Brain health and lifestyle interventions play an important role in longevity. Dr. Rudy Tanzi, Director of the Genetics and Aging Research Unit, Director of The McCance Center for Brain Health at Massachusetts General Hospital, and Kennedy Professor of Neurology at Harvard Medical School, spoke with host Meryl Comer about the latest brain health research. Dr. Tanzi explains the tools for presymptomatic detection and the importance of early diagnosis. Listen as they discuss the benefits of a healthy diet and exercise, and what he’s learned about super agers. You won’t want to miss this episode!
SHIELD - Sleep, Handle stress, Interact with others, Exercise, Learn new things, Diet
Brain health and lifestyle interventions play an important role in longevity. Dr. Rudy Tanzi, Director of the Genetics and Aging Research Unit, Director of The McCance Center for Brain Health at Massachusetts General Hospital, and Kennedy Professor of Neurology at Harvard Medical School, spoke with host Meryl Comer about the latest brain health research. Dr. Tanzi explains the tools for presymptomatic detection and the importance of early diagnosis. Listen as they discuss the benefits of a healthy diet and exercise, and what he’s learned about super agers. You won’t want to miss this episode!
SHIELD - Sleep, Handle stress, Interact with others, Exercise, Learn new things, Diet
Dr. Rudy Tanzi (00:01):
Exercise also helps remove amyloid from the brain. When you exercise such that blood flow is higher, you want to get blood moving, you want to get your heart rate up, it gets the muscles to release a hormone called irisin, I-R-I-S-I-N. That hormone gets into the brain and turns on an enzyme that eats the amyloid and gets rid of it. How do you get your muscles to release that hormone that goes into the brain that tells enzymes to eat the amyloid? Get your heart rate up, just get blood flow going and try to do it at least 20, 30 minutes a day.
Introduction (00:36):
Welcome to BrainStorm by UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24 year caregiver and Emmy Award-winning journalist and the author of the New York Times Bestseller, “Slow Dancing With a Stranger.”
Meryl Comer (00:53):
This is BrainStorm and I’m Meryl Comer. There's no one better or more enlightening to spend time with on the latest in brain health research and Alzheimer's breakthroughs than Dr. Rudy Tanzi, Director of the Genetics and Aging Research Unit, as well as Director of the McCann Center for Brain Health at Mass General Hospital. He is also the longtime Kennedy Professor of Neurology at Harvard Medical School. Welcome Rudy, and thank you for honoring our annual invitation to catch up both on the science and how you see the future.
Dr. Rudy Tanzi (01:28):
Well, it's great to see you and so good to be back for another great interview and talk. I'm sure.
Meryl Comer (01:33):
Rudy, here's a quote of yours from our last conversation. It goes, the elephant in the room is that we don't diagnose Alzheimer's disease until the brain is already deteriorated to the point of dysfunction. My question, are we doing any better?
Dr. Rudy Tanzi (01:49):
We have the tools now to do better and doing better means knowing that someone is developing the pathology of Alzheimer's in the brain but don't yet have symptoms. Or even better, they're on their way to develop Alzheimer's pathology, but are still a decade or more away from symptoms like we do for heart disease. We manage your cholesterol decades before you might have heart disease. We don't wait until you need a bypass to say, oh, now you have heart disease. We don't wait until you lose half the cells in your pancreas to say, oh, now you have diabetes. We look at your glucose levels, your insulin levels, your A1C. Alzheimer's is getting there. The tools to get to that same state are now on the cusp. In fact, some are already there for Alzheimer's. It's a matter of integration and execution.
Meryl Comer (02:37):
Is that why super ages are of such interest these days?
Dr. Rudy Tanzi (02:41):
There's two types of super ages. There are those that just seem to avoid Alzheimer's pathology as they get older. The others are resilient super ages. They may have the amyloid plaques and the tangles to the hallmarks of Alzheimer's pathology, but somehow in their brain, the nerve cells and the connections between them, the synapses are preserved. And we know that the reason for that is that they don't have inflammation. So if there's one thing you can say about a super age body-wise brain-wise is somehow they avoid inflammation.
Meryl Comer (03:12):
The latest research breakthroughs on Alzheimer's disease and dementia prevention keep updating all the time. What are the latest breakthroughs that support the critical need for early diagnosis?
Dr. Rudy Tanzi (03:24):
There's a blood test available that's approved from a company in St. Louis called C two N. And that blood test can basically tell you if you had a PET scan, if you had brain imaging, would you see amyloid in the brain? And this test can tell you whether you would based on just plasma and levels of your amyloid beta. There's also a test, a blood test to tell you whether you have tangles the other pathological hallmark. So some people might say, well, why would I want to know? I have that pathology brewing in my brain if there's nothing I can do about it. Well, we now have newly approved drugs which can remove the amyloid from the brain. They're not cheap, they're expensive, they're not without safety issues. They can cause swelling in the brain and even hemorrhage, fortunately, which is reversible. So they require monitoring the brain, but MRIs on a routine basis while you're on them, that brings the cost of those drugs up to north of 50,000 a year per patient. So they're restricted in terms of how many patients can have them. But scientifically, medically, we do have a way to get rid of amyloid. And we've now seen over the past year the first proof of concept that if you lower the amyloid, you can slow down the disease progression. I think there's an agreement now in the field that the faster you accumulate amyloid in your brain, the sooner you get Alzheimer's disease.
Meryl Comer (04:41):
So Rudy, what's the goal for optimum prevention?
Dr. Rudy Tanzi (04:45):
The goal is to know amyloid is coming and to get rid of it as soon as possible. Decades before you might have the disease. Just like we manage cholesterol to avoid heart disease. This is a controversial statement only because people will say, but wait a minute, Tanzi, how about all those clinical trials that got rid of amyloid and patients didn't get better? Well, that's like saying, hmm, how about those people who needed coronary bypasses and they took Lipitor and it didn't make them better? It's analogous. Cholesterol is to heart disease as amyloid is to Alzheimer's. It's something you detect is going to be a problem early decades before symptoms of disease and treat it. Then when you already have congestive heart failure or need a bypass, hitting cholesterol isn't enough. You wanted to do that 30 years ago. Similarly with Alzheimer's, if you already have Alzheimer's and the elephant in the room, you mentioned the brain has deteriorated to the point of dysfunction, hitting amyloid isn't enough. If you hit it early in at very, very early stages of the disease, you can get some effect. But optimally, we want affordable, safe drugs. Preferably once you can take as a pill that you can start taking decades before you might get Alzheimer's. Because Your blood test says you have amyloid or you're on your way to amyloid in your brain. Let's get rid of it now. Let's clean the slate. We're on the cusp of that early detection, early intervention process to end this disease right now.
Meryl Comer (06:07):
Rudy, there are millions of baby boomers that understandably fear Alzheimer's disease more than cancer or heart disease combined there. They're also intrigued by projections on longevity. What are the breakthroughs in measuring and improving brain health?
Dr. Rudy Tanzi (06:23):
Hitting amyloid is a good thing to do. Anytime. Anytime you can. Hitting amyloids good, just like even if you already have heart disease, you still want to keep your cholesterol down, right? You kind of like blowing out the fires that might start later on. And who knows how long you're going to live, right? So you have to ask them once things go wrong in the brain. Once the brain starts going downhill with cognitive impairment, what is really causing that damage? And I like to put it this way. The amyloid is the match. It's lit decades before the disease. The tangles as they're called, the twisted filaments of these tau tangles that start killing nerve cells are like the brush fires started by that match. The amyloid starts to tangle. The tangle spread as nerve cells die and release a tangle. That tangle can go to a healthy nerve cell and create a new tangle.
Dr. Rudy Tanzi (07:10):
They propagate just like brush fires spreading across the land. Fortunately, if you only have plaques and tangles, you don't get the disease because you don't have enough nerve cell death and synapse loss to suffer cognitive impairment. So you might ask, well then how do you get the disease? Those brush fires have to start a large forest fire, which we call neuroinflammation resilient. Super ages can have plaques and tangles, but the brain doesn't react with neuroinflammation. So they don't get the disease. If you can do one thing to try to preserve your brain and carry out brain care, it's reduced the inflammation. And luckily, we and others are now developing drugs to do that. Repurposing drugs, repurposing even natural products to do that. But you can also live your life in a certain way that minimizes inflammation in your body and brain.
Meryl Comer (08:01):
More and more adults are being diagnosed earlier with MCI or mild cognitive impairment. They also appear more disciplined in following the recommendations on good brain health and trying to preserve whatever is left. What do you say to them?
Dr. Rudy Tanzi (08:17):
We want to get people to take care of their brains with the same level of devotion as they take care of their car or their shoes. Right now we spend time taking care of our hearts, right? We exercise, we think about heart care. People need to keep the term brain care in the vocabulary every day. What is brain care? That's why I developed acronym shield, sleep, handle stress, interact with others, exercise L, learn new things like they're doing right now. Hearing us and D diet, Mediterranean diet plant-based stuff, fruits, vegetables, nuts, whole grains, seeds, things that keep your gut bacteria happy, which keeps your brain happy.
Meryl Comer (08:55):
The acronym is shield. Now Rudy, do you practice what you preach and religiously get seven to eight hours of sleep?
Dr. Rudy Tanzi (09:04):
Absolutely religiously. I do.
Meryl Comer (09:06):
Okay. I believe you. But is there a secret to how you achieve that?
Dr. Rudy Tanzi (09:11):
There is, but it's not easy. I put a heavy emphasis on eliminating internal monologue and dialogue in my mind. So a lot of the reasons why you can't get to sleep or stay asleep is the monologue and the dialogue that goes through the brain, the words, because it's a running narrative that can make you anxious or fearful. And so I spent decades <laugh> working on myself to eliminate internal dialogue and monologue. If you can't get to sleep or if you wake up in the middle of the night and can't get back to sleep, remember it's the words, it's the conversation in your head that's keeping you up. Try to extinguish it.
Meryl Comer (09:45):
So can we stay personal? How do you handle stress, which is one of your shield markers,
Dr. Rudy Tanzi (09:50):
<Laugh>. Two ways. Meditation practice and nothing fancy here, just sit down, quiet and try to sweep away the thoughts and feelings to go through the mind as gently as you can. But I think more than anything, it's replacing the word expectation with intention. So most stress comes from when what happens doesn't match the expectation. It can be that you want something and it doesn't happen. It can be that you're fearful, something might happen and it happens. So expectation versus what happens or observation. Basically the formula that determines stress level versus happiness. So I don't wanna say don't expect anything because we're human. We do expect, we expect to be happy, we expect to achieve. We expect to accomplish our goals. But expectation causes stress, especially when you don't get what you want. If you can substitute the word intention, just pure, this is what I want to happen versus this is what I expect to happen. That's a big release of stress. Even with emails. Like you write an email and you expect somebody to get back to you right away and they don't stress. Right? Social media, nobody looked at my Facebook page today, right? Don't expect put it out there and intent.
Meryl Comer (11:01):
You know much has been written about reducing the risk of dementia through exercise. Now, I used to try to hit 10,000 steps each day, which is recommended to protect your heart until a recent report revealed that's an artificial number and far less will suffice. So Rudy, when the goal is to help prevent dementia, are we talking exercise in general or specific kinds of exercise? And to what degree is it based on the individual and their age?
Dr. Rudy Tanzi (11:30):
Exercise also helps remove amyloid from the brain. But as we just published a paper this past year, we figured out the mechanism when you exercise such that blood flow is higher, you want to get blood moving, you want to get your heart rate up, your heart's pumping, blood is moving. When blood flow is up, it gets the muscles to release a hormone called irisin, I-R-I-S-I-N. That hormone gets into the brain and turns on an enzyme that eats the amyloid and gets rid of it. We showed this, we just published this past year, that whole mechanism, how do you get your muscles to release that hormone that goes into the brain that tells enzymes to eat the amyloid, get your heart rate up. So I don't care how you do it, take a walk, jog, run, get on a treadmill. I have a recumbent bike over here in my office that I get on.
Dr. Rudy Tanzi (12:17):
Just get blood flow going and try to do it at least 20, 30 minutes a day just for 20, 30 minutes a day. Make your heart beat faster than it normally does and get blood flow going and that's going to help clear amyloid. The second good thing it does is it triggers the birth of new nerve cells in the part of the brain that is most vulnerable to Alzheimer's. That part of the brain is the short term memory area called the hippocampus. Hippocampus. And Greek means seahorse because it looks like a little seahorse, that part of the brain. And that's the part of the brain where Alzheimer's begins. So with exercise, you induce a birth of new nerve cells there and you even induce the release of growth factors that help those nerve cells survive. And you're replenishing that part of the brain. So that's why exercise is so huge. But 20 to 30 minutes a day, increase your heart rate. It doesn't have to be crazy, it doesn't have to be aerobic. You don't have to go up to 120 beats per minute. If I'm normally at 58 beats, right? So 20 minutes a day, I make sure my heart rate's up to about 80. That's it.
Meryl Comer (13:16):
So what about an anti-inflammatory diet? Does it help people who are living with MCI an early Alzheimer's disease?
Dr. Rudy Tanzi (13:25):
It's not clear evidence that a good plant-based or anti-inflammatory diet slows the disease yet because again, we don't diagnose this disease until the brain is pretty far along in terms of destruction. But there are studies that suggest that a Mediterranean diet, the mind diet, which is mostly plant-based, and we can talk about why plant-based is good, can help slow down the inflammation, neuro inflammation in the brain and in studies we've done with others. A plant-based diet can also positively affect the bacteria that live in your gut, your gut microbiome in a way that the gut brain axis gets those gut bacteria to induce the clearance of amyloid in your brain. So there's these little cells in the brain like scrub your bubbles. They eat the amyloid while you sleep. Your gut microbiome, the bacteria in your gut. If they're happy and they're happy with plant-based diet, they like crunchy things. Not potato chips and candy, other crunchy things, seeds, nuts, vegetables, fruits, right? What we call prebiotics. And when they're happy, they induce metabolites that go to the brain and tell those little scrubby bubble cells to eat the amyloid just like they do at night when you sleep. So that's why the anti-inflammatory or plant-based diet is good for you. If it's crunchy but it's not full of sugar, salt, or fat, then your gut's going to like it.
Meryl Comer (14:46):
Rudy, we all have pages in our health records filled with measurements on everything except our brain. Can you describe the brain score being developed at the McCann Institute? Is it prescriptive and do you need a specialist to interpret it?
Dr. Rudy Tanzi (15:02):
No, you don't need a specialist. The brain care score was developed in the McCann Center as a way for people to use an online tool or with their doctor. Now at Mass General, every patient has the option with their doctor in their electronic health record to update their brain care score. So I remember when I was inducted into the Rhode Island Hall of Fame and Patrick Kennedy was inducted at the same time. You know, I talked a little bit about Alzheimer's when I gave my speech, and I remember him using the term, there's no checkup from the neck up. And he said, isn't it crazy that when the doctor gets above your neck, all the doctor does is look at the holes in your head, eyes, nostrils, mouth, ears. How about that? Three pounds of important jelly in your skull. Now we don't do that. So the brain care score is for a person to keep track of everything in their body that's affecting their brain care.
Dr. Rudy Tanzi (15:50):
So we ask about your blood pressure. Since you know many strokes can hurt the brain, we ask about your hemoglobin A1C because Diabetes can cause neurovascular effects on the brain. We ask about your cholesterol. Same reason we ask about your BMI, your weight versus your height. We get into your diet. How often are you having a plant-based diet? How healthy is your diet? We ask you about alcohol, smoking. How much exercise do you do to get blood flow going? How much do you sleep? We ask you about your stress level, your social relationships, and we even ask you about your thoughts about the meaning of life. And you get a score. And that score can be anywhere from zero to 21. And it's a way for you on whatever basis you want, every year, every month, whatever you want, just to say, how am I doing? And I think it also inspires you to do better by paying attention to those questions and saying, oh, they're asking me if I have more than four alcoholic drinks per week. I guess that makes me get a worse score. Maybe I'll go down to two or three.
Meryl Comer (16:44):
So this is all about motivational prompts designed to engage people to be their own best advocates with a number scale to show for it, but rooting on the research side, how will researchers correlate lifestyle with the biomarkers that are going to predict the disease? And is this where artificial intelligence can be deployed in a very constructive way?
Dr. Rudy Tanzi (17:05):
Yeah, we talk about the indicators of brain health and the brain care score asks directly about those. When you think about lifestyle interventions, obviously they're going to be related to what we ask in the brain care score, your diet level of exercise, level of stress. How much do you sleep your social interactions, do you have a reason to live? Do you have meaningful life? Are you still excited about life? Do you have passion? So in the future, you know the idea would be to do trials where you use digital devices, actigraphy, a watch, you know, or Fitbit that says how much you sleeping, how much are you moving? Something keeps track of how much you're eating or what you're eating. And then saying, how does that lifestyle correlate? So recently Dean Ornish spearheaded a lifestyle intervention trial on early stage Alzheimer's patients and we collaborated with Dean.
Dr. Rudy Tanzi (17:52):
Dean is famous as you know, for his work in heart health and care of your heart. And now he's interested in care of your brain collaborating with us at the cancer center. So we ran biomarkers for the pathology of the brain, amyloid tangles, inflammation, biomarkers in the blood. And so this lifestyle intervention trial has been completed. The paper's being prepared, now it's on my desktop to go over. And without going into too much detail, it worked. Lifestyle made a difference. It not only made a difference on cognitive ability, but it made a difference on the biomarkers in the blood that were indicative of how much amyloid and entangles and inflammation you're having in the brain. So this is the first time I'm seeing direct evidence that lifestyle can actually make a difference. I think it's going to be a very big paper. And I applaud Dean Ornish for taking it on because who better hopefully he'll do for the brain now with the help of many of us, what he's done for the heart.
Meryl Comer (18:43):
In part two of our conversation with Dr. Rudy Tanzi, we discuss advancements in both invasive and non-invasive neuro technologies. The use of AI to speed up clinical trials. And he weighs in on some of the most popular brain health supplements on the market. You won't want to miss his analysis. That's it for this edition, I'm Meryl Comer. Thank you for brainstorming with us. Our team is on a mission to help you stay up with the latest scientific breakthroughs from new therapies to technologies on early diagnosis and personal brain health advice from well-known experts using an equity lens that promotes brain health for all. Now we'd like to hear what's on your mind, what are the topics and guests you'd like to hear featured on? Brainstorm? Send your comments to BrainStorm@UsAgainstAlzheimers.org.
Speaker 2 (19:39):
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