[00:00:00.000] - Dr. Hathaway
Well, one thing that's sometimes a real amazing thing is treating sleep apnea. We've seen people who have undiagnosed sleep apnea. They get diagnosed, they get on CPAP, and two or three weeks later, their spouse is calling us saying, Oh, my gosh, he is back.

[00:00:24.620] - Dr. Lemanne
You have found your way to the Lemanne, Gordon's podcast, where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:43.580] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:47.420] - Dr. Lemanne
We've been in practice a long time.

 [00:00:49.100] - Dr. Gordon
A very long time.

[00:00:51.400] - Dr. Lemanne
We learn so much talking to each other.

 [00:00:53.490] - Dr. Gordon
We do. What if we let people listen in? 

In today's episode, we have the pleasure of a chat with my longtime friend and colleague, Dr. Ann Hathaway. Dr. Hathaway enlightens us on some of the details of her work with Dr. Dale Bredesen, delving into some aspects of the treatment for mold toxicity and hormone replacement therapy for older women. Dr. Lemanne also has a chance to share some insightful details about her innovative work with hormone pulsing as potential treatment for some hormone sensitive cancers. Join us as we explore these exciting topics and more. It's my pleasure today to welcome to our podcast, our guest, Dr. Ann Hathaway, and she's well known among functional medicine doctors for her clinical achievements. But before I review a few highlights, I just have to celebrate our own friendship because I hope you're all sitting down. We have been friends for 50 years. We became fast friends our first year of medical school, and since then, we've hiked and windsurved. We spent family time together as well as our time in medicine. I treasure her friendship and blew my mind when I realized it's been 50 years. Over the years since then, our paths have diverged in our practice of medicine.

But we came together again, in my mind, in when we both enrolled at Dr. Bredesen's first conference at the Buck Institute, presenting the details of his proposal, his protocol. He was going over the background and features of the protocol he was developing with some contributions by key speakers, including, and I believe this was a spur of the moment request on his part. I don't think you had heads up warning to this, Ann. When he asked Ann to present information on hormone replacement therapy to this full auditorium at Buck Institute. Is that right? It was last minute.

 [00:03:05.580] - Dr. Hathaway
What happened is in the break, he had mentioned in his opening remarks that estradiol was very important for the female brain, and I was really happy to hear him express that. And so I said to him, You know, Dale, I've collected a bibliography on estradiol and progesterone over many, many years, and I would be happy to share that bibliography with you. He said, Well, how about if you present to the audience today? I mean, literally, so trusting that I wasn't a nut job.

 [00:03:47.560] - Dr. Gordon
I thought you had overnight to prepare, but evidently, you just had the lunch hour. Okay.

 [00:03:53.920] - Dr. Hathaway
I had no time to prepare.

 [00:03:56.580] - Dr. Gordon
You knocked it out of the park. And she's still in our cohort of colleagues, she's still our go-to person about safety, protocol, keeping track of current research, and we're going to talk about some of that today. But where we've really dovetailed since, and I think we started working together in 2018. Ann was a key organizer and protocol designer on Dr. Bredesen's first clinical trial. She worked on the design features and was one of the clinicians and authors. As you know, I've I've told all of you about it before. I was honored and delighted to be part of that trial. For those of you who haven't heard me spiel about it, it was a nine-month trial, and 22 of our 25 patients showed marked improvement in their Alzheimer's disease over just nine months. The last little bio bit I'll put in is that she's still a clinician in his current trial, scheduled to be completed this fall, and we'll see what she can tell us about the progress of that trial. Anything important about your history or current activities that you'd like to share that I missed in that?

 [00:05:10.700] - Dr. Hathaway
No, it's so interesting to hear you describe it. It's very nice, Deborah. Thank you.

 [00:05:17.520] - Dr. Gordon
So after that little background about your work with Dale Bredesen and the protocol, I'd like to hear from you what you're most excited about from our one completed trial trial and the current trial that's in progress.

 [00:05:34.320] - Dr. Hathaway
Well, the one completed trial was exciting and fascinating to work on. I was amazed that eight out of my 10 patients had marked improvement in their cognition.

 [00:05:49.600] - Dr. Lemanne
So let me... I'm going to interrupt there just for our audience. My understanding of this trial was to see if you could affect the timeline, the expected timeline of decline, the expected decline in patients with dementia. Could you just give a very brief outline of what this trial was and what it was looking at?

 [00:06:08.690] - Dr. Hathaway
So there are many studies where they show a slowing of decline, not ours. Ours showed an absolute improvement in cognition on various basic tests, AMOCA and another more complex test called the CNS, Vital Signs Test.

 [00:06:29.480] - Dr. Lemanne
And this This was something that had never been done before, is that correct? As you pointed out, people were looking- As far as we know, this has not been done.

 [00:06:36.860] - Dr. Hathaway
That you show, you take a patient where they are, you put them on a specific protocol, which I could go through in detail. I'd excruciating detail. It's a lot, right? We put them on this protocol. We follow them very closely, these research patients.

 [00:06:57.100] - Dr. Lemanne
And these were not necessarily drug-based protocols, although I think they included some drugs, but they were trying to affect the imbalances and deficiencies in metabolic processes, with vitamins, lifestyle, sleep, exercise, ketosis, fasting, those kinds of things.

 [00:07:17.000] - Dr. Hathaway
Yes, you got it. You got it very correct there. Everybody followed a plant-based, mildly ketogenic diet. We like their ketones to be between one and We optimize their sleep. We really pushed hard for everybody to get over seven hours of sleep, seven and a half if they can. We had them do stress reduction training We used the protocol HeartMath, which interacts with the vagal system, and everybody had to do Brain HQ. We're finding Brain HQ is a brain training system that's set up for... It's a little bit like playing games, but the games are not always fun to do. People complain about them. It's work. I do Brain HQ, and I find it frustrating sometimes, but it's scientifically designed to grow new synapses, and it's clear to me that it does that from both my own interaction with it and my patients.

 [00:08:33.060] - Dr. Gordon
But what you say, Dawn, is true, is that it is work. And we, in fact, coached people that this is your job, that you picked a certain amount of time, depending on the patient, but mostly it was about 30 minutes a day, 5-7 days a week. And we said, this is your job. It is work. You have to do it.

 [00:08:53.660] - Dr. Hathaway
Absolutely. And then exercise, of course, is very, very important part of it. Both moderate aerobic exercise, preferably at least six days a week, 30 minutes, high intensity intervals, three times a week, 15 to 20 minutes. We could go into what all these things are. Strength training, absolutely extremely important.

 [00:09:19.760] - Dr. Lemanne
So there were a lot of things, and that's an unusual part of it. This isn't even the half of it. That's an unusual type of trial. Yeah, absolutely. Tell us why you I was to put so many things in this trial. I think that's really interesting.

 [00:09:35.460] - Dr. Hathaway
Because it works.

 [00:09:37.480] - Dr. Lemanne
Okay.

 [00:09:38.000] - Dr. Hathaway
That's the reason. Because we really knew, honestly, Dale Bredesen really knew. Dale Bredesen developed this protocol after 30 years of bench research, right? Understanding what's going wrong in the brain when you develop Alzheimer's and also other neurological diseases. I mean, he understands much more than your average neurologist about Lewy body, about Parkinson's, about frontotemporal dementia, et cetera, et cetera. Vascular dementia. So his wife, Dale Bredesen's wife, Aida Bredesen, is a functional medicine doctor, long-standing, very, very highly involved in functional medicine. And what happened is Dale, with his bench research, came together with Aida Bredesen, and they talked and talked over several years and had many, many aha moments in that process and were able to put together this protocol. Now, these things that I've just mentioned to you, that's just the beginning. That's what everyone does. But after that, then you have to look at each person individually based on lots and lots of testing. You have to treat insulin resistance, you have to support their mitochondria, you have to address any HPA axis problems, you have to support their sex hormones. That's a pet area of mine. Thyroid has to be optimized. Omega-3 and other fatty acids have to be optimized.

 [00:11:26.320] - Dr. Hathaway
Micro and macronutrients support. You have to look for oxidative stress and address it, both the vascular type of stress or other kinds of oxidative stress. You have to treat atherosclerosis if it's there, microvascular disease.

 [00:11:45.960] - Dr. Lemanne
This is so amazing. And one of the things that strikes me about this is that, if I'm wrong, correct me, but one of the things that Dale Bredesen's research has been criticized is for not taking one, isolating one element and comparing that to a control element, and then looking at the differences between those two. Instead, he's doing the exact opposite. He's taking a whole lot of things and dumping them in. And then, not only that, then he's treating each patient as an N of one and fixing each patient's particular endocrine and metabolic issue. And then putting that back together again. This sounds, from from a certain point of view, absolutely not. But when you think about it, it sounds like it's absolutely the medicine of the future, where we actually look at real life inputs. Everybody has a different diet, everybody has different needs, but there are some overarching things that are needed, and there's a whole lot of things that need to come together. There's synergy between these various inputs. So talk a little bit about that, how you and Dale Bredesen have dealt with, and you, Deborah, this criticism and what your thoughts are about it.

 [00:13:05.440] - Dr. Lemanne
I think it's magnificent. You're developing new designs and new research designs, which is fantastic. Now we have to catch up with the mathematics and the statistics, but I think you're way ahead of the rest of us.

 [00:13:19.280] - Dr. Hathaway
The results, I think, speak for themselves. The point is that you have to address each person individually. Each person has different inputs, different reasons why they have cognitive decline. You have to look at the gut. You have to look at the oral microbiome. You have to look at autoimmunity. You have to look at immune deficiencies. You have to look at chemical toxins, metals, heavy metals, and mycotoxins, and Lyme and other tickborne infections, and treat those. All of that has to be treated to fix the brain. And most people, I mean, almost no one is going to have all of those things. But you have to look. You have to look carefully, and then you have to fix.

 [00:14:11.300] - Dr. Gordon
And then you have to look again later. For those of us For those of you, anyone who's maybe not that familiar with Dale Bredeson's work, there's a wonderful TV program. I guess it's a documentary. Of his work. And what's the name of it, Ann?

[00:14:34.500] - Dr. Hathaway

Memories for Life.

 [00:14:35.920] - Dr. Gordon
Memories for Life. I was thinking of chasing memories, but Memories for Life. And in it, there's somebody who does really well with the protocol. And she's like riding a high kite and doing great. And suddenly she starts declining, even though she's doing everything right. So she has to be put back through that evaluation process to figure out which of the links in the chain has broken for somebody for whom it was very successful for a number of years. And they found mold toxicity and she got better. It is a commitment for the patient and the physician for a lot of attention in the moment and treating Jane differently than George. And then staying on that, we have to keep seeing the patient for years in the future doing a similar amount of re-examining.

 [00:15:32.200] - Dr. Hathaway
Yeah. If things aren't going well, then you start back into the complex of testing, right?

 [00:15:40.640] - Dr. Lemanne
What are some really unexpected results that you saw in your work with your patients in this trial? Was there anything that surprised you?

 [00:15:53.080] - Dr. Hathaway
Well, one thing that's sometimes a real amazing thing is treating sleep apnea. We've seen people who have undiagnosed sleep apnea. They get diagnosed, they get on CPAP, and two or three weeks later, their spouse is calling us saying, Oh, my gosh, he is back. He is so much better. So every once in a while, you have that magic thing that happens. And taking someone out of mold, someone who's living in a very moldy environment, you get them out of there into a safe environment. And someone who's aphasic, someone who's not speaking at all, all of a sudden they start speaking. I've seen that happen. Those are some really very fulfilling moments as far as working with this protocol when those things happen. So even though we go through this huge list and we have to go through this huge list and make sure we're addressing everything, sometimes there are these absolutely the transformative things that can happen over a matter of weeks.

 [00:17:04.480] - Dr. Gordon
And I would say I've definitely seen that with mold. I remember the first patient who came to me, suspected mold, and I thought, I don't want to learn about mold. I'm going to I can't refer it. There's nobody to refer her to. Exactly. And I treated her and her husband came back in a month or so and said, I found all the mold and I've cleaned it out of the house. Oh, my God, there was so much of it. And I said, great. She should come back in a couple of weeks and see me again. And she never came back for a follow-up. I reached out to her. She said, I'm so busy. I'm back at work full-time. I don't have time to come see you. And she was nonverbal when she came in with her husband. And she did go through a mold protocol, but it was really getting her of getting the mold out of her house, which something people ask about is we're all living in the house. Why is she suffering? And we initially addressed that by looking at particular gene configurations. But I've just come to the point we're saying we don't completely know why it affects some people more than others, but the estimate is about a quarter of people are highly sensitive, and the other three members of her family She only had one other, but she could have had three other members of her family.

 [00:18:18.740] - Dr. Gordon
Only about a quarter of people are consistently seriously affected by mold. That's a statistic I think of, and I've even made up a four people walk into a moldy bar joke about it. But is Let's hear it. Four people walk into a moldy bar, and one person says, Oh, this bar is too moldy. I am so allergic. I'm going to sneeze and ruin the whole evening. So that person leaves, and three people are left. So you're still three out of four there. And they all do fine over the evening. And they all inhale mold, and they all have mold living in their bodies. But two of the people, their mold starts to reproduce in their body, and their immune system just overwhelms gets rid of it. But that other person starts going downhill, maybe in a couple of months, depending on how many times they've been exposed to mold, maybe not for a year. And then they recall, Oh, yeah, I was in that moldy bar weekly for a couple of months. But it's only one person who walks into that moldy bar out of the four. Right, the laugh is in the first line.

 [00:19:22.000] - Dr. Gordon
Okay, I get it. It's not a funny joke at the end, but the laugh is in the first line and it gets people's attention. But it's about a quarter of people who really respond badly. And the rest of us, knock on wood that we're all in the three out of four category, can tolerate a fair amount of mold and maybe get allergic or stuffy nose, but our body takes care of it.

 [00:19:44.240] - Dr. Hathaway
Yeah, I had a Lewy body patient who was sundowning really badly. And I told his wife, You need to check the house for mold. We'd look for lots and lots of different things. Turned out there, a whole system was infected with rodents. Rodents had gotten in there. So it was all this rodent detritis and thick mold growing in their HVAC. They had the entire thing removed, put in a new one, and he was amazingly better a week after that HVAC system was replaced. Right.

 [00:20:24.040] - Dr. Gordon
Two patients of mine, a couple, work in the same place, and she set out the little petri dishes and discovered the mold coming out of their work HVAC. She set out the little petri dishes and discovered the mold coming out of their work HVAC, and she miraculously got the whole city to invest in this city building and treated all the HVAC systems, which were infested with mold from rodent drippings. They were really glad that the city was grateful to her. She's fine. She's got back the zest that she had before we treated her with mold. But her partner, her guy, still has it in his body, I think, because he's not responded to now being in a mold-free environment. And that's a tip that you're one of the people that can't respond, that can't take care of the mold yourself when even after you're out of the molding environment, if you're not also... I think all the people that you and I were talking about did better out of the mold because we were also treating them for the mold.

 [00:21:27.180] - Dr. Lemanne
So what is treatment for the mold that's living in your body? How do you test for it? If you're looking for that, what do you test for? And if you find it, what do you treat with?

 [00:21:40.080] - Dr. Hathaway
We use urine mycotoxins testing, and you treat them with binders. So there's all different... There's a long list of possible binders. People like various ones. I like activated charcoal. That's one of my favorite ones. I I don't tend to use the more intensive ones, like Well Call and those kinds of things. I like to use the supplements. And you need to put people on them, generally, for a pretty long period of time. Minimum, I would say, of three months and generally longer than that.

 [00:22:18.800] - Dr. Lemanne
Welchol. Is that Cholestyramine?

 [00:22:20.940] - Dr. Gordon
Yeah. Okay. I think it's fascinating. I have a little handout that I give people about mycotoxins, and I've realized I've just recently added a paragraph to in the beginning explaining what mycotoxins are because you inhale the mold when you walk into the moldy bar and it finds residence in some part of your body, your respiratory tract, your gastrointestinal tract, and it decides to reproduce. And when it sends out spores, the spores, in anticipation of a healthy immune system attack on them, the mold spores are coded with toxins. And that's what we test for is the presence of the toxins on the outside of spores that come from reproducing mold. And we hope when we treat the patient, just treating their mold's reproductive process will starve the mold itself, and they'll be cured from that, even though it's a lengthy and sometimes repeated treatment. The part of the treatment that is more variable, and I don't like doing it as much because I think it's toxic itself, is using antifungals to to treat what we presume is persistent mold colonies in the patient. How often do you do that, Ann? Do you use itraconazole?

 [00:23:40.320] - Dr. Hathaway
Rarely.

 [00:23:41.340] - Dr. Gordon
Yeah.

 [00:23:42.320] - Dr. Hathaway
Very rare.

 (00:23:43.110] - Dr. Lemanne
What are the tests that you use for urine mycotoxins? What brands?

 [00:23:49.520] - Dr. Gordon
The company we use Real-Time mycotoxins is great because it's covered by Medicare. They just collect a first morning urine specimen. I ask people to overheat the day before, some way, sitting in a hot car, exercising, sauna, hot tub, something like that. And they test them for the presence of five different mycotoxins. And what's wonderful is they've been very consistent. They've been in practice for a long time. So I have patients I've been seeing for five years, and I'll test them and I'll say, wow, the last year, all your mycotoxins have been nil, nothing. And now they're back up again. What was your re-exposure? But they track in each report a history of them, and they talk about the classically expected symptoms from them. And I think some of the toxins, Dawn, that relate to cancer risk, too. I think ochratoxin and aflatoxin, which we think of as much coming from food as from water damaged buildings. But those pertain to cancer risk, too, don't they?

 [00:24:51.480] - Dr. Lemanne
Especially aflatoxin, yes. It's one of the major causes of cancer around the world.

 [00:24:57.560] - Dr. Gordon
What cancers?

 [00:24:58.650] - Dr. Lemanne
Like liver cancer is the one that's usually brought up. And so people who have access only to moldy grains or peanuts, things like that, there's a lot of aflatoxin in African grains, for instance. And There are many grains that are a little bit off or wet. In the United States, grains are typically supposed to be tested for that before they're distributed. But I can imagine that if that process fails for one reason or another, that they're It could be considerable exposure. I think peanuts are considered a major source in the United States, although I don't know. I don't have my finger on the statistics as to how much of our peanut supply is contaminated and makes a past inspection. With that contamination. But yes, worldwide, aflatoxin is a large problem. And I suspect, though, aflatoxin is one we know about. I suspect there could be Corn is particularly prone to mold. And one of the things that I've noticed is if you go to the grocery store and smell a lot of the ears of corn, they smell really moldy before you even bring them home from the grocery store. Oh, dear. Really? Yeah. Give that a whiff.

 [00:26:15.300] - Dr. Lemanne
Go through the... Make sure nobody's looking at you.

 [00:26:20.280] - Dr. Gordon
At the co-op, you'll see me there sniffing my way through the corn.

 [00:26:27.240] - Dr. Lemanne
But I rarely buy any because it usually smells moldy to me. So I think corn is well known for being easy for mold to attach to and pass on to us.

 [00:26:38.080] - Dr. Gordon
I caution people. I've broken a few people's hearts saying, I think they should stop buying their grains if they're going to still be eating any of them at all or their nuts out of the bulk section.

 [00:26:48.860] - Dr. Lemanne
Oh, that happened to me. Now, don't tell Dr. Gordon, but I bought some rice a couple of weeks ago. And that was from a bulk bin. And I heard Dr. Gordon's voice going through my head. You shouldn't buy things from bulk bins because they're probably moldy. And I thought, I'm buying some rice. I really want some. Mine was in bulk. I got it home. I cooked it. It was so moldy. It was awful. And I thought, yeah. Really? Yeah.

 [00:27:16.820] - Dr. Hathaway
So it smelled moldy?

 [00:27:18.380] - Dr. Lemanne
It tasted and smelled moldy once it was cooked, not when it was dry. And so it was really interesting. And I heard your voice going through my mind. Oh, good. I told you in a good way.

 [00:27:33.050] - Dr. Gordon
Lundberg packages one pound organic rice, and it's not near the bulk section, so we have to walk around the store to find it. But I still eat rice, Dawn, maybe a few times a month. I think we're going to have rice tonight. But it's the bulk that I do my best to avoid. But some things you have to get in bulk, and then you have to... You, evidently, have a very good nose, Dawn.

 [00:27:58.260] - Dr. Lemanne
I do. That's a curse. I can smell somebody smoking a cigarette in the car ahead of me on the freeway. Seriously, I can smell people's deodorant from across the street. I thought everybody could. I thought everybody could. I just thought, well, yeah, I can smell this in everybody. And it turns out that's not the case. I didn't know that. But I just learned that recently, 10 years ago from my spouse who said, you can smell anything. I don't smell any of this stuff. And I said, really? Yeah. So So, yeah, I do have a good nose. But my spouse didn't like this rice either. So it wasn't just me. It was we both took a bite and said, is something wrong with this? And it was.

 [00:28:42.180] - Dr. Gordon

Well, we could go on to mold forever. But I am really interested in picking our hormone experts' brain because without going back to going over the results, Hormones were... Okay. Something I've learned recently is that prior to the WHI results being released a little bit over 20 years ago, almost- 2002. 2002, I was in Montana when we got the news listening to NPR, almost 50% of women were on hormones, on hormone replacement. And they wasn't the kind that we would recommend today, but approximately 50% of women. And today, and then for 20 years, only outliers like you and I and seven other people in the United States. Okay, that's an exaggeration. We're prescribing Hormones. So the vast majority of women were without hormone treatment. And in the last couple of years, it's definitely coming back. But we're still way less than 10% of women.

 [00:29:54.530] - Dr. Lemanne
Now you're talking about postmenopausal women?

 [00:29:56.600] - Dr. Gordon
Thank you. Okay. And that's a very interesting term because it's one of the my pet peeves. We need a different nomenclature because there's premenopausal, which covers a lot of different areas of a woman's life, menopausal, which is the transition, and that as an older woman, I am in the postmenopausal period, but people don't think of that as an era entitled to its own respect. They say, You went through menopause 25 years ago. Why are you still taking hormones? Haven't your hot flashes stopped by now? And of course, my jaw drops and my eyes widen in disbelief. But the rest of our whole life, our life after menopause is still a hormone-absent era, and it's only beginning to change very slowly. And what do you think about how do you see the field of hormone replacement therapy? How is it evolving in good ways, bad ways? Who should, who should not be on hormones?

 [00:31:04.720] - Dr. Hathaway
I recently had a patient come to me who's been with me for many years on hormone replacement, very happily so, doing very well. And she's 71, and she said she went to her GYN at UCSF, and that GYN told her, You know, you really need to go off these hormones. You're too old now. This is someone doing very well on their hormones, no problems at all, right? What is this based on that you need to go off your hormones, right? It's based on the WHI study, which is not the hormones that we are using. There is no study with estradiol transdermal... I just want to say the hormones that we should be using are only transdermal estradiol.

 [00:31:59.340] - Dr. Lemanne
Not pills.

 [00:32:00.000] - Dr. Hathaway
There's many options. There's many options for that.

 [00:32:01.840] - Dr. Gordon

Not pills, exactly.

 [00:32:03.460] - Dr. Lemanne
Okay.

 (00:32:04.080] - Dr. Hathaway
Transdermal, topical, you put it on the skin. There's patches, there's gels, there's creams from compounding pharmacies. That is the estrogen that we know is optimal, right? There's many studies that show this, but they're all small studies, so they get absolutely no respect from the overall gynecological community for many years. It is starting to change. The 2017 Menopause Society Summary of Hormone Replacement said that for women who were doing well on hormone replacement, the data supports continuation, not discontinuation, as long as you were using transdermal topical estradiol. So that's There's one piece of it that in those huge studies, the WHI studies, that reported out they were using an oral estrogen and a non-human estrogen. They were using horse-derived oral estrogen, and that has some problems. That oral estrogen increases the risk of vascular problems because it increases a molecule called CRP, which is vascular inflammation, and it increases fibrinogen. That's because when you take anything orally, part of it passes through the liver. When oral estrogen passes through the liver, it increases CRP, inflammation in the vessels, and fibrinogen. So what do you think happens when you give older women something that increases vascular inflammation and clotting?

 [00:33:57.640] - Dr. Hathaway
They have vascular problems. In In fact, that was the most significant finding. If you look at the details of the WHI study, as far as cardiovascular problems, it was almost all DVTs, strokes, blood clots. Those were the problems that they saw in the vascular, in the cardiovascular area. And of course, so yes, there were some increase in heart attacks. Not a lot, even. Anyway, when you use topical estradiol, and there's many There's at least 10 studies that show oral estrogen increases clotting and vascular risk, transdermal estradiol does not. The reason for the black box warning that we would like to fight with the FDA about on all estradiol patches, estradiol, divigel, all the gels that are commercially available have this black box warning, which is Absolutely ridiculous.

 [00:35:01.940] - Dr. Gordon
It's untrue. It's absolutely- It's absolutely untrue, right?

 [00:35:07.250] - Dr. Hathaway
They have no problem giving birth control pills, which is a form of estradiol, to any woman under 40, and a synthetic progestin with it. No problem with that. But if you're older, you are not allowed to have estrogen. And the problem with taking a woman off estrogen and progesterone, when she's 65 or 70 or 75, is that she is then going to lose her bone benefits because estradiol is tremendously protective against osteoporosis. They lose their vascular protection because estrogen actually increases vascular health, cardiovascular health, topical estradiol, and And not to mention our main focus of the studies Deborah and I worked on, cognitive benefits. The brain is full of estradiol receptors. Not primern receptors, not estrone receptors, estradiol receptors.

 [00:36:20.460] - Dr. Gordon
Let me ask you, because what it's really full of in your brain is two types of estrogen receptors. And I wonder for people who who are particularly phobic about estradiol, maybe a breast cancer patient. I believe the estrogen receptors for the brain are equally, if not more receptive. So there's three types of estrogen in the body. Esdron is the most background type of estrogen, and it's really the only one that older women tend to make at all. Estradiol, which is our primary estrogen through our reproductive years, and estriol, which is our primary estrogen through pregnancy, I believe. But estriol also binds very well, I'm not sure about bone, but I think to brain receptors, brain estrogen receptors. Have you used estriol at all, Ann?

 [00:37:24.560] - Dr. Hathaway
When I make up a... I use compounding pharmacies, at least for half of my patients. I really adapt my treatment to the patient's preferences as long as it works well for them. So probably about half of my patients are on a compounded product of estradiol and Estriol. Yeah. But I do not have confidence that estriol is going to do the cognitive benefit work that we want from estradiol. I think estradiol is the important molecule. Escherol, there's research showing that estriol has some immune benefits. It's certainly very good for skin health. I have a lot of patients who use a low dose of Escherol on their face, and they feel very strongly that it's a benefit there. And also as far as vaginal health, I think estriol makes a big difference there. I often use a combination of DHA and estriol.

 [00:38:35.220] - Dr. Gordon
I learned that from you and my patients. Thank you for that.

 [00:38:39.040] - Dr. Hathaway
Yeah, it's very helpful. I also use a low dose of testosterone in the general area and the vaginal area for libido, for just the overall health of that area of the body. It can do with a A little bit of just a very low dose of testosterone, often well under a milligram. 0. 2 every other day is often a diagnosis...

 [00:39:11.960] - Dr. Gordon
A dosage.

 [00:39:13.660] - Dr. Hathaway
A dose I would use. Sure. Yeah. For example. Just to cover a lot of stuff there in one answer.

 [00:39:22.120] - Dr. Gordon
And the other area that we are all three interested in by professional, and in my case, personal history, is the intersection of estrogen and breast cancer. And since I didn't forward you some very interesting information that Dawn has graciously allowed me to be included in the process of... Dawn, why don't you tell us a little bit about using prescriptive estrogen intentionally with your breast cancer patients?

 [00:39:55.060] - Dr. Lemanne
Well, thank you for the gracious part, but I think I really dragged you into that. I think you're thinking of the patient that we shared together. I dragged you into because I wanted you to actually do the hormone prescribing because that's not something I do a lot of, but I do do some, and I've learned a lot from you. Deborah and I share a patient that I will disguise her identification aspects a little bit to protect her privacy. But she lives in Nevada and is in her 60s and has a history of metastatic cancer, and that was what I was seeing her for. It's just metastatic to the bones. But we decided that the anti-breast cancer drug that she was on, which is a very powerful antihormone, an aromatase inhibitor, was putting her at risk for osteoporotic fractures and brain health issues. And also there is a really interesting field that I'm working on right now with some colleagues at Moffet Cancer Center in Florida. We're working on mathematical modeling of tumor dynamics and pulsed therapies in order to delay the onset of treatment resistance, which is otherwise completely inevitable with the way we use cancer drugs now.

It doesn't matter the drug. It doesn't matter if it's an antihormone or chemotherapy or anything.

 [00:41:20.890] - Dr. Gordon
Or any cancer.

 [00:41:21.850] - Dr. Lemanne
Or any cancer. So this patient, we thought, well, if we keep her on her antihormone treatment, it will kill off all the breast cancer cells that are sensitive to it. And then the ones that remain will be the ones that are insensitive to our treatment, and then she'll be up a creek. So we took her off the hormones, the antihormone cancer therapy, and Deborah, with my blessing, put her on hormone replacement therapy.

 [00:41:47.670] - Dr. Gordon
With the patient's enthusiasm.

 [00:41:49.200] - Dr. Lemanne
With the patient's enthusiasm. And now we're pulsing the hormones and the antihormones, doing our best to make mathematical modeling of this process so that we know when to start and when to stop each treatment with the goal of doing what's called directed evolution, which means that we will control the adaptation of that tumor's various subpopulations so that we can control its treatment and maintain treatment sensitivity. It's a way to keep the patient going and healthy. We don't cure the cancer. We don't even try. We just try to keep it under control. At bay. Yes. We let it grow back, and then we shrink it a little bit, and then we let it grow back, and then we shrink it. And when we let it grow back, we actually encourage the growth of hormone sensitive breast cancer cells by giving hormone replacement therapy. We want the hormone sensitive breast cancer cells. We don't like the hormone insensitive ones.

 [00:42:48.140] - Dr. Hathaway
So you're keeping the balance of cancer cells toward hormone sensitive with your treatment.

 [00:42:53.700] - Dr. Lemanne
Exactly.

 [00:42:54.760] - Dr. Hathaway
Amazing. The anti-hormone you're using is still aromatase?

 [00:42:59.240] - Dr. Lemanne
It's an aromatase inhibitor, yes. Yes. Actually, Deborah and I share a prostate cancer patient with whom we're doing that exact thing. We're using testosterone to maintain his treatment sensitivity of the cancer in between hormonal blockade episodes using mathematical models.

 [00:43:21.900] - Dr. Gordon
And you've been working with him on this approach for quite a while, is that right?

 [00:43:27.180] - Dr. Lemanne
Yes, we're coming out with a paper on his case. We believe that we are the first to ever restore castration sensitivity to castration-resistant prostate cancer.

 [00:43:40.080] - Dr. Hathaway
What does that mean castration sensitivity?

 [00:43:42.540] - Dr. Lemanne
So prostate cancer, when it's first diagnosed, is always sensitive to removal of male hormone, or almost always. And that process is called castration. And in the old days, they literally used to do surgical castration, removal of the testies.

 [00:43:58.060] - Dr. Hathaway
I remember that when I was a I remember people getting that.

 [00:44:02.660] - Dr. Lemanne
So now we have drugs that can do that, thank goodness. But again, after a year, maybe a year and a half, everybody becomes resistant to those treatments. Their cancer does. And that had happened with this patient. We restored the sensitivity by rescuing with male hormone, testosterone, by resc the few remaining testosterone sensitive cancer cells that he had in his body. And that was first, I think. So we'll be publishing that paper hopefully soon. And I think that will be really interesting, I hope, to the medical world, that we can direct the evolution of cancers with judicious and skillful use of intermittent hormone replacement.

 [00:44:47.620] - Dr. Gordon
And for his case, particularly, it works so easily because the PSA is a readily available tumor marker. But you're using something different for our mutual woman patient, right? A different marker.

 [00:45:00.140] - Dr. Lemanne
Yes, we're using circulating tumor DNA, or we're trying to. So we'll see how that goes and let you know. But so far, she's doing fantastically.

 [00:45:11.320] - Dr. Gordon
But this is also an approach you could use with Really any tumor that has... Kind of readily with any... Because this is true about all cancers, right? That as you were just saying, as you treat them, you kill the ones that are sensitive to the treatment and you have the treatment resistant cells thrive. So it would be great with lung cancer or colon cancer if you could not be so aggressive with your treatment and let it ride for a while until a tumor marker comes back up. How many cancers have readily available tumor markers similar to the PSA and prostate cancer?

 [00:45:49.980] - Dr. Lemanne
Almost none. Certain breast cancers will make protein tumor markers, a few gastrointestinal tumors, and a few gynecologic tumors, but a lot of them don't. Those are in the minority. Now, though, we have circulating tumor DNA, which will allow the detection of small amounts of cancer activity in many, many cancers. So and they're not restricted to the type of cancer. So that will be, I think that is helping our work already, and will only get better in the next couple of years.

 [00:46:25.100] - Dr. Hathaway
Amazing, amazing work. I've had several patients come to me over the years for cognitive decline while on aromatase, right? Because aromatase takes your estradiol close to zero. Yeah? But this kind... And they were being treated for cancer, of course, breast cancer. And we switched them, sent them to a different oncologist, switched them to tamoxifen, and their cognition improved. But you can't always do that, right?

 [00:47:03.460] - Dr. Lemanne
Yeah, tamoxifen is a very good drug. It's not as powerful against cancer as the aromatase inhibitors in large populations. Certainly different individuals may have a different... Their mileage may vary. If you give tamoxifen in terms of oncologic outcome, if you give that constantly, you're going to run into the same issue of resistance. So that needs to be addressed as well. But yeah, that's really interesting about tamoxifen versus aromatase inhibitors. The aromatase inhibitors are very difficult for a lot of patients. So it's really nice if you can have a break from them and even have some hormone therapy in between. Patients like it.

 [00:47:48.040] - Dr. Hathaway
I mean, would you treat any breast cancer patient with that HRT aromatase combination? Because...

 [00:47:57.960] - Dr. Lemanne
Oh, no. So only if they have a Some people are instead curable, right? Yes, you would never do that with someone who... These patients all have metastatic disease.

 [00:48:06.680] - Dr. Hathaway
Yes.

 [00:48:07.340] - Dr. Lemanne
That's considered incurable.

 [00:48:10.820] - Dr. Gordon
So I know you've seen a couple of my patients Dawn in consultation and just taking off the charts. There was a woman I interact with on social media. She's the only... I don't really know her, obviously, but I made some disparaging remark about DCIS. I was talking in a pro way about hormone replacement therapy, and she said, Unfortunately, I can't do that because I had DCIS 20 years ago. And I said, Well, DCIS isn't even really considered cancer anymore. And she got really mad at me until I introduced her to your colleague Dawn at UC San Francisco, who's trying to rename DCIS so it doesn't even have cancer.

 [00:48:53.120] - Dr. Lemanne
Dr. Esserman, Laura Esserman, has spent her career trying to de-escalate the treatment of breast cancer. And she's a surgeon. And I think, and I went back and looked at what the new name might be. I think we did that on our podcast a few weeks ago, and I couldn't find it. So I still don't know what the new name is.

 [00:49:14.100] - Dr. Gordon
I think we did find it, but I'm going to look for it again. It's not as user friendly as DCIS, but I did encourage her certainly, I think I on my own, one of my patients in the study was someone who I tried to put on hormones for years. And then she came back when the study started. And by then it had been so long, I even knew I was going to put her because I think it had been 10 years since her DCIS. And I said, okay, it's not only been that it wasn't cancer to begin with, but it's been a decade we're going to treat you. But you and I share another patient who was... Hormones greatly improved her sleep and helped her osteoporosis. And we monitor her and I put her back on hormones. We monitor with MRIs for the first year or so. And she's now, I think, three or four years out with no recurrence and happily traveling the world. And her brain and her bones and her sleep are all fine, and she's back on hormones. And I wish I knew a good tumor marker blood test to do for her, but we'll just keep imaging monitoring her.

 [00:50:17.140] - Dr. Lemanne
Well, she could try the circulating tumor DNA. If she has a tumor specimen somewhere in a lab, they keep them for 10 years.

 [00:50:24.460] - Dr. Gordon
You saw her, so I might ask you again about her to look and see if you have a tumor specimen. I don't know why I didn't do that. Well, we'll arrange for that all to be done. And then when it comes to aromatase inhibitors that do take their estrogen down to zero, what we learned and also talked about in a whole devoted podcast is particularly the aromatase inhibitor, correct my pronunciation, somebody, I call it exemestane or exemestane, something like that.

 [00:50:54.400] - Dr. Lemanne
I don't know the correct pronunciation, so I'll take either one.

 [00:50:57.950] - Dr. Gordon
But that is one where when paired with genistein, they have a cooperative effect. It's more effective against cancer. And of course, they get the genesteine benefit of activating estrogen receptors, not throughout the whole body, not in the breasts and in the uterus, but in the brain and the bones.

 [00:51:17.130] - Dr. Lemanne
You brought that to my attention. I was not aware of that until you taught me that, and it's really interesting. And there's another one that has the opposite effect.

 [00:51:24.780] - Dr. Gordon
I think it's letrozole. Yes, I think so.

 [00:51:27.280] - Dr. Lemanne
So you don't want to give letrozole and genistein together, but you do want to give exemestane and genistein together. And really interesting. I think that's really esoteric, not widely known.

 [00:51:38.440] - Dr. Hathaway
I need that paper. Okay. Deborah will give it to you. I get the questions in our other podcast that are supposed to be for you about genistein. Like, oh,.

 [00:51:52.100] - Dr. Gordon
That's the other thing Ann and I share is that Dr. Bredeson has a monthly podcast for Cognitive Protocol Practitioners and Patients. And she very graciously shared that with me recently. So she does half of them, and I do half of them. And did I tell you, I'm doing one a few days after we get back from Montana. So I'm going to do my best not to- I know.

 [00:52:15.420] - Dr. Hathaway
You have to work on that while we're there? And I will need to catch up with Stacey, my office manager, because we're always getting questions and problems coming in. They don't stop because you go on vacation.

 [00:52:29.420] - Dr. Gordon
You know, I have two new colleagues in my office, two doctors, one of whom has taken the Bredesen training, and one of whom is way more engrossed in full comprehensive primary care from a functional medicine point of view. And we had a meeting yesterday, and I said, you know, someday I'd like to get to the point where we can share a call for each other. And they both said, how about bucking up Deborah? And when you leave town next week, let us take call for you. And I had a panic attack. What? Release control of my patience. I'm going to build up my courage and find a way to do it safely. So I'm not as much online while we're in Montana as I might be otherwise.

 [00:53:15.700] - Dr. Hathaway
I wanted to mention something. My BRCA, one patient who followed for 25 years, her mother and her sister both had breast cancer, so they all got tested. My patient was Brekka positive, too, like her mother and her sister, but she has decided, I don't push her either way, she's decided to stay on estrogen replacement. I keep her a little lower her level than I do other people, maybe more like 50 than 80 to 100.

 [00:53:50.050] - Dr. Gordon
I would like to interject here and say, women, all women listening, if your doctor puts you on estrogen but then never checks your level, have a talk with them about that. Okay, go ahead.

 [00:54:00.480] - Dr. Hathaway
Which is all GYNs, okay? Yes. Okay, let's face it. They say, Oh, those tests are useless, right? I would like to use the better test, the LCMS, but if you go through people's insurance- So that's a more highly sensitive form of estradiol. It's a highly sensitive test. There aren't as many things that interfere with it, but it's $140. It's crazy. Anyway.

 [00:54:31.540] - Dr. Gordon
Anyway, so- Your BRCA patient.

 [00:54:33.220] - Dr. Hathaway
BRCA patient, she follows the protocol for bringing CA, which is that she's monitored every six months. She gets either a mammogram or an MRI, and she's been fine for over 25 years now. So it's interesting. I don't know. What do you think about that, Dawn?

 [00:54:56.260] - Dr. Lemanne
Well, you know, BRCA1 mutations to skew toward triple negative breast cancers rather than the hormone sensitive ones. So I wonder if there's some interaction there. I don't know. We will often use some preventive therapy with tamoxifen in those patients. And there does seem to be, I believe the studies show that that does seem to decrease the risk. Tamoxifen is interesting in that when it's given to decrease risk of breast cancer, it doesn't really decrease your overall lifetime risk. It just moves the diagnosis date back by however many years you're on tamoxifen. So if you take tamoxifen for five years and you were destined to get breast cancer at 45, then you might get it at 50 instead or something like that.

 [00:55:37.990] - Dr. Gordon
I wonder how they know those things. Is there a book somewhere that says what age I'm going to get breast cancer? I'd like to check that book.

 [00:55:44.040] - Dr. Lemanne
These are large groups. Okay, so statistically, we can see... Yes, you can see the curve move in the entire cohort over to a higher age.

 [00:55:54.730] - Dr. Gordon
So they don't stay on tamoxifen forever?

 [00:55:56.980] - Dr. Lemanne
They probably don't want to. And They usually... Brca1 mutation carriers are usually told to get through their period of childbearing and then have some type of surgery, often double mastectomy, removal of the ovaries, the removal of the organs that might be at risk for developing cancer. And there's different penetrations in different families. So you might have a BRCA1 mutation running through one particular family, and maybe 10, 15% of the women in that family will get breast cancer, whereas there might be another family where it's like 85 or 90%.

 [00:56:37.840] - Dr. Gordon
It's never just one gene, just like it's not one thing that causes Alzheimer's disease.

 [00:56:42.740] - Dr. Lemanne
Well, the BRCA1 gene is long, and so there are different places that it can be broken, too. So there are lots of nuances to this. But to go back to Ann's question, what do I think about that? I think we absolutely have no idea. And I think the way we've dealt with cancer in the past is just wait and see if you get cancer. Now we have early warning tests that I think are going to be really change, really change the way we deal with cancer. So pan cancer screening test, which are blood tests looking for at this point 50 different types of cancer and can pinpoint, based on that positive blood test, which organ is likely giving rise to this cancer signal. Those are going to be so important in the next few years. And then if you already have cancer circulating tumor DNA, match to that cancer specimen that we have in the lab somewhere, those things are becoming rapidly treatment changing and practice changing. We can now use those to declare a recurrence rather than waiting for 6, 8, 12 or even 18 months longer for imaging to become positive before we can say that, Oh, this patient's cancer has reactivated.

 [00:58:04.020] - Dr. Lemanne
Those kinds of things are really going to be a big change, changer.

 [00:58:08.840] - Dr. Hathaway
My patient had a bilateral ophorectomy, but elected to keep her breast. And that reminded me that I was stunned this year to learn that ovarian cancer does not start in the ovaries, but starts in the fallopian tubes. That's correct. And so if you are concerned about preventing ovarian cancer, you have your fallopian tubes removed and you can leave your ovaries.

 [00:58:43.080] - Dr. Gordon
I didn't know that. Wow, you can keep your ovaries. 

[00:58:46.680] - Dr. Hathaway

How long have you known that, Dawn?

 [00:58:49.120] - Dr. Lemanne
I mean, is that like- Maybe a couple of years, not long.

 [00:58:54.400] - Dr. Hathaway
It's newer information. You didn't know that, Deborah? No.

 [00:58:58.660] - Dr. Gordon

Maybe that came up our colleagues discussion this year about... We have an older friend in common, a physician who was perhaps facing her ovary removal, then we all said, once you're well past menopause, your ovaries really are not serving you. We don't really need them anymore. But a 40-year-old woman who's at risk for ovarian cancer and doesn't want any more children, wow, great birth control. Remove the fallopian tubes, keep your ovaries. I know.

 [00:59:26.420] - Dr. Hathaway
It's amazing.

 [00:59:28.120] - Dr. Gordon
I had a thought about your BRCA And from what you just said, Dawn, so I didn't know this, that BRCA1 genetics predispose you to getting the worst breast cancer, which is triple-negative cancer.

 [00:59:43.040] - Dr. Lemanne
Well, they can get any breast cancer, but it really skews toward triple negative. That's a risk factor for triple negative breast cancer.

 [00:59:50.700] - Dr. Gordon
So I wonder if giving her estradiol, which is an interesting... It's estradiol's relationship with breast cancer. We've talked about this a little bit, Donna, even on the podcast and separately, it actually reduces your risk of breast cancer unless you have one, which makes it grow. And if you don't have one, it tends to give you a friendly or more easily treatable breast cancer does want to rise in the setting of hormone replacement therapy. Am I remembering that correctly? Yes, you are.

 [01:00:28.260] - Dr. Lemanne
So women who are on hormone therapy when they're diagnosed with breast cancer, so that's assuming or extrapolating that this breast cancer maybe wasn't there when they started the hormones or whatever, or maybe it was and the hormones changed it. They tend to have a better prognosis, stage for stage than women who are not on hormone replacement therapy when they're diagnosed with breast cancer. We don't understand that. There's so much that we don't understand. So I think this... As I'm sitting here listening to this conversation, it just makes me more and more upset that we rely on these large data sets to advise our patients. We have to move toward using the patient's data set alone, with informed by, of course, what has happened to other people. But I guess we have to rely on the patient's data set much more. We have to grow that part of the medical brain so that we are treating our patients truly as individuals.

 [01:01:31.250] - Dr. Hathaway
Especially true because when you ask, say, JoAnn Mason, who is the lead author of the WHI, most of the WHI reports, her name is first, asked her, will there be another We're going to study using the right hormones that we now use, transdermal estradiol and real progesterone? She goes, Probably not. It's too expensive.

 [01:01:54.040] - Dr. Gordon
There you go. The big work is not going to be done. You have to look at the individual patient.

 [01:01:58.880] - Dr. Lemanne
It's the individual doctors who will be doing this work. So Johanna Mason is an epidemiologist. What does she study? Her field is large groups of people, the health of large groups of people, a subset of public health. I have a degree in epidemiology, and that's what it is. And I have a master doctors in public health. And we look at in epidemiology, large groups of people. Now that I'm a doctor, I look at very small non-groups of people, just the one patient in front of me, and it's very different. And so we haven't developed the science of how do you look at and treat one patient. So that's one of my goals. It's a little too lofty for me to carry out, but it's how do we get the conversation back to the patient in front of us? And how do we develop rigorous data so that we can treat that patient? And I'm not talking about data from the next patient in the next exam room. How does that patient's bloodwork and circulating tumor DNA and genetics, how does that Diet and microbiome and mold exposure and hormone replacement, how do all those things interact for that patient?

 [01:03:07.550] - Dr. Lemanne
And what are our goals for that particular patient? And how do we know that we're driving toward that goal? It's by looking at that patient. In a rigorous way. What you folks are doing, and that's what I really, really, I think I went to that first meeting with the Bretterson at Buck Institute, and I'm not a dementia specialist or Practitioner at all. I went because the ideas were so new and spectacular, and the way of conglomerating lots of different inputs, I think, carries over into every field of medicine, including oncology, which is where I practice. And so I learned a lot, and I still think about that meeting every week. That meeting crosses my mind. I remember the roof. Remember the leaky roof metaphor?

 [01:03:57.270] - Dr. Hathaway
Yes. The 36 holes in the roof.

 [01:03:59.790] - Dr. Lemanne
There were 29.

 [01:04:01.840] - Dr. Gordon
I think there's 150 now.

 [01:04:06.340] - Dr. Hathaway
We're up to many, many, many more. It's fantastic to hear you talk about oncology in this functional medicine way. There's the broad understanding and concepts, and then there's the individual patient. That's so fantastic. My brother's multiple myeloma, he's 11 years out from his diagnosis with no recurrence. And his doctor treated him with quetruda, which is after he failed 10 other treatments, which is not a treatment that's known for multiple myeloma, but it absolutely cured my brother.

 [01:04:45.200] - Dr. Lemanne
And that's what he cares about. He doesn't care about those 20 large, randomized, controlled trials that said quetruda doesn't work on average.

 [01:04:56.460] - Dr. Hathaway
Yeah, for this cancer, right? Yeah.

 [01:05:00.000] - Dr. Gordon
So Dawn, I assume you had this orientation or you wouldn't have done the project, but you had a patient quite a while ago, because the book's been around for a while, who is approaching his CLL, I believe, chronic lymphocytic leukemia.

 [01:05:17.550] - Dr. Lemanne
Oh, I wrote a book on a patient. He was not my patient. I didn't treat him. In fact, actually, no doctors treated him. He was followed at Harvard and Johns Hopkins for CLL, and he kept refusing all of their recommended treatments, which were, as they honestly told him, they're not cures. They might help your symptoms. They might not even prolong your life, although you might feel a little bit better as you die. So he said, no, thank you. And he spent 20 years trying to figure out what he might do. And he eventually reversed his chronic lymphocytic leukemia. It's the only case in the medical history. I wrote a case study on him, and I also wrote a popular book with him. He told me a story, and I wrote it down and tried to make it interesting. But yes, that is- The book is titled N of One.

 [01:06:04.920] - Dr. Gordon
For anyone who wants it, it's a good read.

 [01:06:06.970] - Dr. Hathaway
N of One.

 [01:06:08.180] - Dr. Lemanne
N of One. And so that is something that I've always been interested in. And his wasn't a formal N of one where he sat down and tracked out the statistics he was looking for ahead of time and those kinds of things, of course not.

 [01:06:22.500] - Dr. Gordon

But it worked.

 [01:06:25.420] - Dr. Lemanne
You can't argue with success. I don't care if you have a thousand randomized controlled trials, which we in CLL. We have a lot, I'm sure. If they don't work, there's no cure from any of them, not one. Then I think we ought to look elsewhere. That's the wrong venue designed a nine venue for oncology and maybe many other chronic diseases like Alzheimer's.

 [01:06:51.000] - Dr. Gordon
And equally strong N of one is to reinforce the possibility of cure on an individual basis, N of one going in the opposite direction. So you can use N of one for good or for ill, depending on your viewpoint, and you have to read it and with the patient in front of you decide, I don't care what I read in the New York Times article. I talked to somebody else who said this protocol works, so I'm going to try it.

 [01:07:21.740] - Dr. Lemanne
It's like, I tell patients who want to do that. It's like my friend won the lottery, so I'm going I'm going to go buy the ticket. I'm going to go use the tickets, the numbers that he used when I buy my ticket. It's like, yeah, okay. Well, good luck. Talk about some of the successful stories from your studies. That would be really interesting, I think, to our audience to hear. What are some things that you noticed and that really got your interest? That's just fascinating. It's remarkable.

 [01:07:56.440] - Dr. Hathaway
There's so many people who got their lives back. I had a A gentleman in this study who- The current. In this reversal of cognitive decline study, we call it Recode. That's the short little name that we've given it recode for reversal of cognitive decline. Someone who never finished high school, but was obviously pretty intelligent and had scores. I mean, his CNS vital sign scores were, I think, overall score was one percentile, comprehensive memory was 10 percentile, and executive function was seven percentile, comparing him to men of his age. This guy was so enthusiastic about the protocol. Oh, my goodness. What a wonderful, wonderful human being. And he, at the time, was not exercising at all. Thin, underweight person, but just so excited to do the protocol. And he did everything absolutely above and beyond what we asked him to do as far as doing the brain training, taking every single supplement every day, documenting everything he was doing for us. We document a lot, so we know what they're doing. For example, if they're doing Brain HQ, we have that data coming into our data collecting system. This is something different from the first study, Deborah.

 [01:09:36.260] - Dr. Hathaway
We have their Brain HQ data. We have their sleep data on the Oura Ring. I mean, all their sleep data. How much rem sleep, how much deep sleep, heart rate, heart rate variability, et cetera. So he started exercising. He started riding his bike up Mount Ham twice a week, three-hour ride from nothing. Just amazing. Just so curious about everything, so engaged. Well, this guy's final scores were... His comprehensive overall score was in the high '70s. I don't remember exactly, but also his memory score and his- From everything in the single digits in the upper quartile? Yeah, absolutely.

 [01:10:23.780] - Dr. Gordon
And that is, again, is your study frame period nine months? Yes. For the same?

 [01:10:30.710] - Dr. Hathaway
So that's the same- In nine months, he made those changes. Yeah. I have to say, he did over and above. We asked him to do at least 36 levels per week of brain training. He did 45 or 55.

 [01:10:49.560] - Dr. Gordon
Enthusiasts will often do better, and that's great. And he was born with that lucky star over his head, and I'm sure he had some unlucky stars when it comes to his genetics. That sounds like an APOE4 story where they might be slow to get started and miss some keystones along the way, but they're basically usually pretty intelligent people, and then they fall off the cliff sometime late in life, women earlier than men if they don't have hormones. So he was lucky to be an enthusiast, and that will hold him in good stead for the rest of his cognitive and body life.

 [01:11:26.180] - Dr. Hathaway
Absolutely.

 [01:11:27.100] - Dr. Gordon
That's a great story. Yeah. Well, this This has been great. Is there anything else either one of the two of you want to add in?

 [01:11:36.180] - Dr. Hathaway
No. I mean, I feel like we three could talk all day, couldn't we? But wow, so fun to be with you guys.

 [01:11:44.860] - Dr. Gordon
Yeah, well, it's great to have you here, and I look forward to the upcoming weekend. And Dawn, I'll see you soon. And Dawn and I are in offices in the same building now. She's my office neighbor. Oh, how fun. Yeah. So I look forward to seeing both of you. And thanks for your time today.

 [01:12:04.320] - Dr. Hathaway
Yeah. Thank you both. And thank you, especially Dawn. I learned so much from listening to you.

 [01:12:10.760] - Dr. Lemanne
Oh, my pleasure. And vice versa, right back at you. All right.

 [01:12:15.430] - Dr. Gordon
Good talking to you. See you next time. All right. Bye-bye.

 [01:12:18.390] - Dr. Lemanne
Bye-bye.

 [01:12:20.680] - Dr. Gordon
You have been listening to the Lemanne Gordon podcast, where Docs Talk Shop.

 [01:12:26.640] - Dr. Lemanne
For podcast transcripts, episode notes and links, and more. Please visit the podcast website at docs talkshop.com

 [01:12:35.640] - Dr. Gordon
Happy eavesdropping.

 [01:12:41.320] - Dr. Lemanne
Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

 [01:13:02.720] - Dr. Gordon
We make no warranty as to the accuracy, adequency, validity, reliability, or completeness of the information presented in this podcast or found on the podcast website.

 [01:13:14.980] - Dr. Lemanne
We accept no liability for loss or damage of any kind, resulting from your use of the podcast or the information presented therein. Your use of any information presented in this podcast is at your own risk.

 [01:13:29.320] - Dr. Gordon
Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

 [01:13:36.240] - Dr. Lemanne
You must not take any action based on information in this podcast without first consulting your own qualified medical professional. Everything on this podcast, including music, dialog, and ideas, is copyrighted by Docs Talk Shop.

 [01:13:52.740] - Dr. Gordon
Docs Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.