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0:32

Welcome to The Referral. I'm Dr. Karan,

0:35

your friendly neighborhood NHS surgeon, and

0:37

this podcast is your weekly pit

0:39

stop where we cover various aspects

0:41

of your health. We talk about how to improve your

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your gut health, your sleep, your dental health,

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absolutely terrifies me. I've seen

1:02

a lot of stuff in hospital

1:02

and this still frightens the life

1:05

out of me. It's dementia and

1:07

Alzheimer's. There are millions and millions

1:09

of

1:09

people all over the world who live

1:12

with dementia and with Alzheimer's, but

1:14

there's also a significant proportion of those people

1:17

who don't have a diagnosis. If someone

1:19

has Alzheimer's, it is a scary, aggressive,

1:22

inevitable decline into neurodegeneration,

1:26

but there is some hope. There are

1:28

new drugs out there which could potentially

1:30

turn the tide against Alzheimer's. To

1:32

get some evidence-based strategies into how

1:35

we can improve our brain health, but also

1:37

talking about Alzheimer's and dementia and

1:39

future perspectives, I am talking to Dr.

1:42

Ema McSweeney, who is a consultant

1:44

neuroradiologist and she's a global

1:47

authority and expert on Alzheimer's.

1:49

We've had two pandemics in

1:51

my living memory. One is Alzheimer's

1:54

and one is COVID. It's the importance

1:56

of presenting or identifying

1:58

these symptoms when they're very mild.

1:59

mild. Without question, what

2:02

goes on in the guard is

2:04

hugely influencing the brain and

2:07

vice versa. A bit later, I'll be answering

2:09

your questions in

2:10

crowd science. Now remember, if you've got

2:12

a question that you want featured on this podcast,

2:15

feel free to get in touch at thereferralpod.com.

2:18

And if you're interested in even more deep dives

2:20

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2:23

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2:25

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2:27

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2:29

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and hit the try free button to begin

2:34

your free trial today.

2:38

So Dr. Ima McSweeney, Alzheimer's,

2:41

dementia, these things terrify

2:44

me. Tell me a little bit about

2:46

why you're here and what you do.

2:48

So I'm founder and CEO

2:50

of Recognition Health, which

2:52

is a UK and US company, which

2:55

is specifically designed to

2:58

manage conditions of the brain and mind.

3:01

So provide early accurate diagnosis

3:04

and treatment. And there's a number

3:06

of different areas for children and for

3:08

adults, neurodevelopmental, traumatic brain

3:10

injury, and progressive neurodegenerative diseases.

3:13

But as I know today, we're focusing on Alzheimer's

3:15

disease. And we treat patients with

3:18

Alzheimer's disease, not only with

3:21

clinical practice, but also the opportunity

3:24

for those individuals to come into clinical trials,

3:27

where they get new diagnostic techniques

3:29

to accurately diagnose their

3:31

condition and new treatments designed

3:34

to try to slow further progression of

3:36

this disease and effectively in

3:38

so doing change people's future

3:40

because yes, it is a frightening disease today.

3:43

A lot of people seem to think dementia

3:47

equals Alzheimer's, which isn't the case. What

3:49

does Alzheimer's mean to you

3:52

on a biological sense?

3:54

So Alzheimer's disease

3:57

is a condition which is defined

3:59

by its biomarkers, it

4:02

means that an individual has developed abnormally

4:05

elevated levels of toxic amyloid

4:07

protein and tau protein

4:09

in their brain, and those toxic

4:12

proteins are destroying their cognitive

4:14

brain cells. Furthermore,

4:17

this disease is progressive,

4:19

and as these proteins destroy more

4:21

and more brain cells, the individual

4:23

develops the symptoms

4:26

of dementia.

4:27

Dementra is just an umbrella term,

4:29

like headache or abdominal

4:31

pain or something. Now, what

4:34

is important is that as we all

4:36

grow older, and age is the biggest risk factor

4:38

for Alzheimer's disease, Alzheimer's

4:40

disease is actually by far and away

4:42

the most common cause of

4:45

memory problems and other related

4:48

cognitive symptoms. Now, lots

4:50

of surveys have demonstrated that about 80% of people in

4:53

the general public do recognize short-term

4:56

memory loss as a presenting and

4:58

prominent feature of Alzheimer's disease.

5:00

But actually, there's lots of other

5:03

symptoms as well, so difficulty with calculation,

5:06

using more generic words instead of specific

5:09

words, so saying the thingy

5:11

or just shrinking

5:13

of one's vocabulary. And in addition

5:15

to that, it's things like repeating oneself, it's

5:18

getting lost in a familiar environment,

5:21

and all of these symptoms, of which there are many

5:23

more, decision-making, etc.,

5:25

they all present very gradually. And

5:28

in the early stages, it's not possible to say

5:31

just by talking to somebody,

5:33

it's not possible to determine that the problem

5:35

that they have or the disease that they have

5:38

is Alzheimer's disease. So,

5:40

my

5:40

question is, what can we

5:42

do apart from, you know, you've

5:45

said obviously memory loss is a

5:47

potential symptom of Alzheimer's,

5:49

but memory loss could be a symptom of a number

5:52

of things, traumatic brain injury and all sorts.

5:54

So, in a person who is in their

5:57

30s and 40s and maybe even 20s when the

6:00

biological process of toxic

6:02

protein accumulation could occur, assuming

6:04

they have got an adequate sleep, an adequate

6:07

diet, and an adequate exercise, they

6:09

may still develop Alzheimer's, despite

6:12

all of those things being optimized. How can a person

6:14

in their 30s, who knows that it's

6:16

developing decades before their 60s, how

6:19

do they know that they're going to get Alzheimer's?

6:21

Okay, so I think that's

6:23

one of the imponderables in so much

6:25

is that the biggest risk factor

6:28

for Alzheimer's for the general population

6:30

is age. It's the passage

6:33

of time. And unfortunately, currently,

6:37

we don't really understand

6:39

the whole aging process very

6:42

well. Now, there is a huge amount

6:45

of scientific work going on currently,

6:48

which is essentially around the science of longevity.

6:51

And this is looking at proteins, it's

6:53

looking at enzymes, it is

6:55

looking at other sort of like, you know, potential

6:58

genetic factors as well. But

7:01

right now today, and I think it is

7:03

important that people don't become hypervigilant

7:06

and sort of like obsessed with, oh my

7:08

goodness, have I had just like one memory lapse?

7:10

The thing is that, you know, age is the biggest risk factor.

7:14

And if you're in your 30s or

7:16

40s, and 50s, really,

7:19

the most important thing is to maintain

7:22

as best you can a healthy lifestyle. And

7:25

as we've said, of those, it's really

7:27

cutting down on sugar, because that's the one thing

7:29

the brain really doesn't like, optimizing

7:32

all the other healthy foods that we know about. And

7:35

then sleep

7:37

and exercise are probably

7:39

the biggest ones. When

7:39

you say cutting down on sugar, I mean,

7:41

obviously, glucose is part

7:44

of a healthy diet, since the brain thrives

7:48

on glucose as its primary fuel

7:50

source, rather than anything else.

7:53

When you say sugar, would

7:55

you be sort of more

7:58

suggesting ultra processed food?

7:59

which are sort of highly

8:02

manufactured rather than whole foods,

8:04

you know, because an apple obviously

8:07

contains lots of sugar, but also it's

8:10

rich in prebiotics and fibers and is antioxidant

8:13

rich, which naturally would suspect you'd be

8:15

good for the

8:16

brain. Yeah. So it

8:18

is difficult and obviously, you know, it's moderation

8:21

in all things, and particularly, you know, in

8:23

one's like 20s, 30s, 40s. The

8:26

real problem is that the brain processes

8:30

refined sugars very

8:33

poorly.

8:34

And in fact, even

8:36

fruits,

8:37

if you mush up fruits and you put them

8:39

in a fruit juice, so you mush them

8:41

all up in the, you know, in the liquidizer and you

8:43

drink it as pure fruit, then actually

8:45

there's lots of fructose in that. And that's not

8:48

actually that good for you. You're much better to

8:50

eat fruits as the fruit themselves,

8:53

because they have other things in them that help

8:55

with the process

8:58

of the sugar metabolism. But

9:00

generally, it's cakes, it's sweets,

9:02

it's bread, it's, you know, pastas, all these

9:05

things that do have a lot of refined sugar in them.

9:07

I'm not sure I could live a life without pasta

9:09

and bread. Yeah. I mean, obviously,

9:12

it's, you know, it's just being sort of like sensible,

9:15

but

9:17

it is something that actually most people who do

9:19

cut down on refined sugars

9:22

do actually, if

9:23

you ask them, they will

9:25

report that they actually do feel much

9:28

smarter alert, sort of just

9:30

feel better. Yeah. But

9:33

it is complex. And it obviously, it's

9:35

not just like one thing. And unfortunately,

9:38

our addiction to sugar

9:41

is a problem. And it's sugar is

9:43

incredibly addictive. Yeah, I mean,

9:45

I think the role of diet and sort of brain

9:48

health, you could argue, we're still learning

9:50

more about it, but also in our current state

9:52

of society where we've got, you know, hyper-calorific,

9:55

hyper-palatable foods at the touch of a button from

9:58

an app, that's probably significant. different

10:00

to what it was 40 years ago where we'd have to

10:03

make our own food from scratch and eat more

10:05

whole food. Now when I started

10:08

as a first year doctor, I started

10:10

on a geriatric ward from the elderly care ward

10:13

and

10:14

you know I want to say probably around 10% of

10:16

those patients on a 40 bed

10:19

ward

10:20

probably had some form

10:22

of cognitive impairment and

10:24

or a formal diagnosis of

10:26

dementia whether it was vascular dementia Parkinson's

10:29

or Alzheimer's dementia and I noticed

10:32

a lot of the medication

10:35

we were giving them were just medication

10:38

to treat the symptoms and

10:40

even now just for the

10:42

average person with dementia and cognitive

10:45

symptoms it's symptomatic treatment

10:48

but obviously now we've heard in the news

10:50

more of these stories about these lacanumab,

10:53

donanumab, all of these drugs which can

10:56

change the course of the disease and potentially

10:58

reverse the buildup of these toxic

11:01

protein buildup and these plaques

11:04

but the worry I have

11:06

about the sensationalist stories we

11:08

have are cure for Alzheimer's if

11:10

you look into the research of it it

11:13

seems to only work in early

11:15

stage disease and even then the clinical

11:18

translatability seems to be only a very

11:20

modest change in cognitive

11:22

scores so are

11:24

we just at the tip of the iceberg of these

11:27

novel medications and how effective

11:30

can they be going forwards in reversing

11:33

Alzheimer's and actually curing Alzheimer's

11:34

and dementia?

11:35

So interestingly one

11:37

of the comments that a lot of people in

11:40

this sort of like sharp end of the research with these drugs

11:42

is saying at the minute is that right

11:45

now we're at the end of the beginning

11:47

of the development of these types of medications

11:51

so the symptomatic medications on the market

11:53

today are literally just

11:55

trying to just get a

11:57

little bit more energy out of these dying

11:59

brain cells.

11:59

more life out of whatever is done.

12:01

But it's not changing

12:04

the course of the disease. Now the

12:06

new medications, and there is

12:08

actually an array of new meds, I mean there's really a

12:10

bandwidth of new medications now, and it is, you

12:12

know, the science of this is extremely interesting, but

12:15

the ones you mentioned quite correctly, the Lacanumab

12:17

and the Denanumab, that have really hit

12:20

the sort of like news headlines this

12:22

year and sort of like a little bit last year, the

12:25

way those drugs work is

12:28

they actually have the same or very similar

12:30

mechanisms of action. What they do is they

12:32

get into the brain and

12:35

they remove this

12:38

toxic accumulation of amyloid protein

12:40

from the brain. Now if

12:42

you can remove that amyloid protein

12:45

from the brain, you protect

12:47

the brain cells from further destruction.

12:50

Now obviously there is a process whereby

12:52

the original disease is due to the fact that we're overproducing

12:55

this amyloid protein, we can't clear it quickly enough,

12:57

but if we can get something in that can help to

12:59

clear it, then that is going to

13:02

ideally, that will slow down further

13:04

progression of disease. And the exciting thing about

13:06

these new drugs is they have now been demonstrated

13:08

to do that. But the other

13:11

part of this story

13:12

is that with any medication,

13:15

as most medications are designed to do,

13:18

if the purpose of the medication is to

13:20

slow down further progression of

13:22

disease and symptoms,

13:24

then by definition you have to give it

13:27

as early as possible, particularly

13:29

where you have a disease where brain

13:31

cells are being killed and they can't regenerate.

13:35

So yes, you're 100% correct, it has

13:37

been demonstrated particularly in this recent study

13:39

with Denanumab, what it did show

13:42

was that when they took the overall

13:45

group or overall cohort of people

13:47

who had either very mild, mild

13:49

cognitive impairment or mild AD

13:52

dementia, that means their symptoms have progressed a little

13:54

bit further,

13:54

when they took the whole group together,

13:57

they found that they could slow by about 35%

14:00

the rate

14:02

of progression of disease and symptoms. But

14:04

when they took the people with the mildest

14:07

symptoms, they slowed down the rate of progression

14:09

by 60%, which is actually very

14:12

significant if you're slowing, if something's very mild

14:14

and you're slowing it by 60%, but also

14:17

about 50% of those people

14:19

had no change at

14:20

all after one year. What does that

14:22

mean in clinical terms? So if there's someone who's

14:25

got Alzheimer's dementia and those cognitive

14:27

symptoms in terms of the impact

14:29

on their quality of life, what does those percentages

14:32

actually mean? Because often the percentages

14:34

sound impressive in a study

14:36

in terms of, okay, 50%,

14:39

35%, but actually in terms of their cognitive improvement

14:42

in score, what does that mean?

14:44

So it depends,

14:46

and I know this is going to frustrate you when I say this, but

14:49

it depends where you are on

14:52

the

14:53

cognitive decline graph,

14:55

basically. So today,

14:58

if somebody has Alzheimer's and

15:01

they say, how am I going to be like

15:04

this time next year, or slightly

15:07

easier, like how am I going to be in six months time?

15:10

Obviously, no one knows 100%, but

15:13

the best way to answer that is the

15:16

rate of progression gradually

15:18

increases. So how you've been over the last

15:20

six months is the best deter –

15:23

or how you've changed over the last six months is the

15:25

best determinant of how you're going to change over

15:27

the next six months. And then you have to build

15:29

into that, that it is going to accelerate.

15:32

So if somebody really has quite advanced symptoms,

15:35

you would probably say how you've been over the last month is

15:38

going to determine how you've been over the next month. So

15:40

for people who have very mild symptoms, you

15:43

could say, well, how you've been over the last year

15:45

is going to determine how you're going to be over the next

15:47

year. But actually, that's

15:49

where if you're taking this mild

15:52

group, what they found was

15:54

that 50% of those patients hadn't changed at all in

15:57

a year. So it is

15:59

all

16:01

biased to where you

16:03

are in your rate of progression

16:05

of disease at that time. So it's the

16:08

importance of presenting or

16:10

identifying these symptoms when they're very mild.

16:13

Now,

16:14

it is also the case that in

16:16

these studies, people who have

16:18

advanced symptoms of Alzheimer's disease, which

16:21

we can go into this, which

16:23

are then categorized as

16:25

coming under the umbrella of dementia,

16:29

at that point, these

16:31

medications basically won't work

16:34

because the disease has already

16:36

progressed too far. And that's where symptomatic

16:38

medications will always still

16:40

be helpful.

16:47

Why were medieval priests

16:49

so worried that women were going to seduce men

16:51

with fish that they'd kept in their pants? Who

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was the first gay activist?

16:57

And what on earth does the expression sneezing

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in the cabbage mean? I'll tell you,

17:01

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17:03

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18:30

Will Barron, MPH.

18:33

So,

18:34

you know, in terms of screening for

18:36

Alzheimer's, you know, typically,

18:38

I mean, what would your screening test be?

18:40

I mean, MRIs to pick up someone with Alzheimer's,

18:43

the plaques and all of these things in their

18:45

brain tissue. Why couldn't

18:48

we then, you know,

18:49

for someone who's got a strong family history

18:51

or presenting with symptoms, is there

18:53

a role to have national screening

18:56

for Alzheimer's similar to breast cancer screening,

18:59

aneurysm screening, colonoscopies? Is

19:01

there a role for, you know, yearly

19:03

or, you know, some period of brain

19:05

scans? So

19:08

the ultimate answer to that

19:10

is yes, because

19:12

this disease is no different from any other

19:14

disease. So in the same ways we screen for

19:16

cancer or anything else. And

19:20

actually, if I can digress for a second,

19:23

we and other groups around

19:25

the world are currently

19:27

and in fact starting a big study

19:30

in early 2024 for

19:33

people who are, as much of any

19:35

of us are, cognitively normal.

19:38

And these individuals,

19:40

obviously, they'll be age 60 and over, but these

19:42

individuals will be screened

19:45

to see if they have the positive biomarkers.

19:47

Essentially, they'll be screened to see if they have amyloid

19:50

protein in the brain, tau protein in the brain, and

19:52

other biomarkers that we are aware

19:55

of. And the purpose of those

19:58

studies is for people to actually

19:59

gain early access to these

20:02

same types of medications if

20:04

they do have elevated proteins in

20:06

the brain and thereby

20:09

reduce those proteins and

20:11

push out or ideally prevent

20:13

a time that those individuals will ever

20:15

develop Alzheimer's disease and well

20:17

Alzheimer's symptoms. Okay, so

20:20

really the same as diabetes.

20:21

Asymptomatic but some positive

20:23

marker and to prevent the onset of

20:25

symptoms full stop. Exactly right. So exactly the same

20:27

way as we do for, you know,

20:29

we measure blood tests for

20:31

prostate cancer or we screen for

20:34

bowel cancer or we screen for

20:36

diabetes. Any of these things

20:39

Alzheimer's is no different from any other

20:41

disease and we now have identified

20:43

biomarkers that can tell

20:46

us

20:46

if the disease

20:48

is present even though there are no symptoms.

20:52

Now for people with moderate advanced

20:54

existing dementia without scope

20:57

of ever having these medication in their lifetime,

21:00

in addition to symptomatic medication

21:02

therapy like we discussed, Denepazil etc. Is

21:05

there any role and what is the role

21:08

of psychotherapy,

21:11

play therapy and other forms of

21:13

non-medication therapy

21:16

alongside, you know, their family supporting

21:18

them physically? Do

21:21

those have roles to play

21:23

in, you know, offsetting

21:25

the loss of cognitive reserve and slowing

21:28

down brain degeneration in some way?

21:31

So it's difficult. There are a number of

21:33

different things which, you know,

21:35

like

21:36

it's important for

21:39

family and friends and loved ones to

21:41

be aware of and to try to

21:43

do, to optimise

21:45

an individual's brain function and I can sort of

21:47

like run through those. But will

21:50

they like

21:51

actually slow

21:54

down the death of the brain cells? No.

21:57

But cognition is a...

21:59

Cognition is a sort of like a tricky

22:02

thing in so much as that

22:05

even at a very simple level, the

22:08

more one is worried and anxious

22:11

about one's cognition, actually

22:13

the more it will affect the everyday

22:19

cognition that individual experiences.

22:21

So the sort of like extreme form of this is, if

22:24

you're doing something that's really frightening, like you're going up

22:26

on the stage or something, you'll suddenly forget all your lines

22:28

and that's just anxiety that

22:29

has made your memory, if you like,

22:32

worse. Now in terms

22:34

of sensible things that it's important to

22:37

do for any family member or any individual

22:39

who

22:40

notices that they have cognitive symptoms,

22:43

so the first one is obviously healthy lifestyle

22:46

and not to be underestimated, like exercise and things like

22:48

that actually do make people feel better. The

22:51

next one obviously is try and get into a clinical

22:53

trial because that has got a chance of changing the

22:55

future and that is really really important

22:57

because that is actually the only thing that's going to make a

22:59

significant difference, hopefully. The

23:02

next thing really is keeping

23:04

your brain really active

23:05

and that

23:08

is socializing

23:10

and doing all of the things that you would normally

23:13

do and very often people do

23:15

become anxious, they do become self-conscious

23:18

and that's totally understandable. But

23:20

this disease is a pandemic and

23:24

I think that actually being

23:26

more relaxed about it and sharing

23:29

maybe the diagnosis with some sort of like close

23:31

friends and family so that people do understand

23:33

and they can help with things

23:36

like you know just avoiding

23:38

having

23:39

somebody in a really noisy

23:41

room where they can't distinguish one person

23:43

talking to them from other people. So maybe

23:46

at a family dinner make sure they're

23:48

sitting such that they're in more of a one-to-one conversation

23:52

than lots of noise in different conversations.

23:57

I would also say making sure that all

23:59

of the things that can also affect cognition like B12,

24:02

low B12, low folate,

24:04

maybe being a bit anemic, maybe blood sugar

24:06

being too high, you know, all of these things,

24:08

thyroid function, there's lots of different

24:11

things that also affect cognition that do

24:13

need to be reversed and optimised. I

24:15

mean, I feel that obviously there's

24:17

one aspect of the physical degradation

24:20

of the brain that you see in dementia

24:22

from the accumulation of these proteins, but

24:25

also there's that emotional psychological

24:27

aspect and increased risk of depression, anxiety

24:29

that we see. And there's

24:32

a, interestingly in Japan,

24:34

there's a restaurant, the restaurant of mistakes

24:36

where essentially most of the staff

24:39

there are people,

24:39

elderly members of society

24:41

who suffer with dementia and Alzheimer's. And,

24:44

you know, if you order something in that restaurant, they

24:46

will make a mistake and you'll get the wrong item.

24:48

If you ordered, you know, the miso

24:51

soup, you might get a salmon nigiri.

24:54

And I think that's part of the charm is that they

24:56

reintegrate these people with dementia

24:58

who otherwise would have been socially isolated

25:01

into community and into society

25:03

again. And arguably that will improve

25:05

their mental health and whether on

25:08

a cellular level that may or may

25:10

not change

25:10

the course of their disease, but it

25:13

might improve the quality of their remaining

25:15

life. A hundred, a hundred percent.

25:18

And actually reducing anxiety

25:20

is so important

25:22

because a lot of a lot of individuals get

25:24

anxiety separate from,

25:26

and in addition to being

25:29

anxious about, you know, particularly being

25:31

in a, in a social setting and

25:35

decreasing the

25:37

level of anxiety and actually educating

25:40

the family and close

25:42

friends about what the individual

25:44

is experiencing is incredibly

25:47

helpful. I mean, I've, I've done presentations to schools

25:50

to explain to, you know, like, to

25:52

like six formers and that that, you

25:55

know, cause they've all got elderly relatives,

25:57

et cetera. It's like understanding what this is.

25:59

understanding it's just a condition

26:02

like any other disease, and

26:04

understanding the types of

26:06

challenges that individuals

26:09

with Alzheimer's will be facing.

26:11

Because very often, unlike vascular

26:14

disease, they will not completely,

26:17

you know, they'll be physically completely fit and well. And

26:20

also not to forget that, you

26:22

know, this isn't just a disease

26:24

that's affecting people in their, you know, like late 70s

26:27

and 80s. And we have lots of individuals

26:29

are

26:29

recognition health clinics who are in their 50s.

26:33

Early onset dementia? Yeah,

26:35

I mean, it's sort of called early onset, but I mean, essentially,

26:38

it's just they are younger when the disease

26:40

hits.

26:42

And it is important, particularly almost like

26:44

the sort of like young you are, the more important

26:46

it is to present as early as possible.

26:49

One, because you want to find out have you got something

26:51

that's reversible and quickly reverse it.

26:53

And secondly, if it is something that is progressive,

26:56

the earlier you can get to, you know,

26:58

one of these new types of treatments, the

27:00

better your chances of slowing this down.

27:03

So

27:04

I've also read of, you know, nowadays

27:07

in the last decade, I want to say, or maybe even slightly

27:09

longer, without increasing understanding

27:11

of, you know, the microbiome everywhere

27:14

in the body, not just the gut and the skin, you

27:16

know, its connection with the brain, the gut

27:18

brain microbiota axis, as it were.

27:21

Yeah.

27:22

Is there a role in the future

27:24

that you see for manipulating the microbiome

27:27

to manipulate the state of play

27:29

in the brain, whether it's, you

27:31

know, changing the microbiome, so you change

27:33

the inflammatory proteins and chemicals

27:36

in the brain, which then may cause

27:38

a downstream effect to improving

27:40

brain health? Is that something conceivably

27:43

we can see in the future?

27:44

Yeah, 100%. Yeah. I

27:46

mean, I think there's sort of like simple example that most

27:48

people are aware of is irritable bowel syndrome,

27:51

which is, which is a brain condition, if you like.

27:53

Yeah. And yes,

27:55

I mean, the brain got

27:57

access is tremendous.

27:59

Injously important. I

28:02

mean already people are doing work

28:04

with autism as you mentioned Whether

28:06

doing fecal transplants with really quite

28:09

stunning results so

28:12

Without question what goes

28:15

on in the gut? Is

28:17

hugely influencing the brain and

28:19

vice versa and at

28:21

a sort of like a chemical level Much

28:25

of it sort of comes down to in inflammation

28:27

basically neuro and gut inflammation

28:29

Well as you as you touched on I mean often

28:32

we do prescribe antidepressants for

28:34

patients with irritable bowel and they see a

28:36

recession of their symptoms

28:37

Yeah, and even

28:39

though you'd like lots of people with irritable bowel

28:42

say well, hang on a minute. I'm I'm not

28:44

depressed Yeah, it's sort of like

28:46

no, it's not that it's not that we actually

28:48

necessarily think you are depressed it's that the

28:51

chemicals in the brain that are coding

28:53

for the Changes

28:55

in your bowel are sort of like

28:58

need to be if they are corrected then your

29:00

bowel will go back to Behaving normally

29:03

the antidepressant is acting on your gut

29:05

brain. Yeah. Yeah, so we are

29:07

sort of yeah It's incredibly

29:09

closely linked. Do you apart

29:12

from the standard things which would be part

29:14

of a normal diet b12? iodine

29:17

Various things which some you know omega-3

29:19

which could support general health but also brain

29:22

health are there Have you seen because

29:24

as you mentioned previously on as when we're talking?

29:27

There's a growing explosion of people

29:29

obsessed with longevity and anti-aging

29:31

and that's also come with lots of pseudo scientific

29:34

Notions about what we can supplement

29:36

and what we can do to increase our lifespan Is

29:39

there any evidence that any

29:41

of these any supplements out

29:43

there? Is there anything available

29:45

right now that someone could buy which is actually hang

29:47

on that's actually probably pretty good

29:49

for your brain health It's difficult because

29:52

you know, there are a lot of let's call them

29:54

sort of like pseudo scientific or like

29:57

non scientific And I think it is really important to be

29:59

sort of like super

29:59

be careful about these things. And

30:03

just to say, I'm not sponsored or anything by these people,

30:06

but there is a product called

30:08

Souvenade, which

30:11

it's almost like a half food, a half drug,

30:14

if you like. It's in a special category.

30:17

That has been shown without question

30:20

to really sort of

30:23

positively influence brain synapses.

30:26

What does it contain chemically? So it's basically

30:29

lots of different fish oils. I mean,

30:31

that's its main constituent. Fish oils,

30:33

yeah. Yeah. So that is a product that

30:36

you can buy all the components of it, but you'd have

30:38

a big bag of stuff.

30:42

I think there's an increased amount

30:44

of evidence for things like zine, magnesium,

30:46

and all these things. But

30:47

to be honest, most people do have

30:50

most of those things in their diet. Yeah. But

30:56

is there evidence

30:58

now scientifically that

31:01

there's no reason why we shouldn't all live healthily till we're,

31:03

let's say at the minute, they're talking about like 120. Yeah.

31:06

Yeah. I mean, there's lots of evidence that

31:08

that should be the case. And it is really

31:10

just a case of understanding what

31:13

are the things that are going on chemically

31:17

in the body. Again, sort of like at a protein or

31:19

enzyme level that is causing

31:21

us to age. It's almost like the normal

31:24

process would be not to age. And it's

31:26

like something goes wrong that makes us age

31:28

almost. So

31:30

it's not my area of expertise, but I

31:34

can say that there

31:36

is a lot of research going on in that. And

31:38

it's going on mainly because, for

31:40

example, with skin, it's going on for people that have serious

31:44

burns and grafts and things. It's going on

31:46

for people who have

31:48

illnesses and conditions that they are trying

31:50

to slow down or reverse. So it's

31:54

not so much for what

31:56

would be the word, I

31:59

know, just for fun.

31:59

I mean, it's actually to treat

32:02

diseases at the minute. But

32:05

yes, I'm sure it is possible.

32:09

One of the most important

32:11

things I try to do on

32:14

this podcast is debunk misinformation.

32:17

And I've got a couple of common

32:19

Alzheimer's dementia myths that always

32:22

rear their head. We can sort of tackle

32:24

them. So we touched on this briefly, but

32:26

one of the common myths which I see propagated

32:29

everywhere is that dementia is

32:31

all the same.

32:32

Okay, that is not true.

32:34

Yeah. As we said, dementia

32:37

is an umbrella term, a bit like

32:39

headache. There are lots of causes

32:41

of dementia. So Parkinson's disease,

32:45

chronic traumatic encephalopathy, which the sports injury

32:47

patients get, Huntington's

32:50

disease, Lewy body disease,

32:52

frontotemporal dementia. CJD. CJD,

32:55

Alzheimer's disease just happens to be

32:58

the most common cause

33:00

of dementia as we

33:03

age. And they're quite

33:03

wildly different as well. The treatment options

33:06

for Parkinson's is completely

33:08

different to Alzheimer's dementia. So that is

33:10

definitely a myth. Yeah. Another

33:12

one is that, and this is actually

33:15

for a lot of people, maybe quite shocking, losing

33:17

memory and confusion, people

33:20

are told, is a normal part of aging.

33:22

Not correct.

33:24

So the simple example of

33:27

that is you can see two 80 year

33:29

olds sitting having a conversation. One

33:32

doesn't know how they got into the room. The

33:34

other has just been doing the crossword and

33:36

is sharp, bright, having a completely

33:39

normal conversation. It is

33:41

not true. Yeah, so it's maybe right

33:43

to say you might be less mentally

33:46

agile at the age of 90 versus 20, but

33:49

probably quite chronic severe memory

33:52

loss, confusion is

33:53

abnormal. Yeah. So

33:56

if you are experiencing those symptoms, you

33:58

need to get urgently probably checked out. Yeah,

34:00

that's abnormal. What some people

34:02

often sort of confuse as well is, it's

34:05

sort of like concentration and cognitive

34:08

performance. So like we all know if we're on holiday or something,

34:10

you know, it may not be sort of like completely concentrating or someone's talking

34:12

to you about something, you're not interested, you're not really concentrating.

34:15

That is totally different from not being

34:17

able to recall things, forgetting details of

34:19

conversations, repeating yourself unknowingly,

34:22

all of these different things, not being able

34:24

to make decisions. That is

34:26

abnormal. The problem that we have

34:28

is it's a bit like, I don't

34:30

know, cataracts or arthritis in

34:33

that cataracts and arthritis are very

34:35

common

34:36

as we get older, but

34:39

they're not normal. And it's exactly

34:41

the same. Alzheimer's disease is

34:43

very common. It's a pandemic, but

34:47

it's not normal. So we've had

34:49

two pandemics

34:51

in my living memory. One is Alzheimer's

34:53

and one is COVID. So, you

34:56

know, that's how common it is.

34:58

Yeah. Well, Ima, thank you so

35:00

much for coming on here and being

35:03

a voice of expertise and providing some

35:05

science on brain health and Alzheimer's, which,

35:07

as I said, you know, I'm terrified about, but I'm

35:10

glad there is some, you know, optimistic

35:12

tunnel where we're getting these novel drugs. So thank

35:14

you again for coming on. Thank you. So

35:17

Ima, before I let you go, you've got a question

35:19

for me far away.

35:20

Okay. Here's

35:22

the mystery to me is, given

35:25

the amount of press and media

35:28

attention to Alzheimer's

35:30

disease, and particularly

35:33

in connection with the new medications

35:35

that are all over the news in terms

35:37

of

35:38

providing hope now and enabling

35:40

us to be cautiously optimistic about new

35:42

treatments for Alzheimer's, why

35:45

is it that so many people still

35:48

don't really understand that

35:50

this is a condition and that they need

35:52

to be alerted to sort of like presenting early?

35:54

That's

35:55

a good question. I think there is some

35:58

discordance between

35:59

what people see and read, and

36:02

then what they digest, process and understand,

36:05

and how they can act on it. So I've

36:07

made videos about Lecanumab

36:10

when it first came out, explaining without

36:12

being sensationalist that it is a breakthrough

36:14

because anything in Alzheimer's which is positive

36:16

is a breakthrough no matter how small it is. So it's fantastic

36:19

to see this after decades of virtually nothing,

36:22

but also with a caveat that this is

36:24

the beginning of lots more

36:26

research. Those

36:29

videos across Facebook, Instagram, TikTok

36:31

garnered millions of views. There are millions of people

36:34

watching these videos and learning

36:36

about Lecanumab. But

36:38

then I find as often

36:41

you see with cancer medications that are breakthroughs,

36:44

the hype dies down because the media

36:46

also don't keep talking about it. So we

36:48

need people to keep talking

36:51

about it. I've

36:53

worked with you previously on getting

36:55

the message out there, on bringing people to

36:58

these trials, raising awareness about

37:00

these things. And I think it's a constant stream

37:03

of information about that and people

37:05

slowly migrating towards that.

37:08

So I think there is huge scope for social media

37:10

to be almost like a siphoning

37:13

platform to then make people

37:15

aware of trials, whether

37:17

it's cancer or chronic conditions like Alzheimer's,

37:21

but also just understanding the conditions, the symptoms

37:23

so they can present, self present early

37:25

if they notice symptoms. So there

37:27

is great potential there. I still think it's being significantly

37:30

underused.

37:30

Yeah. And because

37:33

I think this is also a major

37:35

problem currently with chronic traumatic encephalopathy.

37:38

And it's a disease a little bit like Alzheimer's

37:40

disease, which is due to the development

37:43

of abnormal tau protein in

37:45

the brain, which the sports players

37:49

are developing as a result of contact

37:51

sports. And to

37:53

me, it's extraordinary that it's

37:56

almost like the biggest denial ever.

37:58

It is.

37:59

Because, you know, we can go into a lot of the politics

38:02

about sports and money, but that's why,

38:04

you know, I've got this podcast

38:06

and I've got experts like yourself to come on and

38:09

hopefully, you know, the sort of millions

38:11

of people watching this will gain

38:13

something from that. And even if it's, you

38:15

know, 100 people who go away from

38:17

listening to this podcast and go and get checked out, that's

38:20

a win. Yep.

38:21

Thank

38:24

you. Thank you.

38:29

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39:32

And don't worry, I've not forgotten, we've got one

39:34

listener question for Crowd Science. This

39:36

week, it's Rachel from Southwest London.

39:39

Rachel said, I have very sensitive

39:41

toenails. If I ever go for a pedicure,

39:43

it's excruciatingly painful rather

39:46

than pleasurable.

39:47

All of my toenails are thicker than my friends

39:50

and have some ridges and bumps on them as well.

39:53

Do you know what this might be? Now Rachel,

39:55

that is a very interesting question and I'm sure

39:57

a lot of people might have a similar

39:59

thing to you.

39:59

to you as well and listen carefully. So

40:02

it's very difficult for me to just

40:04

judge based on your brief introduction

40:07

to your condition to tell you what it is

40:09

exactly, but there are certain conditions

40:11

which may cause a thickening of the toenail.

40:13

For example, you can get a

40:16

fungal infection of the toenail called onychomycosis,

40:19

which can result in the toenail being slightly

40:21

more painful or sensitive, especially when it's moved,

40:24

and it can also be slightly thickened as well. Now,

40:26

the pain you experience when you're moving your toenail,

40:28

again, it could be a number of things, from

40:31

an ingrown toenail to an infection

40:33

of the skin around the toenail. So if

40:36

you are experiencing some pain and thickening

40:38

and some of the signs you've mentioned, it's probably

40:40

worth seeing a podiatrist or at

40:42

least seeing your GP so they'll be able

40:44

to physically look at your toenail and

40:46

examine and figure out what the actual

40:49

cause is. Great question, Rachel. And

40:51

in this week's Crowd Science Extra, I'll

40:53

also be answering this question from Yasmin

40:55

from Leicester. She asks about apple

40:57

cider vinegar and

40:59

why it causes stomach upsets, especially

41:01

on an empty stomach. If you wanna listen to that,

41:04

make sure you subscribe to Crowd Science Extra

41:06

where you can listen to my full explanation on

41:08

that and various other inbox questions. And

41:11

don't forget, if you've got a question you desperately

41:13

want me to answer, you can get in touch at

41:15

thereferralpod.com.

41:18

Okay, guys, thank you for listening to this

41:20

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41:22

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41:24

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41:27

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41:29

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41:31

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41:36

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