Dementia is one of the top causes of dependency and mental impairment in our elderly population. Dr. Heather Sandison was looking for residential care facilities where they were serving organic food and incorporating Dr. Bredesen’s insights for dementia patients, but couldn't find one. As a result, she founded one of the first residential care facilities, MARAMA, where dementia patients can immerse themselves in the lifestyle described by Dr. Bredesen in his book “The End of Alzheimer’s”. Read on for a Q&A on the MARAMA experience.
Heather Sandison, ND is the founder and medical director of North County Natural Medicine and the founder of Marama. Dr. Sandison specializes in neurocognitive medicine and neurohacking.
Why did you start MARAMA?
The first patient I saw had severe dementia. I saw her for the first time and was saddened by how severe her dementia was and impressed by how dedicated her husband was to help her so we put together an aggressive plan. When I met with them again three weeks later she had transformed. She wasn’t 100% better but she was unequivocally better. I wondered, “If this was possible for her, who else was it possible for? What could I do to make the approach accessible to more people and families who were suffering?”
Seeing patients in the clinic, I noticed that those who had a better chance were able to implement complex and time-consuming diet, supplement and exercise protocols at home. Those who weren’t able because of logistical, cognitive, or financial constraints were less likely to benefit. When you are suffering from cognitive dysfunction these things are challenging. Having them done for you in a facility makes perfect sense.
I started MARAMA because the seniors in our lives are at the height of the wisdom and experience they have to share with their families and communities. The longer we can keep them engaged in society the longer they will be able to pass down that wisdom and help us solve modern day problems. We need them.
Additionally, there was no care facility I was comfortable recommending families send their loved ones when they could no longer care for them at home. I looked around for residential care facilities where they were serving organic food and incorporating Dr. Bredesen’s insights. I couldn’t find one! It would take a lot of work, and it isn’t the typical retirement home where lots of hours are spent watching TV and eating ice cream. It takes dedication and some experience to create this type of program. I wondered how hard it could be to make it happen and started looking into it. A lot of the challenging pieces of starting an entirely new venture fell into place quickly.
What do you specialize in and why?
The mission of MARAMA is to create an immersive experience in the approach proven to reverse dementia. We are dedicated to curating the best lifestyle treatments for those suffering from dementia. The goal is not just to make things more comfortable for a patient suffering from dementia, but to provide them a chance to improve. In most residential care facilities the expectation is a decline and then eventually death. At MARAMA we offer hope that some residents will be able to return to independent living.
We offer a setting where our dementia patients can immerse themselves in the lifestyle promoted by Dr. Bredesen in his book “The End of Alzheimer’s”. We have an organic garden, lots of safe outdoor space, a fully organic Keto-flex menu, organic mattresses and linens, daily treatments with devices like the Vie light, LiveO2 oxygen contrast and meditation. The biggest benefit is that the patients don’t need to do it all themselves. We’ve done it for them, and all they need to do is show up and participate!
What do we know about dementia?
We can all agree that Alzheimer’s is a devastating and incurable disease that leaves patients and their families feeling hopeless and terrified. We also all agree that Alzheimer’s starts decades before patients experience symptoms and that is good treatment is good prevention.
Currently, there is no consensus in the scientific community about the causes and best treatments for Alzheimer’s and there is no pill you can take to get better.
The conventional wisdom has been beta-amyloid plaques, tau proteins and neurofibrillary tangles characterize the pathophysiology of Alzheimer’s dementia. Unfortunately, despite billions of dollars invested in the development of medications targeting these processes, the outcomes have been conclusively disappointing. Essentially years and billions of dollars later we have learned that we need to go back to the drawing board when it comes to our understanding of how to treat AD.
The multiple failures of previous anti-beta amyloid drugs may suggest that in the AD brain, the accumulation of beta amyloid could be secondary to an unknown initial disrupting event. The increase in brain beta amyloid concentrations could be a reactive compensatory response of neurons damaged by unknown causes. -Panza, et. al.
It is time to think outside of the conventional paradigm and assumptions to take a holistic look at both our understanding of the disease process and the treatment. We know that stress, diet, exercise, toxic burden and other lifestyle factors play a role in the development of Alzheimer’s and addressing them has the potential lead to cognitive improvement. Why not put that to work?
What is the research behind the method used at Marama?
Dr. Dale Bredesen popularized and helped to centralize the integrative and individualized approach to treating dementia in his book “The End of Alzheimer’s” published in 2017. In scientific journals he has published several case series on the reversal of cognitive decline using his model. Clinical outcomes and peer-reviewed published science inform his approach across many specialties including immunology, sleep medicine, toxicology, nutrition, psychology and exercise science.
We are eagerly awaiting further publications of studies taking a group of patients through the approach so we can answer the question, If I make these changes and put in the effort, how likely am I to get better? My clinic, North County Natural Medicine, is also currently recruiting patients for an observational trial on our approach to dementia.
The new assumption is that this disease cannot be treated with one pill because it doesn’t have one cause. -Dr. Heather Sandison
Due to the individualized model of care it doesn’t lend itself well to randomized, placebo-controlled trials. There are many variables considered and treated at once and so many of the interventions are lifestyle based. It isn’t practical to blind someone into increased activity, ketogenic diets and doing brain games. The new assumption is that this disease cannot be treated with one pill because it doesn’t have one cause. It has many causes that are not mutually exclusive. In one patient’s case they may have high glucose and insulin levels causing toxicity in the brain and in another patient’s case they may not have enough nutrients or hormones signaling the brain to create healthy neurons. In another patient’s case it may be both of those things and a genetic predisposition.
In the clinical setting at North County Natural Medicine we determine which factors are contributing to an individual’s imbalance. At MARAMA in the residential setting we help patients put a care plan into action. We are set up in a non-toxic environment, the food is the best possible food for brain health and regular exercise, meditation and other lifestyle based routines are the default.
What makes MARAMA treatment different?
MARAMA is different because:
1. We expect improvement.
2. We prioritize balance and wellness.
3. We have created a non-toxic environment.
4. We are constantly reevaluating how we can do better.
5. The program has been created by a doctor who has the clinical experience of seeing dementia patients regain cognitive function.
Is full recovery expected? What levels of recovery?
We are new at this and so I don’t know exactly what to expect. I wish I could tell families with more certainty how likely it is that their loved one will get better. We are on the cutting edge and we are learning as we go. I am committed to taking the information we get and new literature as it is published into account so we can offer the best experience possible.
Clinically, I didn’t expect many patients to get better, and then they did. Not everyone, of course but more than I ever expected. Patients with dementia improved when that isn’t supposed to happen.
The earlier we are in the disease process when we start intervening the more improvement I expect.
Personally my mom was noticing cognitive decline and she would joke about it here and there, but I could tell it scared her. She was still working, driving, etc. just noticing changes in her own cognition. She moved into my house for 6 weeks when I had a baby. I was adamant there wasn’t a single food item brought into the house that wasn’t organic, so we ate great food both for her brain and of course for my brand new baby.
When my mom left 6 weeks later she was no longer complaining of forgetting things. She went home and admitted to me a few months later that she had binged at work on Cheetos and Dr. Pepper (eeewwwww!) and noticed her memory issues come back! She’s a complete convert now and one of my most enthusiastic patients. She sends Dr. Bredesen’s book to anyone who shows a glimmer of interest. She’s currently trying to get all of her siblings and their spouses to move into MARAMA. There are 12 of them, so they will take up all of my beds if she’s successful.
What are the potential barriers for others to start a facility like MARAMA?
I hope the barriers are low. My primary goal is that memory care and residential care for the elderly change at an industry level. My hope is that we have lots of care facilities following our lead. It makes so much sense to make the best care available to dementia patients available in the places where dementia patients live.
Barriers, of course, include access to the financial resources it takes to start any business and the ability to navigate confusing and sometimes frustrating state licensing requirements. I toured about 20 facilities before finding the one I thought would work best.
What do you expect for the future?
Unfortunately, I expect the number of dementia patients to rise over the next 5-10 years if nothing changes. There are currently 6 million dementia patients and that number is expected to be 10 million by 2025. It is an epidemic and we need smart solutions. I don’t expect solutions to come in the form of a pill.
I hope that we can publish robust research that proves how beneficial and relatively simple these lifestyle interventions can be. At a societal level, if we make changes in things like the food system, toxic exposure and prioritizing health over mass consumption we can prevent this horrible disease and make it rare.
MARAMA is the only senior living facility with a goal for residents to return to independent living. They provide the space, food, staff, amenities and experience to implement the lifestyle changes necessary to support cognitive health. Their safe, respectful, full-service senior homes are designed to target the disease process.
To speak with a staff person:
Write: [email protected]
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