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

29:04And, you know, this is like, no, this is not. But the idea kind of writ large is how engaged with life are you? Are you actively spending time with friends? Are you engaging with other people? Are you trying to learn a new skill? On this idea of our brains maintaining a degree of neuroplasticity throughout the entirety of our lives is somewhat novel. Like, you know, I grew up in a time where it's like, oh yeah, well, if you're going to learn a language or a musical instrument, you got to do it when you're young and then it becomes hard. And so we all have that experience of not being as neuroplastic as we once were.

29:46And I think we just sort of assume, well, we're just, you know, we just, you know, it just becomes harder and harder to learn new things. But essentially what you're saying is not only can we do that, it's urgent that we are always kind of engaged in that process. Absolutely. I think that whole idea has been embedded in society for more than 100 years, if not well before that. As we get older, we essentially become useless. We're unable to learn new things. We need to be put out to pasture. That was how retirement was framed when it was first popularized back in the beginning of the 20th century.

30:24By the time you're 60, you have no use to society, so we just have to find a corner to stick you in. And we've embodied that as a society, and therefore this is something that we expect. There's this idea of stereotype embodiment theory, which is that if we expect aging to be associated with a significant loss of physical and cognitive function, we stop engaging with the things that maintain physical and cognitive function. Oh, I'm too old to learn that. Oh, I'm too old to lift that. A vicious cycle. Yeah, and it becomes a vicious cycle, exactly. So what you see is that even in people in their 60s, 70s, 80s, when you do a randomized controlled trial of language learning or music learning or physical activity, you can see structural changes in the brain.

31:09You can measure improvements in cognitive function. The brain is still plastic at those ages. it's true that learning is potentially slightly harder and takes a little longer than when you're very young but that's not because the adult brain isn't capable of change it's because you have shaped your brain to allow you to best function in the environment that you've put it in right so you don't want it to be like really really malleable because it's already become the person that you are right and that's what that's what you want so it's capable of change you just have to engage in the processes that drive change, show your brain that it matters.

31:47And the way to do that is by truly focusing on something. And then that change will happen and we can measure changes in both the structure and the function of the brain in regions that are susceptible to the processes of aging that become dysfunctional or lose volume in the processes of dementia. so we can see even later in life we can change that trajectory if we engage in these different you know true sort of cognitive stimuli yeah

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35:13You know, we develop these neural pathways and preferences over time and, you know, kind of groove these ruts in our brain. And we know what we like, we know what we don't like. And the older we get, we're more calcified around doing anything different or new. We're more resistant. As an athlete, I want to do the things that I'm good at that I know how to do. I want to go trail running and I want to go swimming. But what I probably should be doing is taking a jujitsu class or an archery class or trying to develop a new skill in something that I'm not good in. Yeah. There's this interesting thing that you see in adults, which we've all experienced compared to kids.

35:58And I think this is one of the reasons why kids learn much faster than adults do, is that the primary driver of neuroplasticity is errors and making mistakes. so when you are experiencing the world you're not truly experiencing the world right you're experiencing a prediction that your brain has of the world as it happens around you because everything happens on a slight delay so because of that the brain is constantly looking for errors mismatches between expectation and reality and you can measure these mismatches with an EEG, electroencephalography. You can measure electrical activity in the brain.

36:42You can see when the brain notices something that it didn't expect, it's largely driven by a drop in dopamine and a few other things. But then that's what drives change, because the brain's like, oh, hang on a second. I didn't get that right. I need to create new connections. I need to shape something differently in order to improve my prediction in the future. And we see this from learning research as well. What helps people learn faster? And one of the most important things is making mistakes, is making errors, because it drives those processes. That's why a lot of neuroplasticity is driven by neurotransmitters like noradrenaline and dopamine.

37:21And these are catecholamines. These are stress hormones, right? So it feels slightly uncomfortable. And that's part of the point. This is your brain attending to something important and diverting resources to change and response. So what that means for us is that we have to do things that put us in a position to make mistakes or to fail. Occasionally, right? You don't want to fail all the time because it becomes very demotivating. But somewhere you can see progression, but occasionally you're sort of like pushing at the edges of your current capability because that's what drives neuroplasticity.

37:56But adults hate that, right? Anytime you think about doing something, you go to a jiu-jitsu class and you're like, the bottom rung of the ladder and like people are going to kick your ass and throw you over their shoulders and like you're worried about injury and all these other things or you're worried about looking stupid um but it's putting ourselves in those situations where we have the capacity to try fail learn go back again that's what's really driving um those changes in the brain so we need to kind of lean into that discomfort this is not the retirement that i was envisioning for myself.

38:29The idea that the work is never done, the principles that drive growth and evolution for mental health, physical health, et cetera, apply to the brain. And there is no destination or endpoint to this. And if you want to protect your brain, you have to get out of your comfort zone and do things that you're not good at and fail, et cetera. So if you are somebody who is hamstrung by this notion of failure or being in a vulnerable situation, perhaps a mantra is to think of it differently as a brain-promoting, a brain-health-promoting kind of exercise that you're supposed to fail. If you're failing, then you're succeeding because this is enlivening your circuitry and activating your neuroplasticity.

39:15Absolutely. And I think this is where the right social context can make a big difference as well. We know that social connections are an incredibly important part of this. So having other people who are willing to do this with you, you know, you join a class where everybody's a beginner and you learn together, or you and a friend go to jiu-jitsu together and you can laugh at each other as you fall over and try and figure stuff out. that's going to help people feel a little bit more comfortable doing it of course like some people will just like go and try it and and uh they'll lean into it and do great but uh giving yourself a social context to do this and like feel supported and learn together i think that's going to add another layer that might make this a little bit more palatable to people who who could already feel uncomfortable thinking about it which overlaps with the blue zones idea like a big thing that drives healthspan extension is your engagement with your friend group your community whatever that looks like and being accountable to them and doing this as a collective yeah let's talk about exercise uh how important is movement to brain health why is it so important and how should we think about this it's incredibly important and the sort of the most fundamental reason for that, I think, is that historically as a species, we've moved a lot.

40:45And it's kind of like, there's a quote from Inigo Samalan who says that, right, movement is evolutionary baked into our genes. It's like a requirement of our biology. If you want your brain and your body to function well, it needs to move frequently. If you think about sort of even just our recent ancestors were maybe walking 15 to 20 ,000 steps a day, they were moving six to eight hours a day. And it's essentially required just to keep maintenance and other cellular processes going in the body, and that includes in the brain. And so because we no longer have that, just like we've sort of engineered the food environment in a way that means we have to invent diets, We've engineered the built environment such that we now have to invent exercise.

41:32And now I think we're getting to the point where we've engineered the cognitive environment such that we now have to invent new stimuli. That's kind of like the next frontier. But we know that different types of movement actually have different effects on the brain. So even just breaking up periods of being sedentary, what we might call exercise snacks, can immediately boost mood. it changes blood flow to the brain, can immediately change cognitive function. So just starting with regular low-level periods of movement during the day, we already see an impact. And we know that the number of steps that you have in a day, and it could be if you don't walk and some people can't walk, it could be propelling a wheelchair around, however you get about the world.

42:19As that increases up to the equivalent of 8 ,000 to 12 ,000 steps a day, you see a linear reduction in risk of dementia and a linear increase in cognitive function. From there, we know that aerobic type movement. So now if we're getting into brisk walking, jogging, cycling, this seems to be particularly good for memory function and the structure of the gray matter. So if you think about the brain, it's this big wrinkly fatty ball, and the outer part is the cortex, is the gray matter. And then there's more gray matter inside. Part of that is the hippocampus, which we know is really important for memory and is particularly susceptible in the later stages of Alzheimer's disease.

43:03And so we know that people who regularly do something like brisk walking, they can significantly improve the structure and function of the hippocampus. There was a more recent study that kind of told us that intensity is also important. So some of the things that get released during exercise, I mentioned brain-derived neurotrophic factor earlier. There are dozens of myokines or exokines that get released, many of which can impact the brain. But they're released in an intensity-dependent manner. So there was another recent study in individuals in their 60s and 70s. They randomized them into three groups.

43:39They had a control group. They had a zone 2, low zone 3-ish jogging kind of group. And then they had a high-intensity interval training group. And for six months, three times a week, they did 40 to 45 minutes of their chosen exercise. The HIT group did the Norwegian 4x4 protocol. So for those who aren't familiar, it's four minutes of running at 85 to 95 % of maximum heart rate. In this study, they had a three-minute rest in between. Some studies have four minutes, some studies have five minutes. I don't think it matters that much. And then they do that four times over. And they did that three times a week for six months.

44:15and interestingly what they found was that both the sort of the jogging group and the hit group improved cardiovascular fitness by the same amount um but the hit group had much greater improvements in the structure and function of the hippocampus um and so they they did much better on a learning task and that benefit was retained for five years they went back five years later and they still had uh maintained improvement even though they'd gone back to their previous levels of exercise. They hadn't said, oh, I love sprint training, so I'm just going to do more of it. They'd gone back to being relatively sedentary, and they still had benefits five years later.

44:51So that's kind of on that spectrum of aerobic exercise up to sort of sprint training. You see across the entire spectrum, you see benefits, but that type of exercise seems to particularly benefit the gray matter and memory function, largely by improving the hippocampus or supporting in the hippocampus. Then you might think about resistance training. And what we see with resistance training is that it seems to particularly benefit the structure and function of the white matter. So the white matter sits underneath the gray matter, and it's where all the myelin is, like all the sort of fat in the brain.

45:28And it's responsible for the really fast connections. It's really important for our complex cognitive functions like decision-making, executive function, that kind of stuff, which we know is lost even early on in the dementia process. And resistance training, something like the studies they've done two times a week, exercises like on machines in the gym that cover the entire body, you know, five or six different exercises, three sets of eight to 12 reps, a very basic resistance training program, twice a week for six months, significantly improves the structure and function of the white matter.

46:01So improved executive function and other things. And you can see the changes on an MRI scan. And then the final piece when it comes to exercises is like these complex movements that we might call coordinative exercise or open skill exercises, often what they call it in the literature. So like a closed skill exercise is something like running or cycling, like unimodal, unidirectional. Whereas an open skill exercise is something like badminton or a martial art that requires you to kind of learn complex motor patterns, respond to the environment, respond to other people, maybe strategize. you're trying to manipulate your opponent around a tennis court and process information much more quickly which is particularly important as we get older as processing speed tends to drop off but it is trainable if we're doing things that require us to rapidly process information and this seems to be the best way to support sort of overall cognitive function depending on which kind of meta-analysis of the studies that you look at and so that stuff like I said ball sports team sports board sports, martial arts, dancing.

47:09Dancing is often like wins out across, you know, compared to almost any other activity in terms of supporting both mental health and cognitive function. So to then kind of like fit all that stuff together, we can think about just like, just moving regularly throughout the day doesn't have to be particularly intense, just to kind of break up extended periods of sitting. If we can make our sort of aerobic type training um something that has a coordinative component right so it's a and especially if it has a social part right so rather than just going jogging maybe you uh play soccer or you play badminton or even like table tennis um then i think you can get some additional additional benefits there um plus maybe once or twice a week you do some kind of resistance training once or twice a week you do some kind of sprint training where um essentially you're just the the goal really is to generate lactate.

48:03Lactate goes into the brain, switches on production of brain derived neurotrophic factor. And so it doesn't really matter what you do. It's just something that gets the heart rate up, you feel the burn a bit. And that could be part of your coordinates of exercise, right? You get a lot of stopping and starting and sprinting in some things like badminton or tennis, but something like that. So regular movement, some aerobic sessions being that kind of complex coordinative movement, and then once or twice a week you do some kind of more intense sprinting a few times and some kind of basic resistance training program.

48:37That kind of hits all of those things based on what we know. Even late in life can significantly improve and maintain brain function. Essentially what you're saying is it's a yes and approach. It's a buffet. It's not about the Norwegian protocol necessarily. Clearly that's one piece in a larger hole that encompasses every kind of form of exercise that's driving you effectively forward. So aerobic exercise, resistance training, dynamic movements, and high intensity work, and finding a balance. And then the very kind of like low output walking type of activity. All of these things are important for different reasons that impact the brain in different ways.

49:25And if you want to be as comprehensively brain healthy as possible, you have to attune yourself to all of these different forms of activity. Yeah. There's a couple of important takeaways there. One, first, it's worth mentioning that as much as possible, we want to avoid this kind of like medical, what Daniel Lieberman calls the medicalization of exercise, right? And this happens when I cite a specific study and you're like, oh, well then I have to do Norwegian 4x4 to benefit my brain. But that's not the case at all. There's a lot of confusion around Norwegian 4x4. And it all tracks back to our deep-seated need to reduce these things down to like a little nugget that I can remember.

50:09I mean, you are a rower, right? So as a swimmer, as any track and field athlete or rower or swimmer can tell you, you do all kinds of interval work. You're always varying that program. And I think the Norwegian four by four is an effective interval modality, but there's many more. And once you acclimate to that, then you need to change it up, right? Or you're not actually stimulating your physical body in the way that you could be if you're changing the structure of those interval workouts. Yeah, exactly. And so I think if we just think about the physiological response to that kind of thing, heart rate goes up, you release lactate, it's kind of like you're at that high level of intensity, you have rest periods in between.

50:54So you work hard for a short period of time, you rest in between. That's essentially it. You're going to be driving those physiological responses. If people need specific protocols, I provide several in the book that have evidence behind them. But in reality, it's just move really, really quickly, rest a bit. That's going to be driving those functions. Then the other thing to kind of take away is that there are sort of these core principles across all these different types of activity, but how you choose to do that is entirely up to you. Because you'll get similar benefits from dancing or badminton or even your martial arts jujitsu, right?

51:32Because it is doing all those same things in terms of like the pathways is activating. So you can pick one that you enjoy and you want to get better at. And so, like you said, it is a smorgasbord and you get to pick and choose. But don't enjoy it too much or you're going to get stuck there, right? Like that's the thing with me. Like, you know, do I really want to, you know, play pickleball? No, I want to go do the thing that I know how to do. You know what I mean? I don't want to, you know, I don't want to be bad. Yeah. Yeah. So, so then of course we go back to the previous thing, which is, you know, try and find something maybe where you've got some, something to learn.

52:05You're going to, you know, sort of lean into that little bit of discomfort, especially in the complex coordinative stuff. Cause I think that's going to give you extra bang for your buck. On the resistance training aspect of this, um, there's a lot of discourse now around longevity extension and the importance of maintaining your muscle mass. So when you think about resistance training, what's more important, muscle mass or is it functional strength? How do you parse those two ideas? In general, your strength is proportional to your muscle mass. So when you're building one, you tend to build the other.

52:45As we get older, often you train strength more than you train muscle mass but in reality what you want is sort of like the sort of like the the immediate benefits like just like moving your having having muscle and moving it where we release things that go and support support the brain it's important for blood sugar regulation our muscles are our biggest like blood sugar sink for most people i think that any kind of resistance training is going to get you both at the same time when there are some interesting population studies where they look at strength and they look at muscle mass and they look at the relationship to dementia or heart disease risk or mortality risk.

53:29And what you see is that at high levels of muscle mass, you almost start to see risk increase again. So there have been some studies out there that say that at very high levels of muscle mass, you have a higher risk of cardiovascular disease, a higher risk of all-cause mortality. the problem is that those studies don't determine how you gain that muscle mass in the first place so if you gain that muscle mass through resistance training and exercise your muscle mass increases in line with your strength and we know that strength um at high levels of strength you don't have an increased risk of disease like the higher your strength the better essentially so what you're seeing at the population level is that some people just gain more muscle mass because they've gained more total mass.

54:14But that's not functional muscle in the same way as if that muscle was gained through resistance training, if that makes sense. So I think the real kind of takeaway is building strength that's functional and provides relative strength for you. You just need to be strong enough for yourself relative to your own body size, whatever that body size is. And so if you're larger or smaller, you would expect to on average be stronger. If you're larger, you would expect to be stronger. If you're getting to the point where you've gained a lot of muscle mass, but it's not through exercise, that muscle may not be functional in the same way.

54:54So the easiest way to measure this, to kind of like give a takeaway, is that strength is probably more important than muscle mass. And when you work to improve your strength, you will also improve muscle mass at the same time. Sort of like a final important part, particularly if we're thinking about as we are getting older is we can measure multiple things. We can measure muscle mass, muscle strength. So like how much, like the maximum you can lift, but then also things like power. So like how fast can you, how fast can you contract and move your muscles and things like power are lost the fastest.

55:32And that's important because when you lose the muscle fibers that are associated with greater strength and power, that's where you stop being able to like stop yourself from tripping over or grabbing onto a handrail if you're about to fall down. And we know then the knock-on effect is hip fractures and spending a long time bed bound where you then lose even more physical and cognitive function. It's really hard to come back from that. So in addition to just like any kind of weightlifting, I think, which is going to improve strength, there's really interesting studies on like jumping in older adults, just like a minute of jumping a day significantly improves like bone mass and, and muscle strength and power.

56:13Um, so in addition to just like the kind of like, say using weights in the gym, just finding something that requires you to jump, you know, uh, you could be skipping ropes. Um, it could just be like jumping on the spot, jumping on one leg. We know those have additional benefits because you're maintaining some of those, some of those elements of function that we know are going to be Yeah. Interesting. Yeah. If you are weightlifting like a bodybuilder, but you're not thinking about speed acceleration or compound movements, like don't we sort of want to be like Edo Portal or, you know, take Kelly Starrett's advice and make sure that we're supple and able to, you know, bend in all the right ways and move quickly, laterally, forward, backwards, and all these sorts of things that just a, you know, straightforward weightlifting, you know, and the tradition of bodybuilding is really not going to do the trick.

57:12So luckily, I don't think those things are mutually exclusive. Actually, you know, doing even traditional style bodybuilding work can help to maintain mobility and stability. So if people are just getting into resistance training for the first time, the safest and easiest and best way to do it is to train like a bodybuilder. And that could be a combination of compound or machine or dumbbell bands, anything like that. You're going to significantly improve strength. You're going to maintain muscle mass or improve muscle mass. You're going to improve type 2 muscle fibers. These are the ones we know are important for strength and power.

57:52And the injury risk is super, super low. Of course, you're then hopefully doing all these other things that we mentioned that require you to um you know have some element of um you know flexibility uh stability cutting jumping running if you're doing some kind of ball sport or team sport you're doing a martial art um because those things are important as well but even you especially if people are new to it even bodybuilding style training is going to give you a number a number of those benefits so i don't i don't think that we want to avoid it entirely because the evidence that we have from randomized controlled trials for like what type of resistance training significantly improves brain structure and function in older adults is that like super, super basic bodybuilding style of training.

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1:01:34All right, let's turn to nutrition. Danger zone. No matter what you say, you're gonna get shit from people. But I like the fact that you've done a great job of not being reductionist here. You're not talking about any particular diet being the best. And you have a principled approach to how you think about the way we should be thinking about what we put in our mouths. So how do you want to kind of introduce how you think about food? So I think about food in terms of sort of three, again, kind of interacting features of a diet, say. And those are the nutrients, the energy, and then the pattern of the way that you eat that allows you to maintain good intake of the nutrients that you need as well as adequate energy intake.

1:02:33In the modernized, westernized world, I think energy availability is probably the right now seems to be the most important lever that we need to consider when it comes to long-term brain health mainly because of all the things that we talked about earlier right we know that there's an increasing rate of pre-diabetes metabolic syndrome these come with high blood sugar high blood pressure these are significant risk factors for dementia we know that people who have metabolic disease have an increased risk of multiple types of dementia and this is something that really we're at risk at a population level because of the food environment.

1:03:10You do see, and this is relevant to athletes and longevity sort of focused people as well, you see this like bell-shaped curve between the amount of energy that we have in our bodies, amount of energy availability we have in our bodies, and the sort of the structure of our brains, something we call brain reserve, which is essentially a fancy way of saying how much brain do you have in your skull? And the more, the better, usually. so at the high end we know we have lower brain reserve higher risk of long-term cognitive decline dementia we see that based on blood sugar or blood pressure um or um you know set like central central adiposity like a high waist to hip or high waist to height ratio but we also see the same thing at the low end and this has come from sort of big population studies across multiple populations around the world including some hunter-gatherer populations where they don't have access to the kinds of calories that we do.

1:04:08But this is very relevant to sort of like athletes in the longevity groups, because you see that if you have low energy availability, and you'll probably have maybe even experienced this yourself, or you've experienced it with other athletes you've worked with, we know that low energy availability or relative energy deficiency in sport, REDS or REDS, is associated with significant changes in cognitive function, mood, sleep. And it's sort at the population level, those who have low energy availability tend to have smaller brains because they just don't have the energy required to maintain that much structure of the brain.

1:04:42So this is relevant for those who are doing very high volumes of exercise, I think, but it's also relevant to those who think that chronic caloric restriction is like some font of longevity. And I think that we have evidence to say that's probably not the case. You need to get enough energy in that you remain weight stable whilst maintaining strength, performance, fitness, all these other things that we know require some amount of energy. So like chronic restriction is potentially going to be bad there in addition to chronic excess. If we're sort of like attending to our energy needs, then the next important thing or which we know is equally important, at least sort of on a global scale, is nutrients that are essential for brain function.

1:05:28So these are all the things I mentioned earlier are the ones that we have the best evidence for. So iron status, vitamin D status, omega-3, the B vitamins associated with methylation. So the ones that affect our homocysteine level, and homocysteine goes up as our need for these B vitamins goes up. So if we have inadequate levels, homocysteine tends to go up. And so that's B12, folate, B6, and riboflavin, which is B2. and then on top of that you know we know there's important things related to antioxidant polyphenols so the things that make berries purple like the anthocyanins or we see similar compounds in coffee and tea which are associated with a lower risk of dementia at sort of moderate consumption chocolate the roasted skins of nuts and seeds have like similar compounds in them then there's things like lutein and zeaxanthin that make your peppers and carrots, or make your peppers that are red and yellow.

1:06:26The carotenoids include beta carotene in carrots. And then things like astaxanthin, which makes salmon and shrimp pink. All of these have similar benefits. And in terms of they affect gut function, affect vascular function, and they can improve brain function. Some of the best evidence is for blueberries or like dark berries. Dozens of studies showing both acute and chronic benefits in terms of cognitive function with berry intake. And then some of the antioxidants, things like vitamin C, vitamin E, magnesium and zinc crop up frequently as well. All of this to say that I call nutrients the great leveler.

1:07:12These nutrients are important. I want you to have enough of them. I don't mind where you get them from. And I think that matters much less. To your point of not caring where you get them from, do you care if they come from the whole food versus supplementation? I would prefer if they came from the whole food. And I think the best example of that is seafood. So when we look at omega-3 status and dementia risk, in general, it seems that if you're doing epidemiological studies, those who regularly consume seafood have a greater reduction in their dementia risk than those who take omega-3 supplements.

1:07:56That's probably because there's a whole bunch of other stuff in there that's important, right? So selenium, you're maybe eating salmon or shrimp, you're getting astaxanthin as an antioxidant. And in general, our diets are relatively poor in many of these antioxidants I mentioned. Protein, if you're not getting enough protein in your diet. And there's a whole bunch of other stuff. So there's this nice phrase, which is nutritional dark matter, where it basically acknowledges that 90 % of what's in your whole foods, we don't know what it is, and we don't know what it does. There's interesting compounds like ergothionine that you get from mushrooms that's like the new longevity supplement because it does a bunch of cool things.

1:08:39But we're only just learning about them. So when you get it from the whole food, you're kind of stacking the deck in terms of there's some other stuff in here that may be beneficial too. However, there are studies where if you supplement with omega-3s and you're omega-3 deficient, you see significant improvements in cognitive function and the rate of cognitive decline. The omega-3s in particular interact with B vitamin status. So there are multiple studies that show that if you supplement with omega-3s, but you have poor B vitamin status, then you don't benefit from the omega-3s and vice versa.

1:09:09If you supplement with B vitamins, but you have poor omega-3 status, you don't benefit from the B vitamins. And I think this is where reductionism has gotten us in trouble in supplementation studies, which is that we give thousands of people one supplement and we're like, oh, hey, it doesn't reduce dementia risk, therefore it doesn't work. Well, if you didn't measure whether they needed it and you didn't measure the other things that that supplement is dependent on. So one of the reasons why I think it's safer to get things from whole foods is because you're getting these other nutrients at the same time.

1:09:39But with that said, if you're somebody who doesn't consume seafood or any other source of long-chain omega-3s, I know that there's benefit from you supplementing from it. So that's kind of the approach that I would use. Yeah, yeah, yeah. That makes sense. I'm going to have more questions about these pillars, but let's get through them. So we talked about energy, we talked about nutrients, and then the other pillar here is pattern. Yeah. Pattern is just finding a way that you can achieve adequate energy intake and good nutrient intake in a sustainable way for you, right? That's either what you can afford, what you have access to, what makes sense for you culturally or locally, financially.

1:10:26And I think that there are innumerable ways to skin those cats. It's just making sure that you're kind of hitting those targets in a way that's sustainable for you. So that's why like pattern is that last part, because right. When we take a supplement, we usually take it for a month and then we forget to rebuy it. We never take, we never take it again, but this is something that's going to be important long-term. So finding a way to make this sustainable, enjoyable, nourishing, um, like that's where pattern really becomes important. Setting aside this diet versus that diet and returning now to this notion of energy, You mentioned that there is a certain cohort of people in the longevity community who are under the impression that chronic underfueling is some secret to unlocking healthspan extension.

1:11:18But the vast majority of people are overindulging. We're in this world of overabundance. Everybody's eating too much. Everybody is a little overweight, if not a lot overweight. So we can sort of set aside, you know, those longevity people and focus on the average person. And one of the things that I thought was really interesting that you said, which is overeating shrinks the brain. Yeah. So explain that. Because we're all overeating. Yeah. There's definitely like a step in between. But we know that even in short-term overfeeding studies, right? And this is usually done with some version of a Western diet.

1:12:00they add candy bars to the diet or they make you eat an extra like serving of french toast or waffles every day for for like even a week you can start to see changes in um both mood and say like hippocampal function memory function this is in this is in in humans this then you know long term translates into what we see in the large population studies which is people who have higher markers of what I call excess energy availability. And so that's essentially the markers of metabolic syndrome. Those are the ones we have the best evidence for. So a high waist circumference, low HDL cholesterol, high triglycerides, high blood sugar, or high blood pressure.

1:12:40These are all significant risk factors for dementia, and they are direct measurable effects of chronic excess calorie consumption. They are like the outputs of excess energy. And this is what hundreds of millions of people are. If they had their blood work done, it would reflect those very things. Yes. Depending on which estimate and which data set you have, something like 10 % of US adults don't have any of the components of metabolic syndrome. You need three to five to technically have metabolic syndrome, but probably less than 10 % don't have any of them. High blood pressure, elevated LDL. Elevated triglycerides.

1:13:29LDL actually isn't in the... LDL is one of the modifiable risk factors in the dementia prevention reports. So LDL and cholesterol, ApoB, are important, but they're not in the metabolic syndrome criteria. Okay. So given the fact that we're overindulging on food and a lot of these foods, we're not overindulging on whole foods. We're overindulging on ultra processed foods and just a bunch of crap. And I know just as somebody who's always trying to make the right choice when I'm not at home, where I have control over my food, I'm traveling or I'm at a restaurant or whatever, it's very difficult to really eat well because even if you order the salad, there's too much dressing on it or they load it with all kinds of other stuff because they think that's what people want in order for it to taste good.

1:14:21Even the healthy choice is compromised. So you're really going against the grain to try to do the right thing unless you're in your personal controlled environment. I think that's absolutely right. And the way that I would think about this and think about everything that we have talked about and will talk about today is that as much as possible, control this environment at home. So however it is that you eat at home or that you would like to eat, figuring out how you can access those foods, cook them, make them a part of your your diet in a sustainable, enjoyable way, right? And it's the same with exercise, right?

1:15:07You have your routine, you play your pickleball, you go and you lift your weights. So that when you do go out into the world and these choices are harder, it matters much less because this stuff integrates over really long periods of time, right? So one meal out doesn't make that much of a difference. And we get to the point where, like, I have friends where you, historically, when you're in this health kind of world, everybody goes out to dinner after a conference and everybody's stressed about what they can or should order at the restaurant. And I think we want to avoid that because it's a net negative.

1:15:43Just enjoy the moment with the people and what you eat that one time makes much less - This is the flip side of these kinds of conversations because we're basically pushing people towards this optimization mindset. where it's impossible to live up to the standards that are being articulated. And that leads to guilt and shame and stress and all these other things that are obviously cross purposes with the aim. Yeah. No. And I think that a lot of what I write about in the book is the psychology of how we approach this kind of health information, because that's exactly what I want to avoid. I don't want people to feel like they're not doing enough.

1:16:25We know that people need to do the work, right? We know that you need to find a way to kind of have this sustainable, but nourishing diet that gives you the nutrients and that you're not overeating. And we know that you need to create some kind of cognitive stimulus. So you need to lean into the discomfort, right? We know that you have to do those things. But if you get to the point where you're constantly feeling like you're not doing enough, you're not doing well enough, you need to do more, that's an inherent stress in its own way that then negatively impacts your health. And we have studied to started to support that as well so i think it's it's all about doing what you can and like moving things forward and like improving things over time but then once you've built a foundation the occasional thing matters much much less um and the goal would be to avoid getting really stressed about that right i've spent most of the last three months on the road i can't eat i can't work out the way that i would that i normally would but i know i can't sleep the way that i normally would, but I know that I've created a good foundation by having my base at home when I can do these things.

1:17:28And the rest of the time, when I can't control it, I try not to worry about it because I know that there's knock-on effects of that worry as well. On the nutrients side of things, you talked about the importance of omega-3, B vitamins, antioxidants in the berries, et cetera. What are some other foods that are brain health promoting that people can just like, oh, I can remember that and I'll make sure I incorporate that into, you know, tomorrow's dinner. Yeah. My two favorite sort of brain health foods are sardines and blueberries. Don't have to be eaten together though. It's an option. um like so like luckily if you if you eat a varied like whole food based diet um so there's a lot of i talked about interesting structural compounds like um choline and ethanolamine you can get those from eggs but you can also get them from oats and quinoa and other whole grains similar with like uh phosphatidol serine you can get from and and phosphatidolcholine as well you can get from from soy products any of the sort of like colored vegetables are going to give you some smorgasbord of those different antioxidants.

1:18:39We also know that fiber is really critical, right? It's going to support gut health and then sort of fermented foods in that category as well. So sauerkraut, kimchi, fermented dairy, those will sort of like fit into that picture as well. And then like whatever your preferred protein choices are. I think most people probably overeat on the like refined carbohydrate side. Like we don't need tons of rice. We don't need tons of pasta um i would focus on the things that sort of those other because they're not particularly they're both calorie dense um and relatively nutrient poor yeah um so focusing on those other areas um i think is going to give is going to make you more satiated as well as giving you more sort of nutrient bang for your buck as somebody who's been plant-based for a very long time uh other than the sort of obvious uh things that i need to be aware of making sure that i'm supplementing with an omega-3, what else should I be focused on or thinking about?

1:19:40And the B vitamins, obviously. Yeah. So those are the two that I'd, and you can just measure, right? So measure a homocysteine level. The goal is to be at least below 13, ideally below 10. You can measure your omega-3 status. So omega-3 index, at least above six, ideally above eight. The other thing where it's just, it's common, particularly as people get older, to not consume enough of it, just making sure you get enough high quality protein. Especially as people get older, they get more frail, or they experience a metabolic disease that's associated with a faster loss of like muscle mass and strength.

1:20:16And there are randomized controlled trials that show that increasing the amount of protein you eat to sort of actually what is now the target level in the updated dietary guidelines, that's actually in the trials is associated with better maintenance of muscle mass in sort of older adults. So that's the only other thing that I would, those, yeah, so B vitamins, omega-3s, protein are the ones that are maybe easiest to miss out on. The protein recommendations just seem to continue to go up. I've never been eating protein at that threshold level. I think I've always been eating less protein. I still, I really don't have trouble putting on muscle mass.

1:20:56I've now recovered enough from a spinal fusion surgery I had this past spring where I'm in the gym and I'm noticing gains pretty regularly. And I'm not really that focused on protein despite hearing from people like you all the time who are like, you need to be one gram per body weight. I'm way below that. But then I'm like, does it But Matt, I mean, I'm hearing this. Obviously, there's evidence to support that I should be thinking about this differently, but I haven't been. So there's a few different parts that go into that. So the first is that in the context of a calorie-dense, nutrient-poor diet, we know that protein is a lever for satiety.

1:21:41So people will continue, this is some of Kevin Hall's work, right? People will continue to eat until some of it will be some protein threshold. So one reason to focus on protein is that it's maybe going to help you overeat less, right? That's not an issue for you, but at a population level, that can be important. It's also particularly important as people start to age and experience frailty or sarcopenia, right? That's the context that I was talking about earlier. Again, that's not as relevant to you. But I'm at that age where it is harder, you know, and you're just like, well, this is taking a little bit longer, you know, like, so maybe I should be, you know, focused on my protein.

1:22:17You do see that in older adults and now people in their 60s, if they consume again at that sort of level of protein, so like 50 to 100 % above what was like the previous dietary guidelines. So that was 0.8 grams per kilo of body weight. Now we kind of think targeting 1.2 to 1.6 grams per kilo of body weight. At that level, you also have higher like antioxidant status, which we know is important in terms of dementia risk factors is important for recovering from exercise as well. and then you're right as you get older like even if you're doing everything right you're more likely to experience um anabolic resistance where you just need a greater protein signal or more of a training signal to kind of you know benefit from that exercise so it's probably worth you know considering increasing um intake up to somewhere in that kind of range um the but the final thing i was going to say is that when it comes to muscle mass and strength the most important thing is still stimulus, right?

1:23:10So yes, eating more protein will prevent you losing muscle mass if you're not regularly doing some kind of resistance training, but resistance training is still going to be the most important thing. But as you get older, I think that requirements are going to increase a bit. On the topic of omega-3s, I couldn't even count how many conversations with people like yourself sitting across the table, discussing the finer points of how to supplement properly. And to this day, I will admit that I still don't quite under, like there's DHEA and there's DHA and there's EPA. And like, I still don't understand, like when I'm looking at a supplement, like what are the levels I'm supposed to be looking for?

1:24:00How do these things interact? and as a plant-based person, what maybe should I be thinking about that an omnivore isn't in terms of the effectiveness of the supplement? Interestingly, I would say that the majority of omnivores probably aren't eating enough omega-3s either, right? Because they're just like, people just aren't eating that much seafood. So I think this is relevant to most people, regardless. I will say that we, and by we, I mean like well-meaning, health-focused, scientists like me, I think we've overcomplicated it a little bit, right? So the two main omega-3s that we might think about are DHA and EPA.

1:24:42There's also things like DPA, which occurs in sort of smaller quantities. Here we go. Yeah, right. But what I'll say is that all of these are important. Most omega-3 supplements are going to contain DHA and EPA at a minimum, right? And that's where we have some evidence from like giving people these supplements if you're not regularly consuming seafood any kind of supplement you know and assuming like high quality you get it from a good quality manufacturer right because these things can be you know poorly processed and they become rancid and oxidized and things like that you know assuming it's a reasonable quality supplement from a respected manufacturer something that gives you one to four grams of total DHA and EPA a day is probably good enough.

1:25:32Form matters much less. Like people have talked about triglyceride form versus phospholipid form. And you get one in seafood and you get another in like, sort of krill and things like that. Or this is high in this, but it doesn't convert. Like there's this conversion thing. Yes. Oh yeah. So the conversion part is the shorter chain omega-3 fatty acids like ALA, alpha-linolenic acid, which is what you get in chia seeds and walnuts and things like that. Most people, and actually the conversion is worse in men on average than it is in women. If you only get omega-3s in that form, most people won't convert enough into the long chain form.

1:26:14So that's why you need to supplement. But I think in general, if you're getting a couple of grams of long chain omega-3s from a high quality supplement on average a day, that's it. I wouldn't worry so much about the ratios. I wouldn't worry so much about the total amounts because you're then going to be ticking the boxes that you're that you're close enough and you're also well beyond what most people are consuming then the easiest thing that you can do is measure something like an omega-3 index which just measures the amount of those in your blood and say am i close enough to a level that we know is associated with lower dementia risk which would be sort of six to eight percent or like above six percent maybe ideally above eight percent.

1:26:52So maybe that simplified it a little bit. I think that we know that DHA and EPA are both important. You're going to get both from any supplement. The real problem is people consuming none. Once you get to the threshold of consuming some, like more than a gram a day on average, you're already in a much better bucket than most other people. We're tiptoeing towards a longer discussion around supplements and what's effective and what isn't what's nonsense um but before we do that while we're still on food let's talk a little bit about the worst offenders obviously we know ultra processed foods aren't good for us um but what are some maybe less intuitively uh you know bad things that we should avoid you'll notice that i work really hard to not like demonize anything in particular because it makes things tricky cognitively for people and like nothing is black and white.

1:27:52So I'll give one broad example, which is that the levels of homocysteine in the US in general, particularly high homocysteine, which is sort of like above 13, which is associated with increased risk of dementia, that significantly improved since we started to fortify flour with folic acid in 1998. Heavily processed foods can almost be beneficial in one way because it allows us to add back nutrients that the population is missing, right? But in general, I think anything that's full of refined fat or refined carbohydrate that's calorie-dense and nutrient-poor, so that's kind of all of the baked goods, snack goods, things that are very easy to overeat and are designed for that to be the case.

1:28:44It's not that you can't include these, and it's not like I avoid those things completely, but you have to think about them in that goal of overall energy balance and nutrient intake. So you're eating more of those things, you're pulling away from your nutrient goals, and you're also heading towards the risk of overeating so that like that kind of um yeah the the heavily processed carbohydrates and fats are usually where things get trickiest um so you know fried foods uh baked goods uh sweets sodas that you know sugar sweetened sodas that kind of stuff then a big trap that's now easy to fall into is when some something's like hey eat these protein doritos or eat this protein candy bar it's still a candy bar um they've added a little bit more protein but it's not getting to the point where it's actually going to meaningfully move the needle and you're very likely to overeat it uh same for oh hey these these um these brownies are keto or these brownies are like plant-based or vegan right they're still brownies right yeah and they still have you know 900 calories or something like that exactly setting aside the keto thing like sugar yeah i I mean, you can kind of, I know you don't want to vilify any one thing, but, you know, is there really a place for refined sugar in any kind of healthy diet?

1:30:09In the context of all those other things, like occasionally consuming sugar is fine, right? But you have to maintain those other components. And it's likely that if you're consuming sugar at the level that's going to be associated with overeating and, you know, in these other like metabolic health conditions, you're very unlikely attending to those two things. So it is possible to, you know, occasionally consume sugar, be in like, be in a good energy state and overall have a very nutrient-dense diet. It's just that the more you shift in that direction, the harder those things become. So, you know, I will occasionally eat dessert.

1:30:47I don't, I'm not, I have a physically sweet tooth, so I don't eat a ton of it, right? But because I know I've got those other things handled, I'm less concerned about it. So what you often see is that particularly as you get to like processed or packaged foods something will be sold as like low sugar but it's still energy dense it's still nutrient poor that kind of so like it becomes a thing where we can go by oh there's no sugar in this but actually it it doesn't make it any healthier um so that's that's why you know again we've become kind of over over reductionist um so not something that i think that you have to completely avoid but the more you're consuming of it the less you're likely to kind of hit those other things that we know are critically important.

1:31:25Sure. One of the things that you see in the longevity community online is this notion like, oh, if you've been really good and then suddenly you have a dessert, it's like, oh, I feel awful and I couldn't sleep tonight. And it's like, how resilient are you actually if you're so dysregulated by this one kind of indulgence? the i think that's a really i think that's a really important point and i will my guess is that so so yeah like your we know that your gut microbiome will kind of adapt to the foods that you regularly give it so like if you give something so like you know i had family members who are vegetarian for a long period of time and then you know it's sort of harder for them to eat meat later because their body just hasn't adapted to it right we know that there's some shifts that can happen in the gut to kind of support that um and so the same might be for large boluses of sugar um but i think a lot of where that comes from is because and we've we've made this worse with the uh advent of like continuous glucose monitors and stuff like that is you're like i know this is bad and i expect it to be bad and therefore i feel bad because of it um whereas if instead we thought i'm just gonna very occasionally i'm gonna enjoy this as i'm just gonna enjoy it i think you would experience a very different physiological effects from it which gets into mindset and the role that mindset plays in all of this, which you talk about in the book as well.

1:32:51Yeah. So one example that we'll have that you can use here is a study by Ellen Langer, which looked at diabetics and brought them into the lab. And because they're diabetic, they're obviously very cognizant of their sugar and carbohydrate intake. They brought individuals into the lab and they gave them a milkshake and they like look at the look at the um um the nutrients on this on this milkshake there was a high sugar milkshake and a low sugar milkshake and then they measure their blood sugar and the blood sugar was much higher after the high sugar milkshake than the low sugar milkshake like of course as you'd expect the problem is this is the same milkshake so the stress of anticipating a blood sugar spike which they know is going to affect their health, right?

1:33:39Drove their blood sugar up even higher. And so this is, every time we approach anything like this, and we think about, this is going to be bad for me, this is going to be, you know, you might get some benefit, you think it's gonna be good for you. But in general, we see that if we think something's gonna be good for us, it has like a neutral effect. If we think something's gonna be bad for us, it has like a negative effect. This then translates to all the other ways that we can think about health information. So I mentioned earlier that thinking that you're constantly not doing enough can negatively impact your health.

1:34:17And there are some studies that suggest that when you ask people how much exercise they're doing compared to people like them, and you look at those who think they're doing less exercise than people like them, as much exercise as people like them, or more exercise than people like them, people who think they're doing more exercise than people like them tend to live longer and they have better cognitive function however this is after you adjust for how much exercise these people are actually doing and they have like um they use like activity monitors right so is this this and the people who think they're doing less end up having like worse health effects you're just a narcissistic sociopath who thinks you're better than everybody you're there's something screwed up it's like it's like your mind is creating your reality and if you're like i'm doing great then you are creating you know your own version of greatness yeah in your life to an extent so there is some benefit of this sort of like ignorance ignorance is bliss almost right so like this is the and you you've already said this like this is the risk that we run by sort of over analyzing health and lifestyle because everybody's walking around let's face it everybody's walking around thinking they're not doing enough and they're falling short.

1:35:29If you have a social media account and any kind of fitness or nutrition stuff happens to come up, we're all judging ourselves against some imaginary standard that we're not even close to living up to. So every choice that we make is a choice of falling short of what we feel like we should or could be doing. And so when you aggregate that over time, what is that doing to our mindset? We're always in a place of lack. when you look at things like uh self-compassion um which you can break you break down into multiple components of self self-kindness uh mindfulness and common common humanity you see that and this is relevant again to like athletes and to and to like the health of the general population um athletes who are more self-compassionate tend to be more resilient and tend to perform better over long periods of time because they understand the nature of setbacks.

1:36:22They understand that we're just humans and they treat themselves like they would treat other people. And then that allows them to learn, do better, come back and perform again. People who are self-compassionate in the chronic disease setting tend to have better health outcomes for the same reason, right? They understand that, oh, you know, I didn't necessarily eat the way that I would normally do or that I didn't sleep or exercise the way I normally would. But do you know what? I'm human. I'm going to come back and I'm going to do it better next time. And like overall, they tend to see, you know, when they do interventions that improve self-compassion, they tend to see better health outcomes.

1:36:55So like better blood sugar and blood pressure and diabetics who are kind of taught about self-compassion. So what we're kind of told, which is that we always need to do better. We always need to be telling ourselves we're not doing enough. We always need to be pushing through. Right. It's actually the exact opposite of what creates a sustainable and well-being supporting mindset, which is that, yes. I know I can improve yes I know there are these things that I can do and I'm gonna celebrate the wit like my wins I'm gonna celebrate I'm gonna enjoy that feeling of discomfort I'm gonna enjoy the fact that these things are improving but acknowledge that you can't make everything perfect you can't optimize everything um and you know we'll slowly get better over time and then not only are you engaging with the things um that you know will improve your health but you're also maximizing the likelihood that you'll benefit from them because you're not spending the rest of your time beating yourself up that you're not doing even more.

1:37:51I feel like you just said the quiet part out loud and perhaps the most underappreciated aspect of all of this, not just for brain health, but overall health. In this epidemic of loneliness and isolation and disconnection and kind of a decline in our overall mental health on a population level, a lot of it stems towards this sense that we're not enough, that we're not good enough and we have to go out and earn belonging and acceptance. And perhaps the greatest lever for longevity and brain health is adopting a loving kindness meditation practice. Yeah, we could talk about omega-3s, but if you hate yourself and you think nothing's ever going to work out and so-and-so is always going to have more, whatever negative frame that you perceive the world, you can supplement with as much DHA and EPA as you want.

1:38:53But ultimately you're kind of driving yourself towards the grave as much as it is a counterintuitive concept that like the most successful athlete is the most self-compassionate athlete. Because you do think like, well, it's the person who's like, I'm never satisfied and like, I'm just hard driving and that's all coming from that place of lack and not feeling enough, right? Like this compulsion to compete from that negative frame as opposed to like, this is awesome and I'm doing it from a place of joy and self-honoring, you know? So it's a mental health issue as much as it's a physiological issue.

1:39:32Yeah. This is why, you know, so much of the book focuses on the psychological aspects because Because I think that, like you said, the things that are important, we already have some intuition about. Maybe reframing cognitive stimulus is really important. But we know exercise is important. We know that diet is important. It's not an information problem. Yeah, it's not an information problem. It's how we approach that information, how we speak into ourselves, how we engage with that information and applying it to ourselves. because we've been told that if only we weren't so lazy, we could look a certain way or perform a certain way.

1:40:11But it's really not about that. It's all about how we're treating ourselves that even allows us to start to engage with that information in a way that will benefit us, but also that makes it sustainable and supports well-being and hopefully belonging and purpose and meaning and all these other things as well. because I guarantee that the best way to minimize your risk of dementia is not sit at home by yourself chugging supplements, despite what some people are trying to sell to us. It's gonna be much more about how you're treating yourself and how you're interacting with others that then allows you to do some of these things almost naturally.

1:40:49It is the Western frame of mind though that the solution is in a pill or a capsule, this sort of shirking of taking personal responsibility. If I just eat this or I take this stack, then it will take care of it for me, as opposed to what you're advising and what your book is all about, which is shouldering personal responsibility for a lifetime commitment towards the principles and the pillars, like the foundational aspects of what drive health. Even beyond that, I think that we can almost think about shouldering a societal responsibility for that as well. Because the people who have the time and the resources and the ability to think about taking the supplements to kind of hack their way into better brain health, they might not realize it, but they're already at such a privileged and advantaged position when it comes to their long-term dementia risk.

1:41:52Because we know that socioeconomic status and deprivation and not having access to education and healthcare, these are some of the biggest drivers of long-term dementia risk. So not only is it, yeah, how do we treat ourselves and how do we engage with this and show us some personal responsibility, but I think that we could even expand it beyond that to how are we engaging with society in a way that minimizes or improves this risk for other people who maybe don't have the same kind of access and availability and time to do some of these things. Let's do a little truth telling around supplementation.

1:42:26Responsible supplementation has its place. What can you tell us about what's effective versus the perception of what's effective? Well, the first thing you could say is that if you think it's going to help you it might because we know back to that that's an ellen it's all about ellen langer yeah um there was there was a point when uh my editor told me that i referenced too many ellen langer studies in my book so i had to take a couple of them out um she's but why not i say more ellen langer like you know she's amazing yeah incredible um absolutely one of my all-time favorite scientists. But where I think we have solid evidence is essentially the stuff that we've already talked about, is attending to nutrient status for nutrients that we know are critical for brain health that are either deficient or insufficient in the diet.

1:43:21And we know that the majority of adults around the world are deficient in at least one nutrient. So finding some way to attend to that. So it supplements you with vitamin D if you need. So if somebody is to go and get a blood panel done, what are the markers that you would like them to pay attention to? Again, the ones that we have the best evidence for, so vitamin D, you definitely don't want to be deficient, which is less than 20 nanograms per mil. But you ideally are at least above 30, probably above 40 is best. 40 to 60 is probably a good target range. I was below and I started like sort of mega dosing on vitamin D and then my levels were like way too high and I was struggling to sleep.

1:44:09And then I realized like, oh, excess vitamin D can impair sleep. And so, yeah, this is, and I say this just because more is not always better. And, you know, You have to really gauge how you're managing your supplementation, even if you're trying to make up for a shortage or a low level deficiency. Yeah, absolutely. Vitamin D is one of the ones where it's, because it's fat-soluble, it's easy to take too much, especially if you're taking several thousand daily for long periods of time. So yeah, definitely get above 20, maybe target 40 to 60. Homocysteine for B vitamins, like I said, definitely less than 13, ideally less than 10.

1:44:53And if homocysteine is elevated, then those B vitamins I mentioned earlier, the ones that they usually give in clinical trials is B12 and folate, but you might also add B6 and riboflavin. Other things that can bring down homocysteine might include creatine, betaine, or trimethylglycine, potentially choline too. then you might think about that you know are you do you have a diet that includes those things right betaine is high in beets and colon is high in eggs and creatine is is is high in meat and fish right so that might might help help you sort of like target any supplementation if you need it um iron status is is really critical um so you would normally just measure hemoglobin level but then there are a whole bunch of iron metrics that you take along the side to kind of help you interpret it so like ferritin transferrin saturation iron binding capacity but ideally sort of women want their hemoglobin to be at least above 12.5 men 13.5 but not too high so if you're if you're in men hemoglobin above 17 or in women hemoglobin above 16 makes it much more likely that you have something like especially if you're older or you have some elements of metabolic syndrome makes it likely that you have something like obstructive sleep apnea.

1:46:11When you stop breathing during the night, your oxygen levels drop and your body makes more hemoglobin in response. So because we know obstructive sleep apnea and other sleep disordered breathing is a risk factor for dementia, another reason to check your hemoglobin is because you're at the high end and that's something that you need to address as well. Yeah, we already talked about omega-3 status. So omega-3 index, if you can get it. Doctors will do most of the other things that I mentioned. you can just get like an at-home test for omega-3 index if you can't get it through your physician. So at least above six, ideally above 8%.

1:46:48And then other things that are important can be harder to test. It's really hard to test magnesium status, for example, but magnesium tends to be something that people don't get much of or get enough of. And we know that people who sweat a lot or who are athletes tend to need more magnesium. So a safe recommendation is often to think about a magnesium supplement, especially if you're an athlete. So, and particularly for people who struggle with sleep, there's increasing evidence that taking magnesium at night can help to improve sleep. Other things, especially as we sort of get into some element of aging or cognitive decline, there's some evidence for choline, which I'd already previously mentioned, that may be beneficial.

1:47:37But even then, that's sort of like well apart from those others. I think that kind of the core vitamins and nutrients is where we have the best evidence. Then beyond that, it might become very context-dependent, and there's very few things that I would give a blanket recommendation for. If you're getting those blood tests, you're addressing those nutrient requirements, and then you're also testing your blood pressure, testing your blood sugar, testing your cardiovascular risk through your lipids. like that's the big bulk of of risk right there um anything else is going to be like you kind of said like sort of like cherry on the top creatine has been in the news lately uh it went from being this thing that only bodybuilders use to sort of mainstream adoption uh but in limited amounts five grams a day, maybe 10 grams a day.

1:48:28Now we're seeing this science emerge around the relationship between creatine intake and brain health. And every time I open up my social media feed, the daily recommended intake increases. It was 10, then it was 20. I've seen people saying, you should be taking 30 grams of this a day. What say you, sir? so creatine is the only supplement outside of those vitamins and minerals that i mentioned that i actually mentioned in my book not because i i don't think it's i don't think it's magic but there is an increasing burden of evidence that it's that it does interesting things for the brain there's some studies after concussion where it may improve recovery there's studies in the setting of particularly in older adults or what those started to experience cognitive decline creatine supplementation may improve memory in particular.

1:49:22It seems to help improve cognitive function in the setting of sleep deprivation. And now there are several trials where they've added creatine to antidepressants in the setting of treating depression, and it seems to provide additional benefit. So I think it does lots of interesting things for the brain. It's also the best studied supplement. And because five to 10 grams of creatine, which is a fairly standard dose, like even five grams is sort of like long-term, the standard dose, you could achieve that through diet, right? You'd have to eat a fair amount of steak and salmon, but like, it's certainly possible.

1:49:55So like, we know that it's very safe and like, we know that it has very few side effects. So if you're going to, if you're thinking about, um, supplements, I often think of this idea of positive asymmetry. So like, where is there potential for benefit with very low downside other than the cost to your wallet. So in terms of dose, actually some of the first study that looked at creatine in the setting of sleep deprivation was in rugby players. And they looked at rugby specific skills after, you know, in the setting of sleep deprivation, they compared caffeine and creatine. And a standard dose of creatine, five to 10 grams, depending on body weight, right?

1:50:32So a smaller person would take five grams, a larger person would take 10 grams or somewhere in between, was enough to see benefit. in some of the depression trials again they're using five to ten grams um some of them using five grams and seeing benefit in the like the one most recent sleep deprivation trial which is the one that got a lot a lot of press um where people were sort of kept awake for a night and then they were given they were given creatine and it showed that it helped maintain their cognitive function um in the setting of sleep deprivation i think they were using 0.3 grams per kilo so that's where somebody like me would take 30 grams, but somebody like you might take 20 grams.

1:51:12So that's where this dose escalation is happening. If you look at studies where you're looking at creatine levels in the brain, you start to see significant increases in brain creatine at sort of like loading type doses. So that's that kind of like 0.3 grams per kilo per day for a week or more. So that's like, you know, 20 to 30 grams a day. However, some of the evidence of benefit in things that are related to brain function seem to happen at much lower levels. So I'm not convinced that everybody needs to take 30 grams of creatine a day because I have evidence from other studies that actually maybe even at five grams, people are starting to see benefit.

1:51:57So the way I kind of approach it right now is I would generally recommend 0.1 grams per kilo. um so i take 10 grams every day and then yes if you're very stressed or sleep deprived maybe you could you could try increasing the dose so for me as it is for some people but not everybody creatine is quite um alerting like it feels like a very very mild stimulant without making me jittery like i've had a bunch of coffee so i can't take creatine late in the day because i don't sleep as well um but like if i haven't slept well i might double my dose for the day um but that's not like a long-term thing.

1:52:35So I think the standard dose is actually where people will start to see some benefit. And then maybe in edge cases, and I expect much more research in Alzheimer's disease and other things to come, then maybe higher doses will end up being better. I can't let you go without talking about sleep. On some level, we all know this already. It's like, We need to be getting eight hours of sleep. We need to be practicing good sleep hygiene. Clearly, sleep is just absolutely foundational to brain health. And I've had plenty of guests share the sort of detoxing process, the clearing out that occurs overnight.

1:53:20What can you add to this or stress about the importance of sleep with respect to ensuring your brain's health? so that we don't like rehash uh old ground in terms of mechanisms like that i think the the main takeaway is that sleep is when um all the information all the skills all the things you've learned the new synapse you've generated which your brain is constantly generating the ones that are important they are cemented and refined during sleep that's kind of the um there's a synergistic effect between REM sleep and deep sleep that allows you know synapses to be kind of perfected, for want of a better word, based on the previous day's input and integrated into everything we've experienced already.

1:54:01There's also, you know, sleep is also really important for emotional processing and other things like REM sleep in particular. And then, right, you're washing out amyloid and other things that accumulate during the day during deep sleep, but also just sleep in general through the glymphatic system. So we know that people who don't sleep enough long term have a have a higher risk of of dementia the risk really seems to tick up in people who are chronically sleeping less than six hours a night um which is probably lower than most people might expect um in general i think you yeah so like people say eight hours but in reality depending like person to person and it changes over time the window is more like seven to nine maybe even six to ten hours like based on like how much sleep people need so like you're waking up the next day, you're feeling refreshed, you feel good, you're probably getting enough sleep, regardless of what it was.

1:54:54Things to consider, how we think about our sleep is also really important. So people know, you know, all about the sleep routine, like why sleep is important. The sort of like in addition to the sleep time, sleep quality is critical. So usually when we think about poor sleep quality, we know it's associated with increased risk of dementia. The way that we measure that is usually by asking people, do you take something to help you sleep? And those who take things to help them sleep tend to have a higher risk of dementia. That's probably because of a downstream effect of the things that they're taking.

1:55:29So are you drinking alcohol to get to sleep? Are you taking anti-estamines like Benadryl to get to sleep? Are you taking things like Ambien to get to sleep? There is probably a combination of issues that are causing insomnia in the first place that haven't been dealt with, plus the effect of those medications themselves, if we consider alcohol self-medication, that negatively impact our sleep. And that's probably why contributing to long-term increased dementia risk. So alcohol creates a REM sleep deficiency in general. If you're using alcohol to counteract all the caffeine that you drank during the day because you didn't sleep well the night before, which is a very common sort of vicious cycle, then caffeine can also impair deep sleep in particular.

1:56:11So if you're still drinking caffeine in the afternoon, then having a glass of wine to help you fall asleep right there's sort of like a double whammy effect there um ambien seems to negatively affect various aspects of neuroplasticity which um you can see uh this is mainly from animal studies um but uh then the antihistamines because they're anticholinergic and acetylcholine which they sort of influence the function of is really important part of of long-term cognitive function those antihistamines that make you drowsy we know if you take those regularly that's associated with increased risk of dementia.

1:56:44So thinking about, are you using those things to go to sleep? If you require those things to go to sleep, first of all, you're not necessarily asleep. You might just be unconscious. That's not the same thing. It's a facsimile of sleep. It's resembling sleep. Any kind of pharma intervention to produce sleep isn't actually producing sleep. And if it feels like sleep, sleep is not doing the job that sleep is supposed to be doing. There are some new drugs that are maybe changing that. But equally, people who have insomnia, the required architecture to get good quality sleep is still there. It's just that the environment and the cognitive processes around sleep, like they either don't feel safe or they're unable to wind down such that you can produce sleep.

1:57:31So that's where things like cognitive behavioral therapy for insomnia, CBTI, can become important. that's where the sleep environment can become important again. We can become dependent on those medications. So you might need expert help to overcome that, but your sleep isn't broken. You just need to like retrain yourself up. The final thing that I think is worth mentioning is that for many people, we've kind of swung too far in the other direction when it comes to sleep. and the sort of like the hyper focus on wearable data and this idea of orthosomnia where we've become so focused on wearable and like our sleep metrics become the target whereas the target should be that you get a restful night of sleep because it allows you to do all these other amazing things.

1:58:17It's the new garment. Like, oh, if it's not tracked, I didn't actually sleep last night or I wake up and I don't know what to do with myself. I mean, I have a whoop, I love it. I definitely check it every morning, but I try to have an arm's length relationship with how I let that data impact me. I still have to live my day. And if it's all in the red, what is that doing to my mind in terms of how I'm problem solving and approaching those problems and making sure that I maintain a positive mindset? Would I be better off had I not known that I was in the red? From an Alan Langer perspective, if I feel great, you know and i think i have a healthy relationship with that but i can see how that becomes problematic for people and it becomes a you know like a neurosis you know there's one classic ellen langer study she would she wasn't the the senior author the senior author was um stephen lockley because he's a circadian biologist at harvard but they collaborated on a study where they had people come into the lab and they were randomized to sleep either for five hours or eight hours but in classic Ellen Langer style they manipulated clock time right so they changed how long people thought they'd slept relative to how they actually slept and what they found was that how long you thought you slept was a better predictor of how you felt the next and performed the next day than how you actually slept so the example being people who slept for five hours but thought they had slept for eight hours didn't experience any impact on their function the next day and there are other studies that have used wearable data to manipulate this like hey you slept terribly last night even if they slept fine, how fatigued they feel the next day is based on how well they think they slept.

1:59:57This is important because wearables aren't great at actually detecting the quality of your sleep. They can tell you how long you're asleep for pretty well, but telling you whether you're in like deep sleep versus REM sleep, they're really not that good at that. And this is like published data that are out there. So when they use those sleep stages to tell you something about your recovery score, your sleep score the next morning, you're using quite low quality data to tell you how you should feel that day. So the way that I've used this with professional athletes, and they're lucky because I work with their coaches who can sort of, who sort of like oversee this stuff on a day-to-day basis.

2:00:33I would usually have the athlete, the athlete doesn't see the data, but the coach sees the data and they use that to look at trends over time, which are probably more accurate than like individual pieces of data. So then we can integrate it and kind of of change, um, uh, kind of change things if, if we need to, if you can create where you, I think you create like a cognitive distance from the data, but like, I think you can also create a temporal distance from the data because like you don't need to know how you slept last night in order to be able to perform today because you have to perform today regardless, or you have to go about your day regardless.

2:01:07Review like a week later, go back and review the past week. Yeah. Especially if you can then say, oh yeah, I didn't sleep that well that night, but that was the night where I went to bed late, or that was the night where I had an extra beer before bed, or that was the night where I had a coffee in the afternoon. So you can still use those data to inform important things, but you're not allowing it to influence how you then perform on a daily basis. Speaking of the relationship between the rest itself and your mental relationship with the rest, this is something that is kind of an important issue in the world of Formula One, And you've played a role in working with some of those athletes because they're just literally going across the world every week.

2:01:49I mean, the time zone shifts are insane. So what have you learned about working with those athletes and how have you counseled them? Some things that I've learned, which were surprising to me at the time, but maybe shouldn't have been, is that the basics, particularly when it comes to rest and recovery, the basics still matter. So I've had athletes come to me and say, oh, I'm looking at my wearable data. I'm worried I'm not getting enough REM sleep as an example. And I look through the data and it's very clear why. They're spending five hours in bed. If you spend five hours in bed, we know that most of your REM sleep happens at the end of the night.

2:02:29You're going to get less REM sleep. First of all, is that REM sleep number that accurate? Hard to tell. But second of all, the most important thing for getting a good quality night of sleep is getting enough sleep opportunity, which just means spending enough time in bed, ready to sleep. And you see this again and again, like when there's issues with sleep, it's that athletes aren't giving themselves the time and opportunity to get high quality rest. Of course, some of that comes from a travel schedule and things like that. So you kind of have to take that into account. But when they are able to build those routines or maintain those routines or maintain the things that help support sleep at home whilst they're traveling they can maintain a much better quality of sleep something that we do so that i do all my formula one work through a company called hints of performance um and they you know so we work with the with the coaches as well um and the coach is sort of like inserted into the life of the driver they're doing the training program they're doing the nutrition they're like traveling with them the whole time they're they hold the helmet hold the umbrella like they're there the whole time will often do things like jet lag plans.

2:03:37So can we start to have them shift their circadian rhythm before they travel? So it's starting to manipulate caffeine and light and sleep time and food timing a day or two before they travel, so that they're closer to the target time when they get there. And there are a number of apps that kind of allow you to do that now. There's one called Phase that was developed by one of these F1 coaches because he was so used to having to do this on a daily basis. has now kind of created something that people can use themselves. But then sort of like the bigger overarching thing is that, again, like the rest of us, they struggle to just, right, they're getting plenty of stimulation, right?

2:04:20They have very complex jobs, like driving the car, they're getting lots of inputs doing that. But then they also have media commitments, they have meetings with engineers, they're constantly giving feedback on how the car drives right this is all very cognitively stimulating stuff so for them it's it's Finding ways, like I was saying earlier, in that kind of age where they are, maybe 20s, 30s, 40s, where you're doing a lot of stuff with your brain, it's how can you find time to kind of relax and downregulate. Yeah, downregulate. So for them, it's all about how can we give them space? How can we give them time to improve and recover?

2:04:57And that's the message that I hear from them most frequently is like, how can I recover better? How can I switch off? How can I just get some downtime because the demands on them are so high? So then there's all this stuff around sleep schedules, but then it's just finding things that allow them to truly switch off in a sort of a sustainable, regular way. and you know for some of them it's meditation or breathwork practices although most of the times when you say to a 20 year old hey you should meditate more like you just get a funny look and um and then similarly the receptive athlete is the athlete at the in the sunset of their career who's looking to extend you know another year or two yeah they're all about it you know the young ones they're like no no and and young athletes in general can do a lot quote-unquote wrong and still and still but i will say that the young generation of athletes is miles ahead of what the young athletes were like you know 20 30 years ago you know like they're they're very into like you know finding that extra edge with these very types of things absolutely and this is so we because we have a like what hint has this whole driver development pathway right so some of it is about instilling some of these things early on so that it's much easier to make those habits and sustain them once you're in sort of like the the f1 kind of world all right so i want you to imagine the i don't know 35 to 55 year old person who is listening to this or watching this and they're thinking i've been eating the standard american diet for 30 40 years you know yeah my aunt or my what parent is experiencing dementia.

2:06:38I don't want that to happen to me, but I've kind of cast my vote already. When is it too late? Is it too late? Give that person a reason to take what you're offering urgently. The short answer is it's never too late. And actually, this was one of the things I was going to say about sleep. There was an interesting study done by Matthew Walker, where they looked at sleep trajectories in people across their lifetime, and then looked at the burden of amyloid and tau proteins in their brain, sort of like part of that, the process of dementia. And they found that people who'd improved their sleep later in life, so even if it was in their 50s or 60s or 70s, if your sleep improved that was associated with a lower burden of later amyloid in the brain all that saying because people ask well you know i spent all this time i was young i had kids i was busy i didn't sleep that well is it like did i already do this damage is undoable and like on a sleep perspective at least from that study it kind of suggests no it's not and we see that then across all of these different um areas so there are now multiple studies where um you know the the best evidence probably comes from multi-intervention kind of approaches.

2:08:01So the most famous one is Finger. It was run in Finland. It was just repeated here in the US. That study was called Pointer. Lots of other studies around the world have done something essentially similar. But what they do is they address cardiovascular risk. They have people start a new exercise training program with some resistance and aerobic exercise. they have them improve their diet quality. And then there's some other pieces. Sometimes there's like a stress reduction component. But just starting to attend to some of these basics, and this is either in people at high risk of dementia or starting to experience some decline already.

2:08:43And actually you see bigger benefits, you tend to see bigger benefits in people who may be starting to see some decline. Not that they've gotten a diagnosis of dementia, but maybe they're already below the average in terms of cognitive function. And you can see this within 6 to 12 months of just starting to attend some of these basics once you're already in your 60s and 70s. So if you start even earlier, you start in your 30s, 40s, 50s, you potentially have 20 years to change this trajectory. Another example might be when you look at cognitive changes that happen during perimenopause, the menopausal transition in women, which is in that kind of towards the mid to latter part of that time window that you mentioned.

2:09:26We see that greater cognitive changes tend to be experienced in those who have some element of, say, metabolic disease. So the SWAN study in the US showed that. so again we know that changing your diet, changing your physical activity addressing cardiovascular risk factors then affect your the severity of metabolic syndrome and related components that you can improve blood pressure, you can improve blood sugar and doing that at that time period could potentially completely change that trajectory so all of that to say wherever you are in that window even if you're beyond that 55 years old, there's still scope to change that trajectory.

2:10:09That is incredibly empowering and speaks to the unbelievable resilience of the human being. Yeah. It is kind of amazing. But reflecting on how we kind of opened this podcast with this notion that 45, and you say up to 70 % of dementia cases are preventable. And here we are talking about people who are kind of tiptoeing into that, and there's still the opportunity to halt it, reverse some of the symptomology, or stave off this kind of terrible future. Why isn't this something that everyone is shouting from the mountaintops? Like so many people are suffering from this just absolute horrible affliction that is devastating to families.

2:11:01I feel like this is a message that needs to get out there and should be being repeated constantly. You can avoid this. Here's the way to do this. Why is this the conversation that we're not having all the time? Before I get into that, I'll quickly say that that 70 % number wasn't something that I made up. that was another analysis that was done by Professor Jintai Yu using UK Biobank data. So a big data set of more than half a million people in the UK. They estimated the upper end of dementias that may be preventable is over 70%. So again, just like a similar way, you do a big statistical analysis, and that's the kind of number that comes out.

2:11:39So regardless of where the truth is in that range, whatever it ends up being, that's still a huge number of dementias that are potentially preventable. Of course, we're talking at the population level. right we can't and we're talking about statistics and probabilities i'm not saying that you could definitely prevent any individual person from from getting dementia but we know we can dramatically decrease our risk so i'm i'm really hopeful that the conversation is changing like over the last two or three years in particular like especially um a lot of people struggled uh with their brains after covid either due to you know long covid or the effects of you know lockdown and everything, how that changed, you know, the sort of like our lifestyle and our environment.

2:12:25And since, you know, since the last sort of two or three years, people have been talking about brain health more and more and more. And so I see it out there, you know, they're mentioning Jill Livingston's work and they're mentioning some of these analyses and they're saying that, you know, it's not too late, you know, things like the point of trial that was just published last year. So I agree that we're not saying it enough. And I agree that we should be hopeful if we're able to engage at this on a personal level and then ideally make changes at a societal level as well. But I think that tide is changing.

2:12:56So I hope that, you know, you and I speak in a year or two and you can be like, oh yeah, you're right. You know, people are talking about this more and more and people are realizing they have so much more agency here. And so I hope it's going that direction. And it certainly seems like people are starting to go that way. That's very exciting. Yeah. So maybe to conclude the conversation, it would be good if you could, you know, even like look right to camera. It's like, what do you want people to know? Like somebody's listening to this. I've never heard anything like this before. Oh my goodness.

2:13:28You know, I now am going to take greater agency over these decisions that I'm going to make. I certainly don't want to have this kind of thing happen to me. how do I begin and how can you kind of leave them with an empowering message about how to embark upon this journey? Sure. So the thing that I want everybody to know is that we each have a huge amount of control over our long-term cognitive trajectory, and we can dramatically decrease our risk of dementia, even if we have a family history of dementia or know people with dementia. And the best way to start to do this is just to find one thing that you know you can start to move the needle on that feels doable to you.

2:14:17And so it could be slight changes to your diet. It could be adding a new aspect to your exercise routine. It could be going to your doctor and getting your blood pressure checked and treating it if you need to. Think about the risk factors for other people that you know or in your family who had dementia that you might share with them, that's always a great place to start to. And know that because all the different factors that affect brain health interact with one another, when you start to change one thing, the whole network will start to shift in your favor. Amen. I love it. To the audience, I want to say we covered a lot of ground today.

2:14:54And it may feel like, hey, we didn't drill down enough on this, that, or the other thing. Well, the good news is you can find all the particulars in Tommy's new book, The Stimulated Mind, out now. Again, I'll say what I said at the outset, like this is a real public service and your work is vital. Brain health obviously impacts all of us. Very few people are untouched by the diseases of cognitive decline. And so I urgently impress upon everybody who's watching and listening to pick up the book and take your brain health more seriously. So thank you for your time today. Thanks so much for having me and I hope everybody found this useful.

2:15:34Peace. Cool.