[00:00:00.090] - Dr. Lemanne 

For instance, what is Alzheimer's? And until recently, it wasn't diagnosed until after death.  And how dementia reversal was thought to be absolutely impossible…

[00:00:11.910] - Dr. Gordon

Still is, sort of. Thought to be impossible. Normalizing homocysteine, properly replacing nutrients that are lost, treating mycotoxins, treating Lyme disease, replacing hormones that are lost. And at the end of nine months, 22 of the 25 people were markedly better.

[00:00:32.730] - Dr. Lemanne 

You have found your way to the Lemanne Gordon podcast, where Docs Talk Shop. Happy Eavesdropping. 

Standard Intro

00:01 Dr Lemanne

In today's episode, Dr. Gordon discusses the results of a recently published clinical trial in which she was one of three physicians who successfully treated patients with dementia. We get into the thorny question of how cognitive impairment is evaluated and delve briefly into some of the successful interventions that were part of the trial.

[00:01:12.390] - Dr. Gordon

Did you know that two thirds of the identified cases of Alzheimer's are in women?

[00:01:19.450] - Dr. Lemanne 

I have heard that women are more at risk than men, but I didn't know it was that high.

[00:01:23.960] - Dr. Gordon

It's really quite a bit higher.

[00:01:26.330] - Dr. Lemanne 

So, for every three Alzheimer's patients, two are women.

[00:01:29.130] - Dr. Gordon

Two are women.

[00:01:30.750] - Dr. Lemanne 

And now how is Alzheimer's diagnosed? Do you take a test? Is it a blood test or some other kind of test? It's brain scan.

[00:01:37.450] - Dr. Gordon

That's a really good question. And it is a confluence of identifying factors. So right now, the people that diagnose Alzheimer's sometimes are neurologists who do spinal taps and pretty simple MRIs. And they say the hippocampus, the memory little kernel at the base of the brain is shrunken, and they have amyloid in their cerebral spinal fluid, amyloid being a substance that the body creates and circulates in the cerebral spinal fluid and lodges itself in the brain.

[00:02:09.550] - Dr. Lemanne 

In response to some sort of insult or injury.

[00:02:11.220] - Dr. Gordon

And that's the key that has not been well understood. You identified something very key right there, because neurologists diagnose it that way. Neuropsychologists address it by failure on a battery of tests that primarily show a memory deficit. And family doctors diagnose it because it runs in the family. And now Uncle George is beginning to show memory problems and really shouldn't be allowed to drive.

[00:02:39.360] - Dr. Lemanne 

So how important is it to diagnose this very specifically? Is that a big deal? I assume there are many different causes of dementia. Are they all under the Alzheimer's umbrella? And if not, do we need to differentiate between the different types? Is there a different treatment?

[00:02:54.530] - Dr. Gordon

You're, in fact, right. There are many causes of it, and there are slightly different shades of Alzheimer's. 
 
 SIDE BAR? Note?  Let’s back up here:  There are many causes and categories of “dementia”, which is impairment of cognitive function, especially memory but also executive function and emotional regulation.  ONE of those types of dementia is Alzheimer’s Disease and what has not been well-appreciated is that there are many different causes of dementia and each can lead do a slightly different presentation of the disease, depending on what type of function is affected more.  

 Each brain goes a little bit bad in its own way. Your brain is so complicated, has so many backup systems. A lot has to go wrong for you to stop remembering your nephew's name, for you to not remember that you had coffee with Sally last week, for you to not remember that you've seen that movie before. Or not be able to find your way home from the grocery store in the car. Yeah, so all these things so it has long been thought, and the approach has been the monotherapeutics of the pharmaceutical industry has been the silver bullet approach, meaning one drug. What one drug can I monetize? Single therapy. A silver bullet. And it's a little bit like you're insulting me. This is our brain speaking by thinking that I only have to have one thing go wrong to completely lose my way in this world. Our brain is insulted because our brain is so complicated. It has so many backup mechanisms, so many things have to go wrong for it to deteriorate to the point where you're not really functioning and you get a diagnosis of Alzheimer's if you take into account that there are different things that cause it in different people and slightly different manifestations.

[00:04:24.550] - Dr. Gordon

No, there's not one single Alzheimer's, but there is one single approach as long as you let that approach be a systems approach.

[00:04:35.590] - Dr. Lemanne 

Okay, I want to come back to this idea of the brain is insulted. But first I'm reminded of some conversations that I've had with various people over the years where the idea of age-related forgetfulness is thought to be silly or a little bit cute and not really important. I remember somebody saying to me, oh yes, so and so is a little bit senile. That was the word that was used. But you know, it's not so bad. She didn't remember my name, and it was all kind of cute. It's a devastating disease and it's fatal, isn't it?

[00:05:09.960] - Dr. Gordon

That's right.

[00:05:10.390] - Dr. Lemanne 

It's not cute in its manifestations. And I remember that this person, for instance, accidentally set a fire in their house. They got lost. They had accidents that they had no idea how to deal with. For instance, a kitchen knife and a missed vegetable and some blood. But the relatives weren't home to take care of her and it turned out to be a big problem. It was really not cute or benign or fun.

[00:05:35.770] - Dr. Gordon

So people often ask me I couldn't remember, I was at a party last weekend, I met somebody in the first hour and I saw them again 2 hours later, I didn't remember their name. Do I have Alzheimer's disease? They might even say, when I was younger, I know I could be great at that. I used to be great with names. I would say there is a certain amount of cognitive deterioration just like there is physical deterioration that can be accommodated within the scope of normal aging. Well, who decides when it's gotten too far? So I had a new patient yesterday who, on his cognitive testing, failed miserably all the memory portions. But it's really been other people trying to convince him that his brain isn't working that well. He doesn't perceive it.

[00:06:18.860] - Dr. Lemanne 

So there's no insight. Is that always the case?

[00:06:21.280] - Dr. Gordon

No, that's not always the case. One of my patients in the study we completed recently was like, put me in line first at the study. I want to be in this. I know I've got what my dad had a year before he entered into treatment and three years before he died.

[00:06:36.830] - Dr. Lemanne 

Okay?

[00:06:37.490] - Dr. Gordon

So the awareness function is completely varied, and it's very helpful when the patient does self-identify and is therefore motivated.

[00:06:47.870] - Dr. Lemanne 

That would make it a lot easier to treat them.

[00:06:49.910] - Dr. Gordon

A lot easier to treat. Denial is not helpful in this disease. So I asked some pretty simple questions to try and help someone decide. Is there slight forgetfulness of age within normal limits? And if you think about it, at my age, when I think about what my grandparents’ day was like, it's nothing like what my day is like. Just driving to town, I see more people than they would see in a month and interacting. And it's complex. And multitasking and aging don't go as well together as youth and multitasking go together. So as we get older, we're understandably not as great at multitasking. And we do have some forgetfulness. That's a far different thing from having pathological forgetfulness. Not remembering that we went out to dinner last night or what I had for breakfast this morning and forgetfulness that really intrudes on quality of life and longevity. The friend you were referring to.

[00:07:51.050] - Dr. Lemanne 

I want to go back to the brain is insulted idea that you had. That's really interesting. Say a little bit more about what you mean by the brain is insulted by the idea that there's a mono therapy. One approach.

[00:08:02.670] - Dr. Gordon

Well, I would say if the brain could have a persona, it would either be insulted if they're sort of like uppity or laugh at us. The brain is so complicated. I constantly try to think of analogies for this because 

[00:08:16.600] - Dr. Lemanne 

So this is perhaps. The way you think about yes, dementia. This is how you approach it. Your intellectual framework for approaching dementia is to argue back against that idea with some emotion behind it, 

Dr Gordon

with some emotion behind it, 

Dr Lemanne

that there's one bullet.

[00:08:29.480] - Dr. Gordon

And the inputs to the brain are not only multitudinous, what the food you eat, the fuels, the hormones, if interactions you have with the body. And each one has a cascade of effects that can amplify or diminish its own original influence. So, for instance, the one that comes to mind, because you just said relatively permanent, like bone, and I think yes, but bone is actually not that permanent. It is also in a state of flux.

[00:09:07.290] - Dr. Lemanne 

Absolutely.

[00:09:08.000] - Dr. Gordon

And so one of the things I really enjoy treating in my practice are complaints of older women. And again, it's probably two-to-one women-to-men who get problems of diminished bone density or osteopenia or osteoporosis as they get older. And conventional medicine says, well, now, finally they do say take a little vitamin D. They say take calcium. And when it gets too bad, we'll give you a pretty risky drug that will solidify up your bone a little bit. And I say, or you can do a bunch of things that contribute to the process of the bone's own nature. So our bones and the nerves in our brain are constantly remodeling themselves.

[00:09:55.360] - Dr. Lemanne 

No. Well, there's a big connection between bone health and brain health. 

[00:09:58.990] - Dr. Gordon

There is. And many of the things that we would do to benefit brain health also benefit bone health, gum health, and gum health affects brain health.

[00:10:11.720] - Dr. Lemanne 

Oh, my goodness. Okay, so it's all connected.

[00:10:14.070] - Dr. Gordon

But it’s more connected than just being linear. So let's take the gums, because now I said that that's interesting to me. So one of the experiences I have quite frequently is I get a desperate call from a patient or the relative of a patient who says, I saw in the news today that infections of the gums are thought to be the major cause of Alzheimer's. I say, well, they are potentially one cause of Alzheimer's. And so if we were going to help you not have that infection in your gums, I would tell you to floss your teeth. Use a gentle antimicrobial herbal toothbrush. Toothpaste is what I really meant. Use an electric powered toothbrush with this herbal antimicrobial toothpaste. If you're a woman to think about using hormone replacement therapy later in life.

[00:11:12.680] - Dr. Lemanne 

Wait a minute. Hormone replacement therapy helps gum health?

[00:11:16.430] - Dr. Gordon

It does.

[00:11:17.630] - Dr. Lemanne 

Interesting. And also brain health. Wow. Okay.

[00:11:20.780] - Dr. Gordon

Yes.

[00:11:21.240] - Dr. Lemanne 

Okay.

[00:11:21.980] - Dr. Gordon

So by flossing your teeth more, then you're better able to eat more foods. Chewing enhances brain health. And you're better chewing enhances brain health.

[00:11:35.390] - Dr. Lemanne 

Someone who chews tough stuff, raw things or sinewy meat, they're going to have a better brain than someone who drinks their food.

[00:11:44.410] - Dr. Gordon

If they are in every other way the same. Yes, that's true. So there's a feedback. Feed. Chewing. Okay, we're talking about eating, but there is a feedback mechanism whereby having better gum health enables you to keep your gums, keep your teeth, make you a happier person, make you more sociable. That helps brain health, too, being more sociable. So hermits might live and be a healthier life, but in general, the people who are more socially integrated because they have better gums and then they're not only chewing their food, which helps their brain, but they're going to the bridge club, which they still know how to play because they've kept their brains. And they've got a group of friends, which also helps their brains.

[00:12:29.240] - Dr. Lemanne 

So we've been talking about bones and gums and social input and brain health and hormones. This is getting really complicated. How do you approach a patient who comes to you, say, in your research and says, I have memory problems. What can I do? Can you help me?

[00:12:48.020] - Dr. Gordon

And I will say, yes, I have great confidence. I can help you, but it's complicated. How do you study the inputs to a chronic disease unless you can put in more than one thing at a time?

[00:12:59.950] - Dr. Lemanne 

That's a favorite topic of mine. We should probably do a whole episode on this. But the idea that large, randomized, controlled trials where there's one independent variable can help us cure the most devastating chronic diseases of modern time, that idea has been put to rest. There has been no, none, zero cures of things like Alzheimer's, cancer, heart disease.

[00:13:25.260] - Dr. Gordon

Something we do all the time. It's not monotherapeutic, right?

[00:13:28.820] - Dr. Lemanne 

So heart disease is a little bit different. They're ahead of us because they do think that diet and exercise matter in that arena. But in cancer and dementia treatment, neurological conditions, there has been no zero cures from that type of trial. It's the wrong tool. It is using a hammer to try to drive a screw into some wood. It's just not really going to work very well. We need new trial designs.

[00:13:52.050] - Dr. Gordon

Dr. Bredesen first came up with an observational trial, took ten patients, nine out of ten after starting.

[00:13:58.140] - Dr. Lemanne 

Remember that? It was published in Aging.

[00:13:59.750] - Dr. Gordon

It was published in the Journal of Aging. And we'll put that in the show notes, which actually enabled him to entice more significant funding for the trial, which I consider myself very lucky to have been a part of. So this was published in the Journal of Alzheimer's Disease this summer. And the term used, and this is not specific to our program, but others as well, is rather than systems approach, it's a Precision Medicine approach to Alzheimer's disease. And in it, three physicians had 25 patients, and each one was evaluated back and forth a dozen different ways. The very first evaluation we did was asking somebody who knew them well, how did they seem to you? We had a form that they would grade evaluate the person who became a subject in the trial. We would give the person a simple, interactive cognitive test, things you could just do in a doctor's office and then ask them to take a test on the computer. And these tested the difference between whether your impairment was memory. For some people, it was really just memory. Is it visual memory or verbal memory, or is it composite memory for verbal and visual?

[00:15:11.050] - Dr. Gordon

Verbal, visual and working memory working altogether.

[00:15:14.550] - Dr. Lemanne 

Working memory is what?

[00:15:15.860] - Dr. Gordon

Can you remember what I told you in the beginning part of this section of the test? You're going to have to rely on that to complete this task I'm going to ask you to do right now.

[00:15:24.940] - Dr. Lemanne 

So are they prompted to remember something on purpose?

[00:15:27.470] - Dr. Gordon

No.

[00:15:27.770] - Dr. Lemanne 

Remember these three things.

[00:15:29.050] - Dr. Gordon

Those are the specific visual and verbal memory or that's in the simple test. So some of it is directive. 

Dr Lemanne

It is pretty complicated. 

Dr. Gordon

As the designer of the test, this is CNS Central Nervous System V S, Vital Signs likes to say is, this is not an IQ test. This is a brain pathways test. So, for instance, you could have an overall score that looks not that great, but where you look is that you're really failing visual memory because you have developing cataracts or macular degeneration or something that your eye doctor can treat. So they separate all these different pathways.

[00:16:05.110] - Dr. Lemanne 

So it's complicated in the background. But for the subject taking the test, they just sit in front of the computer and follow instructions.

[00:16:12.140] - Dr. Gordon

They follow instructions.

[00:16:13.260] - Dr. Lemanne 

And it's not complicated for them to execute this test.

[00:16:16.150] - Dr. Gordon

It is complicated if they have any cognitive impairment. So that was a part of our evaluation process where they were mightily supported. Somebody sat next to them and said, we're going to do Section one now. These are the directions for section One. Do you understand Section One? I can't help you with section one. Hand, I didn't. But a blind tester who didn't know anything about where that patient was in their well-being or treatment protocol. We also did an MRI and a pretty sophisticated MRI of the brain. So if you go to a conventional neurologist, they do an MRI, really to see, do you have atrophy? Do you have inflammation? They look for a handful of things. We looked at more. We looked at the relative volumes of the hippocampus crucial to memory. We looked at the relative volume of the ventricles of the brain, the fluid filled parts of the brain. And they're asymmetrical if you've had significant traumatic brain injury as part of your medical history.

[00:17:14.990] - Dr. Lemanne 

Okay.

[00:17:15.550] - Dr. Gordon

And that would make some areas of the brain seem enlarged and seem smaller. Some areas, one of my patients on the MRI, her hippocampus, the memory portion was up above the 90th percentile. And before you think that's great, that she's really wow, she must have had a great memory. No, she didn't. She qualified for the test. Her hippocampus was swollen, so we could distinguish the normal range of volume of each of the different brain components versus atrophy versus swelling.

[00:17:49.980] - Dr. Lemanne 

So there's a lot of variety in everything. There's variety in the MRI scans, in the findings, the symmetry. Some people might have a symmetric brain and others may not. In ventricles the size of the hippocampus, small, large, either way can be a problem. And then, of course, the performance on this test. So there's really no way you could have a homogeneous group and just alter one variable and test it.

[00:18:17.420] - Dr. Gordon

Absolutely. And we haven't even gotten to the blood, urine, and feces and saliva.

[00:18:22.180] - Dr. Lemanne 

I can imagine what you tested the blood for. What did you test the urine, feces and saliva for? Start with the urine.

[00:18:27.880] - Dr. Gordon

The urine we tested for remnants of environmental or mycotoxins.

[00:18:33.590] - Dr. Lemanne 

Oh, so you're looking for intoxication.

[00:18:35.630] - Dr. Gordon

Intoxicants or toxicants as contributors. So one woman had a very high level of a toxicant that they figured out came from the copy machine that she was sitting next to at work. That was an old-fashioned copy machine that emitted something that showed up in her urine to a really alarming degree of toxicant.

[00:18:56.710] - Dr. Lemanne 

Well, what about the feces? What are you looking for in there?

[00:18:58.920] - Dr. Gordon

That's a test we almost like to do before we start everything else. So we are looking for the things that anyone would look for. Are you digesting your food? Are you bleeding?

[00:19:08.890] - Dr. Lemanne 

Wait a minute. People don't digest their food well and that can make them demented?

[00:19:12.670] - Dr. Gordon

That's right. So you were saying that we are our food. That what we eat every day.

[00:19:19.430] - Dr. Lemanne 

I guess I should amend that. What we absorb.

[00:19:21.370] - Dr. Gordon

Exactly. So are you absorbing your food? And cows are brilliant, right?

What? Is she changing the subject? No, cows eat grass and never I.

[00:19:31.530] - Dr. Lemanne 

Cannot say I've never had cows and brilliant in the same sentence in my brain before. But carry on.

[00:19:38.650] - Dr. Gordon

I guess I would have to really qualify that and say the physiology of a cow is brilliant. That cow can eat grass all day and make ribeye steaks, whole cream and butter brilliant. 

Dr Lemanne

Brilliant, I agree. 

Dr. Gordon

There some of my favorite foods, both of ours, right? So a little bit we're the same way in that what we eat has to be broken down in our stomachs, absorbed in our small intestine. Are we done with that? Does the colon just make feces? No, in the colon, we ferment our foods and make short chain fatty acids.

[00:20:17.360] - Dr. Lemanne 

And all the organs along the way then must, the pancreas, the liver, the gallbladder, the various parts of the small intestine. You're saying that all of those have to be working or supported?

[00:20:28.710] - Dr. Gordon

Yes.

[00:20:29.550] - Dr. Lemanne 

Or intervene or you might become a brain casualty.

[00:20:32.630] - Dr. Gordon

That's right. And we tested this in a slightly different way. It's a very interesting interaction between our intestines, which end up with fecal matter at the last result, and our bloodstream that has to absorb all the goodies from our colon without absorbing the fecal matter that's sitting at the end of our colon. So we have to let good things leave the intestines and go into the bloodstream, but not the bacteria.

[00:21:02.040] - Dr. Lemanne 

So you're saying that poop can cross the intestinal wall and get into the bloodstream?

[00:21:06.780] - Dr. Gordon

Not poop itself, but the bacteria that thrives in a healthy gut. Your gut is not sterile. The small intestine may or may not be sterile. That's a little bit of dispute. The colon is definitely not sterile and the transition zone is not sterile. And you do not want to have a leaky gut. So you do have a leaky gut. And I'll tell you the situation which you have a leaky gut.

[00:21:30.180] - Dr. Lemanne 

Me personally?

[00:21:30.950] - Dr. Gordon

You personally. You exercise vigorously?

[00:21:34.330] - Dr. Lemanne 

I do. It's good for me. 

[00:21:36.900] - Dr. Gordon

It is good for you. It's really good for you. And in the time period directly after physical exercise, you have a leaky gut.

[00:21:43.530] - Dr. Lemanne 

Really? So there's some translocation of that matter from the gut to the blood just from exercise?

[00:21:50.670] - Dr. Gordon

From exercise, because the barriers between the cells that line the intestines lose their tight junctions, and that's literally what they're called. And you get a leaky gut. And the healthier you are, the more quickly it seals up again.

[00:22:06.360] - Dr. Lemanne 

Is there some hormesis? Please say yes, there's some Hormesis.

[00:22:09.360] - Dr. Gordon

It's all for the good in the end. Yes. There's a degree of hormesis, and one of the things we tested for, and this was in a blood test, was people's reaction to the substance in wheat bread, which we call gluten. People who react to gluten exuberantly know they have celiac disease, and they can't have any gluten, or their intestines are terribly.

[00:22:33.840] - Dr. Lemanne 

I think you're talking about celiac disease.

[00:22:36.330] - Dr. Gordon

I am.

[00:22:36.960] - Dr. Lemanne 

There is an intestinal lymphoma that patients with celiac disease who don't attend to their gluten avoidance needs can develop. Yes.

[00:22:44.040] - Dr. Gordon

What I encounter much more often than celiac disease, because those people are usually diagnosed early, I encounter non celiac gluten sensitivity.

[00:22:52.700] - Dr. Lemanne 

That doesn't seem to be related.

[00:22:55.830] - Dr. Gordon

To lymphoma, to this malignant. Okay.

[00:22:58.830] - Dr. Lemanne 

Any relationship hasn't been discovered would be a more accurate statement.

[00:23:02.930] - Dr. Gordon

I'll leave that as a pondering thought in my mind and keep asking you every six months.  

[00:23:06.920] - Dr. Lemanne 

I want to go back to you test blood, urine, feces and saliva. So I wasn't going to ask you about blood, but I am going to ask you about blood, because now you talked about feces and blood, but first talk about urine. What are you looking for in the urine?

[00:23:19.000] - Dr. Gordon

So in the urine, we're doing the toxins.

[00:23:21.030] - Dr. Lemanne 

Yes, you did talk about that. The urine, the feces and the saliva.

[00:23:24.030] - Dr. Gordon

Saliva. We did genetics tests on people. We did a genetics panel through a wonderful, in my experience, medical commercial lab called Intellxx DNA.

[00:23:35.730] - Dr. Lemanne 

We'll put that in the show notes.

[00:23:36.870] - Dr. Gordon

Not yeah, link to it. And they do have a nice orientation on their website, who took us through the genes that had a cognitive effect in various ways. So there is one gene that is pretty well established, I think, in all circles, as contributing to Alzheimer's disease, and that's the APOE4  gene. It's well enough known that there are.

[00:24:00.860] - Dr. Lemanne 

Several versions of APOE, right? Two, three and four.

[00:24:04.240] - Dr. Gordon

Two, three and four. APOE Three is the common one, and you get a copy from your mom and a copy from your dad, and you kind of hope they're both threes. If you lived on the savannah as an early primate coming out of the trees millions of years ago, you actually hoped you had APOE fours, and those were the dominant genes in that day. And it enabled us to tolerate better starvation, because APOE fours are great at storing fat. They have a heftier inflammatory response, which is great in an infectious and inflammatory environment. Not so great when you have a slightly leaky gut. In a modern environment, you don't want a constant source of inflammation. The more modern gene version of that is APOE two, which is cognitively protective, but a cardiac problem. So you want to have two copies of APOE Three, and just the whole topic of genetics, which we could talk about till the cows come home, the brilliant cows. There’re so many genes that modify the expression of APOE Four.

[00:25:19.580] - Dr. Lemanne 

You can help people dampen down the bad effects of that gene and increase the good effects of that gene.

[00:25:26.060] - Dr. Gordon

That's right.

[00:25:26.640] - Dr. Lemanne 

You can modulate the gene with lifestyle choices.

[00:25:30.970] - Dr. Gordon

I had my own curiosity to solve. I have a patient who had two copies of APOE Four, meaning she got a deleterious copy from mom and from dad.

[00:25:41.310] - Dr. Lemanne 

And what does that mean overall in a population? What's her risk of developing Alzheimer's?

[00:25:45.540] - Dr. Gordon

Six to 30 times the kind of going rate. So it's a big hit to have two copies of APOE Four. What was interesting, what I was curious about, I knew she had APOE Four/Four pretty early on. No history of dementia anywhere in her family. Even though a lot of them did have this APOE Four gene, they had none of the usual APOE Four augmenting genes.

[00:26:08.300] - Dr. Lemanne 

APOE Four has to be in a context of some other genes that accelerate the dementia process?

[00:26:12.140] - Dr. Gordon

And it almost always is.

[00:26:15.510] - Dr. Lemanne 

It's all pointing to such a precision or personalized approach. That's the only approach that makes any sense whatsoever. But go back to blood. So what is it that you test in the blood? I wasn't going to ask you, but I'm so curious.

[00:26:29.890] - Dr. Gordon

You know, they call me Dr. Dracula, and that wasn't even for the study. For the study, it's a lot more.

[00:26:36.110] - Dr. Lemanne 

I've heard your patients say, and Dr. Gordon had me draw 20 vials of blood.

[00:26:44.370] - Dr. Gordon

We did an exhaustive conventional panel. So tests that you would do in any doctor's office, slightly augmented. So we do a more thorough lipid panel. We do a homocysteine. I was going to tell you, one of the things that was beneficial from doing that genetics panel was learning some of the multitudinous ways we can normalize homocysteine. So homocysteine is an amino acid that is kind of litter in the blood vessels. It's a marker of inflammation. We should have a whole podcast on homocysteine. One of my favorite subjects, and I learned some ways to optimize homocysteine that I hadn't learned before. Homocysteine litter in the small blood vessels creates inflammation in the heart.

[00:27:32.180] - Dr. Lemanne 

I'm sorry, what does it do in the small blood vessels?

[00:27:33.200] - Dr. Gordon

creates inflammation.

[00:27:35.820] - Dr. Lemanne 

Inflammation in the small blood vessels.

[00:27:37.500] - Dr. Gordon

And where are your small blood vessels? Your brain, your heart and your kidneys.  So you do want to optimize your homocysteine and the specific malevolent role it plays in the brain. You talked earlier how our bodies are constantly refreshing themselves all the time.

[00:27:58.970] - Dr. Lemanne 

Big turnover.

[00:27:59.870] - Dr. Gordon

Big turnover. And everybody knows that you scratch your skin and somehow it heals. 

Dr Lemanne You’re not the same person you were three years ago, the same person, literally. 

Dr. Gordon   What hasn't been acknowledged is that or is more recently acknowledged is that continues to happen in the brain in older people, that you are building new brain cells as you age. Neuroplasticity is a little bit like, oh, this roadway is blocked. Is there an alternate route to my destination? But actually oh, my brain is shrunken and puny. Can I lift weights for my brain and build new brain cells? So one of the ways you build new brain cells is with the omega.

[00:28:40.620] - Dr. Lemanne 

Your answer is yes.

[00:28:41.960] - Dr. Gordon

Older people can build new brain cells. And there are two of the supplements that we used with people. One of them is the DHA component of omega three, fish oil. Here fish oil.

[00:28:57.700] - Dr. Lemanne 

And there are several types of omega threes in fish oil, and one of them is DHA.

[00:29:04.510] - Dr. Gordon

And DHA is very helpful. It's used in brain injury settings. It's very helpful for rebuilding new brain cells. But if your homocysteine level is too high, DHA can't get into the hippocampus to build new memory cells, short term memory cells.

[00:29:23.370] - Dr. Lemanne 

That's another one of these interactions that you have to be aware of if you want to improve your brain health and probably your overall health. Yeah, very fascinating.

[00:29:33.750] - Dr. Gordon

So we did all that with the blood. We also looked to see if people had evidence of leaky gut and people who have leak.

[00:29:42.160] - Dr. Lemanne 

Did you do that with the feces?

[00:29:43.390] - Dr. Gordon

No, that was the blood.

[00:29:44.830] - Dr. Lemanne 

What were the tests for that?

[00:29:46.430] - Dr. Gordon

So there is a proprietary lab called Cyrex that looks for antibodies to gliadin in the blood. And if it's a really high marker, yes, it'll show up and you can do it in conventional tests. But they also looked for evidence of zonulin. So we talked about how the gut becomes leaky, and that's under the influence of zonulin. Zonulin is a substance secreted by the intestinal cells that regulates the wall of the intestinal, the lining facing the gut. You subject it to slightly change circulation by a vigorous walk or gliadin because you've eaten gluten or perhaps other environmental or food influences. And zonulin loosens the barrier between the cells.

[00:30:34.920] - Dr. Lemanne 

It kind of dissolves the mortar between the bricks of the intestinal walls?

[00:30:38.990] - Dr. Gordon

It more like loosely separates them. And it should be temporary, but it can be more permanent. Some of the damage that's done from gluten and gluten sensitive people can be everything from enhanced production of Zonulin to diminished ability of the tight junctions to recover themselves, to loss of the small intestinal absorptive surface. So, for instance, one of the clinical findings that makes me think somebody might be gluten sensitive is I say, oh, you have osteopenia. Means you probably haven't absorbed early osteoporosis or early osteopenia early in life. Meaning you probably haven't absorbed calcium very well over your life. And you have iron deficiency anemia. Those are both absorbed in the small intestine. And the surface of the small intestine is either permanently or temporarily damaged by exposure to gluten if you are sensitive to it. So that's a very long-winded answer to why I look for evidence, because it's hard to tell somebody. You have to completely give up wheat, rye, barley. And if you're sensitive to those, you're probably also sensitive to dairy. So for at least a little while, you have to give up cow dairy. So I'm looking for evidence. So we had gliadin in the blood, zonulin in the blood, evidence of antibodies to certain food stuffs, and leakage in the gut usually corresponds to a leaky blood brain barrier.

[00:32:12.900] - Dr. Lemanne 

Oh, that does not sound good.

[00:32:15.370] - Dr. Gordon

Exactly. So you walk by somebody who's just done their nails, had a permanent and is working in a print shop, so they have oils and solvents coming off their clothes, and you inhale it. You don't really want those molecules to enter your bloodstream and then go into your brain.

[00:32:36.030] - Dr. Lemanne 

No.

[00:32:36.870] - Dr. Gordon

As the woman in our study, who is sitting by a copy machine which emitted some of those molecules, it did go into her bloodstream, showed up in her urine, and the worry was that was what was contributing to the inflammation seen in her brain. And we looked for inflammation in the brain in both a blood test, TGF beta-1 and MMP-9, both two markers that can be elevated in other reasons. But if you have reason to believe there might be inflammation in the brain, little white flecks on the MRI, then that might confirm it.

[00:33:10.960] - Dr. Lemanne 

So then you check those tests in the TGF beta and MMP-9 in the blood, and if those are elevated, that is somewhat confirmatory.

[00:33:19.850] - Dr. Gordon

Exactly. Somewhat confirmatory.

[00:33:21.640] - Dr. Lemanne 

Right.

[00:33:21.870] - Dr. Gordon

And so that was part of the whole slew of Dr. Dracula 25 tubes of blood that we did at the very beginning of the test and checked for vitamin performance. Yes, your B Twelve level is great, but it's not really performing very well in your bloodstream. And people say, oh yeah, I take this vitamin. Well, it's not showing up in your bloodstream, it's not functioning well in your bloodstream. We need to give you a better version of it. And that frequently happens with B vitamins and homocysteine. A lot of different B vitamins, they all have little numbers attached to them. B6, B9, or B12 helpful in lowering homocysteine. But if you go and get a cheap drugstore, no-name B vitamin, B complex, the B complex, those B vitamins are in forms that may not be suitable for your genetics. And you could take them all night and all day and never lower your homocysteine.

[00:34:17.550] - Dr. Lemanne 

And some people will have a bad reaction to a form of B-9 or folate called folic acid. And that's a little bit idiosyncratic, but people can do poorly on that particular form of that vitamin.

[00:34:28.110] - Dr. Gordon

I have my thoughts about why they don't do well, but in what way do they not do well?

[00:34:31.880] - Dr. Lemanne 

This is purely anecdotal. I've heard of people who have taken folic acid for a while and started feeling very fatigued, have some cognitive issues, and when they stop or replace it with folate, they do well. When are vitamins bad for you?

[00:34:44.560] - Dr. Lemanne 

Sometimes they are.

[00:34:45.440] - Dr. Gordon

Sometimes they are. And in that sense, the genetics are helpful. And so, for instance, there's a doorway through which B nine has to go. And if you crowd your waiting room with folic acid, which is added to so many processed foods, even if you take an additional proper form of folate to get through your little doorway, if the waiting room is crowded with folic acid, the good form that you take in supplement may never get through. So you not only have to eat the good forms, you have to avoid the hazardous forms.

[00:35:21.420] - Dr. Lemanne 

Interesting. So that might even be a reason that some people do poorly with wheat products in this country where by law, the wheat product has to be fortified with certain B vitamins. In fact, in oncology there's a finding where American patients getting the exact same treatment for colon cancer would have huge numbers of side effects compared to European patients. And it was finally traced back to the fact that in the United States, there's a requirement for wheat products and some other products to be heavily fortified with B vitamins, and that caused more side effects in those patients who were eating those foods. But that's another topic. I want to come back to the I think you talked about mycotoxins.

***

[00:36:04.150] - Dr. Gordon

That is a pretty common finding. And so it was introduced to this cognitive treatment network of therapeutic options. I thought so.

[00:36:15.570] - Dr. Lemanne 

Mycotoxins in dementia. Yes. This is a big issue.

[00:36:16.920] - Dr. Gordon

It is a big issue. And I thought, I am just not going here until I had my first success with a patient and was kind of night and day. And this was a patient who had undergone surgery for her cancer, a current patient of yours. It was thought that her cognitive impairment that she developed after her surgery was probably attributable to her anesthesia. It might have been. There are genes in APOE 4 particularly that make people poorly suited to general anesthesia. But in evaluating her, we evaluate people.

[00:36:46.600] - Dr. Lemanne 

Can get lingering brain issues after general anesthesia based on their genotype.

[00:36:51.480] - Dr. Gordon

Yes. And they need a lower dose of anesthesia.

[00:36:57.050] - Dr. Lemanne 

And of course they're tested for this before they undergo anesthesia.

[00:36:59.050] - Dr. Gordon

Only if they're patients who see a doctor who's savvy about this kind of thing.

[00:37:03.830] - Dr. Lemanne 

You'd say that's not being I would.

[00:37:05.380] - Dr. Gordon

Say in general that's not being tested. But what anesthesiologists generally do respect is if you say my mother, my brother and my great aunt Tilly all have terrible responses to anesthesia, the anesthesiologists will respect that, but they typically don't do genetic tests beforehand.

[00:37:21.090] - Dr. Lemanne 

Okay.

[00:37:21.970] - Dr. Gordon

So she was thought to have a response to her general anesthesia, but in process of talking to her and testing, we determined that she had mycotoxins in her urine. So you and I have both been around a moldy location. Whether you can usually tell, right? You can usually tell, but not always.

[00:37:40.710] - Dr. Lemanne 

Not always. You can't know.

[00:37:43.270] - Dr. Gordon

No, not at all our problems with mold as a human species really amplified hugely with the invention of sheetrock.

[00:37:54.550] - Dr. Lemanne 

Sheetrock? You mean our walls?

[00:37:57.450] - Dr. Gordon

Because now mold can hide on the inner side of sheet rock. How many people have ripped out a wall and found out there was mold growing behind it? And a sensitive person unfavorable response would say, oh, mold, there's a nice place for you in the nasal cavity. You could live there or you could live in the gastrointestinal tract.

[00:38:20.090] - Dr. Lemanne 

So they actually infect the body? Yes, they come from behind the walls. This is terrible. This is a bad science fiction movie.

[00:38:27.160] - Dr. Gordon

That could be terrifying. 

Dr Lemanne

Couldn't it give you Alzheimer's disease? 

Dr Gordon

They can definitely give you Alzheimer's disease. And when mold reproduces, it reproduces by sending out spores. And the spores are armed with toxins so that they go to live in a new place. And those toxins impair the immune response to that mold a little bit and enable the mold to set up residence in a new part of the body.

[00:38:54.400] - Dr. Lemanne 

This sounds like cancer. This is what cancer cells do. They prepare what's called a premetastatic niche where the inflammation is just turned down a little bit in terms of cancer killing properties and turned up a little bit in terms of cancer nurturing properties. And then the cancer cells move in and form a metastasis in that new organ.

[00:39:14.790] - Dr. Gordon

This is very much like that. So what we measure in people is that mycotoxins, the armed mechanism of the mold spores, we measure that in the urine. And if you eat any food that's sold in bulk or eat something that's a little moldy, you'll ingest some mold, it will try a little bit to reproduce. There'll be a few spores, there'll be a little bit of mycotoxins. So there is a normal range of mycotoxins, or an acceptable range of people.

[00:39:46.720] - Dr. Lemanne 

Are most people pretty tolerant of the amounts that we encounter every day?

[00:39:50.320] - Dr. Gordon

It's hard to know because many of our tests that we do, we do on all our patients. And I can say, oh really? Only a third of my patients have problems managing their homocysteine. I only do these mold tests on patients where I'm worried that they have mold. And so that would be primarily cognitive patients, but it can cause other problems too. So I have a little YouTube presentation of a talk I did once, and we can put that link in the show notes. And I call mold illness the great imitator because it could look like fibromyalgia, it could look like any kind of chronic.

[00:40:26.560] - Dr. Lemanne 

So some of these weird, unknown, mysterious diseases might actually be a problem with mold.

[00:40:33.030] - Dr. Gordon

Or Lyme. We also tested everybody for Lyme in this study. So then we have to encourage a reluctant body to take down the burden of mold toxins and then see if it, on its own, can get the mold out of the body. Or do we have to give antifungals, either nasal or oral.

[00:40:53.650] - Dr. Lemanne 

You would also have to remove the environmental source.

[00:40:55.710] - Dr. Gordon

Big point. Yes. And sometimes that's the hardest. So the study that we did that was published this summer in Journal of Alzheimer's Disease was interrupted midstream by this little epidemic that happened in March of 2020.

[00:41:13.110] - Dr. Lemanne 

You were right in the middle of your study when that.

[00:41:15.780] - Dr. Gordon

Right in the middle of our study. And there were a couple of people who had just been diagnosed with not only pretty serious mold illness, but living in a very moldy environment and had begun to secure services to remediate their mold. And all that was taken off the table when the pandemic hit. You couldn't have people coming into your house. You couldn't go stay with friends. Right. So we had 25 patients in this study at the end of nine months. And we did all this cognitive testing that we were talking about, including the report of the close loved one and MRIs. We tested them at the beginning of the study. We jumped through all these hoops, and we've talked about a tiny portion of them normalizing homocysteine, properly replacing nutrients that are lost, treating mycotoxins, treating Lyme disease, replacing hormones that are lost. And at the end of nine months, 22 of the 25 people were markedly better. In a few ways, every cognitive test to which they were subjected, they had a statistically significant degree of improvement. The evaluation of their loved ones, 22 out of the 25, statistically significant improvement. MRIs, there is a normal amount of atrophy that's expected in a brain over time.

[00:42:43.110] - Dr. Gordon

We would have expected over nine months for them to have three quarters of a year of brain atrophy, but they had either less atrophy than that or improvement in atrophy to the point of having greater brain volume.

[00:42:59.280] - Dr. Lemanne 

So their brain, instead of shrinking, either.

[00:43:01.640] - Dr. Gordon

Shrank less or grew slightly rebuilt.

[00:43:05.750] - Dr. Lemanne 

That's quite impressive.

[00:43:07.750] - Dr. Gordon

So on every marker that we had of their cognitive improvement and the metabolic markers like blood sugar handling and homocysteine, things that we tested before and after, marked improvement in 22 out of the 25, you think, oh, yeah, that's pretty good. Well, how does that compare to other Alzheimer's research? For decades, the gold standard of the successful Alzheimer's treatment that has yielded us a couple of drugs that are commonly used in Alzheimer's therapies give the patients a small blip of improvement in cognitive function that's transient and do not alter the course of the disease. So if Aunt Tilly has Alzheimer's disease and she's confused, you can give her this drug, and it will improve her cognition for either not at all or for a temporary period of time.

[00:43:58.920] - Dr. Lemanne 

You mean a few days? A few weeks? A few months.

[00:44:01.040] - Dr. Gordon

It could even be a few months. But if you actually tested her cognition, it wouldn't influence the course of the disease. But recently, there have been some breakthroughs, and there's one or perhaps two drugs that do this earth-shaking intervention of slowing the rate of decline in all the tests that our patients had marked improvement at nine months.

[00:44:24.810] - Dr. Lemanne 

So we're talking about drugs which can kind of put the brakes on the downward trajectory, but you're still going down yes. Versus your research, which found that you could actually not only put the brakes on, you could bring it to a complete halt, and in some cases reverse. They could go back uphill.

[00:44:45.430] - Dr. Gordon

And in 22 out of the 25 patients, they really went they went back uphill. Back uphill.

[00:44:51.610] - Dr. Lemanne 

And that's quite remarkable.

[00:44:53.110] - Dr. Gordon

That is quite remarkable.

[00:44:54.930] - Dr. Lemanne 

Were these interventions tremendously expensive?

[00:44:58.350] - Dr. Gordon

Not compared to the drugs.

[00:45:00.570] - Dr. Lemanne 

Okay. What were the most expensive parts of things and what were the least expensive?

[00:45:05.150] - Dr. Gordon

The most expensive thing would be if you really needed to remediate your house of mold. So treating the house treating the house expenses or buying a sauna or taking a sauna on a regular basis, but each individual…

[00:45:21.820] - Dr. Lemanne 

Wait a minute. Saunas. Taking a sauna. You like, this can influence the course of Alzheimer's?

[00:45:29.430] - Dr. Gordon

Can it influence the course of everything? Dr. Lemanne?

[00:45:33.450] - Dr. Lemanne 

That'll be another podcast.

[00:45:34.720] - Dr. Gordon

You know what's interesting about saunas? Saunas are part of helping the body mobilize mold toxins so that they can be excreted with the help of a binder or any toxin. They mobilize things. They get things out of inattentive spots into bloodstream, urine, and feces. The country that probably does the most saunas and has a corresponding low rate of cardiovascular disease is Finland. Another place where they have a lot of saunas, a country I've visited greatly enjoyed, is Iceland. They also have a greater prevalence of Alzheimer's disease than we do in this country. Finland is number one.

[00:46:16.540] - Dr. Lemanne 

They have more Alzheimer's disease per capita. So that sounds like saunas are bad.

[00:46:21.870] - Dr. Gordon

A moldy sauna would be bad. This is an unknown that we have to look into. And I'm going to consult one of the scientists whom I respect the most, who happens to also be part Icelandic and find out what he thinks about why Iceland has a higher rate of Alzheimer's disease than the United States. But Finland the worst of all, and the UK is second or third up there.

[00:46:44.210] - Dr. Lemanne 

Is it something about APOE four?

[00:46:46.200] - Dr. Gordon

I don't think so. So APOE four is quite prevalent in Africa, and the incidence of the disease is less 

[00:46:53.540] - Dr. Lemanne 

Interesting. Okay, well, there's so many mysteries here. Dr. Gordon, thank you so much for telling us about your research in the reversal of dementia. Just fascinating. I really don't know of anybody else in the world who's doing this. We'll put up the information that we want to link to in the show notes so people can go.

[00:47:10.510] - Dr. Gordon

And I want to give people a couple of resources. So the constant question I get is, well, this is great, but what is Aunt Iris going to do? There are online resources for people who are still functioning very well, but believe themselves at risk for it, and online resources as well, for people who need to be hooked up with a more intensive therapeutic approach. And we'll put both those links in our notes because most people would love to have the blinders taken off, find out where they are and find a path forward.

[00:47:41.160] - Dr. Lemanne 

Yeah. Dr Deborah Gordon. Thank you so much.