[00:00:00.210] - Dr. Lemanne

Yeah, so cigarette smoking is actually strongly associated with a lower risk of Parkinson's diseases. In fact, there's an article by authors from Harvard and the Movement Disorders Journal published in just a couple of months ago, February 2024, saying, and this is a quote, The link between smoking and a lower risk of Parkinson's disease is one of the strongest environmental or lifestyle associations in neuroepidemiology. End quote. You have found your way to the Le Monde Gortes podcast where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn Le Monde. I treat cancer patients.

[00:00:49.590] – Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:53.390] - Dr. Lemanne

We've been in practice a long time.

[00:00:54.540] - Dr. Gordon

A very long time.

[00:00:57.380] - Dr. Lemanne

We learn so much talking to each other.

[00:00:59.180] - Dr. Gordon

We What if we let people listen in? We call this episode Good versus Evil, because Dr. Le Monde and I start things off by jumping to the beneficial effects of, of all things, cigarette smoking. Specifically, we discuss the relationship found by research at institutions such as Harvard between cigarette smoking and a reduced risk of two devastating diseases, Parkinson's disease and inflammatory bowel disease. We also discuss how excessive sun exposure, enough to cause skin cancer, is actually associated with a pleasantly lower risk of both heart attack and broken hips. You'll learn the exact dose of vitamin B3 that studies show is associated with decreasing that risk of skin cancer. You'll hear why taking B12 supplements might put you in cancer's crosshairs. We even cover a frightening connection between childhood leukemia and two of our favorite flavonoids, quercetin and genistein, that will be of interest to anyone pregnant. So dive in with us to learn about the health habits that aren't and evil habits that prevent disease. But no, don't start smoking. Just don't.

[00:02:29.820] - Dr. Lemanne

Hey, Hey, Deborah.

[00:02:30.650] - Dr. Gordon

Hey, Dawn.

[00:02:31.980] - Dr. Lemanne

I have something to tell our patients about prevention of two horrible diseases, some action that's been shown to decrease risk of that. Do you want to hear about that?

[00:02:45.730] - Dr. Gordon

I do. I'm so interested in anything that's in people's own hands. They can control their destiny. So what can I start telling people to do?

[00:02:55.450] - Dr. Lemanne

Okay, are you holding on to the size of your chair?

[00:02:57.400] - Dr. Gordon

Okay, I'll hold on to the size of my chair.

[00:02:59.790] - Dr. Lemanne

I'm talking about ulcerative colitis and Parkinson's disease. There is a single action that a lot of people do take that actually is associated with a decreased risk of contracting these diseases being diagnosed with either Parkinson's or ulcerative colitis.

[00:03:15.590] - Dr. Gordon

They seem so different.

[00:03:17.250] - Dr. Lemanne

They are really different. And you know what this action is?

[00:03:20.910] - Dr. Gordon

No.

[00:03:21.880] - Dr. Lemanne

Okay. I knew you didn't know. Thank you for playing along. Cigarette smoking.

[00:03:30.390] - Dr. Gordon

No. How can that be?

[00:03:34.070] - Dr. Lemanne

Yeah. So cigarette smoking is actually strongly associated with a lower risk of Parkinson's diseases. In fact, Harvard, you've heard of that place? There's an article by authors from Harvard and the Movement Disorders Journal published in just a couple of months ago, February 2024, saying, and this is a quote, The link between smoking and a lower risk of Parkinson's disease is one of the strongest environmental or lifestyle associations in neuroepidemiology. End quote.

[00:04:10.700] - Dr. Gordon

Oh, dear. Don't tell the tobacco industry this.

[00:04:13.320] - Dr. Lemanne

I know. And then there's also colitis, which is a terrible disease of the bowel.

[00:04:18.840] - Dr. Gordon

Yeah. So I need some more information about each one of these. But for our listeners, I think probably people are familiar with Parkinson's disease. Michael J. Fox has popularized that, and his biopic about his journey through Parkinson's is really good, if you haven't seen it, and I'll put the name of it in the show notes. But ulcerative colitis, people may not be so familiar with, but it's an inflammatory bowel disease, right? It's autoimmune, and it can be terrible, give you bloody, diarrhea, intoler of almost any meal, and lead to needing parts of your colon removed, right?

[00:04:58.940] - Dr. Lemanne

Yes. And It's a disease, ulcerative colitis. It's mucosal ulcerations, ulcers of the lining, the internal lining of the colon. And it's very painful. It's very debilitating. If people have that, they lose a lot of weight. And blood. And blood, they become anemic. It's an autoimmune disorder. You can see terrible skin problems. Ulcerative colitis can cause terrible ulcers of the legs as well. And so, yeah, it's a terrible thing to have. And it can strike it. It has a bimodal onset in youth, adolescence, young adulthood, and in the 50 to 60 age group.

[00:05:44.940] - Dr. Gordon

So first of all, these diseases are both terrible. They have totally different patterns of onset, and to my minimal understanding, very different mechanisms of action.

[00:05:57.690] - Dr. Lemanne

Well, people have been trying to figure these diseases out. We've known since 1984, well, anyway, the first published report by someone named Logan and a group of co-authors, an observational study, a case control study, 8% of ulcerative colitis patients were smokers, compared with 44% of matched controls. In English, what that means is if you are a smoker, you're much less likely to get or be diagnosed with ulcerative colitis. Is there a causal relationship there? We don't know. But the authors concluded that smoking directly or indirectly confers protection against ulcerative colitis. I'm quoting the authors.

[00:06:45.810] - Dr. Gordon

Do they have any idea how that might be mediated?

[00:06:51.130] - Dr. Lemanne

We don't know, but a lot of effort was put into the idea that nicotine might involved. So this information, this 1984 study led to many more studies, and it led to attempts to try to treat ulcerative colitis with nicotine, nicotine transdermal patches. You don't want people to smoke. So everybody here, I think everybody in our audience, we have an extremely rarefied audience. They're all very intelligent and understand that we're not advocating smoking or nicotine use or anything like that.

[00:07:30.140] - Dr. Gordon

It's This is just- Well, wait a minute. Those are two different things. We're not advocating smoking, but perhaps you're going to tell me something that might advocate for nicotine use.

[00:07:38.110] - Dr. Lemanne

Well, nicotine use for recreational purposes. Let's put it that way. So nicotine is a drug. It can be used to treat various conditions. And there have been attempts made to look at nicotine in ulcerative colitis. So it's been given through a patch and also as nicotine enimus, gets it right into the colon.

[00:07:59.120] - Dr. Gordon

Directly Where the action is.

[00:08:01.950] - Dr. Lemanne

Right. And these studies are ongoing. I think the results are mixed. Some people seem to be helped, some not. But the idea that smoking and ulcerative colitis are related and the relationship as negative, meaning more of one is less of the other, is really, really intriguing. And it makes you wonder, do people who have a propensity toward some digestive upset that and find that smoking cigarettes seems to calm that? It brings up the idea that people are weak for developing sometimes what we call bad habits, but maybe they're smart. Maybe they are medicating something that we haven't found better medications for at this point.

[00:08:52.790] - Dr. Gordon

So in my practice, I actually don't think I've ever had a patient who had active ulcerative of colitis that I was helping contribute to their wisdom to manage. But I do know that I've had patients with Crohn's disease, and I remember talking to one of them, I believe Crohn's disease is aggravated by smoking.

[00:09:18.390] - Dr. Lemanne

Tell our audience what Crohn's disease is. What's the difference between Crohn's disease and ulcerative colitis?

[00:09:23.580] - Dr. Gordon

So ulcerative colitis, proper to its name, affects the colon, the in part of your intestine, from your appendix to your rectum. And Crohn's disease is more patchy. It And then seem to present in the same way, but it's not ulcerative. It's inflammatory on the lining of the intestines. Okay, you're calling up my memory of a patient I haven't had for quite a while.

[00:09:57.490] - Dr. Lemanne

They're actually quite similar, and there's a lot of overlap, is my understanding. And it's difficult to make the diagnosis. Some patients will be diagnosed with one, and then another doctor will come along and say, oh, no, you have the other. So there's no... I think they are distinct entities, but I think it's often difficult to tell the difference. And I would leave that to a gastroenterologist. But they're both terrible diseases of the gastrointestinal tract. I believe that Crohn's can affect the small bowel as well as the large Yes, definitely.

[00:10:31.500] - Dr. Gordon

As I believe, Crohn's is more patchy and can affect the whole intestine. Ulcerative colitis is more progressive, goes from one area to another. But I don't know if that's true anymore. That's an old impression, but it's just the colon. But the key that keeps them the same or keeps them in the same category is they are both inflammatory gastrointestinal autoimmune diseases.

[00:10:55.630] - Dr. Lemanne

Inflammatory bowel diseases, as opposed to irritable bowel syndrome. Which is a whole different animal and has nothing to do with that. But people will often confuse those two. So we're talking about inflammatory bowel disease, IBD, and not irritable bowel syndrome.

[00:11:13.790] - Dr. Gordon

But If it were the theory that people were smoking and thereby calming their nerves a little bit, it's interesting that it really just helps with the calming of the nerves that might lead to ulcerative colitis rather than Crohn's disease or irritable bowel.

[00:11:34.460] - Dr. Lemanne

Well, the actual mechanism is really unknown and interesting. It could be. I mean, some of the things that have been looked at are, is this a change in the microbiome? So smoking definitely changes the microbiome. You swallow a lot of the detritus of smoking after you've breathed out what hasn't gone into the lungs. A lot of it's stuck in the mouth and on the mucus and you swallow that. Smokers don't eat as much as nonsmokers because smoking decreases appetite. They're often thinner. They have a lot more nitric oxide, which is beneficial in some ways. And they also have a lot more carbon monoxide dissolved in the blood. So a nonsmoker will have something like 1% carbon monoxide dissolved in the blood at any moment. Smokers will have, I think it's something like 3 to 5 or 10%, a lot more. It's not the 50% that makes you end up in the hospital or even in the morgue with carbon monoxide poisoning, but it's a lot more than the person who's not a smoker. So it may not be the direct effect on the nervous system. It may be a direct effect on any of these other systems that may be related to...

[00:12:54.210] - Dr. Gordon

You piqued a little interest for me when you mentioned nitric oxide, and this is just a reminder to us. I want us to talk about nitric oxide someday because in vascular health, I think it's only good, but I do know you can have too much of it, and evidently, smokers have more of it.

[00:13:11.600] - Dr. Lemanne

Well, and nitric oxide in response to smoking, Maybe it's a preservative response to increase blood flow to the brain. And maybe that's one of the things that makes people feel a little more alert when they've got some cigarettes going. Their brain perks up and + that's one of the things. Speaking of brains, one of the things that's really interesting is that Parkinson's patients are more likely to smoke, possibly because they feel better if they smoke, at least early in the disease. And we're talking decades before the disease becomes clinically apparent.

[00:13:54.470] - Dr. Gordon

Interesting, which I think in cognitive disease is often true, that their pathology starts decades before we know it.

[00:14:02.360] - Dr. Lemanne

You may be able to speak to this. Something I find really fascinating is that there... Some people claim there's a... Some psychiatrists claim there's a Parkinson's personality. And And it's the mild-mannered accountant type. Nothing wrong with being an accountant. God bless my accountant. But the propensity to avoid risk and to keep a routine and keep things calm and within the rails, that's the Parkinson's personality. And they also have less propensity to addiction. So even if they are smokers, it's easier for them to quit than it is for other smokers.

[00:14:44.450] - Dr. Gordon

You know why this... So in the world of thinking about preventing Parkinson's disease, the main mechanism that we understand from a diet and lifestyle point of view is that there's usually an early life talk toxic exposure, that they grew up near farms with pesticides, or they lived in an industrial part of the world.

[00:15:08.380] - Dr. Lemanne

You know what else? What? Next to a golf course. People next to a golf course have higher rates of Parkinson's.

[00:15:16.530] - Dr. Gordon

And why is that, Dr. Lemanne?

[00:15:17.280] - Dr. Lemanne

Yeah, I don't know. Something about the golf clubs and they're getting hit on the head with golf balls too much?

[00:15:22.330] - Dr. Gordon

I don't think so. What do they use to keep a golf course nice and suitable for those picky golfers.

[00:15:30.620] - Dr. Lemanne

Golf courses are so beautiful. And, boy, you don't want to go barefoot on one of those, do you?

[00:15:36.070] - Dr. Gordon

You don't. And do you want to share with us why?

[00:15:38.910] - Dr. Lemanne

Well, I think I know nothing about gardening. You're the one that lives on a farm. I've been to your house. There's goats and sheep and things I'd have to go back to kindergarten to learn the names of.

[00:15:52.070] - Dr. Gordon

Gross exaggeration.

[00:15:53.960] - Dr. Lemanne

Yeah, the pesticides.

[00:15:56.160] - Dr. Gordon

The terrible pesticide use on golf course. And Living Adjacent puts you at risk for a couple of different kinds of cognitive disease.

[00:16:06.550] - Dr. Lemanne

Really?

[00:16:06.570] - Dr. Gordon

Not just Parkinson's? Not just Parkinson's. Tell me about that. Well, all these brain diseases, if we think that we're having trouble figuring- So now golfing is one of those bad things.

[00:16:21.250] - Dr. Lemanne

Golf is suddenly evil and smoking is good. So exercise with golf and you're cooked. Okay.

[00:16:28.410] - Dr. Gordon

Oh, my goodness. I wonder if you play in a Scottish course if it's different. I believe they have rougher courses, and I can't believe they- If you look at my demographic, you'll understand that I know nothing about golf.

[00:16:42.380] - Dr. Lemanne

So tell me what's going on with Scottish courses versus the course here in Ashland.

[00:16:48.990] - Dr. Gordon

So I will say I also don't have any experience with golf, except that I'm the only member of my family who's gotten to adulthood and not become an avid golfer. Really? But I've broken the chain, so my daughter is also safe from it.

[00:17:06.150] - Dr. Lemanne

I like mini golf. Oh, I love miniature golf.

[00:17:08.180] - Dr. Gordon

And I think that's safe. I don't think they use pesticides on the cement.

[00:17:13.230] - Dr. Lemanne

Yeah, I think it's... What do they call that? Fake grass? Astroturf. It's as close as you get to grass.

[00:17:20.660] - Dr. Gordon

That's probably...

[00:17:22.170] - Dr. Lemanne

Carpeting and AstroTurf.

[00:17:22.830] - Dr. Gordon

A lot safer. So we're telling people to avoid outdoor spaces with large lawns. Large manicured lawns. Okay.

[00:17:33.600] - Dr. Lemanne

Yeah, right. And go for the AstroTurf and carpeting.

[00:17:35.870] - Dr. Gordon

Go for the AstroTurf and carpeting. Or I believe go to Scotland because I believe Roundup, which is one of the more prevalent pesticides and one of the more insidious and persistent ones, I believe, is not used across the pond at all.

[00:17:52.800] - Dr. Lemanne

Okay. It's illegal in Europe?

[00:17:53.890] - Dr. Gordon

Yes. I know it is in the European Union, contraindicated for anything that comes in contact with something people eat. So I'm not sure about the golf courses, but the Scottish golf courses do have a reputation for having a lot more rough on them.

[00:18:12.310] - Dr. Lemanne

They're not manicured?

[00:18:12.970] - Dr. Gordon

They're not quite... I'm sure the Fairway is manicured, but I believe they have more off Fairway roughness. And why do we really care? Neither one of us is ever going to play golf. But the point is- I don't even know what a Fairway is.

[00:18:27.130] - Dr. Lemanne

Okay.

[00:18:28.160] - Dr. Gordon

The pesticides definitely So I think of all these toxins contributing to Parkinson's, and I've never thought that there's something that somebody could be doing decades before that actually might be mitigating, because frankly, both Parkinson's patients that I'm working with actively have a moderate pesticide exposure in their youth, and neither one of them has ever smoked a cigarette. Excuse me for interrupting. You keep mentioning pesticides. I'm wondering if you herbicides when it comes to golf courses. You're right. When it comes to golf courses, I believe it's herbicides and pesticides. Okay. Thank you. You're welcome. Thank you. But more to the point with the golf courses is herbicides. But more to the point of early Parkinson's toxic exposures is the pesticides. So glyphosate is an herbicide. It kills... Okay, we're going to have to...

[00:19:27.100] - Dr. Lemanne

Kills weeds. Yeah.

[00:19:27.820] - Dr. Gordon

It kills the weeds that live around the grape plants. But the early exposures that are Parkinsonian precursors are living near farms where they would use both herbicides and pesticides.

[00:19:43.760] - Dr. Lemanne

Well, do you remember, I don't know, in our younger years, where there was a big push to spray marijuana plants, cannabis plants in Mexico with a particular herbicide so that it would deter for American users. But the problem was that this herbicide apparently caused Parkinson's. Do you remember that? I can't remember the name of the herbicide. Tom, do you remember that?

[00:20:12.430] - Dr. Gordon

I do not. Okay. Very interesting because that's in sync with what I knew about the precursors to Parkinson's. But smoking, I have to ask you, do they have an idea for a mechanism of action in Parkinson's?

[00:20:27.190] - Dr. Lemanne

Yes. It destroys the substantia nigra, the I mean, producing nerve endings in that part of the brain.

[00:20:33.740] - Dr. Gordon

The pesticides do. But what does the smoking do?

[00:20:36.550] - Dr. Lemanne

Oh, no, no, no, it wasn't the smoking. It was the pesticide on the marijuana.

[00:20:39.470] - Dr. Gordon

Right, right. No, but...

[00:20:41.060] - Dr. Lemanne

Yes. That was... Paraquat.

[00:20:45.060] - Dr. Gordon

Paraquat, exactly. Paraquat, great. Yes. Those are in alignment with causing Parkinson's. But you've told me that my two patients who got an exposure to maybe paraquat when they were younger may have been at better risk had they been smoking Are there smokers growing up. And is there any understanding of how smoking can reduce the risk of developing Parkinson's?

[00:21:08.210] - Dr. Lemanne

Oh, I see what you're getting at. Yes. So the most recent research suggests that it's actually The link may be actually carbon monoxide. So carbon monoxide, increasing the carbon monoxide level in the blood, the saturation in the blood, actually turns on neuroprotective pathways, which makes sense. The oxygen level is going down, there's this weird gas. Hey, fellow neurons, we'd better protect ourselves. Let's ramp up things that protect us from the damage from this carbon monoxide. So possibly that is the mechanism. It ramps up neuroprotective pathways. And that's a circular argument we don't really know, but that's the current front runner in terms of possible explanations for why smoking cigarettes has to do with less propensity to developing Parkinson's. And the reason that that's been thought is because intervening with nicotine doesn't seem to help. So nicotine, giving nicotine to patients at risk for Parkinson's doesn't seem to do anything much to that risk. But the carbon and all of these other things, microbiome changes. Now, the microbiome has certainly been implicated in Parkinson's recently as the initiating causative agent with particular organisms in the gut, sending their metabolites up the vagus nerve straight to the brain to do damage there.

[00:22:52.800] - Dr. Lemanne

So that's an interesting idea, too. So I don't think we've really sorted this out.

[00:22:57.590] - Dr. Gordon

But it's not nicotine as best we can tell. It's not nicotine, which I do want to talk about. But you've also piqued my interest now. I want to learn about the microbiome. And so maybe you'll share the link with me so I can see what are those bugs that unless you have them close at hand in your brain, the ones that But if you do travel up the enhanced vagal nerve.

[00:23:18.610] - Dr. Lemanne

I don't think it's the bugs. It's the metabolites that travel and that are toxic. Yes.

[00:23:23.900] - Dr. Gordon

But metabolites of certain bacterias or-I think a lot of them can make it.

[00:23:30.540] - Dr. Lemanne

So it's not really the type of bacteria as much as do these bacteria, which exchange genes. They have this weird way of... Bacteria can exchange genes, like gram-negative bacteria, the one that the family that E coli is in and pseudomonas, those kinds of things. They can actually, in this pseudo sexual way, insert genes into each other.

[00:23:51.810] - Dr. Gordon

Here, I was thinking of a potluck, and you said it's pseudo sexual.

[00:23:55.830] - Dr. Lemanne

Well, yeah. Not that a potluck. It's a different party.

[00:24:01.270] - Dr. Gordon

Yeah, a party situation. So the genes insert their information. The bacteria insert their genetic information into other bacteria.

[00:24:11.690] - Dr. Lemanne

Yes, they exchange, and then they can get the good protective, for them, protective actions of that gene and thrive in a niche that they previously might not have been able to thrive in. So like certain E coli have genes for making certain toxins, and We can actually transfer those genes to other E. Coli. Those are the differences in strains. And I can't speak specifically about Which strain? Toxins in E. Coli, but certainly toxin-creating genes are avidly transferred between various species of bacteria.

[00:24:49.600] - Dr. Gordon

And E. Coli is really prevalent, what's above the species family, something like that. We have lots of E. Coli, but we have different species of E. Coli. And so evidently, maybe what you're saying is-Different strains, I think you mean.Different strains, yeah. And they behave differently. You want some E. Coli, you'd have an empty gut if you didn't have some E coli. But you need caution as to which kind you're going to let survive in your gut, over which you probably don't have conscious control.

[00:25:24.770] - Dr. Lemanne

So I think the idea that's at the forefront of Parkinson's Research right now is that gut bacteria, some of them, can make toxins that travel up the nerves from the gut directly to the brain and damage the brain. And this is a decades long process, of course. But one of the reasons that we think that is because one of the earliest symptoms of Parkinson's is severe constipation. And this is not constipation that gets better with a couple of prunes a day or some fiber. It does not. These people will have one or two movements a week, no matter what they do. And that can start even decades before the Parkinson's comes on. So we think that the nerves to the gut are damaged by these bacterial metabolites. So they cannot squeeze as they should.

[00:26:19.530] - Dr. Gordon

Interesting. I think the gut ends up being related to almost everything, of course. But so in And with Parkinson's, are they... Since they have this correlation with onset and less onset if you smoke, what were you saying about whether or not they've tried using nicotine itself at all in Parkinson's treatment.

[00:26:45.840] - Dr. Lemanne

So noticing this connection, this strong connection. It's not a weak connection. It's very, very strong between Parkinson's and a decreased and smoking. And it's a reversed Or an inverse relationship in that the more you smoke, the less Parkinson's you get, the less you smoke, the more you're likely to get Parkinson's. That's the relationship. So the obvious suspect was nicotine. So nicotine was tried as treatment for Parkinson's and doesn't seem to be particularly exciting. I'm not super familiar with all of this research, but I find it interesting.

[00:27:27.880] - Dr. Gordon

That the smoking did something ahead A lot of time, but it's clearly not.

[00:27:31.730] - Dr. Lemanne

It may not be the nicotine.

[00:27:32.780] - Dr. Gordon

May not be the nicotine. You know, nicotine has been... So the whole relationship between smoking and nicotine and Alzheimer's disease has been looked at because for a while it was thought, and I think probably some circles are still thinking that smoking might reduce your risk of Alzheimer's disease. But that has pretty much been discredited with it too much importance because Alzheimer's is such a late onset disease for so many people, '70s or '80s, that if anyone who's been... The criticism was that maybe anyone who's been a significant smoker has died before then from heart disease or cardiovascular disease.

[00:28:16.640] - Dr. Lemanne

But they have- So it kills you before you get a chance to get Parkinson's?

[00:28:20.910] - Dr. Gordon

No, Alzheimer's. Alzheimer's? Which usually, I think, has a later onset than Parkinson's, unless you have early onset Alzheimer's disease. But they are We're looking at nicotine with Alzheimer's disease. And there are a couple mechanisms where that can work, which is that in Alzheimer's disease, the nerves that make the main messenger in the brain, acetylcholine, they have reduced production of acetylcholine, so the messages are just not getting through. So the Alzheimer's drugs drugs that are conventionally approved and recommended slow down the natural disposal of that messenger. Your body still makes less of that acetylcholine messenger, but the drugs slow down the degradation of that messenger. But the nicotine can work like acetylcholine in synapses in the brain. It substitute for acetylcholine, and that's good, but it's a very limited benefit in Alzheimer's disease, and it's not impressed me any more than the Alzheimer's drugs do. They give you a little bit of a nudge, but no real change in the fact that your body is actually making less acetylcholine, your brain is.

[00:29:51.790] - Dr. Lemanne

So it's a temporary improvement, you mean? It's like smoking a cigarette after the cigarette wears off, you're back to where you started.

[00:29:59.100] - Dr. Gordon

Right. And And the hazard of using nicotine, oh, well, we want it to last longer than a cigarette is nicotine has a lot of side effects for people who are not smokers.

[00:30:11.980] - Dr. Lemanne

It has a lot of side effects for smokers.

[00:30:14.200] - Dr. Gordon

But generally people who've been smokers, at least this is what I looked at when I looked into it with Alzheimer's disease. If you've been a smoker in the past and I want to give you a little nicotine, lately, I've tried it with a long COVID patient for whom it had It's being suggested for long COVID, and he had mixed results with it.

[00:30:33.530] - Dr. Lemanne

For cognitive issues after long COVID?

[00:30:35.380] - Dr. Gordon

Fatigue and cognitive issues and just general wakefulness. But he didn't have the side effects that are reported, which can be awakefulness, nausea, sweating. I mean, it sounds terrible. Who would want to do it? But here's the thing that I'm trying to work my way around. Yes, but, yes, but, yes, but. To the one thing that nicotine can do that is an interesting and little known part of Alzheimer's disease is that there is a balance in the brain, like you were talking about the vagus nerve is the calming nerve in the body, and the sympathetic nerves are the more activating nerves in the body, and the vagus nerve is parasympathetic. Well, there's a similar Be alive, be chill, balance in the brain. And the be alive one is the glutamate system, and it's an excitability promoting part of the central nervous system. And it gets overwrought in Alzheimer's disease. So it's the people who develop, not everybody, but the ones who in Alzheimer's disease develop a lot of anxiety, Insomnia, restlessness. The opposing nervous system in the brain is the GABA system. And GABA is a supplement you can buy at the store or promote with other supplements or a prescription.

[00:32:15.450] - Dr. Gordon

So glutamate, gabba, glutamate, gabba. And glutamate can be toxic to an Alzheimer's brain. And nicotine has been seen to curtail that, which doesn't make sense because nicotine wakes you up, if I'm correct in that assumption. But it curtails glutamate, which is one of the wakeful, agitated neurotransmitters in the brain. But this is all really early and nobody's really sure that this is going to be worth pursuing. This is great.

[00:32:49.880] - Dr. Lemanne

No, this is really excellent. So there's this... Tell me if I've got this right. There's a cycling between glutamate and GABA, and the balance to be kept or you get what's called excitotoxicity. Perfect. And from glutamate. And what you're saying is that the nicotine can curtail that excitotoxicity.

[00:33:09.900] - Dr. Gordon

Exactly.

[00:33:11.450] - Dr. Lemanne

Okay. And that excitotoxicity is one of the pathways to Alzheimer's.

[00:33:15.760] - Dr. Gordon

No, it's one of the expressions of existing Alzheimer's. So if you get a little anxious sometime before you get on a plane and you're one of my regular patients, you might ask for a prescription of a low dose short term benzodiazapine.

[00:33:36.260] - Dr. Lemanne

I should just smoke a cigarette instead.

[00:33:37.660] - Dr. Gordon

Okay, you could smoke a cigarette. But there's lots of medications or supplements people use to calm themselves. Alcohol.

[00:33:46.970] - Dr. Lemanne

You notice that the bars and in airports are always packed. You can't get a seat. Good luck with that.

[00:33:53.980] - Dr. Gordon

Right. But most of the things you do to exert that In fact, even so simple as something like Benadryl can adversely impair the health of the Alzheimer's or Alzheimer's prone brain because it tamps down the production of acetylcholine.

[00:34:17.260] - Dr. Lemanne

Wait, what? Benadryl. Benadryl is bad for your brain?

[00:34:22.380] - Dr. Gordon

Benadryl is probably not as bad as some of the other antihistamines because there are other is that they're anti-cholinergics. So they suppress choline production. And so people who take those repeatedly for sleep, there's mixed results in studies, but some studies have shown that Benadryl as a sleeping agent is associated with a greater incidence of cognitive impairment over time.

[00:34:55.520] - Dr. Lemanne

Well, now that's really interesting. Of course, that's just an association. Perhaps people who are going cognitively impaired feel the need for Benadryl more than the rest of us. So maybe it's reverse causation or something like that. But it's an over-the-counter medication. So you're saying that that's not particularly safe to use for sleep regularly?

[00:35:14.280] - Dr. Gordon

Yes. And sleep is tricky because there's 50 different things that can interfere with or help sleep. So to counsel somebody about sleep is a problem of managing chronic illness. If you don't want to just resort to, Hey, take a Benadryl, you'll be fine, or take a Ambien. I think that's the grown up version of Benadryl.

[00:35:41.220] - Dr. Lemanne

I don't know the mechanism of Ambien. Can you remind me?

[00:35:44.570] - Dr. Gordon

Do you have that on the tip of your tongue? No, I do not have that on the tip of my tongue. It is something more in the glutamate GABA range than the choline range, which is Benadryl.

[00:35:56.600] - Dr. Lemanne

And it's not a benzodiazepine.

[00:35:58.170] - Dr. Gordon

But it's not a benzodiazepine. But I will look up and put in the notes because Ambian-It has a bad reputation. It has a very bad reputation.

[00:36:06.730] - Dr. Lemanne

It has a really addictive, super hard to get off of and having really short-term bad side effects and long-term bad side effects.

[00:36:15.160] - Dr. Gordon

And so I have a confession to make about Ambien. I don't completely agree. So narcotics have a really bad reputation also because you can get addicted to them and die and all sorts of things can happen. But in proper hands, if you have a little codeine or hydrocodone that you use judiciously and you understand that it has a propensity for addiction, it's not a bad drug. The thing I like about Ambien compared to other sleeping pills and there are alternatives that are shorter acting Ambien, is that Ambien is a relatively short acting drug, and very, very low doses work in people who don't have chronic insomnia. So somebody who does not have chronic insomnia I have a friend whose Parkinsonian spouse, awakes them in the middle of the night with their Parkinsonism related insomnia. And then my friend has trouble going back to sleep and has found that about a third of an Ambien tablet will enable a few more hours of sleep to get till dawn. And very, very wary of side effects because of the reputation of this drug has been really pleased with using it a couple of times a week, not having side effects.

[00:37:33.990] - Dr. Gordon

So it's something I need to... I'm not prescribing it, so it doesn't really... I don't feel the responsibility there. But it would be interesting to look into because it's supposed to work in the gabaglutamate system, is there a situation like with smoking? Is there a situation where Ambien, which... You know its greatest reputation in using with older people, it's greatest hazard that they report about?

[00:38:00.190] - Dr. Lemanne

No. What would that be?

[00:38:02.060] - Dr. Gordon

Very illogical, weird, even dangerous behavior in the middle of the night.

[00:38:07.160] - Dr. Lemanne

Oh, well, that sounds pretty bad.

[00:38:09.590] - Dr. Gordon

Yes. No. From things as simple as rating the refrigerator up to more marked, like going outside and trying to drive or running up a credit card bill, aberrant behavior on ambiant in the middle of the night.

[00:38:23.650] - Dr. Lemanne

Well, I've heard of that. Usually in the context is somebody in Washington who has a high-level elected official job, and they're caught in the middle of the night in their car in some compromising situation, and they blame it on Ambien.

[00:38:39.520] - Dr. Gordon

I've never heard that story. Now I'm going to have to look for it.

[00:38:44.190] - Dr. Lemanne

But if you You point out such a good... This is such a good point that in skillful hands, with a skillful physician helping, you can use these very, very powerful tools for good. But it's so easy if all of that is not in place to go off the rails with some of these drugs, which can be really, really dangerous.

[00:39:09.190] - Dr. Gordon

And as simple as Benadryl. I would use Benadryl if I had a really runny nose and wanted to sleep at night. In fact, I did use Benadryl recently when I had a cold, but I wouldn't use it regularly for sleep.

[00:39:22.320] - Dr. Lemanne

Yeah, that sounds that sounds wise. Okay. Well, we talked about smoking being good for you. How about we talk about vitamins, the evilness of certain vitamins?

[00:39:36.590] - Dr. Gordon

Oh, you're touching a subject that's close to my heart.

[00:39:41.630] - Dr. Lemanne

I don't think there were... I'm an oncologist, So I won't talk about hearts too much. But I can talk about skin cancer. Can you hear about skin cancer? I do. Okay. So I'll talk about something good. How does it sound? Okay. Okay. So nicotinamide. Sounds like nicotine, right? It does. And it's related. It's actually a form of vitamin B3. Another name for nicotinamide is niacinamide. And everybody has heard of niacin, vitamin B3. And the deficiency of niacin is a disease called palagra, which causes terrible skin problems on the hand, some other things. But nicotinamide can prevent non-melanoma skin cancers.

[00:40:28.270] - Dr. Gordon

Aha.

[00:40:28.940] - Dr. Lemanne

All right. So This is a study published in the New England Journal of Medicine. Heard of that little rag right next to the National Enquiry at your local 711. Anyway, they published a randomized, a double A well-minded placebo-controlled trial, the very best you can do in these situations, that showed a 23% reduction in non-melanoma skin cancers with niacinamide or nicotinamide supplementation. This was a 2015 study, and I think this is a beautiful study. There are other studies showing the same thing. The studies are pretty clear. There are a few studies that suggest that maybe we need to look at this a little bit more closely. It's not a slam dunk, but it looks like this is something real.

[00:41:20.080] - Dr. Gordon

So this is you're talking about essentially squamous cell carcinoma and basal cell.

[00:41:25.060] - Dr. Lemanne

Mostly squamous cell, though, in these cases. So the basal cell is a little bit more iffy whether the niacinamide actually helps with that. But for squamous cell, absolutely. Even actinic keratosis, which are the precursors for that, are decreased in people who take nicotinamide. And the dose in this study was So let me say, they studied 386 participants who had had skin cancers in the past, at least two. And they gave them either a placebo or the nicotinamide. And the dose in the nicotinamide arm was 500 milligrams twice a day. And they waited for 12 months, did this for 12 months, and then looked at what happened. And there was this 23% reduction in skin cancers. That's huge in one year. So that's a big deal. So I think that that's really quite remarkable. It makes me think good things about nicotinamide. I still think people should get their nutrition, including vitamins from food. So you're going to like Where does nicotinamide or niacin mainly come from in the diet? It comes from animal products. Animal products have about 10 times more than the plant products that are the second best sources. So meat, poultry, fish, those things have a lot of nicotinamide in them.

[00:42:47.510] - Dr. Lemanne

One or two servings a day will get you your recommended daily allowance.

[00:42:51.380] - Dr. Gordon

Oh, that's great.

[00:42:52.280] - Dr. Lemanne

But if you're just not going to eat animals, plants, legumes, avocado, yams, these are reasonable sources for plants, but you have to eat about 10 times as much as you do if you eat animal products.

[00:43:04.700] - Dr. Gordon

But I think people who do eat... I have a patient who's newly vegan, and she does eat a lot more food than she did when she ate animal products.

[00:43:13.880] - Dr. Lemanne

Well, we can talk about that, how if you're low on protein, you will eat more calories to try to make up the protein deficit. So people who eat more protein eat fewer calories per day. But I digress.

[00:43:24.400] - Dr. Gordon

We digress here because I think you are leading me down a thorny, rosy path where the rosy path is the nicotinamide that reduces skin cancer risk. But I think you're saying there are some vitamin thorns in the mix as well.

[00:43:39.440] - Dr. Lemanne

Well, not with B3. Oh, no. Yeah, no. B3 gets a pass today, it's not going to get on the evil side of our good and evil lists that we're making here. But sun, sunshine is on the evil list, right? Of course. Yeah.

[00:43:54.800] - Dr. Gordon

But it's really sunburning, isn't it?

[00:43:58.900] - Dr. Lemanne

Well, No. So sun exposure. Did you know that having a skin cancer, a non-melanoma skin cancer from sun exposure is associated with better health? Getting skin cancer from the sun means that- You've had some sun.

[00:44:18.010] - Dr. Gordon

Yeah.

[00:44:18.220] - Dr. Lemanne

So this is a really interesting study. Some epidemiologists studied Denmark, the entire Danish population, because they have them stuck there on that peninsula and they have medical records. And they looked at the Danish population above 40 years of old, and they watched them from 1980 through 2006. So what is that? Twenty six years. And this is 4.4 million people. That's a lot. And what they found was that having it, and this is a quote from the study, in this nationwide study, having a diagnosis of skin cancer, and then I'm going to add, which they used as a marker of sun exposure, was associated with less myocardial infarction, less hip fracture in those below 90 years of age, and less death from any cause. Skin cancer and less death are associated, and the skin cancer has to come from the sun, though. So no, certainly don't go out and get a sunburn on purpose. But if you're walking the fine knife, you're walking a knife edge between skin cancer and sun exposure and other things, take the sun exposure. And we talk about vitamin D a lot. It turns out that vitamin D supplementation probably isn't the only thing that we get from the sun.

[00:45:42.050] - Dr. Lemanne

There are probably a lot of other things we get from the sun. And in fact, too much vitamin D. Too much vitamin D actually is associated with increased levels of bone fractures. And what's really weird is falls. If you get a big dose of vitamin If you take a vitamin D, especially, if you take one of those 500,000-unit doses once a year or once a week, once a week doses, those are particularly associated with increased falls. So if you're going to take vitamin D, take a reasonable dose, get your levels checked and make sure that they're not too high and take it a little bit every day to get your levels into the normal range. Don't take a big dose every once a week, once a month, once a year, or something like that. Those seem to be associated with bad things.

[00:46:31.030] - Dr. Gordon

And I've always thought that made logical sense because it makes sense to get some sun every day and not to work in an office and go out and lie on the sun for two or three days and get sunburned, because that, isn't it true that office workers have a higher incidence of melanoma, something like that?

[00:46:49.740] - Dr. Lemanne

Well, I haven't looked at that recently, but I know that a few years ago we wondered about that. But we live in Oregon. It's not very sunny here.

[00:46:59.740] - Dr. Gordon

Look Outside. It's beautiful today. I know.

[00:47:01.430] - Dr. Lemanne

But between October and April, you cannot get your vitamin D from the sun here.

[00:47:07.680] - Dr. Gordon

You cannot. Oh, will you please... Where's a sky riding plane to put that up there? People tell me, I don't need to take vitamin D. I get it because I'm out in the sun all day. And of course, my answer is, let's measure it.

[00:47:19.910] - Dr. Lemanne

Yes. So that's a blood test. And I recommend for my patients that they have that blood test two, three, four times a year. And we adjust the dose of vitamin to keep it topped off at a reasonable level. And we need to change the dose if they go out in the sun in the winter, in the summer, and with an organ the rest of the time. And so, yeah, it's an It's a collective process. It's not a one-off.

[00:47:47.030] - Dr. Gordon

And I have two caveats that go with vitamin D, which is you should take it with vitamin K as well because vitamin D will enhance your calcium absorption and vitamin K will tell your body what to do with it. And And then, of course, creatine, but we've talked about that before. Take it with creatine because that reduces your risk of falling. Okay, those are my two caveats about vitamin D. But I think you... So in the first heyday cycle that vitamin D made through our popular attention, there were prominent figures who I believe still think that your vitamin D level should be between 80 and 20. And that's nanograms per milliliter, I believe. I I don't think you go with a range of 80 to 120, do you?80.

[00:48:34.270] - Dr. Lemanne

To 120?Yes. No, but I vary it depending on the type of cancer the patient I have has been diagnosed with. So with prostate cancer and certain lymphomas, I'll aim a little higher, maybe between 80 and 100. If I have a breast cancer patient, there's a J-shaped curve with survival with those patients. So we try to keep it between. I like to get it around 50. If it gets up to 70 or down to 30, I don't get too excited, make a little adjustment. But I don't let it get up to 100 in those patients, definitely.

[00:49:07.300] - Dr. Gordon

The other vitamin, I don't know if it has a J-shaped curve, but you cautioned me or mentioned as an aside one time that not only can vitamin D be too high, there's a vitamin that when it's been too high, I've always said in the past, don't worry, you'll just urinate out that vitamin B12. But I think you told me there's a hazard to having vitamin B12 too high. Is that right?

[00:49:31.790] - Dr. Lemanne

So B12 is stored in the liver. So for instance, we eat liver to get B12 because the animal store B12 in the liver. So it builds up there. So does vitamin D. But B12 is stored in the liver. And this is another Danish study. So they did a lot of this epidemiologic work there. And in 2013, a study was published showing that in people who have never been diagnosed with cancer, the higher their B12 levels, and they measured cobalt amine as B12 in the serum, the higher the level, the higher the cancer risk a year later. And it was pretty significant. So three to four times, actually with a medium high level and 6 and greater times the risk of cancer for really high levels of B12. And this was particularly associated with certain types of cancer. So blood cancers like leukemia, lymphoma, and smoking and alcohol-related cancer. So smoking-related cancer is, of course, would be lung cancer, bladder cancer, kidney cancer, alcohol related cancers, head and neck cancers, maybe liver cancers. So certain cancers were associated with high B12 levels. And then looking at... So then this group, same group, Danish group, did another study looking at people who already were diagnosed with a cancer.

[00:51:05.110] - Dr. Lemanne

And the higher the B12 levels, the higher their risk of death a year later after the B12 level was drawn after this diagnosis of cancer. So it's diagnosis of cancer. So too much B12. Well, B12 is a co-factor for the replication of DNA. It's a very complicated- Good point. Vitamin has a lot of different duties, but one of them is to help replicate DNA. It's required for that. So what do cancer cells want to do before they can divide, which is their main task in life, they have to replicate their DNA. So you don't want to make it easy for them by having so much of this B12 lying around that they don't have to scramble for it.

[00:51:42.390] - Dr. Gordon

So does that mean you should eat less animal products?

[00:51:45.240] - Dr. Lemanne

No, I follow the B12 level in the blood. So most people who have a high B12 level, almost all of them are supplementing. So we don't know if supplementation with B12 is safe if it gets your level up too high. It may not be. Now, there could just be some derangement of the B12 metabolism in patients. So the studies were done in patients who were not supplementing with B12. So it could be an intrinsic derangement of the metabolism. It could just be an association. We don't know. But I can make a very good case for not over supplementing with B12 if you are worried about cancer, either worried about getting it or you already have it. Keep those B12 levels in the normal range if you can.

[00:52:27.960] - Dr. Gordon

Who is not worried about getting cancer? I mean, it may not be an obsession, but I think all of us are concerned about that. So I'm going to... I deal with the other aspect of B12, which is seeing people whose levels are astoundingly low. And one of my caveats- And that's bad, too. That's bad, too. And so do you go... I'm going to say something about that. I think low B12 levels in people who eat animal products imply that they have low levels of stomach acid because they're over 50 or 60 or 70. And so for those people, present company included, I use a chewable B12.

[00:53:10.500] - Dr. Lemanne

Try to get it in through another way. Well, B12 is absorbed in the terminal ilium, which is the last foot or two of the small intestine before it joins at the appendix, as you mentioned before, the colon. And so certainly, if someone is eating plenty of B12 in their diet and it's not reflected a normal blood level, they are for some reason, either because of poor stomach acid or some problem in the Terminal Ileum, for instance, Crohn's disease, they will not absorb the B12. Also, various drugs, so proton pump inhibitors, other antacids, I'm sure you can name many more than I can that are very good at making sure that you do not absorb all of your Yeah, which is one of the reasons that proton pump inhibitors are associated with an increased risk of Alzheimer's disease, because B12 levels are very critical to optimal brain function.

[00:54:15.090] - Dr. Gordon

And for that, I go with the medium to upper level of the normal range on a blood test. Is that your target or where do you go?

[00:54:26.480] - Dr. Lemanne

So I do. I aim for the medium range. So I like it to be in the middle of the normal range, somewhere around 5, 6, 700 nanograms per milliliter or picograms per milliliter, I believe it is for B12. And so that's where I aim. I don't get real excited if it's just a little bit higher or lower than that, if they're asymptomatic, if it's low or if their cancer is under control and it's a little higher. But I do make sure that it doesn't go up. And I check that several times a year.

[00:54:57.240] - Dr. Gordon

So because we've talked about all these vitamins and they're good and they're bad. And we talked about nitric oxide. This reminds me of something I learned about in the last couple of years. Do you know something that can markedly deplete your B12 levels to a level of less than 100 and cause terrible symptoms from it?

[00:55:26.800] - Dr. Lemanne

I bet I'm going to find out something new and delicious.

[00:55:29.880] - Dr. Gordon

Tell Yeah, no, not so new and delicious. It's inhaling nitrous oxide. Well, who does that? Adics.

[00:55:39.100] - Dr. Lemanne

Oh, okay.

[00:55:39.600] - Dr. Gordon

So I learned a lot about the mechanism of this from UC San Francisco. Our Alma Mater has a wonderful service. If you have a patient who has an addiction, and I don't deal with addictions. I'm not an addiction specialist, but I had a patient who was essentially hemipuretic, unable to walk. She had no real motor function of the lower extremities, and her B12 level was less than 100. And nitrous oxide was her drug of choice. Really? And you see San Francisco coached me through the medical part of a recovery. And I wouldn't presume... It takes a special physician to really be an addiction specialist and be able to address the addiction itself. Yourself, wouldn't you agree?

[00:56:31.780] - Dr. Lemanne

Oh, absolutely. What a tough field.

[00:56:33.280] - Dr. Gordon

What a tough field. Yeah. Hats off to all you addiction specialists and all of those who have recovered from a significant addiction in their life. It's a heroic feat.

[00:56:45.520] - Dr. Lemanne

I have one more interesting thing. I think it's interesting to tell you. You want to hear something about genestein and quercetin? Good guys, right? Yeah. Hold on. Hold on to your white hat.

[00:56:59.960] - Dr. Gordon

Yeah.

[00:57:01.270] - Dr. Lemanne

Exposure to genestein and quercetin in laboratory animals during gestation, meaning feeding these to the mother, increases the risk of leukemia.

[00:57:12.620] - Dr. Gordon

Oh, I thought you were going to tell me fibroids because I think you've told me that before about genistein does- I think it's soy.

[00:57:19.520] - Dr. Lemanne

I don't know if we've nailed it to genistein.

[00:57:22.410] - Dr. Gordon

But genistein and quercetin.

[00:57:25.510] - Dr. Lemanne

And this was particularly evident in animals that were all altered to have genetic deficiencies. So in the DNA repair pathway. But that's common in cancer patients. So if you inherit a problem in the ATM gene or the BRCA genes, that decreases your ability to repair some DNA damage. And so that's very interesting. You wouldn't want to overdo those things during gestation. So perhaps, again, just A sign that getting your nutrition from foods rather than in huge amounts from supplements may be a better choice unless you have some really good measurable reason for taking a supplement.

[00:58:15.970] - Dr. Gordon

Right. And I'd say that goes doubly so for our periods of gestation. I think I've said about a thousand times before that my daughter is currently pregnant, and something was going on her early in her pregnancy, and she usually calls up her mom and I say, Oh, why don't you try some of this? But since she's been pregnant, if it's not on the absolutely safe, you're going to have to do it with food.

[00:58:43.720] - Dr. Lemanne

Yeah, I think that's wise. Yeah.

[00:58:48.160] - Dr. Gordon

So a lot of... Nothing comes without it. I'm going to ask you one more thing because this has been... And you don't Maybe you don't have any studies close at hand, but antioxidants have been in the news intermittently over the last decade about being life saviors or hazardous when consumed, I don't know, in extremes or around exercise. That was one of the problems, antioxidants, diminish the response to exercise. But what's your feeling about it regarding cancer?

[00:59:25.700] - Dr. Lemanne

Yeah. So people, these very sober people in ties and high heels will come to blows over antioxidants and cancer. And the thing is, in my opinion, they're all correct. They're all correct. It's just when is the proper time for a big antioxidant load. And I don't think we know that. We know that if you're a competition athlete and in training, leading up to your This season, perhaps you would want to avoid antioxidants so that you get the biggest pro-oxidant stimulus from your conditioning activities so that you get stronger with each conditioning session. Perhaps When you're actually competing, perhaps you want to use antioxidants then so you curtail the damage. I mean, it's something... It's going to be, and I'm not saying that's correct, but I'm saying that we're learning to think about these things in a more nuanced way. And what's right at one moment is... What's good at one moment is evil in another and vice versa. I think that's a really good point that you bring up. And in cancer, so we don't understand. And certainly there are a lot of studies A lot of them sponsored by the supplement industry, looking at antioxidant activity and antioxidant supplements during cancer treatment, and especially in that particular arena, that find some benefit.

[01:01:01.840] - Dr. Lemanne

Are those things suspect? Well, maybe a little bit, but perhaps they're real. I think we need to look at that a lot. One of the things that I tell my patients, a lot of people come to me and say, well, what supplements do I need to take to prevent cancer? It's like, well, exercise, sleep, don't drink. No, no, no. I want it in a bottle. I can go to the drug store, the health food store and buy it and take it. And it's like, that's just not how health works.

[01:01:28.300] - Dr. Gordon

Pipe dream, pipe dream. Yeah, that's not going to pan out very well. You know, something about these antioxidants.

[01:01:38.540] - Dr. Lemanne

So as you- That wasn't a very satisfying answer. No, it was.

[01:01:42.500] - Dr. Gordon

But it did reinforce my thought. So when I hand people a supplement list, usually the second page is food as supplements. So first of all, I'm inspired to reverse the order of those pages from our talk today, to talk with them first about the foods that they should really consider supplements. And so specifically in a cognitive patient eating strawberries, and I'm very specific that they should try and get wild strawberries and not the big, juicy ones that look like a grape when you take the peel off. You can have those.

[01:02:16.830] - Dr. Lemanne

The wild ones are tougher, aren't they? They've got more of the good stuff.

[01:02:19.480] - Dr. Gordon

They have to. They have to do it to survive. But if you say, they say, great, I make myself a smoothie every day with strawberries. I say, great. Those are great flavenols that you're getting from the strawberries unless you put a flavenol-robbing fruit in with them. Do you know what that is?

[01:02:38.600] - Dr. Lemanne

I don't.

[01:02:39.770] - Dr. Gordon

It's just really come out in the last six months that you cannot mix with your strawberries your banana.

[01:02:47.880] - Dr. Lemanne

Oh, dear. Okay. All right.

[01:02:49.990] - Dr. Gordon

Well, I'm guilty. Well, it may still taste good. I did that this week. It may still taste good, but you're not getting the full benefit of the strawberries.

[01:02:58.130] - Dr. Lemanne

I'm not getting the The benefit of the strawberries. Good to know. I can stop doing that.

[01:03:04.380] - Dr. Gordon

You have them in two separate smoothies.

[01:03:07.150] - Dr. Lemanne

Really? Is it literally mixing them in the same carafe or is it at the same meal?

[01:03:11.770] - Dr. Gordon

I think it's at the same meal. I think the carafe could be your blender or your stomach. Okay. Well, yeah. Yeah. And thank you. What I'm inspired to do is really expand this food as supplements part of my supplement handout for people.

[01:03:27.850] - Dr. Lemanne

Oh, I've seen your handouts. They're spectacular.

[01:03:30.290] - Dr. Gordon

Yeah. You say the kindest things.

[01:03:32.230] - Dr. Lemanne

Yeah. No, I have. I've been secretly copying them. One of your patients came to see me and brought that, and I made a copy, and I've been stealing it.

[01:03:45.840] - Dr. Gordon

You're entitled.

[01:03:47.320] - Dr. Lemanne

Thank you. I think I did ask your permission.

[01:03:49.600] - Dr. Gordon

Yeah, that's always granted. Yeah, it's public knowledge. Well, this is exciting. I'm excited to go eat some wild strawberries and go get out in the sun. It's a A beautiful day. Yeah, some sun.

[01:04:01.020] - Dr. Lemanne

And it's April in Oregon, so we can start getting some vitamin D.

[01:04:06.260] - Dr. Gordon

We can start getting some vitamin D. Okay, great talking to you today, as usual.

[01:04:10.090] - Dr. Lemanne

As always. Take care. You, too. Next time.

[01:04:12.390] - Dr. Gordon

Bye. You have been listening to the Le Monde Gordon podcast, where Docs Talk Shop.

[01:04:20.780] - Dr. Lemanne

For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop.

[01:04:29.530] - Dr. Gordon

Com. Com. Happy eavesdropping.

[01:04:40.110] - Dr. Lemanne

Everything presented in this podcast is for educational and informational purposes only. Personally and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[01:04:57.020] - Dr. Gordon

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[01:05:09.110] - Dr. Lemanne

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[01:05:23.540] - Dr. Gordon

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[01:05:30.390] - Dr. Lemanne

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[01:05:48.170] - Dr. Gordon

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