And he serves as an adjunct professor at George Washington University. Welcome, Majid. It's good to see you again.

Thanks very much for having me on your show, Mark. It's so nice to see you. Yeah,

well, you know, we first met when you came to Cleveland Clinic to do a presentation at one of our innovation summits. And we talked about the sort of revolution in brain science that's happening right now. And I think most people have kind of heard about how we can help our brains, but don't really have a clear understanding. We know for our heart, for example, we need to eat healthy and to exercise and to make sure we don't smoke and don't have high blood pressure and control our blood sugar and diabetes. But most of us have really never thought about how do we optimize our brain function? And it's the most important part of our anatomy. I mean, obviously, you talk to any specialist, they think their organs is the best part. But the truth is that the brain without that, we're not us. And as it declines, and as we have various insults to it from our modern world and stress and toxins and our diet and so many other things, our brains tend to not function as well. And many people walk around with brain fog, with trouble concentrating, with paying attention, and even with significant memory loss. So you really pioneered a whole approach to rethinking how we take care of our brains. And I'd love you to sort of share as a neuroscientist, you know, how you first came upon this. Because, you know, typically as doctors, we're trained to essentially just, you know, treat and street, right? We basically, we have a terrible, a terrible thing we say, what we say, we treat them and street them, basically give them the medication or the treatment and not really figure out how to get people healthy, but just treat the disease. Or in neurology, the other thing we often say is we diagnose and adios, right? We diagnose someone, okay, Parkinson's, you have dementia, you have ADD, you have this, and we basically say goodbye because there's nothing much we can do about fixing the brain. But the truth is there's a lot we know. And I created a broken brain documentary a number of years ago that many of you can watch online. It's part of our Dr. Hyman Plus community. And I think there's other ways to access it as well. But it's really a map of a different way of thinking about the brain and how we can optimize our brain function. So let's kind of jump right in. One of the things we're seeing is this rapid explosion in dementia in America and globally. I think six or six million or so are living with Alzheimer's now. It's projected up to 14 million in a decade or two. And the cost is, you know, half a trillion dollars a year to America. This is a massive cost because of the cost of taking care of these patients. It's the number one costly disease. And yet there are no real therapies for this or no real therapies that conventional doctors actually will recommend other than drugs which don't really work. There's been, you know, $2 billion plus spent over 400 studies and not a single drug really has any real impact. Maybe they mitigate things a little bit. Maybe they delay your admission to a nursing home for a couple of months. That's a successful study. So I think we really need to rethink this whole approach. So what are the top things that people can do today to prevent cognitive decline and to optimize their brain function? What would be your highlights? And then we're going to kind of dive into all of it.

I think it will help for me to explain how I got to where I am now.

Yeah. I've

been able to help a lot of people with brain fog or brain dysfunction, memory loss, attention. And we have seen remarkable results in a program that I've developed and is actually available on my website. But let me tell you how, you know, ask me how I got to this point. You know, when I was in Harvard Medical School, I became really interested in brain and what happens to our brain with aging. And when I went to do my residency in neurology at Johns Hopkins, as a part-time job, I work in the Alzheimer's Disease Research Center. My job was to just see these patients who come every year and for us to monitor their progress. It's one-to study looking at people for 30, 40 years. It would come every year. We did questionnaires, testing, MRIs, and so forth. And I was curious that many of them who came with the diagnosis of Alzheimer's disease had diabetes, hypertension, sleep apnea. the things I knew would cause memory loss. And I was wondering, well, why do we call these people as having Alzheimer's disease? They don't have Alzheimer's disease. They have vascular cognitive impairment. So I dig in to see, like, you know, where do people talk about these things? And back then, you know, it was 1997, 1999. There wasn't much. And I was surprised. So, well, this is so obvious. There were some articles about how we are overdiagnosing Alzheimer's. And then I wrote a book about this. It's called The Memory Cure. And in it, I explained that a lot of things we call Alzheimer's is not really a single disease. It's a suite of different things happening over time. Your blood vessels shrink and become hardened. You know, the main issue is to be called hardening the arteries. And I remember from my medical school days when I actually helped brains of people who died and those who have vascular risk factors, have very crunchy arteries. You can actually know. Yeah, yeah, Yeah, it's such a vision. I never forget that I would hold the blood vessels and they were hard, like little pipes. As a healthy person's blood vessels are more malleable. They can move them around. And that book actually did very well, considering that I was just a resident and fellow. You know, I was very happy. And I continued to work at Alzheimer's Research Center. And I was an assistant professor of neurology at Johns Hopkins at a silent hospital i opened a center for memory and brain health you know back in 2002 2004 the idea that you could do things to improve your brain health was still quite new yeah it was quite obvious and i was like you know i can see sometimes you're frustrated about the fact that people don't know how important food is. And if we take care of people's diet, we can have such a huge impact on our country's healthcare and economy. And it's frustrating. Like, come on, guys, this is so obvious, you know? So I did that. I wrote several articles. I published an article, Nature Reviews Neurology, about how we have changing perspective about Alzheimer's. It's not just plaques and tangles. There's a lot more to it. And, you know, I wrote. And then meanwhile, I was following the literature and some recent studies at the time, 2005, showed that you can actually grow

your brain.

Yeah. You exercise, you grow your brain, you increase neurogenesis. I was just amazed. You

get new brain cells. New brain

cells. Yeah. Then I read that meditation can grow your brain. And I thought, really? Just sitting there, breathing slowly, meditating for like 15, 20 minutes for six months, you have anatomical changes in the brain? Is one thing for you to feel better? Is one thing to change the level of neurotransmitters in the brain? Is another thing to grow the brain to the extent you can see an MRI? It's not microscopic, it's macroscopic. And then I was just blown away by the fact that an otherwise healthy person, we don't have to work with a diseased person, an otherwise healthy person can grow his or her brain. And the hippocampus, which is the memory center of the brain, is the part that grows the most. You know, hippocampus is the size of your thumb. You have one on the right, one on the left, and this part of the brain is ground zero for learning and memory. And this part of the brain shrinks by about 25% per year after age 50, on average. But there are things you can do to grow it by a lot. And as I will explain to you in a minute, we did it for our 12-week program. On average, people grew their hippocampus by 3%, which is equivalent to six years younger in brain age within three months. Wow. So then I wrote another paper, and I published in Nature Reviews Neurology, which, as you know, is a very prestigious journal. And one thing I remember from back then, I think it was 2009, when I read that paper, I sent it for reviews. And when you send paper for reviews, usually one likes it, one doesn't like it, and one is in the middle. When I sent that review article, I got three very positive feedbacks. These people said, yeah, he's right. This is right. And yet nobody else was talking about these things. And to me, it was surprising that my neurology colleagues are too busy doing the same old things, do DMT, MRI, spread prescription, go, where we need to hit the pause button and say, wait a minute. What we call Alzheimer's is really not Alzheimer's. It's the soup of problems. A

soup of problems. I really like that. It's a soup of problems. And I think I just want to say something really important here. In traditional medicine, the diagnosis is king. You know, once you get these criteria for a bunch of symptoms, we say, oh, we know what's wrong with you. You have got Alzheimer's. But the truth is Alzheimer's is the name of people, of the thing that happens to people have certain symptoms, right have memory loss so it's not actually the cause uh alzheimer's doesn't cause your memory loss something is going on in your brain and so there's many many causes and many different people will have different causes for their dementia yeah

it's interesting that dr alzheimer's himself alloyed alzheimer's in 1903 wrote a paper that talked about aging and dementia in people is because of multiple factors. He never said, I've discovered a disease. He just said, hey, I saw these few cases. You have these unusual abnormalities. I don't know what they are. But the chairman of his department at the time wanted to make his department look better. It was Berlin versus Prague back then, and he called it an Alzheimer's disease. So he himself, he himself, I have a quotations that says that the convolution of the brain is because of multiple reasons. But anyway, you know, as I went along, I decided to start my own brain center and provide all the things that I know grow the brain for our patients and teach them, educate them about all the things they're not supposed to do. Because if you can stop the things that shrink your brain and do more things that grow your brain, then you're good. understand why things are the way they are you will continue that lifestyle for the rest of your life which means you change your trajectory from getting demented at 75 or 79 or 82 to no 95 because a lot of 105 exactly 105 things that you do actually affect telomeres the same things that are good for the brain are also good for epigenetics and genes as you know so then i started this program uh and i published a paper 2006 you know when i came to cleveland uh clinic at the time i had finished the paper and it got published 2006 in the journal prevention of alzheimer disease where we provide this 12-week program which had three elements. It was an element of lifestyle modification, all the things you tell people to do, and had an element of brain training. And we provided targeted brain training for people. So if someone had memory loss, we provided them with memory training. If they were slow to think, we challenged their processing speed with games, all fun games. And we provided biofeedback, a form of biofeedback called neurofeedback and other forms like HRV biofeedback. And we saw that people who came to our clinic twice a week for 90 minutes at a time over a period of 12 weeks had improved their memory. You know, a lot of the drugs you talk about, these are people who are like 60s and 70s and some 80s. Most interventions that are done for these drug trials look at the rate of slowing, change and rate of decline. Not that people get better, it's that they help a certain percentage of patients get worse slower. They don't actually help patients get better from zero. Instead of going minus eight, they go to minus five, but nobody goes plus two. In our program, 84% of patients had MCI, malcognitive impairment, which is a stage between normal and anal cell emergencies, got better. They had objective improvements in the cognitive tests. So I was really encouraged with that. And then I thought…

And by the way, just to stop you there for a minute. Yeah. Okay. There's really no drug that has ever shown reversal or improvement in the treatment of dementia. There is no drug. There has been a trial called the FINGER trial, which is a large clinical intervention that looked at aggressive lifestyle intervention, optimizing person's health with diet, exercise, sleep, etc., aggressively treating all the risk factors, blood sugar, blood pressure. And they saw not only a slowing, not only a stopping, but actually a reversal of cognitive decline in these patients who already had early memory loss. So this is really important for people to understand, that you can go to the doctor, but they're not going to be able to give you anything that's going to address your memory. You have to do the things that Majid

is talking about, which is essentially addressing brain fitness. Absolutely. And the person who runs that program, Mia Kibipalto, is a friend of mine. We've been talking about how people got things wrong since late 1980s when we were at the Alzheimer's Conference. And we see each other every year at the Alzheimer's Conference and I'm so proud of her for, you know, putting this large program in this program this finger trial is done in Denmark and Sweden where people already have a good lifestyle. You know, they were not in a place where obesity is everywhere and people have poor diet. These people, on average, eat well and exercise and are healthy on average person. So to provide a program to make them better and see results is really remarkable. If you do that program in a small town where people are obese and sleep apnea is common and smoking is common, drinking is common, you would see much, much more robust results. And my program is very similar to hers, except that the difference between my study and her study is that we provided this in a real-life clinical setting. This is not a clinical trial in an academic center where people come to the center for the purpose of clinical trial. This is a real-life neurology practice where an average person shows up and we provide this treatment for them. And the only exclusion criteria was that at the time they start, they wouldn't have schizophrenia or dementia when they start. They could have MCI, they could have got memory loss they could have everything else but they didn't have a major psychiatric disorder and i saw a few people just because of neurology practice people show up so the other thing we did which was really fascinating to me i mean i knew that my program would work, but we did MRIs, and half of our patients had a growth in the volume of their hippocampus as I had expected. I knew it would happen, but the fact that it actually happened, for real, I remember the day I saw the MRI, I was just jumping up and down. I said, oh my God, we did this. And one

of our patients- Hold on for a second, Majid. So just for people listening, what he just said was, was nothing short of revolutionary. The hippocampus is the part of the brain that's the memory center. It shrinks often as we age and it's very shrunken in people with memory loss. We've never seen anything that actually makes it bigger or grow. And now this is what dr uh is talking about which is this incredible science that allows us to intervene with people and actually help them not only slow and prevent the disease but actually potentially even reverse all sorts of brain and mark if we had

if this if a drug had done this it would be bigger than vaccines for COVID. If a drug had done half of this, a third of it, a tenth of it, if a drug had done a tenth of what we did, which is just improve people's cognitive performances on objective testings. You know, just that. Never mind that actually grows the brain. And by the way, all the drugs that are current drugs for Alzheimer's disease all shrink the brain. And this is something that people need to figure out what happens. Anyway, so back it was 2007, 2008. I was so excited. I was providing this program. But since I had a neurology practice, I would also get patients who had concussion or other things. And some people have persistent concussion symptoms, called post-concussive syndrome. And these are people who have had headaches or memory problems. They can't work. They can't think. They have irritability for months to years. And they've seen multiple doctors and nothing has worked. So I had some of those patients and I put them in the program and I saw that our program worked for them as well. And the reason I think the program was so successful is that we had a multidisciplinary intervention. We didn't just say, here's a prescription for your memory or your headache or your sleep. I actually took the time to do an inventory of all their problems, and then we addressed them. We addressed their memory, I mean, their sleep, their anxiety, their irritability with non-medication interventions. Things like meditation, counseling, exercise, diet, stress reduction. And we saw, again, about 80% of patients improved. is standardized neurocognitive evaluation. And we did a series of four or five questionnaires. We did like a Pittsburgh insomnia assessment. We did Upforth for sleep apnea. We did Beck anxiety. We did Beck depression, the scales. And we did my own questionnaires for brain fitness and multiple questions. And these are

standardized, legitimate, peer-reviewed, validated metrics for looking at mood, brain function, and so forth. So it's not like, hey, I think my memory was better. It's literally how

we measure success in science. We used validated, standardized tests, and I felt that I needed to do my own. So I made three questionnaires. And one of the things that we found is that the questionnaires I developed for brain fitness paralleled with the results we saw in the standardized. And so this study also validated my questionnaires because we saw results in our own patient population. So it was exciting. We published that in Journal of Rehabilitation in 2020. And again, being a neurologist, I saw patients would come for attention problems. I had many patients with ADHD, whether they were teenagers, kids, or adults, or people in their 40s, 50s. The one thing I learned, and you referred to this earlier, is that we put a label on people. We say you have ADHD, but it's not like cancer where you look at the mutation and you say you have colon cancer because of this. These diagnoses are based on a group of experts sitting together, making a list of criteria, and then calling it this and that. There's nothing absolute about ADHD. It's just a group of experts coming together and deciding this 5 out of nine here, five out of nine here, and you put a label on people. A lot of times people who have attention deficit disorder in my practice had poorly treated or untreated sleep apnea. Yes, they had attention problems, and they did say yes to all the questions, but the real problem was sleep apnea.

Yeah, I think this is such an important point, because, you know, you know, people don't understand how screwed up medicine is. And most of the diagnosis we have are really just description of symptoms and don't tell you cause. So when you say I have depression, or I have ADHD, or I have Alzheimer's or dementia, it's like saying about a headache, you know, why do you have a headache? Did someone hit you in the head with a hammer? Did you not sleep? Did you eat gluten? Are you having a hangover because you drank too much last night? Do you have a brain tumor? Do you have an aneurysm? There's a million reasons why you could have a headache, and headache just means my head hurts, right? And so the same thing with depression or ADHD or dementia. We have to really start to look at the personalization of health care and the individualization of our treatments that address the root cause or causes. And what you do is really radical, which is what we call a multimodal set of interventions. Typically, doctors and science is all about the one thing, one drug for one disease, trying to find that magic bullet, the silver bullet that's going to fix it. And that's what most drug research is about. What you're talking about is doing all the things we need to help our brain. We need the right diet, we need exercise, we need sleep, we need stress reduction, we need all sorts of different things that we're going to talk about that actually help to optimize your brain function and address your causes. So we really have to start to get this paradigm shift that's happening. And it's not just sort of on the margins of medicine. This is in peer-reviewed journals. But you're right. Like if this was a drug, it would be the biggest blockbuster. It would be bigger than Viagra or bigger than Ozempic or any other drug because it's basically doing something that nothing else can do about a disease that is devastating

our society. Absolutely. I think the key word you said is paradigm shift. We need a paradigm shift in looking at patients who come with memory loss and realizing that it's not just the flags and tangles. And as you mentioned, there'll be several hundred trials on eliminating amyloid and we still don't have a cure. Yes. The newest drug that was presented in Alzheimer's conference does seem to have a slowing of the worsening. One of my colleagues said, yeah, it's great. You get a drug that's going to help you stay in that confused state for a longer period of time. Yeah.