What can you do today to support your brain health and reduce your risk of cognitive decline? In this special community presentation recorded live at the Encinitas Library, Dr. Heather Sandison and Dr. Rachel Heussner share an evidence-based discussion on memory, healthy aging, and the factors that influence brain health over time. Together, they explore what we currently understand about Alzheimer’s disease and cognitive decline, why brain changes often begin years before symptoms appear, and the practical steps people can take to support cognitive function throughout life.
Note: This video transcript has not been edited. Please excuse any transcription errors.
00:00:20:00 – 00:00:39:01
I feel really honored to be here, privileged and to be here with my colleague, Doctor Rachel Heussner. And our goals tonight are to make a really fun, exciting announcement, around the guide program, some new offerings that we are we have at Solcere, our clinic, Solcere, which named for solutions for the cerebrum solutions for the brain.
00:00:39:03 – 00:01:05:04
That is what we do all day long at Solcere. And our goal is to make that more and more accessible. As many of you know, the functional medicine practices are very expensive. It can cost a lot. And so our goal is to create more access and really to create a program that can be implemented across the country to become a model for that, for other other clinics to help, you know, all of the people that we know and love who are affected by dementia.
00:01:05:06 – 00:01:26:19
All right. Okay, so the guide model, this is a new Medicare program. It’s been around since the summer of 2024, and it has just rolled out in select cities across the country. And where we’re still understanding how it works, we’re still getting our feet under us when it comes to providing this guide model. But what it does is it really is about caregiver support more than anything.
00:01:26:21 – 00:01:51:23
Many of you have been in that position of caring for someone with dementia, and it is exhausting. It is a huge financial burden. It is very it’s it’s just more much more than any one person can take on. And so our goal is to make more of that support accessible. There are resources, both financial and physical resources and care coordination resources that are available and covered by Medicare.
00:01:52:05 – 00:02:14:04
And we also have two brand new nurse practitioners who are working with us, and they are going to be providing the medical services that we’re talking about tonight, that we’re explaining tonight. And all of that is going to be covered by Medicare. So we’re really excited to be announcing that. And we want you to tell all of your friends, because I think that one of the biggest things that prevents access is the financial investment that this takes.
00:02:14:05 – 00:02:19:09
And so, we’re just delighted to be part of the guide model and the guide program.
00:02:19:11 – 00:02:38:03
So tonight I want to share with you the following things. I think I might take that. We’re going to go through causes of dementia. And this may not be for those of you who’ve read my book you might read these might be very familiar. For those of you who are more familiar with the conventional model, this might be new information.
00:02:38:05 – 00:02:55:19
So we’ll go through the causes, how we work that up as clinicians in the in the clinic. We’ll go through treatments, some treatments and some of that you have sitting on your chair. You’ll notice you have samples of quality of mind. This is a no trophic product. Kathy Bliss is here tonight. And she’ll be in the back with us at the end.
00:02:55:19 – 00:03:12:17
And she can answer more questions about that. But this is one of the treatments that we use for most of our cognitively decline patients and those looking to prevent cognitive impairment. And then also, I want you to understand how you might track changes. So if you or someone you know is struggling with cognitive impairment, how do we know if they’re getting better?
00:03:12:18 – 00:03:33:02
How do we know if they’re stable? How do we know if they’re getting worse? We want to understand that. And then I also want to take you through some of the current research. So how do we know that this is true? Reversing Alzheimer’s is a very bold claim. How are we so confident that this is true? While I have seen it, I have seen it with my own eyes.
00:03:33:02 – 00:03:54:09
I didn’t believe it before I started seeing it, but fortunately, I’ve seen it over and over and over and over again. And doctor Hunter will also share that she gets to see it in the clinic as well. Also, we measured it. We did. We had the privilege of doing a clinical trial in my office, and we got to measure this with the 23 participants through a six month intervention.
00:03:54:11 – 00:04:17:03
And at the end of it, we saw that 74% of our patients had improved significantly, actually, across the means of all participants. There was significant improvement. And 74% of our participants had improvement. Measurable improvement in cognition. So this works most of the time. And we published that in the journal of Alzheimer’s Disease. So that is peer reviewed literature that is published on the science.
00:04:17:05 – 00:04:42:22
And the best part about my story of having measured it and published it is that other people have too. I’m not the only clinician doing that. So the when I was early on in this journey, Arlene came into my office. It was a thank you. It was late 2017, and when Arlene came into my office, she was barely putting together sentences in action.
00:04:43:00 – 00:05:04:03
Mostly one word answers. And her handwriting was very affected. She was completely dependent on her husband for everything. She she was unable to work of course, she had a Moca score of two. So we’ll talk about this a few times, but the Moca score is the Montreal cognitive assessment. And that cognitive assessment a perfect score is 3026 and above is normal.
00:05:04:03 – 00:05:25:05
And she had a two out of 30. So very, very progressive cognitive decline. And I didn’t think that I could help her. I went through the motions that Doctor Bredesen, my mentor, had taught me, but I had no confidence that she would get better. She came back six weeks later and her Moca score had gone to a seven, and I was in complete disbelief.
00:05:25:06 – 00:05:46:10
I didn’t think that this was possible. That’s what I had been told over and over again, and I had to look at her husband and go, wait, really? Is this true? And he assured me, yes, she was a different. And even in my interaction with her, she was putting together full sentences and she she was able to converse and her handwriting had gone back to this loopy, beautiful handwriting.
00:05:46:12 – 00:06:12:01
She was in fact different, and their lives were very different. And my experience of that day was, if this is possible for Arlene, you know how much unnecessary suffering is happening and how much can we do to prevent it? And so, as since then, my life’s work is telling as many people as will listen that there are options for people who are suffering with dementia, and no one has to get as far along in the process as Arlene.
00:06:12:03 – 00:06:34:15
So when we think about cognitive impairment, I want to offer a new paradigm, a new way to kind of conceptual, a new conceptual framework. If you have a houseplant and it starts to look like this, do you look at it and go, oh, misfolded proteins, we need to take out the amyloid. We need to take out the misfolded proteins.
00:06:34:17 – 00:06:57:05
We would never think that right. It’s common sense to think is it getting enough sunlight? Is it getting enough water? Is there potentially a toxin? Does it have enough nutrients? Right. And so why would we think about the brain any differently for any complex system? We want to think about the inputs and outputs. And how do we balance that complex system.
00:06:57:07 – 00:07:20:02
I’m Doctor Heussner who’s now have been a little quiet over here. Sorry, but this is an interesting systematic review that actually just came out last month in April. And it looked at, the amyloid beta targeting monoclonal antibody infusions, which is the fancy conventional treatments that are now first line for most of, Alzheimer’s patients in mild cognitive impairment.
00:07:20:04 – 00:07:46:22
And what it’s found is that these infusions, they do a really good job at removing that. And alive that we were just talking about. But they don’t do a great job at improving cognition. So the authors of the study were at this, review actually said that future research on disease modifying treatments for Alzheimer’s should focus on other mechanisms of action, not just the amyloid.
00:07:47:00 – 00:08:17:13
And that’s exactly what we do with this protocol. And at our clinic, so the conceptual framework we want to think about is balance. How do we create balance and what does that mean? How do we define balance when we think through too much, too little in the wrong place or at the wrong time? And when we think of any complex system, whether it’s a plant or a financial system or a government system or education systems, what we’re looking for are these imbalances and how do we address them?
00:08:17:13 – 00:08:26:19
How do we systematically go things through things that are going to cause a dysregulation? And in this case, a neurodegenerative process.
00:08:26:21 – 00:08:49:16
I would argue that the causes are finite. There aren’t an unlimited number of them that we can go through primary level causes of neurodegeneration. And really all disease processes, if we look at toxins, nutrients, stressors, structure, infections and signaling. And so we’re going to give you some examples of how we work that up.
00:08:49:16 – 00:09:14:03
So how we understand the data that impacts the balance of these these different factors. And then what we do to correct that. Thank you. And we can see this in The Lancet. This is the medical journal that every couple of years they published, they modifiable risk factors for dementia. So as 2024 these are the 14 modifiable risk factors.
00:09:14:08 – 00:09:42:04
Kind of hard to see. But in early life less it’s less education can increase risk of dementia. Hearing loss vision loss higher LDL higher cholesterol. The Atlas sclerosis. That fun word to say that’s affecting the structure, right. One of those causes that we just talked about, depression, traumatic brain injury, TBI, concussions, those are also impacting structure physical inactivity, diabetes.
00:09:42:08 – 00:10:05:12
How many here know that Alzheimer’s is considered type three diabetes, right. It’s affecting the fuel source, the nutrient that the brain is using. Smoking, smoking. It increases our risk of things like cadmium, heavy metals, a VOCs volatile organic compounds. So we’ve we’ve got a toxic burden is from smoking. My favorite here though is air pollution.
00:10:05:14 – 00:10:31:08
We have research that shows that bad air, poor air quality is an increased risk of dementia. So yes, using an air purifier can help reduce your risk on your brain. Other things like social isolation. We’ve seen that with Covid, right? I mean, people were significantly impacted from the pandemic. Obesity and excessive alcohol increase our risk for most diseases, if not all of them.
00:10:31:10 – 00:10:40:22
So this is what we see every couple of years, but ties into those causes that Doctor Sandison were just explaining.
00:10:41:00 – 00:11:00:16
I won’t go into it. A boring literature review with you here, but I just wanted to show you a few of the other researchers who have published, similar research to what we published in the Journal of Alzheimer’s Disease and basically go through a quick timeline that supports essentially what we’re doing now. What we’re doing is uncommon practice, but it’s common sense.
00:11:00:20 – 00:11:23:04
When you walk into an allergist office, they don’t take you through this process, even though I hope that it becomes the standard of care, because everything we’ve seen, there’s literature, very well established literature and research that supports that dementia is modifiable. The The Lancet Commission report suggests that 45% of worldwide dementias are preventable, that people don’t have to get dementia.
00:11:23:09 – 00:11:43:06
And I think based on our clinical experience, that number is much, much higher. There’s a lot of avoidable suffering that’s happening. It requires work, but it is possible to avoid this disease. So this was one of the first papers that came out. This is my mentor, doctor Dale Bredesen, and the lead author here is is doctor Kat Toups. This was also in the Journal of Alzheimer’s Disease.
00:11:43:06 – 00:12:06:08
And published in the, June of 2020. Excuse me, August of 2022. And then the following year, we did our trial. It was 23 participants. It was six months. And we had patients with eligibility. Their eligibility included people with Alzheimer’s and included Moca scores of 12 to 23. So they were pretty progressed. They had to have measurable cognitive impairment.
00:12:06:10 – 00:12:29:21
And what we saw was that 74% of them improve their cognition rate, most of them in the Bredesen paper from the year before, 84% improved. Now they had a nine month intervention, and they also took participants with Moca scores only down to 19. So they weren’t as progressed. So it makes sense. The sooner we start, the less progression, the easier it is to get more people better.
00:12:29:21 – 00:12:49:09
That’s why we want to focus on prevention and early intervention. And then this paper was published a year later in June of 2024. This was doctor Dean Ornish, his paper. He’s up out of UCSF. And, he you might have heard of him in the cardiovascular space. He’s written multiple he’s kind of a famous doctor in that, in that arena.
00:12:49:11 – 00:13:15:13
And he used the same intervention which included very similar to ours. There were support group supplements. There were some labs that were done. There was exercise, dietary modifications. They actually use a vegan diet in this trial. And this one was only four months long. It was only 20 weeks. And this was the first controlled trial showing that that lifestyle intervention led to immeasurably significant increase in cognitive function.
00:13:15:14 – 00:13:40:03
Now, with those amyloid busting medications, you don’t expect improvement in cognition. You get a slowing of decline. You drag out a torturous process instead of getting improvement. But over and over again, we see that with these lifestyle interventions, you get an improvement in cognition. So this is the most recent trial that was published. And this was just last summer in 2025.
00:13:40:05 – 00:14:08:01
And this is the Poynter trial. This is funded by the Alzheimer’s Association. And it was a 2111 participants. And they broke them into two groups. One was a structured coaching program. Again, folks focusing on these lifestyle interventions improved diet, improved stress management exercise. And the other was just the information. So it’s unstructured, but the same information about how to improve these lifestyle interventions that diet, exercise, stress management.
00:14:08:03 – 00:14:37:11
And lo and behold, across the board they got better. The more structured group got more better rate had even more improvement. And we offer a, we offer a group coaching program. And essentially it’s very much very similar to this trial. So we’re trying to meet people wherever they are to get them access to them to, to this information, to get them access to what helps to implement the information.
00:14:37:11 – 00:14:58:23
Right. Because we can read all the books, we can listen to all the podcasts, but if we don’t implement it, does it work? So the research is clear. These multiple these multi-modal lifestyle interventions, they work. You just have to do them okay. So we’re going to go into our protocol a little bit more. And this is what we start off with.
00:14:58:23 – 00:15:19:19
This is how we can track cognition to see where one might fall on that scale of cognitive impairment. We’ve mentioned this a few times now. This is the Moca, the Montreal Cognitive Assessment. You do have to be Moca certified to administer this. So we, use this in our clinic here. And this was the baseline of Doctor Sandison’s study.
00:15:19:21 – 00:15:44:12
This is perfect. Scores 30 out of 30. 26 to 30 is considered normal. So you can see it’s asking about visual spatial skills. You have to copy the cube. There’s some math skills, short term memory, orientation to date time and place. I myself don’t always know the date, time and place, so there’s room for error. 26 to 30 is considered normal cognition.
00:15:44:14 – 00:16:17:00
Mild cognitive impairment is around scores 18 to 25. Moderate is around score 10 to 17 and below that is more severe. We know what we had talked about is that when you are in those single digit number smokers, it is harder to treat. There is, more dependance on other people. There is more confusion. So, the earlier that we can get people in that mild cognitive impairment state, the better.
00:16:17:02 – 00:16:39:14
We also use bloodwork to diagnose and track. So these are biomarkers beta amyloid 40 to 40 ratio. And tau 217 can help us to track amyloid pathology in the brain. But like we had said right. That is not the complete answer. We want to also look at everything else. It also is important to note that this does not always track with cognition.
00:16:39:20 – 00:17:02:11
We can see people improve and those Moca scores go from 2 to 7 and even further up from there. And these scores might not improve. They might stay the same, they might get worse, but they are helpful for diagnosing. We also use things like imaging studies. So Pet scans as an MRI is can help to show changes in glucose metabolism in the brain.
00:17:02:16 – 00:17:13:14
So how the brain is using the fuel source and any volume or shrinkage of parts of the brain, especially the hippocampus that memory center.
00:17:13:16 – 00:17:38:12
So let’s get into the causes and what we do for it. The first one, I think probably the one we see with almost everybody are toxins. I mean, we live in this. Everybody has toxins. I know that. And plastic and microplastics is more of a conversation these days. Right. This is becoming more of a normal conversation for us to talk about what we can be exposed to on a day to day basis.
00:17:38:14 – 00:17:59:07
When I meet somebody in the office, I’m asking them, you know, what kind of water are you drinking? How close do you live to a freeway? Okay, right. Well, we talked about that before. Air pollution is a modifiable risk factor for dementia. Believe it or not, everybody that is in this room and lives in Southern California, we are exposed to a lot of air pollution, and we can test it.
00:17:59:07 – 00:18:18:19
We test those different petrochemicals that show up when we’re exposed to high levels of smog. I want to know how much fish you’re eating. Do you have any silver fillings that can increase your risk of mercury toxicity? I want to understand what are your hobbies? What are you plant? Are you an artist that you see is lead based paint.
00:18:18:21 – 00:18:44:00
So we really go through toxic exposures and then we can test as well through different tests to see what we need to address. And here’s an example. This is urinary mycotoxins. So so big in Southern California is exposure to water damage or high levels of moisture in the home. So molds can produce mycotoxins which are neurotoxic.
00:18:44:05 – 00:19:11:06
They act especially, this one over here. Okra toxin has been shown to be toxic to hippocampal neurons. So those neurons that are important for consolidating memories and using our short term memory so molds is not great. We want to test that. We’ll ask people and then we’ll test through the urine. Here you’ll see we also have some heavy metal testing on here and some things like glyphosate and other chemicals.
00:19:11:08 – 00:19:28:13
So I want to talk about my patient Victoria. She came into my office. She was in her early 70s, and her son brought her in because she was living on her own in Florida. And all of a sudden nobody had heard from her. There had been a couple of days that went by and nobody heard from her.
00:19:28:15 – 00:19:53:17
So a neighbor went and checked in on her, and she was very disoriented in her room. She actually had a urinary tract infection at the time, which goes into the causes of infections. That is one of the main infections that can impact the brain we see, especially in older patients. They might not have the same urinary symptoms and might have more confusion and brain fog when there’s a UTI present.
00:19:53:19 – 00:20:13:11
But we got her out of the house. We got her over here. We did some testing. Her mycotoxins were through the roof. She had significant mold exposure from living in a house in Florida. So we got her on some detox protocol. They got her into ketosis. She went from America two, which. I’m sorry. No, she was a milk, a three.
00:20:13:13 – 00:20:36:18
Which still is, is very low and considered significant cognitive impairment. A seven in less than three months from getting out of the mold, from getting into detox. She was sweating, working out, doing the protocol and doing the work. She ended up getting to omega ten in the neurology office, which, if you would ask the neurologist, I mean, she was like, this is not this is not possible.
00:20:36:20 – 00:20:40:13
But it was for Victoria and many other people out there.
00:20:40:15 – 00:21:00:07
So nutrients, we think about nutrients in a few different ways, but we are big proponents of the ketogenic diet. If you were to choose one thing to do to help your cognition, it would be metabolic flexibility and getting into ketosis. The brain uses 20% of energy expenditure each day, even though it’s only makes up 2% of body weight.
00:21:00:09 – 00:21:17:12
It is a very, very energy hungry organ. And if we don’t have the fuel to run our brain on, we’re not going to be able to remember where we put our keys or a neighbor’s neighbor’s name. Right? So we’ve got to feed fuel to the brain. And what’s amazing about the human body is it’s like a hybrid engine.
00:21:17:12 – 00:21:38:21
We can go from burning sugar for fuel, which most of us do because we are exposed to carbohydrates. It’s very hard to avoid them, and they taste delicious. But when we switch gears, when we restrict carbohydrates, we add fats and proteins. Maybe we add some exogenous ketones or supplemental ketones. We can flip that switch and burn ketones for fuel.
00:21:38:23 – 00:22:08:12
And when we do that, we create more energy. It’s easier for the brain to burn ketones for fuel. We also create less oxidative stress. And it’s a detox diet as well. We tend to burn fat and we hang on to, toxins, especially fat soluble toxins in our adipose or fat tissue. And so when and we also get the body composition shifts, especially for exercising with the ketogenic diet, we have more lean muscle and less of the visceral adiposity that’s associated with chronic disease as we age.
00:22:08:14 – 00:22:30:08
So we’re huge proponents of a ketogenic diet. And I’ll share an example of why I’m so gung ho about keto. These are a couple of great tools for getting into ketosis. So the keto mojo is a tool that you do have to prick your finger. But this is the best way to measure those keto the ketones in your blood.
00:22:30:10 – 00:22:50:00
There, there. There’s some other things out there like urine strips. They’re much more comfortable, but they aren’t as accurate and they’re not as precise. So I recommend the keto mojo. And then the continuous glucose monitors, they used to only be available, through a prescription. But the stylo and lingo continuous glucose monitors are now available. Just direct to consumer.
00:22:50:01 – 00:23:03:17
We have them in the office up the street. If you want to stop by and grab one, they just go in your arm and then connect to your phone and they tell you in real time what’s happening to your glucose. So if you’re struggling to get into ketosis, sometimes you’re eating something that you don’t realize is raising your blood sugar.
00:23:03:17 – 00:23:31:14
And that’s what’s preventing you from getting, into that ketogenic state. So we measure both micronutrients. So we think about nutrients. We think about micro and macro. So the micronutrients are things like our B vitamins, our polyphenols, our our minerals. And then our macronutrients are our fats, our proteins and our carbohydrates. And we’re talking about balanced too much, too little in the wrong place at the wrong time.
00:23:31:16 – 00:23:52:17
So too much glucose, too much blood sugar, right? Creates type three diabetes or Alzheimer’s disease and also diabetes itself. Right. Insulin resistance. But also we can have mineral imbalances. We can have methylation imbalances. And those have more to do with our micronutrients like our methylated B vitamins. And so we measure all of those so that we can be precise about our intervention.
00:23:52:19 – 00:24:25:15
You and I have different genetics, so I might need more or less B vitamins than you do. It’s not about getting to a recommended daily allowance, but about what’s right for your metabolism. What what’s right and in, you know, than the value of toxins and nutrients and and infections that you might be burdened with. And the other thing that we look at when it comes to nutrients is you could be eating the best ketogenic organic diet, going to Jimbo’s every day, or an end to their, and not be able to digest and absorb it.
00:24:25:17 – 00:24:42:12
And so if you are able to break down fats, well, then if we get you on a ketogenic diet, you’re going to have a lot of fat in your stool. You’re not getting the benefit of it. It’s not going, you know, it’s not feeding your brain because your gut isn’t able to digest and absorb it. So we evaluate for that.
00:24:42:14 – 00:25:02:05
We know that there’s a gut brain connection. Do you have the right microbiome to help you to digest and absorb, and to help feed those healthy neurotransmitters that are present in the gut and in the brain? And then in addition, we’re looking for immune function in the gut. Are you anti-glare? An IGA helps us convince you to get off gluten.
00:25:02:07 – 00:25:22:01
Anti-Glare. And IGA has been. Your body is creating an immune response to gluten. This can create burden. Immune burden that’s going to take away bandwidth from your brain healing. Doctor Bredesen talks about the brain. Like a country my brain a on. So if you think of my brain is done at war against gluten against toxins, it gets infections.
00:25:22:03 – 00:25:39:20
Your brain is stone is not building roads and schools. The synaptic connections between neurons. So what we want to do, what we would literally like, what we do all day is figure out what are all of those things that your brain is at war against. How do we resolve them so that you can shift resource back into repair and synaptic connections?
00:25:40:01 – 00:26:02:10
Right. And a lot of that happens. You know, the root cause is the gut and natural medicine. We say health starts in the gut and the gut starts on that off. So that’s important too. So Richard, he really was one of the first patients that made me emphatic about recommending the ketogenic diet. Richard lived in Utah. He came here to see us with his daughter.
00:26:02:15 – 00:26:22:12
He was dependent on her. He had both, fecal and urinary incontinence and, he couldn’t remember his grandkids names. And they lived in a rural area in Utah, and he would drive down the road, they would be driving up. He was not driving, but they would be driving down the road. And he couldn’t tell. He couldn’t come up with the word cow or force or barn.
00:26:22:14 – 00:26:44:00
And he got into a ketogenic state. It took three days of dietary ketosis and it was like magic. It was a light switch. He started remembering the names of barn animals. He started remembering the names of all of his grandkids and his incontinence resolved. We hear that a lot. If there is a motivation for getting into ketosis, getting control of your bladder and bowels is a good one.
00:26:44:02 – 00:27:05:05
And so Richard’s, Richard’s experience, his son came into town to visit him, and, he had a lot of grandkids. And these this particular group of boys that came to visit, they always hung out with grandpa by getting pizza and ice cream. And so of course, Richard fell out of ketosis. And it was again, it was like a light switch.
00:27:05:07 – 00:27:15:12
Couldn’t remember the grandkids names, couldn’t remember the barn animals names. And so everyone was on board after Sam and the incontinence came back. So everyone was on board. Keep him in ketosis after that.
00:27:15:14 – 00:27:35:02
So this is another patient I’d like to discuss quickly. Ronald. He came in pretty recently. I think this was the fall, late 60s. He was still working, but he got a new position and he just couldn’t understand the new tasks that he was being assigned. It was starting to concern him. And his wife. So they came to see us.
00:27:35:04 – 00:27:57:07
He had positive biomarkers and he was able to be positive, which means he has a genetic predisposition to Alzheimer’s. So ApoE e4, if you are an able E4 carrier, that does increase your risk. And we’ll talk about that in a moment. So both him and his wife, they were disheartened. They he thought he had ten more years of work left him in.
00:27:57:08 – 00:28:15:18
But he was confused. He could not figure out the new tasks. So we worked him up. We found that he, When we did his vitals, I noticed right away his oxygen saturation. You know, when you go have your vitals, your blood pressure taken, they put that thing on your finger. That’s looking at the amount of oxygen that’s in your blood.
00:28:15:20 – 00:28:35:16
And his was low. 96 to 100 is normal. His was in the 80s. So I was a bit concerned. Why is he hypoxic in my office? He had recent pneumonia, so we worked him up. But what we found was that he had obstructive sleep apnea. We did a sleep study and immediately found that he had a moderate sleep apnea.
00:28:35:18 – 00:28:57:10
So we got him on a CPAp. His oxygen went back up and his mind became clearer. So sleep apnea, if you haven’t been tested for that and you have any any kind of cognitive impairment, make sure that is not something that is affecting the structure. If you are going to bed at night and not getting enough oxygen to your brain, you will experience brain fog.
00:28:57:15 – 00:29:26:22
It is also a cause of high blood pressure amongst many other things. Anxiety. So absolutely, that is something that everybody in our office gets rolled out upon itself as an example of something that affects the structure. So, if you have one copy able E4 that can increase your risk of about 30%. I myself am an April A4 carrier, and that’s why I’m here doing this every day, because I do not want to see what my grandmother went through.
00:29:26:22 – 00:29:50:11
I don’t want to see that from my mother, and I do not want to see that for myself. The mind is beautiful. I do not want to see the suffering continue in my family. If you are, if you have two copies of the Apple A4, that can increase your risk up to 70% of developing Alzheimer’s. So these things are modifiable though, but that can affect the structure.
00:29:50:13 – 00:30:17:08
We also talked about traumatic brain injury, right. That will also impact and increase one’s risk of dementia I think on this next slide. Oh but sorry I got a little off track here Ronald. So if he came in he was a smoker 22. So that is considered mild cognitive impairment right. 2018 to 25 is mild. And within less than three months we typically retest every three months or so.
00:30:17:10 – 00:30:33:09
He was at a score of Moca 26, which is normal. Yes. We had gotten rid of some toxins, but the main thing when they sat on that flip switch was when he got on the CPAp. So absolutely crucial that we rule out sleep apnea.
00:30:33:11 – 00:31:00:05
These are a few examples of how we work up structural factors when it comes to dimension Alzheimer’s. So we were doctor user was just talking about the ApoE e4 genotype. So this is a quick it’s simple, inexpensive test. If you haven’t had this done, I highly recommend it. 1012 years ago when people would say, I don’t want to test my genetics because if I’m positive it will just keep me from sleeping, I’ll increase my risk of Alzheimer’s.
00:31:00:07 – 00:31:27:12
I would say, okay, fine, that kind of makes sense, but at this stage it’s overwhelming how much we know we can do to prevent and yes, even reverse the symptoms of Alzheimer’s. And so understanding this, knowing this, I want my daughter to know her ApoE status, because even at 1718 we see differences in cognition for people who are a few ApoE e4 for positive and three for positive.
00:31:27:14 – 00:32:03:23
So even early in life and early life, we can make decisions we don’t. One of them do shift work as an ER nurse or doctor or a firefighter. We want to make sure we’re, you know, keeping the binge drinking under control in college because the TBI is, you know, a career in professional sports that might increase your risk of CTE or, or some of the other chronic, chronic, TBIs that is probably a risk that people who are about three three should take, not with the increased genetic risk, because the ability for status is going to increase, that trigger, to create inflammation and amyloid in the brain.
00:32:04:01 – 00:32:26:16
And so what we want to do is make lifestyle related decisions even early in life to mitigate those risks. So while we can’t change our genetics, we can change our behavior so that we don’t trigger that inflammatory cascade. This next one up here, this is, the findings on, a patient of mine. This was her severe obstructive sleep apnea.
00:32:26:16 – 00:32:52:07
She came in with a Moca of eight and very similar to her. The case that our user presented her Moca jumped to a 16. She went from a single digit Moca score up to a 16. This is unheard of. We’re working with Doctor Bredesen to publish a paper of this. This, Sarah trial, that severe Alzheimer’s reversal attempt is what he calls it, because it’s so unheard of that people in these single digit Moca scores improve.
00:32:52:11 – 00:33:11:07
We don’t see it all the time. We celebrate it when we do see it, it takes a lot more work. But time and again it’s because of sleep apnea. And so it’s really I’ve decided that it’s my job to tell everyone if there is any change in cognition for, you know, negative change in cognition. We want to make sure we’re really not sleep apnea.
00:33:11:07 – 00:33:31:17
Every single person who comes into our office gets a sleep study. And so advocate for yourself, advocate for your loved ones, ask your doctor to get that or come in and see us or the nurse practitioners, and we will order it for you. And then at the top here, this is an MRI report. And what you see I think this one has oh all micro microblading.
00:33:31:19 – 00:33:55:16
So and without significant atrophy. So sometimes we see significant atrophy that can be picked up on MRI. We look at perfusion studies. We do advanced imaging. We work closely with the Pacific neurosciences to up in Santa Monica to order those and really those with the preventive neuro radiologist Cyrus Raji, who we work with. And so we feel really fortunate to get to do these advanced imaging studies.
00:33:55:18 – 00:34:20:16
But this is just a simple MRI that gives us an idea that there’s no atrophy. But there is, Mike. There was microblading. So there’s a cardiovascular there’s a, circulatory component to this, this dementia presentation and, and probably a vascular dementia. Now, these dementias come together. You can have a little bit of frontotemporal. You can have a little bit of Lewy body, you can have some vascular dementia and you can have Alzheimer’s.
00:34:20:22 – 00:34:31:09
It’s not cut and dry. Just like these causes are not cut and dry. You can have more than one of these. They are not mutually exclusive. And many of our patients do.
00:34:31:11 – 00:34:47:23
stress. I don’t know if I have to talk much about this. I think we all know that stress is the silent killer and can increase our risk of nearly every single disease out there. But we do test. So we’ve showed you some things about toxins. We’ve shown you some things about structure and how we test for it.
00:34:47:23 – 00:35:09:10
This is how we test for stress. Or, our stress hormone is named cortisol because we like to test. Don’t guess. We want to know what exactly do we need to work on for you and your individual makeup doctor Sandison just mentioned, most of us have many of these different causes that can contribute to diseases, but we need to know what is it that we need to work on for you.
00:35:09:12 – 00:35:30:15
So this is an example of how we test salivary cortisol, that stress hormone. And you can see it naturally increases in the morning. That’s that normal peak that gets us up, wakes us out of bed and then decreases through the day. That is our circadian rhythm. At night, melatonin kicks in and we should be sleeping. Most of us are exposed to chronic stress right.
00:35:30:16 – 00:35:54:19
It’s out there. It’s all the time between work, between finances, family. But I need to know how much is it really impacting you and your brain? Cortisol is directly toxic to the brain and can cause atrophy. That’s a fancy word meaning shrinkage of parts of the brain. This is an example of somebody who actually has low cortisol, which can also when we’re talking about imbalance, right.
00:35:54:19 – 00:36:25:05
Too low, too little. We want it to be just right. We want things balanced, including stress. So I want to talk a little bit about an Ann is, a delightful woman that came in last year. She’s in her early 60s, entrepreneur, multiple business owner, was a caregiver for her late husband. And her stress was out of control to the point where she was not able to perform in her meetings anymore.
00:36:25:05 – 00:36:47:23
She thought she was going to have to give up her businesses. So she came into our office. She did have an April 8th positive. She was April 3rd four, and she was PTO positive, which led her to come in thinking that her life was over. She’s going to have to give up. Her business is, at the time, she was in mocha 24, so that is still mild cognitive impairment 26 and above is normal.
00:36:48:01 – 00:37:11:10
But her cortisol was through the roof. Her, blood sugar was a bit dysregulated, which we often see when people are stressed. Right. You can have that, like hangry feeling especially more when you’re stressed out. We got her into ketosis and she’s similar to that Richard. Right. Where when she’s out of keto she is not functional. So she lives in ketosis.
00:37:11:15 – 00:37:33:04
But we worked a lot to get her stress down. We had to create boundaries with work. We had to make sleep a priority. And we got her into the Kirtan Kriya meditation, which is a nice meditation that, 12 minutes a day, you can find it on YouTube, but it’s actually backed by the Alzheimer’s Association to help increase cognition and reduce stress.
00:37:33:06 – 00:37:50:13
Meditation is it’s well documented to improve areas of the brain with cognition and decrease that emotional reactivity that can take away from restoring memories and then retrieving, short term memory.
00:37:50:15 – 00:38:00:05
Oh, and by the way, she went up to Moca 29, so nearly a perfect score.
00:38:00:06 – 00:38:26:11
So infections also can play a role. Has anyone seen the kind of click clickbait headlines, news headlines that herpes causes dementia. Herpes causes Alzheimer’s. So anyways seniors right. So it’s really easy to kind of get this idea that there’s one single cause, whether it’s amyloid or inflammation or herpes, but it’s, there’s it’s multifactorial. That’s I hope the takeaway from tonight is that we want to systematically go through all of these potential factors.
00:38:26:13 – 00:38:51:02
Now, there are a handful of of infections that seem to have an outsized effect on that amyloid production in the brain. Now, when I say that amyloid doesn’t cause Alzheimer’s, it doesn’t mean that it’s not correlated to amyloid. Absolutely is correlated to dementia and Alzheimer’s. However, what we want to ask, the question that we’re asking the where I think it’s interesting to play as a doctor is what causes the amyloid.
00:38:51:07 – 00:38:53:21
Right. And so herpes HSV
00:38:54:01 – 00:39:09:09
in that amyloid cascade. And we see on autopsy that people who have abundant amyloid that herpes virus is in the amyloid. The amyloid is anti-microbial. It’s there to protect us. And I think that’s a big part of why when we take the amyloid out, we’re quite good at that.
00:39:09:09 – 00:39:28:20
When we take the amyloid out, we don’t get improvement in cognition because we haven’t treated the cause. So HSV one is something we test everyone for. If we want to treat that, we just add lysine lysine as an amino acid. You can add it with that creatine here. There’s a several amino acids that are, known to support cognition and lysine.
00:39:28:20 – 00:39:29:00
How?
00:39:29:03 – 00:39:55:17
Reduce that viral burden. It’s a gram or two, and your coffee each day reduces that viral burden, so it’s not triggering the amyloid and other infections associated with dimension Alzheimer’s include the lime steer a key. This again has been found in the amyloid on autopsy. Gingival which is associated with gum disease is another bacteria that has been found again on autopsy and that we know is directly connected to cognitive decline.
00:39:55:22 – 00:40:17:18
So this is why good dental hygiene, good oral health is is crucially important to protecting your brain as you age. Brush twice, floss once water picks or and oil pulling. Seeing the dentist every six months. These are really important things to do when we’re considering brain health as we age. And then, Covid is another one that comes up now.
00:40:17:18 – 00:40:53:06
Covid is a different mechanism. Covid, it creates micro clots in the capillary beds. And so in the micro circulation where we get diffusion of oxygen and nutrients into the cells, we don’t get as much of that as easily post Covid. So did any of you experience that like post-Covid brain fog or brain fog with Covid that we think that what we understand is that that’s caused by these micro clots and that big clots that affect our lungs or create a stroke, but micro clots that create, a reduction in cell health because we’re not getting that diffusion of nutrients and oxygen.
00:40:53:12 – 00:41:18:15
So we treat that a little bit differently. But generally we want robust immune health so that again, our our brain is still in that country. That is our brain. This complex system that is our brain is not stuck in that fight, flight, freeze, defend, attack mode. We have the resource available for repair and regeneration. So, Lisa, this is about foremost basically.
00:41:18:16 – 00:41:41:11
So signaling signaling is all of the information going to our brain to all of the signaling molecules, the hormones, the sex hormones, the stress hormones, the thyroid hormones, the vitamin D, which is a hormone, the peptides. You might have heard of peptides. We’re going to take questions. Don’t worry. So we can get into peptides if you like the, stem cells.
00:41:41:15 – 00:42:02:14
What are all of the signals going to our brain? Are the signals telling us to turn on amyloid to turn on inflammatory processes, to, to activate the microglia or the immune cells of the brain, or are the signals to our brain telling us to connect and secrete that synaptic connection so that we can retrieve memories and create memories.
00:42:02:16 – 00:42:21:21
And that’s our work. That is our job is to make sure that those are the signals that are turned on. Hormones have been a controversial subject for a long time for most of my career, and in the last couple of years, the conversation has shifted dramatically. There is much more support for bioidentical hormone replacement than more support than ever.
00:42:21:23 – 00:42:46:02
And I’m a fan. I it’s something that I will do for my brain. I have my mom on hormones. And I think that the benefits far outweigh the risks for the vast majority of men and women. So we use that, routinely. Parathyroid hormone is one that is, highlighted here. This particular patient had a parathyroid adenoma, which hopefully none of you have ever heard of.
00:42:46:04 – 00:43:08:16
It’s quite rare. But when you have calcium toxicity from your parathyroid glands, sit right behind your thyroid, which I’m pointing to here. And when you have an parathyroid adenoma, it’s a very treatable cause, a cognitive decline. It’s there’s no such thing as a, simple surgery or a minor surgery. Right. But it is a relatively simple minor surgery to have an adenoma removed.
00:43:08:22 – 00:43:33:04
And a lot of people get amazing relief. I’ve seen it maybe 12 times in the decade I’ve been, or a little bit more that I’ve been practicing it, and I’ve seen it enough that it’s worth being aware of. Just like normal pressure. I just feel afraid. Shia professional because there are lots of treatable causes, a cognitive impairment, not just the functional medicine that we’re talking about, but where you look a little bit closer, something like the parathyroid and parathyroid hormone.
00:43:33:09 – 00:43:40:01
Sometimes we discover these things that are relatively simple treatments that make a big impact on and how we age.
00:43:40:03 – 00:43:59:19
this is my favorite thing to talk about. So this is what I do, right? I’m able if for positive and I want to protect my brain. Basically everything that we do for treating the way we can do to protect the brain and prevent dementia and cognitive decline, diet and exercise by far are the important things for everybody out there for every condition.
00:44:00:00 – 00:44:20:11
But I myself, I like to go in and out of ketosis, so that way I get ketones for the brain. I limit my sugar intake, no processed foods. I mean, I do have to live a little bit. So I have my desserts every now and then, but I don’t make it a habit, right? I live by like it’s kind of like 8515 rule, sometimes 9010, sometimes 80, 20.
00:44:20:11 – 00:44:42:12
But I have balance. I still go on my vacations to Italy and I drink some wine and I have pasta, but when I come home, I get into ketosis. I eat mostly paleo. I enjoy my nights out every now and then. Exercise. This one’s easy for me. I was an athlete, so it’s easy. I continue my exercise as normal, but the next two are not easy for me.
00:44:42:14 – 00:45:05:11
Sleep and stress management I am like the Energizer bunny. I want to just get my workout in and do what I can to fill all my days, but I have to slow down because I actually track by sleep with an aura ring and I realized I wasn’t getting enough REM sleep. Ren and deep sleep are crucial for restoring brain health, for taking out the garbage that builds up over the day.
00:45:05:13 – 00:45:31:20
And I was not hitting those marks, so I needed to calm down a little bit. I needed to work on stress. I needed to slow down my days and get to bed earlier, make sleep a priority. Toxin avoidance. So being an outdoor pathway doctor, I know just the importance of, drinking clean water and eating organic, but I had to take a little bit closer look at also, what was I applying to my skin?
00:45:31:22 – 00:45:56:05
What were the chemicals that I was, using in my daily personal care products? Even I got my hair done. Summer hats. But I use things like the yoga app Laika, which helps me to scan personal care products, look for things like phthalates and parabens. Bpas, other chemicals that are known to be endocrine disruptors contribute to cancer and can contribute to dementia.
00:45:56:07 – 00:46:22:20
So it’s a day to day practice, and I do what I can. I lean into things that are easy for me, like exercise, but I also challenge myself in the areas that are weak for me. I have created a, routine now with meditation because I know, especially looking at the way my mom is and the way other people in my family are, that stress is a silent killer, and if I don’t get on it now, it’s just going to be a bad habit.
00:46:22:22 – 00:46:43:06
So again, we’re just delighted and excited to be able to offer the guide program to get access to more people at a much more affordable cost. And so please be sure. Spread the word. This is a San Diego local, invitation. So we’re putting together resources specifically for San Diego and here to help the community. So please tell everyone about it.
00:46:43:08 – 00:47:00:23
We also have several other offerings. So we we are both taking patients. If you’re interested in seeing either of us, we have to see patients who are physically in California. We are trained. Excuse me. I wasn’t trained here, but I was. I’m licensed here. We are licensed in the state of California. And so, we are only doctors here.
00:47:00:23 – 00:47:21:02
We can’t be doctors for people who don’t come and establish care with us. But we would love to see people. We have lots of people come in, and travel to see us. So we have our clinic. It’s all ferry right on Engineers Boulevard. And then we also have a coaching program. And as with so fun, I very it’s I love seeing people that we work with and and people that we’ve cared for.
00:47:21:02 – 00:47:41:18
It’s so nice to have you be part of our community. I’m going to get emotional. We’re just so grateful to be able to serve you and support you. And thank you for showing up. Thank you for being here. And participating and just being the wonderful people that you are in, proving to us what’s possible. And I think both of us got into this not thinking there was anything we can do for dementia and Alzheimer’s.
00:47:41:20 – 00:47:59:14
And it’s the bravery and the persistence and the hard work of our patients that shows us what’s possible week after week. And we have hard weeks where we’re like, is this really working? Or are we going to Galvin or anybody? And then someone comes in and has this, you know, miraculous recovery and improvement and it keeps us going.
00:47:59:16 – 00:48:19:11
So we have coaching programs. We have a new creatine products, we have a guide program, we have our practices. And there’s really we have the book. There’s something for everyone. So if you or someone you know is looking for additional resources, please reach out. We also have an incredible staff. We have an incredible team. Santiago is our director of operations.
00:48:19:11 – 00:48:33:12
He will pick up the phone and answer any questions for you. Dana might still be here. The Dana will be the smiling face that at our front desk if you come into the clinic. And so we’re here to help. We’re here to support. And we’re also here to answer questions
00:48:33:14 – 00:48:34:00
00:48:34:02 – 00:48:44:06
All right. I think we’re wrapping up here. Thank you so much for being here. Thank you. Everybody will be in the back kick. You’d like to play 15 or get a book. Listen,
