Apollo Health’s Chief Science Officer Dr. Dale Bredesen and Chief Health Liaison Julie Gregory were joined by Dr. Heather Sandison, founder of Marama, an assisted living facility designed as an immersive experience in the lifestyle proven to support cognitive health, for a Facebook Live session and they discussed how the Bredesen Protocol followed at their facility, truly sets up its residents for success in reversing cognitive decline.

Marama, by offering a non-toxic environment, a brain-healthy diet and encouraging the lifestyle changes needed to stop the progression of neurodegeneration, presents a stark contrast to traditional assisted living facilities that offer the standard of care that inevitably leads to further decline.

Dr. Sandison shared many compelling, hopeful stories of residents who, when placed in the facility, improved their cognitive scores, some dramatically. One poignant story focused on a completely non-verbal woman, in an advanced stage of Alzheimer’s, who eventually improved enough to begin socially engaging with the staff and communicating in full sentences.

We’ve included a complete recording of the session and a full transcript below for your convenience.

Watch here:


Dale Bredesen:

Hi, everybody. I hope everyone is staying safe during these crazy times with the new Delta variant, and another spiking cases, unfortunately. So, I hope everyone is staying safe. It’s my great pleasure and honor today to welcome Dr. Heather Sandison. Heather, welcome. Thank you so much for joining us.

Heather Sandison:

It’s such a pleasure to be here. Thank you for having me.

Dale Bredesen:

And also, Julie Gregory Julie, thank you, as always for joining us, and adding your expertise and experience. This is fantastic. So, we really have just fantastic group with both of these young ladies here today. And Dr. Sandison, you have done a number of things, I think, that are really worthy of note recently. Your Reverse Alzheimer’s Summit, absolutely fantastic.

Lots of people got a tremendous amount out of this, lots of new information, lots of new discussions. And then, of course, also, now it’s been what, over a year, I guess. Since really right about the beginning of the pandemic, you open the first, to my knowledge, the first assisted-living facility that is devoted to improving people’s lives using personalized protocols very much the way we do with ReCODE looking at people.

Heather Sandison:

Sure. So, I was very interested in health, less interested in disease, and how to just focus on disease. I wanted to do a type of medicine, practice a type of medicine that really supported people achieving their ultimate potential. We work with seniors, and seniors have so much to give us. They’re at the height of their wisdom and experience, and they have so much to download to the future generations.

And it’s really one of these troubling things to me, it’s an injustice is how I see it that we put so many of our seniors in front of TVs, and feed them cereal for breakfast, and then sandwiches for lunch, and then pasta for dinner, and then cake and cookies. And that is just the opposite of a brain-healthy diet. I basically saw you at a conference. I saw your talk and I thought, “Alzheimer’s, I’ve been told for so long, there’s nothing we can do about that. That sounds like a challenge.”

And also, this group of people that really need our support. As so many baby boomers are aging, there’s this groundswell of people who are approaching the time in their lives when Alzheimer’s is going to become a big problem. And we need solutions desperately. So, I of course, what’s confusing, “Wait, you’re telling me that we can reverse Alzheimer’s?” That there’s a solution to this when every neurologist tells my patients, every instructor I had had up until that point had said, “Don’t give people false hope, there’s really nothing we can do.”

So, I was a bit skeptical, but showed up at your training in September, I think it was the 2017. And immediately when I came back, there were patients who were excited to do this with me. And I was excited to do it, because I had gotten a lot of confidence from your training. So, immediately, I saw patients getting better. And when I saw that first patient get better, she went from a MoCA of two to a MoCA of seven in six weeks.

And I just thought to myself, how can I do anything else with my career other than dedicate myself to telling everyone that this is possible? Because if this woman is suffering unnecessarily, how many others are out there suffering and not just the patient, but also the caregivers, the spouses, the grandkids that don’t get to interact with that human in the way at their full capacity.

And so, since then, there has been a series of very fortunate events in my life that have allowed me to spread the word and join your team, just changing this narrative around dementia, and Alzheimer’s, and what’s possible.

Dale Bredesen:

Absolutely. And then, tell us a little bit about on your recent summit, the Reverse Alzheimer Summit, which I understand is going to air again, which is fantastic. So, people can take a look at that and I really encourage people to do that. Tell us the one thing that you learned from it from talking to all these various people, and then tell us what’s something you think that everyone should take away from your summit?

Heather Sandison:

Yeah. So, the one takeaway, the big takeaway is that this is possible. And now, we always want more data, we always want more science, that’s a very healthy criticism. It’s like we always want to be adding to what we know and feel more confident in what we know. And we know enough to start. So, don’t wait for more data to get started on this protocol.

Dr. Bredesen:

Your protocol is (what) you and I talk about this all the time, of course, we want to get it better, of course, we want to fine tune it, and understand more always. And yet, right now, we know more than enough, we have plenty of data, we’re seeing even more and more of it confirm what we’re doing that this is the vast majority of people who start on this protocol will reverse their dementia.

Heather Sandison:

Yes. I’m seeing it. You’ll hear me hesitating a little bit, because I want there to be more data. And yet, in my clinic, the vast majority of people who commit themselves to this process reverse dementia. They also reverse high blood pressure. They also reverse, they normalize blood pressure, they normalize blood sugar, they normalize autoimmune disease processes. So, the side effects of the Bredesen protocol of doing this approach is that your health outcomes overall get better. So, I want that to be really clear.

And I think that was very well articulated by lots of the speakers in the summit. Other things that I learned, reversing the trauma-associated dementias. So, Dr. Datis Kharrazian joined us, and he spoke a lot about traumatic brain injuries, and not only how they can lead to dementia, and high risk of dementia, but how do we address that.

And some exciting things, I think from the functional neurology perspective, that is not an area of expertise of mine. But that was really exciting for me to hear about. They’re talking to… I mean, of course, you and Kat about the study. That’s such new and exciting news. That’s so confirming, and also just really hopeful and inspiring. So, yeah, anybody who wants to check out the summit, it’s the Reverse Alzheimer’s Summit. And it’s relatively easy to find online.

Dale Bredesen:

Yeah, fantastic. And then, tell us a little bit about what I see, what really excited me the first time I heard about Marama. And of course, now that you’re getting data from it, and you’re getting results, this is so fantastic. It is a fundamental paradigm shift in the way we think about assisted living. Now, of course, in a perfect world, nobody would ever wait until they get to assisted living.

But unfortunately, of course, people do. We need it. We need a good assisted living. And the idea that you go in, and that you actually have some possibility of coming back out again, or of being very stable, and having interaction with your family members for many years to come, it’s a game changer. Very exciting. So, tell me, the first time you’ve got the concept in your mind, “Wait a minute, we need to do this, and I’m going to call it Marama.” When did that happen?

Heather Sandison:

Yeah. So, what happened was I had patients who were getting better. So, I started to develop a bit of a reputation in our community around reversing Alzheimer’s. And people were calling, or emailing, and asking where can I send my loved one? Many daughters, typically, are caring for their kids. They’ve got a career going on, and then their parent has dementia.

And they want to do the best thing that they possibly can for their parent. And yet, they’re already juggling so much that the thought of cooking all of these meals, motivating them to exercise, doing so much is just beyond their capacity. I totally can relate and get it. And so, when I started hearing this question come up, I wanted to be able to refer people to a place I felt confident in, and I looked around and there was just nothing.

There was no one really doing it. There were a couple places that said, “Oh, we can take you to your medicine doctor.” But they didn’t offer organic food. They didn’t offer a ketogenic diet. They weren’t saying that they had extra exercise that they were supporting or anything like that. It wasn’t as much of the lifestyle piece. And so, I thought, “Wait, well, how hard can this be?”

Come to find out, it’s quite a project, but it’s not impossible. And it is the way that things should be really, I will judge my success, I think over the course of my career. And how many assisted-living facilities can we get to come in our direction? I would love if every daughter, every son, every spouse who was looking considering assisted living for their loved one, or even for themselves, just ask, “Do you have a brain-healthy diet available?”

When you call an assisted-living facility, how much exercise does your typical resident get in a day? What sort of support do you have to get down to the gym? And those are the questions that I think will force that industry to come in our direction and be delivering the type of lifestyle that’s best for not only our brains, but for our health, for our health, generally, our hearts, our muscles, for everything as we age.

So, your question was the story of the concept. I went into work one day and I had a woman, a patient of mine who said, she’s in real estate, and she does some consulting for residential care facilities, and sells them, helps people buy and sell them. And she said, “You should go and give a talk at one of these facilities.” And I said, “No, no, there’s no way.”

By the time people get into those facilities, they’re not exercising, they’re not eating well, there’s really not much I can do because the foundations of the protocol are next to impossible in that environment. So, she walked out, and she was literally checking out at the front desk. And I got one of these emails saying, “Where can I send my loved one?”

I’ve got to send them to a place that can do the Bredesen protocol. And so, again, I got back online, is there any place doing it now? And couldn’t find anything. And a few hours later, a patient of mine who’s in commercial real estate, he came in, and he had a family member who was suffering with end-stage Alzheimer’s, was very aware of your work.

And I said, “Hey, what do you think about this idea?” He said, “Consider it funded. We’ll get you investors. I’ll make sure it happens.” And so, I went from concept to essentially funded in six hours.

Dale Bredesen:

Wow. Fantastic.

Heather Sandison:

That doesn’t happen to many people, I know. And so, it felt to me like this gift, this gift of ease through that part of the process was just basically, a sign that this is my life’s work, that I needed to do this.

Dale Bredesen:

Yeah. It’s a great point that, and we have something that just came through on loving your passion. Michael says he’s loving your incredible passion and hope. And I think this is what we all see. When we start to see people get better, or as Julia seen firsthand, when you’re actually feeling it in yourself.

And you’re actually getting objective improvements, it makes you realize, my gosh, there are millions of people out there who need this. Let’s get people on the right track. So, let’s talk about them. So, you went very quickly, you’ve got the statement. And by the way, how did you come up with the name, Marama?

Heather Sandison:

So, Marama means moonlight in the Maori language. And the way I see what Marama does is, we are the guides, guiding people through that darkness of that lack of memory towards the dawn, that reawakening of remembering who they are, remembering their … getting that short term memory back, getting that relationship that was lacking to those dark days of Alzheimer’s.

So, that idea of wisdom, wisdom as the other meaning of Marama in the Maori language. So, it means both moonlight and wisdom. And I felt like both of those just really represented what we were doing.

Dale Bredesen:

Absolutely, absolutely. So, then, let’s talk about, now, obviously, you opened this right before the pandemic hit, and so many businesses closed down during the pandemic. Unfortunately, so many things failed. So, it’s fantastic that you were able to keep this open, that you were able to keep things rolling. But tell us just an example or two of success stories of people who’ve actually come in and done very well.

Heather Sandison:

Yeah. So, thank you. You came to our grand opening, thank you so much. It was such a pleasure to have you there. It was, literally, I think ten days before the world shut down. We had a grand opening party. And then, the next week, we welcomed our first resident, and then the pandemic hit in early March. And so, it was quite a wild ride.

And really, a blessing because it allowed us to get a really tight-knit community, great staff, and really to hone our processes, and hone how we interact with the residents, the activities, everything just got really well dialed. And so, we’re so fortunate to have with great staff who have stuck in there with us through this pandemic. And we’ve seen some really incredible outcomes.

So, there’s one woman who has been on the Bredesen protocol for a long time. And she had a MoCA of zero. So, I spoke with her, her power of attorney, a friend of her supports her, and really beautifully. And she had called in December of 2019 right as we were taking over Marama, and getting it set up. And she said, “Hey, what do you think about having … I’ll call her “Cale” come?”

And I just said, “I’m not sure if I have the confidence because she has a MoCA of zero.” She was essentially nonverbal. I said, “I’m not really sure I want to save our 12 spots for people I have a lot of confidence with.” And so, she was very understanding and very kind. And then, after a year later, she said, “Would you reconsider?” And at that point, I was open to it because of the pandemic, a lot of things have shifted.

And so, we welcomed her in January and again, a MoCA of zero, essentially, nonverbal. And she has spelled her last name out loud. She now responds, I rubbed her arm one day, this was several months ago. I rubbed her arm one day; she tends to run cold quite thin. And she looked up at me and she said, “Oh, that feels good.” Just absolutely appropriate responses, complete sentences.

Not every single day, but more much more frequently than previously when she was essentially not seeking. She also read a staff member’s name tag one day. She said, “Christina,” and then looked up in her eyes. We all started crying. It was just one of those things we didn’t expect to see happen.

And when we see someone like her going from essentially nonverbal to reading a name tag to speaking in complete sentences, like when we see like my first patient that went from a MoCA of two to a MoCA of seven very quickly, when we see this for Kathleen over the course of several months, and what’s possible for people that don’t have neurodegeneration yet.

They don’t even ever have to get it. When we see these really progressed cases get even marginally better, it just opens this entire world of hope and opportunity to make Alzheimer’s a rare disease, like you say.

Dale Bredesen:

Yeah. And of course, what we’d love to see is if someone does get to the point of coming to an assisted-living facility, but they come in relatively early, and they actually get better and leave. Have you had anyone come in and go out yet?

Heather Sandison:

Yeah. So, we had a couple come in, and they both started, and then returned home. And they both started at about the same spot, about a MoCA of 2021. And he did much better. And there were some things that were missing around her case. She quickly got off of Donepezil, a little too quickly, in my opinion. She wasn’t totally committed to the diet.

They were leaving, and getting a pie, and some things. And so, she didn’t get quite the support I wish she had, but he did you know about the same amount of the protocol. We also found she had some thyroid imbalances, and some heavy metal toxicity that hadn’t been addressed or identified. She’s stabilized. So, she was on a very steep downhill. She’s stabilized, was no longer getting worse. And I think, I hope that at home, she’s getting even better. He did very, very well. It was essentially back at a MoCA of 2930.

Dale Bredesen:

Yeah, which is normal. Right. That’s fantastic. So, again, I think that’s the future. When people are coming to assisted living, and what you’re saying to them is what are your plans for after you leave here, that’s something that just doesn’t happen at a standard assisted-living facility. So, that’s a really fundamental change, very exciting.

And Julie, maybe, I know you’ve interacted with so many people because of the ApoE4.Info that you founded. And because of people in your extended family, people that you’re aware of, et cetera. What would it mean to have various people have access for various relatives and things to a place like Marama?

Julie Gregory:

It would mean everything. I’ve got a relative, my uncle that I’m caring for now who’s in assisted living. And essentially, once you get to that point, you have to get off of the Bredesen protocol. Because you lose the opportunity for exercise, the diet is horrible, very high in sugar and carbs. And it’s very sad to see. I found myself getting emotional as you were speaking about Marama, and your residence.

And it’s just so clear to me that this has to be the wave of the future. I don’t think we have to consider this to be assisted living. I think we need to get people sooner, and we have to consider it an immersive experience that people come to and leave. You just go there for a month to learn the Bredesen protocol, to get your ReCODE report, and go on with the rest of your life.

And I hope other practitioners, and philanthropists, and entrepreneurs are listening. Because the opportunity here is huge. Baby boomers are aging, Gen X is getting to that age, and we need to be there to help these people.

Dale Bredesen:

Yeah. It’s not just about assisted living. And prior to that, it’s about supported living, really making it so that people don’t get in. And so, that we have some of the people get into assisted living. And then, as you said, getting in early and coming back out. And others never having to do that.

Because it really is something where, as a neurologist, the stories I’ve always heard is the person was going downhill, they went into assisted living, and they just really accelerate. That’s what the story we always hear. They accelerated in their decline once they went into assisted living. So, this is huge. And again, it’s a real game changer. So, Heather, let’s talk about some of the challenges.

Obviously, you really had to do a lot to get this off the ground. You’ve had to deal with the pandemic. You’ve had to raise money. You had to get the real estate. You had to get the place, which is beautiful, by the way. For anyone who hasn’t visited there yet, it’s a beautiful sight to see. You had to get all the staff working together, you had to get optimization.

And again, not everyone is going to get better from just the basics. There are going to be people you really have to search for what is the rate-limiting step? What is the thing that’s not allowing this person to get better? And as we evolve, I think we see it better and better. What are the things that are actually going to do that? But here’s one example, you must have people who say, “Well, when I come to an assisted living, I want hot fudge sundaes because I’ve given up on everything. So, where’s my hot fudge sundae?”

Heather Sandison:

Yeah. So, this is something that I think should be really clear. And Julie, please jump in. What we see both clinically and at Marama is there’s a hump to get over. People are addicted to sugar, sometimes to alcohol, definitely to TV. And so, there’s a period of time where it’s pretty uncomfortable. They’re going through a detox.

And a gentleman there, new to Marama in the last few weeks right now, and he’s in it. And it’s hard. He’s grumpy, and he doesn’t … he’s telling his daughter he wants to go home, and we understand. And so, that’s one of the things that get better. So, oftentimes, in assisted living, staff is expecting that decline, it’s so normalized.

Whereas, at Marama, we really expect people to … that our residents will respond, and they’ll rejoin in, and having that encouragement to do it. And also, I think the advantage we have at Marama is that we’re not family. So, we don’t have the baggage of like, “Oh, she’s just saying that because of something that happened 20 years ago.”

Dale Bredesen:

Yeah, yeah. That’s a good point. All right, fantastic. Well, we’ve got some great questions here. So, let’s launch into some of these questions. Mindy is asking about are health coaches needed to support the protocols. Certainly, I think most of us have found that there are better results when you’ve got that coach. And to some extent, what you’ve created is coaching plus, plus, plus.

You’ve got all these people that are really helpful. But maybe you could each could say a word about what’s your experience seeing people who are interacting with coaches versus those who are not utilizing coaches? And Heather, start with you.

Heather Sandison:

Sure. Yeah. So, I think that I have two answers. One, I don’t want to overcomplicate things. So, if a coach has a simple, easy thing to do, just get started. And if there’s a coach that’s accessible, and there’s any way to get a coach onboard, yes, I see that the more comprehensive we can be, the more coaching we can do, the more again, it’s that encouragement, that support that really helps us get the best outcomes.

Dale Bredesen:

Yeah. And then, Julie, what’s your experience with health coaches?

Heather Sandison:

I totally agree. I think they can be a game changer. I’ve seen people struggle on the protocol. I recommend hooking up with a great health coach. It makes all the difference. Having someone hold your hand, and walk you through the process, slow things down, take you step by step by step, and just simplify, yet breaking everything down. I think, fabulous idea.

Dale Bredesen:

Yeah. Fantastic. Then, there’s a question here from Maria. She says, “Hello from Greenville, South Carolina, USA. I love this concept. Hope to see it replicated. It’s where I would love to be. And yeah, Heather, I hope you have 100 of these pretty soon because people need them all over the place.

And one of the things I really like is that people have waited, everything has been so backward in Alzheimer’s disease in the whole field, because we say to people don’t go in early because there’s nothing that can be done anyway. You’re just going to hope it’s not Alzheimer’s. And my argument is no, you want the opposite.

Get in as early as possible, preferably on prevention, or the earliest reversal. And when, by the way, anyone who comes into an assisted living, have all the children get on prevention so that you end it with that generation. But what I’d love to see is for people to come in early, get out early.

Coming in as early as possible, and getting out as early as possible, so that you can really change this, and it’ll be more of a place for people to get better, instead of a place for people just to get worse. So, I know you’ve said recently, Heather, that you’re looking at opening a second one. And do you have any plans yet about where that might be?”

Heather Sandison:

Yeah. So, what we’re going to do first, because the idea is that we will influence this entire industry, and there will be options for people all over the country, if not all over the world. So, the most common question that we get on the phone when someone calls is, “How come there isn’t one in my city? I don’t want my mom moving across the country. I want it down the street,” which I completely understand.

And so, we are hoping to grow the next facility. What we’ve decided to do is get as close to the current facility as possible. And as a professional, as a scientist, what I’m so excited about is to do some AV testing. So, essentially, really hone our practice, it’ll be more of like an expansion, so that we understand how to open a second facility, so that then the next one can be further away and work out the kinks of that process.

But I think you’ll be able to appreciate that I can’t wait to see is it better for everyone to be on keto seven days a week, or four days a week? Is it better for them to be doing the Vielight once a day, or twice a day, or some other? It’s one other, of the other red-light therapy is better than this one? I think there’s a lot of opportunity when we have these relatively controlled environments to optimize what we’re doing on the lifestyle path. And so, that I geek out and nerd out about the opportunity to do that with the second facility.

Dale Bredesen:

Yeah. And I think once we see that this is not a monotherapy disease, now, immediately, the question becomes, how do you keep evolving it? How do you make these incremental improvements? And ultimately, big improvements, like, “Okay, what can we do?” And this is why we’ve talked about all these different things. Is it critical to have plasmalogens.

And is it critical to have stimulation like Vielight? And is it critical to have these other things? What is helping the most? There’s a question here from Raia who says, delighted, you’re part of a spectacular team on the west coast. Thank you, Rajia, for that. Miguel asks, “Hello from Lima, Peru, is it advisable to take magnesium threonate? Is there any contraindication?”

Certainly, the work from Guosong Liu out of MIT, he developed this because of their observation in culture experiments of improvements in the electrophysiology with magnesium. So, they were simply trying to develop a way to get this into your brain. And is this something, Heather, that you use with your patients or not?

Heather Sandison:

Very often, we’re using magnesium threonate, usually, in the evenings to help to calm the system. It can help the bedtime routine. We often use magnesium threonate, and sometimes with taurine, glycine, some of the other amino acids, theanine, that can help to calm the system. Particularly, if someone has a manifestation of dementia that includes some anxiety or difficulty sleeping.

Dale Bredesen:

Right. And I know Julie, you are taking some magnesium threonate yourself. Is that true?

Julie Gregory:

No. I actually ran an N=1 experiment, and I didn’t like the way it made me feel.

Dale Bredesen:

So, what magnesium do you take?

Julie Gregory:

Yeah. I take magnesium glycinate in the evening, very relaxing.

Dale Bredesen:

And so, that comes-

Julie Gregory:

I’m sorry, I was going to say, in the ApoE4.Info community, we always encourage people to run their own experiments, and see how specific supplements make them feel.

Dale Bredesen:

And that’s something that we all see again, and again, and again, everyone is a little different. And please, so it’s really helpful if you can try it yourself, see how it works for you, get an idea, and then adjust accordingly. That’s why I always tell people keep optimizing, because there’s so much that can be done. And be honest about it.

If you’re having some backsliding and I know Julie, you have a great example yourself. When you were backsliding a few years ago, and I kept telling you, “Yeah, you need to get these additional things tested.” And you wrote about it in the new book. So, for everyone, we encourage them, please keep optimizing things, and find the things that are right for you.

And then, let’s see here. Let’s see, Kana asks, “Is the protocol, would it be benefit for people who have FTD?” This is a great point. And I do think we are slowly reorganizing the way, these are all diseases, Frontotemporal dementia, Alzheimer’s, Lewy Body, PSP, CBD, all these different degenerative diseases are currently based on neuro pathology.

When you look under the microscope, and you see amyloid, plaques, and tau tangles, you call that Alzheimer’s disease. If you see Lewy bodies and they’re generalized, you call that Lewy body dementia, and on and on. But as the neuro pathologists have pointed out to us, in fact, in about 70% of the cases of Alzheimer’s, you also see some Lewy bodies, and you also see some TDP-43, which is another aggregated protein.

So, I think we’re changing the way we think about these. Having a diagnosis, Alzheimer’s, pre-Alzheimer’s, Lewy Body, et cetera, really tells us what is the system that is failing. And therefore, what are the likely causes of that? With Alzheimer’s, we know we should be looking for specific pathogens. We know that there are recurrent ones.

We know looking for toxins. We know if it’s Lewy Body, you better be looking very carefully at toxins because those are the common things, not always, but those are the common things that cause this. Now, with Frontotemporal dementia, it has been different. That is essentially a cousin of ALS.

People will often have frontotemporal with a little ALS or ALS with a little Frontotemporal dementia as Dr. Bruce Miller pointed out years ago. And so, this one, we don’t have a lot of data, and I don’t know, Heather, have you had anyone with Frontotemporal dementia come to your assisted-living facility yet?

Heather Sandison:

Not yet Lewy Body we’ve seen. And we are depending on the severity because Lewy Body comes so often with hallucinations, and personality changes, and sometimes more violent tendencies, that I would love to have a facility that had the capacity to welcome those types of individuals at that degree. I know because I’ve seen it clinically, I know that we can help.

And yet, we have to … right now, we’re really making sure that the community, and that social engagement is safe for everyone, and is really positive for everyone. So, in the future, I’d love to have at Marama where there’s 100 beds, and we’ve got people across the spectrum with lots of different diagnoses. And we can see what’s really possible when we support health.

When it comes to diagnoses, we’re putting a name, and really describing, like you said, the pathology. And what’s so much more interesting to me, is how you describe dementias in the causal pathways. Because that’s really where the steps are actionable. And so, I am a naturopathic doctor, I often will see patients who haven’t even seen a neurologist yet.

So, they don’t have a label on themselves, because they’re afraid of that label, quite frankly. And so, I really care less about that label than I do about the causal pathologies, and how we can maximize, optimize cellular function, and create healing.

Dale Bredesen:

Absolutely, yeah. And I think we’re all starting to look at how we redefine these things from pathological to etiological. So, that we can really look at the different, is this mostly vascular? Looking at the root causes is such a huge issue. And I should mention that it’s critical, earlier the better. We hear all the time, someone has oh, they just have mild cognitive impairment, I sent them home, asked him to come back in a year.

Well, mild cognitive impairment is the third out of the four stages. And so, it’s very important to get things started as early as possible. Really, mild cognitive impairment should be called a late-stage Alzheimer’s disease. It’s up later, form of the disease or time. And yet still, we see people with MCI getting cognitive decline reverse all the time now.

If you do the right things, if you look for the right things, evaluate the right things. And I think that we’re going to see this more and more. This says, it’s from Michael, Dr. Sandison, I’m absolutely loving your incredible passion and hope. Thank you, the world needs to finally know hope in Alzheimer’s here. Fantastic … Huma says, “Just started training to be a ReCODE 2.0 certified physician.”

Fantastic. Thank you so much. We need people all over the world. And I’ve asked this all the time. How can I find someone who does this? And again, helpful to train because we do have, this is very much like surgery. There are people who do it very well, and who are seeing people get better all the time. There are people who are not doing it so well and are not seeing so many people get better.

And so, we’d like to make it so that we all get as many people better as possible, because this is such a huge issue. If we fail, then people are headed, unfortunately, for a terminal illness. So, we’d like to get in, make sure that as many people as possible are helped. Let’s see. And then, Maria says, “Amazing, I love your excitement and passion, Dr. Heather.”

Miguel says, “Do you know any similar place in South America? My problem is the language, I speak Spanish.” Okay. And so, there certainly are some people trained in South America. And if you go on, you can see the map of where people are. But yes, we need more people in South America, no question about it. Let’s see here.

Keila says, “It’s like a new kind of rehab of the brain.” Absolutely. As I said, it’s a paradigm shift. This is something new. And I think everybody needs to embrace it and grow it. Maria says, “I love that idea. Supporting living is what is needed.” Absolutely. And then, Sheila says, “What about using CBD during the transition?” And Heather, did you ever use CBD during the transition, this period that you mentioned?

Heather Sandison:

Yeah. So, I have some great organic sources of CBD through some colleagues of ours who’ve created a couple of lines. And so, I will use that for my patients. Now, at Marama, I want to be clear, it’s a residential care facility. So, what we encourage is our residents, they have already established with a ReCODE trained provider, a ReCODE doctor. And that they maintain that relationship with their doctor. So, if you’re in Texas, and you have mild cognitive impairment, connect with a ReCODE doctor there. And then, what we do at Marama is we do all the hard work for you.

So, we do all of the implementation of that ReCODE doctors, is whatever they put on their treatment plan. So, if it’s exercise, an organic ketogenic diet. If it’s all the supplements, maybe some medications, and something like CBD would be on that list from the ReCODE doctor. So, yes, I use it clinically. At Marama, our role is not so much telling people what to do, but helping them with the implementation.

Dale Bredesen:

Yeah, it’s a great point. Maria says it’s a total change of mentality. As we are told, there’s no hope, no cure, and just, “Enjoy life while we can.” To some people, that equates to just giving up on a healthy lifestyle and opportunity to indulge in lots of sweet and high-saturated fats. Yeah. And I think this is, again, there’s so much in the field of dementia that has been backward.

We focus on monotherapies. We tell people to wait. We tell people not to look at their ApoE status. We tell people to go ahead and have a bunch of hot fudge sundaes because there’s nothing you can do anyway. All of these things, I think, are outdated concepts. It’s a little bit like you’re in your boat, and you’re going for the falls, and you just give up, and let your boat go over the falls, or you can flip it around and realize, wait a minute, your boat can actually go a lot faster than you realize.

You can pull away from those falls, and you don’t ever have to go over them. So, there’s absolutely so much, and again, the earlier you turn the boat around, the easier it is to avoid the falls. Dijon asks, “Love the Alzheimer summit that Heather did, any idea when that will be offered again? So, Heather, when will this be offered again?”

Heather Sandison:

So, that is available all the time. The free offering will happen again next June. We’ll update it. We’re going to have lots of great new data available. And we’re working on a clinical trial in my office. We have connected with other phenomenal speakers, and it was just a little bit too late to get them in this year. I have a lot of projects going on this year.

And so, I can’t wait next June, Alzheimer’s Awareness Month, we will relaunch that summit for free. Until then, you are welcome to go to the, something like that. It should pop up if you Google it, and especially associated with my name. You’ll find it, and then you can pay for it if you’d like.

Dale Bredesen:

Fantastic. And then, Karen asks, “How old do you have to be to resident at Marama?”

Heather Sandison:

Great question. So, we are licensed by the State of California as a residential care facility for the elderly. So, the majority of our residents are 65 and older. We can get exceptions and have had residents who are in their earlier 60s. And that’s okay. But predominantly, our licensure requires that most of our residents are over 65.

Dale Bredesen:

Yeah. And when I was training way back in the 80s, in neurology, we never saw people in their 40s and 50s, who developed Alzheimer’s. We saw people mostly in their 70s, 80s, 90s. Now, we understand that this gets started 20 years before, it’s really a disease of your 40s, 50s and 60s that just gets diagnosed 20 years later.

And the other thing is one of the most common things we see now is 52-year-old person who’s got Alzheimer’s and couldn’t believe, oh, my gosh, and it turns out, they have all sorts of toxic exposure. And there was a nice paper from the epidemiologist just a couple of years ago showing that indeed, if you look at the Alzheimer’s as a whole, you are seeing this bump in early onset Alzheimer’s. People in their 50s, and we even see people in their 40s. So, it really has changed. And so, what do you recommend?

Heather Sandison:

Well, that’s when we see the best results. Based on someone who’s younger in their 40s, 50s and early 60s, when we can catch it then, we get consistently, that turns around. They still have capacity to make these changes. They’ve got energy. They’re not also, as stuck in their ways is how I see it. And also, I think there’s more openness to these higher-fat diets.

When people in their 80s and 90s, they really heard for years that they needed to avoid fat, avoid salt, avoid a lot of the things that are so important for brain health. And so, it takes a lot. I’ve heard you use the analogy of the big tanker ship headed fast in one direction. And I think that it’s not only the disease process, but it’s this mentality is just stuck going in this direction.

And it takes a while to turn it around and convince people that it’s okay to eat these good high-nutrient dense foods that we were told for a long time were bad for us. So, 40s, 50s, 60s, it’s a privilege when I get to see someone at that age, who’s identified that they have an issue. And it’s just so much fun. In three months, we’re seeing things totally turned around. Their brain fog is gone. Their MoCA scores are up. It’s such a pleasure.

Dale Bredesen:

Yeah. Absolutely fantastic to see. And this is why this recent book that for survivors of Alzheimer’s and Julie wrote a beautiful story as one of the seven survivors. It’s just so exciting to see people thriving again, so wonderful. And let’s see, and Calico says, “So grateful for all three of you sharing this with the world.” Yeah, thank you, Calico.

We’d like to see; millions of people would like to see a real drop in the global burden of dementia. That is the goal for all of us. Janet says, “Thank you for doing this. What’s the monthly cost for Marama?” So, do you mind sharing that with everybody?

Heather Sandison:

No, not at all. So, the monthly cost includes 24-hour caregivers who are well trained, well versed in redirection, in encouragement. One of our staff members is a personal trainer and a life coach. And so, we have this really phenomenal staff, 24-hour care, it includes a non-toxic environment. So, we’ve got organic mattresses, all organic cotton linens are all 100% organic food.

I’ve had this conversation with the chef only once. Are you sure we have to get this organic? Yes, 100% of the time, that is non-negotiable. All the animal products are grass fed organic, very well sourced from regenerative farms. And then, so we have pillars is the way I think of it. So, the first pillar is the non-toxic environment.

The second pillar is it includes the detergents, the cleaning products, everything in the house. We also have air filters running in very high quality, the GC Multi from IQAir is the one that we have. We use Biogen products. We use Branch Basics. So, we use really high-quality products that are not adding toxins to the system.

And then, we have the organic ketogenic diet, which includes three meals a day, breakfast, lunch, and dinner. And then, snacks in between both of those meals, and a three-hour fast, a minimum three-hour fast between dinner and bedtime. And our staff knows that if somebody asks for that midnight snack, we offer them tea.

So, everyone’s really well versed in making sure people stay on the protocol, even when there’s a tendency to deviate. And then, the third pillar is the activities. So, included in the cost is the daily, they’re getting in, we call it the Casida it’s like a gym set up where we have contrast oxygen therapy, and there’s a rower, a bike, there’s saunas, if your doctor has approved that, and considers it safe, and also effective for what’s going on in your system.

And then, there’s also the red-light therapies, including the Vielight. There’s a bio mat, and I love these things. So, I keep collecting them. And then, as long as I feel like they’re safe and effective, then end up at the sauna. And then, the fourth pillar is the staff, which I’ve mentioned that they are so well trained to be encouraging, empathetic, calming, and really keep people engaged in the process so they’re getting the most out of the whole protocol.

So, the base price is $12,000 per month, this often gets covered by long-term care insurance. So, we have, I think, at least half, if not more of the residents at Marama right now have long-term care insurance covering, if not all the majority of their stay there. And we even have residents who have found that it’s less expensive for them to be at Marama than to hire a chef and a caregiver 24 hours a day and to buy all the devices.

And so, it certainly, if our goal, like you mentioned, is that people would invest in coming to Marama, they would learn the routine. We offer cooking classes, yoga classes, meditation, every day, we do the Kirtan Kriya meditation that has literature supporting that it reverses Alzheimer’s.

So, we do all of these things. And residents learn the rhythm so that then they can take it home with them. So, we see it as an investment in not having to go into a traditional memory care facility, which is upwards of $10,000 a month, and you’re just going downhill.

Dale Bredesen:

Right. It’s a good point. And just for comparison, so the numbers show that on average, in the United States, a person with Alzheimer’s will spend $350,000 leading up to death, unfortunately. And that’s just going downhill. Now, if you go on Aduhelm, that’s an extra $100,000 per year. That’s unfortunate. You’re still going downhill, but you might be going downhill slightly slower.

So, the problem is this is unfortunately, an expensive disease. So, the idea of investing something upfront and certainly, if you come back out of Marama, you may be spending $1,000 a month to get on the right things, to do all the right things instead of $12,000. So, I think the whole idea of having a better lifestyle, having better interactions, all these sorts of things, these are lifesaving.

And so, this is really actually, quite a good investment. And yes, if you can have your long-term care support, that is fantastic if they’ll take care of it. So, that’s great. Then, Christine is saying, “This is great. Thank you. Is a lectin-free diet important for brain health?” And so, I also have a talk coming up with Dr. Gundry. We all look at lectins often as being things, especially for people who have autoimmune issues. What’s your sense about the critical nature of lectin-free diets?

Heather Sandison:

So, my thoughts are, if you are struggling to get the diet that you’re on to work for you, what I think clinically is basically, switching your diet is one of the best things you can do. And if a lectin-free diet appeals to you, or you have some sense that that is the right diet for you, then absolutely, I think that it’s worth a shot. Sometimes people switching from keto to a vegan diet is really, really helpful.

Now, a vegan diet is going to include probably a lot of lectins. But switching back, I don’t know if you guys have seen this as well. But it’s that change in diet. When we think the ketogenic diet, paleo diets, a lot of these diets, they’re ancestral. And when I think about ancestral diets, one of the most consistent things about an ancestral diet was inconsistency.

It was in our diets changed with the seasons, that there wasn’t always sugar available the way it is now. There also wasn’t always a bunch of fat and meat available. So, that shift in diet is really what ICB most effective. And then, finding the right diet for you, I don’t subscribe to that there’s one diet that’s the best for everyone. It’s really about the trial, and error, and also the season of your life.

So, kids will do better on one diet, and then that same individual as they grow up, maybe will do better on a different diet. So, I think that openness to trying different things. And certainly, I appreciate Dr. Gundry’s work, I’m very impressed by him, really appreciate what he’s contributed to this conversation around ApoE4, and around lectins. And just opening our eyes to the different things that we can experiment with, and try out, and see what fits best.

Dale Bredesen:

Yeah. And seeing his own patients get better, I think there’s nothing better than actually seeing human beings. When we had the lab for 30 years, it was always about could we see fewer cells die? Or could we see my Alzheimer’s get better or … get better? That sort of thing. But there was always, yeah, but does this have anything to do with the human being?

There’s supposedly a billion people on earth who are low in zinc, iodine, potassium, choline, we’ve talked about a lot. And choline, especially important for people with cognitive decline, because acetylcholine is such a critical neurotransmitter for memory. And so, I’m sure you look at multiple metals in your patients who are coming in, and make sure that you optimize those.

And what do you do about people who are already underweight? What do you do about the people who come in, and you’re telling them, well, we don’t want you to have a late snack? But they have a BMI of 18 or 17-and-a-half, and they’re really frail. And you’re concerned that trying to push them into ketosis might actually hurt them.

Heather Sandison:

Yeah. This is such a great question. And certainly, something that I have gone back and forth on. Actually, Dr. Gundry was the one who gave me a bit of confidence that underweight in our society is probably a healthy weight. And so, of course, we are concerned about osteoporosis, and fractures, and that kind of thing. But on the Bredesen protocol, we have a lot of support for that.

Minerals, Vitamin D, the hormone, certainly estrogen is very, very supportive of the bones, and then the exercise. And so, as long as we… we typically see a bit of a drop in weight, particularly people have excess weight to lose. Now, sometimes there’s a reshuffling when you get on a ketogenic diet, but this is not a low-calorie diet. So, don’t expect weight loss.

I think a lot of people are afraid of weight loss, especially in the elderly, because they’ve seen someone get sick with cancer, or they’re wasting away. That is the opposite of what we’re doing here. What we see when people mostly get on a good, robust diet that is full of calories, good hype, lots of avocado, and lots of coconut oil, if that’s appropriate for you. This is a really good nutrient-dense foods, and they’re getting the exercise, and they have the hormonal support, they actually start to fill out with muscle.

Dale Bredesen:

Yeah. And I think that this is something we have to all remember. If you actually look at the research, you come to the conclusion looking at the various signaling pathways for APP itself or the amyloid precursor protein. This is fundamentally an insufficiency. It is an insufficiency in a neuro plastic network. And you’ve got the supply and the demand are not matching up.

You got to get that supply up and that demand down. And so, really, we want people to have more, more support. The problem is they get there by having the wrong kind of support, too much of this simple carbs. And so, then many of them get there with obesity, with hypertension, with too much body fat, and so forth, and so on. Let’s see, Dell says something very interesting here.

Says, “I’ve seen this stuff work on someone who is 18 years into dementia, and in their late 90s, they reversed most of their symptoms. What about applying this to later stages?” And I think you did a beautiful job talking about Cale, at the very beginning, and the fact that again, the fact that she had a MoCA zero. I remember when she first started a number of years ago, and her MoCA was never terribly high.

She came in at relatively late stages. But she had a very strong and committed group working with her, which is fantastic. And then, let’s see, Rajai says, can’t remember a line I wrote at the top of the paragraph, forgetting people, went to the Mayo Clinic, told to come back in a year because my brain is supposedly normal with a MoCA score of 25.

Yeah. And then, they said it may be due to the age. And I was on a Dementia Alliance about a week ago. And one of the experts in dementia, one of the well-known experts said, “Everybody has SCI. As you age, it’s just normal.” And I have to say, I disagree with that. There are a lot of sharp people, if you’re doing the right things, you shouldn’t be getting subjective cognitive impairment.

And so, what I would say to Rajai, please, don’t wait, get on an appropriate, and optimized program. MoCA score of 25, even people who are scoring 28, you’ve missed a couple, you don’t have to do that. Most people, there are a lot of people were 28 that’s already MCI. Even though it’s considered normal down to 26. Twenty-five, nobody considers normal.

So, definitely, you’ve got some MCI going on. And please, find out what’s causing this, look into this, get someone who is well versed at this, like Dr. Sandison, find out what’s causing it. And there are over 2,000 physicians that have been trained all around the world. So, please get on that. And then, Karen says read that ApoE4 carriers hyper absorb fat, so is a keto diet recommended for them?

This is a great point. And Julie, you’ve spoken to this eloquently so many times, including a beautiful write-up in the book and in the guides. So, could you talk about ApoE4? You’re a homozygote, and of course, you interact with people. Many, many homozygotes and heterozygous, there are about seven million Americans who are homozygous, about 75 million who are heterozygous. And the feeling is none of them should ever get this illness virtually, if they just do the right thing. So, please talk about fat absorption and ApoE4.

Julie Gregory:

Right. So, ApoE4 carriers do tend to hyper absorb dietary fat. That being said, we need those ketones more than other ApoE carriers, because ApoE4 carriers have a reduction in cerebral glucose usage in the brain. So, we can use glucose effectively, even though there’s plenty of glucose in the system. And ketones are a perfect alternative fuel. Three ways to create ketones, you can do it through a long fast, you can do it through exercise, and you can do it with a low-carb diet.

But ApoE4 carriers do much better with monounsaturated, polyunsaturated fats like avocados, extra virgin olive oil, nut seeds, fatty fish, things like that. In the ApoE4.Info community, we see those that do tend to eat saturated fat also tend to have some negative lipid profiles. So, always do the advanced lipids to see where you stand. But in general, those principles work very well for ApoE4 carriers.

Dale Bredesen:

Yeah. That’s a great point. And this comes back to you, Heather. Do you ever use exogenous ketones when people are just getting started just to get that energy back?

Heather Sandison:

We often do. Yes. So, often, especially if someone is struggling to get into ketosis, that can give them a bump, and a little bit of confidence once they see that they can measure them. And also, if someone is having cravings, that can be more satisfying, and can really help them through that hump I was describing when things get a little bit challenging.

Dale Bredesen:

Okay. And then, final question, which is … because I know we’re running out of time here. But final question would be, what do you do for mitochondrial support? This is such a huge issue. And one of the things that’s always bothered me, and scientifically is why is it that when our brains try to protect themselves, and that’s really what you’re doing, you’re going from a growth in maintenance mode to a protective mode?

Just as we did with our country when we had COVID-19 pandemic, you’re now pulling back, and you’re entering a recession, which is what our brains are doing with Alzheimer’s. And yet, why is it that our brains in trying to protect themselves, and making this a beta, didn’t get something that didn’t affect the synapses so much? Why so much downsizing as protection?

And I think part of the reason is because anything that is going to be antimicrobial, as we learned from the antibiotics, often damages mitochondria. And sure enough, you’ve got damaged mitochondria in many people with cognitive decline. So, what do you like to use for mitochondrial support?

Heather Sandison:

So, an easy thing, relatively easy, passive, it goes around the gut is the red-light therapy. So, red-light therapy helps with some of the biochemistry associated in a non-nutraceutical way. And so, that can be very effective. And we’ve seen, and especially in the more advanced stages, we’ve seen people put on a Vielight, or get in front of the Joovv light and be very different.

The mood improves, even we had a Lewy Body resident who came in, and she would sometimes talk like a child. She would revert to childlike behavior. We would put the Joovv light on in front of her, and the Vielight on her head, and 20 minutes later, she was back to her baseline. So, we’ve seen improvements. And I don’t know necessarily if that was mitochondrial function.

But certainly, that’s part of the explanation that’s presented by Michael Hamblin out of Harvard, who’s done a lot of the research around that. And then, the contrast oxygen therapy also helps with mitochondrial function. Those are some things, I have a lot of patients, I work closely with Neil Nathan who I know you know well, and I see a lot of very sensitive patients.

And so, when we start talking about mitochondrial function, typically, we talk about the nutrients. Your basics are CoQ10, carnitine, riboflavin, ribose. And there’s a lot of products out there. K-PAX is one from integrative therapeutics, MitoCORE is another from that, I think, Ortho Molecular. And then, Qualia Life product is a very sophisticated mitochondrial support product.

And I know that life extension has one, every supplement company that’s worth their weight has some sort of mitochondrial support product. What I think the big question is, is often for people who can’t tolerate all the pills, what do I do then? And that goes back to a really good healthy, clean diet. Exercise is supportive of mitochondria. And then, we can get into some of these devices like the light therapies and the contrast oxygen.

Dale Bredesen:

Yeah, fantastic. All right. Well, this has just been fantastic. Thank you so much. Dr. Sandison. Thank you so much, Julie, as always. This is really a world changing, a complete change in the whole idea of assisted living that you’re pioneering. So, thank you so much for your fantastic work.

And we look forward to greater outcomes, all the things coming in the future, and all the people coming through your assisted living. Thank you for setting up Marama. Thank you for your passion and commitment, both of you, and look forward to a world with less Alzheimer’s. Thanks. We’ll take the rest of the questions online. And again, thanks, everyone. Take care.

Julie Gregory: Bye-bye.

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