DHA Reached the Brain, So Why Didn’t Memory Improve?

In this episode of the Health Optimization Medicine Podcast, Dr. Jup Kuipers, Dr. Allen Bookatz, Dr. Scott Sherr, and Dr. Ted Achacoso explore:

• What Did the Prevent E4 Trial Reveal About DHA and Memory? What did a two-year study of 365 cognitively unimpaired adults find about algal DHA supplementation, cerebrospinal fluid measurements, and cognitive outcomes?
• Does DHA Reaching the Brain Mean It Is Improving Brain Function? Why is an increase in the DHA-to-arachidonic-acid ratio in cerebrospinal fluid not necessarily evidence of incorporation into neuronal and synaptic membranes or improved memory?
• What Happens After a Nutrient Is Delivered? Why should nutrient utilization be understood through three stages: arrival, incorporation into cell membranes, and the functional outcomes that matter in everyday life?
• How Does DHA Travel Into the Brain? What role does the MFSD2A transporter play in DHA transport, and why does the form in which a nutrient is delivered matter?
• Why Do Fatty-Acid Measurements Need Context? How do sample type, units, and denominators affect the interpretation of fatty-acid percentages and ratios, and why is a relative change not always the same as an absolute change?
• What Can We Learn From Other DHA Trials? How do the findings of the MIDAS study compare with Prevent E4, and why do differences in participants, study duration, and outcome measures matter when interpreting research?
• How Should We Measure Meaningful Changes in Memory? Why might remembering names, following conversations, or learning new information provide a more practical picture of cognitive function than relying on test scores alone?
• What Is a Practical Starting Point for Supporting Memory Health? How can tracking meals, sleep, and everyday cognitive function over two weeks help establish an individual starting point without immediately turning to another supplement?
• How Would HOMeHOPe Approach DHA Research Differently? Why should future studies consider individual starting points, nutrient profiles, multiple biological compartments, sleep and recovery, and personally meaningful functional outcomes?

What We Discuss:

00:00 – The Delivery Notification: DHA Reached the Brain
00:26 – Introducing the PREVENT-E4 Trial
01:19 – Was It Really Fish Oil? Understanding Algal DHA
02:05 – What Did the Study Actually Measure?
02:33 – Delivery, Incorporation and Function
04:54 – PREVENT-E4: Study Design and Participants
05:45 – What the Trial Found: DHA and Cognitive Outcomes
06:45 – Cerebrospinal Fluid vs. Neuronal Membranes
07:28 – How DHA Gets Into the Brain: The MFSD2A Transporter
08:35 – Fatty-Acid Ratios: Understanding the Denominator
09:51 – The Cell Danger Response and Recovery Sequence
10:41 – How HOMeHOPe Would Redesign the Study
12:23 – The One-Cent Solution: Start With Function
16:04 – PREVENT-E4 vs. MIDAS: Different Trials, Different Questions
17:21 – Individualized Research and Healthspan
18:40 – Three Takeaways: Arrival, Measurement and Function
19:26 – Beyond the Delivery Notification
21:04 – Learn more from the HOMeHOPe Academy

Full Transcript:

[00:00:00] Dr. Allen Bookatz: Your phone buzzes, delivered. The groceries are sitting in your building's mail room three floors down. 

[00:00:06] Dr. Jup Kuipers: So dinner's handled then? 

[00:00:07] Dr. Allen Bookatz: Ha. Only if someone carries the bag upstairs and cooks, right, before everything gets defrosted. A two-year brain trial recently got its own delivered notification. Fish oil reached the brain, so why didn't memory actually improve?

[00:00:26] Dr. Jup Kuipers: All right. Welcome everybody to the Health Optimization Medicine Podcast, where we look at health at the level from the basic cell. Thank you for joining us. My name is Dr. Jup Kuipers. I'm a general practitioner and HOMe doctor based in Amsterdam. Our showrunner today is Dr. Scott Sherr, board-certified internist and HOMe doctor as well.

[00:00:43] Dr. Jup Kuipers: Our HOMe expert is Dr. Allen Bookatz, emergency physician and HOMe doctor, and with us is Dr. Theodore Achacoso, none other than the founder of the clinical framework of Health Optimization Medicine & Practice. Dr. Scott, what are we unpacking? 

[00:00:57] Dr. Scott Sherr: All right, so we're unpacking a trial that did [00:01:00] exactly what it set out to do on its primary measurement, and left a bigger question standing.

[00:01:05] Dr. Scott Sherr: One group took DHA for two years. The other took placebo. The mark the investigators chose to show it was reaching the brain went up. Thinking and memory scores and brain scans did not pull ahead of placebo, though. Here's a $64,000 question. If DHA got into the fluid around the brain, why isn't that the same as better memory?

[00:01:19] Dr. Scott Sherr: Allen, first, the title says fish oil. Is that fair? 

[00:01:22] Dr. Allen Bookatz: Well, it's shorthand, and basically we should own that. So the trial is called PREVENT-E4. It used DHA made from algae as triglyceride oil, not just some generic fish oil product. The pro- the placebo was corn and soy oil, and both groups also got a B vitamin complex.

[00:01:43] Dr. Allen Bookatz: So when the title says fish oil, really you should hear is one specific omega-3, but from algae in one specific form. 

[00:01:51] Dr. Scott Sherr: Hmm. So the headline's a little like a menu that says seafood and serves you seaweed. 

[00:01:56] Dr. Allen Bookatz: But on a much smaller scale. Think of microalgae, so [00:02:00] technically smaller portions. 

[00:02:02] Dr. Scott Sherr: Right. Noted. So second piece reached the brain.

[00:02:05] Dr. Scott Sherr: What did they actually sample? 

[00:02:06] Dr. Allen Bookatz: Cerebrospinal fluid, or CSF. The primary measure was the ratio of DHA to another fatty acid, arachidonic acid, or AA at six months. That ratio rose in the DHA group relative to placebo. That's real, but CSF is the fluid that bathes the brain and the spinal cord. It's not the membrane of a synapse, and it's not necessarily working as a memory circuit here.

[00:02:30] Dr. Allen Bookatz: It's the building's mail room, not necessarily the kitchen upstairs. 

[00:02:33] Dr. Scott Sherr: Ted, w- that's where your framework comes in. Why does the mail room matter to how you'd frame the question? 

[00:02:38] Dr. Ted Achacoso: Because HOMeHOPe starts from a different question. Illness medicine asks, "What's wrong?" This trial chose its volunteers by dementia risk factors.

[00:02:47] Dr. Ted Achacoso: HOMeHOPe, what's right? What is this person's brain doing well, and what do their cells need to keep doing it? Illness medicine deals with organs. HOMeHOPe deals with their common denominator, the basic cell, [00:03:00] and every cell wraps itself in a membrane built partly from fatty acids. So the question isn't only did DHA arrive, it's did it get built in where it works, and did the person gain something they can use?

[00:03:15] Dr. Jup Kuipers: And I add a distinction there. Delivered is a status. It's not an outcome. So delivery apps are very proud of themselves, but not one of them has ever asked whether dinner was any good. 

[00:03:26] Dr. Scott Sherr: They do have ratings though, right? But so, so what's the outcome we actually care about for the person listening, Jup?

[00:03:32] Dr. Jup Kuipers: Something they would notice on a Tuesday, so remembering the name of a new neighbor, following a conversation at a noisy dinner table, learning the new software at work without three sticky notes. That's function. Just because you're not sick doesn't mean you're healthy. It only means you're not sick. A memory score that didn't fall isn't the same as a memory that's working well.

[00:03:55] Dr. Scott Sherr: Hmm. Allen, why would a careful team lead with a spinal fluid ratio [00:04:00] instead of memory? 

[00:04:01] Dr. Allen Bookatz: Well, because this Phase 2A study pre-specified target engagement as its primary question. Did the DHA shift a chosen marker in the fluid around the brain? And if that marker hadn't moved, then the memory question would be harder to interpret.

[00:04:16] Dr. Allen Bookatz: So the ratio is a sensible first gate here, but it isn't necessarily the last one. 

[00:04:22] Dr. Ted Achacoso: In HOMeHOPe terms, those gates follow the cell, arrival, incorporation into membranes, then function. We want all three on one chart for one person. 

[00:04:32] Dr. Scott Sherr: Right. So reached the brain is gate one of three. 

[00:04:36] Dr. Allen Bookatz: Yes, exactly. So gate one, as the trial defined it, it's a clear rise in the spinal fluid ratio.

[00:04:41] Dr. Allen Bookatz: But that ratio doesn't necessarily measure the building into the synapses themselves. So the rest of today is about gates two and three and what it would take to see them. 

[00:04:54] Dr. Scott Sherr: All right, so then let's go upstairs. Allen, walk us through the evidence. 

[00:04:57] Dr. Allen Bookatz: Okay. So PREVENT-E4 [00:05:00] randomized three hundred and sixty-five adults aged fifty-five to eighty who were cognitively unimpaired.

[00:05:06] Dr. Allen Bookatz: They ate a little, they ate little DHA in their usual diet, and they carried risk factors for dementia. One group took this algal DHA daily for two years at a research dose, and the other took the placebo we mentioned earlier. The design ranked its questions. First, target engagement. Did the CSF ratio move by six months?

[00:05:25] Dr. Allen Bookatz: Second, brain MRI. Cognition was exploratory, meaning that it looked at it, but the study really wasn't built to settle it. 

[00:05:33] Dr. Scott Sherr: And both arms got the B vitamins too? 

[00:05:35] Dr. Allen Bookatz: Yes. So the comparison is DHA plus B vitamins against placebo plus B vitamins. Whatever DHA did or didn't do, it's read against that shared background.

[00:05:45] Dr. Scott Sherr: Ah, good. So and, and the scorecard? 

[00:05:47] Dr. Allen Bookatz: Okay. So the ratio rose decisively, but, you know, over two years, the DHA group showed no detectable advantage over placebo on any of the cognitive testing or on brain structure found on MRI. Two things shape how far [00:06:00] we can read that. About thirty-eight percent of participants didn't complete the study, and neither group declined much on the thinking tests.

[00:06:06] Dr. Allen Bookatz: That makes it pretty hard to show any benefit to show up as less decline. 

[00:06:11] Dr. Scott Sherr: So it's not DHA doesn't work for the brain then? 

[00:06:14] Dr. Allen Bookatz: No. It, it's, uh, in this population with this particular form over two years, a clear change in the spinal fluid ratio did not come with a detected, detected advantage in cognition or brain structure.

[00:06:27] Dr. Allen Bookatz: And so it's pretty precise and, and while precision's useful, it just tells us the mix in the mail room shifted, so more DHA relative to arachidonic acid in the fluid that they sampled. It doesn't tell us how much actually got built into the brain upstairs, or as we follow up with our kitchen analogy, what actually ended up happening in the kitchen.

[00:06:45] Dr. Scott Sherr: Hmm. Did the investigators say anything about that gap themselves? 

[00:06:49] Dr. Allen Bookatz: Well, the lead investigator's lab published a commentary that draws the same line. The spinal fluid is just one compartment, and the membranes of neurons and synapses are another. That's the [00:07:00] investigator interpreting their own trial, not anything new here.

[00:07:03] Dr. Allen Bookatz: So any mechanisms proposed there stays as a hypothesis, but the distinction itself is the right one. 

[00:07:09] Dr. Ted Achacoso: And it's a very HOMeHOPe distinction. DHA isn't a lone hero. In cell membranes, it sits in a network of fatty acids, including omega-6 fats like arachidonic acid, which is why watching a ratio makes sense in the first place.

[00:07:25] Dr. Ted Achacoso: The node is interesting. The network is the story. 

[00:07:28] Dr. Scott Sherr: So Allen, how does DHA actually get upstairs into the brain at all? 

[00:07:32] Dr. Allen Bookatz: All right, so there's some very elegant transport biology here. A 2014 experimental study identified a transporter MFSD2A, remember that, that carries DHA when it's attached to a carrier molecule, lysophosphatidylcholine or LPC.

[00:07:51] Dr. Allen Bookatz: Think of it like a service elevator with its own key card. So that's, that's the mechanism here. It tells us that the building has a specific route upstairs. It [00:08:00] doesn't show us that any product improved memory in adults, and it doesn't tell us which form went where in PREVENT-E4. 

[00:08:06] Dr. Scott Sherr: Ah, so a service elevator with a key card.

[00:08:08] Dr. Scott Sherr: That's the most Health Optimization Medicine Podcast sentence I've heard all month. 

[00:08:12] Dr. Allen Bookatz: Sure, I'll, I'll take that. And, and notice what it implies here. Form can matter for transport. So DHA on a label isn't necessarily the whole description. That's a question for study design, not necessarily a shopping tip here. 

[00:08:26] Dr. Jup Kuipers: Shame. I was ready to found a key card fan club.

[00:08:29] Dr. Jup Kuipers: But still, that's the clinical metabolomics question in miniature, right? Which compartment, which form, which units? 

[00:08:35] Dr. Allen Bookatz: Exactly. And units here deserve a moment. So yep, give them ... You know, you're from Amsterdam, give them the bicycle rack. 

[00:08:42] Dr. Jup Kuipers: Of course. Uh, bicycle examples are mandatory. Picture a rack of 100 bikes, 10 of them red.

[00:08:48] Dr. Jup Kuipers: Someone wheels away 50 black bikes. Now red is 20% of the rack, though not one red bike has actually arrived. So some fatty acid methods work like that rack. The CDC's [00:09:00] red blood cell method, for example, reports each fatty acid as a percentage of the 21 fatty acids it measures. That's a sound method. It just means a percentage is a share, not an amount, and a ratio like DHA to AA can move when either side moves.

[00:09:15] Dr. Scott Sherr: So is this what happened in PREVENT-E4? The ratio looked good, but it was the bikes leaving, Allen? 

[00:09:21] Dr. Allen Bookatz: Uh, no. Uh, not necessarily. And, and that mattered here because we have no basis to call that ratio change like some type of arithmetic illusion. And the bicycle rack doesn't explain the cognitive result. The lesson is general here.

[00:09:35] Dr. Allen Bookatz: Before anyone interprets a fatty acid number, name the sample, the units, and the denominator. That's where HOMeHOPe's discipline starts. Measure in a named sample, compare with an optimal range. Because normal, right, is not optimal. Balance, then measure again. 

[00:09:51] Dr. Scott Sherr: So Ted, where does a cell danger response fit into a story about supply and use?

[00:09:56] Dr. Ted Achacoso: The CDR is HOMeHOPe's model built on Robert [00:10:00] Naviaux' biology of how cells defend and then recover. It starts when a threat exceeds a cell's capacity to keep its balance. Healing then runs through containment, rebuilding, and reintegration, and the clinical sequence is confirm, stabilize, restore, challenge.

[00:10:16] Dr. Ted Achacoso: That sequence gives us a sharper question about any building block. Was the person at the stage where they could use it? Sequence beats intensity when reserve is limited. PREVENT-E4 didn't measure any of that, and no single biomarker panel or symptom complex proves a CDR state. HOMeHOPe reads it as a pattern across the seven pillars and follows the response.

[00:10:37] Dr. Ted Achacoso: So the model isn't an explanation for this trial. It's a blueprint for the next one. 

[00:10:41] Dr. Scott Sherr: Okay, so let's draw the blueprint, Allen. If HOMeHOPe redesigned PREVENT-E4, what changes? 

[00:10:46] Dr. Allen Bookatz: All right, four things here. So first, the starting line. Each person's fatty acid profile in a named sample with units and denominator stated, plus what they actually ate, so we know who started low and who didn't.[00:11:00] 

[00:11:00] Dr. Allen Bookatz: Second, the product. Standardized preparation and track background intake, so DHA means one thing. Third, the compartments. Measure more than just one compartment over time, blood and spinal fluid where it's justified, alongside sleep and recovery after a demanding day. And fourth, the function. Choose a function in advance that the person cares about, like learning a set of new names or follow each person's trajectory.

[00:11:27] Dr. Allen Bookatz: Report the responders and the non-responders, not just the average. 

[00:11:31] Dr. Scott Sherr: Hmm, this sounds like a much bigger budget, Allen. 

[00:11:33] Dr. Allen Bookatz: Well, possi- possibly per person here, but it actually answers the question that an average can't, right? Who changed and by how much and, and what they actually can do. 

[00:11:45] Dr. Jup Kuipers: Right, and test memory at the same time of day every visit.

[00:11:49] Dr. Jup Kuipers: That's chronobiology and earning its place in the design. A test at eight in the morning after a good night and one at four in the afternoon after a rough one aren't measuring the same conditions. [00:12:00] 

[00:12:00] Dr. Ted Achacoso: Which is the whole shift. PREVENT-E4 answer this primary question, the ratio moved. Its exploratory cognitive tests detected no advantage over placebo in the people who barely decline.

[00:12:12] Dr. Ted Achacoso: In HOMeHOPe, health means more than holding steady. The study we propose pre-specifies a function each person wants to do well, then follows who improves and who doesn't. 

[00:12:23] Dr. Scott Sherr: Okay, so time for the one-cent solution. Allen, someone's listening with a bottle of capsules on the counter wondering what this means for them.

[00:12:30] Dr. Scott Sherr: What's the smallest useful next step? 

[00:12:32] Dr. Allen Bookatz: All right, so don't start with the bottle here. Start with the kitchen upstairs. What do you want your memory for, right? Pick one function that you care about that matters on an ordinary day. Is it, is it remembering the names of people you meet? Is it following a recipe without going back to reread it?

[00:12:48] Dr. Allen Bookatz: Is it a, you know, a phone number? Keeping track of a grandchild's school schedule? I mean, you just choose it and make sure it matters to you. Write it as one sentence at the top of a page. 

[00:12:59] Dr. Ted Achacoso: Okay, so [00:13:00] we have- Like, uh, remembering the names of your lovers, Allen? 

[00:13:05] Dr. Allen Bookatz: Too many to keep track of. 

[00:13:07] Dr. Scott Sherr: So all right. Allen, we have the one sentence.

[00:13:10] Dr. Scott Sherr: Then what do, then what do we do? 

[00:13:12] Dr. Allen Bookatz: All right. So then in-- then two weeks, three short lines each evening. Line one, any meal, uh, with fish or seafood in it and, you know, canned counts. So your tin of sardines or wild-caught salmon is an ally in that you're not necessarily compromised. Line two, how you slept in a few words.

[00:13:32] Dr. Allen Bookatz: And line three, one moment where your chosen function showed up, smoothly or not. So no tests, nothing to buy except for maybe the food, and the step itself changes nothing that you already take. 

[00:13:45] Dr. Jup Kuipers: I like that the notebook starts with dinner rather than the supplement aisle. And for my Amsterdam listeners, herring counts.

[00:13:52] Dr. Jup Kuipers: Nobody has to eat it whole at the street stall to qualify. 

[00:13:55] Dr. Scott Sherr: Uh, so raw herring at a stall sounds like a citizenship test, man. 

[00:13:59] Dr. Jup Kuipers: [00:14:00] Only the practical exam. The notebook is the written part. 

[00:14:04] Dr. Scott Sherr: Some people will hear fish and think we just told them to eat more of it for their memory. Allen? 

[00:14:09] Dr. Allen Bookatz: Ah. Fair catch here. Well- Nice

[00:14:12] Dr. Allen Bookatz: the n- the notebook, the notebook is an observation, right? Not a memory prescription. A fish meal is food with far more in it than one fatty acid. So what the notebook gives you is a starting record that belongs to you instead of a trial average. 

[00:14:29] Dr. Jup Kuipers: Hmm. So then the two weeks is just a practical snapshot we picked, not a magic number.

[00:14:35] Dr. Jup Kuipers: But if the foggy days seem to follow the short nights on your page, that's a chronobiology question worth bringing into the conversation before anyone reaches for a lab form. 

[00:14:44] Dr. Scott Sherr: What if the two weeks look completely boring? 

[00:14:47] Dr. Allen Bookatz: Yeah. Well, then you've learned something about those two weeks, and you're-- you own a starting record for the next headline that lands you on your phone.

[00:14:55] Dr. Allen Bookatz: A boring page is information here. 

[00:14:58] Dr. Scott Sherr: Hmm. And the clinician angle, what does a [00:15:00] HOMeHOPe doctor do with that page? 

[00:15:01] Dr. Allen Bookatz: All right. Well, reads it with the person. So the functional sentence becomes the outcome that you both agree to follow. So if they already take DHA or a fish oil product, then they bring the label, and the clinician notes the form because form and compartment are exactly what today's evidence turns on.

[00:15:19] Dr. Allen Bookatz: If a measurement makes sense, clinical metabolomics starts there. Which sample and what the number is a share of. Any balancing decision is clinician work that follows measurement, never a guess from a headline. So then you remeasure, and you reread the notebook. 

[00:15:34] Dr. Jup Kuipers: And notice the order. The clinician hears what the person wants before reading any label.

[00:15:40] Dr. Jup Kuipers: The order is the whole point. 

[00:15:42] Dr. Scott Sherr: Yeah, so a notebook, a pen, and one Ana sentence. That's the one cent part. The sardines are extra. 

[00:15:50] Dr. Ted Achacoso: That's detect and balance in practice. Disease is managed, health is optimized. Here we're asking what's right with this person's memory, measuring what supports it, [00:16:00] and checking whether the plan changed something they notice on a Tuesday.

[00:16:04] Dr. Scott Sherr: So the next better question, there's another DHA trial people will bring up, and it found something, Allen, a little bit different. Give us the data. 

[00:16:12] Dr. Allen Bookatz: Okay, so Scott, this is the MIDAS trial, and it was published in twenty ten. It randomized four hundred and eighty five adults aged fifty five and older who already had an age-related cognitive decline.

[00:16:24] Dr. Allen Bookatz: They gave them DHA or a control for twenty four weeks. The DHA group made fewer errors on visual learning and memory testing, their primary measure. Working memory and executive function tests didn't improve though, and it measured test performance, not necessarily dementia. So it's cool that it's a real finding in its own population.

[00:16:44] Dr. Scott Sherr: So one trial moves a fluid and not the test, and the other moves a test. Do they disagree then? 

[00:16:49] Dr. Allen Bookatz: Well, mm, they answer different questions. So MIDAS enrolled people who already had age-related decline, and they ran it for twenty-four weeks, and they used a different dose and a different endpoint. [00:17:00] So PREVENT-E4 enrolled people without impairment.

[00:17:02] Dr. Allen Bookatz: They ran it for two years. They led with spinal fluid. So side by side, they really make one point louder, where people start and what you choose to measure, deciding what a study can see. 

[00:17:14] Dr. Scott Sherr: Which is a polite way of saying the studies aren't arguing, the headlines are. Ted, then what's the study HOMeHOPe would run?

[00:17:21] Dr. Ted Achacoso: One where each participant is the unit of interest. Evidence-based medicine is really evidence-based illness medicine. It asks what works for most of a population aimed at lifespan. HOMeHOPe is evidence-informed individual cares. What works for this one person aimed at healthspan. So we'd enroll adults with a documented starting status, their fatty acid profile, their stated sample, their usual diet, their sleep.

[00:17:47] Dr. Ted Achacoso: We pre-specify an individualized strategy, food first, with balancing agents only where measurement points to them. We'd follow a function each person shows, plus recovery after demand against a comparison [00:18:00] group, and we'd publish who responded, who didn't, and how fast. 

[00:18:03] Dr. Allen Bookatz: All right. So more spinal taps and more often.

[00:18:07] Dr. Allen Bookatz: So-- And that's, and that I guess is where it's justified here. We keep a spinal fluid measure, so arrival and function sit on the same chart. 

[00:18:15] Dr. Jup Kuipers: As I like to put it, individualization does not replace evidence. It's where evidence meets the individual. 

[00:18:22] Dr. Scott Sherr: Yeah. And so notice what that design adds. It doesn't treat no decline as the finish line.

[00:18:26] Dr. Scott Sherr: It asks whether a chosen function got better person by person. 

[00:18:30] Dr. Ted Achacoso: That's a research agenda, the starting line, the compartment, the function, and the person measured together and reported one person at a time. 

[00:18:40] Dr. Scott Sherr: Okay, so let's talk about our three take-homes from today. Dr. Ted, you're up first. 

[00:18:43] Dr. Ted Achacoso: Arrival is the first chapter.

[00:18:45] Dr. Ted Achacoso: A nutrient in a fluid tells you it was delivered. Health is what the basic cell builds with it and what the person can then do. HOMeHOPe follows the story all the way to the function. 

[00:18:55] Dr. Scott Sherr: Dr. Jup 

[00:18:57] Dr. Jup Kuipers: Know what a number is a share of. [00:19:00] Name the sample and the denominator, then compare with an optimal range. A bicycle rack can change color without one new bike arriving, and a careful reader always notices.

[00:19:09] Dr. Scott Sherr: And Dr. Allen. 

[00:19:10] Dr. Allen Bookatz: All right, so start with the function you want, something you actually care about. Write one sentence about what your memory is for. Keep two weeks of three short lines and bring that page to a clinician. A plan built around your own Tuesday builds a plan built around some type of headline.

[00:19:26] Dr. Scott Sherr: All right, so we're wrapping here. So let, let's go back to the phone that buzzed delivered, Allen. 

[00:19:31] Dr. Allen Bookatz: So okay. So PREVENT-E4 answered its primary questions cleanly. The DHA ratio rose in the mail room, right? It made it into the spinal fluid. But what it didn't show over two years was that there was a better dinner made upstairs, right?

[00:19:45] Dr. Allen Bookatz: It didn't result in any improvement in function. Illness medicine is superb in acute care, where one number fast decides the next 10 minutes. But when the yardsticks are a marker and whether people declined, holding steady can start to look like the finish line. In the [00:20:00] HOMeHOPe framework, not declining is the floor, not necessarily the goal.

[00:20:04] Dr. Ted Achacoso: Health asks a different question. Not only did anything get worse, but what got better? HOMeHOPe asks what the cell needs to work well and whether the person gains something they can use. It detects and balances at the level of a basic cell the common denominator underneath every organ, and it judges success by function, learning, recovery, a good day's work.

[00:20:27] Dr. Ted Achacoso: That is HOMeHOPe's place, a separate framework, not one more tool set inside illness medicine, and the foundation the walls and the roof were supposed to stand on. 

[00:20:38] Dr. Scott Sherr: So foundation first, Allen, bring us home to that notification. 

[00:20:42] Dr. Allen Bookatz: All right. So next time a headline says a nutrient reached the brain or some, you know, tissue of interest, read it like that delivery notification.

[00:20:52] Dr. Allen Bookatz: Good news, right? It's, it's arrived. Now, who's carrying the bag upstairs, and what's for dinner? 

[00:20:59] Dr. Ted Achacoso: That's a [00:21:00] HOMeHOPe question. We measure the delivery, and then we measure the dinner. 

[00:21:04] Dr. Jup Kuipers: All right. So if today's question is the kind you want to ask in your own practice, start with clinical metabolomics, the foundational first module at the HOMeHOPe Academy, then go on to evolutionary medicine for the cell danger response and chronobiology for the rhythms behind sleep and testing.

[00:21:21] Dr. Jup Kuipers: They're at homehope.org/collections. Thanks to Scott, Allen, and Ted, and thank you for listening to the HOMeHOPe Podcast. Until next time, know what your memory is for, guys.

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