142. Dr. Tommy Wood: The Science of Brain Performance Optimization

Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts offering you a step-by-step guide to proactively avoid disease and most importantly, extend your health span. Most people assume memory loss and mental decline are inevitable with age, but the science tells us a very different story. In this episode of Extend, and I'm joined by Dr. Tommy Wood. He's the Associate Professor of Pediatrics and Neuroscience at the University of Washington, and he's the Head of Motorsport Science at HINSA Performance, where he oversees brain health and performance for Formula One drivers. Dr. Wood's work spans neonatal brain injury, cognitive aging, and elite performance. And his upcoming book called The Stimulated Mind challenges the idea that brain decline is unavoidable. We're going to break down why the brain doesn't need comfort. It needs challenge. Dr. Woods introduces his 3S model for cognitive longevity, stimulation, sleep, and nutrient supply. He explains how complex skills, learning, recovery, and metabolic health determine whether your brain adapts or declines. From what F1 drivers can teach us about focus and recovery to how everyday habits build Cognitive Headroom, this conversation offers a science-backed roadmap for staying sharp at any age. Dr. Tommy Wood, welcome. Thanks so much for having me. It's really great to be here. Yeah, you're down from Seattle and huge fan of everything you talk about on podcasts. Thanks. You have such an incredible background. I think it's worth just kind of starting there a little bit about why you're here talking about brain health. And I like knowing your background specifically because, you know, the field that you work in, you have to be an expert of this stuff, right? Yeah. So I wear a few different hats that are related to the brain. So my main day job is I'm an associate professor at the University of Washington. I run a big neuroscience lab. and what we do is we look for ways to treat brain injury uh essentially mainly in animal models but we also do a lot of uh work with clinical data from from various patient populations so we look at neonatal brain injury we look at adult traumatic brain injury we look at neurodegeneration and um age-related cognitive decline right then i have another couple of positions so i work with a a big dementia prevention charity in the uk called food for the brain i'm chief science officer of a company over here called Better Brain, which has some of the best like online free resources for brain health. And then I'm head of science for motorsport for Hints of Performance, which is a company that does work with Formula One drivers. So I help to oversee some performance programs in that arena as well. Yeah, so exciting. I mean, from performance of F1 drivers all the way to brain injury and Alzheimer's disease, like you cover the spectrum in brain science. So It's going to be an exciting conversation. I love it. So, you know, let's start off with F1. And what you see really moved the needle for those drivers as far as, I mean, those guys have to think in milliseconds. I saw this really funny YouTube video where there were a couple of F1 drivers trying to roll a car to the end of a table. Dr. Mike, and did you see this video? I didn't. I saw the interview, but I didn't see the specific video. Yeah. So they're rolling cars to the end of a table and they have to very precisely predict the speed and the distance. And they both hit it, you know, like they got it. Like, I'm like, it would take me 50 tries to do that. Right. And so obviously there's some neurocognitive connections going on there that they developed through their career. And I would love to hear from your vantage point, just kind of a big picture of how you think about their particular neurocognitive abilities and how they continually improve upon them. when you think about any complex skill or actually most brain functions really the primary driver is how you've applied the stimulus to your brain over some period of time in order to drive that function right and this is very relevant to formula one drivers but it's also relevant to everybody else as well so when you think about the skills that those guys have this is something that they've spent every day doing essentially since they could walk some of them right first they're in karting uh like go karts and then they're in you know the various lower levels feeder levels into formula one formula four series formula three formula two finally formula one and throughout that entire time they've slowly been building these these skills as the cars get more complex and the engineering gets more complex and as they have to deal with more information at faster and faster speeds so the reason why they're so good at that is because that is what they've honed their brains to do on a day-to-day basis then when you kind of step back a little bit and think well how can you know what's the best ways to support that kind of performance they get so much stimulation from driving the car uh and they obviously spend a lot of time in simulators because the time in the car is sort of restricted in formula one and they have simulators of differing levels of complexity but they're constantly training those same skills right being able to process multiple streams of information what's coming from the engineer what's coming from you know the car itself what we know what they can see around them so then the the kind of the stimulus that sets up that function or is already exists so what we often spend a lot of time doing is figuring out how can we make sure that they're getting the most out of that session or those sessions and that training they're doing so for some people the stimulus is important but they get so much so then we're thinking about how do you optimize sleep recovery right these adaptation processes that's when the brain sort of responds and function improves um and they're traveling all the time they're in a different time zone every week like they're constantly jet lagged so for them it's often focusing on recovery because you know everything else is kind of taken care of they're already so good in terms of learning the skills. And then it's, you know, how can we support them in other ways to make sure they're always getting the most out of what they've learned? Yeah, it makes complete sense. So the way I like to think about it with the brain is obviously the reps and the number of times you perform an activity has a lot to do with how good you get at it. And, you know, I'm a surgeon, so we it's kind of a similar but different, you know, you just got to do the surgery over and over and over and over again, and then you get it to where it's automatic. And that happens through the neurons, obviously, connecting and having neuroplasticity. But to your point, it's creating the right situation in the brain to be receptive to those connections forming as well. And your neurons connect better and they interact better when you've had good sleep, when you've had, you know, you're nutrently complete. You're you're you've kept the bad stuff out of your brain, right? Like sugar and all these other molecules that could potentially cause long term damage. And so I think creating those situations around being receptive to the stimulus is what you're saying is what you really focus on. Yeah, exactly. So the way I think about this is to bring together all those different points that you made. I have this sort of like model that I've put together for how the brain works. So this is my segue into the three into the three S model. So there are so many things that we know are important for brain function. But I think they sort of first of all, they interact and then they they kind of act at core common pathways or in core common areas. So the first is stimulus. So how you use your brain is the primary driver of its of its function. It's the same with your muscles, your heart, your liver, your immune system. Right. The stimulus that are exposed that those tissues are exposed to is the primary driver of their function. but then if you think about physical function right if you want to get stronger you have to lift weights right but we know that we can improve the adaptation by having good nutrition and by sleeping right every good athlete knows you don't get stronger in the gym you get stronger when you when you sleep or you recover so the stimulus is important but then the next thing that that kind of allows that to happen or the adaptation to happen is what i call is my supply bucket so That's the second S. And supply involves blood supply. So you need a healthy cardiovascular system. You know, it's very important for your blood vessels to be able to respond to different networks in the brain being activated. There's a thing called neurovascular coupling, right, which basically when those neurons and astrocytes become activated in the brain for some specific task, then they tell the blood vessels locally to dilate to bring in more blood flow. So you need a healthy cardiovascular system to do that. then you also need good metabolic health because you need to supply energy for the brain to do that so it could be glucose could be ketones could be lactate depending on the scenario and the final thing you need is a supply of nutrients right we know there are several nutrients that are critical for brain function both for the structure and then its function and then the third s that in my model is support so you've stimulated the brain you've brought in all the nutrients and things that it needs but then in order for it to adapt and respond to the stimulus it needs a period of recovery for that adaptation to occur so sleep is really critical but there are other aspects of support like trophic hormones brain-derived neurotrophic factor we know that other sex like the sex hormones are very important and we also want to avoid things that inhibit that adaptation so chronic stress other sources of inflammation so it could be anything from periodontitis For some people, it could be autoimmunity. It could be smoking. It could be excessive alcohol. It could be air pollution. These things, a large part of what they do is they impair some of those adaptation processes. So then regardless of which sphere I end up working in, maybe it's how am I trying to help this Formula One driver get the most out of his brain, or maybe it's how am I helping this brain to recover from a TBI or a concussion. right you can think about where's where are the biggest limitations where are the biggest issues in terms of those three areas and importantly they also interact right so if you increase cognitive stimulation that drives greater sleep needs so you sleep better exercise is the same or if you start by sleeping better we know that and you haven't been sleeping well we know that blood pressure improves and blood sugar improves and you're most more social the next day you're more likely to do cognitively stimulating tasks so all of these things kind of interact then which allows us to figure out what's the best place to start and then kind of build out from there. Yeah, it seems complex when you talk about it because there's so many different aspects of brain health. But the reality is your brain, your heart, your liver, they all need the same thing, right? And we can first build that pyramid of health by getting the basics right and then adding the support piece to it and obviously avoiding injury as well. So I would love to like dive in a little bit on each one of those S's with you, if you don't mind. So let's talk about stimulus. Okay. So stimulus obviously comes in all sorts of flavors and different intensities and also different time periods that you can apply the stimulus over. Right. And so my point there is, you know, for people that are not Formula One race car drivers, how should they think about the stimulus that they're applying to their brain? And is there a certain amount of time that stimulus can be applied with maximum benefit and then you recover from it? Or can we just, you know, be stimulated for 18 hours a day? Like, how does all this work stimulus wise? Yeah. So the way you phrase the question is really important because there's like two sides to this. And I often think that the modern human brain is both understimulated and overstimulated at the same time. My point exactly, right? And so when we think about the kind of stimulation that drives function, improves multiple cognitive functions, decrease the risk of dementia. We think about complex learning of some kind. So this begins right at the beginning of life. We know that the average peak of cognitive function occurs around the time you leave formal education. So the higher your educational attainment, the higher and later your peak of cognitive function, which doesn't mean that you have to do it through formal education, but it basically says that the more time your your job is learning right you are driving and building capacity in the brain then the rate of decline is often related to how we use our brain later in life so how cognitively stimulating is your work does it involve a lot of social interaction does it involve skills does it involve problem solving or is it very repetitive those have two very different effects on the trajectory of later cognitive um of later cognitive function and cognitive decline. So when we think about things that seem to be really beneficial, yes, formal learning could be history, maths, like biology, whatever it is, right? That's important, that learning piece is critical. But then we would also think about complex motor skills. And so that could be dancing, it could be ball sports, it could be team sports, they seem to have an outsized effect in terms of benefit for the brain beyond the physical exertion. And then you might think about languages and music and the creative arts. There have been some nice recent studies that show that they have, even though they can be quite different, right? Art might be different from dancing. Tango might be different from video games, but they all seem to have these because they require these core complex cognitive skills. They have similar benefits to the networks in the brain that are susceptible to aging. so for those types of stimuli particularly if you're trying to learn a new skill or something the the most efficient way to do it is 30 to 90 minutes two to three times a week and that's because most humans can't really concentrate on something and like be pushing it against the edge of their current capabilities for more than you know like maybe an hour but if you're going to do an hour you probably have to take a break in the middle so every chunks of 20 to 30 minutes and then when you look at how well information and skills are retained, the most efficient way to build them is to repeat every two or three days. You can learn faster if you do it more frequently, of course, but you get the most out of each individual session by allowing yourself to like sleep a couple of nights, consolidate and come back. So if you want to learn something very quickly, of course, you could practice it several times a day, multiple days a week. But most of us don't have time for that. Right. So if we're trying to add something in here, some new skill, a language, a musical instrument, you know, two times a week, 20 to 30 minutes and sort of build up from there. That's usually a good place to start. Right. The other side then is how we use our brains the rest of the time, which is where we are essentially constantly stimulated. We're very busy. Right. But we're never actually driving an improvement in function and we're never giving ourselves a break during the day. And this is a big problem with the modern sort of modern knowledge work. Exactly. Constantly multitasking or technically task switching. Humans don't really multitask. We're constantly in meetings, doing multiple things at the same time. This is inherently very stressful. Plus, each individual piece of work we do tends to be less good because we're trying to do multiple things at the same time. That's also inherently very stressful. And then we never give ourselves a break during the day. so if we can restructure our work so that we can get some focused work done kind of chunk together the kind of multitasking and meeting work that's how i think about it kind of structure your day around that and then give yourself some breaks in between that then allows you to recover you come back with more vigor you get high quality work done you're less stressed at the end of the day because you managed to achieve more of what you wanted to do and then maybe you have some time to go and learn a musical instrument at the end of the day so many great pieces of advice there so What I'm hearing you say is for long-term brain health and, you know, the avoidance of Alzheimer's disease and neurocognitive decline, but also just to keep your brain sharp, I fully agree with you that it takes more complex learning activities. And those can be, you know, I always talk about mental reprocessing where you learn something new, you think about it over a couple of days and you teach it or talk about it to somebody else being one of those types of activities. Also learning a new instrument, learning to dance. I mean, dance has tremendous research behind it about being very protective for your brain. Those are the kind of things you want to think about doing more often. You know, I think there's a lot of talk and a lot of people are getting sold things like brain games on your phone that have you do repetitive tasks or even like Sudoku, you know, those type of things. Where does where does that fit into protecting your brain? Yeah, it's funny because thinking about the whole idea of stimulation and cognitive decline or even enhancing cognitive function, one of the times when the brain is most at risk from cognitive decline and cognitive decline appears to accelerate is at retirement. Because we lose that. We lose all the cognitive stimulus we get from our work and that social and then also all the things that we're doing with our brains. And the challenges. Yes, exactly. The challenges being critical. but then we say well i'm gonna retire but don't worry i'm gonna do sudoku and unfortunately that's not that's not really enough so when you think about how uh like the different ways you can use your brain um there's a there's a nice framework that gloria mark has a psychologist who wrote a very good book called attention span and it's based on how like how focused you are and then how challenging something is and so the type of skills and things we want to do with our brain to enhance capacity include a lot of include high focus and high challenge right it shouldn't be too much challenge because then we get frustrated and we quit but there needs to be enough challenge but sudoku crosswords some of these brain training games in your phone they fall into the requires some focus but it's not really challenging so these are what she calls rote activities and so they can they can be beneficial it's kind of nice to do a sudoku right you get a feeling of accomplishment afterwards it could even be a break from some all the stuff that you're trying to do with your brain, but it's not going to be enough. And that's the case for most brain training games that I think you would see on your phone. There are some brain training platforms that do have some evidence behind them. Most of them you have to do on like a desktop computer, like in a browser. The one that probably has the best evidence behind it is called Brain HQ. And there's a nice story for at least one of the training games that they have. It's called Double Decision. The original version of it was used in a trial, the active study back in the 90s which is still to date like the best study with the best or the evidence the the study with the best evidence for brain training actually doing something useful called the active trial called the active trial and they randomized nearly 3 000 older adults to four different groups they had a control group they had a processing speed training group that was the that was this uh this task which is now in brain hq there was a reasoning uh group and there was a memory group where they sort of like taught people how to use mnemonics and other things to kind of remember things better then they trained for 10 weeks on these different tasks um then they had refresher sessions at one year and three years and they followed they followed these people out for you know some of them up to like 10 plus years and what they found was that all three brain training groups had better quality of life several years later even though this is a very short period of training but the ones who performed the best were the ones who had processing speed training they kept driving for longer they had a few accidents while driving they seem to even though it was a fairly short period of training they seem to retain some of the benefits of your training processing speed within the brain and so this is now within the this that same program that they did is now within the brain hq platform and that's still the best study for brain training so some brain training programs do have some evidence behind them but the ones on your phone are probably too simplistic they don't really challenge uh our brains in the way that they're normally challenged right through multiple senses at the same time like that's really where you know if you compare something on the on your phone versus you know dancing for instance right just that multi-sensory stimulation is just so different um right that i think that's where you're going to see most of the benefit yeah fully agree and i think you know when i talk to patients about this I have a lot of CEO clients that are maybe going through like a sale of their company, right? And they're like, what do I do to keep my brain healthy after this sale? Because I'm going to lose the challenges of, you know, running a massive company for a while. And the way I talk about it is there's different levels of activity. And you want to choose mostly where you're going to spend your time is going to be the ones that are going to give you the most benefit, right? And so then you could fill in some of these other activities such as Sudoku or brain training games underneath that. And I find in general, if you keep it maybe a rule in life to just always be learning something new, right? Whether it's a musical instrument, dancing the tango, starting a new business, mentoring somebody else and teaching them. There's so many ways. I know your mentor teaches banjo now, right? Yeah. So a very good friend and colleague of mine, Dr. Josh Tuckney, he's a neurologist. Yeah. And he formally left clinical practice a few years ago. And now he has this massive banjo training platform online. And so he uses what he's learned about neuroplasticity to kind of help people play the banjo. And I think he also does like the fiddle and some other instruments. But yeah. And thousands of people are doing this. Oh, yeah. And it works because you're learning something new. And coming from a neuroscientist, too, it's that much more legitimate in my view. But I think it's a pretty good rule in life to just always be learning, never stop learning. And then on the other side of that, prior to selling a business or retirement, sometimes people, like you mentioned, they slave away for hours at their computer in very stressful situations. And I think a general rule of thumb is every 30 to 45 minutes, just stop, take a break, do something different, and take a walk around the office, go have a conversation in the water cooler. I think it's worth it. Yeah, there's lots of nice studies where they sort of simulate the workplace or they do it in a modern workplace like that. And you find that even just a five-minute break is enough to then come back with sort of renewed vigor. You feel much less fatigued. You're much more able to focus. And they've used five minutes of a mindfulness practice. one of one of the best is actually uh uh five minutes of watching uh comedy clips on youtube right you just like completely disengaged and there's there's also some nice evidence for for re-watching or re-reading like fictional scenarios that you know right so you know we're like when you get home and you're really tired and you're like you put on a sitcom that you've seen like a hundred times the office that's the one is for me yes for me it's friends or the big bang theory um and so it it restores a lot of that sort of like helps to reduce some of that cognitive load we've been experiencing during the day obviously like getting outside lots of um nice studies on just a few minutes in nature green spaces that can have a similar effect but yeah just and it's the fact that you like stood up because you know that if you're sitting in one place for a long period of time like cognitive function can start to to decline so just that just like moving your body a little bit all those things can then right you do that enough times right that can really add up to a lot of over time exactly and i think um it's critical here to like be be cognizant of your cognitive load and you know when you feel the weight of the world on you because you've just been slaving away for hours feel that in your mind and stop and like doing a youtube video can be very helpful to just completely get that load off of the brain yeah for a few minutes and just kind of reset and and know that when you take a break you you will end up doing more across the day because you've actually given yourself a break. So often we're like, well, I don't have time to take a break, but the breaks can be very short. And then you come back and whatever you're doing, you're going to be, you're going to have better focus. You're going to be more productive. So actually adding in breaks ends up with you doing more and better at your job, even though it feels like it's sort of like wasting time when really you're not. Yeah, exactly. I wanted to ask you about, you know, you mentioned that if you're trying to learn something, you do a session and then take a couple of days off, internalize those learnings, and then do it again in a couple of days. And extremely powerful to do that. I think when people try to learn a new skill and they just, you know, over-exert themselves without a break, they sometimes have a slowdown in how quickly they learn something. But then there's also the opposite kind of thought process. You know, you've got to get the 10,000 reps in, right? And so, you know, with Formula One drivers, you've dived deep into the science of this. How do you get the most reps in but still give yourself that recovery period that you need? Yeah. So the well-known quote about 10,000 hours. Yeah. Right. That comes from a famous study by Anders Ericsson looking at expert musicians, primarily violinists. And actually, 10,000 hours was the number of hours that those experts had trained by the time they were 20. They weren't even experts yet. So 10,000 hours isn't even enough. to become truly expert so that's like a misrepresentation of that study but that study does kind of give some nice idea of of how much we can do in in a given period because they did look at these expert violinists and how much they practiced and they tended to practice twice a day for something like 90 minutes that was like the right the average but then these are also individuals where they've built up their focus muscle if you want to call it to be able to like actually do that kind of hard work for that period of time in that in that skill set so i think that's probably what it looks like for a true expert so then it's still only two or three hours a day it's like really focused work because the rest of the time you need to like recover and adapt and that kind of stuff and that's probably going to be uh very similar regardless of the area you know when you're looking at drivers like sometimes they may spend several hours in a simulator but there's going to be breaks there's going to be lots of different scenarios that they're testing out trying out usually it's usually it's it's less than that when they're actually in the physical car most of the time it's less than that um like because it's usually across a race weekend you have multiple practice sessions but you know none of them are that are that long um and so i think that the most important takeaway is probably that is right it's the consistency much more than the like how much can you get in as soon as possible because then you're going to get the ability to like adapt and generate those skills much faster and there's there's also like lots of nice evidence looking at you do a skill building session and then if you can recover afterwards like sometimes it's a nap sometimes it's some kind of um breath work or something to allow you to down regulate right that's when the adaptation periods start to start to occur um even before sleep you can get some of that consolidation that occurs during wakefulness if you can like truly sort of down regulate afterwards right so i think that you know often we're focused on the the stimulus right and this is something i've seen a lot with amateur athletes they're always like I'm not as good as a professional because I'm not training as much as they are right and what they end up doing is getting overuse injuries stress fractures that kind of stuff because they never recover so I think that often you're right if you're spending a few hours a week on a new skill that's probably enough and then especially because you've layered it on top of family commitments and like how much sleep you can get in your job and all this kind of stuff so then often like the focus should really switch to recovery rather than doing more reps yeah it's such powerful information I I think if people can have that mindset shift, they'll actually learn quicker and it'd be less stressful to learn new skills. And then you said something really quickly that I want to highlight. It is if you're a student listening to this and you have a big test coming up, learning something and taking a nap can actually help you consolidate those learnings a lot faster. Yeah. Yeah. So I learned this the hard way when I was a student. I remember this period of time, like right up before my final exams as an undergrad, where I hadn't done enough work during the year. And I was just trying to cram all this information. And I wasn't I wasn't sleeping within like a week. Like I can't remember anything like have a complete emotional. I run to the bathroom and I burst the floods of tears as I think about my brain is not functioning. and in reality like all the evidence shows that if you you will learn much better if you actually take breaks and then you sleep afterwards so even though it feels less efficient at the time you will learn much much faster that way so and so like i did end up like switching my approach and it all turned out fine of course but that's really where i think a lot of students could could benefit is, you know, give yourself some real break sleep. And so if it's an if it's a like a proper night of sleep, great. If it's just a nap, that's great, too. That will allow you to get much more out of the work that you do actually do. Yeah, absolutely. And sleep is part of your support. Is that right? And so let's talk a little bit more about sleep, if you don't mind. So obviously, everyone has different kind of numbers that they need around their sleep. and for optimal brain performance is you know do you advise your formula one drivers your your patients or anyone seeking your advice on the number of hours of sleep or you focus more on the pattern of sleep the amount of deep sleep they're getting how do you think about sleep and brain activity yeah so often when there there are people who come to me and they're having issues with sleep that you could often like they might have a lot of data right they've like they might be wearing an aura ring or whoop or something similar sure i don't think that most wearables track the different stages of sleep well enough for like us to really get into it um and so i'll give it i'll give an example i had a there was a formula one driver who sent me some some wearable data in their sleep they were concerned because they weren't getting very much rem sleep relative first of all like how well that wearable could tell you you're in when rem sleep is is is one question like the trends over time are probably better than the absolute numbers for for most wearables but so i look at like several nights of of data i'm like well i know why you're not getting REM sleep is because you're getting five hours of sleep right REM sleep tends to happen at the end of the night so if you're not getting enough total hours right then you're going to get less REM sleep yeah and so the most important thing that i see for most people is that they don't get enough sleep opportunity yeah they're just not spending enough time in bed and so to be honest when you live that kind of lifestyle and i understand right you're constantly in private jets right you're in a different hotel every night right first night uh effects are a real thing right you're in a different place it's hard to sleep but so the so the basics always matter and that's that's where i tend to focus so sleep opportunity is is usually the most important thing and that's actually what most people aren't getting enough of sleep opportunity yeah so just like enough time in bed and then if you can't get enough sleep opportunity which just might right you've got kids and you've got to get up in the morning and you've got all these other things to do and like i sometimes get asked about that right if you if you if i can only get six or seven hours a night in bed like yeah i can't do anymore what do i do so then i would focus on then i tend to i would focus on regularity yeah right so we know that uh the different stages of sleep have a circadian component meaning that REM sleep and deep sleep do their best job if they happen at a similar time on a 24-hour cycle which is why like deep sleep during a nap doesn't have quite the same benefits as deep sleep during the night because it's usually happening the naps happening during the day but if you need more if you can't get enough sleep at night and you can get a nap please do nap like don't think that it's not beneficial the nap is great please do it but if you can get a regular six hours then you're most likely to get the most out of that that the period of time that you do have a sleep so yeah we know that quantity quality regularity and timing can all matter for sleep but those those are probably the two areas where i would focus is first can you improve your sleep opportunity then can can you focus on regularity if if opportunity isn't isn't isn't good enough and of course sleep quality and that kind of stuff you can think about bedtime routines and caffeine and alcohol and all those kind of things become important as well right but that's where i would tend to focus yeah that's that's a great structure regularity being critical getting to bed at the same time every night and then creating the opportunity to sleep for seven hours. So almost working backwards, like what time do you have to wake up minus seven hours from that time that you need to be in bed. And that needs to be almost more regular than the time you show up to work, right? It's that important. And then, like you said, after that, then you fill in the rest, optimizing the sleep environment, optimizing more around the routines, etc yeah i think people tend to jump to the you know blue blocking glasses and the supplements yeah the the the supplement people always like that like the supplements i i do wear blue uh blocking glasses do you know like mainly because i've gotten to the point where it's like pavlovian like i don't even know if they're having that much of an effect because like it's less the light that you're exposed to it's more like how you're being exposed to light right if you're watching a scary movie or something it's the movie that's there's the issue rather than the blue the blue light although you know bright lights and blue light do suppress melatonin production so that they are they are important up to a point but like now like i put my glass on and my brain's like oh it's bedtime yeah right so me right so it's i've kind of built this sort of like placebo setup where where it's like part of the routine i think it's you know i think you're like you're right though this is pevlovian is wired into our brain that more than anything like our circadian routines I think are so wired deeply in our brains that if you can simulate a circadian routine in an environment like blue blocking glasses, like it just triggers something in your brain to say it's time to go to bed. Yeah, exactly. But I think what's important there too is creating the opportunity for your brain to recognize Pavlovian routines. Yes. You know, have you read James Clear's book, Atomic Habits? Yes. Yeah. So he talks a lot about this. If you just do something all the time, that's a stimulus. subconsciously, you'll create the sleep pattern around it. So really, really powerful stuff. This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of Wellness, where you can optimize your health span and lifespan using cutting edge technology. I actually founded NextHealth eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in NextHealth using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at NextHealth measure thousands of biomarkers and put into place a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www.next.health to check it out. Okay, let's talk a little bit more around the support of your brain, some things that people don't necessarily think about. It's creating the optimal metabolic environment for your brain as far as like your dietary choices, et cetera. So can you kind of take us through kind of the big picture rocks that we need to all get right but then also i'd love to talk to you about lactate ketones and glucose as fuel sources for the brain yeah so when i think about nutrition and the brain there are three main areas that i talk about that of course like over overlap significantly so one is like energy the other one is nutrients and then the third is is pattern so energy is right it's just like how many calories are you consuming and this is important because when you look at a wide range of data and scenarios and they've done studies in hunter-gatherer populations compared to westernized populations you know you also see things in those with metabolic disease versus the you know athletes who are under eating for the amount of you know the amount of work that they're doing that brain reserve which is essentially just a fancy way of saying like how much brain do you have in your skull and like the more reserve the better generally but also So multiple aspects of cognitive function and cognitive decline, they are accelerated at either end of the spectrum. Right. So when you're not consuming enough calories, then you see changes in mood. You see changes in cognitive function. You see changes in sleep. If you're consuming too many calories where you have metabolic disease, metabolic syndrome, high blood pressure, high blood sugar, high lipids, then you also see accelerated cognitive decline and a higher risk of dementia. So you want to be somewhere in the middle. and the reason why i focus on i also mentioned low energy availability is because there's a you know in some spheres of the longevity arena it's like caloric restriction right eat as little as you can it's going to make you live longer i'm not sure that's true and it's not particularly good for your brain because you're not going to have any buffer there it will just get by with as little as possible exactly rather than you know building up some reserves so having adequate energy availability is going to be important so essentially it's eating as much as you can as long as you're not going towards sort of metabolic disease you're a that's you absolutely want to avoid that then i think about the critical nutrients that sort of come along and the the ones we have the best evidence for in terms of cognitive decline dementia vitamin d omega-3 fatty acids the b vitamins especially those associated with methylation where you see an increase in homocysteine if they insufficient or deficient and iron of course then other things like magnesium zinc the polyphenol antioxidants seem to be seems to be really important for the brain those those are the things that that kind of like have the best evidence for them and then i think about pattern which is like how am i eating every day so that i can achieve achieve those two things i can maximize my brain boosting nutrients so my critical nutrients for my brain and i can make sure that i'm getting you know enough energy but but not eating to excess and i think about it that way because there's a ton of ways to skin that cat yeah right and it doesn't matter as much where the nutrients come from as long as you're getting them it doesn't necessarily matter what your dietary preferences are as long as you're you know you're sort of eating enough to kind of support all those processes and that allows people a lot of flexibility so the diet that most people might focus on for the brain is some version of the mediterranean diet called the mind diet and that does have good evidence to support it but equally i don't think everybody needs to like import olive oil for their brains to work right there's uh there was a really nice study done using data from the uk biobank where they looked at people's diet data and this is like self-reported diet data right there's a there's a lot of issues with nutritional epidemiology it's just that it is what it is but they they then looked at how well people's diets reflected a mediterranean diet using two or three different ways of how to measure a Mediterranean diet. And what they found was that, yes, if you ate more like a Mediterranean diet, you had a lower risk of dementia. But when they looked at each of the individual foods within the Mediterranean diet, there was no one food that was like, if we take this out of the score, it changes the relationship between the diet and dementia, right? So what it tells you is that it's this overall pattern that's generally nutrient-dense. It's less energy-dense, so it's less easy to overeat it. and therefore it gives you all the things that you need so you don't need to like one by one say i need to eat all these things because they're in the mediterranean diet you think about what's the like the overall picture of a mediterranean diet that i can get from my from my own diet and that could be in the nordics it could be in the middle east right it could be you know anywhere in you know south america or south africa right you can hit those same things with local foods exactly and local traditions it doesn't need to you don't need to import everything from the mediterranean Yeah, yeah. And you can create that diet. For example, the Japanese diet is very similar to that. People are very focused on the paleo diet, which I just think is a renaming of the Mediterranean in many ways. And so the biggest components being lots of high fiber organic vegetables, well-sourced protein sources, higher than normally the recommended daily allowances, right? And then finally, some really well-sourced fats, things that are like fatty fish, olive oil, nuts, those kind of things, mostly focusing on unsaturated, polyunsaturated fats, right? Yeah. And that's how to create the big picture rocks in that diet. Yeah, exactly. Yeah. And so these dietary recommendations, I think, are what we know works for most humans. And then obviously, to me, what's even more powerful than constructing a diet around those rocks is just a total avoidance of ultra processed foods as much as possible. Would you agree with some of that? Yeah. So I think as much as is possible. Absolutely. When you then think about trying to apply this at the absolute population level. So people who don't necessarily have access to the kind of food that you and I might do. Some of those things have to have to change a little bit. So we know that I prefer you eat any vegetables, as many vegetables as possible, even if they're not organic. We know that the benefits of the vegetables outweighs the farming method. And it's the same for fish. Farmed fish is better than no fish. And conventionally raised beef is better than if you're going to eat red meat, is better than none because it is actually a good source of protein and it's nutrient dense. So then, you know, just focus on the food itself, like regardless, because, right, those you mentioned fiber is important, the antioxidants are important, the nutrients are important, you'll get those regardless of the method. But then equally, sometimes food processing can be beneficial because there are these big modeling studies where you look at nutrient sufficiency. And like the majority of adults around the world have at least one nutrient insufficiency, right? It's just normal. and so um since they uh fortified refined grains in the u.s in 1998 with with folic acid very high levels of individuals with very high levels of homocysteine have decreased which at a population level is probably going to decrease your help to decrease the overall burden of dementia so i agree like if everybody could eat the way that you first described that would be great but if that's not possible which it is which is the case for many people then sometimes food processing allows you to add protein it allows you to add nutrients right which then which people might not get otherwise yeah the population basis it makes sense right and that's why they put the b vitamins in the grains yeah people just weren't getting enough exactly yeah yeah yeah point point well taken and then do you feel there's any foods that are particularly helpful to the brain like superfoods people talk about blueberries avocados like you know just just to kind of like get your feeling about that yeah um i'm a i'm a huge fan of berries yeah me too so and i think if there is a superfood for the brain it probably is it probably is berries wild blueberries um have a very high anthocyanin content you can buy them in five pound bags from costco that's how that's how i get mine frozen like so like very uh very economical and there are actually the the berry probably matters a little less but the anthocyanin content is important right that's what makes it blue or purple or red. But there are studies looking at both acute and chronic benefits of blueberries, cranberries, strawberries, cherries. It's that it's those polyphenols that seem to have a benefit both for the gut microbiota, for vascular health, and then they may have direct effects in the brain as well. So, yeah, I've had to pick like one like blueberries with a side of sardines. I think that would be like the ideal. Yes, that is. Let's talk about a little bit about blood flow to the brain as well. Hypertension being one of those silent killers of brain function. How does one think about their blood flow to their brain and what are some things they can do to optimize that blood flow? Yeah, I think that in reality, the easiest way to think about it is to think about your blood pressure, because we know that over long periods of time, elevated blood pressure dramatically worsens vascular health, endothelial function, and then can accelerate atherosclerosis. And that includes in the brain, which can which can decrease the ability of those blood vessels to then respond to those stimuli that we were talking about earlier. There are obviously lots of fancy ways that people can measure blood flow to the brain. But but in reality, what we have the best evidence for is either preventing or treating high blood pressure. So then that's where like cardiovascular exercise is going to be is going to be critical. But equally, we know that sleep deprivation, right, that that can that can negatively impact blood pressure. so there may be other areas that people have to attend to depending on what's most most relevant to them and in terms of sort of pharmaceutical therapies that decrease the risk of dementia anti-hypertensives actually have some of the best evidence for them so if you have high blood pressure and lifestyle doesn't like please try lifestyle first you know if you can improve improve blood sugar control and you can improve your sleep and you can you increase your physical activity, that might be enough to improve your blood pressure. But if it isn't, then I would absolutely consider antihypertensives because we have very good evidence that they prevent or they decrease the risk of dementia. Yeah, I'm so glad you mentioned that because, you know, a lot of people, I think, come to us to get them off medications. And I fully agree with that. But I do think that certain medications are incredibly helpful and incredibly protective while you're getting your lifestyle in order, right? And so, like, my personal story is I was on three different blood pressure medications until I finally got this continuous blood pressure monitor. Have you seen one of these yet? Yeah, yeah. Yeah. I mean, they're incredible, game-changing devices. It took me a while to figure out what the right blood pressure medication for me was. And now I think I have a very good lifestyle. I mean, this is as optimal as I can get it, but my blood pressure is still elevated. It's still, you know, sometimes 138 over 86. And the blood pressure medication keeps it as close to 120 over 70 as possible. We know from massive studies that that's the sprint study, for example, the closer you are to 120 over 70, the more is protective, not just for your heart health, but also for your brain health, et cetera. And so I think blood pressure medications have advanced a lot. We know we have great medications to keep your blood pressure under control while you're getting your lifestyle under order. And also the side effects are a lot less now than they've ever been. So it can be a critical part of overall longevity is get on the right blood pressure medication. And then let's talk a little bit about, you know, you have the other side of things, because I want to make sure we touch this is brain injury, right? I think this is one of the most unrecognized problems with brain health today is not really understanding how much brain injury is impacting the future of our brain health. And this becomes a problem from very early in childhood, when we put our kids into contact sports, all the way into like how we treat our brain over over the course of our life and protected from injury. So can you talk about that a little bit and what your research has shown you? Yeah, so I may even start even earlier than that. So a lot of the work that I do in the lab looks at neonatal brain injury. So two main types. One is preterm brain injury, so babies born earlier than the normal. they uh the more preterm or premature you're born the the higher your risk of um some kind of cognitive or neurological impairment or death and then the other is uh what we call hypoxic ischemic encephalopathy which is a fancy word for didn't get enough oxygen and blood flow to the brain and so these babies right they have a normal usually have a normal healthy pregnancy something happens around birth they don't get enough blood flow and oxygen to the brain and those babies in particular they they get cooled down for three days as to kind of like decrease that initial brain injury and it's it's very very protective and when you look at both of those types of brain injury what i found most fascinating like includes some of the research that we did in large large clinical data sets was that if you if you have an imperfect start to life which those babies unfortunately had the biggest predictor of how well you do later on is the home that you go back to so even if you have very significant brain injury in the hospital as a newborn the home environment can be incredibly protective and that's you're going to be related to food access and stresses and you know the education that you get and you know all those stimuli that we talked about and how much you get to play and learn new skills and those kinds of things but the reason why i i sort of bring that up to start with is because it gives us a framework to think about right if we do get brain injuries how do we then you know address that but we know that if you have an early life brain injury or if you're born preterm you have a higher risk of dementia later in life so that also tells us that the you're going to get one brain so you have this right it has to last this full trajectory of our lives and we know that now adult well could be childhood could be adolescent could be adult traumatic brain injury is a significant risk factor for later dementia and there's a few potential reasons for that one is depending on the injury you can get very prolonged neuroinflammation afterwards right which can which which which can both impair cognitive function at the time but that is also part of the process of cognitive decline and dementia it can also be because periods where you decrease like inputs to the brain because you're recovering right or if you never fully recover right you've changed the inputs your brain is getting we know that that's going to then change how your brain function as sort of changes over time and then also there's the right there's the direct injury itself right so the accumulation of of pathology in the brain so if you think about something like chronic traumatic encephalopathy which is repetitive concussions and traumatic brain injuries um over time common in the athletes common in various military groups then you you see this accumulation of um it's a it's a tauopathy so you see the accumulation of of tau in the brain, which then tracks with neuronal loss and the loss of cognitive function. So all of this to say that every every all these things that happen to our brain accumulate over time. But equally, I think we have some power over how well we recover if we attend to the environment and our lifestyle in and around that, because not everybody can avoid these things. Some people, this happened already. And I think if we think about this or the bigger framework, Like, hopefully there's some then hope that we can change that trajectory as long as we address those various risk factors that are happening around the injury. Yeah, it's a really good point. And I think sometimes injuries are unavoidable and having the ability and the knowledge to recover effectively from those injuries can be critical. But then also avoiding injuries as much as possible. Yeah, I think so. And what are some of the ways like do Formula One drivers get a lot of head injury? I mean, they get bounced around a lot of those cars. Yeah. So luckily, no. Obviously, if they – and some of that has improved over time. So historically, there have been – well, there have been a number of deaths, but there's also been some significant head injuries. And so nowadays, there's a halo around the car which protects the head because these are open cockpit cars. But that's probably saved a number of lives already across multiple levels of most sports racing. so you know yes they can they can have significant uh crashes certainly um luckily significant concussions and head injuries are relatively rare now but if you if you go across all the motorsports and all the you know all the different levels that obviously um still occurs so luckily we don't have to worry about that too much but you're there are ways to kind of you're right that depending on the scenarios that you're in doing whatever you can to minimize your risk of traumatic brain injury is going to be important so they've changed the rules in some youth sports which i think is is a great initiative they've uh you know if you're you're getting older you know one of the biggest causes of a traumatic brain injury is a fall so then you prevent falls by making sure that you maintain muscular strength and and power right through things like resistance training and eating adequate protein and you know preventing or treating frailty and sarcopenia right so so yeah Like whatever you can do to minimize your risk. If you want to learn a new skill and that new skill is like a martial art, make it a martial art that doesn't involve you being punched in the head. I think that's probably, you know, like good overall advice. Yeah, yeah. I get this call quite often and I would love to kind of hear your protocol if you were to get this phone call. My son was in a soccer game. He used his head to hit the ball and then he got a – he like fell down at a concussion right afterwards. Edwards teenage son like or I'll give you another one I got just like a week ago a good friend of mine called he was out mountain biking uh flipped the bike over hit his head on a rock was out for five to ten seconds yeah what should these people do immediately after the injury to maximize their recovery potential some some of this we actually published recently we published a paper a couple of years ago that looked at like the evidence for different nutritional and supplement interventions are through concussions and traumatic brain injuries. And so things that I think we have some of the best evidence for are creatine. If you're not taking creatine already, then there are trials, particularly in pediatric and adolescent traumatic brain injury, where creatine is beneficial. So you're talking like a typical kind of loading dose, so like 0.3 grams per kilo or something like that, omega-3 fatty acids. So you do a loading dose of creatine if you're not already on it. Yeah. Do you increase your dose if you're already taking creatine? So you're taking five grams of creatine. Yeah, so then I would go up to the full dose. And you would dose it based on body weight, right, because these are smaller kids. And that's what they did in the trials. Do you think it's beneficial for kids or adolescents to take creatine? Especially if you're in like a sport that involves your head injury potential? Yeah. If you look at official kind of pediatric guidelines, they say don't because, right, They don't they're worried about creatine and they don't know whether people should take it. If I had a kid who was in a sport that had a risk of head injury, I would probably take it. The reason why I'm less worried about taking it is because creatine is naturally occurring in food. If I was giving that kid, you know, fish and beef and right, you can actually get pretty close to some of these doses of creatine from food. So I think that and we know that it's very safe. Sure. So, yes, I think I think it's worth considering if there's a high risk of head injury. Okay, so creatine in the next one was? Omega-3 fatty acids. Oh, and I'll say one final thing. There was a study in high school football players that did MRS, so magnetic resonance spectroscopy, where you can measure the creatine in the brain. And they showed that across the course of a high school football season, creatine in the brain decreased in line with the number of high-speed impacts that kid had had. And they saw something similar for choline. and choline is another thing that i'd consider and so why i say this is because right even if those impacts aren't big they the effect can can accumulate over time it seems and so i would just try and stay on top of that with ongoing ongoing supplementation and that's probably one of the reasons why you see something called second impact syndrome which is you have a concussion it doesn't seem that bad you think you've recovered you go back you have another concussion could be even less severe but you have a much bigger effect and it's probably because you've done things like deplete creatine in the brain so you have less of a buffer if an injury if a second injury happens and then just because i was talking about choline then choline is another thing there are some studies you know meta-analyses in traumatic brain injury that show that choline supplementation improves particularly in neuropsychological um symptoms afterwards so then you're probably talking like 500 milligrams to a thousand milligrams a day of cytokoline or cdp choline those those are the same things then omega-3 fatty acids probably just like a typical like three or four grams a day again there was a nice study now in um or there's actually been multiple since but one of the original studies looked at uh so these division one collegiate football players and now there are multiple trials that have done this they've they've given them fish oil across the course of a season and seen that uh markers in the blood of of uh of like a neurological injury like neurofilament light they they accumulate less if they're taking fish oil during during the season um so fish oil is another one that i'd take those three are probably the main ones there is some slightly less less good evidence for branched chain amino acids but particularly if sleep is impaired then branched chain amino acids may help melatonin would obviously help if sleep is an issue because you want to try and get sleep improved as much as possible because that's when that's going to be critical for recovery there's some evidence for riboflavin so b vitamins are probably important too and then i would just because of it like some of the cool effects that we know that has on the the brain there not great trials in concussion particularly but I would add wild blueberries to the diet as well Like bring the blueberries and sardines. So sardines actually have a very high content of creatine as well as omega-3 fatty acids. So bring back my sardines and blueberries and I would have those as well. Agreed, agreed. Sorry, I was going to mention two more things. or one one main thing which is that early on after a traumatic brain injury or any brain injury thermoregulation is is really important um this is actually what i did my phd on so if you like concussions can often happen in heat stressed environments right you're on a field you're you're hot you're sweaty you already have a you know high temperature you know maybe high 90s into into the hundreds and then you can also get fevers afterwards so making you're minimizing fevers as much as possible so it could just be right just tylenol or something like that just to kind of bring fevers down because that that increases the metabolic stress on the brain at a time when it's when it's injured and getting out of the hot environment getting out of the hot environment yeah and like staying well hydrated and all that kind of stuff you said something about babies being cooled after hypoxic injury so same thing kind of applies later on in life yeah this episode was also brought to you by vita boom vita boom is a revolutionary company that sends you a custom supplement protocol based on your needs using blood-based biomarkers. You can either send them your latest blood test or they will send you a finger stick test for blood analysis. VitaBoom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. What's great is that they also provide all the best brands like Timeline, Truniogen, and many others for your custom daily packs. I love mine, especially for travel, since I don't have to bring 10 bottles of supplements with me and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to Vitaboom.com and check it out. What about exogenous ketones after head injury? Yeah, so if I had a significant head injury, I'd probably take exogenous ketones. I think that there's not enough evidence to say it really strongly. Unfortunately, because we've been in this arena for a long time. We've been talking about the promise of exogenous ketones for brain injuries for so long. A couple of decades ago. Yeah, and I just haven't seen any really good quality trials come out yet. I think some of these trials are being run. They're much easier to do when patients are in the intensive care unit and that kind of stuff. however you know we know that certain ketones can have some anti-inflammatory effects uh we know that like blood sugar regulation uh is affected by by brain injuries so if you can help to maintain a stable blood sugar by you know having some alternative energy sources that couldn't include exogenous ketones right there may be some benefit there uh ketones particularly during development but i also think it's relevant later in life ketones are the brain one of the brain's primary sources of like structural precursors right right so if you're trying to build if you're when your brain is building itself it uses glucose for energy and it uses ketones to make the fat and cholesterol that your brain is is made out right so i think if you're if you're recovering from an injury right ketones could have some benefit there but equally i'm still waiting for these studies to kind of to kind of um you'll answer the promise of ketones for that kind of injury absolutely hyperbaric oxygen therapy is another one yeah so i would i would think about this in two different phases okay so acutely right so if you get a concussion i i wouldn't jump in the hyperbaric oxygen chamber immediately there's some animal work and you know i've heard of some early data from some clinical studies where actually very similar to high temperature is that hyperbaric oxygen can right increases metabolic rate absolutely yeah and so at a time when your brain is struggling to produce enough energy because it's injured right you can increase the gap between like supply and demand which can make the which could make the injury worse but if you sort of fast forward several days or weeks and you have ongoing symptoms then i think we you know there is some initial evidence that hyperoxygen could help with recovery um in these sort of like cognitively degraded states it might be even be similar in early stages of cognitive impairment and cognitive decline i think you know the people always argue about the studies like is the plus you know how much of his placebo effect did they placebo control properly because it's kind of hard to do it in a chamber most of the evidence seems to be you know hard shell two plus you know atmospheres with your breaks in between so you might be doing it for an hour or two but you're taking a break every 20 to 30 minutes you know an air break right um and it's probably like 30 to 60 sessions over several weeks or a couple of months. I think that's where the evidence is best, but still, it's another one of those things where I think there's a lot of promise, but we're sort of waiting for some of the bigger trials to come through. And then, sorry to just throw these all out at you, but I'm going to have you in the chair and ask you all my questions. Peptides like cerebrolysin, what do you think about that? Yeah, I think as peptides go, cerebrolysin for traumatic brain injury is actually one that has some of the best evidence. there are several randomized controlled trials these uh like the captain trials where they gave cerebral lison it's after very severe traumatic brain injury so this is you know you're probably ending up in the intensive care unit for the for these kinds of brain injuries so i think there is some evidence there because that you know these trials have been done for for concussions and other you know other scenarios there's less evidence so it's not something so like we looked peptides when we're trying to when we're writing this paper we try to look for evidence for cerebral license for concussions there isn't really any um so for severe traumatic brain injuries i think it's definitely worth considering uh for less severe injuries right now i don't know it's a leap of faith yeah um and then lastly nad um either intravenously or orally so for either or for any of those like acute brain injuries i'm not really sure we have have very very much evidence at all i will say that it's something that i'm interested in because this is something we're studying in my lab right now so my wife's lab so my wife is an expert in many things including nanotechnology so her lab has developed a nanoparticle that will deliver an nad precursor to the brain for acute brain injuries this is a very very early stages right we would be years If it works, we're like years away. But like we did just publish a paper where we use the first version of this platform in a rat model of acute brain injury and it was neuroprotective. So I wouldn't take it as a human yet. But I think it's a very interesting area that we're kind of working on right now. So your wife is also a neuroscientist with a lab. She's a chemical engineer. Chemical engineer. She works in neurosciences. And one of areas of expertise is in developing nanoparticle technologies for delivering drugs to the brain. That's incredible. We're going to have your wife on the podcast. You should. I'm so interested in nanotechnology and nanoparticles because I do think there's a lot. There's an entirely new category of therapeutics that's being developed right under our noses right now. It sounds like your wife is right in the middle of it. Yeah. Incredible. And then lastly, you know, moving on from therapeutics to diagnostics, are there any signals that someone can use to assess the state of their brain? either they can get it from a wearable or blood test etc um i think i think there's a lot going on in that field you mentioned uh neurofibrillin light nfil i think you mentioned tau protein as well there's a lot going on in diagnostic um area right now can you talk a little about what you're seeing there yeah so this is an area that like you say has expanded expanded a lot and there are lots of things that can be measured right um so right mentioned neurofilmin light a gfap which is a marker of astrocytes that you that also is seems to be you know elevated in people with a high risk of dementia then you have the right the different ratios of the different amyloid proteins which and which have now there's a few versions of that that are now sort of fda approved as as part of a diagnostic pathway for alzheimer's disease and then there's tau so like ptau 217 is you can measure in the blood is probably the one that has the best evidence to support it right now um nobody really knows what to do with results of those tests in people where there's a very low pre-test probability of of dementia or cognitive decline like what does it look like in a normal population if it's elevated what should i do about it and the answer is right now nobody really knows there are some there are some uh clinics like uh which is iserson's clinics done a lot of work with kelly and neotis like in these sort of preventative neurology clinics and they have they've published some initial data where if you have people that have some elevations in these markers and then you address multiple aspects of lifestyle like multiple risk factors so you improve their blood pressure if you know if they have cardiovascular disease risk factors maybe you treat them with a statin you know but then you also give them exercise and nutrition all these kind of things that then some of these markers can improve so if you know elevation of these markers is associated with a future risk of of dementia and we can institute some of these lifestyle changes and see improvements on them like all of that is kind of hopeful that right we're doing the right thing and we're kind of changing risk before it really occurs but again we're sort of like right right at the beginning of that yeah so if people are interested in testing these things it's probably just worth mentioning that right now we don't necessarily know exactly what they mean in a healthy population right and the way that i think about it is that if you if you have an elevation say of of pthel 217 or so you know it's and we don't even know the full like normal range in a normal population but it looks kind of elevated then does that like how does that help you because for most people i'm not sure we need these biomarkers because i know what your risk factors are right i know what the risk factors are for dementia in terms of lifestyle and the environment and that kind of stuff so if you're worried about your dementia risk i can tell you to change those things without having to measure any any blood biomarkers like that but some people may want that information because it helps to like uh you know give them some impetus to make the changes so so i think it's going to be very personal some people don't want to know right we have we have the same with genetics like some people don't want to know their apo genotype because they don't want to know their increased risk because they might just get stressed about that risk and that stress is detrimental so i think it if you're if you're thinking about these things you just need to be working with somebody who like really knows what what they're doing right and that then knows how to address it depending on what those results are um it's not something i just go out and test on everybody because at the end of the day the things that you might want to do to decrease your risk we already know what those are um except for maybe some of those nutritional markers or those nutrients we mentioned earlier right you won't know if your homocysteine is elevated if you need more B vitamins, right? So you should measure that. You should probably measure your omega-3 status. You should probably measure your vitamin D status, right? Make sure you're not anemic or you don't have high hemoglobin, right? Which is a sign of obstructive sleep apnea usually. So I think some of the basic blood markers can be really important to determine what risk factors to address. But some of these other ones, we're kind of right at the beginning of that and try and figure out who does it matter for and how should we use it? Yeah. And to your point, I think you know, we're not at the point where we should be testing this on a population basis. Like, it should not be like a standard blood marker. But we have a few patients that are APOE positive. And I think what it does for these people, like you've mentioned, is it gives them a sense of urgency when it's really, really high, you know, and it points to elevated risk of dementia. And it gives them something to track over time. And I think, you know, if you're a data-driven in person, having a marketer track and to see improvement is because we do know at a lower level, you have less of a risk, right? And so I think that it helps people to institute changes, be more, I guess, put them more into their routine as well and make them more urgent in their lifestyle as well. So it's really like personalized end of one medicine. It can be helpful there. But to your point, you have to have someone that really knows what they're doing because you want to warn people that, look, we're going to measure this. It could indicate that you have a high risk of dementia. It doesn't mean you're going to get dementia. It does mean, however, we do need to institute changes along all the lifestyle factors. And we didn't get a chance to talk about this. And I know I have to have you back again. There's so much to talk about. The hormonal effects of low estrogen for women, low testosterone for men and women can also be a powerful technique to prevent future dementia, but also to optimize brain health in the present. And we can even you know use ptal 217 as one of the indicators that you know we do need to optimize around several factors and then we test hormones and potentially we do hormone replacement therapy as well so that's kind of how we're using it okay yeah yeah and i think that's the you know when you're very thoughtful about it i think there can be some some some benefit that uh well yeah there can absolutely be some benefit there so yeah it all comes down to sort of how you're using blood pressure like so many people don't want to take a blood pressure medication and then we're like Okay, but look, your P-TAL is elevated and you're high risk of dementia. The first thing you do is get your blood pressure control. It pushes them in that direction too. So it's just an incredible world we live in now. I think there's going to be more data points that we have that we can utilize to encourage behavior change and also tell us about dementia risk because it's always been a black box. Wow, what an incredible conversation. I'm so glad that you made the trip down here to do this with me, Tommy. Thanks so much for having me. This is really great. Yeah, and I think, you know, you're such an incredible wealth of knowledge, not just in the research you're doing, but also the people that you're talking to in the F1 side and also your foundation. And so I'm happy to support you in every way we can. Thanks so much. And so tell us a little bit about your book and what people can learn from The Stimulated Mind. This comes out in March of 2026. Yes, yes. The book comes out in March. It's essentially, you know, a kind of a user manual, many of the things that we talked about today. It covers a little bit about why the brain has been such a black box for so long. You know, some of the missteps we've made in neuroscience research and the sort of like this hyper focus on individual cells and proteins and things. But actually, if we sort of step back, we actually understand much more about the brain than maybe we think. But it's all about the inputs that are really important. and so then i cover everything from like why different types of exercise have different effects on different parts of the brain you know all the nutrition stuff sleep uh stimulus like we talked about the importance of social connection you know stress management and adaptation and then sort of all that comes together in the in the 3s model that i mentioned earlier um and you know how those sort of different factors interact and the the final chapter is how do you institute this particularly in terms of you know like a busy work schedule how do you restructure your work day to kind of make the most of these kinds of things, minimize, make sure that you're sort of productive and can maintain your focus and can do high quality work. So hopefully then, depending on where people feel like they need the most help, there's a chapter that can kind of guide them in that way. Incredible. I love it that you ended with the protocol that people can use because so many times you read a book and you get all these concepts and then now what do I do? So it's a great way to end the book and can't wait to read it myself. And where can people find you on social media? Mainly on Instagram at Dr. Tommy Wood, D.R. Tommy Wood on Instagram. I also have a sub stack with Josh, who I mentioned earlier. We have a podcast together. So you can sign up for the free sub stack at betterbrain.fitness is the URL. And then drtommywood.com. That's my website and that all the information about the book is there as well. Fantastic. Well, thank you so much. Thanks so much for having me. that. I love that conversation with Dr. Wood. Here are my top five takeaways from what we just talked about. Number one, your brain declines because it stops being challenged, not because you're aging. The strongest predictor of cognitive decline is not age, genetics, or even diet. It's the loss of meaningful stimulation. Cognitive function peaks around the end of formal education, And the rate decline afterward is directly related to how little we continue to learn. Brains that keep adapting stay younger and longer. Number two, the brain is both overstimulated and understimulated at the same time. Modern life floods us with notifications, content, and information, but very little of it forces true adaptation. Passive entertainment like scrolling, TV, or phone-based brain games don't really build cognitive reserve. Real brain health comes from complex, effortless learning that engages multiple senses at once. Number three, complex skills build headroom that protects against dementia. Learning languages, music, dance, sports, martial arts, or even immersive video games creates what we call cognitive headroom. This is extra capacity that buffers the brain against aging, injury, and disease. The sweet spot is 30 to 90 minutes, two to three times a week, with breaks between sessions to maximize retention and neuronal growth. Number four, recovery is not optional. Sleep is where the brain actually improves. F1 drivers don't train endlessly. They train intensely and then they recover deliberately. Sleep is when the brain consolidates learning, builds new connections, and clears waste. REM sleep, critical for memory and emotional processing, happens later in the night, which means sleep opportunity and regularity matter more than people realize. Number five, brain health is metabolic health and blood pressure is a silent threat. The brain depends on steady energy, nutrients, and blood flow. Hypertension quietly damages brain function long before symptoms appear. Cardio, exercise, adequate sleep, and sufficient calories and micronutrients, especially iron, magnesium zinc omega-3s and polyphenols can be foundational if you had to pick one food for brain health dr wood recommends blueberries thank you so much for listening to the podcast today please remember to subscribe if you like this episode and give us a good review and share a link with your friends it really helps to support all of our efforts i also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. The doctor knows your personal health situation the best, and it's always important to seek their guidance. Thank you.