RELAY Podcast – Nutrition, Metabolism and Dementia PIA

Voice Over:

Welcome to Season Six of the Dementia Researcher ISTAART PIA Relay Podcast. In this special series, we've invited members of ISTAART's professional interest areas to interview each other in a unique relay format. One guest becomes the next's host and the conversation keeps moving episode by episode.

ISTAART, part of the Alzheimer's Association, brings together researchers, clinicians, and professionals dedicated to understanding and treating Alzheimer's disease and other dementias.

We'll be releasing one episode each day in the lead-up to this year's Alzheimer's Association International Conference taking place in Toronto and online highlighting the vital work of ISTAART PIAs and talking hot topics in research.

Thank you for listening and we hope you enjoy the series.

Professor Natalie Phillips:

I'm Natalie Phillips and I'm a professor of psychology at Concordia University and I'm happy to be here today representing the ISTAART Professional Interest Area or PIA, on sensory health and cognition. And I serve as the current chair of the PIA.

Today I'm delighted to be talking with Professor Owen Carmichael from the Nutrition, Metabolism and Dementia PIA. Hi Owen. Can I start by asking you to introduce yourself and tell us about the PIA that you're involved in?

Professor Owen Carmichael:

Sure. My name's Owen Carmichael. I am a professor and director of biomedical imaging at the Pennington Biomedical Research Centre in Baton Rouge, Louisiana in the United States. And I am the incoming chair of the Nutrition Metabolism and Dementia Professional Interest area in ISTAART. And I'll be taking on that role at ISTAART at the end of July.

And at the current time, I am the vice chair of that professional interest area. We try to bring together researchers who have an interest in understanding the effects of metabolism, broadly construed on one's risk of dementia and also nutrition.

And the most basic question that we address in this PIA is how do the things that we eat affect our risk of developing dementia late in life? A rather simple question to state and a very, very difficult question to study actually.

Professor Natalie Phillips:

Knowing I was going to speak to you, I started thinking and asking some of my colleagues about relationships between nutrition and metabolism and sensory health, which is what I'm interested in and cognition. And of course, there's lots of relationships with olfaction and maybe a little more surprisingly with hearing and vision.

So, maybe we'll get to talk about that a little later on if we have time. But I'd like to start with you telling me about your own research. What brought you to dementia research?

Professor Owen Carmichael:

So, I started doing dementia research in 2003. I might be the first chair of this PIA who is a computer scientist by training. And I always have to do a little bit of explaining to people when they look at my CV and they see that my PhD is in robotics,-

Professor Natalie Phillips:

Yes.

Professor Owen Carmichael:

... so, there must be a story there. And the story goes like this. I got my PhD study in computer science, which while it was in a robotics department, it was essentially a computer science type of programme. And while there I studied the analysis of photographs.

So, this was very early in the internet era and, in fact, the days of having one's cell phone automatically analyse one's photographs and figure out who's in each photograph was in the distant, distant future. It was the kind of future that we were trying to build in the programme that I was studying in in my PhD.

So, I had studied those sorts of problems. How do you analyse photographs and extract information from them that is useful? And after I got my PhD, I was looking around for a postdoctoral position and probably the most critical mentor that I had during that period was a radiologist named Carolyn Meltzer, who is now at the University of Southern California.

And she said, "Well, look, if you can analyse photographs and get interesting information out of those photographs, what about images of the brain? Can you extract information from brain MRI scans especially that can be useful for various clinical purposes?"

So, can you look at a brain MRI scan, analyse it and be able to tell us whether the person shown in the picture is at a higher risk of Alzheimer's disease if they are showing ill effects from one type of activity or another. And really that was the key moment in my career.

I switched from looking at photographs for a living to looking at brain MRIs for a living. I fell into a series of studies after that that were focused on brain MRI scans as an indicator of brain health and how various behaviours would affect that brain health.

So, the Cardiovascular Health Study was one where things like how well one manages blood pressure medication and cholesterol medication and takes care of their blood sugar via various medications like metformin, how do those behaviours affect one's brain health late in the lifespan?

And I've really never stopped focusing on that question. How do our health behaviours, the things that we can control, how do those behaviours affect the trajectory of brain health as we get older?

Professor Natalie Phillips:

Wow, that is a journey.

Professor Owen Carmichael:

Yes, it was quite a journey. And people, when I go to a professional meeting for example, and we go around a conference table and people say, "Okay, introduce yourself." I generally don't say, "I'm a computer scientist," because I have to spool out the whole story I just gave you.

I generally will say I am a neuroscientist or a public health researcher or something similar to that. But it really all did start with computer science as it turns out.

Professor Natalie Phillips:

Yeah. I mean, I think the story is incredibly interesting because what your story illustrates particularly for young researchers is that your career is not always a straight line. And people are so fixated like, "Oh, I have to do this next, and I have to do that." It sounds like what you had was incredible mentorship with someone who saw that you had a skill set that was complementary to what she needed.

Professor Owen Carmichael:

Well, as I say, that was really the critical creative moment in my path through various mentors was exactly that. That someone could see in a computer scientist a tool set you could say, that had potential benefits for neuroscience and public health.

And I would say I've interacted with a fair number of people in this professional interest area, and they do come from all sorts of different trajectories. And that's one of the most interesting things that we do, for example, at meetings like AAIC, is talk to people about their professional path.

You've got people who way back when thought they were going to be registered dietitians and then didn't and became some manner of nutrition researcher or people who thought they were going to go into psychology for example and ended up getting into this effects of nutrition on the brain type of activity.

So, there are all sorts, I couldn't agree more, there's all sorts of different curved paths that lead you to where you are.

Professor Natalie Phillips:

And I think it's also to your credit that you didn't have such tunnel vision that you're like, "No, that's not what I do."

Professor Owen Carmichael:

No, this is right. And to be a little bit more sanguine, I suppose, I was incredibly lucky that it all panned out this way. I think it's natural for younger people to feel a certain amount of trepidation towards taking the big leap, but I think it's probably true in most research careers that you do need to hold your breath and take a big leap of faith at one point or another.

Professor Natalie Phillips:

Terrific advice. So, in your area or in the PIA broadly writ, what would you say are the really hot topics and exciting areas in your field of research? And I'm sure there's a bunch that you're thinking about.

Professor Owen Carmichael:

Oh yeah, there's a bunch. I think I can start with nutrition for precision health. So, in the United States, that's actually the name of a very large federally funded research project, but I think it's a general theme.

The idea that currently what doctors tend to do in the doctor's office is suggest that their patients take up a certain type of diet, and that advice does not depend on the individual. So, you've got various prepackaged diets that have been shown to be successful and they're clinically proven.

The DASH diet is one of those. The dietary approach is to stop hypertension. The various forms of the Mediterranean dietary pattern have been suggested. But doctors will generally prescribe these diets in a sense without first looking at the specific biological characteristics of the individual.

It's one thing for a doctor to look at the person's dietary preferences and say, "Well, this person doesn't like fish, olive oil, and nuts very much so maybe I won't go for the Mediterranean diet."

But I think, the concept behind nutrition for precision health is to look at the person's biological characteristics and try to understand whether the individual would absorb certain nutrients better than others in the gut, whether there's a particular deficiency in their metabolic pathways so that they need more of a particular nutrient than another in order to maintain optimal brain health.

Or I think, one example a colleague of mine is working on a study where we specifically look at individuals who carry the most widely agreed upon genetic risk factor for Alzheimer's disease, which is APOE4 genotype, the apolipoprotein E gene, and try to understand whether those individuals should go on a diet that is specific for their genotype.

I think this is the direction that is incredibly hot right now only because it's somewhat of the Wild West in a way. There seems to be broad consensus that this is a direction that we should be going in, but not broad consensus about where we ought to go.

And I think we're pretty far from that envisioned future in which someone does a 23andMe type of genotyping, and the results come back with clinically proven information about what diet they ought to pick. I think we're years away from that, but I think that is the pathway that we're trying to move towards in the field.

Professor Natalie Phillips:

So, what would a diet for someone who's APOE4 positive look like?

Professor Owen Carmichael:

Well, so let's recall that apolipoprotein E is a cholesterol transport protein, so it's intimately involved in the shuttling of lipids from one place to another. And so, one of the concepts out there is... And so that's one thing that's already known.

And we also have this broad concept out there that's out in the lay community as well, that there are so-called good fats and bad fats. That's the thing that we used to think of in the good old days is just being plain old fat with butter being essentially identical or highly similar to olive oil. And now we know that that's not necessarily the case, that they're different from each other.

So, I think, one possibility is that a diet for apolipoprotein E carriers could have differences in lipid composition.

Professor Natalie Phillips:

This is a really new area for me, nutrition as a science and metabolism and it always strikes me, at least what you hear in the popular press is an emphasis on specific micronutrients or specific constituents in food, which always strikes me as ignoring, we don't eat single micronutrients, we eat whole, full diets that are composed of recognisable fruits and vegetables.

And any thoughts on where the field is going in terms of this isolationist, you should be eating things with lots of beta carotene, or should we be eating whole foods that our grandmothers can recognise?

Professor Owen Carmichael:

So, I think you have just articulated one of the central, I would call it, it's maybe dilemma is not the right term, but one of the central tensions I think I would say in the nutrition for dementia field or the nutritional effects on the brain field are between single factor studies and dietary pattern studies.

So, on one end, as you say, you have a study of just one compound. So, for example, far, far back a long time ago we had the GEMS Study, ginkgo biloba for memory study, and that was two groups that are exactly matched to each other except one group has ginkgo biloba, the other one doesn't.

And similarly, you have vitamin E supplementation studies where you are just toggling one factor and one factor only. Those are very attractive studies for the basic scientist, especially people who study mechanisms of disease because it allows you to isolate the effects of that one compound on various pathways. And you build up scientific knowledge over time by building up a number of these isolationist studies.

However, you, I think in a sentence just articulated the problem with those studies, which is that in real life, you never, ever go through a period of time where you halt all of your consumption of all foods-

Professor Natalie Phillips:

Right.

Professor Owen Carmichael:

... except for that vitamin E supplement, right?

Professor Natalie Phillips:

Except for maybe potato chips.

Professor Owen Carmichael:

Yeah, right. And so, the question of nutrient-nutrient interactions is constantly there. Maybe the fact that vitamin E didn't help you in such-and-such a trial had to do with the fact that you ate something else along with it that nullified its effects. It's a continual problem.

And also, it's very, very difficult to get a large group of people to eat identical foods to each other except for the vitamin E in this example. So, it could be that the context of the rest of the diet is what had an effect on your outcome in that hypothetical trial.

Now, on the other hand, there are what we would call dietary pattern studies where you take people who at this moment are largely consuming what we call a Western diet. And we can articulate what that is, but it's the standard classical American-style diet, which has a lot of refined grains in it, high in carbohydrate, not very high in lean sources of protein, not very high in green leafy vegetables and so on.

And we randomise people so that half of them stay there and half of them get either a Mediterranean diet or the DASH diet or the Mind diet is a meld of those two put together and so on and so forth, Icelandic diet, so on.

And then, of course, you have the opposite problem that if the people on the DASH diet end up doing better in terms of cognitive functioning or some brain MRI indicator, the obvious question that always follows the results of those studies is, "Well, okay, why? What was the smoking gun? What exactly was it about that diet that made one group perk up and the other one not?"

And it's a fundamentally unanswerable question because what is different between the standard American diet and the Mediterranean diet is not one compound, it's hundreds of them, maybe even thousands of them. And so, I think a lot of, when we get philosophical in this part of the field, the philosophical question has to do with whether there's a way to meet in the middle.

So, for example, you can imagine only modulating a small set of compounds in the diet instead of just one or a full dietary pattern. Quite difficult to do. Not sure how we would do that. The other approach that you hear is somehow multiplexing.

Where you have, and this is incredibly hard to do as well, but maybe instead of having one group on an experimental diet like DASH diet, you have 10 groups and each of the different groups has peeled off a chunk of what we think is critical to the success of that diet.

And in some way after the fact, we're going to sift through all of the differences between all of those groups to try to get insight into what works and what doesn't.

Professor Natalie Phillips:

That's a big, yeah, that's a-

Professor Owen Carmichael:

It's a big ask.

Professor Natalie Phillips:

It's a big ask.

Professor Owen Carmichael:

It's a big ask.

Professor Natalie Phillips:

It's a big ask. So, I have to put on my sensory health and cognition hat here-

Professor Owen Carmichael:

Absolutely.

Professor Natalie Phillips:

... and in our PIA, we look at all of the senses, but the ones that we have a lot of representation around is olfaction, hearing, and vision.

And olfaction is very interesting because it's thought to be a very early potential non-cognitive biomarker of developing dementia because of the intimate relationship with the limbic system, which is where olfactory processing takes place.

Professor Owen Carmichael:

Right.

Professor Natalie Phillips:

And it is indeed individuals with olfactory loss are at higher risk for developing any one of a number of dementias. But so, what I'm interested in is to what extent do you take olfaction into account in your work? Because of course, olfaction is intimately related with taste, and taste is intimately related with nutritional intake and appetitive behaviours and interest in food. Is this something you have thought about?

Professor Owen Carmichael:

Absolutely. So, I'll tell you one of the longstanding really serious problems that's related to nutrition and ageing is unintentional weight loss late in the lifespan. Combined... Okay, I'll get to obesity later.

But it's long been recognised that there's a substantial number of older adults who lose weight over time late in the lifespan. Let's say you're 75 and you have a certain body weight that you've been bouncing around for decades, and it just starts going away.

And people who experienced... And then if you interview the person and say, "So, what are you doing with your health behaviours?" A lot of times they will not volunteer any information about starting an exercise plan, cutting out saturated fats and cholesterols from the diet, trying to be a little healthier.

They'll look at you quizzically and say, "I haven't been losing weight," when absolutely they've been losing weight. So, people who experience that unintentional weight loss, first of all, have a higher risk of developing dementia in the short term and a higher risk of early mortality.

And also, this constellation of features that we put under the guise of frailty. So, inability to physically function independently at the level that you might think via walking, picking up heavy items and so on. And if you do fitness tests or scans of the person's body, you'll find that not only are they losing fat, but they're losing muscle.

And that's the condition, the loss of muscle late in the lifespan we usually refer to as age-related sarcopenia, which is not good at all. So, there's now a concerted research effort to try to prevent this unintentional weight loss and especially the unintentional loss of muscle mass.

Unfortunately, it's a very difficult thing to study. Firstly, because there are multiple factors that might lead you to unintentionally reduce your food intake. One is cognitive, so there's a problematic association that goes in both directions between your unintentional weight loss having bad effects on the brain, which makes you not think as well.

And you not thinking as well, reducing your ability to think your way through the preparation of a meal, for example. Or on the exercise side, your brain problems reducing your ability to go around the block on a walk without getting lost.

So, it's a difficult thing to study, but I haven't said anything about sensation yet, even though it is a major player. So, it's not rocket science that if food starts to taste more bland or more uninteresting or flat because you're not smelling it anymore and smell is... I mean, you probably know this, whether the cliche is accurate of smell being some percent of your sensation of taste.

Professor Natalie Phillips:

Yeah.

Professor Owen Carmichael:

It's half of your sensation of taste or whatever it is.

Professor Natalie Phillips:

And what people do is they miss attribute. They say, "Well, food just tastes bland,"-

Professor Owen Carmichael:

Right.

Professor Natalie Phillips:

... but in many cases, it's really an olfactory loss that people don't self-report olfactory losses.

Professor Owen Carmichael:

And I think another, maybe this is saying the same thing, but people who work with an elderly individual will often state that the individual has lost interest in food,-

Professor Natalie Phillips:

Yes.

Professor Owen Carmichael:

... which is kind of more of an affective thing. It has to do with apathy, which does occur, but it maybe is not getting down to the root issue, which could be that food just doesn't taste very good anymore.

Professor Natalie Phillips:

I think of it as hedonics, what gives us pleasure. And one thing about the COVID 19 pandemic is it put olfaction on the map in terms of people thinking about what it's like to lose your sense of smell. And what people talk about is things just feel flat.

The world feels colourless, which is interesting because people use metaphors that are not olfactory metaphors.

Professor Owen Carmichael:

Right.

Professor Natalie Phillips:

But that, I think of it as hedonics and more broadly written. I'm so interested in what you're saying that the circular relationship between if you are less interested in eating well and getting nutrients in that has a knock-on effect on your cognition, but then that knock on effect on your cognition then undermines your ability to plan a healthy meal.

Professor Owen Carmichael:

That's right.

Professor Natalie Phillips:

Or more broadly when I think about the other senses, if you added a hearing loss where someone is now a little less willing to go out to the family party because it may be difficult to communicate with lots of people talking.

So, again, it's this embodied, holistic, these hedonic experiences that are, I think can undermine an older adult's ability to engage in the activities that they used to get a lot of value out of in a lot [inaudible 00:27:00]-

Professor Owen Carmichael:

Oh, I think that's right. And I also think that the rituals of eating involve all of the senses, right? So, I can vividly conjure up the sound of bacon sizzling on the stove. And similarly, if you go to a barbecue, the sizzling of the meat, it's a cue.

And so even here, I mean obviously olfaction and taste, they're going to have direct impacts on your sensation of eating, but even your anticipation of eating is going to be affected by all the senses.

So, Pennington Biomedical is first and foremost an obesity research centre so we spend a lot of time talking about the obesogenic environment or the food environment where we're surrounded by visual cues via advertisement for eating all the time.

So, I can even imagine if an older adult can no longer read the billboards out the window of the car that they're riding in, it's almost like an out of sight, out of mind phenomenon where there used to be this pulse of information about food, food, food as you go through your day. And if that goes away, I have to wonder if we're just not, we don't have food on the brain the way we used to.

Professor Natalie Phillips:

Yeah. And we're really not designing environments for older adults in mind, right? And I get really frustrated when I go to a restaurant and they hand me; I have to scan the menu with a QR code. I get really annoyed. Oh my gosh. Okay. We're going to have a lot to talk about when we're in Toronto at the upcoming AAIC meeting.

So, tell me a bit, actually on that topic, what does your PIA have planned for the AAIC meeting coming up in Toronto, which is in late July this year, and will you be presenting?

Professor Owen Carmichael:

So, PIA Day, we have our big event. So, what we try to do during our session at PIA day, which is the day before the start of the classical scientific sessions of AAIC, we have an hour in which we try to take nutrition and metabolism research that is going to be presented in poster form at AAIC at the main meeting and try to highlight it more.

So that's one of our goals. And also take publications that have come out over the past year that are really excellent and have to do with nutrition and dementia and highlight them as well. And it's really, it's just a simple arithmetic argument that the number of posters available for you to look at AAIC is large.

And the ability, I mean, if you've been to AAIC, Natalie, you know that there's just no way that you're going to be able to sift through all of them and see all the excellent science that's going on, so we just try to point people in the direction of the best nutrition and metabolism related posters and talks.

And also, it's not anything controversial to say that there's a lot of papers out there. That so many things are being published all the time, that it's very easy to lose track of all the best papers that come out on that topic. So, we try to really zero in on those with an emphasis on junior investigators to try to give them the exposure that they need to succeed.

Professor Natalie Phillips:

That's great, giving those junior researchers a leg up and seeing that they have a community,-

Professor Owen Carmichael:

That's right.

Professor Natalie Phillips:

... which I think is one thing that the PIA is really does for us researchers. How does the work of the PIA support your area of research?

Professor Owen Carmichael:

I am very interested in lifespan effects. So, I was very fortunate to gain access to an epidemiological study called the Bogalusa Heart Study, which has been following the same individuals since childhood.

Most of them were enrolled in the study around age eight, nine, 10 years old, and now those individuals are in their 60s, with every other year measurements of various metabolic factors including blood sugar, cardiovascular factors like blood pressure and so on.

And so, I'm very interested in trying to do the best that I can to get around one of the central problems in this nutrition area, which is that we've been eating our entire lives.

So, my colleagues who are in drug development have a difficult job of having to develop a new drug, and that's fine, but testing the drug, in my view, is relatively an easy thing because you can be fairly certain that all of the individuals you enrol in your clinical trial of a new drug have zero prior exposure to that drug.

Professor Natalie Phillips:

Right.

Professor Owen Carmichael:

Meanwhile, if I am doing a study of the Mediterranean diet, then perhaps the people who are in the study who are entering the study now eat a Western diet, but maybe at some point in their lives they did eat a lot of olive oil or they went through a fish phase, or they ate a lot of nuts for a period of time and then stopped. You're never going to know the degree to which those prior exposures impact what's happening to you now.

So, I'm very interested in how the events that take place during adolescence and childhood shape brain health decades later-

Professor Natalie Phillips:

Yikes.

Professor Owen Carmichael:

... with one of the concepts being, let's say that we go through and adiposity is a great one.

So, if I unfortunately gain excess fat in say my 20s, and then I get it together and I get on an exercise plan and I fix up my diet and I lose the excess fat and I'm back to a normal weight, do my risks later on go back to normal? A couple years after that, let's say 20 years later, from my body's point of view, is it like I never gained the weight in the first place?

So, with the initial answer being unfortunately, maybe not. So, our initial data from the Bogalusa Heart Study suggests that, for example, children who had relatively high blood sugar went on to have poorer looking brains in their 50s, regardless of what happened to their blood sugar in the interim.

But that's what I'm very interested in, in terms of metabolism especially is lifespan effects. And to what extent, I mean, we really don't like the nightmare scenario that the things that happen to us as children put us on railroad tracks to Alzheimer's disease.

I really don't think that's true. But the extreme on the other side doesn't seem very satisfying either that we can sit on the couch and eat junk food until age 60 and then do a bunch of push-ups. And it's as though we never had any time on the couch with the junk food.

So, I'm trying to analyse that and understand what the mechanisms might be behind lasting effects of prior exposures.

Professor Natalie Phillips:

I remember hearing Jill Livingston present when they present these really impressive analyses of the Lancet Commission on modifiable risk factors for dementia. And of course, she always gets to the question of, "Well, when does this matter? When do we have to modify?" And she says, "Well, it's never too early and it's never too late."

Professor Owen Carmichael:

Correct.

Professor Natalie Phillips:

But it strikes me, and I had this impression from looking at your website that at least one of your studies, maybe it was the Bogalusa cohort, is with African American communities. And I'm just interested in general, how important is it to have diverse representative samples and what are some of the challenges there as well?

Professor Owen Carmichael:

Yeah, so I think one of the emerging bits of wisdom that's come out in various guises over the past couple of decades is that there isn't one... I'll stick to Alzheimer's disease to keep it, conversation a little simpler.

There isn't one Alzheimer's disease that spools out in a biologically identical way across individuals. You can have individuals that develop, for example, amyloid plaques at a certain rate, and neurofibrillary tangles develop far after that, and cognitive effects build up far after that.

And there's very little effect on the vascular system of the brain, okay? That's fine. And we used to think that everyone who got Alzheimer's disease was well described by that. It's absolutely not true.

There are people that have actually relatively low amyloid burden and a whole lot of vascular problems, and they very quickly get neurofibrillary tangles. And they very quickly get cognitive decline and all possible combinations of those being fast, slow, present, absent, and so on.

And it turns out that we don't know why there's such diversity in the development of these various biological processes, but we do know that in certain, what we know about certain underrepresented communities, such as African Americans, is that there's a great deal of diversity in disease effects in those populations.

So, in a sense, you could say, first of all, we haven't studied African Americans very much at all, period. Another thing you can say is that what we do know about African Americans is that Alzheimer's disease appears to play out biologically in a different fashion than it does in white people.

So, I think, there's a really urgent need to just simply understand what the disease is doing in African American adults and why it appears to be playing out differently.

We know that there's, again, going back to our isolating one factor that is different between groups, in African Americans, there's many, many different factors that differ at a population level between them and corresponding whites, including access to education, access to healthcare, exposure to environmental toxins.

There's a whole pile of different factors that differ between African Americans and corresponding white people at a population level.

Professor Natalie Phillips:

At the population level.

Professor Owen Carmichael:

At the population level, right. And then within the African American community, there is diversity as well in terms of some individuals having very low exposure to those and some having high.

So, the first step is to try to overcome some of the things that have happened in the past in terms of under representation. So, we as medical researchers have done all sorts of different things to lose the trust of the African American community. Rebuilding that trust is a long and difficult effort.

So, in Baton Rouge, we happen to be about a five-hour drive from Tuskegee, Alabama,-

Professor Natalie Phillips:

Oh, okay.

Professor Owen Carmichael:

... which is, yeah.

Professor Natalie Phillips:

Maybe for our audience to say [inaudible 00:39:19]-

Professor Owen Carmichael:

Yeah, so scientists often hear the word Tuskegee, and they say, "Oh yeah." But for people out there in the world, it was the site of one of the most egregious acts of research malpractice that ever occurred in which a group of the Tuskegee Airmen, African American Airmen were given, enrolled in a research experiment in which they were inoculated with a disease and not told about it.

So, they did not provide their informed consent. They weren't told what was going to happen. It's now one of the textbook examples of research malpractice, and it caused a great deal of harm. And that story rippled out throughout the South where we live.

Professor Natalie Phillips:

And amazingly, not as far in the past as any of us would like to think.

Professor Owen Carmichael:

It's true. We're not talking about the Civil War; we're talking about something that happened far after that. So, rebuilding that trust is just going to be a long running effort.

Professor Natalie Phillips:

Yeah. Wow, Owen, I mean, this has been really interesting. So, I can't thank you enough for talking with me today, and unfortunately, it's time to end today's podcast.

Okay, Owen, well, before we go, I do have one final question, and for... I'm interested in whether you have any advice, one single piece of advice for any new, young researcher attending AAIC for the first time, or who might be interested in getting involved in your PIA, what would you say?

Professor Owen Carmichael:

My number one piece of advice is to make a plan beforehand, because the AAIC app is actually excellent in terms of searching for content that is of interest to you in making it possible to put on a schedule in the app, because it's very easy to feel like you are not seeing it all, you're not going to see it all.

But if you come in with a plan beforehand about what sessions you're interested in, you maximise your odds of getting as much content that's relevant to you.

Professor Natalie Phillips:

Okay. That's great. Great. So, Owen, I have to thank you for this really great discussion. You've really highlighted the complexity and the challenges and the incredible importance of nutrition and metabolism for brain health in older adults, and indeed for all of us. So, I have to say thank you to you, Owen Carmichael, for taking the time to join us today.

Professor Owen Carmichael:

Happy to be here.

Professor Natalie Phillips:

So, to everyone out there, thank you for listening. You can find profiles on myself and our brilliant guest, Owen Carmichael, and information on how to become involved in ISTAART on our website at dementiaresearcher.nihr.ac.uk, and also at the Alzheimer's ISTAART link. And there's a link in the show notes that you'll see.

So, I'm Natalie Phillips, and you've been listening to the Relay Podcast from Dementia Researcher and the Alzheimer's Association. Hit subscribe on YouTube or in your favourite podcast app to ensure you don't miss an episode. So, thank you. Bye, Owen.

Professor Owen Carmichael:

Bye.

Voice Over:

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