Preventing Alzheimer's: A Holistic Approach to Improving Cognition, with Dr. Heather Sandison

Foreign. Hello and welcome back to the Feel Freaking Amazing podcast. I'm Wendy Trubo. This is my host, Ed Levitan. And I'm so excited to be interviewing our guest today. She's a colleague and a friend of mine. It's Dr. Heather Sandison. She is a distinguished naturopathic doctor. She's devoted her career to providing compassionate care and innovative solutions to those affected by dementia. She's renowned for her pioneering work. She's integrated groundbreaking holistic and multimodal interventions that seamlessly create clinical, residential research and educational platforms. And it goes all together. She has been relentlessly dedicated to reversing Alzheimer's and actually has a book coming out. And if we time it right, the book launches on the same day that you're hearing this. So her book launches on June 11. It is reversing Alzheimer's, the new toolkit to improve cognition and protect brain health. And so we're going to talk about that today, today, because this is her zone of excellence. And Heather, welcome to the show. I'm so excited and we're both excited, but since you and I are good friends, I'm like, so excited to have you here and be able to get the word out about how to keep yourself healthy. So welcome.

Thank you. It's always a lot of fun when I get to hang out with you guys.

Totally. All right, what did you want to say?

No, I just want to say I know you're excited, but this is a cool topic.

Oh, it's life changing and it's with my friend.

Well, double cool. Okay, fine. I mean, to really, like, to think that a disease that people have thought is not able to, like, is a death sentence, basically, to actually think that we can actually stop and maybe even reverse it is crazy.

I know.

So really excited for this.

And not just a death sentence, but like this long, torturous, drawn out goodbye that is like, it feels at times physically bankrupting, financially bankrupting. You are, as a family member of a loved one with dementia or Alzheimer's, you are forced into these absolutely impossible decisions of like, do I medicate with antipsychotics at times because my loved one is being combative or violent even. Even though I know it's going to make them worse. Do I put them in a care home when they asked me to never, ever do that to them, even though I don't have the capacity to care for them? There are just these impossible decisions that come up that are breaking and not just for the patient. Right. Cancer. I wouldn't wish any of these complex Chronic illnesses on anyone but heart disease and cancer, they come up, but you maintain your cognitive ability to make these decisions for yourself. And when it's dementia, when it's Alzheimer's, it is just such a much more challenging situation that can really create a lot of suffering for not just the patient, but their entire ecosystem.

It really is. I mean, tell me, what's the origin of this whole belief system that there's nothing you can do to treat Alzheimer's? What's that about, Heather?

So there's this phenomenal book that much more eloquently, in a lot of depth, goes into how not to Study a Disease. The Story of Alzheimer's. That's the name of the book, how not to Study a Disease. And it's by a gentleman named Carl Haroup, who is a researcher who's been in this space for decades. Dr. Bredesen has worked with him in the past. And essentially what he, he's a historian in this space and he goes through and describes how we, we got it wrong. We have been focused, our financial resources, the time, the effort, the energy has been totally focused on amyloid plaques as the cause of Alzheimer's. When amyloid plaques are, they're antimicrobial, they are a response, they're inflammatory, they are a response to a different trigger. And with Dr. Bredesen's approach, it's really this paradigm shift of when we think about, so you have a plant behind you, right? When you think about a houseplant, if it's starting to degenerate, right? If it's starting to die, if you see yellow leaves and you have some evidence that it's not doing very well. Yours is beautiful.

It needs water. It looks okay.

You don't think, oh, misfolded proteins are causing this problem? You think, does it have enough water? Does it have enough light? Is it maybe over watered? Is there some toxin in the, in the soup of its soil? Is, does it have enough nutrients in its soil? A plant is a complex organism. The brain and the body are complex organisms. And what we want to do is take that same perspective and say, what's causing the amyloid plaques? And this can feel a little overwhelming for people. And so it's, how do we systematically think through all of the potential imbalances that can cause us to get out of that homeodynamics space where things function, where neurons function. And I know you are an expert in toxicity and that that is where we start.

You know, it's funny, we do some of the work. We, we essentially have said to patients. We take Dale Bredesen's book. I know you do a lot of work with him. We've taken his approach to Alzheimer's because it is a functional medicine approach. It just, it just sort of categorizes it. So we, we say to people, look, you know, we're looking at your minerals, nutrients, we're looking at infections, we're looking at toxins, and we're looking at endocrine in a sort of broad brush. And so can you take us back a little bit? How has the science progressed in dementia care over the last 10, maybe 20 years? What happens there for people?

Yeah, so unfortunately, from a pharmaceutical perspective and from a conventional perspective, although there are these big splashes in the news about these new drugs, Leqembi is the one that's available and somewhat covered by Medicare now. And this has just been in the last couple of years. Aduhelm or Aducanumab was the one before and that's been pulled from the market. So these are, again, the target was amyloid. So these are monoclonal antibodies that go after amyloid. And the positive side of this, the reason that it was approved by the fda, both of these drugs, somewhat controversially, but, is that they slow the rate of progression. Right. So we've already established that this is a torturous process. And what happens when you use these monoclonal antibodies early in the disease process. This is only approved for people with mild cognitive impairment, not late stage Alzheimer's. So what happens is that you slow the disease progression by about 30%. And it's also very expensive. And the risk here is that there's a risk for brain bleeding and brain swelling. And so my hope is that these medications, these are kind of first generation, that they figure out a way because there's been so much. Billions of dollars have been poured into this and decades of time have been poured into things addressing the amyloid plaque hypothesis. In fact, Dr. Harup, he talks in his book about how if you were not studying amyloid, you weren't studying Alzheimer's.

Right.

If you had some other take on Alzheimer's, you basically were not in the community. So you weren't funded by the nih, you weren't getting, you know, you weren't getting funded. If you had a pharmaceutical company that was looking into this, it just wasn't happening. And so there was this hyper focus and some of the research that this was based on, and we found out in the last 18 months or so that some of that research was actually fraudulent. They had Been doctoring the pictures, the images that were used to make to draw the conclusion that there was this connection between amyloid and cognition. So one of the things people don't realize is that there was a study published in 2011 that showed that only 2% of everyone from newborns to centenarians, doesn't have amyloid plaque. 30% of people, we all have it. One night of sleep deprivation leads to a measurable increase in amyloid plaque in the brain. One night of sleep deprivation when you're.

In your 20s, 30s, or 40s, oh.

You better make up for it this weekend.

Seriously. I got up to pee and then couldn't go back to sleep. And I was, like, awake. And then the cats were playing and I was, like, awake. Okay. Anyway, not to get too derailed. I was like, were you awake when I was awake?

He's like, yeah.

So, okay, so the, the initial research was fraudulent. We've spent the last 20 to 30 years looking in the wrong direction, essentially. Right. We're. We're looking at the wrong thing, or we're looking at the thing that's not driving the bus. We're looking at the tire instead of the driver.

Wendy, I hope it's not all for. Not. I really hope that these medications, they can, like, they'll, they'll complement what we're doing, right, which is upstream, going upstream and saying what is provoking, what is triggering inflammation, what is triggering amyloid plaques. And so like we talked about, sleep deprivation, obstructive sleep apnea, I think is probably the cause or at least contributory. But we can, we can stack things in both directions so we can stack the risk factors. We can have, you know, someone drinking, smoking, have sleep apnea, obese hypertension, diabetes, and all of a sudden we have a storm, a perfect storm that's going to lead to neurodegeneration. And, you know, when there's that, that genetic predisposition and their APOE, some we can describe what APOE is, but when someone has an APOE 4, a copy of the 4 from mom or dad or both, that increases your risk that when we start to stack these lifest, these negative lifestyle choices on top of each other, it manifests as dementia. Now, we can also go in the other direction and we can stack lifestyle interventions in a positive way. We can adopt an organic ketogenic diet. We can get on our, on detox protocols and get rid of things that have accumulated over a lifetime. We can sleep well, we can manage our stressors, we can get exercise. We can, you know, Foster really loving, meaningful relationships and those things protect us. Are you on that one?

I'm just thinking we see have good relationships, but actually, what would you like to say? Nothing, darling. Mother's Day is coming up though. I guess the question as you were talking about the ketogenic, the organic ketogenic, is the language still being used that dementia and Alzheimer's is essentially type 3 diabetes, is that still in use?

Yes. Yeah, you hear that kind of colloquially now. Whenever I see a paper, it's like, herpes causes dementia or last weekend in Nature there was a publication that said APOE 44 is a cause of. Is the cause of dementia or Alzheimer's. Now there's not one cause. And what works is when you say, okay, what's the blood sugar doing? Insulin, Is there insulin resistance? Is there glycotoxicity, Is there caramelization of the neurons happening? Because that blood sugar has been so for so long. Can this individual turn glucose into ATP? Can we actually make fuel from this? We're hybrid engines basically, right? We can flip back and forth between burning sugar for fuel and burning fat for fuel. And for many people, pretty much all of us, regardless of diabetes status, as we age, we become more insulin resistant and also less efficient at turning glucose into ATP or fuel. And so the brilliance of the system, this design, divine design, is that we can just switch, we can switch to burning ketones or fat for fuel and then burn that more cleanly. It creates less oxidative stress, it's detoxifying, it's anti inflammatory and it gives us that resource. So the brain uses 20% of the energy expenditure every day in our body only makes up 2% of our body weight. So the brain is extremely hungry. And then when you add toxic burden, infectious burden, now we need even more resource because we've got to resolve those things.

I have so many questions.

Yeah, so, but let's back up because we were just talking about all the things, all the challenges and then we went just flipped over to how can we, what can we do? So let's. What is there to do? Like we just talked a lot about it. Is there like a pattern or is.

There a toolkit like. Sure, like in her book.

Sure, that's good. I like that.

Yes, exactly. So Dr. Bredesen, the way he describes the medical side of it is a cognoscopy. So we all get a col. I think now it's 45. You're supposed to get a colonoscopy to understand if you're at risk for developing colon cancer. Or see if there's the early signs of it, are there prevention, early detection, that's what we're after with a colonoscopy, with a cognoscopy. Essentially, it's the same idea, but we're doing it to evaluate are there these risk factors present for your. That's going to put your brain at risk for developing Alzheimer's in 10 or 20 years. We know that those first signs of cognitive change where you can't remember the name of your neighbor who you've lived across the street from for 20 years, or you can't. You keep misplacing your keys or your phone, your brain isn't working the way it did 10, 15 years ago. That early sign, that's happening decades after the changes in your brain have taken place. So there's this wide window where we can detect, are there things at play that are potentially driving a neurodegenerative process? And we can stop them. Also, that moment, it can be so scary for people, especially if they've had family members who've had dementia and they've supported them or watched them go through that awful process when they don't remember their neighbor's name. They go, oh, my God. The trauma comes back, the fear comes back, the terror, right? And so what my goal with the book, being here with you guys today is to say to everyone who's listening, that's the moment to see a doctor like you guys, to see a doctor trained by Dr. Bredesen, to see a functional medicine doctor, a naturopathic doctor, someone who understands this toolkit, who understands how to apply the medicine so that you can get that cognoscopy, so you can evaluate at that moment when it's so much easier to stop the bus, right? To stop that train that's driving you towards Alzheimer's, to stop it in its tracks and start going in the other direction.

So I heard a couple things from what you said. One is, it's never too early, and the time to act is now. Don't wait until it gets worse. It's really. If you have anything in your brain that makes you think, hey, I'm at risk for this, now's the time to get evaluated. Don't wait.

It's so much easier. It's so much simpler. It requires so much less money and effort. If you can get started at those earliest signs, what we see is that, yeah, there are people with later stage Alzheimer's who can improve. They don't go back to work. They don't always get to go back to Independent living. And although some of them get better, not all of them, it's much fewer than if we initiate this process earlier on when people are younger, when they're, they're less progressed along that pathway. And part of it is because of the amount of structural damage.

Right.

When we first get started, it's a biochemical issue. So we can add the nutrients, we can, we can get rid of the toxins, we can do all these things and yeah, we can do that later on, but the plaques have built up, the tangles have built up, the neurons have degenerated, and yeah, we can grow some back, but we're basically asking for a much bigger shift when the disease process has progressed more.

I mean, you see this a lot in the centers that you run for memory care. You have memory care sites called Marama. And you see this. Right. So can you talk about what you're doing there? Because I think it's fascinating. And you study this in your sites.

Yeah. So thank you. It's really exciting and really fun. What happened was in my clinical practice, I was seeing people come in with dementia and many of them got better and mostly the ones who didn't weren't able to do it. It's a lot, it's a lot to ask. And a lot of what's in my book is what we've learned from what we're doing at Marama at the residential care facilities, that what we're trying to do is transform memory care into memory recovery. And just this past Monday, we had our first resident go home with a perfect MOCA score. She went home with a MOCA score of 30. She had been with us for six months. She had a moldy house. And so what she did was she decided, she came on her birthday, it was her birthday gift to herself to come spend six months with us in this immersive experience where the foundations are taken care of for you. So it's an organic ketogenic diet, lots and lots of nutrient rich food, lots of veggies, and then there's a network of people that are doing the same thing. Their entire day is designed to be brain engaging, whether it's activities that are creative or intellectually stimulating. There's music and there's animals and there's all kinds of things that are happening throughout the day. And then there's also vigorous exercise and plenty of it every day. And that social connection between everyone else who's there. Plus it's a non toxic environment. We're hypervigilant around mold, air filters, fresh air Also organic mattresses and bedding and making sure that the air is non toxic. Right. The only smells you're getting are from the kitchen. There's no air fresheners, which you see a lot of in care facilities. So in our community we really aim to spend the days. They're designed to optimize cognitive function. And for her it was really fantastic. She came with a MOCA score that it wasn't too bad. It was in the mid-20s, but she went home with a much higher MOCA score and feeling ready to go back to her renovated house that no longer had.

That was one of my things, like please tell me she renovated the mall. But can you talk? Our listeners might not be aware of what the MOCA score is. Like we know, but. And actually one of the providers in our office does it. I was like, can you do this on the patient? And they did so. But can you talk to people about what it is? Because not everyone's aware.

The Montreal Cognitive Assessment is what a MOCA score is. And you might have heard presidents talking about this, referring to it, because it's a way to establish where you are on the spectrum. Now it doesn't pick up early cognitive decline, subjective cognitive decline when you're experiencing it, but as it gets more progressed, this is a great way for providers to communicate, for family members to communicate about where you are in the spectrum. So it's a one page worksheet where you draw a clock, you copy a cube, you follow some patterns, do some math and identify some zoo animals. And it's out of 30. So a perfect score is 30 and 26 and above is normal. When you start to get down into the low 20s, this is measurable cognitive impairment and we call it mild cognitive impairment. That's the diagnosis, but there's nothing mild about it. These are people who are struggling with their memory. Some are aware, some are not. But it's starting to impact their day to day life. Right. Maybe they're coping by writing everything down or they're just getting, you know, they're getting harassed by their children because they keep repeating the same things over and over again. And then as we get into the teens, particularly into the lower teens, 13, 14, 15, it starts to get it more challenging to reverse this. That's why we want to catch it earlier. And then those single digit mochas are. People are reliant on others for activities of daily living. Cooking, dressing, sometimes toileting, going to the bathroom on their own, bathing and executive function that like, okay, I'm planning to do this, and then I execute that. Doesn't happen anymore.

I have a question that I don't think we'll have an answer, but I think I have to ask it just because I think it's maybe on people's mind. What. How would you approach.

Is this asking for a friend? This feels like an asking for a friend question. Like, hypothetically speaking, for those.

So for those of us that have friends and family that may not be aware that they have some challenges, is there any tricks of the trade that can.

So you're asking, how do you start the conversation?

Well, yeah. How do you approach it? What's a good way to approach it so that people aren't put on the defense.

Yeah.

But actually want to actually do something about it.

I'm so glad you asked. This was really important to me. In the book we have, we actually offer a conversation guide on the Marama website. And in the book, there are basically suggested language that you can use if you are chatting with a loved one who's resistant. Now there's. They're really, really challenging conversations to have. And absolutely, people can be put on the defensive. So what. What we recommend is first, you know, create an environment where they're not going to be easily distracted. So people with cognitive decline, if there's a dog running in and out and there's phones beeping and there's the sounds coming from the kitchen and pots clanging, for all of us, if we're distracted, it requires mental to refocus. And for someone with dementia, it's even more effortful, particularly when the conversation is emotionally charged. So take the time to set it. Don't go to a restaurant where there's dishes and an ambient noise.

Be in a.

In a. In a space where they feel comfortable, maybe in their living room, in their. In their office, wherever makes sense for that person, maybe in their garden where they're comfortable. And then come to the conversation with, you know, talking about their health. Generally. I think when we start to target memory, when we say it's your memory, your.

You're.

When you. When you put the. You in there, instead of saying something like, mom, I really want to help and support you into. To optimize this last phase of your life, to optimize your retirement so that you get the most out of it, I think that you could feel more energetic, or I think that you could feel less frustrated. I think that you could sleep better. If there's another symptom that's more objective, that's more like that. She's maybe been Complaining about if you can start there and then start down this functional medicine pathway. Often what we'll see is that people will be like, oh, I'm not forgetting as much. Or they might, they might sense that, okay, I feel better, I'm less inflamed, I'm not as achy, and that, that's a way to get them more comfort generally, because the side effects of this approach are that people are in less pain, they get off that daily ibuprofen, they get off the antihypertensives, they get off the antidepressants, they get off the metformin. And what we see is generally better health. So that can be a way to sort of attract. That being said, there are a lot of people who just, you know, they come to the conclusion, my mom is not going to do this either. She's too progressed and I can't. It's so much effort and emotional intensity to wrangle her. I can't become a martyr to this. And that's okay. I think then the next step is to say, okay, what about me? How do I do this so that I don't go down the same path in 10 or 20 years? How do I make sure that my kids don't end up in the position I'm in right now, now? And I take full responsibility for my health. If I, if my mom isn't open to doing this.

I have follow up questions. I just want to make sure you're good. So we've talked about the impact of glucose and how we're less efficient over time. And you drew the link between glucose and then switching over to an organic ketogenic diet. And then you alluded to it, Marama, that people are doing a lot of movement. Why? What's the data on this? Why does it matter? Talk to me about that.

I mean, exercise is better than any medication on the market, right? For pretty much all complex chronic disease, the connection between brain health and heart health is really the common denominator. There is plumbing. We've got to be able to get blood around the body to the brain, get it out, in and out. We've got to deliver oxygen and nutrients for our cells to function, whether they're in our heart or in our brain. And then in between, that endothelial lining needs to function, right? It can't be full of plaques and atherosclerotic plaques. It can't be inflamed because then we're not going to deliver that nutrients. Right? So we. Exercise is one of the best ways to get at both of these sleep we discussed briefly, but sleep is often better when we get exercise. And sleep is crucial to brain health because in deep sleep, that's when we rinse, we get that glymphatic rinsing where that's when the amyloid plaques come out. It's also when that daily metabolic waste that every neuron creates comes out of the system. It's when we get rid of the mercury that might have accumulated from that fish we ate. And then during REM sleep, that rapid eye movement sleep, that's when we consolidate memories. That's when we take the emotional charge out of that thing that happened the other day. And so we know need both of these components of sleep, that deep sleep, that REM sleep, we need good quality sleep, not just enough sleep, but good quality sleep for our brain health. And exercise helps us to get that. So exercise is just a crucial component to a brain healthy lifestyle. But one thing that many people haven't heard of is dual task exercise. A lot of people are familiar with aerobic exercise or strength training. Dual task is when you combine cognitive and physical exercise at the same time time. And you actually get more benefit cognitively when you do this. So for every minute you spend exercising, if you can be engaged cognitively, you're going to get more benefit now. Yeah.

No, wait, wait. Okay. So I go to the gym and I go to the treadmill, and I walk on the treadmill and I bring my Kindle.

Okay.

I'm like multitasking. I have my earbuds in to listen to music and I'm reading my book. Is. Are you telling me that what I'm doing is good? Yeah, because I know people would be like, wendy, you need to like amp up your intensity and stop reading the book. But I'm like, I like reading the book and it gets me distracted. So you're telling me that's okay?

Yeah. What you want to do is be basically at like 70, 80% of cognitive and physical capacity. Right. So you don't want to be going.

I don't know that I ever get to 80.

I don't. You don't want to be checked out or like cruising.

Right.

You want to there. You do need some degree of intensity. So the way I describe this, like walking and talking is the simplest form of dual task. But for you guys, that's probably not enough. Right. We've got to be going to one of my favorites is dance class. Right. A Zumba class, a ballroom dance class, a hip hop class, whatever you want. But Even yoga and Pilates, when you're physically and cognitively engaged because you're being cued by an instructor or you need to stay cognizant to the music or your partner, that's a phenomenal way to do this. Or pickleball. There's that big pickleball fad these days. And this is so great because you're socially engaged, strategy involved, there's hand eye coordination involved, you're often outside. It's new to many people, so they're having to learn a new game. And it's physically, especially if you're, if you're a little competitive, it makes you, like, work. And so you're aerobically, really, you're challenged typically. And this is, this is just pretty ideal for a lot of people who are in those earlier stages or, you know, like in middle age. So there's a lot of different ways to do it. There's. We often in our coaching groups will brainstorm, what does this mean for you? And it's dynamic, right for you. As you become, become more, more, you know, you have more capacity, you become more conditioned physically, you need to up the ante.

If you ever talked to Ari Whitten, who, I think last time I spoke with him was living in Costa Rica. And every day he spends like four to six hours, four to six hours doing something. And he's all about energy and brain function and, and recovery. And he spends four to six hours, but it's different every day. So one day he goes rock climbing and another day he goes and does like, paragliding and sailing and like something every day for, but for multiple hours. And his whole belief is we need to make the mitochondria more robust. And if you do the same thing over and over, you get muscle memory, which is good, except then you stop growing and so doing new things and challenging the system. Exactly what you're talking about. That you're going to build your mitochondria that way.

Yeah, your mitochondria, your neurons. I mean, every, everything.

But I want to go back to. You were talking about deep sleep, and I remember, remember when I learned that when you hit deep sleep, the highway in your brain gets bigger, so the cells shrink, the distance between them gets greater, and then you can get that drainage pathway going. I remember learning that being like, are you kidding me? Like, like, just, just. That's fascinating. Just by getting deep sleep, you go, you get the, the glymph going and you get the drainage going and you start to detox. So if you're Someone who's not sleeping thing. You need to get deep sleep so that you can actually preserve your brain health.

And do you go, why did I have all those babies? Because they robbed me of that deep sleep for you.

I remember craving unbroken sleep. Like, I just want to sleep through the night, please.

Yeah. That being said, though, how many women, postmenopausal women, have trouble sleeping, though, that we see all the time.

Yeah. Well, this is why when, you know, you walk in, we're like, let's check your hormones, let's look.

And why so many people tell me progesterone is my new best friend?

Seriously, man, I love progesterone. We'll talk about that in another conversation. Okay, so we've talked about keto.

The hormones are a piece of this.

Hormones are, they're one major endocrine system for Alzheimer's.

Absolutely. You know, thyroid, vitamin D, our bdnf, brain derived nootropic factor, is a signaling. And again, so we mentioned exercise and I talked about dual task, but aerobic and strength are both really important. And bdnf, brain derived nootropic factor, which is a signal that goes to your brain, comes from muscle. And so you can, you can drink mushroom teas and do nootropic supplements and stuff, but muscle is a great way to get both testosterone and BDNF to your brain. And so we don't wanna skip out on, you know, if we're doing dual task, do some of it with your strength training and some with your aerobic training. But yeah, the hormones, the signals that go to our brain, we wanna make sure that those signals, signals are stacked so that they tell the brain to create new neurons, new connections between those neurosis, syndaptogenesis and neurogenesis is what we're after. And there's lots of ways to do that. And you want to make sure that you've kind of got them all covered because it's something we have control over. We can use the hormone replacement therapy, but pregnenolone, dhea, these are available over the counter, bdnf, exercise, there's lots of ways to create these signals. And then not skipping out on the vitamin D and the thyroid optimization, I'm.

So present to Heather that what you're really highlighting is that you're either growing and developing and getting healthier or you're backsliding and shrinking and that, you know, it's almost like this whole philosophy of we need to expand because otherwise we will die off and we just need.

To keep growing you know, Dr. Bredesen has this phenomenal analogy that really struck me when he said it. He's like, think of your brain like a country, my brain a stone. And if that brain is like Ukraine, right, If you are fighting a war, if you are attacking and defending against invaders of toxins or infections, then you are not, you should not be building roads and schools. Right? Right. You, you should not be building new neurons and new connections between them. You should not be focused on infrastructure because it might just get destroyed.

Right?

And you need that resource. You need that resource to finish, finish the job. So, yes, we, we often will do all of these things at once if someone has Alzheimer's. But I think that if you are in the luxurious state of not having dementia, of being in prevention mode, then, yeah, if you defend, attack, finish that job, do the detox, get on the hormone supplementation, get on, get the nutrients balanced, finish that work. And then, you know, there's the things like stem cells and peptides and that regenerative stuff that we can focus on. But I do think that you're absolutely right. You're either, you're either shrinking and defending and getting smaller, or you're going in that direction of, of regeneration.

I want to touch on one thing that you, that both you have said that I really want to kind of even further emphasize which. How many people do we see that at? 60 or 50? When I, when I see them, at least they say, yeah, I exercise five days a week.

Week.

I walk for a mile. And that's, that's okay. But when you look back, they were athletes, they exercised a lot, etc, so forth, and then they, by the time they're 40, 50, 60, it's okay just to walk for exercise. And what you're really saying is, no, you really need to get the heart pumping. Walking is amazing, but, and should be part of that routine, but it's just not enough.

There was a study out of the UK just a couple years ago, it was around December, I think, 20, 21, and it showed. It really validated this idea of 10,000 steps a day, that if you are in middle age and you don't have dementia yet, you cut your dementia risk in half when you walk. It was like 9,800 steps per day. And so that 10,000 steps a day is a great goal. But if we already are in that cognitive decline state, walking is not enough. We are asking for a miracle. We are asking to reverse the progression towards dementia. And that means we've got to do more, we've got to Be willing to make bigger changes.

You haven't talked about stress at all. Heather, can you touch on that? Because I feel like out of all of the things that we've talked about stress, you've probably heard me just say, like, sugar's the devil, alcohol's the devil. But I think really, stress is the devil, devil, when we get down to it, that it's the thing that throws, you know, because your cognitive function can be impaired when you're stressed. So talk to me about where, where does that fall and how do people deal with it?

Absolutely. I mean, this is why torture doesn't work, right? It's because we've all been in that super stressful situation, maybe public speaking or whatever it is, and we can't remember.

Right.

Stage fright. That's what it is. And, and we've all been sleep deprived and not been able to remember. So I think just backing up real quick to say, how do we, how do we organize our. So when we think about imbalance, too much, too little in the wrong place at the wrong time. And then for the brain, we apply this to six different categories. Toxins, nutrients. So imbalances and toxins, and too many, too little in the wrong place at the wrong time, imbalances and nutrients, imbalances in structure, imbalances in stress, imbalances when it comes to infections, and imbalances when it comes to signaling. So we chatted about signaling. We've talked about a few of these pieces, but just to kind of give them us this framework. Where does that fit in? Because it's going to be stress for one person, it's going to be toxins for another person, it's going to be traumatic brain injuries for another person, or it's going to be all of those things. Right. And so for each person, what's paramount? Well, we have to systematically kind of go through and ask the questions and decide together with a provider, hopefully, and then start in this place where we're going to get the biggest kind of bang for our buck. Right? So stress is a huge one, particularly for caregivers, givers. Many people don't realize someone caring for someone with dementia has anywhere from two and a half to six times the risk of being diagnosed with dementia later on in life.

So basically, if my husband got dementia, he'd be going into a nursing home. Is that, is that just what I heard you.

Did I just give you permission to put Ed in a nursing home?

Well, actually, you can put me in a home, too.

Here's the problem, Wendy, is that men who are the spouses of a female with dementia are the ones that have the 6x ray risk. So really, I just gave Ed's permission.

Oh, there we go. Sorry.

Okay, well, you can put me in a home. Honey, give me gluten. I'll be gone really fast. You know, like, let's just not prolong this. Just give me gluten, I'll go and we'd be done.

Well, at least you guys have four kids, so I'm sure at least one of them is going to show up fully for you guys and, and take.

Really good care of you. Right?

Do you know which one?

We'll see about that.

I. I don't want to poison the well, so we'll. We'll just pause. Okay. But what you've also highlighted is this is not the kind of thing that you're going to do alone. There's a lot of things you can do on your own. But if you are concerned that you've tipped from, hey, I'm just perimenopausal, I have low testosterone into. I really clearly see something's not right. That's when you're going to want to get an evaluation. But then what are the things people can do? Because there's so. The things we've even touched on. There's so many things people can do to take back the agency in control of their future. So can you just list out three to five things? Like, you know, you kind of touched on them, but. But let's really nail it home.

Yeah. So what we recommend people do is start with what's easiest or with what's going to make the biggest difference. So if you know that you are a total stress case and that cortisol is coursing through your brain and it's, you know, it's toxic to your hippocampus, then start a meditation practice or a daily prayer practice. Do something that's going to help you manage your stressors. Start going to church, if that's what that means for you. Do what is necessary for you to get that. Because stress, it's an experience, right? And we have control over how we experience stress. So the key is to change our experience of it. We've all seen those people that have been through extremely stressful experiences. Some of them come out doing really well, they're better because of it, and others turn gray and it looks like they're on their deathbed because of it. So we want to be that person where it may makes us better. We want to transform our experience of stress. And then what we want to do, that's. That's stress. But I really think. And this is why I wrote the book, because I. Three or four things. Yeah. Get on an organic ketogenic diet, prioritize your sleep and get a sleep study if you have any cognitive decline because sleep apnea must be treated. Start a meditation or daily prayer practice and start getting exercise, dual task exercise. Those are four things that you can do that everybody can benefit. They're foundational. And then in the book, we basically take you through. All right, which one applies to me? We ask some questions. We get specific about if you're not having a bowel movement every day, that's the place to start because you're clearly not getting the toxins out. But that doesn't apply to everyone. Right. So it's important to. And Dr. Bredesen talks about this, too. We need to be precise. This is the. You know, we're at a time when we have technology, we have great providers. There's more than 2,000 trained by Dr. Bredesen. You guys are in the functional medicine community. There are thousands of doctors that have been trained that way. Find someone, put the data to work and understand what's going on for you so that you can optimize this process.

Yeah, I mean, this is highly personalized. When we do this, we're really look. And it's a very large evaluation. Sometimes it's a.

It's.

And I. I don't know if you tend to do this, but typically I'm working on the foundations, like the things you said. Eat, sleep, move, think, breathe, connect. Those are your foundations. And then we're going to look at what's happening in your gut, your adrenals, your liver, your minerals, nutrients, your hormones, your endocrine system. And then we're going to look at what's happening with your toxins and your exposures and your home and your thoughts and all of it. So it really is like a build on the past information, but it's a big. It's a big chew bite, but it's very rewarding to watch. It works.

It works, it works. The medicine works. The lifestyle works. And I think just circling back to where we started, unfortunately, there is not a pharmaceutical solution. Memantine or Namenda, Aricept or Donepzil. These are medications that work on the neurotransmitters. And sometimes we'll see for three months or so, people will get a little bit better. But five years later, there's a JAMA article, Journal of the American Medical association that showed that five years later, people who got on those medications did worse than people who never started them. They don't help long term. I had a 95 year old patient recently. He's like, I'll just get on him because I'm not planning to be here in five years. I was like, fair enough.

I mean, you know, it's interesting you say that because it almost feels like if you're on a medication, then maybe there's not as much pressure or onus or drive to make sure that you're on an organic ketogenic diet, that you're moving your body and the. What did you call it? The. The buy.

The dual task.

Dual task. Thank you. So that you're doing that, that you're starting. Oh, please. I'm, I'm, I'm already like, I think I need to go on that organic ketogenic diet. So it's gluten free. That's automatically gluten free. It's a great way to eat. So I think you're just. It almost feels like if you're on a medication, maybe you don't need to take as much focus on the foundational things because you're like, well, I'm on this medication. Except the medication I feel like I read in Bredesen's book, I feel like I read this, that essentially these medications, if you have a leaky roof, this medication is putting a bucket under one leak. But you still have 27 other leaks going on and you're only catching one. So you don't see the. It's like sitting on 10 tacks. If you take one away, it's not a really big difference. Take eight away, nine away. Then you're like, oh, now I'm getting better. So it's a multifocal approach.

Precisely. Yeah. And you know, with the medications, you're absolutely right. There's sort of this perspective shift of like, I can rely on something else to fix me. Someone else. Something else. And I wish it worked like that. Right. If there were a magic pill or an IV that I could give people to make the suffering associated with dementia go away, I would be screaming it from the rooftops. I would be the biggest fan of that because I've personally watched so many people go down this path. And it's like I said, it's just bankrupting physically, emotionally, financially. It's so hard. And so the gift, I think, in this, what we're trying to say is like, you don't have to accept that. And that's not going to be for everyone because it requires work. It's not easy, it's not free, it requires work and resources. But it leads to a more fulfilling, more rewarding life in that last phase. And so, you know, I think it's worth it. But not everybody's gonna come to that conclusion. And that's up to them. The only crime is when they don't know that there's an option.

Right. So where can people find you? I know. First off, go buy the book. It should, if we've timed ourselves properly. Today's the day the book launches and today's the day the podcast launches. So go get the book. Is it on Amazon? Is it on. Where's the book?

Wherever you find books. You know, we, we love supporting independent bookstores where, but wherever. Find books, please get, get a book, write a review, tell us what you really think, and then feel free to join the community@drheathersandison.com My last name is spelled S A N D I s o n doctorheathersandison.com and you can sign up for my email list, learn about, you know, our perspectives on new research that's coming out, new offerings, new things that are happening at Marama and at our clinic. We are looking to create more research opportunities for people to get involved as participants in research trials. So really exciting stuff on the horizon. And I just want everybody to have all of the tools, that toolkit, so that they can optimize cognition wherever they are in the spectrum.

Just amazing.

It is, Heather, thank you. So I think what you left us with is a message of hope. And so get the book. Check out drhantersandison.com, we'll put that link in the show notes and then, and to all the listeners, don't give up. Right? You can alter your future. And it starts now. So thanks, Heather, for being here. You're an awesome guest. I love hanging out with you. And to the listeners, thanks for joining us for another episode of the Feel Freaking Amazing podcast. I'm Wendy Trubo at Levitan, and we'll see you again soon. Thanks, Heather.

Thanks, you guys. Be well.

Sam.