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Details of How To Reverse Alzheimer’s Disease: Rational Wellness Podcast 215

Dr. Kat Toups speaks about the Details of How to Reverse Alzheimer’s Disease with Dr. Ben Weitz.

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Podcast Highlights

7:42  Metabolic factors, including fasting glucose, insulin, and Hemoglobin A1C are all important factors in preventing and reversing Alzheimer’s Disease.  Rather than having specific targets for these lab values, Dr. Toups’ goal with her patients is to see how much she can optimize these factors.  Ideally for nutrient levels, we want them in the middle range, but for metabolic factors, we generally want them lower. We know that high blood sugar is destructive to the blood vessels, to the end organs and that has sort of long been known as a factor for dementia and for Alzheimer’s.  They had all the patients follow a ketogenic diet for the benefits of ketones for the brain and the patients were in ketosis for the majority of the time.  This definitely helped to manage the blood sugar and insulin levels.  It is also important to measure insulin to see how hard the patients are working to get their blood sugar to where it’s at. If they are eating too many carbs, their insulin level may end up too high. There are also patient who have had high blood sugar so long that their pancreatic beta cells are not making enough insulin.

16:11  Lipids. It is important to have good blood flow to the brain, so monitoring advanced lipids is important for Alzheimer’s patients.  Most of the patients in the trial saw improvements in their lipids related to the types of carbs and fats that they were eating, as well as due to the exercise, their improved sleep, and the focus on getting them into a parasympathetic or meditative state. Taking statin medications can be a problem for these patients because they can lower cholesterol too much and this can be bad for the brain and it can even cause dementia.  Cholesterol is need for the brain, for the myelin sheath that surrounds nerves, for the phospholipid layers around the cells, and for neuron formation.  Cholesterol is also a precursor for your hormones like testosterone, estrogen, DHEA, and pregnenolone.  Statins can drive the cholesterol level too low, such as down to the 130s.  That is too low to support brain and hormonal health.  Dr. Toups discussed a patient that she had who came to her in his early 90s and his main risk factors for Alzheimer’s were that he had been taking statins for a long time and had cholesterol in the 130s for all that time. He also was taking Finasteride for an enlarged prostate, which can reduce testosterone levels, which can also impact brain health.

22:54  There are a number of medications that can negatively affect brain health, including Anti-cholinergic medicines (which are drugs that block the action of acetylcholine) like some of the older antihistamines like Benadryl and some of the OTC sleep medications and drugs that treat urinary incontinence, antidepressants, antihistamines, some of the nausea drugs, and psych drugs in general. 

25:18  Nutrient status is important for brain health, so Dr. Toups and her colleagues used the NutraEval from Genova, which measures all the vitamins, minerals, antioxidants, fatty acids, amino acids, and even looks at some heavy metals.  She finds that many dementia patients are low in vitamin D and B12.  For vitamin D, Dr. Toups likes to see a level of 50-80 ng/mL.  If your vitamin D level is less than 30, your risk for dementia is increased by 75%.  For most of us, just getting out in the sun a bit is not enough. You still need vitamin D supplementation.  We really should be measuring nutrients levels, including in children because many children are deficient and we need to support our brains and our bodies with the essential ingredients needed.  Unfortunately we grow fruits and vegetables in soil that has been overgrown and is often deficient such as in minerals like zinc and magnesium, as well as having so much toxicity like arsenic and lead and various other chemicals.  All these nutrients like vitamin D are crucial for the formation of our mitochondria, which make the ATP, which is the cellular energy that makes our brain and our bodies work.  Giving your body the right nutrients is like putting gas in your car so that it can go.

32:40  Hormones are also important for brain health.  We need hormones for optimal brain health.  They did a study at Stanford with women who were taking hormones and those that stopped had a decline in cognitive function and had shrinkage of their brains.  There are receptors in the brain for hormones and the brain even makes it own hormones like estrogen.  Dr. Toups has seen testosterone function as an antidepressant for women.  Pregnenolone, which is sort of the master sex hormone, has been studied for dementia and it is an independent risk factor for dementia if it is low.

 

 

 



Dr. Kat Toups is a Functional Medicine Psychiatrist in Walnut Creek, California and the owner/Medical Director of Bay Area Research Institute, a clinical trials research center in Lafayette, CA.  She served as the principal investigator on over 100 clinical trials for 12 years for failed drugs for Alzheimer’s Disease and she is one of the treating doctors and authors of the paper reporting on the new study showing that a Functional Medicine approach could reverse Alzheimer’s Disease: Precision Medicine Approach to Alzheimer’s Disease: Successful Proof-of-Concept Trial. 

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me. And let’s jump into the podcast.

Hello Rational Wellness Podcast listeners. Our topic for today is Alzheimer’s disease with Dr. Pat Toups. Alzheimer’s disease, as most of you know, is a degenerative brain disease, and it accounts for between 60% and 80% of cases of patients with dementia. Patients with Alzheimer’s disease develop difficulties with memory, language, problem solving, and other cognitive skills that affect the person’s ability to perform everyday tasks. So hallmark pathologies of Alzheimer’s are the progressive accumulation of beta amyloid protein that forms plaques surrounding neurons in the brain and twisted strands known as tangles of tau protein inside of neurons. In 2018, near an estimated 5.7 million Americans with Alzheimer’s, and this number is rapidly increasing.  According to one estimate, Alzheimer’s disease is the third leading cause of death in the US. The conventional medical approach to treatment for Alzheimer’s has so far failed. With over 400 failed drug trials, and let’s witness the latest drug that was approved a few weeks ago for this condition, a drug for which I cannot pronounce, but it’s adilumumab.

Dr. Toups:           Aducanumab. I had to practice it quite a bit myself.

Dr. Weitz:            And this is a drug that does not make anyone better. I repeat that. It does not make anybody better. But it merely slows the rate of decline in a percentage of patients, according to how you interpret the data, and the cost is only $56,000 a year. The approval of this drug was so controversial that three of the doctors on the advisory panel resigned over this drug’s approval by the FDA. Because the original report that came out showed there was no clinical benefit at all, despite the fact that the drug helped to clear out amyloid plaque. Yet there’s a study that was just completed and a paper reporting results that has now been published on a pre-print server called Precision Medicine Approach to Alzheimer’s Disease: Successful Proof-of-Concept. And this trial utilized Dr. Dale Bredesen’s protocols with Dr. Pat Toups, one of the treating doctors and the principal author of the paper reporting the results.

In this trial, unlike that drug, patients got better. In 84% of patients with early Alzheimer’s disease, or mild cognitive impairment, showed improvement and reversal of their condition. Dr. Kat Toups, Functional Wellness Psychiatrist at Bay Area Wellness in Walnut Creek, California. And she’s the organizer and administrator for Bay Area Functional Medicine Group since 2012. And at one point, Dr. Toups was the only medical director of Bay Area Research Institute, a clinical trials research center in Lafayette, California. After serving as the principal investigator on over a hundred clinical trials, including 20 failed trials for Alzheimer’s drugs, she realized that the elusive cure for brain and psychiatric illness was not going to be found in a bill. She certified in functional medicine by the Institute of Functional Medicine. Dr. Toups, thank you so much for joining us today.

Dr. Toups:           Thank you. I’m really excited to be here.

Dr. Weitz:            Good, good, good. So I’d like to draw, as you know, I recently got to speak to Dr. Dale Bredesen and we talked a lot about the parameters of this trial, but I’m hoping today that we can really drill down into some of the details of how the patients were managed. But before we get into the details, since it appears to me that you employed a functional medicine approach, why was the approach in this study referred to as a precision medicine approach, as opposed to a functional medicine approach?

Dr. Toups:           That’s a great question. And I actually wondered the same thing. So that was [crosstalk 00:04:56]-

Dr. Weitz:            Is that a more acceptable term?  Will that not get you banned from Facebook or something.

Dr. Toups:           Well, I believe that is kind of precisely what Dr. Bredesen was thinking when he put that title on it. So it is a functional medicine approach. A functional medicine approach is a precision medicine approach, but somehow in the vernacular of general medicine, precision medicine is kind of a new term that’s out there, and I guess more acceptable. I don’t know. I mean, functional medicine has its detractors and its supporters. But it’s the same thing. This is a Functional Medicine approach. I call what I do a functional medicine approach to dementia. So it’s the same thing.

Dr. Weitz:            Good, good, good. So I noticed one of those parts of the program was that patients are assigned specific categories as to the type of conditions that play a role in a causation or a triggering of their Alzheimer’s. How are those categories derived? Are patients put in those categories as a result of history, or is it after the lab tested?

Dr. Toups:           Well, perhaps a little of both. But they’re really pretty artificial and arbitrary. I don’t personally use them in my head the way I think about things. So I think when Dale Bredesen was first conceptualizing these ideas, and he was coming from the bench research side of things, not as a clinician, it’s sort of even more amazing to me how he started to put all this together, not being a clinician. But he was trying to conceptualize what are all the different factors that are affecting the brain. And then, so he kind of came up with those categories, but they’re really arbitrary. And you’d be hard pressed to find someone that only met one of those categories. Most people are a combination of two or three of those categories. So they’re kind of just a general way to maybe talk about things.  So when we say, “Oh, this is a type three patient.” It’s kind of referring to the CIRS patients, the chronic infectious, the mold and the Lyme and the viruses and the infections. But do any of them just have that? No. They’re going to all have some components of inflammatory or metabolic or hormonal or nutritional. So it’s just more a way to make sure you’re kind of in your head, and your investigation’s ticking all those boxes when you’re doing your workup to make sure you investigate all those things. That’s kind of how I think that it’s the most useful.

Dr. Weitz:            Okay. So one of the categories is patients with metabolic blood sugar issues. Right?

Dr. Toups:           Right, right.

Dr. Weitz:            So let’s start by talking about that factor. So what are the, when you’re working with a patient, what are the targets you like to see on lab testing for fasting glucose, insulin, hemoglobin, A1C?

Dr. Toups:           Yeah. I don’t think in terms of what is a specific target, but how good can I get it? And that’s going to vary from person to person. So if someone’s starting out in a hemoglobin A1C of 5.8 or 5.9, well, how good can I get it? I mean, somebody who’s starting lower, they may be able to come into the force, but it’s such a fascinating thing. In this study I have never seen people’s metabolic and inflammatory parameters shift this quickly. And I’m pretty aggressive as a functional person. I always feel like people come to me are so sick and you’re just racing the clock. They’ve been sick for so long. And if they have dementia, you definitely need to get them fixed as quickly as possible because you can’t afford to lose any more brain every day.

Doing full court press in this study, we only had nine months to move the needle. And so we had to test, and I already did this anyway in my practice, like with dementia, I say, “Just test everything upfront.” Some people say, “Well, I’ll work on this. And then they’ll get a little better, then I’ll test that.” And they kind of do it sequentially, but I don’t think that works with this really, there’s so many factors. And if you test everything at once and well, then you have your treatment plan. You have your treatment targets, right? You can figure out, “Okay-“

Dr. Weitz:            In your office, all of them got the testing right off the bat?

Dr. Toups:           Correct. And that was part of the protocol. So we all did the same testing. We came up with a list of tests of all the various things we wanted to look at. There were three investigators, three different locations, and we all did the same testing. And after that is where we diverged. So the treatment plan was individualized based on what was found in that testing. We then used our functional medicine skills and backgrounds to target that.  So some of the patients, I mean, I saw people with A1Cs of 5.8 or 5.9, come down to 5.2 or 5.3 in three months. Seriously.  That was pretty amazing to me how quickly you could shift the needle. People that had high levels of inflammation that plummeted very, very quickly.  So there were a lot of extra benefits of the study besides the cognitive benefits.  But of course, as you’re pointing out, these metabolic parameters are all, whatever happens in the heart and the blood vessels is happening in the brain. So they’re intricately connected there and we have to address those.

Dr. Weitz:            For those who are listening to this podcast, if you’re not really familiar with a Functional Medicine approach, they might not sort of understand what we’re talking about when we talk about some of these lab values.  Because the conventional approach is anything below 5.4 or 5.5 or 5.6, depending on the lab

Dr. Toups:           5.6.

Dr. Weitz:            … you use on your hemoglobin A1C is normal.  It’s not a question of lower. And so in functional medicine, we typically have there’s normal, and normal is just the average person being tested. And then there’s an optimal level. So we’re trying to get people optimal health, not just normal health.

Dr. Toups:           Right. Ideally for things like nutrients, we want them in the middle of the range.  We don’t want them at the top, we don’t want them at the bottom.  We want to be like Goldilocks in that sweet spot. Though with hemoglobin A1C, I guess there could potentially be a too low value, but I haven’t seen it. If you get down to 4.8, 4.9, I think that’s about as good as it gets. The hemoglobin A1C is such a perfect example. My husband had a hemoglobin A1C of 5.6 and it made me crazy.  I’m like, “No, you’re eating too many carbs, blah, blah, blah.”  And he sees an endocrinologist.  He said, “My endocrinologist says it’s fine.”  I don’t treat my husband, of course, but I can nag him a little.  And then all of a sudden, of course, 5.6 is the cutoff.  Above that is called pre-diabetes.  Then all of a sudden, one year it jumped up from 5.6 to 5.8.  That’s when his doctor finally said, “You need to do something.”

And of course he did what his doctor said, not what his wife said.  And he brought it down a few points.  But yeah, so certainly, the blood sugar control, we know high blood sugar is destructive to the blood vessels, to the end organs. That has sort of long been known as a factor for dementia and for Alzheimer’s. So it definitely critical to do that. And in our study, we had everybody do a ketogenic diet. And that was for the benefits of the ketones on the brain and it was a requirement for the study. And there’s many debates. We could have a whole session on whether long-term ketosis is the right thing, the wrong thing. But for the purposes of this study, they all were in ketosis for a majority of the time. And definitely to see the benefits of that for the blood sugar was quite phenomenal. And maybe I’ll jump to another question for you because there’s so many questions about like, “Well, what about the lipids?” You’re putting people-

Dr. Weitz:            You know what? I just want to get a little more detail. Let’s talk about the importance of insulin also as a factor, because typically that’s not tested by normal physicians. The glucose is included in part of the typical panel and that’s all they really pay attention to, but insulin is really important. Maybe you could explain the importance of why we want to measure insulin and why that’s important.

Dr. Toups:           Well, the insulin, we can see it too high or too low. If you’re eating too much sugar and you’re still turning out insulin, you’re going to see the insulin come too high. And sometimes it’s useful instead of looking at a fasting blood sugar to look at a postprandial blood sugar. So after you eat lunch, go and get your lab and see how high is your blood sugar spiking then, instead of the fasting. Because that’s going to be a function of, are you making enough insulin to bring it down? And how high is it getting with what you’re eating? It kind of tells us various things. Some people have had high blood sugars so long that they’re burning out their pancreatic beta cells and they’re not making enough insulin. So the insulin resistance people are putting out lots and lots of insulin and the cells are no longer listening. So it kind of goes both directions with the insulin.

Dr. Weitz:            You can have two patients with, let’s say, they have a fasting blood sugar of 90 or 95, it’s higher than it should be. But if one patient has an insulin level of six, then it’s less of a concern than if your insulin level’s 30. Because a patient who’s insulin level is 30, is working really hard just to get it down to 90. And so that’s more of a problem.

Dr. Toups:           Well, and the whole blood sugar thing comes into play with trying to get into ketosis. Because if your blood sugar’s already high, with ketosis, we’re trying to stop feeding the body the carbs and the sugar as fuel, and shift into burning the fat as fuel, which means you’ve got to get those sugars down. So people with a higher blood sugars have a harder time getting into ketosis. It takes them longer to do that, but there is eventually a metabolic shift. And once they get into ketosis, then it pretty much stays that way.

Dr. Weitz:            Well, let’s get into lipids now. And lipids are important because we have to have a good blood flow to the brain. And so if your arteries are clogged with plaques, then you’re not going to get good blood flow to the brain.

Dr. Toups:           Definitely. That’s yet another factor and so important. So we did advanced lipid panels on all of our patients. We use the Cardio IQ at Quest. It gets into all of the lipid particles and worked on various things with that. I had one patient come in on a statin and was able to get off of that statin. His cardiologist gave him the blessing to get off of the statin because as a consequence of what we did in the study, his lipids came down so beautifully that he no longer needed a statin. I think there were two of them like that. It shows the effect. With the lipids, it’s obviously what you’re eating and the types of fats that you’re eating and the types of carbs and anything inflammatory that you’re eating is going to have a factor on your lipids.

But so do the other factors. So does your exercise, so does your sleep, so does being in a parasympathetic or meditative state. All of these things are things that were components of the study. So they just all came together. And then we saw all these metabolic benefits in the study. We haven’t really even gotten into writing that up, but at some point we need to track what happened. How many people lower their A1Cs, how many people lowered their lipids, how many people lowered their CRP. Well, I can tell you in my 10 patients, a lot of them did. So all of those things come together. It’s not just one intervention that you can do. It’s the stuff that we, our foundational right for health of all kinds of systems.

Dr. Weitz:            So I noticed in your exclusion criteria for this study, you just mentioned statins, but you didn’t really want patients involved in the study if they were taking statins or blood thinners or psychoactive medications like antidepressants. Maybe you can talk about the significance of those.

Dr. Toups:           I think we allowed stable antidepressants. It’s been a while since we first enrolled people now. But the idea is that any unstable medical conditions are not right for a study. Because you could have unintended consequences. And so you kind of want to have people that are stable on their medicines. The idea of no statins, and I think we ended up allowing people if they were going to be able to discontinue those statins. Our concern is that the statins can lower the cholesterol too much. And the cholesterol is so important for the brain. Our brain is like 60% fat, right? You think of that spongy gray material as fat. And so if you don’t have enough fat, then you can’t support your brain. You need it for the myelin sheaths around the nerves, you need it for the phospholipid layers around the cells and your neurons.  And then the cholesterol is a precursor to all your hormones. And I know we’re going to say a little bit about that at some point, but cholesterol turns into testosterone, estrogen. DHEA actually goes directly into pregnenolone, which is so important for the brain. So when people’s cholesterols get too low, it can be actually literally a cause of dementia. I call it iatrogenic dementia. I’ve seen people on statins where they drive their cholesterol down in the 130s. Well, that’s not high enough to support your brain and your hormones. So those were some of our concerns about the statins.

Dr. Weitz:            Now what do you say to conventional wisdom?  Information that seems to be common in the cardiology world, that statins do not negatively affect brain function.

Dr. Toups:           Cardiologists don’t look at brain function. They’re not looking at it. And I had a great case that I started out earlier saying most people with cognitive decline, it’s multiple factors. But I had a gentleman that came to me in his early 90s, and unfortunately it was too late to really move the needle for him. But this gentleman was practicing medicine up until 85, on his second medical career. He was boarded in one area of medicine. He retired at 65. And then he went in and did emergency medicine and got boarded in that and did that for another 15 years. So this guy was doing well. His brain was good. He wasn’t toxic. I mean, to be able to function that long and that well, everything was working well for him. But in his case, there were two factors that I turned up. And one was, he was on the super dose of the statins.  So his cholesterol was in the 130s for a long, long time. And the other thing was that he had an enlarged prostate and he was put on Finasteride for the prostate. And Finasteride can be deadly for the brain. It’s known when it’s given to younger men that can use it for hair loss that they can suddenly develop very severe psychiatric problems. Sometimes even psychosis. There’s been a higher rate of suicide with it. But for our purposes in the older men, it’s blocking the conversion of testosterone to dihydrotestosterone. And it’s blocking the conversion of, I think, pregnenolone to allopregnanolone, or maybe it goes the other way around. I forget right now. But in blocking the testosterone effects, what is that doing to the brain? And we have receptors in our brain for all of these hormones. And interestingly, in his case, his wife confirmed to me that the minute he started on that medicine, their sex life was over.

His sexual functioning was not good anymore. So it was definitely affecting his testosterone system. And for him, I mean, he wasn’t high in toxins his lipids weren’t bad, his blood sugar wasn’t bad. The big thing for him, he didn’t have infections. For him, it was the low cholesterol and a lack of testosterone. I think that it’s pretty clear that these factors are just, we have to watch what we’re taking and what are the downstream consequences. You take a medicine, most of them aren’t affecting just one thing. Our body is interconnected.

Dr. Weitz:            What are some of the other medicines that would be on the top of the list of medications that might negatively affect brain function? Besides you mentioned statins and…

Dr. Toups:           Yeah. Anti-cholinergic medicine. Anti-cholinergic is a type of side effect of a medicine, but there are certain, the older antidepressants, Benadryl, some of the anti-histamines that are anticholinergic. It’s in some of the over to counter sleep medicines. So anti-cholinergic has long been known, especially with aging, aging brain gets actually very confused with anti-cholinergics.

Dr. Weitz:            What are some of the most common anti-cholinergics?

Dr. Toups:           The most what?

Dr. Weitz:            Most common drugs in that category?

Dr. Toups:           I would say the antidepressants, some of the anti-histamines. I think some of the nausea drugs. I mean, psych drugs. You got to watch it with the psych drugs, for sure. But I mean, in the study, one of my patients was taking an over the counter sleep medicine that was anti-cholinergic. And I said, “Oh my goodness. I know you need your sleep, but we have to find another way.” And she confirmed that on the nights that she took it, that she actually was a lot more confused the next day. And she never had put that together with her sleep med. So definitely some of the over-the-counter sleep meds.

Dr. Weitz:            Okay. So what were some of the-

Dr. Toups:           And Benadryl is a huge one. Benadryl. They’ve shown that people, now these days, we have a lot of other anti-histamines that don’t have anti-cholinergic effects, but Benadryl used to be used quite a bit. And they show that when people are taking Benadryl every day, they don’t notice the sedation from it. So if you just take it and you’ve never taken it, you might feel sedated. But when you take it every day, you build a tolerance, but they tested their reaction times. And they found that when people are taking Benadryl daily, their reaction time was as impaired as if they had several drinks of alcohol.  Reaction time was as impaired as if they had several drinks of alcohol.

Dr. Weitz:            Wow.

Dr. Toups:           And people aren’t aware of that. So, if you have an allergic reaction, you need to take some for a day, okay. But chronically, no. It’s going to really affect your brain.

Dr. Weitz:            So nutrient status and nutrient deficiencies are super important for brain health. And I know that you’ve tested certain nutrients. What testing did you do for nutrients and which nutrients did you see most commonly that needed to be supported for brain health?

Dr. Toups:           Right. So for the testing, we use the Genova NutrEval panel, which is an excellent panel as I’m sure you know. It looks at all the vitamins, the minerals, the antioxidants. So it’s a really nice, nice panel to get a big workup.

Dr. Weitz:            I love panels like that, but I often find that medical doctors, in order to try and get it covered by insurance, we’ll just use like a serum B12 and a serum level. What do you think about the efficacy of just doing that?

Dr. Toups:           I think it’s a great place to start and I think there’s certainly more physicians are getting on board. I mean, COVID has helped the general medical population to understand the importance of zinc and vitamin D. We know that people that are deficient in those are much more likely to get a more severe of COVID and much more likely to have mortality. And there again, like when you mentioned the ranges, and the range of vitamin D is 30 to a hundred. And so doctors will say [crosstalk 00:26:50].

Dr. Weitz:            What would you like to see for your patients?

Dr. Toups:           I like to see 50 to 80, is my sweet spot for that. And you know, if you’re at 30, 32, no, you may have some days that you’re in the twenties. And we know vitamin D is such a prime one for dementia and the brain. So if your vitamin D level is less than 30, your risk for dementia is increased by 75%.

Dr. Weitz:            Wow. And that’s gram per milliliter.

Dr. Toups:           I don’t know the units. I just look at the numbers.

Dr. Weitz:            There’s another scale that is different-

Dr. Toups:           Okay. With the traditional numbers that are reported by Quest and Labcorp, and general medical labs. 30 is the cutoff of normal, but really you want to get that up to at least 50 for that. So definitely a lot of this can be done on regular medical insurance. If you have Medicare, actually they cover the Genova NutrEval, so it’s really excellent for the Medicare population to be able to screen them. And of course you have to have the appropriate diagnosis codes for Medicare, but most people of that age have enough diagnosis codes to justify doing a test like that. But you can get from regular Quest and Labcorp, yes, you can get the vitamin G you can get the B12, you can get the B6, you can get some of the genetics. And we get the minerals, so, RBC mag, and RBC zinc, and copper. There’s only so many labs you can get at one time. So doing something like NutrEval is helpful.

Dr. Weitz:            So what were the, some of the most common nutritional deficiencies you saw?

Dr. Toups:           I’d say D and B B12 are the most common that you see. And the vitamin D I mean, I live in a San Francisco bay area. You’re in Southern Cal, so a little closer to the equator than us, but even then we evolve to make vitamin D at the equator. Early humanity, we were at the equator with full sun and full sun year around. Well, here in the San Francisco Bay area, we are too far north. I have people say, oh, well, I work in the sun. I’m out all day in the sun. They’re vitamin D’s are not okay. They’re not okay. Yes, get your sun, I mean, that’s still going to help the whole system and is a natural burst of vitamin D, but it’s not enough.

You need to measure those levels. And we need to be measuring this in children because children are deficient. And these are things that are easy to supplement and safe. If we can support, our brains and our bodies with the nutrients that we need, because people will say, well, I eat an organic diet. You know, I’m eating a whole foods, organic diet. Unfortunately, our soils have been overgrown and I’ve seen maps in different parts of the country. Some parts are deficient in this nutrient and other parts are deficient in that nutrient. Unless they’re amending the soil and really checking it, I think the science of crop growing is evolving that direction to have some awareness that we need to put more nutrients back in the soil so that it comes to our plants that we eat. But at this point in our world, there’s so much toxicity and depletion of nutrients that it really bears testing those. I think in the minerals, zinc and mag, or the most common deficiencies that we see in those are really important to check and supplement, of course.

Dr. Weitz:            If I’m not really familiar with the functional medicine approach, let’s say I’m a conventional primary care doctor listening to this podcast think, well, sure you should have vitamin D and zinc and magnesium, but what the hell does that have to do with Alzheimer’s?

Dr. Toups:           Oh, they’re integral for brain function. Vitamin D is really a hormone. And because it exerts downstream effects, it acts as a messenger to multiple systems. And vitamin D I believe, excuse me, it affects like more than 200 systems in the body and the brain. So these factors are just all integral for all of the complex biochemistry that if doctors think back to their training, they have learned biochemistry and physiology at some point. And just looking at our mitochondrial support, the mitochondria are the powerhouses in our cell. They make our ATP, they feel every function in our body. We have to have energy to run the body. And the mitochondria, if you look at the electron transport chain, which are the final steps of making the ATP, there are many nutrients that are conditional for the ATP to make that energy.  So if you don’t have these nutrients, it’s just like putting gas in your car. It’s not going to go, it’s not going to work properly. And whatever happens in the brain, it starts in the body. They’re connected. I trained as a psychiatrist and back in the dark ages, more than 30 years ago, we were pretty much taught like the brain, you just focus on the brain. You give these meds and help the brain. And we didn’t learn in residency training all the kinds of things that I know now are essential to make the brain work. And so everything’s connected. But that isn’t medicine. It sadly has, as medicine evolved specialists, it became more and more reductionistic. Each specialist deals with their little piece of the body. And I think we all have to shift back into becoming generalist and understanding the interconnection.

Dr. Weitz:            Yeah. I think we have to think, what are the things that we don’t have enough of that’s going to allow our bodies to function right? What are the things that are going to allow us to make new neurons and new neuronal connections? And nutrients obviously is super important, having the right input in terms of energy, which means having our brain work more on ketones, rather than glucose, making sure we have proper blood flow. And then we also have hormones which are super important for giving the right impetus for our brains to work. Maybe you can talk about the importance of hormones.

Dr. Toups:           Right. The hormones have become such an interesting and exciting piece. There was a study done some years ago at Stanford. And they took women who were at risk for Alzheimer’s that were older and had been taking hormones. And they randomized them either to stay on the hormones or stop the hormones. And they followed them for two years. And what they found at the end of two years, they did head scans, they did neuro psych testing, and they found that at the end of two years, 100% of the women who stopped their hormones had a decline in their cognitive function. And you could even see it on a head scan. So there was atrophy or shrinkage in the brain. So that is a clue that hormones are doing something there to protect the brain. And in that study, it didn’t matter whether they were on bio-identical hormones or synthetic field, synthetic hormones that are sadly still in use.

Any kind of hormones that they were on, if they stopped them, they saw a decline compared to the women who stayed on their hormones. So what we’ve learned is there’s all of these receptors in our brain for these hormones. We think of the sex hormones, we think, oh, they’re for our sexual functioning, for reproduction and okay. Yes, absolutely. But just like there’s vitamin D receptors in our brain, and magnesium receptors in our brain, there’s hormone receptors in our brain. And even more interestingly, our brains, both men and women, can make their own supply of estrogen. And I only discovered that I think a year or two ago, I don’t know how long it’s been known, but it’s not widely known. And I was shocked to find that it’s so important for the brain that is going to make its own supply.

And so, as long as we don’t have anything bad going on in our brain, that should still work even after menopause and even after andropause. But whenever we have processes disrupting our brain, which we’re having now with all the toxins, and the infections, and the immune problems that our people are having, then it’s going to disrupt that process as well. Men have estrogen receptors in their brain and they have a supply of making the estrogen in their brain, just they make more testosterone than estrogen. Women have testosterone receptors in their brain, same as men. And testosterone is such a fascinating hormone. I call it a wellbeing hormone. It’s hugely important for the mood and motivation. And I’ve seen it work beautifully as an antidepressant, just amazing antidepressant for people. We have all of these receptors in our brain, which means we need these hormones for our brain to be optimized.

So one of the things that we do is we test all the hormones, the whole cascade of hormones. So cholesterol turns into pregnenolone, well pregnenolone has been studied with dementia. And it’s an independent risk factor for dementia when you’re pregnenolone is low. Now pregnenolone, you can measure at Quest and Labcorp. It’s a regular lab that can be easily tested. And I don’t know why, but you can buy pregnenolone as a supplement, but testosterone is a controlled substance prescription. But the pregnenolone will turn into testosterone so it can definitely drive that up. We tested pregnenolone, we tested DHEAS, we tested estradiol in men and women, we tested progesterone in the women. And then we tested testosterone in men and women, the free testosterone, the total testosterone.

And basically what we did was we worked to just optimize all of those hormones in a reasonable part of the range. Now people say, okay, you’re going to give all these hormones to somebody that are older. Well, there’s a range. When we’re in our twenties, our hormones are surging. That’s going to be the highest amount of hormones that we have as young people, because the goal of those hormones is to support our reproductive years. And people will tell me, well, I don’t want to take hormones. It’s not natural. God didn’t make us to take hormones. But you know, the thing is until a century ago, we didn’t live much past our reproductive age. People died in their fifties and sixties. And now in our generation, people easily living into their nineties if they stay relatively healthy.

We have rapidly shifted evolution as far as longevity. And so we can live a third of our life after menopause or andropause. And so we don’t need those hormones then for reproduction. But in my book, we need them for our brain. And we definitely can see for some people, you’ll start the hormones. And some people won’t notice much, but other people will really notice the cognitive benefit. And it’s somewhat insidious as you build up the levels. But when you stop the hormones, if somebody’s been on them and stopped it, which we sometimes see when people have cancer and their doctors say, you’ve got to go off your hormones, people will crash. Their cognitive function can crash when they stop the hormones. So that’s when you can sometimes see how much they’re doing for your brain.



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Dr. Weitz:            So a follow up question on the hormones. So let’s say we’re taking them, a woman say in her sixties or seventies. And first of all, how valuable is it to really measure hormones because we know they’re going to be low if we’re talking about estrogen, progesterone, et cetera. And then B is, we had the women’s health initiative, which came out in 2001, and showed that there was an increased risk in taking a hormone replacement after menopause. And one of the analyses about why there seemed to be an increased risk of heart disease and cancer was because of the timing hypothesis, which is that most of these women didn’t start taking the hormones still on average 10 years after menopause.   Now there are other problems with this study as well. It’s basically from our functional medicine perspective, and the fact that they were given Premarin, which was oral estrogen. It was hormones that were secreted in horse’s urine, so it wasn’t bioidentical and they were given synthetic [inaudible 00:41:28] I bought that says, now you have this woman, she’s 65 years old, she’s in your office, she’s got cognitive impairment. And now you’re talking about putting her on hormones, aren’t you putting her at risk?

Dr. Toups:           Right. So, you know, the problem with the WHY study and all of the big hormone studies that have been done, as you mentioned, they were done … they did not distinguish between bio identical and synthetic hormones. And most of them like the WHI, was mostly synthetic hormones. And we know that synthetic hormones actually increase your risk for cancer. So we don’t want people taking synthetic hormones for starters. They’re not mimicking the way our bodies are meant to work like the bioidenticals are. So we don’t have great data on the bioidenticals, but there is data coming out on bioidenticals. And with regard to the cancer risk, there’s a couple of studies that show that if you’re taking bioidentical estrogen, it will lower your risk for recurrent breast cancer. And I’m actually finding some oncologists in my area that are aware of that and will allow their breast cancer patients to go back on hormone replacement because your breasts need the hormones to function normally as well.

So if your breast doesn’t have estrogen and it’s all atrophied atrophic, it’s going to be more of a risk for some malignancy to happen anyway. And then with regard to the heart condition, so we know that hormones are protective for the heart. We know that after menopause, women have less risk for heart disease before menopause than men. But after menopause their heart disease risk increases, I think never quite as high as a male, but it really starts to skyrocket. And so continuing hormones in the menopause transition should be protective to some degree for heart disease. And then the issue really becomes that some of the studies show that if you’ve been off of them for 10 years or more, and you start them that you’re going to have a higher risk potentially of cardiovascular events in the first six months.

And so that thinking is if there’s some preexisting plaque that’s going to potentially, if you’re inflamed and break loose, that could be a problem. But we don’t have that data at all for bioidenticals yet, we need it. And in my world, for somebody that’s coming in at 75 with cognitive decline, I have to weigh the risk of heart issues versus their brains going down. It’s a sure thing. And we have treatments for heart disease. Definitely some people die from heart disease, it’s still is a killer of people, but kind of weighing the risks and benefits of that. I think in the context of a study, we had to move fast. But if you have somebody coming in 10 years out and they have some inflammation and lipids then work on that, bring it down, start starting their hormones and people have done well.

Dr. Weitz:            What form of estrogen have you used? You also use progesterone. Do you cycle the progesterone? Do you do it daily?

Dr. Toups:           Right. So the the estrogen, the easiest thing to use are the patches, the Vivelle patches, that you change twice a week. They’re more steady state than the Climara patches that are only changed once a week. For people that have Kaiser, Kaiser only prescribes Climara. And what happens with that one is you put on the patch, your level increases, and then over the course of the week, it falls, falls, falls, and then it goes up again. And so it’s not as steady as the ones that you change twice a week.

And one caveat to know is Medicare will not pay for hormones. They consider you’re over 65, you’re dead. You don’t need any hormones. But it’s very affordable for most people to use a good RX coupon and get the the patches, I would say a month’s supply is about $31. And if you’re at a steady dose and you buy, say a three months supply, the cost comes down and in the 20 something dollar range, almost the range of a copay. And I understand for some people, even that is prohibitive, but for most people they’re relatively affordable.

Dr. Weitz:            Do you use progesterone as well.

Dr. Toups:           Absolutely. When you have a uterus and you’re taking estrogen, you’re going to build up a lining and you need the balance of progesterone to keep shedding the lining. Some people say, well, if you’ve had a hysterectomy, you don’t need the progesterone. Well, it’s true. You don’t need it for your uterus, but you do need it for your brain. We have receptors in the brain. We know that progesterone has gaba like effects in the brain and it really affects sleep. And it really affects anxiety. And it’s trophic for the nerves. So after people have strokes, there’s data that high doses of progesterone can help to remyelinate the nerves in the brain.

So progesterone, it’s good for men too, but it’s, typically we don’t replace that in men, we will just normally work on the testosterone, the pregnenolone, and the DHEA. But regarding the cycling and to not cycle, that’s a whole debate, and the risk of cycling your progesterone is that when you stop it, if you’re cycling and you take it for three weeks on, or even two weeks on, you stop it, you could have a bleed, like a period, a menstrual period. And after a certain age, after women stop having menstrual periods, most of them don’t want to have any more periods.

Dr. Weitz:            A silver lining about menopause, right?

Dr. Toups:           And there are some things that are good about menopause, for sure. For the most part, I have my patients pretty much taking it every night.

Dr. Weitz:            So the women get estrogen patch and progesterone Do they get any other hormones?

Dr. Toups:           And let me just say with the estrogen patch, there’s some different ways you can use estrogen. You can get a compounded cream and the cream is more expensive for starters, and you have to put it on one or two times a day instead of twice a week to keep the levels steady, but it works just fine. And occasionally I’ll have people that can’t tolerate the patches. Sometimes as you increase the estrogen it can cause breast tenderness and most people that goes away, but sometimes it doesn’t and they do better on the cream. But patches are easy, inexpensive, they stay on in the shower and the swimming pool and they’re easy to use. So some people will use a what’s called a troche with estrogen. So it’s a compounded estrogen and you put it in your mouth, under your tongue and you’re supposed to let it absorb through your gums.

And I do not like that. The problem with oral estrogen is it definitely has been clearly linked to cancer. And when you take oral estrogen, it’s broken down in the liver into metabolites and can cause cancer. So we want the estrogen to go through the skin where it doesn’t go to that first pass in the liver. Well, when you have a troche, I’ve had people come in on that from their integrative gynecologist. And I say, tell me, do you, when you’re sucking on that thing do you swallow? Because you’re sucking on it, you’re making saliva, you swallow. And they say, yes, of course they swallow. Well then they’re getting oral estrogen.

So that’s one form I do not like. And then the progesterone, you can get bioidentical progesterone these days from the regular pharmacies. There’s generic bioidentical, progesterone. It may have cleaned it up. It used to have peanut oil and things that some women reacted to as allergens. But I would say most people can tolerate just the regular prescription progesterone, which again, if you’re over 65, you can just get a good RX coupon. And usually it’s cheaper to get the progesterone at one pharmacy and the estrogen at another. But if you’re buying them three months at a time, it’s probably worthwhile because the prices can be really different on good RX and different pharmacies.

Dr. Weitz:            Are you recommending testosterone DHEA pregnenolone with women as well?

Dr. Toups:           Yes. For sure. And obviously the.

PART 2 OF 4 ENDS [00:50:04]

Dr. Toups:           Yes, for sure. For sure. And, obviously, the target levels are different in men and women. So the DHEA and the pregnenolone are supplements. And it’s important once you start the supplement a month or two later, be sure you check the level because sometimes they don’t come up and sometimes they’ll come up too high and people’s responses, particularly with the DHEA, can be all over the map.

Some people, like five or 10 milligrams will give them a big boost and some people are on 30 milligrams and not getting enough. And then the pregnenolone as well, that’s kind of all over the map. And both with both of those, sometimes as you correct all other things that you’re working on, you will see their pregnenolone and DHEA levels come up, on their own, from general health and the body getting into a better homeostasis.  So, it’s worthwhile checking those. With all hormones you don’t want too much, right?

Dr. Weitz:            Right.

Dr. Toups:           Now, the testosterone. Definitely some women you want to test the testosterone before you prescribe it because some women make enough testosterone when they’re older. And that testosterone also can change based on the general health. I’ve seen some women that were on testosterone and then suddenly they don’t need it anymore. For men, after a certain age, they’re probably going to need testosterone.

Dr. Weitz:            What hormones do you typically give to men?

Dr. Toups:           So I generally start with the prescription or the compounded testosterone gels. Some men, you can raise the dose and raise the dose and they’re just not absorbing the gels and then you’ll end up needing to go to injections. But it’s easiest and more accessible to start with the gel.

There’s some different formulations of the gel. I have a local compounding pharmacy that makes testosterone in a brand named gel called Atrevis gel, A-T-R-E-V-I-S and they say that there’s data with that that increases the absorbability of the testosterone. And the cost of doing the compounded testosterone is not all that different than the cost of the prescription gels, if it’s not covered. Usually the prescription testosterone will be covered on the commercial insurance for men. Or if you’re under 65, it’s generally covered, but if you’re over 65, sometimes it’s less expensive to get a compounded testosterone cream or gel.

And the injections, they definitely work, but they can drive up the estrogen levels higher and more quickly than the topical will for some people. But they can also be another great option for people that don’t absorb and I definitely use both.

And for the women, let me say for the women, what do you do for women? Well, there is no commercial product of testosterone for women because we just need tiny little doses compared to a man. So the compounding pharmacies do make testosterone in a cream for women and they do make a tablet. I use Belmar Compounding Pharmacy and I usually have women start with a testosterone tablet. And I don’t know if people know what their LDN is like, it’s a little tiny, tiny tablet, and you can use it vaginally. So I have women, when they’re going to bed, pop in that tablet at bedtime and it’ll break down. And things that you insert vaginally are absorbed super well. And so you definitely want to start with a tiny dose. I start with 0.5 milligrams and that tends to be enough for most women.

Again, I’m not trying to get them at the top of their testosterone range, just somewhere closer to the middle of the range. And so that’s a pretty easy treatment for most women. A few women will say that the little tablet doesn’t dissolve. So it’s something with the pH, vaginally, for them. And they’ll find that it hasn’t dissolved fully and then will switch to a compounded cream. But the tablets are super easy and people generally like those.

Dr. Weitz:            And for men, besides testosterone, are there other hormones? Do you ever use growth hormone? Do you use DHEA, pregnenolone?

Dr. Toups:           Yes. I don’t use growth hormones, I’m personally afraid of growth hormones. I feel like it’s turning on something that wasn’t meant to be turned on. I’m not experienced enough to want to mess with that myself. But the pregnenolone and DHEA, yes, there’s pretty well established levels with those things that you can feel safe that you’re supplementing people to the right level. And pregnenolone, I usually shoot for a level of around 100 in people and if it goes a little over that pregnenolone is a pretty forgiving thing, it’s metabolizing into other hormones.

And then the DHEA typically we’ll have men a little higher than women, but maybe a level of around 150 for women and 200 or a little higher than 200 for men. And, again, forgiving, it can be a little lower, a little higher. But if their DHEA comes in at 350, I’ll say, “Oh, you’re on too much, let’s cut you back.” I don’t want to push people to the top of the range.

Dr. Weitz:            Okay. So we’ve been talking about all the things, the inputs that are going to increase brain health. And then we have to talk about the negative things that are going to reduce brain health. So why don’t we start with infections?

Dr. Toups:           Yes. Infections are such a huge thing. And, again, the world is learning about the impact of infections through COVID and the brain. And it’s being reported every day now that they’re doing autopsies on people and seeing that… I just read something yesterday, I believe that they said, there’s gray matter destruction in the brains of people that died with COVID that looks just like Alzheimer’s.

So, what we have been saying and what we do in the functional medicine dementia world is, infections, some of them like to live in the brain. And the ones that go into the brain, when we have an infection, what happens is our immune system gets activated. So, it’s an immune response to an infection that causes the destruction. And that’s exactly what they’re seeing in COVID. They’re saying, “Well, there’s no COVID left in the brain, but we’re seeing destruction in the brain and we know people with long COVID are having brain fog.”  And typically, our patients that seek conventional doctors with brain fog, “My brain’s not working.” What are you told? “We don’t see anything wrong. You have a psychiatric problem. Go to the psychiatrist.” Well, I am a psychiatrist, so I’ve long believed that these people are struggling.

But the world is learning the effects of a virus on the brain from COVID. So maybe that’s one blessing to have the conventional medical community believe that we think it’s important to treat infections, reactivated infections. And one of the things with viruses is in classical medicine, we were taught, viruses, you don’t really treat them. They’re self-limiting and the immune system will keep them in check.

Well, in my world, when I test for all kinds of viruses and typically the IgG antibodies mean a past infection. But when we see the IgG antibody’s really high, in my world we’re thinking, okay, if it’s more than four times the upper limit of normal, that infection has reactivated and it’s waking back up because we know these viruses, they integrate into our body, they live in our body and our immune system keeps them in check, it keeps a lid on it. But if something happens that affects our immune system, which of course happens naturally with aging, things don’t work as well, then the viruses can wake up and start replicating and they’re not kept in check.

So, we’ll test for things like the herpes viruses, the Epstein-Barr virus, toxoplasmosis, cytomegalovirus, mycoplasma, those are all known to affect the brain and live in the brain. And when we see these things elevated, there’s something we’re going to treat.

So I would say, like the Epstein-Barr virus, we know that by age 18, I don’t know the exact percentage, but I would say it’s maybe over 80% of our population has been exposed to Epstein-Barr or mono. And that’s one that we see quite frequently reactivate with any kind of stress and I have protocols to treat it and you can often see people that are fatigued, that are just not functioning great. And when you treat this, you can see people feel so much better. We’ve seen people with chronic fatigue for two years and suddenly their energy’s back and they can do things.

Dr. Weitz:            Do you use antiviral medication prescription? Or do you use natural immune strengthening antimicrobials et cetera?

Dr. Toups:           Yeah. Mostly herbal, except for the herpes viruses. And with a herpes virus is it’s pretty easy to use a long-term suppressive with valacyclovir, or Valtrex. You just have to follow the kidney function in older people because it broken down through the kidney. So you just want to make sure the kidney function is fine and check it a few times a year.  But there was some fascinating studies that came out, I think now it’s been about two years, Dr. Ruth [Az-a-kian 01:00:08] and another one, where they looked at huge populations of people in Southeast Asia and they looked at 20 or 30,000 people, big populations. They found that if people had taken a single course of an antiviral in their lifetime, they had a much lower risk of Alzheimer’s.

Now it didn’t tell us that that antiviral prevented Alzheimer’s, it just says there’s some association here. What we’ve known for more than 20 years, that when they do autopsies on Alzheimer brain, they’ll find like 99% of them have high levels of herpes virus in their brain, and higher than in the general population.  And so there is approved antivirals for treating herpes, which is acyclovir, valacyclovir. The valacyclovir is little less toxic and more effective, from my read and research, then the acyclovir so that’s the one I tend to use. And you just-

Dr. Weitz:            What type of herbal antivirals will you use?

Dr. Toups:           Yeah. I have a beautiful protocol that I’m happy to send you that you can put on the website that I got from Todd Born. Todd Born is a naturopathic doctor who was local in my area until last year and he’s also the medical director for Allergy Research Group, and I sent him a patient that had Epstein-Barr virus to get some IV vitamin C because IV vitamin C is one thing that’s known to help Epstein-Barr. And he wrote me and he goes, “Kat, I could give her this,” but he goes, “I have this great protocol that works for,” like he said, I don’t know, 90, 95% of his patients, I’d say it works for about 80, 85% of mine. And so I gave me this protocol.

And so in all my study groups, we call it the Todd Born protocol since I got it from Todd, but Todd told me, “Well, I got it from someone else,” but he put his tweeks on it so that’s what I call it, the Todd Born protocol. And it’s a combination of some general therapies, which are interestingly homeopathic kind of remedies. And the formula is all available on Fullscript and Natural Partners. And you get three different things, tamarix, acer and… I’m blanking on the third name right now, but it’s three different… it comes in a liquid and you buy a big glass bottle for a few dollars and you pour those three bottles in there, shake it up. And you take a teaspoon twice a day and then we get another product that’s called a Copper/Gold/Silver (Oligo Element), and it’s a little dropper, and you take a dropper of that twice a day.  And one round of that is amazing for so many people. And I tell people, “Look, if you’re getting better but you’re not fully back where you need to be on your energy then do a second round.” And Todd advised to stop it for a while after two rounds, just to give the liver a break.  So, that protocol is usually my go-to. And then I have other protocols where you can use the olive extract and the monolaurin and I forget what the third thing is off the top of my head. These days I have them programmed into my EMR and I put it in a note and say, “Do this.” But that also works well.  So, there’s a lot of herbals that can definitely help the virus and just general immune support. Anything we can do to support our immune systems, starting from the diet on up to the nutrients and the lifestyle factors are also going to help to keep the viruses in check.

Dr. Weitz:            What’s what’s your favorite panel? Do you ever use the Cyrex Alzheimer’s LINX profile?

Dr. Toups:           Yes, we did use that in the study and in practical life it just becomes those cost factors for people, that’s a definitely out of pocket cost. So, for the most part, I’ll order all of the various viruses from Quest or from Labcorp for people and get it that way.  Yeah, I think those immune panels from Cyrex are beautiful and they’re Cadillac panels, you’ve also got to test people’s microtoxins and their metals and their chemical toxins and-

Dr. Weitz:            Let’s talk about toxins.

Dr. Toups:           But before we leave the infections, let’s just say a word about Lyme and tick-borne infections.

Dr. Weitz:            Okay, yeah.

Dr. Toups:           Because those of course reach [crosstalk 01:04:44]-

Dr. Weitz:            How often do those occur?

Dr. Toups:            A lot. Of course it depends on your geography. Where do you live? But here in the San Francisco Bay area, we have become increasingly a Lyme endemic area and especially along the coast up to Mendocino County. And now they’re reporting all the ticks on the beaches that are infected with Lyme here.  So we see it a lot, I would say, in my study, I had 10 patients at my site, at least four of them I treated for Lyme, not one of them knew they had it. And I say there’s Lyme and little letters and Lyme in capital letters. When you have line in capital letters, you’re really sick. I have people come in and they can’t sit up, they have to lay down on my exam table to talk to me, they can’t take the light and that’s Lyme in capital letters.

But for some people, the Lyme will just go right to their brain. And it’s a spirochete, just like syphilis, it’s a relative of syphilis. And we’ve known since the 1800s that with syphilis, you get the sexually transmitted disease, it goes away, you think you’re fine and then down the road, 10, 20 years, you lose your mind. And Lyme does the same thing. It seems to do it faster for people.

So I think any dementia workup should include a good panel of tests for Lyme and the tick-borne diseases. Of course, we see some of the other co-infections as well. And all of those tick-borne illnesses really affect the brain. So that’s something, if you don’t look for it, you may not realize. And our investigator, Deborah Gordon up in Oregon, she lives in Ashland, Oregon, and they apparently don’t have a lot of Lyme there, and she’s like, “Well, I don’t think I should test my patients because they don’t have any risk factors.” And I said, “Deborah, they’re having cognitive problems that you don’t know where they’ve been, test for Lyme.”  So, that is just such a huge factor with dementia. And I really do believe it’s a factor with some of the other neurodegenerative disorders. We need to be testing them with ALS, MS, anything that’s affecting the brain. You’ve got to test those infections. And what happens when-

Dr. Weitz:            How do you treat Lyme?

Dr. Toups:           Oh gosh, that’s a whole long talk and there’s a difference but there was a beautiful study out of Hopkins in this last year and one of my friends and colleagues from my local bay area functional medicine study group was a coauthor on there because he’s a Lyme expert. And they compared a bunch of the herbal medications to the traditional antibiotics use for Lyme. And what they found was what a lot of us already have seen clinically that when you have acute Lyme, when you just got it, take the antibiotics, for sure, no doubt. You go on antibiotics until you get your tick tested, it’s just worthwhile.  But, if you have chronic Lyme, the antibiotics don’t seem to work as well and sometimes people will get better then as soon as they stop, they crash, they haven’t eradicated the infection.  So, using some of the herbal treatments seems to work better. Well, they show that in this study they show that a handful of the herbals were actually quite superior to… they were doing this in cell culture, but the herbals were more effective at killing the virus and they found that cryptolepis could completely eradicate the Lyme persisters.  So a lot of these things will knock down the Lyme, but they don’t get rid of it totally and they’re called Lyme persisters. So, adding the cryptolepis into the protocols is something that I started doing after reading that paper.

Dr. Weitz:            What is cryptolepis? That’s something new to me.

Dr. Toups:           It’s what?

Dr. Weitz:            That’s something new to me. What is cryptolepis?

Dr. Toups:           Cryptolepis? Yeah, and it’s spelled just like it sounds. I wanted to say crypto-lep-sis, but it’s cryptolepis, I-S. And it’s an herb that comes out of Ghana and that herb only grows there so there was a shortage for a while when COVID started trying to get it shipped over here. The herbalist at Woodland Essence we’re at, I’m ordering it from, told me they cannot grow it here. It just won’t grow here. But it’s an earth that’s kind of been in the Lyme toolkit for a while and that was the best thing as far as wiping out the Lyme persisters.  I can send you the link to that study too.

Dr. Weitz:            That would be great.

Dr. Toups:           I think it’s interesting for people to look at because you’ll see some of the other herbs that were quite effective. And I tend to start with things like the Beyond Balance products, they have mixtures of different herbs and you can start with a milder and work your way up so that you don’t make people sick with the treatment. The Byron White products are also effective but they’re more powerful and so some people you can start those and immediately and they’ll have a Herxheimer reaction and feel crummy.  I don’t believe you need to feel worse with the treatment to get better. I think we can do it more gently and help people get better. I do like to give immune support with the Lyme treatments in particular. I use a lot of LDN, low dose naltrexone, for immune disorders, but also immune support for infections.

Dr. Weitz:            So let’s go into toxins.

Dr. Toups:           Yeah.

Dr. Weitz:            So what is some of the most important toxins that you say that negatively affect brain health?

Dr. Toups:           Right. Well, it’s hard to say that one is more important than others.

Dr. Weitz:            We’ve got heavy metals like mercury, we’ve got-

Dr. Toups:           Sure. Yeah. I kind of separate in my mind the metals and the chemical toxins. So we know that many of these metals are neurotoxic.

Dr. Weitz:            Aluminum is one that’s often talked about.

Dr. Toups:           Right, and mercury and lead and, of course, cadmium and arsenic and aluminum, they all can be toxic to the brain. And so we have to be vigilant in our environment. You can test these at Quest and Labcorp. If you get the Genova NutrEval panel they’ll test lead, mercury and it’s cadmium or arsenic.

Dr. Weitz:            Arsenic, yeah. All four of those. Yeah.

Dr. Toups:           Yeah. These can be tested in panels through Quest and Labcorp as well. With the mercury, I don’t like to do the panel on Quest, it does mercury and lead and cadmium and arsenic by itself, because they’ll tell me on the mercury. On that one, they don’t quantify it. They’ll say, “It’s less than four.” Well, if the mercury is three, I’m not going to be happy. The mercury in older people, it should be less than one.  So, less than four, I need to know the number. So I’ll order that as a standalone test, that will quantify the number. And one of my good friends and colleagues looked at all of her patients in one year that came in with cognitive decline and she was saying, “We know what are the factors here?” And one of the things that she found with regard to mercury is that her cognitive patients, on average, their levels of mercury were twice as high as the age match controls. So they might not be sky high, but they’re still higher.  So what does that mean? Well, we know that it actually just reported in this last week that they found in Alzheimer’s plaques, they found metals inside those plaques. And interestingly, they were elemental metals that they were walled off by the amyloid to stop the metals from going willy nilly when they’re charged and damaging things in the tissue.

Dr. Weitz:            That’s bringing up a really important point that is not understood, which is, if you just focus on the amyloid, you’ve not asked, “Why is your amyloid in the brain to begin with?”

Dr. Toups:           Yes.

Dr. Weitz:            As you just mentioned, amyloid is protecting the brain and so, in this case, it’s helping to protect the brain against heavy metals.

Dr. Toups:           Right, exactly. And this is why all of these anti-amyloid drugs are failing, including the new aducanumab. It’s a smoke and mirrors with statistics to say a small group declined more slowly, but they still declined.  I used to run a clinical trials center and I did many trials. And back in, I don’t know, 2008, I did a trial with one of these anti-amyloid drugs. And in our study we could show on the PET scans that it was really diminishing or wiping out the amyloid plaques, but nobody got better. And so there’ve been some drugs that have gone for FDA approval that have been nixed before this one. They’re like, “Well, let’s throw a bone to people and give them this drug because people need a drug.”  Well, no, they don’t need that drug, 40% of people had swelling in their brain with the drug and I think it was 18% of people actually had bleeding in their brain from the drug. Would you give that to your mother? With a 20 to 40% risk of serious brain side-effects and it’s not going to help her?

Dr. Weitz:            Right.

Dr. Toups:           To me, that’s the question. Would you give it to your family? Because I have some doctors saying, “Well, now I have to prescribe it because it’s approved.” No, you don’t.

Dr. Weitz:            If the amyloid is protecting the brain against heavy metals and you don’t remove this heavy metal exposure, then you’re potentially going to make the brain worse.

Dr. Toups:           Which is why we’re seeing the brain swelling and the bleeding. And that was an issue in the study that I did with one of these drugs back then as well. So, we don’t know if we can detox people from all of these factors

PART 3 OF 4 ENDS [01:15:04]

If we can detox people from all of these factors, get rid of their infections, get rid of their toxins, optimize their hormones and their nutrients, maybe then an anti-amyloid drug could help maybe, but not just giving it to somebody where it is protective. That is what Dr. Bredesen’s been saying all along that this is a protective effect. Think of it like a scab, you’re bleeding and then your body makes a scab to wall off that wound so you don’t get infections. When you have an injury, something insulting your brain, it makes the amyloid to protect that neuron. the problem becomes when you have something going on chronically, chronic infections, chronic toxins, metals, then you’re going to make so much amyloid that it just gums up the works and too much amyloid of course, is going to kill the neurons.

Our thinking is, “Well, let’s start downstream, what’s causing the amyloid in the first place?” It brings us to the question of genetics. People know that when you have the APOE4 gene, that you have a significantly higher risk for developing dementia. One of the things that happens with that APOE4 gene is that you will make more amyloid when you have that gene. I have a 33, I don’t have a 4 in my genetics and so, say you had a 24 or a 34 and we got the same infection that went to our brain, your brain would make a lot more amyloid than mine would make. The E4 gene is called a pro-inflammatory gene, it creates more inflammation as well and so people that have E4s, it’s not a death sentence. It’s not inevitable. There are plenty of people that have 44s that don’t get dementia, but you do have a higher risk. We all need to take the steps to prevent these things so we can live a long and healthy life.

But when you have a 4, it’s good to know just so that it’s going to reinforce, you need to really be vigilant about avoiding aluminum in your deodorant or your pans, or these chemicals. Things that you’re putting on your body that have phthalates. I think to me, I use that to just, not to scare people. It’s just like, “Okay, you have this. Let’s make sure we’re doing all the steps so that you stay fine into your old age.” But that is the issue with the E4 is you will make more amyloid with an insult to your brain. Yeah, the thinking of a drug that doesn’t work, hurts people, and we can’t afford is not a wise move in my book. Okay, so we were talking about the metals. I had people, probably a handful of people that had very high mercury in my study, and what do we do about that? Well, the first thing we do is we take them off of seafood because our oceans…

I have some people that say, “I only eat wild caught salmon,” that can still have high mercury levels. Typically, the thinking is if you eat a SMASH fish, and it stands for salmon, mackerel, anchovy, it’s an acronym for small fish, but what you want to do when you eat fish is you want to eat the small fish and avoid the big fish like the tuna. Because the big fish, they live longer, they accumulate more metals from the ocean and they eat the smaller fish, so they’re taking on their metals burden as well. I mean we got everybody’s mercury down in the study, no problem. It was a pretty slam dunk thing. Some people, pretty much I take people off for six months. I’ll check it at three months. Sometimes in three months, it’ll come down. It’s avoiding the exposure and then giving people some liver support to help them with detoxification. I’m a big fan of Avmacol, which is one of the broccoli extracts, sulforaphane with myrosinase. they have beautiful data.  They do a lot of research and they have data even in autism and schizophrenia, showing that, supporting the detox enzymes are helping the brain.

Dr. Weitz:            What product is that?

Dr. Toups:           It’s called Avmacol.

Dr. Weitz:            Avmacol, okay.

Dr. Toups:           Uh-huh (affirmative). A-V-M-A-C-O-L.

Dr. Weitz:            Okay.

Dr. Toups:           Unfortunately, it’s not on Fullscript and Emerson at this point. I know I’ve been nagging.

Dr. Weitz:            Well, there’s other products that have broccoli seed extract…

Dr. Toups:           Sure.

Dr. Weitz:            Are those equivalent or not?

Dr. Toups:           Yeah. I mean I think they’re all good. I know Designs for Health makes one, and maybe Symogen makes one.

Dr. Weitz:            I know that Metagenics has one and there’s [crosstalk 01:20:07].

Dr. Toups:           But I personally like the companies that do research. These guys have research data and this drug first came… It’s not a drug, it’s a supplement, a nutrient. But my friend who runs Intelex DNA is the first one that told me about it and she said, “It’s a slam dunk. When we have people that have brain fog from mycotoxin exposure,” she goes, “We put them on this Avmacol and their brain fog gets better.” I’m like, “Okay, my mycotoxin people need that.” I told my assistant in my office about it, who’s a health coach, and he had had some exposure to mold in his place and he had also been treated before that for Lyme. He and I both got some and I went away to a conference to give a talk and I came back a week later, and I looked at my assistant and I go, “Doug, you look fantastic. What are you doing?” He got a big smile on his face. He said, “It’s the Avmacol.” He said, “It just cleared up things for me.”  I could tell his brain was really clicking, his processing speed was better. He was the poster child for that. For me, it works, I stick with it.

Dr. Weitz:            … glutathione, either liposomal, or IV, or nebulizing?

Dr. Toups:           Yeah. Well, I think all of those things work and they’re all good. The oral one, the liposomal, I mean the jury is still out, even on liposomal. Because if you take it liposomal, it’s supposed to coat the glutathione, which normally is broken down very quickly in the stomach, and how much are you really getting for the expensive glutathione? The liposomal is supposed to coat it and help it get farther along to be absorbed in the small intestine rather than broken down in the stomach, but some people still make a lot of acid and will break it down and they may not get it. I’ve really dug into the research on S-acetyl glutethione, S-A-G and to me, if they’re going to take glutathione, I think that is a better nutrient. They have nice data that with the molecule shape and absorption, that it will get absorbed and they have a nice area under the curve and a nice Cmax with the glutathione. I either use NAC [crosstalk 01:22:38]. What?

Dr. Weitz:            Do you do IV ,or nebulize glutathione to get it directly into the brain?

Dr. Toups:           I have used nebulized glutathione sometimes with acute illness things. All these protocols are already labor intensive enough and expensive enough. But giving some IV glutathione, sure, it’s a good thing. Do I do it regularly for people? No. If they have something acute or they need to detox from a surgery or something, maybe it’s a good thing. But I mean, I’m a big NAC fan and I’m just praying that it doesn’t [crosstalk 01:23:11], that we don’t really lose it from our toolkit with the FDA making noises about taking it off the market. The NAC will, of course just gradually convert into glutathione and it has a much longer half-life and it lowers glutamate, which is an excitatory neurotransmitter, so helps people, with great data, with OCD and bipolar. There’s just so many benefits with NAC that… Okay. Yes, go get an IV glutathione push, sure. It’s fine, but do you need to do that? I don’t think so.  I think you can still detoxify things without it, as we saw in the study, getting the mercury down.

Dr. Weitz:            Do you use binders as well as part of your detox protocols?

Dr. Toups:           Yes. It’s kind of a mish-mash. People that have viruses tend to have mycotoxins. People have mycotoxins and viruses, and this kind of mixed in with the chemicals. Binders of course, are our mainstay for binding the mycotoxins. They also can bind the metals. There’s a variety of binders and sometimes different ones for different things. We didn’t talk yet about mold and mycotoxins, but we know that that is a huge driver of brain degeneration for some people. Some people, it doesn’t seem to bother and other people, it can be deadly for their brains. I will layer in multiple binders. The jury is still out on a urinary mycotoxin panels. We have two companies that are doing urine mycotoxin, Great Plains Labs and RealTime Labs. My friends that are on the board of ISEAI, you know ISEAI, International Society for Environmentally Acquired Illness. It’s a wonderful organization that was just started. I think we’re now in our third year maybe.

Dr. Weitz:            Okay.

Dr. Toups:           But it was looking at environmentally acquired illnesses, so mycotoxins, infections, and toxins. Actually, they did a drive and asked us to donate money, and they’re doing split samples with mycotoxins right now, and looking at the difference between the panels. We need that kind of information. We don’t know how reliable it is. The thing with the urine mycotoxins is that sometimes you’ll see zero, because the people are not excreting anything. They’re not detoxifying well. Nothing’s coming out. It’s all in their system and then, when we start doing things to support their detox pathways, you see this with the mycotoxins and you see it with the chemicals. Sometimes they don’t have chemicals, but as you’re doing more things to excrete those chemicals, you’ll see the numbers go up on the chemical toxins before they go down. In chemical detox, if you have a lot of chemicals, it’s going to be a lifetime thing of what can you do to keep detoxifying your body and trying to get rid of these chemicals?

We know that there are certain genetic factors that make you not detoxify things as well, MTHFR is a big one. That if you have two copies of that, you’re not going to make the same glutathione as other people, and you can have snips in the glutathione genes. There’s multiple things that… Or the panels now have the GST genes, GST yeah. You can look at a panel of your detox genes, but you don’t necessarily need to know that. Some people, I would include myself in this, I’m a poor detoxifier. I accumulate things, so I’m constantly taking things for detox, doing my sauna. The sauna and the sweating is one of the best validated things for lowering our chemical burden and our metal burden. Stephen Genuis is an MD, researcher up in Canada. I think it was a couple of years ago, at Integrative Medicine for Mental Health, he came and he was showing us all his data.

But you can Google his name and he’s got a bunch of papers. I mean he’s looked at how much of these various chemicals and metals do you excrete in your urine and your sweat, and the sweat is the best detoxifier for most of them. That’s a mechanism that, in the past, we had. It gets hot, in the olden days people didn’t have deodorant, and many cultures use sweating, traditions like the sweat lodges, the baths, that’s a purification ritual, but actually has important benefits for our bodies. These days, they’re making inexpensive saunas that you can get, like the little bubbles with the infrared heat source and you sit on a chair. They’re not fancy and you have to look for the ones that are lower in the EMS. But definitely, sweating is a huge thing. Now that the gyms are reopening, sweating as much as possible.

I tell people the caveat though, when you’re sweating, you need to have a towel and wipe off the sweat as it comes out, because you don’t want it to reabsorb it. Wipe it off and then, when you’ve finished your sweating session, go jump in the shower with some soap and wash off because you’ve just now mobilized all those toxins. You don’t want to take them back in. But the sweating and some Avmacol and liver support and binders, all of those things can help to lower the burden. But I would say with the chemical toxins, we did the Great Plains Labs’, TOX test for our study at the beginning and the end and even though people were doing lots of binders and lots of sweating, you would see some things come down, but in nine months they were not gone. Those things have accumulated over a lot of years and it takes a while. I figured at my age, it’s a lifelong thing I needed to keep up with. Detox is going to be an ongoing thing.

Dr. Weitz:            We’re going to have to wrap here. Just a final question. Practically, it must be difficult to get these patients with cognitive problems to take a bunch of supplements and do a bunch of protocols, isn’t it?

Dr. Toups:           Yes. It’s difficult and of course, it’s costly to take a bunch of supplements as we know, and trying to distill things down to what are the most important things to take. That is where you need to individualize and where you could use help of a physician, or a naturopath, or a health coach. Somebody that understands these thing. I’ve seen people, Dr. Bredesen’s first book, he listed all these great nutrients and then I will read the Facebook support groups and see where people are struggling, and I’ll read people saying, “I’m spending $1000 a month and I’m taking all these supplements.” And I just think, “Oh no, you don’t need to take them all.” That’s where it really helps to test and figure out what do you need. Now, everybody needs mitochondrial support. To me, that’s foundational and the mitochondria with aging, they just start declining rapidly. Certainly after 50, they’re going down. [crosstalk 01:31:09].

Dr. Weitz:            What is mitochondrial supports?

Dr. Toups:           There’s a lot of nutrients that are well-validated for mitochondria. So CoQ10, acetyl L-carnitine, lipoic acid, I use the R-lipoic acid form, PQQ. Those are some of my favorites.

Dr. Weitz:            Okay.

Dr. Toups:           There are some combinations of those things available and I’m actually working on a formula, because to me that’s the most important thing of all. I’m pretty close to finalizing with my formulator a product that we’re going to hopefully have available that is going to have all of those things that you can just take a scoop of something instead of five or six supplements.

Dr. Weitz:            Right.

Dr. Toups:           But I think the mitochondria, aging or chronic disease, good for everyone. On NutrEval and even [inaudible 01:32:09], I measure CoQ10 levels. I mean for cardiovascular, the CoQ10 is essential. We want to see that number at least above one, and I know in studying with Alex Vasquez in the old days, I remember this so well, he said, “The dose of the CoQ10 is limited by the size of the pocket book.” Meaning take as much as you can afford. It’s that good of a nutrient.

Dr. Weitz:            Right.

Dr. Toups:           But then, beyond the mitochondrial support, that’s essential and like acetyl L-carnitine that turns into acetylcholine in the brain. That is the one of the primary neurotransmitters involved with memory. But this is where it does help to work with somebody that can test and guide you so that you are taking what’s right for you, and that you’re not throwing away money on something you don’t need. But one of the things that we did with the study, when people have cognitive decline, they need support and it’s true, they can’t do this on their own. What we found is sometimes the caregivers, their spouse, maybe the spouse was great and could really help and sometimes, especially I saw in places where people were living in mold in their homes, that the spouse was struggling as well, cognitively. As part of our study, the patients work with a nutrition coach and a health coach, and an exercise coach. We didn’t even talk about exercise, but that’s a whole other topic. Exercise for the brain and the heart is essential.

Having that kind of support upfront to have people get started on this just made it a Cadillac program. Having an exercise coach, that’s changed my view of… Moving forward, I’m insisting that people get some sessions with an exercise coach, optimize what they’re doing, make sure they learn how to do high intensity interval training, that they’re doing the whole gamut of aerobics and strength training and balance training. We took people that had never exercised in their life. I had one in my study, never exercised, and now he loves his exercise and it has paid off for his brain, of course.

Dr. Weitz:            Right.

Dr. Toups:           Yeah, I think getting guidance. It’s not easy, but once you sort through what you need, then people can get on autopilot. The people that finished my study, they need to be followed up once in a while, but they don’t need a high level of care. They don’t need to take an expensive drug forever.. They get into a rhythm. Once you wake the brain up, it’s just a matter of keeping it there.

Dr. Weitz:            That’s great. Awesome. This was a great discussion, Kat. How can our listeners find out more about you and contacting you?

Dr. Toups:           Yeah. I can give you the links. I have a Facebook page. You can put my name, Kat Toups in. I have the personal one, but there’s one that says, Kat Toups, Functional Medicine, Psychiatry, and Dementia. I try to post interesting and hopeful articles on there, related to the brain and rehab of the brain. I try to stay away from the doom and gloom. To me, it’s like, “What can we do?” There’s so much we can do to get our brains back. My website, it’s a place to stay in touch. I’m going to put something there to start offering people any eBooks, so I have their emails that I can notify people when my dementia book is ready. That would just be dementiademystified.com. That’s the name of the book and that will link you to my website. But I think the Facebook for me, I can’t do all of those different modalities that everyone does, but I try to use my Facebook group to put interesting and hopeful research.

Dr. Weitz:            Awesome. Thank you, Kat.

Dr. Toups:           Well, thank you so much. Thanks for helping us to get this word out. Actually, I’ll give you the link for our dementia study. As you mentioned, 84% of the people in our study got better and the average, we didn’t even talk about the study, but the average… We track the MoCA scores, which is like a mini mental status scores. The MoCA is better for picking up mild cognitive impairment, which we were targeting people with mild cognitive impairment or early dementia. We do have people benefit with more advanced dementia, but you’re peddling farther upstream the more you let your brain go down. The sooner we can get people to take steps first to save their brain from down, but if you’re having memory problems, just know there are things you can do about it and if you think you’re having problems, you probably are. But I’ll give you the link for the study and it goes through all, we’ve talked about a lot of them here, but even not quite all of them. We haven’t talked about brain training. We haven’t talked about meditation, mindfulness kind of thing.  They all come together and what I found was the people that worked the hardest, all those parts of the protocol come together to help you heal and to feel well and so it’s just exciting to know. I tell people, dementia is not a death sentence. That’s what I want to leave people with. If you have a diagnosis, it’s not a death sentence. There’s so many things we can do to help your brain now.

Dr. Weitz:            That’s awesome. Such a positive message. Thank you.

Dr. Toups:           Thank you so much for having me. I appreciate it.

Dr. Weitz:            Absolutely.

 


Dr. Weitz:            Thank you listeners for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple Podcasts and give us a five-star ratings and review. That would really help us so more people can find us in their listing of health podcasts. I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111, and take one of the few openings we have now for an individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.

 

 

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