Brain-First or Gut-First? Rethinking Parkinson’s Disease w/ Drs. Ray Dorsey & Michael Okun

23:32And so, you know, the enteric nervous system, which controls the gut motility. That's the gut brain. The gut brain. And then the highway that connects the gut to the brain is the vagus nerve. Vagus nerve. How am I doing, doc? You're doing good. You're doing good. You're fantastic. So in 2003, a German pathologist, really smart guy, Heiko Brock, says, Parkinson's disease, the pathology does not begin the brain. He said, Parkinson's disease, which we consider a brain disease, does not begin the brain. He says, I first see the pathology in the olfactory bulb, the smell center of the brain, or in the dorsal motor nucleus of the vagus nerve.

24:07So he says the pathology of Parkinson's begins in the gut and it ascends up like this misfolded protein, like a fall of dominoes. This misfolded protein spreads from one nerve cell to another and goes from the gut up the vagus nerve and then up from the vagus nerve to higher parts of the brain that are responsible for sleep, for controlling our blood pressure. And then only later to the part of the brain, the basal ganglia that you were talking about earlier. The constipation is actually probably one, is a sign that the pathology is affecting, for example, the vagus nerve and we're getting reduced gut motility.

24:41Is it overactive sympathetic activity? Well, it's the damage to the parasympathetic thing. So the parasympathetic, so you got over, imbalanced. So for those listening, you've got the fight or flight response and the relaxation response, the sympathetic nervous system, the parasympathetic nervous system. And what you're talking about here is the parasympathetic nerve that keeps you calm and relaxed, that's why anxiety increases, actually stops working as well. And you get a relative increase in the sympathetic nervous system, which then when you're running from a tiger, you don't want to be pooping.

25:10So your gut shuts down and a whole bunch of other bad stuff happens, right? You got? I personally am waiting until I'm like 90 or 100 to start golfing because it's kind of slow for me. But I play tennis and they live seven years longer. But anyway, for all those golfers out there, no criticism. There's a tremendous amount of toxins sprayed to keep those golf courses looking so great. Is it a risk for people? Should they be worried? Should they stop golfing? What do they do to protect themselves? For sure, don't lick your golf balls, which I know people do, to clean them. Tell us, like, if you're a golfer, WTF?

25:45So, Dr. Brittany Krasinowski is a geographer. She's at the Baroneurological Institute, and she worked with her colleague, Dr. Rodolfo Savika, one of our colleagues of Parkinson's specialist at the Mayo Clinic in Rochester, Minnesota. And she was concerned about the effects of living near a golf course because golf courses use huge amounts of pesticides. And a lot of people live on these golf course communities. And a lot of people live on these golf course communities. So she looked at Rochester, Minnesota, which does a very good job of measuring new cases of Parkinson's disease. And she found that individuals who lived within one mile of a golf course had a 126 % increased risk of developing Parkinson's disease compared to individuals who lived six or more miles apart.

26:23Oh my. So why? And so she spends a lot of time in her paper discussing water supply. And so we talked a little bit about how pesticides can get into the water. For example, people who drink well water, not really by the Safe Drinking Water Act, prone to contamination from nearby farms in rural areas, runoffs, seeps into the ground, yeah. Have a higher risk of developing Parkinson's disease. So she's focused on that. I worry a little bit about the pesticides that are sprayed into the air. There was a small little report in the Annals of Neurology that two neurologists found that 18 of their patients lived near a golf course and 15 of the 18 lived downwind of the golf course.

27:03So I worry about pesticides being sprayed on golf courses or on fields and people living downwind and inhaling them. We talked about how many individuals, most individuals perhaps, Parkinson's begins in the nose. So I worry about nerve toxins being inhaled into the nose. So what to do? One, well, listen. Pickleball, pickleball. You know, why can't we ask golf courses? Pickleball is one of those dangerous sports shows that so many people who are short of shape are filling the emergency rooms with pickleball injuries. I have a whole pickleball for Parkinson talk so we can talk about to keep people safe on the pickleball.

27:40Back to the golf course. So ask the golf course what pesticides they use. See if they can use less toxic pesticides, right? Can they use less? Can they tell you when they're spraying, right? So you can take interventions, especially if you have Parkinson's, maybe, you know, get out of town when they're spraying. You can close your windows. You can get an air purifier. These are all things. You get like an air-conditioned golf cart? Well, you can do an air-conditioned golf cart. And don't drink the water from the course. And it turns out not just living near a golf course has been an increased risk.

28:11Three different studies have found green space workers, including landscapers, to be at higher risk for Parkinson's disease. And one study found that green space workers are higher risk for ALS or Lou Gehrig's disease. So there are lots of clues as to what's causing these brain diseases, whether it's Parkinson's, Alzheimer's, or ALS. Lots of clues telling us that this is a preventable disease. And lots of clues saying that if we pay attention to our environment, like Rachel Carson said, we should. But realistically, like, Ray, can people really, like, reduce their exposure if they're out on a golf course for 18 holes?

28:43Like, isn't it just in there? They're going to be walking on, it's on their shoes, it's on their clothes. It's like. I'm like you, I'm not a golfer, but I can't imagine that golf courses couldn't be using 50 % less pesticides. There are organic golf courses. There are actually. In Martha's Vineyard, they have organic golf courses. If we have organic wine, we have organic produce, if we have organic cheese and dairy products, and meats? Why can't we have organic golf courses? Why can't we enjoy a nice sport without having to worry about getting into the park? Hey, maybe we'll get President Trump on this.

29:13Regenative golf course. But practically speaking, you have a right to know. So ask the course, when do they spray the pesticides, right? Maybe you don't want to play right after they've sprayed the pesticides. Watch the water that's there. Get a carbon filter, maybe bring your own water. And when you're smoking, for those of you that smoke, I'm not saying you should smoke. When you smoke your stogie and your cigar, don't put it on the ground while you're going to hit the ball and then pick it right back up because you're going to put pesticide in your mouth. Thank you. Thank you. That was a good answer to a hard question, which still feels like a bit scary to think about golfing.

29:44But anyway, for those of you golfers out there, just take care of yourself, get your liver working and reduce as much exposure as you can. I mean, this is just such a great conversation because I think I'm like honestly pinching myself because I feel like, you know, I wrote this book, you know, how to fix your broken brain by fixing your body first. And here you guys are neurologists starting to talk about these things. And usually neurologists pay no attention to anything but a little neck, you know, which is just dumb. Guilty. Guilty. Guilty. And now it's like, you know, you can't ignore the science anymore.

30:18And here you are two of the most esteemed neurologists in the world who've written collectively, I don't know, a thousand papers and many books and have led organizations and advised governments and done everything. And here you are going, holy crap, you know, maybe we're living in a stew of toxins and that's a big factor. So let's talk a little bit about the biology. And then I want to go into the toxin story and how you kind of came up with this, because I think it's important to understand that there's fundamental biological processes that occur in the body that are common to most diseases.

30:54And where it hits you depends, I think, on your genetics and who knows what we still don't understand. But like the phenomena of, you know, mitochondria, and you mentioned, you know, the brain has a lot of them. Every cell in the mitochondria has, sorry, in the brain has more mitochondria than any other cell. The heart cell is next. So even more than your heart, your brain has more mitochondria. And they're very sensitive little creatures. They're like little bacteria that we kind of co-evolve with. They kind of hitchhike in our cells, produce energy for us, and we can make them have a home. and it all works out.

31:25The problem is that they're very sensitive to insults. So from your microbiome, from toxins, from stress, from inflammation, from food, from infections. I mean, why do you feel like when you have the flu or COVID, like you can't move and you're tired and you have brain fog? Because your mitochondria are being poisoned, right? But this chronic low-level toxicity is something that has not been really accepted by traditional medicine. It's like, oh, you got acute poisoning, you come to the ER, you know, we'll give you something to fix that. But most traditional physicians just dismiss the idea that low-level toxins are an issue or that there's anything you can do about those.

32:03Can you talk about how you kind of first discovered this and a little bit about the sort of the insights that led you to realize that this is really the big problem? Michael and I were both very, very traditional academic neurologists. And, you know, I went to the oldest medical school in the country. And, you know, we're not told a lot about toxins. We're told a little bit about lead. We're told a little bit about asbestos. We're told a little bit about mercury. We're told a little bit about smoking, which we'll get to in a second, but we weren't taught to generalize this beyond the specific disease.

32:32And only acute. And only acute. Not related to any chronic illness. If you're poisoned, you're poisoned. Talk about asbestos and mesothelioma and stuff like that. But, you know, it was narrow. So I had the gift of a sabbatical. I'm an academic. I was an academic. So I had the give it a sabbatical about eight years ago, and I devoted it to reading the papers of one of my colleagues, Dr. Caroline Tanner, who's a neurologist and an epidemiologist who's now at UC San Francisco. And for 40 years, she's been quietly, diligently telling us that chemicals in our environment are fueling the rise of Parkinson's disease, whether that's air pollution, whether that's pesticides, whether it's a dry cleaning chemical called trichloroethylene.

33:10She's been telling us that these chemicals are causing it. So I'll give you an example of chronic exposure to a toxicant. Lung smoking and lung cancer. So in 1900 United States, there is almost no lung cancer. Lung cancer, the leading cause of cancer death in the United States and around the world simply just did not exist in 1900 United States. It was so odd, it was considered a once in a lifetime oddity. All the doctors and medical students would gather around when they saw a case, thinking they'd never see a case again. And heart attacks and diabetes. And autoimmune diseases. Right. These diseases just didn't exist.

33:43And it wasn't until cigarettes that 25 years after the introduction of cigarettes, you got a corresponding rise in lung cancer. In the United States, we stopped smoking, decreased smoking in 1970s, 25 years later, corresponding. So the challenge with these diseases is that it's not an acute exposure and you get the disease. That's much easier to identify, right? You take too much acetaminophen and you get liver toxicity, you know, it's a lot easier to make that relationship. With smoking lung cancer, which wasn't, connection really wasn't made into the 1950s because there was a 25-year lag between the exposure.

34:15And now we're seeing the same thing with Parkinson's. You don't get exposed to the pesticides as a farmer and develop Parkinson's the next day, next year, next decade. It could be 25 years later, 30 years later. They did a study at Camp Lejeune, which is the marine base in North Carolina, containing it with this dry cleaning chemical. The Marines were exposed at age 20 to the chemical in their drinking water. Dry cleaning like from their uniforms? Yeah. So there was a dry Marines need to dry clean their uniforms. There was a dry cleaning base. ABC dry cleaners on the base that inappropriately disposed of their dry cleaning chemicals got into the drinking water for the Marines at Camp Lejeune.

34:53The Marines even knew about it in the later years, but for 25 years, a million Marines, their family, and civilians were exposed to a cancer-causing chemical in their water that's since been linked to Parkinson's. Dr. Tanner and her colleague, Dr. Goldman, looked at the Marines. What was that chemical? Trichloroethylene, TCE. Yeah, you wrote a paper about that. And they looked at the Marines who were 20 years old when they were exposed. They were only there for 25 months, right? If you're a Marine, you move from base to base. Yet 34 years later, 34 years later, they had a 70 % higher rate of developing Parkinson's disease.

35:27So exposure to toxicants when you're young, some of them were teenagers, when you're young, sets the stage for developing a neurodegenerative disease 34 years later. So true. I mean, I was sharing this story before. I had a patient early on, which sort of clued me into a lot of this stuff, who was about 50. And that's pretty young to get Parkinson's. And she came in with Parkinson's and, you know, I took her history. And, you know, in functional medicine and we do, we start like with what did your mother eat and what was her like in utero environment like, and like, what was your first year like?

35:58And so we go through the whole thing. And she was like, yeah, I lived in the Bronx and we were very poor. And I, you know, we were, we lived in this cockroach infested apartment and the cockroaches would crawl across me at night and freak me out. And so when I married and, you know, had a little more means We moved to Long Island and I just had the exterminator come every week inside and outside. And by the way, I have a barrel of lindane, which is a banned pesticide that is so bad. I was like, this is a big deal. And then, you know, you start hearing that farmers are the most dangerous occupation.

36:35Start to kind of start to dig in and you see what's going on. But I've also had patients who are exposed to other things that can mold, which can be a toxin, or even tick infections, which you wouldn't think, but do contribute. So it's a whole host of things together. And I think we talk about the effect of toxins on your neurology, but Rachel Carson talked about it on fertility. There's a book called Our Stolen Future I read again two or plus decades ago. Shauna Swan wrote a book, Falling Down. You know, Colburn about the effect under reproductive health and the change in fertility rates. And, you know, I mean, I just did a whole talk with a Stanford urology professor about the declining rates of male fertility and what are we doing about it?

37:23And it's affecting everything. So tell us about the most common toxins that you've found are associated with them. Where do we get them? And how do we start to think about, like, avoiding them and dealing with this? There's a pesticide called chlorpyrifos that used to be found on over half of apples in the United States, widely used on golf courses, utility pools. It turned out that chlorpyrifos was used to kill insects in apartments in New York City. And this amazing scientist, Virginia Rao, at Columbia University, looked at the children of women born who were in the homes that were sprayed with this pesticide.

37:58she finds that pesticide in the umbilical cord blood of the children in whose moms were sprayed the homes were sprayed with is chlorpyrifal the higher the level of the pesticide in the umbilical cord blood the lower the iq at three five and seven yeah and then two weeks ago she follows them out to six to twelve and she does mris and they have structural brain abnormalities and they have slowed motor function in the lab these are developmental issues that kids experience as a result of being exposed to these cockroach pesticides that are used commonly in the homes. In New York City. They're no longer allowed.

38:36And then she also found, in addition to having structural brain abnormalities on their brains as early as six years old, they have slow motor function. In the lab, that pesticide damages the dopamine-producing nerve cells that are lost in Parkinson's disease. Which is the basal ganglion cells, right? Yeah. So pesticides as a whole is one is that certain pesticides have the most robust evidence for their role in Parkinson's disease. One of the Parkinson's 25, Mark, we talk about is don't poison yourself. It seems like a no brainer, no pun intended, but don't poison yourself. It's hard though. I mean, I'm on the board of the Environmental Working Group, which is a great organization that has done a tremendous job to catalog, identify all of our exposures across food, across household cleaning products, skincare products, you know, meat, fish, vegetables.

39:29And it really provides a very good guide on, it's evidence-based on how to reduce your exposures, filter your water, air purifier. We can talk about all this stuff. You know, what's really sort of concerning is that these toxins, you know, are found everywhere. The average newborn has 287 toxins in their umbilical cord blood. This was a study done by the Environmental Waking Group. They took 10 newborn babies and And there was stuff like DDT that's been banned or dioxin that's been banned, which is Agent Orange. Which is really bad for Parkinson, those two, by the way. Wow. So the toxic exposures are pretty ubiquitous and it's hard to get rid of.

40:07And there was a big study that was done of the children of farm workers in California. And they collectively lost 41 million IQ points. So this is exactly what you're saying. And some of these toxins are so small that they cross the placenta, right? And they go into the child. and some are fat soluble. So, you know, your brain's covered in fat. Do you know where else they find these toxins? They find them in the breast milk of nursing women. You know, I know that and it makes me so sad. And, you know, I'm not a designer and engineer, but if there's any geniuses out there and want to design a good breast milk filter, that would be a huge boo to humanity because breastfeeding is still the most important thing you do to keep your kid healthy.

40:49and, you know, I mean, we're already born pre-polluted, right? So the question is then, you know, it's the degree, the amount, and if you take a good history, you can actually really find out what people's exposures are, right? And it's all preventable, right? This is what your book, right? This is all preventable. We need not have DDT. We no longer have DDT. We got rid of lead and gasoline. But we made progress. Lead levels today, right, are 95 % lower in kids than when you and I were children. Kids are smarter because we got lead in gasoline and lead out of paint. And the world did not spin off its axis, right?

41:26The air quality in Los Angeles today is 50 % better than it was in the 1960s when Governor Ronald Reagan said we should eliminate all unnecessary driving because you couldn't see across the street, just like you were talking about China. That was 1960s Los Angeles. We fixed our ozone hole because we got rid of CFCs. If we get rid of these chemicals, we get rid of a lot of autism. We get rid of a lot of ALS. We get rid of a lot of Alzheimer's disease and we get rid of a lot of Parkinson's disease. The central thrust of the book is that Parkinson's disease is largely a preventable disease, is a product of the industrial revolution and chemicals in our food, water, and air.

41:59We get rid of these chemicals in our food, water, and air. We get rid of Parkinson's disease. We create a world like 1817 or 1717 when there is no Parkinson's disease or it's extraordinarily rare. I only have one word to say to that. Amen. It is a big lift because the industrialization of the world and the amount of chemicals we use, we all benefit from. And it's really tough to start thinking about how do you re-industrialize to remove those? How do we reduce our exposures? I don't remember. It was at World's Fair. I was living in Queens in 1965 when they had the World's Fair, and I went to it, actually, because I lived in Queens.

42:39and they had DuPont up there and they were like, better living through chemistry and all these Teflon and all these things like the PFAS chemicals. I just did my function health testing, which is a company I co-founded. And one of the things we offer is PFAS or forever chemical testing and phenol A testing and heavy metal testing. And it's hard to test toxins because they're fat soluble. But it's amazing how polluted I am. And I'm like, I'm a guy who tries to be careful, you know, like, and glyphosate levels. And I mean, I eat out and what can you do? Like, it's just, it's, it's really tough. So.

43:13And there's a reason 131 children have autism. There's a reason that more young adults are getting colon cancer, right? When we were in medical school, I mean, no one got colon cancer unless you had a rare genetic cause. No one got colon cancer before 50, right? No. Why do one in eight women get breast cancer? Why do one in eight, one in 10 men get prostate cancer? Diseases have causes. And why is it not uncommon to see young people with Parkinson. You said young people with Parkinson, maybe that's rare when you were describing the person they met. Not so rare. You know, we're, we're seeing lots of young cases.

43:42And in fact, you know, it does increase as you age, you know, over time, but we see people in their teens, twenties, thirties, forties, certainly gets more common the longer you live. But, um, but this is something that another myth that should be busted for people that this isn't just a disease of, uh, of, I don't like to say older, I say more seasoned. This isn't just a disease of more seasoned people. What you're both saying is just so important. And Ray, what you just said, I want to just double click on because you kind of went over really fast. Diseases have causes. Now you would think in medicine that that's what we pay attention to, but unfortunately it's not.

44:21What we pay attention to is what I call the name it, blame, and attainment game. We name the disease by saying, here's the symptoms, here's the science, here's a lab test, Here's the imaging results that explain that you have this pathology. So we are focused on the symptoms and the pathology we can see in the microscope, but not on the cause or the mechanism. And so by understanding the mechanisms and the causes, you can really do something. And the other thing I struck with, Ray, you said, the brilliant thing you said was cancer, you know, autism, Alzheimer's, and the list could go on. Autoimmune diseases.

44:57Now these toxins are called autogens, obesogens. These are toxins that cause obesity, toxins that cause autoimmune disease, toxins that cause neurologic disease, toxins that cause cancer. So even heart disease. But unfortunately, if we're really being honest with ourselves, if this is true, and it's clearly increasingly true, the evidence just mounting every day about the role of toxins across all diseases, what do we do about it other than reducing our exposure? So I'm gonna talk about that. And I wanna talk about like medically, what can we do? Therapeutically, what can we do? And again, it may not be your guys' expertise is what I've been doing for years, but we can kind of jam on it a little bit.

45:30But I'd love to hear your perspective on this. You know, I'll just say, first, for people that are listening, they should know that we should be embarrassed that we spend just two cents out of every dollar on prevention, right? And so it shouldn't be a big surprise that we haven't done the trials, we haven't done the research, and we haven't looked upstream. upstream and so the l so the p in the parkinson plan is about prevent the l is learning why we got to look upstream right and i just want to go back just for a moment and something that you said that resonated and we had done an interview in the book and we talked to buzz jenna at emory and matt lavoie at university of florida and and you know talking about how you know one of the goals here should be the zenness of the cells in your brain right and we call it zen like z-e-n z-e-n And we call it the Zen-ness.

46:22Like a Zen Buddhist. Yeah. Because, you know, again, you think about, okay, so it's in scientific terms, we say homeostasis, right? Right. But, you know, for purposes of talking to a population, we're talking about how Zen are your cells, right? And so you have, you know, a group of circuits and a group of cells that are in the brain, and it's like a thermostat. And what happens in your house when your thermostat goes out, you know? It's too hot or too long. And then you end up with real problems. And when you do that over prolonged periods of time, that's an issue. And so when we talk about both the prevention of Parkinson's, but also the treatment of Parkinson's, zen is an important word.

47:02So we talk about, you want to keep your cells zen. And we know that when it comes to toxicants, we know that they tend to go to the mitochondria and other areas in the brain. We know that the brain has to get rid of things, right? It has, it's like a garbage disposal, right? And that's normal. It has actually, there are cells that, that, you know, that have to eat themselves, right? You know, in order to stay healthy, right? Autophagy, right? Autophagy. So, you know, so it's really important. And then we discovered a system in the brain we didn't even know existed. The glymphatics system. The glymphatics, man, you're, we're like a mad lib.

47:34Now we understand how important these things are. And then you start to say, ask yourself, okay, we got to know why, learn why. So We've got to understand why does a disease start? Why does it spread, right? Why does it progress, right? Those are key elements so that you're not looking downstream. You talked about the canary in the coal mine, everything. We need to understand those things. And actually, that's why prevention is so important and so important for us to think about because we're thinking as far upstream as we can. And we also need to shift our science at the same time to be thinking more upstream and to be thinking.

48:10So when we talk about a few pennies on every dollar, we're also, you know, need to shift our basic science, you know, to be thinking about these systems and the systems that are in place early on. When you look at a toxin and you say, OK, everybody's listening here. Let's we got the toxin. You know, I've been the medical director advisor for the Parkinson Foundation. Mark, just get rid of the toxin. Right. Just get rid of it. Right. Well, there's an acute exposure. Toxins. Right. It's an acute exposure and a chronic exposure over time. And then you take something like paraquat, which has been in the news a lot, like a pesticide that's sprayed.

48:44And by the way, you know, it's doubled in use in the United States here. Weed killer that's sprayed on corn, cotton, soybean fields and continue on. And it doubles in use. And it's banned in 32 countries or over 30 countries, you know. And Great Britain ships it to us, but they won't give it to their own people, you know. I mean, so you look at known toxins like this. Well, it's a challenge, right? Because Paraquat gets into the system quickly and it goes quickly to the mitochondria. It goes quickly to these systems and it clears quickly and it hits your lungs. It hits your brain. It hits all of these things.

49:18Hard to measure, right? Hard to get rid of. So we're going to need primary prevention to just step up and get rid of that. Well, this is a political problem, right? This is an EPA problem. So the prevention, it isn't going to be a pill. It's going to be a policy. Prevention is going to be policy, not a pill, right? I love that. Prevention is going to be policy, not a pill. Yeah. 100%. The fall into winter seasons is when our immune systems need the most support. It's colder, stress ramps up, and we're exposed to more challenges. That's why I turned to HTB Immune Energy Chews from Big Bold Health.

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51:18And sadly, and I was so involved in advising on some of the science around the Maha Commission report, which got very mangled, unfortunately. We're hoping you're going to fix that. the lack of attention to detail on the speed at which it was done, I mean, a lot of the links were all messed up. But that, the basic framework and content was right. And one of the things that had produced was like 40 or 50 pages on the role of toxins in health. And it got removed down to just a paragraph, basically saying, well, pesticides may be an issue, glyphosate may be an issue, but the science really doesn't show it yet.

51:57So we don't really know. So forget about it. And that was like so disappointing to me because there were a whole bunch of scientists that worked on this project that actually documented this. For generations for their lives. So it's really, you know, we've got the agricultural industrial complex, which is a real thing that even the government is actually supporting indirectly through crop insurance and subsidies, which then are used to buy the agrochemicals that then are used to spray that then are used to, you know, help the crops and help the farmers, but ultimately hurt them. And I think hurt the farmers most and hurt their families and then the rest of us downstream.

52:33You know, we have to kind of go from field to fork on this. We have to go from, you know, factory to our closet and to wherever we have to figure this out. And it's not going to be easy, but the problem is that there's such a dearth of research really on funding this. There's also, I think, a real lack of research on what to do once you have the toxins. And this is an area that's sort of been on the margins of medicine. I want to get into it in a minute with you because it's like, you can go to the environmental working group and you can kind of read their stuff and get a pretty good sense of, okay, here's the vegetables I never want to eat if they're not organic.

53:07Here's the fish I never want to eat unless, you know, like unless it's ever like, I'm not going to eat shark. I'm not going to eat swordfish. We're all like cesspools. And the question that becomes is you can do all these things and it'll reduce your exposures. You don't drink out of plastic bottles, filter your water, have an air filter, eat organic when you can. You know, these are all things that you can do. Have better skincare products, household products. that that's that's easy the hard part is okay you've got someone to walk in your office with parkinson's disease who's been exposed to chemicals exposed to heavy metals what do you do um so first of all we're all assessables and we're all victims right yeah yeah no but some people take it take it i know you don't but like we're all victims right these are unnecessary these are involuntary yeah right these are involuntary if you're drinking like a six pack of soda every day, you know what you're doing.

53:56But like here, we're just - But the Marines at Camp Lejeune didn't know that they were drinking and the burn pits and Asian orange and the list goes on and on. And people who work with these dry and clean chemicals likely don't know, many of the farmers don't know that the pesticides are linked to Parkinson's. The vast majority don't. So the first thing you do is stop getting exposed. So if you are a smoker and you get diagnosed with lung cancer, what's the first thing the doctor is going to tell you to do? Stop smoking. Smart smoking. But if you're a farmer and you're coming with Parkinson's.

54:25Not farming. I mean, like, do we even. I have a patient with ALS who's a farmer and he, you know, it's heartbreaking because it's one of those, again, one of those neurological diseases caused by toxins. And sometimes you find it early enough, you know, we could maybe stop it. Yeah, no, I stopped it and reversed it with him. So there are ways that we can do this. So if you're working with Parkinson's, if you have Parkinson's disease, we give you in the book that Parkinson's is 25. 25 actions that can reduce your risk. If you don't have the disease, if you're one of 330 million Americans who don't have the disease, we'll give you 25 actions to reduce your risk of ever getting Parkinson's disease, ever getting it.

54:57If you're not exposed to these chemicals, you are highly unlikely to ever develop Parkinson's disease. And if you already have the disease, they might slow the rate of progression. So I'll give you an actual concrete example. They looked at people who already had Parkinson's disease and they looked at people who lived in highly polluted areas of the country and those who lived in low polluted areas. People who lived in highly polluted areas had an increased risk of being hospitalized due to their Parkinson's disease if they lived in areas with high air pollution. Yeah. So you got an air purifier in the corner, we can get an air purifier.

55:27When you're driving through - I put that in there just for you guys. Thank you. When you're driving through Lincoln Tunnel, you know, roll up your window. Yeah, put the recirculation on. Exactly, recirculate the air. If you happen to live near fields that are being sprayed with pesticides, you know, close your windows. I mean, there are lots and lots of things that we can - I hold my breath while I fill up my gas tank. Literally, I hold my breath. I like. And, but we need to create a world where we don't have to take all these actions. So what are things that we can do in our community? Can we stop spraying pesticides on kids' schools and playgrounds?

55:56That would be a good idea. Right? And we wonder why one in 31 children get autism, yet we spray nerve toxins on their schools and playgrounds. What did TX actually say when he heard of the theory of evolution? How stupid not to have thought of that. So there are lots of things in our communities that we can do. And what are some of these societal actions that we need to do? and I'll let you talk about additional ways to address it. Well, so the other thing is, is that if you - Awareness is important. Yeah. If you're a smoker, you know, what's the first thing you do? You know, if you get lung cancer or whatever.

56:27Stop smoking, right? So, you know, this idea that, you know, once you have the disease, okay, or once you have the diagnosis, that you stop, you know, with these things is sort of another myth that needs to be busted. You know, it is the way that you live. You even talked about some of the people that you see within the functional medicine. You know, in that paradigm, you're thinking about how can we help people to live better, right? Yeah. So the Global Burden of Disease Study told us something really - Just for those who don't know, that's like 195 countries, a study of chronic illnesses all across the world.

57:02It was a large epidemiological study, one of the best ever done. And it gave us a lot of information about who's suffering from what, where. So just so people know what it is. Yeah, so 100%. So back in 2012, I had written this book, 2013 or something, I can't remember now, but we wrote a book called 10 Secrets to a Happier Life with Parkinson, and it kind of became this runaway bestseller. But it was like 10 simple things that you do, right? And in the prologue of the book, I made either the unfortunate or the fortunate choice of two words called the Parkinson pandemic and came under a lot of scrutiny from colleagues and everything, and rightly so, right?

57:37I'm a scientist. I should be able to take it. Turns out you were prescient. Well, you know, like you have to put it forward. You have to, you know, these things need data. So then we write the book Ending Parkinson's Disease in 2020. We have the first cut of that global burden of disease data. And guess what? Ray is better at math than me. He crunches all the numbers. And it turns out by 2035, we should have 12 million people with Parkinson's, which is like, wow, growing faster than Alzheimer's disease. So like percentage wise, how much of an increase in that is like in 50 years? Oh, well, just in 1990, it's estimated that 2.8 million people have the disease.

58:12And I'll steal Michael's punchline. In 2021, they estimated that 11.8 million, a quadrupling. Adjusted for population? So if you adjust for population growth, right, population growth hasn't quadrupled between 1990 and 2001. No, it's still two or three or plus times the amount. In just the last 30 years. After I graduated from medical school. Yeah, but you're supposed to have 12 million, Mark, in 2035. How many do you have today? 2025, 11.8, according to that. You already got the 12 million 15 years before we thought it was going to happen. And when you went to medical school, you know, Parkinson's was there, but it wasn't like everywhere.

58:51Oh, no, no. I mean, I've seen so many people with it. But now, like anyone over 50, if you're over 50, you have friends, you have family members. You know, our inboxes are like it doesn't stop. I walk the streets of New York and I'm like Parkinson. And when I see them, I get pissed off. Why? Because it's a terrible disease and I think it's largely preventable. Yeah. Right? Suffering is part of the human condition, right? You write about this. But preventable, needless suffering, really? Yeah, I agree. I think that's our goal. I mean, for me, my life goal is to prevent needless suffering because, you know, we can't change everything.

59:24So just for the audience, what are the air, food, and water things that they can do to reduce their exposures? So we give you the 25 recommendations in the book. I'm going to read you number one. Wash your produce, even your organic ones. Mark, you know this better than we do. Pesticides have contaminated our food supply. Remnants of pesticides are found in 20 % of common foods. Organic produce, dairy products, and meat can reduce exposure, but can still have unsafe residues of pesticides. So wash your produce at least with water and consider simple vegetable washes, vinegar, or salt solutions too.

59:56When the government measures the pesticide residues on a piece of fruit, they do that after they've held it under cold water for 15 to 20 seconds. If that's what the government's doing, think about what you should do. I'll do the second one. I'll give the last one to Michael. Number nine, use a water filter. A simple carbon water filter widely available in supermarkets can reduce exposure to pesticides, volatile organic chemicals like trichloroethylene, and other chemicals that may be in your water. These carbon filters can be installed for the whole house at the point of entry or at the point of use, such as faucets or even water pitcher.

1:00:35My colleague at Atria Health and Research Institute, Robert Kachko, will tell you reverse osmosis is even better. And I'll let Michael maybe take number 10. Yeah. So, you know, I do reverse us both. In terms of your air, you know, number 10 is consider air purifiers. They're an easy, effective way to lower your risk of disease from indoor air pollution. Air purifiers do a range in cost. They can be as little as$10, as high as$1 ,000. I'm sure the one Mark has us breathing here has got to be the$1 ,000 one. It's not actually, it's$300. All right,$300. And require periodic cleanings. And remember, they need filter changes and may need to be installed in multiple places, depending on the size of the home, school, or workplace.

1:01:17Be sure to use air purifiers that have carbon filters. They're designed to remove the volatile organic chemicals, VOCs, like trichloroethylate, which you all know from dry cleaning story and everything is so important in Parkinson's. This is great. So these are simple things that people do every day. I have an air filter in my bedroom and in the place I spend the most time. I have a reverse osmosis water filter. You know, you know, I think those are the two most simple things you can do at home. Plus go to ewg.org and make sure you clean out all your crappy household cleaning products and your skincare products.

1:01:51And you'll get like 80 % of the way there. And a shout out to Ken Cook, the outstanding leader of the environmental working group. He and his team are helping us understand the role of these chemicals in our environment, in our health, and how to get rid of them. You know, we could talk about, you know, the role of toxins for a long time, but, you know, we kind of covered a lot of the sources. But I kind of want to spend a little time on people who actually have Parkinson's and who are struggling. You know, there's been really shitty drug development in this disease. There is some really exciting new surgical interventions, the deep brain stimulation.

1:02:25You know, Dr. Machado at Cleveland Clinic, who I worked with, was one of the pioneers in this, a neurosurgeon. and I, this guy's one of the pioneers right here. Yeah. You know, you, you obviously, I read your work has been, has been very involved in this and that's a huge boon. It's, it's a, it's a big win, but it doesn't address the, it's just like a downstream sort of better mousetrap to fix the problem, but it's an actually, we still have the mice. I would love to hear from your perspective from like a diet, lifestyle, supplement, detoxification, what you guys know, I would love to sort of unpack what people can do.

1:02:59And can, in the answering of that, can you actually reverse it or stop it? Because right now there's like clinical trials, for example, in Alzheimer's, like the finger trial, the pointer trial, Richard Isaacson's work, where they're showing not just slowing down of the disease, but actually reversing it with intensive lifestyle therapy and risk factor management. So do we see that in Parkinson's? Have you seen that in Parkinson's? You've got guys like Delbredesen, who people think may be a little bit off the rails, but honestly, he's not, reversing Alzheimer's. I just talked to one of my patients two days ago who I've been treating for two years, and she was diagnosed with Alzheimer's, and now she's better and back to work.

1:03:40Let's unpack a little bit, and let's just start with sort of, you know, a few piece. So we need to change the way that we practice when we interact with folks with Parkinson, you know, it needs to be practical, proactive, and preventative. Okay. We need to be thinking of those three Ps when we're, we're interacting. And I know. You might forget one, personalized. Well, personal, we can keep going with Ps too. And, uh, but, but, but absolutely. Although I will say just, you know, like in general, you know how people make things a little too cliche. Sometimes people say personalized and that's going to cure everything.

1:04:15I say, well, what does that mean? Well, the reason I say that is because if you have a diagnosis of Parkinson's, it doesn't mean you know what's really wrong with you. Like I always say, if you know the name of the disease, it doesn't mean you know what's wrong with you. You don't know the cause. You know the name of the symptoms, which can have many causes. So Parkinson's disease, here's another myth. It's not Parkinson's disease. It's Parkinson's disease is. Yeah. Right? There are multiple causes. There are multiple syndromes. Yeah. No two people look alike. and I remember sitting next to Davis Finney in the White House having a nice discussion with him.

1:04:47And, you know, he said, when you have Parkinson's, you got to make every day your best day. That always stuck with me. And then when I made my comments, you know, I said, you know, I think Parkinson's is probably the most complex disease in clinical medicine. And I just, I don't mean to insult other people in different diseases, but think about it. You know, dozens and dozens of motor, tremor stiffness, slowness, non-motor symptoms, anxiety, depression, constipation, sleep, cognition, right? So you've got all of those things, right? Plus you've got this miracle drug, dopamine. You give people dopamine, they wake up, right?

1:05:22And then of course there are fluctuations later. Then you've got, you know, as you mentioned, deep brain stimulation. You've got dozens of different medications. Oh, and by the way, it changes over time. People wear off. They get these dance-like movements. It is a super complex disease, okay? So when you take all of that, we need a different paradigm to care. And so unpacking the first part of your question is, we're doing it wrong, Mark. Like we're caring for people wrong. So when we have HIV, we're able to create navigators. We're able to check people's viral levels. We're able to get people, listen to this, mind-blowing for people.

1:05:56We can get really expensive cocktails of drugs for people all over the world who have HIV. I get L-Dopa for pennies. And you can't get L-Dopa pennies on the dollar. So we call for that as a bold action in the book. 100 % of people on this earth, on planet, if anybody's listening, you know, we need to have - And L-DOPA is the drug that's the main safe for Parkinson's treatment that increases dopamine, which is what gets depleted in the brain when you have Parkinson's. And it's a game changer, right? And so super important to think about that. And cancer, we do better in the way that we bring together the right teams.

1:06:31So thinking about this, we proposed, we used to say the person with the disease or the patient is the sun and we revolve around the patient. I'm like the broken record of saying this for 25 years at the institute I work at called the Fixel. And now we've expanded that to be the Parkinson universe. And let me just explain that for people listening a little bit. So of course, the person with disease is the sun and we should all orbit around them. But what's the closest planet to the sun? Mercury. Mercury is your caregiver. Gets a little hot being the caregiver on both sides because you're in between that and then all the other planets, which are all these different specialists.

1:07:06You might need, you know, a neurosurgeon, a neurologist, a psychiatrist. Mental health is huge in this disease and a problem throughout the world, not just in the United States. All the rehabilitation specialists, PT, OT, speech, swallow, et cetera. So you need all of these people orbiting at different areas. And then you've got mercury, the caregiver in the middle, got to take care of the caregiver. Okay. More men than women get Parkinson. But guess what? When a woman gets Parkinson, they don't do as well as men. And the reason is the caregiver and the care partner. So we always should, we should be challenging men.

1:07:40I'm sorry, men, all the men that come to my clinic, I challenge all of you care better for your, you need to step up. The data says you need to step up. Okay. And then Pluto is the almost planet that stigma, 25 % of people hide their diagnosis with Parkinson disease, unacceptable. So, so, and then, and then what else, Mark? So the stars are all the support groups, right? And then all the satellites are the sensors. We have all these great sensors. I got some of them on. I think you've got sensors too, and watches and rings and all these things, right? That can help us with sleep and exercise and making sure we're doing all those things, bringing telemedicine.

1:08:15Ray is an absolute pioneer in bringing care to the home for Parkinson. Well, I thought that was an interesting thing you said in your book, because it annoys me to no end that the body doesn't change when you move from New Jersey to New York or from California to Nevada, but your license does and you can't treat a patient in another state, which is the most stupid thing. In Europe, if you're a doctor in any country, you can treat a doctor anywhere else. We've uplifted those restrictions during COVID and then we put them back in and it's crazy. And who loses? The medical boards. Yeah, but the patients lose, right?

1:08:49Patients lose, yeah. It's just a money draft because every state has a licensing board and they're all making millions. So we should make it so that any patient, any Medicare beneficiary, any patient can receive care from any clinician that they need to. Absolutely. So thank you for saying that out loud. Like sometimes we think it, but we don't say it. So thank you for saying it. I'm working on a telehealth bill also in Congress. So we're on that. So maybe for the last, you know, two decades with Parkinson Foundation, we may have spent a lot of hours advocating so that your care is defined by where your physician or health care provider is, not where the person with disease is.

1:09:21It's a very simple concept that we just can't seem to get. And then we did a red card campaign in our last book, Ending Parkinson. We actually took over the White House and sent thousands and thousands, like 20 ,000 plus cards. One of the things we called for was just this, watch out the COVID restrictions on telemedicine were lifted. It's going to go away. Pay attention. We need that. And so it was one of the three things that we asked for. So is there more because what you're talking about are sort of structural changes in the care delivery model. Yeah. What I'm really trying to get out here is like doctor-patient, like what are the therapeutic interventions other than just the social support and the structure and the care coordination?

1:10:06All the things you're talking about are really important. But like I'm trying to get to the granular level of like if someone's listening with Parkinson's or someone in their family has Parkinson's, like what do I do? Is there a way to slow this, stop it, reverse it? Yeah. So the practical. Now you're to the P of practical, right? Let's get practical right now. That's good. All right. So we think about practical, right? And the practical advice now that we should be giving that most people don't is, guess what? When you take dopamine, dopamine, the most common drug for Parkinson, very important, still the best drug we have.

1:10:37Ray likes to say, what a travesty that here we are 50 years after and it's still our best drug in the armamentarium, right? That should be unacceptable too. But having said that, dopamine depletes cofactors in your blood. And so your vitamin B6 may go down, your homocysteine may go up, other things that might put you at risk for dementia and other things. So guess what? From a very practical standpoint, you need to be on at least a general multivitamin. I call it like a Centrum equivalent because most people, I don't favor Centrum over any other company. Yeah, don't take the blue pill. Right. I'm not doing that.

1:11:11You don't want to take pills with dyes in them and titanium and you want to clean them. No question about that. But, but, but, but. You're just adding more shit. But, but fundamentally, thank you for saying that. Again, you get to say the things. Talking to the expert here, man. I know. I know. Mark gets to say things out loud that we can't. But from a practical standpoint, you send people to the shelf. Just text me, I'll say it. And say you want to look for a good multivitamin because, because this is going to be super important, right? And then when you're going to your general doctor, you want to have them check vitamin levels on you.

1:11:40You're going to think they're checking. You know, we're so preventative in cardiology, Mark. Why are we not in neurology, right? It's ridiculous, right? Vitamin E levels are low, you know, in Parkinson, right? Vitamin D levels are low, right? And then it's a double-edged sword with vitamin D because we should be telling folks it's twice the risk. Did you know that? Twice the risk of melanoma and Parkinson disease. You sweat different. You smell different. You know, Joy Milne was the famous UK person who could smell Parkinson's disease. And then they said, you know, you talked about quack. They said she's a quack.

1:12:13They put her to the test. sure enough there's a smell yeah so you sweat differently remember it's a full body disease it's in the skin and everything and and you're not as well protected against the sun and so we need to tell people about that and of course practically speaking you can get suburea and other things with skin twice the risk of osteoporosis are you getting regular bone scans you know like i know this sounds like so and we wrote the book 10 secrets you know you think everybody knows this but they don't you know two times the risk of that so we need to pay attention to those things.

1:12:43And then in addition, as we're seeing folks kind of along the way, I know, and Ray may want to talk about this, we need to shift our discussions with them to sort of include the why, you know, figuring out what is your real history. And I was kind of jealous when you said in functional medicine, we always start the visit with the person. And Ray and I have taken care of thousands of people with Parkinson's. We didn't always do this. You always start the visit from the beginning. You know, it's like, you know, Mel Brooks in history of the world, the beginning of time, right? You start from the beginning and you want to know what that story is.

1:13:15And I don't know if you want to comment on that. So I'm going to go to slow, stop and reverse. So can we slow it? Yes. Can we stop it or reverse it? No evidence that we can do that today. But let's talk about slow. I'll jump in on that. I know we're going to, we're going to. It's anecdotal, but I would say it's anecdata. Okay. Anecdata. And so we're going to, so slow, we told you to 25 things, stop getting exposure to toxins. We got that. Next one is exercise. So exercise is probably this century the biggest therapeutic advance. Sir William Gowers, when he described Parkinson's in the late 1800s, he said the life of someone with Parkinson's should be quiet and restful.

1:13:50He was wrong. A hundred percent. If you have Parkinson's, you cannot be quiet and restful. The boxing thing is a real thing that worships your heart. You should be boxing. You should be knocking out Dr. Hyman in the ring with Rocksteady Boxing. 7 ,000 steps a day. So we increasingly know that vigorous exercise, amount of exercise to make you sweat, has enormous health benefits. And it turns out it doesn't appear to be which exercise, whether you like to box, non-contact boxing, you're not hitting people in the head, whether you like to swim, whether you like to jog, it's all beneficial. You don't want the pugilistic Parkinson's that mom thought you had.

1:14:23You don't want that. We can talk about that too. And so it turns out that exercise, as you know, releases brain growth factors in the brain and it likely protects the remaining nerve cells and protects them from dying off. Our colleague, Dr. Bas Bloom, has even shown that, you know, you can see these changes on imaging. So now with imaging, you can actually see beneficial therapeutic effects of exercise. And then Michael and I both have had patients who have, one, either not taken medicine for many years because they were just so prominent on exercising two, three, four hours a day that they've delayed their need for medicine.

1:14:56And we have had patients who've been able to come, who've decided to come off medications and just treat their Parkinson's disease with exercise and other behavioral factors. Although we don't recommend that in general. In general. But it's something we have to have an open mind to. And you said, you know, anecdotes that we see this. So now you want to say stop and reverse. So you know what gets measured gets managed. What gets measured gets managed. And so we - And you've got an MBA, so you know that. That's, what's his name, Drucker? Peter Drucker. Yeah, Peter Drucker. And so cholesterol, we came to the age where cholesterol was starting to be measured.

1:15:31We only got statins and everything like that because we started measuring cholesterol. Hemoglobin A1c, right? After we did our training that we're going to measure the glycolization of hemoglobin as a measure of diabetes. And we do that. But are we measuring? I have never in my entire life. I'm a neurologist. Many pesticides are nerve toxins. I have never measured a pesticide level. Oh, I can help you with that. Okay. But if we're not measuring pesticide levels in people's bodies, how can we manage and see if we're taking steps to reduce it? When we did that with lead, when we measured lead in children, we got really, really serious about getting lead out of paint, lead out of gasoline.

1:16:11Problem is you need a fat biopsy to properly assess. Exactly. But there's other ways. And so there are fat biopsy. So if we start to measure these chemicals in our bodies, whether that's in our blood, our urine, our fat, our hair, or stool, we can take better actions and be more informed. And if we can start measuring these chemicals in our environment, in our water, in our household dust, in our soil, in our air. You know, we have a thermostat in this room. There's actually body things you can now wear. They will register the PPMs or particulate matter in the air. So why don't we have a thing that's measuring particulate matter in our air?

1:16:44Right? That's a more greater determination of our power. Indoor air pollution is a big thing, yeah. Greater determination of our health than the temperature. What gets measured gets managed. We need to start measuring these chemicals in our bodies. We need to start measuring these chemicals in our environment so we can figure out what interventions, which you're going to talk about in a second, can reduce these things in our bodies, in our environment, so we can all live longer, healthier lives, and perhaps slow, maybe get to the point that we can stop. So even at, you know, you just said something like, you know, I never measured a pesticide.

1:17:13So in academic medicine, other than maybe checking your blood, mercury, or lead, maybe our stuff, like doctors don't know what to do. Don't know what labs to send things to. Don't know how to test them, right? They're not widely commercially available. You can't just check them off, generally speaking, on a lab form. I know you - Presently now, they are like - They are. Like, you know, when we were in training, this would be like - But we need to start measuring these things. 100%. The body has an embedded system for removal of toxins. your, you know, sweat, your breath, your poop, your pee, your liver detox systems, you have enzymes.

1:17:44And I think, you know, as we're beginning to understand genetics, I think in we're now we went from a billion dollars, I think it's now 300 bucks to get your whole genome sequence. Yeah. You know, you can actually start to see, oh, I have these detox pathways that may need a little help or my methylation pathways that help also with detox also need a little help. Or, you know, I have certain increased needs for X, Y, or Z nutrient, or one-third of your genes code for enzymes. Enzymes require cofactors or coenzymes. All those are nutrients. And we have huge variations, as Bruce Aime says, in our need for different nutrients at different doses.

1:18:23So we're all very soon going to be able to sort of create a roadmap of prevention and go, oh, here's your genetics. Here's your potholes. Here's what you need to do to fix those and prevent it. And so, you know, one of the things I want to dive into is, one, how do we detox? And two, how do we resuscitate our mitochondria? Because, you know, I don't know if you know Suzanne Goh. She's a pediatric neurologist, Harvard-trained, Oxford-trained, published in the journal, you know, JAMA. and is basically discovered in autistic kids using very sophisticated MRI imaging, functional MRI imaging, that their mitochondria aren't working.

1:19:01And she provides them mitochondrial cofactors, CoQ10, carnitine, things like that. And they actually get better. Now I'm wondering, I remember I read a study years ago where there was, they used like 1200 milligrams of CoQ10. Like normally when you take CoQ10, you take 50 milligrams or a hundred milligrams. They're using 1 ,200 milligrams, and they found an improvement in their clinical outcomes. So is there any conversation among your colleagues, neurologists, like, how do we put together a comprehensive mitochondrial rejuvenation program? And what does that look like? Yeah. So, you know, it's a great question.

1:19:33And I think part of it, too, you know, Tony Lang is one of the leading neurologists in our field in Parkinson's disease. And when we were talking about him and doing interviews, you know, with him about the book, you talk about when something is has dysfunction. So it's not working properly or something's kind of dead or degenerating, you know, and like, where is it on that spectrum? Right. And so I think one of the challenges for us is understanding which segments of ourselves, we talk about the Zenness trying to get ourselves more Zen, which segments of the Zen are still functioning and can we rescue them, which is what you're talking about?

1:20:13And could you rescue them with, let's say, higher dosages of CoQ10 or something else? And which are too far downstream? You know, like they're already gone. They're too far downstream or we need to look more upstream in like for the answer, right? So is the answer going to be done? Yeah. I mean, you're right. I'm going backwards. I'm going, how do you fix the mitochondria? I realize how do you fix the toxins? So let's go back to the toxins, but stay with the mitochondria for now. Yeah. So we know when it comes to toxins for Parkinson, we know that when you take, you know, toxins, and we have a very good friend, he was a mentor of mine at Emory named Tim Greenemeyer.

1:20:47Tim Greenemeyer studied a toxin called rotino, common herbicide in people's garages, you know. It was in the, they used it in the creature from the dark lagoon. They put it into the water and make the fishes all die, instantly come to the top. Great visual effect, terrible if you're the creature, right, who's in the water. But he actually now has Parkinson Johnson himself. And he wrote an article and was interviewed and went public with it in a very, I think, important magazine. I think it was in Science, which is very credible, reputable magazine, maybe on the top levels, I think, talking about this and talking about the lack of protection.

1:21:25But the thing about Rotenone that he studies is it's like MPTP, which is the other toxin that came from the designer drug, where they were trying to make a drug called MPP plus and they made mptp instead and people started to come down with parkinson the frozen addict if you ever watch the old pbs special you know and read the book by bill langston amazing story and it was because of recreational drugs that we actually got our best early animal model so people say oh well maybe recreational drugs are bad maybe not it it spurred decades of research in parkinson and important research for my mentor malin de long and others but what do those toxins do, Mark?

1:22:03What does that do? Mitochondrial poisons. Yes. Complex one of the mitochondrial system. And in fact, it's non-selective for MPTP, which is what we worked with when I was at Emory. What was the street name of that drug again? Crystal something? Yeah. Street form of heroin. Yeah. It's a methamphetamine. It's a methamphetamine and ecstasy sort of in that category of drugs. But it was a designer drug maker trying to make a designer drug. He just got one little thing wrong on the end of that. So you take this complex one. And the one that Greenemeyer was working with, which was different than my mentor who worked with MPTP, that one only does brain cells.

1:22:42It only hits complex one in those dopamine cells, okay, in the brain. It's very specific toxin to that. And then Greenemeyer himself ended up with Parkinson's disease and talked about how he probably should have been more protective. And he's very open, you know, about his story. And I think that's a really, you know, great thing. And the question is, is, is, is access to, so let's say somebody in functional medicine wants to address mitochondrial dysfunction. Awesome idea. Okay. And there are a lot of drugs out there that are addressing it. You got to beat the leaky brain. So that's good, right?

1:23:16You got to beat the leaky brain. You got to get to, and there's mitochondria in other areas besides the brain too, that may be affected as well. And, and then you've got to figure out, you know, how, how far down the system is it gone? What's the dose, you know, response on that. And here we are spending like two cents at every dollar on prevention. We're spending like zero on every dollar trying to figure out, you know, how we could actually try to resuscitate and improve the functioning, make them, make those cells more Zen. Well, this is really important what you're saying. Cause you know, one of the failures of modern medicine came out of Louis Pasteur, which had a lot of benefits, discovered bacteria, but it was like, oh, there's a single cause for a single disease treated by a single drug.

1:23:58You've got pneumococcal bacteria causing pneumococcal pneumonia, treated with penicillin, boom, end of story. And we've been chasing that false tiger for a hundred and plus years for chronic disease, which it doesn't apply. And these conditions are all multifactorial, meaning there's multiple causes and you need multimodal treatments, meaning you need a lot of different things. You mentioned exercise. You mentioned reducing your exposures. You mentioned, you know, mitochondrial therapies. You mentioned L-dopamine. There's lots more things and you can't just do one thing. And people will say, well, you know, how do you do a randomized control trial?

1:24:30You don't know what works. Let's just try CoQ10. Oh no, let's just try lipoic acid or let's just try blah, blah, blah. And I'm like, no, like, it's like, it's like saying, it's like saying we're gonna create, we wanna win the NBA playoffs, but we're only gonna put Michael Jordan on the team and he's got no other players on the team. He's going to lose every time. Yeah. Right. Yeah. So, you know, I think, I think this is a fundamental flaw in research and I don't know how to answer that. Well, let me just add, like, just add on to that and just pile on a little bit and just say, we talk about in the book about combination therapies.

1:25:01Remember, carbidopa levodopa is a combination therapy. You need the two to get it to the brain. Right. And to reduce the nausea, get it out of the blood and up into the brain. Passive lemur barrier. Right. That leaky area. Right. And, and HIV drugs. We talk about HIV drugs and heart therapy, which was, you know, where you take a bunch of these drugs together in combination. And that was the winner. Right. You talk about cancer chemotherapy. Malcolm Gladwell loves talking about this, telling the story. We tell a piece of that story again, the most disagreeable guy at NIH ever that you wouldn't want to be in the same room because he's such a curmudgeon.

1:25:34It takes a guy like that to challenge the system to cure these kids with leukemia, put these combinations together. now we're so far down the road and yet we're still not thinking in combinations and so i just wanted to add on to what you're saying you know like what are we doing well so i i think i'm going to come back to the how do you remove toxins because that's like going upstream but you know often like you can intervene with mitochondrial therapies and you can get pretty you know um i would say complex because there's a lot of different pathways a lot of different enzymes on the steps. So CoQ10, we've talked about.

1:26:07We didn't talk about this, but NAD or NMN, which is a common longevity now supplement, but that actually plays a big role in mitochondrial function. Creatine, which has been shown to help you have different neurological diseases. Helps your thinking in some of these recent studies. Yeah. That's why I'm so smart this morning. I did my 10 grams of creatine. I had chronic fatigue syndrome as a result of mercury poisoning living in China. And I can tell you my CPK, which is muscle enzymes, were 600 for years until I figured out how to fix my mitochondria. So, you know, then there's things that help like other antioxidants, like N-acetylcysteine, things that boost glutathione, there's phytochemicals like resveratrol, curcumin, green tea extract, carnitine, all the B vitamins that your cofactors, particularly riboflavin, niacin B2, B3, all the methylation vitamins, B6, Bola, B12, magnesium.

1:26:59And even there's interesting things like peptides, like SS31 and humanin and MOTC, which are kind of a little bit beyond the conversation we're having here, but that our body's own biological way of regulating our mitochondrial function, peptides are essentially the body's like communication superhighway system. And we've been using them in medicine for years. Insulin's a peptide, GLP-1s are a peptide. So like there are things that can help the body function better. So what I find is those things can be really great, but you have to first deal with the gut. You have to first deal with reducing toxic load.

1:27:30And so that's where I think, you know, you know, we really need to start funding these trials on using these, these multifactorial assessments. Like let's look at all the potential causes. Do you have mold? Do you have mercury? Do you have pesticides? Do you have, you know, suffering from household cleaning chemicals? Are you exposed to particularly air pollution? Like what's your. And we have AI, we have the ability to now deal with multiple factors, right? Like never before, like today in the age that we're in yet we don't study. We don't. And then And then, you know, once you understand those, you start to kind of address all those systematically.

1:28:04And then you start to resuscitate and repair the body. So you take out the baths that put in the good stuff. That's what functional medicine is really. And I think, you know, what I'm also wanting to ask you about before we get into the whole detox thing, because I think I don't want to just end because we're going on a long time. I could talk to you guys forever. Recently, there's been some real advances in blood biomarkers for Alzheimer's, like P-Tau-217 and neurofibromic light chain and other biomarkers. Are there biomarkers for Parkinson's? Because it's a syndrome. What it means is a syndrome is that it's a clinical diagnosis.

1:28:36You go to an expert, you meet these criteria for these features, and you go, okay, you got Parkinson's. But it's not like you do a blood test for blood sugar and you see you have diabetes. So is there now or will there be soon blood biomarkers? So Alzheimer's is just a little bit ahead of us and, you know, and they have, you know, evolving and people should understand these things are evolving because we get better and better and we should get better and better. It shouldn't be a static, you know, type of type of deal. Where we started was by saying, oh, we just have the clinical examination. But if you only train 40 or 50 docs or healthcare practitioners in the United States alone, and Medicare doesn't even cover those, they're covered by grants and philanthropy and things like that, we are going to have a public health crisis.

1:29:25We already have a public health crisis, all right? So we're going to need biomarkers both to tell we have the disease and also to tell how the disease is progressing over time. And so when we make measurements on all these things that you're interested in, we have a way to biologically measure them. So the things that we have so far, okay? So we've got a test called a dopamine transporter test. It's a 1-2-3. It's a cocaine analog. Don't get scared if you don't get cocaine or don't get excited, you know, Mark, you know, like on any way or the other. but it's a test that you can tell how the dopamine transporter is in the brain.

1:29:57It doesn't tell you if you have Parkinson's or not, but it tells you you have a dopamine transporter deficit. And it's an imaging test. It's an imaging, right? It's an MRI. Take a picture. It's like a nuclear medicine test. Nuclear medicine. Yeah. So we have that. We now have, you know, there was a 21 center study that was just done by David Valancourt. I was part of that study from the University of Florida. He developed a free water imaging so we can tell the difference between Parkinson's, PSP, and another mimic called MSA. So there are two other Parkinson common mimics. These are things that look like Parkinson, but aren't exactly Parkinson.

1:30:29Progressive supranuclear palsy Dudley Moore had. MSA is multiple system atrophy. He has all those autonomic features, lighter flight things associated. So in English, it's diseases that seem like Parkinson's, but aren't that you can kind of test for? Exactly. And now we can do something the eyes can't see. It's really cool. The eyes can't see it, but the AI can. So they can take your MRI with this six-minute sequence and tell the difference between these diseases. And then the latest evolution has been blood and skin tests. Yeah, blood. Okay. And so people are really interested in measuring the protein called alpha-synuclein.

1:31:01Okay. So you talk about P-TAL-217, which is really hot and really important for Alzheimer's disease. People have been talking about alpha-synuclein, which is that protein that gets deposited in something called the Lewy body. Again, named after the guy, Lewy, who described it in the microscope, right? Lewy body is like a combo of Parkinson's and Alzheimer's. Yeah. Yeah. So that, so, so. More Parkinson's, but like, it's like, it's like the beta amyloid plaque that you see in Alzheimer's disease, the pathological hallmark, what you see under the microscope and Parkinson's is a Lewy body. I've had many patients with that actually.

1:31:32So we're interested, right. In measuring that. And that is huge, right. So when we can start to measure that and the fluid that bathes your brain and spinal cord called the cerebrospinal fluid. So get to a spinal tap or fingers to a blood tap. Well, that's how it started, you know, with, with spinal taps and, and looking at it. But now there are now evolving ways to look at this in the blood and in other areas. And it's getting better and better. And then also skin. So skin biopsies, you talk about fat biopsies, but skin biopsies as well. For mitochondrial function? And then, you know, no, for synuclein.

1:32:03The misfolded protein is not just found in the brain. It's not just found in the gut. It's actually found in the skin. And just for people understanding, like, you know, genes make proteins. That's all they do. And one of the hallmarks of aging is proteostasis or just funky, merely misshapen and folding proteins that don't work properly. Yeah. So you fold the sheet and, you know, if you have a regular sheet, it's easy to fold and it's nice and neat. But trying to fold a fitted sheet is a really big pain in the behind. Right. Exactly. And so a fitted sheet is always misfolded. And so in Parkinson's disease and Alzheimer's disease and ALS and a lot of other brain diseases, the hallmark of the disease when you look on the microscope are misfolded proteins.

1:32:41But I don't know if this is true. I'm just hypothesizing. Because the genes make proteins and the proteins have functions and they're damaged because of environmental factors that change the gene expression or the what we call post-translational gene products, the proteins that genes make, through proteomics, which is like a new way of actually testing large numbers of proteins in the blood at very low cost. Are we seeing protein signatures of Parkinson's that Yes, we are starting to see them. But as we get more data, we're overwhelmed by the data where AI is helping us. But now you have imaging, you have blood, you have spit, you have skin.

1:33:20And the answer isn't going to be in one thing. You know, people like to go binary yes or no. Because it's like if you're making a difference, how do you know? Like I know if I had 10 with Alzheimer's and I check their P tau 217 and I do 10 things and I check it again six months from now, it can go down. What gets measured gets managed. Right. So is there anything like that coming? So that is right now, like right now, Mark, what so many people all over the world, multiple laboratories are working on because we're not quite there with the statistics to say it's good enough yet. But we're smashing these tests together.

1:33:52And my prediction is, and I think Ray feels the same way when we were writing the book, is it's going to be a combination of these tests that are going to give us those markers. But what you said is so important, and I just want to reemphasize that. We have to be able to measure trajectory. it's not good enough to just diagnose. We don't need a biomarker just for diagnosis. Like you can see a lot of Parkinson, you know, it's a clinical diagnosis. Like you take a stat and your cholesterol goes down, right? Like you want to know what - Yeah, you have Parkinson. If you respond to the dopamine and everything, that's pretty doggone good.

1:34:20What we need to do is we need to be able to see how it changes over time. And then when we intervene, you know, do these things that we're given. Because it might be some of the things we've tested actually did work, but we couldn't measure it, as Ray said. And so it's a problem. It's a challenge, let's say. This is really great. I want to wrap up because, and I don't want to put you on the spot because you didn't learn this in medical school and I spent the last 40 years studying this, which is how do you help someone detoxify? How do you measure toxins? How do you detoxify? So in functional medicine, we can do heavy metal challenge testing.

1:34:53We do blood testing for heavy metals. We can do blood testing for things like PFAS, BPA, glyphosate. Also urine testing. You can look at urine testing for a lot of the things like atrazine and all the things like the pesticides and paraben. So we can actually look at all these things in the urine. And there are specialty labs that do that. It's typically not your average lab. And then we get a sense of, okay, based on someone's history, based on their load, where are they at? And then we design a detox program, which essentially, which uses all your body's built-in waste management systems, right?

1:35:26So sweat, saunas are a great way to mobilize toxins. Making sure you drink a lot of water and pee in a clear urine, simple fiber, like make sure you're pooping and not constipated. You know, I had a patient once I said, I do a regular bowel movement. She goes, yeah. I said, how often do you go? She goes, well, I go once a week. I'm like, what do you mean? That's not regular. She goes, yeah, it's regular for me. I go every week, you know, but you want to go every day at least once or twice. These are just basic things. And then there's all the things you can do to upregulate your body's own built-in detox pathways.

1:35:59And that includes things to do to, with diet. So you obviously reduce all the crap in your diet, all the sugar, all the processed food, that goes without saying. But there's certain foods that have the ability to boost your own detox enzymes like glutathione, which actually you can use intravenously in Parkinson's and temporarily see reductions in tremors. So it's really, it's like one of the most important anti-inflammatory mitochondrial compounds. So we basically give them broccoli and collards and kale and other things like garlic and onions that boost that. And we give them foods that help with B vitamins and methylation.

1:36:32And we do all these, these sort of dietary interventions and we've been talking about maybe keto diets may be helpful. Um, and then you kind of obviously can fix the gut and that's a whole nother functional medicine domain, but in terms of detoxification, you know, there's, there's a chelation, which can be used for heavy metals. And that's been published ADT chelation, DMSA chelation. These are things that are published in JAMA and, and, um, you know, in fact, in one study, they did it for kidney failure and they found that people that had lead, they're more likely to progress to dialysis and they did EDT chelation and those who went through it didn't progress.

1:37:07So we have, we have some data. We don't have enough, but we have some data. So you can do chelation for every metals. And then, you know, for the, you know, the amount of chondro rejuvenation and the cellular removal of toxins, it's a lot harder. And this is where things are kind of, I think need some funding to see what's going on here. Cause clinically I can tell you when we do things like give intravenous glutathione or intravenous NAD, or we give something we call the PK protocol, which essentially is a cellular washout. It's like using high doses of the fat phosphorylcholine that your membranes are made out of it, where all the toxins are, it flushes them out.

1:37:44And then you also combine it with things like glutathione and the B vitamins and carnitine. And you see people's mitochondria come back online. And I have a patient who's like a rock star and, and that rock star couldn't play the guitar because they had Parkinson's. And all of a sudden they did this protocol and boom, they're back on tour. So I think there's a whole bunch of things that aren't drugs, that aren't anybody who's going to fund, you know, a billion dollar study, unless it's the government or philanthropist, but that actually have real promise. And I would love to sort of hear your thoughts on how we start to take some of these things that are in the anecdotal or anecdata stage and actually start to apply them and do clinical trials, sort of like Richard Isaacs is doing, because what all you guys are talking about in here is amazing and it's, it's going to get people a lot of the way there, but there's a whole nother level of thinking about this.

1:38:30I'd love to just get your final two cents on. I think I love the term anecdata, right. You know, and I think that's really important. And, and I'll just say it's, it's, it's tricky because, you know, in the New England journal, they tried to, there's a whole bunch of iron, as you know, in the brains of, of folks with Parkinson's and everything. So they tried to use the standard, you know, chelation, you know, and for iron and that actually did work. Well, sure. Sure. Here's why. Here's why. It's a problem of thinking. If you give someone a drug for chelation and you don't make sure that that compound gets out of their body by peeing a lot, pooping a lot, making the liver enzymes work and binding them up in the gut and doing all these things, of course you're going to get worse.

1:39:13And that happens also when you do treatment for heavy metals. If you don't, if you just give the chelator without all the other support, then of course they're going to get sick. Yeah. And we're not, Ray and I aren't experts on this, but I will say that I was so enthusiastic when the government was investing in that we had a center for alternative medications where they were funding, starting to fund clinical trials. This was many years ago. One of my mentors, Mayland DeLong, was involved in some of those original discussions. And we just need to do more of it. I mean, this is super interesting, super important.

1:39:47And what excites me, and I'm interested to hear what Ray thinks, what excites me about it is the why and looking upstream, right? So what you're talking about is looking for the root cause. And so when the guys— Cause or causes. Yeah, root cause or causes. And so when the guys that discovered Helicobacter pylori, which was this infectious agent— Are you guys the Barry Marshall of neurology? Yeah, well, we have the story in the book. But please don't take the toxins. Yeah. So we have this story. You can drink a baker of bacteria to improve the ulcer, but don't drink a baker of toxins and then get Parkinson's and try to fix it.

1:40:19Yeah, so we have the story in the book about how nobody believed them, that this could be infectious causing all the peptic ulcers. And it turns out it was infectious. They ended up winning the Nobel Prize on this, you know, and it was really important and fundamental. And people, what were they saying? Oh, you need to eat less spicy foods. You need to do all this. They didn't understand upstream what was going on. So I don't know. What do you think? If you guys keep going, I want to be at your Nobel Prize ceremony because I think this is worthy of a Nobel Prize. Well, I think the credit really goes to Dr.

1:40:48Caroline Tanner. For 40 years, she's been detailing this and we haven't been paying enough attention to her. You know, in my mind, she's a giant. In reality, she's like maybe five feet tall. She's over 70. She looks like your prototypical grandmother. And she's been doing this for 40 years. She did studies in China as a woman in the 1980s looking at chemicals and Parkinson's disease. Just imagine that. But we want to say yes. We want to say, right, we want to say yes to everything that you're saying. We just don't have the evidence. And I think both Michael and my minds have been open. We did.

1:41:19If you had asked us 15 years ago about chemicals, we would have been poo-pooing or soft peddling them. And, you know, we just don't have the evidence. We do know the Mediterranean diet, for example, high in fruits and vegetables, low in animal products, perhaps low in toxins that get magnified as they go up the food chain is beneficial for people with Parkinson's and might even prevent you from getting it. We know that vigorous exercise is helpful for people with Parkinson's and might reduce your risk of ever getting Parkinson's. We know that these chemicals are likely causing disease, and we know that stopping exposure to these chemicals is potentially beneficial.

1:41:54We just don't have the data to answer to you here in 2020-25, you know, what complement of mitochondrial supplements or other complementary medicines would make a big difference for people with Parkinson's disease. But the NIH needs to focus on this, right? And then we're going to come back to your house, come back in five years, and we'll tell you what has been found because people like you are constantly pushing the envelope. And you've been doing this for, you know, 30 years, right? Yeah. And you were, you know, not widely, you know. Respected. Don't rain my Wikipedia pitch, please. You know, you and others have made us think about things in a more holistic manner.

1:42:28And you've told us that the power of prevention, you've told us that the roots of these chronic diseases, many of them lie in our environment. if we pay attention, more attention to the Mark Hyman's of the world, if we pay attention to the people who are out there on the front, Vanny Harry and others who are out there telling us that chemicals in our food, water, and air are fueling the rise of chronic diseases, we can prevent them, we can slow them, we can treat them, and potentially we can even cure them once we know the cause. And I'm just going to say by, as an ad, my anecdote, I'm treating dozens of Parkinson's patients over 30 years or people with Lewy body disease.

1:43:04I've had many of those as well, surprisingly. And I'm not a neurologist, but when people try everything and they can't get any help, they come to me and we treat them at the Ultra Wellness Center. And I can tell you, I've had so many patients who we've slowed, stopped, or even reversed significantly their Parkinson's by using this kind of systematic approach. And I think people should be hopeful out there. And I'm really hopeful that you guys are doing this because, you know, we need real scientists. I'm just a science reader. I'm not like a, I mean, I published some papers, but I'm like, that's not my gig.

1:43:36But I read the science and I'm like, I know that the smoke signals are there and that there needs to be a serious investment in this field and in the kinds of therapies that can really improve people's lives, especially as we're seeing the acceleration in this whole thing. So I want to just thank both of you for what you're doing. I think this is such an important book. It's the Parkinson's plan, a path to prevention and treatment. You can get it anywhere. You can get books. It's out now. I would encourage you to get a copy and check it out. Uh, if you know anybody with Parkinson's, if you have it in your family or you don't want to get it, if you don't want to get it, uh, which would pretty much be everybody.

1:44:12And the seeds of the disease are planted early. So decades before decades as a child, as a child, so it's never too early to start. Yeah. So I, I just honor you both for what you're doing, uh, and the courage you have to go against the grain to speak the truth to, you know, honestly, to be exposed to potential ridicule of your colleagues. It's not easy. Right. And, and yet here you are. And, uh, I'm just so impressed, uh, in having this conversation and, uh, you guys are great. Let's keep talking. Let's revisit this. Uh, and when we have more blood biomarkers, when we have more treatments, if you want anybody to kind of give you my data from my decades of doing this to kind of guide some things that could be helpful if you want to get some research funded, if you have some philanthropists or if anybody's listening out there who's a philanthropist who has any of this, like Lewy bodies or Parkinson's, like, please, we need help because the government's not doing it.

1:45:04Pharma for sure isn't doing it. And I think, you know, these guys are doing the work. So let's get some help for all the needless suffering out there. Thanks, Ray. Thanks, Michael. Really great conversation. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more.

1:45:33Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services.

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1:46:34Thanks so much again for listening.