Skeptic’s View: Evolving Past Alzheimer’s

Nate Bergman, DO

Oh, thanks for having us again.

Heather Sandison, N.D.

So you’re still seeing patients at Kemper Cognitive Wellness right now and what are kind of the most critical pieces if someone comes to you with cognitive decline, if they’re looking to improve, which I hope they are, if they show up in your office, what are some of the biggest pieces that work most consistently for the most people?

Nate Bergman, DO

Yeah, so it’s a good question. Yeah, for sure, we still see patients. I mean, we’re always seeing patients, I hope, you know, I think as soon as people, as soon as a clinician stop seeing patients, that’s when they have all the answers. You know, they don’t have the humility of working with real human beings with real problems, right? It’s all theoretical at that point. Yeah, so Kemper Cognitive Wellness in Rocky River, Ohio, which is greater Cleveland, Ohio, yeah, in general, I call this kind of the summary of knowns and this is a … I would say this is sort of an amalgam of peer review and then I would say observations from people like myself, people like yourself, you know, just working with, you know, I have organized a fairly large group of clinicians at this point where we do online meetings and online conferences about what’s working for people and so this is sort of a summary of some of those things, right? Many of those elements in general, right? And we go and we try to follow an evidence pyramid starting with things that are most evidence based and evidence informed and kind of working our way into things that are more esoteric and functional medicine and kind of alternative or integrative medicine space. Actually, I know you’ve had other guests speak about. So I would say the first, really the first and maybe I’m not gonna say it’s the most important, but it’s to act early, right? The earlier things are known, the earlier symptoms are attended to, typically the better and more spectacular the results, right? Like you’re getting things cleaned up, but I would say in our experience, we meet a lot of people that are kind of further along, so people that are losing with Alzheimer’s, that are losing their ability to stay independent. 

They might not be able to drive. They might not be able to remember take medications and certainly, you know, the further on down all the way ’till needing nursing home placement or hospice in some cases and so I think most importantly engagement, so purpose, right? When it comes to these kinds of programs that so many of us are are working with functional medicine principles, lifestyle principles to start, it really requires from a patient or, you know, a family that’s coming to see us, why are we doing this? What is the purpose? What is their purpose? And sometimes I would say one of the things that we’ve learned really probably in the last year, year and a half, even since the last time we talked, you and I have talked, Heather, is it is possible through the same kind of paradigm as iterative change happens, it’s possible to take people from a lack of sense of belief that they can do anything about this, to that they can, and then sometimes that infuses purpose, right? So for example, we’re working with a woman that we started working with last summer about around July 2021. When we saw her, she was just getting a diagnosis of a neurodegenerative disease. It wasn’t Alzheimer’s, but it was kind of similar, and she worked with us for six months and then she joined a program that we have called Brain Fit, which is, you know, a couple hours of different kinds of mental and physical exercise and technologies and things and she’s worked really steadily and when we started with her last summer, we said, hey, let’s call her Mary, we said, “hey, Mary, what’s your goal?” And she didn’t really have a goal. 

She was living alone, still fairly young, but was really kind of scared. Daughters were scared to lose independence, but we have … What is it that someone is doing this work for, right? Obviously, and, you know, some people show up to work ’cause they need a paycheck. For this group of people, I don’t have to tell you, but, you know, for our listeners and people that are watching this, it’s like, if someone doesn’t have a reason and it may be inherent, I just, I wanna always get better. I wanna have, you know, better brain function, but why? And getting into that, we’re spending more and more time kind of digging into that because that is one of, I would say, one of the secret ingredients or secret sauces of getting people kind of activated, moving, and over time, the more that we kind of work with this, it seems that I think the thing that’s surprising is that sometimes people will surprise us. People that don’t really have a clear purpose like Mary, we said, hey, she wants to go on a trip to Europe, to Germany, that was really her goal, and in two, I think in four weeks, she’s headed out, right? She’s improved. Her cognitive scores have improved remarkably. Just her physical self, her ability to feel confident, independent has changed significantly, and, you know, and the scores that we measure on her are improved. So it’s like, those are the kinds of things that the more she kind of sunk in and said, I wanna do this, I wanna get up for this, I wanna, you know … So she’s going with a group of friends to Europe, Germany amongst them, and, you know, those are exciting things. 

Those are the things that I’d say that’s the first thing in terms of what we think we know. Another one seems to be that for many people, but not all, and that’s an interesting maybe conversation, side conversation, like a key sort of rescuing brain energy with some trend or period of time in ketosis or a ketogenic diet, whether it’s nutritional ketosis or people using some kind of powder or pill or liquid outside of just regular food, just food kind of supplements, or exogenous ketones to get people into ketosis, to sort of rescue brain energy. Interesting, we’ve had, and I’m curious to hear what other people are seeing as well, we’ve had some kind of quick results with those for some people, especially if they’re coming from a place of maybe a suboptimal diet, the standard American diet, for sure, but even sometimes people that are kind of eating vegan or, you know, high kind of a high vegetable, low protein, lower fat diet, you can get some pretty quick results. I’m believing right now that the mechanism might be probably neuro-inflammation; can’t say for sure, kind of depends on the choices of the ketogenic diet, but it’s interesting to see people getting results in like two to four weeks where they’re really kind of noticing a difference with cognition. So that’s, you know, it’s to some people kind of old news. I think what’s interesting is to see then how long do you continue that out? Do you drop people into ketosis every once in a while? Like we’re working with one guy who had also had a nice result in his eighties, diagnosed with the pre-Alzheimer’s and now sort of has shifted into an Alzheimer’s diagnosis, classic, you know, short term memory loss, and, you know, it’s the parts of his brain on his brain scans are small. They’re sort of classic for, you know, traditional Alzheimer’s disease and did a period of ketogenic diet, flipped out of it, now is kind of shifting back into it. 

So, you know, it’s not like a lifelong commitment, ketogenic diet, so it’s interesting that, you know, to see people sort of pop in, pop out and that sometimes people lose track of that. It’s easy to lose track of ’cause it’s a hard thing. Anybody’s tried a ketogenic diet, it’s a hard thing to sustain but you can get, you know, kind of a fast result and that’s really neat. Exercising with intensity, so that really is a sweet spot. You’ll see, you probably know, every once in a while, it seems like every couple years British Medical Journal and there was another one, the end of 2021, beginning of 2022, there will be an article saying that too much intensity of exercise does not seem to help people or makes people with dementia worse, particularly Alzheimer’s dementia, but some of these, the British Medical Journal almost probably four or five years ago, wasn’t specific as to what kind … This is like all cause dementia. It’s hard to know. So it does seem though that a couple days a week of something that’s more intense than someone’s usual, so getting heart rate up, working muscles a little bit harder, and that’s gonna look different for everyone, obviously. That’s a recipe for success, but it is also possible just like with Alzheimer’s, just like sort of everything else, to kind of overtrain and so that’s just one of those ones that just for someone who’s kind of further along on that Alzheimer’s journey, maybe they have a later, you know, they’re in mild cognitive impairment, Alzheimer’s kind or sort of a true Alzheimer’s dementia where they’ve already maybe lost some ability to be independent, figuring out how much, you know, and how intense … It’s easy to say exercise with intensity nearly every day. 

I don’t think that’s gonna be … That’s not the sweet spot for every single person, right? There are other aspects in other areas of the body and brain that need to be trained and I think you had a couple people talk about that as well on the summit. Next, the next one’s obvious, but needs to be attended to because it’s kind of rising up, so one A and one B in terms of evidence within Alzheimer’s disease is fixing sleep issues, right? And that might be starting with something like insomnia or sleep apnea. So we’re super aggressive looking for those issues, treating those issues, you know, sleep cycle. Sleep sort of circadian rhythm disorders are common in the population and that’s of course still kind of chicken and egg question. Is it Alzheimer’s that causes the circadian rhythm disruption or is it circadian rhythm dysfunction that’s portends Alzheimer’s? You know, I think the truth is probably gonna be somewhere in between if there’s the anti-symbiotic relationship between the two of them. So pushing really hard because sometimes when you fix sleep just by itself, there’s a pickup in cognition just as a sort of a mono intervention or that’s the only thing people do. 

Dental issues, which I know you’re talking about as well, dental issues and sort of inflammation in the mouth, periodontal disease is another thing that makes a big difference and then think everything else, you know, technologies, hormones, detoxification, infections, things like that, immune system function, all of those things are sort of, I would say, secondary to the kind of the big ones. The one I’m most curious about with the kind of least data and I dunno if you have any good speakers or new notes yourself on this one is sort of the toxin bucket ’cause that’s one that’s hard … All these things are hard to quantify. They’re functional medicines, not rabbit holes, but there’s, I mean, there’s definitely big time links that are accepted, you know, all the way through American Academy of Neurology, just no one knows how to measure these things in a consistent way and no one really truly knows, in my opinion at least, what to do about them. I think we have all of us have sort of strategies about what we think is probably the best thing, but I don’t know if you’ve ever seen, I’ve certainly seen a couple cases where people got worse cognitively with detoxification. So it’s one of those, like, proceed with caution, or at least be working with someone who has some experience taking this journey with other people that have the same kind of diagnosis. That makes sense?

Heather Sandison, N.D.

Yeah, absolutely. That’s a great rundown, very efficient. I feel like that should be the required reading or the required listening for everybody starting off this summit because that was a great, just like, snapshot into everything that we are discussing this week, so thank you. You know, let’s get into one of the other big pieces: this skepticism around the term reversal with dementia. So when I think of it, you know, this doesn’t necessarily mean cure. There are people with severe dementia who will never go back to work, however, I have also same miracles happen where we see people with severe disease get a little bit better and that improves their quality of life. I’ve also seen people with, like you mentioned, earlier on in the severity of the disease and the progression of the disease, and they tend to be younger in their fifties and sixties and in six months, I mean, they have no more cognitive issues. It can be miraculous and really worthwhile and yet, there are also people who still say there’s no such thing as reversal and we certainly have people sign up who do not get better and some that get worse, right? Continue to progress and get worse and so there’s a mixed bag of responses. Where do you perceive the skepticism around the word reversal and Alzheimer’s comes from?

Nate Bergman, DO

Yeah, I mean, so my vantage point was kind of formed and fashioned in an iron sharpens iron kind of an environment like at the Cleveland Clinic and there you couldn’t, you know, you couldn’t just make a claim. You had to come with some kind of graded evidence and that’s, you know, I think that’s a good thing in general for all of us human beings, but we call ’em patients, but I think it’s a good thing for the patient community because there are a lot of people out there that seem to be able to claim a lot of kinds of evidence and even people, you know, five, six years ago were co-opting somebody like Dale Bredesen’s work who had written a paper in 2014 Reversal of Cognitive Decline. That was sort of what started him and started a lot of us and certainly for me, that was really what made me pay attention to, wow we can take a very kind of precise dive into a lot of things, a lot of areas, that kind of drive Alzheimer’s disease and that was early on. I mean, it was like a medical hypothesis paper where he had 10 people that improved, right? Basically following these principles and I, you know, shortly thereafter you’re getting emails from people saying, did you know that Dr. Dale Bredesen has proven that you can reverse Alzheimer’s? It was just like one of these things that got carried away too quickly and so what happens in a place like Cleveland clinic and I, you know, talked to, you know, called ’em serious scientists all over the country in the summer, around the world, and it brings sort of like, undue or unnecessary skepticism to this sort of approach that it’s being talked about in this summit where there’s so much good and if we’re just, I think if there’s just sort of more of an honesty or a transparency about the kinds of results people are seeing and what it takes to be a patient and all that kind thing, I think we’d have less criticism. 

In the meantime, you know, not the Cleveland clinic, not Mayo Clinic, not Johns Hopkins, none of those on their commercials lead with the failures, right? None of them lead with the failures and you can read Marty Makary’s, you can read plenty of people that have worked in these kinds of environments. We’ll talk about, you know, the realities of the hospital itself, but I think mostly the issue is in terms of being honest and transparent about our outcomes and then being honest and transparent about the kinds of approaches that we’re using, as opposed to being sort of ashamed of them. I think a lot of people don’t, you know, well, I don’t know how exactly to look for toxins or what’s the story with mold or Lyme’s disease and I think it’s fair to say, we’re not sure and I think from an academic standpoint, if you’re like, well, you know, there’s no connection, I’ve had so many, I’m sure you have had too, of people will go to their neurologist at, you know, these famous places, famous institutions, and they’ll be like, mold has nothing to do with Alzheimer’s or, you know, and then 5, 6, 10 years ago, you know, 5, 6, 10 years later, it’s like, oh really it did, but by that time, the patient who I’m seeing and you’re seeing now might be long gone, right? Because the academician just either didn’t have time, didn’t have the interest, wasn’t sort of as far down the rabbit hole with some of the kinds of interventions we’re talking about. So I think transparency and choice for patients and then us being diligent about how we collect data and the kinds of research we’re involved in, all those things are important, but the meantime, people are sick and people need help and we need to help them and it’s sort of all hands on deck. 

So being transparent and then just, you know, just spending the time to develop relationships with academic centers and skeptics and I put myself in that sort of skeptic camp because at this point, you know, I think three, four years ago, people didn’t even approach, didn’t sort of even give the metabolic approach, you know, lifestyle, exercise, diet, so they wouldn’t admit that that had anything to do with an improvement in cognition. I mean, we’re talking about, like, we’re not even talking that long ago; we’re talking about like 2018. That was still a controversy, 2019, and now it seems like, you know, Alzheimer’s Society, everybody’s kind of talking about brain health and, you know, you’re not, I mean, I’m definitely following this for a good 10 years this area and, you know, it’s not forever, but it’s, you know, pretty closely for about 10 years and it’s really interesting to see the shift in the last, you know, four years or so. So if that’s the case then, well, then why wouldn’t other things that we’re talking about that are coming down the pipeline and maybe there’s some truth to that? So I think we need to kind of parlay some of the success and the metabolic approaches that are now pretty widely accepted and, you know, Ivy League programs, famous academic programs, are starting these kind of metabolic diseases approaches for Alzheimer’s and then Alzheimer’s precursors, anxiety, depression, bipolar, you know, sort of all like mood disorders, like it’s a big novel thing even though you and I, you know, kinda learned about these things in our training and have been practicing them for decade or more.

Heather Sandison, N.D.

Yeah, I’m curious. I’m putting you on the spot here ’cause we didn’t talk about this before, but have you heard of this book or have you read How Not to Study a Disease: The Alzheimer’s Story, Karl Herrup?

Nate Bergman, DO

I never … Can I see it?

Heather Sandison, N.D.

Yeah. Don’t know if you’ve got your hands on this yet?

Nate Bergman, DO

No, I gotta read that one.

Heather Sandison, N.D.

It’s a good one. It, you know, it might just be because we’re Alzheimer’s nerds, but I mean, I read it cover to cover on one plane flight because it was really fascinating. It’s an engaging story. Lots of detail about … He’s a researcher, a lab researcher in the dementia space, and he just talks about kinda how we came to this being stuck in this dead end rut of the beta amyloid plaque hypothesis.

Nate Bergman, DO

Yeah.

Heather Sandison, N.D.

With so much effort and time and ungodly amounts of money being thrown at this disease that we all realize is, you know, radically shifting right now with the demographics and really a huge detriment to society if we continue down this path, and yet we we’ve gotten stuck in this barking up the wrong tree, basically, and so how to get out of that, how to unwind some of these bad decisions that basically got made along the way where we kept doubling down on this one hypothesis when really it looks like it’s a multifactorial disease. So I think everyone probably agrees, right? Amyloid plaques and tau proteins have something to do with dementia, but how much do they have to do with Alzheimer’s dementia and what else needs to kind of get brought to the table when we have these conversations? So I’m curious your thoughts about medications coming down the pipeline about these hypotheses and kind of how you make sense of it all.

Nate Bergman, DO

Yeah, so I think in general, the more I read about … Look, I’m happy to work in a hospital system. Like, they’re good, they’re generally speaking good places, but they’re businesses, right? And so I think when critics attack a naturopathic doctor or a MD who’s in private practice who’s practicing in a cash-based practice because they cannot keep their doors open if they took insurance, ’cause you simply can’t see five, six people a day and make it on an insurance based practice unless you’re selling something else and people levy criticism against the cash approach when they themselves work for an institution that, as a physician, they’ve completely outsourced. You know, this wasn’t the case 25 years ago. Most physicians, 30 years ago, 25-30 years ago, even, you know, basically since the late 1990s prior to the late 1990s were owning their own practice. There were a lot of people getting very wealthy, just doing kind of usual care and now most physicians, nurse practitioners, physicians assistants maybe in the west coast maybe even naturopaths are sort of working in a healthcare system. So they’ve outsourced all of the billing, all of the costing, and I know if you go to a place here in Cleveland and you don’t pay your bill, first of all, you’re not getting in the door without insurance or you’re not getting a test unless there’s been a prior authorization and then even if you’re two weeks late on a payment, they’re going to collection. So nobody’s doing this for free and it’s just, I think that there’s, again, it’s sort of there’s this partition or separation between the individual, who’s the customer, the patient, me as a patient, the physician in an insurance-based model, and then that’s sort of third party payer. 

So this idea that everybody that’s sort of not charging is doing the right thing I think is completely … I think it’s an ignorant perspective, right? It’s a misinformed perspective because they’re just not aware that all this stuff is happening instead of the same way on the backside. So with that sort of skepticism about medicine and the medical community, right? Like at the same time, knowing that there’s extraordinary people and extraordinary scientists, extraordinary individuals like in these fields, we take, okay, what are the medications that are coming down the pipeline for Alzheimer’s, right? As of this recording, like when we were, I think last year when we were talking about this, aducanumab or Aduhelm had just been approved and then recently, Medicare decided they’re not paying for it except within the context of a trial because you know, all of the reasons, it’ll bankrupt Medicare, I mean all of the reasons they didn’t. How much did it help already? It just didn’t help that much. It seems to slow things down a little bit, which if you’re early stage sounds pretty good. You know, if you’re trying to make it five more years ’til your last child gets married or something like that, maybe that’s a good, reasonable approach, but the idea that that’s what’s true and all these other things are not because they haven’t been sufficiently studied because nobody wants to do the study, that’s not fair, right? But the medications coming down the pipeline, the things that are sort of aducanumab or Aduhelm like lecanemab, like what they call BAN2401, donanimhaber, there are other medications that are in the same class as those, as the original, the one that got the original approval in 2021, they say they’re gonna work better. 

You know, people that I’ve talked to that are in these clinical trials seem to feel like, you know, they’re an improvement over the original one. So I do think that we’ll have this kind of chemotherapeutic approach to Alzheimer’s, but it goes back to what you said before, Heather. I think that still fails to recognize, and I’m interested in that book, it still fails to recognize that there’s not one mechanism for Alzheimer’s. So yeah, you could put the stop and start to eliminate some of these amyloid beta, but A, why is it happening to begin with and B, what are all the other kind of elements? And just like I could definitely envision a day where everybody’s on an Alzheimer’s medicine like everybody’s on statins, you know, like if you have a high amyloid, you get the blood test and if you have an amyloid above this and you have this risk and above this age, you’ll be on an amyloid medication and it probably won’t be in the days of IVs, but it’ll probably when they have an oral pill for something like that and you’ll be on a combination, but that’s, to me, you talking to sort of the amyloid guys that in the field, they’re like, well, if you don’t think amyloid has anything to do with Alzheimer’s, then you don’t understand Alzheimer’s right? Sort of like saying, if you don’t think atherosclerosis or you know, the plaque that builds up in most people’s arteries with heart disease doesn’t have to do with heart disease, then you don’t know where heart disease. So that’s a fair statement, but it’s a little myopic.

Heather Sandison, N.D.

There’s also a lot of data that suggests that that’s not a fair statement, right? Because less than 1% of the population in the entire population on the planet, no matter how old you are, has no beta amyloid plaque in their brain, right? So everyone has some beta amyloid plaque and over 65, so elderly people on the planet, people over 65, seniors on the planet, 30% of them, regardless of their cognitive capacity, have enough beta amyloid to have a diagnosis of Alzheimer’s. You have people with perfect cognitive function who have plenty of plaques and tangles in their brains when they die and so, yes, there’s a connection, but it’s not predictive of cognitive function.

Nate Bergman, DO

Yeah, well, I mean, it’s sometimes predictive of cognitive function, but like you’re saying, it’s such a myopic point, it comes back to well, we did it, we have the answer, come to the hospital for your answer, we can fix you and it reduces the idea of Alzheimer’s and it’s hard to even get clear consensus around what Alzheimer’s is ’cause a lot of people that have been diagnosed with Alzheimer’s probably are … They may not have Alzheimer’s or they probably have, I’m more convinced of, probably people have a lot of mixed type dementias, whether it’s late or it’s a little bit of Lewy body, you know, sort of a Parkinson’s kind of a thing, vascular, I do think though, we’re gonna get … We’re pretty close and we’re getting to that point where we’re gonna have drugs that are approved for Alzheimer’s and then, you know, then for sure they’ll have all the answers. Like now once we have an approved drug, then all the other sort of approaches, that means that none of them are true, right? And I’m just joking in saying that, but I look forward to the time where we can combine medications with the kinds of approaches you and I are talking about today.

Heather Sandison, N.D.

I absolutely do as well. I think that there’s a great complement potential there, right? If we can get rid of the why, of why are these plaques and tangles being formed? Why is there inflammation in the brain? What does the brain feel like it needs to protect you from, protect itself from? Then we can do that first or at the same time, and then get rid of the plaques and tangles. They almost, they’re like scar tissue, right? There’s been some damage done and we wanna get rid of that. Of course we want full healing, yet if we don’t get rid of the reason why they formed in the first place, we’re not gonna get an improvement in cognitive function, which is the whole point of these conversations, right? Is making sure that that person has a better quality of life, better experience, better cognitive function, not the amount of amyloid in their brain.

Nate Bergman, DO

Totally. Yeah, I mean again, just to add more fuel to the point you’re making, if you took most Americans 40 and up off the street and just did x-rays on their back or their knees, nine outta 10 are gonna have arthritis findings, but they might not have arthritis. Same thing you take with the neck or heart, a lot of people have buildup, it’s just not gonna be symptomatic. So for sure, you know, the point about amyloid and just taking amyloid out, point’s well taken, but you know, Biogen’s on it. So you know, there’s a lot of people that are really invested in simple models.

Heather Sandison, N.D.

Right, right. Well, let’s go back to our more complex model because just because it’s challenging or complicated doesn’t mean it’s not worthwhile, right? What does kind of like a rehabilitation process, if you will, look like for somebody who’s already suffering with some cognitive decline?

Nate Bergman, DO

Yeah. I mean, I think, I think for the most part, it’s probably been well laid out by other guests, other speakers, Dale Bredesen, Dr. Komotar, I mean, there’s plenty of people that have the answers to that, that, you know, I’d just be repeating what they’d said, but I think what’s kind of new and interesting that I don’t hear talked about as much is for people that already have dementia, right? So for people that already have dementia, meaning they have cognitive loss and they’ve lost the ability to be independent completely on their own, there’s a lot to be done, right. We were calling it, you know, living well with dementia, and it’s an interesting process right now. So the whole field of cognitive enablement is how much skill can we get back? How much gain can we get back even in someone who is at a real deficit and a real loss who has some sort of a catastrophic or a huge amount of cognitive loss and I think an ideal approach is gonna include some of the mental and physical exercises, but I mean, what we’re doing, we’re really specifically teaching people, we’re doing exercises that will improve verbal memory, visual memory, processing speed, even the ability to attend, to pay attention, which can improve memory, it can improve executive function. All of these are inputs. 

So like if you’re training cognitive skills, cognitive domains will often see the general trajectory of people’s, let’s say just their scores or how they’re doing in life or you ask the care partner how they’re doing, they’ll be doing the same if not better, right? So it’s one thing to see someone who’s mild. 

Like my first patient tomorrow, you mentioned, the kinda person mentioned, late fifties, early sixties, mom passed away with dementia in you know, long term care. She started having real sort of concerning symptoms. Started on the program, snaps back, gets back, you know, like she’s just back to herself, and I mean, those are extraordinary. Those are exciting, but it’s also extraordinary setting in some cases kind of almost more so, because it’s not supposed to happen even more where someone is, like you mentioned, very, very symptomatic and much further along and they start to have a stabilization of decline and then they start to have maybe some days are better or there aspects of their life that are improving, that are clear. 

They’re more able to articulate what they’re doing. They’re better with math. They can calculate tip, just like wild stuff. We just see the brain sort of higher cortical functions, sort of higher cognitive abilities, start to sort of come back online, even if it’s not all the time. It’s really, it’s just enormously exciting. So I think, you know, really being specific about that cultivation of purpose and spirit cultivation on why someone would challenge themselves like this and doing the right kinds of mental and physical exercises and then complimenting that with diet and supplements and sort of all the other things that we’ll do sort of sprinkling in some technology that can accelerate the process here. It’s the most exciting, I mean, among the most exciting things that I’m involved with on a kinda day to day basis.

Heather Sandison, N.D.

Yeah, I couldn’t agree more. I mean, just hearing you kind of explain that you’re seeing similar things, ’cause sometimes I sit here in my office, you know, in Southern California going gosh, like, how am I the only one doing this? This must be happening in other places and just to hear that the same stuff is happening in Cleveland, it’s like my heart is just so full because it means that we’re not, you know, we’re not mistaking what we’re doing. This is real and it just adds more credibility to it and definitely gives me more hope and I think just letting everyone know, you know that, yes, of course we need more science; we always need more science, we always need more data and it’s coming. We finished our 25 participant trial. We’re gonna publish that soon. I wish that it was ready to go out right now and I could talk about it all day long right now, but alas I have to wait, but I’m really excited to get that data out there and then we are going to do a follow up trial. Dr. Bredesen is working on a follow up trial to his first 25 participant trial. They’re gonna do a hundred participant trial. So this is all happening and the context of that is like, why did it take so long, right? Well for a long time, if you weren’t studying amyloid, you weren’t studying Alzheimer’s, right? So everything was going in that direction and then also what we are doing is multifactorial and so getting an IRB or an internal review board to approve that … There’s been funding for quite a while through philanthropy. 

A lot of people have realized that this was worth looking into and there were people willing to fund it, but there weren’t IRBs willing to approve it and to do human research trials, you have to have an IRB that’ll get behind you and so now just in the past five years and maybe in the past four to five years, that’s why we’re seeing so much shift, so we’re more focused when we look at this hierarchy of research, we’re starting to shift our focus towards more patient-centered outcomes and that means including trials that have multiple interventions at the same time, right? This idea is that if you stack things like you’ve been discussing, detox and diet and sleep and you know, exercise, of course if you start putting all these things together, then you would expect to get even better outcomes than if you just do one. There’s this spiraling up or this … What am I trying to say? There’s this momentum, this virtual cycle that you get out of stacking these interventions and so, yeah, I think that that is one of the most exciting things happening right now in this space. I’m curious what else, what other exciting trends you’re seeing?

Nate Bergman, DO

Yeah, I mean, it’s a good place to sort of round out the conversation with. I mean, oh really honestly, the most exciting thing to me right now is the sort of stabilizations that we see with people that already have a diagnosis that are willing to put in same work. That’s really cool. You know, we’re trying to keep people independent and keep ’em out of a long term care, nursing home, whatever you wanna call, is exciting. It really requires people to put in the work and I think we’re seeing more people. We’re seeing definitely a fair number of people that are kind of willing to put in the work. They kind of understand, okay, if I want a different option, then I’m just gonna go to a hospital and get an injection once a month, which would be great, you know, like everybody wants a simple option. That’s number one. You see people stabilizing through the right kind of therapy, right? The right therapeutics. Another thing that we see sort of a signal … I can tell you one impressive story that we had recently, whole kind of field of electroceuticals, right? So electroceuticals could mean anything from sort of like a neurosurgeon opening up someone’s brain and putting in an implantable device for, let’s say, a deep brain stimulator commonly approved for a Parkinson’s tremor that will reduce the severity of a tremor, but there have been devices that have deep brain stimulated that have been big trial failures, big industry sponsored trial failures so far for deep brain stimulation in Alzheimer’s disease. 

But noninvasive brain stimulation with transcranial electrics, light therapies, does have some promise and they’re tricky. It’s a tricky study. They’re tricky studies and they’re mostly small and short, but I’ve talked to three really serious neuroscience researchers, just talked to a really interesting guy, University of California San Francisco, although he works apparently in Emory, works full-time remote and he’s a full professor at UCSF, you know, another brilliant guy, mid-career, Ted Santos is his name, and we were just kind of comparing notes. Like he’s interested in direct current stimulation, alternating current stimulation, sort of other, you know, a number of other things, and I would say where we’re adding entrainment or small amounts of either light or electricity to the brain. So just to make this real for people, we had a woman in her late seventies, let’s call her D. So we saw D. She’s late seventies. She had an APOE4 copy. Dementia runs in her family. She had PTSD, pretty significant anxiousness, probably, you know, what would’ve been called, you know, ADHD now. She was taking stimulants in the 1970s for it and anyways, we see her and she’s trying to live alone. Her son’s trying to do the best by her to get her in home care, but she’s belligerent and angry with the care staff in her house and they keep losing people and she won’t get up. She won’t exercise. She won’t participate in physical therapy. She needs a knee replacement, but they don’t wanna do the knee replacement ’cause she won’t do physical therapy and she’ll just get the surgery and doesn’t do PT then she’s gonna end up in a chair her whole life, right? The rest of her life and so we started off with her and you know, we tried to get her to do many, many things, you know, all the stuff. She was not having it. This is a tough Italian lady. She’s not having it but she, you know, she was a good sport about things, but she didn’t always remember. Just to give you a sense, Heather, her MOCA score, her Montreal Cognitive Assessment score was 13 with a lot of loss. So that’s fairly low, fairly advanced. 

She could still have a pleasant conversation with you and kind of know who you are and that was no issue, but she wouldn’t engage, just wouldn’t get outta bed, couldn’t get dressed, and in the course of in a month … This is one of those ones we saw kind of an immediate impact. She had recently been diagnosed with type two diabetes. So she went on ketogenic diet. Got off, I think almost, she was just on Metformin, got off all her other diabetes medicines really pretty quickly and started, you know, sort of clearing things up. I started another prescription medication on her to sort of calm down excitation in her brain and then we brought her in and that was the only thing we get her to do, those two things, and then we did get her in to come into the office several times a week for these stimulations. Mostly we used alternating current stimulation with her. We use some noise frequency and we tried kind of a few things until we found, you know, the network that we kind of needed to light up with her, the area of the network we need to light up with her, and her MOCA in a month … So again, normal score would be 26 or above technically; hers was 13 to start, in one month she went from 13 to 20, but I mean the scores are interesting, but it’s more about what her life was like: getting up outta bed, ready for a care partner in the morning, eating, participating in cognitive exercises, willing and able to let the physical therapist into her house. So her brain was organizing and it’s funny, her care partner was, you know, not a clinical person and she was more commenting on her mood, right? Her mood seemed so much better. She just seemed so much more agreeable as her brain started to organize more, right? And so, you know, you get rid of some of that inflammation and you start to, you know, let the dust clear with all the blood sugar stuff and then you add some, hey, this is sort of the rhythm and frequency that the brain needs.

Heather Sandison, N.D.

Yeah, let’s be real. I’m more agreeable when I’m in ketosis.

Nate Bergman, DO

I dunno not everybody says that. I’ve met some people, especially some, you know, some premenopausal women I’ve seen that have had a really rough time with a full ketogenic diet, but in general, I think most people feel a cleaner burn. So I mean, technologies are interesting. They’re hard because you know, people have to, in most cases, they have to kind of come into the office. Well, some things, you know, like light and there’s some things that people can do at home. The other thing that I heard … I’ve heard this from really some very credible sources. Do you know who Robin Carhart-Harris is?

Heather Sandison, N.D.

No.

Nate Bergman, DO

Robin Carhart-Harris is one of the leading names in psychedelic research.

Heather Sandison, N.D.

Oh right.

Nate Bergman, DO

He’s kind of a hardcore neuroscientist and you know, doing a lot of FMRI studies. He was in England for a long time. So the University of California in San Francisco just poached him. They got him. So rumor has it that they may be using some of, whether it’s psilocybin I’m not sure yet, but there’s talk from some of the people in that division that they may be starting to use psychedelics in hopes of sort of sparking things from a neuroplasticity or neuro-regenerative point. To me it’s still kind of speculation and I’m gonna wait until kind of the craziness of every psychedelics gonna cure everything, you know? For instance, somebody sent me an article from Harvard where they were touting how exciting the psychedelics are and it seemed like one of those articles where we’re gonna solve everything with psychedelics, which I hope we do.

Heather Sandison, N.D.

Maybe! I know I would love it. That sounds like a lot of fun.

Nate Bergman, DO

I’m more than 85% certain that we won’t. But I hope that we do. I hope that none of us ever have to work again and we live in world harmony and world peace, you know, and for eternity with psychedelics, but preparing for the possibility that that’s not the case, I read this article and it was like, hey, see, these things work. This was for depression, so it wasn’t for Alzheimer’s, but it just, you know, sort of speaks to the unknowns in this sort of world of psychedelics. So 30% of the people with refractory depression, bad depression, it wasn’t getting better with other traditional medicines, improved with psychedelics versus less than 10% with control. That’s 30%. I mean, that’s not 80%, it’s not 60%, but 30% of people, and I’m sure you’ve seen people that have kind of the opposite effect, right? So again, I think that it’s always gonna sort of boil down to are you treating the whole human being? Are you treating the whole human being and does this human being that you’re treating, do they want whole human being treatment, right? Or they just want just gimme the pill, I’ll go for the injection. I mean, those options seem that there will always be available, but kinda the whole human approach, it does seem like, at least in some pockets, more than what was 10 years ago, maybe even five years ago, especially in Alzheimer’s, there seems to be a ray of sunshine of hope that maybe there’s more openness to this than had been before and then I think the other thing that’s really kind of exciting is, you know, as unfortunately more younger people end up with Alzheimer’s, the 35 to 64 population, as we know, is growing in diagnosis … Is it ’cause of pollution? I don’t know, but you know, there’s certainly all kinds of theories like that, ’cause of mitochondria disrepair. 

Is it because of … I’m not sure, but because there are more younger people with this disease as opposed to it’s grandma and she’s in the nursing home and you know, like there’s this picture of Alzheimer’s of someone just in a nursing home with their tongue out and they don’t recognize their spouse or they don’t recognize their child, which is certainly, you know, certainly still happens, but because there’s been more younger people, there’s just more people that are just saying, hey, we’re not gonna take this lying down. We’re gonna fight. We’re gonna do something about this. They’re getting organized. Reminds me a little bit of the Lyme community, you know, sort of people that are gonna take the … Or the chronic fatigue syndrome, sort of people that are gonna take matters into their own hands and that’s exciting because you know, so many times we felt like, oh, we have an answer. I’m gonna build the thing and take it and I know what people need and again, I don’t probably have to tell you, the number of times where we thought we had the answer and we took it and people that are closer to the problem and give us feedback on it as to how to make it better has really been a godsend. 

So even just an organization like DAI, Dementia Alliance International, these are really cool sort of patient or human beings with disease led organizations and while it’s still agonizing to see people with these diagnoses struggling with these diagnoses, the inspiration from the struggle, from watching the struggle, is extraordinary and then I think there’s also more and more room and I know I’m starting to sort of try to figure out ways to naturally include this in the practice and I have been sort of shy to do it for a while, although it’s part of kind of the functional medicine matrix and model is to talk more about spirit and spirituality in the context of these visits because sometimes that’s, you know, it depends on people’s backgrounds and what their sensitivities are and, you know, do they come from a sort of Christian Catholic background? Do they come from kind of another background? But drawing on whatever people have or using the experience of, you know, this sort of harrowing experience … Usually if it’s for a care partner, like losing a spouse to this can be a big opening and obviously a big opportunity for a certain kind of growth. 

So incorporating that in their … It just sort of blows the whole thing up a little bit and then we can start to focus on what you were talking about before of choice and, you know, what are we really doing with this and how much are we helping? And, you know, some people call this sort of a patient-centered approach, an individual or a family-centered approach for, well, you know, what are all the tools that we have? And here’s what we have; let me help you with all of these many, many tools, as opposed to just the one medication. So exciting times, it’s a very exciting time to be in this space. There’s blowing up all over the place and I appreciate you for being sort of one of the mouth pieces for this, for this kinda work.

Heather Sandison, N.D.

Yeah, I feel so grateful and privileged to, you know, be working on this project with you of changing the narrative, right? This isn’t gonna be for everyone. This approach isn’t feasible for everyone, right? And especially right now, it costs money. You have to have resources, you have to have time, and yet everyone should still know that this is an option, right? No one should be told there’s nothing you can do, because it’s almost overwhelming how much is possible to do. Now that doesn’t mean that everybody has to pick it up and run with it and do all of it, but for someone to be told that there’s nothing when there’s all of this potential, I think it’s just, I mean, it’s inhumane. It shouldn’t be legal, right? Yet it’s just the refrain from neurology and so thank you for doing this work with me of changing the story around what’s possible for those suffering. I couldn’t agree more that the passion and energy and inspiration that comes from all of us who wanna reduce suffering in the world, right? And those who are in the throes of either caring for someone with dementia or who have it, who are suffering themselves, that, you know, there’s nothing more amazing than watching a human transform that tragedy into helping and hope for other people and so I love that you kind of mentioned that, that watching these organizations form where people are just not going to give up and are looking for solutions and certainly we’re looking to partner with them. Nate, thank you so much for taking the time. I know you are busy and your kids, your family is waiting to have dinner with you, so I’m going to let —

Nate Bergman, DO

Hear them screaming? they might be screaming in the background.

Heather Sandison, N.D.

No, no, I can’t hear them screaming, but go join in the fun. Let’s not wait so long to connect again. It’s always a pleasure. I learned so much from you and like I said, it’s just so heartwarming to hear that you have similar stories to ours happening across the country. It means that it should be happening in every city in the country and certainly we’ll continue to work towards that. Make sure one more time, tell everyone where they can find out more about you.

Nate Bergman, DO

Yeah, so we’re at Kemper Cognitive Wellness. Just go to KemperWellness.com and you’ll find us.

Heather Sandison, N.D.

Kemper?

Nate Bergman, DO

Yeah, K, KemperWellness.com and we’re there. We’d love to meet you.

Heather Sandison, N.D.

Fantastic, thank you so much Nate.

Nate Bergman, DO

Thanks again for doing this.