Highlights from Jonathan Otto's interview with Dr. Kathleen Toops, for the Depression & Anxiety Series. Kathleen discusses how to reverse Alzheimer's and dementia, and how she overcame her own battle with dementia. Kathleen also discusses the impact of gluten on the gut, and on the mind.

Dr. Kathleen Toups

Dr. Toups: Apart from emotional issues which of course play into every kind of disorder, most physiologic psychiatric disorders are due to problems in the body. So they don’t start in the brain, they start in the body and things get out of balance in the body.

So in order to help people with their brain involvement ... and really we think of it in terms of inflammation in the brain. So it’s not deficiencies of neurotransmitters in the brain which is what mostly we were taught in Psychiatry in the past but it’s really conditions that are creating inflammation in the brain. So we look for sources of inflammation in the body and try to balance those and that affects the brain. Typically we will start with the diet. What are people eating, because that affects the microbiome in the gut, it affects the permeability of the gut and when the gut is inflamed then you know food particles that we eat get through into the bloodstream, bacterial toxins can get through into the bloodstream and that activates our immune system.

So when the immune system is activated, it doesn’t just stay right there in the bloodstream next to the gut, right? We have circulation and we have circulation that crosses the blood-brain barrier so when things get into our blood-brain barrier and our immune system is activated there, it just stays in this inflammatory killing mode. One of the factors that we know is a big issue in the gut is eating gluten for people. It sort of doesn’t matter whether you’re allergic or not. We’ve learned that when we eat gluten it elevates this protein called Zonulin that increases the permeability of the gut. That’s called leaky gut. That’s gotten to be a pretty common medical term these days and leaky gut is what it sounds like. It’s little microscopic holes in the cellular junctions and then since gluten is what created those holes, that’s the first thing that gets through and activates the immune system because it shouldn’t be in the blood. The blood should be sterile.

So when that gets into the brain ... The immune cells in the brain are called microglia and when those microglia get turned on, they don’t have an off switch. They just keep you know churning out those inflammatory chemicals until they die which is reportedly two to three months. So I’ll have some patients tell me, “Oh, I don’t eat much gluten. Once a week, or once a month.” And I tell them, “Well, you’re just staying in that constantly inflamed state.”

What happens when we have inflammation in the brain is, well it affects different people in different ways but it can affect different structures in the brain an d certainly can manifest as anxiety, depression, cognitive problems, ADHD, all of those factors.

From starting with an anti-inflammatory diet and working with the factors?

Jonathan: Yeah.

Dr. Toups: Because that’s just the first step of course is the diet but let me tell you that for some people, I have fantastic results with only working on the dietary issues and healing their gut. So I had a patient who came to me with a severe depression. She was crying all day. She was suicidal. In her case, you know, while we were doing the work up for other factors affecting that depression, you know, I started her on a whole foods diet, eliminate the gluten, eliminate the dairy since that’s another inflammatory factor for people. And this lady came back a few weeks later and her depression was gone. It was completely gone. Like that’s all I needed to do in her case. Well I believe I started a few key nutrients like fish oil and vitamin D, and B vitamins that are also helpful for the brain, but it was amazing. It was gone. And she was scheduled to have a surgery for her hip and her hip inflammation went away and she didn’t need to do that.

Then fast forward, so great, that was all we needed to do for her. She came back many months later and said, “My depression’s back. I’m crying again.” It was in January and she said, “I cheated on my diet during the holidays.” And I said, “Well, that’s a great clue. You know what to do here now, don’t you?” In that case that was just amazing, the power of food for her and keeping her diet clean and anti-inflammatory kept her depression at bay and as soon as she let up on that, there it was, back again. So in her case that was certainly an area of vulnerability that could be controlled simply with diet and nutrients.

So these days I’m working a lot with cognitive impairment and dementia. I’m actually kind of shifting the focus of my practice to that because it’s such an important area that we’ve learned that we can actually reverse mild cognitive impairment and early dementia by looking at all the various factors that are driving that. So it’s never any one thing, it’s not just one thing. So with regard to the diet, of course we start with the diet because that drives the health of the microbiome, the gut and henceforth the brain. We talk about the gut-brain access. So what happens in your gut it drives what happens in your brain.

Now with the diet with dementia, it ends up being a little different. What we’re finding is that ketogenic type diets actually are very effective for people with cognitive decline. Obviously no diet works for everybody and it’s not necessarily right for everybody to be on a ketogenic diet but with a ketogenic diet what one does is they eliminate their carbs or keep their carb levels down below 50 grams a day. And carbs normally turn right into sugar and our body runs on sugar but instead of sugar then when you deprive your body of sugar, it starts generating ketones and those ketones somehow heighten our cognitive abilities in the brain. We’ve seen people three, four days on a straight ketogenic diet that already have improvements in their cognition so that’s a pretty exciting thing.

Oftentimes we’ll have people add the MCT oil, the medium chain triglyceride oil, that further enhances that ketogenic factor. And you know there have been many case reports in the literature of people starting to eat tablespoons of coconut oil and MCT oil and having fantastic gains in their cognition.

So that’s the first place. Obviously there’s many factors that cause dementia and what we’ve learned, I have a done a lot of work with Dale Bredesen and his very important research that is bringing out to the world you know this notion that we can reverse dementia and you know using this method, it’s something that I’ve used for many years previously in working with dementia patients but pretty much what I do is what Dale Bredesen has written about.

So we work with all of the factors so we’re looking at the hormone levels. We know that when we lose our hormones, our estrogen, our testosterone, our progesterone, our pregnenolone, we have receptors for all of those hormones in our brain and so when we don’t have adequate levels of those, what happens to the brain? It atrophies. It shrinks. It doesn’t work. And there’s pretty clear data looking at women and estrogen that the minute women start losing their estrogen, their neurons start degenerating. That research has been coming out more and more I’d say in the last decade. So that’s pretty clear.

But it’s the same thing for testosterone and both men and women have testosterone. Both men and women have estrogen. We have something different levels but we need all of those hormones. They are trophic for the brain and so they maintain the brain. And we need to have adequate cholesterol levels. So some of my patients with cognitive impairment have very low cholesterol. And cholesterol, we’ve been told you know for decades we need to have low cholesterol. Now we know cholesterol’s not the enemy. It may be the lipid sub-particles that are driving the atherosclerosis but cholesterol, the brain is made of fat. It’s like 60-65% fat. So if you don’t have enough cholesterol, that’s a healthy fat that makes our brain.

So we need that cholesterol, one, to support our brain. The myelin sheaths around the neurons, we need those lipids from the cholesterol to do that. So that becomes another factor, keeping healthy fat levels for people, and the ketogenic diet sometimes can add to that.

The other factors, one of the huge factors that I really don’t want to neglect mentioning is infections. It’s really surprising us, in our work with the Bredesen Protocol and one of my study groups with Dr. Bredesen where we’re all going over our cases and putting our heads together on this, we’re finding that huge numbers of our patients are having infections that are driving some of the cognitive problems. So we’re seeing just an epidemic of Lyme disease. We know that Lyme disease is a sporocyte that affects the brain. It’s the same kind of organism as syphilis. We’re just seeing tremendous amounts of our dementia patients turning up positive for Lyme disease.

Another factor that we see that’s driving that brain inflammation is mold or mycotoxin-related illness, and we know that mycotoxins are neuroinflammatories so they’re causing all this inflammation in the brains of sensitive people. Now, with mold, not everyone is sensitive to getting sick with mold. 75% of people, if they have a big mold exposure, they may be ill but their body will clear those toxins and they’ll be fine but about a quarter of people have a genetic sensitivity. There’s an HOA genetic type that we look at for that, and those people, when they get exposed to mold, it just stays in their system and it keeps triggering and triggering the system. It causes tremendous effects in the brain.

I have young people in their 20s that have dementia. I mean, their cognition is so bad. I treat several UC Berkeley students, brilliant young people that have had to drop out of school that can’t even read anymore because of the effects on the brain. And then once we remove them from the moldy environment and do various things to bind-up that mold and support their immune system, their cognition will come back.