 I'm back to Think Tech. I'm Jay Fidel. This is Likeable Science. Likeable Science is one of our oldest shows with one of our oldest host guest co-hosts, Ethan Allen. We're going to talk about new discoveries and treatments for Alzheimer's today. How much will these things help the elderly? How fast are they going? What are they doing? What is the progress? And our guest is, of course, our co-host, Ethan Allen. Welcome to the show, Ethan. So nice to see your smile and face. How are you? Hey, it's good to be back, Jay. Nice to see you, Ian, too. So Alzheimer's feels like it's getting closer to all of us. It's so ubiquitous, not only in the US but in Europe and elsewhere in the world. It's part of modern society. It's part of the technology that lets us live longer. And so here we are facing the possibility of Alzheimer's every day. So what have we learned? Can you talk about modern research, discoveries, developments around Alzheimer's? So, I mean, there's a huge amount that is still not known about it. It's a very puzzling condition. It's still very hard to diagnose early. It's hard to diagnose it until the person who has been suffering from it has actually died, although it can be done now. But what's probably sort of the most exciting recent development is they've begun to associate it with certain relatively common bacterial infections. And for a long time, that was not thought to be or that was a pretty fringe theory for a long while, I guess I should say. Let me go to the oracle here and ask my friend, Alexa. Alexa, what is the relationship between Alzheimer's and bacteria? From NIH.gov, bacteria inhabiting the gut strongly influence this gut brain axis, and thus may participate in AD pathology. Another example of things in the gut brain axis, yes. Well, I mean, when I asked her that question earlier in anticipation of the show, it gave me a completely different answer. Isn't science amazing how fast it moves? In 20 minutes. Okay. So, just on a cellular basis, on a human genome basis, how could bacteria be affecting brain function and how could it be creating Alzheimer's? Well, there is, it's intriguing. The brain is protected in general from bacteria. There is a what they call blood brain barrier, which stops anything circulating in your blood from getting really into the brain tissue itself. And it's intriguing. This is, turns out there's multiple membranes. They used to say there's three. They've now actually just recently discovered a fourth membrane that's protecting it. But it doesn't always seem to work perfectly. And the theory, as I understand it now, is that occasionally even very small amounts of some bacteria, which basically may be living in your gut all the time, pretty harmlessly, and circulating throughout your bloodstream, pretty harmlessly, because most bacteria really are pretty harmless, get into your brain and help start an inflammatory process there, basically. And it's that process that is really causing these tangles and plaques and the various other things that they find in the brains of people with Alzheimer's. As with so many other things that are troublesome for us, this involves the inflammation, specifically inflammation in the brain. And we've done some shows on AstraZeneca as a way to minimize or alleviate inflammation. And I wonder if there's anything in the literature that suggests that if you knock off the inflammation, you reduce the risk of Alzheimer's. That's what has recently been coming up with some of the, I think some of the research has been shown that certain crookings that are associated with high inflammation levels are found at higher levels in people who then go on to develop Alzheimer's. People who are basically more inclined to sort of high inflammation levels. Yeah, it's still, as I say, a lot that's unknown about it. But it used to be completely mysterious. And there was no, there wasn't any real thinking that it was associated with any bacterial infection. So it's very intriguing and actually very hopeful. This may be a very powerful link. Is it genetic? Is it handed down from generation to generation? Well, certainly the way your immune system functions is very determined by your genes. And we all have very different immune systems. And the immune system is an incredibly complicated, multifaceted part of our body. It's still not very well understood. And your genes, yes, you'll get your genes for controlling various parts of your immune system from your various maternal and paternal relatives. And that may make you more prone or less prone to either having a good immune system that cleans things out very efficiently, or maybe immune system that goes tends to go a little overactive and starts reacting against it. It's against some of your own tissues, or maybe one that's sort of defective and doesn't knock out infections. Alexa, what is the connection between Alzheimer's and my immune system? From NIH.gov, the innate immune system plays key roles in controlling Alzheimer's disease AD while secreting cytokines to eliminate pathogens and regulating brain homeostasis. Well, we're right on the right path with that one. Alexa, how do I prevent Alzheimer's disease? According to Sharecare, you can't prevent Alzheimer's disease. Alzheimer's disease is actually a disease of the brain that involves the tangling of the nerves in the brain. There is no known cause. You can see these changes on pathologic slides of brain tissue of those who have died who had Alzheimer's. There does seem to be a family tendency for the disease, but just because someone has Alzheimer's in your family does not mean there is much of a risk that you will get it. There have been some associations like long-standing hypertension and even aluminum exposure that may have something to do with Alzheimer's, but nothing has been proved yet. Aerobic exercise and mental exercises have been shown to make a person cope with Alzheimer's better. Mental exercise. That's it, Ethan. You know, what you do and what we do here at ThinkDeck has a lot to do with staying, staying away, you know, preventing Alzheimer's. I really believe that, too. Oh, look, that's actually been quite well established. There was quite a famous study of a group of nuns many years ago, and they looked at the nuns basically who stayed mentally active through their latter years versus nuns who basically didn't and found quite a striking difference. The ones who weren't staying mentally agile, learning new things, staying involved, their mental faculties basically declined much more rapidly. That's an interesting notion because it means that your thoughts, the activity of your brain, right, can have the physical effect of preventing the tangle of the nerves in your brain. So, you get from a thought process to an unentanglement, so to speak, a physical result, which suggests, you know, that there must be a pharmaceutical possibility here to emulate the activity of the brain and thus to untangle by chemical means, no? Well, but now, again, it's with this new research showing this link to Bercurio, it may just be a function of how your immune system is dealing with it and whether we all maybe have low levels of this bacteria in our brain and some of us, our immune systems, either don't see it or don't care about it and other people, it triggers this pathological reaction causing these plaques and these tangles. Well, let me try this. Alexa, can antibiotics help Alzheimer's? From VeryWellHealth.com, your family member may be able to take an oral, by mouth, antibiotic, but typically oral antibiotics are not as effective in fighting pneumonia in advanced dimension. Well, maybe we're just not using the right antibiotics. What do you think? I mean, as we get more sophisticated with antibiotics than we are, then maybe that would help. Exactly. No, there was some very shun news. It was quite depressing for some years. It seemed like we had sort of run through the antibiotics that we knew about and we were seeing more and more pathological strains of bacteria that were more and more resistant to more and more of these strains. But recently, some folks have just come up with a whole new class of antibiotics. I forget where they dug them out. Some obscure maybe a fungus somewhere, maybe out of alligators. I don't exactly remember where this was, but a completely different chemical family. Hopefully, we may have some new weapons in our arsenal, as it were. Well, there must be plenty of interest in trying to find how it works and what the solutions are and what the care would be because of the number of people who are coming down with this in America and in Europe and, well, everywhere. It really ruins your life. I mean, there was a movie not too long ago which was called The Father. It was a story of a man who was declining into Alzheimer's or dementia or a combination. It's hard to say which one is which. I'd like to ask you that in a minute. The stress and strain it put on his family. This was an interesting study into not only how he declined and the frustration or the level of understanding he had, his self-awareness declined, and his family was increasingly frustrated because he had these moments of exploding emotional moments which were very troublesome the people around him and they couldn't understand and tolerate his behavior. I've heard this in real life. This movie is really a very accurate movie in terms of how people decline and their relationships decline. This has to affect millions and millions of people in a very profound and a very tragic way all over the world and so there has to be a fair amount of research going on. Exactly because it's not just the victim themselves but as that movie dealt with show, it affects everyone around the victim. They end up having to spend their time and energy taking care of this person or hiring people to take care of them. It's expensive. There is I mean this lost productivity, lost work time from both victim themselves but again from those around them who cannot be otherwise now employed in our workforce do another productive work because they're involved in having just to take care of somebody and keep them sort of out of trouble as it were. Devastating can rip families apart and yes people react very differently to going into dementia state. Some people are very sort of calm and accepting of it. It's like oh well you know I guess that's just the way it is and they can sort of smile and laugh about it and other people get extraordinarily frustrated. They get angry that they are frightened. They're understandably if your mind is going and you're able to understand that your mind is falling apart in some sense I can only imagine it must be terribly frustrating. I think terribly angry making you know. Yeah and they can't control their emotions either you know if they're inclined to be angry they're going to be angry without restraint and this is a problem and I know people where this has happened and it results in violence sometimes. Yes. Yeah exactly. Bottom line is it's very expensive business. It's expensive business if somebody in your family has Alzheimer's and you know it either gets into violent episodes or walks away. The walk away problem is really a headache. The institutionalization problem is a headache and you know that a lot of institutions will not accept somebody who is out of control by way of Alzheimer's. This is a problem and if the individual is alone without family which is increasingly the case in our nuclear world you know where the family is spread to far corners of the earth that is really trouble because there's nobody there to take care of this person and if this person doesn't have the funds to pay for institutional private institutional care oh what happens then what a way to go. Right right. No I've had friends who have found themselves on Christmas Eve day having desperately looked for a new higher security care facility for Alzheimer affected relatives and you know it's not the way you want to spend your holidays. So you'd think you know here we are it's 2023 I know that's a fresh thought here in January February well still January and you know you'd think that we had the science we had the technology to address this sort of thing. You'd think we'd know enough about cellular biology to figure out what's going on and then you know address options whether it's black or bacteria or a combination or who knows what maybe you know I hate to say it but maybe it's just a matter of aging we all age differently and this is one of those expressions of aging. Bottom line is that you'd think in 2023 that we would have enough science enough biology to deal with this and yet you tell me you know even even Alexa even Alexa even Alexa doesn't know. It is I mean the leaps and bounds that science is making and technology is making it it's incredible in medical science these days. They now actually can treat sickle cell anemia and made of Lysimia that there's actually a cure for this now it's amazing essentially a one-time treatment that will basically cure those devastating extraordinarily painful debilitating diseases. Only really has come out in the past year they're still waiting for I think final federal approval of this treatment but it's yeah it's not like Alzheimer's it's the Alzheimer's maybe maybe next week maybe next year maybe next decade who knows you know. Yeah well you know it troubles them in the sense that there's a good reason to do the research but for some reason we could solve the COVID you know antiviral vaccinations and antiviral medicines you know within a what a couple years maybe max and actually affect them you know the the pandemic but we can't do this it seems to me that dealing with a virus is more complex but maybe maybe not so the other thing is you have to look at the research establishment out there you have to look at the doctors are doing it clinically looking at you know possible options in terms of treatment medicine you know diagnosis and you have to look at the medical schools you have to look at the you know research universities that are dedicated to this you'll have to look at the source of funding maybe not enough money is coming in it was a crisis with the pandemic and every you know including the government was showing billions and billions and billions at it and you know that tends to expedite the research absolutely it sits capitalism but but we don't seem to have that kind of you know thrust on Alzheimer's why not what's the mark it's I mean it's a strange I see a strange parallel there between and you can make between alzomers and climate change both are sort of slow onset kinds of changes that just sort of every day every few days it seems just it's a little bit worse it's a little bit worse but there's no it's not a crisis like heart attack right it's not a crisis like a cat a cataclysmic uh drought or or something uh yeah it's just this gradual kind of change in our brains are not wired to treat those things as crises there were they are wired to treat you know the bear coming over the next ridge that's a crisis you know you have to do something about right now and we're good at that our brains are very well attuned to that but the fact that it's a little bit warmer than last year the fact that these people are getting a little less mentally capable every year that those slow changes are not we can't see them as crises very well you know and therefore we don't treat them like crises even though they're every bit is damaging I take your point completely and you know one thing you mentioned is worth dwelling on for a moment is that potentially the increase in global temperature could have an effect on this we don't know but it may be that this is one of those you know quiet effects of climate change where like the wine you know wine in in southern california now can't grow as well as in northern california because it's a little it requires colder weather same thing in europe and france in the uk so as as the temperature changes maybe the you know the the demographics change for people and as I said we all age differently and so maybe some people are more affected by very subtle changes in temperature in environment I don't know if anybody's ever said that but seems to me that's a real possibility well yeah the certain the number of dangerously hot days where where you get a heat index to up the ranges where it starts to do real damage are increasing pretty much around the world particularly in tropics and it's certainly having that certainly having bad health effects on a lot of individuals in a lot of different ways and again very sort of widespread effects because it's cutting productivity and economic growth and all that I don't know that anyone has correlated that at all with with alzomers um I don't know if they've actually looked at it I suspect for a strong effect I suspect it would have already been seen but um well you know the other thing about this is that um you mentioned it as you get older and um you uh you you may you may not realize going on especially if there's nobody around to diagnose you and especially if you're alone you know where there's nobody to tell you there's nobody to identify and you're you know increasingly you're out of it so you're not thinking about that and you're not thinking critically so to diagnose yourself and so you as you get older you get weaker make mentally um and so nobody knows you don't know and the establishment around you may not know and you're just sliding down that path and you know that's got to be part of it because you know people it's so easy as you said it's so easy to say well he's getting old that's it for him you know that's that's a product of getting old and not realizing that's a completely separate disease it's not dementia although dementia is one of the effects of it it's not dementia it's Alzheimer's different um so I imagine that in a lot of circumstances and societies Alzheimer's is never diagnosed at all yes I mean now Alzheimer's is a form of dementia it's one of the many dementias that happens um and it you know as as um Alex just pointed out it typically is not diagnosed till after death because it's the way it's in part the way it's diagnosed is by looking at your currently the disease can only be diagnosed after death since brain tissues have to be in analyzed sorry I didn't realize I was calling her up by saying her name she whose name must not be spoken her name exactly you know there's a woman by the name of Linda Wong um she's from Brookhaven and her husband is Thomas Ernst he's also from Brookhaven and they have this fantastic uh machine at the at the base in the basement between his hospital which is a super duper MRI machine and their research functions on the condition of brains as they go down progression in various diseases and the primary disease that they their research addresses is Alzheimer's and they can show you a picture of early Alzheimer's versus later Alzheimer's and how the structure in the brain changes over that period of time I'm not I'm not sure you know that that leads to a therapeutic a pharmaceutical result but at least it tells you how the structures in the brain are changing and so our research seems to be you know early our research seems to be early and you if the if the incentives in the pharmaceutical industry were greater and at the research universities if there were more grants and the like if they were greater then somebody would figure this out it's like there are all kinds of data that tell you a little about this and a little about that but nothing really puts it together nothing really you know tells you whether it's bacteria or tells you whether it's black or tells you how these structures are changing in a way so that you could prevent that um and so I mean I really feel kind of frustrated because here I am you know and I'm getting into the age where my my risk is you know increasing and all my friends their risk is increasing and hopefully we can all stay active physically and mentally and stave it off but some some of us some of them uh you know will suffer this uh Anthony Hopkins fate and you know we sort of it's a it's a race against time isn't it indeed I mean this is very very hopeful to hear that of that diagnostic research because ultimately if they can be uh you can be looking at that group of patients who have who are showing early signs for the super MRI as you put it and people some of those people who die of other causes you can look at their brains and see do they indeed have the playing goals and the tangles and plaques do they have evidence of bacterial infection from some of these gut bacteria that have been now I now suspected of being related um we'll be able to do much better job of then moving on if they can identify one or the other of those as truly causes you will be able to to perhaps develop some treatment you know yeah or a combination of things I don't want to ask uh miss a about this so I'll ask you how can I lead my life aside from staying active and mentally active and and coming on think tech a clear a clear solution here coming on think that absolutely and engaging in this kind of conversation um but what can I do physically mentally in terms of diet and all that in terms of the way uh and I shape my daily activities shape my body um what can I do to minimize the risk because I think it's a it's a hell of a thing to go through a whole working life right and look forward to your retirement and then when you get to retirement age and by the way 65 seems to be the break point uh when Alzheimer's becomes more and more you know possible um so it's a hell of a thing to go through your whole working life uh collect what's left of what they're going to give you in Social Security it that may not be as much in the future as it is today and and uh and then and then this happens but tragedy it's tragedy on so many levels so what can I do Ethan to protect myself even if these steps are not necessarily efficacious I need to have something to focus on to minimize the risk what is it no you you already just said it basically stay physically active stay mentally active eat a reasonably healthy diet you know avoiding lots of saturated fats lots of super processed foods you know try to you know eat sensibly uh you know but those that try out of things of the the physical exercise mental exercise and a healthy diet are probably about as good a preventative as you're going to have at this point um yeah I was going to say and I suppose you could go on on google and look up uh things like the Alzheimer Foundation and make contributions to them uh and hope that that you know accelerates the research and then you you are a possible beneficiary of that research but this raises the question of competence doesn't it because if you're on this path of of losing your ability to think and think critically at some point you're not competent at some point you can't write that check to the Alzheimer's Foundation even though that would be good um and so you know this this opens all kinds of questions for the family questions for the individual for the institution at some point somebody could say and probably often does say he's no longer competent right no I mean there there are sometimes of course serious questions um ask of some of our older political leaders are these people still as sharp as they should be you know are they losing their uh their ability to make those critical key decisions you know that's true and and uh we you know we have extended life these days thanks to medicine in general and lifestyle and what have you um but some people are going to get it anyway I mean there there's there was talk that a number of public officials we know I will not mention any name but Ronald Reagan because it was pretty good no but there have been others too but you're really not sure but you hear stories and read read stories about a fellow who's in office doing critical work even president of the country and shortly after he's out of office you find out that he has Alzheimer's or some kind of dementia and you say wait a minute what about all the things he did while he was in office what about a judge what about a judge on the supreme court of the United States you know they do get old and they're in there for a life term life term maybe something and that goes out here somewhere along the way because you know a lot a lot of organizations won't won't let you stay around past a certain age right seems to me that we that we have a problem because when you say life term um or you have someone who is you know really elderly in a high public office there's a greater chance of dementia to Alzheimer's absolutely and and the person is not really competent well and plus I mean as we got into that kind of age range just the odds of any other kind of a debilitating accident happen or increase right the odds that you could have a fall which 10 years earlier might not have been so bad but you know what if you're 85 or something it's suddenly much worse for you than it was 10 years earlier you know and may it may put you out of commission it may make you incompetent to basically hear out your your work now well that goes to a question of whether Alzheimer's kills I'm not going to ask miss a over here about that but I'll ask you does Alzheimer's kill is the natural progression of Alzheimer's to actually you know put your life short I don't know I don't know that's ever been firmly established um clearly it's interfering in brain functions and a wide range of scales and a wide range of areas in different you know different people's brains so it's certainly not out of the question and it could be interfering in parts of your brain that are running important systems like your respiratory system or keeping track of your heartbeat or whatever it may be I don't know that it's ever been established that somebody actually died directly of Alzheimer's but I've not really studied this enough depth to say that could be could be could happen I guess I know I know one case where a woman fell down she fell down because she wasn't all together and Alzheimer's kind of made her fall down she fell down and she broke her hip and you know they they patched her up the best they could and they put her in a wheelchair and they told her look if you stay in the wheelchair your life expectancy is going to drop for simplicity your ability to recover from the break in the hip you know will you won't be able to recover you'll if you don't get out of the wheelchair you'll always be in the wheelchair but she dementia she had Alzheimer's and she you know what they were talking about and it was ultimately her decision and the institution apparently didn't you know push her to stand up out of this wheelchair and do you know physical therapy and walk around so she stayed in the wheelchair and that's seriously reduced her life expectancy you know ultimately she died of some complications that came from that right so it's not a straight line no no that's that's what I'm exactly my point was that Alzheimer's itself may not may not kill you or probably won't kill you but yeah it can reduce so many other life functions basically that you know your odds on having a untimely death rise dramatically you know yeah people think they're going to live forever and you know with all the medical science they led to believe that you know it's like these these people who shoot each other and they're watching all this television and whenever the good guy gets shot they wheel him into the hospital and and miraculously the doctors were able to cure him and you know in two hours later he walks out of the hospital he pulled all the 27 bullets out of him he walks out of the hospital and it's it's it's it's education educating the public about the miraculous power of current medical science but it's not true it's misinformation right now it's the same thing here I mean I think people think oh yeah well they they'll always have something it's just around the corner this will not affect me and if it does they'll they'll have a drug a magic little pill solve my problem not true well I mean just just imagine though being somebody who has suffered from sickle cell anemia and perhaps having a newborn child or being pregnant right now and suddenly now there is a cure for it you can stop the disease at an early age and you're offspring need not suffer the same fate that you've suffered you know huge bouts of pain throughout your life and and debilitating uh symptoms you know so I mean there are really amazing things happening um but not for everything it's like you know it's like it's like abortion you know I don't think uh Byron's Thomas ever realized that there were medical issues and that if you um if you require all the abortion doctors to leave the field and you don't have them anymore than us is there they can't provide medical care unrelated problems right so women die this should not be a surprise to us oh no no I mean pregnancy is actually very dangerous medical condition right um you know your odds on dying while you're pregnant are considerably greater than they are when you're not yeah one for any given age I believe so it's a matter of mis misperceiving misunderstanding over estimating if you will the power of medical science and uh it comes back I hate to say this but it comes back if you want to understand your relationship with medical science you have got to invest some thought process do you still have thought process you have got to learn about this and gauge your life accordingly because if you think that the you know the guardian angel is going to swoop down from the the the the sign of caduceus and uh and and make you well um that's misinformation absolutely and that's always going to be the case even if our life expectancy gets longer and longer we're still mortal and yeah I mean good good health you know it's dependent on a lot of different things but part of it is you know having a partnership with a good healthcare provider and having a productive partnership where they they know what your situation is are helping guide you and advise you and provide the right kinds of support for for many people that's a close partnership and we our system is not really set up always to support that oh that's a really interesting and valuable point you know as we get into high tech administration of medical care we're not really as close to the you know the the doctor the nomen rock there's no one rock well view if you will of the the young kid in the doctor's office and there's a relationship it's almost paternalistic between the patient and the doctor now um you know maybe it's on email maybe get to see the doctor after a few weeks um and the doctor is going to farm it out to experts and diagnosticians and and be the primary but but not the secondary and not not the expert in a given subject then and so this the issue was really whether the way the medical community is set up and increasingly so these days is really appropriate to solving complex problems about diseases we haven't figured out yet all right right um no I mean you can you can talk to people who are suffering from for instance even relatively minor cases of cancer and that they can have 200 300 medical appointments in the course of a year you know and seeing dozens and dozens and dozens of different doctors along those you know it's it's that gets that's debilitating psychologically right right this is why when I you have people with cancer they say you should always have a healthy advocate with you if somebody who can come to the appointments with you and make sense of it ask the questions that need to be asked because you're just overwhelmed by it you know fighting the disease and then trying to understand all this complex stuff that they're telling you you know do this don't do that you know yeah but you may not have a competent person who can come with you you may be relegated to the doctor and you may not you know have the kind of doctor that looks deeply into your eyes and I believe this is part of diagnosing Alzheimer's looks deeply into your eyes and sees a vacant stare and go with that vacant stare means you know it's just the I don't know what you but a few years ago my doctors when I started going for annual checkups with what at the start say I'm going to give you three words here and I'm going to ask you to remember them you know later on I mean this is this is basically a test they're looking they're wanting to see how how your memory is working are you still sharp right you know seems very sort of simplistic but it's it's a valuable diagnostic tool yeah absolutely incidentally he said what what were the three words I gave you earlier he's laughing because I never gave him three words earlier thank you Ethan Ethan Allen our corporate scientist here chief scientist we really appreciate you coming on and helping us wrestle with these these problems of all kinds thank you so much always a pleasure to be on the show with you really enjoy it aloha aloha thank you so much for watching think tech hawaii if you like what we do please like us and click the subscribe 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