Your Health Toolkit: The Neurology Sessions

Daily Choices for a Younger Brain

• Dr. Lauren Young • Season 2 • Episode 5

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Your brain isn’t on a fixed path. In this episode of Your Health Toolkit: The Neurology Sessions, you’ll hear from Dr. David Merrill, adult and geriatric psychiatrist, neuroscientist, and director of the Pacific Brain Health Center, as he shares how precision brain health can help you prevent or slow cognitive decline by targeting root causes you can actually change.

You’ll learn why memory loss isn’t inevitable, how integrative and functional frameworks uncover what’s driving your symptoms, and why prevention always beats repair when it comes to Alzheimer’s and Parkinson’s.

In this episode, you’ll discover:

  • The difference between normal aging and memory loss, and how to tell the two apart
  • Why movement is medicine, from aerobic exercise that boosts BDNF to strength training that releases myokines and balance work that keeps your neural networks strong
  • How nutrition shapes brain function, with Mediterranean and plant-forward keto diets, time-restricted eating, and metabolic balance
  • The critical role of sleep and stress in brain repair, glymphatic clearance, and nighttime restoration
  • The gut–brain connection in Parkinson’s and how toxins and microbiome balance influence brain health
  • The power of social connection and community-based programs like Memory Club for cognitive and emotional strength
  • How emerging blood biomarkers can help you detect changes earlier and take action when it matters most

Dr. Merrill reminds you that while genes load the gun, lifestyle pulls or spares the trigger. By focusing on movement, nutrition, rest, stress, and connection, you have the tools to protect and even enhance your brain health.

If this conversation sparks a change you’re ready to make, subscribe, share it with someone you love, and leave a review to help more listeners find the show.

Then tell us: Which pillar will you start with this week?

Resources & Links

Your Health Toolkit is a podcast created by the physicians from Collaborative Natural Health Partners (CNHP) – your go-to hub for holistic and integrated family healthcare in Connecticut and New York. At CNHP, we’ve crafted a special blend of expertise, bringing together naturopathic physicians (NPs), osteopathic medicine physicians (DOs), and Advanced Practice Registered Nurses (APRNs) to offer you a warm, integrative, patient-centered approach to health and wellness. If you’re interested in learning more, head over to our website or follow us on Facebook or Instagram for information, articles, and resources to take the guesswork out of your health.

Your Health Toolkit is a podcast presented for general information and educational purposes only. The discussions presented by Dr. Lauren Young and the show’s guests should not be considered medical advice but rather a conversation starter with your doctor. Everyone’s body is unique, and we recommend having a discussion with your personal healthcare team before trying anything discussed on the show.


Dr. Lauren Young:

Hi there, welcome to your health toolkit. I'm Dr. Lornia. And I'm Dr. Ashley Berkman. Dr. Berkman and I have been working together for over a decade at Collaborative Natural Health Partners. We've decided to put together a brand new series all around neurology.

Dr. Ashley Burkman:

Yes, thanks so much for inviting me to be part of this series. Brain and nervous system health is something I care deeply about, both in my work and my personal life. I see many patients who navigate through tough diagnoses like Parkinson's, MS, Alzheimer's, either for themselves or for someone they love, and it can feel like a lot.

Dr. Lauren Young:

So over this series of episodes, we're gonna be bringing you guys specialists from around the country on functional neurology and integrative medicine to explore what's really going on with nervous systems and brains and what we can actually do about it.

Dr. Ashley Burkman:

These conversations with these experts have been eye-opening, very inspiring, and we can't wait to share them with all of you. So let's dive in.

Dr. Lauren Young:

Today on the podcast, we're joined by Dr. David Merrill, adult and geriatric psychiatrist, neuroscientist, and director of Pacific Brain Health Center at Pacific Neuroscience Institute. Dr. Merrill is a leader in the field of precision brain health using cutting-edge science and personalized medicine to help people protect and optimize their brains as they age. His work focuses on helping middle-aged older adults, especially those at risk for Alzheimer's and Parkinson's. We are so excited to chat with him today. Dr. Merrill, welcome to your health toolkit. I really want to start us off by just talking about the big picture. And uh when many of us think about cognitive decline, um, it seems like an inevitable piece of things of aging, and especially if people have a family history of these conditions, from your perspective, how much of long-term brain health is controllable?

Dr. David Merrill:

Yeah, well, uh that's a great opening question, Lauren. I I feel like the perception for decades in the past had been that we're kind of stuck with the starting materials that were given through genetics and through birth and early development. But the reality is that cognitive decline with aging is not inevitable in any sense of the word. We now know that there's over a dozen targetable, modifiable risk factors that can be really adjusted based on behaviors, whether it's conventional allopathic medical approaches or naturopathic uh methods, andor really even just free lifestyle habits that we adopt and adjust to essentially change the trajectory of our aging process, not only for the body, but for the brain as well.

Dr. Lauren Young:

Cool, very cool. And you know, one of the things that was really inspiring us to connect with you was just the Pacific Brain Health Center and how you guys approach all of this uniquely compared to like conventional neurology. Um, can we just can you walk us through like what the experience is for patients at your clinic?

Dr. David Merrill:

Yeah, absolutely. So, you know, I'm really the tip of the spear in terms of bringing a functional medicine or integrative medicine approach or practice into our center, which as it's built out, it's a traditional neurology clinic and a neuroscience institute. So old school kind of standard view is to treat once the symptoms appear, kind of in a you have a cough, let's give something to suppress it, uh, versus the precision medicine approach that I take or bring to the center one of prevention, uh the different stages of prevention. So primary prevention where somebody hasn't developed any signs or symptoms of a disorder, then um secondary prevention. So somebody might have early subjective memory loss or mild cognitive impairment where they're still compensating in life, but they're they're clearly like things are not the way they used to be. And so they come seeking ways to prevent that subjective memory change from getting worse, um, rather than just like give me something to make my memory better now. Uh and so the biggest differentiator is this adopting this functional medicine approach, which as a naturopath I know you're familiar with, which is doing the root cause analysis. So, what's the underlying cause, and usually pretty much always, what are the multiple underlying causes of your risk for or your development of symptoms related to memory, thinking, language? Um, so it's really using a framework of functional or integrative medicine to then identify and attack the root causes of brain dysfunction with aging, which manifests a lot of times with short-term memory loss, the so-called senior moment, or why did I walk in the room? Where did I park my car? What's the word on the tip of the tongue that I wanted to say, but I can't quite think of the right word, so I figure out a workaround. Um instead of coming at that symptomatically, like, oh, you have the clinical symptoms of Alzheimer's, the syndrome, and so we're gonna give you the it's bad enough now. We're gonna give you a prescription for the few, one of the few approved treatments that might lessen your symptoms, but don't really address what's driving or causing your memory loss. Like instead of that, or not instead of, but in addition to that, patients under my care and the precision brain health teams care. Really, we we approach it through integrative or functional medicine where we do this pretty, you know, it's it's it's pretty labor-intensive, and there's really a curiosity to figure out what are the root causes or drivers of memory loss or brain dysfunction in the individual. So it's not always gonna be the same causes for all different people, but if you look at 30 plus odd potential drivers of brain dysfunction with aging, if you can pick out the dozen or so that are the most off or off in an individual and start to address them to the extent you can, we tend to find that people do better uh both in the moment and then their trajectory over time tends to tends to go to go better, tends to go better.

Dr. Lauren Young:

Yeah, yeah. That makes a lot of sense. And so I know we were just talking about cognitive decline. How does this relate to Parkinson's as well? Are you treating a lot of patients with Parkinson's?

Dr. David Merrill:

Yeah, so so that's the nice part of you know the model I've got right now in clinic, which again it's it's both a privilege and then it's also a bit of a curse. And why I like to come on podcasts like this to really disseminate information about the approaches for not just people who have been lucky enough to live in California or live next to the clinic and able to make it, but for everyone. And so the approach is with the process of aging, the brain, just like muscles and bones and all end organs in the body or all parts of the body, the brain becomes increasingly vulnerable to stress, and that can manifest in some as Alzheimer's disease, the syndrome, or in other people, Parkinson's disease, the syndrome. And so in one case with Alzheimer's, we focus on figuring out okay, what are the sources of chronic inflammation in the body? How is metabolic health uh looking for an individual, meaning blood sugar metabolism and things like that, or you know, overweight obesity, and then you know, has somebody for Alzheimer's gone through a period where their their the degree of their cognitive stimulation or their mental activation has declined either through things like retirement or loss of loved ones, you know, relative social isolation. We all went through the pandemic. So, you know, for Alzheimer's, I really focus in on inflammatory factors, metabolic health, and then the degree of cognitive stimulation. It's not that we don't look at these things in persons living with the beginnings of Parkinson's disease, it's just that having both going on at once is not uncommon. I would say, you know, for the Parkinson's focus, we're really looking at, you know, what's going on with the dopaminergic system. So dopamine is a neurotransmitter that helps control movement in the brain and in the body. And so are there factors that are leading to the decline or decay of brain cells that use dopamine as a neurotransmitter? Uh, so we look at factors that could affect that. And one big thing, which I'm you know, jumping ahead a little bit, but for Parkinson's, it really seems like there's a key connection between the gut microbiome and the nervous system function, the brain's function. You know, our gut is so richly innervated by a nervous uh by nerve system uh network that then is like a road into the central nervous system. So looking at the gut health, seeing how that relates to potential previous and current, you know, ongoing uh toxin exposures. So we look at, you know, has somebody had exposure to pesticides or heavy metals or some uh mycotoxins like biologic toxins, like mold toxins. Um and so while we'll also be looking at these in Alzheimer's, more often or not, the gut and toxins rises to the higher level in Parkinson's cases where they take front front and center stage for things that we can work on in the person living with Parkinson's. Um, I guess before we move on, I would also say that for both Parkinson's and Alzheimer's, but Parkinson in particular, getting an activation or a reactivation of physical movement uh tends to be mission critical because the physical movement promotes things like uh stressing the balance system. So you're you're working out your proprioception and your balance training. Uh, and that activates great things like sweating, which helps you detox. And we just really try to get people activated with momentum where they're curious about what are the health factors within them as an individual that have become suboptimal over time, like no judgment and not particularly anybody's fault. I mean, we live in a world that's just like full of potential health stressors, so it's kind of a hazard of being alive that some things are going to get out of balance or suboptimal. How do we meet an individual where they're at with their care partners and loved ones to then start addressing the potentially modifiable factors that that really is just kind of off the cuff, giving you a list of potential things to look at? And we tend to see that in Alzheimer's cases, you see inflammation, metabolism, uh to a lesser extent, but definitely there are toxins, and then Parkinson's is kind of really we're always looking for toxins, and then how's the gut working and functioning or not? And then for all that, this foundational sense. I know we're getting to pillars, and it's always funny.

Dr. Lauren Young:

We're riding with you. I love it. Yeah, yeah. Yeah, yeah, it's perfect.

Dr. David Merrill:

Is it like is it four? Is it four or five? Is it seven? Is it how many pillars are there? So it just depends if you're a lumper or a splitter. So the foundational lifestyle elements, how do you get those optimized, whomever the person is, whatever how, whatever point they're presenting at? Are they a middle-aged adult child who has older parents with one condition or the other? Or do they are you already in the throes of that as an older old adult?

Dr. Ashley Burkman:

I love that visual of seeing a patient with Alzheimer's and then someone with Parkinson's and how you already are cued in on a couple of key things. Well, all of it's important. It's, you know, what's your toxic burden with someone with Parkinson's versus, you know, what's your cognitive stimulation more for an Alzheimer's patient? It's really awesome.

Dr. Lauren Young:

I want to circle back. There was a lot of great stuff, and there's like eight points I want to touch back on. But one of them was the movement piece, which I think is so important. And you're right, like movement is going to help everything from stress hormones to our amuncturies and detox and those type of things. Um Do you have specific types of movement? I'm I mean, I'm sure it's meet the patient where they're at, um, but where is the goal? Like, what's the ideal workout for someone who's looking at an early diagnosis of Parkinson's or Alzheimer's?

Dr. David Merrill:

Right, right. It's a great point. It's a great question. And this is where, you know, it's hard as a clinician. If I, you know, if I have short scheduled visits, it's hard to not fall into handout mode where I'm shooting on my patient, like I'm shooting, like you should do this, you should do that. And it's kind of like, yeah, duh. So we kind of all know, both just informationally and common sense, that use it or lose it, move it or lose it. There's these sayings, right? So within exercise, when when you look at exercise as a foundational pillar, the reason why myself and others give it such prioritization is it tends to link in to all these other pillars in terms of once you start moving your body, you start activating all the other elements of this. So physical activity will make you hungrier. Physical activity at the time it'll be enlivening and like activating, but then you'll be like, boy, I'm really worn out by that exercise. So it'll induce a hunger for sleep. So you have one pillar, it's already you're helping not just physical movement, you're helping kind of have a focus on, well, what are you going to refuel with, or what did you fuel with during or before your workout, and then how are you going to rest and recover from the exercise? And then you start throwing even further. Well, I don't know how what's all the best. Any individual doesn't know everything about something like exercise. So it be it begins this process of like, oh, seek out a fitness trainer, or oh, if you have an injury, seek out a rehab specialist who's focused on neurology. And so, you know, exercise, and we could use the whole time, I could just geek out about the neuroscience of it, but that's probably other podcasts. So, you know, exercise itself basically you're improving blood flow, you're improving oxygenation of tissue, including the brain. You are inducing these growth factors or brain-derived neurotrophic factor that helps brain cells get the signal to stay alive and to connect and reconnect. So, in a sense, when somebody exercises, you can think of it as like, wow, I'm really feeding and fueling my brain to stay alive. So, BDNF, if you think of it like a plant, BDNF is like fertilizer for the brain. And when we exercise beyond a certain amount, so say aerobically, if we go beyond 10, 15 minutes continually at 50 to 65 percent maximal effort. So walking so fast that it's a little bit harder to speak, but not impossible to carry on a conversation. So if you go more than 10 or 15 minutes aerobically, you'll start producing BDNF. If you do strength training, the muscles actually release things called myokines, muscle signals that then go up to the brain and signal more growth factors. So, you know, with strength training, it's you're looking at one to three sets of eight to twelve reps of three or more exercises. I mean, these are all kind of like you want somebody who's been inactive to maybe start with, if they're an older adult, start with physical therapy, somebody can get them safely moving again. And then once they're really up to speed with a PT, then you go to a fitness trainer. And depending on resources, if somebody's fortunate, they could do it with an individual trainer. If that's like a bit of a stretch, do it in a group class for older adults. A lot of gyms have this silver sneakers, you know, benefit where the membership is free, the classes are nominal. So, um, and then certainly not to leave out balance and coordination, especially for Parkinson's type syndromes. That again can really start with a comprehensive assessment, not only by neurology or PT, but also by ENT, and there's specialties within specialties, so like vestibular, neurologic, physical therapy with gait and balance coordination and training, and all that will help. The balance and coordination exercises, once somebody's safe to do that, it really helps with your neural networks peripherally activating with the central nervous system, again, reinforcing this idea of use it or lose it. So if you're using a system, it will tend to survive and strengthen itself, uh, versus if you have what's called disuse atrophy or disuse shrinkage or you know, loss, the same way you you lose muscle mass pretty quickly if you don't move your body, um, you lose brain mass as well. And so what we found, not just myself, but the field, neuroscience, is that all these types of physical activities count towards daily or weekly physical movement. And as you move more of the different types, your brain tends to preserve itself. And we actually see that there can actually be improvement in metrics like the size of the brain, the function of the brain. And it's all very the particulars, like it's not a quick fix or simple thing, but in general, getting your body moving in safe ways that are sustainable really makes a difference for the process of becoming older as as we age.

Dr. Ashley Burkman:

That's incredible. I think you know, the why, everybody wants to know why they need to do something, and that was like amazing. Why you should exercise, all those things.

Dr. Lauren Young:

I think too, the emphasis on the fact that this is um a marathon, not a sprint, not even pun intended, but like that this is a journey that you're gonna be doing this and implementing it slowly and thoughtfully is so incredibly important too. And with the team, I liked all of those points a lot. Um, we're gonna take a quick break, but when we come back, we're gonna dive into more of the pillars with uh Dr. David Merrill. Um, and thanks so much for this insight. Thanks for listening, guys. Be right back. If you're a fan of this show, you'll know we talk a lot about conventional and naturopathic medicine and how they can play a role in your overall health. We call this collaborative medicine, and through the work we do at Collaborative Natural Health Partners, we're able to give people the knowledge and tools they need to feel great every single day. If you're interested in learning more, head over to our website, ctnaturalhealth.com, where you'll find articles, courses, and a bunch of resources to take the guesswork out of your health. Don't wait for your next checkup. The doctor will see you now. Hi, welcome back to your health toolkit. This is Dr. Lauren Young, and I'm here with Dr. Ashley Berkman and our guest, Dr. David Merrill, talking about how to optimize our brain as we age. Um I I am very motivated after just chatting about exercise. I'm kind of proud of myself for getting up and working out this morning. That made me feel better. So thank you. You you uh emphasize that for us. I wanted to just talk about um, you know, the nutrition piece of things as well. I knowing that exercise can be this journey where you start where you are and kind of make goals from there. Um, how do you guys approach nutrition as a pillar for absolutely and you know, one last comment about exercise since uh you brought up, you know, getting up and working out, kudos, you know, for that.

Dr. David Merrill:

Yay. Um, you know, some people are phobic of things like gyms or certain types of you know settings of sports, or I'm not exercising. So really everything counts when it comes to physical movement. Uh, we did a large study with brain imaging and brain volumes and brain structure and function. And so something, anything between gardening, dance classes, walking, gym-based workouts, like it all counts. So I like to say the most effective type of exercise is the one that you'll do. Um, it doesn't make any sense if it's like, oh, you gotta tap your head and you know, rub sorry, rub your head and tap your belly. It's like, well, if you're never gonna do that, that's not the best exercise. So uh, and and the same follows towards nutrition. So there's kind of like what we would do structurally by default. I think if any of us go into a standard American grocery store, it's a recipe for disaster. Uh, especially if you go into the middle of the grocery store, you're like just basically in a food desert within a grocery store. Um, so the beginnings of just again, it's common sense at this point, but a whole foods diet that's eating the rainbow of colors and looking at things that are organically grown and sustainably, you know, brought in to for you to be able to buy or obtain, you know, that's a great start. So you're talking about food that's rich in the leafy greens, has berries, nuts, fatty fishes, extra virgin olive oil, colorful vegetables, like yay to us, like that'd be great. Now, a problem, pretty much that's not what that doesn't get marketed, that's hard to find. Like, even on a restaurant menu, it's these things are hard to find. So, what are we trying to reduce? The ultra-processed foods, anything with a shelf life that's indefinite or packaging, stuff with sugar pumped into it, which is a lot, right? Yogurts and drinks and pretty much any item you can think of, they've been able to figure out how to stuff sugar into it, refined carbs, not as much a problem anymore, but things like the trans fats, or for me, like saturated animal fats, you gotta be careful with in terms of the lipid profiles. But that's just kind of like food types or food approaches within the particular, like, oh doc, you know, what's the best brain diet for aging? Well, it's akin to the exercise, like what will you actually adhere to where you're not spinning out and having like, ah, yeah, I'm usually this, but then I had a pint of Ben and Jerry's ice cream yesterday. Like, you probably weren't on the best, most sustainable diet. So, for some, for like the Bretism protocol, which has found a lot of success with slowing down, even reversing cognitive symptoms in people, the keto flex type diet, which is plant focused, and really trying to get yourself into this endogenous, mild, ketogenic state, where that's a mouthful if you're not familiar with it, but essentially cutting back and restricting your carbs to the point where your body starts generating ketone bodies as fuel for the brain. So that you know can be a powerful tool for somebody who's already into full-blown dementia from Alzheimer's disease, or even somebody with a mild cognitive impairment looking to resolve their cognitive symptoms. If you're able to pull it off to be in a plant-focused, mildly ketogenic diets with lots of good fats like omega-3s, extravagant olive oils, nuts, things like that, if you're able to pull that off and sustain it, then you can see that the ketone bodies themselves, as a fuel, get used by the brain and allow your brain to work again. So you can actually start remembering things and recalling things as you need to. So for a person symptomatic with Alzheimer's disease or dementia syndrome due to Alzheimer's disease, we find that the mildly ketogenic diet is a powerful tool for lessening active symptoms. This kind of, I don't want to say it stands in contrast with or conflict with, but there's a whole nother camp or mindset focused around Mediterranean style diets. We don't live in the Mediterranean diet, so nobody's on the Mediterranean diet in the US, but there are Mediterranean style diets with or without being carbohydrate heavy in terms of things like grains. So one of the newer things that I found really kind of appealing is this concept of a Mediterranean type keto diet. So you're like, well, just keep the good stuff. And so, anyways, there's a ton of evidence about the Mediterranean style diet, combining that with a lower salt diet, so the dash diet, into this mind diet where you have like foods to eat, like eat these foods and then don't eat those foods. And it's kind of obvious, I don't have it in front of me or memorized, but the do-eat foods are a lot of the things we were already talking about: leafy greens, berries, nuts, fatty fish, olive oil, colorful veggies. And then I think the differentiator between the mind diet and the keto is that the mind diet's also saying, like, oh yeah, you know, eat your grains and blah blah blah. And then, you know, some doctors like hairs falling out because they're talking about all these autoimmune stuff and all these gut problems that things like grains and dairy and whatnot causes for them. And this is where it's like it's beyond the scope of our discussions, like for the individual. Can you pull off one diet or the other and age well? So, keto diets, Mediterranean diets, mind diet, some combination thereof. That along with just being mindful of your total caloric intake, not to an eating disordered extent, but just realizing that calorically dense foods and overindulgence has kind of been a mainstay of where we're at uh with food. And then lastly, the idea of time-restricted eating or time windows of you know, fast the last three hours before going to bed, fast while you're asleep, and don't start eating again until it's been at least in the morning, until it's been at least 12, 14 hours since you ate last at night. That seems to help for cleaning out the brain during the night while you're asleep, which I'm we'll get to in a moment.

Dr. Lauren Young:

Yeah, yeah. Um, I do like that we, you know, one of our big pillars in our practice is just making sure this medicine is sustainable for people. So meeting with them where they're at, making meaningful goals and kind of walking them through the path. And so it sounds like you're doing the same thing. Like, what can you do? And then what's the next little thing you can do even better, type of thing. I love that. I love that. Yeah, let's let's dive into sleep because that is such a key component for brain health. Um, you know, what's happening while we sleep? How can we optimize sleep? What are your thoughts on sleep?

Dr. David Merrill:

Yeah, I think so. Sleep to me goes hand in hand with stress because a big disruptor of people getting to sleep, staying asleep is their minds, like the ruminations, the stress levels, kind of processing what's gone on the day. So if you put stress and sleep kind of two sides of the same coin together, you know, we look at high levels of chronic stress drive, we all know kind of stress hormone as a colloquial term or cortisol. So high cortisol chronically drives shrinkage of the memory centers of the brain or the hippocampus. Uh so sleep is a process where our circadian rhythms kind of reset levels of cortisol throughout the 24-hour cycle. And so as we address stress, we tend to get better sleep. And during the sleep cycle, I was alluding to this idea of cleaning out the brain during sleep. So with less sleep, with lower quality sleep, we don't have as much of that nightly brain cleaning. And with less brain cleaning, there's more buildup of misfolded proteins, things like amyloid plaques, cotangles, and also just in general, more buildup of toxic or toxic materials in the brain that otherwise your gymphatic system or the basically the lymphatic system of the brain doesn't have a chance to clean things up. And so, you know, we really I spend a lot of time with my patients, clients, their families, working on what are the factors that are disrupting their sleep? Is it high stress levels that aren't being addressed, of you know, stressors or health factors? Are there medications that are taken during the morning or during the day, like something even like caffeine or alcohol? You know, these are not prescription, but these are drugs. Um, are there things in in somebody's regimen that are uh sabotaging having a good quality night's sleep? And how do we go through the iterative process of weaning somebody off of or away from these stress inducers and sleep disruptors to the point where they're getting to a cleaner state of like where they really have a shot to have a good night's sleep, um to allow things like cortisol reset and brain cleaning through the lymphatic system. Um, yeah, it's a big focus and a great reason we talk about having clinical appointments or having rehab. Have visits or trainers, but this is where uh you know a great health coach is worth their weight in gold. A health coach, and then also trying to find your tribe of like having a small group cohort. I've had the most fun, I think, in my clinic practice of having small groups that meet with some frequency, some cadence, whether it be weekly or monthly or even quarterly, you know, meeting as a small group and saying, okay, today we're gonna focus on stress and sleep. Today we're gonna focus on exercise, or today we're gonna be like, who has an issue that they like to talk about, and then really dive in. And then it's akin to a shared medical visit, or sometimes it can be a shared medical visit where one person, the clinician, walks through with them the problem they're dealing with, how to get a good night's sleep. And then everybody else who's present gets to learn about that by being a participant observer.

Dr. Ashley Burkman:

So that's a cool idea. I had run some similar courses like that in our clinic for food, really. Um, and I found myself, you know, feeling a bit like a robot because you are repeating yourself a lot, but people eat that up. They're like, you know, what's you know the best thing to do for myself? And we and usually there's one person who's more vocal, and you learn from them because they have a lot of questions.

Dr. Lauren Young:

So I love that too, because one of the things I really wanted to tap into your brain about is the social connection piece of things that we know that that's so incredibly important. I feel like more and more we are isolated to our own little social media funnels and like not connecting truly with people. And so I love the idea of group visits for sure. Um, what are other tips and tricks you have for patients to be able to connect socially?

Dr. David Merrill:

Yeah, absolutely. Well, it's a great point. As we become older, the structure, the outlets for being social tend to diminish. So in development, we all know that we've we hopefully we all have the opportunity for school. So as we mature through that and we become working age, then we have work. So like school, work, and then when you become an older adult, like it's not conventional for all older adults to be in school or to be continue working forever. So if those two kind of plugged-in structural connections are gone, how do you reactivate that? Well, where I live and work, for example, at UCLA, uh, there has been, when I was there and continuing, there's been a program called uh senior scholars. So professors are happy to have older adults sit in on their classes, audit their classes. Um, then there's obviously there are things like emeritide program or emeritus programs for older adults, and there's also community colleges. So enrolling in classes or courses, if you can be part of a structured program that's kind of expecting an older adult to be there, that can that can really go well. Um, but even if it's not like a formal course from an institution where other people are going for degrees, just signing up for classes. And this is where you know senior centers kind of get like, oh, I'm not a senior, I'm not old, I'm not gonna go in there. But like, if you can really embrace the opportunity of like, look, this is where tribes are coming to tribes are forming, people are coming together and take a class, take a course, just make that leap of faith. So, regardless of how it turns out, just give yourself credit for like signing up and showing up. And if it fails three times and then the fourth time it really hits, like there you go. Um, so the the secret sauce of social connectedness is that you know it activates multiple brain systems all at once. So brain systems that regulate stress level, that regulate mood, that regulate well-being, sense of well-being. So we're lowering stress, we're kind of like quieting down that depressive thought process and the reduction of the loneliness, those are all risks for dementia. So if left unchecked stress, depression, loneliness, those all elevate your odds of becoming demented. So social connectedness becomes this really powerful tool that's underrecognized to both avoid it, avoid dementia, but there's also great data about how social connectedness, it's really kind of the holy grail of how to achieve this happiness. So there's this large Harvard men's study and like quality relationships and social activity of men in particular in the study. That really is what related to ending up with the in a state of happiness with aging, with being an older adult. You know, a lot of times men are not so good at being socially connected. Women seem to have that down a lot better than men. Um, seeing as there's two of you together there, and I'm all by myself. So uh it's I think it's important for men and women, and especially because we know that women uh tend to be, it's about two-thirds of persons living with Alzheimer's are women, and also very good partners for persons living with dementia, are women as well. So um the condition itself does lend itself towards some opportunities to connect. At our center, we have what's called a lifestyle program, where we have individual and small group uh sessions that are focused around care partners or focus around persons living with dementia. And really, one of the coolest things, which was developed by uh Dr. Karen Miller, is something called Memory Club, where it's for dyads. So we have uh a lot of times husband and wife, one person is an identified person living with dementia, uh, or we have maybe an adult child and a parent. It can also just be whomever their primary caregiver is. So we have dyads, so six to ten of those dyads forming a small group that every week come for a half-day curriculum. So the first hour is a three-hour class once a week, and the first hour is some sort of um topic-based memory training, and we tend to follow the calendar of the year. So if it's about to be Labor Day, the topic could be the history of Labor Day or memorable Labor Days for couples, like what have you done on Labor Day that's been memorable? I got married on Labor Day in Hartford, Connecticut. So this brings memories and all these fond recollections of Labor Day and what significant things happen, what significant things have happened on that holiday. So jogging the memory, being social about it, everybody reminiscing about a wedding they've gone to or a holiday event they've gone to. So the first hour is kind of that memory training based thing, comes with a brain healthy snack, which gets controversial. You know, is it a Mediterranean style diet snack or is it a keto style snack? That's for the second hour. We do this thing called uh dual task training, which uh we've dubbed it called fit brain, which is essentially a fancy way of saying while somebody's physically exercising, you're kind of doing excer gaming. So you have a physical exercise that's tied to a cognitive task. So if you're if you're of a certain age, you would think of dance dance revolution. If that has no meaning to you, maybe we fit or now, like there's actually just a lot of video games that have full motion with achieving the game. So it's basically what we do as a small group because we have this brain gym on site. So we do have an abundance of riches in our clinic. It's been through uh the generosity of philanthropic uh donors, and then also the health system has also invested in our work to provide the so, anyways, memory club for the first hour of the memory training, then the brain gym in the second hour. In the third hour, it really becomes about the psychology of the condition. So for the identified patients with the memory loss, they pretty much have a reminiscence hour of small group reminiscence therapy, might be more of that life events and the kind of cataloging what they've been through. And then it allows for the care partners to have a support group. So we know that as a care partner with a per for a person living with dementia, you're at much higher risk of developing dementia yourself as well, as well as all causes of death, things like heart attacks, strokes, uh, falls, sleep disruption leading to uh ill effects of how you know diabetes, overweight obesity. Pretty much, if you can think of a risk, uh if you can think of a health factor, you're at higher risk of it when you're a care partner. And so having that regular support group for care partners really helps lower stress and also helps them meet uh care needs. So people bring up what's going on. It's not just our center, so Alzheimer's Association, other groups, advocacy groups that are related to neurodegenerative conditions, you know, having a care partner be part of a support group on a regular basis is a critical element of uh delivering the best and the safest care for your loved one.

Dr. Lauren Young:

I'm loving this though, because we've talked with some of the other specialists over the past few sessions about the importance of addressing the caregiver and making sure that's almost like its own pillar is making sure you've got the caregiver supported as well. So that's super interesting. And I love everything you guys are doing out there. Um I would love a closing thought of like what you're seeing in the research or trends or things you're excited about. You know, you're on the cutting edge of so much right now. Where do you see the white spaces that are getting filled in with opportunity?

Dr. David Merrill:

Yeah, well, definitely both in the Alzheimer's realm and then Parkinson's as well, we're seeing that early detection, which has always been talked about as a really important factor. If you can identify who's at risk of a disease andor who's developing the biology of it before they have symptoms, the early detection allows for early intervention. So now within the last year, pretty widespread, there are blood-based biomarkers for Alzheimer's that pretty reliably relate to what's going on in the brain in terms of, excuse me, in terms of amyloid plaques. It's a whole other topic, the extent to which amyloid plaques reflect cognitive impairment or not. But as a proxy or signal of the body's immune system responding in a way that's going into protection mode as opposed to communication mode, you know, brain tests of amyloid plaques, whether it be uh PET scans or cerebral spinal fluid, those are expensive and invasive and involved. Now we have peripheral blood tests that hopefully, as there's more acceptance of their usage, there'll be better coverage for insurance. You know, right now there's a cost even to the blood tests. Um, so being able to identify somebody who's quote unquote biomarker positive but otherwise asymptomatic, not as a reason or a way to intervene in a heavy-handed way for some expensive, dangerous drug, but then to be able to say, hey, look, here's an opportunity. You've checked out 10, 20, 30 years before average onset for memory loss or Alzheimer's would definitely be above 60, if not higher than that, 65, 70. If you're checking age 40, 50, 60, and you see that your biomarkers are starting to shift towards being positive, that might really catch your attention the same way that a high cholesterol check would for heart disease or a blood sugar result would be for pre-diabetes. So the same way that there can be asymptomatic heart disease, prediabetes, um, overweight obesity without the end stage, you know, fallout of that. If we can get to a point where we're saying, hey, it's not so scary. You've started to develop pre-Alzheimer's based on having survived into midlife, into the earlier part of older age, we now know that pre-Alzheimer's doesn't necessarily need to end up in full-blown Alzheimer's, especially if you take action on one or more of these 15 plus, 30 plus modifiable risk factors. So if we can kind of get the cholesterol check for the brain, which would be a blood-based biomarker for whether it's for Alzheimer's, which is available, or we're hoping that a similar type test can become available for Parkinson's, which it's not quite yet, um, if somebody can say have a pre-Alzheimer's condition, can that motivate behavior change in these pillars of physical activity, sleep, nutrition, stress, socializing, and or can it spur optimization of driving uh health, you know, suboptimal health factors that are driving the biomarker becoming positive? Things like blood sugar metabolism, overweight obesity, vascular disease, and using our whole armamentarium. So, like in your clinic where you have primary care doctor really managing cholesterol levels or blood sugar levels, it's also in your clinic where you have a naturopath working with them in terms of microbiome-targeted complementary alternative therapies or the like, um, things with lifestyle medicine happening. We just see we have this whole broad tools, tool set or tool chest where we can apply it to cases of individuals earlier and earlier, those at risk based on family history, genetics, those who are asymptomatic with blood-based biomarkers or other tests changing positive but not symptomatic yet. And the earlier we intervene, that primary prevention or secondary prevention is so much more powerful than trying to reconstruct a brain that is already significantly degenerated or decayed. So, as has been the case for decades, my original academic mentors were really uh putting into me, Gary Small back at UCLA, um, that prevention is so much more feasible than restoration or rebuilding what's come apart. So that's kind of my wrap-up thought, would just be prevention is still more feasible than rebuilding the brain. And so early detection is an important part of that.

Dr. Lauren Young:

Yeah, that's really um, and yet really hopeful that we have all these tools to be able to like, once we really recognize that this is an issue, there's so many things we can do around it. I love it. Um thank you so much for your time today, your insights, um, and really getting to see your approach to Parkinson's and Alzheimer's has been really refreshing. And all right. Yeah, yeah. And thanks to our listeners for um tuning in to your health toolkit. Um if you would like more information about Dr. Merrill or our clinic, you can uh visit ctnaturalhealth.com and we can get some more info out there for you guys. Thanks so much.

Dr. David Merrill:

Thank you. Thank you both.

Dr. Lauren Young:

To all our listeners, thank you for tuning in to your health toolkit. We absolutely love talking about health and wellness. So if you have a question or a topic idea, please find us online at ctnaturalhealth.com or on social media. Until next time, it's me, Dr. Lauren Young, wishing you the best in health, happiness, and longevity.

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Lauren Young, N.D.

Host
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Ashley Burkman, N.D.

Co-host
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David Merrill, MD, PhD

Guest