Ep 79: Rudy Tanzi – Alzheimer’s Updates and Developments; What’s New? (part 2)

In this episode of BrainStorm host Meryl Comer continues her compelling interview with "Rockstar of Science" Dr. Rudy Tanzi, the pioneering Director of the Genetics and Aging Research Unit and Director of the McCance Center for Brain Health at Mass General Hospital. Dr. Tanzi unveils the secrets of brain health and Alzheimer's research. Exploring his innovative SHIELD framework, Dr. Tanzi offers practical strategies for cognitive wellness, from sleep and stress management to diet and lifelong learning.

The episode takes an innovative turn with AI-generated questions that probe the challenges of Alzheimer's research. Dr. Tanzi provides candid insights into prevention, early intervention, and the future of medical science, sharing an unexpectedly optimistic view of combating cognitive decline. Blending scientific expertise with actionable advice, this episode is a must-listen for anyone interested in brain health, aging, and medical innovation.

Transcript

Rudy Tanzi, MD (00:00):

And so this vegan diet, what it really does is a plant-based diet is it positively affects your gut microbiome. And if you've heard the saying, healthy heart, healthy brain as true, healthy gut, healthy brain, when these bacteria in your gut are balanced the right way, they actually, believe it or not, induce the clearance of amyloid in your brain and reduce inflammation. If those bacteria are off, they can cause amyloid in the brain and cause inflammation.

Introduction (00:32):

Welcome to BrainStorm by UsAgainstAlzheimer's, a patient center, 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 (00:50):

This is BrainStorm and I'm Meryl Comer, our guest, Dr. Rudy Tanzi, Director of the Genetics and Aging Research Unit and director of the McCance Center for Brain Health at Mass General Hospital. He is also the Kennedy Professor of Neurology at Harvard. In part two, we discuss strategies for brain health, personal brain care score, how predictive AI models are revolutionizing Alzheimer's research. And we invite chat GPT to offer some of its own rapid fire questions for Dr. Tanzi. 

Meryl Comer (01:20):

Welcome Rudy. The latest edition of the Economist Magazine cites people over the age of 55 as the new problem generation that we are aging disgracefully and keeping our bad habits into retirement. So Rudy, what does that infer about? Progress on intense prevention strategies for brain health, like those promoted by Dean Ornish.

Rudy Tanzi, MD (01:50):

Dean and I did a clinical trial together in Alzheimer's that had remarkably positive results, surprisingly positive results that we can talk about. So at Mass General, I direct the McCant's Center for Brain Health and that's our goal is to teach lifestyle behavioral styles that will promote brain health. I try to encapsulate my lifestyle advice under the acronym shield, and in fact, I'll be writing a new book about this soon. SHIELD is S is for sleep seven to eight hours. Take naps if you have to. That's when you clear amyloid from your brain. It's like literally a rinse cycle for the brain to get rid of amyloid when you sleep. H is handling stress. Stress causes inflammation. Inflammation's a killer. So it's all different ways to deal with stress. Just take some time to sit down and if you can't meditate, at least just try to clear your mind and concentrate on your breathing.

Rudy Tanzi, MD (02:38):

Figure out how to deal with people who upset you, especially social media. Just bring the expectation levels down. My old friend, Deepak Chopra, who I wrote some books where said, happiness is the difference between expectation and observation. If you bring your expectation down a little bit and replace that with good intention, then whatever you observe, you're not going to be as disappointed and unhappy at. Stress. I is interaction. Staying interactive with others. It's good for the brain. The brain is an interactive organ. In fact, loneliness increases risk for Alzheimer's by twofold. If you're stressed about being lonely, E is exercise. Exercise. You know, it doesn't have to be robust. Just get your blood flow going. Your heart rate going 20 minutes a day could be a brisk walk or jump on a exercise bike. But that actually helps clear amyloid as well. We've shown how exercise and increased blood flow and heart rate goes to the brain through a very specific mechanism.

Rudy Tanzi, MD (03:27):

I won't go into here and clears amyloid from the brain. It also induces the birth of new nerve cells in the brain to replenish the neuro network. L has learned new things. That's what we're doing now. Meryl and I made this joke on your show last time. If people are learning new things, we're helping them. And if I'm putting them to sleep, we're still helping them. Learning new things means you make new synapses and making synapses is like putting money in the bank. 'cause As you get older, all these things that can go wrong in the brain we just talked about, it's the loss of the synapses, the connections between nerve cells that get you in trouble. So the more you learn things and make new connections between your a hundred billion nerve cells and try to make trillions of synapses, it's like having synaptic reserve reserves in the bank.

Rudy Tanzi, MD (04:05):

D is diet. And here's where we get to the trial we did with Dean Ornish because the trial with Dean Ornish was largely based on shield and on his book Undo It. The main thing was Dean took vegan recipes from his book and had AC company make the meals and they actually delivered 21 meals plus snacks for the Alzheimer patient and the spouse. And so this vegan diet, what it really does is a plant-based diet is it positively affects your gut microbiome. And if you've heard the saying, healthy heart, healthy brain as true, healthy gut, healthy brain, when these bacteria in your gut are balanced the right way, they actually, believe it or not, induce the clearance of amyloid in your brain and reduce inflammation. If those bacteria are off, they can cause amyloid in the brain and cause inflammation. So if you're eating a high sugar, high fat, lots of processed foods, ultra processed foods, junk foods, this is the 55 plus problem generation, you're eating a bunch of crap.

Rudy Tanzi, MD (05:06):

It's completely offsetting these bacteria that are trying to help you in your gut and it's translating into bad things for your brain. And I don't expect everybody to be vegan and I'm vegetarian, but I'm not vegan. A plant-based diet with high fiber, keeping those gut bacteria happy, makes the brain healthy. But I tell people who say I can't be vegan every once in a while, several times per week, whenever you can use a vegan diet like medicine, right? It's not like you take medicine every day, but whenever you can, even if you are eating a bunch of crap, well try to cut it down. But take some time to eat vegetables, fruits, nuts, seeds, whole grains, anything that's crunchy, that's not a potato chip or a hard candy or a french fry is good for your gut. It's good for your gut microbiome and that means it's great for your brain. D is probably the most important letter in shield

Meryl Comer (05:53):

Rudy, the brain care score that's been developed at the McCanns Institute. Is it prescriptive? Does someone need to interpret it? And what information does it provide our primary care doctors in assessing our brain health.

Rudy Tanzi, MD (06:06):

So the brain care score incorporates shield, but it also incorporates SHIELD 2.0. SHIELD 2.0 is about the things not to do and what to keep track of. How's my brain health? What's my brain health index? It asks questions about your blood pressure. It asks questions about your cholesterol, your A1C. It asks questions about your BMI and your weight. 'cause All of these things contribute to Alzheimer's diabetes and the neurovascular effects and obviously high blood pressure and the risk for stroke. That can be a risk factor for Alzheimer's disease. Are you taking care? Are you keeping track of your blood pressure and and your lipid numbers and your BMI A1C, et cetera? Then it gets into lifestyle and it talks about how much sleep you're getting. It gets into shield, it talks about meaning in life. You still have a purpose. You still connected and feeling excited about life because as we get older, I call it twinkle to wrinkle syndrome. You know when you're a kid, everything's amazing, the twinkle in the eye and you get older and then it's the wrinkles on the sides of the eyes go, yeah, yeah, yeah, been dead, done that, who cares? So you got to bring back the twinkle and get rid of the wrinkle.

Meryl Comer (07:03):

Thank you, Rudy. So now we know the tests that we have to take to our primary care doctor, but as for the data, can we collect it ourselves?

Rudy Tanzi, MD (07:12):

Well, the brain care score, you can just go online and you can take it yourself and keep track of your own numbers. And Mass General, every patient who comes in for whatever they're coming into at Mass General in Brigham offered the brain care score now and it's happening globally.

Meryl Comer (07:23):

Predictive AI models are reportedly revolutionizing Alzheimer's and brain health research as cited in Forbes AI can now achieve over 90% accuracy in detecting Alzheimer's from brain scans. So Rudy, what's your take?

Rudy Tanzi, MD (07:40):

So if AI is being applied to brain scans, yes, it's very good. If AI applied to blood-based biomarkers are be very good. I think the jury's still out on AI as a neuropsych exam tool. Like can an AI do a neuropsych exam of someone assessing their memory and cognition as well as an experienced doctor, a neurologist, a psychiatrist, psychologist? I mean, there's no doubt in terms of data. AI's amazing. In my own lab. I'll have a student come in who did 10 different experiments and shows me all the data and it's all these disparate data points. And then I have to make sense of this before the next meeting and say, I have to come up with a hypothesis and say what to do next. So I go to an AI tool, I go to perplexity.ai and I say, make a hypothesis based on these facts.

Rudy Tanzi, MD (08:23):

And I put in each data point what each experiment showed from that student or that graduate student or postdoc. And then in five seconds I say, I get the hypothesis, the references, the sources, mechanisms, and what would've taken me a weekend to go through and I can say, okay, this looks like here's the next steps we have to take. So AI is, it's indispensable now. We use it every single day for research, for clinical practice. I think we got to be a little careful. AI's great for assessing data like imaging data, but in terms of a neuropsych exam, I think we still need a doctor's eyes.

Meryl Comer (08:54):

What are we learning about AI's potential to augment one's own brain capacity or brain capital?

Rudy Tanzi, MD (09:00):

I got to admit, I use AI all the time. I don't want to put down the search tools, but my go-to is ai. I use perplexity for me as a scientist is the best because I actually get the references and it shows me the figures from the papers that it's referring to. You know, I'm screening known drugs to treat Alzheimer's in my mini human brain organoid model of Alzheimer's where we recreate what takes 30 years in a brain headed toward Alzheimer's in six weeks in a pea-sized mini brain in a dish. And I get a certain drug that somehow stops the tangles. And I'm like, why the heck would this drug is otherwise used to treat problems with urinary flow somehow affect tangles in the brain? According to my screen, I can go to perplexity and say, how would this Flomax over the counter drug? I'm just making this up. I'm not saying Flomax works, but how would this drug somehow affect the formation of neuro fibrate tangles in the brain? And it hypothesizes and it shows papers and it speculates. And what would take me a weekend worth of research? It does in 10 seconds and I can use that as my starting point. So I use it all the time. It's changed everything in research.

Meryl Comer (10:04):

Rudy, an offsite challenge with AI is that inherent sex and gender biases are built into the analysis because of the limitations of the data sourcing. So it's a case of garbage in, garbage out.

Rudy Tanzi, MD (10:17):

Oh, absolutely. There's tons of problems built in. But you know what? Like I said, it's a starting point, right? Before I tackle that problem, it's going to take me hours over the weekend or at night. It gives me a couple of pages of references and papers and references and hypotheses and logical flow of ideas that I can begin with, and it saves a lot of time and get a lot more done.

Meryl Comer (10:37):

So Rudy, I spent a weekend researching just to have a conversation with you that might inform engage, and Eric co-producer Amber Roner, went to chat GPT, put in both our profiles and asked it to come up with some Meryl Comer style questions for Dr. Tanzi. So here we go. Rudy, question number one. Let's cut through the noise. What's the one thing holding Alzheimer's research back right now? Please be brutally honest.

Rudy Tanzi, MD (11:08):

Money

Meryl Comer (11:08):

Number two, are we putting too much faith in genetics and big data? Or are we over-hyping their potential impact on Alzheimer's solutions?

Rudy Tanzi, MD (11:18):

No, genetics is the foundation of understanding this disease and big data is how you figure it out. Just need AI together with that.

Meryl Comer (11:25):

Question number three, if the pharmaceutical industry had half the urgency of the caregivers, where would we be today given

Rudy Tanzi, MD (11:33):

The urgency of caregivers? We'd be a lot farther along, but I think probably need more integration of pharmaceutical companies with academics and also smaller biotech companies where the seeds of discovery are where pharma companies can bring them to full-grown trees.

Meryl Comer (11:45):

Question number four. Rudy, you've worked on this for decades. What's the one mistake the field keeps making over and over again?

Rudy Tanzi, MD (11:54):

Pharma companies chasing after each other and copying each other. As soon as one pharma company does something, all the rest of them do the same thing. And if it's wrong, they all just jump off the cliff like lemmings. So pharma companies need to learn to think for themselves, not worry about this fear and greed thing and fomo, fear of missing out on something new. Do your own thing. Talk to more small biotech companies and academics where there new ideas and don't always think you have to do the same thing as everybody else because it just wastes time and money when everybody's doing the same thing.

Meryl Comer (12:22):

Question number five, if you could break one rule in research or policy to accelerate progress, what would it be? Greater

Rudy Tanzi, MD (12:29):

Integration of starting companies in academia and not being held back by constant perception of conflict of interest.

Meryl Comer (12:36):

Number six, are we spending too much money on breakthroughs and not enough on prevention and care?

Rudy Tanzi, MD (12:42):

Well, I would say the breakthroughs should be in prevention and care. Yes, the key to stopping Alzheimer's is not to wait for diagnosis when the brain's already deteriorated. Early detection, early intervention, in fact, early prediction, even before early detection is how we're going to stop this disease. And I mentioned before, the biggest problem is money because at the McCann Center I'm sitting on dozens of known drugs and natural products that worked on Alzheimer's pathology from my little mini Alzheimer's in a dish model. And I want to do 20 or 30 or 40 clinical trials just quick go, no go clinical trials to say, do these repurpose drugs and combinations of them work. Each trial is about two to 2.5 million. If I had $50 million right now magically from someone, I could do 2025 trials and the odds are I'm going to hit. The odds are that I'm going to find a combination of repurposed drugs and natural products that came out of our screen of our mini Alzheimer's in a dish brain organoid model. And all you got to do is have one or two hits and next thing you know, you have a safe, affordable combination drug or natural product that could be used to prevent this disease. So the only thing that holds me back from that is money.

Meryl Comer (13:44):

Number seven. Some say Alzheimer's research has been in an echo chamber for too long. What voices need to break through besides yours?

Rudy Tanzi, MD (13:53):

It's a good question. I think we need other disciplines, people, especially engineering nanotechnology. We need engineers. Best thing I ever did in my own lab is collaborating and even hiring engineers who could bring the how question to what we're doing. We've spent so much time on what to do and where to do it, but how to get it done is engineering. So I think you need more of an engineering voice in the field.

Meryl Comer (14:14):

How do you respond? This is question number eight to skeptics who think a cure will never happen in our lifetime.

Rudy Tanzi, MD (14:21):

I'm sorry you feel that way. It's going to happen. I understand why you feel that way. 'cause We've made, there have been so many mistakes made and so many fault starts and it's taken so long. But look, Alzheimer's is a tough disease. You have to realize the pathology of Alzheimer's disease in the brain is the pathology of aging. If everyone lives long enough with very few exceptions based on genetics you might take to 120 years old in some, but the Alzheimer's pathology, the match, the fires, the brush fire, the wildfire will start. It's just a matter of time. We're dealing with something that's not just a disease. It's a common part of aging and we're trying to stop it. That's not easy. That's different than treating cancer or diabetes or a very specific thing in an organ. This is actually trying to hit an aspect of aging. So we're entering a golden age right now, so people should be optimistic.

Meryl Comer (15:07):

Question number nine. What's a sacred cow in Alzheimer's research that you would happily slaughter

Rudy Tanzi, MD (15:14):

A sacred cow? I don't know of any, actually. I think some people have attacked amyloid because some of the early trials on amyloid didn't work. Most of them because amyloid is a cholesterol. Imagine if you had someone who needed a coronary bypass in the doctor said, here, just take some Lipitor. No, you had to take that 20 years ago, so you didn't get to the point of needing a coronary bypass. That's why people have called amyloid a sacred cow, but they're wrong. Amyloid triggers this disease, but you have to hit it early on to stop it, just like cholesterol and heart disease. So I don't really have a sacred cow.

Meryl Comer (15:43):

Question number 10. If you had a magic wand but could only use it to solve one part of the Alzheimer's puzzle, what would you fix?

Rudy Tanzi, MD (15:52):

Oh, that's easy. Safe, early prevention of amyloid accumulation in the brain that will stop Alzheimer's disease.

Meryl Comer (16:00):

Okay, Rudy, A final question not generated by chat GPT, but I need to know <laugh>, did you prefer my targeted questions or answering chat GPT?

Rudy Tanzi, MD (16:12):

Well, your questions were deeper, more profound, timely, contemporary, and on target with what's going on right now.

Meryl Comer (16:20):

Thank you, Rudy. Our conversations are always a real treat and top ranked by our audience. I hope you're back next year with a progress report on the field. Our guest has been Dr. Rudy Tanzi, Director of the Genetics and Aging Research Unit, and Director of the McCance Center for Brain Health at Mass General Hospital. He is also the Kennedy Professor of Neurology at Harvard. That's it for this edition. I'm Meryl Comer. Thank you for brainstorming with us. 

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Speaker 2 (17:19):

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