Reversing Alzheimer’s – Hope vs Hype

Dr. Nate Bergman, DO, MBA

Thanks for doing this Heather, it’s nice to be here with you.

Heather Sandison, N.D.

I reached out to you not only because you host the podcast and have talked to so many of the experts in the fields, but also because you’re as bit of a self-described skeptic. And so I love to have conversations that sort of challenge my worldview and help me to think more critically about what’s possible about what we know, what we don’t know. And so that’s where I would really like to go today is into the frank conversation about what we know and what we don’t, according to the science. I’m also curious just to start, you’ve interviewed so many of the voices in this area, what are some of the pearls and concepts that you’ve picked up with them that you’d like our listeners to know?

Dr. Nate Bergman, DO, MBA

Yeah, that’s a good question. There is a lot, I think much is unknown. I think that’s the most honest truth, but there’s enough known where you and I and others doing this kind of work are seeing people stabilized. They’re seeing people in some cases improve, but the key seems to be acting early. The early identification, the earlier people can identify and seek treatment for symptoms like Alzheimer’s the better the results are. For so long people have been on this impression that there’s nothing you can do about Alzheimer’s. And when we speak publicly, that’s what we talk about. Usually talk about early identification, doing something early, and this idea that it’s no longer true, even from an evidence-based medicine perspective, you don’t have to get into functional medicine. 

You don’t have to get into functional neurology. You really just have to follow the data. But for the last few years, there’s been evidence for prevention. There’s been evidence for early improvements. And so that’s like a game changer. So, that’s exciting because it’s never been like that. The other thing, and I give Dr. Dale Bredesen, who I know you’ve had on this summit on, and we both know fairly well. I give him a credit for clarifying and making the analogy between Alzheimer’s and cancer. 

So redefining cognitive impairment like that, as opposed to like when we started the podcast, you’ve all been passed on Alzheimer’s we were using the word Alzheimer’s and at our brand strategy person said to me, she said, “Well, it really evokes this image of someone kind of in a nursing home, against the wall with like hot cereal, spilling out their mouth and completely impaired can’t recognize family members.” And that’s like, people’s notion of Alzheimer’s. And I still see people like that often, and those cases hurt our hearts every day, every week, but Alzheimer doesn’t start there, you know this, and by making this analogy to cancer, somebody tells you cancer, you wanna first know, okay, what kind of cancer is it the treatable kind or not? 

If somebody says they have early stage breast cancer, most of us know that, okay, it was probably picked up on a self exam or a mammogram or something like that. And then there’s a lot you can do, and you don’t have to die of it. You can treat it, you could call it a cure. People are often worried that it will come back. And sometimes it does, but there are treatment strategies around early identification and taking it out as opposed to like stage four pancreatic cancer, which, although there’ve been an incremental improvements is still, it’s wow. Stage four, pancreatic cancer. Most of us know, well that’s tough. So the idea that someone can have Alzheimer’s, but not have dementia is novel. I think that’s still new. And in this sort of academic medicine world, we’re using terms like preclinical or prodromal, as, you know, prodromal Alzheimer’s, amnestic, mild cognitive impairment. 

These are all like stage one, two, three, before you get into Alzheimer’s dementia. And just the difference between dementia and general Alzheimer’s would be dementia is where people have cognitive impairment that’s so bad that they can no longer live on their own. They’re no longer sort of safe or able to be paying their own bills or using a phone, or as it advances, being able to go to the bathroom or dress themselves, or eat by themselves. So like it really pushing the needle and sort of defining Alzheimer’s is something that can happen when you’re 65, 50 years old. And you’re starting to have, I can’t remember the words I can’t keep up at work. Like those kinds of any sort of brain inefficiencies. 

Well, it doesn’t mean it’s Alzheimer’s disease. It may very well be sort of the beginning of the changes that 10, 15, 20 years later might show up as a loss of independence as Alzheimer’s. So I think that’s really critical. And so I think that’s one of the big pearls and concepts. And then, I mean, we can get into specifics, but it’s gonna go back to sleep. We can talk about sleep if you want. And you’ve had Dr. Charles Whitney on talking about this airway and sleep and oxygen, but there’s so much what we’re seeing in kind of brainwave technology and bringing bioenergetics that have to do with sleep. Exercise has really been the most evidence-based thing, of course, for a long time that we know we can do for our brain. 

But I think sleep now is really rising, as sort of a rival in terms of its importance in brain function, overall mood, memory, mind function, almost at the level of the evidence we have for exercise, diet, and then really learning the skills to be able to trauma, anxiety, and building toward resilience, becoming more important in mid in sort of later stages of life. And then the other thing that’s also really important and the keys to start, and we can talk about more of that if you want is just the idea of paying attention to our ability to pay attention, executive function skills, things like ADHD, procrastination, core organizational skills, sort of executive skills. Have a number of patients that right now are in their late sixties, early seventies, they’d have kind of like undiagnosed or unidentified ADHD, and they have maybe a child or grandchild that has it. And then we start to talk about it. 

They never kind of got it treated. And so this is something we’re starting to work with more and starting to pay more attention to no pun intended to and seeing if we can do something about that. And as we do something about that, we anticipate beginning to see improvements because early Alzheimer’s in animals, like in test animals really looks like ADHD, like in flies in mice. And it turns out in human beings a little bit too, and in some kind of human beings, it looks like that because of how we think the frontal lobe of the brain, the front parts of the brain that really control our ability to stay organized and focused in some people, not everybody with Alzheimer’s that really can take a hit early, and then everything else like the memory problems, et cetera, will follow.

Heather Sandison, N.D.

I love what you just said. And if I can just sort of summarize. One of the big goals of this summit of just putting the work in to make this happen is to change the narrative. That if you are noticing cognitive decline, tell someone, get resources, find information that can help you reverse that because there are things that you can do. We don’t have to, the old narrative has been that there’s nothing can be done. So don’t tell anyone it’s really embarrassing. There’s nobody should know. 

I still talk to spouses who are covering for their partner, who is suffering with cognitive decline, and really the opposite should be happening. We should be telling as many people who can get us help as possible getting the intervention started early. And the other piece that I thought was so important that you just said is the foundational piece. Like throughout this summit, we’re talking about testing, that’s exciting and interventions that are exciting and technology that’s exciting. And there’s a lot to be learned there. And yet what we know with certainty is that it’s these basic foundational sleep, diet, exercise, stress management pieces that are so critical that all of that other technology, all of that other, the icing on the cake, it’s not as necessary as these foundational pieces that are relatively inexpensive. So anyone listening that feels a little overwhelmed by how much we can do, just go back to the basics.

Dr. Nate Bergman, DO, MBA

Yeah and just to tweak that a little bit, so I totally agree with what you said and maybe even amplify what you said or add to what you said. Just take sleep as an example, you can take exercise, food, all of these things, even sort of stress or stress responses, but just take sleep for example. So a lot of people have undiagnosed problems with either, the two common asleep issues that are gonna be in some, at least in the United States are gonna be insomnia and obstructive sleep apnea. And this idea that you have to be snoring and the blinds on the shades on the windows have to be shaking and the house has to be shaking– All of those things don’t have to be again. 

You may have had another guest that I haven’t heard yet talk about this. So a lot of dentists that are talking about this, there’s some EMTs that are talking about this. There’s a couple of neurologists that are talking about this. There’s some pulmonologists that are talking about this, but there are a number of other conditions other than sleep apnea that can both interrupt your body’s ability to get oxygen, but also interrupt the brain’s efficiency. So like when we see things brainwaves on EEG, sometimes just like, I’ll have people close their eyes for 10 minutes while we’re collecting EEG, doing a brain map, and you’ll see people sort of doze off in people’s arousal, meaning their ability to kind of reorient to awakens alert state, where they can pay attention, create memories, et cetera, is impaired. And that’s not only in people with Alzheimer’s. This is people with kind of like subjective problems, subjective cognitive impairments, with the early so-called Alzheimer’s. So stage one, stage two, before they get really bad and people are really concerned. And this is like you said, people sweep that under the rug. 

So we’ll sometimes send people to a sleep doctor. I’m not asleep doctor. And there are people that know more sleep than I ever will, but sometimes they’ll do the evaluation. Maybe they’ll get a polysomnogram or a home sleep test, and it’ll say, mild sleep apnea. And the doctors will say, the sleep doctor say, well, just sleep on your side. It’s not a big deal. Like it’s no big deal. It’s kind of waved off. And that’s where we kind of have to pause and say, this approach is different. We wanna be more aggressive about the lifestyle stuff, because like you said, it moves the needle as much, if not better than many other things. So starting with like a more aggressive approach to lifestyle. You don’t have to have a hundred percent perfect diet, but it’s gotta be pretty good. Just kind of walking and gardening may not be enough exercise. But it has to be lifestyle done, right. In a way, as you know, that’s gonna move the needle. I know you know all this, but we’re talking to the public.

Heather Sandison, N.D.

Of course. Yeah. No and I lived that, what we’re asking even dentists, this comes up over and over again. It’s like, no, we’re not asking you to do the minimum where looking for optimization, which is really the theme of functional medicine. And when we look at the alternative, of just kind of pushing things under the rug and not addressing them, then they start to accumulate. And this is what manifests is chronic disease. And so this is reorienting to, let’s be aggressive about our prevention and our treatment when things are early on don’t wait.

Dr. Nate Bergman, DO, MBA

Yeah, totally. And just another thing, sometimes it helps people hear this, like you’ll say, I went to the state doctor, like you said, Dr. Bergman here she said it was just mild. And I don’t have to do anything about it. And I said, okay, well, it’s mild it means just you’re having mild brain damage every night. It’s my opinion. It’s fine. Just to have mild brain damage night after night. And when you say it like that, it’s like a whole different thing. Because what do you mean, I might’ve been like this for 20, 30 years now, I got to do something about it. Like nobody wants a mild, nobody wants any kind of brain damage. So calling it a mild brain damage, sometimes it’s a little bit, even though it’s hyperbole kind of, but sometimes it gives people a perspective that changes what they heard from the sleep doctor.

Heather Sandison, N.D.

That’s helpful. I’m gonna borrow that if you don’t mind.

Dr. Nate Bergman, DO, MBA

Sure.

Heather Sandison, N.D.

So you also recently interviewed Dr. Marwan Sabbagh. You’ll have to say his name for me.

Dr. Nate Bergman, DO, MBA

You said it exactly right.

Heather Sandison, N.D.

And so I was really impressed by this, because again, we wanna kind of poke holes in our world view so that we make sure we’re getting as close to right as possible. But the stakes are so high. There are so many people suffering. So we never wanna make false claims. And although the claim that there’s nothing you can do is clearly false. There’s also a claim that, dementia can be reversed and we wanna make sure that then that’s our entire conversation on the summit. We wanna make sure that that’s accurate too. And if there’s any sort of question about that, that we’re picking through the potential holes in that, and we’re understanding where they are and how we can really optimize what we know to be true. 

So there’s a conversation that you had with him about the new the Biogen product that was recently FDA approved, and there are arguments on both sides about why this was done or shouldn’t have been done perhaps. And I noticed that the Cleveland Clinic where you studied and did your full fellowship has decided to not offer it. And then why didn’t you to speak to some of the controversy and some of the discussion around this, as a society, we consider spending lots of money to intervene in this way with people.

Dr. Nate Bergman, DO, MBA

So I mean, Dr. Sabbagh is, he’s a leader at the Cleveland clinic has been a leader in the Alzheimer’s community for a long time. I mean, he’s basically dedicated his entire career for at least 20, 25 years as a neurologist, as a geriatric neurologist in large part to solve the Alzheimer’s problem. And he’s a proponent and involved in a lot of medication drug studies, but he’s also been pretty outspoken even going back to 2019 and 2020 about lifestyle, lifestyle interventions to some degree he’s sort of been interested in the kind of work we’re doing you and I are doing, but he’s doing it from a standpoint of sort of the resources and rigors of academic medicine and currently at Cleveland Clinic. 

So it’s a different kind of perspective, but it’s important perspective. I worked kind of in the line of fire at the Cleveland Clinic for several years, and it’s a different kind of expectation there. You can’t just do what you want and say things you have to show evidence or do a study. And that’s good, I like you’re saying that’s a good thing. I thought that the perspective that he brought Dr. Sabbagh brought an agile helm and he was, I mean, one to me he’s one of the most outspoken proponents of agile helm in education med and its approval because of what represents to patients and kind of the field we need to win. And while I don’t personally agree with the approval, if somebody could pay for it cash and wanted to try it, I don’t think, and they were early enough on, it’s evidence of course suggested that it would, if it helps then that was sort of a big if. 

If it’s helpful at all and slowing things down, it would be kind of in needed to be given early. Mild cognitive impairment or very early, Alzheimer’s and who knows, maybe it’s even more helpful to somebody earlier stage. The idea that there will be better medications, especially these monoclonal antibodies seems to be pretty clear, although the field’s been saying that for awhile. So the advantage and I spoke to some of my old colleagues at Cleveland Clinic, and they were very proud that they were not going to be prescribing , sort of wait until better medications would come along. And a lot of these people have a lot of skepticism around what we’re doing, kind of into sort of a functional medicine approach if you will, but they’re sort of taking notice at least what we’re doing at Kemper Cognitive Wellness. 

They’re not objecting in some cases, especially those that kind of know me and know the company where we work at Kemper. We have a decent reputation that we are trying not to be unscrupulous and overly hyping results and telling people it’s work like you talked about before with all the lifestyle stuff. But I think in general what was good about, and agile helm is that it raised some awareness about things that you and and Dr. Dale Bredesen and and and some of the other people and Richard Isaacson. And if you can go on and on have been saying for awhile, which is we have to be looking earlier. The time to take care of cancer is not stage four. It’s earlier, you wanna get in to this as early as possible. Some kind of like we started off on this, I think the agile catching up conversation sort of help that kind of boil to the top a little bit in the sense that it wasn’t helpful, or it wasn’t seen to be helpful later. In fact, they only took people in the study that were earlier, because they’ve done many, many, many trials on people that are later stage. 

And while I still work with those folks on a day-to-day basis, these particular medications don’t seem to be helpful. So act early, and now it also raises awareness that seek identification early, and if something can be done, it’s probably early and oh, by the way, we’re starting to have a conversation that there’s something that can be done even in mainstream medicine. Sort of common practice medicine that you may be able to do something, but Alzheimer’s, So all of those things are good for people that are either worried about going through the suffering of Alzheimer’s or someone they care about is going through that. All of those things are positives, whether or not you agree with agile helm approval or not. 

I don’t think it’s feasible, I don’t think it’s tenable and I don’t think it’s probably worth it, but I wouldn’t stop a patients of mine, most likely if they had the signs and sort of met the conditions that the medications seem that they might work on or slow things down. And I don’t think I would stop them. I would actually be very curious when they combine kind of a functional medicine approach with the medication, what that would look like and if that would make the response to medication even better.

Heather Sandison, N.D.

When I saw the price tag, right this $56,000 a year with my experience at Marama, and with my experience with patients, I couldn’t help but think with $56,000 a year per dementia patient, what we could do with that. I mean, we could build parks in people’s neighborhoods who don’t have them. We could get food, good high quality food delivered to people, we could do. I mean, you could get physical therapists or more, somebody to coach more, exercise, all of these things that we already know.

We could put those, funnel those resources into what we do know about the lifestyle that most seniors are not living, or a lot of them are not living and probably move the needle a lot more. There’s another piece to this out of home conversation. And that is that it is the target is beta amyloid plaques. And it seems to me that there’s a big question mark, in this conversation about whether or not beta amyloid plaques are really the culprit, because we’ve seen that there are centenarians who die and have perfect cognitive function who have tons of clack buildup. We’ve also seen that there are people who don’t have a ton of plaque buildup who have dementia, and sometimes they call this something other than Alzheimer’s. 

But to what degree do you think medications that directly target the destruction essentially of beta amyloid plaques or tell proteins will be the sort of the continued trajectory or do we need to kind of take a step back and go, maybe that’s not as big of a deal as we thought?

Dr. Nate Bergman, DO, MBA

Well, I mean, one thing I think Emile made clear in our interview was that if you don’t implicate amyloid beta, at least to some degree in Alzheimer’s, then you really probably haven’t seen enough Alzheimer’s. And so to me there’s no question that amyloid is playing a role in many, many cases of Alzheimer’s. There are all kinds of paradoxes where things that are unexplained, because we don’t fully understand Alzheimer’s disease, neurofibrillary tangles, the idea of addressed with zinc fingers. There’s a whole group, a whole cadre of doctors thinking about a mitochondrial function and vascular implications to hit hypothesis, glyco tangle blood sugar problems, unrelated to amyloid necessarily sort of like on and on physical trauma, emotional trauma, early brain biogenic, sort of a brain bioenergy failure on a network level.

So there are a lot of descriptions of what’s happening with Alzheimer’s and probably like you, we take the holistic approach of, how many things can we look at both from what happened to this individual, through the, their life course, and then are the things that we can specifically measure that will target the problem. More specifically, infections, toxins, et cetera, all of the hormones, these are all like open questions. I’m not married to the idea that amyloid beta is the be all and end all. And I don’t think in the end, even with like a drug only approach, which is of course the Western world, particularly American business model for medicine, you drug it, or, I mean, I’ve talked to a leading ketogenic researcher was working with ketosis and his whole interest in ketosis is to be able to drug it to make it into a drug. 

And that’s the business model. That’s how large healthcare systems really make money as procedures, medications. And it can be more efficient that way. I love what you said about parks and exercise. I mean, and access to good clean food. I mean, those are so important, so important. Even when our Mark Hyman, my old boss at the Cleveland Clinic spoke to the surgeon general at the time. I mean, that was one of his big initiatives was access to clean food and meditation for everybody. It was amazing. So I couldn’t agree more. I’m not married to amyloid beta, have to treat all the causes, at least ones that are known. And then there’s probably, I suspect many things that we still don’t know, but I do think at the end, even if we come to a drug cocktail early stage, it’s a drug cocktail, or it’s some kind of neurosurgical implant or device that’s implanted in the brain. It’ll probably target multiple signals rather than just amyloid.

Heather Sandison, N.D.

So you also bring up a good point about how multifactorial dementia is, and this feels well established that there’s not one thing that causes dementia, that it’s a bunch of things. And so this isn’t a situation like strep throat, where there’s a bacteria in your throat causing a bunch of pain and you want to treat it yesterday. And here’s one pill, an antibiotic, you take it for several days and it goes away. That is not the model here. And so, as you’ve mentioned, the business model around medicine is very much geared towards single interventions and the gold standard of research and how we know what we know is a double-blinded placebo controlled trial. 

Now, in the case of something that is multifactorial and individualized, where two people can have different pathways that they take to get to the same diagnosis. And Dr. Bredesen does a good job of describing, his kind of six pathways or six types. And they’re not mutually exclusive. You can have all six types or you can have one or two. And so when we think about a disease where we know that that’s the process, the double-blinded placebo controlled trials are no longer adequate to answer the question what works and what doesn’t. And so we start having these conversations with people who really value that type of trial and say point to the science, but the science and the way that we’ve designed, the way science works, doesn’t meet the need of the current complex chronic disease landscape that we have in the Western world. So what do we do?

Dr. Nate Bergman, DO, MBA

Yeah, well, I mean, I think part of the, as I became aware of functional medicine and the work of Dr. Bredesen, I was in my geriatrics fellowship at the Cleveland Clinic and was sort of already convinced to some degree that like we needed to do more than one thing. ‘Cause that’s what you saw with healthy people. They were doing more than one thing, people that would beat diseases and sort of keep them at bay either they were just lucky or they were doing more than one thing. And then when you kind of got into it, even back then in 2014, when we kind of looked around the world at what was working, there were people and organizations and serious researchers, mostly in Europe, France, and Finland doing what we called multi-domain trials and I gave a grand rounds with this as a fellow, to the internal medicine department there. And it was interesting to see their response because I wasn’t talking about functional medicine.

I was an internist doing a geriatric fellowship. And we were talking about multi-domain therapies and the effectiveness of those. So a lot of people have heard of the finger trial MAP-T M A P dash T PreDIVA trial. I mean, these were all multi-domain interventions. And weren’t just like, there’s this notion that we have to do more things. So you don’t get pushback anymore from cardiologists that diet’s important from endocrinologists. You don’t get important. You don’t get pushback from endocrinologists people that take care of diabetes and other conditions like that. Diet, exercise, sleep are important, but you don’t get that. But we still get that kind of pushback from oncologists. Like diet doesn’t matter. 

I had a story. This is unbelievable. I have sort of a friend who is a physician and an epidemiologist. His wife is a PhD level therapist. And so they’re very bright. And after he got COVID right early on, right before we were all sort of wearing masks, he had, probable COVID, all the symptoms had really bad brain fog. He’s in his late sixties has a Parkinson’s runs in his family, in a first degree relative. And he started having cognitive changes and he started having like trouble with walking. Which is classic in Parkinson’s. And was obviously very concerned, very concerned. And, he kind of was trying to figure out what to do went to a movement disorder specialist who I know who’s a very good doctor, very smart, like everybody else probably smarter than me. And he went through the diagnosis or the diagnostic process, diagnosed thousands of people with Parkinson’s or sort of related movement disorders. And he told this guy who’s a educated physician, researcher, he said, well, I’m not sure if you have Parkinson’s come back in six to 12 months that I can kind of tell you for sure if you get worse. And it just that was like, okay, all right. I guess that’s sort of just the limitations of medicine. So then he just said, well, what about like nutritional strategies? Yeah, yeah, yeah. 

Nothing. So this guy is smart. So he went and started Googling. Just started doing the research and like immediately you come up with all kinds of research, how nutrition can improve. So he fixed his diet up a little bit. I mean, he was already even pretty well, but he’s fixed up his diet. We talked about brain training. So he was interested in like likes chess. So he started getting back into chess and a lot of his brain fog cleared. Typically there’s a little bit of a workup done in neurology like a thyroid rule some infections will get like a B12 level that wasn’t done here. And to be fair, it was the kind of the middle of the beginning of COVID. So I wanna be a little bit sensitive to the neurologist because, we’ve all missed stuff. We’ve all failed to follow through on something in our careers, but he ended up going to his primary care doctor. And so that he had sort of below red line B12. So not like a sort of low, but in a normal range, it was abnormally low according to everybody. And then he started reading, reminding himself what he learned in medical school about B12 and reading about B12 is like, oh my gosh, if it goes on a long time, it can be permanent, but just started taking B12 and then went on some shots and started to notice sort of even more improvement. So it’s like, he went to one of the best places in the world that you could get a diagnosis. 

He listened to the doctor. And if he just did the recommendations, you would be waiting to see the doctor like for a year and then go back to sort of make the pronouncement of Parkinson’s. But he didn’t because you know, he’s proactive. And those are the people that we see that are succeeding that are sort of saying, okay, well, I’m gonna go to the regular doctor first. And I always, I mean, people shouldn’t skip going to the neurologist. I always refer people back. Why wouldn’t you do the standard of care? First of all, insurance pays for it and you get some good information. The problem is when we get these messages that are just not up to date where, oh your nutrition doesn’t matter. 

Oh, so that’s the disconnect. So that story to me is very, very powerful because this guy is having improvements though he’s still wanting to have more and he still has some struggles, but just with the few things that he does, and this is a very sort of evidence-based family, wife writes evidence-based guidelines that are sort of national level evidence-based guidelines, but when he’s open and curious enough, and he just kind of called me and we had an hour conversation about take a guess, sleep, all the other things, mitochondrial function, et cetera. And so he’s kind of like pursuing that as his own pace. It’s like, we see these things over, over and over again, over and over again.

Heather Sandison, N.D.

How interesting. And I think that’s where it happens. Is when you get a diagnosis or someone in your family gets a diagnosis and you start to really put the effort in, okay, what are some of the options? But what’s impressive about him is he’s not back to a hundred percent it sounds like. And it’s been a year and a half or so, but his doctor was expecting in six to 12 months that he would progress and he’s gotten some improvement. So that sounds like a success. And certainly around the narrative of Alzheimer’s, Parkinson’s a lot of these neurodegenerative disorders, is that the expectation from neurology or a lot of conventional medicine is progression of disease. 

And our expectation is reversal, and we’re not gonna get it a hundred percent of the time and we’re not gonna get it without some significant effort, but we can see that it’s possible. And that is what I want people to understand is that there is a chance of reversal. And so what does a balanced perspective look like in this area right now? What do you suggest seeing that your patients do? How far do you take it? Do you give them the entire list? Do you say these are the things that moves the needle the most do what you can. I think that we all need to allow ourselves a little bit of grace because it can feel overwhelming. It can become a full-time job. It can take a fortune to do it all, but what is a balanced approach look like?

Dr. Nate Bergman, DO, MBA

So just to note, I will answer the question. I do think it reversal needs to be defined and clarified for people because improvements, reablement, return of function. We have someone working with now just at a podcast on she’s pretty advanced by scores. Who’s still kind of living independently pretty much. And she’s feeling back to herself after several months on the program. And her story continues to evolve up, down, up and down. But for many months it was sort of up, uptick. And it wasn’t really anything magical that we did. Like there wasn’t anything that we did that was kind of like magical. 

Like we weren’t bringing her in for IVs at this point, anything, it was just getting engaged in trying to have people, if you’re fortunate enough to have people around you that care about you, that can kind of hold you accountable. That’s like part of a balanced perspective. Doing this alone, I’ve talked to people that are doing this alone. We’re talking to a group of people next month they are trying to do this alone. Sometimes they’re living alone with dementia they are typically younger because as you know, this diagnosis is starting to happen younger and younger, like the 35 to 64 age range is like jumping up in terms of diagnosis, maybe it’s ’cause we’re looking for things earlier and we’re getting better about the diagnostics, but a balanced approach. Really it goes back to the first thing that we started talking about. Like, typically it’s hard for me to add anything, even if it’s sort of monetarily good for the practice that I work for. If people can’t do the basic things, like starting to exercise, changing their diet, ideally, maybe depends on the risk. Depends on the person. And it depends on what you were talking about before. 

Like kind of what kind of Alzheimer’s they have, because it does seem like there’s multiple sort of personalities or kinds of Alzheimer’s and that’s just not Dr. Dale Bredesen talking about that, Cleveland Clinic, we did deep phenotyping work to sort of describe what will the Alzheimer’s look like Richard Isaacson at Cornell. We’ll talk about sort of personalities of Alzheimer’s. So there’s different kinds. Not all kinds of Alzheimer’s look the same, but like getting people in ketosis if it’s appropriate, exercising with some measure of intensity and trying to add like a cognitive load, some type of cognitive tasking. Learning, sort of brain training, if you will. Addressing oxygen issues, like a huge deal. 

Sleep and oxygen issues. And then like the other key that we see is hooking into why do you wanna fight this? Why? This is not easy, right? It can be costly. And it can be at least a part like you were saying, it’s at least a part-time job. Why do you wanna do this? And that’s sometimes a difficult conversation because I’m sure like you have what we see a lot is a spouse or a child of someone who is suffering as the bringing my patient in saying, mom, you have to do this. And I was looking at me like, who said, I wanna do this. And so that sort of presents us with sort of an ethical challenge of like, what are you doing this for? What are we doing this for? So I think purpose is huge and we try to talk about those things. We maybe talk about things like goals or we say in different language, but to start, I think about we start with diet, exercise, sleep issues, purpose, and then we sort of move quickly into mitochondrial optimization and maybe oxygen therapies, neuromodulation. We sort of look a little bit at toxins infections, although I still have my doubts about the diagnostics around that a little bit, but we sort of, we wade through, depending on how advanced someone is or how engaged someone is. 

Because if somebody can’t engage in sort of changing a diet that really helped to start them up on tons and tons of supplements or tons and tons of, like whatever else it’s gonna be start hormone replacement, if there’s any risk of hormone therapy at all, it’s certainly gonna be higher in someone who has inflammation because they’re not exercising enough and they’re not eating well. So we’re maybe introducing a risk that we unnecessarily, not that we’ve never done it. Not that there may not be a time and an individual, but as sort of a general piece of advice, I think that’s the beginning of the balance perspective and then wading into some of the kind of deeper layers, functional medicine, sort of diagnostics and layers are soon thereafter, once you get people started with the core stuff.

Heather Sandison, N.D.

One of my favorite mentors has always said, you can’t out supplement a shitty diet.

Dr. Nate Bergman, DO, MBA

Yeah totally.

Heather Sandison, N.D.

Start there. I’m curious about the infections. Would you just speak a little bit to that and your kind of skepticism around it or what you do? It seems to me like the herpes viruses, certainly the that there is a pretty clear connection between them and amyloid plaques. We know amyloid plaques are anti-microbial. So it just speak to that section of this conversation a little bit.

Dr. Nate Bergman, DO, MBA

So, you mentioned a couple, HSV one, maybe HSV two, HSV six. So these herpes families viruses, no doubt implicated. Like if we’re gonna follow evidence, we definitely have to follow the evidence for those and some other dental infections, periodontal disease. So we’re pretty quick to refer for that, to identify and refer for those. In terms of infections or viruses we look for, I would probably put COVID up there now, although we don’t have long-term data, but the association with Parkinson’s in particular early in the anatomy of where COVID seemed to attack, some of the Japanese buddies were talking about this last year, as to where receptors are right in the same area as classic sort of hippocampal areas and frontal temporal areas in the brain are impacted. Not always, but sometimes in Alzheimer’s. 

So those I think I’m much more quick the dental referrals very quick, because the data is good. It’s when we get into some of these other things Lyme’s disease or Lyme related or co-infections CMV Epstein-Barr . Like where there’s much less data and the treatments aren’t clear. That’s where I think I get my questions are raised as to how do we know? And then we have to say okay, what are we going to treat with? We treat with herbal therapy. Okay. And we know that herbs are safe, something like a Buhner herb or something like that. They’ll seem reasonably safe. That seems like a reasonable thing to do. Are the tests good? Like what are we missing? Herpes viruses. ‘Cause we’re using immunoglobulin tests. Are we missing Lyme? Everybody agrees at the Lyme tests, for whether it’s for berylliosis or any Lyme related infections. The most of the tests that we have are highly inaccurate, it’s just the best that we have. 

So that’s where I’m seeing it. Like it’s people sometimes misunderstand me, like I don’t believe that these things are implicated. That’s not necessarily true. I mean, Alan MacDonald just sort of demonstrated that if you look under at the brain of people that have Alzheimer’s disease, you’ll see more risk barricades, at least in a hundred or so individuals. So he looked at, okay, so that’s data, but how do we test for that? How do we know? What’s the best treatment? And so those things still need to be worked out. And I’m willing to wade through that with my patients and have frank conversations, but sometimes it can feel confusing to them ’cause they just wanna know, do I have it, do I need to treat it and for how long? They want a clear answer, and to me, the honest answers is, we’re not sure. so let’s talk about it and then we’ll wait through it together and for people that are already doing the work, like yeah, that’s my commitment to them, even though it’s not the standard of care. 

I know you, you’ve probably practiced kind of the same way. It’s just I sometimes think that the clarity and certainty that we know people want and that we ourselves want, we sort of convince ourselves that it’s there and that’s where that tricky sort of hope versus hype and that’s where it gets tricky. Because in the meantime, we all have a life that we need to sort of continue to live. We have families, we have businesses, so we need to sort of keep things rolling. And I hesitate whether to talk about that publicly, but I know everybody is thinking about it. Every single person, whether they’re mainstream doctor, they’re a functionalist doctor, or do something completely different. They’re always asking themselves like, okay, what level of certainty do we have here? And so I just feel like having more honest conversations about what we know and what is more experimental, is the best way to go and we still like everybody else, we see some of these remarkable recoveries. 

And then we also are starting to ask ourselves, so what are the characteristics of people that are not improving, and I’m a natural born skeptic. And I’m a son of a doctor and a lawyer who sues doctors and hospitals and they would tell you, I was probably like this when I was six years old. But it’s served me and it’s also, I hopefully serve patients, but sometimes it gets you into like you’re neither here nor there, neither here nor there.

Heather Sandison, N.D.

COVID is this really phenomenal illustrator of this phenomenon. That different people respond very differently to viruses, bacteria, these infections, that some people succumb, some people in fact lose their lives. Other people are asymptomatic. And so what’s the difference? This is sort of host versus pathogen conversation in medicine that has been going on for a hundred, more than a hundred years. And when we think about, my hope is that COVID will sort of open up the conversation around Lyme and the co-infections around EBV and the co-infections and things that, whether they’re functional medicine or integrative or naturopathic or whatever, kind of these alternative doctors have favorites, kind of what you’ll see is that everybody who goes to that doctor is diagnosed with EBV or everybody who goes to that doctor is diagnosed with Lyme. And then maybe what we can do is start to have a conversation about where’s the interface? And not that we don’t, but even more so where’s the interface between, a great, there’s a lot of ubiquitous infections out in the environment. 

What is the host doing and what can the host do to best protect themselves so that these infections don’t become opportunistic and start to create complex chronic disease. What are the things that set people apart? And is it genetic? Is it, it’s probably like dementia, multifactorial. There’s a piece of it that’s genetic. There’s a piece of it that’s nutritional. There’s a piece of it that might be toxic. There’s piece of it that might be stressed and that we can start to unravel this. And although it feels a bit overwhelming sometimes there are things that we do know, and that we can start to eradicate. And there are conversations that we can have with people who are ambitious about getting well and willing to do the work.

Dr. Nate Bergman, DO, MBA

Yeah, now that’s, I think maybe really, maybe the most important, but it’s a very, maybe the most important point, but it’s certainly top two or three, which is, strengthening our organism. And that goes back to the first thing we started talking about diet, exercise, sleep, stress environment, cognitive stimulation. And I know you’ve created an environment at Marama that sort of, we’re trying to optimize for that. We’ve done a similar thing in terms of kind of a program to rehabilitate sort of the term that started showing up in the literature in 2017 was cognitive reablement for people with dementia. So we’re very proud of the small amount of pilot data we have for that. And then we’re sort of extending that environment here in Cleveland. And that’s when you got it. And we wanna like, make the soil header. 

We want to improve people’s overall sort of like neurochemistry, electrophysiology so that all of these toxins, all of the infections that we all encounter sort of on a day to day basis, our bodies can fight it. So I was, I’ve been hearing about this since, before I went to medical school, I was sort of fascinated by the psychoneuroimmunology stuff in undergrad, and sort of followed data points a long time. But I became a little bit more convinced of things when about two to three years ago, when I really started seeing how much of the neuroinflammation was related to the immune system within the nervous system. And this sort of tethering of the nervous system and the immune system. And it seems me right now that if you can rehabilitate an immune system enough by just sort of removing, just going back to basic functional medicine principles, Sid Baker’s sort of rules of like removing what shouldn’t be there and giving the body sort of pressing the levers of wellness, if you will, based on things that are measurable or things that are just common sense are known and driving that like people don’t have maybe as much susceptibility to mold or infections. 

So I agree with you. And then it was a more recent pieces of information came my way, that’s been around for awhile. There’s a, she’s sort of an emeritus professor at University of Texas, San Antonio Claudia Miller, and she’s really her and the group that sort of picked up sort of her proteges that have picked up are really doing the work to show connections to toxins and triggers, including mold and derangement the immune system. Whether it’s so clear that mold causes Alzheimer’s or not, I don’t, it’s not, I’m not certain about it, but I’ve seen people that seem to get worse when they’re in moldy environments. Have you talked to Dale Bredesen or , or Anne Hathaway, the people that just completed the trial. I know you’ve spoken about the trials

Heather Sandison, N.D.

I’ll add my anecdotal information as of yet, we’ll publish it next year, but certainly I see a connection between mold and dementia and then also getting rid of it and improvement.

Dr. Nate Bergman, DO, MBA

Which is expensive. So we try to get, again that the testing are rough. We try to get an indoor environmental professional in there and to examine people’s houses. We know air pollution is linked to Alzheimer’s and Parkinson’s and things. And so I agree with you in terms of how do we improve the organism and then improve our general ability to try to detoxify. And then the specifics of doing that, like the hard work of doing a study and publishing, that’s going to be the thing that will convince the neurologic community, the public at large, instead of, my patients going insane. 

I saw the neurologist who wanted me to see, and she said, mold has nothing to do with it. Like, okay, what am I gonna do about that? What can I show them now? So people like you, people are doing some of the hard work to sort of, to make this point to find out, is it true? How true is it? When is it true? And who do we need to act on? So I have a sense that this is a real thing, but to say it’s proven yet, I think it’s premature. And some of the diagnostic tools that we have are probably not ideal. So I think that’s some of this sort of skepticism or cynicism that some people have, it’s where my own skepticism lies, but we still, again, we still look for it. We still work with it and try to treat it even with the skepticism, ’cause it’s all hands on deck as, you know, what these folks, because we need to do everything we can and support them in every way we can so that they can get better. And so many of them do as we know.

Heather Sandison, N.D.

So we just do our best with what we know now. And as we know more and we know better, we do better. So I would love to hear from you in an ideal world, what would the research look like? Like what would be published or how would a study be designed to help you feel like less of a skeptic? And then I wanna make sure before we go, that everyone knows where they can find out more about your podcast, your clinic, and then also whatever else you have to offer.

Dr. Nate Bergman, DO, MBA

So the question about the research, where does it needs to go? I mean, it’s sort of what we were saying before. Usually the research is done in sort of bits and pieces and threads. So first like Claudia Miller was the first thing that her work and the work of her group was the first thing that sort of was really convincing to me on a sort of a mechanistic level of how mold might trigger the immune system. Because I’ve read a lot, but this was sort of qualitatively different, and I, even though she’s been around for awhile, I hadn’t seen a lot of the people that I look to and learn from, according to her, although they may might have and I just wasn’t, it didn’t sort of put it together yet. 

I know a couple of people that I contacted after the fact said, oh yeah, she’s a giant. But it was a recent paper by her group that was really a head turning to me. And so you’d kind of need the same thing with Lyme, but in order to do that, we need better diagnostics. So like first we need good diagnostic tools, and my main issue is with the testing it’s instead of with, the testing itself, is less question about whether or not it’s playing a role in this sort of multi-factorial issue, but, so less questions about that, but how do we know with certainty to be able to make a recommendation to someone that they should spend $35,000 for meeting their home or leave the house that they’ve been in for 45 years. That’s a hard thing to know without a pretty good level of certainty. We’re starting to be able, so the people that are committed as you know, are willing to do it, but to me I’m not an indoor environmental professional. 

I don’t think that a lot of the sort of urine and blood tests that we have are foolproof. And so we like to have a home inspected by someone that knows what they’re doing, and then we can make a better recommendations, since we’re starting to see that with our people. And that feels more legitimate, than a urine test that I don’t know whether I can trust the results of, because of everything I’ve seen, everything I’ve done, everything I’ve read and every expert I’ve talked to. So we need to sort of do the tests, validate the tests, see if treating the problems improve, either as sort of a one-off basis or as a complex of things. But when you’re treating a complex, I do think that, even when I was at Cleveland clinic, there are technologies that are starting to allow us to do systems interventions. So doing multiple interventions and usually these are used in drug trials, use three or four drugs that say it brings certain kinds of brain cancer was when I first became aware of this a few years ago. 

That can sort of attribute different kinds of improvements to the different aspects of the treatment. So I think those are coming we’re a little bit far away from that in the functional medicine world, but those kinds of treatments and technologies that allow us to sort of assess for, well, how much was it this and how much was it that those are coming. Those are the kinds of things that will be really, really persuasive. And if we have those, this kind of medicine will be mainstream medicine.

Heather Sandison, N.D.

How exciting.

Dr. Nate Bergman, DO, MBA

It’s very exciting where Kemper Cognitive Wellness in Cleveland, Ohio, the podcast is Evolving Past Alzheimer’s and we’d love to hear from you.

Heather Sandison, N.D.

Nate, thank you so much for taking the time for having this conversation with me. I always learn something when I chat with you. And I’m just so grateful that you were part of the team, that’s changing the narrative around this and feel just really grateful to call you a colleague and to have gotten, to have this conversation and share it with all of our listeners. Thank you.

Dr. Nate Bergman, DO, MBA

Thank you, I feel the same about you. Thanks for having us.