Facebook Live: The Most Critical Practices for Reversing Cognitive Decline

During a Facebook Live, Apollo Health’s Chief Science Officer Dr. Dale Bredesen and Chief Health Liaison Julie Gregory discuss the most critical practices to reverse cognitive decline.

Some of the crucial practices that Dr. Bredesen and Julie discussed were how to promote energetics, vascular flow, oxygenation, and mitochondrial function. They shared strategies to enhance these mechanisms and more. They also discussed the diet and lifestyle strategies that are beneficial to brain health and overall well-being, including the KetoFLEX 12/3 diet, exercise, restorative sleep with adequate oxygenation, stress management, brain stimulation, detoxification, and targeted supplements.

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

Watch here:

Transcript:

Dr. Dale Bredesen: Dale Bredesen: Hi, everybody, I hope everyone is staying safe and healthy. And it’s great to have Julie G here today. Julie, welcome.

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Julie Gregory: Thank you, I’m always happy to be here.

Dale Bredesen: And we’re talking about a topic today that’s really close to my heart. Because, as we’ve talked about before, when someone has cognitive decline, hopefully we’re going to help improve them. But if not, of course, the outcome is not a good one. And this has been a problem, this is a huge issue. This is a global problem that is somewhere around 10 times the size of the COVID-19 pandemic, so many, many more people. The currently living Americans will die from Alzheimer’s than have died to date from COVID-19 unfortunately. So it’s something that we really need to focus on. And one of the most common things that I hear is, well, someone isn’t doing as well as we thought they might. And then when I start digging into it and saying, “Okay, well, have you gotten this person insulin sensitive? And are you checking their ketones? And what’s their oxygenation at night?” And all the things that contribute to that important network.

That was a good way to go when we could target things like bacteria. But now that we’re targeting human organisms with everything from type two diabetes, to hypertension, to Alzheimer’s disease and other neurodegenerative diseases, we need to be more complex in our evaluation and in our treatment. So we thought it would be really helpful if Julie and I would talk a little bit about what are the things that are most critical? I’m sure she’ll have some ideas that may be different from some of my ideas, I’m focused more on the mechanistic side, what is the science that actually drives the synapse formation, and what is driving you toward a pulling back, toward a synaptoclastic form of signaling, then translating that over to what Julie is doing with actually using this every day and interacting with many, many people who are using this very successfully. So let me just pull up as an example here. Let me just see if I can share the screen here. And let’s pull up a slide here. Okay. So let’s take a look at this.

Dale Bredesen: And so here are the goals, there are basically 10 major things as far as the science side, things that we want to focus on. So the first one is energetics. And I’ve put these roughly in order of priority. Now, of course, the priority is going to be different for each person, the priority is going to be somewhat different depending on what’s driving the problem. So, this is a rough order based on what we see most commonly. So the first order of business we all need is we all need to make sure that there’s enough energetic support for your brain. And that’s essentially four different things. You need to have something to burn, some fuel. This is why we like to see people getting into mild ketosis. You need to have the cerebral blood flow. So people with vascular disease are at increased risk of course, for cognitive decline. And of course, it used to be thought that vascular dementia and Alzheimer’s were very separate. But in fact, they are actually closely linked.

So vascular flow is critical. Third thing is you need the oxygenation, which is why so many people who have sleep apnea or other causes of reduced oxygenation at night are at increased risk for cognitive decline and that needs to be addressed. And then of course, mitochondrial function. We want to support your mitochondria. And so maybe Julie, if you could talk a little bit about how do you in your program address these four major issues for energetics to get the best energetics to support your brain and of course the many others on ApoE4.Info with whom you interact.

Julie Gregory: That’s a great question and I completely agree that these are the most important by far. So I get into ketosis every day by using a long daily fast, exercising, and by using the diet that we created the KetoFLEX 12/3 diet. So, that allows me to get to get to at least 1- 1.5 mM of beta-hydroxybutyrate a day. I also do daily aerobic exercise, so that increases my cerebral blood flow, also, helps with mitochondrial function, as does ketosis, and oxygenation. I do check that at night with my Apple watch. The series six watch does continuous pulse oximetry at night. So, I make sure that my oxygen is above 95%. And it pretty consistently is. If I have a cold or something I notice it goes down a little bit. But I’m actually getting night  readings almost the same as I am during the day.

Dale Bredesen: It’s a great point because with these various wearables you can really see changes with all these things that you do. I know one person told me that when she had drunk some alcohol late in the day her heart rate was higher than usual when she was sleeping. So you see these things tipping you off and of course this gets back to things like continuous glucose monitoring where you can really see the dips in it and the peaks that you may be missing if you’re not doing that. So energetics really important. And we have to remember ultimately, what the research has shown is that Alzheimer’s disease, what we call Alzheimer’s is essentially an insufficiency of a network within your brain. And unfortunately, it’s an insufficiency that’s often born of excess. That’s the problem. So we have people who are insulin resistant, have had lots of sweets over their lives, and now have insulin resistance and glycotoxicity, so they may have some extra weight.

And yet, what we’re asking them to do now is to keep the support and in fact enhance the support. But do it without all the simple carbs, so that you can actually get the best support. Because what happens is, they lose the ability for the glucose to support the brain because of the insulin resistance, and then they lose the ability of the alternative source which is the ketones because they are not able to produce ketones. If you have a high insulin you don’t produce ketones as well. So we need to get that metabolic flexibility that both Julie and I have talked about in the past, where you can actually do both. We need to restore both the ability to burn glucose and the ability to burn ketones to get the best outcomes. And this is often the beginning of the problem for people. They’re just not getting enough support for what is required of the brain, so no surprise that the brain then begins to involute if you can support a smaller brain which is what your brain will do.

So if you do the right thing, is you can support your large brain which is the goal here. And so then the second thing is, as I just mentioned we need to drive people into insulin sensitivity. There are somewhere around 80 million Americans. So it’s incredibly common who are insulin resistance. And actually a reporter I was working with recently said, “Well, I’m going to check myself.” And said, “Oh my gosh, my HOMA-IR is over two. Now, does that mean something? And I said, “Absolutely, that means you have some degree of insulin resistance. It doesn’t mean you have Alzheimer’s today, but it means that you have increased your risk.” So it’s very simple to check your HOMA-IR and of course we checked it on the recode reports but you can simply check this by looking at your fasting glucose and your fasting insulin. You multiply those two. So let’s say your fasting glucose was 100 and your fasting insulin was four that’s four times 100, so 400.

And then you divide by 405.45, so 405 basically. So you would have a HOMA-IR of right around 1.0. Now, that’s still too high of a fasting glucose, but you’re right on target with the insulin. So as your insulin, we see this all the time, people will have fasting glucose of only say 85. Okay, that’s not so bad, but their fasting insulin will be 10 or 12. So they’re working overtime to keep that glucose down as low as it is. And they really do have insulin resistance. So, it proceeds, it’s telling you that you’re on your way into a pre diabetic and ultimately diabetic state. So, very important. And I know Julie, you’ve looked at your fasting glucose and looked at your fasting insulin, and as we’ve written about, certainly you see people who are doing very well even much lower with fasting insulins of two or three at the time that they have fasting glucose of 70. And that’s even lower. But we worry as people start to jump up their insulins. And again, so Julie talk a little bit about if you would, how do you get yourself to be insulin sensitive?

Julie Gregory: Well, I do it by living the KetoFLEX 12/3 lifestyle, which is putting together our diet, fasting, and exercise. We were born metabolically flexible. We were born to use both glucose and fat as fuel. And in our Westernized modern society, we have an over-abundance of very processed refined food that’s high in glucose and starchy carbs, and we just eat too often. So, most Americans only burn glucose as fuel. And when you don’t practice getting into ketosis, your body loses the ability. And that’s what did happened to me. So, I’ve lived through all of this that you’re explaining. And it was terrifying. And so restoring my insulin sensitivity has been a huge foundational first step towards regaining my cognition.

Dale Bredesen: Yeah, this is so critical. And again, this is to get the best outcomes, we want to make sure that people have all of these things. And anyone who says, “Gee, I know I haven’t gotten as good of an outcome as I’d hoped,” please go over these things, and optimize them because they are the things that are both going to reverse cognitive decline and prevent cognitive decline. And the third one then is, trophic support. And there are really three different groups of molecules that are helpful here. Growth factors, things like nerve growth factor and BDNF. Again, BDNF is something we’ve talked about so much because of its increase with exercise, and it’s increased with things like whole coffee fruit extract, critical for specific synapses within the brain as is nerve growth factor. And then hormones.

This is why the HRT has been so helpful for so many people getting the right estradiol and testosterone and progesterone and pregnenolone, and right thyroid, and these things again, support that network within the brain that we’re interested in with cognitive decline. And then nutrients. And we talk a lot about things like vitamin D. So critical for best outcomes with COVID-19, so critical for reducing risk for Alzheimer’s disease and reversing decline. And again, the earlier, the better. And so you can do this of course, with a combination of a number of things. And of course, this is where you need to talk to your physician as far as any sort of hormones that you want to use. But Julie, how do you assure for example, best nutrients for trophic support for your brain?

Julie Gregory: Well, I do track with Cronometer, I also eat very nutrient dense diet. And I am using bioidentical hormone replacement therapy, also taking a very small amount of thyroid medication to optimize my thyroid function. So, trophic support is so critically important. Once again, this is something that I lived through, because I went into an abrupt state of menopause. And my cognition took a really hard hit. This is so important.

Dale Bredesen: That’s a great point. And you know, it’s been pointed out that compared to our distant ancestors, we actually eat fewer calories per day. And we’re not running around all the time on the savanna. And so if we’re going to do that, we actually have to get nutrient dense food to get the best outcomes. And another common nutrient that we’ve talked about which is deficient for most of us, is choline. And that is a critical precursor for acetylcholine which is the important neurotransmitter for memory and one that is decreased in Alzheimer’s disease brains. So, another critical one. And we often talk also about the fact that things like magnesium and zinc and iodine, most of us are deficient, these are the kind of the typical ones. Potassium is another typical one. So as you said, chronometer very, very helpful for tracking these things free, easily available. And then resolution of inflammation.

And it’s been pointed out by Professor Charles Serhan from Harvard, that it’s not just about an anti-inflammatory, you need to resolve ongoing inflammation first, and then prevent further inflammation. And of course, you have to remove the source. For many of us, we may have chronic mild inflammation, a common source is leaky gut, a common source is some mold within the home. A common source is some dental work that needs to be done. Some gingivitis, some periodontitis. All of these things are relatively common causes. And of course, metabolic syndrome includes inflammation. When you have this combination of poor lipid control, poor glycemic control, some obesity often, and some hypertension, so called metabolic syndrome, a very common cause of inflammation. So identifying it, and then removing it and for resolving it, there are resolvins, you can also take some high dose omega threes over a gram a day, you want.

Some people even use three or four grams, just to make sure that people get that resolution because the resolvins are essentially cousins of the omega threes. They are derived from the standard omega threes. And then again, preventing further inflammation, things like curcumin can be very helpful. Again, omega three is very helpful. Ginger very helpful. And of course, an anti-inflammatory diet, very helpful and an anti-inflammatory lifestyle. So, Julie, what are your favorite things to limit inflammation?

Julie Gregory: Well, of course, I avoid sugar, I avoid all simple carbs, I avoid conventional dairy, and I avoid grains. These are powerful sources of inflammation. I also take really good care of my teeth. I have them cleaned three times a year instead of twice a year. I do daily coconut oil pulling, I floss and brush multiple times throughout the day. I do take omega-3s, I take curcumin. and all of my standard inflammatory markers are fairly low. So, this isn’t a big issue for me now. I’m sure at different times in my life it has been an issue though.

Dale Bredesen: Yeah, it’s a good point and everyone can check their oral microbiome now very easily with something called OralDNA, which is from MyPerioPath, so good idea to find this. And there are now some probiotics, oral probiotics that weren’t available just a few years ago. And there are things like dental siding that can improve the oral microbiome. So really, the ability, the arsenal has gotten larger just in the last few years. And then treatment of pathogens. And this leads right into the next point, which is treatment of any pathogens and optimization of microbiomes. Your gut microbiome, your oral microbiome, your sinus microbiome. Again, we do have people where the problem is that they haven’t identified a specific pathogen, sometimes it’ll be borrelia from Lyme disease, or a related infection like the Babesia as we talked about earlier. Bartonella, Ehrlichia. It can be an ongoing infection, a chronic infection with various mold species.

Dale Bredesen: So that’s really a double whammy because they also often make toxins. Things like Stachybotrys, Penicillium, Aspergillus, Chaetomium, Molinia, those sorts of things can be a real problem. So, identifying and treating those, and then making sure that your microbiomes… Again, when I was in medical school, we talked about something as being infected or not infected. But now we understand that it’s really about the collection. It’s really about the microbiome. And having the good guys helps you not to have so many of the bad guys. So, Julie, what do you do about probiotics and prebiotics?

Julie Gregory: Well, funny, you should ask. We often say that the protocol is much more of a marathon than a sprint. I’m on mold journey right now. So, I am dealing with mold toxicity, and I’ve recently begun treatment. And mold as we know is going to colonize the gut, and it’s going to colonize the nasal passageways. So, I’m doing lots of new probiotics right now. I’ve started to take a couple of binders. And I’m also doing some essential oil sprays into my nose, it’s in a saline solution. And I’ve been instructed to put a few drops of essential oils and spray that into my nose. So, I’m treating both the gut and the nasal passageways. And luckily, I think because I’ve done all this other work beforehand, I’m tolerating the treatment really well. A lot of people when they begin to detox for mold get worse, and I’m feeling better every day.

So I feel very blessed. It’s going to be a long journey. But I have begun this part of it, and I feel so blessed that I know about this. And that I’m able to address it.

Dale Bredesen: You have such a good point. And you’ve got plenty of time till your 100 or so. And so we want to keep everybody sharp until they’re 100, we really do want to make Alzheimer’s a rare problem. And if everyone gets on appropriate prevention or earliest reversal, I think we have a very good chance of doing that. So yeah, I always encourage people don’t try to do everything at once. Just Julie, you’ve written about it be the tortoise, not the hare. And so just take these things one at a time. The other advantage there, is you can then see for each thing, whether it’s improved things, or whether it’s not improved things. And I think before we leave pathogens, we should mention the herpes family of viruses. So in fact, it’s interesting with all the different viruses we’re exposed to, it is that one family that is most associated with cognitive decline. And we always talk about the Taiwanese study that showed that people who addressed in midlife, their herpes and their lip actually had a markedly reduced rate or frequency and likelihood of developing dementia later in life.

So a good idea to target that we now know of course, that HHV6A, which is one that likely comes in through the sinuses, also it can be associated with cognitive decline, and there are others such as Epstein-Barr virus. So good idea to know where you stand with that as well. And then the tough one we always talk about is detoxification, and we’re exposed unfortunately, we’re all living to some extent in an Alzheimer’s soup. And if you’re out here in the California fires, you know that unfortunately, that air pollution from the fires is a risk factor for cognitive decline. If you’re living near freeways, if you’re in air pollution a lot, if you’ve got a lot of mercury around organics, things like glyphosate, and which so many of us are exposed to. And things like formaldehyde, benzene, toluene, things that we’re also finding are important in increasing risk for Parkinson’s, these organic toxins. So important to know about that, and again, you can get evaluated for those. And then biotoxins.

Julie, as you just mentioned, that typically these are toxins made by mold species, especially the big five that I mentioned earlier. And so getting rid of those, just reducing the exposure to those and beginning to get rid of them, so helpful. So, Julie, if you could talk a little bit about how are you removing your exposure to these bio toxins and flushing them out of your system?

Julie Gregory: Right. Well, in addition to the things I’ve already mentioned, I drink lots of clean filtered water every day. I have three or four servings of cruciferous vegetables every day. That’s very important as well. I do regular sauna bathing. I also do lymphatic stimulation by jumping on a mini trampoline. I’ve got a rebounder right here in my office. I also do dry brushing to stimulate lymphatic flow. I take NAC, I take glutathione now, especially now that I’m treating mold. And then all the things that I do to optimize my gut and my nasal passageways are all things that I’m doing to protect myself. And these are things that everybody can be doing. We’ve lived with mycotoxins forever. And it’s only recently that they’re making us sick, and they’re making us sick because we’re not doing all these other things that you’re talking about. So we need to strengthen ourselves so that we come to this fundamentally healthy, so that we can withstand these mycotoxins and not become incredibly ill when we are exposed because we will be exposed.

Dale Bredesen: Yeah, it’s a good point. And the bottom line is we are all living in a world that unfortunately, is relatively filled with toxins. Some of us deal with it better than others. And so kind of continuing to do the right things to get rid of these to minimize the exposure with things like HEPA filters and to help to remove them with things like sauna, sweating, Castile soap, things like that. There are so many things you can actually do to limit your toxicity burden, because that can be such a problem. And then stimulation. We’ve come to again and again and again back to the point that the people who are doing best and this is true for people, whether they have cognitive decline, or whether they have normal cognition, having some form of stimulation, we find light stimulation, things like Vielight, magnetic stimulation, and then of course, brain training, like good stuff and then that gets back to all the usual things that people talk about learning new languages, taking up a new instrument.

You can see here when you do that in isolation with nothing else, it may not be very helpful, but when you do it on the backbone of all these other critical things to optimize your neurochemistry, you get much better outcomes. And Julie, what are your favorite things when it comes to brain stimulation?

Julie Gregory: Well, I Love brain training. I use brainHQ because it has a lot of science behind it. I like to keep it fresh, so I also use Lumosity and Elevate. It’s also important to mention things like socializing.

Dale Bredesen: Yeah.

Julie Gregory: Challenging yourself to learn new things as we age. So many people as they get older, don’t embrace these new cognitive challenges. And I encourage everyone to stay engaged, learn a musical instrument, learn a new foreign language, learn new things, socialize, spend time with your friends, just expose yourself to a variety of stimuli every day.

Dale Bredesen: Yeah, great point. Okay. And then improving your adaptive immune system and reducing the innate. In other words, the inflammation. And this is something that is true both for COVID-19 and for Alzheimer’s disease. So in both of these cases, what we see is, we see that the innate system, the inflammatory, the nonspecific part, this is the older evolutionarily, part of the immune system, is chronically on. Now of course, with COVID-19, that can lead to what’s called cytokine storm and you can die. With Alzheimer’s, we have the same idea, but it’s cytokine drizzle, so it’s a slow thing that’s going on over years. But what we want to do, is we want the adaptive system to kick in, that’s the more specific, that’s the newer part of the nervous system. That’s the part that’s divided up into the humoral with the antibodies and the cellular with T-cells.

So that those parts now will actually kick in, recognize pathogens, specifically remove them, and now turn down the innate system. So you want to get that inflammation side off the adaptive system working. And that includes things like having appropriate omega threes, it includes things like having the right amount of zinc. Interestingly, just being low in zinc, when it’s been estimated that one billion people who live on Earth are deficient in zinc, takes that nice peak where you’re very clearly responding to one thing, and it just broadens it and flattens it. So now you’re responding to too many things, and you’re not getting that big response that you get when you have optimal zinc levels. So there are a number of things you can do. And of course, sleep is an issue. And then some people like to use a low dose naltrexone. And Julie, I know you’ve had some experience with low dose naltrexone, and could you talk a little bit about your experience with it?

Julie Gregory: Yeah, that was a game changer for me. I think like many ApoE4 carriers, my innate immune system is kind of chronically turned on.

Dale Bredesen: Yeah.

Julie Gregory: So, when I began low dose naltrexone, I felt really different almost right away. I just felt my whole body relax. And I began taking that several years ago so I’m somewhat  immune to the effect now. But I wouldn’t give it up for anything, because I know it’s still benefiting me. And I think something else that those of us with over-active innate immune systems, the ApoE4 carriers, I think we can’t overstate the benefit of mindfulness and meditation, just taking deep breathing breaks. All of this stuff helps us keep the inflammation down.

Dale Bredesen: Yeah. And then the next thing here is reducing amyloid. So now you can see when people talk about reducing amyloid with a drug as the only thing to do, you’re now actually reducing your immune systems response to various pathogens and other insults. So doing that alone actually doesn’t make a lot of sense. And of course, the studies have shown exactly that, people don’t get better. And we see a number of people who get worse. But on the other hand, when you’re doing the other things, you’re now removing the sources of why you need that amyloid, you can begin to reduce it. And of course, you can reduce it with things like curcumin, which binds actually quite tightly and helps to reduce amyloid burden. Ashwagandha also helps to reduce amyloid burden, as do a number of other things as well. And of course, there are drugs as well that will do this. I’m very interested to see whether these drugs down the road may be helpful for people who’ve actually done the right things, as opposed to just using them as monotherapies.

And then ultimately, we want to regenerate what’s been lost. By the time people have significant symptoms, as we’ve talked about, you’re relatively late in the course. And so we need to regenerate the synapses that are lost, and for some people, this means stem cells, but other things, again, getting the right hormones, getting the right trophic support. Very, very helpful for rebuilding synapses. And Julie, maybe you could talk a little bit about the things I know you’ve done a BHRT, and have you done the whole coffee fruit extract?

Julie Gregory: I tried that; it made my blood pressure too low.

Dale Bredesen: Oh, interesting.

Julie Gregory: Yeah, it was already on the low side, and it got critically low. So, I wasn’t able to tolerate that.

Dale Bredesen: Yeah. Very interesting. So, there’s a very interesting Professor Dr. Keqiang Ye at Emory University, I think Keqiang Ye has done some beautiful work with looking at … Again, at looking at the whole system that leads to ultimately the production of amyloid. This change in the signaling at the APP, which we look at is going back from a growth in maintenance mode into a protective downsizing mode. And he shows some very interesting relationships between BDNF, APP signaling, track B, which is what binds to BDNF. And these things… So these things are intimately related in terms of building and maintaining your synapses. All right. Well, let’s quickly go to this other piece here. So this is just seven areas that now we want to take the scientific side, and we want to translate this. And this is not the ending, this is the beginning here, because you may have to add things one place or another. But Julie, if you could just talk a little bit about these things, and the things that you feel are most important that you’ve seen again and again that have helped people you’ve interacted with?

Julie Gregory: Yeah, absolutely. So the B7 stands for the Bredesen seven. And as Dr. Bredesen pointed out, this is not a substitute for protocol, you still have to identify and address all of the contributors to your current state of cognition. But these are the foundational strategies that will help you do that. And I love this graphic because so many people think protocol is too complex, I can’t do it. But we show them this graphic and they say, “Oh, I could do this. This is doable.” So each of these strategies alone promotes neuroplasticity. And when you put them together, a powerful synergy occurs. Neuroplasticity is the ability of the brain to heal from trauma in response to stimuli. And researchers have found that our brains can grow new synaptic connections, they can grow new neurons throughout our lifespan. And these are the seven strategies that we use to help people heal.

And we’ve actually put them in order of priority. So, the most important is nutrition. And we’ve created a diet called the KetoFLEX 12/3 diet. I think our audience is probably pretty familiar with it. It’s a nutrient rich, whole foods diet, heavily plant based, we prioritize non-starchy vegetables from every color of the rainbow, preferably local, organic, and seasonal; an adequate amount of clean protein; with lots of healthy fats. And in the book that we wrote, “The End of Alzheimer’s Program,” I think we devoted maybe eight chapters to that. So if you want to take a deeper dive into the diet, please check that out.

Exercise is next. It’s extraordinarily important. We want everyone to try to get some daily aerobic exercise, we want you to work up to a minimum of 30 minutes a day. And we have a little sun in the graphic because we want you to preferably exercise outside. So many people enjoy taking a daily walk. Walk as fast as you can, where talking is a little bit difficult. I like to intersperse my walking with some running. We also want everyone to do some strength training three to four times per week. Strength training is turning out to be incredibly important to not only protect cognition, but to protect our muscles and our bones.

Next is sleep. Optimizing sleep is critically important. We want everyone to try to get seven to eight hours of quality restorative sleep. And as Dr. Bredesen mentioned, we want you to rule out sleep apnea with continuous pulse oximetry. I do it with my Apple Watch, you can use a Fitbit, there’s lots of other tools we recommend. One is called the EMAY Pulse Wireless Oximeter. I was just looking at this one. It’s a clip you put on your finger. It’s on sale right now for $44. And it’s best used for folks who are pretty sound sleepers who aren’t moving around a lot. But this will track your oxygenation throughout the night. And none of these tools by the way, require WiFi.

Stress management is critically important. We’re all exposed to stress and we can’t control that. We can control how we respond to it. So, we’d like to encourage people to use mindfulness, to use meditation. Take deep breathing breaks. If you’re new to this, you can use apps like Calm or Headspace to help you get familiar with it.

Next is brain stimulation. We talked a little bit about this with photobiomodulation, with brain training, we want you to constantly challenge yourself to keep learning, to keep your brain stimulated.

Detox is next. And we also spoke about this. There’s many, many strategies that we can use including drinking clean filtered water, eating cruciferous vegetables, engaging in regular sauna bathing, and so on.

And last but not least, is supplements. And it’s very important to take supplements that are based on your labs. So one of my biggest pet peeves is when somebody says, “Well, I read these supplements could be helpful, I’m going to take this handful of supplements.” Know where you stand. If your homocysteine is already at seven, you don’t need B12, you don’t need folate, you don’t need B6. So it’s really important to do the hard work of identify what your contributors are first, so you can create a targeted supplement regimen.

But I just love the B7, it just feels so accessible and so doable. And you’ll notice it’s on a base of mindfulness. And we did that on purpose because we noticed that people who practice these strategies in a mindful matter, do much better than people that let their brains go on autopilot. And mindfulness is simply the ability of being fully present in a non-judgmental manner. So, when I’m mindful, I can make very smart choices. And when my brain is on autopilot, I tend to make less healthy choices.

Dale Bredesen: Yeah, it’s a great point. And this is also I think, why health coaches can be so helpful to really kind of get in there and make sure that you’re doing these things again. So many people just say I do one thing. I took some supplements, why didn’t this work? We’re at the beginning here of being able to reverse cognitive decline. And so we’re continuing to improve things, and we need to do everything possible, because when you have the beginning of cognitive decline, you’re already saying there is a mismatch between the demand and the supply. We need to reduce that demand and increase that supply until we actually have got a working system, just as for any other network. So let me stop sharing there and let’s go to some questions here.

And so let’s see here. Okay. So, Tim says, “I have a salicylate allergy that gave me my micro bleeds.” I sorry to hear that. Cerebral glucose metabolism deregulation. Yeah. And this is the cerebral glucose metabolism change, we have a decreased utilization of glucose in the temporal and parietal regions characteristic of Alzheimer’s disease. So, yeah. Again, optimizing these things is so critical. And the deep sleep cycles you mentioned, and improper breathing, these are all critical contributors. So again, addressing those will be the most helpful thing.

And then Daly asks, “How do we measure our mitochondrial function?” Yeah, that’s a great point. Currently, it’s not easy to get a great look at mitochondrial function. Probably the best simple way without going to a specific exercise site that is looking at your burning of glucose and measuring your Co2. So, that’s one way to go. But the typical way is people look at organic acids. And your organic acids may increase if your mitochondria… You’re basically making more lactate and you’re not using this if your mitochondria are not doing well.

So, says here, “Can we exercise while positive for COVID?” What a great question. So, I went through this myself when I did the Delta back in July, and it took a couple of weeks for slowly, slowly, for my VO2 max to come back up. And so you just take it slowly. And hopefully if you’re doing all the right things, your COVID should not be with you for long. Hopefully you won’t have long haulers. People whose immune systems are in good shape typically don’t have problems with long haulers. You say, “I’m feeling better.” Okay, well, then I wouldn’t be afraid to work out. But again, I wouldn’t go from zero to 60. Biological systems were not meant to function in square waves. You don’t go in one day and then say, “Okay, I think I’ll do a marathon,” if you haven’t trained up to it. And the same thing here. So I would do a quarter of a workout, do a half a workout.

You say, “I’m 64 and 120 pounds,” but you don’t say how tall you are. So I’m not sure what that means. You said your father’s 97. That is a great sign. If your father is alive at 97, great. You say he has only mild MCI. Okay. Well, again, MCI is something we want to avoid. We want to get to people before that. The fact that this is mild that’s great. In our clinical trial 84% of people with MCI or early Alzheimer’s, showed improved scores. So yes, I would recommend do start to work out, but I wouldn’t push it too hard. And Julie, have you dealt with a lot of people with COVID-19? What have you recommended to them in terms of working out?

Julie Gregory: You know what? That really hasn’t ever come up for me before, but I saw you go through it. And I saw how badly you were impacted. And I saw your ability to exercise was probably the most profound symptom you had.

Dale Bredesen: Oh, it was. It was the worst symptom I had. When I first got the symptoms, the thing that hit me was I was out walking with the dog actually, and I suddenly felt like a train had been over me. You have no energy. And then the next couple days, I would lose my breath going up one flight of stairs. Oh my gosh, this is really striking. So, yeah, I agree. That is the worst symptom certainly I had, and many people have with COVID-19. So, Daly take it slowly, but you should get back to normal. And if not, you need to look into that further and we need to address that.

And then Tim says other brain involving things failing gallbladder type two diabetes, amyloid angiography. Wow! Yeah, so these are all critical and the good news is they can all be addressed. And certainly for vascular dementia, we talk a lot about things like EWOT, exercise with oxygen therapy and also the KAATSU bands, that Julie I know you’ve had very good results as have others with these KAATSU bands.

Sherry says, “My husband’s recent neuropsychology testing brought about a diagnosis of major degenerative disorder.” I’m sorry to hear that. “The doctor said his test did not point to Alzheimer’s, he’s insulin sensitive. Trying to digest this.” Okay, so this is critical then if this is not a major… If it’s a major degenerative disorder, but it’s not Alzheimer’s, what is it? Is it Frontotemporal dementia? Is it Lewy Body disease? Certainly the approach we’ve taken to Alzheimer’s has worked well for a number of people with Lewy body disease. And there are about one million Americans who have Lewy body dementia. That one is typically associated with toxic exposures. So, very important to find out what is this major degenerative disorder, they may want to do a PET scan for example, you can look at the patterns of those to see what this is, because there are certainly a number of them.

And then Missy says, “Diagnosed early-onset at age 45, I’ve had multiple mini strokes.” Okay, so there’s a big vascular component here. Okay, that’s important to know, because there are specific things you can do that. Doctor has her on pravastatin. Okay, following protocol trying to lower cholesterol, which is only borderline high. Not wanting me to come off of them. Yeah. So for statins, again, you have to be very careful. And so you want to do the things that would make it so that you wouldn’t need them, and then you may not need them. And we’ve had many people. We saw this in the clinical trial, where they were able to come off their antihypertensives, their anti-diabetes drugs and their statins. But again, you have to get yourself in the right situation, you don’t want to just cold turkey this. Please be very, very careful. So certainly, of course, listen to your doctor always. And so I would get the other things, you don’t want to obviously drop too low. Talk to him if you’re starting to see these low cholesterol spur. Total cholesterol of 110, 120, which we see all the time, not particularly good for the brain. And yes, you say here, “I’ve seen research, they’re not good for dementia patients.” They can be. And that can absolutely be an issue. So, let’s get everything … Let’s look important to look at your LDL particle number. And it’s also important to look at your inflammatory status. And I would recommend, as so many people will do, and we do this in the trials as well, to look at a calcium scan. And let’s see if your coronary arteries are doing well, that’s going to be important. On the other hand, if they’re not doing so well, you want to be very careful. Obviously, you’ve already mentioned some TIAs and some mini strokes. So you want to find out what’s driving that. There is something that’s not working there with the vessels. The other thing that we’ve seen is people with a hypercoagulable states and that can be picked up on genetic testing things like IntellxxDNA. So yes, please work with your doctor and get these things optimized for you and that’ll give you the best outcome. And remember about things like EWOT that could be helpful to you.

Next, here Denise says, “Any studies about the relation with hepatitis?” Yeah, really good point. And certainly hepatitis does increase risk for cognitive decline, not always related to Alzheimer’s of course, but anything that gives you systemic inflammation. Important to identify. The great news is that certainly with the common one, hepatitis C, there are excellent treatments for that, that weren’t available even 10 years ago. So, getting treated very, very helpful and they’re actually fairly quick to get good treatment.

And then Tim says, “Yeah, brain inflammation involve pathogen related to exposure to shingles.” Yeah, so another. Shingles is another herpes virus. This is called varicella zoster virus. And it is another herpes family member.

And then Sunset says, “Humming creates nitric oxide.” Yeah, absolutely. This has been pointed out by numerous people. Keep that nitric oxide up, and humming is one way to go. And other things like Neo40, and things like beetroot juice and things like that. Julie, what do you like to do to keep your nitric oxide in good shape?

Julie Gregory: Well, a lot of the vegetables that I eat help with that, but KAATSU does as well.

Dale Bredesen: Yeah.

Julie Gregory: It helps trap the nitric oxide in the muscles and tricks the muscles into thinking they’re working harder. So I think that’s another great way too.

Dale Bredesen: Yeah. Great point. And then Marge is saying, “What essential oil does Julie spray in her nose?”

Julie Gregory: Yeah, so there’s a physician called Dr. Jill Christa, C-H-R-I-S-T-A, who has a YouTube video about this. And she also has a book called “Break the Mold.” And the YouTube video tells you a little bit about the process, but I went ahead and bought the book to learn more. I’m using tea tree oil, and I think rosemary, but there’s other options. You can use cedar, you can use pine, and she’s got a whole list of them. And she has this whole ritual for how you do it. You can create this sterile solution of saline water; you can use distilled water with saline powder (a sterile salt solution that’s premixed) and then you put just a few drops of the essential oils. And you can eventually work your way up to like 30 drops. You can do two sprays in each nostril one to five times a day. And I’m tolerating it really well. So, whatever mold I have in my sinuses, I feel like I’m treating and addressing. But the book is called “Break the Mold”, if you want to learn more about it. It’s an excellent book too.

Dale Bredesen: Yeah. Great point. And then, let’s see, Jill is asking about the oximeter. And you mentioned … Of course, you describe this in the book as well. There are lots of different ways to do this. As you mentioned, you can use the Apple Watch. But you can also buy a little finger oximeter, you mentioned the one that you said now actually on sale for only $44 easy to do. So, lots of different ways to do it. You can also check this with your physician, you can actually have a sleep study if you prefer that, that will also give you information about how much time you’re spending in REM. There are certain things like alcohol that are as they say REM robbers, that actually reduce your REM sleep unfortunately. So, lots of ways to go. And Julie, do you have a favorite oximeter?

Julie Gregory: I just use the Apple Watch series six. But I was thrilled to see that one called the EMAY Wireless Pulse Oximeter that was already a great bargain at $99 but is $44 now. So if you or a loved one, are sound sleepers, it’s a great way to track your oxygenation throughout the night.

Dale Bredesen: Right. And then Lita asks, “What is photobiomodulation?” So there’s been work studies over the years, lots of research on this, looking at what actually happens with light stimulation of the brain. And people have used different forms and different frequencies and things like that. And even things like laser stimulation and defocused laser stimulation, there’s something out called Vielight, there are numerous other photobiomodulation apparatuses, so that you can do this. And what was found is that typically stimulation at a certain frequency around a gamma frequency around 40 hertz or so, seems to be the most helpful in terms of memory. And so that’s something to think about and so look at Vielight gamma as an example, they have an alpha and a gamma. And you may find this helpful. Again, when done on the backbone of all the other appropriate things to optimize neurochemistry. And do you have a favorite photobiomodulation approach?

Julie Gregory: I have just started experimenting with that. Dr. Marvin Berman had very generously sent me a helmet. And my experience has been mixed. And we’re guessing it might be because I’m going through my mold detox right now. And I had an odd symptom that occurred, my ears plugged up afterwards and I felt a little odd. So, although I felt like I was getting a little benefit, I felt like there was a negative side effect for me, so I’m Very excited to try that once I’ve got the mold toxicity behind me.

Dale Bredesen: Yeah, absolutely. And then Cathy’s saying, “Steam saunas versus dry saunas.” Basically, anything … And some people like that, the infrared is often suggested because you get some degree of skin penetration. The bottom line here is you want to sweat out these various toxins. And there’s some beautiful work by Dr. Stephen Genuis from Canada, looking at what are the things that are sweated out best if you look at the concentration in the sweat versus the concentration in the blood. And interestingly, he found that the biggest one was actually cadmium. So there’s a number of things that we do sweat out when we are sweating, and that’s why exercise, saunas, things like that can help with detox and then followed by non-toxic showers. And there’s a whole protocol that you can follow to do the best in terms of getting rid of this. Do you have a favorite approach that you take in terms of sweating, Julie?

Julie Gregory: Well, in addition to exercising every day, I do sauna bathe about three times a week, and I’ve got an infrared sauna called the Momentum 98, I think. It was one that was recommended by my functional medicine practitioner. I try to sauna bathe for about 20 minutes and then I followed that with a shower with Castile soap, which is non-toxic to get all the toxins off of me. And I feel really good. It’s very relaxing. I love to do it before bed.

Dale Bredesen: Yeah. And that was a very interesting study. It’s often quoted out of Finland, looking at people who did saunas, in this case when they were actually studying males, but likely this applies to all of us. And so what they were looking at people who did very few saunas per week versus intermediate versus most days, five or six times a week, and as you went to more in fact, the likelihood of developing dementia just went straight down. So it was actually pretty striking that people that were doing more saunas actually had less dementia, less risk for dementia.

And then Gail is asking about safety, but she’s not saying a safety about what. And I’m assuming she’s talking about some of the exercise here. She says she has a stationary bicycle. Fantastic, bicycle’s a great way to go.

Valerie’s asking here about … “Dementia affected my O2 driver.” Okay, great point because of course, various areas of the brain are affected. “Sleep apnea test shows I was 83% and even down to 70% without obstructive apnea.” That’s a good point. And there are people who have, for example, upper so called UARS, upper airway restriction syndrome.

And so checking with oximeter, yeah. Absolutely, you want to keep that oxygenation higher, because again, remember, if the oxygenation is lower, you can’t support the same size brain, you have to have these things working together. And that includes the oxygenation. So very glad you checked it. We hope that everybody will check. As we said, it’s easy to do and it’s important in terms of your risk for cognitive decline. And then Valerie’s asking about the COVID. Yeah, so I was COVID vaccinated… I was fully vaccinated and so was my wife, we went on a trip to UCLA, and unfortunately we… And we took precautions, the usual. We both developed the Delta variant.

Julie Gregory: Your first trip since COVID.

Dale Bredesen: Yes. Yeah. And so, unfortunately, Delta is relatively easy to get. And as we know, many people who’ve gotten Delta, including us, were fully vaccinated ahead of time. Now, and what they pointed out is once you’ve actually had it and recovered, you now have very good immunity from it better than with a vaccine. So, here’s hoping I took a trip to Florida recently to give some talks there and luckily came back and had no problem, didn’t develop COVID. I was very happy about that. So, yes. Everyone, please do the best possible and again, getting on the appropriate things optimizing using saying vitamin D, melatonin and all the things we’ve talked about, very, very helpful for getting you the best outcomes.

And then Jill’s asking about treating herpes. Yeah, so there’s beautiful work over the years from Professor Ruth Itzhaki, who’s shown the relationship between herpes viruses and Alzheimer’s disease.

It’s not the cause of every single person, but of course, but it is a contributor. And it does seem to be of all the different types of viruses, the herpes family is the one that comes up again and again and again. There’s some really interesting work from Dr. Ishu Lingappa, who showed years ago, that in fact, when viruses are assembled, they co-opt the assembly machinery that your cells use normally, to put your cellular constituents together. Things like your ribosome, as he calls it the machines that build the machines. And he can then look at each family of viruses and see what machine in the cells is used. And what he found was striking, was just really interesting is, the herpes family seems to use a machine that’s critical in neurons.

So it does. These seem to be related fundamentally to neurological disease. So, it’s not too surprising that in fact, you see more cognitive decline with herpes related problems, especially with these recurrent infections. So, we recommend things, yeah. Things like Valaciclovir. Absolutely very reasonable. It’s a very benign drug. I know. Dr. Anne Hathaway uses it frequently. And in the trial, pretty much everybody had a trial anywhere from two to six months. But some people will stay on this for years without problems. It depends on how often you’re having the outbreaks. And then Gale asking how do we detox? There’s hours and hours and hours of discussion about this. And please take a look at the end of Alzheimer’s program. So we go through detox in that as well.

And Justin asked, “Is it worth to test my father who has Alzheimer’s for a ApoE4, shows symptoms in his 80s after my mother died, had a difficult life living in World War Two. Is it true that lifestyle is predominant over genetics?” Yeah, so great point. And it’s certainly worth it. And the standard call is don’t check your APOE status, because there’s nothing you can do about it. And I think, Julie and 3500 people on her website with ApoE4.Info  are living examples of why it’s actually very helpful. There are things that are different in terms we’ve talked about hyperabsorption of fats, we’ve talked about differences in response to COVID. Of course, inflammation is a big difference. So, lots of different things. So Julie, when people ask you about, “Do I really need to check my APOE status?” What do you usually tell them?

Julie Gregory: I think, absolutely. In the future, we’re going to be testing infants shortly after they’re born. There’s so many things that I would have done differently had I known my son was an APoE4 carrier, and he is, but of course we didn’t find out until he was an adult. We’re more prone to a bad outcome from head injuries. We handle omega-3 differently. The list goes on and on. So we used to not know as much as we do now. But Justin, I encourage you to get yourself tested. And it wouldn’t hurt to test your dad as well.

Dale Bredesen: Yeah. And when people tell me that their mother or someone is in a late stage, I recommend, please everybody in the family get evaluated. Anyone certainly who is 40 or over. And if it’s not in your family, we recommend just test it when you get to be 45. But if this is in your family, you want to make sure that this is the last generation that’s affected. So it’s getting late here but let’s do the last couple really quickly. REM robbers, things like alcohol, “Why We Sleep”, great book, take a look at that by Matthew Walker to talk all about other ones. Things like benzodiazepines and other things that can reduce your REM. What is the sauna brand that you like? Lita is asking.

Julie Gregory: It’s called Momentum 98. And it’s low EMF, it was recommended by my functional medicine doctor, I love it.

Dale Bredesen: Right. Rhonda is asking about fasting insulin. She says, “Mine is under two.” So glad you asked this, Rhonda, because there are two possibilities here. If your insulin is low, but your glucose is also low, great, so you’re making enough. It’s not so much if it’s low as long as you’re controlling your glucose, great, you just may be very insulin sensitive, that’s good. The ones I worry about are the ones who have insulin of two, fasting glucose 110. So now what’s happening, is you’re not able to make that enough insulin. The people that I see do better when they have the high fasting insulins and then we just have to bring them down. When they have very low, and the glucose is high, we got to get those up. And it means that literally your pancreas, your beta islet cells have to now be able to make insulin where they’re struggling with that. And we do see people as they get better to be able to make more.

And then let’s see here. Tested positive for herpes virus. Never had an outbreak. Great point. If you’ve never had an outbreak, I would look at your titers and first of all see if you have any IGM, which indicates more active cells. If your titers are very low and it’s only to one herpes family member, I wouldn’t worry so much if you’ve never had an outbreak, but if they’re high, then I would be a little more concerned. And then let’s see. Kay, the last one here is asking about MCAS and Alzheimer’s. And so Julie, I know you’ve had tremendous exposure and discussion and we’ve had a discussion about this on numerous occasions. So mast cell activation and Alzheimer’s and I know you’ve discussed it with your group at ApoE4.Info. And you’ve got obviously, personal experience. So, what would you tell Kay?

Julie Gregory: Well, Kay, Dr. Neil Nathan has found that mast cell activation tends to accompany tick-borne illness and mold illness. And at the time I had mast cell activation, I didn’t know I had either of those two. But digging more deeply, I found out that I did. So, the mast cell activation may be the tip of the iceberg. So, I highly encourage you to start working with a really good functional medicine practitioner that’s well versed in… Neil Nathan and Richie Shoemaker, so that you can look into some of these other conditions to see what might be driving the mast cell activation.

Dale Bredesen: Yeah, great point. It really often is telling you it’s like the canary in the mines telling you something’s wrong, please find out and address it. So thanks to everyone for the absolutely great questions. Thank you, Julie, for your wonderful experience and discussion as always, and we look forward to seeing everyone next time. Please stay safe and healthy.

Julie Gregory: Yeah. Bye, bye.

Dale Bredesen: Bye, bye.