Research

Kat Toups, M.D.

Oh, I’m so glad to be here. Thanks for including me.

Heather Sandison, N.D.

You also have a long history of research in this field. And so you aren’t someone like me, who’s very relatively new to it coming and saying, “Gosh, there’s gotta be a better way that we can do this, or let’s apply functional medicine to this very challenging disease.” You’re someone who’s had decades in the trenches, researching solutions to dementia. So can you just kind of tell me, tell us a little bit about that path you’ve taken.

Dr. Kat Toups, MD

Right. So I used to run a clinical trials research center where I did trials with the pharmaceutical industry, and I did over a hundred clinical trials with all different kinds of medications related to psychiatry, dementia, fibromyalgia, things related to the brain. And I was so optimistic with that work that I was doing. Every time I would have a new drug with a new mechanism of action, I’d get excited, like, “Okay, this is gonna be the answer. This is going to help my patients that are suffering.” Well, many of the medications that I worked on, they do help alleviate symptoms for people, but they don’t get people well. And that finally got clearer and clearer to me. And I think the work I did in dementia and Alzheimer’s was very clear. I did 20 long-term Alzheimer trials. 

Many of them went for one or two or more years, and quite a number of patients, and nobody got better. Some of the drugs I worked on were approved for dementia and still are, but they slow the decline of people slightly. And after a while they don’t work, and they’re really not the answer is what we’ve figured out. And so actually fast forwarding to the new drug that just got approved by the FDA, aducanumab for dementia, that drug, the mechanism is that it can wipe… The mechanism of its purported action is that it can wipe out the amyloid plaques in the brain that we know are a factor with dementia and neurodegenerative disorders, right? The amyloid gums up the works of the brain and ultimately kills the neurons. 

And so I worked on a drug in, what was that about 2008, that had a similar mechanism of action. And we could show with that drug it wiped out a substantial number of the amyloid plaques, but nobody got better. They didn’t get better. And fast forward here all these years later, and this drug is approved that in… You know, they finagled the numbers, because initially it was a failed trial, two failed trials. And then they said, well, in a subset of people, it might slow the decline a little bit. 

And so it got this approval, and the notion for me is obviously we’ve all heard about the expense now. And the number that they’re bandying around, $56,000 a year, is just for the medication. It doesn’t include all of the repeated MRI scans and the initial PET scan, the infusion centers, the doctor fees, because it’s a dangerous drug. It causes brain swelling in about 40% of people, so they have to have repeated MRI scans to make sure before the next infusion that there’s no edema in their brain. And I ask people, “Would you want to give your parent a drug with that kind of side effect profile?” And you know, it’s, most people don’t. So the notion of a single drug to fix this complex, multidimensional problem just doesn’t seem to be the answer.

Heather Sandison, N.D.

So let’s talk about what the answer might be.

Dr. Kat Toups, MD

Yeah.

Heather Sandison, N.D.

You recently published a trial with Dr. Bredesen, Ann Hathaway, a number of people who were involved in, so correct me where I’m wrong here. But what I understand is that there were 25 participants that went through the trial, completed the trial, at three different locations.

Dr. Kat Toups, MD

Right.

Heather Sandison, N.D.

And that 84% of those participants had improvement.

Dr. Kat Toups, MD

Right.

Heather Sandison, N.D.

Which is astounding when you compare it to what the alternative is, right? These guys that are talking about a $56,000 drug, they’re not talking about improvement. They’re talking about very small decreases in the progression, right? So some people might not progress as quickly, and that’s their outcome, right? And for you guys, what you’re looking at is actual reversal of disease, right? So if this is like… I mean, they’re total… they’re apples and oranges. We’re talking about the same disease process, but crazy different outcomes. And the, I mean, so wildly exciting in our world that there is an answer. So first of all, correct me where I’m wrong about your trial design, and then tell us what it looked like and what you guys were finding.

Dr. Kat Toups, MD

Yeah, so as you mentioned, it was done at three different sites. So I had two co-investigators that we all follow the same protocol. Drs. Ann Hathaway and Deborah Gordon. And so we all… We had an IRB-approved protocol, and it was a prospective clinical trial. People had to meet particular criteria to come into the study. The cohort that we worked with was a mild cognitive impairment and early dementia. So we’ve definitely had people with dementia that’s farther along that make some progress, but obviously the sooner we can get this, the better chance we have to reverse it and have more healing. 

So people had to have MCI or early dementia. And we had a set protocol that we followed, and kind of the outlines of that are listed in the paper. We all did the same lab testing. We did neuro-psych testing and MoCA testing. So people often ask me about the MoCA. In the old days, when I was doing trials, we primarily used the MMSE, or the Mini-Mental Status Exam. And the MoCA stands for, let’s see, Montreal Cognitive Assessment, and MoCA is more sensitive for MCI or early dementia. And interestingly, I’ll tell you, one of my regular patients that I’ve followed for quite a few years with cognitive decline recently decided to go to the UCSF Memory and Aging Center and get an assessment there. 

And his MoCA scores with me the last time I did it was about a 24. And when he went to the Mecca to have the testing, for some reason, they did the Mini-Mental Status Exam with him, and he scored a 30 out of a 30. So it was an interesting reminder to me of kind of how inadequate the MMSE can be sometimes for picking up the early dementia. And this guy, he’s definitely… We’ve kept him steady for quite a few years and actually gotten some improvement, but he still has some cognitive issues. He should not have…

Heather Sandison, N.D.

Scored perfectly.

Dr. Kat Toups, MD

It shows me the inadequacy of that scale for this population. So for our study, we did rating scales and measurements of cognitive function four different times during the study. So we did it at baseline. We did it at three months, six months, and nine months. So it was a nine-month study. Nine months isn’t a lot of time to do all that we had to do. We kind of had to hit the ground running and move fast and furious on all of the factors that we are trying to correct. And as part of the testing, we cast a very wide net. 

We look at anything that can be affecting the brain. And then our goal is to fix and rectify and treat all of those factors in order to help the brain to heal. And so, I mean, if we had an 18-month trial, I expect we would have seen even more improvement, and what we did see… Actually, can you show the slide of the MoCA and the CNS vital signs? So we did the MoCA testing at each metric point, and then we also did a neuropsychiatric battery. That’s called CNS Vital Signs. And it’s an online test that goes through all of the traditional domains of cognitive functioning that a neuropsychologist would do in a multi-hour test. And it takes about 45 minutes to an hour for people to do, but it’s a validated score that’s been used in other clinical trials. And so what we saw was that we pretty much had continual improvement throughout the study. Let’s see if you can get that slide up or not.

Heather Sandison, N.D.

Is that the one? Can you see this?

Dr. Kat Toups, MD

No, nothing’s showing. It’s black. Okay. It looks like it’s not sharing. So perhaps we can just include that in the notes with the recording, but basically the slide that I was hoping to show, it shows our scales, and you can see steady improvement at all of our data points. So people improved by three months, they improved some more by six months, they improve some more by nine months. So it was quite rewarding to see, clearly we were on the right track here.

Heather Sandison, N.D.

So I’ll just share that we’re doing a clinical trial, very similar to this one in our office. And we are seeing… our end point of our intensive trial outcomes are after six months. And then what we did that was a little bit different was we said, okay, after six months, go ahead and go back to your regular life, your previous life, if you want to. Stay on the protocol if you’d like to, do whatever kind of feels best for you. And then we’re gonna catch up with them at the 12-month mark so that we can see if there’s continued improvement, or if we fall off the wagon, if things kind of start to decline again. 

So we’ll be able to compare some other numbers and hopefully get some more information, because I’m sure, like you, the most common question we were getting from potential new patients and their loved ones was, “Well, if my mom or dad or uncle or spouse does this, if we spend the money and we take the time and we go through all these changes, then how likely is it that they’re going to get improvement?” And based on your trial, the answer is 84% likely. That’s really, really likely.

Dr. Kat Toups, MD

Yeah, it is. It is really likely. And there were even extenuating factors in some of the people that didn’t get better, right? That’s always the important question as well. Why did some people not get better? And I can tell you that several of those people that did not get better were living in moldy environments and did not have an ability to change that. So we know that the mycotoxins from the mold are neurodegenerative and… We also, of course, had the problem that COVID hit in the middle of our trial. And we really had to pivot with that. 

I know that two of my patients in particular, we had turned up mold in their homes and in their own bodies. And we were waiting for the mold remediators to come and help them remediate the mold in their home. But no remediators would come in early in COVID, right? And so they had to shelter in place, stay in their home environment that was moldy. And of those two of mine that were clearly in that situation, one of them took the time that she was stuck at home. 

They got rid of everything they could, cleaned everything they could while they were waiting for the inspector. And she finished strongly by the end of the study. The other person didn’t have the wherewithal and the resources to do that. And he had a slight decline. He was improving. And then he had had a slight decline. He didn’t tank, so to say this wasn’t improvement. I mean, it wasn’t that he got seriously worse, but I do believe the mold was a factor. I know that Dr. Ann Hathaway had a patient, she sent us the photos of the mold all over the walls. It was quite dramatic. That patient had no improvement, and they did not have the funds or the resources to move to clean up. 

They didn’t own the home, and it just wasn’t an option for them. So we’re learning, of course. It shows us the factors of all of these various things that can injure the brain. As you know, the mold is something that many people have a hard time buying into and getting their heads around. But it was a factor for several of our patients that didn’t get better.

Heather Sandison, N.D.

Yeah, this is a big part of my inspiration to start Marama, the residential care facility, is because I had seen so many patients with mold who just felt really paralyzed, right? Their cognitive function isn’t great, because of the mold. And yet they’re in these homes, maybe that… They’ve been there for decades. They’ve raised kids there. They’re very attached to the home. They’re terrified of what might happen if they decide to leave or move, or it’s people who are renting and stuck in leases. 

There’s so many dynamics and things that keep us either financially attached to the house and mentally, or emotionally attached to the house. It can be really, really challenging. And so having a place where the owner, where the management company is thinking about mold and considering that as a factor, I think is just so important, and anyone listening who’s considering a move like that, please ask wherever you’re going next. Make sure that they’re aware of water damage and of potential mold in the building, because this clearly could can affect cognitive outcomes, and not just cognitive function, but so many other health outcomes, that it’s just not worth moving into a moldy place.

Dr. Kat Toups, MD

Right. Right. And you know, it’s also the bigger issue of how widespread is the mold damage in your house? Is it circumscribed to one area? Have the spores traveled throughout all of your belongings? How much do you need to get rid of things that can’t be cleaned, like porous objects, like your books and your papers? I refer some of my patients to people now, health coaches that are specializing in mold, and they call themselves mold coaches. And that’s been immensely helpful, both just for emotional support, how to. ISEAI is an organization that I know you would know about, but it’s spelled iseai.org. And they have resources on there for people looking for mold inspectors, and more how-to. It’s actually becoming more of a research organization. 

It’s an organization of clinicians working with environmentally acquired illness. And so people need so much support. It’s so hard to get their heads around. And I’d like to tell just actually a brief little story about a good friend of mine who had mycotoxin illness and was dementing. And she lived in a beautiful home right on the water in the San Francisco Bay. And we used to have meetings at her house. And every time I went there, I would get a terrible migraine. And I tend to get migraines when I get exposed to mold. And I said, “Do you think there’s mold here?” Well, over time she got sicker and sicker. And I found out that when she first moved in, the inspection reports of her home had identified some areas of mold and suggested remediation, but she didn’t think it was a big deal, right? Most people don’t. 

It didn’t didn’t bother her. It didn’t smell bad. But what happened was she got more and more demented. She got to where she couldn’t even speak. She couldn’t express herself. There’s a form of dementia called logopenic aphasia where, when you talk, people will say, “Um, you know, and then I, I, and I went to uh,” and you can tell that in their head, they’re thinking of what they want to say, but they cannot express it or articulate it. She was like that. It was just so painful for her to try to talk. She got to where she just couldn’t even figure out how to feed herself and get dressed. And she lived alone. It was just horrific. And I kept saying, “You’ve got to get out of this house. We’ve got to get you out of this house.” Well, finally she sold the house, put everything in storage. 

She went to a retreat center in upstate New York, somewhere that did all kinds of detox, and they ate raw food and they did coffee enemas every day. And I don’t know what else she did. She was a friend and not a patient, but at the end of about six weeks, I could not believe how much her brain had come back. It was just bang . It clicked. And yep, she was back to traveling internationally and teaching, and it was quite phenomenal. So I think that for me, it was just such a… It was kind of early on my path of learning about mycotoxin illness, and to see what it was doing to her brain. But I want to say that twice, I saw her decompensate when she tried to take her moldy belongings out of storage and bring some of them back into her life. So once the brain has become sensitized like that, you do have to be really, really careful.

Heather Sandison, N.D.

And the stuff just isn’t worth it. So you mentioned, well, coaching, and I think coaching is such a really important part of both your clinical trial and the design there. Ours as well. This is hard, right? I don’t want anyone to kind of think that what we’re we’re asking is not… It’s not taking a pill, and so there is a lot of kind of retraining about how we eat, how we exercise, what’s normal, what’s not, in terms of sleep or bowel movements or any of these other kind of pieces that are part of being human. And so coaching, whether it’s a mold coach or a health coach or a ReCODE certified coach, some sort of coaching is typically necessary along the way. What have you seen work best?

Dr. Kat Toups, MD

Right, so, oh gosh, I love being able to work with the coaches and the team. And as you said, it’s essential, and courses, but many of the patients’ spouses are aging, and perhaps have their own issues. And so there’s a lot of support that’s needed. And I want to backtrack even to the people, who succeeded in the trial and who didn’t, because it relates to the coaching and relates to the compliance, and the people who did more got more better. So the more you do, all the aspects of addressing the various things in the protocol that we did, the better it gets. 

And one of my patients in the study was an APOE4-4, which of course, if you have a 4-4, and you’re already manifesting dementia, the likelihood that you’re going to progress is extremely high. And he was in the mild Alzheimer’s range. And really, he really could not function in his life in any meaningful way that he previously did, but he could do his protocol. And this guy was the most motivated patient that I’ve ever had. He spent extra time every day doing his brain training and doing his mindfulness training. And he just, he did everything and it had paid off. He he moved from mild dementia to mild cognitive impairment. 

Now, does he have to continue the protocol? Absolutely. It’s gonna be interesting to see what you got from who stays with it and who doesn’t. I did do some, I’m gonna come back to the coaches, but I did… but I do think it’s an important point to make about how to make peace with the aspects of the protocol as a lifestyle, because I did some questionnaires with my patients after three months. And I said, “This isn’t part of the study, but if you’d like to give me any feedback, how are you doing?” And kind of got a sense of who was doing what, and now that it’s been, for some of the people now, it’s been over a year. And I think my final patient it’ll be a year in early October. So I’ll think I’ll go do some more surveys of people. And some of them are still working with me, so I know how they’re doing, but it is important to continue the protocol, for sure. Now the coaches, we had a dream team in the study, because we had a health coach, we had a nutritionist, and we had an exercise coach as part of our team for each patient. And it was so… All of the investigators previously worked with coaches, work with nutrition people, but we all came away with a deeper value and respect for how much benefit that is for the patients to be able to make these changes and shift. 

So in the study, in the beginning, the health coach actually went to the patients’ homes, and they were going weekly and then spread it out a little bit more. So they were able to see how people lived, see where they were struggling, you know, look at the food in their kitchen and help them to start to make these kinds of shifts. So that was immensely helpful, definitely. And then the other part that most of us hadn’t had a lot of experience with was having an exercise coach. And I think the two biggest ways that we know that we can change our brain, the best validated, are exercise and meditation or mindfulness, right? Those are the best-validated ways to increase our synaptic connections in our brain. 

And so exercise is essential for a multitude of reasons, both cardiovascular and emotional, and then cognitive. So our patients were able to go and work with the exercise coaches, who had to pivot also because of COVID and start to do online coaching with them. But it was very eyeopening, because we had our patients do a variety of exercises. So they had to do some cardiovascular, they had to do some strength and balance training, and they had to do some high intensity interval training a couple of times a week. And so I would get reports from the coaches. And one of my patients was a marathon runner. He had qualified for the Boston Marathon, which sadly did not get held in 2020. 

So he didn’t get to go, right? But he was a runner. And the exercise coach gave me a report and said, “Well, he’s not ready for high intensity interval training yet because he has no core strength, and we’re working on the core strength.” And I said, “Well, wait a minute, he’s a runner, right? Like why can’t he do high intensity interval?” He goes, “Oh, he’s completely adapted to that running. That running, you know, he can run long distances. It doesn’t really raise his heart rate.” Like if I went to, you know, go jogging up my hill, my heart would be going crazy, but he was adapted to that. 

So they worked on his core strength first and then gradually ramped him up to where he did some other kinds of high intensity exercise that for him would elevate his heart rate. So, and then I had another person that was also an excellent… She did like, I don’t know, 50 mile bike rides or bike races. And yet she also… and she was younger and she was in good shape, but she also felt like she got really tangible benefits from working with the exercise coach.

Heather Sandison, N.D.

Wow, wow. That’s so interesting.

Dr. Kat Toups, MD

So I have one more to tell you. I have one patient that was in my study who never exercised in his entire life, never. His only exercise was walking a small dog, which isn’t really much exercise, right? But he also was so motivated in the protocol. He did everything right, and fairly early on, he said, “I’m really kind of liking this exercise.” Once you get over the hump, right? It’s really when you’re de-conditioned, and it’s a struggle, but once you start feeling some success from that, he just, he really enjoyed the exercise, and for his vacation, it was his honeymoon, I believe at the end of the study, he went kayaking, ocean kayaking in Monterey. 

And I don’t know if you know, people in other parts of the country probably don’t have access to ocean kayaking, but it’s a very strenuous exercise. You have to have a lot of strength and stamina. So he did it for fun. And so I think to highlight the importance of the coaches and of all kinds, and at least in the beginning of the protocol, getting a lot of support, I think can really, really make the difference and the success for people.

Heather Sandison, N.D.

Yeah, certainly we’ve seen that. Whenever I’ve talked to Dr. Bredesen, his first question, if there’s a patient that I’m struggling with, “Are they in ketosis? Are they in ketosis?” And so measuring, and that’s of course the luxury of being in the trial is that we are measuring frequently. And then also that the coaches can help to troubleshoot, because ketosis is a state of metabolism. And so it’s not always just about what you eat, but how you personally metabolize it. And a wife might metabolize it different than a husband, or a son or daughter, and so making sure that that coach is there to figure out and troubleshoot and help them discover what a ketogenic diet looks like for them.

Dr. Kat Toups, MD

Yeah, well, and ketosis is another interesting aspect of the study. So Dr. Bredesen wanted to have everyone in ketosis for the study, and you know, that, of course, some people can keto adapt really easily. Perhaps their blood sugar’s already low, and they’re already eating low carb, and other people have a very difficult time with getting into ketosis, especially if their blood sugar is already high, but sometimes that wasn’t always the factor. And one of the things that we’ve discovered is that it’s worthwhile, if you’re going to do ketosis, to really get a little deeper into ketosis. 

So if you’re doing a finger stick levels, like I believe in our study, we wanted to have people around 0.9 to 1.3 as a minimum, I forget the exact numbers. But what we discovered was that people that went deeper into ketosis actually often did better. So I would say for people that are trying a ketogenic diet, you know, try to take it farther. And so the people that got two levels of 2, it actually seemed to have additional benefits than people that were at a level of 1. 

Now in our study, we were using the Keto-Mojo finger stick method, but there’s a newer breath meter that’s come out recently that seems to be well-validated, and it’s an upfront expense. I believe it’s about $300 to buy it. And I know Chris Kresser sent me a podcast that he did with the person that did this. I believe it’s called Biosensor. Gosh, I’m blanking on the name.

Heather Sandison, N.D.

I think it is, yeah, Biosense.

Dr. Kat Toups, MD

Is that it, Biosense?

Heather Sandison, N.D.

You know, we tried it and we couldn’t get it to match the fingersticks. So I think maybe it was user error, but we haven’t gotten that one to work quite yet.

Dr. Kat Toups, MD

So it didn’t work so well for your patients?

Dr. Heather Sandison, N.D

Not for us. We’ve tried it at Marama. And we’re comparing finger sticks to the breath meter and yeah, couldn’t get them to match, but we’ll keep trying.

Dr. Kat Toups, MD

Well, was it not correlating with the blood levels?

Dr. Heather Sandison, N.D

No, it wasn’t. Yeah.

Dr. Kat Toups, MD

Well, and you know, I’m not a super expert in this, but you know, I have read that some people think that measuring the breath levels are actually going to be more reflective of what’s happening in the body, than the blood.

Dr. Heather Sandison, N.D

Oh, versus the finger stick.

Dr. Kat Toups, MD

Yeah, that the breath will actually be more accurate than the finger stick.

Dr. Heather Sandison, N.D

Okay. Okay. Yeah, maybe.

Dr. Kat Toups, MD

But I haven’t used that. I haven’t had an occasion to use the new thing yet, but perhaps you can speak with the person in the company and I’ll send you the link for Chris Kesser’s interview. And he does also have a discount code in there for $30 off for people if they want to try it. But it seemed like the person that he was interviewing from the company was very knowledgeable about this. Because certainly it’s much easier, right? 

If people can check their breath, if they can eat something and they can breathe and 30 minutes later, 60 minutes later, has this kicked me out of ketosis, you know, much easier than doing repeated finger sticks. And of course, ultimately much less expensive because every test strip for the finger stick is about a dollar a strip. So even if you did it once a day, that’s $30, but if we can make it work with the breath meters, it’s gonna be.

Dr. Heather Sandison, N.D

I couldn’t agree more. There should be an alternative to the finger stick, because it does take that repeated measuring to really know if you’re getting into ketosis, and it’s hard, yeah. You got to prick your finger, which is like more painful than most things, way more painful than it should be.

Dr. Kat Toups, MD

I would say, you probably know this, but if you’re pricking on the sides of your fingers, it’s less sensitive than the fingertip.

Dr. Heather Sandison, N.D

Thank you for that tip. No, everyone should know that. Prick the side. And then also when you go to type or do something later, you know, that again, and then, yeah, like you’re saying, the expense, it’s just crazy high. And so typically what we’ve been recommending is that if they are doing the finger prick at home is to kind of try a few different foods. So if there’s a food that you have some question about, do it after eating that.

Dr. Kat Toups, MD

Right, right. Exactly. I had one patient, not a study patient, but somebody doing ketosis. And before his appointment with me, he stopped at Roam Burger, which is a place with free-range burgers and organic salads. And he had some sweet potato fries, and he didn’t eat the whole thing. He ate a little bit of the sweet potato fries. And then he came in and then we checked things when he was in the office, and he was still in ketosis. So he was able to eat a little bit of sweet potato fries.

Dr. Heather Sandison, N.D

That’s great.

Dr. Kat Toups, MD

And so of course there’s a difference, right? In how much one person can handle versus another.

Dr. Heather Sandison, N.D

And also how keto adapted you are, right? If your body’s gotten used to being in ketosis, then you can usually have a little bit more of something that would raise your blood sugar, versus if you’re brand new to ketosis.

Dr. Kat Toups, MD

Yeah. Yeah. I want to apologize for the background noise. My dog just woke up and he came and was drinking and now he’s huffing, ’cause it’s hot here.

Dr. Heather Sandison, N.D

What else did you learn that was maybe unexpected from the trial?

Dr. Kat Toups, MD

Oh, well I wanted to mention our radiology data, because that was very unexpected. So as part of the study, we did an MRI at the beginning and the end of the study, and we did NeuroQuant, which probably a lot of the listeners are familiar with. But for the ones that aren’t, NeuroQuant is a special software program that we can upload the MRI data to that will give us a volume metric measure of all of the brain structures. So it’ll tell us the size of everything in your brain relative to an age-matched control. 

And so that gives us a snapshot of what areas are atrophied. And actually some areas that we see are enlarged or edematous. And that sometimes happens when there’s things triggering your brain, like the mycotoxins or you have infections, you know, Lyme disease, viral infections, if you have a heavy metal load. In the beginning, insults to your brain, first off, the inflammation is created, and you will have swelling and edema, and then the longer that goes on, eventually the neurons start to die. 

So it gives us a picture of what’s happening in people’s brains with the volumes. But we also had traditional neuro-radiology looking at the measurements of things, and we had at least two patients that, just looking at their gross MRI, things got better. One of those was mine. I was just shocked, because nine months is not very much time. And do we really expect things to get better on that much of a level to see a change in an MRI? You know, we didn’t expect that. So we had a couple people that, just looking at the MRI, actually had improvement in structures. But when we looked at the overall measurements of things, one of the things we look at is the gray matter in the brain. And that tends to atrophy fairly early with dementia and continue, and so when you have just normal aging, you would expect some decline in things in the brain. 

But in our study, the patients actually got better overall in their gray matter. Let me see, I have the statistics here, because I can’t remember exactly. So with typical Alzheimer’s, your gray matter would decline 2.2 to 2.4% a year. And in our patients, rather than declining, they increased by 0.3%. So normal decline, 2.2%, ours improved 0.3%. And actually with just normal aging, you would expect a decline of 0.8 to 0.9%.

Dr. Heather Sandison, N.D

That should put to rest any question of can I reverse dementia, right? Like this should be, I mean, I get now why Dr. Bredesen says this should be a rare disease. Alzheimer’s is optional. We can make changes to our lifestyle. We can see doctors like you and get better. People can get better. There is hope, and there are answers to reversing this awful, awful disease. And not only can you measure it in terms of patients’ experience, patients’ cognitive function, but you can see it in a picture of their brain.

Dr. Kat Toups, MD

Right. Right. And we saw also, again, unexpected, but the hippocampal volumes. So the hippocampus is a structure that one of the first things that does also decline with dementia, with Alzheimer’s dementia. And that’s our memory center. All our memories are stored in process to the hippocampus. And our patients did have a slight decline in their hippocampal volume, but it was, again, clinically different and statistically significant from normal aging. And also from, of course, dementia, where you would decline much farther. So there was still some decline in the hippocampus, but better than people without any cognitive problems. 

Again, those were our kind of blow-us-out-of-the-water changes. The most important thing really is not those numbers from the MRI, but how are you doing clinically, right? What’s happening in your life? And one of the interesting things that we noted is, you know, we were talking about this on a call afterwards. In early Alzheimer’s, there’s so much stress on a couple, right? You know, somebody’s declining. The other person is trying to understand why won’t they do this and why won’t they do that? And it’s a stress on the family unit, because everybody has their roles in a family. 

It creates just so much marital tension and stress that, you know, we had to sort of become marital therapists in the beginning of the study and help keep reframing things and supporting the spouse without the cognitive decline, because it’s so painful and frustrating. And I say that was an unexpected benefit, or expected. If people are getting better, you could see that the spouse’s stress levels went down, and we weren’t having to give as much emotional support to the spouse as time went on.

Dr. Heather Sandison, N.D

You know, that’s part of what inspired me to just go into this field to begin with is I feel that Alzheimer’s is so tragic, because it doesn’t just take that patient. It takes the caregiver, takes the spouse, it takes someone else with them. And by freeing up, by making Alzheimer’s a rare disease, by making it reversible, by showing the world that this is possible, you don’t only get relief to that individual. You get relief to everybody around them who’s affected by their disease process.

Dr. Kat Toups, MD

Right. Right. I think it’s so important what you’re doing with your facility, because we have people that have no one in their lives to support them, right? They want to do the protocol. And it really, and if you’re, you know, have very mild impairment, you can probably do this protocol on your own without support. But if you’re a little further along, it really does kind of take that village of people to help you with the accountability.

Dr. Heather Sandison, N.D

So I would imagine that with these amazing results, it begs the question of what’s next. So many people, and I think it’s a valid criticism of our field is that there’s not enough research. And it makes me sort of want to like shake something, because I’m like, “Why are all these billions of dollars and decades of brilliant minds going into chasing these medications?” And of course, there’s financial pieces to that puzzle, but there’s so much going down a rabbit hole that we’ve proven over and over and over again doesn’t help. And yet there’s this incredible research, and what we knew before, even, that this was possible, that these diet and lifestyle, and there are other interventions, of course, the detox and the hormones and the other things that we do, but this works and it works well. So how do we fight back so that no one can say any longer that there’s not enough research? What does that look like?

Dr. Kat Toups, MD

Right, and that certainly has been a criticism. It’s been a criticism. I mean, I’ve read many criticisms of Dr. Bredesen’s earlier papers, and they’re saying, “Well, you don’t have data on this. You don’t have data on that.” Well, those were case reports. They weren’t studies, right? People were criticizing them as if they were a study, but they weren’t, but this is a study. And it’s a start. We learned so many things from it, many things we want to incorporate, things we can do better. 

So our benefactor for this study has already committed to the funding for a larger study, bless her heart. We’re so grateful. And this is the Four Winds Foundation, but it’s a private individual that’s funding the research. And the next study is planned for 100 patients. So a larger sample size, obviously, the more statistical significance, and it’s going to be a randomized trial. And half of the people will be randomized to doing our methodology and half will be randomized to standard of care for neurology. And they will still meet with us. We’ll do the testing.

 And these days it does seem like many of the traditional neurologists are incorporating diet and lifestyle changes, but they won’t be required to be in ketosis and do the kind of, all of the other interventions we did in this study, which I should probably say a little more about, but so I think it’s gonna give us a lot more perspective. Now, we are just in the very earliest thinking about that, planning stages, but I think that Dr. Bredesen would like to have the people in the standard of care arm at some point cross over into the active treatment arm so that we can have them as a control group, but then also incorporate them, because it’s very hard to, once people know that this method gives so much hope, to forego the treatment for that. 

So that would be a way to, if they comply with the standard of care arm for a period of time, maybe six months, that then we can offer them the benefits of having some of the extra resources that our study patients have. So there’ll be more investigators with that, more sites, you know, and I know that Dr. Bredesen has decided on a couple of people, one of which is in south Florida and one is in Ohio. So different geographic areas, right? Because the three investigators, we’re in a pretty small area. Two of us are in the San Francisco Bay area, and one is in southern Oregon. So we’ll have more diversity, I hope, in the next study.

Dr. Heather Sandison, N.D

That’s fantastic. How exciting. And each time, each iteration of these trials, there’s more and more and more to learn, right? There are these subgroups, like, could it work for Lewy body? Does it work at different stages? Could it work for people who have a MoCA of 12 or 2? You and I both have instances in our clinical practices where we have seen people at that level improve, but then to get it into the literature, to have it in incorporated it into a study so that we can be really in a validated way, answering those questions from loved ones. How likely is it that my loved one is going to get better?

Dr. Kat Toups, MD

Right, because as you said, it’s not easy. It’s not an easy protocol. I had patients that were working, that pretty much in the beginning had to really curtail their work or stop working for a while, and then were able to resume things as they made peace with all the aspects of the protocol. So it really does take a big commitment. And so I think the more we amass this data to show that is this commitment worth it. And I believe, yes, it is, because we all know the alternative. 

Some people just can’t go there, you know? And it’s the most painful thing when a couple comes on the spouse, who’s not affected, wants to support the patient to do the protocol, and the patient doesn’t want, they’re like, “Oh, no, I don’t want to change my diet. I don’t want to exercise. I don’t want to do all these things.” And you have to just honor that, right? Because if they’re not motivated, it just doesn’t work. And so some people-

Dr. Heather Sandison, N.D

I think that they could be in your control group.

Dr. Kat Toups, MD

Yeah, for sure. But no, it’s super exciting. And I just definitely want to maybe say a little bit about that having COVID has opened the eyes of the academics and, you know, traditional medicine to the effect of a virus on the brain. And that’s one of the things, that many people have in the last few years, five years, 10 years, have come to the conclusion that yes, we need to have diet and lifestyle changes for dementia, but for most people that is not enough. And so that’s where you start, right? The diet and lifestyle changes and the sleep and the stress reduction, but there’s still a reason that your brain is degenerating. 

And so it’s important to look at all of those factors. I mean, it’s long been known the metabolic factors, the high lipids, the high blood sugar, okay. And interestingly, I mean, fairly expected benefits, but we saw dramatic improvements in people’s lipid levels. I had people that… one person that came in on a statin and got off of that statin pretty quickly, people who were in the prediabetes range that came down to perfectly normal, sometimes within three months time, dramatic reductions in their CRP inflammatory levels. 

So that was a consequence of the program, lots of people that lost weight that they needed to lose. So that was great, but the infections are such a huge issue in the brain. And now with COVID, it’s actually, the term brain fog has come into the vernacular, and previously a patient would go to doctor and say, “I have brain fog.” The doctor would be rolling his eyes, “Oh God, here’s another psych case here.” But now it’s quite acceptable for us to understand what this virus that gets into through our nose and into our lungs is going to our brain. And people are having so much cognitive problems, even young people, that it’s really lending credence to the notion that we’ve got to be looking at these infections in the brain, that they’re a huge trigger for dementia.

Dr. Heather Sandison, N.D

One other point that you bring up here around other markers, normalizing. So hypertension, we’ve certainly seen, even depression, anxiety seemed to resolve. And you mentioned the stress between spouses. We are encouraging people to not drink as much. So, I mean, but also, liver enzymes and kidney functions and things across the board are improving. That’s the side effect of our intervention for dementia, versus what you talked about about, that aducanumab. Did I get that right?

Dr. Kat Toups, MD

Oh, yeah, good. Aducanumab.

Dr. Heather Sandison, N.D

This new intervention that was FDA approved, the side effect is brain swelling and micro hemorrhages, so brain bleeding. When we start to look as a society about what adds value, what’s worth $56,000 in our society, but is it this approach that can reduce healthcare spending overall in most cases, or is it this approach that might get a slight reduction in the pace of disease progression, plus add all these other issues that are expensive, right? 

I guess it’s just crazy making to me to put these side by side, and you have a slide here that will be in the show notes that shows that no treatment, so basically the changes in cognitive score, when you look at no treatment, is a decline by about a 3, 3.5 if there’s no intervention at all. And then aducanumab is a decline of between two and three points. And then your trial on the flip side is an improvement of three to four points. So when we think about where our collective resources, so when we’re talking about Medicare, these are taxpayer dollars, when we talk about this and where it comes from and where it goes, it just, it feels like there should be a little more thoughtfulness put into what happens next.

Dr. Kat Toups, MD

Right. I hope with a bigger trial and more exposure that the more academic world and the NIH funders will take more notice of this. We are applying for publication with the Journal of Alzheimer’s Disease. And that’s an interesting journal that is now featuring papers with all of these different kinds of interventions that we did in the study. And when Dale Bredesen spoke to the journal editor, he said this is definitely, I forget the exact word, but you know, a rather groundbreaking study, and he said, “I’ve really come to the conclusion that we need to have multimodal factors of treatment here.” 

Right, that it’s not just one thing. And so that journal is featuring all kinds of things about meditation and inflammation and infections. And so it’s creeping into the consciousness of people, but it’s hard to shift the medical machine. People, they know what they learned, and this is a different approach. And it’s a stretch for physicians also to be knowledgeable about all the kinds of things. I mean, I’ve learned functional medicine over a decade now, but it’s a big shift from traditional medicine, for us to learn all of the factors when, especially some of us that are specialists and know one particular area, have had to become quite a generalist and reacquaint myself with all areas of medicine that I was ignored previously in psychiatry. 

In psychiatry, we were just taught about the brain and the notion it didn’t connect to the rest of the body. Well, that’s wrong. You know, if we want to fix our brain, we have to fix all the things that are wrong in our body.

Dr. Heather Sandison, N.D

And how nice that when we’re fixing in our brain, we are fixing all of the other things that are wrong in our body, right? We’re getting the little twofer there. I thank you for just reflecting that perspective. I am not someone with a terrible amount of patience. And especially when it feels like people are suffering unnecessarily, right? When there is a solution, and there are so many people really desperate to find it because they themselves, or a loved one is declining. I’m just so grateful to you for getting the word out, for dedicating your career at this point to this. And it’s hard work, and not all days are great. Certainly the ones where you see people get improvement are fun, but it’s hard. It’s hard work, and it’s a lot, so thank you.

Dr. Kat Toups, MD

People ask me, they say… Well, the average improvement in the MoCA score was a little over three. You know, it’s a 30 point scale, but I had patients that came in with a MoCA of 29, and I’m sorry, 19 and 20, that have improved to a level of 30. So some improved a little, but some improved… I mean, I have, I would say, six or of my patients, there’s no way they would qualify for a study any longer. They test perfectly. They may have some issues that they’re not the way they were when they’re 40, but some of them are just functioning absolutely beautifully. And of course we know the flip side. 

Without intervention, they would have continued to decline. So I think it’s just so important for people. The more we get this word out. I tell people when you’re, with aging, and unfortunately aging starts to happen in our fifties these days, if you think you’re having a problem, you probably are. And one of the patients in my study had been seen a couple of years earlier at Kaiser. I think he was about 62, 63 in the study, and he was tested, and they said, “Oh, well, you’re, you’re not bad. Only one score is low here.” Well, that one score was his verbal memory. And it was quite low. It was like 19, 20 percentile or something. And this guy was a physician, right? It should have been quite high. And he was running a startup device company of something he invented, quite a brilliant man, and fast forward a couple years later, he came to the study, and that particular score had declined even further.

 And other scores had declined. And at the end of this study, that score was back to normal. So again, without intervention, he would have kept going. And so I think it’s just, thank you for all that you’re doing to get this word out, because we definitely want people to know there is hope, and pay attention when it’s early, because it’s so much easier for us to reel people back in and get things better before the decline is too much.

Dr. Heather Sandison, N.D

Yeah. I love that message, right? If you notice decline, say something, do something, get help, act immediately. For so long, people have been told that there’s nothing you can do. There aren’t good options for treatment out there. And so instead they kind of hide it. They either go into denial or they hide it. They don’t want to tell anyone, their spouse doesn’t wan anyone to know. They don’t want to be shunned or treated differently by their peers. And it just is allowed to progress. And the hope that we want to send out there is like, “No, there is stuff you can do, but you want to act quickly.” So ask for help now.

Dr. Kat Toups, MD

Well, and I think that’s a great point. Just the normalization of talking about it, that it’s not a failure if you’re having trouble with your memory, right? There’s no fault of yours. And you know, you’re not a bad person, kind of thing. The same as with mental illness, right? It’s just the more we normalize this, everybody has mental illness in their family. It’s not a weakness, right? There’s reasons that psychiatric illness happens, just like with dementia. So I do think that people are telling their stories. And I know one of my patients in the study, she’s a physical therapist and Pilates instructor, and she’s got a rather large following. And I know she’s incorporated, she talked about her path all along in the study with her classes and her followers. And she’s somebody who finished, her MoCA is a 30 now, you know, she’s-

Dr. Heather Sandison, N.D

Wonderful.

Dr. Kat Toups, MD

She’s perfect, so Dr. Bredesen also, I think he has a new nonprofit, and he’s gonna be launching a website where people are going to share interviews with their stories, because we need those stories to come out, as well as we need this data, to put a human face to it and to say, “Okay, this was happening for me. I did this. And look at me now.” Because we needed to come out of the paper and into people’s minds and their hearts to really, really believe and know that there’s a way. Now, does this work for everyone? No, it doesn’t. You know, we don’t have all the answers. I don’t want to say, “Oh, we have this method that helps everybody.” You know, they didn’t all get better. But certainly a large preponderance of people got better. And I think with more time and effort, more could have been done with some of our patients. And as you mentioned, there’s different types of dementia.

We didn’t, because this is early dementia. I mean, if somebody like with Lewy body dementia, oftentimes you’ll have hallucinations early on. So that would have been excluded in this study, though. Nobody applied for the study that we excluded for that factor, but it was an exclusion factor, but we have all seen in clinical practice that applying this methodology of looking at all the factors that are affecting the brain and doing everything you can to fix those and then do brain rehab, it can be beneficial and worth trying in any kind of dementia, any kind of neurodegenerative disorder, because again, what are the alternatives? This really might help you, and it’s worth trying in my mind, for sure.

Dr. Heather Sandison, N.D

Absolutely. That’s one of the questions that has come up in these conversations with a patient and their spouse, when they do feel like it’s challenging. We noticed that usually around three, four months, it gets really hard. You know, people have been at it. They want to go on a vacation or they want to take a break. They want to go back to seeing their friends. All of the ways that your lifestyle is impacted by this, it’s significant, especially depending on where you start. So when we have that conversation so often where people end up is, “Well, if I don’t stick to this, what’s gonna happen?” And that is really scary for people, right? They give up on the hope, but they also know the alternative is they can expect pretty rapid decline. And so there’s two pieces here. It’s actual results, but it’s also the hope that it engenders.

Dr. Kat Toups, MD

Right, right. And then just continuing to learn things and site types and you know, who does what. I mean, the sad thing is that we’re seeing cognitive decline earlier and earlier. So when I did my training in the late eighties, and all the trials that I did, I remember one person clearly who had dementia in her early fifties, and I might’ve had one other. And when you get dementia earlier like that, it goes faster, because it’s often more infectious and toxic kind of causes. Now, when you get dementia after, you know, 80, 85, it’s generally a slower process for people, but with the toxins and the stress in the world, we’re just seeing people getting sick earlier and earlier and earlier, and my patients, I would say half of them in the trial were older. 

Our age range was up to 76, and there wasn’t really a lower age range that I recall. And I think Dr. Ann Hathaway had somebody that was 50, 51 in her trial, but I had a fair amount of people in their late fifties, early sixties in my trial. And typically, that’s not what we think of with classic Alzheimer’s, right? So just recognizing these factors, and some of the things, we certainly, we tested a variety of infections. We turned up a lot of Lyme disease and a lot of tick-borne infections. 

And we know that the spirochetes… Lyme is a spirochete just like syphilis is a spirochete. And it goes for the joints and it goes for the brain. Some people it just goes for the brain, and they don’t have any joint manifestation. So that absolutely has to be screened in every patient with cognitive decline. And again, if you catch that early enough, you can make a difference in that. But there have been reports. There was a paper of a report of a woman who was treated for Lyme, no longer tested for Lyme, but when she died with dementia, they tested the amyloid plaques, and she still had active Lyme in her brain. So the notion of the Lyme persisters, and you know, how much treatment is enough treatment? A lot more research needs to be done with that, but you know, that’s a huge factor of looking at the infections. 

You know, we’re working a lot with all the hormones, supporting all of the hormones that we know are trophic for the brain and restarting those and getting all of those in balance. And then people looking at the chemical toxins and the metals. We see a lot of mercury, definitely. and that’s been known to be a neurotoxin since the 1800s, and the mercury, much of it is from the fish. And I had people with very high levels of mercury that in six months of no seafood and giving them some liver support and, you know, detox support, it would come down to zero. So you can get rid of that, but you have to know it’s there, right? And then when you resume eating the seafood, you have to eat the small fish, the smash fish that aren’t accumulating the mercury and no more tuna, the big fish that have a lot of mercury. 

So, yeah, so many factors to look at, but we can look at them all. We can test all these things and we can then have a picture upfront of here’s what we need to do with our treatment plan. We need to do protocols for this, this, this, and this, and everybody’s protocol was different. But my real hope is that we will find a way with economy of scale to make it less expensive for people, have supporting groups. I’m just hoping that institutions like Kaiser would work with developing programs, because of course, an ounce a prevention or early treatment is gonna save a lot of expense later. And for big medical organizations, it’s about the money. They need to make a profit. Right. 

So, okay. But I think to look at the economics of this, economics of treating it early. There’s an upfront cost when you’re initially treating it. But once my patients are doing well, they don’t need to see me very often, twice a year. I mean, it is labor intensive in the beginning, but then things are good. Just keep things in balance.

Dr. Heather Sandison, N.D

That’s so exciting that there are these solutions out there. I’m curious, did you read the JAMA article recently that was talking about the centenarians? I think they were Danish, and they were finding that normal cognitive centenarians, so people over a hundred years of age, when they passed away, some of them had amyloid plaques in their brains, and quite significant amounts, but it didn’t seem to affect their cognitive function. So I’m curious, do you think that we need to, is that reason enough, in addition to some of the other literature that shows that when we reduce amyloid plaques, sometimes cognitive function gets worse. Should we be throwing out the amyloid hypothesis, or should we be just taking it into consideration, but in a different way? Where do you think we are on that?

Dr. Kat Toups, MD

So I think we need to think about what is causing the amyloid deposition, right? Because it’s thought of as a protective mechanism. When there’s something triggering your brain that can injure it and it’s causing inflammation, the amyloid is secreted to kind of wall off that little wounded area of the neuron and protect it. So in the short run, a little amyloid is okay, but if you’re having an ongoing infectious or toxic process, that’s gonna keep irritating your brain and triggering your immune system, then you’re gonna get more and more amyloid. And so there’s a point where it’s too much. 

So a little bit is okay. You know, if it’s just the body doing its job to protect the brain, but it’s just removing these toxic insults. But I think it’s fascinating, of course, plenty of people do die with brains full of plaques and tangles that are an Alzheimer’s type process that don’t manifest the cognitive symptoms. And we definitely want to continue to study those people. What is it, what are they doing? To me, I think that the people that stay active mentally and physically is huge, right? We know that retirement is a risk factor for dementia. If you retire and you decide to sit home and watch TV and you know, not do so much, your brain is gonna atrophy without the stimulation. 

You have to stay engaged mentally with people, you know, stay connected with people. I mean, it’s been a hard thing with COVID, right? Shut people off from their peer groups. I had a patient with dementia, actually the one that was in her early fifties in one of my trials, and husband was still working, a high-powered professional. And he said, I don’t know what’s wrong with my wife. She won’t drive to San Francisco anymore. And I said, “Oh, no, she can’t drive to San Francisco anymore.” Right, part of the marital understanding here. I said, “She’s sitting home alone all day, because she doesn’t have the wherewithal anymore to get herself out of the house and do these things.” I said, “You need to get a caregiver for her.” He had the resources. I said, “Hire a caregiver companion to be with her every day, take her out exercising, take her out shopping, take her places.” And I didn’t know any of this stuff that I have learned in my functional medicine path now, but I knew that she needed that stimulation. 

And she did improve with those things, and the caregiver took her out swimming every day for exercise, and it was a benefit. So all of the things of these healthy aging people, that is just, I think it’s staying fit physically active and strong, because the physical… If you’re strong with your exercise and you’re not weak and short of breath, then you’re gonna be more active, and all of that helps helps the brain. And we also did brain training in the study. We had our patients doing brain HQ training, and so it’s kind of, people have come with way beyond crossword puzzles, but crossword puzzles are fine. You know, there’s nothing wrong with that. Anything that’s triggering your brain. Like I always say my brain training is where have I filed things in my Dropbox, right? I have a thousand files in my Dropbox. 

I’m always saving papers and this and that, and okay, which file did I put that in? That’s my brain training, but the brain HQ training was… They also do lots and lots of research, and they have validated, they’ve looked at, like they know that certain of their tests, one of their tests is called, I mean, it’s not a test; a game, called Double Decision. They did a study where people did, I think, 40 hours of training on Double Decision. And then they looked at ’em again, I believe it was 10 years later. And their risk of developing dementia was greatly diminished. And then they had a cohort that did a booster training a year or two later of another number of hours, and that group’s risk was something like 40% less. 

So keeping that brain engaged and active, and even those people didn’t continue to do it. But if you continue to do things for brain stimulation, you know, how much better will your brain be? And they even have data that they can increase the acetylcholine levels in the brain, which as you know is a neurotransmitter involved in memory, right? And we want to keep those levels high. They have data that some of them helped schizophrenia cognition, some of them help depression. So doing this simple little brain training 10 or 12 minutes a day is one more thing to help make new connections in your brain.

Dr. Heather Sandison, N.D

Whenever a patient is kind of pushing back about needing to do something like that, I also remind them that learning to shop differently, learning to cook differently, learning to prepare foods. You know, if now you’re roasting and you’ve always sauteed, you know, just now you’re using an Instapot and you’ve never used an Instapot before, that that is a type of brain training, that planning, that’s kind of this executive function idea, it’s also the type of brain function and cognitive ability that keeps people independent as long as possible, right? 

So the more that we can get them engaging in new activities that involve planning and executing and following through on a multi-step process, the more that it’s like flexing that muscle, that’s gonna keep them in their home, on their own. It’s gonna reduce their own costs of care as they age. And so getting lots of different, it’s kind of like exercise, right? You want to do cardio, you want to do some strength training, and you want to do some of like the yoga, Pilates, the ballroom dancing, kind of that sequential pieces. There’s so many different types of exercise you can incorporate. Well, there’s lots of different types of brain training. And just starting with a couple will make a difference and shift things over time.

Dr. Kat Toups, MD

Well, and you threw in there the dancing, and I think social dancing is something that’s been so beautifully validated in multiple studies now for dementia and Parkinson’s, and dancing is a rather complex thing, but especially if you’re doing social dancing where you have a partner, you’re connecting with people. You’re touching them. There’s a lot of wonderful brain hormones that happen with connectedness. And then you’re listening to the music, just the sound, listening to music is a stimulation for your brain, right? And then you’re working on carrying out the movements of the dance and the sequencing. 

And so that’s a really fun thing to do. And hopefully in the next year, the world will open up and people can do that kind of thing. But you can turn on a video or put on some music and dance around your kitchen. I mean, that’s really good for the mood, right? When you’re feeling low and crummy, to listen to some music and jump around and dance is a great thing, but yeah, I think the task really is for each individual patient, what kind of brain training works for them? What kind of exercise works for them? What kind of mindfulness program works for them? 

You know, I have some people that come in, they’re experienced meditators, great. Or some people are very experienced qigong practitioners, great. Now that they can do that. I had somebody in the study that was a rabbi. And he said, “I don’t like doing this HeartMath program.” We used HeartMath for mindfulness, which is another well validated, lots of research, that that can improve the vagal tone and lower the anxiety and help the focus. 

And so I call it meditation for non-meditators, and it was something that we could do and measure the time in a study, whereas, you know, with meditation or qigong or gratitude journaling, different things that are helpful, we couldn’t quite measure that in the study, but the rabbi said, “But I feel I really get into that place when I pray.” I said, “Perfect, that’s great.” You know, you still have to do the brain HQ for the study, but, you know, keep your prayer, of course, and he would. And for many people, prayer, it’s a form of mindfulness, right? It’s beautiful. So it’s finding what works for you to achieve those goals of the stress reduction, the mindfulness, the exercise, the brain training, and yes, we have a lot more options with all of those things now.

Dr. Heather Sandison, N.D

So exciting. Dr. Toups, thank you so much for sharing all of your insights and wisdom. It really, what you bring to the table here is so unique, having just completed this trial and having decades of experience with many other trials and interventions for brain health generally. Your perspective is just so, so valuable. And I cannot thank you enough for sharing your time and insights with us.

Dr. Kat Toups, MD

Oh, well, I think thanks right back at you and all that you’re doing and doing your own study, doing your residential facility that’s a model and hopefully more people will follow that model. It’s so, so important. So I’m grateful to know you and all that you’re doing. And I just want to leave people with my favorite saying: dementia is not a death sentence. I just want that to get into everybody’s brains and hearts. And to really know that there’s options, that this doesn’t have to be a death sentence. It’s a symptom of something going wrong, and let’s find out what’s wrong and let’s fix it so that you don’t have to go down that path.

Dr. Heather Sandison, N.D

And how can our attendees find out more about you and your work? You also have an upcoming book. So tell me more.

Dr. Kat Toups, MD

Yeah, I’m working on the book. The dementia study has been such a labor of love and taken so much time, but now I’m trying to get back to writing a book that is really gonna be a how-to of what I do, and how do you test and how do you put all these things into action? And so probably the two best ways to find me are my website. And I have a website, Dementia Demystified, which is the name of the upcoming book. And that will link you to my website. 

And soon people will be able to leave an email if they want to be on the list to be notified about the book, and I keep putting together a little guide of tips for them in the meantime. And then I also am most active in social media on my work Facebook group, and it’s just my name. And then it says, let’s see, Kat Toups, MD, Functional Medicine, Psychiatry, and Dementia. And I try to post hopeful stuff on there, you know, but stuff related to the brain and both dementia and psychiatric issues, and so I have a lot of really interesting stuff on my Facebook group. I like to go back and read stuff from the past and reacquaint myself with the interesting stuff there. So those are probably the two best ways. 

Oh, and I do have a YouTube channel as well. If you just put in my name on YouTube, I’m trying to upload various podcasts and lectures that I’ve done so that people want to listen in more in depth. I do have one talk on there that I gave at the Age Management for Medicine Group annual meeting. That’s a kind of more technical talk with slides for physicians, and it kind of goes through, like many of the testing and the different things that we look at with this kind of work.

Dr. Heather Sandison, N.D

That’s amazing. Thank you so much for creating all those resources, for compiling them, for having them out there. And I know I, for one, will be one of those people on the list that will know where to get your book as soon as it’s available. I’ll add it to my collection, and I can’t wait to read it. So thank you for doing all of this. Your work is so valuable.

Dr. Kat Toups, MD

Thank you. Thank you so much for having me. I hope the word keeps ricocheting around everywhere around the world and we’ll get more. More practitioners are coming. We’re gaining more practitioners that are learning this and recognizing and helping to guide people.

Dr. Heather Sandison, N.D

The world needs them.

Dr. Kat Toups, MD

Yeah, so we’re making that community. And I would say that now on Dr. Bredesen’s Apollo website, they do now have a Find a Practitioner page. And previously you had to actually be part of their program offerings. But now they’ve launched a Find a Practitioner page. So that should make it somewhat easier for people. And then I also do refer people to the Institute for Functional Medicine. 

The ifm.org has a Find a Practitioner page. And what to look for on there for a practitioner would be ideally somebody that’s gone through all of the IFM training, so they’re IFM certified. And then they’ll say something… They used to offer a Reversing Cognitive Decline course at IFM; it’s no longer offered, but you would then go to the person’s website in your area and look and see, because not everybody doing functional medicine works with cognitive decline, but looking for a practitioner that has some understanding and focus there would be what to look for.

Dr. Heather Sandison, N.D

Fantastic. Thank you so, so, so much.

Dr. Kat Toups, MD

Okay, thanks. Thanks again.