Evolving Past Alzheimer's

We have spoken about the effects of stress and memory. This week we will talk about how stress effects memory. FAIR WARNING: This episode is super technical. This will be great for the geeks, nerds, and mechanism seekers among us. BUT HAVE NO FEAR, because practical information does emerge from this episode thanks to our guest's mastery of this subject.

Grant Shields is a Ph.D. candidate in psychology at Univ of California in Davis working with both Andrew P. Yonelinas in the Human Memory Lab and Brian C. Trainor in the Behavioral Neuroendocrinology Lab. He also works with a previous guest of ours, Dr George Slavich, at the UCLA Laboratory for Stress Assessment and Research.

Grant's research is aimed at understanding why our cognitive functions fail us when we seem to need them most. In particular, he studies the effects of stress on both memory and executive functions as well as the biological pathways through which those effects occur...and that is exactly what we want to know about.

What is stress?

In Grant's research he is speaking about "acute" stress which is a limited, subjective experience of a stressor (eg a car crash). This is distinguished from "chronic" stress which is the subjective experience of an ongoing stressor (eg getting a diagnosis of a terminal disease like Alzheimer's).

Classically, a stress response is evoked if an event is uncontrollable, unpredictable, ambigious or has a social threat component to it.

Acute stress is completely adaptive. in other words we typically are capable of experiencing this and moving on. Responses to acute stress can be useful. However, these responses can become maladaptive or inappropriate which can in turn be harmful. Chronic stress is not yet known to ever be beneficial.

Phases of Memory

• -Encoding - the phase of learning something new
  • Stress at encoding can enhance or impair learning and memory. it enhanc
• Postencoding/consolidation period - last about about 60 minutes just after learning something new
  • Memory for something you just learned can enhanced by stress
• Retrieval phase or postreactivation phases

What Stress Hormones/Glucocorticoids do to Memory

It isn't just cortisol that has an impact on memory. Grant explained that, within the hippocampus - an area known to be important for short term memory formation and conversion to long term memory- cortisol's relationship with norepinephrine in the basal-lateral amygdala to boost memory for information during the period of synergy between cortisol and norepinephrine. As cortisol secretion persists they exert genomic effects within the hippocampus and begin to inhibit the processing and storage (memory) of new information.

Executive Function

• inhibition - the ability ignore irrelevant information coming into your brain
• working memory updating - ability to add to what and update your current thinking
• cognitive flexibility/set shifting - flexibly shift between different kinds of thinking

The Physiologic Costs of Stress

Chronic stress, as stated, give rise to elevated glucocorticoids. Over time glucocorticoids less ability to shut off inflammatory signals. Over time, with chronic stress, develops a chronic state of inflammation, immune system function can become impaired, and autoimmune conditions can be triggered. When glucocorticoids bind in the memory centers of the brain, like the hippocampus, it degrades memory formation.

Practical Info

To improve your memory for newly learned things, consider a brief "healthy stressor" like exercise after you have some thing you want to commit to memory. Exercise promotes memory formation in the brain. Meditation, of course, is protective as well.

To Learn More about Grant's work find him here

Conscious Dance is something I think is extremely important in the transformation of a mind, particularly for those with Alzheimer's or at-risk of Alzheimer's. According to Mark Metz, a thought leader in the community, Conscious Dance is essentially "a non-competitive, body based way of raising consciousness."

Our guests today are the co-founders of Open Floor Dance.

Kathy Altman - is a co founder of Open Floor International, an organization that promotes conscious dance as a form of well being, community building, peace making and creativity. She has danced her whole life but moving without choreography imposed from the outside is the skill she relies on most. Kathy has taught dance to thousands of people on many continents for over 40 years.

Lori Saltzman - is a co-founder of Open Floor. Lori stumbled into her first movement workshop with Gabrielle Roth when she was 26 years old. She spent 30 years as Gabrielle's friend, student and close collaborator. The same vital force that wed her to movement led her to meditation, writing and creativity. Five years ago she co-founded Open Floor International, an collaboration of seasoned movement teachers, artists, therapists, and educators who are translating their wisdom to the dance floor.

The 2 primary values of Open Floor Dance:

1. help people move from fixed to fluid movements, extending this into consciousness.
2. "move and include" - when we move, things come up. feelings come up and they can be included and processed in the dance to further our evolution as human beings.

In Open Floor we dance to learn rather than learning to dance. It is free-form dance and movement in a safe space. There aren't intentional, structured partners or choreographed dance steps. Often people use this as a practice and community through which they experience many of the common ups and downs. These groups are for young and "old" and are non-exclusionary. All levels of physical ability from professional dancers to dancers/movers in a wheelchair.

Our guests cite some research for dance lowering the risk for cognitive impairment and dementia. They also talk about how they are able to push their movement limitations and how the body adapts to continuous activity as they age.

To learn more about Open Floor visit here To find a conscious dance group near you use the Conscious Dance Move Map

Traumatic brain injury raises the risk of Alzheimer's by up to ten times the normal risk.

Today we want to share the story of a real American hero. United States Special Forces Weapons Sergeant, Josh Lindstrom. Josh was awarded a Purple Heart for surviving an IED attack in 2012.

His story speaks for itself, but briefly, until 2012 Josh was one of the military's most fit, dedicated and resilient soldiers. After a traumatic brain injury he lost more than his cognitive abilities. He lost his identity, he lost his relationship with his family and struggled to figure out his "Why" for the rest of his life. Overall, Josh employed a Functional Medicine/root cause strategy and found the following interventions most impactful in his case.

• a elimination then Ketogenic diet
• testosterone replacement therapy
• military adaptive sports training

if you would like to contribute to the healing of men and women like Josh please consider a donation to the Task Force Dagger Foundation. This is an extremely worthy cause.

Neuorfeedback therapy for Alzheimer's today has not yet been widely proven. Our guests today were the first ones to publish in a medical journal on this subject.

Robin Elisa Luijmes is a psychologist from the Netherlands. She started working with patients with aquired brain injury. Wanting a broader knowledge of the psychological impact in patients with various forms of medical conditions, she completed her training as a medical psychologist. While working in a hospital in the Netherlands, Robin met Dr. Sjaak Pouwels, MD PhD, an aspiring and highly motivated surgeon and research physician. Because of their common interest in neurobiology together they published the article: "The effectiveness of neurofeedback on cognitive functioning in patients with Alzheimer's disease: Preliminary results." These results were ultimately published as an original article in the Journal of Clinical Neuropsychology in 2016. In this episode we discuss their journal publication and their results. You'll get an inside look at the challenges of academic research - recruitment, funding, and personnel. In brief, they studied a small group of 10 people with Alzheimer's type cognitive decline and performed Neurofeedback. Over the course of getting 2 treatments for 15 weeks these patients had no further decline and 3 patients had improvements in memory/cognitive scores.

Our cells, including brain cells, are influenced by movement mechanics. Our guest today is a leader in movement mechanics and aging. Katy is part biomechanist, part science communicator, and FULL-time mover. Katy Bowman has educated hundreds of thousands of people on the role movement plays in the body and in the world. She is a prolific author of many books and other media outlets. She directs the Nutritious Movement Center in the Pacific Northwest and travels around the world teaching Nutritious Movement™

Katy explains "Nutritious Movement" - the idea that our cells are influenced by mechano-transduction (AKA movement mechanics or the "mechanome"). Movement is not really the same thing as exercise as exercise is more of a sub-category of movement. Katy foresees the day that we will know how individual movements are good for specific aspects of health, similar to how we understand specific micro and macro-nutrients are important for health (eg fats, carbohydrates and various vitamins and minerals). We can open up way more opportunities for people to figure out how movement works if we move beyond thinking about physical activity as exercise alone.

For example, most people arrange their homes so things are easy to get to (reducing our movements) and so it's easy to find a place to sit. And those seating options keep us in the same geometry whether it's the dining chair, sofa or toilet. How can we create more movement opportunities in the home? Katy may suggest things like putting the tea bags on a higher or lower shelf than the mugs so we have to squat or reach for them. Clear an inviting space so one can sit on the floor and stretch. Add a Squatty Potty, etc.

Katy introduces us to some of the co-authors in her book, Dynamic Aging, who are all now in their 70s and 80s and have had success with Katy's movement methodologies over the last decade or so. She challenges cultural norms of how habit and sedentarism give rise to "inevitable" aches and pains of aging. It requires an inventory of all the aspects of our lives that impact how and where we move. Katy starts with how people get dressed, even what clothing we are wearing may restrict our ability to move. Note, footwear is a big deal! Shoes matter.

Our lives require changes in "shape" and "load." Katy explains what it means to change up things in these domains of movement. She elucidates how we can set up our natural state environments like homes and offices to adapt and thrive in our aging bodies and in our daily tasks.

We briefly discuss the roles of stress and trauma on our bodies and how this relates to mechanotransduction and movement mechanics.

Katy recalls her involvement in Move for Minds seminar last year (2017) and we focus the last part of our conversation on brain health.

Learn and Connect with Katy Bowman

• www.nutritiousmovement.com
• Her new book "Dynamic Aging":

She has a great podcast, amazing books, classes and alot more!

Accumulation of stress over a lifetime is linked to cognitive impairment in general and Alzheimer's disease in specific.

To let the cat out of the bag, the practical piece here is to get your "life stressors test" in the form of a lifetime inventory of stress and adversity here (STRAIN score): lifestresstest.com

Read the shownotes below and listen to the second half of the show to get the explanation on this tool.

Dr George Slavich's, research integrates tools and methods from psychology, neuroscience, immunology, genetics, and genomics to explain the effects of stress on aging, mood, and the brain. He is currently investigating how experiences of social stress and adversity reach deep inside the body to influence the activity of the human genome.

Dr. George Slavich holds several titles including a Professorship in Psychiatry and Biobehavioral Sciences at UCLA. He is the Associate Director of the Stress Measurement Network, and Director of the UCLA Laboratory for Stress Assessment and Research (http://www.uclastresslab.org).

Dr Slavich introduces the field of "Psychoneuroimmunology" Psychoneuroimmunology involves how psychological and cognitive processes influences the brain, body, and immune system. He explains what happens to the brain and nervous system over a lifetime of acute and chronic stressors.

"Stress" or a "stressor" may be defined has been defined as any situation, or set of external demands, that requires an organism to expend resources to adapt or cope with its circumstances (Monroe, 2008).

Human Social Genomics, a field pioneered in part by Dr. Slavich and his collaborator Dr Steve Cole at UCLA, demonstrates how basic human experiences - including both minor and major life stressors - influence the activity of the human genome. Using microarray-based genome-wide transcriptional profiles - which he explains is like a panoramic photograph of gene activity across all 25,000 human genes - Dr Slavich's team has observed patterns of negative changes in inflammation and virus susceptibility gene expression as a result of exposure to "stressors."

Dr. Slavich hypothesizes that these negative genetic inflammatory patterns may an innate human ability to preemptively read ques in his/her social environment that gives rise to mobilization of immune/gene products (from bone marrow and fat cells for example) into the blood. This may be why these inflammatory and immune patterns are detectable in his medical experiments. This may also be why even what a human thinks about can trigger these type of immune system abnormalities.

Regarding resilience, Dr Slavich cites some early data that indicate: yoga, meditation, Mindfulness Based Stress Reduction, and Cognitive Behavioral Therapy (CBT) practices likely have positive impacts on the immune systems and so-called resilience genes in the body.

Dr Slavich and his team have developed STRAIN tool - Stress and Adversity Inventory. This online tool allows you to take inventory of all the various types of stressors in your life and target a therapeutic strategy around this.

The STRAIN tool has allowed his team to predict elements around cognitive aging, memory impairment, and challenges in executive function. Notably, there is considerable peak risk-susceptibility in humans around age 55-70 where stress becomes another critical risk factor for cognitive function and overall degradation of health.

LEARN MORE ABOUT DR SLAVICH AND HIS WORK HERE: To perform the STRAIN test on yourself go here:

• lifestresstest.com
• UCLA Laboratory for Stress Assessment and Research (http://www.uclastresslab.org).

We shift gears on this show to begin to talk about thriving in the second half of life. I introduce you to an incredible friend of mine, Sharon Lowenstein Poisner JD, PhD. At the time of this show's recording, Sharon had just turned 80 years old. Sharon continues to give lectures on various topics on brain health and successful life and aging practices.

Parts of this episode are heavy. We talk about the ups and down of Sharon's life and the many challenges of growing through childhood trauma, midlife divorce, death of her spouse in later life. Sharon sheds light on how priorities, goals, and relationships change as someone progresses through their second half of life. Importantly, Sharon shares some of her deep insights on how meditation, forgiveness, and honoring past relationships have shaped her growth in the second half of life.

Robert Hedaya, MD, has been at the cutting edge of medical practice, psychiatry and psychopharmacology since 1979, and has been practicing Functional Medicine since 1996. He is also a Clinical Professor of Psychiatry at Georgetown University Medical Center. Author of three books (Understanding Biological Psychiatry, The Antidepressant Survival Guide, and Depression: Advancing the Treatment Paradigm), and the founder of the National Center for Whole Psychiatry in the Washington DC area. He has been on national media (20/20, 60 minutes, the New York Times, Washington Post etc.) on many occasions and is a frequent, nationally and internationally recognized speaker.

This is a great episode to get the low-down on just who's, what's, and how's of Alzheimer's and Cognitive Impairment programs. We discuss over-hyped and over sensationalized results you may be hearing about in the news and the internet and what you can really expect when you embark on a "reversal" program. Dr Hedaya has seen success applying a Bredesen-style approach to: Subjective Cognitive Impairment, Mild Cognitive Impairment, and early stages of Alzheimer's.

Dr Hedaya explains the difference in his approach to traditional psychological conditions, cognitive impairment, and Alzheimer's. Bob recounts a recent encounter he had at an academic conference where he challenged the current paradigm. We talk about how this approach is generally received by the medical community —because (like Semmelweis) it is often unfamiliar,uncomfortable, and inconvenient for the medical establishment in its current iteration.

We discuss our feelings about the realistic applications and limitations of applying "Alzheimer's reversal" programs. We cover who might be the best candidate to succeed on these programs.

Bob explains his understanding of the systems biology approach of Functional Medicine and how it applies to his work in cognitive impairment and mood disorders.

30-50% of people with depression with develop Cognitive impairment.

We discuss the personal commitments in terms of time and energy someone has to make to become succeed with this kind of program and Dr Hedaya outlines his the first case he handled where someone with cognitive impairment improved.

Dr Hedaya's basic panel to help with determine risk:

• Complete Blood Count
• Homocysteine
• Fasting Cholesterol Panel
• Fasting insulin (goal ~3-4)
• Avoid head trauma
• Check thyroid function (goal TSH ~1.4) as well as checking free T3 free T4
• Estrogen and progesterone (in some women)
• Zinc (RBC) and Copper (16:1)
• Inflammatory markers like high sensitivity CRP

Overall he recommends a Mediterranean style diet as the best diet in general.

• Learn more about Dr Robert Hedaya here https://wholepsychiatry.com/

If you have questions about the Keto diet...go no further. Our guest today is pretty much the Keto science guy. Dr Dominic D'Agostino is a professor in molecular pharmacology and physiology at the University of South Florida Morsani College of Medicine as well as a Visiting Research Scientist at the Florida Institute for Human and Machine Cognition.

Dr D'Agostino tells us how he found his way into the filed of ketosis. He combined interests in nutritional and neuro sciences. From there, Dom developed a deep expertise in underwater medicine and oxygen toxicity seizures where he made the connection with ketones and the brain.

What is Nutrtional Ketosis

Ketones - more specifically ketone bodies- are chemical produced by our livers. Ketone bodies are produced by avoiding most carbohydrates in the diet (eg sugars, breads, fruits, and certain vegetables). A much higher percentage of healthy fats are eaten during a ketogenic diet. When someone follows this diet the body begins to make and utilize ketones more so than on it's typical energy source - glucose. Nutritional ketosis is the sustained elevation of ketones in the blood. To be clear, as long as someone isn't completely lacking insulin (eg Type 1 diabetic), this low-level of ketosis is NOT the dangerous state of ketoacidosis which develops from having a lack of insulin.

What are the benefits of Nutritional Ketosis

Lower states of brain inflammation. Better insulin sensitization and use of ketones for energy in the brain.

What are good foods to stay on the Ketogenic

• See the list for ketogenic: ketonutrition.org
• Note: Dr D'Agostino is currently designing a vegan ketogenic diet (stay tuned...)

How Do I know if I am "in Ketosis"

There are a few things you can buy. Dr D'Agostino recommends:

• Abbot Labs Precision Xtra glucose and ketone meter. (sold on Amazon)
• A Ketomojo

What to expect when you are shifting into Ketosis You can feel somewhat tired, perhaps some "brain fog" or even flu like or low blood sugar sensations for a few days as your body shifts out of using glucose as its primary fuel. What does it feel like once you are in Ketosis and what are the Benefits of Ketosis

• Many people feel more cognitively alert and more even brain energy.
• Lower hemoglobin A1c

Dom explains the synergy between intermittent fasting (caloric restriction) and low carbohydrate/modified ketogenic diet. We discuss the evidence or more specifically the lack of evidence for the Ketogenic diet in Alzheimer's and cognitive decline and where the research is headed. What are some foods that help people stay in Ketosis People use coconut oil, MCT Oil (Medium Chain Triglyceride), Ketone Esters. Coconut Oil and MCT oil are available at many food stores. Ketone esters are available on line. We discuss some of the controversy of using a consistent ApoE4 and a high fat ketogenic diet and what labs you may want to follow if you are thinking about We talk about the possibility of enhancing brain energy metabolism with the ketogenic diet and hyperbaric oxygen. Learn much, much more about Ketonutrition on Dr D'Agostino's website: ketonutrition.org

We are honored to have, Dr Neal Barnard a noted physician, advocate for nutritional science, as well as president of the Physicians Committee for Responsible Medicine on the show.

Dr Barnard explains how and why he started the Physicians Committee for Responsible Medicine (PCRM). PCRM is an advocacy group for information about good medicine, nutrition, and animal rights.

Dr Barnard shares his own experience with Alzheimer's with his father.

Dr Barnard and other experts wrote dietary guidelines to reduce the risk of Alzheimer's. Here are the guidelines:

1. Minimize your intake of saturated fats and trans fats. Saturated fat is found primarily in dairy products, meats, and certain oils (coconut and palm oils). Trans fats are found in many snack pastries and fried foods and are listed on labels as "partially hydrogenated oils."
2. Eat plant-based foods. Vegetables, legumes (beans, peas, and lentils), fruits, and whole grains should replace meats and dairy products as primary staples of the diet.
3. Consume 15 milligrams of vitamin E, from foods, each day. Vitamin E should come from foods, rather than supplements. Healthful food sources of vitamin E include seeds, nuts, green leafy vegetables, and whole grains. Note: The RDA for vitamin E is 15 milligrams per day.
4. Take a B12 supplement. A reliable source of B12, such as fortified foods or a supplement providing at least the recommended daily allowance (2.4 micrograms per day for adults), should be part of your daily diet. Note: Have your blood levels of vitamin B12 checked regularly as many factors, including age, impaired absorption.
5. Avoid vitamins with iron and copper. If using multivitamins, choose those without iron and copper, and consume iron supplements only when directed by your physician.
6. Choose aluminum-free products.While aluminum's role in Alzheimer's disease remains a matter of investigation, those who desire to minimize their exposure can avoid the use of cookware, antacids, baking powder, or other products that contain aluminum.
7. Exercise for 120 minutes each week. Include aerobic exercise in your routine, equivalent to 40 minutes of brisk walking, three times per week.

We discuss what Dr Barnard has seen around memory loss and early intervention and prevention of Alzheimers'.

Dr Barnard discusses his views on the fallacies of the Paleo and Ketogenic diets and contrasts this to a low fat, plant based diet.

Dr Barnard explains gluten sensitivity and what a plant-based aficionado should do about bean and legume sensitivity. He notes that 146 grams of protein are contained with 2000 calories of broccoli – so plants may be an additional and surprising

Extensive discussion around the potential health harms about cheese and dairy and I ask Dr Barnard to talk about his findings from his book, "The Cheese Trap: How Breaking a Surprising Addiction Will Help You Lose Weight, Gain Energy, and Get Healthy" Interesting connections with dairy and inflammation and behavior. I discuss my own stories of "dairy addiction" and behavior changes in one of our children.

Finally, Dr Barnard discusses some of his advocacy work and political activism around nutrition, food science, and transparency in the food industry and biggest fights going on in Washington. He articulates the conflict within the USDA itself with its dual mandate to represent the health of the American public as well as American industry.

Find Dr Barnard on his website: The Physicians Committee for Responsible Medicine see the Kickstart Program to start a vegan program to see if it's right for you. Link to Dr Barnards guidelines on foods to eat to prevent Alzheimer's: http://www.pcrm.org/health/reports/dietary-guidelines-for-alzheimers-prevention