Episode 138 | Jul 10, 2025

How We Can End Alzheimer’s, With Dr. Dale Bredesen

Is cognitive decline an inevitable part of aging? Not according to renowned neurologist and bestselling author Dr. Dale Bredesen. In this week’s episode of Health Coach Talk, Dr. Sandi sits down with Dr. Bredesen to talk about his latest book, The Ageless Brain, and how his groundbreaking work is changing the conversation around Alzheimer’s prevention, brain span, and the power of lifestyle medicine.

“We’re in a new era. You don’t have to just wait for Alzheimer’s. We can all be proactive and make sure we have an optimal brain span… Alzheimer’s is now optional.”

Dr. Dale Bredesen

In their conversation, Dr. Bredesen challenges the outdated belief that brain health is determined solely by genetics or luck. Instead, he explains that Alzheimer’s and other neurodegenerative conditions are often driven by modifiable factors like inflammation, metabolic dysfunction, and environmental toxins. Drawing from decades of research and clinical work, he outlines the six categories of contributors to cognitive decline—and shares the proactive steps we can all take to protect our brain health.

A former Buck Institute president and current Senior Director at the Pacific Neuroscience Institute, Dr. Bredesen has dedicated his career to understanding neurodegeneration at the molecular level. His passion for this work is rooted not just in scientific discovery but in witnessing firsthand how people can reverse early cognitive decline when given the right tools. He’s worked with thousands of patients through his precision medicine approach and continues to collaborate with programs like FMCA to train health coaches in this evolving and hopeful field.

This conversation offers key takeaways for health coaches supporting clients with brain health concerns. Dr. Bredesen highlights how coaching is essential for long-term success—helping clients manage overwhelm, implement new habits, and stick with personalized strategies that reduce risk and optimize cognitive resilience. Coaches trained in brain health can help bridge the gap between information and action, giving clients the support they need to extend not just lifespan, but brain span.

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Transcript

Dr. Sandi: How many times have you heard someone say, I can’t do anything about getting Alzheimer’s disease? It’s the luck of the draw. It’s in my genes. There’s nothing that I can do that’s going to prevent this. Well, our guest today is going to show you how that is not accurate, that you can have an ageless brain. So, let me tell you about our special guest, Dr. Dale Bredesen.

Dr. Bredesen received his undergraduate degree from Caltech, and his medical degree from Duke. He was postdoctoral fellow in the laboratory of Nobel laureate Professor Stanley Prusiner, then held faculty positions at UCSF, UCLA, and UCSD. He was a founding president and CEO of the Buck Institute for Research on Aging, and his laboratory studied mechanisms of neurodegeneration, and published over 230 scientific papers leading to the first report of the reversal of cognitive decline in Alzheimer’s disease. He’s the author of two New York Times bestsellers, and is currently senior director of the first precision medicine program in neurodegenerative diseases, which is at the Pacific Neuroscience Institute. I know you are going to enjoy this important conversation with Dr. Bredesen. Welcome, Dale.

Dr. Bredesen: Thanks so much, Sandi. Great to be on with you.

Dr. Sandi: Well, I am super excited because you have a new book, “The Ageless Brain.” And can you tell us why you chose to write this book, which is a follow-up to “The End of Alzheimer’s,” which was just really a remarkable book that has transformed so many lives for the better?

Dr. Bredesen: Thanks so much. I appreciate it. So, the idea here was to take what we understood about Alzheimer’s disease and what we’ve continued to learn with that, and now to expand it to everybody. So, in other words, for so many of us, we have a lifespan, and that might be 70, 80, 90, or 100 years or 100 or more, but our brain span is often shorter than our lifespan. And it’s such a tragedy as someone who might live to early 80s, but really their brain only is doing well until they’re 65 or 70.

And so, the idea was, how can we show everyone, all of us…let’s make sure that we don’t have problems with our brain span, and that now we understand much better about why brain spans are shortened with all the different issues from various biotoxins, and insulin resistance, and inorganics and organics, and various chronic infections, leaky guts, all the things that you talk about at FMCA. And so, they’re looking for this. And unfortunately, many doctors are not helping people to have their optimal brain span. So, this book sets forth, here’s how you go about optimizing your brain span for all of us.

Dr. Sandi: It’s remarkable. And I’m 75. So, I’m quite interested. And I may be aging, but I want to have an ageless brain. And all too often when I’m speaking to my contemporaries, they will say, well, there’s not much we can do. It’s in your genes. It runs in the family. And they’ll always cite those people who maybe were sharp until age 100, and they ate everything possible, and smoke and drank. And so, they’ll say, well, see, that person was sharp, and so, it has nothing to do with our lifestyle. But can you comment? How would you address a comment like that?

Dr. Bredesen: Yeah. This is such a good point. So, of course, genetics is a part of it. But we know from a number of studies that genetics are not your fate, so that they are a part. And then there are other parts. And, absolutely, the things that you do during your life have a big impact on your brain span. One of the things that I talked about in the book is, where did all these things come from? Why is it that we lose synaptic plasticity? And why is it that we lose control of movements, for example, in someone with Parkinson’s disease? We don’t have that fine modulation of motor system that we do when we’re younger. Why is it that we have things like ALS and macular degeneration?

And if you go back in evolution, what’s happened is, we are constantly evolving for performance over protection, performance over durability. And so, when you take these finely honed nervous systems, you know, they’re doing amazing things. You can store more in your brain than in over 2,000 home computers. So, you’ve got these incredibly finely tuned systems. It’s like taking an Indy race car. It’s not going to be a durable thing that you’re going to drive around the neighborhood for 10 years. It’s made to optimize its performance.

Therefore, we have these systems that do tend to fail as we get older, unless we recognize this, take good care of them, look at these various things that you know about very well, that you teach about all the time, unless we’re aware of what the status is with our gut, what the status is with our methylation, detox. The good news is we now understand for the first time so many of these parameters, which is not to say there won’t be new ones that are discovered, but we understand so many of them that we didn’t understand even 10 years ago. So that for the first time, we can really tell people, look, if you look at these things and you optimize these things, then you can almost guarantee yourself a very good brain span. We’re not 100% guarantee yet, but we can really change the likelihood.

And so, people are often caught unaware. Gee, I didn’t know that this was sneaking up on me. And I talked about a case in the book of a woman who said, well, I think I’m okay. But when she actually got her cognitive testing, she wasn’t okay. Now, she’s done great. She got back to a perfect score on her MOCA, which is great. So, you don’t want to wait. But the good news is we now understand so many of these factors. We can look at them, and we can make sure that people have long brain spans, literally, ageless brains.

Dr. Sandi: So, what are some of these factors that we can be proactive about?

Dr. Bredesen: Yeah. Great point. So, if you think about them in terms of groups, and there are dozens of these factors, things like sleep apnea and things like changes in your oral microbiome, but they essentially fall into three major groups and then three more minor groups. So, the three major groups are anything that alters the energetics. So, changes in blood flow, some vascular disease, some drop in oxygenation while you’re sleeping, for example, due to sleep apnea or upper airway resistance. So, mitochondrial function. So, damaging your mitochondria, things like that. Those are all in the energetics part. The brain needs support, energetic support, no question about it.

The second group is anything that causes inflammation. And that can be mast-cell-related, it can be lymphocyte-related, it can be cytokine-related, microglial activation, any of these things. And those are typically things like tick-borne infections. Often, again, people are unaware of these things, that they’re walking around fighting these things for years. So, any sort of chronic infection, of course, P. gingivalis has emerged as a big one, very common. It’s associated with periodontitis, but this same organism is found in the brain, and it’s associated with Alzheimer’s disease. But there are other oral microbiome changes, T. denticola, prevotella intermedia, F. nucleatum, all of these things are things that can be interacting with the mouth and the brain. And so, it has been surprising. Optimizing your oral microbiome and your sinus microbiome, actually quite important for your long-term brain span.

And then the third group is anything that affects toxicity. And that is three different types of things, inorganics, air pollution, mercury, things like that, organics. And unfortunately, the one that’s really come up recently is microplastics. There’s no question that we are exposed to these. There’s no question that they actually are concentrated in the brain more than the liver, more than the kidney. And recently, they’ve been shown to be associated with cognitive decline. It’s not yet clear whether they cause the decline or whether the decline allows more entrance of these. We don’t know yet, or whether it’s both, but it’s very clear that there’s an association at least between microplastics and cognitive decline. And then things like anesthetic agents are all also in that group. A lot of people will have their cognitive decline starting after a long anesthesia with a surgical procedure.

And then the third of those three groups, of course, biotoxins. And mycotoxins are the big ones, trichothecenes, and gliotoxin, and ochratoxin A. And we see it all the time. It’s one of the most common contributors to cognitive decline. You’ve got to identify it, you’ve got to reduce it, and then people will do very well. So, those are the big three.

The lesser three, but still important, of course, are neurotrophic activity. So, things that support the brain, BDNF, which you get with exercise, for example, nerve growth factor, and other activity there, things like estradiol, thyroid. These all are supportive of your brain function. The second one being neurotransmitters. So many of us are low in choline. We need that acetylcholine to make memories. And many of us, the typical American diet is low in choline, unfortunately. And then the third group there is stress. And as a lab scientist for years, I didn’t think…I thought stress was like, yeah, so what? We all have stress. And yes, humans do very well with stress that comes and goes. It’s that chronic, unremitting stress that has really been harmful for us, and is associated with brain atrophy.

So, those are the big six that we look at and we can define for each person, okay, what are the things that you’re on the wrong side of, that are actually driving this beautiful 500 trillion synapse network to decrease in number? One of the interesting things is that you make the stuff we associate with cognitive decline, such as amyloid, to protect yourself. So, it’s a little bit like…it’s almost like the cerumen in your ear, which has a barrier effect and an antimicrobial effect. Well, that’s what amyloid does. It has a barrier effect. It’s preventing these things from getting to your brain and damaging it or other regions of your brain.

But if you continue to have exposure, at some point, you exceed that ability to hold these in a box. And now, you’re going to create inflammation. You’re going to activate microglia. You may activate mast cells. You’re going to bring on the cytokines. And now, you’re going to see a reduction in brain volume, a reduction in brain synapses, and of course, a reduction in cognitive ability.

Dr. Sandi: So, listening to this, it might be a typical reaction for someone to say, oh, this is just overwhelming. I don’t even know where to begin. It’s too late for me. I don’t know where to start. And we have worked with you. And one of the things I most appreciate about our work together has been that we can train health coaches. So, they go through our program, and then as graduates, they can go on and train with your group, and they can become those guides, those critical support people who can partner with somebody who wants to really take charge of their brain health, because we’re talking a lot about being the CEO of your health, taking charge of your health. You can do it with brain health as well if you have a belief that I don’t have to be helpless, there are things you can do. So, what can you do? Let’s start with testing. What are some of the tests? Or someone says, well, how do I know if I’m at risk or if I have early stage cognitive decline?

Dr. Bredesen: It’s a great point. And what we’re finding again and again, and including in our current randomized clinical trial, which is going on at six sites around the country, that health coaches make a huge difference in outcome. Having a well-trained coach, who understands what you need to do for optimal cognition, working with you, is the way to get best long-term outcomes. So, I would encourage people, please work with a well-trained brain health coach, and you’ll have a much, much better brain span.

And as you mentioned, there really are two major steps. Step one is you want to know what’s my current status. You can actually see your current status for free. Go on mycqtest.com. You can get a free cognitive test. Because these things do sneak up on you. And we think, well, gee, I think I’m okay. I think I’m just getting a little older. But the reality is you should really keep your abilities to remember things, and drive, and find places, and all the things that you do for your entire life. As Professor Mike Merzenich showed, we learned we’re able to have neuroplasticity throughout our entire lives. So, if you’re having problems, please don’t just write it off to you…I’m over 40 now. I’m going to have issues.

So, the first thing then is you want to know your status. And that’s the cognitive test that I mentioned. And then I recommend for everyone, every five years, get a brain scan. And when I say brain scan, this is a blood test. I had it done just a couple of weeks ago. I had my blood drawn right at my kitchen table. And easy. You can do it via mobile phlebotomy. You can actually do it directly. You don’t even need to go to a doctor to order this. So, it’s very easy. Go to getabrainscan.com. You can get that test. And it will give you three things. It gives you p-tau217, which tells you if…it’s a little bit like getting your hemoglobin A1c. So, hemoglobin A1c will tell you, am I on my way to diabetes, and I really should be looking at something now to make sure I don’t get diabetes? Same idea. P-tau will tell you, shall I start something now so that I don’t get Alzheimer’s disease?

So, it’s a really good idea to know that because there’s a tremendous amount. People will say, oh, there’s nothing I can do. That’s absolutely wrong. That has changed over the last 10 years. You can absolutely do a lot. And starting working with a good health coach, and if you’ve got a positive p-tau, work with a well-trained physician, team with a coach, and you can avoid cognitive decline. And then the second thing it looks at is GFAP, which tells you if you’ve got inflammation in your brain. It’s not specific for Alzheimer’s, but it’s very sensitive. And then the third one is NfL, neurofilament light. And that will tell you whether you have damage to neurons specifically, which could be from a traffic accident, Alzheimer’s, frontotemporal dementia, vascular disease, what have you.

So, the three together…and we’ve got a report that will tell you, okay, here’s what this combination means for you. Then the other piece of this is you’d like to know why. In other words, one’s kind of your current, one’s your future. What do I have to be concerned about? Is my homocysteine high? Is my HSCRP high? Are my triglycerides high? All these things that will tell you because each person’s different. So, it’s a little bit like having a fingerprint. Each one has got a different…it’s a brain print. It’s basically telling you, am I concerned because of this or that?

And then we see people who have cognitive challenge because of inflammation. We see those who have it because of more insulin resistance and metabolic changes. We see people because of changes, as I mentioned earlier, in energetics. So, there are lots of pieces. We see atrophic types of cases and toxicity types of cases, and they’re each different in the way that you optimize their outcomes. So, the good news is we can see it coming like never before, and we can help you like never before.

Dr. Sandi: This is such encouraging news, and you’ve seen probably hundreds of people who have made substantial changes with lifestyle. It doesn’t have to be anything fancy. Can you comment about the role of just what…somebody says, well, I really want to change my diet. And what would be some of the most successful? And again, it’s personalized, of course, but putting in the good stuff, taking out the bad stuff, as well as the role of movement and sleep. And as you said, addressing stress and having meaning and purpose in your life, connection with people, relationships, meaningful work. All of those tie into it, I would assume.

Dr. Bredesen: Yeah. We think of it in terms of seven basics and two specifics. So, it’s pretty straightforward. The seven basics, as you indicated, diet, a plant-rich, mildly ketogenic diet is what has worked best so far in terms of improving cognition and getting people, whether it’s exogenous or endogenous, getting them into a little bit of ketosis around 1.0 in that range has worked best for their cognition. And it gives you phytonutrients. It gives you fiber, helps you detox, helps you improve your gut motility, helps you improve your gut microbiome. There’s just endless advantages to this sort of optimal diet and lots of ways to do this. You can now…you can get these directly from Trifecta, this KetoFLEX…what we call KetoFLEX 12/3. You can also, of course, make it. You want to have organic vegetables that are non-starchy vegetables to the extent that you can. And that’s fine to have some wild-caught fish and some grass-fed beef, if you like. Or you can do it as a vegetarian, either way. But either way, you want to have a plant-rich, mildly ketogenic diet.

And then exercise, and you want to have both strength training as well as some aerobics. HIIT, by the way, high-intensity exercise, actually very helpful for cognition. Just be careful, work up to it. And then sleep. And you want to…for sleep, it’s really important. You want to monitor your sleep. And I like to check mine on my watch, but other people like to use Fitbit, or they like to use an Oura ring. Any of these is fine. You want to have at least seven hours of sleep at night, at least an hour and a half of REM, at least one hour of deep sleep, and an SpO2, an oxygen saturation that’s above 92%. You want to have all those things to get yourself the best outcomes, again. And then stress, again, I never used to think stress was a major problem, but it really is. So, you don’t want to have that chronic stress that we talked about earlier.

And then brain training has turned out to be…or even brain stimulation. Some people like photobiomodulation. Of course, some people like to do brain training. Any of these things with some brain stimulation when you’re supporting your brain. Brain stimulation without support, not so good. It’s like working out with weights while you’re malnourished. That’s not going to help you, but there’s a lot of way to support. And then detox, just basic things like castile soap and getting…sweating, doing some sauna, getting out there in the sun, all these things are very helpful. And clean water, high-fiber diet, these things are all so good for detox.

And then the last is some targeted supplements. And there have been so many things. The armamentarium is growing. There’s been a lot of interest in things like creatine recently because it supports the energetics. I happen to like SPMs. These are resolvins, basically, very good for decreasing ongoing inflammation. Obviously, keeping your vitamin D level optimal. There are all sorts of things you can do. And I go into this in the book as well. So, those are the basics.

Then the two specifics are, do I have chronic infections or leaky gut, anything that’s going to give you that chronic inflammation that you’re going to need to deal with then? So many people don’t realize they have chronic Borrelia, chronic Bartonella, chronic Ehrlichia. We see it all the time. Actually, I was just meeting with an old friend who had some of his own cognitive issues. And going through all the things, it finally turned out this guy had been exposed to some ticks, did not realize it was a problem. And he had multiple tick-borne organisms. So, he’s now being treated for those. And then the other one is the toxins we talked about before. So, if you’ve got high mycotoxins, which, again, so many people don’t realize it, getting those down will help you. So, the bottom line is, for virtually everyone, we can optimize their function, their brain function, and their brain protection. And that’s the key to a good brain span.

Dr. Sandi: Well, it sounds like this is certainly a comprehensive approach. And I was excited about this when I first met you years ago. And I have been, as best as possible, trying to implement this on personal level. But it really does show that for so many, Alzheimer’s disease is optional, that it is…you can do something. You don’t have to just say, well, it’s the luck of the draw, and it’s too bad, bad luck, bad genes, and it’s something that just happens to you.

Dr. Bredesen: Absolutely. And you can improve your brain aging with or without Alzheimer’s disease by recognizing that it’s these same sorts of factors. Whether it’s going to be through Alzheimer’s or whether it’s just going to be through brain aging, you can deal with these factors. You can improve them, you can get rid of the critical ones that are giving you a problem or that are putting you at risk. And we’re in a new era. You don’t have to just wait for it. I know people. I remember, Julie G., who has now done well for 13 years, who has genetics that predict that she will get Alzheimer’s. She’s done very well. And when she saw the first neurologist 13 years ago, as she points out, he said to her…she said, can you help me avoid Alzheimer’s? And he said, good luck with that. People tell you just, well, wait for it because there’s nothing that can be done. And that’s really outdated thinking. None of us has to wait for it. We can all be proactive and make sure that we have an optimal brain span. As you said, Alzheimer’s is now optional. I think that’s a very good way to put it.

Dr. Sandi: Yes. And you don’t have to go it alone because the protocols that you outlined, you can have somebody by your side as your health coach, who can help you with where to start, starting small in each of these areas or which area do you want to focus on first. But as you start to implement these strategies that have to do with lifestyle that are so critical, you will see gains. And as a health coach, and we’ve trained so many health coaches who choose to work in this area, they choose to work with people with [inaudible 00:24:33] decline, and they are personally transformed with this work. It is so, so powerful. And I know you have always been so mission-driven in terms of the…just so many obstacles out there for people who think that this is just their fate and it can’t be avoided.

Dr. Bredesen: And the other thing that people find is, when they optimize these various things, when they realize not only do I think better, people will get rid of their depression, people will get rid of their hyper cholesterol, they will not need statins often when they are doing the right things. They will be able to get rid of their antihypertensives. We see this all the time. Well, this person was on antihypertensives, but they no longer need them when they’ve now optimized things. And even people who have pre-diabetes and type 2 diabetes will improve that as well.

So, you get back to the point that you enjoy life again and people will find that, hey, I really have a joy for life. Again, as a scientist, I didn’t used to think that was such an issue biochemically, but it turns out it’s actually very important. And we had one of the earliest women who had clearly improved, and then she had a situation in her life where her granddaughter had left. It was her pride and joy, had left to go off to college, and she just didn’t have that joy in life anymore. And she really didn’t care about her brain status. So, having something in life, whatever it is that you love, turns out to be helpful. And so, all these things work together to give you a more complete life and a better brain span.

Dr. Sandi: This is such a good point because this is the essence of health coaching. It’s really asking those questions, what do you want your health for? What brings you the most joy in life? And to hear them and to see their faces light up when they talk about a loved one, for example, but it is that experience, and I experience on a daily basis just loving where I’m at and feeling so mission-driven to train health coaches who can then go out and help people transform their health. And that lights me up. And so, helping people to have that mission, as you are certainly so mission-driven. Well, I want to say also, thank you. You have been an advocate for health coaches, for FMCA from the beginning. And it has just been a pleasure to collaborate with you on projects so that we can help millions of people with better brain health and better overall health.

Dr. Bredesen: Absolutely. We all working together can reduce the global burden of dementia. And the health coaches, as I said, play the most important role in this for getting really good outcomes. So, thanks very much, Sandi. Always great to talk to you.

Dr. Sandi: And where can people find you and your work?

Dr. Bredesen: Yeah. People can find me on Facebook, Dr. Dale Bredesen, on Instagram, on X, on Bluesky. You can also go to MyCQ test and just to get a look at how to check your cognition. And that will also take you directly to my pages. So, lots of ways to go. And there’s also some stuff on Apollo, YouTube. So, lots of places. And of course, via the books, the new one being The Ageless Brain.”

Dr. Sandi: Check out this important work. Well, thank you so much, Dr. Bredesen.

Dr. Bredesen: Thank you, Sandi.