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Today, we are joined by Jo Grabyn, a functional nutritionist who specializes in helping patients to reverse cognitive decline.

In today’s episode, Jo discusses: 

  • What prompted her to specialise in cognitive decline
  • What role do SNPs play in cognitive decline, and which ones are we to be cognisant of
  • How to intake, assess and test your patient with cognitive decline
  • Treatment consideration
  • Referrals and ethical considerations
  • Where to go to learn more on this topic

About Jo 

Jo Grabyn is the founder of Bounce Matters, a Whole Health Clinic with state-of-the-art equipment in Manly, NSW.

Jo holds a Bachelor of Health Science (Nutritional Medicine) and is a qualified yoga teacher and yoga therapist.

She has also studied NLP, Executive Coaching, psycho-neuro-immunology & psych-neuro-endocrinology.

In 2016, she qualified with Dr Dale Bredesen, author of The End of Alzheimer’s and developer of the ReCODE (Reversing Cognitive Decline) and MEND (Metabolic Enhancement in NeuroDegenerative Disease) programs. Jo has helped hundreds of clients to reverse — and prevent — the onset of early Alzheimer’s disease, dementia, memory issues and cognitive decline.

In 2017, Jo began annual training with Integrative Medicine for Mental Health (US), and Brain Health Coaching with Dr Daniel Amen of the Amen Clinics (US). In 2018 she commenced her studies at the Institute of Functional Medicine which she continues today.

Jo is uniquely qualified in her understanding of cognitive decline, how our thinking and life experiences create changes in brain chemistry & function so she focusses on helping others to achieve WHOLE health using various modalities & treatment options

Connect with Jo:
Instagram: Bouncematters



Andrew: This is “Wellness by Designs.” And I’m your host, Andrew Whitfield-Cook. Today, we are joined by Jo Grabyn, a functional nutritionist who specializes in hyperbaric oxygen therapy but also helping patients to reverse cognitive decline. Welcome to “Wellness by Designs,” Jo. How are you going?

Jo: I’m great. Thanks, Andrew. Thanks for having me.

Andrew: My pleasure. Our pleasure. So, first, can you take us through a little bit of your history. You studied in Melbourne, right?

Jo: Yeah. So, when endeavour was still the Australian College of Natural Medicine, they had a Melbourne and a Brisbane campus. So, I, way back in 2001 actually started studying naturopathy and then switched over to nutritional medicine, which they were in the process of being certified for, with the government at that point. So, I guess, I realized when I started studying naturopathy and then saw nutritional medicine, it was more my thing because we were focusing more on changing lifestyle, long-term for people. Then, I moved up to Sydney the year after I finished studying and helped a company build a food intolerance and testing company, and then spent about eight years working in the hospital nutrition space.

So, I was practising on the weekends upskilling because I’m a science nerd, so I just kept studying doing more and more over that period. But it was actually really interesting getting to work in the hospital system with, you know, everything from hospital dieticians to the directors of pediatric units, and children’s hospitals, and neonatal intensivists who are probably the area of medicine that I found were the most interested in nutrition. And therefore, I got to see the medical side and, you know, what they’re really facing. And then I had a little bit of a health crisis. And decided that I didn’t wanna be making money for big corporates anymore. I wanted to be doing what I was put on the planet to do, which was this. So, then I started working towards having a full-time business really focusing on mental health, brain health, chronic fatigue, that kind of thing.

Andrew: So, this is really interesting because normally you see dieticians only in the hospital space. This is down in Melbourne, so you were a nutritionist working in the hospital space. Was that enlightening or soul-destroying?

Jo: So, I wasn’t working in the hospital as such, I was for companies that produce medical nutrition, so everything from preemie baby formula through to tube feeds that they use for people in intensive care, or oncology, or postsurgical. And to be honest, it was really quite funny. And there were dieticians who tried to block me from being employed, who down the track would pull me aside and go, “You know, I really didn’t want you to get this job, but actually you’re the best person that we’ve ever had because apart from knowing how to build relationships with people, you really connect and understand the nitty-gritty.” And it got to the point that I had, you know, people like the head of neonatology at the Royal Women’s Hospital actually as a referee for me for future roles. So, it’s both, it was challenging, but I’m fairly mentally and emotionally strong. And I don’t really take, to be blunt, and I don’t take crap very well. And I stood my ground because I believed in what I was doing and where I was coming from.

And then as it turned out, once I was doing this full-time, I was actually challenged a few times by naturopaths going, “You know, why do you advocate for baby formula or whatever?” And it’s like, “I don’t advocate for baby formula. I don’t advocate for elemental feeds for, you know, babies with really specialized issues. But when you see a baby that, you know, can’t consume its mom’s breast milk because of what she’s putting into her body every day, then you’ve gotta look at the next best option.” Or “If you have a mom who has an 18-month-old and suddenly she’s got a newborn, the stress of trying to breastfeed the newborn actually negates the benefit of having breast milk because the quality is just not there. It just becomes a really stressful family environment.” So, it was nice to kind of really be able to help people in lots of different ways, like, understand the difficulties at a real human level rather than just being idealistic about going, “Oh, you know, they should have this or they should have that.” It’s like, actually what’s the best thing for this family or this person in this moment to support them, not physically but mentally and emotionally as well.

Andrew: Yeah. I think it’s something that we can all get caught up in about trying to use our modelling for them, but getting caught up in making sure or ordering them to use this model because it’s the best for them. But what’s best for them is what brings the best outcome in the long term, right?

Jo: Yeah, absolutely. And the other side of it that was really exciting for me was there were certain nutritionals that have been used in Europe for years, as in, since the ’80s for wound healing and for pre-op nutrition to optimize post-op outcomes. And so I was, you know, in discussion with intensivists and surgeons around that. And interestingly at Christmas, I went through my own little cancer journey and I jumped back on board with one of those products, which is made by a company that I have zero, or the company that I really don’t like, let’s put it nicely. But the supplement itself is just arginine, zinc, vitamin C, and vitamin E. And I healed that quickly from using it that I actually had to go back into… When I went in to get my stitches out a week ahead of time, they still had to actually re-open the wound to be able to get the stitches out because it had fully healed and grown over. So, you know, there are nutritional products in the medical space that actually would help us, too.

Andrew: That’s really interesting. The simplicity of that product, particularly if you’re talking post-surgery, I would’ve expected at least things like, you know, glutamine, for instance, because it’s a conditionally essential amino acid, but also possibly things like selenium, which they’ve found deficient in certain trauma cases, certain things like that. That’s a very interesting formula.

Jo: It’s really basic, but it’s really helpful. They actually developed initially for pressure sores for people in nursing homes and, you know, quadriplegic paraplegic to bedbound. And the granulation on, you know, healing a wound like that, you know, you need a lot more than someone who’s just healing from surgery. But I’d used it intermittently for various things in the past when I worked for the company and just went, “You know what? Let’s do this and let’s see what happens.” And I’d forgotten how good it was, but it’s that the arginine dose is really high. And that’s just to make sure that you’re getting all of, you know, the vasodilation so you can get nutrients going everywhere. So, you know, also, obviously, I’m a little bit fussy about what food I put in as well. That probably for me, it’s a little

Andrew: Yeah. And, obviously, I just wanna put a caution in there about high dose arginine. That’s not without attendant risks. If you’re gonna have a vasodilator effect and they’re on certain heart medications, you gotta be a little bit cautious.

Jo: And you’re not using it for a long time, you know, you’re using it for a week or two, you know, in the cases like we’re working on or no. But, yeah. Just working in that space gave me a much, I guess,a much greater respect for the medical community and what those guys actually go through every day. Like, you know, in naturopathic medicine, we often have, you know, less and favourable views, whether it be through our own experience or our patients. And, you know, I can’t deny that I was in that group, particularly when I first came to Sydney. And then a lot of my studies since then, because I’ve done study with the Institute of Functional Medicine. And, you know, when I actually did my Bredesen training in San Francisco about four or five years ago, I studied with the bulk of the senior teaching faculty from the Institute of Functional Medicine. And having conversations with those doctors, I said “Look, do you guys reckon, actually go back and do graduate medicine rather than doing what I’m doing?” And they’re like, “Don’t you dare, you know, you are 80% of one of us with all the skills that you have, but then you have so much more to bring to the table.” So, it was a great long-term introduction to doing what I do now.

Andrew: So, let’s talk about what you do now. Andrew’s tangential mind going off on that. But anyway. So, from neonatology, right to the other end of the spectrum, we’re talking about cognitive decline and neurological health, mental health, what prompted you to specialize in that? Because it’s sort of almost the other end of the spectrum you in the life lifespan.

Jo: It is, but in my world, and I’m in my own personal world, not so much. And so I guess there’s a couple of things to take into consideration. So, my grandpa died of Alzheimer’s when I was 11. And I don’t even remember what he was like before he was profoundly affected by Alzheimer’s. And obviously, in the ’80s there weren’t positions, there weren’t beds for men in nursing homes. So, you know, he was cared for at home by my Nana, who was this, you know, tiny little, four-foot nine magic bullet. She made everything happen. And then in my mid-30s, so about 12 years ago, my dad actually had a really serious truck accident and ended up with… Although, the ED doctor told me he’d be gone before I could get there in the morning from Sydney. He spent six weeks in a coma with a profound brain injury, and then another four or five months at the Epworth hospital in a brain trauma unit. And my way of coping is to understand.

So, I was determined to try and figure out how I could help him when, you know, neuroplasticity was really just a very new concept and a new word. And so I went out there and got Norman Doidge’s book, “The Brain That Changes Itself.” So, that was kind of my first step in of going, well, whether it’s stroke or a brain injury, or even potentially, you know, some of the neurological conditions that children have. There are lots of things that we can do to help. So, it kind of opened my mind to this new branch of medicine.

And then about five or six years ago, Dale Bredesen was speaking at a conference that I attended, and was talking about his process of using functional medicine to reverse cognitive decline. And there was a lot of naturopaths in the room, and a couple of people put their hand up and said, “Oh, is this just for doctors, or is it for naturopath as well?” So, he is like, “No, no, we’d really love to have some nutritionist or naturopath there.” And it was an application process. So, you had to basically write a story about why you wanted to go. And because of my health issues in the sort of preceding years and my family history, I was terrified of my own situation. And so I wrote an application.

And little did I know when I got to San Francisco with the 60 of us in the room, and someone actually turned around in the auditorium and said, “The auditorium’s not even half full, like, why are there so few people here?” And he said, “Actually, we had 3,000 applicants and we chose the 60 of you of which 6 were nutritionists.” As, you know, the first people that we wanted to help understand how we can work on this problem. So, it was kind of…

Andrew: Which I’m gonna say is amazing.

Jo: Yeah, it was quite…

Andrew: You go.

Jo: Well, given the way that it’s quite hard to build respect and reputation with doctors in Australia. And I had found that we were always disrespected, negated, discounted, and it was hard to hold your own in that space. And to suddenly be in a room where Patrick Hanaway, who at the time was as, you know, the medical director of the Cleveland Clinic Functional Medicine Hospital. And he stood up at the end of his presentation on the first day and just said, “Look, can I get a show of hands of the nutritionist in the room?” And, you know, I was like, “Oh my God. Yeah, hi.” And he’s like, “Okay. I need everyone else to give those guys a round of applause because we wouldn’t get the results that we got at the Cleveland Clinic without them.” And that was very humbling, but also gave me a huge amount of confidence to come back and go, “You know what? You guys don’t get to say that I’m of no value anymore because if we were elsewhere, you would really understand how much we bring to the table, you know, from naturopathic nutrition and functional medicine perspective. And then…

Andrew: Good on you.

Jo: I was stoked, I have to be honest. The following year I went to the Institute of Functional Medicine their annual conference, which that year was on neurodegenerative disease. So, everything from dementia and Parkinson’s through to traumatic brain injury, concussion recovery, and mould. And then at that conference, I was introduced to a group called Integrated Medicine for Mental Health. And that was, I went to that conference eight weeks later in L.A., I just put it out to the universe, went, “Please let me find the money for the flights.” And I was introduced to the likes of Daniel Amen, who’s a psychiatrist that really at the fact that mental health is brain health, and as someone who has struggled with anxiety and depression, since I was a kid, just to see all of these things that I love being pulled together and all the dots being joined and really understanding how as humans, we’re a system of systems and how every little component that we are connected to affects these things for us. So, I was super excited that we have so much to work with to help people improve their brain function and their mental health. And that excited me.

Andrew: So, Dale Bredesen has a 13-point system, is that right?

Andrew: Can you take us through just the… Forgive me.

Jo: time. It’s like he seems to keep adding to it now that he’s been bought Apollo Health, so. But there’s so much that we look at. It’s really cool.

Andrew: Okay. So, could you take us through just the basics, though, of what’s included in that program?

Jo: Yeah. So, because Dale doesn’t look at Alzheimer’s are being Alzheimer’s, okay? He looks at Alzheimer’s due to what? So, there’s all, you know, no, one’s gonna have one reason that they’ve developed Alzheimer’s, you know, we are doing that development for 30, or 40, or more years before it actually starts to present. So, often we work with people in the early stages, which is the subjective cognitive decline, which is when, you know, your brain’s not working properly, but no one in Western medicine is gonna agree with you. They’re just gonna say you’re stressed. And then you start going into that mild to moderate cognitive decline, which is when people might start to accept that there’s something going on. And it’s normally somewhere in that space that I start to see people. So, we look into everything from a couple of generations back of family history. We look at their genetics, we look at how they’ve lived their life. So, literally from, you know, were you a cesar or a natural birth? Were you breasted? Were you bottle-fed? What kind of illnesses did you have as a child? What surgeries have you had throughout your life? What medications have you had? What environmental exposures or toxic exposures have you had? What does, you know, from a stress perspective, what has that looked like in your life?

With women, we look more so than men, I guess. We do look at their hormonal health, you know, when did they first get their period? How long did they use the pill for? Did they have an early hysterectomy? How many children or how many pregnancies did they have? If they’ve gone through menopause, have they used any sort of HRT at all? Or, you know, because of the 2002 study into breast cancer, that was somewhat misrepresented, to put it lightly. You know, often think women haven’t been supported with estrogen long-term throughout their life. We look at, you know, what accidents, when I say, what accidents have they had. Sometimes you’ve gotta ask people 10 different types of questions to find out if they’ve ever had a concussion or a head injury, you know, and that can take two or three consultations. But before they suddenly go, “Oh, yeah, like, when I was 20 and in university, I had a vaulting accident. And I actually landed on my head on the asphalt.” And it’s like, “Okay. So, it’s taken us about three hours [crosstalk 00:18:05]”

Andrew: That didn’t stick out to you?

Jo: You know, so there’s actually a lot that we look into, you know, were they brought up in a traumatic or abusive household, you know, did they experience any sort of trauma through their life. And, you know, trauma is different for every person. You can’t make a judgment on what’s trauma and what’s not, it comes down to the individual. And also it presents in people in different ways. And then we look at things, you know, that we dig deep into their biochemistry, you know, this is why… You may have heard of dementia being called diabetes Type 3, or Alzheimer’s being called diabetes Type 3. And that’s because you can be insulin resistant without actually being a Type 2diabetic, and your insulin levels are already affecting your brain. So, you know, we’ve gotta look at all of those types of things.

So, when we eventually put a program together for someone, you know, we pick and choose the testing off the back of that initial, very lengthy consultation with a multitude of questions that they fill in ahead of time, we usually engage the family because someone who’s already got cognitive decline is gonna have a lot of gaps in the things that they remember. And then we start looking at food, we look at supplements, we look at lifestyle interventions. There’s very specific levels of exercise. And whether we pick and choose between resistance exercise or cardiovascular exercise, what type of stress management processes do we have in place? You know, there’s what side… You know, do they live in a house that’s got mould in it, or are they someone who in their spare time have spent their entire life renovating at home? So, we might dig into the environmental side and have to do a cleanup from that perspective. And it’s a lengthy process because you just can’t possibly do it all at once. But the results can be mind-blowing.

Andrew: Mind-blowing. Now, there’s a pun. But can we dig a little bit deeper into that, you know, the multitude of etiological factors that can impact on cognitive decline later in life. And I guess one of my pet things is we think about an event, like a stressful event, a trauma, a thing event, a poker, rather than the chronicity of things. Like, for instance, people who deal with anxiety on a daily basis, and they can actually be those, you know, type A sort of personalities that need to the perfectionists who need to get things right. I put my hand up. So, how do you help patients who have a behavioural bent, if you like, for worrying?

Jo: Yeah. So, the first thing to know in regard to cognitive decline is that anxiety is a bigger risk factor for women than it is for men, which is interesting. We don’t know why, but it is. So, if you have a patient that has anxiety, you really need to work hard to help them get a grip on that first before you…and do things very gradually. Also, I find sometimes that these patients it’s releasing information to them very carefully. So, if you have a patient that has profound anxiety, you don’t go and get their DNA panel and go, “Oh my God, you have two copies of the APOE a4,” which, you know, in our world, we know that that increases their risk by 90% of getting Alzheimer’s, but you’re like, “You don’t tell people that, you work on it.” And part of that it’s negotiation with the patient as well. It’s important to make sure they have a really solid support network around them. So, you know, do they have a psychologist, or a counsellor, or an energetic healer, or someone that they trust to work on those things with? You know, if depression is a big part of their world, you work on helping them with their depression because of, you know…and is their depression linked with inflammation? Is it just trauma? How much of it’s genetic? How much of it is nutritional?

And you know, there’s more and more research coming out all the time around the doses of things that we need in regard to supporting depression. For example, Jerome Sarris was part of that study that was released last year, looking at the levels of Omega3 that we need to support depression. And that’s also gonna support your brain from a cognitive decline perspective. So, it is about building a team around people and not just thinking that you can do it all yourself. And, you know, that’s family support, it’s professional support, and working, you know, to expand the mindset of the patient for the different things that they can be doing and really doing for themselves, really empowering them to take whatever steps they need to, to help them get better. And understanding it’s not linear, it’s not, “Oh, we’ve started this now, so it’s all gonna be, you’re just gonna get better.” It’s pros, you know, there’s gonna be some fallback, and then you pick yourself up and you  yourself and you start again.

Andrew: Yeah. I just caught myself in the language that I used, you know, and I said the word, “Worry what.” And I need to apologize to everybody out there that tackles these feelings day-to-day. So, I didn’t mean to trivialize that sort of thing. So, just please accept my apology for everybody on that note. But you may also mentioned the APOE alleles. And this, as you say, is something that we can get caught up in a box with because there’s SNPs that affect the action, if you like. Even if the double for allele, there’s a lot of other SNPs that affect how that’s gonna act. So, you can dampen the effect, the bad effect of APOE 44, by looking at these other SNPs and supporting them as well, right? So, this sort of goes on about how comprehensive you have to be with regards to SNP measurement and management treatment from there, correct?

Jo: Yeah, Andrew, I think sometimes we get really tied up in the single SNP. You know, it’s a bit like when MTHFR, you know, first became the big thing. And people are just sending their patient to the GP and go, “Oh, can you just test the MTHFR gene?” And, you know, now we understand that there are multiple genes that are linked into that space. And there’s also, you know, lots of different nutrients that are linked into that space. And I think, you know, to me, genetics are a map. They help, they give me a little bit more direction about where to look and where to go, and potentially other testing to do, things to keep an eye on, you know, and then support that with nutrients. So, also patients have done their own reading, you know, like we say, the little bit of information can be terrible. And helping them understand from their genetic picture. So, what are all the things that we can actually support to help your brain, and what are all the things that you can do, both the internal and ingestive things, and then the external stuff.

So, you know, we have quite specific meditation-based sound programs that we use for our patients, you know, often we use photobiomodulation or near-infrared light therapy through something like Vielight or, you know, we will use infrared sauna, we’ll use hyperbaric, you know, we use brain training. There’s all of these different things to help people understand what that they can do. And, you know, it might be going down the path as well and going, okay, so do we look at their BDNF SNPs as well, and really help them go, “Oh, actually this person should be able to do BDNF,” well for whatever but a less technical term. And so what sorts of lifestyle things can we implement for them? What can we help them understand they need to be doing? And then if they fall off the wagon and they start to go backwards, it’s like, “Okay. Given your big picture, genetically, what do we need to jump on first to help you come back to where you were?” Does that make sense?

Andrew: It does. Just talking about that BDNF effort for a tick, when you’re talking about exercises, about helping people to make BDNF, so that’s brain-derived neurotrophic factor. These exercises in somebody who has cognitive decline would, obviously, require the support of, you know, family members or those significant others around them, wouldn’t they, or do they have to just come back and revisit you time again?

Jo: The thing is that you are always gonna need a family member to help keep them on track, right? Some of my colleagues in the states, particularly some of the functional urologists I know and work with, they’re like, unless the partner is fully engaged in doing the program at the same time, they won’t touch that patient. Because they’re like, “We know they can’t keep themselves on track.” But it’s also realizing that there is… You know, people can step into this type of work at any moment that they realize that their brain’s not working quite right, if that makes sense.

So, a lot of the patients that I work with aren’t at the point that they’ve had an Alzheimer’s diagnosis, it depends on their age. We know that people under 60, 65 roughly are gonna get better results than someone who’s, you know, 70-plus or particularly 80-plus. And it’s about being realistic about what that person can do as well. But, you know, from, generally, once we have someone moving forward really well on a program, I might only see them and their family once a month. And the rest of it is more or less up to them to stay on track, but they can always check in with me if they need to.

So, you know, it’s not… Things like brain training online, things like their exercise we talk about how much cardiovascular exercise they need at what level, you know, how much weight training that they need to be doing, or resistance exercise, you know, depending on where they’re at. There’s things like the meditations are a recording. So, you know, they can actually sit listening to their meditation with a Vielight headset on, at the same time, and they’re getting double banged for their buck for that 25 minutes of the day that they’re spending, you know, helping themselves out and doing the right thing. But you’ll also generally need really strong support around food because the dietary side of it, in our world, it doesn’t seem like it’s particularly difficult. But when you get someone who’s been living on bread and pasta for the last 50 or 60 years, taking gluten out suddenly seems really hard.

Andrew: Yeah. Yeah. Could we discuss a little bit more about some of the tests that you do? So, you mentioned things like, you know, APOE, obviously. But insulin resistance, do you do fasting insulin, or do you do an HbA1c? What other tests do you do?

Jo: So, I think it’s really important to, as practitioners in our space, to try and build relationships with a couple of GPs, if you can, who trust you and are willing to go, “Hey, I don’t…” So, what I have, I have two different GPs who have both been my personal GPs over the last 15 years, who say, “We don’t wanna learn anymore. We don’t know what you do, but we trust you. So, just send us the list and tell us what you want.” And that first panel that we do for someone is really extensive. We’re looking at hormones, we’re looking at thyroid, we’re looking at inflammation markers, ion levels, you know, B12. Generally, we’ll try and do a plasma B12 that’s getting a bit weird with the way that the labs are actually reporting that now. You know, we’ll look at histamine, particularly, if they have sleep issues or anxiety problems, a couple of the key, heavy metals, in particular.

There’s actually quite a range that I look at. And when it comes to insulin, I will always do a fasting glucose and a fasting insulin and HbA1c because without knowing what the insulin level is, the HbA1c isn’t particularly useful, only if their blood sugars are really bad and they’re like bordering on diabetic, but, you know, your insulin, as we know, has a huge range that it can sit in for an extended period of time before you’re a diabetic.

You know, sometimes it’s keeping an eye on high ion levels because we know the ion in the brain really does do rusting. So, often people need to be giving blood once or twice a year to just try and keep that stable. So, anything that I think Medicare will cover, then I send that to the GP. I do DNA panels. I personally use DNA Life, and that’s because they have a really good solid health panel that includes the APOE, then a whole raft of other things, particularly around methylation, detoxification, inflammation, bone health, insulin sensitivity, a whole raft of nutritional markers. And also things like vitamin D and B12, which are really… B12, in particular, which is a massive player in this space. Zinc is also important because you need zinc and lithium to push B12 into the nervous system. And your blood levels of B12 are not indicative that you have enough B12 in your nervous system.

I’ll nearly always do gut testing. I am a big fan of the GI-MAP. I’ve used a multitude of different tests over the years, and I love the GI-MAP. It covers all the stuff that I need at a really good price for patients. Then, depending on their environmental history, we’ll normally do organic acids, and potentially something like a GP tox, basically that will depend very much on their exposure history over the years. You know, I’m not gonna make everybody do that. And, you know, sometimes people can’t afford it. So, I normally try to step through and work as much with their budget as I can, because the whole process is not cheap. And then follow-up testing will only be to review what’s really been out of whack because you don’t wanna keep spending money for people. And I’d rather that they were spending that money on adjunctive treatments or supplements than testing just for the sake of ongoing testing.

Andrew: There is a big point there to cover. And that is, you’ve got a good relationship with GPs who know how competent and expert you are in this area. But GPs are also bound by what they can screen for. So, for instance, to do a battery of tests, let’s say, on HbA1c in a person with cognitive decline, I’m not sure that’d be covered by Medicare, be a hard push. So, would it be worthwhile sometimes to actually get the patient to pay out of pocket, to do these tests because of the, no offence to holistic GPs, I understand the reason why that you have to charge higher amounts. But for these patients, sometimes they have to, you know, spend $500 seeing a GP and then the Medicare tests on top of that. Whereas you can avoid going to the GP and just pay out pocket for the tests. How do you navigate that one?

Jo: Yeah. My first step of navigating is if they can’t see one of my guys who literally I send them an email, they print it out, they walk in, they do a short appointment. The doctor takes the list and goes, “What does she want?” And prints it out, right? So, that’s a very… I know that I’m really lucky to have that kind of relationship with these doctors.

Andrew: Yeah.

Jo: But, you know, I have patients from all over Australia and New Zealand. So, it’s not unusual for me to say, “Okay. Let me send you the list of what we would like. Please take that to your GP and see what they’re open to testing for you. And then whatever’s leftover, we can look at doing that privately.”

So, at least that probably, you know, you’ll get at least 50% to 70% of it covered. Most GPs, if they haven’t done a HbA1c with someone, and they’re looking at a waistline that would be potentially suggestive of insulin resistance or a woman who’s already gone through menopause. There’s a whole lot of different things that you can gently suggest that would encourage them to be willing to have a look at a few things, especially if the patient hasn’t done excessive testing in the past, at least for the first panel.

Andrew: Yeah. The reason I bring that up is that I think we’ve just gotta be mindful that, whether or not they’re on board, GPs are also governed by quite strict guidelines as to what they can screen for. For instance, vitamin D is no longer covered by Medicare as a screening tool. You have to have a reason to do a vitamin D test. Vitamin B12 even. They can’t do a screening, it was taken off, when was it? 2019? 2018? It was taken off the list. I understand vitamin D testing because people were abusing vitamin D testing. But vitamin B12, I don’t understand why that was taken off. But we’ve saved millions in healthcare dollars by not doing willy-nilly screening for vitamin D tests.

A group of patients, of which were tested, and this is correct, was it 79 times? It was absurd, like it was absurd that this group of patients were tested that many times. It was crazy. This is worked by Kelly Belinsky, forgive me for going off on a tangent there. But the only point I wanna make is that don’t run to your doctor and say, can of this list of 20 tests, which they’re probably not gonna do. You’re an expert, like you have a different relationship with doctors who trust you. So, I just wanna make that point. Let’s move on, though, about when we’re talking about testing, you’ve then gotta instigate management. So, how much of it do you start off with supplements? Or do you tend to work on lifestyle and dietary factors first?

Jo: So, from day one, I always implement some major dietary changes. And it depends on the mindset of the patient as to how big or complex those are. Like, sometimes it might be as simple as asking them to, you know, start reducing gluten or offering them gluten-free options, asking if they can please have three hours between dinner and bedtime so that they try and clear the insulin before they go to sleep and trying to put in a nutritional fasting barrier of about that 12 hours from dinner until breakfast. And then, you know, really encouraging them to minimize anything out of a packet and focus on whole foods. And then, you know, we start implementing supplements. Like, sometimes it’ll be straight up as far as some that are known to help with memory because that’s usually the biggest concern. And then we start to add as we get test results and understand what that person’s gonna need.

Andrew: So, nutritional versus herbs?

Jo: Yeah. There’s a few herbs. You know, I presented to, as part of ACNEM a couple of years ago, I wrote a couple of modules for them in their cognitive decline training. And I dug into the research on, you know, every herb and nutritional as I could find. And we do also all try to go with formulas so that you can have people taking less things because they’re already gonna be taking a lot of things. I think probably one of my favourites in the space outside of curcumin is saffron, you know, I mean saffron helps with mood. But there was some amazing studies looking at saffron compared to the couple of medication or a couple of drugs that are already out there excusing this most recent one for Alzheimer’s. Looking at the impact of the saffron supplement versus these medications over four months. And what they found is once you hit the 22-week point, saffron was more effective for assisting memory than what either of those medications were, one of them being.

And I’m quite concerned about the medications that… You know, like, there was one only a couple of weeks ago that was conditionally approved at $56,000 a year for people who are diagnosed very early for Alzheimer’s. And the big concern around about that is they have to be on it for the rest of their lives. And again, it goes down that route of the silver bullet approach of rather than, you know, trying to optimize your body metabolically so that your brain will work better. It’s like, “Hey, let’s just keep on our fantastic Western diet and sitting on the couch and, you know, doing nothing other than taking this pill.” So, one of the things I love about the program is we are trying to teach people to optimize their health, you know, physically, mentally, emotionally, clean up their environment, and get more quality years out of their life rather than, you know, let’s just take a script, that’s gonna cost a bomb and hope for the best.

Andrew: Yeah. We’ve really got to take our hats off to the work of Jerome Sarris and Adrian Lopresti, just two Australian researchers that have done amazing work on saffron and other aspects of helping people with cognitive decline. But how dramatic can these results be? Normally we think of, you know, basically trying to abrogate the progression of cognitive decline. Can you really get dramatic reversals?

Jo: Yes. And I say that with such certainty because I… So let’s take a step back. I had a colleague of mine who referred one of his best friends from New Zealand to me. This guy was only 54 and had been diagnosed with Alzheimer’s. He had profound anxiety. I literally looked at the case and went, “Yeah, I’m not good enough for that one. I don’t wanna get your hopes up. I’m just not convinced that I can help you.” And funnily enough, they didn’t give me a choice. So, they were just like, “We don’t care. This person referred you, said that you’re fantastic, so we trust you. We don’t expect it to all be linear because you know we’re coaches and we understand human behaviour and it might be two steps forward, one step back, three steps forward, five steps back. But we trust you to work with you and we wanna give this a go.” So, he came in with… Actually, one of his daughters lived quite local. And so he, his wife, and his other daughter moved over here for three months from New Zealand.

And the day that I met him, he shuffled in the door with noise-cancelling headphones and a hat because of the light and the people, and he didn’t wanna be able to see people. He had not communicated outside of his family unit for a really long time. And this is a guy who actually was an Olympic coach, like way back when. And the first session that I had with him, within about five minutes, he was so mentally tired. The rest of the assessment really fell on his family to share the information with me. Now, over three months, we got him to a point and also, like, because he was shuffling, he wasn’t exercising. Over that three months, we did the entire Bredesen program. We had him using the Vielight near-infrared, the Neuro Gamma for his brain. We had him, he called it listening to his sounds. So, we were using the program from Active Minds global. He was doing hyperbaric daily. He was doing infrared sauna a couple times a week. They did an amazing job with his diet and really getting things back.

And slowly but surely, he got to start exercising again. And about a month in, one of his daughters who I’d only met on that first day, she rang me and she went, “Jo, thank you for giving me my dad back.” She said, “You know, he used to be this really funny, bubbly, social guy. And we had dinner with a bunch of my friends last night and he was that guy again.” And sort of around that period, he was starting to exercise again. So, it’s not like he was going for a run every day, but every day… She lived on a hill, so they had him walking down the hill to the water and then back up again and doing some stairs at the building and some resistance training. And bit by bit, you know, he, well and truly, got back on track. And the weekend before they left and went back to New Zealand, he gave me a massive hug and he just said, “Jo, thank you for you giving me my life back.” So, I’m not saying that he’s perfect now. And, you know, it’s a constant journey, and there’s been some other complications. But to see him… You know, he’s still 80% of the time. He’s the guy that he used to be.

Andrew: That’s incredible, Jo. So, I have to ask though, when is it ethical to inter-refer, and who do you inter-refer with? What other, I guess ethical considerations do we have to be aware of when taking on the management of somebody with cognitive decline?

Jo: Okay. So, I think the first step is where are they on the spectrum? And that’s, you know, like, someone like Mark was a long way down the track. Often I get people that are much earlier in the stage, in the case than that. Some patients will already be under the care of a neurologist. But to be honest, neurologists have, my experience has been, they’re not very encouraging and they really… As soon as they give someone a diagnosis of Alzheimer’s, it can be, they pretty much just say, get your affairs in order. So, we don’t necessarily continue to engage with neurologists depending on what that situation is. Often, for me, it’s going a little bit less mainstream. So, depending on what’s happening for them, we may bring in acupuncture, we may look at bodywork. Particularly if someone has a major concussion history, I would normally get a good osteo to assess them or a good chiropractor, maybe someone like does Atlas Orthogonal therapy.

So, we’ve got like Adrian Clegg here in Sydney that does that. I also have a guy who doesn’t like to call himself a chiro. I’m not quite sure what term Nick uses, but he’s like functional neurology chiropractic structure. Nick does very different assessments on people. He did work with that patient that I mentioned earlier. And, really, it’s about optimizing the biomechanics of the body which can also change breathing. It can change glymphatic brain, sorry, glymphatic drainage through the brain down into the lymphatic system. It can be breathwork because sometimes people’s structure due to different areas and different accidents have actually kept them in a permanent fight or flight response. And, you know, you’re not gonna get great results if that’s going on. Sometimes therapy. There’s some geriatricians who do some work in this area. A couple of one, Katrina Eiland, who’s over RPA, and she’s excellent. Really comes down to what the patient and their family are open to. But I think building a team around people is really helpful for everyone in the space.

Andrew: For sure. Absolutely. This is such a massive topic, and we’ve only just chipped away the tip of the iceberg about what you do, certainly. There’s only so much we can cover in one podcast. So, firstly, can I ask you to take us through on another podcast, one of the things that you do with hyperbaric oxygen, because that’d be great to learn a little bit more about that. The second thing is where can practitioners learn more. I mean, certainly in the days of COVID now, it’s very hard to fly overseas to go and do the course. What sort of options are available to learn further and indeed, possibly even to do the Bredesen course?

Jo: Yeah. Bredesen actually sold all of his intel to Apollo Health. I think he’s now their chief science officer. So, you can do trainings through Apollo Health. ACNEM have a cognitive decline module, which is all online. So, I ran that live with them, Georgina Hale, and a number of other practitioners a few years ago. So, they have a week, I think it’s a two or three-day module available. The Institute of Functional Medicine were training Dale’s work. And so you’d need to check in with him because I’m not sure if once Apollo bought that out, I think they may actually have the full rights to that now. And then there are various practitioners. So, you know, Dr. Ken Sharlin, who I trained within the Bredesen training, he’s in Missouri and has a couple of clinics.

So, he actually has his medical clinic. And then he also has a neuro gym clinic to which he’s attached. And he’s connected with Terry Wall as well. So, you know, there are two relationships within that work. She’s amazing. She’s one of my celebrity crushes to be completely honest. And the other one is even something like Daniel Amen University. You know, Daniel wrote a book called “Brain Rescue.” And he has online training for the various programs. So, I do a lot of my mental health training with him. I also did my hyperbaric training with one of the professors that…they were the professor that runs his New York clinic. So, the Amen clinics are really handy because they do, you know, psychiatry and neurology, and look at the connections between the two.

Andrew: Amazing work that you’ve done. And it’s plainly obvious to see your dedication, not just in the history with neonatology which got gained you the respect of those who would otherwise be quite sceptical and even denigrative of nutritionist. But you’ve earned their respect, and indeed you are now adding people’s respect in this space as well. It’s plainly obvious to see your dedication and your care in this area. Jo, I can’t thank you enough for taking us through, just as I said, the tip of the iceberg of how to help people with cognitive decline today. So, thank you very much for joining us today.

Jo: Absolute pleasure, Andrew. Thank you so much for having me.

Andrew: And thank you, everybody for joining us today, as well. Remember that you can get all of the show notes and the other designs for health…forgive me, the other “Wellness by Designs,” podcasts on the “Designs for Health” website and, of course, on your favourite app. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”

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