Reversing Alzheimer’s: Brain Health Strategies for Midlife Women with Dr. Heather Sandison

Dr. Heather Sandison, welcome to the show.

Thank you for having me.

So I don't think we've actually talked much about the subject of Alzheimer's and dementia. It's actually very personal to me because my son who suffered a traumatic brain injury when he was 16, um, when they reevaluated him a couple years ago, found that he was like rapidly declining. So I'm excited about what we're talking about. We have reversed it, as we're going to talk about today. But I would love to know, since this is, this is a very challenging field to work in, and what made you decide to take this one on?

You know, there's so much suffering happening in the world, and I came to this as a skeptic. I learned from my mentor, Dr. Dale Bredesen, and what I realized very quickly after training with him was that there was this slice of suffering that we could really do something about. It is heartbreaking to watch families lose their mom, lose spouses, to have it, that long goodbye that's associated with Alzheimer's. I mean, you, you grieve each day when you have to tell someone to put their shoes on, right? An adult to put their shoes on or to buckle their seatbelt. There's a bit of grief that this person is no longer your mom or no longer your dad or no longer your partner, but a dependent. And that is so painful. It is financially devastating. It is physically devastating. Physically exhausting. It is emotionally bankrupting. And there is so much that we can do to prevent, to delay, and yes, in many cases even reverse cognitive impairment associated with Alzheimer's and dementia.

Good. That was the important thing to get out for everyone from the beginning is it's amazing what has happened in this field. Like it is, it is so, I, I'm so grateful for all of it. I think one of the key things, because it's not like you wake up one morning unless you've had a severe traumatic brain injury, it's not like you wake up and you've got dementia. How would someone know that they're seeing some early signs of it? What, what are those?

Yeah, so feeling like you can't come up with words, spending more time around the house looking for your phone, your keys, your wallet, missing an appointment. Oftentimes people aren't aware, and it's not necessarily denial, it's that they're not self-aware. And so it takes a loved one, a family member who maybe even hasn't seen them for a while, because it can happen so gradually. A family member comes for Thanksgiving. We hear this story all the time. My mom couldn't make Thanksgiving dinner for everybody this year. She was confused. She didn't know where things were in the kitchen. She felt overwhelmed. That feeling of overwhelm around things that used to do easily, like planning travel or hosting. Also, these people, one of the early signs sadly is that they fall prey to fraud, that they get confused about financial things and, and how to navigate all of that. And so they end up clicking on the wrong link or giving away banking information. And so those are some early signs. But I really, you know, 10 years ago, JJ, people would say, I don't wanna know my ApoE status. I don't wanna know my genetics. It's just gonna keep me up at night, which is gonna increase my risk of getting dementia. And so why don't I sleep well, not know, live in, in ignorance, and not have the anxiety. And 10, 15 years ago, that might have made sense because we didn't know as much as we know now. Now it's like, I want everyone to know their APOE status, to know if they have genetic risk, because they want to be more proactive than their neighbors or their spouse or somebody who isn't genetically related to you. They want to get ahead of that and make all of these lifestyle interventions that are so accessible, So simple, totally free. Those are the most powerful things. What we decide to put in our mouth each day, what time we decide to go to sleep, who we choose to engage with, how much movement we get, how we manage our stressors. Those choices that we make each day that seem really simple, those have the biggest impact on our brain health as we age.

And our heart health and our skeletal health. Like it's, It's always great when something that helps with one thing helps with all things. Let's back up, 'cause you mentioned APOE. Let's talk about that and other risk factors. Like, what are the key risk factors that we should be looking at for this?

Yeah, so APOE status, so we, we kind of put these into two camps. There's your unmodifiable risk factors, I can't change these. And then you have your modifiable risk factors. This is where there's so much empowerment. So with our unmodifiable risk factors, we have APOE status. So APOE— bear with me, this is a little bit complicated, but not everyone can follow this. So you get one from mom and one from dad. These— it's a single nucleotide polymorphism, or a SNP. APOE— APOE is an elephant. One from mom and one from dad. So you have two copies. Your options for copies are 2, 3, and 4. So there's no 1, there's no 5. You can have a 2, a 3, or a 4, and you get a one of those from mom and one from dad. The general population, leaving aside APOE, has a 13% chance of developing, being diagnosed with Alzheimer's in their lifetime. If you have one copy of APOE4, that risk goes up to 30%. And if you have two copies of APOE4, one from mom and one from dad, then your risk for developing Alzheimer's in your lifetime goes up to well over 50%. If you know that, then you can make these changes. You can make these decisions early in life. You can get more sleep, you can protect your brain health in many, many, many ways. Other non-modifiable risk factors are your sex. Women are two-thirds of Alzheimer's patients. So for every three Alzheimer's patients, two of them are women.

And your age. Do you know why that is? Is that estrogen related? What is it?

I think there are a number of factors. And when we get into the modifiable risk factors, you'll see some things that affect women, I think more than men. Things like social isolation, depression. Certainly there's a hormonal component to this, and that steep decline in estrogen when— and progesterone when we get to menopause, I believe, plays a role. I see that in my clinical practice, and we see that in the literature, although there is some degree of controversy around that still. The other thing is age. Women live longer, and your age, your chronological age— we can't change the year you were born. We can change your biological age, but we cannot change the year you were born. And as we age, our risk grows and women live longer. So there's— they also, you know, carry multiple roles. So stress and cortisol can become toxic to the hippocampus over time. And when women are carrying the roles of childcare and working and everything else, it can— they can have more stress than men. The sleep deprivation associated with raising children, with having children. So I think there's probably a lot of factors there and we don't know exactly, but what's really exciting to talk about is our modifiable risk factors. This is the stuff we have control over. The Lancet Commission report has been updated several times. The most recent one came out in June of 2024, and they have 14 modifiable risk factors, things like cholesterol levels and hypertension, managing blood pressure. The Lancet Commission report says unequivocally the only medication known to prevent Alzheimer's is antihypertensives. There is not a pharma— pharmacological solution to the problem of age-related memory loss. There are a couple of medications that can help us reduce our risk, and one of those is antihypertensive. So I, I'm a naturopath. I don't reach for medications lightly or quickly. However, if I have someone who has memory impairment and they have uncontrolled hypertension, even if they don't want a medication, I highly recommend they reconsider, look at the different medications that are available. Choose one that's gonna have low side effects and get that under control for kidney health, for brain health, for heart health. All of those things are so important.

And then one, one sec on the hypertensives. Is there, 'cause I know there's a couple different types. Is, does the type matter or all of them? Is it the lowering of the blood pressure that's reducing the risk of Alzheimer's or is it the medication, the mechanism of the medication doing it?

It's reducing blood pressure. So Alzheimer's and vascular dementia are very closely linked. Most people who have one have the other. And hypertension, having that tension on the endothelium, on those blood vessels, on the, on the muscles that make up those blood vessels, that can cause, you know, of course, risk for stroke and cardiovascular issues, but also can be related to vascular dementia. And so we want to make sure that that that pressure isn't there, that, that pressure there, there's a dynamic ability to recover from stress, to bring that down and to pump blood into the brain, right? Sometimes hypertension is related to atherosclerosis. We need to get enough blood and oxygen nutrients into the brain and then also back out, of course. And so the different mechanisms, it really depends on the person. So of course you're gonna wanna talk to your provider. Number one thing, most important that it works. That it brings your blood pressure. I see so many people, I'm on blood pressure medications, but their blood pressure is still elevated. It's not working. We need to figure out a different combination, maybe add some herbs. Of course, of course, of course. Diet, lifestyle, sleep, treating sleep apnea. There are lots of lifestyle-related things that are, are causal when it comes to hypertension. And if it's not working or if we, if it's familial, there's a genetic component, we've gotta do something about it. We've gotta bring that down.

All right, that makes sense. So beyond hypertension, what's next?

This list is long. So I mentioned depression, social isolation, that's kind of in one category, that stress category. The way I organize myself and a lot of these Lancet Commission report modifiable risk factors, they fit into these different categories and it can get overwhelming and I can feel very scattered when I go through this list, but it, let's put it into a framework. So I think of this 6 components of brain health. There's toxins, nutrients, stressors, structure, signaling, and infections. So when it comes to toxicity, on that Lancet Commission report, they include smoking, of course, the toxins associated with smoking cigarettes, and then also air pollution. So these are modifiable risk factors, right? We can quit smoking. Hopefully we can maybe move outside of a place that has a lot of air pollution. But I like to expand that, not so the Lancet Commission report, it acknowledges those two, but it doesn't acknowledge yet mold exposure and biotoxin exposure. It doesn't acknowledge heavy metals like mercury, very neurotoxic. And it doesn't acknowledge chemical toxicity like microplastics and glyphosate and other chemicals that are ubiquitous in our environment. And so we work with patients to talk them through to one measure and then talk them through how to use binders, how to use detox protocols to get get those out so that they're not adding more stress to the brain. We can keep going through all of those if you like.

I, I do. I think it's actually fantastic that there are all these modifiable risk factors. And what's fantastic about— I mean, just even thinking about toxins, well, if it doesn't lead to Alzheimer's, it might lead to cancer, you know. I mean, it's like, might lead to heart disease. I mean, it's going to go somewhere if you don't get it out. So Actually, if you do this, if you work through this, let's say you have an APOE, you know, for one, one of the sides of it. If you do all these things, you're going to make everything else better too. One question before we go to the next one is how long is the process from people starting to have little signs or starting, you know, the brain structure changing or whatever starts to happen before you get full-blown?

So it depends on the person, but there are many reports in the literature. We see that changes are happening in the brain. The pathophysiological neurodegenerative process starts decades before we can't find that word, we can't find our keys. It— there is a long window where we can intervene and we can prevent the symptomatic decline. And that I think is really exciting. To your point, I mean, this is common sense. This is all about healthspan. This is about living a long, wonderful life, you know, to its fullest. Not as much as I want to say, like, take the brain and put it, make it separate from the rest of the body. It is the same things that are good for bone health and heart health are good for brain health and inspires a full life, a full rewarding engaged life as we grow older.

Okay, so beyond toxins, 'cause I know you said there were 6, what's the next one?

Okay, so nutrients. And again, in the Lancet Commission report, diabetes, obesity, these are risk factors, known risk factors for dementia. So we recommend an organic ketogenic diet. You don't have to be in ketosis forever, but going back and forth in and out of ketosis, getting that metabolic flexibility, keeping the hemoglobin A1C at around a 5.3, 5.4. You wanna keep that low, have that metabolic flexibility, keep blood sugar sugar low, prevent the spikes and drops, and then feed your brain ketones. In rare research instances where both ketones and blood sugar, uh, and glucose are available for the brain to use as fuel, the brain prefers ketones. And many of my patients report, I experience it, when you're in ketosis, it's like your brain turns on. And we've literally seen patients who don't remember the names of their grandchildren when they're not in ketosis, and then they get into ketosis 72 hours after carb restriction, adding some exogenous ketones, and they remember their grandkids' names. I mean, it is so heartwarming and so amazing to see that this works. It really works. And especially when we adopt it earlier, when we get that blood sugar control, we don't build that insulin resistance. We just see, we see really impressive, amazing things happen.

I was just going to ask you if exogenous— could you do a modified keto diet, maybe you're not in full-blown ketosis, and supplement with exogenous ketones and get the same type of result? Or do you really need to be in a true ketogenic diet?

We do see some dose dependence. So we see that the people who get their ketone levels the highest, up into like the 2, 3 level on millimoles, if you're looking at a Keto Mojo, or if you're testing blood ketone levels, it's up over 2 and 3 millimoles. We see the biggest delta, so the biggest change in their cognitive scores. That being said, we did a clinical trial in my office. We took 23 participants through a 6-month intervention applying Dr. Bredesen's protocols, and 17 of those 23 participants with cognitive impairment, with measurable cognitive impairment, improved. So 74% of them, the vast majority of them, and not all of them got into ketosis. So you don't have to get into ketosis to get improvement, but all of them did significantly change their diet and reduce especially their processed carbohydrate intake.

Yeah, that is, that is such the big key. And for the rest of them, like walk us through what your ketogenic diet looks like. I'm assuming it's not pork rinds and Tab.

I know. This is, I always say this is not a bacon and cheese diet, right? Yeah. This is about getting, we love eggs. They're full of choline and animal products, organic, organic as much as possible, grass-fed, wild-caught salmon. So it's good healthy fats and oils. It's coconut. I'm a big fan— Mary Newport is another mentor of mine. I'm a big fan of coconut oil because it's got those medium-chain triglycerides in it. It's got the, um, it's also got some antimicrobial benefits to it. So using those really good fats and oils, high polyphenol, olive oil, avocado, lots and lots of veggies, focusing on, you know, most of your plate being green, using things like cucumbers and of course all of leafy greens, artichokes, and green beans, and lots and lots of greens. And then using protein, you know, enough protein. Some of this can come from soy, but primarily we do— I do encourage people to get good high-quality animal protein while on a ketogenic diet. And because we're going to flex back and forth, we're going to go in and out of ketosis with some regularity, go more plant-based. Add squash and seasonal fruit, things that are going to raise your blood sugar when you're not in ketosis. And back off of the animal proteins. With my patient population, the people that we work with, they're concerned about too much weight loss often. But if you're a little younger, if you're in your 40s, 50s, midlife, most people at that stage are actually looking to lose some weight. And getting into a really clean ketogenic diet with very veggie-forward, you know, eggs and avocado for breakfast, if you're doing intermittent fasting, at least a 3-hour window between your last bite of food and getting to sleep, Maybe having 2 meals a day, having chicken thighs and asparagus and broccoli and leafy greens. That's what I often eat for dinner. And then there's coconut yogurt. There's tons of great snacks, keto snacks. There's a lot out there. I have in my tea, I do a matcha with, with a keto creamer that has lion's mane and theanine and MCT powder. There's so many great products out there these days where you can get plenty of protein, lots of greens. Um, and there's also, we have a ton of dessert recipes in the back of my book because I know people always wanna know, well, what do I do if I'm celebrating? Or what if I have a chocolate craving? Fat bombs that are made with nut butters and coconut oil. It's really amazing at Mirama, the residential care facility, uh, communities that we have. Um, the chefs are so creative. Nobody feels deprived at all. You can have a very creative, very fun, very flavorful keto diet that's sustainable. And it, it can take, you know, you, it's helpful if you like to cook, but there are also great food and meal delivery services these days that have been a wonderful resource for people.

There's so many great desserts you can make as long as, like, if you had to go low fat, it would be hard. But gosh, with coconut cream and avocado and nut butters and dark chocolate and some allulose, you can, you can crush it. It's amazing. And some mint and mint.

Mint or cardamom or, yeah, there's so many great flavors out there that we kind of, cinnamon, we associate with sweet and so it's very satisfying. And we encourage people to do minerals, like have sea salt. Yeah, I'm sure you have some favorite recipes.

Oh yes, yes, I have a great dark chocolate mousse. I mean, I actually just did it last night. We did pasta night, but we used konjac and egg white noodles. To do it. Like these amazing— I found these new amazing egg white noodles. I was also using konjac root noodles and it was incredible. Like just incredible. So with my son's amazing grass-fed marinara, you know, meat and marinara and tomatoes and mushrooms and onions and it was fabulous. And then we did this. I made like chocolate, dark chocolate mousse for dessert.

With avocado. Do you do an avocado base?

Yeah, I do avocado, coconut cream, dark chocolate, Um, you know, unsweetened dark chocolate and little allulose. I love allulose. Shout out RX Sugar. I mean, it's— this is not hard. And some coconut cream on top and some dark chocolate chips.

Yeah. If you have a food processor, a Vitamix, like this stuff is quick and easy.

Easy. I mean, those are like 5-ingredient things. Yeah.

So I also think of cooking these recipes, like not only is it super tasty, but it's like bicep curls for your brain to think about buying new things, putting it together in new ways, to go through the executive functioning of planning a recipe, going to the store, getting the things, deciding what you're gonna do. Yeah. And then executing on that and cleaning up after and sharing it with someone you love. That is so good for your brain.

Yeah. The cleaning up after, I don't know that, that my rule is I'm gonna do all this. You guys get to clean up, you know, so I don't feel like that benefits my brain, benefits theirs. All right. So we did nutrients. What's next?

So stressors, uh, all of these things, we wanna think through them in terms of balance and what we're looking for are imbalances, too much, too little in the wrong place at the wrong time. And with stress, this is a great example of where balance is crucial. Some people think of retirement as kicking their feet up, having happy hour at 5, 5 o'clock every day and thinking like not really thinking about much, not challenging themselves, just watching TV and checking out. Ugh. If you lose, if you don't use it, you lose it. And so we need challenge. We need enough stress. We need exercise as a great example of this. We need enough stress. This, I, this concept of hormesis where we are expanding our resilience through stressing the system. So we don't wanna go into decompensation, right? We don't wanna collapse, but we want to challenge the system. We wanna challenge the brain. We wanna challenge the physical body. And in fact, it's even better if we do those together. This is called dual task exercise, where we engage cognitively at the same time that we engage physically. And you actually get more benefit for your brain when you combine those two things. So this can be as simple as walking and talking, or it could be taking a class, a Zumba class, a Pilates class, anything like that, where you're cued by an instructor and you have to keep up with like, okay, right hand, a to my hip. Pickleball, tennis, racket sports are also great. Hand-eye coordination. You also get outside, so you're potentially connecting with nature. You're at least getting sunshine. It's very socially engaging. You've probably heard that ballroom dancing is protective of your brain, right? When we think about how many, how many boxes can we check in terms of how we're engaging our brain, we're socially connected, we're physically active, we're potentially being cued. We've gotta remember the steps. We are, have to kin, kinesthetically, we need to be pro, our proprioception. We have to be aware of where we are in space. There's the musical component that's engaging our brain, right? There's all of these aspects of it that are all layering on top of each other. And when we do that, we get more benefit versus like getting on the Peloton and just checking out, right? I, I, we've probably all been there and like we sometimes we need that. Like we still need to get our cardio in, but we also wanna check out. I really encourage people to like get the stress of challenging yourself cognitively and physically at the same time. The other piece though with that, right? It's like the balance. You want to enjoy it because I'm gonna say this and maybe somebody hears it and they're like, all right, today's the day I'm getting started. But 12 weeks later, what's gonna keep you going? And so knowing your motivations, is it that if I pay for it, I'm gonna sign up because I'm too cheap to like lose the $40 for that class, or if I have to put it on my schedule. I have to schedule it. If I schedule it, I'll show up. Or if I meet a friend, I'll show up for my friend, but I won't show up for myself, right? Knowing our motivations and knowing what is gonna be more of a carrot. We don't do it because we're afraid of Alzheimer's. We do it and we stick with it because we want to, because we enjoy it, because it's worth showing up for. So stress has a balance component. We don't want Caregivers, caregivers are anywhere from 2.5 to 6 times more likely to be diagnosed with Alzheimer's. So you can definitely get too much stress that becomes toxic, but we also want engagement. We want that fun engagement to last a lifetime.

Wow. Caregivers are 2 to 6 times more likely to get Alzheimer's.

It's absolutely heartbreaking. Wow.

Making a little note on that. Yikes. Okay, what's next?

So structure. The first thing that comes to mind for me is sleep apnea. So structure, I think of it, you know, you mentioned your son's traumatic brain injury, right? If you get hit over the head with a baseball bat, you are going to create inflammation in the brain. Now, if you also have genetic predisposition, you're gonna create more inflammation. If you have multiple concussions, if you're not, if you don't have the right nutrients, it's not going to heal as quickly. If you're already inflamed, it's gonna be worse. So there's lots of ways to think about structure. I think macrostructure and microstructure. Microstructure is like our genetics, right? Our molecular structure. But I think if you had one takeaway from this conversation when it comes to structure, it's obstructive sleep apnea. It's plumbing. Can you get enough through the tubes, right? Can you get enough oxygen through hopefully your sinuses at night into your lungs so that you can get enough air to your, or enough oxygen to your brain. So the reason why this is so important, I heard a sleep doctor describe it as obstructive sleep apnea each night is essentially like mild brain damage every night. And as a brain doctor, I don't want that for anyone.

So, you know, I know there's a lot of, um, at-home tests. In fact, I just ordered one to do just to check because I'm not convinced on my Oura Ring. Like, it's saying these things, I'm like, I don't buy it. Um, what's your favorite way? Because it seems to me going to a sleep lab is the most ridiculous thing ever. How are you going to sleep well when you, you know, in this unknown environment where, you know, people are watching, you got a thing on your head, so, or whatever they do? What's your way to look for this?

Yeah, WatchPAT, um, W-A-T-C-H, like watch that you wear. There's a watch and a ring and P-A-T, watch Pat. They have some great technology, sort of in the post-COVID era, there was a lot of technology that came out of these wearables. So you're right, Oura Ring, the data's not great. So you wanna do something else. You wanna look at O2 sats and understand if you're having apnea events at night and treat aggressively. So I agree, going to an overnight sleep study is such a chore. It's still the gold standard even if you don't sleep well. But I get it, you've gotta schedule, it's 6 months out, you need somebody to drop you off and then pick you up. And it is, and then you lose the sleep, you can't do anything the next day. It's a nightmare. It's still the gold standard for ruling in sleep apnea and for also identifying other sleep disorders. So it, it still has a lot of value, but the shortcut is to do these at-home sleep studies. And for those, I have seen patient after patient where we rule in obstructive sleep apnea, thin women who don't snore or their partner doesn't know that they snore because they are, they take their hearing aids out at night or they sleep in another room. And I have literally had patients patients show up to do the sleep study or meet with the sleep doctor and they will say, I can tell by looking at you, you don't have sleep apnea. And 48 hours later we have a test result that says severe obstructive sleep apnea.

Wow.

Yeah, you can't, it's not textbook, right? It's not the obese man who's gasping for air. Yes, he needs to be tested and treated, of course. But that doesn't, a lot of people say, but I don't gasp, I don't snore. I don't care if you have cognitive impairment, then I want you to get a sleep study because I have seen how profoundly it impacts patients. I had a patient who came in and she had a MOCA score of 8. So the MOCA is the Montreal Cognitive Assessment. This is a 30-point scale. Perfect is 30, 26 and above is normal. She was at an 8. As people go towards zero, they're losing the ability to communicate. She certainly was dependent on her family for activities of daily living, getting dressed, showing up to appointments, driving. She was dependent on her husband for everything. And she was, had been a woman who was really engaged, very social, hosted, was the life of the party, and very, she also was very healthy, right? She ate well, she was never overweight. And we've identified that she had sleep apnea. And when I met her, I didn't have a lot of confidence. You know, this has been a theme. I'm a skeptic until I see otherwise, right? She came in, she had the support and love of her family. But at a MOCA score of 8, and she is in her late 80s, I was like, gosh, I don't know that I can help them. And she sure proved me wrong. She came back 6 months later and the primary thing they did was get her on— identify— we identified with the WatchPAT— identified severe obstructive sleep apnea. She got on a CPAP, she wore it religiously. Her MOCA score went up to a 15 and it stayed there for years. So she has improved just dramatically. She's engaged. She's buying age-appropriate Christmas gifts for the grandkids. Her— the cousins were like, wow, do you remember how she was sitting in the corner not even engaged last Christmas? And now this Christmas, she was just like back to being the life of the party. She's engaged in conversations, like she's back. And her daughter was one of the ones that came in and was like, I've got my mom back. It's amazing. I mean, just priceless to have that back. And we did lots of things for her. We did bioidentical hormone replacement, we did detox, we got her vitamin D up and her homocysteine down. I mean, we did all of the Bredesen approach, but the biggest impact from what I saw, from what the family saw, was from using a CPAP to treat her severe obstructive sleep apnea.

So this WatchPAT, this is something that, that you could do at home Or is this a, tell me about this thing. Is this like an at-home sleep thing? What is it?

It's an at-home sleep thing. So you get a watch and a ring and it magically beams the information up to a sleep doctor somewhere who then can analyze it and determine whether or not you need to treat it. And sometimes I say CPAP and people go, no, no, no, I will never wear that. I can't breathe with a mask.

You would if your test was bad.

You should if your test is bad. But they also have oral devices. They're tongue stimulators. They're, you know, even if you, mild sleep apnea, you can treat with mouth tape and Breathe Right strips. So there are, there's a spectrum of intervention. So don't be afraid of a CPAP. And a lot of people are afraid of it. They, they can't get used to it at first, but making friends with your sleep apnea is so important, so crucial to your brain health. So you gotta figure something out to treat it.

I just love this because here's the thing, whether it's dementia, insulin resistance, you know. I mean, there's so many things that sleep impacts. And what you're saying, I'm kind of going, well, how would you know? How would you know?

It's a chore. So be persistent. Ask your provider. Tell your provider if you have any cognitive impairment or if you have any risk, if you're waking up tired, ask for a sleep study. And Watchpad is covered by insurance, by Medicare in particular. So you can get all of this run through insurance. If you are someone who has the means, you might wanna say, I'll just pay cash because I don't wanna wait. Um, and, but it is, it's a chore, JJ. Like it is, you've gotta call, you've gotta harass 'em, you gotta follow up. I mean, it's the medical system the way it is today.

What does it, what does it cost just to do it outside of the system?

We negotiated with a group for $300 per person to do that, which I think is very reasonable.

Yeah, I know the one I just looked at from the sleep doctor is like $189. So I mean, they're all in that range, it's $200, $300. It's, I mean, for what you're going to find from this, I think it's super important.

And I hope that you find you don't have apnea, right? And you can check that box and know that that's not what you're, one of your contributing factors, right?

Full disclosure, so, uh, my husband snores. And so he would like, I'm like, I'd shove him during the night. And then of course we do what you're not supposed to do, which is sleep with our 3 little dogs. So, and I have an old dog who's 19 and she snores. So it's like, I was like, oh my gosh. Anyway, then he's like, when I just push him and I go, you're snoring, he goes, you're snoring. And I thought he was just pushing me. Like, I thought it was just a, and finally the other day he goes, you know, you're snoring. I go, I don't snore. He goes, yes, you do snore. And so now we're all getting sleep tests because I was like, okay, we, you know, can't do one for the dog, but the rest of us, it's like, huh, what's really going on? He's got a deviated septum, so we know that he's got that issue, but it seems to be something that we all should be looking at because gosh, I mean, it impacts everything. How well you build muscle, how well you recover from working out, how well you handle stress, you know, how well you— what's going on with your blood sugar. There's so many things and it would be interesting you know, I always look at blood sugar as this indicator of, of when you see someone with great triglycerides and you know their diet's great and yet they've got this high blood sugar, you kind of go, huh, could that be— I always was like, well, probably a stress. Well, could that stress be poor sleep?

So, right, during sleep, during deep sleep, we rinse the brain, this lymphatic rinsing of the brain where we get rid of amyloid. One night sleep deprivation in someone in their 20s, 30s, 40s leads to a measurable increase in amyloid in just one night.

Wow. And can you make up for that, or is that just, uh, like, what happens? Are you able to deal with that increase in amyloid? Like, what happens?

Well, you can imagine we all create amyloid, right? Amyloid is antimicrobial. Amyloid is protective. It's part of an, a brain inflammatory process, right? It's when we have that microglial activation. It's just like inflammation. We want it in the right cases, but we don't want it to accumulate. We don't want it to be runaway inflammation in the brain. And so we, yeah, we need to get that sleep. If we're not getting that sleep, we're not getting the rinsing. And it's not just amyloid, it's mercury and mycotoxins and glyphosate. And every cell metabolizes each day and has metabolic waste it needs to get rid of. And so if we don't get sleep, we're missing out on the opportunity to do that if we don't get deep sleep. So it's not just the amount of sleep, it's the quality of sleep. Now REM sleep to your point, point about stress, right? If we don't get REM sleep— REM sleep, I'm so excited about this topic. I just want everybody to hear me. I can't even talk right. So if we aren't getting REM sleep, then we aren't getting that memory consolidation. And the amygdala is so closely connected to the hippocampus, you can't separate them. So our emotional body with our memory body, our memory brain and our emotional brain, they are So linked, and a lot of the processing of our emotions tied to our memories, what happened during the day, happens during that REM sleep. And if we miss that, then that thing that happened yesterday that irritated you so much, that, that made you so stressed, when you think about it tomorrow, if you haven't been able to process it, it's gonna create that same spike in cortisol. It's gonna be like you're back in that traumatic experience potentially. You're not gonna process emotionally. So it's just absolutely crucial to brain health that we're getting enough sleep, 7 hours minimum, aiming for an hour and a half of REM sleep, an hour of deep sleep. Now don't let those numbers keep you up at night. Just focus on getting the best quality sleep that you can. But having something like an Oura Ring that gives you a little bit of feedback. When I meditate, when I take some lion's mane, when I, you know, take some melatonin, when I avoid alcohol, how does my sleep change when I drink alcohol? When I do engage in these different behaviors or take these different supplements or medications, what happens to the quality of my sleep and how might that accumulate and get in better in balance or out of balance over time?

So you mentioned alcohol and obviously alcohol for sleep is just a train wreck disaster. Um, where else is it problematic? Is the only issue with it in dementia and Alzheimer's in the sleep interruption or is there more to that story?

Well, toxic, right? It, our, our liver has to process alcohol as well. So alcohol is one of these modifiable risk factors. Excessive alcohol consumption again is in the Lancet Commission report. It's, it's been identified as something that contributes to cognitive decline. And there are severe cases where there's thiamine deficiency and, and with, with alcoholism and excessive alcohol use over many years. But I think in this like even casual use of alcohol, we see a reduction in cognitive function. Now, I think most of us can relate to maybe binge drinking in college and feeling like we weren't as sharp the next day, right? And also with sleep, right? The sleep deprivation associated with jet lag or something, you're not as sharp the next day. And that personal experience, you know, we can talk about all the science and all the papers, but when you have a personal experience of like, when I drink, I don't sleep as well and my brain doesn't work as well the next day, Lean into that, right? Like, and we see, of course, that's apparent in the literature. So toxins— the liver's got to take out a bunch of trash each day. And if we are adding alcohol to that toxic milieu, it's just more for the liver to do. So, you know, what do you do? You maybe give yourself more time to sleep, give yourself some extra doses of glutathione, some liver support capsules. And moderate, you know, don't overdo it. Don't do it. Don't drink regularly. If you have any cognitive impairment, I recommend that my patients eliminate alcohol completely. I just think that the risk is too high. I know it's a big ask, but there are a lot of alternatives and I see even the culture shifting away from kind of this real social need to drink, right? To, in, in order to socialize, you have to drink. There's all of these alcohol-free beverages. There's lots of pieces to that that I think are helpful. Also avoiding sugar with alcohol. That combination of sugar plus alcohol seems to be particularly detrimental on sleep and of course your blood sugar levels.

I think the big question now, it's like the moderate drinking thing has been so refuted. It's like, okay, well what is moderate drinking now? You know, I, I love using an Oura Ring cuz you'll just see, wow, one glass of wine actually interferes with sleep. You know, it's like just one glass of wine interferes with sleep and and then you go, do I really want to do that? And make that decision. And occasionally you might want to, like occasionally if I'm going out to a nice restaurant and having— we went to this amazing wagyu place in Beverly Hills called Matu when we were there recently. I was like, okay, we're gonna have a glass of red wine. But we've cut all of that out at home because we can see it on our sleep scores and it's like just not worth it.

A lot of alcohol, wine in particular, has a lot of toxins in it, right? The sulfites and the glyphosate and We don't drink California wines though.

We stick with Dry Farm wherever possible. Shout out to Todd. But still, even drinking Dry Farm wine, like we stopped drinking California wine years ago after a lecture from Todd on that. And now I look at it and go, and then you've got flame retardants in the soil too. Like, yeah, double whammy. But, just even drinking lower alcohol, you still see it. In your sleep scores. At least I do.

Yeah, the same.

Yep. Okay, so let's see, we've hit toxins, we've hit structure, we've hit stressors and stressors. What's next?

So let's talk about infections real quick. There's 5 infections that really stand out to me, um, that many people don't realize. So oral infections, gingivitis. P. gingivalis associated with gingivitis can trigger inflammation directly in the brain. So what— a couple of these we have seen in the amyloid plaque on autopsy. P. gingivalis will be in the brain of people who have died with Alzheimer's. And so amyloid, again, don't forget, it is antimicrobial, so it's there to protect you. And gum disease will not only increase cardiovascular risk, it will increase Alzheimer's risk and cognitive decline risk. So take good oral hygiene. Again, if you take nothing away when it comes to infections here, brush your teeth twice a day, floss at least once a day, see the dentist at least every 6 months.

And, and I'm gonna link to this interview that we did with Dr. Sandra Moldovan. I don't know if you saw her talk at Mindshare. Uh, she is a functional dentist, but also a nutritionist and does this whole oral detox and found the cavitation in my jaw. Hmm.

The world needs more of her.

I know. I was like, you gotta get out and teach this. Does CT scans and is fine. I mean, it's mind-blowing stuff. So like I'd gone to great dentists for years and no one had ever seen these things. No one ever caught it.

One thing to ask your doctor to do too is to test Lp-PLA2. So this is, many people think of this as a cardiac inflammatory marker. However, it often will link back to an infection, like a cavitation, one of these latent kind of hidden infections in the gum or in the mouth. Jaw. So something to consider, especially if I see that consistently elevated for a patient, I'm referring them to a biological dentist right away.

And so most doctors wouldn't know to do that though. They wouldn't know what— that, that Lp-PLA2 was indicative of a potential jaw issue, would they?

Yeah, a lot of them would send you maybe to cardiology because it's a cardiovascular risk factor. But it—

the—

what is the cause, right? In our world, like, we're just always asking, where is that coming from? Right? Like, yes, we wanna protect the heart, but like, let's get to the why and solve that problem. And sure enough, we see that come down when people treat their cavitations, when they pull that root canal that's got some infection underneath it, uh, we see that those resolve.

Yeah. I had, uh, white blood cell count issues for basically two decades that no one could figure out until this. Gone.

That's amazing.

Yep. Yes. Okay. So infections, what else besides that infection? What else?

So we see that Lyme, Lyme and Lyme coinfections have a big impact on cognitive function, the Lyme spirochete. So getting a referral to a doctor who knows what to do about that, it's really important. If you have had tick bites, even flea bites, um, even mosquito bites, vector-borne disease, I think is, is something that's underrepresented, especially in the conventional world. But you need to find a doctor, an ILADS doctor, someone who knows that well in order to get—

How common do you think that really is? Very.

Yeah. Yeah. I think it's only becoming more so.

And it's just because we weren't aware, right? I mean, it's been there. Is it that we're now becoming more aware in testing, or is it also becoming more of an issue?

I think it gets less cold in the winter in some of the places. So like the, the ticks and fleas, those, those insects that would have died in the winter and really would have had a dormant season, there's a longer season for them. I think that also there's so many toxins and stressors and nutrient imbalances in our systems that we don't have as robust immune function. So I think that there's multiple things going on. And part of the reason I talk about infections in towards the end is because when you have great balanced nutrients, when you're getting great sleep, when you don't have a big toxic burden, your immune system works better. And I think genetically some people are more, uh, kind of vulnerable to these vector-borne diseases. You can have two people that both come back positive with Lyme and one is debilitated. I mean, COVID was such a great example of this, right? You have some people who have zero symptoms at all and then other people who die. And there is a difference in our response and our immune system response and our ability to deal with these infections. And there, there's a spectrum. And finding a good doctor who gets that, who understands that, who can help you through that process, I think is, is important. Dr. Bredesen has seeing patients with especially atypical cognitive decline, right? Where it's happening really early in your 40s or 50s. If it's happening really rapidly, if it happens after COVID, right? Like that's when you wanna find a Bredesen-trained provider who can really help you navigate what could be going on and then potentially get that referral to an ILADS doctor who really knows it. So Lyme and, and Bartonella, Babesia, some of the other coinfections have a big impact on cognitive function for for some people. Now also, um, COVID, COVID is a bit different mechanism. Instead of it being found in the brain of autopsy brain tissue, what we think is going on is hypercoagulation. So it's more related to this vascular dementia that we're getting small clots and that the endothelium, the blood vessels, again, kind of going back to this, this plumbing idea that we're not getting as good of blood flow. And so it's a different sort of approach to that in terms of helping with vascular integrity and helping to break down the cytokines that can accumulate in the bloodstream that can lead to that hypercoagulability. So things like nattokinase and serrapeptidase, of course addressing the virus if that's there, but if it's just that cascade of cytokines that's there, then we really wanna focus in a precise way on getting rid of that. Another infection to consider is herpes simplex. So HSV-1, which is responsible for cold sores, if you're someone who gets cold sores repeatedly, uh, there is a link between that and amyloid plaque production and, and progressing towards Alzheimer's and dementia. So treating that potentially with medications like acyclovir, valcyclovir, or using things like lysine, lemon balm, uh, minerals, there are ways to address that and reduce your risk. We see in the, in the literature that those who have aggressively treated those viruses reduce their risk of developing dementia compared to those who do not, who just have repeat, these recurrent cold sores. So H. pylori, I mean, if you look up infection and Alzheimer's, any infection, any, any microbe and Alzheimer's in PubMed, there's somebody who's done some research that connects them. What we want is to reduce the viral burden, reduce the, we, I think that we used to think of the, I used to think of the blood-brain barrier as being really, really strong and it doesn't let anything in. And I think that we can throw that hypothesis out. Like, it's just not true. There are a lot of microbes that get into the brain. There's almost a, like, I think we should start thinking about what is a healthy brain microbiome and reduce infectious burden, reduce toxic burden, give our brain the, the nutritional support, the engagement that it needs. So put the good stuff in and take the bad stuff out wherever there's an opportunity to do that.

That makes a ton of sense. And the final one, signaling.

So signaling is what, you know, again, putting the good stuff in, right? Brain-derived neurotrophic factor. This comes from exercise. Yes, yes. From muscle, right? So does testosterone. And testosterone, you know, when we think back to being 19, 20, maybe we have kids who are in that, in that zone where you're, you're hormones are peaking, right? Or when you're pregnant and your hormones are just raging, right? The hormones send signals for new growth, new connections. Those hormones literally get sent to build a brain when you're pregnant, right? So we want to have enough hormone. Now, we don't need to go back to our 20s, but we want to have enough signaling showing up in the brain so that those estrogen, progesterone, testosterone, DHEA, pregnenolone receptors are receiving some of that signal to promote new growth, new connections between neurons. Now, I mentioned BDNF. There are other brain signaling molecules, vitamin D, vitamin K. There are, there are, those are signaling hormones that get picked up by the brain. Thyroid hormones. These are just crucially important. And when we are atrophic, when we don't have enough of that signal arriving in the brain, then our, our tissues start to atrophy, right? We don't, we don't get as much of that that signal to connect and create new connections between— it's harder to remember that name, remember that word.

So the biggest challenge I see with all of this is that it's very hard to sell prevention, and then it's very hard to do once someone's getting their, you know, score of 8. Now everyone's involved and the family's involved. How are you helping people? I know you've got your, um, residential center, which is amazing that you're doing this and you're seeing people. Is there, are there any words of motivation, inspiration you can give for people since this is decades to develop to get them inspired to do these things so that they don't come see you?

Yes, that's the goal, right? So really it's an open book. Like I, it's all in the book. You can get for 20 bucks. Reversing Alzheimer's for $22. You can get the book and it's all in there. I think the hard part, as you mentioned, is putting it into action. And so we have steps and support for you wherever you are on that path. So we do online coaching programs that help you implement what's in the book in a group setting with, with my support each week. So that is one option if you want to keep your loved one at home, but you want to implement as much of it as possible and reading the book is just too overwhelming or listening to the book is too overwhelming. So we can do that. We can get you more support that way. We have the clinical piece, the precision-based clinical piece where you come in, get the testing, and that helps us to focus, right? If you don't have sleep apnea, don't treat sleep apnea. If you don't have mold toxins, don't treat mold toxins, right? Focus on the things that are important for you, your smoking gun, what's driving the neurodegenerative process for you. So if you can come to California, we're happy to see you in person, establish you as a patient, and support you in that way. And then for people who have more severe neurodegenerative disease, they're in those later stages, it makes sense to have respite, right? Because of the risk associated for caregivers. Sometimes you need a break and having a place like Morama where you can go to an immersive inpatient overnight residential program where things are just taken care of for you, that can, that can be really valuable for a lot of families. And our goal there is that people move home, that it's a memory recovery program. And so of course, the earlier you come—

that's so different, Heather. That's so different. Like, you look at most of these memory centers. I'm sorry to jump in there, but that's so exciting because you look at, look at these places there. The door goes one way in them, right? You know, the fact that your goal is for people to go home. Is already the biggest differentiator. I mean, that's amazing. What are you seeing? Like, what's the average length of stay that someone would expect to have there?

Usually about 12 months. The first 4 to 6 weeks, people are adjusting, and sometimes they see things go downhill before they get better. And just because it's, it's disorienting, it's a move, it's very stressful, and there's new people, new foods, people are detoxifying.. So we have an organic ketogenic diet there that's 3 meals a day, 2 snacks a day. There's lots of social engagement with the other residents, with staff. Staff are trained to expect improvement, right? If we're not getting improvement, we're wondering what we're missing. And then there's lots of physical engagement, brain gym. We've got red light, we've got all kinds of biohacking equipment and fun stuff like that. We've got oxygen therapy and hyperbarics, and there's just so many fun things that we're doing there and really pushing what's, what's possible and what we can do. And, and people who show up, they're like, I don't have time to waste. So they are all in, they wanna be engaged, they wanna do it. And then we just set it up to make it easy. We manage all the supplements, all the medications, manage all the refills. Any caregivers listening will know how much effort it takes to put this into practice. And so we're trying to make it easy, we're trying to make it doable. Alzheimer's is so expensive. And if we can prevent people from needing places like Marama, prevent people from needing memory care. That's really ultimately the goal, to shift the narrative around what's possible. It's such a devastating thing to think about growing old and, and losing what makes you, you right? Losing your memories, losing your relationships. But there is so much we can do. And so the earlier you get started, the better prevention. Yes. But if you're already starting to notice, I think before people would wait, they didn't wanna see a doctor because they thought, there's something they can do to help me. They're just going to take away my driver's license. I'm going to be more isolated and more dependent. And I, I get that, but that's not the case anymore. Like, the, the story is different now. There are thousands of people who've been trained by Dr. Bredesen, and they're— it's in books. Like, it's just a matter of implementing it, putting it into practice.

Well, and the, the big thing here is everyone's at risk. I mean, if 13% of the population who doesn't have the APOE4, either of those is at risk. Everyone is at risk. And everything that you do for prevention here helps everything else. So it's really, you know, I know this is the niche, but really this is— could be a book written for longevity and quality of life too.

You know, I'm sure you've talked to Kara Fitzgerald. She's a colleague and friend of mine, and she wrote Younger You. And we laugh because it's the same stuff, right? It's the same stuff, just packaged a little bit differently so it makes sense and relates for the people who are, are reading our books. But yeah, it's, it's common sense and now it's time for us to make it common practice.

Exactly. So I'm gonna put, link all of this in the show notes. I'm gonna put them at jjvirgin.com/reversingalzheimers. So your biggest challenge is gonna be to spell that correctly. And what I'll put there is the link to the book so that you can easily buy the book and then all your other services in case someone has a loved one. But just even the fact that you've got these coaching programs, I didn't know you had all of that going on. That's fantastic. And I just appreciate the work that you're doing. The little bit of the foray into this that I've done, it's, it's a really challenging thing to navigate. And you're right, if you go into traditional healthcare, you would think that, that you are just doomed. And the reality is you're not doomed at all.

Yeah, JJ, thank you so Right back at you. The work that you do is so inspiring and so helpful for people living healthier lives. And I just feel so privileged to be part of this group and the people who have paved the way, David Perlmutter and you and Mark Hyman, and that the people in your network are just— I wouldn't have the opportunity to have the privilege of this really gratifying, amazing work that I get to do if you guys hadn't paved the path. So thank you.

Well, wow. I love to be standing amongst those giants. Amazing. Thank you.