The Melanie Avalon Biohacking Podcast Episode #323 - Dr. Heather Sandison

TRANSCRIPT

Dr. Heather Sandison
that this idea that reversing Alzheimer's is controversial, I think that that's going to be very short-lived. We get these cognitive measurements that people are significantly improving. Plus, we get to see them and we get to hear, I got my husband back, I got my mom back. She's having regular conversations again. She's able to dress herself again. These are the things that really matter to people.

We're orienting towards healing, towards repair, towards connectivity between the neurons, synaptogenesis. And that's when we see these better cognitive outcomes.

Melanie Avalon
Welcome to the Melanie Avalon biohacking podcast, where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind, we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying herein. So friends, are you ready to join me? Let's do this.

Welcome back to the Melanie Avalon biohacking podcast. Oh my goodness, friends, what a treasure of a conversation I had today with Dr. Heather Sanderson. I cannot recommend her New York Times bestselling book, Reversing Alzheimer's Enough. And we dive deep into so many things in today's episode. We talk about the problematic history of Alzheimer's and the medical literature and how it is treated in medical science. It is kind of shocking the things that happen with that. We talk about the confusing and potentially misleading role of amyloid plaque in Alzheimer's, your genetic risk for Alzheimer's, including the APOE4 allele, benefits of dual task training, the role of therapeutic fibs, how to prevent cognitive decline from a multifaceted approach, the role of diet in preventing cognitive decline, especially because there seem to be very conflicting diets out there, things like veganism on one hand, animal inclusive on the other, the mind diet, the keto diet, Dr. Sanderson's diet, whether or not you should drink alcohol, the shocking role of clutter in cognitive decline. And definitely stick around to the end because just when I thought we were done, we got into a really good conversation about care for the caregiver.

Things like asking hard questions, the emotional toll, all of that. The show notes for today's episode will be at melanieavilon.com slash Heather Sanderson. That's H-E-A-T-H-E-R-S-A-N-D-I-S-O-N. Those show notes will have a full transcript as well as links to everything that we talked about. So definitely check that out. I can't wait to hear what you guys think. Definitely let me know in my Facebook group, IF Biohackers, Intermittent Fasting plus Real Foods plus Life. Comment something you learned or something that resonated with you on the pinned post to enter to win something that I love. And then check out my Instagram, find the Friday announcement post. And again, comments there to enter to win something that I love. All right, without further ado, please enjoy this fabulous conversation with Dr. Heather Sanderson. Hi everybody and welcome back to the show. I am so incredibly excited about the conversation I am about to have. It is with a book which honestly blew my mind, no pun intended, when it comes to all things, brain health, cognitive decline, and in particular preventing Alzheimer's disease. And friends, this book, so I'm here with Dr. Heather Sanderson. Her book is a New York Times bestseller. It's called Reversing Alzheimer's, The New Toolkit to Improve Cognition and Protect Brain Health.

Melanie Avalon
And it is an incredible multifaceted approach to really preventing and reversing cognitive decline. And I'm sure we'll talk about in today's show, but Dr. Sanderson led a really incredible study that published in the Journal of Alzheimer's Disease in August, 2023, where they actually implemented her techniques in a really holistic manner, a really extensive manner. Dr. Sanderson, I have so many questions about this study, but they actually saw incredible improvement.

And in the book, Dr. Heather goes into all of the different facets of aspects of health that can really address cognitive decline. And not only that, but it addresses the problems and the myths surrounding Alzheimer's, because as I'm sure we will also talk about, the history of this disease is kind of shocking in the myths, the confusions, the misrepresentations, and really what has led to the path that we're on for treating it today conventionally, which does differ a little bit from the approach we're gonna talk about here. So I know I learned so much in the book, and when I reached out to you guys for questions, I just got inundated with so many questions about this topic. So Dr. Sanderson, thank you so much for being here. Melanie, thank you for having me. So I, like I said, I have so many questions for you. And you talk about this in the book a lot. You trained with Dr. Dale Bredesen. Did you train with him, or what was that relationship? Yeah.

Dr. Heather Sandison
Yeah, that's correct. So he did not have any idea who I was, but we met officially. I trained with him in 2017, and then we met officially in 2020 as I was opening up Marama. He was kind enough to come for the grand opening of the residential care facility that we had created.

And since then, I've worked with him relatively closely. We spend a couple hours a week on Zoom calls, reviewing cases at this stage. I partner with him relatively formally through the Pacific Neuroscience Institute at the moment.

Melanie Avalon
And you mentioned it now, I wanted to make sure I mentioned. So the work that you're doing like in the field. So you have, and how do you say it? It's Marama, the residential program. So that's a residential program.

And then you also have a clinic called, is it SoulSayer Health Clinic?

Dr. Heather Sandison
Yeah, so sorry. So I basically what's happened is over the years as we've built this reputation around helping people with cognitive impairment, more and more people come to us with, well, I have this scenario and it doesn't work for me to come to California and become your patient. So how can I do this at home? Or I love the idea of marama, but I can't afford it or it's too far away and I want my mom here living with me or next door.

So how do I do it at home? And so from that we've basically just tried to create resources that can meet people wherever they are, no matter their age, no matter their cognitive status, even at the very severe levels. We're trying to engage them in this a Bredesen approach in a way that meets them where they are so that we can put it to work, right? You can read all these books, you can learn all the information, watch all the webinars, listen to all the podcasts. But if you can't put it into practice, if you can't implement it, that's where we see the wheels fall off. You don't get the outcomes, you don't get the benefit unless you're really putting this work to work.

Melanie Avalon
Yeah, actually to that point. So one of my habits with this show is the night before as a kind of like my Refresher last prep I go and I read all the Amazon reviews of the book Yours has a lot of reviews not surprisingly a lot of really extensive reviews You can kind of tell when you read the reviews Like how much people are into a book or not and so many of the reviews are honestly like novels But they actually say a lot of them say what you were just communicating right now Which is that your book seems to really make this Approach that will actually make change really practical for so many people and so many people in the reviews were saying, you know They've read all these different books tried all these different things But this was the first thing where they actually could implement it and see changes So this is so so incredible before we get more into the actual topic your personal interest and cognitive decline.

Did you always? Know well, I guess we don't know that when we're like born So can't have always been always but when did you realize that this was an area of focus and interest for you? Yeah

Dr. Heather Sandison
people have asked that. And it's not as if I had a family member who, you know, it's not like all of my grandparents had Alzheimer's. It really was this meandering path. I wanted to go to medical school. I wanted to help. I think that there are change makers in the world who have so much to give, who can make the world a better place in their unique way. But when you're sick, it's really hard to show up and do those things. And particularly struggling with cognitive impairment, of course, people are at the height of their wisdom and experience with so much to give. And yet they succumb to this awful torturous disease. And so that's been sort of a guiding light for me. My entire life is like what I want to do. My work in the world is to reduce suffering and to help people shine their own light. This niche, it came out of just being in certain places at certain times. So I went through naturopathic medicine, which definitely oriented me towards more health and wellness and lifestyle medicine. And then I was at a conference, an integrative mental health conference where Dr. Bredesen was speaking. And I had been told just like everyone else in medical training that there was nothing you could do for Alzheimer's or dementia. And that to suggest otherwise would be to really do harm, would be to be giving people false hope. And so I had bought that. I thought that that was gospel until I heard Dr. Bredesen speak. And although my mind wasn't totally changed, the way that he described applying naturopathic functional medicine to neurodegenerative disease, it conceptually made sense to me. Like the common sense was there. If we take everything out that is disturbing the neurons, that is creating inflammation, activating microglia, and we add everything that's necessary to put the neurons into a healing state where we're activating neurogenesis and synaptogenesis. If we can turn all of that on and turn off the inflammatory process, turn off the neurodegenerative process, then we should see outcomes that really matter to people and improvement in cognition. And so he described this and he said that they had found cases. This was back in 2016. I was intrigued enough and sort of naive enough to be like, okay, this makes sense. And if I can treat Alzheimer's, then everything else is going to be cake. So I signed up for his more extensive training, which happened right as his book, The End of Alzheimer's was launching in the fall of 2017. And then when I came back to my clinical practice, after getting that training, I was on his list of trained providers. And there weren't very many of us. I was the only one in San Diego at that point. And so people started coming in. And they had way more confidence in this than I did. I had gone through my medical training being told that this was impossible. And then I just had the privilege of watching the impossible happen, of watching people reverse even severe cognitive impairment.

Dr. Heather Sandison
And they were coming in six and 12 weeks after I'd first seen them doing the work at home, and they were better. And at first, I was in disbelief.

And then as soon as I got over that, I was like, all right, this is my life's work. I have to tell as many people as will listen and help as many people as possible because there's so much suffering that is happening unnecessarily.

Melanie Avalon
It's interesting because I was going to ask the title, Reversing Alzheimer's, this concept of reversing it, and you mentioned it just now, is very controversial. And actually, one of the only few negative reviews of the book, literally all it said was a person said, you can't reverse Alzheimer's, period, and that was the end of the review.

And I was like, okay. So this idea of reversing it or not, and I'm trying to figure out where we should go about this because, for example, you talk in the book about some really shocking stats about Alzheimer's and cognitive decline, which I think most people associate with like plaques and tangles. And I would love to hear your thoughts on that. But for example, you talk about how, let's see, only 2% of people don't actually have plaques and tangles in general, even, let's see, 30% have enough to qualify for an Alzheimer's diagnosis but only 10% have symptoms. And something I had never heard before was that other conditions, not dementia, so things like Parkinson's and TBI and some other things also have plaques and tangles, but we don't make that a criteria for diagnosis for those conditions. And then in the book, you talk about these three different inflations that happen where basically we just got this definition of things which may or may not be accurate. So that was a long windup to say the actual concept of cognitive decline versus an official definition of Alzheimer's and then whether or not that can be reversed. How do you feel about that today? Can it always be reversed? Is there a point of no return? And what is the role of this definition in all of it?

Dr. Heather Sandison
I think that this idea that reversing Alzheimer's is controversial, I think that that's going to be very short-lived. I see it all the time, right, and Alzheimer's, how we define that is somewhat controversial, and I hope that that controversy, you know, resolves itself, but my, what people think of as Alzheimer's, so like when you say the word dementia, there's not this emotional kick to it, right, but you say Alzheimer's, and it puts the fear of God in people.

And that's because of strategic marketing, right, there is a reason that that happens to us, and the diagnosis of Alzheimer's for many years was clinical. You didn't know until autopsy if there were amyloid plaques present, but you could still have dementia, right, you could have this age-related memory loss that someone diagnosed as Alzheimer's. I mean, to this day, we see people come in with an Alzheimer's diagnosis from a neurologist who very clearly have Lewy body, right, and so there's a lot of, and there's a lot of overlap, right, you can have Parkinson's and Alzheimer's, you can have Lewy body and Alzheimer's, you can have frontotemporal dementia and amyloid plaques that are associated with Alzheimer's, and amyloid plaques are absolutely 100% correlated to Alzheimer's, right, so you see that people with APOE for status, they have increased risk of creating amyloid, increased risk of getting Alzheimer's, right, there is definitely a connection between these things, but I don't accept that amyloid alone is the cause of Alzheimer's, right, and I think it's more interesting to ask the question, what is causing the neurodegenerative process? Now, your question, like, reversing Alzheimer's, is this controversial? What I will say is that in my clinical practice at Mirama, in my coaching programs, I have seen people who are diagnosed by a neurologist with Alzheimer's who have measurably significantly improved their memory and their cognitive condition, and that, to me, is enough to say we're reversing Alzheimer's. We are not curing Alzheimer's, so I want to be super clear about that.

So we are reversing the disease process. We see in Bredesen studies that he's published, we've seen that there's actually growth of the brain matter itself, like on imaging, you see an increase in brain volumes, we see a reduction or a resolution of the phosphorylated tau in the system, and then we get these cognitive measurements that people are significantly improving. Plus, we get to see them, and we get to hear, I got my husband back, I got my mom back. She's having regular conversations again. She's able to dress herself again. These are the things that really matter to people, and amyloid is part of this equation.

It's part of the conversation, but it's not the entire conversation. We're really good at getting amyloid out of the body, out of the brain, but it doesn't lead to cognitive improvement. It doesn't lead to what matters most to people.

Dr. Heather Sandison
That doesn't reverse Alzheimer's. That doesn't even improve it.

It just slows the process of degeneration. What we are doing is we are changing the signaling in the brain from microglial activation, from defense, and from attack mode, from that fight and fight mode, right? From getting out of that mode that's going to lead to more inflammation, to leading to we're orienting towards healing, towards repair, towards connectivity between the neurons, synaptogenesis, and that's when we see these better cognitive outcomes.

Melanie Avalon
And where do you fall on the idea that maybe the amyloid plaque is actually protective?

Dr. Heather Sandison
Oh, that's I don't think that's debatable. Yeah, amyloid plaque is antimicrobial.

And so is tau. So these are, these are, you know, we call them quote unquote, misfolded proteins. But they're there to protect us. There's no question.

Melanie Avalon
the plaque there. Is it more causative and early onset versus later or is it still a similar mechanism of action that's just happening earlier?

Dr. Heather Sandison
Yeah, great question. So early onset is associated with several genetic changes. And most people know if they have this amyloid precursor protein or APP and then PSN1, PSN2, these are the genetic mutations that are associated with early onset Alzheimer's, which is when it's happening before the age of 65. So often we'll see families, I mean, not often, it's actually, thank goodness, quite rare. But you may have heard of a family where everyone has passed away with Alzheimer's before they turn 50. It's really heartbreaking.

And that is less of what we do. Now we have patients who we're seeing now who are positive for APP or PSN1 or 2 or multiple. And we are doing a prevention, essentially, and of one trial, right? We don't have a formal trial, but we are seeing these patients. And Dr. Bredesen has a patient who is PSN positive, who has lived another five years after everyone else in her family had died, I believe. And she does not have symptoms yet. So she's in her 50s. And my understanding is that everyone else in her family had died before they reached 50 with Alzheimer's. So we're at the very least potentially delaying. Now we need a lot more data there, but it's very rare.

So the vast majority of our work is on the late onset Alzheimer's, which happens after the age of 65. And the genetics associated with this type of Alzheimer's are APOE, APOE. And if you have one or two copies of APOE, what happens is that your brain triggers the inflammatory process that leads to the cascade that leads to amyloid plaque formation faster than someone who is APOE 2 or 3. So this means that genetically you're predisposed to create inflammation if there's any insult. So if you're not getting enough sleep, if you get a traumatic brain injury, if you're exposed to a herpes virus, if you have nutrient deficiencies or excesses of sugar, if you have diabetes, you are basically going to create beta amyloid faster. You're going to create that immune system inflammatory response faster than your neighbor or your spouse who does not have that genetic predisposition.

Melanie Avalon
Yeah, and to that point, because I know there are, you know, ideas that maybe that was more protective in the past evolutionarily, like there was a reason we had that genetic variant. Why would it not have weaned itself out of the genetic pool?

I am not God.

Dr. Heather Sandison
So I'm not totally sure. But I mean, more or less it has.

Our Neanderthal ancestors, they were all ApoE 4-4. So this is relatively recent. It's the original. Yeah, it's relatively recent. They were where the twos and threes have popped up. So we get one from mom and one from dad. Yeah. So I mean, essentially, that is what's happening as we live longer. The genetic pool is shifting away from the four fours and three fours and towards more threes and twos.

Melanie Avalon
Okay, and then because you're mentioning a lot this fear that surrounds all of this, which I definitely feel. I feel it just if I think about it. I feel it when I ask questions from the audience. I feel it even like in, I feel like in horror movies and stuff they use, you know, Alzheimer's as this, you know, like the crazy person type idea. Like it's just a really scary thing in society.

And I think people who are familiar with the APOE for concept get very scared by or can get really scared by the concept. So if somebody has that either one or two of them, what is the actual risk, like the relative versus absolute risk? Like what is the actual risk increase of getting, you know, Alzheimer's without, I guess, with or without intervention?

Dr. Heather Sandison
APOE, you get one copy from mom and one copy from dad. So you end up with two copies of them, and it can be a two, a three, or a four. And so this is describing sort of what they look like molecularly. So you might be a three, three is the most common. That doesn't change your risk.

If we take genetics out, the entire population has a 13% chance of being diagnosed with Alzheimer's in their lifetime. Now, if you have a three, four, so you have mom or dad has given you some risk, genetic risk for Alzheimer's, that risk goes from 13% to 30%. If you have a four, four, APOE four, four status, you got one from mom and one from dad, that risk goes to well over 50%. And there was a nature paper that suggested that it was essentially inevitable that if you lived over 65, you would be diagnosed with Alzheimer's if you were four, four positive. Now we've seen that when we implement this protocol, this Bredesen approach for people who are three, four or four, four positive, we see that they, they respond that they are great candidates for doing this.

We get benefit and we included many people in our trial who were both three, four and four, four positive, you know, to your point about the fear. So I remember 10, 12 years ago in my practice, people would say, well, why would I be tested for that?

So APOE, it's a single nucleotide polymorphism. It's an inexpensive test. If you ever did 23andMe or any of the other online genetic testing, you probably have it. It might not have been at the forefront, but it's in the raw data there somewhere because it's a very simple, inexpensive test. You can also get it through Quest or LabCorp. It's very easy to get, you can just ask your doctor. Now, what if I don't want to know? Because if I know that it's just going to make me stress out and I'm not going to sleep at night and then I'm just going to be at higher risk for Alzheimer's, right? I totally appreciated that perspective 10 years ago. Now, I think it's actually so empowering to know because now we can make different decisions.

I think about, you know, if a mom is 4-4 positive, she knows she's passed on at least one of those to her kids. I'm going to make different decisions. If I know my daughter or son has even one copy of APOE 4, I am not going to encourage them to play football. I am not going to encourage them to like be an ER doctor or, you know, work night shifts or be a fireman where their sleep is going to be interrupted. I'm going to make different lifestyle decisions for them. I'm going to encourage them to avoid binge drinking. You know, like any of these things that we know are modifiable risk factors when it comes to dementia risk, we want to get ahead of those things. And I think that, you know, even if we don't test our children or we let them decide when they're 18, gosh, that's a great time to know when you're thinking about what you're going to do as a career and you have all this time to protect your brain. People who are APOE 4, 4 positive are testing differently, cognitively in their late teens.

Melanie Avalon
Oh, wow. Okay.

Those were good examples you gave because what I was thinking was I was thinking about how I'm overwhelmingly obsessed with like biohacking and pursuing these different healthy lifestyle choices. And so I was just thinking practically for myself, if I had the for variant, which I'm trying to I know I don't have it. I'm trying to pull up my results of what I do have. I don't remember what I had, ironically enough, but I know it's not the for version. But like examples you gave are very practical examples. Like, true, I could be pursuing a seemingly holistic health lifestyle and all the things and yet still there are things if I had that variant, I would just still probably not want to do like a career where my sleep is for sure going to be super restricted or, you know, if women played football, I would not want to do football. So for that because the TBI potential.

Dr. Heather Sandison
soccer, like heading a soccer ball, big wave surfing. We think about football because of CTE and kind of the press that that's gotten.

But there's a lot of other sports that can lead to traumatic brain injuries.

Melanie Avalon
I'm not a sport person, but anything where that might be the case. So, and you mentioned your study again.

You said that that population, which I read it, I was reading it last night and I'm curious, what was the time, actually I know the timing because you mentioned that you started it and then COVID happened, right? What was that like putting a wrench?

Dr. Heather Sandison
open Marama March 1st of 2020 and we had started recruiting for the trial February of 2020. So you know, in retrospect, I'm like, gosh, what a that was wonderful.

Like we got to slow down there was so much going on and we got to slow down and we got to do it right and with the right people and we had more time to train and get our ducks in a row. And so, you know, in retrospect, it all works out and it's for the better, but it was very challenging going through it.

Melanie Avalon
Oh my goodness, I can only imagine. So did you open, so you said you opened the clinic in February. Did you open it for this study or was it all going together?

Dr. Heather Sandison
Oh, sorry. No, I opened my clinic in 2017. So we'd had the clinic up and running for quite a while.

And then we started recruiting for the clinical trial in February of 2022. And then we opened Marama, the residential care community in March, March 1st of 2020. Okay, gotcha.

Melanie Avalon
So what I really love about this study, and it's something that you talk all about in the book, is you guys, I mean, basically, so there was 23 participants in the end. There was 11 of them did drop out.

Did you find that concerning at all that that higher dropout rate?

Dr. Heather Sandison
that's pretty normal for Alzheimer's studies. Like if you look at the Agilum, like those antibody therapies, it's about a 30 to 35% dropout rate. So I think with that population, you get more of that.

Now COVID, I think also made it a lot more challenging. We had people who, we required that they come in person. And when there were surges, we would have people drop out because they weren't comfortable coming in. There were lots of reasons. I mean, we had people who move. We had, we recruited probably into large of a geographical area. So we had somebody like who was, you know, swore up and down that they would come for every visit. And then it got to be too much to travel. So, you know, there were things, of course we learned, but I think that withdrawal rate is not uncommon in this population. It's actually quite normal.

Melanie Avalon
I was so impressed reading through, I was like, I want to be in this study because you guys really individually, well, actually, I guess I'll let you tell about it. So what were the basic pillars of what people were doing in this study and how did you individualize it to the individual person? Because that was something I was really impressed with, like it said that people who had like, you know, Lyme disease, they were referred to people or referred to doctors or, you know, mold toxicity were given guidance and, you know, it seemed really comprehensive and personalized.

So yeah, what was the setup? How did it work? Also, how does it compare to the pillars in your book?

Dr. Heather Sandison
Yeah. So great questions. We essentially what we were studying, it was a feasibility trial, right? So some people ask, why isn't there a control group? It's like, well, we weren't there yet. We had to first see if we could actually get a complex protocol implemented in a population that has cognitive impairment. We were asking them to do a lot. It was not as simple as taking a pill a couple of times a day. This was changing their diet. So that was part of the eligibility criteria. They needed to be willing to change their diet, their exercise habits, take supplements, potentially take some medications to implement the medicine protocol at home. And if they weren't willing, that was a non-starter.

We did not exclude people if they already had a diagnosis of Alzheimer's. We didn't exclude them if they had other medical conditions because we really wanted to do was, say, will this work in the real world in an outpatient clinical setting? Can we do this? And then, oh, and can we see if we get results or their outcomes? And sure enough, we did. We saw that 74% of our 23 participants improved their cognitive function. And we had statistically significant improvements in overall composite cognition, in mocha scores, in memory, in quality of life, and in sleep across the mean of all participants. So we did there. I mean, the p-values were below. They were statistically significant. So we can say we have a high likelihood of this intervention made a big difference for people improving their cognitive function.

So what we did was apply the medicine protocol. Certainly, everyone was given lifestyle advice and encouraged to get into ketosis and the mild ketosis. We had them change up their exercise habits. I actually had some patients, not the majority of them, but I have some patients who do triathlons. And we're actually telling them, hey, let's maybe scale it back. That might be too much energy or burning. But for the most part, we're asking people to get more cardio, more dual task, more strength training in, and then stress management. So they were recommended kirtan kriya, a type of meditation that has great data around it for improving cognition. And we also had some people do prayer practices, just some sort of stress management practice. So diet, exercise, stress management, these were foundational pieces.

We had people do sleep studies. We had them wear Fitbits. We also did the testing for toxins, for nutrients, for stress and cortisol regulation. Of course, we were looking at blood pressure and hemoglobin A1c and their diabetes status. We were looking for heart disease, anything that's going to impede blood flow to the brain, we were wanting to understand. We also looked at other infectious burden. Did they have pigeon to valus or herpes simplex one or Lyme disease that might have a neurological effect that might create inflammation in the brain? So we looked at all of those things and then we treated people accordingly. So yes, it's highly precise. It's very individualized and it's essentially functional medicine or naturopathic medicine applied to neurodegenerative disease. It's Dr. Bredesen's protocol.

Melanie Avalon
And something you said in the book about it that I thought was so empowering was you pointed out that, you know, this incredible improvement statistic of 74% increase and that's with you said nobody, you know, did it perfectly. So because I think people get they can get really overwhelmed by especially in a multifaceted lifestyle approach where you're not just taking a pill you're quote having to do all these things.

Something you make really clear through the book is you can see improvement even without doing everything perfectly.

Dr. Heather Sandison
Yeah, one thing to clarify, it wasn't 74% improvement. It was 74% of participants improved. Oh, sorry. Yeah, no, just so that people aren't like, wait, I didn't improve 75%.

That's the likelihood. And this was part of why we did the trial is because people would come in and say, hey, if I'm going to spend the time and the money and put the effort into this, how likely is it that myself or my loved one is going to improve? And I didn't know if it was 50% of the time, it was like a one and two chance or, and Dr. Bredesen, they had published a trial, cat tubes and a group up in Northern California. They published a trial a year before me in July of 2022 in the Journal of Alzheimer's disease, very similar intervention. Their participants were not as progressed. They had mocha scores down to 19 where ours had more progressed disease. They were more physically, excuse me, they were more cognitively affected by the disease process. And our intervention was six months where their intervention was nine months. So they had more time and they had less progressed participants, but 84% of them improved. So yeah, you, we can see that the vast majority of people who engage in this program improve their cognition. Now, to what degree we don't have an answer for. And a lot of that depends on I think what, what you're kind of, you were leading into, which is how much of this do I have to do? It's so much work. It is a full-time job. It's a more than full-time job. And it's like, what would you give to have your cognitive capacity? And also the side effects of this are that many people get off their antidepressants. They start sleeping better. Their type two diabetes resolves their blood pressure gets better and they live more joyful, meaningful lives.

So like, what is that worth? And it's not for everyone. However, you know, it's holding a little bit of both, right? The people that we have the most confidence in when we, when we get started with, we kind of think of like a readiness score. Like who do I have the most confidence is going to be successful in this. They're typically younger. They are typically earlier on in the disease process. They're highly motivated and they're ready to dive in, right? They're not just dipping their toe to see like, okay, what's the minimum I can get away with here? They're ready to like fully embrace the program. That's who I have the highest confidence in.

Now, that being said, I have given people very low readiness scores and they have turned around and proven me wrong and like, bam, it's gotten outstanding results. There's also people that have been like, oh, this is in the bag. Like, we're going to be able to do this. And then something pops up and it doesn't work, right? So it's not 100% predictable all the time. But when, you know, what we want to do is not overwhelm. We don't want to go into that analysis paralysis or that overwhelm paralysis where we don't make any changes. It doesn't work unless you do it.

Dr. Heather Sandison
And so how do we kind of get people there? It's easy wins. And that's part of why we start the book with like, if you only did one thing, start with this. And then we can get the momentum of, okay, I'm feeling a little better. I have a little more energy. I've checked that box.

Now where's the next one? That's really what we want to set people up for is to make changes that are significant enough. We see a difference in the outcomes, but also that are sustainable, that are going to last a lifetime and really change the trajectory of health as we age.

Melanie Avalon
I love this so much. Okay, a few different questions here.

So the, because I think when people think, or at least the way I used to think, when people think of interventions to prevent cognitive decline and Alzheimer's, like they'll think maybe like, I think a lot of people are more aware of a keto diet, maybe exercise, they'll think like, like puzzles, like jigsaw puzzles, things like that. So these different pillars that you've come up with, and that they're in the, you know, entire multifaceted approach. And I want to talk about the one thing thing because I love that so much. But so what are the different pillars? Can we go through them really quickly to get the audience an idea of these?

Dr. Heather Sandison
Yeah, absolutely. And I think of these as like the foundation. So like the icing on the cake is all of the intervention that you might do with a provider, right? Like your toxin testing and your nutrient testing and your hormone balancing. But that is the extra.

The foundation and what's really going to move the needle is the lifestyle piece. It's the decisions you make every day about what you put in your body, about what you eat, what time you go to bed, who you spend your time with, how much movement you get, what you engage in. Those are the things that really impact our health. And then yeah, sometimes we'll find like, oh, there's really high mercury and there's really low this and that'll be really helpful and really important. But it all works better if we have this lifestyle foundation in place.

And that's what we talk about in terms of implementing the protocol and getting into these pillars, which are routines, setting up routines so that it's easy to do the right thing and to prioritize your brain health each day, getting the body to move, exercise, feeding the brain with an organic ketogenic diet. And then activities are crucially important. Like how do we engage? You mentioned crossword puzzles and I love that and all, but there's so much more to it than that. And one of the most important things that I find in terms of how we engage is that it's creative and that it's fun, that we enjoy it so that you don't just do it for a week because someone told you crossword puzzles were good for your brain, but you do it for a lifetime because you enjoy it.

You look forward to it. And hopefully there's an element, I'm like efficiency if nothing else is important to me. And so I'm like, okay, how do we do multiple things at the same time? This is where I love to recommend somebody doing activities that include cooking great food or being social or getting outside or connecting spiritually, going to church and going to a Bible study with other people. If you're not religious, then going to cooking classes where you're learning to make good wholesome, great food, gardening with your neighbor. Pickleball is one of my favorite things because you're outside, it's social, it's hand-eye coordination. It's keeping track of the score. It's totally complicated. I can't do it. And then it's spatial awareness. It's all of your muscle engagement and the physical engagement. Ballroom dancing is another one where it's the music and the memory of the steps, but you're aware of your partner. You might be being cued by an instructor. So all of these things, they engage your brain in multiple ways and hopefully they're fun. And what's fun for you won't be fun for the next person. But another one is the environment. So in kind of related to routines, you can set up your environment. You can set up your routines so that you pick up the remote and you turn on the TV and you kick your feet up and you veg out, or you pick up your phone and you scroll for hours at a time.

Dr. Heather Sandison
Or you can set up your routine and your environment so that when you walk into the house, you drop your phone in a box or a jar and you don't pick it up until you leave the house. And while you're at home, you've got magazines and books and puzzles and games at your table where you engage with your family and you pick up a card deck and you play cribbage or something in the evenings instead of turning the TV on.

So you can set up your routines and your environment so that they reflect your priority of brain health. And this is hard because it requires effort. The inertia in our society is to scroll and shop. And we really have to put effort into not doing that.

Melanie Avalon
really excited with the dual tasking piece. And I think about this a lot.

I think we need, I feel like we need a different word for multitasking, because just as a concept, because I think we lump together in it a lot of different ways we can engage with the world that are actually different. So, you know, they'll say that you can't actually multitask, like you can't be doing the same wavelength of your brain required for something, like you can't do two different math problems at the same time. And yet there's this dual tasking where you can do like physical things while thinking about something. And you gave an example in the book, and it was so eerily similar to one of my favorite things to do, which is I love listening to actually I probably wasn't listening to your book while doing this, like listening to podcasts while prepping while like cleaning my apartment or like it's my it's one of my favorite things to do. And so it was exciting to read in the book that this is really great for our brain to be, you know, doing multiple things at one time that aren't actually the the type of multitasking that we can't do.

Dr. Heather Sandison
Yeah, yeah, I think the nuance there is like if cognitively being engaged on two things at once listening to a conversation and writing a separate email, you can't do that. You can't you like you're not present in either of them.

However, when you are dancing, you are engaging multiple parts of the brain, right? So there's an auditory, there's auditory stimuli from the music, there's kinesthetic awareness of where you are in space. There's a social engagement with your partner if your partner dancing. There's maybe you're listening for cues from an instructor about what to do and where to go next. There's short term memory about what just happened and where am I going? What steps do I need to take next? So you're engaging multiple parts of the brain, cognitive and physical. And that's what we mean by dual tasks.

Melanie Avalon
Amazing. I'm really curious when you were picking the quote one thing from each from each section was that difficult like did it for each section did it immediately come to mind or did you have some some debates?

Dr. Heather Sandison
You know, it's my partner in this, Kate Hanley, my writing collaborator, she, this was her idea to pick one thing. And so we went through it and I think it was a little bit of both. You know, there were things that were really clear, like, okay, I've seen so many people do really well with this. If they were just to do one thing, this would be the thing to get started.

And the idea is like, we get these wins. We get this dopamine hit that I'm successful and I'm ready to add the next thing. So what I wouldn't suggest is like, if you only do that list that you're going to see radical improvement, but it's going to get you started and that and I, my hope is that it gives you a kickstart that leads to, to the things that do create radical improvement.

Melanie Avalon
I think the very first one you listed because I was not expecting it and I was like, oh that's okay. It was like take your shoes off when you come inside. Like that literally never occurred to me as something important.

Dr. Heather Sandison
There was a neurologist who was interviewed and he was like, taking your shoes off has nothing to do with Alzheimer's. And I was like, yeah, fair. The idea there is, I grew up in Hawaii where like, that's just normal. It's rude not to take your shoes off in the house.

And that's, you know, Asian kind of culture. But my, where that comes from is that I have had patients who test high for glyphosate, even, which is the active ingredient in Roundup, even when they're eating 100% organic diet, as far as they know, right? They're, they're shopping at places where they're, they're buying things that are labeled organic. And you know, I also, I see a lot of that in my, I recommend that patients eat organic, I eat organic. And then you can see when somebody has elevated levels that do not align with reporting that you're eating organic. What I discovered was that people pick it up on their shoes, that it gets sprayed on sidewalks, right? Because you're trying to keep the weeds from growing between the cracks on the sidewalk. And so I think that part, I mean, this is, I don't know that there's been huge studies on this, but we walk through parking lots and there are petrochemicals and we walk across the sidewalks where there are, there's Roundup sprayed, there's, there's pesticides and herbicide sprayed. And then we track that into our homes. And the home indoor air quality tends to be lower than outdoor air quality because it's concentrated, right? It's, it's trapped. And so opening doors and windows is another thing on that list of like the solution to pollution is dilution. Don't track it in. And then if it does come in, if things are off gassing, open up the doors and windows and get fresh air in. And this, you know, when people do this, we see a reduction in their, in their overall toxic burden. And I think there's, I mean, animals track it into, it's not like you can get this to zero, but I do think taking your shoes off of the door has a big impact on reducing how dirty your house is with these toxins. I love it.

Melanie Avalon
love it so much. And I liked that it was one of the first ones in the book because I was just like, oh, I was like, I'm gonna learn like a lot of stuff in here that I haven't thought about before.

Yeah, that's incredible. And I also really liked the one I think the one thing for the environment involved getting rid of like decluttering.

Dr. Heather Sandison
This is a huge one for people. I mean, if you can just think of a cluttered place like or cluttered, even if it's not in your house, so you're somebody who like has a Zen like environment in your own house.

But when you walk into a place where there's a lot of clutter on countertops or on a dresser, you know, it's just this to do list that creates a low level of anxiety that can contribute to overwhelm that prevents us from doing other things.

Melanie Avalon
I love this concept. I remember reading that when you have stuff out in your environment, and you kind of captured it just now, but even if you're not consciously thinking about it, your brain sees it as like a to-do list or a task or something that needs to be done. So you just can't feel settled and you don't know why.

Dr. Heather Sandison
I think a lot of people can relate to that experience. And then also because we, you know, I engage an adult population who's had years to accumulate stuff, often if you've raised kids in a house and you haven't moved for a while, this creeps up and it can feel so overwhelming to get started.

But just starting with one surface, maybe even one room and going slowly, it's like this weight gets lifted when you go through the process.

Melanie Avalon
So I have a fun game for you that you could implement with your patients. So I'm very passionate about this decluttering. I'm not like a – I'm passionate about it because I have a lot of stuff to get rid of is what I'm saying.

So what I've been doing now for, I don't know, maybe a year and a half, I call it my throw one thing away every day. I realize one day that that rhymed. So every single night I have a little game I play where I say throw one thing away every day and then I find something to throw away and then I put a sticker on my calendar to have like a streak, it makes me so happy.

Dr. Heather Sandison
So fun, I love that gamifying it with a sticker.

Melanie Avalon
I got really, I loved, when you read it, when you said in your book, you gave an example of putting stuff in storage and taking photos of the things and making a photo album and I not freaked out, but I was like, oh my goodness, because that was, that was what I did to convince myself to actually get rid of so many things when I had to go through a storage unit was, I was like, you know what, it's really just the memory of this thing that's making me happy. So how about I take a picture, and then I'll make a scrapbook, and I'll call it things I threw away. And then I'll actually just throw away the things. And that helped me get rid of so much stuff.

And then I never even made the scrapbook because I was overwhelmed by all the pictures, but it really worked.

Dr. Heather Sandison
You realize you don't need that much stuff. And so many people, especially with dementia, some will start to hoard stuff, receipts, or junk mail, because there is a lack of confidence that they know how to discern what's important from what's not, and so a fear that they're going to get rid of something that's really important.

And then there's also a fear of like, what about my things, my things that are valuable, my things that I care about? And so having that picture of, hey, mom, it's here, it's in storage, it's in this spot, I know exactly where it is, that can create a sense of calm. All right, we know where things are, we know what's going on, now we can declutter. It can kind of help get up over that hurdle.

Melanie Avalon
So that actually I have a big personal question for this and at the same time something you're hinting at which is a big part of The book that I so appreciated was there's an entire section on the caregiver and taking care of yourself if you're you know caring for somebody and it's very extensive and I just thought you know really incredible and really helpful because I Think that's also a silent epidemic of people their health is being affected by caring You know for loved ones with this condition and I'm going on tangents because I had a question about that Okay, I'll come back to it. But just really quickly before that so and This is me just not The caregiver and for the person that caring for relationship you you talk about this a lot and how to optimize that How to you know deal with resistance how to gamify things make things fun make things safe so Like can you I feel like this is like an inappropriate question to ask so like if somebody if they're if they're losing their memory and You try to declutter and throw things away for them.

Can you kind of just rely on them not remembering?

Dr. Heather Sandison
I think there's no bad questions, right? And there's so much that comes up. I appreciate this, Melody, because there are really hard, hard questions that come up as we get older. And as we deal with Alzheimer's and dementia, it just gets harder, not easier. And the fear of asking the question, I think, does a lot of harm. And it's like, okay, if we can just open this up and start discussing it, then we know more about what our loved one, what their preference might be, even when they can't articulate it later. And so, just having these awkward, hard conversations is a huge part of what I invite and what I think reduces suffering. So thank you for asking.

Okay. So then the question is basically, can I manipulate the person I love because they have Alzheimer's, right? And they won't remember. And I think in some cases, the answer is yes. And there's a couple of really great rosy things that come out of this, right? If you mess up and you say the wrong thing, you get to try again tomorrow. And they probably won't remember. So there's a benefit there. It's a heartbreaking one. But if you're struggling as a caregiver, you get to try again. And the fact that if you're listening to this as a caregiver, you are obviously doing a phenomenal job. And I hope that you will take advantage of the resources we have because caregivers have anywhere from two and a half to six times the risk of being diagnosed with Alzheimer's later themselves, because of the stress of caregiving.

So compared to people who never serve as caregivers, they're at very high risk. And caregiving is physically demanding. It is emotionally bankrupting, and it is financially very expensive. And so this takes a huge, huge toll. My hope with my work is that we reduce a little bit of that somehow. But every single family has a different dynamic. So for example, we had a woman with dementia living at Marama, and she was in her 90s. And she had a son in his 60s who passed away. And her daughter, the son's sister said, she was talking to us like, do I tell my mom? I don't know if it's appropriate to tell her. And what we landed on was that it wasn't, that she was in her 90s. I think she was 98 when this happened. And she did not have the cognitive capacity to mourn her son. And so to tell her would be to create a lot more suffering. And what we see is that people remember the feeling, but they might not remember the details. So the expectation was that if we had told her, she would be grieving, but not know why, not able to actually process it, and that it might come up for her day to day. And she was quite happy. There wasn't really any reason to give her that burden to bear. But that was a hard conversation to have and a hard decision to come to.

Now, there's also like the therapeutic fib we call it. If you know, mom has dementia, and she starts talking, she's in her 80s. And she starts talking about how she had lunch with her mother today. And her mother's been, you know, passed away 50 years ago, you can say, Oh, what do you creating confusion or arguing with her about reality?

Dr. Heather Sandison
You just join her in her reality. And then you create connection versus correcting her.

So we say connection over correction, excuse me, that the goal is really to connect with someone to reduce their stress, not to correct them and bring them back into our reality at some point.

Melanie Avalon
I love it so much and actually it's similar because I was thinking about it because I was I feel like certain Families will emphasize certain like morals more than others. So like when I was the way I was raised Honesty was like the thing Like you don't lie like do not lie So that's kind of like really instilled in me and I was having this this contemplation with myself when I was engaging with my niece Few months ago and you know, she was just making up this whole story that was just not even true and You know of like fairy tales and things and I was going along with it and I was reflecting on you know this concept of truth of reality versus you know the the situation of the person so if it's a child or a person with cognitive or person with cognitive decline and You know what serves the the best good at that moment So yeah And I love you you mentioned for example like when you're when you're talking with your loved one with cognitive decline that you can Like if you're giving them options of things to do you can like use it to your advantage by ending with the option that you Most prefer because that's what they're likely to remember.

So but thank you. Thank you for Acknowledging the hard conversations and and having that emphasis in the book about like you like you call it connection over correction I think it's so so important is the and this was what I was gonna ask earlier You said the the risk is, you know massively increased for caregivers with that they themselves will get Alzheimer's and you were saying that was from the stress and everything is it also Partly genetic or do you think it's mostly the the lifestyle?

Dr. Heather Sandison
Yeah, great question. So we see with spouses, actually the highest risk is in male spouses of a wife with dementia. So that's not genetic because they're not related.

Melanie Avalon
Okay, that makes sense. Okay. And so for the big pillars, because you mentioned in the study that when you were engaging with the patients, there was a big focus on, you know, diet, exercise, sleep.

Dr. Heather Sandison
Yes. Yes, sleep, stress management.

Melanie Avalon
question about the diet. I have big questions here. So I had on the show that Laura Morris and Jennifer Ventrelli, they wrote the official mind diet. I've been really fascinated by the mind diet for, you know, ever since I first heard about it for years and years.

So I've done an episode on that diet for its, you know, prevention of cognitive health. It's different from a keto diet for sure. So diet, you know, you talk about the power for role of ketones and the brain, and you even stay in the book that, you know, the higher ketones you see in your patients, the better cognitive function you see. What are your thoughts on the keto diet for preventing Alzheimer's? And what are your thoughts on the mind diet?

Dr. Heather Sandison
Yeah. And also the vegan diet, I would add to that.

So Dean Ornish published the first randomized control trial in June of 2024, showing that lifestyle intervention helps people with early Alzheimer's compared to the control group. They improved and they used a plant-based diet. So I would add that to the mix as well. So the wonderful thing about this is that there's not one diet, right? So if you are adamantly opposed to a vegan diet or adamantly opposed to a keto diet, great, go with the mind diet. My opinion and my clinical experience is that when people get into ketosis, it's one of the most profound shifts I see. People like turn back on. And so if you or someone you love is struggling with cognitive impairment, at least give it a try. Don't leave it on the table as an option you haven't explored. No one should be in ketosis forever, right? This is not about a hundred percent keto diet until the day you die. No, this is about metabolic flexibility. It's about getting into ketosis and seeing how you respond. There are some people who don't respond, who don't get anything from it, who feel worse on a ketogenic diet, but not most people. Most people have significant improvements in their cognition. That has been my clinical experience. I have not seen people who at least who I see, right? And I'm paying out of pocket to come see me. So I don't see people who are eating McDonald's three times a day, but I see people who have relatively healthy diets. They're aware of their sugar intake. Most of my patients don't have diabetes. Some of them do, but they're avoiding processed foods for the most part. A mind diet is not all that different from that, right? A mind diet restricts salt, which worries me because most of my patients are postmenopausal women and they need enough minerals. So I'm not a fan of a bunch of sodium and canned foods, but I am a fan of sea salt. I actually recommend that people get one and a half to two teaspoons of sea salt a day, particularly if they're craving salt, because I worry about mineral deficiencies. So that is something I disagree with in terms of the mind diet. And my understanding of the mind diet research is that it reduces risk. So if you take the general population on a standard American diet and you put them on a mind diet, that's an improvement in their diet, no doubt about it. But if you take a population with a relatively healthy diet and you switch to the mind diet, which includes some processed foods like pastries and breads, and I think pastas and stuff, then I don't think you're going to move the needle. Now, I think that when you go into ketosis or when you do adopt a vegan diet, a plant-based diet, what you get rid of is a lot of the junk. And I think some of the benefit comes from that, but typically you're replacing it with very nutrient-dense foods.

Dr. Heather Sandison
And now let me be clear, the ketogenic diet that we recommend is not a bacon and cheese diet. This is a highly nutrient-dense, plant-forward diet.

So yes, there's eggs and I, because I have my little ladies who I'm worried about them losing too much weight, if they tolerate lactose, then we'll do some cheeses and cream, potentially a little bit of cream in their coffee. We'll do some dairy, but Dr. Bredesen actually doesn't really recommend much dairy, some sheep and goat cheese, some A2 cream, but that can be very inflammatory. But what we want to do is really focus on the veggies, on cruciferous veggies, on mushrooms, on as much colorful vegetables as possible, and then lean proteins. And that's where the majority of our calories are coming from. And it's not calorie restriction. And then adding really good fats, the olive oil, the avocado, the coconut oil, those are really important to the success of this. So getting the substrate to create ketones. And just adding exogenous ketones can also be very, very helpful. Now, what do I recommend for most of my patients? If you benefit from the ketogenic diet, be in it more often than you're not, right? And that might mean Monday through Thursday and then Friday, Saturday, Sunday, you're not in ketosis.

Now, I do not recommend binging on cake and cookies, but go plant-based, but add lentils, so high fiber, starchy vegetables. If you add seasonal fruits, that kind of thing, and cut out the dairy and the animal products, maybe for the weekend. Or you can do it for a month at a time, right? If you're planning a trip to Italy, go eat the pasta and have the gelato, right? But when you get back, get back on one of these diets that we know is protective of the brain. And don't be in one forever. One of the consistent things about ancestral diets is inconsistency, right?

You don't have blueberries 365 days a year. You have periods of famine, so you fast. You have periods of abundance of carbohydrates, and you have periods where there aren't carbohydrates, but there's maybe some meat available. So no, you don't have to go to that extreme. You don't have to be a carbitarian and then go into carnivore. But eat seasonally. It's summertime right now as we're recording this. It's a great time to be on a plant-based diet because it's warm out. And then in the winter, it's a little easier to be on more of a ketogenic diet.

So I think it's worth playing with and measuring your ketones. The CGMs, the Stella wasn't available when I wrote the book, but that would have been like, if you don't only do one thing, it would be get a continuous glucose monitor and wear it for two weeks. It's one of the most insightful things I have ever done personally around my health. And I mean, people just have these aha moments of like, whoa, I didn't realize my oat milk was making my sugars go up to 203 every morning. You know, it just can be one of those things where you cut out things that you aren't even that attached to and has a really big impact on your metabolism. So just starting with understanding your blood sugars, I think is important and then playing with it.

Melanie Avalon
I will put a link in the show notes for listeners to the Mind Diet episode. Also, it's interesting you hearing you talk about the vegan approach, because I completely forgot that I've had on the show The Sure's Eyes, who wrote The Alzheimer's Solution, and they're co-directors of the Alzheimer's Prevention Program at Cedars-Sinai, and they have a very vegan approach. It was interesting to interview them and hear you talk supportively of it as well.

I've also had Max Lugavere on the show, who does a lot with, you know, geniuses and brain health. His mom had Lewy Boddy's dementia, and he had a documentary about it, and he's very much not about the vegan approach. He thinks it's actually detrimental to the brain.

Dr. Heather Sandison
it sustained it is. That has been my experience.

I've had patients who have been vegan for five, six, seven years and come in very sick. So if you are vegan, I don't think that it should be long term. If you're a keto, I don't think it should be long term. It should be months, not years.

Melanie Avalon
Actually, and quick question. This is just my own personal question about this, because you're mentioning even like doing a cyclical approach within a week. So doing, you know, maybe the weekdays keto, the weekend knot. For me, I will actually do, so I do daily intermittent fasting. And then I do either like a higher carb low fat, it's all whole foods based, but like a higher carb low fat approach, or I'll do like a keto night, but I don't normally do two keto days in a row.

So this is a very specific question. But can you just from like a single day of a keto diet, get an effect? Or do you really need to like be in it for a few days?

Dr. Heather Sandison
For most people, it takes 72 hours to achieve ketosis. Now, you can get around that if you're keto adapted.

So if you spend a lot of time in ketosis, then some people can get back into ketosis in like 24 hours. Usually it takes a little bit longer carb restriction. The other way around that is to add exogenous ketones.

Melanie Avalon
that point. So I'm also the host of the Intermittent Fasting Podcast and we often talk about how people who are measuring their ketones sometimes will find that when they're in keto for a longer period of time, they actually see a decline in their ketones. They see a higher amount in the beginning and then it tends to go down.

Are they testing urine? Urine, but they see it in blood

Dr. Heather Sandison
sometimes too. Oh, interesting. We definitely see that in urine, but in blood, I don't typically see that.

We use the Keto-Mojo is our testing device. I'm really excited about there's in Europe, you can get a continuous ketone monitor. I'm hoping that'll be available here soon. Oh, really? Oh, I didn't know that. It's called the S-I-B-I-O, SIBO, which makes me think of like small intestinal bacteria all over.

Melanie Avalon
I know, I know. That's interesting. I feel like they're going to have to rebrand that for me. Yes.

Dr. Heather Sandison
going to confuse a lot of people real quick. But I can't wait for that to be available because some people make the mistake of testing their ketones before they've eaten anything.

So it's not like fasting blood sugar. You don't actually want to look at fasting ketone levels. You want to look a couple hours after you've eaten that you have that substrate, right? You have the fat in your system to make those ketone bodies. So I don't know if that might be part of what's happening, but typically we use the keto mojo. We look at blood ketone levels and I haven't seen that people's ketone levels decline. Now it might be that they're using fat stores or they're looking when they're fasting. I'm not really sure what's going on there. We definitely see it with urine.

Melanie Avalon
So, if they're in keto, do you see that in addition they add like MCT oil to their diet or exhaustion as ketones, more benefit from that?

Dr. Heather Sandison
Yeah, yeah, definitely their ketone levels would go up, especially if you're using instead of the ketone salts, the ketone esters, there's a product ketone IQ that I really like and that definitely will raise your ketone levels significantly, even if you don't carb restrict. The ketone salts are best with carb restriction and then they can kind of get you up over the hump, but they kind of nasty tasting.

I mean, all ketones are kind of gross in terms of how they taste, but I tend to use them when I'm getting up over the hump into ketosis, because even I'm not in ketosis all the time, but I'll go into keto every couple of months for three, four weeks. In those first few days, I have like I call them my donut days where all I can think about is carbohydrates. Like I don't eat donuts even when I'm not in ketosis, but I will be craving ice cream or donuts and I just take ketones instead and then that can help get me up over the hump of the carb cravings.

Melanie Avalon
Okay, I'm dying to know where you fall. So the Mind Diet, they do include red wine in their protocol. Where do you fall on the alcohol spectrum?

Dr. Heather Sandison
So I think that their audience is definitely a prevention audience, right? If you have dementia, if you are struggling with cognitive impairment, it's just common sense to cut out alcohol completely. No one's brain works better on alcohol. Like I know that some people maybe tell you, try to tell you that, but it's just like all of us have had that experience. Well, maybe not everybody, but I've had the, I'll speak for myself, I've had the experience of waking up after having a few glasses of wine. My brain doesn't work. I, it's giving your body and your liver one more thing to process when we know that toxins are at a causal level, they impact inflammation in the brain. And so it's just one more thing that your body has to deal with, it's not supportive, that it has to defend against, that it has to metabolize. And so I recommend anyone struggling with cognitive impairment, cut out alcohol completely.

Okay, hard pill to swallow for some people. Yeah, I think if you're in prevention, I recommend staying away from the combination of sugar and alcohol. So, you know, have a little, it's hard alcohol, but I would rather someone have a little bit of tequila with some soda water and lime or some vodka with a little soda water or some kind of mixed drink that doesn't raise blood sugar, and then stay away from beer and wine that has a lot of sugar. And wine has a lot of pesticides. You know, there's a lot of herbicides in there. There's a lot of glyphosate, even on organic wine. I think there's some wine companies out there that are maybe slightly better, but I mean, and maybe this is a personal bias, it makes me feel terrible to drink even one glass of wine. So I just, I don't, I know that there are a lot of people who are very attached to it as a hobby, as a lifestyle, and it's just, I don't think it's serving them.

Melanie Avalon
Have you tried dry farm wines? Have you heard of them?

Yeah, I pretty much only drink dry farm wines and then I have my whole, my whole protocol, like this Z biotic probiotic that breaks down acetaldehyde. I do like NAD, glutathione patches, like a whole, whole thing.

Dr. Heather Sandison
Yeah. And we're doing all that stuff for people without alcohol in the system, right? Like just the fact that you have to do all of those things to process it. It's like if you already have cognitive impairment, why give your body one more thing?

Melanie Avalon
When it comes to if there was one thing for the pillars, would it be diet? I know it's, this is kind of antithetical to the hypothesis or your thesis of the book, but you know, diet, exercise, sleep, is there like one thing?

Dr. Heather Sandison
Yeah. So the way that we direct people is either do something that's easy. So it's like a buffet, right? If you don't like the fish, don't take the fish. But we have this buffet of interventions, of lifestyle interventions, of medical interventions. Say you want to do stem cells. You've got extra money and no extra time. And what you want to do is like the big guns. Go for it, right? But choose something. And the more that you can take, the more variety of these interventions that you can take, the more confidence I have. But if one of these things doesn't fit for you, then leave it.

Diet I see, you can't out supplement a shitty diet, right? You can't correct. You can't out exercise a bad diet. So diet is very foundational and a great place for a lot of people to start. And it's often a place where people see there's a big Delta, right? Like I'm not starting with a great diet. So if I make this change, I'm going to see a lot of impact. And that so doing either something super easy, which is the only do one thing, like taking your shoes off the door should be pretty easy or like getting your hearing tested or wearing the CPAP device that you have already at home, like those easy things, just start.

And that's one place to start. Or what is that big thing? Like I've had insomnia and I've had terrible sleep my entire life. And I know if I could just sleep, then all of this would be better. Then start with sleep, right? Then it's usually as a chore, right? But find the commitment to be like, all right, I don't want to live like this anymore. I don't want to have that risk of dementia later. Today is the day that things change. I'm going to make that appointment with sleep medicine. I'm going to get the sleep study done. I'm going to try those supplements that eight people have told me about. I'm going to go through the process of figuring this out. I'm going to schedule with the naturopathic doctor, whatever it takes, I'm going to solve for this issue because it's the place where I see the biggest potential for change.

So maybe it's exercise, maybe it's diet, maybe it's starting a meditation routine and managing your stress, maybe it's sleep. But one of those foundational pieces is usually where we can get a lot of leverage.

Melanie Avalon
Amazing, I love it. Yeah, that was just such a big takeaway for me was that it's really empowering.

And it's exciting because you get to start, you know, where you want to start and that will, you know, benefit you personally. And I really like you mentioned it really early at the beginning when you're talking about the study, the exercise that you implemented with the participants. But a big takeaway for me was especially with like exercise that it's not just, for example, increasing your exercise, it's doing like new forms of exercise and like changing things up. And I find that to be a really interesting layer specific to, you know, this aspect of health that people might that might not occur to people. I had one other question. Oh, so I did find my so my allele or my APOE is three, three, you have no increased risk. That's great news. What was the one that was decreased risk to

Dr. Heather Sandison
APOE-2 does decrease risk somewhat.

Melanie Avalon
Okay, but 3-3 is just like completely.

Dr. Heather Sandison
in the middle. Yeah, it's basically a 9 to 10 percent risk of being diagnosed with dementia.

Melanie Avalon
So for people like me who don't anticipate having this increased risk, would you still benefit this lifestyle approach in general?

Dr. Heather Sandison
Yeah, so it's funny. Kara Fitzgerald, I think you've probably had her on. She wrote a book called Younger You several years ago, and we shared the same co-PI and the same literary agent and the same writing collaborator. And we kind of joke. We also have very similar books. And her book is about, it's naturopathic medicine for aging well. It's called Younger You. It's about reversing the age clocks. And mine is about reversing Alzheimer's and something that's very feared as we age. But both of them are about how we can age well.

So the side effect of applying these principles are that you get metabolic flexibility and you avoid type 2 diabetes. You optimize your weight. You optimize your cardiovascular health. You optimize your sleep. You optimize your stress response. All of those things are good, regardless of what we're sort of afraid of as we age, right? Like when you're exercising, you reduce your risk of falls. You build that muscle that's going to help with balance. Cardiovascular disease, you reduce your risk of cancer, right? We reduce the risk of pretty much all of the chronic diseases associated with aging and the torture of aging so that we can live well, live meaningful, joyful lives with bodies and brains that function.

And so I think that I'm also APOE33. I feel very fortunate to not have that risk, but I still live this lifestyle.

Melanie Avalon
That's incredible. And that was a big takeaway I got reading the book.

And then like I said, reading the reviews last night, there were so many people who wrote reviews and said, you know, they bought this book to care for a loved one. And it had a beneficial effect on them because you know, now they're changing their lifestyle with everything.

Dr. Heather Sandison
habit of not reading the reviews or the comments, but you're making my day. Thank you, Melanie.

That's the whole point. That makes me feel so good to think that it's having the effect that we hoped it would, that for 20 something dollars, you can get the information, have it be something that will inspire you to take action that will lead to meaningful results for somebody struggling with cognitive decline, but also people who aren't yet, who can avoid that completely. Thank you for sharing.

Melanie Avalon
No, so I'm the same way. I don't read any reviews. I don't read reviews with my podcast. I don't read reviews with my books, like nothing.

So I get excited when I, because I know I feel like a lot of people don't read the reviews. So I know I can, you know, share with you. And I do mean it. I said it earlier, but I think out of, ever since I've started this practice of reading all the reviews the night before, I really think yours had the most like long reviews. Like where people, you could tell people really felt passionate about what they were experiencing reading your book. And they just had so many overwhelmingly good thoughts. So it's clearly having a massive impact. So thank you. Thank you. Thank you. Which actually brings me to the last question that I ask every single guest on this show. And it's also about a topic that you talk about in the book, which is mindset and gratitude. So what is something that you're grateful for?

Dr. Heather Sandison
Oh, you know, my team, we had a huge flood at my clinic a week and a half ago when I was out of town taking my daughter. Of course, I'm super grateful for it, but I was taking her up to, which is in Wizards Camp in Oregon. We were out of town and the whole clinic flooded. And I have the most incredible team. They were amazing.

They got us in a temporary spot that we can operate out of and they salvaged stuff. What could be salvaged? They dealt with insurance people and with contractors and they just, you know, in a stressful situation, they came together in this really beautiful way. And I'm just so proud of them. And above all else, I am super, super grateful for the people I get to work with every day and, you know, do the help other, of course, I'm so grateful for the opportunity to help other people. But right now, and kind of coming out of this crisis, I am most grateful for the team I get to do it with.

Melanie Avalon
Oh my goodness. First of all, I am so sorry.

That happened not to my clinic. I mean, I don't have a clinic, but my apartment flooded and it's like the worst. And then you have to deal with the whole mold issue and...

Dr. Heather Sandison
Oh, yeah, we already had the drywall cut out and the door is not ripped out like it's yeah, definitely not going to deal with mold that high, high sensitivity for that. But it's also one of those things where it does you like, it puts things into perspective. Gosh, we're so lucky nobody got hurt. It could be so much worse.

We could have lost so much more. It could have been a fire, you know, like, we can, you know, there's flooding in Texas right now. There's like so many people who lose so much more. And it just made me it puts things into perspective. And I go, Oh, my gosh, we're so lucky we have so much. And that's also, you know, it's helpful.

Melanie Avalon
amazing. Also, I have to ask Wizards Camp, is that like a magical camp?

Dr. Heather Sandison
Witches and wizards camp. Oh my gosh, it was amazing. My daughter's six and she, a friend of mine who's a naturopath, she has had her daughter go there for the last four years. And she's the way she described it. She's like, they give them a staff. And then they go into the woods and they basically run feral. And I was like, this is exactly what we need. Feral in the woods. Where do I sign up? Yeah, so it was so fun.

Oh my goodness, with a wand. Yeah, with a, yes. No, it's a magical staff and they lean in against the tree to charge it. It was just amazing. They get names. Yeah, it was just great. It was so good. Hiking, waterfalls, streams are up in Bend, Oregon. It's such a beautiful place. And that I'm very grateful for the opportunity to get that trip.

Melanie Avalon
It's amazing. I love that. Okay. Well, thank you. Thank you so much.

Dr. Sanderson. This was absolutely incredible. I loved your book so much. I just really really appreciate and value everything that you're doing.

Yes. Are you writing another book?

Dr. Heather Sandison
I was talking to a partner about that recently, not at this moment. We have this coaching program that's going on that I feel really excited about.

Supporting caregivers is what I'm really drawn to. And then I have a new podcast called Think Well, Age Well, where people who have been through this process as reticent patients or coaching clients at Mirama, they get an opportunity to share their stories so that people can learn from doctors or experts in one regard. But I've never had Alzheimer's. I've never cared for someone as a spouse with Alzheimer's. And so hearing it from people who have been or were experts in the experience, I think is really, I just feel really privileged to share those stories and to help them bring them out.

It's a lot of fun. So I'm focused on that right now and recovering from the blood.

Melanie Avalon
Oh, I know amazing. Well, I do think if you were to do a book like really focused, I mean, it's in this book, but like the caregiver aspect. I feel like that's like a huge, you know, need where people don't feel like they are represented as much.

Wow, amazing.

Dr. Heather Sandison
And it's also, you know, caregiving is, if we could talk for hours, sorry to keep you melody. No, no, no. I love it. I love it so much. Caregivers, I think they're, most people become caregivers at some point in their lives. And it's so challenging. No one can, you cannot prepare for it, right? It's kind of like having a child, like people will tell you their experiences and what it's like and then you are in it and it's like, you just don't see it coming, right? And the other piece is that even though it's hard, really hard in so many ways, people wouldn't give it up for anything. Like when they look back, there's a lot of gratitude for the time.

Growing old is a privilege that's denied to many, many people. And so to have a mom who maybe has dementia, but to have a mom who you can look through photos with and you can have dinner with and you can create memories with and she can have a relationship with your kids or grandkids or great-grandkids, that is really, really special.

And so it's a lot of, when we think back on life, sometimes the highest highs are coupled with the lowest lows. And I think that caregiving is a lot of that.

Melanie Avalon
Yeah, can I say one more thing about that really quick? Oh, yeah. It's interesting because so my grandmother had a stroke and then after that, she got, I guess, dementia from that stroke, from the stroke. So my family members were taking care of her, like my mom and my aunts. And ever since then, my mom has said something to the effect of if I ever get dementia or Alzheimer's, she's like, just put me, she's like, just put me away. I don't wanna be like a burden on the family.

Like, she's like just, so I've thought about this concept of, because I actually think like literally that's my mom's wish. She like, right now it's her wish. She wants to like be in like a home or something if that were to happen to her. But then at that moment were to come, I imagine it would be a different experience because, you know, I just don't know like how people handle that question of how much they're involved as a caregiver versus getting help versus, and this is like a whole nother, I didn't mean to open like a. No, it's.

Dr. Heather Sandison
It's a totally fascinating conversation. I mean, my mom says, Take me out back and shoot me. Right. So, right. And like, obviously, mom, not an option.

But there, there are options in Switzerland. And there are there's physician assisted suicide for certain conditions. And these are hard conversations, like putting someone in a care home, hard conversation, staying at home, but being a burden and knowing that your loved ones can't work or can't care for their children or can't, you know, they've got to care for you. And it might be expensive in different ways. It might be physically taxing. Oh, they might have to remodel the house to do it. All of these things are huge considerations.

And I think the most important thing is to have the hard conversations early on to know what are the preferences and then also acknowledge that those can change the dynamics can change. There's she wrote a book called the inevitable. And she got a Pulitzer Prize last year for her articles around Alzheimer's and dementia and just the nuances of decision making that come up as someone ages and goes through this process and loses cognitive capacity.

And do we honor the wishes of them before they had these cognitive challenges? Yeah, that was my question, basically. Yeah. And I think that it's very dynamic. There are so many considerations, financial, logistical, their presentation, their physical health, not just their cognitive health. There are so many things to consider. And what I will say is it's easy to have judgment, just like parenting, right?

Like before I was a parent, I judged so many people for their decisions and their parenting. Then you become a parent and you're like, oh, I totally get why she was going through the drive-thru or why he was on his phone. And you just have a deeper appreciation. So what I aim to do is create a nonjudgmental space to have these conversations so that there's a little more clarity and maybe it's not 100% clear when you're going through it, but at least you had the conversation and you're not just guessing.

Melanie Avalon
Mm-hmm. Thank you. Yeah, I know that was so helpful and I yeah Wow, okay. Well, thank you again so much.

This was beyond incredible We will put links to everything in the show notes and I will continue following your work And I just I'm sending you all the gratitude and love because this is really amazing. So thank you so much Melanie. Thank you so much

Dr. Heather Sandison
much for having me. Have a good rest of your day.

Melanie Avalon
Thank you so much for listening to the Melanie Avalon biohacking podcast. For more information and resources, you can check out my book, What Win Wine, as well as my supplement line, Avalon X.

Please visit melanieavalon.com to learn more about today's guest and always feel free to contact me at contact at melanieavalon.com and always remember, you got this.