← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Stop Overthinking Your Workout: Your Brain Just Needs You to Move with Dr. Tommy Wood
01:28:31
Did you know that moving your body is just as crucial for your brain as it is for your muscles? Dr. Tommy Wood explains how physical activity is a non-negotiable for cognitive health. Watch the full episode at https://youtu.be/nJhZnzvW-DU
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- [00:01]
A
I think we appreciate that the most important driver of physical function is how we use our bodies, right? If we want to get stronger or fit, then we need to train, we need to lift weights or we need to go running. And the brain is essentially the same. I think that we've gotten to the point where we're so worried about challenge and stimulus and stress that we're now avoiding things that actually drive increased capacity. And that creates a vicious circle, right, so that we have less capacity, we're less able to tolerate things, we do less, and that's what then results in a decrease in function. So the Norwegian 4x4, for those who aren't familiar with it, is 4 minutes, 85 to 95% of maximum heart rate. And then in this study, they took a break for three minutes, and then they do that four times over. And they did this three times a week for six months.
- [00:49]
B
Three times a week.
- [00:51]
A
Yeah. And so if you've ever done this, this is like. And these are like, these are adults in their 60s. This is a fairly intense training program. Neuroscience has, in general done a really bad job of studying the female brain over the past decades. For every one female animal included in a neuroscience study, there were six male animals. Right. Which, long story short, is complete nonsense. Like an analogy I use is if you looked at heart surgery halfway through, it would look like murder. Right? The chest is open, there's blood everywhere, all this kind of stuff. But know, long term, that has a really important, like, therapeutic benefit. And so the same is essentially here.
- [01:35]
B
Hello, my friends. Welcome back to another episode of better with Dr. Stephanie. It's me, your host as always, Dr. Stephanie Estima. If you thought that taking care of your physical body and your brain was complicated, this episode is going to change that for you dramatically. We are talking today with Dr. Tommy Wood and we are talking about how we can do things with our physical body. So aerobic activity, anaerobic activity, resistance training, with our nutrition and with our cognitive faculties, what we have right now so that we can protect our brain in the context of aging. So a little bit about Dr. Tommy Wood. This is his second time on the podcast and he is a neuroscientist, a performance consultant, and elite level professional nerd. My kind of nerd, ladies and gentlemen. He is an associate professor of pediatrics and neuroscience at the University of Washington, where his research focuses on brain health across the lifespan. Tommy holds degrees from the University of Cambridge, Oxford and Oslo, and he is a director of the British Society of Lifestyle Medicine, head of research for food and for the brain and the co host of the Better Brain fitness podcast. So, as I mentioned, we talk all about different types of activity that recruit the neuromusculoskeletal system. So we talk about walking, we talk about sprinting, we talk about aerobic activity, anaerobic activity, resistance training, and we talk about something called coordinate coordinative exercises. So open skill versus closed skill exercises. So listen out for that. And then we get into nutrition. What are some of the nutritional components that we want to make sure that we are including in our diet over the course of a day, a week or a month to make sure that we are supporting our brain in the way that we want? And then we get into the differences in terms of how the female brain ages. And he admits that neuroscience is absolutely terrible at this, but we are getting better at it. So we discuss some of the changes that happen in the perimenopausal and menopausal transition and some of the things that we can do to increase the cognitive demand of the brain so that it can function well into our 60s, 70s, 80s, 90s. So I think that you are going to find this conversation incredibly interesting. Tommy's like a wonderful speaker. He explains research incredibly well. If you're watching this on video, please watch out for my my face when he talks about the Norwegian four by four study. And if you are listening to this on audio, just know that there was my eyes turned big like saucers. I could not believe what he was telling me. Uh, so make sure that you listen out for that. There's a little Easter egg that I'll pop in here for you. And without further delay, please enjoy my conversation with Dr. Tommy Wood. February always feels like that. Weird in between month. Winter's still here, energy's still a little lower, and most of us are cr something that actually helps us unwind without stealing from tomorrow. That is where peak comes in. It's aspirational wellness for people who care deeply about how they feel in their bodies. Not just for tonight, but for the next morning too. Their newest creation is called Vesper and it's designed specifically for the evening ritual because, let's be honest, for a lot of women, winding down still defaults to alcohol. And while it might feel relaxing in the moment, it often comes with fragmented sleep and low grade anxiety the next day that only alcohol uniquely brings. Vesper was created as a better option. It's a non alcoholic adaptogenic aperitif that helps you relax without dulling your nervous system or compromising your sleep. What I notice first is how physical the calm feels. My shoulders drop, my jaw unclenches, my mind slows down. And that comes from ingredients like L theanine and tart, cherry and lemon balm and elderflower. It's nervous system support that you can actually feel. Vesper also includes damiana, which supports that warm, open, receptive state which is perfect for date nights, if you know what I mean. Cozy dinners and just being more emotionally available without needing a drink. And the flavor, ladies, Gorgeous. It's sour cherry up front, layered with grapefruit and bitters. Finishing clean and herbaceous. I actually love it. Over ice in a wine glass with some sparkling water. Put my phone away. Candlelight, slow slips, it's divine. You'll wake up the next morning feeling clear headed, well rested and genuinely glad you chose differently. If you want to redefine your evening ritual and still feel like yourself the next day, you can get 10% off. For life. Yes, for life. @peaklife.com better. That's P-I Q-U-E-L-I-F E.com better. Your nervous system will thank you. All right. Dr. Tommy Wood, welcome back to the show. I'm thrilled to have you here today.
- [06:23]
A
Thanks so much for having me back. It's always such a pleasure to see you and I'm really glad to be here.
- [06:26]
B
Me too. So the first time that you came on the show, we talked a lot about memory. We talked a lot about cognitive decline, specifically as it relates to concussion. What happens to the brain, the differences between the male and female brain when they're concussed. And we have you back on today to talk about your new book, the Stimulated Mind. And in the book you outline a couple of different tenants that are important for the brain aging well. And I'm going to pull out the first two because I think that my audience is going to really resonate with them. The first is move. The second is nourish. So this idea that physical activity is not optional for the brain, and I've heard you talk about this parallel with muscle and the brain. So I was wondering if you might just start there, talk to us about the relationship between the muscular system, maybe the neuromuscular system if you'd like, and how that influences brain function, this is
- [07:24]
A
important on a couple of different levels. So the first is that when we think about physical fitness and physical performance, strength and power or cardiovascular fitness, I think we appreciate that the most important driver of physical function is how we use our bodies, right? If we want to get stronger or fitter Then we need to, to train, we need to lift weights, or we need to go running. And the brain is essentially the same. So if we want our brain to improve its function, we need to think about the ways that we use and challenge our brain in order for its function to be enhanced. And that's the same if we want to maintain function late into life and ideally remain cognitively sharp into our 60s, 70s and 80s. And when you look at the, the kind of the biochemical processes that's happening in muscle tissue when you lift weights or you go running, or that happens in the brain when you stimulate it through cognitively demanding tasks, you essentially see the same things. And these are the processes that reverse or prevent some of the hallmarks of aging related to energy processing, related to DNA damage, related to how, well junky proteins are cleared out, things like autophagy. And so there's this direct parallel between the things that we need to maintain physical function and maintain cognitive function. But there's also this really intimate link between our physical function and our cognitive function as it relates to how we move our bodies affecting our brain. So like you said, physical activity is essentially a physiological imperative for humans. If we want our bodies to perform and feel at their best, we need to move frequently and we need to challenge our physical abilities. And when we move up to sort of the amount of exercise that the average person would reasonably be able to do an hour or two of exercise a day, maximum, up to that point, basically the more, the better, the more we move, the better our brains function. And you can see this in large meta analyses that show that once you're moving sort of 30 to 60 minutes a day across a range of different types of activities, from walking to running, sprinting, lifting, dancing, basically there's a linear improvement in cognitive function associated with that. But we can also break down how different types of activity affect different parts of the brain, because different types of movement do have different brain benefits. So when I think about this, I have a framework that sort of builds up depending on where you're starting from. So if somebody is relatively sedentary, which is, I was going to say, surprisingly common, but probably unsurprisingly common in the modern world, we know that prolonged periods of being sedentary is associated with a greater risk of dementia, greater risk of cognitive decline, and also worse cognitive function on a day to day basis. So it's not just thinking about what happens in 20 years time, it's thinking about what happens right now. Because if you sit still for two or three hours, you Start to see decreases in blood flow to the brain, changes in neurotransmitters in the brain that then associated with slightly worse mood and slightly worse focus and attention. So the first thing to think about if we were trying to support our cognitive function on a daily basis is breaking up prolonged periods of being sedentary. So if you're just like sat in a chair for very long periods of time, just standing up and walking around a bit is enough to have a meaningful effect on cognitive function. We also know. And so I call these. So these are exercise snacks, right? And so we also know that, right, if you don't do any kind of physical activity, just taking the stairs for 20 seconds, you know, a couple of times, and doing that two or three times a week, that significantly improves cardiovascular function, that significantly improves cognitive function. So that's kind of like the starting point, just breaking up periods of being sedentary. From there, we want to ideally add some more prolonged periods of low level activity, right? This could be walking, gardening, cycling, propelling a wheelchair. You know, however you move around the world, it's going to have a similar effect and up to somewhere between sort of 8 to 12,000 steps a day or the equivalent. Again, we see a linear decrease in the risk of dementia. So the more you move, the better. And this is just sort of like daily movement getting around from there. So still, in the kind of aerobic type exercise world, adding some intensity then provides additional benefits. So we know that aerobic type activities on that kind of spectrum of intensity, from walking up to maybe sprinting, there is an intensity dependent effect. So some intensity is important. And the areas of the brain that are particularly benefited by this type of exercise are the gray matter. So that's the wrinkly kind of outer cortex, if you think about, imagine a picture of the brain is kind of like really wrinkled. That outer part is gray matter, that's the cortex. And then sort of inside the brain there's other gray matter like the hippocampus, which is really important for memory. It's particularly susceptible in the later stages of Alzheimer's disease and other dementias. And so those who do more aerobic type activities, or if they do randomized controlled trials, or they do some kind of aerobic type activity, that particularly benefits the gray matter in terms of structure and then function too. So that improves memory. So the first trial to really show this had older adults do brisk walking for 40 minutes three times a week for a year and saw significant improvements in the structure and function of the hippocampus. And then more recently, there was a study that was done where they randomized again, older adults to three different groups. They had a control group, they had a jogging group. So they did like 40 to 45 minutes of jogging three times a week. And they had a high intensity interval training group. This group did something called the Norwegian 4x4 Protocol. You're smiling. So you, so you know, you know what this entails.
- [13:42]
B
It's my favorite and my most hated and my most loved at the same time. Yes.
- [13:48]
A
So it's funny because, like, people who know what it is almost can't believe what they did in this study. So, so, so the Norwegian four by four, for those who aren't familiar with it, is four minutes at 85 to 95% of maximum heart rate, usually on a treadmill, but could be on a bike or a rowing machine or something. And then in this study, they took a break for three minutes. The studies differ. It's three to five minutes, usually the break, and then they do that four times over. So four sets of four minute intervals. And they did this three times a week for six months.
- [14:18]
B
Three times a week, yeah.
- [14:23]
A
And so if you've ever done this, this is like. And these are like, these are adults in their 60s, like doing this. Like, this is, this is a fairly intense training program. But what they found was that after six months, and actually already within a couple of months, because they tested them every month, within a couple of months, they saw significant improvements in both the structure and function of the hippocampus. And then at the end of six months, they sort of stopped training them, but they still tracked their physical activity. So basically everybody kind of went back to what they were doing previously. Then they tested them again five years later and those benefits were retained. So those who did the six month training program still saw benefits to the hippocampus five years later, even though they stopped doing the training program. I think this is one of the best, the most rigorous exercise studies I've ever seen. To follow people for that long is really, really rare.
- [15:18]
B
So they weren't. Okay, so just so I'm hearing this properly, three times, which in and of, I do it once or twice a week if I'm feeling super spicy. Like three times a week is something. Is something. Okay, six months. And then they. Okay, so then they stopped at six months and then they follow them for five years. And at the five year mark, the VO2 max, the cardiovascular, the endothelial function, all the things that they saw.
- [15:43]
A
So no, so. So no. This is the interesting Thing is that they mainly were focused on brain function and brain structure. So they were still, they still had brain benefits five years later.
- [15:52]
B
Okay, so the hippocampal benefits that were describing the gray matter. Okay, okay, okay.
- [15:57]
A
So they did track VO2 max and that did decline again sort of later on because they stopped training as much. But what's interesting is that in the studies where they did like brisk walking and they looked at hippocampal structure, what they found was that basically the fitter people got, the bigger the benefits. In this study, the jogging group and the Norwegian 4x4 group actually gained similar amount, similar improvements in VO2 maximum. So the difference wasn't in level of fitness. And I think what's happening is that when you do more intense exercise, there are a whole bunch of things that get released that aren't released if you're doing less intense exercise. Right. So myokines and exokines that get released and there's a whole host of potential myokines that it could be. So like with this kind of intense aerobic activity, you would see things like vegf, Vascular endothelial growth factor, really important for blood vessels in the brain. And we know that blood supply to the brain is really a critical part of long term cognitive function. But I think probably the what my guess, the most important contributor to this is lactate. So when you make lactate, like often we kind of, we think of lactate as this waste product. It's like you release it when acid is building up in the muscles. And actually lactate is part of an important buffering system. It's, it's helping to decrease the amount of acid that gets produced when, when we're exercising hard. But lactate is this critical messenger from the muscles to the brain. So as much lactate as you make, you know, can get into the brain, there's a direct, there's a direct transporter that basically takes up lactate into the brain when we make it. And lactate switches on the production of things like bdnf, brain derived neurotrophic factor. Because other BDNF that we make in our body when we exercise doesn't get into the brain, it has other effects in the body, but there's no transporter to get it into the brain. So lactate is that critical messenger. This is why I think particularly intense exercise is particularly good for the brain because it switches on the production of these neurotrophic factors that support neuroplasticity. So that's kind of our aerobic, that's our Aerobic exercise, the next thing that we know is important is resistance training. So whereas aerobic exercise and sprinting seem to be particularly good for the gray matter, resistance training is particularly good for the white matter. So white matter sits underneath the gray matter. It's where all our neurons are kind of wrapped in a fatty sheath. That's what makes it white. And it allows for really fast connections between different parts of the brain and then different parts of the brain and the body. And as we get older, we tend to lose structure and function of our white matter, which is actually one of the best predictors of cognitive decline as we get older. But when you take individuals and you start them on a resistance training program, and it's usually once or twice a week, something like five to six exercises, five, six machines that cover the whole body, three sets of eight to 12 repetitions, like a super basic resistance training program that you could do in any gym, within six months, you see significant improvements in the structure and function of the white matter. So in particular, things like processing speed and executive function, so the ability to make decisions quickly. And we think that one of the reasons for this is because when you do resistance training, you release things like IGF1, insulin, like growth factor one.
- [19:34]
B
Another myokine.
- [19:35]
A
Another Myokine. Yeah, yeah. And, you know, last time we spoke, I think I talked a little bit about the developing brain. And IGF1 is really critical for white matter development in babies and toddlers. And it's also really important for maintaining white matter structure as we get older. So resistance training providing this really important signal to maintain white matter structure. And so then more related to things around decision making and fast processing in the brain. The final sort of layer of this, and it can sort of be layered on top, particularly on top of the, like, aerobic type activities, is coordinates of exercise. So in the research, sometimes this is called open skill exercise, but it's basically a physical activity that does have. It has a physical component, but also requires some kind of complex motor skill. So we're talking dancing, we're talking ball sports like badminton, table tennis, pickleball paddle, martial arts like tai chi or any other martial art, where you're having to respond to the environment, respond to another person. And this is kind of the thing that seems to underpin most of these activities and how they affect the brain. Because when you. They've done lots of randomized controlled trials where you have a group that does something like cycling or jogging, a unimodal kind of type of exercise, and you compare it to one of these Other types of exercise that has the same level of physical intensity but layers on top of it, some kind of additional cognitive stimulus. And both are beneficial, but you get better brain benefits from this sort of like coordinative exercises. So that just means that one way you might consider to do some of your aerobic type activities is to do something that has a complex motor skill component on top of it. So ball sports, board sports, team sports, you know, anything that requires you, like I was saying, to sort of process information quickly in a multi sensory way. And maybe that includes some kind of social connection that seems to have an outsized benefit for the brain. And so then if you tick all those boxes, right, you move frequently, you do some resistance training, occasionally you add some intensity, and then, you know, some of your aerobic type activities include some complex motor skill like dancing or some kind of social interaction. You're really kind of hitting the brain from multiple angles.
- [22:05]
B
So just so my listeners are clear on the difference when we're talking about coordinative exercises, open skill versus closed skill. And open skill is where you don't necessarily know what's going to happen next.
- [22:16]
A
Yeah.
- [22:16]
B
Would that, would that be a fair way to describe it? So like, let's say if you're playing football or soccer, you might be a defender or a wingman or whatever, and you don't know exactly what the opposition is going to do, or you're playing tennis, you don't know exactly what, how the ball is going to be returned to you. Dancing, you don't know exactly. I mean, maybe you know the steps, but if you're freestyle, you don't know exactly what your partner, how your partner is going to troll you or whatever the next thing is. So you're, you're not only performing the motor pattern, but there's a certain maybe strategy, I don't know if that's the right word, but there's a certain strategy or a real time response to being able to play in that sport or that game versus a closed skill would be like you get on the recumbent bike and you set the time for 45 minutes and you, you know, pedal for 45 minutes, then you get off and then you're done. Like that would be a closed skill where you're not anticipating anything different than the cadence of your feet going around on the bike.
- [23:13]
A
Yes, so that's exactly right. And I think one of the reasons why those open skill activities you mentioned are so beneficial for the brain, particularly as we get older, is that there aren't many Things we have to do on a day to day basis that require us to rapidly respond to and like strategize, you know, in terms of new information coming in. Right. Being able to like thinking about the ball's being hit at you on a tennis court and you're also trying to manipulate your opponent so that you can get the ball past them in like two or three strokes time. That kind of rapid information processing, even just like processing the ball coming at you at speed. There's just not many things that we do, except for maybe driving, where we have to process information that rapidly in that kind of way. And so I think one of the reasons why we tend to lose processing speed as we get older is because we just stop challenging that with these kinds of activities. But we can retain, we can retain that function if we then are doing this as part of our physical activity.
- [24:15]
B
And I hear over and over again, and this may be, I will fact check myself on this, but I always hear like, people who play racket sports tend to have the lifespan or maybe health span, more accurately a longer health span than other sports. And part of it is, I think everything that you just said, it's the open skill. You have to get your body in position to be able to return the serve. It's social. There's a social. You can't play tennis by yourself or Padel or pickleball by your. You have to be, you know, on a team or just playing someone else. So there's all of these different components to it that make it really healthy for a brain to thrive.
- [24:51]
A
Yes. So, yeah, you're right. Like there are several studies that look at that. I think tennis is the one that's been used most frequently in studies. I think that that type of activity for those reasons is, you know, has an outsized benefit for the brain. One of the potential issues with those kinds of studies though, because those are not randomized controlled studies, those are just observational studies, is that, you know, rich people play tennis and rich people live longer.
- [25:16]
B
Right, right, right.
- [25:17]
A
So we have to kind of acknowledge that that's part of those studies. But when you have, when you have randomized controlled trials that have people do these kinds of activities, then you start to, you know, account for these things and you still see, you know, additional benefits for the brain.
- [25:32]
B
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- [29:14]
A
So I think that in addition to inflammation, I'm going to talk a little bit about stress because I think that both of these things are important to understand. And right now stress or fear around stress is having another moment on social media. Cortisol is bad, stress is bad. And the same thought process, inflammation is bad, right?
- [29:38]
B
Yeah.
- [29:39]
A
And we need to like, it's helpful to step back and think about like what are these things for? Right. So a stress response, the goal is to direct resources to respond to something in the environment. So when you start to pay focused attention to something that is a version of the stress response, you're going to release a little cortisol, a little adrenaline, a little noradrenaline in the brain. Right. Because that's the process of diverting your attention to something that's important. This is also what then directs resources for adaptation. So if you do exercise, you increase cortisol, you increase adrenaline, you do all these things and that's part of the process of performing, but it's also part of the process of diverting resources to then adapt to the training that you did and then come back stronger and fitter. And in many ways inflammation is the same. So if you do exercise immediately, you will, particularly if it's you do a Norwegian 4x4 approach protocol, immediately afterwards your CRP is going to be elevated, your IL6 is going to be elevated, there's going to, you know, a cytokines, there's going to be a bunch of things that you could measure be like, oh, this is really bad for me. Right. A bunch of inflammation, a bunch of, a bunch of stress.
- [30:48]
B
Like my heart rate is up, my blood pressure is high.
- [30:52]
A
Exactly. Why would you do this? This is terrible. But what like an analogy I use is if you looked at heart surgery halfway through, it would look like murder, right? The chest is open, there's blood everywhere, all this stuff. But you know, long term that has a really important, like therapeutic benefit for whatever you're treating. And so the same is essentially here where by initiating some of these inflammatory and stress responses, what you're doing is you're diverting resources to build and repair tissue and build capacity. And so two things happen when you initiate an inflammatory response during exercise. One is, I mean, you're actually repairing, you know, any muscle tissue that may have become damaged. That's not a big part of adapting to exercise. But it is, it is, it can be a small part of it. But what you also see is that longer term, it sort of resets the inflammatory system so you have a lower overall level of inflammation. And so what we really care about when it comes to these processes affecting our long term health is chronic inflammation or chronic stress, which is very different, Right? That's the signal not getting switched off. So chronic stress being like some physical or psychological stressor is like negatively impacting sleep or other things that prevent us from being able to adapt and respond and recover. And chronic inflammation being the same, and that could be from an injury, an infection. You know, when it, when we think about dental or when we think about dementia, then dental health is really important. So periodontal disease is a significant risk factor, probably because it causes chronic inflammation. Autoimmune conditions could do the same thing. So it's really important to think that actually exercise in the moment actually triggers some of these responses, stress and inflammation. But what it does overall then is it decreases the baseline level of stress and inflammation. And we know that exercise is actually one of the best ways to improve our stress tolerance. So people who exercise more frequently, they react less negatively when under significant stress. There's this thing called the cross stressor adaptation hypothesis, which essentially does what it says on the tin. It just says that because you've stressed yourself through exercise, you're then better at dealing with psychological stress and other times when you might be under pressure. So it kind of builds more tolerance in the system.
- [33:14]
B
It's interesting that you say that it's stress is having a resurgence because I, oh, whenever I talk about exercise, whether it's high intensity exercise, someone will say, but isn't that going to drive up my cortisol? Isn't that going To. And it's like. Yes, it is, it is. That is a normal. You would. If it didn't, you know, if your cortisol didn't rise in the morning, you wouldn't wake up. You know, like, we need to have, we need to have a certain level of cortisol. We need to have a certain level of stress or demand, let's say, on the body or on the brain in order to increase its capacity. And like you said, you know, the baseline, the, the net over a longer delta is that your, your baseline level of inflammation is lower because you have these little pungent, like these little bouts of acute stress. Like you said, they have, they have a, you know, you go to the gym, you do your Norwegian four by four. I mean, my. I do four minutes on, three minutes off. The whole thing is 28 or 29 minutes. Yeah. You know, but it's 30 minutes total and then, then it's done. Right. But if I was doing, if I was doing that all day long, I mean, I don't even know these 60 year olds. I'm still in, I'm still in shock that they did it three times a week for six months. I mean, God, I gotta get my, my stuff together. Jesus. But I love this, I love this nuance around. We want to lean into demand or stress as long as we see the end, as long as we see when that will be shut off. Right. It's not that we want to be doing a Norwegian 4x4 for weeks on end. We want to do it for 30 minutes and then it's done.
- [34:46]
A
Yeah.
- [34:46]
B
Yeah.
- [34:47]
A
And that's really the. If you think about improving any kind of function, you require a challenge or a stimulus and then time for adaptation and recovery. It's like this sort of like the yin and yang, but you need both. And I think that we've gotten to the point where we're so worried about challenge and stimulus and stress that we're now avoiding things that actually drive increased capacity. And that creates a vicious circle. Right. So that we have less capacity, we're less able to tolerate things, we do less, and that's what then results in a decrease in function. So you're absolutely right. We need to lean into the challenge and then make sure that we get enough time to recover and adapt to that challenge.
- [35:28]
B
Is there anything that we can infer from a certain amount of muscle mass on an individual as a proxy for brain health? Like, obviously, if you have a larger individual, they're going to by default have more muscle. But is there, is there A way that we might evaluate the quality of muscle tissue as a proxy for brain health. Is that something that we have any data on or can look at?
- [35:53]
A
Yeah, it's a great question and actually something that I'm sort of studying as part of a collaborative research group right now in a number of ways. So one thing that we have done so far we've published on, we looked at leg strength in a group of older adults in nhanes, the National Health and Nutrition Examination Survey. And it was maximum leg power on an isokinetic leg extension. Which is basically what it means is that it's like a leg extension like you do in the gym, but it moves at a fixed speed. So it's like however you push, it kind of pushes harder against you. And it's a way to kind of measure sort of like absolute force that you can generate in the leg. And what we found was that relative leg strength was the best predictor of processing speed in the brain. Did a cognitive test to test processing speed. And what I mean by that is that you just need to be strong enough for you. So that kind of relates to what you're saying is that if you do relative leg strength, so how strong are you relative to your body weight or your. Or your muscle mass? That is, that kind of makes it fair, right, because bigger people have more muscle and they're stronger, but that doesn't necessarily mean that more is better. So I think there is definitely a signal that the stronger you are for you personally, the better. And we see some similar data in, when we look at. There's some studies that look at grip strength and mortality risk and these other things. And what you see is that this is actually particularly in men. And. But the, the, the more muscle mass you have is beneficial up to a point, and then more isn't necessarily better. And what it looks like in the studies is that more is detrimental. And so, like, people say that, oh, well, look, if you have a lot of muscle mass is bad for your health, but that's not actually true. What it tells you is that some people gain. People gain muscle for different reasons. So if you're gaining muscle just because you've gained more total mass, that's not necessarily the functional kind of muscle that you build if you go to the gym and lift weights, because you see that basically more strength is better with no upper limit. So in some individuals who have accumulated a lot of total mass, there's a dissociation between how much muscle they have and how strong they are relative to that muscle if that makes sense.
- [38:09]
B
Yeah.
- [38:10]
A
So to kind of make that practical for people, I think that you can look at some tests of, like, how strong you are relative to you, that gives you a good indicator if you're strong enough. So we've kind of guesstimated across a few different. A few different data sets that if you can, like, leg press, double your body weight, that's like. That's a really good metric.
- [38:37]
B
2ft. 2ft.
- [38:39]
A
2ft on the leg press, double your body weight. That's a really good, like, relative strength. And so that's like a good starting point as sort of what you. What you tend. Because it's hard to really give a hard number because most studies either use grip strength or they use some, like, weird piece of equipment like the one I mentioned earlier that you're never going to have access to. But in general, the evidence suggests that if you're in the top third of the population in terms of muscle mass and strength, so that's enough. So just imagine a room full of people like you, your same age, same sex, same demographics. If you can beat 2/3 of them in an arm wrestle, you're in pretty good shape. That's how I would think about it. So you don't need superhuman amounts of muscle or strength. You don't need to go and lift weights in the gym for several hours a day. Really, the minimum effective dose that will get you into that kind of arena is lifting once or twice a week, like I was kind of mentioning earlier. And then that's probably going to get you enough muscle mass to kind of support brain health and overall physical health.
- [39:47]
B
It's interesting. As you're talking, I'm reminded of my conversation that I had with Dr. Stu McGill. And one of the things he was saying was, you know, people completely misunderstood. This is like, sufficient strength, which we don't want to get greedy with our strength, or we don't want to get greedy with the amount of muscle that we have. We want to have sufficient strength. That leads us into our, you know, 50, 60s, 70s, and 80s, because at some point, the, the pursuit of getting stronger or muscle hypertrophy, you tend to start sacrificing joints right at this. Like, it becomes very difficult on the tendon, very difficult on the ligament, very difficult on the joint. And you can't squat if you have bad knees. You can't do the leg press if you're. If you don't have ankle mobility or your knee, you know, one of your knees has, has an issue with it. So I, I really do like this. It's almost like maturing in the gym. Because when I was, you know, when I was in the gym, you know, been in the gym for a couple decades now, I very stupidly would chase PRs at the cost of absolutely everything. Like, I remember there was one time in particular I was doing a hip thrust. I just PR'd like, I just had like a record that I had never done before and I was like, yeah, instead of. So instead of stopping and allowing my body to adapt and then coming back to it in the next session, I was like, let's just put on another 20, like put a 25 on a 25. Let's just like Fafo, right? Let's just like see what happens. And of course heard a very loud pop. Severe iliopsoa strain. I was like standing at a 90 degree angle for the next three weeks. Thank God for my chiropractor who had to drive me home actually because I couldn't stand up. I could stand up upright for like three weeks because I had this very, very severe sprain. So I, I really do like what you're saying. It's like if you can get to the top third, you don't need to be the 1% of the 1% of the 1%. You can just suff driving. The sufficient strength which is, you know, to your body of work, it's also going to complement your cognitive capacity as well. Because if you have sufficient strength in the body, we can look at the muscles maybe as a proxy for the health and the capacity of the brain.
- [41:53]
A
Yeah, yeah, absolutely. And I think one of the most important things that I like to get across when it comes to exercise and, well, overall health, but, you know, particularly brain health, is that we often assume that heroic amounts are required. Like, you know, it's very common that people say, oh, well, you have to do four hours of Zone 2 training a week or else there's no point in doing any zone two because you haven't done enough to get a stimulus that is 100 incorrect. Yeah, right. Because we know that anything that you do more than you're doing now will be beneficial. But people internalize that and say, well, if I can't do four hours, I'm not going to do any because what's the point? Or they assume that if I tell people that you've got to lift weights, they're like, but I just don't have time to go to the gym and lift weights five times a week. But you don't have to. Right. Once a week is great if you can do that. So. Because we often idolize athletes and these athletic endeavors, and we've kind of assumed that to be healthy, you have to run 5Ks and marathons and all this kind of stuff. Right. We then think that there's no point in doing less than that or that less than that won't be beneficial. But actually, most of the benefit comes from just doing some. And then beyond that, you know, fine. If you want to perform at the top of a sport or be competitive, yeah, you have to. You have to train accordingly. But when we're just thinking about overall health, it doesn't take that much to see really big benefits.
- [43:23]
B
Yeah. And those are two separate outcomes. Like, if you are an Olympic athlete or you're trying to train for, like, you are now sacrificing longevity for the performance in the. In the whatever sport. Right.
- [43:35]
A
Because if it pays the bills, like, that's fine. Like, you. You do what you need to do to do your job, of course. But, yeah, that shouldn't be applied to the rest of us.
- [43:43]
B
It's funny, too, because I have a lot of women that are often, you know, they get their health advice from social media, and then they'll come to me and say, but am I supposed to do zone two? Like, how much am I supposed to do? And, like, how much sprinting am I supposed to. And then they get so overwhelmed that they're like, forget it. I'm not doing any. Like, I don't. Because I don't want to do it wrong. So I'm not going to do any of it. Right. So I love what you're saying is, like, just if you can train once a week, that is way better than what you're doing now, Right. Or if you do one zone two, and you find a way to do one sprinting, or you find a Zumba class that you love, or a step class or a racket sport, whatever. Find something that you love that you can do consistently that is the right way.
- [44:19]
A
Absolutely. Great. Because if you go in, right, you go and play pickleball or tennis or something like that, Right. You're gonna get. You're gonna get some zone two, you're gonna get some sprints, you're going to get some complex motor movement, you're going to get some social connection. Right. You don't have to think about how to structure your training program. It all just kind of happens naturally, and you're getting all of those things and having fun at the same time, hopefully. So. And a movement should be fun. And We've kind of, we've kind of medicalized it to make it in this really kind of dry and very confusing kind of area.
- [44:49]
B
Yeah. And you get deceleration and change of direction training, which I know nobody really talks about, but that really makes me excited too because that if we think about fall risk and all of that for women, change of direction and deceleration training is where it's at. Okay. Okay. So I want to make sure we talk about nutrition and then I also want to talk about the female brain. I just looked at the time. We have just been nerding out for like 40 minutes on muscle. We can do like another 40. But I want to make sure we talk about nutrition because this is another area of interest for my Betties, for my community. So how can we, maybe I'll start with this. How can we manipulate nutrition for better body composition, potentially that would lead to better cognition. Like what are some of the elements that we want to be thinking about from nutrition? And I know that you don't, you're not dogmatic, you're not like, you need to do carnivore, you need to do this. So I talk to us a little bit about what we need to make sure that we are including in our nutritional profile in days, weeks, months, that will help to augment cognition in the long run.
- [45:51]
A
Yeah, I think that sort of the framework that I have for, for diets and brain health, like you said, there's many different ways to skin this cat. And I think that there are some core principles that we need. But beyond that, there's a huge amount of flexibility so that you can make it just work for you so that it's sustainable, enjoyable, and fits into whatever dietary pattern that you kind of enjoy and want to eat. So the first is that there are some core nutrients that we know are critical for brain function and we know are critical for long term brain health and for decreasing dementia risk. So this includes vitamin D, iron, the B vitamins, particularly those associated with methylation. So that's B12, folate, B6 and riboflavin. Omega 3 fatty acids really critical. Magnesium and zinc can become very important too. And then a whole bunch of like antioxidant type vitamins and other compounds like vitamin C and E, but also the antioxidant polyphenols that we get from like berries and fruits and vegetables. So the anthocyanins that make berries purple and red. And there are related compounds that have similar effects in like coffee and tea and chocolate. And in the roasted, the roasted Skins of nuts and seeds, interestingly, also have a similar effect. And they affect gut function, vascular function. So like blood vessels and then having a. May have a direct effect in the brain as well as. And then also the sort of like the oranges and reds and yellows, so like lutein, zeaxanthin and then astaxanthin, which you find, which is what makes salmon and shrimp pink. And so those antioxidants are both, like, higher intakes are associated with better cognitive function. But also they've done studies where they measured the levels of these in people's brains. And those who maintain cognitive function or avoid dementia tend to have higher levels of them in the brain. So those nutrients, I think, are kind of make up the core of what the brain needs. And where you get them from matters much less so. And they're obviously available in a wide variety of foods, but you ideally want to get them from foods that are less. Particularly if we're thinking about body composition and the likelihood that, you know, over time, most of us in the modern food environment are likely to overeat and experience some kind of excess energy availability or metabolic disease. If we get those nutrients from sort of minimally processed whole foods, which come with more fiber, which is really important for gut health and the brain and water. So they're less energy dense, but more nutrient dense. We're less likely to overeat. We're more likely to target our nutrient requirements and maintain good energy balance. As part of that, I would also think about consuming enough protein, really important for everybody, but particularly women and those who are aging, because protein requirements tend to increase as we age. And so we're talking like 1.2 to 1.6 grams per pound of body weight. I'm sure, hopefully people have heard that several times because that's really where we tend to see the best, like antioxidant status. So there are studies in older adults where you feed them 50 to 100% above, like the previous recommended daily allowance of protein, which was 0.8 grams per kilo of body weight. And if you feed people more protein than that, they produce more glutathione, more antioxidants, because those things are made from amino acids in individuals who are at risk of sarcopenia or muscle loss. Again, you know, eating at that level of protein, you see maintenance or improvements in strength and muscle mass, whereas you see loss of strength and muscle mass if you're only eating 0.8 grams per kilo of protein. So focusing on, you know, these nutrient dense foods, ideally with Good protein, protein content that's going to tick multiple boxes in terms of brain health as well as, as well as body composition. But how you achieve that and which foods you use to achieve that, I think you have a lot of flexibility depending on your own personal preferences.
- [50:01]
B
Few things are as traumatic to women than losing our hair. As we age we get hair thinning, hair shedding and hair breakage. It's the worst as we move through perimenopause and menopause. The hair thinning is not just cosmetic, it's a signal. Right? So it's declining estrogen that is going to affect circulation to the scalp, the mitochondrial energy at the hair follicle and cellular repair. Hair follicles are metabolically active tissue and they require energy to grow. And this is where red light therapy comes in it by delivering specific wavelengths of light to the hair follicle that will stimulate mitochondrial function. So more cellular energy means better support for the hair growth cycle. So this is not about forcing growth, but it's about improving the environment so that your hair growth can happen. Higher dose Red light therapy is a FDA approved red light therapy device for promoting hair growth and treating pattern hair loss. It stimulates the hair follicles and it improves density and reduces shedding. It's a hat that I use while I'm reading or answering emails. It's 10 minutes. There's no side effects, there's no recovery time. It's super easy to be consistent so that I can restore hair follicle health as I age. If you're interested in trying red light therapy for hair and scalp health, I've partnered with Higher Dose to offer my community 15% off of their red light hat. So just head over to their website higherdose.com and use code better@check in, that's higherdose.com and use code B E T T E R at checkout. If you are a vegetarian or a vegan, how can you what would be some of the counsel that you might offer them to make sure that they are getting B vitamins, for example B12, B6 just look like iron things that are usually abundant in animal products. I mean we, you know I've of softened my view on animal versus plant. I thought it used to only be animal if you could. If it wasn't animal then you know you're wasting your time. But of course we know that that's not true. You can certainly, you can certainly stimulate muscle tissue with plant proteins. You just have to make sure you're doing your due diligence and you have the complete, you know, amino acid profile. But what, what would be your, what would be your counsel, let's say for someone who doesn't eat meat, who may not be getting the B12, let's say, or the B6 or even the creatine that, that you, that you find in, in, in animal products.
- [52:25]
A
Yeah, this is, this is a great question. And I think there's some increasing evidence that you're consuming some minimally processed red meat in the diet in some studies associated with lower risk of dementia, lower risk of mood disorders. And I think that's probably just because they are sources of nutrients that can be harder to get elsewhere if we're not sort of attending to diet fully. So like B12, I think if somebody is, if somebody is fully plant based, the best people that I know in the plant based arena would tell them that they should take a B12 supplement. And I think that's just a fact of the matter and no issue there whatsoever. You, you, you, you, you take a B12 supplement and that, that probably covers your bases because you're going to get most, you're going to get folate and most of the other B vitamins like riboflavin. You could, you can get some of those things from like beans and nuts and seeds like you, you can, if you have, or if you're eating a lot of soy products or fermented soy products, you'll get some of those, you get some of those as well. Some of them you'll find in truly whole grains like quinoa and whole oats. So I think that's going to cover most of the bases. B12 is probably the one that you might be most concerned about, plus long chain omega 3 fatty acids. So women actually tend to be better at converting shorter chain omega 3 fatty acids to longer chain omega 3 fatty acids. You're more likely to turn like the alpha linolenic acid that you can find in like walnuts and chia seeds. You're more likely to, to be able to turn them into DHA and epa.
- [53:57]
B
Why is that?
- [53:58]
A
Yeah, it's because the, the developing brain needs them so badly that women are better at converting and generating longer shape so they can apply it to a fetus if they're pregnant. If they're pregnant.
- [54:12]
B
That's cool.
- [54:13]
A
So, so actually women may be, may have, be, have slightly decreased risk if they're as long as they're consuming enough sort of shorter chain omega 3s like from Nuts and seeds. But the easiest thing to do would be to Test your levels if you can. So ideally you want an omega 3 index, which is a proportion of long chain omega 3 fatty acids in your red blood cells to be at least above 6%, ideally above 8%. But equally if you want to just cover your bases, I would consider an Algol Omega 3 supplement that gets you some EPA and DHA. So, so yeah, you can, if you're very diligent, get, you know, get it, get it from, get it from diet. You know, hopefully again the risk might be lower in women and better ability to convert that into longer chain fats that we know we need for the brain. But you might consider, you might consider supplementing just like if you eat a very meat heavy low plant diet. I would consider finding a way to supplement with antioxidant polyphenols that you get from plants and berries and things because I think those are also very interesting when it comes to brain health. And we have so many studies that show that supplementing with berries significantly improves both short term and long term cognitive function.
- [55:29]
B
And is that Ross, it's reducing the reactive oxygen species that we see in the brain or what is the mechanism? Why do we want polyphenols? Why do we want these antioxidants toxins in the brain?
- [55:39]
A
Yeah, so they, they do, they seem to do a few different things. So one is they have a, they, they may be affecting gut function and gut health. The other is they seem to have an effect on vascular function. So they improve like blood vessel health and then they may have some direct anti inflammatory effects in the brain. So in particular there are anthocyanins and blueberries that are inhibitors of things called matrix metalloproteases or mmp, which when they're sort of activated in an inflammatory situation in the brain can start to break down like the matrix of the brain and negatively affect some inflammatory processes going on. So they seem to have antioxidant and anti inflammatory and sort of effects throughout the body. So just to kind of say that my ideal scenario is that you eat across a range of animal and plant foods and kind of tick all of these boxes. But if you're in just you know, one end of that spectrum, you know, think about some of the things that you might not be regularly getting from your diet. Although like if you're a carnivore and you drink coffee, you know, maybe the coffee probably gets, gets a lot of those antioxidants in actually in, in the American diet, coffee is the, the biggest source of antioxidants because of the, the polyphenols that it contains.
- [56:51]
B
I want to double click on omega 3s just for a moment. So you mentioned EPA and DHA is there. So you know you can get that for, I mean it's. These are fish oils. So you can extrapolate that you're going to get this from fish. Like the smash, you know, we usually get like Dr. Bredesen has been on the show three or four times now, talks about the smash fish. Let me see if I can remember the mackerel, sardines, anchovies, salmon and what's it, herring. Herring, okay. Yes. So we can get them from fish or maybe we can supplement with them. Is there a target omega 3 and if we break it down between E. So DHA I know is usually more associated with positive outcomes in brain health. Is there like a gram target that we want to be trying to aim for on a daily or weekly basis?
- [57:37]
A
Yeah, so you're right. So DHA in particular is really important for like synapses and mitochondria in the brain, whereas EPA is maybe has more of an effect on vascular function. Again sort of like the health of blood vessels. It's not a perfect separation but they sort of have you share those jobs. And then they can also be precursors for like anti inflammatory compounds in the body. Things like the resolvins and the protectins and the mycens that are kind of derived from omega 3s so kind of help to switch off inflammation if it ever occurs. And like we mentioned earlier, like that can be very important but you obviously want it to be switched off when needed. So in General Something like 2 to 4 grams of long chain omega 3s on average per day, you know, 50, 50ish, EPA and DHA. I'm not too worried about the exact balance but you know, somewhere, you know, if you're averaging a few grams of each per week, you know, 5 to 10 grams of each per week, like you're in pretty good shape. That's going to look something like three or four servings of seafood, you know, maybe a supplement if you're, if you're not eating seafood that frequently and you can. Right. You don't have to get this every day. So extra omega 3s that you consume, they get stored in your adipose tissue and then like overnight or during periods of fasting or exercise, they get released and then if they're needed by the brain, they get taken up into the brain. This is actually a, this is another paper that I published with a colleague of mine, Rory Heath, where we talk about how omega 3 fatty acids are kind of trafficked through the adipose tissue to kind of be used as a depot for the brain. So that also means that if you spent a very long period of your life eating a lot of seafood, you probably have a bit of extra buffer in your adipose tissue that your brain might get access to as needed. So it doesn't have to be a thing that you kind of eat every day. It's sort of a thing that you can sort of eat more of and less of. And as long as you're averaging something like that over weeks or months, you're probably getting enough.
- [59:43]
B
I want to maybe take a slight turn here and talk a little bit about, you know, I know my audience very well. We have perimenopausal, menopausal women who listen to the show trying to optimize, you know, body composition, balance their hormones. All the things in the context of the female brain, how the female brain ages. Are there any sex specific, let's say, dimorphisms or things that we know that are different with the female brain as it. It's aging and may. And maybe even we can talk about the menopausal transition if that feels like a good place to start. But what, what are some of the differences, if, if any, in terms of how the female brain ages versus the male?
- [60:22]
A
Yeah, so this, this is interesting to me as a neuroscientist, because neuroscience has, in general, doesn't done a really bad job of studying the female brain over the past, you know, decades or hundred, you know, 100 plus years. And sort of, if we look at historical studies, and this is like, this is especially if you look at, like, animal studies, where we gain a lot of our initial information, the historical ratio was about. For every one female animal included in a neuroscience study, there were six male animals. Right. And one of the reasons this was done is because researchers were concerned that the menstrual cycle, or in rodents, it's called the oestrous cycle, would create so much variability that would make it hard to do their experiments, which, long story short, is complete nonsense, because actually, male and female animals and humans are just as variable as one another. And by trying to remove that variability, actually we've made it harder to translate stuff to humans, which is why so much rodent work actually never ends up being useful to humans at all, the vast majority of it. And I say that as somebody who does that kind of work for a living. It's just a fact of how that field works. And so for a long Period of time, we kind of avoided thinking about sex differences, but we know that even outside of hormonal effects, male and female brains respond differently to injury and to aging. So male brains and male tissues tend to have a lower antioxidant capacity, so they're more susceptible to oxidative stress and things. And male tissues tend to age faster. That's why men die, on average, a little younger. However, interestingly, on the X chromosome are several genes related to the structure and function of the brain, particularly the white matter. And I kind of mentioned the white matter earlier when it comes to resistance training and cognitive decline. And that's thought to be one of the reasons why the female brain may age differently compared to men is a difference in terms of some of the genes related to white matter structure. And what we see, and as I'm sure your audience is aware, is that dementia burden is greater in women than men. And actually they experience neurological conditions differently. So men are more likely to get strokes, women are more likely to get migraines and experience depression and have a higher burden, particularly of Alzheimer's disease. So if we think briefly about dementia, there are several different types. The most common is Alzheimer's disease. It makes up something like 60 to 80% of dementia. The next most common is vascular dementia, which makes up 10 to 20%. So between them, vascular and vascular dementia and Alzheimer's make something like 70 to 90% of cases of dementia. Men and women experience vascular dementia about the same, but the burden of Alzheimer's disease is about twice in women what it is in men. There are other rarer cases of dementia like or causes Lewy body dementia, frontotemporal dementia, dementia with Parkinson's disease. But right now we think that potentially the majority of cases of dementia are preventable, most of that due to lifestyle and the environment, and again, most of that in the buckets of vascular dementia and Alzheimer's disease. So then the majority potentially being Alzheimer's disease, which then again the majority potentially affecting women. So what we see is that, and in terms of the risk factors for dementia, something that I don't think gets talked about enough that I'm quite hopeful is going to translate to a relative decrease in burden of Alzheimer's disease in women, is thinking about how the environment and how we interact with it affects dementia risk. So if we look more broadly, the age specific incidence of dementia has actually been decreasing over the past few decades. What I mean by that is that that at 70 years old now, you're less likely to be diagnosed with dementia than you would have been 20 or 30 years ago. However, our overall lifetime risk of dementia is increasing because we're likely to live longer. And so we will get dementia, we'll just get it much later. However, I think one of the reasons why we're seeing that is because in the 20th century, there was a big shift in terms of women's place in the world, in the work and home environment. So we know that education is one of the most important protective factors against dementia risk, and we know that late life cognitive activity and cognitive stimulation is one of the most protective factors against cognitive decline. But if we fast forward, if we go back 70 years ago, women didn't have as equitable access to education as they do now. And worldwide, that's still not a problem that has been solved. But in the US at least, it's certainly much better than it used to be. And in the 70s is the time when women's place in the workplace really started to expand and they started to get access to the higher paying, more complex, cognitively stimulating jobs than they would have had access to previously. And so, because we know that those things are so impactful for brain health and cognitive function, I'm hopeful that that's actually going to start to close the gap in terms of the Alzheimer's risk between men and women. That hasn't been proven yet, but I'm hoping that as we increase the focus on women's role in society and their brain health and overall health, I'm hoping that we'll close some of that gap. So that will then also require us to increasingly understand women's brain health and actually focus on researching it. So this is something that has improved a lot recently, which I think is fantastic. So things like the Care Initiative, funded by the Wellcome foundation, that's run by Dr. Lisa Moscone. Last year, in 2025, there were big, like, special editions of Nature and Science published on female health and the female brain. So we're just starting to, like, really invest in this. I, you know, better late than never, I guess we could say. But at least I'm glad that, you know, we're starting to focus on it. So what we know right now, I think, is that the period of time when risk diverges when it comes to dementia, particularly Alzheimer's disease, is around perimenopause and the menopausal transition. That's when risk diverges between men and women. And I think a lot of that risk is because that period seems to be a risk amplification period period. So we see that women who have metabolic disease during that transition are more likely to experience cognitive changes. We also know that the best predictor of cognitive changes during that transition is not hormone changes, but is vasomotor symptoms. So hot flushes, night sweats, and that's mainly because, or it's potentially because like the these rapid swings and activations of the sympathetic nervous system, changes in temperature control and metabolism, they may be negatively impacting cognitive function just during that period. Because we also know that many of the changes in cognitive function that women experience during that transition actually they go back to previous levels of function after that transition period is over. So it's not a permanent state. But we do know that lifestyle factors like physical activity, diet, quality, sleep, metabolic health, these then affect or can affect the severity of vasomotor symptoms which can then have a knock on effect on cognitive changes. So all of that to say that if you're able to engage in some of these lifestyle changes that then helps to manage symptoms, helps to manage quality of life, there'll be a knock on effect of benefits on the brain both short term and long term. And if things like menopausal hormone therapy help with that, help with mood, well being, sexual function symptom control, then I think they will also have a significant knock on beneficial effects for the brain. Right now we can't say that hormonal therapy will decrease the risk of dementia or prevent dementia, but I think that it can be a really important facilitator to help engaging with these things that we know will have a big impact.
- [69:11]
B
I'm just thinking to the last time that you were on the show and we were talking about concussion and one of the things that you were saying, I mean, I know your body of work is in tbi, like traumatic brain injury with children, and you were talking at the time about how we cooled in babies, we cool down the brain in order to prevent long term consequence from the tbi. But that hasn't really been shown in adults. The biggest thing that we can do in adults when there's been a traumatic brain injury is maybe take an antipyretic to prevent a fever, to prevent overheating of the brain because there's this change in metabolic demand, et cetera, et cetera. And just as you, and this may be totally out of left field and completely wrong, but as you're talking about vasomotor symptoms, vasomotor motor symptoms, you know, a woman might have night sweats and she's waking up hot, like it's almost like it's like a little fever. Like, it's like little pockets with little shots of heat. Right. That over time can change and like you said, tends to resolve once she's gone through menopause. We tend to see whatever decline in rearrangement and pruning that we see in the brain. We tend to see that. And mood and affect, all of that tends to change once she's gone through the perimenopausal transition. But I wonder if the vasomotor symptoms that a woman might experience, those hot flashes, night sweats in perimenopause, are in some way replicating some of the increased metabolic demand that we were talking about last time as it relates to concussion, when there's almost. Not. Not. And I'm not. Okay. I'm not saying that there's a. That menopause is a tbi. I'm not saying that it's a traumatic brain injury. But I'm saying that maybe that that acute change, multiple acute changes in heat regulation may be contributing, maybe contributing to her cognitive capacity and then just the structure of the brain as well. Is there. Am I totally off base here? Or feel free to redirect me because I may be totally wrong.
- [71:14]
A
Do you know what? Not. Not necessarily so. So people have definitely considered. And it's hard to. It's hard to really prove this, although I think one of the most impactful studies that has ever been done to improve cognitive function. So this is outside of lifestyle intervention. So there are lifestyle interventions where, you know, aerobic training or resistance training or Pilates, Yoga significantly improves vasomotor symptoms, and that can then translate to improvements in cognitive function. But there was a study that used nerve blocks to decrease vasomotor symptoms, so basically injected anesthetic into nerves in the neck to stop some of these activation of the sympathetic nervous system. That's sort of part of vasomotor symptoms. And critically, this has nothing to do with hormone levels. But in those who saw significant improvements in their vasomotor symptoms, they also saw related improvements in cognitive function. So there's definitely this direct connection between vasomotor symptoms and cognitive changes. And so some people have hypothesized that these big swings in, say, temperature or sympathetic activation may then be affecting the metabolism of certain areas of the brain that then translates into changes in cognition. And if we try and continue the analogy to traumatic brain injury, which I agree this is not the same, but in terms of the analogy, one of the reasons why you don't want to get hot after a traumatic brain Injury is because you create a gap between energy demand which increases when you have a fever, and supply which is impaired because of the injury. And the bigger that gap that can create, it can exacerbate the injury. Because we know that this is a risk amplification period, particularly those who have some element of metabolic disease. We know that changes energy production and energy availability in the brain. And so if you're increasing energy demand because of sort of swings in temperature and you have some underlying metabolic issue related to metabolic syndrome or metabolic disease that we know is a risk factor both during the transition and for dementia long term, it could again be this sort of like gap between supply and demand. So that, that could absolutely, that could absolutely make sense.
- [73:39]
B
Well, the other thing too is sometimes when you get perimenopausal women, and I'll say this just clinically, like, I'm not citing a study, but when you start getting perimenopausal women in the sauna, they're. How would you say it? Like the hormetic stress of the temp, the extreme temperature almost improves their capacity for range in temperature. And a lot of times women will say, once they've been, they do sauna regularly, like say two, three, four times a week, that the incidence, severity and frequency of the hot flashes tend to diminish. And maybe that's because they've increased their tolerance for, for temperature as well. So I, I just, I, I'm, I mean, like you said, it's late. Like, you know, the, the research is late to the party and we're just speculating at this point, but some of these manipulations in temperature, whether it's, you know, amelioration through MHT or it's directly giving a hormetic stress like high temperature to improve the, you know, the hypothalamic, you know, sense of when, when something is, you know, out of bounds versus inbounds. I think that maybe in, in a couple years time, we might start seeing some of these therapies or hypotheses become a bit more cemented.
- [74:53]
A
Yeah, I think that it, it makes sense that if you, Right. If you, if you expand the range that you're used to operating in, you become better at regulating some of those changes. And I think that's probably one reason why exercise is known to be an important potential intervention for vasomotor symptoms as well, because a lot of that then comes down to improving thermoregulation as well.
- [75:14]
B
Do you like nerding out and learning about women's health? As much as I Do. If you do, then let's get you on my newsletter email list. Betty. Every week I put out a free newsletter calling it the Mini Pause. That's my take on menopause that tackles some aspect of female health. Everything from answering the question, is oatmeal stealing your nutrients? To how much zone two should women be doing, how cold is cold for cold plunges, female training, and so much more. Think of it as your weekly roundup of the best action items for women. 40 +, head over to drstephaniestima.com that'S-R-S-T-E-P-H-A-N-I e s t I m a.com newsletter to sign up and you'll get your first one for me this Saturday. All right, so I want to talk about cognitive specific training as well. I want to make sure that I profit from your time here because you. Last time you were on the show, you talked. I think it was Brain HQ was the website that night. I go on it every once in a while and I'm gobsmacked at how bad I am at some of the. It's like before you choose the pail, get the stick. And then I'm like, oh, my God, what? What order is what? So are there ways that we can specific. So we've been talking about physical demands like nutritional inputs, physical inputs, maybe, you know, dimorphisms in terms of how the brain, the female brain, age. But are there specific things that. And you've mentioned a couple of them. You mentioned dancing. Are there things that we can do to stress you? Stress, you know, make demands of the brain in a way that will increase the capacity. So I know you've talked about language and this will help me, like I was saying to you before we got going, justify my duolingo max subscription. But do we want to pursue things like being bi or trilingual, or do we want to try and read as much as we can? Are there word games like Brain HQ and other ways that our brain has to process things that maybe we don't normally get in everyday life?
- [77:14]
A
Yeah, yeah, absolutely. And I think that kind of going back all the way to the beginning of this conversation where I said that the function of a tissue, just like our muscles, is dependent of the demands we place on it. The brain is really the same. And the thing that drives functional improvements in the brain is challenging brain networks and brain function through the development of new skills. And it's primarily the process of failing. And failure drives neuroplasticity because it tells the brain, hey, there's something we're not able to do yet that we need to be able to do. So we need to generate new connections and better network connectivity in order to do that. So that's what drives neuroplasticity in the brain. So all the things that we mentioned in terms of complex coordinates of exercise absolutely play a role here. Then languages, music. And there are studies where again, in older adults, you start to teach them music theory or teach them a musical instrument, or you teach them a, a language, including using duolingo. You can see improvements in brain structure. On an MRI scan, you can see improvements in cognitive function. And then we can expand that out to more creative art. So there was a recent study that looked at creative experiences and brain clocks is what the paper was called. But basically they looked at the connectivity of networks in the brain that are susceptible to the processes of aging. So networks like the frontoparietal network, which is really important for like, attention and encoding memories.
- [78:42]
B
Is this the Horvath cloth? What did you say?
- [78:44]
A
Yeah. Yes. No. So it wasn't the Horvath clock. But the idea is similar. So what they did is using EEG scans of the brain, you can look at network connectivity based on electrical activity in the brain.
- [78:56]
B
Okay.
- [78:56]
A
And then you can say, how stable are these networks? And based on the stability of the networks in the brain, you can estimate how old that brain looks based on its electrical activity. So that, so it was. So it was a similar idea of brain age. And what they found was that people who engaged in creative arts of a wide variety of types. So it was musicians, tango dancers, artists, like painters. And then they also had video gamers and included the effect of a randomized control trial of video games on the brain. And the video game that they used was Starcraft 2. But there is also a ton of evidence for Super Mario 3D World as well as some other, like, action video games, you know, like first person shooter games where you're like, again, you know, you're having to explore a complex environment, you're having to respond to it quickly, you're having to strategize, right? All of these core skills are, you know, are needed across all these different types of activities. So what that tells us is that it matters less what you do. It just matters that you actually do it. Some kind of activity that challenges these processes in the brain. So, so it could be video games or it could be done in virtual reality. So I work with a couple of groups trying to develop cognitive training strategies that you would use in virtual reality. And this is something we use with athletes as well as some groups in the military. And this is something that people could also do. You might also become available commercially if people want to do it that way. But you could also go and play pickleball, or you could go to a tango class, or you could learn how to paint. All of these things require the processes of focus, attention, processing, responding to the environment that then kind of drives these core underlying abilities of the brain. So then the final thing that you mentioned before was like formal cognitive training. So often when we think about I'm going to retire and then I'm going to need to keep sharp, so I'm going to do the Sudoku do. And that's probably not quite enough of a challenge. Yes, reading seems to support cognitive function. Writing, handwriting seems to support cognitive function. Doing some kind of games and hobbies that involve things like Sudoku in crosswords can certainly be a part of that kind of approach. But when it comes to cognitive training, the best evidence is again for cognitive training that really challenges processing speed, because that's something that we particularly lose as we get older. So BrainHQ, which you mentioned, has in it a program that was used in what is still the biggest and best cognitive training study ever done, which is called Active. And Active was done in the 1990s in older adults in their 60s and 70s. And it was nearly 3,000 people randomized to four different groups. They had a control group and then they had three brain training groups. They had a processing speed group that did this program that's now called Double decision, that's in BrainHQ. And then they had a group that did reasoning training, so like trying to find patterns in words or numbers. And then a memory group where they a memory training where they learned how to like, you know, mnemonics and other kind of tools to kind of help people remember things.
- [82:13]
B
Things.
- [82:15]
A
And they trained for six weeks and then they had a booster session at one year and three years. And what they found was that particularly the processing speed group had better maintenance of activities of daily living, better maintenance of quality of life, were more likely to still be driving several years after doing the intervention. And a paper just came out last week that showed that those who were in the processing speed group had a lower risk of dementia long term if they did the booster sessions. So even though this kind of brain training is slightly artificial, right, you're doing on a screen, you're just doing like some kind of relatively simple task, particularly if you're Challenging the processing in the brain, which is one of these fundamental functions that we tend to lose as we get older, there seems to be some benefit that then has sort of long reaching effects. So you could do it in BrainHQ or you could go and play pickleball. I think they're going to have similar effects, but it just gives us a big toolkit to approach this and address it, however feels best for us.
- [83:23]
B
Would you think that someone who speaks more than one language would also have better processing speed because they have to take in inputs? There's an inhibitory component to thinking and speaking in one language versus another. Would you think that there's a processing speed advantage there or no?
- [83:40]
A
So it's not necessarily pure processing speed, but certainly aspects of executive function and decision making do seem to be better in people who are, particularly those who are brought up bilingual. But there is also a benefit if you learn a second language even later in life. So actually some of the core research done in this was done by a couple of friends of mine here at the University of Washington, Chantal Pratt and Andrea Stocco. And what they've shown is that if you grew up speaking two languages, so you're fluently bilingual from early in life, the process of constantly having to suppress one language while you use the other and then suppress the other language while you switch back, this then makes those people better at controlling their attention and switching between different cognitive tasks. And we know the people who are, who grew up bilingual have a lower risk of long term dementia. So yes, part of, like training your brain to manipulate and suppress information in that way does seem to have a long lasting effect in terms of brain health.
- [84:45]
B
Great. So I'll continue with my Duolingo subscription is what you're saying. Yes, well, you know, it's interesting. I'm at the point now where I have, so I speak French, I grew up English and French, Italian, Greek, Arabic and Portuguese are the ones that I'm learning right now.
- [85:00]
A
Oh, wow.
- [85:00]
B
So what I find now is sometimes there's a word that I know more strongly in a, in a, let's say in Italian than I know in French. And I'm trying to speak French and that word keeps coming. Like I'm trying to find the French word, but it's the only, it's only the Italian word that I can find and it's so frustrating. So maybe that's, maybe that's early Elsa. I don't know what that is, but I find I have, there's certain words that I've just Learned that. That for whatever reason, that's the one that comes to me and I can't inhibit it and I can't find it in the French language, which is.
- [85:32]
A
But the process of practicing that will actually have benefits. So even though it's frustrating. Right.
- [85:37]
B
Yeah. It's a failure thing. Right. It's like my, my mind will be like, where is it? You know, so I focus more on trying to find it. Yeah.
- [85:43]
A
Because we. Right. You did the thing that's so natural to all of us. You're like, oh, well, I can't do this thing that, you know, that must.
- [85:49]
B
Right.
- [85:49]
A
Maybe that's early cognitive decline or early out summers, but actually just like leaning into that and, you know, practicing it
- [85:54]
B
and into the discomfort.
- [85:56]
A
That's actually a good thing.
- [85:57]
B
Yeah, yeah, yeah. And like, to, you know, to your point around the failing, I mean, that's what makes you. There's nothing more frustrating to me than the syntax of the French language. Sometimes I'll look at memes. Like, I follow a lot of French accounts and there's words, like, there's literally full words in French. Like Wiseau, for example, is plural for birds. O, I, S, E, A, U, X. None of those words are actually pronounced. Pronounced. When you say was, it's like phonetically, it's like W, A, Z. Oh, right. So I am constantly frustrated by French because, like two thirds of the language is never pronounced right. But it's that failure that frustrates me, that makes me pay attention to it more.
- [86:37]
A
Exactly.
- [86:37]
B
Which is probably driving up my dopamine and my testosterone to try and figure it. To try and figure it out. Or why I, you know, I struggle with a certain tense or what have you. So. Yeah, yeah, yeah, great. Okay. This has been like. I'm just. This, this is going to be so useful because I think that there's a lot of fear mongering online around what is the right exercise that you should do for longevity or health span or how you need to eat or. And the way that you present everything, of course, is steeped in so much research because you are a researcher and a scientist. So that's sort of your primary. The. Where you're coming from it. But I think that a lot of this is really actionable without being overwhelming, you know, even in the way that you outlined. Just start with some exercise, snacks, you know, and then progress to low levels of activity, walking and cycling. I just, I love this and I think that my community is really going to benefit from it. So tell us about the book. Tell us about where we can find more about you and your work, all the places and we will make sure to link everything in our show notes.
- [87:35]
A
Thanks so much. The. The yes, the book is called the Stimulated Mind. It's available for pre order right now. It comes out March 24th. If people order it before March 24th or actually up until the end of that week, then through my website, DrTommywood.com or TheStimulatedMind.com you can put in your receipt number and then I send you a bunch of goodies. So I've got like a workout video, some recipes, an excerpt, an excerpt, a chapter from the book, things on blood tests and nutrients that are important for tracking for brain health. So all of that you get if you pre order the book, then really the structure of the book is to go through all those different areas, many of which we covered. So movement, nutrition, thinking about stress, thinking about sleep, thinking about social connection, and then provide a framework for people to actually apply this in a useful way in their own lives. Because I agree that often we just scaremonger and make things complicated and then people just don't know what to do. So they don't do anything. And that's, you know, really the one core message from my book is if you just start to do one thing because of the nature of the brain and all the different inputs that it has, one thing will start to change everything. So a little bit of movement, you know, improves sleep, improves blood pressure. Right. A little bit more sleep, improves sociability, improves our likelihood to engage in cognitively stimulating activities because we avoid those things when we're tired. So just like, like a small amount of change in one area shifts the whole network in your favor. So just find the one thing that feels like it's doable for you can have a big impact. And that's really sort of like the kind of the structure of the book and the outline so people can apply that. Final place you go to rtommywood on Instagram. I share all my papers and podcasts and things there. And then I do have a podcast with my friend Dr. Josh Turknett, who's a neurologist called the Better Brain Fitness Podcast. Easiest place to get access to that is through substack if you go to BetterBrain Fitness and you can just sign up for the free version, you don't have to pay for it. Everything comes through the free version. And if you have any questions, it's like a Q and A style podcast. So any questions or comments or concerns about anything you heard about Today or anything you'd like to know more about, please come there and we'll try and answer your question.
- [89:46]
B
Fantastic. Thank you so much, Tommy. This has been phenomenal.
- [89:49]
A
Thanks so much for having me.
- [89:52]
B
All right, friends, welcome to the after party where I give you a little debriefing, if you will, of the conversation that we just had. And I gotta say, I love this man. I love Tommy. He has been on the show before. We'll make sure that we link it in the show notes if you want to do a deep dive on. We actually talked about muscle the first time. We were talking about fat free mass, and we were talking about concussion and traumatic brain injuries. But this, this is a fantastic episode, partially because I think that social media, I mean, at least people who are trying to get attention on social media try to make taking care of yourself this extraordinarily complicated affair, right? Like, there are some. There's a specific bro I'm thinking of who is currently charging a million dollars for three people to. For him to basically monitor all of your labs and all your things, which, like, at most is gonna cost somebody like $40,000 a year, like, at most. And that's being super generous. But, you know, because it's a bro who wants to live forever and is scared of dying, he's charging a milli. So I really like Tommy's approach here. It's like something is better than nothing and it has knock on effects in all the areas of your life that you may not have considered before. So even when we were talking about muscle and physical activity in general, you know, started off with exercise snacks, like, how easy is it for you to set a timer on your phone and just get up every couple hours, do some stretches, maybe 10 air squats, or just like walk around just to get some blood flow to the brain and then progress from there, right? Then move from like exercise snacks next to like, you know, doing some prolonged low levels of activity, like racking up 8k steps in a day, and then from there some aerobic exercise and from there some sprinting and from there some resistance training. Like, it was. It wasn't like, hey, you need to, you know, rack up 250 minutes every single week of zone two, and then you got to do this much of Zone 5, and it was like, just get what you can get and that is enough. So I really, really appreciated that in a era of social media where people are trying to make things overly complicated. And what I often find is, because we don't want to do it wrong, we're like, oh, I don't want to overdo it on the zone 2. Isn't that catabolic? Or I don't want to do too much sprinting. Isn't that catabolic? Then we just don't do anything right. So I really, really, really appreciated the simplicity there. I also loved the conversation around nutrition. One of the things that I really appreciated was this female little tidbit when he said that women are actually better converters of alpha lipoic acid ala to omega 3s. And part of that is just because of our reproductive capacity. Right. So we are just better at changing Ala to omega 3s for our offspring. Whether or not you have offspring. Different, different conversation, but the capacity is there. And I liked the. I like the conversation around antioxidants as well. So helping with the gut, helping with vascular, like the vascularity and helping to reduce some of these and these oxidants, let's say, in the brain, that drive up inflammation. And then the other thing I really loved was his conversation on inflammation. Really? I mean, how, again, back to social media. This is why this long form podcast exists, by the way, is that you don't get these little snippets of information from social media that you can actually really luxuriate in an expertise and a conversation with someone like Dr. Wood. But talking about the difference between a eustress and a distress, right, Our good stress and bad stress. So talking about why we actually need acute stress and that lowers our baseline level of inflammation to begin with. I like that, that one. That was just a fantastic conversation. And of course, the differences in terms of how the female brain ages versus the male brain, I mean, you were there for it. You probably were like, yeah. When he said something like, he said, I'm paraphrasing, but he said, you know, we've been pretty bad at studying women's brains. And I was like, yep, yep, yep, yeah, yeah, thanks. We know, we know. So loved that conversation. And then the idea of failing, you know, our favorite F word. We should be failing all the time. We should fail at the gym when we're resistance training or when we're sprinting. Right. We should try to be pushing it to the max if we're doing that. And then in terms of language or in terms of, you know, skill sets that we're trying to acquire, getting frustrated and getting close to failure is actually the goal. That's what makes us pay attention. And it actually helps with the synaptic connections and all the things, things. So I loved this conversation. I hope you did too, and I'm curious about what your action item is going to be. So let us know on Apple if you want to leave us a comment. Let us know what you're going to be doing from this conversation with Dr. Tommy Wood or on Spotify. Let us know what you're going to be doing. We look at all the comments, the good, the bad and the ugly, to help us continue to serve you in the way that you need. So until next time, I bid you adieu and I'm looking forward to seeing what you're going to be doing from this podcast. All right, all right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only. Sa.