Stronger with Don Saladino | "Why Alzheimer’s Cases Are Tripling – And What You Can Do About It"

Date: December 2, 2025
Guest: Luisa Nicola, Neurophysiologist & Host of The Neuro Experience Podcast
Main Theme: Understanding why Alzheimer’s disease cases are tripling, the critical role of lifestyle in risk and prevention, and actionable protocols for brain health.

Episode Overview

This episode features neurophysiologist Luisa Nicola, an expert with deep clinical and academic experience in brain health and Alzheimer’s research. Don and Luisa dive into what’s driving the alarming rise in Alzheimer’s disease, the distinction between dementia and Alzheimer’s, misconceptions about risk, and protocols anyone can use to reduce risk—no matter their genes or stage of life. With grounded, accessible science and practical advice, they cover the impact of exercise, diet, hormones, sleep, and even supplements on the aging brain.

Key Discussion Points & Insights

Understanding Alzheimer’s Disease

• Distinction Between Dementia and Alzheimer’s

  • Dementia is an umbrella term for neurodegenerative diseases; Alzheimer’s is the most common type (~50-60 million cases globally, expected to triple by 2050).
  • "Dementia isn't a disease of old age. It's a disease of the lifestyle that you live." – Luisa (14:43)

• Why Cases Are Tripling

  • Environmental factors, modern lifestyle, and decreased quality of diet, exercise, and sleep.
  • "95% of Alzheimer's disease cases could be prevented." – Luisa (13:10)
  • Genetic risk (APOE4 genes) does not mean destiny—modifiable risk far outweighs genes.

Early Warning Signs & Disease Progression

• What is Mild Cognitive Impairment?

  • “That’s when you start to get those short term memory complaints...then it’s a massive acceleration.”—Luisa (11:17)
  • Example: patient rapidly declining from mild memory loss to full Alzheimer’s in 2 years (11:36).

• Why Women Are at Higher Risk

  • 2/3 of Alzheimer’s patients are women, largely due to estrogen loss during perimenopause and menopause.
  • “Estrogen is neuroprotective...if we lose it, our brain doesn’t function as well because it doesn’t have its protector there.” – Luisa (18:31)

Lifestyle Factors Driving or Halting Decline

Exercise – The #1 Tool

• Meta-Analysis Results:

  • "What is the number one tool to prevent Alzheimer's disease? It is exercise." – Luisa (33:16)
  • "The more muscle mass you build, the better for your brain...actually, it turns out the bigger the legs, the bigger the brain." – Luisa (34:10)

• Recommended Minimums:

  • Strength training: At least 2x per week (females prioritized heavy strength, men also benefit from zone 2 aerobic) (35:20-36:05)
  • Aerobic: 2 hours per week minimum
  • High intensity (Zone 5) especially for women, due to time constraints and hormonal benefit (35:59)

Diet & Nutrition

• MIND Diet:

  • Mediterranean, DASH, and plant-rich, but still including animal protein for choline (“Eat the rainbow”) (27:16, 44:09).
  • High-fiber diet supports vascular health, reducing risk for both stroke and cognitive decline.

• Ketogenic Strategies & Ketones:

  • Exogenous ketones (supplemental) show benefits for cognitive sharpness and appetite during long surgeries; fat adaptation helps when brain glucose metabolism drops post-menopause.
  • “Your brain actually uses ketones way better than it uses glucose, even though glucose is the main energy source.” – Luisa (29:52)

• Specific Nutrients:

  • Choline (eggs), Vitamin D (low levels = higher dementia risk), omega-3s
  • “Choline is jam packed in eggs...we’ve got an epidemic of choline deficiency.” (48:49)
  • Vitamin D: “A recent study came out...showed a 40% reduction in dementia if you have optimized levels.” (46:09)

Sleep – The "Brain Wash"

• Role in Brain Health:

  • Deep (stage 3) sleep activates the glymphatic system, clearing amyloid beta—hallmark of Alzheimer’s.
  • “The brain literally washes itself [in deep sleep]...it gets rid of all the waste products...amyloid beta.” (41:19)

• Why Sleep Gets Worse with Age:

  • For men, prostate issues; for women, estrogen loss (hot flashes) disrupt deep sleep. (42:24-43:42)

Stress, Social Connection, and Brain Training

• Reduction of Risk via Relationships:
  • "Those with the greatest brain health...are those who have quality relationships." – Luisa (62:26)
• Brain Training:
  • Learning new skills, novelty, coordination drills (like throwing tennis balls to the wall), and hand-eye work (“the birth of neuro athletics”).
  • “To form new connections, your brain has to be placed under load. It’s the same as your bicep.” (53:47)

Supplements & New Interventions

• Supplements:

  • Not a replacement, but supportive: Vitamin D, exogenous ketones, possibly omega-3s if bloodwork shows a need.
  • Always personalize to deficiencies.

• GLP-1 Agonists (e.g., Ozempic):

  • Show a 30% reduction in Alzheimer’s risk, but mainly by lowering diabetes/obesity and inflammation. (65:35)
  • “You have to take it responsibly. It’s not used to completely starve you.” (67:20)

• Alcohol & Marijuana:

  • Moderate alcohol creates white matter lesions, impairs sleep and healing (58:28-60:14).
  • “You’re ruining your brain...acetyl aldehyde is poison.” – Luisa (59:04)
  • Marijuana impairs deep sleep; long-term use can induce anxiety/psychosis in vulnerable people (60:47-61:27).

Notable Quotes & Memorable Moments

“95% of Alzheimer’s disease cases could be prevented.”
— Luisa (13:10)

“Do you want to go along the bus at 20 miles an hour, or...bring it down to 2 miles an hour?”
— Luisa, on slowing disease progression (13:46)

“The more muscle mass you build, the better for your brain...the bigger the legs, the bigger the brain.”
— Luisa (34:10)

“If it’s not stressed, [your brain] won’t grow. One thing you can do for brain training...your brain loves novelty.”
— Luisa (53:47)

Audience Q&A Highlights

Q1 (Katrina): What can people in their 20s/30s do for brain health—especially with trauma/family history?

• Build quality relationships ("offset a lot of cortisol"), exercise, sleep, sunlight, measure and optimize bloodwork. (62:25-63:28)

Q2 (Amy): What about GLP-1 drugs for cognitive decline risk if you have family history?

• Check your APOE4 gene status to know risk.
• GLP-1s work by lowering diabetes/obesity/inflammation, reducing Alzheimer’s incidence (30% in studies).
• Not a magic fix—must maintain protein intake and avoid going "skinny fat." (64:09-67:44)

Timestamps for Key Segments

• [05:53] – What does a neurophysiologist do?
• [09:26] – Personal story: why Luisa dedicates her life to Alzheimer’s
• [13:02] – Why Alzheimer’s cases are tripling globally
• [17:05] – Sex differences in Alzheimer’s risk (women vs. men)
• [27:16] – The MIND diet & nutritional strategies
• [33:16] – “What is the number one tool to prevent Alzheimer’s disease? It is exercise.”
• [41:19] – Sleep and the glymphatic “washing” system
• [52:32] – Brain training: neuro athletics and practical drills
• [57:02] – Supplements, ketones, vitamin D, and bloodwork
• [58:28] – The real effect of alcohol and marijuana on brain health
• [61:45, 63:58] – Live Q&A: actionable steps in youth, genetic risk, GLP-1 therapies

Practical Protocols—What You Can Do

• Exercise:
  • Minimum 2x/week strength, 2 hours/week aerobic; women prioritize heavy resistance, men also zone 2.
• Diet:
  • Mediterranean/MIND: high fiber, “eat the rainbow,” ample plants and lean proteins, regular eggs.
• Supplements:
  • Vitamin D, exogenous ketones, and others based on bloodwork.
• Sleep Hygiene:
  • Prioritize deep sleep, address hormonal issues proactively.
• Social Connection:
  • Cultivate strong, safe relationships for stress and brain protection.
• Continuous Brain Challenge:
  • Learn new skills, travel, meet new people, expose yourself to novelty.
• Limit Toxins:
  • Minimize alcohol, be cautious with marijuana, avoid brain inflammation.

Final Reflection

Don closes by sharing his personal connection to Alzheimer’s and hope for the future, emphasizing that while there is no cure yet, the tools for prevention and risk reduction are already clear and accessible—with Luisa declaring:

“Exercise is medicine.” (35:16)

Follow Luisa Nicola:
Instagram: @luisa.nicola_
Podcast: The Neuro Experience
Programs: Neuro Athletics (for coaches), Brain Code (for women’s Alzheimer’s risk)

Stay Stronger—Together.