398: Is It Just Forgetfulness? Surprising Early Dementia Signs, Testing, Hidden Triggers w/ Dr. Heather Sandison

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Is forgetfulness really just a part of aging—or are there early dementia signs you can look for (and tests) that can help you save your brain from Alzheimer’s?

If you've watched or helped a loved one suffer through this devastating cognitive decline that goes far beyond the forgetfulness that can happen to us all, this impacts more than just the person experiencing signs of dementia.

What you might not know is that there are key early dementia signs as well as tests for Alzheimer’s risk that can help you save your brain NOW.

Watching my great-aunt go from a bubbly, funny woman who loved to cook and bake to someone who became completely bedridden, unable to speak coherently, and eventually forgot how to eat left its mark on me.

I don’t want that for my future – and I imagine you don’t want that for yourself, nor your loved ones.

What’s I’ve come to discover about how to prevent dementia and dementia treatments is that you have to start early – long before you’re suspected of having cognitive decline or Alzheimer’s disease.

That’s why Dr. Heather Sandison is here to help us all challenge the fatalistic view of dementia and provide a proactive, science-backed path forward. To give our brains a fighting chance by dealing pinpointing and working on the inflammatory triggers that drive signs of Alzheimer's and dementia.

Dr. Sandison, ND, is a New York Times bestselling author, pioneering naturopathic physician, and nationally recognized leader in brain health and dementia care. She has founded and scaled successful clinical, residential, and virtual platforms aimed at reversing cognitive decline, and has published groundbreaking peer-reviewed research in the Journal of Alzheimer’s Disease.

We’re diving into lots of topics including why dementia isn’t caused by one thing (like amyloid plaque), understanding the difference between Alzheimer's vs dementia, is dementia hereditary, cutting egde dementia treatments, and how multiple root causes specifically combine to impair brain function over time. And of course, we talk honestly about the devastating emotional and financial toll taken on the caregivers and loved ones.

Let’s dive in!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In This Episode:

• Alzheimer's vs Dementia: what’s the difference and key early dementia signs to look for
• Why early cognitive changes like forgetfulness start decades before symptoms appear
• Is dementia hereditary? Best test to assess dementia risk
• The 6 root causes of cognitive decline
• Why women are more vulnerable to Alzheimer’s
• Are caregivers at greater risk for developing dementia?
• Are gum infections, herpes virus, Lyme, or COVID-19 dementia triggers?
• The truth about creatine, vitamin D, and other “brain boosters”
• Brain impact of sleep apnea, trauma + perimenopause
• Latest dementia treatments you should know about

Quotes

“For people who are in their 40s, we can make decisions right now to protect our brain health.”

“We've spent billions of dollars figuring out how to get rid of amyloid plaque, and when we take it away… you don't get an improvement in cognition.”

Links

Find Dr. Sandison online

Get Dr. Sandison’s book, Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health, HERE

Healthy Skin Show ep. 307: Daily Value on Nutrition Label is WORTHLESS (Here’s Why)

 

Is It Just Forgetfulness? Surprising Early Dementia Signs, Testing, Hidden Triggers w/ Dr. Heather Sandison {FULL TRANSCRIPT}

Jennifer Fugo (00:27.597)

Dr. Sandison, welcome to the Healthy Skin Show.

Dr. Heather Sandison, ND (00:30.776)

Thanks for having me, Jennifer.

Jennifer Fugo (00:32.659)

I am really excited for this conversation about early dementia signs, dementia treatments, and more. While I know we're not necessarily gonna talk about anything regarding skin issues today, I actually feel like as I get older, brain health, specifically because of the risk, the real life tragedy, I feel like that dementia is, is something that weighs heavily upon me. And actually I was surprised to find many of my listeners and in my audience on Instagram, because I polled them and they were just like, yes, I really want to know more about this. This is something that I've experienced personally, they've experienced many of them through family members, and it's a real concern.

So I thought it would be great if you could kind of explain to us what is dementia? Like what exactly is that? Is it more than forgetfulness? Because I've experienced it, but I don't know that I would necessarily know what the clinical definition or picture of dementia is. So, what is dementia and what’s Alzheimer’s vs dementia?

Dr. Heather Sandison, ND (01:33.73)

Yeah, great question. So dementia is an umbrella term that includes multiple diagnoses that describe different manifestations of age-related memory loss. And a diagnosis of dementia, in part, is clinical, so there needs to be changes in activities of daily living. A dependence on others for driving, for getting dressed, for getting through the day, for calendaring, for managing finances, and things like that.

So what we have is sort of a spectrum of age-related memory loss that starts, so I think of this kind of like stages of cancer. Alzheimer's is a form of dementia, so under this umbrella term of dementia, we have Alzheimer's, which is quite common, vascular dementia, frontotemporal dementia, posterior cortical atrophy, LATE syndrome, we have Lewy body dementia. There's many different types of dementias, and they aren't mutually exclusive. So they're descriptive, they help us sort of communicate in the medical field between colleagues, like, okay, this patient has Lewy body. We know that there's gonna be particular characteristics of that that are typical histologically, both when we look at the cells under a microscope, but also in how they might present and what the family might need to prepare for as this person progresses through the disease process.

But when we take a step back from that, there are, I think many people experience this fear, this terror, really. If they start to notice changes in their brain, particularly if they've had a loved one, a parent especially, who's gone down this path, it's terrifying. When we start to notice that we aren't remembering that neighbor's name, somebody we've known for 50 years, or we're more frequently forgetting where we put our keys, our wallet, or we're leaving our purse or our phone at the restaurant, these kinds of things and forgetfulness can be really scary. And this is what we call subjective cognitive impairment. So just like cancer, there's sort of these stages that we go through, not just like cancer, but kind of, I think many people are familiar with like, okay, stage four cancer. That's dementia, that is late stage Alzheimer's. That's like that stage four kind of thing.

Dr. Heather Sandison, ND (03:42.988)

But we have so much more confidence in treating, reversing, helping, supporting, reducing the suffering associated with this disease through delay, through reversal, through support. In stage one, which is subjective cognitive impairment. So we have stage one, think of that as subjective cognitive impairment, this is where you notice your brain isn't working as well, maybe your kids are noticing your brain isn't working the way it used to. But if we test you, it's normal, it's average, it's not that bad, right? It's not so bad that it's showing up on testing.

And then stage two is this measurable cognitive impairment, or sometimes you'll hear it called mild cognitive impairment. There is nothing mild about this, at this stage, there's actually quite a bit of change happening in the brain. And this is when, again, we're able to measure it, but maybe you're coping, you're coming up with strategies, you're writing things down, you're calendaring in a different way. There are things that you're doing to make sure that you are not losing independence, right? So this is that mild cognitive impairment.

And then on the next phase, that like fourth stage, is when we get into the more severe dementia, severe Alzheimer's. And really, stage one, I sort of misspoke there, stage one is when there are changes happening in the brain metabolically, but we don't even have the subjective experience of having any cognitive impairment. And this is actually where we want to intervene. This is in prevention mode. There's already something happening. Maybe we have some amyloid plaque buildup, we are probably not metabolizing glucose as well as we used to, so we're not creating enough resource in the brain, maybe we have hypoxia at night from sleep apnea that's starting to be detrimental. But we still wake up and we go through our day, we don't notice any differences.

And so the danger is, when people are told there's nothing you can do about this over and over again, they don't get help early on. When they see that their parent went to a neurologist and the neurologist said, here's a couple of medications, they don't work very well, but come back in a year, we'll measure the decline, that is very disempowering.

Jennifer Fugo (05:58.947)

I know.

Dr. Heather Sandison, ND (06:17.75)

And it also makes people avoid or delay getting help that could reduce the risk of the disease progressing. And so if you take one thing away today, it's if you have genetic risk, to understand your risk factors in your 20s, 30s, 40s, like in midlife. And if you have any subjective cognitive impairment, any experience of your brain not working the way it did, get help from a Bredesen trained, my mentor is Dr. Dale Bredesen, he trains providers that can help people through this process. Get help from a Bredesen trained provider, a functional medicine provider, a naturopathic doctor, a health coach, somebody who can help you understand your risks and mitigate them early on in the disease process.

Jennifer Fugo (06:48.801)

So how long, I'm thinking this is probably a longer process than most people realize, right? Because by the time it's caught, I would imagine. So let me give you an example, my grandmother had some form of dementia. And when we kind of realized it at a certain point, like close to around, it was before my grandfather passed away, we realized that she was having problems. Except when I thought back maybe like 10 or 15 years, I could remember some very odd situations where I was like, in hindsight, I was like, gee, you know what? I wonder if there were these like subtle early dementia signs going on long before that we all, you know, like my grandmother used to have forgetfulness and forget where her handbag was. She'd be at her sister's house and she had put it in some random spot, I don't know why she would hide her handbag in some random spots, and then couldn't remember where she put her bag. And no one really questioned it for a really long time or thought maybe they were early dementia signs. So with that being said, is this timeline longer than like a five year span, or ten? When should we, do you get what I'm saying? Like how long is this progression generally for early dementia signs and signs of Alzheimer’s?

Dr. Heather Sandison, ND (08:06.676)

Yeah, absolutely. So you'll often hear quoted, the changes in the brain start decades before you notice symptoms. So this really is a decades long process. Now we also see that people who have APOE4, so A-P-O-E-4, if they have those genetics that put them at risk for Alzheimer's, we can measure changes in cognition in their teens.

Jennifer Fugo (08:31.242)

Oh, wow.

Dr. Heather Sandison, ND (08:32.014)

So I had patients 10 years ago who would say, oh, I don't want to know my APOE status, I don't want to know my genetic risk. It's just going to keep me up at night, it's just going to stress me out, give me anxiety, and it's going to add to my risk of getting dementia. And I kind of understood that perspective at that point, because we didn't have this data, we didn't have all this information about what you could do about it. But now, I actually suggest the opposite. I want people to be tested, at 18 when they can make the decision to get their genetic testing done, I think that that's ethical. But at 18, if you can know your genetic risk, then you can make very different decisions. I don't want you to be a firefighter, I don't want you to play football. I don't want you to be a nurse and work overnight in the ER. You want to avoid careers that include shift work and sleep deprivation. You probably want to do less binge drinking than maybe some of your friends because you are at higher risk.

So things that are going to trigger that amyloid plaque production, the brain going into that microglial activation, the fight-defend mode, that's going to happen quicker for somebody with genetic risk. And so we really want to avoid as much of that as we have control over. And so we can make very different decisions if we're empowered with that information. Everyone, essentially, from newborns to centenarians, we all have amyloid plaque, kind of again like cancer, right? We all create cancer and our immune system takes care of it. Amyloid plaque production is there as a means of defense for the brain. This serves a purpose.

Jennifer Fugo (10:08.81)

Interesting.

Dr. Heather Sandison, ND (10:22.956)

Yeah, it's antimicrobial. Only less than 2% of the population doesn't have any amyloid plaque. And so we know that this is actually part of a healthy immune system in the brain, but it's when the scales get tipped, just like inflammation, right? When you have chronic inflammation that's too high for too long, this creates issues. But inflammation is part of a healthy system, it's a healthy response. Amyloid is the same. So what we want is the ability to clear it. We want the ability to respond. We want to know if we're at risk for kind of overproducing amyloid. And so that's the benefit that we get from understanding our genetic risk.

Jennifer Fugo (10:50.135)

I wanted to ask you just really quickly, can anyone get this marker run for signs of Alzheimer’s? Is this like something you can run at LabCorp or Quest or a regular lab? And is dementia hereditary?

Dr. Heather Sandison, ND (10:59.66)

Yeah, absolutely it is. And actually, if you had 23andMe done at some point, or you've had other genetic testing done, it's a single nucleotide polymorphism. So it's not like BRCA genes, there's some genes that are much more complex, they're a series. But this is just one single nucleotide polymorphism, or a SNP, which you might have heard if you're familiar with some of the genetic terminology. And so it's a very simple test to run, it's relatively inexpensive, and yes, it can be done through LabCorp or Quest. But if you've ever had genetic testing done, it's probably already been done, and if you go back to that data, it's in there somewhere.

Jennifer Fugo (11:33.901)

And so what would you look for, whether you're positive for this?

Dr. Heather Sandison, ND (11:38.2)

Great question. Okay. So the general population, regardless of genetics, has a 13% risk of being diagnosed with Alzheimer's. 13%. If you have one copy of APOE4, so APOE, A-P-O-E, is you get one from mom and one from dad. And there's no judgment here about who gave you what, right?

Jennifer Fugo (11:59.852)

It is what it is.

Dr. Heather Sandison, ND (12:04.75)

It is what it is. But one copy from mom, one copy from dad, so you end up with two of them, you get two numbers. And the options, the variables, here are you can either get a two, a three, or a four. One copy of APOE4, so a common combination is APOE3/4, one from mom, one from dad. So you get to say a 3 from mom, 4 from dad, that increases your risk of being diagnosed with dementia or Alzheimer's in your lifetime to 33%.

Jennifer Fugo (12:31.501)

Oh, my gosh.

Dr. Heather Sandison, ND (12:32.502)

Yeah. And now say you get a copy of 4 from mom and a 4 from dad, so your APOE4/4, your risk goes to well over 50%, and there was a Nature paper last year that said, essentially, you would at some point be diagnosed with Alzheimer's in your lifetime, essentially you were guaranteed to get it. And that risk increases even more, I'm not sure why, if you come from a large family. So when there's like 10 brothers and sisters, 12 brothers and sisters, even like six or seven, you see that there's an even higher increased risk if they have APOE4/4.

Jennifer Fugo (13:06.125)

I have to say I'm a little taken aback here because this is such a simple test. I think most, actually I don't know, but I personally had a great aunt and then her sister, who was my grandmother, who had dementia, and we took care of my great aunt all the way to the end. My dad was responsible for her, so my mom, my dad, my sister, and I, we helped care for her. And then my grandmother got sick and while my dad's sister, my aunt, took care of her, we would help as much as we could. So I've had two direct experiences with this and it's so hard.

Dr. Heather Sandison, ND (13:49.9)

It is so hard.

Jennifer Fugo (14:04.8)

And my aunt had to eventually go into a home because she couldn't even feed, like she forgot how to swallow, she couldn't talk at all, it was like babbling. And I would just be like, yeah. I alzheimerdidn't know what she was saying, but I just felt like I wanted to talk to her, and I would just have a conversation with her. Like this is so, it's hard for the people who are caring for the person, I think from a financial perspective, it's hard. It's so many things. Why aren't we doing this to give people knowledge to help avoid that? I don't know that we can 100% avoid it, but even if you could mitigate some of that risk of early dementia signs, why aren't we doing that?

Dr. Heather Sandison, ND (14:37.752)

Jennifer, I mean, this is why I get up out of bed every morning, right? It's because, to your point, you cannot overstate how intensely, emotionally, financially, physically draining it is to care for someone with Alzheimer's, particularly in the later stages. And, you know, I have a child, I have a six-year-old. And so at first it was really hard, there's a sleep deprivation, she's totally dependent, changing diapers, doing all that. But she's little itty bitty, she weighs seven pounds, nine pounds, 10 pounds, right? And I know, predictably, she's going to become more and more and more independent, it gets more and more fun, she's easier to communicate with.

This is the opposite of that. People are, they've been independent, and so there's so much loss. And they're large, they're adult size, and you're changing diapers. It's unpredictable how long it's going to last. Is this going to be a three year journey? Is this going to be a three month journey? Is this going to be a 15 year journey? We don't know.

Jennifer Fugo (15:37.056)

Wow. Yeah.

Dr. Heather Sandison, ND (15:54.572)

So there's so much unpredictability, and I call it micro-griefs. For many people who have known a loved one who has gone through this process, when it starts, you sort of have this, each time they lose a little bit of function, there's this grief in that moment. This frustration, and anger, and denial, and all the stages of grief kind of come out when you say, hey Sharon, let's get in the car, and she doesn't remember how to put on her shoes, she puts her socks on over her shoes. Or you have to say over and over and over again, hey Sharon, let's get in the car, hey Sharon, let's get in the car, and she doesn't remember. It's this experience of, she's no longer my partner, or my mom, or my aunt, she's now my dependent. And each time we experience that, there's more emotional burden, there's another layer of emotional burden.

And I couldn't agree more, I actually believe that Alzheimer's is optional for my generation, I'm in my 40s. And I believe at this stage with what I've seen in my clinical practice, what we've seen in Marama, what we've seen in our coaching programs, that people, now, it's no one's fault that they have Alzheimer's right now, right?

Jennifer Fugo (16:51.678)

No. No.

Dr. Heather Sandison, ND (17:17.336)

Obviously, we didn't know this 10 years ago, five years ago. We're learning more and more every day. But for people who are in their 40s, we can make decisions right now to protect our brain health as we age so that our loved ones don't have to go through that process. And with Alzheimer's, one of the most harrowing things about it is it doesn't just take the patient, right? It takes an army of people around them to care for them, who come out of the job market, right? Who have to take time off work, who are not present with their children because they need to be home with mom or dad, who are, for a very clear reason of caregiving, they're stepping away from other things that could be very fulfilling in their lives.

Now, many caregivers, and I don't know if you're in this category, Jennifer, I won't speak for you, but many caregivers look back on that time and are extremely grateful for it. I got to care for my aunt, I got to care for my mom, it was a very meaningful, very joyful time, even though it was very challenging. Growing old is a privilege denied to many. So to have that time with a loved one is precious, but also extremely challenging.

Jennifer Fugo (18:07.294)

Yeah. Well, it's also hard too because some, so my aunt, as an example, was just always very happy. She just had declines in different areas of function to the point where she was then pretty much bedridden, and couldn't remember how to swallow, or talk, or anything, but she was always happy. Whereas my grandmother, she had that sort of sundowning effect, that by like four to five o'clock in the evening would become very agitated, we’d be like, we need to lock all the doors, you can't go outside, it's very dangerous. And it was almost like, she never, and I do know there are some individuals who have experienced where their their loved one has almost become kind of slightly violent or really difficult.

Dr. Heather Sandison, ND (18:47.82)

Yeah, or very violent.

Jennifer Fugo (18:54.348)

Yeah. So are those different types of dementia where that happens, and if so, do you know any reason why one person might just lose function but be kind of relatively happy or seem happy, whereas somebody else might have this like distinct almost switch that, it's like a light switch goes on, and all of a sudden it's like danger, danger, danger, and they're like fearful of everything and can become combative?

Dr. Heather Sandison, ND (19:18.592)

Yeah, so we see more of the paranoia and anxiety in Lewy body dementia and frontotemporal dementia. Frontotemporal dementia is more common in men, whereas most dementias are more common in women. Frontotemporal dementia is more common in men, and it actually happens earlier. This is what Bruce Willis was diagnosed with. And this is sometimes misdiagnosed as schizophrenia because people can have these very dramatic personality changes.

So there's a couple things going on. The type of dementia, like I mentioned, this can help us prepare. So Lewy body dementia is characterized often by hallucinations, visual hallucinations. And so people can become very paranoid. I had a patient who, he saw people climbing over the wall of his garden that was right outside of his bedroom. And his wife was right there, she said, no, they're not, they're not there, but he was adamant that they were there, was very concerned about them. Of course, if you see people you think are trying to break into your house, you're paranoid and concerned and anxious.

Jennifer Fugo (20:19.788)

Of course.

Dr. Heather Sandison, ND (20:41.504)

And it was a visual hallucination that was associated with his Lewy body. And Lewy body is what Robin Williams had, and that led to him having a lot of mental health disorders, sort of manifestations, at the end of his life. So yes, it can be caused by the type of dementia. Also, we see that it's the part of the brain that's affected. So the memory center of the brain, of course, is typically affected in dementia, although there are some, sometimes we'll see like an aphasia type picture where people struggle with words, but you can see that cognitively they're totally keeping up, they just can't find the words. So there's a joke in this space of, if you've seen one dementia patient, you've seen one dementia patient, right? Because they all manifest so differently.

Jennifer Fugo (21:08.086)

Yeah.

Dr. Heather Sandison, ND (21:09.336)

But another characteristic that we'll see is, you mentioned your aunt went in one direction, she was very happy, and then your grandma was a very different picture. We'll see phases. So sometimes people say, oh, yeah, my mom, for the past three months, she's been very combative and agitated and aggressive. And then there will be some sort of phase that she goes through, some transition, some progression, where all of a sudden she's very docile and sweet and kind again. So sometimes we see that, although it's very unpredictable.

Another thing that will come up is sometimes we'll say, oh, my dad's in denial. Like he's making all these mistakes, he's forgetting all this stuff, and he doesn't believe me when I tell him that he's repeating himself. He's like in denial about his process. And there is, you know, and this is harder to work with. Of course, it's harder to get people to make changes when they don't realize that they're having cognitive deficits. But it's the part of their brain that affects self-awareness that is affected. And so it's not that they are in denial, it's that they really are not aware, because of the disease. And so I hope that this can help anyone listening who's experienced something like that to find a little bit more compassion. And of course, it's gonna be much harder, if not impossible, to get them to engage in behavior change.

Jennifer Fugo (22:08.598)

Yeah.

Dr. Heather Sandison, ND (22:32.27)

Just because there's not a lot of motivation. I tell people when they come into the clinic or join our coaching programs earlier on in the disease process, and they're aware of their changes, I'm like, this is something to celebrate. I know it's super uncomfortable and you hate it, but this is great because it's gonna give us the motivation to make the changes to reduce our risk of progression.

Jennifer Fugo (22:52.138)

Yeah. I will also share that I had gone to the premiere for Empty Little Boxes by Max Lugavere. He has the Genius, I think it's the Genius podcast, Genius Life podcast. And so it was really interesting because it's about his mother's journey and experience, and obviously him, and I believe his brother’s, of supporting his mother as she kind of went down the path of Lewy body dementia and what happened to her.

Dr. Heather Sandison, ND (23:15.543)

Yeah.

Jennifer Fugo (23:20.364)

And I think it's sobering for anyone who either hasn't had that experience, or you have. I didn't have that experience because my family never had that particular type of dementia that we experienced. But it really takes away from so many people, not just the person who it's directly impacting. So, question for you. In terms of the science, because I feel like there is more science, I am deeply frustrated that I wish I had known that I could just go get that SNP tested for, the APOE4. So now I know, everyone knows now that they've heard that from you, because I think that is important. That's an easy step that many of us could do.

But what does the research currently say? I've seen some really interesting papers on maybe the gut microbiome possibly impacting the brain. I mean, it impacts so many things, so I wouldn't be entirely surprised about that. I saw a paper recently about gum infections that could potentially be considered a trigger, which I think it was the Porphyromonas gingivalis species, which I've talked about in regards to skin issues and other metabolic concerns, so that was interesting. But what are some of the things that you're seeing now that maybe many of us aren't hearing about?

Dr. Heather Sandison, ND (24:42.934)

Yeah. So what I would, I want to take a step back, right? It's not one thing.

Jennifer Fugo (24:46.592)

Sure, right.

Dr. Heather Sandison, ND (25:13.378)

So we get this, we call it one thing, right? We call it dementia, we call it Alzheimer's, we call it Lewy body. It's a neurodegenerative process that is the result of microglial activation of activating the defense mechanisms in the brain. And so the question becomes, you know, the paradigm shift is, many people have been told like, it's amyloid plaque is the cause of Alzheimer's. If we get rid of amyloid plaque, Alzheimer's goes away. We've spent billions of dollars figuring out how to get rid of amyloid plaque, and when we take it away, which we've gotten pretty good at, you don't get an improvement in cognition.

Jennifer Fugo (25:18.731)

Really?

Dr. Heather Sandison, ND (25:41.902)

You actually often see declines. Yes. Because amyloid plaque is not the cause, it's the result. So what we're looking for is what triggers amyloid plaque production? What triggers inflammation? Inflammation is not the cause, it's the result. So we're looking for what triggers. Now, you mentioned a couple things. Infections. But what I want to do is, I never want anyone to read a paper and go, oh, herpes is related to Alzheimer's, and so herpes is the cause of all Alzheimer's.

Jennifer Fugo (25:49.864)

Yeah, right. It's that one thing. I'm like, never, it's never just one thing, usually.

Dr. Heather Sandison, ND (26:04.308)

No, never just one thing. Like with skin, right, the skin is this manifestation of everything that's happening on the inside. The brain, so I would argue, this is how I see it in this paradigm shift. You don't look at a house plant and go, it's misfolded proteins, it's amyloid plaque causing my house plant to die, right? You go, does it have enough food? Does it have enough water? Are there toxins in the soil? Is it getting enough sunlight? You think, okay, this is an organism, a complex organism, a complex system, what does it required to thrive?

And so that is the approach. This is common sense, just uncommon practice in medicine, where we have this paradigm of how do we have a single molecule intervention of something that's patented, that a doctor can provide in seven to 15 minutes, you can go to the pharmacy and pick up and take. That doesn't work. It's an oversimplified paradigm. And so we need to have a solution that matches the complexity of the disease. And so that is where I would invite you to go.

So how do we think through this? Because it is complex, but it doesn't have to be complicated. What we're looking for are imbalances in this complex system. Too much, too little, in the wrong place, at the wrong time. And what I would argue is that there's six primary level causes of all complex disease in the body, whether it's acne and skin issues or it's dementia and Alzheimer's. So what we're looking for are toxins, too much, too little, in the wrong place, at the wrong time. There's a normal amount of metabolic waste that's produced every day. If it accumulates somewhere, it's too much in the wrong place at the wrong time, right? So toxins are number one.

Number two is nutrients. Macro and micronutrients. So you can have way too much blood sugar leading to type three diabetes. sometimes you'll hear Alzheimer's called type three diabetes because we lose the ability to turn glucose into fuel. And so this is where you have too much sugar, too much glucose, too much carbohydrates turns into a toxin in the brain. And then we also have micronutrients. Our antioxidants, our B vitamins, our minerals, all of these, if we have too little or too much of them, can cause imbalances. We know that homocysteine is a reflection of methyl donors and B vitamin status, and when we have elevated levels of homocysteine, our brain shrinks more quickly.

Jennifer Fugo (28:18.209)

Wow.

Dr. Heather Sandison, ND (28:22.446)

So this is a simple way. Yeah, this is a simple way to look at some nutrients and understand the balance for you. Beause you might be getting the recommended daily allowance, the RDA of methyl B12 or of B12, but you still have high homocysteine for you.

Jennifer Fugo (28:31.79)

Yes, the RDA, I have a whole podcast on why that's not a good thing to go by, but another day.

Dr. Heather Sandison, ND (28:49.036)

Yes. So we can look, we can use precision medicine to measure these things and understand. Then number three, so we have toxins and nutrients, stressors. So stressors, again, you want enough. You want purpose, and meaning, and a reason to get out of bed. You don't want to kick your feet up in retirement, and watch TV, and have happy hour every day, and eat whatever you want. That will lead to atrophy.

Jennifer Fugo (29:01.527)

So lack of engagement is a problem.

Dr. Heather Sandison, ND (29:18.078)

Yes, it's exercise, right, it's stress. You need enough. You need it to hit enough tension that you're going to build resilience. This is a hormetic idea that the hormetic effect, H-O-R-M-E-T-I-C, hormetic effect, hormetic theory, is that we need enough stress. It's like a rubber band, we want to stretch it so that we have more resilience. This is exercise, fasting, or fasting mimicking diets, this might be hot and cold exposure. This can be even oxygen if we exercise at elevation, we create more erythropoietin and we have more mitochondria, we have more oxygen, more hemoglobin going to our cells.

So we want to stress the system to get more resilience. Now, if we're in a frail state, we don't want to do that. If we're already super stressed, we don't want to add more stress. But what we want is not so much stress that we decompensate, but stress so that we have more resilience. Now, caregiving. Caregiving is a huge stressor, right?

Jennifer Fugo (30:04.597)

It is.

Dr. Heather Sandison, ND (30:16.942)

It affects our sleep, it affects our emotions, and it's financially stressful. When we're caregiving, we can become a martyr to it, where we're not getting exercise or eating well or sleeping well. And we see in the data that caregivers, depending on who they are, are anywhere from two and a half to six times more likely to be diagnosed with dementia later in their life.

Jennifer Fugo (30:27.914)

Oh, wow.

Dr. Heather Sandison, ND (30:45.482)

So it increases their risk of becoming the patient. So it's really important that caregivers modulate their stress, keep that down. Cortisol, which is a stress hormone, can become toxic to the hippocampus. And I see in my clinical practice, I ask everyone about trauma, abuse, neglect history as a child, and many people say yes. Now, probably true that trauma was pretty common, trauma is pretty common. But I see it in an outsized number of the patients in our dementia population.

Jennifer Fugo (30:59.605)

Is it that they had trauma, or is it that the trauma was never, I don't wanna say resolved, but I've talked a lot about trauma on the Healthy Skin Show where essentially it's, the easy description is it's like a misfiling of the experience so that the brain can't appropriately sort of have some level of peace with it. So that way, like if you see red sunglasses out on a sunny day, like all of a sudden that's a problem because your mind is like, so would somebody who maybe has gone through therapy and really addressed that trauma, or made peace with it to some degree, do you find that that might be a helpful thing to do?

Dr. Heather Sandison, ND (31:40.258)

Yeah, great question. Yeah, I'm a huge fan of therapy and working through trauma and finding as much peace as possible. And the reason, the mechanistic reason is because it only makes sense that if we grow up in a household with maybe alcoholic parents or violent parents, or where we're neglected, or things are unstable, we are focused on survival. And that is appropriate. And we go into that fight, flight, freeze state, and our brain develops in that state. And that's normal and appropriate, like that is what allows us to survive.

But if our brain develops in that, we don't know another way. And so our brain is bathed in cortisol and it becomes toxic. We are in that fight, defend, fear mode, and we don't heal in that state. We're not getting into that rest, digest, and heal state, and that reduces immune function. What we're talking about is, I think of it like this split in microglial activation. We have two pathways that we can go down. One is where we activate the microglia and we turn them on, we create more plaques and tangles, and we have more inflammation in the brain. And that is going to be triggered by just being in that state of fight, flight, freeze, that is going to be triggered more easily.

Now, if we can slow down, if we process our trauma and make peace, we find gratitude in our experiences, if we can get into that state more often, now of course no one stays in that state, it's dynamic, we go back and forth. But if we can get into that state more regularly, we reduce the cortisol, we get into that rest, digest, and heal state and we start to have feedback loops that send signaling that it's okay to grow. My mentor, Dr. Dale Bredesen, he talks about the brain as like a country. My Brainistan. So if you're thinking about My Brainistan and My Brainistan is at war, it's using all of its resources to attack and defend against toxins, against infections, against whatever scary thing is coming next, then it's not building roads and schools. And appropriately so, it shouldn't be. So we want to resolve those things that we're fighting against, that we're defending from, and then we want to go into that neurogenic synaptogenic mode, that healing state that allows us to create new connections between our synapses, between our neurons, our brain cells.

Now, I think most people can relate when we talk about stress, most people can relate, like when you're under a ton of stress, you haven't slept well, you are jet lagged or flying, and you have a big talk that you need to give, or you know you need to go into this conflict-ridden conversation, your brain doesn't work as well. And so just that experience, like imagine if you were there all the time.

Jennifer Fugo (34:30.326)

All the time, yeah. And I don't know if you've ever noticed, I've had this experience where you're not sleeping well. So I'm also in my 40s and in that kind of perimenopausal state. I feel like a lot of things do shift in your worldview when you get into your 40s, because all of a sudden you start realizing like, oh shoot, this stuff is not that far ahead of me potentially, I need to start to prepare, shift, change, address, whatever. And that's why probably one of the reasons this is important to me now. I mean, it's always been important, but this is like now more of a focus. And so with that being said, does this shift in hormones as well, especially you said this is a bigger thing for women.

Dr. Heather Sandison, ND (35:13.166)

Yeah, okay. So you’ve got a great question. I just want to make sure we stay in this framework because I, it's me, it's my problem. I get so overwhelmed so easily when I'm thinking through these complex things that I have to keep this framework so that I can put everything in like the right place in my brain.

Jennifer Fugo (35:32.3)

Fair enough.

Dr. Heather Sandison, ND (35:43.242)

So we have toxins, too much, too little in the wrong place at the wrong time, nutrients, stressors, structure, signaling, and infections. So let's go through them because hormones are the signaling. And you talked about infections, but I wanna make sure that people understand other ones as well to be aware of. So let's talk about structure real quick because this is an important one. This is the plumbing. This is, and there's macro and microstructure. We talked about microstructure. That's our genetics, our molecular structure that puts us at risk. We can't change that, that's a non-modifiable risk factor. Where we really wanna focus our effort is on what can we do about it, what are the modifiable things? So that's the macrostructure.

So think about this like, am I getting enough blood flow to my brain? Am I getting enough oxygen to my brain? Does my brain get everything it needs through the plumbing, through the arteries, through the airway? And also like, if I get hit over the head with a baseball bat, we know that that traumatic brain injuries increase the risk of Alzheimer's and dementia. We can see on imaging, when somebody has a TBI, they end up with less perfusion where they hit their head and often in the contralateral spot.

Jennifer Fugo (36:37.804)

interesting.

Dr. Heather Sandison, ND (36:42.53)

So if you get hit your right front, like your right frontal lobe, you'll get some in the left occipital lobe. So you'll see a reduction in perfusion and it's like the brain is rattling around in there and you're going to affect perfusion through these TBIs. Now some are worse than others certainly, when you have multiple TBIs there seems to be a compounding effect. There's the CTE that's associated with football players and that pretty specific type of head injury that comes from playing football. But I see big wave surfers who have experienced this, soccer players who experienced it.

Jennifer Fugo (37:13.004)

Or strokes, if somebody had a stroke?

Dr. Heather Sandison, ND (37:39.84)

Absolutely. So that is the vasculature. So you get hit on the head, that's one type of traumatic brain injury, but strokes, either hemorrhagic or ischemic strokes prevent the flow of blood. You're not getting blood to that area for whatever reason, and now that tissue is going to die and not work as well. So absolutely, that is a huge deal. Now what causes the strokes is either the blood vessel ruptures, that's hemorrhagic stroke, so that's about the integrity of the lining of the blood vessels. Is that good high integrity, or is there a potential strain there? And then the other thing is clots. So either blood clots or plaques can cause ischemic strokes, where it plugs, so again, it's plumbing, right? It's like in your sink, if the drain is clogged, you're not gonna get water where it needs to go. If the blood vessel is clogged, you're not gonna get blood where it needs to go. And this is going to lead to death of the tissue. So absolutely, that's part of why LDL, so our cholesterol levels are something that we wanna keep a close eye on. We look at cardiac calcium scores, we will do ultrasounds of the carotid arteries to understand is there blood flow through this structure? Does the structure work?

And then another really, really important one. If anyone is noticing cognitive impairment in themselves or a loved one, please ask for a sleep study because I have seen over and over again women who are thin, who nobody hears them snore, either because they take their hearing aids out, or they sleep in a different room, or they don't have a partner anymore. And they have sleep apnea, severe obstructive sleep apnea. And I think in our minds, it's the fat guy who snores, and he's red in the face, and he clearly, like something that's going on. And over and over again, I see thin women, no one knows that they snore, and they have severe obstructive sleep apnea that's having a huge impact on their cognitive function.

Jennifer Fugo (39:13.162)

So if you have sleep apnea, that could be a risk factor as well in not addressing it. Wow.

Dr. Heather Sandison, ND (39:17.662)

A hundred percent. I have seen miracles with getting someone on a CPAP who has obstructive sleep apnea. Because imagine if you have airway obstruction at night, you're hypoxic. You're not getting enough oxygen into your lungs, air into your lungs, so not enough oxygen to your brain. And this is scary. Your body basically can't actually get rest in that state, so you are, you really need the sleep, you're exhausted, but your body isn't allowing you to get into that really restful state because you're also suffocating. And so you don't get REM sleep, which is where we consolidate memories. It's where we take the bite out of stressful events that might've happened in the day. We process them so that tomorrow when we think about that hard conversation we had yesterday, it's not as stressful.

And then deep sleep is when we do the glymphatic rinsing. It's when we get the toxins out of our brain that have accumulated from the day, whether it's like mercury, or it's amyloid plaques, or it's just metabolic waste from cellular processing. And if we don't get into those states of REM and deep sleep, our brain, I mean, it's going to be affected so quickly. It's like mild brain damage every night to have apnea. So this is high, high priority.

Jennifer Fugo (40:37.654)

So, and I'm gonna add, I guess kind of back to the question about the hormones, like in perimenopause, some women like myself end up with this drop in progesterone that, to be honest, I did not realize that was what was wrecking my sleep. I felt it every day, I felt this cumulative exhaustion that was impairing brain function, and memory recall, or word recall, and all sorts of things, and some support with oral progesterone has, it's like night and day, better sleep. Could that potentially?

Dr. Heather Sandison, ND (41:10.35)

Yes, yes, yes. I love that you have this personal experience with oral progesterone. It's like the one thing that I prescribe most often in my clinical practice, where people come back and they're like, this is my best friend, don't ever take it away from me, I need enough progesterone to last the rest of my life, because it's such a common experience. Now, not for everyone, not everyone tolerates it.

Jennifer Fugo (41:32.278)

Sure, that's true.

Dr. Heather Sandison, ND (41:39.746)

And some people can get some breath tenderness when you first start it. But oral progesterone is just one of those miracle things that you can do at bedtime. So let's talk about signaling. So we talked about, the only other thing with structure is chronic pain. So if your hip bone is not connected to your leg bone in the right way and you've got sciatica, that will affect sleep, it makes you stressed, I mean, anybody who's had a headache, right, you can't think straight. And when you do that chronically, it affects your brain. And then narcotics. Medications can really have a big impact, both benzodiazepines, opioids, opiates, narcotics, they can have a huge impact. Also, antihistamines are anticholinergic, they can have a big impact. So just being careful with medications, talking to a doctor about that with this in mind, especially if you have a risk for developing dementia.

Okay, so signaling. Signaling is, what are the signals going to our brain that are going to tell our brain to get into that healing mode, to tell our brain to get in that synaptogenic, neurogenic mode where we're building new connections and even new neurons sometimes. And getting out of that fight, fight, freeze state, defend, attack mode. And sex hormones are among them. Vitamin D, also a hormone. Thyroid also, that's a really important hormone that helps with metabolism and cognitive function. If those are not balanced, we're not going to have optimal cognitive function. BDNF, brain-derived neurotrophic factor, comes from muscles, there's also some things that you can take to support BDNF production, but that is another signal going to our brain that tells our brain to get into that neurogenic state. Good polyphenols, catechins like from matcha or green tea, lion's mane, there's a whole host of sort of these neurogenic compounds. Ketones. So getting into ketosis is highly neurogenic. So the signals coming to our brain, what are they?

And absolutely hormones. So sex hormones. When you think back to when your hormones in your life are peaking, like our late teens, early twenties, and we don't have to go all the way back there. But this is when we are making social connections. We're often getting into our trades or we're in college, our brains are ripe for connectivity. They are in sort of that peak of learning and making those connections, whatever they are. And this is what we're sort of approximating. So we're not going back to like men having levels of testosterone at 1500 like they did in their 20s, totally obsessed with sex. We don't have to go back that far. But what we can do is get those testosterone levels up so that we're getting the benefit of the neurogenic effect.

Same thing with progesterone and estrogen. Many women have shared with me that this happened in menopause. My brain hasn't felt the same way since I went through menopause. Some of it's the sleep deprivation, some of it comes from like night sweats at night waking you up. There's lots and lots of factors. We have estrogen, progesterone, testosterone, DHEA, pregnenolone receptors in our brain. And those signals help for a more, I hesitate to say youthful, but they help to have sort of a more youthful manifestation of those signals and the behavior of the cells.

Jennifer Fugo (44:46.614)

Sure.

Dr. Heather Sandison, ND (44:53.376)

So we want that benefit if we can tolerate it. And we also see in the data, there was a paper that came out last year, women over 65, 10 million women over the age of 65, Medicare eligible women, who were on hormone therapy, particularly estrogen, had a 2% reduction in risk of dementia. But they had nearly a 20% reduction in risk of all-cause mortality, reduction in risk of cancers, heart disease.

Jennifer Fugo (45:14.9)

Wow. Yeah.

Dr. Heather Sandison, ND (45:22.69)

So it's highly protective to have these. And I see that in my clinical practice, women who are on hormone therapy post-menopausally, they're just, they look younger, they act younger, they're having more sex, you know, they're just like, they're more youthful generally and they have more capacity. And of course, bone health.

Jennifer Fugo (45:35.872)

Of course. I mean, I think that's one of the concerns is that some individuals in this phase of life, like perimenopause into menopause, feel like, Dr. Kerry Jones was on the show and she was talking about this whole, the brain impacts of perimenopause and that it's, I don't remember who she quoted, but she said it's like, you're living in a house that's being renovated. That's sort of the brain experience of perimenopause.

Dr. Heather Sandison, ND (45:58.702)

Well, think back to puberty. One of the ways that we can sort of predict how a woman will fare through perimenopause and menopause is asking her about her puberty. And people who had really intense puberty, where their hormones were all over the place, and they had acne, and they felt driven by something that wasn't themselves, it's very similar. And it kind of gives me some more compassion for the poor teenagers in my life, like they're going through a lot. Yeah, like they're living in a house that's being renovated. I love that analogy.

Jennifer Fugo (46:35.5)

Yeah, I just thought it was interesting because I was like, you know, that actually is a very interesting way to put it. The further I get into this, it feels like that more and more. But I wonder for some, is it possible, she said, look, some of the brain impacts are going to shift and eventually it'll settle down, but maybe for some, it's not. You get to menopause and you keep going. Now you're five years, 10 years into menopause and you're still struggling. Like you said, all of a sudden you can't remember where you put your keys. There's little things, it's like you feel like you're slipping, but you don't want to admit it, maybe your family's starting to notice subtle changes. Is it possible that menopause could be part of the reason why women seem to be impacted more so with dementia?

Dr. Heather Sandison, ND (47:23.434)

Without a doubt, yeah, that steep drop in estrogen and progesterone as we go through menopause, whereas men have andropause, but it's much more gradual. So absolutely, women are two thirds of Alzheimer's patients, and they're also much more likely to be caregivers. So women are the people who are most affected by Alzheimer's. I have an elephant on the cover of my book because, well, elephants remember, right, they're kind of known for this, and they're so majestic and amazing. They're matriarchal as well. And it's this representation, like if something's going to happen and we're going to reduce the burden of disease, associated with this disease, it's going to come from women. It's going to be us that really need to make these lifestyle changes and support our family members, whether it's our husbands, or our sons, or fathers, whoever they are. Really the change comes, I think, from us, at a societal level.

And I think when you go through menopause, I want every woman to know, you don't have to suffer. There's support. And we were told it was risky. I mean, this is one of the failures of modern medicine, is that we were told how risky hormone therapy was, when it's actually extremely protective. And I feel like there's a generation of women who experienced so much suffering related to menopause who didn't have to.

Jennifer Fugo (48:38.572)

Yeah, who did not have to, exactly, exactly. So I wanted to ask you, I have like so many questions. I feel like, I have like so many questions for you, but like we only have so much time. So I wanted to talk through, just briefly, a little bit of things that might be overhyped online that perhaps might not actually be helpful, versus some things that you think could be helpful for people to consider. Obviously we've talked about getting some genetic testing done, that I think is something everybody here hopefully will talk to their doctor about. But are there certain things, like somebody asked me about creatine. Another person asked about, do hyperbaric oxygen chambers help? I've seen some really interesting research on vitamin D. Like what do you think is more like hype, versus what is helpful?

Dr. Heather Sandison, ND (49:30.882)

Yeah, great question. So I think whenever we think about this, we want to zoom out and take the time to go through this kind of more strategic and structured approach to understanding our own risk factors, because there's not one answer. And it's really about supporting the brain. You cannot out-supplement a bad diet. You can't out-exercise a bad diet either. You can't out-exercise poor sleep. So foundationally, diet, exercise, sleep, stress management. There's not a magic pill. I wish there were, I would tell you about it. I would scream from the rafters about anything that helped that was easy and simple. It takes work. That is the truth.

Now, creatine, great data. I mean, it's a small study. It was a 19-person study, 20 grams over four weeks for people with Alzheimer's showed a statistically significant improvement in cognitive scores in multiple domains.

Jennifer Fugo (50:28.32)

Wow.

Dr. Heather Sandison, ND (50:30.092)

And it's also relatively safe. Now, you do need to watch kidney function, creatine and creatinine sound similar because they very much are. So you'll see an increase in creatinine. You can measure cystatin C as a different kidney marker if that is a concern for you. And I wouldn't start it if, certainly don't start at 20 grams. It can cause water retention, so just pay attention to that. I typically have people start at three to five grams and then slowly work up, it's tasteless. I use it every day, I probably take about 20 grams these days, and I just put scoops of it into my matcha, into my matcha powder tea in the morning, and then throughout the day if I'm having like a mud water or other sort of like turkey tail kind of tea, I'll just add more of it. It tastes like nothing.

Jennifer Fugo (51:13.29)

Yeah, it doesn't, I've added it to my coffee. It doesn't taste like anything.

Dr. Heather Sandison, ND (51:16.16)

Yeah, I don't drink coffee, but yes, you can totally add it to your coffee. And then vitamin D, I'm a huge fan of vitamin D. Watch your calcium levels. So work with a provider. As you're adding these, many of them are very safe, but you just want to work with a provider to make sure you're not causing a new problem. So watch calcium levels. But vitamin D, most people, it's very safe to take 5,000 IUs a day, and you want to get that vitamin D level up. It's good for mood, it's good for bones, it's good for brain health. It is a hormone, so again, helps with that synaptogenesis, neurogenesis, and immune function in the brain so that we're not activating the microglia.

Now, I mentioned, we've talked about P. gingivalis. So infections are the sixth causal level issue with dementia that are gonna trigger amyloid plaque. So sometimes you'll see in the news, herpes virus is associated, it causes dementia. That's not the only cause, but it certainly contributes. And so you can have toxins, you can have high heavy metals, and herpes, and a traumatic brain injury, and be APOE4 positive. And yes, treat the herpes, but I don't want somebody to think, oh, if I treat the herpes, I'm not gonna get Alzheimer's. What we wanna do is take this comprehensive look. We don't wanna miss the opportunity to say, okay, I have this, this and this contributing to my risk and I want to mitigate all of them, or as many of them as possible.

And so there's a handful of infections that we know are more likely to trigger beta amyloid production, more likely to trigger microglial activation. And like you mentioned, it's P. gingivalis, gum disease, very quickly triggers brain inflammation. So do herpes viruses, including shingles. And so we see that the shingles vaccine, there was a great, well-designed study, it was in the population. They basically said, if you turn 80 on this day, you can get the shingles vaccine, if you turn 80 on that day, you can't. And so it was this amazing kind of study, these two groups who were very, very similar because they were just born days apart. So they took like the week before and the week after, the month before or after, and they compared them. And people who got the shingles vaccine were 20% less likely to develop Alzheimer's in the next seven years.

Jennifer Fugo (53:12.768)

Wow.

Dr. Heather Sandison, ND (53:30.522)

And we've seen other data that supports this. it's been corroborated by more and more studies, but we see that the Shingrix vaccine reduces the risk of dementia. And this is because those herpes viruses, they live in the nervous system. They're very quick to create microglial activation. So if you're someone who gets cold sores, the herpes viruses, those outbreaks, then get lysine. Lysine is another amino acid, doesn't taste like much. You can add it to your coffee, to your tea, and also ask your provider for some acyclovir or valcyclovir, the Valtrex. This is something to just have in your back pocket if you ever start to notice an outbreak. I'm quick to suggest that people take something, do something to stop it because you want to quell that inflammation.

Jennifer Fugo (54:20.991)

Yeah, and in the skin world, eczema herpeticum is a huge problem, and sometimes it gets let go as just being in a flare. You have to jump on it. If you are on a biologic drug, like sometimes dupilumab, or also known as Dupixent, and some of these others, can cause people to have cold sores and other eczema herpetic-type outbreaks. Like you really do have to be prepared for that. I kind of wonder and I have to ask, I had, I got shingles at 27. Is that, for those of us that have gotten it younger, is that a bad sign?

Dr. Heather Sandison, ND (54:55.822)

No, no, not at all. You just want to, like there's something you can do about it, right? You can't go back and not have had shingles.

Jennifer Fugo (55:00.191)

Right. Right.

Dr. Heather Sandison, ND (55:02.321)

So what can we do going forward? And I typically recommend, if you're over 55 or 60, get the shingles vaccine. Now, not every body can tolerate that. Just like hormones, just like any of these things. I think of it like a buffet. If you're anti-vax, whatever, don't get the shingles vaccine. But do everything else. Make sure you're doing the diet, and the exercise, and the sleep, and everything.

Jennifer Fugo (55:20.565)

Yeah, and know the symptoms of what shingles are, and go to the doctor immediately. Do not wait.

Dr. Heather Sandison, ND (55:25.91)

Yes, yes, yes. So we see herpes viruses, the oral bacteria, we see that Lyme spirochetes, and Bartonella and Babesia, the vector-borne illnesses, they have an impact on cognition. So getting ahead of them, living with them symbiotically if you aren't able to fully eradicate them, but making sure that you're keeping them as much under control as possible and you're avoiding tick bites, flea bites. These vector-borne diseases can have a big impact on our cognitive function over time. And we see that Lyme spirochetes have been found in the amyloid plaques of Alzheimer's patients on autopsy. Same thing with herpes viruses, same thing with P. gingivalis and other oral bacteria.

Jennifer Fugo (56:05.517)

Jennifer Fugo (56:10.125)

Wow.

Dr. Heather Sandison, ND (56:18.19)

And then COVID. COVID is a different mechanism, it's not like we see COVID in the amyloid plaques as far as I'm aware. But what happens is it creates a hypercoagulable state. So it leads to that structural issue where we have clotting, microclotting in the vasculature, which prevents good blood flow, and increases cytokines, which create more inflammation as well. So again, treating that, avoiding it, is a way to reduce our risk. Whenever our immune system is super hypervigilant, that's gonna increase risk because we're getting that signal. Instead of the signal to create more neurons and to create more connections between them, we're getting the fight and defend signal.

And so, if you're on social media, if you're looking at these things that people are saying, put them in context. So evaluate, is this a risk for me? Maybe you have great vitamin D levels. Let that go then, you're doing great, keep taking your vitamin D. Maybe you're already taking creatine, or maybe you're adjusting the dose. Great. Wonderful. But those things alone are not going to prevent or reverse Alzheimer's. It's really about taking this comprehensive approach to evaluating your risk factors and addressing each one as you're able.

Jennifer Fugo (57:28.993)

And so if we are starting, if somebody listening to this, either they're noticing issues or they're noticing issues in a loved one. And it sounds like at that point, what you're saying is that's the time to intercede. You have the best chance as early as possible when thinking about how to prevent dementia.

Dr. Heather Sandison, ND (57:43.894)

As early as possible, yes.

Jennifer Fugo (57:58.837)

And so I know you have a really great book that I think has done very well. It's called Reversing Alzheimer's: The New Toolkit to Improve Cognition and Protect Brain Health. Is that a good place for people to really start to just understand? I know you also have a ton of tools on your website as well.

Dr. Heather Sandison, ND (58:06.826)

Yeah, at drheathersandison.com, that's an easy place to go for this. But yeah, the book, that was the idea was that everybody could, and I've had people come into my office with either one of Dr. Bredesen's books or my book and have it dog-eared and underlined. And they're like, my cognition is already better, my dad's cognition is already better, and now we want to put the icing on the cake. That just makes my day, because that was the goal, that was the hope, is that people would have this $25 book, that if they had the motivation, they could read through it, make the changes. It's very practical. There's recipes in the back, there's suggestions for daily guides, for how to get started. There's of course a conversation about how we get to this paradigm, how we think about it. But really the bulk of the book is just taking you through the different foundations of brain health so that you can create a really comprehensive approach to optimizing cognitive function at any stage, at any age.

Jennifer Fugo (59:01.515)

Yeah, this is so important. Oh my gosh, I have so many more questions for you. I feel like you're going to have to come back because I just have more questions about dementia treatments. And I feel like everyone listening to this, I love how these conversations open the door, or the window, of curiosity to other things to help us connect different, like I didn't see where this was going in terms of like the shingles outbreak or eczema herpeticum, or even you brought up so many really amazing points I didn't know about, I didn't think of, and these are important for us to know.

So I really hope that you'll come back because I mean, I think for many of us, if you don't have the ability, I think I'll leave it at this. My dad was an ophthalmic surgeon and so most of his patients were in their, like the average age was probably 80. And many of his patients told me while I was in my 20s, the golden years are a lie. It's horrible. I'm on tons of meds, I sit and watch TV all day, my family doesn't really do much with me, I'm all alone. And they didn't have a great quality of life. And that's really stuck with me. And then watching my two close relatives go through dementia also left a really deep mark on me. And I feel like when you don't have your health, it really drastically impacts so many things. And when you can't think through things, when your brain isn't working the way it's supposed to, it kind of sometimes feels like you're trapped. And so what I'm hearing from you is that we can do something about this. But the sooner we start, the better.

Dr. Heather Sandison, ND (01:00:44.424)

Absolutely. You asked about the gut microbiome. We didn't even get into the gut and how big of an impact that. So yes, we'll have to continue this conversation.

Jennifer Fugo (01:00:48.019)

I know. Yeah.

Dr. Heather Sandison, ND (01:01:10.102)

My work is really about how to make those golden years your best years. It's, how do we look forward to aging? There's so much wisdom, and experience, and joy, and connection that we get that's different from the first half, the first three quarters, of our life. And I feel like so much of the influence of culture and of, I'm in Southern California, it's all this obsession with youth. And we're missing how precious, and amazing, and valuable those last years of life can be, particularly if we're healthy.

Jennifer Fugo (01:01:25.877)

Yeah, absolutely. Well, thank you so much for joining me today to discuss early dementia signs, signs of Alzheimer’s, and so much more. I'll make sure to put the link to the book, which you can get on Amazon and everywhere else, and your website, and social media so people can connect with you. And I just thank you so much for being here, Dr. Sandison.

Dr. Heather Sandison, ND (01:01:44.76)

Jennifer, thank you for the work that you're doing. Thank you for having me.