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Alzheimer’s Starts Decades Before Symptoms... | David Perlmutter | DSH #1888
26 Mar 2026
Chapter 1: Why does Alzheimer's start decades before symptoms appear?
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Chapter 2: What is the connection between metabolism and brain health?
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As it relates to Alzheimer's, the changes metabolically that presage the development of the cognitive issues begin 20 or 30 years ahead of time. That's why I talk to somebody who's 28 right now and not waiting till somebody's 65 or 70 and comes to me and says, my memory's fading.
Chapter 3: How do lifestyle choices impact Alzheimer's risk?
Because what's going on in your metabolism right now is critical in terms of your brain's fate, your brain's destiny. And you, my friend, are the architect of your brain's destiny, not me as a neurologist.
Okay, guys, we're here at A4M. Dr. David Perlmutter here today. How did your talk go at the conference?
Chapter 4: What role does the APOE4 gene play in Alzheimer's?
It went really well. It was great because the speaker before me was our son. Oh, nice. So as he walked off the stage, I gave him a hug. He had to give me the clicker anyway, right?
Chapter 5: What are the alarming statistics about Alzheimer's prevalence?
Right. And all I could think about was him when he was maybe one and a half to two years of age, and I was carrying him to his bedroom. And, you know, I don't know why I thought about that at that exact moment. I haven't even told him that yet, but that's a while back. Yeah, it must have been a full circle moment for you, right? It was great. It was really great. It's such a privilege and honor.
Talk to us about the book, new book, Brain Defenders.
My new book, Brain Defenders, Harness the Power of Your Immune Cells to Protect Your Brain for Life.
Chapter 6: How can we effectively prevent Alzheimer's rather than just treat it?
And what it means is that upstream of all of the things that we focus on that go bad in a brain, like amyloid accumulation in Alzheimer's disease. We were just having a conversation in the hallway about this. This is upstream of all of that. And so it really allows us to understand that the first thing that's going bad in a brain to make it go bad are changes in the immune system.
And we've got to recontextualize how we understand the brain's immune system called the microglial cells.
Chapter 7: What is the impact of exercise on brain cell growth?
So for the quiz, that's going to be on the quiz, the microglial cells for everybody who's listening.
Microglial, never heard of it.
Yeah, well, you have now. So these are cells that can be friend or foe. Normally we think of the immune system as that's the system that's involved to protect us against infection, to help us heal when we've had trauma, et cetera, and it does.
Chapter 8: How do emotional healing and human connection influence brain health?
But the other side of the coin is that meanwhile, when these things aren't happening, well, they're not just sitting around waiting for the fire, right? What the firemen do when there's no fire is they take care of their fire engine and they fix things. And in a very similar way, our microglial cells exist in a form that's healing the brain.
And what happens is we do things that shifts them to becoming the evil twin, that then lets them degrade away our neurons, degrade away our synapses. We get things like Alzheimer's and Parkinson's. And it all depends on their metabolism.
When their metabolism is good and their mitochondria are working, they stay in what we call the M2 configuration and are loving and supporting and nurturing our neurons and synapses and the blood-brain barrier. When they shift to becoming the evil twin, they destroy your brain. And again, it depends on their metabolism. And the empowering part of the whole story and what this book is about
is that their metabolism, in other words, what dictates whether they are friend or foe, mirrors your body metabolism. So what did I just say? I said that if you can get your body metabolism on track, your brain's gonna be really happy and resistant to decline. Wow, so there's a direct connection there. You bet.
Your metabolism, how you control your blood sugar, your insulin functionality, your body weight, your lipids, your blood pressure, these are metabolic markers. influences whether your brain's immune system is going to be on your side or geared up to lead to destruction.
Interesting.
And it is SciTech magazine. I just made a slide for my talk here. SciTech magazine called this the number one new idea of 2025. So it's right here on your show. It's Leading Edge.
That's exciting. Yeah, I feel like I was blessed with a pretty fast metabolism, but I have noticed it's slow. And let me work with that a little bit.
It's not a question of fast or slow metabolism. It's deeper than that. And people say, I really want to turn up my metabolism. I want to lose some weight.
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