The New Science Of Preventing Dementia: Protect Your Brain, Boost Your Focus, Resist Cognitive Decline with Dr Tommy Wood #638

30:15Improved relaxation, enhanced focus and deeper sleep. And there are so many studies now showing the potential wide-ranging benefits of red light therapy, including better eye health, pain relief, reduced inflammation, enhanced recovery, improved sleep, and even better skin. So if you're looking to take charge of your health at home, I highly recommend you consider adding the Demi red light therapy device into your daily routine. And Bond Charge are giving my audience 20 % off all of their products on their website, just go to bondcharge.com forward slash live more and use coupon codes live more to save 20%.

31:08There are, well, there are actually trials that do look at that. It's interesting because the timeline matters, right? If you ask somebody how they feel about quitting social media after just a week or two, they might not feel that good about it. You still get, you know, FOMO and these other things because you're not interacting in that world. It's like asking how a smoker feels two days after they quit. They don't feel great. But if you go out long enough, four weeks plus, there seems to be an overall increase in well-being. and this is also driven by what people do instead, right? This is where a lot of the issue with social media comes from, I think, because it can be a way to increase social connection and social contacts that you wouldn't have had otherwise.

31:55And we see this in studies in older adults where they're using Facebook for the first time, they can communicate with family members that they wouldn't have done otherwise, you know, share photos, that kind of stuff. That is a net benefit. but if you're using social media to consume content instead of going and meeting people in real life that's a net negative and we see that very clearly in terms of well-being so yes you there is maybe some benefit from at least decreasing our exposure to social media but you can also curate the way that you use it such that it becomes a net positive plus you need to think about what am i doing instead and then there are multiple different ways to navigate that but just appreciating that these are potential issues based on the fact that if you're constantly, you know, being exposed to content from people that makes you feel less than, either consciously or unconsciously, it might be having a net negative effect on your health.

32:52Yeah, it's the tool, right? And like all tools, it depends how you use it. I agree. And at the same time, I think something has happened recently, which makes that even harder. So a few years ago, I thought, right, I'm going to call everyone. When it was still called Twitter, I thought I'm going to unfollow everyone and just follow the people who I think really are giving me value. So some of these, you know, there's a few endurance coaches who I really like following. They share research papers on exercise physiology and their experience coaching. You know, the things that I really enjoy looking at.

33:29And I did that for a while, it worked. I thought, okay, because whenever I go on, And all I'm seeing is stuff from people actually I want to see stuff from. But I think algorithms have changed out where you don't only see stuff anymore from people you follow. Yeah. In fact, that's only a very small percentage of who you see. So I do think it's getting harder. And you do talk about this in the book, right? You talk about the halcyon days of social media. And you were very early because I think your uni was like the third uni to get Facebook or something like that? Yeah, one of the first unis to get Facebook outside of the US in 2004, I think we got it.

34:04Yeah. But I remember back sort of, I don't know, 2007, 2008, Facebook was great. Yeah. It was a way of staying in touch with mates. You know, you'd share photos, you'd see what your mates are doing. You might follow a few people and see their content. And it was, I think, unless I'm looking at it through rose tints and glasses, it seemed to be connection, like social connection. Yeah. I think for many reasons, which you don't necessarily have to go into on this show today, but you write about, is it Prime? Prime, yeah. Just explain what Prime is. Yeah, so this is information that we prioritize as humans.

34:39So the Prime stands for prestigious, in-group, moral, and emotional. And this is because we prioritize information that tells us something about our social environment, because that's going to help us survive, right? And we are inherently social beings. and so this then is what's i think leveraged by the algorithms to have us stay engaged or you know continue scrolling and so they know that information that you will respond to either positively or negatively in a large way is the kind of information that's going to keep you keep you hooked in because your brain thinks this is important information about my social environment that I need to gather such that I will then survive better in my environment.

35:26And so that will include the things that you want to see, right? But it might also include stuff that they know will elicit a negative emotional reaction because you get these large swings in dopamine that then drive learning, right? That dopamine is largely responsible for learning what's important. And that's done on purpose. And so I think that social media takes advantage of our need for social information whilst giving us social disconnection but we keep going back because we're like well next time i'll learn something that will really help me um and that's how you get sort of stuck in the loop okay tommy so so far we're basically up to the point where we're saying that a lot of dementia cases are preventable which is a very empowering message.

36:17You've mentioned that the brain can adapt at any age. Again, very empowering. It doesn't matter how old you are when you're listening to this. I don't know if we'll get to your owl story or not today, but you start the book with a beautiful story about owls, which really highlights this point, right? That the brain can adapt at any age. We're talking a lot about social connection and I want to really talk about the 3S model that you put forward in the stimulated minds. Okay, because, well, firstly, I do have to tell you, I think this is one of the best health books I've ever read. Thank you. It's absolutely fantastic.

36:50And it's so thorough. I'll tell you what I like about it the most. Not only is it grounded in a lot of scientific research, it's very clear that you've got a lot of practical knowledge about the application of it as well. And that's not always the case. You know, there are sometimes books from researchers, which are great. And you see all the science. But, you know, as someone who's spent many years practicing, I'm like, yeah, but that doesn't... There is a different skill, I think, to application of these things for real life people who are busy. So it's a beautiful blend of that. You also, and I know this whenever I talk to you, you seem to know a study for absolutely everything.

37:32I can literally say anything.

37:36And you know a lot of studies, don't you? Yeah, that's part of it's an occupational hazard at this point. I think the book has a reference list of it will be about 2000 studies, 99.9 % of which are in humans that people can have access to if they're interested in digging in further. It's very rigorous, which I think is great. But I really love this 3S model that you put forward in the final third of the book, as it were. stimulate supply and support. And I'll just, before you sort of go, you know, outline it for us, something I read last night, which I've been thinking about ever since, is this idea that nutrition, of course, is important.

38:25But I think it's only one of the S's. Yeah. And I think that's quite novel because we think, well, what can I eat to support my brain? You're making this case throughout the book but that actually stimulus to the brain is perhaps the most important thing. So it made me think, well, hold on a minute. If we think about physical health, right? We can talk about eating protein for your muscles, but if you're never stimulating your muscles with movement or with lifting weights, is that protein really going to translate to muscle growth? and then I thought about it through the lens of the brain we can have the right diet the right omega 3s and all the things you talk about we can have them in our diets but that seems to be only one of the S's if we're not also stimulating our brain we're perhaps not getting the full benefit so I said a lot there I think it's interesting can you walk us through the model then comment on anything I've just said that you feel is important yes so what you say is exactly right And where the model comes from is all the different pockets of neuroscience that I've worked in or coached in over the years.

39:42So I'm thinking about the developing brain, thinking about individuals who suffer some kind of brain injury during life, like a traumatic brain injury or concussion, or trying to help elite athletes perform at their absolute best. And then also thinking about, you know, what are the factors that contribute to long term cognitive decline and dementia? And you see the same things pop up again and again and again, which sort of makes me feel like there are these core foundational inputs that the brain requires in order to perform at its best, both on a day-to-day basis, but then also long term. So things that you can do right now to improve how your brain functions today or tomorrow, then translate into a longer term, lower likelihood of dementia.

40:24And, you know, you're much more likely to maintain the function that you do have, or maybe even improve it, right, in your 60s, 70s, 80s and beyond.

40:33and there are a whole host of factors that we could talk about. We've already talked about several of them, right? But for me, they coalesce around these three common areas, which are the three S's, so stimulus, supply, and support, like you said. And I think that stimulus is something that we inherently know is important. Everybody said use it or lose it at some point, right? But I don't think we've quite understood what that truly means. in order to give our brains the stimulus or the stimuli that they benefit from the most. But I do relate it to this idea of physical performance and physical health because we kind of inherently understand that, right?

41:15If I want to get bigger and stronger, right? I want bigger biceps. The most important thing to do is to do bicep curls, right? I can improve my response to my training with a higher quality diet and making sure I attend to sleep and recovery. But I can't just drink protein shakes and nap and hope that my biceps get bigger. Okay, this is great. So in that physical health example, right? You're making the case that the three S's are still important, but the stimulus is the most important. Yes. Which I think makes intuitive sense if we step back and think about it. Exactly. And in reality, the function of any part of your body is driven by how you use it, right?

42:06And you can think about your bones when you do your weightlifting, or you can think about your heart when you go running, right? The way that we use our body is the primary determinant of how it functions. And the brain is exactly the same. So I'm making the case that how you use your brain is the primary driver of how it works. Okay, so we have this 3S model, and I wonder if we could just go through the three of them and, you know, stimulate. How do we stimulate? Supply. How do we supply? Support. How do we support? Yeah. Yeah, give us a sort of top line on that. Sure. So the stimulus that I think that we need more of, and I will acknowledge that I quite like the title of the book, The Stimulated Mind, because it's provocative.

42:55in a way, because right now we are at the same time understimulated and overstimulated. Yeah. Everybody feels overstimulated, right? So Tommy, how can you tell me that my brain isn't stimulated enough? Like I'm constantly feeling stimulated. And so it's the type of stimulus that really matters. And I think we can talk about, and social media is one of those things, we can talk about how you can decrease these other stimuli that make us feel overstimulated or stressed, because that's an important part of it that will end up in our support bucket. But the kind of stimuli that drive the development of the human brain are learning, knowledge acquisition, skill acquisition, social interaction, pro-social behavior, languages, music, complex movements in sports, social connection.

43:42these things that require us to learn a skill and apply that skill in a way that involves processing information quickly, in a way that involves responding to the environment, responding to other people, and through multiple senses, right? Our hearing and vision and touch, taste, smell, like all of these things actually can be important stimuli for maintaining cognitive function. And it's that kind of complex skill development and expression across all those domains, including arts, including computer games, like complex computer games can even improve cognitive function because it's the same thing, you know, multi-sensory, complex cognitive stimulus.

44:28These are the things that I think we need more of. And we need to spend time really attending to them and focusing on them. Is it the complexity of the stimulation? You mentioned this kind of the paradox of the time in which we live, you know, the book is called The Stimulated Mind. As you say, many of us go, yeah, but most people are overstimulated. But is it that it's almost like we've got too much of the wrong kind of stimulation, like the unidimensional, perhaps, like the scrolling. Because, you know, let's say you wake up and you go onto your social media platform of choice for an hour whilst drinking coffee, okay?

45:08You're getting stimulation, right? You might in that hour see more information in that hour than maybe your ancestors would see in a year or maybe even longer, right? Okay, let's just work this 3S model. Let's say for that one hour, you got all of this stimulus in, right? And then we go to the supplier and go, yeah. And let's say you've got an exceptional diet and you're moving your body regularly. So you're getting supply and you're sleeping well that night to allow that learning. In theory, could that stimulation be beneficial for the brain? To an extent. So if you're using Instagram and you're consuming educational content, such that you're learning important facts.

45:56And thinking. And thinking. absolutely that can be an important stimulus we know that educational attainment is the primary driver of education and the environment are the primary drivers of brain development and educational attainment is one of the best predictors of long term cognitive function and cognitive decline so that's literally just every day your job is learning right you're learning you're applying that knowledge that's why attainment is important right you're actually remembering things applying that knowledge in exams or however that that knowledge is so okay so attainment that's so it's not just going to school and passively uh consuming stuff you have to actively engage in some way yeah so the to kind of like really simplify that it's the difference between you spend 10 years at school and you you know pass your A-levels or you spend another few years and you get an undergraduate degree, right?

46:58Those levels of attainment versus you spend 10 years retaking the same year in school because you never pass an exam, right? You spend the same time in education, but those are two very different outcomes in terms of applying your brain and making sure that you're using the knowledge that you've gained. And can the stimulation that we need, like the primary stimulus to the brain, we don't all need the same. Because when you've been on the podcast, you have spoken a lot about, you know, when do we have peak cognitive status? Is it after university or in your late 20s, maybe in kind of the modern Western world in terms of how people who go through education and then they might go and study beyond that.

47:45But then it made me think about hunter-gatherer communities. And I thought, well, do we know in these traditional societies whether they have high rates of cognitive decline if they've not done the same type of education but then i think well but they would be getting stimulated in other ways maybe not in the conventional or the modern academic stimulus you know there's stimulus can come in a variety of different forms can't it yeah so i think that's an important clarification to make because these studies are done in a typical west you know western environment we're doing specific tests of cognitive function you know related to a whole bunch of different functions of the brain that could involve memory attention decision making processing speed like how quickly you can process information but this is these are just the data that we have access to this is how we understand it right and what that what those data show is that the cognitive function peaks around the time that you leave formal education.

48:48So the later you leave education, right? So the longer you spend at school or you're getting degrees, the higher and later your peak of cognitive function, because I think you're just getting this stimulus on a day-to-day basis. But that doesn't mean that that's the way that you have to do it, right? This could happen outside of a formal educational setting. And in those traditional hunter-gatherer groups, they will actually constantly be learning. And then at some point they'll transition from learning to teaching right this is this is a big this is a big part of you know um later life where we know that older adults in those communities in their 60s 70s and 80s are just as active as their as their younger community members but they transition to being repositories of knowledge and that that is that's the expression of these complex skill skills and information they've learned, you know, back to younger individuals who are now developing.

49:43So they're still constantly engaging their brains. It's just then using the information that they've gathered. So cognitive stimulus of this type can come from anywhere. And you see very interesting studies looking at different types of skills that have the same core effects on the function of the brain. So there was this, one of my favorite papers of all time was published very recently. It was called Creative Experiences and Brain Clocks. And what they did is they looked across multiple creative experiences or skills. So they had tango dancers, they had musicians, they had visual artists like painters.

50:22And they actually also included a computer game group, gamers, including a randomized controlled trial where they had people game and looked at the effect on their brains. and across all those different um these are very different skill types but across all of them they had this as you gained expertise in these complex skills they saw the same effects on different networks and functions within the brain so there are the the brain has all these different regions and each region has a specific function or that but what we're now learning is that really functions are distributed across the entire brain into these complex networks and how well these networks are connected and how efficient they are is a primary determinant of how our brains function as we get older so as we get older these networks tend to become a little fuzzier and a little less efficient and that makes it harder to say pay attention or maybe slightly harder to remember something but as people gained expertise in a complex skill those networks strengthened, regardless of what that skill was.

51:29This is networks like the frontal parietal network is really important for attention and memory. So what that says to me is that when we're doing these inherently human, creative, multisensory things, that requires us to pay attention, it requires us to focus, it requires us, you know, it drives neuroplasticity through learning. And then this is what's important for maintaining brain function, the function of these networks for processing information and, you know, language and the social aspects of the things we want to do with our brains. And that also then means, depending on what you find interesting to do, right, I just listed four or five things that are very different, but they all have similar effects on the brain.

52:13So that just means pick the one that you enjoy. And, you know, start by not being good at it, and get better. And it's in the getting better, it's in the, you know the learning and the failing that's what drives the improvement of connections in the brain that's what drives um the you know the improvement in the in the function of these networks that then ultimately translates to improve cognitive function over long periods of time that whole interconnected nature of the brain but also more widely the body is also another theme that that underpins the whole book which i absolutely love it's how i've always seen health and well-being And I think when people think about, I guess, the typical, you know, in inverted commas, lifestyle factors like nutrition, exercise, sleep, stress management, whatever it might be.

53:05I love that section at the end when you quote quite a few people there about the interconnected nature of health. You change one thing, you change everything. And I think that's really empowering for people, especially when they get bogged down with what that expert said. These are the benefits of yoga. and that expert said that this is the benefit of running and that expert said these are the benefits of meditation and yes, yes, yes and you don't have to do them all you do the stuff that you want to and you'll probably find that that starts to change other things in the body yeah, so that's and I think to fully unpack that we can like flesh out the model a bit more because then you kind of understand how this works which then gives us a lot more agency and it's a lot simpler in terms to start applying this stuff and benefiting from it.

53:53So we have stimulus, right? You've stimulated your brain doing something, right? Starting to learn a new language. When the areas of the brain that are related to that skill that you're learning are activated, they ask for more blood flow. There's this thing called neurovascular coupling where the neurons and the astrocytes in that area stimulate the local blood vessels to bring in. They need more oxygen, right? They need more glucose or whatever fuel you're fueling your brain with. And so those blood vessels dilate, they widen, they bring in more blood flow. This is then, so now we're in our supply bucket.

54:30And so that's where cardiovascular health becomes important. We know that things like high blood pressure, high blood sugar are important risk factors for long-term dementia. And that's at least partly because they affect the health of those blood vessels. if you want your brain to be able to react and adapt and do a whole range of different things that our blood vessels need to be healthy and respond accordingly so so you've stimulated your brain and now we're going to the second s supply when you have chronically high blood sugar or you have poor metabolic health you are negatively affecting the supply and the supply is important to get the most out of the stimulation that you just gave your brain.

55:12Exactly. And is this why perhaps we read things where let's say we've done a 90 minute bounce of work and, you know, because my son's in his GCSE year, I'm talking a lot to him about how he revises and how important it is to move his body. And, you know, so, you know, you do the stimulus, let's say you've revised, whatever, whether it's a child or an adult, let's say you work for 60 minutes on something quite cognitively challenging. Is it overly simplistic to say that if you then go for a walk or a run, you've done the stimulation with a one hour work, the run and the walk has basically got your blood flowing.

55:51So your supply from nutrients, from oxygen, everything is increased. That's correct, right? Yeah, so one of the reasons why movement is so beneficial for the brain in the very short term is because it improves blood flow to the brain. So the supply, the second S. Improves supply, exactly. And then that also translates long term, right? Long term, if you're more physically active, you maintain better physical fitness and physical health, metabolic health. Then you maintain good blood flow to the brain because your blood vessels are healthier. The other part of that is that, and we may get to this more later, is that if you increase arousal, which exercise does, you increase some of the neurotransmitters that are related to learning and focus and attention.

56:41And that then afterwards, once you've taken a chance to recover and adapt, you remember things better. So we know that if you do exercise before or after learning something, partly due to blood flow, partly due to arousal and neurotransmitter release, you will then remember those things better. So that's why movement around learning can be really important. Plus, if you've been learning, because you've been sat in a chair the whole time, we know that if you sit very still for long periods of time, blood flow to the brain starts to decrease and that can decrease mood and attention a little bit.

57:16So it's another way to just kind of reactivate everything related to that learning process. Okay, so let's get back to the three S's. We've stimulated the brain and now you're talking about supply.

57:33Today's episode is sponsored by Peloton. Now we all know that moving our bodies more is good for us, but despite that knowledge, many of us find it hard to actually implement. And that's where the new Peloton Cross Training Bike Plus, powered by Peloton IQ can really help. It's built for fitness breakthroughs with real-time insights and endless ways to move. And you can go from cycling on the bike plus to strength training off it with one smooth spin of the swivel screen, which offers endless ways to train for a well-rounded routine. While you lift, Peloton IQ counts reps, corrects your form, and suggests new weights, so you're always making progress towards your goals and Peloton's movement tracking camera provides real-time feedback so that you can train safer, lift smarter and make every move count more.

58:34With over 15 types of workouts, expert instructors to keep you motivated and a personalized plan tailored to your goals, the Cross Training Bike Plus takes the guesswork out of working out so that you can move freely and let Peloton handle the rest. Let yourself ride, lift, stretch, move and go. Explore the new Peloton Cross Training Bike Plus at onepeloton.co.uk That's O-N-E-P-E-L-O-T-O-N.co.uk And please note Peloton All Access membership is required to access all Peloton content and applicable features on your Peloton hardware. Dr Tommy Wood and Dr Tommy Wood So you've stimulated an area of the brain or the networks in the brain, we're now bringing in more blood flow.

59:36Right, so we've talked about why physical health becomes really important there to maintain healthy blood vessels, maintain a good glucose supply to the brain. And we know that in individuals with Alzheimer's disease in particular, there's a decrease in glucose getting into the brain. That may be, there's two parts of that. One may be due to decreased stimulus, right? If you're not using your brain in the same way, the brain is going to ask for less glucose, but it may be also an issue with the glucose getting in if we have poor physical health, metabolic health. So then the final part of supply is nutrients.

1:00:09The critical nutrients that we know are important, both for cognitive function on a day-to-day basis, but also in terms of long-term dementia risk. So the ones that we have the best evidence for, vitamin D, iron, omega-3 fatty acids, B vitamins, especially the B vitamins related to methylation, like B12, folate, B6, and riboflavin. Other things that we see are important for a long-term cognitive function are like the antioxidant vitamins like vitamin C and vitamin E. Antioxidant polyphenols is very cool things that you can get from, you know, that make berries purple and red or that make, you know, fruits and veggies, orange and red.

1:00:51So like gluteins, zeaxanthin, astaxanthin, that's what makes shrimp and salmon pink. These antioxidant polyphenols seem to have really interesting benefits for the brain, both in the short term and the long term. And then some other minerals like magnesium and zinc, things like that become important too. So those are the critical nutrients that we're hopefully getting from the diet. that then get directed to the parts of the brain that are building new connections, building new synapses, as it sort of cements the things that you're learning, right? And so that's the final part of supply. And then you've stimulated a part of the brain, you've brought in all the resources it needs to do the thing that you've asked it to do.

1:01:31Then we know that for a tissue, including the brain, to adapt to a stimulus, it needs a period of time to do that. And that's usually during rest. right so um it's the same if we uh if we if we're going training for something like a marathon right you don't get faster while you're running you get faster while you recover after the training run that you did and so the brain is the same this is where sleep is really critical so now we're in the support the third s um so sleep is a big part of support that that's when all those connections that we've made are cemented that's when um you know we're building that function in the brain based on the stimulus that we've applied.

1:02:14But we can also further support that adaptation through a variety of different things. So that's where hormonal status can become important. That's where other factors that get released by the body can support the neuroplasticity and development in the brain, things like brain-derived neurotrophic factor, which is released during exercise. These can kind of help to support the direction and creation of new connections in the brain. and then sort of the other side of support is we want to avoid things that inhibit that process so smoking, excessive alcohol, air pollution other things that can cause chronic increases in inflammation so we already talked about the social side but that could include like dental health and oral health is an increasingly recognized risk factor for dementia either because of the direct effect of the bacteria but also maybe the inflammation that they create and then chronic stress plays a role here too because we know that if you never get a chance to fully switch off because you're chronically stressed then that can sort of impair our ability to adapt so then you realize that all these different buckets are interconnected, right?

1:03:26So stimulus drives supply and stimulus also drives support so when somebody does a cognitively challenging task they then have a greater need for sleep that evening so they actually they may sleep better because they have a greater drive for it so just sorry to pause you there but that could mean if someone's listening to this and they sometimes struggle to sleep and there's many reasons for that one of the reasons might be that you're not stimulating your brain enough yes so one of the ways that we know know that one of the ways we understand that the best is through exercise we know that exercise improves sleep, can improve sleep onset as well as sleep quality.

1:04:09But there are really interesting studies in older adults where they have them do a brain training program for a few weeks. And what they see is that compared to a control group who are just doing much less cognitively stimulating stuff on a computer, they were using like paint to just like, you know, make some things, but it's not the same as like really challenging your cognitive function with some of these brain training programs. Those who are cognitively stimulated, they ended up sleeping better because they're creating greater sleep drive. And so I often wonder if part of the reason why as we get older, we sleep less is because we're not using our brains in the same way.

1:04:47We're not stimulating them. We're not asking as much of them. So we're not creating that sleep pressure, that drive to sleep. And so because all of these things are connected, that then means exactly what you said earlier, which is when you change one thing, you change everything. So we know that if you start to sleep a bit better, then your blood pressure improves and your blood sugar improves. And the next day you feel more sociable. So you're more likely to engage with other people in some kind of social interaction. We also know that if you're less fatigued because you've slept better, you're more likely to engage in a cognitively stimulating task because we avoid cognitively challenging things when we're tired.

1:05:25And the same is true, right? If you stop smoking, right? Blood pressure improves, inflammation improves. you're more likely to exercise, you're more likely to make a more like nourishing meal choice. If you start to exercise, then you sleep better. And all those other things kind of come off that. So if we understand that these are not a long list of things that all these things we have to do, but instead, even just within one bucket, you would identify something where you're like, oh yeah, I could start to make a small change there. We know that benefits tend to be linear, right? A little bit more is going to have some benefit, right?

1:06:06You don't have to do four hours of exercise in order to see benefit, right? Anything is going to start to be beneficial. But you pick the thing that you feel like you can make some change in, you would enjoy doing, or you're able to do. The whole network starts to shift in your favor. And then you can start to come in from other places as well. But understand that it's not a long to do list that's overwhelming. It's a network that allows you to come in pretty much anywhere and start to see big benefits. That has huge practical application. I think back to earlier on in my career. And I very quickly learned that if I was to tell a patient, or give them loads of things that they could do.

1:06:50You know, say, hey, and I give them the research, say, hey, you know what? If you do this, it's going to do that. If you do that, it's going to do that. And they come back four weeks later, they haven't done anything. Yeah. Right? I was like, oh, I've actually just overwhelmed them. Have you found that to be true yourself in your own sort of coaching and in your own life? Absolutely. I think that right now, it's very common on social media to see, here's a list of things to do for your brain health. And they can all be very evidence-based, right? Could be all the things we've talked about today.

1:07:21But I've seen time and time again, you give somebody a list of 37 things, they will do zero things, right? For those exact reasons. And my favorite personal experience is the first time I worked in Formula One. I, you know, I had sort of interacted with the team a little bit before. This is, I do all of my Formula One work through a company called Hints of Performance. And I was invited to go to the US Grand Prix in Austin. And I was going to be in the paddock, meeting with coaches and drivers and team principals and all these amazing people. And I was a big Formula One fan. So this was a big deal for me.

1:07:54You nervous? Very nervous. And then I did what any good nerd would do. And I massively over-prepared. I was like, I went in armed with 100 things and 200 studies to be like, I'm ready. I've got all these things that people could do to improve performance and health and all this kind of stuff. and I remember having a conversation with a coach and so the way that HINSA works is the majority of the drivers that we work with they have a HINSA coach this is usually somebody they have like a master's degree in strength and conditioning or they're a physio or some of them have a psychology background just depending on what the driver needs but they're there like inserted into the life and world of the driver they're there every day they hold the helmet next to the car hold the umbrella they're doing all the warm-up drills they're doing all the training, and they're looking after diet, all this kind of stuff.

1:08:48They're sort of like organizing their lives. And these are the individuals that I spend most of my time interfacing with. Like, how can I help the coach do their job better? And so I'm meeting with his coach for the first time. And I think I probably start throwing out all these different ideas. And he's like, we've got time for maybe one thing. Maybe, right? What you don't realize, or maybe you don't think about, is that, first of all, drivers are essentially jet lagged nine months of the year because they're constantly flying from place to place plus you have to do all the um where there's the races but then there's all the preparation in between there's media days there's you got to go and schmooze the sponsors right because everybody wants their piece plus you've got a million people like me showing up be like hey try this thing do this thing hey right and so so then it it comes he's like right we've got time for one thing what's the one thing that you think would have the biggest impact and so like ever since then that's the mindset that i've had to take in like if we we can start with a big net but first of all like where's the biggest potential anchor or issue that's affecting this one individual what's the highest return thing that that person could do with the time and resources and things that they have available and that's what that's where you start um and yeah sometimes you get it wrong um and that's true for all of us right we need to experiment yeah yeah And of course, some of this requires some trial and error.

1:10:15But starting with the one thing that you think is most likely to have an effect is always going to be much more likely to actually start to move the needle because you'll actually start to do it rather than thinking about a hundred things that I've suddenly thrown at you. Like, well, I just don't know where to start so I won't do any of it. You mentioned Formula One and I know I've always wanted to delve deep with you about your experience there because it's super fascinating. as you were describing the drivers there and the pressures on them the pressures to compete to perform at a high level to deal with jet lag sponsors everyone wanting a piece of their time I thought wow that must be quite stressful and perhaps some of these extra commitments that they have potentially are going to get in the way of their ability to perform which is ultimately what they're paid to do but of course they have to appease the sponsors and all that kind of stuff as well from all your time in For Me The One and having worked with several drivers would you say there is something that's common to all of them like a skill or an attribute that actually you know what they all seem to have that something that I see across you know all the successful athletes that I've either worked with or interacted with

1:11:39is in a way that's relevant to them, focusing on process above results. Because, and I think this is also relevant to everybody. Yeah, for sure. Because you will never achieve the result and you can never guarantee the result, right? But you can enjoy the process and figure out what works best for me. How can I make this better? How can I continue engaging with that? How can I be more targeted in the things that I do and don't do so that I have better overall balance? I think it's people who love that process and really focus on improving the process itself then end up consistently achieving high levels of anything.

1:12:24And this works in academia and sports and any kind of area that you might think about. the other thing that I see very consistently and I don't just say I like we as a team the team that I am part of I'm head scientist for motorsport for Hintzer but you know we have doctors we have coaches we have a bunch of performance experts psychologists right that we all and we all work together the thing that I see most consistently then is is this need for down regulation and recovery, right? So if we're thinking about our three S's, it's very unlikely that we can come in and somebody's already performing at that level and say, do you know what?

1:13:06You need more stimulus, right? Because they've spent their entire lives learning how to drive those cars and dedicated to that craft. You're driving around the track at 200 miles an hour. You're getting plenty of thing is, right? And, you know, we spend a lot of time, you know, looking at blood work, looking at diets, tweaking those things just to kind of make sure that they have all the bases in place. But really recovery is where a lot of the benefit is going to be seen. Like how can we allow these guys to rest, recover, downregulate, adapt, so that they can get the benefits from the the stimuli they're receiving, the physical in their training, in the car, everything they have to do around engineering and working with the teams there.

1:13:54So the third S, support. The third S becomes really critical for them. And that's probably where we spend a lot of our time focusing because in driver development, and this is something we do a lot of now as a company and we're doing more and more over time and trying to improve these processes. If you have a young driver wants to be in Formula One in five, ten years time. Yes, we might focus on stimulus. How can we build skills and fitness and performance, cognitive, physical? And so that's maybe where we focus. But once you get up to that tip, it's thinking about how can we make sure they're getting the most out of what they're doing so that they can sustain performance for long periods of time.

1:14:38Yeah. it reminds me a little bit of um i think a case you write about in your book when you first started coaching perhaps was it a was it a runner yeah who was well you can tell the story because it's it it really now i'm looking at that fresh through the lens of the three s's going you can stimulate all you want a supply or you want but if you ain't got the capacity for the support for the rest the sleep for you to absorb the stress and adapt to it you ain't going to get any faster yeah and and so this is this is something that's very common in amateur athletes so like this this this uh individual was they were they were a high performer they can they competed at a high level but they were they were an amateur um as in you know they weren't paid to take part in their sport and so this was a runner who came to us several years ago and did felt like his um performance was going backwards.

1:15:36So like he wasn't getting the race times that he wanted and was also sort of like slipping back in the field whenever you compare to others. But he was training, wasn't he? He was training. Yeah, so he and was training very, very hard. Plus you layer on top of that a travel schedule that was quite brutal because every two or three months he would travel internationally to compete. And so the reason why I tell this story in the book is because it was the first time that I, as a coach previously, I would focus on stimulus, right? What's the training program? Like, how can we improve that? But it was the first time when I looked back, I looked across everything that I had from this individual and thought, all these other pieces are the most important pieces.

1:16:20And so like, I think the first thing I said to him was if you continue this, the only thing I can guarantee is that you'll get a divorce. And it was a bit tongue in cheek, but basically you're seeing somebody who's over-trained, not able to eat enough calories or not able to have the cognitive bandwidth to focus on getting enough calories in because they're so focused on their training plus a brutal travel schedule plus they're a husband, they're a father they have a family that they should spend time with that they're not focusing on because they're just so focused in on their training and this then essentially made me realize that it's all these all these other things are going to affect our capacity to a get the benefit of the stimulus that we're applying um but you know the overall picture of of what it even means to be an athlete or be an individual in the world that we want to be, right?

1:17:25He presumably, and I think this was the case, and he made changes to his training program and his race schedule to kind of take account for these things. Right? Having a family and being a husband and father was more important than racing. But like once you're so deep into this and you're so stressed and overworked, you become very focused on singular things. Like what's the thing that I can control? And what he felt he could control was like, I'll just train more. I'll just do more, right? That's the thing that I, that's the needle I can move. When actually that was the thing he needed to pull back on so that he could then benefit from that and actually think about who is actually, who is the person I want to be that yes, is an athlete and performs well, but also does all these other things.

1:18:11And so then by focusing on the recovery aspects, by focusing on these other areas, maybe even training a little bit less, making sure that he was eating enough, right? enough supply to kind of support the adaptation. Then he ended up doing less, but performing better because he was taking care of these other areas. I imagine a lot of people listening are probably thinking, well, yeah, I could probably get more stimulation. You know, I could probably learn new things or get more social connection or whatever it might be, learn new skills, all that kind of stuff. Regular listeners to this podcast will of course know about the importance of regular movement, good nutrition, but the stuff that you'd put in that second bucket of supply.

1:18:56But I think this third S of support is something that a lot of people need help with these days. So many people struggle to downregulate and switch off and maybe they're not getting the right kind of stimulation in the day or when they're scrolling in the evening, but it is so common now for people to feel wired but tired, right? They are knackered, but they can't switch off and fall asleep. yeah so i know you sort of there's a whole chapter on this in the book but have you got some sort of practical guidance of people who might be experiencing that at the moment i think one of the thing things that ends up being very common is because of the way we structure our workday, we get to the end of the workday and we're still sort of stressed about what we have and haven't done.

1:19:53Plus, we're sort of desperate for some kind of way to switch off, that we end up spending a lot of time on screens, social media, right? And those things can be beneficial if we, or, you know, they don't have to be detrimental if we craft our experience with them. But a lot of what happens when people can't sleep, you know, this sort of like tired and wired thing, I think is downstream of our lack of structuring how we spend our days. so in one of the one of the first people that i met when i was working when i started working with him so it's a guy called uh james hewitt um he's uh he used to be a professional cyclist and now he's a sort of a cognitive performance specialist and he wrote a book with aki who founded hincer called exponential where they they outline this idea of cognitive gears and it sort of again relates to the physical side of physical training and but basically we have three gears in which we can use our brains um high gear is sort of really deep focused work like this is when we're paying attention to one thing at a time we're doing something complex we're learning we're problem solving um you know these big tasks that we have to get done in our days.

1:21:20Low gear at the other end is, you know, when we're fully, you know, switched off, relaxed, you know, our brains free associate, right? You know, this is why we have moments of inspiration in the shower, because we're not sort of constantly having to deal with other inputs. Or this is, you know, often happens when I'm in the gym, like that's when I'm not thinking about anything else, and sort of like ideas kind of appear. Same when you go for a walk, right? and ideally your brain spends a lot of time in this kind of mode because you need that mode to recover from this like complex cognitive work that you've been doing even during the day like in addition to sleep where we spend most of our time if not all of our time is in the middle gear so think about high gear is like sprinting low gear is like walking and middle gear is kind of like jogging or running and we basically spend our entire day running and if you imagine like how exhausting is it to run all day you couldn't do it right but you just like keep trying to keep keep going um and this is essentially what we're doing to our brains in the modern work environment and it's uh the middle gear is meetings uh emails dealing with slack and teams and all these different inputs multitasking or task switching across multiple to like trying to deal with multiple things at the same time.

1:22:34So like you're trying to do some work and then an email comes in or a message comes in or we get to the point where we're so used to distractions that we distract ourselves. There's some really nice work from Gloria Mark, fantastic book called Attention Span, if anybody's interested in this. But basically, if we're distracted a lot, our brains get used to distractions and then we go looking for distractions. You know, like when you go to pick up your phone, even though it hasn't gone off. And there's no, I mean, you have your framework, like why now? why am I doing this? Like, what was it for?

1:23:05But we basically get to the point where our brain gets used to distraction and goes looking for it. And so we know that when we're forced to multitask or, you know, we're interrupted in our work, which is essentially everything we're doing in the modern work environment, it's inherently stressful. It creates this low level of stress. And then you layer on top the fact that you never get a chance to do the really high quality work that makes you feel useful, right? This is what I'm good at. This is a job that I'm here to do. And it could be researching or writing a book. It could be preparing presentations for a board.

1:23:44It could be, luckily, if you're like a surgeon, they get to remove all the distractions and actually do their work. But that's the kind of thing that we want to be doing, like focused, this one thing that we're doing. This is the thing that we're good at, really applying ourselves. But we'll do that with a surgeon because we know that someone's life depends on it. But without being flippant, you could kind of make the case that all of our lives depend on it, right? Like if, yes, we're not surgeons or many of us are listening and not surgeons. I'm sure there are a few surgeons, I think. But, you know, the quality of your life probably does depend a lot on how you're spending each day, right?

1:24:26So yeah, a surgeon has a reason to do that, But we kind of need to give ourselves that reason as well, I think. Exactly. And so we want to feel useful and productive, right? We're no longer, you know, as a species, our history was largely, you know, our productivity was largely due to physical work, right? Hunting, gathering, farming. But now the product of our work is due to our brains, right? We're knowledge workers. I'd like to call us all cognitive athletes, right? And so like that's important because the best athletes, like I was saying earlier, They know they're very targeted training. They're very targeted stimulus.

1:25:02And then they focus on recovery, adaptation, getting the most out of their training. Whereas we just spend all day jogging and never think about the recovery that our brains need in order to perform our best. So then what happens is at the end of the day, you've felt very busy and very stressed because you're constantly bouncing around between all these different things. You're in Zoom while you're also writing an email, but you're like not paying proper attention to either of them. And so that process is inherently stressful. And we know that people make more mistakes and errors and feel more stressed when they're interrupted or they have to multitask.

1:25:39And then you're stressed about the fact that you didn't actually do that really high quality focused piece of work that you needed to do because you were so busy in meetings and multitasking. And so then when you get to the end of your day, you're like, you're stressed about the fact that you didn't do those things. And then you have to try and somehow wind down and go to sleep. So you then may rely on other things that you feel like are allowing you to relax, but could compound that. So it could be social media, or it could be a glass of wine, which then impairs your sleep, or two glasses of wine.

1:26:11And then the next day, the whole kind of cycle starts again. So I kind of start by thinking about how can I structure the workday so that even if it's just for 30 minutes, I can just get the thing that I need to get done today done. and you do that by, if you can, structuring your day so that whenever you feel best, each of us feels most focused, most alert, most attentive at one specific time of day. And it could be in the morning, it could be in the evening, right? Depending on chronotype and other things. During that period of the day, just set aside half an hour to do the thing that you need to do.

1:26:47And then you can also set aside time to do the meetings and other things, and the emails, we all have to do that. But in between those things, allow yourself time to have a break. Can you go for a five-minute walk? Can you just look outside at something green? There are studies that show that we can become reinvigorated and less cognitively fatigued just by looking out a window at greenery for 90 seconds. So it doesn't necessarily take that much. There are also some nice studies where people feel reinvigorated after five minutes of watching comedy clips on YouTube. Just something to completely disengage from the work that you're doing.

1:27:24so can you build some structure in that allows you to do high quality focused work can you build in breaks during the day that um so that you can you know recover just like in between bouts of sprinting right you can't sprint forever you have to like take a break and then you go back and do it again and then at the end of the day if there's anything that's still on your mind you know that you need to get done on your to-do list like we know things like mental offloading can really help with sleep so you write down your to-do list you write down the things you're worried about. And then that helps people fall asleep.

1:27:57It literally gets it out of your mind. Get it out of your brain. Yeah, exactly. And then maybe you can also think about those other things that you might be doing the evening that could impair your ability to sort of wind down and recover. But I kind of think about it in that way, that you're sort of like tired and wired thing starts at the beginning of the day. And then there's also like the cycle of alcohol and caffeine, which is very, which is very common that can then also impair that process. But just thinking about how we structure how again how we use our brains I think sets us up for the ability to wind down in the evening yeah I love the idea that if you're feeling tired and wired in the evening think about how you started your day yeah it's not just about what's happening in the evening right the whole day plays into that one thing I've often spoken to patients about is this idea of a stress threshold and that you accumulate all these stress doses in the day.

1:28:54And when you get to your personal stress threshold, and we all have one and each one of ours can be different depending on our resilience, depending on what we've got going on in our life. But it's when you hit that threshold that the problems often start. So when you get close to it, your back goes, your neck goes, you react to an email, you said something about you shouldn't have done or whatever it might be and i have seen over the years if once people understand that stress threshold concepts and go yeah so i've been working for a couple of hours as i'm getting closer to it can i take a five minute break just move myself away from it yeah in the day you just keep you never let it accumulate to the point where you hit because once you've hit it it's harder you can down regulate with you know there's breathing sections in your book that you you know different exercises people can do and there's all kinds of things but if you can and if you do have a degree of autonomy over your day building in those like regular sort of micro breaks yeah it has an outsized effect in my experience absolutely um especially if you can right so so like um like i said any any kind of hard cognitive work right you need you need a break from just like with just like with physical work and it doesn't have to be that long it just has to be something that completely just you know allows you to disconnect.

1:30:11And, you know, even better if you can pair it with just like a very brief exercise snack or period of movement, because like I was mentioning earlier, if we spend long periods of time sitting, mood starts to drop, right? Maybe that's what, you know, maybe like our stress threshold decreases, right? Blood flow to the brain decreases a little bit. You know, we don't have quite the same sort of level of cognitive function. So just like breaking up sitting and using that as a cognitive break, right? If you can go outside or you can just like do anything, you can just like step back. There's multiple things that then happen at that moment in time that allow you to then go back into it, you know, just a few minutes later.

1:30:52Let's talk about women's brain health. It's getting a lot more attention these days, very rightly so. Absolutely. I know you've got some really quite thought-provoking ideas relating to women's brain health through the Lentiview 3S model in terms of stimulation. So can you speak to that as a topic? Yeah, absolutely. So another reason why I think we have this hopeful message for dementia prevention and decreasing population dementia burden in the future is because over the past 100 years, we've seen a decrease in the age-specific incidence of dementia. and that's measured in a very specific way.

1:31:38But what we hear all the time is dementia cases are going to triple in the next 10 or 20 years. You know, the risk of dementia is constantly increasing. And those things are technically true because the world is, you know, the population is living longer. And if you live longer without dying of something else, then you're more likely to get dementia. We know that. But you are less likely to be diagnosed with dementia at the age of 70 like today than you ever have been in previous history. And people don't realize that. So what that means is over time, age-specific incidence of dementia has decreased.

1:32:20What does that mean, age-specific incidence? So that's exactly what I was saying. So if you pick up a specific age, 60 years old, 70 years old, you're now less likely to have dementia at 70 years old than you were 20 or 30 years ago. And I just want to make sure everyone's got this. So why is there this apparent discrepancy then between rates going up, but our individual risk at any given age going down? It's because we're living longer. So it is true that because now we're more likely to live to be 80 or 90, that yes, the risk of having dementia at 80 is lower than it was previously. But because more of us will live to 80, more of us will have dementia at some point in our lives, but it will just happen later in life, if that makes sense.

1:33:05So both of those things are happening at the same time, which is complicated, like I understand it. But what's then interesting is you see that it is possible to move the needle on the incidence of dementia at any given age, which then means that it's probably also possible to move the needle on dementia overall, right? Which just goes back to the fact that dementias are preventable or some proportion of dementia is preventable. But when you think about, well, why might this be? Because it kind of goes against some of the narrative. And one is an improvement in cardiovascular health. And this seems to have particularly been beneficial for men, decreasing the age-specific incidence of dementia for men because heart disease risk factors overlap very tightly with dementia risk factors.

1:33:56we've already talked about, blood pressure, blood sugar, but smoking, blood lipids play a role here too. We've become much better at treating and preventing heart disease. And that seems to have translated to a lower age-specific instance of dementia, maybe more so in men because men tend to have higher heart disease risks than women. But we do also see some of this shift happening in women as well. And there were these big meta-analyses that have been done in studies using data from the US, from the UK, from multiple European countries. And I wonder if some of what we're seeing, particularly in women, is the changing role of women in society, which has been, you know, overwhelmingly beneficial.

1:34:41So if you think back to, I mentioned Warner Shies, Seattle longitudinal study. And one of the things that they looked at in the Seattle longitudinal study was environmental enrichment or an enriched environment, which basically meant how complex and cognitive stimulating is the world that you exist in, largely related to your work and your hobbies. And the more enriched or complex your environment, the lower your risk of dementia or cognitive decline in the Seattle longitudinal study. But there were a group of individuals who had low environmental complexity and a higher risk of cognitive decline dementia.

1:35:24And they were all overwhelmingly women, which was the housewife. And this in the 1950s was a very traditional thing, right? And the way that they measured these things and the way they wrote about them, you know, is partly of their time, right? Now, 60, 70 years ago. But something that they saw in that study was that that environment was not necessarily as stimulating or complex as you know the work environment or the other people might have access to but we've seen both within you know westernized societies but also globally as education has become more accessible and equitable to women in particular dementia rates and dementia risks have decreased right that's one of the reasons why education is actually the risk factor in the Lancet commission report.

1:36:16That's the biggest number, 7 % of dementias related to education. And then we think about the work environment. So women's presence in the workplace only really started to expand in the 1970s. This is based on like US labor and statistics data. And so there's been this big shift from, you know, what is maybe the potential for a less cognitively stimulating environment. And I realize that that doesn't have to be the case, right? People can be primarily at home and most of their work and commitments are at home with their children or family or family members, right? And that's what they do. And that can be incredibly stimulating and incredibly enriching and incredibly satisfying, of course, right?

1:37:04So we're talking like averages and maybe how things looked 60 or 70 years ago. um but as those things have shifted right women have been allowed access to more complex um higher higher power jobs and more education again both within westernized countries and globally we've seen a specific instance of dementia decrease so i think as society becomes more equitable across the sexes we may start to see some of those benefits pay off in terms of dementia rates because right now right about two-thirds of alzheimer's disease burden is in women right we know that but the those statistics come from women who are who are largely of that period and so i think so i my hope is that yes we should do a a whole bunch of additional research where you know women have been left out of neuroscience and neurology research for decades and i'm so happy that that's changing but i also wonder if like this shift in in society will pay off in a beneficial way because of the the stimulus that you can get from from work and education that now more people have access to it's so fascinating to think about that and it all feeds back to this idea that the stimulus to the brain is the most important thing going back to women's health again and specifically women's brain health how do you think about the menopause and the hormonal changes that occur in the menopause and risk of cognitive decline this is an area that still right now is is hotly debated.

1:38:52Yeah. And this is probably the most challenging part of the book for me to write, mainly because I want it to be very evidence-based. But equally, like, women should feel supported by men. I am absolutely a feminist and I want that to come across. And so, first of all, there's a whole bunch of studies that need to be done. things like Lisa Moscone's care initiative funded by the Wellcome Trust like fantastic like really excited I'm really excited to see those things happen but right so right now we know that just like really simplify it if you live long enough as a woman all women will experience the menopause right but only about 20 % will experience dementia so that means that that decrease in hormones is not going to automatically result in cognitive decline dementia.

1:39:52Exactly. We know that from the data. Now, if somebody is experiencing symptoms related to perimenopause and menopause, particularly vasomotor symptoms, night sweats, hot flushes, problems with sleep, even cognitive changes, which do happen, then I think things like menopausal hormone therapy can be incredibly powerful by improving quality of life by improving sleep by improving a well-being sexual function mental health how likely people are to engage in other important aspects of lifestyle you know critically important and that's what the current guidelines say that to address symptoms and quality of life menopausal hormone therapy is an incredibly powerful tool and for other things you know bone health, cardiovascular health, when used in that way, in collaboration with your physician.

1:40:48But the hormonal changes don't seem to be enough to explain cognitive changes. And actually, the data seem to suggest a couple of things. One is that vasomotor symptoms are better predictors of cognitive changes than hormonal shifts are. And for people who don't understand the term vasomotor? Yeah, so like I mentioned, the hot flushes, night sweats, that kind of stuff, like those kind of symptoms that the women get during the menopausal transition. And there was, so like one example is there was a very interesting study where they used nerve blocks to, so like you sort of like inject an anesthetic around nerves in the neck, which decreases some of these symptoms.

1:41:28And in those who had significant symptoms, and they saw that by blocking these nerves that affected vasomotor symptoms, they saw improvements in cognitive function. Nothing to do with hormones, right? And this is probably because changes in body temperature regulation and blood flow and activation of stress hormones, these can then affect certain parts of the brain that might affect cognitive function. So we know that there are a whole host of lifestyle factors that relate to those symptoms, right? So we know that you can improve them by improving diet quality. You can improve them by improving physical activity, right?

1:42:07So yes, hormones play a role, and that is part of that. But we know that other lifestyle factors are critically important as well. We also know that this is the period when the risk of Alzheimer's disease diverges between men and women. And so it seems like the menopausal transition is a risk amplification period. And what I mean by that is that other risk factors for dementia and cognitive decline, their effect seems to get larger in women as they enter that transitional period. So one example is there was a study done in the US where the largest cognitive changes seem to be in women who had evidence of metabolic disease.

1:42:52So that's, again, we know the metabolic disease is a risk factor for dementia and cognitive decline. During that transition, in those who had metabolic disease, they saw a bigger impact on their cognitive function. So I tend to think of it as a risk amplification period such that if we think about all the things we've talked about today, any ongoing risk factors may have a larger effect as you enter menopause. But that also means that those are things that you have control over. Because by the same token, we know that if you improve your diet quality or if you improve your movement, then you can help control those symptoms and those symptoms are the things that correlate with changes in cognition.

1:43:32And the final piece that I think is important is that it is a transitional period. So there was the SWAN study in the US found that in women who did experience some cognitive changes during the menopausal transition, they actually went back to almost exactly where they were beforehand once the transition was completed. So if you do experience some cognitive changes during perimenopause, menopause, it's not um it it is it is a transition you may you like they may well improve later and of course like in the meantime if menopausal hormone uh menopausal hormone therapy or other lifestyle or environmental interventions improve that that's great and we should actually do that to focus on quality of life and a whole host of other things but it's not um it's not guaranteed that those any changes are going to be uh permanent um and there are several cognitive functions that continue to improve as we get into our 50s, 60s, and 70s, and well-being as well in both men and women, where, you know, the components of crystallized intelligence, which is a fancy way for saying wisdom, you know, elements of taking a bigger picture, thinking about all the things that we know, putting them in context, they actually improve, as does well-being.

1:44:45So... A different type of cognition. It's a different... Yeah. So cognition doesn't get worse as we get older, it just shifts, right so some things change right and you can measure reaction time or something maybe that decreases but we get better at other things so like all that to say that this is an incredibly important topic and i want everybody to feel amazing every day regardless of where they are in that in that period but we've kind of boiled it down to two groups who are like um hormones to everything and we need menopausal hormone therapy because if we don't, we're going to have cognitive changes and experience dementia.

1:45:25And the other group was saying, well, there's no evidence for any of that. And the second group is actually more right, I will say, based on the available data. Because there are studies where they give bioidentical hormones to women in the menopausal transition and they don't see any effect on cognitive function. Like the KEEPS trial, KEEPS COG done in Canada. But they can have a massive impact on quality of life and all those other things that I mentioned. So it is incredibly nuanced. And the main thing that I've seen is that there've been two sort of very black and white pictures of it. And the person who doesn't benefit is the woman in the middle who's just like, I just want to feel better.

1:46:04I want my brain to work better. And that's the person that I really feel for. And I hope that they understand that there are all these different parts and actually a whole bunch of things that they can potentially do, including related to hormonal therapy, if that makes sense for them. But also there's a lot of power to improve physical health, start resistance training, which we know can improve symptoms. You start to focus on sleep if you can, or maybe the hormones help you sleep and then you sleep better. So all these things should be kind of taken into account when we're having these complex conversations about menopause and cognitive function.

1:46:43Yeah, hence the importance of women having better access to well-educated healthcare professionals who know the nuances, right? Because that's something probably that hasn't been there. But what, as you said at the start, it's kind of like, well, if you live long enough as a woman, you're going to go through the menopause. So everyone has hormonal changes and a hormonal decline, but not everyone gets dementia, right? So it can't just be that that is solely responsible. Could genetics play a role? Could other factors play a role? It is incredibly nuanced. Of course, we want more data and more research.

1:47:19Let's talk about exercise. I know we've spoken before about the importance of exercise for our brains. Perhaps you can give us an overview of that. But today, I thought it'd be interesting to specifically go into what do the different types of exercise do to our brain? And also, is it fair to say that exercise just fits in that second S supply? Because I kind of feel some exercise could count as stimulation. And of course, like we've already said, and if you exercise enough, it's going to help you with your support and recovering from it. Yes. Yeah, so... Lots of yeses. Yeah, lots of yeses. So one of the potential downsides of thinking about, and I've experienced this when trying to explain the 3S model to some people, is they expect that any given activity only fits in one bucket, when of course they don't, right?

1:48:22So I think that there are types of exercise that could absolutely hit all 3Ss at the same time, right? So if we're thinking about big leverage points, there are things that we can do that hit multiple buckets at the same time right so like that's definitely something we could take into consideration but when you think about exercise in the brain it it's a lot they largely comes in three flavors um so like aerobic type exercise um resistance training or weightlifting and then coordinative exercise and in the research they might call it open skill exercise and I'll get to that kind of last. But the most important thing to say first is that any physical activity that you do will improve cognitive function.

1:49:11If you're starting from a low level of initial physical activity, right? So we know that the more steps you take per day, the lower your risk of dementia up to sort of somewhere around 8 ,000 to 12 ,000 steps per day. The first time we really saw that exercise could improve the structure and function of the brain, particularly the hippocampus, which is important for memory and is vulnerable on Alzheimer's disease, was with a brisk walking intervention, brisk walking 40 minutes three times a week. So like anywhere you start that just like starts you moving your body regularly is great. But aerobic exercise, across the scale of intensities, because at the low end, you might just have like walking and the top end, you might have high intensity interval training, you know, where you do sprinting on a bike or a treadmill or a rowing machine for some period of time, and then you recover and you do a few rounds.

1:50:08Those types of exercise seem to be particularly beneficial for the gray matter of the brain, which is sort of like the wrinkly outside the cortex, as well as like some stuff inside, like the hippocampus. and particularly beneficial for memory. So if you're looking at different cognitive functions. And at the higher levels of intensity, we see a greater benefit probably because of the production of lactate, which has been sort of derided as a molecule that we want to avoid that's somehow bad for us for long periods of time. But what we're seeing increasingly is that it's a very powerful signaling molecule, particularly in the brain.

1:50:48so when you make lactate you feel the burn and lactate is part of the buffering system that we use when we're doing anaerobic type exercise or very high intensity exercise and lactate goes into the brain and it switches on the production of BDNF brain derived neurotrophic factor which supports the function of recently activated neurons so it supports the process of neuroplasticity which is what underpins learning and improving function in the brain so and again when you look at studies where they do high intensity interval training interventions for long periods of time you see improvements in the structure and function of the hippocampus in particular so you can see that on a brain scan then you also see improvements in memory specifically so that's like the aerobic bucket then the next bucket is resistance training So a lot of what's different across these different types of exercises is what gets released while we exercise.

1:51:51And so while we might think about something like lactate, brain-derived neurotrophic factor with aerobic type exercise, with resistance training, we release more things like IGF-1, insulin-like growth factor one, which is really critical for white matter. So this is something that we see even in babies born preterm who are at risk of injury to their white matter and then associated increased risk of things like cerebral palsy. And IGF-1 is really critical for the white matter. And one reason why babies born preterm have issues with white matter development is because the placenta normally provides the IGF-1 that they use to grow their white matter.

1:52:33But then we see the same thing later in life where if you do resistance training, you release IGF-1 and the structure and function of the white matter improves so it's critical like throughout the entire life that this is a very important molecule for white matter so the white matter kind of sits in the middle of our brains it makes about 60 % of the human brain and it's responsible for these fast connections between different parts of the brain and the brain and the body and so when we do resistance training and we do the randomized controlled trials you take older individuals you have them do a resistance training program for a few months you see improvements in the structure of the white matter and then improvements in sort of like overall cognitive function, but particularly things like executive function or rapid decision making.

1:53:15And that's because of the effects on white matter, we think. And actually white matter changes, the changes in structure and function of white matter better predict cognitive decline and loss of cognitive function than some other things that we've tended to focus on more as a community like amyloid protein in the brain. White matter changes seem to precede that and actually predict some of those cognitive changes better. So that's where resistance training becomes really important. And then the final piece is this coordinative movement. So there are now a huge number of studies where you take two different types of exercise that have the same physical intensity, right?

1:53:59They raise the heart rate the same amount, for example. but those that then have a complex movement component on top seem to have an additional benefit for the brain so it's like comparing dancing to cycling or you know they've done table tennis and badminton compared to cycling and they've done running around an obstacle course compared to just running around a track and presumably the table tennis the badminton the dancing these are these complex tasks where as well as fitness you're doing other things as well so more complex stimuli to the brain exactly yeah so all activity is great for the brain right but there seems to be an even greater benefit and you can measure this in terms of cognitive function you can measure this in terms of sometimes they've looked at brain scans like changes on a brain scan that if you have a complex movement component on top of the physical component, there's additional benefits for the brain.

1:54:58So we're talking dancing, martial arts, ball sports, racket sports, any kind of team sport. And what all these things involve is learning complex motor skills, movement skills. But also often there's a social component. There's also a requirement to respond to the environment, respond to other people, react to the ball being hit at you and strategize quickly and in real time, right? So if you're playing tennis, I'm a terrible tennis player. So like not me playing tennis, but a good person playing tennis, right? You're trying to not only respond to the ball being hit at you and moving your own way around the court, but you're trying to manipulate the positioning of your opponent so that you can hit the ball past them, right?

1:55:45And you're doing this at high speed. And so you're challenging multiple senses. And so it's these kinds of complex movements that seem to have an outsized benefit for the brain. So again, across the things I mentioned, there could be 12, 20 different things that you could do that challenge the brain in the same way. So pick one that you enjoy. and if we are thinking about like really high impact or activities that maybe hit all the different nodes of the 3S model, you might think of something like dancing or paddle or pickleball in the US, right? There's a social component, there's complex movement, so you're getting physical activity, you're getting cognitive stimulus, you're going to sleep better afterwards, right?

1:56:34All of those things you're doing at the same time. So when people do inevitably ask me, well, what's the one thing I should do? These kinds of activities are the one thing that I would. If you're going to pick one thing, pick a new sport that requires you to learn a complex skill and do it in a social setting. You've hit all those different, everything in one go. God, I love that. So many thoughts came up for me. First thing is to reinforce this message that the brain can adapt to any age. Yeah. Last summer, my son broke his wrist at the end of the summer holidays and had to wear a cast. And one of the things we like to do, particularly in the summer, we have this outdoor table tennis table.

1:57:16And we basically decided, with a bit of cajoling from me, that we were going to play left-handed table tennis while his cast was healing. I'm a kiddie. Like we started off the first time as, oh man, this is, you know, we're decent players with our right hands. Yeah. And it was a bit tricky with the left hand. Literally within about two days, we're having good rallies. And after about 10 days, he was going and playing tabletop at school and he was beating other people who were playing with their right hands. He's a decent player. But I just thought, wow. And I think that speaks to this broader point, doesn't it?

1:57:51About how quickly our brain can adapt and respond. And I've also read some stuff that perhaps learning it with the weak hand then improves your ability with the stronger hand because different regions of the brain are connected. So that was one thing I thought about. The second thing I thought about was in relation to this, I know we've not spoken today about headroom and cognitive reserve. I know we've spoken about that before. And obviously you write a lot about it in the new book. I thought about Novak Djokovic. Oh, yeah. Okay, so he's still getting to Grand Slam finals. I think he's 38. He's in phenomenal shape, arguably the greatest tennis player of all time.

1:58:38Now, I'm wondering if as a thought experiment, if he was to retire, let's say at the age of 40. So for many, many years, he's been learning these skills, right? And also he pays attention to detail, like he leaves no stone unturned in his desire to get better, whether that's eye training, juggling before he might go out onto the core, you know, mindsets, nutrition, movement, recovery, all these things that you probably see when you're Formula One drivers, right? So let's say at 40, he just stopped. Hypothetical scenario. So he's had all this incredible stimulus, supply and support for the first 40 years of his life.

1:59:26So he probably has a huge amount of cognitive reserve and headroom. If the day after he retired,

1:59:36he, I'm almost certain he wouldn't do this, but let's say the day after he retired, I used the word retire because this is kind of what happens to people at 65, right? He stopped doing anything. So he just sat at home in his nice house watching box sets on Netflix. They're not even called box sets anymore, are they? Streaming, he was streaming series on Netflix. is it fair to say that because he's worked that capacity for so much it will take him longer to have a decline in function that is noticeable compared to someone who has not stimulated their brain as much or do we not know well so there's there's two competing parts of this that make me say maybe and I'll explain I'll explain them I'll explain them both so because you've built so much additional capacity with all this training do you then have a longer trajectory before you've lost so much function yeah right and the there's probably again there's probably two areas of this one could be like tennis specific skills right even if he doesn't play for 10 years and like when he's 50 he's still going to be a better tennis player than me right even if he's although we're roughly the same age so maybe that's a bad comparison he's going to be still be a better tennis player than like some 20 year old off the street yeah but he the the amount of skill that he's lost will be massive like the relative loss of skill will be huge because he had so much previously but if we're thinking about this more broadly in terms of like broader cognitive decline and dementia then i'll briefly go back to the the example of education educational attainment so when we when we look at um and so like his primary education has come on the tennis court right if that's his primary mode of stimulus and so when we look at uh cognitive trajectories over over a lifetime those who have high levels of educational attainment they have a higher peak of cognitive function right happens slightly later they do have a they have a lower risk of dementia and they tend to get dementia later because they've started at the same peak.

2:01:56But the early stimulus doesn't change the rate of decline, right? So if you remove that stimulus, you're still going to decline, right? It doesn't prevent that. There are some studies that suggest that those who have the highest levels of educational attainment or the highest job complexity lose function, relative function, like relative to where they were, they lose it faster after retirement because their body was so used to performing at a high level and having high levels of stimulus that they actually have a higher drop-off rate. So one could say that Novak Djokovic's tennis-related skills are going to drop off faster than most other people's because he had so much and we're so used to getting so much.

2:02:48So the relative drop-off rate is going to be faster. And so there's a few different things that you have to balance there. One is, yes, you build overall capacity, but the system may adapt such that it requires greater ongoing stimulus in order to maintain that capacity, if that makes sense. Because you have more to lose because of what you've built. So you do have some buffer, but it doesn't mean that you can rest on your laurels because you build this capacity, right? that ongoing stimulus is required. And then where you end up in terms of that final trajectory is probably going to depend on the whole kind of network.

2:03:26So it's actually quite a complicated answer to your question because you're going to have all these competing things going on. Yeah, it's interesting to think about that, you know, no matter what your job is, no matter where you are, you know, you've got to keep using it, right? Basically, like you said at the start, use it or lose it. it may be overly simplistic, but people get that. You have to keep giving your brain a reason to adapt. And as it happens, I think he speaks maybe seven or eight different languages. I think he's a very, very rounded and intelligent individual. So I suspect, I can't imagine he's going to retire and then do nothing.

2:04:04But it's an interesting thought experiment. Just coming back to those three types of exercise, I just want to, as you said, the practical take home is move, right? you know, and as you said, I think you said, dementia risk goes down up to about 8 ,000 to 12 ,000 sets. Doesn't mean you can't do more than that, but you may not get the benefits in the same way. Or you just, you don't see additional benefits. You don't see additional benefits. Yeah, yeah, yeah. When it comes to lactate, and I think you spoke about in the context of high intensity movement, lactate has particular benefits for the brain.

2:04:40Yeah. That doesn't mean that people shouldn't do low intensity training because keeping your lactate low for an hour and a half walk also has benefits for mitochondria and your ability to burn fat and your metabolic health. So how do you see that? I want to make sure that everyone listening understands that when it comes to brain health, how do they interpret those three buckets that you spoke about and introduce it into their lives? Yeah. So if I'm honest, I feel like people in the health sphere, podcasting sphere, spend way too much time talking about exercise strategies that are only relevant to elite athletes and people who spend all their time exercising.

2:05:27if you can only exercise in a formal way two or three times a week which is the case for most people then getting like getting in a little bit of structured resistance training and maybe the occasional sprint session right that's where i would focus the rest of the time i'd just be like during the day how much can i just move around as much as possible like breakup periods of sitting take the stairs walk for 20 or 30 minutes a day i have in the book i have this movement funnel that I think people should work through. And the first level is snack, which basically is just break up periods of being sedentary during the day.

2:06:01However you do it, stand up, walk around, take the stairs, anything. Then the next level is propel, which is basically just do some low level movement, or whatever you can. And so it can be cycling, it can be rowing, it can be walking, it could be propelling a wheelchair, right? Anything like that. Low level activity. That's what most of us should spend most of our time doing. But just because it's part of our day. Then on top of that, I would layer in some kind of structured higher intensity stuff. So maybe it's, right, you go for a walk, and then you make it brisker. And then towards the end, maybe you just like sprint for a little bit or something.

2:06:36You just like layer on little bits of intensity, because we know that that has additional benefit. And then once or twice a week, I'd go and lift, do some kind of resistance training. And that's what we think the minimum effective dose to build strength, muscle mass, and then also improve brain health at least once a week, probably. Very basic. Six or eight exercises that cover the whole body. Three sets of eight to 12 reps. Like the basics. Like maybe the best is twice a week if you can. But then in reality, if you're going to try and tick multiple boxes in just like a normal person's schedule, I would make some of my aerobic type exercise something that's more coordinative, right?

2:07:23So like rather than going for a jog, go and play football, go and play table tennis, go to a dance class, right? So you're getting that aerobic training, but you're also getting additional benefit and all the other things that we've talked about. That's it. Super helpful. And that's one of the things, Tommy, I've always liked about your approach. It's very, very pragmatic and practical. It's really trying to look at the big picture and see where most people are at and acknowledging that we have this healthcare crisis. And actually, if we make it too difficult and if people feel it's too difficult in the context of their everyday life, they're not going to do anything.

2:08:02It's going to be paralyzing, right? And yeah, I think sometimes what happens is that researchers talk about optimal or what they've seen in the lab, which is great. And I love reading about all that stuff, but it also needs that conversion to the man or woman on the street who's just trying to get a little bit healthier. Yeah, exactly. right um tommy i could talk to you for hours and um there's just of course because you've such a thorough book we barely scratched the surface of what's in it i want to reiterate i think it's one of the best health books i've read it's so good um i love the title i love the subtitle the stimulating minds future proof your brain from dementia and stay sharp at any age on a personal level how has it been for you doing all these interviews about your book you're traveling a lot, you're doing a lot of podcasts, that takes its toll.

2:09:02Yeah, it's... Well, maybe before I get to that part, I just wanted to say that this book exists because of you. And I wanted to say thank you for that. So for two main reasons. The first being that you were the first person that I think I really spoke to about wanting to write a book. Several years ago, right? We talked about this. And I had various ideas and those ideas have shifted over time, but you were sort of the first person to kind of encourage me to do that. And I really appreciated that. And then one of the previous episodes that we did, I think it was the second time I was on the podcast.

2:09:45There was somebody, she used to work at Ebrey, which is a penguin imprint. She's called Anya Hayes. She now works for Hay House. But she sent me an email and was like, I listened to your episode with Rangan. I think you should write a book. And that was the first time that I actually took it seriously and started to work on a proposal and all the kind of stuff that kind of brought us to here today. So, like, thank you. Like, this exists largely because of you. And I want to, like, really say that. Well, I really appreciate that, Tommy, and it's my absolute pleasure. And I say no credit for how great the book is.

2:10:19But thank you. So, yeah, then, like, writing the book, I loved it. It's hard. It's a very different type of writing from how I normally write, which is very academic. and dry and all that kind of stuff. So like, it took me a while to kind of find that voice. But it's still, you know, reading research, thinking about ideas, how to bring them together, how to make them practical, which was really important to me. Like, I loved it. But the hard part is then you have to go out and you have to tell people about it, right? And you obviously have done a lot more of this than I have. But yeah, in general, I quite like being at home.

2:10:56I like working with the people that I have in my lab. I like spending time with my wife and my dogs. And it is also an incredible experience to come out, like come and visit you and talk about these things and do some of the shows that I've done. You know, be on podcasts that I've listened to for more than a decade is an incredible experience. But you're right. There's jet lag, travel, you know, stress, not being able to do the things that you normally do to kind of like look after your health. it's been a bit of a it's definitely been a bit of a roller coaster and whirlwind and I'm incredibly grateful for all of it but you're right there's only so much of this that one person can do because it does it takes a lot of effort and if we look at that I just had a thought there if we look at that through your 3S model which we can apply on a daily basis a weekly basis but I guess you could also apply it across a period of months so we could say let's forget about the writing of the book just for a moment, let's say all this travel and being asked questions about, you know, it's such a thorough book, people could ask you something from anywhere and you've got to answer questions and have something to say, right?

2:12:05You're getting a lot of stimulation. I know you, so you'll be to the best of your ability trying to make sure that supply is good. So you'll try and eat well. We haven't spoken about blood flow restriction today, but we're going to do that next time for sure, right? So you'll be doing things about exercise and making sure that there's enough flow to the brain. But I guess when I think about support and how you can rest and sleep and integrate all of this into your brain and your life, I guess the thing that comes to me is once this is done or this initial batch, have you planned in a period of prolonged support so you can adapt, rest, sleep, get all the benefits.

2:12:54You know what I mean? Yeah, absolutely. And that is definitely in the plan. Like, you know, my wife and I, we've sort of sat down and there's been a big burden on her to like, there's more that she has to do when I'm not at home, right? So it's been a burden on both of us and then figure out like, when's this hopefully going to wind down? What are we going to do to kind of take some time to ourselves and spend time together? So So that's a big part of it. But I think that your point is really important because all of these things integrate over incredibly long time periods, right? We have decades over which that we can influence our health, both good and bad.

2:13:35But what it means is that you don't need to worry about it as much on a day-to-day basis. Yeah, if you can then use it to say, oh yeah, today I'm going to do a little bit of this, I'm going to do a little bit of this, that's great. but I certainly go into this knowing hey do you know what there's going to be a few months where I'm not going to move as much as I would otherwise and I'm not going to sleep as well as I would otherwise but actually because I spend so much time creating that foundation and I know I'll go back to it you know what I know I'll be just fine and I think that's something we can give ourselves a little bit of grace on that as well because we just it's not always going to be perfect we're not going to be able to do everything and know that these things integrate over long periods of time for that person who has listened to us tommy and is really really scared that they're going to get dementia because a lot of people in their family have had it and let's assume they don't have one of these predeterministic genes okay what are your final words for that individual i would want i want them to know that we each have huge power over our long-term risk of dementia and our cognitive trajectory.

2:14:51And regardless of where a family history may come from, and sometimes it's genetic, it could be related to ApoE genotype, which is a common risk factor for dementia. It could be related to, you know, there's a whole host of genes that come together, you know, thousands of genes, you get like risk increases and decreases related to that. A lot of family history of dementia and risk comes from shared environments and shared behaviors. Across all of those, you can dramatically decrease your risk by starting to engage in some of the things that we've talked about today. And I think that the two things, or maybe three things that I would want to say is, one, know that this is possible, right?

2:15:38Know that you have massive capacity to change cognitive function, that decline is not inevitable. Then know that just starting with very simple things can have a big impact, right? for the reasons that we talked about. And know that even if you have some previous risk, you can mitigate the majority of that risk, regardless of where that risk comes from, by engaging in those behaviors. And maybe that's one way that you might look at it. So if you have a family member who had dementia, my grandfather died of dementia. I know that so far, knock on wood, I've avoided his major risk factor. He was an alcoholic, right?

2:16:19so the if you think about you know my mother my grandparent sibling had cognitive decline and dementia what were the things that they did or didn't do that maybe map onto some of the stuff we've talked about today maybe that's a place to start right because those shared risk factors are a lot of things that sort of come across in families and then know that by changing that by starting to move that needle and it's just you know I say in the book everything counts right each little bit that you can do to work on that will have an impact um know that you have control over that and focus on the things that you have the ability and resources and time to focus on because anywhere you start right in in the model anywhere you start the whole network starts to shift in your favor tommy i love it it's a very hopeful message it's a very empowering message guys get the book it's really really good the stimulating mind tommy thanks for coming back on the show and let's do another one very soon.

2:17:19Yeah, I would love to. Thanks so much for having me. A blast as always.

2:17:26Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember when you teach someone, it not only helps them. It also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming and quotes that have caused me to stop and reflect.

2:18:12And I have to say in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com forward slash Friday Five. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change, movement, weight loss, and so much more.

2:18:49So please do take a moment to check them out. They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family, or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health.

2:19:32Making lifestyle change is always worth it. because when you feel better, you live more.