Episode 32: Reducing Dementia Risk - The Role of Diet, Sleep and Social Interaction with Dr. Tommy Wood

What do Bruce Willis, Ronald Reagan, Sugar Ray Robinson, Tony Bennet, and Gabriel García Márquez have in common? 

Besides being well-known worldwide for their talent in their respective fields, such as leaders, writing, music, sports, and acting, they also suffered from a common disease that regular people from all walks of life can be affected by: Alzheimer's and dementia.

According to the American Alzheimer's Association, more than 6 million Americans of all ages have Alzheimer's. An estimated 6.7 million Americans age 65 and older will be living with Alzheimer's in 2023. Seventy-three percent are age 75 or older. About 1 in 9 people age 65 and older (10.7%) has Alzheimer's.

In today's episode, our guest, Dr. Tommy Wood, assistant professor of pediatrics at the University of Washington, tells us how to decrease the risk of dementia through lifestyle choices to preserve cognitive function.

Dr. Wood, with his wealth of knowledge, helps us understand the importance of nutrition, physical activity, and sleep while emphasizing the significance of community and stress management.

During our conversation, we also touched upon the vital role of mental stimulation through hobbies and learning activities in protecting our brains from cognitive decline. We explore the possible benefits of creatine, choline, and omega-3s in concussion prevention and recovery. 

Tune in as we unravel the profound influence of lifestyle decisions on our brain health and risk of dementia.

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Transcript

Speaker 1: 0:05

Welcome to the your Lifestyle is your Medicine podcast, where we do deep dives into topics of mind, body and spirit. Through this conversation, you'll hear practical advice and effective strategies to improve your health and ultimately add healthspan to your lifespan. I'm Ed Padgett. I'm an osteopath and exercise physiologist with a special interest in longevity. Today we're talking to Dr Tommy Wood. He's an assistant professor of pediatrics at the University of Washington, where he studies brain injury and how lifestyle choices and environmental factors contribute to brain health, cognitive function and chronic disease. I thought he would be the perfect person to talk to about how we can tease out some of the research in cutting edge science to help stave off or prevent cognitive decline, aka dementia, as we age.

Speaker 1: 0:48

Today, tommy and I look at aspects of lifestyle medicine and what we can do with nutrition, exercise, sleep and community to protect our brains as we age. In the next 50 minutes, tommy tells us the essential nutrients our brains need to recover from injury. He tells us how much exercise we need and what we need to do to keep our brains from shrinking. He tells us why sleep is so important and how to improve it, and also how we are wired to be community animals and how being a lone wolf actually changes our body chemistry. Don't miss this one. It's a really special episode. So, tommy Wood, welcome to the show.

Speaker 2: 1:28

Thanks so much for having me really excited to be here.

Speaker 1: 1:32

Yeah, we're going to go through a lot of stuff in this hour, so we're going to be super quick and super focused. But I know that you can talk about any one of these subjects we're going to get into for hours and hours and hours. So I'm going to maybe ask you to sort of put your money where your mouth is and give us some actionable steps on these aspects of lifestyle medicine. So you're involved with lifestyle medicine in the UK, is that correct?

Speaker 2: 1:57

Yeah, a few years ago probably seven or eight years ago now I was involved as a founding trustee and I'm still a trustee and director of the British Society of Lifestyle Medicine, which is, I think, the fastest growing and maybe second largest lifestyle medicine society in the world right now, and working really hard to support lifestyle medicine around the world. So building these communities of lifestyle medicine societies within individual countries and helping other countries build their own lifestyle medicine societies, as well as trying to build out some educational processes so doctors can get diplomas and things like that and learn about lifestyle medicine.

Speaker 2: 2:42

So, yeah, it's kind of an exciting time because that's really a growing field right now.

Speaker 1: 2:47

It is, and the reason that I'm interested in lifestyle medicine to help people basically add health span to their lifespan is that I see there's kind of two silos in medicine. There's this more holistic approach, lifestyle medicine. Everything's interconnected. And then I think and you correct me if I'm wrong but in the future there's going to be more than nano medicine, where it's very sort of precise and the two are not mutually exclusive. But I feel as though, for me anyway, I'm putting my hat on the lifestyle medicine because I'm not trained and don't have the experience in the nano medicine. Is that correct, or am I oversimplifying things?

Speaker 2: 3:26

No, I think that's right. I would say that nano medicine is probably sort of an over specialization. I'd maybe zoom out a little bit and say personalized medicine, perhaps. So then we're talking about individual treatments based on genetics or a better understanding of some of these individual biomarkers. Nano medicine could go into that. So you know a targeted therapy to get the exact drug you want to, only the part of the body you want to get a specific response that decreases side effects and stuff like that. That's actually something I do do a little bit of work in as well, or my wife does, and I collaborate with her. She's the expert in nano medicine.

Speaker 2: 4:13

But there's two broad schools of thought there, you're right. So lifestyle medicine right now says what are things that we can do to, at the population level and the individual level, improve somebody's overall health and decrease their risk of chronic disease and or maybe even reverse or put into remission some chronic disease and those you know? I think those are the basics that we should provide to everyone. And then that's not always going to do the trick. There's not. Not every disease is going to be fully prevented, or, you know, there are some diseases that require a different approach, and that's what I think. Personalised medicine is then going to come to the forefront, but we're really right at the beginning of that, and so if you were kind of trying to get your biggest bang for your buck in terms of population and individual health right now, I think lifestyle medicine really is the place to focus.

Speaker 1: 5:09

Yeah, okay, good, we're in the right place. Okay, so we've got that. Lifestyle medicines that are tenants are nutrition, physical activity, sleep and recovery, avoiding toxic substances, stress management and community right. So there's a high level overview. So I want to take those and I would love to pick your brain about what we can do to help stave off. You know, basically the big one is any sort of form of dementia, and how do we do that using each one of these principles? So the first one is nutrition. So what's the science saying to help the average person now, or maybe even if they have the first symptoms of dementia, what do they do with nutrition?

Speaker 2: 5:48

I think that the simplest answer to that is to eat a nutrient dense, minimally processed diet, and there are just so many ways to do that, and by focusing on sort of the overall quality of food, we might then be able to skip some of the arguments about keto versus plant based versus carnivore versus something else. Right, because what I think most of those diets have in common is that, compared to the standard British or American diet is they are much higher in nutrients and they have far less, or maybe none, ultra processed foods, both of which, you know, avoiding one and getting more of the other are critical for long term brain and overall health. So that's where I would start. If you think about dementia and usually when people are asking dementia, they are actually asking about Alzheimer's disease, which makes up about 80% of dementia on average, particularly late onset Alzheimer's disease. So there's not a specific genetic cause for that, and that is, you know, probably 95 to 99% of Alzheimer's disease. So we're still talking roughly 80% of all dementia Then there are some specific nutrients that we can really focus on.

Speaker 2: 7:12

The first are B vitamins. There are some very nice studies looking at homocysteine levels. So homocysteine is a marker of overall B vitamin and methylation status and those who have elevated homocysteine, which is actually quite common, although that's come down a little bit after we started to fortify foods with B vitamins like photocacid. High homocysteine is associated with increased risk of dementia, as well as cardiovascular disease and a whole bunch of other things, and if we supplement with B vitamins and bring our homocysteine down, then we can decrease the risk or the rates of cognitive decline, decrease the rates of brain atrophy, which is basically your brain shrinking as you head into cognitive decline and dementia. The other side of that is omega 3 status. So there are now several randomized, controlled trials that say that you can't just have one or the other, you have to have both. So you have to have low homocysteine and you have to have adequate omega 3s, primarily going to come from fatty fish and or fish oil.

Speaker 2: 8:17

And one of the problems that we've had in the nutrition arena with cognitive decline and actually in general, is that we treat it like it's a single variable problem. Well, I'll take everybody and I'll give them omega 3s, and then I'll say, well, omega 3s don't work because we didn't decrease dementia, but that's because you didn't look at homocysteine and maybe some other things and all these factors interact, but those are probably the most important things, and then from there there's obviously a whole host of other nutrients that are interesting in terms of cognitive function and cognitive decline. Polyphenols from things like berries and coffee seem to be protective. Again, there's randomized, controlled trials.

Speaker 2: 8:57

Choline, which you primarily get from eggs and liver, also very important. Magnesium, potentially very important, but you'll tend to get more of these things as long as you just focus on a less processed diet, and it's these nutrients that tend to get removed when we do these, the sort of ultra processing of these modern industrialized foods. And then the other side is that if we eat more of those ultra processed foods, we have a higher risk of dementia. There's a number of reasons why that might be. It might be because you have larger blood sugar spikes and or other, and we haven't talked about blood sugar control, but that's an important part of nutrition.

Speaker 1: 9:41

How does the blood sugar spike sort of damage the brain?

Speaker 2: 9:46

That's a tricky question to answer and we're not sure yet that one spike in blood sugar really does damage the brain. It's probably a compounding effect of multiple things. So larger blood sugar swings tend to result in more being more likely to be hungry later, being less satiated, and so then you're more likely to over consume foods. Foods that are in that category tend to be low in protein. That also results in larger, larger blood sugar spikes or larger blood sugar swings. And we have a there's this idea of the protein leverage hypothesis we call it, which basically says that you have an amount of protein you need to eat every day and if you don't get enough, you'll just keep eating. You'll keep being hungry until you've consumed enough protein. So that's, that's another problem with those the.

Speaker 2: 10:47

The thing that we do know about blood sugar control and dementia is that the higher our fasting blood sugar and the higher our HB1C, which is a marker of longterm blood sugar control, the higher our risk of mild cognitive impairment, which is sort of the pre Alzheimer's disease, a change in cognitive function, and then Alzheimer's disease and dementia. So as we go into, say, pre diabetes or the type of diabetes, our blood sugar control worsens and that's related to a whole host of factors like sleep and physical activity and nutrient quality all the things we're going to talk about. Then we know our our risk increases. So there's there's several potential reasons why ultra processed foods might be associated with with worse overall cognitive function and increased risk of dementia.

Speaker 1: 11:32

So someone listened to this. We've got sort of two bits of advice for them. We can say okay, if you, if you haven't got any cognitive impairment, we recommend eating these non processed foods and avoiding processed foods. And if you have got some symptoms, some mild symptoms, of cognitive impairment, do they double down on those supplements that you mentioned, the mega three B vitamins, folate, cooling.

Speaker 2: 11:55

I would. In general, if possible, I would recommend testing. Yeah, you can test your HB1C, you can test your home assisting level. You can test your mega three level. It's fairly easy to get a hold of nowadays. The GP will do most of those if you ask nicely. So I would test and then figure out where you stand. That's the. That's the. That's the best approach.

Speaker 1: 12:19

You were involved with a company that did the testing, I believe, or you're still involved with them.

Speaker 2: 12:24

Yeah, I work with a company that does some at home testing called Thriver Um, but equally, if you can get it for free through your GP, I would recommend you do that. Yeah, um, uh. So anyway, that you can access those tests and then so say, if you're a home assisting is elevated. The sort of best evidence suggests that you would supplement with a B12, a B9, which is folate, um B6, and then potentially Riverflavin as well, which is B2. Um, and you probably only need ather around um the the sort of the recommended daily allowance, maybe a bit more than that. So not huge doses Um. Then retest a few months later. If you haven't come down, maybe increase the dose Um, that. That. That's the best approach.

Speaker 1: 13:09

Yeah, yeah, I did, actually did the inside tracker. They do 46, um biomarkers in the US and uh, I was surprised to find out I was low in magnesium, even though I was supplementing with magnesium. But uh, you know, typically when you get the supplements they say take three a day. I was like, well, I don't want to do that, I'll just take one. And it turns out I was about 60% down on what I should be. So if I took the other two tablets every day, maybe it, maybe it would have been better. But I've subsequently changed, retested and it's all back to back to normal.

Speaker 2: 13:37

Magnesium is. Is is tricky to test. Um, red blood cell magnesium is, is is okay. Or you can get total magnesium. That's all right. I did both In. In general, I would recommend a few hundred milligrams a day for most people. Um, so if you're taking one tablet and it's a hundred million, it's a hundred milligrams. It might not make that much difference. Um, but yeah, uh, a higher dose for most people seems to do the trick.

Speaker 1: 14:03

And I've seen you um on a podcast with Paul Saladino, the carnivore MD, and Rich Roll, a um plant-based athlete and podcaster, and I thought it was really nice the way there's actually a lot of common ground between, like a carnivore diet versus a um plant-based diet. But interesting when you're talking about some B vitamins, the amegas, the colons, they seem to come from from animal products.

Speaker 2: 14:33

Yeah, um, and I think that the smartest people I know in the, the plant-based world of which there are many um, and I believe they're doing good work they would recommend either testing or supplementing with some of those key nutrients that you might uh be less likely to get on a plant-based diet, particularly B12. Um, but some of those other things may be, you know cause you're probably gonna get. If you're eating lots of greens, you'll probably get plenty of folate, um, but similarly, you know on, on any diet it's possible to not be getting enough of what you need. And then, you know, a testing and supplementing appropriately, I think, is perfectly, perfectly reasonable. Um. Other things we haven't talked about vitamin D, iron level, uh, both of those very important for for dementia risk. And if you have low iron or you're anemic, uh, or you have low vitamin D, there's both also associated with increased risk of dementia. And those are easy to supplement with. Yeah, easy to supplement with and easy to test, uh, most doctors will, uh, will, will test those.

Speaker 1: 15:36

And they will help methylation. Is that correct?

Speaker 2: 15:39

Most of them do Uh. Choline and the be? Uh. Most of the B vitamins I mentioned do Uh. Creatine is another favorite supplement of mine that is also involved in in methylation and it really does seem that methylation is is a critical component of of long-term uh long-term dementia risk.

Speaker 1: 15:57

Can you just explain what methylation is to the layperson?

Speaker 2: 15:59

Yeah, it's essentially um. Well, so a, a methanol group is one carbon with three hydrogens attached. That's it's most like the most simple, most simple explanation. But what it is is it's just a tag that gets kind of moved around. It does a whole bunch of things.

Speaker 2: 16:18

So, um, it's added to molecules as part of biochemical cycles, it's added to DNA as part of epigenetic regulation, which basically says, you know, turning genes on and off.

Speaker 2: 16:30

So it's essentially just this simple tag that the body uses, uh, uses, to say, you know, we'll now use this molecule for this thing or we'll now turn this gene on or off, um. And if we have issues with methylation, so either we use this recycling some of those groups or being able to attach or detach those groups as we want, you know, then we, you know we, we can't manage our metabolism or gene expression in the way that we'd like, um, and one sort of Catchable output from that system is home assisting. So if you're not able to uh run your methylation system as you might like, then home assisting tends to go up. So that's why it's so. It doesn't tell you where the issue with it is necessarily Um, but it's kind of a good catch, all marker to say you know, this is something that you know, maybe I should think about. And new, new, new nutrition and or supplementation is usually the first place to start.

Speaker 1: 17:20

You work for your, your consultant for a company called HINSA, and HINSA, uh help train people like myself to become HINSA performance coaches, which help people use aspects of lifestyle medicine um to increase their performance. And as part of that, you give us some lectures, and one of the lectures you gave us mentioned about how blood sugar can actually be affected by the person's belief in what they're eating. I thought that was fascinating. Can you just can you tell us a little bit about that study?

Speaker 2: 17:48

Yeah, it's become very sexy recently to track your blood sugar all the time. Continuous glucose monitoring you get these patches Depending on where you're based. You know there are apps that can do it and or doing it as part of research has become quite a big thing, and I believe that it's. You know, managing blood sugar regulation is important. I've already mentioned one of the reasons why that's the case. However, there are a whole bunch of things that affect that, and there have been some recent studies that suggest that if you take the same person and you feed them the same meal a week apart or two weeks apart, they will have completely different responses in terms of blood sugar to that same meal. So it's incredibly variable from person to person and we don't always know what that within the same person to the same meal over time, and that's related to how you've slept, what time of day it is, whether you've exercised before or after. So it right now it's this really complex sort of moving target that I think is probably too much for most people to worry about, and one of the other reasons that I think that most people don't need to focus on this is because there is a, there becomes a stress and a lot of people associated with tracking this, and I've seen this in some of the clients that I've worked with. They, like they become that they see a spike in blood sugar which is, like I mentioned earlier, like one spike. Depending on the size and the frequency, probably not a big deal, but we're kind of becoming conditioned to think that blood sugar going up is all of a sudden a bad thing and they get stressed about it and that probably makes the sugar spike go up even higher, because as you get stressed, you release adrenaline, you release cortisol. Both of those things drive your blood sugar up. So the stress itself, you know, as well as because of other things, is probably worse than the blood sugar spike.

Speaker 2: 19:47

And so then this brings me up to the study you're asking about, where they gave. These are diabetics, so they're already very conscious about their blood sugar, and they gave diabetics two different milkshakes. One was a high sugar milkshake, your mom was a low sugar milkshake and they looked at their blood sugar responses over time and they showed them the nutrition label. You know, this is what you're about to drink. This is how much sugar sugar is in it, and these people have to have some idea of how that's going to affect their blood sugar, because you have to track your blood sugar with your diabetic and, as you would expect, the high blood sugar milkshake calls the bigger spike in blood sugar. The twist is that it was the same milkshake both times.

Speaker 2: 20:35

So the expectation and maybe even a bit of stress, because you know if you're managing your blood sugar, then anything that's going to increase your blood sugar you have to think about. Do I have to do this by insulin or do something else? You know all that is sugar bad for my diabetes. You know all those things come into play. So it's probably partly driven by a stress response. You can see that manipulated blood sugar, more so, actually, than the milkshake itself. So there's a number of reasons why. Yes, blood sugar is important, but I think we've gone to the point where we're over focused on it and it's started to become a stressor for some people, which I would argue is probably a net negative.

Speaker 1: 21:13

Yeah, how interesting. I think like I had the whoop wristband for the year and it was a stressor After a while when I wasn't getting the green recoveries. I was like wondering what's going on.

Speaker 2: 21:25

You know that obviously led to less green recoveries and yeah, I had the same experience with with with an aura ring. I think it's worth saying that. I think some of these data can be really helpful. But the ideal scenario is that I collect my data and I never see it, but say my coach or somebody else sees it and helps me integrate it over time. Like that, I think, is the perfect scenario, rather than you know, like you sleep terribly and the first thing you do is you open up your whoop app and see, oh, I slept terribly last night. So actually the same.

Speaker 2: 21:59

Now is another study related to that. It was the same group at Harvard that did the milkshake study. In this study, what they did is they took people and they had them sleep in a lab and they had them either sleep for five hours or eight hours. But what this group likes to focus on is the manipulation of clock time. So they randomized half the people to be told the opposite of what they actually slept.

Speaker 2: 22:25

So some people slept five hours and were told they slept eight hours, and some people would slept eight hours and were told they slept five, and what they saw was that the amount of sleep you thought you got was a better predictor of your cognitive function and and like how sleepy you felt the next day than the amount of sleep you actually got. So I can just imagine where you open your app and it's like, hey, you slept terribly last night. And then that becomes a self fulfilling prophecy. You think, well, I'm gonna, just my brain's not going to work, I'm going to be tired, and it's all because of your expectation rather than necessarily because of how you actually slept. And so, again, I think these data are interesting, but we just have to think about how it affects our psychology and our physical, and our psychology affects our physiology as well.

Speaker 1: 23:13

Exactly, it's a two way street, isn't it? Yeah, yeah, all right. Well, you know we need to. If we're going to get through all six, we need to move on. I don't know if we're going to. We're going to make it All right. So, physical activity everyone knows they need to do something. Aerobics and strength work maybe. What's the research saying that we should be doing? Let's say, someone's 40 years old and up, what's the research saying they should do to stave off all cause mortality or dementia?

Speaker 2: 23:41

Basically, the fitter and stronger you can be, the better, and there's vast amounts of research that support that. When you look at how much is enough, there have been some nice meta-analyses of studies that suggest that basically hitting the standard government guidelines for physical activity like 150 minutes a week of moderate to vigorous physical activity that's the minimum effective dose to significantly improve cognitive function, so achievable by anybody, and it's all sort of you can just think of an equation in your head. We don't think about an equation, but you just think about, right, the more intense it is, the less I need to do. The less intense it is, the more I need to do. So if you're going to do some light gardening, maybe you do an hour a day and that's your quota for the day. If you could do some sprinting, five minutes is probably enough, and in terms of how they affect the brain, those things are roughly equivalent. So then you just kind of you can patch together little bits of movement depending on what it is that you like to do. Interesting.

Speaker 2: 24:52

Okay, there are some interventional studies, because some of that data is epidemiological. It's like asking people how much exercise they do and looking at their cognitive function and that's kind of confounded by other things, like people who come from a higher socioeconomic status background are more likely to do exercise, so you kind of have to. For various reasons they have more time or resources, so you kind of have to account for some of that. But in trials they've shown that if you do something like a brisk walking, intervention seems to be protective of the hippocampus, which is an area of the brain that's important for memory and is affected by Alzheimer's disease. And that was just 40 minutes of brisk walking three times a week, which they did for a year. There was probably slightly more impressively, there's been a couple of studies looking at resistance training. So, depending on the study, two to three times of like going to a gym picking six to eight weights, machines, doing three sets of eight to 12 reps just like super standard resistance training approach that's associated with improvements in structure and function of many areas of the brain as well as cognitive function. So if you're then trying to kind of put together a bare bones plan, I would say some kind of aerobic activity two or three times a week, some kind of resistance training activity two or three times a week, 30 to 45 minutes each time, and the final piece is that, in general, the most protective physical activity for the brain is that which includes some kind of coordination. So nice evidence of things like yoga, tai Chi and it's probably because that coordinates of component provides an extra stimulus to the brain.

Speaker 2: 26:48

And I think one of the most important, if not the most important thing for maintaining cognitive function long term is to keep stimulating your brain by doing new and challenging things. So those kinds of activities are really important. So you could have extra sessions right. Well, on top of everything else, you do some yoga as well, but yoga adds some muscle strengthening and your aerobic activity session could be badminton rather than going for a run, and then you have that coordination component. That that's important.

Speaker 2: 27:20

So it's not that you need to do separate sessions for all those things. You can often tick multiple boxes at the same time. Like dancing gives you physical activity, it gives you social connection we haven't talked about that, but that's important and it gives you coordination. So it gives you a whole bunch of things and there are some studies that suggest you know, if you're looking at the structure of the brain and you make people do either dancing or some kind of unimodal circuit training or something, the dancing is better, probably because you're doing all those different things at the same time, so you can tick multiple boxes within single activities if you're crunch for time.

Speaker 1: 27:55

Yeah, I remember you saying about how you know, even if someone loses their hearing, it's a decreased cognitive activity because they're not getting that stimulus and that can help the. That makes the brain atrophy slightly.

Speaker 2: 28:07

So yeah, so what? Why you're saying that that those are very important things in it. It doesn't really doesn't quite fit within the the lifestyle medicine framework, but maintaining those inputs is really important. So, if you have cataracts, get cataract surgery. If you have hearing loss, get hearing aids, because we know that those that can help stave off an increased risk of cognitive decline if you start to lose your senses, particularly in those at high risk.

Speaker 1: 28:34

I got a quicker side, so I thought I'd just dabble with some psychedelics. A couple of years ago and I took the ayahuasca, which is South American plant and vine, and it can give you a hallucinogenic experience and during it you sort of get into a dialogue with whatever the voice is and and it was saying to me okay, so you're an astropath, you use your hands to help people stay as well, and how does that work? You're not changing the. This is saying you're not changing the ligaments under your fingers. I'm like, no, it doesn't work like that.

Speaker 1: 29:04

I think it's probably a pressure input that goes up the nerves, the brain, and somehow the brain modulates the reflex. And the ayahuasca says, okay, so how does hearing work? I'm like, well, sound wave goes in, turns into electrical impulse in the brain. Because, yeah, how does smell or how does taste work? How does it's the same thing. It goes in, it's an electrical impulse, turns around, comes out as a reflex. And so I was like, okay, yeah, we're on the same page. And the ayahuasca says so why are you limiting yourself to just a physical input? That's not going to help people as well as if you do all the senses. And I was like, oh geez. And then I said how do I do that? And the ayahuasca said you got to dance with your clients. That's what it was saying. And there you go, there it is. I mean, if you get the music and maybe there's a smell or a color, you got all the stimulus.

Speaker 2: 29:50

It's a very human thing to dance and I think, when you boil down these important inputs to the brain, the ones that are the most protective are these sort of like core human traits, like language, music, dancing, and I think that's something that we've sort of lost. But now, you know, in the in the era of evidence based medicine, we're now starting, you know, even though intuitively we could think, well, yeah, it makes sense that that would be important, now we're starting to see some, some good evidence to support that as well.

Speaker 1: 30:24

Yeah, I think so. I think that's the medical model, right. We have to dissect it, reduce it down to its components and then build it back up until we're happy that what we may have known intuitively before would now we can prove it. Yeah, yeah, all right. So let's move on to sleep and recovery. Sleep is important, as we think it is.

Speaker 2: 30:42

Yes. Okay, tell me that there are a couple of different aspects to that If we try and think about putting together this model of how the brain works so that we can maintain its health long term. We've kind of mentioned that these critical stimulating inputs probably regulate a whole bunch of the main processes in terms of maintaining brain function.

Speaker 2: 31:14

When you stimulate an area of the brain, it then needs to recover. It undergoes plasticity, maintaining, developing connections, maybe bringing in new cells either bringing in or making new cells. That critical period of adaptation happens during sleep. There are some studies that suggest that if you stimulate one area of the brain, that area of the brain then sleeps more or sleeps differently afterwards because it is then actively recovering from that process. We have to provide that period for the brain to adapt and recover.

Speaker 2: 31:54

There are lots of epidemiological studies that say that if you're regularly sleeping less than six to seven hours a night, that's associated with an increased risk of dementia. Low or poor sleep quality is probably also as important as quantity, but quantity is easier to measure and change. Give yourself enough time and bed. Give yourself enough sleep opportunity. People who are regularly resorting to medications to help themselves sleep or their report waking up several times during the night, that seems to be associated with a high risk of dementia as well. One common risk factor for that is sleep apnea, which is again associated with particularly obesity or other body composition changes that then make it harder to keep your airway open as you sleep. That's something that people should just keep an eye on. If you are doing blood tests, your hemoglobin, which is a measure of your red blood cells, is going up. That is often a sign of sleep apnea, because what happens is you get hypoxic at night. Your body tries because of your hypoxic, your body tries to make more red blood cells to deliver more oxygen and that causes your hemoglobin to go up. It's very common we'll see, particularly in older men, if their hemoglobin starts to go up it's because they are sleep apnea.

Speaker 2: 33:15

I think there are other reasons why sleep is really important. Short-term sleep is associated with cognitive function a whole range of them reaction time. We know that cognitive function decreases pretty rapidly, certainly with complete sleep deprivation, but also chronic sleep loss. Other important aspects, like people who are sleep deprived are less empathetic. They are more likely to respond negatively to others. The amygdala becomes over-activated. That's the area of the brain that fights flight or fright. You're more likely to have a negative response to something. Normally you just let it wash over you, but if you're sleep deprived, the amygdala lights up and then you're more likely to get angry or wound up or have a negative response or interaction. Short-term and long-term sleep seems to be really critical for cognitive function and then dementia risk.

Speaker 1: 34:19

I think you shared a study with us on sleep masks as well, saying that sleep mask can change things.

Speaker 2: 34:25

There was a nice study done over in the UK and they had two cohorts of students. They looked at them, particularly in the summer, where light the sun is either going to rise early in the morning or it's going to be not set yet when they go to bed. The sun is going to be potentially affecting sleep. And then they had them wear either a Zorro mask, where they had the feeling of wearing a mask but the eye holes are cut out so the sunlight can still get into the eyes or a sleep mask that completely covered their eyes, and they found that those who slept with a sleep mask had particularly improved reaction time the next day Psychomotive vigilance is the fancy term for that and I think they also had some improvements in memory retention. So if you are unable to keep your bedroom completely dark alarm clocks, lights and other things, street lamps outside then a sleep mask is a really easy way to get around that. I sleep with a sleep mask every night. It's just become a thing that I do.

Speaker 1: 35:32

Me too, and I have earplugs and a sleep mask as well.

Speaker 2: 35:36

I prefer white noise to earplugs or some kind of either a fan or air conditioning or something like that.

Speaker 1: 35:44

Well, I live in Nicaragua, so I've got the fans, but they're so loud because it's so hot here that I don't like sleeping with AC. So I've got a bit of everything. Okay, let's move on. There's one called avoiding toxic substances, one of the tenants, but I think we can come back to that one because it's a bit more obvious for most people. But I wanted to get into community, because lifestyle medicine it talks about, you know, sleep and nutrition and so on and everyone's like on board with that. But then community is a harder one for people to actually realize that it can affect their health and their longevity. What are the studies showing around community and how can people help that?

Speaker 2: 36:24

There are again some quite large meta analysis studies of many studies looking at social support and social connection and risk of dementia, and essentially the risk goes in both directions. So if you're well supported, you feel like you know you have good social support. In a way, they measure that like your subjective feeling of social support. So how supported do you feel? You know, in a time of crisis, do you have somebody who you can talk to? You know, do you have a partner that you live with? Those kinds of things? That's associated with a decreased dementia risk, whereas the opposite is also true. If you feel socially isolated, you don't have that kind of social network or it's a poor quality social network, then you have an increased risk of dementia.

Speaker 2: 37:13

I think there's just a whole range of reasons why this is probably the case. So interacting with other humans is one of those critical inputs that the brain relies on in terms of overall cognitive function that we mentioned earlier. And it's just not the same. If you're just, like you know, watching TV or something else, you need that two way interaction. And similarly, like often, people will say well, I retired, so I'm going to start doing some crosswords and Sudoku and that's going to stimulate my brain and those things seem to be more of like a meditative stress reduction practice. So it's not that they're not good for the brain. Like that can be beneficial in terms of reducing stress and having sort of like more kind of like mindfulness, but it's not directly stimulating the brain as it would be if you're having a conversation like we are. So that's one part.

Speaker 2: 38:10

But then there are these pretty well defined now responses to good social support and lack of social stress, or the opposite being that if we are socially stressed, particularly if we feel isolated, it has direct effects on our physiology. So activate stress responses, it activates inflammatory responses and this is this evolutionary aspect of survival. So if you're alone, you, your body, needs to respond to different threats than if you're living around and supported by other people. There are threats in both. Like if you're living in a community, you're more likely to get viral infections, you know cold things like that that pass along. But if you're out isolated alone in the wilderness, you're more likely to die from like a bacterial infection or a cut or something like that. So your immune system shifts accordingly. In the long term, that shift associated with isolation is sort of provide this chronic pro inflammatory status and is associated with a whole host of sort of cardiovascular and other chronic diseases.

Speaker 2: 39:20

So I just did a whole special issue of the lifestyle medicine journal that I helped to edit with my friend, dr Julian Abel, who's a he's a planet of care doctor in the UK, an expert in the effective community and social connection on health, and we essentially got all the experts in the world on this field to write papers and they're part of the special issue. But there's one in particular, written by George Slavich, who's at UCLA, that looks at how does social isolation and social stress affect your physiology, how does it affect your gene expression, how does it affect you know information. It's a really cool paper so you can kind of look at these direct effects on our physiology from being socially isolated or not having that kind of human connection. This translates to long term chronic disease risk. So elevated inflammation, systemically elevated cortisol, other stress hormones we know those things are associated with high risk of dementia in particular, because that's what we're talking about as well. As you know, you've lost those critical connection inputs from interacting with other people.

Speaker 1: 40:33

And in your day job you're helping neonates and infants rebuild brains and the sort of act of growing up and going through those developmental stages is a huge input to a brain. And when we tell older people who maybe think about retiring to keep stimulus and just keep their brain stimulated, and we say, do a crossword or do a puzzle, these two things aren't on the same level, are they?

Speaker 2: 41:04

No, absolutely not. And that's kind of informed how I think about the brain, because if you think about the things that are required to build a healthy brain or, say, repair an injured brain early on, we know that supportive environment and there's various ways to manage that, but it's generally related to education and other inputs has a huge effect on recovery as well as the initial development of the brain. And when you then look at cognitive function across the entire life, what happens is that cognitive function essentially peaks around the time that formal education ends. So you have spent the first, depending on who you are 12, 14, 24, 30, in my case.

Speaker 1: 41:57

Yeah, you're okay, I was a perennial student.

Speaker 2: 42:02

You spend this period of time where basically you are a full time learner, you know, first you're learning to walk and talk and social interaction, you know. And then you're learning some maths and then you're learning some biochemistry and at some point maybe you're learning to drive. But it's just this concerted period of you know one to three decades where all you're doing is stimulating your brain, essentially that that's your job. You know in most, in most situations Though not everybody gets that situation all those sort of benefits, privileges, and then at that point, once formal education stops, then your cognitive function just decreases over time on average, and we put that down to aging around.

Speaker 2: 42:46

My brain is getting older. It doesn't work as well. I would argue that it's flipped. It's that we use, we stimulate our brain less, we teach it fewer new things, we do fewer challenging things, which we love to do as kids. Right, because we want those inputs.

Speaker 2: 43:02

It's almost like in our genes to go out and experience the world and get those inputs, whereas when you're an adult you go to work, you do the same thing again and again and again. You specialize more and more and more. In general you feel busy because you got emails and files to put out and everything every day, but it's just not the same. So I would argue that one of the primary drivers of cognitive decline is the fact that we stop using our brains in that way. So when you then retire, there is some evidence to suggest that that's the period of the fastest. Cognitive decline is right after retirement, because you do get some stimulus from your work and then you remove it, and then if all you do is a little bit of Sudoku, it's just not enough to make up for it, and my colleague, dr Josh Turkan and I wrote a paper about this that came out last year. We've got lots more papers coming out on it because we're quite passionate about this idea.

Speaker 1: 44:00

This was shown with the amateur versus professional musicians. Yes, there was a study on that. Can you tell us about that one?

Speaker 2: 44:08

Sure. So there's a machine learning algorithm that they use on MRI scans. It's now been used in, I think, hundreds of studies and it's called brain age. And so if you train up this algorithm with thousands of MRI scans and then you take a new MRI scan and you say, how old does this brain look? Right, compare it. If you've looked at all these brains, you've trained it on brains across a whole range of ages, and in this study what they found was that musicians of the same age as controls you know, normal people had younger looking brains. I think they in general this group was sort of in their 30s. But amateur musicians had even younger looking brains than professional musicians.

Speaker 2: 44:58

And the hypothesis posed by the authors is that learning a musical instrument is hard. It's this critical additional input that the control group weren't getting. But for an amateur it's even harder. Right, once you're a professional, it's sort of it's all happening by. You know a lot of its reflexes, it's just habit, it's just happening, whereas when you're an amateur you have to work much harder to get a good, a good, good performance, say. And that was associated with an even greater benefit. And there are similar studies around language. So people who grew up. Bilingual seem to have protection of some areas of the brain associated with lower risk of dementia. So all of these critical inputs can can provide this resilience and improved function throughout life.

Speaker 1: 45:50

So the take home here then is to say if you're getting towards the end of your career, don't just sit and watch Netflix. You got to take on a hobby that's mentally challenging to keep the cortex kind of stimulated.

Speaker 2: 46:03

Absolutely. And then, when you get good at that, do something else that you're bad at. So it's I mean, it's nice to be good at things, and often we can do that in a social situation and go and meet other people. Right, that can build our community, that can manage our stress, that provides, you know, these sort of challenging inputs to the brain. So keep doing things that you're good at. That's also important because it's enjoyable, but always, you know, occasionally do things that you're bad at, because that's this novel stimulus to the brain that I think is is a very important thing, but I think is is really critical.

Speaker 1: 46:35

Okay. So I don't think we've got quite enough time to get into stress management, because that's a huge topic. And the toxic substances, you know, I think people know not to smoke and drink too much alcohol, but there was something that when I was researching this for this podcast concussions came up and I was like, okay, this is an interesting one because this isn't a toxic substance, it's not, it doesn't fit anywhere else, but it's a could be a sporting thing as a youngster. And in there you you've talked about creating as being slightly protective of a brain that may come under stress of a concussion. And you mentioned creating in the nutrition is, if I've got that right, is it protective or is it something that just changes with people who have concussions?

Speaker 2: 47:16

Yeah, that's an interesting question and you're right, that sort of injury to the brain is, is it's whole separate factor? But you can, you can almost build it into the same model, because when you into the brain you probably trigger some kind of inflammatory response. And and one thing that we see with the brain is that if you injure it, you have, you can have inflammation in the brain for decades, but they just, it just keeps on going. There's these immune cells in the brain called microglia that just get angry and they stay angry and when they do that that can eventually cause damage, damage in its own right. So there's things like that, that and then when you're doing that, you are preventing this ability to adapt and respond to inputs. So it you can kind of fit it into the same model as well. As you know it affects, you know how well the neurons use their energy and all these other kinds of things.

Speaker 2: 48:12

Creatine, I think, is important. So there are a couple of studies where they looked at creatine in people's brains and you can measure it on a certain type of MRI scan called a magmatic, magmatic resonance spectroscopy scan or MRS scan. You can look at things like colline and creatine in the brain and they looked at high school American football players and over the course of the season, the more collisions they were involved in, the greater the decrease in creatine and colline in certain areas of the brain. And Nobody has really used then creating supplementation to say, well, this decreases your risk of concussions or the negative effects of concussions long-term. But we do know that in animal studies if you give them a similar amount of creatine as you might take as an athlete and then you expose them to a traumatic brain injury, that creatine is protected. So there's kind of two parts of it. One we know that concussions maybe decrease or impacts of the brain decrease, creatine Decreasing.

Speaker 2: 49:20

Creatine may be part of what they call second impact syndrome, which is when you have one hit it doesn't have that much of an effect, but when you get the second hit it has an outsized effect. You're like, well, that wasn't really that bad of an impact, but all of a sudden this person has much worse symptoms and it may be because you've sort of depleted some of these protected factors in the brain and then the brain gets injured again. So I think there are a few things that are potentially beneficial here. So creatine is one, choline is another, and choline has been used in some randomized controlled trials after traumatic brain injury and has been shown to improve particularly neuropsychological outcomes. So there's randomized controlled evidence for it. Omega-3s there was a study again with American football where they supplemented with DHA across the season and there was less of an accumulation of a marker of a neuronal injury in the blood over time. So again, omega-3s fish can be really important. So some of these basic nutrients that we mentioned earlier, it's the same things that are important in both settings.

Speaker 1: 50:25

And, as I understand it as well, if you have a concussion, that's gonna help on the building the brain. But then it's avoiding some things as well, like fatty foods, bright lights, too much computer work and so on, in the acute phase anyway.

Speaker 2: 50:40

Yeah, some things. So if somebody is recovering from a concussion, some other things that are important are early return to physical activity, but up to a threshold that doesn't make your symptoms worse. So the sooner you can get moving again, do some light aerobic activity, that seems to be protective. Most of those studies come from the sort of pediatric or teenage population rather than adults, but it seems we kind of think it's gonna be the same in adults. But as long as you're not exercising enough to make your symptoms worse, blood sugar control is probably gonna be really important. So again and there are lots of animal studies that show if you increase blood sugar around the time of a traumatic brain injury or afterwards, you can have a greater injury.

Speaker 2: 51:26

And temperature is another one that I'm sort of I often get on my third box of bags. I did my PhD on temperature after brain injury. So basically preventing a fever after a concussion is really important, because if you get a fever after a concussion, that can worsen the brain injury because you essentially increase an energetic deficit in the brain. When you increase temperature your metabolic rate goes up, but you've created an injury that decreases your ability to generate energy in the brain and so you kind of increase the gap there and that can make the injury worse. So avoiding getting too hot and or taking things to decrease the fever, like paracetamol or something like that, really important particularly early on the first sort of two or three days after a concussion Perfect. Okay, tommy, thank you so much for dropping some knowledge bombs on us here.

Speaker 1: 52:18

I know that you're a busy man and you've got to get on, but where could people find out more about you? If they listen to this podcast, they're like, oh, he's an interesting guy.

Speaker 2: 52:29

The best place is usually Instagram at Dr Tommy Wood. On Instagram, if you go there, or to my website, which is drtommywoodcom, you can find my podcast called the Better Brain Fitness Podcast, which I do with Josh Turkinet, who I mentioned earlier, and it's a Q&A format. So you can go to the podcast website. You can either record a question or you can type in a question and we answer questions that we think sort of people, the generalist and the ship will be able to answer questions that the generalist and the ship will be interested in. And then we also do some other things, like sometimes we do a little journal club and talk about recent papers and sometimes we have guests. But in general, if you have a question about any of the stuff that I talked about today, check out the podcast and or ask us a question and we'll try and get to it. Great Thanks for being on the show, tommy. Thanks so much for having me.

Speaker 1: 53:20

Thank you for joining me in my conversation with Tommy Wood. If you're enjoying listening to and learning from this podcast, please leave me a comment and you can leave a suggestion for a future podcast guest that you would like us to feature. In addition, on Apple, you can leave us a comment and up to a five star review. Now, in case you didn't know, I actually help people using the tenants of lifestyle medicine to recover from illness and injury, and if you want my direct help, you can send me an email, ed at edpagetcom, or visit my website, edpagetcom, once they can also sign up my weekly newsletter, which is packed full of great advice about using lifestyle medicine to add health span to your lifespan.