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

0:00The 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

1:01and 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

2:04with 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

3:10will 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

4:11much 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

5:14percent 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

6:15the 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

7:15we 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

8:16this 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

9:17large 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

10:18which 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

11:19consider 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

12:25that 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

13:28a 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

14:34in 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

15:35that 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

16:38cool 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

17:41derived 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

18:42to 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

19:44science 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

20:46scrolling 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

21:52previously 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

22:55you 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

23:58worse 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

25:00everybody 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

26:02right 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

27:05you 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

28:05got 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

29:06you 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

30:10that 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

31:15it'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 different you know true sort of cognitive stimuli yeah hydration is one of those things

32:21that is far too easy to forget just like element forgot to add vowels into its product name oh i just but in truth for a long time i treated hydration like something that i only needed when i was training hard or out in the heat but the more i've learned the more i've come to see hydration as a baseline for everything it completely shapes your energy your clarity your mood basically your entire day and that my friends is where element comes in element is a zero sugar electrolyte drink mix and now a sparkling electrolyte drink with no artificial colors or sketchy ingredients formulated for a 12 ounce serving these gorgeous slim cans deliver 500 milligrams of sodium 100 milligrams of potassium and 30 milligrams of magnesium they're delicious they're perfect for those in between moments mid afternoon if the studio after a long walk or you know i don't know when i just need something crisp and refreshing that actually supports my body and the flavors are great they're bright they're clean they've got black cherry salt lemonade salt orange salt and pineapple

33:25salt it's hydration that feels intentional but not indulgent and for me element has shifted hydration from something that i have to remember to do into something that i genuinely look forward to so check it out right now all of you guys my listeners will receive a free element sample pack with any order at drinklmt.com slash rich roll one thing i see all the time in myself and in the people i talk to is that progress rarely falls apart because of one big mistake it's usually the small things the go-to tried and true fundamentals that are easy to dismiss and overlook when life gets busy for me one of those under the radar fundamentals has been fiber most people think of fiber as just digestion and gut health but it turns out that fiber plays an enormous role in overall health like stabilizing energy improving nutrient absorption and ultimately influencing

34:26how well your body recovers and performs and the shocking part is that nobody is talking about this well nearly 95% of people in america continue failing to get enough wondering why they don't feel as good as they could that's why momentous created fiber plus something that helps everything else you're already doing work better if you want to improve performance at the source and eliminate the guesswork here's what you're going to do you're going to shop momentous fiber plus and you're going to do it by going to live momentous.com and there you will get up to 35% off your first order when you use a super secret code don't tell anyone the code is 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

35:32we'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

36:37with 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

37:43position 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

38:45do 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

39:45more 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

40:48from 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

41:51might 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

42:53gray 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

43:59familiar 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

45:04particularly 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

46:05then 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

47:09is 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

48:10you 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

49:12right 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

50:13field 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

51:17way 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

52:24of 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

53:29see 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

54:29for 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

55:35when 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

56:39but 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

57:41that 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

58:42birch for many years now and what I have realized over time is how much my day actually starts the night before when my sleep is solid shocker everything feels steadier my energy my focus my mood you all know what I'm talking about so your mattress matters and with birch I sleep cooler I sleep deeper and with a kind of quiet ease that I don't think I really had before I don't love the idea of spending a third of my life surrounded by synthetic foams or off-gassing materials so I appreciate that birch is made from natural responsibly sourced materials comfortable but also built to last birch mattresses are thoughtfully designed they're stylish and they're crafted with organic fair trade cotton and natural latex all chosen very intentionally to support better more restorative sleep birch also gives you this amazing 120 night risk free trial so you can truly see how your body responds and they stand behind their work with a limited lifetime warranty

59:47I want all of you to experience what I get to experience which is a deep restful night sleep with a new mattress from birch go to birchliving.com slash ritual for 20% off site-wide every once in a while you witness something come into being that feels bigger than a product and honestly I got to tell you that is how go-browing feels to me personally because a few years back I spoke at this event in Illinois it was called go and it was all about taking inspired action in your life and I had no idea that something from that day would land so deeply with Joe the founder of the event or that it would eventually become the spark for his next mission which is reimagining what social drinking could look like what impresses me the most is how seriously the entire team at go takes their craft these guys spent years testing thousands of batches in their lab

1:00:48and the results reflect that they've received gold and silver medals at the best of craft beer awards in the past two years their lineup is thoughtful it's distinctive you can feel the intention in every can the alcohol free movement is officially here I'm definitely and officially here for it and now I think it's a great time for you to officially get into it because if you go to go-browing.com slash ritual 50 you my friends will get 50% off your first subscription order to go-browings beer club go-browing.com slash ritual 50 to get 50% off your first subscription order 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

1:01:53the 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

1:02:56high 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

1:03:59sort 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

1:05:02weight 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

1:06:07coffee 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

1:07:11great 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

1:08:11in 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

1:09:14and 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

1:10:19what'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

1:11:23in 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

1:12:24um 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

1:13:28triglycerides 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

1:14:33absolutely 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

1:15:35right 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

1:16:36you 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

1:17:41B 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

1:18:43gut 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

1:19:45and 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

1:20:49think 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

1:21:54right 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

1:23:00that 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

1:24:04thinking 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

1:25:05regularly 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.

1:26:07Most 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

1:27:11better 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

1:28:15that 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

1:29:17sugar 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

1:30:19at 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

1:31:19to 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

1:32:25this 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

1:33:25sugar 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

1:34:29much 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

1:35:30media 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

1:36:33tends 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

1:37:36better 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

1:38:37hate 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

1:39:38think 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

1:40:40are 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

1:41:45into 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

1:42:49edits 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

1:43:5540 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

1:44:59usually 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

1:46:02especially 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

1:47:05who 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

1:48:09kind 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

1:49:14particularly 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

1:50:18that 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

1:51:23you 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

1:52:24bunch 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

1:53:29so 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

1:54:36you 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

1:55:39there 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

1:56:41take 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

1:57:46need 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

1:58:50I'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

1:59:50even 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

2:00:55like 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

2:01:58some 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

2:02:58things 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

2:04:00these 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

2:05:01like 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

2:06:04development 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

2:07:07lifetime 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

2:08:09pointer 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

2:09:10change 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

2:10:14unbelievable 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

2:11:15not 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

2:12:16the 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

2:13:20right 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

2:14:23doctor 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

2:15:25watching 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