Richard Isaacson (on Alzheimer’s prevention) | Armchair Expert with Dax Shepard

welcome welcome welcome to armchair expert experts on Expert I'm Dan Shepard and I'm joined by Lily padman hi there hi this is our first laboratory episode where we do Labs real time we do the beginning of the episode is us getting blood taken and you'll hear a bunch of that enrolling in a study I don't think I've ever been a part of a study before this that you know of well that's true I guess they probably on our phones they're probably running all kinds of exactly but not to worry if you feel like it's boring at the beginning I thought it was interesting okay but it ends and then we get into a real interview what if the whole episode was us just getting blood taken the reason we're getting our blood taken is because our guest is Dr Richard Isaacson you probably remember if you listen to the Sanjay Gupta episode he had done a piece on Alzheimer's and interacted a bunch with Richard because he is one of the foremost experts on Alzheimer's he's a neurologist with a focus on the treatment and prevention of Alzheimer's disease and he is the director of the Precision prevention program at atria and the Atria Institute provides cordinated healthc care and comprehensive predictive testing to enable a highly personalized approach to wellbeing and we are now enrolled in a stud so cool and he's not going to take this unsolicited advice but if he changed his name to Dr playful it would work he's very playful but very knowledgeable yes although Dr playful sounds a little too sexual sick yeah okay so we'll stick with Dr Richard Isaac and please [Music] enjoy this is nice to meet you nice to meet you D pleas right on next now we probably cuz you're going to do glucose no not glucose in theory for the finger Pricks you don't have to fast if you ever want to do the actual blood the big panel which is the Boston heart and all the cholesterol all the other Stu metabolism that's got to be fasted thanks for wearing white pants I appreciate that I didn't even think about that wearing white pants I I've only gotten blood everywhere like once you're in a white shirt well I have I have this oh definitely oh yeah I put a blanket over my waist no it's going to be okay anticipate gushing no no I can't believe you have this whole Lab Set up we have people in New York that get blood draws and we have a hit now grip strength Monitor and so we'll start with the blood stuff yeah I'm ready you want to go yeah let's do it we're going to need you to turn your head and cough okay wonderful I feel like I'm at a bar like serving I know you could set this up at a bar people with get drunk and do it and do it exactly this is the one if you want to bleed everywhere so I'm going to use the blue ones okay okay why that's just a bigger it's a bigger gauge yeah we're going to do four cards so this is a research study so we're learning this is a research study it's voluntary basically we're trying to figure out the colloquial way of saying it is can we develop like a cholesterol test for the brain so just like we know what HDL is the good cholesterol even though that may not be true LDL apob and triglycerides and all these things basically uh we're trying to do that for the brain right so we're making progress Boston Heart Labs is the lab we use it's a clinical test that like you can order clinically but it looks at all the particle fractions it looks at metabolic numbers you can check your apoe Gene but if you do want to do that it's all included in the research then you would have to like those boxes but that we would set up a mobile blood draw and we would get that at some Pointon and yet there is zero identifying information in any way shape or form you guys are going to be somewhere like 115th person or so in the study Sanjay was one of the ogs I like that semi ogs let's do some blood do that first ready to rock and roll ladies first oh sure the goal here is to actually for people to eventually be able to do it by themselves because it's research we're doing four cards at a time hopefully only one or two is necessary but we're we're getting extra because we got to do researchy type things basically it's a little prick shouldn't be painful at all have you ever done this before yeah okay cool you've done this before had a little prick oh God it's just right there it just can't be can't be resisted it's just sitting on a silver resisted by you you could not resist okay so I think this is correct here we go it's always good when the physician goes to your fingers with a needle and say says I think this is correct did that hurt at all no great could you do this at home do you think one day definitely great good to hear cuz that's the goal we're trying to democratize access to I mean anyone who has diabetes has to do this like every day right exactly you got it this some hamburger hanging out yuck okay that's it look at that you are a champ next victim okay and three two one oh boy how'd that go wonderful hurt no no no great oh there we go okay we got a bleeder like when you do a blood draw it's the vein and this is a mixture of capillary blood which is a mixture of arterial blood like from the arteries and from the veins so the reason we have to validate or prove that the tests work is because the different blood sources and that is it wobby wob your turn wow that was easy look at you guys you guys are Champs I'm on mic now Rob so I'm going to add some content does this feel like peer pressure or do you have genuine interest in this I have genuine interest you do okay how old are you I'm 36 great perfect nice getting people from all over the age spectrum is really really helpful oh I'm supposed to ask you guys a couple of questions about age and family history anyone have a family history of Alzheimer's here grandmother on which side father okay maternal grandmother great okay anyone Parkinson's vascular dementia and you have my grandfather had dementia maternal grandfather it just I'm sorry about that that's terrible and I don't think so Parkinson's vascular nothing okay and white privilege okay three two one and you didn't really feel it either did you wow love it people could definitely do this okay great we're all pretty high I don't know if that was that you warned about that that may have something to do with it is it fair for me to Guess that you're not normally administering this part of the time you probably have a nurse I have well we have two nurse practitioners and a research coordinator I've done this probably half a dozen times okay I said five it was six was your well this is this is four five four five and six there you go so you've done it three times yeah The Langham Hotel New York has blood on the carpet for me that is for sure we've done this in interesting places but we appreciate that you're doing it absolutely I wonder if everyone in the trial where do you get these people it's Bezos it's Zuckerberg it's it's us he's not saying anything this is like the most warped sample size ever the vast majority of people are like normal people probably 15% are exceptionally sign up yeah how do people get enrolled in this they've emailed the Alzheimer's prevention Clinic which we started over a decade ago at Cornell a lot of those people came a lot of families do it for example we see a person with Alzheimer's and then we do the family members sure which is which is really the meat of what we do yeah is it time for that yeah yeah you guys want to do a okay so left-handed yes sir just do a little grip but that's not to say that's my strongest hand should I be using my strongest hand your strongest hand yeah it's my right oh really you you can do both wow that's pretty good nice okay you win again kilog uh did you want it in pounds actually kilog okay okay uh thank you you're supposed to do it as hard as you can yep oh yeah definitely broke my wrist but it was worth it that reaction I do want to do my left hand after this just to see cuz I assume that my right is okay oh no it's not great no it's not bad that's actually not bad at all grip strength let get 27 just hold so I can make sure 58 good job that's jez pretty good okay we should this at the end depressing you're going be oh oh did you beat me what did he get what the wow W he get what you get over here W nice you try try no you you still won but I know but I just want to see this is on my own curiosity with my life you were 55.3 no no you were 58.6 oh sorry oh yeah press that okay oh it's close no you're right your right was Stronger what's average for a woman in a man uh there's like um percentiles and you have to like look and there's you no no no actually actually everyone did really well on um everyone did well on grip stength oh this is so everyone did well we should do more things where we get tested okay so just depending on how much we use of that real audio just want to bring everyone to speed we started with a pin prick to the fingers all three of us and we put it on four different cards and then we went onto a mobile lowii dexa scanner right it's a biometric scale and it's going to tell us what percent body fat and muscle mass what about bone not this version this is kind of like a screening test which is pretty good and it's an at home scale which is helpful but it's not gold standard but it's helpful and then we had a hand grip strength test which was really fun and Rob was very strong I was hoping to beat Rob by a lot more than I did that was impressive have you done it I have I've done everything what is your hand strength don't FIB wait in kilograms yeah oh I don't remember well guess what you get take a test now too no we've never put a guest on the spot like let me show you my blood biomarkers I put my best foot forward but my hand sweaty because here the excuses it's a athlete who blames his equipment oh my gosh hold on like I got this I no I had a plastic glove on love this it matters so much to us hold on I'm starting it wasn't humans are incredible oh I'm so upset my hands are sweaty I had your blood yeah you have your our blood on your I can't even no this isn't fair I can't even I'm so upet no he's using two hands now oh my God that was 44 that's not bad at all I don't think 47 recently oh my god oh [ __ ] body F okay anyway ah sunjay was really fun we should add you're kind of here cuz we had sunjay on and he did a multi-part series on Alzheimer's and you are a large part of that investigative work he did sanj's the man yeah is he the most have you hung out with him socially I met him briefly like a decade ago and I haven't told him this I met him at like a backstage at Dr Oz or something and I'm a fanboy now I know Sanjay and it's like amazing that I've gotten to know mostly during Co but I wanted to be sanj 20 years ago he's a six-year grad I'm a six-year Medical school grad like called the baby doc program the way he could just communicate science it's just different and that was my career path a little bit when I was in academics used to teach the faculty how to communicate your science so that's kind of what I did and I looked up to Sanjay and now it's so cool but I don't think of it like I kind of like separate 46 three years my junior and you're probably N9 years yeah around there okay he's mid-50s looking great then he wrote a great article that I read talking a lot about you and he yeah he said he he knew you over the years and he would often reach out to you for certain topics we were in touch a lot during Co cuz the [ __ ] was hitting the fan in the world and you have to have a network of Specialists you can rely on and Sanji was always there when I had questions and he had questions for me he's always calling me about interesting people I'll just put it that way yeah I bet he's probably conduit I bet when people bump into Sanja yeah this is the same with Adam do you know Adam Grant I don't well he'll really connect you with everyone believe no more be careful you you have to do this everywhere and then when did you meet a TIA I met Peter in 2014 is at The Breakers Hotel oh oh down in Florida we were speaking at some I didn't even know what I was doing I don't know and didn't know who Peter was aside from he had this blog or micro blog but this was like a decade ago and he would talk about nutrition I knew of him from some nutrition stuff and it was me Peter and Jay Walker the price line guy it was 11:00 p.m. I was exhausted next thing we know it's like 1 2 o'clock in the morning we're all talking on a couch and I'm arguing with Jay Walker I enjoy Vegas and I thought that you could beat the slot machines cuz I had a method my uncle lived in Vegas my aunt cuz he has like hundreds of patents on slot machine randomization codes or something I'm totally probably mangling this cuz this is a decade I wouldn't have known that at all so he has all this intellectual property whatever and I'm like so did I beat it did I win he's like it's all random oh and I'm like no no no trust me trust me Jacks Are Better high limit $5 a like I had it all figured out you really believed it 100% oh my gosh wow this illustrates a fascinating point about all of us no matter how smart you get and in fact a lot of people talk about dny and Krueger effect it almost affects smart people more it's more dangerous to be really smart in one area cuz you can be misled but you genuinely thought you had a system for slot machines I was certain of it and were you shook when he explained to you how that was impossible I'm still not okay like I I've never gone back to the high limit no now I play crap six and eight the best odds is what I choose but I'm still upset yeah they say craps is mathematically the best odds L 6 and8 Vegas that's as good as it's going to get exactly I mean Peter's one of the more influential top 10ish or so medical people in my career that's changed the way I think about medicine and I was pushed into a little box because I was always trying to get ahead of things and we have a sick care system but I'm a preventative care kind of guy and Peter just saw things the way I saw things so it was just really reassuring motivating he mentored me in a way to say you know I was an academics and I had to prove what I was doing but he really helped he kind of told me to stick to it did you participate in outlived at all I feel like I saw a version of that book when it was either called the manifesto or it was very long and very different I think I mentioned on some page I think I gave feedback but I didn't see outlive until I got a copy of it so our history is we interviewed Peter it was very fun we walked out turns out he's a Bonkers Gearhead like I am so then we started doing a lot of Motorsports stuff together so now we're just Pals but when I was learning of sanj's work Visa you I was like oh this is very outlived the brain health is a metabolic condition this all feels very very in keeping with what aa's prevailing theory on all this is yeah and we sometimes disagree and when I've disagreed with Peter it's caused me to like go down very long time consuming complicated and expensive rabbit holes to prove or just prove like this whole genetic thing him and Bob Kap Nick's Denon is awesome the guy who does the podcast now but I was running in Central Park 2018 and he was talking to Bob Kaplan about how genetics it doesn't help and 23 of me is bad and I'm just like what do you mean I think you can personalize care and this is more brain health and he said something and I got so pissed off and ran my fastest 10k or whatever around the reservoir and then we did like a half a million dollar research study to try to prove whether or not genetics was whatever and we spent a lot of time and a lot of money and now he's talking about won um well he's talking about clotho and apoe and he's talking about all these things so you know we were both right because doing whole genome sequencing for example is super expensive super time consuming we did it on like a whole bunch of people during Co spent a whole year on it spent a lot of money and 44% of the time we found something that was impactful but greater than 50% of the time we didn't so that's the challenge with genetics but that was fun you know I've been fighting tooth or nail about these blood-based biomarkers trying to develop this cholesterol test for the brain using blood tests for the brain which we can talk about but I'm not sure he's fully convinced yet but he is talking about them now so right we're going to earmark cholesterol because he has kind of a provocative take on cholesterol that's very appealing to me I've always just had high cholesterol regardless of what my diet is are you a LP little a guy or just an LDL guy or apop high guy I have low high density and high low density so the reverse of what you want yes the absolute opposite of what you would hope for maybe sort of HDL is complicated yeah and I've have since started taking a lot of red yeast I have lowered it into a insane level isn't it more about the ratio or no let's earmark it though cuz we need to do a full clust all deep dive but let's start with your story which you already said you had this accelerated Medical School plan you had a ba at 19 does that mean you entered College earlier in New York I made the cut off so I was young I graduated high school at 17 did a lot of AP classes and I clept out of stuff and whatever those tests were missed a lot of parties oh it was terrible but I was a substitute teacher for a while cuz that's how I made money in med school and the river boats that's gambling but I had a lot of college credit did finish my undergrad requirements in the first two years actually it was a bla bachelor in Liberal Arts oh okay I've never heard that differentiate I learned how to ask seminal questions in life would you like fries with that I don't know what I learned in my bla will you be eating in or taking out exactly then medical school so I was 17 years old I remember this vividly got my white coat I'm in rounds in the hospital on Tuesdays and Thursdays for part of the day I'm in medical school on Tuesday my dosent is what it's called like a mentor where we go around and around University of Missouri Kansas City gusos fighting kangaroos and we basically learned When We Were Young that medicine can be taught early and and the founder of our medical school went over to China and went over all these different places and learned that a lot of countries out there you start med school out of high school this was a unique program I have regularly wondered why the Ba's necessary because even if you're on the medical path only 20% of what you're studying is applicable to that why are we doing all this other stuff we're know what we're going for I can see both sides of that argument but I think being well-rounded getting psychology classes understanding liberal arts I did take History of Rock and Roll I did take some of those silly but kind of cool classes I think it's important I don't know if the full fouryear degree but I'm very supportive of the combin well let me hit you with even more provocative people hate this opinion I think surgeons should skip a ton of the stuff that's a tough opinion because you really need to be medical to be a surgeon critical care when the stuff's hit in the fan you got to know general medicine do you need to know mitosis and meosis and do you need to no organic chemistry you're a human mechanic this is a very valid point biochemistry I don't know what I remember from it or what I learned in orgo I remember Benzene rings but how that does anything and then add and you're a surgeon I think it's even less applicable so I don't know some of it's a little gratuitous but alas why were you in such a hurry I knew 100% that I wanted to be a doctor well you have an older brother though you got it I had a picture of C ever Coupe on my wall the old Surgeon General oh oh oh wow wow oh yeah yeah I wanted to be surgeon like in fifth grade So when you say you want to be sunj you really did oh I had these like as you have a VC Murthy poster in your office he's wearing a speeda I shouldn't have said that no so my brother is a neurologist 13 years old than me he's the smart one in the family I'm the better looking one clearly this is a podcast so that works out and you know I had my neuroanatomy made ridiculously easy and understandable book and I used to bring it on a camp trip cuz I was like that dorky kid but I wanted to be a neurologist kind of knew it I thought the brain was cool and I went to medical school with a plan and I just wanted to just do it okay so there's any number of fields you could have probably focused on as a neurologist how do you get driven into Alzheimer's and Dementia as a specialty it was a little circuitous because I was fascinated by the brain thinking skills memory cognition I always thought was interesting I also kind of enjoyed the fast-pace nature of medicine so for a little bit I thought I was going to be like a vascular neurologist with strokes and do like what Cardiology just do and put piping in and put balloons and Sten and I kind of went down that phase but vascular neurology cardiovascular medicine and brain health and cognition were the things I was most drawn to you have a family history of Alzheimer's disease I have several family members with the disease my Uncle Bob amazing guy was diagnosed when I was in high school back then there were no treatments in the years going into medical school there were no treatments and I wanted to be a neurologist since I was like 8 years old you can't do anything my Uncle Bob introduced my parents my Uncle Bob saved me when I was you know drowning in a pool very common Uncle thing to do yeah a lot of people get rescued by their uncles Navy guy still remember I Don't Go Near The Water anymore but seriously I don't go in the pool I live in Florida it's the whole thing no really quick you could have one or two reactions to that as you enter a field nothing's known about it so you're like why am I going to go practice this thing where you have no impact on anyone a you know if you're kind of defe us and pessimistic like myself or you could go wow this is a field where I could actually make a real mark on it because no one knows what the [ __ ] they're doing it was probably the latter because there was the decade of the brain I don't know when this was I think it was the '90s or 2000s or something and it was supposed to be like when the decade was over the brain is going to be understood and the decade ended and there really wasn't that much traction was that driven by fmri or was there a technological breakthrough That was supposed to unlock all these secrets you know it was a saying that tried to get people interested and tried to get funding whatever the saying was because we could say the least understood orgon at that point yeah it's kind of like a venture bet you know how Venture capitalists put a long hedging bets or VC or whatever the term is but you put money in and then 10 20 years down the line you know that something's going to change I kind of thought about that I wanted to be challenged in my career I wanted to do something that I'm interested in Long position yeah long position that's what I'm trying to say exactly and I thought or predicted or was hoping that 10 15 20 years after I graduate med school that's when it would hit and guess what I know I know you're actually living and realizing your dream it's crazy so give us a brief history of Alzheimer's as a disease when is it first identified when do we get that label and how are they diagnosing it back then and walk us up to when you enter the scene yeah so over 100 years ago Alo Alzheimer is the doctor's name and Augusta derer derer was the first person that was given the diagnosis and it's a little funny but she was given this diagnosis of Alzheimer's she had a very uncommon form of Alzheimer's disease she had early onset Alzheimer's in her 50s and she was shown to have cognitive changes before she passed and when she passed they looked at the brain and there was amalo in the brain and there were these path ol ological features and amalo is a sticky protein it builds up in the brains of people with Alzheimer's there's also this tow proteinic to Tangles and amalo and to characterize the disease but I'm doing characterize with my carrots or fingers like in the air quotes thank you so the brain looked like amalo and TOA and the patient looked like this so the disease was characterized that way that's something that didn't make sense to me and it still doesn't make sense to me and this is not a common belief in my field what aspect of it didn't make sense they were saying hey look at these two proteins this brain is riddled with it it has an abnormal amount that we don't see often this must be the cause of it it's probably interrupting neurons from communicating a gummy plaque like an engine analogy the causitive part was the problem for me yeah right like is this the result of a disease or is this the cause of the disease exactly and to me the term biomarker is a biological something that can be a Hallmark of a disease or a condition just because there was amalo and Tow there like it didn't jive with me because I'm a clinician first 80 90% of the time a neurologist makes a diagnosis it should be made based on the clinical history and I was seeing patients and also in my own family like I had a family member I was sitting next to her at a wedding and she kept repeating herself it took years for conventional medicine that were following this amalo and TOA diagnostic criteria this framework that was set decades before to be able to make a diagnosis but I saw something feel with the felt off and if something feels but the amid in town may or may not be there then there's got to be something else that precedes it right right and that's what changed things for me and that's why I went this way this is the great Universal conundrum in medicine period I have my own example of that which is people with arthritis or serotic arthritis like mine often have low vitamin D D and the original assumption was low vitamin D leads to inflammation but then at some point someone finally said no low vitamin D is the result understanding the order of these things is imperative and makes the world a difference it's very hard to figure out if you have a contrarian Viewpoint it's hard to go up against and get funding to research it impossible and you know that's something actually that Peter encouraged me to just keep going you my old chairman Dr Cliff sa at Beth Israel Deacon as Harvard Medical School he wrote this email to me said you know Richard you're a trailblazing you're doing great things in 2006 I remember the email I printed it it was on my wall next to cord coup sanj sanj never made the wall one day but he said you're a Trailblazer I said wow he's saying this about me little old me I'm like 20 something years old but there's not easy funding mechanisms to do this so you're going to have problems in your career and he was 100% right and I've had to beg and plead and ask and beg again and traditional grant writing doesn't really work because you write a grant and then you submit it and then it takes six months 9 months and then no one gets it in the first Trend and then you get funded two years later and that Grant was written based on science that you just zoomed past and in prevention and reducing risk the science moves even faster and it's contrarian it's controversial so I just kept striking out and striking out and striking out most of our funding 70 80% are donations and philanthropy and that's how we did it was your original goal to uncover whether the amalo was a product of or the cause of or did you have a more specific narrower objective so in 2006 a paper came out looking at omega-3 fatty acids and it's relationship to brain health and cognition and Alzheimer's risk it was convincing you take omega-3 fatty acids which to me made intuitive sense good for the brain here we go quotes quotes again okay I learned I learned it's good for the brain the outcomes are good and everyone in my field shunned it really it's not POS omega-3 it's not emlet tow but it's the synapse it's the Brain Cell It's oxidative stress it's mitochondria there's other things that omega-3 fatty acids do they would have wanted it to reduce amalloy and TOA to be a convincing exactly gotcha as some of us would say that really grinds my gears right it just ate at me so I said okay I'm going to start putting people on omega-3 fatty acids and I'm going to track stuff you're basically conducting your own in my clinic patients because I was interested in vascular brain health Dr Arthur agaton also one of my m on the agaton calcium score he's the South Beach Diet guy but before that I met him in 2001 when I was a lowly intern at mounts Medical Center in Miami the way he thought about things was just different and he believed in nutrition he believed in prevention I started putting people on omega-3 fatty acids and checking their cholesterol even though I'm a neurologist which is kind of okay for stroke doctors but not really for Alzheimer's Specialists I saw the cholesterol getting better and I said okay I don't know what that does and maybe the Cog tests were H maybe a little better I don't know but it wasn't working the same in everybody can ask you a dumb question now I'm always curious about this with blood tests which is if you find it present in the blood does that necessarily mean that the body is using it absorbing it bringing it into protein synthesis or is it just mean it's floating around cuz you dumped it in there does that make any sense like how do we know that it's being used as opposed to just present so the way to check it with omega-3 fatty acids Dr Hussein Yin did some amazing work where they did spinal taps to see how much omega-3 is making it into your basically and I maybe mangling this conceptually a little bit cuz basic science I didn't do too well in orgo I got to be in organic chemistry in medical school but that's not important anyway right Omega-3s is like a perfect thing so people with an apoe4 variant apoe4 is the most common genetic risk factor for Alzheimer's disease 25% of the population have it there's four of us in here probably one of us have it Rob cuz he had the grip strength I got to get rid of him he's my closest competition to grip strength so apoe for increases risk but omega-3 fatty acids preferentially protect against Alzheimer's in people with the apo4 variant now you have this concept of personalized medicine Precision medicine we've heard about this in cancer we've heard about this in other conditions and that's kind of what just changed the way I think about Alzheimer's disease well we should point out another Paradigm you inherited which I think has pervaded medicine the whole time which is we have this really weird compartmentalized view of the brain as something completely separate SE from the rest of the body there's this Blood brain barrier so even the Omega-3s I'm sure people are arguing at that time that's not even making it to the brain you know there's this kind of arbitrary division that's its own Paradigm you're fighting against so I'm going to say something that I don't know if I've said before I've said in lectures maybe but I believe Alzheimer's disease is a medical condition when people have like high blood pressure or high cholesterol or diabetes Well people can have kidney failure my buddy Dave his mom was on dialysis terrible well she had diabetes she had uncontrolled vast ular risk factors and it affected the end organ the end organ damage exactly of the kidney and this is very controversial but I absolutely believe it I feel it but I've seen it the end organ damage of various medical conditions of the body in certain people whether they're genetically susceptible or otherwise is the brain while elevated cholesterol blood pressure blood sugar don't really think that causes Alzheimer's disease it can fast forward Alzheimer's pathology in a certain person so I believe that Alzheimer's is a medical condition most of the time or a lot of the time and I'm not sure exactly what that is it depends on the person's genetics depends on the individual characteristics you know men and women are very different women that go through the par menopause transition with the apoe4 variant the estrogen drops the amalo goes up you need to intervene then and follow very closely hormone replacement therapy is controversial but it's a whole thing I believe that you can prevent reduce risk for delay onset of whatever words you want to use that you feel comfortable with would I be wrong to say like a lay version of saying it is the whole system's connected nothing's compartmentalized you have an overall metabolic health and if you have poor metabolic Health it may materialize in any number of down river symptoms it could be a kidney issue it could be a brain issue depending on your genetics and I remember learning about all these Concepts Megan lry she taught me you know trust but verify you don't have to always trust the Dogma just don't believe blindly Dr Kap explained to me and he was telling me the story about at the bedside seam Miller Fisher and he's the stroke guy and he would tell these stories about intermittent Interruption of behavior and that was a sign of ureia which is a kidney problem and I'm like wait a minute you can make a diagnosis of a kidney failure based on the way someone's cognition changes what that's what got me to like link that medical conditions medical disease is related to the brain and the brain function something called pseudo dementia of depression someone can be depressed with low serotonin levels and have problems with attention or speed of processing if someone's not paying attention they can't remember things that's not dementia that's a cognitive problem that is related to low serotonin if you're not encoding the memory then you can't remember it later that's a pseudo dementia of depression so all things biological can cause cognitive changes cholesterol problems with executive function vitamin D Omega-3s they metabolic Health when I I think of metabolism I think of memory people with elevated fasting blood sugar and diabetes twice the risk of Alzheimer's disease but there's a correlation you hear and you see the high blood sugar and you do the cognitive testing and it's usually it's a little lower correlated y stay tuned for more armchair expert if you dare this is a great opportunity right now sorry I'm going to fold you into an ongoing argument by proxy with Monica's father who is so smart a shoke he's one of the smartest guys in the world her maternal grandfather passed of dementia and he also was diabetic he cut out rice from his diet a shoke observed that those were pretty correlated with the acceleration of dementia you're not representing him properly and so a show has decided even though he is pre-diabetic he's going to start eating rice again because he's made this connection small out small out he's worried wait wait this is maternal right they are not related okay but he felt that his brain decline started once my grandfather fully took rice out of his diet so my dad has stopped eating carbs basically because he's trying to be healthy and then he second guess that decision because of all this and he thought he might incorporate rice in a little bit more and look the thing is I don't know what erasing carbs fully from a d diet it could affect your brain and energy like you said it's all connected and different people with different genes respond differently to different diets which is why nutrition research is all just completely discombobulated and impossible but if someone wants to do a test like that an experiment on themselves what we preach and what we suggest is what we call an endof one trial an endof one trial is a person uses themselves as their own control you make one change you then repeat the blood test before and after you check your body fat you check your muscle mass you do some cognitive tests I'd imagine in our program yes but even people out there that don't have access to a preventive neurologist because there's a handful of like even less single digits the key here is if he's going to make that change try to have some objective data there's so many well I'll say it cuz I'm not a doctor and I won't get sued but Granddad had a diet that led to diabetes the diabetes had a terrible impact on his brain health he cut out the carbs but it was far past that point and aoke observed this decline because he was observing diabetes at a stage where it required the deduction of all the rice to be fair we don't know his age 100% unfortunately but probably around 94 when he died this isn't a situation of like death or something like that so he was diagnosed with diabetes fairly young I mean he was probably in his 40s or 50s lived with that for a long time before there was a pretty steep decline in cognition so that's what my dad's doing he's not like oh Dr isaacson's not going to give us a full verdict that's okay Ellen snare other people you did this not me no no I know well you bring in the age thing cuz you know you got to have sustenance you don't want to lose weight and you need to have enough nutrients so was part of the decline related to nutrition density and malnourishment this is leaning towards a choke now there is some plausibility here but uh tell aoke to call me later job that kind of went your way I'd want my dad to be right yeah of course obviously don't we all okay so at what age do you dedicate your work and focus to prevention you adopt this view that this is treating it down river generally the outcomes aren't great my grandma when she got it there's nothing and it was very much posed to us as a genetic thing she just had this there's nothing environmental she did and this is what her jeans wanted for her y alim's disease and other neurodegenerative disorders such as Parkinson's disease Louis body dementia start in the brain and body because Parkinson's actually can start peripherally decades before the first symptom begins I knew this saw this I felt this right that's the subjec of the clinical like you felt something was wrong but then you couldn't detect it until later and in about 2009 I said if I'm going to see someone with Alzheimer's a person with Alzheimer's my patient and their family member wants to try to do something to reduce their risk then maybe I should see families that was the first concept that makes a ton of sense when you see a family and I learn this very quickly I'm a pattern recognition Guy this is not rocket science I don't understand the biology as well I don't get the ortho you know the Benzene ring this is pattern recognition it's not like I'm trying to figure out some scientific millu of some Advanced theory of biochemistry you find out all nine family members swam in this Creek no and swam and and they all have glowing fingers you're like okay it's exactly it and I was treating a patient of mine amazing guy retired physician wrote a major textbook and he had two children and one looked more like the dad and the other one didn't and it was my job to deduce what that was that feeling your gut impression what does that mean can you find a biological marker can you find a cognitive testing marker can you find a body composition marker can you find something and that's what set it off and I talked to the son who's also a physician in the hallway that was my first Alzheimer's prevention consult ever for 40 minutes in a hallway talked to the daughter later in the same week in medicine things happen in threes Dr agaton referred me my first Alzheimer's prevention patient Dr agaton published on this calcium score in like 1989 when did it make the diagnostic guidelines for Cardiology what year do you think 2015 2018 well I was going to say I got pitched having one in 2020 okay and it's the first time I ever heard of it so I have to assume it was relatively new in 2020 for me to go get that test over 30 years not it's okay that you got it and that's a good thing and I believe in it but maybe not for you because we're playing the long game with you and 10year risk can be deduced by the calcium score in a younger person in their 40s maybe the calcium score isn't the perfect measure it's a good quick measure it's quick it's 100 bucks whatever it is tiny little bit of radiation oh no I'm talking about the one where I went in and they put fluid in they looked at my heart and they told me how much calcium I had in every single artery a ctog I wouldn't remember the name of it but they give you a percentage of calcium build up in every single artery in your heart that's what you leave with and to my enormous shock and amazement I was Zero I Was preparing for much worse yeah okay I think that was a calcium squ there is more advanced testing Now using instead of just a quick CAT scan a little it's called the CTA ctog where they can use artificial intelligence to understand where in the blood vessels there are soft plaques not just hard plaques hard plaque is calcium that's one degree of risk to me soft plaques is what I want to know for you if your calcium score is zero okay that means your risk in 10 years is low but you're in your 40s so why is your going to be high to me getting soft plaques is something that I'm very interested in there different that's like the predecessor to a hard plaque exactly it would turn into and there's things that I believe you can do proactively before there's a problem to maybe even have regression in the plaques and that's what we're trying to do now and what we do is we use what we find in the heart to try to correlate what does that mean for the brain and how does that mean with cognitive function we do know that having a high calcium score increases your risk of vascular dementia two decades later so soft pla has to be the same thing but we don't fully understand it and is it executive function is it memory is it speed of processing is it attention everything that our Cardiology friends have been doing and preventive cardiologists have done now we have to do this for the brain and we have to understand people say like what's good for the heart is good for the brain that is like so oversimplified it's a good saying to kind of get you motivated and get you you know okay I got to pay attention there's a lot of nuance there that's what we're trying to sort out okay so Sanji did all these tests and he wrote a great piece on I recommend everyone read it it's on CNN.com we went through okay when was it label disease we got that oh uh here's a quick question about Alzheimer's since it's Discovery and an accepted diagnostic approach are we seeing it increase or decrease oh this is a good question and this is one of those incidence prevalence questions explain the difference between that I wasn't good at that class either that's like a Statistics question like let me figure this out so one is the prevalence is I don't know how many people have it but the incidence means how many people have it per group of people or proportion I may have mixed that up but different studies will say different things I believe the total number of cases out there are going up because we have an aging population we have a lot of things that are charting up over the last 30 years we also have obesity charting up there's a lot of factors you could correlate probably the rates are actually coming down for Alzheimer's oh they are but the number is high but the total number is higher CU we have an aging population I got you depends on what statistics you look at what study you look at what the risk factors were but because we're getting better control over vascular risk factors like diabetes high blood pressure and high cholesterol if we can slam the brakes on those we're going to delay cognitive decline in Alzheimer's okay that makes sense how OIC is going like this is what we look at we have multiple people in our study where we do the blood biomarkers and Sanjay outed me by the way yeah yeah I think on this show thanks well he was the patient so he was allowed to say whatever you said to him Hippa H yeah so for science I took three doses of tppa M jar and I got a blood test before and then I got a blood test afterward you did an N of one you could to you're hred you're HED so we did an N of one I don't have the results back yet but we'll get those back very soon and then I'll just come clean I then did another experiment by the way when I went on this tppa tide the glp1 and I have nothing to disclose I don't have any relationships with pharmaceutical companies or supplement companies or anything like that I tried to keep it clean I wish I did have relationships I would have paid off my student loans earlier it took me 22 years to pay off my student loans but when I did this my LDL dropped from 109 which was like borderline my apob was 72 which I'm like H when do I need something my LDL dropped from 109 to 60 what on the after three doses of tepati wow my body fat went down from 20.5 to 17 how long is three doses I spaced it out I was experimenting on myself I did dose one then I did 8 days for the second dose and I felt like a little sick and I waited 13 days for the third one you know 2.5 Mig is the low that you could get with the injections and it just floored me I didn't leave my couch for 3 4 days kiding I was so sick cuz I didn't need it I was doing like an experiment I guess what I was asking is how long was the window you were on it a month so in a month you dropped 3% you know interestingly I lost a little muscle mass but I gained it back I have more muscle mass now than I did 6 months ago because I did a second n of one I felt the 2.5 Mig of tritide was too much for me so I did the unthinkable thanks to my niece she was the guinea pig first but we got compounded tepati which I shouldn't be talking about but whatever it's all good and I injected 1 milligram and then 1.1 and 1.2 and then after three doses I got terrible heartburn and I'm like I'm done and then I got another blood draw so I used myself as an N of one study with the realtor zepeti and then the compounded tepati and we're going to look at amalo and Tow before and after so tepati is the active ingredient in all these different brands uh it's uh manaro and zound are tepati OIC and wovi are semaglutide okay MOG glutide is a glp1 that's been out for by the way these glp1 drugs have been out for decades yes when I argue with people about these I go this is isn't brand new yeah 20 years oral the semaglutide injections have been out for like 5 six years and the tepati injections just like a year or two and the ones you're running on the black market just a few weeks old exactly yeah I don't know that I'm going to do that again that was very bad so has your cholesterol stayed down it went back up to 90 okay but still much better than and my you know what and my apob was 68 I didn't check my apob the second time but my apob is lower and my LDL is lower with gp1s there's vast amounts of data that suggest that people that take gp1s so semaglutide tepati all the brand names absolutely have lower risk of dementia and Alzheimer's there's actually a study being funded by the semaglutide company it's called evoke I believe and it should report out in a year or so where semaglutide the oral is being used in a preventative trial to see if it can delay mild cognitive impairment the first symptomatic stage of Alzheimer's from progressing to the dementia phase so there are randomized double blind Placebo control trials ongoing Now using gp1s to try to reduce the risk and try to look at the effects we have patients our study is a Biore repository study so you donate your plasma get your blood drawn and when people are in our study they are treated by their own doctors so Dr agaton actually treats one of the patients that was in the CNN documentary Simon amazing amazing guy and Dr agaton prescribed tepati and Simon took appetite he went an hour and a half of strength training three times a week so it's not to reduce muscle mass because the critics of it will point out that it's very common to lose muscle mass there's a lot of micromanaging and Nuance here but I don't exactly agree with that if the person sticks to the plan like I won't allow one of my patients to continue on T epatite if they are not doing strength training not happening and no refills like forget it I want the inbody I want taking pictures I want to see what your body fat is what your muscle mass is so what we do in our research study is we look at the change over time in blood-based biomarkers amalo tow all these other markers and we're trying to figure out when people are seeing their doctors to reduce their risk of Alzheimer's disease based on modifiable risk factors does that have a downstream positive or negative or neutral effect on the brain markers we've only presented 15 patients you know what the American Academy neurology meeting and we're presenting some new data at the Alzheimer's Association International Conference we have little bits of data but the data looks amazing the GP ones are working anti amid drugs just had a new FDA approval for a new anti amid drug we have lanam and danab people go on the anti amid drugs and the amalo and Tow improve people go on gp1s amalo and to improve okay but really quick so back to your original question decades ago of whether the ameloid and to was a result or the cause when people are seeing a reduction in the amalo to what are you deducing from that great question it's a biomarker of disease that's what I believe amalo and Tow are I don't know what causes Alzheimer's disease if anyone can tell me that they are definitively certain that they know what causes Alzheimer's disease I'll respectfully disagree because there's a lot of smart people so I guess yeah it doesn't answer the question because even if you're seeing a reduction in the amalo and then an improvement in the cognitive function you can't really then conclude oh it was the amalo that caused it you could say well whatever this treatment is it's reducing the production of the amalo and Tow so anti- amid drugs reduce amalo and reduce towel okay that's easy right but if you were only red ucing the symptoms non amid targeting drugs are still lower this guy Kevin he just exercised he changed his diet and he reduced alcohol by 30% no anti- amid drugs no gp1s nothing and his amalo in town normalized someone just told me last night I was having a dinner with a woman whose father's got Alzheimer's and she was saying that yeah alcohol is really powerful in this specifically in people with the apoe4 variant especially two copies of the apoe4 variant one % of the population has two copies of apoe4 smoking alcohol poor diet poor exercise much worse effect on people with one or more copies of E4 we are going to find out if we have these so today all we did was just the finger prick test that would require a fasting blood draw yeah I got to find out if I have that I do too I'm nervous you more than me I don't smoke or drink yeah I do drink okay so it would be helpful to know jeans are not your destiny you can win the tug-of warar against your jeans I really believe if someone has the APR E4 variant great I know what to do about it one copy no big deal I believe you can neutralize the negative impact of that Gene probably 80 90% of it by living the right lifestyle and modifying risk factors let's talk about if you have that Gene what factor are you going up in your odds of getting it because a lot of these things like when we did a 23m me thing and you get these results back and you actually start looking at the uptick that the gene predicts it's like 30% more likely well 30% is that more likely he's not that big have you guys both done 23 of me yeah yeah a while ago so you have a we know oh it's there if you log into 23 of me you scroll down you have to take some health quizzes and just verify that you understand the limitations you'll see a very Dapper looking neurologist pop up he very good-looking Dapper de sure pretty low hand strength though very low hand strength oh you got me that was in better shape then there will be a video in education materials that is personalized based on your genotype oh really it's already there there oh my God I want to go look that wasn't one that they were flagging yeah we did that like six years ago those videos were recorded in like 2017 2018 oh wow so we already know again if you have the apoe marker what percentage are you more likely to get Alzheimer's I'm glad we're talking about this because the answer to this question is impossible to figure out and every media story out there would say two copies of apoe4 equals an 8 to 10 to 12 fold risk or you have a 90% chance of getting Alzheimer's if you 4S that is such [ __ ] different people with different genes respond differently I have so many apoe 44 patients and this is clinical observation taller lighter eyes lighter skin thin the impact of 44 I don't see it clotho for example can neutralize it the gene right upstream and right Downstream apoc1 which is a cholesterol Gene Tom 40 which is a mitochondrial metabolism Gene it's the total picture it's called polygenic risk if there's one for was it from mom or dad because maternal history is worse than paternal men with 44 eh not that big of a deal women with an E4 higher risk why par menopause transition so what is the apoe4 risk in a woman who goes on hormone replacement therapy during the par menopause transition well it's not the same as a woman that has the gene that doesn't go on HRT and has a rapid withdrawal of estrogen and then amalo starts oh my God I need to find out right now you're going to start shooting up some um par menopause is on its way well hold on you're I mean you know can happen in your 30s it's not going to happen late 30s the roof could also cave in Hest that could happen Liz thought she had it yeah Kristen's I think been convincing herself I think you all are going to have a rude awakening when it really well whatever still good to know as early as possible I agree and there's something you can do about it fearing genes means that there's a misconception or misunderstanding of what the genetic information is telling you knowing your numbers knowing your genes there are things that you can do about it you can grab the B by the horns and same with this is the future of medicine yeah your genes are interacting with the environment Robert sapolsky's book had just a great section about we had this lamaran fear of how Evolution worked and lo and behold it kind of works in both directions we have a full chemistry set that can be turned on and off as needed more than we previously thought they're a little more variable than we thought agree Sanjay brought this up but we have a sick care system not a preventative health care System our entire Health Care system is built the wrong way we're treating disease whether it's cardiovascular disease or Alzheimer's decades after it's too late in so many cases and to get ahead of things to have these conversations Alzheimer's shouldn't be talked about in your 60s 70s and 80s it should be talked about in your 30s 40s and 50s when I was in academic medicine aside from struggling getting grants and trying to see patients and not getting reimbursements you know you see a patient there's no code that is a reimbursable code for an insurance company to reduce risk for Alzheimer's yeah like they need to go back to the drawing board and they got to go all right what's our total output for these insured people it's 2 trillion a year what if we divert 35% of that and we take this other approach it's looking at it like vaccines but they need to be proved that they're going to win financially but they're going to win financially it's just I think shifting that what a heavy slow-moving ship it is rebuilding medicine from the ground up with a preventative mindset I think is really the only way to do it I do a lot of research now at the institute for gen of diseases in Florida it's amazing we get to do fun things and fancy things and outside of Academia when you get a donation or you get something you get to use it right away an Academia there's all this red tape I practice now in a place called Atria and Atria is both in New York and in Palm Beach and this is a different way to practice medicine I don't have to worry about insurance because it's set up in a different way it's trying to engage the science The Cutting Edge science with the medical practice immediately and it's preventative health care first you have the sickcare you have the preventative health care and it it's just a different way to practice medicine and that's just not prime time right now and I can't wait until it is you can feel I'd imagine that you're approaching a Tipping Point I think like the enormous popularity of aa's book I think people actually feel empowered by this mindset and approach which is you're not just waiting for the knock on the door to tell you you have this disease you're going you know you're going to be largely in control of who knocks on the door that's comforting it's daunting Lifestyle Changes scare people it's it's hard to create habits but for me that's just very empowering it's the future how do we get there sooner you know it takes 17 years on average for something proven in medical science today to get translated into Medical Practice commercial insurers now if they're going to do something to prevent the disease in you 20 years from now you know what they're doing they're saving money for their competitors cuz people don't stay in the same insurance companies they just flip around I've had three different insurance companies in the last like four or five years and that's a problem Medicare and Medicaid okay at 65 they pay for a bunch of stuff yeah cuz they're kind of the only system set up that could enact some kind of system but you're joining it way too late this is just an opinion question I want to preface it by saying this do you think Alzheimer's existed in the Paleolithic Era well did people live long enough what was the average lifespan but that's very misleading people love to say that people only live to 40 that's [ __ ] people lived to 80 and 90 infants died at a rate of 35% which drives down the overall mean age even look at our scientists Galileo living to 89 you know like if you made it to 20 you could make it pretty far they had to have manifested symptoms of cognitive decline how to diagnose Alzheimer's back then I'm not sure we just have a lot of modern diseases a lot of people would agree on that our diet was very specific you didn't have probably type 2 diabetes that's an evolution result of our diet the level of coronary disease we have certainly wasn't existing in a hunting and Gathering population it's hard for me to guess and there's just so many differences I don't know I could speculate either way yeah let's just say this do you think that the treatment that would be widely recommended would involve physical activity Community a diet that's probably fruits nuts Vegetables and protein those are the tenants people come to me in New York people were on the weight list for 4 and A2 years we have thousands of people that have reached out based on the CNN documentary we have had hundreds and hundreds of people people on a waiting list for years and it's like I don't even know how to do this is why we're trying to scale care using lowc cost fingerprick test hopefully bring cost down we could do a test through the mail and Screen positive you're working on an app too that can administer the cognitive portion of the test the cognitive assessments retain your brain it's a NIH funded study that people can go on we had a, 1500 person study fill in 48 hours wow wow then we had another ni study filled a th000 people there's so much demand we have to figure out a way to scale this and we're just scratching the surface one one day we'll fix these things because the things I'm reading about so a lot of the let's just put it this way you couldn't have lived almost any other way 6,000 years ago it wasn't an option all the things you're prescribing you had to live that way you had to eat that way you had to do physical exercise all day long because you had to forge and you had to do these things the medicines that are there now and even thinking about vitamins and supplements those are a drop in the bucket or something in an ocean or something in a swimming pool whatever that's saying is if you don't have the basic t down of regular physical activity between strength trading and cardiovascular you neglect sleep fast forward amalo that's when the trash gets taken out and you need to sleep you need to prioritize sleep you need to prioritize mental health and stress mitigation well as you said depression can lead to decline in pseudo not only can it cause a pseudo dementia but it's actually a risk factor for dementia due to Alzheimer's disease also so the core tenants of brain health are the things that we have control over the micromanaging all the fancy gp1s and the inject this and that it's just not going to do anything for you if you don't have the other things right that's I think a concept that people don't fully understand yeah that's like moving in from 80% prevention pushing yourself up to 100% prevention will involve all those other things but I guess I think that's what's wonderful and empowering about a TS book which is the bulk of the important stuff is very doable I don't need to have access to you I agree what we try to do is get free educational resources online because people do have a lot of nuanced questions related to apoe what is the difference between a brain healthy diet and a heart healthy diet and a brain healthy EX exercise and heart healthy exercise there is Nuance there and we try to just push that out there not on social media but we put videos we have a free mastering brain health course on IND and.org it's totally free two hours of me just blabbing in front of a camera and IND d.org .org yeah it's our foundation can we talk about a couple of the fun ones I wouldn't mind giving people a few pointers while we're here please this is from sanj's article he said loading the spine with additional weight helps activate core muscles such as abdominal and oblique as well as stimulating the growth of new bone cells this could lead to a critical redistribution of the fat muscle and bone in the body and help drive down in any insulin resistance that I may be genetically predisposed to and eventually lower my risk of developing amalo in the brain so yeah just how you work out well said I don't recall telling him that so he learned that on on his own so that's pretty amazing but osteoporosis and osteopenia when a bone is not very dense it's one of the leading causes of death you you think of women that have osteop osis and they fall and break a hip well men get it too so it's men and women calcium intake vitamin D okay there's lots of things but just staying physically active and weight training doing strength training is absolutely critical for building and maintaining muscle mass as we age you know interesting with Sanjay when I was talking to Sanji about what he does and his exercise I'm like he's so fit he does everything right he's so on it but conceptually when we did the scale and the this and the everything what happened was is he's been doing the same activities over the last two decades and as you get older you need to personalize or modify some things because your body is different 20 years later you're the same person on the inside in some ways but you're different your bones are different your muscles are different your nutrition is different your sleep is different aging causes specific changes so doing things passive so if you're going to go for a walk anyway try a weighted vest or a ruck sack just add a little bit of load if you're going to exercise and you want to lose body fat well work smarter not harder zone two exercise keeping a pulse rate of 60 65% of your max heart rate that's the body fat burning mode as a pelaton Enthusiast during the pandemic you can go all out and do your hit but it's not as efficient to burn body fat you keep your PSE lower good for your max vo not great for your body fat burning so you want to do all the stuff you want to have a comprehensive and you personalize it based on your numbers so if you have apoe4 if you have low body fat high body fat High muscle mass low muscle mass you can personalize an exercise routine that targets these individual numbers and then you track the numbers that's the core of Precision medicine Precision exercise who you will who's going to help us yeah who's going to tell us exactly what to do based on these numbers I don't know how to do that myself and if I don't no one does clear where's a where's a I wish medicine could move at a faster pace and it's not doctor's fault doctors try the best they can how do you get 15 minutes per patient how is that even fair and reimbursement for like our Healthcare System is broken but preventative health care in the United States that's the disaster and the remedy that we need to fix these problems long term how do you learn this well there's a preventative medicine sub specialty of medicine you can be board certified in preventive medicine and lifestyle medicine that's an actual subsp specialty you can go see a preventive cardiologist that's different from a treatment cardiologist although often times they do both I'm a preventive neurologist There Are Places out there that do this I'm a preventative health doctor I'm a preventative medicine not certified in preventive medicine but I work with a preventive medicine specialist I work with a family practce nurse practitioner I work with a team of Physicians and a team of Allied Healthcare professionals Pas NPS physical therapists we have a whole comprehensive team if you don't have access to that kind of care a try to seek it out just try to find someone that's preventive minded if you can't talk to your doctor and see what they can do for you and if 15 minutes isn't enough you got to be a citizen scientist and this is terrible until our Health Care system is fixed but we're trying we're putting educational resources it's all free we're trying but I I wish had better answers I want to introduce a concept that I think about often and maybe you'll agree with it maybe you'll disagree with it but I think for me kind of a light bulb moment was your body is the ultimate responsive machine so this stuff that's kind of counterintuitive but as you say bone density Health you lift heavy your body has to respond it has to make the bones thicker it makes the bones thicker you have more blood production it has to make the tendon attachment stronger it has to make the tendons more flexible as you load it it responds and just as a mindset knowing that the body will respond to what you throw at it so if you want it to be a certain way there's a paradigm there that I don't think people generally think about their body they think their body like but well I should eat good and put good stuff in my body and that will magically make everything good down river no it's kind of the opposite you stress the [ __ ] out of it and it reinforces itself I think when it comes to the concept of food as fuel I eat to live not live to eat maybe I'm lucky like I don't enjoy food I like chocolate milkshakes and actually since using these glp 1s I almost can't even eat a cheeseburger anymore and my chocolate intake has come down I feel like it's reset my brain it's been really interesting but I believe food is fuel I eat different levels of protein and different amounts of protein at different time based on did I do strength training that day that's how Dax lives too yeah and conceptually was I taught that in health class like three meals a day by the way do we really need three meals a day that's a whole different concept is that pyramid correct oh defin I mean my God oh my God the food pyramid is like so broken and our whole system of Education in America between food and exercise your body kind of like you said it's like a sports car it's even better than a sports car your body is a sports car you drove at 180 and the next day it went 185 and then you drove it at 185 and it retrofitted itself to go 190 it's actually even better the body's incredible treat it that way you know give it the fuel that it needs it's a machine and you need to nourish it you need to make it change its tires and you need to stretch and you need to build muscle and maintain muscle so conceptually I think we're looking at medicine the wrong way and it affects the brain in a negative way stay tuned for more armchair expert if you dare last thing I want you to talk about cuz it's so stupid that I want to talk about which is toes spacers this is preposterous this is the one that hit me yeah I was like well I'm certainly not doing that so yeah I mean I guess it makes sense with the way I just describe the body which is it responds and it keeps things healthy that are being used so yeah talk about your toes when you use different parts of your body that haven't been used you learn how to use them and you can refine I am far from the expert here Beth Lewis has taught me a ton and I've listened to her podcasts and watched her videos but use it or lose it and movement and motor Rehabilitation when you pay attention to your toes you activate Pathways and signals and preventing movement disorders we talked a lot about Alzheimer's disease and Vascular Parkinson's disease Louis body dementia what about movement rehab and maintaining or focusing on movement as a way to prevent a movement disorder these are biological diseases but they're also motor conditions and motor diseases so I think conceptually toes spacers learning something new a new language a new skill these are things that it sounds out of the box but it makes a lot of sense yeah it's the longest nerve in the body obviously from your brain to your toes and if that then fatigues and atrophies then things now further up River start yeah the whole thing it's like a grayscale on Game of Thrones starts moving through your body all right I have one self- serving question then I'll let you go I tell myself that this is a really great job for myself because I have to six times a week learn a lot about somebody learn a lot about their discipline hold it for several hours while I talk to the person is this good and I also look at some of my heroes right like Letterman just so [ __ ] sharp Stern is so sharp and again how you say you know you just recognize patterns you can't help but ignore it and I go yeah there's something to having to engage in a very intense way what part of your brain has to be activated to do that socialization and communication and learning new things staying intellectually active is critical for maintenance it's called the catsman theory of cognitive Reserve so building a backup system building backup Pathways if something goes wrong you're going to have a backup there so basically reinforcements are coming through all the different neurons and brain Pathways I think the other thing here is having a sense of purpose what you guys do is you spread the message far and wide on topics that are really important I appreciate this thank you for allowing me to talk about our research our work trying to democratize access to care you're doing a service and you have a sense of purpose you come to work X days a week X podcasts a day whatever it is and you're giving back and the countries that have the earliest retirement years like the younger the people retire have the earliest onset of cognitive decline and dimension yeah that makes sense there's like robust data about that oh yeah directly correlates well that's not promising for a future in which AI is replaced everyone's jobs and if people have [ __ ] Alzheimer's at 30 we're going to need to Define purpose or figure out our purpose in a different way outside of work that sweet sweet green whatever it takes well Dr isacson this has been a blast I can't wait for our results will be very public and we definitely want the follow-up stuff right we want we want to go all the way yeah especially and I've heard some stuff about cholesterol we earmark that should we do a little bit yeah let's do a few seconds on cholesterol you know the test that we do is a regular cardiovascular disease risk panel that's what the company does we use it for brain health we have the cholesterol test for the brain that's the research that's the stuff we're doing here and then we have the usual blood test so different cholesterol particles different risk factors is someone an over absorber or over producer of cholesterol there is a Precision way a personalized way that I believe that people need to be treated for cholesterol in a brain-friendly manner this is a controversial complicated whole thing but I'm prostatin I think statins do amazing things and meta analysis and they're protective and they reduce all these bad things from happening but in the wrong person at the wrong dose versus the right person at the right dose we can personalize and individualize cholesterol Management in a more brain healthy targeted way and this is what we do so one of the benefits of the testing it's in a research study that you're getting access to it it's all free and people can participate and all that kind of stuff but the challenge here is how do we interpret the cardiovascular test for the brain so in the panels that we'll get we're going to understand why you have high cholesterol and then you treat it accordingly and that's the future of medicine we're going to look at your blood sugar for example hemoglobin A1c heard about this it's like the diabetes test it's like a really bad test in a lot of people depends on how long your red blood cells live you're going to get a false up or down whatever what's your fasting blood sugar and what's your fasting insulin levels those are really important do you have inflammatory markers so if you have high cholesterol but your inflammatory markers are flat like your blood vessel inflammation marker is flat well that probably means that you don't have problems in your vessels yet but if your blood vessel inflammation comes up and your cholesterol is high then we better do something so it's like if this then and if that and if this and we have all these paradigms and then we personalize it for brain health we're going to check your omega-3 fatty acid levels we're going to look at testosterone and and hormones estrogen for example which is complicated for men easier in women to understand thankfully we finally understand this now after years and we're going to look at other things like B12 level and homosysteine and if you want to slam the brakes on brain shrinkage and possibly even improve memory a little bit you can use a certain type of B complex vitamins to lower homosysteine but if you have one gene versus another then we need to use a different type of B vitamin so basically there's does of blood tests that we'll do to try to give you a personalized plan and I understand that this is in a research study and I understand this is like still early days but this is not rocket science the goal of our work is to try to figure out what is the minimal amount of tests in the cheapest most accessible way could we do this all through fingerprick then people don't have to go get a blood draw comes in the mail you send it away in the mail you get marching orders yep you stick it into a computer and it pops out we are mission driven and we want to democratize access let's just get people the care they deserve create online resources videos are like easy to make a little graphic design a little whatever you mail in your thing you get the result back and you get a personalized plan the other thing that I always want to say is we also have to promise not to overpromise this is like super exciting stuff I love it and the results that our team has seen you know you could watch the CNN documentary like Simon's brain got bigger I have multiple people whose brains are getting bigger and their amalo and Tow is improved what is happening here all this stuff I was talking about is real but there's a lot of people that could do everything right and still get Alzheimer's disease and are different people with different genes and different risk factors you have figured out some subset of the pool yes and there'll be many others that need a more bespoke approach that's exactly it and all we need is a little more funding and a little more time okay this was great I'm so glad sanj turned us on to you good luck with all of this I hope to God you get massive funding and we figure out how to fix all this stuff up River personalized care let's do it all right be well appreciate it ni is the fact that I don't even care about facts I just want to get in your pants I was freezing last night in the in the oh yeah like Jethro had it at 67 uh not his money I was acting like he's at a hotel what a prick oh he's a nice guy he is he's lovely he might actually not have touched it they were there fixing do you know the do you remember when you would turn on the air in there it go th if the bathroom fan was also on make that clicking noise they finally fixed that and they were there monkeying with it and when I went in there last time I turned it off and it was on 66 I should have adjusted it but maybe he just turned it on and left it maybe he's not a prick maybe maybe also could still be a prick no he's not no we'd love Jeth roben the way the TV folds out mhm I laid my head where my feet would be normally to watch TV and so I wasn't under the blanket so I was just in my Underpants yeah and I started shivering and I was like oh my God I'm so jealous [ __ ] then before I knew it I I grabbed the thing put it on 72 and hid under the covers my my number one complain about our house even though I love it is the upstairs you really can't cool it down you can keep it from getting hot oh but you can't really you don't have an extra air conditioning up there no it's it's totally inadequate and then this maddens me so when the girls it's not cold enough in the room they and the temperature set at 72 right but it's 75 in there whatever so they put it down to like 60 sure sure sure and I try to explain would you do that too Monica um to lower it though it is going to register at a lower temp even if it's not 75 I mean if it's if it's 75 in there and they have it on 74 and it never gets to 74 it's working as hard as it can already to get there so if you put it on 60 it's still 75 is just like the lowest is going to be well it just the point is it's not variable it's on or it's off and so if you have it set to a lower temp than it is in the room it's on as hard as it can work right try to get it down and all that happens when you get frustrated and you put it at 62 in the middle of the night once it has cooled down enough and it then they wake up freezing and they got to wake up in the middle of night and adjust it up and I'm just always I I've many times tried to explain like it's on or it's off it's not going to blow colder air or get there quicker cuz you have it lower maybe you should get an ice block and a fan maybe and a big bucket to keep and a big bucket that capture the water melting that sounds good I did get given this crazy portable cooler from benack and I I haven't used it yet but I think somehow it's an air conditioner that you don't have to have an exhaust fan for have you seen these yes I want yeah I think maybe I should just put that in the girls room and blast it it's big industrial is it similar to a is so it is it a something you plug in or no yes you plug it in but I don't think it's a swamp cooler cuz that's another thing you can have right yeah like the Home Depot bucket with and waterers running through it yeah and you cut a hole in it oh wow I don't know all those steps you got to buy bucket with the thing you buy cut a hole Yeah a whole cutter and then then you got a size of little uh camping fan fit in there oh wow I don't know about this one so money why do you have a headache do you suppose did you under hydrate yesterday well we gave a lot of blood this morning oh it we started post blood giving yeah oh interesting so maybe it is that we did give a lot of blood is a ding ding ding cuz this is for Richard isacson so this is perfect oh I can't believe it timed out that way yes um we did a follow-up test today a lovely lady came and took a her name was Holly shout out she came and took a lot of our blood and then did more finger Pricks now we're going to get like full Real Results I'm very excited about yeah and I have to give blood every few months I do a blood panel because I'm on hormones and so I'm used to that but we gave she filled 11 vials I've never outside of when you donate blood to the Red Cross if I given that much blood I did have the thought I was like I'm technically when I'm at my regular weight which I am right now okay not anymore after losing that blood exactly two pounds of blood I'm not allowed to give blood normally yes and so I did have the thought when she was taking so much like huh I I don't think I'm actually allowed to do this give this much blood but I did and it was fine but I do have a headache and she told me Rob she she broke your confidentiality you got a little well right I got nauseous immediately after was like am I supposed to be am I supposed to pass woo no it was like I wanted to throw up it wasn't even woozy well that sounds the same wo woo a woozy pass out I guess and I think those both yeah lot of overlap but I gave blood a lot for uh egg retrieval but you had to go every other day and they took blood not 11 vials yeah what a vial couple vials couple vials yeah I normally don't have any problems I didn't really I just I have a headache but also could be that yesterday I made pork chops made a pork chops I made four pork chops wow oh wow and they were so good they were yes I think pork Chop's a hard thing to make at home it is I was scared they dry out easy right so I dry brine for over a day in the fridge tell me about a dry brine okay so it's a brine not a Bry and well it's also pork chops not Chop what did I say you said I made a pork chops yes okay well I you put a you put a ton of salt and pepper first you have to get really good pork chop okay and you get it at Mall's I get it at Mall's you went to the new location had it delivered they have a delivery service oh wonderful cuz they moved out of our neighborhood I know so they're you know the thick pork chops even harder to cook and then you put like you know you salt and pepper it very liberally and then Max who's a very good cook gave me the idea I said oh do I just like put it in the fridge on a plate and he said don't worry bacteria doesn't jump so that's fine but put it on a drying rack on a um baking sheet yeah so that it can have air flow oh and so I did that and it over 24 hours this is Alison Roman's recipe by the way and I had decided at the beginning of the summer when she first posted the video that I was going to make it during the summer it was a summer goal okay one of your summer goals yeah and Summer's fastly I don't want to talk about it but it's leaving it's leaving it's on its way out and so I had to do it and I I did it and it was so good you bake them no Skillet pan fry oh yeah seven minutes on one side five on the other it's very crisp and it was it was do you wrap it and let it sit for any moment not wrap rest yeah rested for a while okay and I had it in it had a caper thyme garlic sauce on top I made a palenta with corn paa and Parmesan and roast and then cabbage and you cook it in the pork fat W and a tomato a salad and did you eat all four by yourself Y no I didn't I had friends over okay wonderful and the reception I'm sure was it was very positive I was happy I was scared it was a big scary thing I did I applaud your bance no yeah and we watched Olympics and we ate it okay Olympics this will be a few days late but we got to talk about it obviously a lot of things happened big stuff happened heartbreak and Victory what's really funny is we've already you and I have chatted a little bit about it and we already had two different takeaways from both very big uh events well also we haven't even all Simone like we've missed a lot okay Simone yeah is just eviscerating the comp yes which is great she's won everything she's competed in she's so good I love her so much love her so much I learned a lot about her on the podcast I did blind Landing oh the one that you did right after the the all around competition I learned a lot she's extreme generous she has her own gym and she invites a lot of people to come train there a lot of international people to come train there competitors yeah and I wanted to talk to you about this okay I felt that the gymnast really proved my theory that the big brand commercial that we brought up before um that that message is incorrect I wanted to text you about it but I thought I'd wait and do this in I mean this will be a circular debate it did you watch you can't wish well for the person you're trying to beat or you're wishing that you don't win no this is a oxymoron or Paradox let me tell you about winning okay let me let me teach you something about winning okay great you want to beat someone at their best sure that's fine so you want them to do the very best they can and then and you want to do the best you can and you want to win win I mean that's the end this you know what this you know what this debate is identical to oh God Net versus or worldwide versus International versus domestic yeah no it's the debate I I endlessly am in and shouldn't be in anymore about selfishness you can act selflessly out of selfishness but you know I don't think an animal can do anything but be selfish and in their self selfish Pursuit they can be quite selfless so just you you believe that you can be motivated yeah um I want every I I when I and a lot of people do I I I recognize a lot of people think that well they're cheering for each other yeah they're being very supportive but they want to win and they don't want the other person to win that's that's all it's about for me is like they don't wish that the person win yeah that's not the argument the argument is that you have to be insanely Cutthroat you have to be no empathy you have to yeah and you don't you can want to win and not want somebody else to feel bad or lose or do their worst or I agree with you I don't think you have to want the person to feel bad or suffer but you have to want them to not win minimally that's it and I I think that's all the commercial says I don't you want me to play I can't play no we're going but people should go and yeah a lot of people agreed with you a lot of people don't like that commercial in the comments people agreed also not everyone me is talking about it so it obviously worked it got people to talk yeah although I have not seen that commercial since I said it oh you think they really they pull it well it's also interesting because they have shikari on so many of those and it says winning and she didn't win and I'm like what happens then they they film those commercials pull it it's like when get it out of there get it out I don't want everyone see it again pull it did you have that thought too yeah well I had the thought of God this [ __ ] the pressure again it's like you're on all these commercials and and then you have to deliver well it's a also the result is the difference in tens of millions of dollars it's like the rest of your life she better still get that money listen I love her so much so we had different reactions to Shakari getting silver I was like completely devastated and Crest fallen and heartbroken yeah and I wanted to appeal and start a campaign well ding ding ding we'll Circle back to that okay because there was a bunch of weirdness that happened before her race we found this out after but didn't it happen to the only thing that gives so you did tell me that and that's really interesting you should tell everyone about that but also the same woman did beat her in the semis so that's at least comforting it's not like she blew that woman away and then she was in this weird bus situation and then lost that would that would be unacceptable like that would be really hard but some but you don't know what's going to happen on any individual race and if you just lost an hour H Noahs he lost he did not win either the quarters of the semis and he won the final yeah okay so your reaction was like you were really happy for she got so I was like I I was sad for her but I was also happy for the person who won oh sure I was like oh man that sucks and also because I felt that the pressure was insane on her her and that didn't feel fair but I was happy for this woman who won that's that Aon yeah St Lua St 300,000 two or 300,000 whatever Aon said a few hundred, people to draw from and they have the fastest woman on the planet I love that see that's happy and I was also happy that Shakari she was such a good sport like she she looked happy yep she did she was upset but she also I think was like yeah [ __ ] yeah I got a silver medal in the Olympics like that's damn good it's it's not she's the second fastest human on the planet do we know if she was faster uh three years ago or now I don't know what her age is doing or she's gotten faster or slower but what would be heartbreaking is if that she could have got gold in Tokyo but I think she's gotten faster I think she's become more she won nationals last year worlds worlds is that what it's called oh yeah Nationals that would be domestic not International international box office okay then Noah ly was like the ly's as I said pork chop is now the opposite scenario which is like he was finishing second second and I was like oh no I'm losing face Shakari I was like oh yeah she's gonna do it no I was like what's going on uh although low expectations 200's his event exactly yeah and even it was spoiled for me that he won before I could see it so sorry that happened and there was a there's a weird bullshitty thing with the programming like all the stuff's available for me once it airs it records but for some reason the final was you couldn't view it until the 7:00 reiring and then not until 11: even though you recorded it exactly it didn't record I'm recording every Olympic event and that one was unavailable they did this with a Formula 1 race one time I've got a phone to pick yeah I think something happens where it bumps up against local programing I don't know what happened oh my god well I saw oh how exciting was that cuz it it did not look like he won I know even when I saw the replay knowing he won my first reaction was oh the Jamaican must have disqualified him himself and come out of the blocks early like that Jamaican won how's now he going to win but boy by by oh God by oh boy boy oh boy they show that Freeze Frame and he was he's at 4 Ines ahead 4 Ines not 4 inches like like 1 cmet 1 cim ahead 1 cim ahead [ __ ] he really wanted it was crazy it was really it was that was really heartwarming I okay then I felt really bad for that silver see you were happy when Shakari lost for the yeah very you're very Underdog I get it I want my friends to be happy and I want underdogs to be happy yeah I want everyone to be happy see you this is why the commercial doesn't work for you you wanted everyone to win it's like our guy we've been rooting for won and you feel bad and that's great there are there's a group of folks listen listen okay I'll cut this I love bread okay I don't love Noah I like him I like him but he's you don't like he's on the verge for me of being too cocky and I I can buy it to a certain extent but sometimes it's it's too much so you know there's a little bit of leave that in there a lot of people are wrestling with that I don't want to say anything disparaging cuz I do really like him he's a nice [ __ ] boy like forget like all the whatever bragging he's doing he's with his whole family he's got no group of like buddy he's with his mom and dad all the time he's a sweet sweet boy also on the dock he's encouraging other people to be cocky which I like right like that's what made me like him it's like he's he told the English guy he's like he's like don't be so modest oh yeah you're going to [ __ ] break that what are you talking about so I like him a lot for that wasn't you say bolt telling him to be cocky too oh that the uh sport needs it well that's the whole thing oh that's interesting I think it also it's it it depends what you loved Growing Up So Muhammad Ali is the number one bragard he started this whole thing this genre of athlete that's exuding confidence in bradia and trying to intimidate his opponents through this mental battle so while it was happening people hated that about Muhammad Ali right but then he becomes a legend and he occupies such a place in history and obviously he's such a an incredible role model yes historically and he stood up for the right stuff and he you know all this stuff now you watch it you find it quite charming and you also go like yeah it was very effective and because that's the example I grew loving I look at Noah ly with an S and I go um yeah man he's fallen right in the footsteps of Muhammad and it's actually so brave cuz man if you don't do it the [ __ ] embarrassment of having bragged so like I I couldn't be that way because I don't believe in myself all that much but the risk that he's taking on by by doing this and trying to transcend the sport make it bigger than just running all that stuff you know I'm I'm for it I'm for it too but I just personally I like quiet luxury sure I like a quiet not a purple Lamborghini with a Gucci I don't I just like I like you to be quiet and win talk with your actions exactly okay but it makes it so much more fun it's fun I I love he's great also the one interview afterwards I love so much is he's like I'm GNA be honest with you I didn't think I got it I said to the Jamaican I think you got this one he goes then I saw that that photo and I said my Lord I'm incredible I thought that was the greatest 180 he's like my Lord I'm incredible but he had the cutest little wink like he's letting you know he knows it's yeah people no it's great I got look it's great I love it I love it and then I didn't feel that bad for the Jamaica that was his very first Olympics that margin the five millionth of a second or whatever it was 10 millionth of a minute I can not I would die that's hard to hard hard process SW but even look at um Freddy I love Fred Fred's only point two or he's like 02 I know it's all so close I said it last time but I got to say it again what's insane is that these guys in Formula 1 are getting the same time down to the 1,000 sometime that's like when you see it in a 10-c race and it happens it's mind-blowing but then you think about a minute and 12 second lap I know that one for me is less because it's a machine and it's not a body but there's so many variables it's like a different manufacturer a different driver a different all this stuff and somehow they get this those are the same margins in Formula 1 yeah speaking of cocky athletes yeah um I rewatched air this weekend you did I love that movie who's cocky in that Jordan oh he's not very cocky uh yeah I like it on him yeah that's the thing a little we are all full of contradictions but he's the number one hate your opponent guy he he is the embodiment of that commercial he had to find something he hated about each team he played and he wanted to but he actually wanted ill will to fall upon them you know he went even a step further than I'm comfy with yeah but he um he's handsome didn't the p kind of make him that way when he came out of the I think he was that way at North Car yeah if you watch Last Dance I think he had some weird rivalry he gave himself they're all fake but he also has chips on it he has a lot of chips on his shoulder yeah and chips in his bank account hell yeah oh yeah and at the end of that movie they oh god the numbers at the end of that movie are [ __ ] mindblowing yes why what's it say he makes $400 million in passive income a year on the shoes a year a year w so he's made like5 billion as he should yeah don't get me started I love it and I that's I watched that speech a few times two speeches I watched this Matt spee well okay are we going to talk about it we going to talk about the elephant in the room oh I know about this there's a reason I did a little Marathon I watched air and then I watched Goodwill Hunting oh you were in a real I was in a mood this is post pork chops taking him back oh wow now this is Friday no wonder you have a headache oh this is Friday no yeah this is Friday all sat Saturday night okay um I was going to go to sleep till Goodwill Hunting but then I kept watching wow you know I applaud you thank you um it was weird cuz it's been a minute since I've watched it okay other than watching it in my head you know and they're so young in that movie probably way younger than I think they are yeah they're like probably 24 well sure I was Bri and I went on one of our first dates and I was 20 and she was 19 or 21 and 20 yeah I think I think they won the Oscar when when Matt was like 25 oh wow so they must have shot it when they were 24 or three or something I want to rewatch oh God is it a good movie but also it was weird because now you're feel weird to young for me to be horny for allow yourself I do but I really had to jump some mental hurdles I was like oh my God they look so boyish right I mean and for my whole life they were always old old and hot and now they're young and hot and that sun comes don't fight that you know there's no ethical issue there first of all they're 20 you could [ __ ] a 24- year-old be fine I did think about that I was like you know legally this is fine anyway yeah yeah yeah who' I just find out daating someone like wait oh yeah we have a friend I just found out is oh she's our age and she's dating like 20 yeah 24 maybe good job and I was like good work man [ __ ] yeah it's about time well I the script ladies I have heard from Liz um that that um male sex drive goes down as they age and women's goes up until menopause and so there is a period of time where it actually makes sense for an older woman to be with a young guy it always makes sense yeah I mean I I'm cuz I'm not a young guy anymore but me too yeah do you think your sex drive has gone down oh God yes see yes I think I think she's right about that oh anyway um okay so the reason I watched air okay oh yeah the speech he made such a good speech I watched and then wait what speech did you watch his Oscar speech no no no no in air oh oh Matt makes an impassion speech yes yeah yeah yeah well listen he's I mean I don't I'm I'm reticent to declare someone the best actor but what I'll say is there's nobody better than Matt Damon he's so [ __ ] good and for all the reasons when we interviewed him I said to him he's not flashy it's so natural he's so not an attention seek just like so [ __ ] consistent and the variety of characters he's played are when you contrast them against each other they it is a flashy career he's as good as it gets he's as good as it gets he's so good at that movie anyway he makes a great speech but then Viola Davis makes an even better speech yeah an even better speech okay on the phone about value and worth and it's so good so I love that movie I had to be in my Bonnet yeah to get some mat back in my life for me to reclaim him as mine as he is yes of course because you have sto you have done your you've done the worst thing imaginable got's referring to my muscles I told him the story and I I explain like the only thing I can explain why Matt's interested in me is that my muscles that's what I've concluded I think that's why he was willing to like start chatting you you you hung out with him this Summer a little bit and and we're falling in love what do you I'm trying to I people need to know why you're mad is it worth losing me as a friend to gain him as one are you going to make it that I'm just wondering what you're willing to what you're willing to lose I'm I'm kidding obviously and I have to say I'm kidding no I have to make it clear that I'm kidding cuz one of the mean comments is like why does Monica care who Dax his friend with I was like go [ __ ] yourself you have no idea who we're talking about um but anyway I was walking down the street leaving dead pool as I discussed great film great film and I happen to walk right over his star yes so I was like what a prime opportunity I'm always looking for an excuse to contact him so I took a picture of myself in front of his star and I wrote in all caps rock hard yeah and then he wrote something back very lovely I will not I will not dishonor it by saying what he said but he sent a very beautiful text back which put a real spring in my stuff and I was coming directly from there to meet you at Reefer Madness yeah so it had just happened yeah and again we were back to the thing there's no way I can keep that from you it would have felt weirdly unethical to keep that from you I appreciate that and I showed you and you left your body your skeleton left your body and marched around the room it and then it did take flight and then you reentered your body the text was so beautiful and kind and like loving the everything I would could ever dream of to hear from him I get it Del you that's a that's whoa I mean look by the way I agree with him do you some days I agree with what he said obviously some days um I know the the the perfect comp is like you and pit I said I am going to become best friends with him I have I have fully declared that yep and then you got to show me the text I'll show you I'll show you like one or two and you'll see that there have been others but you don't get to see those okay all right okay just prepare yourself now for how that I hope both those men are flattered by this and don't feel exploited by this let me just say that I hope so too it's only flattering yeah if I lose this new friendship because I put put it up this is like who was it someone was dating hi Berry there's an Infamous story and then they were on stage and she had called and he answered on stage and then there was a bit of showing off and then they broke up and I guess this is identical to that although you brought it up does that make me get me out does that get me out of jail well I hope I hope you're not in jail because he's just a great person he is I'm learning that yeah you were you were on to the right path I guess that's really what this all circles back to is you have an eye for talent I do my instincts are just always correct and I wish you would remember that he's impossibly sweet yeah yeah yeah yeah how does this make you feel Aaron oh yeah you're you this is great what an opportunity I was I was very excited for Dex and um and immediately said oh uh oh for me for yeah for you yeah uhoh uhoh no I'm happy I want I want more love in this world the more people who love I thought you were asking a threaten that is what I was asking oh God no I didn't even know that's what you're asking don't be crazy oh that's right well that's the right answer there's nothing to be threatened by no it is very truthful I believe Hi man hi Maddie my number is 313 300 and my name what if I gave you his number then you went onto the Hollywood Boulevard shot a picture of yourself just cold text in that photo got your number from Dax I'm his original best friend thought we should meet mama I did think when I was watching the movies I think it's great and I think it's very very sweet what he said but and and there there is there's a one be I am being honest I I just got to ask one question okay did any party by be honest any party's no no no no no I mean always any he's involved no no did you go and just wait till you get to know him better any hint of a voice say that no okay I mean I didn't think he doesn't know him that well it's early it's early to be saying stuff like this you're Adent I'm kidding I did not I did not think that um I did think there's a small percentage very small like 3% that feels uncomfortable I have a guess at a potential thing okay which is I think you might be feeling some weird tension of your fantasy world and your real world overlapping and intersecting yes that's it's like he he's another he represents something else for me and he lives on another planet almost does it demystify him a bit that he he's friends it's not that it demystifies him but he's falling off a Mount Olympus if you me no there's something like when he when he came here that moment is an indicator that dreams can come true like that's a weird thing to say but that is it's like oh my God I used to sit in my bedroom and dream of an interaction like this yeah it's just like life is long but things kind of come full circle and that's a beauti like life is magical that's sort of like for me what what he and my interactions with him represent yeah so yeah when you're like hanging out with him and you're my best friend it's like wait this is [ __ ] up my thing and it's very compartmentalized he's the Ben and Matt are the only people left really yes yes that remain special to me yeah yeah everyone else is real like they're just humans and humans can be difficult and tricky but those two like have remained I've kept them in a very precious little box in my head and you are like prying open that box yes I understand your little grubby hand greedy hand grease there's grease on my fried chicken grease my [Laughter] porcelain so anyway I just I just want to be honest about that but that's only 3% no I understand 97% is H very happy yeah it's interesting yeah um blood um well just I just wanted to say that Aaron and I tried moo barbecue oh yeah move have you been now yeah that's good it's not as far I thought it was downtown but it's not it's Lincoln Heights or something which kind it delivered oh you did I think oh I've tried it maybe I didn't check the right nice experience you it it's really cool in person yeah I felt like we were in Texas yeah like when we went to schmidy's yes exact that's the one yeah yeah y you walk up to that counter you're not huge into barbecue are you Monica I like it you should go yeah it's outrageous um we had a brontosaurus rib that was as big as a picnic table it was ridiculous it had it had a full brisket on it like we had ordered brisket a and then there was brisket attached to a bone oh and we got the burger and we got the and we got a sausage saus Co potatoes yeah sounds yummy did you see the French pole vter okay I've only God guys I've only I've gotten I've seen in the comments that I miss it and it's filling me with panic you guys saw it no you just watch for 5 seconds yeah oh yeah a clip fastic what happens his dick gets stuck on dick balls get stuck on the he's over and then his penis just knocks it off I did see it show it me I guess I assumed that was I was like is that from this Olympics cuz I would okay yes wonderful it's fantastic because it gets completely stuck and his body keeps going down and then it it slingshots out it's a nice package yeah great dring balls you have been waiting and you got a really good one yes and um soon as track and field started I was like here we go who's the dicks they're out and about yep um oh this is great cuz Aaron's here can we ask him so we I we were talking about how much I like the penises in the Olympics and then I said I'm a 10 that I like looking at penises yes and then I asked Rob what he was and he thought he was a six and what are you at looking at penises yeah like them bouncing in the outfits and anytime you can see them being amused by it it's more it's more than looking at them sure sure sure Obsession I'm um year by year I like them more okay so I like them a lot right now okay great like I watched that video 50 times this morning and um there you go oh it's so wrapped around like I'm like the balls and the I was trying to see where the balls met the dick and the what was happening and then I was picturing mine and if it was like a you know some nights it's real Acorn up and small and sometimes it's really warm like it is in France it might look like that oh oh yeah so you were looking at more of like a CL climat I'm always thinking of a climate control cuz I always have to make an excuse before anything happens did I tell you that was my idea I wanted to do a contest um where it's a small penis cont like you have to go on the cold plunge for 3 minutes naked and then get out and then we measure everything that would be great and then like 10 men compete I would love that contest I would I would run away with the gold on the small penis yeah presumably some men's penises would dis entirely yeah like just go inside the body yeah bye y okay so but you're are you willing to quantify it with a number um eight eight great room to grow good pun intended there you go well yeah I don't think I ever could be you you've been a 10 for a long time from the jump right yeah yeah yeah yeah yeah yeah you were you were you came out with it before anyone was willing to look at a penis thank you a trail laser yeah you were he were so I think what he's saying is he agrees with me that you over index sure and you always have yeah I was more making I I was assuming men like it well let me ask you this when you're watching righteous gemstones and there's that great scene and it's like um our lead character is making a speech and behind him's playing on a big movie screen this guy's penis walking around his head and the whole speech is just penis moving back and forth like that's as funny as it gets for me but everyone laughed at that wasn't G that was just funny like that's like a funny clever thing to to do in a in a show yeah I just love it's my favorite kind of joke isz when you get one of those penises look ridiculous I mean a lot of people have been catching on over the years the um the small uh small penis oh in The Patriot patri oh hello hi hi oh you're oh my God oh my Lord honey it's beautiful wow it's a work of art oh my gosh it's really good linky say what I had blue eyes on him oh as you should did your dad have blue eyes he did not he absolutely did but a are empty socket so I had to fill them in oh I love it honey tell people what happened oh um Lincoln has drawn done a painting of a can of Ted Seager yeah it looks good it's really good it's really really good you want us to keep it up here very good artist maybe this will go in the new filming space we could put it here for now on top of the thing oh yeah put it lean it under the T oh I love it I love it lean it under yeah yeah yeah like lean it against the T we can put this yeah it it stay good job linky cute thank you really good I love you bye bye buddy bye bye okay bye that's a Delta's nailed that by she always by that way um wait penises vagina but back to some facts okay great because I do have some cuz Alzheimer's episode it's important so we should give it some whatever the opposite of levity is some gravity some gravity okay the calcium test mhm so there's two kateed ultrasound for neck arteries yeah I've done that okay and then there's a CT angiogram it's called a CTA it's a medical imaging test that uses a CT scan and a contrast die to create detailed pictures of blood vessels and tissues in the body um and you said you had that right yeah and they tell you before they inject you with the contrast that it's going to feel like you peed your pants which I was so excited about of course would that wouldn't you look forward to that feeling yeah did it not as much as I wanted to I made my whole chest cold in a fun way yeah but I did want to feel like I had wet myself like a baby and I'd say oopsies Gaga I did a boo boo okay so most ctas take about 15 minutes but the actual scanning only taking a few minutes uh patients typically don't need to be admitted to the hospital for a CTA I was not admitted in and out okay great there's also a coronary artery calcium score that's C that's a non-invasive imaging test that can help detect early signs of heart disease mine with the contrast gave me a calcium score they would tell you what percentage Cal yeah it's just more intense yeah okay prevalence versus incidence prevalence the proportion of a population that has a specific characteristic at a given time regardless of when they developed it prevalence is usually expressed as a percentage of the population for example in a one-year study of diabetes prevalence would include anyone who had diabetes during that year whether they had it at the beginning or developed it later prevalence can be a useful tool for planning Health Services incidents the number of new cases of a characteristic that develop in a population during a specific time period incidents can also be a measure of the risk of getting a disease during a given period for example in a one-year study of diabetes incidents would only include people who who developed diabetes during that year incidents is often reported for infectious diseases and researchers may study it to help identify causes and prevent future cases even with that explanation yeah it's not the most obvious difference well new cases versus all cases yeah um I guess it is e makes sense youas it that way it's saying is the is it increasing is the incident increasing all right well I thought maybe we would look into to the 23 and me and see if we could find our APO through remember he says we it was on it but I can't find that that's from years ago I know I cared a lot when he said it and I was like I'm going to do that and then I just never thought about it again not do it for me I think like if you're already doing everything that's prescribed for it what's the point of knowing like it'd be one thing if you like I don't want to make these life changes so I'm only going to do it if I find out I'm an increased risk but if I'm already doing all the stuff what doesn't really matter I need to know right yes cuz you could do much more heavyweight training I know you're not looking forward to that no who got the time what part of it just the thought of the exertion no cuz I like cardio right I just it is time it is that it's like I add that in like who there's no time just no time only time for ring Paleolithic I know you don't like this you don't like this and I know and you already said it in here that it's [ __ ] and people did leave live to be very old yeah um but well what I yeah it includes infant mortality yeah but life expectancy in the Paleolithic stage was 33 but again because of an infant mortality rate at like 60% although it says 75% of deaths were caused by infection including diarrheal diseases Hest uh that resulted in dehydration and starvation thanks for putting it into our yeah I I didn't think you'd know what that meant um so yeah I'm I'm I know what you mean you do yeah and if you look up Italy 1600s life expectancy it's probably in the 40s and yet we had Galileo at 8 like we know all these people documented that lived into their 80s and 90s from the these eras not Paleolithic but there's if you believe youve all Harari we were actually much healthier in the Paleolithic Era because we weren't keeping animals so we weren't getting all the animal transference pathogens which we most of our diseases have come from living with animals tell me about it how are your dogs I love them I know obessed loes them like crazy you should have met they had a little tiny guy here last week they had an a just stopped in for a week yeah they F you guys fostered a little puppy yeah and he was really cute he was outrageous like he just bounced around the backyard he hopped like a bunny his name was Cowboy not the most suited name he was also the run to the litter which is weird to name the Run Cowboy he was really cute though you would have liked him cuz he he was little doodh mhm yeah he might who knows got a good snuggle with him yeah you could I've told you why every time Aaron's walking his dogs people are yelling out the window what kind of doodle is that yeah yeah people love a doodle oh man they love a [Applause] d hey man what kind of doodle you got look at this D that's it we'll tell everyone our results oh yes from this our blood results I don't even know results are in the car I'm not even sure what we're going to learn but I guess we'll learn hopefully a lot from 11 V I know right I want know the exact day I'm going to die what they're like you're going to die at 9:30 on March 209th 2065 no 2090 yeah it's nice that' be 115 that's a good that's a that's a great age to die good year um all right well I love you well eron will still be around for Monday's fact check okay but we are going to invite people to um go meet Aaron at the avit show in Detroit oh oh yeah the details get your Deeds but Aaron's going to be at the AIT show with the Ted seager's tasting station party talk about a marriage of things we love yeah I like that all right how's your headache feel do you get any better during this yeah my Advil kicked in okay wonderful I mean my pain Rel are kicked in yeah I don't want to all right okay love you bye love you [Music]