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The Dr. Hyman Show
Brain-First or Gut-First? Rethinking Parkinson’s Disease w/ Drs. Ray Dorsey & Michael Okun
01:45:17
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Adjusted for age, the rise of Parkinson's disease is going up 60%, far faster than Alzheimer's disease.
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It turns out by 2035, we should have 12 million people with Parkinson's. There's a big myth about Parkinson's and the myth is, is that it's just a brain disease. This is a whole body disease. We have to start thinking about Parkinson s in a different way.
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Ray Dorsey, MD, MBA is a leading neurologist and Parkinson's expert. He's the director of the center for the Brain and the Environment at Atria Health and Research Institute and he's a professor of Neurology at the University of Rochester. Michael Okun, MD, is Distinguished professor of Neurology at the University of Florida and he's co founder of the Norman Fixel.
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Institute for Neurologic Diseases and medical advisor.
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For the Parkinson's Foundation. Both have been recognized by the White House as Champions for Change for their dedication to advancing research, care and advocacy.
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For people living with Parkinson's disease.
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There are all these symptoms that are non movement that actually appear early and they call them prodromal features. Constipation, acting out your dreams, loss of smell in your nose, those olfactory nerves, gut dysfunction and changes, and even some of the neuropsychiatric things.
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For all those golfers out there, is it a risk for people? Should they be worried? Should they stop golfing? What do they do to protect themselves?
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Individuals who lived within one mile of a golf course had a 126% increased risk of developing Parkinson's disease compared to individuals who lived six or more miles apart.
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D
Oh my.
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Do you know where else they find these toxins? They find them in the breast milk of nursing women. And it's all preventable.
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Okay, you've got someone to walk in your office with Parkinson's disease. What do you do?
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D
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C
All right, Ray, Michael, welcome to the Dr. Hyman Show. So good to have you.
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Thank you very much for having us. Mark. Great to be here.
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Yeah, amazing to be here.
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You both have come all the way from Florida and New York to Austin, Texas, to talk about your new book, the Parkinson's A New Path to Prevention and Treatment. As a functional medicine physician doing this for over 30 years, I was like, finally there's these straight up neurologists from top academic centers who get it. They get that we are living in a sea of toxins, environmental toxins, everything from heavy metals to pesticides to plastics and the list goes on that are impacting our health in real ways and that we have to confront and face as a society. And that the canary in the coal mine, which is another story of the coal mine where they put the canary in it and if it dies, you know, the air is bad and the coal miners have to get out. The canary in the coal mine here is Parkinson's disease, which is what your book's about. For those of you who don't know what Parkinson's disease is, I want to let you explain that. But essentially it's a movement disorder where you get really slow and shuffly and you talk soft, and it's just like a. It's a very debilitating disease that happens as people get older, but it's happening in younger and younger people because we're living in A increasingly toxic world that's impacting our health. And not just across Parkinson's, but across everything from autism to Alzheimer's to cancer to diabetes to autoimmune diseases. I mean, the whole shebang. You guys are both neurologists, but as a, what I call myself, as a. Not a subspecialist or a super specialist, but as a super generalist, I know a lot about a lot of things, and not like, not as much as I'd like on many things, but I, I go. I go pretty broad because I see the patterns and connections between things. And so what really got me excited was that, you know, finally there's. There's two neurologists who are talking about. Know how to think about this particular disease, Parkinson's, in a different way, and also pointing out that what. What a dramatic increase we've seen in the incidence of this disease. It's always been around, but, you know, why all of a sudden, is it skyrocketing? Most people think, oh, it's genetics, and most diseases are genetic. But the truth is, and Eric Burdon said this, he's been on the podcast, that 93% of disease, chronic illness, is not genetic. It's, it's. It's basically the environment influencing our gene expression, where we might have predispositions, but we're not predestined to the problem. Also, what was really interesting literature to me in Parkinson's, it. It was one. It's one of the few diseases that I. I've always said, you know, throughout my 30 years of talking, that even traditional healthcare and doctors and neurologists understand that, that toxins are a major risk factor for Parkinson's. If you're a farmer, that's the most dangerous occupation on the planet, not because of injury from factory farm equipment, but from the toxins that they are exposed to. So why don't sort of, I guess start with Ray, Michael, just sort of talking to me about, you know, Parkinson's. What is it? Give us a little background on the biology of it and then the increasing incidence of it and what you think are the major reasons why we're seeing this increasing, dramatic, increasing incidence. It's like orders of magnitude. It's not just like a 10 or 20% increase.
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Parkinson's. The first major description of the disease was by Dr. James Parkinson in 1817 in London.
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C
You know, why do these guys name disease after Alzheimer? Alzheimer's, Dr. Alzheimer's.
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A
He didn't name it after himself. He called the shaking palsies. That other guy, the father of modern Neurology named after him. He didn't have an ego, so he's 61. He's a surgeon, actually, and he's actually even a geologist. And he sees something new on the streets in London, something so new that at 61, he bothers to write a case series. He basically writes his case series on six people, five at least, five of whom are men. They're all older and they have tremor, which has long since been described. But they have this stoop posture, this hunched posture, and this tendency to walk faster and faster and to fall forward. And he said in 1817, this has not been described in the medical literature.
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C
Really? This is 1817.
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So in 1817, Dr. Parkinson says that park disease, that became known as Parkinson's disease has not been described in the medical literature. Ergo, I'm describing something new.
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And this was the beginning of the.
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Industrial Revolution, and it's the beginning Industrial Revolution. And where is it? It's in London.
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Yeah.
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And air quality in 1800 London is equivalent to what is in Delhi, India today is equivalent to what was over in New York City with the Canadian wildfires. You remember, two or three summers ago.
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Yeah.
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The sky turned orange. That was every day. 1800 London.
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Yeah.
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So I think Dr. Parkinson is describing the effects of chronic exposure to high levels of air pollution. And so Parkinson's disease, we think as.
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And by the way, it was coal.
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Coal.
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Because coal was what they used to heat and do industry with. And that's full of mercury and lead.
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Exactly. And so we look in the brains of people with Parkinson's disease, they have high levels of heavy metal. And so when you look at smog in la, for example, you're seeing little pieces of dirt and soot that are suspended the air. The fancy term is particulate matter. Most of them we cough out or sneeze out. But some are so small, less than 1/30 the width of our hair, they penetrate the nerve that hangs down. The response for smell that hangs down on our nasal passages. And hitchhiking on those pieces of dirt and soot are toxic metals.
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Wow. So it's a super highway from your nose to your brain.
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Exactly. It's a front door to your brain.
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Wow.
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And it's the blood brain barrier, you remember from medical school. Right. Doesn't let things in.
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Well, kind of it does, but. It kind of does.
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But this is a little leaky. But this, this is the front door. This is doesn't go through the blood brain barrier, it's just going through the olfactory nerve, the nervous Ulcer smell that's hanging, it's. And it's hitchhiking. Are these metals lead from gasoline, iron from brakes, platinum from catalyst converters. And so people with Parkinson's and Alzheimer's both have high levels of metals in their brain. No one's really been able to explain why, but I think one of the reasons why is air pollution, which is one of the toxins that are inhaled that lead to Parkinson's.
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C
Yeah, we're exposed to. I mean, listen, we're exposed to mercury in the fish we eat. Lead is, you know, in their food. And, you know, if you eat a lot of kale is grown in urban environments, it just picks up all the lead. You know, what you said was so interesting to me about the leaky brain because, you know, when I was in sort of my early years of practicing, we were talking about a leaky gut. And I used to get laughed at all the time by traditional doctors because they're like, oh, that's nonsense. It's just, you know, you're quack. And for a long time I've also basically been saying that there's a leaky brain. Well, Michael, you sort of just sort of brought this to attention because I think people don't really understand what that is. I mean, leaky gut is when the berry brain breaks down and food and poop leak in and affect your immune system and then start to cause all kinds of havoc, you know, and. And as you mentioned. Michael.
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Michael.
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That you basically have this barrier, this blood brain barrier, but it becomes permeable, and then all of a sudden things get in from the outside. So it's not like a, like completely impenetrable barrier. And I think we're seeing increasingly things that cause a leaky brain, like stress and many other things, like toxins. So maybe you could talk a little bit about this leaky brain phenomena because it's really how the toxins get into the brain that are causing all these problems. When you do bioptopsies and you're finding toxins and heavy metals in the brains, what's happening?
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Yeah, and you're absolutely spot on when you talk about leaky gut, too. And it turns out the gut is also a pathway where you can hitchhike in and potentially cause Parkinson S as well. We talk about now brain first, Parkinson S and gut first, Parkinson. And so this leakiness, this permeability to stress and. And other factors that can get across is really important. So if you think about the brain as having like a force field, if you're a Star wars fan, you know, it's kind of got like a force field. And we've always kind of taught all the medical students, we've taught everybody in medicine that this is this impenetrable force field. Nothing's going to get through this force field. It's actually not correct. Not only is it not right, but as we develop, you know, treatments and as we develop, you know, different, you know, therapies, we're actually able to defeat the blood brain barrier is what we call it, or the bbb. We're able to defeat that. And it's so super important for us to remember that things can get through it. We can use that for therapeutics. We can also need to be thinking about that for cause and getting to the root cause of Parkinson S. And one of the things. And even treatment. And even treatment. But one other thing I just wanted to bring into the discussion and I'm so glad that you mentioned the gut is there's a big myth about Parkinson's. And the myth is that it's just a brain disease. It's a whole body dise disease, Mark. And we see it in the gut. You know, we see the proteins in the gut, we see it in the skin, we see it in multiple systems. And so we.
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Proteins that are expressed in the body in Parkinson's.
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Absolutely. And so misfolded. Yeah, and misfolded. I mean, we have twice the risk of malignant skin cancer, you know, melanoma and Parkinson disease, twice the risk of osteoporosis and Parkinson disease. This is a whole body disease. And as we think about it, and I love, you know, kind of how you describe yourself as someone that, you know, thinks of, everyone thinks of the whole. We have to start thinking about Parkinson s in a different way. It's not just a brain disease and it's not just a disease of dopamine. There are certainly multiple circuits in the brain. And then, you know, this barrier that we, you know, have, you know, invested so much in, in all of our textbooks, we've got to rewrite those.
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C
So essentially what you're saying is the ankle bone's connected to the shin bones connected. The knee bone's connected, the hip bone, everything's connected. And we can't separate out the body into these organs and, or I mean it's. It's such an unfortunate problem we have now because as we're beginning to understand the body as a network or as a system, network biology. You know, traditional medicine is organized according to parts like geography. Where is it in your body Is your head, is it your stomach, is it your joint, is it your knee? Like, whatever. So you've got all these specialists that are specialized in their organ. But if you start to read across specialties, you see there's these common themes that are like inflammation, mitochondrial dysfunction, oxidative stress, the microbiome involvement, the misfolded proteins. Things like, all these things you're talking about aren't just about neurology, they're about everything. And so, so that's why, you know, you can start to really help people by understanding how these systems.
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And we miss it, Mark. Like so we miss the point and, and, and we miss the diagnosis and we miss the treatments and we miss the approaches because no one takes a step back. Everybody's doing their super, you know, specialists and Ray and I are completely guilty. You know, we're guilty of a lot of things, Mark, but we're definitely guilty of being super specialists. Right on top of, you know, neurology, which is already a specialty, then we have a specialty of Parkinson S and Basil Gingley and all these crazy brain circuits. Right. And so we have to step back, create navigators for people that are, you know, suffering and, and you know, dealing with these symptoms and help to think of this as a whole body disease.
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C
It really is. And, and you know, we were chit chatting before and I mentioned this paper I read like, I don't know, 20 years ago. It was in Jama, I think, and I forget the exact title, but it was essentially explaining how Parkinson's, the biology of Parkinson's disease and what happens. And you know, one of the key things we talk about in functional medicine is the mitochondria, which is our energy system, how we take food and oxygen and combust it in our cells. And through a very series of steps we actually can produce ATP or energy that runs the body. And ultimately the end result of what's happening, and you can explain this probably better than I can, is there's mitochondrial damage, particularly in the area of the brain we call the basal ganglia, that, that is responsible for movement. So this is a movement disorder. Tell us about the, the increasing incidence of this and why we're seeing so much. It's not just the prevalence which will grow as the population grows, but the actual incidence of how many new cases per case per population is actually happening and why we're seeing this accelerate over the last 50 years.
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Yeah, so when Dr. Parkinson described, he described six people in 1817 with the disease 2017, the Global Burden of Disease Study estimates 6 million people have the disease. How do you go from 6 to 6 million in 200 years? Aging alone doesn't explain it. Adjusted for age, the rise of Parkinson's disease is going up 60%, far faster than Alzheimer's disease. 60% adjusted for age, which is shocking, right?
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Yeah.
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Did you just say faster than Alzheimer's?
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And Alzheimer's is very growing very fast.
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It can't be genetics because our genes, you know, don't change, generally speaking, for just 200 years. So it has to be in our environment. And if you look at a map of the world, areas of the world that are most industrialized, like the US and Canada, have the highest rates of disease. Areas of the world that are least industrialized, like Sub Saharan Africa, adjusted for age, have the lowest rates of the disease. And areas of the world undergoing the most rapid industrialization and pollution, India and China have the fastest increasing rates of the disease. And so these chemicals, the ones that are limping, Parkinson's disease are all mitochondrial toxicants. Means that they damage the energy producing parts of cells. You know that the brain is only 2% of our body weight, but 30% of our energy consumption is going to the brain. And nerve cells are the chief drivers of that. 75% of energy demands are from nerve cells or neurons. And so these toxicants, whether it's air pollution, whether it's dry cleaning chemicals, if you can believe it, whether it's pesticides, they all damage the energy producing parts of the cell. Some of them we inhale, some we ingest. Some Parkinson's disease begins in the nose. Some Parkinson's disease begins in the gut. Right. So when Parkinson described the condition, he thought it began the brain. I'm describing a brain disease. It must begin in the brain. Actually, Parkinson's disease. Per Borgheimer, one of our colleagues in Denmark, says that there are two forms of Parkinson's. One that's brain or nose, first pathology beginning in the nose, and one that's body or gut, first pathology beginning in the gut.
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C
Yeah, interesting.
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And so these toxins we. I said to him, I emailed them, I read all his papers, I print them out on my Sunday evening and Sunday afternoon. I just read them all. I thought I was in my pen and I'm like, holy cow. And I emailed him, I said, well, how does this fit with like chemicals that we eat or swallow or ingest, leading to a gut first form of the disease and chemicals that we inhale? He was skeptical at first, but we wrote a paper called the Body, the Brain, the Environment and Parkinson's disease Arguing that Parkinson's that begins in the gut is due to chemicals that you ingest, like well water that's contaminated with pesticides. Chemicals that you inhale leads to a nose first. Chemicals that you breathe in, like if you live near a golf course, for example, might be breathing in the chemicals.
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C
Yeah.
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A
Or air pollution will lead to a nose first form of the disease.
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D
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C
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C
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D
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C
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D
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C
What you're talking about is just is such an important concept here around the load of toxins and the gut. Yes, we eat toxins from pesticides and chemicals and ingesting all this stuff. But I think it's more than that. I read a paper years ago where there was a 400%, a fourfold increase in Parkinson's in those people who are constipated. Now I don't want to scare you. If you're constipated, you can fix that with magnesium and probiotics. And I've written a lot about that. But like that's a really interesting phenomena. And the, and the, the. I don't know if you're aware of this phenomena, but in the metabolic health, there's something called metabolic endotoxemia, which means in English that there's bad bacteria in your gut that release toxins we call EM LPSs or lipopolysaccharides, which are like little endotoxins or little poisons produced by these bacteria that we absorb across a leaky gut that interact with their immune system and cause inflammation which then leads to insulin resistance, which leads to weight gain, lensing diabetes. So I'm sure this metabolic endotoxemia also could be affecting the brain not just because you're ingesting toxins, but the microbiome itself is so messed up because of our lack of fiber and polyphenols and probiotics and the use of antibiotics and so on.
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B
So this gets back, right, Mark, to this whole thesis of like Parkinson S is a whole body disease. You're making the argument for us and you know, it's really, you know, interesting, you know, so for almost 20 years I've been the medical director advisor for the Parkinson's foundation in addition to being a professor at University of Florida. And when early on when we started to look at websites and you know, you and I and Ray were old enough to remember the early days where you get an analytic and you're like, oh my gosh, all these people are actually clicking, you know, on these things. Well, we actually used that, you know, in the early days to see what people were interested in searching on the Parkinson foundation website. And guess what kept coming up? Number one, constipation. Constipation. You got it, Mark. I mean, it's just sort of like my gosh. And so fast forward now, you know, so, you know, a couple of decades ago, Ray and I, and I'm always the skeptic of the two. I work a lot in more of a science laboratory setting and developing devices and things. And so, you know, Fast forward. A couple of decades ago if you said to somebody, Parkinson's could be set off by a toxic kent or an environment or whatever, people would say you're crazy. Right? And now as we've learned more and more we learn about, hey, do you know what Parkinson actually sets up many years in advance of? When you see, you mentioned movement disorder. But there are all these symptoms that are non movement that actually, you know, appear early and they call them prodromal features.
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C
Just like pre diabetes but pre Parkinson's.
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B
Ah, exactly. You know, spot on. And so these are things like. And what are they? Constipation, acting out your dreams, loss of smell. You talk about the hitchhiker, you know, in your nose, those olfactory nerves, you know, gut dysfunction and changes and even some of the neuropsychiatric things. So when you see middle aged men, now there's a study in Parkinson showing middle aged men in their 50s suddenly start to get anxious. Right. They've not been anxious before. That's, you know, they may be the beginning of developing Parkinson's symptoms. This is a whole body issue that's, that's going on. And so, so I think it's important to keep those perspectives. But there's nothing crazy about constipation, Parkinson S and how it ties in.
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C
Well, it may, it may be both a cause and an effect, right?
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B
Yeah, both.
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C
It's like, you know, so.
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A
Exactly. So I think it's actually an effect of the toxicants. So we mentioned that the toxins can be ingested. Right. And so you know, the enteric nervous system which controls the gut motility, that's the gut brain. The gut brain. And then the highway that connects the gut to the brain is the vagus nerve. Vagus nerve.
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C
How am I doing, doc?
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B
We're doing good.
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A
You're doing fantastic. So in 2003, in 2003, a German pathologist, really smart guy, Heiko Brock, says Parkinson's disease, the pathology does not begin the brain. He said Parkinson's disease, which you consider a brain disease, it does not begin the brain. He says, I first see it, the pathology in the olfactory bulb, the smell center of the brain, or in the dorsal motor nucleus of the vagus nerve. So he says the pathology of Parkinson's begins in the gut and it ascends up like this misfolded protein, like a fall of dominoes. This misfolded protein spreads from one nerve cell to another and goes from the gut up the vagus nerve and then up from the vagus nerve to higher parts of the brain that are responsible for sleep, for controlling our blood pressure. And then only later to the part of the brain, the basal ganglia that you were talking about earlier, that constipation is actually probably one is a sig is a sign that the pathology is affecting, for example, the vagus nerve. And we're getting reduced gut motility.
- [24:42]
C
Is it over overactive sympathetic activity?
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A
Well, it's the damage to the, to the, to the parasympathetic.
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C
So they got over imbalance. For those listening, you've got the, the fight or flight response and the relaxation response. The sympathetic nervous system, the parasympathetic nervous system. And what you're talking about here is the parasympathetic nerve that keeps you calm and relaxed. That's why anxiety increases, actually stops working as well and you get a relative increase in the sympathetic nervous system which then when you're running from a tiger, you don't want to be pooping, so your, your gut shuts down and a whole bunch of other bad stuff happens. Right?
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A
You got it.
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C
I personally am waiting till I'm like 90 or 100 to start golfing because.
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D
It'S kind of slow for me.
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C
But I, I play tennis and you know, they live seven years longer. But anyway, for all those golfers out there, no criticism. There's a tremendous amount of toxins sprayed to keep those golf courses looking so great. Is it a risk for people? Should they be worried? Should they stop golfing? What do they do to protect themselves? For sure, don't lick your golf balls, which I know people do, to clean them. Tell us like if you're a golfer, WTF?
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A
So Dr. Britney Krasnowski is a geographer. She's the Baron Neurological Institute. And she worked with her colleague Dr. Rodolfo Savica, one of our colleagues at Parkinson's specialist, the Mayo Clinic in Rochester, Minnesota. And she was concerned about the effects of living near a golf course because golf courses use huge amounts of pest.
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C
A lot of people live on these golf course communities and a lot of.
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A
People live on these golf course communities. So she looked at Rochester, Minnesota, which does a very good job of measuring new cases of Parkinson's disease. And she found that individuals who lived within one mile of a golf course had a 126% increased risk of developing Parkinson's disease compared to individuals who lived six or more miles apart.
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D
Oh my.
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A
So why. And so she spends a lot of time in her paper discussing water supply. And so we've talked a little bit about how pesticides can get into the water for example people who drink well water not really by the safe drinking water act prone to contamination from nearby.
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C
Farms in rural areas runoff seeps into the ground. Yeah.
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A
Have a higher risk of developing Parkinson's disease. So she's focused on that. I worry a little bit about the pesticides that are sprayed into the air. There was a small little report in the analysis of Neurology that two neurologists found that 18 of their patients lived near a golf course and 15 of the 18 lived downwind of the golf course. So I worry about pesticides being sprayed on golf courses or on fields and people living downwind and inhaling them. We talked about how many individuals most individuals perhaps Parkinson's begins in the nose. So I worry about nerve toxins being inhaled into the nose. So what to do one well pickleball.
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B
Pickleball.
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A
You know, why can't we ask golf courses Pickleball.
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C
One of those dangerous sports show. So many people who are so out of shape.
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B
Listen, that's another discussion.
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C
Are filling the emergency rooms with pickleball.
- [27:36]
B
I have a whole pickleball for Parkinson s talk so we can talk about to keep people safe on the pickleball golf.
- [27:41]
A
Back to the golf. Golf. So ask the golf course what pesticides they use. See if they can use less toxic pesticides. Right. Can they use less, can they tell you when they're spraying? Right. So you can take interventions, especially if you have Parkinson's. Maybe you know, get out of town when they're spraying. You can close your windows, you can get an air purifier.
- [28:01]
C
These are all things like an air conditioned golf cart.
- [28:03]
A
Well you can do an air and.
- [28:05]
B
Don'T drink the water from the court.
- [28:06]
A
And it's and it turns out not, not just living near a golf course has been an increased risk. Three different studies have found green space workers, including landscapers to be at higher risk for Parkinson's disease. And one study found that green space workers are higher risk for ALS or Lou Gehrig's disease. So there are lots of clues as what's causing these brain diseases, whether it's Parkinson's, Alzheimer's or als. Lots of clues telling us that this is a preventable disease. And lots of clues saying that if we pay attention to our environment like Rachel Carson said we should but realistically.
- [28:37]
C
Like, like Ray can, can people really like reduce their exposure if they're out on a golf course for 18 holes? Like isn't it just in there they're going to be walking on. It's on their shoes. It's on their clothes.
- [28:49]
A
It's like, I'm like you. I'm not a golfer, but I can't imagine that golf courses couldn't be using 50 less pesticides. There are organic golf courses.
- [28:56]
C
There are, actually.
- [28:57]
A
In Martha's Vineyard, they have organic golf courses. If we have organic wine, we have organic produce. If we have organic cheese and dairy products and meats, why can't we have organic golf courses? Why can't we enjoy a nice sport without having to worry about getting a parking spot?
- [29:12]
C
Maybe we'll get President Trump on this regenerative golf course.
- [29:15]
B
But practically speaking, you have a right to know. So ask the course. When do they spray the pesticides? Right. Maybe you don't want to play right after they've sprayed the pesticides. Watch the water that's there. Get a carbon filter. Maybe bring your own water. And when you're smoking, for those of you that smoke, I'm not saying you should smoke. When you smoke your stogie and your cigar, don't put it on the ground while you're going to hit the ball and then pick it right back up because you're going to put pesticide in your mouth.
- [29:39]
C
Thank you. Thank you. That was a good answer to a hard question, which still feels like a bit scary to think about golfing. But anyway, for those of you golfers out there, just take care of yourself, get your liver working and reduce as much exposures as you can. I mean, this is just such a great conversation because I think I'm like, honestly pinching myself because I feel like I wrote this book, how to fix your broken brain by fixing your body first. And here you guys are, neurologists starting to talk about these things. And usually neurologists pay no attention to anything but a little neck, you know, which is just dumb.
- [30:11]
B
Guilty.
- [30:15]
C
And now it's like, you know, you can't ignore the science anymore. And here you are, two of the most esteemed neurologists in the world who've written, collectively, I don't know, a thousand papers and many books and have led organizations and advised governments and done everything. And here you are going, holy crap. You know, maybe we're living in a stew of toxins, and that's a big factor. So let's talk a little bit about the biology. And then I want to go into the toxin story and how you kind of came up with this, because I think it's important to understand that there's fundamental biological processes that occur in the body that are common in most diseases. And where it hits you depends, I think, on your genetics and who knows what. We still don't understand, but the phenomena of, you know, mitochondria. And you mentioned, you know, the brain has a lot of. Every cell in the mitochondria has, has, sorry, in the brain has more mitochondria than any other cell. The heart cell is next. So even more than your heart, your brain has more mitochondria. And they're very sensitive little creatures. They're like little bacteria that we kind of co evolve with. They kind of hitchhiked in our cells, produce energy for us and we can make them have a home. And it all works out symbiotic.
- [31:26]
A
Really.
- [31:26]
C
Yeah. I mean the problem is that they're very sensitive to insults. So from your microbiome, from toxins, from stress, from, you know, from food, from infections. I mean, why do you feel like when you have the flu or Covid, like you can't move and you're tired and you have brain fog because your mitochondria are being poisoned.
- [31:42]
D
Right.
- [31:43]
C
But this chronic low level toxicity is something that is not been really accepted by traditional medicine. It's like, oh, you got acute poisoning, you come to the er, we'll give you something to fix that. But most traditional physicians just dismiss the idea that, that, that low level toxins are an issue or that there's anything you can do about those. Can you talk about how you kind of first discovered this and a little bit about the sort of the insights that led you to realize that this is really the big problem.
- [32:13]
A
Michael and I were both very, very traditional academic neurologists. And you know, I went to the oldest medical school in the country. And you know, we're not told a lot about toxins, we're told a little bit about lead, we're told a little bit about asbestos, we're told a little bit about mercury, we're told a little bit about smoking, which we'll get to in a second. But we weren't taught to generalize this beyond the specific disease.
- [32:33]
C
And only acute, like, only acute and not related to any chronic illness. If you're poison, you're born.
- [32:38]
A
Talk about asbestos and mesothelioma and stuff like that. But you know, it was, it was, it was narrow.
- [32:42]
C
Yeah.
- [32:43]
A
So I had the gift of a sabbatical. I'm an academic. I was an academic, so I had to give a sabbatical about eight years ago. And I devoted it to reading the papers of one of my colleagues, Dr. Caroline Tanner, who's a neurologist and an epidemiologist who's now at UC San Francisco. And for 40 years she's been quietly, diligently telling us that chemicals in our environment are fueling the rise of Parkinson's disease. Whether that's air pollution, whether that's pesticides, whether it's a dry cleaning chemical called trichloroethylene, she's been telling us that these chemicals are causing it. So I'll give you an example of chronic exposure to a toxicant Lung, smoking and lung cancer. So in 1900 United States, there is almost no lung cancer. Lung cancer, the leading cause of cancer death in the United States around the world, simply just did not exist in 1900. Yeah, United States it was con. It was so odd. It was considered a once in a lifetime oddity. All the doctors and medical students would gather around when they saw a case, thinking they'd never see a case.
- [33:39]
C
And heart attacks and diabetes.
- [33:42]
A
Right. These diseases just didn't exist. And it wasn't until cigarettes that 25 years after the introduction of cigarettes you got to corresponding rise in lung cancer, United States we stopped smoking, decreased smoking, 1970s, 25 years later, corresponding. So the challenge with these diseases is that it's not an acute exposure and you get the disease that's much easier to identify. Right. You take too much acetaminophen and you get liver toxicity. You know, it's a lot easier to make that relationship with smoking. Lung cancer, which wasn't connection really wasn't made until 1950s because there was a 25 year lag between the exposure and now we're seeing the same thing with Parkinson's. You don't get exposed to the pesticides as a farmer and develop Parkinson's the next day, next year, next decade. It could be 25 years later, 30 years later. They did a study at Camp Lejeune, which is the Marine base in North Carolina. Contaminated with this dry cleaning chemical, the Marines were exposed at age 20 to the chemical in their drinking water.
- [34:36]
C
Dry cleaning, like from their uniforms?
- [34:39]
A
Yeah. So there was a, there was a dry. Marines need to dry clean their uniforms. There was a dry cleaning base, ABC Dry Cleaners on the base that inappropriately disposed of their dry cleaning chemicals, got into the drinking water for the Marines at Camp Lejeune. The Marines even knew about it in the later years. But for 25 years, a million Marines, their family and civilians were exposed to a cancer causing chemical in their water that's since been linked to Parkinson's. Dr. Tanner and her colleague Dr. Goldman looked at the Marine.
- [35:08]
C
What was that chemical?
- [35:09]
A
Trichloroethylene tce.
- [35:11]
C
Yeah, you wrote a paper about that.
- [35:12]
A
And they looked at the Marines who were 20 years old when they were exposed. They were only there for 25 months. Right. If you're a marine, you move from base to base. Yet 34 years later, 34 years later, they had a 70% higher rate of developing Parkinson's disease. So exposure to toxicants when you're young, some of them were teenagers, when you're young, sets the stage for developing a neurodegenerative disease 34 years later.
- [35:37]
C
So true. I mean, I was sharing with story before. I had a patient early on, which sort of clued me into a lot of this stuff, who was about 50 and I was pretty young to get Parkinson's. And she came in with Parkinson's. And you know, I took her history and you know, in, in, in functional medicine. And we do, we start like with what did your mother eat? And what was her like in utero environment like? And like, what was your first year like? And so we go through the whole thing and she was like, yeah, I lived in the Bronx and we were very poor and I, you know, we were. Lived in this cockroach infested apartment and the cock. Cockroaches would crawl across me at night and freak me out. And so when I married and had a little more means, we moved to Long island. And I just had the exterminator come every week inside and outside. And by the way, I have a barrel of lindane, which is a banned pesticide that is so bad. I was like, this is a big deal. And then, you know, you start hearing of farmers are the most dangerous occupation, start to kind of start to dig in and you see what's going on. But I've also had patients who, who are exposed to other things that, that can, like mold, which can be a toxin or, or even tick infections, you know, which you wouldn't think, but do contribute. So it's a whole host of things together. And I think, you know, we talk about the effect of, of toxins on your neurology, but I mean, Rachel Carson talked about it on, on fertility. There's a book called Our Stolen Future I read again.
- [37:04]
A
Two or plus decades ago, Shauna Swan wrote a book, Falling down the Colburn.
- [37:08]
C
About, about the, the effect on her reproductive health and the change in fertility rates. And you know, I mean, it's, it's. I just did a whole talk with a Stanford urology professor about the declining rates of male fertility and what are we doing about it? And it's all, it's affecting everything. So tell us about the most common toxins that you found are associated with them. Where do we get them and how do we start to think about like avoiding them and dealing.
- [37:35]
A
There's a pesticide called chlorpyrifos that used to be found on over half of apples in the United States. Widely used on golf courses, utility poles. Turned out that chlorpyrifos was used to kill insects in apartments in New York City. And this amazing scientist, Virginia Rao at Columbia University looked at the children of women born who were in the homes that were sprayed with this pesticide. She finds that pesticide in the umbilical cord blood of the children and whose moms were sprayed. The homes were sprayed with his chlorpyrifa. The higher the level of the pesticide and the umbilical cord blood, the lower the IQ at 3, 5 and 7.
- [38:16]
C
Yeah.
- [38:16]
A
And then two weeks ago she follows him out to 6 to 12 and she does MRIs and they have structural brain abnormalities and they have slowed motor function in the lab.
- [38:26]
C
These are developmental issues that kids experience as a result of being exposed to these, these cockroach pesticides in that are used commonly in the homes in New York City.
- [38:35]
A
They're no longer allowed. And then she also found in addition to having structural brain abnormalities on their brains as early as six years old, they have slow motor function in the lab. That pesticide damages the dopamine producing nerve cells that are lost in Parkinson's, which.
- [38:50]
C
Is the basal ganglion cells, right?
- [38:51]
A
Yeah. So pesticides as a whole is one is the certain pesticides had the most robust evidence for their role in Parkinson's disease.
- [38:59]
B
One of the Parkinson S25. Mark, Mark we talk about is don't poison yourself. You know it seems like a, like a no brainer, no pun intended but you know, don't poison yourself.
- [39:08]
C
It's hard though. I mean we, we, we. You know I'm, I'm on the board of the Environmental Working Group which is a great organization that has done a tremendous job to catalog identify all of our exposures across food, across household cleaning products, skincare products, you know, meat, fish, vegetables. And it really provides a very good guide on that's evidence based on, on how to reduce your exposures, filter your water, air purifier, we can talk about all this stuff. You know, what's, what's really sort of concerning is that these, these toxins, you know, are found everywhere. That the average newborn has 287toxins in their umbilical Cord blood. This was a study done by the environmental organ group. They took 10 newborn babies and they were like. There was like stuff like DDT that's been banned, or dioxin that's been banned, which is Agent orange, which is really.
- [40:00]
B
Bad for Parkinson S, those two, by the way.
- [40:02]
A
Wow.
- [40:03]
C
So the toxic exposures are pretty ubiquitous and it's hard to get rid of them. And there was a big study that was done of the children of farm workers in California, and they collectively lost 41 million IQ points. So this is just exactly what you're saying.
- [40:17]
A
Exactly. And some of these toxins are so small that they cross the placenta.
- [40:20]
B
Right.
- [40:21]
A
And they go into the child. And some are fat soluble. So, you know, your brain's covered in fat. Do you know where else they find these toxins? They find them in the breast milk of nursing women.
- [40:30]
C
You know, I know that and it makes me so sad. And, you know, I'm not a designer, an engineer, but if there's any geniuses out there and want to design a good breast milk filter, that would be a huge boon to humanity because breastfeeding is still the most important thing you do to keep your kid healthy. And, you know, you're there. I mean, we're already born pre polluted, right? So the question is then, you know, it's the degree, the amount, and you can, if you take a good history, you can actually really find out what people's exposures are. Right.
- [41:03]
A
And it's all preventable. Right? This is all. This is what your book. Right. For every. This is all preventable. We need not have ddt. We no longer have ddt. We got rid of lead and gasoline still. But we've. We made progress. We lead levels today. Right. Are 95% lower in kids than when you and I were. We're children. Kids are smarter because we got lead and gasoline and lead out of paint. And the world did not spin off its axis. Right. The air quality in Los angeles today is 50% better than it was in the 1960s when Governor Ronald Reagan said we should eliminate all unnecessary driving because you couldn't see across the street. Just like you were talking about China. That was 1960s Los Angeles. We fixed our ozone hole because we got rid of CFCs. If we get rid of these chemicals, we get rid of a lot of autism, we get a lot rid of a lot of als, we get rid of a lot of Alzheimer's disease, and we get rid of a lot of Parkinson's disease. The central thrust of the book is that Parkinson's disease is largely a preventable disease, is a product of the industrial revolution and chemicals in our food, water and air. We get rid of these chemicals in our food, water and air. We get rid of Parkinson's disease. We create a world like 1817 or 1717 when there is no Parkinson's disease or it's extraordinarily rare.
- [42:09]
C
I only have one word to say to that. Amen. It is a big lift because the industrialization of the world and the amount of chemicals we use, we all benefit from. And it's really tough to start thinking about how do you re industrialize to remove those, how do we reduce our exposures? I remember there was a world's fair. I was living in Queens in 1965 when they had the World's fair. And I went to it actually, because I lived in Queens and. And they had Dupont up there, and they were like, better living through chemistry and all these Teflon and all these things like the PFAS chemicals. I just did. I just did my function health testing, which is a company I co founded. And one of the things we offer is pfas or forever chemical testing and bisphenol A testing and heavy metal testing. And it's hard to test toxins because they're fat soluble and you know, they. But it's amazing how polluted I am. And I'm like. I'm a guy who tries to. To be careful, you know, like, and glyphosate levels and I mean, I eat out and what can you do? Like, it's just, it's. It's really tough. So.
- [43:13]
A
And There's a reason one in 31 children have autism. There's a reason that more young adults are getting colon cancer.
- [43:18]
C
Right.
- [43:18]
A
When we were in medical school, I mean, no one got colon cancer unless you had a rare genetic cause. No one got colon cancer before 50, right?
- [43:24]
C
No.
- [43:25]
A
Why do 1 in 8 women get breast cancer? Why do 1 in 8, 1 in 10 men get prostate cancer? Diseases have causes.
- [43:32]
B
And why is it not uncommon to see young people with Parkinson? You said young people with Parkinson s. Maybe that's rare. When you were describing the person they met. Not so rare. You know, we're seeing lots of young cases. And in fact, you know, it does increase as you age, you know, over time. But we see people in their teens, 20s, 30s, 40s. Certainly gets more common the longer you live. But this is something that. Another myth that should be busted for people that this isn't just a disease of, I don't like to say older I say more seasoned. This isn't just a disease of more seasoned people.
- [44:04]
C
What you're both saying is just so important. Ray, what you just said, I want to just double click on because you kind of went over really fast. Diseases have causes. Now you would think in medicine that that's what we pay attention to, but unfortunately it's not. What we pay attention to is what I call the name it blame it attainment game. We name the disease by saying, here's the symptoms, here's the signs, here's the lab test, here's the imaging results that explain that you have this pathology. So we, we focus on the symptoms and the pathology we can see in the microscope, but not on the cause or the mechanism. And so by understanding the mechanisms and the causes, you can really do something. The other thing I was struck with, Ray, you said the, the brilliant thing you said was cancer, you know, autism, Alzheimer's, and the list could go on autoimmune diseases. Now these toxins are problems. Autogens, obesogens, these are toxins that cause obesity, toxins that cause autoimmune disease, toxins that cause neurologic disease, toxins that cause cancer, so even heart disease. But unfortunately, if we're really being honest with ourselves, if this is true, and it's clearly increasingly true, the evidence just mounting every day about the role of toxins across all diseases, what do we do about it other than reducing our exposure? So I'm gonna talk about that and I wanna talk about like medically what can we do? Therapeutically what can we do? And again, it may not be your guys expertise is what I've been doing for years. So we can kind of jam on it a little bit. But I'd love to hear your perspective.
- [45:33]
B
You know, I'll just say first for people that are listening, they should know that we should be embarrassed that we spend just 2 cents out of every dollar on prevention. Right. And so it shouldn't be a big surprise that we haven't done the trials, we haven't done the research and we haven't looked upstream. And so the L, so the P in the Parkinson plan is about prevent. The L is learning why we got to look upstream.
- [46:00]
A
Extreme.
- [46:00]
B
Right. And I just want to go back just for a moment on something that you said that resonated. And we had done an interview in the book and we talked to Buzz Jenna at Emory and Matt Lavoy at University of Florida and you know, talking about how, you know, one of the goals here should be the Zen ness of the cells in Your brain, right? And we call it like Zen Z E N. And we call it the Zen ness.
- [46:22]
C
The Zen Buddhist.
- [46:23]
A
Yeah.
- [46:23]
B
Because, you know, again, you think about. Okay, so it's in. In scientific terms, we say homeostasis, right? For purposes of talking to a population, we're talking about how does it enter your cells, right? And so you have a group of circuits and a group of cells that are in the brain. And it's like a thermostat. And what happens in your house when your thermostat goes out? It's too hot or too hot things, right? And then you end up with real problems. And when you do that over prolonged periods of time, that's an issue. And so when we talk about both the prevention of Parkinson but also the treatment of Parkinson, sin is an important word. So we talk about, you know, you keep your cells in. And we know that when it comes to toxicants, we know that they tend to go to the mitochondria and other areas in the brain. We know that the brain has to get rid of things, right? It's like a garbage disposal, right? And that's normal. It has. Actually there are cells that, you know, that have to eat themselves, right? You know, in order to stay healthy.
- [47:24]
C
Autophagy.
- [47:25]
B
Right, autophagy. So, you know, so it's really important. And then we discovered a system in the brain we didn't even know existed.
- [47:31]
C
The glymphatic system.
- [47:32]
B
The glymphatics, man, you're. We're like a mad lib now. We understand how important these things are. And then you start to say, ask yourself, okay, we gotta know why, learn why. So we gotta look upstream, right? We gotta understand why does a disease start? Why does it spread, right? Why does it progress, right? Those are key elements so that you're not looking downstream. You talked about the canary in the coal mine. Everything. We need to understand those things. And actually that's why prevention is so important and so important for us to think about, because we're thinking as far upstream as we can. And we also need to shift our science at the same time to be thinking more upstream and to be thinking. So when we talk about a few pennies on every dollar, we also need to shift our basic science to be thinking about these systems and the systems that are in place early on. When you look at a toxin and you say, okay, everybody's listening here. We got the toxin. I've been the medical director advisor for the Parkinson Foundation. Mark, just get rid of the toxin, right? Just get rid of it, right? Well, there's an acute exposure, right? Toxins, right? It's an acute exposure and a chronic exposure over time. And then you take something like paraquat, which has been in the news a lot, like a pesticide that sprayed. And by the way, it's doubled in use in the United States here.
- [48:49]
A
Weed killer that's sprayed on corn, cotton, soybean fields and continue on and it.
- [48:53]
B
Doubles in use and it's banned in 32 countries or over 30 countries. And great Britain ships it to us, but they won't give it to their own people. I mean, so you look at known toxins like this. Well, it's a challenge, right, because paraquat gets into the system quickly and it goes quickly to the mitochondria, it goes quickly to these systems and it clears quickly and it hits your lungs, it hits your brain, it hits all of these things. Hard to measure, right? Hard to get rid of. So we're going to need primary prevention to just step up and get rid of that. Whereas when we.
- [49:26]
C
Well, this is a political problem, right? This is an EPA problem.
- [49:29]
B
So the prevention isn't going to be a pill, it's going to be a policy.
- [49:33]
D
Policy.
- [49:33]
B
Prevention is going to be policy, not a pill, right?
- [49:36]
C
I love that. Prevention is going to be policy, not a pill. 100%.
- [49:42]
D
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C
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D
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- [51:18]
C
And sadly, and I was so involved in advising on some of the science around the MAHA Commission report, which got very mangled unfortunately.
- [51:29]
B
But we're hoping you're going to fix that.
- [51:31]
C
The lack of attention to detail on the speed at which it was done. A lot of the links were all messed up, but that the, the basic framework and content was right. And one of the things that had produced was like 40 or 50 pages on the role of toxins in health and it got removed down to just a paragraph basically saying, well, pesticides may be an issue, glyphosate may be an issue, but the science really doesn't show it yet, so we don't really know, so forget about it. And, and that was like so disappointing to me because there were a whole bunch of scientists that worked on that, this project that actually documented this for.
- [52:07]
A
Generations for their lives.
- [52:09]
C
So it's really, you know, we've got the, the agricultural industrial complex, which is a real thing that even the government is actually supporting indirectly through crop insurance and subsidies, which then are used to buy the agrochemicals that then are used to spray, that then are used to, you know, help the crops and help the farmers but ultimately hurt them and I think hurt the farmers most and hurt their families and then the rest of us downstream, you know, we have, we have to kind of go from field to fork on this. We have to go from, you know, factory to our closet and to wherever. We have to figure this out. And it's, it's not going to be easy. But the problem is that there's, there's such a dearth of research really on funding this. There's also, I think, a real lack of research on what to do once you have the toxins. And this is, this is an area that's sort of Been on the margins of medicine. I want to get into it in a minute with you because it's like, you can go to the environmental working group and you can kind of read their stuff and get a pretty good sense of, okay, here's. Here's the vegetables I never want to eat if they're not organic. Here's the fish I never want to eat unless, you know, like, unless it's ever, like, I'm not going to eat shark. I'm not going to eat swordfish. We're all like cesspools. And the question then becomes is you can do all these things and it'll reduce your exposures. You don't drink out of plastic bottles, filter your water, have an air filter, eat organic when you can. You know, these are all things that you can do. Have better skincare products, household products. That's easy. The hard part is, okay, you've got someone to walk in your eyes, office with Parkinson's disease, who's been exposed to chemicals, exposed to heavy metals.
- [53:37]
D
What do you do?
- [53:38]
A
So first off, we're all accessibles and we're all victims, right? Yeah, yeah. No, but some people. Take it, Take it. I know you don't, but, like, we're all victims, right? These are unnecessary. These are involuntary. Yeah, right. These are involuntary.
- [53:53]
C
If you're drinking like a six pack of soda every day, you know what you're doing. Yeah, but like, here we're just.
- [53:57]
A
The Marines at Camp Lejeune didn't know that they were drinking. And the burnt and Asian orange, and the list goes on and on. And people who work with these dry and cleaning camels likely don't know. Many of the farmers don't know that the pesticides are linked to Parkinson's. The vast majority don't. So the first thing you need to do is stop getting exposed. So if you are a smoker and you get diagnosed with lung cancer, what's the first thing the doctor's going to tell you to do?
- [54:21]
C
Stop smoking.
- [54:22]
A
Smoke smoking. But if you're a farmer and you're coming with Parkinson's, not farming. I mean, like, do we even.
- [54:28]
C
I have a patient with als, is a farmer, and he, you know, it's. It's heartbreaking because it's one of those. Again, one of those neurological diseases caused by toxins.
- [54:34]
A
Sometimes you find it early enough, you know, we could maybe stop it.
- [54:37]
C
Yeah, no, I stopped it and reversed it with him.
- [54:40]
A
So there are ways that we can do this. So if you're working with Parkinson, if you have Parkinson's, we give you in, in the book the Parkinson's 25. 25 actions that can reduce your risk if you don't have the disease. If you're one of 330 million Americans who don't have the disease, we give you 25 actions to reduce your risk of ever getting Parkinson's disease. Ever getting it. If you're not exposed to these chemicals, you are highly unlikely to ever develop Parkinson's disease. And if you already have the disease, they might slow the rate of progression. So I'll give you an actually concrete example. They looked at people who already had Parkinson's disease and they looked at people who lived in highly polluted areas of the country and those who lived in low polluted areas. People who lived in highly polluted areas had an increased risk of being hospitalized due to their Parkinson's disease if they lived in areas of. Of the. With high air pollution.
- [55:23]
C
Yeah.
- [55:23]
A
So you got an air purifier in the corner. We can get air purifier. When you're driving through traffic in there, just for you guys, when you're driving through Lincoln Tunnel, you know, roll up.
- [55:31]
C
Your window, put the recirculation on.
- [55:34]
A
Exactly. Recirculate the air. If you happen to live near fields that are being sprayed with pesticides, you know, close your windows. I mean, there are lots and lots of things that we, we can.
- [55:42]
C
I hold my breath while I fill up my gas thing. Literally, I hold my breath for though I like.
- [55:47]
A
And, and. But we need to create a world where we don't have to take all these actions. So what are things that we can do in our community? Can we stop spraying pesticides on kids? Schools and playgrounds?
- [55:56]
C
That would be a good idea.
- [55:57]
A
Right. And we wonder why 1 in 31 children get autism, yet we spray nerve toxins on their schools and playgrounds.
- [56:03]
C
What did TX actually say when he heard of the theory of evolution? How stupid not to have thought of that.
- [56:08]
A
So there are lots of things in our communities that we can do. And what are some of these societal actions that we need to do? And I'll let you talk about additional ways to address it.
- [56:17]
B
Well, so the other thing is, is that if you.
- [56:19]
C
Awareness is important.
- [56:20]
B
Yeah. If you're a smoker, you know, what's the first thing you do? You know, if you get lung cancer or whatever, stop smoking. Right. So, so, so, you know, this idea that, you know, you, you once you have the disease. Okay. Or once you have the diagnosis that you stop, you know, with these things is sort of another, another myth that needs to be busted. You know, it is the way that you live. You even talked about some of the people that you see within the functional medicine, you know? You know, in that paradigm, you're thinking about how can we help people to live better. Right? Yeah. So the Global Burden of Disease study told us something for those who don't.
- [56:58]
C
Know, that's like 195 countries, a study of chronic illnesses all across the world. It was a large epidemiological study, one of the best ever done, and it gave us a lot of information about who's suffering from what, where. So just 100%. Just so people know what it is.
- [57:10]
B
Yeah, so 100%. So back in 2012, I had written this book. 2013 or something, I can't remember now, but we wrote a book called 10 Secrets to a Happier Life with Parkinson s. And it kind of became this runaway bestseller. But it was like 10 simple things that you do. Right. And in the prologue of the book, I made either the unfortunate or the fortunate choice of two words called the Parkinson pandemic. And came under a lot of scrutiny from colleagues and everything, and rightly so. Right. I'm a scientist. I should be able to take.
- [57:38]
C
Turns out you were pressing see it.
- [57:39]
B
Well, you know, like, you have to put it forward. You have to, you know, these things need data. So then we write the book ending Parkinson's disease. In 2020, we have the first cut of that global burden of disease data. And guess what? Ray's better at math than me. He crunches all the numbers. And it turns out by 2035, we should have 12 million people with Parkinson's, which is like, wow, growing faster than Alzheimer's.
- [58:03]
C
So like, percentage wise, how much of an increase in that is like in 50 years?
- [58:06]
A
Oh, and well, in just in 1990, it's estimated. Estimated that 2.8 million people have the disease. And I'll see a little Michael's punchline. In 2021, they estimated that 12.8 million. A quadrupling. A quadrupling adjusted for population. So even if you adjust for population growth. Right. Population growth hasn't quadrupled between 1990 and.
- [58:25]
C
22 or 3 or plus times the amount, which is in just the last 30 years after.
- [58:31]
A
After medical school. Right. Since your medical school.
- [58:35]
B
12 million mark in 2035. How many do you have today? 2025. 11.8. According.
- [58:41]
A
You already got the 12 million 15 years before we thought it was going to happen. And when you went to medical school, you know, Parkinson's was there, but it wasn't like Everywhere?
- [58:51]
C
Oh, no, no. I mean, I've seen so many people with it.
- [58:53]
A
But now, like, anyone over 50, if you're over 50, you have friends, you have family members. You know, our inboxes are like, it doesn't stop. I walk the streets of New York and I'm like Parkinson's. And when I see em, I get pissed off.
- [59:05]
C
Why?
- [59:06]
A
Because it's a terrible disease and I think it's largely preventable.
- [59:09]
C
Yeah, yeah, right.
- [59:10]
A
Suffering is part of the human condition. Right. You write about this, but preventable, needless suffering. Really?
- [59:16]
C
Yeah, I agree. I think that's. That's our goal. I mean, for me, my life goal is to prevent needless suffering because, you know, we can't change everything. So just for the audience, what are the air, food and water things that they can do to reduce their exposures?
- [59:29]
A
So we give you the 25 recommendations in the book. I'm gonna read you. Number one one, wash your produce, even your organic ones. Mark you this better than we do. Pesticides have contaminated our food supply. Remnants of pesticides are found in 20% of common foods. Organic produce, dairy products and meat can reduce exposure, but can still have unsafe residues of pesticides. So wash your produce, at least with water. And consider simple vegetable washes, vinegar or salt solutions too. When the government measures the pesticide residues on a piece of fruit, they do that after they've held it under cold water for 15 to 20 seconds. If that's what the government's doing, think about what you should do. I'll do the second one. I'll give the last one to Michael. Number nine. Use a water filter. A sipping. A simple carbon filter water filter, widely available in supermarkets, can reduce exposure to pesticides volatile to organic chemicals like trichloroethylene and other chemicals that may be in your water. These carbon filters can be installed for the whole house at the point of entry. Entry. Or at the point of use, such as faucets or even water pitch, water pitcher. My colleague at Atria Health and Research Institute, Robert Kachko, will tell you reverse osmosis is even better. And I'll let Michael maybe take number 10.
- [60:44]
B
Yeah, so you know, yeah, I do reverse osmosis in terms of your air. You know, number 10 is consider air purifiers. They're an easy, effective way to lower your risk of disease from indoor air pollution. Air fire, air purifiers do a range in cost. They can be as little as $10, as high as a thousand dollars. I mean, sure, the one. Mark, how's us breathing Here has got to be the $1,000 one.
- [61:05]
C
No, it's not, actually. It's a few hundred bucks.
- [61:07]
B
All right, 300 bucks. And require periodic cleanings. And remember, they need filter changes and may need to be installed in multiple places, depending on the size of the home, school, or workplace. Be sure to use air purifiers that have carbon filters. They're designed to remove the volatile organic chemicals, VOCs like trichloroethylate, which you all know from dry cleaning story. And everything is so important in Parkinson.
- [61:31]
C
This is great. So these are simple things that people can do every day. I have an air filter in my bedroom, and in the place I spend the most time, I have a reverse osmosis water filter. You know, I think Those are the two most simple things you can do at home. Plus, go to EWG.org and make sure you clean out all your crappy household cleaning products and your skincare products, and you'll get like 80% of the way there.
- [61:53]
A
And a shout out to Ken Cook, the outstanding leader of the environmental working Group. He and his team are helping us understand what are the role of these chemicals in our environment in our health and how to get rid of them.
- [62:03]
C
You know, we could talk about, you know, the role of toxins for a long time, but, you know, we, We. We kind of covered a lot of the sources. But I, I kind of want to spend a little time on. On. On people who actually have Parkinson's and who are struggling. You know, there's been really shitty drug development in this disease. There is some really exciting new surgical interventions that deep brain stimulation. You know, Dr. Machado at Cleveland Clinic, who I worked with, was one of the pioneers in this a. And I.
- [62:31]
A
This guy's one of the pioneers right here.
- [62:33]
C
Yeah, you know, you. You obviously read your work has been. Has been very involved in this, and that's a huge boon. It's. It's a, It's a big win. But it doesn't address the. It's just like a downstream sort of better mousetrap to fix the problem. But it's actually, we still have the mice. I, I would love to hear from your perspective from like a diet, lifestyle supplement, detoxification. What you guys know, I would love to unpack what people can do and can. In the answering of that, can you actually reverse it or stop it? Because right now there's like, clinical trials, for example, in Alzheimer's, like the finger trial, the pointer trial, Richard Isaacson's work, where they're showing not just slowing down of the disease but actually reversing it with intensive lifestyle therapy and risk factor management. So do we see that in Parkinson's? Have you seen that in Parkinson's? You have guys like Delbresen who people think may be a little bit off the rails, but honestly, he's not reversing Alzheimer's. I just talked to one of my patients two days ago who I've been treating for two years and she was diagnosed with Alzheimer's and now she's better and back to work.
- [63:41]
B
Let's unpack a little bit and let's just start with sort of a few piece. So we need to change the way that we practice when we interact with folks with Parkinson s. You know, it needs to be practical, proactive and preventative. Okay. We need to be thinking of those three P's when we're interacting. And I know you might forget one.
- [64:02]
C
Personalized.
- [64:03]
B
Well, personal. We can keep going with peace too. And. But, but, but. Absolutely. Although I will say just, you know, like in general, you know how people make things a little too cliche sometimes people say personalized and that's going to cure everything. I say, well, what does that mean? Like.
- [64:16]
C
Well, the reason, the reason I say that is is because if you have a diagnosis of Parkinson's, it doesn't mean you know what's really wrong with you. Like I always say, if you know the name of the disease, it doesn't mean you know what's wrong with you. You don't know the cause, you know the name of the symptoms. Symptoms which can have many causes.
- [64:31]
B
So Parkinson's disease, here's another myth. It's not Parkinson's disease, it's Parkinson's disease is right. There are multiple causes, there are multiple syndromes. No two people look alike. And I remember sitting next to Davis Phinney in the White House having a nice discussion with him and he said, when you have Parkinson's, you gotta make every day your best day. That always stuck with me. And then when I made my comments, I said, I think Parkinson's is probably the most complex disease in clinical medicine. And I don't mean to insult other people in different diseases, but think about it. Dozens and dozens of motor tremor, stiffness, slowness, non motor symptoms, anxiety, depression, constipation, sleep, cognition. So you've got all of those things, plus you've got this miracle drug, dopamine. You give people dopamine, they wake up and then of course there are fluctuations later. Then you've got, as you mentioned, deep brain stimulation. You've got dozens of different medications. Oh, and by the way, changes over time. People wear off, they get these dance like movements. It is a super complex disease. Okay? So when you take all of that, we need a different paradigm to care. And so unpacking the first part of your question is we're doing it wrong, Mark. Like we're caring for people wrong. So when we have hiv, we're able to create navigators. We're able to check people's viral levels. We're able to get people. Listen to this. Mind blowing for people. We can get. Get really expensive cocktails of drugs for people all over the world who have HIVA for. And you can't get L Dopa pennies on the dollar. So we call for that as a bold action in the book 100% of people on this earth on planet. If anybody's listening, you know, we need to.
- [66:14]
C
And L. Dopa is the drug that's the main say for Parkinson's treatment. That increases dopamine, which is what gets depleted in the brain when you have Parkinson's.
- [66:22]
B
And it's a game changer, right? And so super important to think about that. And in cancer, we do better the way that we bring together the right teams. So thinking about this, we propose. We used to say the person with the disease or the patient is the sun. And we revolve around the patient. I'm like the broken record of saying this for 25 years at the institute I work at called the Fixel. And now we've expanded that to be the Parkinson universe. And let me just explain that for people listening a little bit. So of course the person with disease is the sun and we should all orbit around that. But what's the closest planet to the sun? Sun. Mercury. Mercury is your caregiver. Gets a little hot being the caregiver on both sides because you're in between that and then all the other planets which are all these different specialists. You might need a neurosurgeon, a neurologist, a psychiatrist. Mental health is huge in this disease and a problem throughout the world, not just in the United States. All the rehabilitation specialists, PTO T, speech, swallow, et cetera. So you need all of these people orbiting at different areas. And then you've got Mercury, the caregiver and the. The middle. Got to take care of the caregiver. Okay. More men than women get Parkinson's. But guess what? When a woman gets Parkinson, they don't do as well as men. And the reason is the caregiver and the care partner. So we always should. We should be Challenging men. I'm sorry? Men. All the men that come to the clinic. I challenge all of you care better for your friends. You need to step up. The data says you need to step up. Okay, and then Pluto is the almost planet that stigma. 25% of people hide their diagnosis with Parkinson disease. Unacceptable. So, so. And then, and then what else, Mark? So the stars are all the support groups. Right. And then, and then the, the. All the satellites are the sensors. We have all these great sensors. I got some of them on. I think you've got sensors too, and watches and rings and all these things. Right. That can help us with sleep and exercise and making sure we're doing all those things. Bringing telemedicine. Ray is an absolute pioneer in bringing care to the home for Parkinson.
- [68:19]
C
Well, I thought that was an interesting thing you said in your book because, you know, just. It annoys me to no end that the body doesn't change when you move from New Jersey to New York or from California to Nevada, but your license does. And you can't treat a patient in another state, which is the most stupid thing in Europe. If you're a doctor in any country, you can treat a doctor anywhere else. We uplifted those restrictions during COVID and then we put them back in and it's crazy.
- [68:44]
A
And who loses?
- [68:45]
C
The medical boards who make.
- [68:47]
A
Yeah, but the patients lose.
- [68:48]
C
Patients lose. Yeah, it's just a money draft because every state has a licensing board and they're all making millions.
- [68:53]
A
So we should make it so that any Medicare beneficiary, any patient, and receive care from any clinician that they need to.
- [68:58]
C
Absolutely.
- [68:59]
B
So thank you for saying that out loud. Like sometimes we think it, but we don't say it. So thank you for saying it out loud.
- [69:03]
C
I'm working on a telehealth bill also in Congress, so we're on that.
- [69:07]
B
So maybe for the last two decades with Parkinson S foundation, we may have spent a lot of hours advocating so that your care is defined by where your physician or healthcare provider is, not where the person with disease is. It's a very simple concept that we just can't seem to get. And then we did a red card campaign in our last book ending Parkinson S. We actually took over the White House and sent thousands and thousands, like 20,000 plus cards. One of the things we called for was just this, watch out. The COVID restrictions on telemedicine were lifted. It's going to go away. Pay attention. We need that. And so it was one of the three things that we asked for.
- [69:49]
D
So Is there more?
- [69:50]
C
Because what you're talking about are sort of structural changes in the care delivery model.
- [69:55]
B
Yeah.
- [69:55]
C
What I'm really trying to get out here is like, doctor, patient, what are the therapeutic interventions other than just the social support and the structure and the care coordination? All the things you're talking about which are really important. But like, I'm trying to get to the granular level of, like, if someone's listening with Parkinson's or someone in their family has Parkinson's, like, what do I do? Is there a way to slow this, stop it, reverse it?
- [70:18]
B
Yeah. So the practical. Now you're to the P of practical, right?
- [70:21]
C
Let's get practical.
- [70:22]
B
Right? No, that's good. All right, so. So we think about practical, right. The practical advice now that we should be giving that most people don't is, guess what? When you take dopamine, dopamine, the most common drug for, you know, for Parkinson's, very important. Still the best drug we have. Ray likes to say, what a travesty that here we are 50 years after, and it's still our best drug in the armamentarium. Right. That should be unacceptable, too. But having said that, dopamine depletes cofactors in your blood, and so your vitamin B6 may go down, your homocysteine may go up, you know, other things that might put you at risk for dementia and other things. So guess what? From a very practical standpoint, you need to be on at least a general multivitamin. I call it like a Centrum equivalent, because most people, I don't favor Centrum over any other company.
- [71:08]
C
But don't take the blue pill.
- [71:09]
B
Right. I'm not, I'm not that.
- [71:11]
C
But you don't want to take pills with dyes in them and titanium and.
- [71:14]
B
No question about that. But, but, but, but you're just adding more. But, but fundamentally, thank you for saying that. Again, you get to say the things.
- [71:22]
C
Talking to the expert here.
- [71:23]
B
I know, I know. Mark gets to say things out loud that we can't. But from a practical standpoint, you send people to the show, say, and say you want to look for a good multivitamin, because this is going to be super important. Right? And then when you're going to your general doctor, you want to have them check vitamin levels on you at your regular thing. They're checking. You know, we're so preventative in cardiology, Mark. Why are we not in neurology? Right. It's ridiculous, Right. Vitamin E levels are low, you know, in Parkinson S. Right. Vitamin D levels are low. Right. And then it's a double edged sword with vitamin D because we should be telling folks it's twice the risk. Did you know that? Twice the risk of melanoma and Parkinson disease. You sweat different, you smell different. You know, Joy Milne was the famous UK person who could smell Parkinson's disease. And then they said, you know, you talked about quack. They said she's a quack. They put her to the test. Sure enough, there's a smell. So you sweat differently. Remember, it's a full body disease. It's in the skin and everything. And you're not as well protected against the sun. And so we need to tell people about that. And of course, practically speaking, you can get seborrhe and other things with skin, twice the risk of osteoporosis. Are you getting regular bone scans? I know this sounds like so. And we wrote the book ten secrets. You think everybody knows this, but they don't. Two times the risk of that. So we need to pay attention to those things. And then in addition, as we're seeing folks kind of along the way. I know, and Ray may want to talk about this. We need to shift our discussions with them to sort of include the why. Figuring out what is your real history. And I was kind of jealous when you said in functional medicine, we always start the visit with the person. And Ray and I have taken care of thousands of people with Parkinson s. We didn't always do this. You always start the visit from the beginning. You know, it's like, you know, Mel Brooks in history of the world don't know the beginning of time. Right. You start from the beginning and you want to know what that story is. And I don't know if you want to comment on that.
- [73:16]
A
So I'm going to go to slow, stop and reverse. So can we slow it? Yes. Can we stop it or reverse it? No evidence that we can do that today. But let's talk about slow.
- [73:26]
C
I'll jump in on that. I know.
- [73:27]
B
We're going to.
- [73:27]
A
We're going to.
- [73:27]
C
It's, it's, it's anecdotal. I would say it's anecdota.
- [73:31]
A
Okay. Anecdote. And so we're gonna. So slow. We told you, do 25 things. Stop getting exposure, toxin. We got that next one is exercise. So exercise is probably this century, the biggest therapeutic advance. Sir William Gowers, when he described Parkinson's disease In the late 1800s, he said the life of someone with Parkinson's should be quiet and restful. He was wrong 100%. If you have Parkinson's, you cannot be quiet and rest.
- [73:54]
C
Boxing thing is a real thing.
- [73:55]
A
That should be loud. You should be boxing. You should be knocking out Dr. Hyman in the ring with Rocksteady boxing 7,000 steps a day. So we increasingly know that vigorous exercise, amount of exercise to make you sweat, has enormous health benefits. And it turns out it doesn't appear to be which exercise. Whether you like to box, non contact boxing, you're not hitting people in the head, whether you like to swim, whether you like to jog, it's all beneficial.
- [74:20]
C
The pugilistic Parkinson's, the mild, we had.
- [74:23]
A
We don't want that.
- [74:23]
B
And we talk about that too.
- [74:26]
A
And so it turns out that exercise, as you know, releases brain growth factors in the brain, and it likely protects remaining nerve cells and protects them from dying off. Our colleague, Dr. Boss Bloom has even shown that, you know, you can see these changes on imaging. So now with imaging, you can actually see beneficial therapeutic effects of, of exercise. And then Michael and I both have had patients who have one either not taking medicine for many years because they were just so prominent on exercising two, three, four hours a day that they've delayed their need for, for medicine. And we have had patients who've been able to come, who've decided to come off medications and just treat their Parkinson's disease with exercise and other behavioral factors.
- [75:06]
B
Although we don't recommend that in general, in general. But, but it, but it's something we have to have an open mind to.
- [75:11]
A
And you said, you know, anecdotes, do we see this? So now you want to say stop and reverse. So, you know, what gets measured gets managed. What gets measured gets managed. And so we.
- [75:20]
C
And you got an mba, so, you know, that that's. What's his name? Drucker.
- [75:24]
A
Peter Drucker. And so cholesterol. We came to the age where cholesterol was starting to be measured. We only got statins and everything like that because we started measuring cholesterol, hemoglobin A1c, right after we did our training that we're going to measure the glycolization of hemoglobin as a measure of diabetes. And we do that. But are we measuring. I have never in my entire life. I'm a neurologist. Many pesticides are nerve toxins. I have never measured a pesticide pesticide level.
- [75:53]
C
Oh, I can help you with that.
- [75:54]
A
Okay, but.
- [75:55]
C
Exactly.
- [75:56]
A
But if we're not measuring pesticide levels in, in people's bodies, how can we manage and see if we're taking steps to reduce it, when we did that with lead, when we measured lead in children, we got really, really serious about getting lead out of paint and lead out of gasoline.
- [76:10]
C
Problem is you need a fat biopsy to properly assess.
- [76:13]
A
Exactly.
- [76:13]
C
But there's other ways.
- [76:14]
A
And so there are fat biopsies. So if we start to measure these chemicals in our bodies, whether that's in our blood, our urine, our, our fat, our hair or stool, we can take better actions to be more informed. And if we can start measuring these chemicals in our environment, in our water, in our household dust, in our soil, in our air. You know, we have a thermostat in this room. Why don't you have a.
- [76:34]
C
There's actually body things you can now wear that will register the, the ppms or particulate matter in the air.
- [76:40]
A
So why aren't we, why don't we have a thing that's measuring particulate matter in, in our air? Yeah, right. That's a more. Greater determination.
- [76:46]
C
Indoor air pollution is a big thing. Yeah.
- [76:48]
A
Greater determination of our health than the temperature. What gets measured, gets managed. We need to start measuring these chemicals in our bodies. We need to start measuring these chemicals in our environment so we can figure out what interventions which you're going to talk about in a second can reduce these things in our bodies, in our environment so we can all live longer, healthier lives and perhaps low, maybe get to the point that we can stop.
- [77:07]
C
So even in, you know, you just said something like, you know, I never measured a pesticide. So an academic measure, medicine, other than maybe checking your blood, mercury or lead, maybe your arsenic. Like doctors don't know what to do, don't know what labs to send things to. Don't know how to test them. Right.
- [77:22]
A
They're not widely commercially available. You can't just check them off, generally speaking on a lab form.
- [77:27]
C
Increasingly now they are like they are.
- [77:29]
A
You know, when we weren't training this would be like.
- [77:31]
C
But we need to start measuring these things. The body has this embedded system for removal of toxins. Your, you know, sweat, your, your breath, your poop, your pee, your liver. Detox systems, you have enzymes and I think, you know, as we're beginning to understand genetics, I think in we're now we went from a billion dollars, I think it's now 300 bucks to get your whole genome sequence.
- [77:52]
A
Yeah.
- [77:53]
C
You know, you can actually start to see, oh, I have these detox pathways that may need a little help or my methylation pathways that help also with detox also need a little help or you know, I, I have certain Increased needs for X, Y or Z nutrient. Or one third of your genes code for enzymes. Enzymes require cofactors or coenzymes. All those are nutrients, like so. And we have huge variations, as Bruce Same says, in our need for different nutrients at different doses. So we're all very soon going to be able to sort of create a roadmap of prevention and go, oh, here's your genetics, here's your potholes, here's what you need to do to fix those and prevent it. And so, you know, one of the things I want to dive into is one, how do we detox? And two, how do we resuscitate our mitochondria? Because, you know, I don't know if you know, Suzanne Go, she's a pediatric neurologist, Harvard trained, Oxford trained, you know, publishing a journal, you know, jama, and is basically discovered in autistic kids using very sophisticated MRI imaging, functional MRI imaging at their mitochondria aren't working. And she provides them mitochondrial cofactors, CoQ10, carnitine, things like that. And they actually get better. Now, I'm wondering, I read a study years ago where there was. They used like 1200mg of CoQ10. Like normal, when you take CoQ10, you take 50mg or 100mg. They're using 1200mg, and they found an improvement in their clinical outcomes. So is there any conversation among your colleagues and neurologists, like, how do we put together a comprehensive mitochondrial rejuvenation program? And what does that look like?
- [79:30]
B
Yeah, so, you know, it's a great question, and I think part of it, too. You know, Tony Lang is one of the leading neurologists in our field in Parkinson disease. And when we were talking about him and doing interviews, you know, with him, about the book, you talk about when something has dysfunction so it's not working properly, or something's kind of dead or degenerating, you know, and, like, where is it on that spectrum? Right. And so I think one of the challenges for us is understanding which segments of our cells. And we talk about the Zenness, trying to get ourselves more Zen. Which segments of the Zen are still functioning and can we rescue them, which is what you're talking about, and could you rescue them with, let's say, higher dosages of CoQ10 or something else, and which are too far downstream? They're already gone. They're too far downstream, or we need to look more upstream for the answer.
- [80:27]
C
Yeah, I Mean, you're right. I'm going backwards. I'm going, how do you fix the mitochondria? I realize, how do you fix the toxins? So let's go back to the toxins, but stay with the mitochondria for now.
- [80:36]
B
Yeah. So we know when it comes to toxins for Parkinson S, we know that when you take toxins. And we have a very good friend, he was a mentor of mine at Emory named Tim Greenemeyer. Tim Greenemeyer studied a toxin called rotenone, common herbicide in people's garages. They used it in the Creature from the Dark Lagoon. They put it into the water and make the fishes all die instantly. Common to the top. Great visual effect. Terrible if you're the creature. Right. Who's in the water. But he actually now has Parkinson S himself. And he wrote an article and was interviewed and went public with it in a very, I think important magazine. I think it was in Science, which is very credible, reputable magazine, maybe on the top levels, I think talking about this and talking about the lack of protection. But the thing about rotenone that he studies is it's like mptp, which is the other toxin that came from the designer drug. You know, where they were trying to make a drug called MPP and they made MPTP instead. And people started down with Parkinson, the frozen addict. If you ever watch the old PBS special and read the book by Bill Langston, amazing story. And it was because of recreational drugs that we actually got our best early animal model. So people say, oh well, maybe recreational drugs are bad, maybe not. It spurred decades of research in Parkinson and important research for my mentor Malan delong, Wrong in others. But what do those toxins do, Mark? What does that.
- [82:04]
C
Mitochondrial poisoning.
- [82:05]
B
Yes, complex one of the mitochondrial system. And in fact it's non selective for mptp, which is what we worked with.
- [82:12]
C
What was the street name of that drug again? Like Crystal something?
- [82:15]
B
Yeah, it's a, it's a, it's a.
- [82:16]
A
Form of heroin that.
- [82:18]
B
Yeah, it's methamphetamine. It's a methamphetamine, an ecstasy, you know, sort of in that, it's in that, that category of drugs. But it was a designer drug maker trying to make a designer drug. He just got one little thing wrong on the Internet of that. So you take this complex one and the one that Greenemeyer was working with, which was different than my mentor who worked with mptp. That one only does brain cells. It only hits complex one in those dopamine cells. Okay. And the brain, it's very specific toxin to that. And then Greenmeyer himself ended up with Parkinson disease and talked about how he probably should have been more protective. And he's very open about his story. And I, I think that's a really great thing. And the question is access to. So let's say somebody in functional medicine wants to address mitochondrial dysfunction. Awesome idea. And there are a lot of drugs out there that are addressing it. You got to beat the leaky brain. So that's good, right? You got to beat the leaky brain. You got to get. And there's mitochondria in other areas besides the brain too, that may be affected as well. And then you've got to figure out how far down the system is it gone, what's the, the dose response on that? And here we are spending like 2 cents out of every dollar on prevention. We're spending like zero on every dollar trying to figure out, you know, how we could actually try to resuscitate and improve the functioning, make those cells more Zen.
- [83:43]
C
Well, this is really important, what you're saying, because, you know, one of the failures of modern medicine came out of Louis Pasteur, which had a lot of benefits, discovered bacteria, but it was like, oh, there's a single single cause for a single disease treated by a single drug. You've got pneumococcal bacteria causing pneumococcal pneumonia treated with penicillin. Boom. End of story. And we've been chasing that false tiger for a hundred and plus years for chronic disease, which it doesn't apply. And these conditions are all multifactorial, meaning there's multiple causes and you need multimodal treatments, meaning you need a lot of different things. You mentioned exercise, you mentioned reducing your exposures. You mentioned, you know, mitochondrial therapy. You mentioned l dopamine. There's lots more things. And you can't just do one thing. And people will say, well, you know, how do you do a randomized control trial? You don't know what works. Let's just try Coq 10. Oh, no, let's just try lipoic acid. Or let's just try blah, blah, blah. And I'm like, no, it's like saying, we're going to create, we want to win the NBA playoffs, but we're only going to put Michael Jordan on the team. And he's got no other players on the team. He's going to lose every time. Right? So, you know, I think, I think this is a fundamental flaw in research. And I don't know how to answer that.
- [84:53]
B
Well, let me Just add like, just add on to that and just pile on a little bit and just say we talk about in the book about combination therapies. Remember carbidopa? Levodopa is a combination therapy. You need the two to get it to the brain, right. And to reduce the nausea, get it out of the blood and up into the brain, pass the blood, brain barrier. Right. That leaky area. Right. And HIV drugs. We talk about HIV drugs and heart therapy, which was, you know, where you take a bunch of these drugs together in combination and that was the winner. Right. You talk about cancer, chemotherapy. Malcolm Gladwell loves talking about this, telling the story. We tell a piece of that story. Again, the most disagreeable guy at NIH ever, that you wouldn't want to be in the same room because he's, you know, such a curmudgeon. It takes a guy like that to challenge the system to cure these kids with leukemia, put these combinations together. Now we're so far down the road and yet we're still not thinking in combinations. And so I just wanted to add on to what you're saying, you know, like, what are we doing here?
- [85:49]
C
Well, so I think I'm going to come back to the. How do you remove toxins? Because that's like going upstream. But you know, often like you can intervene with mitochondrial therapies and you can, can get pretty, you know, I would say complex because there's a lot of different pathways, a lot of enzymes, a lot of steps. So Coq 10 we talked about, we didn't talk about this, but NAD or NMN, which is a common longevity now supplement, but that actually plays a big role in mitochondrial function. Creatine, which has been shown to help you have been different neurological diseases, helps your thinking.
- [86:21]
B
And some of you think recent studies.
- [86:22]
C
Yeah, that's why I'm so smart. This morning I did my 10 grams of creatine. I had chronic fatigue syndrome as a result of mercury poisoning. Living in China. And I can tell you my CBK, which is muscle enzymes, were 600 for years until I figured out how to fix my mitochondria. So, you know, then there's things that help like other antioxidants like N acetylcysteine, things that boost glutathione. There's phytochemicals like resveratrol, curcumin, green tea extract, carnitine, all the B vitamins that your cofactors, particularly riboflavin, Niacina and B1, I mean B2, B3, all the methylation vitamins, B6, folate, B12, magnesium and even there's interesting things like peptides like SS31 and humanin and mot C which are kind of a little bit beyond the conversation we're having here. But that our, our body's own biological way of regulating our mitochondrial function. Peptides are essentially the body's like communication superhighway system. And we, we've been using them in medicine for years. Insulin's a peptide, GLP1s are peptide. So like they're, they're, there are things that can help the body function better. So what find is those things can be really great. But you have to first deal with the gut. You have to first deal with reducing toxic load. And so that's where I think, you know, you know, we really need to start funding these trials on using these, these multifactorial assessments. Like, let's look at all the potential causes. Do you have mold? Do you have mercury? Do you have pesticides? Do you have, you know, stuff from your household cleaning chemicals? Are you exposed to particular air pollution? Like what's your.
- [87:50]
B
And we have AI we have the ability to now deal with multiple factor, right? Like never before, like today in the age that we're in. Yet we don't study these, we don't.
- [87:58]
C
And then, and then, you know, we, when you understand those, you start to kind of address all those systematically and then you start to resuscitate and repair the body. So you take out the bats that put in the good stuff. That's what functional medicine is really. And I think. You know what I'm also wanted to ask you about before we get into the whole detox thing, because I think I don't want to just end because we're going on a long time. I can talk to you guys forever. Recently there's been some real advances in blood biomarkers for alcohol, Alzheimer's like P Tau 217 and Neurofemin Light Chain and other biomarkers. Are there biomarkers for Parkinson's because it's a syndrome. What it means is a syndrome is that it's a clinical diagnosis. You go to an expert, you meet these criteria for these features and we go, okay, you got Parkinson's. But it's not like you do a blood test for blood sugar and you see you have diabetes. So is there now or will there be soon? Blood biomarkers?
- [88:51]
B
So Alzheimer's is just a little bit ahead of us. And you know, and they have evolving and people should understand these things are evolving because we get better and Better. And we should get better and better. It shouldn't be a static type of deal. Where we started was by saying, oh, we just have the clinical examination. But if you only train 40 or 50 docs or healthcare practitioners in the United States alone, and Medicare doesn't even cover those, they're covered by grants and philanthropy and things like that. Like that, we are going to have a public health crisis. We already have a public health crisis. All right. So we're going to need biomarkers both to tell we have the disease and also to tell how the disease is progressing over time. And so when we make measurements on all these things that you're interested in, we have a way to biologically measure them. So the things that we have so far, okay, so we've got a test called a dopamine transporter test. It's a 1, 2, 3. It's a cocaine analog. Don't get scared. You don't get cocaine. Or don't get excited. Mark another way or. But it's a test that you can tell how the dopamine transporter is in the brain. Doesn't tell you if you have Parkinson S or not, but tells you you have a dopamine transporter deficit.
- [90:00]
A
And it's an imaging test.
- [90:01]
B
It's an imaging. Right.
- [90:02]
C
It's an mri.
- [90:03]
B
Take a picture. It's like a nuclear medicine test.
- [90:05]
C
Nuclear medicine, yeah.
- [90:06]
B
So we have that we now have. You know, there was a 21 center study that was just signed by David Valencourt. I was part of that study from the University of Florida. He developed free water imaging. So we can tell the difference between Parkinson S PF and another mimic called msa. So there are two other Parkinson common mimics. These are things that look like Parkinson S but aren't exactly Parkinson Progressive supranuclear palsy. Dudley Moore had MSA is multiple system atrophy. Has all those autonomic features, the fight or flight things associated.
- [90:36]
C
So in English, it's diseases that seem like Parkinson's, but aren't it that you can kind of test for.
- [90:40]
B
Exactly. And now we can do something the eyes can't see. It's really cool. The eyes can't see it, but the AI can. So they can take your MRI with this six minute sequence and tell the difference between these diseases. And then the latest evolution has been blood and skin tests.
- [90:56]
C
Yeah, blood, yeah.
- [90:56]
B
Okay. And so people are really interested in measuring the protein called alpha synuclein. Okay. So you talk about P Tau217, which is really hot and really important for Alzheimer's disease. People have been talking about alpha synuclein, which is that protein that gets deposited in something called the Lewy body, again named after the guy, Louis, who described it in the microscope. Right. So.
- [91:16]
C
But Lewy body is like a combo of Parkinson, Parkinson's and Alzheimer's.
- [91:19]
B
Yeah. So that. So.
- [91:20]
A
So the Parkinson's. But like, it's like. It's like the beta amyloid plaque that you see in Alzheimer's disease. The pathological hallmark, what you see under the microscope, is a Lewy body garbage.
- [91:30]
C
I've had many patients with that, actually.
- [91:32]
B
So we're interested. Right. In measuring that. And that is huge. Right. So when we can start to measure that and the. The fluid that bathes your brain and spinal cord, called the cerebrospinal fluid, so.
- [91:42]
C
You have to do a spinal tap.
- [91:43]
B
Well, that's how it started. Started, you know, with. With spinal taps and. And looking at it. But now, there are now evolving ways to look at this in the blood and in other areas, and it's getting better and better. And then also skin. So skin biopsies. You talk about fat biopsies, but skin biopsies. And then, you know. No, for.
- [92:01]
A
For synuclein, the misfolded protein is not just found in the brain. It's not just found in the gut. It's actually found the skin.
- [92:07]
C
And just for people understanding, like, you know, genes make proteins. That's all they do. And one of the hallmarks of aging is proteostasis, or just funky, merely misshapen. And folding proteins that don't work properly.
- [92:22]
A
Yeah. So you fold the sheet and, you know, if you have a regular sheet that's easy to fold and it's nice and neat, but trying to fold a fitted sheet is a really big pain in the behind.
- [92:29]
C
Exactly.
- [92:29]
A
And so a fitted sheet is always misfolded. And so in Parkinson's disease and Alzheimer's disease and ALS and a lot of other brain disease is the hallmark of the disease. When you look under the microscope, are.
- [92:40]
C
Mispronouncing, but I don't know if this is true. I'm just hypothesizing because the genes make proteins and the proteins have functions and they're damaged because of environmental factors that change the gene expression or the. What we call post translational gene products, the thing, the proteins that genes make through proteomics, which is like a new way of actually testing large numbers of proteins in the blood and very low cost. Are we seeing protein signatures of Parkinson's that can be identified?
- [93:10]
B
Yes, we are starting to see them. But as we get more data, we're overwhelmed by the data where AI is helping us. But now you have imaging, you have blood, you have spit, you have, you have skin. And the answer isn't going to be in one thing. People like to go binary, yes or no, because it's like, if you're making.
- [93:25]
C
A difference, how do you know? Like, I know if I had 10 with Alzheimer's and I check their P Tau 217 and I do 10 things and I check it against the six months from now, it can go down.
- [93:35]
A
What gets measured gets managed.
- [93:36]
C
Right. So is there anything like that coming?
- [93:38]
B
So that is right now, like right now, Mark, what so many people all over the world, multiple laboratories are working on, because we're not quite there with the statistics to say it's good enough yet, but we're smashing these tests together. And my prediction is, and I think Ray feels the same way when we were writing the book is it's going to be a combination of these tests that are going to give us those markers. But what you said is so important and I just want to reimagine, emphasize that we have to be able to measure trajectory. It's not good enough to just diagnose. We don't need a biomarker just for diagnosis. Like, you can see a lot of Parkinson S. You know, it's a clinical.
- [94:13]
C
Take a stat and your cholesterol goes down.
- [94:14]
D
Right.
- [94:14]
C
Like, you want to know what?
- [94:15]
B
Yeah, you have Parkinson S. If you respond to the dopamine and everything, that's pretty doggone good. What we need to do is we need to be able to see how it changes over time. And then when we intervene, you know, do these things that we're given, because it might be some of the things we've tested actually did work, but we couldn't measure it as, as Ray said. And so it's a, it's a problem. It's a challenge, let's say.
- [94:35]
C
Yeah, this is really great. I want to wrap up because, and I don't want to put you on the spot because you didn't learn this in medical school. And I spent the last 40 years studying this, which is how do you help someone detoxify? How do you measure toxins? How do you detoxify? So in functional medicine, we can do heavy metal challenge testing. We do blood testing for heavy metals. We can do blood testing for things like pfas, bpa, glyphosate, also urine testing. You can look at urine testing for, for a lot of the things like Atrazine and all the things like the pesticides and parabens. So we can actually look at all these things in the urine. And there's specialty labs that do that. It's typically not your average lab. And then we can get a sense of, okay, based on someone's history, based on their load, where are they at? And then we design a detox program which essentially which uses all your body's built in waste management systems. Right? So sweat, sweat saunas are a great way to mobilize toxins. Making sure you drink a lot of water and pee and clear urine, simple fiber, like make sure you're pooping and not constipated. You know, I had a patient once, I said, do you have regular bowel movement? She goes, yeah. I said, how often do you go? She goes well I go once a week. I'm like, what do you mean that's not regular? She goes yeah, it's regular for me. I go every week, you know, but you want to go every day at least once or twice. These are just basic things. And then there's all the things you can do to upregulate your body, body's own built in detox pathways and that includes things to do to with diet. So you obviously reduce all the crap in your diet, all the sugar, all the processed food that goes without saying. But there's certain foods that have the ability to boost your own detox enzymes like glutathione, which actually you can use intravenously in Parkinson's and temporarily see reductions in tremors. So it's really, it's like one of the most important anti inflammatory mitochondrial compounds. So we basically, basically give them broccoli and collards and kale and other things like garlic and onions that boost that and we give them foods that help with B vitamins and methylation and we do all these sort of dietary interventions and we even talk about maybe keto diets may be helpful. And then you kind of obviously can fix the gut. And that's a whole nother functional medicine domain. But in terms of the detoxification, you know, there's chelation which can be used for heavy metals and that's been published. Adt, chelation, DMSA chelation, these are things that are published in jama. And in fact in one study they did it for kidney failure and they found that people that had lead, they're more likely to progress to dialysis and they did ET chelation and those who went through it didn't progress. So we have some data, we don't have enough, but we have some data. So you can do helation for every metals and then for the mitochondrial rejuvenation and the cellular removal of toxins, it's a lot harder. And this is where things are kind of, I think need some funding to see what's going on here. Because clinically I can tell you when we do things like give intravenous glutathione or intravenous NAD or we give something we call the PK protocol, which essentially is a cellular washout. It's like using high doses of the fat phosphatidylcholine that your membranes are made out of, where all this toxins are, it flushes them out and then you also combine it with things like glutathione and the B vitamins and carnitine and you see people's mitochondria come back online. And I have a patient who's like a rock star and, and that rock star couldn't play the guitar because they had Parkinson's. And all of a sudden they did this protocol and boom, they're back on tour. So I think there's a whole bunch of things that aren't drugs, that aren't anybody's going to fund, you know, a billion dollar study unless it's the government or philanthropist, but that actually have real promise. And I would love to sort of hear your thoughts on how we start. Start to take some of these things that are in the anecdotal or anecdote stage and actually start to apply them and do clinical trials sort of like Richard Isaacs is doing. Because what all you guys are talking about in here is amazing and it's going to peel a lot of the way there. But there's a whole other level of thinking about this. I'd love to just get your final 2 cents on.
- [98:32]
B
I think I love the term anecdote. Right. And I think that's really important. And I'll just say it's tricky because in the New England Journal they tried. There's a whole bunch of iron as you know, in the brains of folks with Parkinson s and everything. So they tried to use the standard, you know, chelation, you know, and for iron. And that actually did work.
- [98:55]
C
Well, sure, sure. Here's why. Here's why. It's a problem of thinking if you give someone a drug for chelation and you don't make sure that that compound gets out of their body by peeing a lot, pooping a lot, making their liver enzymes work and binding them up in the Gut and doing all these. These things, of course you're going to get worse. And that happens also when you do treatment for heavy metals. If you don't, if you just give the chelator without all the other support, then of course they're going to get sick.
- [99:20]
B
Yeah. And we're not. Ray and I aren't experts on this, but I will say that I was so enthusiastic when the government was investing in. We had a center for alternative medications where they were starting to fund clinical trials. This was many years, years ago. One of my mentors, Maylon delong, was involved in some of those original discussions. And we just need to do more of it. I mean, this is super interesting, super important. And what excites me, and I'm interested to hear what Ray thinks. What excites me about it is the why and looking upstream. So what you're talking about is looking for the root cause. And so when the guys.
- [99:58]
C
Cause is.
- [99:59]
B
Yeah, Root cause or cause is. And so when the guys that discovered Helicobacter pylori, which is this infectious agent.
- [100:05]
C
Are you guys the Barry Marshall of neurology?
- [100:07]
B
Yeah. We have the story in the book.
- [100:09]
C
But please don't take the toxins.
- [100:11]
B
Yeah, we have this.
- [100:12]
C
You drank a beaker of bacteria and prove you had an ulcer. Don't drink a beaker of toxins and then get Parkinson's infection.
- [100:18]
B
So we have the story in the book about how nobody believed them that this could be infectious causing all the peptic ulcers. And it turns out it was infectious. They ended up winning the Nobel Prize on this. And it was really important and fundamental. And people, what were they saying? Oh, you need to eat less spicy foods. You need to do all this. They didn't understand upstream what was going on? Going on. So I don't know. What do you think?
- [100:40]
C
If you guys keep going, I want to be at your Nobel Prize ceremony because I think this is worthy of a Nobel Prize.
- [100:46]
A
Well, I think the credit really goes to Dr. Caroline Tanner. For 40 years, she's been detailing this, and we haven't been paying enough attention to her. You know, in my mind, she's a giant. In reality, she's like, maybe five feet tall. She's over 70. She looks like your prototypical grandmother. And she's been doing this for 40 years. She did studies in China as a woman in the 1990s, 1980s, looking at chemicals. Yeah. And Parkinson's disease. Just imagine that we want to say yes. We want to say. Right. We want to say yes to everything that you're saying we just don't have the evidence. And I think both Michael and my minds have been opened. We did. If you had told us this 15 years ago about chemicals, we would have been poo pooing or soft pedaling them. And you know, we just don't have the evidence. We do know the Mediterranean diet, for example, high in fruits of and vegetables, low in animal products, perhaps low in toxins that get magnified as they go up the food chain, is beneficial for people with Parkinson's disease and might even prevent you from getting it. We know that vigorous exercise is helpful for people with Parkinson's and might reduce your risk of ever getting Parkinson's disease. We know that these chemicals are causing the likely causing disease and we know that stopping exposure to these chemicals is potentially beneficial. We just don't have the data to answer to you here in 20, 22, 25. You know, what complement of mitochondrial supplements or other complementary medicines would make a big difference for people.
- [102:05]
C
But the NIH needs to focus on this. Right.
- [102:06]
A
And then we're going to come back. You have us come back in five years and we'll tell you what, what has been found. Because people like you are constantly pushing the envelope. And you've been doing this for you know, 30 years, right?
- [102:15]
C
Yeah.
- [102:15]
A
And you were, you know, not widely, you know, respected.
- [102:20]
C
Don't read my Wikipedia page, please.
- [102:23]
A
You know, you, you and others, others have made us think about things in a more holistic manner. And you've told us that the power of prevention, you've told us that the roots of these chronic diseases, many of them lie in our environment. If we pay attention, more attention to the Mark Hyman's of the world, if we pay attention to the people who are out there on the front, Vanny, Harry and others who are out there telling us that chemicals in our food, water and air are fueling the rise of chronic diseases, we can prevent them, we can slow them, we can treat them and potentially we can even cure them once we know the cause.
- [102:55]
C
And I'm just going to say by as an my anecdote, I'm treating dozens of Parkinson's patients over 30 years or people with Lewy Body disease, I've had many of those as well, surprisingly, and I'm not a neurologist, but when people try everything and they can't get any help, they come to me and we treat them at the Ultra Wellness Center. And I can tell you I've had so many patients who've, we've slowed, stopped or even reversed significantly. Their Parkinson's by using this kind of approach, systematic approach. And I think people should be hopeful out there, and I'm really hopeful that you guys are doing this, because we need real scientists. I'm just a science reader. I'm not like a. I mean, I publish some papers, but I'm like, that's not my gig. But I read the science, and I'm like, I know that the smoke signals are there, and there needs to be serious investment in this field and in the kinds of therapies that can really improve. Improve people's lives, especially as we're seeing the acceleration in this whole thing. So I want to just thank both of you for what you're doing. I think this is such an important book. It's the Parkinson's A Path to Prevention and Treatment. You can get it anywhere. You get books. It's out now. I would encourage you to get a copy and check it out if you know anybody with Parkinson's, if you have it in your family or you don't want to get it, if you don't want to get it, which would pretty much be everybody.
- [104:12]
A
And the seeds of the disease are planted early. So the decades before. Decades. As a child. Yeah, as a child, teenager.
- [104:19]
C
It's never too early to start. Yeah. So I. I just honor you both for what you're doing and the courage you have to go against the grain, to speak the truth, to, you know, honestly, to be exposed to the potential ridicule of your colleagues. It's not easy. Right. And. And yet here you are, and I'm just so impressed in having this conversation, and you guys are great. Let's keep talking. Let's revisit this. And when we have more blood biomarkers, when we have more treatments, if you want anybody to kind of give you more. My data from my decades of doing this to kind of guide some things that could be helpful if you want to get some research funded, if you have some philanthropists or if there's anybody's listening out there who's a philanthropist who has any of this, like, Lewy Bodies or Parkinson's, like, please, we need help because the government's not doing it. Pharma for sure isn't doing it. And I think, you know, these guys are doing the work, so. So let's. Let's get some help for all the needless suffering out there. Thanks, Ray. Thanks for really great conversation.
- [105:13]
D
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- [105:20]
C
That's exactly what you'll find at my.
- [105:21]
D
Supplement store, where I've hand selected each and every product to meet the most rigorous standards for safety, purity and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity or reduce your disease risk, or you're looking to improve your sleep, blood sugar, metabolism, gut health, you name it, Dr. Hyman.com has the world's best selection of top quality premium supplements, all backed by science.
- [105:45]
C
And expertly vetted by me, Dr. Mark.
- [105:47]
D
Hyman so check out Dr.hyman.com because when it comes to your health, nothing less than the very best will do. That's Dr. Hyman.com d r h y m a n.com if you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions, YouTube of of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it to comes comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.