Root Cause: Impacting Brain Function

David Haase, M.D.

Oh, Dr. Sandison, thank you very much for having me.

Heather Sandison, N.D.

So you and I share a passion for solving the unsolvable, some of the hardest patients, and dementia is certainly among them. So many of us have been told that there’s nothing you can do if your brain starts to falter, if you start to suffer with cognitive decline. What got you into treating dementia?

David Haase, M.D.

Well, I didn’t want to. I really didn’t want to, because the traditional view of dementia, there’s nothing you can do. I mean, they’re the most depressing visits you can have as a primary care doctor, because that person comes in and you have, like, these two medicines that maybe you can give, that don’t do a lot. And I really didn’t want to do it, but I really recognized that people could get better. I mean, I’ve been working with individuals with cognitive decline for over 15 years. And this has been, you know, taking a functional systems approach to this. And the bottom line is people can get better. Now, the challenge is neuro degeneration, as soon as we start to recognize that it’s happening, once we have symptoms, we got to recognize symptoms are actually a late-stage manifestation. And that’s what people don’t really get. They think, oh, like when I’m start to shake with Parkinson’s, oh, that’s when it started. No, that was like 20, 30 years ago. And with Alzheimer’s, if it’s some short-term memory loss, oh, that’s when it started. No, it happened a long time before that. And so I think with the recognition that that was really what was going on I said that, a fundamental belief that I came to while I was at Mayo is that the body heals. And that my job as a physician wasn’t just to diagnose and treat disease but, rather, to investigate what could create health. ‘Cause the body heals. And it happens every day. We cut our arm, it just knits itself back together, without our understanding of exactly how it happens but it just does. 

But we know if we give the body more of what it needs to do its miraculous healing job and we remove the barriers that are impairing that healing capacity, it just does its thing. And, yes, we’re always fighting time, friction, erosion, you know? Those things keep going on. And the more birthdays we accumulate, the harder it is. There’s no doubt about that. But I really, I think that we should be shooting for higher quality of life. And I’ll say one more thing, the thing that really caused me to dig in, and put my effort, and energy and focus to this domain is my love for wisdom. I think wisdom is the most precious resource that exists in the world. And wisdom, live wisdom, exists in elders. And we need to elevate eldership again to the rightful place that it is, which is really the top of society. And when we start seeing our older humans start to lose their capacities that make them an elder, that is a terrible tragedy, because we need the context, and the wisdom and the perspective of those people who have had a huge amount of lived experience. And so, for me, the fight against neuro degeneration is really the fight for elders and so to elevate the meaningfulness of those individuals of advanced years.

Heather Sandison, N.D.

I have a similar perspective. It’s like we’re preserving that value. And right now it’s a squandered resource, right? We allow our elders, at the height of their wisdom and experience, to just go into these homes where they’re put in front of TVs, they eat cake and ice cream. And they just basically fall out of society. And they have so much value to give. If we can, you and I together, and all of the other doctors doing the work similar to us, and then the hard work of the caregivers at home to make sure they’re getting the right lifestyle, the right diet, all of those things, so, so essential. Then we can, we can preserve, we can protect and then we can allow those elders to give their wisdom to the generations that are coming after them. So important. So tell us a little bit about how, you know, this can be a very complex, we’re talking about decades-in-the-making disease. And it’s overwhelming. So for a doctor who has 15 minutes to come in and out of a room and a couple of medications at their disposal, it’s really challenging. But you’ve built some tools that can help guide a systems-based approach so that more doctors can get this out to their patients. So describe that.

David Haase, M.D.

Yeah, absolutely. Yeah, I’ve been working for many years on something that could be economically accessible, a tool for, is a comprehensive assessment of cognitive decline. Medicare is really supporting this. The federal government has stepped up and they said, yes, the comprehensive assessment of cognitive decline is something that is so important, we’re gonna give it its own code, its own payment strategy, because the data is clear, lifestyle interventions absolutely do affect cognitive decline. There’s no question about this any longer. But it is complex. How do you step back and recognize what are all the pieces that are out of place for that particular individual? Because, just like everybody’s brain is different, everybody’s dementia is different. And so just because, hey, we start with a unique brain, and then our pattern of degeneration and the forces that cause that degeneration are unique. So you have to throw the net broadly. So there’s many reasons why I created a platform, but we call it MaxWell Brain. And MaxWell Brain is increasingly available in the United States to Medicare providing physicians. So a patient can come in, the doctor, if they have the right diagnoses and issues, can order a cognitive test for them, so they can get a baseline assessment of their information. And then they go to a standard lab and have a series of blood tests done. They’re typically covered by Medicare, almost always. Ideally, we’d have them do some genetic testing. That’s probably not covered by Medicare. 

But then what happens is, through no cost to the doctor and no cost to the patient, the physician gets a report about what is all going on with that patient? What are the most important things that should not be missed and are causing a potential worsening of cognitive decline? And so now we have a plan of action. There’s a plan of action for the doctor. There’s a plan of action for a health coach that can work with that individual. Recommendations are made about what medications to consider stopping or switching, what kind of medication should be started, what lifestyle issues should be happening. Changing your diet, changing your stress. How do engage brain exercise? And then recommendations on supplementation about, and in a prioritized manner, like, these would be most important to start. And even recommendation on additional testing. Because what we do is really specialized. It’s really, you know, this is the very first layer of what you and I would do in working with somebody. So it is not the end all, be all examination but I really recognize there’s a need for a large group of doctors and patients to have access to customized personalization. And that’s what MaxWell Brain is really about. And so it’s still new. We’ve only allowed a few physicians into it for some beta testing, but hopefully it will be released soon. And this has just been a passion project of mine, certainly not anything that will create revenue, but it’s definitely something that is going to, I think, make a big difference in the world. And so that’s very exciting.

Heather Sandison, N.D.

Where can someone go to find out more? And if maybe their doctor or a doctor near them is on the list of MaxWell’s Brain providers?

David Haase, M.D.

Yeah. Just go to maxwellbrain.com. And there you can put in your information and get more information as a patient or, hopefully, as a physician. And be directed to resources that can help move this forward. Every little bit counts. Heather, some of the work you’re doing in your center, that’s really making lifestyle easy for people with cognitive decline, that’s a great model for what has to happen as a culture. So the more people we have making small shifts, the more resources are gonna become available and the easier living a life that promotes a great brain is going to become. So the more we do this, the better that gets.

Heather Sandison, N.D.

One of the call-to-action steps that I hope that many of our listeners and summit attendees will take is ask your doctor. Even if you’re in a spot where there isn’t a doctor who’s doing this kind of work, ask them, have you heard of MaxWell Brain? Have you heard of these things? Have you heard of this testing? Have you heard of a comprehensive approach? And if someone is calling to reach out, they find themselves in need of a senior living facility, like Marama, if there isn’t a Marama near you or if there isn’t a place doing an approach like this, a more individualized lifestyle approach, then ask, do you serve organic food? Can you help with these dietary interventions? How much movement is someone getting at your facility? Just ask, because it starts the conversation and it tells the people on the other end of the phone that you’re interested, that you value that. And that’s what’s going to move those needle. That’s what’s going to make them start offering those services.

David Haase, M.D.

Absolutely. And they will, because they’ll know there’s interest. And people that work in these facilities and are dedicated to that work have good hearts. They want to do good for people. And they’re always wanting to do something else that’s actually gonna be of benefit. So you’re absolutely right, ask, ask. And do a little pushing, right? That’s okay. And there are many of these kind of platforms. Dr. Isaacson from Weill Cornell has done, doing some wonderful work. He’s been such a great leader in pushing forward the lifestyle medicine approach to cognitive decline. There’s so much good data out there to show that these things work. And it’s important to start somewhere. So I would just encourage, whatever resources someone has, please engage those. I’m in favor of all of them.

Heather Sandison, N.D.

Right. And we see, of course, that the more of them that you can do, right, when you can do diet and lifestyle, and exercise, and supplements, and you can shift, get off the cholesterol medication, potentially, if that’s safe for you. And when you can do all of these things, you can incorporate the stress reduction techniques, and meditation and brain games, the more you can do, the more confidence I certainly have in the outcomes. But even a little bit shifts the trajectory in the long term. So if you can do part of it, start today.

David Haase, M.D.

Yep. Yep, absolutely.

Heather Sandison, N.D.

One of the most exciting things that I’m thrilled to talk to you about right now is plasma exchange. So there’s, some people call it young blood therapy. I want you to talk about the words we use and why that’s important, what they mean. And then dive in, tell me everything that you know about plasma exchange.

David Haase, M.D.

I have to talk really fast. So I did a Ted Talk about this almost three years ago when we were already in this process for a couple of years. So you can hop in to look at that, and kind of how our approach to dementia and plasma exchange, and where that plays a part there. Oh man, it’s such an exciting story. Do you remember when I’d said at the beginning, you know how I had this revelation that the body creates health? And that just changed my entire view of healthcare, right? Giving a medication that blocks something that the body does. Medications usually have names like “anti” this, or “blocker” that or “inhibitor” there. I like helping the body do what it wants to do to heal. And I’ve never, I will have to say this is a monumental shift. We are going to look back and see regenerative plasma exchange as one of the great therapies. And something like this is going to be at the foundation of all longevity medicine in the future. And you know me well enough, I don’t make grand statements very often. Do I?

Heather Sandison, N.D.

No, and actually I was, it took me aback. I was like, wow, you, yeah, this, you believe this.

David Haase, M.D.

Yeah, I’m-

Heather Sandison, N.D.

That’s good.

David Haase, M.D.

I’m typically a radical moderate, right?

Heather Sandison, N.D.

Yeah.

David Haase, M.D.

I usually find a problem with every one of my good ideas, right? And that’s just kind of how I am. But I am so excited about this, because it follows the precepts of what creates health. How do you create health? You remove something bad and you add in something good. And you allow the body to do its job of regeneration. So what is plasma exchange? Plasma exchange is a process by which we literally clean the blood of its impurities, of the damaged molecules, of accumulated oxidative stress. And, as a result, we change the environment to the body. And as we change the environment to the body, the stem cells body-wide believe that they’re in a younger body. And if they believe they’re in a younger body, they start acting younger. And when stem cells start acting younger, you have this remarkable regenerative spurt that happens, not just in the brain but as a multi-tissue regeneration.And so the science on this is really beautiful. It started out with an idea called parabiosis. And parabiosis took two little mice that were clones of each other, an old mouse and a young mouse. And they surgically attached them side by side. I know it sounds kind of gross. But after about a week of running around the cage attached by a little flap of skin on their side, an amazing thing happened. At about a week after that, the old mouse started to started to turn young. It was found later that there was neuro regeneration, that there was changes to fatty liver, the hair started growing in better, that the muscles would repair more easily, that the sense of smell of the mouse returned. 

And that T cell and B cell function, the immune system started to work better. Amazing. So that old mouse started to turn young by getting exposed, they thought was getting exposed to the young blood of the young mouse. And but the other thing that happened is the young mouse was stunted. It was poisoned by old. So the young mouse was actually impaired by its exposure to the plasma or the bloodstream of the old mouse. So a lot of studies went after this, and either taking old mice and injecting them with the plasma from young mice. And, hey, that helped. And then you took old mice and you actually cleaned their blood. And, hey, that helped. And all of the helping was really around how does one turn on the body-wide stem cells? And so as the excellent science would do, you say, well, how do we do this in humans? None of us have a small clone that we’re gonna sew on us, right? That’s kinda creepy, and gross and everything and makes me cringe and, even just joking about it. But, instead, how do we clean this old blood out of, this old plasma out of us? And that’s a very standard medical procedure. I’m a qualified apheresis specialist. Now, apheresis is the medical specialty of removing blood from the body, doing something with it and then replacing it back in the body. And we do that to treat all kinds of serious disease. But if we focus on the plasma, the liquid part of the blood, we call that plasma exchange. 

And so a very large study was done, started four or five years ago now, called the AMBAR study. And the AMBAR study blew my mind away. We were already well down the path of doing this work and we were gonna use the plasma from young, healthy donors. And so we could take out the old plasma from old individuals or diseased individuals and put in plasma from young, healthy donors. But the AMBAR study instead used just albumin, used just the major protein that comes from plasma collection centers as its replacement fluid, as well as use some antibodies that also come from plasma donation centers. And what they did is they took a look at about 500 patients. And over the course of 14 months, they were able to show that in comparison to placebo, in this multinational, multicenter, double-blind, randomized, case-controlled trial, or sham-controlled trial, that in the individuals with moderate Alzheimer’s disease, and when I say “moderate Alzheimer’s disease”, those are individuals who often can’t remember the names of their family any longer. There’s nothing moderate about moderate. They’re usually institutionalized at that point. Those individuals had a 60% decrease in the rate of progression over 14 months. 60%. 

But what’s even more remarkable is that in individuals with mild Alzheimer’s disease, there was a very strong trend towards improvement over those 14 months. Now, that was a remarkable study. And it took like two years for the data once it came out to get published, because there’s nothing proprietary about that, right? These are generic materials. But it’s also, I give such great credit to the company Grifols that funded that study and has done that study. I think they have done the world a great service and I see many more great things coming from them. So anyway. But we’ve been working with plasma exchange for the treatment of not just reversing cognitive decline, for not just Alzheimer’s disease, but for other forms of cognitive decline. And we’re also have been doing a lot with longevity promotion. As you know, you know, I don’t, do you know many docs who do more testing than I do? So I, you know, I love all the data, from genomics to transcriptomics, metabolomics, connectomics. Whatever I can measure to see are we actually making a difference, I’m all geeked out about that and-

Heather Sandison, N.D.

Every time we get on the phone, you have a new lab that you are introducing me to. And then I’ve got to call you back and say, “Hey, wait, how do I interpret this? What does it mean?”

David Haase, M.D.

Well, because I don’t really trust my own, I think cognitive bias is a big problem with humans. And data is something that can help us argue against our bias. It can help us make sure we’re not smoking our own dope, right? And so that’s one of the reasons I love data, is what I’m doing really making a difference for people? And that has been astounding. So the AMBAR trial was a great proof-of-concept study. It’s the largest apheresis study ever completed, when you look at total number of treatments, remarkable study. And so at that point, we now know something works. Now, it’s not a drug that would get the same kind of FDA approval. So, I mean, here’s the problem. You don’t have an FDA approval for this because there’s nothing to be approved. This is a standard medical procedure, with standard products and things like that. And so, and there’s also no big drug company that’s gonna plunk down the money to do this work. And so here we have an ethical problem, because we have something that can be really beneficial. We have, our center’s been, you know, it’s really one of the leaders in doing this and providing this service. We have people flying to us from all across the United States to engage in this process. And I think that it holds huge promise. 

But, again, there’s a lot of barriers. It’s very expensive, it’s time-consuming and it really requires a level of commitment. But when you realize that living in a memory care center will cost you something like 80 to $120,000 a year, all of a sudden maintaining your memory and being able to enjoy the years you have left with an intact brain, the investment of that starts to make more sense. So it’s a very exciting time. But I don’t see it in isolation of all the other components that need to take place, one of the reasons we need to still take a systems approach to seeing humans. What are all those things that are causing problems? Let’s remove those. What are all the things that are missing? Let’s make sure those are added in. And now plasma exchange gets to help the bodies hit a reset button. It changes the behavior of the immune system, it changes the behavior of stem cells and it has great potential. And we’re studying this, we’re tracking our results, we’re continually modifying our approach. And we call what we do regenerative plasma exchange, because we really believe that, done properly, and we have good evidence to show that there are, we’re seeing regeneration happening. 

I have a patient of mine that had to leave his business and was a really remarkable, he had built a company up with many employees, and had kind of started from scratch and he had many people depending upon him. And he was no longer able to keep it together. He had to exit his business, and the place was kind of in chaos ’cause he didn’t really have the ability to deal with what was happening. Anyway, we started our process of a functional and systems approach. And he had some improvement. He had stabilization, enough where he could listen in on some of the meetings that were happening again. But then we started our regenerative plasma exchange process. And not only did his memory come back, he had, his skin looks frickin’ amazing. I mean, he looks like he’s un-aged 10 years. And I just wish we had enough funding and such to measure all the things that have changed. Because we asked his wife, well, how is he doing? And my usual standard is like, all right, since we’re in a degenerative process, how is he now compared to X number of years ago, right? How far have we turned back the clock? Is he functioning like he was a year ago, two years ago, four years ago? I think that’s one of our most important measurement sticks. She said, “Well, first of all, he’s happy. I’ve never known him happy. He is, he doesn’t, stress doesn’t bother him anymore. And he is just a can-do guy. Number two, he’s completely gone back to work. He’s now running his whole company again, doing everything.” And she says, “Frankly, he’s as good as I have known him in the 12 years we’ve been together.”

Heather Sandison, N.D.

Wow.

David Haase, M.D.

And so what the heck? What the heck?

Heather Sandison, N.D.

Everyone needs some.

David Haase, M.D.

What the heck? But I think it’s, and the hard part is these are individual results. Why was he such a great responder, you know? And in others where we’re able to help prevent progression, I believe, but and so that is where all this data comes in. How do we figure out what works for whom when? That’s the super important. But the time to start all of this is now. Neuro degeneration, if you know it’s going on, the worst comorbidity for neuro degeneration is denial, right? People say, “Ah, I’m just getting a little older. Oh, it’s just a little bit worse. I’m just not able to think quite as good as I should. It’s really not a problem. Oh, it’s not a big deal.” Those are the worst things that can happen to people. And-

Heather Sandison, N.D.

I have a big, I have a question that I haven’t asked a doctor like you yet. But I see people, some who are very, quite progressed, in complete denial. And then I see others who are early in their disease process, earlier, I guess, and they really understand that their memory is going. Others, quite progressed, they get that their memory is going. The difference there, and I don’t think that the ones in denial are really in denial. I think it’s a different part of their brain that’s being affected. Do you, is that possible?

David Haase, M.D.

So it’s a great question. And I think the answer is gonna be an all-of-the-above answer. So, yes, I think there are neurodegenerative processes that decrease the amount of insight and judgment people have. But, I’ll tell you, woman near and dear in my life, I would love to be treating her. And there’s no way on earth that’s ever gonna happen, because she is in complete denial that there is ever a problem. You are not allowed to talk about memory loss because her mom had died from Alzheimer’s disease and her grandmother had died from Alzheimer’s. And the last thing, she was not going to have it. So you are not allowed to talk about it. So in her case, it was very much already a cognitive decision that if I have memory loss, I cannot accept having memory loss because it would be the worst thing possible to occur. And so that was a psychological reason, not a neurocognitive reason. And then I also think, just in general, as people age, we lose neurons. And the neurons that we keep are the ones we exercise the most. So an individual as they get older gets more and more biased. I mean, they become a more extreme version of whoever they used to be. We see this all the time, right? That nice lady becomes just sweet as candy, right? And that kind of crotchety dude becomes that horrible, you know, horrible, dirty old man, right? And we get this, that happens, it just happens. And so I think it’s a, you can look back in people’s life and say, is this some individual that actually deals with reality in a way that says, yeah, life is hard, and I’m gonna be honest and real about it, and deal with it? Those people, I have not witnessed them having much denial. So when we really ask about what is their kind of psychology set point and is it okay to have a problem like this? So, Heather, I think it’s, it’s been the hardest problem. But, again, the only people I see are the people who have really, have this growth mindset, that say, yes, I am going to do something about it. The people who want to be in denial, well, I never get to see them except if they’re family, right?

Heather Sandison, N.D.

Right, right. This is, the way my brain works, I want to create a table here with you and be like, okay, apheresis, versus plasmapheresis, versus AMBAR, which was just albumin, versus stem cells, which you’ve mentioned. So I know we can’t create a table right here, an Excel spreadsheet for everyone, but can you just break it down? I want to understand what’s what, how are they different? Who might one serve? Where are we in the process of understanding the science? Are they all, I know this is a lot, do what you can.

David Haase, M.D.

Okay. Well, I’m gonna come back to the fundamentals, okay? That, for instance, why did you create your lifestyle facility for the treatment of cognitive decline? Because the more things you do, the more likely the sum total is going to have a positive effect. Fair?

Heather Sandison, N.D.

Exactly, right.

David Haase, M.D.

Okay. And so it’s no different here. The more frequent, so, for instance, AMBAR even saw that the more complex, so the AMBAR study, they did one plasma exchange a week for six weeks and then a mini plasma exchange once a month then for 14 months. And it was very clear the first six weeks that was where a lot of the improvement happened. So frequency matters. I think volume matters. How much plasma are you removing from the body? That matters. And how about the underlying function of the body? Are you supporting immune function or not? That matters. I believe there’s a huge role for stem cell products, exosomes. I think things that turn on the body’s regenerative processes, those need to be studied and added in when they can be. I think that, but there’s so much that we don’t know in the particulars, because we don’t have a lot of experience there. We’re probably the, we probably have more experience than any other center in the United States. And even so it is a, it’s a challenge to sort out from many, many different patients, with all the different comorbidities and problems that they have, which work more? So I think the principle is really that you have to look at this as an investment in brain health. And to say how am I going to, let’s be really honest about resource allocation, you know? I mean, we’re not at a place where this is covered by insurance or Medicare yet. Let’s be, let’s recognize that everything in healthcare, there are always unlimited desires that are met with limited resources, limited resources of time, money, energy, effort. 

And we, I think each of us have to decide what we can do with the limited resources of time, money, energy and effort that we have. And what is important to us? Why are we doing this? We spend a lot of time asking, what do you want from your health? Why are you doing, you know, what is your health for? And how do you want to contribute in the world? I think elders have this massive need to contribute in society. And the ones who recognize that, they’re like, yeah, I’m in, why would I not invest in this way? For the people who are going like, well, I’m just here to pass money on to my kids, well, you know what, this is not for you. If you’ve already cashed your chips in with regard to your level of contribution being just what is left in your inheritance, then you don’t have a mindset to go after this and you even resent people that want to push you there. And kids who go, like, “Oh, my gosh, mom, I want you around. I want to be able to talk to my mom,” and things like that. these are hard discussions. And when we meet friction points like this, sometimes people feel angry, sometimes people, you know, it’s like this should be easy. I resent getting old. I resent having cognitive decline. I resent this being available to some people and not others. I resent, you know, those are real emotions and they’re hard. But those emotions I think are, you know, just show us how precious our brain is and how precious the experience of life is. And if we can be honest about that, then there’s all kinds of things. It’s one of the reasons MaxWell Brain was put together, I want everybody to have access to the best that they can have. 

And so that’s a platform that is, you know, again, it’s covered by Medicare. The doctor even gets paid for submitting, you know, running the report and sending it in. And there’s a special code to get paid for the doctor to spend the time to go over the results with people. So we have to always do what we can, where we are, with what we have. And that’s, that is our integrity. That is actually what we’re here for on earth. MaxWell Clinic is our clinic here in Nashville. And it’s amazing to see the self discovery that goes on in the process of a family engaging in cognitive decline, right? The self discovery that happens. Wow! They actually have to figure out what matters in their life and what, and kids, oh my gosh, the relationship that actually improves so many time with a child and their parents, because now all of a sudden the child is taking care of mom and dad. And they feel like, wow, I’m giving back. And there are, there’s so much healing that can take place, even in the realm of neuro degeneration. We have to recognize that it’s not just the brain that matters, it’s our humanity that matters. And that’s what we’re really treating. And as we engage that, and we’re open to the discovery process in this space, people can have levels of healing that are far beyond seeing the brain regenerate. So it’s such a privilege to get to be in this space. It’s just amazing to see the healing that can happen and the possibility that it’s there. So, yeah.

Heather Sandison, N.D.

I’m so glad you’re speaking to this, because the dynamic can feel really challenging, right, when you have an elderly parent who’s struggling with cognitive decline. And if the spouse is still around, plus multiple kids, you’ve got siblings, those siblings that are adults, they’re managing sometimes a full-time workload, plus their teenage kids, or their kids in college or their grandkids.

David Haase, M.D.

Very challenging.

Heather Sandison, N.D.

Very, very challenging. Lots of tension, lots of different interests, lots of fears, lots of dynamics from childhood, childhood traumas that come up. And I love how you’re presenting it as this opportunity for healing, and for discovering more of our humanity and the people we love most. And that MaxWell becomes this place, this sort of reservoir, this container where that can happen, as Marama has become. And that there is, that there’s some challenge there, right? That it’s not always easy but it’s worth it.

David Haase, M.D.

Yeah. This is what life is, right? We’re living. And I think medical care is all about this militaristic model of, oh, we’re going to kill disease, we’re going to fight disease, we’re going to… But, really, healthcare should be all about how do we create health? How do we discover, enable and enjoy the fullest sense of who we are, no matter what our age is, no matter what’s the challenges going on in our family? How do we discover what an amazing advocate we can be for our parents in a challenging time? And as a result go like, yeah, I did something really hard, and I’m really proud of it and how I’ve done that. You know, at MaxWell Clinic, we’re continuing to grow. We’re seeking out new doctors that want to work with us. We are gonna be training more doctors and, because the need for this is massive. And but to find those physicians that have a great heart and a great head, that want to be humbled by how challenging this is, that want to wrestle with the individualities of challenging patient care but get to do so in a way that they are doing what they went to medical school to do. Yeah. So I see huge, beautiful things happening in healthcare. And it happens one doctor/patient relationship at a time. It has to happen in the sanctity in the relationship of the healing relationships.

Heather Sandison, N.D.

How beautiful. Just beautiful. So I want to go back to, another dynamic that you mentioned was just the financial situation, right? And I would imagine every single person who comes into your clinic and has the financial capacity to do some realm of this, some piece of this, the individualized workup, the shifts in diet, lifestyle, supplements and then eventually, hopefully, plasma exchange. When they’re doing that, they are contributing to the data. Even if they’re not in a clinical trial, that informs you, which you then go teach doctors, right? So there is this really important contribution. And that’s kinda just where we are in the steps of collecting the data, is that they’re each an N of 1 but they contribute to the numbers that you are collecting in your brain, in your clinical brain-

David Haase, M.D.

Mm-hmm.

Heather Sandison, N.D.

database. And I’m curious as well, what, if you could just put aside all the financial components and you had someone, I know this is a little challenging, but say you have someone with a MoCA of like 19/20, right? So kind of mild but present cognitive decline, measurable. And they show up to you and they say, “Money doesn’t matter. What do I do?” What does a plan look like for them? What does the next 2, 3, 4 years working with you look like?

David Haase, M.D.

Yeah. Well, so, did you see my little tensegrity back here?

Heather Sandison, N.D.

Show it to me again.

David Haase, M.D.

You know I love my tensegrity. So the tensegrity structure is something that was coined by Buckminster Fuller. And I think this is the most beautiful, the simplest way to see what a complex system is, right? A complex system is something that is greater than the sum of its parts. And here we got a bunch of dowel rods and rubber bands. It’s an adaptive system, right? It gets a stressor, it changes. And this is the way I see the human physiology. This is the way I see the human experience, that we have, we’re incredibly connected inside, all of your cells connect, talk to every other. And in our experience we’re connected each other as humans. And so I bring that up because I see every person walking in the door as a sacred patient. I think that, and I know this, I don’t have a list here for you, okay? So I’m gonna give you some highlights. But the most important thing is to have an intense curiosity about what’s going on. First of all, help that individual understand why they’re doing this and what matters to them. I actually have a few patient consultations that happen, we dig into this and they go like, “Yeah, you know, this is amazing, this is great. But I actually want my husband to go through this rather than me,” right? And so we’ve had, because it’s actually more important that they are taken care of, et cetera. It’s interesting. I will tell you that everybody that comes through needs to be heard, because the story matters. We need to understand how did this process occur? So everybody will get an extensive history. 

We’re gonna go through and really understand when were you last well and we’re gonna dig deep into that, because those are clues, Because the number of things that can possibly throw off cognitive decline, we have numbered up in around 600 that we’ve identified thus far. And so that’s a huge number of potential burdens to kind of go through and check everything. So we kind of target how we evaluate based upon the history that comes in.We do, like, I recommend genetics for everybody. We do whole genome analysis and whole myotome analysis usually, because neurogenetics it’s come, the cost has come down. And you should look at your genetics as a resource and have it be the last genetic test you ever do as opposed to always doing another genetic panel. This is now your resource that you can keep diving into and seeing what’s there. I’m big into assessing the transcriptome, what happened? What are actually, which genes are actually being expressed? And then we do markers of looking at genetic age. I use a platform called True Age and that looks at 850,000 CpG methylation sites. And it gives us an idea of that individual’s biologic age. We look at telomere testing. And then everybody gets neurocognitive testing to understand how is their brain performing? We do a quantitative EEG. That’s measuring the brain waves and what goes on. And so, and that gets compared against an FDA database, we do an MRI to see what parts of the brain are shrinking and a comprehensive evaluation of gut, immune, toxicity. And then we decide, right? Then we decide. 

Now that we have a good data set, now what are the most important things that we need to focus on? Now, there are some things that don’t need any data, right? This is lifestyle approaches. Everybody needs more, almost everybody needs more movement, healthy levels of sunshine. Deep sleep, always spend so much time improving sleep patterns. Light exposure. We, you know, diet is a huge part and diet can be modified a lot by one’s genetic panels. So but carbohydrate, you know, simple carbohydrates don’t do the brain any good. They just don’t. And you want a plate that’s just loaded with beautiful plant matter. And I kind of think of meat as a condiment. And so, and it depends upon, so the details of diet depend upon genetics and depend upon that person’s manifestation. And then we also do, we’re pioneering work with the microcirculation. So we have a test called the GlycoCheck, and this is a micro camera that goes under the tongue, and it measures red blood cells shooting through the capillaries. We end up measuring about a hundred thousand capillaries, taking about a thousand measurements of each one. It takes like a 9-core computer a good half hour to create a report. And but what that does is it helps us understand what’s the health of the microvascular system? That’s the business end of the circulatory system. 

We pay attention to the heart, and the arteries and veins, ’cause they’re big and we can see them. But actually what matters are the capillaries. And especially since COVID, we’ve seen such just ravaging of the capillaries and this Teflon-like coating in the inside of the capillaries called the glycocalyx. And COVID will just damage that incredibly, but so will oxidative stress and infection. And we’ve been doing plasma exchange, we’re recognizing that we’re drastically improving the function of a microcirculation. And that’s why we’ve been surprised sometimes with people having almost immediate improvement after plasma exchange. And that was very confusing to me, because all of my mechanisms had to do with genetic behavior, and stem cell function and things like that. I was like, well, wait a second, they’re getting better too quickly. What’s happening? So we got this technology, we’re one of only like 60 centers in the US that has this to try to understand and quantify, and hopefully that’s gonna become more available. But so I guess, you know, it’s so hard. this is hard work. There’s a reason that there’s not a lot of doctors doing it, because it’s a very multifactorial problem. Dementia is a final common systems failure. It’s when multiple systems have failed too much and they can’t compensate anymore. 

And then you get this cascading forward of one system after the other, after the other kind of crashing. And then, finally, it feels like it is a unrelenting slippage into ongoing degeneration. And the only way you can deal with that is to pursue the individual systems and start augmenting care in each one of those systems. So, yeah, and I’m really glad you said, what would you, a three or four year like experience because that’s actually the way we frame it, because these are not short-term fixes. It did not, nothing, none of this came on in a short term. And to think that it’s going to go away in the flash of a pan, that’s just crazy talk. And it’s wishful thinking. But, man, the body heals. And if ever there is a work worth engaging, this is worth engaging. Because as an individual who has cognitive decline digs into it, what you see is this wake that happens behind them. And the wake that happens behind them is, wow, their kids start making some of these changes a generation sooner. And their grandkids go like, “Wow, look at what grandma’s doing. Grandma is, she can make changes, she’s getting better. And she did that by the sweat of her brow and the choices that she made.” It creates this opportunity of an example of self-efficacy. And self-efficacy is everything when it comes to creating health. Knowing you can do it is the biggest challenge. 

My practice, you know, I was very proud to have an only-insurance practice for like 15 years.  I did everything I could to stay inside insurance, because I really want this kind of care to be available to everybody, and the challenge, and there was just no way to make it happen. But what happens is that when you see people, so the people who had come to me, there weren’t often barriers of cost. But the people which came to me were the people who had a sense of self-efficacy. The people who somehow in their life had made a choice, and had followed through with challenging things and had made a difference in their life, ’cause they saw me and they went, hey, there’s a doctor that’s interested in the cause, I want to get to the cause, I don’t, I know I’m gonna have to work to reverse whatever cause there is. And they want to, and that was the defining characteristic of who sought us out as a clinic. Gosh, I’ve been doing this over 20 years now. It’s so encouraging to see so many kind of people starting up in longevity medicine and functional medicine. It’s so great to see that happen. But I’ve gotten to see a lot of fads come and go, right? And a lot of them keep recycling and you’re like, oh boy, here’s another person who’s hawking some kind of simple solution, because it’s easy to frickin’ market. And I have no patience for that. I think that we have to be honest that this work is challenging to do. But it’s worthwhile to do.

Heather Sandison, N.D.

You said it’s not just the brain that matters, it’s our humanity and that’s what we treat.

David Haase, M.D.

Yeah.

Heather Sandison, N.D.

That I think just speaks volumes about who you are, how you do take on tough things but the ones that matter. And that you’re not gonna oversimplify, right? You’re not going to sugar coat things. You’re gonna do the hard work with the patients doing the hard work and you’re gonna get results. And that, Dr. Haase, I just, getting the opportunity to see patients with you and to get to know how you work is such an inspiration to me. It’s such a privilege. And you are an inspiration to me as a provider to my patients. And I often think what would Dr. Haase do in this situation? And so I’m just so privileged to get to spend this time with you, to download your wisdom and share it with our attendees, our summit attendees here. And that I just hope everyone realizes how honored and privileged we are to get this wisdom from you.

David Haase, M.D.

I’m just, listen, I’m just doing my thing, you know? I couldn’t-

Heather Sandison, N.D.

Thank you.

David Haase, M.D.

I couldn’t not do this. Okay? I couldn’t not do this. And everybody is, oh, we’re all miracles. We’re all walking miracles, you know? And but it has been an incredible honor to be with you. And thank you for doing the summit. Thank you for bringing education out to people and giving them hope. ‘Cause I think hope is the most important thing. And to start where you are with what you have. Don’t hold out some idea that, gosh, since I don’t have, since I can’t do that thing out there then, oh, there’s no hope. No! Good gracious. The body is designed to heal, the body is designed to heal. And that should be a hopeful message. So thank you.

Heather Sandison, N.D.

Absolutely.

David Haase, M.D.

Thank you, Dr. Sandison.

Heather Sandison, N.D.

Thank you. Thank you.