Louisa Nicola: Why 95% of Alzheimer's cases are preventable

1. SBSteven Bartlett0:00

   We have this white powder in front of me. You've got a big smile on your face.

2. LNLouisa Nicola0:04

   I do, because I don't care who you are, you should definitely be having this. [ding] So let's talk about creatine. Phenomenal research shows you can creatine your way out of sleep deprivation. It can protect your brain against a concussion, stroke, from stress, and there was a study done on Alzheimer's disease patients, and they found that patients not only preserved their cognitive functions, but they had more energy, and they were able to exercise more. And I know this because I'm a clinician, and over the last decade I've been surrounded by the greatest neurosurgeons in the world studying the brain. And so I'm here to tackle one disease, and that is Alzheimer's, because it generally starts in our 30s, and sixty million people worldwide have Alzheimer's, seventy percent being women. And I get angry, and I get passionate because women have been lied to, they've been underrepresented, they downplay their symptoms, or they're too scared to ask their doctor for advice. And what people don't really know is that it is a preventable disease, but it's like end-stage cancer. Once you get the diagnosis, there is no cure, and the fact that so many people are at the mercy of a disease that is preventable is not okay with me, and I don't think people understand these things. Like, people don't really know that we're becoming more sedentary, which is a disease. And there was a study that was done on this that showed that if you do ten air squats every hour, this can compensate for your sedentary lifestyle. And then we have several lifestyle factors that can lower your risk of getting Alzheimer's disease, as well as showing you what five minutes a day can do for your brain performance, just using a tennis ball and an eye patch.

3. SBSteven Bartlett1:41

   [drumbeat] Guys, I've got a quick favor to ask you. We're approaching a significant subscriber milestone on this show, and roughly sixty-nine percent of you that listen and love this show haven't yet subscribed for whatever reason. If there was ever a time for you to do us a favor, if we've ever done anything for you, given you value in any way, it is simply hitting that Subscribe button. And it means so much to myself, but also to my team, 'cause when we hit these milestones, we go away as a team and celebrate. And it's the thing, the simple, free, easy thing you can do to help make this show a little bit better every single week. So that's a favor I would ask you, and, um, if you do hit the Subscribe button, I won't let you down, and we'll continue to find small ways to make this whole production better. Thank you so much for being part of this journey. It means the world, and, uh, yeah, let's do this. [upbeat music] Louisa, what is it you do, in simple terms? And I guess most importantly, why is it that you do it, and why now?

4. LNLouisa Nicola2:38

   Over the last decade, I've been studying the brain. I'm both a clinician and an academic, so I get to see the brain, and I also get to research it. And I'm really here to tackle one disease, and that is Alzheimer's disease.

5. SBSteven Bartlett2:54

   Why is this so important now?

6. LNLouisa Nicola2:57

   Right now, because sixty million people worldwide have Alzheimer's disease. That number is going to triple by the year twenty fifty. A hundred and ten million women will have Alzheimer's disease by the year twenty fifty. This is a disease that robs you of who you are, your complete identity. So we're gonna get really into this straightaway, 'cause I brought Henry with me. Right? So-

7. SBSteven Bartlett3:23

   And for anyone that can't see, Henry is a model brain that she's holding in her hands.

8. LNLouisa Nicola3:27

   This is around two pounds, and if you actually feel it and, you know, if you actually feel a real human brain, it feels like tofu, but this is everything you are. And the fact that so many people are at the mercy of a disease that is preventable is not okay with me. It doesn't sit well with me. We used to think that women were disproportionately affected by Alzheimer's disease because we lived longer, because age played a role in it. But we now have substantial evidence to show that it's not the fact that women live longer, or people in general, because dementia and Alzheimer's disease are not part of the natural brain aging process. For women, and they differ from men, and we can separate the sexes and talk about it, for women, it is purely because being a woman is a risk factor for getting this disease. Now, if we go through and we have a look at all of the people that currently have Alzheimer's disease, ninety-five percent of them could have been prevented because this is not a disease of genetics, it's a disease of lifestyle.

9. SBSteven Bartlett4:31

   Ninety-five percent of it could have been prevented?

10. LNLouisa Nicola4:33

    Correct. We're, we're born with our, with our genetic makeup, meaning that, for example, if you have a genetic mutation on chromosome four, you will get Huntington's disease. There is nothing we can do about that. That's how you were born. But when it comes to Alzheimer's disease, there's around twenty to thirty genes involved in the disease. Only around three percent of the disease cases right now were driven through those genetic mutations. The genetic mutations that you are born with, you get them from mom and dad, are presenilin one, presenilin two, and the amyloid precursor protein. So you-- if you have a genetic mutation in one of these genes, you will get some form of dementia.

11. SBSteven Bartlett5:22

    What is the age range where people will start to experience Alzheimer's?

12. LNLouisa Nicola5:25

    Let's just actually take a broad overview of what Alzheimer's disease is, okay? So you've probably heard of dementia.

13. SBSteven Bartlett5:31

    Yeah.

14. LNLouisa Nicola5:31

    So dementia is the umbrella term, so Alzheimer's disease is sits under the umbrella. It's a form of dementia.

15. SBSteven Bartlett5:38

    Yeah.

16. LNLouisa Nicola5:38

    There's frontotemporal dementia, which is what Bruce Willis has. There's dementia with Lewy bodies, there's Parkinson's dementia, there's vascular dementia. This disease, dementia or Alzheimer's disease, is a disease of midlife, and so it generally starts in our 30s. It starts in our 30s, but the first symptoms show up in our late 60s, 70s, and beyond.

17. SBSteven Bartlett6:04

    ... When you say it starts?

18. LNLouisa Nicola6:06

    Yes. Our brain fully develops at around 25 years old, 25 to 30, and after that, that's when we- if we don't take care of our brain, we start getting a decline in these functions. Now, let's go back to the brain. The brain is 87 billion neurons, around 5,000 to 10,000 connections per neuron. The-- my favorite area of the brain is the cerebellum, and the Purkinje cells inside the cerebellum have upwards of 50,000 connections per cell. So, so tightly dense, and there is so much happening, it takes 20% of the total calories that you consume every day to power this thing, and it's the most vascular-rich organ in the entire body. Over time, through things such as sleep deprivation, poor diet, lack of physical activity, environmental toxins, this slowly erodes at the functioning of the brain, and over time, this starts to compound, because that's what biology is. Everything is compounding. One night of sleep deprivation raises your risk of amyloid beta, which is one of the hallmarks of Alzheimer's disease pathology, by 4%. That's just one night of sleep deprivation. Imagine a new mother, or a shift worker, or a physician in their residency getting countless nights of sleep deprivation, day in and day out. Imagine all of that compounding, and what happens? Well, we end up with either neuronal loss, which is like the complete atrophy of certain parts of the brain, and that's what is mild cognitive impairment. Mild cognitive impairment is a pre-dementia state.

19. SBSteven Bartlett7:44

    So what is this that I have here, this photo, um,...

20. LNLouisa Nicola7:46

    So-

21. SBSteven Bartlett7:46

    of a brain?

22. LNLouisa Nicola7:47

    ... You've got the sagittal view right now of the brain, and we're looking at a healthy brain on here. As you can see, I'm gonna show it up here. On the left-hand side, you can see that the brain is thick. We can see that the integrity of the gray matter, which sits out here, is thick. It's volumous, okay? We can see that the ventricles are smaller. We go over here, and we see thinning of the cortex. You can see these big spaces between the gyri. These are thick because the gray matter has atrophied. It's shrunk. You can see that the space between the cortex itself and the skull, there's a bigger space. You can see these ventricles here, these butterfly-shaped ventricles, this is thicker. This is thinner. We can see atrophy down here. So essentially, the brain is getting smaller and smaller.

23. SBSteven Bartlett8:38

    At the age of 30, if I do everything right, and we were to sort of plot this on a graph of where I land at 70, what is the variance of where I'll end up at 70? You know, my brain is quite important to me, and I do worry. I think, fuck, like... I think I worry in part 'cause I, I, I sit and interview a lot of people at a lot of different ages, and one thing you notice as an interviewer is some people at 60 have, are razor sharp-

24. LNLouisa Nicola9:06

    Mm-hmm

25. SBSteven Bartlett9:06

    ... and some people at 60 are not as sh- razor sharp.

26. LNLouisa Nicola9:10

    Yeah.

27. SBSteven Bartlett9:11

    Their, uh, ability to articulate their words, their memory recall, their ability to understand stats and stories, all of this, and I sit here and go, "I wonder what the difference is?"

28. LNLouisa Nicola9:17

    Yeah, and that's actually beautiful because it brings up this important concept in neuroscience called cognitive reserve, and that's your brain's ability to withhold capacity to overcome stresses, okay? So you've probably heard, for example, let's use the analogy of physical performance.

29. SBSteven Bartlett9:36

    Mm-hmm.

30. LNLouisa Nicola9:36

    Your VO2 max, which is a measure of your peak respiratory fitness, you know, how well you can utilize oxygen-

Episode duration: 2:05:13