Updated: Aug 15
When I come across people like Heather Sandison, a naturopathic physician in southern California, who is taking Dale Bredesen's dementia reversal work and building on it in a super practical way, I look for the highest rooftop from which to shout the news.
(access her June 2023 paper here)
While in many ways her results corroborate the findings of previous studies of Dale Bredesen's "ReCode" approach, Dr. Sandison boldly admitted people with much lower MOCA scores— down to 12 and 13— than anyone before had done. (The typical cut-off has always been around 19.) And yet her results were almost identical: 75% who were able to stick with the program stabilized or improved at 6 months. That's roughly half of all who enrolled. Her study began shortly before Covid hit, so it's likely that fewer people would drop out if it were done again today.
(If you're not a medical journal paper reader type (but this one is really quite readable), you can scroll down to the end of this post for a list of what they did— or the video interview.)
By the most conservative analysis ("intent to treat"), 50% of people had stabilized or improved @ 6 months. But that was 75% of the people who stuck with the program. And there were more than a few amazing, surprising, delightful turnarounds.
While the first half or so of the Facebook Live session (YouTube link) Heather did with Dale Bredesen a couple of weeks ago is kind of a sleeper, you can maybe FAST FORWARD to around 34:00 or even 34:20 where, if this were theater, Dr. Sandison gets her bring-the-curtain-down shop stopper. At just six months, one woman mostly written off had gotten her life back!
Why isn't this on the Evening News and hogging Yahoo and Google news feeds in place of these inane LEQEMBI stories where, after professionally massaging the data, all they can come up with is a 25% slower progression (oh, and risk of fatal and nonfatal brain bleeds)—and only in carefully pre-chosen subpopulations??
It should be noted that the accumulated experience of the past ten years or so of Dr. Bredesen's holistic approach pretty consistently finds the six-month mark to be sort of turning point; that is, at somewhere between three months and six months on the program, but often not until six months, THAT'S when changes begin to be noticed— a switch flips— with folks beginning to experience actual improvement in their mind and memory from there on, as long as they keep up with 85-90% or so of the program.
Please, please, please do not waste precious time with things like donepezil or memantine, lecanemab or semaglutide.
(And read, no study, Karl Herrup)
But this is also why it is KEY, KEY, KEY to start thinking about this type of approach EARLY, EARLY ON. Please do not waste precious time with things like Aricept (donepezil) or Namenda (memantine) or any of the other pointless medications (looking at you, lecanemab and aducanumab), while you and yours wait for the imminent, promised therapeutic breakthrough. This only gives you a false sense of doing something. Instead, you are LOSING precious time.
As a kind of cheat to get going with the program, Valter Longo's Nutrition For Longevity (at $159 per person per week) now offers a "KetoFlex" meal delivery service throughout the U.S. You can opt in or opt out of the addition of highest possible polyphenol count organic olive oil. For many people, this can provide kind of "training wheels" support while they get used to the initial changes in menus (more plants and healthful fats) and frequency (minimizing or eliminating snacking). There are no caloric restrictions to KetoFlex 12/3; you can eat all you want. You just have to stick to their 21st century food pyramid, with things like dark chocolate, red wine and even dairy being special treats!
Here are some of the elements that jumped out at me after spending a little time with the information from the supplementary tables 2 and 4 of the published paper:
1. DETOX SUPPORT. All but one person was found in need of detoxification support. In most cases this consisted of a vitamin-mineral-amino acid-phytonutrient blend plus Biocidin's GI Detox+ binder product (zeolite clay, activated charcoal, silica, apple pectin, humic powder, aloe vera). In people with elevated mercury levels, a special thiol-functionalized silica product (Quicksilver Scientific's IMD powder) was also included. Chlorella (tablets), cholestyramine (powder, by prescription) and EDTA (intravenously administered) were also used in 1-2 isolated instances.
2. GUT IMMUNE SUPPORT (BOVINE-DERIVED IMMUNOGLOBULIN CONCENTRATE). This was possibly the biggest surprise for me. Yet again, all but one of the participants were judged to be in need of this gut immune intervention. IgG 2000 CWP product from Xymogen.
3. HORMONE SUPPORT. All but three participants were judged to be in need of hormone support: from E2 and E3 (topical cream) and P4 (oral or topical cream) to T (topical cream) and Dhea (oral, 10-25 mg daily) and including a whopping 50 mg daily dose of pregnenolone (oral), the "memory hormone."
4. NUTRITIONAL SLEEP SUPPORT. Just shy of three quarters of participants were found to benefit from nutritional sleep support; i.e., magnesium, myo-inositol, taurine, GABA, l-theanine. RelaxMax product from Xymogen.
5. GUT ANTIMICROBIAL PROGRAM + REPAIR. A full two thirds were found to suffer from bacterial/fungal overgrowths and/or parasitic infestation and were treated with Biocidin drops, extra oregano oil and Xymogen's GlutAloeMine gut lining repair product. One person found infected with Giardia was treated with prescription nitazoxanide .
6. 50B CFUs PROBIOTIC FORMULA DAILY. Absolutely everyone took a daily probiotic blend made up of four different Lactobacillus and Bifidobacterium strains, totaling 50B CFUs.
(Xymogen does not make its products available through Fullscript but instead set up its own mini dispensary (104 brands) they call "WholeScripts." Access it here.)
Dr. Sandison gets goosebumps as she shares the story of one program participant she anonymizes as "Mary." The health coaches were initially reluctant to admit her into the study because her MOCA score was brushing up against the minimum 12-13 cutoff, and she appeared a lost cause: no family or support system, her home and yard hopelessly cluttered, unpaid bills, unopened mail, unpaid taxes. Incorrigibly anxious and self-proclaimed "terrified" of further decline, her single goal was to get better enough in order to qualify for admission to the assisted living place in Los Angeles where two of her cousins (her only living relatives) had moved.
Fast forward six months: "She blew us away," Dr. Sandison tells, her voice breaking. "She decided to make this about other people," specifically, her neighbor with cancer. Mary made up her mind that she was going to prepare all these healthy, ketogenic meals not just for herself but to share with her neighbor. Mary's health improved so dramatically that she has for now put off the assisted living idea. She is too busy reclaiming her life.
"I will never again refuse anyone admission to this program," Dr. Sandison now says. "You can never fully predict whose trajectory might be turned around, whose life might be reclaimed."
This is what can happen when we give the body what it needs— and remove what is getting in the way.
This is the power of a slow, thoughtful, methodical, comprehensive, "root cause"-based approach to chronic illness and health. This is what I live to hone and to share!
Point by point, as enumerated in the Journal of Alzheimer's Disease paper, this is the approach:
Clinical Visit Content
A 90-minute clinical initial intake visit was conducted for each participant, with subsequent visits (@ 30 days, month 3 and month 6) lasting from 45–75 minutes.
Analysis of blood, urine, hair, and stool samples to look at biomarkers of environmental toxicant exposure, blood sugar dysregulation, gastrointestinal health, nutrient status, cardiovascular disease, systemic inflammation, chronic infection, and hormone dysregulation.
Environmental exposures assessed included metals (e.g., mercury, lead, arsenic, and cadmium), chemical pollutants (e.g., petrol chemicals, phthalates, herbicides, pesticides, and glyphosate), and biotoxins (ochratoxin, gliotoxin, trichothecenes, zearalenone, and aflatoxin).
Stool analysis included markers for impaired digestion and absorption, dysbiotic flora, gut specific inflammation, impaired gut immune function, and infection (e.g bacteria, fungi, parasites).
Systemic inflammation was evaluated by hs-CRP, ferritin, and LpPla2.
Chronic infections associated with cognitive decline screened for included Herpes simplex, P. gingivalis, Borrelia, Babesia, Bartonella and chronic sinusitis.
Hormones tested included sex hormones, adrenal hormones, complete thyroid hormone panel and pregnenolone
Any of the above found to be in need of treatment were treated (link to spreadsheet "menu" of individual treatments for each, from Supplementary Table 2 from published paper; it's a bit overwhelming, and I will prepare separate blog post, doing my best to summarize it, asap).
The goal of evaluation and resulting treatment was to identify and optimize biometric markers and lifestyle choices associated with neuronal function. All participants were provided nutritional support including a nootropic blend (Qualia Mind of Neurohacker Collective), omega-3 fatty acids (1-3g EPA:DHA mix daily), vitamin D (nearly 7,000 IUs daily), probiotic (50B CFUs), support switching to a ketogenic diet and suggested to aim for half the number of pounds of body weight in ounces for water hydration daily.
--> Update after 8/14 online Q&A
"Why blood ketone measurement and not breath or urine?" Heather prefers finger prick (KetoMojo) for monitoring ketones because she has found the breath devices (Dr. Bredesen had initially recommended the rather pricey Biosense product) unreliable and says measuring urinary ketones are only useful for the first month. Other finger prick brands KetoSens, KetoTrak, KetoBM appear a little less expensive than KetoMojo, but she prefers KetoMojo, and it's only like fifty bucks.
"What ketone level am I aiming for?" It can be challenging at first for some to get into even mild ketosis, so anything 1.0 and above is considered success. Longer term, the real benefits for most seem to come when you can get up into the 4/5/6 range— even all the way up to 9 or 10.
"How long do I have to be in ketosis?" Heather says for people already experiencing diminished cognitive function (even slight), "you really need to shoot for a full 6 months.
Folks in more of a prevention/optimization mode can probably get away with 3 or 4. Her very practical rule of thumb for folks in this group is to think of the calendar year in quarters and then spend one month of each quarter in ketosis; for example, January, April, July, October.
Because it can take a few weeks to actually get into ketosis, Heather does not recommend breaking up these time periods into anything shorter than 1 month.
Participants were encouraged to increase exercise and adopt novel exercise routines with the goal of getting regular aerobic and strength training exercise. Depending on participant activity level at baseline, these recommendations varied (e.g., if a participant was already doing strength training, aerobic exercise was added, etc.). If participants were doing no exercise at the time of study enrollment, then a recommendation to walk each day was recommended as a starting point. All participants were also encouraged to engage in mindfulness practices, including daily meditation or prayer depending on participant preference.
To optimize metabolism, a ketogenic diet was encouraged for all participants: high in non-starchy vegetables, high in fats, with carbohydrates limited in order to achieve blood ketone levels > 1.0 mmol/L, and a fasting period of a minimum of 12 h each night. Organic produce, wild-caught low mercury fish, and consumption of organic, pastured eggs and poultry, organic dairy, and 100% grass fed meats were encouraged. Participants were asked to eliminate alcohol, processed foods, and grains.
Sleep hygiene was supported and tracked using a Garmin Vivo Smart 4 to measure hours and quality of sleep per night, plus oxygen saturation. All participants with O2 saturation levels falling below 85% during sleep were referred to sleep medicine for further evaluation and treatment of potential sleep apnea.
Traumatic brain injury (TBI) treatments
Those with a history of traumatic brain injuries or stroke were provided oral supplemental phosphatidylcholine, phosphatidylserine, omega-3’s, methyl-B12, and intravenous nicotinamide adenine dinucleotide (i.e., NAD+).
Bio-identical hormone replacement and/or herbal hormonal support was initiated for participants with laboratory confirmed reduction in hormone levels. Thyroid hormone replacement was prescribed as clinically appropriate.
Watch a Facebook Live (via YouTube) discussion of an earlier, similar study, "74% Stabilize or Improve" (link)
Watch a Facebook Live virtual reunion with four of the original dementia reversal successes (link)
While Dr. Sandison's published study was conducted with "out-patient" clients of her private practice, she is also now overseeing the same program as an "in-house" residential option at her Solcere (Encinitas, CA), Marama 1 (Vista, CA) and what I was calling "Marama 2" but now has its own name, the Clear Mind Center (Witchita, KS) facilities. We all hope and expect this list to continue to grow. Something on the East coast, please? Or heck, even Michigan/Wisconsin!
More (video) links:
Heather with Dale Bredesen at the opening of Marama, ~2 minutes (link)
Heather with Nikki Romani, describing day-to-day at Marama, ~90 minutes (link)