Dhru Purohit Show
Why Blood Sugar Regulation is a Key Part of Alzheimer’s Prevention
Mon, 03 Feb 2025
This episode is brought to you by Cozy Earth and Pique Life. We know the seeds of Alzheimer’s are planted at least twenty years before a diagnosis. So, it’s never too early to make crucial lifestyle changes that can influence brain health and the risk of developing neurodegenerative diseases. Today on The Dhru Purohit Show, we’re bringing you a special compilation episode featuring Dhru’s conversations with leading experts on Alzheimer’s and brain health. Dr. David Perlmutter explores the key factors that influence Alzheimer’s risk and shares his top lifestyle strategies for prevention. He also discusses tools to assess brain energy usage and dives into the gut-brain connection. Dr. Mosconi explains what happens to a woman’s brain during menopause and its connection to Alzheimer’s disease. She also shares how recent research validates women's experiences in perimenopause and menopause, along with key lifestyle habits to prevent dementia and support a smoother transition. Dr. Perlmutter is a board-certified neurologist and five-time New York Times bestselling author. He is a fellow of the American College of Nutrition and serves on their Board of Directors. He has published extensively in peer-reviewed scientific journals, including the Journal of Alzheimer’s Disease, Archives of Neurology, and Neurosurgery. Lisa Mosconi, PhD, is an associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine and the director of the Women’s Brain Initiative and the Alzheimer’s Prevention Clinic at Weill Cornell Medicine/NewYork-Presbyterian Hospital. She is the New York Times bestselling author of The XX Brain and Brain Food. In this episode, Dhru and his guests dive into: Genetics vs. Lifestyle: Their roles in diagnosis and impact on health (1:39) How Insulin Resistance Affects the Brain: Compromised brain energetics (04:20) Key ingredients that impact the body like sugar (11:11) Blood Sugar Game-Changers: Strategies for better management (20:14) Foods Dr. Perlmutter avoids & the gut-brain connection (27:32) The brain’s energy demands & top antioxidant-rich foods (34:32) What’s happening in the brain during menopause (38:31) Validating menopause symptoms and women’s experiences (47:32) Brain changes in perimenopause & key transitions (52:02) Why the brain is unique and why consistency is key (59:32) Also mentioned: Full episode with David Perlmutter Full episode with Dr. Lisa Mosconi This episode is brought to you by Cozy Earth and Pique Life. Right now, get 40% off your Cozy Earth sheets. Just head over to cozyearth.com/dhru and use code DHRUP. Right now, Pique Life is offering 20% off the Pu’er fermented black and green teas. Plus, you’ll get a free beaker and frother when you go to piquelife.com/dhru. Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What are the alarming statistics about Alzheimer's disease?
Hi everyone, Drew Proat here. Let me share some pretty sobering statistics with you. Globally, 55 million people have been diagnosed with Alzheimer's disease, and that number is set to triple by 2050. But you might be surprised to learn that only 3 to 5% of those cases of Alzheimer's disease are driven by only genetics.
The truth is that Alzheimer's disease and all cognitive decline has largely been shown in surveys all around the world to be seen as one of the scariest things that anyone could imagine happening to themselves. And I've seen this firsthand and the devastating impact that this can have on individuals and families with my own grandfather.
who I took care of while he was going through his own Alzheimer's diagnosis. But we know now that there is so much more that can be done to support our brain health, as well as reduce our risk of developing Alzheimer's disease and dementia.
And in today's compilation episode, I'm talking with board-certified neurologist and best-selling author, Dr. David Perlmutter, about the crucial role of blood sugar regulation in preventing Alzheimer's disease. I'm also speaking with Dr. Lisa Moscone, an associate professor of neuroscience in neurology and radiology at Cornell Medicine.
and the director of the Women's Brain Initiative and the Alzheimer's Prevention Clinic at New York Presbyterian Hospital. Dr. Moscone and I talk about the impact of glucose metabolism on brain health, particularly in menopause. But first, let's dive into my conversation with Dr. David Perlmutter.
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Chapter 2: How significant is the role of genetics in Alzheimer's?
Give us the next big bucket that you often see for people that often doesn't get as much attention as diet does when it comes to cognitive decline, dementia, and Alzheimer's.
I'd say that first as a counter to the notion of what are the big legs that support this decline would be genetics. Genetics is not that relevant. In fact, playing only about a 5% role that people say, well, I carry the APOE4 allele, therefore I'm at greater risk. But understand that that so-called Alzheimer's gene plays upon other variables that we can absolutely control.
So, you know, the point I want to make for your viewers is really quite simple. And that is if mom or dad had Alzheimer's, or if you know that you, by virtue of your 23andMe or other genetic profile, carry one or two of what are called the APOE4 alleles, which are indeed associated with increased risk for Alzheimer's, All well and good and interesting.
No question that having that genetic predisposition and others, presenilin-1, for example, increase your risk. But by all means, the dye isn't cast. It means that our choices, we have control over things that are really influential. And
I think the biggest issue would be, and they're all important, don't get me wrong, but I think the biggest issue, at least in our modern world, has to do with our metabolism and elevation of our blood sugar, and therefore compromise of our ability to have insulin in the body do its job. And I think... To take a step back, back to high school biology, well, what's the importance of insulin?
Insulin is important for getting glucose or sugar into the cell and therefore lowering or regulating blood sugar levels. Well, all well and good, but I think that we have a tendency to be really myopic when we assign our understanding of insulin or glucose other things in the body, other metrics to a specific, uh, area to the exclusion of other functionality.
And, you know, for example, we say, well, testosterone is the male hormone. You know, women need testosterone, very important. Uh, progesterone was named because it's pro gestation. It's the, you know, a female hormone that goes up during a gestation. Why would my body have progesterone receptors? I think it's important to expand less in this case, uh,
on what insulin does in the human body, and specifically vis-a-vis our conversation now, how does insulin relate to the brain? Well, insulin does play a role in allowing brain energetics. We'll come back to that in a moment, but it's the way that blood sugar gets into the brain glucose to ultimately lead to the powering of the brain cells, the neurons specifically.
And that's really important when our Bodies become insulin resistant. We'll talk about how we get there. I guess I'm paving the way for a lot of conversation. Then that functionality, brain energetics is compromised. That's a bad thing. We can scan brains 20 years ahead of time
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Chapter 3: What impact does insulin resistance have on brain health?
and that we need to do everything we can getting back to diet. And I know you wanted to move past that, but I chose not to because it's so important, something we all make choices about every single day, unless we're fasting, of course. And
Everything we can with reference to diet to keep blood sugar levels under control, basically lower than they might otherwise be these days, I think is very relevant. Utilizing things like continuous glucose monitoring, checking our blood for ketones, being really aware of fructose in the diet.
So many things that influence blood sugar, our sleep patterns, our exercise patterns, sleep as we measure with our wearable devices, all of these things play into balancing blood sugar levels. And the brain is exquisitely sensitive to its provision of its fuel, which is basically glucose. And when that's compromised, when that is threatened, that really does set the stage for future decline.
I'm glad that you doubled down on the diet. I did want to cover diet. I was going to cover a few other things, but I'm glad you actually forced it in the direction that you wanted to go in because it's just another reminder that just like we say, you can't exercise your way out of a bad diet. If you're serious about brain health, you cannot approach the topic without thinking
thinking about blood sugar regulation. And I think that's an important message for our listeners. And it's a hopeful one because that's actually something that's largely in most people's control and will continue to be in their control as they start to use wearables like CGMs. And I know you're affiliated and I'm affiliated with a company that's doing some great stuff in that space.
We'll chat about them a little later on. I'm glad you doubled down because I think that is just an important thing for everybody to remember is that we're looking for sometimes the right supplement in the traditional world of medicine. It might be actually what medicines are there that you covered earlier, but it really has to come back to core blood sugar regulation.
While we're on that topic, you're not just talking about sugar. and high levels of sugar in the diet or in added sugar in the foods that are there, even for people that consider themselves quite healthy, there's other forms of things that are regularly part of our lifestyle today, even in the world of modern wellness food, that are consistently throwing off our ability to regulate our blood sugar.
What were some of the surprising things that you found over the years in putting your books together that... Act the same as sugar inside the body. All right, here's a little secret. This Valentine's Day, I'm going to let you know exactly what I'm getting my wife. More sheets and pajamas from Cozy Earth, which happen to be her personal favorite. You can ask her. You can DM her on Instagram.
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Chapter 4: What lifestyle changes can help manage blood sugar?
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Well, that act the same as sugar in the body. Let me just take that back a little bit. And one of the surprising things that I found that really plays such a central role in blood glucose regulation is a different sugar called fructose. You know, the amount of fructose we are consuming now is, I think, breathtaking, seeing that table sugar is 50% glucose and 50% fructose.
That's what sucrose or table sugar is. But now we're seeing our foods peppered, wrong term, sweetened with what is called high fructose corn syrup, which might be 52% fructose, but in reality, maybe as high as 90% fructose.
Now, the messaging on fructose over the years was, hey, that's a better choice than eating glucose because fructose, unlike glucose, does not elicit this insulin response that we just spoke about. And while that may be true in the short term, we know that ultimately through its unique metabolism that fructose is extremely threatening to
to the way that insulin works in the body and ultimately leads to elevation of our blood sugar, elevation of our blood pressure, dysregulation of our lipids, increased risk of obesity, increased risk of other metabolic issues. So we've been told that fructose is a safer sugar. Even the American Diabetes Association did until quite recently recommended fructose
as an alternative to glucose or highly refined carbohydrates in general. So I think we now understand, and we'll get to this later, that through its production of something called uric acid, that fructose is a powerful threat for our metabolism, therefore elevation of blood sugar, and then this increased risk of insulin resistance that we talked about just a moment ago. But you know,
I think that we could take this conversation to a lot of places. We can take it to the gut bacteria because we know that the signals sent out by our gut bacteria have a huge role to play in regulating our metabolism. There is well-described changes that can occur in the gut bacteria that pave the way for insulin resistance. And in fact, we know that
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Chapter 5: How does menopause affect women's brain health?
We had it when the fruit was ripe. And before modern agriculture, fruit is ripe in the late summer, early fall, signaling to us that winter is coming. Winter, a time of caloric scarcity. So fructose changes our gut bacteria such that it prepares us for winter because our gut bacteria get the fructose signal and say, hey, winter is coming.
We need to change metabolism here and start storing fat and reduce the burning of fat so that we keep it around. We actually have to make more glucose, a process called gluconeogenesis. So it's the response that we get from fructose, not only in terms of our gut bacteria, but also in terms of what has created the downstream metabolism of fructose, which is uric acid.
Uric acid is the danger signal saying winter's coming, not going to be a lot of food. You'd better make fat. You'd better store fat because you're We have higher levels of uric acid because of a unique series of mutations that occurred in our primate ancestors 14 to 18 million years ago, whereby we have much higher levels of uric acid.
So those ancestors in our primate lineage who had those mutations survived. And now you and I and every other human walking the planet has an... and increased production of this uric acid such that we make fat, we store fat, our blood pressure is at risk for being higher.
We develop non-alcoholic fatty liver disease and we develop dyslipidemia, higher levels of LDL and cholesterol because these were actually protective of us in the day. So what I'm describing then is what is called an evolutionary environmental mismatch, where in our past, these mutations, these changes to our metabolism allowed our survival.
But now, because of the different environment being pounded by fructose day in and day out, lack of restorative sleep, lack of enough exercise. You know, we'll talk about these things. And, you know, challenges our genome.
And it's really, I think, the fundamental of the so-called paleo movement that we really need to respect our paleolithic genome and give it the signals that we can control that it wants in order to keep us healthy and allow us to survive, allow us to procreate, and allow us to be disease resistant.
It's such an important point because so many times when people... whether they're in the wellness world or they're just somebody who's just trying to live their best life. This is not an area they study. They may not be listening to this podcast. Anybody who's dealing with extra fat on their body and has struggled with it for a while feels that their body is working against them.
They feel that there's something wrong with them. They feel like even some cases I've heard people – go to an extreme and feel like their body is almost punishing them. And what you're really highlighting here is that your body is doing exactly what it was designed to do. It's just, we're giving it the wrong signals.
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Chapter 6: What surprising dietary choices could impact blood sugar?
But I think that what is most important is not to define the best diet for everybody. And that's been the trend. Everyone should be vegan. Everyone should be keto. Everyone should be paleo. And I think what is more valuable is to define the goals. What are we trying to achieve with our diets?
Certainly, as you well mentioned, that control over blood sugar, keeping blood sugar in check is a certainly valuable goal. If you want to take it further than keeping uric acid in check, keeping other inflammatory markers in check, all well and good, having a diet that caters to the a gut bacteria, a diet that's rich in polyphenols, antioxidants, all well and good.
But I think these days we have the ability to personally obtain the metrics that can then reveal the value or the threat imposed by the dietary choices that we make. That's the science part. There's a social part to our dietary choices as well. And we leave that up to the individual. But all roads lead to Rome. any of the popular diets and modify them to reach our goals.
Like you say, what might have raised my blood sugar might not raise your blood sugar, but we can determine that when we're careful and we start doing a little bit of science and understand that we're all different. We all have certainly different genomes. We all live in different places. It's varying times of the year. Seasonality varies across the planet.
And perhaps most importantly, aside from our genome, our microbiomes are very different. And the array and diversity and numbers of organisms living in the gut are really influential in terms of how we interpret the foods that we eat and how it plays out in terms of measurable metrics like blood sugar, for example.
So I think gaining that information through the technology that we have as individuals, apart from what we can get in the doctor's office, I think is exceedingly valuable. And it gets back to, you know, earlier part of our conversation where we were developing, we went somewhere else.
But we're developing a dichotomy between just the notion of sort of living your life however you want and then hoping for an Alzheimer's drug versus really beginning to embrace the notion that our choices have huge impact in terms of our brain's destiny. And that's a wedge being drawn in our society right now, really tending to...
really reveal how polarized we are, that the mainstream would have us believe that there's another drug down the pike coming soon enough that'll save us all, and getting excited about a drug that slows the progression by 32%. That all well and good, but I am not really interested in a drug that'll slow Alzheimer's progression by 32%.
I'm interested in lifestyle approaches that can reverse that problem, for example, and put people back on their feet. And that is, again, in the realm of personalized medicine, what does that individual need? It's much more important to know the person who has the problem rather than understand the problem the person has.
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Chapter 7: How can gut health influence brain function?
Again, just for you that you've monitored and you saw.
No, I love them.
Yeah, though you love them and I'm sure you have them occasionally and it might just mean less quantity, right? And being aware. Is there something on a gut health level that you find doesn't work for you? Like sometimes people see that, you know, even though certain types of dairies might actually could be beneficial, right? Like super high quality dairies or goat's milk or sheep's milk.
You know, I personally know for me. Yeah, I personally know for me that... dairy, no matter how high the quality, I have to be very careful about the dose because I still am very reactionary, probably because I was on a lot of antibiotics when I was younger and it decimated a little bit of my gut bacteria.
When it comes to your gut health, and we're also eating for our gut, are there foods that you just know that don't sit with you as well, if there are any? So I recently sat down with one of the biggest experts in the food is medicine space, and he shared some pretty fascinating information about the power of tea. Yes, that's right. Tea.
Now I grew up in a tea drinking household to say the least, but I didn't realize how beneficial tea was until I got older and dug into the incredible research. There are so many different types of teas, but the ones that I like. And the ones that this expert recommended to me are Peaks Green and Black Pu-erh Tea.
These teas are known for having a high concentration of polyphenols, higher than many other teas on the market, and they are fermented, which means that they can support your digestion and your gut health too. Plus, they have high concentrations of antioxidants, which we could all use a little bit support to support our immune system these days.
I love sipping on Peak's green and black pu-erh teas mid-morning or after lunch when I need a little bit of a boost. They contain L-theanine, which also helps me stay focused even on my busiest days.
I really do think that it's important to be super careful about where we source our coffee and teas, and that's one of the reasons that I love Peak because they've always upheld a standard that makes me feel confident in their product. Because I'm obsessive about quality, I love that these teas are triple toxin screen for pesticides, heavy metals, and even things like mold.
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Chapter 8: What are the key takeaways for Alzheimer's prevention?
We're still able to recover markers that allow us to determine what the bacteria was like. Anyway...
The study today said that these people who are infested with all kinds of bacteria, but beyond that, all kinds of worms and other parasites, that they demonstrate larger brains, reduced risk of cardiovascular disease, and really preservation of their bodies as they age in comparison to age-matched individuals living in modern society.
So my point is that this relationship, we've been talking about this since we started today, this relationship between what our gut bacteria are doing and their diversity is huge and extremely valuable. We're just beginning to understand it and therefore be able to tap into it as another powerful tool in the toolbox. I interviewed a Dr. Molly Fox recently.
several years ago, a researcher who in 2013 published a report that correlated Alzheimer's risk with what's called hygiene, basically. And the marker of hygiene was looking at how many parasites were in the gut. Those countries, she looked at 100 countries around the world, those countries around the world that had poor hygiene,
as evidenced by higher levels of parasites in the gut, had the very lowest risk of Alzheimer's. Countries with great hygiene, countries in Northern Europe, the United States, et cetera, that are very much invested in hygiene, keeping us sterile, keeping us clean, keeping our kids from playing in the dirt, had the highest levels of Alzheimer's.
A correlation, certainly back in 2013, just a correlation, though I've interviewed her more recently.
And now that we understand mechanisms whereby the gut bacteria are regulating what we've been talking about, our blood sugar, regulating the set point of inflammation, regulating autoimmunity, I think it becomes extremely valuable information as it relates to understanding the relationship moving forward and what we can do about it between the gut and the brain.
I think the take-home message here is to just embrace the incredible role that these bacteria and other species are playing in the gut in terms of regulating so many important aspects of our lives, whether it's our metabolism, whether it's our mood, whether it's our brain functionality moment to moment, immune system, that's for sure. Even our gene
expression to some degree is regulated by some of the products manufactured like short chain fatty acids by the very bacteria that live within the gut.
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