Mary Kay Ross, MD, is the CEO and founder of the Brain Health & Research Institute (BHRI), in Seattle, WA, and Watkinsville, GA, which is committed to treating all major forms of dementia. She is also the founder of the Institute for Personalized Medicine (IPM) in Savannah, GA, which specialized in a functional medicine approach, focused on dementia, mycotoxins, traumatic brain injury, and hormone replacement therapy in addition to most chronic diseases.
Robert Rountree: I understand that you grew up on a farm. Where was it located?
Mary Kay Ross: I grew up on a 1000 acres right outside Richmond, Virginia, and my parents were in the thoroughbred business, and I was an only child for eight years, and a big tomboy, so very into the outdoors and animals, and I probably have raised everything you can imagine that was wild—you know, some sort of baby that was left and I would bring it in and raise it. I do not know that that is the beginning of my interest in medicine, but in some ways it might be, because I really thought I wanted to be a vet for a long time. I was the kid who was down at the barns that would be letting everybody know when babies were coming, and right in there helping. I can remember trying to rescue a baby boxer puppy that needed an airway. I was probably eight, but my mother was right in there with me, doing that, so I definitely developed a healthy respect for nature and life. That is something that I was very interested in.
Dr. Rountree: You were actually studying real-life biology!
Dr. Ross: That is right. I used to love to get the pond scum and put it under a microscope when I was teensy, so, yes. I was very much into that farm life, which is kind of why I am back in Georgia now. I have just purchased a farm. It is 35 acres, and it was raw land really, and right now we have had one barn put up, and I have an Airstream on it. I think I will do a little bit with food as medicine. I have got a huge garden, actually, that is being plowed as we speak. My plan is to have a medicinal herb garden, a healing garden, and a cooking garden. And lots of vegetables. Then I am into gypsy horses as well. I have a gypsy horse that just had a baby. A gypsy horse is interesting. They are considered one of the world's most beautiful horses. They were bred by the gypsies in England, and they have bloodlines from the Shire, which is a draft horse, the Clydesdale, and Irish ponies—they are beautiful. They have feathered legs, so they are very hairy, and very flowing manes and tails that are just really pretty, and great dispositions. They are kind of like the Labrador Retriever of horses.
Dr. Rountree: Since we are on the subject of farms, I have got a book recommendation for you (and our readers). It is called Shaman by Noah Gordon, and it is about the life of a doctor in the mid-1800s who is a general practitioner and sheep farmer in the prairies of western Illinois. It is a fascinating portrayal of life in the last days of the Native American tribes in that area and how medicine was practiced back then—as in shearing the sheep in the morning and then going out and delivering a human baby that afternoon. So there is some overlap with what your life was like growing up. I am amazed at how many doctors I know who grew up on a farm!
Dr. Ross: Oh, cool. Isn't that something?
Dr. Rountree: At what point did you decide that medicine was the route for you?
Dr. Ross: I grew up, we moved away from the farm, and I moved to Kentucky. We always had family farms with horses in Louisville, Kentucky, and that is probably the racehorse–thoroughbred connection. I got married young, and had three little boys, and was really interested in psychology, but I was also very interested in medicine. I really struggled with which way to go. I have always felt like if I were going to be a psychiatrist, that there was more prescribing of drugs than I wanted, in that it was not really as much of a relationship with your patients. I just felt like medicine was my calling at that point, so when my youngest started kindergarten, I started medical school, almost the very same day. That was in Louisville, Kentucky.
Dr. Rountree: I interviewed Dr. Mary Hardy not long ago. She talked about going to medical school in Louisiana, and what an interesting time that was for the few women who were pursuing a career in medicine. I am wondering what it was like for you going to medical school in Kentucky.
Dr. Ross: It was interesting, not only being a female, but also a mother of three children, and so there were many younger people who had a completely different approach and interest. I spent the summer getting prepared for medical school with my children in camp, and I was studying at Kaplan trying to get prepared for the Medical College Admission Test. As a parent I felt like I did not have the luxury of taking the test more than once. I could not apply to more than one medical school, because I was married and I had three little boys and could not just uproot everybody. So it was a difficult thing—there was a lot of stress. There was a fair amount of middle-aged students who were on sort of the five- or six-year program. And I could not afford to do that, either. I was like, “This has got to work. We're going to make it. We're going to do it. And off we go!” It was kind of crazy. When I started my first day of medical school, my youngest son had an accident at a pool the day before and completely shattered his nose, and had raccoon's eyes. It was pretty awful looking, and he had to have surgery. My mentor in medical school was an ENT, and she performed the surgery. The medical school had a day to bring your family, and we looked a little rough. Then that continued on with my first year of medical school. My oldest son had some sort of accident with a bush in his eye, and he was in surgery. Then another one broke an arm. And then I had to take my boards, and my middle son ended up in the hospital for a month with pancreatitis, so it was kind of a crazy period of my life.
Dr. Rountree: So you got to see the health care system from both sides. What was your impression?
Dr. Ross: I sure did. I think I was under so much stress as a new medical student and trying to juggle the whole family thing, injured and sick children, and the whole bit, and I felt like it was pretty tough. I spent a lot of time studying at medical school, and the juggling between school and family was difficult, very difficult.
Dr. Rountree: At that time, did you have any thoughts about the overall system itself, as in how Western medicine was practiced? Or were you pretty much going down the straight and narrow?
Dr. Ross: I definitely had thoughts about it. I began to realize that the current model of treatment was not truly healing people while working in the emergency department (ED). It was not uncommon to see the same patients over and over again in the ED and I was commonly frustrated by the lack of time I could spend with patients to delve deeper into the causation of their disease.
Dr. Rountree: You spent some time teaching medical students, right? And being directly involved with medical training? I wonder how you brought in that perspective of how grueling and hard the training was on people as human beings, who are also trying to live their lives. Have you been able to institute any changes in the medical training system as a result of that?
Dr. Ross: Actually, after my residency and graduation, I worked at Eastern Virginia Medical School. I took a faculty position there as a part of my first job. It was really interesting. I was supposed to take over training the residents for their oral board examinations. And I remember watching people so stressed and in tears. So I came up with a new way, a new approach to the cases, and tried to take the stress out of it and help people work through it. I do not really think we have to crucify ourselves or each other to learn how to heal people. I feel like medicine is something that started out very difficult, obviously, with all the hours and residencies and mistakes that people would make, and it was more of a man's world, and then women obviously entered into it, but I like to think today that it is an easier thing to do, and a little kinder, gentler.
Dr. Rountree: More than once I have heard the old system described as a “good old boy network.” Growing up in the American South, we know what “good old boys” are, and that is how the system was run. It was very patriarchal and administered from the top down. The reason I ask is because I have had a number of conversations with doctors who had expanded their sphere from conventional practice into functional medicine or integrative medicine who were saying once we bring in a more feminine perspective, it changes everything from the ground up.
Dr. Ross: It definitely does. I agree with that. Absolutely. It is a different lens with which to look at things, and a different approach. It just adds more humanness, a kinder way, which I really think then, in turn, helps you be a better physician for your patients. It helps you relate to the patients better, on a different level. Gosh, I feel light years away from where I was when I was in emergency medicine and from the way that even my partners practiced medicine.
Dr. Rountree: Let us talk a little bit about that evolution. I know that as a trainee you went into emergency medicine and worked in emergency rooms. I guess we do not call them emergency rooms anymore, do we? We call them what? Emergency care units or EDs—short for emergency departments? I guess it all started in a room, eh? So what was your personal evolution? Over the years you have become a specialist in dealing with cognitive and neurodegenerative diseases, especially Alzheimer's. How did you get from the ED to the brain department?
Dr. Ross: Sure. It was quite an evolution. I loved emergency medicine. I practiced it for 10 years. I love teaching. I love having a team approach to anything. I never felt above or below anything that you would do in the emergency room, or ED. And I loved the challenges of it. But it also highlighted an area of medicine for me that over time seemed to get worse, and that is the chronic illness and the chronic patient with the big bag full of drugs that is sitting in the hall on the stretcher that was there just last week, and you start going through the drugs and you realize all of your emergency medicine partners, their names are on those drugs, your name is on those drugs, and there does not really seem to be any organization to how this disease process is being approached. People are considered frequent flyers, and they come in and out, and go, and I really felt like chronic illness is something that, first of all, from a medical perspective, from just looking at medicine, it is going to be the bane of the existence, because we are not approaching it right. We are just band-aiding it, a pill for the ill, and they are back again next week. Nobody is looking into anything or doing anything right for these patients. So that was one thing that was really highlighted for me.
Then I became a patient. I went through a toxic mold exposure, and honestly I thought I was going to die. It developed over time—and when things like this happen to you, you do not notice initially that these diagnoses are compiling one on top of the other, if that makes sense. And then all of a sudden, you look back and go, wow, a year ago I was a healthy human, and now I am an asthmatic with chronic bronchitis, occasional pneumonia. I have insomnia. I have vertigo. And then I developed psoriatic arthritis. They wanted to put me on Humira, and I refused. This was a big shock for me, to be on the side of the patient for this. I had this tenosynovitis in my hand, and it was horribly painful, and I contacted a friend of mine who is a radiologist and I said, “I think I need an MRI on my hand,” and I had conducted all the regular studies on yourself that you can think of doing. What is my white blood cell count? What is my inflammatory marker? Blah blah blah. And I could not really see any trauma, or I had not had a bite or anything that I could think of. So we did the magnetic resonance imaging (MRI), and he said, “You really need to go see the rheumatologist.” So I made an appointment. I contacted his office, made sure I had all the laboratories that he would want, and went in, and I was probably in there for five minutes. He literally, very nicely, came in and said, “Oh, Dr. Ross,” and he started looking at my fingers, looking at my feet, and he said, “You have psoriatic arthritis. You need to go see your primary physician, have a physical, make sure you don't have tuberculosis, and we need to get you started on a drug.” And I was like, OK, well, I was really shocked. So I laughed, and I never went back. Ever. And I did go get a physical, and lo and behold, I had tons of thyroid nodules, and so I had to have various biopsies, which were inconclusive.
I really cleaned my diet up, and I went to the Institute for Functional Medicine, and I literally signed up and went from that moment forward to every class that was available for the next two years. I was still trying to work. I honestly thought I was going to go on disability. I ended up in the cardiac cath laboratory. Interestingly enough, I had done a test on myself, I did a salivary cortisol, and my cortisol was through the roof. And I do not really know what prompted the whole thing, but I developed Takotsubo, stress-induced cardiomyopathy. I had never heard of it. I was actually giving grand rounds and I started having chest pain. It really truly went through my mind, “Gosh. Here I am at Memorial Hospital. Maybe I'm having a heart attack. Maybe this is a pulmonary embolism. Maybe this is just indigestion.” I had never had anything like that. So I decided to continue with my lecture, and I never said anything to anybody. After the lecture, I went back to my office, took my blood pressure, took an aspirin, did an electrocardiogram, and decided I should just sort of sit on it for a minute. I saw some patients. It was a Friday. And the pain never left—it was not reproducible, but worsened when walking down the hall. So finally, on our way home, I said to my husband, “I think I'm just going to call and see who's working in the emergency department,” and went in, and to my surprise, my troponin was slightly bumped, and we called cardiology, obviously, and I went to the cath laboratory, and I will never forget, I tried so hard to stay awake, and he said, “You know, Mary Kay, if you're going to have anything cardiac, this is the thing to have. Your vessels are pristine,” he said, “but your ventricle is just sort of flapping in the breeze, and you have Takotsubo.” I spent the weekend in the hospital on a monitored bed, because you are at risk of arrhythmias. There is nothing really else to do for it. I think they gave me a beta blocker. And then the next Friday, I was in Boston at the cardiometabolic conference.
Dr. Rountree: Was that with Mimi Guarneri and Mark Houston? How fortunate!
Dr. Ross: Yes. Absolutely. I remember telling Mimi, “I just got out of the cath lab!” For me all of the illnesses were really big things, and exposure to mold ended up being at least part of this whole thing with various symptoms and illness. Who knows what else I had been doing, whether my diet was horrible, whatever, but it ended up being that we had a huge leak in our house that was not as apparent. A lot of it was between the walls. And for better or worse, I discovered Dr. Ritchie Shoemaker, and I just did all of this on my own, just trying to survive, trying to figure out what is going on.
Dr. Rountree: Dr. Shoemaker has done a lot of work with biotoxicity from water-damaged buildings. Did you find out your health problems were the result of just one biotoxin, or was it a mix of things?
Dr. Ross: My mycotoxin test was very positive, and lots of gliotoxin and trichothecenes. Our house was really a bad house, and we have moved since then, and I left everything I own and started over. Interestingly enough, I went to the International Lyme and Associated Diseases Society (ILADS) conference, and I will never forget sitting in the lecture, and you have to realize I am a patient the whole time I am doing this, right? And I am sitting there, and Dr. Burrascano is talking, and he is going through this list of symptoms, and I looked at my husband and said, “I think I've got this!” I can relate to everything he is saying. Lo and behold, my IGeneX (a CLIA-certified commercial laboratory that performs ImmunoBlot antibody testing for tick-borne diseases) was positive for Lyme. How much of that is Lyme and how much of that is mold—I think all of that can be a very blurry boundary. But for me, cleaning my diet up, changing everything in my life, over time I have healed. Getting out of the house was huge. But then it took a while to get over the asthma, and I think I probably had a little bit of mast cell activation. I had some gastrointestinal (GI) issues. All of those things you have to work through. And today I feel great.
Dr. Rountree: Wow! So it all resolved?
Dr. Ross: It has all resolved—I lead a pretty healthy life, and I feel great. I am not on any medications. I do take supplements, and I am a big believer in using food as medicine.
Dr. Rountree: That is an inspiring story! How did you get from there to getting involved with the Brain Health and Research Institute, and working with Dr. Dale Bredesen? Please connect those dots.
Dr. Ross: What happened is, with all of this in medicine that was happening to me, I ended up opening a private practice—the Institute for Personalized Medicine. I just could not do emergency rooms anymore. And my practice was doing really well, and I will never forget watching Dale Bredesen give grand rounds at Cleveland Clinic, and his discussion with inhalational Alzheimer's. It just hit a bell with me. I was like, “Oh my gosh, and it's not just mold. We're talking about particles in automobile emissions, and all kinds of things.” But I was like, “Wow, when I was in my house, and having problems, I wasn't the only person. My husband was ill—he was diagnosed with mild cognitive impairment (MCI).” And he has overcome that since.
But all of this really just was like “Wow, I need to get involved in this.” So I remember telling Stephen, “I've just heard this doctor speak, and I need to work with him.” And he said, “Oh, well, who is he?” And I said, “Oh, his name is Dale Bredesen.” He goes, “Where is he?” And I said, “California.” And he said, “Well you are in Savannah,” and he is a neurologist in CA. He goes, “Whatever.” Two days later, a patient called my office, and it was a physician and his wife was the patient. And he said, “I need your help. I need to get these labs. I'm going to see Dr. Bredesen.” I said, “Oh! That's fantastic.” So I was like, “I'm going to work with you, because I really want to work with Dr. Bredesen.” And that is how Dale and I got together. And the interesting thing was, I was so interested in type 3, because of my experience.
Dr. Rountree: By that do you mean type 3 Alzheimer's Disease—what Dr. Bredesen refers to as “cortical” or toxic Alzheimers
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?
Dr. Ross: Anything related to toxicity. Anything—it is not just mold, but toxicity. Environmental exposures, all of that just fascinated me, with how quickly I became so sick, and my husband, and then undoing it with functional medicine, and how quickly we became well, and that was my bag, if you will. So then Dale and I started working together, managing patients. And then they invited me to become chief medical officer of MPI Cognition. So I moved to Los Angeles. And the thing was, I had just left my house a year before, so I felt, in some weird way, I felt free. I still had an office with brick and mortar, and the whole bit, which ultimately was hit by a hurricane. I felt free, you know? I went. And I worked in Los Angeles, Santa Monica, for several years. And then when Dr. Bredesen sold his company, he invited me to go with him, but I had another offer from Dr. Hood at the Institute for Systems Biology, which prompted me to move to Seattle and form the Brain Health & Research Institute.
So, here is what happened. I felt that the thing that is lacking in functional medicine and in the multimodal approach to brain health and everything else that seems to hold this all back is the lack of scientific studies, because it is so hard to do controlled studies utilizing a multimodal program. I wanted to do anything I could to contribute to this becoming a more accepted approach, because it is obviously the way that medicine needs to be practiced for treating chronic illness. And so when Lee Hood invited me to join him and partner in research, we had our offices set up for all of six months before COVID hit.
Dr. Rountree: This all happened just before the pandemic? Oh my gosh. And the whole idea of the institute was to do clinical studies?
Dr. Ross: Yes. We currently have one longitudinal study going right now. I am also in the process of joining the University of Washington and the Institute for Systems Biology, in a study that is looking specifically at the microbiome in Alzheimer's patients. I am working on a global brain fog study that is looking at COVID long haulers and traumatic brain injury as well as chemobrain.
Dr. Rountree: Have you ever run into the work of Dr. Paul Cox? I heard him speak at an herbal conference a number of years ago, and thought his work was literally mind boggling. He was doing research in Guam, where they have a very high incidence of a weird and devastating neurologic disease that is somewhere between amyotrophic lateral sclerosis and Parkinson's. Their hypothesis is that there is a toxic cyanobacteria that lives in cycads that grow in the water, and the locals make flour out of the seeds. It turns out there is this neurotoxin that is in the flour. The locals also eat flying bats that live on the cycad nuts, and so these people are bioaccumulating this toxin, which I think is an amino acid called BMAA. The amazing part of the story is how they made all of those connections by conducting really meticulous research. That is why I brought it up, because it seems like you are going down a similar path of looking for connections between substances in our environment and neurotoxicity.
Dr. Ross: Yes, I do know of Dr. Paul Cox, absolutely. And yes, it is BMAA. I think that is fascinating. And aren't they using serine?
Dr. Rountree: Yes, they have been studying l-serine as a possible treatment for this condition and possibly other neurodegenerative diseases as well. The scenario with BMAA is that it displaces serine in neuronal tissue. Using high doses of l-serine might reverse that process. They are also suggesting it might be helpful for Alzheimer's in general. I do not know about how effective it has been. Perhaps you can tell me.
Dr. Ross: Well, I do not know about that, either, actually. I am familiar with his work, and I remember when it first came out and thinking that maybe l-serine would be the answer. You know what I really think the take-home message is? I think that it is fascinating how they put that together, but I also think that Alzheimer's disease—and this is just my belief—is the end result of many different insults. So that is one example of a toxic buildup that causes Alzheimer's. I do not know that the exact same mechanism would be in place with certain other toxins and, therefore, I am not sure that l-serine would be the answer for everything. Does that make sense?
Dr. Rountree: I hear you. As Dale Bredesen talks about it, dementia is a leak in normal brain function that could be caused by some 36 different holes in the ceiling. And if you do not plug all of them, you are still going to have a leak.
Dr. Ross: That is right. Or at least you plug enough until your body can start taking over. And it does happen that you can fix some of the “holes in the roof” and then the body takes over and fixes the rest. It is interesting, really. I think toxicity is probably the hardest thing to fix. But when you get someone with mild cognitive impairment (MCI) or early Alzheimer's, and they have that horrible standard American diet, and they have got insulin resistance and glycotoxicity, those people, believe it or not, are very easy to fix, as long as you can get them to stick with the program.
Dr. Rountree: Yes. That leads into my next question regarding your clinical practice. You are not just doing research, you are also working with people in early stages of dementia. Perhaps you could outline what your program is?
Dr. Ross: I am. I am seeing people in all stages. I would love it if they were all early. And I also have prevention patients. What I do is this: I view the program as, number 1, my job is to do the laboratories and try to determine what kind of things we can optimize, whether they are nutrients, thyroid, we look at everything. But then we have the pillars of the program, and the pillars are going to be sleep, brain exercises, mindfulness, exercise, and diet. Diet is huge. When I first opened the Brain Health & Research Institute, and we had our offices, bricks, and mortar, we had a teaching kitchen. And I had a brain gym, and people would come in and get evaluated, and we were able to do all of that. We do not have that right now. We are closed. Everything I do is virtual and via Zoom, and I have a team, they are all in Seattle, and actually we have small groups. We realized that people learn well in a small group. They really need to have other people to bounce things off of, and, “Oh, I found this helpful. What are you doing for that?” rather than just talk to me or my health coach. Because the reality is, you can end up in the same sort of rut and each week the conversation is similar. So our groups surround the pillars.
We actually have a diet group, where everybody is monitoring their glucose, their ketones, they are talking about fasting, they are keeping logs. We have cooking shows. We have recipes and meal plans. And at the end of it—we usually do it for six to eight weeks—they graduate very happy. It is kind of like biohacking. We do the BIOSENSE ketone breathalyzer, we do continuous glucose monitoring, and we also use the Keto-Mojo meter, where they stick their finger—and they are just learning all about how they can do this.
And the brain exercise is really interesting. I use BrainHQ. I really like them. It is a Web-based program from Posit Science. It is probably the most well-studied and documented brain exercise program supporting brain health and neuroplasticity. Dr. Michael Merzenich is the founder of it. He is sort of the father of neuroplasticity. It has been proven to help. So I now have their brain health coaches on my small groups teaching my patients how to use it.
Then I have a physical therapist that does exercise. We are trying to incorporate dual tasking, where instead of just physical exercise, we are incorporating cognitive exercises as well. Then we try to take it a step further and take the information that we have gained or gleaned from the volumetric MRI and from their neuropsychological evaluation and finding weaknesses and trying to strengthen that part of the brain. People really, really love it. They engage and enjoy it more than getting on a dreadmill, if you will. We are doing it all virtual. Right before I got on this call, I was on what we call our Cognitive Connection Community meeting. I think I had 25 patients on there, and I just popped in to visit them. They have that meeting every Friday. It is just more of a social meeting, and then we have speakers that come in and educate them. So we feel like we have really developed a community.
Dr. Rountree: Are you still working with Dale? How is that going? Is he still part of your network?
Dr. Ross: Dale is definitely part of my network. I think I just spoke with him yesterday. We are writing articles together. And sometimes we comanage patients together. We stay in touch, definitely.
Dr. Rountree: That is great. I first heard about this approach through working with a client on the Metabolic Enhancement for Neurodegeneration (MEND) program (offered by Muses Labs out of Raleigh, NC). The scientific underpinnings were solid, but they were basically taking people with cognitive impairment—or at risk of developing it because of their ApoE4 status—and plugging them into an elaborate AI software program and saying, “Here are your genes and your labs,” followed by, “Here are the supplements you need to take and the diet you should follow.” “Here's what you need to do, see you later.” My experience of that program, which is admittedly limited, is nothing like what you are talking about, which involves a high level of engagement with the client. I can see why you would be so much more successful, because of all that interaction and ongoing support. I have found that if you have someone with cognitive impairment and ask them to take on a complicated program, especially if it involves an unfamiliar diet or a long list of supplements, you cannot just send them home with an instruction sheet. Otherwise the failure rate from lack of compliance tends to be very high.
Dr. Ross: No. You cannot do that. Think about what you are doing. You are taking older people who have been living a life of whatever they are doing for a long time, and you are suddenly saying, “Here's a book, and I want you to make these changes, and good luck,” basically. You cannot do that. One of the things I promised myself when I went to Seattle—and I think we are delivering, I hope we are (obviously, we are not in person anymore)—was to be able to do whatever I think it takes for someone to get well. I do not want to leave that up to them. So you know how you said you are giving them information and hoping they do it. I do not want to leave it up to them to purchase a meter to check glucose and ketones, because they never do it. Or to practice mindfulness. They just do not get it done. So what we do is we really are “plug and play.” And we may not be for everybody, because we can be pretty intense. But at the same time, when you are in our sleep group, which, I think the groups are the best way for me to approach this, if we think that you have any risk for sleep apnea, we are going to do a sleep study at home, and we will help you with the sleep study reading and how you get the continuous positive airway pressure and the settings and the mask and the whole bit. We are there for all of that. We just walk them through everything we need to do.
Dr. Rountree: And that is the only way this is going to work.
Dr. Ross: I think it is. And the other thing is, it is the only way we are going to know for sure if it works. Because you can always have barriers and say, “Oh, their wife wasn't really involved, and I don't think they had success or support,” and the reality is with some of it, the onus may have been on you.
Dr. Rountree: Without stating the obvious, is your sense that success depends on how early you intervene—the earlier you get people, the more successful you are going to be? Or can you still have an impact in people in more advanced stages, as in some of the cases that were reported in Bredesen's original article,
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that showed he could get reversal of MCI and even with some cases that appeared to be in full-blown Alzheimer's? Are you still seeing that effect sustained?
Dr. Ross: I think I am, yes. What I am seeing is that if you have early MCI, and you do the program properly, it should be no more impactful than type 2 diabetes. We can get rid of it all day long. Whereas if you come with early Alzheimer's disease, we really have to work at it, and what I find is people do get better, and then when they lighten up with the program, sometimes it comes back. I have a gentleman in Savannah who had early Alzheimer's, and his wife is a nurse, and she said to me probably three months ago, “Wow, you've given me my husband back completely.” Now, they have been working with us for over two years. And then I just had a meeting with them this week, and she said, “He's actually gotten a little worse, I've noticed.” And we were wondering two things. He had had his COVID vaccine; we did not know whether that had any effect—it was within the last two weeks. He has not been as diligent as usual.
But yes, I think we make a difference. And I think that one of the things you can do is in a fairly advanced stage is stabilize them. I do not know that I would say reverse. I do not like to use that word, actually. Every time I talk to a family, especially if they have any sort of advanced disease, I want to talk about what is a win for you. What do you expect? Because I do not want to embark on this program and then I have one expectation and you have another. You know?
Dr. Rountree: Sometimes I think one of the biggest differences between mainstream medicine and what we do in either integrative medicine, functional medicine, or whatever you want to call it, is this focus on achieving a win for the client. In mainstream medicine, the presumption is the best we can do is give the person a diagnosis and try to suppress his or her symptoms with medication. And that is it. In particular, once the person has been diagnosed with a neurodegenerative disease, he or she needs to accept that his or her condition is uncurable. Whereas there is another perspective that says maybe pathology can be halted. Maybe some conditions can even be reversed. Take your experience of being diagnosed with psoriatic arthritis for example. You refused to be forever defined by all the things that happened to you back when your health fell apart. And now you are completely well. There is nothing in our training in medical school or residency that maps out how we can get that kind of win. “Hello students, here's how we get to yes.” At least that was not the situation where I went to school.
Dr. Ross: That is right. You are absolutely right. We were trained to look for the “what” as in what the patient has wrong and not the “Why” they have it. We were also trained to determine what medication to give for each illness rather than look for the underlying cause. So what do you think the diagnosis is, and what do you want to treat it with? It is a pill for the ill, whereas we are looking for the why. We are really getting down in the weeds with the patient in his or her life and trying to understand the causes of things and what can we do to undo this process.
Dr. Rountree: I am glad, since you brought that up about the why, you are telling me that you think a big part of the why with Alzheimer's disease is some kind of toxicity that is melting our brains. Correct? So that is a big question why.
Dr. Ross: Well, I like to be careful with that, because I also think it is diet related. To me, diet is your biggest exposure. So yes.
Dr. Rountree: Yes, yes. Toxins and sugar.
Dr. Ross: Right.
Dr. Rountree: So that brings me to the inevitable question: What about people who are young and healthy who—for one reason or another—have gotten tested and found out they possess one or two copies of the APOE-ɛ4 genetic variant? They have this strong genetic predisposition for late onset Alzheimer's and want to do everything in their power to avoid getting it once they come of age, which is typically 65 years and older. What is your sense of the pathology involved, and how can it be averted? What do you think makes the biggest difference for keeping someone like this from getting dementia?
Dr. Ross: I think it is their lifestyle. I do not think they have to develop Alzheimer's. But I think if you look back at the gene, it is a very old gene, and there was a day when it was a preferable gene to have, it was successful. That is when we had more information and our diet, meats were not cooked, and we were basically evolving. In today's world, I think that the standard American diet is a nightmare for these people. So I think diet is huge. I think they do very well with fasting. I think that intermittent fasting should be incorporated. And sometimes, if they are homozygous, I really push them to fast for a longer period of time, and I find what is really interesting is they like it. I find that 3.3s do not really like to fast as much as 4s, and I am wondering whether it is a genetic thing, whether it is something that is easier for an APOE 4 to do. But I think the diet is huge. And then I always think we should all realize we live in a really toxic world and do what we can to think about where you put your body, which in turn is where you put your genes, what you are dipping your genes into. I think that is really important. But I think diet is essential for an APOE-ɛ4.
Dr. Rountree: It sounds like you have a more optimistic view than what is in a lot of the mainstream literature. You do not tell people, well, you would better expect that your brain is going to eventually give out on you, just because you have got these genes?
Dr. Ross: Absolutely not. And I have people who are APOE 4.4s who are doing great.
Dr. Rountree: Can you track them?
Dr. Ross: Oh, I definitely track them. Yes. Absolutely.
Dr. Rountree: You mentioned that you are also focusing on the role of the gut microbiome. Nathan Price and his group at the Institute for Systems Biology just published an article in Nature Metabolism, which concluded that the composition of the gut microbiome predicts healthy aging
3
The implications of their research were discussed in a recent article in The New York Times,
4
so this is a timely topic. I am wondering what specific changes do you think are going on in the microbiome that led to Alzheimer's disease?
Dr. Ross: I think we all know that there is a gut–brain connection, and I think that is key. But the thing that I was recently talking with one of the scientists at University of Washington and Institute for Systems Biology about is that they have a mouse model that is showing that cadmium exposure is causing a leaky gut, and they really believe that it is leading to Alzheimer's, at least in the mouse model. So that is something that we are now going to look at in our patients, because we actually get a heavy metal test on everybody in the blood, and their interest is in blood and stool. It will be interesting. They really believe, from their model, that Alzheimer's disease is a GI issue.
Dr. Rountree: Do you foresee a time when we can do a gut microbiome test, using DNA sequencing analysis, and come up with specific information that we can use to come up with a therapeutic plan?
Dr. Ross: Absolutely. I definitely think that time is right here. And I think that we can even have interesting ways for collection. There are discussions about “smart toilets” and all kinds of things to promote the study of the microbiome and gut health.
Dr. Rountree: Along those lines, I was reviewing one of your lectures, in which you mentioned our old friend Porphyromonas gingivalis in the mouth and how it has been implicated in autoimmune disease, especially rheumatoid arthritis. You said something that I had not heard before, which was that Porphyromonas gingivalis makes a toxin that can damage neurons. So it is not just gut bacteria, it is also oral bacteria that can affect our brains.
Dr. Ross: That is right. Absolutely. It is definitely oral. We do an oral DNA test on our patients.
Dr. Rountree: Is this on every patient?
Dr. Ross: Well, it is one of those things. I vacillate a little. I did it on every patient, and then I was working with a dentist, and we were really trying to get these data and figure out what to do about it, and they put everybody on antibiotics. And I feel like I hesitate to put them all on an oral antibiotic and affect their microbiomes. So what I have been doing is actually working on using Biocidin® and a different rinse, an antibiotic rinse that can be compounded, and see whether we can affect it that way. The test is “Oral DNA.” It identifies the different bacteria, and it has got a great chart that shows the patient, that gives you cardiac risk, and that gives you cancer risk. This gives you Alzheimer's risk. So it is really interesting. We work on implementing that with a dentist, and having them help me treat the patients as well and follow-up on them and retest them.
Dr. Rountree: That would really shake up the neurology community, if you told them, hey, you need to look in your patients' mouths!
Dr. Ross: Well, they do need to. They absolutely do need to.
Dr. Rountree: With some of your patients with more advanced dementia, do you typically see that they have a lot of gum disease? Is that a common finding?
Dr. Ross: I do see a fair amount of that, and the reality is, you never know, if you did not have them before they became diagnosed with dementia, you wonder whether it is a hygiene thing, or which came first, the chicken or the egg.
Dr. Rountree: Regardless, you should always look in your patient's mouth, even if you are not a dentist.
Dr. Ross: Yes. I think you absolutely have to look in your patient's mouth. I spoke at an event for a dentist and the overall message was that we all need to evaluate our patients' dentition and oropharynx. We need to evaluate for infection as well as possible sleep apnea.
Dr. Rountree: As I mentioned, the program that Dr. Bredesen put together is complicated, and you have already said that you achieved the most success by a lot of engagement. You are really involved with your patients. I am wondering whether there is one area in that program wherein you place emphasis as the single most important thing a person can do. Is it getting their blood sugar down to normal levels? Is it a ketogenic diet? Is there really one intervention that makes the biggest difference, or is that impossible to tease out?
Dr. Ross: I probably think that a patient will see the biggest bang for the buck with changing his or her diet. Understand, I have managed to make this practice, it was very heavily slotted in my time, and I now have a team that administers this program with these groups and with coaching one on one, and then I made a point of putting myself in everybody's life once a month, even if it is 30 minutes and there is no laboratories, I just want to eyeball people and know that everything is going well, and then I pop in on the meetings. I do not go to every meeting, but I do pop in. I think diet is key, and I think, for me, glucose is huge, which goes hand in hand with diet. Fixing the gut problem if they have one is enormous, and then you know that is going to have a profound effect on their cognition and their health. Seventy percent of your immune system is in your gut. So it is crucial. If you were going to start somewhere the diet is a good place.
Dr. Rountree: I have to say that is a huge contrast from what mainstream medicine is doing for patients with Alzheimer's, which is looking for a drug to get rid of the amyloid. Right? Or they are looking for the one magic bullet that can treat the symptoms. But the trials all seem to fail pretty miserably.
Dr. Ross: That is right. Yes. Over 450 failed drug trials. Dale says—and I think he is right—that amyloid is something your body creates in an effort to protect you. It is a mechanism. And with that thought in mind, if you do not know what your body is trying to protect you from, and you are just removing the amyloid, you probably are not getting to the root cause of the problem.
Dr. Rountree: As the saying goes, “if we keep doing what we're doing, we're going to keep getting what we're getting.” It seems like we are not getting a lot of progress here. A lot of the mainstream articles that I read are stuffed full of gloom and doom. And it sounds like you are a lot more optimistic.
Dr. Ross: That is exactly right. They are full of doom and gloom. I feel like there is no doubt that there is a cutoff for how severe a patient can be and still hope to get better. I cannot really quantitate that for you, but people past a certain point are not going to get stellar results. But, having said that—and I remind people of this—you have what you had when you came, right? We can only strive to improve things. You got the diagnosis and you are going to have to live with it one way or another. Where do we go from here? How this plays out can be very different depending on how we decide to engage with the diagnosis. Do you want to stay at home and try to stop the progression and live the best life you can live?
Dr. Rountree: What does the future look like for you? It sounds like you have more exciting research that you will be publishing, and new interventions you are going to try.
Dr. Ross: I am very interested in applying more of a precision medicine approach to health, and I feel like this whole protocol, if anything, highlights what you have to do to have a healthy long life, and live the best life that you can while you are alive. That is the goal, because if you do that, you are keeping people out of hospitals, off drugs, and I think that should be everybody's goal. Be the best that you can be.
Dr. Rountree: That is a great place to conclude this discussion for now. If people want to follow you or keep up with what you are doing, how do they track you? Do you have a preferred website? Are you accepting clients now?
Dr. Ross: We are accepting clients, and we are at https://brainhealthandresearch.com, and certainly we are very accessible. We are also on social media, if they want to follow what we are doing. Right now it is all remote. But we do have a presence on both coasts, which is good.
Dr. Rountree: Well, I really appreciate your time. We will be in touch soon.
Dr. Ross: Thanks Bob. I appreciate it.▪
