Future-Proof Your Brain from Dementia & The Lifestyle Levers That Keep You Sharp with Neuroscientist Dr. Tommy Wood

The best way to minimize your risk of dementia is not see at home by yourself

joking supplements. It's going to be much more about. Dr. Tommy Wood is a UK

trained physician. His research focuses on brain health across the lifespan. How

things like exercise affect dementia? If some proportion of dementia is

preventable then we must be able to change the trajectory of cognitive

function and cognitive decline. What is driving this and what else should I be

focused on or thinking about? How we use our brains is the primary

determinants of how they will function. Low HDO cholesterol, high

triglycerides, high blood sugar, or high blood pressure. These are all

significant risk factors for dementia and they are effects of

Tommy so nice to meet you. I am thrilled to have you here. I think your work is

vitally important. It touches me personally because I have to mention my family

and it's been a very difficult past couple of years. I've been witness to

just how devastating the diseases of dementia, Alzheimer's, etc.

You know, have on not just the individual who's victimized by it but also

the families, etc. And then the basically inhumane way in which

modern healthcare kind of like manages this right now. And so I think your book and your message

is one that you know I'm proud to help amplify here and to get into with you today. So thank you.

Thanks so much for having me and I appreciate that and I'm looking forward to talking with you about it.

Cool. Is it true that the adult brain is destined for an inevitable decline? Yes or no?

How did you arrive at this conclusion and how do we how do you support that conclusion?

Some proportion of dementia are probably preventable. If we think about adult cognitive decline

with you know a terminal decline to the point where you're no longer able to look after yourself

on a day-to-day basis which we would call dementia. If some proportion of dementia is

preventable then we must be able to change the trajectory of cognitive function and cognitive decline

in adults. Is this a controversial position to take in neuroscience or in neurology?

Not anymore. Potentially 10 years ago it would have been but if you look at probably the

best supported evidence out there formalized as part of the Lancet Commission on Dementia Prevention

spearheaded by Professor Jill Livingston it's now in its second iteration that was updated in 2024

where global experts in neurology and neuroscience and the science of dementia and the factors

that contribute to dementia risk come together and estimate which risk factors are strongly sort of

will be think we can causally link them to dementia risk long-term that are potentially

modifiable and they estimate that when you sum up all those different risk factors it's a sort

of a statistical approach that says imagine that this risk factor didn't exist at all what

proportion of dementia would we expect to never happen and when you add all those up the number

they currently have is 45% of dementia's are potentially preventable and this is published in

the Lancet you know the one of the premier medical journals in the world so at least 45%

are thought to be preventable and there are risk factors that are strongly linked to dementia risk

are also modifiable that they weren't yet able to add into their models that you know some people

think it could even be more than that potentially the majority of dementia's may be preventable.

In certain respects from a non scientific point of view like a very basic you know perspective on

this whole thing issues of cognitive decline are on some level a function of a circulatory problem

much like heart disease right these amyloid plaques etc. they can deposit it in your brain are

are you know caused at least in part by lifestyle choices that produce them right so why did it take

until 10 years ago to you know come to this conclusion. That's a great question potentially the

treatment of heart disease and we've got much better at treating heart disease in the last 50-60 years

that has then changed the age specific incidence of dementia in the population and what I mean by

that is that at any given age you are now less likely to be diagnosed with dementia than you were 20 or

30 years ago so at 70 years old or 80 years old you're less likely to be diagnosed with dementia now

than you would have been done previously and part of that is thought to to be because we've

gotten so good at treating cardiovascular disease which is a risk factor both for vascular

dementia which makes up something like 10 to 20 percent of dementia and Alzheimer's disease

which has a vascular disease component so and that's you know Alzheimer's disease is maybe 60 to 80

percent of dementia so at least 70 to 90 percent of dementia do you have cardiovascular risk factors

as a risk and that's something that we've actually gotten better at treating but even if you go

back to the the 50s and 60s the Seattle longitudinal study it was one of the first studies where

rather than taking a whole population and looking at their cognitive function and seeing well

the you know the average 70-year-old has lower cognitive function than the average 50-year-old

and we're talking broad cognitive function if you test multiple different multiple different

functions you sort of add them up this was one of the first studies where rather than just taking

a big population and looking at cognitive function across that group they looked at the same people

over a long period of time and so he brought people back every seven years and re-measured

their cognitive function and what he found first one one of the papers they published was that

cardiovascular risk factors were strong predictors of change over time so we knew that back in the

you know 60s and 70s when he first published those data and then the other thing they found was that

the average effect so more than 50 percent of people maintained cognitive function from their 50s

into their 60s 70s and 80s nowadays we call people who do that super ages right because we think

it's so unusual but actually we knew even back then that the the majority of people sort of 50 60

percent maintained cognitive function into those later decades and those data were actually used

to raise the retirement age in the U.S. in the 1980s so we've had some inklings of this for a long

time it's just that getting a big enough set of data finding a systematized way to really sort

of put it together in and then frame it as prevention rather than these are just risk factors right

that and knowing that we if we treat heart disease for example and as a result a specific

instance of dementia comes down which is what is sort of like part of the hypothesis of that

then for the first time we can say oh yeah if we do something at the population level

we can see changes in dementia risk therefore we can now start to talk about prevention

the statistics bear out a rapid rise in Alzheimer's and dementia I looked into this from what I

gather the it's due to double in the U.S. by 2060 going from seven to 14 million there are currently

somewhere between 6.7 and 7.1 million people in the United States with Alzheimer's this is

predicted to be 139 million worldwide by 2050 there are 10 million new cases annually my

perception is that you know maybe it's just my age or because of what's happening with my mother

that you know this is rampant and happening everywhere so what is driving this and what should

we understand like what you know what's what's vital to extract from those statistics about

this condition the statistics that you give and the ones that I gave are both true at the same

time meaning there's a high there's a high degree of agency in terms of prevention and yet we're

also seeing this you know rapid rise well at the same time and the age-specific incidents has

declined over the last 100 years right so you're less likely to be diagnosed with dementia at 75

years old now than you ever have been but you're also more likely to have to ever be diagnosed with

dementia because we're going to live much longer yeah both of those things are true at the same time

people are projecting that the burn of dementia may double or triple in the next few decades

and that's larger due to an aging population but some people such as those who have analyzed the

data and shown that age-specific incidents has decreased have suggested that maybe that

that sort of projection is a bit of an overestimate and that the increase in burden may not be that

large however things that seem to be contributing to it in particular are the ongoing worsening

metabolic and cardiovascular health of the population so we're still seeing even though many

things have improved smoking heart disease treatment access to education access to complex

cognitive-estimulating jobs particularly for women which has which has sort of massively improved

over the last 100 or 50 years or so that is contributing to some of that decline in age-specific

incidents at the same time we're seeing worsening in obesity rates and type 2 diabetes rates and

we know that those are significant high blood pressure is one of the most important

predictors of dementia risk so if we don't manage to change that trajectory that's one of those

are one of the things that are expected to continue to drive up the burden of dementia however

we say that in the age of the GLP1 receptor agonist and the other therapies in that in that class

which have huge effects on cardiovascular disease risk blood pressure blood sugar so it's

possible that actually we're we're also changing that trajectory due to the nature of those medications

which if started early enough you would expect to decrease dementia risk because of the effect they

have on metabolic health given the high degree of agency that we have to stave this off

let's get into how we can be brain protective and brain health promoting and what I like about

your approach and your work is that it's grounded in in in the basics you know I think when we

you know cast our gaze on the internet there's a lot of fancy due dads and you know latest breakthroughs

in supplements etc you know which is which is a lot of cherry on top of the Sunday kind of stuff

we're very dialed in on the connection between things like nutrition exercise lifestyle choices

recovery etc when it comes to our physical health and we've gotten a lot better about how we

consider our mental and emotional health but we really don't think about this thing between our ears

and the fact that these decisions that we're making every single day actually impact like how well

this is functioning so what is your kind of top line thesis on how to enter this aspect of the

conversation one place to kind of transition from what we were talking about to to this place is to

think about some of the the risk factors that we know are in that list of your modifiable risk

factors for dementia that were included in the Lancet Commission report so it's things like

education and we know that cognitive stimulus is really important it's maintaining

sensory input so hearing loss and and vision loss are significant risk factors for dementia

it's all the cardiovascular stuff that we talked about high blood pressure diabetes

smoking alcohol air pollution obesity a head trauma is another one and when we think about that

we can very rapidly create this massive list of things that we need to think about other things

that weren't included in that in that report but which I think we have strong strong enough

evidence for to talk about in terms of prevention include nutritional status and the certain

nutrients we know are critical for the brain sleep we know is a critical component and so the way

that I think about it and it's probably largely because I spent a lot of my time working with athletes

and you know being an athlete myself I actually I draw lots of parallels between physical performance

and cognitive performance and and long-term cognitive function because essentially the

principles seem to be very similar and many of the things that you would do to improve physical

health or mental well-being our physical performance they actually translate very nicely over

it's shocking how those they line up like that yeah yeah and I think that's lucky right because

then we don't need to we don't need to focus on different things we can just appreciate that

that they're also maybe doing some benefit from or making some kind of pure choice

between physical health and brain health exactly the way I think about it is very similar to

a stimulus recovery adaptation model that you might see in physical exercise so if you're trying

to improve physical performance we know that the primary driver of improved cardiovascular fitness

or improved muscle size or strength is the stimulus that you apply to it right so the training

that you do for your marathon or the lifting you do in the in the gym if you're trying to build

muscle strength you can improve how you adapt to those stimuli by attending to your nutrition

and attending to your recovery but the stimulus is the most important thing right I like to lift weights

and unfortunately like no matter how many maps and protein shakes I have I can't I won't get

bigger biceps unless I you know do some bicep curls and the brain I think is essentially the same

so the thesis in the book is that how we use our brains is the primary determinant of how they

will function and that means that we need stimulus and I know that this is slightly controversial

in the current world where where I believe that we're we're chronically overstimulated while

being underestimulated at the same time we're sort of constantly bombarded with multitasking and

multimedia and social media and these things that don't truly drive improvements in brain function

and feeling overwhelmed because of it whilst not being able to attend to the real focused deep

learning and skill development which is what really drives brain function and so the stimuli that

we can think about the sort of drive this whole system I include education and learning any kind of

skill development be that music languages complex motor skills and then also social like social

interactions which we know is a primary driver of both human brain evolution and then human brain

development and maintenance so we need to think about like how we're using our brains but then once

you've stimulated a region of the brain by engaging it in some task you need a supply of the things

that allow that to happen so now we're kind of getting into what I call the 3S model the first

S is stimulus the second S is supply and so right if you activate a part of the brain the local cells

the neurons the astrocytes they stimulate the blood vessels to dilate to widen to bring in more

blood flow so that's where we need good cardiovascular health right you you need that to be able to

respond to changes in activity in the brain and then you also need a supply of energy so that's

where we need good energy regulation good metabolic health because glucose glucose is going to be our

primary source of energy but ketones lactate right those those those can play a role 2 and then

we need a supply of nutrients they're kind of run that system so things that become critical

particularly in terms of dementia risk are B vitamins associated with methylation omega-3 fatty acids

vitamin D iron and then some others like magnesium zinc antioxidant vitamins like vitamin C vitamin E

and then the antioxidant polyphenols that you can get from colorful foods do a bunch of

cool stuff for the brain there may be some other precursors like coline or ethanol amine that you

can get from eggs or whole grains like those kind of provide a structural component and we can get

into all of these different sections but so we've stimulated the brain we've brought in a supply

of things that we need to kind of allow it to do its job and then just like with our physical

performance you don't get stronger when you're training you get stronger when you rest and recover

afterwards so this is my third S which is support so sleep is a critical part of that that's when

all the synapses that you've generated during the day by through your skill learning are cemented

and refined to kind of be a build part of or like build new aspects of structure and function

in the brain and we can see that with skill learning we can see the brain change on MRI scans as

these sort of processes are driven even in older adults in their 60s and 70s then we can support

those processes with what we call trophic factors for things that like support the growth of

synapses and function of neurons in the brain so one that's produced during exercises brain

derived in your trophic factor hormones play a role here too I mean you had an excellent episode

with Lisa Mosconi and that's really her area of expertise but hormones sort of support brain

function as well and then we want to avoid things that kind of inhibit the adaptation process so

this is where things like alcohol smoking chronic stress air pollution come into play and so

all of these things interact and the reason why I talk about it in this way is because it's not

this massive list of 20 things you need to attend to because stimulus drives the processes of adaptation

and stimulus drives the processes of supply and supply drives support the interact and what you

see quite clearly is that when you change one thing you change lots of lots of things at the same

time so you can so if you start by stopping smoking right you've removed one risk factor but you

will also see improvements in inflammation and improvements in blood pressure and you're more likely

to make other healthy diet like diet choices for example we know that that happens or if you start

to sleep better again blood pressure improves and the next day you feel more social and you're more

likely to engage in cognitive estimating tasks so I think about it this way so that there's an

in for everybody and that in could just be one thing and then the whole sort of network starts to

shift in your favor there's so much in there don't worry we're going to tease out all of these

things individually but I really like this paradigm this 3s model of brain health stimulus supply

and support and within that you canvast exercise nutrition you know challenging your brain you know

stimulating it in various ways supplementation etc within the hierarchy of those respective pillars

what is to your mind like the most important or is that too reductive like like you're you have a

whole kind of thing in your book about like the problems with you know the reduction in nature of

science and yet you know you get asked these questions that are compelling you to kind of reduce

these things down yeah so this is actually another part of the question that you asked earlier which

is you know why haven't we started to think about dementia prevention in this way until very recently

and I think part of it is because we we've been chasing down one reductionist pathway which is the

amyloid cascade and then that's kind of I think it's distracted us a bit not that that's not

important right that should remain a part of the whole picture but it's kind of it drew resources

and attention away from these other things that we can talk that we can talk about the answer is

that it's going to differ from person to person of course and I think that these things shift across

the life course so in younger individuals maybe in their 30s and 40s I think in general

they're probably receiving a good amount of stimulation you know unless they're just like at home

scrolling on Instagram all day which is going to be some portion of the population but if you think

about knowledge workers in their 30s and 40s they're probably going to be doing some kind of

complex cognitive stimulating work but what they need is more on the sort of like the support and

recovery side are they ever giving their brains a break are they spending all the days

task switching and multitasking which we know are inherently stressful are they giving themselves

the time to kind of sleep to be able to recover and adapt to which we know that is critical for the

brain then as you know sort of people get older we might start to see declines in physical activity

or metabolic health so maybe that becomes a really critical component in midlife and then later in

life particularly as people retire I think that's when that's when they're at the biggest risk of

a decline in cognitive function and we see that from from the you know the research as well

and so then I think that's where stimulus really comes to the fore is making sure that you're

maintaining these either complex skills or learnings or social interaction that you got from work

previously or that you got from education previously but then become harder to come by once once

you've retired and I think that's one of the reasons why cognitive decline tends to accelerate

at retirement it's because we lose those those stimuli so I think that as we go through a sort of a

standard life course the things that are most important are probably going to shift in that kind of

amount of it the stimulus aspect of this is very interesting the idea that we're overstimulated

in all the wrong ways and underestimulated in the right ways like just scrolling on Instagram

or offloading the synthesis of information or the processing of information to AI like all of these

things are are basically harmful to our you know long-term brain health we think they're you know

that we're engaged you know in these tasks but we're just basically you know kind of short

circuiting our ability to problem solve and to do the deeper kind of thinking and in our distracted

you know we're just so increasingly distracted now that you know there's great opportunity for

somebody who can carve out you know the nobody you know you can make your way in the world better

than ever right now because like the competition is like all distracted right yet you know when

you think of that from a population level what is that doing to you know millions if not billions of

people like you know fast forward 30 40 years from now and what are our brains going to look like

because we haven't really had to do the kind of problem solving that historically we always have

yeah like an important place to start is that these technologies aren't inherently bad it all comes

down to how we engage with them right so if so there's even some evidence to just that something

like five minutes of scrolling on Instagram as long as it's not making you mad because of you know

of some emotional political information or as long as it's not only exposing you to people who are

richer better looking more successful than you are which sort of like makes you inherently feel

worse about yourself that has sort of like triggered triggers effects in our physiology that can

negatively affect our health if it's just like you spend five minutes looking at dogs doing funny

things which is a lot of my Instagram feed right that can actually be a real mental break that

will allow you to go back and and do hard work but the problem is that's not well that's not how we're

using it we're constantly we're using it for extended periods of time plus using it while we do

something else right so you're scrolling on Instagram while you've got Netflix on or while

you're doing emails or while you're in a in a zoom meeting and what you see there's some really

interesting studies where they look at how much people multitask across different multimedia

in that way and what you see is that just as you'd expect if the stimulus is the primary driver

of how our brains function our brains do actually adapt to that so people who do that kind of thing

are better at multitasking and the way you would test that in in a study is you have one cognitive

task and then you have them do have to do another like another cognitive task at the same time and

everybody who multitask does worse on both tasks right because the human brain actually isn't

it cannot multitask properly you can't give full focused attention to two different things at

the same time but people who do a lot of like Instagram plus Netflix plus zoom meetings etc um

they are better they they have less of a multitasking cost when they multitask the problem is

that other studies show they're also more distractable because their brains have learned to stop

filtering out information from the periphery because they're trying to attend to multiple things

at the same time so yeah and then the result is that we're we're distracted right and we

it impairs the ability to actually do the deep work exactly because you're not acclimated to it

yeah but this is again it's just the brain responding add to the stimulus right it's you're training

it to do this and it gets better at this but there's a trade off right just if you want to be an

elite level marathon runner you're not going to be a super heavyweight powerlifter at the same time

right and this is the brain like you're training it to multitask so therefore it's less good at

deep focused um like a attention driving work so then it comes down to how are we using these tools

how are we using technology and right the other example that would it's going to come up just like

you kind of mentioned is is AI right anything we say about AI is probably going to be completely

obsolete in two in two months time um but I think again we can there's like a framework that we can

that we can use um and this was some of this stuff is proposed more than a decade ago by a

colleague of mine called Ken Ford who's an expert in AI and like back when AI wasn't even a thing

he talks about this idea of cognitive prosthetics versus cognitive orthotics and orthotic is

something that you use to enhance or support your current levels of ability right so when I think

about orthotics I think about um shoes for individuals as cerebral palsy right if because of

you know issues with motor control they're unable to walk but you give them the right orthotic

they can walk you've enhanced their capacity um whereas you use a prosthetic to replace something

that you don't have you have a prosthetic leg because you're missing part or whole of your leg

we are a risk of using AI as a prosthetic instead of our brain as if we didn't have one

and we know that when we don't continue to engage those skills or things that you know we're

using AI to do for us we will lose those functions or we'll never develop them in the first place

um but we could use these tools as an orthotic we could say um we do the work ourselves right and

there are some initial studies on this with students writing essays this is one study this sort

of blew up the internet I was an essay writing study at MIT so the students who ended up doing the

best with with with the students who wrote the essay first themselves and then afterwards they

got access to an AI tool um and then it's then you're saying you know how can I improve this what can

I do better what what number thought about what am I missed and then you take that information and

you integrate it back in yourself right so all of that requires you to do the work it requires you

to be engaged but you could use these tools sort of like help you learn and expand your capabilities

but it's all going to come down to to how we choose to engage with them yeah are you using them

for the purposes of offloading or synthesize it like if you're if you're using as a tool and then

you're doing yeah the synthesis yourself the heart the heavy lifting of like how do these pieces

fit together yeah that would be brain health promoting because it's a stimulus exactly it seems

like in the context of of dimension Alzheimer's stimulus speaking of reductionism sort of been

reduced to this well you do cross you know crossword puzzles and you know like no this is not

you know the idea kind of writ large is you know how engaged with life are you like are you

you know actively spending time you know with with friends are you engaging with other people are

you trying to learn a new skill like on this idea of our brains maintaining a degree of neuroplasticity

throughout the entirety of our lives is somewhat novel like you know I grew up in a time where it's like

oh yeah well if you're going to learn a language or a musical instrument you got to do it when

you're young and then it becomes hard and so we all have that experience of not being as neuroplastic

as we once were and I think we just sort of assume well we're just you know we just you know it

just becomes harder and harder to learn new things but essentially what you're saying is not only

can we do that it's urgent that we are always kind of engaged in that process absolutely I think

that sort of whole idea has been embedded in society for more than 100 years if not well before

that that as we get older we essentially become useless right and we're unable to learn new

things we need to be put out to pasture right that was that was how retirement was framed when

it was first popularized back in the beginning of the 20th century was by the time you're 60 you're

essentially you have no use to society so we just have to like find a corner to stick you in and

we've embodied that as a society and therefore this is something that we expect right this is

idea of stereotype embodiment theory which is that if we expect aging to be associated with a

significant loss of physical and cognitive function we will know we stop engaging with the things

that maintain physical and cognitive function oh I'm too old to learn that I'm too I'm too old

to lift that vicious cycle yeah and it becomes a vicious cycle exactly so what you see is that

even in people in their 60s 70s 80s when you do a randomized controlled trial of language learning

or music learning or physical activity you can see structural changes in the brain you can

you can measure improvements in cognitive function the brain is still plastic at those ages

it's true that learning is is potentially slightly harder and takes a little longer than when

you're very young but that's not because the adult brain isn't capable of change it's because

you have shaped your brain to allow you to best function in the environment that you've put it in

right so you don't want it to be like really really valuable because it's already

become the person that you are right and that's what that's what you want so it's capable of change

you just have to engage in the processes that drive change show your brain that it matters and the

way the way to do that is by truly focusing on something and then that that change will happen

and we can measure changes in both the structure and the function of the brain in regions that are

susceptible to the processes of aging that become dysfunctional or lose volume in the processes

of dementia so we can see even later in life we can change that trajectory if we engage in these

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you know we develop these neural pathways and preferences over time and you know kind of

like groove these ruts in our brain and we know what we like we know what we don't like and

you know the older we get we're more kind of calcified around like doing anything different or new

we're more resistant right as an athlete like I want to do the things that I'm good at that I know

how to do like I want to go trail running and I want to go swimming and you know is but what I

probably should be doing is taking a jujitsu class or an archery class or you know trying to develop

a new skill where you know in something that I'm not good at yeah there's this um interesting thing

that you see in adults which we've all experienced right compared to kids and I think this is one of

the reasons why kids learn much faster than adults do is that the primary driver of neuroplasticity

is errors and making mistakes so when you are experiencing the world you're not truly experiencing

the world right you're experiencing a prediction that your brain has of the world as it happens

around you because everything happens on a slight delay so because of that the brain is constantly

looking for errors mismatches between expectation and reality and you can measure these mismatches

with like an EEG electroencephalography you can measure electroactivity in the brain you can see

when the brain notices something that it didn't expect it's largely driven by like a drop in dopamine

and a few other things but then that's what drives change because the brain's like oh hang on a second

I didn't get that right I need to create new connections I need to shape something differently in

order to improve my prediction in the future and we see this from learning research as well like what

helps people learn faster and one of one of the most important things is making mistakes is making

errors because it drives those processes that's why you know a lot of neuroplasticity is driven by

neurotransmitters like noradrenaline um and dopamine you know and these are

catacole means it's a stress hormone right so it feels slightly uncomfortable um and that's

part of the point um this is your brain attending to something important and diverting resources

to change in response so what that means for us is that we have to do things that put us in a

position to make mistakes or to fail occasionally right don't you don't want to fail all the time

because it becomes very demotivating but some way you can see progression but occasionally

you're sort of like pushing at the edges of your current capability because that's what drives neuroplasticity

but adults hate that right anytime you think about doing something like you go to a jujitsu class

and you're like the bottom wrong of the ladder and like people are gonna kick your ass and throw

you over their shoulders and like you're worried about injury and all these other things all you

worried about looking stupid um but it's putting ourselves in those situations where we have the

capacity to try fail learn go back again that's what's really driving those changes in the brain so

we need to kind of lean into that discomfort this is not the retirement that I was envisioning for myself

you know the idea that like the work is never done the principles that drive growth and evolution

for mental health physical health etc like apply to the brain and there is no destination or endpoint

to this and if you want to protect your brain you have to get out of your comfort zone and you know

do things that you're not good at and fail etc so if you are somebody who is hamstrung by this

notion of failure or being in a vulnerable situation uh perhaps a mantra is to think of it like

differently as you know a brain promoting a brain health promoting kind of exercise that you're

supposed to fail if you're failing then you're succeeding because this is you know in liveening your

circuitry and activating your neuroplasticity absolutely and I think this is where um the right

social context can make a big difference as well but we know that social connections are

incredibly an incredibly important part of this um so having other people who are willing to do

this with you uh you know you join a class where everybody's a beginner and you and you learn

together or you like you and a friend go to jiu jitsu together and you can laugh at each other

as you like fall over and try and figure stuff out that's going to help people feel a little bit

more comfortable doing it of course like some people would just like go and try it and uh they'll

lean into it and do great but uh giving yourself a social context to do this and like feel supported

and learn together I think that's going to add another layer that that might make this a little

bit more palatable to people who who who could already feel uncomfortable thinking about it

which overlaps with the blue zones idea like a big thing that drives health span extension

is your engagement with your friend group your community uh whatever that looks like and being

accountable to them and doing this as a collective yeah let's talk about exercise uh how important

is movement to brain health why is it so important and how should we think about this

it's incredibly important and the sort of the most fundamental reason for that I think is that

historically as a species we've moved a lot um and it's kind of like there's a there's a quote

from minigo samadhan who says that right is that movement is evolutionally baked into our genes

it's like a requirement of our biology if you want your brain in your body to function well

it needs to move frequently if you think about sort of even just our recent ancestors were maybe

walking 15 to 20 thousand steps a day they were moving six to eight hours a day um and it's essentially

required just to keep maintenance and other cellular processes going in the body and that includes

in the brain um and so because we no longer have that you know just like we've um sort of engineered

the food environment in a way that means we have to invent diets we've engineered the the

built environment so such that we now have to invent exercise and now I think we're getting to

the point where we've engineered the cognitive environment such that we now have to invent new stimuli

right that's kind of at the next frontier but we know uh that different types of movement actually

have different effects on the brain so even just breaking up periods of being sedentary um what we

might call exercise snacks um can immediately and boost mood it changes blood flow to the brain can

immediately change cognitive function um so just starting with regular low level periods of

movement during the day we already we already see an impact and we know that then sort of like

number of steps that you have in a day and it could be right if you if you don't if you don't walk

and some people some people can't walk you could be like propelling a wheelchair around or however

you get about the world right as as that increases up to sort of the equivalent of eight to 12,000

steps a day you see a linear reduction in risk of dementia and a linear increase in in cognitive

function from there we know that it wrote sort of a robotic type movement so now if we're getting

into brisk walking jogging cycling this seems to be particularly good for memory function um and the

structure uh and of the gray matter so like if you think about the brain it's this big wrinkly

sort of fatty ball and the the outer part is the is the cortex is the gray matter and there's more

gray matter inside um part of that is the hippocampus which we know is really important for memory and

is particularly susceptible in the later stages of of Alzheimer's disease and so uh we know that

people who regularly do something like brisk walking they can significantly improve the structure

and function of of the hippocampus there was a more recent study uh that that kind of told us that

intensity is also important so some of the things that get released during exercise

mentioned brain derived neurotrophic factor earlier there are you know dozens of of myakines or

exakines that get released many of which can impact the brain but they're released in an intensity

dependent manner so there was another recent study uh in individuals in their 1670s

they randomized them into three groups they had like a control group they had a sort of like a

zone two low zone three-ish sort of jogging kind of group and then they had a high intensity

interval training group and for six months three times a week they did 40 to 45 minutes of their

chosen exercise um the the hit group did the Norwegian 4x4 protocol um so for those who aren't

familiar it's four minutes of running at 85 to 95 percent of maximum heart rate in this study they

had a three minute rest in between some studies have four minutes some so these have five minutes

I don't think it matters that much um and then they do that four times over and they did that

three times a week for six months and interestingly what they found was that both the sort of the

jogging group and the hit group improved cardiovascular fitness by the same amount um but the hit

group had much greater improvements in the structure and function of the hippocampus um and so they

did did much better on a learning task and that benefit was retained for five years they went back

five years later and they still had maintained improvement even though they'd gone back to their

previous levels of exercise they hadn't said oh I love sprint training so I'm just going to do more

of it um they'd gone back to being relatively sedentary and they still had benefits five years later

so that's kind of on that spectrum of aerobic exercise up to sort of sprint training um you see

um across the entire spectrum you see benefits um but that type of exercise seems to

particularly benefit the gray matter and and memory function uh largely by improving the

uh the hippocampus or supporting the pacampus then I might think about resistance training um

and what we see with resistance training is that it seems to particularly benefit the structure

and function of the white matter so the white matter sits underneath the gray matter um and it's where

all the milen is like all the sort of fat in the brain and it's responsible for the really fast

connections it's really important for you know our complex cognitive functions like decision-making

executive function that kind of stuff which we know is lost even early on in the dementia process

and resistance training something like the studies they've done two times a week exercises

like on should be machines in the gym that cover the entire body you know five or six different

exercises um three sets of eight to twelve reps are very basic resistance training program

twice a week for six months significantly improves the structure and function of the white matter

so improved executive function and other things and you can see the changes on an MRI scan

then the final piece um when it comes to exercises is like these complex um movements um

that we might call co-ordinative exercise or um open skill exercises often what they call it in

the literature so like a closed skill exercise is something like running or cycling like unimodal

unidirectional whereas an open skill exercise is something like badminton or um a martial art that

requires you to kind of learn complex motor patterns respond to the environment respond to other

people maybe strategize um right you're trying to manipulate your opponent around a tennis court

and process information much more quickly um which is um particularly important as we get

older as processing speed tends to drop off but it is trainable if we're doing things that require

us to rapidly process information and this seems to be the best way to support sort of overall

cognitive function depending on which kind of meta analysis of the studies that you look at um

and so that stuff like I said ball sports team sports board sports martial arts dancing uh dancing

is often like winds out across you know compared to almost any other activity in terms of supporting

both mental health and a cognitive function um so to then kind of like fit all that stuff together um

we can think about just like just moving regularly throughout the day doesn't have to be particularly

intense just to kind of break up extended periods of sitting um if we can make our sort of aerobic

type training um something that has a co-ordinative component right so it's a and especially if it has a

social part right so rather than just going jogging maybe you uh play soccer or you play babanton

or even like table tennis um then I think you can get some additional additional benefits there

um plus maybe once or twice a week you do some kind of resistance training once or twice a

week you do some kind of sprint training where um essentially you're just the the goal really

is to generate lactate um lactate goes into the brain switches on production of brain derived

neurotrophic factor and so it doesn't really matter what you do it's just something that

you know gets the heart rate up you feel the burn a bit um and that could be even part of that

could be part of your coordinates of exercise right you could you you get a lot of stopping and

starting and sprinting in in some things like you know babanton or tennis but something like that

so regular movement um you know some aerobic sessions being that kind of complex coordinate

movement and then once or twice a week you do some kind of more intense you know sprinting a few

times and and some kind of basic resistance training program that kind of hits all of those

things based on what we know um even late in life can significantly uh improve and maintain

brain function essentially what you're saying is it's a yes and approach but it's a buffet it's

not about you know the Norwegian you know protocol necessarily that's one piece in a larger hole

that encompasses every you know kind of form of exercise that's you know driving you effectively

forward so aerobic exercise resistance training dynamic dynamic movements and high intensity work

right and finding a balance and and then the very kind of like low output walking you know

type of activity uh all of these things are important for different reasons that that impact the

brain in different ways and if you want to be as comprehensively brain healthy as possible you

have to you know attune yourself to all of these different forms of activity yeah there's a couple

of important takeaways there one um first is worth mentioning that uh we were as much as possible

we want to avoid this kind of like medical like what Daniel Lieberman calls the medicalization of

exercise right there and this happens when I I cite a specific study and you're like oh well

then I have to do Norwegian four by four like to benefit my brain but like that's not that's not the

case told it there's a lot of confusion around the Norwegian four by four and it and it all

tracks back to our you know our deep seated need to you know reduce these things down to like a little

nugget that I can remember I mean you were a rower right so yeah as a swimmer any as any track and

field athlete or rower or swimmer can tell you you do all kinds of interval work yeah you're always

varying you know that program and I think the Norwegian four by four is a is an effective like

you know interval modality but there's many more that and once you acclimate to that then you

need to change it upright or you're not actually stimulating your physical body in the way that you

could be if you're changing the structure of those interval workouts yeah exactly and and so I think

if we just think about the physiological response that kind of thing heart rate goes up you release lactate

is kind of like you're at that high level of intensity you have rest periods in between so you work

hard for a short period of time you rest in between that's essentially it you're going to be driving

those those physiological responses if people need like specific protocols like I provide several

in the book that have evidence behind them but in reality it's just move really really quickly rest a

bit that's going to be you're driving those functions then the other thing to kind of take a

way is that there are sort of these core principles across all these different types of activity but

how you choose to do that is entirely up to you because you'll get similar benefits from dancing

or badminton or even your martial arts jujitsu right because it is doing all those same things in

terms of like the pathways is activating so you can pick one that you enjoy and you want to get

better at and so like you said it is a smorgasbord and you get to pick and choose but don't enjoy it too

much you're going to get stuck there right like that's the thing with me like you know do I really

want to you know play pickleball no I want to go do the thing that I know how to do you know what I

mean I don't want to you know I don't want to be bad yeah yeah so so then of course we go back to

the previous thing which is you try and find something maybe where you've got something to learn

you're going to sort of lean into that little bit of discomfort especially in the complex

coordinate stuff because I think that's going to give you extra bang for your buck on the resistance

training aspect of this there's a lot of discourse now around longevity extension and the importance

of maintaining your muscle mass so when you think about resistance training what's more important

muscle mass or is it functional strength how do you parse those two ideas in general your strength

is proportional to your muscle mass so when you're building one you tend to build the other

as we get older often you train strength more than you train muscle mass but in reality what you

want is to have like the sort of like the immediate benefits like just like moving your having

muscle and moving it where we release things that go and support support the brain it's important for

blood sugar regulation our muscles are our biggest like blood sugar sink for most people I think

that any kind of resistance training is going to get you both at the same time when there was some

interesting like population studies where they look at strength and they look at muscle mass and

they look at the relationship to dementia or heart disease risk or mortality risk and what you

see is that at high levels of muscle mass you almost start to see risk increase again so what

so like there are some there are in some studies out there to say that are very high levels of muscle

mass you have a higher risk of cardiovascular disease a higher risk of all causes mortality

the problem is that those studies don't determine how you gained that muscle mass in the first place

so if you gain that muscle mass through resistance training and exercise your muscle mass

increases in line with your strength and we know that strength at high levels of strength you

don't have an increase risk of disease like the higher your strength the better essentially

so what you're seeing at the population level is that some people would just gain more muscle mass

because they've gained more total mass but that's not functional muscle in the same way as if

as if that muscle was gained through resistance training if that makes sense so I think the the

the real kind of takeaway is building strength that's functional and provides relative strength

for you you just need to be strong enough for yourself relative to your own body size whatever that

body size is and so if you're you know larger or smaller you would you would expect on average be

stronger you know if you're larger you would expect expect to be stronger if you get into the point where

you know you've gained a lot a lot of muscle mass but it's not through exercise that muscle may

not be functional in the same way so the the easiest way to measure this to kind of like give a

takeaway is that strength is probably more important than muscle mass and when you work to improve your

strength you will also improve muscle mass at the same time at the same time sort of like a final

important part particularly if we think about as we getting older is you know we can measure multiple

things we can measure muscle mass muscle mass muscle strength to like how much like the maximum

you can will lift but then also things like power so like how fast can you how fast can you contract

and and move your muscles and things like power are lost the fastest and that's important because

when you lose the the muscle fibers that were associated with greater strength and power

that's where you stop being able to like stop yourself from tripping over or grabbing onto

our hand rail if you're about to fall down and and we know then the the knock on effects is hip

fractures and spending a long time bed bound where you then lose even more physical and cognitive

function it's really hard to come back from that so in addition to just like any kind of weight

lifting I think which is going to improve strength there's really interesting studies on like

jumping in older adults just like a minute of jumping a day significantly improves like

bone mass and and muscle strength and power so in addition to just like the kind of like say

using weights in the gym just finding something that requires you to jump you know that you could

be skipping ropes and it could just be like jumping on the spot jumping on one leg we know those

have additional benefits because you're maintaining some of those some of those elements of function

that we know are going to be important yeah interesting yeah if you are weightlifting like a bodybuilder

but you're not thinking about speed acceleration or compound movements like don't we sort of want

to be like edo portal or you know take take Kelly starretz advice and make sure that we're supple

and able to you know bend in all the right ways and move quickly laterally forward backwards

and all these sorts of things that just a you know straight forward weightlifting you know in the

tradition of bodybuilding is really not going to do the trick so luckily I don't think

those things are mutually exclusive actually you know doing even traditional style bodybuilding

work can help to maintain mobility and stability so if people are just getting into resistance

training for the first time the safest and easiest and best way to do it is to train like a bodybuilder

and that could be a combination of compound or machine or you know dumbbell bands anything like

that you're going to significantly improve strength you're going to maintain muscle mass or

improve muscle mass you're going to improve types of muscle fibers these are the ones we know are

important for you know strength and power and the injury risk is super super low of course

you're then hopefully doing all these other things that we mentioned that require you to

you know have some element of you know flexibility stability cutting jumping running if you're doing

some kind of ball sport team sport you're doing a martial art because those things are important

as well but even you especially if if people are new to it even bodybuilding style training is

going to give you a number a number of those benefits so I don't I don't think that we want to avoid

it entirely because the evidence that we have from randomized controlled trials for like what type

of resistance training significantly improves brain structure and function and all of adults is

that like super super basic bodybuilding style training interesting I've been sleeping on my

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to go-browing beer club. All right let's turn to nutrition. Danger zone. No matter what you say

you know you're gonna get it. You're gonna get shit from people but I like the fact that you've

done a great job of not being reductionist here you're not talking about any particular diet being

the best and you have a principle approach to how you think about the way we should be thinking

about what we put in our mouths so how do you want to kind of introduce how you think about food.

So I think about food in in terms of sort of three three again kind of interacting

features of a diet say and those are the nutrients the energy and then the pattern of the way

that you eat that allows you to maintain good intake of the nutrients that you need as well as

adequate energy intake. In the kind of the modernized westernized world I think energy availability

is probably that the right now seems to be the most important lever that we need to consider when

it comes to to long-term brain health mainly because of all the things that we talked about earlier

why we know that there's an increasing rate of prediabetes metabolic syndrome these come with

high blood sugar high blood pressure these are significant risk factors for dementia we know that

people who have metabolic disease have an increased risk of multiple types of dementia and this is

something that really we're at risk out of population level because of the food environment. You do

see and this is relevant to athletes and and longevity sort of focus people as well you see this

like bell shaped curve between the amount of energy that we have in our bodies amount of energy

availability we have in our bodies and the sort of the structure of our brains something we call brain

reserve which is essentially a fancy way of saying how much brain do you have in your skull

and the more the better usually so at the high end we know we have lower brain reserve

high risk of long-term cognitive decline in dementia we see that based on blood sugar or blood

pressure or you know like central central post at a post like a high waist to hip or

high waist to high ratio but we also see the same thing at the low end and this has come from

sort of big population studies across multiple populations around the world including

some hunter-gatherer populations where they don't have access to the kinds of calories that we do

but this is very relevant to sort of like athletes and the longevity groups because

you see that if you have low energy availability and you'll probably have maybe an experience

this yourself or you've experienced it with other athletes you've worked with we know that low

energy availability or relative energy just deficiency in sport are reds or reds is associated with

significant changes in cognitive function mood sleep and it's sort of like the population level

those who have you know low energy availability you have tend to have smaller brains because they

just don't have the energy required to maintain that much structure of the brain so this is relevant

for those who are doing very high volumes of exercise I think but it's also relevant to those who

think that chronic chloric restriction is like some font of longevity and I think that we have

evidence to say that's probably not the case you need to get enough energy in that you remain

weight stable while maintaining strength and you know strength performance fitness all these

other things that we know require some amount of energy so like chronic restriction is potentially

going to be bad there is in addition to chronic access it was sort of like attending to our energy

needs then the next important thing or you know which we know is equally important at least

sort of on a global scale is is nutrients that are essential for brain function so these are all

things I mentioned earlier are the ones that we have the best evidence for so iron status vitamin D

status omega-3 the B vitamins associated with methylation so the ones that affect our homocysteine

level and homocysteine goes up as our need for these B vitamins goes up so if we have inadequate

levels homocysteine tends to go up and so that's B12 folate B6 and riboflavin which is B2

and then on top of that you know we know there's important things related to antioxidant polyphenols

so the things that make berries purple like the anthocyanins or we see similar compounds in

coffee and tea which are associated with a lower risk of dementia at sort of moderate consumption

chocolate the roasted skins of nuts and seeds have like similar compounds in them then there's

things like lutein and zizanthin that make your peppers and carrots or we make your peppers sort of

red and yellow the the carotenoids include like beta carotene in carrots and then things like

astasanthin which makes salmon and shrimp pink all of these have sort of like similar benefits

or and in terms of they they affect gut function affect vascular function and they can

improve brain function this is some of the best evidence is for blueberries or like dark berries

dozens of studies showing both acute and chronic benefits in terms of cognitive function with

with berry with berry intake and then yeah some of the antioxidants like vitamin C, vitamin E

um magnesium and zinc crop up frequently as well all of this to say that I call nutrients the

great leveler like these nutrients are important I want you to have enough of them I don't mind

where you get them from and I don't think I think that matters much less to your point of not

caring where you get them from do you care if they come from the whole food versus supplementation

I would prefer if they came from the whole food um and I think the the best example of that is

is seafood so when we look at omega-3 status and dementia risk in general it seems that

it's sort of like the pop you know if you're looking at epidemiological studies those who

you know regularly consume seafood have a greater reduction in their dementia risk than those

who take omega-3 supplements that's probably because there's a whole bunch of other stuff in

there that's important right so uh selenium you may be as you're eating salmon or shrimp you're

getting asses and thin as a as an antioxidant and in general the the are diets are ready to be poor

in in in many of these antioxidants I mentioned um you know protein if you if you need to if you're

not getting enough protein in your diet so and there's a whole bunch of other stuff so there's this

nice phrase which is nutritional dark matter where it basically acknowledges that like 90% of what's

in your whole foods we have we don't know what it is and we don't know what it does um there's uh

interesting compounds like ergothione that you get from mushrooms that's like the new longevity

supplement because it does a bunch of cool things um but we're only just learning about them so when

you get it from the whole food you're kind of stacking the deck in terms of there's some other stuff

in here that may be beneficial too however there are studies where if you supplement with a

mega-three is a new omega-three deficient you see significant improvements in cognitive function

and the rate of cognitive decline um the omega-three is in particular interact with bevitamin status

so there are multiple studies that show that if you supplement with omega-3s but you have poor

bevitamin status then you don't benefit from the omega-3s and vice versa if you supplement with

bevitamins but you have poor omega-3 status you don't you don't benefit from the bevitamins

and I think this is where reductionism has gotten us in trouble in supplementation um

studies which is that we give thousands of people one supplement and we're like oh hey it doesn't

reduce dementia risk therefore it doesn't work well you didn't measure whether they needed it

and you didn't measure the other things that um that supplement is dependent on

so one of the reasons why I think it's safer to get things from whole foods is because you're

getting these other nutrients at the same time but with that said if you're somebody who doesn't

consume seafood or you know any other source of long chain omega-3s I know that there's benefit

from you supplementing from it so that's kind of the the approach that I would use yeah yeah yeah

that makes sense I'm gonna have more questions about these pillars but let's get through them so

we talked about energy we talked about nutrients um and then the other pillar here is pattern yeah

passing is just finding a way that you can achieve adequate energy intake and good nutrient intake

in a sustainable way for you right that's either um what you can afford what you have access to

what's um makes sense for you uh culturally or locally um uh financially and I think that

there are innumerable ways to to skin those cats it's just making sure that you're kind of hitting

those targets in a way that's sustainable for you so that's why like pattern is that last part

because right when we take a supplement we probably usually take it for a month and then we forget

to rebuy it we never take we never take it again but this is something that's going to be important

long term so finding a way to make this sustainable enjoyable nourishing um like that's where pattern

yeah really becomes important setting aside this diet versus that diet and returning now to

this notion of energy you mentioned that there is a certain cohort cohort of people in the longevity

community who you know are under the impression that like chronic uh underfueling is some secret to

unlocking health span extension but the vast majority of people are overindulging you know we're

in this world of over over over abundance everybody's eating too much everybody you know is a little

overweight if not a lot overweight so we can sort of set aside you know those longevity people

and focus on the average person yeah and one of the things that I thought was really interesting

that you said which is overeating shrinks the brain yeah so explain that because we're all overeating

yeah there's definitely um like a step a step in between um but we know that even in short term

overfeeding studies right and this is usually done with some version of a western diet they add

candy balls to the diet or they make you eat an extra like serving a french toast or waffles

every day for like even a week you can start to see changes in um both mood and say hip like

hippocampal function memory function this is in this is in in humans this then you know long term

translates into what we see in the large population of studies which is people who have

um higher markers of what I call excess energy availability um and so that's essentially the markers

are metabolic syndrome those are the ones we have the best evidence for so a high waste

circumference low HDL cholesterol high triglycerides high blood sugar or high blood pressure

these are all significant risk factors um for dementia and they are direct measurable

effects of chronic excess calorie consumption they are like the the outputs of excess energy

efficiency this this is what hundreds of millions of people are you know if they had their blood

worked on it would reflect those very things yes the depending on of which estimate and of which

dates that you have something like 10% of US adults don't have any of any of the um components

of metabolic syndrome you need um uh three to five to uh technically have metabolic syndrome

but probably less than 10% don't have any of them um high blood pressure elevated LDL elevated

triglycerides LDL actually isn't in the LDL is one of the modifiable risk factors in the

dementia prevention reports about so LDL and cholesterol apo B are important but they're not

in the metabolic syndrome criteria okay so given the fact that we're overindulging on food

and a lot of these foods are we're not overindulging on whole foods we're overindulging

on ultra-process foods and just you know a bunch of crap and I know just as somebody who's always

trying to make the right choice when I'm not at home where I've control over my food I'm traveling

or you know I'm at a restaurant or whatever like it's very difficult to really eat well because

even if you order the salad there's too much dressing on or they loaded with all kinds of other

stuff to because they think that's what people want in order for it to taste good like even the

healthy choice is compromised so you're really going against the grain to try to you know do the

right thing unless you're in your you know kind of personal controlled environment I think that's

absolutely right and the the way that I would think about this and think about you everything that

we have talked about and we'll talk about today is that as much as possible you know control this

environment at home right so if you you know however it is that you eat at home or that you would

would like to eat figuring out how you can access those foods cook them you know make them a part

of your your diet in a sustainable and enjoyable way right or and it's the same with exercise right

you have your routine you play your pickable you go and you lift your weights so that when you do

go out into the world and these choices are harder it matters much less because this stuff integrates

over a really long period of time right so one meal out doesn't make that much of a difference

and we get to the point where like I have friends where you and you know historically you go you

when you're in this health kind of world you you every goes out to dinner after a conference and

right everybody's stressed about what they can or should order at the restaurant right and I think

we want to avoid that because it's a net negative right just like in in enjoy the moment with the

people and like what you eat that one time makes much less this is the flip side of you know these

kinds of conversations because we're basically you know pushing people towards this optimization

mindset where it's impossible to live up to the standards that are being articulated and that

leads to guilt and shame and stress and all these other things that are obviously you know across

purposes with the aim yeah no and I think that you know a lot of what I write about in the book is

the psychology of how we approach this kind of health information because that's exactly what I

want to avoid I don't want people to feel like they're not doing enough I mean I we know that people

need to do the work right we know that you need to find a way to kind of have this sustainable

but nourishing diet that gives you the nutrients and that you're not overeating and we know that

you need to you know create some kind of cognitive stimulus you need to lean into the discomfort

right we know that you have to do those things but if you get to the point where you're constantly

feeling like you're not doing enough you're not doing well enough you need to do more that's an

inherent stress in its own way that the then negatively impacts your health and we have studied

to study to support that as well so I think it's it's all about doing what you can and like moving

things forward and like improving things over time but then once you've built a foundation the

occasional thing matters much much less and the goal would be to avoid getting really stressed

about that right I've spent most of the last three months on the road I can't eat I can't work out

the way that I would that I normally would but I know I can't sleep the way that I normally would

but I know that I've created a good foundation by having you know my base at home to do you know

when I'm when I can do these things and the rest of the time like the thing when I can't control

that I try not to worry about it because I know that there's not going to affects about of that

worry as well on the nutrients side of things you talked about the importance of omega-3

B vitamins antioxidants in the in the berries etc what are some other foods that are brain health

promoting that people can just like oh I can remember that and I'll make sure I incorporate

that into you know tomorrow's dinner yeah my two favorite sort of brain health foods are

sardines and blueberries don't have to be eaten together though it's an option

like luckily if you if you eat a varied like whole food based diet so there's a lot I talked

about interesting structural compounds like colean and ethanol I mean you can get those from

eggs but you can also get them from oats and quinoa and other whole grains similar with like

phosphatidol serine you can get from and phosphatidol codeon is where you can get from from soy

products any of the sort of like colored vegetables are going to give you some smorgasbord of those

different antioxidants we also know that fiber is really critical right it's going to support

gut health and then sort of fermented foods in that cascary as well so salcrout kimchi fermented

dairy those were sort of like fit into that picture as well and then like whatever your preferred

protein choices are I think most people probably overeat on like refined carbohydrate side like we

don't need tons of rice we don't need tons of pasta I would focus on the things the sort of

those other because they're not particularly they're both calorie dense and relatively nutrient

tall yeah so focusing on those other areas I think is going to give is going to make you more

satiated as well as giving you sort of more sort of nutrient bang for your buck as somebody who's

been plant based for a very long time other than the sort of obvious things that I need to be aware

of making sure that I'm supplementing with an omega-3 what else should I be focused on or

thinking about and the B vitamins obviously yeah so those are those are the two that I'd and

and you can just you can just measure right so measure a homocysteine level the goal is to be

at least below 13 ideally below 10 you can measure your omega-3 status so omega-3

3 index at least above 6 ideally above 8 the other thing where it's just it's common particularly

as as people get older to not consume enough of it's just being sure you get enough high-quality

protein especially as people get older they get more frail or they experience some metabolic

disease that's associated with a faster loss of like muscle mass and strength and they're

around amized control trials that showing that that show that increasing them at a protein you eat

to sort of actually what is now the target level in the the updated dietary guidelines that's

actually in the in the trials is associated with better maintenance of muscle mass in in sort of

older in older adults so that's the only other thing that I would those yeah so B vitamins and

omega-3s protein are the ones that are maybe easiest to to to miss out on the protein recommendations

just seem to continue to go up I can't I've never been eating protein at that threshold level I

think I've always been eating less protein I still I really don't have trouble putting on

muscle mass like I've now recovered enough from a spinal fusion surgery I have this past spring

where I'm in the gym and I'm noticing gains pretty regularly and I'm not really that focused on

protein despite hearing from people like you all the time who are like you need to be you know

well a one gram per body weight like I'm way below that but then I'm like is it is it doesn't

matter I mean I'm hearing this obviously there's evidence to support that I should be thinking

about this differently but I haven't been so there's there's a few there's a few different parts

that get the go into that so that the first is that in the context of a calorie dense nutrient

diet we know that protein is a lever for satiety so people will continue this is some of Kevin

Hall's work right people will continue to eat until they they some of it will be some some protein

threshold so one reason to focus on protein is that it's maybe going to help you overeat less

right that's less of that's not that's not an issue for you but a population level that can be

important it's also particularly important as people start to age and experience frailty or

psychopenia right that's the context that I was talking about earlier again that's not as relevant to

you but I'm at that age where it is harder yeah and you're just like well this is taking a little

bit longer you know like so maybe I should be you know focused on my protein you do see that in

older adults and our people in their 60s if they consume again at that sort of level of protein so

like 50 to 100 percent above what was like the previous dietary guidelines so that was 0.8 grams per

kilo of body weight now we kind of think targeting 1.2 to 1.6 grams per kilo of body weight at that

level you also have higher like antioxidant status which we know is important in terms of

dementia risk factors is important for recovering from exercise as well and then you're right as you

get older like even if you're doing everything right you're more likely to experience anabolic

resistance where you just need a greater protein signal or more of a training signal to kind of

benefit from that exercise so it's probably worth considering increasing intake up to somewhere in

that kind of range the the final thing I was going to say is that when it comes to muscle mass

and strength the most important thing is still stimulus right so yes eating more protein more

prevent you losing muscle mass if you're not if you're not regularly doing some kind of resistance

but resistance training is still going to be the most important thing but as you get older I

think that requirements are going to increase a bit. On the topic of omega-3s I've had I couldn't

even count how many conversations with people like yourself sitting across the table you know

discussing the finer points of you know how to supplement properly and to this day I will admit

that I still don't quite under like there's DHA and there's DHA and there's EPA and like

I still don't understand like when I'm looking at a supplement like what are the levels I'm supposed

to be looking for how do these things interact and as a plant-based person what maybe should I be

thinking about that an omnivore isn't in terms of the effectiveness of the supplement.

Interestingly I would say that the majority of omnivores probably aren't eating enough

omega-3s either right because they're just like people just aren't eating that much seafood.

So I think this is relevant to most people regardless. I will say that we and by we I mean like

well-meaning health-focused scientists like me I think we've overcomplicated it a little bit right

so they're the two main omega-3s that we might think about are DHA and EPA there's also things

like DPA which occurs in sort of smaller quantities. Here we go. But what I'll say is that like all

of these are important most omega-3 supplements are going to contain DHA and EPA at a minimum right

and that's where we have some evidence from like giving people these supplements. If you're not

regularly consuming seafood any kind of supplement you know and assuming like high quality you get it

from a good quality manufacturer right because these things can be you know poorly processed and

they become rancid and oxidized and things like that you know assuming it's a reasonable quality

supplement from a respected manufacturer. Something that gives you one to four grams of total

DHA and EPA day is probably good enough. Format is much less like people have talked about

Tragus ride form versus phospholipid form and you get one in seafood and you get another in like

sort of krill and things like that. Or this is high in this but it doesn't convert like there's

this conversion thing. Yeah so the conversion part is the shorter chain omega-3 fatty acids like

ALA alpha-linic acid which is what you get in like chia seeds and walnuts and things like that.

Most people and actually the conversion is worse in men on average than it is in women.

Most people if you only get omega-3s in that form most people won't convert enough into the long

chain form so that's why you need to supplement but I think in general if you're getting a couple

of grams of long chain omega-3s from a high quality supplement on average a day right that's

it. I wouldn't worry so much about the ratios. I wouldn't worry so much about the total amounts

because you're then going to be ticking the boxes that you're close enough and you're also well

beyond what most people are consuming. Then the easiest thing that you can do is measure something

like an omega-3 index which just measures the amount of those in your blood and say am I close

enough to a level that we know as associated with lower dementia risk which would be sort of six to

eight percent or like above six percent maybe ideally above eight percent so maybe that simplified

it a little bit. I think that we know that DHA and EPA are both important you're going to get both

from any supplement. The real problem is people consuming none like once you get to the threshold

of consuming some like more than a gram a day on average right you're already like in a much

better bucket than than most of the people. We're tip-toeing towards a longer discussion around

supplements and what's effective and what isn't what's nonsense but before we do that while we're

still on food let's talk a little bit about the worst offenders obviously we know ultra-process

foods aren't good for us but what are some maybe less intuitively you know bad things that we should

avoid. You'll notice that I work really hard to not like demonize anything in particular because

it makes things tricky cognitively for people and like nothing as black and white so I'll give one

broad example which is that the levels of home assisting in the U.S. in general particularly

high home assisting which is a sort of like above 13 which is associated with increased risk of

dementia. That significantly improved since we started a fortify flower with photoc acid in 1998.

Heavily processed foods can almost be beneficial in one way because it allows us to add back nutrients

that the population is missing right. But in general I think the you know anything that's full of

refined fat or refined carbohydrate that's so calorie dense and nutrient poor so that's you know

kind of all of the baked goods snack good like snack goods things that are you're very easy to

overeat and are designed to for that to be the case. It's not that you can't include these and

it's not like I avoid those things completely but you have to think about them in that goal of

overall energy you know balance and nutrient intake so like you're eating more of those things

you're sort of like pulling away from your nutrient goals and you're also kind of heading towards

the risk of overeating. So that like that kind of yeah the heavily processed carbohydrates and

fats are usually where things get trickiest so you know fried foods, baked goods, sweet sodas that

sugar sweet and sodas that kind of stuff. Then a big trap that's now easy to fall into is when

something's like hey eat these protein or they're like Doritos or eat this protein candy bar

it's still a candy bar. They've added a little bit more protein but it's not getting to the point

where it's actually going to meaningfully move the needle and you're very likely to overeat it.

Same for oh hey these brownies are keto or these brownies are like plant based or vegan right

they're still brownies right. Yeah and they still have you know 900 calories or something like that.

Setting aside the keto thing like sugar. Yeah. I mean you can kind of I know you don't want to

vilify any one thing but you know is it really a place for refined sugar in any kind of healthy diet.

In the context of all those other things like occasionally consuming sugar is fine but you have

to maintain those other those other components and it's it's likely that if you're consuming sugar

at the level that's going to be associated with overeating and you know and these other like

metabolic health conditions you're very unlikely attending to those two things so it is possible

to you know occasionally consume sugar being like being a good energy state and overall have a

very nutrient dense diet it's just that the more you shift in that direction the harder those things

those those things become so you know I will occasionally deserve I don't I'm not

particularly sweet too so I don't get ton of it right but because I know I've got those other

things handled I'm less concerned about it so what you often see is that particularly you get to

like processed or packaged foods something will be sold as like low sugar but it's still energy

dense it's still nutrient poor that cut so like it becomes a thing where we can go oh there's no

sugar in this but actually it doesn't make it any healthier yeah yeah yeah so that's that's why

you know again we become kind of over over reductionist so not something that I think that you have

to completely avoid but the more you're consuming on it the less you're likely to kind of hit those

other things that we know are critically important sure one of the things that you see in the

longevity community online is you know this this notion like oh if you you've been really good and

then suddenly you have a dessert it's like oh I feel awful and I can you know I couldn't sleep

tonight and it's like how resilient are you actually if you're so dysregulated by this you know

this one kind of like indulgence the I think that's a really I think that's a really important point

and I would my guess is that so yeah like you're we know that you've got microbiome will kind of

adapt to the foods that you regularly give it so like if you give something so like you know I had

family members who have vegetarian for a long period of time and then you know it's sort of harder

for them to eat me later because their body just hasn't adapted to it right and we know that

there's some shifts that can happen in the gut to kind of support that and so the same might be

for large boluses of sugar but I think a lot of where that comes from is because and we've made

this worse with the advent of like continuous glucose monitors and stuff like that is you're like

I know this is bad and I expect it to be bad and therefore I feel bad because of it whereas

if instead we thought I'm just going to very occasionally I'm going to enjoy this is I'm just

going to enjoy it I think you would experience a very different physiological effects

yeah which gets into mindset and the role that mindset plays in all of this which you talk about

in the book as well yeah the um so so one example the one how that that you can use here is there's

a study by Edon Langer which um looked at diabetics and you brought them into the lab and

because they're diabetic um they were obviously very cognizant of their sugar and and

carbohydrate intake they brought individuals into the lab and they gave them a milkshake and they

like look at the look at the um the nutrients on this on this milkshake there was a high sugar

milkshake and a low sugar milkshake and then they measured their blood sugar and the blood

sugar was much higher after the high sugar milkshakes and the low sugar milkshake like of course

as you'd expect the problem is this is the same milkshake so the stress of anticipating a blood

sugar spike which they know is going to affect their health right drove their blood sugar up even

higher um and so this is you know every time we approach anything like this and we think about

um this is going to be this is going to be bad for me this is going to be you know you might get

some benefit you think it's going to be good for you but in general we see that if we think

something's going to be good for us it has like a neutral effect if we think something's going to

be bad for us it has like a negative a negative effect this then uh translates to all the other

ways that we can think about health information so i mentioned earlier that thinking that you're

constantly um not doing enough can negatively impact your health and there are some studies that

suggest that when you ask people how much exercise they're doing compared to people like them

and you look at um those who think they're doing less than less exercise than people like them as

much exercise as people like them or more exercise than people like them people who think they're

doing more exercise than people like them tend to live longer and they have better cognitive function

however this is after you adjust for how much exercise these people are actually doing and they have

like um they use like activity monitors right so there's this there's and the the people who think

they're doing less uh end of having like worse out if you're just a narcissistic sociopath who

thinks you're better than everybody you're there's something screwed actually but there's like

there's almost like your mind is creating your reality and if you're like i'm doing great

then you are creating you know your own version of greatness yeah i like to to an extent and so

there is some benefit of this sort of like ignorance ignorance is bliss almost right so like

this is the and you you you've already said this like this is the risk that we run by sort of

over analyzing health and lifestyle because everybody's walking around let's face it everybody's

walking around thinking they're not doing enough and they're falling short yeah if you have a social

media account and any kind of fitness or nutrition stuff happens to come up we're all judging ourselves

against some imaginary standard that we're not even close to living up to so every choice that we

make is a choice of falling short of what we feel like we should or could be doing and so when you

aggregate that over time what is that doing to our mindset we're always in a place of lack

when you look at things like self-compassion which you can break down into multiple components

the self-self-kindness mindfulness and common humanity you see that and this is relevant again

to like athletes and to and to like the health of the general population athletes who are more

self-compassionate tend to be more resilient and tend to perform better over long periods of time

because they understand the nature of setbacks they understand that we're just humans and they

treat themselves like they would treat other people and then that allows them to learn do better

come back and and perform again people who are self-compassionate in the chronic disease setting

tends to have better health outcomes for the same reason right they understand that oh you know

I didn't necessarily eat the way I that I you know would normally do although I didn't sleep or

excise the way I normally would but you know what I'm human I'm going to come back and I'm going

to do a better next time and like overall they tend to see you know when they do interventions that

improve self-compassion they tend to see better health outcomes are like better blood sugar and

blood pressure and diabetic so we're kind of taught about self-compassion so

um what we're kind of told which is that we always need to do better we always need to be

telling ourselves we're not doing enough we always need to be pushing through right it's actually

the exact opposite of what creates a sustainable and well-being supporting mindset which is that

yes I know I can improve yes I know there are these things that I can do and I'm going to

celebrate the wit like my wins I'm going to celebrate I'm going to enjoy that feeling of

discomfort and enjoy the fact that these things are improving but acknowledge that

you can't make everything perfect you can't optimize everything um and you know we'll slowly get

better over time and then not only are you engaging with the things um that you know when

improve your health but you're also maximizing the likelihood that you'll benefit from them because

you're not spending the rest of your time beating it beating yourself up that you're not doing

even more I feel like you just said the quiet part out loud and perhaps the most under-appreciated

aspect of of all of this not just for brain health but overall health in this epidemic of loneliness

and isolation and disconnection and you know kind of a decline in our overall you know

mental health from on a population level a lot of it stems towards this sense that we're not

enough you know that we're not good enough and you know we have to go out and you know earn

belonging and acceptance uh and perhaps the greatest lever for longevity and brain health is

adopting a loving kindness meditation practice like yeah we could talk about omega-3s but if you

hate yourself and you think you're you know nothing's ever going to work out and so and so is

always going to have more whatever you know whatever negative frame that you perceive the world

you can supplement with as much DHA and EPA as you want but ultimately uh you're kind of driving

yourself towards the grave as much as it is a counterintuitive concept that like the most successful

athlete is the most self compassionate athlete because you do think like well it's the person

who's like I'm you know I'm never satisfied and like I'm just hard driving and that's all coming

from that place of of lack and not feeling enough right like this compulsion to compete from

that negative frame as opposed to like this is awesome and I'm doing it from a place of joy

and self honoring you know so it's a mental health issue as much as it's a physiological issue

yeah this is why you know so much of the the book focused on the psychological aspects because I

think that like you said the the things that are important we already have some intuition about

right maybe reframing cognitive stimulus is really important but like we know exercise is important

we know that diet is important right we know that information problem yeah it's not an information

problem it's how we approach that information how we speak into ourselves how we engage with

that information and applying it to ourselves because you know we've been told that you know if only

we weren't so if only we weren't so lazy we could look a certain way or perform a certain way

but it's really it's really not about that it's all about how we treat ourselves that even allows

us to start to engage with that information in a way that will benefit us but also that make

you make it sustainable and supports well-being and you know hopefully belonging and purpose and

meaning and all these other things as well because I guarantee that the the the best way to minimize

your risk of dementia is not sit at home by yourself joking supplements despite what some people

are trying to sell to us it's going to be much more about how you're treating yourself and how you

interacting with others that then allows you to do some of these things almost naturally it is

the western frame of mind though that the solution is in a pill or a capsule this this this

sort of shirking of taking personal responsibility like I if I just eat this or I take this

stack right then it will take care of it for me as opposed to what you're advising and what your

book is all about which is shouldering personal responsibility for a lifetime commitment towards

the principles and the pillars like the foundational aspects of what drive health even beyond that

it's I think that we can we can almost think about

shortaring a societal responsibility for that as well because

what the people who who have the the time and the resources and the abilities to think about

taking the supplements to kind of you know get you know get you know to kind of hack their way

into better brain health they might not realize it but they're already at such a privilege to

an advantage position when it comes to the long-term dementia risk because we know that

socioeconomic status and deprivation and not you're not having access to education and health care

these are some of the biggest drivers of a long-term dementia risk so not only is it yeah how do we

how do we treat ourselves and how do we engage with this and shoulder some personal responsibility

but I think that we could even expand it beyond that to how are we engaging with society in a way

that minimizes or improves this risk for other people who maybe don't have the same kind of

access and availability and time to do some of these things let's do a little truth telling

around supplementation okay responsible supplementation has its place what can you tell us about

what's effective versus the perception of what's effective um well the the first thing you could

say is that if you think it's going to help you it might because we know that that's an Ellen

it's Ellen it's all about Ellen Langer yeah um there was there was a point when my

edits had told me that I referenced too many Ellen Langer studies in my book so I had to take

a couple of them out um but she's but you why not I say more Ellen Langer like you know she's

amazing yeah incredible um absolutely one of my all-time favorite scientists um but

where I think we have solid evidence is essentially the stuff that we've already talked about is

attending to nutrient status for nutrients that we know are critical for brain health

that are either deficient or insufficient in the diet and we know that the majority of

adults around the world are deficient at least one nutrient so finding some way to attend to that

so it supplements you with vitamin D if you need so somebody is to go and get a blood panel done

what are the markers that you would like them to pay attention to again the the ones that we

have the best evidence for so vitamin D um you definitely don't want to be deficient which is

less than 20 less than 20 nanograms per mil um but you ideally are at least above 30 um probably above

40 is is best 40 to 60 is probably a good target range I was below and I started like sort of

mega dosing on vitamin D and then my levels were like way too high yeah and I was struggling to sleep

and then I realized like oh excess vitamin D can impair sleep and so yeah this is and I say this

just because more is not always better and you know you have to like you know really gauge how

you're managing your supplementation even if you're trying to make up for uh you know a shortage or

low level yeah absolutely so and vitamin D is one of the ones where it's because it's fat

sorry well it's easy to take too much especially if you're taking like several thousand daily for

long periods of time so yeah definitely get above 20 maybe target 40 to 60 homocysteine for for

b vitamins um that like I said definitely less than 13 ideally less than a daily less than 10 um

and if homocysteine is elevated then those b vitamins I mentioned earlier the the ones that they

usually um given in clinical trials is b12 folate um but you might also add b6 and ribofl and

riboflavin um other things that can bring down homocysteine might include creatine

uh b-tane or trimethyl glycine um potentially coolean too then you might think about that you know

are you do you have a diet that includes those things right b-tane is high in beats and colon is high

in eggs and creatine is is high in meat and fish right so that might might help help you sort of

like target any supplementation if you need it um iron status is really critical um so you would

normally just measure hemoglobin level but then there were a whole bunch of iron metrics that you

take along the side to kind of help you interpret it so like ferritin transfer and saturation iron

binding capacity but ideally sort of uh women want their hemoglobin to be at least above 12.5

men 13.5 um but not too high so if you're if you're in like in men a hemoglobin above 17 or in

women a hemoglobin above 16 makes it much more likely that you have something like is though

especially if you're older or you have some elements of metabolic syndrome makes it likely

that you have something like obstructive sleep apnea um when you stop breathing during the night

your oxygen levels drop and your body makes more hemoglobin in response um so because we know

obstructive sleep apnea and other sleep disordered breathing is a risk factor for dementia

another reason to check your hemoglobin is because of the high end and that's something that you

need to address um as well yeah we already talked about omega-3 status so omega-3 index if you

you can get it um doctors will do most of the other things that i mentioned um you can uh just get

like an at-home test for omega-3 index if you can't get it through your physician um so at least above

six ideally above eight percent um and then um other things that they're important um i can be

harder to test so like it's really hard to test magnesium status for for example but um magnesium

tends to be something that people don't get much of or get enough of and we know that people who

who sweat a lot or who are athletes tend to need more magnesium so a safe recommendation is often

to think about um magnesium supplement especially if you're if you're an athlete um so and that

particularly for people who struggle with sleep there's increasing evidence that taking magnesium

a night can can help to improve sleep other things especially as as we sort of get into um some

element of asian or cognitive decline like there's some evidence for colean uh which are already

previously mentioned uh that may may be beneficial but even even then that's sort of like well apart

from those others i think that they're kind of the core vitamins aware where we have the nutrients

where we have have the best evidence um then beyond that it might become very context dependent and

there's very few things that i would give a blanket uh recommendation for if you're getting those

blood tests you're you're addressing those um nutrient requirements and then you also you know

testing your blood pressure testing your blood sugar testing your cardiovascular risk through your

lipids like that's the big bulk of of risk right there um anything else is going to be like you

kind of said like sort of like cherry on top creatine has been in the news lately uh it went from

being this thing that only bodybuilders use to sort of mainstream adoption uh but in limited

amounts five grams a day maybe 10 grams a day now we're seeing this science emerge

around the relationship between creatine intake and brain health and you know every time i

open up my social media feed the daily recommended intake increases it was 10 then it was 20

i've seen people saying you should be taking 30 grams of this a day uh what say you sir

so creatine is the only supplement outside of those vitamins and minerals that i mentioned

that i actually mentioned in my book not because i i don't think it's i don't think it's magic but there

is an increasing burden of evidence that it's that it does interesting things for the brain there's

some studies after concussion where it may improve recovery there's studies in the setting of

particularly in older adults or what those starts to experience cognitive decline uh creating

supplementation may improve memory uh in in particular um it seems to help improve um cognitive

function in the setting of sleep deprivation um and now there are several trials where they've

added creatine to antidepressants in the setting of treatment treating depression and it seems to

provide additional benefit um so i think it does lots of interesting things for the brain it's also

the best studied supplement and because you know five to 10 grams of creatine which is a fairly

standard dose like even five grams or sort of like long term the standard dose you could achieve that

through diet right you'd have to eat a fair amount of steak and salmon but like it's certainly

possible so like we know that it's very safe and like we know that it has very few side effects so

if you're gonna if you're thinking about um supplement side often think of this idea of positive

asymmetry so like where is their potential for benefit with very low downside other than

the the the cost to your wallet um so in terms of dose actually some of the like the first study

that looked at creatine in the setting of sleep deprivation was in rugby players and they looked

rugby specific skills after you know in the setting of sleep deprivation they compared

caffeine and creatine and a standard dose of creatine five to 10 grams depending on body weight right

so a smaller person would take five grams a larger person would take 10 grams or summer in between

was enough to see to see benefit in some of the depression trials again they're using five to 10

grams um some of them using five grams and seeing benefit in the like the the one most recent

sleep deprivation trial which is the one that got a lot a lot of press um where people were sort of

kept awake for a night and then they were given they were given creatine and it showed that it

helped maintain their cognitive function um in the setting of sleep deprivation I think they

were using point three grams per kilo so that's where something like me would take 30 grams um but

you know something like you might take 20 grams so um that's where like this dose escalation is

happening um and if you look at studies where you're looking at creatine levels in the brain

you you start to see significant increases in brain creatine at sort of like loading type doses so

that's that kind of like point three grams per kilo per day for you know a week or more um so

that's like you know 20 to 30 grams a day however some of the evidence of benefit in things that are

related to brain function seem to happen at much lower levels so I'm not convinced that everybody

needs to take 30 grams of creatine a day because I have evidence from other studies that actually

maybe even at five grams people are starting to see benefit um so the way I kind of approach it

right now is the general I would generally recommend point one grams per kilo um so I take 10 grams

every day and then yes if you're very stressed or sleep deprived maybe you could you could try

increasing the dose so for me as it is for some people were not everybody creatine is quite um

alerting like it feels like a very very mild stimulant without making me jittery like I've had a

bunch of coffee so I can't take creatine late in the day because I don't sleep as well um but like

if I haven't slept well I might double my dose for the day um but that's not like a long term thing

so I think the standard dose is actually where people will start to see some benefit um and then

maybe in edge cases um and that I expect much more research in Alzheimer's disease and other things

to come um then maybe you know higher doses will end up being better I can't let you go without

talking about sleep uh on some level we all know this already it's like we need to be getting eight

hours of sleep we need to be practicing good sleep hygiene clearly sleep is just absolutely

foundational to brain health yeah um and I've had plenty of guests share you know the sort of

detoxing process the clearing out that occurs overnight um what can you add to this or stress

about the importance of sleep with respect to ensuring your brain's health

so that we don't like rehash uh old ground in terms of mechanisms like that I think that

the main takeaway is that sleep is when um all the information all the skills all the things

you've learned the new synapse you just you generated which your brain is constantly generating

the ones are important they are cemented and refined during sleep that's kind of the um

there's a synergistic effect between REM sleep and deep sleep that allows the

synapses to be kind of perfected for one of a better word based on the previous day's input

and integrated into everything we've experienced already there's also you know sleep is also

really important for emotional processing and other things like REM sleep in particular um and then

right you're washing out um amyloid and you know other things that accumulate during the day um

during deep sleep but also just sleep in general through the glimphatic system so um

we know the people who don't sleep enough long-term have a have a higher risk of

of dementia the risk really seems to tick up in people who are chronically sleeping less than six

hours a night um which is probably lower than most people might expect um in general I think

you yeah so like people say eight hours but in reality depending like person to person and it

changes over time the window is more like seven to nine maybe even six to ten hours like

based on like how much sleep people need so like you're waking up the next day you're feeling

refreshed you feel good you're probably getting enough sleep regardless of what it was um things to

consider how we think about our sleep is also is also is also really important so people know

you know they're all about the sleep routine like why sleep is important um the sort of like an

addition to the sleep time sleep quality is critical so usually when we think about poor sleep

quality we know it's associated with the increased risk of dementia the way that we measure that is

usually by asking people do you take something to help you sleep and those who take things to help

them sleep tend to have a higher risk of dementia that's probably because of a downstream effect

of the things that they're taking so are you drinking alcohol to get to sleep are you taking

antihistamines like Benadrill to get to sleep are you taking these like ambient to get to sleep

there is probably a combination of um issues that are causing insomnia in the first place that

haven't been dealt with plus the the the effect of those medications themselves um if we consider

alcohol self medication then negatively impact our sleep and that's probably what contributing to

long-term increased dementia risk so alcohol creates a REM sleep deficiency in general um if you're

using alcohol to counteract all the caffeine that you drank during the day because you didn't sleep

well the night before which is a very common sort of vicious cycle then uh caffeine can also

impair deep sleep in particular so if you're drinking still drinking caffeine in the afternoon

then having a glass of wine to help you fall asleep right there's sort of like a double

whammy effect there um ambient seems to negatively affect various aspects of neuroplasticity which um

you can see uh this is mainly from animal studies um but uh then the antihistamines because

the anticolyanergic anastocoline which they sort of influence the function of is really important

part of of long-term cognitive function those antihistamines that make you drowsy we know if you

take those regularly that's associated with increased risk of dementia so think about are you using

those things to go to sleep um if you require those things to go to sleep first of all you're not

necessarily asleep you might just be unconscious that's not the same thing it's a facsimile of sleep

yeah exactly resembling sleep you know any kind of like pharma intervention to produce sleep

isn't actually producing sleep and if it feels like sleep it's still the sleep is not doing the job

that sleep is supposed to be doing there are some new drugs that are maybe changing that um but

equally uh people and people who have insomnia the the required architecture to get good quality

sleep is still there it's just that the environment and the cognitive processes around sleep like they

that don't feel safe or they're unable to wind down such that you can produce sleep so that's where

things like cognitive behavioral cognitive behavioral therapy for insomnia CBTI can become important

that's where the sleep environment can become important again we can become dependent on those

medications so you might need expert help to overcome that but your sleep isn't broken you just

need to like retrain yourself up the the final thing that's that I think is is worth mentioning

is that for many people we've kind of swung too far in the other direction when it comes to sleep um

and the sort of like the hyper focus on wearable data um and this idea of all

orthosomnia where we become so focused on wearable and like our our sleep metrics become the target

whereas the target should be that you get a restful night of sleep because it allows you to do

all these other amazing things it's the new garment like oh if I if it if it's not tracked I didn't

actually sleep last night or I wake up and I don't know what to do with myself I mean I you know

I have a whoop I love it I definitely check it every morning but I try to have an arms length

relationship with how I let that data impact me I still have to live my day and if it's all in the

red you know like what is that doing to my mind in terms of how I'm a problem solving and approaching

those problems and making sure that I maintain a positive mindset would I be better off how

I'd not known that I was in the red you know like with from an Ellen Langer perspective if I like

I feel great you know and I think I have a healthy relationship with that but I can see how that

becomes problematic for people and it becomes a you know like a neurosis you know there is one

classic Ellen Langer study she she wasn't the the senior author the senior author was um Steven

Lockley because he's a circadian biologist at Harvard but they collaborate on a study where

they had people come into the lab and they were randomized to sleep either for five hours or eight

hours but in classic Ellen Langer style they manipulated clock time right so they changed how long

people thought they'd slept relative to how they actually slept and what they found was that how

long you thought you slept was a better predictor of how you felt the next and perform the next day

than how you actually slept so the example being people who slept for five hours but thought they

had slept for eight hours didn't experience any impact on their function the next day and there

are other studies that have used wearable data to manipulate this like hey you slept terribly last night

even if they slept fine how fatigued they feel the next day is based on how well they they think they

slept um this is important because wearables aren't great at actually detecting the quality of your

sleep um they can tell you how long you're asleep for pretty well but telling you whether you were

in like deep sleep versus REM sleep they're really not that good at that and this is like published

data that are out there so when they use those sleep stages to tell you something about your recovery

score your sleep score the next morning you're using quite low quality data to tell you how you

should feel that day so the way that I've used this with professional athletes and they're lucky

because I work you know with their coaches who can sort of who sort of like oversee the stuff on a

day-to-day basis I would usually have the athlete the athlete doesn't see the data but the coach sees

the data and they use that to look at trends over time which are probably more accurate than like

individual pieces of data so then we can integrate it and kind of change kind of change things if

we need to if you can create where you I think you create like a cognitive distance from the data but

like I think you can also create a temporal distance from the data because like you don't need to

know how you slept last night in order to be able to perform today because you have to perform today

regardless or you have to go about your day regardless review like a week later go back and review

the past week yeah especially if you can then say oh yeah didn't sleep that well that night but that

was the night where I went to bed late or that was the night where I had the next trip here before

bed or that was the night where I had a coffee in the afternoon right so you can still use those

data to inform important things but you're not allowing it to influence how you then you know

perform on a daily basis speaking of the relationship between the rest itself and your kind of

mental relationship with the rest uh this is something that is kind of an important issue in the

world of Formula One and you've you know played a role in working with some of those athletes because

they're just literally going across the world every week I mean the time zone shifts are insane

so what have you learned about working with those athletes and how have you counseled them

some things that I've learned which were surprising to me at the time but maybe shouldn't have been

is that the basics particularly when it comes to rest and recovery the basics still matter

so I've had athletes come to me and say oh yeah I'm looking at my wearable data I'm worried I'm not

getting enough REM sleep as an as an example now I look through the data and it's very clear why

they're spending five hours in bed if you spend five hours in bed we know that most of your REM

sleep happens at the end of the night you're you're gonna get less REM sleep first of all

is that REM sleep number that accurate hard to tell um but second of all um like the the most

important thing if you're getting a good quality night of sleep is getting enough sleep opportunity

which just means spending enough time in bed ready to ready to sleep and you see this again again

like when there's issues with sleep it's the athletes athletes aren't giving themselves the time

and opportunity to get high quality rest of course some of that comes from a travel schedule and

things like that so you kind of have to take that into account um but when they are able to build

those routines or maintain those routines or maintain the things that help support sleep at home

whilst they're traveling they can maintain a much better um quality of sleep something that we do

so that I do all my formula one work through a company called hints of performance um and

they you know so we work with the with the coaches as well um and the coaches sort of like

inserted into the life of the driver they're doing the training program they're doing the nutrition

they're like traveling with them the whole time they they hold the helmet hold the umbrella like

they're they're the whole time we'll often do things like jet lag plans so can we start to have

them shift their circadian rhythm before before they travel so it's starting to manipulate caffeine

and light and sleep time and food timing um a day or two before they travel um you know so

that they're closer to the the target time when they get there and there are a number of apps

that kind of allow you to to do that now there's one called phase that was developed by one of

these f1 coaches uh because he was so used to having to do this on a daily basis he's now kind of

created something that that people can use themselves but then sort of like the bigger overarching thing

um is that again very you know like the rest of us they struggle to just right they're getting

plenty of stimulation right they have very complex jobs like driving the car they're getting lots

of inputs doing that but then they also have um media commitments they have meetings with engineers

they're constantly giving feedback on how the car drives right this is all very cognitively

simulating stuff so for them it's it's finding ways like i was saying you know earlier sort of like

in that kind of you know age where you know they are maybe 20s 30s 40s where you're doing a lot of

stuff with your brain it's how can you find time to kind of relax and down regularly yeah so it's

all about so for them it's all about how can we give them space how can we give them time to improve

and recover and that's the the message that I hear from them most frequently is like you know

like how can I how can I recover like how can I recover better how can I switch off how can I like

you know just get some get some downtime because the demands of them are so so high so then there's

all this stuff around sleep schedules but then it's just finding things that allow them to to truly

to truly switch off in a sort of a sustainable regular way and you know for some of them it's

meditation or breathwork practices although most of the times when you say to a 20 year old hey you

should better take more like you just get a funny look and and and simply the receptive athlete

is the athlete at the in the sunset of their career is looking to extend you know another year or

two yeah then they're all about it you know the young ones they're like no no and young athletes in

general can do a lot quote unquote wrong and still and still but I will say that the young generation

of athletes is miles ahead of what the young athletes were like you know 20 30 years ago you know

like they're they're very into like you know finding that extra edge with these very types of

things absolutely and this is so weak because we have a like a little hint as this whole driver

development pathway right so some of it is about instilling some of these things early on so then

it's much easier to make those habits and sustain them once you're in sort of like the the F1 kind of

all right so I want you to imagine the I don't know 35 to 55 year old person who is listening to

this or watching this and they're thinking I've been eating the standard American diet for 30 40

years you know yeah my aunt or my parent what parent is experiencing dementia I don't want that

to happen to me but you know I'm kind of like cast my vote already when is it too late is it too late

give that person a reason to take what you're offering urgently the sure answer is it's it's never too

late and actually this was one of the things I was going to say about sleep there was an interesting

study done by Matthew Walker where they looked at sleep trajectories in people across their

lifetime and then looked at the burn of amyloid and tal proteins in their brain you know sort of like

part of that the process of of dementia and they found that people who'd improved their sleep

later in life so even if it was in their 50s or 60s or 70s if your sleep improved that was associated

with a lower burn of later amyloid in the brain all of that saying because people asked well

you know I spent all this time I was young I had kids I was busy I didn't sleep that well is it

like did I really do this damage is it undoable and like on a sleep perspective at least from

that study it kind of suggests no it's not and we see that then across all of these different areas

so there are now multiple studies where you know that the best evidence probably comes from

multi like multi intervention kind of approaches so they're the most famous one

as finger was running Finland it was just repeated here in the US it was that study was called

pointer lots of other studies have around the world have done something essentially similar but

what they do is they address cardiovascular risk they have people start a new exercise training

program with some resistance and aerobic exercise they have them improve their diet quality and then

you know there's there's some other some other pieces sometimes there's like a stress reduction

component but like just starting to attend to some of these basics and this is either in people

at high risk of dementia or starting to experience some decline already and actually you see bigger

benefits who tend to see bigger benefits in people who may be you know starting to see some decline

not that they've gone a diagnosis of dementia but you know maybe they're already below that below

kind of the average in terms of cognitive function and you can see this within sort of like six to

six to 12 months of just starting to attend some of these basics once you're already in your 60s and 70s

so if you start even earlier right you start in your 30s 40s 50s you potentially have 20 years to

change this trajectory another example might be when you look at cognitive changes that happen

during perimenopause the menopausal transition in women which is in that kind of towards the you

know mid to latter part of that that time window that you mentioned we see that a greater cognitive

changes tend to be experiencing those who have some element of same metabolic disease so the what

the swan study in the US showed that so again we know that changing your diet changing your physical

activity addressing cardiovascular risk factors then affect your the severity of metabolic syndrome

and related components that you can you can improve blood pressure you can improve blood sugar

and you know doing that at that time period could potentially like completely change that that

so all of that to say like wherever you are in that window even if you're beyond that 55 years old

there's still scope to change that trajectory that is incredibly empowering and and speaks to the

unbelievable resilience of the human being yeah like it's it is kind of amazing but reflecting on

how we kind of opened this podcast with this notion that 45 and you say up to 70 percent of

dementia cases are preventable and here we are talking about you know people who are kind of

tiptoeing into that and there's still the opportunity to halt it reverse some of this

symptomology or like stave off you know this this this you know kind of terrible future

why isn't this something that everyone is shouting from the mountaintops like so many people

are suffering from this just absolute horrible affliction that is devastating to families like

I feel like this is a message that needs to get out there and should be being repeated constantly

you know you can avoid this here's the way to do this why is this the conversation that we're

not having all the time I'll I'll I'll I'll before I get into that I'll quickly say that that

70 percent number wasn't something that I made up there was another analysis that was done above

by professors entire you are using UK biobank data so a big data set of more than half a million

people in the UK they estimated the upper end of of dimensions that may be preventable is over 70

so again just like a similar way you do a big statistical analysis and that's the kind of number

that comes out so like regardless of where the truth is in that in that range whatever it ends up

being right that's still a huge number of dimensions that are potentially preventable of course

we're talking at the population level right we can't and we're talking about statistics and

probabilities I'm not saying that you could definitely prevent any individual person from from

getting dementia but we know we can dramatically decrease our risk so I'm I'm really hopeful that

the conversation is changing like over the last two or three years in particular like especially

and a lot of people struggled with their brains after covid either due to you know long covid or

the effects of you know lockdown and everything how that changed you know the the sort of like our

lifestyle and our environment and since you know the lot since the last sort of two or three years

people have been talking about brain health more and more and more and so I see it out there

you know they're mentioning dual living students work and they're mentioning some of these

analysis and they're saying that you know it's not too late you know things like the point of trial

that was just published last year so I agree that we're not saying it enough and I agree that we

should be hopeful if we're able to engage at this on a personal level and then ideally make changes

at a societal level as well but I think that tide is changing so I hope that you know you and I

speak in a year or two and you can be like oh yeah you're right you know people are talking about

this more and more and people are realizing they have so much more agency here and so I hope it's

going that direction and it certainly seems like people are starting to go that way that's very exciting

yeah so maybe to conclude the conversation it would be good if you could you know even like look

right to camera is like what do you want people to know like that somebody's listening to this I've

never heard anything like this before oh my goodness you know I now I'm going to take greater

agency over these decisions that I'm going to make I certainly don't want to have this kind of

thing happen to me how do I begin and how can you kind of leave them with an empowering message

about how to embark upon this journey sure so the thing that I want everybody to know is that

we each have a huge amount of control over our long-term cognitive trajectory and we can

dramatically decrease our risk of dementia even if we have a family history of dementia or no

people with dementia and the best way to start to do this is just to find one thing that you know

you can start to move the needle on that feels doable to you and so it could be slight changes

to your diet it could be adding a new aspect to your exercise routine it could be going to your

doctor and getting your blood pressure checked and treating it if you need to think about the risk

factors for other people that you know or in your family who had dementia that you might share

with them that's always a great place to start to and know that because all the different factors

that affect brain health interact with one another when you start to change one thing the whole

network will start to shift in your favor amen I love it to the audience I want to say we

covered a lot of ground today and it may feel like hey we didn't drill down enough on this that

or the other thing well the good news is you can find all the particulars in Tommy's new book

this stimulated mind out now again I'll say what I said at the outset like this is a real public

service and your work is vital brain health obviously impacts all of us very few people are

untouched by the diseases of cognitive decline and so I urgently impress upon everybody who's

watching and listening to pick up the book and take your brain health more seriously so thank

you for your time today thanks so much for having me and I hope everybody found this useful peace

you