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Dr Orlena: Hello, Michael, welcome to fit and fabulous. It's amazing to have you here.
Dr Michael Kentris: Thank you so much for having me. I appreciate the opportunity.
Dr Orlena: Well, it's lovely to chat somebody who is gonna tell us all the amazing things we are gonna avoid, or perhaps I haven't said that, right? That all the horrible things we're gonna avoid, but before we dive into why and how please, could you just introduce yourself and tell people a little bit about what you.
Dr Michael Kentris: Sure. I'm, I'm Dr. Michael Kentris. I'm a clinical neurologist in the us. And I have a subspecialty in epilepsy, but I do mostly general neurology. And yeah, that's, that's kind of my, my deal.
Dr Orlena: Perfect. Perfect. So on the front line, as we like to say yes. Yeah. And so today, what I really want to talk about is lifestyle and neurological problems and essentially.
Dr Orlena: What we can do now. I always say we've got this, you know, golden moment right now to make changes. So the big question is why should we bother? What horrible things are we gonna avoid? And then obviously, What we have to do to avoid them so over to you.
Dr Michael Kentris: So, so yeah. Right. You know, obviously you know, I'm a little biased, but I, I would say developing neurologic problems is one of the things that most people would want to avoid in particular, our minds and our memories that makes us who we are just so disorders that affect that is going to change kind of a quintessential piece of, of who we are.
Dr Michael Kentris: And especially, you know, as we, you know, mu much of the Western world, we have an aging population. And so we're seeing more frequently different types of dementia, most commonly things like Alzheimer dementia or dementia from strokes, things like that. And, you know, While certain things are kind of baked into the cake as it were into our genetics, but there are still many things that we can do to mitigate those risks and try and set us up for, you know, like you said maybe better golden years as well as this golden moment.
Dr Michael Kentris: But but there are, you know, like I was saying, Unfortunately that one risk factor that we really can't get away from, especially when we talk about dementia would be age. It really is kind of an age dependent process. So we, we start seeing that, you know, after about the, the seventh decade, the, the risks start to go up.
Dr Michael Kentris: And then in those about 85 or older it's almost 10% of people will start having some signs of dementia. And it might be good to kind of talk a moment about like, what. What is dementia versus like what is just normal, normal aging. And that would be perfect. Yeah. Because I know I, I get a lot of folks from time to time who are like, oh, you know, I'm, I'm just slowing down and like, well, this is a little bit more than that.
Dr Michael Kentris: So it's normal as we get older to, to kind of. Like you slow down a little bit. Our thought processes are a little bit slower, but you should still be able to accomplish those same cognitive tasks that you were able to do when you were a younger person. It's a little bit of a shift from more of working memory towards a more crystal line memory, because you have all these experiences and knowledge over the course of your lifetime.
Dr Michael Kentris: You're still able to use those and sometimes. Maybe even get to a, a solution to a problem faster than a younger quote, unquote faster thinking person might be able to. So, so that's a normal part of aging, but when we start running into things that are more difficult. So some of the things that, you know, maybe you or a family member might be noticing about someone is like, maybe they're, they're not paying their bills on time, or maybe they're overpaying on their bills.
Dr Michael Kentris: They're forgetting the stove on, they get lost driving to familiar places, or, you know, any one of a number of things like forgetting names of very familiar family members. And they're not, you know sure. Everyone has that name finding here and there, but as long as it comes to you within a minute or two that's that's, so, okay.
Dr Michael Kentris: That can be normal. Certainly I do that and I, I certainly hope I don't have dementia, but But it's when of these things start interfering and in more severe situations, you start saying like, I, you know, they can't dress themselves, right. They can't cook for themselves. They can't bathe themselves. So they become very dependent for these, these quintessential activities of daily life that you need to be independent.
Dr Michael Kentris: So when we start seeing those kinds of abnormalities creeping into someone's life, then we start being more concern.
Dr Orlena: And is there a, is there a diff you mentioned two different types of dementia. You mentioned Alzheimer's and you mentioned stroke and clinically as people present. Is there a difference in how they present or is that just all, you know, you and your clever diagnostics?
Dr Michael Kentris: You know, a lot of it can. Like so many things, right? Simple tools are often best. So just getting the story a lot of times with, with, you know, Alzheimer dementia, it's kind of this very slow, gradually progressive decline in. Different areas of cognition and that can, you know, the, the classic form is like memory problems, but there are many different subtypes that are a little harder to pin down from time to time.
Dr Michael Kentris: Whereas a what we call vascular dementia or dementia from recurrent strokes, you tend to have this kind of stepwise decline. Like, you know, you hit a plateau. Maybe you have another teeny tiny stroke, not enough to maybe bring you to hospital, but. You know, maybe there's a touch of weakness in an arm or a leg, or maybe a little bit more language problems.
Dr Michael Kentris: And it's kind of this little, you know, step, step, step down rather than a slow gradual decline that can be hard to sometimes draw out. But that would be kind of the classic way it would present. And, you know, unfortunately a lot of people don't fall nice and neat into one box. So you do get a lot of overlap in different types of processes.
Dr Michael Kentris: Especially when we talk about like Alzheimer's and then, you know, another common form be like Parkinson's related dementia and things like that. So it, it does kind of all, unfortunately, if it gets to a severe enough state, there often is more than one different problem going on in the background.
Dr Orlena: Okay. So I think we all agreed that any kind of dementia is something that we would like to avoid. Yes. So how do we do that? So, you know, we're thinking now in our forties, perhaps perhaps a little bit older, how can we lead a life such that we can increase our chances? And I know you said, you know, some of it is genetic, but how can we increase our chances?
Dr Orlena: Of not getting dementia.
Dr Michael Kentris: So, so there are a number of risk factors that have been associated with it. So folks who have diabetes that it's not well controlled uncontrolled blood pressure depression has been associated with developing dementia later on, which I know has been a big thing. Over the last couple years for a lot of people obesity.
Dr Michael Kentris: History of heart disease in particular, severe enough to list require heart surgery, like a bypass surgery history of head trauma. So, so all of these are associated with developing dementia later in life. So, you know, a lot of it is kind of that, you know, heart, heart healthy is brain healthy so to speak in terms of diet, you know, it's a big thing for a lot of folks.
Dr Michael Kentris: There haven't been in, unfortunately, a lot of rigorous studies, but you know, like the classic Mediterranean style diet has been associated. Yes. you may
Dr Orlena: not be a regular listener to my, my podcast, but basically I teach people the Mediterranean style. yeah.
Dr Michael Kentris: You know, it tastes good. It's healthy for you. What's not to like, but but yeah, it's, that's been associated as well.
Dr Michael Kentris: There's a few other things that are a little less definite But have some suggestions. So late life dementia, some people have been found to have elevated levels of homocystine which can sometimes be associated with B12, deficiencies, things like that, or full late deficiencies, I should say.
Dr Michael Kentris: Again, these aren't. I would say that the evidence isn't to the point where you would routinely recommend like folic acid be six, B, 12 for everybody. But a lot of times when we're talking about reversible causes of dementia or what's, sometimes it's not in favor in the literature right now, but, or pseudo dementia is something that comes up from time to time.
Dr Michael Kentris: And again, that's kind of one of these things that can mimic dementia. And, you know, that kind of goes back to like depression. That's not well treated sleep apnea or just sleep disorders in general. That's something that's kind of emerging in the literature a little bit, interestingly something in the brain called the glymphatic system.
Dr Michael Kentris: So everyone's, you know, most people are familiar with the lymphatic system in the rest of the vein. This is essentially the same thing, but in the brain. So they tacked on a G unfortunately I haven't looked into the etymology of the word, but what we find essentially is that when we're in deep sleep, is that essentially it washes out.
Dr Michael Kentris: Those abnormal proteins, that amyloid and stuff like that out of the brain to a degree. So folks who are having poor quality sleep or fragmented sleep that also has been shown to potentially increase risk later in life as well. So sleep quality is also very important and sleep apnea just tends to be kind of the more common one that we see, especially with unfortunately, obesity being such a, a big problem in the.
Dr Orlena: You'll be pleased to hear that my, I have four pillars. So my, my first pillar is healthy eating. My second pillar is exercise that lights you up and pillow number three is sleep. But what I do find for a lot of people being, you know, parents that I talk to young kids like sleep does get really disturbed and, you know, lots of people have problems.
Dr Orlena: I know I'm not talking about sleep apnea because obviously that's a separate issue, but right. Just that. It can be difficult to get a good night's sleep. And if you're a light sleeper, there are, I always say there are lots of things you can do to improve your sleep, but sometimes people are doing quite a lot of that and still not getting sleep good sleep, but yes.
Dr Orlena: Yeah. Sleep is pillar number three now I know the internet is a dangerous place to get your medical advice from . But one of the things that I see like floating around is bread and bread and connection to Alzheimer's. So is that true or is that just one of those myths that we need to ignore?
Dr Michael Kentris: So. I, I would say it's one of those things that is being researched that hasn't been well proven.
Dr Michael Kentris: Yeah. There's, there's a lot of this gut brain hypothesis literature out there, or probably not as much as there needs to be with Alzheimer's I would say it's not as well established, but there is with like Parkinson's disease, actually a decent amount. There are actually some old experiments where they did bilateral Vagus nerve.
Dr Michael Kentris: Cuts, essentially vagus autotomies and
Dr Orlena: because, so just to explain that's the nerve that goes from your stomach up to your
Dr Michael Kentris: brain. Yes. And vice versa as well. So, right. The vagus nerve controls, like heart rate, you know gut transporting the first two thirds of the intestines. As well as like, you know, it even controls our vocal chords to an extent.
Dr Michael Kentris: So it does a whole host of things. So obviously cutting it, especially on both sides is a very severe measure. And obviously it's not routine treatment, but these were some experiments that were done, you know, in the past. And they, they did find that there's potential slowing of the progression of Parkinson's in those people.
Dr Michael Kentris: Obviously they had. Lots of other side effects. So it's not again a standard treatment, but it just kind of supports a little bit that gut brain hypothesis, where we have some inflammatory gut process going on, like maybe folks with some gluten issues or what have you or even some sort of infection in the past that went unnoticed.
Dr Michael Kentris: And then we kind of see this retrograde, you know, or traveling up the nerve towards the brain as opposed to going down away from the brain as it normally would. These, these proteins that are causing problems later in life. And. In particular with, Parkinson's not to get too into the weeds call it alpha syle.
Dr Michael Kentris: And so the family of disease is, is called alpha Andies , that's too
Dr Orlena: long, but that's too long a word for my podcast. We don't do long words here.
Dr Michael Kentris: but but to your point, you know, so, so it just link those things together. So like Parkinson's Lewy body dementia, or even much more esoterically, multiple system atrophy and these types of kind.
Dr Michael Kentris: Neurodegenerative processes, these progressive neurologic declining processes. Can, they might have a link now? It's not well established in terms of bread specifically, but, you know, I would, I would agree with you in terms of, you know I've lost a lot of weight on low carb diets myself in the past.
Dr Michael Kentris: And while I know some people get a little bit of that brain fog with it. I, I think it's, it's good to have a consultation with a, a good dietician, although I'm biased.
Dr Orlena: So here's a question. How much, how much bread do you eat personally?
Dr Michael Kentris: It, it depends on the week and how
Dr Orlena: stressful. So it's not like you've excluded bread because you're worried that it's going to lead to problems later on.
Dr Michael Kentris: No, no. I had a couple grilled few sandwiches yesterday, so ,
Dr Orlena: so let's go with bread in moderation. I like things in
Dr Michael Kentris: moderation. Yes. Moderation. Yes.
Dr Orlena: Perfect. Fabulous. So what I'm hearing from you is that essentially my four pillars. So I didn't tell you the last pillar, the last pillar is essentially emotional wellness.
Dr Orlena: So thinking about your stress levels and your relationship with yourself and food and obviously other people. So those are the four pillars that I teach people. And essentially what you're saying is all of those four pillars are really gonna help you lead. Avoid problems later in life, partly cuz they're going to help your heart.
Dr Orlena: And if you can help your heart, then you're not going to get the problem. The vascular problems. With vascular dementia. And partly because there are actually other than the vascular problems, things like Alzheimer's any other specific things that you would recommend that we do or don't do.
Dr Michael Kentris: So actually two year, you know, two year four pillars, there, there are actually studies that show increased stress.
Dr Michael Kentris: Yes. Increases risk for dementia. Increased exercise reduces your, and that can be even if you're later, you know, later on in life, over the age of 65, 70, there's still data that shows that by doing exercise at that point in life, even if you hadn't done it up to there can still reduce your risk. And I would say the last thing I would.
Dr Michael Kentris: The last thing I would say is remaining cognitively active, doing things that, that make you, I, I was like this one phrase I came across skull, sweat where you should be doing things that challenge you, you know like I know, you know, a lot of my, my little, little lady patients who go out and play bridge and things like that, like that's hard.
Dr Michael Kentris: If you're able to play bridge, I'm not worried about you having dementia.
Dr Orlena: Well, I have to learn bridge then I've never played bridge. Yeah. So I tell you, here's like I hear about this brain activity. Yes. So what exactly does that include? Because you know, things like learning a new language. Yeah. Crosswords, easy crosswords puzzles.
Dr Orlena: Wordle is the thing that's, you know? Yeah. Everyone's keen on. And how often do you have to do them for
Dr Michael Kentris: how long, you know, that's, that's something that they've looked at and there hasn't been a clear cut answer. But I mean, my, my usual rule of thumb is if you spend 15, 20 minutes a day doing something, then that's.
Dr Michael Kentris: Probably going to be good, but that's not really rooted in evidence. Unfortunately, but I, it shouldn't be easy. That's the thing. It should be something that pushes you that is hard to do, like, you know, reading a novel relaxation before bed. That's not probably gonna cut it, you know, pick up one of those, you know, Western cannon novels.
Dr Michael Kentris: We'll spend a few minutes with that and be like, what the heck are they trying to say here? So things that really push you to think beyond. What you're comfortable doing and engage in those more challenging aspects of thinking could tick crossword. It
Dr Orlena: is then
Dr Michael Kentris: yes, yes. Yeah. It should be something that hopefully enjoyable, but maybe a touch frustrating as
Dr Orlena: well.
Dr Orlena: Yes. Okay. Fabulous. And what about our alcohol?
Dr Michael Kentris: So, so that's one of those things it's like, I feel every year or two, you see another study coming out like yes. A little bit's good for you. No, everything's bad. I think the most recent one I saw just in the last few months said that any amount of alcohol is a risk factor for dementia.
Dr Michael Kentris: But looking back a couple years, you'll see like one to two glasses of like red wine is, you know, protective. So I would say that. Probably again, one of those moderation type of situations. I think this
Dr Orlena: is a really interesting thing though. I'd like, you know, I'd like to hear your opinion on sort of moderate.
Dr Orlena: I live in Spain. And so, you know, in Spain, in this area, you know, and in France, my mom lives in France, quite a lot of expats from the UK come over and then enjoy this Mediterranean. Sort of retired lifestyle, which includes wine at lunch, and then again at dinner. And I think it becomes very easy for it to become habitual right.
Dr Orlena: And people, you know, when people hear this word moderation, they think, oh yeah, I'm just drinking in moderation. But really my feeling is that actually it's a lot bigger risks than they, they, they realize. And I do hear stories of people, you know, overdoing it and suddenly doing things like dying from liver cirrhosis or even, you know, something like.
Dr Orlena: Ver Z, which right. Is obviously not great. So that's just to explain when your brain basically goes C put cuz of perhaps you can explain it better than me.
Dr Michael Kentris: Yeah. Essentially certain parts of your brain you, because this is usually, and unfortunately I see there's not uncommonly in the, the area that I practice in, but Because of the, the alcohol abuse you see people develop vitamin deficiency is specifically vitamin B, one or thymine, and certain parts of the brain really require that.
Dr Michael Kentris: To function. And so you develop this kind of, you know, amnesia and sometimes some abnormal eye movements and confusion. A lot of times they'll have like delusions, things like that. And if you treat it aggressively, if you catch it early on, it's reversible, but if not, it becomes this war NICU Corsica syndrome, which is not reversible.
Dr Michael Kentris: And you know, it, it is another again, form of kind of severe dementia that can come on. Abruptly in addition to just the toxic effects of the alcohol. I mean, you know, I, I like a drink, but it, it is a poison, right. We're being very precise with our words. So in moderation typically it would usually be like one standard serving, which is usually like considered a four ounce pour of wine for women and one to two for men in a, you know, a day.
Dr Michael Kentris: So more than that would be consider. Not moderate. Unfortunately.
Dr Orlena: Yeah. And having a break, I think not doing it every single day of the week.
Dr Michael Kentris: Yes. Yes. Yeah. That's one thing if, like you said, you're on vacation, but if you, you know, you retire in your fifties or sixties and now it's every day, well, you're probably gonna shave some years off of your life.
Dr Michael Kentris: You know, That's obviously a personal decision, but I would say it's probably not the right one in the grand scheme of things. Yeah. And
Dr Orlena: I think people, you know, have the right to make that decision with their eyes open. And I think what often people don't have their eyes open and they just carry on with this habit without really realizing how dangerous it can be.
Dr Orlena: Absolutely fabulous. So I think you have told us everything that we need to know to lead along and healthy life from a neurological point of view. Any last words of wisdom from you?
Dr Michael Kentris: You know, I think I, you know, the four pillars that you're talking about, that's, that's pretty much everything that's gonna do, you know, BARR, any, you know, acts of God that are gonna impact your health.
Dr Michael Kentris: That's pretty much all you can do is take care of yourself and practice, you know, Good healthy habits.
Dr Orlena: Healthy habits. Yes. I love it. I love it. That's exactly. and it's really interesting that, you know, on this podcast, when I first started out, I interviewed a cardiologist and I interviewed a cancer specialist and I interviewed.
Dr Orlena: A diabetes specialist, like different people. And essentially they all said exactly the same thing more or less, which is exactly what you are saying. And, you know, that's where those four pillars came from. It wasn't that I just invented them. I was like, hang on. These people are all saying exactly the same thing.
Dr Orlena: You know, experts in their area saying you can avoid these illnesses if you do these things. And happily for us, you know, that it's all, it's all the same stuff. And you know, it's easy. And I say fun when you know how, and as you said, it's all about habits. Right. Thank you so much for spending some time with us today.
Dr Orlena: Where can people find more of you?
Dr Michael Kentris: So I'm, I'm all over. I'm on Twitter at Dr. Kentris at Dr. R K E N T R I S. And I also have a podcast called the neurotransmitters, which you can find on. Pretty much all of your podcast hosts and it's it's primarily a neurology education podcast, so it's a little bit more oriented towards people in healthcare.
Podcast: The Neurotransmitters
Dr Michael Kentris: But we do have interviews with folks as well from the community with different neurologic problems and advocates and things like that. So we do have some conversations that are more broad as well.
Dr Orlena: Perfect. Thank
Dr Michael Kentris: you so much. Thanks. Thank you. Appreciate it.