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Supporting Patients Through Cognitive Decline with Christine Pope

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Supporting Patients Through Cognitive Decline with Christine Pope

What are some of the major risk factors for developing cognitive decline and how does the ReCODE protocol developed by Dr Dale Bredesen help improve patients with this condition?

In today’s episode, Naturopath and Nutritionist Christine Pope discusses what got her interested in treating patients with cognitive decline, the importance of fish oil and other supplements and dietary changes in combating this condition, and what she’s learned from implementing the ReCODE protocol with her own patients.

She also talks about her involvement with ATMS, and the upcoming Natural Medicine Week in May.



[00:50] Welcoming Christine Pope
[01:37] Christine’s journey from banker to nutritionist and naturopath
[04:12] Christine’s experience with the ATMS board, lobbying, and advocating for the industry
[07:48] How Christine became interested in treating patients with cognitive decline
[09:43] Benefits and mechanisms of action of fish oil in cognitive decline
[12:49] Gluten and brain fog
[15:52] Does the Bredesen protocol work for significant cognitive impairment?
[17:57] How hormonal changes increase risk for cognitive decline
[21:11] The APOE4 gene 
[22:15] Heavy metal toxicity
[23:31] Common improvements seen with the Bredesen protocol
[25:30] Interventions with the biggest ‘bang for your buck’ 
[30:13] Warfarin and working with doctors for INR testing
[32:59] Major risk factors: Infections & heavy metal toxicity
[37:37] Additional treatment options: carminatives and turmeric
[40:07] Discussing Kava
[41:31] Natural Medicine Week
[44:42] Additional resources
[45:31] Thanking Christine and closing comments



Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Christine Pope, who is a naturopath and nutritionist, and who has clinical experience at Elemental Health in St Ives in Sydney, as well as currently serving as a director on the ATMS board, where she's the treasurer and also chair of the marketing committee. 

Her focus on the ATMS board is to promote natural medicine and its benefits to practitioners and public of Australia. Christine was a lecturer and head of nutritional medicine at Nature Care College for over five years. Her expertise and clinical practice is on supporting women dealing with menopause, autoimmune disorders, and cognitive decline. 

Welcome to FX Medicine, Christine. How are you going?

Christine: I'm good. Thanks, Andrew. Yourself?

Andrew: I'm very well, thanks. We're seeing cognitive decline affecting more and more Australians. Indeed, around the world, it's going to be a scourge of our health systems. But I think before we get into how you care for these patients, tell us a little bit about how your career began, Christine?

Christine: Well, this is probably my second career. My first career was actually in banking, which is probably a dirty word after the Royal Commission, but was actually a really interesting career. I worked for Macquarie Bank for a number of years and got to see a lot of really interesting transactions and deals. 

But at a point, I became really interested in health. Personally, I found that most of the mainstream interventions that I was being offered weren't really agreeing with my system at all. It was usually the cure was worse than the disease. So I started looking for other options, and I found that some herbal medicine and homeopathy and nutrition and supplements worked a lot better for me. 

So when I was at a stage that I had young kids and I was looking for something else to do that was a little bit more family-friendly, I became interested in studying and I went to Nature Care and studied nutrition and homeopathy and then more recently, I upgraded to naturopathy in 2017. So it took me a while to knock off all the herb subjects.

Andrew: Which I couldn't do without. What I think is interesting is, very commonly it happens that people are okay with the medical system, the orthodox medicine system, until it fails them, until something doesn't suit them or it doesn't help with their condition, something like that. 

Is that the sort of thing that happened with you that you were using normal pharmacological approaches and it just wasn't getting you the results that you needed?

Christine: Yeah. And mine specifically was around antibiotics. As a child, I was allergic to penicillin. So I was already restricted in what I could use. And after one year, when...you know what it's like. I mean, most of the mums out there would know what it's like. You got two young children, they get sick all the time, you nurse them, and then you get it worse. Unfortunately, every time I go to the antibiotics, I have such a range of side effects that I actually got really afraid of getting sick.

Andrew: Right.

Christine: Fortunately, my mother dragged me along to see her naturopath the first time. And that was when I sort of went, "Okay. I've got to try some other things." I mean, to me, diet was also a big thing, too. 

Andrew: Sure.

Christine: I’m a little bit embarrassed about how bad it was at that time. But can I say there was a lot of coffee and I can't drink coffee anymore.

Andrew: Right. So tell us a little bit about your progression to being elected to the ATMS board.

Christine: Well, I had actually been on a small association board. And while I was there, I found I really liked working on projects for that group. It was really frustrating not having any resources because there's so much you want to do when you're on a not-for-profit. In our industry, there's just so much that needs doing, and you're constantly being limited by people's time and availability and willingness to write a report or spend six weeks down in Canberra lobbying.

So I was actually approached. I've been working on a group that was looking at other registration models for the industry called the Natural Medicine Register. And I was working with a couple of ATMS directors and I got approached about standing for their board. 

I'm a nutritionist so I have been a member of ATMS for a number of years because they're one of the few associations that was covering my qualification. So I was really originally appointed on a casual vacancy and then stood for election, and I’ve been reelected twice. So that was how I got involved with the ATMS board. 

But I think it's really interesting being part of a multimodality group because so many practitioners aren't just one thing. They don't just use diet, they don't just use herbs, they use a range of different tools. In one sense, it's really good having that broad aspect of looking at bodywork and TCM and what I would call ingestives but, naturopathy herbs, nutrition, etc. 

Another sense, that can also be frustrating because then, of course, you've got 20 different modalities of things that they should be the only focus that you have.

Andrew: As is always the way.

Christine: Yeah. But it's been good. In the last 12 months, I've got really involved in terms of lobbying and advocacy. That came out of the marketing role. I was comfortable being able to talk to people about the benefits of natural medicine and I've been talking to press, the media, and then it was a logical extension to then go down to Canberra and talk to them. 

But I've also got a commercial banking background. So I could also run the small business argument. You're not just affecting people who are claiming rebates with these changes, you're actually affecting 20,000 small businesses that employ 3,000 to 5,000 people Australia-wide and contribute about $4 billion to the Australian economy.

So think about the broader aspects of what you're doing. ATMS has always been running lobbying on two platforms. One is natural medicine, but the other one is small business. We also worked with an association that does a lot of lobbying for small business, which is called COSBOA, which is the Council of Small Business Associations. So we had some really good help there. They really helped us get in the door with a lot of people.

Andrew: Okay. It's COSBOA.

Christine: Yeah. So, Council of Small Business Associations.

Andrew: Got you.

Christine: Having someone kind of helped guide us through that process was invaluable. I mean, there's a lot of lobbyists in Canberra, but these guys are basically representing a lot of small business associations to try and get them the same entry into Canberra that those of us who can afford lobbyists have.

Andrew: Right. Let's get on to the topic for today, cognitive decline. What sparked your interest in caring for these patients?

Christine: Well, there was one case where I got really frustrated that I didn't have the tools available. I’ll always remember because this guy had great family support, but I thought when I first met him he was nonverbal because he didn't actually speak to me at all in the consultation. I had to work with his wife and one of his children, who basically gave me the case. There were some things we found that really helped him, but it really just stalled things. It didn't cause it to regress. And over about 18 months, 2 years, he got into a situation where he needed higher care.

But really interestingly, fish oils and phosphatidylcholine were the two things that the family could see really made a difference. So they kept him on that, regardless. So it was one of those sort of moments of going, "Okay, well, this obviously helps with the brain." 

I got frustrated with the case a little because the family weren't prepared to make any dietary changes. And that was one area where I felt that really the diet wasn't supporting him. It was a very traditional, what they call SAD diet, the Standard Australian diet. And given his background, I felt a Mediterranean style diet would have been a lot better for him. 

But that was when I saw Dale Bredesen speak a couple of years ago, and I then went and did the training in San Francisco that he offered. It made sense with all the other pieces that were coming into play, that there needed to be more intervention. And it needed to be a much wider range of interventions than just one or two supplements, or one or two dietary changes.

Andrew: Now you mentioned that there wasn't a regression of symptoms. And this is obviously one of the sad things of cognitive decline and Alzheimer's, something that's very frustrating to all practitioners that we just don't have any regressive medications. But what about the use of fish oil? How did it help this patient?

Christine: Well, it was really interesting. It actually had an impact on his mood and behaviour, which isn't surprising from anyone who's ever used it for anxiety and depression. 

Andrew: Yes.

Christine: But it actually made him calmer. 

Andrew: Right.

Christine: Because the other reason I was interested in this area is because a lot of people in my age group are actually coping with parents or relatives with dementia. And one of the things is there's a lot of anxiety. And basically, they can actually be quite aggressive. And what was coming up with this particular patient was, he was a lot calmer when he was on fish oil.

I'm pretty sure it was due to the fact that from the perspective of cell membrane integrity, when your diet is not very good, those cell membranes are not in very good order. And effectively, things aren't working as well. 

So putting in a good quality fish oil supplement… and I probably wasn't dosing high enough. I was using a teaspoon a day. But that seems to have enough of a benefit. So we're talking five to six grams equivalent. 

Andrew: Yes.

Christine: It made a difference to his brain health, and he was there calmer and easier for the family to manage.

Andrew: And this is, again, is one of the issues is that very commonly, these patients are heavily medicated. One could argue that it's common for these patients to be over medicated. But let's not get into that.

Christine: That's a tough one.

Andrew: Yeah. But it's very interesting that in light of a poor diet, one can have dramatic effects with very simple additions. Obviously, we'd want to change diet first. And that's the great lessons that we've learnt from people like Felice Jacka. But then we've got Julia Rucklidge over in New Zealand having brilliant results with different patient populations, but very interesting how it works on the mind, if you like. How fish oil works on the mind.

Christine: It is. And when you think about it, I mean, your brain is coated in fat. And if we've been introducing really poor quality fats for a very long period of time, the raw materials that the brain’s had have been really deficient for a long period of time. So it's not surprising it affects function. 

It was one of those interventions where at the time, I really wanted to focus on diet and other stuff, but I was getting quite limited by what the family were able to do. Mum wasn't coping well either, which is not uncommon in these situations. And so it was like, "Okay, what are some simple things I can do that will make a difference straight away?"

Andrew: Yeah, great stuff. And how did the treatment change, or your treatment for patients change, before your introduction to Dale Bredesen and his protocol that he's developed, to now that you're using that?

Christine: Oh, okay. Well, I think one of the things is I've always been… because my background is nutrition, I've always been really interested in getting people on the right diet for them, which doesn't mean one-size-fits-all. 

But with a lot of the autoimmune patients, I've seen, in particular, can I say, gluten is not their friend. 

Andrew: Yeah.

Christine: And it's amazing with how many people you just say, "Well, can we just take it out for four to six weeks and see?" Because they don't test as Coeliac. They may or may not have one of the genes for potentially being Coeliac. But brain fog is a big issue for them. 

For me, brain fog is not just about gluten. It can be about a whole… any food intolerance can present as that. It's kind of that whole, leaky gut/leaky brain type connection. But what I did find was with a lot of these autoimmune patients, they take out gluten and they come back and go, "Oh, my God. I've got energy again, I can think. I can function. I just feel so different." And often the aches and pains would let up too. 

That was another thing in the Bredesen protocol, it does have a number of dietary changes, which include removing gluten. And I do think it's really critical that you actually look very carefully at the diet and the right diet for that person.

Andrew: Yeah, so with regards to that, do you find sometimes that we might be looking for gluten to be the bad guy but it could be as simple as carbs in general? The sugar, the basic intake of our standard Australian diet that we have?

Christine: Well, I think it's that sugar/wheat combo. But the problem is by the time someone has got to developing symptoms of cognitive decline, it's too late to just improve their gut. You have to go more aggressively. 

And I think this is one of the other things that's changed is… I've always been a very cautious doser. I'd look at the back label, and I'd probably start with half and see how they go and then gradually build up to the recommended or therapeutic dose. Or I'd see what they needed. And I don't use a lot of supplements. I don't know whether it's because one of my trainers was always, "Try and pick just three."

Andrew: Yes. Or less.

Christine: Or less. But what I have noticed with this protocol is that there are a lot of supplements in it, and you really do need to use them in the first few months to get that shift. Because you're already talking pathology at mild cognitive decline, you need to get in there with the big guns quickly.

Andrew: Okay, so just on that, so does the Bredesen protocol work best with only early interventions? Or can it have dramatic effect for those people that are well along their way with cognitive decline?

Christine: I really think at this stage the research is there to support its impact for mild cognitive impairment. They also talk about SCI, which is significant cognitive impairment, but I think when you've got people who are nonverbal and aggressive, I'm not sure that you've got the capacity to make a huge amount of difference at that point. 

And look, saying that, there's just not the research to support it at the moment. I mean, when I did the protocol, Dale Bredesen had announced that he had 10 cases of reversal on his ReCODE protocol, which is what he calls it.

Andrew: Yes.

Christine: More recently, I think last year, they published...they've now got that case series to 100. So it happened since 2016. But a lot of those cases were at the earlier stage. Certainly they had a diagnosis, and his protocols are really detailed around making sure that you've got the right diagnosis, which is also really important. 

Andrew: Ah. There’s a hurdle.

Christine: Make sure that it's not something else. But also make sure you understand where it's coming from, like what has been the trigger for this. And, to me, that's very naturopathic. I don't know how often I've been to an event, and there's a speaker who's a doctor, but you think, "Geez, you spent 30 years studying to become a naturopath." 

Andrew: Right, yeah.

Christine: You’ve actually gone back to understanding, not just trying it. Because he spent a long time trying to find the one thing that turned off plaque production and couldn't find it.

Andrew: Welcome to Alzheimer's.

Christine: Yeah. Well, it's a lot more complicated than just one thing. And when you're first looking at it, there are five different areas that they focus on, in terms of establishing what was the trigger for this person developing it versus someone else. And the big two from our perspective, are what they call glycotoxicity, so diabetes type 3, and hormonal changes. 

So it's known that women who have an early hysterectomy, or particularly they have an oophorectomy as well, are more likely to develop Alzheimer's. 

Andrew: Ah.

Christine: So this was actually an area where it was really tricky for me, because I've been trained in that area when the Nurses' Health Study came out and it's like, "Oh, my God, HRT is the evil antichrist. And you don't want anyone on this because it's really bad for them and they're all going to develop breast cancer."

And then, of course, I'm sitting here going, “Actually, these women particularly do need to be on HRT until they would get to a normal age for menopause, or their risk of dementia is significantly higher.” So there was actually some good... But, I mean, yeah, basically, it all came down to supporting appropriate detoxification of those hormones so that they went down a non-proliferative pathway.

Andrew: Yeah. I mean, the HRT issue was such an interesting one with the Women's Health Study. There was some scaremongering, but there was also some placation of a real issue. So both sides, to me, were at fault. 

One was there were more people who got breast cancer. It wasn't great. But if it was your mum, it would be a great event, as in a significant event caused by a medication. So not to be belittled and shoved under the carpet, "Don't worry about it. It was only 1 in 1,000 or 1 in 5,000," whatever. I don't believe that that's good enough. 

But wouldn't it be great to be able to tease out those women who were more at risk and then treat them accordingly? But I do take your point about that HRT is also, for most women, quite safe for around that eight-year mark. And then there's a veil. We just don't know about what happens after that.

Christine: Well, it's safe for...if you're also working with ensuring that the liver is functioning correctly, and it's going down the non-proliferative pathways, which turned out was all about using our favourite liver herbs and citrus to support them. Or things like indole-3-carbinol, or something like that.

Andrew: I'm a fan of DIM.

Christine: Oh, okay. Is there a divide? I just found it really interesting that, at the end of the day, having to get through this process of, in my head, getting through the whole HRT debate. There was a really good reason why these women, particularly if there was any family history of Alzheimer's as well, had a genetic predisposition, and that would be a very unfortunate combination.

Andrew: So with regards to genetic predispositions, is that something that Dale Bredesen does as a standard, to work out at-risk? Yeah.

Christine: Yeah, so it's called the APOE4 gene. I assume it's called that because no one can say the full name, like many of these genes. But it depends whether, if you have one copy of the gene, your risk is increased by about 30%. And I think if you've got both copies, it can be up to about 70%. So I had both copies of the gene, I'd be putting this protocol into effect in my early 50s, not waiting. 

Andrew: Very early, yeah.

Christine: And this is the other area where I think ways naturopaths can make a real difference is actually looking at managing health risks around this. If you've got Alzheimer's and dementia in the family, or if you have other risk factors that put you at potential risk, we can start getting people to make some of the changes that will actually support them longer term.

And a lot of them are very naturopathic. You're talking diet, you're talking exercise, you're talking... The other things you want to look at are whether there's a history of heavy metal toxicity, which, I have to say, is fairly common. Anyone who's got a mouth full of old fillings, their mercury levels are on a rating of chronic, mercury is going to be quite elevated.

Andrew: What about lead?

Christine: Lead comes up in some people. I do some in-house testing with heavy metals. And what I've found is lead is less common. I don't know if it's because we moved to unleaded petrol in the '90s. It's interesting, I've had quite a few people from the UK who've tested high in lead. Here it seems to be more mercury. And I don't think it's necessarily because of fish. I think it's because of a couple of other suspects, particularly a mouthful of old fillings. 

It's interesting when you're reading the results, I can basically look at it and go, "Oh, they've got silver and mercury. It must be old fillings, because that's the combination that was used." 

Andrew: Right.

Christine: Not just the heavy use of colloidal silver or something.

Andrew: Yeah, the Purple Man.

Christine: Yes.

Andrew: So what are the most common effects or benefits that you see happening with...let's concentrate on mild cognitive impairment?

Christine: One of the things that you often see happening is that the brain fog lifts for people, which is really, really fabulous. So they will see small signs of memory improvement, maybe it's they remember where they parked the car in Westfield. Maybe it's that they remember where the keys are, or what their partner said to them two minutes ago in the kitchen, and then they walked out and forgot all about it. 

But also, you find that because the protocol is working on other things as well, because you're working systemically to reduce inflammation, other health challenges will also improve. So really, I see often, things like aches and pains… I had a patient who I've been using aspects of the protocol with her. There is dementia in the family, but I was actually working with her on rheumatoid arthritis.

And one of the things that she said before she started is that she would have good days and bad days. And in any week, it could be half and half. And now what she noticed is that the bad days are very rare. So her overall health has improved significantly. And that's a really nice benefit. 

You're looking for the things around memory to improve. Sometimes it can take three to six months before we see any real changes there. If other aspects of their health start improving, then you actually know that you're on the right track with what you're doing as well. It just gives you those pointers that, "Hey, this is actually having an effect." 

And I see often with dietary changes, it will be… with a patient with less pathology, it's usually 6 to 12 weeks before they really start to get the full benefit of the changes. With these patients, it's probably three to six months.

Andrew: Right. And I guess we've got to also ask the question, when you're getting an elderly patient and you've got a diagnosis, let's say you've got a diagnosis of mild cognitive impairment or even moderate cognitive impairment. 

I guess there's got to be that question of, "Okay, what bang for buck are you going to get for how much money are you going to throw at this?" So changing a diet is something that as long as it's helpful and well thought out, well planned, and that's a real issue, if they're in an institution. But let's just take the utopian view and say that they're still at home being cared for by family members. 

So if dietary intake can be changed to a more Mediterranean style, then that's something that's very affordable, it's very usable. But once you start adding in a lot of supplements, that becomes a real drain on a lot of family purses. So, how much bang for buck do you get with this? Is it worth it with these elderly patients? I know that's a horrible decision.

Christine: Look, I think with mild cognitive impairment, it probably depends a little bit if you're being realistic on when it hits. If you've got someone who's in their early to mid-50s, and they may need to stop working because of this, then I would say invest the money in the supplements. Give it three to six months. 

Because, seriously, if you can keep someone in the workforce for another five years, they'll more than pay for it themselves. Where it gets difficult is when they're retired and they're on fixed incomes, in which case as a naturopath, you go, ”Okay, I would look at it from the perspective of, what are the three or four things that are most essential? What can I do with diet? And is there anything I can do with diet?" And it's really hard at this stage.

Realistically, what would I be paring down to if I had to do that? I'd definitely be looking at having done the gut work, essentially, keeping gluten and dairy out of the diet, and having a very sound Mediterranean diet, probably with a lot of seafood in it as well. 

And then looking at, okay, you've done your gut repair, look at fish oils, look at blood sugar. I mean, the blood sugar support is critical in this. The brain uses 30% of the body's glucose. I suppose the other dietary tweak I would look at is seeing if they can fast for up to 12 hours overnight, which actually isn't that difficult, really. You're talking finish eating dinner at 7:00 and don't have breakfast till 7:30-8:00 am. So that doesn't tend to be too problematic for people. But it does make a difference for a lot of patients I have to use some form of fasting so that their brain fog lifts. And again, that's not an expensive intervention. 

But I would also...I would really be looking at those clients with some form of blood sugar support, whether it's your herbs or whether you're using cinnamon or chromium and magnesium, which I think are also essential with those cases. You've got to make sure that you're supporting those mechanisms. And then it's really specific to whatever else is going on for them.

So when you're looking at the protocol, you look five areas that are actually relevant for the causation. So traumatic brain injury is one area. So we know that people get punched in the head, like boxers a lot, are more prone to developing it. I've never actually tried any cases like that. I think it probably progresses way too fast. 

We know that, as I mentioned, the hormonal and the glycotoxicity. The other areas are heavy metals and vascular, where it's associated with increased cardiovascular risk. 

So if you're looking at vascular, you're obviously going to be looking at all the things that would support the vascular system as well. So you're looking at your magnesium. You're looking at a good quality multivitamin. You're making sure that they've got adequate levels of B9 and B12, in particular. And you'd be looking definitely at fish oils. And then I think whatever else is indicated by the case in front of you would probably be where you would go in terms of supplements if you had to pare it down. 

Andrew: Yes.

Christine: And then there's also things like Bacopa and Ginkgo, which you obviously want to improve brain perfusion. But obviously, they've got cardiovascular risks, so you've got to be careful with the herbs you use as well.

Andrew: For sure. So what about interactions? Are there any red flags that we really need to know about?

Christine: Look, I haven't seen anything. I mean, it's always specific to the particular medications. What I found is most of the time, it's not a problem. It's just if they're on the dreaded warfarin, that can make life really, really difficult.

Andrew: Interactions with everything.

Christine: Yes, basically interactions with everything. So then you're really looking at having to focus very heavily on diet. I mean, you can monitor INR if you can get the doctor to work with you on it. That is an option. 

Andrew: Yeah.

Christine: But, I don't know, I'm fairly risk-averse. So I would always want to try and do as much as possible with nutrients because you're pretty safe with most of your nutrients, except, of course, if they're on a potassium-sparing diuretic. Then, of course, you have to be very careful not using anything that has more potassium in it than a banana.

Andrew: But I just wanted to catch myself there, I made a flippant comment about warfarin, “interaction with everything.” Indeed, as you say, there are a lot of things that when you look at it, the concerns that have been voiced and still exist indeed still require mandatory warnings in Australia. Really, they don't stack up, and it's a sad state of affairs where I get that the TGA errs on the side of caution for the safety. 

But where it's actually been shown to be not the case, it's a little bit of a sad case that those warnings remain. I'm talking specifically about CoQ10 here. 

Christine: Oh, okay. Yeah.

Andrew: But as you say, in all cases, INR must be monitored. And the worst thing that you want is to have an adverse effect from an interaction. So you've got to get the permission of the doctor to work with you to check the INR more regularly.

Christine: And that's probably the other tricky thing with running this protocol is I have only just found a couple of GPs, who are in my area, who are quite supportive of running the mainstream tests I need for their patients. But usually, it's a bit of a journey with those doctors. There's another guy who is working a lot in this area, and he is an integrative GP. 

So if you can find those people to work with, that's really helpful too because he's got access to a broader range of testing than we do. And when I say access to a broad range testing, I mean, they can actually prescribe more under Medicare, which helps keeps the cost down for patients. And that's the big issue. The testing on this is actually quite a detailed list of things that need to be checked.

Andrew: Let's go back to the risk factors. Is there anything else that we really need to know about there?

Christine: Look, I think one of the big ones that I probably haven't gone into enough detail on is infection and heavy metal toxicity. So for example, the research says that if you've worked with aluminium processing, and this could be you're the foreman and you're above the factory floor, but your risk of developing Alzheimer's can be up to eight times higher. So it's really important to make sure that they don't have high levels of aluminium, that they don't have other heavy metal toxicities. 

And the other area that's really concerning is infection. So in the U.S., they talk a lot about CIRS and Lyme. So CIRS is the chronic inflammatory response syndrome arising from mould toxicity. But that's becoming an increasing area of interest in Australia, and particularly anyone who's working in Queensland after those floods will have seen a lot of cases of mould-related illness. But where you've got that chronic infection that just keeps producing inflammation, it does affect the brain.

And Lyme-like...well, we call it “Lyme-like illness” in Australia is also another risk factor for that. But don't forget things like simple dental inflammation. So things like people who've had underlying abscesses that haven't been treated, etc. 

There was an Indian Journal of Psychiatry article in 2006 that highlights that somewhere of...up to 23% of so-called reversible dementias relate to heavy metal toxicity, as well as Lyme and advanced syphilis. But we don't see a lot of advanced syphilis in Australia.

Andrew: Thank goodness for that. That's really interesting, though. Advanced syphilis, you can really get reversal of advanced syphilis?

Christine: Well, I think the thing is it this is an Indian journal. So I'm not sure what they had actually defined as advanced syphilis. But I would presume it was cases where in Australia I think it will be treated very early, in India, that may not be the case. So where they were along that progression, whether they're at the stage of having a lot of...

Andrew: Organic brain disease, yeah.

Christine: ...organic brain disease or other appearances, other changes to the physical appearance as well. Because it's a really damaging disease. But I would have thought, perhaps it's something that hasn't been treated in the first few years and has done some damage to that person. Anyway, it was an "Indian Journal of Psychiatry" in 2006, and it was an article on reversible dementias.

Andrew: Oh, okay. Well, we'll put that article up on the FX Medicine website for our listeners to access. That's really interesting. 

And, of course, there are these chronic infections. Whenever we talk about infection, we always think about a known infection, something that causes you to think of being infected: a fever, pain, the five hallmarks of inflammation. But very often we've got these chronic, insidious infections, dental issues, for instance, one of the horrible things, propionibacterium acnes.

So we talk about these fulminant type infections, but very often there are these chronic infections that cause really bad health effects, not just cardiovascular, but mental as well.

Christine: Well, yeah. And you even looked at things like chronic fatigue being triggered off someone having CMV or glandular fever. 

Andrew: Yes, yes.

Christine: These viruses, most of the population recovers, but there's a certain percentage that don't, and they have these underlying health effects for years and decades.

Andrew: And that, to me, is a hallmark or a flag that should be waved. We very often think about attacking the offender. But what about resilience? What about looking at these base bodily defences, the normal reaction that our body uses to cope with these. And why don't some people react in that same way? How can we best support that organism? And that goes back to diet, as you say, primarily, but I guess there are other things that we can intervene with as well.

Christine: Well, diet and supporting the immune system. But also I think getting the gut working effectively, getting that broad range of different gut bacteria to support our function and support our immune system.

Andrew: Yes, indeed. Now, you mentioned earlier regarding fish oil and how it calmed patients with aggression, things like that, or agitation even. And I guess this goes back to good naturopathic management. But what other things would you use there, or could you use?

Christine: Well, I think all your carminatives, if they're able to be used in this situation, would be really helpful. I mean, simple things. Like, if you want to do it from a dietary perspective, you might use chamomile or chamomile tea, passionflower, magnolia, those sorts of things. Because a lot of the time in Alzheimer's and dementia, the agitation is around the anxiety of, "I can't remember this stuff. I don't know what's going on." 

And, of course, the other really important one to use is obviously curcumin or turmeric, because that's got a really nice anti-inflammatory effect to the whole brain. And when the brain is disordered in this aspect, anything you can do which supports reducing inflammation, I think, is really helpful. 

Andrew: Absolutely.

Christine: And I think for the patient, you want to go in with some gentle herbs to work on this and also the things that don't tend to have a lot of other interactions with any of the other medications they might be on.

Andrew: But if nothing else, curries. Lots and lots of curries.

Christine: Yes, a lot of curries. If you want to get five grams of turmeric in there, you're going to be very yellow.

Andrew: But you know what, even with a stir fry, I find that it's amazing how much turmeric you can load into a stir fry. When you get the chicken and the oils protected there and some nice garlic and onion going, and then you can just shake, shake away, mix, shake away, it's amazing how much turmeric you can load into like a chicken stir fry or something like that.

Christine: And yeah, in traditional diets, in the areas where the research has come about turmeric and curcumin, they are using that and they're using it every single day and they've been doing it for years. 

Andrew: Yes.

Christine: I mean, I think the reason for us to use supplements, in this case, is possibly because that may be too big a shift for their diet at this point. And also, you're trying to load a lot of curcumin in.

Andrew: Very true.

Christine: But I think those carminative herbs can be really helpful for managing some of the side effects with those patients.

Andrew: What about herbs like Kava? To me, Kava is one of my favourite go-to herbs. And indeed, if I had a clinic and had to choose between 20 things, Kava would have to be in there. The evidence is there. Jerome Sarris has done really good work showing that it doesn't have the impairment that things like benzos do, for instance, and that it indeed works with at least generalised anxiety disorder. 

How useful do you find it when you've got quite a complex array of things going on and you've got medicines that you have to be careful of?

Christine: I guess I haven't been thinking about that one so much. I probably seem to have, I think I have a preference for the flowers. But it was interesting. I was in Fiji last year, and Kava is basically a solution for everything. 

Andrew: Yeah. Sure.

Christine: Upset stomach? Have some Kava. Anxious? Have Kava. Can't sleep? Have Kava. And it really did make me start looking at Kava in a slightly different light apart from having it from the dried root is quite disgusting.

Andrew: Drinking mud.

Christine: Yeah, that's probably the best description I've heard of it. So I presume as a capsule or tablet, it's probably a bit easier to absorb. But it seems to me that that would also be a good addition.

Andrew: Now, Natural Medicine Week is coming up in May. I guess we're going back to the future here or back to the beginning: ATMS. What events has ATMS organised to help natural medicine professionals to celebrate Natural Medicine Week?

Christine: So what we've been doing is we're actually trying to encourage practitioners to run events around Australia to promote natural medicine during Natural Medicine Week. There's actually a specific website, naturalmedicineweek.com.au

And when I say practitioners, ATMS is being quite collaborative with this. We're opening it up to any member of a professional association. You don't need to be a member of our association. You can be a member of any of the other associations, but we will still promote your events on the site. 

Last year, we had over 100 events and special offers promoted, but I think this year with an election in the offing, it's really important that we have natural medicine in all our local members' faces as much as possible during this time. Well, local members and the candidates for their seats at the moment because it looks like there's going to be a little bit of change.

Andrew: Absolutely. And...

Christine: And we're also looking at a potential review of the situation with health funds. So, again, I think it's even more important this year that people promote the benefits of natural medicine. 

And the sort of things people are doing are workshops, tea tasting…We've got webinars that we're running that people can share with their clients. So this is for people who don't want to run their own workshop, this is an alternative. They can share the webinar with their clients on a range of topics. 

Andrew: Got you.

Christine: So the idea is that we're hoping to get as much information about Natural Medicine Week out into community as possible through that.

Andrew: Yeah. I think it's important that we realise that many Australians choose some form of natural medicine. We need to do it safely. And we need to do it under the care of responsible practitioners who know what they're doing and are appropriately trained in their area. And I think this is a great way in which we can highlight what Australian natural medicine practitioners do for the public to help guide their health with whatever evidence is available in those sort of modalities. So it's a great thing.

Christine: Absolutely. And, look, if people are still interested, we will list events and special offers on the website up to Natural Medicine Week starting on the 20th of May. So if people are interested, they just go to the website and click the button at the top on the right-hand side to register their event, or they can just register a special offer in their clinic. 

So a lot of our massage therapists are just registering an offer where it's either it's a discount on treatment or it might be in addition to treatment. Some people are offering an extra 15 minutes for the 1-hour massage during Natural Medicine Week, or giving an oil blend, or something else additional as part of an offer to encourage people to book in and experience natural medicine for themselves.

Andrew: That's great work that the ATMS is doing for Australian practitioners. 

Christine, just as a last thing with regards to cognitive impairment, any further resources that practitioners can access so that they can learn more about how to manage these patients appropriately?

Christine: Yeah, absolutely. I've got a blog where I've summarised the course ideas and also some tips on treatment. It's christinepopenutritionist, if you want to just google it. And there are also links on there to quite a number of the research papers that Dale Bredesen mentioned, and there is training in the U.S. that's offered on a regular basis for the ReCODE protocol by Dale Bredesen so that if you're really interested, that would definitely be worth following up.

Andrew: Fantastic work. Fantastic resources. Well done, Christine. And thank you so much for taking us through this. I mean, it's a tragic group of conditions and with a very sad end in many cases, but you're doing really good work to ease that burden of healthcare and ease the suffering of these patients, so well done to you.

Christine: Thanks, Andrew.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.


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