Neuroscientist Reveals The LIFESTYLE HABITS That Prevent COGNITIVE DECLINE! | Dr Tommy Wood

I think that the common view in society is that as we get older our brain function has to decline what's your view I think that it's true that it does on average and you can see that uh multiple large population studies show that pretty much every cognitive function that you can measure decreases fairly linearly over time except for memory about the good old days the majority of people seem to be able to remember the good old days but every other you know the executive function short-term memory all these other functions decline over time however I don't think it needs to be that way um part of what I find to be very interesting about uh cognitive function and the way we think about it when we age is that there's this story that says you're born with some like X number of brain cells and then like every time you maybe drink a little bit too much or you don't sleep you're killing brain cells and it's just this inexorable decline that you can't change and that's not true um we can make new brain cells in some areas of the brain um particularly in some areas of the hippocampus which is associated with memory um but even then even if you're not making new cells the cells you have can make new connections you can change the structure around those cells in the brain which is what helps support their function and you can see that in multiple studies even as people get older you give them a new challenge of some kind you challenge their brain and then they'll make new connections those areas of the brains will get bigger you can see it on an MRI scan so what I find interesting is that just like the muscles of your body which is easier to think about because you can visibly see it if you train it it gets bigger you can see strength much more easily but the brain is is very similar if you challenge it and you ask it to do new things it can adapt um pretty much any time in life so part of it is getting over this thought that um you know I'm old my brain doesn't work anymore there's nothing I can do about it so stop telling yourself that story and then introducing things to to ask more of your brain and then it will function better that's really empowering for us to realize that there are actually things that we can do we're definitely going to get super practical and talk about a lot of those things you mentioned that there were studies showing that various functions of cognition various functions of our brain do start to go down with age these studies that have been done when have they been done because we know that there's a poor level of background Health in the population metabolic Health you know cognitive Health all kinds of things that generally Society is pretty unhealthy now in many ways so therefore are we just studying a sick society and seeing cognitive decline go down or is it something that's actually an inevitable part of Aging in your view so until we get to the point where we can completely stop the aging process which I think is unlikely to happen anytime soon function will decline over time in anybody when you like how long that takes and what sort of the the ultimate end of that I think is modifiable and very much so so there is going to be a decline over time but you can change the trajectory quite dramatically so that that's where you where you end up um but when you ask about how these studies are done without this I mean I guess there's two different ways one is you do this large population observational studies so you you look at the cognitive function in multiple people of different ages and then you kind of see that across ages as you look at older people their cognitive function declines uh you can do that in large populations uh in a smaller population you might be able to take the same people and look at their cognitive function over time um and or look at their you know future risk of dementia and that's and that's been done too um however when you're studying the population and in general these are studies done in modern westernized industrialized populations and we're at a stage where we have to say that those populations are on average unhealthy um they the vast majority have at least one of the components of metabolic syndrome they on average take one prescription medication on average have at least one chronic health condition so we know those various things that poor systemic health is associated with worse brain health and an increased risk of cognitive decline so you're right it's very difficult to study very healthy people and look at what happens to their brains because they just aren't very many of those people to study anymore when we think about cognitive function a lot of people are thinking about Alzheimer's yeah they're thinking about I don't want to get Alzheimer's when I get older maybe they've got a parent or you know an auntie or a grandparents you know it is affecting many people's lives these days they're seeing what happens so I wonder if you could explain first of all what is Alzheimer's um and just just compare that to cognitive function because declining cognitive function so declining brain function as we get older is not necessarily the same as Alzheimer's is it what we call Alzheimer's disease is essentially two different diseases in my mind the original Alzheimer's disease as described by Dr Alois Alzheimer is what we would Now call early onset or familial Alzheimer's disease is caused by a single mutation in a single Gene there are a few genes that you could have a mutation in we just need a mutation in one gene that causes early dementia like 30s or 50s so third to fifth decade of life and has sort of like a steady decline in quite rapid and that's a huge genetic component it's almost all genetic okay and it's less than five percent of cases of Alzheimer's disease so it's it's it's fairly rare relatively what most people think about when they think about Alzheimer's disease is what we might call sporadic or late onset Alzheimer's disease it maybe occurs in your 60s to 80s or later if you live longer and it's very heterogeneous it's very variable from person to person um there's a this old adage that says that if you've seen one person without simers you've seen one person with Alzheimer's because it's like how it expresses itself in different people is very different based on the environment their genetics their lifestyle their General Health and that second disease I don't think is Alzheimer's disease as he originally described it they're very different and you can you can look at them completely separately so that we might call or I have called in in a paper that I published with a colleague of mine recently age-related dementia um and it's influenced by all the things that we just mentioned and we could talk about that more as you go into that there is this period of cognitive decline so clinically you might call it mild cognitive impairment as a specific diagnosis and again it's sort of like the prodromal period before Frank uh dementia sets in but everything happens on a Continuum so if you look at cognitive function over the light over the lifespan like I said it sort of from your 20s or 30s that on average steadily decreases um so these processes are happening are starting much earlier in life and that's that's been described these processes of the um maybe the the brain atrophying you know starting to lose cells uh but also measurable changes in function some of these things you can see on scans it might start very early but it takes a long period it takes a long time before you get to the point where your actual function is detectively decreased if that makes sense yeah and the way I I again liken it to uh physical function or and because again I think that's something that people can picture more easily so if you imagine that whatever you're able to lift say um on a daily basis um you know shopping bags things like that you can probably lift more than that right you have this Headroom what you have to do every day versus what you would be capable of doing however as function declines eventually your maximum capacity is what you're able to do every day and that's what we would call Frailty physical Frailty because you have no capacity for us to say if you stumble you can't save yourself right you're going to fall over um or if we're thinking about leg strength your leg strength will decline to a point where getting up from a chair is as much as you can do right you have no Headroom and so that's what happens with cognitive reality or cognitive decline you just don't have any extra capacity you know there's the brain can't do any more than you asking of it every day and eventually the you get to the point where the function isn't good enough to do your your daily tasks and then that's when you start to go down into dementia yeah super helpful and and really really clear so as we progress this conversation let's be really clear that when we're talking about you know Alzheimer's we're not talking about the early onset the classic Alzheimer's we're mostly going to be talking about age-related dementia this I think is what many people are quite scared about yeah uh certainly the older people get and it's not uncommon now in people's 30s or 40s and I can't remember stuff like I used to right so I think everyone is aware of the kind of phenomena we're talking about let's say people get a diagnosis in their 60s when does it actually start in their brain so it probably start it probably starts right after your brain finishes developing so after you've built you've built the brain you've built the connections you've put down the final parts of white matter in your prefrontal cortex that maybe happen in your 20s or your mid-20s early 30s that's that's when the decline starts so you you increase uh you build the brain you increase its function and then it starts to decline I don't mean that in a negative way that is just when the process starts and part of that I think is driven by societal pressures um rather than some process that we have no control over yeah and what I mean by that is um I to try and think about what a brain needs to maintain its function because I'm a neonatal neuroscientist that's my my day job so I think about what does it take to build a brain in the first place and obviously you need you know the actual structure so you need the nutrients and the the fats and the things that that make up your brain but you also need the kind of stimulus that it takes to build build connections and so think about babies and toddlers they're continuously exploring trying new things failing um uh building like building motor skills right tripping over trying to stand trying to climb trees but they do the same with language they do the same with social skills they're constantly pushing themselves trying new things and sometimes they fail um but you know they laugh it off and they just keep going and then they do that for a period of time and then they they sleep they rest and recover they need that for what we call consolidation in the brain for that period of plasticity where you're sort of building new connections adults don't do that yeah we do the same things again and again and again and part of what I think happens um in your 20s and 30s is that you leave formal education you leave that period of trying new things learn new things you know learning how to drive all of that's done and then you become increasingly good at the things that you do every day which isn't stimulating your brain in the same way yeah so I think we can build those things back in but part of the reason why that decline happens at that period of time is because that's the time when you stop challenging your brain to develop new connections and to to maintain the structure that it has yeah I mean it's so so beautifully simple the way you look at that when you look at kids yeah try new things they're failing they're exploring they're experimenting and then they sleep yeah right so giving it the stimulus you're giving it that new information so the brain adapts and then you're resting so it can grow Stronger Yeah and yeah as adults certainly as adults in the current society in which we live um we don't tend to do that it's really interesting to tell me as you were talking and he was saying that that cognitive decline that that decline in brain function probably starts somewhere around our early 30s and before you were talking about how our brain mirrors our muscle well we know that from the age of 30 we start to lose lean muscle mass unless we do something about it so there really is a very strong similarity isn't that between muscles and brain the more I think about this and look at this from the societal down to the biochemical level I think they mirror one another almost exactly and it's the same with almost any tissue in the body um in particular the thing about muscle tissue in the brain it's very easy to draw lines across them which is the the structure and function of a tissue is directly proportional to the demands you put on it right the more you challenge your muscle the more muscle you grow but in order to grow you need a period of rest and Recovery and the brain is exactly the same um and you can think about that in terms of building new connections building new cells but also processes of repair so autophagy is this thing that people are really interested in now where you start to break down the accumulation of damaged proteins and other things within cells and in muscle tissue the best thing to do if you want to increase autophagy or muscle tissue is you exercise it you move it um and it seems that the brain is the same that stimulating the brain is protective because it upregulates these repair processes and so that then gives you this framework where you say well in order to improve the function and structure of my brain I need to challenge it but then I also need to give it everything that needs in order to adapt to that challenge so that can be nutrients it can be sleep and Recovery it can be making sure that there aren't toxins in your environment like we know air pollution is linked to an increased risk of dementia things like that which then may inhibit your ability ability to to adapt but the primary driver in my mind really seems to be like how much are we asking of our brains and how much are we allowing it to recover um and that that brings in a part of things around Health Equity because not everybody gets to take you know gets to sleep um you know people working multiple jobs with um you know or lots of family members in a small space it's very difficult to sleep or being chronically exposed to societal stresses and that chronic stress is probably something that prevents adaptation because you don't get a recovery period so you can start to see how all the things that we know are linked to an increased risk of dementia may be linked to first of all how much are we challenging our brains and then how are we supporting and its ability to then adapt to that challenge I want to get to the Practical things we can do shortly earlier today I spoke to Tim Peake um British astronaut he spent six months on the International Space Station and that's a couple of things in that conversation that I think really speak to what you have been speaking about he spoke about the training process he had six years of training now in that training there's all kinds of things they do they put them in super uncomfortable situations they're really trying to build physical resilience psychological resilience they take him to cold dark caves they deprive them of time they you see what happens when you are under that much pressure so they're they're being pushed out of their comfort zone to see how they respond but he also had to learn Russian now I don't know how old Tim was but that's interesting based on what you have said right because I'm thinking yes he's being trained to be an astronaut so you know teamwork be resilient deal with pressure but actually a lot of that training is also going to reduce the likelihood that he's going to get age-related dementia what would you say to that uh I'm sure that's the case um other than the fact that uh microgravity or lack of gravity I was thinking that as I said the question otherwise has an interesting effect at least on muscle tissue um and so how it affects the brain would be an interesting thing but in general from his time on Earth yes all of those things had he done the training and not gone to space then that would be brain training yeah but again learning Russian like we tend to learn languages at school because we have to yeah but that new paper you published which was wonderful like it was such a good paper and we'll definitely link to it in the show notes people can read it themselves you made a very strong case with your I think co-authors yeah um that a lack of stimulus to our brain May well be causative so not associated with but causative of this age-related decline in brain function so that's certainly how I read the literature and so I published this paper with uh Dr Josh turkin who's a neurologist and it's difficult to really unpick causation in humans so to say you've really proven it and in fact it's impossible to prove anything in biology I think that you know people need to appreciate that however if you look across a broad range of animal studies human studies that's really again how it looks and it comes down to how much you're challenging your brain and then supporting your ability to adapt to it so it's not the only thing but again uh to draw a connection back to muscle tissue imagine you had the perfect diet and plenty of sleep and strong social connections all these things that we know are supportive of Health um but you didn't do any exercise you were you were you sort of confined to your bed and there's been hundreds of studies done on bed rest or immobilizing a limb you know if you've broken your ankle and then you put your leg in a cast and you take that cast off the muscles on that leg have gotten smaller I know if you lay in the bed and you don't move your muscles get smaller so even if everything else is perfect if you don't stimulate that tissue it will reducing both size and function and the Brain seems to be uh seems to be the same I think one of the most interesting lines of evidence that supports that idea is based around retirement there are multiple studies in multiple populations that suggest that the earlier you retire the earlier you get cognitive decline and dementia and this is particularly in people who have cognitively stimulating jobs in fact the then the effect is bigger there and this is after you adjust for you know you might retire early because you have a medical condition that's also associated with with cognitive decline this is hard to adjust for those things you see this sort of Rapid decline in cognitive function when people retire and that's because work is uh the thing that's most cognitively stimulating for most people and then you remove that and you don't replace it with other stimulus that's when you start to see the sort of inexorable or sort of faster decline in cognitive function so for people listening right Tommy who either have retired themselves or are thinking about their parents or we have a lot of younger listeners these days who might be thinking about their grandparents based upon that they've retired they've left their job so what practical advice would you give to them as to how they can sort of make up for that lack of cognitive stimulus so what's nice about this is that it seems that there are many different ways to overcome this all of which are very likely to be effective so you alluded to one of them which is learning a language and learning languages even late in life have been shown to improve cognitive function and be protective for certain areas of the brain physical movement does it uh resistance there are randomized controlled trials that show that resistance training improves the structure and function of certain areas of the brain so just going and starting to lift something if you've never done that before um with respect to movement it seems that you get more benefit if you do a movement that has some kind of coordination component so you might think Tai Chi or yoga one of the modalities that's best um researched is dancing so if you have older older adults in their 60s and 70s and you make them do some kind of circuit training at the gym or the same amount of effort of activity but in a dance class instead they'll get more cognitive benefit from the dancing and actually you can even see that on an MRI scan that hippocampus gets gets bigger more than the other group and what's nice about something like dancing is that there's a music component there's a social component there's a movement component all of these things we know support Health both you know physically and mentally so all of those things I understand in isolation would be helpful music social connectivity very very good for the brain physical movement all these things individually I think have benefits but you Chuck all three together and mix them up at the same time then you're you know it's almost like a three-dimensional stimulus for the brain rather than just a one-dimensional one yeah exactly and there is some specificity in terms of what are you asking your brain to do versus what did it get better at so when they've done studies of individuals that did a very challenging learning stimulus um the best example that I know of is taxi drivers who are learning the knowledge um in London so so they they took three groups or they they ended up with three groups of individuals so for those who don't know I guess people don't need to learn the knowledge anymore but it's uh 25 000 streets or six uh six uh mile radius around Charing Cross Station in London you have to learn to be a taxi driver in London so it's a huge amount of things you have to like I mean just the memory component is is incredible and it took two years uh so people who they and they did brain scans before and after and those who learned the knowledge and passed they saw an increase in the size and some of some measures of intensity of connection of the hippocampus which is the area related to memory in the brain and these are these are adults in their 30s and 40s those who um didn't manage to pass didn't see that and then also they had a control group that where they didn't see any change so specifically in those people who managed to do this huge learning task saw benefits in that area of the brain but then they saw a slight decrease in some other aspects of cognitive function because they've put so much into memory so if you if you really focus on one thing you become really good at it but then maybe you've taken away some some things from other areas of the brain as possible so if you take something that gives you all of those at the same time so you mentioned like social connection uh the the benefits of physical activity plus the coordination component uh plus music I think there's multiple aspects of stimulus there's multiple parts of the brain but they seem to come together in a way that's it's difficult to say if it's true Synergy which is that it's more than the sum of its parts but definitely seems to be more beneficial than doing any of those things individually just on the Black Cab London uh taxi example which I think is a really beautiful one to think about certainly my experience if I'm ever in London is you take an Uber and they're just following the sat nav you go the black cab driver they seem to go through all these crazy back roads and you get there quicker so I suspect there's still something going on with that test there but the wider point for me is you know we're talking about how Society changes our behaviors smartphones GPS's and our cars right so many people now have no real perception of where they're going if that sat nav is not on so what do you think the consequences might be as we Outsource more and more of our brain function to devices and Technology I think as the way that you describe it there's there's clearly a possibility that is going to be detrimental right we've offloaded all the things that our brain is really good at that you know some of which make us uniquely human and we've uploaded them we no longer ask our brains to do those things and if you don't ask a tissue to have a certain function it will no longer have that function right it's the same with um you know your cardiovascular function if you're running um so so I think that's definitely something we need to consider but there's also the possibility that with the with the sort of Advent of new technology we ask our brains to do different things and be good at different things and that may also be just as good right so I noticed myself because I only have access to huge volumes of information and for my job I need to know huge volumes of information and the majority of the time I probably don't remember all of the things that I could possibly need to remember and I notice that what I remember instead is where that information is right so I still have memory of important things but I don't necessarily remember the exact facts but I know where that fact is so when I'm preparing to do a podcast I'm like I know I need this piece of information from this paper and I know who wrote it um and I know where to find it so I can go back and read it so I'm still requiring memory but just in a different way um which I think is is probably not necessarily detrimental it's just different yeah and I guess you know thinking about what you said just before that that if you are putting all your attention on learning the huge amount of roads and Backroads around Sharon cross station that takes up so much of your cognitive Reserve that you have less available for other stuff yeah so yeah sure you're a great taxi driver but maybe other areas of your brain have been neglected I guess you could make the case with technology that I don't know let's say you're driving to a podcast to be a guest instead of using up your cognitive reserve on the way trying to figure out where am I going where's the street actually it can make it quite a stress-free experience if it's all working and you know things go smoothly which means that you have more cognitive reserve for the important activity that you're about to do yeah I think so um there is you know more and more evidence that suggests that you know you can't you don't burn more calories by thinking harder um but it doesn't require your brain doesn't require more or less total energy but it there certainly seems to be reserves of things like you know willpower and decision making and you know access to cognitively challenging things that you can probably only do for a short period of time before you need some rest and recovery so if you're offloading difficult but more menial tasks to something else that does give you greater capacity and Theory to then apply that to other to other areas we know that you know the brain does not multitask as much as we like to think that we multitask you people don't multitask uh when you task switch from one thing to another you end up wasting a lot of time as you adapt from one from one task to the other so if you're in some deep period of writing you just stop to check your email it will take several minutes when you switch back before you get back into the same flow of the writing that you were doing before so [Music] being able to be more fully focused on one thing because you you offload tasks say to technology I think could be very beneficial um and there are other tasks that maybe didn't exist 10 or 20 years ago or 50 years ago that that now our brains are very good at so recently somebody asked me about video games and a lot of video games can involve you know reactions uh fine motor control problem solving um all these things that we we can sort of like be challenging our brains in in in in a completely different way from how we might have done 100 years ago but that doesn't mean it's not beneficial I think that's very beneficial it's just different different you know what's really interesting on that I heard over the past few months you may know Bethany because I know you do some work with formula one I believe one of the current top drivers apparently was an avid video game player growing up and actually because of the way these cars are now controlled hey I'm no expert on this this is just what I've heard from someone in Formula One that actually there may well be a lot of transferable skills from your ability to handle a video game controller and your ability to drive a Formula One car yeah sorry to interrupt the conversation we'll be back in just a moment now to live a long and healthy life it can be really helpful to understand what's going on inside your body people age at different speeds and the typical annual blood work doesn't properly evaluate your biological age but inside tracker does inside track Air is a truly personalized nutrition and performance system that's designed to extend your health span and slow down the aging process inside tracker uses your test results to give you personalized recommendations on things that you can actually control like food supplements workouts and other lifestyle choices for a limited time you can get 20 off the entire inside tracker store all you have to do is click on the link in the description box below and use the discount codes live more one of the reasons why I said earlier that to some degree maybe the challenge doesn't matter like there's some specificity but just increasing challenges on the brain may give you greater overall adaptability and function um is because we know that formal brain training so like computerized brain training which which is used very frequently in um adults with cognitive impairment or cognitive decline because it's something that's very easy to standardize systematize ease to track uh so it's often implemented in clinical trials if you do this sort of abstract online brain training games um it translates over to a better working memory executive function and sort of things you actually need in real life yeah all right you're not you don't just get better at the game you also get better there would transfer the things that transfer so of course video games may be very similar um to driving Formula One car but there is some you know just overall challenge increases overall function which then does sort of translate to other areas you mentioned the term executive function a couple of times of this conversation can you elaborate exactly what that means in the simplest sense uh the way I think about executive function is your capacity to make informed decisions about your behaviors in the in the moment in the moment generally and it's more complex than that maybe people have heard the old stories where we learned about different areas of the brain based on uh either soldiers getting very specific damage to areas of the brain during war or that you know there's this very famous case where a guy got like a railway pylon that just like took out just as pre-fore frontal cortex of his brain and that guy you know just said whatever he thought and it was very vulgar and very impulsive um an executive function is essentially your ability to override those things so like we all think stuff and there's a part of our brain that says don't say that right it's a really bad idea for you to say that um or you know you sort of have these everybody has intrusive thoughts occasionally you're like what what would happen if I just jumped out the window right now right like I've I've randomly had that thought it's a right but executive function is no you really should not do that um so it's those things which require and it happens just the fraction slower than like the impulse and it's your ability to control that and then sort of have some control over your actions yeah so it's actually function is clearly a higher brain function that we would want to maintain we don't want it to be declining yeah um you know she was saying that I was thinking you know if you look around on social media these days sometimes you you see comments and I'm thinking you know that's a public comment don't you you know other people are seeing that I mean that's just like well I guess it's off topic but but is it no that's kind of that's an element of excessive function I think so and as I guess there's two parts to this right one is the you know people talk about um the anonymity of social media you know you could just say stuff because there were no repercussions right usually part of you deciding not to do something is because there's some social repercussion which in General on social media that there isn't um the other parts of it which I've read about um uh from Mark Manson who's just one of my favorite or my favorite pop psychologist if you want if you want to call him that um where he made the point that because of social media you're exposed to the opinions of far more people than you would be otherwise right so 100 years ago when you couldn't have online interactions with people you essentially don't know you might have seen 10 people in a day and you might have seen 100 people in a week um and some proportion of the population are probably people who aren't who are going to say things that you don't agree with or just aren't very nice right um but on social media you may be exposed to a thousand or ten thousand people a day if you've got you know a lot of comments on social media so part of it I think is directly in relation to the how you might behave differently in social media rather than in person and part of it is that you're exposed to so many more people that some of those people are just going to be unpleasant and you're gonna see that if we get back to that family member who's retired and so you were suggesting certain things that they could do to maintain that cognitive stimulus to reduce the likelihood that they're going to get age-related Dementia in the future I know we touched briefly on this in our first conversation but I think it's worth going into again Tommy it's not about Mastery is it it's not about being an expert in fact in some ways you're better off doing something that you're not very good at that's one thing I wanted to talk about and then I wanted to almost go from there to something practical for people because let's say we're trying to reduce the rate of decline in our brain function something that I've been thinking a lot about over the past couple of years may be influenced by our first conversation as well if I'm honest Tommy is what am I doing in the next five years of my life or in this decade of my life that is different and new and something I couldn't do in the last decade and I I think about this I have this thing inside me that at some point in the near future I'm going to take up martial arts because I'm fascinated by I've never done it before I'll probably be pretty poor at it when I start but for my brain function that's probably a good thing is it yeah and specifically related to martial arts and there are so there are multiple different um Sports where they've looked at this but if you match the exertion level during learning martial arts versus some other thing like running right we can get the same cardiovascular workout but there's no movement or coordination challenge or you know having to think about not being punched in the face or kicked in the face if you're you're actually sparring you get a greater measurable benefit from the martial arts than you do from the running in terms of cognitive function right because of the additional challenge um the question you asked about doing things that you're bad at I think is the perfect one because that then allows you to figure out the things that you might want to do um in order to increase the sort of stimulus prevent the cognitive decline that we talked about earlier and one of the best examples that I have of that is a study that was done in musicians and they looked at how old their brains look on a brain scan so you can do an MRI scan of the brain and then there's this machine learning algorithm called brain age that basically says how old does this brain look you know nothing about this person but how old does their brain look and they did a study of musicians and they had professional musicians and amateur musicians and compared to the average population all the musicians had brains that you looked younger on the scan than they were in terms of their actual age in years so being a musician seemed to be beneficial regardless of what type of musician you were but the amateur musicians had a greater benefit you know statistically significantly younger looking brains compared to professionals because it's harder right if you're an amateur and you're not very good at it then it's more of a challenge like that that's what the conclusion that the authors came to so there's an interesting conundrum here for me as I hear that right I'm thinking okay so someone may hear this and go all right I'm in right I'm gonna I don't want my brain functions to go down I'm going to learn a new language yeah so they sign it for a course or they buy a book or whatever it might be and they start learning that language and find out oh man this is really difficult can't do this is really really difficult I've got a few words I can't put together in a sentence okay if they persevere with that that's going to be great for their brain function but I guess if they're not enjoying it because they're not good at it they're probably not going to do it much yeah so you know how help us understand practically what we should do in that in that situation and that's absolutely right so I think the the process of learning and failing um developing a skill that you can probably only do in 20 or 30 minute chunks if you think about a martial arts class after you've warmed up and the warm down and the stretching like how much time are you spending learning new patterns new movements it's maybe 20 or 30 minutes in a class if you are if you do a language class you know after you've uh said hello to everybody and kind of got into it and opened the books and you know you have a couple of conversations how long do you really spend sort of pushing the limits of your language skills it's maybe 20 or 30 minutes an hour because that's really the period of time when it when humans can really sort of like push on the edges of their skill so if you think about learning new skills then that's that's kind of what you're thinking about something that you can spend 20 to 30 minutes you know really sort of exploring the limits of what you can currently do getting a little bit better and that's it right it should be hard after that and then you know you get frustrated or you get cognitively tired and that's when you need to rest and recover what you choose to do that I think matters a lot less because of all the things we've talked about language we talked about movement you know it could be like knitting um it could be video games it could be online brain training all of these things have been shown uh to have benefit and so yes just doing something that's hard is going to be is going to be beneficial to a certain extent but if it's not something where you can continuously go back to it because you enjoy it then you're not going to stick to it so it's the thing it was a combination of something where you're learning over time and getting better but also something that you enjoy because that's the thing that you're going to do more of yeah so that's super practical for all of us whether it's our retired parents or or ourselves it's like what are we doing in our lives currently that is challenging and that we enjoy yeah I guess and you're saying this sort of 20 to 30 minute period are there any specific trials on that was that sort of an amalgamation of other Neuroscience research that that means yeah we kind of think it's about this time yeah it's it's probably um at least partly related to you know focus and attentional capacity and in other areas you see something you see some something similar so I'm I'm stealing ideas from say the Pomodoro Technique which is where you have uh 20 or 25 minutes of focused work within a five minute five minute break where you completely detach yourself because 20 minutes is is the period of time when you can really focus on on something and and devote yourself to it before again your mind starts to drift or you go elsewhere and then if you think about well in scenarios where we're teaching people new skills you know of course you're usually trying to fit something into an hour because that's just like the standard unit of time but in general like how long are people really working on these things and it seems to be someone like 20 to 30 minutes so part of it is practical but then part of it is based around on average that's the period of time when somebody can really focus on something crosswords Sudoku do they help I don't my guess is a little bit but probably not nearly as much as any of the other things that we've talked about um purely because there just isn't that kind of there isn't that kind of challenge or skill in the same in the same way um maybe cryptic crosswords of their own separate because there's there's um there's a skill around cryptic crosswords right you need to know what the clues are for what you need to do with either the words or the letters um in order to to get the final word um a traditional crossword is usually just memory and yeah that could that could be useful but it's not it's not that same kind of Challenge and again once you're good at it so once you're really good at cryptic crosswords it's probably not the same challenge anymore once you're really good at Sudoku it's probably not the same challenge anymore and people often like to do um those things because they're you know it takes five or ten minutes it passes some time it's nice to complete something but then you're in some area where it's not really the same kind of challenge so so maybe but probably not the same way as some of those sort of more all-encompassing skills that we've talked about yeah I love this Tommy it's it's super practical I know we spent a lot of time on this kind of um how are you stimulating your brain in a new way in a novel way that's challenging we'll definitely talk about food and sleep and movement and stress and that stuff we're definitely going to get to that but I think it's worth I think it has been worth really hammering home this point um in terms of looking at what we can do to prevent our brain function going down with age I love the way that I've heard you think about this before and say the reason we know what to do is because we know how to create cognitive decline in animal models yeah and I thought that's a really peaceful way of us looking at it so perhaps you could explain your framework and then we could see where we're up to and where else we need to go sure so again like I mentioned earlier uh in my day job I'm a neuroscientist and the vast majority of that is doing work in animal models of brain brain injury and brain disease neurogeneration I think what you see is that you're from those models and and what's nice about those models you can isolate a single thing so I've been talking I've been having conversations about this recently um in relation to you know what do you need you know what's important for cognitive decline what's causative in humans um and I've had some conversations around the work of David Smith who's a Emeritus Professor from Oxford who ran you know groundbreaking trials showing that if you give B vitamins to lower homocysteine um in humans who have elevated home assisting you can slow the rate of brain atrophy and cognitive decline like just with a simple uh with a simple multivitamin uh and they then there's a interaction with omega-3 States as well so nutrition incredibly important but then there's a question of the homocysteine which is the thing that you measure to decide whether this person needs this supplement or not um is the homocysteine damaging itself or is it just telling you something about this nutrient deficiency um and that's a question that we can't answer in humans because you can't dissociate the marker the thing itself from what's causing it to be elevated yeah you can do that in animals um I don't think it's been done in a way that sufficiency answers the question that I have which is that is it just the B vitamins or does the high home assistant itself have a uh have a causative effect on cognitive decline and some people think yes and some people think no but that's a question you can only answer in animals um but more broadly you need um you know there are essentially three different ways that you can create cognitive decline in animals and that's not doing genetic manipulation that's kind of I'll keep that separate assume that you just have a an otherwise healthy rat or Mouse you can um decrease the supply of things that are important for the brain and you can do that in two ways you can either decrease the amount of those things being around so nutrients being one we just talked about some or you can decrease the flow of blood and oxygen to that area of the brain you can create like a chronic decrease in blood supply to the brain and so you're either not providing enough of the nutrients or those nutrients aren't able to get there that's that that's one thing so on that one thing that's uh for a human that's a poor diet yes not getting enough nutrients in to supply the brain or it's having again a non-scientific term but furred up arteries so that you know you can't deliver as many of those nutrients that you may be taking in to that part of the brain but that's all part of that first exactly thing that you can do to cause problems yeah okay so yeah so any kind of vascular Supply so it could be and it can happen in the arteries in your neck it arteries in the brain and it's usually you know it's the same kind of process that happens in the arteries in the heart it might lead to a heart attack can we just pause on that a second tell me because theme I think throughout this conversation is that you may not get the diagnosis of age-related Dementia or Alzheimer's till you're 65 or 70. but the process that leads to that diagnosis May well be starting in your 30s or your 40s I know Professor Dale bredesen who I've spoken to before on many occasions the neurologists in America he I'm pretty sure he said you know if this starts at least 30 years before handing the brain yeah exactly so I think that's key point so we're going to talk about diet shortly and also in terms of nutrients getting up again people may be familiar with Strokes or heart attacks where that's a very late stage when actually you've got problems and symptoms but many of us probably without realizing May well have degrees of furring well before that yeah and so everything happens on a on a Continuum and you can yeah you might have this you know acute very acute change or lack of blood flow that's what we would call a stroke an ischemic stroke um but you can also just have um and it may not even be right if you had a a scan on your arteries you may not even see that there's this huge blockage or anything like that but over time again as your vascular system you know your your blood vessels as they age and that's related to a whole bunch of these very similar things um they become more stiff and when they're more stiff they it means that they can't regulate themselves the way they normally would and we do this process in the brain called neurovascular coupling which basically says that when a neuron is more active it asks for more blood flow right I'm gonna and the muscles do the same right when you work your muscles harder your body diverts blood to those muscles and the Brain should be the same way but over time the blood vessels may not be able to do that so when the brain is asking for more oxygen I was asking for more nutrients the vessels don't respond um so that's so that's kind of one thing you're not getting enough of whatever it is you need to the to the point then another way is to provide some kind of chronic for one of a better word toxic exposure uh so that's the second way to damage the second way to create cognitive decline in an animal model um and you know they've you can sort of like poison very specific parts of mitochondria or other things so like very small like they've done it with very small doses of cyanide but you could equally do it uh by exposing uh an animal to um like car exhaust um you know sort of more common things that that we know are part of the environment and so those things essentially inhibit either energy production or the ability of the the cells in the brain to re to to respond or or adapt or maybe directly damaging so toxic exposures so it could be cigarette smoke it could be car exhausts um it could be heavy metals and fish uh either so heavy metals and fish so potentially Mercury although if it comes from fish the selenium and the Omega-3s and things like that in the fish may protect us yeah may protect us and sort of overcome any detrimental effect there but something like lead seems to be um you know and it's very common in some water supplies even in you know industrialized countries so for years it was in the paint yes yeah in the paint in the pipes I mean we're in in so that was part of air pollution right because of leaded petrol of course I mean we're only two into the three ways in which you can because it's actually a fourth I forgot it's actually that's the fourth right so only two of the ways in and I'm already thinking about what you said at the start about the societal pressures and you know poor nutrition poor Lifestyles um air pollution right it's no wonder when we currently study populations like there's a linear decline in in our brain function yeah so with all the good news that's going forward let's get to number three it's like it's lack of stimulus right so we've already talked about in multiple ways but if you um the way that we would do that in animal models um is we either socially isolate an animal which is incredibly stressful and you have to get um what's interesting and it's important it's incredibly important for doing high quality animal work that's ethical and that actually helps us move human health forward which is ultimately the goal if it's not doing that I don't think it's worth doing um that you know in order to do ethical animal work you have to you know look after those animals as best as you possibly can and one of the ways that that's insured is you know there are committees at every University that make sure that every experiment that's proposed is sort of as ethically sound as possible but unless you have a really good reason to there are two things you're not allowed to do you're not allowed to socially isolate the animal and you're not allowed to remove any stimulus from the environment what we call environmental enrichment and that can be in terms of uh like a running wheel for mice or it could just be like toys or something in the cages um and if you think about humans socially isolated lack of cognitive stimulus like we're doing this to vast proportions of our population particularly as they get older and we've taken away social connection we've taken away stimulus um you're not allowed to do that to a rat in a lab unless you have a very good reason for doing it but you can do it to a human no problem that is just to look at it through that lens is completely nuts isn't it yeah wow so that's that's the third part and then the fourth part we kind of talked about a little bit as well which is that right you need the stimulus you need the things that require nutrients to respond to the stimulus you need the absence of toxins and then you need some kind of period of rest and recovery so that's why sleep is critical but then also our um absence of chronic stress is probably something you could put into that bucket as well and um you can do this uh with social stresses say um in in if you're going to do this in an animal model um so we talked about social isolation that's that's a chronic stressor but you can also do it with um aggressors so you might have an aggressive um mouse that you introduce into the cage and then that continuous aggression which uh could be uh discrimination based on your physical ability based on your race based on your socioeconomic status you know these things that people are exposed to again and again and again we might model it in that way and then that's you know there's a whole host of um physiological immunological you know things that we can measure that result from that but you know cognitive decline and chronic health conditions can be one of the things that come from yeah I'm thinking of that aggressive boss that aggressive family member but the sort of thing we can all think about in our own lives whether currently or previously and what an impact that can have and it also speaks to what you said early on in the conversation and it's something we have to be super conscious of when we're talking about making changes to improve the quality of Our Lives you know I'm all like you for empowering people with helpful information but I think we do need to acknowledge maybe in this Wellness Community more than often does get acknowledged that there are huge psychosocial stresses cultural stresses for different communities Financial stresses racial stress these things hugely impacts our biology and our physiology and for some of us it's easier to make those changes than for others isn't it yeah and I think it's a it's been something that sort of aimed at uh whether you you know the lifestyle medicine or functional medicine or intuitive medicine ancestral Health communities you know those people who focus on these lifestyle factors that we've talked about and it's a worthy Christian criticism to say not everybody can do that right not everybody has the financial ability to remove themselves from the environment that they're in if it's you know um they have to live close to a road or they have to live close to uh refinery right so in in the in the United States um you know near you know large petrochemical plants that's where you've had redlined housing areas where people from low socioeconomic status usually more likely to be black have been put around these areas and then it's you know it's baked into the environment and you can't afford to move out um and or it may be you know we talked about food but you know what food do you have access to um do you even have a kitchen you know do you have are you working two jobs you do you have time to cook um you know we need to be very mindful that the social determinants of Health play a big role here yeah I mean I certainly agree with that I think it's I think there's a lot of nuance to that because sometimes that criticism gets leveled and say we shouldn't be giving any information out because it's not relevant to that Community yeah I don't agree with that it's like we should definitely be giving out information but we also need to be aware that that information may not be relevant or as relevant and so we shouldn't look down when people can't take that advice for example you know and I've always fought for that uh Wellness for one of a better term is for everyone I think every single human being has the right to good quality health information that they can try and apply in their own life and my bias comes from my clinical practice so um I've worked in lots of different practices throughout my career but there was a particular period of time where I worked in a practice in Oldham in North Manchester and it was a very low socioeconomic status area lots of immigrants lots of people on benefits people working two jobs lots of single parents a lot of inadverse commas struggle for day-to-day life compared to other areas of work where it's um you know more affluent the struggle there as well in a different way and you know what I learned Tommy in that is it because I think it's easy and I see this in the media a lot we it's either we can Empower people with their lifestyle choices or we say that there's huge social determinants about it's kind of like well why does it have to be that black or white I think all these things are nuanced and I'm I do passionately believe that this information is relevant for everyone and we should be giving it to everyone but with the acknowledgments that for some people it's harder yeah and I completely agree and I in that line I think it's very both patronizing and disempowering to say that oh you shouldn't be talking about lifestyle or Diet because it's you know these people you know may or may not have an ability to change it's very condescending it's incredibly condescending so but we just need to acknowledge that all of these things are important um but again there have been uh there was a recently published study came out and launched at Public Health a few years ago that looked at using UK biomack data looked at like mortality risk um and the stratified individuals by some lifestyle factors are based on quality of diet whether they smoke you know physical activity and then also stratified them by social deprivation and you see that yes as your um like socioeconomic status decreases overall risk increases but when you look at the effects of Lifestyle movement diet there's still great benefit there so so yes the overall risk is greater but you can like those there are individuals there you know reducing it through those through those activities so to say that we shouldn't be talking about it I think it's incredibly condescending and also you know what I found tell me is that if I change the advice I give them because I make that assumption I'm depriving them of good quality advice and what I learned there is actually sometimes in the poorest communities they would actually literally follow my advice to the letter more than in more middle class athletic communities like I remember I thought you know there wasn't much money in the family and you know at the time I don't think we were allowed to give vitamin D this lady had really bad pains and I was convinced it was related and um you know she went and bought from the local health food shop supplements for her and her family and got huge Improvement and like it's unfair to to think that we know what they will prioritize with their money it's not up to us yeah I think this is this is complex but I think it's important that we talk about it actually yeah absolutely um all of the all of these pieces are you know different parts are are important for different people in in different amounts and um there's you know part of it is just getting information out there and and so again empowering people to to know what may or may not be important uh for them for and it could be where they're worried about their risk of Dementia or heart disease or you know they just want to be able to play with their grandkids uh you know you know often people's goals are much more practical than a doctor might think you know you're you're worried about some diagnosis or something but people you know want to be able to just interact with their family or something like that and different things are going to be different relative importance for different people but they should be allowed to to make those decisions yeah you know yes we should I think that um we need greater support for Behavior change for individuals who want it um we don't necessarily do a good job of that and doing something new that's stimulating and challenging there are a lot of low-cost ways to do that if not three ways to do that you know absolutely balancing hopping around your you know I don't know we can make up all kinds of things that would actually provide a stimulus yeah absolutely and so I think that's a great piece of practical advice okay so that was in the first bucket the second bucket was about important nutrients not getting to the brain whether that be because we're not taking them in or because we're taking them in or we might be taking them in but they're not able to get to where they need to get because let's say our our blood vessels are in poor health for whatever reason so you've been on a bit of a journey Tommy since I've known you and from what I've seen in public um as we have this conversation in 2022 uh what is your current viewpoint on nutrition for human health uh I guess specifically we're talking around brain health preventing cognitive decline as we get older which I think everyone wants what kind of advice would you give to people regarding Foods I think the starting point is that you should eat something that is accessible to you that you enjoy and is sustainable like that has to be a starting point because I could give you a whole bunch of recommendations but if it's none of those things then you're not gonna do it or not gonna stick to it and one thing that constantly fascinates me about the human body is how adaptable it is um and the wide variety of diets that people um evolved while eating or you know ancestrally you know the the different diets that you know my ancestors ate a very different diet to your ancestors just because of where they are on the planet and they both thrived and I find that fascinating and so it's the same thing now like what somebody enjoys and is sustainable to them is very different from the person next to them and they may sustain their health in an identical manner with you know objective objective measures that you could take so I don't have any particular one way that I would recommend that people eat but it should support your health and we can certainly talk about things that you might measure and want to to track um over time specifically for the brain because we have Interventional studies that show it's the case um B vitamins are incredibly important so we're talking um B12 which generally you can only get from meat and animal Foods um if you are vegetarian or plant-based I think the best people who promote or work with individuals of those diets would recommend you take a B12 supplement um then folate B2 which is riboflavin and B6 those are probably the most important nutrients for for brain health and again you know any diet that has a reasonable number of Whole Foods plants vegetables eggs meat fish will have enough of those probably um then the other important thing specifically for the brain is uh the Omega-3s long chain Omega-3s and in this in these studies I mentioned earlier uh by David Smith they showed that the greatest benefit from the B vitamin supplement came from those who had what they called adequate omega-3 status and against these long chain um omega-3 fatty acids like EPA and DHA which in the diets are generally only available from Seafood but there is a there is a slight genetic component based on people who can take shorter ones that you might get in chia seeds or walnuts and then convert them to longer chain ones um but so again there's there's a slight genetic component there but some seafood is probably important as well yeah okay this this is super interesting so you first mentioned B12 and as you say if people are reading animal products in their diet they're likely to be at least taken in enough B12 what I've found when I used to measure this quite a lot is that even people who were taken in reasonable amounts of B12 had sub optimal B12 levels on their bloods yeah there's a whole variety of reasons why that might be I have my view I I feel I certainly feel stressed as a huge part of it because to be able to actually absorb that B12 what needs to happen can be impaired I think buy too much stress because I was thinking why is it that they're eating enough B12 from what I can tell yet that's not being shown up and there's all kinds of reasons for it that's just one of my views I mean what's your perspective on that is that something you've seen and do you have any opinions as to the reasons why that might be yeah absolutely and I I remember even um you know 10 years ago uh which is now 10 years since I worked as a doctor pretty much uh as a junior doctor at St Thomas's in London I was working on the elderly care Ward and when people got a first diagnosis of dementia even then one of the first things we did was something called a dementia screen which we looked at iron status uh vitamin D and some B vitamins B12 and folate at least and then if um B12 was low there was a second test they called methylmalonic acid which is produced uh when you're B12 deficient and so even then we were doing it in an NHS Hospital 10 years ago yeah right just these basic nutrients that status checks and I think uh stress you know stress um certainly may affect um acid production which is really important for B12 and also iron absorption um but then some medications can do it so metformin can can affect B12 absorption proton pump inhibitors which people might take for um you know reflux that can affect B12 absorption these are very common drugs yeah to prescribe so uh you know there's probably some some lifestyle factors but then you know it may also be a result of some something else that somebody's taking yeah remember Professor Bradison when I spoke to him about this a few years ago he he will work with his patients to do all the tests the homocysteine the the MMA that you mentioned and the serum B12 and at the time I remember thinking I can't get this stuff for my NHS patients back then and he said he likes to see for cognitive function a serum B12 right so that's your regular cheap uh B12 test um and you know I'm gonna say it depends on your lab but you know the normal value that will be reported would typically be something like 200 250 to 7 800 maybe 900 depending on the lab yeah right so a huge huge range of normal yeah and he said in his experience if it's under 600 he would treat it and remember I came back because I was chatting him in America and I tried that with a few patients actually and again this is just anecdotal it's not a scientific study but people would come back say yeah they feel sharper their Kongs to function has got better when I'd treat their serum B12 from let's say a normal level of 250 what do you think so that I think that's um I mean I'm not necessarily surprised uh again it probably depends what's interesting about um the difference between the US and the UK is that in the U.S you can't get an active B12 test what we would call holotranscobalamin and it's very common to do in the UK you can't do it in the U.S so you in on the US test you probably need to be at the hot at the upper end of normal because um there are lots of other things that can cross-react with the test and they look like B12 but they don't have the function of B12 and that's the case with some like plant-based B12 analogues so that so for him I imagine that's probably one reason why that may be the case but equally more broadly I spent a lot of time uh looking at looking at and thinking about blood tests and if we think back to what we said right at the beginning which is that the average population the average adult has at least one chronic condition takes at least one medication has at least one if not two of the components of metabolic syndrome of which there are five if that's the average person and the normal range is just the way you define the normal range is you test a whole bunch of people and you take the middle 95 and whatever the bottom the lowest person of that middle 95 or whatever the top person is that's the normal range and if the average person sick to some degree then what's normal is not necessarily normal and I think that's part of and you see this again and again um that they've changed the ranges over time that's been uh it's been the case for certain sex hormones you know like and people have talked about this a lot you know they're decreasing the normal range for testosterone in men because they think that testosterone is decreasing on the population level where there's actually true or not is Up For Debate but there's something that's happened that's you know they've changed the ranges if they see that you know the overall the population level changes I saw something similar when they were trying to develop normal ranges for grip strength um and what they saw over you know Generations you know from you know like uh Generation X uh Generation Y Millennials like uh coming through to well in America we call gen z um grip strength was declining particularly in males so there was a publication that said that and said we need to change the normal range for grip strength rather than saying we're getting weaker why aren't we working on that and so you know it's it's like um the the frog that sits in water from when it's cold and then if you if you boil it it will slowly heat up it will never jump out because it never realizes because it's so incremental and slow and so that's that's one of the problems is that we're looking you know some normal ranges are constructed around a population that's sick so the normal isn't necessarily isn't necessarily normal and that's that may be playing part of the role there too yeah it's it's super interesting hopefully we'll get time to go into some blood tests that people can do you mentioned Seafood why do you think Seafood is so important for our brain health and then for people who are vegan or you know choosing not to have animal products can they still have good brain health and get those nutrients that you would get from Seafood in other ways so there are a few strands um the the of information that leave me to think that that seafood or I say Seafood because it's the the most common dietary um component that gives us long chain Omega-3s what I'm really interested is long chain Omega-3s particularly DHA in the brain and again if I go back to what does it take to build a healthy brain in the first place DHA is preferentially sucked up into the brain while you're making it as much that the mother will sacrifice her own DHA status so that the baby gets enough because it's one of the most critical fats that makes up the brain for a number of reasons um it and it goes It goes directly into the the cell membrane so people may or may not know that most of your brain which is in water is fat almost all of it right so because fat makes up all the insulation around the nerves it makes up all the the membranes around the cells and DHA is incredibly important both for the function of the synapses how they talk to each other because of its because of the because of its structure it has this you know very important um role in terms of like how the synapses work how neurons talk to each other but then it's also accumulated into the mitochondria which people might know as the PowerHouse of the cell it sits inside the cell generates most of the energy and some of it is really cool physics that basically how electrons travel through DHA is really interesting um but equally you know it's sort of like a more basic way you can see that the more DHA that's in a mitochondria the greater energetic capacity it has the more energy it can produce um and that's the reason why and and there were some evolutionary theories that say that you know maybe the human brain as it currently exists developed in a sec in like a group of hominids that had either direct access to a lot of seafood or to the brains of other animals uh because brains are an incredibly rich source of DHA because your your body preferentially shuttles it to the brain during development so it has this really important functional role um and when you um don't have it as associated with neurodevelopmental disorders or developmental delay um risk of other neurode like neurodevelopmental issues um and then you can also see things like um there have been some interesting studies done in the UK and in the Seychelles where uh you look at the the amount of seafood that a mother or her her children eat and then you look at long-term neural development and you you ask about heavy metals earlier particularly Mercury is important for seafood but it seems that even if you have a higher Mercury burden because you eat a lot of seafood you get a you get greater benefit because of the mega-3s in the diet um so that kind of you know that sort of first principles approach says what does a brain really want when it's developing and it really wants DHA it's you know it's it's essentially that's where all your DHA goes is your brain and again one of the things that is interesting about humans is that we're the only mammal that has fat babies no other animal has fat babies and one of the reasons why um human babies are fat is because they have adipose tissue as a store of DHA for the brain as it grows when you say fat you don't mean unhealthily fat no I mean I mean like healthy chubby plump little babies right so if you look at any other mammal um when they're born they're very lean even other primates they don't have large adipose stores and what you know it's it's an and it's so it's an energetic store right we know the adipose tissue fat tissue is a is a store for energy but what but it also stores fats that are then particularly used to the brain and DHA is one of them so a developing brain needs it yes can we therefore say that a developed brain also needs it so this is an exceptionally nuanced topic even more so than any of the other topics that we've talked about a colleague of mine Dr Roy Heath and I wrote a paper recently about DHA and Alzheimer's disease and some people have said that the DHA in in patients with Alzheimer's disease in their brain is low others haven't quite found the the same thing uh part of it is probably that again your adipose issue is is essentially a very nice buffer of DHA that you can use across your lifetime so it's it's it's quite if somebody is unless somebody has never eaten seafood or has never eaten really any long chain Omega-3s it's very unlikely that you're going to be deficient um in for the brain for cardiovascular function um and other things that that may not necessarily be the case um and that's why the omega-3 index or you know how you know your Omega-3s in your blood is a increasingly used um risk predictor of cardiovascular disease and things like that um so it's so it's very nuanced but if you're going to be maintaining cell membranes and cell function you're definitely going to need some and then the much better line of evidence comes from systemic measures of Omega-3 it's impossible for me to measure how much DHA is in your brain right but I can measure how much is in your blood right and when these studies were done at Oxford they showed that you needed both adequate B vitamins and enough Omega-3s in order for you to get this slowing in in brain atrophy and cognitive decline so if you measure omega-3 levels in people and they're low they have a faster rate of cognitive decline which tells me that that's important because if you fix it then you can you can change that yeah it's super Nuance um but it's super important because you know tell me one of the things that I've noticed is I have seen patients thrive on radically different diets yeah so I'm like there is no one true human diet that's for everyone in my view it's just based upon 21 years now of clinical experience it's like I I I I've seen nothing to back that up there are some principles Whole Foods as much as you can minimally processed you know decent amounts of healthy fat that there are some basic principles but you can twist it in many different ways culturally ethically you know taste preference wise using those principles to seemingly be in good health I so I completely agree with with everything that that you've said and I've also seen people thrive on an incredibly wide range of diets like I said earlier I think that's one of the most fascinating things about humans and we have to take individual health into consideration and so lots of things are done at the population level that are very important but if two different individuals can thrive on very different diets and it supports their health in objective ways and they feel good we have to be able to support them and and and in doing that um and to go back to Omega-3s like I don't if you don't want to eat seafood there are algol um sources of long chain Omega-3s right so you can do plant-based versions absolutely and you would recommend that to people um I would recommend so I don't want to show up and just say people should take all these supplements ideally you'd test right it's not difficult I mean an idea you know in in my perfect world you would have access to this test of your doctor it shouldn't be something you have to pay for because is much cheaper than you getting a whole bunch of cardiovascular and cognitive diseases because you just didn't know that what you needed was a bit more omega-3 so you would just you would you would do one of those what blood spot tests yes for an omega-3 index um and if you're in a good range then don't worry about it um if so that's I think that's really empowering it's like look if you're choosing to eat predominantly plants you're choosing not to eat animal products and you're maybe thinking about what Tommy just said and other guests have said in the past thinking okay well why don't I just go and measure my levels yeah that seems like a pretty practical approach to take yeah and there are there are some studies that have been done that have looked at the omega-3 levels the DHA levels of um omnivores versus vegans and sometimes vegans have lower levels but there have been studies that showed no difference right so you can eat a plant-based diet and maybe you don't have any issues whatsoever one one thing that's interesting is that they may you know I don't at this point believe in mutual genomics where you can measure your you can you know get a genetic test that will tell you the foods that you should eat I don't think we're at a point where we can do that but one of the things that we know the most about is how our body metabolizes specific types of fats um and there have been there have been some studies that showed that if your ancestors became agriculturalists longer ago right so they were usually close to the equator usually became Farmers um further away in the in your in our ancestral history like more thousands of years ago than the body has adapted to being able to take shorter Omega-3s like um ala which you can find in nuts and seeds and some grains and then turning into these longer chain ones by comparison um say half you know half of my family is from Iceland right you can't grow grains in Iceland um there's not a starchy carbohydrate to be seen anywhere right they ate seafood and they still do and you know that was where they got their Omega-3s so their bodies never had to adapt to it yeah so there may be some people and one of the reasons why they thrive on a completely uh plant-based diet is because they're really good at converting some of these precursors to the longer chain Omega-3s and that's partly based on their ancestry and some other genetic components so that's why I don't think that everybody eats a plant-based diet should take an omega-3 supplement I think they should test and then if they need to change something they should but if they don't then great yeah something potentially so simple has become so complicated because for years we would have just had our nutrition dictated by geography climber by culture what our parents and grandparents fed us you know what was really interesting time I went to Greece this summer and we were on this island called ethaki beautiful islands we'd been in Greece for about 10 days at this point and yeah we've been enjoying chill out time my wife myself the family we've been enjoying Greek Foods um but most of the vegetables we were getting served were aubergines and tomatoes like literally every day and we were at this restaurant in athaki and remember um I think the kids fancy something different and I said to their I think she owned the restaurant she was serving us I said hey um you know do you have any like other vegetables at all like I don't know broccoli or something else and I've learned so much Tommy because she just looked to me bathroom and she just said no they're not in season yeah and I thought isn't that interesting it it she couldn't even fathom what what you you want to eat something that's not in season like it didn't compute and it was really lovely actually it really made me think about how by having access to different foods three times a day and seven days a week we can eat something different we've I don't know it was I don't know any comments on that at all I think more broadly it's very possible that in the future we'll figure out the perfect human diet we can engineer it down to like the micronutrient and the exact level that each individual needs for each you mean the personalized diet for each person at some point in the future that may be possible but right now it isn't and so where I think we should get a lot a lot of our information around our diet are those things like what seasonal what was available to us you know in recent history um and then yes I think you should also take advantage of modern medicine and test the things that you should test and there are objective measures that we can take uh for our health from blood tests or you know if people or you know colonoscopies and all these right there were these things we could take advantage of if your diet is supporting your health and or there were it's you know you fit you feel great and and everything is going well I see no reason to change it um and like that I think that's what's really critical yeah why would anyone change their diet when they're thriving yeah like whatever it is whatever it is yeah and one of the Hidden one of the unintended consequences like I want to start gut health with you because you you published a a I've read it today it's a brilliant brilliant paper um I think it was in 2021 last year yeah yeah one of the other things I've been reflecting on over the summer is gut health we didn't know about this organ really on a on a big scale maybe 10 years maybe 15 years ago it's not it's pretty new what are we missing and in particular Tommy you mentioned some of your friends who are we saying maybe what might be termed a carnivore diet these days and they're seemingly thriving I'd had Tim Spector on in July and I mentioned to Tim because Tim was talking about gutter health and talking about 30 plant Foods a week and I mentioned and I've got patients like this I've got friends like this one particular friend of mine who I spoke to Tim about I said Tim but I've Got a Friend who has tried everything she used to be paleo she was vegan she was raw food she's very educated on health she's a practitioner and about five years ago she pretty much moved to close to carnivore and I don't know many people she's in her 50s she is thriving she looks great she can run Ultra marathons I've don't step without I've seen her work she can work for 14 hours straight cognitive function completely just as good at 9 00 PM as it was at 7am it's phenomenal to see but I'm thinking if we take a step back for a minute there are so many reports of people thriving on these animal heavy diets autoimmune symptoms going joint pain going like we can either put our head in the Sun as a profession and go no you've got to do this you've got to eat more fiber or go wait a minute well what's going on here why are people not following the dietary advice and are thriving and she's also done all her blood tests her triglycerides HDL ratios fantastic hba1c is amazing what's your perspective Tommy so I completely you know on the gut front and again I I know people who are much smarter I know much more about this than I do so I've learned a lot from them one of them is uh Dr Lucy mailing who I wrote this this paper with um and I think the gut has really been this thing where the more we know the more we realize we don't know um and again the the paper we wrote tried to come at this from like a first principle's idea which is that so if you think about the wide variety of of environments and diets that humans thrived in and thrived on how common is it how common would it have been for you to have 30 different plant Foods in your diet in a week right you're in Greece two things are in season tomatoes and aubergines you talked about that right what are the other 28 that you're supposed to find in the environment like it's just not something that our guts ever you know are used quote unquote used to seeing that doesn't mean it's bad right I'm not saying that it's bad I'm just saying like what are the things that you know our guts have helped us through in the past and if you think about it that way then you have to think about scenarios when like there were no plants right so so you know we've come at it from this idea that uh for the gut plants for essential fibers fiber is essential and that's pretty much because in large population studies um we've told people that that's the case so people who are more health conscious do that but they also don't smoke and they sleep more and they exercise more right the healthy user bias um and if we think about our guts and you know the rest of the body is the same but in a healthy individual it's it's adaptable to many different types of fuel right um is it blood glucose or is it fat or is it ketones right these these different um sources of energy that you can use that you need to run your heart or your muscles or your brain your gut is the same and the traditional story is that you need fiber the gut bugs turn to something we call short chain fatty acids like butyrate that provides the fuel for your enterocytes the cells in your gut but what you see quite clearly is that your gut can use a wide range of fuels so yes it can use those if uh if you predominantly plant Foods you'll make short-term fatty acids like butyrate that will that will be the source of fuel but if you eat more protein then you'll make what we call ISO short chain fatty acids and those essentially have the same function so you can support your gut health just fine with the metabolites from meat rather than plants the gut the gut cells will still use it you can also use acyl carnitines which are metabolites of fats or if you're on a ketogenic diet the the it doesn't come from inside the gut like those other things do from the gut bugs it can come from the blood so you can take the the cells in the gut can take ketones from the blood if you're fasting or um you know fasted because there's no food available right if there's no food available your gut still has to be able to survive it can't just like give up and stop working right because as soon as you get food it needs to function so then if you're whatever reason don't have access to food your body makes about of Keystone bodies and the gut can use those for energy as well so the gut is incredibly metabolically flexible based on the systemic health of the body and physiology of the body so what I think we've seen in a lot of studies around the gut is that something that affects systemic physiology affects the gut and then that affects the types of microbes that get selected for within the gut let's just back up systemic physiology well how would you say that in layman's yeah so so basically your General Health right so you do something that's affecting your general overall health yes that's then affecting the health of your gut yes and then you're measuring bugs in there and we're making we're drawing conclusions from that exactly and it's uh it goes in both ways so we know that the bugs in your gut can affect your body but it really seems like what's happening in your body elsewhere and that can happen with changes in sleep or diet or physical activity right so when you exercise that affects your General Health it affects what happens in your heart and your blood vessels and your muscles they you know secrete a bunch of um chemicals and hormones and things like that that kind of that affects your health it also affects your gut and then what happens is your gut is affected by that like just by your health changing that then changes the kind of bugs that survive in that gut so you'll see things change within the gut right you'll see different bugs but it's because of what's Happening elsewhere in the body so I think we've ascribed too much to the bugs that we measure and it's also the bugs we can measure yeah there's a whole bunch of stuff that we're just not able to measure and this has been another problem with um studying the gut microbiome is that historically we've used um a cheaper measure called looking at something called 16s RNA and when I've talked about this previously the level of information it gives you is it's like if you think about the lineage of dogs right they're in animals and then canines and then the sort of that the house dog the dog that we have the dogs that we have at home so a 16s RNA can tell you this is a dog rather than a cat but it can't tell you whether it's a French Bulldog or a doberman right which are vastly different dogs and it's the same thing with gut bugs so it might tell you yes I think I have an idea what this bug is but it tells you nothing about its specific functions um and a lot more about what's happening in the gut is based on the function of the bug rather than what the bug is and so vastly different bugs can have the same function but you might just focus on one that has a specific function and think we need this when actually something else entirely could take that function so it's do the information that we have is incomplete um I think we've ascribed too much um you know too much to its to its activity doesn't mean it's not important I think it's very important no for sure but I I think we've given it too much credit and and taken away what's maybe happening elsewhere in the body and also maybe it's not even giving it too much credit but it could also be you know we're overly focusing on lifestyle change influencing the gut microbiome implements singer overall health maybe it's just the lifestyle changes influenced seeing our overall health as you say which is then influence in the gut microbiome exactly and this is one of the key things I think I've evolved my view on uh over the past few years is this Maxim that we need fiber for Optimal Health I I don't know the answer to that I've just I'm very open-minded and I I just I can't um make that work in my head cognitively and also see many many people thriving literally thriving in every way that I can see on low fiber diets yeah I think it doesn't add up like we've got to do better like that's that's do you know what I mean yeah and and again um I think when we when we've looked at so I'm I'm not going to say the fiber isn't important because I think in the in the setting of The the modern mixed diet where most foods are Ultra processed and we think about the things that we talked about earlier that may be able to you know help support gut function you're probably not getting any of those and in that setting fiber may be beneficial it's also uh fiber in the diet and we ask people about their diet it's like a marker of a bunch of other things like usually if you're using more fiber you're eating high quality foods and fiber may affect things like satiety right so if you're using more fiber then maybe you eat total fewer calories in an environment that encourages us to eat more calories than we need so there are these signals that maybe it's beneficial but that doesn't mean that it's essential yeah and just to just to clarify my interview I'm also not saying fiber is not important there is plenty of research which is suggesting that more fiber is associated with Better Health outcomes I've written about this before right so I'm I'm just I think we always need to remain open-minded and go just because we believe this to be true just because everyone said it was true maybe it's a partial truth yeah maybe maybe it's true for a lot of people and also the other thing I think with diet Tommy is that when we look at these ancestral populations these hunter-gatherer tribes and we look at what they're eating and you know they had to try and Tanzania are reported to eat a ton of fiber maybe 150 grams a day I've seen in some reports compared to you know an urban population a western population that may be struggling to get 15 20 25 grams a day right so I get that on the face of it it seems like a huge difference and hey we want better health outcome so let's do that let's increase the fiber but it also depends doesn't it that diet on top of what yeah so if you've grown up there with low stress eating naturally in sync with the seasons you know without the the urban Western societal pressures that you know affect all aspects of our physiology well maybe that diet works really well but maybe maybe in the you know the world in which we we live you live in America now I live in the UK but so many people have got poor metabolic Health already they're already um got sub-optimal health so maybe they need a corrective diet do you know what I mean it's kind of like and I I sort of hypothesized in my first book by a low carb diet seems to work so well for so many people in the western environment might be because we're overly stressed we're under slept we're under moved where we've had too many calories at the wrong types of calories we we are insulin resistant and therefore maybe in that setting there's a there's a kind of unique role for it yeah I don't know I mean I'm not saying I've got the answers or I don't think you're saying you've got the answers either but it's worthy of discussion yeah um in my mind uh there's this you know every every everything that we use to describe human health everything we use in biology is some kind of model right um and because we can't we can we're unable to completely explain everything right it's not physics and even in physics they can't do that um but this is Fame uh George box is a statistician as his famous quote which is called which says all models are wrong but some models are useful and I think that's that's really and I think that's really important to think about because everything we're talking about here is some kind of model to describe human health and if your model doesn't allow for the individual that is doing amazingly well eating nothing but beef then your model is wrong right then it's more wrong than any kind of model you can build that that encompasses that so I always think like the outliers are important because they force you to change the parameters of your model and if you don't I think that's incredibly unscientific so yes you can say that's interesting I want to learn more about that but at some point you then have to try and incorporate it into whatever model it is that you're building that says you know well why is it that we've seen you know if humans can thrive in a scenario where they're not eating any fiber then that has to be incorporated into the model somehow yeah I love that I love that muscles right we've we've drawn an analogy you've drawn an analogy early on about muscle health and brain health yeah and I'm really interested as to practically what advice would you give to people who want to optimize their brain health in terms of yes physical activity but but I guess specifically I'm interested in in muscle um I know you know you lecture on this you're going to give a talk I think this weekend's on muscle mass and long have you ever see in the UK which you'll hear we had Dr Gabrielle lying on recently she was talking um about protein intake uh the importance of resistance training I would love your perspective on these things so I obviously haven't heard your interview with uh with uh Dr Gabrielle but I imagine that I will have agreed with pretty much everything she said so you can hear what I say and then you can because in general I I think she's she's fabulous and she she focuses on on really important things such as muscle tissue and protein intake um and the re I mean there are multiple reasons why muscles are important there are biggest glucose sync so we talk about blood sugar you talk about you know that being important for diabetes risk but also cardiovascular disease risk dementia risk 75 of your blood sugar is taken up into your muscles and the more muscle you have and the more you move it the more glucose blood sugar that they take up so if you're trying to regulate your blood sugar which is relevant to the vast majority of of adults because they probably you know again the average individual at least has pre-diabetes average adult in in the US and the UK and and similar Studies have been shown that in Europe it's pretty alarming yeah and so so I think the the projected number in the US is 60 um have at least pre-diabetes or obviously if you progress then that includes pre-diabetes and Frank type 2 diabetes 60 of us adults currently currently and do you know what that figure is in the UK um I believe it's 40 or 50 yeah so muscles are your most important glucose sync if you want if you want to regulate your blood sugar you need to create somewhere for that blood sugar to go right um and muscles are the thing at 75 of blood sugar goes up into into your mind so the more muscle you have yes the easier it is to regulate your blood sugar absolutely and the more you move it so and so both are important right so the total mass and then how much movement you the amount that you move it um and there are several studies that have shown that but you can in you know again in type 2 diabetics you can put on continuous blood sugar monitors or look at their you know blood sugar and the more they move the better their blood sugar is controlled um and if you have more muscle and you move it more you can control that even better so that's one reason my muscle is important it's also um it's a it's an organ it secretes factors and hormones and things that we're still learning about right um every month there's a another paper in a fancy Journal that says we just learned this thing that happens when you exercise and it makes this molecule and then we inject that molecule into mice and they live longer that speaks to what you just said about the gut right how long have we been studying muscles compared to how long ago we've been studying the guts years decades on muscles and we're still learning new stuff that we're like oh we didn't realize yeah so it's kind of naive on the go isn't it think after 10 years of study we can't even know all this stuff yeah exactly and so one of the reasons why I like to use exercise as an example is because everybody right diet we can argue about some other things we can argue about nobody argues about physical activity right yeah everybody recommends it every Health body every governmental organization every non-governmental organization says you should you should move more right physical activity is good for your health but we don't know how it works yet I mean we know lots of things but we don't know all the things that happens when it happens when you exercise and so what you know it's a um when you when you exercise you release a whole bunch of factors that you know directly support the brain things like brain derived neurotrophic Factor you secrete things that decrease systemic inflammation um a whole wide range of things so it's this it's a secretory organ of course you know just like um just like the the pancreas or the thyroid um but when you move it um and then sort of more practically as you get older we we know that you lose muscle mass as you age and it particularly starts to decline from about 60 muscle muscle mass so it starts slow in your 30s and then it really accelerates when you hit about 60 on average but strength declines pretty much continuously from your 30s so you lose strength more than you're more more quickly than you lose muscle tissue and strength is really the thing like functional functional capacity of muscle is is really important it's like saying you don't want a bigger brain you want a brain that works better right like that's that the function is the important thing and uh strength is a really important predictor of mortality and cognitive decline and there are simple things like if you have enough muscle mass and enough strength then you're not going to fall over you know and break a hip and right if you get into your against your 70s or 80s you fall and break a hip you have a very high chance of dying within the next well even days then also weeks and months afterwards so like your muscle tissue supports pretty much you know all the all these important like it supports every other organ in the body um and what's interesting to me about exercise particularly when you think about on longevity and aging um there was a uh about 10 years ago there was a paper that came out called the Hallmarks of Aging which are all these things you can measure biochemically in cells that happen as the as the body or the cell ages physical activity and exercise is the only thing that reverses all of those components like it's the only thing that can actively anti-age you in everything that happens as you age um so it basically affects everything and then I know it's important to give practical advice right how how like what's how much is enough and um you know whenever I talk about muscles I have to you know I have a philosophical conflict which is like I really like lifting weights right so everybody you know the first thing that happens when I talk about muscle mass is people like well I don't want to look alike don't want to look like you and like that's fine that's great you don't have to um and you basically just have to be in the top 50 of the population right so if you go out and you find 10 people like you if you have if you're in the top half in terms of the amount of muscle mass then you're good that's enough so that's the challenge to the listeners find some people who are like you and have a press that competition yeah exactly and if you're if you're if you're in the top half in terms of the number of press-ups you can do then you're fine um you don't have to do that but so what does it take to achieve that kind of um some something like that and it's it's really not very much um if if you've never done any kind of resistance training and a resistance training I mean uh it could just be a bodyweight stuff to some of the things from your books uh like your kitchen workout uh it can you can use bands yes you can use weights and go to the gym but you don't need to um uh this morning I watched a talk by Professor Muir gray um who who was talking about um the healthiest thing to do with uh bags of sugar is to use them as weights I was like great yeah you could so you could use bags of sugar you could use cans of beans um that provides resistance and if you do um two to three sets per muscle group right so maybe you have to do bicep curls and squats and a press to like cover all your your your your muscle groups two to three sets per week is probably enough two to three sets per week per week so the minimum effective dose to to increase strength is somewhere between two and four sets per muscle group per week when we say sets is that 10 bicep curls is that five is it fifteen what how did we Define a set so that's a great question and the again what's really great is the answer is it it doesn't matter as long as you go to something approaching what we call voluntary muscular failure which is basically this is really hard I can't do anymore right so if you pick if if whatever you're doing you can do five and you're like I can't do six then that's enough but if whatever you're doing you can do 30 but you can't do 31 then that's enough so you just have to get to a point where it gets hard enough that you say I probably can't do any more um and you don't need to like really push it and like get to the point where you're like you know yeah your form looks terrible because you're sort of like trying to muscle this thing up you don't need to do that it's the same Principle as doing something new isn't it you're just saying maybe 20 to 30 minutes on something that you find challenging but then it's probably enough after 20 minutes or so yeah it's a similar kind of principle with the muscle yeah exactly and so 20 minutes two or three times a week and even if it's just one set each time where in that show in whatever you're doing so you're doing uh some squats and if you can't do squats then you could just do like getting up and down from a chair right if that's the limit and if you get up and down from a chair 15 times you're like oh I probably couldn't do a 16th then that's great but you've yeah I think the important message there is for people because people tend to get hung up on numbers a lot of the time is it 10 is it 15 is it five it's like no it's voluntary muscular failure so and that's going to change as you get stronger yeah right so maybe it's you can do only two press-ups now but as you get strong it'll be you know five is what you need to do and as you get stronger it's gonna be ten yeah yeah so that's the minimum effective dose yeah okay so the premises we're trying to maintain our brain health as we get older above the age of 30 we start to lose muscle mass you're making the case that lean muscle mass is very important for our cognitive health and many other aspects of our health yeah so you're saying the minimum effective dose is two to three sets on most muscle groups a week so that's going to do something that you're going to get benefit from that yeah you've given us the minimum effects of dose but presumably more up to a point I guess can be better yes and so what I think is the bat like the best balance of like the amount of response you get versus what's practical for most people is probably something more like eight to twelve sets per muscle group per week split over two to three sessions and so it's very common in the exercise literature to see three times per week three sets per muscle group and then you know they usually do like something like eight to twelve reps and and uh change the weight to get it so that by you know 10 or 11 you're at that point of failure like whatever that is for you yeah so that's and that's very common and so there was um they've done studies where they've compared individuals in their 70s versus individuals in their 20s and with that kind of training protocol so three times a week three sets per muscle group maybe so maybe six to eight different exercises each time even individuals in their 70s you know are gaining significant muscle mass significant strength right so again it's not the thing you can't do it right the body still responds it still adapts once you've achieved whatever level you want to achieve you need much less to maintain it right you can maintain it with those levels we were talking about before two or three times per week uh whatever you've built up um so that's important too right maybe you get to a certain point and you're like well I only just want to maintain my strength you much less to maintain that you need than you need to actively build so that's important too um there's a there was a very nice study uh called the smart the smart trial where they did gave people either resistance training or cognitive training or both and they looked at sort of function and and um and and things uh like structure of the brain they were looking particularly at the brain and these again individuals in their 70s and the resistance training protocol which significantly improved function and structure in some areas of the brain because we were talking about the brain was just that it was three times a week uh three sets of six different machines in the gym so you could go to your local you know local gym you just do like some kind of row some kind of press a leg press right five or six different machines three times a week three sets of eight to twelve for each and then that shows significant benefits in the brain each session was close to half an hour so it's 90 minutes a week very doable yeah and and so really tie in what we were talking about before Tommy about access and you know making Health advice relevant to everyone maybe people who don't have much disposable income yeah gyms can be expensive oh yeah right this doesn't have to be a gym you mentioned bags of sugar it could be used as weights tins of beans you know many of us have got dumbbells kicking around you know in the first lockdown in the UK back in 2020 you could not buy dumbbells or kettlebells anywhere I think after a few weeks literally everyone had sold out yeah so based upon that this is not science but based on that there are many people who have got dumbbells or kettlebells kicking around sitting at home maybe in a box baby in a Cupboard maybe in the garage and there's some dust it's not costing any money if you've already bought it she was huge huge benefits for your current health your metabolic Health your brain health I mean I know we know this stuff but when when you say it out loud sometimes you go guys you got it you just gotta do it you can't just hear the podcast and go oh yeah I know how important muscle mass is you've got to actually go and do it but what you're saying is it's not actually that much I think that uh one of the most important messages that I like to give around exercise is that literally anything is beneficial like it's it's linear like anything more than what you're doing now will have significant benefits for your health and what we often think um and we may have talked about this in the last podcast was that you know if you're going to go running or it has to be an hour and it has to be hard for it to be doing you're just like what's the point in going running if I don't have an hour or if I don't get really out of breath and that's not true right it could be 20 minutes and it could be a brisk walk and we know that has significant health benefits and resistance training is the same people think that you know what's the point in doing it because you know it's only a four kilo kettlebell like surely that can't make much difference it does it makes a huge difference so it doesn't take much um and you can do it with So like um I'm traveling for 10 days right now I won't have access to a gym I brought two things a set of resistance bands and Blood Flow Restriction customers you can talk about more if you want but basically it makes any exercise that you do much harder with your body weight and you sort of augment the response to it um and it weighs I don't know maybe a kilo could put it in the bottom of my backpack and I will get great workouts and oh and it maybe costs 20 quid in total the things that I have in my bag um and that'll be enough right if I was somebody who was just focused on resistance training for health I could have those two things and do everything that I needed to do to get almost all the benefit yeah you know when I travel you know what I take with me what skipping rope yeah great now I'm super tour right so I had to get an extra long skipping right maybe about seven years ago so I got it with my life it's quite hard to get you know people don't realize when you're as tall as a giraffe it ain't easy to get stuff but I took that a whole day with him in the summer pretty much done more skipping this summer than I've done in my life it's phenomenal oh yeah uh you know this whole thing about it not being accessible that successful what you just said is accessible um these these restrictors these blood cuff what were they called against blood flow restrictions Blood Flow Restriction yeah do you want to talk about them but I think we're gonna have to save that for uh conversation number three which I hope we can have because I so enjoy talking to you we've tantalized people with uh blood tests throughout this conversation so some of these blood tests that are you know pretty well available for people um what blood tests do you recommend what do you think of the most important ones that they're only going to do a few and I wonder if you're open to sharing what you think the optimum parameters are what people should be aiming for done like I said earlier a bunch of work in blood tests and I've also done a bunch of gut testing and fancy urine testing and all these all these kinds of things on yourself or myself yeah me too others on you know clients and athletes that I've worked with and again and again again I just like come back to some of the basics that I think can can be really important the average adult in the UK probably has at least one or two of the components of metabolic syndrome and so just say we what metabolicism is yeah yeah so so we're talking about we talk about metabolic Health we talk about insulin resistance these things are you know related to diabetes and cardiovasculars risk and Alzheimer's you know dementia risk and one of the easiest ways to explain metabolic Health uh to me is the absence of metabolic syndrome which is this syndrome that's um increasing in prevalence and it basically the the more factors you have increase your risk of cardio acid disease certain Cancers and it's basically this expression of systemic insulin resistance so your your body's inability to handle energy properly that's probably the easiest way to do it and in order to talk about it and the way we measure that is with the blood sugar test that's one of the ways we measure insulin resistance um either just a fasting blood sugar in the morning or on hbo1c which is more of like a you know a picture of your blood sugar over the last couple of months and the components of metabolic syndrome are an increased waist circumference um they are low HDL cholesterol and it's different for men or women high triglycerides high blood sugar and then high blood pressure so if you were to avoid having any of those things you're already in such great shape and those that's a really low bar to hit and those are things that you can get from your GP and you can easily track over time and they're very cheap so that's absolutely where I'd start okay so let's go through some of them yeah uh fasting glucose so fasting glucose um the the criteria for high fossil glucose in metabolic syndrome is the the presence of pre-diabetes so um there are two ways that you can diagnose that one is either a fasting blood sugar um over 100 milligrams of deciliter which is 5.6 ish millimoles per liter um or an HBO and see above 5.7 I can't remember what that is in millimoles per mole but you know what's a really interesting is that in the US the pre-diabetic threshold is an A1C of 5.7 in the UK it's six oh interesting so we have actually a different arbitrary number yeah when we call it yeah and it is arbitrary we've had to pick a cutoff point but of course these things are you know on a Continuum like everything that we've we've talked about but so if we go on A1C and fasting glucose for a minute because there's normal yeah that's okay and then there's optimal right so of course not being in the abnormal rages is a good start but many people I would guess many people listening to the show or actually going yeah okay but what what should I be really aiming for yeah so with an hba1c again in kind of old money um you know 6.5 is a diagnosis of type 2 diabetes six in the UK or 5.7 in the US is a diagnosis of pre-diabetes where would you ideally like to see people's a1cs can we say that yet um so there are a number of very large population studies that have looked at blood sugar levels both fasting blood sugar and hbo1c and then looked at things like mortality yeah which is like a hard end point it's easy to know like is this person dead or not and and you can then say well where is the lowest risk of death on you know on the glucose scale and it seems to be somewhere around far you know maybe 4.5 to just over five millimoles of fasting blood sugar and maybe something similar for HBO and see like five to maybe 5.5 is where the lowest uh risk of mortality is at the population level um that's probably because having much lower blood sugar is usually associated with other problems like alcoholics yeah have lower blood sugar and it's not the low blood sugar that's that's the problem it's the fact that they're alcoholics so you're looking after someone and they've got an A1C an HP A1C which everyone listening to this show at the moment probably has access to for either free or very low cost right so it's something practical that people can actually measure look at and then compare it to what we're saying if someone's got it between then five and 5.5 let's say it's 5.5 so only 0.2 away from 5.7 right are you happy with that or do you think lower might be better or does it depend on the concepts of everything it absolutely depends on the context of everything else if you're uh HP A1C is 5.5 and you you know you have um I think waist circumference is tricky um I like waste to height ratio yeah me too um so so see you have a white so say you have a an HB and C of 5.5 but your waist to height ratio is close to or below 0.5 which I think is a good a good cutoff again that's been above that is associated with a higher risk of mortality um and you have good blood pressure and and everything else is good no I'm not going to focus on decreasing it further um what's tricky about hbo1c is that an H an hbo1c is supposed to be a picture of your average blood sugar but you and I could have the same HBO and c and have very different blood sugar over time uh for any because there are a number of things that affect red blood cells which are then part of that HBO and see a measurement so say you're at the upper end you're near the threshold then I would look at fasting blood sugar um you know if that looks good you know you know you can if you want to dig even deeper you can look at like how hard how hard is your blood sugar Spike after meals right because if it goes really high and it takes a long time to come down and you've got a sort of a a borderline HBO and see maybe that's that's a picture of you maybe on the way to having some blood sugar okay so that's harder for people to measure unless they're wearing a continuous glucose monitor yeah because you know it's certainly in the UK not that accessible to be able to do something like that but I but I agree and I guess a wider Point Tommy which I think is worth just pausing on here is looking at just one of these tests sure can be helpful yeah but it's best to look at them in combination altogether you know what what is your blood pressure what's your triglycerides what's your A1C you know to build up a picture would you agree with that oh absolutely um and I think one thing that particularly individuals who are very health focused as they become too focused on optimizing each individual thing when in reality we have no evidence that that's that important which is why I think taking the context of like one thing being maybe close to a cut off that somebody said wasn't that great in the you know if everything else looks really good and you feel good I I mean I think at that point you should just you should just stop worrying about it right take it into the context of everything else don't like hyper focus on every individual number and try and maximize it blood sugar in the contact surf brain health cognitive health right just to sort of close that Loop a little bit um we're talking about fasting Sugar We're talking about hpa1c things that people can do they can see what you know if it needs Improvement if they need to make some changes but what is the relationship between high blood sugar raised blood sugar swinging high and low blood sugars basically what is the relationship between poor metabolic Health in in many ways and brain health some people have called Alzheimer's disease like the late answer outside mercies the age-related dementia will talk about type 3 diabetes some people may have heard that and that's because the brain becomes insulin resistant you see that the brain is able to take up less glucose and with that you're delivering less of one of those things we talked about right glucose is an energy source is one of the things that your brain needs like we talked about earlier and there are a number of reasons why why that may happen um but when we see peripherally when we when we look when we measure our blood sugar there there was a a nice study that I think it was uh but he was done in the UK there uh Aging in England study or something like that and they look to individuals that had normal blood sugar uh pre-diabetes or type 2 diabetes and within those categories as you went up each category the cognitive decline was faster and brain atrophy was faster so the higher your blood sugar that's associated with faster cognitive decline within those within those categories either by normal pre-diabetes or types diabetes it seems that this is like systemic reflection of your health that is directly affecting the brain and we see similar things with blood sugar swings so there was a nice study done in Japan and actually a lot of a lot of studies looking at blood sugar variability have been done in Japan but they look at something called the Mage the mean amplitude of glycemic excursions which basically says how big are your spikes in blood sugar and the bigger your the bigger your spikes in blood sugar after a meal a car is correlated with those things we talked about pre-diabetes types diabetes so the bigger the spike the more likely you are to have pre-diabetes or types of diabetes or get those conditions but related to the brain specifically uh this was a trial of a of a drug to treat uh type 2 diabetes um and at the beginning of the trial they looked at Mage like how how big are this an individual's blood sugar spikes out of all the things they measured blood sugar spikes were the best predictors of cognitive function um I.E the bigger the spikes the worse the cognitive function but what's really nice and really important is that this effect was reversible so the greater that the more that somebody's spikes improved over the two-year trial the more their cognitive function improved so again it's one of those things where you know somebody could say well I have pre-diabetes it's going to affect my brain there's nothing I can do about it that's not true like there are studies that show this is reversible if you can improve your blood sugar control you can improve your cognitive function yeah I mean that's super powerful Tommy and again we're trying to close down this conversation there's there's new avenues being opened up all the time so we're gonna have to we're gonna have to commit on air to a part three at some point uh just to finish off the podcast is called feel better live more when we feel better in ourselves we get more out of our lives in the context of brain health right at the end of this conversation for people who want to optimize their brain health reduce how much it declines as they get older have you got any finer words for them yeah it all boils down to you know everything we've talked about in relation to the brain and the body um the the function depends on the demands you put on it and I mean that in a good way so do things that are difficult and then give yourself a period to to rest and recover um that's it really is it's fairly simple and it can you know anything that you enjoy you know if you can do it in a social situation maybe that's even better right there are benefits from from from social interaction so few times a week spend 20 minutes doing something that's difficult learning a new skill um and that's probably the by far the biggest change that you can make to really change the trajectory of your long-term brain health if you enjoyed that conversation I think you are really going to enjoy this one about the daily things you can do to lose weight and prevent disease I used to think you know weight loss is just about willpower it's about calories and calories out the energy balance equation is always true but people always misinterpret it to mean that just eating fewer calories leads to body fat loss it does not

Channel: Dr Rangan Chatterjee

Views: 115,838

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview

Id: P-s3UTa_qlQ

Length: 129min 44sec (7784 seconds)

Published: Wed Nov 30 2022