Podcast – Diet and Alzheimer’s Disease, ISTAART Research Perspectives

Voice Over:

Welcome to the NIHR Dementia Researcher podcast brought to you by dementiaresearcher.nihr.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society supporting Early Career Dementia Researchers across the world.

Fernando Peres:

Hey everyone. And welcome to the ISTAART Research Perspectives Podcast, a place to combine the point of view of both someone living with dementia and a researcher on the same subject. Today, we are going to talk about diet and yes, I know I should redo mine. And probably these episode will highlight this even more. Numerous studies are linking what we eat to our brain health, indicating that healthier diets may reduce our risk for dementia. How strong this evidence is, will be the focus of our conversation today. And just to remind you on our virtual couch is my co-host Clara Dominguez, a brilliant neurologist who try to force me a healthier diet.

Dr Clara Domínguez Vivero:

Greetings everyone. My name is Clara Dominguez. I work as a clinical neurologist in Spain, and I have had a personal interest in cognitive disorders since I started studying medicine. Now as a clinician, I see every day people with cognitive issues and more and more, I am seeing people with a family history of dementia that come to my clinic, quite worried about their brain health and asking what they can do now to prevent future cognitive decline.

Dr Clara Domínguez Vivero:

Diet is a key factor in prevention. So let’s talk about it. Following, we will see two complimentary perspectives on this subject. First, we will have the chance to talk with Dr. Claire McEvoy, who is a leading expert on dementia risk factors, particularly on diet and its effects on our brain health. We will discuss what are the best options, science wise, in order to prevent cognitive decline.

Dr Clara Domínguez Vivero:

And then we will look through the eyes of the upper and retired neurologist, Daniel Gibbs, who is living with Alzheimer’s. And for sure has also a lot to say about diet. So thank you so much for joining us today, Claire. I am sure our audience is eager to hear your expert opinion on the role of diet on brain health. Firstly, can you give us an overview of your research?

Dr Claire McEvoy:

So hello, Clara and thank you very much for the invitation. I’m really happy to join the podcast today. Well, so firstly, I’ve always been pretty much passionate about food and its effects on health. And I’ve been working in the field of public health nutrition for over 20 years. First, as a clinical dietician, which involved translating the most up-to-date scientific research on food, health, and disease into practical everyday advice, to help support people, to make appropriate food choices for their own health and wellbeing.

Dr Claire McEvoy:

And then as an academic nutrition scientist, and that’s where I really developed a keen interest in understanding high nutrition, particularly plant-based diets impact on cognitive impairment and dementia risk. So we’ve been learning more and more that lifestyle could influence the onset and progression of Alzheimer’s disease. And potentially 35% to 40% of dementia cases could be prevented or delayed by targeting modifiable risk factors.

Dr Claire McEvoy:

And many of these studies are showing that vascular disorders such as heart disease, as well as metabolic abnormalities, such as obesity and diabetes are linked with the pathophysiology of Alzheimer’s disease. And of course, many of these cardiometabolic risks are influenced by our diet and what we choose to eat. But actually there are very few dementia researchers studying diet.

Dr Claire McEvoy:

So in my research, I examine links between different dietary patterns, cognitive decline, and dementia risk in population studies. And I also design and test diet and lifestyle interventions in people at increased risk of dementia to see what works for what subgroup of our population in what country so that’s the overview of my current research.

Dr Clara Domínguez Vivero:

Thank you, Claire. So I imagine there are many diets that have been implicated in the progression or risk of dementia. So firstly, could you tell us more about, for example, the mind diet and what it entails, it’s history and also the evidence base for it?

Dr Claire McEvoy:

Yeah, sure. So MIND is an acronym for the Mediterranean-DASH Intervention for Neurodegenerative Delay. So it is a little bit of a mouthful, but luckily MIND is easy to remember. So this is a diet that was developed by the late Martha Clare Morris from Rush University in Chicago. And Dr. Morris and her research group combined elements from the DASH diet. And this is a diet that’s used to lower blood pressure and treat hypertension.

Dr Claire McEvoy:

And also then the Mediterranean diet, which is more of a cultural diet model, but shown to be strongly cardio protective. So it’s a mash of these two very important, healthy dietary patterns for cardio protection. And then also amend to incorporate the latest evidence on specific nutrients and foods that are shown to be important in the diet and dementia fade.

Dr Claire McEvoy:

So for example, the Mediterranean and DASH diets recommend around four daily servings of vegetables, but the observational data that we have suggests benefits of around two servings a day of vegetables for brain health, but actually the type of vegetables that people were eating are really important. So green leafy vegetables like cabbage, kale, and spinach appear to get the greatest protection against cognitive decline in dementia.

Dr Claire McEvoy:

And then another important difference in the MIND diet is for fruit intake. So Mediterranean and DASH diets recommend at least two portions of fruit per day, but fruit has not been consistently related to cognition in the evidence base. And so when the evidence was reviewed, it shows that the type of fruit is important for the brain and suggests that there are two servings of berries like strawberries and blueberries provided neuroprotection.

Dr Claire McEvoy:

So in terms of the diet itself, it has 15 components. So there are 10 recommended brand healthy components, and these are leafy green vegetables, other vegetables and berries. And then in addition to that, we’ve got whole grains, beans and pulses, nuts, olive oil, as a primary source of fat in the diet, fish, and moderate intakes of poultry and wine, if enjoyed.

Dr Claire McEvoy:

And then five unhealthy components are those that are typically high in saturated fat and refined sugars that we know are detrimental for brain health. And they’re advised to be eaten in limited amounts. And these are butter, cheese, processed meats, fried foods and confectionary. And then when we look at the evidence, it’s mostly observational data that we have at the moment, but greater adherence to the MIND diet has been associated with slower cognitive decline and around 50% reduced Alzheimer’s disease risk in the Chicago Memory and Aging Project.

Dr Claire McEvoy:

And what’s also really interesting is that people didn’t need to have perfect compliance with the diet. So even moderate compliance showed a protective effect on the risk of developing Alzheimer’s disease. And we, and others have shown the benefits of the MIND diet on cognitive performance and other population studies. Of course, correlation from observational data doesn’t necessarily mean causation.

Dr Claire McEvoy:

And we have very few clinical trials studying diet in the dementia field. However, there is a large three-year multicenter randomized controlled trial that is currently being conducted in the USA. And it’s evaluating the effect of the MIND diet on cognitive decline in a large group of older people who are cognitive risk. So we hope these findings will be published soon and be able to tell us a little bit more about how adopting the MIND diet can impact on cognitive function.

Dr Clara Domínguez Vivero:

Thank you so much. I think MIND is a really catchy name and I think the diet sounds delicious from my point of view. So I don’t think it’s a problem to follow it, but anyway, there are many other diets we hear implicated though, including some restrictive ones like the ketogenic diet. So what are diets have a good evidence base? And is there any that where maybe this evidence is lacking?

Dr Claire McEvoy:

So plant-based diets. I think plant-based diets are really important and probably will be more effective for people were cognitive impairment has not become apparent yet. So mostly for primary prevention, but there is interest in developing more targeted dietary approaches, particularly to delay the progression of cognitive decline in Alzheimer’s disease.

Dr Claire McEvoy:

And we know that the brain is a very highly metabolic organ. It uses up around 20% of our daily energy intake, preferably in the form of glucose, but glucose uptake can become impaired in the aging brain. And we see accelerated decline in glucose uptake and insulin resistance in cognitive impairment and Alzheimer’s disease. So dietary ketones and particularly beta-hydroxybutyrate can still cross the blood-brain barrier and provide an alternate source of energy for the brain and Alzheimer’s disease. And the ketogenic diet is a high fat, low carb, very low carb diet that stimulates ketone production in the body.

Dr Claire McEvoy:

So experimentally providing ketones have been shown to decrease amyloid accumulation, neuroinflammation and insulin resistance. And there are some human studies suggesting cognitive benefit of adopting a ketogenic diet or taking a ketogenic supplement, but the evidence is largely inconsistent. So for example, in a well-conducted randomized controlled trial, there was no cognitive benefit of ketone supplement in mild-to-moderate Alzheimer’s disease patients.

Dr Claire McEvoy:

But on the other hand, in older adults with mild cognitive impairment, ketone supplement, significantly improved cognitive functions in the domains of memory, executive function, and language. What we have to remember is that this is an emerging research area, the ketogenic diet studies that are performed mainly being in small samples. And these are the human studies. The trials have been off short duration and there have been variable doses of ketones which have been examined.

Dr Claire McEvoy:

So that makes it really difficult to know if ketogenic approaches can be beneficial for people, particularly those with cognitive impairment. We really need large scale interventions of sufficient duration to test these out in humans and coming from the clinical perspective that my dietary background, the diet is very restrictive. So it is difficult to adhere to in the longer term. And that could be also a problem when testing it out in research studies.

Dr Claire McEvoy:

And there are concerns about using ketogenic diets for older people. So while it can provide sufficient amount of calories, extreme carbohydrate restriction can reduce diet quality. Low carb diets are often low in B vitamins, vitamin A and important minerals such as calcium, magnesium, and iron. So following these restrictive diets could increase the risk of nutritional deficiencies for older adult and longer term effects.

Dr Claire McEvoy:

It could be things like anemia, which may not be good for brain health and then as well as low bone mineral density, higher cholesterol levels and kidney problems. So we need to be able to test these dietary strategies and also minimize the potential adverse effects when using ketogenic approaches for dementia.

Dr Clara Domínguez Vivero:

Okay. Thank you so much. Definitely, it sounds much more difficult to stick to these restrictive approaches. So as well as many foods on diets are being proposed as beneficial or detrimental, there is also many pathways proposed for why they may have such effects. For example, I’ve heard about how the benefits of diet may stem from its influence on inflammation and also cardiovascular health. Could you tell us more about why certain foods or diets are thought to be protective?

Dr Claire McEvoy:

I think we don’t know for sure, but we’re beginning to understand more about the mechanisms of high specific foods and dietary patterns affect cognitive health and really from a range of studies conducted in the lab in animals and also in humans. So we know that plant-based diets are rich in antioxidant vitamins, like vitamin A and as well as other brain-healthy nutrients, including B vitamins, selenium, folate, plant bio actives, like polyphenols and also long chain omega-3 fatty acids.

Dr Claire McEvoy:

And as mentioned earlier, fish is an important component of a brain-healthy diet. So oily fish like salmon, trout, mackerel are rich sources of omega-3 fatty acids, especially the docosahexaenoic acid or DHA for short. And this is highly abundant in the brain and important for neuronal cell function. So high DHA obtained from fish and importantly fish not from supplements has been associated with improved cognitive health and reduced risk of Alzheimer’s disease.

Dr Claire McEvoy:

So we do recommend two weekly servings of oily fish. Olive oil is another major component of a brain-healthy diet and is high in anti-inflammatory polyphenols and also really healthy monounsaturated fats. So olive oil reduces amyloid and animal models of AD and greater consumption of olive oil has been associated with protection against cognitive decline in older adults.

Dr Claire McEvoy:

And then, so those are some of the good things, but on the other hand, dietary saturated fats and refined carbohydrates like sugars are shown to be in neuroinflammatory and detrimental to neuronal cell function. So I suppose the message is that different foods and nutrients can affect inflammation, oxidative stress, blood flow to the brain as well as neuronal cell function. But of course, we don’t just eat one food or one nutrient.

Dr Claire McEvoy:

So perhaps the balance of our diet is most important. And in our studies, we find that individual food components on their own tend to have weaker associations with cognition compared to the overall dietary pattern. So the combination of foods and nutrients within our diet, like the MIND diet, for example, can act synergistically to have greater biological effects in the brain.

Dr Claire McEvoy:

So yes, diet like DASH, Mediterranean and MIND can improve our vascular function and inflammation. And they’ve been linked to also more favorable brain structures and functions that protect against cognitive decline in the aging brain. Greater adherence, I mean, the Mediterranean diet is probably the most widely studied in this field and greater adherence to the Mediterranean diet is associated with lower rates of brain atrophy, better structural connectivity, and also less amyloid accumulation.

Dr Claire McEvoy:

But again, the data hasn’t been entirely consistent. And I don’t think we can leave this conversation without mentioning the gut microbiome because there’s a lot of interest in the gut microbiome and it’s links to brain health. And as we get older, the bacterial community and our gut becomes less diverse and also pathogens that can increase, which have been implicated in the development of Alzheimer’s disease by initiating and exacerbating neuroinflammatory processes.

Dr Claire McEvoy:

So diet can really influence the composition of the gut microbiome. And there has been one European study called New Age where adoption of a Mediterranean diet was associated with more favorable gut microbiome. Microbiome profile reduced inflammatory markers and also better cognition. So we are learning that dietary patterns can work through several mechanisms to influence brain health.

Dr Claire McEvoy:

But we need to study these more comprehensively, as I said, “There’s very few intervention studies in this field and we do need intervention studies to better examine the mechanistic effect of dietary modification on cognitive outcomes to really understand the full picture.

Dr Clara Domínguez Vivero:

Yeah. The full picture seems very, very complicated, but we have great people working on it. So we have discussed the evidence base, but we now put in theory into practice in our lives can be easier said than done. So these dietary approaches can be especially hard for those who may lag their resources in terms of time or money. So do you know if there’s any research under place to help ensure that all have accessible and sustainable choices for their diets?

Dr Claire McEvoy:

Yes, completely agree. And while it is important to generate the robust evidence base of what works. It is really difficult for people in real life to change their dietary habits. And so a key challenge from a research perspective is to find effective ways to support dietary behavior change for dementia prevention. I think that’s somewhat lacking in our focus at the moment.

Dr Claire McEvoy:

However, one of the key barriers that we have found in our population is cost of a healthy diet. And that comes up pretty consistently as a barrier to adopting some of the key food components like vegetables, fish, nuts, olive oil, for example. A healthy diet, it does cost more, but it can be achieved even on a limited budget.

Dr Claire McEvoy:

And we have worked a lot with study participants to develop resources that can help with this, overcome this barrier to achieving a healthy, balanced diet. So things like frozen fruits and vegetables can be a really economical choice. Also, a practical choice because they can be easily portioned. They require little preparation and you don’t have to worry so much about the high price when items such as berries for example, are in season or how they make you perish easily before you can use them up.

Dr Claire McEvoy:

So frozen fruit and vegetables are a great choice. They’re healthy choice, and you can add an extra serving of vegetables, into soups and stews and the green leafy vegetables, and pasta dishes to really bump up the vegetable intake. Also, canned and frozen varieties of oily fish are perfectly acceptable sources of omega-3 fats. And they’re cheaper than some of the fresh fish varieties.

Dr Claire McEvoy:

So canned fish are really versatile for things like sandwich fillings, pizza toppings. We use them in salads and pasta bakes. And then some people, particularly people who are involved in [inaudible 00:22:04], they report things like dental and chewing problems, and they often find nuts difficult to eat.

Dr Claire McEvoy:

So natural nut butters like almond butter, for example, can be a very easy and acceptable way to increase the intake of natural nuts in the diet. So our studies at mid and older age have shown that it is achievable to eat a Korean healthy diet and maintain it at longer term, even if there are budget and time constraints.

Dr Claire McEvoy:

And some of the facilitators to changing that behavior in our studies were the provision of individualized dietary advice, written education, meal plans, shopping tips, recipe ideas, and all of those things can help support people to really translate the recommendations into their daily routine.

Dr Clara Domínguez Vivero:

Yeah, definitely. There are many, many options and of course a personalized consult could help. Well, Claire, thank you again for participating in this podcast. We hope this shared knowledge would help improve our dietary habits under for our present and our future. Thank you very much.

Dr Claire McEvoy:

Thank you.

Fernando Peres:

Great to have you with us Dr. Gibbs, can I call you Dan?

Dr Daniel Gibbs:

Of course.

Fernando Peres:

So Dan, could you please briefly introduce yourself?

Dr Daniel Gibbs:

Yeah. I’m a retired neurologist. I was a general neurologist in Portland, Oregon for 25 years. I also have a PhD, but that was in brain science, but I generally just saw all commerce, but I did have a lot of dementia patients while I was practicing neurology. And I really had no idea of being on the Alzheimer’s spectrum until I accidentally discovered I was a homozygote for APOE 4. I had two copies of the APOE 4 Allele.

Dr Daniel Gibbs:

Both of my parents had died in mid age from cancer. So there was no clear family history of Alzheimer’s, but that certainly got my attention. And so that was in 2012. And in retrospect, I think my first symptoms of Alzheimer’s were back in 2006. So six years earlier when I started to lose my sense of smell and began to have what are called phantosmias. They’re stereotypical olfactory, not really hallucinations, they last longer than olfactory hallucinations, but that probably was the first sign of Alzheimer’s.

Dr Daniel Gibbs:

Although I didn’t make that connection at the time at all, my diagnosis didn’t come until 2015 as part of a study at the University of California of San Francisco, where they were testing a then new tau ligand for PET scanning. And I had two days of cognitive testing and a tau-PET and an amyloid-PET that was the PET scan there. And the amyloid scan was positive showing amyloid in my prefrontal lobes precuneus.

Dr Daniel Gibbs:

And interestingly also in the piriform cortex, in the mesial orbitofrontal cortex, which are areas involved with higher processing of olfaction’s so that was cool. And we all looked at those scans and had our scientists hats on, were thinking this is pretty neat. The tau at that time in 2015, the tau-PET just showed the beginning of abnormal tau in the mesial temporal lobes, more on the left.

Dr Daniel Gibbs:

Then when those scans were repeated, three years later, the tau had spread continuously back into the posterior temporal lobes bilaterally. And there was a lot more amyloid than there had been three years earlier. So my diagnosis in 2015 was mild cognitive impairment due to Alzheimer’s pathology.

Fernando Peres:

You know Dan, I never interviewed a medical doctor or a scientist that is living with dementia. So that’s a different point of view for me. And Dan, we are talking here about diet and its influence in Alzheimer’s and dementia in general. Can you please tell us how was your diet before being diagnosed?

Dr Daniel Gibbs:

Yeah, actually fortunately was pretty good. My wife and I gave up eating beef 20 years ago, mainly for political reasons around the… Well, let’s just say that for a number of reasons, we gave it up and health was not the major one at the time, but by serendipity, that was just a very good thing to do. But we also ate pretty much a plant-based diet regularly with a little bit of pork and lamb, but mainly chicken and fish and turkey as meat sources.

Dr Daniel Gibbs:

And we ate salad every night so that really wasn’t that… It was a pretty good diet. It wasn’t your typical American T-bone steaks or hamburgers all the time. Although, I have to say that I did get my share of French fries that probably weren’t that great for me. But that changed once I found out that I had Alzheimer’s, that I started digging in with my scientist hat and seeing what was important.

Dr Daniel Gibbs:

And so in 2015, the first paper from the Rush Group on the MIND diet came out and caught my attention. And I have to say that I’ve been a pretty good, I’d say on the high side of conformity to the MIND diet ever since 2015. It’s gotten even better because my one weakness that I had a heart, that I really didn’t give up was cheese and dairy is not part of the MIND diet. And you’re only allowed I think, one serving of cheese per week, and I was violating that.

Dr Daniel Gibbs:

And then just recently I’ve developed lactose intolerance. So I’ve had to give up dairy. So that’s been great because now I’m a strict adherent to the MIND diet. And I have to say that the MIND diet for me has not been hard. A lot of the vegetables that are recommended are not ones that are on most people’s favorite vegetable list, because they tend to be bitter. But for me, I think because of my loss of smell and consequent loss of taste discrimination, I actually like things that are bitter now.

Dr Daniel Gibbs:

And so I eat kale every day and I eat it raw and cooked. And that probably is the highest, reasonable thing. At least the highest content of flavonoids, which are felt to be a strong component of why the MIND diet works. I think I’ve watered off from the question that should I think-

Fernando Peres:

No worries and why MIND diet in particular. And I was imagining here Dan, for instance, I am 30 years old now, but who is counting? And if I change my diet today towards the MIND diet, what impact do you think this would have on my life in general?

Dr Daniel Gibbs:

Okay. Well, the one message I am trying to get out to people is, that lifestyle changes really do work for reducing the risk of getting Alzheimer’s disease. And there’s really good data for all of them, but particularly for exercise and for diet, but they have to be started early. So by the time you have dementia, they don’t really add much.

Dr Daniel Gibbs:

And I wouldn’t discourage people from doing it, but for exercise in particular, in the studies that have looked at the effects of aerobic exercise and people who already have dementia really haven’t shown any benefit, but it’s the people who don’t have the dementia yet, who are still have MMCI or, and this is the key thing in your case is a family history of dementia.

Dr Daniel Gibbs:

So I would recommend that people who have first degree relative with Alzheimer’s disease or from that matter, any other neurodegenerative disease, because diet seems to be important for Parkinson’s as well. So I would recommend that at least by midlife, they should start making an effort of… They don’t have to be 100% in, but doing everything they can to reduce their risk going forward. And that includes going on a more plant-based diet and getting the aerobic exercise and getting enough sleep.

Dr Daniel Gibbs:

And of course that’s hard in midlife because we’re the busiest time of our life. We’ve got a job, we’ve got kids, we’ve got a lot on our plate, but I think it’s important for people to realize that that’s the time to really start intervening. Maybe not at 30, but I would say by 40 or 50.

Fernando Peres:

Well, but it’s good to start early, right? I think just like-

Dr Daniel Gibbs:

That’s right. It can’t hurt. Start developing that taste for kale.

Fernando Peres:

Okay. I promise, I will try. But then how easy was to shift your diet? Because while I’m giving a little bit of my perspective as well. So I tried a zillion of diets in my life. I’m only 30, but I tried a zillion and trying something new is not really hard, but sticking to it after one week or one month, that’s the hardest part. So how was for you to change some aspects of diet?

Dr Daniel Gibbs:

Well, not as hard as you might think, because, and I think this is just opinion. I can’t point to any research to support this, but the fact that I can’t smell, I have absolutely no sense of smell now. And my taste is limited to distinguishing salt, sweet, sour. I don’t think I have much umami taste left. So pretty much everything tastes the same so that’s bad in some sense, but it makes it easier to make changes in diet because I actually enjoy the bitter taste now, because I really can get it.

Dr Daniel Gibbs:

For example, with beer, I’ve really gone to high bitterness like IPAs and things like that. I much prefer to a sweeter beer because I can really taste it and on wine for example, I mean we’re allowed to have one glass of wine on the MIND diet and I don’t have to wait. I don’t waste money on expensive wine because they all taste the same to me. So as long as it doesn’t have an acid flavor, then I can still enjoy it. So I guess that’s one of the blessings of losing your sense of smell is that it’s not hard to get on a diet that it might not be as tasty as what you’re used to.

Fernando Peres:

Yeah. Well, we have another something in common. I also don’t spend a lot of money on expensive wines, but maybe not for the same reason, but I’m also drinking cheap wine. So you’re a medical doctor yourself, but I’m just wondering here, how your physician approach your diet after being diagnosed? They try to make any changes or no one talked about it?

Dr Daniel Gibbs:

Yeah, I’m really a special case in that. The beauty of being a neurologist with Alzheimer’s disease is that it allows me to step back and approach intellectually, which is a real important defense mechanism. And my interactions with my doctors has been more as colleagues rather than as a doctor-patient thing. So we come up with ideas together, but it’s not really a typical doctor-patient relationship. So I’d have to say that. I don’t think any of the neurologists that I’ve seen have mentioned diet because they know what I’m already doing and I’ve already written about it. So it’s a big thing for me.

Fernando Peres:

Yeah. So you’re always one step ahead.

Dr Daniel Gibbs:

I don’t know if I’d say that, but maybe one step ahead in two steps behind and other things.

Fernando Peres:

And this phrase of yours was amazing. The beauty of being a neurologist with Alzheimer’s. Do you think I still have time to become a neurologist?

Dr Daniel Gibbs:

Sure. Yeah. Why not?

Fernando Peres:

As I do have a family history on Alzheimer’s maybe I should.

Dr Daniel Gibbs:

Well, no, maybe you should be getting out there and doing some running if you’re not already or at least some walking and eating a better diet.

Fernando Peres:

Okay. Well, I will try, I promise you that as well. So then how the modifications in your diet affect your mood and energy throughout the day and your sleep at night?

Dr Daniel Gibbs:

I don’t know that I can say that modifications in my diet that have had a noticeable effect in any of those things, except that it’s part of the global thing of knowing that I’m doing the right thing to stave off Alzheimer’s as long as possible. I mean look, truly my first symptom of Alzheimer’s was back in 2006, I still test in the mild cognitive impairment range, even though I’ve got tau and amyloid all through my brain.

Dr Daniel Gibbs:

So I don’t have dementia yet. I’m getting there, but very, very slowly and I can’t help, but think that’s due at least in part to the diet and the exercise and sleep. I follow all these things very religiously. The thing I have the hardest time with among the recommended lifestyle changes is social engagement because for most people with Alzheimer’s disease being social becomes very difficult.

Dr Daniel Gibbs:

Part of that is a degree of apathy. That’s common with the frontal lobe damage that occurs early, but a big part of it and I’ve spoken to other people with Alzheimer’s about this is that, it becomes really difficult to follow multiple conversations. So if you’re in a social gathering, even a family dinner thing and several peoples are speaking, I can’t sort them out. And I think that’s because I think our brains tend to parse a sentence that we hear such that we don’t have to hear every word. We can fill it in by context, if we didn’t hear something, I can’t do that anymore.

Dr Daniel Gibbs:

So for example, my wife has gotten to the habit of when she starts to tell me something, she’ll repeat the first sentence or first part of it, because until I lock in on what she’s trying to say, I can’t understand it. I can no longer supply missing words by context so that’s another thing that makes social engagement fraud. And I work on that. I mean, I try to talk to neighbors.

Dr Daniel Gibbs:

Another aspect of Alzheimer’s that I’ve written about is face blindness and it’s very common in Alzheimer’s even early on. And I have it moderately severely where I can’t tell my neighbors apart sometimes. And that happened just the other day that I mixed up two neighbors who look a little bit alike, but it can be embarrassing, but oh, I’ve wandered totally off what you ever asked me. So I’ll let you get us back on track.

Fernando Peres:

And I totally relate to that. Trying to go back to the time I was caring for my grandma because diet and food in general is not just for feeding your body, but also it’s a social time for you to sit in the table, to talk to your family, to talk to your friends, to talk to your neighbors, perhaps to go out, to go to a restaurant. So it’s a social moment as well. And I saw that my grandma was facing a lot of challenges in the beginning. So she was preferring to have her meals alone.

Fernando Peres:

And then we discovered that something was going on and we tried to adopt all our family and our routine to be a better moment for her to engage with us. And then in my case, I don’t have much time to cook because of work and not just me. I am pretty sure and healthy foods are basically too expensive where I live.

Fernando Peres:

So there is a push for certain diets with oil seeds and types of fish, but that in some parts of the world can be very frustrating because of the cost impact. Do you have any advice for other families, other people that are maybe hearing us right now that want to change their diet, but with few resources?

Dr Daniel Gibbs:

Well, I think there is pretty good evidence that doesn’t have to be a problem. I’m forgetting the words for the… There are a number of places in the world where people live a long time into their hundreds. [inaudible 00:41:39] the Blue Zone, right? Thank you. And there been people that their diets have been studied and for the most part, these are not in prosperous parts of the world and whatever they’re doing, they’re doing right in terms of being a healthy diet.

Dr Daniel Gibbs:

So I don’t think it’s necessarily true that it has to be expensive. And I can’t remember all the details of the various Blue Zone diets and they’re a little bit different, but they share a lot in common even though they come from different parts of the world. So I’m sure you guys are, or somebody there is much more expert on that than I am, but I don’t buy your argument that it’s too expensive to jump on board.

Dr Daniel Gibbs:

The one thing I worried about a little bit was I do eat fish every day, which is part of the Mediterranean diet and it’s not part of the MIND diet. And I started to worry a little bit about whether I was poisoning myself from mercury. So I actually got my mercury levels checked and they’re fine. They’re not a worry at all. Because for lunch every day I have either can tuna or canned salmon on a salad or in a sandwich. And it just, I thought, Ghee, I wonder if I’m just eating too much of that stuff because of the mercury issues. But at least for me, that was not a problem.

Fernando Peres:

Yeah, you’re right. Maybe I’m too lazy. And you know what? when I was living in Dublin for a year, food there and the cost impact of having a healthier diet was so different than in Brazil, eating fish every day was a reality there rather than in Brazil, which is crazy. And now I am in the exact moment in Costa Rica, I’m very close to one of the Blue Zones and I’m planning to go there next week. [inaudible 00:43:41].

Fernando Peres:

So yeah, it’s a good timing to mention that because I will be paying attention in the diet. Let’s see what you’re eating there because I want to live a hundred as well. So then last question for you. The audience here for this podcast are primarily Early Career Researchers and well at least we expect them to be listening. So do you have any message or question for them?

Dr Daniel Gibbs:

Well, I would give them the same message that I gave you that they shouldn’t assume that Alzheimer’s only strikes the elderly because Alzheimer’s disease, if you allow me to call it that, starts 20 years before there’s any cognitive impairment. And in my view, and this is not universally held, but I think the presymptomatic stage of Alzheimer’s is going to be where we have the most success early on.

Dr Daniel Gibbs:

It’s certainly is the time when the lifestyle modifications are probably most likely to be beneficial. And my bias is that our first successful drugs for Alzheimer’s will be most effective in the presymptomatic or firstly symptomatic stage, your mild MCI. And that’s something I’m passionate about in trying to get that message across and to the young investigators, you’ll think about that.

Dr Daniel Gibbs:

You’re not invincible at 30, you may feel like it, but now’s the time to start making some changes. And if it’s only to exercise regularly, which is great, but also watching that diet and starting to look research wise at the early stages of Alzheimer’s disease and Alzheimer’s risk, which of course is a very complicated issue.

Fernando Peres:

Yeah. I completely agree because I feel so frustrated when I am talking and giving a lecture or something. And I see that society still perceives Alzheimer’s as an old people’s matter. And actually when you bring this message that it starts 20 years before any symptom. So you can see that it’s not notes… It’s people matter. So you need to be worried your entire life with your habits perhaps, and changing that to avoid being diagnosed or at least to delayed a little bit, right?

Dr Daniel Gibbs:

And I should add because I think I forgot to say this. I’m sure all your listeners should know this, but what I meant by saying that Alzheimer’s disease starts 20 years early, earlier than cognitive impairment. That means that the amyloid plaques and even neurofibrillary tangles are starting during that period, years before there’s any cognitive impairment.

Fernando Peres:

Exactly. Well, Dan, thank you so much for sharing your story and your brilliant knowledge with us.

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Brought to you by dementiaresearcher.nihr.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society supporting Early Career Dementia Researchers across the world.

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