What if your risk of Alzheimer's isn't predetermined by your genes—but influenced by the metabolic health of your brain?

My guest, Dr. David Perlmutter, is a board-certified neurologist, six-time New York Times bestselling author, and one of the world's leading voices on brain health and neurodegenerative disease. His latest work reveals a fascinating shift in how we understand Alzheimer's and Parkinson's: the role of the brain's own immune cells.

At the center of our conversation are microglia—specialized immune cells that can either protect your neurons or contribute to inflammation and neurodegeneration. Dr. Perlmutter explains why their function is closely connected to metabolic health, and how insulin resistance, obesity, poor sleep, gut dysfunction, chronic inflammation, and environmental toxins may influence the way your brain ages.

We also challenge the idea that carrying APOE4 means Alzheimer's is inevitable and examine research showing how lifestyle interventions can influence cognitive function—even later in life.

In this episode, you'll learn:

• How microglia can shift from "brain defenders" to drivers of neuroinflammation

• Why metabolic health and insulin resistance are connected to Alzheimer's risk

• How the gut microbiome, leaky gut, antibiotics, and inflammation can affect the brain

• What emerging research says about GLP-1 drugs for Alzheimer's and Parkinson's

• Why current amyloid-targeting Alzheimer's drugs may not address the underlying problem

• How sleep, exercise, nutrition, and environmental exposures can influence cognitive aging

We also explore emerging approaches to brain health, including 40 Hz light and sound therapy, TREM2, mitochondrial health, and metabolic monitoring.

The biggest takeaway for me is that protecting your brain starts long before memory loss appears. Your genetics matter—but so do your metabolism, sleep, exercise, environment, and the choices you make every day.

You have more influence over how your brain ages than you may think.

Learn more about Dr. Shah:

Website: drshah.com

Clinic: next-health.com

Instagram: @extend_podcast and @darshanshahmd

Learn more about Dr. David Perlmutter:

Website: drperlmutter.com

Dr. Perlmutter's groundbreaking new book, Brain Defenders, is now available. Discover how to protect your brain and future health - order today at braindefenders.com

Thank You to Our Sponsors:

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192: Dr. Perlmutter: How to Protect Your Brain From Alzheimer's & Cognitive Decline

Extend Podcast with Darshan Shah, MD

192: Dr. Perlmutter: How to Protect Your Brain From Alzheimer's & Cognitive Decline