Protect Your Brain, Extend Your Life: 7 Mistakes to Avoid for Better Cognitive Health with Dr Tommy Wood #681

0:00It's never too late to start thinking about dementia prevention. Studies in individuals in their 60s, 70s, 80s, they start an exercise program, they start with some dietary change, they do some cognitive training, you know they start language or dance classes or they start to improve their sleep, you start to see benefits. So start wherever you are and even just starting with one thing can have significant benefits. Hey guys how you doing? Hope you have any good weeks so far. My name is Dr. Rongan Chatterjee and this is my podcast Feel Better Live More. For many if you listening today's guest needs no introduction. Dr. Tommy Wood has been on this podcast more times than almost anyone else. This is his fifth appearance and every time we speak he gives us something new to think about when it comes to brain health and meaningful longevity. Now if you're

1:03new to Tommy he originally trained as a medical doctor and now he's a world leading neuroscientist and performance coach whose research spans brain development, traumatic brain injury and dementia. His very first book The Simulated Mind came out earlier this year and is honestly a fantastic weed for anyone who's interested in brain health, focus and longevity. In this conversation Tommy and I explore seven common mistakes that many people are making when it comes to protecting their brains. Now some of them may surprise you but honestly there's no need to worry because as ever Tommy is full of practical ways to address them. We talk about mindset and while you're beliefs about aging shape how you go on to age we get into blood pressure, blood testing, supplements or all health microplastics and whether or not you should

2:05be filtering your water and perhaps most importantly if all we debate the risk of becoming so focused on optimizing your own health that you forget about other people. As Tommy says social connection does not just make life feel richer, it helps protect our brains and extend our lives as well. So if we chase longevity but lose our connection to others along the way well maybe we've missed the entire point. This is a really empowering and practical conversation that at its core has the message that it's never too late to make the simple changes that can improve the health of your brain. You are back this is number five. Wow I think that's a record. Yes thank you just just gone ahead of Gabel Mase. Number five. Well hopefully it's not a competition

3:10we have to keep having because I'm sure he'll win out but while I'm ahead I will enjoy it. What I was thinking about how to go about our fifth conversation I was trying to think of a different framing and the framing I thought would be quite fun and useful for people is basically around the common mistakes people make when it comes to brain health and longevity and health span. So you got for this? That's great. Different kind of form. Yeah. Mistake number one I think relates to mind sets. We neglect how much our perception of aging impacts how well we age and in your latest book which I love you quote the Ohio longitudinal study of aging and you write that those were a more positive perception of aging were found to live on average seven and a half years longer. What's going on? There's several things going on and it's difficult to tease the model part

4:13in a study like this but essentially what they did is they asked people how they felt about the process of aging so they asked them to ray on a scale of you know one to five how do you feel about questions like when I get older or when people get older they become less useful things like that and those who had a higher level of the positive perception of aging tended to live longer like I said seven and a half years longer on average and then you have to adjust for other things like age and health status and some other things and some of it could be what we call reverse causality right so if you're already feeling out you're experiencing the process of aging you've lost some of your health then you might feel more negative about aging and it's the health that's really driving it rather than your perception so some of that is certainly playing a role but I do think that having a positive outlook on the processes of aging will then allow you to

5:13continue to engage in the world in a positive manner that then drives a whole host of benefits and we know that mindset and how we feel about our own health and our well-being are important drivers of our physiology and important predictors of our long-term health so some of that reverse causality is possible there too but we do know that how you feel about the future and how you feel about your health and then aging as part of that is going to change both how you interact to the world and change your physiology and I think that that's what we're seeing some some of in in that particular study and where this then becomes really interesting to me is when we think about this idea of chasing longevity in particular then inherent in that is some idea that aging is bad right because in order to fight against aging you have to think that aging is inherently

6:14detrimental and yes we we know that with aging you will lose some function it just it is what it is we can't prevent it entirely but if you have a negative perception of that then when you start to see aging happen regardless of your efforts I think that could then have an even worse effect on your psychology and mindset because you've kind of internalized this idea that aging is bad when with aging could come a whole bunch of changes in say cognitive function and other aspects of personality that may be beneficial but we might miss out on that if our primary focus is on preventing entirely because we think that it's bad when we think about changes that we can make to help increase our health span we can think about individual changes that we can make but we also need to think about I guess collective changes and the influence that culture and society

7:15has on us so if we're constantly being surrounded by a message that aging is bad how can you fight the aging process stop the aging process it kind of undermines like a central truth which is you're actually aging from the minute you're born right it is just a truth of life when we see this I think I mentioned to this and maybe one of your previous appearance says that there's quite a bit of research showing that cultures where women aging is seen as a good thing report less menopausal symptoms I think that a lot of what we experience we know is based on how our culture sees these processes of aging and I really enjoy there's actually a very recent paper that came out called humans peak in midlife and actually talking about the fact that when you look at just individual factors and we're talking about cognition and personality here primarily

8:20then you might look at something like how quickly can you process complex information and maybe do some kind of nonverbal reasoning something like that yes that peaks early in life 20s and 30s and then on average tends to decline but that's one very narrow idea of cognitive function right so when you look across a whole different range of things that the brain does and they sort of had various scales and ways to integrate all these different things you think about the fact that other things increase over time and maybe even into our 60s and 70s things like crystallized intelligence which is a fancy word for wisdom but also emotional intelligence and like moral reasoning right on average a 20 year old probably isn't as good as sort of like thinking about the moral big picture as a 40 56 year old because they have more experience they've kind of integrated all these different things so when you look across all those different factors then on average people sort of tend to peak somewhere between 55 and 65 sort of like you have

9:21you still have a good cognitive function plus you've built other aspects of wisdom and emotional intelligence and sort of integrate and like that's actually when people tend to peak and so that's after the menopausal transition in women and obviously it's you know similar ages seen in men so we can continue to grow cognitively emotionally and see benefits from that you're much later maybe than than people might otherwise think yeah what's the practical take on then for an individual is it a bit like gratitude where if you focus on what you lack you lose what you have yeah I think maybe it's worth just talking for a minute on the the process of aging and what what aging is and there are lots of different theories of what of what aging is and so like one is actually the developmental theory of aging which is that aging is the continuation of developmental processes the caused growth earlier in life and then as they sort of continue decades later they actually

10:24drive a functional decline although what I would argue and this is right the major point point of my book as well is that it it might be that we stop giving the body inputs that maintain function and then that's why function declines and that would make sense with development because development is all about building function relative to inputs so if you stop giving those inputs then function declines because the body is trying to match function to to whatever it is that you're you're doing so that would fit with the developmental theory of aging but there are other theories like the information theory where you know damage accumulates and you know DNA doesn't replicate as well and then the that kind of drives these aging processes but regardless of you know what aging actually is which people don't actually agree on what aging is the one thing that most people do agree on is that we we may not be able to slow aging down but we can accelerate aging right and that's by not sleeping and eating a poor quality diet and not moving and you know not being socially connected so

11:28when we're thinking about aging in general know that the best place to start is just do those things that I just mentioned the things that you talk about all the time because by not doing those things you could accelerate the process of aging you probably can't slow aging down or at least at this point we're not sure how much we can slow aging down so then if you tick those kind of boxes those big boxes that I think each of us can do in our own way and can have a big impact even with relatively minimal effort then the rest is just acknowledging and understanding that yeah things will change over time but you also see you know with this kind of idea that humans peak in midlife you actually tend to see an increase in satisfaction with life and happiness as you get older and that's probably a a downstream effect of all these things kind of integrating and coming together so the maybe the main takeaway is in that kind of middle portion as you transition into sort of mid and later life just don't maybe don't fight it as much because then it's just a it increases

12:31distress without you're any kind of major benefit of it and so so it's just acknowledging that it's happening acknowledging that actually there was some there's some benefit to it and at the same time you're you're doing you know you're kind of covering your bases so that you're not kind of accelerating any kind of biological process associated with aging but but I think just knowing that it happens and knowing that actually there's some net benefit to it is probably a starting point because then you're not constantly fighting your biology which is going to win out at some point so it's interesting it makes me think of the stress response and I guess a more spiritual or philosophical explanation of stress is to do with resistance right if you resist what is happening that is what creating the stress yeah the more you can accept and not resist the less stress you are going to experience and I guess we could bring that argument in here and go if you try and resist

13:31the aging process to a degree we're not saying don't do the things that are going to help you age well but the more you resist the fact that your hair's going gray and that you're not going to run probably your 5k pb at 70 yeah and that's okay yeah yeah just not essentially wasting mental and physical energy in resisting something that will happen to all of us because then you may be more like to see the benefits of the things that will happen as we change over time before we move to mistake number two I've heard you talk before Tommy about how we perceive stress changes the physiological stress response yeah and I think you know we're broadly talking about mindset here and how the right mindset as we age can potentially help us live longer improve our brain health and improve the quality of our lives right so talk to me a little bit about stress maybe from a less philosophical lens and a more scientific lens yeah what it is and how reframing that stress in

14:39particular ways can change the way that our bodies respond yeah so where we've gotten to right now and there's actually been a lot of it in the last couple of years where people are talking about right stress is inherently bad in all situations regardless of what's happening and fundamentally that just is not true the stress response is incredibly important and it's also a general response to the outside environment changing and your body realizing I need to do something in response to this thing that's outside of me that's essentially all the stress response is and that might be psychological it might be physical but the initial response you release adrenaline cortisol heart rate goes up blood sugar goes up your body is diverting resources to allow you

15:42to respond to this change in the environment and it's why historically I the sort of like the the kind of the father of the modern stress response right is hand cell you know right and he called it general adaptation syndrome initially and I quite like that because it's like this is your body signaling the adaptation is required so when you're focused and learning and maybe failing and we've talked about the importance of failure before for building cognitive function and building skills it's stressful your heart rate goes up you release stress hormones like noradrenaline in the brain but it's your brain diverting resources to say hey I need to change my structure my functioning so that I can adapt to this thing that I'm being exposed to and right exercises the same if you did somebody's your blood pressure and measured their heart rate and measured their glucose and cortisol right measured that in you after a paddle game you'd be like god paddler terrible right just look how stressful it is for your body but as a result your body adapts right resting heart rate

16:47improves inflammation improves strength and speed and power improve v02 max improves and that's driven by this stress response so the first thing that I hope that people realize is that stress is useful it's your body's signal to adapt to some change yes chronic stress where it then starts to impact sleep and it impairs your ability to adapt to which can which can happen if you're not a stressor isn't you're removed or relieved or you're unable to process that stress yes it can be maladaptive or problematic but in the moment stress is actually incredibly beneficial and then we know kind of to get to your question we know that how we think about stress affects how we respond to it so most of this work is done has been done by Arlie Crum she's at Stanford she worked as a PhD student she worked with Adam Langer who I know we both love love love her work and

17:52so it's very much in a like Arlie's work is very much in a similar vein but as obviously taking it and built built an amazing career in her own right and what she researches or one of the things she researches is this idea that stress is enhancing and they've done randomized controlled trials where you take a group of people and one group you say just think about how terrible stress is right it sort of it breaks you down it impairs your decision making right it's just you know just really really bad for you stress is debilitating right it prevents you from being able to perform your best and another group they sort of show them videos and they prime of this idea that stress is enhancing think about all the amazing people who've performed under incredible stress so you might talk about Winston Churchill or Abraham Lincoln or Sully Salamberger who landed the plane in the in the Hudson you're famous he said think about all the times that you've performed under stress like think about how amazing you can be even when you're stressed and then you put

18:55them in a stressful situation and there are experimental ways to do this one is called the trial social stress test where there are different versions of it but essentially you go into a room and there's a panel of people in front of you and they're like you have to speak for five minutes on this topic that you haven't prepared at all and while you do that the audience just sits there completely impassively just like staring at you which is like very very stressful and what you see is that those you're both groups they get stressed right quarter-zone goes up the same in both but you see a few other things that happen in those who are told that stress is enhancing so you see other hormones increasing at the same time so one of them is DHA which is a steroid hormone and that is it like DHA is part of that adaptation process it kind of helps to facilitate growth and the you know the building the adaptation of tissues and that goes up in the stress and

19:55heart and group whereas it doesn't in the stress and debilitating group there have been other studies by other groups that looked at hormonal responses to stressful situations and they found that those who release more DHA when stressed tend to make better decisions under stress it may not be the DHA it may be this sort of like whole physiological kind of setup of thinking that stress is enhancing that you can then or you know being that in that kind of situation where you don't necessarily think stress is debilitating that allows you to make better better decisions under stress but this is very interesting that not only does your mindset change your physiology and response to stress but it may also then change your ability to perform under stress so I think some of this just requires us to acknowledge hey stress is actually good it's a good thing first of all it's for survival but it's also for growth and adaptation and you know making us bigger and stronger and smarter and then acknowledging and thinking about the fact that yeah actually I probably can perform

20:56under stress and then in doing that you will perform better under stress yeah okay let's get to point two okay so mistake number one about having the wrong mindset mistake number two and I can I've started with these on purpose I don't think they're spoken about enough focusing on solo health habits at the expense of social connection and I guess the point to want to make here is if we consume all the health podcasts and hear the list of things that we could be doing and perhaps should be doing to optimize our health and longevity you could end up living quite an isolated life if you were going to get your five hours a zone two and do you know region four by four and never eat out late and all this kind of stuff you could find yourself spending a lot of time by yourself yes you've optimized certain metrics but potentially at the expense of social connection yeah I think that this is in particular a risk for those who are very hyper focused on on this area

22:04and and I don't think any of us needs to go very far to see examples of this in popular media social media where people who are trying to push say the edges of longevity essentially live indoors by by themselves with a very perfected sleep schedule food schedule supplement schedule and it's very possible that they'll live a little longer I don't think they're going to live 20 years longer but I I think that it's possible they could undo or even go in the other direction because by being so hyper focused on optimizing everything which I think is a misnomer in the first place you miss out on this core part of human biology physiology which is the connect which is the connection to others and we know that is health promoting and health driving as well as just being a part of humans evolved so one of my my favorite stories around this goes back to Charles Darwin

23:13because when we think about Darwin we think about evolution we think about survival of the fittest although survival of the fittest was not his term it was coined by somebody else later but this idea that like it's every species are individual for themselves and it's just like this battle to survive and reproduce and right that's that's how you that's how you win um but 12 years after he wrote on the origin of species which is like the you know the the the set of essays that kind of came that that founded the theory of evolution supposedly Darwin thought well actually survival of the fittest is an idea doesn't explain human evolution and so he wrote another set of text called the descent of man and essentially came up with this idea instead that um the group that was the most he called them sympathetic the like the the group of humans that were most sympathetic we would we would call it empathy now that looked after each other the most that cared for each other the most actually they

24:15would be the ones that would that would survive and that that kind of better explained human evolution and then Dachakeltner uh sort of much later um it ended up calling this survival of the kindest um and there's now a huge amount of uh science to show that when we act pro socially like we connect with others particularly when we're helping others um and this is where some of those ideas of why like purpose and meaning can have such a big effect on our health you can see again physiological responses so you see activation of the vagal nerve and um like heart rate variability improves and you know stress responses decrease and all these things that we know it again tied to to long-term health um and so I think that there's this we know there's this core requirements of our biology to be connected with others and especially to act in in the benefit of others or the benefit of things outside of ourselves and I think we miss out on that when we're so hyper focused on optimizing everything for ourselves individually um and I've seen this a ton with

25:19you know clients that I've worked with over the years where they you know they stop going out they stop seeing friends they stop timing meals and restaurants because they're so worried about the food that they'll eat or whether they won't get to bed in time um you know everything else will kind of fall out of kilter because then they're not at home to kind of get their perfect routine um and I think that the health suffers because of it and like there's there's almost I imagine everybody who works in our fields right I don't see patients clinically I haven't for a long time but you know when you've worked with people as a health coach everybody has a story of the person who essentially gave up their diet and gave up their exercise and just started hanging out with their mates again and all of their health problems improved um and yeah you know there's maybe exceptions to the rule because you know those aspects of lifestyle still do matter a lot but I think there's this critical importance of social connection that we lose out on when we're so

26:19hyper focused on you know getting everything else perfect yeah your book Tommy the simulated mind which you know how much I love it you know how much of what people to get it because I think it's one of the books of the year it's absolutely fantastic there's two studies in that book that I wrote I sort of wrote down to discuss with you which relates to this topic right a Japanese study of 9000 adults greater than 65 years old more frequent social contact was associated with higher brain volumes and less age related white matter injury and then you also spoke about the 2025 world happiness report showing that one of the strongest predictors of well-being across 142 countries was the number of meals per week people share with others I mean this is huge right because as we're talking about here you can solo optimize but you miss out on all of the social inputs and if we go back to your 3S model which I'd love you to just briefly summarize for people

27:23who've you know come and see for the first time well when we think about stimulating the brain yeah it can be learning new things for sure but you can also argue that having conversations with other human beings being around other human beings well that's also an important stimulus for the brain isn't it yeah so I think it's maybe worth first thinking about today's episode is sponsored by AG1 a daily health drink that has been in my own life for over 7 years now it's natural to look for extra ways to support our immune defences but most people don't want to juggle multiple pills they want something simple effective and easy to stick with AG1 is a daily health drink that provides key immunity supporting nutrients vitamin C vitamin A zinc and selenium all of which contribute to the normal function of the immune system these nutrients are

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30:36join them in their mission to get more people meditating around the world for listeners of my podcast the way is offering thirty three days to establish your own meditation practice all you have to do is go to the way app.com forward slash live more to get started what's the point of living longer and maintaining cognitive function for long periods of time because i don't think it's to stay at home by yourself for more time right more more Netflix watching by yourself you know why we evolved i mean you know i absolutely love a good Netflix change of course but from the vast majority of people and actually yes the sort of the extreme optimizer and bio hackers i think it's it's almost like theater it's interesting

31:37um i'm glad people are doing it because you know maybe i'm sure we'll find out some useful stuff but the vast majority of people don't want to just live longer they want to get to 80 something and be in good health for the majority of that time and why do they want to do that because they want to spend time with family and friends that's like that's what it boils down to so it's the spending time with people that that is the primary motivator for all of this in the first place right so you don't want to miss out on that in the pursuit of it because you're never actually get the thing that you're trying to live longer for in the first place um so i think that for most of us that should kind of like frame why are we even doing this in the first place to kind of to go to the the 3s model so um this is kind of my idea of how we bring together all these different aspects of lifestyle and the environment that affect cognitive function but it's actually this is the same the same principles work for physical function and you know many other

32:39aspects of our health and so the 3s is a stimulus supply and support so stimulus being how essentially how we're using our brains the idea um is that how we use our brains is the primary determinant of how our brains function just like the how we use our bodies is the primary determinant of how our bodies function um and that could be you know learning skill building languages music but of course like social interaction and and there are many examples where there's an outsized benefit from something that includes doing it with other people uh be that volunteering or sports dancing and like similarly languages music often happen with with other people right that's what that's why you do it um is to play with other people or uh perform in front of other people or to kind of do something communally and so that kind of is the driver of adaptation building structure and function in the brain and then you kind of activate networks in the brain in order for

33:41those networks to do what you're asking them to do you need to supply various things so that's our second death so it's a blood supply um energy supply and then nutrient supply so these things come from physical health cardiovascular health um diet quality and then like we were kind of talking about earlier right we know that stimulus drives some version of a stress response this drives adaptation so that brings us to our third death support and that most adaptation happens during sleep but essentially during periods of rest so that's the kind of a major part of support um but then we can support adaptation in other ways hormonal status is important as well as avoiding you know another kind of aspects of physical health that sort of support adaptation and then avoiding things that impair that process so alcohol smoking that certain environmental exposures that that can kind of increase inflammation or oxidative stress and which some of which I think we'll get to today so that's kind of that's kind of the three S's but so many of like

34:41the overall goal of thinking about the 3S model and then many of the primary inputs in the stimulus bucket come from things that either we learn and do with other people or where we can we want to express them and use those skills and abilities with other people or cohesive functions be able to you know play with our grandkids or you know do any kind of sort of sport or other activity with them and that's why we're trying to maintain function in the first place so I really think that that part of human connection is critical to all of this and I will say that I wrote a paper on this with my colleague Josh Turkner a few years ago talking about how the sort of potentially the primary driver of loss of function with age and this was focusing on cognitive function was stopping doing the things that maintain function right stopping stimulating the brain and then when I spoke to my friend Julian Abel who is you know famous for his working compassionate

35:47communities and you know the importance of social connection on health his responses like was yes this is great but of course it's all driven by the human need for social connection because so much of this happens through our connections with other people you know he's absolutely right that is sort of like fundamental to to so much of this yeah can we say that social isolation is a form of stress so yes on multiple levels we we see in controlled studies that being social isolated increases stress responses which you can you know measure through things like horror variability and cortisol levels and there are studies where they've done this for instance NASA another space agencies around the world have wondered how will people do if we if we send them to Mars right so there've been some Mars simulation projects where you put people either on their own or a very small group in a tight combined space for extended period of time and even that for just weeks

36:51significantly increases stress responses we know it's inherently stressful even if there are other people there it's you're relatively isolated because there's only one or two other people and we also know that when you look at when you look sort of across a big population those who are more social isolated particularly those who feel lonely they have other markers of of a heightened stress response so you can measure these stress responses in people who are isolated in a variety different ways either experimentally or just as part of there you know unfortunately where they are in the world right now and on the other side you can also see a response or changes in the brain with social isolation that look like the removal of stimulus and accelerated brain aging so when you look at the areas of the brain that are the human brain that are most driven by the environment and are most driven by experience and sort of interaction with the world around you

37:53they're also responsible for some of our most complex cognitive functions areas like the prefrontal cortex the lateral priorsal lobe at the lateral temporal lobe so kind of like the front and sides of the brain essentially which are responsible for things like decision making focus and attention memory language you know vision or visual processing social cognition things like that these areas of the brain are essentially completely undeveloped at birth they are their development is driven by the environment and how you engage with it during childhood and then early adulthood but these are also the areas of the brain that are most susceptible to the process of aging particularly the removal of stimuli right I mentioned earlier that part of the reason why I think our brain ages because we stopped doing the things that help build these functions in the first place interacting with other people learning skills focusing on stuff you know kind of doing complex activities and those areas of the brain that I just mentioned when you look at people who are

38:55socially isolated those areas of the brain are the areas of the brain that tend to either get smaller or tend to lose function and they've done studies where you look at yeah so people from those like sort of simulated Mars trip studies or people who were polar explorers right on their own off you know on some snowy glacier for months on end or in a prisoners who are placed in solitary confinement those same areas of the brain that I mentioned tend to lose structure and function as a result of that loss of social input so not only is social isolation and loneliness not only are they inherently stressful you're also removing a critical input that maintains these really important structures in our brain even if you're a polar explorer right and you're getting stimulated by all kinds of things in your environment and you know you have to be vigilant and all kinds of stuff right even with that kind of stimulation you're missing out on a very important

39:59part of stimulation or stimulation for the human brain and we may be think the brainy stimulation and this I guess fits in with this second mistake of focusing on solar health habits at the expense of social connection let's say you're an 80 year old and you live by yourself okay and you've heard Tommy Wode or you've read your book you go yeah I need to stimulate my brain so you are learning new skills on your computer your competing at chess online with other people but you're doing it all in isolation so you're giving it a lot of stimulus but it's individual stimulus as opposed to social stimulus can we say then or or do you can we hypothesize that even with all of that stimulus you are still missing a significant primary stimulus that the brain needs which is social connection the way that I would answer it is that if that person feels lonely or feels

41:02beyond what they're currently doing they lack some kind of purpose or meaning then yes I think there's more to be gained if that life is incredibly fulfilling to them which for some people it will be then no I couldn't say well you have to go out and make friends right so I think some of it is going to come down to like fundamentally how do you feel about the kind of setup and your current connection to other people because often when you talk about social connection and rightly so some people will say this is directed at extroverts who like you spend time with other people I was just going to bring up exactly and you can be connected to a lot of people and still feel lonely and some people only do a very small amount of human connection to feel like they're getting everything they need my friend Dr Ben Ryan who wrote an excellent book called Why Brains Need Friends you know talks about you know a flower in a pot and like some people

42:08the soil in the pot needs a lot of watering right needs a lot of social connection for them to feel kind of fulfilled but like some people are a succulent or a cactus right they only need a little bit and they feel just fine and like wherever you are on that spectrum is absolutely fine as long as you're getting what you need to feel like you're connected to feel like you're supported to not feel lonely to feel like you have you know some kind of you know your life has some meaning you know outside of do you just yourself so I want to make that very clear that it will come down to how you feel about the situation yeah that's a really important point and I think for those people who were pushing back when they hear social connection I think that hopefully appeases people and helps clarify things okay we've done two of these mistakes so far mindset and this so they'll health have it focused at the expense of social connection I'm going to go to some areas that I think we haven't spoken about before one is blood pressure so I would say mistake number three that I think gets made a lot is ignoring high blood pressure do you agree with that statement

43:13yeah yes and I didn't necessarily realize it until I was doing the research for my book but the evidence for blood pressure management and dementia risk is actually incredibly strong it's one of the few interventions where we have multiple randomized controlled trials that have been put into meta analyses to show that if you address this risk factor you see a significant reduction in dementia most of the other things we talk about come from big population studies observational studies yes we're pretty sure that that connection is there and if you you modify this risk factor you'll see you'll see benefit but blood pressure actually has really high quality evidence so when we talk about blood pressure normally we're usually thinking about heart health right and you know heart disease risk and it's obviously important there too but if I've learned one thing over the past few years is that even when people are taking cardiovascular disease risk fairly seriously

44:20it's not as much of a motivator for behavior change as we might hope whereas when we think about this in terms of our brains often that's the right somebody wouldn't maybe worry about that blood pressure that's always a little bit high it's probably fine when you then realize that this is a critical risk factor for the majority of dementia both Alzheimer's disease and vascular dementia which have a lot of overlap and they between them the makeup 70 to 90% of dementia's often that's the key maybe to for people to think about it but we don't really think about the brain when we think about blood pressure but we know that once your blood pressure goes you're much above sort of 120 over 80 and you're really once you get into the sort of the metabolic syndrome criteria level of blood pressure which is you want over 130 over 85 you see a significant increase in the risk of dementia and if you can reduce it you see a significantly reduced risk of dementia and the sort of the average benefit

45:22if you can get your systolic blood pressure down by about 10 points you see a significant benefit in terms of your dementia risk so there are multiple ways to do that right we know we can do it through physical activity we can do it through other you know other lifestyle changes to improve metabolic health but these studies are with blood pressure medications and you see significant benefit in terms of dementia risk so if you need a blood pressure medication or your blood pressure is high and is not fully controlled you know I think that is something that we really should take seriously yeah I guess one of the problems with or or potential problems with blood pressure is that people often don't feel anything wrong yeah they use the sign that killer right I think so in medical school I'm pretty sure that's what we used to get taught that it's just going on in the background I'm literally at the moment trialing the high low bands I think it's the to my knowledge it's one of the only FDA approved continuous blood pressure monitors the goal is that that is telling you more accurately

46:28whilst you're going about your everyday life what actually is my blood pressure doing yeah but of course you know there are 24 ion monitors that you can get on the NHS so there's all kinds of ways but I guess the message you're sort of I guess trying to get people around brain health is get your blood pressure checked yeah and we've now got to a point where yeah you could go to boots and a blood pressure monitor was it 20 or 30 quid yeah probably not that much I mean right and if you do it two or three times a day at home or you could even get it you know your GP could prescribe it for you on the NHS right so you might not even have to pay for yourself but just like like you said having some some idea what's in the morning what's you know in the afternoon take it two or three times a day that's going to give you a much better picture plus you get used to having your blood pressure taken so you have less of that kind of anxiety of you know it feels kind of weird and yeah getting stressed about what it might be and I think now it's gone to a point where blood you know relatively regular blood pressure monitoring is something that's

47:29easy for all of us to do and and you know we should be doing yeah I think that's a good segue to get into the fourth mistake which is not doing any form of blood testing until maybe until you get sick right before we just jump there though I guess this is related to blood pressure I mentioned early one in this conversation that's over the last 12 months I have taken up paddle one thing I've noticed since I started playing and you got a bear in mind it wasn't as if I was sedentary beforehand I was already I was say pretty healthy before I started paying paddle my resting heart rate has gone down by about four beats right that is significant we never covered resting heart rate before there is a linkage here with blood pressure of course but you know as well as being a brain how that's but you were a performance coach for for me the one driver's and a lot of high level athletes what is the benefit of a resting heart rate going down in this context yeah the

48:33the there are several metrics that you can sort of track physiologically that do seem to correlate with longevity chronic disease risk you know hard disease risk in particular and resting heart rate is is one of them heart rate variability is another and I imagine if you're resting heart rate it's dropped to your heart rate variability it has also gone down yeah and then resting respiratory rate is another one that there maybe we don't appreciate as much which is basically you know how many breaths you take a minute and that also seems to be a good predictor of you know stress burden other things as well as being you know related to some aspects of long long term health and when your resting heart rate is lower your heart is essentially more efficient right to to get blood around the body and we know that those who have a lower resting heart rate tend to be fester they tend to live longer they tend to you know have fewer chronic diseases less less heart disease and that's probably a combination of yeah improved fitness decreased decreased stress

49:38responses and you know all those kind of things are related to that so having lower lower resting heart rate is absolutely like a measure of better sort of like overall health of fitness like you said in in this context there are times when low resting heart rate can be a bad thing you have later risk of things like heart disease half failure and so by improving efficiency and improving heart function your decrease in the risk of that happening long term yeah and almost certainly had I been tracking my blood pressure which I was not I might also have seen that come down as a consequence right because these things of course don't work in isolation let's get to that mistake number four you know this this idea of not doing any form of blood testing until you get sick and and I guess underpinning this as a mistake it's an idea that I don't think is widely known with the public and you know I very much appreciate your take on

50:40this which is this idea that the bulk of our medical education and I would say certainly here in the UK the way that NHS is broadly speaking set up is to diagnose disease and treat it okay and I think it can do that exceptionally well the creation of health is a little bit different from the diagnosis and treatment of disease and one of my frustrations over the last couple of decades or so is being that we in medicine and maybe we could argue there's no resource for that within medicine but for whatever reason I feel that people are allowed to deteriorate somewhat not quite get into a disease category but deteriorate and say everything's fine until actually something happens where we go oh no you've got targeted IBCs let's talk about metformin and insulin and sulfon

51:42are your ears and all that kind of stuff right so this idea that HBA1C for example your average blood sugar marker here in the UK at 6.0 on an old money it becomes pre-diabetes at 6.5 your quarter type to diabetic but that does not mean that 5.7 and 5.8 and 5.9 is fine and many people in the UK if you go and get an HBA1C test from your doctor you're told that's normal now those are the results usually within the NHS I accept at the same time I think our approach to prevention is a lot prehistoric it's kind of a 20th century approach even though we're now at 2026 we're in the 21st century and so I believe it's much better if we were able to track certain

52:46metrics and start to see when things start to go wrong so we can say hey listen you're not pre-diabetic but you're not where you were a year ago you're on the way would you like some help in making some changes which will perhaps stop this process right so do you have any sort of thoughts on that initially at least I completely agree with you this is relevant to pretty much any chronic disease is relevant to we've talked about blood pressure it's relevant to blood tests I mentioned the cognitive tests previously or it like just in passing earlier because nowadays you can't get cognitive tests from a neurologist or an old age psychiatrist or who would ever who ever would be doing it until somebody suspects you have cognitive impairment there had to be some trajectory of decline but we know it no idea where you started no idea how long that took no idea how long you've or like how much function you've lost in order to get to the point where somebody diagnosed you with the same old cognitive impairment from a from a cognitive function test because we

53:49don't track these things over time the a charity that I work with food for the brain that has an online cognitive function test the people can do for free if they're interested but more importantly they just got a big invent UK grant to try and develop it so that it can be used in the NHS hopefully so that people will do it more regularly and then they can track their own function over time but this relates this relates to everything why I think it's so important right is because if you were doing an annual cognitive test you may realize that 48 hey listen at 45 I was scoring here at 48 I've just gone down a bit Jesus hey doc what can I do here so it might motivate people to start these changes earlier yeah absolutely I think that's the case for for many you know very basic blood tests just like it was just like it is for blood pressure we have to have diagnostic cutoffs like the ones you mentioned for pre diabetes and typed to diabetes when when it comes to blood sugar you have to have some decision making point where you

54:51should say right this is the this is right now it's time to treat with the medication I completely understand why we have those that's very important but blood sugar is a good example so HB A1C because two people can have the same HB A1C but have very different blood glucose or blood sugar trajectories or experiences over over the day because HB A1C is affected by many other things including the life of your red blood cells and there's some genetic components as well so what they do is they say you HB A1C is this your average blood glucose was this but actually there's a huge amount of error in that right two people with the same HB A1C can have very different average glucose levels and one may be problematic for the other may not be and so where HB A1C is most useful is tracking your own changes over time so but again you can't do that unless you have a baseline what was my HB A1C when I was young healthy everything was good right because for some people that might be close

55:53maybe not that far from a pre diabetic cutoff from other people it for other people it may be much lower and then it's watching that change over time when it does start to change realizing oh maybe maybe now's the time or you know I should be doing something to intervene yeah this is one of the reasons that I have created something called do health here in the UK initially and the the truth is I I never had any aspirations to do something like this a health app or preventative health app to help people get on top of the health early but what I realized told me is that I've been talking about this stuff with the public now for maybe 12 or 13 years and people were saying yeah doctor actually I get all this but I'm going to my doctor and I can't get this right and some of the tests that you talk about like fasting in stone or home assisting I just can't get I might be able to get an A1C but I can't get it regularly I can't track it yeah and I've been wanting the NHS to do this in the UK for years I mean my honest hope

56:56would do health is that within a few years we'll approved the case that the NHS take it and go actually we want to roll this out let's see what actually happens but this idea that if you can empower people early you can see certain things early you can naturally do something about it and there's you know there's coaching built in and all this kind of stuff which so it's not just do it it's like let's find out where your current state of health is let's help you make changes and then let's recheck to see if those changes actually made a difference I don't want to go through all the tests that we're doing but two I I love your take on and and I really pushed hard for these two because you can't really get these easing on the NHS it's fasting insulin and home assisting both are very important home assisting what we'll start with so home assisting is a is a marker related to methylation in the in the body particularly related to the status of

57:57b vitamins related to methylation so b12 folate b6 and riboflavin for most people potentially you know and that that may be a genetic component as there as well so the two most important are b12 and and folate and we know that having elevated home assisting is associated with a higher risk of cardiovascular disease but also in particular dementia so it also influences the trajectory of cognitive decline so those who have elevated home assisting have a more rapid rate of brain atrophy right their brain shrinks faster and they lose cognitive function faster or they're cognitive decline they're cognitive function declines more rapidly there's sort of the threshold based on the randomized control trials that have been done is probably somewhere around 10 or 11 so ideally you'd get your home assisting below 10 you'd definitely want to below 13 because that's

59:01that's considered elevated and you'd see a more rapid cognitive decline associated with that and then the the intervention that you would do is you know supplement with b vitamins or make sure that you get enough b vitamins in your diet the proportion of people who have very high home assisting has come down a bit in countries that have started to fortify white flower with photoc acid so in the big population studies done in the US where they started to fortify flower with photoc acid in 1998 the proportion the number of people who had elevated home assisting did decrease after that so just we know they're getting more of this in the diet definitely I bring some assisting down randomized controlled trials have used folate and b12 and then plus or minus b6 as well and we also know people in particular people who have a MTHFR polymorphisms they have elevated home assisting if they don't get enough rye of flavin but by enough I just mean

1:00:03the the recommended daily I know what you mean when you say that but a lot of people will hear MTHFR polymorphism go say come again could you could you just try and explain absolutely enlaimers us what that means today's episode is sponsored by ex-hale coffee who are literally offering you a free bag of coffee now if you know me you'll know that I absolutely love my morning coffee for me it's about ritual enjoyment and starting off each day with intention a few years back I switched to ex-hale coffee you see most of the coffees on the market are over-roasted and have lost up to 90% of their healthiest compounds and were still many have been contaminated with mold micatoxins or pesticides ex-hale independently test their beans to produce a coffee that's higher in the good stuff

1:01:06and has none of the bad in fact an independent test found that a single cup of ex-hale coffee has the same antioxidants within it as consuming 55 oranges now if you're hesitating to try ex-hale because you're worried that being healthy it won't taste as good ex-hale removes the risk they are so confident that you'll love the taste as much as how it makes you feel that they'll send you a bag to try for free they'll even cover the cost of shipping so you won't pay a single penny head to www.ex-halecoffee.com forward slash live more and tell them where to send your free bag of coffee today's episode is sponsored by do health the preventative health app that I have helped to create to transform the way we think about health now as you've probably heard me say before there are specific blood markers that can show you your it elevated cardiovascular risk

1:02:07years before you ever feel a symptom in fact 46% of due health members had hidden cardiovascular risk they potentially had no idea about over 25% of members had suboptimal home assisting levels which is linked to an increased risk of Alzheimer's and this is exactly why I decided to build do health to help people understand when things are starting to move in the wrong direction inside their bodies instead of waiting until they get sick do health takes everything I know about health including my four pillars and makes it personal to you an initial blood test screens for over 50 bar markers then zeros in on the 11 core markers that relate to your metabolic health every four months we retest your blood to see what's changing and what is not and in between tests you have unlimited coaching with our in-app coach joy and together we help you build a lifestyle plan

1:03:08personalized to you you can sign it to the wait list today all you have to do is go to do health dot c o for a slash live more and use the code live more yeah so unfortunately um you'll actually you know I imagine a lot of people who who listen to this podcast will have heard about mthfr it's uh it's a gene uh methylene tetrahedral folate reductase um there'll be a test later um that that is involved in this sort of methylation pathway and into which is essentially one one methylation is maybe let's let's talk about that methylation is this process of moving um carbons with some hydrogen's attached is one carbon with three three hydrogens is a uh methyl group moving them around the body and when you move methyl groups you turn on genes you activate proteins you it's like it's really important signaling molecule that we use to

1:04:11kind of control biological processes um and there are you know the the b vitamins are involved in kind of providing the the methyl groups for our body to do that just to kind of move these signals around turn things on and off and so one of the the enzymes in that pathway mthfr it's very common most of us have a polymorphism which is just a slightly different genetic code that makes this enzyme that just changes how that enzyme functions a little bit and we're often you know if you go out into the world and you look up mthfr it's uh usually like sold as this disastrous thing like your body can't do these methylation processes and you need all these fancy supplements to overcome it none of that is true and so if you go out and see a bunch of doom and gloom around mthfr i would ignore the vast majority of it because most of us actually the majority of people have you're one of these polymorphisms that changes activity a little bit but what these polymorphisms do

1:05:16and they absolutely have some kind of benefit right because we are most of us have at least one is that changes how that enzyme binds to a cofactor or cofactor being the thing that just allows that enzyme to run and that cofactor is made from riboflavin which is vitamin B2 and there are studies the randomized controlled trials that show that if you just get enough riboflavin which you can find in whole grains and liver and things like that then it's not then it's not an issue so for most people if you go out and you kind of see what's on the internet you'll be told that things like homocysteine and methylation are driven by your genetics then not they are largely determined by nutrient status just getting enough B vitamins so if you just get the recommended daily allowance you've ticked that box but if you do measure homocysteine and it's elevated then the other B vitamins are a great place to start there are some other things that you can think about

1:06:17as well but you know those core B vitamins are really the main drivers this just highlights something that has happened in the last 24 hours so one of my really good mates has just done their due health blood tests and he tests me yesterday same way I've got my results and I'm loving air loving the whole thing and they're out of the explanations so mate if you're open to sharing some of these things and I can give you some advice if you want now you know he gets advice on the app anyway but his homocysteine was 15 okay well now why I why I'm so passionate about this Tommy is that you've already mentioned and I don't know if we've covered before or not but this idea that elevated homocysteine can increase your risk of cognitive decline as you get older he has a family member who has got dementia now it could well be for this individual that

1:07:19this elevated homocysteine is increasing his risk of cognitive decline like some family members of his I'm being very careful so it's not possible to identify who this person is I'm talking about okay as I was really interesting as if you don't have your homocysteine checked which is the norm at the moment I was saying the NHS then you don't know a critical piece of information but it's actually quite easy to address yeah I said to him listen mate you can try it with diet if that doesn't work it's quite easy with relatively simple supplementation of B vitamins and folate to bring that down I said at the same time mate you've got to be you've got an Sun that your omega-3 status is also important here you know but the point is is that that piece of information will directly impact his behavior and when he rejects the bloods in four months we will know has that made a difference if

1:08:20it has great have we bought it down under 13 but ideally under 11 under 10 and that is a meaningful piece of the picture in terms of his risk of getting to mention in the future so when I think about prevention one of the things that led to me doing all the words to try and create this is to go well there is another model out there for prevention that doesn't currently exist but any comments it's all on what I just said about homocysteine and sort of my friend and how he can meaningfully reduce his risk of getting sick in the future yeah one of so one of the reasons why homocysteine isn't routinely measured is because homocysteine had a moment 20 years ago in cardiovascular disease and neurological disease or neurodegenerative disease prevention and then there were some trials where they gave people a bit of a bit of a bit of a bit of a bit of a bit of a bit of a bit of a much of an effect and so everybody like if you speak to neurologist now most of them will say oh well

1:09:22we looked at homocysteine and we tried it and the supplements don't work now the critical part of that then is what you mentioned about omega-3s and this is now been replicated in multiple clinical trials and it actually makes perfect sense that if you take a person and they have insufficient levels of one bevitamin they're probably one vitamin one nutrient they're probably going to be insufficient in others right not everybody but in general these things don't calm one at a time and when we've done clinical trials in the past we haven't looked at a full picture of some of these nutrient status and kind of addressed multiple things at the same time we just like we just we've done the same thing with omega-3s actually this person's at high risk of dementia we give them omega-3s does it decrease their dementia risk now it doesn't seem to have a big effect in most clinical trials because we didn't check whether this person needed more omega-3s in the first place or plus nutrients don't act one at a time yeah right in order to like ascend to send a signal in the

1:10:28brain you need bevitamins right for mitochondrial functions right to for your for your brain to make the energy to send the signal in the first place and then you need to send that signal down a long kind of arm of the neuron we call an axon and it's got this sort of wrapping a fat around it to kind of allow that signal to be transmitted faster called myelin and then it's like iron status is really critical for myelin and then you get to the end and you're trying to send the signal if it's like a serotonin neuron right then we need vitamin D in order to make that serotonin in the first place and we need a omega-3s to kind of sit at the end of that neuron at the synapse that sends the signal to the next neuron we need like dHA which is a long chain omega-3 kind of concentrates the eggs it's really important to kind of make the little sort of envelopes or vesicles of neuro transubits to send them right so you need all of those things for that to happen at its kind of

1:11:28best and so for this reason when you look at sort of multi-component interventions or you look at the status of multiple nutrients you see that they interact so the first time this was found this was the Vitacog study run by David Smith at the University of Oxford yeah and this was the first study to show that if you have people with high home assisting and you give them BVTM's you slow their rate of brain atrophy and cognitive decline but only if they have adequate omega-3 status that's now been replicated in multiple clinical trials you can't just address one or the other you need BVTM's and you need omega-3s so this is one of you're thinking about this is like a single variable nutrient problem is one of the reasons why it's hard to get a home assisting test today because those previous trials didn't kind of address this full picture but that's the kind of hangover of the kind of reductionist approach to health that we've taken right which is obviously

1:12:31how we test pharmaceutical interventions you know you go 100 people 50 get the drug 50 don't is there a difference yeah but of course as you're saying you know and I love the vice-cultural other side there they yeah lower the homocysteine and it will lower your risk of cognitive decline if you have sufficient omega-3 if you don't it won't yeah I think is very very empowering which is why I told my buddy it's so like there's a yeah omega-3 needs to be there as well right so of course testing omega-3 is a little bit harder yeah do you think people need that or if they're I guess if you're if you're reaching fatty fish two to three times a week do you really need an omega-3 test yeah maybe if you're vegan it's a good idea you know how do you think about this yeah it's an important question because very quickly we can accumulate a large you know bill of test yeah a large costs for for all these tests so I will say that so food for the brain the charity that I mentioned does have an at home blood test called the drift test that includes HB1C

1:13:35vitamin D home acistene and omega-3 status you have to you have to you have to pay for it it's somewhere between one and two hundred pounds so it's not cheap and I'm not saying that everybody needs to do that test but if somebody wants to test omega-3s right that that is an option the when you then think about testing omega-3 status dementia risk if you're regularly eating fatty fish cold water fish sardines macro salmon two or three times a week you probably don't need you probably don't need to test equally if you're not doing those things and you'd rather just you know take a high quality fish oil or omega-3 supplement I think that's fine too and often you know when I talk about this yes those who have a deterian or vegan they certainly have questions I would recommend like an algal you know an algae based omega-3 supplement so it's it's not an animal based

1:14:36supplement but you you can still get those fats you know diet and then you know you take you know one to two grams of omega-3s a day that's probably going to cover your bases that's going to you know that's I think that's going to be enough for most people yeah what we do on do we don't actually test omega-3 maybe it's something we'll bring it at some points in fact one thing I was very clear on is that over testing is a massive problem you know one thing I've I know in America there's loads of companies now who are doing you know we're going to do 200 bar miles we need 400 we need 600 right and I got that one thing clinical practices taught me is that too much data and too much information becomes very very confusing so our focus really is on what I call the 11 core biomarkers which are I think 11 biomarkers which have a really good amount of evidence and science behind them which are all to do essentially with metabolic health yeah and interestingly enough and I I can't remember the exact statistic just on home assistant Tommy I think so far the few

1:15:40thousand people have gone through I think over 25 might be over 30 percent of people have got elevated home assistant which is quite interesting yeah there's been some recent discussion about where these blood test fit in in dementia prevention in particular so I think last time we talked about the Lancet Commission report on dementia prevention run by Professor Jill Livingston they identified 14 modifiable factors for dementia estimated that 45 percent of dementia is maybe preventable if I wasn't in that wasn't it was 14 I don't know it wasn't and so the rest actually letters written to the Lancet where it was published and then this was actually discussed in the sort of popular media as well that be vitamins and omega-3 status weren't discussed you know even though we have some fairly good evidence for those I absolutely don't want to put like words in people's mouths but there was some discussion as to whether insufficiencies in be vitamins and omega-3s were common enough that it was worth kind of you know building an evidence base around them

1:16:44but like I think you're right that particularly as people get older 10 to 20 percent of individuals at least may have elevated home assistant so that's like a significant chunk up the previous analyses done by other groups suggested that potentially up to 20 percent of cases of dementia were related to elevated home assistant and low levels of omega-3s so that's you know even if even if it's not 20 percent it's still a meaningful it's a meaningful contribution to future risks so yeah I think to kind of go to your original point about like what's it worth testing I also agree that just like more testing isn't isn't always the answer and I do agree with this idea that if you're doing a test you should be answering a specific question like why am I doing this test so rather than just like doing a scattergun test everything and right in medicine we have this idea of a pre-test probability like how likely is it that you're going to find something that you and that you can

1:17:45address it yeah and I think that's really important so we focus on metabolic health we know that the vast majority of adults have at least one risk factor for metabolic things right so it's very likely that you're going to find some kind of modifiable metabolic health. That's why we focus on metalwell health and I had a criteria when choosing the 11 that's got to be a good evidence space behind them and we've got to be able to do something with the results and I guess in answering some of the stuff around home assistant in omega-3s we've slipped into mistake number five which is thinking all supplements are a waste of money okay so again the framing here is that Tom has been on this show four times in the past so this is appearance number five if you haven't heard the first four please go and listen to him there are wealth of information the whole point today is to go through common mistakes that people often make when it comes to brain health and

1:18:46longevity we've done four so far we've covered mindset social connection high blood pressure and sort of testing the fifth one which I think relates to what we've just been talking about is this idea about you know supplements thinking all of them are a waste of money I think is a common mistake you've already mentioned the potential benefits of B vitamins and omega-3s I want to go through some other supplements with you to get your take on them but I wonder if it's worth talking about the cosmos trial yeah and what you're taking is on that track because I thought it was really quite illuminating yeah so the the cosmos trial was a recent trial run in the United States thousands of people as a massive trial older adults randomize the four different groups so they had a control group and then they had a group that took a basic multivitamin centrim silver was the multivitamin it is it centrim silver essentially just has a hundred percent of your RDA of like the basic vitamins another group got cocoa flavonol supplements so cocoa flavonols are like the

1:19:51the poly phen like the antioxidant polyphenols that are in cocoa you know you you have similar compounds in coffee tea chocolate berries for example like things that make berries sort of purple and red and then one group got both right so we call it like a two by two design um and what they found was that in the two groups they got the multivitamin there was a significant reduction in estimations of brain age and cognitive functions such that you know on average people's brains acted as if they were two years younger so you kind of saw this slowed slowing of brain aging by taking a multivitamin and this is the most basic multivitamin like you go to boots and you get an over 50s multivitamin that's essentially what it is and I'll also say this about the viticog study the viticog you know often when we're sold supplements and vitamins were like you have to have this fancy version and this bioavailable version is going to

1:20:51cost you know x amount of money the best evidence that we have for multivitamins for B vitamins is the most basic version you know the essential you know some photoc acid and cyanocabalamin if everybody's like there's a form of B12 it's like the cheap the cheap version of B12 that's what showed benefit in viticog just like the most basic low essentially low dose multivitamin showed showed benefit in cosmos and there may actually be a thing where your massive doses could potentially be detrimental whereas you know cosmos just gave you you hit 100% of your idea you've got your basis covered that's it and that showed benefit in the the sort of the cocoa flavonal supplement was a little bit more nuanced where benefits were largely seen in groups that had low diet quality so if you're getting few like plant polyphenol antioxidants because you don't eat many fruits and vegetables or drink much coffee or tea because actually coffee is the most for most people as

1:21:57the primary source of antioxidants in their in their diet if you had a low quality diet there are lots of processed foods just like processed fats and and carbohydrates and few nutrient to a nutrient poor diet then taking the cocoa flavonal supplement was beneficial if you already if you have a high quality nutrient dense very diet it didn't seem to have as much of an as much of an effect which I which I think makes sense yeah there's often been a negative view with doctors around supplements possibly because the industry has been unregulated yeah right which I which I which I get but the truth is is that I have seen so many patients over the years where the right supplement can be game changing but I think the cosmos charge has showed us actually for across a broad population there can be a benefits with the brain for a multivitamin in mineral okay so we're think is a really good take home we've covered B vitamins and omega-3 the supplements off the moment is of course creating okay you take crazy in every day should the listener also take

1:23:02crazy in every day I recently heard this nice idea for how to think about supplements that I hadn't really have for this from as actually was on a panel with Jeff Blan to you know people calling you know the father of function medicine and the first thing that he said we should think about not is will could this work for me is is it safe because if it if it's safe then you can try it with very little risk yeah if we don't have good safety data then the will it work for me becomes much much riskier yeah right and so so chemotherapy right yeah it's like you want really good evidence that this is going to help you before you expose yourself to the downsides because we because there are a lot of downsides yeah and so I think that for most people you know

1:24:04you're a very basic level of B vitamins supplement right we know it's going to be safe if you're not taking your massive massive dose is going to pee out any extra yeah like worth potentially trying especially if you've got some markers to kind of suggest that you you could take it vitamin D trickier because again in very high doses a fat soluble vitamin you don't want to overdose on vitamin D there's some some downsides there but we know people with vitamin D deficient absolutely but you said it's prescribed on the NHS for people who are deficient we know it's important brain health bone health etc then you come to things like creatine one of the reasons why I think it's actually okay that creatine is the supplement at the moment it's because we know it is incredibly safe it's been tested in probably thousands of clinical trials at this point randomized control trials for various people in various conditions low doses high doses years at the time recent meta analysis found essentially no side effects with creatine compared to placebo on average and that's probably because it's something that we can get from the diet

1:25:09maybe not quite the doses that some people might take but you know close so we know you know assuming that you're getting a high quality source it's not contaminated contaminated that kind of stuff all right so you would you want a reputable supplement maker hopefully they've done something called third party testing it's been tested for impurities they can send you a certificate to show that they've done that every every good supplement some company would be able to do that but we know that creatine is incredibly safe even as well like frail order populations so then we might say well is there a possibility that it might benefit me so creatine has been used for decades as a supplement in sports performance particularly strength and power it helps you do an extra rep or two in the gym and then if you do that over time you can build more muscle you can build more strength the effectiveness isn't huge but it is statistically significant and meaningful right it's not it's not magic but it helps you do a little bit more work in the gym in that compounds over time it's become of particular interest

1:26:11in the brain world recently because there have been some studies to show that actually several different studies to show that it might help particularly in what we could call or what I might call cognitively degraded states so something has happened that's affected cognition or mood and then creatine may may be of some benefit there so for the average person who thinks that their brain is working really well there might not be that much of an effect and when you look at metanarcy studies of many studies of creatine it tends to benefit older people and particularly as beneficial for memory that's that's kind of where it's been shown to to have some benefit in other populations the sum evidence is actually better evidence in like kids with concussions but the sum evidence that taking creatine after like a traumatic brain injury may help with some elements of recovery in the the kind of the really flashy study that got a lot of press recently was an individual who asleep deprived and they took a high dose of creatine I was kind of the

1:27:14equivalent of sort of 20 to 30 grams of creatine when maybe a standard dose is like five to 10 grams and they saw that people maintained brain energetics you can do a brain scan you can measure energy sort of the production of a certain energy metabolites in the brain and that was and cognitive function was retained better when sleep deprived when taking the creatine this was like a single night of sleep sleep sleep deprivation and there was an older study and rugby players actually that showed that when they were sleep deprived taking creatine actually a low dose sort of five to 10 grams helped to maintain rugby specific skills when they were sleep deprived similar to caffeine actually because they also did use caffeine in that study as a comparison so in those kind of settings when sleep deprived maybe creatine can help to maintain some elements of cognitive function and then there were a few randomized controlled trials now although some people have suggested that you know they were done in countries where maybe the quality of the science

1:28:16isn't as good as in the UK or the US if some people have kind of questioned the quality of these trials but it's been shown two or three times that in individuals with depression supple you know adding creatine to say a medication regimen if they've received if they haven't had full you know remission of symptoms may may improve like symptoms of like moon and well-being or or depression symptoms and again sort of a five gram kind of dose so lots of different pockets of things suggesting that creatine may be beneficial for the brain across a wide range of doses a lot of people are now saying that you take a very high dose for it to benefit the brain but I don't think we've seen that from the studies I think we've seen benefit even it's sort of a standard lower dose which is five to 10 grams which is five to 10 grams and the reason why they say that is because when you look at studies of creatine like increasing creatine levels in the brain that takes longer and higher doses but you may actually see benefits of creatine before you're seeing

1:29:18increases of like creatine levels in the brain if that makes sense what you don't need to be saturating the brain with creatine to see benefit for the brain because it could be having other other effects there was one study in individual without cybersis where they gave them creatine and sought some improvements in cognitive function however there wasn't a control group and we know that when you enroll people with even with cognitive decline in a study they tend to do better they get better at the test they even though they're some of their cognitive function may be impaired they do better at the test the second time they start to feel a bit better there's a placebo effect of being part of a trial connecting with other people is kind of stimulating in its own way so I tend to not include that trial when I say there may be some benefits for creating for the brain just because it was you know no control group we know in cognitive in studies that look at cognitive function it's really it's really hard to to look at the effect of an intervention without

1:30:23having a control group because you get better at the test there's significant placebo effects things like that so but if you're somebody who identifies with any of those things that I mentioned right steep deprivation maybe some issues with memory when you're older you know you're maybe you're you have been diagnosed with depression and you have had some benefit from a medication but you might consider adding creatine on which is what some of these studies have done then I think is worth trying we know it's safe it's cheap it's not again it's not going to be a panacea it's not going to be magic but you know I think we're starting to see more and more evidence that it may have some benefits for the brain are you happy to share why you specifically choose to take it yeah I mainly take it from a performance standpoint so I train for one compete in Strongman and so I definitely can tell that I just a little bit a little bit stronger you know a little bit faster

1:31:24in the gym when I'm taking it I find creatine to be mildly stimulating for me and that is the case for some people like I kind of mentioned that rugby player study right seeing similar benefits with creatine versus caffeine in the setting of sleep deprivation and so I definitely notice that I take it later at night I don't I don't sleep as well and so for the same reason I do feel like I get a bit of a cognitive boost from it when I take it in the morning but some of it might be placebo right I kind of maybe expect some of that but it could be that if you do get a mild stimulating effect from it whereas caffeine can often like over stimulate people where so say if you if you had several espresso before you play paddle you might be sweaty anxious you like you don't you don't quite have the accuracy because right you're you're sort of overstimulated creating could give us a like a mild stimulating effect and it doesn't happen to everybody but those who experience it you know if you're one of those people maybe it's useful then but in terms of sort of the strength

1:32:28and the power effects and the fact that you know paddle is more of a sort of aerobic cardio type sport it's less likely to give you that kind of performance benefit but there's a possibility of it in some people there may be some kind of cognitive effect bringing it back to the start if you bring up mindset right and so there's good science on creating but if you also believe that taking it is helping you and making you sharper it's hard not to hit the case of that is going to do something as well which is I guess the kind of hidden glue with all the same if you believe something's helping you it it it probably well yeah okay we've got to find mistakes so far we're not going to get to eleven but I think the two I would like to get to because we haven't talked about them before it's number one neglecting oral health and number two ignoring the toxic load of the modern world okay slightly inflammatory but I'm talking about things like microplastics and should we filter our water and that kind of stuff so perhaps we can sort of zoom through oral health point number six what's the relationship between oral health and brain health and

1:33:33oral health and longevity it's been known for maybe 10 or 20 years at this point that there is a connection between oral health and cardiovascular health that was probably I think that was probably found first in fact there are some of the bacteria that you get when you have gum disease or what we call so so gum disease has two stages the first is gingivitis and then if it starts to affect kind of the underlying bone then it would be called periodontitis but I think we could call it just gum disease more broadly and some of the bacteria that tend to overgrow in the setting of of gum disease things like pseudomonas gingivitis and streptococcus mutants you can find those bacteria in atherosclerotic plarks in in the heart which we know sort of trigger trigger heart disease and some of the thought is that because you sort of like have all this inflammation around

1:34:35the gum disease and you know bleeding and things like that that actually those bacteria can get from the mouth into the bloodstream and then can trigger systemic inflammation might trigger the formation of some of these plarks in heart disease and they've actually been found in amyloid plarks in the brain of certain individuals and some people argue that one of the reasons why we accumulate amyloid is you know one of the parts of kind of the process of developing Alzheimer's disease is because it has antimicrobial effects so it's accumulating around say bacteria that might have gotten into the brain and one way that happens and does seem to happen is through gum disease this doesn't mean that if you have gum disease you're definitely going to get dementia right we're all talking about what increases and decreases risk so there are several studies that show that having gum disease is associated with increased risk of dementia in you know multiple sort of perspective is in sort of like you follow people over time studies and then in at least one study they also found that in people who have gum disease

1:35:43those who get treatment for that gum disease something like scaling and replaning which your dentist would do they then decrease their risk of dementia over the next several years compared to those who don't get treatment there have been other studies that show that the amount of antibodies you have circulating in your blood against those bacteria that tend to sort of accumulate because of gum disease the more antibodies you have kind of suggesting that you have had a higher exposure they those people tend to have a higher risk of dementia as well so like from multiple different directions it seems that gum disease is associated with increased risk of dementia and then there's also some evidence that if we treat that gum disease that risk of dementia is decreased yeah basically don't ignore going to the dentist don't ignore your oral health yeah and in terms of xyletol gum you're a fan so yes and my favorite story about xyletol is actually a colleague of mine

1:36:43Greg Valentine who I work with the University of Washington he's run several clinical trials he's still running clinical trials looking at this but his work is looking at ways to decrease pre-term birth so there's nothing to do with dementia although people who are born pre-term do actually have an increased risk of dementia so it could sort of have this full kind of life lifespan effect but we know that having gum disease is a risk factor for pre-term birth because it creates this inflammatory effect that and we know that chronic inflammation is a potential trigger for pre-term birth so baby's being born too soon and the more pre-term you're born the higher your risk of both death but also neurodevelopmental impairment multiple long-term health issues obviously not everybody born pre-term experiences those but it's just on average so he's run multiple clinical trials he's running them in the US right now but the clinical trials he ran already are in Malawi

1:37:45in Africa Malawi has the highest rate of pre-term birth in the world and the majority of pregnant women in Malawi have gum disease and so one trial they did was this large cluster randomized trial where they had different villages in Malawi and they sort of they gave them some of the villages Zyna told gum to chew like three times a day throughout the last chunk of pregnancy and they saw significant improvements in gum disease and a statistically significant reduction in pre-term birth rates which to me is just like mind-boggling amazing and right the design of the trial wasn't perfect they didn't have a placebo gum and that kind of stuff those are the trials he's running right now but like even that you would see that kind of effect is just incredible to me and so we know that chewing Zyna told gum or using Zyna told mouthwashes can address the oral microbiome and it's really the microbiome that kind of an imbalance in the microbiome that drives a lot of gum disease without having negative effects so other types of mouthwashes for

1:38:52example like a alcohol based or a chlorhextine based mouthwash they can actually get rid of good bacteria that you want in your mouth whereas Zyna told seems to particularly kind of decrease the ones that maybe we were like a little bit less of so if you do have gum disease I absolutely goes to your dentist have it addressed whatever they suggest but you know Zyna told Zyna told gum is one thing that you could try at the same time yeah okay very very important message okay the final mistake for this conversation right is say number seven ignoring the toxic load in the modern world now I don't want to scare people okay so I think one of the problems with healthy Zyz people get quite scared and I think we've got to be careful not to do that but I think a few things that people often talk about and worry about are microplastics should people be filtering their water or not in your view and air pollution inside and outside so wonder if we can just sort of talk about these themes and how they relate to people's lives yes so

1:39:58the the issue with all of these is that there's absolutely some important signal and as it relates to these exposures and in our health but there's also a huge amount of kind of hyperbole and it's overblown and there's a ton of scam ungrowing but there is sort of like in the middle of those I think there is a way for us to navigate it fairly reasonably without sort of being overly stressed about what it might mean or you know overselling the effects of these things on our health so I think we can go through them one by one microplastics certainly got a lot of press recently and these are essentially the breakdown products of plastics that you know we use for packaging for food or you know utensils or other things so our primary

1:40:59our primary exposure is from the food that we eat you can get some from like skincare products and things like that but there there have been some recent studies to suggest that maybe our primary exposure is through food food and drink and a couple of years ago there was this study that said you know the average human consumes a credit card's worth of plastics a week or something and then everybody lost their minds then some more recent studies they got a lot less press went back and they read the calculations and they were like we estimate that this is out by like several orders of magnitude it's like not it's like a fraction of 1% of the amount that they said previously so like the decimal place went in the wrong spot the decimal place was like miles out like several like I can't remember exactly how many it was like six or seven places in the wrong place like it was it was it was it was huge the difference and so that's one part is yes we do

1:42:04consume these things but the amount that we've been told with the we're consuming is probably a lot less than than than we've been told then the next part is there have been studies that have looked at microplastics in the body in right tissues of people who've dis who are deceased and like looked at them in say arsory plaques looked at them in the brain and and you know they've they've looked at them in like testicles and other organs and and basically suggested that in those who have a higher disease burden say higher heart disease burden or higher dementia burden they have higher so like people who have a higher dementia burden or people with dementia have more microplastics in their brain um this is certainly possible but there's a few reasons why I'm not yet certain it's like the thing that we have to worry about so the first is that we know that

1:43:05that vascular disease so issues with blood vessels are present in most people with dementia if you have issues with blood vessels in the brain blood flow is going to be slower you're more likely to accumulate microplastics that that might be in your bloodstream so the dementia is probably driven at least partly by the blood flow issue the the the the the you know vascular disease and then microplastics just kind of accumulate you know they come along for the ride we also have a big issue in terms of how microplastics are measured in these studies so when you when you take tissues and then you try and measure them out of microplastics in them the typical way you do that is through something called pyrolysis which is essentially just a fancy word for heating something up a lot um and so what they do is they they essentially vaporize the plastics and then measure it in something called a mass spectrometer

1:44:11the problem is that that doesn't work very well in tissues that have a high fat content like the brain in particular because when you vaporize fat tissue it looks like plastic um it breaks down into the same compounds as plastics do so there have been some papers that say that you're particularly in tissues that have a high fat content like the brain pyrolysis is not a valid way to measure microplastics so it could be that when we're seeing high microplastics in some of these studies it's actually just an error in the measurement right because of the method that's being used so I think that some of that is overblown too so some of the exposures overblown um maybe some of like what we're measuring in tissues is overblown however we do know that some of the compounds that come in plastic some of the plasticizers uh thalates uh bisphenols right um people have heard of BPA right with the lining of cans um and there are many other breakdown products of plastics right they are certainly linked to

1:45:17some changes in cognitive function issues with neurodevelopment in kids um high-risk high rates of heart disease um so these things aren't you know completely benign um and so like I think we can end up down this middle road where we're like yes some of it's probably overblown or at least we don't have the data to be you know really say that it's this primary driver but we also know that then that they're not benign and we should try and minimize our exposure where we can there was a recent trial where they uh randomized individuals to multiple different groups where they change different plastic exposures and then tracked their sort of levels it was levels in the urine of these different of different plastic breakdown um compounds and the biggest driver seem to be the food so they so they uh gave people that so they they stopped them uh using canned uh or reduced their canned foods reduced a storage um of foods in plastic yeah reduced uh plastic utensil use so you know if you're if you're kind of like staring apart and you've got a plastic spoon

1:46:20right stopping it for a metal spoon or a wooden spoon and then they reduced the number of foods that were just stored in plastic right so you know they actually controlled a lot of the food production process so that at no point were foods kind of uh stored in plastic for a long period of time so you go to the supermarket and you're getting your your veggies kind of loose and you're just throwing them in your basket rather than kind of packaging them up and stuff or you know getting things that are that you can buy loose rather than things of a sort of like pre-chops and stored in plastic that kind of stuff i would say that if you're um going to avoid foods and then not replace them with other similar healthy foods that aren't stored in plastic i would rather you eat those foods right so if you're if the reason why you get you you can eat vegetables is because you get them frozen and they come in a plastic bag but they're already pre-prepared and it's really easy to prepare them and you're going to throw them in a pot and then make make dinner quickly do that right that is has a much bigger signal in terms of benefit but if you can you know don't you don't store your left

1:47:27overs in plastic get a wooden spoon um minimize the amount of foods that you get that that are kind of stored in plastic or right wherever that's possible um drink a few of drinks out of plastic bottles or cans um then do that so wherever you can start to move that need a little bit just decrease your exposure i think that's going to be beneficial but you know what if if the reason you eat beans is because beans come in cans i would still eat those beans right because we know that they have a lot of a lot of health benefits so it's all about just reducing your exposure where you can rather than being really really concerned about all the different ways that you that you might be exposed yeah i think that's a reassuring message yeah i guess importantly i guess we can probably make the case i think that a thousand years ago humans probably weren't being exposed to plastics in this way yeah so it's a it's a new thing so of course we have to see how the research plays out and if we're going to learn more things remember when Dale bredison came on

1:48:30recently to talk about dementia risk and you know brain health um you know he was you know at some what we spoke about micro plastics and i think to be fair today all he said look we we don't know the full story yet i said to him have you seen enough to make you at least reduce how many micro plastics you're exposed he goes yeah yeah so wherever possible i try not to and i guess that's the approach i've taken for a couple of years i'm you know i try you know it's very rare for me to drink out the plastic water bottle now and let someone apply in for eight hours and actually have you know thirsty right and i personally no longer have done this for a while we'll get a take out coffee in a in one of those containers you know because the heat and that have that interact with the cost again for me and my life that's not that difficult to do yeah um you know and you know certainly at home we we don't store in plastic anymore we store in in glass containers when we over cook food

1:49:34and that kind of stuff so i think there's a lot of practical things people can do without necessarily worrying but i guess time will tell yeah with the science how much effort impact this is having on health yeah okay i'm sure we could talk for an hour on plastic but let's leave it there on plastic what should take on filtering uh drinking water yeah so i'd start by saying that you know luckily for i imagine everybody listening to this podcast are like water suppliers very safe right and so the in many countries yeah in in the in the in the vast majority of countries not not not all but right i i would expect that wherever you're listening to this your your water suppliers is is safe and it's it's not it shouldn't be a primary concern however um we do know that for example you know several pipes in the uk and the us still contain lead right and so there are several places where you drink the the tap water and there's a significant amount of of lead in it um we also know that there are other things ending up in the water that are very hard

1:50:36to remove like uh the pfa's and the like the you know the forever chemicals um plastics and plant and plastic so thawlates and things like that can can end up in the water as well um and we know that these have we know that these have some potentially negative health health health effects so the way that i've approached this is that i do i do filter my water i have an infridge filter you can get a jug filter although um the main thing with the jug filter is just remember to replace it because i know there are people who have a jug filter and then it's in there for a year and then it starts to grow stuff and right you you've probably undone the good work of filtering a filter in your water um right you're probably adding your own contaminate exactly and right and then you can scale that up to under you know some people have you know you can get under sink filters and stuff like that but the i think about it very similarly to how i think about microplastics and actually this now i think about this like um whole topic in general is that wherever whatever you're able to do

1:51:41do that and you're almost certainly decreasing your exposure over time right so most jug filters will do a decent job of decreasing things like lead if there is lead in your water or they'll do a decent job of decreasing thawlates and other things if they are if they are in your water and all of this stuff integrates over time right so if you just continuously do that you'll be decreasing your exposure over time and it's sort of like a other than you know remembering to change your filter it's kind of like a set it and forget a thing it's low low risk high potential for benefit not particularly um cost intensive depending on which filter your filtration system you go for so i that's that's generally how how how i approach it there's probably a level of water filter that each of us could do i i don't think you have to do it but if we're trying to think about something that might give us benefit over long periods of time slow risk relatively low cost i think i think it's a worth considering yeah i think all these things you know it just depends some people get very triggered over water filtration go the tap water is completely safe and it's like

1:52:47yeah compared to you know many countries around the world it probably is certainly here in the UK and i think that's fine and if you are looking to just do a little bit extra as i certainly am you know it's one of those things i didn't do till about three years ago i don't think you know so i live most of my life drinking tap water yeah and i think i'm doing fine and as i learn more i think hey you know what it's not that much of a heavy lift to have a water filter at home yeah so i've got something i think i think it's called aqua true so reverse osmosis filter bought it about two three years ago it reminds you when you filter these change and you know it's just we have a habit now in the house so we fill it up and you pop it on and it you know but yeah it is met you could call that hassle if you want because it takes out lots of good stuff as well it takes out of minerals it takes on the minerals so we have to put some drops to re-mineralize it now

1:53:49someone might call that a faff it possibly was a faff three years ago when i first started doing it now it's just the new norm which is what we do and so i think that's what one thing i always like what you tell me is a very practical nuance approach which is you know really at its heart trying not to scare people and go yes things are changing in the world it is harder to eat nutrient density it is we all been exposed to all kinds of new things now which weren't in our evolutionary history at the same time going back to point number one about mindset worrying about this stuff ain't going to help you that much you know what can you feel that you have an element of control over watch for take on a sauna use filtering out microplastics because i think there's quite a lot of noise emerging now that that could be a good way of removing it from our system yeah so you do definitely sweat out some of these compounds that you get so exercise of course what you got as well yeah so so i i think that sweating is important it is a detoxification pathway in the most important

1:54:56sense right is one of the ways right just like with our liver and our kidneys it's one of the ways the we excrete things that our body doesn't want inside you're in feces skin yeah right yes exactly yeah so i do think sweating is probably beneficial we know that some of these compounds can be excrete excrete excrete and sweat exercise that causes you to sweat is free right so i don't and actually many of the benefits of sauna particularly dry you know dry sauna sort of like a finish hot hot sauna many of the benefits of sauna actually overlap very significantly with aerobic exercise the the pathways they get activated right the sweating um so yes i think sauna is is a possible intervention but i don't think everybody needs to sauna if you've got one and you enjoy it great but equally you could go you could go for a jog go play paddle and you're probably you know sweating out in a similar way so yes i would think about sweating um but however

1:55:58you achieve that sweating um i think matters a lot less well that's a great message however you achieve your sweating it's so do you yeah you choose the answer to see what yeah okay um because i mentioned it let's just touch on pollution in the air because well when i think about have that thing about controllables and uncontrollables okay so we know the air pollution from planes and cars and diesel and stuff can negatively impact human health and increase risk of dementia but there's also the pollution inside our home again i don't think we've covered this before Tommy so i think we have covered the big leave as a lot so um yeah external air pollution i know there's a link to be vitamins and i'm gonna tell you i'll rest so yeah what's your sort of top level take on pollutants in the air yeah so it it's very similar to to the others um yeah i guess we can touch upon that that that the beviative in study this was done um actually at the university washington where i work um and they looked at air pollution exposure so it's particularly

1:57:03people might have heard of PM 2.5 it's like the two like two and a half micron that's the size particles that are released from you know cars and roads and things like that um that seemed to be whether there were other aspects of air pollution as well that are linked to human health but but they're they're kind of the most frequently studied and you know associated with increased risk of heart attacks and and dementia so this study looked at dementia and they found that those who had good beviative in status if they were exposed to high levels of air pollution they had that sort of mitigated the risk of of of of dementia of course this is not randomized controlled trial but um it's thought the exposure to air pollution increases home assisting which we were talking about earlier and so if you measure your home assisting level on its high and then you supplement beviative in and it comes down if it was the air pollution that's driving that you've maybe offset a lot of the risk of the air pollution you're by supplementing with beviative in study i think that that makes sense so it's just another reason to maybe consider getting enough beviative in your diet um then the

1:58:09you know a lot of these sort of inside air um where it's obviously connected to the outside air but because where you've got closed windows you know things sort of like accumulate um over time and so often the um if you if you look at things like the environmental protection agency in the US they sort of have this big part on the website about how indoor air quality is often worse than outdoor air quality um for that reason and so i think that again uh if you especially if you live somewhere you live near a main road or so i live in Washington state in Seattle in the summer we have lots of wildfires like often the the the the air outside is filled with smoke the house smells of smoke um and we know that's linked to poor health you know uh it affects in the in the local population like several studies have shown that so i think in those kinds of settings if you do have high exposure to air pollution then i would consider getting an air purifier it in the rooms that you spend a lot of time

1:59:11and there was one recent study uh where they actually did a randomized control trial of air purifiers in people who have high um exposure to air pollution and they they saw that having an air purifier on significantly significantly reduced blood pressure so again a meaningful intervention that's kind of like a set it and forget it thing in people who have high exposure or high risk you know definitely there's something worth considering but again right we can't you know it's often very there aren't many people who can just move because they have a lot of air pollution right so i think that if you can address that by just you know if you're spending if there are rooms you spend a lot of time in to the bedroom get an air purifier um again over time you're dramatically decreasing uh your exposure with a relatively simple um intervention yeah and of course something we have covered before is the socioeconomic sort of um input here in the sense that you know

2:00:13in in many places in the world your socioeconomic status hugely influenced as how politics yeah you're environmentally right so you know the the the the middle classes and the wealthy people can live out in the suburbs and have um less busy roads around them etc etc so i think we always acknowledge i think it's always important to acknowledge that that everyone has a different ability to make changes uh Tommy uh i i i i love chatting to you you know as you know you're you're one of the doctors and the health commentators who i respect the most i love your your balanced nuanced but also open minded approach to health um i think the book uh the stimuli that i mind is fantastic and i really would encourage people to to pick it up and take a look at it i know we haven't covered some of the interventions we covered before in today's show but i guess just to finish off for that person who has been listening to us talk and throughout the conversations has realized

2:01:21that they've neglected their brain health for a number of years maybe decades and is one doing well you know maybe it's too late maybe there's nothing i can do um what would you find a worse for that individual be i would say that um it's never too late to start and we actually have really good evidence for that um i talked to the you know i mentioned the Lancer Commission report again the first time they published that report in 2020 they even said that on the front page of the Lancer like the one of the world's premier medical journals it's never too late to start thinking about dementia prevention that's because they're focusing on dementia uh but then your brain health more more broadly um studies in individuals in their 60s 70s 80s they start an exercise program they start with some dietary change they start to improve they do some cognitive training some or like some kind of you know they start language or dance classes or you know musical instrument or you know they start to improve their sleep you you start to see

2:02:22benefits you know even at the those later ages so know that start wherever you are and even just starting with one thing can have significant benefits is it taking more steps a day or getting an extra 15 minutes of sleep or volunteering for something like because you because you sort of connected to the stuff that we talked about in terms of in terms of social connection is it just like getting an air filter and a water filter and those are just that's all you can do right now but you set it and forget it or you know you start uh be vitamins supplement um these things we know have significant impact with through very high quality trials regardless of the age that you're at um and by starting one thing sort of like the whole system we talked about the 3S model that whole system shifts in your favor and yes maybe you have to you would ideally make multiple changes over time but these things you know just just one one thing is the place to start

2:03:24and then build from there yeah very very empowering message i just want to highlight your key message from the last couple of appearances on my show about learning a new thing give your brain a reason to grow and adapt and i think since our last conversation which was only a few months ago Tommy um these are some of the comments that came in on the back of that rt has told us she started playing netball and paddle come loud we started figure skating Lin started reformer polatis Dorothy started tap dancing classes so see started heels dancing class Heather started playing pickle ball Louise started ballet after a recent Parkinson's diagnosis and Darryl started playing table tennis and badminton and honestly that's all because of the information you shared on my show so i think you're doing wonderful work Tommy um thank you for sharing your research so generously with us all and uh a little forward to number six at some point in the future um thanks

2:04:25so much for sharing those with me that's that's um so so cool i'm so glad that people are just finding like you said right at the beginning you'll find something that you enjoy right you do it because um do it because it's fun right and then oh yeah just happens to have all these other sort of health benefits on the side so like pick something that you know any of those things that fantastic i'm so i'm so happy people are doing it um i really appreciate your time as always and thank you for having me on really hope you enjoyed that conversation do think about one thing that you can take away and apply into your own life and also have a think about one thing from this conversation that you can teach to somebody else remember when you teach someone it only helps them it also helps you learn and retain the information now before you go just wanted to let you know about friday five it's my free weekly email containing five simple ideas to improve your health and happiness

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2:06:32the podcast with your friends and family all either of you on apple podcasts thank you so much for listening have a wonderful week and please note that if you want to listen to this show without any adverts at all that option is now available for a small monthly fee on apple and on android all you have to do is click the link in the episode notes in your podcast app and always remember you are the architects of your own health making lifestyle changes always worth it because when you feel better you live more