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- [00:04]
A
Welcome to the youe Are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality. Enjoy the show.
- [00:18]
B
Hey everybody. Welcome back to the youe're Not Broken podcast. So excited to have Max Lugavere on today, who is a health and science journalist, filmmaker and bestselling author of the Genius trilogy of books. You have a New York Times bestseller. And we connect because you did a post about hormones and the causation to dementia and that's how I discovered you and your life's passion. So thanks for joining us today.
- [00:42]
C
Yeah, no, it's great to be here. Yeah. That article that I guess went viral has somehow been able to thrust me into the Menaverse is how I've heard it referred to. Yeah. By our mutual friend Dr. Gilbert Lenz, who's incredible. And yeah. So it's just, it's an honor to be here and thanks for having me.
- [01:02]
B
Totally. I was listening to an interview you did with Jordan Peterson and I like, I really resonated with, I was like, oh, he. What happened to him is. What happened to me is like you did a six plus year deep dive into dementia health, the causations, the prevention, and then you can't sit with all this knowledge. You have to do something about it. You have to talk. And I feel like that's what I did with female sexual health and hormones is like you deep dive and you come out on the other end and you're like, people need to know this information.
- [01:33]
C
Yeah, 100%. I mean, I didn't go through the traditional channels. I'm not a medical doctor, I'm not an academic scientist. And medical literature was fairly foreign to me at the time at which I undertook this process. But when my mom became sick at a young age, I mean, I've never experienced in my life a stronger call to action. I was compelled in a way that I just, I simply couldn't ignore. And I dove in. You know, I had been a journalist for six years prior. I worked for a TV network that was co founded by Al Gore. It was a television network in the United States. It was a news and information channel. And I had always been passionate about fitness and nutrition. So I knew where to look for research. I knew what PubMed was, and you know, as a journalist, I knew how to identify the skill of being able to identify credible sources and weed out the ones that were less so. But Alzheimer's literature, dementia literature, it was all completely novel to me. But because My mom was sick and because I was so desperate for answers. It's a journey that began about 10 years ago and it'll continue on for the rest of my life.
- [02:48]
B
Yeah, I think our brain's ability to make stuff stick because of like an emotion and because of like a passion and a drive of like. I was just reading a brain markers. Lisa Moscone, Dr. Moscone sent this to me, who I know you had in your documentary. She sent this article looking at biotracers in the brain and what happened if you took menopause hormone therapy versus if you didn't. And like, I've been in the menoverse, I know tons about hormones and I'm reading this paper that I'm like, You need a PhD in neuroscience for some of this stuff. It gets thick pretty fast when you start getting into the tracers in the brain and the parts of the brain and stuff like that.
- [03:29]
C
Yeah, it's insane. I mean, I think the blood biomarkers that we typically associate with risk for cognitive decline, I think those are great, like A1C, insulin, fasting glucose, homocysteine lipids and things like that. Omega 3 index. These are all fantastic. But now they're starting to. I mean, this is the new frontier. Starting to look at biomarkers that are specifically related to amyloid, for example, the AB42 to 40 ratio, for example P Tau in serum. And none of this has been clinically validated, but they're really hot on the trail for these biomarkers that might indicate years, if not decades before the onset of symptoms. Who is most at risk. And I think that's kind of like the new frontier of Alzheimer's disease. Because right now, when you are diagnosed as, you know, you're catching it late in the game. I mean, Alzheimer's disease is essentially a disease of midlife with symptoms that appear in late life. And it's very similar actually to pancreatic cancer, which my mom actually passed from. Most of the time when pancreatic cancer is caught, it's already too late because there is no routine screening for it. It's part of the GI tract that it's just. It's very easily able to metastasize. And I'm certainly not a cancer expert, but that is also analogous actually to Alzheimer's disease in the sense that by the time it's diagnosed, it's a disease process that's already decades progressed. And so we need to find these biomarkers that we can identify earlier so that we can then intervene and Actually move the needle on the condition because at this point right now, by the time you're diagnosed, intervention is just not super great, as you know.
- [05:15]
B
Yeah. The medications that are FDA approved certainly aren't moving the needle very much and certainly no cure. I think one thing that stood out that you said is like, this stuff is happening 20 years before you're getting a diagnosis and people aren't thinking of that. And then I started thinking like, well, that's what heart disease does too. And probably not all cancers, but that's what breast cancer does too. Of like, they're like, you know, you've probably had this for eight years before you actually, on Tuesday you get the diagnosis of breast cancer. Right. But it's like it didn't happen with a light switch or overnight or because you partied one weekend or something like that. And I think it's just gonna take a whole paradigm shift of how people think of disease. Kind of like a light switch, like you have it or you don't have it. And what we're saying is like, no, your lifestyle over decades and decades and decades turns into kind of this when the diagnosis goes on the computer.
- [06:10]
C
Yeah, I mean, these are slow moving disease processes. And so I think that's like really actually quite empowering because it gives us the opportunity to intervene. It offers agency. We might eat a certain way or adopt a handful of new healthy habits that might change the course of our cognitive destiny. But it's really important to. There's a quote that I love to invoke. I think JFK said it, who was before my time. But in any case, the quote is great and it's relevant to what we're discussing. And it's that the time to fix the roof is when the sun is shining. And I think so few people really grasp that. You know, it's only when there is that health scare that people most often get that motivation, or when a loved one gets sick, as it did for me. And so, because that was in fact the case for me, that's why it's emblazoned this desire to evangelize healthier lifestyle habits. Because the time to fix the roof is when the sun is shining. And there's no better time than right now to start.
- [07:15]
B
Yeah, I mean, I think, you know, in thinking about what you're saying is like, you guys, you actually have tons of agency. There's actually tons. We can do a little bit every day adds up to a really healthy way of living. And it flies in the face of the gene theory of Disease, which is what doctors are taught. And I think that people have really bought this of, like, it's your family. Like, how many women do I hear they're like, well, my aunt had breast cancer, so I'm probably gonna get breast cancer. It's this, like, giving up of agency because genes are rock solid. And it's like, the science of epigenetics and how your environment affects the genes hasn't caught up with, like, the dogma of, like, nothing you can do, can't pick your dad. And, like, this really passive way of being like, your body is not your destiny at all.
- [08:02]
C
Yeah, totally. I mean, the Human Genome Project, I wrote about this in my first book, Genius Foods, was actually a letdown, despite being this incredible, exemplary illustration of human might and ingenuity. And it was actually, you know, we undertook it with the intent of being able to cure all disease. Essentially. If you can understand the genetics of a disease and you can obviously, whether through gene editing software or what have
- [08:29]
B
you, you just cut it out.
- [08:30]
C
You just cut it out.
- [08:31]
B
Yeah.
- [08:31]
C
But the reason why it was a letdown is because the vast majority of diseases that people are suffering from today are actually not genetic in origin. They're epigenetic, if you will. They're the result of genetic interaction with the environment in which those genes were tasked to thrive. And often we're not thriving, we're suffering. And that is absolutely the case for the conditions that I've decided to focus on, like Alzheimer's disease and Parkinson's disease, where the heritability is incredibly low for Alzheimer's disease. I mean, the vast majority, 97% of cases are what's referred to as late onset or sporadic Alzheimer's disease, which is essentially the result of lifestyle exposures. And we don't yet have all the answers, but we've been able to identify a few really significant risk factors. And then Parkinson's disease as well. You know, the heritability for Parkinson's disease is incredibly low. One to 2% of cases are attributed to genes. The vast majority are due, again, to some kind of exposure or set of exposures. And yet I was actually speaking at an event called the Brain and environment symposium in D.C. a couple months ago, and I was shocked to learn that the vast majority of research funding actually goes into the genetics of Parkinson's disease when it's not a genetic condition. So I thought that was really shocking and unfortunate.
- [09:57]
B
Yeah, I think it's just the power of this gene theory, like the dogma of it's just a dirty gene find It. To get a drug to turn it off.
- [10:06]
C
Exactly. Yeah. It's not really doing anybody any favors. I mean, I'm all for research, but we need to start talking about these exposures. Whether it's exposure to the standard American food environment or the standard American lifestyle, which is by and large a sedentary one. Exposure to environmental pollutants like certain herbicides, pesticides, industrial solvents and things like that. I think we need to start talking about this more.
- [10:31]
B
Yeah. Alcohol. It's crazy what alcohol does to the brain. And like, alcohol doesn't even have to be labeled as like, this is a toxin. Like, it's not even labeled as this.
- [10:42]
C
It's a carcinogen. I mean, you know, this like alcohol is, there's, there's really no safe level of alcohol consumption. I mean, certainly, I think it's the, the body is resilient and there's a certain probably threshold of tolerance that that one might develop. But yeah, it's not good for the brain.
- [11:00]
B
With the window of opportunity being 18 to 24. Probably once, once you're older than that, the brain's like, no, not gonna, I'm not gonna repair as much. No, it's crazy, the lack of education on like the toxin that's sold on every street corner.
- [11:18]
C
That's exactly right. And it's sad, it's unfortunate. I mean, you know, I imbibed now and then. I'm not a, you know. But even if you take the definition of moderate drinking, it's heavy drinking.
- [11:31]
B
Yeah, right, right, right, right.
- [11:33]
C
The definition of moderate drinking is not moderate at all. I mean, moderate drinking is one serving a day for women, one to two servings a day for men. I mean, that's seven servings a week. On the conservative end. That's insane to me. You know, I don't have that, that number of servings of alcohol in a year. I don't think. I mean, maybe like once a month I'll enjoy a glass of wine, but no, it's a neurotoxin and it's, you know, everything in life has trade offs. There are risks and benefits to literally everything. I mean, I'm risking my life when I get in my car, you know, when I fly across the country in an airplane. Like, there are certain risks that are worth undertaking, and that's something that we each have to decide for ourselves. But in general, the idea that alcohol is that we've so closely associated it with celebration, intimacy, or relationships. It's. Yeah, it's really unfortunate because it is, as you said, I mean, it's so brilliantly put that it's a toxin available on every street corner.
- [12:28]
B
It's wild. I mean, when I started looking into like, you know, the role of alcohol and cancers and dementia and realizing how I was trained as a physician. Physicians are not taught to tell people to not drink. We were fed the moderation, moderation, moderation. It's always don't do drugs, don't smoke and alcohol in moderation. That is the party line. And it's so crazy of like, I have to thank the alcohol lobby. Like I don't otherwise know why. Unless there's just a bunch of physicians who loved alcohol who are making these guidelines. But like you will not find in any medical thing don't drink alcohol. It says alcohol in moderation always.
- [13:09]
C
Well, you're right. A lot of those studies that did for many years lead the American public to believe that moderate drinking is actually good for you. A lot of those studies were first of all flawed studies or not necessarily flawed, but they were stretched beyond the ability of those studies to determine cause and effect. They were observational studies. And a lot of those studies were funded by the alcohol industry.
- [13:33]
B
Yeah, I mean the alcohol industry is currently fighting very hard for America to not clamp down on stating that alcohol is dangerous. I don't know if you've been following that because Canada came out, the government of Canada came out about two years ago saying there's no safe level. And like, for Canada to say that is a pretty big deal. They have a drinking culture. Maybe it's because they pay for their healthcare. I'm not sure, like why they came down on it. So they said there's no safe level and caution if you go above that. And America hasn't said that yet, but America, it sounds like America, whoever the people who decide this are, is looking at it. And the big people against it are the, they're like, you're going to hurt our economy. You know, you're going to hurt Northern California's winery economy. It's all like an economic counteract to kind of saying how unsafe alcohol is.
- [14:20]
C
Well, it's very similar to the food industry here and the influence that the food industry has on, for example, our dietary guidelines, the latest committee, because you know, our, these committees meet every, every five years and determine how Americans should eat. And most recently the committee determined that there wasn't enough evidence linking ultra processed foods to obesity.
- [14:44]
B
I think I saw that. Did that make news? I feel like I saw that.
- [14:47]
C
I don't know if it made news, to be honest. I know that it, you know, people were talking about it, it was trending, a trending topic on X. But yeah, it's, it's incredibly unfortunate. I mean we have all the research that we need. I mean we, there was a recent updated meta analysis published that ultra processed food consumption was tied to 30 negative health outcomes. And these aren't just health outcomes for non communicable diseases like heart disease, cancer, type 2 diabetes, dementia, but worse mental health. So we have these observational studies that are clearly strongly linking ultra processed food consumption to these negative health outcomes. But then we also actually have randomized controlled trials to prove cause and effect. I mean, one of the seminal studies came out three, four years ago led by Kevin hall, who's a well known obesity researcher funded by the nih, found that when people are given only ultra processed foods to consume, they tend to over consume their calorie budget for the day by about 500 additional calories. So I mean that's a lot, that's a lot of additional calories. And you do you eat 500 additional calories every single day over the span of a week. That's a pound of fat gain. So it's like, hello. And nonetheless, there's quote unquote, not enough evidence to, to causally relate it to the obesity epidemic. It's, it's just so crazy to me, you know, but then you Hear that in 2020, 95% of members on the committee had ties to the food industry, to the pharmaceutical industry. I believe it's about half of the committee members on this year's committee. So it's just the system is rigged and it's unfortunate. But advocating such as you are with your podcast and you know, as I do with my podcast and my books, I think it's, I think, significant way to fight back. So I just hope people are listening.
- [16:31]
B
I think it ties in, you know, your conversation with dementia and prevention ties in so perfectly with where the basically the Gen Xers are right now, right? The elder millennials. Because they're like, I'm seeing my parents age or I took care of my parents age. So they see that, they see what 75 can look like and they're like, it has to be different for me. And they are in the conversation, especially in the hormone conversation, right, of like, what can I do to be the 80 year old I want to be? And it's like whether it's the hormones or the exercise or the diet or the relationships with alcohol, but I feel like the prevention discussion is happening more than it's ever happened now. And maybe that's because we're seeing the older generation age so poorly.
- [17:21]
C
It is happening. But I always try to be mindful of the fact that what I perceive to be progress might just be my own echo chamber.
- [17:27]
A
You're in a.
- [17:28]
B
We're all in a bubble, right?
- [17:29]
C
Yeah. I mean, we're speaking to people who are, who are health conscious, who are interested in these topics. But if you zoom out and look at the population as a whole, I mean, public health statistics are getting worse and worse. You know, by the year 2030, one in two of us are going to be not just overweight, but clinically obese. I think that's shocking. And I don't know, I'm not. I try to be optimistic, but we're certainly not trending in the right direction.
- [17:53]
B
Yeah, totally. I mean, was it a shock to you? The medical doctors, they're not very prevention heavy. Like maybe, you know, you found the Alzheimer's prevention guy, but like the one dude. But like by and large there's a million physicians. We're all trying to take care of people and people are getting sicker. So you have to be like, doctors, what's wrong? Right. If we're just getting sick, maybe we aren't dying, but we're certainly not healthy.
- [18:21]
C
Yeah. I just don't know if medical doctors are incentivized to advocate for prevention. I just think it's, there's no money in that. And that's not to say that doctors are ill intentioned, but it's just, that's not part of their business model. And so it's unfortunate. Yeah, I mean, I literally have, I've been able to identify and actually collaborate with one of the primary researchers in the, in the field who's a neurologist, who's also rigorously studying and pushing forward the science of dementia prevention. And I, I even actually got to collaborate with him on a chapter in a Clinician's Handbook on the Clinical Practice of Dementia Prevention. It was published by Springer in 2019. So I'm trying, I'm trying to do my best to teach lay people and physicians alike. They just have to be, you know, open minded to it. Many, many physicians, there are so many fantastic physicians out there, but a lot are also very kind of mired in their own biases, their own sort of, I don't know, preconceptions about these conditions. I don't know how many are that open minded, particularly within the field of neurology, to the idea of prevention. I don't know if we're putting too much pressure on physicians, I mean, by the time when you show up to a neurologist, usually, I mean, it's not, that's not a good day.
- [19:39]
B
You're not going in to say, how can I prevent the shit you see every day.
- [19:42]
C
Yeah, exactly. So, I mean, it's the primary care physicians, but even beyond that, it's the fact that we just need to make this a public zeitgeist conversation. And I think that's a pretty heavy lift for most physicians who are not necessarily the best communicators. So yeah, I don't know, I'm trying to do my part.
- [20:03]
B
No, I think it's an impossible ask. I mean, the way you have 10 minutes to see a patient these days, 15 if you're freaking lucky. Right. And writing a prescription is way easier. Reimburses more, because there's more risk. It's not that doctors get. For people who are listening, it's not that doctors get paid more for doing a prescription. You get paid more based upon the level of risk that you're discussing. So you're discussing surgery versus you're discussing you should walk 20 minutes a day. Right. So it's a discussion of risk in how reimbursement gets calculated. So there's more risk in a prescription, but a prescription's a lot easier. And you know, I talk to a lot of doctor friends, they're like, my patients aren't exercising, they can't eat right. They don't know how to cook, they don't have the money. You know, they're blah, blah, blah. So to them it's like they're kind of hitting their head against the wall. Because at the end of the day, it is on the human to try to have healthy habits. The doctor can't go home and make sure you get eight hours of sleep.
- [21:00]
C
Yeah, I mean, it starts with you. Wellness is what happens when you're negotiating with yourself to get off the couch and get your butt to the gym. Wellness is what happens when you're pushing your shopping cart around the perimeter of the supermarket and you're avoiding despite every cell in your being urging you to go into those aisles where we know the ultra processed foods lie in wait to tempt you, to minimize your exposure to those foods which are designed essentially to be over consumed and to be hyper palatable. So wellness is definitely an inside job and it's definitely something that people need to recognize as something that really is within their control for the most part. Because by the time you show up To a physician. I mean, usually it's sick care that most people are looking for, which is fine. I mean, if I get sick, I'm going to a physician and I'm going to shut up and I'm going to let him tell me what he thinks I have so that I could then use that information to help myself, you know, once I leave the clinic. But, but wellness is something definitely that I feel that I have the reins on in my life. And it's something I think about, you know, with every, essentially with every choice I make.
- [22:06]
B
Yeah. When you started filming this documentary, because you. This is how many years old now was the start of you filming this?
- [22:12]
C
10 years.
- [22:13]
B
10 years, right. So when you started it, were you like, was your vision different? Were you like, I'm going to find the cure for my mom? Or like, how did you go in thinking this was gonna go versus how it ended up going on, really diving deep into prevention and what you can do for lifestyle?
- [22:30]
C
I think I was probably a little bit more zealous, maybe overzealous going into it, wanting to, yeah, find that sort of silver bullet diet. And probably, yeah, probably at the beginning I kind of wanted it to be more of a nutrition documentary and it definitely has a bit of that. But what I've realized, thanks to my unfortunate real world experience and exposure to the field, is that there really are no easy answers and there is no silver bullet. And if you spend any time on social media engaging in what's sometimes referred to as the diet wars, the one positive thing to come from those debates which seem never ending online, is that you realize that there are lots of potential diets that could work for people that, you know, people are highly adaptable. You look across the world and there's tremendous diversity in terms of the dietary patterns that are associated with longevity. It's not a plant based diet necessarily. It's not an all animal source food diet necessarily. But the one thing that they all tend to have in common, the one thing is that they tend to be low in ultra processed foods. They tend to be low in added sugar, for example. They tend to be not as highly industrialized as our food here in the United States for so many of us. And so that's really kind of the, I would say the core dietary message that we want to kind of push forward in the documentary. Not that there's one silver bullet diet, because that wouldn't be accurate. That wouldn't be true to the science. And so, yeah, kind of communicating that nuance in a film is hard But I think we did a pretty good job. But that's. Yeah, that's one area where it. Where the film kind of has shifted over the past 10 years of working on it.
- [24:16]
B
Yeah, I mean, my opinion about the whole diet wars, which is just like, it's obscene. The people. That side note, I'm actually in a standup comedy class with like a bunch of angry comedic vegans, which is hilarious. It's super funny. I'm like. I tell the instructor, I'm like, I don't think they know that I'm not a vegan. I hope they don't kick me out. This is funny stuff. But, I mean, I think the whole argument is like, between vegan and meat eating and blah blah to me. I'm like, I think this is just a distraction created by, like, processed foods to keep us confused and stressed and unsure. Because if we're confused and unstressed or stressed about, like, what actually is good, we're just gonna reach for what's cheap and easy 100%.
- [25:00]
C
I mean, people adopt veganism for many different reasons. There's an ethical argument, and I think that's fine. I think if you choose to abstain from meat for what reason, I think by all means do it. But the problem is when they start making health claims and they start making claims such that their diet is the healthiest diet for humans, that everybody should be abstaining from animal source foods. That's from like, okay, pump the brakes. This is hearsay. There's no evidence to support what it is that you're saying. And the evidence that we do have that you are using to support your statements is very weak. And the literal wrong kind of evidence to that should be used to steer behavior, which should ultimately be randomized control trials and things like that, which we have precious few in the field of nutrition. And animal source foods are some of the most nutrient dense foods available to people. And. And I just think it's like really sad that in a food environment where 60% of the calories of your average American's diet comes from ultra processed foods, that anybody out there is still demonizing. Any whole food, to me, is just really sad and amoral. Actually.
- [26:07]
B
I feel like my whole life was born in the late 70s. My whole life has been a back and forth about the arguments of are eggs good or not. My whole life has had that argument of like, oh, cholesterol and blah, blah. And I think for the cholesterol thing, we've come full circle to the point where people are now questioning stat in being like maybe we're not supposed to knock people's cholesterol down so low. And this whole like theory that food made the cholesterol go high versus lifestyle and processed foods and sugar, too much sugar is making your cholesterol go high. It's not the cholesterol Animal food. Do you want to dive into cholesterol and kind of the evolution of that?
- [26:46]
C
It's a contentious topic because cholesterol is an industry. We have to remember that as much as it is a represents a handful of biomarkers. It's all very, it's very much an industry. And it's, you know, billions of dollars worth of statin drugs are sold every year. But it's not just the pharmaceutical industry that has a vested interest in perpetuating the notion that, you know, for example, LDL cholesterol is bad. It's also the food industry because the food industry sell these highly profitable super high margin refined, bleached and deodorized seed oils which also reduce LDL cholesterol compared to for example saturated fat, which is often the argument made to use.
- [27:25]
B
That's all your heart health margarines. Is that right? Okay, that's in air quotes for people who can't see my air quote. Heart health margarines out there. Yeah, my in laws only will eat that after his heart attack.
- [27:37]
C
It's crazy. Yeah, I mean I grew up on that stuff. Those are the kinds of fats that my mom consumed for the majority of her life because my mom was particularly heart health conscious. And social media tends to surface very extreme viewpoints. And so you also, we also live in a world where there are people who are on the so called carnivore diet who will make claims on social media like there's no upper threshold of ldl. And you know, we can essentially be walking around with our total cholesterol in the 500s and it's all good. You know, I would never say that because I think that's an irresponsible claim as well. But the way that I view ldl, for example, and apob, which is a more specific bucket into which LDL falls along with other lipoproteins, is that it's, it should be used as a check engine light if your LDL is high. I mean you might have subclinical hypothyroidism, you know, which you correct for that and you might see your LDL levels normalize. A higher LDL could be a response to infection. It could be due to being overweight. I Mean, there's a lot of factors here that come into play, but so often in these sort of diet arguments, and there's also a big genetic component, as you know. But oftentimes people will use LDL to point the finger at red meat. See, we shouldn't be eating red meat. And I'll concede that LDL is a newly high midlife. LDL is a newly identified risk factor for Alzheimer's disease identified in the 2024 Lancet Commission on Dementia Prevention. But again, we can't just look at these biomarkers in isolation. I think we have to. And we also, when the leap gets made to our behaviors, our food choices, I think so often people will use that to point a finger at red meat. And it's like, if you start, if you cut out red meat from your diet, what's the risk of doing that? Yes, your LDL might come down a little bit, but you're foregoing a really high quality source of dietary protein. You're foregoing an unprocessed or a minimally processed food. In so doing, you're cutting out of your diet a really significant and important source of dietary choline, for example, which we know is really important to brain health. Creatine, which we know is supportive of brain health. All of these other nutrients that we know are so important. And so we can't just myopically focus on this one single biomarker and use that to make these sweeping excisions with regards to our, to our diets. It's just, I think, not smart.
- [29:57]
B
Not smart. Is there a, is there a marker of inflammation that you think stands above the noise as, like this says there's inflammation going on in your body and maybe it's a check engine light. Is there a favorite that kind of floats up?
- [30:10]
C
I mean, as far as I know, it's really only crp. I mean, you could get more granular and look at these other cytokines like IL6NF, Kappa B, like that. But I don't know how clinically validated those are. And they might be more, those might be more labile, you know, as compared to crp. So, yeah, I would say, I mean, as, as far as like a standard basic lab panel goes, CRP is pretty, pretty good.
- [30:35]
B
Yeah. When you started this and you were starting to like, I am assuming, changing your lifestyle, unless you were born brain, brain prevention, like from the get go, but it's like, did you get pushback from family? Did you get pushback from friends or they like gone too far or it Was everybody super, like loving and accepting and open? Like, what did you. Because, for example, when people want to stop drinking, it's a big disruption to their friend unit. Right? So, like, did you have to go through that on your hero's journey?
- [31:05]
C
Yeah, I mean, I definitely have gotten pushback. I mean, I've gotten pushback every step of the way. Not exclusively from, from family, although I think, yeah, there was a period where my mom was always super gung ho, but my brothers, my little brothers always, I think were many times were scratching their heads wondering what the hell I was doing. But no, I mean, generally people have been, It's a really noble aim to try to elucidate a path to better brain health. I mean, what's more important than that? The pushback that I do get occasionally, you know, I've been steeped in this topic for over a decade at this point, but I'll still get, you know, people will say, oh, well, Max is not a medical doctor. You know, Max is not a PhD in nutrition, which is fine. I don't, I don't, I never aim to misrepresent myself. I'm not. But I've been studying and quote, unquote reporting on the research that I've been doing. And obviously I've created a really significant body of work at this point. So if people choose not to listen to me, that's totally fine. They can get their information elsewhere. But I do my best to stick to the scientific evidence while still remaining open minded to the possibility that our evidence base is, can be pretty weak, particularly with regards to nutrition. And I try to always keep my biases in check and to update my knowledge base and to pivot when new data presents itself where I might have been, for example, incorrect in the past about a given idea or whatever. So, yeah, I mean, I think the problem with many quote, unquote experts is that they tend to be mired in what they learned in school and they might not necessarily have the real world experience that I have had with my mom. And maybe they have other, what I call covert biases. You know, like I see a lot of people, for example, that advocate for veganism as a diet who are what I refer to as covert activists. So maybe they are very passionate about climate change, for example, and. But they're not as forthcoming with that, that interest of theirs. And so that is sort of coloring how their dietary recommendations go. So I don't really have any of that. My number one priority is health and reducing suffering in the world through the lens of Health, primarily nutrition. And so yeah, I think as long as I keep being really open and honest and transparent about my motivations, it's been pretty. I'm pretty easily able to swat off the critics, so to speak.
- [33:33]
B
Yeah, totally. I mean somebody had said that you bring reason and common sense back to the conversation around diet and it's like, nothing is hotter. Well, politics I guess, but like diet is, it's like religion. Right. It's like you're people take it immensely personal and you're able to step back and be like, listen, the data is shitty, but what keeps being repeated as. And can we, you know, get some lessons from the noise of it? And I think your power in not being a physician, in a physician more than Ph.D. i would say, is like you're able to say like, listen, the statins are in the top 20% of all prescribed medications in this country. There's a lot of vested interest in the status quo. And we know you're not swayed by any of that.
- [34:18]
C
Yeah, I'm not.
- [34:19]
B
And you're able to see it, you know, whereas doctors, doctors are like, well, our jobs to prescribe. What do you mean? We shouldn't be doing this. Right. And then. But you're able to actually like be like, because I'm not a doctor, I don't have those decisions.
- [34:30]
C
Yeah. And unfortunately, I mean my passion has been forged in the fire of real serious disease. And my mom was on a statin drug when these symptoms first emerged. And if there was a pharmaceutical that I could have had filled for my mom, a prescription that I could have gotten filled for my mom, that would have saved her from what it was that she developed, I'd be first in line to fill it and I'd, I mean, I'm not averse to pharmaceuticals, I'm not anti them. I'm very much pro doing whatever it takes to be healthy today. But unfortunately there is a lot of commercial interest and commerce with regards to these drugs and with these diets. And like the plant based food industry is, I mean it's worth billions of dollars at this point. And part of the reason for that is that plants are subsidized in this country. Nutrient poor, energy dense plants tend to be subsidized, the most subsidized and they form these products which have incredibly high margins.
- [35:38]
B
Yeah. Is that Michael Pollan's book?
- [35:41]
C
Yeah. Michael Poland's a journalist, he's written a lot on diet.
- [35:44]
B
That was eye opening.
- [35:45]
C
Yeah. So yeah. So I just try to help people kind of understand all these intricate connections and yeah, not fear, not leading with fear. Kind of expressing the nuance and the imploring people to become advocates for themselves. And yeah, that's pretty much.
- [36:03]
B
I think speaking as a urologist, all you really need to do is tell all the men that this is going to let them have erections longer because it's true that you're missing that big hook opportunity on social media. As a urologist, there's my advice. It's good for your penis too. Amen. Let's talk about exercise, because I know you had mentioned it several times. The data on exercise and Parkinson's is profound. And then exercise is prevention plan. And then number two, exercise. Once you have the diagnosis, you got your mom into the gym. The role of exercise and slowing the progression of Parkinson's, when you're really losing that inner motivation to do something because the disease kind of takes that away from people of like, I want, I feel like I want to get up and go. Right. That kind of takes that away. So the role of like family and being like, mom, we're going to go on a walk.
- [36:57]
C
Yeah. Staying active is incredibly important and, and exercise is incredibly important, particularly when compared to inactivity. I mean, inactivity is death. And so any mode of activity that you can embrace, that's going to get your butt up and off the couch. I think that's fantastic because, you know, your body has fluids in it that don't necessarily have their own heart, but even your blood, I mean, we, we see that sedentary. Being sedentary literally drains blood from your brain. I mean, if anybody who's sat for an extended period on an airplane knows that, you know, over time your legs start to swell up. You know, it's like gravity does have an impact on, I guess so stiff,
- [37:40]
B
like the joints, crazy.
- [37:41]
C
Same. So you got to move, you got to keep these fluids moving your lymph fluid, which is important for cancer prevention. I mean, exercise is one of the best things that you could do to reduce risk for cancer. But for the brain, I mean, yeah, it's keeping your blood sugar levels stable. It's fostering whole body insulin sensitivity. It's burning off some of those sugar calories that we know are typically make their way into, you know, even your most ardent dieter's diet, typically, because it's just become so common, so ubiquitous in the food supply. And we're now starting to see the resistance training. Building muscle is really important from a longevity standpoint. You know, I'm a big advocate of resistance training. I think the research has really come around to appreciating the benefits of resistance training. Whereas in the past there was an most of the emphasis emphasis I would say was placed on aerobic style training, cardiovascular training, which of course is important. But resistance training is crucial. And your muscles are a sink for glucose disposal. I think that's really important. When you consume a higher carbohydrate diet. The glucose that you ingest by way of your diet, there's only so many places that your body can store that sugar. And your muscles are one of the main sites of glucose storage in the form of glycogen. So that's really important as well as. And being stronger in body gives you the ability to stay mobile and to be able to continue to exercise throughout life. So it is crucially important. Inactivity is a modifiable risk factor for Alzheimer's disease, physical inactivity. So you want to make sure that you're staying active and then God forbid you do one day receive a diagnosis for a condition like Alzheimer's disease or Parkinson's disease. I mean there is evidence suggesting that exercise can slow the progression of of these conditions. So whether it's by way of the increased expression of BDNF or brain derived neurotrophic factor or just the increased blood flow that exercise, the impact that that has on the brain, it's all really beneficial. So you have to find what you most enjoy and just stick to it.
- [39:45]
B
Yeah. And you. I always tell people, I'm like, you don't wait till you want to do it. Like you just do it. It's like, I wish I wanted to tie my shoes. We don't walk around with untied shoes. You just tie them and then you do them. Before we wrap up, I want to jump on hormones just to see where you are on them. I've read the data on testosterone in men and the risks of dementia, the risks of frailty. I think the male testosterone data is a lot stronger. There's just more of it, probably a gender bias, I think. Lisa Moscone's 2023 meta analysis looking at estrogen early for prevention. Again, hormones prevent, hormones don't treat. I think that paper is. People are being way too quiet about it. You know, people are sitting around, they're like, we don't have anything FDA approved for prevention. And I'm like, we can't sit around and wait for the FDA to approve something. It's going to be years and billion dollar studies. Where have you gotten with the role of hormones for? We'll Just narrow it down to brain prevention of debilitating diseases.
- [40:45]
C
Yeah, I mean, I'm pro HRT based on everything that I've learned from experts such as yourself and others like Dr. Gilbert Lenz, Dr. Moscone, Jolene Brighton. Dr. Brighton. It seems like there has been great misconception about the purported risks of these treatments. And it seems like the benefits generally outweigh the risks. And we know that estrogen is protective from a brain health standpoint. And to me, it's a, it's a crime that this has been this ongoing that there have been so many misconceptions based on really poor data, if I recall correctly, that has led women astray. And it, it only reminds me of the misconceptions surrounding animal sourced foods that still exist today, like eggs and like red meat and things like that. Like, it's a crime that we're demonizing these foods. And it's a crime they're not totally related. But it's a crime also that we've been sort of misled for so long about the risks regarding HRT and the potential benefits. I mean, my mom was somebody who was always afraid of it. I just grew up hearing about it because my mom, you know, we had these conversations growing up around the dinner table that my mom was afraid of HRT because she thought that it was associated with increased cancer risk and if it would have made her quality of life better, I mean, that's something that she should have been on. And if it would have helped prevent the dementia that she developed, I mean, that would have been an amazing boon. You know, that would have eased so much suffering that my family underwent. And so, yeah, I just think it's a real problem. But I'm just so grateful that we have advocates such as yourself debunking a lot of these misconceptions. It's so important.
- [42:33]
B
I'm a big testosterone proponent for all bodies at this point. Like, the effects on the brain with testosterone is insane. You know, they're like, it's only for libido. And I'm like, where's libido come from? The brain, right? This is a brain hormone. That's, that's why we have a libido, is because the brain's functioning and like memory, recollection, curiosity. Somebody's German, they learned as a child has coming back since starting testosterone, the brain is waking up on testosterone. And to me, I'm like, there's, there's not enough studies. And women don't want to wait around for studies. They want to feel like themselves.
- [43:09]
C
Yeah. What do they say? If you're horny or healthy, that's a pretty good surrogate. Surrogate marker for health. I mean, don't you.
- [43:17]
B
Maybe eggs and Pfizer need to team up and do some sort of like, egg. Eggs are gonna. They all need to get out. It all comes back to the erections, man. That's how you get to get the people to pay attention.
- [43:29]
C
Yeah. I mean, if you're. If you're horny, you're healthy. And actually there's some interesting data on sildenafil, which is Viagra.
- [43:35]
B
Yep. And dementia.
- [43:37]
C
And dementia vasodilator. There you go. So, I mean, yeah, I definitely think there's some truth to that. If you're having good erections, you're probably. And you know, women have an analogous tissue as well, so I don't know how. It's not as easily observed, I suppose, in women as it is in men, but it's definitely like, if your erectile tissue is working as it should, that's probably a good thing from this and a good sort of indicator of systemic health.
- [44:03]
B
Yeah, we have that data is old data in men showing longevity. The longer you're sexually active, the longer you live. And there's probably many factors on that. You live with somebody, they're probably helping you make food. Like, there's probably a lot of things to that longevity data, but the correlation is that the sexually active people do have longer lifespans. But we have. We actually don't have data in females. Nobody's looked.
- [44:28]
C
Oh, man. Well, that wouldn't be the first time.
- [44:30]
B
I know, right? Well, thank you so much for coming on. Check out his Genius Life podcast, which is super cool.
- [44:36]
C
Yeah. What do you think of the documentary?
- [44:37]
B
Dude, documentary is so good. I watched it. It's my favorite thing. Two favorite things about the documentary is, number one, how you probably very on purpose showed your mom in the prime of her life, in the stark contrast of. You showed what was lost. Right. Because I think to be a doctor, to be somebody who just met this 60 year old woman, you'd think, well, maybe she was kind of always like that. You don't know. And you showed her loving on you so much and loving where she lives and loving her community. And the stark contrast to be like, that's not who she is anymore. You know, that part is. That's what this disease takes. This disease takes that part of you. And I thought that was so well done. And I thought that the music that you had in which there was this you put in a song and it said this thing. It was like when you're old, you're remembering. When you're young, you're waiting to get started and in the middle of your life, that's where you're living. And it just really spoke to me of like, because I know I'm in the middle part right now. Right.
- [45:46]
C
That might have been. Was that the. During the credits?
- [45:48]
B
Yeah, it was at the end song.
- [45:50]
C
That was the one and only Matt Nathanson's song Pictures. Matt Nathanson is a multi platinum artist who actually gave us that song to use for the film. And it's such a poignant, beautiful song.
- [46:00]
B
So poignant. It was like perfect for the documentary.
- [46:03]
C
Thank you.
- [46:04]
B
So, yeah, that's what my takeaway was. Especially I think people our age, we're not always thinking about what does down the road look like. And to really put a person on this disease of like it takes from you everything that you were. That's why you're so passionate about saying you guys do you know, we can actually do stuff to decrease our risk of this.
- [46:30]
C
Amen. Yeah, well, people can. Anybody anywhere can watch the documentary@littleemptyboxes.com littleemptyboxes.com, we're doing a fully independent release. We've had very little support other than from generous podcasters such as yourself to have me on to spread the good word. But yeah, it's an independent film and just super grateful that it's now out there after 10 years of effort. And I think it's the most important thing I've ever done. And yeah, I would just love to invite all of your listeners, viewers to go over and watch it, get to know my mom, get to see the real science of dementia prevention and share the film with loved ones too. It's a powerful film to watch with family. So thanks so much for having me on to talk about it.
- [47:14]
B
Thank you. Thanks for coming on.
- [47:16]
A
Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly, a private podcast, coaching and educational empowerment. And you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and adult sex ed masterclass members get the Master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast are not giving individual medical advice or practicing medicine. See and consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist, or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time. Remember, you are not broken.