Speaker 1:
Welcome to The Dr. Gundry Podcast where Dr. Steven Gundry shares his groundbreaking research from over 25 years of treating patients with diet and lifestyle changes alone. Dr. Gundry and other wellness experts offer inspiring stories, the latest scientific advancements, and practical tips to empower you to take control of your health and live a long, happy life.
Speaker 2:
Welcome to The Dr. Gundry Podcast. Well, you know Alzheimer’s disease. It’s a diagnosis that strikes fear into the hearts of millions. And for good reason. It’s not only a condition that’s impacting countless lives today, it’s one that threatens to affect millions more in the years to come. But if you’ve been following me for a while, you know that I’m a firm believer that no disease, including Alzheimer’s, is inevitable. And my guest today wholeheartedly agrees, and that’s why I wanted her to come on the program. I’m thrilled to be joined in person by Dr. Heather Sandison, a leading naturopathic doctor specializing in neurocognitive medicine. She’s the founder of Solcere Health Clinic, San Diego’s go-to brain optimization center and Marama, the first memory care facility focused on returning residents to independent living. Can you believe that?
So, today, we’re exploring her brand new book, Reversing Alzheimer’s, The New Toolkit to Improve Cognition and Protect Brain Health, where she challenges everything we thought we knew about this disease and actually offers practical tools to keep your brain sharp in any age. We’ll explore the myths, the science, and most importantly, how you can take action today. So, stick around. We’ll be right back. You don’t want to miss this one. 55 million people worldwide are living with dementia, and that’s going to jump to 78 million by 2030 just really a few years away. I tell my patients all the time, poor health, including that of your brain is not a normal part of aging. So, what’s really happening here from your perspective?
Heather Sandison:
So, as the demographics have shifted towards elder adults, we have more people living in that time of their life when they’re at the highest risk of developing dementia. So, actually, the incidence of Alzheimer’s and dementia is going down. So, per 1,000 people in the Western world, fewer of us get Alzheimer’s. However, so many of us are in that age where we have high risk, and this is one of those things, the year we were born, we can’t change. Our gender, we cannot change. Our APOE status, we cannot change, our genetics. And yet, the message is that those unmodifiable risk factors are what count, and that’s what’s going to determine how we age. Yet, you and I well know from working with patients, from working with clients, from all the testimonials I’m sure you get from your books, that there is so much we can do to change how we age and how those genetics express themselves as we go into that last chapter of life.
There is almost an overwhelming amount that can be done to change the trajectory of our health. And really, what we have to do is not get overwhelmed, be systematic about how we apply these modifiable risk factors. So, don’t worry too much about the things we can’t change, but really focus on the things like our diet, what we decide to put in our mouths each day, what time we go to sleep, the people we surround ourselves with, how much movement we get. Those are the things that determine whether or not we’ll get dementia, whether or not we’ll age gracefully and well.
Speaker 2:
Well said. First of all is… Well, that’s you and I both deal with folks who carry the APOE4 gene, the quote, “Alzheimer’s gene.” I wish that had never been used, but in fact, at least in my practice, I see more people with dementia and or Alzheimer’s who don’t carry the Alzheimer’s gene than I do who do carry it. Is that true?
Heather Sandison:
I see a mix of both. And unfortunately, there was a recent Nature paper, I’m sure you’re well aware of this, that essentially said that, “If you carry the APOE4/4, if you got a copy from mom and a copy from dad, you eventually will get Alzheimer’s and dementia.” And yet, the Lancet Commission report suggests that 40% of worldwide dementias are preventable or at the very least, delayable. And I think that that’s much more true and much less alarming and much more empowering. And I suspect that as the research evolves, we’re going to see that that number, that the Lancet Commission report, that 40% is actually closer to 60, 80, maybe even 90% of us can think of Alzheimer’s as optional, that there’s a lot that we can do even if our genetics prime us towards the production of beta amyloid plaques, towards the potential for vascular dementia, heart disease as you well know, your background.
And so, I think that APOE, what I encourage people to do it this stage, when I started my career, people would say, “Oh, I don’t want to know my APOE status because it’s just going to give me anxiety. It’s going to keep me up at night, and there’s nothing I can do to prevent or delay or reverse dementia.” And yet, now, what I’ve seen in my career is that that’s absolutely false, and that knowing your APOE status earlier on means that you can make different decisions from your spouse or your neighbor who you’re not genetically related to. You can decide to do the things that protect your brain health and start earlier.
With Alzheimer’s, we know that changes in the brain start happening decades before we even have that first symptom of not remembering where our keys are or what the name of that person was or the name of some noun in our life that we should know, that we would’ve known five or 10 years ago. When we notice our brain changing, that’s definitely time to take action. But if we know our genetic risk, we can take action even sooner and prevent.
Speaker 2:
Yeah, you’re right. I’ve been testing the APOE4 for 25 years now, and early on, a lot of people said, “No, no, no, I don’t want to know.” And I said, “Oh, you do want to know because you can take action.” In fact, in one of my books, there’s a wonderful study looking at women who carry the four, and regular exercise in those women, a lifetime of exercise really is preventative of developing dementia, but if you develop it, it’s delayed 11 years compared to people who don’t have a regular exercise program. That’s the difference. Let’s suppose you were going to get it at 75. Well, now, it’s at 86. Well, that’s a whole lot of time to enjoy your spouse, your grandchildren, maybe your great-grandchildren. 11 years, that’s worth it.
Heather Sandison:
It’s why I get out of bed in the morning, Dr. Grundy. Really it’s because I hear from patients and their family members, “I got my mom back. I got my life back.” And I hear these stories of grandma who was in the corner, dejected and isolated basically during the holiday. And the next year, a year later, she’s picking out age-appropriate gifts for her grandkids and cooking her famous apple pie and really back in the game of enjoying life and those meaningful connections. That’s why I show up. That’s why I do this. In the clinical trial, going back to the APOE conversation, in the clinical trial I had the fortune of doing in my office, we had a six-month feasibility trial, and we took 23 participants through this trial, and it was a six-month intervention of completely based on Dr. Bredesen’s work, my mentor’s work.
And what we saw was that after just six months of this intervention, 74% of participants or 17 out of 23 improved. And now, all of these participants had measurable cognitive impairment. We used the MoCA score to determine eligibility. So, the MoCA is the Montreal Cognitive Assessment, and a perfect score is 30 out of 30. Normal is 26 and above. Our participants all had MoCA scores between 12 and 23. This is moderate cognitive decline, and some had diagnoses of Alzheimer’s. And we saw that most of the time, 74% of the time, they improved within just six months. And many of them were either APOE3/4 or 4/4 carriers.
Speaker 2:
Yeah. I keep reminding my patients, I have a gentleman who carries 3/4, and he’s now 98 years old, and he runs his family business. His three daughters will not let him retire because he’s so good at it. And he drives from LA to Palm Springs to see me twice a year, drives his own car, and he doesn’t have Alzheimer’s. Years ago, I met young woman who was 85 who carried the 4/4, and 85, and actively plays tennis. I described her as ditzy, which I guess is a nice, maybe a terrible term to use, but-
Heather Sandison:
Hopefully, an endearing.
Speaker 2:
An endearing, but perfectly… Lived alone, perfectly functional. And she was 85 with a 4/4. And when I first met her, because I have been taught that, oh, come on, a 4/4 will never make it to 85 without dementia. And there she was and talking about her tennis scores and hopping in. She’d always come in in her little tennis dress, and she actually made it to 91. So, I think we’re all trying to rewrite the expectations of what most of us were taught that oh yeah, maybe we can slow this down. But the idea of reversing it or delaying it a considerable period of time, I think that’s why, you’re right, we get up in the morning.
Heather Sandison:
I came to this as a skeptic. I had been told like everyone else trained in the years that we were, I was, that this was not anything that you could do something about, that as a provider to suggest that you could help someone with Alzheimer’s was to actually give them false hope. And as Dr. Bredesen now says, “That’s actually false hopelessness and that’s detrimental. That really does our patients a disservice to tell them there’s nothing they can do for Alzheimer’s or dementia because there’s an overwhelming amount that we can do.” And I think where we went wrong was these perverse incentives in the pharmaceutical industry that have us target, use taxpayer dollars to figure out what that single molecule intervention is going to be that’s going to solve this problem. So, we went down this path of beta amyloid plaques as the cause of Alzheimer’s and dementia, missing the common sense analysis of no, a complex organism is going to have multiple things that are going to lead to the same dysregulation and neurodegeneration in this case.
It’s so simple for us to look at a house plant, right? And if it’s wilting, if it’s dying, you don’t think, oh, it must be misfolded proteins. I better get those misfolded proteins out of the plant. You think, is it getting enough sunlight? Is it getting enough water? Is it getting too much of something? Does it have enough nutrients in the soil or has it outgrown its pot? You think through what are the inputs and outputs of a complex system that are required for it to thrive?
And when we apply that concept, which is what Dr. Bredesen does, to the brain, we get common sense outcomes. We get better neurological function, better neuronal function. And then, all of the downstream effects of better cognition, better mood, better health over time as we age. So, even though I came to it skeptical, when I heard Dr. Bredesen speak at a conference, what he described was so common sense and it fit my ethos as a naturopathic doctor. How can we focus on health rather than on disease? And if we focus our energy on promoting health of the system, of the cell, then we’re going to get better function. We’re going to avoid disease and particularly the complex chronic diseases associated with aging.
Speaker 2:
Since you brought up looking for miracle cures, the one thing that’s going to do it, a few years back, there was a miracle cure breakthrough treatment for Alzheimer’s. Walk me through why the talk about false hope. Why do these things keep coming up and why do they all almost always fizzle out?
Heather Sandison:
Well, we think of beta amyloid as the cause, and unfortunately, it does us a disservice because it is an oversimplification. Now, beta amyloid are absolutely associated and correlated with Alzheimer’s disease, however, they’re not the cause. There’s something above the beta amyloid that triggers the production, and the beta amyloid is actually there to protect us. We know now that it’s anti-microbial. Literally, if an microbe enters our brain, things like P. gingivalis associated with gingivitis, things like herpes simplex virus, that can trigger the production of beta amyloid. We know that one night of sleep deprivation leads to a measurable accumulation of beta amyloid in people in their 20s, 30s and 40s. But we also know, so we know that if this accumulates, it can leads to structural change in the brain, which is very real and associated with age-related memory loss. However, we miss the point if we don’t say what triggered the production of beta amyloid or what allowed for the accumulation of beta amyloid. If we don’t use it as an invitation to look for the cause, then we miss the point.
And the other issue is that when we take it away, we’ve gotten very good at this. We’ve gotten very good at getting rid of amyloid. And in the research models, we’ve used that as a surrogate marker. So, instead of asking what’s really meaningful for patients, is your cognition better? Is your quality of life better? We’ve asked, is your amyloid gone? And what we see is that, yes, we can do that, but it doesn’t lead to better cognitive outcomes. Unfortunately, the best that these new drugs do, these are antibody therapies, monoclonal antibodies that remove amyloid, they reduce the rate of decline. So, what you do is you take a torturous process, the long goodbye that is Alzheimer’s, and you draw it out. And this is not a last-ditch effort that you use when somebody has severe Alzheimer’s. Actually, it’s only really clinically indicated for people who are in the earlier stages, and unfortunately, it works least well in women who are APOE4/4 positive, who are the most likely to end up with Alzheimer’s.
And it comes at a cost, not only financial cost, but it comes at the risk of brain bleeding and brain swelling. Recently, my friend Dr. Cyrus Raji, he is a neuroradiologist and he was showing the images of before and after MRIs of the brains of people who are getting these antibody therapies. And in six weeks, it looks like they’ve aged 100 years. You can see this on imaging and they call it pseudo atrophy. And I don’t know what kind of gas lighting is happening here, but you can see the brain changing with the use of these antibody therapies that don’t actually give us meaningful benefit. They do not improve cognition. At the best, they slow the rate of decline by about 30% with the risk of brain swelling and brain bleeding.
Speaker 2:
And the risk is very real.
Heather Sandison:
Very real, and the cost is very high.
Speaker 2:
And the cost.
Heather Sandison:
Right. Thousands of dollars out of pocket, thousands of dollars, tens of thousands of dollars to Medicare. Plus, you need to be close to a large medical center. So, the algorithm of who fits in or the Venn diagram of who can get access to these medications is quite low because you need to be close to a major medical center, because you need to be monitored for these potential side effects. And it’s going to take the time, right? You’ve got to go get the MRIs, you’ve got to follow up with this specialist, and you’ve got to go get these IVs that may or may not be helpful.
Speaker 2:
Take me back. You said you entered this as a skeptic, and certainly, my experience with Big Ed, who I write about in my books, I was certainly skeptical that you could do anything about reversing coronary disease. Your first patient’s name was Darlene?
Heather Sandison:
That’s right. Yeah.
Speaker 2:
So, tell me about Darlene.
Heather Sandison:
Yeah, she came in with her husband completely dependent on him. She had a MoCA score of two, so again, normal is 26 and above 30 is perfect. She had a two. I was talking to-
Speaker 2:
We’re not talking about a chocolate cappuccino you get at Starbucks, a MoCA score?
Heather Sandison:
Montreal Cognitive Assessment.
Speaker 2:
Oh, okay. Thank you.
Heather Sandison:
People might be getting the SLUMS test or they might be getting the Mini Mental State Examination. These are all out of 30, and different providers have a preference for different ones. What we use in my office is the MoCA, the Montreal Cognitive Assessment, and she had a two. Essentially, my interaction with her, I’d start to ask her a question, what did you have for dinner last night? Or how much exercise have you gotten in the past week? I could see the wheels in her brain spinning, but by the time she was ready to formulate an answer, she’d forgotten the question. She might have enough to give me a yes or no. And her handwriting was really cramped. It was at an angle. You couldn’t even read it. She had trouble communicating. She was completely dependent on her husband. There was no way she was going to work.
She was a liability to him basically. And he was terrified, and he was so dedicated, and she had this huge smile. She connected with you. You could see her soul was there, and she had this pink floral dress and this black leather-studded bag. And he would talk about how one of the functions she retained was she would play dress up. She would basically go into her closet and put on all these clothes. She was just this amazing woman. She had been a teacher, a school teacher, and you could see that there was creativity still in there. There was this soul still in there. And I was heartbroken the day I saw them because I could see how special she was, and I can see how much he loved her and cared for her, but I had never seen someone get better. And her husband had, thank goodness, way more confidence than I had.
This was in 2017, right after Dr. Bredesen had published his book, The End of Alzheimer’s. So, he had the book and he was very attached. He was like, there was no talking him out of this. He was in it, and I had to sort of hide my skepticism. I didn’t have enough confidence, but I went through the motions. So, we talked about getting her amalgams out. We’d got her on bioidentical hormone replacement. She got on the supplements that were nootropics, also detox supplements. They were living in a moldy bedroom, and they actually just walled off their bedroom and moved into the living room. They started ballroom dancing three times a week, which they had done previously. They started walking. They got on the ketogenic diet. They were all in. They dove in fully. And really he did because she didn’t have the ability to.
Speaker 2:
She didn’t have a choice.
Heather Sandison:
She didn’t have a choice. He was all in. So, I said, “Goodbye,” and wished them well, but did not expect what I saw six weeks later, which was her MoCA score went up to a seven. She was talking in complete sentences. They were bickering about something that had happened on the way into the office, and she was there. She was back. Now, she wasn’t going back to work, but this was just six weeks later. And what I saw was she continued to improve as we worked together. But in that moment, it’s one of those moments, I’m sure maybe with Big Ed, you remember this, but I remember exactly what I was wearing and the way the light was shining in the room when I saw those two MoCA scores, the two compared to the seven, just six weeks later. And I looked up at her husband and I was like, “We must have done something wrong. This isn’t possible.”
I questioned myself. I was still that skeptical, and he’s like, “No, no. Talk to her. This is very real.” And then, where my brain went next was, oh my God, if this is possible for Darlene, what about everybody else? What about all that suffering that’s happening out there that’s avoidable and people are still being told that there’s nothing they can do when right here in front of me, this miracle just happened. So, she was the first one, and that was the moment I decided to dedicate my life to this. How can you not?
And then, I saw it over and over and over again in my clinical practice, that people with early stage dementia, with mild cognitive impairment, and even with severe dementia got better, that their quality of life improved. They were able to communicate again and say, “I’m hot. I’m cold. I’m hungry. I need to go to the bathroom.” They were able to get back… They lose continence, and they were able to get back bladder control and bowel control. Really big things that changed the quality of our lives and our dignity as we age, and that, it’s so meaningful. And then, I very fortunate to get to do research in my office, and then, open Marama and just expand the access to this type of care.
Speaker 2:
And so, at your center, you actually want to try to get people out of your assisted living center back into their home.
Heather Sandison:
That’s the goal. And it works. It happens.
Speaker 2:
You’re kind of a halfway house.
Heather Sandison:
Or sort of a retreat center. I think of it a spa-like experience. I want everyone to want to come.
Speaker 2:
There you go. Yeah.
Heather Sandison:
Really, we wanted to… My mom, she said, “Take me out and shoot me before you send me to one of those places,” right? Because she’s seen what happened to her grandma and what happened to other people in our family where their resigned to a senior living facility where they lose all dignity, they’re locked in a room, they’re watching TV, they’re fed cake and cookies, and it’s just the long goodbye, right? It is just waiting for their demise.
And yet, I think that it’s very easy to get an alternative to that. I think if we invest in our health earlier, and I think if we take it seriously around retirement age or maybe a little bit later, if we’re starting to notice those cognitive changes, that we fully immerse ourselves in a program, whether it’s at home or with more assistance and an immersive experience, that we fully immerse ourselves in the lifestyle that generates good health habits and gets us that cellular function back. And that’s not impossible. And we see that people who move in in the earlier stages, in six, eight months, we see them fully regain cognitive function. They’re able to move home with the MoCA score of 30. So, it depends. We don’t guarantee results, but when we set people up for success, it works.
Speaker 2:
One of the things that I argue that you can actually catch diseases from the people you live with primarily through the microbiome that you exchange and the food that you exchange. How much of it is your control or the family members’ control of what goes into their mouths, what they’re doing? Is that a big factor?
Heather Sandison:
It’s absolutely crucial that people with dementia have the support of those around them. Like Darlene, she wouldn’t have gotten the benefit of this if her husband hadn’t made it happen for her, right? And especially as we progress down the disease process of dementia, we’re more and more reliant on others. So, it’s up to them to make decisions that promote our health. But before that, we have control to a point. What is the saying? We are the average of the five people we spend the most time with. And our spouse, our partner, makes a huge impact on what we decide to eat, the foods that show up in our refrigerator, the supplements that end up on the shelf that are easy and accessible for us to take. How much they exercise influences how much we exercise. So, we want to be very conscious about who we surround ourselves with.
As we age, we want to look to people 10 years older than us. I want to age like that, and so, I’m going to start spending more time with people like that. It’s very easy for adults especially to mimic the behaviors around them. So, be conscious about who you spend your time with and be conscious about who you share your microbiome with, because that also, to your point, makes a huge difference in our health. There’s a bunch of things. The ketogenic diet is one of the, where I’ve seen the flip side of the Darlene story where a spouse will bring in their partner, but they’re not ready to go into ketosis with their partner yet.
So, there’s cookies on the counter and there’s bananas, and fruit is not inherently bad. There are great polyphenols and anthocyanidins and all kinds of benefits, but if the goal is ketosis, it’s going to keep you from getting there. So, we want to make sure that your environment is set up to promote the goals, to help you get to achieve the goals that you have set. And if you have a spouse who’s undermining that, it’s not going to be helpful. Or if you have a caregiver or I had an adult child who was like, “No, no, I want to have happy hour with my mom every day.” So, she’s going to have her scotch. She has dementia. You’re just adding another toxin that doesn’t need to be in the system that’s going to undermine her cognitive performance.
Speaker 2:
Yeah. Her right to have her piece of cake every day. She’s always had a piece of cake every day, and it’s cruel to take that away from her. How do you handle that?
Heather Sandison:
For every family, there’s different dynamics, unique dynamics. There are, as people age, there’s conversations around inheritance. There’s conversations about how we treat our elders. There are very complicated dynamics that show up in families, and I’ve seen people who are become martyrs to this, who are so self-righteous in their, but we’ve got to do this diet this way, and mom’s not getting the best care, and somebody else is hurting her because she’s not getting this or that. And I would offer that becoming the model yourself, taking that energy and turning it back towards what you can control.
Again, just like our modifiable and unmodifiable risk factors. We can’t change the unmodifiable ones. We can’t change other people’s behavior to a point. Sometimes, we can. We can influence them, but we don’t have ultimate authority over someone else’s behavior. What we have authority over is our own. So, if we can take all this great information, your work, Dr. Bredesen’s work, hopefully, my book is going to have an impact on people’s lifestyle behaviors, but focus it on your own and become the model of good health, of optimal health so that other people then see that and want more of it, and you become an authority through that path rather than trying to force it down someone’s throat, which often leads to resistance.
Speaker 2:
Let’s talk more about the ketogenic diet. Long ago, with my APOE4s, and I think, Dale, we were very afraid of fat for Alzheimer’s. And certainly, my training as as heart surgeon, fat’s evil. And I think I’ve certainly come around, and I know you’ve come around, and Dale’s come around. Why should we embrace a ketogenic diet, a lifestyle, MCT oils in people who we thought that this was deadly for?
Heather Sandison:
Right. I’m sure you’re familiar with Mary Newport’s work, and there’s been a renaissance, I think, around how good fats are. And thank goodness because our brain, the myelin sheath, as you well know, made of fat. We need fat. The brain prefers to burn ketones over sugar as fuel. As we age, we all become, regardless of diabetes status, we all become somewhat insulin resistant. We’re not as efficient at burning sugar, turning it into ATP. It also creates oxidative stress when we’re burning sugar for fuel. As you well know, the ketogenic diet can help with it. The reduction of fat soluble toxins. It can be a detox diet and anti-inflammatory diet, but it’s also supportive generally of just better neurological function. What we see, and I think common sense based on ancestral diets, we’re designed to go back and forth. The body is just this divine design blows me away. It just inspires me every day.
But we are designed as hybrid engines to be able to go back and forth between burning fats for fuel and burning sugar for fuel, because our hunter-gatherer ancestors did not have blueberries available 365 days a year. They didn’t have high starchy foods. They didn’t have Kit Kat bars available 24 hours a day at 7-Eleven. Oh my gosh.
Speaker 2:
The horror.
Heather Sandison:
We’re not designed to eat the highly profitable, highly palatable, highly processed foods that are available ubiquitously in our environment. We’re designed for some famine. We’re designed for whole foods, for the things that come straight from the ground, straight from the tree, straight from the animal. So, when we shift our diets into that, we see better cellular function. And with the ketogenic diet and fats, unfortunately, so many people, and especially, my older women who were health conscious in the ’80s and ’90s, they remember that food pyramid and this and the Women’s Health Initiative study.
The two biggest failures in medicine in America, this idea that we were meant to get grains as a foundation of our diet and that fats were vilified. Well, now, when I suggest ketogenic diets to women, older women, I have to be really careful that I explain how good fats are. Because what they hear is that sugar and carbs are bad. They reduce that, but they’re still afraid of fats, and they start being undernourished and losing too much weight. So, I really have to emphasize, these fats are not terrible for you. They are actually good. They’re a source of fuel. They are healthy, and particularly if you choose the right ones. We’re not talking about a bacon and cheese diet.
Speaker 2:
Oh, man.
Heather Sandison:
No, sorry to disappoint everyone, but lots of olive oil, avocado, all of these, coconut oil, and I’d love to get your insights. Mary Newport, she suggests that coconut oil actually can be good for people with APOE4/4. I’ve had patients where I’ve seen actually lipid profiles improve when they’re consuming coconut oil. But I know that there’s also a caution there with APOE4/4 and the metabolism of saturated fats.
Speaker 2:
With my patients. I like them to have MCT oil. For them, coconut oil, I see their small dense particles really go up and they oxidize their particles a lot more. So, coconut oil, at least in my patients, is still off the list. However, I like particularly goat and sheep-based cheeses and yogurts because about 30% of the fats in goat and sheep are actually MCTs, medium-chain triglycerides. And I don’t think it’s a surprise that four out of the five blue zones are sheep and goat herders and a huge amount of goat and sheep products in their diets. And it’s pushed under the table by my good friend Dan. But I don’t think it’s a shock that four out of the five blue zones are big-time sheep and goat eaters.
Heather Sandison:
And I’m so pragmatic. When it comes to the ketogenic diet, I want people to feel satisfied. I want it to be an accessible diet that they’re able to do. And I think that adding some of that dairy, the sheep and goat dairy, the A2 dairy potentially, that makes it very satisfying, particularly when you’re having those sugar cravings in the first few days.
Speaker 2:
How do you advise everybody, particularly I guess the caregivers, how do you get past these sugar cravings? Because it’s very true. Your brain lies to you that your brain is starving for sugar, which it is. And because it can’t utilize it and it says, “Oh my gosh, you’ve got to go find some sugar.” I hear it in my patients. I see it in my patients. How do you help?
Heather Sandison:
I get into ketosis three, four times a year, and I call them my donut days because I haven’t had a donut in 15 years. I’m a naturopath, right? I gave that up long ago. However, I can’t stop thinking about donuts for about 24 hours when I’m going into ketosis. And it is exactly what you were just describing. It’s this physiological addiction to sugar. And when that comes up, I recommend that patients, one, be prepared for it. So, fat bombs are one of my strategies personally. I get a 32-ounce mason jar and I fill them with fat bombs before I’m planning to go into ketosis so that if I have a hankering for something sweet or chocolate or salty, I can grab one of those, and it’ll reduce that craving. It’ll hit that craving and I won’t need more. And then, high fat, getting really high fat foods in and protein can help with satiation so that you’re not going through these blood sugar spikes and drops.
Often, those drops lead to the biggest hankering for sugar. So, then also just being prepared for it, I think gives us that reassurance that it’s temporary. We’re going to get through this. In three days, once I’m 72 hours into carb restriction, I’m going to get to the other side. Another good strategy is exogenous ketones, which often can taste… They’re very sweet. I don’t love the taste, but I will use them in those first few days to get my ketones up before my blood sugar has fallen, and that can help me get up over that hump as well.
Speaker 2:
But you got to keep all the carbs out of the house.
Heather Sandison:
Oh, absolutely. And particularly for people with dementia, they’re not going to remember that they can’t have that apple. So, they’re going to have that sugar craving, walk through the kitchen, see an apple, and grab it, let alone a cookie. So, cleanse your kitchen is one of the things that we guide people to do. And I’ve had someone say, “Oh, I can’t get rid of that bottle of soda. I paid for that. I bought that…” It’s toxic. Just get rid of it. Just throw it away. You do not need that. It does not serve anyone. And I think there’s a spectrum there, but cleansing the things from your house that are going to be tempting, especially those go-to easy quick foods, make sure you have an alternative. And in your pantry, you can even design your pantry so that what’s at eye level is the quick, but keto friendly foods. What’s below or above what you can see are those things that you maybe want to hide from yourself for a few weeks or a few months.
Speaker 2:
Yeah, because a lot of my patients say, “Oh, gee, I paid good money for this stuff. I don’t want to waste it.” And I go, “Look, just give it to somebody you don’t like. I’m sure you’ve got several neighbors that you want to poison.”
Heather Sandison:
Exactly.
Speaker 2:
And they said, “Oh, that’s a great idea. Okay.” All right. Last but not least, because this comes up all the time with my patients. What the heck is a cognoscopy? Is somebody going to put an instrument into my brain and look around or up my nose?
Heather Sandison:
So, this, I love for Dr. Bredesen for so many reasons, but one of them is because he’s created these great visuals that really stick with this that have an emotional impact. He’s got many of them, but the cognoscopy is one of them and hits home because the cognoscopy, it’s uncomfortable, but it’s a way to prevent a very serious disease. It’s a way to catch it early, the risk factors, polyps that can lead to colon cancer over time. And you do it around the time that you’re 50 to prevent the risk of disease. And his point is, if we can look for the risk factors for cognitive decline in our 40s and 50s, then we can reduce our risk of developing disease as we age. So, a cognoscopy is essentially systematically going through the medical workup to look at toxins, infections, nutrient deficiencies or imbalances, excess or deficiencies.
So, look at stressors. What is our cortisol doing? To look at sleep. Do we have sleep apnea? Are we getting enough sleep? To look through all of those modifiable risk factors in a way that we can quantify, so that we can identify things like mold toxicity or heavy metal toxicity, or herpes infection, or a gingivitis that might cause and pull that trigger that’s going to produce beta amyloid plaques or misfolded tau proteins in our brain. So, we can basically be empowered by this data, by this information and reduce our risk when we look before we have symptoms just like you would with a colonoscopy. Now, to add some icing to the cake, you’d ask, are they going to put a probe in my nose or up in my brain? No. But we can do imaging, and now, we can look at things like p-tau217, p-tau181, our amyloid ratios.
We can look at some of these tests that give us an indication of are these changes already happening in our brain? We can do the NeuroQuant testing or the quantitative testing of the brain regions. We can also look at the arterial spin labeling, the MRIs that can give us a sense of our glucose uptake and metabolism in different regions of the brain. And these, although I have these two categories when it comes to testing, in a cognoscopy, I would include both of those categories. But we have the tests that are going to drive the treatment plan. If there is mercury, we want to get that out. That’s going to be high priority. If your blood sugar is high, your A1C is elevated, your homocysteine is elevated, we need to change your diet. We need to add some supplements. We need to do things that are very actionable. You and I are going to send our patients home with a list of what they’re going to do.
Now, when we look at the images or when we look at the p-tau or when we look at the amyloid ratios, they don’t necessarily tell us how to change the treatment plan. What they do is they tell us where our baseline is. They give us a measuring stick. So, we’re here today in 2024. Where are we going to be a year from now? Are we getting better or worse? And that, I think of as a luxury. For my patients who are financially strapped, if they don’t have… Because those are not covered by Medicare at this stage. They’re out-of-pocket tests. So, for me as a researcher, as a clinician, I want them, I would love them-
Speaker 2:
Please.
Heather Sandison:
Please get the imaging. A picture tells us a thousand, so many things. However, if you’re financially strapped, I leave those out at this stage because the actionable things are what’s most important to me. And those are sort of a luxury.
Speaker 2:
There’ll be blood tests shortly that will be able to diagnose your risk of Alzheimer’s. We’re not talking about the APOE4, circulating tau, circulating beta amyloid. Something we should get, or is it too soon to tell?
Heather Sandison:
So, I love for all of my patients to get that. They’re not covered by Medicare. So, they have to have the financial resources to do that. And we are still figuring out what they mean. So, if you lose weight, if you gain weight, that will change those numbers. And that has to be taken into consideration. And I’ve had a few patients who have done them and they’ve come back abnormal, and they are anxious as all get out. They can’t sleep because they think this is a diagnosis of Alzheimer’s. There was a patient who was seen on the East Coast, actually a colleague of mine recently, and he was diagnosed with Alzheimer’s based on those labs.
Speaker 2:
Whoa.
Heather Sandison:
And I thought that that was really inappropriate and did him a disservice. He had been very anxious, couldn’t sleep. He was trying to figure out how he’s going to live the rest of his life and what… He was basically putting his affairs in order. And I think that that was detrimental. I think that the stress actually had a poor impact on his health, the lack of sleep. And that isn’t the interpretation that I have of those tests. When we see them, they’re directional. So, when we have longitudinal markers, we can see, are we going in the right direction or maybe are we not? But any one in and of themselves, it can go up or down. The amyloid ratios can go up or down if you get COVID or a cold or a flu.
They can go up or down if you lose weight or gain weight. And many people on our protocols are going to change their body composition. So, I think we need to take those markers with a grain of salt at this stage. And I hope, I hope I have the privilege of running them on people who are well-resourced enough to get me the experience so that I can help other people interpret them over time, and that we’ll all learn together to make those useful tests. But right now, I think it depends on the person.
Speaker 2:
Yeah, no, I think I, hopefully, or like you, I learn from every one of my patients.
Heather Sandison:
Absolutely.
Speaker 2:
In fact, I dedicated one of my book just to thank them for letting me learn from them. And the more of these we can get people to get, it’s very helpful.
Heather Sandison:
It’s such a privilege.
Speaker 2:
In fact, just throw this out, you talked about mold. I have two patients in LA who are renting a house, and they’re very conscientious about all these factors. And we got mycotoxin tests on them, and they both came really high for black mold. And they brought in two companies and they couldn’t find any black mold in the house. And I said, “That must have been the house you were living in before.” Okay, so six months passed, and we retested them. They’re still in this rental house, and the husband’s, his have dropped almost out of the red, dramatic drop. He’s kind of in the yellow. She hasn’t changed one iota. And I saw him before I talked to him. I said, “Well, that’s interesting.”
So, we zoomed and I said, “This is really weird. Do you guys sleep in separate bedrooms? What’s going on?” And he says, “Oh, I’ve been on the road a lot the last few months, and I really haven’t been home.” And she said, “And I haven’t traveled at all. I’ve been home.” I said, “Wow, this is great information. Your house is killing you. He’s getting out, and now, you need to take this to your landlord. You now have proof that you’re in a sick house, and this is killing you.” But yeah, we learned, wow, how come you didn’t change and he changed? I’ve been traveling.
Heather Sandison:
It’s fascinating. I’ve had similar experience with the mold testing. Somebody will swear up and down, “There’s no mold in my house, there’s no mold in my house.” It’s through the roof. And I’m going, “There’s something. There’s something.” And sure enough, this gentleman, I knew there was mold somewhere. He was denying it. And the roof, the ceiling above his bed dropped on him in the middle of the night one night. It was literally crumbling right above his bed from a rain that had gotten in through a roof leak that nobody knew about.
Speaker 2:
All right. Well, I got to let you go. Where can people find your book? It’s a bestseller. Congratulations.
Heather Sandison:
Thank you. Wherever books are sold, Reversing Alzheimer’s, Dr. Heather Sandison, and you can learn more, stay up-to-date about the research on Alzheimer’s and dementia and caregiver support at drheathersandison.com.
Speaker 2:
And I think the takeaway for everybody is that this is not a death sentence, and we don’t want to just mark time by parking somebody somewhere. There are active things that you can do. I actually write about it in my upcoming book, The Gut Brain Paradox, that you can change these things. It’s exciting. It’s exciting. Thank you for doing the work you do. It’s time for our audience question. And this one comes from Wager Lee on YouTube. They want to know, I heard on the news that the shingles vaccine dramatically reduces the chance of getting Alzheimer’s. Should I get the vaccine? Well, what say you, Dr. Sandison?
Heather Sandison:
So, we know that the herpes simplex viruses are associated with a risk of Alzheimer’s. We know that they trigger amyloid plaque production, and we’ve seen this in epidemiological studies. Those who are treated aggressively for herpes have less risk of Alzheimer’s compared to those who are not. Now, the shingles vaccine is also part of the herpes virus family. This is a neurological virus. It’s in the nervous system. And it makes a lot of sense to me that if you don’t have a shingles outbreak, if you can prevent that through a vaccine, that you’re going to have a lower risk of developing Alzheimer’s. So, I do recommend that there’s two different herpes, or excuse me, two of different shingles vaccines, and it’s the newer one, the Shingrix one, that is the one that has the most reduction of risk. Interestingly, the reduction of risk and the delay of dementia that’s associated with that vaccine is the same as the amyloid monoclonal antibody therapy.
So, it’s on par in terms of outcomes with that. So, you’re not getting an improvement in cognitive function if you have dementia with this vaccine, but you are getting a reduction of the risk of developing dementia. And I think that’s worthwhile to take advantage of as we age. I have seen in my clinical practice, it’s a two-part vaccine, so you need to get two of them to be protected. And I have seen in my clinical practice that I’ve had a handful of patients who end up getting shingles after the first one. So, that’s just a curiosity to me. I don’t know if there’s an increased risk, but it’s something that I’ve seen clinically. But I’ve also seen patients with shingles and that is torturous. It is so painful. It interrupts sleep. It’s very, very stressful to be in that kind of chronic pain. I’ve seen people end up addicted to gabapentin afterwards and addicted to pain medication. So, avoiding shingles, I think is a worthwhile endeavor, especially as we age.
Speaker 1:
I hope you enjoyed this episode of the Dr. Gundry Podcast. If you did, please share this with family and friends. You never know how one of these health tips can completely transform someone’s life when you take the time to share it with them. There’s also the Dr. Gundry Podcast YouTube channel, where we have tens of thousands of free health insights that can help you and your loved ones live a long, vital life. Let’s do this together.
