With rates of Alzheimer’s and dementia rising steeply, especially among women, the conventional pharmaceutical model has largely failed in treating the brain. Functional Medicine takes a different systems-based, personalized approach—focusing on inflammation, metabolic health, and environmental exposures—which offers real hope for prevention and even reversal of cognitive decline. In this episode, I discuss, along with Dr. Heather Sandison, Dr. David Perlmutter, and Maria Shriver, why it is possible to reverse cognitive decline and the cutting-edge science of brain health and Alzheimer’s prevention. Dr. Heather Sandison is the The New York Times bestselling author of Reversing Alzheimer’s The New Toolkit to Improve Cognition and Protect Brain Health. As a renowned naturopathic doctor specializing in neurocognitive medicine, she’s the founder of Solcere Health Clinic, San Diego’s premier brain optimization clinic, and Marama, a residential program turning memory care into memory recovery. Dr. Sandison has dedicated her career to supporting those suffering with dementia and published her most recent clinical findings in the Journal of Alzheimer’s Disease. She’s excited to shatter common misconceptions about Alzheimer’s and share what she’s learned about keeping your brain sharp at any age. Dr. David Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition. He is the author of Grain Brain and Drop Acid, among others. Dr. Perlmutter received his M.D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition. Shriver is a bestselling author, award-winning journalist, former First Lady of California, founder of the Women’s Alzheimer’s Movement, and Strategic Advisor on Women’s Health and Alzheimer’s at Cleveland Clinic. Shriver works to use her voice and platforms to advance some of our nation’s most pressing issues affecting women and women’s health. In November 2023, Shriver joined the President and the First Lady to announce the first-ever White House Initiative on Women’s Health Research, an effort led by Dr. Biden and the White House Gender Policy Council, to galvanize the Federal government and the private and philanthropic sectors to spur innovation, unleash transformative investment to close research gaps, and improve women’s health. Shriver’s advocacy led to the establishment of this historic initiative, and she continues to advise and collaborate with Dr. Biden. She is also the co-founder of the brain health and wellness brand MOSH and founder of Shriver Media. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: How to Reverse Dementia with Dr. Heather Sandison https://drhyman.com/blogs/content/podcast-ep929?_pos=24&_sid=7873ecf2c&_ss=r How to Prevent Alzheimer’s with Your Fork https://drhyman.com/blogs/content/podcast-ep47?_pos=8&_sid=7873ecf2c&_ss=r Maria Shriver's Journey: Redefining Women's Health and Alzheimer's Prevention https://drhyman.com/blogs/content/podcast-ep908?_pos=12&_sid=7873ecf2c&_ss=r
Chapter 1: What can we do to protect our brain health?
So what you set up is what we call a vicious cycle, whereby eating the wrong foods changes the microbiome, it changes your brain, it makes you less able moving forward to make the right choices. So you make further bad choices, further damaging your gut bacteria, further changing your brain.
Now, before we, did you know that over 75% of people are deficient in magnesium? That's a problem because magnesium is essential for over 600 functions in your body, including energy production, stress regulation, and deep sleep. But here's the catch. Not all magnesium is created equal.
Chapter 2: How does diet influence cognitive decline?
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Right now, Bioptimizers is offering my listeners a special discount. Just go to bioptimizers.com slash hymen and use code HYMEN10 at checkout. Don't wait. Your body will thank you. To jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale.
And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. And if you're in need of deepening your knowledge around your health journey, well, check out my membership community, Dr. Hyman Plus.
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I came to this as a skeptic. I had heard, like most clinicians, I was trained that there was nothing you could do. And as you mentioned, to suggest there was something we could do for someone struggling with cognitive decline on their way towards Alzheimer's, it would be to give them false hope.
The conventional model and the incentive structure of sort of the pharmaceutical industry, the insurance industry, the way that healthcare is set up is that what we want to find is a single molecule intervention, right? That can be patented. that is very simple to dispense from a pharmacy. There's simple instructions. Just take this one pill once a day and you'll feel better.
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Chapter 3: What are the key factors influencing Alzheimer's?
And that works if you've got a UTI, right? And we can get a cure. And that can be in the past. Take antibiotics for seven days. Don't have to think about it again, hopefully. Now, when we're talking about Alzheimer's, this is very complex. And our friend, Daniel Schmottenberger, he really taught me to think. And I feel very privileged to have spent a lot of time discussing.
We would meet every Tuesday afternoon for four, five, six hours on these marathons, just kind of reprogramming my brain about how to think through diagnosis of complex disease. And put simply... When you think of any complex system, whether it's a houseplant or a financial system or government systems or the brain, what you're looking for is balance, right?
And imbalance is going to create dysfunction in that complex system. And so imbalance is going to be too much or too little or at the wrong time or in the wrong place. And when we think of the brain, this leads to disease when we have imbalance, especially over time. And so we can say, okay, imbalance that this is helpful. We'll simplify.
And then we want to systematize imbalance of what, what are the causal level factors? And I would argue that they are, there's six of them. It's toxins. And so imbalances of toxins in the wrong place at the wrong time, too much, too little. nutrients, right? You mentioned insulin resistance and blood sugar becoming so high that it becomes toxic. That can be a problem.
But also you mentioned B12 and having too little B12 associated with genetics. And maybe for your neighbor, they need more B12 than you do. So we have these individualized needs and requirements where we're going to get that functional requirement met, not just the RDA, not just that recommended daily allowance. So we have toxins, nutrients, stressors.
We can have too much or too little stress, right? Some people want to kick their feet up and just relax in retirement, but they're not getting that engagement. And then we also know on the flip side that caregivers, care partners for people with Alzheimer's are at higher risk of being diagnosed with Alzheimer's themselves later on because they have too much stress.
Cortisol becomes literally toxic to the hippocampus, those memory centers of the brain. So toxins, nutrients, stressors, structure. You mentioned getting hit over the head and causing pain. Well, that can also cause inflammation in the brain and be a traumatic brain injury that can put us at risk. You mentioned ApoE4.
We can have molecular structure, genetic structure that puts us at risk for developing Alzheimer's later on. So again, toxins, nutrients, stressors, structure. Infections. We know there are a handful of infections that are directly associated with the triggering of amyloid plaque production. So things like P. gingivalis, which causes gingivitis in the mouth.
Also, the Lyme spirochete has been found in amyloid plaques. as well as H. pylori is associated, and herpes, the herpes simplex, one virus is another one.
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Chapter 4: Can lifestyle changes reverse cognitive decline?
They don't ask you about exposures. They don't do any testing about it. And one of the challenges is that it's very hard to test for some of these compounds. There was a great lab for mycotoxins that was run out of business because insurance companies didn't like it because they were getting Actually, I think I was the cause of it, actually. I think it was like 20 years ago.
But I had a patient who was in a house that was affected by mold. She had chronic fatigue. Her daughter had juvenile rheumatoid arthritis. And they lived in different bedrooms. And I had them go assess what was going on in their house and what was growing in each room. And they were at different molds.
And then when we did lab work with Dr. Barjani's lab, it was called Immunosciences, that did these mold toxin lab assessments. It matched exactly like the mycotoxin antibodies or the mycotoxins that were in the room. And then she got a million dollar settlement. Then the insurance company in California came to shut down to the government, shut down the lab. It's pretty bad.
But anyway, that aside, it's sometimes hard to test for these things. Heavy metals are easier to test for. You can look at Blood testing, that's helpful. There's challenge testing where you can take a key liter and collect your urine. But the other toxins, which are ubiquitous, like phthalates, BPA, glyphosate, PCBs, pesticides, plastics, microplastics, they're very hard to assess.
I recently learned about how to assess it in a different way. I want to tell you about it in a minute, but I'd love to hear how you think about those rather than just your general, like try to reduce your exposures and improve your own body's detoxification system, which is sound advice. What are the other ways that you kind of assess these?
Yeah, so we do tests through real-time labs, has an environmental pollutant panel. And so I do look at urine, at urine levels of excretion. And what I've seen is many of the sickest people, they actually don't collect much in their urine the first time.
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Chapter 5: What role do toxins play in dementia?
But then as we start using some binders, some glutathione, some support, some biochemical support, as we start getting them sweating, maybe get them on a detox breathwork practice, we see that those numbers will go up. And so it's almost like, again, hidden, even with our testing, some of those exposures and that total toxic burden, it takes a little bit to uncover.
And three, six months later, we see those numbers go up even when there isn't an active exposure, but it's just that they're starting to actually mobilize more of it. Also, getting on a ketogenic diet, we start to mobilize fat-soluble toxins.
As we are using the fats to create fuel, we can get that from adipocytes, and then we're releasing those toxins into the bloodstream, and then it's coming out in the urine a little bit more. I think that many of these toxins, initial testing can also be deceptive. Most of my patients are over 65. They've had a lifetime to accumulate these things. And this can be such a scary conversation.
It can very quickly go to overwhelm and anxiety about how much toxicity is in the environment. We can only control what we can control. So I think testing your water or getting spring water, findaspring.com, I think is a great source to find spring water near you that hopefully isn't contaminated.
I'd love your opinion on RO, water reverse osmosis, is a great way to get a lot of toxins out, but it does require remineralization because it'll take the minerals out of the water. Yeah. So getting away entirely from plastic, from drinking anything out of plastic, particularly because hot plastic will leach into the water.
But even just the screw cap, it's like you've got plastic sawdust in there. And so I think plastic water bottles are just toxic for so many reasons. But yeah, we could talk for a weekend on all of the ways to think through toxicity. Yeah.
I'm going to tell you something that might blow your mind. And it's blown my mind, actually. But before I do, I just want to kind of reinforce that the approach you're talking about fundamentally is lifestyle. It's what we eat. It's how much we exercise. It's sleep. It's how we manage stress. It's some basic nutritional support. And those have a profound impact.
And there are some trials that have been done, the finger trial and the pointer trial, which is underway, which are multimodal lifestyle interventions with risk factor management that have shown not just to slow dementia, but to actually reverse it. which is, again, something that all the drug studies never show, right?
So even the best drugs that have been approved, there's not many of them, they don't show that. And I don't know why it's not something that's headline news, because studies are published. Your study should have been headline news. Again, it was published in the Journal of Alzheimer's. Because if something is incurable,
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Chapter 6: How can we assess our toxic exposure?
I'm curious if you have any experience with that, what you think about it, if you know what I'm talking about. The lab is a German lab. It's called IGL. IGL. Are you feeling stressed, sluggish, or struggling with sleep? You might be low on magnesium, and trust me, it's a bigger deal than you think.
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Oh, I'm writing that down. I'm not familiar with IGL, but I have been using the Patricia Kane, the phosphatidylcholine for a long time, for many years, the IVPC. And we do the exchange by IV and then also oral PC, which we know helps with gallbladder, basically the discharge of bile, that toxic sludge that we build up.
And so PC, I think also very clear that that helps with the brain as this phosphatidylserine and choline is part of acetylcholine, a neurotransmitter, the most abundant neurotransmitter in the brain. But choline, we do know that choline has a big role to play in the brain. So not just the phosphatidylcholine, but choline found in eggs and in other food sources and also in many nootropic formulas.
Right. That's the major neurotransmitter that goes down is acetylcholine in Alzheimer's. I don't know what doses you're using, Heather, but we're using basically 20 grams, which is a lot. And over 10 weeks, we give two kilos, basically, of phosphatidylcholine intravenously.
Are you doing the inessential vials?
Yeah, but we're doing 20 of them.
20 of them. Wow. Yeah, we do five typically.
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Chapter 7: What is the link between diet and Alzheimer's?
But they ask... Just to give this perspective, it's out of 30. So if your score is less than 25, it's a problem. Two is, you know, nobody's home.
Yeah. 26 and above is normal. Once you're down in the single digits, this is severe dementia. This is where you are dependent on others for activities of daily living. Your dignity is more or less gone, right? You're not able to do anything on your own.
And so she was in that, in that state, but she had this bright smile and her eyes would track me and she had on this beautiful floral dress and you could just see how much soul was in her. And they just shocked me. Um, she came back, uh, six weeks later and her mocha had gone up to a seven. And of course my initial response was like disbelief.
I was like, Oh my gosh, we must have done the test wrong. Like this isn't possible. Like what is going on here? And her husband assured me, no, no, she's different. Listen to her. She was speaking in complete sentences. They started bickering about something while they were in my office and she was remembering things that he had said and And she wasn't going back to work. She wasn't 100% better.
But this was the moment. I mean, I remember it like exactly what I was wearing and the way the light was shining in the room because it was so emotional for me to be like, what? If this is possible for Darlene, what is possible for everybody else who's not so far down along this path? There is so much suffering that we could be avoiding by taking this approach. So what did they do?
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Chapter 8: How do we approach the treatment of dementia?
They moved out of a moldy bedroom, and they didn't have to move out of their house entirely, but they moved into their living room. They started ballroom dancing three times a week, even though they weren't very good at it. They were going on walks every day. They got on a ketogenic diet. They ate only whole foods, got rid of all of the processed foods in their diet.
She got on all the supplements that we put together based on Dr. Bredesen's approach. She got on bioidentical hormone replacement. She went and got the mercury out of her teeth, her root canals out. She got all of her dental work taken care of very quickly. And lo and behold, she improved.
And I really owe so much to obviously Dr. Bredesen, but also to Darlene and her husband, because that was the moment I could not deny how much better she had gotten. Yeah.
What was her score after you'd done all that?
It was a seven men and she continued to go up a bit. I've lost touch with them. They're doing things on their own, but we were together for a couple of years and probably like your patients, you hear from them years later and you think, oh, have they gone down or do they need extra help? And she'll probably be like, nope, we're doing great. They were very motivated. It was really fun.
What you eat, looked at through the lens of your microbes, does affect your behavior and your choices. And at the same time, those choices that you make affect the health and vitality of your gut microbes. So what you set up is what we call a vicious cycle, whereby eating the wrong foods changes the microbiome, it changes your brain, it makes you less able moving forward to
to make the right choices. So you make further bad choices, further damaging your gut bacteria, further changing your brain. And let me say that it's not just moment to moment changes in your brain that happens, you know, that you make the wrong decisions. But ultimately, as you continue to make these wrong decisions, you rewire your brain. through a process called neuroplasticity.
So you compromise your ability to tap into that part of your brain that lets you make good and appropriate decisions and you connect more aggressively to the part of your brain that is much more impulsive and much more fear-based and much more narcissistic.
So basically we move from a place of love and connection to a place of fear
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