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