Why Alzheimer’s is Optional: The Fight Between Hope and Hopelessness

Heather Sandison, ND

Thanks so much for having me.

Cheng Ruan, MD

Well, let’s talk about what you do because I think it’s very incredible the things that you’re actually providing for people. It’s very unique. So let’s talk about the clinic and let’s talk about exactly what you’re involved in.

Heather Sandison, ND

Yeah, sure. So we have a few different things that we’re doing right now. One of the questions I was getting most regularly from patient and and and their loved ones after being trained by Dr. Bredesen and his approach was if I do this if I take the time, spend the money, make the effort to make all these lifestyle changes, do all these labs take the supplements take the hormones all the medications, how likely is it that I’m going to get better or that my loved one is going to get better and I think that’s such a reasonable question. And unfortunately the science is behind for a number of reasons, but primarily because the complexity of dementia, the complexity of cognitive decline doesn’t have a solution that matches the complexity of the problem. Right? Like so and then also the paradigm in science, this reductionist like,  complex intervention, it’s really hard to put into that box and so you can’t blind lifestyle interventions.

This is not one intervention.

This is a precision medicine approach that looks at the individual and then addresses the individual from a like a functional medicine or precision medicine perspective, a naturopathic perspective. And so we’re looking at the question we’re asking is how do we optimize cell function at the neuronal level, at the, at the level of the cell in the brain? How do we optimize function? And there are so many different answers to that question really, depending on the individual. So what I have done is a few different things that hopefully make it a little bit more practical for people to implement this when we did a clinical trial in my office and we’re excited to publish those results this year. They were very um encouraging and exciting and definitely suggest that we should be doing more of this multimodal sort of intervention and testing that and understanding the science behind that. Is it working right. As a clinician, as a scientist, we always want to be asking that question like is it working? How else can we make this better? But Dr. Bredesen published his trial with cat tubes. Deb Gordon? And half the way there was a group of providers who did this approach in a clinical study, much like mine and 25 participants went through that in 84% of the time they are improving cognitive function. I mean this isn’t meant to happen right? What we typically expect is the natural process of this disease. If nobody intervenes intervenes in dementia or cognitive decline, Alzheimer’s then what we expect is about a three point drop on a 30 point scale per 12 months. So some people are familiar with like a MoCA score. This is the Montreal cognitive assessment where you draw a clock and you copy a box and you name zoo animals. Count back from 100. This is a 30 point scale. 

Thirty’s perfect. Anything over 24 or 26 is is normal. And then when you get start dropping down into the teens, this is pretty severe, noticeable cognitive decline, you know, at at to below five. It’s hard for people to get answers to questions out definitely their memory is highly severely impaired and they’re debilitated. So this is a kind of a good scale to use in Dr. Bredesen’s trial. They took participants with MoCAs down to 19 and they did a nine month intervention. So this is mild cognitive impairment is what what we call it in a clinical setting. That’s the the I.C.D. 10 diagnosis that we would give it as mild cognitive impairment. However, there’s nothing mild about this right for someone experiencing cognitive impairment. This is they’re losing their phone there, leaving their purse at restaurants. They can’t maybe remember their neighbors names. This is really an impairment. And so we what we found is that a neurologist or even their primary care provider because they don’t think they have anything for them, right? And doctors want to help. But the medications at their disposal that have been FDA approved for this thing’s like a settler colonists. Trees inhibitors. They don’t work very well. 

So what often happens is people go in sharing that they’re concerned about cognitive decline and then they leave without a driver’s license, right? They get there, they get their independence taken away. And so there’s not a lot of incentive to go get help from someone who’s going to give you a drug that doesn’t work. Tell you to put your affairs in order and then to take away your independence and so sadly people don’t go in for help. However, what we’re finding is that that is the time to intervene and there are so many things that we can do. So we have a clinical offering, you know, people can come into some areas and in my clinic solutions kind of for the brain is what we’re doing there were doing clinical research there. And then I also created Marama which is a residential care facility for the elderly where people who have diagnosed Alzheimer’s can come and live the lifestyle and an immersive experience that Dr. Bredesen describes. So we have and then we also coach and train caregivers so that they can create the Marama experience and the comfort of their own homes and keep their loved ones there with them.

Cheng Ruan, MD

It’s amazing, you know, it’s for the immersive experience. We know a lot of that stuff works on different disease states, especially with something as complex as memory loss and cognitive impairment dementia. And Alzheimer’s I think it’s it’s really needed, especially since a lot of people don’t have any support. You know, we we do a lot of memory care services here at Texas and for lifestyle medicine, but it’s so difficult when they don’t have the support system and when they don’t have not just the support system, but a lot of times they don’t have a clinical support system or doctors that’s guiding them in the right direction and just become so detrimental at times, you know, and we do the best that we can for the tools that we have, right then doctors do whether it’s prescriptions and we do group visits and stuff that as well. But I think something like an immersive experience is the best when it comes to living the style of some person who’s actually healing the brain and knowing exactly what those components are. You know, and I wish is as easy as take, here’s some take some supplements beyond diet. Takes some meds. It will be okay. But it’s a whole lot more than that. Yeah.

Heather Sandison, ND

Well this Bredesen approach is a big lifestyle change and it’s also an unlearning of everything that we kind of thought that was true or were told through the 80s and 90s, right? That food pyramid that says 6 to 8 servings of whole grains a day and very few fats that you know, we’ve kind of turned that on its head. The bread. The best brain diet is really a ketogenic diet. And for someone with full cognitive capacity. Right? Sometimes it’s still hard to wrap our minds around. Like, wait, what an apple. I thought an apple was really healthy. An apple a day keeps the doctor away right? Like I’ve heard this my whole life, you’re telling me that an apple isn’t good for my brain and so there’s a concept here around getting into ketosis is like a light switch, you’re either in it or you’re not. And what you’re doing when you get into ketosis is you’re changing the fuel source from sugar or carbohydrates, glucose to fat or ketones. And when we do this, when we present this alternative fuel source to the brain, we often get better energy, more efficient energy production and utilization. And there’s also lots of other sort of mechanisms involved there, but certainly reducing glycol toxicity or that excess sugar that can lead to these like oscillated in products and basically lead to cellular damage because there’s too much sugar. It’s sugar has become a toxin. 

Also we get around this insulin diese insensitivity, right? This insulin resistance, we get around that and we can get this fuel source in the brain so that the brain finally can turn back on. So many people will report after getting into ketosis, but it’s like, it is like the lights turned back on that they can remember things that their mood is better. I had a patient in my office a couple weeks ago and he got into ketosis and um, he was driving down the street with in their neighborhood in Colorado. Excuse me, in Utah and there were animals like deer and previously he wasn’t able to remember the names of the animals. And after getting into ketosis, he was like, oh, there’s some white tailed deer and he was like pointing out the animals and naming them by name. And so things like that, you hear stories like this all the time of like, oh, now I have more energy, I’m sleeping better and that gets better cognitive function anyway, so, but this whole concept of changing the fuel for the brain and that you would eat a lot of fats and restrict carbohydrates. People wonder like is that bad for my heart is just going to cause my gallbladder to act up. 

Is what? What? But I have diabetes, Is that going to be a problem? And what we actually see, because this is a fasting mimicking diet and also an ancestral diet. Our bodies are actually programmed to go in and out of ketosis. And so we don’t want people like ketosis forever. That’s just as bad as burning sugar for fuel forever. We want people to have this dynamic ability to go back and forth between burning fat for fuel and burning sugar fuel and that is really a brain healing diet, is to get the best of both of those worlds. And we are giving away a free keto diet guide because I’ve come to think that like the ketogenic, It is about 50% of this Bredesen protocol and that intervention and it’s also something that’s free and it’s easy to do at home and it’s a great place to start because it is kind of challenging for some people. So if you just get started and go in that direction, you typically start seeing benefits relatively quickly and they’re relatively significant. So it’s exciting to support people through that process. Awesome.

Cheng Ruan, MD

Well, first of all, how do people get this guide?

Heather Sandison, ND

Yeah, so we’ll have it as a free gift on your summit and then you can also go to solcere.com and there will be a prompt to sign up for our email list and the first thing we will send you a pdf of that guide.

Cheng Ruan, MD

Amazing. Amazing. So, you know, so we know diet is a big contributing thing, but there’s a lot of things that surrounds diet, I think, right, those cultural differences, there’s relationships with food, self and other people around that formulate this concept and belief system behind food, right? That’s why I think the immersive experience into what a brain healing lifestyle should be is possibly the best thing that we can do for patients with, you know, memory loss. Right? Let’s talk about relations. Yeah, let’s dive into relationships for a second because I think it’s that’s something that people don’t talk about a whole lot. So in working with people with memory loss, there’s um there’s a lot of pre existing concepts around food and lifestyle and sleep and sort of the Western philosophy behind that, especially people in professions like mine and yours and the professional profession is we just have to keep going, go, go, go go until sometime later in time we retire and we try to enjoy things. But really truly what happens is people get depressed and people get lonely during those times, as evidenced by the pandemic, right? So what we’re seeing is that during the pandemic, memory loss is becoming far more apparent. Oh my gosh, like it’s, it’s almost the, there’s a pandemic of memory issues and depression that we see in the population. And the relationships are kind of really uprooted because we’re so used to engagement like physical contact engagement. What have you seen during the pandemic house? It really affected your practice? 

Heather Sandison, ND

Yeah. These are such great points that you bring up. So just anecdotally what we saw at Marama. We were of course to C0V!D very seriously. That affected the senior living industry and seniors of course really profoundly. And so we took C0V!D very, very seriously. And there was one case of C0V!D in a resident at Marama and that would happen in January of 2022. And so what we do, we isolated everyone from each other. So all of the residents were isolated from each other. So they still stayed on the program. They stayed in ketosis. The caregivers and our care partners, all of our staff would go to different people and everybody would go for a walk and they would go down into, we call it the casita. They would do the circuit the exercise circuit. They would be doing brain games. But they were isolated from their peers from each other. And what we saw was over 10 days. And the woman who got C0V!D, it was funny because she wasn’t isolated from her husband. They had a room together and he never got C0V!D even though they shared a room the whole time. But she tested positive for C0V!D. She had a sore throat, we found out on Friday, she had a sore throat Friday and Saturday that was gone by Sunday and then she was congested, you know, Monday, Tuesday, Wednesday. And I don’t mean to discount like obviously C0V!D was killing people, especially in the age group. Like C0V!D was very, very, very serious is very serious. I don’t think that’s a non issue. However, what we saw over the course of those 10 days that everyone was isolated is essentially an increase in incontinence in changes in behavior. 

We saw changes in sleep, dysregulation and now mind you, everyone was still on their routine. They just were not seeing each other, their peer group, they were seeing caregivers, but they were taking meals in their rooms, They weren’t engaging in activities together, they were still getting exercise, they were still getting their supplements, still getting their medications and we had I think three falls in those 10 days. So an increase in fall risk increase in incontinence, irritability, aggression, like all of the behavioral changes that we saw changes in sleep. And it took about 10 weeks to recover from those 10 days of isolation for everybody to get back to baseline. And this is just an antidote, a small, a small sort of like end of 10 of who was at Marama at that time, but it was so eye opening for me to watch how much of a difference it made in the quality of life for everyone living at Marama to engage with each other, to engage with other people and in a similar situation to them. And to disrupt the routine as well. So it showed me the value of community and what I think you’re sort of alluding to this right in our, in our earning years are 30s, 40s, 50s, 60s, we are just going for it, right. And so many people this mantra, like I’ll sleep when I die, I’ll sleep when I retire. Like I’m just gonna keep pushing, pushing, pushing and we know now that that puts us at risk for cognitive decline later and as you mentioned, it puts us at risk for isolation and depression and anxiety. 

The other thing that happens to seniors as the age I mentioned, like going to neurology or going to a primary care provider ending up with a dementia or Alzheimer’s diagnosis, you get your driver’s license revoked. Well now it’s harder to get to the senior center now, it’s harder to get to church now, it’s harder to get to bridge. Now, it’s harder to get you to your kids house for Tuesday dinner and people become more and more isolated and we know that this has a massive impact on cognitive function. Like this is in the Lancet. This happened in 2020, they had a commission report on Alzheimer’s and they list them very conventional right? The Lancet is a very well respected medical journal out of the UK and the commission report suggests that 40% of dementia is worldwide can be avoided, can be prevented. And in their list of things that cause dementia is social isolation, also hearing loss, diabetes, toxic exposure, like pollution exposure. There’s a long list of things smoking, there’s a laundry list of excuse me of things that they suggest and so many of those things we have control over and social isolation is certainly one of them. And in my experience both clinic and in Marama. It’s yeah it’s an absolutely critical component to have that community.

Cheng Ruan, MD

This is a powerful observation. I mean like crap. I mean you have this cohort of people that you manage over there that’s getting the best care possible. But it’s really the lack of interaction during those 10 days that created physical manifestations, not just brain manifestations but incontinence falls. I mean come on these are things that we worry about as care providers all the time in the memory patients and and how many times do these people go to the doctor and no one asked about their social situations, loneliness as a factor. But what you just described is the power of relationships and the power of contact. Human contact as a driving factor for– were beyond memory loss now. Right? We’re at physical manifestations of isolation. So this is um this is something that I think that as part of a memory care providers that we really have to engage in the patients on depressed, are they, are they really lonely? Like what’s going on? What is the support structure? And I really want to reflect on that observation by making our own observation  during the pandemic. The people who are the hardest to improve are the people who are the most isolated and they have no family members around no caregivers. 

Yes, they have home health and stuff that’s taking care of them, but it’s so difficult for those patients and we know that even if they’re truly compliant with the diet, they’re great with supplements, they’re great with other things in life. But if they’re actually lonely, the prognosis is not great. Right? And so it’s so now we have a risk assessment actually looked at the loneliness scale to figure out Prognosis to see how people are actually doing so. So that really reflects on what you saw with those 10 patient cohort, which I think is something that we really all have to get out there. And this is, what I mean by that is now we see a lot of people who have been sort of like engineers and doctors and lawyers like their whole lives right? And they’re like oh I can figure this out, I can figure out this brain thing, I read this book and did all the stuff but part of the obsession with the data that’s out there is that allows them to be, continue to be socially isolated without having the relationship discussions with their families and that healing process and those are the people who are the hardest to heal, you know what I’m saying?

Heather Sandison, ND

Yeah, yeah, it’s interesting just hearing you say like oh as providers we need to do this and this and this and I would just say that like it’s even bigger than that societally we need a paradigm shift right? Like my the essence of my work is facilitating inter generational wisdom transfer like I see my purpose as supporting seniors and their cognition, cognitive health so that they can help us generate solutions to the complex problems in the world, right? We need the wisdom and experience of our elders and right now it’s a squandered resource. Typically what happens is that we park our seniors in front of TVs all day, they eat cake and cookies for dessert, they have cereal for breakfast on a sandwich for lunch and pasta for dinner and there’s a soft serve literally when you walk into many of these senior living facilities, there’s soft serve ice cream on demand, they can have it any time they want, right, this is the exact wrong diet for cognitive health, for health in general, right.This is a recipe for diabetes and heart disease and dementia. And then they’re told, you know, you don’t have to walk, you don’t have to get out of your wheelchair, you don’t have to get out of bed because you’re a fall risk. And so we essentially relegate our seniors at the height of their wisdom and experience when they have so much to give to these senior living facilities that do the exact opposite of what they should do. And, and essentially, like, right, this office, oh, well, they’ve, lived a long life and they deserve to enjoy themselves, right, 

When it enjoyment, really indulging in these unhealthy practices or is there an alternative? And of course, I, you know, I own a senior living facility. But ultimately,and that’s that’s really a proof of concept of, like, look, what’s possible. How do we take this thing that’s kind of broken the senior living industry and create at least the best thing that we can in in the context of what exists and yet really, what I would love to see happen in my life time is that those places become obsolete as a society. We just reject that, that’s what we do with our seniors and really what we do is we keep them in the fabric of our communities that people if they want to be

engaged in church, if they want to take care of the youngest generation, if they, which I think is is actually critical to a healthy society is that we have, you know, our earners are 20s, 30s, 40s, 50s, 60s, they’re at work, they’re contributing at a different scale and then are the grandparents and great grandparents are taking care of the youngest among us. And that is really how we get more compassion, more empathy, more understanding. It’s like this, you know, people talk about the super power of time travel like that is spending time with our elders. We can do that so easily, but we don’t set up life so that that that that happens right? We think we can do this all on our own. 

We don’t need them. There’s too many weird dynamics. So I don’t want mom around and instead of working through it that we we isolate ourselves that kind of every stage of life. So my hope is that we will see bigger shifts like that, but also just this idea, right? This the food pyramid, that that what we’re told from the powers that be is actual and evidence based and true in terms of what supports health, it’s exercise, sleep, the right diet, stress management, social engagement, challenging ourselves, getting that dopamine hit and not the quick dopamine hits of scrolling through social media, but those real deep that satisfaction that comes with doing something challenging and working through something hard, learning a new skill at any age. Those are the types of things that we want to facilitate and value as a society so that it’s not all on the provider like, oh, I’ve got to ask the right questions and spend the right amount of time and then and then what? and then and then how do I get someone out of social isolation? Really, it has to be a village effort, a group effort.

Cheng Ruan, MD

Really does have to really agree with that in. We learned a lot of this from other industries like in hospice and palliative care. We know that the more touchpoints the patient has in metastatic lung disease, the longer they live literally its mortality benefit. By touch points, right? We know that in those people with PTSD in the military veteran population, the more touch points they have with people independent of medications or therapies and stuff like that, The more engaged they are with people and providers, the better their PTSD outcomes are. So we see this in other aspects of life as well, diabetes, the largest diabetes that we’ve ever done, seeing the reduction in blood sugar and improvement in blood sugar control with the people who have the most touchpoints, whether that’s through diabetes coaching or through dietitians etcetera, etcetera, right?  And once again, also independent of medications and drugs, right? And so it’s not surprising, but at the same time, it’s frustrating. I think it’s frustrating just from my point of view is because that, you know, I wish I was kind of taught this in med school, right? 

And I wish that there’s more that we can do about it in terms of getting the people not the care that they need, but the care that they actually want, right? And there’s a big difference between serving ice cream and the senior living home, right? And saying, hey, you know what? You’re here to actually build powerful, meaningful relationships, not just get ice cream, right? And just kind of, you know, brush them off to the side, which I believe and that’s the hospitality business, right?  The hospitality business is, you know, giving people the thing that they desire. But at the same time when you are at the intersect of health, this paradigm shift really has to exist, right? So, so this brings up to this next topic that me and you talked about at the reverse Alzheimer’s summit that you held and you talked about why Alzheimer’s is optional. So this is pretty controversial.

So, can you can you can you digress, can you kind of dive into what that means. 

Heather Sandison, ND

Yeah. So, what I have seen clinically is that Alzheimer’s is reversible most of the time. And we have much higher confidence when we intervene early on in the disease process. When people are younger, when people are aware of their cognitive decline and when they jump in fully, so this is not dipping your toe in like maybe I’ll eat a little bit better. But it’s the diet, the exercise, the sleep with the supplement, the hormone replacement. It’s the whole getting the toxins out. It’s when you dive in completely, we see the best results. So I believe that Alzheimer’s can be an optional and rare disease, especially for our generation, right? There’s what I never want to suggest is like that people chose to get Alzheimer’s like obviously that’s not at all the suggestion. However, I think that we need to say something like Alzheimer’s, it’s optional to get people’s attention to say like, hey the narrative you’ve been told that there’s nothing you can do that is factually inaccurate. There is so much that you can do and there is a big impact that you can have on your cognitive function as you age, particularly if you don’t have symptoms yet. This is preventable and how do we do that? We, you know, it’s this immersive sort of lifestyle very most of it 80% is lifestyle based. It’s getting in and out of ketosis. And so I need enough time in ketosis that you really get the benefits of that. It’s prioritizing sleep, treating sleep apnea, these social connections that we’ve been discussing challenging our brain and then getting enough exercise. 

One of the things I remind everyone is walking is not enough. So if you want to prevent and reverse cognitive decline or alzheimer’s you need to get lots of exercise. We this is essential for so many reasons, but even just like at a simple level, this is blood flow to the brain, It’s blood flow out of the brain, it’s, you know, bringing the all of the building blocks that you need for cognitive function, whether it’s the amino acids that are those building blocks of neurotransmitters or if it’s the fact that that myelin sheath is made out of all of those things are so critically important, we need to get enough oxygen. We need all those nutrients to be delivered efficiently to the brain and then we need to take the trash out, right? We gotta get rid of the toxins. Just those metabolic, we don’t even have to talk about mercury and mold and chemicals, just the metabolic toxins and metabolic waste that’s created each and every day. That needs to be taken out so that we don’t have that brain fog and fatigue. So exercise helps with with blood flow. But it helps the trophic factors and increases brain derived neurotrophic factor BDNF also. You know, as we build muscle that increases testosterone, which is another trophic factor tells the brain to make new connections, right? When we’re at the height in our teens and early twenties, those hormones are raging. That’s also when we’re making those connections, building those skills, that’s usually when we’re in in training or in school and we want to approximate that as much as we can as we age and we see this in the blue zones, right? The longest lived people. They have those big thigh muscles, typically they’re walking up and down stairs, they’re in shape. And so these lifestyle pieces are like the again this 80 percent of this intervention and so crucially important to brain function.

Cheng Ruan, MD

That’s I totally agree with you there. I want I want to address the people who are listening to this, who are either diagnosed with Alzheimer’s disease or they’re listening for a loved one with Alzheimer’s disease. And what mostly happens is that they go into the neurologist’s office, they take a neurocognitive assessment. They may or may not have imaging by that time. Maybe they see some brain shrinkage on the M.R.I. Maybe they have a DaTscan or PET scan of the brain showing possible amyloid deposits etcetera. So, you know, there’s a lot of diagnostic tools when it comes to neurology, right? Is there anybody who is listening right now who may be to further along into the disease state for any sort of reverse ability. What do you think about that?

Heather Sandison, ND

So I arrived at this as a skeptic, right?So I had been told there was nothing you could do by very smart. And and so I was intrigued by what Dr. Bredesen said. I saw him speak at a conference in 2015, so not even that long ago. Right? And and I heard what he said, but I was like, no, you can’t reverse Alzheimer’s like nobody can do that. If you could do that then like we would be. And but I was intrigued enough because the concepts made sense to me. Like he was saying the same thing. You know, I’m now repeating what he says, right is let’s take a look at all of the interventions, all of the factors that impact neuronal function. And then let’s address them all, let’s not pick and choose one or the other. Let’s address all of them systematically and see what happens. And so when I went to his training, it made sense. And then as a natural path, I had been trained in, in environmental medicine or detox kind of work. I had been trained in hormone replacement. I have been trained in, you know, lifestyle medicine and dietary interventions. I’ve been trained in all of his like verticals if you will. And so I was able to do this in my practice. 

And I was also on the list of people who have been trained by him. So I had people showing up saying, hey, can you help us do this Bredesen protocol. And one of my first patients, her name was Linda and she came in with a MoCA of two. So again this 30 point cognitive scale two is extremely severe disease. Her handwriting was affected, she could barely answer questions and yes or no. One word answers. I could see that her brain was computing the question but she couldn’t remember the question long enough to get an answer out. She couldn’t find words. Of course her relationship with her husband was severely impacted but they were both her husband especially because he was, you know at this point he’s the decision maker, he’s driving because she has so little capacity, she’s so debilitated. So he was very enthusiastic and had more confidence in Dr. Bredesen’ s approach than I did at that point and they did it all. So she had a MoCA of two when she showed up and six weeks later she had a MoCA of seven. 

They got out of the moldy environment, they ballroom dancing three days a week, they changed to a ketogenic diet. She got all of her amalgams out of her mouth, had all her dental work done, she got on all the supplements, got on the hormone replacement. I mean they did it all, they did it quickly, they jumped into that pool headfirst and dove deep and they got the results and when I I mean the first time that Linda came back when I saw that MoCA score that second MoCA score. I thought like did we do it wrong? I think this isn’t supposed to be possible. And then I just started like crying right of course I was like wait what just happened? And then of course my next thought was like if this is possible for her, what’s possible for everybody else and how do I do anything else with my life other than tell everyone that this is possible because they’re getting a different story and I was getting a different story. And so you know as a provider, I was perpetuating this idea that you couldn’t do anything when like in front of me a miracle had happened now it took effort, it took work and I’ve seen that play out over and over and over now does it happen for everyone? No, but I you know fast forward a couple years later in December of 2019, we announced that we were opening Marama, this residential experience the summers of experience and 

Dr. Bredesen’s approach and so I had people calling from all over the world saying can my loved one come and I got a call from a woman in New York saying hey I really want my friend to come. She has been on the Bredesen protocol, I know that this would be the best place for her. She has a MoCA of zero, would you consider that? And I said no you know I really want to save, we only have 12 beds and this is the first time we’re doing this, I want to save it for the people. I have the most confidence we can help. Well then we opened our doors March 1st of 2020 and the world shut down with C0V!D. And so everything out flipped on its head. And I heard from this woman again at the end of 2020 she said, I know you know the vaccines are out and C0V!D is changing. I’m wondering if you would reconsider. And at that point I said, wow, she’s persistent, They’re committed. Let’s see what happens. And so she moved in with a MoCA of zero and within three months she had read a name tag of one of our staff members. She had spelled her name to a new staff member when they ask what her name was. So she went from nonverbal and she’s not going  back to work.

Cheng Ruan, MD

Nonverbal, like can’t speak at all right? Like zero speech to like naming names. That’s that’s crazy. 

Heather Sandison, ND

Crazy. Absolutely insane. Right? So again, I’m like bawling like how is this possible? This isn’t supposed to happen. Like I wouldn’t believe it if somebody told me this story. But now I’ve seen these miracles happen enough that I know that we’re onto something and you know these patients. I’m so grateful to them for showing us what’s possible. I don’t you know, I want to believe that we’ll find a stem cell or we’ll find some sort of intervention that’s going to get her back to 100% and we’re going to get her back and yet I don’t I don’t know that that will happen in my career. But I know that there are our people that we can impact and we can prevent them from going to that level. We can prevent a MoCA of zero when I get a patient with a mocha in the twenties, you know, where they’re aware they’re having issues like we can measure the difference from what it used to be. I’m like, we’re good as long as you’re willing to do this, I have so much confidence, we can get you back to 30 and I know that’s kind of crazy to say like not many people will say that, but we see it over and over and over again. What do you think are the most common like lovers to pull when it comes to patients like that with these sort of miracle cases? 

Like what are the most commonly missed things? Missopportunities? You know, I Dr. Bredesen and I have this conversation all the time. I love him. He is so amazing. He he’s the type of person right? Where he’s like, call me with everybody who’s not getting better because I know that it’s possible. We’re just missing something, right. Like what is it? We’re missing? And so he’s always just looking for how to make this protocol better, how to streamline things, how to make it more accessible to more people? And these days, you know, his first question is, are they in ketosis. Ketosis is really one of those big things that’s relatively simple. The other thing that I think it’s missed is toxic exposure or toxic accumulation toxicity, some mold exposure, maybe even mercury exposure, those really pretty significant neurotoxic components that if those aren’t measured and if they’re missed, it’s really hard to get up and over that. It’s right. It’s like there’s this hurdle this big obstacle in the way of healing. And then exercise, I think a lot of people don’t get enough exercise. They kind of think that right? Like I mentioned, walking is enough. It’s not, we really need to get lots of aerobic exercise. We I tell people to aim for 200 minutes. 

This is from the Framingham trial. 200 minutes a week of moderate to vigorous exercise. Getting strength training so that you have muscle tone and then dual task exercises where you are both getting cognitive engagement at the same time. It’s physical engagement. That also is very, very helpful. And then contrast oxygen therapy can also be very helpful. So there, you know, is that that’s not exactly low hanging fruit. But it’s hard because people are like, what’s the one thing that you would do? It’s like probably the ketogenic diet. But really the two things that I would do if I had a loved one at home would be the liver to contrast oxygen therapy and the ketogenic diet. Those two things move the needle for a lot of people in a very measurable way and I can never stress enough that it’s not about one or two things, it’s about all of it and putting it altogether. And that’s really when we get the best outcomes, I will never tell anyone there isn’t hope right and I don’t want to give people false hope. However, I have, there have been people I didn’t have hope for who have proven me wrong over and over.

Cheng Ruan, MD

You know, those are there’s a really amazing, amazing and hopeful stories to piggyback off of and of course building relationships, letting go of resentment, you know, calling or talking to the people that you haven’t talked to in a long time you always wanted to talk to. We have a lot of those engagement process in mind-body medicine. So the the the point of I think our talk is that there’s there’s hope and um this the scary part for most people is what if there’s false hope and as I talked to Dr. Bredesen before interviewing you, he said that hopelessness is a bigger pandemic because there’s actually a lot of things that that can be done and we just have to to work there and engage um the and you probably know this as well as I do that a lot of people, a lot of the elderly that really come into the picture, they have a sense of guilt, you know, like they’re a burden to their family. And that they don’t, they don’t want to have hope because their family is more important to them than themselves. We have a lot of people like that. What do you say to those people?

Heather Sandison, ND

Yeah, Well, you know, my goal is to facilitate this intergenerational wisdom transfer, right, get that value back and have those people contributing. And really the best thing that they could do is prioritize their brain health so that they are not a liability so that they don’t become this train that requires so much care. And, and if if you’re someone who puts your family first, well, you, you can’t serve from an empty vessel, right? Put your own oxygen mask on first. And I would say this to caregivers as well. Caregiving is extremely stressful, very, very demanding, has a high burden and puts caregivers at 2.5 times the risk of developing Alzheimer’s in their lifetime compared to the general population. So caregivers need to put their oxygen mask on first, they need to be getting the exercise, doing the meditation, prioritizing sleep and getting help. And again, this is one of those societal things, I really hope that as baby boomers ages, these demographic shifts happen that there’s more Medicare and you know, societal, right, like at a government level at a bigger level that there is more care provided so that there isn’t that isolation and then there isn’t that tax that burden on the generation below that’s caring for people. 

So really, I think that the best thing that you can do is jump in and dive into this, do as much of it as you possibly can reach out, get support, get help enthusiastically jump into the, because we see such incredible results. And yes, it’s hard. It’s not easy, but just because it’s hard, doesn’t mean it’s not worth doing. The benefits of the rewards of this are just so great. I, my hope is that more and more and more people get access.

Cheng Ruan, MD

Yeah, me too. I do as well. And I think that the limited resources, that is the big problem right now, right? Two major factors: you have stigma, which I think is the biggest issue, and then you have the limited resources, which is probably the second biggest issue. And then, and then you have coverage, insurance coverage, Medicare coverage and stuff like that, which is another issue as well. And you know, right now, the way that our insurance system is really set up is for drug discovery and drug trials. And so, when you have something like what your trial is. Yes, It’s not one standardized, double blind randomized placebo controlled trial. It’s actually designed for medications and drugs and it’s not one lever to pull you’re exactly right. And, you know, earlier you said that, you know, maybe hopefully there’s some cool things coming up that like stem cell therapy or something like that, that can possibly improve things, but I don’t think that’s ever gonna happen. And the reason is this, I think that if something like that happens that contradicts all of science and it’s because even though we’re talking about Alzheimer’s today, you know, memory loss and sequestration is how our body defends ourselves. 

And so if we don’t have memory loss, we may have been dead much earlier on because we can’t sequester some of the brain functions that we can have seizures, we can die. And so a lot of what’s talked about Alzheimer’s like the plaques and the tangles that develop in the brain is part of our immune system doing us a favor. So if our body is not sequestering memory, and and at the same time sequestering toxins and infections, we don’t have that immune process. Our life expectancy possibly will be decades earlier. So we do have to think, think our brain and think are, you know, body for that as well. So if we ever do find some miracle cure, I just, I just don’t think it’s gonna happen. But if we ever do find some miracle cure, we’re still gonna have the foundation of food and relationships and activity. You know, all the things that that create this, you know, longevity as well. Right?

Heather Sandison, ND

So yeah, there’s no doubt about it. It’s not an either or it would, I hope both and that we can discover that really helps with regeneration. I just have to stay hopeful again, there’s this whole beta amyloid plaque and tau operating like we can go into that for a minute. I can get on my soapbox about that. But this is this is really frustrating part of the narrative, right, Is that there have been several missteps along the way from the entire history of the Alzheimer’s epidemic rate. It’s like starting in 1907 when when Alzheimer’s first had his STD, the patient who had this early onset memory last. She was early in her life.

She, in her 50s, she lost her memory. And then there was an autopsy that was done on her brain and they found these plaques and tangles in the brain under a microscope with the histology. And then the misstep that happened was it was a marketing play by Alzheimer’s superior, wrote a textbook on neurology and he had a new addition coming out and he wanted new juicy things to put in this new edition. And so he put this case study, one case study of a STD that Alzheimer’s had treated and put that into a textbook that doesn’t happen. That’s not how it’s meant to happen. He was doing that to sell more textbooks. And so this got elevated to be this this disease. Well, that would have been fine if in 1970s, the National Institutes of Aging hadn’t decided that they wanted to get a bunch more funding. And so what they decided was to basically make Alzheimer’s the primary cause of senile dementia. And so I actually use the term dementia because I think it’s more accurate. But Alzheimer’s is a marketing word, right? Like this is this is used because it puts the fear of God in people. Like if you say dementia, people like, oh, whatever. But if you say Alzheimer’s, they are terrified, right? This is losing your mind, losing your dignity. And and so this word, Alzheimer’s began to be used to describe most of senile dementia, right? You still see in all the scientific papers, Alzheimer’s the most common cause of dementia type of dementia. 

Well, I mean maybe. But Alzheimer’s has been equated with beta amyloid plaques and tau proteins and this is this has basically directed research funding and time with smart people’s time and effort and for decades now and we’re at a dead end. It doesn’t work when you reduce amyloid plaques or when you reduce these plaques and tangles in the brain what you you don’t get an increase in cognition, you get a reduction in cognition. So 99.6% of all trials that were focused on beta amyloid plaques have not shown outcomes that are helpful for anyone. And so we’re barking up the wrong tree. we’re totally going in the wrong direction and there’s this like beta amyloid plaque mafia that like says if you’re not studying beta amyloid plaques, you’re not studying Alzheimer’s when that’s, that’s not true. 

And we actually found out recently that some of the research, some of the seminal research that was published in 2006 has been sighted over 2300 times. That was that connects the smoking gun of beta Amyloid plaques with Alzheimer’s, but that was actually fraudulent that the photos were doctored. And so we really are at a time where the paradigm and science needs to change. You know, there’s bad actors in every community, but it’s just disheartening when it’s, you know, shifting taxpayer dollars in this desperately needed area towards something that doesn’t work. It’s just really so sad and frustrating. And I think it’s also this wake up call that we need to switch gears, we need to switch to something that works. Something that makes sense. Like a common sense level, right? Like what are all of the things that affect cell function in the brain, not how do we how do we fit this in our box of reductionist science that we want to work so desperately right? Like, let’s let that go and focus on the things that really work and on the things that make sense.

Cheng Ruan, MD

Yeah, absolutely.  Great soapbox to be on by the way.

Heather Sandison, ND

It makes me so upset.

Cheng Ruan, MD

No, no, no, but it’s it’s good to talk about and I’ll tell you my reflection point on this. So there’s a recent drug that came out which is Aduhelm by this company called Biogen and this and you know, the data on it is still relatively limited, There’s a conditional approval by the FDA and but the reason that we decided to go and be a provider for this, alright, listen to this is because those people come into the clinic and they’re amongst their peers and we could do group sessions with them, we can incorporate the lifestyle with them and while they’re either getting infusion or they’re doing some other things that are there. And one of the greatest benefits behind delivering a drug like that is actually we get to talk about things that they’ve never heard about. You know, they’re researching all these, you know, latest drugs and getting on the drug trials, but at the same time we’re like hey you know, there’s this other thing called a ketogenic diet, you know, nutrient diet. There’s another thing called exercise and there’s tai chi and qi gong you can incorporate. So we have this full support line for these patients who really enjoy the process not even knowing that something like that existing. So it’s sort of a trojan horse effect for us.

Heather Sandison, ND

I love it. Yeah, you’re using it as like this delivery mechanism for all the other stuff.

Cheng Ruan, MD

It is so I do appreciate it because of that aspect. But if you actually look at the at home trials, right? And so they did, they started this back in 2012. And if you actually look at those trials, the biggest improvement by far are all the questionnaires that deal with relationships were like, well why? And it’s because they have to come in every time. They have caregivers there and the caregiver perception of the patient improvement are the biggest results in Phase One and Phase Two clinical trials for those medications. I’m like, duh, you’re having people come in and doing something about it and addressing something that creating that, that creating that value that’s there. And so you see that in in both groups, the placebo group as well as the home group. Right? And so we’re finding something that even though this is kind of poo pooed upon in pharmaceutical science, that’s something that I held onto you was like, wait a second. These people actually coming in and getting stuff done. And also there’s there’s other aspects about memory care that are also being done. This is a big deal. So I kind of use it to sort of hack my mentality behind these these drug trials, but I agree with you overall that targeting just the effect, right? Not to cause just the effect, which has been amyloid and tau protein is not necessarily very useful because if we didn’t have the beta amyloid, if we didn’t have those tau proteins, we’d be dead decades before.

Heather Sandison, ND

The reason they’re there in response to something to trigger an infectious trigger or a toxic trigger. And so they’re there for a reason. If we don’t take away the trigger, we just take away the the effect then we get it makes sense. You would get a reduction in cognitive capacity. But if we can, what I love is this idea that maybe we could marry both. Right, let’s get rid of the toxin. Let’s get rid of let’s get rid of all of the things that are creating this response. And then after let’s get rid of the amyloid plaques too. And see if we can support regeneration through stem cells and NAD. And you know, all of all of the exosomes, whether whatever it may be, even psychedelics, right? Let’s push on the trophic factors and push that regeneration after we’ve gotten rid of all the that’s in there, mucking it up and creating this mandatory response. And that’s like this is that whole idea. Like let’s stack everything we know that works. Let’s put them on top of each other and then look at what outcomes we can get and that that’s really exciting and really where I think the research I hope is headed um where we can use the best of both of these worlds. And I love how you’re doing this, like, okay, there’s this benefit of getting people to show up and you’re also attracting the people who are early adopters who are excited about doing something you know, who want, who want an intervention, who feel hopeful and I think that yeah, that’s a that’s exciting. I’m glad to hear. I’m really curious what you find as people go through using Aduhelm.

Cheng Ruan, MD

I’ll tell you something I didn’t really expect to find when we started doing this, is that one of the most common common causes of acute and sometimes chronic memory loss is recurrent urinary tract infections. And more than half the people who show up for memory programs have recurrent urinary tract infections and actually treating urinary tract infections improves neural cognition a tremendous amount even after a couple of weeks. Right? And especially men, because when men have urinary tract infections, uh antibiotics are needed for 4 to 6 weeks, not, you know, seven days or three days, like women, right? And so, what we find is that there’s so many of these kind of easy wins when they come in for the drug discovery trials and stuff like that were like, oh yeah, before we get you on this, let’s deal with this, like, Oh yeah, and your blood sugar is high, let’s kind of deal with that in preparation, right? In preparation for being on different medications and Aduhelm being one of them, right?

And that creates a lot of excitement behind. Oh my gosh, yeah. You know mom and dad were was treated with medications for the urinary tract infections, they got better, you know, their diet got better and they got better. We haven’t even started the drug yet. And that’s the point, right? And that is sort of the integrative approach that I think that we should really look at addressing cannot combine all our powers together, you know, Anyways. But as we conclude, how do people find more about you and your programs and everything that you do?

Heather Sandison, ND

Yeah. So I’m at Solcere, S-O-L-C-E-R-E, Solcere.com and Marama, M-A-R-A-M-A, Maramaexperience.com. And either place you can sign up for our email list and we’ll keep you abreast of all of the new and exciting things we have available. We have a Marama at home course where people can learn how to do all of these things at home. We have coaching that comes with that as an optional offer to a to that and that’s where we see, you know, it’s just so much fun to engage with people at home and really rewarding to see people get better and stay with their families with their loved ones in their community. It’s just an absolute privilege to get to do this work.

Cheng Ruan, MD

That’s amazing. I want to thank you for coming on what a fabulous discussion between two like minded people and we need to have a whole lot more of this. So I think my biggest takeaway for people who are listening to this watching this is that we get excited, both Heather and I, because there’s a lot of hope and and hope shouldn’t be wasted and we also Heather and I both think that there’s a lot of ageism, especially within the Western society where we think that the people who are elderly don’t have as much valuable and reality, the opposite is true. You know, partially, probably because you know, come from China and Buddhist and so this is sort of our philosophy that age will always supersede anything when it comes to enlightenment in my culture. But those are the things that I would love for people to kind of take away from this, So thank you everyone for listening and watching.

Heather Sandison, ND

Thank you Cheng, I just want to add like how inspiring you are and how much that you make happen in the world and that it’s always a pleasure to chat with you and collaborate with you on anything, So thank you for having me.

Cheng Ruan, MD

Likewise, thank you.