Ep. 458 Brain Health Tips to Fight Cognitive Decline with Dr. Heather Sandison
- Team Cynthia
- 4 days ago
- 36 min read
Aging is the leading risk factor for cognitive decline, and projected statistics show that the number of people diagnosed with Alzheimer’s will reach 8.5 million by 2030 and 11.2 million by 2040.
Today, I am thrilled to connect with Dr. Heather Sandison, a naturopathic doctor and the founder and medical director of Solcere Health, a San Diego-based brain optimization clinic, and Marama, the first residential memory care facility that aims to return its residents to independent living. Dr. Sandison is also the New York Times bestselling author of Reversing Alzheimer's.
In our conversation today, Dr. Sandison and I explored the most common signs of early cognitive decline, looking at ways to differentiate dementia from formal Alzheimer's disease. We dive into the causes of dementia and Alzheimer's, examining six key imbalances that can affect ApoE status and tackle the limitations of current approaches to Alzheimer's research. We also share information on current drug modalities and touch on the importance of brain-nurturing environments and helpful activities for maintaining cognitive status as we age.
I look forward to having Dr. Sandison back for a second conversation, where we will dive deeper into practical ways to support and improve brain health.
IN THIS EPISODE YOU WILL LEARN:
Some early signs of neurocognitive decline
Barriers to care for those with dementia or Alzheimer’s
What differentiates dementia from Alzheimer's?
Various factors that could cause Alzheimer's
The role ApoE genetics play in Alzheimer's risk
How addressing lifestyle factors can help prevent cognitive decline.
The limitations of current Alzheimer's treatments
How the results of clinical trials on the Bredesen intervention have shown significant improvements in cognitive function
Why individualized treatments are essential for managing Alzheimer's and dementia
Making healthy choices accessible and creating environments that support cognitive function
The benefits of making positive changes in your daily life and taking small steps to enhance brain health
"A clue for early cognitive decline most people are not familiar with is being a
victim of fraud."
-Dr. Heather Sandison
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Connect with Dr. Heather Sandison
Transcript:
Cynthia Thurlow: [00:00:01] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor to connect with Dr. Heather Sandison. She is a naturopathic doctor and the founder and medical director of Solcere Health Clinic, a San Diego based brain optimization clinic, Marama, the first residential memory care facility to have the goal of returning its residents to independent living. She is also the New York Times bestselling author of Reversing Alzheimer's.
[00:00:54] One of many reasons why I wanted to have Dr. Sandison on is that 64% of Americans fear dementia. That's over 212 million people. Aging is the biggest risk factor for cognition decline and the number of those with Alzheimer's is expected to reach 8.5 million by 2030 and 11.2 million by 2040.
[00:01:16] Today, Dr. Sandison and I talked about what are the most common signs of early cognitive decline? How do we differentiate dementia from formal Alzheimer's disease? What actually causes dementia and Alzheimer's, and six key imbalances that can contribute, the impact of ApoE status, that's A-P-O-E, limitations to current approaches to Alzheimer's research and oversimplification, as well as specific information on current drug modalities. And lastly, we touched on both the importance of a brain nurturing environment and cognition and specific activities that can be helpful for maintaining cognitive status as we age. Don't worry, Dr. Sandison will be back for a second conversation while we will dive deeper into ways that we can specifically benefit brain health. I know you will find this to be a truly invaluable conversation.
[00:02:14] Dr. Sandison, I'm so excited to have you on the podcast. As I was mentioning before we started recording, we were supposed to actually record in December and then my husband had a little bit of a healthcare hiccup, so I'm glad that we were able to re-coordinate our calendars to have this discussion because it is a vital one.
Dr. Heather Sandison: [00:02:31] Well, I'm so delighted and feel so privileged to be here with you.
Cynthia Thurlow: [00:02:33] Thank you. I think for nearly every middle-aged person, women in particular, we're all concerned, worried. We look at older family members, patients, if we are clinicians about subtle signs of some degree of progressive, even mild cognitive impairment. And as a clinician, what are some of the most common signs or things that patients identify or bring up to you that might be a clue that there could be some early neurocognitive decline?
Dr. Heather Sandison: [00:03:06] Yeah. A sense of overwhelm. So, tasks that used to be simple or easy, like planning a trip or hosting a dinner party, if that used to be easy for someone, and all of a sudden, they're like, “That's too overwhelming. I don't, that doesn't sound like fun to me anymore.” That can be an early sign. And then of course, I think what most people are familiar with is forgetting words, not being able to come up with the word couch, maybe being able to say, “You know, that squishy thing in front of the TV,” but not finding the word couch that is very normal in our vernacular. Not a hard word or a multi syllable word or even the name of a neighbor who maybe you're not super close to, but you've lived across the street from for 25 years, I should know that person's name. Those are really common early symptoms.
[00:03:52] Another one that people aren't as familiar with is being a victim of fraud. So, this baby boomer generation, they are targets because cognitively and technologically they might not be as savvy. And so it's not the Nigerian prince anymore. It's the person who calls and they say they're calling from the sheriff's department and they've got all your information and you need to transfer money to help your grandchild or you need to transfer money to-- You need to go to Walmart and get gift cards or whatever it is. And there's always this element of like they know a lot about and there's something in it that rings true.
[00:04:30] I've heard from patients, “Oh, my neighbor lost her entire life savings.” And so hopefully if this comes up as an early sign, it is a small impact on your financial health. But these are one of those things like, “Oh, dad's giving away money to these fraudsters, like what?” That is a sign of cognitive impairment. It's the change in judgment. And I think people become very-- at risk for this because they're losing confidence. So, they want to feel like they're doing the right thing for this person that's calling, they feel like they have good judgment or they want to have that confidence, but sometimes it's lacking and this is a way to sort of course overcorrect. So those are common things that'll come up.
[00:05:13] The lack of ability to go through executive function tasks like okay to plan, so cooking, this is why hosting comes up, planning a trip comes up, but you may that somebody who wouldn't take that on previously, there's small executive function tasks. So, I'm going to cook for myself, means I go to the store, I pick out food for the meal, I come home and I wash it and I peel it or I make this dish that maybe I've made in the past and now I'm skipping steps. I'm not picking up that thing from the grocery store or I'm not putting it away in the refrigerator or something gets left out. So, noticing those changes, many people will notice around the holidays. Mom used to do this every Thanksgiving or this every Christmas. And now the gifts are no longer age appropriate or something's just off.
[00:06:00] Now many people are aware of their own cognitive decline. Some people are not. It's that part of the brain I think that's affected is that self-awareness part of the brain. And then other people are very scared, so they're terrified. Now as we age, it's fascinating to watch as a provider. Cancer treatment has changed dramatically. People don't die of cancer and cancer treatment the way that they used to. Radiation today is not the radiation of the 1990s. It's really amazing. Heart disease, you've been in Cardiology. Cardiology has come a long way. What we can do to prevent plaques-- atherosclerotic plaques and keep the heart functioning, it's just incredible. Modern medicine has really, I think reduced the suffering associated with those diseases. But Alzheimer's and dementia is sort of the opposite story where it's almost gotten scarier because there is no pharmaceutical intervention that works. And I think that emotional intensity, that fear associated with Alzheimer's, with the word Alzheimer's, with that thought of like, “Am I losing my mind?” It prevents people from getting help. And--
Cynthia Thurlow: [00:07:17] Well, I think it's a pride thing as well. I have a family member that will remain nameless because I'm in a public forum, is unwilling to get evaluated for neurocognitive decline. And I have gone to the ends of the earth to try to find an individual who's highly specialized in their area. And every time I tried to broach the conversation with their spouse, it was very clear. It was like this person's not open to this conversation, they're unwilling, there have been multiple instances where this individual's like lost their wallet. Not just once, but like multiple times or gotten lost with just leaving the neighborhood. So, things that are frightening for loved ones to kind of witness. But I think the barrier to care in many instances can be an unwillingness to look for help or to be evaluated.
[00:08:07] And I jokingly tell my husband, because we have these conversations now that we're in our 50s, I'm like, “Listen, if you ever see something starting to slip, step in and don't be embarrassed and let me know.” It becomes a running joke between the two of us. Because sometimes we can be forgetful or we may be a little less stress resilient because of circumstantial reasons. And that's not what we're speaking to. We're looking at consistent trends over time, as opposed to, I was sick, I forgot to do X, Y and Z, which is normally something you might do, and it's just always on your radar, that is different.
[00:08:40] When my husband got sick, there were things that got pushed to the side. That is very different than consistent new patterns that we're seeing. And my hope, as I know it, is yours as well, is that by educating this community that people will not be afraid to seek care if they notice something, seems like it's not-- Word finding is a great example. I think everyone fears the word finding piece because we know that can be exacerbated by a low estrogen state and how important estrogen is for insulin signaling and energy. I mean, just many things that estrogen's involved in. And I can't tell you how often I think about Dr. Lisa Mosconi's work, the XX Brain, and I'm like, gosh, reading that book completely changed my whole perspective. It's like, oh, we need to be talking about the hormone piece because a lot of people don't realize that they're at much greater risk for some of these neurocognitive issues as they're getting older. And it's not anything that you're doing wrong, per se. But obviously we're going to talk a lot about lifestyle today.
[00:09:42] When we're talking about dementia. Not all dementia is Alzheimer's. And I think that it perhaps is helpful to how do we differentiate dementia specifically from Alzheimer's, which is obviously a most severe manifestation of this neurocognitive decline.
Dr. Heather Sandison: [00:09:58] Yeah. So, there's-- You just said so much right there. And I want to double click on a couple of things. So, one, another early sign of cognitive decline is, as you mentioned, spending more time looking for things around the house. And you're absolutely right, it's these patterns. And then someone who's resistant to care. There's no one right answer. Dementia is dynamic. It changes cognitive decline, memory, age-related memory loss. There is not one right way to do this and there's not one right way to do it as we navigate the entire spectrum of this disease, as we navigate aging.
[00:10:34] And there are many pragmatic reasons why people avoid getting care. They don't want their driver's license taken away. They're worried about their health insurance or their long-term care insurance. Maybe they haven't gotten that all dialed in. They're worried that somebody's going to try to get conservatorship, they're going to lose control, they're going to lose independence. And these are all very valid concerns. And so, I think that-- I don't know the dynamics in your family and I want people to get help, but I also think-- And I want people to go to neurologists, I want them to get imaging, I want them to get thorough workups from people who are covered by Medicare.
[00:11:11] And I want to encourage people to see a Bredesen-trained provided because it's a very different experience to go into a neurologist and be offered Aricept or Namenda, the very common medications that are prescribed for age-related memory loss or to go in and be offered the amyloid antibody therapies that really don't work very well, have very high risk and to feel kind of hopeless, like “Really, is that all you got?” And then have your driver's license taken away and then for them to say, “Come back in six months and we'll measure the decline,” that's really demoralizing. And I get why people avoid that.
[00:11:48] So, I think having a plan, “What does that look like when I go into my neurologist, like what do I want to ask for? What would really be helpful?” I think imaging is helpful, because as you mentioned, there's different types of dementia and vascular dementia and Alzheimer's often come together. So, I want to answer your actual question, which is like, where does Alzheimer's kind of fit into this world of age-related memory loss? So, think of dementia as our umbrella term. And a lot of things fit underneath that, including Alzheimer's, the most common form, but also frontotemporal dementia, posterior cortical atrophy, primary progressive aphasia. We've got LATE syndrome, we've got all these different types of dementia. And then there are Parkinson's associated memory loss and dementia. There's a bunch of neurodegenerative--
[00:12:35] Even macular degeneration is part of the nervous system. That's a degenerative disease of the nervous system, MS, there are a lot of things under this umbrella, and we're going to talk about ways that you can basically reverse that process, that neurodegenerative process. So, I'm not talking about a cure. This is always something that needs to be managed. When you get a urinary tract infection and you take some antibiotics, it goes away, you never have to think about it again. And you get pneumonia, take the antibiotics, goes away, you don't have to think about it. When it comes to managing neurodegenerative disease, it's a lifestyle we choose. And if we fall off that lifestyle, we often see the symptoms come back. It's not something where we never think about it again.
[00:13:16] All right, so these different neurodegenerative diseases, so the example of vascular dementia and Alzheimer's coming together, sometimes we see Lewy Body with Alzheimer's. So, they're often not clean and cut and dry. We want these black and white diagnoses, and that can be helpful. Particularly if we have like an amyloid angiopathy where there's an integrity lacking in the blood vessels, we don't want to give a bunch of fish oils that might put us at risk for a hemorrhagic stroke. But if we've got a really different thing going on, maybe if we have traumatic brain injury that's associated with high levels of inflammation, hey, we are thinking about high doses of fish oils. So, getting imaging to understand what's going on in the vascular system, maybe where it is affected, what part of the brain is affected? Is it language centers? Is it visual centers? Where is it that we are having an impact? And then what does the change look like over time?
[00:14:17] So seeing very well-trained provider who can order the right testing, who can understand what's going on, and then give us a yardstick for like p-Tau, p-Tau217 is a widely available Medicare covered lab blood test that you can get through a neurologist or a Bredesen-trained provider. And it gives us this measuring stick, where am I in this neurodegenerative process and what direction am I headed? Is that number getting better or is it getting worse? Just like we can do with neurocognitive testing.
Cynthia Thurlow: [00:14:45] I think that's really important because at the basis of all this, we clinicians like to measure things. And I think it's helpful for patients to have an objective perspective on what may be going on. And as someone who had a loved one who passed away last year, my stepmother was first diagnosed with vascular dementia, then ultimately Alzheimer's. And I know that we'll talk about how current treatments for Alzheimer's and many medication treatments are largely ineffective. But what I found really interesting, when I had to go through my father and my stepmother's home with my brother to organize things to donate, etc., I was able to see, to be witness to my stepmother, who was such a conscientious, organized person that as her cognitive status was declining, she started creating more and more notes and notepads for very simple things that normally she would not have had trouble doing. And to watch the evolution of these notepads. My dad and my stepmother were like notepad people. They had thousands of notepads. But I went through all of them to make sure there wasn't some nugget that I needed to keep for the family.
[00:15:56] And it went from like being organized about grandchildren's birthdays and Christmas gifts and receipts and things that are very normal down to how do I turn on the computer? How do I send an email? I mean, it was things that we take for granted that very clearly my dad was trying to help her organize her thoughts so she would know, “Okay, these are the five steps I need to do to send an email. These are the three things I need to do to turn the computer on and off.” And to me, it was so sad because she was very much aware of what was happening and even at the end of her life would say, “My brain doesn't work right.” She was aware of that enough and the distress that it caused.
[00:16:38] So, I think for so many of us that may be navigating the trajectory of a loved one's neurostatus and working with a neurologist or a functional medicine or a primary care provider, just knowing that there are diagnostic tests that are very helpful, there are lab work that is covered by conventional labs. I think that's something that many people struggle with, is that there are labs that are available, but maybe their practitioner is not ordering them. It's not in their kind of grab bag of offerings. And so, it's very helpful to know that there are things that are covered by insurance that are pretty straightforward that can be very helpful.
[00:17:13] Now, you mentioned there's different types of dementia, none all of which are actually Alzheimer's. And that's an important distinction. And not all of Alzheimer's is familial or genetic, and I think that's a common misconception is that, “Oh, my grandmother had Alzheimer's, so that means I'm at greater risk for Alzheimer's.” And it's my understanding that actually the bulk of Alzheimer's is actually not genetically mediated and certainly perhaps we can kind of differentiate. I think that in many instances, there are some things that can make us more susceptible but they are not per se, a given. If you have the ApoE4, that is for sure, like you are going to develop this unless you take action.
Dr. Heather Sandison: [00:17:55] So I think that we're learning a bit about that. So, ApoE, let's talk about that. But what I love to do is kind of put it into the context and a framework for how we're thinking about what causes Alzheimer's and dementia. So, I studied under Dr. Dale Bredesen, he's a mentor of mine, whom I have huge amount of respect for. He's really led the field in this and kind of been yelling into the wind for a long time about how important functional medicine and lifestyle medicine is to preventing, delaying and yes, even reversing the symptoms associated with Alzheimer's and dementia.
[00:18:26] So, when we think about this, I like to kind of go, okay, causal level. What is going to cause neurodegeneration in the brain? It's a complex system. So, like if I have houseplants behind me-- If I had a houseplant that was struggling, I wouldn't look at the houseplant and be like, “Oh, it must be misfolded proteins, it must be amyloid causing this houseplant to suffer.” And we would think like, “Is it getting enough sun? Is it getting enough water? Is it getting enough nutrients? Oh, is it being poisoned? what is going on in this dynamic system where this living organism is not getting enough to thrive or getting the wrong thing that's causing it to degenerate.” So, same thing with the brain, it's simple, it's common sense, it's just uncommon practice because our scientific model has gotten into this paradigm of like we need a single molecule intervention so that it can be patented and delivered in a seven-minute visit with our provider.
[00:19:20] And so the science is not sophisticated enough to meet the complexity of the disease. And so, what we want to do is be good scientists, take that step back and say, what are all of the causal level pieces that will cause imbalance? Too much, too little, in the wrong place or at the wrong time in the brain and we can extrapolate this. Any complex system, government systems or financial systems, or education systems, any complex system, when you have imbalance in it it's going to be dysregulated. Same thing in the brain.
[00:19:52] So, when we come to the brain, I would argue that there's basically six causal level imbalances that are going to lead to neurodegeneration. And one of those is structure, which includes molecular structure, which includes our genetics, so that's one thing. But these things-- remember these six things, we'll go through them, they are not mutually exclusive. So, you can have a genetic predisposition structurally. And then another structural thing is vascular dementia. We've already discussed, its sleep apnea, it's traumatic brain injuries. Being hit over the head with a baseball bat is not good for your cognition. And then we have--
[00:20:25] So, let's go through all of them. We have toxins, I measure toxins including heavy metals, chemical toxins, and then also mycotoxins associated with molds or water-damaged buildings. And we can have too much of those, they can be in the wrong place. We also have metabolic toxins. We've already talked about hormones and how hormones can accumulate and throw things off. You can also have-- A good thing can become toxic, that takes us to nutrients.
[00:20:51] Glucose become very toxic. Sometimes you'll hear Alzheimer's called type 3 diabetes because high levels of glucose and insulin resistance can lead to inflammation, but they can also lead to neurodegeneration and a lack of resource of the brain. So, our brain is only 2% of body weight, but uses 20% of energy expenditure. And if we can't turn efficiently and effectively glucose into ATP that fuel our cells run on, then we have a resource deficit. We have an energy deficit in the brain, a very, very energy hungry organ. So, just flipping the switch into ketosis using intermittent fasting, that can help with cognition profoundly and quickly, but that's macro nutrients. So nutrient balance at a macro level is thinking about our carbs, which is glucose. Carbohydrates, fats and proteins.
[00:21:39] But at a micro level, a quick and dirty example is homocysteine. Homocysteine is-- Elevated levels of homocysteine are associated with too few B vitamins, methylated B vitamins. So, adding methyl B12, methyl B9 or folate and B6 can help bring that down very quickly. Adding other methyl donors helps too. And elevated levels of homocysteine are associated with increased rates. So faster atrophy or shrinkage of the brain. And so we want to get ahead of that, that's a micronutrient that we're talking about, so we want balance. And one person's homocysteine is going to be really high, whereas another's won't, even if they're getting the same amount of B vitamins because a lot of that does depend on our genetics, how likely we are to accumulate this. Now, that's one quick example. But we have that throughout the body in terms of minerals and ratios of minerals and of course our other B vitamins and antioxidants.
[00:22:35] So, toxins, nutrients, structure we touched on really briefly, but we're talking again, macro structure, which is the airway. Are the pipes open? Can we get blood flow in and out of the brain? Can we get air into the lungs and oxygen to deliver to the brain? And then macro structure also is this traumatic brain injuries. Chronic pain, if I have chronic sciatica because my nerve is being impinged, then that's going to cause chronic pain that can keep me from getting the movement that I need. That will impact dementia. It's also going to increase stress and stress can increase cortisol, which can bathe the brain to the degree that it again becomes toxic and shrinks the hippocampus.
[00:23:19] So, macro structure and then our molecular structure, this is our ApoE. So, bear with me here. I'm going to break down ApoE real quick for everyone because this is A-P-O-E as an elephant, so A as an apple, P as in Paul or Peter, O as in orangutan, and E as an elephant. So, ApoE, now you get one from mom and one from dad. So, you have two copies. And these copies can be, we give them numbers, 2, 3 or 4. So, there's no ApoE1, there's no ApoE5. It's 2, 3, or 4. Most people are ApoE 3, that's the most common. And again, you get two. So, a lot of people are ApoE3/3. I'm a 3/3. Very grateful to be that. You are as well, great. So, this is not associated with any increased risk of dementia.
[00:24:07] Now, the general population has a 13% chance of being diagnosed with dementia throughout our life. So, if you just forget genetics, anyone walking around in the world, 13% chance of getting dementia. If we have one copy of ApoE from mom or dad. So, say we're a 3/4, we about a 30% risk of developing dementia as we age. Now, that means 70% of people with ApoE4 with one copy, never get Alzheimer's or dementia. So, those are pretty good odds.
[00:24:35] And what we want to do, this whole conversation is about how do we shift those odds towards 90% that we don't get dementia, prevent, delay, and then even reverse those stages of cognitive decline. Now, somebody who's ApoE4/4 who got an ApoE from mom and dad, there are differing opinions about out there, but there was a Nature paper recently that said “Essentially you will inevitably get Alzheimer's at some point in your life.” So, we want to be very proactive. So, if somebody is ApoE4/4. I used to have patients who would say 10 years ago, “I don't want to know because it's just going to give me anxiety, it's going to keep me from sleeping and that's going to be detrimental to my health.” And I kind of got where they were coming from.
[00:25:14] At this stage in my career understanding what I know about how much we can do to prevent and delay and reverse cognitive decline as we age. I want people finding out in their 20s, because you can make different decisions about shift work, about exercise, about alcohol consumption, about so many things. And so ApoE status and understanding where yours is, I think is really empowering information.
[00:25:43] So, we've talked about a little bit about toxins, nutrients, structure, now stressors. So, stress, balance, you want purpose and meaning, but we don't want decompensation from too much stress. We want exercise. We want to push the muscles and push our heart, get that cardio and that strength training exercise. We want to push ourselves cognitively, we want that purpose, meaning, connection and relationships are so important, but we don't want to have so much stress that again, that cortisol becomes toxic.
[00:26:10] Caregiving, being a care partner for someone who is struggling with dementia increases our risk of developing dementia by anywhere from two and a half to six times compared to those who never serve as a caregiver. So, the stress associated with caregiving is very impactful. And again, when I'm talking to a patient, the care partner is also a patient. I'm also thinking about them because we really need to-- Just like that 20-year-old with ApoE4/4, we need to get really proactive because of that increase in risk.
[00:26:43] So, toxins, nutrients, structure, stress, infections. There are a handful of infections that lead more directly to neurodegeneration, neuroinflammation and amyloid. So, we think of amyloid as this cause of Alzheimer's and there's a lot of controversy around that right now and fraud and craziness and the arrogance in the research community around this amyloid hypothesis and this amyloid mafia that's really pushed that hard for a long time and prevented us from expanding our understanding of the disease in some ways. And so amyloid is absolutely associated with Alzheimer's. How causal it is? Amyloid is there to protect us, it's antimicrobial. So, we often see inside in autopsies of people with Alzheimer's-- who have passed from Alzheimer's, inside the amyloid plaques there will be herpes viruses, there will be Lyme spirochetes, there will be the P. gingivalis or the bacteria associated with gingivitis will be in those plaques because the brain has developed this path, this protection system that includes amyloid as part of the inflammatory system, as part of the immune response in the brain. And so, we want to keep those infections under control and down. We want really good dental hygiene. We want to know if we've been bit by a tick and exposed to Lyme or vector borne diseases. And we also want to be really proactive about treating herpes viruses.
[00:28:09] We saw there was a recent article just last week about the shingles vaccine preventing-- basically reducing your risk of developing Alzheimer's by 20%, which is a lot over seven years. If of all of the vaccines out there, and I know there's a lot of people with differing opinions on vaccines, the shingles vaccine is one that I do recommend, particularly if you have risk for other reasons.
[00:28:36] Now the last piece, toxins, nutrients, stressors, structure. We talked about infections just now and Covid, I would put Covid in there as well, although it's a very different mechanism. And then the last is signaling. So, you talked about estrogen and the importance of sex hormone signaling. So, estrogen, progesterone, testosterone, DHEA, pregnenolone, it's all in that sex hormone category. And these signal-- Think back to your 20s, when our hormones are just peaking, that's when we're learning, we're making social connections, we're learning skills, we're in school. Our brain is just absolutely ripe for synaptogenesis, for making these connections, and part of that is that hormonal signaling.
[00:29:17] Now we don't want to miss BDNF, brain-derived neurotrophic factor. It's another signal, thyroid hormone. There are lots of signals that we can send to the brain just getting that engagement sense signals. Getting into that rest, digest, and heal state into that parasympathetic signaling helps us to learn more, helps us to remember more. So, thinking through this signaling. Light, light is a signal, getting that circadian rhythm back on board. So, there's lots of different signals, peptides, stem cells, exosomes. There's a lot that we could go into here that's sort of on the frontier, but definitely things that we want to keep in mind in our entire repertoire of making sure that our brain is optimally functioning as we age.
Cynthia Thurlow: [00:29:59] Well, and I think you did such a beautiful job of kind of giving an overview of these six tenets and then differentiating between ApoE, because I think a lot of people are fearful, as you said, some people just don't want to know. I tend to be a-- I'd rather be proactive than reactive. I was encouraging family members to get tested, and I said, I think for me, knowing that I don't have two copies of ApoE4 was helpful because I have other genetic peculiarities that are unique to me. And I said, it's just one less thing I have to worry about. It doesn't mean I am not concerned, conscientious about being proactive about lessening my risk of cognitive decline.
[00:30:38] One thing that I thought would be really interesting, and for me, being a clinician myself, there are limitations to the current approaches for Alzheimer's treatment, and you were talking around one of them. A lot of it, seemingly, from my perspective, is that the current research model is problematic. Meaning that when we are just looking at one pharmaceutical agent with one intervention, it's not accounting for the plethora of lifestyle pieces that really do impact our cognition over time.
[00:31:17] I would love to talk about some of the research limitations as well as some of the missteps. You were talking about this amyloid focus, and there was a book that just came out earlier this year called Undoctored. And I'm really looking forward to interviewing that investigative journalist because he's speaking to this specifically, why we've gotten frankly focused one etiology of Alzheimer's, and there's a lot of other contributory issues, as I know, you know. Let's talk about the research piece because I think this has impacted our ability to move forward. I think there's also this piece of the medication that has come out from some of these trials has largely been ineffective. And I know this personally from watching what my stepmother went through over the last 10 or 15 years as well.
Dr. Heather Sandison: [00:31:59] Yeah. Charles Piller is the investigative journalist of Doctored he-- That I read it in a weekend because I'm an Alzheimer's nerd. And there's also one called How Not to Study a Disease, the Story of Alzheimer's by Karl Herrup. And I think that the reason of this conversation, I don't want to spend a ton of our time talking about this because it's not the what to do, but I think it helps to put us into context of like how did we get here? What happened? People have spent, we taxpayers, we have spent billions of dollars trying to solve this problem and countless, like careers trying to solve this problem, super, super smart people. And where did we make that wrong turn? Like what happened?
[00:32:48] And so I think that it's important to kind of understand. So, if Alzheimer's is that word that puts the fear of God in us, but if you talk to a doctor from the 1970s, they're like, “Wasn't that called senile dementia? Like what's going on here?” So amyloid, all of us, whether we're 2 years old or 102 years old, have some amyloid. Amyloid is a natural process. We develop amyloid and then we clear it. One night of sleep deprivation will increase amyloid in people in their 20s, 30s and 40s in just one night in cerebral spinal fluid. So amyloid is present in all of us. It's part of the brain's defense mechanism, but we need to clear it. And when it's accumulating, certainly it can turn into plaques. And this is associated with age-related memory loss, but you have centenarians with perfect cognition who have tons of amyloid and have perfect cognition. So, it's not the entire story.
[00:33:39] However, for a long time there was a culture in Alzheimer's research that if you weren't studying amyloid, you weren't studying Alzheimer's. And so, we got pigeonholed in this hypothesis and there were powers that beat in that field who published fraudulent research. And around 2006 when sort of the industry, the community studying Alzheimer's was really starting to look for new hypotheses and abandoning or turning away from this commitment to amyloid, there was a paper published that connected cognition with amyloid. And unfortunately, it was all based on Doctored research. And it's really heartbreaking because that paper was cited over 2000 times and it was used to justify many, many research dollars later on.
[00:34:32] So again, it's this paradigm that we live in of the single intervention, the randomized control trial, the limit of all the variables, and where we end up is with medications that don't work very well. So, what we need, I would argue is an intervention that's individualized and precise and complex, yes. Because it's a complex disease with multiple reasons, with multiple whys, with multiple causes. There is not one cause of this disease. And so, we can't have this simple single molecule intervention. It's just not going to work. And maybe, I hope they figure it out. Like, I will be the first to tell you, if there's an IV or a medication that you can take that will reverse or cure this disease, I want nothing else in the suffering associated with this awful disease to go away.
[00:35:21] So, what are the medications currently out there? So, there's Aricept and Namenda. They work on acetylcholine and then glutamate. And there's also galantamine is one that includes nicotinic receptors. So, these medications are out there. I'm going to talk about Aricept and Namenda real quick because there was a 2019 study that said essentially that taking those five years later, if you decide to take them, you're worse off than if you decided to never take them. So, this is really unfortunate. Do not stop these medications. So again, big red warning light here. Do not adjust your medication doses without talking to your provider. Do not stop these medications. So, my recommendation is, read the paper, ask your provider. It’s in JAMA, The Journal of the American Medical Association from, I think January 2019. And if your provider says, “Yeah, I agree, they don't really work that well. You don't have to take them.” That's probably-- For most people, that's probably the right decision. Don't start them. I don't tend to start people on them.
[00:36:22] But if someone is already on them, these are medications that affect our neurotransmitters. And just like coming off of a benzodiazepine, just like coming off of an SSRI, just like changing our relationship with alcohol, these are stressful. It is stressful to the brain to change the doses of these medications or to stop them. And what I have seen several times, heartbreakingly, is that people who will hear on a podcast, “Oh, those medications don't work.” They'll stop them. And then they'll go through cognitive impairment and decline, rapid decline, that is very hard to recover from. So, super stable-- keep that dose super stable. I don't typically recommend to my patients that they increase it. I don't typically recommend that they start it, but do not stop it.
[00:37:07] Now the antibody therapies, so this is Leqembi is out there, lecanemab, there's a couple of them still on the market. One of them, Aduhelm, aducanumab came off the market. These are IV therapies and as we get more of them on the market, you need fear of them and maybe you don't need them as long. The challenge with these medications is what they do is they slow the rate of decline so you don't actually get better. The expectation is not that someone improves, it's that they draw out this torturous process and the cost of that is very high. So, both the risk is brain bleeding and brain swelling. And the risk is highest in women who are ApoE4 positive.
[00:37:57] So, the people who have the highest risk-- women are two thirds of Alzheimer's patients. The people who have the highest risk of developing this disease are not candidates for this intervention because the risk of brain swelling and brain bleeding and death is too high. And then the other issue is that they are very costly, they're very, very expensive. You need to be within a certain radius of a major medical hospital because you have to be assessed for these side effects, the brain bleeding and swelling, so, you need to be getting regular MRIs and you need to be able to get the IVs and they need to be able to treat the side effects that they come up, so you can't be in a rural area that reduces your eligibility. So, there are a lot of constraints and the upside is not that high.
[00:38:43] My hope is that over time these will improve, that these medications will really add a lot of value. But the contrast to that, what we've seen in our research. So, I had the privilege of doing a clinical trial in my office. It was just 23 participants, but we took 23 people with cognitive impairment with MoCA scores. So MoCA is the Montreal Cognitive Assessment. This is a one-page PDF that it needs to be administered by someone who's trained to do a MoCA that you can assess, we can get, it's a blunt instrument, but it tells us if you have cognitive impairment.
[00:39:19] So, it's out of 30. Again, it's one page. You identify zoo animals, copy a clock, tell us where you are in time and space, do some math, and if your score is 26 and above, that's normal as we go towards zero, that indicates progression of the disease state. So, we recruited these participants between 12 and 23. So they had measurable cognitive impairment. And we did not exclude people who were diagnosed with Alzheimer's. What we saw was that after six months of this Bredesen intervention, 74% of them improved. So, we published that in the Journal of Alzheimer's disease in 2023-- August of 2023. And that was the second paper, very similar. So, there was one the year before in July of 2022, led by Kat Toups, they published a very similar trial. They had a nine-month intervention where we had a six-month intervention. They had 25 participants and their MoCA scores were 18 and above. So, they were not as progressed and they had nine months and 84% of them improved.
[00:40:20] So, most people who take on this intervention improve. Now, it's not necessarily that they're going back to work and they're 100% better. But the reason I get out of bed in the morning, Cynthia is because I've had enough people tell me at work I got my mom back, she's back, she's herself again. And that, I mean, it's miraculous. It's amazing, that is why I am here, just telling as many people as will listen, because I think that this, I was told you could do nothing about this disease. I am terrified of it, but there is-- Not only is there nothing you can do, even though the medications don't work, there's an overwhelming amount that we can do to enhance our cognitive function as we age.
[00:41:01] So yeah, the pharmaceuticals don't work that well, but the research, there is research. Now because we can't patent this. We can't get billions of dollars from a pharmaceutical startup because you can't limit the variables. This is not about limiting variables. This is about throwing everything at Brain Health. Dr. Dean Ornish-- So, there's not just one way to do this. I'm a proponent for diet wise of a ketogenic diet and we do some intermittent fasting with that as long as we're not at risk for frailty. Dr. Dean Ornish did a four-month intervention with 70 participants. And this was the first randomized controlled trial. It was published in June of 2024. And in that they actually used a vegan diet. So, they did support groups, so stress management. They used a plant-based diet. They did exercise. They had supplements. And in this randomized controlled trial, they saw that people with early Alzheimer's and mild cognitive impairment improved compared to—the intervention group compared to the control group improved. So, this was really exciting.
[00:42:01] So, I've done research in my clinical practice. Dr. Bredesen has done it through multiple clinicians. They're actually collecting data on another randomized controlled trial that should be published in the next 12 months. And, it's a really exciting time. Like even though there isn't a medical intervention that's super-- Like a conventional pharmaceutical intervention, that's really helpful, there is so much hope. There is research, like, don't let anybody tell you there isn't research, it is out there. And the side effects of this intervention are that your diabetes resolves, your hypertension gets better, that your mood is better, your sleep improves. And it's so fun to watch people come in with this long list of polypharmacy of all this stuff they're on. And then as they get the exercise, as they start eating the great foods, as they engage cognitively and things that they enjoy, all of a sudden life is better and they can get off some of those medications.
Cynthia Thurlow: [00:42:54] Well, your enthusiasm is truly infectious. And thank you for giving us kind of a gestalt to some of the conventional treatment options and limitations to those specifically, but also speaking to the fact that lifestyle is so critically important. And obviously my community is familiarized with low-carb ketogenic diets, but it really speaks to the value of lifestyle, and this is not sexy. This is not, “I take a pill and it makes me better. And I think that--” I will sometimes say to patients myself that “I wish I just had a magic wand. And I could say, yes, HRT is going to fix it all,” but lifestyle is foundation.
[00:43:35] And so, when we're looking at solutions and things that are important. When I was rereading your book, things that stood out to me, that I was sitting at our kitchen isle and saying to my husband, “Okay, these are the things that we need to be thinking about.” Let's talk about why it is so important to have a brain nurturing environment to do specific skills and to engage with the brain in a way that we are learning, we are being creative, how that impacts the trajectory of cognition patterns over time.
Dr. Heather Sandison: [00:44:05] Yeah. So with environment, there's two things I think about. One is, “Am I in a toxic environment? Is there something coming in that is going to affect my brain?” And so, mold. Mold is what comes up here most often, but also chemicals, Glade PlugIns. And you don't need that stuff. Dryer sheets, like you just don't need that stuff. It's adding more chemicals to the system. And the scents, unnatural scents, they go through our olfactory nerve, they go into our brain and they actually put us in a fight-flight freeze state, they're toxic.
[00:44:35] So, thinking about toxins and can I reduce my exposure to them? Sometimes it's as simple as opening doors and windows. Not wearing your shoes, not tracking glyphosate in from the sidewalks or petrochemicals from the parking lot. Taking your shoes off at the door. Again, opening doors and windows or maybe it's running an air filter. They don't pay me to say this, but IQAir, the GC multi from IQAir, it's a great white noise machine to run in your bedroom at night, but also to just run in your home 24 hours a day, seven days a week. Indoor air quality is much worse than outdoor air quality because our flooring is off gassing, our furniture is off gassing. There's just junk that accumulates in a contained space, but the solution to pollution is dilution, so getting that fresh air, whether it's going outside or again, opening doors and windows, we can reduce that.
[00:45:24] The other concept I want to present when it comes to environment, I think we can all relate to at some level, but it's a matter of taking action. So, James Clear, you know, he talks about habits, atomic habits. I'm sure most people have read it. And I like to give this example from my own life of TV. I was just at my mom's house for a couple of weeks for my daughter's spring break, and she has a TV front and center in her living room. It's like in the great room. And so, the dining room table isn't far from the TV. And if you sit on the couch, what you look at is the TV and it's just always there, and so it's really easy-- and the remote is right there. It's really easy to go from dinner to just like sitting down on the couch and turning the TV on.
[00:46:08] Whereas in my house, in the last two homes I've lived in, we've intentionally set it up so that the TV is hard to get to. So, in our great room, my daughter has a stack of coloring books. She's got colored pencils and crayons, and there's books all over the place. And it's really easy to go from dinner to sitting down on the couch and picking up a book or starting to color or doing a little art project. She's got her knitting and all her little things there and we'll do that together. Whereas at my mom's house we would just turn the TV on. And I don't even like to watch that much. There's not really that much that's out there and I don't want her watching it. I actively avoid this kind of thing, but when it's set up so that it's very easy, like basically the path of least resistance when you're tired at the end of the day you, that's what you do.
[00:46:55] In my previous home, we had a TV to watch things that would come up that we were interested in, but we actually kept it in a closet. And you had to go to the garage and like get the extension cord. You had to like make a- clear a space, whether it was on the countertop or on the coffee table or wherever we're going to put it, there wasn't space for, we didn't have it attached like above the fireplace. So, there wasn't space for it on the mantel. So, you had to like figure out “Where am I going to put this? And okay, is the Wi-Fi going to be good enough and do I have the power cord?” It took so much effort to get the TV out that we never did it. And so, this is just a classic example of how do we create an environment so that it enhances the habits we want to enhance and it makes it harder for us to do the things that we know aren't good for us whether or not we have ice cream in the freezer. If ice cream is in our environment, it's much more likely that we're going to consume it. If it's just not there, we probably won't.
[00:47:56] If we have our-- if there's an exercise machine or a yoga mat between, like where we pass by it, we see it constantly, we're much more likely to use it. So, it's kind of putting the things in your way that you want to engage in and then putting the things that you've thought through. And part of this is taking the time say, “Hey, what is it that helps and enhances my brain health and what doesn't? What am I willing to give up? What am I willing to let go?” Because this is a full-time job. A brain healthy lifestyle is not something that happens overnight. And you can just do one thing at a time. It's not about taking all of this tonight or being perfect about it. It's a practice and it's coming back to it. It's me going to my mom's and acknowledging, “Gosh, we've watched way too much TV and ate way too much sugar. What are we going to do now? What are we going to do differently? How do we want to live the next phase of life?” And those are-- I would encourage you to just take a minute right now, like, “Okay, how am I going to implement?” All this stuff is doable. I see it even with people who have cognitive impairment, but it's hard for people even with perfect cognition. What it takes, though, is implementation. It doesn't work if you don't do it.
Cynthia Thurlow: [00:49:04] Yeah, absolutely. And I love that you're so conscientious about making the TV as inaccessible as possible. It's funny, there was a time probably 10 years ago where we decided not to have a TV in our bedroom anymore. And TV is something that's downstairs. There's a specific reason if the TV is on, admittedly, we've been watching White Lotus, which is probably the same as everyone else. Otherwise, I don't watch a lot of TV, but that is Ben, and admittedly Pitt, because I'm a former ER nurse. And so, for me, that just lights me up because it's the most realistic medical drama I've ever watched. But I think in so many instances, TV becomes white noise. People have TV on all the time. They think about as being so benign.
[00:49:47] I remember years and years and years, I would have the news on in the morning, pre pandemic. I would have the news on the morning just to get caught up, but it becomes this white noise, and we don't realize that in many instances, it's not serving us. Well, how many of my patients would tell me, oh, their husband, significant other, watches TV until midnight, so they have like this ambient noise, and the light from the TV, and the noise from the TV going on, that has become their norm. And so, you're right, we have choices. And certainly, environment is really important.
[00:50:19] Mold and mycotoxins is something that has been on my radar because there are 25% of us are more sensitive to mold and mycotoxins than other people are. And so, for that reason, I think being conscientious, if you know you're part of that 25% of us, like I am, there's a lot that we do in our very human state to mitigate that. What I would love to do, because I could spend quite a bit of time continuing this conversation, is bring you back, if you are open to doing that, so we can continue talking about the lifestyle piece. Because I think that this is like having a mini masterclass in brain health, cognition reduction, and the likelihood that we will transition into neurocognitive issues. If you're open to that, I would love to bring you back and talk more about your work and your book. And your enthusiasm for all of this is truly infectious.
Dr. Heather Sandison: [00:51:12] There is not an easy way to, I think, impart all of this at once. So, thank you. It's a lot, but I think instead of becoming overwhelmed, thinking of it as empowering and saying, “Okay, if I can do one thing today that's super simple I one thing that I picked up from this conversation, what can I do to enhance my cognitive function, my brain health as I age?” And for some people, it's like, “Oh, I heard that really hard thing, but I know it's going to make a huge difference.”
[00:51:43] So we usually recommend in our coaching is choose one thing. It might be that big thing and like, today is the day I commit to it, or it might be that small win that we need that is going to help build that dopamine hit of success, and then we're going to be able to build on that. So, I just encourage everyone to take a moment right now to commit to changing one thing to enhance your brain health. I'm noticing that my tongue has been green our entire conversation because I had my matcha. [Cynthia laughs] Sometimes it's just switching from coffee to matcha. Something that's a little bit better for our cognitive function or adding a powder of Lion's Mane or collagen or something that's going to be good for our brain in our morning drink, even if it is coffee.
[00:52:30] So, thank you so much, Cynthia. Absolutely. I'd love to be back anytime. I'm so grateful for the work that you're doing and inspiring women our age to live healthier lives. It's just really wonderful and helpful and there's so much value in it. So, thank you, thank you, thank you for having me.
Cynthia Thurlow: [00:52:45] Yeah, absolutely. I look forward to continuing the conversation.
Dr. Heather Sandison: [00:52:47] Same.
Cynthia Thurlow: [00:52:51] If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.