Doctors Ayesha and Dean Sherzai founded the Healthy Minds Initiative (HMI) to scale their impact on the tragic epidemic of dementia plaguing the world today. 

The first thing that we have to understand is that the majority of dementias are preventable through diet and lifestyle. The Sherzai's acronym NEURO—nutrition, exercise, unwinding, restorative sleep, and optimization—encapsulates the pillars that can determine our cognitive trajectory as we age. 

Second, individual behavior change is hard. And it's especially hard when the community norms are unhealthy.

Third, traditionally underserved and marginalized communities are bearing the brunt of the damage and ensuing tragic consequences.

And fourth, circling around, those communities can actually become leaders in the public health crusade against toxic lifestyles, since their empowerment can become the solution. 

HMI exists to empower communities to spread both the message and practice of lifestyle medicine. But in order to do that, the Sherzai's and their partners can't come in as experts. 

Instead, they approach as curious partners, willing to learn, and willing to stick around and provide support for the long term, and not just until the latest research grant runs out. 

In our conversation, we talk about the need for systemic change in research models that prioritize community engagement and sustainability. 

And we talk about what sustainable progress looks like, and can look like—in other words, a blueprint for community engagement and empowerment that can create a grassroots, decentralized, democratic health movement.

Links

The Healthy Minds Initiative

The Brain Docs

Nourishing Our Brains and Preventing Dementia with Ayesha Sherzai, MD: PYP 279

The Role of Science in Public Discourse and Racial Justice: Dean and Ayesha Sherzai, MDs: PYP 414

The Alzheimer's Solution, by Drs Ayesha and Dean Sherzai

The 30-Day Alzheimer's Solution: The Definitive Food and Lifestyle Guide to Preventing Cognitive Decline, by Drs Ayesha and Dean Sherzai

Today's conversation involves time travel between me and the brain docs, Aisha and Dean Sherzai, MDs. We started our conversation in June and something glitched and we got disconnected and could not reconnect that day or the next. And eventually life intervened and we didn't manage to get back together to do another recording for four months.

So you're going to see me in the middle, just kind of stitching together those those two conversations. But as always, we're talking about brain health, about the tragedy of dementia and how freaking preventable it is in so many cases, which makes the tragedy just compounded because it doesn't have to happen when we know people who were bright, shining.

fixtures in our lives whose light has dimmed, whose cognition is gone, who are no longer the people they were, no longer having the memories or the connections of the relationships. So hard and the Shurzai's have devoted their lives and their considerable energy and width and charm and powers of persuasion and teaching ability to spreading the message that it doesn't have to be this way. So two conversations for the price of one strap in enjoy.

Without further ado.

Ayesha and Dean Sherzai, welcome back to the Plant Yourself podcast.

you

Thank you so much for having us, Howie. I'm so glad that we could work our schedules together to get together and speak again. Missed you. It's always a pleasure speaking with you.

Yeah.

Yeah, I'm just having a flashback. I think the first time you're on the podcast, I think it was Ayesha by yourself. I think Dean was busy with something. And then I remember both times I'd met each of you for the first time. I was really nervous because you guys were such superstars. I really don't want to mess this up. And you're still superstars, but I'm no longer nervous.

my gosh. Your family. And I do remember that conversation. I was so thrilled. I knew of your work and continue to be such a big admirer of your incredible conversations and the kind of information that you put out there for everyone. So thank you.

Well, right back at you. You guys have jumped into podcasting in a huge way in the past year.

Yeah, it's going well. We love the forum, the venue and the concept of bringing the perspective of everything from a neurological perspective, from a neuroscientific perspective. It just came naturally, I guess. It really did. We had such a fun time speaking about the concepts and it has grown. It's been in the top 20 in sciences continuously.

Yeah, it's been so much fun to actually sit down across incredible people who are doing amazing work and just talking to them. It's almost selfish. It is. I don't consider it work. It's just a selfish way of just enjoying life to have conversations with these incredibly wonderful people.

Yeah.

Yeah, I've been thinking that because I'm approaching like episode 600. And I think about the people that I've talked to and all of a sudden I'm like, I must be really smart at this point. Like, I've talked to some of the smartest people in the world for hours. But I must know something.

That's literally that you have your own personal course. That's true. Yeah. That's very...

Yeah. Yeah. So I have three things I wrote down that I wanted to talk to you about. Let's start with with number one, which is the Healthy Minds Initiative, the work I'm on the board. So, you know, follow what you're talking about. And I just I just want this work this work to get out more and more people to know about it. And and some deep pocketed

Billionaire is listening and is gonna help it go forward. So Maybe just you know a brief Summary of the work of what it is and then what what what you're up to now

Absolutely.

Absolutely. We are so pleased to have you as part of the board. Your conversations during the board meeting just livened the whole team up. And we are so excited that you're bringing your leadership and management and especially coaching and guidance perspective into this because it really centers around that, right? The point of HMI or Healthy Minds Initiative is to bring brain health to communities

and give them ownership and give them capacity and give them a way forward and then not just be overseeing and dictating downward but being partners and letting them become the best versions of themselves. And part of the most important part of that is ability to give people the tools of self -improvement.

And it's available to everyone. It's within all of us. It's the impediments that need to be addressed. And you do that so beautifully. I mean, absolutely. And Healthy Minds Initiative has done this in many communities, but right now we're focusing especially in a project that we think is the ultimate meaningful project when it comes to health in general, to be honest. And as it happens, the laser focus of this topic is brain health.

but it applies to all health, which is listening to the communities and then creating programs around the community's proclivities, tendencies, needs, resources, their fears, their desires, all these things are basically driven by the community. Even the research model has to be driven by the community, meaning that there has to be conversation at the core. There has to be...

conversation with leaders, with community members, knowing how to interact, how to connect, what language to use, what resources to use. It's not going to be people being brought into a clinic and given Mediterranean diet, which is ridiculous. Or some of the studies that we've been part of, big studies, big universities, and then halfway through we find out that because we were part of the overseeing board.

that the intervention was a protein bar. That's not something sustainable. That's not something that's possible to bring about change. In order to bring about change, you need to understand communities and to listen to communities. And that's where your incredible gift has been a profound gift for HMI.

Yeah.

Well, so I want to unpack that, the whole approach, because people who are listening might think, well, that all sounds pretty obvious. Like, there's nothing exciting about what you said. It was just like, duh. But it's not what happens. Right? The protein bar is sort of the tip of the iceberg of how these things end up. But in terms of how...

Thank you.

health professionals approach communities, specifically marginalized and traditionally underserved communities is very different. By the way, before we get to that, I live a mile from the Mediterranean. And I have to say that if I had the Mediterranean diet, it would consist solely of seaweed and jellyfish. So I don't know what people are talking about. There's almost nothing good in that sea.

Yeah, yeah, yeah, exactly.

Yeah, yeah, yeah. And imagine we feed the Southeast LA seaweed and jellyfish. Yes, yes. But yeah, to unpack it at the core is listening. And the reason it's not happening because it takes investment from the researchers. I mean, imagine an average researcher has a

team and they have a budget, finite budget, and they have a protocol to follow. And that protocol has to have a timeline, a lifespan. And if it's broader than just give the survey, collect the data, come back, put the intervention in.

record the outcome in six months. If it's anything more than that, it becomes daunting and it becomes problematic. It becomes a little uncomfortable for researchers who are not used to talking to people, right? But reality is you have to speak, you have to listen. Listening is leadership. Listening is the core of leadership. And that takes time. There's a model called CBPR, Community -Based Participatory Research.

the action part is CBPA. So at the core of that model is listening to the community first through focus groups and then taking that writing and distilling it into meaningful actionable steps and then listening again with the community with the new data. And then so multiple steps until you get to a core that is actually the community.

with some food given and then some cognitive testing done, even if you see a delta or change, which actually a lot of times is contrived, I can assure you, but with that period of time, it's not gonna be meaningful long -term. What have you done as far as sustainability of that? What have you done as far as making sure that that becomes part of that community's culture? And that's the core of this.

Well, and I mean, it sounds like that your basic mindset is that these communities are not broken. They're they're not helpless, that they have the knowledge, skills, drive networks, connections to better their own health. And they need a catalyst and they need someone from the outside to believe in them. And they need they need some coordination to remove the impediments.

Absolutely. I think that was beautifully stated. In many situations, you realize that one of the key ingredients that is not present in any model of change introduced by health care providers or an outside agency is understanding the status quo or the existing knowledge within that community, because nobody really has time for conversations because it's tough.

And somehow brochures are created and dispersed within the community that has nothing to do with their day -to -day living or their understanding or their function of what health is. And so that discrepancy causes failure. And unfortunately, that keeps getting repeated over and over again. And what we're doing in Healthy Minds Initiative is starting with a conversation. We've had multiple conversations, first of all, to find out the pain points

the strengths, the limitations, any impediments, and just working with those pain points and limitations and trying to see how we can provide assistance for them to continue living the kind of lives that is appropriate for them, that is helpful for them. And as far as health literacy is concerned or understanding and awareness is concerned, those are the things that we actually help provide. So for example,

just a, just a small example, the thought that dementia is synonymous with aging. And that has become a part and parcel of certain communities culture. it's really normal for grandma to have memory problems. It's really normal for dad to have blood pressure when he's in his fifties. Right. So, so that those need to be broken. And those are the kinds of conversations that we truly love engaging with where we say, no.

There is another way to live. There is another way to exist. And here is what we can all do to kind of change that narrative, change that language. So it's a really comprehensive and a multifaceted approach to health and wellness and longevity. And to be honest with you, it's a lot of fun too. And the learning is both ways. We actually learned so much about how information is consumed within each community too, which is fascinating.

So what's coming up for me is questions about resistance to, first of all, resistance to you guys coming in, because until they know you, you could just be another bunch of Harvard researchers coming to do a survey. So I'm imagining that there's some barriers you need to break down to prove to people that you're interested in them and not interested in doing things to them.

Let's start with there because I don't want to mix the two questions. I have another one that I wrote down, so I'll probably remember it.

So breaking through those barriers are difficult. Let me give you an example. In 2010 or 11, as part of my PhD, I actually went to communities. I was fortunate because I was getting my PhD as an attending, so I had a little more resources. I went to the communities. And most of the communities, well, the Native American community here in San Bernardino or in the empire.

They said, we don't want to work with anybody from the university side. I was shocked. I mean, because we were bringing some, some, you know, information, some tool they, and what we heard from the leadership was that people come, they do all kinds of the usual gestures and smiles and, and handshakes and documents and pictures and PowerPoints and all kinds of stuff. And then after they've collected data, they disappear.

They completely disappear and nothing for the community except their time wasted, their hopes raised. And I call this the nuclear landscape of leadership. When you're a leader or you're given or you've been given the privilege of being a leader and leader is not somebody who's taking somebody to a war or something like that. It's anybody who actually takes the lead in an activity or is given the privilege of being given the lead in an activity.

When people come to that person, they're actually suspending their natural inclination to disbelief, their natural inclination to be protective of themselves. They're suspending all these fears. They're suspending the incredulity and they are opening up. And they're opening up because they have hope. Most important thing we have.

And then when somebody fails that, they're not just, they've not just affected that interaction. They've affected that landscape of that person's mind for years going forward. This person will not be open to other people who might be good people who are trying to do things because the person or the community

has been lied to, their hopes have been toward it. And that's a nuclear landscape that you've created because you took the lead and all you did was use that situation for your momentary gain. So there's an incredible immense responsibility. We are, you know, a little, we don't have camps.

And the peers, we live in a world of camps and right now there's a plant -based camp and then the meat -eating camp and this camp and that camp. We have none of those camps. It's the camp of the person in front of us that needs help. And we have to listen to that person and we have to listen to the point that the person that believes you. And then once they believe you, then their responsibility is immense to do everything to make sure to at least

give the effort to make the outcome come about. Nobody's expecting perfection. Often they expect failure if they see effort. So that trust building is immense. That trust building takes time. That trust building takes investment. That trust building requires not contrived social media sacrifice, but real life time and effort and blood and sweat sacrifice. That doesn't sound like research, does it?

But that's real leadership and research is that. And hopefully we've done that in HMI enough where we're whatever communities we've gone to, we've given that part at least. And that's important because then that becomes the night is of building everything else. You want to change people's behaviors towards healthier life. Why would people change their comfort that they've grown up with for 50, 60, 70 years? Because you just said so, because you're from Harvard.

or from your Stanford. They might for a short period, but they're going to go back unless they trust not your accolades and the number of degrees behind your name, but the words that you say that affect them personally.

Wow, let that sit for a second because it's so different. I mean, when I think about I had a master's in public health and my job, I wasn't doing anything big. I didn't have any funders. I was just trying to get a damn master's degree. And so I had to go find a group of people and basically extract data from them. Like that was my mission. And that's what I did. And I didn't help anybody. And I probably hurt a bunch of people.

Thank you.

Yeah.

You know, it was a small scale, so it wasn't probably not terrible. But I was never taught to go in and have those conversations to really ask what people need, you know, that we had models. The models had that kind of questioning embedded in them. One of them, I remember, was called precede proceed. That was very complex and had all these different inputs. But the reality was you didn't have the time to do that. So you just read reports and you read other people's studies.

And you talk to a couple of leaders and really was treating these and these were all marginalized communities that were, you know, I worked with kids in a juvenile detention center like they didn't exactly have the power to say no. You know, I was more interesting than basketball, I guess, you know, so they would hang out with me for a little while. But it feels like just the way the research

Yeah.

Yeah, yeah.

industry is set up, it can't be anything but extractive. And I'm wondering, you know, you guys are doing amazing work, but it's a drop in the bucket of this behemoth. And the more the behemoth rolls along, the harder it is for you to do your job. Are there systemic solutions or do we have to rely on tireless heroes?

no, no, no, never tireless heroes. That never works. That's not sustainable. And there are no tireless heroes. You know, we all have our flaws and all of that. But reality is there has to be some systemic change introduced into the research model. And I think there is, at least in the academic realm,

and within the academic circles and within the academic PowerPoint presentations, there is a change. I've seen it in universities coming and we've had many conversations and spontaneously we hear this approach of community based and listening to the community. At least that first awareness, that first point of awareness is becoming more ubiquitous.

universal and people are becoming aware. Whether it's being applied is now the next thing, which is the funding and the infrastructure has to adapt to that awareness, that consciousness. And that's usually how it happens. When the signal from the truth becomes massive enough, then the system and the funding changes towards that. So the first step is we're hearing it everywhere now. Yes, definitely. You see it in

specific research, RFAs, supports, calls to actions from bigger organizations, but this is something very new. And I think it's happening because of just the massive failure that a lot of these organizations have seen over the last few years and decades where spending millions and billions of dollars on a quote unquote intervention led to nowhere.

even though we have, you know, shiny diagnostics and research equipment, when it comes to true health and change in the quality of life, we didn't really see any changes. So like Dean said, the narrative is changing and that's a good thing.

I'm curious about whether effective altruism, that movement is having a positive or negative or neutral or bipolar effect on research because I've heard so much of it makes sense and there's a lot of assumptions baked into the algorithms by which they choose to direct their donations.

I mean, I think the concept is sound and it makes sense. It's almost like functional altruism. It's the idea that you find the mechanisms behind it, the algorithms behind it, and then you make it come about. And at one level, it does make sense. But it has to be

It has to be inculcated in the consciousness at a higher level as well. The greater understanding, social understanding has to be that there's mechanisms behind it and we all have to follow those or we have to be aware of those mechanisms for the outcome to take place. So yeah, in short, I think there is something to it.

So the other thing that I wrote down that I wanted to follow up on is when you tell people, you know, the thing you offer is hope and you say it doesn't have to be this way. And I'm thinking that there are people for whom that message would actually be really hard to hear because it would mean they would have to face a lot of grief. Right. It didn't have to be this way.

you know, that we thought this was just the way things were and there were things that could have been done. Do you get that kind of reaction? Do people have to go through that?

Yeah. yeah. Yeah, definitely. I experience it in clinical setting almost all the time. And I think that's just my design because unfortunately the clinic system is such that the need arises when things are out of hand and people truly experience the

the negative effects of any condition, right? So at that point, when they come into the clinic, although that has changed in our clinic, we're actually promoting prevention. But most of the time when people come in with neurological conditions, in our case as neurologists, that have advanced significantly, there is only so much that you can do. So prevention matters, early detection matters. And when the conversation comes in, I guess,

I don't have a particular specific, you know, cookie cutter approach to it. It just depends on the person. But we try to mitigate their fears and make them not feel any blame or shame. Yeah. That is not because they didn't do anything about it. It's mostly because we're learning. We're growing. This is this is something that we've just come to understand more and more more recently. And

specifically when it comes to diseases of the mind and especially cognitive impairment, there's always a there's always a notion that it's a personal condition, but it's not it's more of a family condition. It's more of a community's condition, you know, the caregivers, the loved ones around that particular person, their colleagues and everybody else is affected in many ways as well. So it's not just intervention at the patient level, but at the family level as well. And so

dispersing this information seems empowering. So it just depends on the kind of words that we use, the person's situation, the family around them.

And I have to give a lot of credit to my lovely husband. I used to joke around. So, you know, he wasn't attending at Loma Linda and I was a resident. So I was a resident fellow just a few years behind him. And whenever Dean would actually have patients in his clinic room, we would all know that all the chairs from every clinic room would disappear because he would grab all the chairs and take it to his room. And his room would be packed with six, seven, even 10 people. And then some people wait.

outside. He would invite the whole family to come for conversations about it. And the same thing happens within the community as well. So, and I've never heard laughter from a room when, you know, a devastating condition like dementia is being used. But there would be laughter, there would be like, we're going to do this together.

There's a lot of hope. Let's go ahead and start this project. And so that's the approach that I have actually personalized as well, where there's no blame. There's no shame. There's no feeling bad about it, but

What do we have? What can we do about it moving forward? And also separating the medical condition from the person. Sometimes people start defining themselves by the chronic conditions that they carry. Human beings are human beings. They're the lovely people that they are that was the same when they were four years old or nine years old and now they're 99 years old. They are that person. The condition that they're experiencing is completely a separate situation.

and the conversation is about that, not about the person. So with those kind of techniques, I think we get to a place where there's that feeling of comfort and giving them enough tools to move forward.

Just a little side on that is that what you bring is actually extremely important because as we become more aware of the underlying mechanisms of disease and when you bring light upon those underlying mechanisms, no matter what, people feel guilty. And the language out there is one of blame and shame, whether it's obesity, whether it's diabetes,

whether it's hypertension, whether it's, you know, stroke and dementia, it's, it was, it had to do with cholesterol and you didn't go, you know, full, whole food plant based and you, you heard about it and these, and the sooner we realized that it's a cognitive journey that we're all going through and there's no blame. It's just a...

self it's ever manifesting truth to all of us then then it becomes a sense of we all are going through this together I have beginnings of this disease you have beginnings of that disease or you have this condition and that condition we all had things happen to us that we could have done all otherwise but it's just a ever manifesting truth and then that takes away the blame it is such an important concept it is such an important concept

that the idea of tacit shaming is so prevalent in medical fields. I mean, you and I, we are all involved in social media and these diet wars, part of it is shaming. And it's critical that we take all of that out and make it data -driven. There's the human side, which we must love.

in all their totality, all their frailty and all our incompleteness and all our... And then there's the data side, which we should separate and say, okay, if we want to lower this outcome, stroke, which comes from a -fib, hypertension, diabetes, these are the inroads, including, you know...

access to information, access to resources, knowledge and ads in the region as far as the four hours timeline, all that. It's the input and output kind of a situation when it comes to data. And put the human component separately and just love the people. I mean, that dichotomy is critical. Again, it takes effort, doesn't it? Yeah.

Yeah.

Yeah, and I think it's so I feel the urge to shame other people about their health choices when I'm scared for myself. Because that gives me a feeling, well, I have control, so it's not going to happen to me. Right. So I could feel where it comes from.

Yeah. Yeah. Completely. Yeah. Absolutely. Absolutely.

I was just reading a book today by Charles Duhigg, who's a sort of a science journalist. And he wrote a book called Super Connectors, Super Communicators, the people who are incredible at communicating. And I was just reading a section about, I'm not going to remember his name, he was a doctor, surgeon at some of the prestigious hospitals in New York City.

Mm -hmm.

who was advising people, men who are going to have prostate.

possibly having prostate surgery because they had been diagnosed with prostate cancer. And his read on the literature was that in almost all cases, active surveillance is preferable to surgery. And he was telling people this and going over all the details in the studies and giving them papers with yellow highlighted results. And the more he talked, the more people were actually going for the surgery. They were just getting more and more terrified. And he reached out to

a communication specialist who followed him around, watched what he was doing and realized that he was talking about data and analytics and information. And people were interested in how long, you know, what will my sex life be? Will I be there for my kids? What is five years of life worth the pain? And he was completely missing the human experience. So I think it's

Yeah.

It's so beautiful that you bring up like we're going to talk about the humans. And then on top of that, separately and additionally, we're going to bring the science, but only when people are receptive for.

Yeah, absolutely. Absolutely. It has to be that way. As you said beautifully, I'm definitely going to look into this book. Yeah. But if you're not going to connect to the people, no amount of data is going to change people's minds. Absolutely. Yeah.

So before we move on, you just have a couple of stories of like HMI, you know, outcomes, successes, fun, like a picture, a vivid picture of what's going on.

Yeah. We've had three community events, which were incredible. Incredible. I mean, the whole community came out. It's Crenshaw. It's one of them in Southeast LA. And the number of people that came to these events to learn, to participate.

to change their lives. Let me give you an example of how important it is not to push an agenda, but to connect to people. We're a whole food plant -based. And when we go to the communities, we never push that concept. We say, eat less saturated fat, eat less processed carbs, eat more plants, greens.

That's it. Nutrition wise, that's basically it. They know what we are. We actually say ahead of time, this is what we are and why and all of that. But where you are is around your life and your situation and your diet. And we said, no plant -based food. We don't push it.

In the second event, we had community members bring food, have stalls where people actually could create food and sell it to others. And we never pushed the plant -based version or any of that. And every single stall was plant -based without us ever bringing it up. Because when you push the idea aggressively without making the connection,

Without the connection, it's imposition. Without the connection, it's absolute imposition and it's an edict. Even though it's coming out of papers and data and so on and so on, it's an edict.

But when you're connecting and they're connecting to you, then it becomes much more receptive. And we take pride in that moment more than any other. And similarly, this has happened over and over and over and over again. And one of the efforts in the community was people think that when we come to the community, as far as brain health, we are going to do some kind of special exercise on cognition. The first event was about giving away blood pressure machines.

because 20 to 30 % of cognitive decline and dementia is a treatable to untreated blood pressure, easily treatable thing. And the number of community members that got blood pressure machines and got involved, and then they would come in back and tell us about their numbers and the fact that they took these numbers to their doctor, and then their blood pressure was changed, was just unbelievable.

And it was incredibly powerful because you could see the tangible change in front of you over weeks after that simple, simple act. So it's going to take those kinds of simple acts that have sustainability, that has meaning to them. And so many of those stories like that. And we discovered that there were already so many amazing people that were doing great work.

They were just not highlighted. For example, we met Ruth. I think she's in her 90s. She's one of the most beautiful women I've ever met. She's in her 90s and she used to be a teacher. And throughout her career, she actually taught kids how to create a garden. So she actually had created multiple gardens in the small little school patios that they had in Southeast LA.

And she came to one of these events and she was telling us her stories and we realized that, you know, she was already, she was doing, she was doing the good work already. And so what we did was we connected her to the group of individuals who were community workers, social workers, trying to, you know, raise awareness and concern about what their children were eating. And by just bringing them together in that platform, they actually started a whole project.

and they pushed it forward. Or for example, we realized that there were so many amazing nurses and nurse practitioners within that community that were already dispersing information about blood pressure management, cholesterol, diabetes, weight issues, and they volunteered. They came and they actually taught hundreds of people of how to measure their blood pressure. They created...

blood pressure diaries, we actually helped them create sleep diaries. We actually had booths for women and men who would come in and want to talk about their mental health issues with someone. So these nurse practitioners and nurses just automatically became community leaders. And what we were doing in the back end was just kind of giving them all the resources that they need so they could continue doing the great work that they were already doing it. Just kind of gave them the framework.

And this happened within like three events. Imagine if this is a continuous process and that's what we're actually doing. Kind of highlighting these incredible human beings that are already doing wonderful things for the community and make sure that most of the community members have access to that kind of information.

How do you, if it's an event -based collaboration, how do you know what happens between events? Because you'd mentioned that there's so many interventions that come in that don't get sustained, that leave the community. You come in with firecrackers and you leave the community high and dry. What is ongoing and sustainable about the HMI approach?

Yeah. Yeah. So even the mechanism of data collection and surveillance is within the community. So we have people we have Ron, who is how old is he? He has in the 70s. He has been the director of Alzheimer's awareness for the community for a long time.

one of the, again, one of the loveliest human beings. Him, along with the nurses and others are continually engaging with the community members, getting feedback, getting information, collecting information. And that's going to continue and actually expand as we go forward so that...

that system of surveillance and course correction is actually incorporated within the community as opposed to it's a contrived mechanism that's put on, superimposed on a community. So that is another pride point that the community members will be able to sustain this mechanism going forward. And it's a continuous iterative process. So we see the magnitude of change after a particular

intervention or introduction of an intervention. And so there's a lot of course correction, there's a lot of change and focus on things that need the most attention. And I think that's the example of that systematic approach that we were discussing earlier. You know, the feel good sessions of getting everybody together is very, very important. But the follow up with data and with feedback.

and surveys, that's the research component of it that actually helps us course correct and highlight the necessary interventions that are needed within the community.

Now, I know that HMI would like more funding and at the same time, it sounds like this is a very lean model. Like it's a it's a model that could be replicated in lots of places that would cost a lot less than things that are happening now that might be.

that's a beautiful question. Scalability.

Because if it's not scalable and adaptive to every community, then we've just done what we just said was not useful, which is this model of collecting data from the community that's community specific, community unique, and identifying the resources and all the tools, and then implementing changes using all the resources that already exist in the community and following outcome in an iterative process.

is definitely scalable and changeable. So I think that this is the way to go. And this is the only program that I think that takes scalability into perspective at a cost that's almost nominal.

for some reason, the connection got cut and being as busy as we all are, that was in June, we rescheduled for early November. So coming back in to the conversation, honestly, we had forgotten what we talked about. So if there's repetition or disjointedness, please forgive us.

But again, happy to present Aisha and Dean Sharzai.

Hi, we're back. I forgot to check continuity. I don't know if we're wearing the same clothes as probably not as our conversation that we had at the end of June. It's over four months later. I don't know what we were talking about then, but tell me about what you guys are up to, what's happened over the summer and where you guys are now with this with the idea of a community based approach.

no. No, probably not.

to brain health and overall health.

Yeah, we are very excited. We have two realms that we work on. One is our clinical and our own.

life work where we have to kind of create a persistence and resources for ourselves and our family and things of that nature and we'll delve into that. But then the other part is, which is our passion, which is the community side of things. How to bring brain health into the communities and it matters because at end of the day, our brain is us. It's what makes us and we do change. If things left to their own,

We change negatively, we deteriorate because the things around us are deteriorating. Whether it's the noise around us.

or the environmental stimuli, or the foods that are being advertised, or the stress that's being imposed, or the traumas that are being imposed on us. And all of these things are going to deteriorate our cognitive function, brain function. It's going to steal from us, not build us, but reduce us. Reduce us in so many different ways. Reduce us as far as our breath and depth.

of the understanding of this complex thing that is our living experience.

And at the same time, it's going to reduce us as far as the functionality of our brain. The damage that accumulates can be quite significant. And we see this in people. You've seen this on TV and everywhere around you, where the same people that you've known 30 years ago, they don't sound the same. But the alternative is available. And this is not one of those gimmicks because we're not selling anything. It's critical that we speak about those alternatives to fight in the face of

the negative environmental variables that are there to decay. Not in a nefarious way, it's just the nature of how the world has developed. And being aware of it gives you some tools. And I think that's our passion. And the reason is certain communities are more susceptible to that damage because of the differential lack of access

or prevalence of harm in certain communities. And it's a cumulative harm, meaning that what's going on in their childhood, what's going on in their environment as they grow up, what's going on in their neighborhoods, because it's much more easy to build a fast food joint. I was about to name a company and you were gonna get banned again for another six months. But from some fast food joints.

You

It's much easier to build that and push it out on people than healthy resources like fresh fruits and vegetables and things of that nature. It's much easier to occupy people to sit in front of the boob tube television for hours at a time and market to them than to go out there and experience environment and beauty and everything else which actually has been created into cement blocks.

And the point of this is not to put down the world we live in or the economic system we live in. That's fantastic. It's by our awareness we can change the direction of what's happening around us and also the destiny of the thing that makes us who we are, which is our brain.

So, I mean, it seems like it's possibly iterative in that. we have we have this amazing world. have incredible technologies. We have wealth beyond anything that previous generations could have ever imagined. And yet, you know, it's it's increasingly concentrated in the hands of fewer and fewer people. And a lot of that, the wealth concentration seems to be at the expense.

Thank

of people who live in communities like this. there some way that like the little stuff that we can do around a community, getting them to fend off some of these deteriorations, can they then access their brains to make bigger changes?

I suppose, so it's a complex formula.

you essentially provide enough information and enough knowledge to a community that is palatable, that is within their scope of understanding. It's almost like you're giving them a pair of glasses with specific lenses to be able to look around them and identify factors that are going to help them be the best versions of who they are. And that lens is

different for each and every community. a step previous to that is understanding and defining what that lens is and what the resources are within the community. And once that happens, reiterating the specific components around them that could help them build a better brain, a better awareness, better understanding, and better cognition at the end of the day. As neurologists, that's our ultimate goal for people to

have you know a healthy brain and the best cognitive prowess that they can use to you know experience life and to enjoy life and to live a life where they don't rely on anyone you know to the best of their capacity and so giving them enough knowledge identifying the resources and having them make decisions that are not difficult that are not

back breaking because as you know, as a coach and as someone who is very, very knowledgeable about habit creation, it has to be easy. It has to be small. It has to be incremental. And so how do you, how do you provide them with that, with that package is what requires a lot of work on our end. And it's a, it's a lot of fun, but the reason why it has failed in the past from the different data that we're seeing is at multiple levels. Either there was lack of identification,

of resources or the scientists and the implementers of the plan didn't really consider identifying those lenses that I was talking about and then abandoning that plan and not having enough motivational steps to propagate the message and give them a message of hope and get rid of the fear-mongering of this concept of change.

Hmm.

Yeah. Well, I remember, you know, in graduate school, the health belief model, right? This was this idea that if you just told people the consequences of their behavior, that they would change, that we're rational actors. Then when I when I went to work in change management in an organizational level, the mantra was people don't change because they see the light. They change because they feel the heat. And there's there's a lot of truth to

Yeah.

the initial impetus often being negative, right? For an individual, it's a heart attack or someone someone close to you, you know, who you identify with dies or gets sick. But what we're what we've learned and I think what you what I see you guys do so well is you immediately like once there's that motion, you immediately work to convert it into a positive vision that

Thank you.

that people can get excited about moving towards rather than something that they're just fearing and have to move away from.

Yeah, I definitely think so. I think irrespective, it's signals, right? The brain works on signals. How much signal is the underlying current that's pushing in one direction or the other? So that's one element. And then there's the small systems of push and signals that are maintaining that directional change.

That's basically it. And how do those two systems work is at the limbic level and their interaction with the frontal lobe. Frontal lobe creates the arguments, the concepts, the patterns. And the limbic system is the emotional tone that keeps you going in one direction or the other. And if you do the mathematical model of that for each individual, let's take it in, it's figuring out what...

is the underlying drive. And the simply stated, I've seen this in so many talks, find your why. Okay, great, I found my why. That's the little agitation. That's the language around that agitation. That's that fear element. That's that emotional element that's there. You've created memories around it. And if you're good at it, you're create multiple memories. And if you're really good at it, you're gonna create multiple memories around that in different regions and different places that you usually fail so that that triggers and all that. Okay, fantastic. So that you have control of

one element of that emotional signal which is the fear element. Then the other thing is the attractor that had you going in the other direction. Being aware of that.

or those is critical. What is the thing that keeps failing you? What's the thing that you've just fasted and you just ate well and everything and then but you just turned the corner and you went in a party and all of a sudden you saw wine and or you saw some piece of cake or something like that and that signal was more powerful than all the signals that you had created, all the triggers that you had, all the...

Hmm.

tripwires that you had set in place. So knowing that is critical as well. that's it. So that creates the, you're creating your landscape triggers and tripwires and the signs, the X signs, all of that. were watching the movie Planet of the Apes. There's a part where they're not supposed to cross this area because there's these Xs on top of the mountain. Well, in this story, it's a good thing. This is, I'm not gonna go there. It's gonna trigger.

kind of setting of triggers of positive triggers of negative gives you some measure. And then then comes the third element, which is the dopamine surge of moving forward. And once you figure out the triggers, the positive and negative triggers, then now you work on the dopamine steps of moving you forward. And that is different for each person. The length of those

triggers dopamine triggers are different for each person. You can see it's complex but it's actually not that complex. Where we have failed people is the biggest model is forget about this trigger or that trigger just pull yourself up by the bootstraps look I did it so you can do it. It's the

The dumbest of all, as a scientist, you're not supposed to use emotional terms like dumb, but there's a little bit of a... I'm trying to trigger an emotional pushback against that kind of simplification from here on going forward. It's not going to work like that. The people that have failed are not bad. The people that have failed, I don't even call them failed, but are not dumb. It's more complex than just saying that. And if we just listen to our communities, at the community level,

you broadly can figure out the triggers that makes them afraid of their own environmental consequences. The communities that you and I and all of us work in the African American communities, stroke is threefold, dementia is threefold, diabetes, exponential, mean, everything. The first step is being aware of those things and what are those things linked with? Now, okay, that's great. Those are triggers that we created and...

and where you see that and this and that, you create that knowledge, awareness. And then the next step is the positive side, the little steps that you can take around the home. So that takes some work. That's not a survey that you created in Harvard and then you apply to San Bernardino. The survey was created in the 50-year-old white men and then applied to 70-year-old Hispanic women, which doesn't even make sense because the triggers are different.

The environmental triggers are different. The social triggers are different. The cultural triggers are different. Positive and negative. The movements, the steps of movements are different. And if we just listen to people, truly listen to people, and not listen to them give surveys, not listen to them trigger the next thing of yours, which is the next research project, then you'll get to understand some of the mechanisms. And I think that is so important. That's the work that you do. We really...

Love your approach to coaching, your approach to teaching, your approach to understanding, your approach to change. And we want everybody to kind of listen to you and hopefully we do kind of the same thing as well. But that's the approach.

Well, thank you. I'm going to bask in that that lovely praise for a moment and just let it wash over me and grow. So thank you. mean, you know, the the problem with that, I know it's not really a problem for you guys, is that it's not really scalable in the way, you know, like if you were to just to say, here's my business plan, if you were to go to a bunch of VCs and say, can you give me 50 million dollars?

you

of a series A round because I want to do this. I want to build this community based approach to cognitive function and brain health. And you said, here's my plan. We go in and we listen to each community and it's a bespoke thing. And we have no idea what the intervention is going to look like before we go in. And we're going to empower the community members themselves rather than salaried people, you know, kind of running the program from above.

you wouldn't get a penny.

I think the problem is not so much scalability. The problem is time scale. The problem is that companies and governments work on different time scales. And these are false delineations which take away from the true power of these slightly longer projects. Let's take one of those variables, blood pressure. We'll take two of them.

Actually three, we'll take sleep, blood pressure, and hearing. So now we know that hearing loss has been attributed to about 10 % or more of cognitive decline, actually probably higher in cognitive decline, but 10 % of dementias. The cost of Alzheimer's dementia by itself is 345 billion direct costs, another 350 billion indirect costs per year. That's massive.

And that's going to go above a trillion fairly soon, which by itself will... If you can affect that by 5%, that's $350 billion a year. sorry, yeah, the 5 % about... Sorry, $35 billion a year. And over 10 years, 350... Just hearing. Meaning that this project is going to save the government, it's going to save the insurance company, it's going to save the caregiving companies,

profound amount of money, but the time scales are a little longer. The data is actually stronger than anything they have. What is the data on treating Alzheimer's now? Zero. So 10 % is phenomenal. Let's take the next thing, blood pressure. By the most conservative measure, that's gonna affect Alzheimer's by 20%, vascular dementia by 50 % or more, strokes by...

profound amounts. mean, we're talking, yeah. The disease after disease, we're talking about potentially just addressing blood pressure. It's going to easily affect $500 billion in the United States. I mean, because of multiple diseases, including cancers affected by blood pressure, you name it. But yet when we go to communities, blood pressure is the number one variable that's killing people in the communities. The number one under known understated

under resourced thing in the communities. So just increasing knowledge about blood pressure, creating tools that measure blood pressure more acutely, creating triggers that then push the treatments towards blood pressure, both lifestyle or otherwise, you save profoundly. So it's not a matter of scalability. Blood pressure is easily measured at large scale and the cost is actually pretty nominal, yet the outcome is massive.

One stroke patient costs the hospital system more than $50,000.

That's just stroke. And we have 800,000 of them every year. Every year. So it is scalable. It's not, it's not around the time scales of companies or governments. And I'm going to leave this podcast in that case. Okay, Howie, this is, this is done. I can't take this. This is abuse. This is complete and utter abuse.

Well, I want to push back a little bit because I think I agree with you that the interventions, the base. Yeah, we're done.

It was a total ad hominem.

A total ad hominem. Just attack from the left field, what is this? No, I'm kidding. Go for it.

Yeah.

The interventions, the technical parts of the interventions are scalable, but the community approach has to be bespoke and it's not in your control. Right. Like you're you're, know, and I know this about me from the way you guys work in communities, unlike.

organizations that think of themselves in terms of the efficiency of a fast food company that say, teaches everybody how to flip burgers. it's a that most health interventions that try to scale are using a franchise model and you are using the exact opposite. You're saying we go into every community knowing nothing about what's important to them, about who their leaders are, about how social contagion works.

Right. Like, can we we talk about like you go into a community? Like what what what does it look like?

Yeah. Yeah. By the way, that was the weakest pushback. I would only expect that from a vegan. It was a very soy push. Very soy push. I'm not intimidated by that at all. No, I'm just kidding. No, but... No, I've tried 20 years.

Yeah

Hahaha

I should, can you not control your man? What's going on?

I failed. I'm myself, I'm a soy push. Yeah, don't worry about that. But... Yeah, no, but all things being equal. It does take a little bit of mechanism. It's mechanism, right? It's mechanism. It's... Scale is even understanding of communities and...

Don't worry, can fix the eye rolls in post.

level of interjection is it's a matter of just understanding those and creating mechanisms around that. And I hate my word, you know, I hate when people say common sense. It's a silencer. Like don't talk to me. That's just common sense. Like, no, I'm going to talk everything. I'm going to ask everything. I'm going to push back on everything. Or define the elements of Define the elements of common sense in this context. So I love that push. But I think either we believe that things are system driven

Or we throw our hands up and say, let's wait for the faith, for our faith, you know. So if it is systems driven and we can figure out those systems and these are not undefinable systems and we've done these systems in other places, whether it was cessation of smoking or whether it was driving where you've reduced mortality profoundly at the national level, whether it's, when we have the impetus, we do it, we do it. But in other places, I mean,

heart disease. We know the relation between LDL and heart disease. That's only controversial on social media. It's not controversial in well-diagnosed, well-done, from ward studies all the way to community-based studies, that relation between LDL and heart disease. That can be operationalized. The relation between high blood pressure and those diseases, it can be operationalized. It's systems...

The systems within communities can be identified, the triggers can be identified. The problem is that those that deal with the financial level of things, that's broad enough, yeah, that financial level of things don't have the impetus to put the little bit of effort needed to create systems of abatement. And so when they don't do that, why don't they do that? Because

The system is set up to create, to get financial, remuneration, financial gain, and financial gain can be done at, at the point of creating the disease. Sorry, that a little hard, but, but yeah, I mean, and financial gain is quicker when it comes to those kinds of things, which, which run along the line of our survival proclivities. The survival proclivities, get me the sugar, give me the fat.

because I need survival. That's easier. You can make people addicted to that easier because that's the survival mechanism for millions of years for humanity. You can build quick financial mechanisms around that. And the powers to be, and this is not a conspiracy theory, I'm not, but we all know this, the financials of building financial gain around your evolutionary proclivities of survival is a lot easier than the other way around. And so how do you change that?

is complex conversations where you make it known that yes, it is complex, but the outcome is this and the methods is systems and systems that can be scalable have been done multiple times, but it's our choice to create those systems. it requires this kind of complex conversations.

Yeah. Can we talk about what's been going on at CCC since we last talked in June?

Yes. So since we last talked in June, we have significantly refined the entire protocol and the process. And earlier in the month of October, we introduced the concept to the community. We had an event where we shared the launch of the Inspire project.

which looks at specific factors that are associated with cognitive health and introducing that in a beautiful way with the community and involving community members, specifically nurses, social workers, other healthcare providers, and members of the community to be brain health ambassadors. So what we're trying to do is to give resources and train

specific trainers within the community so that they can talk to the members and share information about brain health, making them aware about the risk factors, and ultimately be in an environment where we can share information and see how the specific factors impact their brain health. And the specific outcome that we're looking for is preventing cognitive decline and Alzheimer's disease and dementia.

Okay, can we look specifically at like how you go about doing that so you don't come in as the external saviors?

Yeah, yeah, that was a huge, think that's central to the project is to make sure that whatever resources are dispersed within the community stay with the coaches. They stay with the trainers and training the trainers was at the core of this particular goal. So, you know, we've created online resources, conversations with them and giving them

all the information that they need to know and specifically adding on models of coaching so that they know how to communicate that with individuals. Yeah and focus groups meeting with the nurses we actually had at least four meetings with the nurses and the community coaches that they self-volunteered and many of them already had experience

working in the churches and in the communities with the health side of things. So there's some awareness of how to connect to the community. There is some intrinsic knowledge of what the community impediments are, what the community proclivities are, what the community opportunities are. And having those conversations with them and making sure that we are as open as possible so that we don't bias two experts coming in, three experts coming in, it's intimidating. So people actually might...

being completely open. Some of the conversation were had by some of our friends online who are not from the community. They're not healthcare workers, but just had, you know, asked the right questions. A good friend of ours, Caroline, has had many conversations with the leadership of CCC, as well as the nurses, many conversations. And then we ourselves have had conversations with the nurses. In fact, from here on, we'll be going there once every two weeks, having conversations with the nurses.

getting them ready for starting January, February where the study or the project will start. We don't call it a study with the project because even in the study, there's an idea that this will be sustainable long-term. So all the elements are from the community, including the testers, including the life coaches, including the people that are gonna be leading the project going forward, all are from the community. And where we come in is making the environment conducive for...

for the right conversation to bring out the right information. And as much as possible, and we have to be aware of that, as much as possible, we try to make sure that we don't inject our own supposed expertise and our own pre-knowledge into those conversations. And we've learned a lot from those. Yeah, really have. The focus groups have been immensely helpful.

So what's next? I know you guys have to go in a few minutes to to a more important podcast than this. So. Familiarity. What can you give me quickly an example of a community impediment that you wouldn't necessarily have thought of that came up through these focus groups and through this community involvement, empowerment and how.

Yeah, I mean, of course. Not more important than this. You're our brother.

the community is addressing it.

Well, one of the ones that I have seen is, so I kind of knew about this, but it's a powerful thing, incredulity, disbelief, suspiciousness, and they deserve those emotional triggers that have been placed over time. Scientists come, collect data, and then they disappear. People come, talk to them,

all kinds of hugs and high fives and this and that and even throw some money and then they disappear or worse than that and the historically from Tuskegee and others where people have been abused and the guise of research and so that's much deeper than you would think everywhere and and appropriately so and and and no matter how much trust you create and we've created an immense trust that's always in the back of the

mind of their mind and also a silent force in the ether which means that it's not just a matter of building trust it's sustaining trust so you always every conversation you have to be aware of that you have to be aware of it you have to make sure that you don't overextend yourself somebody like me who's very proactive and kind of wants to push to the next step to the next step to the next step that's not gonna work

It comes across as somebody just too eager, too pushy. And you can't do that. And that comes to understanding the community, right? And to me, that psychological impediment, which is not going to go away in the next few years, and it shouldn't, is something that's not so much an impediment, it's an awareness that must functionally slow down the process so that you address their fears.

Ahem.

And it's probably like with any bad habit or any negative force that's preventing progress, it has a protective purpose.

Yeah, yeah, yeah. And protection is our best friend, but in a world where survival is not the only element, it can be our worst enemy. The communities that have been most devastated are the ones that have also opened themselves up least to opportunities. People that have been most damaged, talking about individually, myself and others that have gone through childhood traumas, are the ones, ironically and sadly, are the ones that are

making themselves least open to opportunities that require a little bit of fearlessness, a little bit of openness. This is a tangential talk, not just about this community we're in, but all humanity.

The universe is not only not fair, the universe has a negative bias for those who've had a negative experience, sadly. And we have to be aware of that. And that's where it comes. When people, not to make this more controversial than it is, but when we're talking about giving certain resources more for some communities than others, it is so important.

Hmm.

for people to understand the complexity of that because the backgrounds of individuals do matter because they slow down the growth exponentially and you have to as a society that's just accommodate for that or otherwise you're just going to accommodate to the most powerful, to the most lucky and to the most resourced people over and over over again and you're to create an imbalance which ultimately will collapse.

That was a little bit of a tangential political statement, but so be it.

Well, I'd love to I'd love to follow that up. And, you know, I mean, talking about like I'd love to talk about the the cognitive implications of our current political situation as we're recording this. less than a week away from the twenty twenty four presidents.

Do you want to be banned from all of media? You just have a death wish. You just want to be banned from everything, don't you?

Yeah, they can't cancel me.

They can't know? at all. When I'm sitting in my room with my guitar there, they can't cancel my music. No.

Yeah

So I would love to schedule another one to talk all about that. But in the meantime, I know you guys got to go. I want to thank you for hanging in for jumping back in to complete this episode. And how can people find you stay in touch with you, learn from you?

It's always a pleasure speaking with you, Howie. We love you. You're our brother. It is. It is. definitely is. No, believe it. People can find us on our website. We're thebraindocs.com and we're the brain docs on social media as well. Happy to answer anyone has and yeah. And our podcast is Your Brain On. Yes, we have a nice podcast. It's called Your Brain On and we talk about the neuroscience of everything.

Isn't it though?

By the way, Howie, is that just a show guitar or do you play the guitar as well? No, he does, Can you play some for us now? Because I'm going to bring my guitar and we're going to duel. We're going to do a go out on a deal duel.

I play the guitar.

Okay, well...

Are you bringing Europe?

So I'm just going to say that the tuner for the G string has stripped. So I have to tune it like this. That's not terrible. All right, what's our song?

You

You already have an excuse.

you

Okay, Aisha, you're gonna sing with us. Hey Jude. Okay, hey Jude.

Hey Jude, in what, D or G?

whatever's easy for you. Yeah. She's fine. There you go. There you go. You got it. Hey, don't be afraid. Take a sad song and make it better. Remember to let her into your heart. Then you can die.

And make it better, better, better, better. That's it. Okay. It's a good way to end it.

You know, it's funny, I just I just rewatched the movie yesterday. Not I didn't watch it yesterday, but I watched yesterday last week and which, of course, is all about memory and memory loss. And Ed Sheeran is convincing him to be much better if the song was Hey, dude.

Yes! I love that movie.

Yes.

Hahaha!

And of course, the scat in the middle is, hey, doody, doody, doody, doody.

Okay.

Thank you. Thank you so much. you so much, Bye, see you soon.

So, that was terrific. Thank you so much for suggesting that. See you guys later. All right.

And that's a wrap. Hey, if any of my vegan friends know Paul McCartney personally, please ask him.

And that's a wrap. Hey, any of you know Paul McCartney personally, please ask him to go easy on us with copyright infringement, singing his song there without getting permission from Apple Publishing. Yeah, that was unexpected and a hoot. So let's see what else is going on in the world. Got a paddle tournament coming up next weekend. First time I have played competitively, which is to say.

somebody else is keeping score and presumably I'm going to get some kind of a rating. So looking forward to that and ultimate season, the tournament season here in Spain is really ramping up. There's beach tournaments pretty much every weekend. So getting back in shape for that as well. That's about all that's going on here. I hear there was an election in the US. Yeah, so not to get too down.

for a second, I spent a couple of days after the election results came out being pretty.

Apathetic, kind of withdrawn, low, like, what's the point? And I'm coming back, coming out of it and really thinking about, like, what's the gift that I have for the world at this point? What matters? What makes a difference? And been doing a lot of thinking and journaling and talking to people who know me. And I think the thing that's getting me out of it is the thing that I can help other people with, which is to remember what we're up to.

to really focus on the person that we want to be in the world in challenging moments, in times when it's unclear which team is going to win and to recognize one thing that really helped me was realizing like the sadness and the fear and the loss is all the inverse of what I love, what I care about, what I cherish.

And so that's the work I'm starting to offer to individuals, to executives, to teams, to leaders, to activists is a space where we can feel that grief and then rediscover and recommit to what it is where we're here to do. So if you're interested in that, you can hit me up HJ at PlantYourself.com and we can have a conversation. So wishing everybody a week of uplift.

of coming together, of collective support, of remembering to smile and laugh and feel joy. Right. In times like this, joy is a revolutionary act and be well, my friends.