hope. A lot of people out there kind of dealing with this in their families, so there is hope that it might be able to get better. [00:36:58] Dr. Burke: There is hope, but again, I would emphasize that once we are very far down that path and the brain has atrophied and been damaged, we’re not going to be able to get as good a result as we could get if we’re working with someone who’s here where they have just subjective cognitive impairment. That’s the things we talked about at the very beginning, where you have an awareness that things aren’t quite right, but they don’t impact your ability to do your job and handle your finances and go through your day-to-day life. There are kind of more annoyances.
And then we get into mild cognitive impairment, where those things are a little bit more noticeable. They start becoming noticeable to family members. Maybe there’s a little bit of impact on your day-to-day life, but you’re still able to maintain and continue to be in charge of your finances, for example.
And then we move into dementia, where we start to lose those abilities. So at each step of the way, even if we can get the same level of improvement, for example, like in the study, the average improvement was 4.5 points on a MOCA score. So just to give you some perspective, the drug that was just approved, Lecanemab, had a half a point less decline, so no improvement, just a half a point less decline. And about 24% of the participants in that trial had brain inflammation and brain hemorrhage. That’s at a pretty high cost to just get a very slightly less decline, whereas in the precision medicine approach, we are not experiencing negative outcomes, and we’re getting a substantially better improvement in cognitive function.
But if you’re at a MOCA score, for example, of 11 or 12, which is someone with Alzheimer’s disease, and we can get you to 16, when 30 is normal, you’re still going to be impacted. You’re going to be a lot better than you were before, but you’re not back to your old self. That’s a hard thing to grapple with because significant improvement from something that’s pretty bad is still going to feel like dementia. So yes, we can absolutely have a profound impact. It’s just the day-to-day experience that may not be what someone’s hoping for. All the more reason we start back here, where we could go from the low twenties and get somebody up into the normal range. That’s hugely impactful. People back to work, back to their jobs when they couldn’t work before, and back to driving when they couldn’t drive anymore. Those are really life-altering.
I think one of the most impactful things of doing the work that I do in dementia reversal is experiences like the one that I’m thinking of. We had a patient come in. She was pretty significantly affected by dementia.
And you know when you’re talking, or you’re interacting with someone like that. Their eyes are kind of blank. It’s like you can’t really connect with that person’s soul, with them anymore. And this woman went from being someone that was blank to someone who could come in and look you in the eye. You had that electric connection of knowing that you were connecting with her soul. And that all came back because of the work that we’re doing. It gives me goosebumps, even right now, just sitting here thinking about it. Like, how could anything be better than that?
Loneliness, social connections, meaning, and purpose[00:40:20] Dr. Patti: Let’s talk a little bit about social connections and maybe also about meaning and purpose in life. Those might be two separate discussions. [00:40:28] Dr. Burke: Social connection has so many impacts. I’m sure you’ve seen the headlines: loneliness is the new cardiovascular risk factor or chronic disease risk factor. And what we’ve just been through in the pandemic created an immense amount of loneliness and isolation. And so I think for years to come, we’re probably going to be seeing some of the impacts of that.
When you think about what that means, social connection creates meaning and purpose in life. And so that’s going to be an important part. Having a purpose maybe outside of social connection, whether that’s in a hobby or in helping and volunteering, working around your yard or around your house. It doesn’t have to be some aspirational purpose. It just has to be something that brings meaning to you and to your day-to-day life. I think oftentimes people that have a tendency to be comfortable being alone, introverts, I’m talking to you, those are often people that will lose social connection because it takes so much more energy for them to create social connection.
And so it doesn’t mean you need to have a huge network of people, but you need to have a connection that’s meaningful to you. You can also bring some connection through your spirituality. Your spiritual practice, whatever that may be, whether it’s connecting with nature or connecting with God or connecting with fellow mankind, those are all things that are going to bring that purpose and meaning into our lives. And when we have that, we see improvements in heart rate variability. So we know that that has a physiologic effect as well.
Meditation and brain health[00:42:07] Dr. Patti: And you mentioned earlier something that ties into a few different parts of this, which is meditation. So I’m thinking about that could be a spiritual practice, that could also be a mental practice, a stress reduction practice. So talk a little bit about meditation and how it affects brain health and if you see any specific types or forms of meditation that are the most beneficial or how people could get started with that. [00:42:30] Dr. Burke: There are studies that have shown less brain atrophy in meditators. So we have objective data that meditation does literally change the brain. So we know that this is true and that this is possible.
For many people, the idea of meditation is a bit off-putting, or they feel intimidated by it, or they are someone that has the monkey in the brain, and they just think, I just can’t be a good meditator. For someone like that, guided meditations, and there are many out there, many apps and different ways that you can access guided meditation where you’re listening to someone talk you through the meditative process. You have something to focus on. That can be really useful for someone that’s challenged with just quietly meditating on their own.
The HeartMath that I spoke about that is, as Dr. Toups likes to say, meditation for non-meditators because it is a focus on your breathing and a focus on love and gratitude in your mind. And bringing those two things together, your breath, love, and gratitude sensation, creates that meditative state in a focused way. And the app allows you to see your progress. So for our high-achieving CEOs that want something quick, you can do HeartMath for five minutes a day, which will change your brain, and you get to see your results. So if you’re a results-oriented person, it’s nice to see your score and how you’re doing over time. So there are so many different things that we have access to depending on what kind of lights your fire? What makes you feel good about the mindfulness practice that you want to choose.[00:44:08] Dr. Patti: Beautiful. So again, personalizing and finding your own way that works the best for you. [00:44:13] Dr. Burke: Yeah, I think that’s my theme. [00:44:16] Dr. Patti: It’s a wonderful theme. Amir, do you have any questions? You’re always so patient.
Dementia reversal trial[00:44:22] Amir: Super exciting news on the trial you mentioned. Is the approach there similar to the approach you shared with us, with the SEEDS and lifestyle? [00:44:31] Dr. Burke: That is absolutely a core piece. So the lifestyle piece is like the foundation of a house. You cannot create health in any arena of the body without that foundation. But then you have to build up from there. And so the research trial is looking at in depth at all of these things that I’ve touched on, the toxins, the hormones, the biologic toxins, chronic infections, which we haven’t really spoken much about, looking at the amyloid, looking at levels of BDNF, looking at things like Phospho-tau, which is released from the brain as damage is occurring.
So we’re looking at a wide variety of biological markers so that we can see, because we know from the proof of concept trial and our own clinical practice, for those of us that have been doing this, that this is a successful methodology for reversing cognitive decline and maintaining cognitive health.
But what we don’t know are some of the nuances about what’s the best way to monitor this. What are the earliest abnormalities? What are the most impactful interventions? Because people ask that of us all the time. It is a lot to do. And it’s overwhelming for patients. It’s onerous for providers. It’s a very heavy lift. And so people are always asking, well, what’s the most important thing? We don’t know yet. That’s part of what is still to come in the research. Right now, what we know is when we do all of this, we see profound results. What we don’t know yet is which pieces are having the greatest impact and which pieces are maybe things that we could ease off on, do later, or maybe not have to address. I think that’s probably unlikely, just based on what we understand about the complexity of the interactions of our physiology. But those are the pieces that are still to come, and we’ll just start to get a glimpse of that in the trial that we’re planning.
Also, while we’re talking about the trial, I just wanted to mention If anyone is interested in potentially being a subject for the trial, either for themselves or for a loved one, we do have a website with some information. It’s called dementia reversal trial.com, and we’ll be taking people’s interest from there. And then, we’ll be able to evaluate them for whether or not they qualify to participate in the trial, which is really exciting.[00:46:50] Amir: That is super exciting. And for those who may not know what precision medicine is, this is where you personalize the approach for each person based on their biomarkers, et cetera, right? [00:47:03] Dr. Burke: Exactly right. So functional medicine is like the operating system. It’s the system’s biological approach to understanding the root causes. So what did the body need to function optimally that it hasn’t been getting, and what has it gotten full of that it needs to get rid of. And then how all of those things interact through so many different physiologic processes, like our barrier function, our gut barrier, and leaky gut, and our brain barrier and leaky brain. Those two things often go hand in hand. So we do a lot of gut restoration, and that’s also a foundational piece. It’s not a lifestyle piece per se, but that’s foundational as well in the interventions.
Now Precision medicine, on the other hand, is really the analysis of the individual data points and diving deep into the data of that individual and looking at how that needs to be reorchestrated and rebalanced to be able to bring their body back into optimal physiologic function.[00:48:05] Amir: And that’s a key message. There is really no one size fits all approach to health or to brain health. [00:48:12] Dr. Burke: Exactly right. Exactly right. We need to be able to look at why the brain has degenerated and address those reasons why, and then address the things the brain needs to be able to heal. And that together is how we create these remarkable results.
Genetics testing[00:48:30] Dr. Patti: You’ve mentioned a few times genetic differences or predispositions that people might have. So are there any types of genetic tests that people can do to give themselves a sense of what their risk is and what they might need to do on a personal level to help them stay free of dementia? [00:48:46] Dr. Burke: Yeah, there’s a lot of direct-to-consumer genetic testing available. There are a couple that actually requires there to be a provider intermediary. And I feel like we get more actionable information from those types of reports because it’s a voluminous amount of information, and many times multiple different things will come out with conflicting recommendations. And it’s really not at all useful to just get an 800-page printout that five times says you shouldn’t do this and eight times says you should do this. Like, what do you do with that? Like how do you, what do you do with that? And honestly, I feel the same as a clinician. Like, what do I do with that?
So a couple that I really like, I really like 3×4 genetics. They organize your genetic information into the top three areas that are likely going to be impactful for your health. And then they give us actionable recommendations in terms of diet, in terms of movement, and lifestyle interventions. And then also in terms of supplements that are going to be particularly useful for your genetic predisposition. That speaks to what we were talking about before. How do you know what the best supplements are for you? That’s a really great test for that because that is that nutrigenomic platform. It’s a beautiful report, very user-friendly, and easy for patients to understand.
Another really excellent one is IntellxxDNA. It feels like a bit of a deeper dive. Great information organized into the top impactful, a little bit differently than the other ones, but it hits your high points.
And then a third one that I like is the DNA company. I don’t use that personally, but I am aware of their platform and know that they do a good job and that their information is really sound.
Those are probably my top three favorites in the field. I’m sure there are others that I maybe just am not familiar with, but I think that focusing on something that’s going to give you more actionable and coalesced data. The weighting of which of your different genetic variations are going to have the greatest impact is super important because not all SNPs, as we call them, which are genetic variants, are created equal. You could have a multitude of abnormalities in this area, but it’s going to have far less impact on your health than one thing that’s wrong over here.
As a consumer, you don’t have any way to know that, and frankly, as a clinician, it’s an overwhelming amount of data to try to interpret. This is really where these types of algorithms, like what 3×4 Genetics is using, what IntellxxDNA is using, with machine learning and that bigger dataset data science management, that’s really where I think we’re going to get more actionable info out of DNA because it isn’t as simple as, oh, I have this SNP, therefore X, Y, and Z are never going to work for me, or I’m inevitably going to get this. That’s a super common misconception that’s just not true. Most genetics do not have an inevitable outcome, but they do often have an inevitable response to either what you’re getting or what you’re not getting rid of.
Final thoughts[00:52:25] Dr. Patti: So much great information. And I know this is going to be a huge ask, but could you sum up your top tips or the way that people can think about protecting their brain health and keeping themselves cognitively healthy for as long as possible? [00:52:41] Dr. Burke: I think the first message is if you have a relative with Alzheimer’s disease or a form of dementia, you have likely inherited some of the genetics that made them vulnerable to brain degeneration. And the time to act is the moment you hear this message. You need to be proactively working on your brain health. I think that’s the most important thing.
Then as we’re looking at, just in general, how do we build this process? The first is the seeds of true health. We want to build that foundational lifestyle platform so that we give our bodies the optimal ability to deal with whatever comes at it.
Then I think we want to be potentially thinking about what are the things I need to work with a practitioner that’s experienced in functional and integrative medicine and evaluating this type of data. What might I need to be doing further testing on, whether that’s cognitive testing, chemical toxins, heavy metal toxins, or biological toxins like mycotoxins. What are the things that I need someone guiding me in evaluating and managing what I have accumulated and what I need to get rid of so it doesn’t damage my brain.
And then I think we want to be looking at doing all of the extra things that we talked about, whether that may be necessary to take the next step of doing a deeper dive. Like what we do, where we’re doing a full evaluation of the cognitive function, of the brain structure, of all of these pieces of the puzzle.
Because obviously, as we move our way through that pyramid, the expense increases. And so not everybody needs to be up here. For example, in our memory protection program, we’re doing a massive deep dive into the data and manipulating a lot of variables at once, which is a very labor-intensive and ie expensive process. But we can take it down a notch and start building those foundations, investigating things that may be the most likely (* impactful), and evaluating your genetic vulnerabilities. And that would be where we would start with – understanding what we need to move forward. But if even that is unattainable, then everything on that lifestyle foundation that’s all doable on your own.