← Feel Better, Live More with Dr Rangan Chatterjee
Feel Better, Live More with Dr Rangan Chatterjee
How To Protect & Enhance Your Brain Health: The Simple Daily Habits That Can Transform Your Mental Performance with Louisa Nicola #522
02:09:18
Do you think that it’s inevitable that the function of your brain will decline as you get older? Or, do you believe that there are simple things you can do each day to preserve, protect and enhance it?
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- [00:01]
A
I don't think any other intervention can compare to exercise. I believe that exercise is the panacea for health. Exercise is medicine and our muscles are like pharmacies.
- [00:16]
B
Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better Live More. Do you think that it's inevitable that the function of your brain will decline as you get older? Or do you believe that there are simple things you can do each day to preserve, protect and enhance it? Louisa Nicola is a neurophysiologist, brain health researcher and founder of Neuro Athletics where she works with high performing individuals to optimize their cognitive function. Nine years ago, Louisa was training to go to the Olympics to represent Australia in the triathlon when she was hit by a car and suffered seemingly insurmountable injuries. Desperate to accelerate her recovery, she integrated brain training into her her approach to physical health and she made a near miraculous recovery. Since then, she has helped many elite performers perform better, think faster and live longer by leveraging neuroscience, exercise physiology, sleep science and nutrition. In our conversation, we discuss how our brains work as an intricate network, the latest research about Alzheimer's disease, including why it affects more women than men, why a combination of regular aerobic exercise, high intensity training and resistance sessions can help protect our brain function, the importance of consistent quality sleep to support your brain's natural cleaning processes, and how supplements like creatine, monohydrate and omega 3 fatty acids can support our brain health alongside the right nutrition. Now, one of the key themes in this conversation is that our daily habits compound over time to either protect or compromise the health of our brains. And throughout, Louisa shares a variety of practical strategies that we can all adopt, suitable for every age and fitness level. Yes, our modern lifestyles may well be damaging the health of our brains in so many different ways, but as you're about to find out, we have a lot more control than we might initially think. You've been studying the brain for many years and I'd love to know at the top here, what are some of the common habits that people are doing or not doing that predict the function of our brains and things like Alzheimer's as we get older?
- [03:19]
A
Wow, that's a, that's a hefty. That's a hefty question. Because there are so many things to consider if we are looking at long term brain health outcomes, which is what we all are really looking for. If we're looking at these neurodegenerative diseases and we reverse Engineer those. We know that they are driven through lifestyles. So the habits of not sleeping well, not exercising enough and adequately, I would have to say, the foods that we're eating, the stress that we are having, because inflammation, which we'll touch on, is a very big factor here. So if we look at these five things and we think, what are we doing each and every day to form good habits around those? We can set ourselves up for a healthy, performing brain as we age. But unfortunately, we're just not doing that.
- [04:10]
B
If we look across society, whether it's here in the UK or where you live at the moment, in the us, in frankly, many other countries around the world, what's the state of our brain health? How does it compare to where we were a few years ago? And what are the predictions for the future?
- [04:30]
A
The state of our actual global health, in my opinion, is horrific, to say the very least. Right Now, Alzheimer's disease, 55 million people worldwide have this disease. That number is going to triple by the year 2050. In the UK, Alzheimer's disease is the second leading cause of death and the first leading cause of death among women. Now, two out of three Alzheimer's disease cases globally are female. So that's something to consider. And you know, Rangan, I rack my head every day. I am deep in the weeds of Alzheimer's disease. I study it, I have been. I first authored a paper on it and I'm going to be doing several others. So I'm critically analyzing the evidence. And if we date back to the early 1900s, when, sir, Alzheimer actually found this disease, we haven't really made much progress since then. So the state of our, of our global, I would even say our global health crisis is something that we need to, that we need to talk about.
- [05:36]
B
I think there's a common belief in society that our brains are going to decline as we get older. I think many people believe that Alzheimer's is an inevitable consequence of the aging brain, but it's simply not the case, is it?
- [05:54]
A
Absolutely not. And I always tell people that dementia is not part of the natural brain aging process. So we can take a trip down what is about to happen to both you and I and everybody as we age. And I will clearly point that out. But we have to understand first of all what Alzheimer's disease is, what dementia is, and, and then what the brain really is. So dementia is the umbrella term used for Alzheimer's disease, Parkinson's dementia. So we've got dementia, then we've got all these different sub dimensions underneath it. And Alzheimer's disease is the most prominent one, as I mentioned the statistics earlier. And Alzheimer's disease is a multiproteonopathy, meaning that there are two proteins at stake here. We've got amyloid beta, which has been demonized, by the way. It first. This disease first started off with something called the acetylcholine hypothesis. Now it's the amyloid cascade hypothesis, which is still what we used to think of back in the early 1900s. We're still. We're still calling it that. Whereas, you know, we're demonizing this protein, we're demonizing amyloid. And amyloid isn't the demon here. Amyloid is actually a great antimicrobial peptide. It is there to protect our brain against insults, against stress, against inflammation. So we need it. So that's one protein at stake in Alzheimer's disease. The second protein is tau, and tau is phosphorylated within the axon of the actual brain cell. So we've got two cells, we've got two proteins here. We're really attacking one when we talk about these therapies, you know, these newly approved FDA therapies that you can administer when you have Alzheimer's disease. We're just attacking it as a one size fits all approach for one protein.
- [07:53]
B
Yeah. A few years ago, I was in America doing some work with Professor Dale Bredesen.
- [08:00]
A
Oh, I love him.
- [08:01]
B
Yeah, Dale's great. And I remember him talking to me about beta amyloid at the time and saying, look, we're trying to target this and get rid of it, but it's there for a reason. And I think that's, of course, one of the reasons potentially why all these treatments to get rid of beta amyloid aren't working so well. Cause it's actually not perhaps addressing the underlying root causes. So if we follow that logic and say, okay, in Alzheimer's and other conditions, of course, there is beta amyloid protein in our brain. I've heard you say in previous interviews that beta amyloid is accumulating in our brains maybe from the age of 25 or 30.
- [08:47]
A
Yes.
- [08:47]
B
Right. So let's explore that, because that's really interesting. If it's there to protect our brains, what are we doing? That means that it's having to do that job at such a young age. And therefore, and this is one of the things I love the most about your message, it's very empowering. The message you're putting out there to the world on podcasts, in your work in New York, on your Instagram, is very much about saying to people, look, this is not an inevitable consequence. There is so much that you can be doing right now, no matter how old you are, that's absolutely gonna make a difference in the future.
- [09:24]
A
100%. We think about Alzheimer's disease as this one point in our life, in our 70s that we're diagnosed with. But Alzheimer's disease is comparable to end stage cancer. When you get Alzheimer's disease, there is no reversal, there is no cure, there is no going back. There is Alzheimer's disease and it is a very, very, you know, another two, three years until death. Okay, so that's what we need to be talking about. We need to be talking about that when you actually are diagnosed in your 70s or in your 80s, that disease has been accumulating since your 20s, your 30s, and your 40s. And like we mentioned, let's talk about beta amyloid, this toxic protein, which, it's not a toxic protein, it is a sticky protein. It actually lives outside of the neurons and it accumulates over time. And it's actually part of our innate immune system. So when we are stressed, we can be stressed from anything. It's emotional stress. Anytime we raise our inflammation, our brain says, okay, we're under attack. Now remember, our brain is really responsible for two things, survival and reproduction. So it basically says, she's under attack. Let's raise the level of amyloid beta. So we activate our innate immune system, we raise amyloid beta in a way to protect the brain cells. It lives outside of the brain cells, and it says, let's protect her brain cells against these various insults, that is inflammation. Now, if you have a healthy performing brain, you then activate your other immune system and it kind of down regulates the innate immune system. We've all got that. But what happens is when we don't take time to rest and we don't have time to clear out that amyloid, then it starts to build up and it starts to stick together and end up. We end up with a head full of maybe about 4.5 grams actually has been noted in some of the brains of Alzheimer's disease patients.
- [11:26]
B
There's a couple of principles I just want to highlight because you've just brought them up and they come up in different forms with regularity on this podcast. One is this idea that chronic disease, the diagnosis of any chronic disease does not happen overnight. So you just mentioned that the process in the body that ultimately leads to a diagnosis of Alzheimer's at some point, let's say when you're 70 years old, right. That starts at least we know 30 years before that. Right. And you're saying it might even be, you know, 40, 50 years, potentially, that process. Right. We know that type 2 diabetes, when you get that, that doesn't just happen. You don't just go on holiday, have too much alcohol and have too many rich, calorie dense meals and come back with a diagnosis of type 2 diabetes that has been building up the for 10 years. Right. So I think that's a really important principle for people to think about. And it's also what you said about inflammation, this idea that, you know, if there's an insult to the body, if we're having a stressful time in our lives, that's okay if we rest and allow everything to recover. But if it's chronic and we don't allow ourselves to switch off. So you can apply this principle to inflammation. Acute inflammation, helpful. Chronic inflammation, problematic. Acute stress, helpful. Chronic stress, problematic. Those two kind of core principles, I think, are absolutely at play when we're thinking about the brain.
- [13:05]
A
Yeah, absolutely. I also think there is miscommunication around what this disease is, how to treat it. And look, when you're in your 20s, you're not really thinking about Alzheimer's disease. You're not thinking about a nursing home. Why would you? I wasn't in my twenties, to be honest. I wasn't thinking about that. I thought I was invincible. And then things evidently start to slow down as we age, just due to the brain aging process. But let's just actually also reflect on what Alzheimer's disease actually is. It's not just the accumulation of amyloid beta and phosphorylated tau proteins. It is a network insufficiency. What do I mean by that? Let's look at the brain. The brain is around 2 pounds. It's kind of got the consistency of hard Jell O. If you look at it, it's got around 87 billion neurons. They're brain cells. These neurons each have around 5,000 connections. So the way neurons communicate with each other is via these connections. We call them dendrites. These dendrites synapse together and this is how we create our emotions, our feelings, thoughts, all the actions we produce. So that's a network in and of itself. So 87 billion neurons, 5,000 connections. So at any given point in our 24 hours each day, we're producing around 500 billion, if you do the math, connections. Alzheimer's disease is a breakdown of those connections. Dementia is a decline in our cognitive performance. Our cognition is things such as information processing speed, Reaction time, memory, they decline because we have an interference within the connections of these neurons. And that interference is amyloid, because amyloid lives outside of the neuron cell body, and it interferes with the connections. And what ends up happening is the connections start to die. It's not the neuron itself, per se. The connections start to die. So we have a network insufficiency.
- [15:14]
B
Yeah, that's super interesting. So it's not the brain cells that are dying necessarily. It's more that the connections between them are starting to go. So. So I don't know.
- [15:27]
A
Would.
- [15:27]
B
Would this analogy work? Right. Let's say you have a field of trees, right? The trees representing the nerve cells. I guess the branches aren't connected to the other trees, so maybe it doesn't work. But it is one helpful way of looking at it that you really want, as you get older, each of these brain cells to be rich with all these connections. And as we get older, if we don't do the things that you're gonna be talking about on this podcast today, then actually those connections start to go down and. And at some point you pass a critical threshold, and then you start to get symptoms. Is that a reasonable explanation, would you say?
- [16:12]
A
Correct. And I love the analogy of a tree because actually, if you do imagine an entire tree, the word dendrite actually comes from the Greek word tree, so it's somewhat similar. And if you imagine the axon as the trunk, so within the axon, that's where the tao builds up, and it actually breaks down. You get the collapse of the axon within that. So it's a collapse of the trunk. Then we move up the leaves. The leaves are the. Let's just say, the dendrites that connect with other leaves. If we get pruning away of those, then, yes, we end up losing the ability for one neuron to connect to another.
- [16:55]
B
We've given a lot of technical terms so far. Talking about amyloid, you know, beta amyloid protein and tau protein and all these things and dendrites and connections. Before we go into those practical things that people can do, which you're so passionate about, let's humanize this condition a bit. Because when I see you online talking about this, there's a real passion that comes across. This doesn't feel. In some ways, I can almost say it feels personal, like there's something that you are driven to communicate with the world about. This condition. There's a really fiery passion, which I'm sure we're gonna see shortly. Where does that come from? Why Does Alzheimer's mean so much to you?
- [17:44]
A
You know, I don't have a personal story per se. My father, in 2019, did have a stroke of the right parietal lobe. And I've seen some cognitive decline since then. But my real passion comes from actually working in clinical practice. I mean, you're a physiologist by trade. And as part of that, we scan brains using an electroencephalogram. And I remember scanning brains and my main job was to look for dysfunction, dysfunction in different brain lobes. And I remember this one patient, let's call her Betty, and she, she was very young. And by young I'm talking 55. And I remember her coming in, she had three kids and her husband, and she ended up. I worked with her for a year and I saw the decline. Ended up she couldn't even remember who I was. And I saw the look in her husband's face. He said, sometimes we wake up and she doesn't even know who I am. So why would she remember who you are, Louisa? And this woman had done nothing wrong. She actually didn't even have the genetic risk factors that predisposes you to certain types of dementia. She didn't even have the risk genes. She wasn't even positive for APOE 4. And when I looked at her, she was actually doing everything right, wrong. And she was doing what she thought was exercise, doing what she thought was good eating, trying to sleep and, you know, maintain her, you know, being a full time mother and also working full time. And I thought, who has failed you because she actually had no idea what Alzheimer's disease was. She didn't know what dementia was. She just thought, this is something that occurs when you are 80. And it was at that moment that I thought, something has to change. And ever since then, that was 2019. Ever since then, it breaks my heart to think that we are spending millions of or billions of dollars trying to get to space, literally trying to figure out how can we live on a different planet, and yet we haven't solved for a disease where you literally forget your husband's name and your children's name, you forget who you are. You know, the FDA will have you say that we're making progress through these various types of drugs, you know, Donanemab, leqembi. But we've seen that these drugs just treat the symptoms. That's not progress. That is a systemic failure of our healthcare system.
- [20:21]
B
It's the same thing with, frankly, every chronic disease, is that most of the time the pharmaceutical drugs are treating the symptoms, which May have value in some conditions, some of the time. But what really drives me, and I really feel it drives you, is to try and help people understand the root causes of what's going on. So you are saying that brain decline as you get older is not necessarily inevitable, at least not to the degrees that we're seeing. And you're saying Alzheimer's is not inevitable and it's not a normal part of aging. Yet you're also saying you're sharing statistics that rates are gonna triple by 2050.
- [21:01]
A
Yes.
- [21:01]
B
Right. And I love that analogy saying we're spending billions on trying to get to space and live on a different planet. Right. But let's figure out how to live well on this planet.
- [21:12]
A
But it's literally, basically, it's like the 1900s called. They want their medications back. That's like a dad joke, right? Because we are still not understanding that we are attacking the wrong thing. We are basically saying, that's okay, guys get Alzheimer's disease because we have therapies that are going to eliminate the symptoms. And by the way, I don't know if you read the New England Journal of Medicine where they did the study on Donanemab, which is an intravenous drug that you get, and it's around. I'm telling you, it's around 50 or $60,000 in the U.S. and what does that drug do that actually. Well, it's a monoclonal antibody that eliminates the amyloid. And what we've seen is that the risk factors associated with that is micro hemorrhages. So they're getting brain bleeds from these patients. Edema. So you're getting brain swelling from taking this drug. And some of them have caused death in some patients. So we're attacking the symptoms of this disease where, by the way, even if you remove the amyloid, even if you remove the 4.5 grams of amyloid from somebody's brain, you are still not curing Alzheimer's disease, because you're going to build that back up if you don't address the root cause of. Why do you keep attacking your innate immune system for it to raise amyloid beta in the first place? And not just that. Let's look at it this way. There is a supply and demand issue here. If you do not supply the neurons or if you do not supply your brain with the things that it needs to not only survive and thrive, but be able to meet the demands of everyday life, you will succumb to this disease. So you need to have more supply than demand.
- [23:04]
B
Yeah. Okay. So in terms of getting into the root causes and specifically the things that we can do today, Whether we are 50 or 60 or whether we're 20 and 30 years old, I think it's relevant for all of us, right, to start doing these things as soon as we can. So let's just set out and address a common misconception, genetics v Lifestyle. Right. Because there is still this perception out there that genes are a big thing for brain decline and things like Alzheimer's. People will still say, oh, you know, my grandma had Alzheimer's, so I think I'm probably gonna get it. Can you clear that up for us before we get into the lifestyle factors?
- [23:56]
A
Absolutely. And almost everybody can say that they know somebody who had dementia. When people find out, you know, when they get a chance to speak to me, they're like, oh, Louisa, Yeah, my grandmother had dementia. And I always ask, did she have dementia or did she have, like, what type of dementia? Nobody ever knows. They just say dementia. When we talk about genetics, it's important to determine and differentiate between risk factor genes and genetic mutations. So genetic mutations, for example, if you have a genetic mutation on chromosome 4, you will get Huntington's disease. So these genetic mutations that you are born with, unfortunately, if there is a disruption in your DNA somewhere which has been passed down from your parents, you will get the disease associated with that gene. When it comes to dementia, there are three involved in the mutation process. You've got presenilin 1, presenilin 2, and then a mutation on the amyloid precursor protein that represents a mere 1% of the Alzheimer's disease population.
- [25:02]
B
Wow.
- [25:03]
A
Genetic risk factors, which is still a small percent of the population, are the very famous genes that most of us have heard about, and ApoE4. So we have ApoE2, apolipoprotein E2, which is protective against Alzheimer's disease. We have ApoE3, which is basically a null. It doesn't protect you, but it also doesn't raise the risk. And then we have the APOE4. Now we get two genes. We get one from mom, one from dad. So you could be E3, E4, which raises your risk slightly to get the disease. Raises your risk. Notice how I say raise your risk, not it means you'll get it. If you are a 3, 3, you're part of the population, the average population. I'm a 3, 3. If you are a 4, 4, then you've raised your risk by 12 times of getting the disease.
- [26:00]
B
So significant increase in risk.
- [26:02]
A
It's a significant increase in risk. However, it's not a foregone conclusion that you will get it.
- [26:07]
B
Okay, so this is really interesting. So you mentioned there are some genes that are predictive. Yes, but that's only. That's under 1% of this population. Right. So let's assume that most people don't have those, which I think is a pretty reasonable assumption given how low that number is. You mentioned APO3 and APO4. I think many people will have heard of those things. Now, first of all, I want to know, do you recommend people get tested? So I think this is quite a tricky area for people. And I think we also have to acknowledge, aren't there studies in places like Nigeria where people with APOE4 double APOE4 don't end up getting Alzheimer's?
- [26:53]
A
Yeah.
- [26:53]
B
Right. So what can we learn from that? Just taking a quick break to give a shout out to Bon Charge, who are sponsoring today's show. Now, something I often cover on this podcast is the importance of sleep and how beneficial better sleep can be for our health and well being. Now, often it's the small things that really can make a big difference. And for me there is no question that when I swapped out my usual bedside bulbs to the low light ones from Bon Charge, it made a huge difference. In fact, in my house for many years now, all of the bedside lamps contain Bon Charge's amber low light bulbs. Bontrage also make fantastic blue light blocking glasses which I think are some of the highest quality out there. There are products of theirs that I really like that many of you I know also are big fans of is their infrared sauna blanket which is much cheaper and more accessible than having a sauna in your own home. It's really easy to set up, takes less than a minute and you can basically enjoy a 30 or 40 minute session whilst relaxing, reading or watching TV. And this can help with all manner of things including relaxation, stress reduction and sleep. If you go to boncharge.com livemore and use the coupon codes livemore, they are giving you an incredible 20% off all of their products. That's B O N C-H-A-R-E.com livemore and use the Coupon Codes livemore to save 20%. Vivobarefoot are one of the sponsors of today's show. Now I am a huge fan of Vivobarefoot shoes and have been wearing them for over a decade now, well before they started supporting this podcast. I've also been recommending them to patients for years because I've seen so many benefits I've seen improvements in back pain, hip pain, knee pain, foot pain, and even things like plantar fasciitis. And contrary to what you might initially think, most people find Vivos really, really comfortable. But I have to say, especially at this time of year, as the temperature is starting to drop, their winter boots are absolutely fantastic. And I myself am really enjoying wearing their brand new goby warmlined winter boots now as well as adults. I think they are a fantastic option for children and I really hope that in the future more and more children start wearing barefoot shoes like Vivos, as I think this can prevent many downstream problems in the body later on in life. And remember, whether for your children or yourself, if you've never tried Vivos before, it's completely risk free to do so as they offer a 100 day trial for new customers. So if you're not happy, you just send them back for a full refund. If you go to vevobarefoot.com livemore they are giving 20% off as a one time code to all of my podcast listeners. Terms and conditions do apply. To get your 20% off code, all you have to do is go to vivobarefoot.com livemore.
- [30:33]
A
Well, that means then that these risk factor genes just raise our risk of getting it. Just like going out into the sun, you raise your risk of getting skincare. It doesn't mean you're going to get it. It just depends on what you do and how long you spend in the sun and how you protect yourself, et cetera. If you have. I think everyone should get it. It is a controversial topic. I understand that it's scary for some people. You know, if you want to go and get it done and you need genetic counseling that is always offered to you.
- [31:02]
B
Well, why do you think people should get it?
- [31:03]
A
I think everyone should understand their risk.
- [31:06]
B
Okay. Now, of course, some people, even if they had the knowledge that you have and had the means to get their genetic testing, they just wouldn't be able to do that.
- [31:18]
A
Exactly.
- [31:19]
B
Financial reasons, family commitments, whatever it might be. Okay? So we have to acknowledge that, that not everyone can do that. But I think there's a wider point here, which is how much information should we get? Because, you know, I remember back at medical school when we used to talk about these deterministic genes for various conditions, that if you have them, you know you're gonna get the disease. And we used to have ethical things at med school and we'd have to write, you know, essays on both sides, the pros and cons of Actually, should someone know or is it gonna just stress someone out for the entirety of their life? Because they're gonna get it anyway. I probably wired a bit more like you, I would like to know because I very much like to take agency over my life. I like to know what's the situation so I can take action. But I also think some people have a personality whereby this sort of stuff really stresses them out. I've seen that honestly, with blood pressure monitors, that some people find having a blood pressure monitor incredibly stressful or putting on a CGM incredible, incredibly stressful. They're worrying about every single thing they eat. Whereas other people could go, okay, this is really interesting. Now that I've seen that this food puts me consistently into the type 2 diabetic range, I'm gonna now use that information to make different choices. So I kind of feel that's a wider conversation. Right. But it's really, really interesting to me that you do recommend testing and I think for me, I would like to know. I don't. I meant to do it a few years ago, I never got around to it and now you're making me think, actually maybe it's something I'll prioritize.
- [32:54]
A
So you want to know if you're raising your risk and then it becomes about education.
- [32:58]
B
Yeah. And also I think the empowering thing is that even if you have it, it's not a life sentence. It doesn't mean you're going to get it. This is where I think this information can be massively useful for people. Let's say you're a bit passive about your health and you're like, you know what, I'm 40 and things are going fine. I don't need to change much. And when I finish work on Friday, I go out and have a few drinks with my friends, but everything seems fine. Yeah, Grandma had Alzheimer's, but I think I'm fine, which is the state for many people.
- [33:29]
A
Oh, yes.
- [33:30]
B
If you then go and get it and see that you are a double APOE 4, if you get the appropriate education around it, that may be a very significant wake up call to go, okay, wow. I have an increased risk, a significantly increased risk. It doesn't mean I'm going to get Alzheimer's, especially if I now start to take control of my life and pay attention to these. I think you mentioned five factors at the start. You mentioned physical activity, sleep, stress, nutrition. Was it inflammation? Was the fifth one. Yeah. So let's then look at these five factors. Let's go through them and see what we can educate people with, I think exercise is your passion. So let's start there. What do you wish everyone knew about exercise in the brain?
- [34:25]
A
I wish everybody would exercise for their brain health and for health outcomes and longevity rather than aesthetics. In my world, people are. But that's a mere, probably 10% of the population. The physical activity guidelines globally state that we should be exercising around 150 minutes to 300 minutes per week. And that's moderate to vigorous physical activity.
- [34:52]
B
Which means what?
- [34:54]
A
Exercising at around 65% to 75% of our maximum heart rate.
- [34:58]
B
And for people who have never taken their heart rate, are you able to give some examples of activities that might fall into that category?
- [35:07]
A
Yeah. So imagine you are running up a flight of stairs and you are going full force. And the last step is when your heart rate, you feel like it's going to come out of your chest. You've reached most likely your maximum heart rate. Let's just say that's 200.
- [35:26]
B
Okay.
- [35:26]
A
Okay. You want to be working. I mean, that would be very high. That's a young, young person. Let's just say 100 then, just for argument's sake. That means that we want you working out at 65% of that 100 beat. That is your maximum heart rate. So we want you to be working out for 150 minutes at 65% of your 100. So 65 beats per minute.
- [35:52]
B
Okay. So that's going to depend on who we are or what our maximum heart rate is. But essentially we're talking about things like a pretty fast walk.
- [36:01]
A
Fast walk? Yeah, fast paced walk, a jog, an easy jog, where you can, where you can hold a conversation, but you are, you feel like you're working out at the same time.
- [36:13]
B
Okay. Do you agree with those physical activity guidelines, first of all, or do you think they are conservative?
- [36:19]
A
They're conservative. I think that there's a nomenclature issue here. People think about physical activity. And by the way, I do all of these epidemiological experiments on my parents. For example, my mother, if you said physical activity, she will say, but I took the clothes out today and put them on the line. That's not what we're talking about here. We need to change the word physical activity to exercise. So you should be exercising. Physical activity is literally anything above sedentary behavior. So for you and I, when we walked in here, that's considered physical activity. That shouldn't be part of your 150 minutes to 300 minutes. That's the first thing. The second thing is I don't think many people really understand 65% of maximum heart rate.
- [37:01]
B
Like you just said, this is what we just explored. Right. I think that one of the problems with the way we as doctors and we in this healthcare profession often communicate is that we use a different language that the lay public doesn't understand. So even moderate physical activity, I believe if you ask 10 people what that is, you're gonna get 10 different interpretations, which then creates confusion and therefore inaction.
- [37:34]
A
Yep. And if we can first start with understanding that every single day, I believe we should be moving our body. Second part of that is we can split exercise up into three different parts. We can talk about aerobic, which is what we should all be doing. We have to be doing resistance training. So that is exercising with weights, weight training. And then there's a third part which is called neurocognitive training.
- [37:59]
B
Wow. So let's go through those three and before we do, let's just clarify that point. Let's say you were doing moderate to physical activity, 150 to 300 minutes a week. I know. Cause I've spoken to people in public health over the years that sometimes public health guidance is given not necessarily because it's optimum, but because it's like, well, if we push it much beyond this, no one's gonna do it.
- [38:30]
A
Yes.
- [38:30]
B
Right. And so I get it. We've got a sedentary population across the world.
- [38:36]
A
Well, it's around 80%.
- [38:38]
B
80% what?
- [38:40]
A
People who are not meeting the physical.
- [38:41]
B
Activity guidelines in what countries like America and the uk?
- [38:45]
A
Yes. Correct.
- [38:45]
B
Yeah. Okay. And we know that physical inactivity is one of the leading causes of premature death globally. Right. So that's pretty well established. So if 150 to 300 minutes a week is not enough, what is enough in your view, based upon the research that you've seen?
- [39:05]
A
Yeah, that also that 150 minutes to 300 minutes encompasses everything people don't know. How many times am I meant to be doing weight training? How many times am I meant to be doing aerobic training? So they're just compiling it all together. So let's break it apart. Your aerobic training should be made up of at minimum three hours a week. So aerobic training are things like your long distance running, cycling, anything where you're able to move at around that 65% of maximum heart rate.
- [39:36]
B
So you don't feel as, so you're crushing it or you're pushing hard. It's quite, you know, aerobic, it's easy.
- [39:44]
A
It's your long, slow Distance running, I call it.
- [39:46]
B
So what about someone who doesn't run? Right? And they're like, okay, like, I really want to protect my brain. I'm hearing what you're saying. Exercise is one of the most important things to focus on. Like, I really want this to be accessible to people and I don't want people to get put off because they're like, well, I don't run. What else counts for that? Aerobic activity in your view?
- [40:07]
A
I'm so happy you pointed that out. Because your brain doesn't know the difference between you running, cycling or swimming. It just knows heart rate. So get on a bike, get on anything. There is an elliptical trainer at the gym. Anything that is that, it's in the cardio zone of the gym. Anything that's just going to get you into that steady state of 65% to.
- [40:29]
B
75% and you don't have to push yourself hard here. I think that's important. Right, so you should be able to have a conversation whilst doing this.
- [40:35]
A
Yes. At the end of every sentence you should be like, you know, you have to take a breath.
- [40:40]
B
Okay. So you're lightly exerting yourself, but your heart rate is certainly elevated compared to when you're just sitting down.
- [40:48]
A
Yes.
- [40:48]
B
And you would say, what, maybe 30 minutes a day is good for that?
- [40:52]
A
Well, I think that you should be doing at minimum 45 minutes per session.
- [40:56]
B
Okay.
- [40:57]
A
So if you're doing three hours a week, make it around a 45 minute session.
- [41:03]
B
And is that because if you've been doing that and your heart rate is elevated for 30 minutes, you could obviously do that every day. 7 times 30 is 210 minutes. Or you could do, you know, let's say five 45 minute sessions, which is, you know, a bit more like 225 minutes. Is there, do you think, a benefit from actually having it longer than 30 minutes? Going at 45 minutes?
- [41:31]
A
Yes. And the reason being is that it does take a while for your heart rate to elevate and then steady out. But second thing, let's talk about the benefits of aerobic training and what it does, because the benefits really come when you're okay, you're in the zone. You and I, right now, we're in our zone one, Right. When we talk about zones, we talk training zones. Zone one, we are set entry that zone two, is that next level up? 65% of maximum heart rate, we've got zone three. And then when you're in that zone four, I call that the death zone. That's when you are working so hard running up those stairs to your maximum.
- [42:05]
B
The death zone.
- [42:06]
A
Yes, the death zone. And we'll talk about what that means in terms of VO2 max.
- [42:10]
B
And is this on a five zone model?
- [42:13]
A
I use four, some people use five, some people use six.
- [42:15]
B
But is it useful for us? This is how often have explained it to patients in the past. I say, think about your car. Your car's got five gears, okay? Think about your body. And when you're moving your body, also in terms of five gears, you can be going really slow. First gear, a bit more, second gear, third gear, fourth gear, fifth gear. And now let's think about your activity and figure out, you know, where are you putting, you know, which gear are you in? Would you say that's a helpful way to think about it?
- [42:44]
A
Really helpful. And everyone needs to understand it's very individualized. Your zone two is different from my zone two. If I am not very metabolically fit, my zone two might be fast paced walking. My parents zone two is fast paced walking. My father is 72 and my mother is 69.
- [43:07]
B
You mean if someone's not that fit.
- [43:09]
A
Correct.
- [43:10]
B
Then it's not gonna take much to get them into second gear. Right.
- [43:17]
A
Think about second gear is above first gear and first gear is us sitting down.
- [43:22]
B
Okay, so another, another way of looking at this is let's say someone's at the same age, right? So if they're getting fitter, if they were measuring their heart rates, right? And they. And they sort of go, okay, I want to be just a bit better than, you know, a bit higher than me just sitting down. And you can go to labs and measure lactate thresholds and all this kind of stuff, which I have spoken about before with Steven Seiler when he came on the show last year. But I guess the point is as you get fitter, you'll be more efficient. And therefore it may be that now, for example, if you start moving your body, you get into zone two, just walking around the block. But maybe in six months time, if you are consistently doing this 200, 300 minutes a week, actually that's no longer going to be in zone two. That's almost going to be zone one. And you're going to have to push yourself even further because you've got that much fitter.
- [44:24]
A
Yes. And that's a good thing.
- [44:26]
B
That's a good thing.
- [44:27]
A
That is a very good thing. And I'll tell you why you are improving your stroke volume. Stroke volume is how much blood you pump out with every beat. We need that because when you Pump blood to your body, especially your brain, you get a profusion of oxygen and nutrients, everything our brain needs to survive. As we get older, the stroke volume tends to decrease just because the valves of our heart and our aorta tends to stiffen as we get older. So the more you strengthen your heart through aerobic physical activity and aerobic exercise, the greater amount of blood you can pump out with each beat. So meaning that you can be pumping more blood efficiently through your body.
- [45:18]
B
Listeners to this podcast will have heard us talk about strength training before and this idea that once you hit the age of 30, you start to lose muscle mass each year, unless you're doing something about it. Okay, yes, try and build up as much as you can before that period, but certainly after 30, make sure you're doing things to prevent how much that's going to decline and hopefully keep it static or even increase it. Can we think about cognitive capacity in a similar way? Like, I know, just to take it out of exercise for a minute, this idea of you mentioned about our brain cells, the neurons, and all of these connections, and you mentioned before that Alzheimer's, in your view, is a connection issue. So can we think about it in a similar way? Like, should we be doing something at a young age to maximize those connections? Is there an age where they start to go down that we have to be working on them to prevent the rate of decline?
- [46:22]
A
Yeah, that's a really good point, because we see that a lot of these connections die off. And at one point in our life. Do you know when that is? It's when we retire so we can think about the same thing. Because when you retire, you think you lose some form of social interaction, you lose your thinking abilities. You know, I saw it in my parents. My father was no longer doing calculations, and he was no longer working with money per se, so he had less pressure in that instance. So he wasn't really exercising his brain. So your connections die off if you don't use them. Your brain basically says, use it or lose it. And we have a map of the brain. They're called Brodmann's areas. And every single part of your brain is responsible for something different, whether it's climbing a tree, whether it's throwing a ball, jumping up and down, plyometrics. If we stop doing those, we lose the network. Okay, the neural pathway that connects us, neuroplasticity. That connects that we lose it. So, yes, we should be doing things. We should have variety. Your brain loves variety. We should be having variety in everything that we do.
- [47:27]
B
Yeah. Retirement is quite a modern phenomenon as well. If you think about it on an evolutionary level, it kind of didn't really exist. You don't just suddenly, at one age, go, you're useful to people, and then because you've had a birthday, you suddenly can't go in anymore. It really is. And I've seen it in family members, actually, as well, like when they retired. And again, you could say, oh, they're also older when they retire. But I've seen it enough times, and I've seen it with patients enough times to go, wow, there's something seems to happen to our brain function when we retire. Unless, of course, you stay engaged.
- [48:03]
A
Well, here's the thing, the beautiful thing, which we realized in 1964, Marian diamond did the first ever experiments on mice to show that exercise actually grows the gray matter of the brain. Meaning we have gray matter and white matter. The gray matter holds the cell body of the neurons, and the white matter is the axon, the myelinated neurons. She showed that after six months of aerobic exercise, the brains of these mice increased. So greater brain volume and the gray matter thickened. The gray matter, which I want everyone to know is not increased. They didn't produce more neurons. They increased the synapses. They increased the connections between the neurons, and that is what formed greater brain volume. So with that said, we know that aerobic exercise grows new connections in the.
- [49:01]
B
Brain, so not new nerve cells.
- [49:04]
A
No, that's actually a really critical point because adult neurogenesis doesn't exist. And I am seeing a lot of that on social media. I've got two pet hates when it actually comes to social media. And there are two myths that we should debunk. The first one is doing meditation induces neurogenesis. Adult neurogenesis does not exist unless it's in the hippocampus of the brain.
- [49:26]
B
So neurogenesis, meaning the growth of new nerve cells.
- [49:30]
A
Correct.
- [49:30]
B
Right. So you're saying that adults cannot grow new brain cells in humans, but they can in the hippocampus?
- [49:41]
A
Yes.
- [49:42]
B
Why do you think that is?
- [49:43]
A
We're still trying to figure that out. I wish I had an answer, but I touch on that a lot in my paper where I show you that through exercise, through a specific pathway, it's the myokine pathway, when we are engaging in aerobic activity, we get this expression, this release of a growth factor. It's called bdnf.
- [50:05]
B
Okay, so pet hate one was that meditation induces neurogenesis. What's pet hate two?
- [50:13]
A
That cholesterol is Good for the brain. Meaning? Okay, there are people saying that if you eat cholesterol rich foods, it will help you with your brain and it will feed your brain. And that is not true.
- [50:29]
B
So you're not talking about serum cholesterol, your blood cholesterol, you're talking about dietary cholesterol. Eating cholesterol in foods will not increase the cholesterol in your brain.
- [50:40]
A
A cholesterol molecule cannot pass the blood brain barrier, and if it did, you have more problems than that because that would mean you'd have a compromised blood brain barrier.
- [50:50]
B
And why are people saying this in terms of, is it the makeup of the brain?
- [50:54]
A
Yes, because we do know that the brain is made of both water and fat. But the lipid component of the brain isn't the cholesterol found in food. In fact, 20% of the total lipids in the brain are actually made of dha, which is a type of fat, polyunsaturated fat that comes from fatty fish, for example, omega 3s.
- [51:14]
B
But we can get that into the.
- [51:16]
A
Brain from the diets that can get into the brain.
- [51:19]
B
So if you're eating dha, fatty fish, of course, is one of the richest sources, although not the only one that can actually help our brain matter and our brain structure.
- [51:30]
A
Yeah, and we can talk about that later on.
- [51:32]
B
Okay, so let's go back to aerobic exercise. You said some really interesting things there. So you mentioned that aerobic exercise can increase the gray matter of the brain.
- [51:41]
A
Yes.
- [51:42]
B
That sounds really great. I'm sure to many people in terms of what that actually means for them if they have more gray matter. What is that? Is that the way they process information, the way they think?
- [51:55]
A
Absolutely. Everything your brain is responsible for everything that you do. It is responsible for who you are, how you see, how you interpret information, how you sleep, how you eat, even down to the spouse that you choose. So your brain, if you have a better functioning brain, more gray matter, more functional neural networks, you will perform better, think faster and live longer. It'll make you a better human.
- [52:22]
B
And aerobic exercise, which isn't actually that difficult, is going to help you do that?
- [52:28]
A
Absolutely.
- [52:29]
B
And what are the mechanisms there? You mentioned bdnf?
- [52:33]
A
BDNF is one, yes.
- [52:34]
B
Okay, so what is bdnf and is it aerobic exercise that specifically increases it, or do other forms of exercise like resistance training and high intensity training also do it?
- [52:45]
A
Please. Yeah. So BDNF stands for brain derived neurotrophic factor. It is a growth factor for the brain, meaning that when it is Expressed. And you have to be just say we're at that zone two, right. We're running. It gets expressed into the bloodstream. So it's a little hormone, if you will. And when it does, it goes through the bloodstream up into the brain. It does cross the blood brain barrier, by the way. The blood brain barrier is a collection of cells on the outside of the brain that is there to protect you, protect your brain from having unwanted things coming in. But this is a really great thing. It gets in there and it goes into the hippocampus. The hippocampus is this seahorse shaped structure deep in the temporal lobes. And when it goes in there, it basically helps you grow new brain cells in that area. Now here's the phenomenal thing. That is the first structure of the brain to go during Alzheimer's disease. That is the part that holds your memories, short term memories. It's where memory formation occurs. And we've seen now through human studies that the hippocampal sub regions, the areas around the brain can also change in structure. But the volume of the hippocampus grows, it increases, becomes more dense.
- [54:04]
B
I think I read some research a few years ago from Art Kramer and from recollection, it was people in their 60s, maybe in their 70s.
- [54:14]
A
Yes.
- [54:14]
B
And just from walking, not that much every week. You may know the study to hand. I think a year later the hippocampus looked bigger.
- [54:24]
A
Yes. And that's because the starting point, they were very inactive.
- [54:29]
B
Okay.
- [54:30]
A
Yes.
- [54:31]
B
So that's really interesting. So if you're really inactive, anything you do is going to make a difference.
- [54:38]
A
That's the great point. Yes.
- [54:39]
B
That's really empowering for people because you don't want, you know, when we start talking about zone 2s and zone 5s and high intensity and VO2 maxes. And I want to talk about all those things. I think some people who don't move that much are like, yeah, I mean that all sounds great, but I don't know where to start. Like, I don't really move much at the moment. So I think we wanna leave that message at least that, hey, it doesn't matter where you are, just start moving a bit more.
- [55:04]
A
Also, I want to point out that I'm not disillusioned by this. I have, like I mentioned, I have parents who, we have literal, you know, fights at home around exercise, you know, when I call them and I see what it's like for, you know, a 50 plus year old who's, let's just say you've never exercised I understand it doesn't come as second nature to you, so I understand that. I see it. But we have to do something. And so even if that involves you walking for 10 minutes a day, you know what's really great? If you live around hills, just walk for 10 minutes a day. Maybe get on one hill, call it a day. Don't scare your brain. Don't go out too hard, too fast. I've done that before, and it scares your brain into not wanting to do it again. You stop releasing that dopamine, which is that molecule of motivation and drive. So just get out and just do it. Easy. Because when you do, you will feel the benefits. By the way, bdnf, when it is expressed, it doesn't just help with hippocampal volume. We get other things as well. It helps with the expression of different neurochemicals that are involved in mood. We know that there is a direct correlation between depression and exercise. Why is that? Maybe it's because you're changing the structure of your brain through physical activity.
- [56:21]
B
So your recommendation for aerobic exercise is what? Like, for optimum brain health, at minimum.
- [56:28]
A
Three hours per week of 65% of your maximum heart rate. That zone two zone.
- [56:34]
B
Okay, so conversational pace, little bit out of breath, but not too out of breath. Three hours. Yes. Okay, fine.
- [56:42]
A
So that's minimum.
- [56:44]
B
Minimum. So at least half an hour a day, which I think is pretty reasonable. And I do. You want to make things accessible to people at the same time you want to be honest with them and sort of go, listen, you have to move your body.
- [56:56]
A
And for the people who are like, but I don't have enough energy, this actually helps you create more energy. When you're training in this zone, you're trading the mitochondria, which is the. The powerhouse of our soul, where we produce our energy to work better, to function better, to create more of itself.
- [57:12]
B
Yeah.
- [57:13]
A
So you can have more energy.
- [57:16]
B
The lifestyle factors we've sort of touched on, and there's plenty more to say on exercise, but exercise, sleep, stress, and food, they're all important. Yeah, but if you had to pick one for people to focus on, is there one that comes to the surface for you?
- [57:36]
A
I don't think any other intervention can compare to exercise. I believe that exercise is the panacea for health. Exercise is medicine, and our muscles are like pharmacies. Let's move into another area of exercise, which is our peak aerobic zone. So you mentioned something called the VO2 Max. VO2 Max is a test that measures our cardiorespiratory fitness, pretty much how fit we are. And it basically takes, it's your heart rate times your stroke volume. But basically it wants to assess how efficient are you with taking the oxygen from the atmosphere when you breathe it in, pulling it into your body and extracting it to your muscles. At what rate can you do that and how fit are you? And we want to be able to do this. You can measure this at home even without a device. I think everyone should go and get a VO2 max test. I don't know if you've ever gotten one.
- [58:37]
B
I have, but not for a few years now.
- [58:38]
A
Well, it benchmarks you against your age and your gender. So you know, oh, this is how fit I am. I'm below average, I'm fit, I'm super fit.
- [58:46]
B
And some people will have smart watches or Garmin watches and they'll use them when they walk or run. A lot of these things now do estimates. What's your take on those estimates?
- [58:57]
A
So I don't think that they're good. I don't think you should be relying. They're very inaccurate when it comes to measuring your VO2. I know because I've done one in a lab and then I also wear a Garmin to just track my mileage.
- [59:11]
B
So you're not a big fan of them in terms of for accurate VO2 for testing?
- [59:15]
A
No.
- [59:15]
B
Yeah. Okay, so a VO2. And why do you think people would benefit from doing a VO2 max test?
- [59:20]
A
Again, because then you have the data. You can't optimize what you don't measure. So then we have the data to say, well, here we are, we've got a VO2 max of, let's just say 45. That puts me in the elite category. I'm fit. But not just that, it also gives you a representation of your training zones. So it basically tells you what your peak is. So you can work back from that.
- [59:43]
B
Okay, so if we just use this gear model, just so everyone's following. So you made one recommendation. Well, let's even back up even further. You're saying that exercise is probably the number one thing that people can do and focus on to protect their brains long term.
- [60:03]
A
Yes.
- [60:06]
B
One of the mechanisms by which exercise does all this magic in our bodies and frankly our brains, is through bdnf, brain derived neurotrophic factor. And you're saying that we need to do a minimum, really of three hours aerobic exercise a week. Okay, you've also just mentioned VO2 max. Okay, how does that relate to what kind of activities that we actually practically do. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. AG1 has been in my own life for over five years now. It is a science driven daily health drink with over 70 essential nutrients to support your overall health. It contains vitamin C and zinc which helps support a healthy immune system, something that is really important, especially at this time of year. It also contains prebiotics and digestive enzymes that help support your gut health. And all this goodness comes in one convenient daily serving that makes it really easy to fit into your life no matter how busy you feel. It's also really tasty as well. Now, the scientific team behind NG1 includes experts from a broad range of fields, including longevity, preventive medicine, genetics and biochemistry. And I talk to them regularly and I'm really impressed with their commitment to making a top quality product. For listeners of my podcast, AG1 are giving a special exclusive offer. You can get a free one year supply of vitamin D and K2 and five free travel packs with your first order. These packs are perfect for keeping in your backpack, office or car. If you want to give them a try, just go to drinkag1.comlivemore.
- [62:19]
A
Yeah, so when we are training in that zone 4 or zone 5, so this is more intense.
- [62:27]
B
High intensity.
- [62:28]
A
High intensity, right. So that's the sprints, that's when you're doing running up those stairs where you're really like struggling to get air. Many things are happening in this zone. You're doing a lot for cancer outcomes and for brain health outcomes. So remember, when you're training at that zone, you're getting a massive shunt of blood to your brain and to the rest of your body. During that process, during the sheer force and the shunting of the blood, you are able to have an effect on 13 types of cancer. You are able to inhibit 13 types of cancer through this type of training.
- [63:08]
B
Wow.
- [63:08]
A
Yeah. And the way that it does that is there's three ways. The first one is when you exercise in this zone, you are increasing your production of natural killer cells. And these natural killer cells, they're a lymphocyte. But without getting too much into it, these natural killer cells are able to locate a circulating tumor, circulating tumor cells, and kill them. These circulating tumor cells are abundant through our body. If we have a tumor, let's just say you are diagnosed with stage one cancer, which is the best type to get diagnosed with it. There is a tumor that has formed somewhere in your body. What happens is that tumor, some of the cells tend to break off and we call these circulating tumor cells and they roam around through the body looking for a different site to lodge and create another tumor that we then move into metastases. During that process, these circulating tumor cells through the body can actually be ameliorated through the sheer force of this blood flow via that maximal aerobic exercise.
- [64:15]
B
Wow.
- [64:16]
A
Yeah.
- [64:17]
B
So it's helpful for your brain function as you age, but it's also helpful for reducing your risk of getting cancer.
- [64:24]
A
Absolutely.
- [64:26]
B
Okay. There's going to be some people listening who go, well, I'm no longer physically capable enough to run up a flight of stairs. You are at your age and your fitness level. I am. But some older listeners may go, well, hold on a minute, I can't do that. Or I feel that would injure me.
- [64:43]
A
Yes.
- [64:44]
B
These heart rates and these zones are all relative to your own baseline. Right. So what someone in their 30s might do might be different from someone who's 70.
- [64:55]
A
Yes.
- [64:55]
B
Yeah.
- [64:56]
A
And so what I do with my parents is I get them to walk up a hill. We've got this steep hill back at my home that I grew up in and once a week they have to walk up and down that for 20 minutes. And let me tell you, they are getting to their maximum. I even get to my maximum if I'm jogging up that hill. It is really steep. They have to take some breaks as they're going up. They're not running, they are just walking up a hill.
- [65:22]
B
I think walking up hills is one of the very best forms of movement. It really is.
- [65:29]
A
And look, it only needs to be done 20 minutes a week.
- [65:32]
B
So this kind of training, in terms of your brain prescription, you're saying three hours aerobic, 20 minutes of this form of exercise.
- [65:43]
A
Yeah.
- [65:44]
B
Okay. I mean, one of my favorite recommendations to patients over the years regarding intensity, you know, maybe above the age of 50 or above the age of 60, depending on their age, would be okay where you live. Okay. Walk around the block as a warm up. And then if you're back at your house, see in one minute, walk as fast as you can and see what number door you get to. Okay. When you get there, walk back relaxed and then you come back. Hopefully by the time you're back to your house, you're feeling really relaxed and you've recovered. And then go again as fast as you can and see what number house you can get to and maybe do that four or five times. And then what I really liked about it, it was a very simple and accessible way for people to start playing around with intensity and using their inner competitiveness to go, oh, you know, I got up to number 24 yesterday. Oh man. You know, Doc, after two weeks of doing it, I could get to number 28.
- [66:51]
A
So you're gamifying it.
- [66:52]
B
Exactly. And I found for people who maybe get put off by going to the gym or maybe hill walking, seems like something that they can't do. Or if you live in a really urban environment that's flat and you don't have access, I found that quite useful. What would you say about something like that?
- [67:08]
A
I think that too. And I wouldn't discount running groups. I actually want to start one in every city. Right. Even if it's in age groups, it's a really great way to just get together and you push each other, you motivate each other. And I think that's a really great way too. I understand the gym is off putting for some. If you can afford a trainer, maybe that might be good. But yeah, just definitely doing whatever you can to motivate you to do the work.
- [67:34]
B
And where have these numbers come prom? This three hours of aerobic, the 20 minutes of intense training. Like this is all coming from the research that you've studied, right?
- [67:46]
A
Absolutely. And one other thing I want to point out, and by the way, everything I'm talking about I've researched thoroughly. I think my last paper there was about 1500-2000 references. And that's what I do daily. So they're very gold standard when we come to academic research. But if that doesn't motivate you to exercise, I'm going to give you something else that this maximal aerobic activity does. There is a wonderful doctor by the name of Ben Levine. He's a sports cardiologist and he did an amazing study on the hearts of 50 year olds. So basically he got a group of 50 year olds and he worked with them for two years. He subjected them to to three hours of maximal aerobic exercise per week. Now that's a lot. Okay, but just remember this was a study. So he took scans of their hearts. Remember, they're 50 year olds. He took every type of scan he could to assess the functioning of the heart. Now remember, as we age, your heart ages too. We get stiffening of the arteries. So the aorta, for example, the big pump that comes out of your heart that stiffens and it narrows. Therefore less blood flow goes through it. We also get something else called left ventricular hypertrophy. So we just get thickening of the walls around the heart, less blood that can be pumped out and profuse to the rest of the body. What he found was that after the two years he rescanned the hearts, he reversed the age related decline of their heart by 20, 20 years. He actually turned these 50 year old hearts into 30 year old hearts. So these people, these 50 year olds were walking around reversing, basically giving themselves a 30 year old heart, which I think is absolutely, that is better than any other medication.
- [69:40]
B
Yeah, I think people really need to pause on that and just reflect on that and just think about the implications of that for them in their life. Just have a think about where are you in life at the moment? How was your health? How is your well being? How do you see your future? Are you happy with the choices you've made over the past 5, 10, 15, 20 years? If not, okay, you can't change what's happened, but you absolutely can change what you do going forwards. And something like that is really, really empowering because we're not looking at 20 year old athletes, we're looking at people in their 50s and going, you can, by changing your lifestyle, effectively reverse the age of your heart by 20 years.
- [70:25]
A
Yes.
- [70:26]
B
That is huge. Now that was three hours of maximal aerobic training, right?
- [70:31]
A
Three to four hours, yes. So don't quote me on the actual time.
- [70:34]
B
Okay.
- [70:34]
A
Yeah.
- [70:35]
B
But is that the zone that you just spoke about where you recommend 20 minutes?
- [70:39]
A
Correct.
- [70:39]
B
Okay, so this is quite significant.
- [70:41]
A
It was, it was around 75% of maximum heart rate. You're around a zone three.
- [70:46]
B
Yeah. So that's the point. It's not like as gear 4 or gear 5. If you car where the engine's revving, it's like. Yeah, it's higher than your light aerobic walk. But it's not ridiculous. It's not like sprinting.
- [71:01]
A
No.
- [71:02]
B
So what should people take from that?
- [71:05]
A
People should take that. Every time you do this type of exercise, you are adding to the VO2 Max. Right. So you can measure your VO2 Max, like I said, and we can train it and get fitter and fitter and fitter. For every ML that you go above your VO2 max, that is a 45 day life extension. So when we measure your VO2 max, it is measured in milligrams per kilogram per minute. You don't need to understand that. But for every ML that you measure, increase your VO2 max, that is a 45 day life extension. You can get a 5 year life extension. If you go from one group, which is the average group on your VO2 max to above average.
- [71:54]
B
Yeah.
- [71:55]
A
So you're increasing your lifespan, your health span, your rate at inhibiting cancer diagnostic outcomes for other different types of cancer.
- [72:07]
B
One of the biggest things I've changed in my life over the past two years is my levels of physical activity.
- [72:14]
A
You have to love it.
- [72:16]
B
Yeah. You've got to find something that you love and something that's going to allow you to do this regularly without it being a real pain. And everyone's got something they can do if you find it. I guess for me, I've realized that for much of my 20s and 30s, I felt life was very busy, it was very stressful. I've had caring responsibilities for elderly parents, and I would very much prioritize short, intense bursts of activity that didn't take long. That kept me fit. But when you really dive into the research on exercise and longevity and brain health and cancer and all these things, it's very hard not to come away with the conclusion that despite the common narrative that society today often puts out, which is, you know, take it easy as you get older, I kind of feel that's problematic. I feel the older you get, the more you have to be thinking about moving your body and not allowing yourself to get sedentary. So what does that mean for me? I now, I would say 95% of the time, I'm walking for at least an hour a day.
- [73:28]
A
Yes.
- [73:28]
B
Like, it's just something I've decided. I made a decision in my brain, a conscious decision, a couple of years ago, saying, no, wrong. And listen, if you want good brain health, good heart health, if you want to be functioning as well as you can as you get older, if you want to be the best dad, the best husband, the best son, you have to move your body. You cannot let other things get in the way of that. Am I fortunate to have some autonomy in my life to do this? Yes, I am. But nonetheless, with the autonomy, I've made that choice. And that's kind of like a minimum for me. I do other things as well, but one hour's walk is kind of a minimum for me.
- [74:08]
A
And I remember, you know, think about this for a moment. What is evolution? Basically, if you look back into evolution and we look at the fact that we need to fight for survival, right. We need to place stress upon a system, fight for it to grow. That's how we get our immunity. That's how we, you know, the stress response, the allostatic stress response. That's how we grow our muscles, because we're placing our muscles under stress. Why have you told yourself that at a certain age you need to take it easy? Why is that? If we look back into the fact that we need to be stressed, to make ourselves fitter, to be able to adapt and survive, and we need to build our reserve because God forbid that we fall over at the age of 85. If you fall, maybe you break your hip, maybe you don't survive the fall. You don't know what you're coming up against at 85. But I know for damn sure for myself and for my parents, I want them strong enough to be able to withhold whatever it is that is coming for them at that age.
- [75:17]
B
How important is strength training?
- [75:19]
A
Oh my gosh. Well, now we're getting into a. Strength training, I believe is probably fundamentally the most important part of exercise. Really many reasons. One, you're increasing your muscle mass. We know that at the age of 40, we get a decline exponentially in strength and mass. Think about muscle as your reserves, okay? Muscle is an endocrine organ. It stores a lot of our mitochondria where we produce all of our energy. It helps us and stabilizes us as we get older. But it's the journey of building the muscle that is the most important. Because when we are strength training, we are releasing and expressing a whole host of myokines. Now we mentioned bdnf, that's a myokine, but oh my gosh, strength training releases another 100 of them.
- [76:12]
B
And what do myokines do?
- [76:14]
A
Myokines are muscle based proteins that when they go into different organs in the body, the brain, the liver, the pancreas, they have positive effects. So for the brain, they help preserve the synapses. So those dendrites that die off, they help preserve them, they help the other neurons survive, they help with the growth and proliferation of of other neurons in the hippocampus. So they're doing the same thing as bdnf, but they're doing even more than that. Remember, BDNF just goes into the brain. But these myokines can actually go elsewhere. We know that this is the one responsible for inhibiting prostate cancer. There was a wonderful, there was a wonderful study that was produced in cell press journals that actually showed downregulation of tumor. Like the tumor actually strung due to this myokine activity. We know that Interleukin 6 can help us with immunity and with our mitochondrial function. Interleukin 6 has this dual effect. We know that it can be pro inflammatory depending on which site it's released from. But when it's released from the cells of the muscle. It's anti inflammatory.
- [77:28]
B
And this is why you are calling our muscles our own internal pharmacy.
- [77:33]
A
Our muscles are our own internal pharmacy. And the myokines are the medications that you need to survive as we age.
- [77:44]
B
Relating to something you said before, you said you wish that people would exercise because it's good for their brains, not necessarily because it's good for their physique.
- [77:58]
A
Yeah.
- [78:01]
B
I think certainly over the last few decades and still today, although I think it's changing, is that the number one reason most certainly many people exercise is to have a better physique is to look better. Is that problematic or are you okay with that because it gets them into the gym to get those brain benefits anyway?
- [78:29]
A
I'm okay with that to an extent, but I'm seeing a lot of people, remember, what is the number one problem that you would come into contact with, with a patient if you were to tell them to exercise more? Adherence.
- [78:43]
B
Adherence, yeah.
- [78:44]
A
Right. So out of exercise, sleep and diet. Diet's probably my worst one. Right.
- [78:49]
B
In terms of your own behaviors.
- [78:51]
A
My own behaviors. And now that is a behavioral trait. Adherence to a diet for me is way hard than adherence to a sleep protocol and an exercise protocol. That's just me.
- [79:00]
B
Okay.
- [79:00]
A
So if adherence is the hardest thing, then just going into the gym and getting anything done is great. But I would rather people know why they're doing what they're doing. Because what I'm seeing now is that people are just going for aesthetic purposes. They're not touching on the hiit training. I hear people saying it's, you know, if I do aerobic training, it's going to eat into my muscle gains. And then I just see people just pumping weights just purely for muscle mass and not even touching on strength. And they're two different things.
- [79:32]
B
Yeah. I guess the problem with doing it around aesthetics, and I understand the desire to do it around aesthetics, who doesn't want to look good and lean and have a great physique? Right. I totally get that. But I guess if you're dependent on that as the outcome, if you're not getting that outcome, and if that outcome is not coming as quick as you might want it to, you risk stopping doing it.
- [80:02]
A
Yes.
- [80:03]
B
Whereas if the motivation to go to the gym or move your body or pump weights or whatever it might be is this is one of the best things I can do for my brain to function well whilst I'm alive on planet Earth. Well, you've always got a reason to.
- [80:20]
A
Go and you will adhere to this Every single day throughout the lifespan Instead of taking massive breaks just because, oh, I'm going on holidays, I'm just not gonna exercise for the next two weeks because I'm gonna have. I'm gonna binge eat. I'm gonna drink.
- [80:33]
B
Yeah. It also means for people who, let's say, naturally are leaner than others, and there are many people out there who can seemingly get away, at least from their external appearance, from not eating. Well, obviously, there is a condition which colloquially is called skinny fat, where on the outside we look lean, but on the inside, we've got, you know, visceral fat, the fat around our organs, which is incredibly dangerous and increases our risk of getting sick. The reason this conversation, this part of it, I think is really interesting, is because if you look at yourself in the mirror and go, well, I'm okay. You know, I might have a little bit of a belly, but there's nothing to worry about at the moment. You're not then being driven into these behaviors because you're not connecting it with your brain. You're just connecting it with your physique. And if you think your physique is fine, you may not engage with the behavior.
- [81:28]
A
And you're basically doing this elimination. Oh, I had two drinks today. I had three drinks today. But I'll just burn it off at the gym, and that's not the right attitude. Or I'm gonna have a cheat meal today, and then I'll just burn it off at the gym. I hate when I hear that, because that just means that you're just going to the gym just to basically burn the calories that you ate.
- [81:47]
B
Yeah. Okay, so it was three hours of aerobic, 20 minutes of intense. So kind of gear four and gear five, or zone four and zone five. Whatever you want to. How you. Everyone you want to think about it. Do you have a specific recommendation for resistance training?
- [82:05]
A
So in the paper that I authored alongside our friend Dr. Tommy Wood, I.
- [82:11]
B
Think Gabrielle Lime was on that as well.
- [82:13]
A
Gab was on it too. Yeah. So this was, at minimum, two days a week. And this is compound movements.
- [82:20]
B
What does that mean for people who've never heard that term?
- [82:21]
A
Yeah, so that's just squats. Instead of doing the designer aesthetics. Okay. You want to be doing things that move as many muscle groups as possible per exercise.
- [82:30]
B
So not the bicep curl while looking in the mirror?
- [82:32]
A
No, no. So you want to be doing squats, bench press, walking lunges are great. Anytime. You can really work the lower part of your body as well, just due to vector size of your quads, for example, you're just increasing your gray matter.
- [82:49]
B
So two sessions a week, that's minimum.
- [82:53]
A
I do believe you should be doing three.
- [82:55]
B
You do. Okay. And you have, I mean, obviously the time thing's quite tricky because it depends what you're doing with that time. Are you, you know, in between sets on Instagram for five minutes whilst you recover or are you moving from, you know, exercise to exercise? I think it's quite tricky. But are you basically saying two to three times a week resistance training for at least 20, 30 minutes kind of thing?
- [83:18]
A
Correct. Yeah.
- [83:19]
B
Yeah. Okay.
- [83:20]
A
Make it hard, go to the gym, make it hard. The one thing I don't like is middle aged women. And by the way, I'm not. This is just what we're finding from the data. Maybe go to the gym and they're lifting well below their average. They're lifting these tiny weights because they're afraid that they're going to get big muscles. That's not true.
- [83:38]
B
And so, okay, for women then in their 40s and 50s, obviously that's a time also when there are quite significant hormonal changes happening. Is there something specific they should be focusing on around resistance training?
- [83:55]
A
Yes. Doing it and doing it hard. Working at a. Like you have on your sixth rep, which is what I generally say when you get to the sixth rep, that's when you should be struggling, you should be shaking.
- [84:10]
B
Okay, I want to look at this a slightly different way if possible. You've got so much expertise in this area with your company, Neuro Athletics. Are you dealing with a certain type of population? Are these sort of high achievers high performing?
- [84:26]
A
Yes. So they're generally the CEOs of major banks and so they are very high performing.
- [84:32]
B
Okay. So a lot of these guys and gals in general, in my experience are well a. They have financial resource.
- [84:43]
A
Yes.
- [84:43]
B
Okay. For various things like a trainer and a gym membership. Some of them, of course, you can't make things to generalize, but many of these high achievers are quite a type and they sort of, you know, go, go, go, struggle to switch off. You know, they're sort of working hard, then they're exercising hard, which can have its own potential problems in terms of the stress response and not switching off. But I really want to dial into these exercise recommendations and maybe get your perspective on three different groups. Okay. So if someone's listening and they are a high performer and they've got time and money, what is the optimum thing you'd recommend for their brain? And let's contrast that with someone who doesn't move at all, but is interested into what you're saying and going, okay, all right, where can I start?
- [85:35]
A
Yeah. So if you've got time and you've got money, great place to be in in life. Congratulations. If you've got all of that, then hire yourself a trainer and just work on building strength and muscle three to four days a week.
- [85:50]
B
And the trainer's there for safety and for motivation and accountability.
- [85:54]
A
Safety, motivation, yes, all of that.
- [85:57]
B
Okay.
- [85:57]
A
Because what I see a lot of as well is many people going to the gym, they don't even know how to do the correct exercise. So you're gonna just end up leading yourself to an injury.
- [86:05]
B
An injuries are really apart from the pain and the frustration of being injured. I'm realizing this more and more as you get older. There's a massive cost to injury that goes beyond the direct injury because it's the fear it puts into you about future exercise. It's then the lack of movement that you're doing potentially whilst you're recovering, and then how long it takes you to get back to your baseline because you weren't moving. So it really is. I think an injury can compound quite quickly into the negative impacts. So trying to prevent injury is actually. Look, you could try and prevent injury by not moving at all. Right. So that's an extreme. Which is probably going to have other deleterious consequences, but you have to kind of get that sweet spot. So as you say, if you're lucky enough to have the resource to hire a professional to help you, you're saying go for it.
- [87:02]
A
Exactly. Now let's talk about somebody who doesn't even. And they've never been into a gym before, you can still get the same benefits. You know, if I put my. We have a close family friend and she was kind of like a grandmother to me. She's not. She's 98 years old. Cognitively, she is firing. She's unbelievable. She's maintained exercise and dancing her entire life and social interactions. Right. If I was to tell her to increase her muscle mass, we just have to get her to wall sit. She can increase her muscle size in her legs and get massive gains. If she was just to wall sit for me, that wouldn't work because I have stronger legs and I'm much younger than her. What I mean by that is if you are completely set entering, you want to start lifting weights, you don't have to go into the gym and pound these weights. As I'm saying, you can start with calisthenics. Which is just body weight move. Start with doing some push ups. Almost everyone has access to the Internet, right. You can go onto YouTube and just type in beginner workouts for 50 year old females. I've seen them, I set them up for my mom all the time. When she tells me she doesn't know what to do, I'm like, there you go, there it is. So you can be doing that and that's how you can start.
- [88:24]
B
Yeah. So don't allow where you currently are to put you off getting started basically. So the recommendations you've given around the three hours of walking, 20 minutes of intensity and two to three sessions of resistance training a week with some of your real elite achievers. Is that what you recommend to them or do you push them even higher?
- [88:51]
A
So with them everybody comes to us with a goal in mind. So we have to take that and we take look, we take a battery of tests, we're looking at blood work, we're doing blood, sweat, urine. When we're doing full body MRIs, I'm really understanding as some of them, you know, I've got females who are optimizing for fertility. That's a different, that's a different performance routine than a 52 year old male who's like got the APOE4 gene and he's just wants to do better. Everybody's different.
- [89:18]
B
Yeah. I've heard you talk about the combination of, of resistance training with brain training and I found this absolutely fascinating. I don't think we've ever covered that on this show before. So can you explain what that is and why you might even get some additional benefits by combining these two? Cause it's so interesting, that's where the.
- [89:43]
A
Name neuro athletics came from. So there's this whole part of training called cognitive training where you're training your brain, we're training it to think faster, to react faster, to have better vision. Because remember, your eyes are two pieces so you can literally work on your vision in many ways and strengthen your brain. And it's as easy as getting a tennis ball and throwing the ball to the wall. You're doing so many things when you do this. Remember the last time, you know, badminton for example, is wonderful. It's probably one of the best brain training exercises you can do.
- [90:17]
B
Why?
- [90:18]
A
Because you're incorporating so many different cognitive abilities. You've got reaction time, you have to think, you have to process when the ball's going to come. You're also in that aerobic Z, sometimes you're dipping into Zone 4 and it just does wonders. You've got vision in place.
- [90:35]
B
I went on your neuro athletics website this morning, and one of the reviews at the bottom was from someone who was saying that Louisa's really helped me with my peripheral vision.
- [90:44]
A
Oh, there you go.
- [90:45]
B
Yeah. And I found that fascinating. That's come up a little bit on the show over the last couple of years, because since I started working with my own movement coach, Helen hall, who's phenomenal, one of the things that we've been working on is eye movements, really. And she's been tracking. She's got this very, very sensitive device. There's under 10 around the world in terms of our spinal movements. And what's happening when you're in gait? How is every vertebra moving? How's your pelvis? You know, it's phenomenal. What if you know how to interpret it, which Helen does, it can be incredibly helpful. And I've seen how just something as simple as walking or running on that treadmill with peripheral vision versus focused concentric vision changes the way you move. And she can measure that. She can show you. It's really, really interesting. And so without going into a deep rabbit hole there, which I'm sure you'd be really interested in, actually, is this idea that. Well, first of all, I'm thinking a lot now with my kids about what exercises are also helping them with their vision. So I've become a real fan, I always have been. But things like tennis, badminton, where you're tracking something that's moving far and then near and then far and then near. So that's an incredible workout for your eyes. And I think about, on an evolutionary level, we had to track animals. We had to. You know, we're losing a lot of those things, especially with screens and all this constant near vision and being inside. Yeah. So I think trying to combine things is a really good idea. Have you spoken before about some studies where you're doing, let's say, squats, but also Counting backwards from 100 serial seven. Yeah. Serial sevens. Can you explain that and explain what are the. So what are the benefits of. Let's say you're doing bodyweight squats and you can do 10. Let's say, what's the benefit of also counting backwards and subtracting sevens at the same time?
- [92:52]
A
You are working on the neurocognitive part of training. That's actually pretty hard. Okay. Take out the fact that you are squatting in and of itself. It requires a lot of concentration. Right. Your neuromotor system is really getting a Workout the way that your brain talks to your body. So we're working that out. But if you combine that with stimulating brain exercises, literally counting down while you're squatting from seven, it creates a lot of pressure in your brain. And what did we say earlier?
- [93:23]
B
You adapt when you stress the system.
- [93:26]
A
Exactly. And so how often do you stress yourself? People ask me, what about Louise? If I do Sudoku, it's like that has kind of, you know, crossword puzzles, chess. Yes. You are thinking, right. But that's just taking one part of cognition into the process. We've got. Now we're squatting. You're counting down from, you know, counting down from seven. There's another exercise that I think everyone should do. Go to your local pharmacy and get an eye patch. You know those eye patches. If you have an eye infection, you're literally blacking out half of your brain. You're blacking out 50% of your vision. So therefore your. The other half of your brain, your entire brain, has to work harder to compensate for that. So we do. We do drills with just one eye. Sometimes, like throwing the ball to the wall with one eye.
- [94:12]
B
Wow.
- [94:12]
A
Yeah. We're doing these counting drills. You know, there's a. You know, when you have. We had a battery of tests for Alzheimer's disease patients where we were getting them to do, like, different senses, smelling spices. Right. Because smell and hearing are one of the risk factors of Alzheimer's disease. We've also got language processing. We would get them to say different words that were beginning with letters, such as F, S and A. If you can do this, this helps with the language production of your dominant lobe. For example, if you can be doing this whilst exercising as well, you're just creating more pressure and stimulus in your brain.
- [94:50]
B
Is that effectively what's going on? So you're basically saying that if you stimulate the brain and ask it to do a little bit more, all the muscles than it currently can do comfortably when you rest, the body's going to grow back a little bit stronger. It's going to adapt for the new demands that it thinks it needs.
- [95:10]
A
Yes.
- [95:10]
B
So instead of something really practical, someone could go, okay, Louisa, I've got to exercise more. Got it. I'm going to do 10 squats in my kitchen every day whilst I wait for my coffee to brew, let's say. But now, instead of just doing those 10 squats and thinking about my to do list or whatever I have to do today and let my mind wander, no, what I'm gonna do is do these serial sevens. I'M gonna start at a hundreds and go subtract by seven each time, which is, frankly, for some people, that's hard to do without squatting.
- [95:47]
A
Right.
- [95:47]
B
So, like, you know, just to make it really practical, people, that would be down to, you know, 93, 86.
- [95:54]
A
See? Yes.
- [95:55]
B
79, 72. Right. 65. You're going down that you're saying that's better than just squatting.
- [96:03]
A
Yes, if you can do it. But remember, you want to do this air squats. Right. Because the last thing you want is an injury because you're thinking so much.
- [96:10]
B
This is body weight squats at home. Right. Safe. But it would be fun for people to play with that and see how their experience of it changes. But what is, is there. There's some papers which have studied this, right? I mean, has there been research on this in terms of what it actually does?
- [96:26]
A
It grows gray matter in the brain. So basically this was a juggling study that they did and they did MRIs and FMRIs on these patients and they put them through a juggling protocol. So they got three balls. And I know that we can't all juggle. I can't even juggle. But they showed that due to hand eye coordination, reaction time and thinking, and they were also placing the, the, the benefits of serial 7 and other different mathematical equations and puzzles onto them. They grew the gray matter of their brain.
- [96:57]
B
I mean, even that phrase, they grew the gray matter of their brain.
- [97:01]
A
They increased the connections.
- [97:03]
B
No, I'm saying it's a positive thing. I'm like, genuinely, I'm thinking if you take nothing else from this, just this idea that you can do something at home that literally is changing the structure and function of your brain, that's pretty empowering.
- [97:23]
A
That is the most beautiful thing about exercise, that 85% of brain gray matter is modifiable by exercise.
- [97:34]
B
Yeah. We haven't really covered some of the other factors. We've gone deep into exercise, which I think was really important. Let's go to sleep. What would you like everyone to know about the relationship between sleep and brain function?
- [97:52]
A
First of all, sleep is the best way for you to clear out these amyloid proteins that build up during the day.
- [98:01]
B
Wow.
- [98:03]
A
When we sleep, we dip into our deep sleep zone, which is stage three sleep. We generally, when I talk about sleep, I really just talk about stage three sleep and stage four. Now, stage three is non rapid eye movement sleep. This is our deepest sleep possible. Two major things happen during this stage. This, and this is towards the, you know, around 90 minutes after you fall asleep. We're going to our deep sleep zone. You're activating something called the glymphatic system. And this is when all of the cerebral spinal fluid in our brain washes out all of the debris. So those toxins that built up that we mentioned earlier, the environmental toxins, the mycotoxins and the amyloid beta, when that builds up in the brain, it has a chance at night, during deep slow wave sleep, to be cleared out. And it does this because there's certain brain cells in our brain called glial cells. They shrink in size and they stick between neurons as well. They're our immunity, our immunity cell. They shrink in size and that's what allows the cerebral spinal fluid to act like a washing machine.
- [99:12]
B
So sleep's important to clear out toxins that may build up over the years.
- [99:17]
A
Yes.
- [99:18]
B
Just a reminder for people what we said right at the start, which is this idea that beta amyloid protein, which yes, we do see in people's brains with Alzheimer's, is not really the root cause of what's going on. And beta amyloid perhaps is a response to inflammation and stress and all kinds of modern day insults. And that accumulation may well be starting at the age of 30 or 25. Okay, so when we think about that, you're now connecting sleep, saying, listen, this stuff may start to appear in your brain because of the stressful toxic lives manifest. Now lead, especially we live in urban environments. Right. But actually one of the best ways to insulate yourself from that potential damage and accumulation is to focus on your sleep.
- [100:10]
A
Yes. Remember also I mentioned that the amyloid gets triggered due to the innate immune system. It's the body's first line. Then we've got the adaptive immune system, which is meant to take over and basically calm down the innate immune system. So this is your chance, all right, of when you're sleeping, you're also building up immunity. We've actually seen through a really well documented study presented in PNAS where they took a group of healthy men and they subjected them to sleep deprivation for one week, which was around six hours per night, just in one week. And what they found over just that seven day period was that they had a epigenetic change of 3%. So they changed their genome. So we have around 20,000 genes in our human genome. They changed 3% of this genome. So they changed around, I think it was 711genes.
- [101:05]
B
For the worse.
- [101:06]
A
For the worse.
- [101:07]
B
Hold on a minute, did you say they were deprived just for one week, but the sleep deprived individuals were sleeping six hours a Night, Yes. Right. Six hours a night.
- [101:18]
A
I know.
- [101:19]
B
That's the problem is actually what some people are happy if they're getting six hours a night. That's their, hey, I had a great night, I slept for six hours.
- [101:26]
A
Yeah.
- [101:26]
B
And that was the sleep deprivation. So that impacts the way your genes are expressed. Okay. There is a growing awareness in society, particularly people who listen to health podcasts, of the importance of sleep. But you specifically focused on stage three and stage four, the deeper phases of sleep. Now, most people are not going to a sleep lab every night and tracking what their phases of sleep are. So how do people know if they are getting these phases or not?
- [102:00]
A
Well before they even look into that? Right, let's get the basics down. What are the most important factors of sleep? We've got quality, obviously, quantity. I do believe we should all be sleeping at minimum, seven and a half hours of sleep. If you've had a really tough day, both physically, mentally, emotionally, maybe you need eight and a half or nine hours. Everybody's different. But at minimum, I believe every human should be sleeping seven and a half hours. The second thing to that, what we're now finding in the research is regularity is actually more important than anything else, which sucks. Right. But so you need to be sleeping every night at the same time and waking up at the same time every day. Now that's hard because we're not robots. So what I say is stick to 80% of the time you're sleeping regularly. So my bedtime is, you know, if I'm lucky, 10pm, 10pm till 6am, that is a beautiful sleep. If I get that and I try and stay within around, you know, 10 to 20% of that. So maybe I'll sleep at 10:30 one night, maybe 11. But I wouldn't be sleeping at 2am one night, 9pm the next night. There's too much variation.
- [103:11]
B
Yeah. I think the. Was it the UK Biobank study, loads of people, they showed it's like a 10% variation will start to be associated with negative outcomes. I think.
- [103:24]
A
Yes. And increases in all cause mortality. And I believe it comes down to what I just mentioned with the epigenetic change. You know how I said 711 genes, half of them were upregulated, mean that they were switched on. That's what genes do, they switch on and switch off. The ones that switched on were the genes responsible for tumor production. So you're increasing your likelihood of developing cancer from sleep deprivation. The ones that were down regulated were the immunity genes.
- [103:54]
B
Yeah, I've always been, I Feel very susceptible to changes in my daily rhythms. I know I've always felt great when there's a consistency. I think everyone does. Frankly, not everyone can do that. Shift work, you know, all kinds of things. I've said this many times on the podcast, but I'll repeat it again in case it's new information for people. I really prioritize my bedtimes. I'm asleep by 9pm Most nights.
- [104:26]
A
Oh, wow.
- [104:26]
B
Yeah. And again, that works for me at this stage of my life with kids and I'm happily married and all this kind of stuff, that works for me. I'm not saying it works for anyone else, but yesterday I did something I haven't done in years, which is I'm making a TV documentary at the moment about smartphones. I forgot how long filming days are. And I didn't get back to my hotel last night till about quarter to 11. So normally I would have slept by an hour and 45 minutes. So I got back to the hotel, then I had to unwind. And although I slept pretty well last night, I'm feeling it today.
- [105:05]
A
Yeah.
- [105:06]
B
And it. So I think I got maybe enough hours because I did lie in a bit, which is unusual for me, but I'm not my best self and I'm sure missing that routine, you know, nine to five. I. I think that's.
- [105:21]
A
Yeah.
- [105:21]
B
One of the main reasons why.
- [105:22]
A
And this is one of the main reasons why a lot of people feel like they've got brain fog.
- [105:26]
B
Yeah, exactly.
- [105:27]
A
And they're like, why do I have brain fog? It's like, well, did you sleep and did you activate that glymphatic system to clear out all of these toxins which are pretty much what's giving you that brain fog. So when it comes to sleep, without getting too deep into it, we really need to prioritize it. And you mentioned earlier, like, how do we track it? Yes. Caveat. You can wear a sleep tracker. I've got an OURA ring on right now. I love it. I sleep on a temperature controlled mattress. My house is pretty much like a lab. It's not that accurate. I want to be clear on that. I don't care. You know what the best thing this does is I use it for heart rate variability and how long I stayed in bed. It can't really. And this is coming from somebody who, you know, I was trained in sleep science. You know, I had to go into a polysomnography, which is a sleep study. When you see what we put patients through, you've got these leads coming off you. You've got a head like we're measuring so many things. It's hard to think that that can replicate, be replicated just on this ring.
- [106:28]
B
I really appreciate what you're saying about trackers because I think all of them, including the really good ones, some of their sleep stage reports I don't think are that accurate, but I think they can be useful for trends.
- [106:41]
A
Trends, yes.
- [106:42]
B
And if you're someone who likes data, I think they could be so helpful to helping you act to go, actually, you know what, I'm actually not sleeping for as long as I thought I was and the amount of time I'm spending in bed is going down. So for some people, I think they're game changing. If they can keep a healthy relationship with them and not become obsessed, which I think also can happen.
- [107:02]
A
Yes. And there's now a phenomenon used for that. But look, when you do, you know, just take it for what it is, use it for trends and use it for just tracking. Okay. Last night my heart rate variability was 150, today it's 50. Might I be getting sick in some.
- [107:17]
B
Of these high performers who come in to see you at your athletics, Would you say some of them, because they're so on and wired with work and stuff, struggle to switch off at night?
- [107:29]
A
Yes.
- [107:29]
B
And if so, what are some of your top tips to help people with that?
- [107:33]
A
So I generally like to ask two questions. Are you having trouble falling asleep or are you having trouble staying asleep? I find that once men reach the age of around 55 and above, they tend to start waking up and going to the toilet at around 4am and they switch the light on and then they can't get back to sleep. But if we're talking about my high performers, it's always, I'm having trouble settling my mind down. So I attack this from a behavioral perspective and also a supplement perspective. So from a behavioral perspective, what I want everyone to do is actually just write down everything that you have in your head before you go to sleep. Your brain wants to be able to process it. If you're not gonna process it on another individual, probably not your spouse. But if you wanna just process it in a journal, just write down all the things that are worrying you. Cause that's what's keeping you up at night. Setting clear guidelines and standards with yourself. Here's something to recognize. Most of my clients who are high performing, they don't set goals, they set standards. They have a standard for, I'm going to be offline at 8:30pm, I'm going to dim the lights. I'm going to have my last meal by 8:30. And then once you get into that routine, your brain settles down in terms of supplementation. And by the way, everybody should always talk to their healthcare provider. But there are supplements that can help you really down unregulate cortisol, such as ashwagandha. I love turmeric. Turmeric has a really great role in inhibiting this, this pathway. It's called the NF kappa B pathway, it's an inflammatory pathway. But then even gaba. Gamma aminobutyric acid has really been shown to help people with a racing mind. And you can get all of these over the counter. G A, B A. It really just settles your mind down and helps you fall asleep.
- [109:25]
B
Any other supplements you recommend for other reasons?
- [109:29]
A
Oh, yes. Okay, so we're getting into it now. I've gone viral for talking about this one supplement. Okay. I don't know why, but it's creatine. Creatine monohydrate. It helps with cell energy metabolism. And we used to think of creatine back in the day of this bodybuilding drug. But creatine is so much more than that. It is the safest supplement on the market. It is the most studied and it's arguably the cheapest. May not be cheap, but in terms of other supplements, it's the cheapest. So we have natural stores of creatine in our body. But this one, if you take monohydrate specifically, it helps give your cell more energy and it also helps with your brain.
- [110:15]
B
If someone's listening to this and they're not pro supplements, they're like, I think supplements are overhyped. I'm a food first guy or whatever it might be. Why would you recommend they consider taking creatine?
- [110:31]
A
So first of all, there's two supplements I recommend everyone take, regardless of a blood panel.
- [110:37]
B
Wow.
- [110:38]
A
I would never tell you to take zinc if your zinc levels were fine. I would never tell you to take vitamin D if you had, if your vitamin D was 60 nanograms per deciliter. However, creatine and omega 3 fatty acids by far across the board, everyone should be taking them.
- [110:54]
B
And why do you say that?
- [110:55]
A
It doesn't affect hair loss, it doesn't affect your kidneys. It doesn't have any damaging effects in any way. It doesn't make you big or bulky or bloated. And it helps with the stores of creatine in your body. We already, guys, we already have creatine in our body.
- [111:13]
B
What is it? Explain to me what is creatine?
- [111:16]
A
It basically helps with the regeneration of ATP. And ATP is the currency of energy within the mitochondria of our cell.
- [111:26]
B
Okay. So people might hear that go. Okay, so is it gonna give me more energy if I take it?
- [111:31]
A
Yes, it's going to. Oh, not as in caffeine energy.
- [111:35]
B
Okay.
- [111:35]
A
We're not talking stimulant energy. It's going to help your cells work better. I have not seen a really well designed study to show that creatine has any negative side effects.
- [111:51]
B
When our mutual friend Tommy Wood last appeared on this podcast. I think Tommy's been on three or even four times over the years. I love Tommy. I think he's fantastic. He's so knowledgeable. He puts everything in context. There's appropriate nuance when he talks about different concepts. He also is a big fan of creatine.
- [112:10]
A
And Tommy will probably also. He probably also stated that is is neuroprotective. It protects the brain cells against certain insults.
- [112:20]
B
So if someone wants to start taking it, you're saying they don't need a blood test and are there different dosages and things that they should be thinking about?
- [112:29]
A
You can start on 5 grams a day. And for the ladies listening, this is not going to make you bigger. I just want everyone to be aware of that. You can start. Minimum recommendation is 5 grams a day. You can take it pre workout, post workout, at night, in the morning, in your coffee. You can take it anytime, anywhere.
- [112:46]
B
Wow.
- [112:47]
A
If you want the more brain health benefits. So I mentioned earlier, my father had a stroke in 2019. I would get him to be taking 10 to 12 grams of creatine because you do lose the bioavailability when it crosses the blood brain barrier and it's uptaken by the neurons.
- [113:03]
B
So you want more there to start with. And it's a powder that you put in water?
- [113:08]
A
Yeah, it's just a scoop. It usually comes in a five gram soup. But Louisa, can't we get creatine from the meat we eat? Yes, but it's a very, very small amount and it's not that bioavailable.
- [113:19]
B
Okay, omega 3s. Why do you recommend those for everyone? And also you said specifically you don't need to do any testing beforehand.
- [113:28]
A
No, I mean you can get a test, an omega 3 index test, really good pinprick test, and it will test the amount of omega 3s in your red blood cell. It gives you a percentage. If you are part of the average population in the US you will get a 4% result which will put you in the same category in terms of all cause mortality as a pack a day smoker.
- [113:52]
B
So hold on a minute. The normal population in the US have levels of omega 3 in their body. That puts them at the same risk as someone who smokes a packet of cigarettes a day. Yeah, you're gonna have to explain that to my audience.
- [114:06]
A
Yes. So we want so omega 3 fatty acids which come from fatty fish. It's made up of three parts. EPA, DHA and ALA. I'm not going to touch on ALA because that's the plant based Omega 3 that we get from flaxseeds. We know that we need an omega 3 content in our body for the survival and growth of our cells. It helps with many things. The first thing that it does is it acts as an anti inflammatory. It has a way better safety profile than Nurofen, for example, the nsaids. It has a high safety profile. It acts in my opinion as an FDA approved drug. So it is incredible for downregulating inflammation. The second thing that it does is it helps with cell membrane fluidity. So the way that our cells move throughout our body, it helps with the outer portion of our cell. It even helps in some instances with ameliorating some of these plaques, the amyloid beta.
- [115:11]
B
And is it more important in your view for people who are choosing to be vegan or vegetarian, is it even more important for them, do you think?
- [115:22]
A
Yes, because they cannot get it naturally from their diet. And I understand that there's going to be and I've got friends in the plant based community who will argue and throw different studies at me to prove otherwise. But a lot of these studies are done looking at 4 grams of EPA and DHA per day. I don't know where you're going to get that from.
- [115:43]
B
Yeah, when I touched on this with Tommy, actually we discussed this issue with meat eaters, vegans and any combination in between. And we were really discussing that everyone converts to these ALA in different amounts depending on genetics and all kinds of different factors. So one of the things we discussed was if you have access to an Omega 3 test, let's see what your level is if you're vegan. And that level is really good. He was saying, well, maybe you don't need to supplement. Exactly. But maybe that's where an omega 3 test could be potentially very, very useful. There's quite a few out there. Is there one specifically that you Recommend?
- [116:32]
A
OmegaQuant by Dr. Bill Harris.
- [116:34]
B
Yeah. And why is it that one you recommend as opposed to a lot of the Other ones out there?
- [116:38]
A
Well, this one specifically measures the Omega 3 in the red blood cell. If you were to get by your general practitioner, they're not measuring the amount of omega 3s in the red blood cells. So this one is really accurate. It's the only one I've used. So I like it. I like that it's a ping prick test. It's easy, it's affordable.
- [116:56]
B
Yeah. Do you know what I like about that is ultimately, whenever we are debating can one get enough Omega 3 from this diet or that diet, we kind of forget that we're all individuals. So maybe some people actually can on a particular diet. But that's where I think testing the right test perhaps can become really, really valuable. Because then you know, you're like, actually, yeah, I'm one of these people who maybe genetically and whatever other reasons are there am able to have adequate levels of omega 3 with what I'm currently doing. But other people may find actually, wow, that's really low. It's increasing my risk of dying like you just mentioned. Right. So maybe I need to either up things in my diet or I need to take a supplement.
- [117:45]
A
Not just that. Remember earlier how I said 20% of the lipid component in your brain is made of dha? Yeah, it's made of dha. So you're literally feeding your brain what it's made of.
- [117:57]
B
Yeah. Incredible. I want to briefly touch on something you said earlier and we were talking about your pet hates on social media. One of them was people saying that meditation increases the growth of nerve cells in your brain. You're saying it doesn't. Let's just close that loop. You are not saying that we shouldn't meditate, are you?
- [118:17]
A
No, meditation's wonderful.
- [118:19]
B
Yeah. You're just simply saying. Cause I just wanna make sure no one takes that away from this. You're basically saying that meditation does many things, but one thing it doesn't do is increase the growth of nerve cells.
- [118:31]
A
Correct.
- [118:31]
B
Why has that idea been perpetuated? Were there some studies that have been misinterpreted?
- [118:38]
A
Imagine a supplement company marketing to you that you can grow new brain cells. Wouldn't that be incredible? Imagine if we could just eat our way through more brain cells and grow new brain cells. We'd all be doing it. So of course it's going to be marketed to you in any way, whether it's through exercise, whether it's through meditation, whether it's through food. So that's where I think that we're going wrong. And I actually have been sent many Labels of different supplements that say this increases neurogenesis.
- [119:14]
B
Yeah, it's interesting because I can't see yes, meditation apps, but I can't see the massive business opportunity for someone.
- [119:24]
A
Maybe I'm being naive about headbands. That where they're trying to mimic. This is another thing. They're trying to mimic an EEG as.
- [119:31]
B
They'Re trying to mimic some of the meditation benefits through other things and saying, do this. Okay, fine. So let's just then try and close this off and go, okay. We have covered exercise in quite a bit of detail. You've said a few things about sleep that are really important. In terms of food, we've mentioned at least omega 3s and creatine as a supplement and we haven't really touched on stress. Of course, meditation is a great way for some people at reducing stress. What would you like people to know about the impact that chronic stress has on our brain function?
- [120:10]
A
Chronic stress ends up leading to that chronic inflammation. Right? That's something that we really need to take care of. Because remember, inflammation is one of the root causes of what is killing the network in our brain. It's killing the synapses. So we've got a network problem here. And if we want the growth and survival of this network which preserves our cognitive functions as we age, which basically halts the onset of Alzheimer's disease, we need to get our inflammation underway. You can go and get this tested by getting something called a hscrp, High sensitive C reactive protein, which is a measure of inflammation in your blood. You want it to be below zero, but what do we do on a daily basis to manage this? Okay. Because every time you get stressed, you activate that innate immune system. You increase the amount of amyloid in the brain.
- [121:05]
B
And for short periods of time, that stress is okay. It can help you perform better, it can help you function well. It's that that chronic day after day, especially with no recovery, where this starts to become a problem. Right?
- [121:18]
A
I see everything, Rangan, as an allotment. You have a certain allotment which you probably have told your patients of how much radiation you can have each year. You know, just getting an X ray is not going to be bad. If you're doing an X ray every single day, it's probably going to be bad for you. I believe this is just my own thinking. We have an allotment of stress. Let's say we stress our body by going to the gym, because that's what we do. We micro stress. But it's a good stress, right? If we Stress, our body at the gym and we are sleep deprived and we are having the worst day and we're negative and we're angry and we're emotionally triggered and we're having refined sugars and ultra processed foods. You've exceeded your allotment of stress.
- [122:03]
B
We're in the middle of London at the moment. You're basically talking about, I would say.
- [122:08]
A
Is that a normal thing? I don't. That's a make believe thing to me.
- [122:12]
B
I think it is pretty normal now for many people. I really do. I think having, you know, refined sugars, ultra processed foods, being sleep deprived, being chronically stressed, getting angry, emotionally reactive, and if you do get any time, you go and kill it at the gym and add to your stress load and maybe not have the proper sleep and recovery afterwards. I don't think it's as uncommon as you might think.
- [122:41]
A
And that's probably why Alzheimer's disease is as common as you think and gonna triple by 2050.
- [122:48]
B
Because that is the lives that so many people are living these days. Right. And I get it that for some people they are living tough lives. The world does feel out of control. There's all kinds of events going on that people don't like. Maybe they're struggling to have the money to do the things that they want to do. Right. So I think we have to acknowledge that, that, that is real. But one thing I like about your message is that a lot of what you're talking about actually doesn't cost that much money. It really doesn't. Right. What do you say for stress for some of your high performers? Write down everything in your mind. Right. That really doesn't cost any money.
- [123:31]
A
No.
- [123:31]
B
Right. You're talking about walking, brisk walking, you know, maybe doing some squats while actually trying to do some calculations. In terms of practical advice for people, there's a lot one can do if they don't have the financial results. Of course, they do need the time, resource. And there's some people who are working two or three jobs to make ends meet and they don't feel that they have the time. So do you think that's a fair reflection? Is that fair for what I said in terms of your work?
- [124:00]
A
And another thing I wanted to point out is what above all controls all of this. It is your outlook, it is your perspective, it is your mind. I believe we've got three different minds and they all live in the brain. So a stronger brain, a stronger network, a stronger mind, you'll be able to talk yourself into creating the life that you can have to improve these brain health outcomes. You just, you said it yourself, it's free.
- [124:29]
B
Yeah. I think one of the most important decisions you can make in life, that is at the root of your health outcomes and your happiness outcomes is whether you're a victim to life or you're in charge of life. And I say that with all the compassion that I have within me. Wherever you are in life, you have to take agency and go, okay, what one small five minute action can I do today for my health, for my wellbeing, for my family's wellbeing? Start there. But if you don't have that agency, I don't think it matters what else you try and do. I think you are going to be a victim to life and a victim to external circumstances.
- [125:12]
A
Yeah. And I use the analogy of compound interest. Everything you do has an effect for the positive or the negative when it comes to your longevity, your mindset and your brain health. One night of sleep deprivation probably won't do anything. If you don't exercise and you set entry for maybe five, six days, that won't do anything. It is the compounding effects of that certain habit. So you want to be able to fix it. You want to be able to build a stronger mind, which will build a stronger mindset so you can have that ripple effect.
- [125:44]
B
I love it, Louisa, honestly, I really love what you're doing out there in the world. You're publishing studies, you're looking at the research and then certainly what I've seen on your Instagram, you're trying to put out this positive, inspiring message for people to say, look, brain decline is not inevitable, you can do something about it. So please start. If people want to stay in touch with you, they want to find out more about your work, where would you send them?
- [126:07]
A
Definitely come to Instagram. That's where I hang out a lot. We actually, at Neuro Athletics, we have our flagship course, which is the Neuro Athletics Coaching Certificate, where we actually teach coaches our pillars of human performance.
- [126:21]
B
Yeah, fantastic. And if there's one final message you could leave for people, right, let's imagine you're talking to that one person who has just stumbled across this podcast or this video on YouTube. They'd never heard any of this before and they thought, wow, I didn't know, I didn't know that I had this much control over my brain function. But they're struggling with motivation to get started. Talk to that individual. What would you say to them?
- [126:50]
A
You know, we get one life and the one thing that you don't want is to lose or forget who you are. Because we spend our entire lives in search of meaning, of who we are and to come to the end of your life and to think, I could have just exercised. I could have just slept. I could have just not stressed out as much. The last thing you want is to look in front of the mirror and see your reflection and not recognize that and not recognize who your children are. So it is my dream that one day we have a cocktail of interventions where everybody, no matter what your location is, geographic location, or your socioeconomic status, that everybody is able to exercise.
- [127:41]
B
Louisa, you're doing incredible work. Thank you so much for coming on the show.
- [127:44]
A
Thank you so much for having me.
- [127:50]
B
Really hope you enjoyed that conversation. Do think about one thing that you can tell, take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if if that sounds like something you would like to receive each and every Friday, you can sign up for free@drchatterjee.com Friday 5 Now if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world covering all kinds of different topics. Happiness, food, stress, sleep, behavior change and movement, weight loss and and so much more. So please do take a moment to check them out. They are all available as paperbacks, ebooks, and as audiobooks which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show when without any adverts at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health. Making lifestyle change is always worth it because when you feel better, you live more SA.