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

seeing at home by yourself, jogging supplements.

It's going to be much more about. Dr. Tommy Wood is a UK trained physician. His research focuses on brain health across the lifespan. How things like exercise affect dementia? If some proportion dimensions are preventable,

then we must be able to change the trajectory of cognitive function and cognitive decline. What is driving this?

“And what else should I be focused on or thinking about?”

How we use our brains is the primary determinant of how they will function. Low HDO cholesterol, high triglycerides, high blood sugar, or high blood pressure. These are all significant risk factors for dementia,

and they are effects of. Tommy, so nice to meet you. I am thrilled to have you here. I think your work is vitally important. It touches me personally because I have to mention my family,

and it's been a very difficult past couple of years. I've been witness to just how devastating the diseases of dementia, Alzheimer's, et cetera, you know, have on not just the individual who's victimized by it, but also the families, et cetera.

And then the basically inhumane way

in which modern health care kind of manages this right now. And so I think your book and your message is one that, I'm proud to help amplify here and to get into with you today. So thank you.

“- Thanks so much for having me and I appreciate that.”

And I'm looking forward to talking with you about it. - Cool. Is it true that the adult brain is destined for an inevitable decline? Yes or no?

- No. How did you arrive at this conclusion? And how do we, how do you support that conclusion? - Some proportion of dementia's are probably preventable. If we think about adult cognitive decline

with a terminal decline to the point where you're no longer able to look after yourself on a day-to-day basis, which we would call dementia. If some proportion of dementia's are preventable, then we must be able to change the trajectory

of cognitive function and cognitive decline in adults. Is this a controversial position to take in neuroscience or in neurology? - Not anymore. Potentially 10 years ago it would have been,

but if you look at probably the best supported evidence out there, formalized as part of the Lancet Commission on Dementia Prevention, spearheaded by Professor Jill Livingston.

It's now in its second iteration that was updated in 2024

where global experts in neurology and neuroscience and the science of dementia and the factors that contribute to dementia risk come together and estimate which risk factors are strongly sort of we would be think

we can causally link them to dementia risk long term that are potentially moreifiable. And they estimate that when you sum up all those different risk factors, it's sort of a statistical approach that says,

imagine that this risk factor didn't exist at all.

“What proportion of dementia would we expect to never happen?”

And when you add all those up, the number they currently have is 45% of dementia's are potentially preventable. And this is published in the Lancet, the one of the premier medical journals in the world.

So at least 45% are thought to be preventable. And the risk factors that are strongly linked to dementia risk are also modifiable, that they weren't yet able to add into their models that some people think it could even be more

than that potentially the majority of dementia's may be preventable. In certain respects, from a non-scientific point of view, like a very basic perspective on this whole thing, issues of cognitive decline are on some level,

a function of a circulatory problem, much like heart disease, these amylide plaques, et cetera, they can deposit it in your brain, are caused at least in part by lifestyle choices that produce them, right?

So why did it take until 10 years ago to come to this conclusion? - It's a great question. Potentially the treatment of heart disease. And we've got much better at treating heart disease

in the last 50, 60 years. That has then changed the age-specific incidents of dementia in the population. And what I mean by that is that at any given age, you are now less likely to be diagnosed with dementia

than you were 20 or 30 years ago. So at 70 years old or 80 years old, you're less likely to be diagnosed with dementia now than you would have been done previously. And part of that is thought to be because we've gone

so good at treating cardiovascular disease, which is a risk factor both ofascular dementia,

and Alzheimer's disease, which has a vascular disease component.

“And that's Alzheimer's disease may be 60 to 80% of dementia.”

So at least 70 to 90% of dementia do have cardiovascular risk factors as a risk, and that's something that we've actually gotten better at treating. But even if you go back to the 50s and 60s, the Seattle Longitudinal Study,

it was one of the first studies where

rather than taking a whole population and looking at their cognitive function and seeing the average 70 year old has lower cognitive function in the average 50 year old. And we're talking broad cognitive function

if you test multiple different functions, you sort of add them up. This is one of the first studies where rather than just taking a big population and looking at cognitive function across that group,

they looked at the same people over a long period of time. And so he brought people back every seven years and re-measured their cognitive function. And what he found first, one of the papers they published

was that cardiovascular risk factors were strong predictors of change over time. So we knew that back in the 60s and 70s,

one of the first published those data.

And then the other thing they found was that the average effect, so more than 50% of people maintained cognitive function from their 50s into their 60s, 70s and 80s. Nowadays, we call people who do that super-ajors, right, because we think it's so unusual.

But actually, we knew them back then that the majority of people sort of 50, 60% maintained cognitive function into those later decades. And those data were actually used to raise the retirement age

in the U.S. in the 1980s. So we've had some inklings of this for a long time. It's just that getting a big enough set of data, finding a system-tized way to really sort of put it together and then frame it as prevention rather than,

these are just risk factors, right, that. And knowing that if we treat heart disease, for example, and as a result, a specific instance of dementia comes down, which is sort of like part of the hypothesis of that. Then for the first time, we can say,

oh, yeah, if we do something at the population level, we can see changes in dementia risk. Therefore, we can now start to talk about dementia. - The statistics bear out a rapid rise in Alzheimer's and dementia.

I looked into this from what I gather. It's due to double in the U.S. by 2060,

going from 7 to 14 million.

There are currently somewhere between 6.7 and 7.1 million people in the United States with Alzheimer's. This is predicted to be 139 million worldwide by 2050. There are 10 million new cases annually. My perception is that maybe it's just my age

or because of what's happening with my mother that this is rampant and happening everywhere.

“So what is driving this and what should we understand?”

Like what's vital to extract from those statistics about this condition? - The statistics that you give and the ones that I gave are both true at the same time. - Meaning there's a high degree of agency

in terms of prevention and yet we're also seeing this rapid rise. - Well, at the same time. And the age-specific incident has declined over the last 100 years, right?

So you're less likely to be diagnosed with dementia at 75 years old now than you ever have been. But you're also more likely to have to ever be diagnosed with dementia because we're gonna live much longer. - Yeah.

- Both those things are true at the same time. People are projecting that the burn of dementia may double or triple in the next few decades. And that's largely due to an aging population. But some people such as those who have analysed the data

and shown that age-specific incidents has decreased have suggested that maybe that that sort of projection is a bit of an overestimate and the increase in burn may not be that large. However, things that seem to be contributing

to it in particular are the ongoing worsening metabolic and cardiovascular health of the population. So we're still seeing even though many things have improved smoking, heart disease treatment, access to education, access to complex cognitive

estimulating jobs, particularly for women, which has sort of massively improved over the last 100 or 50 years or so. That is contributing to some of that decline in age-specific incidents.

At the same time, we're seeing worsening and obesity rates and types of diabetes rates. And we know that those are significant high blood pressure

“as one of the most important predictors of dementia risk.”

So if we don't manage to change that trajectory,

that are expected to continue to drive up

the burden of dementia. However, we say that in the age of the GLP-1 receptor agonist and the other therapies in that class which have huge effects on cardiovascular disease, risk, blood pressure, blood sugar.

So it's possible that actually we're also changing that trajectory due to the nature of those medications, which if started early enough, you would expect to decrease dementia risk because of the effect they have on multiple nerve.

- Given the high degree of agency that we have to save this off, let's get into how we can be brain protective and brain health promoting. And what I like about your approach and your work is that it's grounded in the basics.

“I think when we cast our gaze on the internet,”

there's a lot of fancy due dads

and latest breakthroughs in supplements, et cetera, which is a lot of cherry on top of the Sunday kind of stuff. We're very dialed in on the connection between things like nutrition, exercise, lifestyle choices, recovery, et cetera, when it comes to our physical health.

And we've gotten a lot better about how we consider our mental and emotional health. But we really don't think about this thing between our ears and the fact that these decisions that we're making every single day actually impact,

like how well this is functioning. So what is your kind of top line thesis on how to enter this aspect of the conversation? - One place to kind of transition from what we were talking about to this place is to think about some of the risk factors

that we know are in that list of modifiable risk factors for dementia that were included in the Lancet Commission report. So it's things like education. We know that cognitive stimulus is really important. It's maintaining sensory input.

So hearing loss and vision loss are significant risk factors for dementia. It's all the cardiovascular stuff that we talked about high blood pressure, diabetes, smoking, alcohol, air pollution, obesity,

a head trauma is another one. And when we think about that, we can very rapidly create this massive list of things that we need to think about. Other things that weren't included in that report,

“but which I think we have strong enough evidence”

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

we know are critical for the brain's sleep.

We know is a critical component. And so the way that I think about it and it's probably largely because I spent a lot of my time working with athletes and being an athlete myself, I actually draw lots of parallels

between physical performance and cognitive performance and long term cognitive function because essentially the principle seem to be very similar. And many of the things that you would do to improve physical health or mental well-being

of physical performance, they actually translate very nicely over. It's shocking how they line up like that, yeah. And I think that's lucky, right? Because then we don't need to focus on different things.

We can just appreciate that they're also maybe doing some benefit from it. Well, we're making some kind of peric choice between physical health and brain health. Exactly, yeah.

The way I think about it is very similar to a stimulus recovery adaptation model that you might see in physical exercise. So if you're trying to improve physical performance, we know that the primary driver

of improved cardiovascular fitness or improved muscle size or strength is the stimulus that you apply to it, right? So the training that you do for your marathon or the lifting you do in the gym if you're trying to build

muscle strength, you can improve how you adapt to those stimuli by attending to your nutrition and attending to your recovery.

“But the stimulus is the most important thing, right?”

I like to lift weights and unfortunately, like no matter how many in apps and protein shakes, I have, I won't get bigger biceps on this. I do some bicep curls. And the brain, I think, is essentially the same.

So the thesis in the book is that how we use our brains is the primary determinant of how they will function. And that means that we need stimulus. And I know that this is slightly controversial in the current world where I believe that we're chronically

over-stimulated while being under-stimulated at the same time. We're sort of constantly bombarded with multitasking and multimedia and social media and these things that don't truly drive improvements

in brain function and feeling overwhelmed because of it, whilst not being able to attend to the real focused, deep learning and skill development, which is what really drives brain function. And so the stimuli that we can think about,

and learning any kind of skill development

“be that music, languages, complex motor skills.”

And then also social interactions, which we know is a primary driver of both human brain evolution and then human brain development and maintenance. So we need to think about how we're using our brains.

But then, once you've stimulated a region of the brain by engaging in some task, you need a supply of the things that allow that to happen. So now we're kind of getting into what I call the 3S model, the first S is stimulus, the second S is supply.

And so, right, if you activate part of the brain, the local cells, the neurons, the astrocytes, they stimulate the blood vessels to dilate, to widen, to bring in more blood flow. So that's where we need good cardiovascular health.

Right, you need that to be able to respond to changes in activity in the brain. And then you also need a supply of energy. So that's where we need good energy regulation, good metabolic health.

Because glucose is going to be our primary source of energy,

“but ketones, lactate, right, those can play a role too.”

And then we need a supply of nutrients that kind of run that system.

So things that become critical, particularly in terms

of dementia risk are be vitamins associated with methylation, omega-3 fatty acids, vitamin D, iron, and then some others like magnesium zinc, antioxidant vitamins like vitamin C, vitamin E, and then the antioxidant polyphenols

that you can get from colorful foods do a bunch of cool stuff for the brain. There may be some other precursors like Koleen or Etholomeen that you can get from eggs or whole grains, like those kind of provider structural component.

And we can get into all of these different sections, but so we've stimulated the brain. We've brought in a supply of things that we need to kind of allow it to do its job. And then just like with our physical performance,

you don't get stronger when you're training, you get stronger when you rest and recover afterwards. So this is my third S, which is support.

So sleep is a critical part of that.

That's when all the synapses that you've generated during the day by through your skill learning are cemented and refined to kind of build part of, or it like build new aspects of structure and function in the brain.

And we can see that with skill learning, we can see the brain change on MRI scans as these processes are driven even in older adults in their 60s and 70s. Then we can support those processes

with what we call trophic factors, the things that support the growth of synapses and function and neurons in the brain. So one that's produced during exercise is brain derived in a trophic factor.

Hormones play a role here too. I mean, you had an excellent episode with Lisa Mosko and he that's really her area of expertise, but hormones sort of support brain function as well. And then we want to avoid things that kind of inhibit

that adaptation process. So this is where things like alcohol smoking, chronic stress, air pollution come into play. And so all of these things interact. And the reason why I talk about it in this way

is because it's not this massive list of 20 things you need to attend to. Because stimulus drives the processes of adaptation and stimulus drives the processes of supply and supply drives support, they interact.

And what you see quite clearly is that when you change one thing, you change lots of things at the same time. So you can, so if you start by stopping smoking, right, you've removed one risk fact to be, you also see improvements in information

and improvements in blood pressure. And you're more likely to make other healthy diet choices, for example, we know that that happens. Or if you start to sleep better, again, blood pressure improves.

And the next day you feel more social. And you're more likely to engage in cognitive stimulating tasks.

“So I think about it this way so that there's an in for everybody”

and that in could just be one thing. And then the whole sort of network sauce is shift in your favor. - There's so much in there. Don't worry, we're gonna tease out all of these things individually. But I really like this paradigm,

this 3S model of brain health, stimulus supply and support. And within that, you can't just exercise, nutrition, challenging your brain, stimulating it in various ways, supplementation, et cetera. Within the hierarchy of those respective pillars,

what is to your mind, like the most important,

or is that to reductive? Like you have a whole kind of thing in your book about the problems with the reduction of the nature of science. And yet you get asked these questions that are compelling you to kind of reduce these things down.

- Yeah. So this is actually another part of the question that you asked earlier, which is why haven't we started to think about dementia prevention in this way until very recently. And I think part of it is because we've been chasing down

one reductionist pathway, which is the amoloid cascade.

Not that's not important, right? That should remain a part of our whole picture. But it's kind of, it drew resources and attention away from these other things that we can talk about.

The answer is that it's gonna differ

from person to person, of course.

“And I think that these things shift across the life course.”

So in younger individuals, maybe in their 30s and 40s, I think in general they're probably receiving a good amount of stimulation, unless they're just like home scrolling on Instagram all day, which is gonna be some portion

of the population. But if you think about knowledge workers in their 30s and 40s, they're probably gonna be doing some kind of complex cognitive stimulating work. But what they need is more on the sort of like the support

and recovery side. Are they ever giving their brains a break? Are they spending all their days, task switching and multitasking, which we know are inherently stressful?

Are they giving themselves the times kind of sleep to be able to recover and adapt,

which we know that is critical for the brain?

Then as people get older, we might start to see declines in physical activity or metabolic health. So maybe that becomes a really critical component in mid-life.

And then later in life, particularly as people retire,

“I think that's when they're at the biggest risk”

of a decline in cognitive function. And we see that from the research as well. And so then I think that's where stimulus really comes to the four is making sure that you're maintaining these either complex skills or learnings or social interaction

that you've got from work previously or that you've got from education previously. But then become harder to come by once you've retired. And I think that's one of the reasons why cognitive decline tends to accelerate at retirement.

It's 'cause we lose those stimuli. So I think that as we go through a sort of a standard life course,

the things that are most important are probably gonna shift

in that kind of manner. If the stimulus aspect of this is very interesting, the idea that we're overstimulated in all the wrong ways and understimulated in the right ways. Like just scrolling on Instagram

or offloading the synthesis of information or the processing of information to AI. And like all of these things are basically harmful to our long-term brain health. We think that we're engaged in these tasks,

but we're just basically short-circating our ability to problem-solve and to do the deeper kind of thinking. And in our distracted, we're just so increasingly distracted now that there's great opportunity for somebody

who can carve out, nobody, you can make your way in the world better than ever right now.

“'Cause like the competition is like all distracted, right?”

Yet, when you think of that from a population level, what is that doing to millions if not billions of people? Like that's forward 30, 40 years from now. And what are our brains gonna look like?

Because we haven't really had to do the kind of problem-solving that historically we always have. - Yeah, like an important place to start is that these technologies aren't inherently bad. It all comes down to how we engage with them, right?

So if, so that there's even some evidence of just something like five minutes of scrolling on Instagram, as long as it's not making you mad because of some emotional, political information or as long as it's not only exposing you to people

who are richer, better looking, more successful than you are, which makes you inherently feel worse about yourself that has triggered, triggers effects in our physiology that can negatively affect our health. If it's just like you spend five minutes

looking at dogs doing funny things, which is a lot of my Instagram feed, right? And that can actually be a real mental break that would allow you to go back and do hard work, but the problem is that's not how we're using it.

We're constantly, we're using it for extended periods time, plus using it while we do something else, right? So you're scrolling on Instagram while you've got Netflix on or while you're doing emails or while you're in a Zoom meeting.

And what you see, there's some really interesting studies where they look at how much people multitask across different multimedia in that way. And what you see is that just as you'd expect, if the stimulus is the primary driver

of how our brain's function, our brains do actually adapt to that. So people who do that kind of thing are better at multitasking and the way you would test that in a study is you have one cognitive task and then you have them do have to do another,

like another cognitive task at the same time. And everybody who multitask does worse on both tasks, because the human brain actually isn't

to two different things at the same time. But people who do a lot of Instagram, plus Netflix, plus Zoom meetings, et cetera, they have less of a multitasking cost when they multitask.

The problem is that other studies show

they're also more distractable, because their brains have learned to stop filtering out information from the periphery, because they're trying to attend to multiple things at the same time. So, and then the result is that we're distracted, right?

- It compares the ability to actually do the deep work. - Exactly, because you're not acclimated to it. - Yeah, but this is, again, it's just the brain responding to the stimulus, right? You're training it to do this and it gets better at this,

but there's a trade-off, right?

“Just if you want to be an elite level marathon runner,”

you're not going to be a super heavyweight power after at the same time, right? And this is the brain, you're training it to multitask. So, therefore, it's less good, deep-focused, like a tension-driving work.

So, then it comes down to how are we using these tools, how are we using technology? And, right, the other example that is going to come up with just like you kind of mentioned is AI, right? Anything we say about AI is probably going to be completely

obsolete in two months' time. But I think, again, we can, there's a framework that we can use, and this was some of the stuff that was proposed more than a decade ago by a colleague of mine called Ken Ford,

who's an expert in AI and, like, back when AI wasn't even a thing, he talks about this idea of cognitive prosthetics, versus cognitive orthotics. An orthotic is something that you use to enhance or support your current levels of ability, right?

So, when I think about orthotics,

“I think about shoes for individuals as cerebral palsy, right?”

If, because of, you know, issues with motor control, they're unable to walk, but you give them the right orthotic, they can walk, you've enhanced their capacity. Whereas, you use a prosthetic to replace something that you don't have, you have a prosthetic leg,

because you're missing part or whole of your leg. We are a risk of using AI as a prosthetic, instead of our brain, as if we didn't have one. And we know that when we don't continue to engage those skills or things that we're using AI to do for us,

we will lose those functions,

or we'll never develop them in the first place.

But we could use these tools as an orthotic. We could say, we do the work ourselves, right? And there are some initial studies on this with the students writing essays. This is one study that's sort of a blow up the internet,

was an essay writing study at MIT. So, the students who ended up doing the best with the students who wrote the essay first themselves. And then afterwards, they got access to an AI tool.

“And then it's then you're saying, how can I improve this?”

What kind of do better? What number thought about? What am I missed? And then you take that information and you integrate it back in yourself.

So all of that requires you to do the work, it requires you to be engaged. But you could use these tools to help you learn and expand your capabilities. But it's all going to come down to how we choose to engage with them.

Yeah, are you using them for the purposes of offloading or synthesize it? Like, if you're using as a tool, and then you're doing the synthesis yourself, the heart, the heavy lifting of like,

how do these pieces fit together? That would be brain health promoting. This is, it's a stimulus, exactly. It seems like, in the context of dementia and Alzheimer's, stimulus, speaking of reductionism,

sort of been reduced to this, well, you do cross-word puzzles. And this is like, no, this is not the idea. It kind of writ large is how engaged with life are you? Like, are you actively spending time with friends? Are you engaging with other people?

Are you trying to learn a new skill? Like, on this idea of our brain's maintaining a degree of neuroplasticity throughout the entirety of our lives, is somewhat novel, like, you know, I grew up in a time where it's like, oh, yeah, well, if you're going to learn a language

or a musical instrument, you got to do it when you're young and then it becomes hard. And so we all have that experience of not being as neuroplastic as we once were, and I think we just sort of assume, well, we're just, you know, just becomes harder and harder

to learn new things. But essentially what you're saying is not only can we do that,

it's urgent that we are always kind of engaged in that process.

- Absolutely. I think that sort of whole idea has been embedded in society

That as we get older, we essentially become useless, right? And we're unable to learn new things. We need to be put out to pasture, right?

That was how retirement was framed when it was first popular,

right, back in the beginning of the 20th century was. By the time you're 60, you're essentially, you have no useless society, so we just have to find a corner to stick you in. And we've embodied that as a society

“and therefore this is something that we expect, right?”

This is this idea of stereotyping body material, which is that if we expect aging to be associated with a significant loss of physical and cognitive function, we will stop engaging with the things that maintain physical and COVID-19 function.

Oh, I'm too old to learn that. Oh, I'm too old to lift that. - That's just like all. And it becomes a vicious cycle, exactly. So what you see is that even in people in their 60s,

70s, 80s, when you do a randomized controlled trial of language learning or music learning or physical activity, you can see structural changes in the brain. You can measure improvements in cognitive function. The brain is still plastic at those ages.

It's true that learning is potentially slightly harder and takes a little longer than when you're very young. But that's not because the adult brain isn't capable of change. It's because you have shaped your brain

to allow you to best function in the environment that you've put it in, right? So you don't want it to be really, really manageable

“because it's already become the person that you are, right?”

And that's what you want. So it's capable of change. You just have to engage in the processes that drive change, show your brain that it matters and the way it's to do that is by really focusing on something.

And then that change will happen. And we can measure changes in both the structure and the function of the brain in regions that are susceptible to the processes of aging that become dysfunctional or lose volume

in the processes of dementia. So we can see even later life, we can change that trajectory if we engage in these different truths of cognitive stimuli. - Yeah. (upbeat music) Hydration is one of those things that is far too easy

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and preferences over time and, you know,

kind of, like, groove these ruts in our brain. And we know what we like, we know what we don't like. And, you know, the older we get, we're more, kind of, calcified around,

“like doing anything different or new or more resistant, right?”

As an athlete, like, I want to do the things that I'm good at that I know how to do. Like, I want to go trail running, and I want to go swimming. And, you know, but what I probably should be doing is taking a jujitsu class or an archery class

or, you know, trying to develop a new skill where, you know, in something that I'm not good at. - Yeah, there's this interesting thing that you see in adults, which we've all experienced, right, compared to kids. And I think this is one of the reasons why kids learn

much faster than adults do is that the primary driver of neuroplasticity is errors and making mistakes. So, when you are experiencing the world, you're not truly experiencing the world, right? You're experiencing a prediction

that your brain has of the world as it happens around you. Because everything happens on a slight delay. So, because of that, the brain is constantly looking for errors, mismatches between expectation and reality. And you can measure these mismatches with like an EEG

electroencephalography. You can measure electroactivity in the brain. You can see when the brain notices something that it didn't expect, it's largely driven by, like a drop-in dopamine, and a few other things.

But then that's what drives change. 'Cause the brain's like, oh, hang on a second. I didn't get that right. I need to create new connections. I need to shape something differently

in order to improve my prediction in the future. And we see this from learning research as well. Like, what helps people learn faster

and one of the most important things is making mistakes,

is making errors. 'Cause it drives those processes.

“That's why a lot of neuroplacicity is driven by”

neurotransmitters like Nora adrenaline and dopamine. And these are catacolymes, it's a stressful moment, right? So, it feels slightly uncomfortable. And that's part of the point. This is your brain attending to something important

and diverting resources to change in response. So, what that means for us is that we have to do things that put us in a position to make mistakes or to fail. Occasionally, right? You don't wanna fail all the time

because it becomes very demotivating. But somewhere you can see progression, but occasionally you're sort of like pushing at the edges of your current capability, 'cause that's what drives neuroplacicity.

But adults hate that, right? Any time you think about doing something, you go to a jiu-jitsu class and you're like, the bottom wrong of the ladder and like, people are gonna kick your ass and throw you over their shoulders

and like, you're worried about injury and all these other things, all you're worried about looking stupid. But it's putting ourselves in those situations where we have the capacity to try, fail, learn, go back again.

“That's what's really driving those changes in the brain.”

So, we need to kind of lean into that discomfort. - This is not a retirement that I was in for months.

You know, the idea that like the work has never done,

the principles that drive growth and evolution for mental health, physical health, et cetera, like a polite of the brain. And there is no destination or endpoint to this. And if you wanna protect your brain,

you have to get out of your comfort zone and do things that you're not good at and fail, et cetera. So if you are somebody who is hamstronged by this notion of failure or being in a vulnerable situation, perhaps a mantra is to think of it differently

as a brain-promoting, a brain-health-promoting, kind of exercise that you're supposed to fail. If you're failing, then you're succeeding because this is, you know, in life and anger, circuitry,

and activating your neuroplasticity. - Absolutely. And I think this is where the right social context can make a big difference as well. We know that social connections

are incredibly important part of this. So having other people who are willing to do this with you, you know, you join a class where everybody's a beginner and you learn to get there. Or you're like, you and a friend go to jutsuits together

and you can laugh at each other with you as you like fall over and try and figure stuff out. That's gonna help people feel a little bit more comfortable doing it. Of course, like some people would just like go and try it and they'll lean into it and do great.

But giving yourself a social context to do this and like feel supported and learn together, I think that's gonna add another layer that might make this a little bit more palatable to people who can already feel uncomfortable thinking about it.

- Which overlaps with the blue zone's idea. - Of course. - Like a big thing that drives health span extension is your engagement with your friend group, your community, whatever that looks like

- Yeah.

Let's talk about exercise.

How important is movement to brain health?

“Why is it so important and how should we think about this?”

- It's incredibly important. And the most fundamental reason for that, I think is that historically as a species, we've moved a lot and it's kind of like there's a quote from many goes somewhere on who says that raise.

Movement is evolutionary bait into our genes. It's like a requirement of our biology. If you want your brain and your body to function well, it needs to move frequently. If you think about sort of even just our recent ancestors

were maybe walking 15 to 20,000 steps a day, they were moving six to eight hours a day. And it's essentially required just to keep maintenance and other so that a process is going in the body

and that includes in the brain.

And so because we no longer have that, just like we've sort of engineered the food environment in a way that means we have to invent diets. We've engineered the built environment so such that we now have to invent exercise.

“And now I think we're getting to the point”

where we've engineered the cognitive environment such that we now have to invent new stimuli, right? That's kind of like the next frontier. But we know that different types of movement actually have different effects on the brain.

So even just breaking up periods of being sedentary, what we might call exercise snacks, can immediately boost food, change the blood flow to the brain can immediately change cognitive function. So just starting with regular low-level periods

of movement during the day, we already see an impact.

And we know that the sort of number of steps that you have in a day and it could be right if you don't walk and some people some people can't walk you could be black-prepending a wheelchair around, or however you get about the world, right?

As that increases up to the equivalent of 8 to 12,000 steps a day, you see a linear reduction in risk of dementia and a linear increase in cognitive function. From there we know that it wrote sort of a rogue-type movement. So now if we're getting into a risk walking, jogging, cycling,

this seems to be particularly good for memory function and the structure of the gray matter. So like if you think about the brain, it's this big, wrinkly sort of fatty ball. And the outer part is the cortex is the gray matter.

And there's more gray matter inside, part of that is the hippocampus,

“which we know is really important for memory”

and is particularly susceptible in the later stages of Alzheimer's disease. And so we know that people who regularly do something like brisk walking, they can significantly improve the structure and function of the hippocampus.

There was a more recent study that kind of told us that intensity is also important. So some of the things that get released during exercise, mentioned brain deriving in retrophic facts earlier, there are dozens of myocines or exocines

that get released many of which can impact the brain, but they're released in an intensity dependent manner. So there was another recent study in individuals in their 60s and 70s, they ran themized them into three groups. They had a control group, they had a zone

to blow zone three-ish jogging kind of group, and then they had a high intensity interval training group. And for six months, three times a week, they did 40 to 45 minutes of their chosen exercise. The hip group did the Norwegian 4x4 protocol.

So for those who aren't familiar, it's four minutes of running at 85 to 95% of maximum heart rate. In this study, they had a three-minute rest in between, some studies have four minutes, so those have five minutes, I don't think it matters that much.

And then they do that four times over, and they did that three times a week for six months. And interestingly, what they found was that both the jogging group and the hip group improved cardiovascular fitness by the same amount.

But the hip group had much greater improvements in the structure and function of the hippocampus. And so they did much better on a learning task. And that benefit was retained for five years. They went back five years later.

And they still had maintained improvement. Even though they'd gone back to their previous levels of exercise, they hadn't said, "Oh, I love sprint training." So I'm just going to do more of it. They'd gone back to being relatively sedentary,

and they still had benefits five years later. So that's kind of on that spectrum of aerobic exercise up to sprint training. You see across the entire spectrum, you see benefits. But that type of exercise seems

particularly benefit the gray matter and memory function, largely by improving the hippocampus or supporting the hippocampus. Then I think about resistance training.

is that it seems to particularly benefit

the structure and function of the white matter. So the white matter sits underneath the gray matter, and it's where all the mile in is like all the sort of fat in the brain. And it's responsible for the really fast connections.

“It's really important for our complex cognitive functions”

like decision-making, executive function, that kind of stuff, which we know is lost even early on in the dementia process. And resistance training, something like that the studies have done two times a week. Exercises like on which it would be machines in the gym

that cover the entire body, five or six different exercises, three sets of eight to 12 reps, a very basic resistance training program. Twice a week for six months significantly improves

the structure and function of the white matter.

So it improved executive function and other things. And you can see the changes on an MRI scan. Then the final piece when it comes to exercises is like these complex movements that we might call coordinates of exercise or open skill exercises

often when they call it in the literature. So like a close, skill exercises, something like running or cycling, like unimodal, unidirectional. Whereas an open skill exercise is something like badminton or a martial art that requires you

to kind of learn complex motor patterns, respond to the environment, respond to other people, maybe strategize, you're trying to manipulate your opponent around a tennis court and process information much more quickly, which is particularly important as we get older,

as processing speed tends to drop off, but it is trainable if we're doing things that require us to rapidly process information.

“And this seems to be the best way to support sort of overall”

cognitive function depending on which kind of meta analysis of the studies that you look at. And so that stuff, like I said, ball sports, team sports, board sports, martial arts, dancing, dancing is often like winds out across compared to almost any other activity

in terms of supporting both mental health and cognitive function. So to then kind of like fit all that stuff together, we can think about just like just moving regularly throughout the day, doesn't have to be particularly

intense, just to kind of break up extended periods of sitting. If we can make our sort of aerobic type training, something that has a coordinated component, right? So it's a, and especially if it has a social part, right? So rather than just going jogging, maybe you play soccer

or you play Babinson or even like table tennis. Then I think you can get some additional additional benefits there. Plus maybe once or twice a week, you do some kind of resistance training, once or twice a week, you do some kind of sprint training

where essentially you're just the goal really is to generate lactate. Lactate goes into the brain, switches on production of brain or I've been a trophic factor. And so it doesn't really matter what you do.

It's just something that gets the heart rate up. You feel the burn a bit. And that could be even part of, that could be part of your coordinates of exercise, right? You get a lot of stopping and starting and sprinting

in some things like Babinson or tennis. But something like that. So regular movement, you know, some aerobic sessions being that kind of complex coordinates of movement and then once or twice a week, you do some kind of more intense sprinting a few times

and some kind of basic resistance training program. That kind of hits all those things based on what we know. Even late in life can significantly improve and maintain brain function. Essentially what you're saying is it's a yes and approach.

It's a buffet. It's not about the Norwegian protocol necessarily. That's one piece and a larger hole that encompasses every kind of form of exercise that's driving you effectively forward. So aerobic exercise, resistance training,

dynamic movements and high intensity work and finding a balance. And then the very kind of like low output walking type of activity. All of these things are important for different reasons that impact the brain in different ways.

“And if you want to be as comprehensively brain healthy as possible,”

you have to, you know, tune yourself to all of these different forms of activity. Yeah. There's a couple of important takeaways there. One,

first is worth mentioning that as much as possible, we want to avoid this

kind of like medical, what Daniel Leaveman calls the medicalization of exercise, right, that, and this happens when I, I sight a specific study and you're like, oh, well, then I have to do Norwegian for by four like to benefit my brain. But like, that's not, that's not the case at all. There's a lot of confusion around the Norwegian for by far.

And it, and it all tracks back to our, you know, our deep-seated need to, you know, reduce these things down to like a little nugget that I can remember. I mean, you were a rower, right? So as a swimmer, any, as any track and field athlete or rower or swimmer can tell you,

that program. And I think the Norwegian for by far is a, is an effective,

like, you know, interval modality. But there's many more that, and

“and once you acclimate to that, then you, you need to change it up, right?”

Or you're not actually stimulating your physical body in the way that you could be if you're changing the structure of those interval workouts. Yeah, exactly. And, and so I think if we just think about the physiological response that kind of thing, heart rate goes up, you release lactate is kind of like, you're, you're at that high level of intensity. You have rest periods in between.

So you work hard for a short period of time, you rest in between. That's essentially it.

You're going to be driving those, those physiological responses. If people need, like,

specific protocols, like I provide several in the book that have evidence behind them. But in reality, it's just move really, really quickly, rest a bit. That's going to be, you're driving those functions. Then the, the other thing to kind of take away is that there are sort of these core principles across all these different types of activity, but how you choose to do that is entirely up to you. Because you'll get similar benefits from

dancing or batminton or even your martial arts jujitsu, right? Because it is doing all those same things in terms of like the, the pathways, it's activating. So you can pick one that you enjoy and you want to get better at. And so, like you said, it is a small business board,

“and you get to pick and choose. But don't enjoy it too much. You're going to get stuck there, right?”

Like, that's the thing with me. Like, you know, do I really want to, you know, play pickle ball? No, I want to go do the thing that I don't have to do. You know what I mean? I don't want to, you know, I don't want to be bad. Yeah, yeah. So then of course, we go back to the previous thing, which is, you know, try and find something maybe where you've got something to learn, you're going to, you know, sort of lead into that little bit of discomfort, especially in the

complex coordinates of stuff, because I think that's going to give you extra bang a few of a buck. On the resistance training aspect of this, there's a lot of discourse now around longevity extension and the importance of maintaining your muscle mass. So when you think about resistance training, what's more important? Muscle mass, or is it functional strength? How do you parse those two ideas? In general, your strength is proportional to your muscle mass. So when you're

building one, you tend to build the other. As we get older, often you train strength more than you train muscle mass. But in reality, what you want is to sort of like, the immediate benefits, like just like moving your, having, having muscle and moving it, where we release things that go and support support the brain, it's important for blood sugar regulation, over our muscles are

“our biggest, like, blood sugar sink. For most people, I think that any kind of resistance training”

is going to get you both at the same time. When there are some interesting, like, population studies where they look at strength and they look at muscle mass and they look at the relationship to dementia or heart disease risk or mortality risk. And what you see is that at high levels of muscle mass, you almost start to see risk increase again. So like there are some studies out of the say that a very high levels of muscle mass, you have a high risk of cardiovascular disease, a high

risk of all cause of mortality. The problem is that those studies don't determine how you gain

that muscle mass in the first place. So if you gain that muscle mass through resistance training and exercise, your muscle mass increases in line with your strength. And we know that strength, you know that at high levels of strength, you don't have an increase risk of disease like the high, the high, the higher strength the better essentially. So what you're seeing at the population level is that some people would just gain more muscle mass because they've gained more

total mass. But that's not functional muscle in the same way as if that muscle was gain through resistance training, if that makes sense. So I think that the real kind of takeaway is building strength that's functional and provides relative strength for you. You just need to be strong enough for yourself, relative to your own body size, whatever that body size is. And so if you're you know larger or smaller, you would expect on average be stronger. If you're larger, you would

expect to be stronger. If you're getting to the point where you've gained a lot of muscle mass bit, it's not through exercise. That muscle may not be functional in the same way. So the easiest way to measure this to kind of like give a takeaway is that strength is probably more important than muscle mass. And when you work to improve your strength, you will also improve muscle mass at the same time. So like a final important part, particularly if we think about as we're getting

older, we can measure muscle mass, muscle strength, like how much, like the maximum you can

contract and move your muscles. And things like power are lost the fastest. And that's

important because when you lose the muscle fibers, there are associated with greater strength and power. That's where you stop being able to like stop yourself and tripping over or grabbing onto a handrail if you're about to fall down. And we know then the knock on effects is hip fractures and spending a long time bed bound where you then lose even more physical and cognitive function. It's really hard to come back from that. So in addition to just like any kind of weight

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

jumping in older adults, just like a minute of jumping a day significantly improves like bone mass and and muscle strength and power. So in addition to just like the kind of like say using weights in the gym, just finding something that requires you to jump, you could be skipping ropes. And it could just be like jumping on the spot, jumping on one leg. We know those have additional benefits because you're maintaining some of those, some of those elements of function that we

know are going to be imposing. Yeah, interesting. Yeah, if you are weightlifting like a body builder, but you're not thinking about speed acceleration or compound movements, like don't we sort of want to be like Edo portal or take Kelly Starretz advice and make sure that we're supple and able to bend in all the right ways and move quickly, laterally forward backwards and all these sorts of things that just a straight forward weightlifting, you know, and the

tradition of body building is really not going to do the trick. So luckily, I don't think those things are mutually exclusive. Actually, you know, doing even traditional style body building work can help to maintain mobility and stability. So if people are just getting into resistance training

for the first time, the safest and easiest and best way to do it is to train like a body builder.

And that could be a combination of compound or machine or, you know, dumbbell bands, anything like that. You're going to significantly improve strength. You're going to maintain muscle mass or improve muscle mass. You're going to improve types of muscle fibers. These are the ones we

“know are important for, you know, strength and power. And the injury risk is super super low.”

Of course, you're then hopefully doing all these other things that we mentioned that require you to, you know, have some element of, you know, flexibility, stability, cutting, jumping, running. If you're doing some kind of ball sport, teams sport, you're doing a martial art, because those things are important as well. But even, especially if people are new to it, even body building style training is going to give you a number of those benefits. So I don't, I don't think that we

want to avoid it entirely because the, the evidence that we have from randomized control trials for like what type of resistance training significantly improves brain structure and function in order of adults is that, like, super, super basic body building style training. Interesting. I've been sleeping on my birch for many years now. And what I have realized over time is how much my day actually starts the night before. When my sleep is solid, shocker, everything feels

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Go Bruyne.com/Ritual50 to get 50% off your first subscription order to Go Bruyne's beer club. All right, let's turn to nutrition. Danger zone. No matter what you say, you're going to get shit from people. But I like the fact that you've done a great job of not being reductionist here. You're not talking about any particular diet being the best. And you have a principle to approach to how you think about the way we should be thinking about

what we put in our mouths. So how do you want to kind of introduce how you think about food? So I think about food in terms of sort of three again kind of interacting features of a diet, say. And those are the nutrients, the energy, and then the pattern of the way that you eat that allows you to maintain good intake of the nutrients that you need as well as

“adequate energy intake. In the kind of the modernised westernised world, I think”

energy availability is probably the right now seems to be the most important

lever that we need to consider when it comes to long-term brain health. Mainly because of all the things that we talked about earlier where we know that there's an increasing rate of pre-diabetes, metabolic syndrome, these come with high blood sugar, high blood pressure, these are significant risk factors for dementia. We know that people who are metabolic disease have an increased risk of multiple types of dementia. And this is something that really we're at risk at a population level

because of the food environment. You do see, and this is relevant to athletes and and loggevity sort of focus people as well, you see this like bell-shaped curve between the amount of energy that we have in our bodies, amount of energy availability we have in our bodies. And the sort of the structure of our brains, something we call brain reserve, which is essentially a fancy way of saying how much brain do you have in your skull and the more the better, usually.

So, at the high end we know we have lower brain reserve, high risk of long-term, cognitive decline in dementia. We see that based on blood sugar or blood pressure or, you know, like central, central, central, like a high waist to hit or high waist to high ratio. But we also see the same thing at the low end. And this has come from sort of big population studies across multiple populations around the world, including some hunter-gatherer

populations where they don't have access to the kinds of calories that we do. But this is very relevant to athletes and the longevity groups because you see that if you have low energy availability and you'll probably have maybe an experience this yourself or you've experienced it with other athletes you've worked with. We know that low energy availability or relative energy deficiency in sport, reds or reds is associated with

significant changes in cognitive function, mood, sleep and sort of the population level those who have low energy availability have tend to have smaller brains because they just don't have the energy required to maintain that much structure of the brain. So this is relevant for those who are doing very high volumes of exercise. I think but it's also relevant to those who think that chronic chloric restriction is like some font of longevity and I think that we have evidence to say that's

“probably not the case. You need to get enough energy in that you remain weight-stable whilst maintaining”

strength and strength performance fitness or these other things that we never require some amount of energy.

So like chronic restriction is potentially going to be bad. There was in addition to chronic access. It was sort of a contending to our energy needs then the next important thing or which we know is equally important, at least sort of on a global scale is nutrients that are essential for

for. So iron status, vitamin D status, omega 3, the B vitamins are associated with methylation.

So the ones that affect our homocysteine level and homocysteine goes up as our need for these B vitamins goes up so if we have inadequate levels, homocysteine tends to go up. And so that's B12

“folate, B6 and riboflavin which is B2. And then on top of that we know there's important things”

related to antioxidant polyphenols, so the things that make berries purple like the anthocyanine. So obviously similar compounds in coffee and tea which are associated with a low risk of dementia, it's sort of moderate consumption, chocolate. The roasted skins of nuts and seeds have like similar compounds in them. Then there's things like looting and zazanthin that make your peppers and carrots.

Or we make your peppers that are red and yellow. The crotinoids include like beats of

caratine in carrots. And then things like astasanthin which makes salmon and shrimp pink. All of these have sort of like similar benefits or in terms of the effect. It's got function effect, vascular function and they can improve brain function. For some of the best evidence is for blueberries or dark berries. Dozens of studies showing both acute and chronic benefits in terms of cognitive function with berry and take. And then some of the antioxidant things like

vitamin C, vitamin E, magnesium and zinc crop up frequently as well. All of this to say that I call nutrients the great leveler. Like these nutrients are important. I want you to have enough of them. I don't mind where you get them from. And I don't think that matters much less. To your point of not caring where you get them from. Do you care if they come from the whole food versus supplementation? I would prefer if they came from the whole food. And I think the

the best example of that is seafood. So when we look at omega-3 status and dementia risk, in general it seems that sort of the pop you know if you're doing epidemiological studies, those who you know regularly consume seafood have a greater reduction in their dementia risk than those who take omega-3 supplements. That's probably because there's a whole bunch of other stuff in there that's important right. So selenium, you know maybe as you're feeding salmon or shrimp

you're getting acids and thinners as an antioxidant and in general there are diets that

“relatively poor in many of these antioxidants I mentioned. You know protein if you need to”

if you're not getting enough protein in your diet. So in there's a whole bunch of other stuff.

So there's this nice phrase which is nutritional dark matter where basically acknowledges that like 90

percent of what's in your whole foods we have we don't know what it is and we don't know what it does. There's interesting compounds like earthyening that you get from mushrooms that's like the new longevity supplement because it does a bunch of cool things. But we're only just learning about them. So when you get it from the whole food you're kind of stacking the deck in terms of the some other stuff in here that may be beneficial to. However, there are studies where

if you supplement with omega-3s and you're omega-3 deficient you see significant improvements in cognitive function and the rate of cognitive decline. The omega-3s in particular interact with b-vismin status so there are multiple studies that show that if you supplement with the omega-3s but you have poor b-vismin status then you don't benefit from the omega-3s and vice versa. If you're so good with b-vismin but you have poor omega-3 status you don't

“you don't benefit from the b-vismin's and I think this is where reductionism has gotten us in”

trouble in supplementation studies which is that we give thousands of people one supplement well like oh hey it doesn't reduce dementia risk therefore it doesn't work well you didn't measure whether they knew it and you didn't measure the other things that that supplement is dependent on. So one of the reasons why I think it's safer to get things from whole foods is she'll getting these other nutrients at the same time. But with that said if you're somebody who doesn't

consume seafood or you know any other source of long chain omega-3s I know that there's benefit from you supplementing from it so that's kind of the approach that I would use. Yeah yeah yeah that makes sense. I'm gonna have more questions about these pillars but let's get through them so we talked about energy we talked about nutrients and then the other pillar here is pattern. Yeah, passing is just finding a way that you can achieve adequate energy and take

and good nutrient intake in a sustainable way for you right that see the what you can afford what you have access to what makes sense for you culturally or locally financially and I think that

those targets in a way that sustainable fuse that's why like pattern is that last part because

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

“rebuy it we never take it again but this is something that's gonna be important long term so”

finding a way to make this sustainable enjoyable nourishing like that's where pattern really becomes important. Setting aside this diet versus that diet and returning now to this notion of energy you mentioned that there is a certain cohort of people in the longevity community who are under the impression that like chronic under fueling is some secret unlocking health span extension but the vast majority of people are over indulging you know we're in this

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

if not a lot overweight so we can sort of set aside you know those longevity people and focus on the average person yeah and one of the things that I thought was really interesting that you said

“which is overeating shrinks the brain yeah so explain that because we're all overeating yeah”

there's definitely like a step a step in between but we know that even in short term overfeeding studies right and this is usually done with some version of a Western diet they add candy bowls to the diet or they make you eat an extra like serving a French toast or waffles every day for like even a week you can start to see changes in both mood and say like hippocampal function memory function this is in this is in humans this then you know long term translates into

what we see in the large population studies which is people who have higher markers of what I call excess energy availability and so that's essentially the markers of metabolic syndrome and those are the ones we have the best evidence for so a high waist circumference low HDL cholesterol high triglycerides high blood sugar or high blood pressure these are all significant risk factors for dementia and they are direct measurable effects of chronic excess calorie consumption

they are like the the outputs of excess energy this this is what hundreds of millions of people are you have they had their blood worked on it would reflect those very things yes the depending on of which estimate and which dates that you have something like 10% of US adults don't have any of any of the components of metabolic syndrome you need three to five to 10 if you have metabolic syndrome but probably less than 10% don't have any of them um high blood pressure

elevated LDL elevated triglycerides LDL actually isn't in the LDL is one of the modifiable risk factors in the dementia prevention reports about so LDL and cholesterol apobi are important but they're not in the metabolic syndrome criteria okay so given the fact that we're overindulging on food and a lot of these foods we're not overindulging on whole foods we're overindulging

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

trying to make the right choice when I'm not at home where I've control over my food I'm traveling or you know I'm at a restaurant or whatever like it's very difficult to really eat well because even if you order the salad there's too much dressing on or they loaded with all kinds of

“other stuff because they think that's what people want in order for a taste good like”

even the healthy choice is compromise so you're really going against the grain to try to you know do the right thing unless you're in your you know kind of personal controlled environment I think that's absolutely right and the the way that I would think about this and think about you know everything that we have talked about and we'll talk about today is that as much as possible you know control this environment at home right so if you you're however it is that you eat

at home or that you would you would like to eat figuring out how you can access those foods cook them you know make them a part of your diet in a sustainable enjoyable way right or and it's the same with exercise right you have your routine you play your pickable you go and you lift your weights so that when you do go out into the world and these choices are harder it matters much less because this stuff integrates over a really long period of time right so one meal out doesn't

make that much of a difference and we get to the point where like I have friends where you

every goes out to dinner after a conference and right everybody's stressed about what they can or should order the restaurant right and I think we want to avoid that because it's a net negative right just like enjoy the moment with the people and like what you eat that one time makes much less

this is the flip side of you know these kinds of conversations because we're basically you know

pushing people towards this optimization mindset where it's impossible to live up to the standards that are being articulated and that leads to guilt and shame and stress and all these other things that are obviously you know across purposes with the aim yeah no and I think that you know a lot of what I write about in the book is the psychology of how we approach this kind of health information because that's exactly what I want to avoid I don't want people to feel like they're

not doing enough I bring up and we know that people need to do the work right we know that you need to find a way to kind of have this sustainable but nourishing diet that gives you the

“nutrients and that you're not over eating and we know that you need to you create some kind of”

cognitive stimuli so you need to lean into this comfort right we know that you have to do those

things but if you get to the point where you're constantly feeling like you're not doing enough you're not doing well enough you need to do more that's an inherent stress in its own way that then negatively impacts your health and we have studied to support that as well so I think it's all about doing what you can and like moving things forward and like improving things over time but then once you've built a foundation the occasional thing matters much much less and the goal would be to

avoid getting really stressed about that right I've spent most of the last three months on the road I can't eat I can't work out the way that I normally would but I know I can't sleep the way that I normally would but I know that I've created a good foundation by having my base at home to you know when I when I can do these things and in the rest of the time I think when I can't control it I I try not to worry about it because I know that there's not kind of thanks about that worry as well

on the nutrients side of things you talked about the importance of omega 3 b vitamins anti-oxidants in the in the berries etc. what are some other foods that are brain health

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

into you know tomorrow's dinner yeah my two favorite sort of brain health foods are sardines and blueberries um don't have to be eaten together though it's an insurrection like so luckily if you if you eat a varied like whole food based diet um so there's a lot I talked about interesting structural compounds like um co-lean and ethanol mean you can get those from eggs but you can also get them from oats and quinoa and other whole grains similar

uh with like uh phosphatolsyry and you can get from and and phosphatol coding is where you can get from from soy products any of the sort of like colored vegetables are going to give you some small goes board of those different antioxidants um we also know that that fiber is really

critical right it's going to support um gut health um and then sort of fermented foods in that

category as well so sourcrow, kimchi, fermented dairy um those were sort of like fit into that picture

“as well and then like whatever your preferred protein choices are um I think most people”

probably overreat on like refined carbohydrate side like we don't need tons of rice we don't need tons of pasta um I would focus on the things that sort of there's other because they're not particularly they're both calorie dense um and relatively new true control um so focusing on those other areas um I think is going to give is going to make you more associated as well as giving you sort of more sort of nutrient bank for your book as somebody who's been plant based for a very long

time other than the sort of obvious uh things that I need to be aware of making sure that I'm supplementing with uh and Omega 3 um what else should I be uh focused on or thinking about and the B vitamins obviously yeah so those those those those are the two that that I'd and you can just you can just measure it right so measure your homicistine level the goal is to be at least below 13 ideally below 10 uh you can measure your Omega 3 status so Omega uh three index at least above 6

ideally above 8 the other thing where it's just it's common particularly as people get older so not because you know enough of it just being sure you get enough high quality protein um especially as people get older they get more frail or they experience a metabolic disease that's associated with a faster loss of like muscle mass and strength um and they're around amised control trials that's showing that that show that increasing the amount of protein you eat

to sort of actually what is now the target level in the the updated dietary guidelines that's actually in the in the trials is associated with better maintenance of muscle mass in in sort of older

protein are the ones that may be easiest to to to miss out on the protein recommendations just

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

I've always been eating less protein I still I really don't have trouble putting on muscle mass like I've now recovered enough from a spinal fusion surgery I had this past spring where I'm in the gym and I'm noticing gains pretty regularly and I'm not really that focused on protein despite

“hearing from people like you all the time who are like you need to be you know one gram per body”

weight like I'm way below that but then I'm like is it is it doesn't matter I mean I'm hearing this obviously there's evidence to support that I should be thinking about this differently but I haven't been so there's there's a few there's a few different parts that get the go into that so

the first is that in the context of a calorie dense nutrient poor diet we know that protein

is a lever for society so people will continue you know this is some of Kevin Hall's work right people will continue to eat until they they some of it will be some some protein threshold so one reason to focus on protein is that it's maybe going to help you over eat less right that's less of that's not that's not that's not an issue for you but a lot of population level that can be important it's also particularly important as people start to age and experience frailty or

sarcopenia right that's the context I was talking about earlier again that's not as relevant to you but I'm at that age where it is harder yeah and you're just like well this is taking a little bit longer yeah like so maybe I should be you know focused on my protein you do see that in older adults and now people in their 60s if they consume again at that sort of level of protein so like 50 to 100% above what was like the previous diet you guys learned so that was 0.8 grams

per kilo of body weight now we kind of think targeting 1.2 to 1.6 grams per kilo of body weight at that level you also have higher like antioxidant status which we know is important in terms of dementia risk factors is important for recovering from exercise as well and then you're right as you get older like even if you're doing everything right you're more likely to experience antibiotic resistance where you just need a greater protein signal or more of a training signal

to kind of benefit from that exercise so it's probably worth you know considering increasing intake up to somewhere in that kind of range the but the final thing I was going to say is that

when it comes to muscle mass and strength the most important thing is still stimulus right so

yes easy more protein will prevent you losing muscle mass if you're not if you're not regularly doing some kind of resistance training but resistance training is still going to be the most

“important thing but you know as you get older I think that requirements are going to”

are going to increase a bit. On the topic of omega 3s I've had I couldn't even count how many conversations with people like yourself sitting across the table you know discussing the finer points of you know how to supplement properly and to this day I will admit that I still don't quite under like there's DHA and there's DHA and there's EPA and like I still don't understand like when I'm looking at a supplement like what are the levels I'm supposed to be

looking for how do these things interact and as a plant-based person what maybe should I be thinking about that an omnivore isn't in terms of the effectiveness of of the supplement. Interestingly I would say that the majority of omnivores probably aren't eating enough omega 3s either right because they're just like people just aren't eating that much seafood so

“I think this is relevant to most people regardless. I will say that we and by we I mean like well”

meaning health-focused scientists like me I think we've overcomplicated it a little bit right so there the two main omega 3s that we might think about are the DHA and EPA there's also things like DPA which occurs in sort of smaller quantities. Here we go. Yeah right so like but but what I'll say is that like all of these are important most omega 3 supplements are going to contain DHA and EPA. At a minimum right and that's where we have some evidence from like

giving people these supplements. If you're not regularly consuming seafood any kind of supplement you know and assuming like high quality you get it from a good quality manufacturer right because these things can be you know poorly processed and they become rancid and oxidized and things are that you know assuming it's a reasonable quality supplement from a respected manufacturer. Something that gives you one to four grams of total DHA and EPA day is probably good enough.

Four masses much less like people have talked about targets right form versus phospholipid form

Or this is high in this but it it doesn't convert like there's this conversion thing.

Yeah so the conversion part is the is the shorter chain omega 3 fatty acids like ALA, alpha living like alpha living like alpha living like acid which is what you get in like chia seeds and walnuts and things like that. Most people and actually the conversion is worse in men on average than it is in women. Most people if you only get omega 3s in that form most people won't convert it enough into the long chain form so that's why you need to

“that's why you need to supplement. But I think in general if you're getting a couple of grams”

of long chain omega 3s from a high quality supplement on average a day right that's it.

I wouldn't worry so much about the ratio that wouldn't worry so much about the total amounts because

you're then going to be ticking the boxes that you're that you're close enough and you're also well beyond what most people are consuming. Then the easiest thing that you can do is measure something like an omega 3 index which just measures the amount of those in your blood and say am I close enough to a level that we know is associated with lower dementia risk which should be sort of 6 to 8%. Or like above 6% maybe ideally above 8%. So maybe that simplified it a little bit.

I think that we know that DHA and EPA are both important you're going to get both from any supplement. The real problem is people consuming none like once you get to the threshold of consuming

some like you know more than a gram a day on average right you're already like in a much better

bucket than most of the people. We're tip-toeing towards a longer discussion around supplements and what's effective and what isn't what's nonsense. But before we do that while we're still on food let's talk a little bit about the worst offenders. Obviously we know ultra-process foods aren't good for us but what are some maybe less intuitively you know bad things that we should avoid. You'll notice that I work really hard to not like demonize anything in particular because

it makes things tricky cognitively for people and like nothing is black and white. So I'll give one broad example which is that the levels of home assisting in the US in general particularly high home assisting which is a sort of about 13 which is associated with increased risk of dementia. That significantly improves since we started to fortify flour with folic acid in 1998. Heavenly process foods can almost be beneficial in one way because it allows

us to add back nutrients that the population is missing right. But in general I think the you know anything that's full of refined, fat, refined carbohydrate that's so calorie dense and nutrient poor. So that's you know kind of all of the baked goods, snack goods, the like snack goods, things that are you're very easy to overeat and are designed to you know for that to be the case. It's not that you can't include these and it's not like I avoid those things completely but

“you have to think about them in that goal of overall energy you know balance and nutrient”

intake. So like you're eating more of those things you're sort of like pulling away from your nutrient goals and you're also kind of heading towards the risk of of overeating. So that like that kind of yeah the the heavily processed carbohydrates and fats are usually where things get trickier. So you know fried foods, baked goods, sweet sodas that you know sugar sweet and sodas that kind of stuff. Then a big trap that's now easy to fall into is when some something's like hey eat these

protein or they're like Doritos or eat this protein candy bar. It's still a candy bar. They've added a little bit more protein but it's not getting to the point where it's actually going to meaningfully move the needle and you're very likely to overeat it. Same for oh hey these these brownies are keto or these brownies are like plant-based or vegan or they're still brownies. Right. Yeah and they still have you know 900 calories or something like that.

Setting aside the keto thing like sugar. Yeah. I mean you can kind of I know you don't want to vilify anything but you know is a really a place for refined sugar and any kind of healthy diet. In the context of all those other things like acacia consuming sugar is fine.

“Right but you have to maintain those other those other components and it's it's likely that if”

you're consuming sugar at the level that's going to be associated with overeating and you know these other like metabolic health conditions you're very unlikely attending to those two things. So it is possible to you know occasionally consume sugar being like being a good energy state and overall have a very nutrient-dense diet. It's just that the more you shift in that

dessert I don't I'm not that physically sweet too so I don't eat a ton of it right but

because I know I've got those other things handle I'm less concerned about it. So what you often see is that particularly as you get to like process or package foods something will be sold as like low sugar but it's still energy-dense it's still a nutrient-poor. That kind of so like it becomes a thing where we can go by oh there's no sugar in this but actually it doesn't make it any healthier. Yeah yeah yeah yeah yeah. So that's why you know again we become

“kind of over overductionist. So not something that I think that you have to completely avoid”

but the more you're consuming I mean the less you're likely to kind of hit those other things that we know of crispy and important. Sure. One of the things that you see in the long-gevity

community online is you know this this notion like oh if you you've been really good and then

suddenly you have a dessert it's like oh I feel awful and I can't you know I couldn't sleep tonight and it's like how resilient are you actually if you're so disregulated by this you know this one kind of like indulgence. The I think that's a really I think that's a really important point and I my guess is that so yeah like you're we know that you're got microbiome we'll kind of adapt to the foods that you regularly give it so like if you give something so like

you know I had family members who were vegetarian for a long period of time and then you know is sort of harder for them to eat me later because their body just hasn't adapted to it right we know that there's some shifts that can happen in the gut to kind of support that and so the same

“might be for large bonuses of sugar but I think a lot of where that comes from is because”

and we've made this worse with the advent of like continuous glucose monitors and stuff like that is you're like I know this is bad and I expect it to be bad and therefore I feel bad because of it whereas if instead we thought I'm just going to very occasionally I'm going to enjoy this as I'm just going to enjoy it I think you would experience a very different physiological effects from it which gets into mindset and the role that mindset plays in all of this which you talk

about in the book as well yeah the so one example the one that you can use here is there's a study by Ellen Langer which looked at diabetics and you brought them into the lab and because they're diabetic they're obviously very cognizant of their sugar and and a carbohydrate intake they brought individuals into the lab and they gave them a milkshake and they like look at the the nutrients on this on this milkshake there was a high sugar milk shake and a low sugar milkshake

“and then they measure their blood sugar and the blood sugar was much higher after the high sugar milkshakes”

than the low sugar milkshake like of course as you'd expect the problem is this is the same milkshake

so the stress of anticipating a blood sugar spike which they know is going to affect their health drove their blood sugar up even higher and so this is it every time we approach anything like this and we think about this is going to be bad for me this is going to be you know you might get some benefit you think it's going to be good for you but in general we see that if we think something's going to be good for us it has like a neutral effect if we think something's going to be

bad for us it has like a negative a negative effect this then translates to all the other ways that we can think about health information so I mentioned earlier that thinking that you're constantly not doing enough can negatively impact your health and there are some studies that suggest that when you ask people how much exercise they're doing compared to people like them and you look at those who think they're doing less that less exercise than people like them as much exercises

people like them or more exercise than people like them people who think they're doing more exercise than people like them tend to live longer and they have better cognitive function however this is after you adjust for how much exercise these people are actually doing and they have like these like activity monsters right so it's this and that the people who think they're doing less and of having like worse health if you're just a narcissistic sociopath you think you're better than

everybody you're you you're something screwed actually but there's like it's like your mind is creating your reality and if you're like I'm doing great then you are creating you know your own version of greatness yeah in your life to to an extent and so there is some benefit of this sort of like ignorance and ignorance is bliss almost right so like this is the and you you mean you've already said this like this is the risk that we run by sort of overanalyzing health and lifestyle

because everybody's walking around let's face it everybody's walking around thinking they're not doing enough and they're falling short yeah if you have a social media account and any kind of fitness or nutrition stuff happens to come up we're all judging ourselves against some imaginary standard that we're not even close still living up to so every choice that we make is a choice

over time what is that doing to our mindset we're always in a place of lack when you look at

“things like self compassion which you can break down into multiple components of self”

kindness, mindfulness and common humanity you see that and this is relevant again to like athletes enter and to like the health of the general population athletes who are more self compassion tend to be more resilient and tend to perform better over long periods of time because they understand the nature of setbacks they understand that we're just humans and they treat themselves like they would treat other people and then that allows them to learn do better come back and

perform again people who are self compassionate in the chronic disease setting tend to have better health outcomes for the same reason right they understand that oh you know I didn't necessarily eat the way that I you know would normally do or that I didn't sleep or exercise the way I normally would but you know what I'm human I'm going to come back and I'm going to do a better next time and like overall they tend to see you know when they do

interventions that improve self compassion they tend to see better health outcomes are like better blood sugar and blood pressure and diabetics who are kind of taught about self compassion

so what we're kind of told which is that we always need to do better we always need to be

telling ourselves we're not doing enough we always need to be pushing through right it's actually the exact opposite of what creates a sustainable and well-being supporting mindset which is that yes I know I can improve yes I know there are these things that I can do and I'm going to celebrate the width like my wins I'm going to celebrate I'm going to enjoy that feeling of discomfort I'm going to enjoy the fact that these things are improving but acknowledge that

you can't make everything perfect you can't optimise everything and you know we'll slowly get better over time and then not only are you engaging with the things that you know when improve your health but you're also maximising the likelihood that you're benefit from them because you're not spending the rest of your time beating your self up that you're not doing even more I feel like you just said the quiet part out loud and perhaps the most underappreciated

aspect of all of this not just for brain health but overall health in this epidemic of loneliness and isolation and disconnection and you know kind of a decline in our overall you know mental health from on a population level a lot of it stems towards this sense that we're not enough you know that we're not good enough and you know we have to go out and you know earn belonging and acceptance and perhaps the greatest lever for longevity and brain health is adopting a loving kindness

meditation practice like yeah we could talk about omega 3s but if you hate yourself and you

think you're you know nothing's ever going to work out and so and so is always going to have more

whatever you know whatever negative frame that you perceive the world you can supplement with as much DHA and EPA as you want but ultimately you're kind of driving yourself towards the grave as much as it is a counterintuitive concept that like the most successful athlete is the most self-compassion of that because you do think like well it's the person who's like I'm you know I'm never satisfied and like I'm just hard driving and that's all coming from that place of

lack and not feeling enough right like this compulsion to compete from that negative frame as opposed to like this is awesome and I'm doing it from a place of joy and self-honoring you know so it's a mental health issue as much as it's a physiological issue yeah this is why you know

“so much of the the book focused on the psychological aspects because I think that like you said”

the the things that are important we already have some intuition about right maybe reframing cognitive stimulus is really important but like we know exercise important we know that diet is important right we know that information problem yeah it's not an information problem it's how we approach that information how we speak into ourselves how we engage with the information and applying it to ourselves because you know we've been told that you know if only we weren't so if only we weren't

so lazy we could look a certain way or perform a certain way but it's really it's really not about that it's all about how we treat ourselves that even allows us to start to engage with the information in a way that will benefit us but also that make you make it sustainable and supports well being and you know hopefully belonging and purpose and meaning and all these other things as

“well because I guarantee that the the the the best way to minimize your risk of dementia is not”

see at home by yourself joking supplements um despite what some people are trying to sell to us it's gonna be much more about how you're treating yourself and how you're interacting with others

frame of mind though that the solution is in a pillar of capsule this this this sort of

shrinking of taking personal responsibility like if I just eat this or I take this stack right then it will take care of it for me as opposed to what you're advising and what your book is all about which is shouldering personal responsibility for a lifetime commitment towards the principles

“and the pillars like the foundational aspects of what drive health even beyond that it's I think”

that we can we can almost think about um shouldering as societal responsibility for that as well because um what you know the people who who have the the time and the resources and the abilities to think about taking the supplements to kind of you know get you know to kind of hack their way into better brain health they might not realize it but they're already at such a privileged an advantage position when it comes to that long-term dementia risk because we know that socioeconomic

status and deprivation and not you know not having access to education and health care these are some of the biggest drivers of a long-term dementia risk so not only is it yeah how do we how do we treat ourselves and how do we engage with this and shoulder some personal responsibility but I think that we could even expand it beyond that to how are we engaging with society in a way that minimizes or improves this risk for other people who maybe don't have the same kind of access

and ability but it's the end time to do some of these things let's do a little truth telling around supplementation okay responsible supplementation has its place what can you tell us about what's effective versus the perception of what's effective um well the the first thing you could say is that if you think it's going to help you it might because we need to factor that that's an Ellen it's all about Ellen Langer yeah there was there was a point when my edits has told me that I

reference too many Ellen Langer studies in my book so I have to take a couple of them out um but she's but why not I say more Ellen Langer like you know she's amazing yeah incredible um absolutely one of my

“old-time favorite scientists um but well I think we have solid evidence is essentially the”

stuff that we've really talked about is um attending to nutrient status for nutrients that we know

a critical for brain health that are either deficient or insufficient in the diet and we know that

the majority of adults around the world are deficient at least one nutrient so finding some way to attend to that so it's supplementary to a vitamin D if you need so if somebody is to go and get a blood panel done what are the markers that you would like them to pay attention to again the ones that we have the best evidence for so vitamin D um you definitely don't want to be deficient which is less than 20 nanograms per mill um but you ideally release above 30

probably above 40 is is best 40 to 60 is probably a good target range. I was below and I started like sort of mega-dosing a vitamin D and then my levels were like way too hard and I was struggling to sleep and then I realized like oh excess vitamin D can impair sleep and so yeah and I say this

“just because more is not always better and you know you have to like you know really gauge how”

you're managing your supplementation even if you're trying to make up for you know a shortage or a low level. Yeah absolutely and vitamin D is one of the ones where it's because it's fat-soluble it's easy to take too much especially if you're taking like several thousand daily for long periods of time so yeah definitely get above 20 maybe target 40 to 60 homocysteen for for bee vitamins um they're like I said definitely less than 13 I do less than 10 um and if

homocysteine is elevated then those bee vitamins I mentioned earlier that the ones that they usually given in clinical trials is uh B12 folate um but you might also add B6 and riboflavin um other things that can bring down homocysteine uh my include creatine uh beetain or trimethyl glyceine um potentially coling to then you might think about that you know are you do you have a diet that includes those things right beetain is high in beats and cone is high in eggs and creatine is is

um high in mean vision alright so that might might help help you sort of like target any supplementation

if you need it um iron status is really critical um so you would normally just measure hemoglobin level

but then there are a whole bunch of iron metrics that you take along the side to kind of help you interpret it so like ferritin transfer and saturation um iron binding capacity but ideally sort of

if you're if you're in like in men a hemoglobin above 17 or in women a hemoglobin above 16

makes it much more likely that you have something like is there especially if you're older or you have some elements of metabolic syndrome makes it likely that you have something like obstructive sleep apnea um when you stop breathing during the night your oxygen levels drop and your body makes more hemoglobin in response um so because we know obstructive sleep apnea and other sleep disordered breathing is a risk factor for dementia it's another reason to check

“your hemoglobin is because of the high end and that's something that you need to address um as”

well yeah we already talked about omega 3 status so um omega 3 index if you you can get it um doctors will do mostly other things that I mentioned um you can uh just get like an at home test

for omega 3 index if you can't get it through your physician um so at at least above 6

ideally above 8% um and then um other things that they're important um I can be hard at a test so like it's really hard to test magnesium status for for example but um magnesium tends to be something that people don't get much of or get enough of and we know that people who who sweat a lot or who are athletes tend to need more magnesium so a safe recommendation is often to think about um magnesium supplement especially if you're uh if you're

an athlete um so and that particularly if people who struggle with sleep there's increasing evidence that taking magnesium a night can can help to improve sleep other things especially as we sort of get into um some element of asian or cognitive decline like the some evidence for co-lean which I already uh previously mentioned uh that may be beneficial but even even then that's

“sort of like well apart from those others I think that that kind of the core vitamins or where”

we have the new trends so where we have the have the best evidence um then beyond that it might become very context dependent and there's very few things that I would give a blanket uh recommendation for if you're getting those but tests you're you're addressing those um neutral requirements and then you're also you're testing your blood pressure, testing your blood sugar, testing your cardiovascular risk through your lipids like that's the big bulk of of risk right there um anything

else is gonna be like you kind of said like sort of like sharing all this all. Creatine has been in the news lately uh it went from being this thing that only bodybuilders use to sort of mainstream adoption uh but in limited amounts five grams a day maybe 10 grams a day now we're seeing this science emerge around the relationship between creatine intake and brain health and you know every time I open up my social media feed the daily recommended intake increases. It was 10

“then it was 20 I've seen people saying you should be taking 30 grams of this a day what's say you”

sir. So creatine is the only supplement outside of those vitamins and minerals that I mentioned that I actually mentioned in my book. Not because I I don't think it's I don't think it's magic but there is an increasing burn of evidence that it's that it does interesting things for the brain. There's some studies after concussion where it may improve recovery there's studies in the setting of uh particularly in older adults or what those starts to experience cognitive decline

creating supplementation may improve memory uh in particular um it seems to help improve cognitive function in the setting of sleep deprivation um and now there are several trials where they've added creatine to antidepressants in the setting of treatment treating depression and it seems to provide additional benefit. So I think it does lots of interesting things for the brain it's also the best study supplement and because you know five to ten grams of creatine which is a fairly

standard dose like even five grams or sort of like long term the standard dose you could achieve that through diet right you'd have to eat a fair amount of steak and salmon but like it's certainly possible so like we know that it's very safe and like we know that it has very few side effects. So if you're going to if you're thinking about um supplements I often think of this idea of positive asymmetry so like where is their potential for benefit with very low downside other than

the the the cost to your wallet um so in terms of dose actually some of the like the

the first study that looked at creatine in the setting of sleep deprivation was in rugby players

and they looked at rugby specific skills after you know in the setting of sleep deprivation they compared caffeine and creatine and a standard dose of creatine five to ten grams depending on body weight right so a smaller person would take five grams of large person would take ten grams or some room between was enough to see to see benefit. In some of the depression trials again they're using five to ten grams um some of them using five grams and seeing benefit in the

people were sort of kept awake for a night and then they were given they were given creatine

and it's sure that it helped maintain their cognitive function um in the setting of sleep deprivation.

“I think they were using point three grams for kilo so that's where something like me would take”

30 grams um but you know something like you might take 20 grams so um that's where like this dose escalation is happening and if you look at studies where you're looking at creatine levels in the brain you you start seeing significant increases in brain creatine at sort of like loading type doses so that's that kind of like point three grams per kilo per day for you know a week or more so that's like you know 20 to 30 grams a day. However some of the evidence of benefit

in things that are related to brain function seem to happen at much lower levels. So I'm not convinced

that everybody needs to take 30 grams of creatine a day because I have evidence from other studies that actually maybe even at five grams people have started to see benefit um so the way I kind of approach it right now is generally recommend point one grams per kilo um so I take 10 grams every day and then yes if you're very stressed or sleep deprived maybe you could you could try increase in the dose. So for me as it is for some people we're not everybody creatine is quite

alerting like it feels like a very very mild stimulant without making me jittery like I've had a bunch of of coffee so I can't take creatine rates in the days I don't sleep as well but like if I haven't slept well I might double my dose for the day but that's not like a long-term

“thing. So I think the standard dose is actually where people will start to see some benefit”

and then maybe in edge cases and there I expect much more research in Alzheimer's disease and other things to come then maybe you know higher doses will end up being better. I can't let you go without talking about sleep. On some level we all know this already. It's like we need to be doing eight hours of sleep. We need to be practicing good sleep hygiene. Clearly sleep is just absolutely foundational to brain health and I've had plenty of guests share you know the sort of detoxing

process the clearing out that occurs overnight. What can you add to this or stress about the importance of sleep with respect to ensuring your brain health? So that we don't like rehash all ground in terms of mechanisms like the I think the main takeaway is that sleep is when all the information or the skills or things you've learned the new sign-ups you've just you generated which your brain is constantly generating. The ones that are important they are cemented and refined during sleep. That's kind of the

there's a synergistic effect between REM sleep and deep sleep that allows the sign-ups is to be kind of perfected for one of a better word based on the previous day's input and integrated into everything we've experienced already. There's also you know sleep is also really important for emotional processing and other things like REM sleep in particular and then right you're washing out amoloid and other things that accumulate during the day during deep sleep but also just sleep

in general through the climatic system. So we know that people who don't sleep enough long term have a high risk of dementia. The risk really seems to tick up and people who are chronically sleeping less than six hours a night which is probably lower than most people might expect. In general

“I think there's like people say eight hours but in reality depending like person to person”

and it changes over time the window is more like seven to nine maybe even six to ten hours like based on like how much sleep people need. So like you're waking up the next day you're feeling refreshed you feel good you're probably getting enough sleep regardless of what it was. Things to consider how we think about our sleep is also is also really important. So people know you know they're all about the sleep routine like why sleep is important. The sort of

in addition to the sleep time sleep quality is critical so usually when we think about

poor sleep quality we know associated with the increased risk of dementia. The way that we measure that is usually by asking people do you take something to help you sleep and those who take things to help them sleep tend to have a higher risk of dementia. That's probably because of announced you're in effect of the things that they're taking. So are you drinking alcohol to get to sleep? Are you taking antihistamines like Benadroll to get to sleep? Are you taking these like ambience

to get to sleep? There is probably a combination of issues that are causing insomnia in the first place that haven't been dealt with. Plus the effect of those medications themselves if we consider alcohol

long-term increased dementia risk. So alcohol creates a REM sleep deficiency in general. If you're

using alcohol to counteract all the caffeine that you drank during the day because you didn't sleep well the night before which is a very common sort of vicious cycle then caffeine can also impair deep sleep in particular. So if you're drinking still drinking caffeine in the afternoon then having a glass of wine to help you fall asleep right the sort of like a double whammy effect there. Ambience seems to negatively affect very suspects of neuroplasticity which you can see.

This is mainly from animal studies but then the antihistamines because they're anti-coat allergic and Astacoline which they influence the function of is really important part of long-term cognitive function. Those anti-estamines that make you drowsy. We know if you take those regularly that's associated with increased risk of dementia. So think about are you using those things

to go to sleep? If you require those things to go to sleep first of all you're not necessarily

asleep you might just be unconscious that's not the same. So it's a facsimile of sleep. Yeah, it's exactly resembling sleep. Any kind of like pharma intervention to produce sleep isn't actually producing sleep and if it feels like sleep it's still the sleep is not doing the job that sleep is supposed to be doing. There are some new drugs that are maybe changing that but equally people and people who have insomnia the the required architecture to get good quality sleep is still there.

It's just that the environment and the cognitive processes around sleep like they that don't feel safe or they're unable to wind down such that you can produce sleep. So that's where things like cognitive or cognitive behavior therapy for insomnia, CBI can become important. That's where the sleep environment can become important again. You can become dependent on those medications. So you might need expert help to overcome that but your sleep isn't broken. You just need to like

“retrain yourself up. The final thing that's that I think is is worth mentioning”

is that for many people we've kind of swung too far on the other direction when it comes to sleep. And they're sort of like the hyper focus on wearable data and this idea of all the insomnia where we've become so focused on wearable and like our sleep metrics become the target whereas the target should be that you get a restful night of sleep because it allows you to do

all these other amazing things. It's a new garment like if it's not tracked I didn't actually sleep

last night or I wake up and I don't know what to do with myself. I mean I you know I have a whoop I love it. I definitely check it every morning but I try to have an arms length relationship with how I let that data impact me. I still have to live my day and if it's all in the red you know like what is that doing to my mind in terms of how I'm a problem solving and approaching those problems and making sure that I maintain a positive mindset would I be better off how

I'd not known that I was in the red you know like from an Ellen Langer perspective if I like I feel

“great you know and I think I have a healthy relationship with that but I can see how that becomes”

problematic for people and it becomes you know like a neurosis. You know there's one classic I don't like a study she wasn't the senior author the senior author was Stephen Lockely because he's a circadian biologist at Harvard but they collaborate on a study where they had people come into the lab and they were randomized to sleep either for five hours or eight hours but in classic Ellen Langer style they manipulated clock time right so they changed how long people thought

they'd slept relative to how they'd actually slept and what they found was that how long you thought you slept was a better predictor of how you felt the next and perform the next day than how you actually slept so the example being people who slept for five hours but thought they'd slept for for eight hours didn't experience any impact on their function the next day and there are other studies that have used wearable data to manipulate this like hey you slept

terribly last night even if they slept fine how fatigued they feel the next day is based on how well they they think they slept this is important because wearables aren't great at actually detecting the quality of your sleep they can tell you how long you're asleep for pretty well but telling you whether you were in like deep sleep versus REM sleep they're really not that good at that and this is like published data that that that around there so when they use those

sleep stages to tell you something about your recovery score your sleep score the next morning

“you're using quite low quality data to tell you how you should feel that day so the way that”

I'd use this with professional athletes and they're lucky because I work with their coaches who can sort of who sort of like oversee this stuff on a day-to-day basis I would usually have the athlete the athlete doesn't see the data but the coach sees the data and they use that to look at trends over time which are probably more accurate than like individual pieces of data so then we can integrate it and kind of change kind of change things if if we need to

if you can create where you I think you create like a cognitive distance from the data but like

know how you slept last night in order to be able to perform today because you have to perform today

“regardless or you have to go back to be on this review like a week later go back and exactly”

the past week yeah especially if you can then say oh yeah didn't sleep that well that night but that was the night where I went to bed late or that was the night where I had an extra beer before bed or that was the night where I had a coffee in the afternoon right so you can still use those data to inform important things but you're not allowing it to influence how you then perform on a daily basis speaking of the relationship between the rest itself and your kind of

mental relationship with the rest this is something that is kind of an important issue in the world of formula one and you've you know played a role in working with some of those athletes because they're just literally going across the world every week I mean the time zone shifts are insane yeah so what have you learned about working with those athletes and how have you counseled them some things that I've learned which were surprising to me at the time but maybe

shouldn't have been is that the basics it's particularly when it comes to rest in recovery the basics still matter so I've had athletes come to me and say oh yeah I'm looking at my wearable data and worried I'm not getting enough REM sleep as an as an example and I look through the data and it's very clear why they're spending five hours in bed if you spend five hours in bed we know that most of your REM sleep happens at the end of the night you're going to get less REM sleep

first of all is that REM sleep number that accurate hard to tell but second of all

“like the the the most important thing for getting a good quality night of sleep is getting enough”

sleep opportunity which just means spending enough time in bed ready to ready to sleep and you see this again again like when there's issues with sleep is the athletes aren't giving themselves the time and opportunity to get high quality rest of course some of that comes from a travel schedule and things like that so you kind of have to take that into account but when they are able to build those routines or maintain those routines or maintain the things that help

support sleep at home whilst they're travelling they can maintain a much better quality of sleep something that we do so I do all my Formula One work through a company called

hints of performance and they you know so we work with the coaches as well and the coaches

sort of like inserted into the life of the driver they're doing the training program they're doing the nutrition they're like traveling with them the whole time they're they hold the helmet hold the umbrella like they're they're the whole time will often do things like jet lag plans so can we start to have them shift their circadian rhythm before they travel so it's starting to manipulate caffeine and light and sleep time and food timing a day or two before they travel you know

so that they're closer to the target time when they get there and there are a number of apps that kind of allow you to do that now there's one called phase that was developed by one of these F1 coaches because he was so used having to do this on a day basis he's now kind of created something that people can use themselves but then sort of like the bigger overarching thing is that again you know like the rest of us they struggle to just like they're getting plenty of

stimulation right they have very complex jobs like driving the car they're getting lots of inputs doing that but then they also have media commitments they have meetings with engineers they're constantly giving feedback on how the car drives right this is all very cognitively stimulating stuff so for them it's it's finding ways like I was saying you know earlier sort of like in that kind of you know age where you know they are mid 20s 30s 40s where you're doing a lot of stuff

with your brain it's how can you find time to kind of relax and downright get downright yeah so it's all about so for them it's all about how can we give them space how can you give them time to improve and recover and that's the the message that I hear from them most frequently is like you know like how can I how can I recover like how can I recover better how can I switch off how can I like you know just get some get some downtime because the demands of them are so so high so

then there's all this stuff around steep schedules but then it's just finding things that allow them to truly to truly switch off in a sort of a sustainable regular way and for some of them it's meditation or breath work practices although most of the times when you say to a 20 year old

“hey you should better take more like you just get a funny look and and similarly the receptive”

athlete is the athlete at the in the sunset of their career is looking to extend you know another year or two yeah they're all about it yeah the young ones they're like Nana and and young athletes in general can do a lot quite wrong and still and still players I will say that the young generation of athletes is miles ahead of what the young athletes were like you know 20 30 years ago you know like they're they're very into like you know finding that extra edge

as this whole drive a development pathway right so some of it is about instilling some of these things

“early on so then it's much easier to make those habits and sustain them once you're in sort of”

like the the S1 kind of world all right so I want you to imagine the I don't know 35 to 55 year old person who is listening to this or watching this and they're thinking I've been eating this standard American diet for 30 40 years you know yeah my answer my parent what parent is experiencing dementia I don't want that to happen to me but you know I'm kind of like cast my vote already when is it too late is it too late give that person a reason to take what you're offering

urgently the show answer is it's it's never too late um and actually this was one of the things

I was going to say about sleep there was an interesting study done by Matthew Walker but they looked at sleep trajectories in people across their lifetime and then looked at the burn of amoloid and towel proteins in their brain you know sort of like part of that the process of dementia

“and they found that people who'd improve their sleep later in life so even if it was in their”

50s or 60s or 70s if you're sleeping proved that was associated with the lower burn of later at amoloid in the brain all that saying because people asked well if I spent all this time I was young I had kids I was busy I didn't sleep that well is it like did I already do this

damages are undurable and like on a sleep perspective at least from that study it kind of suggests

no it's not and we see that then across all of these different um areas so there are now multiple studies where um you know that the best evidence probably comes from multi um like multi intervention um kind of approaches so the the most famous one as finger was running in Finland it was just repeated here in the U.S. that study was called pointer um lots of other studies have around the world have done

“something essentially similar but what they do is they address cardiovascular risk they have people”

start a new exercise training program with some resistance and aerobic exercise they have them improve their improve their diet quality and then you know there's there's some other some other pieces sometimes there's like a a stress reduction component um but like just starting to attend to some of these basics and this is either in people where high risk of dementia or are starting to experience some decline already and actually you see bigger benefits

who tend to be bigger benefits in people who maybe you know starting to see some decline not that they've gone a diagnosis of dementia but you know maybe they're already below that below kind of the average in terms of cognitive function and you can see this within sort of like six to six to 12 months of just trying to attend some of these basics once you're already in your six and 70s so if you start even earlier right you're starting your 30s 40s 50s you potentially

have 20 years to change this trajectory another example might be when you look at cognitive changes that happen during um primary menopause the menopause will transition in women which is in that kind of towards the you know mid to latter part of that that a time window that you mentioned we see that a greater cognitive changes tend to be experiencing those who have some element of same metabolic disease so the what the swans study in the US showed that um so again we know that

change your diet change your physical activity um addressing cardiovascular risk factors then affect um your uh the severity of metabolic syndrome and raising components that you can you can improve blood pressure you can improve blood sugar and you know doing that at that time period could potentially like completely change that that trajectory so all of that to say like wherever you are in that window um even if you're beyond that 55 years old there's still scope to change that

trajectory that is incredibly empowering and and speaks to the unbelievable resilience of the human

being yeah like it's it is kind of amazing but reflecting on how we kind of opened this podcast

with this notion that 45 and you say up to 70% of dementia cases are preventable and here we are talking about you know people who are kind of tiptoeing into that and they're still the opportunity to halt it reverse some of the symptomology or like stave off you know this this you know kind of terrible future why isn't this something that everyone is shouting from the mountain tops like so many people are suffering from this just absolute horrible affliction that is devastating

repeated constantly you know you can avoid this here's the way to do this why is this the conversation that we're not having all the time oh like before I get into that quickly say that that 70% number wasn't something that I made up that was another analysis that was done above

by professor Gentile you are using UK by bank data so a big date set will in half a million

people in the UK they estimated the upper end of of dementia that may be preventable is over 70% so again just like a similar way you do a big statistical analysis and that's the kind of number

“that comes out so like regardless of where the truth is in that in that range um whatever it ends”

up being right that's still a huge number of dementia that are potentially preventable of course we're talking at the population level right we can't and we're talking about statistics and probabilities I'm not saying that you could definitely prevent any individual person from from getting dementia but we know we can dramatically decrease our risk so I'm I'm really hopeful that the conversation is changing like over the last two or three years in particular like

especially um a lot of people struggled with their brains after covid either due to you know long covid or the effects of you know lockdown and everything how that changed you know the sort of like our lifestyle and our environment and since you know the last sort of two or three years people have been talking about brain health more and more and so I see it out there you know they're mentioning uh Jill Livingston's work and they're mentioning some of these analysis and they're saying

that you know it's not too late you know it's like the point of trial that was just published last year so I agree that we're not saying it enough um and I agree that we should be hopeful if we're able to engage at this on a personal level and then ideally make changes at a societal level as well

“but I think that tide is changing so I hope that um you know you and I speak in a year or two and”

you can be like oh yeah you're right you know people are talking about this more and more and people are realizing they have so much more agency here um and so I hope it's going that direction and it certainly seems like people are starting to go that way that's very exciting yeah so maybe to conclude uh the conversation it would be good if you could you know even like look right to camera

is like what do you want people to know like the somebody's listening to this I've never heard anything

like this before oh my goodness you know I now I'm gonna take greater uh agency over these decisions that I'm gonna make I certainly don't want to have this kind of thing happen to me how do I begin and how can you kind of leave them with an empowering message about how to embark upon this journey sure so the thing that I want everybody to know is that we each have a huge amount of control over our long term cognitive trajectory and we can dramatically decrease our risk of dementia even if we

“have uh family history of dementia or you know no people with dementia and the best way to start”

to do this is just to find one thing that you know you can start to move the needle on that feels doable to you and so it could be slight changes to your diet it could be adding a new aspect to your exercise routine it could be going to your doctor and getting your blood pressure checks and treating it if you need to um think about uh the risk factors for other people that you

know or in your family who had dementia that you might share with them that's always a great

place to start to and know that because all the different um factors that affect brain health interact with one other when you start to change one thing the whole network will start to shift to your favor amen I love it uh to the audience uh I want to say we covered a lot of brown today uh and it may feel like hey we didn't drill down enough on this that or the other thing while the good news is uh you can find all the particulars in Tommy's new book this stimulated mine out now

again I'll say what I said at the outset like this is a real public service and your work is vital brain health obviously impacts all of us very few people are untouched by the diseases of cognitive decline and so I urgently uh impress upon everybody who's watching and listening to pick up the book and um take your brain health more seriously so thank you for your time today thanks so much for having me and I hope everybody fancy's for please cool