Dr. Kara Fitzgerald | New Frontiers in Functional Medicine, Longevity, Epigenetics

What if cognitive decline isn't always a one-way street? For decades, the conventional approach to Alzheimer's disease and cognitive impairment has focused largely on slowing progression. But emerging research is challenging that assumption—and raising important questions about what may be possible when we address the multiple factors contributing to brain dysfunction.
In this episode of New Frontiers in Functional Medicine, Dr. Kara Fitzgerald welcomes Dr. Dale Bredesen and Dr. Kat Toups to discuss their recently completed randomized controlled trial investigating a personalized, systems-based approach to cognitive decline. The nine-month study enrolled 73 participants across six sites and reported significant improvements in several measures of cognitive function, including memory, processing speed, and overall neurocognitive performance.
The conversation goes beyond the headline results to examine the metabolic, inflammatory, hormonal, infectious, and environmental factors that may contribute to cognitive impairment. They also explore a surprising finding: cognitive improvements were not accompanied by equally dramatic changes in traditional Alzheimer's blood biomarkers, raising questions about how we measure meaningful recovery.
From ketogenic nutrition and exercise to sleep optimization, hormone health, targeted testing, and multidisciplinary coaching, Drs. Bredesen and Toups share the clinical thinking behind their precision medicine protocol, what the trial revealed, and what researchers still need to understand.
For clinicians working in functional medicine, brain health, and longevity—and anyone interested in the evolving science of Alzheimer's prevention and cognitive health—this episode offers a compelling look at the possibilities and remaining questions surrounding personalized interventions for cognitive decline.
In this episode of New Frontiers, learn about:
A New Randomized Trial for Cognitive Decline: What a nine-month, 73-participant study revealed about personalized precision medicine, including improvements in memory, processing speed, and overall cognitive function compared with standard care.
Reversing Cognitive Decline vs. Slowing Progression: Why Drs. Bredesen and Toups believe a systems-based approach may offer opportunities beyond conventional symptom management—and what the results do and don't establish.
The Alzheimer's Biomarker Paradox: Why substantial cognitive improvements occurred without equally significant changes in amyloid-related and other blood biomarkers, including p-tau217, GFAP, and neurofilament light.
The Hidden Contributors to Cognitive Impairment: How metabolic dysfunction, chronic inflammation, infections, environmental toxins, and other potential treatment targets were evaluated within the study's personalized protocol.
Nutrition, Exercise, and Sleep for Brain Health: How a plant-rich ketogenic diet, aerobic and resistance exercise, sleep apnea screening, glucose monitoring, and cognitive training were incorporated into the intervention.
Hormones, Menopause, and Cognitive Function: Why estrogen, progesterone, testosterone, and other hormones were considered important components of the protocol, particularly in the context of age-related cognitive changes.
Infections, Mold, and Environmental Exposures: What the investigators observed when evaluating herpesviruses, tick-borne infections, mycotoxins, heavy metals, and other exposures—and why more analysis is needed to determine their individual contributions.
The Role of Health Coaching and Personalized Care: Why nutritionists, exercise specialists, health coaches, and trained clinicians were essential to implementing a complex intervention and supporting patient adherence.
The Future of Alzheimer's Prevention and Precision Medicine: How early cognitive assessment, individualized treatment, additional research, and integration into healthcare systems could reshape approaches to brain health and healthy aging.

Full show notes + references: https://www.drkarafitzgerald.com/fxmed-podcast/
*GUEST DETAILS*
Dr. Dale Bredesen
Dr. Dale Bredesen received his undergraduate degree from Caltech and his medical degree from Duke. He was a postdoctoral fellow in the laboratory of Nobel laureate Prof. Stanley Prusiner, and then held faculty positions at UCSF, UCLA, and UCSD. He was the Founding President and CEO of the Buck Institute for Research on Aging, and his laboratory studied mechanisms of neurodegeneration and published over 230 scientific papers, leading to the first publication of the reversal of cognitive decline in Alzheimer’s disease and two successful clinical trials. He is the author of three New York Times bestsellers and is currently the Senior Director of the first precision medicine program for neurodegenerative diseases at the Pacific Neuroscience Institute, and Chief Scientific Officer at Apollo Health.
Dr. Kat Toups
Dr. Kat Toups is a board-certified neuropsychiatrist, Distinguished Fellow of the American Psychiatric Association, and IFM Certified Practitioner specializing in geriatric psychiatry and cognitive decline, with nearly four decades of clinical experience.
She is Principal Investigator of the Evanthea and Four Winds Precision Medicine Dementia Reversal Trials and has served as principal investigator or lead investigator on more than 100 clinical trials, including over 20 focused on mild cognitive impairment and Alzheimer’s disease.
She previously held academic and leadership appointments at the University of California, Davis, including Assistant Professor of Clinical Psychiatry, Chief of Inpatient Psychiatry at the VA, and Residency Training Site Director at David Grant Medical Center.
Dr. Toups’ work focuses on systems-based, personalized approaches to brain health, integrating metabolic, infectious, inflammatory, immune, hormonal, vascular, toxic, and lifestyle contributors to cognitive decline.
In collaboration with Dr. Dale Bredesen and colleagues, her research has explored multimodal approaches to improving cognitive function in early impairment.
She is a frequent invited and keynote speaker at national and international medical conferences and is actively engaged in advancing precision medicine approaches to cognitive and psychiatric disorders.
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Sauna is everywhere in the longevity conversation, but are all saunas actually doing the same thing? In this episode, Dr. Kara Fitzgerald sits down with Sunlighten co-founder Connie Zack to unpack the science of infrared sauna vs. traditional Finnish sauna, how different wavelengths of infrared and red light interact with the body, and what the research suggests about cardiovascular health, mitochondrial function, recovery, metabolism, and healthy aging.
They explore the important distinction between heat therapy and light therapy, including far-, mid-, and near-infrared wavelengths and red light, why wavelength, dose, and proximity matter, and how these modalities may be used together. They also discuss practical sauna protocols, including how long and how often to use infrared sauna, and why hotter isn't necessarily better.
In this episode, you'll learn:
How infrared sauna differs from traditional Finnish sauna
Why heat therapy and light therapy affect the body differently
The differences between far-, mid-, and near-infrared light
How near-infrared and red light interact with mitochondria and cellular energy
What research suggests about infrared sauna and cardiovascular function
Emerging research on photobiomodulation and metabolic health
How long and how often to use infrared sauna
Why hydration, minerals, dose, and personalization matter
Whether combining infrared heat with near-infrared and red light may offer additional benefits

Full show notes + references: https://www.drkarafitzgerald.com/fxmed-podcast/
*GUEST DETAILS*
Connie Zack is the co-founder of Sunlighten. After witnessing her brother’s health transformation through infrared therapy, she and her husband, Aaron, left careers in pharmaceuticals to focus on infrared light and heat. Over more than 25 years, Connie has become a leading expert in the field, working alongside researchers and clinicians to advance understanding of how infrared therapy can support healthspan and whole-person wellness.
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In this episode of New Frontiers, Dr. Kara Fitzgerald sits down with longevity physician Dr. David Barzilai to separate promising science from hype and explore where the field of longevity medicine is headed.

They discuss the evolution of biological age testing, including DunedinPACE and other aging clocks, and why these tools can provide useful information without telling the whole story. They also explore how AI and emerging technologies could transform personalized medicine, helping clinicians better identify which interventions may actually benefit an individual.

You’ll also hear why the fundamentals still matter, how to think critically about the growing number of supplements and longevity “hacks,” and which emerging interventions deserve attention as the science evolves.

In this episode, you’ll learn:
- What biological age and aging clocks can—and can’t—tell us
- How to distinguish promising longevity science from hype
- Why slowing the rate of aging may matter more than chasing a biological age number
- How AI could change personalized longevity medicine
- Why individualized diet, exercise, sleep, and other foundational interventions still come first
- How clinicians can evaluate emerging longevity therapies without getting ahead of the evidence
- Where longevity and geroscience may be headed next

If you’re interested in biological aging, healthspan, precision medicine, or the future of longevity science, this conversation offers a practical look at what we know today—and what may be coming next.

Full show notes + references: https://www.drkarafitzgerald.com/fxmed-podcast/

GUEST DETAILS
Dr. David Barzilai, MD, PhD, MBA, MS, DipABLM* is a longevity medicine physician, Harvard Medical School Lecturer, and founder and CEO of Barzilai Longevity Consulting. He specializes in precision, evidence-based strategies to extend healthspan and improve long-term health outcomes. A Diplomate of the American Board of Lifestyle Medicine and faculty member at the Geneva College of Longevity Science, Dr. Barzilai integrates nutrition, exercise, sleep, stress management, and emerging therapeutics into personalized longevity strategies. He works with individuals, clinicians, and organizations worldwide to translate cutting-edge longevity research into practical applications.

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Better Broths and Healing Tonics book: https://tinyurl.com/3644mrfw

In this episode of New Frontiers in Functional Medicine, Dr. Kara Fitzgerald sits down with neuroscientist and mitochondrial health researcher Dr. Siobhan Mitchell to explore emerging research on mitochondrial dysfunction, aging, and longevity. They discuss how mitochondria change as we age, how mitochondrial dysfunction may contribute to chronic inflammation and age-related disease, and why supporting mitochondrial health could be an important strategy for extending healthspan.
The conversation explores the relationship between mitochondrial dysfunction and biological aging, inflammation, cardiovascular and metabolic health, cognitive decline, and chronic disease. Dr. Mitchell also discusses emerging biomarkers of mitochondrial stress, including GDF-15, and what they may reveal about mitochondrial health and aging trajectories.
Dr. Fitzgerald and Dr. Mitchell also examine practical and emerging approaches to supporting mitochondrial function, including creatine, NAD+ precursors, S-equol, exercise, and targeted mitochondrial support, along with research on vascular function, cellular energy production, and mitochondrial DNA damage.
In this episode, you’ll learn:
How mitochondrial dysfunction may contribute to inflammation and accelerated aging
Why mitochondrial DNA damage could play a role in chronic disease
What GDF-15 may reveal about mitochondrial stress and aging
How creatine supports cellular and brain energy
The connection between estrogen, S-equol, and mitochondrial health
What emerging research says about NAD+ precursors and aging
How targeted mitochondrial support may influence vascular health, exercise recovery, and cellular function

Full show notes + references: https://www.drkarafitzgerald.com/fxmed-podcast/

GUEST DETAILS
Dr Siobhan Mitchell PhD., MitoQ Chief Scientific Officer
Holding a PhD in neuroscience from SUNY Albany, Siobhan Mitchell has also completed a post-doctoral fellowship on brain aging at the University of Washington. She has over 15 years of clinical research experience, seven patents on mood and cognitive food products, and has authored over 50 papers on aging, brain health, nutrition, metabolic health and more.
With a personal passion for brain aging research, Siobhan has worked on metabolic and skin health, appetite, sports physiology and of cellular health – which she now focuses on as the Chief Scientific Officer for research-backed cellular health company, MitoQ – creators of the world’s first mitochondria-targeted antioxidant.

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Younger You book: https://tinyurl.com/mr4d9tym

Better Broths and Healing Tonics book: https://tinyurl.com/3644mrfw

GLP-1 receptor agonists have transformed weight loss and metabolic health—but what are we overlooking? In this episode of New Frontiers in Functional Medicine, Dr. Kara Fitzgerald is joined by Dr. Sanjay Bhojraj and Dr. Alexis Gonzales to explore the clinical tradeoffs of GLP-1 therapy, including lean muscle preservation, nutrient status, weight regain, and long-term metabolic health.

The conversation also examines SiPore, an engineered silica-based intervention that works locally in the GI tract to slow the breakdown and absorption of carbohydrates and fats. Dr. Fitzgerald and her guests discuss findings from the randomized, double-blind, placebo-controlled SHINE trial, including outcomes related to A1c, visceral fat, waist circumference, cholesterol, and lean mass.

They also explore how CGMs can reveal post-meal glucose patterns, why muscle preservation matters during weight loss, and how clinicians can support patients transitioning off GLP-1 medications—including those preparing for pregnancy, IVF, or surgery.

Full show notes + references: https://www.drkarafitzgerald.com/fxmed-podcast/

GUEST DETAILS

Sanjay Bhojraj, MD, FACC is an interventional cardiologist and Fellow of the American Academy of Anti-Aging Medicine specializing in cardiometabolic health, longevity medicine, and precision cardiovascular prevention.

He’s the founder of the Laguna Institute of Functional Medicine. His programs focus on reversing metabolic dysfunction, improving resilience, and reducing cardiovascular risk through lifestyle optimization and advanced diagnostic testing.

Dr. Alexis Gonzales ("Dr. G") is OvationLab’s Senior Clinical Implementation and AI Specialist, translating breakthrough research into practical clinical workflows, and holds advanced degrees in biochemistry (Saint Mary’s), biotechnology (Johns Hopkins), and naturopathic medicine (Bastyr).

She provides concierge functional-medicine care at her private practice in California—focusing on endometriosis, fertility, PCOS, and menopause—while distilling emerging research into practical frameworks at conferences to make integrative solutions accessible.

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Younger You book: https://tinyurl.com/mr4d9tym

Better Broths and Healing Tonics book: https://tinyurl.com/3644mrfw
Younger You book: https://tinyurl.com/mr4d9tym
Better Broths and Healing Tonics book: https://tinyurl.com/3644mrfw