How to Reverse Dementia with Dr. Heather Sandison

Mark Hyman, MD

Full Transcript

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Dr. Heather Sandison: There are a ton of things that you can do without the help of a doctor. Right? The foundations, like if that's the icing on the cake is all of the functional medicine intervention. The foundations are really come back to diet exercise, sleep, stress management.

Mark Hyman: So, Heather, it's so great to have you on The Doctor's Farmacy podcast. I've been following work for a long time. I'm very inspired to see how you're addressing this epidemic of dementia Alzheimer's in a totally new way that we're gonna dive into today. So Thanks for joining me.

Dr. Heather Sandison: Thank you so much for having me. It's a privilege to be here.

Mark Hyman: So before we kinda dive into the meat, or maybe the vegetables, or maybe the fat, I don't know exactly what. I want I wanna kinda give people a little bit of a background on where we are in the world of dementia. And given how advanced medicine is how much we've learned about addressing things like diabetes and heart disease and cancer. We've really missed the boat on dementia. And we really have failed to stem the tide, which is growing dramatically in 2024.

Mark Hyman: I think there's 6,900,000 Americans who are 65 and older living with Alzheimer's. The numbers projected to go up to 8.5 by 2030, and I think 14,000,000 by 2050. Across the world. It's also a problem. There's 55,000,000 people living with it now, and this will go to 82,000,000 by 2030 and even more.

Mark Hyman: And the cost is just staggering. I mean, I think we the direct to indirect costs makes this the most expensive health condition out there. The direct to the the costs in 2024 were $360,000,000,000 a $1,000,000,000 a day. And and there's also a lot of, you know, unpaid costs that are are given by family members and so forth. So it's it's by 2050, the cost will be about a $1,000,000,000,000.

Mark Hyman: That's, you know, right now, that's about $116 of our economy. So it's a problem. And globally, the costs are now, 21,300,000,000,000 in as of 2019 and 2,800,000,000,000 by 2030. And and yet we're kind of miserably failing. And it's not for lack of trying.

Mark Hyman: And I think what we're gonna talk about today is is we've been misguided in how we've been investigating this problem. We've been misguided in where to look and what to do. We've been chasing down the wrong alley for the answers. And we're really not much closer than we were a few decades ago in my view. There's enormous amount of research.

Mark Hyman: It's not like there's a lack of research. I think since the early 2000s, there's been about 292 interventional trials, funded by the National Institute on Aging. In 2024, there's a 100 71 studies ongoing and a 134 drugs for Alzheimer's disease and dementia. And yet, none of the work. We're and we're spending about $3,500,000,000 per year, doing this research, and we're getting no return on investment.

Mark Hyman: Really? I think the failure rate is over 99% for drug candidates. And the drugs that get approved are basically marginally effective and they're considered a success if they slightly slow the progression. No reversal. Just slightly slow the progression.

Mark Hyman: So with that context, I kinda wanna I kinda say something really radical, which is that there are people out there like you and like others like Dale Bredesen. And and in my practice, well. What we're seeing people actually reverse dementia, not just slow it down, not just kinda delay the entry to a nursing home by a few months, but to literally stop it and turn back the clock and bring people's memories Not always, not in every case, not a 100%, but some are. And if that's the case, then we should be deeply looking at the data around this. Now One of the one of the good things is that you're you're thinking about this differently.

Mark Hyman: And I think the issue has really been a thinking problem. We've been thinking we're gonna find the single drug, the single pathway, the miracle cure for dementia. We just are not gonna find it because it's a very complex problem. That's not what disease. It's many, many different kinds of things that go into causing someone's brain dysfunction and the common symptom is dementia.

Mark Hyman: Just like pain can be the common symptom of everything from cancer to dehydration, to, you know, banging your head to you know, a million different reasons you can get pain. The same thing with dementia. It's just a symptom. And the question is, what's the cause? So With that in mind, I I kinda love you to sort of to talk about how you came to kind of a different way of thinking about Alzheimer's and and what you talked about in your book, which was really your radical idea, which is called reversing Alzheimer's, the new toolkit to improve cognition and protect brain health.

Mark Hyman: Now that title alone should make people stop. Like, it's one thing to reverse diabetes, although some doctors still don't think you can do that. But, reversing dementia, pretty much nobody in their right mind would even, hazard to say that because it sounds like it's giving people false hope and it's maybe it's just snake oil and why should we kind of be paying attention to that when we should be actually doing the real research on what's going on. So I I'm kind of excited to talk to you about this whole idea of reversing dementia. So tell us, sir, how did you first come upon this and how did you first sort of understand that our thinking was wrong and that we needed to kind of refocus how we were doing things around both diagnosis and treatment for dementia.

Dr. Heather Sandison: I came to this as a skeptic. I had heard like most clinicians I was trained that there was nothing you could do. And as you mentioned, to suggest there was something we could do for someone struggling with cognitive decline on their way towards Alzheimer's, it would be to give them false hope. And through my work after being trained by Doctor. Dale Bredesen, I saw what was possible.

Dr. Heather Sandison: My patients prove to me that in fact you could reverse this disease process. You could reverse the symptoms associated with Alzheimer's. And my mind has changed. I I think that there's actually a lot of hope and the false hopelessness that comes with being told there's nothing that can do for Alzheimer's actually is, I think, at this stage, criminal, right, we're we're told. I still have patients showing up in my office saying, I saw the neurologist, very well informed, great guy, but he told me there's nothing I can do.

Dr. Heather Sandison: I need to get my affairs in order. They're gonna take my driver's license away. And there's a couple medications. They don't work very well, but I can come back in 6 or 12 months, and they'll measure the decline. And this is really unfortunate because there's a lot of great research showing us that there is a multitude of things that we can do to support not only cognitive health, but neuronal health, the cellular health of our brain.

Mark Hyman: Yeah. That's quite an an amazing statement that, you know, you're seeing actually people reverse this. And you mentioned a guy named Dale Bredesen, who's a friend and colleague of mine. And, actually, his wife was a functional medicine doctor and He was a trained traditional Alzheimer's dementia researcher and she kept pushing him to kind of learn more and she gave him a book that I wrote I think in 2009 called the Ultramind solution where I detailed how our bodies and our biology impact our brain function, everything from autism to Alzheimer's. And he I'd I'd share a number of cases that I had of reversing Alzheimer's, and I think it got him very interested because he saw that what I was observing in the clinic were the same things that he was observing in his research lab that he then saw a connection with and that realized there may be a a clinical pathway, not just a research in a lab with mice, but actually a a clinical approach that really helps to address the root causes and to get people a chance of actually getting their brains healed.

Mark Hyman: And that's, that's kind of how he started his whole his whole journey. And now he's been doing this for decades and how you learned from him and it's sort of makes me really happy. You know, I I, I remember, you know, a number of cases I had. I'm just gonna share a few cases and give people some context here. Look to hear some of your cases then talk a little bit more about what what actually the the meat of this is.

Mark Hyman: But, you know, I had a number of cases that I had it for my career. One was a a woman who was probably, like, early eighties, and she was a very smart woman who'd been the treatment of many boards, and it was very active in her community. And her doctors told her she had early dementia and to get her affairs in order. Just exactly you told her, and I I I just like you said, right? I mean, the the the joke about neurologists is they're they're basically, say, diagnosed and audio basically, here's the diagnosis.

Mark Hyman: Something I can do with you later. And, unfortunately, that's just sad because there's so much that can be done. And this woman, she, you know, she was really declining. And I I did what I usually do, which is I asked a lot of questions, and I did a bunch of diagnostic tests. And I found it actually.

Mark Hyman: She was very impaired in her ability to what we call methylate, which is to convert the folate and the b vitamins from your diet into the right ones, and she was also a very nutritionally deficient in B Twelve because as you get older, you don't absorb it as well. And so I gave her B Twelve shots, and I gave her high dose of methylating b vitamins, folate b 6 b 12, and literally, like, her memory came back like that. And that was a very quick easy one that no longer like that. But it was pretty dramatic. And, and then and about maybe maybe 6 or 7 years later, she called me and I thought, oh, maybe she's declining and there's something wrong and She's gonna need more help.

Mark Hyman: She goes, well, Doctor Jaime, I'm going trekking in Butan, and I wanna know what I should do to prepare myself. I'm like, great. So, there was that story. And I didn't want a guy who was, a seven year old guy who owned his own company and was quite a large company and was the CEO and and just couldn't function anymore. It was very, impaired, had severe memory loss, severe depression, his family couldn't manage him, and his wife brought him in kind of with the last legs, kind of hopeful that something could be done.

Mark Hyman: And I said, look, I don't really know but I'm just gonna apply the principles of looking at all the variables that could affect the brain function and correct them. And maybe it'll work and maybe it won't, but let's try it. And we found a whole bunch of things that we now know are at the root cause of dementia. We found he had significant insulin resistance. He had severe you know, prediabetes and severe gut issues, and what we call bacterial overgrowth.

Mark Hyman: And, that bacteria was affecting his brain. He had also very high levels of mercury extremely high, like on a challenge test. You will understand this, but his his mercury was 350 after giving a DMSA challenge test. Was actually the MPS at the time. And, you know, normally, it should be less than 3 over 20s bad, and his was 350.

Mark Hyman: And he also had really impaired methylation out of high and low cysteine. He also had the genes, the end of APOE double 4. He which is the Alzheimer machine. He had the, Alzheimer's risk gene. He had also, impaired methylation genes with methion genes.

Mark Hyman: So, you know, a whole bunch of stuff. That we corrected, and we got rid of the metals. We fixed his gut. We optimize his diet, fixes insulin resistance, optimizes nutrients, and he ended up reversing his cognitive loss and was able to go back to work and be a functioning member of his family again. And, you know, at the time, it was a miracle for me because I was like, wow, this is quite amazing and it kind of made me realize that that, we're we're not telling the whole story here.

Mark Hyman: We're missing the vote. So, can you talk a a little bit about the approach that you take and you you've done a bunch of research. You published a paper that I think is we'll talk about a little bit. Called, you know, observed improvement in cognition during personalized lifestyle intervention and people with cognitive decline. Basically, taking people who are already mentally impaired, cognitive impaired, and putting them on a multimodal intervention to address all their causes and variables that you found.

Mark Hyman: And it's very personalized. It's not here's the treatment for Alzheimer's. It's very personalized. So so can you share a little bit about, the approach in general? How do we how do you think about, dementia differently than than other practitioners years.

Mark Hyman: How do you think about the diagnosis of what the causes are? And let's start there and then let's sort of go into some of the the treatment modality.

Dr. Heather Sandison: Yeah. I think it helps us start with this conventional model. Ray, what are we comparing it to? So the conventional model and the incentive structure of sort of the pharmaceutical industry, the insurance industry, the way that healthcare is set up is that what we want to find is a single molecule intervention, right, that can be patented that is very simple to dispense from a pharmacy that it's it's they're simple instructions. Just take this one pill once a day, and you'll feel better.

Dr. Heather Sandison: And that works if you've got a UTI, right? And we can get a cure and you can that can be any of the past, take antibiotics for 7 days don't have to think about it again, hopefully. Now when we're talking about Alzheimer's, this is very complex and our friend, Daniel Schmottenberger, he really taught me to think, and I feel very privileged to have spent a lot of time discussing, we would meet every Tuesday afternoon for 4 or 5, 6 hours on these marathons. Just kind of reprogramming my brain about how to think through diagnosis of complex disease. And put simply, when you think of any complex system, whether it's a house plant or a financial system or government systems or the brain, what you're looking for is balance.

Dr. Heather Sandison: Right? An imbalance is going to create dysfunction in that complex system. And so imbalance is gonna be too much or too little or too at the wrong time or in the wrong place. And when we think of the brain, this leads to disease when we have imbalance, especially over time. And so we can say, okay, imbalance that this is helpful.

Dr. Heather Sandison: We'll simplify, and then we wanna systematize imbalance of what? What are the causal level factors? And I would argue that they are there's 6 of them. It's toxins. And so imbalances of toxins in the wrong place at the wrong time, too much too little nutrients.

Dr. Heather Sandison: Right? We you mentioned insulin resistance and blood sugar becoming so high that it becomes toxic. That can be a problem. But also you mentioned B12 and having too little B12 associated with genetics and maybe for 1 maybe for your neighbor, they may need more B12 than you do. So we have these individualized needs and requirements where we're gonna get that functional requirement meant not just the RDA, not just that recommended daily allowance.

Dr. Heather Sandison: So we have toxins, nutrients, stressors. We can have too much or too little stress, right, where some people wanna kick their feet up just relax in retirement, but they're not getting that engagement. And then we also know on the flip side that caregivers care partners for people with Alzheimer's are at higher risk of being diagnosed with Alzheimer's themselves later on because they have too much stress. Cortisol becomes literally toxic to the hippocampus, those memory centers of the brain. So toxins, nutrients, stressors, structure.

Dr. Heather Sandison: You mentioned getting hit over the head and causing pain. Well, that can cause inflammation in the brain and be a traumatic brain injury that can put us at risk. You mentioned APOE 4. We can have molecular structure genetic structure that puts us at risk for developing Alzheimer's later on. So again, toxins, nutrients, stressors, structure, infections, We know there are a handful of infections that are directly associated with the triggering of amyloid plaque production.

Dr. Heather Sandison: So things like p gingival so p gingivalis, which causes gingivitis in the mouth. Also, the Lyme spirochete has been found in amyloid plaques as well as, H. Pylori is associated. And herpes. The herpes simplex.

Dr. Heather Sandison: One virus is another the gut brain connection and infections on the gut can can lead to imbalances in neurotransmitters and there's many other, I mean, and In fact, I have a reverence for how complex the gut brain connection is and wouldn't Yeah. Tend to understand it fully, but we know that there's a lot of back and forth communication between the gut and the brain and the crobe specifically in the in the gut have a lot to do with that. So again, toxins, nutrients, stressors, structure, infections can lead to dementia. And then signaling, are we getting the signals? Doctor Bredesen has this phenomenal.

Dr. Heather Sandison: I love this analogy of brain health, thinking of your brain like a country, my brain is gone. If we are stuck in that fight and defend mode, if we're being invaded by infections or if we're being if we need to defend against toxins like heavy metals you mentioned or mold toxicity or chemical toxicity, then we're using our resource to take care of that attack and defend. We're not able to use that resource to build the infrastructure, right, to build new neurons and new connections to between those neurons, the way a country might build roads and schools. We wanna use those nutrients to to fully resolve those issues that we're attacking and defending against. And it makes sense that if we're trying to do both, we're not going to be very good at doing either.

Dr. Heather Sandison: Right? We're not going to fully resolve the infections or fully resolve the toxic burden. And we're also not gonna be that great at having functional neurons to help remember our neighbor's name or remember where we put our phone or our keys. So what we wanna do is think really holistically about this. You mentioned, you know, there's multiple factors that go into brain health, and this is what I would think of as a comprehensive list, although I'm sure we will continue to know more, but it's a much more comprehensive way to approach each individual and what's causing them to go down this path towards this common diagnosis of Alzheimer's or memory loss associated with age.

Mark Hyman: Yeah. It's it's it's something I see a lot of. You know, it's just, you know, we we get in this reductionist model where we're looking for the single drug for the single disease, like you talked about, and it's why we spent 1,000,000,000 and 1,000,000,001,000,000 of studies with 0 real benefit. And and I think, you know, what you're speaking to is that this is a complex set of diseases, not just one disease, even if it's called Alzheimer's or other forms of dementia, they're really complex and have multiple causes. Not everybody who has that has the same causes.

Mark Hyman: They might overlap, but it's really important to look at what's going on for that individual. Like that one patient I said, she had vitamin deficiencies. Another guy he had a whole host of things like mercury. So you have to find out what the treatment is for that person, not a kind of one size fits all, and it's just the antithesis of how we do research. And I think what you're talking about also, there's insults that happen.

Mark Hyman: You know? Basically in the way I think about it is too much bad stuff, not a good stuff. And and I think you're talking about we were missing the things that we need to make our brains work well, and we're having too much of the stuff whether it's infections or microbiome or toxins or sugar or stress that actually cause damage to our body. So, when you start to think about someone like this, you know, you're you're thinking about a lot of these these factors that that have have modifiable solutions. Right?

Mark Hyman: It's not like, oh, well, if you have a toxin, there's nothing you do about it. Oh, oh, if you have insulin resistance, there's nothing you do about it. Oh, if you're nutritionally deficient, there's nothing you do about they're all treatable. Right? And so that's the beauty of this whole approach of functional medicine and this approach to dementia is that it really helps you to navigate a very complex set of of variables and and kind of understand how to start assessing them and actually and actually treating them.

Mark Hyman: So so when you start to do assessment, you know, one of the things I I love that, that Dale talked about was this whole idea of dementogens, you know, and, I wonder if you could kind of go through what you kind of did a little bit, but I think it's sort of worth, you know, going through what the kind of framework is of these dementogens that that he talks about and and how and how those can impact are us. And what those what we call the exposedome, which are the hidden things that that tend to cause brain dysfunction.

Dr. Heather Sandison: Yeah. So when when I work with a functional medicine patient, you know, there are all these medical pieces that I almost think of as icing on the I definitely wanna go in this direction and and support people in knowing how to communicate with their doctor and knowing what to ask ask for and what kind of testing and and certainly there are a ton of modifiable things that we can address. And I also wanna just take this step back to say, there are a ton of things that you can do without the help of a Right? The foundations, like if that's the icing on the cake is all of the functional medicine intervention, the foundations are really come back to diet exercise, sleep, stress management. And so I I, of course, wanna because we're both functional medicine practitioners.

Dr. Heather Sandison: I wanna dive into that deeply, and I wish that the whole medical system was coming in that but I also don't want to miss the opportunity to tell people if you don't have access to that, if cost is an issue, there are many, many, many things that you have an outsized impact, that really come back to what are the things I put in my mouth every day? What do I eat? What do I consume? What is what are the nature of my relationships and my stress levels? What time do I get to bed each night?

Dr. Heather Sandison: How much movement do I get each day? Those are the things that really impact health over time. Now these hidden causes, these hidden things, this exosome, these dementogens, toxins are a big part of that, and I think of 3 flavors. There's chemical toxicity, which is ubiquitous. None of us are going to be able to avoid it all, but there are great strategies avoiding the things that we have control over.

Dr. Heather Sandison: You talked about modifiable risk factors and not modifiable risk factors. And just to give people kind of a sense of what the difference is there. We can't change the year you were born. Right? We can't change your chronological age.

Dr. Heather Sandison: That as that increases, our risk of dementia goes up. We can't change that you're born male or female. And if you females have higher risk of dementia, they're 2 thirds of dementia or Alzheimer's patients. And we also can't change your genetics, your APOE status. This is said, but what can we change?

Dr. Heather Sandison: We can change our toxic exposures. We can increase our ability to detoxify whether it's one of these 3 flavors, heavy metals, micro talk or mold associated toxins, associated with water damage buildings, which I see many elderly folks who have been in their house for a long time.

Mark Hyman: Huge.

Dr. Heather Sandison: Really big kind of underrepresented issue. And my other mentor is Doctor Neil Nathan who I'm sure you've come across.

Mark Hyman: Yeah. Neil. Yeah.

Dr. Heather Sandison: I feel really grateful to have learned, from him how to support very sensitive patients and also to just be hyper vigilant about that potential mold exposure. And then these chemical toxins that I mentioned. So metals, molds, and chemicals. And although you can't completely avoid all of them, what we can do is we can measure how much we're being exposed to and see if there is some detective work that can go into lowering our exposure to phthalates or petrochemicals or round up life Sate is a big one that directly impacts the nervous system. I'm sure you're familiar with the work of Stephanie Sinha.

Dr. Heather Sandison: She was out at MIT. And has done extensive research on how glyphosate impacts the nervous system. And so understanding

Mark Hyman: the podcast. We'll link to that in the show notes. But, yeah,

Dr. Heather Sandison: Yeah. She's fantastic. And understanding why didn't what's coming into my system? And then can my genetics tolerate those toxins? And how can I increase my ability to get rid of toxins through my liver, through my bowels, through my kidneys, through skin and limp, maybe even through breath work, through the lungs so that we can optimize for cellular health?

Mark Hyman: Yeah. This toxin thing is big. You know, there's there's other things we're gonna point to that that are modifiable like diet, like your microbiome, like infections. You know, there's things that actually can be modifiable, but the toxin 1 is huge. And I think, like the case I mentioned, it's one of those things that's if you look at the scientific literature, There's ample evidence that toxins are linked to dementia.

Mark Hyman: But on our clinical level, nobody's really looking at this from a traditional medicine when you go to a neurologist, they don't measure toxin levels. They don't ask you about them. They don't ask you about exposures. They don't do any testing about it. And, you know, one of the challenges is it's very hard to test for some of these compounds mold.

Mark Hyman: You know, there was a great lab for micro toxins that was run out of business because insurance companies didn't like it because they were getting, actually, I think I was the cause of it. Actually, I think it was, like, 20 years ago. But I had a patient who was in a house that was affected by mulch. She had chronic fatigue. Her daughter had juvenile rheumatoid arthritis, and they lived in different bedrooms and had them go assess what was on in their house and what was what was growing in each room, and they were different molds.

Mark Hyman: And then when we did lab work with doctor Bajani's lab, It's called the immunosciences that did these mold toxins and lab assessments. It matched exactly like the the microtoxin antibodies where the microtoxins that were in the she got a $1,000,000 settlement. Then the the insurance company in California came shut down to the government, shut down the lab. It's pretty bad. But anyway, that aside, it's it's something that's hard to test for these things.

Mark Hyman: Heavy metals are easier to test for. You can look at blood testing, that's helpful. There's challenge testing where you can take a key leader and and collect your urine. But the other toxins, which are ubiquitous, like phthalates, BPA, glyphosate, PCBs, pesticides, plastics, microplastics, they're very hard to assess. And I've re recently learned about how to assess it in a different way.

Mark Hyman: I I wanna tell you about it a minute, but I'd love to hear how you how you think about those rather than just your general, like, try to reduce your exposures and improve your own body's detoxification system, which is a sound advice. What are the other ways that you kind of assess these?

Dr. Heather Sandison: Yeah. So we do test through real time labs has an environmental pollutant Panel, and so I do look at urine. At year end levels of excretion. And what I've seen is many of the sickest people, they actually don't collect much in their urine the first time. But then as we start using some binders, some glutathione, some support, some biochemical support as we start getting them sweating, maybe get them on a detox breathwork practice, we see that those numbers will go up.

Dr. Heather Sandison: And so it's almost like, again, hidden, even with our testing, some of those exposures and that total toxic burden can it takes a little bit to uncover. And 3, 6 months later, we see those numbers go up even when they're in an active exposure, but it's just that they're starting to actually mobilize more of it. Also getting on a ketogenic diet, we start to mobilize fat soluble toxins as we are using the fats, to create fuel, we can get that from adipocytes. And then we're releasing those toxins into the bloodstream, and then it's coming out in the urine a little bit more. So I think that many of these toxins initial testing can also be deceptive.

Dr. Heather Sandison: Right? They're most of my patients are over 65. They've had a lifetime to accumulate these things. And Mhmm. This can be such a scary conversation.

Dr. Heather Sandison: Right? It can very quickly go to, like, overwhelm and anxiety about how much toxicity is in the environment. We can only control what we can control. So I think getting testing your water or getting spring water, find a spring dot com. I think is a great source.

Dr. Heather Sandison: To find spring water near you that hopefully isn't contaminated. I'd love your opinion on RO water reverse osmosis is a great way to get a lot of toxins out, but it does require re mineralization because it'll take the minerals out of the water. So getting away entirely from plastic, from drinking anything out of plastic, particularly because hot plastic will leech into the into the water. But even just the screw cap, it's like you've got plastic sawdust in there. And so I think plastic water bottles are just toxic for so many reasons.

Dr. Heather Sandison: But, yeah, the we could we could talk for a weekend on all of the ways to think through toxicity.

Mark Hyman: I'm gonna tell you something might blow your mind. And it it's blown my mind, actually. But before I do, I I just want to kind of reinforce that the approach you're talking about fundamentally his lifestyle is what we eat. It's how much we exercise. It's sleep.

Mark Hyman: It's how we manage stress. It's some basic nutritional support. And those have a profound impact. And and there are some trials that have been done. The finger trial and the pointer trial, which is underway, which are multimodal lifestyle interventions with risk factor management that have shown not just a slow dementia, but to actually reverse it.

Mark Hyman: Which is, again, something that all the drug studies never show. Right? So it's, like, even the best drugs that have been approved and there's not many of them. They don't show that. And I don't know why it's not something that's headline news because studies are published.

Mark Hyman: Your study should have been headline news. Again, it was published in the journal of Alzheimer's because, you know, if if something is incurable, and you actually reverse it, then don't you think we should be actually spending the billions on that rather than more drug studies?

Dr. Heather Sandison: Yeah. That brings you more.

Mark Hyman: Yeah. So so we're gonna get into all these factors that were studied in the finger trial and the point of trial and your data. As well, but I I just kinda wanna get back to the talks and conversation for a minute because, you know, I've personally had mercury poisoning and I know what it does in my brain. It was bad. I've also had mold toxicity.

Mark Hyman: So I know what that does to my brain. It made me very demented. And and I had terrible memory issues and cognition issues. And I I figured out how to treat that. Thank god, but I recently, had been using a test out of Germany.

Mark Hyman: It's a relatively new test. That measures not just the stuff that comes out in your urine that's in your blood, which is, by the way, these toxins that you're talking about are stored in fat. And so if you if you look at what's in your blood or what's cleared in your urine, there's not they're not gonna be there. Like, they're just they're just not that's not what there's. It's like it's like looking I don't know.

Mark Hyman: It's like looking at your urine for red blood cells. They're just they're not supposed to be there, so they're just not gonna be there. And and this test that they do uses an analysis of cells, not not blood, but your actual cells and cell membranes and using lymphocytes, and they they find the load of toxins in there that we've never been able to see before. And it's kinda shocking to me how loaded people are and how loaded I was with everything from pesticides, to phthalates, to glyphosate, to metals, And and I, I've been treating myself and a bunch of others with a procedure called the PK protocol, which is designed to help place, the toxins in your cell membrane to improve cell membrane function, fluidity, and cell communication, and mitochondrial function, all of which are the things that go wrong when you have a neurologic disease or dementia. And so I I I just talked to a patient, actually, a couple of days ago, who is a dementia patient.

Mark Hyman: She's, in her early eighties and very bright woman and was was starting to go downhill and was diagnosed with, MCI, myocardial impairment, and was getting worse and worse. And I and I did this test on her and I got the result and I was sort of shocked and and, you know, it matched against what I would expect her her history was. For example, she was a smoker So there was a lot of cadmium in her cells. Cadmium is a metal that you get from smoking. She also had Lending, which is a pesticide that's been banned for years.

Mark Hyman: She had glyphosate. She had all these plastics fungal toxins that were in her cells. And what we did is a protocol that basically flushes out all that stuff using high doses of intravenous phospholipoline, which is basically the fatty substances that makes up your cell membranes. And then we for partner with the glutathione and things healthy, talks fine, the b vitamins we talked about and a bunch of other minerals and support. And I talked to her on Sunday, and I was like, how's it going?

Mark Hyman: She's like, I don't know. It's amazing. My memory's back. I have full short term memory and long term memory is better. You know, I I someone can tell me something morning.

Mark Hyman: I remember the next day, you know, that was she couldn't remember 5 minutes from before when when she had a conversation with her husband something and 10 minutes later, she wouldn't remember it. And and it was so exciting to me because I'm like, wow. Finally, we have a way to actually assess and to monitor and to treat in a way that I I don't think I've ever seen before in my practice. I'm curious if you have any experience with that, what you think about it. If you know what I'm talking about, the lab is a German lab.

Mark Hyman: It's called Igl,

Dr. Heather Sandison: Igl. I'm writing that down. Yeah. I'm not familiar with Igl, but I have been using the Patricia Kane, the p is hospital cooling for a long time for many years. The IVPC.

Dr. Heather Sandison: And we do the the exchange, by IV. And then also oral PC, which we know helps with gallbladder, basically the discharge of file, that toxic sludge that we build up. And so PC, I think Also, very clear that that helps with the brain as this phosphatylserine and choline is part of acetylcholine, a neurotransmitter, the most abundant neurotransmitter in the brain, and that part of the the mechanism around ARISTEP or, some one of the medications that's used for dementia. Although it doesn't work very well, it is an acetylcholine acetylcholine, the uptake inhibitor. And so that is, basically trying not breaking down acetyl choline so that we have more of that in our brain.

Dr. Heather Sandison: And that can help with memory short term, but we see over the course of 5 years and set using those medications Actually, people are worse off 5 years later than if they never took them. But Colleen, we do know that Colleen has a big role to play in the brain. So not just the phosphatidyl choline, but choline found in eggs and, yeah, and in other food sources and also in many nootropic formulas.

Mark Hyman: That's the major neurotransmitter that goes down as acetylcholine in Alzheimer. So, you know, I don't know what doses you're using. Heather, but, we're using basically, 20 grams, which is a lot and we over 10 weeks, we give 2 kilos, basically a fossil cooling intravenously.

Dr. Heather Sandison: Are you doing the inessential vials?

Mark Hyman: Yep. But we're doing 20 of them.

Dr. Heather Sandison: 20 of them. Wow. Yeah. We've we do 5, typically.

Mark Hyman: Yeah. I think I think that's way under dosing. That that yeah. I think that I because I used to do five I didn't see the same results. And it's it's done over a period of time, but it's it's essentially twenty miles twice a week for 10 weeks.

Mark Hyman: And if people are wanting to know how to do this, we do this at our center and ultra wellness center in Lenox, Massachusetts. I'll send heavier the protocols.

Dr. Heather Sandison: I would love that. Yeah. Because are you tripping it in D5W?

Mark Hyman: Yeah. It's stripped in. And, right, you're dripping it in, and then you'd drip in a bag of glutathione. You have multi I mean, that, that's a folate and and Luca Voren and and and other Biatanovich other stuff. So it's it's a pretty interesting thing, but I I did make before and after testing, and it was completely different.

Mark Hyman: I mean, I'll I'll even share my my, my results in the in the in the, show notes because I think it's so compelling. And I I think the before and after was just striking, and I personally felt different, dramatically different. So I think we're, like, we're learning about all these things that we didn't even know before. Medicine is advancing so fast. And you know, there's the there unfortunately, there's not 1,000,000,000 of dollars spent on researching, IV phospho choline in dementia, but we should because if if what I'm finding is what I think is I'm finding, it's pretty exciting.

Mark Hyman: And then, of course, you know, for the mold stuff and the metal stuff, there's other things to do. The fossil choline actually also helps in the mold, but there's other things you could do for mold, but it's important to really assess whether you've got mold exposure because it's it's really one of those things that can be treated and so it can heavy metals. Like, I I shared in my in my case study with with a patient where we do chelation on him. And other things like infections. Right?

Mark Hyman: I mean, Chris Kristofferson have Lyme disease that caused his dementia when he treat as Lyme disease, his dementia got better. So

Dr. Heather Sandison: Yeah. Rich Horowitz is also seeing that the treat the treatment of Lyme disease can help with dementia. My patients the first patient I who really opened my eyes to this. Darlene was her name, and she came in soon after I was trained by Doctor Bredesen in 2017. And she and her husband came in.

Dr. Heather Sandison: She was entirely dependent on him. She had a MOCA score of 2. So the MOCA is the Montreal cognitive assessment, and we use this as a clinical tool to tell us where on the spectrum of cognitive decline someone is. And a perfect score is 30. It's a one page worksheet that some of your listeners may be familiar with.

Dr. Heather Sandison: You copy a cube and draw a clock, identify some zoo animals, and she had a mocha score of 2. So she was essentially answering. Yeah. She was answering questions with, like, yes or no and not much more than that. Their life had been completely, you know, changed since she had gone down very quickly with dementia and diagnosed Alzheimer's.

Dr. Heather Sandison: Now her very dedicated loving husband had read Doctor. Bredison's book and was all in. I mean, he had, thank goodness, enough confidence for both of us because I had never done this. And she was so severe that I was I didn't I wasn't hopeful at all. But they asked

Mark Hyman: me just to give this perspective, if you're it's out of 30. So if your score is less than 25, it's a problem. 2 is, you know, nobody's home.

Dr. Heather Sandison: Yeah. 26 and above is normal. Once you're down in the single digits, this is severe dementia. This is where you are dependent on others for activities of daily living. Your dignity is more or less gone.

Dr. Heather Sandison: Right? You're not able to do anything on your own. And so she was in that in that state, but she had this bright smile and her eyes would track me and she had this beautiful floral dress and you could just see how much soul was in her and they just shocked me. She came back 6 weeks later and her mocha had gone up to a 7. And of course, my initial response was, like, disbelief.

Dr. Heather Sandison: I was like, oh my gosh, we must have done the test wrong. Like, this isn't possible. Like, what is going on here? And her husband assured me, no, no, she's different. Listen to her.

Dr. Heather Sandison: She was speaking in complete sentences. They started bickering about something while they were in my office, and she was remembering things that he had said, and she wasn't going back to work. She wasn't a 100% better, but this was the moment. I mean, I remember it. It like, exactly what I was wearing and the way the light was shining in the it was so emotional for me to be like, what?

Dr. Heather Sandison: If this is possible for Darlene, like, what is possible for everybody else? Who's not so far down along this path, there is so much suffering that we could be avoiding by taking this approach. So what did they do? They moved out of a moldy bedroom and they didn't just they didn't have to move out of their house entirely, but they moved into their their living room. They started ballroom dancing three times a week, even though they weren't very good at it.

Dr. Heather Sandison: They were going on walks every day. They got on a ketogenic diet. They ate only whole foods, got rid of all of the processed foods in their diet. She got on all the supplements that we put together based on doctor Bettison's approach, She got a bio identical hormone replacement. She went and got the mercury out of her teeth.

Dr. Heather Sandison: Her root canals out. She got all of her dental work taken care of very quickly. And lo and behold, she improved. And she I really owe so much to obviously Doctor. Redison, but also to Darlene because and her husband, because that was the moment.

Dr. Heather Sandison: Like, I could not deny how much better she had gotten.

Mark Hyman: Yeah. What was her score after? Are you done all that?

Dr. Heather Sandison: It was a 7 men and she continued to go up a bit. I I lost touch with them. They kind of they they're doing things on their own, but they we were together for a couple of years and probably like your patients, you know, you hear from them years later and and you think, oh, has it gone down or do maybe like extra help? And she'll probably be like, were doing great. They were That's amazing.

Dr. Heather Sandison: Very motivated. It was really fun.

Mark Hyman: And and for people listening, I just I just wanna point something out here. This is something that you just don't hear about. Right? The the the reversal of dementia is just something in traditional medicine that's considered heresy. And if you talk like this, if you say what we're saying, you're thought to be a quack.

Mark Hyman: And, you know, I don't mind being a quack. Actually, I guess. You know, it means I'm thinking differently, and I'm pushing the envelope a little bit, but I don't really care because when I see my patients get better, that's what matters to me. And I and I know we can have an impact on these people. Now, not everybody's gonna get better.

Mark Hyman: I've had cases where I I just didn't find the thing or the things to do, and there may be more of a a more pathology going on that I didn't really understand, and they couldn't figure out yet. But but the good news is you can start to really assess people differently. So maybe you can talk about how we start to assess someone completely in what we do in traditional medicine and how that's different with the approach that you're taking. I don't know what you call it, but I call it functional medicine.

Dr. Heather Sandison: You know, I'm trained as a naturopathic doctor, which essentially is functional medicine. And going to doctor Benson's training, I was very struck by you know, I have all of these tools. I learn them all in naturopathic medicine. It's just applied to dementia and the brain, And also, I I wasn't stacking them. I didn't have, I think, a respect for how much synergy there is between doing these things together.

Dr. Heather Sandison: And when we're looking to reverse Alzheimer's, we really do need to throw everything at it. So people will ask me, well, do you start with the gut, or do you start with detox, or do you start with infections? Like, say no, no, we don't, we just do all of it. We throw everything at it because we're asking for a miracle. We're asking for the reversal of this neurodegenerative process, and we need to do it yes today.

Dr. Heather Sandison: Now if we're in prevention mode, we have it's a much more of a luxury. Right? If you know your APOE status, you're at risk for dementia, and Alzheimer's, then start in your twenties. We know that there's basically 4 stages of Alzheimer's. There's a presymptomatic stage where there are changes happening in the brain, you might have amyloid plaque accumulation.

Dr. Heather Sandison: There's there's things happening that are going in the direction of neurodegeneration, maybe inflammation, there lots of different things that can happen in response, but that is happening before we notice that we're forgetting anything. And then you have that symptomatic phase where it might not be measurable. We call subjective cognitive impairment where you know that your brain isn't working the way it did 5 or 10 years ago, but we wouldn't pick up anything on a mokus for, for example, or on other neurocognitive testing. And then we have something called mild cognitive impairment. As it progresses, we start to be able to measure that your cognition is not as good.

Dr. Heather Sandison: And there's lots of different ways to do neurocognitive testing. We use the MOCA score in my office because it's quick, simple, very inexpensive, And we we did the clinical trial, we also used the Cambridge Brain Sciences battery of cognitive testing, and those matched And so instead of charging patients a lot more and taking more of their time, we we rely mostly on the MOCA these days.

Mark Hyman: Mhmm.

Dr. Heather Sandison: But that mild cognitive impairment stage there's nothing miles about it. It's actually quite devastating. It sounds like you've experienced it once again.

Mark Hyman: It's not a nursing home, but you're, you know, You're still not great.

Dr. Heather Sandison: Yeah. You might not be able to work anymore. You're not connecting it. You're not experiencing your relationships. I had a patient come in.

Dr. Heather Sandison: I've Sara for the first time this week, and she actually signed up and got my book early. So she was able to read it 6 or 8 weeks ago and started implementing a lot of the program. And she I mean, this just made my day. I'm sure you've heard the story. I I read your book and I'm already doing better.

Dr. Heather Sandison: I wanna get even better. And She had, as I was asking her, you know, are you forgetting words? Are you having trouble with word finding or names? I used to, but I don't anymore, and her husband agreed. Again, in the last few weeks, she's been doing a lot better.

Dr. Heather Sandison: Are you repeating words or phrases or stories? I used to, not anymore. Are you overwhelmed? So many people, one of the early signs that this is starting to take place is that they used to host Thanksgiving for their family. For twenty people.

Dr. Heather Sandison: And this year, nope. She can't do it. It's too much to take on. This woman owned owns a restaurant and She had felt so overwhelmed by payroll and employees, and she said to stop going into her restaurant because she would just cause more harm than good. Now she looks forward to going in and taking care of all the things that need to be taken care of.

Dr. Heather Sandison: And this just happened over the course of about 8 weeks that her life transformed so dramatically. And so these, these signs that this mild cognitive impairment, again, she was she was basically kind of going towards retirement, forced retirement. She wasn't already at that that phase of Alzheimer's, more severe Alzheimer's where you're dependent on others for dressing and eating and driving, of course, that kind of thing.

Mark Hyman: Yeah. Well, I think what you said earlier was so important. I wanna to it in in such a great story and it's so inspiring. And and the the thing you said earlier was that, you know, people say, where do I start? And, you know, typically we we have a very reductionist view in medicine where we just do the one thing.

Mark Hyman: And, you know, my my mentor, Sid Baker had a rule, which is called the attack rule or the attack rules. The first rule is if you're standing on attack, it takes a lot of aspirin to make it feel better. Right? If you got mold toxicity or mercury toxicity or your guts of masks or your mask and nutrition deficient, you can take all the Alzheimer's drugs you want. They're not gonna work.

Mark Hyman: Right? And second is if you're standing on 2 tax, taking one out doesn't make you 50% better. So you have to find all the factors that may be going on and address all of them. And and this is this is what we call network medicine or systems medicine or functional medicine. It's the idea that diseases have multifactorial causes, meaning there are many causes for any single disease.

Mark Hyman: In any one person. So not just it's not just their multiple causes in different people, but even in the same person, there may be 4 or 5 factors that are driving the disease. Like in that patient I said, it would insulin resistance and be vitamin efficiencies and gut issues and mercury toxicity hit all of it. Right? We can't just do one thing and hope he gets better.

Mark Hyman: And and so that leads to what we call multimodal interventions. And this is a really unique idea in medicine, which is that you do more than one thing. Right? It's like, well, How do you how do you sort of prevent heart disease? Well, just to exercise.

Mark Hyman: Well, no. You have to eat better. You have to sleep. You have to deal with stress. You can't just do one thing.

Mark Hyman: It's like, Oh, I'm just gonna and I and I had this conversation with we're trying to do a dementia study when I was in Cleveland. I had a had a discussion with one of the head researchers there, brilliant woman and amazing. And I said, well, we have all these things we wanna do and look at, and we need to do them all at once. And she's like, no. No.

Mark Hyman: No. You have to study exercise, and they will study diet. And then we'll study vitamin d and then we'll study vitamin B Twelve. And then we'll say, no. I mean, that's not how the body works.

Mark Hyman: And it's very tough. Because that's how our research infrastructure set up. But you you need this study, which I'd like you to kinda unpack for us now, who's published in 2023 in the journal of Alzheimer's. Or disease. We're gonna put that in the show notes a link to it.

Mark Hyman: It was called observed improvement in cognition during a personalized lifestyle intervention and people with cognitive decline. So take this through the design of that study, how many people, what were the, diagnostics you did, what were the findings, and then and then what were the changes you made in interventions you did, and then what were the outcomes? So walk us through that.

Dr. Heather Sandison: Yeah. Sure. So what we did was we recruited 25 participants to go through a 6 month intervention. And like I mentioned, we just threw everything at them. So we did all of the testing.

Dr. Heather Sandison: We had them make the diet changes, the exercise changes, sleep, stress management changes, all the foundational lifestyle changes, Plus, we looked for toxins and infections. Did it all and we did bio identical hormone replacement when appropriate supplementation treated their gut we've looked at, you know, anything and everything that we could, their cortisol levels, their hormone levels, their thyroid levels, anything that was there that was out of balance, we treated. And we did this aggressively. We did it quickly. And In those 6 months, 17 of the 23 participants improved their cognition.

Dr. Heather Sandison: So the reason I did this trial was I had patients asking me a question I didn't know the answer to. If I do this, if I spend the money, if I make the effort for to do this for my mom or dad or for myself, How likely is it to work? And I didn't know if it was gonna be half the time, a quarter of the time, 80% of the time, and what we was it when we recruited patients with MOCA scores between 123. So again, a normal is 26 and above. Perfect is 30.

Dr. Heather Sandison: 12 to 23 is in that mild cognitive impairment to kind of more moderate even going. We had patients. We did include patients with a diagnosis of Alzheimer. And we saw that most of the time, 74% of the time people improved. We saw that there were statistically significant Yeah.

Dr. Heather Sandison: I mean, I it blew my mind. We also saw that there were statistically significant improvements across the mean of all participants included in the MoCA, the Montreal cognitive assessment, and as well as memory, specifically, and overall composite cognition on the Cambridge Brain Sciences testing. We also saw Yeah. Improvement.

Mark Hyman: So in English, that means it means based on validated metrics that are used by researchers to evaluate the success and intervention on cognitive function that this program that you did worked, and it worked better than most other drugs that we find. Right?

Dr. Heather Sandison: Any drug. Yeah. This this improved, yeah, this improved cognition measurably statistically significantly and on multiple, basically everything that we tested had an improvement. It was statistically significant for the MoCA memory specifically, and that that depart that there was also verbal ability and focus, and those ones that were improved, but not statistically significantly, and then overall composite cognition was also improved as well as quality of life and sleep. And so we saw these really dramatic, amazing improvement Now, I wanna put my study in the context of other research that's hap that's been published.

Dr. Heather Sandison: So doctor medicine and tubes, Deb Gordon, there's a group of people that have also published a trial that's very similar. So they took a 9 month intervention. Our study was a 6 intervention, so quicker intervention. They had 9 months, and they took participants with MOCUS scores down to 19, and they had 25 participants. Very similar intervention.

Dr. Heather Sandison: Doctor Bredesen's work applied clinically, and they saw that 84% of their participants improved. So we saw 74% with more progressed disease. Right? They would have worse cognition to start, and we only did 6 months of intervention. So neither of these trials were randomized control trials, which is sort of the gold standard in research.

Dr. Heather Sandison: Both of these were feasibility trials. The question we were really asked was with a cognitively declined population. Can we do this complex intervention? Is it like, will they even be able to do it? And we saw, yes, not only can can they do it, can patients do it, but they will get improvements most of the time when they do.

Dr. Heather Sandison: Now really, really exciting in the research. I'm sure you saw this, but just a few weeks ago in June of 2024, Doctor. Dean Ornish published a trial that is a randomized controlled trial, and he took 49 participants through a 5 month intervention. So my study was 6 months Doctor reticent's group, they did 9 months, and Dean Ornish did a 5 month intervention. And he had a control group and compared the 2 And what they saw, I mean, I just got chills when I read the conclusions that they drew in this trial.

Dr. Heather Sandison: It was It was I I mean, I just do a happy dance every time I think about it, but it was a comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with mild cognitive impairment or early dementia due to Alzheimer's disease. I mean, this and this did make front page news. Asha Gupta on CNN did a docu series related to some of these patients. And so I think the narrative finally, I mean, I just am doing a happy wiggle right now talking about it. The narrative is finally shifting.

Mark Hyman: That's so good. I I wanna talk to you about this, because I think, you know, you're you're you're pointing to the the phenomena that this can get better. The question is what's the right approach? And, you know, you mentioned earlier that you use ketogenic diets which is extremely high fat diet. It's like 70 to 75% fat.

Mark Hyman: I think doctor Ornish used a very low fat diet. Like, 10% fat, vegan, 10% vegan. So how do you reconcile that in your mind between a diet that that have been actually shown in other data to actually be effective around using ketogenic diets. I've seen this in my own patients. When they go on a ketogenic diet, they get better, which is the opposite of a 10% low fat vegan diet.

Mark Hyman: So can you kind of help us understand how to think about that?

Dr. Heather Sandison: Yeah. I'm just pinching myself that I get to have this conversation with you because I think, you know, the food systems and, like, talking about diet. This is such a the crux of what you've done and paved the way for, and it's so crucially important to this conversation around brain is what we eat. And so what I suspect will happen, I've used the ketogenic diet in my practice. It's a plant forward ketogenic diet, right?

Dr. Heather Sandison: So it's not a bacon and cheese diet. This is a very nutrient dense healthy diet, but metabolically, the goal is to get into ketosis and burn fat for fuel. And oftentimes, it's like the lights come on. There is clearly something that happens, and I think I, again, have a reverence for how much complexity there is in that shift in metabolism. Of course, we're getting more fuel.

Dr. Heather Sandison: There's detoxification happening. There's less oxidative stress. I think there's a multitude of mechanisms at play with the keto giant diet. But I also think that one of the big things that happens with a ketogenic diet is you get rid of processed foods that are so harmful. I think that also happened happens in a vegan diet if you do it right.

Dr. Heather Sandison: So you can have unhealthy keto. You can have unhealthy vegan diet. Doctor. Ornish, they used a very healthy vegan diet, and I suspect that what we'll see will play out over time. And as we compare these to each other, is, an ancestral diet is really what's best.

Dr. Heather Sandison: And what was consistent about an ancestral diet was inconsistency. Right? We were in ketosis sometimes because there was always carbohydrates available. And then we were vegan other times because there wasn't always meat available. There wasn't always animal protein available.

Dr. Heather Sandison: And so I suspect that what's for our brain, what's best for our body is to actually change diets. It's to not always be on the same diet, but to get the metabolic flexibility of going in and out of keto And what I recommend to my patients now is if you have cognitive impairment, get on a ketogenic diet for 3 to 6 months. There are benefits, and I think there are healing benefits for the brain of being in ketosis solidly for 3 to 6 months or so. And I don't have data to back that up. It's from my clinic.

Dr. Heather Sandison: Well, I have my clinical experience in what we've seen in the LAMA, the residential care, facility that we have where we we have an immersive experience in this. So that's I haven't seen this published, but it's what I see playing out as best for my patients. The thing with ketosis is it's not sustainable for the our lives. You're gonna go to a wedding. You're gonna go to Italy and wanna have some pasta or some gelato.

Dr. Heather Sandison: You're gonna go to, you know, you're gonna go somewhere where you're gonna fall out of ketosis. And so then what choices to make then non process? I think the overarching message around what is a brain healthy diet is avoid processed foods eat whole foods that are nutrient dense organic as much as possible and then shift your metabolism.

Mark Hyman: Yeah. Because I think if you're if you're going on a whole foods real food nutrient dense diet and you're switching from a standard American process diet, you're gonna see a benefit if you go to being vegan like but the question is what happens over time? How does that low fat affect your brain? You know, how how would that compare to the head to head comparison with a healthy ketogenic diet versus a healthy vegan diet. And, you know, how do you address the other variables that he's not addressing, whether it's heavy metals or the microbiome or nutritional factors.

Mark Hyman: So I think it's complex, and we need to do more research. So I I think, it got a lot of headlines, but I I do I am concerned about you know, having a a low fat vegan diet as they kind of focus for dementia because I think it it might be problematic, especially, you know, over time these patients become more insulin resistant.

Dr. Heather Sandison: I agree. I think that there can be benefits gained from changing your diet. And then you don't wanna stick with one diet for too long. I think that and especially vegan keto, right, to try to do both, I wouldn't suggest anyone do that because you start being too strictive and you end up with nutrient deficiencies. We know in vegan diet, you're gonna have to supplement with B12 B12, as you mentioned, talking about some of your cases very crucially important to cognitive function.

Dr. Heather Sandison: And so having a diet that restricts that is is not gonna work long term. And that's part of why this this alternating different diets eating seasonally. The way our ancestors would have ate, it will, I think, help us to prevent those deficiencies and get the right types of nutrients without getting the excess in terms of carbohydrates.

Mark Hyman: So, you know, diets key is foundational, right, to getting people better with brain disorder because what you eat determines the function of your body and your brain. So you just gotta deal with that. But, There are a lot of other things that you do as well. And a lot of these multimodal, finger, and pointer studies, and the doctor ownership study also did this exercise stress management, sleep. Those are foundational.

Mark Hyman: What I wanna sort of dive into is some of the other stuff. We talked about toxins, but, you know, there's some other things that that are done to sort of assess the overall function, like hormone levels, nutrient status, the microbiome. Can you talk more about some of the other things that might not be common that people know about that you do as part of the the treatment and work up.

Dr. Heather Sandison: Yeah. Sleep is one of these pieces that I think is really underrepresented. I've had 2 patients in the last 18 months or so who have come in with single digit MOCA scores. They 2 women who came in with MOCA scores of 8, who nearly doubled those MOCA scores. They went up to 1 went up to 13 and then to 15 and the other went up to 15 and then to 16.

Dr. Heather Sandison: And both of them had undiagnosed untreated sleep apnea. And that was a big part of our intervention. Now we did everything else. Right? We measured the toxins.

Dr. Heather Sandison: We measured infections. We got them on hormone replacement. Progesterone help them sleep. I'm sure. We did we did all the things.

Dr. Heather Sandison: Right? But the big, I think the big shift was getting sleep. So And it made me wonder when I saw both of those patients kind of in succession, how much Alzheimer's? How much suffering is happening? Because people aren't getting access to sleep studies.

Dr. Heather Sandison: One of these women was actually told by the sleep technician who did her her study that she didn't have sleep apnea before she when she came in, Oh, you you're not overweight. You're not male. You're not snoring. You don't have sleep apnea. And sure enough, she had severe obstructive sleep apnea.

Mark Hyman: Wow. Wow.

Dr. Heather Sandison: And so I think many people are told that they don't have it or it's not looked into at this stage in my career any patient with any cognitive decline, I am testing for sleep apnea. And I'm really excited because there are there's new technology since COVID for doing at home sleep studies so it can make it less cumbersome. It's less of a chore. It's less expensive than going into an overnight sleep study. That still is the gold standard, and there are a lot of sleep disorders you can't rule out, by these at with these at home sleep studies, but we have caught many cases of sleep apnea using these the watch pack is the one that I use.

Dr. Heather Sandison: The watch. A watch

Mark Hyman: pack. Yeah.

Dr. Heather Sandison: Yeah. And so we're identifying sleep apnea and able to treat it. What happens during sleep is that, of course, we get we get that rest. Right? But we need about 7 hours minimum of sleep, some people need more than that.

Dr. Heather Sandison: And we want at least 90 minutes of limb sleep and about an hour of deep sleep minimum so that we can consolidate memories so that we can take the bite out of stressful events that happen. So our cortisol doesn't spike the next day when we remember them. It also helps us to get rid of the the amyloid. Amyloid can build up after just one night of sleep deprivation. If you're in your twenties, forties, Just one night of sleep deprivation.

Dr. Heather Sandison: I know.

Mark Hyman: Must be messed up because I lost so many nights of sleep as a resident intern and medical student and living babies, working the ER. I must have a lot of loss, a lot of brain function.

Dr. Heather Sandison: Well, it's good. You know, functional medicine, and you can clear that amyloid out. And I hope you're prioritizing sleep these days.

Mark Hyman: So sleep is important, and I didn't get that. I'm I'm interested in some of the other things besides the foundational lifestyle stuff, besides sleep and exercise and diet. What what else are you doing for these people?

Dr. Heather Sandison: Yeah. So, looking at infections, you know, we are treating Lyme aggressively. We're doing, prophylact in terms of herpes. So if somebody has herpes outbreaks, we wanna get aggressive about that. There are epidemiological studies that show that, that can be associated with dementia.

Dr. Heather Sandison: The dental work, I recommend, going to a biological dentist, making sure that you even I'm sure you've had patients like this with root canals that are affecting their total body, how their whole body health in one way or another, creating Yep. Autoimmune processes. And inflammation in the brain. So getting really thorough workup of what's going on in the oral microbiome is super crucially important. And then so from an infectious perspective, getting ahead of all of that stuff and treating it aggressively, particularly if there's that APOE status?

Mark Hyman: The sort of realm of of toxins is something that, you know, you we did talk about, but I think it's one of those factors that's important. Infections and then you just gotta dig until you find what's going on. And some of these layers of diagnostics. You know, I I cofounded a company called function health and in in that initial membership fee of 499, you get a whole suite of tests that your doctor typically doesn't do that play a huge role in your cognitive function. You know, not only do we look at your levels of inflammation, insulin resistance, metabolic health, but we look at toxin levels like mercury and lead.

Mark Hyman: We look at also the nutritional status like methylamonic acid and homocysteine, which are really critical for memory and brain, which are often not tested. We look at vitamin d, omega 3 fats, and really get a a profound, deep study. We're also, able to do APOE testing and and soon we'll be adding something called 80 detect, which is a a from Quest. It's a newer test. They're they're not available widely, but it looks at sort of early biological markers in your blood that can predict what's going on.

Mark Hyman: Isaacson's doing that, and it's he's an incredible sign because I've had him on the podcast. I'm probably I'm back in Purino's work, but he's he's, developed another test, which is different than that, but it's is using PETA, and it's a very useful biomarker because when you see people improve, it gets better. So it's like a blood test to see whether or not what you're doing is better, not just a MOCA test or it's what's people say it's maybe a subjective or little squishy test, but natural blood test. So I think we're gonna get more and more sophisticated about our diagnostics and assessments. I think, you know, people are listening out there and have loved 1 or have memory loss themselves.

Mark Hyman: I wouldn't just take it at at face value. I would say you should be aggressive about investigating other therapies and other treatment and starting with the foundational stuff, you know, what you eat, exercise, dress management, sleep, community relationships, you know, becoming active. You know, those are things that really matter. And then there's all these other layers of nutrition and infections and toxins in the microbiome and hormones and things that we talked about earlier, but it's really all of it, right, whether some people need more testosterone or more estrogen. We will need you know, to have their thyroid fixed.

Mark Hyman: I mean, what, you know, you can have dementia from having a little thyroid that may not be picked up. So I think there's so there's so much happening in this world so exciting and you're at the leading edge of it. I wonder if you share a little bit about, your residential program because that's a really unusual idea. And I think Part of the challenges, when we're thinking of doing research on this at Cleveland Clinic is, like, I wanted to bring people in for, like, an immersive program to be able to understand what's going on, to learn all about it, to be able to sort of internalize what we talk because, you know, in a in a doctor visit, you basically it's hard to just sort of get everything and people are overwhelmed and kind of get you know, kind of during the headlines sometimes, but but an immersive program is very different. Can you talk about it?

Mark Hyman: What you've done and and what you've found?

Dr. Heather Sandison: Yeah. Sure. So around the same time you're doing the clinical trial and getting this question, how if I do this, if I put in the time and effort and money to do this, how often do people get better, we also we're getting the question, hey, I know I want this. I get it intellectually. I want this for my dad or I want this for myself, but I can't do it.

Dr. Heather Sandison: It's too much. I'm overwhelmed or, of course, the sandwich generation of people who are working full time, raising kids, and their parent is sick, has an diagnosis of Alzheimer's. They want doctor Bredesen's approach for them. They want functional medicine for them, but they can't spend their, you know, it's a full time job to provide this sort of care. And so this question was coming up.

Dr. Heather Sandison: Where do I send my loved one? And I looked around and there wasn't a place that was really offering an immersive experience, the organic ketogenic diet, a non toxic living environment, social engagement, physical engagement, cognitive engagement, the management of all of the supplements and medications, all of that takes a lot of labor. It takes a lot of time and effort. And so we thought I well, I thought how hard could it be to just create a residential care experience for people in offer that up. And so we went it was kind of 9 months and all of a sudden, we had done it.

Dr. Heather Sandison: And then COVID started, which was a story for another day, because we opened our doors March 1 2020. And then the world shut down about a week later, but we had this we had this really I mean, I just am so grateful to the families who've trusted us to support their loved ones. And what we see in the opens is sister facility in Kansas. So now we have two locations and The Kansas data is a lot cleaner because COVID wasn't in the mix, but the first six residents that have lived there for over 6 months and 5 of them improve their cognition.

Mark Hyman: Wow.

Dr. Heather Sandison: But we also see in this experience is that people get off their antihypertensive. They get off their antidepressant They get off their diabetes medications. My favorite thing to hear from a someone is I got my mom back, right? They're they get to have another Christmas where their mom is able to pick out age appropriate gifts for the grandkids. Right?

Dr. Heather Sandison: They get another anniversary, another summer, where they can really have a quality relationship with their loved one because of what we see with being able to fully implement the program.

Mark Hyman: Now is is this a place where people go and then they leave or go and stay?

Dr. Heather Sandison: You know, that's the goal. I think as the narrative shifts, what I'm hoping is that people will come earlier on in the disease process. So right now, the answer is either, whatever serves that that person. We had in this May of 2024. We had our first resident move home with a mocha score of 30.

Dr. Heather Sandison: So she came when her mocha score was 24. She had found mold in her home. Her brain was not working the way that it had been. She was getting measurable cognitive impairment was being picked up, but it was in the earlier stages. She decided that she was gonna have her home remediated, come to Marama, move in, and then sure enough, she was 6 points higher, mocha score of 30, when she moved out May 4 2024.

Mark Hyman: Amazing.

Dr. Heather Sandison: I would love for that to be what happens. Excuse me. So what I would love is that we don't have to relegate our elders to these senior living facilities. Right? They are at the height of the peak of their wisdom and experience where they have so much to share, so much value to bring to our communities, and yet they often get relegated siloed often these here living facilities.

Dr. Heather Sandison: And they become a detriment. Right? They become a liability to society. It costs so much to care for someone who has to mention Alzheimer's, as you mentioned, at the top of the podcast. Yeah.

Dr. Heather Sandison: And if we could get them back, if they could help take care of the our our the youngest generations, their grandkids, and great grandkids, and in in part that wisdom, I think that we would get so much back.

Mark Hyman: It's so powerful. It's such an incredible mission you're on. I think you know, anybody listening to this podcast, I hope, it it's hopeful. And and I think, in my practice, I've seen this. You've seen this.

Mark Hyman: Dale seen this. Many others doing this. And, of course, even in traditional medicine, we're seeing this now with the finger trial, the pointer trial, Doctor Richard Isaac, his work, it's tremendous. And I think we'll put links to all that in the show notes. And and people need to understand that that we are in traditional medicine mostly in the dark ages when it comes to dementia.

Mark Hyman: People are not getting the best care available. They're not getting to take advantage of some of the things we've talked about today. And that and that it it requires a little more effort obviously, then they're just kinda going to your doctor and taking a pill, but it really is worth the effort in terms of helping to slow and and even reverse, cognitive decline as we get older. And by the way, a lot of these things are good from a prevention point of view. You know, do we do these decades earlier?

Mark Hyman: You're not gonna end up with dementia. Right? So it's about getting on the track early on. Really wanna thank you for your work, Heather. It's it's just been a pleasure to talk to you.

Mark Hyman: It's been very inspired to hear about your research, to hear about what we're seeing clinically and to actually give people a little bit of a road map, and your book is out now I encourage you to go check it out. It's called reversing Alzheimer's, the new toolkit, to improve cognition and protect brain health. You can get everywhere you get your books. And, I think it's a it's a great journey. You can check out the Albrightis's work, Richard Isaacson work.

Mark Hyman: You can check out my book that I wrote a long time ago, the UltraMind solution, which I'm thinking redoing and writing a new book on this because so much has happened in the last 15 years. And, and, hopefully, we'll see you next time on The Doctor's Farmacy.

Dr. Heather Sandison: Thank you so much for having me

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