Live Like a Girl with Dr. Mindy Pelz - Alzheimer's Toolkit for Midlife: Empower Your Brain Health with Dr. Heather Sandison

Episode Date: December 16, 2024

Are you worried about aging and memory health? Join us as we dive into strategies that empower women in their 50s to live healthy, vibrant lives while reducing the risk of dementia and Alzheimer's. In this episode, Dr. Heather Sandison discusses cognitive health strategies to combat dementia and Alzheimer's. This episode dives into the early signs of these neurodegenerative diseases, emphasizing the importance of lifestyle interventions, such as diet, exercise, and sleep. Dr. Sandison also explores scientific misconceptions around existing treatments, focusing on the benefits of ketosis, metabolic health, and innovative treatments. Dr. Sandison shares her professional insights and practical tips for those caring for aging parents, as well as providing guidance on the path to optimizing brain health at any age. To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://drmindypelz.com/ep266 Dr. Heather Sandison is the NYT bestselling author of "Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health". She is a renowned naturopathic doctor specializing in neurocognitive medicine and the founder of Solcere Health Clinic, a premier brain optimization clinic based in San Diego, and Marama, a residential program changing memory care to memory recovery. Dr. Sandison is dedicated to supporting those suffering with dementia and is the primary author of peer-reviewed research published in the Journal of Alzheimer's Disease. She is shattering common misconceptions about Alzheimer's teaching lifestyle change protocols that keep your brain sharp at any age. Check out our fasting membership at resetacademy.drmindypelz.com. Please note our medical disclaimer.

On this episode of the Resetter podcast, I bring you Dr. Heather Sandison. Now, this is another gem of a conversation for those of you that are either worried about dementia and Alzheimer's and memory loss in your own life, or those of you that are dealing with a parent that has dementia and Alzheimer's. and let me give you a little bit of a background on Dr. Sandison and what you're going to hear in this conversation because I think there's a lot for all of us to learn in what Dr. Sanderson is teaching. So for starters, she's a New York Times bestselling author and her book reversing Alzheimer's just came out. I can tell you I will be buying it because as you'll hear in this conversation, it's something that we can actually give caregivers if you have an aging parent.

She actually speaks directly to that caregiver that is taking, you know, that is feeding your parent and looking after your parent. What's really cool is she's created this new toolkit to not only help us improve cognition and protect brain health, but again, she is also trying to change the cultural conversation around Alzheimer's. And she studied under Dr. Dale Bredesen, who I have brought him on to this podcast. And, you know, with his teachings, her experience,

and this new book, it's really becoming clear that Alzheimer's is optional. So what you're going to hear in this specific conversation is not only the toolbox, you're not only going to hear this new toolbox that she has. And she goes through six different things that we can be doing in our life

to really make sure that we keep our cognition at its best. But then in the back half of the conversation, we went into ketones and ketosis. And where does that fit in to stopping Alzheimer's? Of course, this is one that's near and dear to my heart because I have witnessed over and over and over again in our community when you put a 60-year-old, a 70-year-old, an 80-year-old into ketosis,

you get their brain back. and it is really a quick, quick way into better cognition. So I wanted to understand from a science level, I wanted to understand like how do we actually get an aging parent into ketosis? When do we need to start thinking about ketosis in our own life so we can get that neuroprotective benefit from ketones? If you wanted to know anything from fasting to low carb dieting to the power of a ketone, on a person's brain, this is absolutely the conversation for you.

And, you know, with aging parents, the interesting part of that is we have other resources outside of just fasting them. We talk about exogenous ketones and what is, can they actually take a supplement and get those ketones in in a new way without having to change diet? So there's so much here that I hope will not only be beneficial to you, but also be ben, beneficial to an aging parent that you might be taking care of. So incredible toolbox on Alzheimer's, incredible resource, and I'm so excited to bring you Dr. Heather Sandison. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again.

If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Let's start the conversation of us just by welcoming you to the Resetter podcast. I'm so happy you're here. Well, thank you so much for having me, Mindy. It's a pleasure to be here. Yeah. So I always like to teach from humanity.

I feel like we're, you know, we're all swimming in this life together. And we're all have similar issues that we're dealing with. And I think a lot of people are in my shoes right now in their 50s trying to figure out how to take care of aging parents and are also trying to make sure that we don't get dementia and Alzheimer's. So where I'd like to start this conversation is from the place of what are the early signs? Like I'm going to start from my 54-year-old lens. What are the early signs of dementia Alzheimer's that I should be concerned about? So the first sign many people tell me about is an inability to come up with words, especially nouns or names.

And also this feeling of overwhelm, of, oh, 10 years ago, I would have planned that trip to Europe and it would have been no problem. Or I would have hosted that Thanksgiving dinner for 25 people. And it would have been a non-issue. But now that feels so overwhelming. I can't wrap my head around it. or I'm getting confused, and it just feels like it'll take too much energy for me to pull off something I used to be able to do.

So those are some early signs. But those symptoms, Mindy, they don't show up until decades often after the pathophysiological process starts happening in the brain. And so what that means is that there's this really empowering time for 10, 20 years, where we can do things to optimize our cognitive function so that at the very least we delay and prevent that from happening. And sometimes we can even reverse that. In fact, oftentimes we can reverse those early signs.

And even in late stage dementia, we can get some improvements. Now, none of this is a cure, right? You have to stay on the program long term in terms of diet, exercise, lifestyle interventions. But there is so much hope for this disease. And when it comes to aging parents, many of them are stuck in that, you know, medicine of the 1980s. and maybe 90s. The doctor is the penultimate.

They know best, and they're going to tell me what to do, and they're going to have this cure for me that comes in the form of a pill or an IV maybe, and that's going to solve my problem. The science is going to catch up, right? This promise of better living through chemistry and all of those messages that our parents were told, they still hang on to that. And then when they go to the neurologist and they're told, sorry, there really isn't a medication that can help.

There isn't much that we can do. go ahead and put your affairs in order. Sorry, I've probably got to take away your driver's license. I'll see you in six to 12 months and we'll measure the decline. That is heartbreaking and they take it as gospel. And unfortunately, it's factually inaccurate that there's nothing we can do for dementia Alzheimer's. In fact, there's almost an overwhelming amount that we can do and getting strategic about it and getting organized about it so that we can help to our aging parents who might be starting to suffer and then also most importantly help ourselves so that we can prevent, you know, our kids from bearing the burden of caring for us later.

Yeah, it's a really interesting time of life because I feel like I, my kids are 24 and 22. So they're off doing their adulting. And for the first time I have freedom. And now I'm looking at my parents and really having to parent them. And so, and then in the parenting of them, I've been thinking a lot about how do I make sure my parents are 85 and 88 and I'm like how do I make sure I don't end up like that. So it's like a really weird juxtaposition of like you're caring for them. And at the same time, you're like, how do I not end up here?

So can we start with this thought of what's the difference between dementia and Alzheimer's? And just so we're clear on that. And what, like right now in my 50, you know, almost 50-fifth year, what do I need to know about my lifestyle now so I don't end up with dementia and Alzheimer's? Like, are there foods I can eat differently right now? Foods I should be avoiding right now. And, you know, what's that difference? Because I think dementia and Alzheimer's just gets thrown out all the time as sort of mixed together. Is there a difference? Yeah, so dementia is the umbrella term.

And underneath that is Alzheimer's dementia, which is a type of dementia, right? Dementia is memory loss associated with aging. And Louis body dementia, which Robin Williams had, frontotemporal dementia, which Bruce Willis was diagnosed with earlier this year. These are other types of dementia. Vascular dementia is another form. So there's many of them, and there's a lot of overlap between them. So somebody with Louis body pathology often has amyloid pathology.

So Alzheimer's disease is characterized. by beta amyloid plaques and tau proteins that are misfolded and they create these tangles. And so these changes in the brain structure, essentially, are what typically characterizes Alzheimer's disease. Now, that being said, there's a lot of confusion, even among neurologists, that when everybody has amyloid plaque, except for 2% of the population when you,

this was a 2011 study showed that if you take all of the people of the planet, essentially, from babies to centenarians, only 2% of the population does not have amyloids. So we all create amyloid. In fact, amyloid is there to protect us. It's antimicrobial. So it's we pull that trigger when there's toxins or infections that create some inflammation in the brain that promotes the production of amyloid. When we don't get restful sleep, we don't clear the amyloid so then it accumulates in the brain. And so there's lots of things that we can do to reduce

the production of amyloid. But knowing that, you know, even though Alzheimer's is kind of characterized by this, when we get rid of of amyloid, we don't get better cognition. And part of that is this paradigm, right? This one pill for an ill that if we get rid of, yeah, if we get rid of, I hate the one pill for an ill. It's not a, it's not a helpful, it's not a helpful mechanism when it comes to healthcare. Well, and it doesn't work. And we've spent so much time and money putting effort towards us as a society, right? Our taxpayer dollars goes into funding these potential cures. And when we get rid of amyloid, we see that we're good at that. We can get rid of the amyloid, but it doesn't improve cognitive

function, which is where the rubber meets the road. That is what we care about as we age, and if we're worried about developing dementia. So what can we do? If Alzheimer's is the most common form of dementia, it's associated with these amyloid plaques, but that's not the whole story, right, because there are people who are centenarians who have plenty of amyloid plaque but have good cognition. There are people without amyloid who have been diagnosed with Alzheimer's, then the testing and diagnostics are getting better, but what we really care about is cognition as we age. And so how do we optimize for that?

Well, we can go upstream of the amyloid, and we can start applying a different paradigm, a complex system science paradigm, to neurodegeneration. Now, whatever the diagnosis of dementia is, whether it's Lewy body or vascular dementia, or frontotemporal dementia, or Alzheimer's, we can say what we want to do is improve the health of every neuron, of every cell in the brain and the connections between them.

So when we think through that, you know, I have a house plant behind me, right? If we were to see a house plant that was suffering, we wouldn't look at it and go, oh, misfolded proteins, we should get rid of those and the plant will thrive. Right? We would think, is it getting enough water? Is it getting enough light? Is it getting enough? Does it have too much water, right?

Does it have toxins potentially? Does it have nutrients in the soil? And if we apply the same concept simple and if we're systematic about how we apply these concepts to the brain, we can think through the causal level issues that might potentially trigger amyloid or Lewy body pathology or tau pathology. And when we turn that off, we get better neuronal function. So is there a checklist we can lean into? I geek out on neurons.

I love neurons. And there's just so many, there's so much going on in the connection between the dendrites and the neurotransmitters and then the toxins that can get stuck in there. Like, you can spend your whole life, obviously you have, really understanding neuronal health. But is there like a checklist of like, here are the five things you want to do every day? Six. Great. Tell me what they are. So what I'm going to actually start with is this framework, right? The six components of brain health.

If there is imbalance in any of these six factors, then we are going to get downstream dysregulation. So we want balance the right amounts at the right time and the right place of toxins. We're going to get toxins in our brain. That's just part of living on Earth today. And it's part of cellular metabolism. There's waste. And so we need to be able to get rid of that.

So toxins, the right amounts in the right place at the right time. Nutrients. Again, you talk a lot about fasting and metabolism and how. crucially this is, how crucially important this is, not just for brain health, but right, for bone health, for healthy metabolite, for cancer prevention, for diabetes prevention, for heart health optimization. We need to be aware of our metabolism and our nutrients, right, at a macro level in terms of carbohydrates, fats, and proteins, but also at that micronutrient level, do we have enough minerals, do we have enough B vitamins, do we have enough

antioxidants, in order for our cells to be optimally functioning? Because that's what we're looking for is optimization. And then third, we want to look at stress, right? Many people people in your position, right, where we're considering being a caregiver. Caregivers for someone with dementia are anywhere from two and a half to six times more likely to be diagnosed with dementia later in their lives compared to those who never serve as caregivers. Oh, wow. Wait, so wait, wait, stop for a second. So that means now at almost 55 years old as I'm caring for my parents, definitely the stress has gone up. And that's leading me to the path, potentially, of what I'm caring for my parents for.

That's precisely right. And this is terrifying when you see spouses caring for each other, right? Like if your mom was to serve as the primary care partner for your dad, that can put a very high burden on her, especially if he becomes unable to keep his circadian rhythm as the disease progresses and he's awake at night. Now it's interrupting her sleep. Many care partners, you know, they're so dedicated. and they're just such an inspiration. And yet they become martyrs. They're not getting the exercise.

They're not eating well. Their identity gets lost and caring for this person. And so they lose their friends. They're not socializing. All of those brain protective things that we know are so beneficial get put to the wayside in order to care for that person. So that's too much stress, right? What we want is enough stress that we have, we're excited to get out of bed and seize the day.

right we have purpose and meaning whatever that is for you you're engaged in some sort of physical activity that keeps you right use it or lose it you need to lose use your cognitive function you need to use your physical body in order to maintain enough stress that we're kind of pushing against that edge and we're not losing our function so toxins nutrients stress structure so you mentioned your parent is suffering potentially with dementia or Alzheimer's, are you at genetic risk becomes one of the questions that comes up? And I think is really important to answer when we're in our 40s, 50s, 60s before we're starting to experience symptoms. Because this can motivate us. If we know our APO-E status, APO-E, if we carry one or two copies of APO-E-4, then we know that we have

to work harder than our spouse or our neighbor who doesn't have that genetic risk, and we need to start looking earlier at our risk factors so that we can mitigate them sooner, and again, delay, prevent, and then potentially reverse any cognitive decline that's already happening. So structure comes in macro and micro as well. So that microstructure is that genetic molecular structure. Now the macro structure, I know you can probably speak to even better than I can as a chiropractor, we need to be able to get blood to our brain and out of our brain. We need to have, you know, our head carriage can't be too far forward. If we're in chronic pain, the cortisol that comes with that can become toxic to the hippocampus, the memory center of our brain.

And if we can't keep our airway open at night, if we struggle with sleep apnea, this essentially becomes mild brain damage each night. Hypoxia is very, very toxic to the brain. We need to be able to get oxygen and fueled to the brain. And especially at night, if we suffer with sleep apnea, we're not getting. the restorative healing REM sleep and deep sleep that we so desperately need to maintain cognitive function. Structure was number five, four? Four. Okay.

So number five. Yeah, the last two. Is infection. And number six is signaling. So infections, there's a handful that are really important when it comes to cognitive function. One is P. Gingervalis. So gingivitis, the bacteria that caused gingivitis, when they get into our bloodstream, they can cause cardiovascular risk, but all.

also directly trigger the production of beta amyloid in the brain. So we want to make sure, you know, you talk about this so much. So I know your audience is very familiar with this adage that health starts in the gut, but the gut starts in the mouth. So we've got to maintain really good oral hygiene so that we can maintain good cardiovascular health and good brain health. Really important. And then also there can be kind of latent infections underneath root canals in cavitation,

associated with the, if you have your wisdom, that's a whole, that's, yeah, that's like a, that's such a can of worms, but for some people, it's really important. So I, I, I hear you on that. I measure LPPLE, too, on advanced cardiometabolic workup. And if I see that regularly, you know, two or three times, if I see that elevated and someone tells me they have maybe complicated dental history, then I'm referring out to a biological dentist. If you had told me in training that root canals would be associated with complex chronic disease and outside of the mouth, I would have thought you were totally nuts. But I have seen it enough now. I've seen this play out with enough patients that oral health, I mean, it's so, so, so important. So signaling, oh, sorry, let me go

through these other infections. So Pige and Jabalus in the mouth, and then also herpes simplex virus one in particular. So if you get regular cold sores, that's something, I'm a naturopath, I don't, I'm reaching for pharmaceuticals that frequently and there's a lot we can do with lysine and lemon balm and some other antiviral herbs that you can do for prophylaxis. However, if you're prone towards regular herpes outbreaks, repeated herpes outbreaks, then it's important to get ahead of those. And I typically will give my patients, certainly acyclivir or valcyclovier, to have on hand with travel, with stress, anything that's going to trigger an outbreak. And I'm pretty quick to get aggressive about that, just because the research is pretty clear that,

when we treat that relatively aggressively versus when we don't, the people who treat are at lower rates of dementia. Because, again, that virus that hangs out in the nervous system triggers the production of neurodegenerative processes. So Pige and Javallis, herpesyplex, COVID is another one that comes up. And this is a little bit different mechanism. Yeah. So this one tends to create more hypoagulability. And so it's in the vascular system, but can be a little bit more. prevent good blood flow to the brain. So we come at that a little bit differently and that we're

trying to reduce inflammation in the cardiovascular system. So looking at things like lumbrokinase and natokinase, that kind of thing to help with the viscosity of the blood. And then the lime spirokates are another one. We know that syphilis, another spirokate, has a neurological presentation. Lime also has a neurological presentation. And so it's important to be screening for these Lyme, Borrelia, Babesia, Bartonella, or Lycia, that and the co-infections, so not just Borrelia, the kind of classic Lyme disease, but also the co-infections that can have an impact and wear on the immune system and put us at higher risk for cognitive decline as we age. So those are the infections that I really like to kind of be, if you go on PubMed and you look at age

pylori and dementia, there's a connection. Generally, we want to keep our infectious burden overall to a minimum so that our body's not spending time and effort and energy combating those, protecting against them, but we can spend our time and effort and energy and resource, creating new neurons and connections between them. The last one is signaling, and this is a really exciting conversation, I think, with your population and your audience in particular, because of the new research that came out recently looking at postmenopausal women, women over 65 in the Medicare system, 11 million women were included in this study, and it showed, I think, unequivocally, that bioidentical hormone replacement as we age reduces our risk of all-cause mortality,

cancer, dementia by about 10%, and then cardiovascular disease. So there was a lot of confusion around the women's health initiative study that came out in the early 2000s. And that has completely been turned on its head, and it's really, I think, an empowering time showing women that you don't have to get off by a hormone replacement. You know, that was kind of the words of wisdom from people who are suffering with two people who are suffering with severe hot flashes or sleep deprivation or mood changes as they went through menopause. It's like, you can stay on this, but not for too long. And for many people, they were talked out of even getting on it. And I talk to patients in my practice all the time who are terrified of hormone

replacement, when in fact, it seems to really be beneficial for almost all health outcomes as we age. And I didn't even mention bone density because that wasn't included in the trial, but that is another, the reduction of the rates of osteoporosis and osteopenia are very clearly understood with the addition of estrogen in particular. You know, it's interesting, as I'm listening to you, I'm thinking, wow, like we have really redefined the path into these aging years. you know, it's in, and I think our parents are, like you said, remnants of an old health care model. And this kind of discussion you and I are having right now, they didn't get that discussion.

And so, you know, I think for, you know, like my generation, I'm a Gen Xer, like in that generation, we are all starting to look at aging from a new lens. And I hope that my kids who are Gen Ziers, By the time they come into this conversation, it'll be very clear that lifestyle matters when you start to age. Of the six you just said, the two that are, that, you know, as I was listening to that, I was thinking, yeah, that's an amazing list. And if I was somebody who was just trying to understand how to prevent Alzheimer's and dementia, I would be overwhelmed with those six things. because how can I, I'm managing an aging parent. I'm managing my own life and now I got to manage those six things. But when you break it down, I feel like the door in, the easiest door in to increasing

your immune system, to balancing your hormones, to helping your body detox is the second one, your metabolism. And this is why I'm such a fan of fasting and looking at our glucose levels. and our ketone levels and how that affects brain function. So that leads me to this question, and it was something that Lisa Mascone and I discussed when she came on on this podcast, and that was that as we age as women,

our brain becomes less sensitive to glucose and more sensitive to ketones. So I wanna ask if you find the same thing, and does, I mean, of course I have to go into the fasting realm, have you seen as women, and this probably works for men too, as we age, the more we can get some of those ketone hits, the healthier our brain is as we go through those years. Unequivocally, in my clinical practice, in my experience, getting into ketosis is one of the most miraculous interventions for cognitive decline. It is a game changer. And I think it does about

50% of the heavy lifting of everything that we do. Now, if there's a smoking gun, like a ton of mercury or a ton of mold toxicity or a severe B vitamin deficiency, right, we need to find that, right? That's important. The functional medicine perspective of this, I think, is important. Now, that being said, I don't think anyone should be in ketosis forever, right? I'm wearing a continuous glucose monitor right now. Yeah, me too. So I think, like what, what, nine out of 10 diseases associated with aging or chronic conditions associated with aging have to do with high blood sugar. We have created a society where we're sick, we're obese and sick and have diabetes and heart disease and cognitive decline because of the amount of processed food that we

consume and particularly the amount of sugar. And these blood sugar swings and spikes, they are so detrimental to sleep, to mood, to energy levels, to so many of the other downstream things. And so absolutely what we see, I have patients who have gone from not being able to remember their grandchildren's names to being totally incontinent to three days later, 72 hours about what it takes to get into ketosis with a significant carbohydrate restriction. And we see that they remember their grandchildren's names and they have control of their bladder and bowels. I mean, it is profound.

And people, my personal experience with ketosis, I get an hour and a half back in my day because I wake up at 5 a.m. ready to go. I don't have to go through that kind of groggy 6 to 630. Like I need my macha kind of vibe. I can just get started with my meditation and my morning routine. And I don't, there's no delay. And I also, my mood is better. My sleep is on my ordering. I can track it. My sleep improves. My deep sleep improves. My HRV improves. And I just get off the roller coaster. So many people can relate to this. Also, the bloating. goes away, right? My stomach is flat again, you know, just aesthetically it feels great. So we guide people into ketosis and I recommend for anyone struggling with cognitive decline three to six months

solidly in ketosis and then going back and forth between potentially a plant-based diet or a paleo-mediterranean diet, still a non-processed diet when you're going back and forth. Now, trips to Italy happen, I want you to enjoy that. Weddings happen. I want you to enjoy that. So people come off. And I think that's okay. It's all about being in the mindset that if I'm genetically at risk or if I'm symptomatically feeling like my cognition is not optimized, I need to get back into ketosis and I need to spend more time in ketosis than not. Oh my gosh. Thank you so much for saying that because it's been interesting being in the keto world. I've been in this world for a long time and there have been a lot of critics of ketosis. And the way I like to get people into ketosis is

through the door of fasting. Like just take that window, compress it so you have this longer period of fasting and then clean up your food in that eating window. And if you go low carb, in that eating window, you're going to go into even deeper ketosis. And this is why Fast Like a Girl was written was because so many people were like, no, this isn't good for women. This isn't good for women. And I'm like, really? Because I got 80-year-olds that are dropping weight And like you said, remembering their childhood phone number because I put them in ketosis. And so I don't know if there's like a media attempt to keep people out of ketosis because then they'll need drugs for some reason.

But I have seen the same thing across hundreds of thousands of people that if you take a menopausal woman, if you take an aging woman and you put her into ketosis, you give her her brain and body back. and I think it's something we should be shouting from the rooftops. Now, the second thing I want to say is when you balance somebody's metabolic health, you also balance their immune system. So when we look at those infections, you're talking about, if I can get them metabolically healthy, I can get their immune system up. And when I can balance their metabolism and get that hemoglobin A1C down,

I can also see that they need less bioidenticals. That, I think, is the Wild Wild West right now. I believe in us all getting on them. But there's a huge learning curve for women when they get on these bioidenticals. So we have to pair the lifestyle to that. So, you know, I think, and I'm a question for you is every woman should start this keto journey when the hormones start to go crazy in those perimenopausal years, like at 40, would you say there's a time that you just stop ignoring that ketones are this driving fuel

source for your brain and you really need to embrace a lifestyle that brings ketones back in? So I think that all humans should go in and out of ketosis. That's what we're designed to do. We're essentially hybrid engines and our ancestors, the consistent thing about ancestral diets was inconsistency. We didn't have blueberries in December. Yes, thank you. And so we had meat available in the winter that was, you know, stored or frozen or salted or whatever it was. But we didn't have abundant amounts of carbohydrates available 365 days a year. It just wasn't how our bodies were designed. And now we are overfed. And so it's really

important that we get inconsistency in our diet, and this is part of fasting. Now, that being said, with what might be good for you if you're in your 30s, 40s, 50s might not necessarily be good for mom or grandma because there is weight loss associated with ketosis and we don't want to go in the direction of frailty. Now there are great ways to mitigate that and we have tons of resources I'm sure you do as well. But going into fasting plus ketosis for someone who's already frail, it can be a little bit too much sometimes. So we want to build resilience. This is that hormetic effect, right? We're stressing the system by going into either into fasting or a fasting mimicking state with ketosis.

And what we want to do is stress the system so that it's more resilient. This is a definition of health, right? It's more resilience when we come into contact with any sort of stressor. Now, that being said, if someone's frail, that stress can lead to decompensation a little bit quicker. So for those of us in, you know, in this perimenopausal range, I would say it's better to start even earlier, right? I think women in their 20s and 30s can get tremendous benefits from going into ketosis.

In terms of hormonal regulation, right, this insulin, insulin resistance can start early, depending on what lifestyle and diet habits have been. But PCOS is something that I think can be really supported through fasting and ketogenic diet and getting the sugar down. You mentioned the connection between ketosis and metabolism and addressing metabolism and how it impacts the immune system. sugar feeds cancer. Sugar feeds candida in the gut, but not just that. It feeds the gingivitis in your gums. It feeds every other infection. So getting the sugars down that starves out these

infectious agents, and you can really reduce that burden significantly, directly, right? And then you also get all of these other benefits. You mentioned the conversation with Lisa Moscone and how all of us, regardless of our diabetes status, regardless of our fasting insulin or our blood sugar, fasting blood sugar, as we age, we become less sensitive to glucose in our brain. Our brain prefers ketones to sugar. And again, I think back, not that I was there, but to ancestors, but what were our ancestors living? Maybe we were there. We've been reincarnated. But if we were running from a bear, if we didn't have food shelter or water, if we didn't have that food, we didn't need our brains to turn off, we actually needed them to turn

on. And so when we get into a fasting mimicking state because there's food scarcity, right, this is contrived in our day and age, but if the way it was for our ancestors, our brains turn on. And it's this ancestry, it's this evolutionary, it's like design, right? It's just a divine design that if we are on the edge of starvation or going in that direction, we need to be able to think clearly find food, find what we need, find the resource we need. And so that happens. We have the benefit of that now. And we just have to put, yes, it can be somewhat uncomfortable, but the rewards are so worth it. They're so worth it. I mean, I'm sure you do it this way, too, is like when I have a day where I need my brain to be on, that's when I fast. It's like,

I need those ketones because they work so much better than glucose when I need that sharpness. One of the struggles I have found, and I think other people may have found this too, is getting my 80-year-old parents to adhere to certain diet changes. And one of the things, my dad just with full transparency, he's the one we're the most concerned about right now, is that he forgets. So when I'm like, hey, dad, you're not eating a big bowl of cereal first thing when you get up in the morning. He's like, okay, he remembers when I tell him, and then the next morning he goes and eats a bowl of cereal. So I have been trying to figure out outside of just going in and making sure there's no cereal in his house.

Like, I've even wondered about something like exogenous ketones. Could I put some exogenous ketones into him to be able to spark that brain activity? And how do I get an aging parent to change their food habits? Because that's been tough. It's such a great question. I was with my mom recently, and she always gives me a hard time. She's like, you're trying to give me an eating disorder when you try to get me into ketosis. And so I got my CGM on, and I asked her to put her one on her and supported her in that process, just so she could learn.

So she could get more information about what's going on and start connecting what she's eating to how she's feeling. And sometimes that's just an invitation, right? we can't change other people's behavior, but sometimes they can influence it. And I think that modeling is one of the most important things. So us taking this on, showing what's possible, sharing how we feel, sometimes my mom's cousins are really into it. And so they've started doing it. And all of a sudden she's like, oh, maybe I should listen to Heather, right?

Like it changes her perspective, right? Who's influencing your dad, right? Is there a good friend of his? Is there someone in his bridge club or somebody that he plays? tennis with who might have a bigger impact than us as the daughter, right? Like, what do you know? I'm the parent in this relationship. And so that can be one strategy. You mentioned environment. Like, what do? Should I just take the cereal out of his house? Yeah, I think you should. Right. We call this cleanse your kitchen. You go in and you take everything out because people struggling with

dementia. If there's a banana on the counter, they're going to go, oh, this is healthy for me. And especially people in their 70s, 80s, right, they remember that food pyramid from, the 80s and 90s that killed people literally has caused chronic disease in this country, right? It's criminal that we were told to eat eight servings of grains a day, and that was the foundation of our diet with sugar, processed grains. I mean, and that fats were vilified. Really, that should be turned on its head, and we should be having a lot of fats. But fruits are one of those really confusing ones for people. Are you telling me fruit is bad for me? No. But it won't help you get into ketosis if that's the goal.

No. Right? So we need to be strategic about what we allow into the kitchen. And so that somebody who is struggling with dementia or to even wrap their head around the concept doesn't have a lot of the junk or even anything that's going to raise blood sugar easily accessible. Now this is part of why I created Marama, which is a residential care facility for the elderly where we have an immersive experience in this approach. It includes an organic ketogenic diet, all of the brain healing,

exercises the socialization, a non-toxic environment, and caregivers who are trained to expect people to get better and also know how to manage the supplements and the hormones and all of the things that the medications that someone on a Brutton type approach would be doing. And so it's because of this question from people like, you, I want my dad to get the benefit of Dr. Brutton's approach, my mentor's approach. But what am, can I, do I move in with him? Do I quit my job? Like, what about my kids? What about my relationship? How do I? I navigate this and get him the benefit when I can't drop everything and do it for him. And this is challenging. And the dynamics are different. Right, often we'll talk to people

and, hey, my sister doesn't believe that there's any science behind this now. Yes. Send her. You can send her the Ornish paper that came out in June, which showed that lifestyle randomized controlled trial, the first of its kind that showed that these interventions can be helpful. They used a vegan diet. So, you know, I'm a fan of keto with animal products. I think that that makes it so that our diet is not too restrictive, but you have options, right? There's science suggesting that changing to a, from a standard American diet to a vegan diet or a ketogenic diet can be very, very helpful for cognition. And so, you know, there's science out there, but if your sister is totally anti, come back to you, be the model,

do it for you and prevent cognitive decline, you know, especially if you're genetically related to whoever you're concerned about, make sure that you are being the model and you are putting this information to work for your brain. We're not going to be able to convince everyone, but we can give them information and we can set things up. There's meal delivery programs through Apollo Health, Nutrition for Longivity, does ketogenic meal delivery, which makes it a lot easier. So there's resources and there's support. Yeah, it's funny because on that topic, my brain has been saying over and over again, like, don't lose your life in trying to save theirs. And it's a little bit like I can feel them declining very quickly.

And my sister and I are like tag teaming every day talking about, okay, I talked to them today. They're doing this. We've had to take over their finances because my dad was paying things like five, six times. and it's interesting what you said about there's this line between you want to help them, but you also want to save yourself and not lose your life in that process. So I tried the glucose monitor on my dad, and he couldn't, he couldn't figure out how to use it. It was like so complicated.

I'm like, okay, I'd have to like be with him day in and day out and scan it on him for him to see it. So would you say that if you had an aging parent, a really good, that hat is going through this, a really good number just to keep your eye on is hemoglobin A1C? Absolutely, without a doubt. And we use the Moka score, the Montreal cognitive assessment, as a way to put a number on where someone's cognition is. And we have much more confidence, right? The earlier on in the disease process, the easier it is to turn things around.

So if you're starting to notice that mom or dad is forgetful, start then. get a mocha score and then do what Dr. Bredesonocopy, right? Just like we get a colonoscopy to see if we have risk for colon cancer, get all of the lab testing done. Look at toxins, look at nutrients, look at gut, look at all of the things a functional medicine doctor would look at and see if there are risk factors

that you have control over. And then do what you can to address them. And of course, the lifestyle medicine is the most important. That is the foundation, right? The functional medicine testing and all that is the icing on the foundational case. of diet, exercise, sleep, and stress management. So get those things dialed as much as you can. And then in these conversations, you know, it's just, I mentioned I was with family recently,

and I have an aunt who's the matriarch of my family. I mean, I just adore her. She's been one of the most impactful people taught me so much throughout my whole life. And she's been suffering with dementia for five or six years. And her husband is a conventional MD, and they had very little interest in what I was doing. And just, recently, my mom texted me this morning. She's like, oh, that, you know, they're asking questions and they're engaging about what's in your book. And I was like, what? Like, I brought tears to my eyes. Like, what? Like, I might be able to help this woman I love so much after feeling for, sorry, I'm like getting emotional. After feeling for years, like, I couldn't, right? Because I wasn't

speaking her language. And so sometimes it just takes a little bit of patience and putting it out there and not pushing too hard. I think when we push too hard, people become resistance. It's human nature, right? Especially if we're trying to control someone else's behavior. But if we can just keep modeling, giving them information, maybe putting resources in front of them like meal delivery that make it easy, then I think that is potentially a way to get some change. And then there's so many directions we could go with this. Yeah, right, exactly. Well, the ketones.

Yeah, before you answer that, I want to address the, the doctor issue because every time my dad goes and gets blood work, I say, give it to me, let me take a look at it. And what I'm finding is not happening in the doctor's office with him is this acknowledgement of how important hemoglobin A1C is. I feel like if we just used one target, let's just like create one target for everybody. And so he's like, my doctor says I'm fine. And I'm like, yeah, but dad, you're at. But he's at like 6.2 or something. Yeah, I'm like, you're at a really, like, I want you at 5.0, and he's at about 5.7. So it's like my doctor says, I'm fine. I'm like, you're not fine. We have to get this one thing down.

So is there a way, do you think that story about your aunt? And, you know, are the tides turning? Are doctors waking up and realizing that neurodegenerative decline is intimately tied to metabolic? symbolically unfit humans? Well, certainly the research is there. This is published. But it takes a long time to get in front of primary care providers and neurologists who are having these conversations with people day to day. And I think there's also this element of, well, this person's retired. They've done the work. Let them indulge. Let them enjoy the retirement. Yes. And I think that that does people a disservice. Not everyone wants to hear that. There are people who, you know, you know, know, when they're facing this last chapter of life or this last season of life, they want to live it

fully. They want to be present at their grandkids. Yeah. And so. He's like, I'm tired of being disciplined. He's like, I just, he's kind of got a fuck it attitude. He's like, whatever. I don't know how much longer I have here. I had a conversation with a 95-year-old gentleman recently in the aeroseptin. So a couple of medications that are available for dementia, they don't work very well. And five years later, people are not doing as well as if they never started them, right? Denepezil or Erecept and Nameda or Mimantin, these two medications they get used together and separately. And if you start them, sometimes people get a little bump,

but five years later, they're worse off cognitively than if they never started them. So I have this conversation with a 95-year-old man who's like, I'm not going to be here in five years. Just put me on them, you know? And so I had to laugh and I had to respect that, right? It's his decision. And so all we can do is give people information. And then it's not for everyone.

requires work. It requires some, yes, some discipline and some, figuring out the Dexcom or whatever can you use glucose monitor you use. Figuring out the ketone, all of these things. And I'd love to go back to the exogenous ketones because I do think that that's a great conversation that can make it easier for people to get into ketosis. And for some neurodegenerative diseases like ALS in particular, we do not want to restrict carbs. We want to have ketones and carbohydrates because resources are being utilized so quickly. It's really hard for anyone to keep up. In fact, that's part of the disease process. So when we add exogenous ketones, what we can do is get into ketosis, get the benefit of the ketones without having to do so much carb restriction.

And sometimes for people who are a risk of frailty or weight loss, this can be kind of a happy medium. Or like your dad, hard to get him there, feels almost impossible to get him into carb restriction. Okay, let's just add some ketones. So there's different kinds of ketones. There's ketones salt, and ketone esters. And I think they both taste disgusting. Yeah, they're horrible. Especially the ketone esters taste like gasoline. But this is what professional athletes will use these and they will get your ketone levels up. So if myocetosis is 0.5 to 0.9, I think of actual ketosis is 1.0. Usually you're getting maybe to 3.0 on that very high ends, just with fasting and consuming heart.

fats. And then if you start adding ketone esters, these are the gasoline, like the real fuel, you can get that ketone number up often to five. And with ketone salts, we're going to see those ketone numbers go more like to what you could get to metabolically between one and three, but you're going to get there faster with less carb restrictions. So there's powders, there's capsules. I'm personally a fan of the ketone capsules because I hate the taste. But some people love the sweet taste of the ketone salts and they can use it as a snack between meals when they're starting to either fast or they're starting to go into ketosis and carb restriction. I don't, you probably have the, oh, go ahead.

Well, no, so what, here's the question I always ask myself is, so ketones were meant to be present when glucose was low. So my intuitive, and I'm actually, as I'm going, through this conversation with you thinking, okay, yeah, I'm definitely going to try the exogenous with my dad. But I would intuitively say it needs to be in the morning before he eats anything and brings his glucose up. Now, having said that, I have had Lat Manzoor on here, who is the founder of ketone IQ. And he believes that if your glucose is high and you take these exogenous ketones, it actually helps, it can mitigate the high spiking blood sugar. So it can actually be a tool for bringing the blood sugar down.

So do you have an opinion on that? And then the second part of that question is ketones are neuroprotective, right? Are they going to create, are they going to stop the placking? Are they going to stop the degeneration? Will they block the neurons from being infected by the infection or the toxins? Like, is that like a shield for these decaying and placking neurons? Yeah, great question. So the brain takes up 2% of body weight, but 20% of energy expenditure every day.

It's a very, very expensive machine to run, right, in terms of resource. And when we can't turn ATP is the fuel that our neurons run on, every cell in our body runs on. So we need to be able to turn the fuel source into ATP. And that fuel source can be, we're hybrid engines, right? It can be glucose, carbohydrates, sugar. we'll use those interchangeably or fats or ketones. And when we make ketones available, whether there's glucose there or not, we're basically saying, here, brain, here's some extra resource.

The way Dr. Bredesen talks about the brain, he uses the analogy of like your brain being a country, my brain is done. And if your brain is at war, right? If it is fighting and defending, like think of your brain like Ukraine, right? It is out of money. It is desperate. It is fighting and defending and can barely. maintain any function. So if we can resolve, if we can give an extra resource, right, if we can get

that extra money to that country at war and get them the extra things that they need to resolve it, right, to fight those infections, get rid of the toxins, then now we free up resource. And we can go on to regenerate. We can create new neurons, new synapses, the connections between the neurons, and that's what we're trying to do when we add more resource to the brain with ketosis. Now, with exogenous ketones, I should say. Now, if we're actually in metabolic ketosis with carb restriction, we get the benefits of less oxidative stress. Burning sugar for fuel creates oxidative stress. So we skip that, and we don't get that oxidative kind of trash that we, when we're burning ketones for fuel. Additionally, in ketosis, as you well know, we're metabolizing fats,

which is where we hold a lot of fat-soluble toxicity, so we can start getting rid of toxins. So it's antioxidant, it's detoxifying, it's anti-inflammatory, reduces inflammatory burden, which is part of the trigger of neurodegeneration. So there are so many benefits to getting into ketosis. And I think that we don't even fully understand all of the mechanisms. Dr. Stephen Gundry talks about the mitochondrial uncoupling as one of the proposed mechanisms. I think there are many, many, many at play. But primarily when we're talking about adding exogenous ketones, when you're not in carb restriction,

I think what we're trying to get is this resource utilizing. question answered and just basically give the brain as a gift, here's more fuel to get to do the jobs that you need to do throughout the day, particularly resolving these highly resource, you know, resource draining things like fighting infections and toxins. So then you would be a fan of, it doesn't matter if glucose is high, you're just given another resource for the brain and it wouldn't bother you to put the two together. In an ideal world, we're doing carb restriction as well. But if we can't get that.

But we have an aging parent. The reality, so much of what we do is pragmatic. It's like, what's going to work? Exactly. And I think that ketones are kind of a cheater's way to get this extra fuel source to the brain. Yes. It's a short cut. It's so funny because when I first discovered fasting, my parents were in their late 70s.

And they were like up for anything. They, they, they, they, my mom actually raised me in a very clean, nutritionally clean home. She, we didn't have sugar in it. Like, so much of what she did with us in our childhood, she's actually not doing in her senior years. And so, but one of the things when I first started understanding fasting and teaching it to them, I mean, they were the most vibrant. I have seen them in their late 70s because of skipping breakfast and compressing their eating window. and they were willing to do all of that. And now, as they've gotten older, the willingness has gone away.

And one of the places it's gone away, and this would be another question for you, is that they have a caregiver now. And as wonderful as the caregiver is, my dad no longer cooks and cleans and we're making him walk the dog. But life got really easy. And so what part, I mean, this is where you could also look, can get them to fast a little bit longer or get some carbohydrate restriction out so you get the ketone, but you're also microdosing hard. And I'm curious if microdosing hard in an 80-year-old is still increasing neuroplasticity because the brain has to find new pathways to deal with the

hard. Yeah, so I think there's a couple things that come up here, one caregiving. So I think for any family who has somebody with dementia, find a caregiver fast. Before you think you need them, get somebody who your parent knows, enjoys, likes being around, who knows them. That is really helpful because I have seen too many families backed into a corner out of desperation just finding a warm body to show up and babysit because they are pulled away for some other family emergency or they have a fall or their primary caregiver is unavailable. And so having somebody who's kind of in the family are ready makes it so much easier if there's ever any transition. The other thing is caregivers need time for themselves. So if your dad needs someone there all the time, then giving

your mom that break so that she can go play cards with her friends or go to lunch and not talk about dementia and her husband, and she can get that social connection and have that identity outside of caring for him, that is really, really important to her long-term health. Now, okay, so the caregiver, we have caregiver training programs because so many caregivers are, they want the person they're caring for to like them. So they want to feed them cookies and ice cream. They want to shop for them in that way. They want to let them sit at, you know, at the TV and they want to take care of everything because that's what that person wants, even though it's not what's best for them. And so having caregivers that are well trained to engage that person, they know what motivates them, they know how to engage them so that they can have a good, time, staying cognitively engaged, physically engaged, and eating the right foods. So the caregiver's

mindset needs to be, and their values need to be in alignment with this Brutocent approach, I think, to get the most out of it. And that can be done. We see it all the time. It's fantastic. What's the name of the program that you, the caregiver training program? It's called reversing Alzheimer's at home. So that's actually where my book is from. The reversing Alzheimer's is my book that came out in June with Harper Collins. We hit the New York Times bestseller list. And by the way. I know it's done really well. It's available wherever books are sold. And this is that we had designed the training program. We were doing it. We did it for about 200 people and then wrote the book based on what we were doing in the caregiver training courses. And so that's what

the book is. And then we have group coaching programs that go about 12 weeks. We're starting the next one on Labor Day. And we run those about three times a year so that we create community so that we have people sharing their secrets. And I mean, it's so valuable to have that, dialogue around what's working, what's not, what's coming up for people, how to best serve those we love suffering with dementia and prevent it for ourselves. That's so smart because, I mean, I've had to really work with the caregiver. Did you do the audiobook? Did you read your audiobook? I heard you saying that you were doing that. So I had to negotiate with them and I was able to do the introduction and the acknowledgments. They were like, no, no, we're getting a professional

for the rest of it. You know, I'm torn. I have mixed emotions, but you've done your audiobooks, right? Oh, yeah, I do all my audiobooks and they're horrifically hard to do. But the reason I ask is because I may have the caregiver listen to your audiobook, especially as she's cooking or doing anything like that, I can see that where that would be really helpful. Do you think with this new explosion of conversation around dementia and Alzheimer's, that we literally, if we like listen to podcasts like this and we really read books like yours and we understand the impact of lifestyle, that by the time our grandchildren go into their senior years,

that Alzheimer's and dementia could be a thing of the past? I believe that for our generation, Mindy, Alzheimer's as optional, that there is so much we can do to prevent this disease, that if we are willing to do the work and do what it takes, then yes, we can prevent having this disease as we age. Amazing. Amazing. Well, again, I'm going to send everybody to get your book. I know they call us the sandwich generation. We're like sandwiched between the kids and the parents, but my kids are, you know, off and learning how to adult. And I'm left with my parents. And, you know, this conversation has never been more real for me. And it came on so quickly, so quickly. Like out of nowhere, it was like, my mom was thinking my dad had dementia. And I'm like, yeah, I don't think so. And then as I look, closer, I was like, ooh, yeah, she's right. So work like yours is really important. So I really appreciate that and what you're doing. And how can people find you and find all the wonderful things

you are up to? Thank you. Yeah, Dr. Heather Sandison, S-A-N-D-I-S-O-N-O-N-com, where you can stay up to date about the latest research and our offerings and support for those suffering with dementia and their families. You know, Mindy, I have the privilege of talking to many, many patients and coaching clients and residents at Marama who are in that sunset of their lives, right? And asking them, what's most important? What have been your happiest memories? What lights you up to think back on? And it's the connections.

It's the connections with the people that they love nine out of ten times. It's not how much money they made or the vacations that they went on unless they went with family. And that is just this reminder. it's like we have this opportunity to maintain meaningful connection as we age if we maintain our memory and our brain health. And it takes some responsibility, it takes some action, but it is so well worth it and it is so accessible if we're willing to do it. Amazing, amazing. So, and I agree, I agree, and I can even say at 54, you know, connections matter more than anything to me now. So I can only imagine what it is for my

parents and you watch them light up when the grandkids are around and when we walk in and it really I can really see that. So let me finish on this question. It's when I ask everybody and that is what is your definition of health, you personally, and how do you know when you're healthy? Would you have a measurement for it? Yeah. So getting up in the morning, feeling good and ready to start the day is my personal definition of health. Just feeling like I can take it on, feeling excited about what I'm doing, and thinking about how I'm going to have an amazing day and feeling like I have the energy for it, that is my personal feeling of like, yes, I'm healthy. Now, there's another one that I offered. A definition of health is how well,

how resilient we are to stress. Yes. And I do think this hermetic effect, right, fasting, ketosis, exercise, cold, hot and cold therapies, even oxygen contrast therapy. can be things that are uncomfortable when we get outside of our comfort zone, but expand our resilience to stress, I think that that is a, it's a continuum, right? Health is a continuum. It's like a homeodynamic state, right? It changes throughout the day and throughout the month and throughout the years. But when we can expand our resilience to stress, I think that that puts us in a healthier state. Oh, I love that. I love that. Well, keep doing the amazing work you're doing. This is such a necessary topic. And so many of us,

are sitting in the position I'm sitting in, like really wanting to prevent it for ourselves and managing it with elderly parents. So if anybody listening to this gets a little sense of peace, like I just had over the last hour of talking to you, I hope that we can change the way that we look at this because it's really hard to watch the people you love decline so quickly.

So just thank you for everything you're doing. And how do people, The people can come to your website. Is that like where your main source is? Yep, Dr. Heather Sandison.com. Again, S-A-N-D-I-S-O-N, and the book is reversing Alzheimer's. And thank you so much, Mindy, for having me. I really appreciate you helping me to change the narrative around what's possible

for those suffering with Alzheimer's and dementia and reduce that suffering, hopefully in real time. Yeah, thank you, Heather. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it, so please leave us a review, share it with your friends, and let me know what your biggest takeaway is.