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In this episode, you will learn about a toolkit to improve cognition and protect brain health from cognitive decline.

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About My Guest

My guest for this episode is Dr. Heather Sandison.  Heather Sandison, ND is a renowned naturopathic doctor specializing in neurocognitive medicine and the founder of Solcere Health Clinic, San Diego’s premier brain optimization clinic, and Marama, the first residential memory care facility to have the goal of memory recovery.  She has dedicated her career to supporting those suffering with dementia and is the primary author of the peer reviewed research “Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline” published in the Journal of Alzheimer’s Disease.  Dr. Sandison hosts the annual online Reverse Alzheimer’s summit where she shares cutting-edge and tried-and-true insight into what is possible for those suffering with dementia.  She is excited to shatter common misconceptions about Alzheimer’s and share what she has learned about keeping your brain sharp at any age.  She is also the author of the newly released book “Reversing Alzheimer’s The New Toolkit to Improve Cognition and Protect Brain Health”.

Key Takeaways

  • What are the most common factors impacting cognitive health today?
  • What are some of the top tools for mitigating environmental toxicity?
  • What approaches lead to optimal microbiome diversity?
  • What is the role of herpetic viruses in Alzheimer's?
  • How much more important has vascular health become in the pandemic era?
  • What are the genetic contributors to cognitive decline?
  • Is the presence of amyloid correlation or causation?
  • How can one more consistently remain in ketosis without dependence on exogenous ketones?
  • Should certain people avoid saturated fats?
  • What are some of the tools that may assist in balancing lipid dysregulation?
  • Is there a place for limbic and vagal work in optimizing cognitive health?
  • What are some of the common challenges preventing optimal sleep?
  • Are all seed oils toxic?
  • Can vegetarians and vegans optimize cognitive health without animal protein?
  • What is the role of hypercoagulation and arterial calcification in cognitive decline?
  • How important is reducing EMFs in reversing Alzheimer's?
  • How can mitochondrial health be supported to optimize energy currency production?
  • Can antimicrobial mouthwashes actually make things worse?
  • What is the role of peptides in supporting brain health?

Connect With My Guest


Interview Date

June 18, 2024


Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  


[00:00:02] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts; empowering your better health. And now, here's Scott, your BetterHealthGuy.

The content of the show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:35] SCOTT: Hello, everyone. And welcome to episode 202 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Heather Sandison. And the topic of the show is Reversing Alzheimer's. Dr. Heather Sandison is a renowned naturopathic doctor specializing in neurocognitive medicine and the founder of Solcere Health Clinic, San Diego's premier brain optimization clinic, and Marama, the first residential memory care facility to have the goal of memory recovery.

She's dedicated her career to supporting those suffering with dementia and is the primary author of the peer-reviewed research Observed Improvements in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline, published in the Journal of Alzheimer's Disease.

Dr. Sandison hosts the annual online Reversing Alzheimer's Summit where she shares cutting-edge and tried-and-true insight into what is possible for those suffering with dementia. She's excited to shatter common misconceptions about Alzheimer's and share what she's learned about keeping your brain sharp at any age. She is the author of the newly released book Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health.

And now, my interview with Dr. Heather Sandison.


[00:01:54] SCOTT: There are 6.7 million people aged 65 and over with Alzheimer's. And it's now the fifth leading cause of death in older Americans with a cost of over $345 billion in 2023 alone. Today we have Dr. Heather Sandison here to talk with us about her new book Reversing Alzheimer's. Thanks so much for being here today, Dr. Sandison.

[00:02:19] DR. SANDISON: It's a privilege to be here. Thanks for having me, Scott.

[00:02:19] SCOTT: First, talk a little bit about what drives your passion for the work that you do. Did you or a family member have your own health journey that really led to your passion for working with cognitive rehabilitation and optimization? Or was your passion today more from observation, working with your patients and then wanting to support them in avoiding the suffering that often comes with cognitive decline?

[00:02:45] DR. SANDISON: Yeah. I think of it, it's like an injustice. Right? I think is where I came to. I had heard over and over again that there was nothing you could do for a patient with Alzheimer's. And to suggest that you could was to do harm, was to provide false hopelessness. And so, we should never do this under any circumstances.

And yet, then, when I heard Dr. Bredesen's work and when I was in clinical practice supporting patients and watching them get better not just once or twice, but over and over again, I saw this phenomenon of people with cognitive decline anywhere on the spectrum able to improve their outcomes and improve their quality of life; improve the quality of their relationships.

And I guess I just got to this place where it was like I saw that enough that I couldn't do anything else with my life other than figure out how to shout from the rooftops, "They're wrong there." It's not that there's nothing you can do. It's actually that there's this overwhelming amount that you can do. And I want to help people take advantage of Dr. Bredesen's work and all of the people who have come before me in functional medicine to help navigate this what can sometimes feel contradictory, or overwhelming, or complex. And really help navigate putting these insights, this information that we've learned into action so that they can get the benefit and, yes, reduce the suffering.

I grew up in Hawaii, a place very affected by colonization, right? Where you could watch over the course of just a couple of generations the switch from whole foods grown in backyards to highly-processed foods. And the effect and the toll that that took on people's health and how they weren't showing up at neighborhood board meetings, right? They weren't effective in creating solutions for their communities. And that kind of bigger picture perspective of like we need our elders. We need the wisdom and experience of the people who have come before us to find the solutions that are going to get us out of this mess that we find ourselves, that humanity finds itself in right now.

[00:04:44] SCOTT: I think we both are huge fans of Dr. Bredesen. He's been on the podcast previously. Definitely a big mentor of mine as well. And I know you have the honor and privilege of working with him, and doing research, and trying to figure these things out. I have to imagine that you have learned a tremendous amount from his work as well.

[00:05:03] DR. SANDISON: A huge amount. Oh, my gosh. I pinch myself that I get to sit in on meetings and download his genius and have him look at some of the cases that I've seen in clinical practice. And also, Neil Nathan, my practice for a long time. I know that he's a good friend of yours as well. My practice for a long time was sort of half dementia, half mold. And having the privilege of training with both Dr. Nathan for the past decade or so and then Dr. Bredesen for the past seven or years, I've really combined those approaches.

And both of those mentors are – one of the things I appreciate so much about them, what they have in common is their compassion. They are great humans. They are good doctors and they are just good humans. And they want to see people get better. And both of them, they don't stop because it's hard. That just sort of fortifies them and they just keep going. Looking for solutions. Looking for answers to reduce people's suffering.

And so, I have the privilege and benefit of having learned from them and be able to pass on all of what they in their decades between them. They have decades of experience and thousands of patients that have trusted their health with them. And then I get the learnings, so that my patients hopefully get there a little bit quicker.

[00:06:19] SCOTT: You say that there are six integral components of a healthy brain, being toxins, nutrients, stress, structure, infections, and signaling. My perspective has been that environmental toxicants are probably one of the biggest health-negating factors in our world today. I'm interested in which of those six components of a healthy brain do you find most commonly impacting your patients? Or are they all equal in their contribution?

[00:06:48] DR. SANDISON: Yeah. When we did our clinical trial, we took 23 participants through the six-month intervention and we did testing on all of them. And what we find in most people over 65, they have toxins. We live in a toxic world. They have accumulated toxins. Now, what is paramount for one person might not be for another.

We also have patients with, yeah, there are toxins. But is that the smoking gun? No. It's actually the traumatic brain injuries and maybe their genetic predisposition. Or the fact that they have really high blood sugar. And I guess the sugar at that point becomes the toxin. But it's not always the smoking gun.

Although, I would agree with what you mentioned. That in this day and age, toxins do seem to be a big part of the reason why we have so much more complex chronic disease. The Lancet put out a commission report in 2020, in 2017 originally and then updated it in 2020, and it's on Alzheimer's and dementia and the modifiable risk factors when it comes to dementia. The Lancet, again, very reputable journal out of the UK, suggests that 40% of worldwide dementias could be prevented. I think that that number is much higher. And there's patterns in what they suggest is these 12 modifiable risk factors. And you'll see that they fit into my six categories. And one is smoking and the other is air pollution. Both of which fit into this toxic category.

We measure environmental pollutants, the PCBs, and phthalates, and MTBE, petrochemicals, plastics, that kind of thing. We also measure glyphosate, the active ingredient in Roundup. We measure mycotoxins and then heavy metals. And those are kind of our flavors of toxins that we look at. But there are many, many, many others that we never get to measure just because toxins are so ubiquitous in the environment.

And toxins, again, they're at this causal level. You mentioned those six things. And so, toxins, nutrients, stressors, structure, infections, and signaling. And the cause, the problem with those things is when they're out of balance. When the toxins accumulate in the brain. If they can't get out because we're not getting deep sleep, they're accumulating and creating inflammatory responses in the brain and leading to dysregulation, inflammation, dysregulation, and then neurodegeneration eventually.

And so what we want is to basically have toxins flowing out of the body. We can't stop them from coming in. It's just not the reality that we live in anymore. But can we make sure that we are upregulating our emunctories or those organs of elimination? That we're doing what the body – we have enough nutrients to help get the toxins out of the system. And then that we're limiting our exposures as much as possible.

[00:09:26] SCOTT: I love that when people use words on the podcast like emunctories. Maybe soon, we'll talk about the extracellular matrix. I mean, that's my jam. I wanted to talk a little bit about mold and mycotoxins. I know earlier on, Dr. Bredesen's work had talked about that being a fairly significant component, or a finding, or factor in many people dealing with cognitive decline. My understanding is that, more recently, that number is much higher. And they're finding that mold and mycotoxins may be a component or contributor in 90% or more of people that they evaluate. I'm wondering if you can tell us a little bit about that. And is that in fact accurate?

[00:10:05] DR. SANDISON: Yeah. I don't know that I have an exact percentage of how many of my patients have significant mold exposure that are Alzheimer's patients. We test it on everyone. We use urinary mycotoxins and we tested on everyone. And I would say that 90% of people I probably test have something there. Now, how significant it is? Is it off the charts? Is it really high? Are they currently being exposed? Is it what's causing their neurodegeneration?

Scott, part of this is that we never do one thing in isolation. I would never test just someone's mycotoxins and only treat that. We're looking at their sex hormones. We're looking at their thyroid. We're looking at vitamin D levels and homocysteine. We're looking at infectious burden. We're looking at nutrient balance and gut function. And whether or not they have the right microbiome.

And so, I sort of reject this old paradigm that there's one thing causing it. But when you start layering mycotoxins on top of heavy metals, on top of high stress, and sleep deprivation, and maybe a sedentary lifestyle, and a standard American diet, it's part of this mixture of lifestyle and inputs that's going to create this downward spiral towards neurodegeneration. It's sort of common sense. It's going to add insult to injury.

[00:11:24] SCOTT: Yeah. And, sadly, the fact that there isn't one thing, and that we often have to do several things is often the criticism that the more conventional medical people tend to use against something like the Bredesen protocol, right? Because it is complex. And we do have to look at lots of different things.

Let's talk maybe a little more about detox since that's where we are at the moment. When we think about things like metals, and chemicals, and pesticides, and mycotoxins, what are some of your favorite tools for helping people to open the channels of elimination? The emunctories that you mentioned. How to improve excretion of a lot of these toxins and get them out of the body?

[00:12:04] DR. SANDISON: Yeah. First, I want to start with just listing those organs of elimination. The emunctories, if you will. Right? Emunctories is our fancy naturopathic word for all of these organs that help us detoxify. Our body is designed to detoxify. And so, if we can sort of amplify, if we can turn up the volume on each of these organs and its ability to do its job, then we can kind of spread the burden, right? We can spread the load and make it more efficient.

And as I list these, I'm sure – well, your listeners are so well-educated. But there might be one where you're like, " Oh, I need to put a little bit more effort into that." And so, just kind of make a mental note or make a physical note. Write it down. Or order that thing that you've been meaning to order and just start opening up this elimination pathway. And there's so many ways to do this.

What I'm going to do is I'm going to just rapid-fire give you all of them and kind of talk through them and I hope organize them a little bit. But when I list this, it's not because I'm suggesting that everyone needs to do all of these things. They're just to consider. To help you to get these organs distributing the toxic burden more evenly, and more efficiently, and more effectively so that you can reduce that.

And I'll start with Walter Crinnion. I'm sure that you – I hope you had a chance to interview him. But he said – oh, in honor of the late Walter Crinnion. He used to say, "The solution to pollution is dilution." Right? The more that we can eliminate through – and, also, he said 75% of environmental illness is stopping the exposure. These concepts, like start with that as sort of foundational. Stop the exposure. And then dilute. Open doors and windows. Get air flowing. Drink plenty of water. Dilute as much as we can wherever we can.

Okay. Organs of elimination. Bowels, liver, kidneys, lungs, skin, and lymph. Starting with bowels. One bowel movement every 24 hours at least. If you aren't starting there, then work with your provider to figure out how to have a daily bowel movement. Maybe it's magnesium citrate. Maybe it's something more cathartic than that. Maybe it's changing up your diet. Maybe it's the microbiome. Figure out what's preventing you from having a daily bowel movement.

And if you're one of those people where it is severe, you cannot have a daily bowel movement, then think about enemas, or colonics, or something else to keep your bowels moving even if it's temporary. We have to be able to through our bowels. Otherwise, if we don't, it's going to build up in our liver, in our skin. It's going to have to come out through our skin, through our kidneys, through our lungs, somewhere else. The bowels are a huge way we release toxins every day. Obviously, right? Everybody can sort of nod their head and agree with that.

The liver. The liver, in all of its brilliance, it will stop phase 1 detox if we don't have enough nutrients for phase 2 detox. Making sure that you have a multi. Every good supplement company has some sort of liver detox multi that has all of that phase 2 support so that the gridlock doesn't happen in the liver.

And then we can also support the gallbladder that spits out that toxic sludge called bile. If that bile goes into our gut and we're not having a bowel movement – the enterohepatic recirculation is the fancy word we use for that reabsorption of that toxic sludge that's in the system. And now it's going back into the bloodstream. Back to the liver. And the liver's got to take out yesterday's trash in addition to today's. That's part of why it's so important to have a bowel movement.

But, also, we want to have plenty of nutrients available for the liver. And then the gallbladder really likes phosphatidylcholine to help get that bile fluid moving, that bile moving. The liver and the gut are working together. And so, giving them all of the support they need. Also, to bind bile, we use a lot of cholestyramine. We'll use fiber, of course. Other things to bind and bulk the stool so that you're moving toxins through that organ.

The lungs – I want to go to the lungs next, because they're less obvious. I think a lot of people forget that acid-base balance, it depends on our inhales and exhales. If we are drinking too much and driving, a cop would pull you over and use a breathalyzer, because they would pick up the toxins that we're releasing through our breath. Now it's not just with alcohol that that happens. We can release many toxins through our exhale. And I think this is a really underutilized detox organ.

And when we use our breath, when we – I mean, this is a whole – you could spend a lifetime understanding breath work and different breath work practices. But in many of our ancient traditions, there are great breath practices. There's a book called Breath by James Nestor that's a phenomenal read and has a lot of great ideas and lots of different kind of pathways that you can take and run with.

But first, just breathing through your nose rather than your mouth. Primarily making sure you're getting – you're breathing through your nose at night so that you're getting oxygenation and you can go through the detox pathways in your brain. But using detox breath work. There's lots of these. You can find them on YouTube. Many of the yoga studios have detox breath work night, or a class, or something that you can engage in. But you can basically go down a rabbit hole with this. And it can be very effective not just for detox, but also for limbic retraining and for autonomic nervous system balance. For oxygenating your cells. I mean, there is a long list of why this can be so beneficial. But detox is among them.

We talked about bowels, liver, lungs. Kidneys. When it comes to kidneys, we want to make sure that we're getting plenty of water. Usually, I suggest people aim for about half their body weight in ounces as long as you have good kidney function. Fantastic. And that you're getting mineralized water. We don't want it to be toxic water.

I live in San Diego. The water here is number nine in terms of the worst cities in the states. It's terrible water. If you live somewhere where the water is good, by all means, drink that tap water. But if you don't, consider getting spring water in glass that's bottled at the source. Hopefully, has the least amount of contaminants. Or using reverse osmosis. But if you do reverse osmosis, make sure you add back minerals. Because you don't want to become mineral depleted by having really depleted water.

Getting good, high-quality water is one of the keys to making sure your kidneys are staying functional. But also, just managing blood sugar, calcium levels. There's a lot of different things that can have – medications. Right? Reducing those wherever possible, so that we don't have so much burden on the kidneys and they can do their job.

We talked about gut, liver, lungs, kidneys. And then skin and lymph. I love this for last, because it's like going to the spa. This is so fun. You get to do lymphatic skin brushing, lymphatic massage. Maybe a rebounder, chi machine, castor oil packs. There are just all of these really fun ways to increase. Sit in the sauna.

Skin and lymph is just the best, because, basically, you can talk – you can use your health as a reason to just take care. It's all about self-care I think when we come to skin and lymph. And so, it's a reminder that when you do that, when you invest in those things, like a massage, a lymphatic massage, or taking the time to dry skin brush before a shower, it's an investment in self-care and your health. And it tends to also help with that autonomic system balance and that feeling of rest and recovery that so many of us need.

Detox, we can almost broaden that to what are we allowing in our thoughts and our mind? And we can detox our mind as well. And I think some of these practices help to create that stress balance that so many of us need.

[00:20:00] SCOTT: That was a lot of pearls for the first few minutes of our conversation. And I think one that I always found very powerful was recognizing that we can take binders all day long. But if we're not really optimizing the bile flow and getting those toxins from the liver, to the gallbladder, into the small intestine, there may not be a lot for the binders to bind on to in terms of toxicants. Right? And so, by doing some of the work that you mentioned with the gallbladder, bitters, phosphatidylcholine, those kinds of things, we're increasing the binders opportunity to help remove things from the system. I think that's so powerful.

You talk about the microbiome in the book, and I think many people, especially in my audience, that have had chronic Lyme disease as well, chronic infections, have done sometimes antibiotics for many years, I personally never found probiotics to make a huge difference and to really move the needle to optimize the microbiome. I think takes a lot more effort than maybe we previously thought. Looking at prebiotics, and probiotics, and postbiotics, and maybe even paraprobiotics. Wondering what are some of your favorite tools that clinically have really helped people to create more diversity in their microbiomes?

[00:21:13] DR. SANDISON: I think diet. Changing your diet has the most profound impact on gut microbiome. I think it's the quickest, fastest way to improve the microbiome. Of course, shifting from a standard American diet that's high in carbohydrates, it's going to feed fungus and bacterial overgrowth. To whole foods, maybe even a ketogenic diet or a Candida diet where we're really restricting carbohydrates and sugars so that we're feeding the good stuff. And then, of course, having fermented foods. Diet by far is the way I've seen patients shift their gut microbiome the fastest.

Now for some people, they've already done that. That's already been part of what they've been doing for a long time. Other ways – I mean, you mentioned them. And I think that with probiotics, I will say my clinical experience has been that there's not one probiotic that works for everybody. But often, people will land on one. There will be a new one that comes out and is getting really well-marketed. And they'll try it and be like, "Oh, my God. For the first time, I'm having a bowel movement every day." There will be this really big clinical shift. When you find the right particular one, it's like got that thing that you were missing that helps to balance your personal gut.

And so, what I recommended – and that there was a friend of mine who did her PhD in gut physiology. And, basically, her dissertation was on how do we get the gut to colonize probiotics. And she had a few takeaways. One was rotate all the different – what we want is variety. Variety is going to be the name of the game here. Don't take the same probiotic and buy the same one month after month after month. Maybe have a couple and rotate through different ones. That will help to get the most amount of variety into your gut.

She said take them with food, so that the acid basically doesn't kill them. Because they colonize in the lower intestine. And most of the probiotics that we would get from fermented food, they come as food. You want there to be food in the gut when you take them.

I had teachers who used to say take them before bed. Away from food. And her experience, what she found when she was doing her research, was that it's best – they colonize best if you take them with food. And then the other thing she said was take a ton of them. We're not talking about a million. We're not talking about 5 million. We're not even talking about five billion. We're talking about a hundred billion.

I know there's people who are highly sensitive who listen to your podcast. Obviously, do the things that that are within reason for your vigilance level. But for many people who are struggling, they're not taking enough to colonize. And what we're trying to do is to get them to colonize. Now, again, as you mentioned, prebiotics. And there are so many other things that can make a difference.

I think that one thing that's underutilized is anti-parasitic. I am pretty quick in my clinical practice to treat parasites. And part of the reason is because these multi-celled organisms, they harbor their own organisms. If you have a larger organism, it's going to have its own yeast, and potentially bacteria, and viruses within it. The single-celled organisms can live within that. It's like host within a host.

Thinking through that. Being aware of that, especially for people who have traveled extensively, had animals in the house, in the bed with them. They have exposures. And/or have had immune suppression in the past. That. If they've been on PPIs, proton pump inhibitors. Things that have reduced stomach acid, which is one of our defense mechanisms against parasites. Anybody who has that type of history, I'm going to want to be aware of the fact that parasites might be present.

It's kind of funny. I think it's the gross factor. But we treat and we see that our mammal animals live longer when we treat them regularly with antiparasitics. But then we don't think to extrapolate that to humans. And I think that there's a lot of people who might do better generally if they did a round of Alinia once a year. Not that I do that for absolutely everyone. But I'm probably quicker than most clinicians to go in that direction.

[00:25:20] SCOTT: One of my two favorite pharmaceutical drugs, the other one I won't mention because it could potentially get this episode censored, but people can probably figure out what that is. And so, it's interesting. You're using the antiparasitics in a way to create space then for beneficial flora to start to colonize and start to become more diverse by removing some of the pathogenic organisms, it sounds like?

[00:25:44] DR. SANDISON: Yeah. And, also, if we can get rid of those bigger organisms that are harboring the smaller ones, then now we don't just keep recolonizing with the viruses, and bacteria, and fungus that are inside those organisms. Right? It's a way to reduce that exposure as well. Not just make space. But, yes, I do think of the gut as sort of like a neighborhood. It's like real estate. If we're going to move out the bad guys, we got to make sure we're moving in the good guys.

[00:26:13] SCOTT: Stress plays a key role in health as well. Are there specific practices that you find helpful for your patients that really are having more pathogenic levels of stress? We know that there's hormetic stressors that we need stress, but that it can become excessive. And that then becomes a health-negating component. Do you find that some of the maybe emerging techniques or devices for stress, anxiety, and even vagal tone are helpful for your patients?

[00:26:42] DR. SANDISON: Yeah. Balance, right? If we're out of balance. Dysregulation. Too much, too little, in the wrong place at the wrong time, we're going to have dysregulation and then disease in the system. And stress is just this classic example. What we want is balance. We want to get enough exercise, but not so much that we're decompensating. Hormesis is kind of what we're going down that concept of like we want to stress the system so that we create more resilience. This is a definition of health. How do we respond to stress?

And for many of us, we live in a world that's highly stressful. We're sleep-deprived. We're juggling too much. The stakes feel really high. The world feels like it's falling apart. How do we manage our stressors? And there are a huge number. Whatever your flavor, there's one out there for you. There is always a way to navigate this. I think sometimes it takes discipline, unfortunately. Putting it to work.

Now I love the limbic retraining programs. And Dr. Bredesen, and Dr. Nathan, and I had a chance to talk last week about this and how we think this is sort of an underrepresented tool in the Alzheimer's space. And, especially, I think for caregivers, caregiving for someone with dementia is very stressful. And for some people, traumatic. And so, using the limbic retraining to maintain that nervous system balance I think is a tool that hopefully we'll see adopted more and more.

But I love the Gupta Program, of course. DNRS, Annie Hopper's work. And then the Primal Trust. I think all of those are great tools. As far as dementia and Alzheimer's, there is wonderful research around Kirtan Kriya as a 12-minute. Totally free. This is the Sa Ta Na Ma. There's a vocal component to it. There's a physical component. The hand movements. And then it's a meditative practice. It only takes 12 minutes. And there are review papers published about this and how it gets at these causal level factors. It reduces stress. It balances autonomic system. It actually increases telomere length. But it helps to balance blood sugar. It helps to reduce inflammation.

There's a bunch of different mechanisms at work putting the Kirtan Kriya in place as a routine. Doing it daily for just 12 minutes. I mean, totally free. Very quick. There's no reason not to do it. But there's lots and lots of meditative practices. We find that prayer and prayer practices. I've had patients say, "No. No. No. That's against my religion. I'm not interested in doing meditation." But just doing a regular daily prayer practice, or reading the Bible, a gratitude journal. Anything that helps us to support mindfulness. And taking that time, that quiet time out for yourself. That alone can set the tone for the day.

I personally experience that. My day doesn't feel like complete if – and it did feel sort of off-kilter if I don't drink my tea and meditate for 20 minutes. That time is sacred for me. I protect it, because of my personal experience. But, also, watching patients and how transformative that's been for them.

[00:29:52] SCOTT: And if I remember correctly, that specific practice that you just talked about is outlined in the book step-by-step. What you exactly can do to incorporate that into your routine?

When we think about herpes simplex, primarily HSV1, it has been implicated in Alzheimer's. Everyone alive on this planet likely has this virus. Do you think that it's causative? Do you think it's more of a correlation? Similarly, we know that amyloid is found in the brains of people with cognitive decline. But we also know that it's not causative. How do we know that viruses like HSV1 and maybe even COVID, which will talk more about in just a few minutes, how do we know that those are causative? And then how do you support your patients in dealing with many of these chronic, reactivated viral issues that we commonly see in chronic illness?

[00:30:42] DR. SANDISON: Great question. When we talk about the amyloid – well, let's go to amyloid. Amyloid is very correlated with Alzheimer's. ApoE – when you have ApoE4, you have higher levels of amyloid production. It basically responds quicker to these insults, viruses among them. But when you have that apoE, you create more amyloid more quickly. That's associated with higher rates of Alzheimer's and dementia.

We know amyloid is related to Alzheimer's. But is it causative? I would agree with you. It's not causative. But it does is it begs the question why? What provoked the amyloid? Amyloid is antimicrobial. And so, Lyme spirochetes can do this. We found in the autopsies of people with amyloid plaques and dementia, there are Lyme spirochetes. And, essentially, the amyloid is there. It's developed to protect the brain. And so, this happens with herpes simplex virus 1. It happens with Lyme spirochetes. And it also happens with P. gingivalis. And if you Google or go to PubMed and look at H. pylori and Alzheimer's, there's a connection.

I think that the danger here and what I've seen in some of the research is you know HSV1 should be explored as the cause of Alzheimer's. No. It's one of them. Right? It's one of these insults. That when you stack them on top of each other, you start going in the direction of neurodegeneration. And if you're ApoE4 positive, you go there quicker.

First, what we do is we look for them. That's step one. If someone has some sort of cognitive decline or if they're ApoE4 positive and they're going to go towards cognitive decline and dementia faster than others, then what we want to do is get proactive. Dr. Bredesen calls this a “cognoscopy”. We would want to test for these viruses. We would want to test for the bacteria. We want to have a really good handle on the oral microbiome and understand if gingivitis is showing up. Or latent infections in root canals or in cavitations. We'd want to know that sooner.

And then what do we do? We basically treat as aggressively as we can. With herpes simplex viruses, if somebody is having recurrent infections, if they're having recurrent outbreaks, then – I'm a naturopath. We've already talked about Alinia. Again, I agree. One of my favorite meds. But I'm not shy about using – I don't usually jump towards medications. But I'm not shy about using the Acyclovir or Valacyclovir for people with recurrent outbreaks. Because we see a difference in dementia outcomes for people who aggressively treat and use that as prophylaxis versus those who don't.

Whether your flavor is more of the lemon balm and a little lithium, and, of course, lysine. Or if it's easier for you and your family to do the Acyclovir or Valacyclovir, at least having something onboard for prevention and then aggressive treatment at the first sign of prodrome I think is important.

Now if you come up as IgG positive and you've never had an outbreak, I don't think it's as important to be treating. We want to look for it. See if there's an immune response. But what we're going to do – it's like where's the smoking gun? I think of them is buckets. Is your toxic bucket full? Is your infectious burden full? Is your nutrient bucket too low? Where are we in all of these things? And what's the most important piece for this individual in front of me? And then we can create a priority list. And we want to do as much of it as possible. That's when we see the best outcomes. But I think we're constantly weighing what makes the most sense to do.

[00:34:14] SCOTT: When it comes to a lot of the chronic viruses, one of the things that I found not tremendously helpful is traditional antibody testing. But what I have found helpful in some people is looking more at the T-cell responses with Armin Labs or Infectolabs or something. And sometimes that can give you more of an indication of activity within the past few months. And sometimes it's really surprising when you see someone who had a history of Lyme and coinfections and that's not lighting up at all. And, yet, every single virus you test for is off the charts.

I actually was listening to a presentation recently. I think it was on SOT from Dr. Andrew Petersen. And one of the things that he commented about was when he's treating people for HSV1 or even HSV2, that we oftentimes think that it's a localized symptom-type scenario only. But that he's often surprised by how many systemic issues get better when he's treating these herpes simplex viruses. I think viruses are so important. And I really appreciate your insight on that.

Let's talk a little bit more about the amyloid piece, which I heard about in 2006 from Dr. Dietrich Klinghardt, who's been my biggest mentor over the years. And his comment back then was that amyloid was the body's attempt to resolve a problem. Or essentially the water to put out the fire that it was not the fire itself. Is there value in removing amyloid if the fire is still raging? Or turning off the water if the fire is still raging? Could that make the problem worse? And then building on that, is there value in removing or reducing amyloid if the fire has already been put out?

[00:35:53] DR. SANDISON: Yeah. Great question. And I think that I don't know that anyone knows the answer to this. What we've seen is that if you take out the amyloid and you're not addressing the root cause, for the most part, people's cognition gets worse. There are drugs that remove amyloid and the cognition outcomes are not necessarily positive. You can sometimes slow the rate of degeneration. But that just draws out a torturous process. You are not solving the problem.

In my mind, amyloid, it's a containment strategy. It's like building a wall around the virus, or around the bacteria, or around the toxin, so that it doesn't harm more of the brain. It really is a protective mechanism. But that can get out of control. Just like inflammation. Inflammation is the body's attempt to heal. It's this divine design that's about resolution. However, it can get out of control. If you have inflammation turned on for too long, the cytokines self-perpetuate. And I think that you can have a similar process with amyloid.

Now, Dr. Bredesen, Dr. Perlmutter, the neurologists in this world are – they're so much smarter than I am. They would know the details and the pathophysiology. And they would be able to describe it much more eloquently than I. But I go to – I think what I add to this is the practical how do we implement? How do we get this information and put it into practice so that people get the benefit of all of this great science?

And there's a lot I was sharing with you before we started recording. I have such a reverence for the human body, whether it's the microbiome or the gut-brain interaction. I don't have this idea that I'm ever going to understand it perfectly or know it to every detail and all of the mechanisms. What I do think is that nature has wisdom and that there are things – whenever we can sort of align to how we've evolved, right? If we can go back to these ancestral diets, that is helpful for our microbiome. When we can look at like, "Okay, this inflammation and this amyloid is being created, how can we help the system protect itself? How can we help the system resolve?"

Contrast hydrotherapy, one of our naturopathic tools. Going back and forth between hot and cold water. This basically amplifies that inflammatory process so that we can get to that resolution faster. Instead of suppressing inflammation with steroids that create immunosuppression, and bone health issues, and all of these other issues over time, how can we actually turn this up? Just like we talked about the emunctories. How can we turn up the volume on the natural processes so that we get that resolution faster? And how can we go back to sort of that common-sense natural process over and over again to get better cellular function?

[00:38:39] SCOTT: Suzanne Gazda is a world-renowned neurologist in Texas. Someone that I have just the utmost respect for. She's talked about that, since COVID, she's seeing more and more young people going from fully cognitively normal to having dementia in a matter of months or a couple of years. Not several years or decades like we normally think of it.

I'm wondering what your observations have been in terms of what's changed in patients since the pandemic in terms of cognitive health. And then if we think about some of the Bredesen types, we know there's the vascular type. In the pandemic era, how much more important is vascular health as a result of what people are dealing with from COVID?

[00:39:22] DR. SANDISON: Yeah. I think what you're alluding to is that COVID basically has a slightly different mechanism. Two viruses. We talked about HSV1. How this triggers amyloid production in the brain? And an inflammatory response basically to protect the brain.

With COVID, the mechanism that's proposed here is slightly different. It's that COVID actually creates a hypercoagulable state. So that we're going in the direction of clotting. And that can lead to strokes and more of a vascular dementia-type picture.

And I have seen this play out, particularly symptomatically patients who have COVID, long-haul COVID, got exposed to COVID, the virus one way or another and then ended up not being the same after. Brain fog. Not always just brain fog and memory issues. And their memory issues tend to be less sort of specifically – dementia and Alzheimer's have this pretty classic, like, "I can't remember words. I lose my train of thought. I'm more easily overwhelmed." There's sometimes some behavioral changes. Personality type changes. And with the post-COVID kind of brain changes, it's like people will describe, "I'm walking through a fog. I feel like there's a spider web in front of me." And it's more of kind of like a Lyme picture. The symptoms are more nebulous.

I followed the Patterson Lab out of Stanford. We do the cytokine testing. And I'll use a little bit of Maraviroc, Selzentry. That medication that specifically lowers RANTES. I've seen that be well-tolerated in people. I've seen it be effective in reducing inflammation. Also, pro-resolving mediators. Much easier come by. But things like SPM Active is the one that I tend to use that can help to reduce that inflammatory process and kind of reset that runaway – the Cell Danger Response, if you will. This runaway train of cytokine production that is associated with COVID exposure.

And then, of course, from the vascular perspective, fish oils. But, also, Serrapeptidase, Nattokinase, our enzymes, those proteolytics that can get in there and break up that potential for coagulation and reduce that risk. I think those are strategies. And they're part of a multi-pronged approach, I think for anyone. And a precision medicine approach.

We talked about this, right? COVID being this great example of some people die and other people never have a symptom. And some people have long-haul COVID. Other people have a sore throat for two days and then it's totally gone. What's the difference? What I've seen over and over again, the people that ended up with long-haul symptoms or more pronounced symptoms, they had a high-heavy metal burden. They had a high viral burden already. They had something else that was creating a host that was ripe for this virus to take hold.

[00:42:09] SCOTT: With early-onset Alzheimer's, in the book, you talk about APP and the PSEN gene. Wondering if those are correlated to apoE. Or are they entirely different genetic risk factors? And then given that these are only in about one out of a hundred people in the population, how often do you see early-onset Alzheimer's, or signs of dementia, or cognitive decline in people younger than 65?

[00:42:35] DR. SANDISON: Yeah. Right. Kind of twofold. Early-onset Alzheimer's that's associated with APP, PSEN1 and 2, these are quite rare. This is not the majority of Alzheimer's. And this is very different from the apoE genetics. ApoE is for the late-onset Alzheimer's.

And the language gets confusing here, because early-onset Alzheimer's typically shows up 40s, 50s. Before 65. And the late-onset associated with apoE shows up typically after 65. That's kind of our line in the sand there. It's arbitrary. But generally speaking, right?

And the apoE, what we are talking about is this, right? Is that late-onset Alzheimer's. We know what to do. We see in the literature, we see in our studies, in Dr. Bredesen studies, this helps people delay and prevent Alzheimer's associated with apoE. With APP, PSEN 1 and 2, these early-onset Alzheimer's, I think that it's worth doing these strategies. These are health-promoting strategies. But we do not have as much literature. It's much less rare. And I think that it's a much harder lift to prevent, and delay, and reverse that.

Now, I want to also say that these are – you have these two distinctions between these two types of genetically-related Alzheimer's. Now, that being said, what we see is that late-onset Alzheimer's. And so, the language here gets so confusing because we're saying early-onset Alzheimer's and late-onset. That's about the age when it happens. How many years old you were? What year you were born and when it's happening?

But a lot of people will say early-onset Alzheimer's. And they're talking about their mom who has the early stages of Alzheimer's and she's 85. I just want to make that distinction there. That is late-onset Alzheimer's in its early stages. Mild cognitive impairment maybe.

Now, in people with that late-onset Alzheimer's, we are seeing that happen before 65 more and more often. And this is because of a standard American diet. This is that downward spiral of lifestyle standard. American diet, sedentary lifestyle, toxic exposures. Maybe living in a moldy home. Or eating too much tuna. Or whatever it is. Having parasites. And then sleep deprivation. All of the these really common lifestyle factors that happen in the Western World.

[00:44:53] SCOTT: Modifiable risk factors for dementia have said to include less education, hearing loss, traumatic brain injuries, which you mentioned, hypertension, weight, alcohol consumption, sleep, physical inactivity, depression, type 2 diabetes, smoking, you mentioned, social isolation, and air pollution, which you also mentioned. Fortunately, a naturopathic, broad, holistic approach to health like you talk about and like Dr. Bredesen talks about really considers these and many other factors in improving cognitive health and overall health.

And in the book, you list eight practical and magical tools as part of your Alzheimer's toolkit. And those include a nutrient-dense, high-fat, low-carb, ketogenic diet, exercise, brain-stimulating activities, a supportive daily routine that reduces stress, a non-toxic environment, restorative sleep, loving communication and care for the caregiver. Let's dig into some of those. And let's first start with diet.

I've seen many people that have shifted their diet to a very healthy high-nutrient dense, low-carb, high-quality, high-fat diet. And, yet, oftentimes it seems like they still need exogenous ketones to more consistently remain in ketosis. How do you get that population more consistently in ketosis where they don't have an ongoing reliance on exogenous ketones?

[00:46:23] DR. SANDISON: Yeah. Typically, people become pretty keto-adapted and I think a high-fat diet. Oftentimes, there's all kinds of things that we mitigate here. And people have all kinds of challenges. Keto is where we get the vast majority of the questions. And so, with my patient population, typically, women over 65. And we're concerned about frailty. We want to make sure this is a high-calorie diet. Not a low-calorie diet. It's a low-carb diet. And then we're also using exercise to keep the muscle mass on. And maybe go shift the body composition. That shows up.

I'm having trouble getting into ketosis. Sometimes intermittent fasting will help to get people consistently into ketosis. But we run into that frailty issue. We don't want too much weight loss. And so, we're always balancing multiple things here. But getting into ketosis, we can add intermittent fasting. We can add exogenous ketones. And I don't see a reason to not do that long term. And particularly for someone who's not ready to be fully carb-restrictive, you can add ketones. You can add MCT oil. You can add coconut oil. The backbone, coconut oil and MCT oil turn into beta-hydroxybutyrate or that ketone that our brain will burn as fuel.

And so, you don't have to go all the way out. Though, I would love for people – but I don't – I'm hesitating a little bit, because I don't want to send the message that don't go into ketosis. But if you're not quite ready to fully jump into that, there are people that get the benefits just from adding the exogenous ketones.

Now, staying in ketosis. I actually don't recommend that people stay in ketosis forever. I think that we get benefits of metabolic flexibility going back and forth. And I get the practicalities of I'm going to Italy for a week and I want to enjoy the food. Or I'm going to a graduation or Thanksgiving and my in-laws are cooking. And I don't want to be that pain-in-the-ass guest who's coming and showing up and has to eat my own food. And so, I think that it's normal to go in and out of ketosis. We go through airports. Stuff happens. But then getting back into ketosis, when we have more control and we're in our own environment is important.

And I think that what I've seen clinically is that when people go back in forth and when they fully commit, they get their fats up, some people as they ate – the over 65 crowd remembers that food pyramid from the 80s and 90s that was lots and lots of grains and afraid of fats. And so, we have to retrain that so that we're not getting low calories. That we're not restricting fats and carbs because we're afraid of the fats. And really get the fats up. And that will help give us the substrate for ketones.

There's so much we could talk about here. I think I wanted to mention the Ornish paper that came out in early June, which was a lifestyle intervention. And the conclusions were – I mean, it just gave me chills. It was really exciting. And I was disappointed, of course, that he did not mentioned Dr. Bredesen. But, still, what they did was a five-month intervention. And it was the first randomized control trial.

And the conclusions that they drew were that – I want to read this specifically. That comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with mild cognitive impairment or early dementia due to Alzheimer's disease. This is a really big deal, because it's the first randomized controlled trial to draw this conclusion.

And the improved part is important, because the medications that are available do not improve the cognitive capacity of anyone. What they do is they slow the rate of decline. And so, this is an improvement. This is really meaningfully important. And this is after only a five-month intervention.

Now the reason I bring up this study right now when we're talking about ketosis is that what they did was a vegan diet. You don't have to get into ketosis to improve cognition. I think that it's important. I think that there are reasons why it's particularly brain healing. But I think I also – the ideal diet, if you want to reach for the ideal, would be to go back and forth between a plant-based diet and a ketogenic diet in my mind. Get in and out of ketosis. When you're not in ketosis, eliminate all processed carbohydrates, all processed foods entirely. But add starchy veggies. Things like sweet potatoes, seasonal fruits potentially. And then go back into ketosis. And go back and forth and back and forth. And that that would be the best diet. This is kind of an ancestral diet. This is what you – our ancestors did not consistently stay in ketosis. They didn't consistently stayed in glycolysis. They went back and forth, because we didn't have blueberries available 365 days a year.

What was consistent about that diet was inconsistency. It was that some things were available in the fall and other things were available in the spring. And so, I think that that probably will turn out to be the best brain healthy diet. And then getting into ketosis all the time in my mind is not the goal. It's the metabolic flexibility and keto adaptation. So that when you go to get back into ketosis after taking a weekend off, you actually get there much quicker. Instead of 72 hours, you're back in ketosis after 24 hours.

[00:51:19] SCOTT: Unfortunately, our ancestors didn't know how to make the sweet potato fries.

You talk about the importance of fats that can then be metabolized into ketones. I personally put three tablespoons of fat into my morning power shake. Wondering what some of your favorite fats are for supporting the brain, for supporting the myelin, our nervous system, our nerves, the membranes of our cells. And then are there some with cognitive decline where some fats may be contraindicated? If we have ApoE4/4 or maybe 3/4, do we need to be careful about too much fat?

[00:51:59] DR. SANDISON: Yeah. I'm a big fan of Dr. Mary Newport's work around ketosis and the benefits for brain health. You may have heard of her story. She supported her husband who was diagnosed with Alzheimer's. Gave him coconut oil and watched his MoCA basically go up over a matter of days. And so, there is a lot of research on ketosis for dementia. Again, I don't think it's the only way to get benefit. But I do think that it has particularly healing benefits.

In coconut oil – and we've talked a lot about the microbiome. The oral microbiome. The gut microbiome. Coconut oil has not just MCT oil, which that median-chain triglyceride is the backbone for beta-hydroxybutyrate. A ketone that we can burn as fuel. But it also has Lauric acid in it. And that can help with the oral microbiome. Oil pulling. We can use coconut oil for oil pulling, which I'm a fan of. Because we know that gingivitis can trigger amyloid plaque production in the brain.

But, also, as we swallow coconut oil, this can help to balance the microbiome in the gut. It's mildly antifungal and mildly antimicrobial. And so, we get that benefit using the whole coconut oil instead of using just the MCT oil. But phosphatidylserine, phosphatidylcholine. Of course, eggs that have choline in them. So beneficial for brain health. Avocado, avocado oil, of course. Or olive oil. There was a recent olive oil study that consuming some pretty small amount, like a very normal amount of olive oil, reduces your risk of Dementia by 30%. We can definitely put these foods to work as medicine.

And I think fats are the substrate. Fats are – you mentioned the myelin sheath. Our brain is made out of a ton of fat. We need enough of it. And we want to avoid – the apoE discussion, I think that the – Gundry, Bredesen, Perlmutter, they're cautious of saturated fat. MCT, medium-chain triglycerides found in coconut oil are a saturated fat. Now they're the shorter ones, like the C8. That's the number of carbons. There's C8, C10, C12. If we get the shorter ones, there's probably less risk. Longer saturated fats that are found in processed oils, these are more dangerous for ApoE4.

And so, then the question is are these coconut oil, these medium-chain triglyceride oils also more dangerous because they're also saturated? And Mary Newport would say no. Bredesen, Gundry, Perlmutter would say yes. That you should avoid them.

My clinical experience has been that you don't need to avoid them. That we see people with apoE3/4, 4/4, and we watch their lipids very closely every 12 weeks. And I don't tend to say avoid coconut oil. Because I feel like it gets very restrictive and it's harder to get into ketosis if we do that. And what I want is for them to just get into ketosis and see how they feel. See what happens to their cognition.

And then we watch their advanced cardiometabolic markers very closely. And we see LP(a) improve. We see HDLs improve. We see LDLs improve. And so, I think that as long as you're working with a provider and you're watching your lipid panels closely, that you can have some coconut. And then if it's not going well, try taking the coconut out and see what happens. But I don't think that there's increased risk based on my clinical experience.

[00:55:25] SCOTT: All right. I had a tablespoon of olive oil this morning. I'm on a good path there, I think.

[00:55:32] DR. SANDISON: Olive oil is one of like the most contaminated products. It's like honey and olive oil. They have the most counterfeit products on the planet. And so, I'm always like make sure you know your farmer. Know where your olive oil is coming from.

[00:55:45] SCOTT: I've seen some people with very high lipids, including high apoB, which I don't know that we always even look at. I would say most practitioners maybe don't even order that. I see people with elevated small-density LDL as well. Maybe they've already done red yeast rice, which has its own potential problems that I know you talk about. Maybe they've done bergamot. Maybe they've done other things for lipid balance but still are not in a normal or healthy range. How do you approach balancing lipids particularly in those that have these kind of recalcitrant apoBs and small-density LDL? Is that something where you would then move to a drug? Can we do it naturally?

And then maybe broadening that out just a bit, when do you consider high cholesterol to be more pathogenic versus potentially supportive in terms of serving as a raw material to create hormones and other restorative, regenerative materials in our body?

[00:56:46] DR. SANDISON: Yeah. I don't aim for a total cholesterol under 200. I always am running an apoB. I'm always running sdLDL. Always running LP(a), Lp-PLA2. We're looking at these advanced cardio metabolic workups, and especially those lipid panels. We want to know not all cholesterol is bad as I think you're alluding to. But is at high-risk for developing atherosclerotic plaque? Are we going to put somebody at risk of vascular dementia because their cholesterol is elevated?

The strategies. You mentioned some of them. The supplements. The niacin, and bergamot, and the amla. And there's a bunch of herbs that we can use, that if taken regularly for some people, those work. Those do the trick. Not for everybody. Then, of course, there's diet and lifestyle things. If you have that familial hypercholesterolemia, no matter what you do, no matter what you eat, sometimes we can never get that down.

Then we go towards like the drug strategies. I've already mentioned cholestyramine as a binder. Cholestyramine is called cholestyramine because it was designed to bind bile and reduce cholesterol. It's not that good at it. But it can move the needle somewhat.

And so, I do have patients who take cholestyramine to reduce their lipid panel – to basically optimize their lipid panels. And sometimes that's enough between bergamot, and diet, and exercise, and some cholestyramine, we keep them in range. I am becoming more and more a fan for those people who they don't want to take a statin, their cholesterol levels are up, their total cholesterol is up over 300, 350. I'm nervous about it. I don't want to be responsible for them having a cardiovascular event or a stroke.

And so, Zetia, or this is a something that reduces absorption. This is an alternative to a statin that reduces the absorption of cholesterol. And I think that that – I think the studies have mostly been on a statin plus Zetia. But bergamot, plus cholestyramine, plus Zetia is another basically alternative. And then we can continue to watch those lipid numbers and see if that gets us into the range that we're looking for that cardiology, and primary care, and everybody's comfortable with.

I think when there's family history – my dad died in his 50s. And I want to be around for my grandkids. There can be a big – an emotional sort of investment. Like, "I want to make these numbers work." And I get that. And I want to be supportive of that. Now, statins, I think there's also this conundrum that comes up in many families dealing with Alzheimer's, is my mom or my sister's in charge of my mom's medical management. And I don't want her on statins. But my sister's husband is a medical doctor. And he thinks that it will kill her if she comes off of them. Put her on CoQ10. Do what we can to manage the risks associated with statins. Think about doing Crestor instead of Lipitor. There are ways to reduce the risk associated. And I think being stressed about not having control, that's worse for your health than just kind of working with them to figure out – sometimes, than to figure out how to manage those risks. Because, yeah, it's really challenging the dynamics that come up in families when we're so certain. Like, that's the wrong way to do it. And then someone else is so certain, "No. If you do that, you're going to hurt them." And I think that there are ways to come to solutions and compromise, and especially in this realm of the cholesterol. Because we have a lot of tools in that tool belt.

[01:00:20] SCOTT: Let's build then on the lipid conversation and talk about plaques in our arteries that can impact cognition, can lead to other serious health complications. We can do things like a coronary arterial calcium scan. But now we can also do things like CLEERLY AI that can look at soft plaques that maybe have not yet calcified. When you use these tools that are available to us now, how often do you find that there is a need for therapeutic intervention relative to plaques? And what are some of your favorite tools for removing or reducing either calcium or soft plaques in our arteries? Are we talking about nattokinase, or serapeptase, or EDTA. Or what are some of your favorite blood flow and vascular health optimization tools?

[01:01:07] DR. SANDISON: Yeah. Arterosil is another one. I don't tend to use EDTA these days. I'll use a little bit the Interfase Plus product that Neil Nathan talks about. Will use as a biofilm disruptor and also potentially to clear some of those calcium plaques out. But I don't tend to use as much of that. Because most of my clients – most of my patients are women over 65. And I'm worried about their bone health. And so, as much as possible, I try to stay away from chelating agents.

If we're going after tetals, I love the IMD product from Quicksilver. I think that does the trick there. And then when it comes to the plaques and that kind of thing, Arterosil, the lifestyle pieces, of course, the fish oils. Yes, the serratiopeptidase, nattokinase. Is it Boluoke?  I never know how to say that word. Yeah. That's one of my favorites. A lot of people will notice, those can open up biofilms.

And so, if you're feeling worse afterwards, please connect with your provider. Because it means there's something there. We have unleashed something. And so, you want to take that opportunity to go ahead and resolve whatever infection we might have stirred up.

I think that also important to remember, Lp-PLA2 is one of these markers that can indicate gingivitis. And when a conventional doctor sees that elevated if they run it, they're sending you off to cardiology because it can increase our risk of cardiovascular events. Now what's happening though is that P. gingivalis the and the gingivitis-causing organisms get into the bloodstream and they create inflammation in the arteries. And they create inflammation in the brain. All of these things are interrelated. We can't separate them entirely. Why are those plaques forming? Why is there irritation in the endothelium that's creating a happy home for plaques? Sometimes it's infectious. Sometimes it's toxins. Toxins can create inflammation in the endothelium as well.

And so, looking – again, going back to these causal level factors. What is my toxic burden? If I can get rid of that, can that improve my cardiovascular health? Yeah. What about the infectious burden and resolving that? Will that improve cardiovascular health? Yes. And cognitive health. Right?

We can't separate brain and cardiovascular health. They are one and the same. And they have the same causal level factors. Toxins, nutrients, stressors, structure, infections, and signaling. And so, I think going back to those pieces to look – and, of course, there's these nuanced approaches to helping support healthy blood flow. But, really, the connection is plumbing. Right? Can we get blood flow to the brain? Can we get blood flow to the coronary arteries? If so, we have a healthier system. Because then we're getting nutrient supply. We're getting oxygenation. We're getting toxins out.

If we have start to have issues in the plumbing because there's clogs in that, there's plaques in that, or we're getting ischemic events, we're getting full ischemia because we're getting a full blockage, then we're going to have issues downstream in the tissues.

[01:04:08] SCOTT: Do you sometimes find that the coronary arterial calcium scan looks pretty good, but then the CLEERLY testing that can look for soft plaques may reveal a slightly different picture? And it's interesting, because it seems like conventional medicine thinks that once you have soft plaques, the only thing that can happen is for them to become calcified. My thought process is, well, why would we want to wait for them to then become calcified? Why can't we use some of these tools to reduce or eliminate them in the state that they're currently in?

[01:04:41] DR. SANDISON: Yeah. And also, conditional medicine will say, "Oh, you never need to repeat a coronary calcium score, because it's not going to go away." But we see that you can get improvements. And so, I'd have to wait at least two years to look at those again. Because it takes time. But using some combination of these things, it should help to improve those.

[01:05:01] SCOTT: I've seen some people that are on higher protein, high-fat diets that have pretty solid-looking glucose patterns when they do a CGM. Maybe over a two-week period, their highest blood sugar is in the 120s. Their average is like 92. And, yet, they still have a slightly elevated fasting glucose. Either in the upper 90s or low 100s. And I've heard some people, Gabrielle Lyon comes to mind, talk about the fact that people that have higher protein diets, that maybe they're using less glucose. And so, maybe it's not so much of a concern that they have a little more glucose in the blood. Wondering if you see that. And how do you know when a slightly elevated fasting glucose is a problem versus potentially not a concern?

[01:05:49] DR. SANDISON: Gosh. That's so interesting. I think that if I saw that A1C was normalized, it was below 5.6, if I saw that fasting insulin was well below 10, if I saw – I don't know that I would take one number and have a cause for concern, especially when we can triangulate. I would think, "Okay, if you're using a CGM and you're mostly in the 70s, 80s, maybe low 90s, we're on track. We're doing the best we can probably."

I love the CGM. This is just such a phenomenal tool. I wish it looked at ketones, and cortisol levels, and all of these other things continuously. That's my wish for the future. But the CGM, it's so insightful. And doing this once a month for 10 days or for a couple weeks, it can be so insightful. And then it gives us this ability to test. I'm not going to claim to know exactly what's going on with high protein, and the fasting sugars, and all of that for that individual. But I bet that what we could do is we could say, "Okay, let's reduce the protein a little bit. And let's increase the fat. Does that change it? What about if we add a little bit of carbohydrates and we cycle carbohydrates, what changes?"

I think that there's so many different things that we can start to test in one trial and see for me as an individual how do I respond to different changes? Because it's not just foods. I know that we like to kind of simplify it and fully understand it and say, Okay, it's the foods that I'm consuming that are affecting my blood sugar." But stress affects blood sugar. Exercise affects blood sugar. Sleep affects blood sugar.

And so, I think that, hopefully, if we can isolate variables – depending on how nerdy you are and OCD you are, you can isolate these variables. Figure out what's causing these changes or what gets you these changes. I mean, we do the same thing with sleep. I'm wearing an Oura ring. And I want – how do I get my REM sleep up and my deep sleep up? And if I change the temperature of my bedroom, will I – yeah, you've got one there too. Will I get slightly more deep sleeper? Will my fasting blood sugar go down a little bit? And I think all of these variables have an impact. And what difference it's going to make for you as an individual? Do the experiment. Run the experiments. It's really fun.

[01:08:02] SCOTT: Yeah. And it's kind of interesting with fasting glucose, because I think we know that as cortisol rises, blood sugar can also rise. And when is cortisol highest? Well, ideally, in the morning. Right? In some ways, I mean, you would kind of expect fasting glucose to be maybe when it is going to be a little higher because you have that cortisol spike as well.

I think everything in healthcare changes when we can get a wearable that shows blood glucose and ideally not EMF, Bluetooth, Wi-Fi connected, all that stuff as well.

When we talk about exercise, we want that hermetic response that we talked about that is positive, that builds the body. Rather than being too aggressive can be then more damaging. I have historically prioritized walking. I try to walk about four miles a day. But I also love all of my devices. I love my exercise with oxygen therapy. I'm a huge new fan. Literally, this is just the past couple weeks of something called the CAROL bike, which is a cardiovascular respiratory optimization logic that uses what's called REHIT, or reduced-exertion high-intensity training. I think it's incredible.

Wondering what approaches do you find are most supportive in the exercise realm for cognitive health?

[01:09:15] DR. SANDISON: Yeah. One that people may not have heard of is dual-task exercise. This is dual, as in two. Where you're exercising cognitively at the same as physically. And you might be doing this without even realizing it right. The simplest example of this is walking and talking, where you're engaged cognitively, but you're also moving.

And I think there are stories of Einstein. He never sat down at his desk. If he really wanted to think of something new and creative, he was out on a walker. He was pacing the halls. He's moving at the same time he's thinking. And so, there are tons of examples of doing this. But we see in the literature is that you get more benefit from your exercise when you're cognitively engaged at the same time when it comes to cognitive outcomes.

You might as well – I mean, I'm a queen of efficiency. I've got to do things, as many things at the same time as possible. And so, if we can go into a class where you're queued by an instructor, a Zumba class, or a Pilates class, or a ballroom dancing class where you're queued by the instructor. And then, cognitively, you have to stay engaged and physically you're engaged.

Now, ballroom dancing, you start to check multiple boxes, because there's social engagement, there's cognitive engagement, there's memory. You got to memorize the steps. There's musical. The auditory parts of our brain are lighting up with the music. There's a lot of different things happening with ballroom dancing.

Pickleball is another great example. You've got hand-eye coordination. It's social. You're often outside. Maybe it's new for you. So there's strategy involved. And then there's movement involved. You're getting your heart rate up. There's lots of different ways to do this.

And sports, I think – and fun. Of course, having fun is one of the most important pieces of this. We learn better when we're having fun. When we're under less stress, we cognitively – we remember more. We're able to come up with more. We remember words. Also, process more. And then we're also just more likely to do it long-term. It's more likely to become part of our routine if we're enjoying ourselves.

And so, I always want to drive that part of the message home around exercise. For people who don't like exercise, find a way to trick yourself into it. Do it with someone you love. We notice at Marama, at the residential care facility where we have an immersive experience on this. When the hot PT guy shows up, all the ladies are like, "All right. Tell me what to do." They're like jumping to it.

And so, figuring out what are my motivators? Do I love seeing my sister? And she always makes me laugh. And she would love to go for a walk with me every Thursday morning. Schedule it. Make it part of the routine. You'll look forward to it. You'll enjoy it.

I know that for me, if I pay for a class, I'm too cheap to not show up and lose my money. I schedule them and pay for them in advance. And I know it's going to motivate me to get there. Also, if I'm showing up for a friend, I'm more likely to show up than if I just say, "Oh, I'll go for a run in the morning by myself," I might find something else to do instead of that.

And so, I think with exercise, we want to use some of those. The atomic habits, these ideas of like what helps us create habits. Make it easy. Make it fun. Schedule it. Make it part of the routine. So that we stick with it. With exercise, really, movement is crucial. If we can get about guidelines, our 200 minutes a week of moderate to vigorous exercise. Some combination of strength and aerobic. And then wherever you can, make it dual task. Make it cognitively engaging as well.

[01:12:35] SCOTT: Sleep apnea is a common issue in many with health challenges, including Alzheimer's and dementia. One of the challenges I've seen is that CPAPs can readily grow mold and then you're trading one problem for another. How do you tell your patients to maintain their CPAPs to avoid that potential mold and mycotoxin exposure? And then what are some alternatives to CPAPs to improve oxygenation while we're sleeping? How often do you find mouth taping can be a significant intervention?

[01:13:05] DR. SANDISON: Yeah. I think that I've had two patients in the past couple years where they had MoCA scores of eight. MoCA, normal is 26 and above. 30 is perfect. Eight is advanced. Right? This is severe cognitive decline and Alzheimer's most likely. And two patients, we realized that – and they were thin women. They were not classic overweight men that snored. Two women who were thinner. They either didn't have partners or their partner was hard of hearing or slept in another room. They had sleep apnea. Severe obstructive sleep apnea, both of them.

And when we got them on CPAPs, their MoCA scores nearly doubled. I mean, both of the families said, "I got my mom back." It was a dramatic improvement in their cognition. And although we did all the other stuff, I think that what did the heavy lifting was treating their sleep apnea. I think it made me realize that there probably is a lot of undiagnosed sleep apnea contributing to Alzheimer's. And this is a suffering that can be avoided. What it takes is advocacy.

You asked about cleaning. I think this is a really great point that you bring up, is what if it's moldy? What if our CPAP is moldy? And so, there's different ways to do this. I refer back to the manufacturer. There's lots of different types of machines. But I think keeping your machine clean. Making sure that's part of the weekly routine or daily routine, whatever it is that that's recommended for that machine. And then taking it in. Having it tested. Getting them repaired and getting them replaced regularly.

And this becomes a chore. But make friends with your sleep doctor. I think it's so important. Because the masks don't always fit. Or sometimes they fit for a while and then you lose weight and now it doesn't fit anymore. And maybe the apnea isn't fully resolved.

You brought up mouth tape and other alternatives. I basically think of three or four options. There's the CPAP, which is the continuous pressure option. Some people love this. It can take some getting used to. It does require keeping clean. Some people prefer the APAP, the alternating pressure. This basically doesn't have that same continuous pressure. And it seems to be more comfortable and allows people to go to sleep more easily. It's a little bit easier to get used to. And some people will call it the Cadillac of apnea devices or CPAPs.

There also are travel versions. There's one that comes with a little pillow instead of having to wear a big mask. There's some that come with a mask that goes up over the top. Some that go to the side. And so, there's lots of different types of devices. And if you don't love the one that you're using, find one. Keep trading them out until you find one that you like. Because it's so crucial that you get – that your airway stays open. That you get oxygenation to your brain at night.

Now, there are oral devices as well. And, typically, you want to go to a dentist who specializes in this. But there are ways to keep the airway open at night using a mouthpiece.

Mouth tape. Again, I think very underutilized, but popularized by Breath, the book Breath and James Nestor. The literature suggests that we can treat mild sleep apnea with mouth tape. Probably not obstructive sleep apnea. But mild sleep apnea can be treated with mouth tape. We also see improvements in allergies, and anxiety, and cognition, of course. But mental health generally.

I think that we need to breathe through our nose at night. There are so many reasons why we don't. A lot of it is because we tend to eat softer foods. So our palate and bones of our face are not designed to have more soft foods. And so, the more that you can crunch and eat harder foods. Our ancestors nod on bones, and bark, and all kinds of things for hours and hours each day to get enough calories. And we don't do that anymore. We can get a lot of calories in very soft food that doesn't require chewing. And so, this has narrowed our airways.

And there's different devices to basically expand the pallet. There are types of mouth guards and like orthodontia that can do that at some level. There's different ways to come at this. Losing weight can be very helpful but doesn't always arrive at the resolution of sleep apnea. Work closely with a sleep doctor. Know that there are lots of options out there. Don't stop at, "I don't want to wear a CPAP." This is so crucially important to brain health. And like I mentioned, I'm very concerned that there is unidentified, untreated sleep apnea contributing to the tsunami of people affected by dementia.

[01:17:35] SCOTT: Given that sleep is so critical, I want to dive a little bit deeper. In the book, you talk about a number of supplements, and herbs, and other tools for sleep optimization. We just touched on the importance of oxygenation for sleep as well. What are some of the other key things that you find move the needle the most or maybe things that people are doing that are impacting their sleep negatively? Do you find blood sugar is a common issue? What are some of the things that really have shifted sleep for your clients?

[01:18:03] DR. SANDISON: Yeah. Great question. Many people will say I hear you saying that sleep is so important for my brain health. But I'm trying. And I can't. And so, then what is it? Are you having trouble falling asleep? If you're struggling to fall asleep – I am a fan of melatonin. I usually use smaller doses. But melatonin is antioxidant. There's a lot of benefits outside of just sleep for melatonin. Now if it causes grogginess in the morning or you get really crazy dreams, there are other options as well.

Ziziphus – traditional Chinese medicine has options for falling asleep. And I like to kind of go down those herb pathways. Or we can use things like lemon balm, like theanine, taurine. There are herbs. Poppy. And then, also, the amino acids. Sorry. I started listing those together. But there's herbs that we can use like poppy, and lemon balm, and valerian plant. Lots of herbs. And you'll see them kind of mix together in some formulas. Or there's sleeping time teas and stuff like that we can use and make a ritual out of it. Kind of wind down.

And then there's amino acids. Inositol, you'll find with these. And Inositol is actually really great, because it helps to prevent amyloid plaque deposition. Inositol, it can be very calming. This is more of in the sugar category, but doesn't raise blood sugar. But you'll see it combined with things like magnesium, and taurine, and theanine, and glycine. The calming amino acids that support the production of our neurotransmitters that help to relax the system.

5-HTP. As long as you're not on an SSRI, 5-HTP is a great product for helping us stay asleep. If you have trouble getting to sleep, these herbs I listed, melatonin. And, of course, all the sleep hygiene practices that we can go down that path if you want. But for many people, it's the staying asleep that's a problem. I get to sleep just fine, but then I wake up.

Cortisol. We talked a little bit about cortisol. Phosphatidylserine. And there's a product called Seriphos that I really like. That can help us to metabolize cortisol. And for many people, that will help us to stay asleep longer. Also, a 5-HTP – melatonin helps us get to sleep. Serotonin can help us to stay asleep. And 5-HTP can be the backbone for that serotonin production. Just don't take that if you're taking an SSRI or an anti-depressant. Talk to your provider before you jump on that one.

I'm also a big fan, Christine Schaffner. I'm sure you know her. She created a product called Somnium, which is a topical GABA cream that I personally sleep much better when I use. And that's nice, because you don't have to swallow anything. You can just apply a cream at night. Somebody has a pill fatigue and they're already swallowing too much, that's a great option as well.

Lion's mane is another great one. I mean, the list just goes on and on here. There are so many things. I'm a huge fan of HonoPure, the honokiol product. It's a magnolia bark that you can take before bed. Also can be beneficial for sleep. There are lots and lots of things to try. If you feel like you've tried them all, take a look at the list in the book. Hopefully, you'll find something unique there that might help you get some better sleep. Getting into a meditation practice before bed typically will help with sleep. It might not help the first night. But a consistent practice will reap rewards certainly.

[01:21:19] SCOTT: And based on Neil Nathan's latest book The Sensitive Patient's Healing Guide, for many reasons, I've become a fan again of Epsom salt baths. And with the magnesium, that could be another nice one for sleep. But it also helps sulfate deficiency, and balancing oxalates, and whatnot. Starting to feel like that's a tool that's so simple and very much underutilized in many chronic illness protocols.

[01:21:40] DR. SANDISON: Agreed.

[01:21:41] SCOTT: How much do you feel that genes play a role in Alzheimer's? We know about apoE. We know about APP, PSEN, some of the others that you talked about earlier. And that they're not our destiny. Do you think genes are more key or more causative? Or do you think that it's more the epigenetics and that our genetic expression is determined and influenced by our environmental influences? And then when do you think we'll move away from looking at SNPs and the potential for problem with detox, with blood flow, with so many other things? And to tests that actually are exploring how a gene is currently expressing?

[01:22:23] DR. SANDISON: Yeah. ApoE, we know this is absolutely increases risk for Alzheimer's. And I think even 10, 12 years ago, I had patients saying, "Well, why would I even test that?" This is a single nucleotide polymorphism. It's a SNP. It's a very simple genetic test. You don't have to go to a genetic counselor. This is simple easy. If you've done 23andMe, you know your apoE status. Or it's somewhere in the data. What we see is that the general population has a 13% chance of developing dementia. If you have one copy – apoE, we get one from mom and one from dad. It can be a 2, 3, or 4. If you have one copy of ApoE4, your risk goes up to 30%. If you have two copies of ApoE4, one from mom and one from dad, ApoE4/4, your risk goes up to greater than 50%.

There was a recent nature paper that essentially said, if you have ApoE4/4, you're destined to get Alzheimer's at some point. I don't think that that is an appropriate conclusion to draw. I think that we can do a lot. Now I think what's true here, the conclusion that I come to is that you do have a higher risk. What's going to happen is that if – this is about where the amyloid protein is cleaved.

If you are more likely to cleave it in a different place, you're more likely to create the amyloid plaques, this protective mechanism. But you're going to be on the defense quicker. You're going to be in that attack and defend mode more often than you're in the regenerate and heal mode. And there's risk associated with this.

How do we reduce that risk? I think it gives us clear direction. If we know our apoE status, what we have to do is we have to start in our 20s and 30s to make sure that all of the risk factors we have control over we are modifying to our benefit. We're getting enough sleep. We're getting in and out of ketosis. We're avoiding processed foods. We are maybe taking some supplements to protect our brain. We're engaging in positive relationships and managing our stressors and we're getting regular exercise. We need to take care of these foundational pieces and not wait until we're 40 or 50 or when we're starting to notice decline. We have to do it sooner.

That's kind of my answer to like how much of a role are genetics playing. They play a role. They're part of the picture. They certainly can put people at risk. We need to do more. I don't know if you've come across Breaking the Age Code by Becca Levy? She did the research that shows that people with a positive association with aging live seven and a half years longer than those with a negative association with aging. And that you can actually negate your apoE risk by having a positive association with aging.

People who live in societies that revere their elders actually do not have cognition that worsens with age. We sort of assume, "Oh, I'm just getting older. I'm having these senior moments. It's normal for my cognition to decline as I age." It's not.

In the deaf community in the US, that culture reveres the wisdom of their elders. And they actually have better cognitive scores as they age. They get smarter as they get older even with apoE genetics. There's something going on about how we think of aging and just what we expect.

And so, I mean, that's a whole another piece of the puzzle. But you also asked about single nucleotide polymorphism, detox pathways. And kind of I think of Bob Miller as kind of being the expert in this and really good at the nuances. Of course, Paul Anderson as well. And looking at these – my clinical experience at least 10, 12 years ago was that the more people looked at these, the more complicated things got and the more they started to go into this feeling of like, "I can never take that. And I can never do this. And I'm always going to have that."

And I thought that that felt very disempowering. I have moved away from looking at that. It also was extremely expensive. Now, Bob Miller, I think that he makes it really accessible. And then you get the video. And so, you can go back to it, because a lot of it goes over my head even now having learned a lot about genetics over the years. How meaningful is it? As you kind of alluded to, I feel that the epigenetics are much more important.

If we're looking into the genetics and we don't have the nervous system balance, and we're not eating a healthy diet, and we're not prioritizing our sleep, I kind of feel like we're missing the forest for the trees.

[01:26:59] SCOTT: Yeah. And it's interesting a number of people that I've communicated with over the years that are really tied to their MTHFR status. And you say, "Well, have you tried this?" "No. No. No. I have MTHFR." "Well, have you done this for detox?" "No. No. No. I have MTHFR." And it's almost like the message that they've internalized in and of itself becomes the epigenetic influencer of gene expression. I am personally not convinced that MTHFR is as much of a defining genetic in someone's outcome as many people interpret it to be. And there's so many other complexities, and backup systems, and whatnot.

[01:27:39] DR. SANDISON: I couldn't agree more. I'd much rather look at homocysteine level or a histamine level to understand the epigenetics of your methylation status. And then provide methylation support based on that. I agree. I feel like people got very attached to their MTHFR status and then felt broken. And they were unfixable. And that I think does more harm than good.

[01:28:02] SCOTT: So many online influencers these days talk about seed oils being toxic. And I personally don't resonate with that message. I think we're kind of throwing out the baby with the bath water. When we think about things like hemp seeds, and sunflower seeds, pumpkin seeds, flax seeds, black seed oil. That's one of my favorite things that's been so helpful over the years. And so, I think that there are healthy seed oils. But maybe the focus should be more on not cooking with seed oils rather than not ingesting high-quality seed oils at all. And I'm wondering, where do you stand on the seed oil debate?

[01:28:39] DR. SANDISON: Yeah. I definitely agree that like rapeseed oil or canola oil, many of these cheap oils that are used, especially in processed food and in restaurant foods. Wherever somebody's looking for profit or margin. They're going to use these really cheap seed oils. Not the olive oil, and the avocado oil, and the coconut oil that we recommend cooking with at home.

But I also couldn't agree with you more that flax seeds, and these seeds, and the seed oils that come from those that you listed also can be very beneficial. And so, I hear what you're saying that there's a nuance to that. And my understanding of kind of what they're talking about is basically avoiding processed foods that contain these super cheap oils. And those are detrimental.

[01:29:26] SCOTT: How much harder would you say it is for a vegetarian or a vegan to support their brain health without some animal-based proteins in their program? And how does the clinical outcome compare when we're looking at a vegan or vegetarian relative to those that do incorporate some animal products?

[01:29:46] DR. SANDISON: I mentioned the Ornish paper that came in just a couple weeks ago. And the Sherzais are also neurologists who support brain health or married couple. And they are proponents of a vegetarian diet. I think that you can choose either. I have been a fan of the ketogenic diet. I've watched so many people get better. I think vegan keto is very hard, and very restrictive, and hard to do in a healthy way. You absolutely must be supplementing with B12. And I worry that people become nutrient-deficient because it's so restrictive. And your variety is really limited. I would never recommend that someone do vegan keto for more than a week or two.

Now, that being said, I think that there is evidence that a vegan diet can support brain health. And we didn't do the same type of trial, right? Ornish did a randomized control trial. I would love the nerd in me, the researcher in me is like what if we compared Dean Ornish's approach to our approach? And would we get different outcomes? Would we get more improvement in MoCA score? Would we get better improvements on the ASLs on the brain imaging? What would that look like? Is one better than the other?

And I would love to know that we had funding to do a trial like that. It would be quite an undertaking. But I hope that that's the direction the science starts to go. It's like what is the most brain-healthy diet? My opinion right now is like I mentioned before, it's probably to go back and forth. That you wouldn't completely eliminate animal proteins from your diet.

I mean, eggs – I actually personally have an egg allergy. I can't eat eggs. But I do think that they're a perfect food. It's what mom would pass on to baby. It's got full of choline. It's so good for the brain. And I think when you completely eliminate all animal protein and you go vegan, you end up with deficiencies over time. And so, if you can go back and forth. I also think of vegan diet is the best diet for the planet, right? But the best diet for certain individuals I think typically includes some animal protein and animal fats.

[01:31:54] SCOTT: Just very quickly then, with the vegan diet then, do you not commonly find that patients have issues with oxalates, and with lectins, and with some of these plant defensive compounds? Has that not been a big issue?

[01:32:05] DR. SANDISON: No. Actually, this came up yesterday. Someone on a more of a vegetarian based keto diet. She was having basically nodules show up on her fingers. And when she cut back the almonds, and the cashews, and the chia seeds, and the spinach, they started resolving. These very high oxalate-rich foods. And so, I think, again, variety. Variety is how we stay out of this.

The consistent thing about ancestral diets was inconsistency. You didn't have spinach three meals a day, seven days a week for months on end. You switch it up and make sure that you're not having too much of any one thing. I see the almonds, right? It's almond milk, plus almond butter, plus almond flour, plus almonds as a snack. And, all of a sudden, you're getting really high in oxalates. Making sure that you have a ton of variety in your diet is one way to avoid that. But, yeah, the oxalates can definitely be an issue.

[01:32:55] SCOTT: You have several activity categories in the book to support cognition, such as interaction with nature, connection, brain engagement, creativity, physical activity, fun and recreation, relaxation, meaning and purpose, and health promotion. You talk about creating a brain-nourishing environment for cognitive health such that the environment is non-toxic. Incorporates nature. Natural lights, is quiet and soothing. Comfortable, natural scents, few distractions, good air quality, and no clutter.

How important is reducing unhealthy frequencies like EMFs and even using maybe tools for putting healthy frequencies into an environment? Some have suggested that one of the most common causes of insomnia, for example, is high EMFs in our sleep location. Wondering how much we need to think about EMF mitigation to optimize cognition?

[01:33:50] DR. SANDISON: Yeah. I definitely think that this is part of the picture. And I see that the sicker people become, the more sensitive they are. I think we're all sensitive to some degree, right? It's like noise pollution. And I think that also the issue with it is how much control do we have? Can you turn off the Wi-Fi at night? That's something that – make sure your phone isn't in your bedroom. Or at least have it on airplane mode if you use it as an alarm. There certainly are ways to go about this.

Now what I don't want to do is scare people into feeling like it's something they don't have control over. Because you can't turn your neighbor's Wi-Fi off at night. And if your bedroom happens to be on the side of the house where their router is hooked up, you just might not have as much control. And I don't want people going into this like anxious loop about it. Because I don't think it affects everyone equally. Kind of like COVID, right? Some people die and some people have no symptoms at all. EMF is sort of on that spectrum too. Some people are highly sensitive to it. And other people are not overly affected. And so, I don't want people kind of going down a rabbit hole if – although, I think it would be healthier for everyone to have less of that exposure. It's just like the risk-benefit analysis of being afraid of it I think is sometimes challenging to square.

[01:35:10] SCOTT: You highlight the importance of mold and mycotoxins. You even share your own experience with recent water intrusions at Marama. With remediation or moving generally being important kind of that first step of getting the patient away from the toxin? Do you then use binders? We talked a little about cholestyramine. And then how often do you find a need for antifungals for fungal colonization?

[01:35:34] DR. SANDISON: Yeah. Again, Walter Crinnion. What I want to do is get people out of the environment as quickly as possible. This can be challenging, especially with older folks who've been in their homes for 50, 60 years. There probably has been water damage. They're maybe not aware of it. And we're starting to uncover it. It can feel really overwhelming for someone who has cognitive decline to think about remediation, to think about moving. Maybe they're comfortable in their house. Or it's the most comfortable place for them. It's hard for them because of whatever constraints to get out to a hotel. Or they couldn't go camping maybe the way that somebody younger could.

They might not also be on a fixed income. Not have the financial bandwidth to be undertaking these projects. It can be very, very, very challenging. It can be very emotional. It's a big project that requires executive function. And so, sometimes now there's adult children getting involved. We want to do the best that we can, of course.

I had a patient, one of my earliest patients. She came in with a MoCA score of 2. Very advanced disease. And her and her husband were living in a moldy bedroom. And what they did was they just moved from the bedroom into the living room. They moved the bed. I think they got a new bed or something. Because we talked about how the mattress might have – it's very porous. So it might have the mold. And so, they moved into the living room. Into a less moldy part of the house. And just sealed that off for a while. I've had other patients move from their bedroom into a guest room.

It's hard for it to be perfect. And I think it gets harder as we're more cognitively declined and as we don't have – if we don't have the financial resources. But I love the IQAir, the GC Multi by IQAir is my favorite air filter. If that's an issue, and especially if you live near the freeway, or if you know that there's industrial pollutants outside and you can't open your doors and windows, increasing the quality of indoor air through air filters I think is one of the ways to do it. They don't pay me. But I do see patients who have tried other air filters. The favorite ends up being the GC Multi by IQAir. That's a potential.

I've had the privilege of learning from Neil Nathan for years. I really follow what he suggests, which limbic retraining, plus binders, eliminate exposure, mast cell stabilizers if necessary. And then, typically, antifungals. And I'll use anything from the herbs to potentially the medications. I'm a huge fan of using antifungals intranasally. I sometimes will still use BEG spray, but less frequently. I'm typically using Biocidin, Silver. We'll use stevia and xylitol together for the biofilm disruption and the stevia. Sometimes we'll do some of the EDTA sprays. But, again, like I mentioned, I try to stay away from the – even intranasal. EDTA tends to be pretty caustic. Not as much the bone effects. But I'll get nosebleeds. People will have more nose beds and have irritation. And so, if I can use some of these other things. They're easy to come by. They're over the counter. And then I use the kimchi juice to reinoculate. I'm sure you've heard of that one. But I –

[01:38:38] SCOTT: I sprayed it once in a nasal spray bottle into my nose and it burned for 4 days afterwards. I think I must have overdone it.

[01:38:45] DR. SANDISON: Q-tip and the juice is how we do it. But I have patients who that's been really effective to help with nasal recolonization and preventing sinus infections going forward. I do treat the sinuses. Treat the gut. Do antifungals and use binders. And just try to get those mycotoxin levels down as close to zero as possible.

[01:39:07] SCOTT: Everything in the body requires energy. You suggest that those with more vitality often do better. How can we support the mitochondria's ability to produce more ATP or energy? Or said differently, what can we do to increase our vitality? Have you seen things like methylene blue helpful in this arena? How important is the focus on mitochondrial function in support of cognitive health?

[01:39:32] DR. SANDISON: Yeah. I'm a fan of methylene blue. I think it's less – and you said it, antimicrobial or as a mitochondrial reboot. I am more of a fan of NAD. Because methylene blue, it just messes with my labs. And sometimes it's hard to get. But IV NAD is one of my favorites. We see that be a nice reboot. Red light therapy is another one that I'm a huge fan of. And then Qualia, the Qualia line of products. Qualia Mind. Neurohacker Collective. I'm good friends with the guys who formulated those products. Again, they don't pay me. But they have created very sophisticated formulas. And Qualia Life is one of my favorites. That's a mitochondrial support formula.

I also am a fan of K-PAX from Integrative Therapeutics. Or MitoCORE from Ortho Molecular. And so, there's great mitochondrial support. And as a naturopath, I was always trained. CoQ10, and ribose, and Corvalen.  There's basically a trifecta of things that you needed. And now I think that we're more – it's kind of grown in sophistication that we can do more for the mitochondria. Not just nutrients. But we can have more mitochondrial nutritional support.

But, also, the red light therapy and the natural red light. Being awake at sunrise and watching the sunset. That can help with, of course, our diurnal rhythms and the signaling with that. But I think that also helps with mitochondria. This is how we're designed. And then getting additional supplemental red light can be helpful with that as well. I think that the Hamlin mechanisms that are described in his research are pretty clear.

[01:41:09] SCOTT: I love that. Did 40 minutes of red light shortly before our conversation. Yay. Wondering if you started doing some of the newer labs that Dr. Bredesen discusses, such as pTau-217, the neurofilament light, the glial fibrillary acidic protein. Any of those that you're finding helpful yet clinically?

[01:41:29] DR. SANDISON: Yes. We use the 217, pTau-217. And 181, we were running before pTau-217 was available. These are helpful I think for directionality. We use EEGs kind of in this realm as well. What we're looking for is MoCA score. A Montreal cognitive assessment or some other type of cognitive assessment and the MRIs. These are ways to understand, are we going in the right direction? Are we getting better? Or are we getting worse?

And they don't tell us what to do in terms of treatment. If someone is – they're not covered by insurance at this stage. If someone is restricted in terms of cash, in terms of resources, I recommend looking at heavy metals. Looking at mycotoxins. Looking at viruses and infectious burdens. Understanding your nutrient imbalances. Understanding what your gut is doing. That changes treatment. Those are causal level factors.

When we're looking downstream, what is pTau doing? What are amyloid ratios doing? And amyloid ratios, they can also come up transiently. Again, amyloid is antimicrobial. If you are fighting an infection, your amyloid might be higher. And then the next time, it'll be lower. That doesn't mean that you had worse Alzheimer's last time and your Alzheimer's is better this time necessarily.

What we're looking for is longer-term trends. And so, I worry that – what I don't want them to do, if your pTau is slightly elevated, I don't want someone to go into like panic that they have Alzheimer's. What we're looking for are trends over time. Same with the imaging. People were doing NeuroQuants and saying, "But my hippocampus is like 0.1% of normal." And just totally feeling distraught and anxious. And that was creating anxiety. That was causing cortisol to be toxic to the hippocampus, right? Now we've created a new problem.

And so, I urge caution around those. If you're going to look at them, make sure you're working with a provider who knows how to interpret them. And that we're using them really kind of more as research. What you're doing is you're contributing to the body of knowledge of the provider that you're working with so that we all understand how to look at them over time. And make sure you have an extra 400 bucks for that. And if you don't, focus on the labs that are going to change the treatment plan.

[01:43:43] SCOTT: You've mentioned several times the impact of oral health in cognitive health. And more and more, I'm reading people raising concerns about using antimicrobial mouthwashes and toothpaste and that being counterproductive in that we're imbalancing the healthy microbiome of the mouth as well. How do we reduce the pathogenic organisms while supporting the healthy ones?

[01:44:06] DR. SANDISON: Yeah. I'm so glad you brought this up. The mouthwashes, I'm not a fan of. I don't think that anyone should use those. That reduces nitric oxide production. We need good bugs in our oral microbiome in order for us to produce nitric oxide in the vascular system to help us oxygenate our brain and all of our tissues. I recommend avoiding all of those mouthwashes that contain alcohol.

We have great natural alternatives. And I also am not a fan of fluoride. I think there's enough data to suggest that that is detrimental to the thyroid. We want to avoid the halogens that are non-iodine. And I not a fan of too much iodine all at once. I think that can also throw things off. You want to do small amounts of iodine over time. Make sure you have plenty of minerals that will help with thyroid balance and thyroid health.

And then if we're avoiding fluid – I'm a huge fan of – is it RiseWell? The mineral toothpaste? The hydroxyapatite. I think Boka is one brand. RiseWell is another one. They have great flavors. They don't have fluoride. And they help with the remineralization of the teeth. I think you can get good, healthy versions of these things.

Xylitol – I'm not a fan of kind of gum generally. But, basically, avoid the conventional gums, and the conventional mouthwash, and the conventional toothpaste. I think that that's important. Best for our oral health and our whole-body health. Health starts in the gut. The gut starts in the mouth. I have a biological dentist here in San Diego who I refer to, who I see personally. I think that working with a whole body or biological dentist is really important, because our oral health can impact so much of our whole-body health.

I would not have believed it if you had told me this in training, Scott. But I have seen people get that root canal out and their Crohn's that they've had for a decade goes away overnight. I mean, I would not have believed it if you had told me this. But now that I've seen it, I've realized – and not everybody that has Crohn's has a root canal that, when they get it extracted, it resolves their issue.

I had a woman with autoimmune glomerulonephritis who was in line to get dialysis who got another tooth infection resolved. And, again, overnight, her GFR shot back up. Her kidney function improved. She no longer needed to go on dialysis. And so, I've watched this impact of latent infections and oral health impact significantly autoimmune diseases and other issues throughout the body that you would not have directly correlated if you weren't paying close attention. I am a huge proponent of oil pulling, water picking. Of course, brushing, and flossing, and using the healthier alternatives, the alternative products with that.

[01:46:51] SCOTT: We talked a lot about lipids and their important place in supporting cognitive health. Wondering if you've Incorporated plasmalogens in supporting cell membranes and brain health. And what you've observed clinically?

[01:47:03] DR. SANDISON: Yeah. I feel like Dan Goodenowe has added a lot to the conversation around these thoughts and the plasmalogens. And there's, of course, the testing. The before and after testing that you can do. I think that they can – I've had patients say that there's an improvement. I think that they need to be part of, right? Dr. Bredesen talks about a buckshot instead of – like we have to – there's not going to be a silver bullet. It's going to be about doing a lot of things. And plasmalogens can be very helpful as part of a whole-body solution and a whole brain solution.

[01:47:39] SCOTT: In the book, you talk about future treatments such as red light, photobiomodulation, plasmapheresis, stem cells, peptides, exosomes, psychedelics, and many others. Wondering when we look at the peptides like Cerebrolysin, Selank/Semax, Dihexa, and possibly others, how are those changing the cognitive health landscape? And how significant are those in helping your patients? Maybe even the immunomodulatory peptides for immune modulation and reducing inflammation like we talked about earlier.

[01:48:10] DR. SANDISON: Yeah. I mean, peptides I start with are BPC-157 and Ta1. And the BPC, for the gut. Ta1 for immune modulation. I've Just seen incredible results with those over the years. The biggest issue – and then Selank /Semax, they're intranasal and they're a little bit easier to come by than some of the injectables. And what I typically see with Selank and Semax is people will get a little bit of a bump and then it kind of plateaus. And you don't get as much benefit over time even if you continue using them. It's almost like you get that bump and then you've kind of gotten everything that you can out of them. That's at least been my clinical experience. Others might share something different. That is anecdotal just based on the patients who have used it in my office.

Now, that being said, I really am excited about peptides. They're just hard to get. And they keep getting harder and harder to get. And so, the practicalities as a clinician of connecting patients with the pharmacies that have them and then making sure that the pharmacies can ship them to California where I am, it just gets complicated. And so, it's not the first thing that I choose. They also are costly.

I haven't seen them be – I would love to have them be part of everyone's plan. But there are other things that I rely on because they're more consistently available. They're less expensive. And I have more confidence in them. I don't recommend that patients start there. Now, if you have a great peptide source and you want to be using them – or intranasal makes a lot of sense, because you can't swallow things. That's when I'll kind of – when we're trying to think outside the box of like, "Okay, this person can't swallow five caps of Qualia Mind, and bunch of fish oils, and vitamin D, and zinc, and the B complex, and all of that." When I'm thinking outside of that box, if I have to choose other tools, okay, we can do intranasal. Because if they have a swallowing problem, we can do – let's do Selank. Let's do Semax.

Dihexa is an interesting one. They're studying this at University of Washington. They published. And kind of looking at a drug option using Dihexa. But it has significant side effects. Unlike a lot of the other peptides, Dihexa can be delivered orally. Whereas most of the others are either intranasal or injectables.

Peptides like insulin being the OG peptide, I'm sure many of your listeners understand peptides and what peptides are. But they're signaling molecules. And if you consume them orally, you'll break them down into the amino acid components instead of getting the benefit of the peptide itself. Unless the target tissue is your gut, you really need to inject it.

And insulin, most people are familiar with this. They've known someone who is an insulin-dependent diabetic who has to inject the insulin for it to work. If you swallowed insulin, it wouldn't work as insulin. Same thing with these other peptides. And Dihexa is one that you can take orally. But it has all of these other side effects. And so, not appropriate for everyone. But it is something that I'm – again, I put it in that chapter of kind of on the horizon. Is there a way that maybe Dihexa will be used so that it doesn't have as many side effects? Or will the formula change a little bit so that we get more benefit? I don't know. And I'm curious. I'm excited to see what happens.

[01:51:17] SCOTT: And for people listening, please explore potential peptide sources with your doctor. There's a lot of websites and things popping up. And you just don't know where those things are coming from. And if you're injecting them into your body, let's make sure you're getting things that we know the quality of talk.

To us about Marama and what you learned from your residential program that you created. What's the success rate of Marama residence? Do some actually go back to independent living? And then what is Marama at home?

[01:51:46] DR. SANDISON: Yeah. Thanks. Marama right now is evolving. And we are hoping to make it accessible to more people by partnering with larger facilities and making it basically a unit in the larger facilities. I think that that's going to be the model that allows us to expand across the country as fast as possible.

And so, we have a sister facility in Kansas that has been open for about a year. And so, we've had six residents who have lived there for more than six months. And five of them improve their cognition. There's one woman there, very interesting story. She came to Marama here in San Diego originally. She came with a MoCA of about 12. And she moved home with a MoCA near 20. Much improvement.

She went back to her family. And we communicated, "We need to maintain this at home." But she ended up mostly isolated. Her children travel frequently for work. She wasn't getting the same food. She wasn't getting the same social engagement. She wasn't getting the same physical engagement or cognitive engagement. And her MoCA dropped back to a 13.5. She moved into our Kansas facility and her MoCA is now back up at a 21.

It's like when she's doing it, it works. When she's not doing it, it doesn't. Her cognition slips back. We see that this is certainly something where most of the time when someone moves in, they improve their cognition or they at the very least stabilize. Not all the time. This is definitely not guaranteed. But our goal is for people to get better.

What we saw just in May, we had our first resident move home with a MoCA of 30. A perfect MoCA score. She moved in with a MoCA of 24. She had a moldy house. And what she did was she moved into Marama for 6 months while her home was being remediated. And then she was able to move back into a clean home, a clean environment.

And she came and her MoCA was a 24. Earlier on in the progression of the disease, but still measurable cognitive impairment. And then 6 months later was at 30. That would be the goal, right? Is that people move in for 6 to 12 months, improve their cognitive function and then return to independent living. Go back.

Kind of coming full circle with our conversation, why do I do this? It's because I believe that our seniors should be showing up at PTA meetings, and showing up at neighborhood board meetings, and having an impact on the solutions that we come up for society at large. But also, especially, in our communities where it really impacts the quality of day-to-day life not only for them but for future generations. We're rebranding to reversing Alzheimer's at home.

Essentially, Marama at Home came out of doing the summits. And these reverse Alzheimer's summits, we wanted to have a course on the backend. Because people are like, "All right, I got all of this information. I was drinking from the fire hose for seven days. Now how do I put it into action?"

And so, it was a coaching program that we developed over 12 weeks. It was 11 modules. And that's become the book. All of the learnings, taking over 200 people. I think when the book was fully edited, we had 200 people go through the program. Now we've had about 250 people go through this 12-week group coaching program.

And the book basically took all of the learnings, from Marama, from the clinical experience, and then also from these online group coaching programs. And all of that learning got into the book. And then now we use the book with the Marama at Home program or the reversing Alzheimer's at home videos. There's a bunch of resources. There's a workbook. And then the book itself basically guide you through how to incorporate these lifestyle changes at home over the course of 12 weeks.

[01:55:17] SCOTT: My last question is the same for every guest, and that is what are some of the key things that you do on a daily basis to support your own health?

[01:55:23] DR. SANDISON: Yeah. Every morning, I wake up between 6 and 6:30 typically. Although, if I'm in ketosis, at 5. And I've got like an hour and a half extra in my day. And I have matcha. And I usually put some organic collagen powder in it. And the Keto Brainz is my keto creamer of the month. So I'll put some sort of keto creamer in there with – I do a ceremonial organic matcha. Andrew Weil’s product that I love. I'm totally addicted to it, with a little bit of almond milk. I have my tea. Drink my tea. I try to get up before anybody else in the house so I have my alone time. And then I meditate for 20 minutes.

I go to Pilates a couple times a week and try to get out for walks or other aerobic exercise, a run, or I'll row if the weather isn't great. And so, exercise. Exercise and meditation. Those are my medicine. And then plenty of sleep. I tend to go to sleep with my daughter between 8:30, 8 and 8:30. Try to get up early in the morning.

[01:56:22] SCOTT: This has been such an amazing conversation. You were so generous with your time. You shared so many pearls. I know people are going to learn so much from this. I'm going to go back and relisten to it again myself. Super excited with all the work you're doing.

I've often wondered who are the people that are going to take the work of Dr. Dale Bredesen and Dr. Neil Nathan and really carry it forward and continue to evolve a lot of these important concepts? And it's really meaningful to see that you're doing that. That you're putting it together in a way that people can really benefit in your book, Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health.

And I really just want to thank you for being here. But thank you even more just for the work that you're doing to help minimize the struggle, minimize the suffering of people that are dealing with cognitive health issues. And to make their brains a little brighter and a little more cognitively capable. And bring some joy and happiness into their lives. Thank you so much, Dr. Sandison, for all that you do.

[01:57:24] SCOTT: Scott, thank you. That's so kind. And also, I would be remiss if I didn't say thank you for the work that you're doing to help us get the word out. But also, I have heard over and over and over again throughout my career, people point to your podcast and what you've done. And how much it's helped them. Because you take the time to take these deep dives. You were very well-prepared for this conversation. You had phenomenal questions. And these conversations are so much more meaningful when they're not superficial, when we can really dive deep and get people the information, and the whys, and the practical stuff so that they can implement it at home. And you do that. And you have helped many, many, many people. I've heard it myself from your fans and from the patients who, out of desperation, look for solutions. Because they're not finding in their day-to-day clinical experience and in the conventional system. Thank you. Thank you for spreading the word, for helping us. Not just with this book. But, generally, help to just reduce the suffering in the world from complex chronic illness.

[01:58:27] SCOTT: Thank you. That means so much..


[01:58:29] SCOTT: To learn more about today's guest, visit ReversingAlzheimersBook.com. That's ReversingAlzheimersBook.com. ReversingAlzheimersBook.com.

Thanks so much for listening to today's episode. If you're enjoying the podcast, please leave a positive rating or review, as doing so will help the show reach a broader audience. To support the show, visit BetterHealthGuy.com/donate. To get my newsletter, visit BetterHealthGuy.com/newsletters. To follow me on Facebook, Instagram, X, or TikTok, you can find me there as BetterHealthGuy. This and other episodes can be found on Apple Podcasts, Spotify, Amazon Music, YouTube, and Odyssey.

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