Alzheimer’s Toolkit for Midlife: Empower Your Brain Health – with Dr. Heather Sandison

Dr. Mindy  

Heather on this episode of The Resetter podcast, I bring you dr Heather Sandison now this is another gem of a conversation for those of you that are either worried about dementia and Alzheimer’s and memory loss in your own life, or those of you that are dealing with a parent that has dementia and Alzheimer’s. And let me give you a little bit of a background on Dr Sandison and what you’re going to hear in this conversation, because I think there’s a lot for all of us to learn in what Dr Sandison is teaching. So for starters, she’s a New York Times best selling author, and her book reversing Alzheimer’s just came out. I can tell you I will be buying it, because, as you’ll hear in this conversation, it’s something that we can actually give caregivers. If you have an aging parent there they she actually speaks directly to that caregiver that is taking you know, that is feeding your parent and looking after your parent. What’s really cool is she’s created this new toolkit to not only help us improve cognition and protect brain health, but again, she is also trying to change the cultural conversation around Alzheimer’s. And she studied under Dr Dale Bredesen, who I have brought him on to this podcast, and you know, with his teachings, her experience and this new book, it’s really becoming clear that Alzheimer’s is optional. So what you’re going to hear in this specific conversation is not only the toolbox. You’re not only going to hear this new toolbox that she has and she goes through six different things that we can be doing in our life to really make sure that we keep our cognition at its best. But then in the back half of the conversation, we went into ketones and ketosis. And where does that fit in to stopping Alzheimer’s? Of course, this is one that’s near and dear to my heart, because I have witnessed over and over and over again in our community, when you put a 60 year old, a 70 year old, an 80 year old, into ketosis, you get their brain back, and it is really a quick, quick way into better cognition. So I wanted to understand from a science level. I wanted to understand like, how do we actually get an aging parent into ketosis? When do we need to be start thinking about ketosis in our own life, so we can get that neuro protective benefit from ketones. If you wanted to know anything from fasting to low carb dieting to the power of a ketone on a person’s brain, this is absolutely the conversation for you. And you know, with aging parents, the interesting part of that is we have other resources outside of just fasting them. We talk about exogenous ketones, and what is, can they actually take a supplement and get those ketones in in a new way without having to change diet? So there’s so much here that I hope will not only be beneficial to you, but also be beneficial to an aging parent that you might be taking care of. So incredible toolbox on Alzheimer’s, incredible resource, and I’m so excited to bring you dr Heather Sandison,

 

Dr. Mindy  

Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again, if you have a passion for learning, if you’re looking to be in control of your health and take your power back, this is the podcast for you.

 

Dr. Mindy  

Let’s start the conversation bus just by welcoming you to the Resetter Podcast. I’m so happy you’re here.

 

Dr. Sandison  

Well, thank you so much for having me. Mindy. It’s a pleasure to be here. Yeah. So

 

Dr. Mindy  

I always like to teach from humanity. I feel like we’re, you know, we’re all swimming in this life together, and we’re all have similar, similar issues that we’re dealing with, and I think a lot of people are, in my shoes right now, in their 50s, trying to figure out how to take care of aging parents, and are also trying to make sure that we don’t get dementia and Alzheimer’s. So where I’d like to start this conversation is from the place of what are the early signs like I’m going to start from my 54 year old lens. What are the early signs of dementia and Alzheimer’s that I should be concerned about?

 

Dr. Sandison  

So the first sign many people tell me about is an inability to come up.

 

Dr. Sandison  

With words, especially nouns or names, and also this feeling of overwhelm, of Oh, 10 years ago, I would have planned that trip to Europe, and it would have been no problem, or I would have hosted that Thanksgiving dinner for 25 people, and it would have been a non issue. But now that feels so overwhelming I can’t wrap my head around it, or I’m getting confused, and it just feels like it’ll take too much energy for me to pull off something I used to be able to do. So those are some early signs, but those symptoms Mindy, they don’t show up until decades, often after the pathophysiological process starts happening in the brain. And so what that means is that there’s this really empowering time for 1020, years where we can do things to optimize our cognitive function so that at the very least, we delay and prevent that from happening, and sometimes we can even reverse that. In fact, oftentimes we can reverse those early signs, and even in late stage dementia, we can get some improvements. Now, none of this is a cure, right? You have to stay on the program long term in terms of diet, exercise, lifestyle interventions. But there is so much hope for this disease. And when it comes to aging parents, many of them are stuck in that. You know, Medicine of the 1980s and maybe 90s, the doctor is the penultimate they know best, and they’re gonna tell me what to do, and they’re gonna have this cure for me that comes in the form of a pill or an IV, maybe, and that’s gonna solve my problem. The science is gonna catch up, right? This promise of Better Living Through Chemistry and all of those messages that our parents were told, they still hang on to that. And then when they go to the neurologist, and they’re they’re told, sorry, there really isn’t a medication that can help. There isn’t much that we can do. Go ahead and put your affairs in order. Sorry, I’ve probably got to take away your driver’s license. I’ll see you in six to 12 months, and we’ll measure the decline. That is heartbreaking, and they take it as gospel, and unfortunately, it’s factually inaccurate that there’s nothing we can do for dementia and Alzheimer’s. In fact, there’s almost an overwhelming amount that we can do, and getting strategic about it and getting organized about it so that we can help to our aging parents who might be starting to suffer, and then also, most importantly, help ourselves so that we can prevent, you know, our kids from bearing the burden of caring, from us caring for us later. Yeah, it’s a really interesting time of life, because I feel like I my kids are 24 and 22 so they’re they’re off doing their adulting, and for the first time, I have freedom, and now I’m looking at my parents and really having to parent them and so and then in the parenting of them, I’ve been thinking a lot about, how do I make sure my parents are 8085

 

Dr. Mindy  

and 88 and I’m like, How do I make sure I don’t end up like that? So it’s like a really weird juxtaposition of, like, you’re caring for them, and at the same time, you’re like, how do I not end up here? So can we start with this thought of, what’s the difference between dementia and Alzheimer’s? And just so we’re clear on that, and what like right now in my 50, you know, almost 5050, year, what do I need to know about my lifestyle now so I don’t end up with dementia and Alzheimer’s, like, Are there foods I can eat differently right now, foods I should be avoiding right now? And you know, what’s that difference? Because I think dementia and Alzheimer’s just gets thrown out all the time as sort of mixed together. Is there a difference? Yeah,

 

Dr. Sandison  

so dementia is the umbrella term, and underneath that is Alzheimer’s dementia, which is a it’s a type of dementia, right? Dementia is memory loss associated with aging, and Lewy body dementia, which Robin Williams had, Frontotemporal dementia, which Bruce Willis was diagnosed with earlier this year. These are other types of dementia. Vascular dementia is another form, so there’s many of them, and there’s a lot of overlap between them, so somebody with Lewy Body pathology often has amyloid pathology. So Alzheimer’s disease is characterized by beta amyloid plaques and tau proteins that are misfolded and they create these tangles, and so these changes in the brain structure, essentially, are what typically characterizes Alzheimer’s disease. Now that being said, there’s a lot of confusion even among neurologists when they’re everybody has amyloid plaque, except for 2% of the population when you this was a 2011 study showed that if you take all of the people of the planet, essentially from babies to centenarians, only 2% of the population does not have amyloid. So we all create amyloid. In fact, amyloid is there to protect us. It’s antimicrobial, so it we pull that trigger when there’s toxins or infections that create some inflammation in the brain that promotes the production of amyloid. When we don’t get restful sleep, we don’t clear. The amyloid, so then it accumulates in the brain. And so there’s lots of things that we can do to reduce the production of amyloid, but knowing that, you know, the even though Alzheimer’s is kind of characterized by this, when we get rid of amyloid, we don’t get better cognition. And part of that is this paradigm, right? This one pill for an ill that, if right of Yeah, if we get the one killed for

 

Dr. Mindy  

an ill it’s not a it’s not a helpful it’s not a helpful mechanism when it comes to health care well,

 

Dr. Sandison  

and it doesn’t work. And we’ve spent so much time and money putting effort towards this as a society, right, our taxpayer dollars goes into funding these, these potential cures. And when we get rid of amyloid, we see that we can, we’re good at that. We can get rid of the amyloid, but it doesn’t improve cognitive function, which is where the rubber meets the road. That is what we care about as we age, and if we’re worried about developing dementia. So what can we do? Right? If Alzheimer’s is the most common form of dementia, it’s associated with these amyloid plaques. But that’s not the whole story, right? Because there are people who are centenarians, who have plenty of amyloid plaque but have good cognition. There are people without amyloid who have been diagnosed with Alzheimer’s, then the testing and diagnosis are getting better, but what we really care about is cognition as we age. And so how do we optimize for that? Well, we can go upstream of the amyloid and we can start applying a different paradigm, a complex system science paradigm, to neurodegeneration. Now whatever the diagnosis of dementia is, whether it’s Lewy body, or vascular dementia, or Frontotemporal dementia or Alzheimer’s, we can say what we want to do is improve the health of every neuron, of every cell in the brain and the connections between them. So when we think through that, you know, I have a house plant behind me, right? If we were to see a house plant that was suffering, we wouldn’t look at it and go, Oh, misfolded proteins. We should get rid of those. And the plant alive, right? We would think, is it getting enough water? Is it getting enough light? Is it getting enough does it have too much water, right? Does it have toxins, potentially? Is it? Does it have nutrients in the soil? And if we apply the same concept simple, and if we’re systematic about how we apply these concepts to the brain, we can think through the causal level issues that might potentially trigger amyloid or Lewy Body pathology or tau pathology. And when we turn that off, we get better neuronal function. So

 

Dr. Mindy  

is there a checklist we can lean into? I, you know, I geek out on neurons. I love neurons, and I there’s just so many. There’s so much going on in the connection between the dendrites and the neurotransmitters and then the toxins that can get stuck in there like you could, you can spend your whole life, obviously you have really understanding neuronal health. But is there like a checklist of like, here are the five things you want to do every day. Six. Great. Tell me what they are. So

 

Dr. Sandison  

what I actually start with is this framework, right the six components of brain health. If there is imbalance in any of these six factors, then we are going to get downstream dysregulation, right? So we want balance the right amounts at the right time, in the right place, of toxins, right? We’re gonna get toxins in our brain. That’s just part of living on earth today, and it’s part of cellular metabolism. There’s waste, and so we need to be able to get rid of that. So toxins, the right amounts in the right place at the right time, nutrients, again, you talk a lot about fasting and metabolism and how crucially this, how crucially important this is, not just for brain health, but right for bone health, for healthy metabol rate, for cancer prevention, for diabetes prevention, for heart health optimization, we need to be aware of our metabolism and our nutrients right at a macro level, in terms of carbohydrates, fats and proteins, but also at that micronutrient level, do we have enough minerals? Do we have enough B vitamins? Do we have enough antioxidants in order for cells to be optimally functioning? Because that’s what we’re looking for, is optimization. And then third, we want to look at stress, right? Many people, people in your position, right, where we’re considering being a caregiver, caregivers for someone with dementia anywhere from two and a half to six times more likely to be diagnosed with dementia later in their lives compared to those who never serve as caregivers. Oh, wow.

 

Dr. Mindy  

Wait. So wait, wait, stop for a second. So that means now, at almost 55, years old, as I’m caring for my parents, definitely the stress has gone up, and that’s leading me to the path potentially, of what I’m caring for my parents for. That’s precisely, right? And this is terrifying when you see spouses caring for each other, right? Like if your mom was to serve as the primary care partner for your dad, that can put a very high burden on her, especially as if he becomes unable to keep his circadian rhythm as the disease progresses and he’s awake at night now it’s interrupting her sleep. Many care partners, you know, they’re so dedicated.

 

Dr. Sandison  

It, and they’re just such an inspiration. And yet they become martyrs. They’re not getting the exercise, they’re not eating right. They their identity gets lost in caring for this person, and so they lose their friends. They’re not socializing. All of those brain protective things that we know are so beneficial get put to the wayside in order to care for that person. So that’s too much stress, right? What we want is enough stress that we have. We’re excited to get out of bed and seize the day, right? We have purpose and meaning, whatever that is for you, you’re engaged in some sort of physical activity that keeps you right. Use it or lose it. You need to lose use your cognitive function. You need to use your physical body in order to maintain enough stress that we’re kind of pushing against that edge and we’re not losing our function. So toxins, nutrients, stress, structure. So you mentioned your parent is suffering potentially with dementia or Alzheimer’s. Are you at genetic risk? Becomes one of the questions that comes up, and I think is really important to answer when we’re in our 40s, 50s, 60s, before we’re starting to experience symptoms, because this can motivate us. If we know our Apo E status, A, P, o, e, if we carry one or two copies of Apo e4, then we know that we have to work harder than our spouse or our neighbor who doesn’t have that genetic risk, and we need to start looking earlier at our risk factors so that we can mitigate them sooner and again, delay, prevent, and then potentially reverse any cognitive decline that’s already happening. So structure comes in macro and micro as well. So that micro structure is that genetic, molecular structure. Now, the macro structure I know you can probably speak to even better than I can as a chiropractor. We need to be able to get blood to our brain and out of our brain. We need to have, you know, our head carriage can’t be too far forward if we’re in chronic pain. The cortisol that comes with that can become toxic to the hippocampus, the memory center of our brain, and if we can’t keep our airway open at night, at night, if we struggle with sleep apnea, this essentially becomes mild brain damage each night. Hypoxia is very, very toxic to the brain. We need to be able to get oxygen and fuel to the brain, and especially at night, if we have suffer with sleep apnea, we’re not getting the restorative, healing, REM sleep and deep sleep that we so desperately need to maintain cognitive function

 

Dr. Mindy  

structure was number 544, okay, so number five, yeah, we’re the last two

 

Dr. Sandison  

is infection, and number six is signaling. So infections, there’s a handful that are really important when it comes to cognitive function. One is p gingivalis. So gingivitis, the bacteria that cause gingivitis when they get into our bloodstream, they can cause cardiovascular risk, but also directly trigger the production of beta amyloid in the brain. So we want to make sure you talk about this so much so I know your audience is very familiar with this adage that health starts in the gut, but the gut starts in the mouth, so we’ve got to maintain really good oral hygiene so that we can maintain good cardiovascular health and good brain health, really important. And then also there can be kind of latent infections underneath root canals in cavitations associated with the that’s a whole.

 

Dr. Mindy  

That’s such a can of worms. But for some people, it’s really important. So I hear you

 

Dr. Sandison  

on that. I measure LP PLA too, on advanced cardio metabolic workup. And if I see that regularly, you know, two or three times, if I see that elevated and someone tells me they have maybe complicated dental history, then I’m referring out to a biological dentist. If you had told me in training that root canals would be associated with complex, chronic disease and outside of the mouth, I would have thought you were totally nuts. But I have seen it enough now. I have seen this play out with enough patients that oral health. I mean, it’s so, so, so important. So signaling, oh, sorry. Let me go through these other other infections. So pigeon Vallis in the mouth, and then also herpes simplex virus, one in particular. So if you get regular cold sores, that’s something. I’m a naturopath, right? I don’t. I’m not reaching for pharmaceuticals that frequently, and there’s a lot we can do with lysine and lemon balm and some other antiviral herbs that you can do for prophylaxis. However, if you’re prone towards regular herpes outbreaks, repeated herpes outbreaks, then it’s important to get ahead of those. And I typically will give my patients, certainly Acyclovir, valcyclovir, to have on hand with travel, with stress, anything that’s going to trigger an outbreak. And I’m pretty quick to get aggressive about that, just because the research is pretty clear that when we when we treat that relatively aggressively versus when we don’t, the people who treat are at lower rates of dementia. Because, again. That virus that hangs out in the nervous system triggers the production of neurodegenerative processes. So Paige and chavalis, herpes simplex COVID is another one that comes up, and this is a little bit different mechanism, yeah. So this one tends to create more hypocoagul ability, and so it’s in the vascular system, but can prevent good blood flow to the brain. So we come at that a little bit differently, in that we’re trying to reduce inflammation in the cardiovascular system, so looking at things like lumbrokinase and nattokinase, that kind of thing, to help with the viscosity of the blood, and then the Lyme spirochetes are another one. We know that syphilis, another spirochete, has a neurological presentation. Lyme also has a neurological presentation. And so it’s important to be screening for these, these Lyme and Borrelia, Babesia, Bartonella or Lich Yeah, that and the CO infection. So not just Borrelia, the kind of classic Lyme disease, but also the CO infections that can have an impact and wear on the immune system and put us at higher risk for cognitive decline as we age. So those are the infections that I really like to kind of be if you go on PubMed and you look at h pylori and dementia, there’s a connection. Generally, we want to keep our infectious burden overall to a minimum, so that our body is not spending time and effort and energy combating those right, protecting against them, but we can spend our time and effort and energy and resource creating new neurons and connections between them. The last one is signaling, and this is a really exciting conversation, I think, with this, with your population and your audience, in particular, because of the new research that came out recently looking at post menopausal women, women over 65 in the Medicare system, 11 million women were included in this study, and it showed, I think, unequivocally, that bioidentical hormone replacement as we age reduces our risk of all cause mortality, cancer, dementia by about 10% and then cardiovascular disease. So there was a lot of confusion around the Women’s Health Initiative study that came out in the early 2000s and that has completely been turned on its head. And it’s really, I think, an empowering time showing women that you don’t have to get off by a hormone replacement. You know, that was kind of the words of wisdom from people who are suffering with two people who are suffering with severe hot flashes or sleep deprivation or mood changes as they went through menopause, like you can stay on this, but not for too long. And for many people, they were talked out of even getting on it. And I talk to patients in my practice all the time who are terrified of hormone replacement, when, in fact, it seems to really be beneficial for almost all health outcomes as we age. And I didn’t even mention bone density, because that wasn’t included in the trial. But that is another the reduction of the rates of osteoporosis and osteopenia are very clearly understood with the addition of estrogen in particular. You

 

Dr. Mindy  

know, it’s interesting. As I’m listening to you, I’m thinking, wow, like we have really redefined the path into these aging years. You know, it’s in and I think our parents are, like you said, remnants of an old healthcare model. And this kind of discussion you and I are having right now, they didn’t get that discussion. And so, you know, I think for, you know, like, like, my generation, I’m a Gen Xer, like, in that generation, we are all starting to look at aging from a new lens, and I hope that my kids, who are Gen Zers, by the time they come into this conversation, it’ll be very clear that lifestyle matters. When you start to age of of the six you just said the two that are that, you know, I, as I was listening to that, I was thinking, Yeah, that’s a an amazing list, and it if I was somebody who was just trying to understand how to prevent Alzheimer’s and dementia, I would be overwhelmed with those six things, because how you know, how can I I’m managing an aging parent. I’m mad managing my own life, and now I gotta manage those six things. But when you break it down, I feel like the door in the easiest door in to increasing your immune system, to balancing your hormones, to helping your body detox, is the second one your metabolism. And this is why I’m such a fan of fasting and and looking at our glucose levels and our ketone levels and how that affects brain function. So that leads me to this question, and it was something that Lisa Moscone and I discussed when she came on on this podcast, and that was that as we age as women, our brain becomes less sensitive to glucose and more sensitive to ketones. So. So I want to ask if you, if you are, you find the same thing. And does I mean, of course, I have to go into the fasting realm. Have you seen as women? And this probably works for men too. As we age, the more we can get some of those ketone hits, the healthier our brain is as we go through those years,

 

Dr. Sandison  

unequivocally, in my clinical practice and my experience, getting into ketosis is one of the most miraculous interventions for cognitive decline. Yeah, it is a game changer, and I think it does about 50% of the heavy lifting of everything that we do now, if there’s a smoking gun, like a ton of mercury or a ton of mold toxicity or a severe B vitamin deficiency, right? We, we need to find that, right? That’s important. The functional medicine perspective of this, I think, is important. Yeah. Now that being said, I don’t think anyone should be in ketosis forever, right? I’m wearing a continuous glucose monitor right now. Yeah, I so, I think, like, what nine out of 10 diseases associated with aging or chronic conditions associated with aging have to do with high blood sugar? Right? We have created a society where we’re sick because we’re obese and sick and have diabetes and heart disease and cognitive decline because of the amount of processed food that we consume, and particularly the amount of sugar. And these blood sugar swings and spikes, they are so detrimental to sleep, to mood, to energy levels, to so many of the other downstream things. And so absolutely what we see, I have patients who have gone from not being able to remember their grandchildren’s names to being totally incontinent to three days later, 72 hours about what it takes to get into ketosis with a significant carbohydrate restriction, and we see that they remember their grandchildren’s names, and they have control of their bladder and bowels. I mean, it is profound. And people, my personal experience with ketosis, I get an hour and a half back in my day because I wake up at 5am ready to go. I don’t have to go through that kind of groggy six to 630 like I need my matcha kind of vibe. I can just get started with my meditation and my morning routine, and I don’t there’s no delay. And I also my mood is better. My sleep is on my ordering. I can track it. My sleep improves, my deep sleep improves. My HRV improves, and you I just get off the roller coaster. So many people can relate to this. Also, the bloating goes away, right that my stomach is flat again, you know, just esthetically, it feels great. So we guide people into ketosis, and I recommend for anyone struggling with cognitive decline, three to six months, solidly in ketosis, and then going back and forth between, potentially a plant based diet or a paleo Mediterranean diet, still a non processed diet when you’re going back and forth. Now, trips to Italy happen. I want you to enjoy that. Weddings happen. I want you to enjoy that so people come off and I think that’s okay. It’s all about being in the mindset that if I’m genetically at risk, or if I’m symptomatically feeling like my cognition is not optimized, I need to get back into ketosis, and I need to spend more time in ketosis than not.

 

Dr. Mindy  

Oh my gosh. Thank you so much for saying that, because it’s been interesting being in the Keto world. I’ve been in this world for a long time, and there have been a lot of critics of ketosis. And the way I like to get people into ketosis is through through the door of fasting. Like just take that window, compress it so you have this longer period of fasting, and then clean up your food in that eating window. And if you go low carb in that eating window, you’re going to go into even deeper ketosis. And this is why fast, like a girl was written, was because so many people were like, No, this isn’t good for women. This isn’t good for women. And I’m like, really, because I got 80 year olds that are dropping weight, and like you said, remembering their childhood phone number because I put them in ketosis. And so I don’t know if there’s like a media attempt to keep people out of ketosis, because then they’ll need drugs for some reason, but I have seen the same thing across hundreds of 1000s of people, that if you take a menopausal woman, if you take an aging woman, and you put her into ketosis, you give her her brain and body back. And I think it’s something we should be shouting from the rooftops. Now the second thing I want to say is, when you balance somebody’s metabolic health, you also balance their immune system. So when we look at those infections you’re talking about, if I can get them metabolically healthy, I can get their immune system up, and when I can balance their their metabolism and get that hemoglobin a 1c down, I can also see that they need less bio identicals that I think, is the wild wild west right now. I believe, I believe in us all. Getting on them, but there’s a huge learning curve for women when they get on these bio identicals, so we have to pair the lifestyle to that. So, you know, I think, and I’m a question for you, is every woman should start this keto journey when the hormones start to go crazy in those perimenopausal years, like at 40. Would you say there’s a time that you just stop ignoring that ketones are this driving fuel source for your brain, and you really need to embrace a lifestyle that brings ketones back in.

 

Dr. Sandison  

So I think that all humans should go in and out of ketosis. That’s what we’re designed to do. We’re essentially hybrid engines and our ancestors. The consistent thing about ancestral diets was inconsistency. We didn’t have blueberries in December, and so we had meat available in the winter that was stored or frozen or salted or whatever it was. We didn’t have abundant amounts of carbohydrates available 365, days a year. It just wasn’t how our bodies were designed. And now we are overfed, and so it’s really important that we get inconsistency in our diet, and this is part of fasting Now that being said, with what might be good for you if you’re in your 30s, 40s, 50s, might not necessarily be good for mom or grandma, because there is weight loss associated with ketosis, and we don’t want to go in the direction of frailty. Now, there are great ways to mitigate that, and we have tons of resources. I’m sure you do as well, but going into fasting plus ketosis, for someone who’s already frail, it can be a little bit too much sometimes. So we want to build resilience. This is that hormetic effect, right, where we’re stressing the system by going into either into fasting or a fasting mimicking state with ketosis. And what we want to do is stress the system so that it’s more resilient. This is a definition of health, right? Is more resilience when we come into contact with any sort of stressor. Now, that being said, if someone’s frail, if that that stress can lead to decompensation a little bit quicker. So for those of us in, you know, in this perimenopausal range, I would say it’s better to start even earlier, right there. I think women in their 20s and 30s can get tremendous benefits from going into ketosis in terms of hormonal regulation with this insulin insulin resistance can start early, depending on what lifestyle and diet habits have been, but PCOS is something that I think can be really supported through fasting and ketogenic diet and getting the sugar down. You mentioned the connection between ketosis and metabolism and addressing metabolism and how it impacts the immune system. Sugar feeds cancer. Sugar feeds Candida in the gut, but not just that. It feeds the gingivitis in your in your gums, it feeds every other infection. So getting the sugars down that starves out these infectious agents, and you can really reduce that burden significantly, directly, right? And then you also get all of these other benefits you mentioned the conversation with Lisa Moscone and how all of us, regardless of our diabetes status, regardless of our fasting insulin or our blood sugar, fasting blood sugar, as we age, we become less sensitive to glucose in our brain. Our brain prefers ketones to sugar. And again, I think back, not that I was there, but to answer John,

 

Unknown Speaker  

maybe we were there,

 

Dr. Sandison  

but if we were running from a bear, if we didn’t have food, shelter or water, if we didn’t have that food. We didn’t need our brains to turn off. We actually needed them to turn on. And so when we get into a fasting mimicking state, because there’s food scarcity, right? This, this is contrived in our day and age, but if the way it was for our ancestors, our brains turn on, and it’s this ancestry, it’s this evolutionary it’s like design, right? It’s just a divine design that if we are on the edge of starvation or going in that direction, we need to be able to think clearly, find food, find what we need, find the resource we need. And so that happens that. So we have the benefit of that now, and we just have to put Yes, it can be somewhat uncomfortable, but the rewards are so worth it.

 

Dr. Mindy  

They’re so worth it. I mean, I’m sure you do it this way too. Is like when I have a day where I need my brain to be on, that’s when I fast. It’s like I need those ketones, because they work so much better than than glucose. When I need that sharpness. What one of the struggles I have found, and I think other people may have found this too, is getting my 80 year old parents to adhere to certain diet changes. And one of the things my dad just so with full transparency, he’s the one we’re the most concerned about right now, is that he forgets so when I’m like, hey. Dad, you’re not eating. We a big bowl of cereal first thing when you get in, the more up in the morning, he’s like, okay, he remembers when I tell him, and then the next morning, he goes and eats a bowl of cereal. So I have been trying to figure out outside of just going in and making sure there’s no cereal in his house, like I’ve even wondered about something like exogenous ketones. Could I get put some exogenous ketones into him to be able to spark that brain activity? And how do I how do I get an aging parent to change their food habits?

 

Dr. Sandison  

Because this is tough. It’s such a great question. I was with my mom recently, and she always gives me a hard time. She’s like, you’re trying to give me an eating disorder when you get me into when you try to get me into ketosis. And so I, you know, I got my CGM on, and I asked her to put her one on her and supported her in that process, just so she could learn, so she could get more information about what’s going on and start connecting what she’s eating to how she’s feeling, and sometimes that’s just an invitation, right? We can’t change other people’s behavior, but sometimes they can influence it. And I think that modeling is one of the most important things, so us taking this on, showing what’s possible, sharing how we feel. Sometimes my mom’s cousins are really into it, and so they’ve started doing it, and all of a sudden she’s like, Oh, maybe I should listen to Heather, right? Like, it changes her perspective, right? Who’s influencing your dad? Right? Is there a good friend of his? Is there someone in his bridge club, or somebody that he plays tennis with who might have a bigger impact than us as the daughter? Right? Like, what do you know, I’m the parent in this relationship, and so that can be one strategy. You mentioned environment like, what should I just take the cereal out of his house? Yeah, I think you should, right. We call this cleanse your kitchen. You go in and you take everything out. Because people struggling with dementia, if there’s a banana on the counter, they’re gonna go, oh, this is healthy for me, and especially people in their 70s 80s, right? They remember that food pyramid from the 80s and 90s that that killed people literally has caused chronic disease in this country, right? It’s criminal that we were told to eat eight, like servings of grains a day, and that was the foundation of our diet, with sugar, processed grains, I mean, and that fats were vilified, really, that should be turned on its head, and we should be having a lot of fats, but fruits are one of those really confusing ones for people. Are you telling me fruit is bad for me? No, but it won’t help you get into ketosis, if that’s the goal? No, right? So, so we need to be strategic about what we allow into the kitchen, and so that somebody who is struggling with dementia or to even wrap their head around the concept, doesn’t have a lot of the junk or even anything that’s going to raise blood sugar, easily accessible. Now this is part of why I created Marama, which is a residential care facility for the elderly where we have an immersive experience in this approach, it includes an organic, ketogenic diet, all of the brain healing exercises, the socialization and non toxic environment, and caregivers who are trained to expect people to get better and also know how to manage the supplements and the hormones and all of the things that the medications that someone on a Bredesen type approach would be doing. And so it’s because of this question from people like you, right? I want my dad to get the benefit of Dr Bredesen approach, my mentors approach. But what am I? Can I do? I move in with him? Do I quit my job like what about my kids? What about my relationship? How do I navigate this and get him the benefit when I can’t drop everything and do it for him? And this is challenging, and the dynamics are different, right? Often we’ll talk to people and hey, my sister doesn’t believe that there’s any science behind this. Now, yes, send her. You can send her the Ornish paper that came out in June, which showed that lifestyle intervention randomized control trial, the first of its kind, that showed that these interventions can be helpful. They used a vegan diet. So, you know, I’m a fan of keto with animal products. I think that that makes it so that our diet is not too restrictive. But you have options, right? There is, there’s science suggesting that changing to a from a standard American diet to a vegan diet or a ketogenic diet can be very, very helpful for cognition. And so, you know, there’s science out there, but if your your sister is totally anti come back to you, be the model. Do it for you and prevent cognitive decline in you know, especially if you’re genetically related to whoever you’re concerned about. Make sure that you are being the model, and you are putting this information to work for your brain. We’re not going to be able to convince everyone, but we can give them information, and we can set things up. There’s meal delivery programs through Apollo health nutrition for longevity, does ketogenic meal delivery, which makes it a lot easier. So there’s there’s resources and there’s support.

 

Dr. Mindy  

Yeah, it’s funny, because on that, on that topic, my brain has been saying over and over again, like, don’t. Don’t lose your life in trying to save theirs. And it’s a little bit like I can feel them declining very quickly. And my sister and I are like, tag teaming every day, talking about, okay, I talked to them today. They’re doing this. We’ve had to take over their finances because my dad was paying things like five six times. And it’s interesting what you said about there’s this line between you want to help them, but you also want to save yourself and not lose your life in that process. So it’s in and I tried the glucose monitor on my dad, and he could, we couldn’t. He couldn’t figure out how to use it. It was, like, so complicated. I’m like, okay, I’d have to, like, be with Him day in and day out, and scan it on him for him to see it. So would you say that if you had an aging parent, a really good that hat is going through this a really good number, just to keep your eye on, is hemoglobin, a 1c

 

Dr. Sandison  

absolutely without a doubt. And we use the Mocha score, the Montreal cognitive assessment, as a way to put a number on where someone’s cognition is. And we have much more confidence right the earlier on in the disease process, the easier it is to turn things around. So if you’re starting to notice that mom or dad is forgetful, start, then get a mocha score and then do what Dr Bredesen calls a cognoscopy, right? Just like we get a colonoscopy to see if we have risk for colon cancer, get all of the lab testing done, look at toxins, look at nutrients, look at gut, look at all of the things a functional medicine doctor would look at and see if there are risk factors that you have control over, and then do what you can to address them. And of course, the lifestyle medicine is the most important. That is the foundation, right? The functional medicine testing and all that is the icing on the foundational cake of diet, exercise, sleep and stress management. So get those things dialed as much as you can. And then in these conversations, you know, it’s just I mentioned I was with family recently, and I have an aunt who’s the matriarch of my family. I mean, I just adore her. She’s been one of the most impactful people taught me so much throughout my whole life, and she’s been suffering with dementia for five or six years, and her husband is a conventional MD, and they had very little interest in what I was doing. And just recently, my mom texted me this morning. She’s like, Oh, but you know, they’re asking questions and they’re engaging about what’s in your book. And I was like, what like? I brought tears to my eyes, like, what like? I might be able to help this woman I love so much after feeling for Sorry, I’m like, getting emotional after feeling for years like I couldn’t right, because I wasn’t speaking her language. And so sometimes it just takes a little bit of patience and putting it out there and not pushing too hard. I think when we push too hard, people become resistance. Resistant. It’s human nature, right? If we, especially if we’re trying to control someone else’s behavior, but if we can just keep modeling, giving them information, maybe putting resources in front of them, like meal delivery, that make it easy, then I think that is potentially a way to get some change. And then there’s so many directions we could go with this. Yeah, right, exactly.

 

Dr. Mindy  

Well to keep Yeah, well, before you answer that, I want to address the doctor issue, because every time my dad goes and gets blood work, I say, Give it to me. Let me take a look at it. And what I’m finding is not happening in the doctor’s office with him, is this acknowledgement of how important hemoglobin, a 1c is. I feel like, if we just used one target, let’s just like, create one target for everybody. And so he’s like, my doctor says I’m fine. And I’m like, Yeah, but, but

 

Dr. Sandison  

like, 6.2 or

 

Dr. Mindy  

something, yeah. I’m like, you’re at a really, like, I want you at 5.0 and he’s at about 5.7 so he’s like, my doctor says I’m fine. I’m like, You’re not fine. We have to get this one thing down. So is there a way? Do you think that story about your aunt and you know, do we is the are the tides turning our doctors waking up and realizing that neurodegenerative decline has is intimately tied to metabolically unfit humans? Well,

 

Dr. Sandison  

certainly the research is there, right? This is published this, but that takes a long time to get in front of primary care providers and neurologists who are having these conversations with people day to day. And I think there’s also this element of, well, this person’s retired. They’ve done the work. Let them indulge, let them enjoy their retirement. Yes, and I think that that does people a disservice. Not everyone wants to hear that. There are people who you know, when they’re facing this last chapter of life or this last season of life, they want to live it fully. They want to be present, yeah, and

 

Dr. Mindy  

1. I’m tired of being disciplined. He’s like, I just he’s he’s kind of got a fuck it attitude. He’s like, whatever. I don’t know how much longer I have here.

 

Dr. Sandison  

I had a conversation with a 95 year old gentleman recently in the ariceptin. So a couple of medications that are available for dementia, they don’t work very well, and five years later, people are not doing as well as if they never started them right done. Episode or Aricept and Namenda or Memantine, these two medications, they get used together and separately, and if you start them, sometimes people get a little bump, but five years later, they’re worse off cognitively than if they never started them. So I have this conversation with a 95 year old man who’s like, I’m not gonna be here in five years. Just put me on him, you know? And I had to laugh, and I had to respect that, right? It’s his decision. And so all we can do is give people information, and then there’s it’s not for everyone. It requires work. It requires some, yes, some discipline, and some figuring out the Dexcom or whatever continuous glucose monitor you use, figuring out the ketone, all of these things, and I’d love to go back to the exogenous ketones, because I think that that’s a great conversation that can make it easier for people to get into ketosis. And for some neurodegenerative diseases like ALS in particular, we do not want to restrict carbs. We want to have ketones and carbohydrates, because resources are being utilized so quickly, it’s really hard for anyone to keep up. In fact, that’s part of the disease process. So when we add exogenous ketones, what we can do is get into ketosis, get the benefit of the ketones without having to do so much carb restriction. And sometimes for people who are at risk of frailty or weight loss, this can be kind of a happy medium, or like your dad, hard to get him there. Feels almost impossible to get him into carb restriction. Okay, let’s just add some ketones. So there’s different kinds of ketones. There’s ketone salts and ketone esters, and I think they both taste disgusting, so especially the ketone esters taste like gasoline. But this is what professional athletes will use these, and they will get your ketone levels up. So if my ketosis is point five to point nine, I think of actual ketosis as 1.0 usually you’re getting maybe to 3.0 on the very high end, just with fasting and consuming fats. And then if you start adding ketone esters. These are the gasoline, like the real fuel. You can get that ketone number up often to five, and with ketone salts, we’re gonna see those ketone numbers go more like to what you could get to metabolically, between one and three, but you’re gonna get there faster with less carb restrictions. So there’s powders, there’s capsules. I’m personally a fan of the ketone capsules because I hate the taste, but some people love the sweet taste of the ketone salt, and they can use it as a snack between meals when they’re starting to either fast or they’re starting to go into ketosis and carb restriction. I don’t you probably have the Oh, go ahead. Well,

 

Dr. Mindy  

no, so what, here’s the question I always ask myself, is, so ketones were meant to be present when glucose was low. So my intuitive, and I’m actually as I’m going through this conversation with you, thinking, okay, yeah, I’m definitely gonna try the exogenous with my dad. But it would, I would intuitively say it needs to be in the morning before he eats anything and brings his glucose up. Now, having said that, I have had lat Manzoor on here, who is the founder of ketone IQ, and he believes that if your glucose is high and you take these exogenous ketones, it actually helps. It can mitigate the high blood spiking blood sugar, so it can actually be a tool for bringing the blood sugar down. So do you have an opinion on that? And then the second part of that question is, ketones are neuro protective, right? Are they going to create? Are they going to stop the plaquing are they going to stop the degeneration? Will they block the neurons from being infected by the infection, or the toxins, like, is that like a shield for these decaying and plaquing neurons? Yeah, great

 

Dr. Sandison  

question. So the brain takes up 2% of body weight but 20% of energy expenditure every day. It’s a very, very expensive machine to run, right in terms of resource, and when we can’t turn ATP is the fuel that our neurons run on. Every cell in our body runs on. So we need to be able to turn the fuel source into ATP. And that fuel source can be, we’re hybrid engines, right? We can it can be glucose, carbohydrates, sugar, we’ll use those interchangeably, or faster ketones. And when we make ketones available, whether there’s glucose there or not, we’re basically saying, Here brain, here’s some extra resource. The way Dr Bredesen talks about the brain, he uses the analogy of like your brain being a country, my brain is done. And if your brain. Is at war, right? If it is fighting and defending like, think of your brain like Ukraine, right? It is out of money. It is desperate. It is fighting and defending and can barely mean maintain any function. So if we can resolve, if we can give an extra resource, right, if we can get that extra money to that country at war, and get them the extra things that they need to resolve it right, to fight those infections, get rid of the toxins. Then now we free up resource, and we can go on to regenerate. We can create new neurons, new synapses, the connections between the neurons, and that’s what we’re trying to do when we add more resource to the brain with ketosis, now with exogenous ketones, I should say, Now, if we’re actually in metabolic ketosis with carb restriction, we get the benefits of less oxidative stress. Burning sugar for fuel creates oxidative stress, so we skip that, and we don’t get that oxidative kind of trash that we when we’re burning ketones for fuel. Additionally, in ketosis, as you well know, we’re metabolizing fats, which is where we hold a lot of fat soluble toxicity, so we can start getting rid of toxins. So it’s antioxidant, it’s detoxifying, it’s anti inflammatory, reduces inflammatory burden, which is part of the trigger of neurodegeneration. So there are so many benefits to getting into ketosis, and I think that we don’t even fully understand all of the mechanisms. Dr Stephen Gundry talks about the mitochondrial uncoupling as one of the proposed mechanisms. I think there are many, many, many at play, but primarily when we’re talking about adding exogenous ketones when you’re not in carb restriction. I think what we’re trying to get is this resource utilization question answered and just basically give the brain as a gift. Here’s more fuel to get to do the jobs that you need to do throughout the day, particularly resolving these highly resource, you know, resource draining, things like fighting infections and toxins. So

 

Dr. Mindy  

then you would be a fan of it doesn’t matter if glucose is high, you’re just given another resource for the brain, and it you would, it wouldn’t bother you to put the two together. In

 

Dr. Sandison  

an ideal world, we’re doing carb restriction as well, but if we can’t get that, but we have an aging parent, it’s a reality. So much of what we do is pragmatic. It’s like what’s gonna work exactly, and I think that ketones are kind of a cheater’s way to get this extra fuel source to the brain. Yes, you

 

Dr. Mindy  

really it’s so funny, because when I first discovered fasting, my parents were in their late 70s, and they were, like, up for anything they my mom actually raised me in a very clean, nutritionally clean home. She we didn’t have sugar in it, like so much of what she did with us in our childhood, she’s actually not doing in her senior years and so but one of the things when I first started understanding fasting and teaching it to them, I mean, they were the most vibrant I have seen them in their late 70s because of skipping breakfast and compressing their eating window, and they were willing to do all of that. And now, as they’ve gotten older, the willingness has gone away, and one of the places it’s gone away, and this would be another question for you, is that they have a caregiver now, and as wonderful as the caregiver is my dad no longer cooks and cleans, and we’re making him walk the dog, but life got really easy. And so what part I mean? This is where you could also look if you can get them to fast, a little bit longer, or get some carbohydrate restriction out so you get the ketone, but you’re also micro dosing hard. And I’m curious if micro dosing hard in an 80 year old is still increasing neuro plasticity, because the brain has to find new pathways to deal with the hard.

 

Dr. Sandison  

Yeah. So I think there’s a couple things that come up here. One, caregiving, so I think for any family who has somebody with dementia, find a caregiver fast before you think you need them. Get somebody who your parent knows, enjoys, likes being around, who knows them. That is really helpful, because I have seen too many families backed into a corner out of desperation just finding a warm body to show up and babysit so because they are pulled away for some other family emergency, or they have a fall, or their primary caregiver is unavailable, and so having somebody who’s kind of in the family already makes it so much easier if there’s ever any transition. The other thing is, caregivers need time for themselves, so having if, like, your dad needs someone there all the time, then giving your mom that break so that she can go play cards with her friends or go to lunch and not talk about dementia and her husband, and she can get that social connection and have that identity outside of caring for him that is really, really important to her long term health. Now, okay, so the caregiver. We have. Caregiver. Training programs, because it’s so many caregivers are. They want the person they’re caring for to like them. So they want to feed them cookies and ice cream. They want to shop for them in that way. They want to let them sit at, you know, at the TV, and they want to take care of everything, because that’s what that person wants, even though it’s not what’s best for them. And so having caregivers that are well trained to engage that person. They know what motivates them. They know how to engage them so that they can have a good time staying cognitively engaged, physically engaged, and eating the right foods. So the caregivers mindset needs to be and their values need to be in alignment with this Bredesen approach, I think, to get the most out of it. And that can be done. We see it all the time. It’s fantastic. What’s

 

Dr. Mindy  

the name of the program that you the caregiver training program.

 

Dr. Sandison  

It’s called reversing Alzheimer’s at home. So that’s actually where my book is from. Reversing Alzheimer’s is my book that came out in June with Harper Collins. We hit the New York Times color list done really well. It’s available wherever books are sold. And this is that we had designed the training program. We were doing it. We did it for about 200 people, and then wrote the book based on what we were doing in the caregiver training courses. And so that’s what the book is. And then we have group coaching programs that go about 12 weeks. We’re starting the next one on Labor Day, and we run those about three times a year, so that we create community, so that we have people sharing their secrets. And I mean, there’s it’s so valuable to have that dialog around what’s working, what’s not, what’s coming up for people, how to best serve those we love, suffering with dementia and prevent it for ourselves.

 

Dr. Mindy  

That’s so smart, because, I mean, that I’ve had to really work with the caregiver. So I’m, did you do the audiobook. Did you read your audiobook?

 

Dr. Sandison  

I heard you saying that you were doing that, so I had to negotiate with them, and I was able to do the introduction and the acknowledgements. They were like, no, no, we’re getting in professional for the rest of it. You know, I’m torn. I have mixed emotions, but you’ve done your audio books, right? Oh, yeah,

 

Dr. Mindy  

I do all my audio books, and they’re horrifically hard to do. But the reason I ask is because I may have the caregiver listen to your audio book, especially as she’s cooking or doing anything like that. I can see that where that would be really helpful. Do you think, with this new explosion of conversation around dementia and Alzheimer’s, that we literally, if we like, listen to podcasts like this, and we really read books like yours, and we we understand the impact of lifestyle, that by the time our grandchildren go into into their senior years, that Alzheimer’s and dementia could be a thing of the past.

 

Dr. Sandison  

I believe that for our generation, Mindy Alzheimer’s that’s optional, that there is so much we can do to prevent this disease, that if we are willing to do the work and do what it takes, then yes, we can prevent having this disease as we age. Amazing.

 

Dr. Mindy  

Well, again, I’m going to send everybody to get your book. I, you know, I know they call us the sandwich generation. We’re, like, sandwiched between the kids and the parents, but my kids are, you know, off and learning how to adult, and I’m left with my parents. And this conversation has never been more real for me, and it came on so quickly, so quickly, like, out of nowhere. It was like, my mom was thinking my dad had dementia. And I’m like, Yeah, I don’t think so. And then as I look closer, I was like, Ooh, yeah, she’s right. So work like yours is really important, so I really appreciate that and what you’re doing, and how can people find you and find all the wonderful things you are up to.

 

Dr. Sandison  

Thank you. Yeah. Dr Heather Sandison, s a n, d i, s o n.com, where you can stay up to date about the latest research and our offerings and support for those suffering with dementia and their families. You know, Mindy, I have the privilege of talking to many, many patients and coaching clients and residents at murama who are in that sunset of their lives, right? And asking them, what’s most important, what have been your happiest memories? What do you what lights you up to think back on and it’s the connections, it’s the it’s the connections with the people that they love. Nine out of 10 times, it’s not how much money they made or the vacations that they went on unless they went with family, and that is just this reminder like we have this opportunity to maintain meaningful connection as we age, if we maintain our memory and our brain health, and it takes some responsibility, it takes some action, but it is so well worth it, and it is so accessible if we’re willing to do it,

 

Dr. Mindy  

amazing, amazing. So and I agree, I agree, and I can even say at 54 you know, connections matter more than anything to me now. So I can only imagine what it is for my parents. And you watch them light up when the grandkids are around and when we walk in, and it really, I can really see that. So let me finish on this question. It’s want to ask everybody, and that is. What is your definition of health you personally, and how do you know when you’re healthy? Do you have a measurement for it?

 

Dr. Sandison  

Yeah, so getting up in the morning, feeling good and ready to start the day, is my personal definition of health, just feeling like I can take it on, feeling excited about what I’m doing and thinking about how I’m gonna have an amazing day, and feeling like I have the energy for it, that is my personal feeling of like, Yes, I’m healthy. Now there’s another one that I offered. The definition of health is how, well, how resilient we are to stress, yes, and I do think this hormetic effect, right? Fasting, ketosis, exercise, cold, hot and cold therapies, even oxygen, contrast therapy, can be things that are uncomfortable when we get outside of our comfort zone, but expand our resilience to stress. I think that that is a it’s a continuum, right? Health is a continuum. It’s like homeo dynamic state, right? It changes throughout the day and throughout the month and throughout the years, but when we can expand our resilience to stress, I think that that puts us in a healthier state.

 

Dr. Mindy  

I love that. I love that, well, keep doing the amazing work you’re doing. This is such a necessary topic, and so many of us are sitting in the position I’m sitting in, like really wanting to prevent it for ourselves and managing it with elderly parents. So, you know, I, if anybody listening to this gets a little sense of peace, like I just had over the last hour of talking to you, I hope that we can, we can change the way that we look at this, because it’s, it’s really hard to watch the people you love decline so quickly. So just thank you for everything you’re doing. And how do people the people can come to your website. Is that like, where are your main sources?

 

Dr. Sandison  

Yep. Dr Heather Sandison.com, again, s a n, d i, s o n, and the book is reversing Alzheimer’s. And thank you so much Mindy for having me. I really appreciate you helping me to change the narrative around what’s possible for those suffering with Alzheimer’s and dementia, and reduce that suffering, hopefully in real time.

 

Dr. Mindy  

Thank you, Heather, thank you so much for joining me in today’s episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we’d love to know about it, so please leave us a review. Share it with your friends and let me know what your biggest takeaway is. You.