O n a warm sun-lit afternoon, the first after a month of cold and storms, I walked down my street with a new goal. Could I identify each tree by its bark or with a clue from emerging buds? In an instant I spotted the dappled trunk of a sycamore. With other trees, I often had to guess. Where did I find motivation? From Marama, a residential treatment center in sunny San Diego. With its well-tended garden and beautiful surroundings Marama might seem like simply a place of comfort and respite, but Marama offers residents something more: inspiration and renewal for intellect and soul.
In 2017 Marama’s founder, Dr. Heather Sandison, learned of the research of neurologist Dr. Dale Bredesen, and she recognized his work as a revolutionary approach for treating Alzheimer’s patients. Motivated by his results, she resolved to offer care to enrich the quality of life for assisted living patients. In February 2020, she opened Marama with a mission to help people recover memories and rediscover joy in everyday living.
Dr. Heather Sandison, ND. Photo by Alyssa Levine.
Marama’s program is designed to create a balance in a patient’s biological system, providing an environment free of toxins and serving nutritious meals matched to individual needs. Menus follow a Keto-flex diet, featuring vegetables grown in the center’s garden served along with protein-rich foods and healthy fats. They strictly avoid highly processed fare. The goal is to jumpstart healing in the brain by boosting the body’s ketones – the fatty acids created when the body uses fat rather than glucose for fuel. Over time individuals often add foods with more carbohydrates, like vitamin-rich squashes and quinoa or other high-fiber grains, as choices move toward a Mediterranean diet and eventually alternate between the two patterns of eating throughout the year.
Community activities include movement, meditation, relaxation, music, creative expression, and experiences in nature. Patients may choose to join in at their own level of ability. This integrative, multimodal approach has brought success, and now Dr. Sandison’s clinic, Solcere in San Diego, and a midwestern affiliate, Marama Kansas, offer programs with allied goals and methods.
Marama’s personalized strategies were tested in a study in 2023 with twenty-three patients participating. After six months, seventeen people experienced cognitive improvement and showed higher scores on two standard clinical tests, the Montreal Cognitive Assessment (MoCA) and the Cambridge Brain Sciences (CBS) battery. CBS results registered positive changes in memory, reasoning, verbal ability, and concentration. After publishing these results, the Journal of Alzheimer’s Disease reported, “Further research is warranted to validate and expand upon these findings.”
In her book, Reversing Alzheimers, Dr. Sandison describes how people can begin to live by Marama’s principles in their own homes. She leads online support groups for patients and caregivers, including participants from distant regions. As her cousin and a senior citizen interested in wellness, I’ve participated in these discussions. Hoping to learn more, I spoke with her about recent progress in Alzheimer’s treatment and responses she’s received from patients and readers.
Liz Macklin: It seems like there is a lot of new information coming out. People are really interested in research in this area now.
Dr. Heather Sandison: Yes. [Our approach] is becoming more mainstream. People are having more of these conversations. It’s not fringy anymore.
Well, that’s good to hear, because sometimes I talk to people and they’re going “Ohhhhhhhh,” but basically … it is just wellness – taking care of yourself. Although there is a lot in industry that works against us. It helps that you’ve said that you don’t have to do everything at once. People can take on pieces as they progress.
I’ve looked at my local library. They added another copy of the book Reversing Alzheimers. They must have requests and there are holds on it. I checked.
It’s happening!
So you say you feel like things are more mainstream. Are you getting requests to speak at more medical groups?
Not medical. It probably won’t become mainstream like neurology. I don’t see that happening right now because a lot of it is nonmedical, but I think that more medical doctors will be saying, “Look into the lifestyle pieces.” I say that because I did an interview with the New York Times… and The Today Show reached out. The CNN docuseries went live last May – and then Time magazine. There are just a lot of things that are getting picked up in the popular press. There is a certain threshold and it’s exciting. It’s great.
So, it will catch people’s eye that way. Do you think there will be funding for research then?
We have some funding through the Pacific Neuroscience Institute. I don’t have a nonprofit, so we’re recommending that people go through the Pacific Neuroscience Institute. We’re collaborating with Dr. Bredesen. He’s there on staff, as is Dr. David Merrill, and I share patients with him, so Solcere, my clinical practice, is becoming a functional medicine arm of the research center at Pacific Neurosciences, too.
That’s wonderful.
For our article in Plantings, I want to ask you about two areas. One is about diet and how plants play an important role in that. Then there is the bridge to ecology and spending time in nature that includes exercise and aspects of lifestyle. I want to know what you have to say about those topics.
I feel like diet does 50 percent of the lift in terms of improving outcomes for patients suffering from cognitive decline. Eating plants is a big part of that – eating good, high quality nonstarchy veggies.
The other piece, the activities like getting out in nature, gardening, cooking food that you grow yourself, can be so beneficial. Many people in the generation that is suffering from Alzheimer’s right now have a background in gardening and in cooking and nurturing. It’s not for everybody but for many people gardening can be how you get exercise. You can be outside. You feel connected to nature but you also have a sense of accomplishment.
Patients respond and think I remember this. I know this. I know to plant the geraniums next to the vegetables, because the geraniums keep the bugs away. I know because my grandma taught me that. These are things that I learned from my mom and my grandma, and now I’m teaching my grandchild in the garden.
There is intergenerational wisdom transferred.
I think it’s beautiful. At Marama we’ve seen that someone will move in and we’ll ask, “What do you want to plant? What do you want to grow?” And all these memories come back about gardening as a child, about gardening when they were raising children and things that they learned along the way – tips and tricks in terms of gardening.
There are foods we eat that are helpful for memory. The ingredients we cook with can kindle memories of foods we ate long ago. They could be spices or other plants. In our western herbal tradition, rosemary is associated with memory. Turmeric reduces inflammation, particularly in the gut. Coconut oil and plant-derived fats can aid ketosis. Also, supplements like lion’s mane mushrooms can improve neuroplasticity and mood, as can many of the spices from all over the world. They have such an impact on our cognition, stress levels and mood… Green tea, matcha…the list is long.
So, the food and the herbs establish connections that people can build on?
Yes, and it’s confidence boosting.
Because they say, “Oh yes, I know about this.” That kind of thing?
It’s a case of comfort and familiarity for many people that have a past with gardening.
I worked with children – teaching art. Whenever I could make a connection to something they already enjoyed or knew about, it was like having hooks to put memories on.
Exactly.
And then they could say, “I know about this, but I’m interested in this, too,” and they started to open up.
Yes, and it has a way of settling people and putting them in that place where they are right for neuroplasticity. They are right for making those connections. We’ll see that at Marama. People might start from a place of stress. They’ll do something challenging like a Word Find or an executive function project where they follow directions and go on to the next step and they’ll feel frustrated and overwhelmed and fatigued. Then we’ll go down to the garden and they’ll relax. It’s like Oh, I know what this is. I know how to do this.
It takes them to a place where they can, as you said, start hanging new ideas on this coatrack.
It’s like I already know how toplant geraniums. Now we’re planting the bell peppers and tomatoes. This should go here. We’re going to add greens, and oh, they’re sprouting. This feels good. I can see the sprouts come up, and I had a hand in this. I picked this, and I watered that.
There’s a sense of familiarity, so they can get into that rest, digest, learn and heal state.
That’s an interesting sequence. At Marama patients with memory loss go through a process and structure, and sometimes they can go back home and continue at least for a while. Is it hard for people to do it outside of a place that provides that atmosphere and structure?
What I see is a range. For some people it’s relatively simple to implement at home. They have an adult child or a spouse who understands. The caregiver might have a medical background or a coaching background and it’s built in, so all of a sudden all they need is a little more information and it’s easy to do.
We had a patient who had a granddaughter who was a nurse. She helped Grandma with cooking and shopping. She’s the one putting the supplements together. They are able to do it.
But then other people struggle on their own with cognitive impairment and it is impossible.
How about the walks? Sometimes you take people on walks as a group, right? What kinds of things do people see when you do that?
At Marama everyone who is ready for it goes for a walk together. We try to keep people engaged identifying trees, neighbors, saying hello to people, looking for flowers. We might have a scavenger hunt looking for three red cars… looking for three red flowers, picking them and bringing them back. We might have a break at a park and look at the clouds. What do the clouds look like? Little things like that will keep everyone engaged.
The walks are different lengths depending on what everyone can do, especially given the hills. What people can do varies from day to day. Some people are in wheelchairs, so we will stay close by.
In Kansas we have weather to contend with, even temperatures over 100 degrees. [With bad weather] we have to do things differently, but going back to the walks is really important.
I just read an article by Master Gardeners about small space gardens, even gardening in just one pot. Any size is good. You could start with one pot, or you could have several, like a geranium garden one of our relatives has in her house. Whatever a person feels they can manage and would be interested in might be of benefit.
I think there is some intangible benefit of putting your hands in the soil and then also watching something grow.
On social media, I saw an excerpt of a presentation where you said, “Whatever you do, avoid processed food.” I’m wondering what you see as the combined benefit of, if possible, having a choice in what you prepare to eat or having a hand in it depending on what your level of ability is. I know people do some cooking at Marama.
There are varying degrees of interest. I know that people are more interested in cooking when we incorporate food that they helped grow. You know, “We got it in the garden and brought it in and we washed it together.”
Washing cucumbers outdoors on a hot summer day
Oher times there can be a sense of “no you take care of that. I’m going to rest.” It’s just really a matter of meeting people where they are. Some residents who have more cognitive function are more inclined to be active in the kitchen and that is fantastic.
If you have the option to go on the computer and play some brain games versus learning a new way to cook, a new way to shop and new plants to grow, and if you get excited over what’s in your garden so you can cook it in the future – I would really rather you do some planning and executive function with food and with gardening than with online programs. That is by far my recommendation. But not everybody wants to do that.
Or is able, and I remember you saying that if their day is already full but they need to eat something healthy, people shouldn’t feel hesitant. To the extent that they can afford it, they should get help or have something brought to them.
I think you are speaking to what we see. There is a huge amount of variety in what works for people. There is a lot of complexity and unique dynamics in every family and for every person. If someone has a fall or is hospitalized or needs a procedure, often they need their food delivered. There is no way they can do their own cooking. If somebody is available to help them, their capacity increases and they are able to do a lot more. We see a spectrum in what’s necessary and what helps. We’re trying to meet people in all of those places. If that’s an aspiration but not your reality, then Chefs for Seniors is fantastic and there are other meal delivery services.
I would prioritize that there are simple quick meals that can be made and become your go to but meet the criteria of promoting health. I like to think of the meal as 75 percent greens served with some sort of protein and fat.
You’ve mentioned how plants have medicinal properties. Not only does the food we grow in our garden taste good, but there might be certain ways it’s good for you, too.
Sage, rosemary and other Mediterranean herbs can be slightly antimicrobial while also supporting microbes in the gut that help cognitive function. It depends on what your issue is. My caveat here is that you should talk to a Bredesen trained provider… but generally speaking if we have a diet rich in polyphenols, a variety of colorful spices and colorful foods then we get the benefit of that long term, particularly if it’s not something we do occasionally but if it is something we do as a practice.
If there is something in a person’s family that an aunt or uncle or grandparents have found health benefits from or that they enjoy, there might be a story there. It would be worth investigating why that person chose to eat the food.
In our family, right?
Yes, we’ve been told that our grandfather loved green tea, and that his preference could go back to drinking tea in China as a child. I think everybody’s family has something like that if you listen. It’s worth finding out – another memory.
A memory you could share and impart on the next generation.
Our conversation ended on a theme of sharing stories and time together, affirming what I had learned from her online discussions. While many factors affect dementia, lifestyle makes a difference. Changes can improve cognition. Her work points to the value of eating wholesome, unprocessed foods, especially green, leafy vegetables and a diet high in protein and nutritious fats. Time in nature also contributes to relieving stress with added benefits for brain health from fresh air and exercise. Caring for plants in the garden sometime inspires people to take the next step, preparing salads using the greens they’ve grown and then sharing food with fellow patients and friends.
More research is needed, but a healthy lifestyle clearly brings rewards. The way forward will take time and commitment. As we care for ourselves and our families, let’s cherish our lush, green world and do our best to create happy memories.
To learn more about Dr. Sandison’s work and to purchase her book Reversing Alzheimer’s:
Sandison, Heather, with Kate Hanley, Reversing Alzheimer’s: The New Toolkit to Improve Cognition and Protect Brain Health, Harper Collins, New York NY (2024).
Thank you to Susan and Ellie for allowing me to photograph their vegetable garden and sunroom geraniums. Thank you, also, to Starstead Farm, our source of delicious organic vegetables at the Westover farmers market. http://starsteadfarm.com/
Liz Macklin is an artist and writer who enjoys working with family members, young and old. Together they tend gardens and plan hiking expeditions in Virginia’s Blue Ridge. You can learn more about her work via Instagram.
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