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

Transcript from https://podmenti.com/t/d01155d4f989f344

Hello, boys and girls, ladies and germs. This is Tim Ferris. Welcome to another episode of the Tim Ferris Show, where it is my job to interview world class performers to tease out how they do what they do, or
To tease out the framework, the specifics.
The practical tactical that you can apply to your own lives.
This episode I've been trying to set up for a while.
My guest is Dr. Tommy Wood. He is an associate professor of pediatrics and neuroscience at the University of Washington, where his research focuses on brain health across the lifespan. This includes therapies for brain injury and newborns.
prevention and treatment of adult brain trauma and the factors that contribute to long term
cognitive function and cognitive decline. It turns out there's a lot that you
Can actually do it is not
an inexorable decline into
not recognizing your family. There's actually quite a bit from the perspective of lifestyle, supplementation, and much more that you can do to try to stack the odds in your favor, cognitively speaking. Tommy received an undergraduate degree in biochemistry from the University of Cambridge.
A medical degree from the University of Oxford, and a PhD in physiology and neuroscience from the University of Oslo. Alongside his academic work, Tommy is head scientist for motorsport at INSA Performance.
where we're seeing health and performance programs for multiple Formula One drivers. He works with a lot of professional athletes. He has also trained and competed in multiple sports himself, coming in the top twenty in the world.
For the world's first ever fully off-road Iron Man triathlon and second at Washington strongest man in twenty twenty four. Tommy is
One of a kind. He's also co host of the Better Brain Fitness Podcast.
and author of the forthcoming book, The Stimulated Mind, which I encourage people to check out. His website is drtimmywood.com with a DR.
D R
Tommy Wood, Dr Tommywood.com. You can find him on Instagram at
Dr. Tommy Wood, also DR at Dr. Tommy Wood. And without further ado, please enjoy a very wide ranging, very, very concrete conversation with Dr.
Tommy Wood.
Optimal minimal.
At this altitude, I can run flat out for a half mile before my hands start shaking. And then also you put some questions.
No seen it kinda.
a cybernetic organism, living tissue over metal endocalyptic.

No
Tommy, Tommy, Tommy, nice to see you. Nice to see you. Thanks for making the time. Thanks for having me. Absolutely. And as mentioned before we started recording, this is just gonna be like our last conversation because I wanted to reach out to you because
Cognition, cognition, cognition. Boy oh boy is out on the mind and pun intended.
On one level.
But we are gonna bounce all over the place.
And
I hope to give people, including myself, a lot of
Tactical, practical.
recommendations also being clear where the science is solid and where the science is maybe a little thinner ice, right? Or where something is plausible but not yet proven out.
And
You've got me chewing xylitol gun. You got me looking at air purifiers, but I'm skipping ahead. Let's go back to the beginning. And I want to give the good old Dr. Chatterjee a nod here because it came up in a conversation you had with him and I was like, wow.
I never would have thought of that. Why are human babies?
So plump. Why are they so fat?
Compared to other species.
If you look at human babies compared to pretty much every other mammalian species
We are the only species that's born fat, even compared
to other primates. And it's thought that the primary reason for this is that
That fat.
is a repository for things that the brain needs in order to develop. And the
Two that are probably most interesting to you and
that seems to be particularly important are DHA, the omega three fasci acid.
And fats as a source of ketones.
for the brain.
when the brain is developing in particular, and I think this is also very relevant to recovery from brain injuries and
Other states.
The
Preferred
synthetic precursor as in the thing that the brain uses to make structure like fats and cholesterol and that kind of stuff, which makes up a significant chunk of the brain. Ketones are the preferred source, particularly in the developing brain, but I think also in the later on in
you know, various states as an adult.
And so
In order to support that very
hungry brain, which it is particularly in in humans. We're born fat so that we can generate
A bunch of ketones to support that brain developing for the first.
Especially for the first few weeks, but maybe even for months after that.
Also have lots of as I understand it beautiful
Bath brown adipose tissue. To keep those hairless monkeys warm. Yeah.
Yeah.
All right.
We're gonna talk about because I think the
In a sense the extremes inform the mean, but not the other way around. So we can talk about certain maybe edge cases.
Things that people might
not view as immediately relevant to themselves. But since we're talking about
Newborns. I'm curious. You've looked at
Therapies.
Various types of
research into brain injury in in newborns.
What do you do? What can you do? I mean, what's the state
of the art when it comes to treating
brain injury in newborns or in infants.
There's two main
brain injuries of babies that I study. And they're probably also the two main brain injuries that are most broadly studied just because of their impact.
And so the first is preterm brain injury. So that's
A baby's born early, the earlier you're born, the greater the risk of neurodevelopment impairment or you know some other kind of neurological disorder, cerebral palsy.
Other impairments.
Later in life.
And
The other is something that we call hypoxic ischemic encephalopathy, which is essentially you get to normal full term
Something happens.
Not enough oxygen.
Exactly. Not enough blood flow, not enough oxygen get to the brain. Something happens usually during childbirth. And people will think about, you know, the cord is wrapped around the neck, or you can get placental abruption, right? The placenta kind of tears off the inside of the uterus, or like the uterus can completely rupture. But sometimes we don't know what happened. The baby just comes out and like
Something has happened. In that.
Scenario, the second one.
H. I. as we call it.
Those babies are cooled down. So this is something that I studied a lot in my PhD. You take that baby.
And
As long as you start within a few hours of birth, you cool them down to thirty three.
Point five degrees Celsius.
For seventy two hours.
And that significantly reduces death and disability.
That's ninety two point three degrees Fahrenheit for you Yankees out there.
Although even in the US, many of the cooling machines are made in Europe, so they still run on
Celsius. So those babies get cooled down, and that's really the state of the art, although now we're starting to figure out that.
There are still a whole bunch of injuries where that doesn't help, including preterm babies. So if you're born preterm, cooling doesn't help, actually, it can be detrimental. And
In that scenario
One of the things that they found recently, which is probably
Most beneficial is caffeine.
So yeah, caffeine is not given for neuroprotection.
It's given.
Because babies were born preterm.
Don't breathe.
As well. They have this thing called apnea prematurity. So they don't have like a normal respiratory drive. So you give caffeine to stimulate that.
But the trials that used caffeine
It's a treat.
Happening at prematurity saw significant improvements in cognitive function.
And those were durable improvements or just during treatment with caffeine?
When you do these kinds of trials, usually you follow those babies up to something like two or three years old.
That's mainly because
An N. I. H funded trial.
Or and I its grant last five years.
So if you're gonna do a full trial in five years, then you have a year or two to enroll in treat and then you you have two or three years to follow them up.
And so they see significant improvement at that age, but then also, you know, going into childhood, which is ideal. You really want to look out as far as you can. So
Then there's now a an a renewed interest in caffeine in other
brain injuries and babies, and that's something that we've tested in my lab. There are some trials now starting in other brain injuries.
But beyond that.
In both
Groups.
Really the biggest impact on
later outcomes is
The home environment.
That kid.
So
Yes, my colleagues who are the practicing theologists do a whole bunch of amazing stuff to keep these babies alive and keep their brains in good shape as much as they can when they're in the intensive care unit.
But actually the home environment.
Is where
the biggest impact happens. And so then that means that even if you have an imperfect start to life.
There's probably a lot that you can do as a parent.
to help that brain to develop and grow, you know, as normally as possible.
We're gonna
Continue to talk about
Brain injury for
A little bit. Then we're gonna
Talk about a whole lot of
Sort of multifactorial.
prisms around cognition and whether or not you can
Intervene with the fates to preserve or enhance cognition.
As an adult.
Right, so we're gonna get to that. But
If we make the hop from
Infant to
adult, right? If you slipped on the ice
and hit the back of your head and suffer at a severe concussion.
What would you personally do after that?
There are
A few things that I think we can probably do, and we actually um wrote a paper about this came out last year that covered various nutritional strategies and most of the strategies will be nutritional supplements.
that would I pr I would probably lean on.
And assuming that I didn't have any control over what happened beforehand, ideally I'd do lots of things to improve the health.
Of myself.
Right, because I think that's gonna affect how my brain and body then respond to the injury. But
After that point.
Then
There's
A couple of things that I would do. One
Is
I would manage fevers.
So
This goes back to the hypothermia that we talked about in babies.
Lots of trials have tried hypothermia for traumatic brain injury.
In
older humans and adults and they haven't really shown any benefit.
What does seem to be beneficial is preventing hyperthermia. So if you have significant trauma.
one of the things that happens is the immune system gets activated you get is you get a fever.
And that fever.
increases this gap between
The metabolic demand in the brain
And the supply of energy
Because the mitochondria become
Damaged.
During the entry.
So if you increase that gap because the higher metabolic rate because you're hotter
That seems to make that injury worse. And this has been found in some animal models, but also in some human data. So the most important thing to do is to prevent fevers.
So get your flu shots, et cetera. Other things.
So in this scenario
You know, if you need to take Tylenol to prevent a fever. I see, take a citamine if it's a little bit.
Yeah, acetominophym, paracetamol, depending on where you are in the world. Yeah, where you are. Um
Yeah, maybe
Even there are some devices where you can do some neck cooling or head cooling. They probably don't have as much of an effect as some people think they do, but
Whatever you can do to maintain your body temperature. And so antipyretics, so things that help prevent fever is going to be helpful.
I would then also manage blood sugar.
The main thing being probably avoiding things that are gonna cause large
Glucose spikes.
So avoiding refined carbohydrates.
Why does that matter acutely after you whack your head? So you see again in in multiple studies of
And we have to do this experimentally, so some of this comes from animal models, but
If you
create diabetes or the hyperglycemic during the injury or immediately afterwards. And some of it is driven by the injury. If you have
Like an acute injury, you're gonna get higher blood sugar. So some is cause, some is effect.
But it seems that these high glucose spikes are again stressful in that setting of an acute brain injury. So just minimizing that as much as possible, that doesn't mean that you shouldn't eat carbohydrates, but just like
I would avoid refined carbohydrates when I sort of worked with athletes at high risk of concussions. Like if you're being taken off the field
A low risk thing is just to not chug power aid.
as you're being like taken down the tunnel.
Other things that are gonna become important with varying degrees of evidence, but still good enough.
There there's a high sort of
Positive asymmetry, right? High possibility of benefit with low risk.
Creatine supplementation. Creatine is probably more beneficial if you have it on board beforehand, but there's at least one trial in pediatric TBI that showed uh creatine enhanced recovery.
Omega three fatty acids the same.
U would certainly include those as well.
And then the next thing is I would do is I would take exotic ketones.
I have them.
At home, there are things I've played with. I don't use them regularly.
But in this setting again, I think there's enough promise to suggest that they're worth taking. I didn't include that in this paper because we don't have good evidence for it, but if I had a brain entry, I would take these all of those key tests. I would too.
Yeah, I would too.
And then
There are a few other things that have an increasing amount of evidence for them, so
There's some studies on some B vitamins, particularly riboflavin.
Branching amino acids.
Seem to be
beneficial
And that seems to be by improving
Sleep.
Then if you have sleep issues, melatonin has some evidence for it as well, I would avoid
Caffeine actually in this scenario, there's a little bit of evidence that says that again, uh it's probably due to increasing brain metabolic rate in that sort of early window.
Similar to high temperature, so I would avoid caffeine particularly early on. And then
Probably the most
important thing that we have evidence for is early return.
to physical activity.
So low level of aerobic exercise, as soon as you can tolerate it.
At a level that doesn't make symptoms worse, and then increasing that over time as you get better. That's going to be an important part of recovery as well.
What's the
Supposed mechanism of action.
with the return to physical exercise and the impact that has on the
recovery from, say, concussion.
There's probably a few different mechanisms and
To be honest, I I don't think anybody really knows. Again, the the evidence is best in
Pediatric.
Brain injury, particularly uh pediatric sports related concussions, that's where they've done most of these like randomized controlled trials.
But there's a few things that are gonna be happening. You're gonna be improving
Starbuclow probably gonna get
A whole bunch of my kinds.
exocines that get released during physical activity. We know many of those can have a beneficial effect on the brain. And then you may also see improvements in sleep, right? We know that physical activity helps support sleep. So
Many of those could be going on at the same time, as long as you're not doing a level of activity that's then making symptoms worse.

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I
All right, so we're gonna take a moment, not for a commercial break, but just for a topical break.
To ask a very important question, which is when you came in second at Washington's strongest man
In twenty twenty four.
And then
When you came in the top twenty in the world's first ever fully off road Iron Man triathlon.
What were your weights?
What was your body weight in both of those cases?
Those two competitions were more than a decade apart, I will say, so
In twenty twelve is when I did the world's first
Fully off road, Iron Man. It was initially called X Man and then
That Marvel sued the company.
So it ended up being called X Tri twenty four.
So when I did that
I think I was probably something like
Low eighty kilo eighty two, eighty three kilo, so like you know, hundred and eighty four.
Five pounds, something like that.
And then
Fast forward a decade.
When I was competing in Washington the strongest man.
I
Was in the middleweight class.
And
To get into that class.
I had to basically die it down and then do a water cut to get under a hundred and ninety eight pounds. So I was just under ninety kilos on the day. Although na you know, normally I'd I'd hang out like fifteen pounds higher than that.
It's okay, super interesting.
We may come back to that. We're certainly gonna talk about your own
Personal.
Routines.
And
tricks of the trade that you apply.
Before we do that I want to tie up a couple of loose ends. Specifically
Infant baby.
This thing you mentioned, D H A.
And
Why that?
And or omega threes more broadly speaking are important. And
I, for instance.
I'd say one meal a day is probably right now two cans of sardines or
Shub Mackerel.
Uh-huh. Next to us.
Some type of oil.
Like olive oil or M C T oil.
With a splash of
Apple cider vinegar. It's shockingly good. It sounds like cat food. It's actually better

But
Could you explain
why this DHA
Et cetera is important. You also mentioned the omega three.
in the context of recovery from
brain injury. So
Why is it important and what is the prescription, so to speak? Like how can people translate that into something they actually do?
When you think about
Again, sort of the structure of the brain.
And you're trying to develop the brain in the first place.
Big pile of fat. Big pile of fat.
And
A lot of that fat.
is DHA and actually brain
If you don't mind eating brain, brain is a great source of omega threes.
I tried it. I tried sheep brain in Turkey. I'm gonna tell ya, the presentation could have used some work. It was just like a straight out of the formaldehyde jar popped onto a plate. It was a bit much for me, to be honest. But
Yeah.
You can fancy it up if you want.
Brain consumption is is not required. So
DHA tends to concentrate at the synapses of neurons. It seems to be really important for like helping to regulate the release of neurotransmitters, like being part of the structural component of those synapses. It also tends to accumulate in mitochondria.
And the DHA content of mitochondria.
is like positively correlated with their capacity for energy production.
Some of it could be due to like some some weird like physical as in physics.
properties of DHA, like how
electrons move through it differently from other fats. But anyway, it seems that particularly for
mitochondrial function as well as synapsic function, DHA is critical. And so it sort of preferentially accumulates in those areas.
Very important.
During brain development, so much so that the
Mother will sacrifice her own DHA stores so that the baby gets enough if
She's sort of borderline in terms of DHA levels.
And it's also why women in general tend to be better at converting short chain omega three fatty acids like ALA.
to DHA and EPA. It's thought that that's
Because that's gonna be needed for a baby one day.
More so than in men.
So eat brains or s find someone you can breastfeed on.
Am I hearing this correctly? Uh yeah.
Are those the only two options? I'm not sure. I'm kidding. Oh wait, I forgot about the fish. I forgot about the fish.
Or you could eat some fish. Optional third. Then
We also know that
DHA in particular, but also uh EPA.
These are the both are long chain omega three fasci acids. They're important precursors for various signaling molecules that are important as it
Pertains to
Brain function, but also recovery from brain injury.
What is an example of a signalling molecule?
A lot of the various
Molecules that
have various functions in our body, activating receptors, turning genes on and off.
Uh
Derived from different fats.
And so
In
This setting, the ones I'm thinking about are called like resolvins, Marisins, Protectins.
That are derive from these unsaturated fatty acids.
And so neuroprotectin D one is one that people are very interested in. It's being tested as you know, you give it exogenously after different
Brain injuries. We're not at a point where I would
recommend that people take it, but that's something that that's being studied right now.
And neuroprotectin D one is derived from DHA.
In the setting of brain injury.
These
Resolvins and protectins seem to be really important for regulating the immune response. In particular, switching off the immune response, right? The immune response is important, but we also need to be able to switch it off.
And that's probably part of the role that they're playing.
When you look at
long term omega three supplementation. There was a study that was done
Then
Football players.
Where they randomized them to different levels of DHA across the season.
And they found that those taking one to two grams of DHA a day saw less of an accumulation of a marker of brain injury in the blood called neurofilament light.
Across
the season. The thought being that, you know, all these small
Sort of soft.
concussive impacts that
the kids experience on the field is generating this sort of low level of injury that accumulates across the season, and Omega 3s or DHA seem to protect against that. So
All of those to say that if you want
To maintain brain function and we and we see
If you're mega three deficient, you're a higher risk of dementia, cognitive decline. That's dependent on other things like methylation status. But
is an gonna be an important component of maintaining uh brain structure and function. So I think that kind of level, you know, once two grams a day on average.
At least
Yeah, if you get two or three good servings of seafood a week.
Or a a reasonable supplement.
That's gonna be
Probably enough to consistently hit those levels.
The other part of it is that your body will
Actively sequester extra.
Up to a point.
So
When people are talking about different forms of DHA, right, should you take your omega threes as a phospholipid form or a triglyceride form? And the triglyceride form is more common in seafood.
The studies that look at these over long periods of time, what happens is if you consume a lot of the trigostero form from seafood
Your adipose tissue is used
As
A storage.
place. So it cycles through the adipose and then it gets released and the brain can use it afterwards. So
That
probably requires you to
spend periods of time where you're accessing your Adipost issue, right? You're not constantly
eating. So exercise or periods of fasting may help you access that depot. But that depot
you know, allows us to then use these other forms of of DHA that can sort of accumulate in our bodies over time and then we use them as we need them.
I'm wondering if there's anything else.
And w it may
end up circling back around as well. But is there anything else?
related
to Omega three specifically.
That you'd like to comment on. And am I
I could be hallucinating here. It's not just AI that does it, but
Omega three
Does that have
Oh no, it was be complex, which you brought up.
Before, perhaps.
Or maybe there is an interaction with omega three and homocysteine. I'm trying to figure out where homocysteine fits into the picture with respect to cognitive health.
They're
Absolutely seems to be this interaction between Omega three status.
And B vitamin status, particularly the B vitamins that are involved in methylation, so they affect the level of something called homocysteine.
And
This is something you can get uh blood test for.
And
Those who have inadequate
B vitamin status or when adequate methylation status to have an elevation of homocysteine.
There have been multiple trials that that happened sort of
Two or three decades ago.
Yeah, maybe even um in the last decade.
Where
People thought, oh, omega threes are gonna be the answer to dementia prevention, or B vitamins and home assistants are gonna be the answer to dementia prevention. And then they would give people B vitamins or omega threes, and then they didn't see much of an effect. What we found out later
Yeah, the scientific Wii.
Was that
Both are required in order to see benefit. So this was probably first seen in the Vita Gog trial, which is run by David Smith.
At Oxford.
And they found in individuals with elevated homocysteine so that was a level above thirteen.
Giving B vitamins to reduce homocysteine significantly improves rate of brain atrophy and
Cognitive function.
Only in those who had an adequate omega three status.
And the same thing was seen in the B proof trial subsequently, and then the opposite, which was seen in the omega A D trial, where they gave omega three fasci acids, but they found they only saw benefit in individuals who had
A low enough home assisting.
It's thought to be because
If you want DHA to be in a membrane
In a cell in your brain.
It needs to be attached to some kind of
Phospholipid, right.
Fats don't just like float around. They're part of these phospholipids that sit inside the cell membrane. And
That requires it to be attached to a head group.
These head groups are usually derived from choline.
or an ethanolamine, although those can be converted from one to the other.
And in order to do all of that kind of
Biochemical attaching and placement requires methylation.
It's very methylation dependent. So it's thought that
In order for DHA to do its job, you need
Adequate methylation status so that all those processes can run. And if you only have one or the other, then you won't see benefit.
Got it.
Yet another reminder.
For long term listeners, this will come as no surprise, but you gotta get
blood tests, comprehensive blood tests and really track this stuff with trend lines over time. But that's a much longer
Conversation, but suffice to say, you need the orchestra, right? Or you need multiple legs of the stool. Yeah. It's not just one leg of the stool.
Alright, so let's
Maybe return to I'm gonna use a term that's a little dangerous to throw around, but
Kind of first principles or fundamentals, maybe is a better way to phrase it.
I'm terrified, as many people are, of this thing called Alzheimer's disease.
And
You could
throw in dementia, cognitive decline in general. And conversely very interested in
extending health span. I'm not totally convinced that
You know, we're gonna get to
A hundred, fifty years, two hundred years. Like all the tech billionaires might want to have us believe.
But it does seem
Certainly if I look at my own.
health span kind of local maximum right now for myself. It's not really low spirit just capacity right now compared to prior generations. I feel very good about it. So I feel like I can extend that runway. And cognition for me is just the most
One of the most maybe the most
Important pillars of that.
Because having seen multiple people disintegrate
Cognitively.
They don't just lose their ability to remember, they basically lose their identity. They lose their ability to emote. It's a loss of the self. I mean, it's a death before death almost in a way.
So really would love to
do anything possible with the right risk benefit ratio to avoid it.
But
Fundamentals.
Should we talk about
I'm gonna fuck this up.
August Dieter. Augusta Dieter. Data?
How do you say this name?
August Dita?
I think.
Who is this person? Because a lot I'm guessing most folks will not recognize the name. Certainly I didn't recognize the name. Hadn't seen it until I got a couple of notes from you prior to hopping on.
So August
Detail or if you read some of the original papers, August D
With
Alzheimer's index patient. So Allos Alzheimer's the
Alzheimer's disease is named after
was a psychiatrist.
in the earlier twentieth century.
And he took a particular interest in
Individuals who had
sort of rare or unusual cases.
Of
pre senile dementia. So what we now call or what now most of us call Alzheimer's disease.
Which is sort of a late onset dementia.
was called a senile dementia, which
Just meant that it occurred after sixty five years old.
That was not what Alzheimer's studied. He studied
unusual dementia where people who are quite young, sort of in the th you know, forties or fifties, experience significant cognitive decline.
And dementia and Augustita was one of them.
He then after
studying them as a psychiatrist or working with them as a psychiatrist w after they died, he then looked at their brains under a microscope.
So he was the first person to see Amyloy Clark's
Tow tangles.
That
A now sort of.
Pathenomotic, they're like what we consider to be sort of required as part of Alzheimer's disease.
But it's just interesting that
What we have now is not what he studied. So over time, people thought that the brains of individuals who had this sort of early onset Alzheimer's or these early onset dementia that Alzheimer's studied and those who have these late onset dementia that we now call Alzheimer's disease, those brains looked very similar under microscope. So they've kind of lumped together. Although
We do still have two kind of broad forms, the early onset.
Alzheimer's which is usually
A single genetic mutation in something like a precedent gene or the amyloid precursor protein gene.
That
then creates a picture that's much more like what Alzheimer studied or the late onset Alzheimer's, which is what most people think about when they think about Alzheimer's disease is probably somewhere between 95 and 99% of cases of Alzheimer's.
And
there is a genetic component to risk, but it it seems to be much more tightly tied to lifestyle and the environment and other lifestyle factors that that we have.
Some control over, hopefully.
And the reason why August Disa is interesting to me is because
I don't think she actually had Alzheimer's disease, as we would now think of it.
There have been groups that have taken
sections of her brain from like
Yeah.
Alzheimer's old collections, and they've done genetic studies, and she didn't seem to have any of the genes that cause early onset Alzheimer's disease, or any of the mutations that cause early onset Alzheimer's disease. She wasn't an Apo E4.
Carrier.
I think she was three three, if I remember correctly.
So she didn't have any of the genetic risk factors.
So what caused this and caused this so young, I think she was in her fifties, right? It's still actually unknown. Some people think there have been some like recent retellings of the story. Some people think that she may have had Neurosyphilis.
And Neurocyphilis actually causes amyloid accumulation. It looks very similar to Alzheimer's disease.
Neuro syphilis, meaning she had syphilis and it got into her brain.
Got it. Yeah.
And that can look
Very similar under a microscope, especially
Hundred years ago, or more than a hundred years ago, when we were just sort of first starting to look at brains under microscopes.
And then others have suggested that it could have been
more sort of psychiatric
nutrient deficiencies certainly very common. Could have been, you know, just like the the your other components of her environment. She was
By all accounts a sort of like a
Downtrodden.
housewife that maybe didn't get
sort of much engagement or stimulation, or you know, wasn't particularly well treated at home, and that could have sort of precipitated it. And we don't actually know, but many of these things kind of
It just seems interesting that
It's
Probably quite likely she didn't have Alzheimer's disease at all.
Wild. All right.
So I'm gonna take this in a few different directions and as per usual s turn it around to be self serving for
Yes, truly, but
I'm going through some of the notes that I had for our conversation.
And I'm sure I will have mentioned this in the bio and intro.
at the very top of the show, but
I have this bullet in front of me and I just want to make sure this
Is something you feel is defensible. Forty five to seventy percent of dementia is preventable through lifestyle.
Is that a defensible statement?
Yes, as far as
We think it can be.
Defensible. Yeah, I'm not trying to put you in the hot seat. I'm just saying like I don't know where that number comes from. So I can tell you where that number comes from.
I mean that sounds great. Yeah. I mean that seems like a ray of sunshine and a pretty gloomy
possible conversation, right? Where people think you're just like, okay, there's genetic determinism. You got this thing, and you're screwed. If you have a bunch of it in your family.
You're also screwed, et cetera. But it seems like there's a lot you can do to right the ship for a period of time. Okay. So where does 45 to 70 percent of dementia is preventable from lifestyle? Where does that number range come from? So
Forty five percent.
comes from the most recent edition of the Lancer Commission report on dementia prevention, which is
Overseen by Professor Jill Livingston.
And brings together all these different experts in
Dementia and its risk factors.
And they
sort of scour the research for observational studies and then as much as possible interventional studies. A lot of it is
Yeah, epidemiological data.
looking at different risk factors that have a consistent
relationship with dementia risk.
And then you do these sort of statistical calculations to look at something called population attributable risk, which is
Essentially saying
If I eliminated this risk factor entirely.
From the population.
What percentage of dementia would I expect?
Two
No longer happen.
That's essentially what it means.
And
All of these different percentages.
Add up.
to forty five percent.
So
It's
couple of percent for smoking, it's seven percent
F
Low level of earlier education.
It's like a percent for alcohol.
Then there's hypertension, hearing loss.
Or sorry, high blood pressure. Hypertension is a fancy medical word. High blood pressure, hearing loss, obesity.
Low physical activity and all these different percentages add up.
to forty five percent.
There were some things that were on that list.
Or that aren't on that list that I think
should potentially be included. So like sleep.
Loss or poor sleep and insomnia is not included. Late life physical activity was discussed in the report.
But was not included, even though there seems to be some good evidence there.
So actually
That suggests that
There may be more than forty five percent.
that are preventable. And there are other studies, like there was one big study done from the UK Biobank data by Professor Yin Tai Yu that estimated that up to
Seventy two percent.
of dementias were preventable.
If this was gonna happen, this would require like a complete societal overhaul because
A lot of this risk comes from
low socioeconomic status, low educational and work opportunities, like all these other things that are kind of baked into societal risk for dementia. But others are things that we have more control over, like level of physical activity, whether we smoke, whether we drink.
So
Some is directly under our control. That's probably something like fifteen to twenty percent, maybe more.
And some is kind of driven by these maybe bigger kind of societal risk factors.
But
If you did all of that and we managed to completely change
how everybody lives and all of these risk factors, the idea is that
Yeah, maybe even up to three quarters of dementia cases could be entirely prevented.
Now
That's very different from saying that I could
guarantee that you will not get dementia, right? That's not the same thing. We're talking about this stuff at the population level. And I I have to say this because if I talk about physical activity or sleep or nutrition, and these are really important for dementia risk.
Somebody will always say, Well
My family member did all that stuff and they still got dementia. So we're talking about probabilities, we're not talking about
I can definitely guarantee that somebody will avoid dementia, but
I think we can definitely say you can stack the deck massively in your favor.
through a whole variety of actions that should
Decrease risk long term.
All right. So
Part of the reason that I make this very self-interested is because I'm self-interested. The other part is that I think the personal is very easy for people to
Concretize, right, for themselves.
So they can interrogate.
how they're behaving, what they might do differently, what they might add, what they might subtract.
So
Let me tell you some of what
I am observing and then some of what I'm doing. And I would love for you to identify or maybe speak to things that
Are
Low hanging fruit or
Reasonably accessible that are missing.
So a few things. Lots of folks in my family currently
Who I'm caring for.
in one way or another deteriorating very quickly with what has been called Alzheimer's. Again, kind of a tricky diagnosis. Not sure how much they're actually looking at.
Whether it's spade amyloid.
tower or anything else. But
Certainly in some cases these blood relatives are ApoE three three, so I'm like, huh.
also raises the question of is there an un
Diagnosed.
Infection. Maybe it's an STI. Who knows? Right. Like I I don't know what the answer is to that. It's kind of another line of testing, perhaps. So I've been trying to do a few things for myself.
Recognizing that
If someone starts to
really show obvious
symptoms that can't be easily explained away.
in there
Seventies, let's just say. The
process probably started what decades earlier, right? I mean, the cars have started to pile up, the machinery has started to break a lot sooner. So it would seem like the earlier you intervene with better lifestyle
Changes, etcetera.
the better off you'll be. So
I've got
the fasting and the ketogenic diet and all of that stuff, right, which I do regularly.
They've got the exogenous ketones, which like you I use sparingly. I don't use them all the time because particularly like
Before this conversation I took eleven milliliters of a ketone monoester, but
I think once all is said and done, it's basically fifty one percent
one three beauty and dial, and I have some concerns around
One three butane dial specifically.
In chronic use.
Or at
Sufficiently high doses, say thirty plus per day.
So I tend to use it for special occasions like this, you know, toast, have a glass of champagne, have some exogenous ketones and off to the races. All right, so there's the ketone piece.
Which I think is
non trivial. There's the
For the most part, avoiding
Crazy glucose spikes all the time, right? Occasionally I'll have like Christmas, sure. I had a bunch of cookies. Like who cares? It's Christmas. It's fine. Add a bunch of pie.
But
I have a CGM on right now. I had a continuous ketone monitor on.
at the same time for about twenty eight days, I'm really interested to look at all of that, but I'm generally following like a slow carb diet or Mediterranean style diet. I am getting enough
Omega three. I know that because of
Fish intake and also when needed supplemental intake.
I do seem to be a poor methylator, so I'm taking B vitamins, L methylfolate, all of that stuff.
Tracking blood once a quarter. So I've got
Super comprehensive stuff on that side.
Zone three training, I do find it is
boring as watching paint dry, even when I'm listening to a podcast or watching a Netflix miniseries or something. But probably doing two to three
sessions a week of let's call it thirty to sixty minutes, walking every day, lots of walking, and we'll come back to that.
Because actually I can't resist. We probably will come back to it, but
Walking four thousand plus steps a day reduces dementia risk twenty five percent, optimal ten thousand steps daily.
And then reverses hippocampal shrinkage.
Two percent increase versus expected one to two percent decrease. That's the bullet that I
Highlighted.
And then weight training a couple times a week. I could keep going. I'm not gonna bore people to death with this Doctor Evil life story, but I will say that
I've also wanted to get a snapshot of what things look like. So I've
I'm gonna be having a call. I won't mention the company by name because I haven't done all of my due diligence. They have some scientific advisors who I think are very credible, but have done brain MRI. I've done the blood draws, the DNA tests, everything else.
So I'm Ape O E three four.
And looking at the brain MRI, I mean I'm a muggle, right? So I probably shouldn't be allowed to sort of

Grab the wheel when driving on the MRR reading, but I I wanted to look at the data. It seems like, and who knows how defensible this is.
But my
MRI predicted brain age based on hippocampal volume, et cetera, et cetera, et cetera, is forty-six instead of forty-eight. So I wasn't thrilled about that. I'm like, well
All right.
Not sure what else I can do. Maybe a
flood dose of I began. Uh actually pr pretty interesting data around that from Dolan Williams, but
Not something I would recommend to most people, including myself. So there's that.
Did a whole battery of cognitive testing through this startup.
Now that
Came in at
Brain age of twenty years predicted.
twenty eight years younger than your chronological age.
But
you can kind of beat the test. Like there's some gamification. So I don't know how heavily to weigh this, right? So brain age of 20 years, man, sounds great. There's certain aspects that are harder to
game, like reaction time testing. Okay, so
I had
Like two hundred and sixty seven milliseconds.
Basically, versus four hundred and six milliseconds. Okay, great. There could be some training effect, like learned training effect, but
Then there's like number span.
Focus
I won't bore.
Everybody with that, but word pairs, names and face pairing with mnemonic devices, if you train yourself, you can really
sort of game the test.
And TBD on like proteomics, I'm be getting all sorts of stuff drawn to try to get a accurate baseline of where I stand now so that I can measure all of the the effect, hopefully, of these interventions.
Over time.

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What would you
say or like, mm, there are twenty things I could mention, but like here are
Three or four that I would also
Pay attention to.
So
First, a couple of comments on
All the stuff that you mentioned about what you're currently doing.
So
I think
I've already mentioned uh
I think that there's a lot of promise for keetones.
I'm not sure that ketones necessarily have to have a place in prevention.
And I'm not sure that you would necessarily need them from a prevention standpoint.
There are
Some reasonably good data, so like the medium change regular work from Stephen Canaine's lab is quite compelling. In uh the Alzheimer's disease, taking MCT oil seems to increase the C2 acid uptake into the brain. This is associated with improvements in cognitive function.
And
This is
Overcoming what looks like an energetic deficit.
in individuals who have Alzheimer's disease. And this is something that again is one of those things that are pathognemonic, right? We think that we see this and this is like kind of like part of the picture of Alzheimer's disease. We see that like this is Alzheimer's.
Can I pause for one second? Yes.
J real quick, don't lose don't lose where you are. We're talking about MCT oil. Number one, if people want to play with MCT oil, be close to a bathroom when you start. And if you combine it with double espresso and creatine.
Definitely have some depends around. The second
Yeah is
The ketogenic diet for me just to
Briefly provide a little more context is also
For
It's
I think plausible anti-cancer effects and just kind of all cause mortality plus
mental acuity. I just think a lot faster when I have
more metabolic flexibility with something like intermittent fasting. That's another thing I do a lot of.
Where my body is has just got the machinery to produce ketones. But yes, I hear you. Okay. So the thought being here
Right, there's a difference between what you find works really well for you versus what the listener thinks should have to implement for themselves. And so I'm now going down the road the road of why I don't think we all need to be in ketosis to prevent dementia. Yep.
So I think from a therapeutic standpoint, it seems to be beneficial overcoming this energetic deficit that we see in
Alzheimer's disease, particularly early Alzheimer's disease.
Or maybe it's easier to overcome earlier on.
And one of the ways we look at this is with something called a PET scam.
So you do
An FTG.
You give
Labeled glucose molecule.
You inject that, you see how much gets into the brain in individuals without Syme's disease.
Less glucose is
Getting into the brain.
We've traditionally come at it from a point of
That glucose can't
Get in, right? There's some kind of metabolic disease, insulin resistance. This is where the idea of type three diabetes has come from, where insulin resistance in the brain, that glucose isn't getting in. But uh
PET scan cannot differentiate between the glucose can't get in versus the brain isn't asking for that glucose in the first place. And there are actually some very nice studies.
That looked at
Brain activation and glucose uptake.
In response to cognitive stimulus.
in individuals out Sisease. And what
They see is that yes, at baseline, there's less glucose being taken up into the brain of individuals with Alzheimer's disease, but if you stimulate that brain cognitively,
It can take up glucose just fine.
so that you get into the range of a normal healthy brain in early Alzheimer's disease. Once you get to like advanced stage dementia,
It's too late.
But at that early stage, I think part of the reason
why we're seeing less glucose uptake is'cause those parts of the brain are less active because we're just not using them as much.
And just like glucose uptake into the muscles
Which is demand driven.
You work your muscles, they ask for more glucose, they take more up.
The brain seems to be the same, at least early on.
So I think
We think a lot about
The
Supply side, right? The energetic supply side, but I don't think we think enough about the demand side, how to create energetic demand in the brain such that.
We are maintaining glucose uptake, maintaining energetic state.
And then doing that also maintains all the metabolic machinery that
You really care about in terms of long term function.
Alright, so if I'm hearing you correctly.
This is something I've you know chatted with Dom Dagasino about, but
I'm wearing this CGM, so I've got this device on my arm.
That tells me what my
Lucus levels.
are at any given point in time with whatever, three minute sampling or something like that.
You gotta calibrate that with a finger prick, by the way, folks.
But
If I eat a meal
And then I don't go for a walk.
My glucose spikes and I might conclude, wow, my muscles are really not accepting glucose. My muscles are bad at accepting glucose, but that's not.
actually true in in my case, right? If I go for a walk or I do some light exercise.
I guess it's like Glute Four transporters or whatever.
Get all jazzed up and help that glucose to be
better disposed into muscle tissue. And like you said, in the case of the brain and people referring to Alzheimer's as type three diabetes, it's like wow, the brain can't use glucose or it's very bad at using glucose. But
If I'm hearing you correctly.
The additional question that they should be asking is
Is it just that or
Is the brain not
Asking for glucose, the equivalent of the Glutefor transporters. Like is the brain basically offline? It's a car up on blocks.
But if you take it down, like yeah, it's gonna use gasoline just fine.
If that's the case
I guess it's just a call to action for
more stimulation.

First just coming across
Your notes that you sent prior to this conversation, I went on chat GPT and I was like, what are the most glucose intensive activities for the brain?
And they gave me a bunch of
mental exercises, which isn't exactly what I was looking for, but I could have prompted it better. And it said, but even still
The sort of improvement or increase
Might be
plus less than ten percent in terms of the total. And then I was like, Well, are there other activities such as physical activities?

That might
Increase
Likus.
Uptake in the brain. And it gave me a whole list. But rather than regurgitate that.
Or all of
Types of stimulation created equal or are there some.
sort of eighty twenty analysis like okay.
There are
Some tools that are better for the job.
Yeah, so
When looking at this
Purely in relation to glucose uptake.
Those data don't exist. So we're gonna have to extrapolate further than that. And I I think that's important because
A decrease in glucose uptake is just
a signal that that area of the brain isn't as metabolically active, which means Windows not using it as much at the the simplest level.
So
Then
If you think about
various activities that we could use to stimulate
the brain, which do seem to be protective in various different ways, both
they can enhance cognitive function in the short term and then protective against dementia in the long term.
This ties very nicely into the comment that was gonna make about your physical activity routine, because this is where I think some things could be layered on.
When you look at the different physical activities and or exercise and and how they affect the brain, different types of exercise affect the brain differently. So
You certainly need a smallgers board of all of them to kind of get a global support.
For the brain, but something that seems to be particularly beneficial.
Is coordinative exercise.
Oh
Open skill exercise.
Yeah, plus or minus
things that have a navigational component. And these are essentially
sports or activities where you're constantly having to respond to the environment and
Adapt.
That's what makes them open skill, rather than
Close skill or unimodal exercise like
Going for a jog or sitting on a bike or something like that.
So
When they compare.
sports or activities that have the same amount of physical challenge
But different amounts of cognitive challenge because of the open skill nature. You see greater benefits in terms of brain structure, improvements in cognitive function. And open skill just means high level of unanticipated variety or variety. What is that?
Both.
So it basically has a greater amount of
Complex motor skill required.
Some of it can be learned. So dancing is one
Example, right? So'cause you learn the steps of a dance.
single strongest activity for dementia prevention. Am I overstepping there?
Yeah, probably. If you look at physical activity
And the effect that it has on cognitive function. And also mental health. Yeah.
But in terms of both uh mental health, so studies in depression as well as studies
Looking at
Different activities that people do and the risk of dementia and studies
Where they randomise people to
Different types of activity, including dance.
dance seems to have the the highest sort of effect size.
Compared to other types of physical activity.
But there's multiple components to dance, right? So you have to learn the steps, but there's also a social component, there's a music component.
All these things probably part of the magic source together. But
Open skill sports also include
board sports or ball sports or team sports where you're having to like
React to the environment and other people around you.
Do you say bull sports like rodeo? What are we talking? No bull sports. B A H It's not gonna be good for the T B I to get people on top of bulls, but I think bull sports would probably be good if you could avoid the T B I
Like.
Actually, probably right up there. Similarly, martial arts, also good, as long as you don't get punched in the head a bunch. Oh, kicked in the head a bunch.
Or choked out too much.
So beyond
The physical strain that these exercises have, they seem to have an additional aspect of
Requiring reaction speed, challenging processing speed.
Yeah, learned complex motor skills, they seem to have an outsized effect in terms of cognitive function.
Something else.
This is kind of an aside, but just based on the
physical activity component. When you're looking at
More aerobic or
Yeah, even like close skill unimodal running, cycling kind of sports.
The benefit seems to be intensity dependent. So yes, if you're not doing anything, then going for a walk and walking a certain number of steps a day is gonna be.
Great.
beneficial decreased dimension risk, absolutely.
But looking at hippocampal structure and function, for instance, which you mentioned, right? You're talking about
Measuring your hippocampus on an MRI scan.
higher intensity activities seem to be better. So probably the
longest study where they they ever did something like this. They had people this is a on Australian study where they had people do the Norwegian four by four protocol.
Three times a week.
For several months.
Oh my god.
And so for anybody who doesn't know what this involves, it's
Four sets of four minutes on a treadmill at eighty five to ninety five percent of your maximum heart rate.
With four minutes rest, you do that four times.
It is miserable.
I mean that's like pretend like you're being chased by wolves through the snow.
For four minutes.
And then take a four minute rest. And then do that.
Yeah, four times. Yeah. Okay, right.
But they saw significant improvements in hippocampal structure and function that were maintained for several years after the end of the trial. Several years. Several years after the trial. So a few months. Yeah.
And then sustain for several years. You think they focus on for five years after the end of the trial. That makes it much more interesting.
Okay.
And
I think a lot of this is driven by lactate.
So
When we talk about
The various things that support the brain.
Direct size.
We often talk about BDNF, brain derived neurotrophy factor, which has increased
With exercise.
But
B D and F that you produce
But you can measure in the blood.
that's produced by the muscles during exercise doesn't really get into the brain very readily.
Most of the BDNF we have in the brain is produced locally.
And it's actually
Driven by things like lactate.
So lactate does get into the brain. The more lactate you have in the blood, the more it gets into the brain.
And then that acts as a histone DSylase inhibitor that activates the product of BDNF. Ketones do the same thing. Osteocalcin, which is released when we sort of load
The bones structurally, right, is released from bones seems to do something similar.
So
Generating lactate.
Seems to be beneficial because probably because
One of the things it's doing is it's generating more BDNF.
that then is associated with improvements in hippocampal structure and function. So
As long as you're
Doing sports that
have some high degree of intensity. So you're regularly producing lactate.
And then either in the same sport or separately doing these sort of high skill
High reaction time, open skill kind of sports.
That's probably
gonna be beneficial from a
Excellent standpoint.
I'm still completely stuck on the
Three times a week. Basically VO two max training, right?
for a few months. Is a few months like three or four months, or how many months was it?
This study was either six or twelve months. I can't remember the the intervention period. It was one or the other. And with durable effects over
A follow up period of
five years or something like that. Like that is a great investment. That makes it much more
a much more compelling sales pitch for me. And like I've done plenty of VO2 Max training in the past, but like it's not necessarily fun. Right.
I mean, I will say if you can again avoid getting your arm snapped, exhibit A right here with my elbow surgery. But if you can avoid the breaking limbs and getting choked out.
too frequently.
Something like Jujitsu, right? Is actually fantastic because you might have three to five minute rounds.
And then you take a break for a round and then you go back in and chances are, depending on who you're rolling with, it's gonna be pretty intense.
Obviously depends on how competitive the gym is.
But the durability's just remarkable. That is really, really, really, really interesting. Now
Is the threshold for sufficient intensity, I imagine it varies tremendously from person to person depending on lactate threshold, right? But like for you.
Do you need to do something approaching the Norwegian four by four?
to
cross the threshold sufficiently in your mind, or does something less suffice?
The problem with
Having just one
I mean, it's one very good study, but just having one study
On this, is that we
Get really focused on the protocol.
Yeah.
I think that
Anything that is
regularly producing
You're getting above your lactate threshold, you're generating significant, you know, several millimoles of lactate.
I don't think people need to measure it.
But
You know.
If you're getting
Six seven.
Plus something like that, right? You're you're definitely gonna be in that range.
Is there something like a people use a talk test, for instance, Peter Tia talks about this for zone two training?
Where you can kind of s have a conversation in belabored short sentences, but you don't really feel like it as an indicator that you may be roughly in zone two. Is there an equivalent for that?
range of
Lactate.
Not that I know of.
Ten percent from puking into a bucket. Yeah, it's definitely gonna be misery related.
Ha ha
So I think about um a lot of the training that I did as a student was I was I was a rower.
Right.
And this is something Oh brutal. You love misery.
I actually I I don't love misery enough, which is why probably why I wasn't as good a Rover as I could have been.
But
There are lots of
protocols where you're doing relatively short sprints with relatively long rest periods.
That still generate
Large amounts of lactate.
And so
In studies where they've done this, you know, you're talking about like thirty seconds flat out.
on a bike or a ride machine with several minutes of rest.
Times six
Eight, ten rounds.
By the end.
you can generate a lot of lactate.
without having to do something continuously for, you know, several minutes at a time.
I was just reading the
one of the favorite
training protocols for one of the like world champion rowers was forty five seconds
I'm flat out, like completely flat out on the right machine. Within six minutes of recovery.
But doing that, you know, several times. And then at the end, you're generating several millimolar of lactate. So
I think anything like that.
That's gonna get you in that zone. It just requires
Maximum effort for
Even just like twenty to forty something seconds.
Even with several minutes breaking between, you're gonna be hitting that.
So I imagine the gold standard do you have some kinda
lab coat and with a clipboard who
pricks your finger or something and does these blood draws to determine the millimolar concentration of lactate.
Is there a breathable option?
As there is with
ketones, right? Where you can measure acetone through something that looks like a breathalyzer as opposed to a finger brick for
BHP. Is there something that is does anything like that exist?
And s some people do s sort of have those
Right.
near being commercially available. So some people do have access to those already.
But equally, I would argue that it doesn't matter that much. Just like
Go and do something really, really hard.
Fa
a short period of time and do that a few times over and do that relatively regularly. Like that's probably enough
majoring in the minors that that you need to do to to kind of
Get that benefit.
Sounds like my sled assignment. I do love my sled pushing and pulling. You can definitely
Wipe yourself out with that stuff. Okay.
Right.
Without necessarily the impact of me trying to run from wolves on a treadmill or something.
Okay.
I do wanna take a brief commercial break, but it's not for any sponsor. It's just to mention
And then we're gonna kinda dive straight back into the programming and discussion, but
You have a book.
That is coming out shortly called The Stimulated Mind. It goes through all the stuff we're talking about and a lot more.
People should pick it up. That's
Doctor Tommy Wood, obviously, but the stimulated mind. There's so much
horseshit and charlatanism floating around out there in the world of anything related to
cognition and memory. It's part of the reason it's gonna segue is a little awkward, but part of the reason I wanted to have you I was like that's part of the reason I want to have you on is not to h highlight necessarily that, but the antithesis of it, which is someone with
real clinical expertise.
research credentials.
who is also a
practitioner, right? It's like
You
Walk the walk.
Ask you
You mentioned supplements earlier, and of course everybody loves to hear about supplements, but
What are some that may not be on the usual
list of suspects, so to speak. I mean, one I would love to hear you speak to is CDP colean.
People might not think of xylitol.
as a supplement, but certainly you could argue that maybe there's a place for it. Do you wanna
add anything to that and just expand on those?
But I think that
The supplements that we have the best
Evidence for
Uh really
They start with those
core nutrients that we could
Get it from the diet, but if we don't
then we definitely should supplement. So we've mentioned omega threes.
B vitamins, especially those involved in methylation, so that's vitamin B twelve, folate, which is B nine, riboflavin, which is B two, and B six.
Vitamin D.
Obviously critical.
Iron supplementation.
particularly if people are a anemic. So that requires a whole assessment for like why are you anemic in the first place, but
Often particularly
More common in women.
And many of the symptoms that women may experience around peramenopause are associated with inadequate iron status. So getting your iron status uh checked and addressed is really important.
Magnesium certain
Critical as well.
If we're thinking about
Other things that do seem to have
both an acute and long term benefit in terms of cognitive function, then
All the kind of antioxidant polyphenols are very interesting, uh, particularly those that come from berries, but related ones in coffee, tea.
on the skins of roasted nuts and seeds, like they have similar effects. And then
So you mentioned
Choline.
And
Right at the beginning when we were talking about Omega Threes.
I think choline is critical because
its importance as a head group for fats to be attached to in membranes.
That's maybe one of the reasons why it's important for the brain and
Various estimates suggest that we're becoming increasingly choline deficient.
as you know, we stop eating things like eggs and liver, which are our richest sources of dietrocholine.
But there are randomized controlled trials.
in two different settings that we've talked about already. So one in older adults already experienc some degree of cognitive decline, where supplementing with CDP choline
Which is also called Citycholine, seems to improve
Certain aspects of cognitive function.
And then
Again after traumatic brain injury.
There are met met analyses that show that supplementing with CDP coding can improve some neuropsychological outcomes in particular after TBI.
So
I think most of us can probably get choline from the diet, but
In some of these cognitively degraded states, we might call them.
Yeah, something like five hundred to a thousand milligrams a day of choline seems to be beneficial.
Do you take it or do you just get it from
Eggs. I get it from eggs. Eggs and liver. And some seafood sardines have some choline in, as do
Some
Whole grains, like oats have some, quinoa has some, so all of it kind of.
That's up.
So I I don't supplement with codeine. I do supplement with creatine. I don't have the perfect trial that creatine is gonna prevent dementia, but I think we've seen enough interesting data across
Depression.
Again, sleep deprivation. Sleep deprivation. How many grams do you take daily? What's your standard dose? Ten grams every day.
Single dose or divided, doesn't matter.
So I take it
All in one go in the morning.
There's some evidence that suggests that once you get above five grams, you probably start to saturate creating up to transporters so you don't necessarily maybe you don't take all of it up.
But the reason why I take it all in one go is because I remember to take all of it w in one go.
Another reason is that I find creatine to be quite stimulating, quite cognitively stimulating for me. So where you took your ketones, I took my creatine before.
I got on this call. And
So if I take creatine later in the day
I don't sleep as well. It's very noticeable for me, but it's not that's not the case for everybody. Some people take creatine and they don't notice the cognitive effect. They doesn't affect their sleep. So it's very different from person to person.
So those are the reasons why I I just take it all in one go in the m in the morning. Especially if you're gonna take
Over ten grams, twenty, thirty grams.
You're probably best splitting it up into several doses so that you absorb more of it.
Yeah, thirty grams at one go also is tempting the gods to smite you with a really, really bad bathroom situation. So yeah, and a lot of people do mention
GI side effects from creatine. I think some of that
Is
due to the quality of the supplement that you're taking.
Yeah.
I agree. So if you're taking like create pure creatine monohydrate.
That's what most studies that have tested creatine have used and
There was actually uh
Systematic review meta-analysis that just came out that found that across all the studies they could find compared to placebo creatine didn't have any additional GI side effects.
But also those studies use high quality creatine.
Also, not all those studies use 30 grams. So you could certainly get to a point where you're gonna start have GIF X based on those. Yeah, I think it also has to do with the fact that my like poly farm in the morning when I'm just getting booted up, it's like I might be having the coffee plus the creatine plus
You know, like sardines with M C T oil. Yeah, I mean, there's a lot going into the cocktail of potential disaster, which you do acclimate to.
Quick question before I forget.
On
Black tape.
Is there any argument to be made for
anything that you would ingest or otherwise put into your body, not to avoid doing the intense exercise, but to
increase the amount of lactate.
that you uptake into the brain.

Is that something that people have looked at or is that just
risky business and to be avoided'cause you'll end up in like some type of acetosis or some other problem.
So
People have looked at exogenous lactate itself, right? Usually as lactate salts, just like you people have looked at ketone salts.
You can bump up blood lactate a little bit, but similar to ketone salts, that you don't get nearly the the increases you uh do with with with other compounds. You don't need to do anything.
To increase
brain uptake of endogenous lactate because the brain will generally just take up as much as you've got.
Similar to ketones, right?
I think I I didn't ask I misspoke when I was asking the question. I guess it was just increasing the amount of circulating lactates, your brain just sucks it up like a vacuum. Yeah.
I think you can make plenty of lactate yourself.
So
You know, another way to do it.
Blood flow restriction is another great way to produce lactate with low load. There are some studies where that well, they have them do leg presses, but like sets of
twenty leg presses, wearing blood flow restriction cuffs.
That will get you up there as well. Again, several millimolar of like it's not fun. I think I'd rather do the Norwegians. Four by four by four. Uh yeah. Oh wow.
That's intense.
So that's not the way to do it. So if you
for whatever reason don't want to do sprints on a running machine or you can you can probably get up there
with some blood flow restriction under low load and high rep. But no, I I don't think there's anything that I would take to increase lactate. Okay.
Just because you can make it so easily yourself.
Alright, so I wanna hop on the

What
make and model do you use?
What's your
Kind of tool of choice for the BFR stuff. I use the B strongs.
So they have a

B E. So capital B
Strong.
Oh, okay, kinda. I have no affiliation with them other than like I know some of the guys.
But I paid for my device myself.
So it has leg and armcuffs, but it comes with a
Like a sphigmominometer, right? More of those blood pressure things to kinda pump it up to get the pressure.
Those are the ones I use.
Yeah, nice and simple. I'm testing a few different ones right now. So
When you travel
Right. People think of exercise as this thing that involves all
Potentially all sorts of machines and you need your kit.
There can be a lot of
excuses or things that people imagine as obstacles that are not in fact obstacles. So talk to me about your
Exercise when traveling with blood flow restriction. What does it look like?
So
As uh
My wife calls it, I have my gym in a bag, which I take everywhere I go when I travel, and it is a set of blood flow restriction.
Cuffs and a set of bands. I use the Black Mountain products bands, which come with handles. Like I like them because they come with a lifetime warranty. Like I break them and snap them all the time, and you just like email them and be like, hey, this broke, and they just send you a new one. And they cost forty bucks or something like so super cost effective.
For people who are not looking at Tommy, I mean

Freaking giganti. I mean, you look gigantic. You're wearing like a very thick sweatshirt, and I can still see your pecs moving around, for God's sake.
What are your dimensions here? Not to turn you into like a Playboy Playmate or something. So I'm six two. I'm two usually two hundred and twenty pounds.
Yeah.
I usually hang out somewhere around twelve percent.
Body fat.
Yeah, strong unit. Okay. But the the reason that I brought that up is not to flirt with you. Although I'm not against that.
There's somebody out there who's like in
Internet keyboard jockey on Reddit who who's like living in a basement and squats
one thirty five and it's like, Oh that guy must be some pencil neck d we have and it's like no
Actually not. He's pretty big.
And yet, like you can get
Sounds like a decent workout with bands that costs forty bucks and blood flow restriction. How is that possible? What do you do? So
When I travel
'Cause I'm usually at work, conferences, I'm doing podcasts, whatever, like
I don't have two hours to go to the gym, which I like to have if I'm at home. So I I might do ten to fifteen minutes and right. You put on the cuffs legs and arms, I'll do some lunges
Like bodyweight lunges, squats.
Presses.
push ups and then bicep curls and tricep extensions, and that's probably it.
So
A pretty standard protocol which is
Essentially in three to four minutes you accumulate somewhere between seventy five and a hundred reps.
So
Thirty
twenty twenty twenty or
twenty, fifteen, fifteen, fifteen, fifteen, something like that. With
Thirty seconds of rest in between.
Try and do one body part at a time, but you can superset them if you're kind of
Short on time.
That's it.
And
Kind of to your point.
When we moved into this house, this was now eight years ago.
I built my own gym here, but for a long period of time I didn't have a gym.
And I was working from home and all I had was bands and PFR cuffs and
Then it wasn't even the B Strongs, it was like these really cheap
ones that kind of look like something that would somebody would use to kinda like draw your blood.
Yeah, like train spotting. Yeah, exactly. It looks like um it looks like a tournique, like to to tie off your leg if you've like
Blown off your foot.
And again, they cost like twenty bucks.
They're probably not the best.
Anyway, so I had some of those and some like forty buck bands, and that was all I used to work out for like
Four or five months, and I didn't lose any muscle mass or strength. I just got straight back into it afterwards. So like you can maintain
And gain pretty well. As long as you w my BFR can be
Yeah, a little bit painful.
If you sort of push it. But also very, very safe. Like that that's it's been used in rehab, right? All these other things that frail individuals. People are like, what the hell are they talking about? Okay. So imagine you have I'll use an analogy. This isn't exactly what's happening, right? But imagine you had a small belt, tiny belt that you put around
Your upper arms, right under the shoulders, right at the top of the biceps. Let's just say keep it simple. And then I guess
Close to the hip, right? On the on the legs. Yeah, like right up in the groin.
And your
partially occluding blood flow, right? So you're not totally cutting off blood flow, but you're making it a lot harder for blood to get to your arms and your legs.
It's mainly blood to get out. So the blood can you're not yeah, you're not compressing the arteries where the blood gets in. You're stopping the blood from coming out.
So Venus returned. Yeah, exactly.
Okay, got it. Yeah. And the nut
effect is if you're like

Arnold Schwarzenegger and you're like, ah the pump, I feel like coming. Yeah. It's if you want to take that to like a twenty X extreme.
and feel very, very, very uncomfortable. BFR is a great way to do it.
Again, for people who are like, Oh, come on, man, I squat three fifteen or whatever, like I'm guessing you probably squat like at least three fifteen or more. And
What what do you squat? I'm curious now.
My best squat as a couple of years ago, four or five is my best squat.
Better deadlifter than I am a squatter.
What do you deadlift? What's your PR for deadlifting? Five fifty.
Yeah. It's up there. All right.
And I think you would probably agree if you put somebody in leg cuffs and you're like, Yeah, do proper lunges like knee to the ground.
And go for like
A hundred yards and come back.
I don't even think most people could do that, but it's just like you're gonna feel it, right? Like you are absolutely gonna feel it.
All right, Jim and a bag. We'll link to all this stuff in the show notes as well.
So I wanna list off a couple of things here and then
Talk about
We can keep
Bouncing around a lot.
Well, on these supplements, you know, I'm gonna kinda cut this short and we'll put things in the show notes.
But
The uh
Periodontal health, mouth health.
And
Dementia, right? The connection there, hence the use of
Xyletol?
Whether that's the gum.
Epic Kaigum.
Or air purifiers, mouthwashes. We've got all this stuff. So I'm gonna link to that in the show notes, just in the interest of time.
And certainly feel free to chime in. I wanna talk about
Cognitive stimulation, right? So we spoke about dancing earlier.
Could you
speak to language learning and music.
'Cause I'm realizing I think accidentally I might have
really helped my brain a lot early.
Which is great as a surprise.
But also have next to me
an Ohana ukulele, which is gift to me, that has basically just been gathering dust and after
doing prep for this and then looking into it. I'm like, you know what?
I should spend
A couple of minutes a day just screwing around with this. It seems like a great use of time. But could you speak to
Music and language learning.
So this actually
If we include dance
This comes back to something that
we kinda started talking about earlier, which is you know, what are these experiences or what are these activities that you can do with the brain that
kind of maximally activate it or increase glucose uptake.
And
There was
A really interesting
study that came out recently called Creative Experiences and Brain Clocks.
Creative experiences and brain clocks. Yeah. So I'll break that down into the it's different components. So
Kind of like when you did an MRI scan for your brain.
And and all those other tests you did. There were various different ways that people can sort of like estimate how old the brain looks.
And I don't know if that's hugely B S or not. I don't know.
It's a bit of both. Yeah.
In this context, I think it's kind of useful because
When
You think about what happens to the brain as it ages.
There are a few things that happen, right? The structure changes, different parts of it get smaller, right? You lose volume.
But then functionally it also changes.
The different networks that we have in the brain that have different
Functions and activities.
They
become less discreet.
And they become more
distributed. You get less of these kind of very
functions specific.
tightly knit networks and connections and then everything just like

loose and different areas of the brain get connected together and it's it's sort of like a bit more of a mismatch. You get this increase in entropy. Initially what we call it is brain entropy, right? It's not as discrete.
Entropy then decreases again as we get towards the end stages of dementia just because this
Not much going on.
in there, unfortunately, anymore.
Sorry, that's bad. That's the best way I could put it. Okay.
And
So
When you look at different ways to
quantify how old this brain looks. One way is to look at the structure and the connectivity of the networks.
And how like discreet they are.
Things like the frontier parietal network, the salience network, right, the attention network, like these parts that are really important for like
Executive function, focus, attention, all this kind of stuff.
And they tend to lose function as we get older.
And the easiest way to do this is with EEG, so electroencephalogram, where you measure the electroactivity in the brain. And so in this study,
What they did is they took a whole bunch of different
studies and they looked at these different creative experiences.
So one was tango dancing, one was language learning, then there was uh musicians, they had artists, and they also had video gamers and they had an interventional study where they had people learn the video game and it was StarCraft was the game that they used, just in case anybody was wondering.
Although most if we're talking about video games as a cognitive stimulus, the one that has the best evidence is Super Mario three D world.
Just in case you you were interested. Lots of studies of that, actually.
And what they did is they compared amateurs to experts, and then they also looked at the effect of
an intervention where people actually were trained in this thing. And
As you increase in expertise in these different creative complex arts, you see
Improved structure.
And discreetness of these like
really critical networks that are susceptible to aging as we get older. So
But the effect was similar in tango dancers versus those who are bilingual versus those who are artists versus video gamers.
So
The some
core effect of these complex
Like multi sensory stimuli.
That require us to gain significant expertise and skill in order to perform them that seem to have this broad effect. So part of this.
Is probably because we're training our brains to be able to focus and learn.
And then part of it is just like
The actual
Engagement in this complex task.
And so
When you look at say languages.
Two very good colleagues of mine at the University of Washington, Andrea Stocco and Chantel Pratt. They study individuals who are bilingual.
And what they see, they've done this from both uh like measuring brain activity and different types of cognitive function, and then trying to like model like what's actually going on.
And what it looks like is that those who grew up bilingual
perform better on tasks requiring executive function. So things like response inhibition, which is
You kinda want to do something, but you stop yourself just in time.
normally when I talk about it, it's like you know when you have these thoughts
Of like
Oh well what would happen if I just opened this window and jumped out?
Or you think something
And
You stop yourself just before you say it, because it's a really bad idea,'cause it's like your boss.
How do they test that? Are they using like a Stroop test as uh I'm just throwing something out there.
So often it's like a go, no, go task. You're presented with different stimuli and it's whether you react to it or not.
But like a strooper is partly a an example of that.
When people don't know what stroop is, like you get shown
Words.
That spell a colour.
And they are also
Coloured.
And then you have to respond based on whether
The word
spell the colour you're looking for or is the colour you're looking for. And so it like requires you to
Trouble these multiple things.
So yeah, they they use tests like that. But basically it seems that because
You spend your entire life
having to suppress one language while you activate another and then move back and forward. Your brain becomes better at suppressing these different so
At the same time.
Interestingly, it seems that you become less good other things. So it's like none of this is good or bad.
But
People who are bilingual seem to be less
responsive to the what's immediately happening around them in in the outside world. And that's probably again just because of
how their brains have adapted to these different stimuli.
But
You do see that those who were born bilingual or that who grew up bilingual have a decreased risk of dementia, or if they do get dementia, they get it later.
But
You also see improvements if you train in a language, even like using an app on Duolingo, they've shown that in older adults you use Duolingo
And of course, you have to like actually move through it, not just like stare at it for thirty minutes a day. But that you see significant improvements in executive function. You see the same thing with with music learning. So there is something to these
complex, very human kind of skills.
that have these carryover effects into these kind of core components of cognitive function.
I'd never heard about the
Response inhibition.
With
Subjects who are bilingual.
But it might explain in a totally separate battery of cognitive testing that I did, which was much more rigorous, I think, than what I did a few days ago.
My digit string memorization
Despite all my mnemonic trickery.
is very bad because it's only flashed for a second and then you have to
Do your best. If you gave me a bunch of time, I could use all my trickery. But if it's just a flash and it's kind of relying on, I guess, my hardware, then
I'm very bad, like to the point where people might have some concern, but I've always been like that.
Conversely, with something like this there's a test.
That was pretty much exclusively the Stroop Test.
But it had a few things that were very similar. And I was like
I'm exaggerating, but like ten standard deviations.
Outside of the norm. Like I was so much better.
That
They were like why?
Why are you so good at this? Like we've actually never seen something like this. And it could be studying all these different languages. I don't know. Maybe.
So do you know what I'm I'm actually the same and like we're kind of convincing ourselves that this is real just because it's the is it's the case for us. But
I often do cognitive function tests on people we work with in studies and that kind of stuff, and we do this full battery, all the things that you mentioned. And on every test, you know, memory, all these other things, I'm just like, I'm perfectly average. Right. And you kind of
You always think that, Oh, I'm so smart, so therefore I should be at like
Uh what X standard deviation but no, I'm like perfectly average on everything except for
Response inhibition to us or the street test. Then I'm like
And I also grew up speaking multiple languages, so I I don't know that maybe that's the thing, we don't know.
Which which languages for you?
So I I speak Icelandic, my mom's Icelandic, so half my family were Icelands.
Then I lived in Germany and France when I was a kid for various periods of time and then
I did my PhD in Norway and I taught in the medical school, so I had to learn Norwegian so that I could teach
Norwegians medicine. Wow.
That's hardcore.
Yeah, it's quite a few.
For people out there who are like, Well, I wasn't raised
buyer trilingual. I didn't really even get started until I was fifteen, sixteen.
Thought always assumed I was very, very bad at languages for reasons that were mostly related to the schooling and not to any inherent ability.
But
I'm also thinking about, you know, tango as an example, because I spent a lot of time doing tango. That was I'm not sure if you have any familiarity with this chapter in my life, but
In 2004, basically spent like six to eight hours a day doing tango in Argentina and competing ultimately and going to the world championships and all this craziness. But you have the physical component, but like you said, it's actually a pretty complex cocktail. And
In my case you you not only had
Sure you have the
dancing, but you also have Spanish, right? I was learning Spanish at the same time.
And then you have the music, and I'm wondering if
Studies have been done.
looking at the effect of listening to or having to track different types of music versus producing music.
Yeah, has anyone looked at that?
Not as much. Certainly
Frequent music listening.
It's associated with lower risk of of dementia as much as you can like and cognitive decline, as much as you can like get rid of all the sociological
pieces of o of that. There are some studies looking at
Training adults in musical theory, which requires
actually listening to music and then pulling out the different components. The
Seem to be as again associated with
Similar benefits to say learning to play a musical instrument.
So
I think
Even some of that.
Attentive.
Listening.
And actually
So like engaging with the music as a listener.
seems to have some of the benefits of the in addition to like producing the music yourself.
Yep, except with dance, obviously if you actually have a hope of dancing well.
you have to listen very, very carefully to the music. And in particular, I mean, you could have choreographed dancing, but what interested me about Tango, which I didn't
realize in advance of getting to Argentina is that the vast majority of it Tango de Salón is
Improvised.
So
If you're gonna compete
in that particular style of tango, a salon tango.
You don't know what music's gonna be played.
And then they just serve up whatever the songs happen to be. So you're not only responding to the music, but you're memorizing music.
In any case, makes me want to get back to Argentina.
Maybe as though that time off is that's why your hippocampus has been catching up with you.
Yeah, exactly. Oh add that to my litany of complaints. So I wanted to highlight something.
You've mentioned this. I don't think we need to spend a lot of time on it right now, but sensory loss, hearing, vision, right? Getting AIDS slash surgery.
As soon as possible. Since
Those seem to be so correlated.
Two
Increas or onset of
Dementia. I want to mention two things and then
I'll let you rip. The second one.
Is now
I'm kind of paraphrasing here, but like error detection triggers adaptation. So like the importance of failure.
Because
With a lot of the
Hand wavy.
Pseudoscientific.
Games and this, that and the other thing that are sold for
helping b supposedly, right? Helping people with memory, cognition, etcetera
A lot of them don't seem to check that box.
So maybe if you could speak to the sensory loss and then the kind of error detection.
And defining that and the importance of it.
There were
Several studies that suggest
that sensory loss, particularly vision loss through cataracts and hearing loss
through age related hearing loss presby accuses.
Or associated with an increased fiscal dementia.
And that this risk is reversible.
So
If you have cataract surgery, then
that increased risk is no longer there.
And if you get hearing aids again.
That risk is no longer there.
Of those two, randomized control trials have only been done with hearing aids and they only showed significant benefit in those who were at an increased risk of dementia for other reasons, so like poor health, cardiovascular disease, these these other things.
So
It may be that it's kind of exacerbating other
Underlying risks.
But equally we can think about
two broad reasons why sensory loss might lead to cognitive decline and why
Often as people get older, they're like
I don't want to get hearing aid because then I'm I I'm like then I'm old.
Right. Conceded defeat. Yeah. And so th this happened with my mum, actually, and she recently got hearing aids, and I encouraged her. I was like, As soon as there's a thing that you need, you should get it.
And it's had a dramatic effect on our quality of life.
And so
We know that if you lose an input to an area of the brain, that area of the brain is going to decrease function as a result, right?
It's no longer being used and
with a process of anastasis or constantly adapting to the demands that are placed on you.
That part of the brain is just going to diminish its function.
So that's part of it.
But I think a a bigger part is that when you lose senses, you no longer engage in the world in the same way that you did previously. You go out of the house less, you socialize less, you do less tango dancing, right? Because you don't feel like you can engage with it in the same way. So I I think there's a lot of benefit from recovering lost senses.
That's not the same as so if you are born
Or if you've never had sight.
Or you never had hearing.
That's not associated with increased risk'cause you learn to engage with the world in other ways. Right. So it's the loss of that engagement that I think is important.
Then
The error part.
The easiest way to think about this is the
If we're trying to
Improve.
function and structure of certain parts of the brain that allows us to have greater reserve
you know, greater total capacity, and therefore if we do lose some volume or some capacity as we get older, right, we have more to lose. So we, you know, we're less likely to get to the point where we have
Significant deficits.
In order to drive improvements in structure and function
Right, we need to drive these processes that we call neuroplasticity.
New connections, new branches, all the supporting machinery, the other cells that are necessary, right? We think a lot about neurons, but there's a whole bunch of other cells and stuff in your brain that are really important as well that are part of this response to stimulus.
But to drive neuroplasticity.
You essentially have to have
A difference between
Capacity and expectation. The best way to uncover that is with mistakes or errors.
Well it's kinda like muscular training to failure. Exactly. Yeah. If you don't ever get to the point where you're no longer capable of doing the thing that you want to do.
Nothing needs to change.
You can already doesn't need to adapt. Exactly. Yeah. So that's essentially it.
And this is w what becomes important in
dancing, learning languages, learning music, right, is that
you having these opportunities to
fail to kind of get beyond your current capabilities and like that's what drives the processes of learning and plasticity.
What else do you have in your
Personal
regimen of kind of non negotiables.
You got
Obviously you're lifting weights.
You're doing
You're
blood flow restriction, torture every once in a while.
I don't know if you're much of a ballroom dancer. I was a uh I was uh a field raver in my youth, but I was never much of a ballroom dancer. Get that man some glow sticks.
You know, I have a few part of the the reason, a big part of the reason I got elbow surgery was to get back into rock climbing, which I think is just a phenomenal, phenomenal sport for mental and
physical development. I mean it's just
A kinesthetic puzzle on a wall. I mean then
was really inspired over the last two years seeing people in places like
Colorado, Idaho, Utah, where I'd go into these gyms and you see
People in their sixties and seventies who are doing stuff that I can't even imagine doing physically. And they meet
couple times a week and I was like, wow, okay, if you can have that kind of longevity in this sport, like that seems like a great investment. Plus I just really, really enjoy doing it. But what are some other
non-negotiables, right? If you look at
All the possible things you could do, all the things you do.
And you're like, all right, these are the things that are meaningful and that I stick with consistently.
what falls in that bucket, right? Because a lot of people will get these like twenty-seven things, forty-seven things you can do to improve your brain health lists or whatever.
And
Even if they want to do all those things, there's no way they're going to.
There's a question of
sustainability or adherence as well.
Yeah, what are some of the other non negotiables for you?
The one that we haven't talked about that really is non negotiable is sleep.
Yeah, let's talk about it.
I think this is the the major thing that's missing from these studies looking at dementia prevention, like as as a risk factor. I think inadequate sleep.
Really?
seen in like so many studies now that's associated with increased risk of dementia.
So that's something that
I very consistently
make sure that I get enough of that's like the one thing that really is non negotiable. Like I can
I don't mind if my diet gets a bit crappy for a few days, or I don't mind if I can't get to the gym for a few days, like
This stuff integrates over months and years, like but
If I can only focus on one thing then sleep is really critical for me.
But I will say
One thing that
I've noticed a lot.
Was that historically
I used to really get in my head about my sleep and I know this is gonna be the case for many people.
Who have tracked their sleep or used wearables or thought about the importance of sleep. Right.
And so
Something that changed recently, particularly because I spent a lot of time looking at the research and this also affected me at home because my wife was like, If you don't sleep and then you don't get your coffee, like I don't want to be around you because just picked up a moderate heroin habit.

A lot of it was was honestly self-induced because I I thought I didn't sleep well, therefore I'm not gonna function well, I'm gonna be grumpy, like all this kind of stuff. And we know that.
This is influenced by outside factors. It's influenced by our own thought processes. There are studies that have shown this.
Yeah, randomizing people to be told by their wearable they didn't sleep well, even though when they slept just fine.
And w what you see
Long term sleep is critical, right?
Absolutely.
And any sleep you can get.
more than you are having now, the better. Right. So if you sleep six hours a night, you can get six and a half. Great. Like don't think that you have to sleep eight hours. Like you can get an extra half an hour. That's amazing.
But
In short periods of time, actually sleep deprivation doesn't have as much of a negative effect on cognitive function as
We think.
And this is just important so that we can go about our day to day lives and perform well when we don't sleep well.
Especially when you have a chalk bag full of creatine at your desk. But so like yeah, the creatine helps. But equally like we travel, we have kids, right, all this kind of stuff.
Sometimes you're just not gonna sleep well. But
In short periods of time over like a few days.
What happens is that
Processing speed slows down, but accuracy doesn't. So
The quality of your work is just as good. It just might take you a little longer.
And mood is affected much more than performance. So
Actually we don't perform less well, we just feel more grumpy about how we performed.
So
Actually jo knowing this
I then like just completely changed how I approached my sleep. So if I didn't sleep well, I'm like, Do you know what? I'm actually gonna be fine.
Then it turns out I am fine. So
That's like
Yes, sleep is critical.
But how we think about these things I think is is really important. So like
Important factors are gonna be avoiding
Excessive alcohol, don't smoke.
But then two things that that we you've mentioned we haven't touched upon fully, I'll kinda like briefly talk about one is
Air quality and air pollution.
Which is a significant risk factor for dementia.
A lot of these studies are quite recent, looking at say wildfire exposure and
Things like that.
But even
Living near roads.
Like in the short term as associated with greater cardiovascular risk, higher blood pressure.
which you can improve with having an air filter of the all the different like
metabolic type risk factors for dementia, high blood sugar.
And high blood pressure are the two most important
Lipids and other
things are important as well, but those are the consistently the highest risk factors.
Managing blood pressure.
is really important. And if so you live near somewhere where there's a lot of air pollution, then air filters certainly seem to help there.
And then oral health is the final one. So like
I say this because
I appreciate that I'm British and I'm gonna tell you you should go to the dentist.
So historically when I lived in the UK, I did not go to the dentist very frequently. And actually the first time I went to the dentist here in the US, I have this one
metal crown from back when I was a medical student.
And my dentist looked at it and he was like, You didn't get that done in the US. That was his first comment.
But
Gum disease.
So ginger vitis, especially if it advances the periodontitis.
Is it significantly associated with an increased risk of dementia. This is probably both due to an increased like systemic inflammatory effect plus
Those bacteria can get into the bloodstream. They're found in atherosclerotic plaques in heart disease. They've been found in amyloid plaques in the brain.
So
treating gum disease is really important.
Whatever that requires. And that's why I mentioned xylitol to you, because there are several studies showing that xylitol gum or xylitol mouthwash can improve the oral microbiota.

Cavity and prodontitis causing bacteria like strep mutans and porphyromonis gingivalis.
So it's just like a really
Low risk kind of thing.
There he is with his gum.
Piece of gum in my pocket.
The lower thing to consider and I don't think they've looked at it by Apo E4 genotype, but
Things that
have an anti-inflammatory effect or decrease inflammatory burden seem to have an outsized benefit for those who are po E4 carriers. And so
Gum disease would obviously be one of those that's worth keeping an eye on.
That's part of the reason not to keep banging on this drum because I know it's not the shoe that fits everyone, but that's another reason for my
Fascination with ketones.
just remarkably anti inflammatory on a couple of different levels. So for folks who might be
Wondering and we'll put these in the show notes as well. Air purifiers. Do you mind if I just read from this email that you sent to me? Because of course I'm such a stickler. I'm like, what exactly make and model.
So I'll just read from this. The blood pressure study I mentioned, this is I equals Tommy, used the healthmate. That's one word. Jasper is good. That's J S P R, as are most of the blue air, one word, blue air models tailored to the size of the room. The co way
C-O-W-A-Y Air Mega is a good budget option. So we'll link to all these in the show notes. This is one.
God with travel. Such a pain in the ass. Although I have I think it was James Nestor who wrote the book Breath.
Who was giving me just some horrifying
sort of quantified self data related to looking at like CO two concentration in various hotels and airplanes and so on. And so he I I don't think he'll stay in a hotel that has sealed windows.
I think it's kind of part of his policy. Yeah, high CO two really negatively impacts sleep.
Like lots of people in a small room that's not ventilated, that can definitely negatively impact sleep. So we always have a window open or something for that reason. Yeah.
Anything else that you do for sleep?
Besides not becoming too orthoraxic about it and like
Freaking out on the wearables and stuff, which is a real thing for sure.
So besides recognizing that
You're gonna be fine. Humans have been dealing with this for a long time.
What else would you say, right? I would imagine
Yeah, there's things people have probably heard, like keeping the temperature sort of
Whatever it might be, like sixty five to seventy degrees Fahrenheit.
et cetera.
Other things that you find particularly helpful.
Things that have helped me a lot.
I stop work before dinner. I don't do work after dinner unless I really, really have to. And that that helps a lot because I find I ruminate a lot more if I if I do work late into the evening.
A basic shutdown routine. I put on the blue light blocking glasses. They're probably just placebo at this point, but like I put them on and like my brain is like oh it's bedtime.
And then I read
Fiction before I go to sleep.
I have a
Quite a recent purchase was an eight sleep, which has been amazing'cause I tend to get quite hot.
When I sleep, that's helped a bunch. So it's kinda helped stay cool. And then I I wear an eye mask.
Which I really like for, you know, blocking out light. There were also some very nice studies on that.
One of my favorite studies looking at IMAS. You ever see this one where
In the control group they had them wear like a Zoro mask, so they were still wearing a mask, but like the eyes were cut out.
No. And this was during the summer when light would come in early in the morning and disrupt sleep, and they saw significant improvements in cognitive function in those wearing the regular eye mask versus like the Zorrama. Yeah, so it's hilarious. That's probably my list.
Okay.
I'm gonna ask you
Something
specific about sleep, but just because I have it in front of me to ask you. Vitamin K two, do you supplement K two or do you get it from something else?
I do generally supplement just like a few micrograms.
A day.
Maybe fifteen or twenty.
But
That's mainly because it comes with my vitamin D that I was suffering, particularly in the winter.
Uh, in the summer I get plenty of sun exposure on bear skin, but in the winter can't do that in Seattle.
But
I also don't mind a little bit of natto or
You know, some fermented foods that that would have K two in as well. So don't need to supplement.
Stinky spiderwebs. If anybody likes the sound of stinky spider webs, try not though. N A T T O. It's the one that Japanese people like to give foreigners to watch the face.
Some people like it. I can handle a little bit. I can handle a little bit. I mean I grew up eating rotten shark in Iceland, so
Oh that stuff is so
Fucking bad. I don't I w I went to
This place called Hotel Ranga.
I think it's Ranga to bring my family. You know, my mom had always her whole life wanted to see the Northern lights. And so we went there in the middle of the winter. By the way, folks, not a whole lot of light. It's like twilight for a few hours. That's all you get. But
There was some fermented shark.
celebratory day and we drove to what looked like and I think it was a gas station, but had a restaurant attached to it and ate this fermented shark.
I don't even know how to describe how would you describe it? It was like
I mean fermented shark as you would imagine, but like
Eating something soaked in like ammonia like the
Pungency when it hits your sinuses is like smelling salt. Yeah.
Because it is ammonia, so to make
Greenland shark, which is the type of shark edible.
So
Greenland sharks don't have kidneys, so they're
Tissue the
body accumulates urea, right? Because they can't they don't pee it out.
So in order to make it edible, that urea has to break down to ammonia.
Then it becomes
Edible.
And so it is ammonia that you're tasting, but it's it's like
It's got the texture of tuna.
And
The taste of a really, really, really strong blue cheese that you peed on.

I will say I wasn't
Really hankering for our return trip.
To that particular gas station to eat fermented shark.
But
Watching my brother try to eat it was one of the most entertaining
moments I'd had in a in a long time. So you know you're supposed to alternate shark with bentavine, which is Icelandic aquavine. You eat the shark, then you use the benovine to take away the taste of the shark, you use the shark to take away the taste of the blendine, and then you just continue that until So you just get hammered enough that you don't care that you're eating fermented piss shark. Exactly. There is one thing that's
So actually I I don't mind
the shark that much. There's one thing that's much, much worse. If you ever have a chance to try Surströming, which is
A Swedish fermented herring in a can.
That is the worst thing I've ever put in my mouth. It's terrible.

It's like when you open the ca actually if you if you look it up, there are all these YouTube videos of people who like get it in the US and they open it and like the smell comes and then they immediately throw up.
It's like you open the tin and you like take out those like rotting bones of herring that you kinda put on bread.
Highly recommended.
Yum. Alright, I know what I'm doing for New Year's. Alright, so sleep.
Do you have a position on the DORAS on the like dual Erexin receptor antagonists? I was uh'cause I've chatted with folks.
including Matt Walker, who's you know, very credible in the space.
With respect to sleep research.
The potential that Dora's could help with
the clearance of beta amyloid
What is it, P Tau two seventeen, et cetera, and possibly be of
Some help.
in preventing the accumulation of things that later contribute to
All cyber.
The vote is in and it's a hundred percent. But there seems to be some
A couple of interesting publications around it, including in humans.
Do you have a position or any thoughts on it?
So like very quickly we know that
Sleep quality and quantity affect
amyloid accumulation in the brain. That can be seen over short periods and long
Periods, and that's some of that work is from Matt Walker's lab.
And he's even done studies that show that later in life, if you can improve the amount of sleep that you get, that's associated with a lower overall amyloid burden.
I think that some of this, like we get very focused on amyloid, it's a part of the picture of Alzheimer's dementia, just like you said, it's not the full picture.
But I think we look at it.
And it's a market for all the things that you should be clearing out of the brain when you sleep that you aren't, right? Amyloid is one of those things. There are probably many other things as well.
So the Dora have
Yeah, now several studies in different
states in insomnia, in sleep apnea, you know, these states where we know people are getting lower quality sleep.
And they certainly seem to improve that.
I think that in individuals you have
some kind of sleep issue, be that insomnia, something else that's going to prevent high quality sleep.
Then
Improving that is certain.
gonna be beneficial. Right now, the door is now the best option. Previously
People recommended Tracodome, which is like
we talked previously like the least worst option, because it doesn't negatively affect sleep architecture, unlike many of the other
sedatives that people might use to help sleep.
But
If you're sleeping fine or you manage to maintain high quality sleep
As you get older, I don't think we need to start taking doors to prevent Alzheimer's,'cause I think your sleeper's probably already doing the job.
That it's doing and
There are studies that show that increased cognitive stimulation in older adults improves sleep quality, or that
Engaging in cognitive stimulating activities.
helps to offset some of the potential increased risk that we would have
With poor or less good deep sleep, which is when a lot of this clearance happens. So I think a lot of the other things that we mentioned already, physical activity, we know improves sleep quality.
So
I wouldn't jump straight to Dora's
But
In somebody who who does have
Insomnia and say CBTI is a CBT for insomnia doesn't help them, or some of these other things that we can do to improve sleep and those don't work.
And you've ruled out
Anything sinister.
Then you know, I think they're now they're now our best option to help.
Supposedly.
Alright. We have covered
A lot. I want to know why you decided to do something very difficult, which is write a book.
The stimulated mind. What was the driver behind this and
Who is the book for?
I like to joke that the book is for anybody with a brain.
The the subtitle is about preventing dementia, but really a ton of it is just about
cognitive function and cognitive performance in general. So even people who are
Younger.
And aren't thinking about dementia. Yeah, although like you said
It's worth thinking about it earlier than you think.
I think for most people who
think about how their brains work or want their brains to perform better and or want to prevent or minimize their risk of dementia long term.
It's
Got what I think uh
The
Big rocks.
And the tactics for how to address those that we know substantially increase dementia risk, all those things we talked about earlier that kind of contribute to those.
Dementias that are potentially preventable.
And the reason I wrote it
Is because I didn't think.
That
Book really existed.
Like people might focus on one particular area.
Mm.
They might
Focus on
Everything, right? There are books on dementia prevention that are just like
Endless tables of blood tests and supplements and this stuff that just like most people are never gonna do, right? It's not gonna be sustainable.
I didn't really see a middle ground.
But equally
I wanted it to be
very heavily referenced. So if people want to get into the references, I have a reference list. It's gonna be two thousand papers, all in humans.
And it's cited in the text where I have like little
Superscript citations. Teased the subtitle a little bit. It's a good subtitle. I've so wanna give it some real estate here. So the stimulated mind subtitle Future Proof Your Brand from Dementia and Stay Sharp at Any Age. I'm looking at the Amazon page for the first time. I hadn't looked at it. I had no idea that you know Kelly.
And Juliette Starrett. Those are two very close friends of mine. Yeah.
And you got a very nice quote from uh Dr. Kelly.
And Juliet for the book. That's fantastic.
I only really connected with them about a year ago, but they've been some of the most I like I just
have like they've been so, so helpful. Like what do you do when you wrote a book and how do you get it out there? And how do you get people to read it? Like they've given me so much of their time and help. It's they've just been they've been amazing.
Yeah, they're fantastic. All right. So
Doctor Wood, that's you, explains that a brain that improves with age is the result not of expensive pills, far off discoveries, or strict lifestyle optimizations.

But rather of actions within our control, diet, sleep, physical activity, social connection, stress, tolerance. And obviously it goes on and on. But clearly.
You have a lot of very practical, specific advice that people
Can implement.
And
What else makes this book different?
So I I think
Those things that I mentioned make it different. I think it's very practical and approachable, but very
science driven and if people want to like dig into the references th those are available. And then
I think like towards the end
Right, after I've given you like there's all these different areas where we talked about nutrition, sleep
physical exercise, I give like how you would approach each of those things in terms of supporting cognitive function and minimizing dementia risk.
But then I kind of bring them together in a model of how I think
People can implement this in our daily lives. Like, how do I just pick one thing? And actually, does picking just one thing help to support?
Like the overall function of the brain and the answer is yes, it does. Because
When you sleep better.
To say if you focus on improving sleep, you're more sociable. You're more likely to engage in cognitively challenging tasks. You're
Blood sugar improves, your blood pressure improves. So
just changing one area, suddenly the whole network shifts in your favor. And that's the case
from almost anywhere you where you kind of approach it. And I think that means that people are much more likely to actually start
Doing this stuff and realise that
It doesn't require a ton of work to start moving the needle. And then these things.
you know, sort of compound over time.
Alright, the stimulated mind, folks, go grab a copy. Obviously
You know, I hate when people say obviously, but I'm gonna say obviously
Doctor Tommy would
Has the credentials, has the expertise, has the
Bona fies with respect to research in humans.
And
has provided a lot that you can use in this conversation and a lot more is in the stimulated mind. So check it out. Why on earth
is your ex account called Dr. Ragnar.
Uh
I first started blogging around the time you first started podcasting. I remember listening to your like first interviews with Dom Dagostino back in the day when I was like
In my PhD chair kind of.
Writing blog posts. But my middle name is Ragnar.
So I I I created a website it was Doctor Ragnar, that was initially where I
Say my stuff.
So let me think about this for a second.
I'm gonna make myself probably regret
Asking this question, but what is Ragnar does Ragnar mean anything?'Cause now I'm thinking of Ragnarok and if those two have any connection. Is does it mean anything in particular?
No, so you're right, like Ragnarok is like the final battle of for Valhalla.
And actually there are like some online gaming accounts where I use the name Ragnarok. But
No, I think what it means, the translation for the Old Norse is like wise counselor. I think that was another reason why I picked it, because it was very self important as a as a thirty year old uh health blogger.
But it was my grandfather's name, and then these names sort of get passed down in the family.
Technically it should've'cause I was the first born grandson. It should have been my first name, but my dad was English and it was like
People are just gonna make fun of him at school, he's gonna get bullied if he's called Ragnar.
It's very cool now, right, because of Vikings and like all these other
T V shows where Ragnar now appears.
I mean, you could make it work, but Dr. Ragnar Wood also is a little s has this kind of a strange combo one two to it. Yeah. All right.
Got it. At Doctor Ragnar R A G N A R on X for people who want to check it out. To be honest, I don't use X. So you can follow me on X, but you won't see anything.
But people can find presumably there's something at dr tomewood.com. Dr. Tommywood.com. So that is the
That's the home base online.
Instagram.
Instagram at Dr. Tommy Wood again. DR Tommy Wood. All right, folks. So you got it. Check out the stimulated mind. I'm a huge fan of what you do.
I am going to try to
Improve my
Chesticle and armed situation with
More use of BFR and bands. And is there anything else you would like to say before we
Wind this to a close. Anything you'd like to
Ask of the audience, point them to requests, complaints.
Anything that comes to mind?
D.
Other than, you know, if you do happen to pick a copy of the book and you do have any complaints, do send them to me. One of the reasons why I
wanted to make it so that like every statement that I have in the book has a citation. You can go, you can read that paper.
If you disagree with my interpretation of it, I want to know. Like I can't promise that I have all the answers. So that will help me uh learn more. So
Yeah, if you have a complaint.
Just uh tell me about it.
All right, Tommy. I really appreciate all the time, man. This was great. Took tons of notes for myself, which is always a good sign. So thanks for carving out.
A bit of time to be on the show.
Really appreciate it. Thanks so much for having me. This is uh so much fun.
And for everybody listening, as per usual, we'll provide copious links and show notes at Tim Dot.
blog slash podcast, Tim Dotblog slash podcast. And until next time, be just a bit kinder than is necessary to others and also to yourself. As Jack Cornfield says, if your compassion does not include yourself, it is incomplete. Thanks for tuning in.
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