How Personalized Lifestyle Interventions are Revolutionizing Dementia Care and Treatment - An Interview With Dr. Heather Sandison

What follows is a transcript for the podcast Dementia - Dr. Heather Sandison - Lifestyle Interventions.

Topics within the interview include:

• Dr. Heather Sandison’s journey to creating Marama, an immersive experience in the approach proven to reverse dementia
• How Dr. Sandison has seen the Bredesen approach benefit Alzheimer’s Disease and cognitive decline firsthand
• A day in the life of Marama
• Heather’s latest work: Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline
• Lifestyle interventions proven to slow cognitive decline at any age
• The age where everyone should start paying attention to their brain health

Dr. Greg Kelly: Hi. This is Dr. Greg Kelly, and today we have Dr. Heather Sandison. She's a naturopathic doctor who has dedicated her career to supporting those suffering with dementia. She's also the founder of Solcere Health Clinic and Marama, the first residential care facility for the elderly of its kind. She has created unique, successful solutions for patients and caregivers using clinical, residential research and educational platforms employing holistic and multimodal interventions. She's also a medical advisor here at Neurohacker. Heather, thank you for joining us today.

Dr. Heather Sandison: Such a privilege, Greg. Thank you for having me.

Dr. Greg Kelly: Oh, it's absolutely our pleasure. Now, I'm sure some of our listeners will recognize both your name and your voice as being a former host of Collective Insights Podcast. In fact, I routinely tell people you my favorite of all time, so I feel really thrilled to be on this other end and get to make you the star today. So with that, can you really share with our audience a little bit about your journey to become a naturopathic doctor? I don't think they've ever heard that part of your story.

Dr. Heather Sandison’s Journey to Creating Marama, an Immersive Experience in the Approach Proven to Reverse Dementia

Dr. Heather Sandison: Yeah. I was planning to go to conventional medical school. I went to San Francisco for undergrad, really hoping to go to UCSF which was the best medical school on the West Coast with that as the goal. And then I ran into some of my own health challenges while I was living there. And the person who helped me was an osteopath actually, and she encouraged me to go to naturopathic school. So through my health challenges, I had tried to do everything and anything. I suffered with something called TMJ. I couldn't open my jaw. I was losing weight because I couldn't eat right. I couldn't brush my teeth. I was distraught over this and I was going to medical doctors, I was seeing psychiatrists and psychologists and the dentist a thousand times. And I went to acupuncture and I went to massage and I went to yoga and I was just trying to do everything that I possibly could and feeling more and more desperate.

And in that, I wasn't getting help through the conventional medical system. And the person who really helped me was outside of that system and encouraged me to go down that path because she found it very gratifying, very fulfilling. And also she found that she was able to get solutions in places where the conventional medical system wasn't. Particularly in chronic disease. And so that was really inspiring for me and obviously very visceral because it was my own experience. I was also working in a lab at UCSF and didn't enjoy it very much. And so I took those two things as a sign to explore other paths. And right around that time, there was a course offered at my undergraduate alma mater at San Francisco State called Introduction to Naturopathic Medicine. A colleague of ours, Sally Lamont, was the one teaching it. And I was just like, I want to be her. She's incredible.

And I just felt so inspired. And it was a lot of the things I had been thinking around, well, what is wellness versus what is disease and how do we use the common sense of our lifestyle to support wellness and avoid disease in the first place? And so those concepts really hit home for me, and that was what inspired me to go to naturopathic school. My own experience, a little bit of learning and discovery process. And then fast-forward to getting out of naturopathic school, I met Daniel Schmachtenberger who is a founder of Neurohacker and he really inspired me to think in a very different way. Using integral theory inspired by Ken Wilbur and think about the human body, chronic disease in a really different capacity .in a much more complex but much more comprehensive way.

And through that, I was introduced to Dr. Bredesen after hearing his talk at a conference and then trained by him. And really from then on, it just has felt like divine intervention that I can't explain. But one thing has led to another where I have had these opportunities to just delve deeper and deeper into this dementia and Alzheimer's space in a pretty meaningful way, including doing research of which I hope we get to talk about today because I'm very exciting. I just got the PDF today from the Journal of Alzheimer's Disease saying it is officially published in the print edition. And so I'd love to talk a little bit about what we found in the research, but then also the residential care facility being very unique and the clinical work being really, really gratifying and meaningful and watching people reverse their Alzheimer's disease.

Dr. Greg Kelly: We're absolutely going to talk about the study, but before we get there, I wanted just to do a little background. So I mentioned your medical home, Marama, in your intro to your bio, and I was privileged to actually get to go there during the grand opening. So maybe we can just start talking ... You have your successful practice in Encinitas, Solcere, but then Marama, which I think is ... It's the first of its kind, so maybe we can start there.

Dr. Heather Sandison: Yeah. I feel so fortunate that I had support to open this residential care facility, and we got that going at the beginning of 2020, and then I still just can't not giggle when I tell people I opened a nursing home the first week of March of 2020 and the next week the world shut down. And obviously senior living was severely affected by the covid pandemic. But it was also this amazing gift in that we slowed down. So when I had announced that we were opening in December of 2019, we had a wait list almost immediately because so many people were having the same question come up. I understand Dr. Bredesen's work, I get it, I love it, I want it for my loved one. I just don't have the capacity to do this at home myself for my mom or dad or spouse. I need to be able to send them somewhere. I've got a job, I've got kids to raise, I've got a house to manage, I've got a relationship to keep together. I can't do all of this.

So this was an answer to those questions and those pleas for help. So that wait list was almost immediate in December of 2019. And then when everything shut down in March when we were ready to welcome people, we really, really slowed down. So we stayed at half capacity, so only six residents for a little over a year. And everyone on my team was very supportive of that. We thought half the residents, half the risk, half the staff. It just really simplified things so that we were able to use that time as a real learning experience because this was the first time anyone was implementing a Bredesen protocol in a residential setting. And so we just got to fine tune our recipes and our activities and everything that we were doing with this family essentially that got created there.

And it was just magic. When I think back, I just have such warm, happy memories of that time. My daughter was about a year old when the pandemic hit, and so the whole year she was one, she was going there and she would be outside because of the pandemic. She couldn't go inside. But the residents would be able to see her running back and forth and playing in the gardens and stuff and it was just a really fun, warm time in my life and creating that and something that my team and I are really proud of.

Dr. Greg Kelly: Well, you should be proud. We've had Dr. Bredesen on Collective Insights in the past. Matter of fact, you interviewed him, if my memory serves. But for the audience that may not have listened to that or be as familiar, could you just maybe touch on a little bit of what the Bredesen protocol is and Dr. Bredesen?

How Dr. Sandison Has Seen the Bredesen Approach Benefit Alzheimer’s Disease and Cognitive Decline Firsthand

Dr. Heather Sandison: Yeah, absolutely. Dr. Bredesen, Dale Bredesen is an MD, a neurologist who was trained at Duke, and he started the Buck Institute on Aging and has been a professor at UCLA. I think he's been a professor at UCLA, UCSF and UCSD at different points in his career. And he's done a lot of research. And he'll be the first to tell you that he thought that a solution to Alzheimer's would be in a pharmaceutical. He happens to be married to a functional medicine doctor who told him over the years that, no, no, what you're going to find is that lifestyle is going to play a big role in this. And sure enough, that's what he discovered over time working on what he'll call mouseheimer's. They did a lot of lab work working with mice. And what he saw was that diet, exercise, lifestyle, and then functional medicine made a really big impact on the trajectory of someone's cognitive function.

And so in 2014, he started publishing case studies. This is just single examples of people reversing their Alzheimer's or a series of three or a hundred. And there was a lot of criticism for a while that hey, there's not a trial that's showing that this intervention is actually meaningful or that's making the change. And so what he ran into was that IRBs or these internal review boards were very hesitant to approve a trial, a human research trial that had a multimodal intervention where there wasn't one pharmaceutical or one thing doing the work. And this is a paradigm shift. This is very much a philosophical discussion around what is the hierarchy of research and what is most meaningful. So is it really that we want to be studying these single interventions? It's very much set up for the pharmaceutical industry to test one variable, and yet we're human and we don't live in one variable lives. We live these very complex lives with lots of things going on. And the suggestion is that stacking these helpful interventions is actually going to get a synergistic effect where we're going to get even better outcomes.

And so that's what Dr. Bredesen proposed many times, but was shut down by the IRB. So he's had funding for the research for a long time, but not been able to use it because of this paradigm shift that's necessary in medicine that's much more focused on patient outcomes, patient-centered outcomes. Not these surrogate type markers like beta amyloid plaque numbers or something like that. So Dr. Bredesen published in 2017, his book, The End of Alzheimer's, which lays out this approach to reversing Alzheimer's or preventing Alzheimer's. And it essentially takes a whole lifestyle approach of a diet that's antiinflammatory typically getting you into ketosis, and then exercise, of course. Sleep interventions like treating sleep apnea, but also optimizing sleep, quality of sleep and the length of time, prioritizing sleep. And then there is mention of stress management, whether that means meditation or prayer practice or gratitude practice, whatever that means for you.

And then stacked on top of that is the medical interventions. Things like doing the dental work to get the infections out of your mouth. Optimizing hormonal signaling. Especially post-menopausal women are at the highest risk for developing dementia. Elderly women. And so considering as appropriate bioidentical hormone replacement, optimizing inflammatory markers, things like HSCRP, homocysteine, a SED rate. Any generalized inflammation or autoimmune process. Getting rid of the infections. Looking for toxins and eliminating those. And then optimizing nutrient status. So whether it's vitamin D or B. Daniel and I have described this before as we can think about all complex chronic disease basically coming from an imbalance. Too much, too little in the wrong place or at the wrong time.

And then the things that can be out of balance in a human system are going to be finite. There's only so many things that are going to throw things off at a causal level. And it's imbalances and toxins, nutrients, structural issues, whether that's macro structure like your hip bone connected to your leg bone or how big the diameter of your arteries is or if it's clogged, and then also genetic or molecular structure. So we have toxins, nutrient structure, stress, both good and bad. Do you have enough stress to get you up off the couch and do you have enough stress that you're not overwhelmed by it, that it doesn't become something that's becoming toxic in terms of the signaling of cortisol potentially to the brain? And then infections. And those pieces when we can get them into balance, really optimize cellular function, neuronal function in the brain when we're specific to the brain so that we can get that synergistic and virtuous cycle promoting health generally but optimizing it really with the brain in mind.

Dr. Greg Kelly: I think because there's those different big buckets, for lack of a better way to describe them, and different people would have challenges. Maybe someone in all of them. Someone else maybe in one or two. And because of that, it complicates it because you have to be almost a medical detective to figure out what's going on, but then address the protocol in a very individualized way, which I think was part of the big challenge with Bredesen getting the funding. Because even those original cases, it's like case one, this was the person and this is what we did, and case two, this is slightly different and we did something slightly different. So just for the audience, the amount of individualized care that Heather and her team give to the people that went through this study is just phenomenal. So just that caveat so that our audience is aware how individualized this program. So with that, I wanted to just maybe now start to talk a bit about the study. So as Heather mentioned, the pre-print came out a bit ago, and I got to read it while in advance of this interview. But the actual physical printing is coming out. You said just got released in the journal?

Dr. Heather Sandison: Yeah. The second week of August of 2023 we're in print.

Dr. Greg Kelly: Wow. Congratulations.

Study Spotlight: Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People With Cognitive Decline

Dr. Heather Sandison: Thank you. Yeah. This was a five-year project. And it's not over yet because we've got more papers to publish about sleep and quality of life and the biometric data that we're excited to share. But this was the primary outcomes paper. Both Bredesen and I both have gotten funding from philanthropists because this isn't a good investment for a pharmaceutical company. There is nothing to patent here. This is a multimodal lifestyle intervention. There's no pill that we can sell on the other end of this. And so there is not an investment from an industry to do this. Now, I would argue that Medicare should be investing in this because it should save them money on the risk side later on for people if we can prevent tens of thousands, if not millions of people from developing dementia over time. But just so that people understand the context, there's a very rational criticism that there's not enough research of what we've done.

And there's also a big bucket of context that that sits in around what motivates. The motivating factors and the reward factors around this. And so no one is going to make billions of dollars on the back end of this because there's no pill that we can sell through neurologists around the country for this or primary care, whoever it is. So that's part of why it takes longer. The other thing is that research just takes a while. And like I had mentioned, the paradigm in research has shifted a bit so that you can do now these multimodal interventions that are very individualized. It's more of a systems-based approach. And so yes, that takes a while. It also takes bigger numbers because we're not doing the same thing over and over again with one variable for thousands of people. So what Dr. Bredesen published about ... Well, with Kat Toups was the primary author, but the Bredesen team published in July of 2022, also in the Journal of Alzheimer's Disease, a very similar trial.

And we were both recruiting at the same time, also through covid. So I got funding, we got through an IRB, and then we started recruiting in February of 2020 for the trial. We shut it down and then started again late 2020. And Bredesen, I think they had already recruited by the time covid hit so they were about a year ahead of us. And they did a 25 participant trial over a nine-month intervention with MoCA scores down to 19. A MoCA score, the Montreal Cognitive Assessment, is a way that we can put a number on someone's cognition. It's a one-page worksheet that some of you may have seen where you draw a clock, copy a box, name some zoo animals, identify where you are, what day of the week, what time it is. And that is out of 30. So a perfect score is 30, anything over 26 is normal, and then below 26, we start to get into measurable cognitive decline.

And so they took people with MoCA scores down to 19. And I'll tell you the outcomes of theirs. So it's 25 participants over nine months and MoCA scores down to 19. So that mild cognitive impairment range, but still measurable. And they showed that 84% of their participants had an improvement in their cognitive scores after nine months. So our trial, the one that was conducted at Socere at my office, was 23 participants and we did a six-month intervention and we recruited patients with more severe cognitive decline, so people with MoCA scores between 12 and 23. So there was nobody with a MoCA score over 23 where they had people who were higher on that spectrum. And we had a shorter intervention. It was only six months versus nine months, but we showed that 73.9 or about 74% of our participants, 17 out of the 23, had an improvement in their cognitive function.

We did that in two ways. We measured through both the MoCA score, which I actually am really proud of MoCA because it does a great job. When we compared it to Cambridge Brain Sciences, which is about an hour long test, a battery of testing that's more research based, but it is covered by Medicare. You can ask your provider for this. The Cambridge Brain Sciences battery of cognitive testing. It basically breaks things down more granularly and is a more extensive test. It's more expensive. But our MoCA scores matched it almost exactly and so it proved to me that we can rely on those MoCA scores, which take about 30 minutes, and a tech can do that in a clinical setting. So what we saw on both of those was the same outcome. That 17 of these 23 participants got improvement. And then we saw that the means scores also had ... There was statistically significant improvement in MoCA scores, the memory component of Cambridge Brain Sciences and also the overall composite score of Cambridge Brain Sciences when we took the mean score at baseline compared to six months.

Just to put into context, Leqembi or Lecanemabthe, new FDA drug for Alzheimer's slows the rate of progression. So when I think about this in a very human way, what that does is it draws out a torturous process. You don't get an improvement in cognition. The best case scenario is that that person lives with dementia longer. Our standard is that people get better. We want people more engaged in life. We want them to be able to extend their work life, to know their grandkids. We want them to be able to cook and maintain their independence. All of those things are what are important to us and how we measure success. And so that's what we saw the majority of the time. And it corroborates Dr. Bredesen and Kat Toups. Deb Gordon, Kat Toups, and Bredesen. Their whole team who's phenomenal. I want to give everyone credit because there are huge teams. And I worked with Healthgot, my colleagues, Ryan Bradley, John Phibbs and Nini Callan, just incredible people. There are so many behind the scenes doing so much work.

Dr. Greg Kelly: Well, they're fantastic results and I want to highlight a few things to maybe even make them sink home even more for our audience. So in the Cambridge Brain Science test ... We've used that in Neurohacker Collective at one point for Qualia Mind. We did a study on it. Concentration is one of the areas, memory, you highlighted. So my recollection is the improvement in memory was in the average of about 10%, which is a remarkable achievement even in a healthy brain nevermind one that started the trial with fairly significant challenges.

And then the two points I wanted just to make on the MoCA score. My understanding is a change of about 1.7 points would be a meaningful clinical change. And the average change for your whole group I think was 2.1. So the average change exceeded that. And then one of the things ... And this would be a Danielism. A Daniel Schwantnburger truism, right? Because we've talked about this. Is that we tend to think at Neurohacker Collective in Daniel's way, but it's that for any intervention, you're likely to see a subset of super responders, a subset of good responders like responders, and some non-responder and potentially negative responders, like side effects. And when I looked at your individual data in the published paper, it was clear there was some super responders. Their MoCA scores jumped up way more than 2%, right?

Dr. Heather Sandison: Yeah. This is very much anecdotal, but I share this with other clinicians in terms of an observation, is that the ketogenic diet seems to be what gets that super response. And particularly when you can get blood ketone levels up over two. The bigger the delta in that ketone level ... So we think of mild ketosis as blood levels of 0.5 to 0.9, and then full ketosis over 1.0. And then when you get up over two and three, that's when you get those jumps of people going from a MoCA of 19 to 30. Back to perfect. And we see that.

Dr. Greg Kelly: It's just phenomenal. So let's now shift gears and talk a little bit about what you had these people at Marama do. My understanding based again on the paper and having spoken with you in the past, it was certain core things that everyone did and then an individualized component. So maybe we can start with some of the core things because no matter what our status, those are likely to be things all of us can benefit from.

Dr. Heather Sandison: Oh, absolutely. So just to be clear, everyone in the clinical trial was at home. None of them lived at Marama. None of them had this done for them. This was all people who were doing this work at home. Maybe with the support of a spouse. If somebody had a MoCA score below 16, we had them come in with a medical proxy. We required that they had support. And then people who had over 16, of course they could, and many did come in with their spouses, with their adult children. They had support. But no one in the trial was living at Marama. That gets confusing because I have both projects going on and so a lot of people assume that we did the study on the people living there, but that's not the case. Now, at Marama, we do incorporate all of these things that we learned from the trial. Everything that we've learned from Dr. Bredesen. It is an immersive experience in this same approach. And we see MoCA scores by and large improve there as well. And that's not what we published. So just so that that's super clear.

So what do we do? And maybe what I'll do is just take you through a day in the life at Marama because the whole day is designed to ... And it's the ideal. Now, the ideal is the horizon so we never actually arrive there, but if we set up our days so that they're optimized for cognitive health, this is essentially what they look like. So wake up, get all the empty stomach medications in. It's like the morning routine. Whatever that looks like for you. Taking those supplements. The oral hygiene is so important when it comes to cognitive function. So if that means oil pulling or water picking or whatever that means for your oral health on top of maybe just brushing, flossing twice a day, taking care of that before we start anything else.

And then at Marama we do breakfast at 8:00 AM. A lot of people in this space, if you're at home ... Now, at Marama we are constrained by California state regulations and so we have to feed people three meals a day and snacks in between. We can only have a 15-hour fast. So we have dinner at five and then breakfast at eight. But many of my patients will skip breakfast and maybe do a matcha with ketones or with cream. Bulletproof-ish, but some sort of keto friendly morning concoction, if you will, which also serves as a ritual. It's a grounding ritual in the morning that you can look forward to. Drinking tea or coffee and setting that time aside to orient your day. Maybe there's a gratitude practice or a journaling practice or a meditation practice that goes with that.

So that happens at Marama to some degree, but then there's also breakfast involved. And so breakfast is organic and keto. Very, very heavy on the plants. Lots of green leafies. Lots of greens involved. But also we'll do keto waffles and keto pancakes and the good stuff too, especially on the weekends. And then after breakfast is a walk. So getting some physical engagement. Connection to nature. Outside. That social engagement. And then after that is some creative activity or some cognitive engagement. So at Marama this might look like a hobby the way many of us at home might think of it. So maybe it's sculpting or painting or writing or something to that ... We're engaging cognitive capacity but it's also fun and people look forward to it. We will do it around the holidays. There will be a Valentine's theme or a Thanksgiving theme or a St. Patrick's theme. And we really try to engage emotionally as well.

So it might be communicating with family members or even something as simple as sharing a story from your life that's meaningful for you, that you care about. And then lunch. Lunch is organic and keto again. And the afternoon goes back into the creative pursuits and the hobbies. And then there's snacks. Usually a green juice or maybe it's deviled eggs. Something keto and organic. And we have a long list of fun, yummy, very satisfying recipes over there. And then the afternoon, there's more intense exercise. We have this casita that we have our circuit in, and it might look like doing contrast oxygen therapy while on a treadmill or on a bike. We use the red light therapies, we use the Joovv light and also the V-Lite, [inaudible 00:27:41] light which directly sits on the head kind of like a helmet that has good science and very low risk for enhancing mitochondrial function in particular.

And then we'll do resistant bands or the mini trampoline or a sauna or weights, whatever. Some of our residents are working with PT so whatever you're doing. That we put in the afternoon. The more intense exercise. For aerobics, strength and then also that combination of cognitive function with the exercise. So there's a lot of data that shows that dual task exercise is what's best for your brain. And this is regardless of where you are on the spectrum of cognitive function. If you're just looking to optimize cognitive function, this is a great tool. So learning something new. For me, pickleball is the thing that I'm doing right now. So I'm learning to play pickleball. It's outside, it's social, it's engaging, and I'm getting my aerobic exercise in. For other people, it might be ballroom dancing. Because cognitively, you've got to engage your brain, remember the steps, you listen to the music, be attuned to your partner, and it's physically exertion. You're physically exerting.

This has been used a lot in the stroke, post TBI world. Parkinson's as well. Where you might have somebody on a BOSU ball balancing and they're doing math problems in their head. So the idea with dual task is that you engage at your edge cognitively and physically at the same time. And what we see is really significant increase in the amount of cognitive benefit you get from that versus just doing strength training or just doing aerobic exercise on its own. So we take our residents at Marama through that in the afternoons. And then in the evening we have dinner and after dinner ... Again, dinner is organic keto. After dinner it's really easy. I think a lot of us can relate to maybe even growing up in households where you just turn the TV on. Once dinner's over, everybody's checking out. And at Marama, we encourage everyone and we set it up and facilitate games like card games or bananagrams or even calling and talking and connecting to loved ones at that time.

So it's different for everybody, and it's different from night to night. Sometimes there will be a sing along. And this of course is in a senior living facility setup. But at home ... Whenever I look at that Marama outline for the day and the schedule for the day, I'm like, how can I do more of this for myself? Because again, it's the horizon. So if you're working, there's just no way. Hopefully you really love your work and it's super cognitively engaging and it does count here. But there's no way we can set our lives up like Marama but that is a structure or skeleton for what would it look like ideally if I spent from the time I woke up to the time I went to bed, optimizing my day for my brain health? And that's a little bit of what it would look like.

So what are the things that we can pull in if we're in prevention mode so that we never have to get to that point of needing memory care? So that's how I frame it and think about it. And then the evenings are doing things like reading. Things that will help you wind down, but that are not in front of blue light or a screen. Certainly not watching the news or things that are going to upset us. But engaging in things that feel like they set us up for really optimal sleep. I know you guys have thought extensively about this with the Qualia Night products. This made a ton of sense to dig into the science of sleep and how we get really good quality sleep, whether it's temperature, light, noise, of course sound. All of the things that are going to potentially interrupt us. What's the ideal mattress? What's the ideal setup so that we can optimize for really good sleep recovery? We know that people in their 20s, 30s, 40s, who have even one night of sleep deprivation, have an accumulation of amyloid plaques that are associated with dementia and Alzheimer's after just one night. So you can imagine that over decades, if you're not getting good sleep or enough of it, you're going to be at risk for dementia. And of course, when you have some degree of cognitive impairment, then it's ever more important to optimize that sleep.

Dr. Greg Kelly: I know going back from when I was in the Navy before becoming a naturopath, but even when I went to Southwest College, we didn't have financial aid my first year so I worked three nights a week at a teen shelter for about ... Not quite a semester, but a fairly good chunk of time where I would ... When I woke up Thursday morning, I didn't get to sleep again until Saturday when I would finish my shift at the ... Because I would go from school to eight at night till eight in the morning, at the teen shelter on Thursday night to school Friday morning to the teen shelter. Maybe a little nap after class. And then Saturday morning I would ... And so super quickly, my thyroid ... I remember the docs in the clinic wanted to put me on hypothyroid. I'm like, pretty sure I just need sleep.

Dr. Heather Sandison: It's amazing what fixes itself when we take care of those foundations of diet, exercise, sleep, and stress management. I mean, we're both naturopaths, but it still blows my mind how resilient the body is and how it's just divinely designed to heal.

Dr. Greg Kelly: Yeah. So much of my belief is get the foundational things in place and then, as you mentioned, the model that Daniel and you use, identify, are there toxins, are there infections, are there these things that are going to ... I guess I think of it as they're the obstacles for healing to happen. We'll need to remove those or disassemble them. So we need to do the good stuff so the foundational stuff is in place and then find the obstacles. And I think with that, maybe we can talk a little bit about some of those obstacles because that was a big part of the study, individualizing for those particular obstacles that each person ... So maybe share a bit about those.

Dr. Heather Sandison: Yeah. And I'm going to borrow some of Dr. Bredesen's phenomenal analogies. So the way he describes dementia, it's like this destination. When you have a diagnosis of dementia, you've arrived at this diagnosis, and there are different pathways that you can take to get there. And so what we want to identify as a functional medicine, Bredesen trained provider, my goal is to say, which paths did you take? Was it a traumatic brain injury? Was it hormonal insufficiency like thyroid or sex hormones or cortisol or there are many, many ones that we want to track and look at from an endocrinology perspective. And then is it glyco toxicity? Do you have too much sugar? Sometimes we refer to Alzheimer's as type three diabetes. And you get the point, this list goes on and on and on and on. And those pathways are not mutually exclusive. So you might have diabetes and have had a traumatic brain injury.

So what we want to do is identify all of them and then basically go back down the path and reverse that. And so these all trigger inflammation typically at some level, or they interfere with our ability to create energy or resource, ATP, that currency that our cells run on. And the brain only takes up about 2% of our body weight, only accounts for about 2% of our body weight, but it uses about 20% of the energy that we use every day. So the brain is an energy hungry machine, and if we are not feeding it adequately, or if it's not efficiently turning the fuel source, either glucose or potentially ketones, into ATP, then we have a problem really quickly. The other great analogy Dr. Bredesen uses is if you think of your brain as a country, like Mybrainistan, if your brain is at war, if you are defending or attacking against maybe infections or toxins, you do not have the resource or capacity, nor should you be using resources to create new connections and to lay down new infrastructure, new roads.

You can think of those neuronal pathways, those synapses as these roads where information is like an information highway back and forth from the brain to the tip of your toe. And you're not going to be setting up that infrastructure if you are spending resources on defending and attacking. So we want to get rid of those things. We want to end the war in your brain. And identifying things like toxins, which I think of in three flavors. You've got your heavy metals, your biotoxins, things that are typically found and mold is what we're looking for primarily there, things found in water damage buildings, and then your chemical toxins, things like Roundup and petrochemicals, maybe because your bio freeway or things that are on textiles or in detergents or cleaning products or in water. We want to be looking for those things and then eliminate them and also support the body in getting rid of them.

So this is where opening up the organs of elimination, our kidneys, our bowels, our liver, our skin and lymph and our lungs so that we can adequately offload these things so that they're not mucking up our brain. And then that's where getting the sleep comes in handy, because at night, that glymphatic system in the brain essentially rinses the brain of toxins. So if we don't get sleep, they accumulate in the brain and then start that inflammatory process that is triggering the beta amyloid plaque production, and then we're unable to get rid of them. So we want to make sure that we are able to get rid of toxins and we're eliminating as much exposure as possible. Then infections are another really important obstacle. And things like P. gingivalis. I mentioned dental health being really important to brain health, also very important for cardiovascular health. We want to make sure we don't have bacteria in our mouth that's going to, when introduced to the bloodstream, can create a significant amount of inflammation and again, trigger beta amyloid plaque production and protein misfolding in the brain.

So the four major ones that come up there are P. gingivalis, herpes viruses, Lyme, and the spirochetes associated with Lyme, but also the co-infections associated with Lyme like Bartonella, Babesia, Ehrlichia, and then also covid. And many people are familiar, and maybe some of our listeners here have had that experience of having covid and then feeling the brain fog that lasts for months and months and months after. Much of that is thought to be associated with the inflammatory cytokines that are triggered by covid. And then they get kind of on this self-perpetuating cycle where you can't break the cycle of cytokine production. And so getting in there, and yes, addressing the infection, but also addressing that inflammatory process in a way that helps to resolve it once and for all.

Another consideration here, of course, is the resource idea. So yes, the brain is going to prefer ketones to glucose, and very rare under research scenarios, they have created a brain that is basically being fed both ketones and glucose at the same time. And the brain prefers ketones. So much more efficiently, the brain will turn ketones into ATP or fuel. It also burns more cleanly so we don't have the oxidative stress associated with burning glucose. And glucose, sugar, carbohydrates, I'll use those interchangeably when we talk about this metabolism part of the picture, but when we switch to burning ketones for fuel, again, the human body just blows me away because we're essentially hybrids. We can run on either fuel. We can run on sugar, carbs, glucose, or we can run on fats or ketones. And as we age, regardless of our diabetes status, we do not turn glucose into fuel as efficiently.

We become somewhat insulin resistant and somewhat glucose resistant. And so the fact that we have this option to switch to ketones, I'm like, oh my gosh, this is underutilized, fancy thing that our bodies can do that we're not using. And what I see is that a lot of patients, their brains will just turn on. I literally have a patient who is able to remember his grandchildren's names when he's in ketosis and he's not when he's not in ketosis. It is so apparent, and all of his kids are on board now. They made the mistake a couple of times of feeding him ice cream and pizza. Did not go well. So it really is one of those things that can make a massive, massive impact on cognitive function. Brant Cortright who I also interviewed for Collective Insights, he wrote a book called The Neurogenesis Diet and Lifestyle, and he really explains how this ketogenic diet is so helpful in repair for the brain.

We also get this hormetic effect, which I know the Neurohacker discusses at length, but this hormetic effect essentially is the idea that we're stressing the system. So the ketogenic diet is a fasting mimicking diet that is stressing the system. And so you get the die off of senescent cells, the turnover recycling of those cells. You get a lot of the benefits of a fasting mimicking diet or that hormetic stress when you switch up your metabolism. You get this benefit of metabolic flexibility as well. Your body knows how to go back and forth in and out of ketosis when you've done it a few times. But many of us live the standard American lifestyle and diet, and we have access to carbs 24 hours a day, seven days a week and so we never think to not have them. I highly encourage that. Nutrients and having a balanced amount of nutrients, whether it's we're talking about sugar and glyco toxicity, having too much sugar or wanting more ketones, but also things like vitamin B12.

And we used the Qualia Mind product in the clinical trial in part because it has ... I think of it like a multivitamin for the brain. So we use that foundationally for everyone included in the trial because it's got a lot of these nutrients that are so necessary for cognitive function and from an individualized perspective, we measured nutrient status, so we knew what vitamin D levels were doing, what mineral levels ... All of the things that we can measure, we did, and then when they were deficient, we added them back so that wasn't the limiting factor, the limiting step in terms of brain healing. We need resource, we need the backbone, we need the neurotransmitters, we need the choline. We need all of those nutrient pieces in order for the brain to heal. There's so many other pieces I could go into, but I want to make sure we're on track.

Dr. Greg Kelly: Yeah. Well, I know we're starting to run out of the time we had allotted for this, but one of the things ... You had mentioned Qualia Mind, and the way I think of Qualia Mind is, and you've used the word resources several times, our brain needs resources. It needs energy. And so my story is simple. If I'm asking my brain to do more, it needs more energy, more resources, and I just think of Qualia Mind as one of those things. It's resources in a supplement for my brain. So I did before we end, wanted to cover a few additional things. One would be what age should we start caring about our brain? I know what my answer would be, but I'm curious to get yours.

Lifestyle Interventions Proven to Slow Cognitive Decline at Any Age

Dr. Heather Sandison: In utero.

Dr. Greg Kelly: Exactly.

Dr. Heather Sandison: From conception and even preconception, because toxins, our exposure to toxins in utero is important. So thinking for the next generation, I encourage patients who are thinking about having children ... I see fewer of those these days. I see people later in life typically, but I see the daughters and then the granddaughters of my patients with dementia, and I encourage them to make sure that they don't have heavy metals that they're going to pass on, that their chemical load as low as possible in that preconception phase. And then Dr. Bredesen, again, he talks about the cognoscopy. And I completely agree with him, of course, that I think everyone, by the time they turn 40, 45, should be looking to see if they have any of these risk factors that are modifiable. There are some things we can't control. We can't control our gender, we can't control our chronological age.

There's some things in terms of risk factors for dementia that we can't control, but there is a long, long list of things that we can control. And so those are the things that we want to focus in on that feels really empowering, and the sooner we know that data, the better our outcomes are, the more chance we have to resolve them before they become a problem. So what we do know about dementia is that the changes in our brains start decades, sometimes 20 more years before we have any onset of symptoms, before we're losing our keys or not keeping track of names or whatever it is. Those changes started decades ago. And so if we can know about them before they start, I mean, prevention is so much less expensive, so much less time consuming, so much less effort than reversal. I recommend that, especially if you know your APOE status, for instance, if you know that you have a genetic predisposition or if there are several people in your family who have had dementia, even just one person in your family who's had dementia, then the time to start is now.

The time to start is immediately. I've seen miracles happen. I've seen people with MoCA scores of zero get better. That's really what motivated me to do more and more of this work is that I watched miracles happen so many times. I had to shout this from the rooftops that there's something that you can do. And over and over again, what I've seen is not everybody gets better, and my confidence is higher if you're younger, if we are all in, if you're committed to the process, if you're diving in fully to all of these components and not just dipping your toe in the water. And then the earlier on in the disease process, of course, that's when we see the best outcomes. When people have MoCA scores in the twenties, I feel relatively confident we can get them back up into normal. When they start to get down into the teens, it's harder work, it takes longer, it takes more resources. And so the time to start is now.

Dr. Greg Kelly: Great. Well, before we started recording, you were mentioning some work you're doing on a book. So can we end with you sharing a little bit about what's upcoming and how our audience can follow you?

Dr. Heather Sandison: Yes. I was telling you that I'm going to lock myself away next weekend because my manuscript is due to the editor on ... Oh my gosh, in a week. And so, yeah, I feel really, really, really fortunate for the opportunity to write this book, which is essentially a how-to manual of a lot of what we talked about today, but in more depth with suggestions. Basically whether you're in prevention stage, if you have early cognitive decline, or if you're caring for someone with more severe Alzheimer's, we have ideas and tips and tricks and a lot just downloading what we've learned from the research, from the clinical practice, and then having residents at Marama, what you can do to optimize cognitive function really at any age. So be on the lookout. The working title right now is Reversing Alzheimer's: The new toolkit to know that you're doing everything you can to prevent and reverse dementia at any stage. So that will be hopefully out in June of 2024 with Harper Wave.

Dr. Greg Kelly: Wonderful. Well, Heather, it's been an honor and a privilege to get to sit in this position and share you with our audience and highlight you after all the amazing work you've done and all the wonderful people you've highlighted on past episodes of Collective Insight. So thank you so much for being with us today, for the work you've done and what you're continuing to do. Any last words before-

Dr. Heather Sandison: No, I'm just so grateful. Thank you so much for having me.

Dr. Greg Kelly: Our pleasure.

*QUALIA MIND IS NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE. While we are encouraged by the results of this study, it was based on a multimodal therapeutic approach. As such, it is not possible to isolate the contribution, if any, of each of the interventions to the overall results. Therefore, these study results should not be interpreted as an indication that Qualia Mind reduces cognitive decline.