Episode 5: Advances in the Prevention of Dementia and Alzheimer’s with Dr. Kat Toups — Part 1

Show Notes

This two-part episode of Conversations for Health features Dr. Kat Toups, a Functional Medicine Psychiatrist at Bay Area Wellness in Walnut Creek, CA, and organizer and administrator for Bay Area Functional Medicine Group since 2012. She is a Distinguished Fellow of the American Psychiatric Association, Board Certified by the American Board of Psychiatry and Neurology.  Dr. Toups is a former Assistant Professor of Psychiatry at UC Davis, and later the Owner and Medical Director of Bay Area Research Institute, a Clinical Trials Research Center in Lafayette, CA. After serving as the Principal Investigator on over 100 clinical trials for 12 years, including 20 failed trials for Alzheimer’s drugs, she realized that the elusive cure for Brain and Psychiatric illness was not going to be found in a pill.

In the first part of our conversation, Dr. Toups explores key distinguishers between Alzheimer’s, dementia, mild cognitive impairment, and general cognitive health. She highlights the real source of the cure for dementia and considers the underlying causes that can trigger dementia.  Together we discuss her pilot study, statistics regarding the benefits of investing time and money in cognitive health, and the role that hormones and oral hygiene play in brain health.

I’m your host Evelyne Lambrecht, thank you for designing a well world with us.

Episode Resources:

Dr. Kat Toups

Journal of Alzheimer’s Disease Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project

Dementia Demystified

Design for Health Resources:

Designs for Health

Alzheimer’s Protocol

Chronic Lyme Disease Support Protocol

Oral Health Support Protocol

Presentation: (CASI 21) Keynote | Dale Bredesen, MD – The End of Alzheimer’s: Preventing & Reversing Cognitive Decline

Presentation: (CASI 22) Richard Horowitz – Lyme Disease & Stealth Infections: The Current State of Diagnosis and Treatment

Blog: Recent Review Explores the Roles of Certain Nutrients in the Risk of Developing of Alzheimer’s Disease

Blog: Recent Review Explores Potential Connection Between Oral Microbiome and The Immune System

Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars and our blog.


[1:56] Kat reveals where the cure for dementia is going to be found.

[4:13] Details of her pilot study in which 84% of patients showed statistically relevant signs of improvement in cognitive decline.

[8:44] Surprising head scan findings at the conclusion of the study.

[10:56] Key distinguishers between mild cognitive impairments, dementia, and Alzheimer’s.

[18:20] Approaching the challenges of multi-layer interventions and addressing multiple variables.

[26:18] Infectious causes of Alzheimer’s and herbal and immune support treatment modalities for Lyme disease and EBV.

[38:37] Oral pathogen testing and the impact of dental infections on cardiovascular health.

[44:40] Kat’s personal experience with dental health and immune system triggers.


Voiceover: Conversations for Health, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips. Our mission is to empower you with knowledge, debunk myths, and provide you with clinical insights. This podcast is provided as an educational resource for healthcare practitioners only. This podcast represents the views and opinions of the host and their guests, and does not represent the views or opinions of Designs for Health, Inc. This podcast does not constitute medical advice. The statements contained in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Now let’s embark on a journey towards optimal wellbeing, one conversation at a time. Here’s your host, Evelyne Lambrecht.

Evelyne: Welcome to Conversations for Health, I’m your host, Evelyne Lambrecht, and today we’ll be talking about Alzheimer’s, dementia, and mild cognitive impairment as well as general cognitive health. I am delighted to be joined here today by Dr. Kat Toups. Welcome to the show, Kat.

Dr. Kat Toups: Thank you so much for having me.

Evelyne: Dr. Toups is an MD. She’s a distinguished fellow of the American Psychiatric Association, an Institute for Functional Medicine certified practitioner. She’s also a former assistant professor of psychiatry at UC Davis, where she was the inpatient residency training director and later the owner and medical director of the Bay Area Research Institute, a clinical trials research center in Lafayette, California. After serving as a principal investigator on over a hundred clinical trials for 12 years, including 20 failed trials for Alzheimer’s drugs, she realized that the elusive cure for brain and psychiatric illness was not going to be found in a pill. So where is it going to be found?

Dr. Kat Toups: Yes, exactly. The problem with dementia is it’s usually a multifactorial cause. It’s not just one thing. I like to say it’s not this mysterious disease that just happens. It doesn’t happen for no reason. It doesn’t happen just because you have a genetic risk. It happens for all of these underlying causes that can trigger the brain and cause the deposition of amyloid that people talk about. Traditionally the prevailing theory with Alzheimer’s has been that amyloid is destroying the brain, and so therefore we need a medication to get rid of the amyloid. I did trials a long time ago with medications that could get rid of the amyloid, we could see that on the PET scans, but people didn’t get better clinically. So somehow, we have to say maybe this theory is not correct.

But what we’ve learned in order to get people better clinically, is we need to investigate and search out and find all of the various underlying causes that are affecting the brain, and then remove those causes, replace whatever the brain needs to function well, help it with exercises and training to enhance neuroplasticity so the brain will make new connections because we know that we can make new connections in our brain up until the time of death in a very old age. That’s been shown clearly at this point. It’s putting all these things together and this is what we’re finding both clinically and in the clinical trial that I’ll tell you about that we did. This is what’s needed to help people regain, basically stop the decline and then regain their brain function on top of that.

Evelyne: That’s amazing that we have neuroplasticity all the way through because I think we used to learn that it stops, I don’t know, in your what? Early 20s or something.

Dr. Kat Toups: Yeah, 18. That was your allotment of neurons. That was all you’re going to get, and then it was going to be downhill from there. So that’s-

Evelyne: That’s encouraging.

Dr. Kat Toups: There we go. For some of us that are past 18.

Evelyne: I want to talk more about the pilot study that was published last year. Congratulations on that. So, it’s published in the Journal of Alzheimer’s Research, and you did a pilot trial at a few different sites. You published that with Dr. Dale Bredesen, and 84% of patients in that trial showed improvement in cognitive decline. I’d love to talk more about your findings, any surprising findings, but also how you designed the trial and how that’s now leading to the trial that you’re currently doing.

Dr. Kat Toups: Right, right. Well, thank you. It was published in a Journal of Alzheimer’s Disease, so JAD, and you could probably put a link in the show notes here, but-

Evelyne: We will.

Dr. Kat Toups: … people could just search my name and precision medicine and it should come up pretty easily. The title of it was a precision medicine approach. So, in this trial we had 25 patients. We had three locations. I worked with Dr. Ann Hathaway and Dr. Deborah Gordon. So, three different locations and the patients were in a nine-month trial, and it was sort of full court press, functional medicine, precision medicine approach. So, we tested everything right upfront and figured out what were their treatment targets, and then we did a multi-modal approach. So, kind of the foundation of all health is of course, you’ve got to deal with the diet and the exercise and the sleep and the stress, right?

That’s the foundation of if any health. So of course, that’s where we started with those factors. But then on top of that, we are searching for other causes, hidden causes of neurodegeneration, like the role of infections in the brain, the lack of hormones in the brain, and I’ll say more about that, but the hormones, the brain has receptors for all of these different sexual hormones, and of course we’re losing that at the same time that we’re seeing dementia coming. And so, we repleted the hormones and then we also looked at the toxins and worked with a lot of detoxification for people that had high levels of chemical toxins, metals, and also mold or mycotoxins was a factor in some of our patients.

So one of the things that we did was each patient was assigned a health coach, a nutritionist, and an exercise coach. And I feel like that was one of the things that really made a huge impact on our outcomes. Obviously we had to work on all these infections and hormones and nutrients and toxins from the medical end, but I think having that great support, all of us doing this kind of work like our patients to be able to have supportive health coaching and nutrition coaching, but to have the level of support we did upfront when patients are trying to make these changes rapidly made all the difference in the world. And one of the things, when we looked at our results, we tracked several different cognitive markers. So, we use the MoCA, which is the Montreal Cognitive Assessment, which is a rating scale for all the different domains of dementia and how people are functioning cognitively.

So that was one of our main markers. And then we used a neuropsychiatric battery, and we used an online neuropsych battery called CNS Vital Signs, and that’s about a 45 to 50 minute test, but it goes through all the different domains of functioning that you would get working with a neuropsychologist on a multi-hour battery. We track those two things, and then we also involved the study partner, generally the spouse, but they did a caregiver rating scale at the beginning and the end, and sometimes in between perhaps where we were tracking progress. But here’s the exciting thing, at only three months of time, three months into this, we already had separation from baseline for all of those markers are cognitive markers. And then they got even better in six months, and then they got slightly better at nine months.

So, we saw a steady increase, but even at the three-month mark, we could see a statistically relevant amount of clinical improvement, and it was translating to how people were improving in their lives. And I might stop there if you have a question, because I wanted to tell you about the unexpected findings with the head scans.

Evelyne: Okay. Go into that first, and yes, I do have a bunch of follow-up questions , but tell us about the unexpected findings.

Dr. Kat Toups: The big surprise was the radiology data, and we did an MRI head scan at the beginning and the end of the study, and we did what’s called the volumetric head scan. We used NeuroQuant, and it’s a program where they upload the MRI data and then they give us the volume of every structure in the brain, and they give us that compared to an age match control and normal control. So, we can see if certain areas of the brain are degenerating or smaller than normal, we can see if certain areas are bigger than normal, which would tell us something is inflaming that area. We did all these measurements on the MRI, and what we found, even from just the basic MRI data, not even specifically the NeuroQuant, was that our patients did better in their gray matter volume of their brain and their hippocampal volume of their brain than even people with no dementia, no cognitive decline.

They did far better than people that had mild cognitive impairment or early dementia. So, what we saw in the gray matter was that gray matter actually increased. It’s supposed to decrease at this age when you’re dealing with people in their 50s, 60s, 70s, but ours actually got larger, and then the hippocampal volumes got larger. They did decline slightly over the nine months, but they declined much less than the normal controls. So that for us was, it was just so exciting to get, this is pretty hardcore data, this is measuring volumes on a head scan, and-

Evelyne: That’s incredible.

Dr. Kat Toups: … completely unexpected that in such a short time of people whose brains are degenerating, right? They’re going down, they’re struggling, they’re having cognitive problems. Some of the patients in a study, several of mine were one point away from moderate dementia, so they weren’t just mild cognitive impairment, they were already in the early Alzheimer’s phase and very close to the moderate phase. So, to be able to see increases in their brain volume was really exciting for us.

Evelyne: That’s incredible. I actually want to back up a little bit because we’re talking about mild cognitive impairment, dementia, Alzheimer’s. Can you talk about the differences and also when does it transition from, say, when you have say a memory lapse like I often do, or something where you’re forgetting things and is it just too much information coming at me and too much stress versus, okay, this is actually something’s wrong in my brain?

Dr. Kat Toups: Right. Right. Well, and that is a difficult distinction in the beginning. So first off, I want to say that sometimes Alzheimer’s and dementia are used interchangeably. Alzheimer’s is one type of dementia. It’s the most common type of dementia. But from my perspective, you could know all these types of dementia, but really, I want to know not what name of the dementia is, but what’s causing it. I want to know why. So sometimes we use dementia and Alzheimer’s interchangeably, but Alzheimer’s is a specific type of dementia, and it has specific pathology. And definitely we see the increased amyloid and the neurofibrillary tangles that deposit over time. And it often attacks the hippocampus first, which is our memory centers and other types of dementia sometimes will go after different parts of the brain, but they’re all neurodegenerative disorders.

So first we have those senior moments that you mentioned and just simple forgetting, and sure there’s a lot coming at us from all angles these days, and when is it beyond just a simple forgetting? There’s a term that Dale Bredesen, I believe he’s the one that coined it, called subjective cognitive impairment. And that is really when you start to worry, when you get a little sense like it’s more than just forgetting a name now and then, or not being able to pull something out of your head, but later you remember it. But it’s when you really start feeling like, gosh, this is kind of affecting me. I’m spending too long looking for where I put things, and I used to be organized. And just sometimes it’s a general sense of overwhelm. And when we start having memory problems, it didn’t just start then, it probably started years down the road and all of these various factors that I mentioned, and when we talk about more of them sort to come together and affect the cognitive functioning.

I had a patient in my study, he was, I’d say about 63 maybe, and he was and is a very high functioning physician and really quite successful, smart, developed devices and very creative person. But he had gone to his doctor a couple of years before he came into our study. He went to his doctor at Kaiser, and he said, I’m having trouble with my memory. And they tested him. They did the neuropsych battery, and they said, oh, you’re not bad, you’re only bad on your verbal memory. And it was the 19th percentile. Now 50 percentile is average, and here’s somebody with his high level of education and intellect. He should be far above average. But they said, well, don’t worry about it, eat right, exercise, take care of yourself. And so, he did. What did he do? Nothing. Right? The doctor told him he was okay, so he did nothing.

And then two years later, he heard about the study, things were getting worse, he was having trouble participating. By then we were doing more Zoom meetings, and he was having trouble or having to take notes of who was who and who said what. At that point I tested him, and that verbal memory had come down to the 11th percentile. He lost a lot of ground in those two years that he could have been doing something to help his brain. Now let’s fast forward to the end of the study, I believe he finished at the 94th percentile.

Evelyne: Oh, my goodness. That’s amazing.

Dr. Kat Toups: And these were some of the, not everybody, people had different amounts of improvement, but I think that’s a great example. So, we see him declining, declining, declining, and then get him back on his curve of where he’s supposed to be. But if he had done nothing for two more years, where would he be? So, he came in and his diagnosis was mild cognitive impairment at the level he was. And those are artificial dichotomies, what’s MCI versus early Alzheimer’s? But we use those MoCA rating scales, and then there’s cutoff scores with that. Of course, there’s some variability, so somebody with a lower education level, you might give them the range of cutoff for when it’s strictly called MCI, you expect a higher score with a higher education level. So, they stratify those actually based on education as well.

But basically, it’s declined to the point that it’s really starting to affect functioning. It’s probably starting to take you into the MCI range. And then we know the typical Alzheimer’s disease, it’s about a 10-year path generally for people with diagnosis to death of that decline.

Evelyne: Wow, that’s quick.

Dr. Kat Toups: Well, that’s not that quick because the problem is we have other types of neurodegenerative disorders and other reasons where it will go much faster than that. And so, one of the things that I often see is people who come in that are younger, they might get diagnosed with Alzheimer’s and it probably is an Alzheimer’s pathology. Again, that to me is not as important as why what’s happening to their brain, what’s causing the problem. And especially in people that are younger, you’ll see a more rapid decline. I think COVID is one thing that’s shown us this for some people. Now we’re all aware of the effects of a virus on the brain, and this is one of the things that in the work that I do, we look hard for reactivated viruses. We look hard for Lyme disease and the co-infections that are known to affect the brain on different bacterial infections, parasites.

And so it’s been known to people in the functional medicine world for a long time, but now the rest of the world can see how devastating a virus can be when it likes to attack the brain tissue. We’re seeing with COVID, brain fog has now come into the vernacular, pretty much that’s a common term that maybe five, 10 years ago wasn’t in people’s vocabulary. We’ve seen young people coming in with very bad cognitive problems after COVID, having long COVID, which we think is probably still the virus actually replicating at that point.

Evelyne: I want to get more into the causes. And I also have a question, in your trial, I’m wondering, well two things. One is you said they had a health coach, a nutritionist, and a basically personal trainer, and they have their doctor. And so, something that I hear from people who either have had a family member or a practitioner treating a patient with Alzheimer’s, it’s so challenging to do all of these different interventions. It’s costly. It takes up so much time. So, I’m wondering about your thoughts on that. And also, in terms of clinical research, and you obviously did that for so long, you’re usually looking at just one thing that you’re testing, one single drug, and hearing your trial, you’re testing all of these different variables and also changing all of them, which I think is absolutely incredible. How has that been received or perceived by maybe other professionals who are not in our space?

Dr. Kat Toups: Right. Well, let’s say, we had difficulty just with the IRBs or the institutional review boards. When you go to do a human trial, you have to submit to the IRB, and they’re there to help on behalf of patient protection. They want to make sure your trial is safe, that you’re doing everything right, you’re not going to hurt people. And I know before I started working with Dale Bredesen, he had applied to some IRBs for other trials through the years, and he was turned down. And I believe the first one we talked to with this trial we just published was really uncertain about us having so many variables because basically we did the same thing in our assessments. Everybody had the same testing upfront, but that’s where the sameness stopped.

So patient A might have cardiovascular problems that they needed to work on, and their blood sugar wasn’t good, and they weren’t sleeping, and patient B might have infections and toxins and their hormones were a mess. So, everybody brought different things to the table. And so, their treatment was individualized based on their symptoms, their labs, their history. So, it’s been a challenge. And even with the new study that we’re just launching now, we went back to the first IRB that we started with on the last trial, and they started giving us grief about things that it was just clear that we were going to spend a year going round and round with them, and I said, let’s cut our losses, let’s go to someone else. And we went to a different IRB that then has been delightful to work with. They’re so excited with our multimodal approach. So, it’s definitely its own challenge.

Now, back to the thing of it’s hard for patients to do. It is hard, this is a hard protocol to be able to change your diet and do mindfulness training, because we know that 12 minutes of meditation a day can change your brain. It’s a very important thing for neuroplasticity to do some kind of meditative mindfulness practice. So, we had our patients doing HeartMath, which I call meditation for non-meditators. It’s a little device, I know you know about it, Evelyne, but it pretty much tells people to breathe in and breathe out and think of someone they love, which causes a hormonal flood that lowers your sympathetic nervous system tone. And so, we had people doing HeartMath six days a week, and we had people exercising six days a week, and we had people, a lot of them needing to do detox and sauna treatments.

And of course, they had many of them. It was major dietary shifts, major exercise shifts. So, there’s a lot of moving parts, but definitely people got into a rhythm with it. I had a couple people that had stopped working or really cut back on their work because of their cognitive struggles and then all that they needed to do for the study, but they ended up going back to work partway through the study. So yes, upfront it’s a little difficult. It would just be wrong to say, this is some easy program. It’s much easier to take a pill. Of course, it is. And it would be great if we had that magic pill that worked great. But I think you have to frame it, what is going to happen if you don’t make these interventions? If somebody is working, maybe they need to be on temporary disability for a few months to be able to have time to integrate all the features of the program.

Because once you integrate them, then people get in a groove and they’re able to start doing it. But I do think also the level of having support with nutrition, exercise, it made a huge difference. And that’s not something you need forever. You needed to get started and you needed somebody to help you make these shifts and then you integrate them. Yes, there’s some upfront costs if you’re going to have to pay these different practitioners for support. But if you look at the cost of one year in assisted living in the San Francisco Bay Area where I live, it’s way over $100,000. So some of it you have to think of pay now or pay later kind of. And I think as we’ve got the first clinical trial data, we’re starting the next clinical trial. I think we have lots and lots of patient stories, lots of clinicians having amazing successes.

But I do think having the trial data helps people at another level to understand that perhaps this is worth it. It’s worth the time. It’s worth the stress of majorly changing your diet if you’re not eating a great diet. It’s worth the factor of making the time every day for exercise. Actually the physician that I told you about that was sliding down on his verbal memory, he had never exercised a day in his life. He wasn’t overweight. He looked good, he looked healthy from the outside, but he was an academic intellectual, he was not an exerciser. He went from that to, he really started to enjoy working out with the trainer and the exercise programs. He was very religious on every aspect of the protocol. And that’s what I want to say that that’s another factor of there’s so many things to do, but the people who do better do it all.

They don’t say, I’m not going to do that mindfulness training, or I’m not an exerciser. It kind of all fits together. We’re addressing all different aspects that you need for your body to help heal your brain. But he went from no exercise to, at the end of the study he told me he was going ocean for his anniversary. And if anybody’s ever gone ocean kayaking, it’s very strenuous. You have to be strong; you have to have endurance. So I just thought, wow, this guy has made, he’s really incorporated that shift and it’s opened up new things in his life, which are also war stimulation for his brain to do new things.

Evelyne: That’s incredible. I also love that you shared some pearls about how practitioners can encourage their patients, like some of those statistics about the costs to make it worth the investment of time and money to make these changes. My next question is going to be around some of the causes of Alzheimer’s, and I know you have your own personal story in here as well. I know it’s multi causal, but I’d love to talk about infections a little bit more, which you did already bring up, as well as toxins and then hormones. So, let’s talk about infections first. You already mentioned COVID. What are some others?

Dr. Kat Toups: Other infections, yeah. And those three things I would reiterate, these are the things that I think not enough people are addressing with cognitive decline, infections, toxins and lack of hormones. And many very successful and smart people are talking about the diet, the exercise, the lipids, the blood sugar, they’re all equally important. But the infections are a big one. And I’d say one of the trickiest infections is Lyme disease and with global warming, Lyme is on the march. The CDC has acknowledged that they underestimated the incident by probably several zeros after it. It’s moving into parts of the country that it was not before. In California, we have Lyme reported in every single county in the state of California. Some areas like here in the San Francisco Bay Area and Marin County and up to Mendocino County actually is where it’s always been the worst for us here. It’s quite a problem.

And so, Lyme is an organism that’s like syphilis. And most people can recall the story of syphilis in the 1800s and early 1900s. And a man would get an STD and they would have a visible symptom of it, but then it would go away. And then some years down the road, they went crazy. They had become demented. And so, Lyme is a spirochete just like syphilis, and both of those Lyme and syphilis like to go in the brain. The brain tissue, Lyme goes to the joints or the brain or both, and it can go into different areas, but the biggies are the joints and the brain. And so, people can have Lyme disease and perhaps even they knew about it, maybe they had some acute treatment, and sometimes that gets it and you’re fine. But sometimes the treatment isn’t sufficient, and it can kind of go underground. It’s called a stealth organism. It can take different forms in the body cyst and cell wall deficient forms and spire spirochete forms, and it can be hard to detect in the blood.

And so, our testing is not perfect for Lyme disease. And it can sort of go untreated, but it can be affecting the brain. And then over time it can cause degeneration of the brain. And there was an autopsy done on a woman who had been treated for Lyme years earlier, and they found live spirochetes in her brain. It’s pretty creepy that it can still be there. And when we have an infection in our brain, what happens is it’s the immune system, then it comes in and does a lot of damage, because, and we’ve again learned about this from COVID in the first form of COVID in the 2020s, we all learned about cytokine storm. And so, we have this virus, our immune system kicks in, releases all these inflammatory cytokines to kill the virus. And if you have enough to kill it and not damage us, then that’s great.

But some people’s immune systems will have a more exuberant response and then they will overreact to that and cause problems. And it’s probably one of the factors with the long COVID population that we’re struggling with now. So, when we get an infection in our brain, our immune system turns on to kill that invader, but it can kill the surrounding tissue. We’ve learned that, back to that amyloid in the brain, the feeling now is that that is secreted in response to something hostile to the neurons. It’s a protective response. So, if something is irritating or killing a neuron, it can secrete that amyloid to maybe wall off that area and protect it because it’s a thick, gooey substance. And so, if it’s a short-term insult and it stops, then a little bit of amyloid might be okay. But if it’s something chronic that’s going on over years especially, you’re going to be building up and having more and more damage to the brain.

So, Lyme is a biggie. Some of the Lyme co-infections, Babesia and Bartonella are both known to really affect the brain, and they both have different kinds of psychiatric symptoms associated with them. And then we test for a lot of other viruses. So, Epstein-Barr virus is one that is common. Herpes simplex is another one. And herpes has been known about for a couple decades, the effects of, looking at people who died with Alzheimer’s, there was a much higher incidence of herpes simplex one in their brains and in the general population. And herpes simplex one is, it’s the cold sores. Most of us have that as children. It’s one of those viruses that’s just ubiquitous. I don’t know the exact statistic, but I’d say maybe close to 90% of people have been exposed to that. And if our immune system is working well with these viruses, we don’t get rid of them, they stay inside of us, but our immune system kind of keeps a lid on them.

And then when something happens as we age, the immune system doesn’t work as well with aging. If we have a big stress like a surgery or a medical problem or a death in our family, something very emotional, any kind of stress can impact our immune system. And so, if the immune system then is not working optimally, these viruses can wake up or reactivate and start causing symptoms of the disease again. So, treating the herpes I think is important. There were a beautiful couple of studies that Dr. Ruth Zaki did and published, I believe it was three, maybe four years ago now, it’s getting longer. But she looked at giant populations of people and found that if people had taken a single course of antivirals, like you can take valacyclovir or acyclovir, common antivirals or herpes, a single course of it greatly diminished their risk of developing Alzheimer’s still.

Evelyne: Wow, that’s fascinating.

Dr. Kat Toups: Really a powerful, and it was looking at 30,000 people or more, so large numbers of people. And so, what they’ve got us to thinking is, okay, when we are seeing these high levels, maybe we need to treat this virus and try to knock down those titers. And normally if you’ve had it, you’ll probably get some level of positivity on the test, which is a common test you can do at Quest or LabCorp, a general physician can look at this. But the teaching is if the elevation is more than four times the upper limit of normal that you should consider that this virus might be reactivated. And that is a time then that we would look at treating the virus.

Evelyne: So, in your trial, if somebody had EBV or Lyme, so were you treating with antiviral drugs? Were you giving supplements? Can you talk more about the treatment and then we’ll move on to the toxins?

Dr. Kat Toups: Lyme, that’s a two-hour talk of-

Evelyne: You’re right.

Dr. Kat Toups: … these treatment modalities for Lyme. But I would say the three investigators in the study, we were more comfortable using herbal treatments and immune support. I don’t think that any of our patients used antibiotics. It was an option if we thought they needed it. And there are sometimes situations where you might really want to consider treating with antibiotics, but there’s some nice data that came out of Johns Hopkins a couple, two years ago now, two, three years ago, and they show that for chronic Lyme, the herbal treatments were actually superior to the antibiotic treatments. So again, it’s not for everybody. Some people have certain conditions that may make you want to treat with antibiotics, but they did some very nice data, and in particular they showed that Cryptolepis, an herb from Ghana, I believe, could completely eradicate the Lyme persisters.

Because Lyme, as I mentioned, can be hard to treat, and it’s got ways to avoid detection in the immune system. And so, we may be knocking it down, but have we gotten rid of it? So, getting rid of those persisters can be an important thing. So, they were all treated with herbals as well as immune support. So, we do different things to help the immune system to function better. And of course, that starts with some of the foundational stuff, the diet, the sleep, the stress reduction. But we often, probably a lot of us used LDN or low-dose naltrexone, which is an immunomodulator that can give immune support. And then other supplements depending on what was indicated for that person. For the EBV, there’s a couple of different herbal protocols that seem to work well. It’s sadly not one thing you can take, but you have to mix in several things.

And with those kind of viruses like herpes and EBV, it’s not a four to six week treatment where you take antibiotics for 10 days, two weeks, occasionally four weeks. The virus is that they take a long time to eradicate, so people have to be patient with these herbal protocols. With the herpes, two studies kind of informed my thinking a little bit. I found that Columbia was doing a study of treating with valacyclovir for herpes as a primary treatment for Alzheimer’s. And in their study, they were using 18 months on the medication. I need to go and look it up because I’m not sure what happened that was starting just in the beginnings of COVID, and that really derailed a lot of people’s research. I don’t think that as a monotherapy that’s going to treat Alzheimer’s. It may help, but why is their herpes high? What’s wrong with their immune system? What else is going on with their hormones?

But still, I was intrigued that they used 18 months, that’s kind of a long time. And there was another study that Stanford had done using valganciclovir, another antiviral medication, and it was for chronic fatigue syndrome, which is also at this point believed to be something with a viral etiology and of course the impact of the immune system. And they also were using 18 months of their antivirals. That’s a pretty long time, and I think I kind of have to just feel it out. With Epstein-Barr, that’s mononucleosis or chronic fatigue as one of the things now we know as a factor with chronic fatigue. The symptoms will sometimes guide how long I treat. Sometimes I’ll see people on an antiviral protocol just wake up in one or two weeks and tell me they have so much more energy, they can get a lot more done.

And other people, it’s not so dramatic. And sometimes you’ll use one herbal protocol and do that for a couple months, and if say they have fatigue and that’s not doing it, then you may switch to another one and come at it from different angles.

Evelyne: Before we talk about toxins, I was just reminded in the presentation you recently gave at the IFM conference, you also talked about dental infections. And this is scary to me. I know about the importance and the link between oral health and cardiovascular health, I don’t often think of it for the brain. So, tell us more about that.

Dr. Kat Toups: Yes, that’s a huge factor and something we addressed in the last study, and we’re addressing even more in this study. The microbes in the mouth can tell easily up into the brain, also what’s in your sinuses, chronic sinus problems, gum disease, it goes right through. There’s a cribriform plate that is very porous, it’s got holes and it’s very easy for those microbes to get into the brain. And at this point we have a really increasing body of literature and data about the correlation with the microbe infections of the mouth and especially gum disease and brain disease. And there’s three, four organisms I think that are most highly correlated. There’s one called P. gingivalis. So, people get gingivitis, that’s the infection of their gums, inflammation, and people need to think of that as an infection.

If they’re having swelling in their gums, bleeding gums, tenderness, bad breath, that’s an infection that’s happening and it needs to be addressed to help your brain. We used in this current study that we’re just starting; we’re just launching, we’re using oral pathogen testing. There’s three different companies that I know about there. We chose to use MyPerioPath because it looks at the most microbes, and they give a nice report that shows you how high you are on 11 different common strains in the mouth that cause problems. And they’ll show you, okay, these are the ones linked to cardiovascular disease. These are the ones linked to arthritis and joint problems. These are the ones linked to brain problems. Obviously, you don’t want any of those things to happen if you want to address all of those things.

So, working on oral health I think is essential. And one of the things I’ve incorporated in my treatments is something called the cone beam CT scan or a CBCT for short, cone beam CT scan. And it’s a special dental x-ray. It’s like the Panorex, so it’ll go around and look at all your mouth, but it tells us about hidden infections in the mouth. And one of the biggies with that is the root canals. When we have a root canal, we typically have an infection in a tooth, and they give you antibiotics and they try to clean it out and it’s not getting better. And so, the dentist says, okay, we need to do a root canal. So, when they do a root canal, they’re taking out all the root and that stops the pain, right? Because they’ve killed the root, which is our sensory organ in the tooth that tells us that there’s pain and something going on.

So okay, your root is gone, but where did that infection go? So, it clearly wasn’t getting taken care of by the antibiotics. And beyond the root I’ve learned there’s these microtubules and they’re little, tiny canals, and apparently there’s miles of them with each tooth. So, if you’ve had an infection in that root, it can theoretically get into those microtubules. You’ve got rid of the root, no more pain. You don’t think there’s a problem, but you have this sort of subclinical infection. You’re not really aware of it, but it’s there. And what does that do? It turns on your immune system. It can keep your immune system chronically activated trying to get at it. And of course, as I said, it can travel up into the brain. So, one of the things that we started to see is people have gotten more aware of this.

Now there’s some couple of, is it periodontists that work with the roots? And some people have developed techniques for cleaning out the root, opening it back up, taking everything out, using your laser treatment to try to clean out things, and then using an ozone treatment, ozone, it’s a gas that’s a powerful antimicrobial. So, they can put that in. And the feeling is maybe it’s diffusing higher up into the microtubules. And so, some people may be okay with that. Some of our preference now is to watch these root canals on the cone beam CT scan. And I’ll tell you my own situation, I have been following, I have three root canals and I’ve been following them on the cone beam CT scan since 2012. So, this is 2023. So, I’ve been watching them for a long time. I do it every kind of two years.

I did it last year and there’s two of them together for me. And they started to look like they were breaking down, so they didn’t look like they were perfect. And then I did it again recently and they looked a little worse. And in between from that year to this year, I had a bad case of COVID. Five weeks after I recovered, it triggered all kinds of major serious immune problems for me. And I have a history of lifelong immune problems, and I’ll get them completely settled and calm and recover from things you’re not supposed to recover from. And then I’ll get a trigger and then something new happens. So that happened to me with COVID. And now that I’m finally getting past all of that, I did the cone beam CT scan, and I said, it’s time, it’s time for me to get rid of those root canals because I feel like there’s something that still keeps triggering my immune system no matter what I’ve done so much work for the years on myself.

A psychiatrist I know told me she pulled a couple of root canals, and she had severe chronic fatigue for a couple of years. She said almost overnight, within a couple of weeks, that completely resolved. We hear clinical stories like this. We see people that when you take out the triggers, clinical symptoms get better. But it’s a huge thing with dental health. And now we’re getting more and more into different natural products to help herbal antimicrobials, the toothpaste, the rinses. But I just think it’s imperative to look at what’s happening in your mouth if you want to keep your brain healthy.

Evelyne: Yeah. Thank you so much for sharing that. And I think for the practitioner listening, I hope this is something else that maybe we’re not looking at, not asking patients or clients about. So very important, we’re going to pause here. In the next episode, join us for part two of Advances in the Prevention of Dementia and Alzheimer’s with Dr. Kat Toups. In part two, we’ll cover the role of genetics and treatment protocols, dietary recommendations, sleep hygiene considerations, and learn about Kat’s favorite supplements. Thank you for tuning in to Conversations for Health. Check out the show notes for resources from this conversation. Please share this podcast with your colleagues, follow, rate, or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips.

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