Reversing Cognitive Decline: A New Approach - Episode 282

Welcome everybody to this edition of the Gladden Longevity Podcast. I'm your host, Dr. Jeffrey Gladden. And today I'm here with Heather Sanderson and Heather's doing some remarkable work, really kind of a work that's been needed for a long time. And she's taken a completely different approach, I would say really to the whole space of cognitive decline, dementia, families involved, the whole concept of, um, you know, caring for people, right?

So there are these centers associated with, you know, cognitive care. um And yet in my estimation, they're really just custodial places, right? So memory care is really is what they're called, but there's nothing really going on except watching people's memories decline. So you've really taken a different approach to all this. So, Heather, welcome to welcome to the show. Thank you for having me. It's a privilege to be here.

Yeah. So tell us a little bit about how you got into uh this whole space. I'm sure when you were five or six years old, you had it predetermined. You know, I'm going to change the world when it comes to dementia. yeah. And what was I went to naturopathic school and learned a lot about functional medicine. Other people have sort of termed it that, but how to think about health and instead of disease, right, how to think about optimizing a complex system, the human body and the human brain.

And yet I was still told that there was nothing you could do to support someone with Alzheimer's or dementia. And so I took that as gospel. I got out of school and really didn't think that... I would ever see an Alzheimer's patient. just thought there was nothing I could do for them, right? And then I saw my mentor, Dr. Dale Bredesen speak at a conference. And he said the opposite. He actually said, this can be reversed.

There are things that we can do to optimize cognitive decline for patients who have, are at any age at any stage of the disease process. There's something we can do to intervene. And what he was presenting was essentially naturopathic medicine, functional medicine as applied to neurology and cognitive function.

And when I heard him speak and he was talking about these different components and how if we stacked all of functional medicine on top of itself and we applied each of these things in a precise way for that individual, if they change their lifestyle, their diet, their exercise habits, their sleep habits, their stress management, we could see outcomes.

And although I was very skeptical when I heard this, because again, I had taken this gospel that there was nothing we could do, I was intrigued because it made sense. was common sense. Just no one was practicing it this way. And so then Dr. Bredesen published his book in 2017, The End of Alzheimer's. And I was on the list of providers who'd been trained by him because I was so intrigued. I signed up for training and realized these were things I had learned to do in school, right?

It was the detox. was the hormone balancing. It was the lifestyle medicine. And so after,

getting his training and starting to see patients, I was no longer a skeptic. I watched miracles happen in my clinic, not just once, but over and over again. People with even severe cognitive function, severely declined cognitive function were improving. People with diagnosed Alzheimer's were getting better. Now, of course, it's easier when they're younger, it's easier when they have mild cognitive impairment or even those early signs, but I saw them getting better over and over again.

And then I got the call. Hey, my uncle has Alzheimer's, where do I send him? I don't have the bandwidth to cook all of his meals, to get him to exercise, to do all this stuff, but I want him getting the benefit of this approach. So where does he go? And as you mentioned, Memory Care is a place no one wants to go. No one has any interest in ending up. You end up there when you have no other option and it's expensive and essentially they park you in front of a TV.

and help take care of your activities of daily living while you await demise. And it is heartbreaking and torturous. And so the alternative is, again, it's common sense, just not common practice. It's how do we create a space? It's just putting the best of what we know in memory support, in cognitive optimization, into the place where people with memory issues live. It's just combining two things that already exist. Yeah, exactly.

So did you actually start a facility then that where people can go that's kind of an alternative to memory care? Is that what we understand here? Yeah, exactly. So in 2020, we started Marama. And it is an immersive experience in Dr. Brutison's approach where all it's done for you, right? The meals are organic and mildly ketogenic. They're high, full of veggies so that you get that high polyphenol rich foods, lots of cruciferous veggies for detox support.

We're just that we're using food as medicine. We also get the social engagement in a non-toxic environment. So by default, you're forced to have meals with people, converse with people, engage with people, garden with people, exercise with other people. We heal together. We're a social species. We don't heal in isolation. Getting people back together is part of what's happening. We also have a non-toxic environment. We're hypervigilant about mold.

We use organic mattresses, and bedding, and food, and non-toxic cleaning products so that we're not getting any inputs that are going to increase our risk, right? We're not getting neuroinflammatory chemicals that we're inhaling. We're really careful about that. And then our staff, uh we have basically four pillars. It's diet, it's the environment. Our staff expect improvement, right?

And so you treat someone really differently if you expect them to improve versus if you expect them to just decline. You engage in a completely different manner.

And our staff are also very familiar with the supplements and medications that are most common on a Bredesen protocol. And then the fourth piece is engaging in the exercises, the brain jam, the mental and emotional engagement that keeps things compelling so that we're looking forward to a bright future. Right. No, that's a wonderful approach. You he really, when I first read his book, you know, the 36 holes in the roof, I think is what it is. Right.

So it's basically breaking down all the different contributing factors because it's never just one thing. And then, you know, beneath that, there are a couple of things going on. uh One is genetic predisposition. So everybody knows that there's genetic predisposition. The second is the aging process itself, which can have a big impact on hormones and estrogen and thyroid and things like that, which also can play a major role.

Um, and so, you know, in our world, when we think, when we see somebody that's suffering with cognitive decline, the first thing that we end up doing is our genetic, uh, test to kind of figure out, okay, what genes do they have? Because there are many different gene sets that can predispose somebody to dementia, if you will. Some of them are. you know, more slated towards Alzheimer's, APOE4, APOC1, TOM40.

But there are many others that can actually impair cognitive abilities as go forward as well. uh we found that to be kind of really helpful. And then we've also found real issues with thyroid. So the DIO2 gene is a big one, right? People don't basically convert inactive to active thyroid in the brain efficiently. And uh if you give them T3, even if they're technically normal thyroid, my gosh, their brains wake up. We've seen this many times, right?

uh So there's many nuances to this as well, right? um And I think it's a really interesting field because I think a lot of people feel relatively hopeless in this space. And yet I think there's a tremendous amount that can be done based on kind of what you're doing. And then it sounds like maybe some things that support that as well, right?

So are you involved with any of the, any of the research trials around things like TB 006 or any of those kinds of things, antigallectin three, is that something that you're having an eye on or thoughts about that? Yeah. Yeah, I haven't seen that many people improve on it, although I do have a new patient that I saw recently who's been doing that. And when she doesn't get her TB 0.006, she does not do as well. So I know that it is helpful for some people.

I think it's interesting that they're not testing Galectin 3 levels. I don't know if there's some explanation for why you wouldn't test Galectin 3 before to see it, to evaluate if that was going to be beneficial. For me, I find it helpful.

to create some structure and a framework for how you would think through this, because I think there is a lot of overwhelm. And for good reason, Dr. Bredesen and his group at Apollo, Julie Gregory, they say that there's sort of this false hopelessness that comes out of conventional community, that there's not reason to be excited about improvement, potential improvement.

And yet when we look at it, there's... an overwhelming amount of things that you could do to optimize cognitive function, including looking at genetics, considering TB 006, including, you know, potentially looking at antibody therapies, the amyloid antibody therapies, those are not appropriate for everyone, especially people who are ABUE 4, 4 positive or 3, 4 positive, but there are lots of things to consider.

And so how do we create structure so that we can systematically go through that list of options? And what's important for me as an individual, these, as you mentioned, 36 holes in the roof, it's probably more like 7,000 potential holes in the roof, right? How do we approach this? So I think of the six components of brain health, toxins, nutrients, structure, stressors, signaling, and infections. So under structure would be our molecular structure or our genetic risk, right?

You mentioned APOE, there's also APP, PSEN, the... piece in one and two, which are associated with early onset Alzheimer's versus our later stage after post 65. so there's genetic structure can put us at risk, but then it's going to be those environmental factors, those lifestyle factors that pull the trigger. So we can talk through all of those if that's helpful to kind of get a sense of what do we prioritize? Where do we focus?

And how do we make sure that we're not chasing something that maybe isn't? necessary for us personally, but we're looking at things that have good data behind them, good support that are relatively low risk, high reward. Yeah, I think that's right.

think, um you know, our approach over here, and I think yours is very similar, is that we like to, whenever we see somebody, we like to deconstruct the problem before we actually start recommending solutions, because it's really easy to say, well, we could do this and this and this, but it may not be the right thing for that individual, right?

So deconstructing in terms of, you know, their gut biome and their... their mold toxicities and the infections they carry and the inflammation in the brain, right? And the genetics that they carry with those predispositions are insulin resistance, right? Cardiovascular health. um All these things kind of get broken down to actually understand, okay, these are contributing factors.

Then you can sort of formulate a plan where to your point, you can actually reverse uh cognitive decline or the flip side of the coin is you can actually enhance cognitive

function, right? So yeah, super exciting stuff. Yeah. One of the things that I've gotten into recently is uh optimizing ATP levels in the brain. So I think part of the issue is that as people age, the amount of ATP they have in the brain goes down. m And so even when we get everything set up properly, they still don't have the energy, if you will, to kind of heal.

So we've been impressed with using a product called Vitality, which is basically think of it as an NAD precursor combining it with, you know, Apigen, which basically blocks an enzyme that breaks down NAD. As we age, we build up this enzyme called CD38 and it breaks down our NAD. So we end up tired and old, so to speak. Right. So uh anyway, you block that, you boost the NAD production, but then you go jump in an ozone sauna. So ozone sauna basically oxidizes NADH back to NAD.

And my gosh, I mean, it's like you're on another planet, right? For two or three days. It'd be interesting to see if you had an ozone sauna in one of your facilities, what that might do in a situation like this, because ah there's so many, there's so many little twists here, right? Little peptides, things that we use, other stuff, right? That become really fascinating.

I think it's, the point is I think when we combine these approaches in a, in a thoughtful way, not just, you know, throwing everything at everybody, but in a thoughtful way, it's really possible to reverse Alzheimer's, quite honestly. yeah. Have you spent any time looking at Dan Goodenow's work at all? Dan Goodenow? Mm hmm. Yeah. So he's doing some pretty remarkable work also with regards to dementia, even ALS, things like that. He's starting to show a reversal of...

And I know he's really big on functional MRI scans to actually outline what the brain is doing, things like that. um And then he also has sort of a dietary plan, things like that. But it just feels like the field is kind of um bringing forward enough complimentary technologies that people that are listening to this should understand, you know, if you're suffering with cognitive decline, you know, just raise your hand because there's help out there. There really is help out there.

So what are some of the um common things that you see that seem to work the best for people? Yeah, again, the thing that I think does the most heavy lifting is getting into ketosis. Now, not everybody can do that, but our brains and our bodies are just absolutely miraculous to me. think it's so fascinating and impressive that we're like hybrid engines. We can go back and forth from burning sugar for fuel versus burning fat for fuel.

And many people, when I encounter them, have never burned fat for fuel. They've never been in ketosis. And as you mentioned, ATP is harder to make as we age.

So regardless of our diabetes status, as we age, we're less insulin resistant and we're less sensitive. We're no less capable of turning glucose into ATP efficiently in the brain. So switching the fuel source to ketones, beta hydroxybutyrate through either exogenous ketone supplementation or through a diet that restricts carbohydrates can be a fantastic way to do that.

And I have seen really profound improvements in cognition where a patient will not remember their grandchildren's name one day and three days later after they're in metabolic ketosis, they're remembering the names of their grandchildren. mean, real profound impacts from this. And so it's something that's free. It doesn't cost a lot of money. It is very safe to do. I mean, work with a provider. For many people, we worry about frailty as they age.

And so we want to make sure they're not losing too much weight. Now, if you want to lose weight or if you have diabetes, you mentioned metabolic. uh syndrome or having metabolic issues around, again, turning glucose into fuel. And then getting uh into ketosis is actually very, very helpful.

You need to watch blood pressure and watch if you're, certainly if you're taking insulin or even metformin or other diabetes medications, you want to watch and be able to monitor those and adjust the medication doses. Because what we see is that people, their mood improves, their sleep improves, their blood pressure improves, and of course, their A1Cs and their blood sugar control improves on an organic ketogenic diet. So we get the toxins out and the fuel up.

The brain is a very resource intensive organ, right? It's 2 % of body weight, 20 % of energy expenditure each day. And so we need to make sure we're getting enough fuel there. We use IV NAD. em You mentioned getting NAD levels up. We do a lot of NAD precursor support, ATP support, of course. But really what we're looking at is an energetic issue. You mentioned imaging. We look at ASLs. So this arterial spin labeling, it's MRIs of the brain that looks at perfusion. So we look at atrophy rates.

So we're looking at volumetrics, brain MRIs and volumetrics so that we see is the hippocampus aging at an accelerated rate? Is the amygdala aging at an accelerated rate? What about the precuneus, the temporal regions, prefrontal? Where is this affecting this person in terms of the size of the different areas of their brain? That can give us some insights, but what's even more insightful is looking at perfusion. This seems to be a leading indicator of where atrophy is going to go.

So if we aren't getting enough blood flow into areas of the brain, then of course we're gonna end up with atrophy and potentially cognitive impairment associated with that. And so that's been the most helpful thing for me. We can also see, you know, is there a risk of microbleed? like the AIM and spec scan? The MRI, yeah, OK. ASLs.

Yeah. And then we work, I feel very, very fortunate to be partnered with the group at Pacific Neuroscience Institute, including David Merrill, Dale Bredesen, Karen Miller, and Cyrus Raji is the neuroradiologist who we collaborate most closely with. He's at Washington University in St. Louis.

Cool. Very cool. Yeah, very cool. So, yeah, so to the point there, you're really kind of deconstructing an individual to understand where they are in the process, where the issues are, what's happening, what's contributing. And then do you end up taking different strategies based on what you find? Absolutely. Yes, that's the whole point of looking for them.

I would never suggest a test for a patient if it wasn't going to change the outcome of the test, the results of the test, we're not going to change the treatment plan. Now I have a couple of exceptions, A MOCA score, Montreal Cognitive Assessment. We want to understand, it's a yardstick, right? It's saying where are we on this spectrum of decline?

And that outcome is, that number isn't going to potentially... I mean, I say this, I'm starting to say this out loud and they're like, well, it can change my treatment. It will change how much I emphasize how fast we need to go. Right? If we're in more of a mild, mild cognitive impairment, you know, we say mild, even though this is affecting people's lives often at this stage, there's nothing mild about it.

But if we have a higher MOCA score than maybe we had anticipated, then maybe we're not as rushed to do everything yesterday. But if we have a lower MOCA score, then It changes how we talk about our expectations. We see that people with MOCA scores of 18 and above, 30 is perfect. So this is a one-page PDF worksheet, the Montreal Cognitive Assessment. draw a clock, copy a cube, identify zoo animals, identify where you are in time and space. 26 and above is normal.

And then as we go towards zero, that is representing more severe cognitive impairment.

And we see that right around 16, 17, 18, there's sort of this spot where we have real high confidence above that, that if people put in the work, do what they need to do, take the supplements, do the hormone replacement, they get the toxins out and the infections dealt with and the blood pressure under control and they get their hearing aids and they do everything, they treat their sleep apnea, we see improvement the vast majority of the time.

Now when they're below that level, we see improvement. It takes more effort, takes more investment of a caregiver, a care partner's time. and it requires more resources. I mean, it just takes more work and our confidence is not as high. It's not guaranteed, right? And so that is, it's a test that I do where we're assessing where someone is.

The PTAO levels, PTAO-217 is another blood test that we use to assess where someone is on a spectrum of neurocognitive, neuropathology, neurodegenerative pathology. And that's another test. Like I'm not going to change my treatment plan based on this, but it gives us a yardstick, a measuring stick for where we are. Are we getting better or are we going downhill?

Sure. So I mean, but those tests are useful to your point to give you an idea where somebody's at, right? And I think to your other point, I think the other tests do give you clues as to where to intervene or how quickly to intervene or how to collaborate with different modalities or weave together different modalities to get the best effect. It's interesting that the ketosis is kind of sounds like that's really kind of a rock, ah right? A base rock.

uh foundational piece for you in this whole process. And I know Bredesen talks about that as well. um Is there anybody in which you don't do that apart? In other words, let's say they don't have a medical contraindication, but um is there anybody in whom you don't see that be a positive uh contributing factor to their outcome? Yeah, there's definitely patients who are an exception to that. uh I've had South Asian patients who are vegetarian.

It gets very challenging to be on a ketogenic diet if you're not doing animal protein, and particularly if you're vegan. Now, interestingly, Dean Ornish published in June of 2024 the first randomized control trial showing that people with mild cognitive impairment and uh dementia due to early Alzheimer's improved in an intervention group compared to the control. on a vegan diet with some supplementation, with support groups, and with exercise. there are other dietary interventions.

I suspect that over time, hopefully the science will play out and we'll have even better data to suggest the best diet for brain health. But I suspect it will be going back and forth between a ketogenic diet, a ketogenic state, and potentially a plant-based diet. high polyphenol rich, again, lots of veggies, lots of fiber, no matter what diet you're in, and eliminating the highly processed foods. I think that that's going to be one of the most important pieces.

But metabolic ketosis, there's a magic about it. I recommend that most people experiment with it, see what it feels like to be in ketosis. I personally feel brighter. My mood regulates. I get off the blood sugar roller coaster. I have less anxiety. I get better sleep. I get more efficient sleep.

I wake up at 5 a.m. ready to get out of bed rather than kind of dragging myself out of bed between 6 and 6 30 I get an hour to an hour and half back in my day when I'm in ketosis so I can speak from personal experience I don't I hope I don't have dementia but I don't have cognitive impairment at this stage but there's an optimization that happens and my blood sugar is

much better managed and I think people at any age can get that benefit but particularly people who are noticing cognitive impairment Mm-hmm. a lot on the table if we don't at least try and see an experiment with getting into ketosis. So when you talk about going into ketosis for the audience here, they're listening to this. are different ways to go about that, right? I mean, you can just go on a water fast. You can do a five day fast mimicking diet.

You can ah just cut out all the carbs and sugar in your life or whatever. So how would you instruct them to think about this um if they're sitting at home listening to this and they want to try something? Yeah, and you mentioned medical contraindications. like, work with a provider, right? If you've ever had an eating disorder of any type, I don't recommend restriction, right?

If you have gallbladder issues, if you have hyperglypidemia, if you're on medications, especially for high cholesterol, you've been managing cholesterol, this is controversial, but we see a lot of people improve their lipid outcomes when they get into the right type of ketogenic diet, right? This is not a bacon and cheese diet. This is lots of plants, lots of fiber, and you're burning lipids, right? So those numbers actually go down over time.

But you want to work with a provider and see what happens to my lipids. Am I increasing cardiovascular risk? I think you can decrease cardiovascular risk with the right type of ketogenic diet. And then with gallbladder issues, with kidney issues, you just want to make sure you're working with a provider. The first step is to get the carbohydrates out and increase plants.

most of my patients are not getting enough good green veggies, lawn starchy veggies, increasing that, increasing uh good high quality proteins. I am not afraid of dairy. I know some people feel that that's very inflammatory. As long as you're not lactose intolerant, I find that to be a great source of protein and fat that can help feel very satisfying. And then we're big fans of fat bombs.

getting whatever you need for that sugar craving that's undoubtedly going to pop up as you're trying to get into metabolic ketosis and having some sort of coconut oil, cacao, maybe there's a uh sweetener that won't, a monk fruit or a alulose sweetener with some nut butter. There are these fabulous fat bombs. If you Google fat bombs, there's a thousand.

uh I'm sure there's well over a thousand recipes for delicious fat bombs that can be great to have in the freezer or in the fridge for when you're having that hankering for something sweet.

Nice. Okay. That's good advice for people. Yeah, I think, you know, it seems like dementia is really um on the rise, right? It seems like, I don't know if we're just diagnosing it better or people are living longer and we're seeing more dementia or we're just living in a more toxic environment, but it seems like more people are struggling with cognitive decline.

Do you have uh recommendations for how people kind of architect their homes and environments to kind of, uh you know, minimize the toxins? Yeah, absolutely. So the demographic shifts, I think, are what are primarily contributing to this rise in dementia. Everyone knows someone who's been affected. And that's because such a huge chunk of our population, the baby boomers, are approaching that age where they're at the highest risk.

So we can't change the risk associated with age, but we can change our biological age. We can't change the day we were born, but we can change how we age. And I think environment plays a huge role in that. Another demographic change that we see is how young people are when they're diagnosed with Alzheimer's and dementias. And these are not genetically associated necessarily, right? There might be an APOE 3-3 person who's in their 50s or late 40s who's experiencing cognitive impairment.

And I think there are multiple things at play here. One, you mentioned toxic environments, and two, screen time and stress, the stress of modern society. The group, the generation that is approaching this higher risk age category has spent a lot more time in front of screens than any generation that has ever preceded us. And I think that really is having an impact on cognitive function. Tell us about that a little bit.

you think it's a blue light phenomenon or do you think it's ah just a passive consumption of information or what's your take on that exactly when you're talking? stress, sleep. It keeps people from sleeping. Yes, I think there's a blue light. I'm not an expert in this and I haven't, you know, but I do think that there's something there in terms of what are the differences between this generation versus the ones that came before us. And toxins are the other big one.

Now, environment, your question was about environment. How can we set up our environments to reduce our risk?

Where do you put the TV? Where do you put your phone? Where do you charge your phone? Are you tempted to be on your phone or on your computer or on a screen all day long? And is your house set up so that it's easy to go from looking at one screen to looking at the next screen? Just thinking through that, I've lived in places where we hide the TV from ourselves. We put it in a closet. We only bring it out if that's what we really wanna do.

We put our phones in a box at the door and we drop them there and we eat dinner with our phones in a different room. So really intentionally getting the screens out from in front of your face, And then, so we can talk about how behavior is impacted by our environment all day long, right? There's lots of things we can do. What it comes down to is like a James Clear atomic habits kind of perspective is how do we put in front of us so that we see it?

How do we make it easy to do the things that are? beneficial for our brain health, like getting exercise, eating the right foods. So this is just like organizing your refrigerator so that what's right in front of you is not the sweets and the treats and the processed food, but all the veggies. Then how do we optimize our environment to make it harder to do the things that aren't as good for us, right? This is putting the TV in the closet or putting it in a cabinet that closes.

Just that one little extra bit of effort to open the cabinet or to go find the remote. or to get up and change the channel, get rid of the remote, those things can create enough friction that we don't do it, we don't engage in those things that aren't as good for us. So intentionally taking the time to think through that. I think this uh is brilliant, really. think the way we think about it from the longevity perspective is that we all live in four environments for the most part.

We live at home, we live at the office or work, and we live on business travel and we live on vacation travel. So it's important to intentionally architect each of those environments to actually support the mission so that otherwise the wheels come off. I was doing great, then somebody went to Italy for two weeks and everything flew apart. If you're listening to this, just think about how you would, I mean, you would just take 30 minutes and intentionally architect your home, right?

The way that Heather's talking about here to, you know, keep the screens away. And the other thing is to understand that willpower is, you know, very, very high in the morning and at 0 % at eight o'clock at night. Right. So willpower runs out. So if you, if you don't architect the environment to keep the ice cream out of the freezer, you know, if it's there. I don't have perfect willpower. it's there, I would eat it, but I just don't put it there. that way I avoid it, right?

So you have to really understand that you oh can never really count on your willpower to get this done. You really have to architect the environment to support you. That's how I think about it. Yeah, I love that idea about vacations, right? I want people to go enjoy their Italian vacation, but can you make it about cycling? Can you make it about hiking so that you are doing it in a way that's active? Yeah, that's such a great point of all these four environments.

The other piece about environment is toxicity, right?

We're hypervigilant around mold and moisture and environments because we have seen mycotoxins play a big, well, we know that they are carcinogenic. We know that they are immunosuppressive. We know that they are neurotoxic. This is not controversial, right? We see that in the animal husbandry industry, there's a trillion dollar investment in getting mycotoxins out. This is a trillion dollar industry with huge amounts of investment going into getting mycotoxins out of sheep and cows and.

rabbits and horses and any mammal that is used uh to make money. And yet landlords have a very different financial incentive than a potentially sick tenant. uh HOAs and apartment buildings have a very different incentive than the potentially sick person that's living in them.

Understanding that there's a little friction between the interests at play can help us understand that there's really different types of mold inspectors, different types of mold testing, and uh each of them sort of support the interests from the group that typically pays that way. So being careful about that. I've had clients that were deathly ill from mold. uh Had the inspector come in, looked through everything in their office, whatever, found nothing. Were still deathly ill.

Had to actually quit work. An attorney actually had to leave work, uh was disabled. Then somebody came in and actually took apart the ceiling and they found all kinds of mold in it, right? So The point is there's mold inspection and there's mold inspection. And I think the same is true for water. I think the same is true for air. um think we really need to be vigilant because to your point, the landlord will never be vigilant on this front. They simply want to rent the space, right?

And they don't want to have to pay for any renovations. So they're simply there to rent the space. So if you smell anything that's funny, I would run the other way, quite honestly. I mean, that's your first cue. It's not the only cue, but yeah. Yeah, so this is a whole, there's a big can of worms, but we see that it directly impacts cognitive function, even in people without dementia. But of course, it's contributing in those who do have Alzheimer's or dementia. So we want to get that out.

And if we have control of our environment, right, if we are the landlord, if we are the owner, then doing what we need to do to make sure that we're not being exposed at work or at home. And then uh Just opening doors and windows can be really helpful or using an air filter can be really helpful. The kitchen is a place where we could talk about plastic, you know, and uh nonstick pans. We want to get as much plastic out of the kitchen as possible. Nonstick pans, want to break up with those.

Be patient when you cook. Cook on medium and use good coconut oil and butter to grease your pans. But use stainless or cast iron cookware because that's how we can prevent those toxic chemicals from getting into our system through our food. uh Tell me what would be of value to your audience because there's so much we could talk about in this environment uh conversation that could be.

Yeah, I was just thinking too about the aging process itself and menopause and andropause and the impact that changing hormone levels has on cognitive function. Right. So a lot of uh individuals, male and female, will complain, you know, my memory is shot now or whatever. Right. And it can be in a perimenopausal or peri-andropausal state as well. So I think I think it's very important.

from our perspective that people, unless there again, there's some contraindication that they be hormonally optimized for longevity and for the health of their brain. uh Super important, quite honestly, and estrogen becomes super important. Many men will get testosterone, um go to a testosterone clinic, get testosterone, then get put on anastrozole, which basically blocks the conversion of testosterone to estrogen.

And it really does them a massive disservice because men need estrogen, just like women need testosterone. And so you really want to make sure that if you are doing well, if you're ignoring hormone replacement, certainly think about it. Now, there are reasons not to do it. And we won't go into all those, but work with a provider to do that.

But but if you if you are going to go forward and be healthy and have a healthy brain, I think having some hormone optimization becomes important and then doing it safely. Right. So you're looking at metabolites and how you're metabolizing your. and making sure it's done well on your screen to make sure that you don't have cancer and prostate cancer, breast cancer, endometrial cancer, whatever it may be.

But I do think that, um you know, having estrogen is very, very helpful for both men and women. So I don't know. You probably have a similar uh view of that, I suspect. But but I don't know. Yeah, no, absolutely. So this is under signaling for us. So what are the signals going to our brain? And if we think back to when we're in our late teens and 20s, and we don't necessarily have to go back to hormone levels that high, but that's that stage where we're making these social connections.

We're learning new skills. We're maybe in college. Our brains are ripe for all that synaptogenesis. We're making connections between neurons. And what we want to do is approximate that, get the benefit of those signals. So what are those signals? And not just sex hormones, but I couldn't agree more. Estrogen, progesterone, testosterone, DHEA, prognanolone, all of these are worth considering and talking to a provider about. I think the conversation around that has really changed.

Just in the last 12 months, there was a study published about 12 months ago on 10 million women over the age of 65, so Medicare eligible women comparing 9 million of them who were not on hormone replacement therapy to another million who were. They saw a reduction in the risk of all-cause mortality by 19%. You get a reduction on your risk of dying by nearly 20%. Reduction in risk of cancer, heart disease, dementia, and then of course you get the bone benefits.

So this matches what I've seen clinically. People who are on hormone therapy, they tend to look and act and feel younger. So definitely worth considering making sure that that's done appropriately and with risk mitigation and working with the provider, as you mentioned. But not forgetting about thyroid, you mentioned T3, we're huge fans of Cytomel, I think, but you know, I've seen it work for sleep, right? It's not even supposed to work for that, it's supposed to give you energy.

And I've seen people get better sleep, of course, weight management, energy, mood, so many things. And most doctors leave out T3 from thyroid supplementation, they just use T4. looking uh with a functional medicine doctor at what your full thyroid health looks like, looking for Hashimoto's, all of those pieces. Vitamin D em is another, important hormone, a signaling hormone that vitamin D and D3 and K2 are both important for the brain.

BDNF, brain dry and no trophic factor and all of the other nerve growth factors that signal to our brain to make those connections. We want those signals going to our brain, not the microglial activation that says protect and defend in flame. We want to switch. are signaling to synaptogenesis, neurogenesis. We don't get a lot of new neurons, but we get new connections between neurons, even as we get older.

And then other pieces in signaling, I'm sure you probably use a lot of these, but you mentioned peptides, exosomes, stem cells. How can we really turn up the signaling that tells our brain that we are healthy and regenerating and in a repair state so that we can make those new connections? Yeah, we use all those quite honestly, ah all of those and the peptides as well.

know, things like dihexyl will boost BDNF and C max and C length and, you know, cerebral lice and there's lots of different things that can actually help improve brain function. But to me, they're, they're kind of a little bit of the icing on the cake. It's, it's kind of like the cake is building. Um, for me, the cake is actually understanding your genetic predispositions, right? And then building. on top of that with understanding where are you in the aging process, right? What's your thyroid?

What's your resting metabolic rate? What's your DIO2 genes? What genes do you have that may predispose you towards one thing or another? Then taking action there, then basically looking at, you know, your environment that you reside in, which has to do with how much exercise you're getting and what kind of area of breathing, toxins, infections, and then kind of working your way up into, okay, if we fix all those things, are we where we want to be?

If not, then let's look at, you know, peptides like... look at stem cells, let's look at some other things, right? And then doing the diagnostic tests that you've talked about. oh So I think it's a really exciting time because it used to be, to your point when you graduated, it's like, no, there's just nothing I can do for you into, my gosh, I think the Basvenjorda people can be significantly helped. In your work, you also talk about helping the caregiver. Right.

So someone that's living with someone that's suffering with cognitive decline, we know that for them, it becomes a diagnosis as well. Right. I mean, their health is impaired, their life expectancy is impaired as well. And so do you want to talk a little bit about the, uh you know, the work that you do to kind of help the caregiver in this regard?

Yeah, absolutely. So what we see, we put this kind of in that stress category. And when we're talking about anything, toxins, nutrients, stressors, structure, signaling, and infections, too much, too little, in the wrong place, at the wrong time. That's what we're trying to identify. Where is the imbalance that's affecting this particular individual? And we see that caregivers with stress We want enough exercise. We want enough stimuli.

We want enough stress that people are engaged in purposeful and meaningful experiences day to day. But the scales get tipped for many caregivers. It is so much stress that we see in the literature that it can, being a caregiver, serving as a caregiver for someone with dementia increases your risk of a dementia diagnosis anywhere from two and a half to six X. Right. So this and its highest for male spouses of a female partner with dementia.

And so when a patient comes into my office and they come with a partner with a caregiver, the caregiver becomes a patient too, right? This is not about my wife who has dementia getting on the ketogenic diet and I don't need to. It's not about my wife getting the sleep study and I don't need one. It's not about her cholesterol and not mine and her A1C and not mine.

This is about how do we change the lifestyle and get both of you optimize so that we address your risk while we're in this luxurious position of prevention and we address her risk and turn on her signaling so that we get back into that repair mode. So it's about both and, it's thinking of both the care partner and this dyad, right? We're part of a complex, you know, we call them dyads. It's just not as simple as.

there's this one patient and they're responsible for everything and they're going to do it all. The caregiver is just as inherently important because we really depend on their involvement, particularly when people are more progressed. But even in early stages, we depend on everybody being on board so that they're not creating an environment where there's cake and cookies on the counter.

And they're not saying, hey, instead of going to that exercise class, why don't we go out to dinner and get a couple of cocktails? Right? We really need that. whole system to be in alignment, rowing in the same direction to get the best outcomes. Yeah, no, I think it's think it's true. It is a massive stress um on the caregivers. And I think it's kind of overlooked for the most part.

So it's really it's really quite wonderful that you actually are treating the dyad and not just the, you know, the patient, quote unquote, patient. Right. And then groups are really, really beneficial and particularly in-person support groups.

Of course there are online support groups, but whenever you can meet with other diads, or even just with other caregivers, we prefer to have both people come and then sometimes we'll pull the caregivers apart and do something specific for them and have the patients with dementia do something specific.

But we really like having everyone there in the same room, having those conversations, it just sparks so much and people feel like they're not alone, can be very lonely to be a caregiver because your entire life is wrapped up in dementia.

If there are any caregivers listening or if you care for a caregiver, the one piece of advice that I want you to walk away with is that I believe caregivers should have eight hours a week, eight consecutive hours hopefully, to themselves where they are not caregiving, right? They don't go take care of grandkids. They don't go pick up the teenage grandkids from school. They don't go do other things that are caring for another person. They care for themselves. They focus on their hobbies.

They see their friends. They don't talk about dementia unless they need to vent. But they really focus on creating an identity outside of being a caregiver. And this is important for mental health after that role resolves one way or another, but also for sustainability of the caregiving role and quality of the care that you provide. Yeah. No, I think there's so much wisdom in that because it's easy with any 24-7 tasks to literally burn out, right?

And then it's very difficult when you're burned out to really have the compassion and empathy that you even want to have, love towards the individual that you're there to care for. So taking time away is critical for any caregiver, right? We also see families really forced into a corner when something unexpected comes up for the caregiver. They break a femur bone and they can't walk anymore.

They, you know, from a slip and fall or the daughter who's across the country needs help because something comes up and they've got, they need to go. They have another priority that supersedes their caregiving role. And now they're just looking for a warm body to keep their loved one alive. Right. And it's not, it's not a great fit.

And so if we can get help before we think we need it, then we have the time and we can put in the effort of finding the right fit, someone who's really gonna understand and know our loved one, get along well with them, inspire them to eat well and get the exercise and get to bed on time and do all those things versus.

Yeah, do you ever find dyads that come together and sort of tag team in a sense of, know, one caregiver will act will look after two or three uh patients while the other two caregivers get a break or that kind of thing. you ever see that happen either organically or or under your tutelage? Less than I would like to, I think it's a good idea, right? And I think maybe as communities are designed with aging in mind, we'll maybe see more of that.

uh But I think people feel like they have a lot on their plate to begin with and get overwhelmed very easily. uh So I haven't seen much of that actually manifest yet, but I love that idea. Mm-hmm. Yeah, it just seems like there's more of a communal element to it and you you might make some friends with some other caregivers as well, right?

So. We see senior centers being a great resource for people, I can get my loved one to go play bingo and play cards and be engaged with arts and crafts for even just four hours during the day. And then I can come back and pick them up. That makes it more sustainable. Cause now I can check off a list of things I need to do, or I can go get my exercise, that kind of thing. Right, Perfect. Awesome. So um just to kind of finish up here, what's kind of on the cutting edge for you?

What are you looking forward to that you're not doing currently? there some things that you're thinking about? Gosh, I wish we could do that or this or I'm waiting for something else to happen or how are you feeling about that? Or you feel like you're pretty complete? I don't know.

Yeah, I there's a lot we're looking forward to and excited about. em My book, Reversing Alzheimer's, came out last year and through that we've had a lot of really exciting collaborations and partnerships and we're expanding Murama through partnerships. So we are working and collaborating with a handful of groups across the country uh to deploy essentially a Murama model in these existing senior living communities. And that is what I'm really, really excited by.

I had my hand at operating and owning a facility and I realized there's a reason why people spend entire careers doing that. And I really appreciate the expertise and wisdom that our collaborators have. And so I really want to focus on the part that I'm good at, which is the immersive experience of diet, exercise, programming, and environment and helping people. apply that in these communities and making that accessible. So I think that'll have a really big impact.

I'm really, really excited about that. The other piece is research. Dr. Rettison is in the uh middle of collecting data for a controlled trial, and they'll finish that up in the fall and then hopefully be publishing pretty quickly after. And we, through Pacific Neuroscience Institute, uh I am working with that group to also fundraise for another clinical trial. We're looking forward to contributing, continuing to contribute to the research. Yeah. What will the next clinical trial be?

What question will it be asking? Essentially, the question I want to ask is how do we get this reimbursed? How do we get more access to more people will come through making it financially affordable? And so if we can show that we can do this in an institutional kind of setting, then I think that we'll be a little closer to that. And it will in some ways replicate the control trial that Dr. Bredesen is doing now to show that we can do it in multiple settings. There are six clinical trial sites.

So I think that they're establishing that. but I think we can show hopefully not just in a small functional medicine practice, you can do this, but hopefully also in a larger institutional setting. Yeah, beautiful. Beautiful. Well, I really congratulate you on the work you're doing ah and the passion that you have for this.

You know, I think what's exciting is that you continue to kind of push forward into it, innovate, find new solutions, and then find ways to actually democratize, if you will, ah the things that you've learned to impact more people. Right. So that's, that's a beautiful thing when you can step outside of your own practice, so to speak, and actually start to expand this. So that's really, really fun to see.

Yeah. so inspired by the patients, you know, who are the pioneers in this space, really putting their faith in us, doing the hard work and looking, just looking for the options, not taking no for an answer from the neurologist and being willing to do the work. I wake up every day because I know how hard people are working. And also when I get to hear someone say, I got my mom back or I got my dad back, just is, it makes every bit of work worth it. absolutely. Yeah, that's the best thing, right?

mean, um yeah, hearing that, I got my dad back, my mom back. I mean, it almost makes you cheer up, right? Quite honestly, seriously. I mean, it's so emotionally rooted in what you do. I know this feeling. yeah, congratulations to you on all that. Beautiful. Well, thanks so much for joining us. Such a pleasure to be here. Thank you for having me. Oh, my pleasure.