Discover The Key To Fighting Alzheimer’s With Fasting

Joshua Helman, MD

Heather, it’s fun to be here.

Heather Sandison, ND

We got a chance to meet each other in person. That was so fun at a conference recently, and I was just so impressed by your background. Again, it’s just so unique, and no one has quite your skill set or everyone’s is unique. But when I heard about yours, I was just like, I could talk to you for hours and learn from what you’ve seen with your patients. Could you just tell us a little bit more about the different places you’ve worked and what you’ve done there?

Joshua Helman, MD

But what’s important for people to understand is that I started very traditional. I got two degrees in biochemistry. I started in general surgery, switched to emergency medicine, and went through the full residency training. Then I’m licensed in 14 states. I worked all around the country. I’ve seen acute medicine, and I’ve seen chronic diseases and how we try to manage them in emergency rooms and how they’ll use emergency rooms for second, third, and fourth opinions on these chronic diseases that don’t have one quick fix in most cases. 

Heather Sandison, ND

Then, and what was that transition like going from conventional medicine towards, you’ve been at a water fasting clinic, which is pretty extreme by anyone’s measuring stick. How did that transition happen?

Joshua Helman, MD

It’s funny from my perspective now; it’s natural. It’s something that our ancestors, hundreds and thousands of years ago, had to do because, most of the time, food wasn’t plentiful every season and every month. But for me, the motivation a dozen years ago was some personal medical issues. Specifically, I was 50 pounds overweight, and I had high blood pressure, and I couldn’t figure out how to fix these problems, even though I had all this traditional training. That’s how I went into the alternative world. But frankly, integrative. I’m still writing prescriptions. I’m still a fan of traditional medicine. But when it comes to chronic diseases that may have ten, 20, 30, or 100 different underlying root causes, I’ve learned you can’t eliminate any possibility.

Heather Sandison, ND

We’re all fans of the emergency room when it’s needed. If I have had a car accident, please take me straight to the emergency room. There is no question about that. There’s a place where conventional medicine shines, and it’s certainly where you were in the emergency room. It does. Although the story you hear from so many of my friends who are in that conventional M.D. role of burnout is that it’s unhealthy. You can show up in these long shifts, especially through residency, you’re sleep-deprived, and then you’re trying to make life-or-death decisions for other people and care for other people. You might go in with this ideal mindset about helping others and maybe getting that schedule where you don’t have to take a lot home with you as an ER doctor, but then people end up burnt out. It was that part of your journey.

Joshua Helman, MD

Part of it is that some people have to work the midnight shift just because people have emergencies in the middle of the night. We know now, or I didn’t know 30 years ago when I started all this, that shift work was awful for brain function. But we certainly know that now. That’s one thing that adds stress. Another is that I love hospitals as institutions, but often they’re very authority-driven. For someone like myself who’s creative and wants to pull in treatments from lots of different approaches, I would ruffle some feathers sometimes because I didn’t necessarily want to prescribe the first and follow guidelines rigidly when not every patient is going to follow the guidelines. A patient might not have just one condition. They might have five. You have to balance everything together.

Heather Sandison, ND

Treating the individual instead of just going back to the algorithm. you were on your journey. You had to be Hippocrates. Then, at True North, what were the biggest takeaways from your experiences at those places?

Joshua Helman, MD

I would say that in both of those places, I would see that daily, people get better from chronic conditions. In the case of the Hippocrates, it was eating a raw vegan diet. In the case of True North, it was eating plants in addition to water fasting or, in some cases, juice fasting for between a week and 40 days. One of my takeaways from that was that it wasn’t necessarily the fact that they were eating plants as much as what they weren’t doing. If someone is water fasting, they’re not putting things into their mouth that are pro-inflammatory, and added salt, oil, and sugar can wreak havoc metabolically. I wish that conventional physicians could see this because if they could see people who had had chronic conditions for decades, just within the course of one to three weeks, many times these things go away. 

We talk about the reverse of these chronic diseases when you never see it in conventional medical treatment. And that’s why, from this perspective, having treated thousands of patients that way, it’s natural to consider those things. But you’re going back a dozen years before I had that journey. I can see from that lens that it’s different, it’s an alternative. I’ve talked to some of my classmates from Harvard Medical School, and they’re like, You fast. That’s so dramatic. I’m like, I guess, to me, it’s natural because that’s the way it works.

Heather Sandison, ND

The standard American diet is pretty dramatic. If we talk about what’s dramatic, especially if we compare it to what our ancestors were eating—a fasting-mimicking diet, a fasting diet, or a vegan diet—that is much less extreme than Cheetos.

Joshua Helman, MD

100%. The takeaway is that processed foods are not good for you. But, back to not only what I was taught at Harvard Medical School, but what I saw in the cafeterias. the food normally is most of it highly processed.  I remember talking to a Harvard dietitian 30 years ago, and she said that every morning as part of her class, she would learn how to bake muffins and other cooked goods. I think this is ludicrous that we put such an emphasis on them, and I understand those foods are addictive. I was certainly addicted to them as an intern and a resident going through this, traditional medicine. 

But if people are willing to take a step back, and in my journey, it didn’t happen overnight; it took me years to cut out some of these addictive things. But I’m so glad that I did. I have patients who, when they have a diagnosis, whether it’s cancer or Alzheimer’s or whatever it is, want to make changes quickly. But for some people, like myself, it had to be a gradual approach. and everyone’s different, and I certainly have empathy because, for me, it was hard to make all these changes all at once.

Heather Sandison, ND

Tell me where you landed on the best diet for you and why.

Joshua Helman, MD

For me personally, I like a mainly raw diet: raw plants, fruits, vegetables, and some whole grains. I try to avoid adding salt, oil, and sugar. I’m not perfect, but from the studies, those things—those three substances—sure, they’re highly addictive, but they will promote early aging. One of the mechanisms is that they lead to blood vessel destruction through the endothelium, through the very fine, very small blood vessels. and that’s one of the origins because you’re as healthy as your blood vessels are.

Heather Sandison, ND

This is the reverse Alzheimer’s summit. You’ve been talking about reversing chronic disease. That’s one of them, and particularly a complex one with devastating consequences. What are some of the takeaways you have? You have worked specifically in the Alzheimer’s space, and after leaving, you were at a clinic that was very focused on neurodegenerative disease. What were your takeaways in terms of fasting and diet as it pertains to brain health?

Joshua Helman, MD

It’s interesting fasting itself, I found them like when I did a water fast and when I met one of my patients doing them. Fasting was associated with lower energy. For me, I couldn’t work. Now some people can work when they fast. Having said that, the real magic of fasting, I believe, happens when you stop fasting and start refeeding, and it’s in that process that you’ve gotten all these toxins and other bad actors out of your body, and when you start refeeding, that stimulates the production of your stem cells, including stem cells in your brain. That itself leads to better cognition and better brain function.

Heather Sandison, ND

With fasting, is there something that you recommend in terms of getting support for that rate? I’m sure some people are listening to this and going—that’s extreme. There’s no way I’m going to starve myself. That sounds like an eating disorder. then there are other people going; how do I even get started? What would that look like? Is it intermittent fasting, like the gateway drug here? Or do you recommend a 40-day fast right out of the gate? How do people get into this?

Joshua Helman, MD

The first thing is to understand that there is no one right way to fast, just like there’s no one right way to exercise. What’s cool about biochemistry is that the biochemical changes when you fast are almost identical to those when you exercise. and I don’t recommend people exercise and fast at the same time, just to be clear, because that leads to muscle breakdown, which most people do not want. In terms of the ideal way to fast, I would say if, to me, the purest way to fast is water fasting, just drink water. Whether that’s for three days, a week, or 40 days,  I would recommend that if you’re doing them for more than two or three days, do it under medical supervision, just because even some of the healthiest people I’ve seen will get reactions from water fasting. at least at True North, you’re monitored twice a day. 

You’ve got people rounding on you. It’s a safe environment. Now there are some doctors doing fasting via telemedicine. You can seek that out but don’t think that you have to start there. intermittent fasting or specifically just choosing a feeding window, whether that’s skipping breakfast every day or maybe only eating from noon until 8 p.m. or whatever time zone works for you, or maybe only eating one meal a day, but what I found is that the more you fast, the easier it gets. Just with exercise, if you’re not exercising at all, just walking around the block is going to be amazing enough. For you, that is going to be perfect. then once around the block, it can go twice or three times around the block. What I would say is to seek out an expert if you want to fast. But you don’t need an expert to start. Just start skipping breakfast.

Heather Sandison, ND

With Alzheimer’s specifically, we know that toxins play a role in fasting, and as you mentioned, it’s a way to not put some toxins in. Can you just take the threads through that alignment and tell us what’s going on—their diet, toxicity, and Alzheimer’s—and how they all connect?

Joshua Helman, MD

One of the things that happen if and when you water fast or take some of these other fasts—fasting-mimicking diet—is that you’ve got choices when you do these things. You’re correct. You’re not putting toxins in your mouth. But the other exciting thing is that, at least with some of these fasts, as you become a ketotic, guess what? If you’re only drinking water for a few days, your body by definition is going to need calories, and it’s going to get them by creating ketone bodies, and it’s going to get some of those from the visceral fat cells in your body. 

I showed it to myself when I water fast, and we replicated that at True North with some other patients by doing DEXA scans and looking at and watching the visceral fat, which is a type of highly inflammatory fat that surrounds organs like your liver, kidney, and heart. It’s normally not a good thing to have, but it’s the most metabolically active fat, which is why your body will go after it first. It’s a win. But as it’s going after this visceral fat, there are many fat-based toxins, whether they’re PCBs, forever chemicals, or similar types of fatty toxins, that will get mobilized in this process of the body using the visceral fat cells. Just in the process of fasting, your toxin level will gradually go down in time while you’re fasting.

Heather Sandison, ND

That’s great. Then toxicity and inflammation, how did those interact with or relate to each other?

Joshua Helman, MD

There are so many of these toxins whether it’s DDT, PCBs, or BPA.

Heather Sandison, ND

Maybe you will be exposed to these different things.

Joshua Helman, MD

It’s sad. It’s now in the rainwater. I grew up in Los Angeles, and now that DDT was used, it was produced in Los Angeles and then ended up getting dumped in the water between Los Angeles and Catalina Island. I grew up, went to the ocean, and, was exposed to some of those toxins there. But it’s also in the food chain, which is one of the reasons I recommend people eat mainly plants, because the higher up you eat in the food chain, you’re going to get a much higher dose of these toxins. and studies have shown that vegans will have about ten times lower levels of these toxins because they’re eating lower on the food chain.

Heather Sandison, ND

It sounds like it’s almost impossible to completely avoid them. But if we can make choices to reduce exposure and then keep, I’m sure it’s like part of it is about just keeping things flowing. Like using our bodies to detoxify where we can. Then we’ll keep the inflammation down.

Joshua Helman, MD

That’s part of it. 

Heather Sandison, ND

Do you have any other recommendations for detox other than dietary changes?

Joshua Helman, MD

Some other approaches that I’ve seen work are colonics, where you’re irrigating the colon with water. That’s one approach. Another thing we talked about is exercising. When you exercise you sweat and mobilize toxins, the same thing if you want to do it’s in a sauna. That’s another way to mobilize sweat, which is one of these ways to move out toxins. Another thing for lowering inflammation levels is going to be getting adequate sleep, like we talked about, too. Those are some simple, simple ways, simple approaches.

Heather Sandison, ND

To get toxins out of the brain. Sleeping is so important for that.

Joshua Helman, MD

There are supplements that I like glutathione is the body’s master detoxifier, or if you’re taking lipophilic glutathione, that’s one approach. there are many different ways to try to minimize your exposure. But one thing that I don’t think people understand is that when you talk about PCBs and these fatty toxins and forever chemicals, they can have a half-life in your body of like 30 years. We’re not talking just about your exposures today. We’re talking about some of the exposures that you may have had in utero, while breastfeeding, or from a very early age. It’s not just what you’re doing today, even though doing what you’re doing today is important. But I’ve seen people with mold toxicity, the mold fatty toxins that they were exposed to as little kids.

Heather Sandison, ND

They can persist. Then, from your experience with Alzheimer’s, how much of a role does infection play in the neurodegenerative process?

Joshua Helman, MD

It’s common, and not every case is going to have the same infections. But it seems to be a common theme among the patients I’ve treated. and some studies have shown that exposure to spirochetes, including Lyme, the Lyme spirochetes, and syphilis, are two famous ones, are associated with a ten times higher risk of Alzheimer’s. It’s a real deal, but it’s not just the spiral that keeps bacteria. There are also viruses like HSV herpes simplex virus number one. There are also parasites. Many of these parasites, within the parasite itself, can store viruses and bacteria. What seemed to be a common theme was that infection, in many cases, is a factor. But the key thing is that people are listening to this and saying, “I’ve got to treat my infections.” You may, but you have to do it carefully. What I found the best order to do is to detoxify first because as soon as you start talking about killing bugs in your body, that normally will mobilize lots of toxins in other sub-infections that have been brewing, often for ten, 20, or 30 years.

Heather Sandison, ND

When you look ahead ten, 20, or 30 years, what do you see as the future of either the diagnosis, the understanding, or especially the treatment of dementia?

Joshua Helman, MD

It will be 10, 20, or 30 years. People will start to appreciate what you and I both realize: that the root causes are so many that you could easily have 30, 40, or even 100 different root causes. People will start getting more comfortable with not only identifying or diagnosing 30 causes but also figuring out how to treat and coordinate the treatment. This is a complicated, complex disease. In many cases, it’s not going to be one magic drug or one magic lifestyle change that you have to layer on top of. You have to stack them up. and people will start to understand that, just like we understand that, if you’re trying to fix your car,  unlike 40 years ago, things were pretty simple. But if you’re trying to fix your car today, you need to analyze the computer, etc.   We’re going to start having artificial intelligence and machine learning and be able to analyze each individual person. And like here are 50 causes, and these are the top three things that you should start worrying about.

Heather Sandison, ND

That’s an exciting future to look forward to. Hopefully, technology will save us right now and not the opposite. Dr. Josh, I want people to understand where they can find out more about you.

Joshua Helman, MD

Probably the easiest way is that it’s going to be through my website, which is just drjosh.com  DRJOSH dot com.  My email address is drjosh, DRJOSH @drjosh, DRJOSH dot com. Then I’m on all the social media, including TikTok, where I’m Doctor, @DOCTORJOSHMD is on TikTok, but I’m on other social media, and I love that as a framework to get the message out to as many people as possible.

Heather Sandison, ND

Thank you. That is so generous of you to share your email address and to be so accessible. You have collected a wealth of experience and, information as well. that so many of your patients benefit from. thank you for doing the work that you do. Is there anything else you want to share with the audience?

Joshua Helman, MD

This isn’t going to be aired immediately, but I’m excited. There’s a brand new immune modulation treatment that I’m getting set up to offer. It’s called TB006.  It goes after one factor in inflammation, or at least the early results that we’re seeing are amazing in terms of not only reversing Alzheimer’s but not causing the brain swelling and bleeding that we’re seeing with other treatments. This is available intravenously and I also recommend layering this on with the other traditional supplements and lifestyle changes. getting.

Heather Sandison, ND

Rid of what caused the inflammation in the first place.

Joshua Helman, MD

Is exactly getting after the root causes.

Heather Sandison, ND

We learned about TB006. You went much more in-depth than I did, but we both saw this at the conference we were at and were like, Is this the thing? Is this that IV that might make so many people better, that might reduce the suffering and the costs, expenses, and heartbreak associated with dementia? That is an exciting look toward the future. Will you explain a little bit about how the people can have access to that research because they would be study subjects in a clinical trial? Right now, they’re looking at the safety of it. There’s quite a bit of data, but they’re doing the FDA, checking their boxes, and going through the FDA process to get enough safety data to then go into a phase three trial.

Joshua Helman, MD

That’s exactly correct. It’s been approved for compassionate use by the FDA because the data have looked so good that they’re like, No, you don’t have to wait six years until this is a final approval. We want to get this out to the general public, but we also want to make sure that what we’ve seen so far doesn’t have any serious side effects. We want to make sure that that continues.

Heather Sandison, ND

That’s such an incredible option for people. exciting stuff. Thank you for being one of those who are making it available. Dr. Josh, it’s such a privilege to be here with you. Thank you for joining us.

Joshua Helman, MD

Likewise. And Heather, thank you for what you do. Let’s do this again. 

Heather Sandison, ND

I’d love it.