Dhru Purohit Show - Early Signs of Alzheimer’s Disease and a Comprehensive Approach to Addressing Memory Loss with Dr. Heather Sandison

Episode Date: July 22, 2024

This episode is brought to you by OneSkin, Bon Charge, and Lumebox.   The rates of Alzheimer’s, dementia, and overall cognitive decline are increasing. However, our daily choices can increase our risk or set us up for optimal brain health, regardless of age. Today’s guest shares powerful research demonstrating how positive lifestyle choices can prevent decline and how she guides her patients in implementing these practices daily. Today, on the Dhru Purohit Show, Dhru interviews Dr. Heather Sandison about neurodegenerative diseases like Alzheimer's and dementia and the importance of early detection and prevention. Dr. Sandison explains the Bredesen Protocol, which takes a comprehensive approach to brain health, and shares why she follows that protocol in her practice. She also discusses the benefits of sleep, stress management, exercise, and the ketogenic diet in preventing cognitive decline. Additionally, she shares why reducing environmental toxin exposure, maintaining metabolic flexibility, and practicing meditation are other vital parts of assessing overall brain health.  Dr. Heather Sandison is a renowned naturopathic doctor specializing in neurocognitive medicine and the founder of Solcere Health Clinic, San Diego’s premier brain optimization clinic, and Marama, the first residential memory care facility to have the goal of returning cognitively declined residents to independent living. She is the primary author of the peer-reviewed research “Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline,” published in the Journal of Alzheimer’s Disease. Dr. Sandison hosts the annual online Reverse Alzheimer’s Summit, where she shares cutting-edge and tried-and-true insight into what is possible for dementia patients. In this episode, Dhru and Dr. Sandison dive into (audio version / Apple Subscriber version): Early warning signs and detection of Alzheimer’s (00:00:21 / 00:00:21) Early detection using The Bredesen Protocol and six components of brain health (2:31 2:31) Compounding lifestyle habits that can prevent or lead to cognitive decline (13:50 / 9:21) Brain healthy diet (21:55 / 18:11) Body composition and the role in brain health (32:32 / 26:51) Stress and sleep deprivation (34:41 / 29:00) What participants in Dr. Sandison’s study implemented and the results (39:11 / 33:30) Environmental toxins (1:01:00 / 55:20) Types of Infections found to be associated with cognitive decline (1:13:41 / 1:08:00) Supplements for brain health (1:20:00 / 1:14:20) GLP-1 prescriptions (1:33:41 / 1:28:00)  Also mentioned in this episode: Dr. Sandison’s book- Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health For more on Dr. Heather Sandison, follow her on Instagram, Facebook,  or her website. This episode is brought to you by OneSkin, BONCHARGE, and Lumebox.   Right now, OneSkin is offering my community 15% off; just go to oneskin.co and use coupon code DHRU to save 15% and give your skin the scientifically proven, gentle care it deserves.  Right now, BON CHARGE is offering my community 15% off; just go to boncharge.com/DHRU and use coupon code DHRU to save 15%. Lumebox is offering my community $260 off their FDA-approved portable Red Light device—that's over 40% off! Go to thelumebox.com/dhru to get your Red Light device. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Heather Sanderson, welcome to the podcast. You know, Alzheimer's disease is one of the most scariest diagnoses that somebody could end up with. But a key part of your education and why you're here today is helping people understand that the disease starts years before the diagnosis. What are some of the earliest warning signs of the scary disease that our audience should be paying attention to? that feeling that my brain doesn't work the way I did five or ten years ago, where you struggle to remember your neighbor's name or the name of objects is often an early one. The nouns, nouns and names tend to come up for people, but also this sense of overwhelm. Like my mom used to cook Thanksgiving dinner for 25 people, and the thought of her taking that on this year is just

way too much. Those types of things, or travel, travel's another one that comes up for people. Oh, mom used to travel to Europe, even on her own, or she would coordinate the trip for the whole family, and that she's going to miss the, we're going to get on the wrong plane at the wrong time and not have a hotel booked. If that kind of thing is starting to happen, like this executive function, that planning and then execution starts to feel overwhelming, those are some early warning signs that I think a lot of people are not aware of. sense of smell comes up as well, and there are even some tests that are being developed as an early detection for Alzheimer's, but you can lose your sense of smell for many other reasons, including allergies and a cold and COVID and things like that that people are familiar with. So don't jump to the conclusion that you have Alzheimer's if you've lost your sense of smell. Now, Drew, what is really important to talk about here when we talk about early warning signs

is that we actually know now, based on the science, that Alzheimer's and the neurodegeneration that ends up leading to Alzheimer's starts taking place in the brain sometimes decades before that first early warning sign that we experience before that first symptom. And so that's what's really exciting to start talking about is that prevention and that early detection rather than just those early warning signs. That's fantastic. You know, you're a clinician, but you're also a researcher in this space. So people actually come to you in your clinic in California and this larger group that you're a part of that's researching this using the Breedison Protocol, what kind of test are you running them through to basically help them assess how damage their brain is or how

healthy their brain is? Yeah, so Drew, I came to this as a skeptic. When I first learned from Dr. Bretteson, I didn't really think that we could reverse dementia. And now my book is called reversing Alzheimer's because I have seen it happen over and over again. And what I'm even more excited about these days. We've proven we can see in the research that we can reverse Alzheimer's. But what's even better, we can prevent and delay it so that people don't even have to go down this path of ending up with the symptoms. And the first step to doing that is what my mentor, Dr. Dale Redeson, calls a cognoscopy. So what does this look like? This is basically what I'm saying is that we can see those early signs. If we do the testing, if we do a little bit of work early on,

he calls it a cognoscopy because just like a colonoscopy, right? It's not particularly comfortable, but if we show up and we get it done, then we can get that early detection of cancer, of colon cancer, and we can eliminate it. So very similarly, when it comes to brain function, when the way that I create a framework for this, right, because it can start to feel a little bit overwhelming, but essentially we're taking all of functional medicine, which I know many of your listeners are deeply familiar with. We're taking all of that and applying it to the brain. What we want to, want to know is where is the imbalance that might lead to neurodegeneration? And so I think of kind of of six components of brain health and what we're looking for is balance, the right amounts

and the right place at the right time, so that the body can create that homeodynamic balance. It's changing, but it's not static, but it's changing in a very fluid way, right? Our melatonin is going up so that we can get to sleep and our cortisol is going down so we can get restorative restful sleep. And then our cortisol is coming up in the morning so that we can be be present and awake and alert during the day. And so what we want to look for in six different components, there's these six different components, and we can look for that balance, the right amounts, so the right time and the right place, of toxins. We think of toxins in three flavors, heavy metals, micro toxins or mold toxins, and then chemical toxicity. We want the right amount,

we're going to be exposed to toxins as part of the reality of the world that we live in, plus each of our cells that metabolizes. So we need to be able to get rid of waste. And so thinking through that, testing that, making sure that we're able to do that effectively is one component of brain health. Another component is nutrients. Do we have the right amounts of the right time at the right place? Is there too much sugar, which can lead to what we call type 3 diabetes, where that sugar becomes toxic to the brain, creates a caramelization, an irreversible degeneration of the neurons themselves because of that toxic sugar? It also means that we're not getting enough nutrient, not just nutrients, but we're not getting enough energy if we can't turn that sugar

into fuel because of insulin resistance associated with diabetes. So this is why we also will recommend a ketogenic diet, an organic ketogenic diet that's low toxins, but high nutrients. And then we also want to know, you know, functionally, do we have enough B-12 to methylate and keep our homocysteine down that's associated with brain atrophy? So toxins, nutrients, stressors are another component of this. And again, it's too much or too little. We don't want to check out in our retirement and not have any purpose and meaning in our life, but we also don't want to be so stressed that we're not sleeping or we're not taking care of ourselves. We're not getting self-care. We don't have the capacity to get exercise or see the people that we love or eat good food.

And then structure is another component. And one of the early detection, the things that we can do is look to see if we're genetically predisposed. So is there a molecular, structure that is increasing our risk for developing dementia in this lifetime. And APOE status is one of those things that we might want to find out in our 20s so that we can make different decisions throughout the course of our adult life to maybe get enough sleep to keep our stressors under control, to eat a brain healthy diet, to avoid toxicity that might later pull that genetic trigger, that loaded gun, if you will, and pull that trigger that will then lead to beta amyloid accumulation and neurodegeneration. So we talked about toxins,

nutrients, stressors, molecular structure, but also the macro structure. Is enough air getting in through our nose and into our lungs so that we can oxygenate at night or do we have obstructive sleep apnea? What about traumatic brain injuries? This can also be a structural component to cognitive decline and the production of inflammatory cytokines in the brain. And then also pain, Chronic pain over time can be one of those stressors. Is my hip bone connected to my leg bone, right? Or do I suffer with sciatica or chronic pain that keeps me from sleeping increases cortisol, which can become toxic to the brain?

And many of these have feedback loops. Toxins, nutrients, stressors, structure. Infections is another one. We know that COVID, herpes, Simplex 1, also P. gingivalis associated with gingivitis and Lyme spirochetes, H. pylori, basically if you Google or go into PubMed and put any sort of infection with Alzheimer's, you'll see that there's often a connection because some of these and some more than others will trigger the production of inflammation and beta amyloid in an effort to protect the brain.

So we want to make sure that those infections are under control. And then lastly, the sixth component of brain health, and again, put it in this context of balance, is signaling. Do we have enough of the signaling going to the brain that says produce new neurons, produce new connections between them, or is the signaling telling us to protect, to defend, to attack, and to basically reduce the capacity of cognition through being detrimental to the neurons themselves? So we want to enhance that signaling, usually through sex hormones like estrogen, progesterone,

testosterone, DHA, Pregnantalone, but also signaling hormone also includes vitamin D, thyroid hormone, brain-derived notrophic factor, and some of the other things going to the brain, basically putting us into a regenerative state. So those are our six components, again, just one more time. Toxins, nutrients, stressors, structure, infections, and signaling. And when we can do a cognoscopy to evaluate all of these, we know that different people show up at this diagnosis of dementia or Alzheimer's, but they've sometimes taken different pathways to get there. And so that's what we want to understand, is that precision medicine, how to do you? this individual get here so that we can kind of go backwards down that path and resolve these things?

We all may have some areas where we're not sort of optimal in these different categories, but what I'm hearing you highlight as a researcher in the space and a clinician who's working with Alzheimer's patients or those that are working hard to not end up with that diagnosis, is that, sure, we're not going to be optimal in every area. But if you are subpar on multiple areas, the combination of those things could be so much stress that they could increase your likelihood of ending up with Alzheimer's disease, or you could end up with a diagnosis as these things being key contributing factors. Is that accurate? Exactly. And they're not mutually exclusive, right? You might have a few of these. And then the way I imagine it, Drew, it's almost as if we're,

it's that downward spiral, right? It's like we compound. If we have a traumatic brain injury that's on top of our genetic predisposition and then we have a standard American diet that's very high in sugar that creates more inflammation. Now we've compounded the problem and it's more likely to turn into cognitive decline and potentially Alzheimer's eventually. But we can use that same concept and we can go in the other direction. We can spiral up. We can start stacking these interventions on top of each other. We can get the toxins out. We can we can adopt these brain healthy lifestyles And then we can make sure that that genetic predisposition never manifest as disease. We can be in the category of people with those genetic markers who don't end up diagnosed with

Alzheimer's. You know, the beauty of today's conversation and why I'm so excited to have you on is that this conversation truly is for everybody. If you're somebody that's my age, I'm turning 42 in a little bit. If you're 42 years old or you're somewhere in your 40s, you know, millennial, Gen X, you're starting to pay attention. Maybe even some of you are caretakers for parents who are on this journey right now. You're going to learn how your decisions at this age dramatically impact your likelihood of a diagnosis in the future or the lack of, that's our hope, of a diagnosis in the future.

If you're somebody that's older, you're going to know who, let's say you're in your 50s, 60s, 70s, 80s, and you are not at a place where you're experiencing, cognitive decline. First of all, congratulations because so many people are. And you're also going to know what areas to double down on or maybe give more attention to so you can stay on that road. Now, if you're somebody else that either is experiencing cognitive decline, knows somebody that has a diagnosis, unfortunately might have a family member that's in that camp or maybe that person is you, this conversation is also going to be interesting and exciting because you're part of some early and proof of concept research showing that focusing on these key areas following this protocol has led to, in a clinical setting, patients experiencing a reversal of cognitive decline where not

only did they stop getting worse, but they actually got better. Is that an accurate summary of some of the things that people are going to learn today? Yeah, absolutely. It's such an exciting, hopeful time. And I think unfortunately, people are still told by very well-meaning, well-educated neurologists, primary care providers, that if you're starting to go down the path of cognitive decline, if you have a family history of Alzheimer's, if you are diagnosed with Alzheimer's, there's nothing you can do. There's a couple medications. They don't work very well, but the message is typically, I'll see you in six to 12 months, will measure the decline and sorry, I've got to take your driver's license away. And that is such a, it's so, like even I can feel it right now

as I describe it, it's just such a depressing and it like takes the rug out from under so many families. They feel helpless and hopeless. And Dr. Bredison and many of the people on his team, they have coined this now false hopelessness. Because we used to say to suggest to someone that you could do something about their Alzheimer's was to give them false hope. But now we know there are so many entry points. There are so many things that we can do day to day. It really is those decisions that we make. is they feel like small decisions, what I decide to put in my mouth, how much exercise I decide to get

today, what time I go to bed, the people I interact with, how I manage my stressors, whether I pray or meditate, those decisions that feel very small, when we can consistently make good ones day after day after day, that is what changes the trajectory of our health as we age. That is what determines whether or not we get dementia. And the research supports this. So what we see from the medical conventional perspective is what there are some incentives right in the pharmaceutical industry and the medical industry to have these single molecule interventions that can be patented and that they're also simple to provide in a clinical setting. Right. Here's a prescription. Go to the pharmacy.

Get this fill. Take this pill or get this IV. And then hopefully you get better. But that paradigm doesn't work for a complex chronic disease like Alzheimer's. because of the multiple reasons that someone can arrive at dementia or cognitive decline. What we need is a more comprehensive approach that includes these healthy lifestyle behaviors. And so in the research, what we've seen is in July of 2022, Dr. Bredison and his team, the lead author on that paper was Kat Toops.

They published a trial in the Journal of Alzheimer's Disease. They took 25 participants through a nine-month intervention where they used this Breedison approach detailed in his book, The End of Alzheimer's. It's essentially that cognoscopy, treating all of the components in there, adopting an organic ketogenic diet, exercising, prioritizing sleep, and managing stressors. And this approach showed that in patients who had mocha scores down to 19, so mocha is the Montreal cognitive assessment, it's a way that we put a number on where someone's cognitive decline is.

A perfect score is 30, normal is 26 and above. They took participants with cognitive decline down to a mocha of And over nine months, they saw that 84% of their participants improved. This is amazing. Now, this was like my trial that was published a year later. It was a feasibility trial. So what we did was we compared baseline to an end point, a preset endpoint. And in their case, it was nine months.

What we would typically expect for someone suffering with cognitive decline like this is that they would have a three-point drop on that Moka score per 12 months. So if we see an improvement, this goes to the number of this goes to, This goes against the grain of what we would expect the natural course of that disease to be. So a year later in the journal of Alzheimer's Disease as well, I published our trial. I was a lead author obviously had a huge team of support to get this done and was very fortunate to have philanthropic funding for a six-month intervention, very similar to the Bredeson-Tube's paper.

We took 23 participants, but we did it in six months. We did a six-month intervention, and we took people who had more progressed disease. They had mocha scores between 12 and 23. So again, 26 and above is normal. 30 is perfect. As you go towards zero, people have more progression of their cognitive decline. So we took people with mocha scores between 12 and 23, and 74% of them improve their cognition after six months.

So just this year, another year later in June of 2024, Dr. Dean Ornish published his randomized control trial in the journal of Alzheimer's research and therapy. And I am pulling it up to redo the conclusions in the abstract, because it gives me chills every time I read it. And this is the first randomized control trial. And the story is changing so profoundly right now in terms of what's possible for those suffering with Alzheimer's and dementia. He writes, comprehensive lifestyle changes may significantly improve cognition and function after just 20 weeks. So this trial was five months in many patients with mild cognitive impairment or early dementia due to Alzheimer's disease.

This is radical. This is so exciting. We basically now have three trials that have been published in peer-reviewed journals that say that lifestyle interventions, that this approach helps to reverse the symptoms of Alzheimer's disease, the cognitive decline associated with Alzheimer's disease. And the medications that are available right now, even these brand new, you know, like front page news medications that cost tens of thousands of dollars, what they're going to be. do is they slow the rate of progression. You don't get better. You get worse, more slowly. And so

this is really, it's so empowering because everyone can make these lifestyle decisions. You don't even have to talk to a doctor. And you can decide to change your diet. You can decide to engage in more exercise or more stress management or reach out to those loved ones or prioritize and get better sleep. These things are all within reach. And they make a significant difference in how we age. So much to talk about there, but I want to start off with the six that you mentioned. When you look at our modern world and you look at communities or societies where Alzheimer's disease is much less prevalent than it is in the United States and other westernized ultra-processed food countries, if you had to rank them, even though every patient out there is different

and their contributing factors are different. If you had to rank them society-wise, in terms of the ones that give the biggest bang for the buck, and therefore also when we get them wrong, the biggest contributors to cognitive decline, especially for young people who are getting it now, even sometimes people in their 40s and 50s, which is so scary to see,

how would you rank them? What would you put as number one on your list of six that you mentioned? Yeah, this is always right. People are like, where do you start? And if I could just do one thing, what would it be? There's a whole section in my book. If you do one thing, like this is where to start because we want it to be easy and we want people to get that dopamine hit of success, but also the benefits, right? And so diet is pretty much always where we try to start. Now, not everybody's ready there, but if you can adopt an organic ketogenic diet, you will feel different. You will get that metabolic, that metabolic switch. flips and many people experience improvements within a few days. But that can be challenging. So the thing with diet, you cannot out supplement a shitty diet. You can't out exercise a shitty diet. Excuse me. I'm not sure if we're allowed to swear on your... Swear as much as you want. But it usually drives it home a little bit better, right? So you cannot, if you are eating a standard American diet, if you are eating fast food, I'm kind of like,

don't waste your money on the rest. Don't waste your effort on the rest because you literally are what we eat. And what we eat determines the health of our gut. Our gut, our health starts in our gut. And our gut starts in our mouth, right? And what we eat determines the health of our teeth, the health of our microbiome. So many other things come from what we decide to put in our mouths. Our energy levels, our blood sugar regulation, how well we sleep. So many things are impacted by that. And so if someone is willing to start with diet, that is where I see the most bang for our back. Within that category of diet, we'll come back to it, but just one or two things that are going to significantly move the needle forward when somebody's talking about cleaning up their diet to

support their mental health. Okay, so overarching number one piece of dietary advice that I have eliminate processed foods. So if you can start eating things that are from the plant, from the animal, from the ground, minimally processed. If it doesn't exist in your pantry, but it's on the label, like the malodextrin and the carigenin and the guargums, then don't buy it, don't consume it. That is the number one piece of advice I have. Now, if you're ready to take it a step further than that, or if you want more direction, then organic and keto is what I recommend and I think is the best brain healing diet. Now, interestingly, with the Ornish paper that was just published, they adopted a vegan diet. And I suspect, now this is speculation. There's no head-to-head trial.

has not been studied, but from my clinical experience and what I've seen, I think that probably what will bear out, the research will show us is that the best diet for brain health is going back and forth between organic keto with some animal protein, A2 dairy or sheep and goat dairy, grass-fed meat, wild-caught salmon, having some of that, mostly veggies, lots and lots and lots of veggies, lots of colorful veggies, but not raising blood sugar enough to throw you out of ketosis. Being in ketosis most of the time, maybe 60% of the time, a little bit more than half the time. And then going back and forth between that and a plant-based diet, always non-processed. I think that that will bear out as the best brain-healthy diet.

But that's yet to be determined, really, I think, in the science. But that's what I recommend these days to my patients. I think that it's not practical to stay in ketosis forever. And I don't think that it's also what we want. physiologically being in ketosis for three to six months initially for people who are already struggling with cognitive decline can be very brain healing and we see remarkable results with that alone and then what are we going to do long term hopefully go back and forth between always non-process and then ketosis and come out of it introducing more of the starchy veggies your carrots

your beets things that are again colorful but going to raise blood sugar and also your seasonal fruits your grains potentially like quinoa, maybe rice, things that are non-processed, but may raise your blood sugar so that you can back off some of the animal protein. You know, you mentioned the Ornish diet, and not only does Dean Ornish advocate for a primarily plant-based, actually exclusively, it sounds like according to this study on Alzheimer's patients, the randomized control trial, but also they tend to, and his protocol is mostly known for being low fat, because he believes that going low fat, follows sort of his theory around preventing heart disease that's there. Now, there's a lot of different approaches, and as you mentioned, there's no head-to-head trial

that's being studied out there to look at your approach, his approach. But the consistent themes are both diets that are out there that are part of these three diets, these three studies that you're talking about. Yours with the work with Dr. Dale Bredesen, and then obviously the Ornish trial that's out there, they all have removed ultra-processed foods. So I think that we can all learn that if our diet is primarily based on ultra-processed foods, which a lot of people don't realize that even drinking, you know, I'm not demonizing orange juice.

I'm not here to demonize any food that are out there. But if your diet is, you know, bread and butter in the morning and cereal and, you know, orange juice, that's considered ultra-processed. And it's not that those foods are necessarily bad. There's not bad foods in that way, but they crowd out the room for all these incredible and healing foods some you are going to advocate for, as I believe in my own bias, are going to be meat, higher fat foods, et cetera, but are also going to be plant foods, which you include plenty of in your program, and there's plenty in Dean's program.

So there may be some differences, but largely these diets are going to look very different than the standard American diet of fast food and ultra-processed food. Is that a fair assessment? Yeah, absolutely. And I think that what's exciting about this, and one of the reasons I like do a happy wiggle every time I read the Ornish paper is because there's not one way to do this, right? So there's going to be access for people who want or more drawn to the ketogenic direction. Then there's going to be people that are more drawn in the vegetarian vegan direction.

And I think that there's ways to do both of these things. Now, I do have concerns about long-term vegan diets and low-fat diets. I do think that there's a lot of benefit to B-12, and you want to make sure that you're supplementing with B-12. You're adopting a plant-based diet for any length of time. So I think that we might end up with deficiencies or excesses, having any of these, maintaining any of these diets for too long. And so that's the beauty of going back and forth. I think that when we look at these ancestral diets, right, before we had a highly processed food,

what we see is that ancestral diets, the consistent thing about them was inconsistency, that we didn't have access to fruits and veggies all winter long. They kind of went away and all we had was meat. And then when the sun came out and the plants grew, we had access to more naturally occurring fruits and vegetables. And so I think that like learning from the wisdom of like our ancestors and the rhythms of the planet, there's a lot of health that's generated from that. And so I think that that's part of my recommendation that people rotate their diets and kind of go in and out of different diets, if you will. But avoid always ultra-processed foods.

One more question about food. When it comes to a patient's body composition, whether they're over-feworthy, fat or under-muscled, have you seen those things play a role with the research, as well as the patients that you've clinically worked with? You know, how important is it for patients to start moving in the right direction with their body composition, not being too overweight, and in some cases for people, especially a lot of individuals from my background, Indian background, South Asian, that are under-muscled from having diets low in protein for a long period of time? How important are those things or how not important are those things?

Well, so I work with many women who are postmenopausal, right? And frailty is something that comes up a lot. And also when we think about what are the scariest things associated with aging from a doctor's perspective, it's up and from an expense, from cost, quality of life, like so many perspectives. What will make you dependent fastest on somebody else is a fall, is a breaking a bone. And one of the best ways to prevent that is to maintain much. muscle mass. And so we highly recommend this combination of diet and exercise, of course. And with

a ketogenic diet and often with some testosterone supplementation or at least DHA supplementation, some of the signaling that helps us to go in that regenerate mode, including our muscles, including building muscle. When we can combine those things, what we see are these shifts in body composition, away from excess, especially visceral adipose or that fat associated with our organs in the middle and towards more lean. muscle mass. And that, I think it protects us, that we see in the literature that that protects us from cognitive decline, from metabolic imbalances like diabetes, insulin resistance. It helps us prevent falls and fractures. It helps with bone, basically going from osteoporosis to osteopenia.

We even see people resolve that over time. It helps with a ton of the things that are, and also, of course, building muscle, we say that that helps with mood. And so depressive. And so depressive, depression and heart disease, right? We're protecting ourselves, basically when we can engage our muscles, when we can engage physically, both aerobic and strength training, then what we see is we reduce our risk. If we could bottle this, right? We wouldn't have complex chronic disease as we age. We can reduce our risk of many of the complex chronic diseases that are associated with aging if we can get regular, moderate to various exercise. When we move out of diet and we look at that list of six, what would you put as number two in terms of priority that people should be paying

attention to? Yeah, so stress is where I would go next. And, you know, this encompasses quite a few things. But sleep deprivation and sleep apnea and that quality of sleep. So it's the amount of sleep. Ideally, you want at least seven hours of sleep and then about an hour and a half of REM sleep and 60 minutes or so of deep sleep. Now, these are, I don't want anybody. to get hung up on these numbers and then not be able to sleep tonight. But this is just to give us sort of guidelines for how much you want to be getting. Now, how do we get there? Many people will say, well, I can't sleep because I'm stressed or I can't sleep because I'm overcommitted and I've got things to do. And so balancing all these things, this is part of the human experience.

But what I've seen several times in my practice is women who don't snore or maybe they don't have a partner or their partner's heart of hearing, we don't know that they have signs of sleep apnea. And now in my practice, I have decided that anybody with any cognitive decline, I am referring for a sleep study. This has gotten a little bit easier because we can do at-home sleep studies these days. The gold standard is still to go into an overnight sleep clinic and be evaluated. But if you don't have access to that or if it's going to keep it from getting done, just do the simpler one. Do it at home. Because when we've ruled in sleep apnea and been able to treat it, we see dramatic increases in cognition, even within people who have quite progressed

disease. There was a woman who I've been seeing her whole family for a while, and my favorite part of clinical medicine is having somebody tell me, I got my mom back or I got my husband back. And we see that happen really dramatically with such a simple intervention that's available to people through Medicare. It's covered by insurance, right? This is highly accessible. You don't need to see a naturopath, you don't need concierge medicine to go get a sleep study done and be evaluated and then treated aggressively for that. Now, both of these women who went, they started with mocha scores of eight and nearly doubled them within the year. You know, it was one went up to 16 almost immediately and the other one went up to 13 and then 15. And both of them were told that by sleep medicine

staff members that they did not have sleep apnea before they got their testing done. And then lo and behold, had severe obstructive sleep apnea. But they didn't fit this typical picture that we think of. Overweight male who snores at night. They were thinner females who were in their 80s. But this was having a huge impact on their cognitive decline. I mean, there were dramatic changes in how they interacted with the world in their quality of life.

Of course, the quality of their sleep, but in their cognition and in their diagnosis of Alzheimer's. So treating sleep and treating sleep is, I like revere sleep, right? It's so crucially important. I fully reject this idea that you can sleep when you die. We need sleep in this lifetime so that we have the chance to get rid of the toxins. This is when that glymphatic system rinses the metabolic waste out of our brain. It's when we consolidate memories.

It's when we kind of take the emotional bite out of things that have happened so that we're not as stressed tomorrow when we remember whatever that conversation that triggered us from today. So stress is a big component. And what I recommend people do is if you're traveling, having trouble with sleep, adopt a meditation practice or a prayer practice right before going to bed. We all have morning and evening routines, whether we're proud of them or not, we have them. And it's such a great place to start adopting these healthy behaviors because it's anchored to whatever we're doing right before we go to bed or right when we wake up. And so if we can

anchor, again, if we can connect one of these healthy behaviors like a meditation practice to that morning or evening routine, we often get outside's benefit and more. We're more. We're more likely to maintain the new habit. And so that's one way that people can kind of immediately, starting tonight, you can start a meditation, even five minutes before bed. I mean, ideally maybe 20, 30, 60 minutes before bed, but even just getting started with a practice like that can have huge impacts on how well we sleep and then how much energy we have the next day so that we make better healthy food choices and better exercise choices because we have the energy to do it. You know, in your proof of concept study with the 23 participants, one of the reasons

it was so groundbreaking was because you showed that in a shorter period of time, people could improve their sense of cognitive decline that you guys were measuring, right, through this moka squirt. What did you tell them to do and follow in that shorter window when it came to diet and sleep? What did you have them doing and what did you have them not doing? Yeah, so we recommended pretty much the same thing to everybody. Many other clinicians, especially we'll ask, where do you start? Do you just start in the gut or do you just start with diet? No, we do all of it. We do everything. So we hope that people dive in fully. I mean, if we are treating people with cognitive decline on their way towards Alzheimer's or with Alzheimer's, we are

asking for a miracle. There is not an easy button out of this. I wish that there were. If I could give you a pill that would take that away, I would be screaming from the rooftops telling everybody about it yesterday. But this takes work. It takes effort. And We have the highest confidence when people start earlier in the disease process, so with those early warning signs or even before in prevention. And we have the highest confidence when people dive in fully, when they're not just dipping their toe into like, okay, maybe I'm going to reduce my sugar or alcohol and maybe I'll go to bed an hour earlier.

But when they're like, really like, okay, what are the supplements? What is, what kind of diet, how do I fully get into ketosis as quickly as possible? I'm getting my sleep study done. I'm getting my dental work done to make sure I don't have gingivitis or, I'm mercury exposure from in there. We were doing it all. So we were looking at all six components. And there were foundational things that we had everybody do. So one of them was a notropic supplement, vitamin D, omega's, probiotics. I think we did digestive enzymes for pretty much everybody. And so we did do some supplements for everyone. We had people change up their exercise. So we evaluated. Are you

getting enough strength? Are you getting enough aerobic? If not, how do we increase that? Or do we need to change it up a little bit? Have you been going for a run for 30 minutes every day for most of your life? And you're not ever getting strength training or you're not getting dual task exercise, which is where we combined both cognitive and physical exercise together. That's a great way to kind of get more out of your workouts. We had people prioritize sleep and make sure that they were getting enough. And we also have them wear watches to evaluate if they were potentially going towards a low O2 sats at night.

So we did evaluate for that. we had people start either a meditation practice. The Kirtan Kriya has a lot of great research on it. There's a gentleman Kassla who's published extensively, including review papers, that shows that Kirtan Kriya just 12 minutes a day of the Satanama meditation, that that increases the length of telomeres, it enhances insulin sensitivity, it helps with depression and anxiety, it helps with cognition, most importantly.

It helps with blood pressure. basically helps with a lot of these causal level factors that can create neurodegenerative disease. And so just 12 minutes a day, totally free. We recommended that everybody do that. And some people push back. They were more comfortable adopting a prayer practice or a gratitude journal or something different, but some sort of mindfulness practice every day. And so we had people drink half their body weight in ounces in terms of water. So we had them hydrate. We made sure they were having a bowel movement every day so that we could have, they would be eliminating. I'm sure there's other things that I'm forgetting, but all of this is in a diagram in the paper

and typically where we start with patients these days as well. And is that protocol also featured inside of the book that you walk people through? Yep, exactly. So a good reason for anybody watching today, if you want to know exactly what people did, it's reversing Alzheimer's, the new toolkit to improve cognition and protect brain health. I believe it came out just in June 11th around them. Exactly. And so it's available.

You can get on Amazon. We have the link in the show notes below. So a couple questions for you on this. For the individuals that went through your protocol, or let's say, you know, Dale Bredesen's study that you hinted at earlier, did you have? Because making the claim that Alzheimer's is reversible is a bold claim, right? And you know that and you addressed it earlier. Were there independent individuals saying that, hey, this person doesn't present with this disease anymore? Or is it based off of just the shift in the mokos?

score. Like, were there people that came in with Alzheimer's, and now they're not being sort of diagnosed as having Alzheimer's disease? Yeah, great question. So we did include people with Alzheimer's who had been diagnosed with Alzheimer's in the trial. And it's kind of interesting because, like, one of the gentlemen who was diagnosed with Alzheimer's, he actually had Lewy body. So it was like even a misdiagnosis. This is pretty common in the medical community, unfortunately. But we, even since we created the clinical trial, things like Ptow 217 is now available. the imaging that we get is now has changed so that we can get better diagnoses. In the book I talk about chapter two is really a, there's more to it than that,

but there's a summary essentially of the work of the book called How Not to Study a Disease, the story of Alzheimer's, which is by a gentleman named Carl Harup. And there's a lot of nuance and there's a lot of confusion and there's a lot of reasons that are absolutely not scientific that we diagnose something as Alzheimer's. And so really the diagnosis itself, I think we want to put a fancy word. We want to diagnose something so that we have this understanding. We feel like we understand it. Right. And yet it's such a complex disease that again, there's not one cause of it. There's not one way out of it. Now, to your point, you know, have we reversed Alzheimer's. So people who have mild cognitive impairment are on the way towards Alzheimer's, right? There's, these different stages of Alzheimer's. There's the pre-symptomatic phase that I was alluding to. That's where it's great before we even have any of these early warning signs,

before there's any symptoms at all. If we can understand what might lead to neurodegeneration, if we can catch it then, that's fantastic. So that's that pre-symptomatic phase. And then- Just like any other disease, right? Like cancer, the earlier you catch it, the earlier it is to treat it.

Right. And the reason people don't is because they're afraid of it. They're in denial because we thought there was nothing you could do, but that's not right anymore. That's not true anymore. So this really matters. Now, the second phase is that symptomatic phase. It's the subjective cognitive impairment where we're starting to feel different. And maybe our kids are noticing that we're not remembering things. We're not able to take on the activities that we used to. We feel more overwhelmed or confused more

easily. Then the third phase is where it's measurable cognitive impairment or mild cognitive impairment. Now, this is mild cognitive impairment. You'll see it abbreviated to MCI. This is a bit of a misnomer because there's nothing mild about this. This is basically on your way to Alzheimer's, probably not working anymore, having trouble keeping up with appointments. There's confusion setting in. And this is people often, this is making an impact in your life. Now, diagnosed Alzheimer's, some of this has been arbitrary for a long time. Like, where is it Alzheimer's versus mild cognitive impairment? And does, you know, what are people measuring? And to be clear, in our clinical trial, we did measure mocha scores, certainly. And we, we published that because we saw statistically significant improvements in that across the means.

But also, we looked at the Cambridge Brain Sciences battery of testing, cognitive testing. So we did more robust, validated cognitive testing than just the mocha. And both of those matched each other. So it wasn't just one type of cognitive testing. Now, if we were redoing this trial again, we would be looking at the imaging and we would be looking at the Ptow 217, which can give us directionality. Are we reversing this disease process? And in Brennison's group, the Ptow 217 wasn't available yet, but the imaging was.

And what you see is increases in brain size, right? So instead of atrophy, instead of shrinking, they were actually creating more brain tissue, right? So this is a reversal of the disease process. Now, there are people in my patient group that we need to publish that have had diagnosed Alzheimer's who have reversed that process. Now, this is not a cure. I want to be very clear about that language. You know, I think of a cure of like you get a UTI and you take a pill and it goes away and you never think about it again, right? Or you get pneumonia and you take some antibiotics and it goes away and you don't have pneumonia again. That's like a cure. And we've been socialized to kind of have

this idea that we should go to the doctor and get a pill and then be cured. That's not what this is. This is adopting a lifestyle that supports brain health and keeps us oriented towards that. regenerative direction versus that attacked, defend, shrink, atrophy direction. And what we see is that when people fall off the wagon, when they're not adopting that healthy lifestyle, they go right back in the direction of cognitive decline pretty quickly. And so this is really about adopting a lifestyle that helps to manage this potential towards neurodegeneration. And I think that when we're in prevention and delay mode, we have a lot of luxury, right? If we can go a little slower. We

don't have to do as much to get the outcomes and the benefits. But once we're on that path towards Alzheimer's, it's less likely we're going to be able to turn it around. There are no guarantees in this. And it takes more work. It often takes labor of love of someone who's willing to put aside time and effort and energy to put into making sure you get the right diet and you're getting to the exercise and you're getting to bed on time and you're getting to the sleep study. All of those things you're relying on someone else to do it. And so it's much more challenging, much more effortful. But we see it. We see people with Alzheimer's improve. Now, not necessarily go back to work, not necessarily get back to a mocha of 30, but we see them improve

often. That's incredible. Thank you for breaking that down, because as you've mentioned, this area is so complex and it's also so scary for a lot of people. But I think that what you're really bringing to the table here is that if somebody's willing to, you know, you can fall into sort of two camps for sort of simplicity purposes. Number one, there's a bunch of things that we're all doing every single day and some of those behaviors could be taking us in the direction towards cognitive decline and some of those are going to take us away from those. A lot of those six that you mentioned earlier. And so being aware that the majors match, and we want to focus on them.

The sleep, the diet, staying away from ultra-process foods, maintaining lean muscle mass, exercising, getting in some sort of resistance training or something that's challenging to the body at least a little bit, right? That can even be working with bands. It could be anything. Priorizing sleep, et cetera. But also, you're being realistic with anyone that's already experiencing as the medical industrial complex, we call it mild cognitive decline, you're being serious with somebody

and saying, look, that's very serious. And how strict you are is how sick you are. So if you are in that camp where you're already experiencing those themes, you are already having a diagnosis, even if that diagnosis is mild cognitive decline. If you want to see improvement, you have to not only take this seriously, adopt this as a lifestyle, this is just a new way of being, but also you have to give all of these areas priority until maybe one day, you know, five, 10, 15 years down the line,

you guys see that, hey, these things matter more than other things. We don't have to focus on these things as much. But at least the research shows right now that you guys are involved with right now and more importantly the clinical experience that all of these things, deserve equal attention, which is why you have patients go full on. Now, the question that I have is number one, is that right? And number two, then for most patients who are in that boat, anybody who's listening to

this podcast, would it be fair to say that if you're serious about this, you have to find a practitioner that you can work in conjunction with? Yeah, so I do want to make one point because, thank you. for, that was very eloquent. It could be wrong, but it could be eloquent, but it could be wrong. No, it was absolutely right. And I just want to double click on one thing there. No one in our trial did everything.

So you don't have to do it perfectly, but you have to be willing to do something significant. And so I think that that is, there's a little bit of nuance there. It's like, yes, we want you to dive in fully. We want you to be fully committed. You're going to have to work hard. But you don't have to do it perfect, right? So I don't want the perfect to be the enemy of just getting it done. And there can be so much joy in this.

Like, what are we going towards? I think of channeling like my inner Betty White. Like, I just want life to get better as I get closer and closer to 100. That we have the capacity to have really fulfilling, meaningful lives. And that's why we're making these decisions. We have the capacity to continue to connect with our loved ones and make memories and look forward to things and enjoy holidays and birthdays and celebrations into our 90s and beyond. And so we're making that choice. Like this is really about empowerment and choice and hope and looking forward to that phase of life. And that it's not about

deprivation and like and pain. But it's really about stepping in and taking this invitation towards this meaningful, fulfilling last chapter of life. And so you don't have to be on board. You don't have to take the invitation. And it's not for everyone. But there is hope. There is an option. There is a way to enhance cognitive function throughout our lives, no matter where we are. Fantastic.

And great reminder there. What about the second part of that question, which is that if somebody is in an unfortunate position of having some cognitive decline right now, you know, and I want the real answer because that's what our audience is listening for, are these things that they can work on on their own? Obviously, your book is available, reversing Alzheimer's, the new toolkit to improve cognitive function and protect brain health. Can they follow along and do these things on their own? Or do they need a clinician to play kind of quarterback who then sort of gives them guidance, but is also doing an honest cognoscopy and other things and then kind of familiar with this program so they can tell them step one, step two, step three?

So ideally, you get a quarterback, you get a clinician who is well-versed in this. We can do the testing to understand, is there a smoking gun here? Is there really high mercury that, like, if we didn't do the testing, we wouldn't have known about, or really high mold, or something else that is really driving this neurodegenerative process, that if we eliminate it, what a luxury, how incredible, wonderful. Yes, in an ideal world, everyone gets access to that. It's not the reality that we live in, however, and it's costly. It's expensive.

I have people who have brought in Dr. Brutton's book, dog-eared with underlines and notes in the margin, and have said, I am so much better or my mom is so much better just because we took this information and we put it to work. And now we're ready. We save the money and we put the time aside and we're investing in putting the icing on this foundational cake, right? And so it's both and if you can work with the provider and you have the financial resources or someone, you know, maybe close by and with telemedicine now, this is relatively,

easy to find, but just look up Bretteson trained provider in my area or close to me. And there are over 2,000 doctors who have been trained by Dr. Brettison. And I think having that person, and a health coach, health coach is great bang for your buck as well. Having that person on your team where you can get your questions answered, we actually do online health coaching as well. We do 12 big programs. It's actually where the book came out of is through those coaching programs. So we've had people from the comfort of their own home, never having seen me as a clinician, who improve their moka scores and improve their cognition and improve their quality of life significantly. And there are other people where that's not enough. They need more of the clinical handholding.

They need more of the testing. And that's a huge luxury when we can do that. And then we also, I created the immersive experience, Marama. So I've made the mistake true of telling people there was no hope of basically writing them off and saying like you don't have a capacity to do this or you're too far gone or your loved one's too far gone. And then they proved me wrong. And this has happened over and over again. And so I have learned the lesson the hard way of not telling people there is no hope because, I mean, I've just seen too many times. Somebody that has a mocha score of zero starts reading or starts talking again. And you're like, where does this come from? How everybody told me this was impossible. So I will never tell someone there isn't hope. Now the degree of help

that you might need to get that benefit, I don't know. But just getting started, that's why that was the impetus of the book is like, how can I get people that the, the, with the learnings, everything that I've learned, you know, everything Dr. Bretteson's learned, everything I've learned from him, all of the stories that we've seen, how can I get people the inspiration and the tools so that they can get access to this for $30 instead of thousands of dollars? But then we've had people trying to do it at home. They show up at Marama in the immersive experience and all of a sudden they get a little bit more benefit and they get even better. So it really is about what your capacity is, what do you have access to you, what

what's possible because not all of it is financially feasible for everyone. I'm going to come back to the beginning of the conversation where we were talking about early warning signs. What are some of the cognoscopy tools that you look at that maybe a lighter version or a consumer version could be available to an audience member who's even trying to get a snapshot of where they stand? Let's start off with the first one. The Moka score came out of, I believe you mentioned University of Montreal. Yeah, Montreal Cognitive Assessment is what Moka stands for. Is that something that our listeners can do on their own?

Can they take that test on their own? So you need, it's like a tech can do it, a clinician can do it. And there are three of these that you can ask for. One is called the Moka, the Montreal Cognitive Assessment. That's my favorite. It's the one that we use. The many mental status exam is another one. And then the Slums test or the St. Louis mental status test.

But this one is, these are all three 30 point scales and it's a way to put a number on where that cognition is. Now, there are also online. So CNS Vital Signs is an online way to test your cognition. And there are others that you can self-administer. So that is a great place to start. It's like, do I have an issue? Now, I think most people know.

Most people have us, if you're wondering if you have an issue, it's probably because you do. And now is the time to get started. And the side effect of doing these interventions is basically that your heart disease, your risk for heart disease goes down, your risk for diabetes goes down, your risk for depression and anxiety goes down, your sleep improves. So I really think that this is part of a healthy aging. I'm sure you've talked to Kara Fitzgerald. You know, she and I are colleagues, and we've laughed about how similar our approaches are. And she's looking at optimal aging. I'm looking at optimal cognitive function.

But the overlap is like the vast majority of it overlaps. There's some slight differences when we're looking at genetic predisposition for dementia or the medication somebody might be on. But really, the lifestyle approach is the same across the board. So you mentioned a couple of those. So the Moka score, it's got to be a tech. It's got to be somebody who's sort of trained. Trained in this process.

Yeah. Do you know if they have like a practitioner database or a tech database? You can look it up or you can just, it's free. It's a PDF that's available for free online. And then to be trained to provide the Moka, it's like $100. So you just have to try. to find somebody like mocha score tech in my area? Is that like a best way? Oh, probably going to your primary care provider or your neurologist and asking, can I have a mocha score or many mental status

or a slums exam? Okay, great. And if that doesn't work or somebody may not have insurance, which is an unfortunate reality, you know, here in the United States, you were mentioning a website CNS Vital Signs? Yes, CNSvitalS.com. And we were mentioning, Dr. Bredesen has his work through Apollo Health, and they offer that as kind of a screening. And then through them, you can get the initial lab work done that gives you sort of an, it's abbreviated compared to what we do, but it's a lab components of much of the cognoscopy that we discussed today. Got it. And if you mentioned, and as you mentioned, there's also the Breedison Protocol Practitioner database. I think that's on the Apollo website. And so you can go on there.

It might be a monthly subscription. I think I've paid for it before. It's like, you know, not too expensive, $49. And you can find a practitioner for somebody based in different areas. You can look for an MD, an ND, a DO, you know, PA, health coaches as well, who are a cheaper option. Obviously, they can't do a lot of the testing fully that's out there. They can't prescribe, but they can at least get you started on some aspects. So those are some tools that are there. You know, you mentioned something that has been a little bit of a scary topic on this podcast

that's been getting a little bit more attention. And that is the topic of toxins, environmental toxins. Let's take a step back because from my sort of world of being a health layperson, people would talk about general toxins in the environment and the importance of avoiding, you know, pesticides and glyphosate and general things precautionary that we should be doing. but now I hear more and more practitioners saying, just like with sleep apnea, so many practitioners like yourself are saying we need everybody screened because there's so much misdiagnosis. I'm hearing more practitioners talk about how they need to screen their patients for some array

of environmental toxins that could be heavy metals in many cases, as you've mentioned. It could be mold that you're talking about or poor indoor air quality. why is the topic of toxins become such a big part of addressing when it comes to your patients, especially the ones that are dealing with cognitive decline? Okay, so first we need to come up with a new title for you because you're not a health lay person. You need a promotion from that. And then second, toxins. So it makes me like my heart swelled when you're like more practitioners are saying we need to screen everyone for toxins because it's like, yes, yes.

Yes, these are my people. Most of my patients, like I mentioned, are over 65. They've had a lifetime to accumulate toxins, metals, mycotoxins, chemical toxins. And our world has only gotten more toxic. And instead of putting our heads in the sand or just getting frustrated or being angry about it, I'm like, okay, how can we arm ourselves with more information? And I think that the testing is a great way to do that because many of us don't know just how much we're being exposed to. And we don't test all of the tens of thousands of chemicals that are out there,

but we can get some sense with a panel of 19 of them or so. It's like, is this overwhelming for me? Do I have an overwhelming amount of toxicity in my system? Or is, am I doing okay? Am I, like, using the EWG site and it's on the Healthy Living app and Skin Deep? And I'm avoiding paraben and that likes pretty well. And yeah, I have some petrochemicals, but who doesn't, especially in Southern California. So maybe I should sweat some more. You know, we can start asking ourselves these questions and potentially eliminate and reduce those. They make a really big impact in the health and the function of our cells, not just the cells in our brain, but everywhere throughout our body. One of the ways that toxins really directly increase our risk of cardiovascular issues and

also vascular dementia is that they create a lot of inflammation in the endothelium. So in that inner lining of the blood vessels, and that can have a big impact on blood supply. I mean, and that's cardiovascular system, but like the blood is supplying our brain. It's supplying our big toes, supplying our everywhere, right? So we need healthy vascular. The rest of our body depends on it, literally. And toxins reduce the integrity of that system. And so I think that's a very straightforward way that these impacts our health generally,

but in the brain, glyphosate. Glyphosate sounds like glycine because they're very similar molecularly, and glyphosate will take the place of glycine and is associated with ALS or Lou Gehrig's disease. It's associated with Parkinson's and with other neurodegenerative diseases. And so taking that seriously, that's why we recommend an organic diet. But some people eat organic for the most part, and it turns out that they're walking around and tracking it in and their dogs are tracking it in because it gets sprayed on the sidewalks to prevent the weeds from growing.

And so we can be exposed in different ways. Or it's like that one thing that we don't give up, like the corn chips that are super sprayed in glyphosate or something, right? Like everybody's got their vice. And identifying that, recognizing it, seeing that it's there, and then feeling empowered to do something about it, whether it means upping our game in terms of sweating or getting our bowels moving or drinking more water

and just opening up the organs of elimination or really doing the detective work of where is this coming from and how do I eliminate my exposure? I think that those things are empowering and we see we see health shift when we make those decisions. And mold, I mean, to the point of other people you've interviewed, if I waited for people to tell me that they had a mold exposure, I would miss so much mold exposure. There are lots of people who think they've never been in a water damage building, are not aware of any leaks. And sure enough, we find that they have very high levels of mold. And maybe it was a previous exposure or we figure out that it's in their current home or their current work environment.

And then we can do something about it. And they typically feel much better. Not everybody has symptoms associated with mold, but we know that it's causing neurotoxicity. We can see that pretty clearly. Which of the toxins are you the most concerned about, especially when it comes to cognitive decline. Is there a one, two, and three that you're paying attention to the most right now? Yeah, mercury glyphosate and okrotoxin, I would say, are the ones that I am kind of hyper aware of. I see them the most frequently. And we have very accessible, reasonably priced treatments for this.

And so it's sort of, you know, it's satisfying, right? If we find them, we can get rid of them. people feel better and it's pretty accessible and easy. What was the last one that you mentioned? Mercury glyphosate and okrotoxin is one of the mycotoxins associated with aspergillus and penicillium exposure. Got it. So again, mold exposure in the home often, leaky pipes, rotting wood, often something that we can't see.

It's not the mold that we can see. It's behind the walls. You don't even know that it's there. And, you know, a good clinician like yourself or other individuals that are trained on the Brettison protocol can run some test and to see if there's actually those mycotoxin exposure inside of the human bloodstream or urine, et cetera. And if you're listening and particularly interested in this, I, Neil Nathan, Dr. Neil Nathan is another mentor of mine. He and Dr. Brutton are my primary mentors. And he, so if mold and

mycotoxins is something that's particularly concerning for you, you can find providers who have been trained by Neil Nathan or Jill Krista. or they kind of collaborate on trainings these days. And I think that they are doing the best work in the mold kind of medicine world. Fantastic. So, you know, on that list of six, we covered a lot of them. We covered the topic of toxins. We covered the topic of sleep and stress, right?

We cover the topic of diet. We might have a little bit more to say about that in a minute. We also talked about the importance of having healthy, stress, exercise. Again, I don't know if exercise was one of the six or if it was part of another one. Are there anyone's inside of there that we didn't cover that you want to get a chance to mention right now that are important part of the total package of addressing a patient's health if they're really going to get out of cognitive decline that they're already experiencing. Are you sure? I mean, I could talk about this for days.

Long format podcast. We're here. Great. I love it. All right, let's keep going. So yeah, exercise. Exercise fits into that stress category, right? Too much, too little in the wrong place at the wrong time. You can get too little exercise. You can also be getting too much. I don't see that as commonly. But getting enough exercise is part of like pushing against, right, we need to push against something. If we don't use it, we lose it, whether it's cognitive function, right? It's like a muscle or it's our actual muscles. So exercise absolutely fits into that stress category. There's another stress component, which is social isolation. So we know from the lands. There was a Lancet Commission report published in 2017 and updated in 2020. And some of the risk factors associated with cognitive decline and dementia risk include depression and social isolation. And so those go hand in hand. But community, we see Becca Levy's work. I'm a huge fan of her work. She's a researcher out of Yale.

She wrote a book called Breaking the Age Code. And if you've ever heard someone refer to how if you have a positive outlook for aging or if you're optimistic, you live seven and a half. years longer. That's her work. She also showed that Confucius societies, so societies that revere their elders, where there's a, there's, you know, we respect wisdom and, and, and experience. And, you know, unlike Western kind of Southern California culture where we value as youth, in those societies, also the American deaf community is another society or another community where there's a lot of emphasis put on the value of elders. We see that people even with ApoE, even with genetic predisposition towards dementia, that genetic predisposition is negated.

You don't have it. You don't have a higher risk for dementia if you live in a society that respects you as you age. And so again, this is like that channeling your inner Betty White or whoever you see is like this exemplar of healthy aging and what it looks like to enjoy life as you age. If we imagine that the best is still ahead, that there's more to come, there's more to look forward to, our muscle mass doesn't drop, our cognition doesn't drop. So she has recorded this over and over again. People actually get smarter as they age.

We kind of assume that there's this healthy, normal reduction in cognition as we get older. Oh, a senior moment. That's normal. It's not. That is a product of the society we live in and the stress of ageism. So that is something to just like, I think at a very high level, we have full, This is something within our grasp. We don't need a doctor to call a friend to make connections to show up,

whether it's a senior center or a church or at work or wherever your network is, in-person interaction with your peers is hugely important. And we see this at Marama, where people who have been at home kind of doing the Breitizen protocol in isolation don't do as well as when they show up and they're getting encouragement. They're celebrating. They're in community. There is something really, really valuable about community. we're social creatures. And we know that social isolation is worse for our health than smoking.

Basically, if you're a smoker and you go outside and you connect with people, that is the better decision than stopping smoking and being completely socially isolated, which is wild. Like, don't smoke. But it's just such a great illustration of like, oh my gosh, it is really bad for us to be isolated as humans. And COVID, you know, COVID illustrated a lot of this as well. So that's another component of the stress piece. There's a lot of components of the stress piece. I think that PTSD and high childhood adverse events, like high ACE scores, is also associated with cognitive decline later in life. So there's a ton of pieces that we could go into in terms of the stress.

So we talked about toxins. We talked about nutrients and diet. I mean, the gut. I'm sure you've had lots of experts on the gut brain connection and exercise, excuse me, not exercise, but probiotics, healthy microbiome, the ability to not only choose the right foods to put in, but then can we digest them? Can we absorb them? Can we assimilate those nutrients? And then can we eliminate what doesn't serve us? The GI tract has to work for the rest of us to work. So that's a component of the nutrient conversation. And then stress, we've talked about, I think

we've covered most of the big bases there. Structure, we talked about sleep apnea. We talked about molecular structure, APOE4, right? So if you are positive for one or two copies of APOE4, you have much higher rates of developing dementia. If you have two copies, there was a recent nature paper that essentially said that you are destined to get Alzheimer's. Now, I think that that's a little bit overkill. I think that we have some choices we can make in terms of lifestyle and reduce that risk, but much higher risk. You basically go from 13% risk to well over 50% of risk of being diagnosed with dementia in this lifetime if you have AboE44 status. So the idea is get the cognoscopy early, get all of this information so that we can be empowered to make the best decisions

for our brain health as we age. So that's the other structural component, I mean, traumatic brain injuries we could talk about. We could do a whole podcast on traumatic brain injuries. I'm happy to go into that. We haven't talked about infections or signaling much. No, let's talk about those. Okay. So infections, there's four big ones.

So Lyme spirochetes, pea ginger valis, or the bacteria associated with gingivitis, and herpes simplex one, these all have been found in amyloid plaque on our. autopsy. And what is happening, amyloid plaque is associated with Alzheimer's, right? This is the whole original Alzheimer's case that was published in 1903. It was amyloid plaque in the brain. It looks different. Histologically, there's structural changes in the brain that are essentially, they're not there to cause Alzheimer's. They're not there to cause memory loss as we age. They're there to protect us. So they get triggered, and particularly in people with genetic predisposition, this production of amyloid plaque is triggered when certain things show up in the brain that put our brain into that defend mode or attack mode. The brain is trying to kind of wall it off and protect the rest of the brain from these infections often.

So again, herpes simplex virus one, I'm an anthropopathic doctor, but if I have someone who's getting repeated outbreaks of cold sores, I will put them on valcyclovir or asy. like Levere at any sign of projome because we see in the literature people who are more aggressively treated versus those who are not have lower rates of dementia. And then the Lyme spirochet, so Dr. Richard Horowitz, who I'm sure you're familiar with and interviewed, he is one of the kind of preeminent Lyme doctors and I followed his work for a long time. I also followed Bob Moziani. So there are people in the kind of the Ilads Lyme world who I work closely with and will refer out to if necessary. Because Lyme is one of these things, again, where we see that it triggers neuroinflammation. And they're just like syphilis, very similar kind of structurally syphilis and Lyme are both spirochetes.

And there is a neurological manifestation of these diseases when it gets into the brain. And so it can directly cause cognitive decline. So we want to be addressing this. We want to be finding it early. We want to do everything we can to treat that as aggressively as possible. And Dr. Horowitz has people who have recovered their cognitive function through the treatment of Lyme. So it's something that we don't want to miss, right? We don't want to assume it's not there.

And I think vector-borne illnesses, Bartonella, Babesia, Lyme, of course, Borrelia, early. These things can become together often and create a huge immune burden. So we want to take it seriously, look for it, find a Lyme Literate doctor if that's part of your story. And then peach and javelis. So again, health starts in the gut, gut starts in the mouth. If there is inflammation in the mouth, for many people are familiar. If you've ever heard, you have a family member or a loved one who has an artificial heart valve or an artificial knee or another joint. Before they go to the dentist, they get antibiotics.

Now, the reason is because when we get a deep cleaning, it's more likely that we're going to introduce the bacteria, the bad bacteria in our mouth into the bloodstream. And what that can do is increase inflammation. We can actually measure this with LPPLA2. And when I see that elevated once or twice or even more, I am sending patients to a biological dentist because there may be an insidious infection in the mouth, whether it's under a root canal or under a crown or in the gums.

This can put some pressure on the nervous, or excuse me, the pressure on the immune. system that is kind of distracting. It's like irritating. It doesn't ever fully resolve because it's on a spot that doesn't get great blood supply. But gingivitis and latent infections in the mouth, and particularly in the upper teeth where it can get into the sinuses and cause recurrent sinus infections, this can lead to neuroinflammation and neurodegeneration over time. Not every time, not for everybody. I wouldn't tell everybody to go get every root canal out. But there's a reason to be cautious around them and to double click on it and to see if see a biological dentist get a

cone beam and see if potentially infections in the mouth and mercury amalgams in the mouth too might be contributing to toxic burden or infectious burden. So those are COVID. A lot of people have had the experience of long COVID and oh yeah, of course COVID causes dementia right because I fell demented after I had COVID or while I had COVID. And so that is a little bit of a different mechanism. It's not necessary. Well, maybe it's, maybe we'll find out that it is. But what's happening with COVID is more this hypercoagulability and inflammation, the cytokine storm that comes with COVID. And right, some people have long COVID or some people died from COVID. Other people never had a single symptom. Maybe you didn't even turn up positive, even though they were exposed.

There's a wide spectrum of how people responded to this. And for some people, there's this neurological, cognitive manifestation. And part of that we think is maybe, through vascular dementia of having more, like being predisposed towards clotting. So things like serapeptides, natokinase, things that arterial cell, things that can support the vascular supply to the brain after COVID can be potentially helpful and are worth discussing with the doctor if you're experiencing that cognitive brain foggy kind of feeling after COVID. So those are, that was a kind of brief synopsis of the infectious piece there. Now, again, if you look up H. Pylori and Alzheimer's, you'll see that there's connections. What we basically want

to do, we want to, we want to make sure that the immune burden, just like we think of toxic burden, right, if you have a ton of toxins, it's going to drive the signaling in your body and inflammation. We want to reduce that. If we have this huge infectious burden, it's going to drive this hyper-inflammatory state, and we want to get that under control. We want to resolve that. so that you're not constantly spending resources in that fight-defend mode. That's fantastic. Thank you. You know, you went to toxins, but before that you briefly just touched on the idea of, you know,

supplements and nutrients. And you talked about that earlier in the context of diet, that you had put people on certain supplements because it was things that maybe we might be deficient in, or in the case of the gut, making sure to really protect the gut. Can you just recap those? You know, as you mentioned, you said in the beginning of the interview, if you have a crappy diet, lifestyle, et cetera, a ton of stress, you know, supplements are not really going to do much for you in that sense. But if you are focusing on a lot of the basics and you need a little bit of supplemental boost, there could be targeted supplements that are supportive in this process. So just recap some of those

that you put people on during the protocol. And I would even add the perspective, Sometimes, like, this is the easy win. So sometimes supplements are the place to start. It's like, okay, if I take this supplement and all of a sudden now I'm able to sleep at night, that gives me the capacity of take on more. So supplements are sort of this window or this doorway into this world in many cases, because it's easy. It's the paradigm of like, let me just take a pill and feel better.

And it's not everything, but it's often a great place to start. So I start with Qualia Mind, which is, made by Quality of Life is the company. And it's a very sophisticated not tropic formula that I like a lot and has a little bit of caffeine in it, which many people can relate to this, right? It's like after that cup of coffee, I drink matcha. It's like, okay, my day can start after that cup of matcha. Like now my brain is on. And there is some benefit, I think, to coffee, a whole coffee extract we see is associated with cognitive function. So notropics are basically these supplements, whether the herbs or nutrients that help to enhance that signaling that says to our brain,

you know, produce the neurotransmitters that are going to help me think clearly and have that memory and stay focused and on task. And they also help to send the signals of neuro-generation, right, to create neurogenesis and synaptogenesis, the connections between them. So I think having a good notrophic stack on board makes a lot of sense. So nootropic stack, the one that I like is called qualia mind, Q-U-A-L-I-A, fish oils. Super important, lots of good data. I recommend four to five grams, three-to-five, three grams minimum of EPA and DHA each day. I'm a fan of the Zimogen products in Monopure, but the Nordic Naturals is another easily accessible

great brand that does pretty high-dose fish oils. So when you look at that, make sure if it says you just need two soft gels, but you're only getting a gram or 1,000 milligrams of EPA and DHA, you need to. you need to like triple or quadruple that amount. So just to make sure you're getting that brain healing amount. And then vitamin D. Vitamin D is a signaling hormone that supports cognitive function. And so getting enough of that, we usually like to dose it so that you're getting between

60 and 80 nanograms per millimeter on testing and blood testing. And for most people that ends up around 5,000 I use a day. Now, as long as you're not on a blood thinner, vitamin K2 is also healthy for brain. and bone health. And so you often see the vitamin D3 with K2 and that combination is great. You cannot take K2 or vitamin K if you are on blood thinner. So talk to your provider about that. Now, there are exceptions to that depending on which one you're on, but you want to have that conversation with the provider. So we talked about anotropic stack, quality of mind, fish oils, vitamin D3, hopefully with K2, if that works for you. Probiotics are another one that I really like because

of that brain connection. Now, eating fermented foods is the best, that's the gold standard in probiotics, it's fermented foods, things like sauerkraut, kimchi, kefir potentially, if you're not lactose intolerant. I like the goat kefir's kombucha, make sure there's not too much sugar in there, but there's lots of different ways to get fermented. Most cultures have a fermented vegetable or something, and that is the best way to repopulate. Also, avoiding sugar, the ketogenic diet is an anti-candita diet. It often starves out those bad gut bugs, and that can have a dramatic impact on the health of our gut alone.

And then getting enough fiber, right? A diet has a huge, huge amount to do with the health of our gut. But we can kind of cheat the system and take a encapsulated probiotic that can make a big difference often as well. My favorite one is probiotics by zymogen. And then digestive enzymes are another one that comes up, particularly in an aging population or in a highly stressed population, which is most of us. When we're overeating or we're mindlessly eating, we don't always digest

and assimilate our food. And so when we get a little extra supplemental support from digestive enzymes, that can help us to get more of the nutrients out of each bite that we take. And so considering a digestive enzyme with or without hydrochloric acid or BT and HCL, depending on your preference, maybe talk to a provider or health coach about that, but there are different strategies with enzymes, whether they're digestive or proteolytic, but there's a lot of benefit from using those to reduce information and get more bang for your buck when you eat good high-quality foods. Amazing. You know, it feels like on the topic of brain health, creatine, which is one of the most

studied supplements in the history of supplementation, primarily for its role in supporting lean muscle mass gains, a lot of people now are talking about it. in the role of cognition and protecting our brain health. Any thoughts about that being part for people stuck? Absolutely. Look at kidney function. Sometimes as people age, their kidney function can go down and so amino acids and protein and stuff, collagen, we want to just be somewhat mindful of. So people ask about, like, what about methyl B12? How come that's not on your list? Well, because I look at homocysteine and then we decide. And, you know, if you tell me your sleep is, isn't great, then we're going to add some sleep things day one. If you tell me that you're not having a bowel movement,

we're going to add, you know, things to get your bowels moving day one. So the list that I just gave you was kind of like general. Most people get benefit from that. Now, creatine and the amino acids, collagen powder, I often will end up recommending things like that for, for patients. And not all collagen powders have creatine in them, but creatine is made up of a couple of amino acids. And sometimes you get collagen powders that have those components or creatine itself. Anyways, there's lots of ways to get this. And I basically, make that decision when we have the labs back. Is someone deficient in this? But I have had many patients tell me that creatine seems to help their cognition. Yeah, so clinically, I've seen that that

bears out. And then one of the things just to, you know, people hear you, they're really excited about the work that you're doing. You're a clinician, a naturopath, who's writing and seeing people every day and getting results. I've been a little bit more, you know, making sure that people understand the conversation of sugar in context that's there. You know, you mentioned like avoiding sugar. Of course, people are going to eat sugar through anything that they have, anything that's going to have carbohydrates, there's going to be sugar inside of it. Sometimes my audience, some listeners are like, look, I'm trying to avoid sugar, but I'm looking at it and it's in everything. I think that what you mean, and I'll let you, you know, talk about it further,

is we're talking about avoiding added sugar inside of the diet, generally sticking towards lower glycemic fruits and vegetables. Is that what you generally mean on the topic of sugar? Yeah, so it depends on your goal. So for us, often the goal is to get into metabolic ketosis, where we're burning fat for fuel. And in order to do that, you really have to restrict carbohydrates pretty significantly. And a CGM, a continuous glucose monitor, this is just my new favorite toy.

I prescribe it for pretty much everyone I see for all new patients, anybody that will take one and use it, I am happy to facilitate getting them one. Because we're in a CGM, I actually have one in the other room that I need to put on today. It's been so eye-opening for me personally. I learned so much when I use a CGM myself. And for patients, connecting the dots, basically making those connections between what I ate, yes, what I ate and what happened to my blood sugar and then how I felt during that spike or during that drop. And then also how my blood sugar responded not just to what I ate, but to my stress, to how much I slept or how well I slept, to the exercise I just got or didn't get today. Seeing how each of these behaviors contributes to this measurable shift in my blood sugar status, and then how I feel with that is so enlightening.

And then seeing that we can make these behavior changes, that we can adjust how we eat or what we're doing so that we get more stable, blood sugar and maybe even get into ketosis. Just like making all of those connections, I think has a huge impact on the choices that we make. And it has an impact on behavior change. It basically makes it easier to adopt a healthy brain diet. Now, I don't think everybody needs to be in ketosis all the time. I'm not saying that seasonal fruits are bad and not healthy. I think there's a great place for them. But metabolically getting into ketosis and going in and out of ketosis, getting that metabolic flexibility of going back and forth, I think is very, very healthy. It's very health promoting and helps with healthy aging and brain health over time. So it's not that sugar is always

bad, but too much sugar and not having periods of sugar restriction or carbohydrate restriction, I think we miss out on the benefits of that metabolic flexibility and the ketogenic diet, that our ancestors, you know, we're programmed for that to go back and forth. Great. Thank you for that. As we zoom out over here and we're putting this all together, what are the messages that you want to share with our audience when it comes to, you know, if you look at the statistics, it's abysmal and it's scary, the rate of people that will end up with Alzheimer's. And then you forecast out 10, 20, 30, 40, 50 years ahead. It's astronomical. You know the stats better than I do. and you could talk about them.

What do you want to share with our audience about why this new approach is worth us paying attention to? I mean, it's hopeful. We don't, I believe that we can get to a place where Alzheimer's is optional. I'm 41, about to be 42 as well. And for our generation, I think we can choose to not get this disease, to not have to put our kids through the burden of having to care for us. I really do think that that is within our reach.

And I think that we're going to get help from technology, and we're going to get help from hopefully these first-generation drugs, the monoclonic antibodies for aneloid, things like Lechembi, Lucanamab, and then the new Elyli-Li-Lyloin Danam are now available. And although they don't work that well, they slow the rate of progression, I think that the combination of hopefully the second generation of that or the third generation of those medications, they figure out a way for them to have less of the side effects,

more of the benefit, and then in combination with these lifestyle choices, my hope is that our generation does not have to suffer with this disease. And I think that there's also, you know, again, scaling, like zooming out, what causes complex chronic disease, highly processed, ultra-profitable, highly palatable food that is not really food? And that is when we think about, like, what do we, when I think about what's causing the problems of the world today, like what it basically comes down to is farming and food. Where do we get our food? What's the health of our soil?

And can we make decisions for ourselves and our families to get higher quality food so that we become that, right? That is what makes up ourselves. And so when we vote, when we vote with our dollars, when we buy food, get it from the farmer's market, grow it yourself, make these vote for people who support regenerative farming. and let's, you know, let's try to solve these problems together. And I think that what it ultimately comes down to is the quality of our food and the food

system. I think the medical system has at play here as well. You know, that's in trouble. But if we can solve the food and we can have healthier people, I think we're more apt to be able to solve the problems at face society. And then also getting the wisdom and experience of our elders into these conversations, not having them siloed away in memory care and senior living, but getting them back. in the fabric of our communities through maintaining healthy aging lifestyle practices so that

they're adding value not becoming a burden. That's huge. Probably one of the best things I've done in my adult life is convincing my parents to move from Delaware, which is where we primarily grew up in when we moved to America from Nairobi Kenya. And right before the pandemic, we convinced them to move down to San Diego closer to where you are, not too far away. Your clinic is based in Encinitas.

And just having them nearby, being able to see them on a regular basis, having them close to my brother-in-law, my sisters, my brother-in-laws who are really into fitness and have gotten them using the sauna, fitness, they have a walking group in their community. It just brings, you know, a huge smile to my heart. Because, number one, of course, I care for them, and I want to have them in the best health possible. But number two, just being nearby family and not having them age separately from family and grandkids and these other things, I know that plays a huge part on their happiness, but also their health span and their lifespan.

So it's been an amazing opportunity to have them nearby here. And to the last point there, to be able to learn from them, all the wisdom, you know, I love my parents. and anything I can learn from them on how I can be a better human being is fantastic. One thing that I want to bring up here is that in your interview with Dr. David Perlmutter, one of the topics that came up, and I love that, and David's a good friend of mine, one of the things that came up in the conversation was the topic of these peptides, GLP1 agonist. And surprisingly, how they also might be able to play a part, right?

apart, as I understood from the conversation, of helping us tackle this big, big problem of cognitive decline, which here in America, it's impacting both people that are well off, that can afford organic, et cetera, that are listening to podcasts, but it's also impacting people who are not well off, who are struggling with severe obesity, access to food, etc. And are hyper addicted to, you know, the different processed foods that are in our environment today. What do you want to tell our audience about these GLP1 agonists, just that they should be

kind of paying attention to of their possible role in helping us tackle this crisis? Yeah. So I think many people are surprised when I'm not totally opposed to OZMPIC. There are issues, right? And right now supply is one of them. Cost is another. They're not always accessible. especially the people that potentially can benefit the most.

But I do think that this is part of the equation. If we can reduce inflammation, I mean, I use osympic or semi-glutide as a mass cell stabilizers to reduce inflammation in the system and low doses. That seems to work. There's a lot of utility to these GLP1 agonists. And so I think if people have access to them, if they can get them, it's part of a whole body approach. I think this is one of these like literal you can have your cake and eat it too,

kind of things, right? You can eat whatever you want and not gain weight, not have the insulin resistance and the diabetic directionality happening when you use these drugs. So I don't know, you know, is this the solution? I think it's part of a comprehensive approach and I'm certainly not opposed to putting that tool to work. Particularly, you know, there are dementia patients who are drinking excess alcohol and eating excess food. Now, it makes me wonder, like, could therapy be potentially part of the solution? Right? We want to take a whole brain, whole body approach.

Why is there this need to overeat and overindulge in alcohol? But when we can reduce the cravings, then we can, you know, reduce the exposure to the toxin of alcohol and reduce the exposure to the toxin of sugar. And now all of a sudden, we're going to be able to do that. to get better outcomes. And that can be that bridge. That can be certainly part of a solution. I don't think it's the entire solution, but part of one. That's fantastic. Now, I've been asking practitioners for a long time now because we want to hear people's clinical experience. And there is a shift that's happening in the conversation. A lot of practitioners like yourself

who are having open and honest conversations about the role that some pharmaceuticals, and in this case, you know, these gLP ones, they're peptides. And if, If you're using certain tools in the toolbox to help people get healthy, I want my audience to know, whether it's supplements, a prescription, peptide, exercise, whatever. Let's talk about it all on this podcast. So I appreciate you sharing the both sides of that and how you have been using it as a tool in the toolbox. But it's not the magic bullet that's out there for everything. Ultimately, all roads lead down to habit change that's there in multiple aspects of our life.

but that doesn't mean we should throw out the baby with the bathwater. And peptides, you know, peptides are a much bigger conversation. C-Ling, C-Mex, cerebralicin, accessibility, again, you know, I think with all peptides, that's kind of part of what it comes down to is like, are they, can you get them? But there are peptides that specifically, dihexa is one that's being studied up at the University of Washington in an oral form. Peptides are something that we can use for cognitive enhancement. This is part of that signaling.

We haven't talked about hormones, but bioidentical hormone replacement, I think, has a large role to play in the signaling. How do we tell the brain to produce more neurons, to produce more connections or to create more connections between neurons synapses? They found it with Albert Einstein. They thought when they did the autopsy of his brain, that his brain would be larger. But it actually had more synapses. There were more connections between the brain. So that's what we're looking for is those we want to make the, we want the opportunity for neuroplasticity to make the connections and to create the neurons as well. The signals are really important to this.

And I think peptides play a role in that. Now, peptides like thimpsin alpha-1 that can help with immune burden and immune modulation, BPC, which can help with gut function. For certain patients with dementia, we're using these tools when we have access to them. And I think it's an exciting time in that. And I hope that they become more and more accessible and better studied. And then also, like stem cells, exosomes, there's a whole world. The last chapter of my book is kind of like looking forward,

what's next? And I think that there's a role for some of these things that have been used in the neurodegenerative world, but in the regenerative medicine world where those can start to augment what we're doing, make it easier, quicker, faster to get even more benefit. You know, on that topic of things that are up and coming, one that I feel like is just worth mentioning that I heard you also talk about was oxygen therapy. as being one of the tools in the toolbox for patients that are on their way or are currently experiencing cognitive decline. What is oxygen therapy? And why would somebody might want to try it? Yeah. So I think that there's oxygen therapy. And then also there's carbon dioxide therapy, believe it or not.

And I think a lot of us think of carbon dioxide as a waste product is something we want to get rid of. But carbon dioxide in the body can actually play a role in enhancing our ability to put oxygen into the cells where it's needed, right? So carbon dioxide helps us to vasodilate, and it can increase the disassociation of oxygen to get it again where we need it. So what I recommend is either exercising with oxygen for people who are older and kind of going in the frail direction or haven't been exercising much, what we're doing is we're exercising and then breathing in concentrated oxygen, sometimes as high as 80%. And this reduces lactic acid build. And it reduces. Lactic acid, up, we have more stamina. This can help us to kind of gain that confidence that we're ready

to get more involved in exercise and start adopting more exercise programs. Now, there's other ways to use this. And Dr. Prometter is a fan. We were chatting about hyperbaric oxygen therapy. And there are studies. There was a study done in Florida, an Israeli group, who used large, hard chambers. And so putting pressure, so you're not exercising, but you're in a chamber, not the type that you typically see at like a chiropractor's office that are soft, but a more robust one where the pressure is higher, I think up to about four ATMs. And then the contrast is between the pressurized oxygen and sea level. So pressurized oxygen is like you're going scuba diving, like you're going below the sea level and you have the pressure of the water. And that's

essentially what they're approximating in a hyperbaric chamber. And so you're getting more oxygen be driven into the body that way. Now, there's another way to use this. And so they see good results with dementia, when you go back and forth between being in that hyperbaric chamber and then coming out of it, being in it and coming out of it. And it seems to trigger basically an uptake of oxygen, right? Like, as you would expect.

Now, this hormetic effect, I'm sure that you've had lots of people on this show talking about this hormetic concept, right, where you stress the system, with the goal of getting more resilience on the other end of that stress. So we see this with fasting. And the ketogenic diet is a fasting-mimicking diet. Typically, this kind of thing puts us into a synolytic state where we're actually getting rid of old kind of spent cells that aren't operating optimally.

We push them over the edge towards apoptosis. So we get rid of those cells. We recycle them. And then we also get the signaling associated with new, again, that regenerative, that new cell. So fasting mimicking diets do this. Fasting itself does this. Exercise does this, right? Like what we're doing when we do a bicep curl is we're putting microchairs of the muscle

and that's that repair. It's the stress on that that then makes more resilience, more strength. We can do this with hot and cold. This is kind of Wimhoff and that whole idea of cold therapies. And going back and forth between hot and cold, this is a classic in naturopathic medicine. We had an entire year on contrast hydrotherapy and the benefits of it. That was back before it was cool. but it's still cool, even cooler, literally, and Wim Hof has made it very accessible.

These places are popping up all over the place where you can get the benefits of that and be guided through it. Now, another one is contrast oxygen therapy. So again, it's in this hormetic category. We don't recommend the people who are super frail or with severe dementia do this, but I've had lots of patients experience contrast oxygen exercise where we go from high altitude. basically at like Everest, right, where you're getting 8% oxygen, very depleted oxygen for sprints for like 90 seconds or two minutes. You drop your O2sats. CO2 builds up. You get vasidilatory benefits. And then you flip the switch. You go to concentrated oxygen while you're

working while you're exercising. So we're getting blood flow all over the body. And then you get concentrated oxygen. And we see these pretty incredible benefits of more energy, more detox. talks, people get through this senolitic experience. And then also higher mitochondrial density over time when we do this. So kind of stereotypical hormetic effect, you stress the system. It's very uncomfortable. Lots of people aren't willing to do it. But on the other end of it, people get that mental clarity and energy in particular. It seems like the mitochondrial enhancement is probably a big part of the mechanism because people tend to have a lot more energy. after a month of doing this pretty regularly.

That's awesome. And where would somebody find something like that? These are going to be like biohacking sort of places that people go to. Yeah, yeah, exactly. So actually chiropractors will have them. You can go to live.0.2.com and if you call them or reach out to them, they'll tell you if there's somebody in your area that has one. And they then exactly.

It's like biohacking centers. There's a place called Fitness Genome down the street from my house where they've got one. and you can go in there and they've got all kinds of gadgets and lasers and, you know, all these fun tools and contraptions that you can use, but that's one of them. And there's a lot of places popping up like that. That's awesome. And always good things to, you know, pay attention to, to look at, but really bringing it back to your book and the message today is that first we need to major in the majors. We need to focus on the most important things. That list of six, especially if we care about cognitive decline, with the heavy emphasis on the dietary factor,

avoiding ultra-processed foods, you know, getting to that place where you have a balanced blood sugar, or at least have metabolic flexibility, you know, potentially training your body how to dip into ketosis if you're more serious or have a diagnosis that's there, sleep, stress, exercise. You know, those are the things of the foundational. and the beautiful thing about it is that you've written about them and you walk people through what you had the individuals in your study do. And remind us again, in how short of a period of time, did individuals in your study see an improvement

when they focused on those areas on the Bocas score? So we measured our endpoint, our primary endpoint that was predetermined was six months. But we often have people in four weeks having improvements. Three months is very, very common. So the benefits of this come quick for most people. Now, not everybody. Sometimes it does take six and 12 months. It takes a little bit longer. But for many, many people, the results are quite quick, especially if they're willing to jump in and do the work. And in the Ornish trial, it was five months was their primary in point. So other clinicians are noticing this too. This happens faster than you might think. Beautiful. Again, the book is out reversing Alzheimer's, the new toolkit to improve cognition and protect. brain health. It's a fantastic read. Thank you so much for putting it together. And if people want to reach out to your clinic or some of the coaches or providers or check out one of your courses that are there, where do you want to send our audience? Dr. Heather Sandison.com. My last name is spelled S-A-N-D-I-S-S-O-N.

Dr. Heather Sandison.com. Well, Dr. Sandison, thank you for being on the podcast today. I'm definitely a fan of your work and I'm excited that you were able to break things down so clearly for our audience today. Well, Drew, you are a masterful health guide. Thank you for the opportunity. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app.

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