Peptides for neurocognitive function

Heather Sandison, N.D.

Thank you so much, Matt, for having me. It’s been so fun. I had, just so listeners know, I had the chance to go up to your clinic and hang out there for a week and see what kind of magic you guys are up to and what you do, the procedural side of the injections, the plasmapheresis, the ozone dialysis, all of these things really compliment I think what I do so well and of course, as the doctor I am, I’m like, oh, how can I do this down in my practice? How can I incorporate more? So I’m excited to, you know, share more patients with you. Everyone who has been up to see you guys, all of my long term patients that have been up to see you already have really benefited a ton and so I’m just grateful for what you’re up to in the world and just how generous you are with sharing what you do.

Matthew Cook, M.D.

Oh, thanks, yeah, we have the grateful dead model. I think we’re trying to give that away. So, because there’s so much, yeah, I’ve had this give it away idea of just saying almost anything that we think is true because there’s, they say the computer chip doubles every two years and how fast it is and I think the information and regenerative medicine and integrative medicine is doubling every two years because people are just, there’s so much information there-

Heather Sandison, N.D.

There really is and I don’t want people to be overwhelmed by that because sometimes that can lead to sort of this paralysis and-

Matthew Cook, M.D.

Hmm-mm.

Heather Sandison, N.D.

Especially in the case of Alzheimer’s, dementia or any sort of dementia, any sort of cognitive decline, sometimes that can start to feel really overwhelming of like, oh, I’m not getting it quite right or I don’t have that magic bullet yet or they’re learning so fast that I don’t have to worry about it now, when in reality we know so much that we can do for cognitive decline and really my message, if anyone takes anything home from me today, it’s that if you’re noticing cognitive decline, the time to engage with a doctor who can, a functional medicine doctor who’s probably trained by Dr. Bredesen to help you reverse that cognitive decline, you wanna do that immediately. You don’t wanna wait for it to get worse. It’s so much less expensive. It’s so much easier to prevent dementia than to treat it. However, we see miracles happen. So we’ll talk about that.

Matthew Cook, M.D.

Okay, great. So then let’s dive in, define dementia for me.

Heather Sandison, N.D.

Yeah, so yeah, and one of, I’m reading this book, I actually have a right here, it’s called ‘How Not to Study a Disease, The Story of Alzheimer’s.’ So a lot of people say Alzheimer’s and they mean dementia and Alzheimer’s is the most common form of dementia but dementia is essentially when the nerves in your brain, the connections in your brain start to break down for one reason or another and Western medicine has had this approach of calling things one thing when you got, so calling a disease like dementia, one word, when really, there are probably 75 different ways, there are causes that you got there and so what we call it, so whatever the name is, I, you know, I really don’t care. You can call it Alzheimer’s, you can call it dementia and some people get attached to these ideas and there are differences with like Lewy body dementia where people have hallucinations and big personality changes. This can be extremely torturous for family members especially. Frontal temporal dementia’s, vascular dementia’s. 

There are different types that sometimes start to speak to etiology or the why, the pathophysiology, what went wrong at a cellular level? However, even in many of those cases, it’s very unclear, right? You can have people with Alzheimer’s who have amyloid plaques and TAL proteins, but also have Lewy body. You can have people who were clinically diagnosed with Alzheimer’s but then when they die and we see what’s in their brain, they actually have no amyloid plaques. We also have a flip side of that, where people die at 105 and they have no dementia, no cognitive decline at all. They’re perfectly in great cognitive shape and they have brains full of amyloid plaques. So this gentleman, Carl Herrup, I’ve only read his name, sorry, not heard it, but he wrote a book recently this, ‘How Not to Study a Disease’ and he breaks down this story of how with dementia, we got so off track and it was really, you know, there were some egos involved. 

There was some bad timing. There was certainly politics and money involved, but we’ve started to, we’ve been really attached to this idea that we need to go after amyloid plaques in the brain and what we’re learning after billions and billions of dollars and countless hours of very smart people’s time is that we’ve been on the wrong track and we really need a full paradigm shift away from this reductionistic idea that one thing is causing this disease. We need to take that step back and say, okay, how can we support cellular health? How can we support the health of every cell in the brain? Whether it’s, you know, the immune cells or the neurons themselves or the support cells or myelin sheath’s around it, how do we support the mitochondria inside of them? How do we support every step along the way and make sure we, at a very simple level, we’ve got the junk out and the good stuff in supporting cognitive function?

Matthew Cook, M.D.

Okay, perfect. I would totally agree with that and from a reductionist perspective, you know, Western medicine, I even, there was like some ads I heard, you know, on the TV, the music came off and the TV accidentally came on and I was hearing, you know, advertisements for like the new medications for dementia but the reality is, is I think that it takes an integrative functional approach to deal with cognitive change and probably Dr. Bredesen has been the person who really defined that, maybe introduce people to who he is and what happened around that and how you used his perspective.

Heather Sandison, N.D.

Yeah, he really is, has paved the way here and I’m shamelessly riding his coattails. So Dr. Bredesen is a neurologist and he is also a bench scientist. So he’s contributed a lot to the research and throughout the 80s, 70s, 80s, 90s, he was working on what he calls Mouse Alzheimer’s. So he was in a lab looking at what was going to affect the brains of mice, both in good directions and bad and over time what he realized was that, you know, like many people I think in the dementia space, especially in the pharmaceutical space, they realized like we’re barking up the wrong tree and so he took, he did that. He took the step back and said, okay, what are all of the things that are supporting or destroying neuronal cell health? And in that, he came to a more kind of complex system science approach and when I heard him give a talk in 2016, 2017, I heard that approach. He was being comprehensive about it and unapologetic about how comprehensive he was and in that, I was intrigued and yet I had heard from well-meaning instructors and very smart people that there was nothing you could do for dementia and to suggest otherwise to their friends and family and to them would be to, you know, to give them false hope and it would really be detrimental. 

So here I am listening to Dr. Bredesen, very intrigued and compelled by his approach, but not really believing it, feeling very skeptical. So I went to his training ’cause I wanted to know more and then I ended up on his list of doctors who had been trained. So then I had patients coming to me with their spouses, their loved ones and they were more convinced than I was but there I was, I was gonna to follow the protocol. That’s what they were there for and so we ran all the tests and we did all the things, we got them on hormones and got them on the right supplements and we figured out what was going on and got them out of moldy homes and my first patient, Linda, she came in with a MOCA of two. So a MOCA is a 30 point scale. It’s the Montreal Cognitive Assessment Score. She had a MOCA of two the first day I met her and I would ask her a question. I could see her comprehend the question, but by the time she was able to answer it, she had forgotten what the question was. 

So we couldn’t really have a dialogue. Her handwriting had been affected. She was a shell of herself. Of course her relationship with her husband was affected, but he was very, very committed and so they did everything and they came back seven weeks later and her MOCA was now a seven out of 30 and when I saw what was possible for Linda, her handwriting was back to normal. She could answer a question. She could carry on a conversation and the best part was she was bickering with her husband about something that had happened the night before. So their relationship had changed. Her life had changed and when I saw what was possible for someone like her, whose disease process was so progressed, oh, I mean, how could I not commit myself to this work for the rest of my life, right? Like, imagine what’s possible for people who are earlier on in the disease process, if that was what was possible for Linda. So since then, I have been seeing reticent patients, cognitive decline patients and then I was very fortunate to be awarded a grant to study this approach. So we took 25 participants through a six month protocol of aggressively treating their dementia, doing all the functional labs so that we could understand how were nutrients, how were toxins, how were stressors, how were hormones, traumatic brain injuries we talked about and treated, infections we tested for and treated. 

So once we got this really comprehensive view of what was going on, what was affecting that cellular health, we treated it and then six months later, we measured again what their cognitive function was doing and so we’re excited to publish results around that. Dr. Bredesen did a very similar trial and his group , and a couple other doctors, they published about in April of 2021 and they showed about 75% of their participants reversed their cognitive decline. Some by a little, some by a lot and compared to our conventional treatment, right? Most neurologists are gonna say, here’s some Aricept or some Namenda. It doesn’t work very well but maybe it’ll give you a little bit of time to get your affairs in order and then the expectation is that you go downhill. What we’re showing is that there’s so much more that’s possible.

Matthew Cook, M.D.

So then that first case, Linda, she came in with a two for her score, tell me about like somebody who just is first having cognitive change. What are some numbers you’re gonna see? What are the spectrum of numbers you see? And then once people start to get treated, how much do those improve?

Heather Sandison, N.D.

Yeah, so this is a 30 point scale. The MOCA is, and 30 is perfect and many of you have probably seen this. There’s a rhinosaurus and lion and so you name the animals and draw a clock and copy a box and, you know, there’s a pattern and you count back by some number from 100 and so it’s a 30 point scale. So if you get all of ’em right, it’s 30, normal is over 26 and if you’re starting to be under 24, you’re probably having some cognitive decline. Now it’s a huge privilege. It’s my favorite thing when someone walks in and they say, I’ve just started noticing that I’m not remembering things I would’ve 10 years ago, names, places, my schedule, what time my flight leaves in the morning, those kinds of things that I used to have a really good handle on, I used to be able to figure out new things or read the instructions and build something or get something done and I just am not as sharp as I was. 

That is my favorite time to intervene because those people are better sometimes in a month, sometimes in three months and then if they can just maintain a relatively healthy lifestyle, they’re pretty good to go. So, and then of course, you know, annual check-ins, but it’s not heavy, heavy lifting, it’s minor tweaks and that’s really exciting and really fun. Now if we have someone who’s more progressed, you know, say in the twenties. So we’ve had handful of people who have a MOCA of say 20, 21, they’re in their 50s, 60s, early 70s, they’re getting back up to 30. So that happens regularly and this is, you know, this is measurable cognitive decline. So it’s not like we’re taking people at 30 and then they’re telling us that subjectively they’re better, right? They’re just telling us that they feel better, we’re measuring people who are saying 20 years ago, I could figure the computer out and now I can’t keep up and then we get them back up to 30 and it there’s a lot of overwhelm that comes with this and the overwhelm goes away. 

One of my favorite stories from one of our patients, she, you know, of course loves her son. So her son lived about an hour, hour and a half away and she was so overwhelmed by getting on the freeway to go see him and to drive to him and afraid of getting lost and worried about maybe, you know, being out after dark and how she might not make her way home and so she had stopped going to see him and she wasn’t seeing her grandkids and by the end of six months, she’s like, it’s no problem. I go see my grandkids every week now. So it was just really neat to hear that this kind of thing, this kind of work rate, I think we can all agree, there are a lot of problems in the world, right? There’s this idea of this like meta crisis, like what, like the planet, society, like, what are we doing financially, economically, there’s a, politically, and we need our elders. We need these seniors who are at the height of their wisdom and experience. We need them engaged with us. We need them talking to their grandchildren. We need them to here to help us figure this out and so that’s really what I see my work as is protecting and preserving that wisdom and experience that the world so needs right now.

Matthew Cook, M.D.

That’s a good one and what I would say is that from a financial perspective and at a societal perspective, those early cases where people are, you know, just having that initial change, the modalities that you’re talking about and I think this is maybe gonna be a jumping point in terms of kinda getting into that, are not super expensive because basically what Bredesen’s looked at is he said, hey, let’s pay attention to blood sugar. Let’s pay attention to all of the obvious functional medicine things. Let’s take a systems biology approach basically and apply it to the brain and see what we can do. How do you put together your thoughts on sort of, let’s say we’ve got a simple case and no case of cognitive change is gonna be simple but how do you put that together in terms of how you think about it and how you talk to people about it?

Heather Sandison, N.D.

Yeah, so if I have the privilege and the opportunity, I like to be as comprehensive as possible about workup from day one, because what I don’t wanna do is spend people’s time and money and six or eight or nine months down the road, we go, oh, we never tested for heavy metals. We never tested for mold and then that’s what’s holding us back. So what I really like to do is get a lay of the land, understand, and the, you know, most of these people are in their sixth, seventh, eighth decade and so there’s a long history. So we spend 90 minutes together the first time and I collect as much information as possible about anything from their history perspective could be impacting their cognitive function and then from a lab of perspective, I have buckets, right? So again, at a very simple level, we’re gonna get the junk out and get the good stuff in. 

So I wanna know about toxins and I think of them in three flavors, mold toxins, chemical toxins and metal toxins and if any of those are there, step one is to get them out and then from a nutritional standpoint, I wanna know, do you have enough? Do you have enough in your cells? Do you have enough from a functional medicine perspective, right? Not too little vitamin C that you have scurvy and your teeth are falling out, but do you have enough B12 so that you’re methylating at an adequate level so that you’re able to metabolize your neurotransmitters and detoxify and so we were looking for that kind of level through O testing, I use serum testing, I can use intracellular testing and depending on the patient and their insurance and we try to be practical and keep the cost down and then infections, oh, well, back to nutrients, a GI panel, a stool panel, I do want everyone. 

If they’re having, you know, hopefully everyone’s having a bowel movement a day but even if they are, I want a stool panel because whether or not you can digest and absorb your nutrients, has a massive impact on whether or not you’re gonna have enough of the good stuff and then also it’s very easy to get inflammatory markers or inflammatory cytokines or inflammation in the gut basically, inflammation often will start in the gut, infectious imbalances, parasites, things like that. I wanna catch them early so that we can balance the gut, right? Health starts in the gut and then the guts starts in the mouth so addressing dental stuff comes up very, very quickly as well. So in toxins, nutrients and then infections, I wanna understand right away, because if somebody has hepatic outbreaks regularly, if they have P-gingivalis in the mouth or if they have Lyme, the Lyme spirochete in particular can cause a lot of inflammation in the brain. 

So those three are the ones most associated or most directly associated with dementia but a high infectious burden in anyone is going to just be a drain on this system, right? You’re gonna be spending resources fighting infection versus building neuronal connections and so we want our bodies, our brains oriented towards growth, towards new and so another piece of that is the signaling. So hormones and this is the Peptide Summit. So thinking about what kind of signals can we send and how can we do that? So things like stem cells and exosomes and peptides certainly come up, but so do testosterone, estrogen, progesterone, vitamin D, thyroid hormone, getting all of those things nicely balanced makes a huge difference. We know that women suffer from dementia’s, about two thirds of the cases of dementia are female. 

So it’s not a 50-50 split. Part of this is explained because women live a bit longer than men, but another big part of it is just menopause, that women have this drop off of hormones when they hit menopause and that’s when they experience a lot of cognitive decline for many people, not everyone. And so we wanna be supportive of their brains by giving them back some of that hormone, of course, working with a provider that’s skilled in this area and can assess risks and benefits with you and talk you through all of that but trophic support is really important to maintaining and then, and reversing cognitive decline, maintaining cognitive function and reversing decline. So another thing I talked a bit about the mouth. So certainly from an infectious perspective, if there are cavitations or root canals or abscesses that people don’t realize, mercury amalgams still in the mouth, that’s a pretty high priority to take care of. The other piece that comes up in the mouth is structural in terms of sleep apnea. 

So can you keep your airway open at night? So there are two things that stop me in my tracks. One, if you’re not having a bowel movement every day, that’s step one. If you’re not sleeping, if you’re not getting good sleep or if you can’t get air into your lungs at night, you can’t get oxygen to your brain at night, that’s also step number one. So those become absolutely critical. They have be addressed immediately. In most of my patients I’ll order an at home sleep study on these days because I just don’t trust when someone says, no, I’ve never snored, but nobody sleeps with me. I just don’t know. I don’t trust it and oh, I’ve never woken up gasping for air. You do not need to be overweight. You don’t of wake up gasping, just waking up tired in the morning is enough for me to say, oh right, let’s get a sleep study done and we live in such a day and age. It’s great, you know, you can get a Garmin or a Fitbit or an Oura Ring or an Apple Watch. 

There’s so many things that you can get to monitor your sleep and get some sense of, okay, am I getting good oxygen flow to my brain? To all of my body? Am I getting restful sleep, deep sleep, REM sleep? What does that look like? And so getting that feedback and then tweaking things so that you’re optimizing sleep, it’s such an important time for the brain to detoxify, also to process memories. So really, really important. Another critical piece of this puzzle is stress. So we want some, but not too much and too much stress particularly for caregivers. If there are any caregivers listening to this, the people who care for dementia are at much higher risk of getting dementia. 

It’s two and a half times the normal population because it’s such a stressful job and particularly when it’s a family member, someone you’re deeply emotionally connected to, when you see them, frankly, losing their minds, that is really physically challenging, emotionally taxing and financially often a huge burden and so for caregivers out there, I really wanna stress the importance of taking care of yourself and managing stressors. So whether it’s meditation, prayer, yoga, whatever that means for you, exercise is another big component of this. There’s lots here and I don’t wanna overwhelm anyone. However, I do, I think that so often we’re told neurology or super smart people, right? That there’s nothing you can do when in the reality, there’s so much that you can do and just getting started is really step one.

Matthew Cook, M.D.

Okay. So then that was a lot. Let me recap that and because that’s so, it’s so good and I think it’s so worth hearing. So, there’s a few things that when they happen are just relatively catastrophic for the body and one of ’em is sleep apnea. A friend of mine shared a hotel room with her sister and then she called me and she said, well, my sister snores and has sleep apnea but so then, you know, then you think, and you think about cognitive change and it could be toxic. So then you think, oh, okay. So mold toxins and water damaged buildings, the mold is kind of mold the and maybe some other bacteria too, that’s one thing you can check in the house and so then for people listening, all of a sudden there’s a detox to your life and there’s also a detox to your house. 

There’s a whole bunch of other toxins and so then you begin to say, oh, okay, well maybe we should do some testing and start to figure this stuff out and probably sooner rather than later, you know, maybe in your, if you’re 65 and you’re starting to have some mild issues, these are relatively cost effective strategies of working your way through and then, you know, we have not done a great job in Western medicine of paying attention to stealth infections. Things like , all of these things but I think with COVID and with, you know, COVID, people can have long COVID, people can have long term viral things. All those things can be an immune stress and so suddenly you begin to pay attention to all of this stuff and so then you start to pick off and work your way through, there’s the gut brain access. So then you’re basically paying attention to all of that. How big of a deal is blood sugar?

Heather Sandison, N.D.

Oh, Matt, I’m so glad you asked that because somehow I forgot the most important piece. I essentially will not work with somebody who isn’t willing to change their diet.

Matthew Cook, M.D.

Okay.

Heather Sandison, N.D.

‘Cause I lose, that does 50% of the lifting. I lose so much value from our approach if we don’t have that, that I just lose confidence that it’s going to work and so what I recommend is that if you haven’t tried it and if you’re working with a provider, that you get into ketosis, if you’re struggling with cognitive decline or you have APOE E44 status or even 34 status. So if you know that genetically you’re predisposed to dementia, maybe you have several people, grandparents or parents who have had dementia. Then I recommend getting into ketosis yesterday. This is essentially switching the fuel for all of your cells, but in your brain, it’s particularly important because your brain needs so much fuel. So switching your fuel from sugar or carbohydrates to fat can be profoundly impactful and the side effects are pretty incredible too, because it’s usually better sleep, better mood. 

You get off the sugar swings, your blood sugar comes down, your diabetes reverses. This is, the A1C’s come down. So this is so impactful and sometimes challenging, right? There’s a little bit of, people call it keto flu or even just sugar detox, right? We can physically be addicted to sugar and so it takes a few days to get up and over that withdrawal but once you’re there, you get the benefits of mental clarity. Fasting is part of this as well. So people get even better results when they can incorporate intermittent fasting. Sometimes just 12 hours of fasting per 24, 12 consecutive hours or sometimes people are going up to 16 or 18 hours of fasting and this can help you get into ketosis and then it can all also help to get even more improvement in terms of the cognitive function. What I’ve seen clinically is if you’re testing blood ketone levels, now there’s breath meters and there’s urine strips and then there’s blood and what I’m talking about here is blood because I have found it to be the most consistent. If you are aiming for about over one. 

So getting over one millimole on a blood keto meter is in ketosis, mild ketosis is over 0.5 but you really wanna be up over one and then we see that the people who can get to two or three or even four do even better. So the higher you can get your ketones, the more cognitive impact you get and this makes some sense. I think of it from an evolutionary perspective. Like if we think of our hunter gather ancestors, they didn’t have access to sugar 365 days a year, right? They had times when they were starving. They basically, and they needed to look for more food or maybe it was winter and they couldn’t, there weren’t carbohydrate rich foods available and so our, we have evolved to go back and forth from brain sugar to brain fat. Now the other thing is, if you can’t find food, you don’t want your brain to turn off. 

You want it to turn on so that you can figure out where that next food source is and what we’re doing in ketosis and with intermittent fasting is a fasting mimicking diet. So you don’t have to be one of our hunter gatherer ancestors that was dying of starvation. What we wanna do is trick the body into thinking that we are so that it turns on cognitive function and this is, I’m sure you’re familiar with David Sinclair and his work on lifespan, health span and brain span, like how long our brains stay active, fasting is one of the few things that has been proven to improve lifespan and health span. So, you know, this, again, the side effects of doing this are improved health. You’re gonna be here longer and you’re gonna live here healthier. So not a lot of downside. Now, if you don’t have a gallbladder, if you have kidney issues, you know, we wanna be working with a provider to make sure that this is healthy for you. Particularly if you have extensive health history.

Matthew Cook, M.D.

For years I used to fast one day a week and so then I, and I started doing it during the week and, you know, people, you would say, oh, well, is that hard to do, you know, when you were like, I was doing like really big surgeries and stuff like that and I found that initially you go through all of these cycles like getting crazy hungry and then all of a sudden you feel totally fine.

Heather Sandison, N.D.

Yeah.

Matthew Cook, M.D.

And then you get hungry again and then you feel totally fine and then going through that process, basically, I overcame that. And so then if you said, oh, you can’t have anything until tomorrow, I would be totally fine now but once I kinda, and so I found it to be one of the most impactful things that I’ve done and I really, I did notice it really kind of turns your brain on.

Heather Sandison, N.D.

Yeah, it really does and it’s free, right? Everybody has to eat and in fact, you might spend a little less because you’re gonna be eating less frequently and so I think sometimes people get caught up in this idea that I’ve gotta get all these tests done and I’ve gotta do all of these things and I need expensive this or that and really getting into ketosis and getting more exercise, prioritizing sleep, meditating, just doing that alone can have dramatic impacts on cognitive function at any age, right? Like this is good for teenagers. Well, teens in ketosis, maybe not, but a 20 year old, you know, somebody in college who’s looking for a little bit of an edge cognitively, prioritize sleep, get into ketosis, meditate. You know, make sure you’re having a bowel movement every day. These things are profoundly effective and then we can start to layer on top things like and Clink and Cmax and all of our BBPC and TA one, all of our peptides.

Matthew Cook, M.D.

Right, so then we’ll get into that, although it’s important to hear that for cognitive change and that’s why I wanted to kind of to talk to you about it, because I think this is, what we’re talking about, all of the entry level things are the most important and that’s also where all of the data is and that’s where you’re turning it around because what happens, I think cognitive changes is, the change is a consequence of lifestyle and so then to change the cognitive change, you have to change lifestyle. Which.

Heather Sandison, N.D.

Yeah.

Matthew Cook, M.D.

Which is a good one. Now then, but you are doing something very interesting to me that I think is probably one of the most interesting things I’ve come across in my entire career, which is that you realized these easy cases you can handle in the clinic but then for the hard cases, it takes a more intensive approach and so then you have an inpatient facility where you’re working with people.

Heather Sandison, N.D.

Yeah, thank you. It’s been a wild ride and really fun, very rewarding. So it’s called Marama and it’s a residential care facility for the elderly that I created and it was really inspired by caregivers and patients, right? These people I saw working so hard to take really good care of their parent or spouse when they were juggling, you know, often with adult kids, they’re juggling their own kids and they’re juggling full-time jobs and then they’re trying to take care of mom or dad and they really, you know, they’re bright people. They get the reticent approach, but just doing it takes a lot of time and energy that they just don’t have and I saw that and related to them and so I had a few people asking me where can I send my uncle or my dad or my loved one and when I looked around to see is there a facility, is there a senior living facility doing this? There wasn’t, there wasn’t one that I could really trust and so I thought, well, how hard could it be? We’ll just make one and there have been, we opened March first, 2020 and the world shut down the next week. 

So it’s been a wild ride, an absolutely wild ride, but really, really inspiring to see we have a woman with us now, I actually, her caregiver called me in December of 2019, so before COVID hit, and at this point I was creating Marama and we had a facility, a physical facility and we were doing all the work to get it ready for residents to move in in March and I had lots and lots of people calling from all over the world and we basically had a waiting list pretty much right away and this woman called and she said, hey, I have my friend, is this incredible woman. She has a MOCA of zero. So she’s nonverbal essentially and she needs one-on-one care and I just said, you know, I don’t know that we can help. I don’t know that she can get any better and so I wanna save our 12 spots for people where I have a higher level of confidence and so then COVID hit and everything fell apart. 

You know, everything was different after that but her caregiver called me back again the following December and she said, I know that you said that it wasn’t a great fit a year ago, but what do you think about taking her on now? And because the caregiver was so persistent, I was like, all right, let’s have her come. So she moved in about a year ago and this woman who was nonverbal and she would grab someone’s arm and like shake it, right? She couldn’t speak. So she couldn’t tell you she was uncomfortable and she was not violent, but, you know, she had to communicate somehow and she has like, she has read someone’s name tag, if you would say, hey, how are you doing? And I’ll rub her back and say, hey, how are you doing? I’m great and now she’ll respond appropriately sometimes, she spelled her last name for someone not that long ago. I mean, she’s not going back to work, right? Like, I don’t want.

Matthew Cook, M.D.

Her MOCA would be now.

Heather Sandison, N.D.

Her MOCA still a zero, right? She’s not, she’s not able to write or draw or anything. Her MOCAs still a zero, but she can tell us I’m cold. She can say I’m hungry. She can communicate and you can see the joy in her face that wasn’t there before. So she’s not going back to work, but the message I have and what I learned at just like a soul level was I can never tell anyone again that there’s not hope. There is always hope and watching her experience of the world change so profoundly made me feel that even if people aren’t getting a hundred percent better, having them get somewhat better so that their existence is more manageable, is more enjoyable. That is worth every minute that we spend doing it.

Matthew Cook, M.D.

What are the top five modalities that you guys do at an inpatient level?

Heather Sandison, N.D. ketogenic diet, right? So we don’t want any junk coming in. So no toxins coming in, everything is highly nutrient dense, really yummy food. I try to be there for lunch as often as possible and then brain activities. So the entire day is set up to allow people to be stimulated. The community setting also, I think is really, really important. So having each other, not being isolated and then the engagement is stimulating, not overly stimulating so that people you feel, it’s not chess. Nobody’s learning to play chess but banana cams and simple Scrabble and UNO and puzzles and we’ll do something we call daily chronicles most days and that looks like what happened in this day in 1945, right? And then that sparks conversation and people will share, oh, on March 7th, I got married to my first husband and we had this beautiful ceremony and so they’re engaged and they’re remembering and they’re sharing with each other and then celebrating with each other as well. 

When there’s an anniversary in the house or there’s a birthday, it’s really fun. So that sense of community, the brain challenging games and we do brain HQ. We use several of those. We have sing alongs, so it’s really about keeping everyone engaged and we have the amount of staff that’s necessary to do that, right? It’s very easy for someone to walk off and be like, oh, I’m just gonna go take a nap or I’m gonna go listen to music or something and they’ll walk off but we have enough staff that say, no, if you leave, we’re gonna miss you or, we need help with this, right? Different people are motivated by different things but our staff are attuned enough that they kinda know how to keep people engaged and so the staff, the other thing with staff is that they expect our residents to get better. They see it every single time someone moves in. They see them get better cognitively. They see them get stronger. 

They see them sleep better. They see their mood regulate and so our staff are expecting that and if they’re not seeing it, they’re coming to me, they’re coming to whoever, they’re telling the doctor. They’re telling somebody, hey, like this person, they’re not better yet and so what are we missing? And then, so we have the diet. We have the activities, we have the exercise. So we have personal trainers on staff and people who have experience with physical therapy. They’re not PTs on staff, but they’re PT assistants and so they help with posture, getting everybody engaged. We have a circuit, what we call as a circuit and in our , so it’s a little gym that’s set up and our residents rotate through the LiveO2 which is a contrast oxygen therapy machine and there’s a bike associated with that. So some people use a treadmill, we use a bike, and then we have a rowing machine. We have a rebounder which is good for detox. We have saunas, we have a BioMat, which is a warm amethyst mat that especially is great when someone has a bit of anxiety and they can just lie on the mat. 

We don’t force anyone to do anything, but that team, we have people go down in groups and when we have really great staff who are great cheerleaders and coaches and then also having that group dynamic of doing it together really gets people pumped and so in some days, you know, somebody wants to sit it out and that’s all right. Rest is important too and yet going down there day after day after day, you start to see the accumulated benefits of it. So diet, the activities, the exercise, the caregivers and then the environment. So at M, you mentioned mold, I am adamant that if there is ever a leak and sure enough, there always, we have the dishwasher leaked one day from the kitchen down into the floor below, we had a gasket around a shower that, you know, eroded somehow and it was dripping into the closet below. So those things happen. 

The difference I think with we don’t just plug it up and walk away and assume that it’s fine because we caught it quickly. We have the mold guys coming out and they’re cutting out any drywall that got wet, they’re testing and then they’re coming back a couple weeks later to test again. So we are adamant that no mold grows in that house. We have IQ air filters on each floor that get the, you know, there are some things like fires, right? Like we’re in Southern California. We can’t help it if there’s a fire, you know, a hundred miles east or 50 miles east, wherever it is and so we wanna keep any of that toxic air, anything in the air, we wanna keep that to a minimum and so we run those filters all the time. We change the part that needs to be changed regularly ’cause that’s only as good as the filter that’s in there and then we have organic mattresses, organic linens, non-toxic cleaning products from the detergents to the personal care products. 

So the shampoo’s, conditioners, the shaving cream, whatever it is, the toothpaste, we supply all of that for everyone so that it’s not something that their daughter needs to worry about, right? We just make sure that it’s all non-toxic. We aim to use fragrance free because some of those fragrances are quite toxic for the brain, especially the synthetic ones. The natural fragrance not as much, but so we aim to keep the environment very calming on the nervous system and so for lavender might be calming for one person but might trigger a memory for somebody else that isn’t the best one. So keeping the sounds, the visual stimuli, all of that serene kind of zen-like is part of our goal. 

So we don’t have TVs on every wall, we have a TV and it gets closed behind a cabinet and it comes out for musicals or the opera. We do the , the sa-at-na-ma, that 12 minute meditation we do every morning and that has, there’s some literature, some science that supports that that is helpful for cognitive decline, for reversing cognitive decline. So we’re committed. It’s just 12 minutes. You can find it on YouTube. There’s no reason that anyone can’t do it. Everyone should be able to fit it in and again, caregivers, I recommend doing it with whoever you’re caring for. It’s really neat to watch the residents ’cause they first start it and they can’t find the other finger and then after a week or so they’re they’re in it. They’ve got it.

Matthew Cook, M.D.

Oh really?

Heather Sandison, N.D.

It’s really neat to see. So environment, diet, caregivers, the activities, both exercise the brain stimulating activities. We have yoga and meditation. We have people who come in, we have pets and animals that come by and visit, pet therapy and music therapy that comes occasionally as well but the day-to-day flow is essentially that.

Matthew Cook, M.D.

Just interesting. I’m just thinking about like my life as you’re telling this story, ’cause you know, I used to go to nursing homes to like, if somebody broke a hip, you might go over there and pre-op them so that they could come to the hospital or if we had somebody that a big surgery and a lot of the times they’d go to a small nursing facility and then we would go see them kind of for pain management and so then I used to do that and essentially the most toxic smelling place that I have actually been in my life and all 10 of ’em would all be nursing homes, like, it’s crazy to think about that and then to think the worst food that you can eat on the planet generally is you’ll find in one of two locations, you’ll either find it in a hospital, hospital food is absolutely, or a nursing homes, you know, because it’s just, .

Heather Sandison, N.D.

Nursing homes, they’re getting like the grade D meat-

Matthew Cook, M.D.

Uh-huh.

Heather Sandison, N.D.

So bad, yeah, you know, this whole, I mean, this is why I do this work, right? Is I know we can do better. Like at a societal level, it’s not okay. Like we can’t park our seniors in front of TVs and feed them cereal for breakfast, a, you know, a baloney sandwich for lunch, pasta for dinner and cake for dessert and alcohol even and Coke all day and the soft serve on demand. Like it’s just not, it’s the worst diet for your brain and of course then the expectation is that people go downhill when they move into a facility like that and the smells, the care, it’s just, I mean, obviously it’s a entirely different experience at Marama but seeing, like, you seeing that, me seeing that, it inspired me to be like, no, no, we can definitely do a better job here. So let’s do it.

Matthew Cook, M.D.

That’s amazing. And you know, the mold thing, you gotta get, you know, people gotta get into understanding this and thinking about this because when people have, when there’s a building that has a high level of mycotoxins, particularly after water damage, I will often, when I’m talking to people, you’ll be sitting there and you’ll be trying to figure out, this person was doing totally great and then three years ago, all hell broke loose and then you you’re talking, talking and a lot of times you end up finding out that the house was flooded or they moved into an apartment and that apartment was moldy around that time. I can’t tell you how many times you’re talking through a complex problem and that’s what you come to.

Heather Sandison, N.D.

I would agree, yeah. I see that often as well.

Matthew Cook, M.D.

So I’m just a hundred percent in love with what you’re doing. I’m totally supportive and I think the most important thing is at a baseline, those are these obvious things to do. In terms of peptides, how do you put together which ones you like to use, where you like to start and how you think about that vis-à-vis, you know, cognitive change?

Heather Sandison, N.D.

Yeah, so the peptides I’ve used the most are not directly related to cognitive function. They’re BPC and thymus and alpha one and the reason why is because when we treat the brain, we’re treating cognitive decline, we’re treating the whole body, right? When I say that we want the brain cells to be functioning optimally and have the junk out and the good stuff in, but that really relies if we’re gonna do that for the brain, we’ve gotta make sure that the gut is healthy, that people are out of pain, that they’re not in the stress of having a joint that’s been destroyed, that they don’t have an overactive immune system or an underactive immune system that isn’t effectively basically battling the infections that can lead to inflammation in the brain and so to do this, I leverage thymus and alpha one and BPC often, especially when I can get them and patients can get them. So, and I’ve seen miracles happen. I would say that with TA1, more times than not, if somebody as a positive ANA or an anti-nuclear antibody and we can use injectable TA1 regularly for three months, that ANA is often disappearing, right? Their immune system is-

Matthew Cook, M.D.

Auto immunity is going down.

Heather Sandison, N.D.

Auto immunity is going down, right? And this is another disease process that we’re told over and over again, it’s irreversible. So just use steroids or you, you know, address the symptoms but don’t ask the question from a kind of reductionist perspective or from a Western perspective. We’re not asking the question, okay, well, why is the immune system out of balance? And that’s the more interesting question to me and getting our diets dialed, you know, all those foundational pieces we talked about, we need to do that first, or at least simultaneously, because if we wanna send those signals to the cells to behave, to basically have that normalized function, we wanna make sure that we’re getting rid of the signal that has told them to not do that, right? to be out of balance and otherwise we’re spinning our wheels and then BPC has been so profoundly helpful for the gut. 

I had patients, several patients who had Crohn’s disease, colitis and to watch that disappear in a matter of weeks after having patients having suffered with that for years was just absolutely miraculous and BPC has made huge, profound impacts even on people that didn’t have quite as severe disease but just in regulating gut function and helping the soft issue injuries to heal. So GHK is the other one that can be really helpful if somebody has pain or, you know, has some sort of joint issue and so those are in my arsenal and if somebody has those particular issues, I jump to them when they’re available quickly and then from a cognitive perspective, the ones that stand out are Cerebrolysin, Clink, and Cmax and Cerebrolysin is very, pretty specific and this is an injectable and it is, helps with trophic support. So with, again, that signaling for growth. 

So neurotrophic support to grow new neurons, have more connections to basically create more in the brain and as we age, a lot of the signals are saying to create less, right? When we imagine ourselves at 21, this is when people, many people are in college and like retaining a ton of information. It’s really easy to learn and grow and create, get new skills and what we want is more of that and Cerebrolysin sends that signal as well as nootropic. So this is the idea of creating better cognition, just thinking more clearly and then also creating more memories. So Cerebrolysin is great for that and then Clink and Cmax are both intranasal and these ones are interesting, ’cause they help a bit with nootropic and neurotrophic support. So that growth as well as cognition and memory but then they also have effects like many of the, these kind of signals that our bodies create endogenously. 

So our bodies create this category of hormones that corticoids, I think, and that MSH coming from the pituitary gland. So things like ghrelin and leptin are coming from here and in this category, they help not only with nootropic and neurotrophic support, they also help with blood sugar management to some degree, they help with clotting, blood clotting and so that vascular dementia and better blood supplier or lower risk of stroke and so these things can be Cerebrolysin, Clink and Cmax are more specifically kind of for that cognitive function, but Clink and Cmax has kind of these added benefits on the side and even some neuro inflammatory and immune regulatory properties as well and it’s great ’cause they’re intranasal. 

So somebody that doesn’t wanna inject themselves doesn’t need to and they’re relatively available. My clinical experience has been that some people use them for a while and then other people kind of get that hit from them and then don’t need them long term. So if that’s a relief for anybody, usually when you’re paying for them that is, you don’t have to pay for them forever. You can take them for a bit, get the improvement and then kind of ween off of them and so that’s how I use them in my clinical practice and I’d love for you, I’d love to hear more. When I was up with you guys, somebody mentioned FGL being really helpful for cognitive function. So really, I’m here to learn from you as much as you are from me.

Matthew Cook, M.D.

Well, I appreciate that. You know, so if you go back to the beginning, we talk about kind of functional medicine and gut brain access and so then BPC 157 is one of these great peptides that comes from the gut, it’s actually secreted from cells in the stomach and there are some oral formulations and injectable formulations. Interestingly, both can have an effect on the gut and there are some rapidly absorbable oral formulations with the idea that it’s gonna get absorbed in the small intestine or have an effect in the small intestine and some long acting versions with the idea that that’s gonna get more towards colon and so then that can be helpful, in terms of the BPC 157, sometimes people will do multiple doses in a day. 

So two or three doses in a day ’cause it’s a relatively short half life and so then that, but then BPC 157 also has the added benefit of having some benefits in terms of angiogenesis and so then we know that it’s gonna, and it also tends to be anti-inflammatory and so it’s gonna have some anti-inflammatory and blood vessel health benefiting effects of the brain but then it may begin to be at least play part of a role in terms of GI stuff, leaky gut and then inflammation and then within that, there are different dosing algorithms and so then there’s even some crazy things like for example, you can do like an insulin pump and then put peptides in an insulin pump and in interestingly, the one thing, if you do the BPC157 in an insulin pump, that you can do lower amounts because you’re having a real low, over a long period of time effect and that one definitely people will say, oh my God, my gut felt perfect. You know, and I’ve had that experience quite a bit. 

So, you know, that one and because in terms of dosing, because you’ve got that oral formulation, that may be an interesting idea. A lot of times there are some pharmacies and then some people will combine one of those MSH type of peptides, KPV with BPC and then that’s a great combination orally. Sometimes that’ll calm down mass cell activation and so it helps to calm down some of the immune cell, the immune activation or inflammatory aspects of immune stress in the gut and so then you realize, okay, just to get going, we’re having this very functional medicine kind of gut brain access because fixing cognitive change takes such a total approach that it’s not just gonna be one thing. When you think of all things immune, then one of the number one things you think about is these chronic, either active or stealth infections, , all of the tick born and vector infections, chronic viral infections and then we’re just having this conversation but in 10 years, we’re gonna be having a long COVID conversation and cognitive change. 

I can’t tell you how many people say, oh yeah, I’m basically fine, but my memory’s not as good. Like I’m hearing a lot of stuff. So it’ll be interesting to see what the research and the science says around that, TA1 has been relatively unavailable in North America, but worth the podcast is worldwide and what I can tell you is you with TA1, you really seem to see immune regulation and so you were talking about like the ANA which is a marker for certain forms of autoimmune problems. If inflammation is high, it tends to bring it down. If people’s immune system is dysfunctional and not working well, it seems to bring it up, you know? And so then that one is really an injectable and we found it to be profoundly helpful and it’s also, we found it to be fairly helpful for patients with mold and it probably is gonna be helpful for detoxing and kind of resetting immune status, and a mold really, mold creates something called chronic inflammatory response syndrome and basically our anti-inflammatory strategy in the brain which is somewhat dependent on MSH, this protein, really gets depleted and it gets low and it leads to an inflammatory process in the brain and cognitive change is probably on that spectrum and so then everything that can begin to regulate the immune activation and immune stress around that can be helpful. 

Our philosophy is that number one is, and it’s kind of a good trajectory of the conversation is ’cause number one is detox and these, and so then if that was mold that might be binding. So taking things like charcoal and binders which are gonna start to begin to reg, you know, help just pull those toxins. Basically the charcoal or different binders will bind onto a metal or bind onto a mycotoxin and they’re too big of a molecule to be absorbed and so you pull ’em outta the body. Number two is regulating sort of immune response and that one is important to do before you start to try to turn cells on and then once that’s kind of stable, then step three is to begin to think about the things that can stimulate mitochondrial function. 

So we have a lot on those diet lifestyle supplement side on that, but then humanin is a mitochondrial peptide, mod C and then FGL are three sort of interesting peptides that people can kind of cycle through that are mitochondrial stimulants and then a lot of times we’ll tag team that with NAD and so then do a day of NAD, a day of humanin, NAD, humanin and kind of doing every other day strategy for a week and then follow that by maybe another week of NAD and FGL. So then kind of sequentially staging through different mitochondrial peptides. There’s some that are not available that I think probably be interesting directions for people to kind of research in the future. Things like SS31 which is a mitochondrial peptide that’s probably quite helpful but not really available right now either.

Heather Sandison, N.D.

Yeah, we didn’t talk about traumatic brain injuries much and just hearing you mention NAD reminded me that that really sets people up, right? Like we’ve heard the kind of idea around football and hitting our heads repeatedly, particularly in the helmet and how this leads to a certain type of encephalopathy and then like essentially brain damage that causes dementia and personality changes and often violence, right? So we’ve heard that story, but even just hitting your head, certainly repeatedly, but soccer, heading a soccer ball, a lot of things people don’t realize, getting hit in the head when you were a child and being in car accident, these things can have a big and lasting impact and making sure that the brain has the resources to heal from that is important and I, you know, if we can intervene in that 18 month kind of window pretty quick after a traumatic brain injury, again, my confidence is higher. However, we even see pretty impressive benefits and we do EEGs. 

We use the WAVi, we do a wet EEG to get a sense of where people are and what the voltage, like how much energy is in that part of the brain, how quickly is the brain responding and we see changes after traumatic brain injuries, even ones that happened decades previously. So getting things like NAD, phosphor choline, we’d like to use phosphoserine, methyl B12, big doses of omega three fatty acids and then also that contrast oxygen therapy that I was talking about, the LiveO2 and so going back and forth, kinda like in ketosis where we go back and forth from burning sugar for fuel, the fat for fuel, if we can exercise and go back and forth between positive oxygen and negative oxygen, that increases something called the hormetic effect. 

So we basically get benefits from stressing the system a little bit, exercise is very similar, right? We’re kind of damaging our muscles just a little bit, stressing them just a little bit so that we get more muscle, more capacity to lift something heavier and the same thing is happening with LiveO2, you’re essentially stressing the system when it’s depleted of oxygen and then adding more oxygen going back and forth between that stresses the system so that we get more mitochondria per cell. So that that NAD works even better. It has more places to work. It also kicks out senescent cells. So we get that recycling happening when there are cells that are kind of just getting by, not really excelling at their, whatever their job is. So those are just a couple of additional thoughts. We do something slightly different, right? For each person based on why they have dementia and that traumatic brain injury piece is I think, important for a lot of people.

Matthew Cook, M.D.

I think that that’s important, you know, one thing that we started doing and this has been a very good experience, is we do do IV therapy and I typically will do kind of a relatively balanced, so something that has a medium dose of vitamin C and vitamins and minerals and B complex and B12 and followed by glutathione and other antioxidants and NAD. So we kind of get a, do our total antioxidant and mitochondrial support of IV maybe with or without peptides and then afterwards I do a stellate ganglion block and then the stellate ganglion block causes the fight or flight nerves to go to sleep and so then that causes the carotid artery to get vasodilated and it increases blood flow and in Lyme and complex illness, there’s this evidence that people have decreased cerebral blood flow because of, I think, long term inflammation and so then that one’s an in interesting, another interesting direction I think.

Heather Sandison, N.D.

You know, you guys have a few things that I think are really compelling for dementia, right? There’s been a trial on plasmapheresis and you guys offered that at BioReset and then there’s the stellate ganglion block, which I think is profoundly affected, like you said, for PTSD and kind of quieting that, over that sympathetic overdrive and helping to upregulate that parasympathetic state which is that healing state and then in addition, of course, the peptides and then the NK cell therapy also is really compelling to me in terms of things that you guys do that I don’t, that I think would be just like, could really increase the speed of the trajectory towards healing this dementia crisis and so I’m always intrigued by what you guys have going on, but those three things in particular stand out to me.

Matthew Cook, M.D.

Oh, thank you. Yeah, no, the plasmapheresis has been completely a game changer. I think everybody that lives without cognitive change has seen a little PTSD and then the NK therapy is something that’s not done, we don’t do here in the United States, but it is part of our international plan and I think illustrates, you know, the fact that people do well with that illustrates what a profoundly important aspect immune stress and immune dysregulation is and so then diving into that when you need to. I know that we have a time limit and so I gotta respect that but it’s just a hundred percent delightful to talk to you and I even found myself the other day in clinic, they were asking me a question, I go, you know what? I don’t know the answer to that question, call Dr. Sanderson and see what she says. So it’s just a pleasure. Where can people find you? And where can they learn about what you’re doing with the inpatient treatment? Because I think that that is the future of cognitive change.

Heather Sandison, N.D.

So we’re at Solcere, S-O-L-C-E-R-E.com, Solcere for sun or solutions, the brain and then at Marama experience, M-A-R-A-M-A, maramaexperience.com is our inpatient facility and yeah, sign up for our email list. We’ve got lots on the agenda. We’re doing a free webinar series called Marama at Home where we just are trying to get caregivers the support they need to implement all of this at home and so, and join our community because you’re not alone. I think a lot of people start to feel isolated as they’re caring for a loved one with dementia, and you’re not alone. There are lots of people, many more than me who have lots of answers and help and support and resources for you. So please sign up and keep in touch.

Matthew Cook, M.D.

Okay, what you’re doing is totally amazing and so I’m that you are a human being doing good stuff.

Heather Sandison, N.D.

Matt, thanks so much for having me, same right back at you.

Matthew Cook, M.D.

Okay, have a great day.