#851: Dr. Tommy Wood — How to Future-Proof Your Brain from Dementia

This is Tim Ferriss.

“Welcome to another episode of The Tim Ferriss Show,”

where it's my job to interview world class performers, to tease out how they do what they do, or to tease out the frameworks, the specifics, the practical tactical that you can apply to your own lives. This episode I've been trying to set up for a while.

My guest is Dr. Tommy Wood. He is an associate professor of pediatrics in neuroscience at the University of Washington, where his research focuses on brain health across the lifespan. This includes therapies for brain injury and newborns,

prevention and treatment of adult brain trauma, and the factors that contribute to long-term cognitive function and cognitive decline. It turns out there's a lot that you can actually do. It is not an inexorable decline into not recognizing your family.

There's actually quite a bit from the perspective of lifestyle, supplementation, and much more that you can do to try to stack the odds in your favor, cognitively speaking. Tommy received an undergraduate degree in biochemistry from the University of Cambridge,

a medical degree from the University of Oxford, and a PhD in physiology and neuroscience from the University of Oslo. Alongside his academic work, Tommy is head scientist from motor sport

at insect performance, overseeing health and performance programs for multiple formerly low-end drivers. He works with a lot of professional athletes. He is also trained and competed in multiple sports himself,

coming in the top 20 in the world

for the world's first ever fully-offered Iron Man triathlon,

and second at Washington's strongest man in 2024. Tommy is one of a kind. He's also co-host of the Better Brain Fitness podcast and author of the forthcoming book, The Stimulated Mind, which I encourage people to check out.

His website is DoctorTommyWood.com with a DRDR. TommyWood.com. You can find him on Instagram at Dr. TommyWood also DR at Dr. TommyWood.

And without further ado, please enjoy a very wide-ranging, very, very concrete conversation with Dr. TommyWood. - Optimal manual. - At this altitude, I can run flat out

for a half mile before my hands start shaking. - I know I also request a question. - Now I'm at a senior book at TommyWood. - What's like in the eye? - I'm a cybernetty book isn't living this show

with a metal-imposed color. (upbeat music) - Tommy Tommy Tommy nice to see you. - Nice to see you. - Nice to see you.

- Nice to see you. - Absolutely. - And as mentioned before, we started recording. This is just gonna be like our last conversation because I wanted to reach out to you

because cognition, cognition, cognition, cognition. Boyo boy is out on the mind and pun intended on one level. But we are gonna bounce all over the place and I hope to give people including myself

a lot of tactical, practical recommendations. Also being clear where the science is solid

“and where the science is maybe a little thinner ice, right?”

Or where something is plausible but not yet proven out. And you've got me chewing. Zylitol gum, you've got me looking at air purifiers but I'm skipping ahead.

Let's go back to the beginning and I wanna give the good old Dr. Chattergy and not here because it came up in a conversation you had with him and I was like, wow.

I never would have thought of that.

Why are human babies so plump? Why are they so fat compared to other species? - If you look at human babies compared to pretty much every other mammalian species, we are the only species that's born fat,

even compared to other primates. And it's thought that the primary reason for this is that that fat is a repository for things that the brain needs in order to develop and the two that are probably most interesting to you

and that seems to be particularly important are DHA, the Omega-3 fatty acid and fats as a source of ketones for the brain. When the brain is developing in particular,

“I think this is also very relevant to recovery”

from brain injuries and other states. The preferred synthetic precursor as in, the thing that the brain uses to make structure like fats and cholesterol and that kind of stuff which makes up a significant chunk of the brain.

Key tones are the preferred source, particularly in the developing brain, but I think also in the later on in various states as an adult. And so in order to support that very hungry brain,

which it is particularly in humans, we're born fat so that we can generate a bunch of ketones

to support that brain developing for the first,

especially for the first few weeks, but maybe even for months after that. - Also, lots of, as I understand it, beautiful, fat, brown adipose tissue to keep those bones.

- Keep them hairless. - Monkeys warm. - Yeah. (laughs)

because I think the, in a sense, the extremes

“and form the mean, but not the other way around.”

So we can talk about certain maybe edge cases, things that people might not view as immediately relevant to themselves, but since we're talking about newborns, I'm curious, you've looked at therapies,

various types of research into brain injury and newborns. What do you do? What can you do? I mean, what's the state of the art when it comes to treating brain injury and newborns

or an infant? - There's two main brain injuries at babies that I study, and they're probably also the two main brain injuries that are most broadly studied just because of their impact.

And so the first is pre-term brain injury.

So that's a baby's born early, the earlier you're born, the greater the risk of neurodevelopa some impairment, or some other kind of neurological disorder. So we'll pause the other impairments later in life. And the other is something that we call high-potsky,

we can set floppy, which is essentially

“you get to normal full-term, something happens not enough oxygen.”

Exactly, not enough blood flow, not enough oxygen, get to the brain. Something happens usually during childbirth. And people think about the cortisol drown the neck, or you can get a central abroption right,

the center kind of tears off the inside of the uterus, or the uterus can completely rupture. But sometimes we don't know what happened the baby just comes out and something has happened. In that scenario, the second one, HIE, that's we call it.

Those babies are cooled down.

So this is something that I studied a lot in my PhD. You take that baby. And as long as you start within a few hours of birth, you cool them down to 33.5 degrees Celsius for 72 hours.

And that significantly reduces death and disability. That's 92.3 degrees Fahrenheit for those Yankees out there. Although even in the US, many of the cooling machines are made in Europe, so they still run on Celsius. So those babies get cooled down,

and that's really the state of the art. Although now we're starting to figure out that there are still a whole bunch of injuries where that doesn't help, including preterm babies. So if you're born preterm, cooling doesn't help,

actually it can be detrimental. And in that scenario, one of the things that they found recently, which is probably most beneficial is caffeine. So yeah, caffeine is not given for in Europe protection. It's given because babies were born preterm,

don't breathe as well. They have a single apnea prematurity. So they don't have like a normal respiratory drive. So you give caffeine to stimulate that. But the trials that used caffeine to treat apnea prematurity

sourcing different improvements in cognitive function. And those were durable improvements were just during treatment with caffeine. When you do these kinds of trials, usually you follow those babies up to something

like two or three years old. And that's mainly because an NIH funded trial or NIH grant last five years. So if you're going to do a full trial in five years, then you have a year or two to a role in treat.

And then you have two or three years to follow them up. And so they see significant improvement at that age, but then also going into childhood, which is ideal. You really want to look out as far as you can. So then there's now a renewed interest in caffeine

in other brain injuries and babies. And that's something that we've tested in my lab. There are some trials now starting in other brain injuries. But beyond that, in both groups, really the biggest impact on later outcomes

is the home environment that kid goes back to. So yes, my colleagues who are practicing the neurologists

do a whole bunch of amazing stuff

to keep these babies alive and keep their brains in good shape as much as they can when they're in the intensive care unit. But actually the home environment is where the biggest impact happens. And so then that means that even if you have

an imperfect start to life, there's probably a lot that you can do as a parent to help that brain to develop and grow as normally as possible. All right, we're going to continue to talk about brain injury for a little bit.

And we're going to talk about a whole lot of sort of multifactorial prisms around cognition and weather or not you can intervene with the faiths to preserve or enhance cognition as an adult. So we're going to get to that.

“But if we make the hop from infant to adult, right?”

If you slipped on the ice and hit the back of your head and suffered a severe concussion, what would you personally do after that? There are a few things that I think we can probably do. And then we actually wrote a paper about this came out last year.

The covered various nutritional strategies and most of the strategies will be nutritional supplements that would probably lean on. And assuming that I didn't have any control over what happened beforehand, ideally, I do lots of things

Because I think that's going to affect how my brain and body

then respond to the injury. But after that point, then there's a couple of things that I would do. One is I would manage fevers. So this goes back to the hyperthermia that we talked about in babies.

Lots of trials of tried hyperthermia for traumatic brain injury in older humans, add adults. And they haven't really shown any benefit. What does seem to be beneficial is preventing hyperthermia. So if you have significant trauma,

one of the things that happens is the immune system gets activated is you get a fever. And that fever increases this gap between the metabolic demand in the brain and the supply of energy because the mitochondria have become damaged during the injury.

So if you increase that gap, because the higher metabolic rate, because you're hotter, that seems to make that injury worse. And this has been found in some animal models, but also in subhuman data.

So the most important thing to do is to prevent fevers.

So get your flu shots, et cetera, other things.

“So in this scenario, if you need to take”

Tylenol to prevent a fever, - I see, take a sediment if a-- - Right. Yeah, it's a menifin paracetamol, depending on where you are in the world. - Yeah, where you are. - And maybe even

there are some devices where you can do some neck cooling or head cooling, they probably don't have as much of an effect as some people think they do, but whatever you can do to maintain your body temperature and so anti-paratics. So things that help prevent fevers are going to be helpful.

I would then also manage blood sugar. The main thing being, probably avoiding things that are going to cause large glucose spikes, so avoiding refined carbohydrates. - Why does that matter acutely after you whack your head?

- So you see, again, in multiple studies, and we have to do this experimentally. So some of this comes from out of the models, but if you create diabetes or the hypoglycemic during the injury or immediately afterwards,

and some of it is driven by the injury. If you have an acute injury, you're gonna get higher blood sugar. So some is, of course, some is effect, but it seems that these high glucose spikes are again stressful in that setting of an acute brain injury.

So just minimizing that as much as possible, that doesn't mean that you shouldn't eat carbohydrates, but just like, I would avoid refined carbohydrates. So when I sort of worked with athletes at high risk of concussions,

like if you're being taken off the field, a low risk thing is just to not charge power aid as you're being like taken down the tunnel. Other things that are gonna become important with varying degrees of evidence,

but still good enough that there's a high sort of positive asymmetry, right? High possibility of benefit with low risk, creating supplementation, creating is probably more beneficial

if you have it on board beforehand, but there's at least one trial in pediatric TBI that showed a creatine in enhanced recovery. Omega-3 fatty acids, the same, but would certainly include those as well.

And then the next thing is, I would do as I would take as much of these ketones. I have them at home, there are things I've played with. I don't use them regularly, but in this setting again,

“I think there's enough promise to suggest that they're worth taking.”

I didn't include that in this paper because we don't have good evidence for it, but if I had a brain injury, I would take these all of these ketones. I would too.

Yeah, I would too. And then there were a few other things that have an increasing amount of evidence for them, so there's some studies on some bivisements, particularly riboflavin, branch chain amino acids,

seem to be beneficial, and that seems to be by improving sleep. Then if you have sleep issues, melatonin has some evidence for it as well. I would avoid caffeine actually in this scenario.

There's a little bit of evidence that says that again, it's probably due to increasing brain metabolic rate in that early window, similar to high temperature, so I would avoid caffeine particularly early on.

And then probably the most important thing

that we have evidence for is early return to physical activity. So low level of ribokexides, as soon as you can tolerate it, at a level that doesn't make symptoms worse, and then increasing that over time as you get better,

that's going to be an important part of recovery as well. What's the supposed mechanism of action with the return to physical exercise in the impact that has on the recovery from say concussion? There's probably a few different mechanisms

and to be honest, I don't think anybody really knows. Again, the evidence is best in pediatric brain injury, particularly pediatric sports related concussions.

“That's what they've done most of these randomized controlled trials.”

But there's a few things that are going to be happening. You're going to be improving, so above flow, probably going to get a whole bunch of my kinds, exakines that get released during physical activity. We know many of those are beneficial effect on the brain.

And then you may also see improvements to sleep, probably know that physical activity helps to sleep.

as long as you're not doing a level of activity that's then making symptoms worse. - Just a quick thanks to our sponsors and we'll be right back to the show.

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That's 50% off your first year at Monarch.com with code Tim. All right, so we're going to take a moment, not for a commercial break, but just for a topical break to ask a very important question, which is when you came in second at Washington Strongest Man

in 2024, and then when you came in the top 20 in the world's first ever fully off-road Iron Man triathlon, what were your weights? What was your body weight in both of those cases? Those two competitions were more than a decade apart, I will say.

So in 2012, I was only in the world's first fully off-road Iron Man. It was initially called X-Man and then Marvel sued the company. So ended up being called X-Try 24.

“So when I did that, I think I was probably something like,”

low A to Q that A to A to A to A to A to A to A Q, so like, you know, 185 pounds, somehow that. And then fast forward a decade, when I was competing and watching to the Strongest Man, I was in the middleweight class. And to get into that class, I had to basically die it down

and then do a water cut to get under 198 pounds.

Although normally I'd hang out like 15 pounds higher than that. It's okay, super interesting. We may come back to that. We're certainly going to talk about your own personal routines and tricks of the trade that you apply.

Before we do that, I want to type a couple of loose ends. Specifically, infant baby, this thing you mentioned, DHA, and why that end or Omega 3 is more broadly speaking are important. And I, for instance, let's say one meal a day is probably right now two cans of sardines or chub macro mixed with some type of oil,

like olive oil or MCT oil with a splash of apple cider vinegar. It's shockingly good. It sounds like cat food. It's actually better than it sounds with some salt.

“But could you explain why this DHA, et cetera is important?”

You also mentioned the Omega 3 in the context of recovery from brain injury. So why is it important and what is the prescription, so to speak? How can people translate that into something they actually do? When you think about, again, sort of the structure of the brain,

and do you try and develop the brain in the first place?

Big pile of fat. Big pile of fat. And a lot of that fat is DHA, and actually brain, if you've done my eating brain brain, is a great source of Omega 3s. I tried it.

I tried sheep brain in Turkey. I'm going to tell you the presentation could have used some work. It was just like a straight out of the formaldehyde jar and popped up and played. It was a bit much for me to be honest. But yeah, you can fancy it up if you want.

But equally, brain consumption is not required. So DHA tends to concentrate at the synopsis of neurons.

“It seems to be really important for like helping to regulate the release of neurotransmitters,”

like being part of the structural component of those synopsis. It also tends to accumulate in mitochondria, and the DHA content of mitochondria is like positive and correlated with their capacity for energy production. Some of it could be due to some weird physical, as in physics, properties of DHA, like how electrons move through it differently from other fats.

Anyway, it seems they're particularly for mitochondrial function as well as synaptic function

and DHA is critical, and so it preferentially accumulates in those areas.

Very important during brain development, so much so that the mother will sacrifice her own DHA stores so that the baby gets enough if she's sort of borderline in terms of DHA. Levels also why women in general tend to be better at converting short chain Omega 3 fatty acids like ALA to DHA in EPA, it's all that that's because that's going to be needed for a baby one day, more so than in men.

So eat brains or find someone you can breastfeed on. Am I here in this crack like, "Oh yeah, that's a kick." Are those the only two options? I'm not sure. I'm getting it.

Oh wait. I forgot about the fish.

Oh, you could eat some fish, optional third.

Then we also know that DHA in particular, but also EPA, these are both a long chain Omega 3 fatty acids. They're important precursors for various signaling molecules that are important as it pertains to brain function, but also recovery from brain injury. What is an example of a signaling molecule?

A lot of the various molecules that have various functions in our body, activating receptors, turning genes on and off, are derived from different fats.

“And so in this setting, the ones I think about are called, like, resolve in, maricins,”

protections that are derived from these unsaturated fatty acids. And so neuroprotecting D1 is one that people are very interested in. It's being tested as you give it exogenously after different brain injuries. We're not a point where I would recommend that people take it, but that's something that's being studied right now.

And neuroprotecting D1 is derived from DHA. In the setting of brain injury, these resolve in, as a protection seems to be really important for regulating the immune response, in particular, switching off the immune response, right? The immune response is important, but we also need to be able to switch it off. And that's probably part of the role that they're playing.

When you look at long-term and omega-3 sort of mutation, there was a study that was done in football players, where they randomized them to different levels of DHA across a season. And they found that those taking one to two grams of DHA day saw less of an accumulation of a marker of brain injury in the blood, when you're a filament light across the season, with all these small sort of sub-concussive impacts that the kids experience on the field

is generating this sort of low level of injury that accumulates across the season and omega-3s or DHA seem to protect against that. So all of those are say that if you want to maintain brain function and we see if you're

on other things like methylation status, but isn't going to be an important component

of maintaining a brain structure and function.

“So I think that kind of level, you know, once two grams a day on average, at least you”

get two or three good servings of seafood a week or a reasonable supplement, that's going to be probably enough to consistently hit those levels. The other part of it is that your body will actively sequester extra up to a point. So when people are talking about different forms of DHA, right, should you take your omega-3s as a phospholipid form, we're a triglyceride form, and the triglyceride form is more common

in seafood. This studies the look of these of a long periods of time. What happens is if you consume a lot of the triglyceride form from seafood, your adipose tissue is used as a storage place. So it cycles through the adipose and then it gets released and the brain can use it afterwards.

So that probably requires you to spend periods of time. We're accessing your adipose tissue, right? You're not constantly eating, so exercise or periods of fasting may help you access that

“adipose, but that adipose allows us to then use these other forms of DHA that can accumulate”

and our bodies over time, and then we use them as we need them. I'm wondering if there's anything else in it may end up circling back around as well. But is there anything else related to omega-3 specifically that you'd like to comment on? I could be hallucinating here, it's not just AI that does it, but omega-3 does that have

oh no, it was B-complex, which you'd brought up before perhaps. Or maybe there is an interaction with omega-3 and homosystems. Yes. I'm trying to figure out where homosystem fits into the picture with respect to cognitive health.

There absolutely seems to be this interaction between a omega-3 status and B-Vitamin that are involved in methylation, so they affect the level of something called homosystem. And this is something you can get, a blood test for, and those who have inadequate B-Vitamin

“status are where an adequate methylation is set to set to set of an elevation of homosystem.”

There have been multiple trials that happens two or three decades ago, you know, maybe even in the last decade, where people thought, oh, omega-3 is going to be the answer to dementia prevention, or B-Vitamin's, and homosystems are going to be the answer to dementia prevention. And then they would give people B-Vitamin's, or omega-3s, and then they didn't see much

of an effect. What we found out later, you know, the scientific we, was that both are required in order to see benefit.

So this was probably first seen in the Vitercog trial, which was run by David Smith at Oxford,

and they found in individuals with elevated homosystem, so that was a level above 13, giving B-Vitamin's to reduce homosystem significantly improved rate of brain entropy and cognitive function, only in those who had an adequate omega-3 status. And the same thing was seen in the B-proof trial subsequently, and then the opposite, which was seen in the omega-d trial where they gave omega-3 fatty acids, but they found they only

saw benefit in individuals who had a low enough homosystem. It's thought to be because if you want D-H-A to be in a membrane, in a cell, in your brain, it needs to be attached to some kind of phospholipid, right, fats don't just float around their par, these phospholipids that sit inside the cell membrane. And that requires it to be attached to a head group.

These head groups are usually derived from co-lean, or an ethanol, I mean, although those can be converted from one to the other, and in order to do all of that kind of biochemical attaching and placement requires methylation, there's very methylation dependent. So it's thought that, in order for D-H-A to its job, you need adequate methylation status, so that all those processes can run, and if you only have one or the other, then you

won't see benefit. Got it. Yet another reminder for live-term listeners is, "Well, come as soon as surprise, but you got to get blood tests, comprehensive blood tests, and really track this stuff with trend lines over time, but that's a much longer conversation, but suffice to say.

You need the orchestra, right, or you need multiple likes of the stool. It's not just one like of the soon. All right, so let's maybe return to, I'm going to use a term that's a little dangerous

to throw around, but kind of first principles or fundamentals, maybe is a better way to

phrase it. Not terrified as many people are of this thing called Alzheimer's disease, and you could throw in dementia cognitive decline in general, and conversely, very interested in extending health span. I'm not totally convinced that, you know, we're going to get to 150 years, 200 years, like

all the tech billionaires might want to have us believe, but it does seem certainly if I

lost, but just capacity right now compared to prior generations, I feel very good about it. So I feel like I can extend that runway, and cognition for me is just the most, one of

“the most, maybe the most important pillars of that, because having seen multiple people”

disintegrate cognitively, they don't just lose their ability to remember, they basically

lose their identity, they lose their ability to remote. It's a loss of the self, I mean, it's a death before death almost in a way, so really would love to do anything possible with the right risk benefit ratio to avoid it, but fundamentals. Should we talk about, I'm going to fuck this up, August, Deeter, Augusta, Dita, how do you say this name?

August, Dita. I think. There we go. Who is this person, because a lot, I'm guessing most folks will not recognize, and I'm certainly, I didn't recognize the name hadn't seen it until I got a couple of notes

from you prior to hopping on. So August, Dita, or if you read some of the original papers, August, D, was Alzheimer's

“index patient, so alo's Alzheimer, that Alzheimer's disease is named after, was a psychiatrist”

in the early 20th century, and he took a particular interest in individuals who had sort of rare or unusual cases of pre-seenile dementia. So what we now call, what now most of us call Alzheimer's disease, which is sort of a late onset dementia, was called a senile dementia, which just meant that it occurred after 65 years old.

That was not what Alzheimer's study, he studied unusual dementia, where people who were quite young sort of in the, you know, 40s or 50s experienced significant cognitive decline and dementia and August Dita was one of them. He then after studying them as a psychiatrist or working with them as a psychiatrist, after

they died, he then looked at their brains under a microscope, so he was the first person

to see amylide plaques, tau tangles that are now sort of pathochromotic, they're like, what we considered to be sort of required as part of Alzheimer's disease, but it's just interesting that what we have now is not what he studied. So over time, people thought that the brains of individuals who had this sort of early onset Alzheimer's or these early onset dementia, the Alzheimer's studied, and those who had this

late onset dementia that we now call Alzheimer's disease, those brains looked very similar under a microscope, so they've kind of lumped together, although we do still have two kind of broad forms that early onset Alzheimer's, which is usually a single genetic mutation in something like a precedent in gene or the amylide precursor protein gene that then creates a picture that's much more like, well, Alzheimer's studied or the late onset Alzheimer's,

which is what most people think about when they think about Alzheimer's disease, is probably somewhere between 95 and 99% of cases of Alzheimer's, and there is a genetic component to risk, but it's usually much more tightly tied to lifestyle in the environment and other lifestyle factors that we have, some control over, hopefully. And the reason why Auguste data is interesting to me is because I don't think she actually

had Alzheimer's disease, as we would now think of it. There were being groups that have taken sections of her brain from like, you know, Alzheimer's old collections, and they've done genetic studies, and she didn't seem to have any of the genes that cause early onset Alzheimer's disease or any of the mutations that cause early onset Alzheimer's disease.

She wasn't an apoi for carrier, I think she was three, three, if I remember correctly. Because she didn't have any of the genetic risk factors.

“So what causes, and causes so young, I think she was in her 50s, right?”

It's still actually unknown. Some people think there's like recent retelling of the story, some people think that she may have had neurocyphalis, and neurocyphalis actually causes them all the accumulation that looks very similar to Alzheimer's disease. Neurosyphalis, meaning she had syphalis, and it got into her brain.

Yeah, and that can look very similar under a microscope, especially under a year ago, or

more than a hundred years ago, when we were just sort of first started to look at brains

under a microscope. And then others have just said that it could have been more sort of psychiatric, nutrient deficiencies, certainly very common could have been, you know, just like the, your other components of her environment. She was by all accounts, sort of like a downtrodden housewife that maybe didn't get

sort of much engagement or stimulation, or it wasn't particularly well treated at home, and that could have sort of precipitated of it, and we didn't actually know, but many of these things kind of, it just seems interesting that it's probably quite like she didn't have Alzheimer's disease at all. Wild.

All right. So I'm going to take this in a few different directions, and as per usual, turn it around to be self-serving for here, it's truly, but I'm going through some of the notes that I had

the very top of this show, but I have this bullet in front of me, and I just want to make

sure this is something you feel is defensible, 45 to 70% of dementia is preventable through lifestyle. Is that a defensible statement? Yes, as far as we think it can be defensible. Yeah, I'm not trying to put it in the hot scene, I'm just saying, like, I don't know

where that number comes. So I can tell you where that number comes from. I mean, that sounds great. Yeah.

“I mean, that seems like a ray of sunshine and a pretty gloomy, possible conversation, right?”

Where people think you're just like, okay, there's genetic determinism, you got this thing, you're screwed.

If you have a bunch of it in your family, you're also screwed, et cetera.

But it seems like there's a lot you can do to write the ship for a period of time. Okay. So where does 45 to 70% of dementia is preventable from lifestyle? Where does that number range come from? So 45% comes from the most recent edition of the Lancet Commission report on dementia

prevention, which is overseen by Professor Jill Livingston and brings together all these different experts in dementia and its risk factors. And they sort of scour the research for observational studies, and then as much as possible, interventional studies, a lot of it is epidemiological data. Thinking at different risk factors that have a consistent relationship with dementia risk,

and then you do these sort of statistical calculations to look at something called population attributable risk, which is essentially saying, if I eliminated this risk factor entirely

“from the population, what percentage of dementia would I expect to no longer happen?”

That's essentially what it means. And all of these different percentages add up to 45%. So it's a couple of percent for smoking, it's 7% for low level of early education, it's like a percent for alcohol, then there's hypertension, hearing loss, or sorry, high blood pressure.

High potential is the fancy medical word. High blood pressure, hearing loss, obesity, low physical activity, and all these different percentages add up to 45%. There are some things that are on that list, or there aren't on that list that I think should potentially be included, so like sleep, loss, or poor sleep, and so many it is not included.

Late life physical activity was discussed in the report, but was not included, even though there seems to be some good evidence there. So actually, that suggests that there may be more than 45% there are preventable. And there are other studies like there was one big study done from the UK by bank, data, by Professor Yantai U, the estimated that up to 72% of dementia's were preventable.

If it is going to happen, this would require a complete societal overhaul, because a lot of this risk comes from low socioeconomic status, low educational and work opportunities, like all these other things that are kind of baked into societal risk for dementia. But others are things that we have more control over, like level of physical activity, whether we smoke, whether we drink.

So some is directly under our control. That's probably something like 15% to 20% maybe more, and some is kind of driven by these maybe biggest kind of societal risk factors. But if you did all of that, and we managed to complete change, how everybody lives in all of these risk factors, the ideas that, you know, maybe even up to three quarters of dementia

cases could be entirely prevented. Now, that's very different from saying that I could guarantee that you will not get dementia, right? That's not the same thing. We're talking about this stuff at the population level, and I have to say this because

if I talk about your physical activity or sleep or nutrition and these are really important

for dementia risk, somebody will always say, well, my family member did all that stuff

and they still want dementia. So we're talking about probabilities. We're not talking about, I can definitely guarantee that somebody will avoid dementia,

“but I think we can definitely say you can stack the deck massively in your favor through a whole”

variety of actions that should decrease risk long time. All right. So part of the reason that I make this very self-interested is because I'm self-interested. The other part is that I think the personal is very easy for people to concretize, right, for themselves, so they can interrogate how they're behaving, what they might do differently,

what they might add, what they might subtract. So let me tell you some of what I am observing and then some of what I'm doing, and I would love for you to identify or maybe speak to things that are low hanging fruit or reasonably accessible that are missing. So a few things.

Lots of folks in my family currently, who I'm caring for, in one way or another, deteriorating very quickly with what has been called Alzheimer's again. Kind of a tricky diagnosis, not sure how much they're actually looking at, whether it's

are APOE33, so I'm like, huh, also raises the question of, is there an un-diagnosed infection?

Maybe it's an STI, who knows, right, like I don't know what the answer is to that.

It's kind of another line of testing, perhaps. So I've been trying to do a few things for myself, recognizing that if someone starts to really show obvious symptoms that can't be easily explained away in their 70s, let's just say,

“the process probably started, what decades earlier, right?”

I mean, the cars have started to pile up, the machinery has started to break a lot sooner. So it would seem like the earlier you intervene with better lifestyle changes, et cetera. The better off you'll be. So I've got the fasting and the ketogenic diet and all that stuff, right, which I do regularly. They've got the exogenous ketones, which like you, I use sparingly.

I don't use them all the time, because particularly like before this conversation, I took 11 milliliters of a ketone monoester, but I think once all is said and done, it's basically 51%

one three-butane dial, and I have some concerns around one three-butane dial, specifically

in chronic use, or at sufficiently high doses, say, 30 plus per day. So I tend to use it for special occasions, like this, you know, toast, have a glass of champagne, have some exogenous ketones, and off to the races. All right. So there's the ketone piece, which I think is non-trivial.

There's the, for the most part, avoiding crazy glucose spikes all the time.

“Occasionally I'll have a Christmas sure at a bunch of cookies, like who cares?”

It's Christmas. It's fine. How to much pie. But I have a CGM on right now. I had a continuous ketone mono deron at the same time for about 28 days.

I'm really interested to look at all of that. But I'm generally following like a slow carb diet or Mediterranean style diet. I am getting enough omega-3. I know that, because of fish intake and also when needed supplements to intake, I do seem to be a poor method later, some taking B vitamins, all methyl folate, all of that stuff,

tracking blood once a quarter. So I've got super comprehensive stuff on that side. Zone 3 training. I do find it as boring as watching paint, right? Even when I'm listening to a podcast or watching a Netflix mini series or something.

But probably doing two to three sessions a week, I'll let's call it 30 to 60 minutes, talking every day, lots of walking and we'll come back to that because actually, I can't resist. We probably will come back to it. But walking 4,000 plus steps a day reduces dementia risk 25% optimal 10,000 steps

daily and then reverses hippocampal shrinkage, 2% increase versus expected 1 to 2% decrease. That's the bullet that I highlighted. And then weight training a couple times a week, I could keep going. I'm not going to bore people to death with this doctor evil life story, but I will say that I've also wanted to get a snapshot of what things look like.

So I'm going to be having a call. I won't mention the company by name because I haven't done all of my due diligence.

“They have some scientific advisors who I think are very credible, but have done brain MRI.”

I've done the blood draws, the DNA tests, everything else. I'm APOE34 and looking at the brain MRI, I mean, I'm a muggle, right? So I probably shouldn't be allowed to sort of grab the wheel and driving on the MRI reading, but I want to look at the data. It seems like and who knows how to offensively this is.

But my MRI predicted brain age based on hippocampal volume, et cetera, et cetera, is 46 instead of 48. I wasn't thrilled about that, I'm like, well, all right, not sure what else I can do. Maybe a flood dose of eye began, actually is pretty interesting to take it around that from Nolan Williams, but not something I would recommend to most people, including myself.

So there's that did a whole battery of cognitive testing through this startup. Now that came in at brain age of 20 years predicted 28 years younger than your chronological age. But you can kind of beat the test. There's some gamification, so I don't know how heavily to weigh this, right?

So brain age of 20 years, man, sounds great. There's certain aspects that are harder to game, like reaction time testing, okay.

So I had like 267 milliseconds, basically versus 466 milliseconds, okay, great.

There could be some training effect, like learned training effect, but then there's like a number span focus, I won't bore everybody with that, but word pairs names and face pairing with pneumotic devices. If you train yourself, you can really sort of game the test.

baseline of where I stand now, so that I can measure all of the effect, hopefully, of these interventions over time.

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And disclosure, I am a client of Crescent. There are no material conflicts other than this paid testimonial. And of course, all investing involves risk including loss of principle. So, do you do diligence? What would you say are like, hmm, there are twenty things I could mention, but like, here

are three or four that I would also pay attention to.

So first, a couple of comments on all the stuff that you mentioned about what you're

currently doing. And so, I think I've already mentioned that I think that there's a lot of promise for key tones. I'm not sure that key tones necessarily have to have a place in prevention. And I'm not sure that you would necessarily need them from a prevention standpoint.

There are some, it reasonably good data, so like the medium-chator, which I work from Steven Kane's lab is quite compelling in the Alzheimer's disease taking MCT oil seems to increase the C2S stay uptake into the brain. This is associated with improvements in cognitive function. And this is overcoming what looks like an energetic deficit in individuals who have outside

the disease.

“And this is something that, again, it's one of those things that are path demonic, right?”

We think that we see this, and this is a kind of like part of the picture of Alzheimer's. You can see that like, this is Alzheimer's.

Can I pause for one second?

Yes. Real quick. Don't lose where you are. We're talking about MCT oil. Number one, if people want to play with MCT oil, be close to the bathroom when you

start. And if you combine it with double espresso and creatine, definitely have some depends around. The second is the ketogenic diet for me just to briefly provide a little more context. It is also for it's, I think, plausible anti-cancer effects and just kind of all cause mortality

I just think a lot faster when I have more metabolic flexibility with something like intermittent

fasting. That's another thing I do a lot of where my body has just got the machinery to produce ketones. But yes, I hear you. Okay. It's CT.

So the thought being here, right, there's a difference in what you find works very well for you versus what the listener thinks they should have to implement for themselves. And so I'm now going down the road. Yeah. The road of why I don't think we all need to be in ketosis and prevent dementia.

Yep.

“So I think from a therapeutic standpoint, CZ beneficial overcoming this energy deficit that”

we see in Alzheimer's disease, particularly early Alzheimer's disease, or maybe it's easier to overcome early on. And one of the ways we look at this is with something called a PET scan. So you do an FDG PET that you give labelled glucose molecule. You inject that.

You see how much gets into the brain in individuals without Alzheimer's disease, less glucose is getting into the brain. We've traditionally come at it from the point of that glucose can't get in, right? There's some kind of metabolic disease in some resistance. This is where the idea of type 3 diabetes has come from.

My insular resistance in the brain, that glucose isn't getting in. But a PET scan cannot differentiate between the glucose can't get in versus the brain

isn't asking for that glucose in the first place.

And there are actually some very nice studies that looked at brain activation in glucose uptake in response to cognitive stimulus in individuals without Alzheimer's disease. And what they see is that yes, at baseline, there's less glucose being taken up into the brain of individuals without Alzheimer's disease. But if you stimulate that brain cognitively, it can take up glucose just fine, so that

you get into the range of a normal healthy brain in early Alzheimer's disease. Once you get to like advanced stage dementia, it's too late. But at that early stage, I think part of the reason why we're seeing less glucose uptake is because those parts of the brain are less active because of which is not using them as much.

And just like glucose uptake into the muscles, which is demand driven, you work your muscles. They ask for more glucose. They take more up. The brain seems to be the same, at least early on.

“So I think we think a lot about their supply side, right?”

The energetic supply side. But I don't think we think enough about the demand side. How do create energetic demand in the brain, such that we are maintaining glucose uptake, maintaining energetic state? And then doing that also maintains all the metabolic machinery that you really care about in terms of long-term function.

All right. So from hearing you correctly, this is something that you don't chat with dumb digs you know about. But I'm wearing this CGM. So I've got this device on my arm that tells me what my glucose levels are at any given

point time with whatever three minute sampling or something like that. You got to calibrate that with a finger prick by the way, folks. But if I eat a meal, and then I don't go for a walk, my glucose spikes, and I might conclude, wow, my muscles are really not accepting glucose. My muscles are bad at accepting glucose, but that's not actually true in my case, right?

If I go for a walk or I do some light exercise, I guess it's like glute for transporters or whatever, get all jazzed up and help that glucose to be better disposed into muscle tissue. And like you said, in the case of the brain and people referring to Alzheimer's as type three diabetes, it's like, wow, the brain can't use glucose or it's very bad at using

glucose. But if I'm hearing you correctly, the additional question that they should be asking

“you is, is it just that or is the brain not asking for glucose?”

The equivalent of the glute for transporters, like, is the brain basically offline.

It's a car up on blocks, but if you take it down, like, yeah, it's going to use gasoline just fine. If that's the case, I guess it's just a call to action for more stimulation of the brain. When I was first just coming across your notes that you sent prior to this conversation,

I went on Jackie Petina. I was like, what are the most glucose intensive activities for the brain? And they gave me a bunch of mental exercises, which isn't exactly what I was looking for, but I could have prompted it better. And it said, but even still the sort of improvement or increase might be plus less than 10%

in terms of the total. And then I was like, well, are there other activities such as physical activities that might increase glucose uptake in the brain and it gave me a whole list, but rather than regurgitate that, are all types of stimulation created equal, or are there some sort of 80/20 analysis, like, okay, there are some tools that are better for the job.

Yeah. So, when looking at this purely in relation to glucose uptake, those data don't exist. So, I'm going to have to extrapolate further than that. And I think that's important because a decrease in glucose uptake is just a signal that

at the simplest level.

So, then, if you think about various activities that we could use to stimulate the brain,

which do seem to be protective in various different ways, both, they can enhance cognitive function in the short term and then protective against dementia in the long term. This type of very nice is the comment that I was going to make about your physical activity routine because this is where I think some things could be laid on. When you look at the different physical activities and the exercise and how they affect

the brain, different types of exercise affect the brain differently. So, you certainly need a smorgas board of all of them to kind of get a global support for the brain. But something that seems to be particularly beneficial is coordinate of exercise or open skill exercise.

You have plus or minus things that have a navigational component. Because these are essentially sports or activities where you're constantly having to respond to the environment and adapt.

“That's what makes them open skill rather than close skill or unimode like size, like going”

for a jog or sitting on a bike or something like that. So, when they compare sports or activities that have the same amount of physical challenge, but a different amount of cognitive challenge because of the open skill nature. You see greater benefits in terms of brain structure, improves the cognitive function. And open skill just means high level of un-inticipated variety or variety, what does that?

Both.

So, it basically has a greater amount of complex motor skill required.

Some of it can be learned, so dancing is one example why it's because you learn the steps of a dance. Single strongest activity for dementia prevention. Am I overstepping there? Yeah, probably.

If you look at physical activity and the effect that it has on cognitive function and also one of the mental health. Yeah. But in terms of both mental health, so studies in depression as well as studies looking at different activities that people do and the risk of dementia and studies where they randomize

people to different types of activity including dance, dance seems to have the highest sort of effect size compared to other types of physical activity.

But there's multiple components to dance, right?

So you have to learn the steps. But there's also a social component, there's a music component, all these things probably like part of the magic source together. But open skill sports also include board sports or ball sports or team sports where you're having to react to the environment and other people around you.

Do you say ball sports? Like rodeo? What are we talking? No. Balls.

Balls. Yeah. It's not going to be good for the TBI to get people on top of balls.

“I think ball sports would probably be good.”

If you could avoid the TBI actually probably write out there. Similarly, martial arts also good as long as you don't get punched in the head a bunch. Oh, kicked in the head a bunch or choked out too much. So beyond the physical strain that these exercises have, they seem to have an additional aspect of requiring reaction speed, challenging processing speed, you know, learn complex

motor skills, they seem to have an outside effect in terms of cognitive function. Something else, there's kind of an aside, but just based on the physical activity component, when you're looking at more aerobic or, you know, even like close to go unimodal running cycling kind of sport, the benefit seems to be intensity dependent. So yes, if you're not doing anything, then going for a walk and walking a certain number

of steps a day is going to be great, beneficial, decreased dementia risk, absolutely. But looking at hippocampal structure and function for instance, which you mentioned, right, you're talking about measuring your hippocampus on an MRI scan, higher intensity activities seem to be better. So probably the longest study where they ever did something like this, they had people,

this is an Australian study where they had people do the Norwegian 4x4 protocol, three times a week for several months, oh my god. And so where anybody who doesn't know what this involves, it's four sets of four minutes on a treadmill at 85 to 95% of your maximum heart rate with four minutes rest, you do that four times.

It is miserable. I mean, that's like pretend like you're being chased by wolves through the snow for four minutes and then take a four minute run and then do that, yeah, four times. Yeah, okay, right, but they saw significant improvements in hippocampal structure and function that would maintain for several years after the end of the trial several years,

several years. So a few months, yeah, and then sustain for several years, okay, five years off to the end of the trial.

“That makes it much more interesting, okay, and I think a lot of this is driven by lactate.”

So when we talk about the various things that support the brain through exercise, we often talk about BDNF brain derived neurotrophic factor, which is increased with exercise.

during exercise, doesn't really get into the brain very readily.

Most of the BDNF we have in the brain is produced locally and it's actually driven by things like lactate. So lactate does get into the brain, the more lactate you have in the blood, the more gets into the brain. And then that acts as a histone, deaccessalase inhibitor that activates the blood should

be the left ketone to the same thing. Obstricalcin, which is released on these sort of load, the bones structurally rise released from bones seems to do something similar. So generating lactate seems to be beneficial because probably because one of the things that's doing is it's generating more BDNF, but then is associated with improvements in hippocample,

structure and function.

So as long as you're doing sports that have some high degree of intensity, so you're

regularly producing lactate and then either in the same sport or separately doing these sort of high skill, high reaction time, open skill, kind of sports. That's probably going to be beneficial from an exercise standpoint.

“I'm still completely stuck on the three times a week with basically VO2, max training, right?”

For a few months, is a few months like three or four months or how many months was it? This study was either six or twelve months, I can't remember the ins face face face face. It was one of the other. And with durable effects over a follow-up period of five years or something like that. Like that is a great investment.

That makes it much more a much more compelling sales pitch for me. And like I've done plenty of VO2 max training in the past, but like it's not necessarily fun. Right?

I mean, I will say, if you can, again, avoid getting your arms snapped exhibit A right

here with my elbow surgery, but if you can avoid the breaking limbs and getting choked out to frequently, something like jujitsu, right? It's actually fantastic because you might have three to five minute rounds and then you take a break for a round and then you go back in and chances are depending on who you're rolling with.

It's going to be pretty intense. Obviously, it depends on how competitive the gym is, but the durability is just remarkable. That is really, really, really, really interesting. Now, is the threshold for sufficient intensity? I imagine it varies tremendously from person to person depending on lactate threshold, right?

“Like for you, do you need to do something approaching the Norwegian 4x4 to cross the threshold”

sufficiently in your mind or does something less suffice? The problem with having just one, it means one very good study, but just having one study on this is that we get really focused on the protocol. But I think that anything that is regularly producing, you're getting above your lactate threshold, you're generating significant, you know, several millimoles of lactate.

I don't think people need to measure it, but you know, if you're getting 6, 7 plus, something like that, right? You're definitely going to be in that range. Is there something like a people who use a talk test for instance, Peter Tia talks about this for zone two training, where you can kind of have a conversation in belabored short

sentences, but you don't really feel like it as an indicator that you may be roughly in zone two. Is there an equivalent for that range of lactate? Not that I know of. 10% from puking into lactate.

Yeah, it's definitely going to be misery related.

“So if I think about a lot of the training that I did, there's a student was, I was a”

roger, right, and this is something brutal. You love misery. I don't love misery enough, which is why I probably wasn't as good a roger as I could have been. But there are lots of protocols where you're doing relatively short sprints with relatively long breast periods that still generate large amounts of lactate. And so in studies where they've done this, you're talking about 30 seconds flat out on a

bike or a roger machine with several minutes of rest times six, eight, 10 rounds. By the end, you can generate a lot of lactate without having to do something continuously for several minutes at a time. I was just reading that one of the favorite training protocols for one of the world champion rowers was 45 seconds flat out, like complete flat out on the roger machine within six

minutes of recovery, but doing that several times. And then at the end, you're generating several minimal of lactate. So I think anything like that, there's going to get you in that zone. It just requires maximum effort for even just like 20 to 40 something seconds, even with several minutes breaking between you're going to be hitting that.

So imagine the gold standard, do you have some kind of lab coat and with a clipboard

concentration of lactate?

Is there a breathable option as there is with ketones, right, where you can measure acetone through something that looks like a breathalyzer, as opposed to a finger brick for BHB? Is there something that is, does anything like that exist? I would make it a little... No, the working on continuous lactate monitors, just like you would have, and some people

do sort of have those, they're right, near being commercially available, so some people do have access to those already, but equally, I would argue that it doesn't matter that much. Just like go and do something really, really hard for a short period of time and do that few times over and do that relatively regularly, like that's probably enough majoring in

“the miners that you need to do to get that bit of it.”

Sounds like my sled assignment, I do love my sled pushing and pulling. You can definitely wipe yourself out with that stuff, okay, all right, without necessarily the impact of me trying to run from wolves on a treadmill or something. Okay, I do want to take a brief commercial break, but it's not for any sponsor, it's just to mention, then we're going to kind of dive straight back into the programming and discussion,

but you have a book that is coming out shortly called the stimulated mind, it goes through all the stuff we're talking about and a lot more people should pick it up, that's Dr. Tommy Wood obviously, but the stimulated mind, there's so much horseshit and Charlottonism floating around out there in the world of anything related to cognition and memory. It's part of the reason, it's going to segue as little awkward, but part of the reason

I want to have you, that's part of the reason I want to have you on, is not to highlight necessarily. That, but the antithesis of it, which is someone with real clinical expertise, research credentials, who is also a practitioner, right, it's like you walk the walk and I wanted to ask you, you mentioned supplements earlier and of course everybody loves to hear about

“supplements, but what are some that may not be on the usual list of suspects, so to speak?”

I mean, one I would love to hear you speak to is CDP calling. People might not think of Zylitol as a supplement, but certainly could argue that maybe there's a place for it. Do you want to add anything to that and just expand on those? I think that the supplements that we have the best evidence for are really, they start with

those core nutrients that we could get from the diet, but if we don't, then we definitely should supplement. So we've mentioned omega-3s, B vitamins, especially those involved in methylation, so that's vitamin B12, folate, which would be 9, riboflavin, which would be 2 and B6, vitamin D,

obviously, critical, iron supplementation, particularly if people are anemic, so that requires

a whole assessment for why you're anemic in the first place, but often particularly more common in women and many of the symptoms that women may experience around perimenopause are associated with inadequate iron status, so getting your iron status checked and addressed is really important. Magnusium, certainly, critical as well.

If we're thinking about other things that do seem to have both an acute and long-term benefit in terms of cognitive function, then all the anti-oxidin polyphenols are very interesting, particularly those that come from berries, but related ones in coffee, tea, on the skins of roasted nuts and seeds, like they have similar effects, and then, to

“mention, coly, and right at the beginning, when we were talking about omega-3s, I think”

colyn is critical because it's important as a head group for fats to be attached to in

membranes. That's maybe one of the reasons why it's important for the brain and various estimates suggest that we're becoming increasingly colyn deficient as, you know, we stop eating things like eggs and liver, which are richest sources of dietary colyn, but there were randomized controlled trials in two different settings that we've talked about already, so one in older adults already experiencing some degree of cognitive decline, where supplementing

with CDP colyn, which is also called citric colyn, seems to improve, so an aspect of cognitive function, and then again, after traumatic brain injury, there are methanocies that show that supplementing with CDP colyn can improve some neuropsychological outcomes, in particular, after TBI. So, I think most of us can probably get colyn from the diet, but in some of these cognitively degraded states, you might call them, you know, something like 500,

2000 milligrams a day of colyn seems to be beneficial. Do you take it or do you just get it from eggs, eggs, eggs and liver, and some seafood tidings have some colyn in. As do some

supplement the colyn. I do supplement the creatine. I don't have the perfect trial that

creatine is going to prevent dementia, but I think we've seen enough interesting data across

“depression, again, sleep deprivation, sleep deprivation, that that's what the great”

time to do take daily. What's your standard? I take those 10 grams every day. Single dose, or a divided, doesn't matter. So, I take it all in one go in the morning. There's some evidence that suggests that once you get above five grams, you probably start to saturate creatine up to chance potters, so you don't necessarily, maybe you don't take all of it up, but the reason I take it all in one go is because I remember to take it all of it one go. Another reason is that

I find creatine to be quite stimulating, got a cognitive estimulating for me, so you took your

key turns, I took my creatine before. I got on this call, took five grams of creatine to it. And so if I take creatine later in the day, I don't sleep as well. It's very noticeable for me, but it's not, that's not the case for everybody. Some people take creatine and they don't notice a cognitive effect, they doesn't affect their sleep, so it's very different from person. So those are the reasons why I just take it all in one go in the morning, especially if you're

going to take over 10 grams, 20, 30 grams, you're probably best spitting up into several doses so that you absorb more of it. Yeah, 30 grams at one go. Also, as tempting the guards to

smite you with a really, really bad bathroom situation. So yeah, and a lot of people do mention

GI side effects from creatine. I think some of that is due to the quality of the supplement

“that you're taking. Yep. So if you're taking like, create your creatine on a hydrate, that's what”

most studies that have tested creatine have used and there was actually a systematic review metinosis that just came out that found that across all the studies they could find compared to the CBO creatine didn't have any additional GI side effects, but also those studies use high quality creatine also not all those studies use 30 grams. So you could certainly get to a point where you're going to start with GI effects based on those. Yeah, I think it also has to do with the fact

that my black polypharm in the morning when I'm just getting booted up, it's like, I might be having the coffee plus the creatine plus, you know, I think sardines with an STT oil. Yeah, I mean, there's a lot going into the cocktail of potential disaster, which you do acclimate to. Quick question before I forget on lactate. Is there any argument to be made for anything that you would ingest or otherwise put into your body, not to avoid doing the intense

exercise, but to increase the amount of lactate that you uptake into the brain? Is that something that people have looked at or is that just risky business and to be avoided because you'll end up in like some type of acidosis or some other problem? So people have looked at exogenous lactate itself, right? Usually as lactate salts just like you people have it to ketone salts. You can bump up, blood lactate a little bit, but similar to ketone salts that you don't get nearly the increases

you do with with other compounds, you don't need to do anything to increase brain uptake of endogenous lactate because the brain will generally just take up as much as you've got similar to

“ketones, right? I think I didn't ask, I misspoke when I was asking a question. I guess it's just”

increasing the amount of circulating lactates, your brain just sucks it up like a vacuum. Yeah, I think you can make plenty of lactate yourself. So, you know, another way to do it, blood flow restriction is another great way to produce lactate with low load. There are some studies where, well, they have them do like presses, but like sets of 20 leg presses where in blood flow restriction costs, well, man, that will get you up there as well. Again, several melomonas of lactate,

like, it's not fun. I think I'd rather do the Norwegians before but before, yeah, oh wow, that's intense. So that's another way to do it. So if you, whatever reason don't want to do a sprints on a rhyme machine, or you can, you can probably get up there with some blood flow restriction under low load and high rap, but no, I don't think there's anything that I would take to increase lactate. Okay. Just because you can make it so easily yourself. All right. So I want to hop on the

blood flow restriction because what, making model, you use, what's your kind of tool of choice for the BFR stuff? I use the B strongs. So they, the company is called B strong, B E. No, capital B strong. Okay. I have no affiliation with the mother than, like, I know some of the guys who worry about that, but I hate for my device myself. So it has leg and armcraft, but it comes with a, like, a big moment on it. Right. One of those blood pressure things to kind of

few different ones right now. So when you travel, right, people think of exercises this thing

“that involve so potentially all sorts of machines and you need your kit. There can be a lot of”

excuses or things that people imagine as obstacles that are not fact obstacles. So talks me about your exercise when traveling with blood flow restriction. What does it look like? So as my wife calls it, I have my gym in a bag, which I take everywhere I go when I travel and it is a set of blood flow structure. He's cuffs and a set of bands. I use the black mountain products bands, which come with handles. Like, I like them because they come with a lifetime warranty. Like,

I break them and snap them all the time and you just, like, email them and they're like, hey,

this broke and they just send you and you and they cost 40 bucks or something like. So super

cost effective. For people who are not looking at Tommy, I mean, you're freaking gigantic. I mean, you look gigantic. You're wearing like a very thick sweatshirt like it's just your pecks moving around for God's sake. What are your dimensions here? Not to turn you into like a playboy playmate or something. So I'm 62. I'm 2220 pounds. Yep. I usually hang out somewhere around 12% 25. Yeah, strong unit. Okay. But the reason that I brought that up is not to flirt with you. I go. I'm not not

against somebody. I appreciate them. Yeah. You know, the reason I wanted to bring it up is people might think there's somebody out there who's like an internet keyboard jockey on Reddit who's like

living in a basement in squads 135 and it's like, oh, that guy must be some pencil next to him.

And it's like, no, actually not. He's pretty big. And yet, like, you can get

“sounds like a decent workout with bands across 40 bucks and blood flow restriction. How is that possible?”

What do you do? So when I travel, because I'm usually at work conferences and doing podcast over like, I don't have two hours to go to the gym, which I like to have if I'm at home. So I might do 10 to 15 minutes and write you put on the cuffs, legs and arms. I'll do some lunges, like bodyweight lunges, squats, presses, push ups, and then bicep curls and tricep extensions. And that's probably it. So a pretty standard protocol, which is essentially in three to four minutes, you accumulate somewhere

between 75 and 100 reps. So 30, 20, 20 or 20, 15, 15, 15, 15, something like that. With 30 seconds of rest in between, try and do one body part of the time, but you can super set them if you're kind of sure on time, that's it. And kind of to your point, when we moved into this house, this was now eight years ago, I built my own gym here, but for a long period of time, I didn't have a gym and I was working from home, and all I had was bands and BFR cuffs. And then it wasn't even the B-strongs.

It was like these really cheap ones that kind of look like something that somebody would use to kind of like draw your blood. Yeah, like train sparring here. Yeah, exactly. It looks like, um, it looks like a tourniquet, like to tie your leg if you've like blown off your foot. And again, they cost like 20 bucks. They're probably not the best anyway. So I had some of those and some like 40 buck bands. And that was all I used to work out for like four or five months. And I didn't

lose any muscle mass or strength. I just got straight back into it after it. So like you can maintain and gain pretty well. As long as you, my BFR can be, you know, a little bit painful if you just sort of push it. But also very, very safe. Like that, that's it's been used in rehab, right? All these other things that that frail into people who are like, what the hell are they talking about? Okay, so I'm imagine you have, I'll use an analogy. This isn't exactly what's happening, right? But imagine you

had a small belt, tiny belt that you put around your upper arms, right, under the shoulders, right at the top of the biceps. Let's just say, keep it simple. And then I guess close to the hip, right on the other legs. Yeah, I've right up in the groin. And you're partially including blood flow, right? So you're not totally cutting off blood flow, but you're making it a lot harder for blood to get to your arms and your legs. It's mainly blood to get out. So the blood can, you know,

get out. You're not compressing the arteries where the blood gets in. You're stopping the blood from coming out. So the venus for you. Yeah, exactly. Okay, got it. Yeah. And the net effect is, if you're

“like Arnold Schwarzenegger and you're like, ah, the pump, I feel like coming. Yeah, it's, if you want to”

take that to like a 20x extreme and feel very, very, very uncomfortable. BFR is a great way to do it. Again, for people who are like, ah, come on, man. I squat through 15 or whatever. Like, I'm guessing you probably squat like at least three fifth day or more. And what, what do you squat? I'm curious now. My best, what is company is go four or five is my best squat better deadlift than I am a squatter. What do you deadlift? What's your PR for deadlifting? 550. Yeah, that's up there.

yeah, do proper lunges like knee to the ground and go for like 100 yards and come back. Like,

“I don't even think most people could do that. But it's just like, you're going to feel it, right?”

You're like, you're absolutely going to feel it. All right. Jim and a bag. We'll link to all this stuff in the show notes as well. So I want to list off a couple of things here and then talk about, we can keep bouncing around a lot. Well, on these supplements, you know, I'm going to kind of cut this short and we'll put things in the show notes. But the period until health, mouth health and dementia, right? The connection there, hence the use of Xylitol, whether that's the gum,

epic, kai gum, or air purifiers, mouth washes. We've got all this stuff. So I'm going to link to that in the show notes just in the interest of time and certainly feel free to chime in. I wanted to talk about cognitive stimulation, right? So we spoke about dancing earlier. Could you speak to language learning and music? Because I'm realizing, I think accidentally, I might have really helped my brain a lot early, which is great as a surprise. But also have next to me

and O'HANA, Eucalyeli, which is gifted to me, that his basically just been gathering dust and after

doing prep for this and then looking into it, I'm like, you know what? I should spend a couple of minutes a day just screwing around with this. It seems like a great use of time. But could you speak to music and language learning? So this actually, if we include dance, this comes back to something that we kind of start talking about earlier, which is what are these experiences, what are these activities that you can do with the brain that kind of maximally activate or increase

glucose up to? And there was a really interesting study that came out recently called creative experiences and brain clocks. Creative experiences and brain clocks? Yeah. So I'll break that down into this, it's different components. So kind of like when you did an MRI scan for your brain and all those other tests you did, there were various different ways the people could sort of like estimate how old the brain looks. And I don't love that's hugely BS or not. I don't know.

“It's a bit of both. Yeah. But in this context, I think it's kind of useful because when”

you think about what happens to the brain as it ages, there were a few things that happened where the structure changes, different parts of it get smaller, right, you lose volume, but then functionally it also changes. The different networks that we have in the brain that have different functions and activities, they become less discreet and they become more distributed. You get less of these kind of very functions specific, tightly knit networks and connections. And then

everything just like becomes a little bit more loose and different areas of the brain get connected together and it's sort of like a bit more of a mismatch. You get this increase in entropy, initially we call this brain entropy, right? It's not as discreet. Entropy then decreases again as we get towards the end stages of dementia just because there's not much going on in there. I'm fortunate

“anymore. Sorry, that's bad. That's the best way I can put it. And so when you look at different ways”

to quantify how old this brain looks, one way is to look at the structure and the connectivity of the networks and how like discreet they are, things like the front-to-private on that work, the salience network, the attention network, like these parts that are really important for like executive function, focus attention or this kind of stuff. And they tend to lose function as we get older and the easiest way to do this is with EEG, so let's throw and settle a ground where you measure

the electro activity in the brain. And so in this study, what they did is they took a whole bunch of different studies and they looked at these different creative experiences. So one was tango-dancing, one was language learning, then there was musicians, they had artists and they also had video gamers and they had an interventional study where they had people learn the video game and it was starcraft was the game that they used just in case anybody was wondering. Although most,

if we talk about video games as a cognitive stimulus, the one has the best evidence is Super Mario 3D world. Just in case you were interested, lots of studies were there actually. And what they did is they compared images to experts and then they also looked at the effect of an intervention where people actually were trained in this thing. And as you increase in expertise in these different

creative complex arts, you see improved structure and discrepaness of these like really critical

networks that are acceptable to aging as we get older. So the effect was similar in tango-dances versus

core effect of these complex, multi-sensory stimuli that require us to gain significant expertise

“and skill in order to perform them that seem to have this broad effect. So part of this is probably”

because we're training our brains to be able to focus and learn and then part of it is just like the actual engagement in this complex task. And so when you look at say languages, two very good colleagues of mine at the University of Washington, Andrea Stockholm and Shantel Pratt, they study individuals who are bilingual. And what they see, they've done this from both their measuring brain activity and different types of cognitive function and then trying to model what's actually

going on. And what it looks like is that those who grew up bilingual perform better on tasks requiring an executive function. So things like response inhibition which is you kind of want to do something that you stop yourself just in time. Normally when I talk about it it's like you know when you have these thoughts of like oh well what happened if I just opened this window and jumped out? Or you think something and you stop yourself just before you say it because there's a

really bad at it because it's like your boss. How do they test that? Are they using like a strup test as I'm just throwing something out there? So often it's like a go no go task. You're presented with different stimuli and it's whether you react to it or not but like a struper is partly an example of that but people don't know what struper is like you can explain it. Yeah so you

“you get shown words that spell a color and they are also colored and then you have to respond based”

on whether the word spells the color you're looking for or is the color you're looking for and so it like requires you to draw with these multiple things. So yeah they they use tests like that

but basically it seems that because you spend your entire life having to suppress one language while

you activate another and then move back and forward you're bringing to come to suppressing these different. So at the same time interestingly it seems you become less good other things. So none of this is good or bad but people who are bilingual seem to be less responsive to what it's immediately happening around them in the outside world and that's probably again just because of how their brains have adapted to these different stimuli. But you do see that those who are born

bilingual have a decreased risk of dementia or if they do get dementia they get it later. But you also see improvements if you train in a language even like using an app on dualingo they've

“shown that in older adults you use dualingo and of course you have to like actually move through it”

not just like stare at it for a few minutes a day but that you see significant improvements in exactity function. You see the same thing with with music learning. So there is something to these complex very human kind of skills that have these carryover effects into these kind of core

components of cognitive function. I'd never heard about the response inhibition with subjects

or a bio-langual but it might explain in a totally separate battery of cognitive testing that I did which was much more rigorous I think than what I did a few days ago. My digital string memorization despite all my pneumonic trickery is very bad because it's only flashed for a second and then you have to do your best. If you gave me a bunch of time I could use all my trickery but if it's just a flash and it's kind of relying on I guess my hardware then I'm very bad like to the point where

people might have some concern but I've always been like that. Conversely with something like this there was a test that was pretty much exclusively the strip test but I had a few things that were very similar and I was like I'm exaggerating but like ten standard deviations outside of the norm. Like I was so much better that they were like why are you so good? That's like we've actually

never seen something like this and it could be studying all these different languages. I don't know

maybe. Do you know what? I'm actually the same and like we're kind of convincing ourselves that this is real. It's the case for us but I often do cognitive function tests on people we work with in studies and that kind of stuff and we do this full battery all the things you mentioned and on every test you know memory all these other things I'm just like I'm perfectly average right and you kind of you always think that oh I'm so smart so therefore I should be like what X standard deviations

but no I'm like perfectly average on everything except for response inhibition tasks or the strip test then I'm like and I also grew up speaking multiple languages so I don't feel that maybe that's the thing we don't know which languages for you. So I speak Icelandic because my mum's Icelandic so I found her in Iceland and then I'd lived in Germany and France when I was a kid for various periods of time and then I did my PhD in Norway and I taught in the medical school

Yeah that's quite a few and for people out there who are like well I wasn't raised

“by or tri-ling well I didn't really even get started until I was 15-16. I thought”

all was assumed I was very very bad at languages for reasons that were mostly related to the schooling and not to any inherent ability but I'm also thinking about either tango as an example because I spent a lot of time doing tango that was I'm not sure if you have any familiar with

chapter in my life but in 2004 basically spent like six to eight hours a day doing tango in Argentina

and competing ultimately and going to the world championships all this craziness but you have the physical component like you said it's actually a pretty complex cocktail and in my case you not only had sure you have the dancing but you also have Spanish right I was learning Spanish at the same time and then you have the music and I'm wondering if studies have been done looking at the effect

“of listening to or having to track different types of music versus producing music”

has anyone looked at that? Not as much certainly frequent music listening it's associated with a risk of dementia as much as you can like and then cobble to the

declines as much as you can you know like get rid of all the sociological pieces of that there are

some studies looking at training adults in musical theory which requires actually listening to music and then pulling out the different components that seem to be as again associated with similar benefits to say learning to play a musical instrument so I think even some of that attentive listening and actually it's like engaging with the music as a listener seems to have some of the benefits in addition to like producing the music yourself. Yeah because with dance obviously if you

“actually have a hope of dancing well you have to listen very very carefully to the music and in”

particular I mean you could have choreographed dancing but what interested me about tango which I didn't realize in advance of getting to Argentina is that the vast majority of it tango this alone is improvised so if you're going to compete in that particular style of tango a salon tango you don't know what music's going to be played and then they just serve up whatever the song is happening to be so you're not only responding to the music but you're memorizing music

in any case makes people want to get back to Argentina. Maybe as though that time off is that's why your hippocampus has been catching up with you. Yeah exactly that to my litany of complaints so I wanted to highlight something you've mentioned this I don't think we need to spend a lot of time on it right now but sensory loss hearing vision right getting aids slash surgery as soon as possible since those seem to be so correlated to increased risk or onset of dementia I want to

mention two things and then I'll let you rip. The second one is now I'm kind of paraphrasing

here but like error detection triggers adaptation so like the importance of failure because with a lot of the hand wavy pseudo scientific gains in this that and the other thing that are sold for helping supposedly right helping people with memory cognition etc a lot of them don't seem to check that box so maybe if you could speak to the sensory loss and then the kind of error detection and defining that and the importance of it. There are several studies that suggest that sensory loss

particularly vision loss through cancer acts and hearing loss through age related to hearing loss presbycuses are associated with an increased risk of dementia and that this risk is reversible so if you have cancer surgery then that increased risk is no longer there and if you get hearing aids again that risk is no longer there. Of those two randomized control trials have only been done with hearing aids and they only showed significant benefit in those who are at an increased risk of dementia

for other reasons so like poor health cardiovascular disease these other things so it may be that it's kind of exacerbating other underlying risks but equally we can think about two broad reasons why sensory loss might lead to privacy decline and why often as people get older they're like I don't want to get hearing aid because then I'm old right conceited defeat. Yeah and so this happened with my mum actually and she recently got hearing aids and I encouraged her as soon as there's a

thing that you need you should get it and it's had a dramatic effect on our quality of life and so

function as a result right it's no longer being used and with a process of out of stasis or constantly adapting to the demands that are placed on you that part of the brain is just going to diminish its function so that's part of it but I think a big part is that when you lose senses you no longer engage in the world in the same way that you did previously you go out of the house less you socialise less you do less tango dancing right because you don't feel like you can engage with in the same way

so I think there's a lot of benefit from recovering lost senses that's not the same as so if you

are born or if you've never had sight or you've never had hearing that's not associated with

increased risk because you learn to engage with the world in other ways right so it's the loss

“of that engagement that I think is important then the error part the easiest way to think about this”

is that if we're trying to improve function as structure of certain parts of the brain that allows us to have greater reserve you know greater total capacity and therefore if we do lose some volume or some capacity as we get older right we have more to lose so we you know we're less likely to get to the point where we have significant deficit in order to drive improvements in structure and function right we need to drive these processes that we call in your plasticity new connections

new branches all the supporting machinery the other cells that are necessary right we think a lot about neurons but there's a whole bunch of other cells and stuff in your brain that are really important as well that a part of this response to stimulus but to drive in your plasticity you essentially have to have a difference between capacity and expectation

“the best way to uncover that is with mistakes or errors what's kind of like muscular training”

to failure exactly yeah if you don't ever get to the point where you're no longer capable of doing the thing that you want to do nothing use to change you can already you need to adapt yeah so that's essentially it that and this is what becomes important in dancing learning languages learning music right is that you're having these opportunities to fail to kind of get beyond your current capabilities and like that's what drives the processes of learning and plasticity

what else do you have in your personal regimen of kind of non negotiables you got obviously you're lifting weights you're doing your blood flow restriction torture every once in a while I don't know if you're much of a ballroom together I was a I was a a field rava in my youth

but I was never much of a ballroom dancer get that man some glow stick so you know I have a few

part of the reason the big part of the reason I got elbow surgery was to get back into rock climbing

“which I think is just a phenomenal phenomenal sport for mental and physical development I mean”

it's just a kinesthetic puzzle on a wall I mean then was really inspired over the last two years seeing people in places like Colorado Idaho Utah where I'd go into these gems and you see people in their 60s and 70s who are doing stuff that I can't even imagine doing physically and they meet a couple times a week and I was like wow okay if you can have that kind of longevity in this sport like that seems like a great investment plus I just really really enjoy doing it but

what are some other non-negotiables right if you look at all the possible things you could do all the things you do and you're like all right these are the things that are meaningful and that I stick with consistently what falls in that bucket right because a lot of people will get these like 27 things 47 things you can do to improve your brain health lists or whatever and even if they want to do all of those things there's no way they're going to there's a

question of sustainability or adherence as well yeah what are some of the other non-negotiables for you the one that we haven't talked about that really is non-negotiable as sleep yeah let's talk about it I think this is the the major thing that's missing from these studies looking at dementia prevention like as a as a risk factor I think inadequate sleep really seen it like so many studies now is associated with increased risk of dementia so that's something that I very consistently

make sure that I get enough of that's like the one thing that really is non-negotiable like I can I don't mind if my diet gets a bit crappy for a few days or I don't mind if I can't get to the gym for a few days like this stuff integrates over months and years like but

if I can only focus on one thing then sleep is really critical for me but I will say

one thing that I've noticed a lot was that historically I used to really get in my head about my sleep but I know this could be the case for many people who have tracked their sleep or used

particularly because I spent a lot of time looking at the research and this also affects it be at home because my wife is like if you don't sleep and then you don't get your coffee like I don't want to be around you because I picked up a moderate heroin habit yeah and a lot of it was was honestly self-induced because I thought I didn't sleep well therefore I'm not going to function well I'm going to be grumpy like all this kind of stuff and we know that

this is influenced by outside factors this influenced by her and thought processes there are studies that have shown this you know randomizing people to be told by their wearable it didn't

sleep well even though when they slept just fine and what you see long term sleep is critical right

absolutely and any sleep you can get more than you are having now the better right so if you

“sleep six hours a night you can get six and a half great like don't think that you have to sleep”

eight hours so if you can get an extra half an hour that's amazing but in short periods of time actually sleep deprivation doesn't have as much of a negative effect on COVID-19 function as we think and this is just important so that we can go about our day-to-day lives and perform well when we don't sleep well especially when you have a chalk bag for the creativity in it you're dead yeah but so like you have the creativity and help but equally like we travel we have kids

right all this kind of stuff sometimes you're just not gonna sleep well but in short periods of time

over like a few days what happens is that processing speed slows down but accuracy doesn't so

the quality of your work is just as good it just might take you a little longer and mood is affected much more than performance so actually we don't perform well we just feel more grumpy about how we performed so actually doing knowing this I then like just completely changed how I approached my seat so I didn't sleep well I'm like do you know what I'm actually gonna be fine then it turns out

“I am fine so that's like yes sleep is critical but how we think about these things I think is really”

important so like important factors are gonna be avoiding excessive alcohol don't smoke but then two things that do we you mentioned we haven't touched up on fully I'll kind of like briefly talk about one is air quality and air pollution which is a significant risk factor for dementia a lot of these studies are quite recent looking at say wildfire exposure and things like that but even living near roads like in the short term as associated with greater cardiovascular risk higher blood pressure

which you can improve with having an air filter of all the different like metabolic type risk

factors for dementia high blood sugar and high blood pressure are the two most important

lipids and other things are important as well but those are consistently the highest risk factors managing blood pressure is really important and if so you live near somewhere sort of air pollution then air filters certainly seem to help there and then oral health is the final one so like

“I say this because I appreciate that I'm British and I'm gonna tell you you should go to the dentist”

so historically when I lived in the UK I did not go to the dentist very frequently and actually the first I went to the dentist here in the US I have this one metal crown from back when I was a medical student and my dentist looked at it and he was like you didn't get that done in the US that was his first comment but gum disease to junior writers especially if it advances the period on site is is a significantly associated with an increased risk of dementia this is probably

both due to an increased like systemic inflammatory effect plus those bacteria can get into the bloodstream they're found in atherosclerotic plaques in heart disease they've been found in amyloid plaques in the brain so treating gum disease is really important whatever that requires and that's why I mentioned zylitol to you because there are several studies showing the zylitol gum or zylitol mouthwash can improve the oral microbiota decrease some of these

cavity and proton titus causing bacteria like strep mutants and porphyromones ginger vialis so it's just like a really low risk kind of thing there he is with his gum piece of gum in my pocket a low risk thing to consider and I don't think they've looked at it by Apple E4 genus type but things that have an anti-inflammatory effect or decrease inflammatory burdens seem to have an outsized benefit for those who are po E4 carriers and so gum disease would obviously be one of those

that's worth keeping on that's part of the reason not to keep banging on this drum because I know it's not the shoe that fits everyone but that's another reason for my fascination with ketones just remarkably anti-inflammatory on a couple of different levels so for folks who might be wondering and we'll put these in the show notes as well air purifiers do you mind if I just read from this email that you sent to me because of course I'm such a stickler I'm like what exactly

make in model so I'll just read from this the blip pressure study I mentioned this is i equals Tommy

word blue air models tailored to the size of the room the co-way COW AY air mega is a good budget option so we'll link to all these in the show notes this is one god with travel such a pain in the

“ass although I have I think it is James Nestor wrote the book Breath who is giving me just some”

horrifying instead of quantified self data related to looking at like CO2 concentration in various hotels and airplanes and so I don't think he'll stay in a hotel that has yield windows I think it's kind of part of his policy yeah high CO2 really negatively impacts sleep like lots of people in

a small room that's not ventilated that couldn't definitely negatively impact sleep so we always have

a window open or something for that reason yeah anything else that you do for sleep besides not becoming too orthorexic about it and like freaking out on the wearables and stuff which is a real thing for sure so besides recognizing that you're gonna be fine humans have been dealing with this for a long time what else would you say right I imagine you know there's things people have probably heard like keeping the temperature so there's whatever it might be like 65 to 70 degrees Fahrenheit

“etc other things that you find particularly helpful things that have helped me a lot I”

stopped work before dinner I don't do work after dinner and I said really really have to and that that helps a lot because I find I've ruminate a lot more if I if I do work late into the evening a basic shutdown routine I put on the blue light blocking glasses they're probably just placebo at this point but like I put them on and like my brain is like oh it's bedtime and then I read fiction before I get sleep I have a quite recent purchase was an eight sleep which has been

amazing because I tend to get quite hot when I sleep that's helped a bunch so it's kind of

help stakeholder and then I wear an eye mask which I really like for you know blocking out light they're also some very nice studies on that one of my favorite studies looking at eye mask you have a see this one where in the control group they had them wear like a zoro mask so they were still wearing a mask but like the eyes will come out no and this was during the summer when light would come in early in the morning when disrupt sleep and they saw significant improvements in

cognitive function in those wearing the regular eye mask versus like the zoro mask as a whole yeah so there's hilarious that's probably my list I'm gonna ask you something specific about sleep but just because I have it in front of me to ask you vitamin K2 do you supplement K2 or do you get it from something else I do generally supplement just like a few micrograms a day maybe 15 or 20 but that's mainly because it comes with my vitamin D that I was supplement particularly in the winter

and the summer I get plenty of sun exposure on bearskin but in the winter can't do that in Seattle but I also don't mind a little bit of nato or you know some fermented foods that they would have K2 in as well so don't need to supplement sticky spider webs if anybody likes the Santa Stinky spider webs try not though it's the one that Japanese people like to give foreigners to watch the face some people like it I can handle a little bit I can handle a little bit

I mean I grew up eating rotten shock in Iceland so oh that stuff is so

“fucking bad I don't I went to this place called hotel ranga I think it's ranga to bring my”

family you know my mom had always her whole life wanted to see the northern lights and so we went

there in the middle of the winter by the way folks not a whole lot of light it's like a twilight for a few hours that's all you get but there was some fermented shark celebratory day and we drove to what looked like and I think it was a gas station but had a restaurant attached to it and ate this fermented shark I don't even know how to describe it it was like I mean fermented shark as you would imagine but like eating something soaked in like ammonia like the

pungency when it hits your sinuses is like smelling salt yeah because it is ammonia so to make Greenland shark which is the type of shark edible so Greenland sharks don't have kidneys so they're tissue the body accumulates urea right because they can't fit in here out so in order to make your edible that urea has to break down to ammonia that it becomes edible in quotation marks and so it is ammonia that you're tasting but it's it's like it's got the texture of tuna and the taste

of a really really really really strong blue cheese that you peed on I will say I wasn't really hankering for a return trip to that particular gas station date fermented shark but watching

know you're supposed to alternate shark with brinnaven which is Icelandic aquavit you eat the

shark then you use the brinnaven to take away the shark you use the shark to take away the taste of the brinnaven and then you just continue that until you just get hammered enough that you don't care that you're eating fermented fish exactly there is one thing there's so actually I don't mind the shark that much there's one thing that's much much worse if you have a chance to try suits drumming which is a Swedish fermented herring in a can that is the worst I'm ever put on

my mouth is terrible it's like when you open the cat actually if you if you look it up they're all these youtube videos of people who like get it in the US and they open it and like the smell comes and they immediately throw up it's like you open the tin and you like take out these like

rotting bones of herring they can't have come on bread or like the recommended yeah no what I'm

doing for new years are so it's sleep do you have a position on the dora's on the like dual erects and receptor antagonists as a subchatted with folks including Matt Walker who's it a very credible in the space with respect to sleep research the potential that dora's could help with the clearance of beta amolide what is a p-tout to 17 et cetera and possibly be of some help in preventing the accumulation of things that later contribute to Alzheimer's it's not like

the vote is in and it's a hundred percent but there seems to be some a couple of interesting publications around including in humans do you have a position or any thoughts on it so like very quickly we know that sleep quality and quantity affect amolide the accumulation

of the brain that can be seen over short periods and long periods and that's some of that

workers from that walkers lab and he's even done studies that show that later in life if you can improve the amount of sleep that you get that's associated with a lower overall amolide burden I think that some of this like we get very focused on amolide it's a part of the picture of Alzheimer's dementia just like you say it's not the full picture but I think we look at it

“and it's a market for all the things that you should be clearing out of the brain when you sleep”

that you aren't right amolide is one of those things there are probably many other things as well so the door has have you know now several studies in different states in an insomnia in sleep app near you know these states where we know people are getting lower quality sleep and they certainly seem to improve that I think that in individuals you have some kind of sleep issue be that in some near something else that's going to prevent high quality sleep then improving that

is certainly going to be beneficial right now the door is now the best option previously people recommend a trasodone which is like we taught previously like the least worst option because it doesn't negatively affect sleep architecture unlike many of the other sedatives that people might use to help sleep but if you're sleeping fine or you manage to maintain high quality sleep as you get older I don't think we need to start taking doors to prevent

“Alzheimer's because I think your sleep is probably already doing the job that it's doing”

and there are studies that show the increased cognitive stimulation and older adults improves sleep quality or their engaging cognitive stimulating activities helps to offset some of the potential increased risk that we would have with poor or less good deep sleep which is when a lot of this clearance happens so I think a lot of the other things that we mentioned already physical activity we know improves sleep quality so I wouldn't jump straight to doors

but in somebody who does have insomnia and say CBTI is a CBTI for insomnia doesn't help them or some of these other things that we can do to improve sleep and those don't work and you've ruled out anything sinister then I think that now then now our best option to help so mostly all right we have covered a lot I want to know why you decided to do something very difficult which is right above the stimulated mind what was the driver behind this and who's the

book for I'd like to joke that the book is for anybody with a brain there the subtitle is about preventing dementia but really it's one of it is just about cognitive function and cognitive performance in general so even people who are younger and aren't thinking about dementia yet although

“like you said it's worth thinking about earlier than you think I think for most people who”

think about how their brains work or one their brains perform better and or want to prevent or minimize their risk of dementia long term it's got what I think the big rocks and the tactics for how to address those that we know substantially increase dementia risk all those things we talked about earlier that kind of contribute to those dementia that are potentially

people might focus on one particular area or they might focus on everything right there are books on dementia prevention that are just like endless tables of blood tests and supplements and

this stuff that's just like most people are never going to do right it's not going to be sustainable

I didn't really see a middle ground but equally I wanted it to be very heavily referenced so if people want to get into the references I have a reference list it's going to be two thousand papers all in humans and it's cited in the text right I have like little superscript citations in the text this subtitle a little bit it's a good subtitle I've so I want to give it some real estate here and so the stimulated mind subtitle future proof your brain from dementia

and stay sharp at any age I'm looking at the Amazon page for the first time I hadn't looked at it I had no idea that you know Kelly and Juliete Starat those are two very close friends of mine yeah and you got a very nice quote from Dr. Kelly and Juliete for the book that's fantastic I only really connected with them about a year ago but they've been some of the most I like I just have like they've been so so helpful like what do you do when you wrote a book

and how do you get out then how do you get people to read it like they've given you so much of

that time and help as they've just been they've been amazing yeah they're fantastic all right so

Dr. Wood that's you explains that a brain that improves with age is the result not of expensive pills far of discoveries or strict lifestyle optimizations but rather of actions with an uncontrolled diet sleep physical activity social connections stress tolerance obviously goes on and on but clearly you have a lot of very practical specific advice that people

“can implement and what else makes us book different so I think there's things that I mentioned”

make it different I think it's very practical and approachable but very science driven and if people want to dig into the references that those are available and then I think like towards the end

by after I've given you like there's always different areas where we talk about nutrition sleep

physical exercise I give like how you would approach each of those things in terms of sports and cognitive function and minimizing dementia risk but then I kind of bring them together in a model of how I think people can implement this in our daily lives like how do I just pick one thing and actually does picking just one thing help to support like the overall function of the brain and the answer is yes it does because when you sleep better just say if you focus on

improving sleep you're more sociable you're more likely to engage in cognitively challenging tasks your blood sugar improves your blood pressure improves so just changing one area suddenly the whole network shifts in your favor and that's the case from almost anywhere where you kind of

“approach it and I think that means that people are much more likely to actually start doing this”

stuff and realize that it doesn't require a ton of work to start moving the needle and then these things you know sort of compound every time all right the stimulated mind folks go grab a copy obviously you know I hate when people say obviously but obviously Dr Tommy would has the credentials has the expertise has the bonifies with respect to research in humans and has provided a lot that you can use in this conversation and a lot more is in the stimulated mind so check it out why on earth

is your ex account called Dr Ragnar I first started blogging around the time you first started podcasting I remember listening to you like first interviews with Dom Dagestina back in the day when I was like in my PhD chair kind of writing blog posts but my middle name is Ragnar so like I created a website was Dr Ragnar that was initially where I did my stuff so let me think about this for a second I'm gonna make myself probably regret asking this question but what is Ragnar does Ragnar mean

anything so now I'm thinking of Ragnar Rock and if those two have any connection is does it mean anything in particular? No so you're right Ragnar Rock is like the final battle of Valhalla and actually

“there are like some online gaming accounts where I use the name Ragnar Rock but you know I think”

what it means the translation for the analysis like wise counselor I think that was another reason I picked it because it was very self-important as a third-year-old health blogger but it was my grandfather's name and then these names sort of get passed down in the family technically it should have because I was the first born grandson it should have been my first name but my dad was English and it was like people just gonna make fun of him at school he's gonna get put if he's called

Ragnar it's very cool now right because of Vikings and like all these other TV shows where Ragnar now appears I mean you could make it work but Dr. Ragnar would also as little it has a kind of a strange

it's like don't use X so you can follow me on X but you won't see anything but people can find

“presumably there's something at Dr. Tommywood.com dr. Tommywood.com yeah so that is the”

that's the home base online. Instagram Instagram at Dr. Tommywood again do you know Tommywood. That's Dr. Tommywood. All right folks see you got it check out the stimulated mind the huge fan of what you do I am going to try to improve my chesticle and arm situation with more use of BFR and bands and is there anything else you would like to say before we win this to a close anything you'd like to ask of the audience point them to

requests complaints anything that comes to mind. No other than you know if you do happen to be a copy of the book and you do have any complaints do send them to me one of the reasons why I wanted to make it so that like every statement that I have in the book has a citation you can go you can read that paper if you disagree with my interpretation of it I want to know like I can't promise

“that I have all the answers so that will help me learn more so yeah if you have a complaint just tell me”

about it. All right Tommy I really appreciate all the time and this was great took tons of notes

for myself which is always a good sign so thanks for carving out a bit of time to be on the show

really appreciate it. Thanks so much for having me this is so much fun and for everybody listening as pre-usual will provide copious links and show notes at tim.blog/podcast, tim.blog/podcast and until next time be just a bit kinder than is necessary to others and also to yourself as Jack Cornfield says if your compassion does not include yourself it is incomplete thanks for tuning it. Hey guys this is Tim again just one more thing before you take off and that is five bullet

Friday. Would you enjoy getting a short email for me every Friday that provides a little fun before the weekend? Between one and a half and two million people subscribe to my free newsletter

“my super short newsletter called Five Bullet Friday. Easy to sign up, easy to cancel. It is”

basically a half page that I send out every Friday to share the coolest things I've found or discovered or have started exploring over that week. Kind of like my diary of cool things it often includes articles and reading book some reading albums perhaps gadgets gizmos all sorts of tech tricks and so on they get sent to me by my friends including a lot of podcast guests and these strange esoteric things end up in my field and then I test them and then I share them with you so if that sounds

fun again it's very short a little tiny bite of goodness before you head off for the weekend something to think about. If you'd like to try it out just go to tim.block/fryday type that into your browser Tim.log/fryday drop in your email and you'll get the very next one. Thanks for listening.

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