- The importance of caring for the caregiver.
- Managing stress to prevent dementia.
- Practices for mental and cognitive health.
Heather Sandison, N.D.
What a wonderful second day of the Reverse Alzheimer’s Summit. Thank you so much for joining me. I am going to dive into a little bit more detail about what I do personally at the clinic here at Solcere and also what we’ve learned at Marama about the impacts of stress on the brain, on our cognitive function, and on our risk for developing dementia. So I wanted to go through a little bit more of the science. You heard us refer to some of this today and I know many of you are caregivers who are so dedicated. You’ve shown up here. You are listening to these interviews all day, maybe even all night. And I want you to fully understand your risk here because we cannot serve from an empty vessel, right? We’ve all heard this. We hear this over and over again and I think we get this. Many of you are moms as well as caregivers for maybe an elderly parent and I certainly get this from a mom perspective is we wanna take care of everyone else. Maybe it’s a female perspective, right? We’re always looking to take care of others.
And sometimes that comes at our own risk, right? We forego exercise or meditation or taking that break or getting to bed an hour earlier. We wake up an hour earlier so that we can get everything done to take care of everybody else. And sometimes that means we’re not taking care of ourselves. And I wanna let you know that there is real risk involved in this, right? And not only for you, but this paper here that I’m referring to, this is a little snippet of an abstract where it actually shows that how caregivers take care of themselves impacts how safely they perform their caregiving tasks. So when you don’t take care of you, this doesn’t have to be selfish when you schedule that massage or get that extra bit of sleep, this really is how you increase your ability to take care of your loved one, to take care or do your job if this is maybe even someone that you’re working for. So caregivers average lower cognitive scores compared to normative, and this is kind of generally. So caregivers perform significantly worse on processing speed, so you’re not thinking as quickly or as clearly. And poor sleep is what we believe impacts caregivers. And this is across, so this data, it’s even if you are highly educated. So even if you have a PhD or a doctoral degree, it still reduces your processing speed and ability to respond to information if just being a caregiver does that.
And so I wanna take this to a more empowering message about what you can do, but first, I want you to fully understand that you’ve gotta put your oxygen mask on first, right? If you pass out while trying to help your child or the one that you’re caring for, put their oxygen mask on, you’re no help to anyone and now you just need help, right? Now somebody else needs to help you. So taking care of someone with dementia is a long-term responsibility. It’s extremely stressful. And we know that stress increases our risk of developing dementia. It can lead to depression. Depression increases our risk and there’s some question about if depression is increasing our risk of dementia or if dementia increases depression, but these certainly come together and they perpetuate each other. So depression and related behavioral and cognitive changes among caregivers can in turn affect the status and prognosis of the dementia patient, right? So this is where you’re not putting your oxygen mask on. You’re focused on them and then they end up actually being the ones that pass out from lack of oxygen because you’re so focused on them. If you’re focused on them and you’re not taking care of you, you’re not giving them as good of care. So put your oxygen mask on, make sure your vessel is full, whatever is important to you, you’re getting your needs met. And there are a couple of conclusions that’s drawn out of this science around caregivers and their risk and one is the type of coping strategies we use. So caregivers with higher levels of self-compassion report lower levels of burden and this is at least partly due to the use of less dysfunctional coping strategies.
I love this term, less dysfunctional coping strategies, like getting super angry and upset or pushing, pushing, pushing, pushing, pushing, and burning out. Like these are less dysfunctional coping strategies. Blaming, right? We’ve all got them. We’re all human. So self-compassion is about remembering your humanity, remembering that you’re doing your best. So interventions that develop self-compassion could represent a useful intervention for struggling caregivers. So you have caregivers who, all of them, all caregivers across the board, regardless of levels of education, are at higher risk of developing dementia and having their measurable cognitive engagement, their processing speed affected by the stress of caregiving. So that’s true across the board. And then when we take caregivers who have higher levels of self-compassion, they have lower levels of burden and so they’re less cognitively affected. So we wanna harness that. We want to use that self-compassion. And so the Gupta Program that we discussed today, go back and listen to the conversation with Asha Gupta. He’s a phenomenal resource. And the Gupta Program is really, really beneficial for both caregivers and those struggling, that’s one way to do it. And some other ways to cultivate self-compassion is to write in a journal. So just purge. It’s cathartic to get it all out. And you can either do this first thing in the morning or some people prefer to do it late at night or in the evening, not too late at night.
We want you to prioritize sleep, but even just 10, 15 minutes of writing in a journal, getting it out can be really, really beneficial, and schedule that. Schedule that. Make sure you’re taking those breaks. And then maybe the break is to go write in the journal or even just to go for a walk. Make sure those breaks are scheduled, ’cause it’s so easy to just move on to the next thing. If somebody comes to relieve you to say, okay, I’m gonna get that laundry list of things that I’ve been planning to do done in the next 15 minutes, but take the time to go for a walk. Take the time to go get a cup of coffee with a friend. Take a real break so that you are, again, filling that vessel so that then you have more to give again. Touch. So if you don’t have a romantic partner in your life who you can prop your feet up for and ask to rub your feet, then schedule a massage. Maybe take a Reiki class or a massage class. Find community where you can engage in physical touch. This is so important to anyone, any human being. We are social creatures and touch allows our nervous systems to calm down. Of course, this is healing touch, loving touch.
And so finding that opening for that in your life, whatever it looks like for you. I know different people are in different situations and there are different constraints. Sometimes it’s financial. Hey, I can’t afford the time or the money it takes to go get a massage. Maybe it’s a pedicure or a manicure. That’s a little less expensive and you get nice nails to show off afterwards, but that includes just that massage, that touch. Prioritize that. And sometimes it’s just asking a friend or loved one to, like I said, rub your feet or rub your back or braid your hair, something. So don’t forget about that, that touch just has this very healing component, this regulating component that balances our autonomic nervous system, that parasympathetic sympathetic balance. We want more of the parasympathetic, a little less of that sympathetic that drives that fight, flight, freeze kinda state. Another tool in cultivating self-compassion is to ask, how would you treat a friend? What would you say to a friend? Probably something much kinder than you say to yourself, right? We have these days where we mess something up. Maybe we miss a doctor’s appointment or we’re running late and so we don’t get as much from whatever we’re we’re going to do or we forget that ingredient that we needed for that new keto recipe and now we can’t make it and it was the time that we set aside to do it. Whatever these little things are that come up, maybe we mix up the morning meds with the evening meds and it causes so much stress, and usually what a lot of humans do, I might guilty myself, is berate ourselves.
How could I have done that? I’m such an idiot. Why did I do that? Right? Stop, stop, stop, stop, smile, and reset. How would I treat a dear friend? None of us are getting out of this alive, right? And, but this one body, this one brain, this is what we’ve got. And how would you, thinking through the language that you would use with someone you care deeply about, what would you say if they made a mistake? It’s okay. Try again tomorrow. You’ve got this. What’s a creative solution? There are ways that we can, we all have this mental chatter and there are ways that we can make it worse for ourselves, unfortunately, and drive that heart rate up, drive that blood pressure up. And then there are ways that we can communicate with ourselves or in ourselves that’s kinder. And this is self-compassion, right? Changing your language is very, very similar. Being mindful is the first step around that language, the language that we’re using and being mindful of it, noticing when I’m saying things like you’re such an idiot to yourself, so mean, when we’re doing those things, just noticing and at least giving ourselves that window, that mindfulness gives us that window to respond a little bit differently, to choose a different path. And that’s where all the magic is. Then identifying your needs. And maybe these needs aren’t being met today, but creating a list of what are my needs? Maybe I do need one afternoon a week to go get a massage or every other week or once a month. Maybe I need to be able to get out and get a pedicure once a month. If these are your needs, maybe a need is for time to read, time to pray. Maybe a need is to get another caregiver in or get someone to do some food prep. Whatever that need is, write it down. It might not be possible to fill that need today, but getting it written down and starting to create a plan, maybe starting to ask for help, whether it’s from siblings or a spouse or your children or someone else.
Maybe it’s looking to a senior center for resources, reaching out to a doctor or a social worker who can help get you some help. All of these resources are available. And so I know it takes a little bit of extra effort to get them aligned and it can take some extra time. So these needs might not be met today, but again, be compassionate with yourself, find a little patience, and then put together the puzzle pieces so that you can be getting your needs met. So, so critically important is caring for the caregiver. So, Kirtan Kriya is another tool that I absolutely love and highly, highly recommend. This is a 12-minute meditation that you as a caregiver or you as someone starting to notice cognitive decline can do for 12 minutes, totally free. It’s on YouTube. And I have this picture up of this gentleman sitting in Lotus because this is my favorite one of the YouTubes and this is the one that we use. You can see the same picture is here. This is at Marama with all of our residents gathered around doing their meditation. We use this at Marama. It’s my favorite of these 12-minute meditations. It doesn’t have a lot of a fluff at the beginning explaining why, but there are other YouTube videos that do a lot of that. And I highly recommend kind of understanding a little bit more about this Kirtan Kriya. There is great data showing that it reverses many of the things that set us up for dementia and it’s very, very simple, so just “sa, ta, na, ma.” and I invite you to pause here and jump on YouTube and do this for 12 minutes right now. The 12 minutes, everybody has 12 minutes. It’s totally free, once a day.
It’s amazing and incredible to see the changes that we see just in the vibe in the room at Marama before and after meditation. So this is true for the caregivers who are there. We encourage them to participate and just like you, they wanna go run and do the laundry. They wanna put this on and then go run and clean the dishes or do whatever it is that’s on their list. Oh, I gotta get those medications ready for the next round of them, right? So take the opportunity. I invite you. I implore you, take the opportunity. When the person you are caring for is taking 12 minutes out of their day to do this meditation, do it with them. It will change your world to have a regular meditation practice. And maybe it’s a prayer practice. We use different language, but kind of the same thing, that moment of mindfulness, the mantra, or the communion. So take that moment. This is, yeah, highly, highly effective, again, 12 minutes a day. And I’ll share a little bit of the science. Here it is. I skipped right past it. So an easy, cost-effective meditation technique requiring only 12 minutes a day successfully employed to improve memory in people with subjective cognitive decline, so this is before we can measure it, mild cognitive impairment, which is after we can measure it, but not yet full-blown Alzheimer’s, and highly stressed caregivers, all of whom are at increased risk for subsequent development of dementia. Kirtan Kriya has been shown to improve sleep, decrease depression, reduce anxiety, downregulate inflammatory genes, upregulate immune system genes, improve insulin and glucose regulatory genes, and increased telomeres. So this list, like if only we can put this into a pill, right? That would be incredible.
The good news is, it’s almost easier than swallowing one more pill when you’re on the Bredesen Protocol, right? It’s just 12 minutes a day of sitting peacefully, “sa, ta, na, ma,” over and over. So, sleep, let’s take that one first. We know what a huge impact sleep has on depression, or excuse me, on depression as well, but on dementia, that there have been studies just in the past year correlating even how much sleep and sleep deprivation, particularly in our thirties and forties, with its subsequent risk of developing Alzheimer’s. I see patients in my office who treat their sleep apnea and their cognition improves. We’ve all experienced jet lag or getting on a red eye flight or for whatever reason, being sleep deprived, being a new mom, and how our brain doesn’t work as well when we don’t get that good, solid, regular sleep. So if we can get sleep improvement through Kirtan Kriya, we want to harness that. Now, depression. We know hippocampus is the memory center of our brain, the amygdala, that emotional center of our brain. Lots and lots of cross-connections in there. We of course need sleep in order to make those memories, make sense of those memories at night. And then depression, we see that when people are depressed, that also affects the hippocampus. So we don’t have as much energy basically in the hippocampus and we see hippocampal atrophy. Anxiety, kind of similar in that there’s a correlation with memory with anxiety. If we’re in that fight, flight, freeze state, we’re at higher risk of developing dementia.
So having had PTSD puts us at higher risk of dementia. And then also, kind of like being sleep-deprived, we’ve all been in that state of stress. And this is like stage fright, right? Where we can’t remember what to say. We don’t know what to say. We can’t remember what happened in the past. If somebody ask us a question, we don’t remember the answer. So this is very similar. If we can reduce anxiety through regular meditation, we’re gonna be able to go back and retrieve those memories more easily. Then, downregulating inflammatory genes. So the why of beta amyloid plaque formation, tau protein formation. The why for that, often people will say, oh, it’s secondary to inflammation. Well, why the inflammation, right? We still wanna ask that question. Sometimes it can be the immune system or insulin and glucose, but inflammation, if we can reduce it, chronic inflammation overall, we’re gonna have less of a trigger to create tau proteins and beta amyloid plaques that are associated, essentially the scar tissue of Alzheimer’s. Upregulating immune system genes. We’ll talk more about the connection between like P. Gingivalis and the mouth, herpes, Lyme disease, and how these can all impact, COVID, of course, how all of these can impact how well our brain thinks. So, and remember, so getting that immune system more balanced. Of course, getting our insulin and glucose more balanced. We’ve heard over and over again that Alzheimer’s, it can also be called type three diabetes.
So this insulin and glucose sensitivity in the brain changes as we age. This happens in everyone, not just those people with dementia, and this is one of those great reasons why it makes a lot of sense to switch to keto. This improved insulin and glucose regulation at the genetic level is supremely helpful when it comes to dementia. So, and then telomeres are these end caps at the end of the genetics that help with genetic integrity and this is the largest change ever recorded in telomeres activity happened with Kirtan Kriya, at least at the time that this was published in 2015. There might be new studies out there. So Kirtan Kriya also improves psycho-spiritual wellbeing, spiritual fitness, important for the maintenance of cognitive function and the prevention of Alzheimer’s dementia. It’s easy to learn and practice by aging individuals and I can speak to this at Marama. We often will have people move in and it’ll be really hard for them to connect the right fingers and as the weeks go on, they get right in lockstep with everyone else, “sa, ta, na, ma,” and it’s really beautiful to watch those neural connections form. It is the premise of this review, so this is a review paper. A review paper is kind of up that hierarchy of scientific papers because it’s taking lots of different trials and putting them together. And so the premise of this review, that meditation in general and Kirtan Kriya specifically, along with other modalities, such as dietary modifications, physical exercise, mental stimulation, and socialization may be beneficial as part of an Alzheimer’s dementia prevention program. And I would even go so far to say since 2015, we’ve realized that this is even helpful for reversal. So, and this is exactly what we’re doing at Marama, right? Dietary intervention, where we have our organic ketogenic diet, physical exercise. We take everyone through our circuit every day.
Mental stimulation with brain activities. And then of course, we have the community, that social community, so, and Kirtan Kriya. So I love that they spell out essentially what we’re up to and what you’re up to at home. So creating balance in your life is such an important piece of integrating the Bredesen Protocol at home. It can be easy to get to this checklist of like, yep, supplements, doctor’s appointments, the next thing, next thing, next thing. And we kind of lose sight of like, all right, are we nourishing ourselves really in a holistic way? So what helps you create a level, balanced life, whether you’re a caregiver or someone who is suffering with dementia and really looking to embrace this protocol? It’s a lot to add. We’re all juggling a lot. There’s this glorification of busy. There’s social media scrolling to do. What helps you create more balance? Are there things that are maybe that you don’t really value as much? Maybe it’s rushing off to every other birthday party you’re invited to, or maybe it is social media scrolling, or maybe it’s watching the news and realizing that really doesn’t serve you much. What is it that can help you create more balance? It’s not always taking things away. Sometimes it’s adding. And I’m curious to hear from everyone. Please put comments in the comments section today. I really wanna know what people are valuing and I’d love to help create community amongst us here on the Reverse Alzheimer’s Summit. We learn a lot, of course, from all these speakers, but even more from each other. So please tell other people what helps you create more balance.
There will be someone out there who will say, I haven’t thought of that. I need to reach out to the person in my life that fits that and ask them for help or get together with them. So I wanted to share a little bit about what helps me personally create more balance in my life. So as many of you know, I have a three-year-old daughter and she’s phenomenal and some of the most important part of my day is before she wakes up in the morning. And so for those of you who are caregivers, maybe creating some space, wherever it is. I prefer it in the morning. So my daughter goes to bed a little later, probably, but then she sleeps a little later and I have about an hour and a half in the morning where I can get up and I make my matcha. I love my matcha tea and I put in some, right now I’m using a keto powder, a keto creamer powder, and some raw cream, raw dairy creamer, and not the creamer creamer, but just straight raw dairy and raw cow’s cream. I think it’s like the heavy whipping cream and it’s so delicious. I absolutely love it. And I go outside. I’ll be fair. It’s May here right now and so it’s a little warmer, although gray in San Diego, and I enjoy my cup of matcha outside and then I do a meditation. So my meditation, I love Breaking Beyond, and I just found it on the podcast app. And I do about a 25-minute meditation. It’s guided. For me, like many of you probably, I have trouble letting my mind just go blank and just watching my thoughts. I prefer being led and guided, at least at this stage in life.
And so they’re shamanic kind of journey meditations and I enjoy them. So again, it’s called Breaking Beyond and I think her first name is Jill and I just love her. So that’s what I’ve been doing lately. I think she’s got two or 300 meditations on there and I have yet to get through all of them and probably by the time that I get to the end, she’ll have even more. And then great food. So I prioritize food. I know it gets expensive. I hear that a lot from friends and I just don’t even look. Food is something that I prioritize and I cook for myself, which helps keep the cost down. I am in ketosis, and we’ll talk more about that tomorrow, but having really great food, that helps, and eating regularly, prioritizing meals so that if you’re not in ketosis, your blood sugar isn’t going up and down and up and down, and if you are in ketosis, you’re not stressing about where your next meal is gonna come from and if it’s only gonna be bread and pasta that’s available wherever you’re off to. So making sure that there’s good food available, having a routine around that, enjoying it, savoring it, and having good company. Supplements are also helpful for me. I use them supplementally. So I will take Qualia Mind on big days where I feel like I need to be on. I get a ton of benefit from it. I’ll also take a little melatonin if I’m having I’m struggling to get to sleep. I usually take about 0.3 milligrams, so very small amounts, and that’s enough for me. That works. I’ll also take vitamin D. Helps me in the winter with mood. And I take zinc, which helps me as well. Again, my three-year-old, she’s always coming home with some kind of cold, so it helps me to stay healthy so I don’t get every other cold that she comes home with. And then meaningful connection. So that time with my daughter is so important to me. I prioritize it.
I will leave work on time to make sure that I get that evening routine with her. And I also, I’m in a book club with the girls, women who are my age who are also moms. I love connecting with them. I’m in several other groups where we get together regularly. There’s a safe container created where we can be really open and vulnerable and honest. And I highly encourage you, if you’re a caregiver or someone struggling with dementia, to find a peer group where you can not only have logistical conversations and share referrals, but also just really share your experience so that you feel heard and understood and like you’re not alone. That has been very helpful for me and I think I took it for granted before COVID and now kind of coming back out into society in this, well, I’ll call it post-COVID world, I’m appreciating more and more that meaningful connection and interaction regularly with people who I can relate to and who relate to me. Physical exercise is another one that is so important for me, of course, staying fit, but also just staying sane. So I need to move my body and regularly, and I have to schedule it. Work gets busy and parenting gets busy. Life gets busy and there’s always a lot going on and always something else that seems more important. So I just schedule it and then it’s sacred. Nobody interferes with that. So I go to Pilates these days, twice a week. I have a rower and that because I love efficiency, I use my rower and I live close enough to the beach that I have the luxury of being able to run down there and go for a run or at least a walk and I try to do that around sunset time, especially now that the days are longer, it works out.
And so I encourage you guys. I aim to get exercise five days a week. It probably actually happens four days a week and sometimes I get lucky on the weekends and I’ll get in two workouts. Time management. So this idea of scheduling so important because it is so easy. Even this morning as I was coming into work, there’s 18 emails and if I start with emails, I will just be checking emails and responding to emails for the rest of the day. And if I let other people direct where my calendar goes, I’ll never get control back. But if I have things scheduled, like doing this recording, and I stick to my schedule, it’s on there and it gets done. So I would highly encourage you, if you’re having trouble balancing everything, then make a list of your priorities and then look at how you spend your time and if they don’t align, rearrange it. So my daughter is a huge priority to me, right? And so I make sure that I have time scheduled and my work life is scheduled around my daughter, not the other way around. So look at that, look at your priorities, compare them to how you’re spending your time, and then make sure they match because if you don’t have that congruence, that leads to stress. And then staying inspired. The way I typically do it is through books. I know some people go on YouTube and other people go online and other places. I like to read. I like books, paper books. And so that is how I stay inspired. One of the ones I read recently, it’s just right here. Oh, it’s called, I think I’ve mentioned it. You may have heard it on some interviews already, but I mentioned “How Not to Study a Disease: The Story of Alzheimer’s” by Karl Herrup. This really inspired me.
He lays out just kind of the history, but also the future of where we’re going in terms of the science around Alzheimer’s and other dementias. And I just felt so inspired by that because I feel like part of the conversation, I feel so grateful to be part of the conversation, part of the solution, and that inspired me to work harder. My patients, of course, also inspire me. They’re incredible families. The caregivers who show up here, and of course, everyone at Marama. All our staff and residents there are such an inspiration. So connecting with them, finding those moments where we’re not just fighting with a leak or something needs to be fixed in a house that needs to be managed or somebody needs time off when it’s our busiest time. Right? There’s all of these little things that come up, like coming back, finding compassion, not only for myself, but for others, and then staying inspired. And a lot of these overlap, right? Like I’ll get physical exercise outside. I will have great food with somebody who’s super inspirational and I’ll feel connected. So these things don’t have to be all separate. I love the efficiency of combining them. Time outdoors, really important. A couple weeks ago, I had an opportunity to go up to Sequoia National Park and walk amongst the giants there and it was so healing. And as I mentioned, I like to exercise down at the beach, go out, get outside. So wherever that is for you, that you get sunshine, that vitamin D, you get just that exposure, that looking at the horizon. I grew up in Hawaii and so just seeing the horizon, I think I’ve had some other people tell me. I hope that you’ve gotten a little bit out of me sharing what we’ve seen at Marama, what we’ve seen here at Solcere, and what I do personally, understanding that I can relate. I’m a mom. I’m juggling the multiple businesses and seeing patients three days a week. So there’s a lot going on and it takes a lot.
I get how much it takes to prioritize caring for yourself and especially when it’s a new pattern, that it can be a particularly heavy lift to change your diet, to create new exercise habits that weren’t there before, to start prioritizing sleep when you’ve been told your entire life you can sleep when you’re dead, but these things take some time. It takes some mental ingenuity and some mental energy to learn new recipes, to create that new pattern of going to the gym. So I get it, and we are here to support you. We have multiple ways that we can do that and we’ll be discussing that throughout the week. We have health coaching available at Solcere, which is what comes up for me mostly as we have this conversation. So somebody to hold you accountable, somebody to be there as that extra resource, somebody who can help make sure you feel heard and make sure you understand that you’re not alone. So if you have any interest in health coaching at Solcere, please go to the Solcere website, just Solcere.com, and follow the links to health coaching and you’ll be connected with Whitney, who is here on our team, who can help get you set up with an excellent health coach. We work with only Bredesen-trained health coaches to support caregivers and those struggling with dementia to help them find balance, get on the diet, do all of the components, ’cause it’s a lot. So if you have interest in that, we would love to support you and work with you and with whatever capacity makes the most sense. All right. Looking forward to seeing you tomorrow for day three, where we’re going to do a deep dive into the best diet for brain health. See you then.