Unlocking Neurology’s Pillars For Alzheimer’s Care

Kenneth Sharlin, MD, MPH, IFMCP

Let’s do it. Thank you for having me.

Heather Sandison, ND

It’s such a pleasure. You talk about the five pillars of integrative neurology in your work. Will you take us through those five pillars?

Kenneth Sharlin, MD, MPH, IFMCP

I’m sure this is going to take the majority of the interview today. We’ll break it up and have a conversation as we go. I want to set the stage with a couple of ideas. First, what is your experience when you have to see a neurologist? What has that experience been like? Chances are that the neurologist you see is not certified and is not trained in functional medicine, natural medicine, or lifestyle medicine. When you come in, there’s a little intake, maybe with the nurse. A neurologist comes in and takes a brief history. When it comes to cognitive decline, unfortunately, a lot of what happens is what I call 20th-century medicine, and that’s the 21st century. If you’re practicing 20th-century medicine, something is a little off. What that means is that very often patients do a little pencil-and-paper memory test like what we call a Montreal Cognitive Assessment, a mini-mental state exam at Saint Louis University, or a mental status exam. Maybe they get some blood tests, and an MRI, or maybe they get sent for what’s called neuropsychological testing. But that’s about the extent of it. 

Much of the time, not all the time. Much of the time, people’s told, it looks like you have Alzheimer’s disease. I’m sorry. Fortunately, there’s not much you can do about it. Come see me in six months, I’ll check you out and see how much you have declined, which is very depressing. It strips a person of all of their humanity, so to speak. We are sexually told in the traditional system that there is nothing we can do about it. But the reality is, if we look at the pie, this is gluten-free, by the way, low-sugar. But the pie graphs say where does disease come from? Because culturally, we go, well, it’s in my family and my genes, and the sooner we get it because they got it, that thing. But the reality is that we know that lifestyle and environment play a massive role. The majority of the influence and why these complex chronic diseases like Alzheimer’s, Lewy body, dementia, Parkinson’s, ALS, etc. happened. The majority is environment and lifestyle. The reason that’s so important to understand is because these are things that we have influence over, which puts you as a patient, as a caregiver, and as part of a team. Back in the driver’s seat, you may not be able to fix it all, but some things can be done that can change the trajectory. Would you agree with that?

Heather Sandison, ND

That has been my clinical experience. it’s heartbreaking. Every time I have a patient come into my office and say, We saw the neurologist, they say there isn’t much we can do. They took away his driver’s license. Now he can’t drive, so he’s more socially isolated. They said, Come back in six months and try these drugs. They don’t work very well. It is so depressing. It’s so demoralizing and takes the wind out of their sails. When they come into my office and stumble upon your work, Dr. Bredeson, where so many of the functional medicine-oriented people are supporting those with dementia and Alzheimer’s, there’s hope again. I’m sure you were trained just like the way I was to suggest there’s hope with Alzheimer’s was to give people false hope. Yet over and over again, I see in my practice, just as you do that there is hope. There’s an overwhelming amount of work that we can do. You have it narrowed down to the five pillars, and I can’t wait to hear what they are. But, often, we think, there are hundreds of things that you could do. If you break it down, there are different types of exercise that you can get. There are different meditations you could do. I like to think of it like you’re at a restaurant, and you get to order from the menu the things that look good for you. So,  I can’t wait. I’m chomping at the bit, like, how’d you do it?

Kenneth Sharlin, MD, MPH, IFMCP

Now, when I do a lot of public speaking, I teach other doctors how to do the type of work that I do. I show a slide that refers to quantum physics. It’s like, What is it, Schrödinger’s cat, whatever it is like it’s a cat, alive or dead? They look in the box. It’s both alive and dead at the same time and all that. The bottom line is this: I believe, as a three-decade practitioner, that we have to understand the person with the disease. But we also still have to understand the disease as best as we can because there’s quantum physics to it. We’re going to focus, and we’re going to make our care patient-centered. But until we’re at a place where we’re 100% during these conditions, we have to stay a step ahead of the game and understand what the things are that can at least happen so we can understand if things do happen. Is that typical? Is that normal? What’s the typical strategy that’s applied? Is this out of the ordinary? Do we need to investigate further, etc.? We have to understand the diagnosis. Pillar one is to essentially correctly identify the problem. I mentioned 20th-century medicine, implying that there’s 21st-century medicine. 21st-century medicine is precision medicine; it’s biomarkers; it’s metabolomics and proteomics, and all of those things that have big, fancy words behind them. But it boils down to precisely understanding what is going on and, potentially, what we can do about it. Then even beyond that, being able to track how we’re doing. We know we are on the right course. 

Do we need to slightly change course? In my office, when you come in and have trouble remembering things, I’m repeating myself; I’m putting things down and losing them. I can’t remember people’s names. I’ve gotten lost driving to my friend’s house, my daughter’s house, whatever, when I’ve been there a million times, and I just stop and think about where I was driving. Of course, all of those are red flags. Does that always mean this is Alzheimer’s disease? Not, but are we going to diagnose Alzheimer’s disease just by doing a pencil and paper exam? No, we’re going to get the. It’s like putting a little slide on your finger and testing the direction of the wind. There’s a problem here. We’re going to acknowledge that. Then what are the next steps? In the neurologist’s office, like mine, yes, you do get some imaging. Maybe you can also get 3D volumetric images. We can accurately measure the volume of different parts of the brain. We can measure the characteristic proteins associated with Alzheimer’s disease in the spinal fluid through a lumbar puncture. Now, with the advancements made in blood chemistry, we can use tests like the passivity test out of C2N Diagnostics to get a very accurate measure of the likelihood that if we put you in a PET scanner and measure the amyloid in your brain using that scan, or similarly did a spinal fluid test, we could get darn close. 99% accurate just by doing a blood test. I don’t need to send you to see the neuropsychologist anymore. I need to use precise information to correctly make the diagnosis. Pillar 1: Identify the problem.

Heather Sandison, ND

I have a question for you there because you talked about referring to neuropsychology, and I always struggle with that because it’s such a stressful experience for patients. They come out of there, and they’re like, It didn’t change anything. I still have Alzheimer’s. They still took my driver’s license. Now, I guess there’s more data; there’s more detail about how my brain isn’t working. But it didn’t change the treatment plan. I went through so much stress and so much time that somebody had to drive me, so I typically recommend that patients skip it. Is that doing them a disservice?

Kenneth Sharlin, MD, MPH, IFMCP

First of all, I certainly have a lot of respect for neuropsychologists, and there are situations where having testing is very appropriate. However, I do not use the neuropsychologist at all when it comes to looking at cognitive decline and making the diagnosis of Alzheimer’s. I agree with everything that you’ve said. It’s lengthy, it’s exhausting, and it’s stressful. How much does that impact it? From a neuroanatomical perspective, although ultimately Alzheimer’s disease affects all of the brain, we think of it primarily as affecting the temporal and parietal lobes in general. There are exceptions. In years past, when I’d send someone to the neuropsychologist, I’d say, Is this more temporal-parietal? Is this more frontotemporal? Is this more parietal-occipital? Because those can imply different dementias. Those could imply Lewy body dementia; those could imply frontotemporal dementia versus Alzheimer’s disease. But I never got that information back. They had exhaustively tested the patient and then said, Well, cognitive decline could be Alzheimer’s. I go. Well, I  knew that. That’s why I sent them to you. It’s a waste of time, money, energy, emotion, etc. Let’s be precise.

Heather Sandison, ND

So that’s a pillar one. Thank you. Pillar two.

Kenneth Sharlin, MD, MPH, IFMCP

Pillar two then is how did this happen? We’ve already said that environment and lifestyle play major roles. We’re going to then investigate those root causes, and that starts with sitting down and taking a different type of history. In traditional medicine, it is still an important tool. We’re going to sit down and say, When did that problem start? How did it progress? Does anything make it better? Does anything make it worse? Things like that. That’s called the history of the present illness. In functional medicine. We take what’s called a timeline. We want to know: tell me where you were born. As to your brothers and sisters, how are their health and your parent’s lives? How was their health? What did they do for a living? Where did you grow up? Was it rural? Was it suburban? Was it urban, where maybe you were exposed to a lot of air pollution? Or could you have been exposed to, say, agricultural poisons, pesticides, herbicides, etc. in a more rural upbringing? Were you born by cesarean section, where you were bottle-fed or breast-fed? Tell me about your health growing up. Did you have any head injuries that you treated with antibiotics? You have surgeries where you’re given general anesthesia. We’re looking for what we call those triggers, and they lead up, of course, to the moment, when something’s not right with my brain. That’s the tipping point. 

Then what are the mediators? What are the things that are keeping you on that trajectory? They can include lifestyle factors and, very importantly, the quality of your sleep. What does your diet look like? What is your digestion like? Are you moving your body in a mindful, meaningful way that enhances not just your strength but maybe your balance, your cognitive function, your flexibility, your mobility, your endurance, and all those other things? How is your stress, resilience, and practice? How do we all live in the fast lane? 99% of the time, we live in the United States. Thank goodness we’re in a pretty safe place compared to some parts of the world. But we still have things on our plate. So as important as it is to eat a nourishing meal to deliver to our cells, when our cells need to thrive, we have to deliver to our bodies and our minds. that limbic system, a practice of calming and balancing the brain and the body. For a lot of folks, it’s very easy to take that for granted and not have that piece of the puzzle. Are you socializing? Do you feel connected? Are you purpose-driven? You’re there; what are you waking up for every day? Is it your grandchildren or whatever? The work that you’re passionate about, the book that you want to write—all of those things are important to understand. then we take a deep dive into labs to look at things more from this at the cellular level and say, What are the things that drive inflammation? What are the things that drive oxidative stress? Have you been exposed to toxins or things like that? All of that gets thrown in the pot together, and that’s what we call investigating.

Heather Sandison, ND

All pillar one: what’s going on? What’s the diagnosis? Pillar two?

Kenneth Sharlin, MD, MPH, IFMCP

Identify the problem.

Heather Sandison, ND

Identify the problem, number one. Number two: investigate. Number three?

Kenneth Sharlin, MD, MPH, IFMCP

Number three is to think of this as a thousand-piece jigsaw puzzle. You get the jigsaw puzzle, and you’re all excited. You’re even. You’re pretty good at them. You dump the pieces on the table, That’s a lot of pieces. You’ve got to figure out what’s important. How don’t you get to turn some of them over? You have to move them around. Those colors look like they go together. It looks like that part of the picture here is an edge piece. We got it. We had to put those pieces together. Let me tell you, there are a lot of companies out there in the community health space that are gunning for your money. They want to test and testing is important. I do testing, but I never saw an MRI that made anyone better. You’re not curing yourself in an MRI or even a blood test that might be revealing until there’s an action step associated with that information because that’s what you’re getting when you test. Then the information is not meaningful and may make you feel good, like, I took a step. But ultimately, being able to put those puzzle pieces together—that’s the integration pillar, and that’s the third pillar.

Heather Sandison, ND

Amazing. That takes skill. That takes experience and skill. So for people who are like this, I guess this is probably why you train doctors: so that people can get access to this because it is not widely available. That’s not what you’re going to get if you go see a primary care provider or a conventional neurologist.

Kenneth Sharlin, MD, MPH, IFMCP

It’s not so, and there are different dimensions to this. I have a pretty large practice, so we’re able to use a team-based approach. You have a dietician, you have a coach, and you have a movement person. You have me. I  keep an eye on the big picture of everything that’s going on. I’m the captain of the ship, but because I’m also a neurologist, I can focus on the sleep component of the lifestyle medicine piece where I have a movement person, I have a dietician, and I have the person who does the mind-body type work that is critical as well as the social aspect that’s also extremely critical. We use a team-based approach. The other part of that, I would say, Heather, is that it goes back to that timeline. This has been a very big issue for me and one that I don’t pretend to have made up by any means, but it’s one that we don’t spend enough time on in practice and medicine, and that is to understand the power of narrative, because all of that information that you got has to be pieced together into a story about you, the person who is a fat dude who has come to the doctor, and how that narrative is told. I would refer to people like Dr. Arthur Kleinman, Harvard University, the great psychiatrist who wrote a book called The Illness Narrative. There are other people out in the States doing similar work, but I would even point to people like the great Joseph Campbell, who died many years ago. 

But the great mythologist in the 20th century helped us understand the hero’s journey and is a co-response symbol for some of our great movies, like Star Wars. Of course, he worked closely with George Lucas, but these are our stories. We want our stories, first of all, to be heard. That is very important. We want our stories to be understood. We want to understand our stories. What I’m getting at is that to integrate is not just to have a team; to integrate is to be able to take action steps. This has a lot to do with us as human beings and our behavior how we change and how we go. It’s not even in my reality that you can do anything about Alzheimer’s disease. Wait a minute, I heard that some pretty interesting people like this, Dr. Sandison, and this, Dr. Bredeson, are doing some interesting stuff. I don’t know too much about it, but I heard about it when I bought the book, and I’m thinking about it like a book. I got some recipes. I went and shopped at the organic market, so I got the stuff in the fridge. I don’t know quite what to do with it yet, but I’m gunning; I’m ready. Then there’s a boom. Action, trigger pull, doing it. How do you get through those steps, and how do you maintain that trajectory? A lot of it has to do with the narrative. A lot of it has to do with you. It’s not just about up here. It’s about here. You have to feel it. You have to believe it. You have to know it. Through your heart and your emotions, it’s so important because this is hard work. 

This is not a seven-day course of antibiotics, and you’re better. That’s not a 30-day course of antibiotics. That’s just showing how long you’re not going to have to take this supplement. We’ll do some follow-up testing. When we do that testing, we’re going to look at your levels to see if they’re right where they need to be. That tells me that the combination of food, which is where most of your nutrition needs to come from, plus this supplement, is getting you where you need to be if your levels are still low, we’ve got to figure out why you’re taking the supplement. Are you following that diet plan? If, on the other hand, you have to make something up, like I saw a patient yesterday whose vitamin D level was 135. It’s good that you have a robust vitamin D level, but it’s probably higher than it needs to be. Some data suggests that you could develop pseudohypoparathyroidism or have hip fractures. Let’s maybe bring it a little down. I’d be happy with 60, so there are situations where, yes, we back down, of course. But the idea is that this is a lifelong process. This is for the rest of your life. The rest of your life. I got you here right up to this point. Now, the rest of your life moving forward is what’s going to help you change that trajectory and maintain it in the long run.

Heather Sandison, ND

That’s challenging. You have health coaches on your team and a lot of support for people because we see that commonly, people are excited and motivated at the beginning, they get better, they get results, and then they burn out, and it’s keeping them on. The trajectory is important because we also see that when people can do that, there’s a virtuous cycle where they keep getting better and better. Now, I don’t want to give anyone the impression that we stop people from dying and that other things happen, like falls. As people age, other things happen, and it can get even more challenging to maintain this lifestyle. But having that great support makes it a lot easier.

Kenneth Sharlin, MD, MPH, IFMCP

That’s where a community comes in. What is your provider offering you to create that community? Hopefully, you will bond with that person. That’s probably the most important thing. But in the long run, do they have something like free yoga every Thursday morning? We have our Facebook group, which we monitor all the time and post to interact with people. We have our brain-tuned university, get on every other Tuesday, and spend an hour and a half with our team. Everything that we can do on our end does ask you to engage. Now that it’s working for me, when’s the last time you got to engage in something? You see, you have done it. It’s a little give and take. But you have to create a community one way or another, and you have to have a community not just in a medical facility like mine or yours. You have to have a community at home or wherever you happen to live. You have to create your spouse. Your partner has to be supportive of this. It’s like trying to quit smoking when somebody else is sitting across the table with their cigar and coffee; no way is it going to work. Community is probably the most important thing in the long run.

Heather Sandison, ND

We couldn’t agree more. So, identify the problem and investigate the problem. Integrate, investigation. Pillar four?

Kenneth Sharlin, MD, MPH, IFMCP

Restore. One of my associates says you’re the best version of yourself you’re restoring. That’s true. Another piece of it for me is going from functional medicine and then bringing in some of the toolboxes of regenerative medicine and realizing that hormones are critical for, our whole body. But I’m a neurologist. I’m going to focus on the brain and talk about all of the incredible things that maintaining optimal hormone levels does for us. that, of course, includes things like estradiol and progesterone for women and testosterone for men and for women as well. DHEA: When I say optimal cortisol levels, that can mean, that you don’t want to be bottomed out and exhausted, but you also don’t want to be in that constant fight or flight either. There’s a balance. Recognizing where you are on that normal cortisol and circadian rhythm—that’s an important piece of the puzzle. I look at hormones. I do treat people with hormones. We do. It’s all bioidentical. We make a lot of pellets. I’ll do some orals, some creams, and some, but mainly utilizing pellet therapy. That’s a big game changer for people.

Heather Sandison, ND

What about peptides, stem cells, or exosomes? Are you doing regenerative medicine at that level?

Kenneth Sharlin, MD, MPH, IFMCP

So, the fifth pillar is to generate. Now I don’t do peptides, and I’ll be very honest and transparent with you about that. First of all, I am a researcher. I have over 45 clinical trials. These are all institutional review board-approved; these are multi-center trials. FDA is involved in things like that. I am a supporter of when there are appropriate pharmacological treatments. This is why I came from traditional neurology, and I was burned out and tired and all that stuff. Then I found functional medicine; it was like the gates of heaven opened and I found my meaning and purpose. I want to be just like Dr. David Perlmutter or whatever. Then it started to do that stuff I was doing before. There’s value there. I did a lot of trials, and we brought several important products to market. We’re still involved in bringing about other new things that are just around the corner. But the point here is that part of the reason there are regulations is that they protect us as human beings. There’s a very dark history of experimenting on human beings, from the Tuskegee experiments to the experiments in Nazi Germany. Don’t get me wrong, I’m not suggesting that peptides or exosomes are; there’s not. I’m not suggesting that the practitioners aim to hurt someone by any means. There are, of course, peptides that are fully FDA-approved, like semaglutide, like insulin, or, in my world as a neurologist, the drug Copaxone, Vladimir Acetate is a peptide that treats multiple sclerosis, but a lot of the peptides are completely unregulated. The vast majority of them have not been through the rigors of clinical trials, and I am personally very against that because I want these peptides to be helpful and effective. But we have a litmus test, and there are many folks out there. I’m willing to bet many folks watching this summit are very, very leery of the pharmaceutical companies and the drugs.

Again, for full transparency, there are issues; of course, there are. That’s another interview. But there are many good things that these drugs have done. The point is that the same companies have spent billions of dollars to put their products through clinical trials to show dosing, safety, efficacy, and all that stuff. They have to have a package insert. The guy on TV who talks a million miles an hour rather than making my dad go talk to your doctor—where is that happening with peptides? I cannot utilize peptides in my practice. I would not. The FDA has recently cracked down on peptides. They’ve cracked down on exosomes, and that has stopped some practitioners from using them. No, in my opinion. Does that take advantage of people who don’t otherwise know? Yes. They shouldn’t be doing that. Could they be helpful? Maybe. Let’s study them. I don’t do any of that stuff now. I don’t know if we get in late, but I do offer some treatment in the arena of stem cells, and there’s a little bit of federal regulatory language, but there’s a difference between what’s called a 351 product and a 361 product, and what that all means is that 351 products are drugs. Even if they’re tissue therapy, they have to have been manipulated in some way or they come from something where someone could be a thing like an animal or a thing like, and say,  placental tissue or umbilical cord, but it’s not you. We call it allogeneic. 361 products have to meet very specific criteria that have to do with the fact that they’re your cells, and they’re being used to do what their cells normally do in your body. They can’t be mixed with anything. They can’t be used systemically. They can’t be manipulated in any way. If those guidelines are followed, you will have in your body, in your bone marrow, for example, what are called mesenchymal stem cells or what are sometimes called medicinal signaling cells. What these cells do is not what many people associate with the word stem cells because they say, I have Parkinson’s. this thing dopamine cells that you can these stem cells, will that replace my brain cells in my brain and make me whole again? No, that’s not what they do. They’re anti-inflammatory. They’re involved in tissue repair. This is a normal function in the body. They help to slow, curb, or turn off that process we call programmed cell death. There is an anti-inflammatory, reparative role for these cells that we can deliver by harvesting them out of your bone marrow. Using an FDA-cleared system to separate all the red blood cells and other things. We only have your stem cells and then deliver them directly, not systemically, into the spinal fluid to help support the overall treatment of the patient. Not making disease treatment claims, focusing on what the role is in the body, and could that be like the next level for me? I got the food down, I got my meditation, I got my sleep, and I’m taking my supplements. What else can I do? Here’s something.

Heather Sandison, ND

I love how you put that in order. I was talking to someone else earlier today, and it was like, You can do the right things, but you can do them in the wrong order and not get the benefit. stem cells are in that category where you still have all the toxins and infections and your nutrient supply is depleted. You’re not going to get the same benefit from those stem cells as if you waited a little bit and put the work in, got many of the systems balanced, and then added those cells as is. That has not been your experience, and the cost is something to consider.

Kenneth Sharlin, MD, MPH, IFMCP

There is a cost, and not only that, this is not a once-and-done. There are companies out there in the commercial space in the United States doing the research and doing the clinical trials because there are three states there. STEM cell products are 351. They’re manipulating them, but ultimately, mechanistically, very similar to what we’re doing. I would even argue in most respects identical. The one that immediately comes to mind is called Brainstorm Cell Therapeutics. They have a stem cell product called Neuron. They got through phase four, which is essentially the just-before-FDA approval phase, the trial phase for ALS. They’re in phase two for multiple sclerosis, progressive multiple sclerosis. The interesting thing is that those are your cells, which are very similar to what we do. But once they’re harvested, they do get sent off for processing to cause or induce those cells to express what they call neural elements. But what’s very interesting, and what the literature tells us, is that it causes those cells to express neural elements, spinal fluid, and urine. That’s well documented in the literature. Part of our Western capital, unless capitalism and the system of medicine are what everyone wants and they have some trademark copyright, patent protected, what have you? We don’t know what system they’re using to cause these cells to express neural elements. Right now, it’s a tube of spinal fluid sitting in a lab somewhere, and then they just harvest those cells right back and give them to people. I’m not saying that is what it is, but, interestingly, the literature supports the role that spinal fluid plays in inducing these cells and gives us a huge opportunity as practitioners to do this in a fairly affordable way in medicine.

Heather Sandison, ND

The lumbar puncture.

Kenneth Sharlin, MD, MPH, IFMCP

By just harvesting your cells, a kit that we purchased from the manufacturer for $1,000. We have the equipment that we need to harvest your cells and separate them from everything else. then, a lumbar puncture tray and the cost of my professional time and the cost of, not just me personally as a professional, but if you have 100% of my focus on keeping my lights on in my clinic, there is a cost to that. I’m not saying that it’s super cheap. Nothing is, but there are no drugs for ALS and multiple sclerosis. For example, you’re talking about anywhere from $80,000 to $150,000 a year. If I can offer you a treatment for $8,000, that is a relative bargain, but you do have to plan on repeating it. It’s not a once-and-done.

Heather Sandison, ND

This is fantastic, fascinating, and such a great conversation. I want to make sure our listeners know how to find out more about you, your practice, and if they’re looking to train with you. We’ve got many providers here joining us, so please tell us where we can find more.

Kenneth Sharlin, MD, MPH, IFMCP

Our main websites are functionalmedicine.doctor. I do have other websites, and some of them link from functionalmedicine.doctor to sharlinregeneration.com, and sharlinresearch.com. We have our big research website, our imaging website, and we do onsite imaging for MRI and PET scans and things like that. But the main one you want to look at is functionalmedicine.doctor.

Heather Sandison, ND

Dr. Sharlin, it’s been such a privilege to have you here. Thank you for sharing your time and expertise with us.

Kenneth Sharlin, MD, MPH, IFMCP

My pleasure. Thank you for having me.