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Episode 6: Advances in the Prevention of Dementia and Alzheimer’s with Dr. Kat Toups — Part 2

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 second part of our conversation, Dr. Toups continues our exploration of approaches to Alzheimer’s, dementia, mild cognitive impairment, and general cognitive health. She highlights the role of toxins testing, the importance of sleep hygiene and dietary monitoring, and the part that hormones play in overall brain health. Her personal and professional experiences are both encouraging and enlightening, and she offers an array of action items for anyone that is invested in dementia prevention efforts.

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

Blog: Minerals for Detoxification Support

Blog: The Latest Clinical Research on Zeolite and Heavy Metal Detoxification

Blog: Exploring the link between the ApoE4 gene and increased risk for Alzheimer’s

Webinar: Fueling and Building the Brain – Understanding the Role of Fat & Ketones in the Brain

Journal: Fish oils review, Chapter 91, 2020 Textbook of Natural Medicine

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


[1:24] Kat’s experience with toxins testing, treatment, and study findings.

[7:52] Two main considerations of the role of genetics in treatment protocol.

[11:30] Dietary monitoring recommendations for advanced APOE4 genetic lipid markers

[14:42] Sleep hygiene considerations and device recommendations.

[17:05] Two Designs for Health supplements were used in the trial study.

[20:14] Dementia prevention supplement recommendations include fish oil, B-complex, and vitamin D.

[23:53] Kat’s personal favorite supplements and mitochondrial support.

[27:03] Kat’s top and non-negotiable health practices start with what she puts in her mouth.

[32:08] A holistic approach is the answer to finding lasting health.

[33:40] The role of hormones in achieving optimal brain health.


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. This is Part Two of Advances in the Prevention of Dementia and Alzheimer’s, with Dr. Kat Toups. If you missed part one, go back and check out that episode. In part one, we covered many topics including Dr. Toups’ pilot study, Key Distinguishers Between Mild Cognitive Impairment, Dementia and Alzheimer’s, and the Impact of Dental Infections on Cardiovascular Health. All right, let’s dive back in. Let’s talk about another contributor to Alzheimer’s toxins, in general, and I know you have your own story around this. So what types of toxins are we talking about? What is the treatment like? What did you see in the study?

Dr. Kat Toups: Right. So, with the toxins, we’re testing a couple of things. We test the metals levels. How high is the mercury, how high is the lead, the cadmium, the arsenic? We know that many of these metals can cause brain degeneration and neurologic problems, and those are simple tests that can be done at Quest and LabCorp. These aren’t specialty lab tests. Yes, you can get them done from the specialty labs, but it’s easy for most practitioners to order those. And mercury is just hugely on the rise because our oceans are being polluted. Mercury is a known neurotoxin and you can get those levels down if you know that they’re elevated.

So the first thing, in my book, is you just need to test for everything because you need to know, “Okay, I can check that off. Mercury isn’t my problem.” But if it is, what I saw was, in people that would have high mercury levels, I would ask them to eat no seafood for a number of months. I would put them on liver support for detox and have my patients do, if they could, sauna, sweating. Because we know that when we sweat, the metals and the toxins will come out through our sweat. So ancient tradition in many cultures of sweat lodges and baths and sweating has so much wisdom for us. So having people do those things and avoiding the seafood, pretty much you can get that mercury down to zero unless it’s from a different source than the seafood.

But in three, four, six months, it can come down of high levels down to zero. And then what I would do is have people go back to eating seafood, but ask them to eat the small fish, the anchovies, sardines, wild-caught salmon, scallops, things that are smaller, don’t concentrate the mercury, but the big fish like the tuna, so many people love tuna, but they’re large and they live a long time and they eat the smaller fish and they concentrate the mercury, so you’re just going to get too high a load. I remember when I learned detox years ago in my functional medicine training, one of our instructors said every time he eats sushi, he would take some DMSA. We used to be able to get that as a supplement.

Evelyne: Right.

Dr. Kat Toups: But we no longer do that. But he would do a little detox prophylactically every time he ate sushi. I think that one thing I like people to think of is detox is not like a little procedure or protocol that you do and then you’re done. The world has just become increasingly toxic so we all need to think about just detox is an ongoing process that we need to incorporate in our lives with the sweating, with the liver support. I like some of the sulforaphanes for that. But definitely we need to be so aware of what we put in our bodies and what we put on our bodies, everything topical that we put on, our lotions, our shampoos with the chemicals.

We did do a panel for chemicals, some of the chemical toxins, and some people are familiar with parabens and phthalates, but there’s a whole list of chemicals that are hazardous for us. So we did a panel of those and what you see is some people detoxify better than others and that’s probably our genetics. And I’ve learned in my own self that, I’ve learned all of these layers on myself through the years, but I’m not a great detoxifier, and so I will have high levels of chemicals even though I’ve been so careful about exposures and organic foods for 20 years now. But some people are better at it than others.

I had a patient years ago, when I first started doing this work, come to me. She was already in a nursing home with her dementia and they wanted to know what could they do. I tested everything and she had some cardiovascular risk factors, but it didn’t seem to account for why. It just wasn’t enough. And then I did her toxin screen and they say if you have one thing in the red zone that’s considered serious, but she had nine things in the red zone, or 11 things. It was just everything was red, red, red, red, red. And you think, oh my God, what? Did this woman work in a factory with a lot of chemicals or did she live in an agricultural area where they were spraying a lot of Roundup and other chemicals in the soil?

No, she was a school teacher. And so what does that tell me? Her genetics are not good. She’s just not a great detoxifier and so she accumulated all of these toxins and her daughter told me that her mother was always into health, the ate as clean as they could. So I said to the daughter, who was in her 50s, “Gosh, do you want me to order this test for you so that you can have a look?” And sure enough, the daughter was high in toxins as well. So we have to be mindful that all of these metals and chemicals are adding to our burden that are causing degeneration of the brain and the heart and other factors in the body.

Lead is another big one, and one of the things we see in the elevated lead levels is, when you detoxify from lead, sometimes you’ll see rapid improvement in people’s cognition. But in my area, I don’t find elevated lead very often. Mercury is much more common in my population, and sometimes we see the cadmium and the arsenic from the rice and other foods that people are eating. But if you’re the person with a high lead, you want to know that and you want to see a practitioner that can help you lower your lead levels.

Evelyne: Since you brought up the genetics part, we know that our genes are not our destiny, but we do hear a lot about APOE4 and if somebody has a heterozygous or homozygous mutation in APOE4, does that change the treatment protocol?

Dr. Kat Toups: It doesn’t change the treatment protocol. There’s just two things to know about that. I mean, do you have one copy of APOE4? It’s very, very common. It’s at least 25% of the population. And having two copies of E4 does increase your risk of having Alzheimer’s slightly, but there’s other factors involved with that. When you have E4, the thinking is that people will have a more exuberant or overactive amyloid response. I mentioned that amyloid happens from an insult, something that’s injuring our neurons, so if you have a 4, and I am a 3/3, I know, so if we had the same infection in our brain and you had a 4, you might make more amyloid than I make, which, again, more amyloid does start to gum up the works of the brain and then starts killing the neurons. So people that are a 4/4, they typically have a higher risk, but we’re all working with patients with 4/4s.

I have somebody that I’ve worked with for seven, eight years and she must be getting around 60. Her father had Alzheimer’s, and so she came to me some years ago, “What can I do to prevent this?” She does everything and we’re following, now, brain biomarkers and new things that are happening, but she’s doing fine. And we’ve had patients with double E4 that came with dementia where we can stop that and get them better. So it is a factor, but even within the genetics, it’s gotten a lot more sophisticated in the last couple of years. So there’s other SNPs that you can have that will, even if you’re a 4/4, are going to reduce your risk. And then there’s some SNPs that will increase your risk, maybe even if you’re a 3 or if you’re a 4.

So there’s several different things that will really change that outcome. But just to say, “I’m a 4/4,” well, maybe you have these two other SNPs that are going to decrease your risk to almost the same as a 3/3. So it’s gotten more sophisticated. The only company that I know of yet that’s testing those is the one that we used in the study last time and that we’re using this time. It’s a very expensive panel, so it’s not something that’s easy for everyone to do. I believe the cost is about $900 for their panel and they’re testing all kinds of other factors, diabetes and detoxification.

I mean, it’s a beautiful test, but it is cost-prohibitive for many, many people. But I hope that that will become more available because it does help us. There’s certain anxiety that when people say, “I’m a 4/4 and people in my family have all had Alzheimer’s,” but I just want people to know that that really doesn’t, as you said, it doesn’t equal your destiny, it just means that you need to try harder and be even more mindful. Keep up with your exercise, your tolerance, test your infections, test your hormones.

Evelyne: Yeah, I want to get back to the hormones, and I also want to talk about supplements for a moment. I know that in the study-

Dr. Kat Toups: Wait, excuse me.

Evelyne: Yes.

Dr. Kat Toups: One second. We could come back to it, but maybe if we talk about other dietary things, because we use ketosis in the study and there’s some pluses and minuses with that, but the APOE4 is also called the fat bucket gene. And so people that have E4s tend to store their fats more and they can accumulate not only around the midsection but in the blood vessels as those dreaded lipids. We don’t want our lipids to be too out of control because that’s damaging our blood vessels and our heart, and of course the blood flow to the brain, as well as the heart, the kidneys, the organs, everything else.

So just one caveat for people with E4 is to especially keep an eye on their lipids and their advanced lipid markers, not just a short lipid panel that historically has been done, but now Quest has Cardio IQ that will tell us all the advanced lipids. LabCorp has an NMR test, and then you have to add the LP(a), which is a really important cardiovascular marker. And I would say, in the study, because of trying to move the needle and standardize some things, we had everybody do a ketogenic diet. And some people say, “Well, if you have E4, you can’t do a ketogenic diet because it’s a high-fat diet, right? You’re cutting out the carbs and you’re limiting the carbs to lower the blood sugar and force the body to shift into burning fats for fuel instead of sugar for fuel.”

And in that state of a ketonic state, for some people, it really enhances their brain clarity. They can know pretty quickly that it’s helping them. And with aging, people lose their metabolic flexibility and they can develop insulin resistance or just they’re not using sugar as well. And sugar and carbs are the same thing. So with a ketogenic diet, what I do is when I start people, I will check their advanced lipids before and then I’ll check them again in a few months. And if you see people starting to elevate their lipids, then you need to adjust their diet and take out the saturated fat or lower the amount of saturated fat. You can still do a ketogenic diet. You just shift to things like more olive oil instead of coconut oil.

But I had people with two E4s and one E4, and they did not elevate their lipids at all because they were eating a clean diet, they were exercising, they were sleeping. Sleep apnea is another really important thing that we test all of our patients for. 100% of patients, I don’t care if they say they don’t snore, if they’re thin, you will still find it. So they all need to be tested because we worry, with a seizure, if somebody has a seizure, for a brief time they’re not getting oxygen to their brain. But if you have sleep apnea, it’s like all night every night, you’re not getting enough oxygen for your brain or your heart. You will develop congestive heart failure over time, but you’ll also develop dementia if you’re having chronic hypoxia when you’re sleeping.

Evelyne: Yeah, that’s a very helpful tip because, I mean, there are so many things to evaluate, but I think sleep apnea, we consistently hear from many different issues why that’s so important to evaluate in most people, especially if they don’t wake up rested or if they don’t present with a typical picture of what maybe “somebody with sleep apnea,” what we think that person looks like.

Dr. Kat Toups: Let me just say testing for the sleep apnea now can be done at home. The physician can order home sleep testing. The sleep lab will give you the device, you just wear a little thing around your wrist and a sensor on your finger, and it records during the night. And I think that’s a beautiful screen. I have my patients do it for three nights in a row. I have a device that the practitioners can buy or lease a device, and then when I check it out to my patients, I’ll have them do it three nights because sometimes I’ll have two nights that look okay, and then I’ll have a third night that looks kind of dicey. Then I will send them to the sleep lab and we’ve picked up some apnea that way but-

Evelyne: What’s the device you use?

Dr. Kat Toups: The one that I have is called Patient Safety Inc. And there’s another good company called EndoPAT, E-N-D-O-P-A-T.

Evelyne: EndoPat, yeah, I know that one.

Dr. Kat Toups: That’s one that I know about and there probably may be more. But they both make really nice devices. Because it’s not only sleep apnea, but more common in women and thin women where you wouldn’t think apnea, they have something called Upper Airway Restriction Syndrome, UARS. And what happens with that is, while you’re sleeping, the airway can just get a little flabby and it can temporarily collapse and you’ll have a brief, very brief, hypoxia.

But what that does is it shoots up your nervous system, your heart rate jumps up, and it’s causing arousals in the nervous system, and that can affect the sleep, and it can just cause this high level of stress while people are sleeping when they’re supposed to be restoring things. I know a younger woman, a physician, who told me getting that diagnosis and having treatment for that completely changed her life because of her insomnia and her stress levels. So that’s another thing that can be picked up on these home sleep studies.

Evelyne: Yeah, thank you for sharing that. I do want to talk about supplements a bit because, in addition to the supplements that you use specifically for, say, treating infection or some of the other things, you also use some specifically for brain health. And at your site you actually use two Designs For Health supplements specifically, and because you used them in the trial, I want to talk about those. So what were those two?

Dr. Kat Toups: Well, the first one is fish oil. And that’s one of the, I mean, the top three nutrients that I think everybody needs to be on because, even if we’re eating perfect organic diets and varying everything with the seasons, still, our soils are robbed of nutrients, so we need to have certain level of support. The fish oil is definitely something that’s well known to help the cardiovascular system. And whatever is good for the heart is good for the brain, just those are almost equivalent because it’s a whole vascular system, and then the inflammation that’s happening there. So fish oil, probably hundreds of studies showing the benefits for the heart, but also lots and lots of studies to benefit of the brain.

I’m a psychiatrist by training, before functional medicine, and many, many studies for depression and anxiety with the benefits of fish oil. And in those cases they use really high doses, like seven or eight grams a day. But what I’ve come to sort out clinically is those were short-term studies, like eight weeks long. So if we can flood the brain and the body with a fish oil, get the levels up, then you can back down and you don’t have to take… Because who wants to take seven or eight grams a day? It’s very expensive and it’s a lot of stuff to take. I think most people seem to need about two or three grams a day is what some of the data shows.

There’s lots of companies that are reputable, making good clean fish oil. Fish oil is a supplement and you must know the manufacturer. You must know that they’re testing for metals, that they’re purifying it, because if you’re taking cheap fish oil that might have high levels of metals, you’re going to be undoing any good that you’re doing. So Designs For Health is always in my top level of supplement companies that I trust because I’ve seen their testing because I asked for it, and a lot of my stuff. So I use the fish oil. I use the OmegAvail Hi-Po. And those, I like the capsules. Not capsules, they’re soft-

Evelyne: Softgels.

Dr. Kat Toups: Softgel, and they’re kind of tapered at the ends. Because fish oil pills can be really big and as people get older sometimes they don’t swallow as well. So I like the size of them. They’re kind of skinny and tapered. They go down easier. And I know that if I have people take two in the morning and two at night, they’ll be on three grams a day. That’s what I use with all my study patients. And the other just basic nutrients, I think everybody needs to be on a B complex or a multivitamin. I tend to often go with the B complex because they’re giving me higher levels of the balanced B vitamins and the brain really needs those.

And then vitamin D, which is another huge one. Vitamin D is really a hormone. It’s not just a vitamin. It affects 200 things in our body and we are almost all deficient. We evolved to extract our vitamin D at the equator. And so if you’re living at the equator and you’re in the sun all day, great, but even in the southern part of the US, people are still coming deficient, especially in the winter. And again, that’s an easy test. If your vitamin D level is less than 30, you have a 75% increased risk of dementia, and I see people that are less than 20 and that risk is sky-high.

And that’s such just an easy thing to test your level, take a good clean supplement and get your level in the range. I like to see it above 50, like 50 to 80. So those are my big three. But you mentioned the cognitive function supplements. We call those nootropics, and they just are things that are multiple different supplements, have data showing that they can help the actual functioning of the brain. I’m not a big fan of thinking of nootropics as my main treatment modality. I want to fix the deficiencies and the causes and give people what they need. But in the beginning, certainly, and in my protocol, I had a short time. We only had a nine-month study, we had to move the needle very quickly, but I think you need to move it quickly when your brain is degenerating anyway. So I chose to use the Designs For Health, I call it Brain Vitale, and-

Evelyne: I call it Brain Vitale.

Dr. Kat Toups: Vitale.

Evelyne: They both work.

Dr. Kat Toups: Yeah, it’s got it that E on the end of it. But it’s just a nice combination of different nootropics that are validated to help the brain. I like the formula. So I did offer that to my patients in the study, especially at the beginning, to help the cognitive functioning. And many of them felt like it was useful for them. I mean, we weren’t doing one thing at a time. So no, it’s hard to say, but people kind of know when they start a new supplement, sometimes they say, “It’s not doing anything.” Sometimes they say, “I like this one, it helps me.” I got some good feedback and so I like that formula, and I did use it in my study.

Evelyne: I do notice when I take it that I feel a lift in my brain. That’s how I would describe it. And, with the OmegAvail Hi-Po, there is a liquid version now, too, which has three grams of EPA and DHA per teaspoon, so that might be easier for patients who cannot take a softgel for whatever reason. Because those can be hard to swallow sometimes for some people.

Dr. Kat Toups: I would say that Designs For Health has done a great job of making available a lot of liquids and powders. I remember a couple of years ago asking my representative to give me a list of everything that was a liquid and a powder because people differ. Some people don’t want to take the liquids and powders, that’s too much work, but other people, having to take handfuls of supplements, it becomes quite cumbersome. So it seems like Designs For Health has some good options that way with a lot of your products. I like that. Thank you for doing that.

Evelyne: Yeah. Kat, I do want to switch because we could talk for so many more hours, probably, about different factors and treatments. I just love listening to you and all the stories that you’re sharing. It’s amazing. I do have some personal questions for you, like what are your, say, top three favorite supplements to take?

Dr. Kat Toups: Well, I think I kind of told you that. Those are just my fish oil, vitamin D and B complex.

Evelyne: Okay, perfect.

Dr. Kat Toups: I just think those are basics that are covering so many things in our body. Here’s an example of something where you could see shift so easily. I mean, I had a patient come to me some years ago with severe depression. She was crying all day. She was feeling suicidal, hopeless. So basically I told her, I mean, I always start with the diet and I want people ideally off of gluten because of the inflammatory nature of it and that it’s causing leaky gut and causing all kinds of inflammation, and then dairy for her, again, because of the inflammation. So I said, “Okay, I want to get you on a gluten-free, dairy-free diet.” And we started fish oil, vitamin D and B complex.

This cured her depression in short order. I mean, we went from hopeless, crying, suicidal to she was fine. Most patients are not that easy but for her, that’s all it took. And it just showed me the importance of researching all those things and the factors that they bring to the table for the brain and the mood. And then she came back again some months later and she said, “My depression’s back. I’m crying again.” It was January. And I said, “Okay, what’s going on?” She said, “I cheated on my diet over the holidays.” And I said, “Well, okay, that’s good information. Just get back on the horse and get going.” And that worked for her.

But I think it’s not just the diet, it’s those supplements, basic supplements. So those three I think are easy, and then beyond that. My next level, though, I just want to say, I know you want three things, but for the brain, mitochondrial support is my next big horse that I want to get on and ride. Our mitochondrial function just starts to declining with age and by 50 it’s really starting to go. And that dovetails with some of the levels of some the nutrients. I think CoQ10 is one of the best known mitochondrial nutrients, and we see those levels really declining with age.

So I do give a lot of mitochondrial support with neurodegenerative disorders and just aging in general, so CoQ10, acetyl carnitine, lipoic acid. There’s just more beyond that. And even things like vitamin K turns out to be a mitochondrial nutrient. So that would be my next thing. I think somebody, who is it, has a book? Is it Terry Wahls or somebody, Minding My Mitochondria? Pay attention to the mitochondrial support. I think that would be the next level with aging that I would look at.

Evelyne: Absolutely. And what are your top health practices for your personal health and wellbeing, your non-negotiables?

Dr. Kat Toups: Yeah. Yeah. Well, for me, diet for me is non-negotiable. When I first came to this table, I had multiple chemical sensitivity and I was allergic to everything. I do have a lot of challenges with some of the things to react to, but keeping my diet organic. I’m personally not a great cook and I’m so envious of my friends who are, so I always ate out a lot and I like to eat out. It’s very nice. But I really I had to quit that because, when you’re eating out, it’s so hard. Now, I know all the places around here where I get organic food and free-range meat, but I think for me that’s non-negotiable. Start with what I’m putting into my body, for sure. And it’s really worth the extra expense to get free-range meats and wild-caught fish because it’s pay now or pay later. It will catch up with you.

So diet, I think, is non-negotiable. Exercise, I think, is the next thing. And if you want to age well, you can’t slack off on your exercise. You need to try harder to stay on the curve. The exercise, it increases our blood flow and it increases our oxygen to all of our tissues. And you can do that for free. There’s so many great free resources on the internet these days with exercise programs, even if it’s simply walking. But I think you need to try harder than that. With aging, we like incorporating the high-intensity interval training. And again, that stuff is free and you don’t have to go to a gym to do it. You can incorporate lots of little ways to raise your heart rate for three minutes. So exercise.

And then a certain thing, I think, would have to be sleep. Sleep is when our brain detoxifies. We’ve talked about the importance of detoxification, and we know that when we sleep, our lymphatic system in the brain, it’s called the glymphatics, and that is a system of fluid that can get activated to clean out the toxins. And they say that when we go to sleep, the glymphatics and the ventricles will actually enlarge and the lymph in there will start churning around, kind of like a washing machine, and pull out all the toxins that we’ve accumulated in the day. So if we’re chronically under-sleeping the number of hours of sleep, we’re losing that many hours of detox and also restoration, because now that many people are tracking their heart rate variability during sleep with Oura Ring. I have a Garmin Vívosmart watch. There’s Apple watches.

Looking at getting into the deep sleep, and there’s many factors that affect your deep sleep, but even just starting to just protecting the number of hours of sleep. If you sleep chronically six hours a night instead of eight, you may get by. But I think what I certainly noticed with aging is I used to easily get by with not enough sleep, and now I can really feel the difference in my cognition when I don’t get enough sleep, so looking at that. So really, I think they’re very simple. They’re simple basics, right?

Evelyne: Right.

Dr. Kat Toups: Diet, exercise, sleep. And then I guess I would have to add a fourth which would be stress management, right?

Evelyne: Right.

Dr. Kat Toups: I’m a psychiatrist. All the ways that our stresses are affecting our nervous system. We know that stress and depression are risk factors for dementia. We know that depression alone will degenerate your hippocampus more quickly, which is your memory center. So I guess I would probably want to add that as a fourth. They’re simple. They’re things that we can all incorporate in our lives, and they’re just the foundation. There’s lots of cool things happening with exosomes and peptides and lasers for the brain. I love photobiomodulation, the different red light therapies for the brain. So there’s a lot of cool stuff you could add on top of that, but you can’t just do the fancy stuff and skip those basics. It won’t work.

Evelyne: Right. Yeah. All the biohacking practices, all the basics have to be in place.

Dr. Kat Toups: Exactly. And I see too many people, you probably do, too. I mean, there are people that want to do those things, but they’re not exercising, they’re not eating clean, and they’re only going to get limited benefits.

Evelyne: Right. Last question for you, though. I feel like you may have already answered it earlier, but this is something we ask every guest. What is something you’ve changed your mind about through all your years in practice? Is it related to, say, the amyloid beta and doing the clinical trials, or is there something else?

Dr. Kat Toups: I mean, I think the big thing for me was, as you alluded to in the introduction, that the answer to health is not a pill. I mean, as a psychiatrist, I was an expert psychopharmacologist, and I did all of these 100-plus clinical trials. And every drug, I would be excited. Okay, here’s a new mechanism of action. This is going to help my patients. And maybe they helped, some of them helped, but they don’t get people well. And so, for me, the biggest shift is not symptom management, disease management, but it’s that shift into wellness. What can we do to have people really be well, not be dependent on taking this medicine for the rest of their life?

Maybe they need it in the short term. Okay, I’m not anti-medication. There’s a lot of beneficial medications that we need. But I think that’s my biggest shift is that we are trained as physicians in sickness and disease management, and we weren’t trained in wellness, we weren’t trained in nutrition. We weren’t trained in the importance of all the things that you and I have been talking about. So I think that’s the biggest shift.

And I would just add a correlate, because I don’t want to end this without saying a few words about the hormones in the brain. Because I do think that’s something else that’s missed, and many of us came of age when the hormone studies came out and said, “Oh, estrogen can cause cancer. It can cause breast cancer.” And in my own case, we didn’t get into my story, but I came to all of this at age 50 when I was getting as demented as the patients in my Alzheimer’s clinical trials. And if people put my name in YouTube, I have a little five-minute talk at Mindshare that talks about how bad my symptoms had gotten.

And it was a three-year journey for me of learning functional medicine and working through all these layers on myself to get my brain to come back online. But it coincided with the menopause transition was one part of it. I was 50 years old and my doctor had put me on hormones because I was having word-finding difficulty and she said, “Oh, don’t worry. That’s just a sign of perimenopause.” And I felt comforted for half a minute and said, “Oh, it’s perimenopause. Okay.” But then I thought, “Okay, as women, 50% of us are going to get Alzheimer’s, you or me, and maybe those of us that are having some problems with our memories and our word-finding, as we go through the menopause transition, maybe we’re the ones that are going to get it.”

Well, fast-forward, of course, I had major cognitive problems that you could hear about if you find that video. But then the World Health Organization report came out back then and told us, “Okay, these hormones cause cancer,” so I stopped mine along with everybody else that just bought that big study. But it turns out that the synthetic hormones that we were using in Premarin and Provera, those things definitely are linked to increased risks of cancer and increased cardiovascular risk.

But the bioidentical hormones that now have been in use for a long time, and they’re all available in generic, you don’t have to go to a compounding pharmacy to get them anymore, actually seem to be protective. There’s some data showing that, if we’re giving the body what it needs to maintain our organs, that they’re going to do better, that there’s less risk of… A couple of studies showing even after breast cancer. Not all breast cancer seems necessarily safe to give hormones, but a lot of types are in there.

And I see my patients, their oncologist and their surgeons are letting them go back on their hormones after they know that all the breast cancer is gone. So just like the breast shrives up without the hormones, so does the brain. We have receptors in our brain. Men and women have estrogen receptors. Men and women have testosterone receptors, progesterone receptors. Progesterone’s well known to be useful after stroke and helping the myelin sheaths of the nerves regenerate.

So you can measure all these levels, and even as you’re going through perimenopause, and also we look at pregnenolone and DHEA levels, so all of those are in the brain, and it’s not hard to get people on supplements and medications to support their hormones. But I just want to say there’s a study that was done at Stanford a few years ago, and they took women that were high risk for Alzheimer’s, based on their genetics and their family history, that had been on hormones, and they randomized them either to stay on the hormones or stop them, and then they followed all their cognitive testing and their head scans for two years.

And what they found was 100% of the women who stopped their hormones had degeneration of their brain. They could see it in the head scans, and it didn’t matter whether it was synthetic hormones or bioidentical, just those hormones definitely seemed to have some protection for the brain. It’s one of the things that we see sometimes quick changes is, when people haven’t had hormones and we give them back hormone support, you can, again, just like some people, I see a quick change in the ketogenic diet and other people don’t. But with the hormones, they’re definitely one of the things that I strongly believe in supporting.

It’s also the shift of people say, “Well, it’s not natural.” And I probably didn’t believe it was natural, like if God wanted us to have hormones, would keep them. Well, it’s interesting that we’re supposed to keep them because the brain actually makes its own supply of estrogen and its own supply of testosterone. So if everything is working well and we haven’t damaged our brains from other things, like infections and toxins, maybe it’ll keep making what the brain needs, but for most people it isn’t.

And we, until the last century, we didn’t live that long past perimenopause or menopause, and andropause for men. And so now you and I are the longest generation. Our life expectancy keeps increasing at this point. We can live a third of our life past menopause or andropause, so we’ve kind of shifted evolution in that way. I didn’t want to end without talking, in my mind, about the importance of hormones and the work that we do with helping people to reverse their dementia, but that was, again, another shift, in my mind, as a physician and as a woman, the importance of supporting the hormones.

Evelyne: Thank you so much for sharing that. I know we wanted to talk about it, and then we started running out of time so thank you for bringing it back. There is so much, yeah.

Dr. Kat Toups: I want to leave one other tip, too. They’ve looked at risk factors and reversible risk factors for dementia. We didn’t spend any time talking about the lipids and the blood sugar, but I think a lot of people are aware of that and I’m sure you have other guests that will get into the importance of that. But the most reversible high-risk factor is midlife hearing loss. It’s an insidious thing as we’re losing our hearing. Not everybody loses their hearing but that’s something that, now, as part of my workups, prevention or people have cognitive problems, I make sure that we get their hearing checked, that we get their vision checked, and that they stay up on that every year.

So hearing, vision, dental, think of those senses there in the top of your… They’re in your head and they’re going to your brain, but as you lose your hearing, you lose the inputs into your brain of different sounds, and they say, “Use it or lose it.” Just like with exercise, if you’re not firing those pathways, those neurons will stop working and they’ll get pruned out of the brain. So I think that’s something that usually the family might be aware of the hearing loss, but the person will say, “No, I don’t have any problems with my hearing.” That’s something easy to check. Get an audiology exam and get those. Don’t wait until people are shouting at you. You want to get the hearing aids sooner rather than later, if you need that.

Evelyne: Yeah. Thank you so much. That’s a great clinical pearl. And, Kat, thank you so much for being here today, for sharing your expertise with us and also for all the work that you’re doing in the world. I can’t wait for your upcoming book and also for your trial to be published. So thank you.

Dr. Kat Toups: Oh, thank you. Thank you for helping us to get the word out. I like to end with my favorite saying, which is, “Dementia is not a death sentence.” It’s just, it’s not inevitable. Don’t believe it if you get this diagnosis and you’re told to get your affairs in order. There’s so many things you can do. And obviously all the things we talked about work for prevention so do all those things before you need it. But if you have it, you need to kick into gear and just know that there’s reasons for this, that you can treat this. Thank you for mentioning my book that I’m trying to get finished, but in the meantime, I actually have a free eBook on my website that goes through a lot of the stuff that we talked about, so I wanted people to have something since it’s taken me forever to get this book written.

Evelyne: And what’s your website?

Dr. Kat Toups: They could just go to

Evelyne: Perfect.

Dr. Kat Toups: Or they can just put in, if you have my name here, Kat Toups. I don’t think there’s too many people with that name. It’s a Cajun name, Toups, and it’s common in Southern Louisiana, but you’ll find me quite easily by putting that in. And just as soon as you go on the website, it pops up, “Free ebook.” Put in your email and it’ll give it.

Evelyne: We’ll share your website in the show notes, as well as the clinical trial. Thank you so much for tuning into Conversations for Health today. 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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