Alzheimer’s As Type 3 Diabetes

Heather Sandison, ND

Thank you so much for having me.

Beverly Yates, ND

Absolutely. Would you introduce yourself to the audience and give them a sense of your background?

Heather Sandison, ND

Yes, absolutely. I went to Baxter University and got the Doctorate in Naturopathic Medicine that you mentioned. After that, I came to San Diego, where I currently practice, and I have been very fortunate. I have had the privilege of studying with Dr. Dale Bredesen, and through his work, he is the New York Times bestselling author of The End of Alzheimer’s. Through his work, I have been referred to many patients who I got to see with my very own eyes. I saw them reversing Alzheimer’s and their cognitive decline. From there, I developed a bit of a reputation, and I was awarded a grant to study an integrative and individualized approach to reversing cognitive decline. We are really excited. The paper should be published in the Journal of Alzheimer’s Disease this summer of 2023.

We have a research arm for my project down here in San Diego. We’ve got the clinical space where we see patients in person and virtually. I also have a residential care facility for the elderly where we welcome patients who are suffering from cognitive decline to experience the immersive lifestyle approach to this disease. There is an organic ketogenic diet, there is exercise, and there is a lot of mental and social engagement there. The whole day is basically designed so that each choice you make is not your own. But every single thing you do throughout the day helps to support your cognitive function. We also see that the people who do really well with this have the most support. 

Although I do not want people to need to move into Marama to be in these residential care facilities, we do have them as an option because some people just get to that stage. Their family is not in a position to be able to care for them, and they want that for the immersive experience. But we also have Marama at home, which is coaching, so that you can do this at home, and then also a tech platform that we are introducing so that people have that hand-holding, that ability to stay at home where they feel comfortable with their loved ones in their communities, hopefully working and engaging with their grandchildren and great-grandchildren. We are trying to get as much support out there as possible so that people can live with this and get all of the benefits of the reticence approach.

Beverly Yates, ND

Wow, what a brilliant assembly of fabulous options for people, wherever they may be in their journey. This is such a growing issue. I think as people are living longer, many people unfortunately do not have the experience of living well. You say, Live long and live well. Now this is how we put those pieces together. I so love what you are doing. I respect it and support it. Thank you for that work and for taking that leadership, because if it were not for people leaving, these things would not have happened. They do not happen by accident.

Heather Sandison, ND

Well, you are so kind. It has been so fun chatting with you, and as we have gotten to know each other, we have realized how much overlap there is in what we do. Much of the brain’s health has to do with metabolic health. This is the connection between type 2 diabetes and Alzheimer’s. We often hear Alzheimer’s referred to as type 3 diabetes.  What people are referring to here is that Alzheimer’s does not have just one cause but a very common one, particularly in our society. The standard American lifestyle and diet are such that we see blood sugar creep up over time, and then insulin resistance starts to become a problem. People are not able to, and I am sure most of your listeners know this; you certainly know this backwards and forwards, but it makes it harder for us to turn that glucose into fuel, or ATP, in our cells. So as that happens, if insulin is more resistant to insulin, we cannot get the glucose out of our bloodstream into our cells, turning it into sugar. 

There are a couple of things that happen when we are energy deficient, and the brain, although it only takes up about 2% of body weight, uses more than 20% of the energy every single day in our bodies. We cannot turn that glucose into fuel. Our brain is starved of energy. Even though we are getting enough calories and sugar, they are just not turning into fuel. The other thing that happens is that, because insulin is resistant, we cannot get that sugar from our blood into our cells. That means it builds up in the blood and creates glycogen toxicity. This means that that sugar becomes almost like an onion that caramelizes at the end stages of those capillary beds, at the tips of our noses, or in our brains. We have places where that toxicity actually causes advanced glycation in products that damage the tissue itself, and that can lead to inflammation and eventually lead to things like beta-amyloid plaques or other misfolded proteins, the Tau proteins that we so closely associate with Alzheimer’s. We want to stop this in its tracks. We have lots of ways that we can support you in doing that.

Beverly Yates, ND

That is all great to know. Thank you for explaining this. Now you have richly painted the picture here and connected the dots between brain health and blood sugar issues, also telling people why Alzheimer’s disease is often referred to as type 3 diabetes. For some people, they are familiar with that knowing picture and that way of talking about it. But for other people, this might be a new thought. Anyone for whom this is a new idea, please take notes and consider everything that I understand insane because the threat of your blood sugar issues can affect your organs unevenly. It is affecting you, but some things might be more vulnerable, shall we say, than others. For some people, it is going to be these brain problems and what might originally show up as mild cognitive impairment. Can you tell us a little bit more about that and what the path is from mild cognitive impairment, that diagnosis, to dementia and Alzheimer’s?

Heather Sandison, ND

Yes.  This may also be really surprising to people. I did not realize until I was in the dementia world how long this runaway is before we take off with Alzheimer’s. The early pathological changes happen 20 to 30 years or decades before you actually experience memory loss. We have so much time where there is plenty of room for prevention, particularly if we know that there is a genetic predisposition or something else going on that puts us at higher risk for developing dementia later in life. We have lots of room to create change and to start preventing this. That is actually where I have the most confidence, even though it is the hardest thing to prove. Then, a little bit later along the path, you run into subjective cognitive impairment. Subjective, which means it might not be measurable. 

We might not see this on a test, on a clinically administered test, or even on a brain scan. But we start to feel like our brain is not working the way it did ten years ago. I would have remembered that neighbor’s name; I would not have misplaced it, and I would have been able to come up with that word five or ten years ago. But I am noticing that I am not able to do that anymore. That is subjective cognitive impairment, and that is also a really great place to intervene and a really great time to make changes. Do not get scared; get active. Use that as something to empower you to make the changes so that you can reverse them because it is the easiest, cheapest, and least effortful time to make the changes. 

The next stage is called mild cognitive impairment or measurable cognitive impairment. You sometimes hear it called, and this is where we can measure it. I think it is a complete misnomer to call this mild cognitive impairment because this is essentially stage four cancer. Alzheimer’s is in its late stages. This is when people lose their dignity. They are losing their ability to dress themselves, put sentences together, feed themselves, live independently, and certainly thrive. This is a very late stage of the disease. Although we can support these patients and we sometimes do see reversal of the disease process and that they get better, I have yet to see someone with late-stage Alzheimer’s go back to work fully and get their life back. I think that, and hopefully the science will support that. In time, we’ll find stem cells and other interventions. Maybe the combination of our approach and getting rid of the beta-amyloid plaques through some of these new medications can help there. But there is oh, so much that we can do in the stages of prevention, subjective cognitive impairment, and mild cognitive impairment. In fact, most of the time when we work with a patient who has measurable cognitive impairment, we see improvements, and often if the cognitive impairment is ours, the MOCA scores are what we use, and if they are in that mild cognitive impairment stage, even though I do not call it mild, they meet that criteria. We can often get them back to perfect on a MOCA score. back up to 30 out of 30 points on that worksheet. If they are in that range of about 16, 18, or above.

Beverly Yates, ND

That is great to know. Thank you for making that quantifiable and understandable, both from a subjective symptomatic experience as well as the objective, quantifiable checklist. What is your score? There will be some parameters that people listening will be familiar with, as well as people who might be new to this journey too. Okay, here we are at the Reversing Type 2 Diabetes Summit together. I have got to ask you the question: is it possible to reverse Alzheimer’s?

Heather Sandison, ND

Yes, emphatically yes. I see it all the time. I know many people will be going. Why have I not heard that before? Why is no one talking about that? I think it is a great question, and it drives me crazy because we see that there are these medications that came out to a lot of fanfare and some controversy, but they were all over the news, and they are the monoclonal antibodies that allow us to get rid of beta-amyloid plaques, which is one of these hallmarks we think of as being causal for Alzheimer’s. But that is not quite right; I think we have gotten that wrong. Part of the reason is that those amyloid plaques and those tau proteins are misfolded proteins that are happening in response to something.

Even though the message that we have been told for decades is that science will save us, there is going to be a magical drug. Once we get rid of the plaques and tangles, everything will be well, and people will not have Alzheimer’s anymore. But what they have actually found is that when they get rid of those plaques, oftentimes people get cognitively worse. In the best-case scenario, what happens is that they get less cognitively well. They get cognitively worse more slowly. So this means that this tortuous process for both the patient and the caregiver and the whole family—everybody who loves this person—is basically drawn out. It is delayed. They are still getting bad. They are still losing their dignity. They are still losing their memory, but it is just happening a little less quickly. Now, that is a win. That is not a win. However, if you compare that to an exercise-meditation approach, what we found is that people actually get better. Not only do you stop the decline, but what they are doing is slowing it down. They are not even stopping it with those very expensive and risky medications. Those medications are associated with brain bleeding and brain swelling. These are not without risk, and they are very expensive. Those medications slow the process. They do not even stop it. But other things that we know well that are totally free and that are very safe, such as exercise, meditation, and healthy diets, not only stop the disease process when you layer them on top of each other, which we do, but you also see a reversal of the disease process and improvements in cognition. That is a reversal of the Alzheimer’s disease process. It is better than any drug on the market.

Beverly Yates, ND

That is amazing. That is fantastic. What a gift to humankind it is to be able to literally untangle these things and figure them out without causing other kinds of harm, because that usually seems to be the trade-off with these kinds of treatments that seem to be a blockbuster approach to a chronic illness when actually you are just treating one set of problems for another.

Heather Sandison, ND

Precisely. That is so scary to me because one of the things that we are facing as a society is that as the baby boomers age, we have, as you mentioned, more people aging, more people approaching this as a risk, and as more people in our communities have dementia, who is going to take care of them? This is very costly. It is very intensive for anyone out there who is a caregiver for a loved one with dementia or even diabetes. You need someone to pick you up and take you to appointments—to doctor’s appointments—and if you have Alzheimer’s, you need someone who is basically there 24 hours a day, often, or at least at some point along the way on this path. This is so expensive for society, and there is so much wisdom and experience in that generation. We need them. We need them to impart their wisdom to the next generation. We need them to not be parked in front of the TV watching, God knows what, and eating cake and cookies. This is not a good use of that resource, this incredible resource of our elders.

Beverly Yates, ND

I agree. I watched my mother-in-law go through this process, and I wish we had known then what we know now. This was years ago. One of the first things that changed in her health, interestingly, was that she became pre-diabetic. She never got to type 2 diabetes before it became apparent that she had Alzheimer’s. Her decline was really rapid, and she is from a family of people who live a long time. It was just so sad to watch her fade away. I hear every word you are saying, and I hope everyone is taking notes, listening, and paying attention here because these really are life-changing, life-altering, life-improving, and life-affirming options, that is for sure.

Heather Sandison, ND

I am so sorry to hear that. It is just heartbreaking to watch someone go through this process. It is the long goodbye of Alzheimer’s. She went through it relatively quickly. But for many people, they do not know how long they are going to care for a loved one with Alzheimer’s; it might be five years, it might be ten years, or it might be 15 years. It is a really long process that can be very taxing physically, emotionally, and, of course, financially.

Beverly Yates, ND

Yes, that is absolutely true. Okay. Dr. Sandison, what are some other considerations that people should keep in mind or be aware of when a person is being treated for suffering from this and dealing with dementia, or if they are looking to prevent it?

Heather Sandison, ND

Yes.  I do not know how you feel about the ketogenic diet, but this is one of those number one things that I recommend is dietary. Getting rid of carbs in your diet or almost completely getting rid of carbs in your diet so that you flip your metabolism from burning sugar for fuel to burning fat for fuel is very effective in improving cognitive function. Also, energy, mood, stability, and better sleep. I do not want people to be in ketosis forever, but getting into ketosis for 6 to 12 weeks if you are experiencing cognitive decline can create some really incredible benefits. They can then start to perpetuate other ones. You have more energy, so now that you are getting more exercise, you are getting better sleep. Now you will be able to eat those better foods and engage in creative social brain activities. 

We often suggest the ketogenic diet first. This helps for so many reasons. One, because just where we started this conversation with fuel, if you are not effectively turning glucose into fuel, the body is just absolutely miraculous. With a car, you cannot do this. You cannot take a gas-guzzling car and just put diesel in it. But with the human body, you can switch from burning sugar to burning fat for fuel, which is much more efficient. We make ATP out of ketones. We ask the body to do that. Also, this is a weight-loss day, but it certainly helps with blood sugar. and I am sure that you are well aware of that, and many of your listeners may have heard of this. I highly recommend doing a veggie-heavy ketosis—lots and lots of leafy greens and cruciferous veggies—not your bacon and cheese keto, but no, no, no. But a high-fiber, high-vegetable ketone that just cuts out the carbs, processed foods, and carbs and temporarily your fruit sugar, your seasonal fruits, and your starchy veggies, but just temporarily so that you can get the benefits of getting into ketosis.

Then, when we switch out of ketosis, I usually have people go towards a paleo Mediterranean diet, Whole30 diet, AIP diet, or whatever is appropriate for them, so that they are just maintaining that elimination of highly processed foods. Highly processed foods are highly associated with both diabetes and Alzheimer’s. We want to completely eliminate those as a lifestyle in the long term. Diet is a consideration. Exercise is another consideration. We know that our muscles are actually our endocrine organs. They send signals from the muscle tissue itself to the brain, including BDNF, or brain-derived neurotrophic factor. This is one of the signals that tells the brain to create new nerves, new neurons, and new connections between those neurons and muscle. It also sends testosterone around the body. Muscles are sending signals. Testosterone, yes. Is that feeling of, I got this now that you are not as afraid of risk, but also more energy, better mood, and better muscle building, which in this population that I treat with dementia, we are not only worried about their brain, but we are often worried about falls and fall risk and balance? Because of falls and dementia, these are the things that really cause people to go downhill. I know lots of people are concerned about heart attacks and cancer, and of course those are big deals too. But we can help avoid all four of those things. Cancer, falls, diabetes, and heart disease—well, what was the other one? I just. Cancer. No, Alzheimer’s, of course. Where are we? Basically, all of the scary things we face as we age can be eradicated more or less by getting regular, vigorous physical exercise.

I tell patients, if you have not done anything, if you do not even walk to the mailbox, then start, and just 11 minutes of exercise a day reduces your risk of Alzheimer’s mortality by 23% over the next five years. There is a big benefit to just getting pretty small amounts of exercise, but 150 to 200 minutes per week of moderate to vigorous exercise significantly reduces your risk of cardiovascular disease and really improves the risk of cognitive decline. There is a whole spectrum. If you are already exercising and you are walking, walking is not enough. Remember, we are asking for a miracle if we are asking for the reversal of Alzheimer’s. You have got to do more than just walk. However, if you are not doing anything, just walking regularly is going to have a huge impact. My recommendation to most patients is to do a little bit more and mix it up. If you have not been doing Zumba classes, go to Zumba, yoga, Pilates, or start playing pickleball. Do something new and engaging that you get excited about and look forward to.

Beverly Yates, ND

That totally makes sense. The whole old adage of use it or lose it or keep moving applies to things that are really important, and in today’s lifestyle, much of the world is so much more sedentary than we have ever been before in human history. We are seeing all the various metabolic disorders that are going on, including type 2 diabetes and Alzheimer’s. These things are all related.

Heather Sandison, ND

We talked about diet and exercise. Sleep is another big component. We know that cognitive function will go downhill very quickly with sleep apnea. Sleep apnea. I want people to think of an apnea event at night as mild brain damage. So as a brain doctor, I am not okay with that. Even if somebody has mild sleep apnea, it is not moderate or severe. I still recommend some treatments. There are lots of different things out there. You do not just have to get a CPAP or those Darth Vader machines at night, though sometimes they do work really well for people, and that is the answer. But other times people use an APAP, which is an alternating pressure device, or they will use the travel version, which can feel a little less cumbersome. Alternatively, there are oral devices that your dentist can create, or maybe a referral to a specialist that a special dentist can create. There are also things like mouth tape or breath strips that keep your nasal passages and then your airway open with just some positioning. That can be helpful as well. If you have a sweet partner who tells you you snore, absolutely. Get a sleep study if you have cognitive decline. I actually recommend it to anyone with cognitive decline. Have a sleep study done because I have so many patients who are thin and female, never snore, and still have sleep apnea.

Beverly Yates, ND

Again, say it very gently. People make the assumption that if someone is overweight or obese, they either have sleep apnea or type 2 diabetes. Conversely, if they are lean, they do not have these things, and if they are not, you cannot just look at somebody and diagnose him. Please repeat what you just said.

Heather Sandison, ND

Yes. Exactly what you said. People who assume that you cannot have sleep apnea if you are not overweight, if you are not male, if you do not snore at night, if you are not gasping for air—I have people tell me all the time, Oh, no, I am not gasping at night. I do not have sleep apnea. You do not know that, actually. If you have any cognitive decline, regardless of your body type or whether or not you snore, I do not care. Just get a sleep study done. Since COVID, this has actually been one of the great things about COVID. Since COVID, we have more of these at-home tests that are validated, and they are actually quite good. They are really good at ruling out sleep apnea. I have their sleep medicine doctors, who still want people to do an overnight sleep study in the hospital. But there is a lot you can do with the at-home watches that have a ring that beams information up somewhere, and then some magical sleep doctor somewhere in the world reads it, and these get covered by Medicare. You will often get the devices covered by Medicare or any referrals covered by Medicare. I highly recommend doing that as part of what Dr. Bredesen, my mentor, calls cognoscopy. If you have cognitive decline, you want to do this very thorough cognoscopy and look at your blood sugar, your sleep patterns, your toxic burden, your cholesterol levels, your vitamin levels, your thyroid and hormones, and all of the pieces so that, if there is an additional risk from any of these different components, we can identify it. We talked about diet, exercise, sleep, and, in particular, sleep apnea.

Stress is another big one. We see this with blood sugar as well. Great meditation, prayer, moments of gratitude, doing quite random acts of kindness, and finding ways to create mindfulness, slow down, and become present in the moment have massive effects on our health, and they help to regulate that sympathetic parasympathetic balance that allows us to rest, digest, and heal in that fight-free state. We want to spend more of our time in that resting, healing state. This is good for everything, including diabetes and cognition. We know that stress is highly associated with being out of balance. Stress, which you do not want too much of. You do not want to at all. Some of my patients run into the issue of, Okay, I am retired, so I am going to kick my feet up. I am going to go on cruises and I am going to watch TV, and that is going to be my life after retirement because I earned this and that. You said that if you do not use it, you lose it. So you want to stay engaged, but you do not want so much stress that you feel constantly threatened. You are in that fight-fleet-free state because cortisol is actually damaging to the hippocampus, the area of our brain that is related to memory, and the amygdala, which is related to our emotional center, especially our anger and fear at the amygdala and the hippocampus, which work very closely together. Putting our bodies actively working to make sure our bodies get back and remembering that resting and digesting our heel state through mindfulness is very beneficial, there is really impressive data on Kirtan Kriya, which is a type of meditation. It is this: Sa Ta Na Ma. There is a mantra: just 12 minutes a day has very impressive benefits not only for glucose and insulin regulation but for cognition itself.

Beverly Yates, ND

That is great information. Thank you so much for making that clear and unpacking it for us. So as we consider what people’s options are given the fact that this is such an amazing issue, it compels an awful lot of heartache and problems. If we can get in front of it, reverse it, or not even have any of this happen, this is all a blessing. All of it. What are the challenges that you find that the people that you have worked with—your patients and the residents at your care center—experience, and how do you provide support for them through these challenges? Because for many families and certainly the individual who has somewhere on the spectrum of the poorly named mild cognitive impairment through Alzheimer’s and dementia, there are all these different touchpoints. We all know the challenges that happen are real. What can you share with us here?

Heather Sandison, ND

Yes, in the neurology community, they say if you have seen one Alzheimer’s patient, you have seen one Alzheimer’s patient. They are all different. Everyone presents differently, in that as people lose their memory and as they change and decline over time, there is just this endless combination of issues that come up. The biggest one I see as preventing people from getting benefit from this approach is that it is hard for them to do. Most of the people who show up in my practice or who contact us about Marama, they get it. They have read the Reticent book; they have heard of this. This is common sense. If you do all these things, of course you are going to get better. Your body is going to work better, and your brain is going to work better. But how do I do it? It is really about day-to-day implementation.

Having people around you who are supportive of this and then also having the tools and knowing that you have a lot of resources is essentially my life’s work. It is creating resources and pragmatic tools—just the practical things that you need—the lists, the recipes, the reminders, the stuff that you need to be able to implement this at home. The other thing that I see come up that is really sad and challenging and that we try to be supportive of is communication. Often, the dynamics of Alzheimer’s are challenging. There’s usually the patient involved, and if they are far enough along the process, they have a power of attorney or someone they have put in charge of their affairs. This can be either a spouse or an adult child—someone else in their network who they trust—and sometimes there are multiple adult children whose interests, beliefs, and values are not always aligned with the others. We see a lot of infighting in the families. It can be really challenging to put the well-being of the patient first, but I get it. There are lots of dynamics at this stage, but I think communicating lovingly and aligning on the mission is really, really helpful.

Our mantra is connection, not overcorrection. If we are looking for if we are looking to support any family, whether you are talking to the patient who has Alzheimer’s or if you are talking to your brother or sister or to your mom or dad who does not have Alzheimer’s but who is involved in this, it is so much more helpful for everyone if the focus is on connecting, understanding what the other person’s point of view, rather than connecting or proving that you are  or or especially with someone who is struggling with Alzheimer’s, we highly recommend that if they start to tell you about something that did not really happen, or if they start to tell you about something that happened 20 years ago is if it happened 10 minutes ago, just go with it. Go and meet them in their world. By doing that, you are going to diffuse. You are going to create less stress for them. It does not matter that they do not know that their mom is not alive anymore. Do not remind them that she passed away. Just go and meet them there.

There was a patient of mine who had been describing the breakfast that she had with her mom. Instead of saying, Hey, your mom passed away 20 years ago; don’t you remember? Don’t. Also, do not ask them to remember anything; asking them to remember can be very stressful. But instead, say what your mom makes for you, what you guys enjoy for breakfast, and just ask her to describe that. Asking them to describe their senses, what did the sensory experience taste like? What did it smell like? What did you see? Did you help? Asking them to describe the details of their world can help you connect with them, and then they feel more at ease. Everything goes better; they sleep better, and they are more willing to exercise. They are more willing to eat what you put in front of them. They have better digestion, and everything’s a little bit easier. If we can diffuse those situations and not escalate or feed that fire.

Beverly Yates, ND

That makes sense. It sounds like a loving, caring way to meet them where they are at, rather than keep harping on the fact that you are not having a shared experience of reality and that they will understandably become alarmed and stressed by this. This is not going to help. I have not seen stress help anything, so I get that.

Heather Sandison, ND

Exactly.

Beverly Yates, ND

Cool. These are all wonderful insights. One of the things I think is not apparent on this journey with dementia and Alzheimer’s is all the ways in which people’s social interactions shift. A lot of times, the people who love and care about someone the most are often the least equipped to deal with it because they do not have the emotional space. It is almost like their soul or their spirit is so stressed in the moment and suppressed, and they are alarmed, understandably, as their loved one continues to recede into the midst and into the breadth and depth of this illness.

What are the things that you think would be helpful? Is there any language in any early conversations that might need to be had among family and friends? I think a lot of people start to see the train jump on the tracks in slow motion. The wheels are starting to screech; all sorts of things are happening, and they do not really know what to do. I often find that because these are difficult conversations to navigate, people really need some support around them. Any thoughts?

Heather Sandison, ND

Yes, so many things come to mind. I think there is one piece to this, as you were describing, that caregiving can present quite a burden, and it can feel very burdensome. If you have not been a caregiver yet, it is coming. It will happen at some point. It is just a phase of life, and finding the joy in it and the gratitude there is difficult. There are people who lose their parents way too young, and they do not get the opportunity to care for them. Reframing this as an opportunity: Most caregivers—many, many caregivers—at the end of that phase of life, when they are no longer caring for their loved one, have so much gratitude for the ability to have been there and for all of those moments that they got to share. I think remembering that this is an opportunity to care and then doing everything you can to find joy in those moments is a good idea. Certainly, there are lots of resources out there. It is not my area of expertise, but working with an estate planning attorney, a caseworker, or a social worker is something anybody can do. There are lots of resources out there to basically help you make sure that legally things are in place so that that does not become burdensome or worrisome later on.

I think doing that as early as possible, before someone has dementia, before you are questioning their judgment, before there is any question around their judgment, is important so that they are not taken advantage of later on, but also so that their intentions are followed and their expectations are very clear from the beginning. That can, of course, be really helpful. We work with people all the time where, for example, mom does not want any life-saving items. She just wants to eat cake and cookies. That is how she planned to spend the end of her days. We are not going to do this; this is just too much. It is not what she would have wanted. Then there are other people who are doing everything. We are going to do everything for as long as possible. We are not giving up. We are where you no longer are. What else can we do? They have the resources. They have the energy and the ability to pour everything into it, and they know that it is what mom wanted. Having those conversations so that there is not a question of what that person would have wanted ten years ago or when they were at full capacity. Sometimes you end up in these absolutely impossible situations.

Recently, one of my coaching clients, Joe, is an engineer who cares diligently for his wife, and he has spreadsheets mapped out for everything: all the music that they do and the exercise they get in; the ketogenic organic recipes that they are trying every day; and he has just been so dedicated to her because his son lives halfway around the world. So Joe is asking me, Should I take Marilyn to see him today? She takes her ten out on a ten-hour plane flight halfway across the world, or is that going to be too disorienting? I was like, Oh, that is way too disorienting. Please do not forget that that often means exposure to germs. It is stressful on the system, just from the circadian rhythm of travel and the changes in time zones and jetlag. It is so hard on anyone’s body, let alone someone who is struggling so much cognitively. Well, then he was, but he is getting married. His mom needs to be at his wedding. There are just these absolutely impossible decisions that end up being made along this journey. It is the individual’s choice and what it is. Through this coaching call, what we brainstormed was a group coaching call, and I cannot take any responsibility for it. It was really the group. Someone said, Well, could your son maybe have two weddings, and his mom could be at one of them near you?  I think that is the direction that they were going to go. But you are not alone. There are so many people who are struggling with these really impossible decisions and feel backed into a corner. There is often an adult daughter who is caring for someone; she has kids that she is raising, and she has a full-time job. She wants to manage, and she has a husband who is trying to maintain a relationship with her.

Beverly Yates, ND

She is sandwiched.

Heather Sandison, ND

She has been totally sandwiched. Then her parents need help, and it can feel absolutely impossible to do it all. When asking for help, know that if you are listening to this, you are doing the best you can. having compassion for yourself and getting help where you can and before you need it, I really implore caregivers, because caregivers are anywhere from two and a half to six times more likely to be diagnosed with Alzheimer’s later in life. It is a very stressful and burdensome job. Change the mindset. We have got to work on the mindset, but also do what you can to care for yourself. I strongly believe that having at least one full day off per week—at least 8 hours that are completely to yourself—is really important, as is having those other people involved in the caregiving process. That is not just because one person can do it alone; it is just not possible. Get those other people lined up, whether you pay them or whether it is a sibling, an in-law, a friend, a neighbor, or someone from church. Get that other person involved so that the saddest thing I see is when people are in crisis mode and they need somebody to show up, so they are finding someone on Care.com. If they have never met, nobody’s comfortable with them, especially the person with dementia. It is a stranger I’ve never met, and they are totally backed into a corner. So having those conversations and getting those things lined up before you think you need them is really helpful for a lot of families.

Beverly Yates, ND

Yes, that is a great, wonderful way to just take that whole perspective on that journey and find what is going to work for somebody and to try to be ready before you need to be ready. There is no such thing as being ready too soon. From what I have seen of how this unfolds, anyone listening to this, if you are a caregiver, please take the advice that Dr. Sandison just shared with us about trying to build that world around you where people are supporting you. I know sometimes that is not easy because sometimes people really are the rock; they are the connector. They are the ones that everybody else goes to for help. One of the things I have noticed clinically for type 2 diabetes and pre-diabetes many times in people’s journeys to those particular diagnoses is that they have often been the caregivers, caring for others while their own self-care was not prioritized as job number one. That old thing about putting your own mask on first before assisting those around you. Sometimes it is easier said than done, depending on the people we are with and the kinds of relationships we have.

Anyone listening here who has not had the opportunity to be a caregiver—if you have ducked it or if you have actively avoided it—I am going to ask you to step up, gather your courage, and show up. Whether or not you are directly the caregiver, perhaps someone who is just jammed. They’ve got entirely too much to do; offer them generously and with compassion from a real place. Whether or not you can help, maybe you can come over and do the laundry. Maybe you’re going to do the dishes, or maybe you’re going to go to a store. You’re going to sit there and listen to them. Maybe you are going to take a few shifts so that they can then have these 8 hours off, etc. that Dr. Sandison is talking about. I have some pretty strong views about that, in part because I am an only child and I had a chance to be a caregiver for my mom during her time of need. It was just such a life’s joy and a blessing to be able to give it back to her because she had fought so richly. To me, I would not have the life I currently enjoy had it not been for her love and focus. I was sad that the situation was happening and glad that I could help. All I can say is, Please. I hope folks are listening and taking this completely to heart. We really have to find a way to, in this world of more isolation, push away that isolation and link arms, and help each other when appropriate, wherever and however we can. Okay, I will get off my soapbox. Go ahead, Dr. Sandison.

Heather Sandison, ND

I love it. Dr. Yates. It is just so important. You mentioned social connection, and I could not have designed this experiment. But what happened at Marama really illustrated to me just how critically important social connections are, especially from our peers—not just people that work for us, not just doctors, not just where we are running around appointments and running into people at the grocery store, but real social connections. 

At Marama, we have a facility that is big enough for about 12 people. In that facility, we had a COVID outbreak not that long ago, and it took us a couple of years. We went a couple of years without any COVID among the residents. But finally, it happened. It got into the building, and for the resident who first had it, it was, of course, a Friday afternoon. We found out that she had a sore throat. We found out that, sure enough, it was COVID. We isolated all of the residents in their rooms. No one else in the building had COVID. We tested everyone every day. Each day the residents were exercising; they got their organic ketogenic diet; they were in their nontoxic living environment; they did their creative exercises; they did their brainwaves; they did all of those things. But they did it just with the caregivers, not with their friends, not with the community that lives in that building with them.

We isolated them for ten days. In those ten days, we had three falls. We had not had a fall in six months before that. We had incontinence and sleep issues. I mean, the number and cause of measurable cognitive decline and rapid cognitive decline in just ten days? It took ten weeks for those. There were 11 residents there, and it took ten weeks for those 11 residents to get back to baseline after ten days of isolation from their peer group, not isolation completely, and still doing all of the lifestyle things. Just ten days of isolation from their peer group. I mean, I could not have thought of it. I mean, you could not. It would be cruel to do that to anybody with what I know now. COVID itself. was very isolating. Now I get the severity of how obviously life-threatening that was for people. But social isolation is one of these modifiable risk factors that affects blood pressure, stress, and sleep. I mean, we are social animals. We need connections. Join that club. Go do it. Go to that party, do that thing, and maybe wear a mask. if that makes you feel more comfortable. But whatever it takes, get together with other people who are in your peer group. So important.

Beverly Yates, ND

It is so important for all ages and stages. Absolutely. I think we are learning so much more about ourselves, both as a species and as individuals, within our families and our friend groups and networks. Having come through the earlier stages of the pandemic and whatever health things may be in front of all of us, in terms of possible event horizons, those connections matter. It is ironic, excuse me, that in today’s world we have all these ways to supposedly connect digitally, but it probably never felt more lonely. It’s just that it’s quite a conundrum. It is just a real thing.

Heather Sandison, ND

You’ve got to show up in person. It is not the same to scroll through Facebook as to be at a club or in a group. Beverly, thank you so much for having me. It is always a pleasure to connect with you.

Beverly Yates, ND

Absolutely. I was just getting ready to wrap this up. If you have any last-minute tips, here is your chance. Otherwise, please tell us where we can connect with you. We want to follow up for more information.

Heather Sandison, ND

Yes. DrHeatherSandison.com. I will connect you to all of the projects that I have going on. If you are interested in learning more about Alzheimer’s, we are also going to have a free gift with the Ketogenic Diet Guide. Feel free to grab that. You will find us at Solcere.com or Maramaexperience.com. That is maramaexperience.com or solcere.com. If you are interested in either clinical support, residential support, or even at-home caregiving support and training,

Beverly Yates, ND

Great. Thank you so much for your leadership here, taking action, and making this world a better place. I appreciate you.

Heather Sandison, ND

Dr. Yates, Right back at you.