A (3:01)

Right.

B (3:02)

Then I have another couple of positions. So I work with a big dementia prevention charity in the UK called Food for the Brain. I'm chief science officer of a company over here called Better Brain, which has some of the best, like online free resources for, for brain health. And then I. I'm head of Science for Motorsport for Hints of Performance, which is a company that does work with Formula one drivers. So I, I help to oversees some performance programs in that arena as well.

A (3:28)

Yeah, so exciting. I mean, from performance of F1 drivers all the way to brain injury and Alzheimer's disease. Like, you cover the spectrum in brain science. So this is going to be exciting conversation. I love it. So, you know, with, let's start off with F1 and what you see really move the needle for those drivers as far as, I mean, those guys have to think in milliseconds. I saw this really funny YouTube video where there were a couple of F1 drivers trying to roll a car to the end of a table. Dr. Mike and did you see this video?

B (4:01)

I didn't. I saw the interview, but I didn't see this specific video.

A (4:04)

Yeah, so they're rolling cars to the end of a table and they have to very precisely predict the speed and the distance and they both hit it, you know, like they got it. Like, I'm. Like, it would take me 50 tries to do that. Right. And so obviously there's some neurocognitive connections going on there that they developed through their career. And I would love to hear from your vantage point, just kind of a big picture of how you think about their particular neurocognitive abilities and how they continually improve upon them.

B (4:32)

When you think about any complex skill, or actually most brain functions, really the primary driver is how you've applied the stimulus to your brain over some period of time in order to drive that function. Right. And this is very relevant to Formula one drivers, but it's also relevant to everybody else as well. So when you think about the skills that those guys have, this is something that they've spent every day doing, essentially, since they could walk, some of them, right. First they're in carting like go karts, and then they're in, you know, the various lower levels, feeder levels into Formula 1, Formula 4 series, Formula 3, Formula 2, finally Formula 1. And throughout that entire time, they've Slowly been building these, these skills as the cars get more complex and the engineering gets more complex and as they have to deal with more information at faster and faster speeds. So the reason why they're so good at that is because that is what they've honed their brains to do on a day to day basis. Then when you kind of step back a little bit and think, well, how can, what's the best ways to support that kind of performance? They get so much stimulation from driving the car and they obviously spend a lot of time in simulators because the time in the car is sort of restricted in Formula one and they have simulators of differing levels of complexity. But they're constantly training those same skills, right? Being able to process multiple streams of information. What's coming from the engineer, what's coming from the car itself, what they can see around them. So then the kind of the stimulus that sets up that function or already exists. So what we often spend a lot of time doing is figuring out how can we make sure that they're getting the most out of that session or those sessions and that training they're doing. So for some people the stimulus is important, but they get so much. So then we're thinking about how do you optimize sleep recovery, these adaptation processes, that's when the brain sort of responds and function improves. Um, and they're traveling all the time. They're in a different time zone every week. Like they're constantly jet lagged. So for them it's often focusing on recovery because, you know, everything else is kind of taken care of. They're already so good in terms of learning the skills and then it's, you know, how can, you know, how can we support them in other ways to make sure that they're always getting the most out of what they've learned.

A (6:54)

Yeah, makes complete sense. So the way I like to think about it with the brain is obviously the reps and the number of times you perform an activity has a lot to do with how good you get at it. And you know, I'm a surgeon, so we, it's kind of a similar but different, you know, you just gotta do the surgery over and over and over and over again and then you get it to where it's automatic. And that happens through the neurons obviously connecting and having neuroplasticity. But to your point, it's creating the right situation in the brain to be receptive to those connections forming as well. And your neurons connect better and they interact better when you've had good sleep, when You've had, you know, you're nutriently complete, you're, you're, you've kept the bad stuff out of your brain, right, like sugar and all these other molecules that could potentially cause long term damage. And so I think creating those situations around being receptive to the stimulus is what you're saying is what, where you really focus on.

B (7:51)

Yeah, exactly. So the way I think about this is to bring together all those different points that you made. I have this sort of like model that I've put together for.

A (7:59)

I love it. Let's talk about the three S's for

B (8:01)

how the brain works. So this is my. Yeah, the segue into the 3S model. So there are so many things that we know are important for brain function, but I think they sort of first of all they interact and then they kind of act at core common pathways or in core common areas. So the first is stimulus. So like how you use your brain is the primary driver of its function. It's the same with your muscles, your heart, your liver, your immune system, right? The stimulus that are exposed, that those tissues are exposed to is the primary driver of their function. But then if you think about physical function, right, if you want to get stronger, you have to lift weights, right? But we know that we can improve the adaptation by having good nutrition and by sleeping, right? Every good athlete knows you don't get stronger in the gym. You get stronger when you, when you, when you sleep or you recover. So the stimulus is important. But then the next thing that kind of allows that to happen or the adaptation to happen is what I call is my supply bucket. So that's the second S, and supply involves blood supply. So you need a healthy cardiovascular system. You know, it's very important for your blood vessels to be able to respond to different networks in the brain being activated. This thing called neurovascular coupling, right, which basically when those neurons and astrocytes become activated in the brain for some specific task, then they tell the blood vessels locally to dilate to bring in more blood flow. So you need a healthy, you need a healthy cardiovascular system to do that. Then you also need good metabolic health because you need to supply energy for the brain to do that. So it could be glucose, could be ketones, could be lactate, depending on the scenario. And the final thing you need is a supply of nutrients, right? We know there are several nutrients that are critical for brain function, both for the structure and then its function. And then the third S in my model is support. So you've stimulated the brain, you've Brought in all the nutrients and things that it needs. But then in order for it to adapt and respond to the stimulus, it needs a period of recovery for that adaptation to occur. So sleep is really critical, but there are other aspects of support, like trophic hormones, brain derived neurotrophic factor. We know that other sex, like the sex hormones are very important. And we also want to avoid things that inhibit that adaptation. So chronic stress, other sources of inflammation. So it could be anything from periodontitis for some people, it could be autoimmunity, it could be smoking, it could be excessive alcohol, could be air pollution. Right. These things, sort of a large part of what they do is they impair some of those adaptation processes. So then regardless of which sphere I end up working in, you know, maybe it's how am I trying to get them, you know, help this, this Formula one driver get the most out of, out of his brain? Or maybe it's how am I helping this brain to recover from a, from a TBI or a concussion?

A (10:47)

Right.

B (10:47)

You can think about where's, where are the biggest limitations, where are the biggest issues in terms of those three areas? And importantly, they also interact. Right. So if you increase cognitive stimulation that drives greater sleep needs, so you sleep better, exercise is the same. Or if you start by sleeping better, we know that and you haven't been sleeping well. We know that blood pressure improves and blood sugar improves and you're most more social the next day, you're more likely to do cognitive stimulating tasks. So all of these things kind of interact then, which, which allows us to figure out what's the best place to, to start. Yeah. And then kind of build out from there.

A (11:21)

Yeah, it's such a, it seems complex when you talk about it because there's so many different aspects of brain health. But the reality is your brain, your heart, your liver, they all need the same things, Right?

B (11:34)

Yeah, exactly.

A (11:35)

And we can, we can first build that pyramid of health by, you know, getting the basics right and then adding the support piece to it and obviously avoiding injury as well. So I would love to like dive in a little bit on each one of those essays with you, if you don't mind. So let's talk about stimulus. Okay. So stimulus obviously comes in all sorts of flavors and different intensities and also different time periods that you can apply the stimulus over. Right. And so my point there is, you know, for people that are not Formula one race car drivers, how should they think about the stimulus that they're applying to their brain? And is there a certain amount of time, that stimulus can be applied with maximum benefit, and then you recover from it. Or can we just, you know, be stimulated for 18 hours a day? Like, how does all this work, stimulus wise?

B (12:20)

Yeah. So the way you phrase the question is really important because there's, there's like two sides to this. Right. And I often think that the modern human brain is both understimulated and overstimulated at the same time.

A (12:31)

My point exactly. Right.

B (12:32)

And so when we think about the kind of stimulation that drives function, improves multiple cognitive functions, decrease the risk of dementia, we think about complex learning of some kind. So this begins right at the beginning of life. We know that the average peak of cognitive function occurs around the time you leave formal education. So the higher your educational attainment, the higher and later your peak of cognitive function. Which doesn't mean that you have to do it through formal education, but it basically says that the more time your. Your job is learning, right, you are driving and building capacity in the brain, then the rate of decline is often related to how we use our brain later in life. So how cognitively stimulating is your work? Does it involve a lot of social interaction? Does it involve skills? Does it involve problem solving? Or is it very repetitive? Those have two very different effects on the trajectory of. Of later cognitive. Of later cognitive function and cognitive decline. So when we think about things that seem to be really beneficial, yes, formal learning could be history, maths, like biology, whatever it is. Right. That's important. That learning piece is critical. But then we would also think about complex motor skills. And so that could be dancing, it could be ball sports, it could be team sports. They seem to have an outsized effect in terms of benefit for the brain beyond the physical exertion. And then you might think about languages and music, all of the. And the creative arts. There have been some nice recent studies that show that they have. Even though they can be quite different. Right. Art might be different from dancing. Tango might be different from video games, but they all seem to have these because they require these core complex cognitive skills.

A (14:19)

Exactly.

B (14:19)

They have similar benefits to the networks in the brain that are susceptible to aging. So for those types of stimuli, particularly if you're trying to learn a new skill or something, the. The most efficient way to do it is 30 to 90 minutes, two to three times a week. And that's because most humans can't really concentrate on something and, like, be pushing it against the edge of their current capabilities for more than, you know, like, maybe an hour. But if you're going to do an hour you probably have to take a break in the middle. So every chunks of 20 to 30 minutes. And then when you look at how well information and skills are retained, the most efficient way to build them is to repeat every two or three days. You can learn faster if you do it more frequently, of course, but you get the most out of each individual session by allowing yourself to like sleep a couple of nights, consolidate and come back. So if you wanted to learn something very quickly, of course, so you could practice it several times a day, multiple days a week. But most of us don't have time for that. Right. So if we're trying to add something in here, right, Some new skill, a language musical instrument, you know, two or three times a week, 20 to 30 minutes, and sort of build up from there, that's usually a good place to start.

A (15:26)

Right.

B (15:27)

The other side then is how we use our brains the rest of the time, which is where we are essentially constantly stimulated. We're very busy, right? But we're never actually driving an improvement in function and we're never giving ourselves a break during the day. And this is a big problem with the modern sort of modern knowledge work.

A (15:46)

Exactly.

B (15:47)

Constantly multitasking or task, technically task switching. Humans don't really multitask. We're constantly in meetings, doing multiple things at the same time. This is inherently very stressful. Plus each individual piece of work we do tends to be less good because we're trying to do multiple things at the same time. That's also inherently very stressful. And then we never give our. Never give ourselves a break during the day. So if we can restructure our work so that we can get some focused work done, kind of chunk together the kind of multitasking and meeting work, that's how I like to think about it. Kind of structure your day around that and then give yourself some breaks in between. That then allows you to recover, you come back with more vigor, you get high quality work done, you're less stressed at the end of the day because you managed to achieve more of what you wanted to do. And then maybe you have some time to go and learn a musical instrument at the end of the day, right?

A (16:34)

No. So many great pieces of advice there. So what I'm hearing you say is for long term brain health and the avoidance of Alzheimer's disease and neurocognitive decline, but also just to keep your brain sharp. I fully agree with you that it takes more complex learning activities and those could be, you know, I always talk about mental reprocessing, where you learn Something new, you think about it over a couple of days and you teach it or talk about it to somebody else. Being one of those types of activities. Also learning a new instrument, learning to dance. I mean, dance has tremendous research behind it about being very protective for your brain. Those are the kind of things you want to think about doing more often. You know, I think there's a lot of talk and a lot of people are getting sold things like brain games on your phone that have you do repetitive tasks or even like Sudoku, you know, those type of things. Where does. Where does that fit into protecting your brain?

B (17:28)

Yeah, it's funny because thinking about the whole idea of stimulation and cognitive decline or even enhancing cognitive function, one of the times when the brain is most at risk from cognitive decline and cognitive decline appears to accelerate is a retirement, because we lose that. We lose all the cognitive stimulus we get from. From our. From our work and that social. And then also all the things that we're doing with our brains.

A (17:51)

And the challenges.

B (17:52)

Yes, exactly. Challenges being. Being critical.

A (17:55)

Yeah.

B (17:55)

But then we say, well, I'm going to retire, but don't worry, I'm going to do Sudoku. And unfortunately, that's not. That's not really enough. So when you think about how, like, the different ways you can use your brain, there's a nice framework that Gloria Mark has. She's a psychologist. She wrote a very good book called Attention Span. And it's based on how, like, how focused you are and then how challenging something is. And so the type of skills and things we want to do with our brain to enhance capacity include a lot of. Include high focus and high challenge. Right. It shouldn't be too much challenge because then we get frustrated and we quit. But there needs to be enough challenge. But Sudoku crosswords, some of these brain training games in your phone, they fall into the. Requires some focus, but it's not really challenging. So these are what she calls rote activities. And so they can. They can be beneficial. It's kind of nice to do a sudoku, right. You get a feeling of accomplishment afterwards. It could even be a break from some other stuff that you're trying to do with your brain, but it's not. But it's not going to be enough. And that's the case for most brain training games that I think you would see on your phone. There are some brain training platforms that do have some evidence behind them. Most of them you have to do on a desktop computer, like in a browser. The one that probably has the best evidence behind it is called Brain hq. And there's a nice story for at least one of the training games that they have. It's called Double Decision. The original version of it was used in a trial, the Active Study, back in the 90s, which is still to date. Like the, the best study with the best or the evidence with the, the study with the best evidence for brain training actually doing something useful.

A (19:35)

It's called the Active trial.

B (19:36)

Called the Active Trial. And they randomized nearly 3,000 older adults to four different groups that a control group. They had a processing speed training group. That was the, that was this, this task which is now in Brain hq. There was a reasoning group and there was a memory group where they sort of like taught people how to use mnemonics and other things to kind of remember things better. Then they trained for 10 weeks on these different tasks. Then they had refresher sessions at one year and three years. And they followed these people out for, you know, some of them up to like 10 plus years. And what they found was that all three brain training groups had better quality of life several years later, even though this is a very short period of training. But the ones who performed the best were the ones who had processing speed training. They kept driving for longer. They had a few accidents while driving. They seem to, even though it was a fairly short period of training, they seem to retain some of the benefits of training processing speed within the brain. And so this is now within that same program that they did is now within the Brain HQ platform. And that's still the best study for brain training. So some brain training programs do have some evidence behind them. But the ones on your phone are probably too simplistic. They don't really challenge our brains in the way that they're normally challenged right through multiple senses at the same time. Like that's really where, you know, if you compare something on the, on your phone versus, you know, dancing, for instance. Right. Just that multi sensory stimulation is just so different, Right. That I think that's where you're going to see most of the benefit.

A (21:10)

Yeah, fully agreed. And I think, you know, when I talk to patients about this, I have a lot of CEO clients that are maybe going through like a sale of their company.

B (21:17)

Right.

A (21:17)

And they, they're like, what do I do to keep my brain healthy after this sale? Because I'm going to lose the challenges of running a massive company for a while. And the way I talk about it is there's different levels of activity and you want to choose mostly where you're going to spend your Time is going to be the ones that are going to give you the most benefit. Right. And so then you could fill in some of these other activities, such as Sudoku or brain training games underneath that. And I find in general, if you keep it maybe a rule in life to just always be learning something new. Right. Whether it's a musical instrument, dancing the tango, starting a new business, mentoring somebody else and teaching them. There's so many ways. I know your mentor teaches banjo now, right?

B (21:59)

Yeah. So a very good friend and colleague of mine, Dr. Josh Turkney, he's a neurologist and he formally left clinical practice a few years ago, and now he has this massive banjo training platform online. And so he uses what he's learned about neuroplasticity to kind of help people play the banjo. And I think he also does like the fiddle and some, some other instruments. But. Yeah.

A (22:21)

And thousands of people are doing this.

B (22:22)

Oh, yeah, yeah.

A (22:23)

And it's. And it's, and it works because you're learning something new. And coming from a neuroscientist too, it's, you know, it's that much more legitimate in my view. But I think, I think it's a pretty good rule in life to just always be learning.

B (22:36)

Yeah.

A (22:37)

Never stop learning. Yeah. And then on the other side of that, you know, prior to selling a business or retirement, sometimes people like you mentioned, they slave away for hours at their computer in very stressful situations. And I think a general rule of thumb is every 30 to 45 minutes, just stop, take a break, do something different and take a walk around the office, go have a conversation in the water cooler. I think it's worth it.

B (23:02)

Yeah. There's lots of nice studies where they sort of simulate the workplace or they do it in a modern workplace like that, and they, and you find that even just a five minute break is enough to then come back with sort of renewed vigor. Right. You're. You feel much less fatigued, you're much more able to focus. And they've, they've used like five minutes of like a mindfulness practice. One of, one of the best is actually five minutes of watching comedy clips on YouTube. Right. You just like completely disengage. And there's, there's also some nice evidence for, for rewatching or rereading like fictional scenarios that, you know. Right. So, you know, we like when you get home and you're really tired and you're like, you put on a sitcom that you've seen like 100 times.

A (23:45)

The office. That's the one.

B (23:46)

Yeah. So for me, it's Friends or the Big Bang Theory. And so it restores a lot of that sort of like, helps to reduce some of that cognitive load we've been experiencing during the day. Obviously, like getting outside. Lots of nice studies on just a few minutes in nature, green spaces that can, can have a similar effect. But yeah, just. And it's the fact that you stood up because you know that if you're sitting in one place for a long period of time, like cognitive function can start to decline. So just that just like moving your body a little bit, all of those things can. Then you do that enough times. Right. That can really add up to a lot over time.

A (24:19)

Exactly. And I think it's critical here to like be, be cognizant of your cognitive load. And you know when you feel the weight of the world on you because you've just been slaving away for hours, feel that in your mind and stop. And like doing a YouTube video can be very helpful to just completely get that load off of the brain for a few minutes and just kind of

B (24:41)

reset and know that when you take a break, you will end up doing more across the day because you've actually given yourself a break. So often we're like, well, I don't have time to take a break. But the breaks can be very short. And then you come back and whatever you're doing, you're going to be that you can have better focus, you're going to be more productive. So actually adding in breaks ends up with you doing more and better at your job, even though it feels like it's you sort of like wasting time when really you're not.

A (25:10)

Yeah, exactly. I wanted to ask you about, you know, you mentioned that if you're trying to learn something new, do a session and then take a couple of days off, internalize those learnings and then do it again in a couple of days in. Extremely powerful to do that. I think when people, when people try to learn a new skill and they just, you know, over exert themselves without a break, they sometimes don't. They sometimes have a slowdown how quickly they learn something. But then there's also the opposite kind of thought process. You know, you got to get the 10,000 reps. Right. And so, you know, with Formula One drivers, you've dived deep into the science of this. How do you get the most reps in but still give yourself that recovery period that you need.

B (25:52)

Yeah, so the, you know, well known quote, about 10,000 hours. Yeah, right. That comes from a fame, a famous study by Anders Ericsson looking at expert musicians, primarily violinists. And actually 10,000 hours was the number of hours that the, those like experts had trained by the time they were 20, they weren't even experts yet. So 10,000 hours isn't even enough to become truly expert. So that's like a misrepresentation of that study. But that study does kind of give some nice idea of, of how much we can do in a given period because they did look at these expert violinists and how much they practiced and they tended to practice twice a day for something like 90 minutes. That was like the right, the average. But then these are also individuals where they've built up their focus muscle, if you want to call it to be able to like actually do that kind of hard work for that period of time in, that's in that skill set. So I think that's probably what it looks like for a true expert. But so then it's still only two or three hours a day. It's like really focused work because the rest of the time you need to recover and adapt and that kind of stuff. And that's probably going to be very similar regardless of the area. When you're looking at drivers, like sometimes they may spend several hours in a simulator, but there's going to be breaks, there's going to be lots of different scenarios that they're testing out and trying out. Usually it's usually it's less than that when they're actually in the physical car. Most of the time it's less than that because it's usually across a race weekend you have multiple practice sessions, but none of them are that long. And so I think that the most important takeaway is probably that is right, it's the consistency much more than how much can you get in as soon as possible. Because then you're going to get the ability to adapt and generate those skills much faster. And there's, there's also like lots of nice evidence looking at you do a skill building session and then if you can recover afterwards, like sometimes it's a nap, sometimes it's some kind of breath work or something to allow you to downregulate. Right. That's when the adaptation periods start to start to occur. Even before sleep you can get some of that consolidation that occurs during wakefulness if you can like truly sort of downregulate afterwards.

A (28:03)

Right.

B (28:04)

So I think that, you know, often we're focused on the, the stimulus. Right. And this is something I've seen a lot with amateur athletes. They're always Like, I'm not as good as a professional because I'm not training as much as they are. Right. And what they end up doing is getting overuse injuries, stress fractures, that kind of stuff, because they never recover. So I think that often you are. If you're spending a few hours a week on a. On a new skill, that's probably enough. And then especially because you've layered it on top of family commitments and, like, how much sleep you can get in your job and all this kind of stuff. So then often, like, the focus should really switch to recovery rather than doing more reps. Yeah.

A (28:38)

It's such powerful information. I think if people can have that mindset shift, they'll actually learn quicker and it'd be less stressful to learn new skills. And then you said something really quickly that I want to highlight. It is, if you're a student listening to this and you have a big test coming up, learning something, then taking a nap can actually help you consolidate those learnings a lot faster.

B (28:57)

Yeah, yeah. So I learned this the hard way when I was a student. I remember this period of time, like, right up before my final exams as an undergrad where I hadn't done enough work during the year. And I was just trying to cram all this information and, you know, I wasn't. I wasn't sleeping within, like, a week. Like, I can't remember anything. Like, I have a complete emotional. I run to the bathroom and I burst the floods of tears as I think about, yeah, my brain's not functioning. And in reality, like, all the evidence shows that if you. You will learn much better if you actually take breaks and then you sleep afterwards. So even though it feels less efficient at the time, you will learn much, much faster that way. And so, like, I did end up, like, switching my approach, and it all turned out fine, of course. But that's really where I think a lot of students could. Could benefit is, you know, give yourself some real break sleep. And so if it's. If it's a, like a proper night of sleep, great. If it's just a nap, that's great, too. That will allow you to get much more out of the work that you do actually do.

A (30:03)

Yeah, absolutely. And sleep is part of your support, is that right? And so let's talk a little bit more about sleep, if you don't mind. So obviously everyone has different kind of numbers that they need around their sleep and for optimal brain performance is, you know, do you advise your Formula one drivers, your patients, or anyone seeking your advice on the number of hours of sleep or you focus more on the pattern of sleep, the amount of deep sleep they're getting. How do you think about sleep and brain activity?

B (30:32)

Yeah. So often when there, there are people who come to me and they're having issues with sleep that you could. Often they might have a lot of data. Right. Like they might be wearing an aura ring or a whoop or something similar. I don't think that most wearables track the different stages of sleep well enough for like us to really get into it. Um, and so I'll give it, I'll give an example. I had a, there was a formula one driver who sent me some, some wearable data. When they sleep. They were concerned because they weren't getting very much REM sleep relative. First of all, like how well that wearable could tell you you're in REM sleep is, is, is one question. Like the trends over time are probably better than the absolute numbers for, for most wearables. But so I look nights of, of data, I'm like, well, I know why you're not getting REM sleep is because you're getting five hours of sleep. Right. REM sleep tends to happen at the end of the night. So if you're not getting enough total hours. Right. Then you're going to get less REM sleep. Yeah. And so the most important thing that I see for most people is that they don't get enough sleep opportunity.

A (31:38)

Yeah.

B (31:38)

They're just not spending enough time in bed. And so to be honest, when you live that kind of lifestyle, and I understand you're constantly in private jets, right. You're in a different hotel every night. First night effects are a real thing. Right. You're in a different place. It's hard to sleep. But so the, so the basics always matter. And that's, that's where I tend to focus. So sleep opportunity is, is usually the most important thing and that's actually what most people aren't getting enough of.

A (32:04)

Sleep opportunity. Right.

B (32:05)

Yeah. So just like enough time in bed.

A (32:07)

Yeah.

B (32:07)

And then if you can't get enough sleep opportunity, which just might. Right. You've got kids and you've got to get up in the morning and you've got all these other things to do. And like I sometimes get asked about that. Right. If you, if you, if I can only get six or seven hours a night in bed, like, yeah, I can't do anymore. What do I do? So then I would focus on, then I tend to, I would focus on regularity.

A (32:29)

Yeah.

B (32:29)

Right. So we know that the different stages of sleep have a circadian component, meaning that REM sleep and deep sleep do their best job if they happen at a similar time on a 24 hour cycle. Which is why like deep sleep during a nap doesn't have quite the same benefits as deep sleep during the night. Because it's usually happening, the naps happening during the day. But if you need more, if you can't get enough sleep at night and you can get a nap, please do nap. Like don't think that it's not beneficial, the nap is great, please do it. But if you can get a regular six hours, then you're most likely to get the most out of that, the period of time that you do have asleep. So yeah, we know that quantity, quality, regularity and timing can all matter for sleep. But those are probably the two areas where I would focus is first, can you improve your sleep opportunity? Then can you focus on regularity if opportunity isn't good enough? And of course sleep quality and that kind of stuff, you can think about bedtime routines and caffeine and alcohol and all those kinds of things become important as well. Right, but that's where I would tend to focus.

A (33:30)

Yeah, that's a great structure. Regularity being critical, getting to bed at the same time every night and then creating the opportunity to sleep for seven hours. So almost working backwards, like what time do you have to wake up minus seven hours from that, that time that you need to be in bed.

B (33:45)

Yeah.

A (33:45)

And that needs to be almost more regular than the time you show up to work.

B (33:48)

Right.

A (33:49)

Is that important? And then like you said, after that, then you fill in the rest, optimizing the sleep environment, optimizing more around the routines, et cetera. Yeah, I think people tend to jump to the, you know, blue blocking glasses and the supplements.

B (34:05)

Yeah, the, the supplement people always like, like the supplements. I, I do wear blue, blue light blocking glasses. Do you know, like, mainly because I've gotten to the point where it's like Pavlovian. Like I don't even know if they're having that much of an effect because like it's less the light that you're exposed to. It's more like how you're being exposed to light. Right. If you're watching a scary movie or something, it's the movie that's the issue rather than the blue light. Although, you know, bright lights and blue light do suppress melatonin production. So they are important up to a point. But like now, like I put my glass on and my brain's like, oh, it's bedtime.

A (34:39)

Yeah.

B (34:40)

Right. So. Right. So it's. I've kind of built this sort of, like, placebo setup where. Where it's, like, part of the routine.

A (34:46)

I think it's. You know, I think you're, like. You're right, though. This is Pavlovian is wired into our brain that more than anything. Like, our circadian routines, I think, are so wired deeply in our brains that if you can simulate a circadian routine in an environment like blue blocking glasses, like, it just triggers something in your brain to say it's time to go to bed. Exactly. But I think what's important there, too, is creating the opportunity for your brain to recognize Pavlovian routines.

B (35:13)

Yes.

A (35:13)

You know, have you read James Clear's book Atomic Habits?

B (35:16)

Yes. Yeah.

A (35:17)

Yeah. So he talks a lot about this. If you just do something all the time that's a stimulus, subconsciously, you'll create the sleep pattern around it. So really, really powerful stuff. This episode was brought to you by NextHealth, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United states and Canada. NextHealth is the apple store of wellness, where you can optimize your health span and lifespan using cutting edge technology. I actually founded NextHealth eight years ago to give my patients a place to go, get extensive biomarker testing done, and provide them with all the tools that I use to get my health in order. The longevity circuit in NextHealth using hyperbaric oxygen sauna, cryotherapy, and LED light, is a game changer. In addition, the doctors at NextHealth measure thousands of biomarkers and put into place a longevity optimization plan using advanced tools like ozone, plasma exchange and peptides. Go to www.next.health to check it out. Okay, let's talk a little bit more about around the support of your brain. Some things that people don't necessarily think about is creating the optimal metabolic environment for your brain as far as, like, your dietary choices, et cetera. So can you kind of take us through kind of the big picture rocks that we need to all get right? But then also, I'd love to talk to you about lactate ketones and glucose as fuel sources for the brain. Yeah.

B (36:54)

So when I think about nutrition and the brain, there are three main areas that I talk about that, of course, like, overlap significantly. So one is like energy, the other one is nutrients, and then the third is pattern. So energy is like, it's just like, how many calories are you consuming? And this is important because when you look at a wide range of data and scenarios, and they've done studies in hunter gatherer populations compared to westernized populations, you know, you also see things in those with metabolic disease versus, you know, athletes who are under eating for the amount of, you know, the amount of work that they're doing. That brain reserve, which is essentially just a fancy way of saying, like how much brain do you have in your skull? And like the more reserve the better generally. But also multiple aspects of cognitive function and cognitive decline, they are accelerated at either end of the spectrum. Right. So when you're not consuming enough calories, then you see changes in mood, you see changes in cognitive function, you see changes in sleep if you're consuming too many calories, where you have metabolic disease, metabolic syndrome, high blood pressure, high blood sugar, high lipids, then you also see accelerated cognitive decline and a higher risk of dementia. So you want to be somewhere in, in the middle. And the reason why I focus on, I also mentioned low energy availability is because there's a, you know, in some spheres of the longevity arena, it's like caloric restriction. Right. Eat as little as you can, it's going to make you live longer. I'm not. That's true. And it's not particularly good for your brain because you're not going to have any buffer there. It will just get by with as little as possible.

A (38:26)

Exactly.

B (38:27)

Rather than, you know, building up some reserves. So having adequate energy availability is going to be important. So essentially it's eating as much as you can. As long as you're not going towards sort of metabolic disease, you absolutely want to avoid that. Then I think about the critical nutrients that sort of come along and the, the ones we have the best evidence for in terms of cognitive decline, dementia, vitamin D, omega 3 fatty acids, the B vitamins, especially those associated with methylation, where you see an increase in homocysteine, if, if they're insufficient or deficient, and iron of course, then other things like magnesium, zinc, the polyphenol antioxidants seem to be, seems to be really important for the brain. Those, those are the things that the kind of like have the best evidence for them. And then I think about pattern, which is like, how am I eating every day so that I can achieve those two things? I can maximize my brain boosting nutrients or my critical nuisance for my brain and I can make sure that I'm getting enough energy, but, but not eating to excess. And I think about it that way because there's a ton of ways to skin that cat. Right. And it doesn't matter as much where the nutrients come from, as long as you're getting them. It doesn't necessarily matter what your dietary preferences are, as long as you're, you know, you're sort of eating enough to kind of support all those processes and that allows people of flexibility. Sort of the diet that most people might focus on for the brain is some version of the Mediterranean diet called the mind diet. And that does have good evidence to support it. But equally, I don't think everybody needs to like import olive oil for their brains to work. Right. There's, there was a really nice study done using data from the UK Biobank where they looked at people's diet data and this is like self reported diet data. Right. There's a, there's a lot of issues with nutritional epidemiology. It's just that it is what it is. But they, they then looked at how well people's diets reflected a Mediterranean diet using two or three different ways of how to measure a Mediterranean diet. And what they found was that, yes, you know, if you ate more like a Mediterranean diet, you had a lower risk of dementia. But when they looked at each of the individual foods within the Mediterranean diet, there was no one food that was like, if we take this out of the score, it change the relationship between the diet dementia.

A (40:39)

Right.

B (40:39)

So what it tells you is that it's this overall pattern that's generally nutrient dense, it's less energy dense, so you're. So it's less easy to overeat it and therefore it gives you all the things that you need. So you don't need to like, one by one say, I need to eat all these things because they're in a Mediterranean diet. You think about what's the, like the overall picture of a Mediterranean diet that I can get from my, from my own diet. And that could be in the Nordics, it could be in the Middle East. Right. It could be, you know, anywhere in South America or South Africa. Right. You can hit those same things with local foods. Exactly. And local traditions. It doesn't need to, you don't need to import everything from the Mediterranean.

A (41:15)

Yeah, yeah, you can. And you can create that diet in like, for example, the Japanese diet is very similar to that. People are very focused on the Paleo diet, which I just think is a renaming of the Mediterranean in many ways. And so the biggest components being lots of high fiber organic vegetables, well sourced protein sources higher than you normally the recommended daily allowances. Right. And then finally some really well sourced fats, things that are like fatty fish, olive oil, nuts, those kind of things. Mostly focusing on unsaturated polyunsaturated fats. Right, yeah. And that's how to create the big picture rocks in that diet.

B (41:51)

Yeah, exactly.

A (41:52)

Yeah, yeah. And so this is, these dietary recommendations, I think are what we know works for most humans. And then obviously the. To me, what's even more powerful than constructing a diet around those rocks is just a total avoidance of ultra processed foods as much as possible. Would you agree with some of that or.

B (42:09)

Yeah, so I think as much as is possible. Absolutely. When you then think about trying to apply this at like the absolute population level. Right. So people who don't necessarily have access to the kind of food that you and I might do, some of those things have to have to change a little bit. Right. So we, so we know that I prefer you eat any vegetables, as many vegetables as possible, even if they're not organic. Right. We know that the benefits of the vegetables outweigh.

A (42:31)

Absolutely.

B (42:32)

The farming method. And it's the same for fish. Right. Farmed fish is better than, than no fish.

A (42:37)

Right.

B (42:38)

And so. And conventionally raised beef is better than is, you know, if you're going to eat red meat. Right. It's better than none because it is actually a good source of protein and.

A (42:47)

Exactly.

B (42:48)

And it's, and it's nutrient dense. So then, you know, just focus on the food itself, like regardless. Because. Right. Those you mentioned, fiber is important, the antioxidants are important, the nutrients important. You'll get those regardless of the method. But then equally, sometimes food processing can be beneficial because like there are, there are these big modeling studies where they look at nutrient sufficiency and like the majority of adults around the world have at least one nutrient insufficiency. Right. It's just, it's just, it's just normal. And so since they fortified refined grains in the US in 1998 with, with folic acid, very high levels of individuals with very high levels of homocysteine have decreased, which at a population level is probably going to decrease, you know, help to decrease the overall burden of dementia. So I agree, like, if everybody could eat the way that you first described, that would be great. But if that's not possible, which it is, which is the case for many people, then sometimes food processing allows you to add protein, it allows you to add nutrients. Right. Which. Which people might not get otherwise.

A (43:51)

Yeah. The population basis, it makes sense. Right. And that's why they put the B vitamins in the grains. Yeah, people just weren't getting enough.

B (43:58)

Exactly.

A (43:58)

Yeah, yeah, yeah. Point, point well taken. And then do you feel there's any foods that are particularly helpful to the brain, like superfoods? People talk about blueberries, avocados, like, you know, just, just to kind of like get your feeling about that.

B (44:11)

Yeah, I'm a, I'm a huge fan of berries.

A (44:14)

Yeah, me too.

B (44:15)

So. And I think if there is a superfood for the brain, it probably is, it probably is berries. Wild blueberries have a very high anthocyan. You can buy them in five pound bags from Costco. That's how, that's how I get mine frozen. So like, very, very economical. And there are actually the berry probably masses a little less, but the anthocyanin content is important. Right. That's what makes it blue or purple or red. But there are studies looking at both acute and chronic benefits of blueberries, cranberries, strawberries, cherries. It's that it's those polyphenols that seem to have a benefit both for the gut microbiota for vascular health and then they may have direct effects in the brain as well. So, yeah, if I had to pick like one like blueberries with a side of sardines, I think that would be like the ideal combination.

A (45:02)

Yes, that is, you're right. Let's talk about a little bit about blood flow to the brain as well. Hypertension being one of those silent killers of brain function. How does one think about their blood flow to their brain and what are some things they can do to optimize that blood flow?

B (45:18)

Yeah, I think that in reality, the easiest way to think about it is to think about your, your blood pressure. Because we know that over long periods of time, elevated blood pressure, you know, dramatically worsens vascular health, you know, endothelial function and then, you know, can accelerate atherosclerosis. And that includes in, in the brain, which can, which can decrease the ability of those blood vessels to then respond to those stimuli that we were talking about earlier. There are obviously, you know, lots of fancy ways that people can measure blood flow to the brain. But, but in reality, what we have the best evidence for is either preventing or treating high blood pressure. So then that's where like cardiovascular exercise is, is going to be, is going to be critical. But equally, we know that sleep deprivation, right, that, that can, that can negatively impact blood pressure. So there, there may be other areas that people have to attend to depending on what's most, most relevant to them. And in terms of sort of Pharmaceutical therapies that decrease the risk of dementia. Antihypertensives actually have some of the best evidence for them. So if you have high blood pressure and lifestyle doesn't like, please try lifestyle first. You know, if you can improve, improve blood sugar control and you can improve your sleep and you can, you know, increase your physical activity, that might be enough to improve your pressure. But if it isn't, then I would absolutely consider antihypertensive because we have very good evidence that they prevent or they decrease the risk of dementia.

A (46:41)

Yeah, I'm so glad you mentioned that because you know, a lot of people I think come to us and they to get them off medications and I fully agree with that. But I do think that certain medications are incredibly helpful and incredibly protective while you're getting your lifestyle in order. Right. And so like my personal story is I was on three different blood pressure medications until I finally got this continuous blood pressure monitor. Have you seen one of these yet?

B (47:05)

Yeah, yeah.

A (47:06)

I mean they're incredible game changing devices. It took me a while to figure out what the right blood pressure medication for me was and now I think I have a very good lifestyle. I mean this is as optimal as I can get it, but my blood pressure is still elevated. It's still, you know, sometimes 138 over 86. And the blood pressure medication keeps it as close to 120 over 70 as possible. We know from massive studies that that's the Sprint study for example. The closer you are to 120 over 70, the more is protective not just for your heart health but also for your brain health, et cetera. And so I think blood pressure medications have advanced a lot. We know we have great medications to keep your blood pressure under control while you're getting your lifestyle under order. And also the side effects are a lot less now than they've ever been.

B (47:50)

Yeah, absolutely.

A (47:51)

It can be a critical part of overall longevity is get on the right blood pressure medication and then let's talk a little bit about, you know, you have, let's look at the other side of things because I want to make sure we touch. This is brain injury. Right. I think this is one of the most unrecognized problems with brain health today is not really understanding how much brain injury is impacting the future of our brain health. And this becomes a problem from very early in childhood when we put our kids into contact sports, all the way into like how we treat our brain over, over the course of our life and protected from injuries. So can you talk about that A little bit. And what your research has shown you.

B (48:29)

Yeah, so I may even like start even earlier than that. So, so the, a lot of the work that I do in the lab, it looks at neonatal brain injury. So two main types. One is preterm brain injury. So babies born earlier than, than the normal, they, the more preterm or premature you're born, the, the higher your risk of some kind of cognitive or neurological impairment or death. And then the other is what we call hypoxic ischemic encephalopathy, which is a fancy word for didn't get enough oxygen and blood flow to the brain. And so these babies, they have a normal, usually have a normal healthy pregnancy. Something happens around birth, they don't get enough blood flow and oxygen to the brain. And those babies in particular, they get cooled down for three days as to kind of like decrease that initial brain injury. And it's very, very protective. And when you look at both of those types of brain injury, what I found most fascinating, like including some of the research that we did in large, large clinical data sets, was that if you, if you have an imperfect start to life, which those babies unfortunately had, the biggest predictor of how well you do later on is the home that you go back to. So even if you have very significant brain injury in the hospital as a newborn, the home environment can be incredibly protective. And that's, you're going to be related to food access and stresses and you know, the education that you get and you know, all those stimuli that we talked about and how much you get to play and learn new skills and those kinds of things. But the reason why I, I sort of bring that up to start with is because it hope it gives us a framework to think about, right. If we do get brain injuries, how do we then, you know, address that? But we know that if you have an early life brain injury or if you're born preterm, you have a higher risk of dementia later in life. So that also tells us that you only get one brain. So you have this, right, it has to last this full trajectory of our lives. And we know that now adult, well, could be childhood, could be adolescent, could be adult. Traumatic brain injury is a significant risk factor for later dementia. And there's a few potential reasons for that. One is depending on the injury, you can get very prolonged neuroinflammation afterwards. Right. Which can, which, which, which can both impair cognitive function at the time, but that is also part of the process of cognitive decline and dementia. It can also Be because periods where you decrease like inputs to the brain because you're recovering or if you never fully recover. Right. You've changed the inputs your brain is getting. We know that that's going to then change how your brain function as sort of changes over time. And then also there's the. Right, there's the direct injury itself. Right. So the accumulation of. Of. Of of pathology in the brain. So if you think about something like chronic traumatic encephalopathy, which is repetitive concussions and traumatic brain injuries over time, common in the athletes, common in various military groups, then you, you see this accumulation of it where it's a, it's a tauopathy. So you see the accumulation of. Of tau in the brain which then tracks with neuronal loss and, and the loss of cognitive function. So all of this to say that all these things that happen to our brain accumulate over time. But equally, I think we have some power over how well we recover if we attend to the environment and our lifestyle in and around that. Because not everybody can avoid these things. Some people, this happened already. And I think if we think about this sort of the bigger framework, hopefully there's some then hope that we can change that trajectory as long as we address those various risk factors that are happening around the injury.

A (52:05)

Yeah, it's a really good point and I think sometimes injuries are unavoidable and having the ability and the knowledge to recover effectively from those injuries can be critical. But then also avoiding the injury as much as possible. Yeah, I think so. And what are some of the ways like do Formula one drivers get a lot of head injury in. I mean they get bounced around a lot of those cars.

B (52:26)

Yeah, so. So luck. Luckily, no, obviously if they. And, and some of that has. Has improved over time. So historically there have been. Well, there have been a number of deaths, but there's also been some significant head injuries. And so nowadays there's a halo around the car which, which, which protects the head because these are, you know, these are open cockpit cars. But that's probably saved a number of lives already across multiple levels of, of most sports racing. So, you know, yes, they can, they can have significant crashes. Certainly luckily significant concussions and head injuries are relatively rare now. But if across all the motorsports and all the, you know, all the different levels, there obviously still occurs. So luckily we don't have to worry about that too much. But you. There are ways to kind of. You're right that depending on the scenarios that you're in, doing whatever you can to minimize your risk of traumatic Brain injury is, is going to be important. So they've changed the rules in some youth sports, which I think is, is a great initiative. They've, you know, if you're, you're getting older, you know, one of the biggest causes of a traumatic brain injury is a fall. So then you prevent falls by making sure that you maintain muscular strength and, and power right. Through things like resistance training and eating adequate protein and, you know, preventing or treating frailty and sarcopenia.

A (53:45)

Right.

B (53:46)

So, so yeah, like, whatever you can do to, to minimize your risk. If you want to learn a new skill and that new skill is like a martial art, make it a martial art that doesn't involve you being punched in the head. I think that's probably, you know, sort of like good overall advice.

A (53:59)

Yeah, yeah. I mean, I get this call quite often, and I would love to kind of hear your protocol if you were to get this phone call. My son was in a soccer game. He used his head to hit the ball, and then he fell down at a concussion right afterwards. Teenage son or. I'll give you another one. I got just like a week ago, a good friend of mine called. He was out mountain biking, flipped the bike over, hit his head on a rock, was out for five to 10 seconds. What should these people do immediately after the injury to maximize their recovery potential?

B (54:35)

Some of this we actually published, recently published a paper a couple of years ago that looked at the evidence for different nutritional and supplement interventions after concussions and traumatic brain injuries. And so things that I think we have some of the best evidence for are creatine. If you're not taking creatine already, then there are trials, particularly in pediatric. An adolescent traumatic brain injury, where creatine is, is, is beneficial. So you're talking like, you know, a typical kind of loading dose. So like point three grams per kilo or something like that. Omega 3 fatty acids.

A (55:08)

So, so by creatine. So you load, you do a loading dose of creatine if you're not already on it.

B (55:13)

Yeah.

A (55:13)

Do you increase your dose if you're already taking creatine? So you're taking five grams of creatine?

B (55:17)

Yeah. So then I would, I would go up to, I would go, I would go up to the full dose. And you would date, like dose it based on body weight. Right. Because if these are smaller kids and that's, that's what they did in, in the, in the trials, do you think

A (55:27)

it's beneficial for kids or adolescents to take creatine? So especially if you're in like a sport that involves your head injury potential.

B (55:34)

Yeah. If you look at official kind of pediatric guidelines, they say don't because. Right. They don't, they're worried about creatine and they don't know whether people should take it. If I had a kid who was in a sport that had a risk of head injury, I would probably take it. The reason why I'm, I'm less worried about taking it is because creatine is naturally occurring in food. If I was giving that kid, you know, fish and beef and. Right. You can actually get pretty close to some of these doses of creatine from food. So, so I think that it, and we, we know that it's very safe.

A (56:05)

Sure.

B (56:06)

So yes, I, I think, I think it's worth considering if there's a high risk of head injury.

A (56:10)

Okay. So creatine and the next one was

B (56:12)

omega 3 fatty acids. There are. Oh, and I'll say one final thing, that there was a study in high school football players that did mrs, a magnetic resonance spectroscopy where you can measure the creatine in the brain. And they showed that across the course of a high school football season, creatine in the brain decreased in line with like the number of high speed impacts that kid had had. And they saw something similar for, for choline. And choline is another thing that, that I'd consider. And so why I say this is because. Right. Even if those impacts aren't big, they, the effect can, can accumulate over time, it seems. And so I would just try and stay on top of that with ongoing, ongoing supplementation. And that's probably one of the reasons why you see something called second impact syndrome, which is you have a concussion, it doesn't seem that bad. You think you've recovered, you go back, you have another concussion, could be even less severe, but you have a much bigger effect. And it's probably because you've done things like deplete creatine in the brain. So you have less of a buffer if an injury, if a second injury happens. And then just because I was talking about choline, then coding is another thing. There are some studies, you know, meta analyses in traumatic brain injury that show that codeine supplementation improves particularly neuropsychological symptoms afterwards. So then you're probably talking like 500 milligrams to a thousand milligrams a day of cytocholine or CDP choline. Those, those are the same things. Then omega 3 fatty acids, probably just like a typical, like three or four grams a day. Again, there was a nice study. Now in or. There's actually been multiple since. But one of the original studies looked at, so these Division 1 collegiate football players, and now there are multiple trials that have done this. They've. They've given them fish oil across the course of a season and seen that mark is in the blood of. Of. Of like a neurological injury, like neurofilament, like, they. They accumulate less if they're taking fish oil during. During the season.

A (58:04)

Interesting.

B (58:04)

So fish oil is another one that, That I take. Like, those three are probably the main ones there. There's some slightly less. Less good evidence for branch chain amino acids, but particularly if sleep is impaired, then branch chain amino acids may help. Melatonin would obviously help if sleep is an issue, because you want to try and get sleep improved as much as possible, because that's when that's going to be critical for recovery. There's some evidence for riboflavin, so B vitamins are probably important too. And then I would just because of, like, some of the cool effects that we know that has on the brain. There's not great trials in concussion particularly, but I would add wild blueberries to the diet as well. Like bring the blueberries of blueberries inside. So sardines actually have a very good, very high content of creatine as well as omega 3 fatty acids. So bring back my sardines and blueberries and I would. I would. I would have those as well.

A (58:53)

Agreed, Agreed.

B (58:54)

Oh, sorry. I was gonna mention two more things or one. One main thing, which is that. But early on, after a traumatic brain injury or any brain injury, thermoregulation is really important. This is actually what I did my PhD on. So if you, like. Concussions can often happen in heat, stressed environments. Right. You're on a field, you're hot, you're sweaty, you already have a high temperature, maybe high 90s, into the hundreds. And then you can also get fevers afterwards. So minimizing fevers as much as possible. So it could just be. Right. Just Tylenol or something like that, just to kind of bring fevers down because that's. That increases the metabolic stress on the brain at a time when it's.

A (59:32)

When it's injured and getting out of the hot environment.

B (59:34)

Getting out of the hot environment. Yeah. And like staying well hydrated. Hydrated and all that kind of stuff.

A (59:37)

You said something about babies being cooled after hypoxic injury, so same thing kind of applies later on in life.

B (59:44)

Yeah.

A (59:47)

This episode was also brought to you by Vitaboom. Vitaboom is a revolutionary company that Sends you a customer supplement protocol based on your needs using blood based biomarkers. You can either send them your latest blood test or they will send you a finger stick test for blood analysis. Vitaboom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. What's great is that they also provide all the best brands like Timeline, Tru, Niagen and many others for your custom daily packs. I love mine especially for travel since I don't have to bring 10 bottles of supplements with me and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to Vitaboom.com and check it out. What about exogenous ketones after head injury?

B (60:43)

Yeah, so if I had a significant head injury, I'd probably take exogenous ketones. I think that there's not enough evidence to like say it really strongly unfortunately, because we've been, I've been in this arena for a long time. We've been talking about the promise of exogenous ketones for brain injuries for so long.

A (61:01)

A couple of decades.

B (61:02)

Yeah. I just haven't seen any really good quality trials come out yet. These, I think some of these trials are being run. They're much easier to do when patients are like in the intensive care unit and that kind of stuff. However, you know, we know that certain ketones can have some anti inflammatory effects. We know that like blood sugar regulation is affected by, by brain injuries. So if you can help to maintain stable blood sugar by, you know, having some alternative energy sources that could include exogenous ketones. Right. There may be some benefit there. Ketones, particularly during development. But I also, also think it's relevant later in life. Ketones are the brain, one of the brain's primary sources of like structural precursors. Right, Right. So if you're trying to build, if you're, when your brain is building itself, it uses glucose for energy and it uses ketones to make the fat and cholesterol that your brain is, is made out.

A (61:52)

Right.

B (61:53)

So I think if you're, if you're recovering from an injury. Right. Ketones could have some benefit there. But equally, I'm still waiting for these studies to kind of, to kind of answer the promise of ketones for, for that kind of injury.

A (62:06)

Absolutely. Hyperbaric oxygen therapy is another one.

B (62:09)

Yeah. So I would, I would think about this in two different phases.

A (62:12)

Okay.

B (62:13)

So acutely. Right. So if you get a concussion, I, I wouldn't jump in the hyperbaric oxygen chamber immediately. There's some animal work. And you know, I've heard of some early data from some clinical studies where actually very similar to high temperature is that hyperbaric oxygen can. Right, it increases metabolic rate.

A (62:33)

Absolutely, yeah.

B (62:34)

And so at a time when your brain is struggling to produce enough energy because it's injured, right. You can increase the gap. Gap between like supply and demand, which can make the. Which could make the injury worse. But if you sort of fast forward several days or weeks and you have ongoing symptoms, then I think we, you know, there is some initial evidence that hyper oxygen could help with recovery in these sort of like cognitively degraded states. It might be even be similar in early stages of cognitive impairment and cognitive decline. I think, you know, the people always argue about the studies like is the place, you know, how much of his placebo effect did they placebo control properly? Because it's kind of hard to do it in a chamber. Most of the evidence seems to be hard shell 2 plus atmospheres with breaks in between. So you might be doing it for an hour or two, but you're taking a break every 20 to 30 minutes, an air break. And it's probably like 30 to 60 sessions over several weeks or a couple of months. I think that's where the evidence is best. But still it's another one of those things where I think there's a lot of promise, but we're sort of of waiting for some of the bigger trials

A (63:36)

to come through and then. Sorry to just throw these all out at you, but I forgot to have you in the chair and ask you all my questions. Peptides like cerebralysin. What do you think about that?

B (63:47)

Yeah, I think as peptides go, cerebralysin for traumatic brain injury is actually one that has some of the best evidence. There are several randomized controlled trials, the captain trials where they gave cerebralyzin. It's after very severe traumatic brain injury. So this is, you know, you're probably ending up in the intensive care unit for the, for these kinds of brain injuries. So I think there is some, some evidence there because, you know, these trials have been done for, for concussions and other, you know, other scenarios. There's less evidence. So it's not something. So like we looked at peptides when we were trying to, when we were writing this paper, we tried to look for evidence for cerebralysis for concussions. There isn't really any. So for severe traumatic brain injuries I think think is definitely worth considering for less severe injuries right now. I don't know.

A (64:35)

It's a leap of faith yeah. And then lastly, nad, either intravenously or orally.

B (64:41)

So for either of. For any of those, like, acute brain injuries, I'm not really sure we have. Have very, very much evidence at all. I will say that it's something that I'm interested in because this is something we're studying in my lab right now. So my wife's lab. So my wife is an expert in many things, including nanotechnology. So her lab has developed a nanoparticle that will deliver an NAD precursor to the brain for acute brain injuries. This is a very, very early stages. Right. We would be years away, like, if it works. We're like, years away. But, like, we did just publish a paper where we used the first version of this platform in a rat model of a cube brain injury, and it was neuroprotective. So I wouldn't take it as a human yet, but I think it's a very interesting area that we're kind of working on right now.

A (65:31)

So your wife is also a neuroscientist with a lab.

B (65:34)

She's a. She's a. She's a chemical engineer. She. She works in neurosciences, and one of areas of expertise is in developing nanoparticle technologies for delivering drugs to the brain.

A (65:45)

That's incredible. We're going to have your wife on the podcast.

B (65:48)

You should.

A (65:48)

Because I'm so interested in nanotechnology and nanoparticles because I do think there's a lot. There's an entirely new category of therapeutics that's being developed right under our noses right now, and sounds like your wife is right in the middle of it. Incredible. And then lastly, moving on from therapeutics to diagnostics, are there any signals that someone can use to assess the state of their brain? Either they can get it from a wearable or blood test, et cetera. I think, I think there's a lot going on in that field. You mentioned neurofibrillin lite, nfil. I think you mentioned tau protein as well. There's a lot going on in the diagnostic area right now. Can you talk a little about what you're seeing there?

B (66:33)

Yeah. So this is an area that, like you say, has expanded. Expanded a lot. And there are lots of things that can be measured. Right. So mentioned neurofilament light, gfap, which is a marker of astrocytes that you can. That also is. Seems to be, you know, elevated in people with a high risk of dementia. Then you have the right. The diff. The ratios of the different amyloid proteins and. Which have. Now there's a few versions of that that are now sort of FDA approved as. As part of a diagnostic pathway for Alzheimer's disease. And then there's tau. So like P Tau217 is. You can measure in the blood. It's probably the one that has the best evidence support it. Right now, nobody really knows what to do with results of those tests in people where there's a very low pretest probability of dementia or cognitive decline. Like, what does it look like in a normal population? If it's elevated, what should I do about it? And the answer is right now, nobody really knows. There are some clinics, like Richard Isaacson's clinic, done a lot of work with Kellyanne Neotis, like in these sort of preventative neurology clinics. And they have, they've published some initial data where if you have people that have some elevations in these markers and then you address multiple aspects of lifestyle, like multiple risk factors, so you improve their blood pressure. If, you know, if they have cardiovascular disease risk factors, maybe you treat them with a statin, you know, but then you also give them exercise and nutrition, all these kind of things that then some of these markers can improve. So if, you know, elevation of these markers is associated with a future risk of, of dementia and we can institute some of these lifestyle changes and see improvements on them, like all of that is kind of hopeful that, right, we're doing the right thing and we're kind of changing risk before it really occurs. But again, we're sort of like, right. Right at the beginning of that. So if people are interested in testing these things, it's probably just worth mentioning that right now we don't necessarily know exactly what they mean in a healthy population.

A (68:31)

Right.

B (68:32)

And the way that I think about it is that if you, if you have an elevation of say of. Of P Tau 217 or it's A, you know, it's. And we don't even know the full like normal range in a normal population, but it looks kind of elevated. Then does that, like, how does that help you? Because for most people, I'm not sure we need these biomarkers because I know what your risk factors are. Right. I know what the risk factors are for dementia in terms of lifestyle and the environment and that kind of stuff. So if you're worried about your dementia risk, I can tell you to change those things without having to measure any, any blood biomarkers like that. But some people may want that information because it helps to like, you know, give them some impetus to make the changes. So, so I Think it's going to be very personal. Some people don't want to know, right? We, we have the same with genetics, like some people don't want to know their APOE genotype because they don't want to know their, their increased risk because they might just get stressed about that risk and that stress is detrimental. So I think it, if you, if you're thinking about these things, you just need to be working with somebody who like really knows what, what they're doing.

A (69:31)

Right.

B (69:31)

And that then knows how to address it depending on what those results are. It's not something I just go out and test on everybody because at the end of the day, the things that you might want to do to decrease your risk, we already know what those are, except for maybe some of those nutritional markers or those nutrients we mentioned earlier. Right. You won't know if your homocysteine is elevated, if you need more B vitamins. Right. So you should measure that. You probably measure your Omega 3 status. You should probably measure your vitamin D status. Right. Make sure you're not anemic or you don't have high hemoglobin. Right. Which is a sign of obstructive sleep apnea usually. So I think some of some of the basic blood markers can be really important to determine where to like, what risk factors to address. But some of these other ones, we're kind of right at the beginning of that and try and figure out who does it matter for and how should we use it.

A (70:16)

Yeah. And to your point, like, I think, you know, we're not at the point where we should be testing on, testing this on a population basis. Like it should not be like a standard blood marker. But we have a few patients that are APOE positive. And I think what it does for these people, like you mentioned, is it gives them a sense of urgency when it's really, really high and it points to elevated risk of dementia and it gives them something to track over time. And I think if you're a data driven person, having a marker to track and to see improvement is because we do know at a lower level you have less of a risk. Right. And so, so I think that it helps people to institute changes, be more, I guess put them more into their routine as well and make them more urgent in their lifestyle as well. So it's really like personalized end of one medicine. It can be helpful there. But to your point, you have to have someone that really knows what they're doing because you want to warn people that, look, we're going to Measure this. It could indicate that you have a higher risk of dementia. It doesn't mean you're going to get dementia. It does mean, however, we do need to institute changes along all the lifestyle factors. And we didn't get a chance to talk about this, and I know I have to have you back again. There's so much to talk about. The hormonal effects of, you know, low estrogen for women, low testosterone for men and women can also be a powerful technique to prevent future dementia, but also to optimize brain health in the present. And we can even, you know, use P Tau217 as one of the indicators that, you know, we do need to optimize around several factors. And then we test hormones and potentially we do hormone replacement therapy as well. So that's kind of how we're using it.

B (71:52)

Okay. Yeah, yeah. And I think that's the, you know, when you're very thoughtful about it, I think there can be some, Some. Some benefit that. Oh, yeah, there can absolutely be some benefit there. So, yeah, it all comes down to.

A (72:03)

So even though treating blood pressure, like, so many people don't want to take a blood pressure medication. And then we're like, okay, but look, your P Tau is elevated and you're. You're high risk of dementia, the first thing you do is get your blood pressure control, and it pushes them in that direction, too. So it's just an incredible world we live in now. I think there's going to be more data points that we have that we can utilize to encourage behavior change and also tell us about dementia risk, because it's always been a black box, you know. Wow. What an incredible conversation. I'm so glad that you made the trip down here to do this with me, Tommy.

B (72:34)

Thanks so much for having me. This is really great.

A (72:36)

Yeah. And I think, you know, you're such an incredible wealth of knowledge, not just in the research you're doing, but also, you know, the people that you're talking to in the F1 side and also your foundation. And so I'm happy to support you in every way we can.

B (72:48)

Thanks so much.

A (72:49)

And so tell us a little bit about your book and what people can learn from the stimulated mind. This comes out in March of 2026.

B (72:55)

Yes, yes. Book comes out in March. It's essentially a kind of a user manual. Many of the things that we talked about today, it covers a little bit about why the brain has been such a black box for so long, some of the missteps we've made in neuroscience research, and this Hyper focus on individual cells and proteins and things when actually if we sort of step back, we actually understand much more about the brain than maybe we think. But it's all about the inputs that are really important. And so then I cover everything from why different types of exercise have different effects, effects on different parts of the brain, all the nutrition stuff, sleep stimulus, like we talked about, the importance of social connection, stress management and adaptation. And then sort of all that comes together in the 3S model that I mentioned earlier and how those sort of different factors interact. And the final chapter is how do you institute this, particularly in terms of a busy work schedule? How do you restructure your work day to kind of make the most of these kinds of things? Minimize, make sure that you're sort of productive and can maintain your focus and can do high quality work. So hopefully then depending on where people feel like they need the most help, there's a chapter that can kind of guide them in that way.

A (74:11)

Incredible. I love it that you ended with the protocol that people can use because so many times you read a book and you get all these concepts and then now what do I do? So it's a great way to end the book and can't wait to read it myself. And where can people find you on social media?

B (74:27)

Mainly on Instagram. Rtommywood. Dr. Tommywood on Instagram. I also have a substack with Josh who I mentioned earlier. We have a podcast together so you can sign up for the free substack@betterbrain fitness is the URL and then drtommywood.com, that's my website and all the information about the book is there as well.

A (74:46)

Fantastic. Well, thank you so much.

B (74:48)

Thanks so much for having me.

A (74:54)

I love that conversation with Dr. Wood. Here are my top five takeaways from what we just talked about. Number one, your brain declines because it stops being challenged, not because you're aging. The strongest predictor of cognitive decline is not age, genetics or even diet. It's the loss of meaningful stimulation. Cognitive function peaks around the end of formal education and the rate decline afterward is directly related to how little we continue to learn. Brains that keep adapting stay younger longer. Number two, the brain is both overstimulated and understimulated at the same time. Modern life floods us with notifications, content and information, but very little of it forces true adaptation. Passive entertainment like scrolling TV or phone based brain games don't really build cognitive reserve. Real brain health comes from complex, effortless learning that engages multiple senses at once. Number three, complex skills build headroom that protects against dementia. Learning languages, music, dance, sports, martial arts, or even immersive video games creates what we call cognitive headroom. This is extra capacity that buffers the brain against aging, injury and disease. The sweet spot is 30 to 90 minutes, two to three times a week, with breaks between sessions to maximize retention and neuronal growth. Number four Recovery is not optional. Sleep is where the brain actually improves. F1 drivers don't train endlessly. They train intensely and then they recover deliberately. Sleep is when the brain consolidates learning, builds new connections and clears waste. REM sleep, critical for memory and emotional processing, happens later in the night, which means sleep, opportunity and regularity matter more than people realize. Number five Brain health is metabolic health and blood pressure is a silent threat. The brain depends on steady energy, nutrients and blood flow. Hypertension quietly damages brain function long before symptoms appear. Cardio exercise, adequate sleep and sufficient calories and micronutrients, especially iron, magnesium, zinc, omega 3s, and polyphenols can be foundational. If you had to pick one food for brain health, Dr. Wood recommends blueberries thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.

B (77:58)

Sam.