What Your Skull Reveals About Your Brain Health

Cheng Ruan, M.D.

Thanks for having me. I’m super excited to be on to show some of what we found at Texas Center for Lifestyle Medicine to be quite useful for a lot of people.

Heather Sandison, N.D.

Excellent. So, you focus a lot on the anatomy on the skull. Tell me, I know the skull is the house for the brain, but how does it impact cognitive function?

Cheng Ruan, M.D.

Right. So I may surprise you to know that a lot of times, patients walk through our doors and then we look at their facial structures and their posture and their spine, and we already know what to focus on for their memory issues. And it’s because our bodies are made to restore symmetry and to restore function. And the center of our bodies is really our spine and it supports the base of our skull and then our actual anatomical features within the skull, like the teeth and the airway. These are really simple things to focus on to actually improve memory outcomes for short-term memory and long-term memory. And a lot of studies have been done on this. And unfortunately our skulls are actually changing quite a bit over the last couple hundred years. It’s talked about in this really great book called “Breath” by James Nestor. If you guys haven’t read it, it’s a great book that talks about how the skull development and the features within humans and homo sapiens have drastically changed because our food source and our food quality has changed and our air pollution, everything has changed. So, we humans are living sort of in this world that we weren’t really designed to live in and that’s why we focus on a lot of anatomical structures so much.

Heather Sandison, N.D.

Yeah, our environment, our lifestyle, all of that impacts how our anatomy gets formed. And so this becomes a really big issue with cognitive function because of course, we need blood being able to be delivered to the brain and blood, all the venous blood, all the toxins, to be able to get out of the brain. We need oxygen going to our brain. We need inflammatory cytokines coming out. We need carbon dioxide coming out. So, tell us a little bit more about how you would approach that at your office.

Cheng Ruan, M.D.

Sure. So, let’s look at statistics for a second. So, we know that one in four humans have some sort of airway restriction. When I say airway, I mean the way that we actually intake air. So through our nostrils, into our sinus cavities and empties into our trachea and our lungs, right? So that’s one path and the other path is through the mouth. And so, if we think about it, air is kind of everything. It’s needed to restore function to every part of the body, really not just the brain, right? And so whenever there’s any sort of airway compromised, the brain is the first organ to react. And it’s because the brain is very much, the function is very much dependent on this pathway called the nitric oxide pathway that gets produced and stimulated every time someone takes a nasal breath, through the actual nose and the sinus and stuff like that. And so what happens is, if you think about that, then what would be the opposite of that? And how would someone not take a breath through the nose? Well, they’ll be breathing through the mouth like this. And sound really nasally like this, right? So a lot of times people come into the office and they’re actually sounding nasally. 

And then I might ask, “Is this how you normally sound?” They don’t really notice that they’re mouth breathers, or if they do notice they’re mouth breathers they’re like, “Oh, it’s just allergies.” Well, allergies are a big deal because allergies restrict the flow of air through the skull. And decreased flow of air through the skull means decreased nitric oxide, means decreased oxygen delivery to the part of the brain. So the brain’s flipping out, it’s freaking out, right? So in our practice, we use something called the BrainView, which is an EEG, which is looking at the electrical conduction of the brain over 20, 22 minutes. And we see that as people sit there with the little laptop, looking at sort of different things, checkerboard, hearing different sounds, and we’re really challenging their brain, their brain continues to kind of flip out. 

We call it high frequency patterns. And so, these patterns correlate with different disease states like obstructive sleep apnea, PTSD, traumatic brain injury, right? So these are all the hallmarks of what can create this thing called Alzheimer’s or called dementia. And so, as we look at the patterns of the brain, we know what lever to pull first. If I see someone with really bad sleep deprivation patterns, we’re gonna be focusing on sleep. Before we even talk about supplements or food, I’m gonna need a sleep study to see exactly and quantify what your sleep mechanism looks like. ‘Cause sleep is how we regenerate these brain cells or actually all the cells in the body. So that’s probably the most common way that we look at a case of someone with memory loss. 

And the second most common way is infections. And guess where most infections lie in the body? The teeth, the dental areas. So I rely so much on my dentist and biological dentist to really take a really deep look to see exactly what’s going on in the periodontal areas. ‘Cause those infections also stimulate the same areas of the brain to just fire, fire, fire, so much so that the brain can’t, they can’t sustain attention. So people are diagnosed with attention deficit or bipolar disorder and then later on to memory loss, right? And so these are just names that we have given people in medicine to look at an observed outcome of what has happened and the root cause may be either infection or airway or something like that. So these are probably the two most common presenting symptoms.

Heather Sandison, N.D.

I love what you’re talking about because it’s at that primary level, right? You’re not just talking about the name, the label that we put on the symptoms that someone has, but you’re asking the question why? What’s at the root cause? And that structure, my model is very, very similar. I always tell people, let’s look for toxins, nutrients, structural issues, stressors, and infections. And that structure is kind of what you’re speaking to. That those infections are what you’re speaking to. So rather than saying, “Oh, let’s put a label on it and say the cause is bipolar disorder,” that’s not the cause. The cause is what happened before that set someone up for the imbalance. So, I think part of what you’re speaking to as well is these diagnoses. We get really attached to what we name something. Dementia is sort of this, we say Alzheimer’s, reverse Alzheimer’s, because I think that’s what most people associate with dementia. And that’s the majority of dementia cases, are Alzheimer’s. But what else gets confused with dementia when we’re talking just about naming it with a diagnosis?

Cheng Ruan, M.D.

Oh, my gosh. Pretty much every mental health disorder you can think of. Let’s take dementia for a second and let’s kind of define it. And Dr. Bredesen does a really great job on this, so I’m not gonna beat the dead horse. So if you look at Dr. Bredesen’s research and read “The End of Alzheimer’s” book, it talks about these plaques and tangles. And a lot of conventional medicine looks at these plaques and tangles as something that’s pathological. Well, no, this is just an observation of something that’s happening. And so these plaques and tangles that get within the brain that get stuck there, is there for a reason. In fact, if it’s not there, you might be dead because these actually sequester these toxins, these sequester the infections that are there. And so, these are part of the brain’s immune system. The brain actually has its own immune system that’s completely independent of the rest of the body within the blood brain barrier. It’s really cool. These called microglia cells. And these immune system do certain things to sequester these toxins here. So whenever we see a patient, maybe they’ve had a complete neurological workup, maybe they got a DaT scan or some other type of scan that shows, hey, there’s a lot of these amyloid plaques in there and they label them Alzheimer’s. 

We’re like, well, where do these toxins come from? Let’s investigate that. And so, what we do is very much an investigational approach where, okay, well, we know these are there, let’s peel back the layers to see exactly what potentially they could be. But what we did, maybe in 2018, 2019, is not what we do now. What we used to do is we go toxin hunting. We do all these different tests and a lot of different things that can let us know whether there’s mold, whether there’s heavy metals, whether there’s non-metal toxins, styrofoam, plastics. And we found is that we literally found everything as long as we looked for it. So we stopped doing these testing. One, Medicare didn’t cover it. And most of our patients are not in the category where they can even afford these expensive testing. And two, we actually didn’t think it was necessary because if we look at our body’s physiological structures, our detox mechanism starts with air. 

So, if I were to look at your or toxin testing, find a bunch of plastics and heavy metals and all that stuff in there, but then I already know your airways is compromised, it’s not really a reason for me to look at these testing and then go directly to the airway. Let’s improve the airway first. So it’s like the one lever to pull for a very, what do you call it? Very big momentum in improving the detox pathways. And then we have other biomarkers that we look at, like HSCRP and other different things in labs that show us the body’s actually improving. And so, whenever we address something like Alzheimer’s and dementia and stuff like that, doesn’t matter what type of dementia there is. There’s always some sort of immune response. If there’s vascular dementia, blood vessels compromised, you still have some plaques in there. If there’s Parkinson’s dementia, well, you still have the same plaques that are in there. And so, getting tied to the diagnosis is not really useful, but getting tied to the actual solution and simplifying the process one at a time, that’s how we get the best results for our patients.

Heather Sandison, N.D.

I love it. I love it. You mentioned the dentist, I wanna go back to that. And you mentioned a biological dentist. So, I think a lot of people aren’t used to their doctors saying, “This is a high priority, go back to your dentist and get that figured out.” Also, you spoke to cost. This can be really expensive. So how do you help patients navigate, one, what dentist to see? Who is a biological dentist? And then how do they prioritize this?

Cheng Ruan, M.D.

Right. So let’s talk about from an insurance standpoint. So, especially if someone is in government insurance and Medicare, they don’t necessarily have dental benefits. However, there’s a bit of a loophole. And the loophole is that if I can show that dentistry is actually needed for a medical outcome, then that dental appointment can be potentially covered by their medical insurance, okay? So we do this with sleep apnea, for example. Someone has documented sleep apnea, they try to use a CPAP and they can’t tolerate it. They go to a dentist for oral appliance to help improve their airway. Well that oral appliance then is considered under medical insurance. So, a lot of the navigation is proving to the insurance companies that people have a medical ailment because of X, Y, and Z. And hopefully this X, Y, and Z could be covered. Now, I’m only saying this because this is what we see right now. Insurance may change in the next quarter, and I have no idea. But as of right now, that’s kind of what we see. And then there’s a difference between a biological dentist and other conventional dentistry. 

So biological dentist take it a step further, well, several steps further, to look at potential root causes of toxins. Sometimes you can have mercury amalgam in there. That off-gas that the plaques in the brain has to sequester there. And then some biological dentists also have much more in-depth imaging to look at micro-abscesses, little small pockets of infection that’s missed by the regular dentist. And so, we’re very adamant about seeking out biological dentist that has the ability to do that. But yeah, a lot of them are kind of cash-based, that is very costly. But if you were to allocate your cash to pay for something, it wouldn’t be a diet, it wouldn’t be supplements, it is to get a screening of exactly what infection is here. Because even if you do change your diet, even if you’re on the best supplements you can think of, spend tens of thousand dollars on it, you may not get anywhere without looking at the root cause. And it could literally be in a root canal. It could literally be in periodontal area. So I think airway and dentistry and focusing on the skull is just astronomically important.

Heather Sandison, N.D.

Okay, so you’ve talked about the skull. I think when I heard you mention the skull, I was thinking like, okay, the cranium, right? Like the occiput and the parietal lobes or the parietal bones. What I’ve heard you talking about is a lot of the facial structure. So, what’s going on in the mandible, in the jaw, in terms of teeth and then also in our facial bones around the nose and the sinuses, maybe. What about traumatic brain injuries? Are you seeing things like that? In where the skull kind of the way I was imagining it is also involved?

Cheng Ruan, M.D.

Yeah. So the facial feature’s are obviously very important, but let’s talk about the actual cranial portions of the skull. Now, the skull obviously houses your brain, right? And so, if you were to have trauma to the skull, a skull fracture, then the immune system of the brain would also freak out and say, “Hey, what’s going on here? I must sequester whatever toxins that are there that may be exposed to from the injury.” Now, if you’re thinking, “Well, what if I have a concussion? I don’t really have anything penetrating my brain. What do I do there?” So as it turns out, if you have concussive injuries, like I’ve had multiple times in different sports, what happens is, the brain becomes primed, right? This is literally a scientific term. So you have priming of different cells. And these cells are called M1, M2 macrophages. And other different names that are out there. So the brain is now primed to stimulate a higher immune response, so it has a higher propensity to sequester these toxins. And some people are even genetically predisposed to it, through something called APOE4 that I think other members are talking about in the summit. 

And so, if you’re genetically predisposed to increase sort of this priming, this mechanism of the immune response then the immune system takes over and it starts sequestering these toxins in brain areas. And then, depending on the way that the protein is folded, it may render that area of the brain less effective and then you can have memory loss, you can have tremors, you can have mood disorders, depending where the part of the brain it actually is. So, that’s where it gets a bit complicated. So yes, you can have penetrating trauma to the skull, which obviously it causes major issues, right? And you have a non-penetrating trauma like a concussion that actually can prime the brain to develop this immune response. Now, what is it priming to? This is the freaky part that no one really talks about. On the brain maps that we do, I can’t tell a difference if you have a psychological trauma or a physical trauma, okay? The pattern looks identical. 

So for example, if you were to have a concussion on the side of the head, your brain is already primed and so it triggers these areas of the brain to operate in much higher frequencies. You can actually see the graph go like this and the higher frequencies in that part of the brain. So, what happens is that if you have a psychological trauma, PTSD, something to that state, your brain is also primed to do the same thing. And there’s several mechanisms as to why. So, the first mechanism when you have a concussive trauma is obviously you have a physical concussion there, it messes with the brain chemistry, right? So that’s obvious. A psychological trauma, people tend to breathe a lot shallower, they don’t take deep breaths, they’re less active, they’re more fearful. So a lot of the things that increase sort of that nitric oxide bathing the brain just habitually because of the psychological trauma they’re not doing. 

They’re less likely to hang out with friends, less likely to go outside. They’re more likely to involve themselves in other habitual things, whether it’s alcohol or cigarettes or something like that. Or that they can develop addictions, higher propensity for addictions. So things like gambling, sex, pornography, et cetera, et cetera, and all these different things compound together, so over time, the brain chemistry looks so identical. It’s really hard to distinguish a concussive traumatic brain injury and PTSD. And so the idea here is I don’t wanna separate actual physical trauma and psychological trauma. We still wanna go down to the basics. Let’s make sure that your airway is nice and to make there’s no infections over here. Make sure you’re eating good quality food, that your gut is healed. And all the different aspects and the different pillars of our health still needs to be optimized, whether or not you have a concussive injury or some sort of psychological trauma. And honestly, a lot of people have both.

Heather Sandison, N.D.

I was just about to mention that. Especially victims of abuse, right? They are getting both sometimes physical trauma and psychological trauma at the same time. And then when you combine that with a developing brain, so child abuse, this is where it gets, I mean, it’s challenging for me to even talk about it. Women are more affected by dementia than men and I think this is part of it. They’re also the victims of domestic violence much more frequently than men are. And so it’s this perfect storm of stress and psychological trauma and physical trauma and even airway because sometimes part of it is asphyxiation or suffocation, at least in some cases, not all of course. But it’s really terrifying. And although a lot of research has been done on athletes and also combat veterans and stuff like that, that’s primarily men. And then when you add in, well, maybe there’s a hormonal component. What happens when there’s estrogen and progesterone in the brain? And does that impact how psychological trauma, physical trauma, might be affecting neuronal function? And so there’s a lot of nuance there and I really hope that there’s interest in pursuing that research because I think there’s also a lot we don’t know.

Cheng Ruan, M.D.

Right. And I do wanna make a comment on that. My job on this summit is to make this so simple that anybody can go through the medical path. So, one of the traumas we didn’t talk about is medical trauma. A lot of people with a history of abuse, with a history of concussive traumas, are made to feel that their symptoms are normal or they’re just aging, or they just need some antidepressants. And so, as they go through the medical system, there’s a lot less listening and a lot more prescribing. So a lot of people develop this multi-physician medical trauma and we can’t undermine that. So the medical system, unfortunately in the United States, can create that sort of trauma. It doesn’t matter what diagnosis you have. Especially brain diagnosis because there’s no machine that we know of that can specifically look at how the brain functions and put a number to it. So the outcome is not quite there. Well, there is one machine, it’s the one that we use, it’s called BrainView. So, if we can turn words into numbers, then we have a win-win. 

So for example, let’s say I have a patient that comes in and say, “Hey doc, I go into the room and I forget what I’m doing there. Or I misplaced my keys or I misplaced purse,” whatever it is. And so one of the things I always say is, “Hey, you know what? Let’s turn those words into numbers. Let’s look at your brain mapping and let’s see. Let’s see how you compare your brain to other people’s brains and let’s put a number to it.” And that number is what we call standard deviation in statistics. So this portion of the brain is this far away from normal. Well, this is easy to understand because we already do this in other types of medicine called osteoporosis. So we do bone densities. And the score is actually how far away you are from the normal population. We do the same thing with the brain. And so you can’t do that on MRI. You can’t do that on a CT. But there’s only very few modalities you can do that on. 

And so, what I like to do is really educate a lot of doctors that you can actually look at brain functionality from a qEEG or some other toys, if you will, that we have to look at it. And then, even though it doesn’t tell us what to prescribe, it validates the patient actually has these symptoms. And I can’t tell you how many times, ’cause all the symptoms listed on page two, page one is like their actual image, page two is all the symptoms. Patients will look at the symptoms, they start tearing up, and they start taking pictures of it, they send it to their spouses. Like, “Yeah, this is exactly what I’m feeling that’s on this page. I didn’t tell the machine that I’m feeling this, but the machine just by looking at the brain map tells me that I’m actually feeling this,” that’s what’s powerful about the newer age technology these days.

Heather Sandison, N.D.

Have to unwind that trauma from the medical system ’cause it’s like, “Finally somebody understands what I’m experiencing.” The other piece there is that I think doctors don’t fully appreciate that somebody who has some dementia, that’s part of why they can’t follow through. That’s why they’re not remembering to take their supplements or their medications or do these complex treatment plans at home. It’s not that they don’t want to, it’s that they don’t have the capacity. And so, understanding that and putting things in terms that they can either do it at a pace that works for them or they’re not doing too much, but kind of aligning all of that so they’re set up for success is part of treating the medical trauma.

Cheng Ruan, M.D.

Absolutely. And that’s why during the pandemic we built our online platform, is to teach patients that there’s actually a way to maneuver through this. It’s a lot more simplistic than most people actually think. ‘Cause right now I think we’re just bombarded with Instagram ads of, I won’t say the actual supplements, but there’s this for the brain, this for mood, this for X, Y, and Z. But there’s so much labeling there and complexity is the enemy of progress when it comes to brain disorders. And if someone is saying, “Hey, I can take all these different things.” Let’s say, and this happens all the time, patients come in and they have 15 different brain supplements that they’re on. “Doc, is this useful?” It’s like, “I don’t know, let’s look at your airway.” And so, checking that hierarchy allows us to check boxes and then the improvements can occur. But the one other thing that I really want to hit on that just really came into my mind, talking about medical trauma, is that I really want patient’s families and caregivers to know that sometimes whenever we work with patients and improve their memory, they get more depressed because they are now aware of their deficiencies. 

And the family will look from an external point of view and say, “Doc, he or she’s getting worse.” We call that pseudo dementia. So even though the patient’s actually getting better, they’re more aware, they’re more withdrawn. They’re probably talking less. They’re feeling of depression becomes sky high because before they may not be aware of their memory loss. Now they’re hyper aware and that’s actually a sign of improvement that we really have to pull them through and create that support structure to pull them through. And so, this is the hardest part of me talking to patients is because on the brain map, I can see that, “Hey, your brain activity actually looks better, but let’s not be put back that by the fact that your family member looks more demented or looks more depressed. It is because they’re now cognitively aware. So it’s creating those communications and creating hugs, if you will, for the patient that is tremendously important in that stage.”

Heather Sandison, N.D.

I’m so glad you mentioned that because I’ve something very similar clinically that people come in sort of blissfully unaware. “No, I’m good. It’s just normal aging. Everybody my age has that. I can’t remember a name or where I’m going.” And then as we start to unravel things, as we look at the labs, as we start to treat, they go, “Oh my gosh, everybody’s been helping me cope. And I really am declining.” And I think that that awareness becomes a little overwhelming. And so having that support set up and kind of anticipating that that’s gonna happen the way it sounds like you are, is really, really helpful. And it’s nice to see them kind of get up over the hump of that as well.

Cheng Ruan, M.D.

Just gotta pull them through, pull them through.

Heather Sandison, N.D.

Yeah. Just get them to the other end. So you keep talking about the airway. I’m really just curious what your thoughts are because I often tell people to use the Breathe Right strips or the mouth tape while we’re waiting on a sleep study. So those are $20 interventions you can buy them at the local pharmacy and start breathing better tonight. If sleep apnea is part of what you have or snoring is part of the issue. I’m just curious. Have you seen success with that? Do you recommend them? What comes up in your practice?

Cheng Ruan, M.D.

Absolutely. So let’s break it down into science for a second. And the best example are baboons. So, all mammals have some sort of paranasal sinuses, or basically they’re little holes here that activate sort of this nitric oxide. Baboons don’t have them. So baboons heart are naturally larger. Their blood pressure naturally higher because they don’t necessarily have the mechanisms to support that structure. And so, we know that the Breathe Right strips, they really help with the paranasal sinus areas that are right here, but it’s not long-term because what happens is if the body is already toxified, you’re gonna make more mucus. My mom’s Chinese medicine and acupuncturist so we call that phlegm. We call the upper airway phlegm. Phlegm in Chinese medicine in that energetics. So you’re gonna develop just more phlegm, even if you open up these airways. And so, on top of our Brain Train Master Workshop, we develop a secondary course called the Mind Sculpting Master Workshop. And this is to utilize breathing mechanisms like yoga breathing, autogenic, which is basically like a self-hypnosis to get your brain to a calm state to train you to breathe. And as research shows, the more you actually train yourself to breathe in this pattern, you’re able to change your brain chemistry and structures and able to increase your breathing patterns. 

So while people are waiting to either go to an ENT or sleep medicine doctor, something like that or their biological dentist, we walk them through a coaching program. And this coaching program really focuses on how to breathe. There’s people listening is like, “Oh, I know how to breathe.” No, you probably don’t. I didn’t know how to breathe until I got coached on it by my coach. And in fact, and if you actually watch me talk, a lot of my shoulders are up here because I’ve been a mouth breather for most of my life as I have sleep apnea so my scalenes are shorter right here so I’m actually already prone to doing this. And the more I talk, the more short of breath I get. And so, the actual breathing, pausing, these mechanisms, really affect our day-to-day mental health and stuff like that as well. And so we wanted to create this other workshop to really cater towards the population. Okay, what can I do right now, myself, to improve my breathing process as we get some of this other medical stuff figured out?

Heather Sandison, N.D.

Got it. So can you take us through even just a little snippet of how to breathe a little better?

Cheng Ruan, M.D.

Yeah. So I’m not the best on this. My health coaches actually do this. So the easiest thing that we start working with is we start with the intention. And I’m a mindset guy. So, if you come to my office and you wanna know, “Hey, I wanna know about my brain or X, Y, and Z.” My daughter will tell you that my favorite letter in the alphabet is Y, so why do you wanna know that? And so, from a mindset perspective, we all go through these medical diagnoses for specific reasons. And so, 10 people can come in with memory loss issues for 10 different reasons. One of them is like, “Hey, I wanna see my grandchildren walk down the aisle.” Another one is, “I feel like my relationships are in jeopardy because of my memory. I think there’s something wrong with me.” Another one may be, “People are telling me I’m becoming more forgetful. And because my parents both have dementia, I don’t want that to happen.” So everyone has a different why. So part of the mind sculpting is that you have to own your why, so you know what outcome you want to achieve. So that part actually starts before the whole breathing thing. And so let’s, for example, say, “Hey, I wanna walk my granddaughter down the aisle in 2024. 

And I wanna retain my memory.” Then guess what’s gonna happen the next visit? The granddaughter’s gonna be part of that visit or part of the equation that we actually talk about it so they can focus on their why and create these structures to improve the outcome. So this is basically what I like to call identity-based medicine. Most medicine is outcome-based medicine, like dementia or cholesterol or heart disease. This is identity-based medicine. So, because you want to connect with your granddaughter, walk your granddaughter down the aisle, therefore this is the outcome here. This is your specific outcome. Now, we can give you the tools to improve that. Here’s some box breathing. Inhale through your nose for four seconds, hold for four seconds, exhale for four seconds, and et cetera, et cetera. And here’s some other techniques that we can use with the specific end outcome of watching your granddaughter walk down the aisle. So whenever we shifted our technique of practicing medicine, into more identity-based medicine, then everyone has a very special story that they’re actually falling into that makes practicing medicine just a whole lot more fun as well.

Heather Sandison, N.D.

Wow. That does sound like fun. Yeah, I’m just thinking of a couple of patients that I’ve had recently. And one of them, she couldn’t have a memory issue when she moved into senior living. And her cousins, she has no siblings, no kids, but her cousins were living in the senior living community, and she really wanted to be with them. But she couldn’t have any dementia. She couldn’t have that diagnosis. And so sure enough, she was able to reverse her dementia, and then she was eligible to live in that community with her cousins. Well, sure enough she got so much better. It was really amazing, but she got so much better. She’s like, “I don’t wanna live in senior living anymore. I’m gonna stay out here and maintain my independence.” She was able to get back to her work and she was able to clean. It just didn’t feel as overwhelming to take care of her own home and cook for herself and do all of these other things. And it was really just so inspiring for me to see that she had sort of this rebirth. She had this idea of what was motivating her at the beginning and then even that transformed as she went through the process.

Cheng Ruan, M.D.

Right. Absolutely. And guess what? If I talk to a bunch of people with dementia, they all exhibit very similar things. So now I’m getting into the moderate to severe dementia phase, right? Where it’s progressively on. So, talking with dementia patients can be tough if you don’t know what to look for. And so this is why I wanna teach the family members that are going through this as well. So one of my favorite things to do is I like to teach the family members how to communicate with their family with dementia. And so, let’s say that it’s my grandmother that has dementia and I’m the family member. So a lot of times what I do is I try to make my grandma a normal part of society, bring her on birthday parties, have her experience different things, take her to the beach. Just a humanistic aspect of it. But what happens when my grandmother does not remember me? It makes me feel very devalued on the actual inside. So, one of my favorite things to do is that it’s not that she doesn’t remember you, it’s that she just transcended time and she’s in another year right now. 

And that year you may not have been even born. So instead of trying to get her to remember you, talk to her and say, “Where are you? What time are you in? What year is it?” And you go into there with her, now you’re part of her journey. When you’re part of her journey, she’s able to express to you in significant amount of detail what happened during that year. And we see these people in war-torn countries and stuff like that. So they’re able to be extremely detailed in what happened in 1972 or something like that. And so, what happens is now you or me, I get to connect with my grandma back in time. This is a superpower that I now have with my grandma that I could have never done this without her having this quote unquote dementia. 

And because I’m able to explore that with her, I know what her underlying physiology, when it comes to the brain and thinking about that is, and then you can slowly bring her back into 2022 or whatever year you’re actually watching this and say, “Hey, this is actually 2022 and I was born in 1983 and this is what actually happened,” and believe it or not, this is how you can fish people back into your reality, if you respect their reality. And I’m able to watch this happen on several different occasions. And it’s just really incredible that we don’t want to view dementia as a diagnosis. we just want to view this as something occurred where their brain is in a specific time and we have to honor that and let’s go to the time with the person rather than trying to always put them in part of the social norm. And I think that’s really important for a lot of family members to understand.

Heather Sandison, N.D.

That’s such an amazing practical tip about how to engage and approach someone. And I think one of the big pieces that you mentioned that I wanna just really drive home is how it affects us personally, when we’re talking to somebody who doesn’t remember us. And that you have to put that aside and really say, “This isn’t about me, this isn’t personal. It really is their disease process.” And having some compassion, showing up with that compassion, and really, like you’re saying, becoming present, meeting them where they are and not being attached to them being where we are, even though that’s of course a healthy brain would do that. But setting that judgment aside and saying, “All right, I’m gonna meet you there and be with you there and even get a bunch of value out of it because I get to hear these amazing stories from a lifetime ago.” How neat? And really just insightful. Thank you for sharing that.

Cheng Ruan, M.D.

Yeah, yeah. And the reason I share that is because I like to play this game with people. What if the opposite was true? And instead of seeing this person as demented, what if the they’re super cognitively aware in a specific time period and they’re in an alternate reality? So just step into the reality with them, explore what that’s like. The first time I experienced this was with a 92 year old gentleman. At the time I was 12 years old and it was my friend’s great-grand father. And my friends like to avoid grandpa, ’cause grandpa doesn’t really know what’s going on and who’s around. And I just sat there and listened to him tell me war stories and I was just enamored at the fact that I’m able to get all this information and my brain is actually with his brain. And I’m just asking about different guns and what does the smell of gun powder feel like? How does it really feel to kill somebody? And this person, who’s supposedly super demented, can recall with the greatest detail what’s going on. 

And after that experience, I’m like, “This is kind of cool.” So I started going to Sheltering Arms, which is the memory care unit here in Houston. And it’s right next to my middle school, like walking to distance. So I would go there, I would volunteer there. I would just listen to these stories and I just had a ball because I’m very much a big nerd and historian. And so I’m listening to these people and getting so much value from it, so when I became a doctor I’m like, “Man, this is actually fun. Let’s go back to my childhood. Let’s talk to these patients and meet them where they are.” And as it turns out what I experienced when I was 12 years old, I’m still experiencing. And I’m 38 now, so still the same as I’m 38 years old. And I just find that to be super valuable. And I was like, “Hey, you know what? This person has super powers. Let’s harness that.”

Heather Sandison, N.D.

So much of what I do at at my clinic and then also at Marama and then just in my work collaborating with Dr. Bredesen to reverse dementia and prevent dementia, is about exactly what you’re speaking to. It’s how do we make sure that our elders have value and wisdom that they’re contributing to society today? And you’re making that happen with or without dementia. And it would be so incredible, like you said, just to pull them back into the fold of society in whatever way works. I mean, that’s so healthy for anyone, right? How are we contributing? How are we showing up? How can they be an asset versus a liability?

Cheng Ruan, M.D.

Absolutely. And this is exactly the reason why I developed Texas Center for Lifestyle Medicine. Is to serve this Medicare community. I’m functional medicine trained, but at the same time, I know a lot of it’s not necessarily accessible, but when it gets down to the root of it, a lot of this is based on communication and based on the allocation of resources. So by becoming resourceful, pulling in the ENTs, pulling the dentist, pulling in the myofunctional therapist that work on the tongue positioning, pull in the pediatrics that focus on tongue tie and ADHD and stuff like that. If we can all coexist in this world, it’s actually pretty easy to navigate once the guidance is there.

Heather Sandison, N.D.

There, what you’ve put together is just really, really valuable and so creative. You’re creating this unique opportunity for people to get through something that feels kind of overwhelming and complicated in a very simple way and get as much insurance coverage for it as possible to make it more accessible to more people. I’m really grateful and impressed by what you’re up to and I wanna make sure that people know how to find out more about you. And also, are you taking new patients?

Cheng Ruan, M.D.

Yeah, we are. Obviously, since we started doing this, the demand has really outweighed the supply. So we’re definitely working on growing the team quite a bit. But for people who just wanna hear me talk more, I ramble on a lot at TCLM University. So it’s www.tclmuniversity.com, which stands for Texas Center for Lifestyle Medicine. And you’ll see my big smiling face there and then we’ll have so many different modules that are there. So I have one on autoimmune, gut health, and every aspect that we can think of. And then there’s three specifically on mind and brain. And accessing those, you’ll see exactly what the values are. And even if you don’t see us as practitioners, you don’t necessarily have to once you know sort of how to navigate the healthcare system.

Heather Sandison, N.D.

That’s incredible. Thank you so much for sharing your time and expertise with us today. I know that so many of our listeners are gonna get a ton out of this. And it’s just a delight to be on this path with you supporting patients. So thank you for showing up.

Cheng Ruan, M.D.

Yeah, my pleasure. Thanks for having me on, appreciate your time.