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Feel Better, Live More with Dr Rangan Chatterjee
The New Science Of Preventing Dementia: Protect Your Brain, Boost Your Focus, Resist Cognitive Decline with Dr Tommy Wood #638
02:19:20
This podcast contains some of the simplest, most effective advice on brain health you will ever hear. It explains why the cognitive decline we expect with age isn’t inevitable at all. And why up to 70 percent of cases of dementia are, in fact, preventable.
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- [00:01]
Dr. Tommy Wood
We expect a certain amount of decline as we get older. And if you expect decline, then you embody this idea that you will decline and therefore you stop doing the things that prevent decline and therefore it becomes a self fulfilling prophecy. But the first thing we have to realize is that there is this huge possibility to enhance function, physical function, cognitive function at essentially any age. As long as we engage in these skills and challenges, we can expect that most people will maintain function later into life.
- [00:37]
Dr. Rangan Chatterjee
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
- [00:47]
Dr. Tommy Wood
More
- [00:50]
Dr. Rangan Chatterjee
if you think about getting old, one of the issues you might fear the most is dementia. Perhaps you've seen family members suffer and you're worried it's written into your DNA. And whilst that quiet fear is totally relatable, did you know that around 70% of dementia cases are thought to be preventable? That is the astounding news that my guest, Dr. Tommy Wood, brings to the this insightful conversation. Tommy is not only one of the doctors I respect the most, he's also a neuroscientist, brain researcher and performance coach who works with many of the top Formula one drivers. And he's back on my podcast for his fourth appearance to celebrate the publication of his first book, which, as you might expect, is absolutely brilliant. The Stimulated Mind Future Proof your brain from dementia and stay sharp at any age. In this conversation, we talk about why your expectations around aging matter more than you think. We also explore Tommy's 3S framework stimulate supply and support to ensure that your brain thrives today and for decades to come. We discuss why it's so common to feel tired, but why it at the end of the day, how different types of exercise help our brain, why we need to think differently about women's brain health compared to men's, and how regular social media use can stealthily undermine your well being. Tommy has worked with Formula One drivers, elite athletes, and everyday people, yet still his learned practical advice comes back to one Keep it simple. It's much easier than you think to help your brain thrive at any age. It's never too late and every single thing you do counts. So sit back, relax and enjoy. In the new book, you state that 45 to 70% of dementia cases may be preventable. You also state that when you say that to people, there's often disbelief and or resistance. Yeah, where does that statistic come from? And why do you think so many people push back at it?
- [03:29]
Dr. Tommy Wood
That statistic comes from two separate studies, 45% comes from the Lancet Commission on Dementia Prevention Report. There have been two now. The first was in 2020. Most recent one was in 2024. They upgraded the number from 40% of dementias potentially being preventable to 45%. The 70% number comes from a study using UK Biobank data performed by Professor Yin Tai Yu's group. And they sort of looked at all the different modifiable factors and risk factors for dementia to estimate. If we removed all of these risk factors from the population, what proportion of dementias would we expect to no longer happen? And this is essentially what the Lancet Commission report does as well. So they have these statistical ways of estimating how much a given risk factor translates to a proportion of dementia in the population. It is an artificial way of doing it, because we know that risk factors to any chronic disease are not a one to one thing. Right? And people often have multiple risk factors together and they compound and they interact. But that's the best way to truly estimate right now how different aspects of the environment and society impact dementia risk. And so it's things like 7% of dementias are thought to be preventable if everybody got access to high quality education and, you know, high levels of educational attainment. And then there are risk factors related to smoking, head trauma, obesity, hearing loss, et cetera. And the 45% number from the Lancet Commission report, I think that could be conservative because they didn't include things like poor sleep, which we know is a risk factor. They didn't include things like late later life cognitive stimulation, which we know is important as well. So that's why potentially this 70% could be the upper limit perhaps of dementias that are preventable. But you're right that when you say something like that, first of all, people are surprised. I think this is new information. And then people, especially those who have some kind of relationship with dementia, they had a loved one or family member with dementia, they have a family history of dementia. If you say that dementias are potentially preventable, they might interpret that as if there's some blame on an individual who previously suffered from dementia or is currently suffering from dementia, when that's absolutely not the case. Right. We've just said that we're only just starting to appreciate that dementia may be preventable, or a certain proportion of dementias may be preventable, certain types of dementia may be preventable. And we know it's very complicated. Multiple risk factors may come together in an individual. Genetic risk factors, environmental risk factors. And I truly believe that Each person is doing the best with the information that they have and the things that they can do at the time. So it's more an idea of hope. Right. Should we be able to modify our environment? Should we be able to make societal change to remove some of these risk factors, because some of them are related to socioeconomic factors? There is the possibility of dramatically decreasing dementia burden in the population. And yes, individually we can take that on and decrease our own risk of dementia. But it's really sort of an idea of what's possible, rather than saying, oh, because somebody got dementia, they did something wrong.
- [07:11]
Dr. Rangan Chatterjee
Yeah, that whole thing about blame is something I think a lot about on this show. Cause each week we're trying to empower people with the things that you might be able to do in your own life. It doesn't mean, though, that if you get something, you failed in some way. Do you know what I mean? It's a tricky one, isn't it?
- [07:31]
Dr. Tommy Wood
It's also hard for us to think about this as individuals because we're talking about probabilities. Right. So it would be impossible to say that any individual case of dementia is preventable. It would be very possible to say, were you to address certain risk factors, you will decrease your risk of getting dementia. But I could never say I can guarantee that one individual won't experience dementia. They may experience it later. They may have, you know, less of a decline, fewer symptoms. They may not experience it at all. But it's sometimes hard to wrap our head around the fact that when you're talking about statistics, you're talking about probabilities rather than certainties. And often in the health sphere, we're sold certainties and black and white stories. And it can be difficult to understand that there's some nuance in what we're trying to get across and what we could potentially do.
- [08:23]
Dr. Rangan Chatterjee
I think those statistics, firstly, they're very empowering, but I think they're empowering on a couple of different levels. I think firstly, it means, oh, wow, just because Mum had it, maybe it doesn't mean that that's my fate. And so, oh, let me learn more to see what I can introduce into my life. So I think it's hopeful on that level, but I think deeper to that. It more broadly to me, speaks to our collective attitudes towards aging. Yeah, right. Are we expecting our brains to get slower, weaker, poorer, whatever that might be, as we get older, or do we actually think that that doesn't necessarily have to be the narrative? And, you know, in the new book, the Stimulated Mind, you Very clearly make the case that that does not need to be the case. Let's talk a little bit about mindset and attitude to aging. Cause I think that's quite key, isn't it?
- [09:21]
Dr. Tommy Wood
Yeah, I think so. And this is something that we've embodied as a society almost that we expect a certain amount of decline as we get older. And I lay some of this blame at the feet of Sir William Osler. If anybody's heard of him, he's a very famous physician. He was a Canadian physician, helped to found Johns Hopkins Hospital in the US and then he was a professor of medicine at the University of Oxford. And in the early 20th century, Osler helped to popularize the idea of retirement. Because before then, other than sort of like military pensions, it wasn't normal for people to retire. But he gave this famous address at Johns Hopkins where he said that at the age of 60, the average adult is useless and should be put out to pasture. And this then is something that we have internalized as a society. And this is essentially what we expect. I will give him a little grace by saying that at that time average life expectancy in the US was in late 50s. So maybe he was right that once you were 60, the average individual wasn't in great health. But that's no longer the case. With the advancement of medicine and everything we've been able to do to extend both lifespan and health span at the population level. And despite that, I think we expect some level of decline. And because of that we do things or stop doing things that then make that inevitable. So there's this idea of stereotype embodiment theory based on some of the work, including like Ellen Langer's work, you know, you know her work. Well, she's great. And she talks about the fact that if you expect decline, then you embody this idea that you will decline and therefore you stop doing the things that prevent decline. And therefore it becomes a self fulfilling prophecy. So if we expect to lose physical function, we expect to lose cognitive function, then we stop doing the things that help us to maintain function. Oh, I'm too old to learn a new language. Oh, I'm too old to pick that up. Oh, you know, I might get, might get injured. I don't want to do that. And we stop doing those activities that challenge our physiology, which are inherently the things that help us maintain function. And as a result we see decline. So I think the most important thing to realize is, and we could certainly go into the evidence that decline doesn't have to be inevitable, but the first thing we have to realize is that there is this huge possibility to enhance function, physical function, cognitive function, at essentially any age, as long as we engage in these processes and skills and challenges that help that to happen.
- [12:23]
Dr. Rangan Chatterjee
Yeah. When I think about how our attitude influences the reality of our lives, I think about two cases or two sort of examples where there are some South American tribes, running tribes, where you grow up, from what I understand, with the belief that as you get older, you get faster. Right. And look, I haven't seen the physiological data. I haven't seen the VO2 maxes that they've measured or not measured, but apparently in your 60s and your 70s, they are the fastest runners. Right. And it, you know, we can look at the science go, yeah, but we know you lose muscle mass from the age of 30, and we know that this is going to decline. Right. Or whatever it might be. And also, let's also not forget that if you grow up in a culture where it's believed that you get faster as you get older, how much of an impact does that have? Yeah, there's also some research I saw where, if you live in a culture where older women are looked up to.
- [13:28]
Dr. Tommy Wood
Right.
- [13:29]
Dr. Rangan Chatterjee
And they're really valued, I think in some of those cultures, they have less reporting of menopausal symptoms. Now, I'm sure there's multiple complexities there. You know, are they reporting them on Earth? Are they doing them the same way, whatever it might be? I just find this whole idea that our mindset and the influence it has, and of course, Ellen Langer's work is hugely saying your mindset is massive. It's kind of interesting, isn't it?
- [13:54]
Dr. Tommy Wood
Yeah. There's so many examples of how what we think and what we expect drives our physiology as well as driving our behavior, and then essentially creates the reality that we. That we expect. And you can measure this in many different ways. And, you know, Ellen Langer's work is critical to that, be that, you know, manipulating how people think about their sleep then affects how they perform the next day, regardless of how they actually slept, or manipulating clock time and. Or how people think about the food that they ate, which then affects their blood sugar responses to it, even if, you know, it's a standardized meal under different conditions. And so we know that what we think drives physiology as well as behavior, and then you sort of get the outcome that you expect to a certain degree. And therefore, I think we need to understand that this doesn't have to be the case when it comes to cognitive decline in particular. And there's a few different ways that we can approach that. But the first thing, if people think about cognitive function, you think about a graph, right? So on one side you've got cognitive function, like on the y axis on the left hand side, and then along the bottom you've got age. And everybody might expect some. They've seen some curve where it peaks around your 20s or early 30s. This is exactly the same with physical strength or muscle mass, and then sort of just like declines from there. And then eventually at some point, you'll lose enough function that you might reach a threshold that we call dementia. When you're doing those kinds of studies that result in those kinds of graphs, what you tend to do is you just sample a whole bunch of people, maybe thousands of people, and you measure their cognitive function and you see that on average, yes, as you get older, the function is lower, right? You add up everybody's cognitive function divided by the number of people, you get the average. And yes, some people, as they get older do lose function. So there are people who are sort of dragging the average down. But asking what the average function is or the change in function in an average population over time is not the same as saying, what's my function going to be in 10, 20, 30 years time? And so when studies have looked at that, there was a classic study, I think it was one of the first studies to do this. It was called the Seattle Longitudinal Study run by Warner Shahy. And he took individuals starting in the 50s and he measured their cognitive function every seven years for multiple decades. And every seven years he would bring back the old participants and add new participants. So in the end, he had data from people in their 20s up to people more than 100 years old. And what he saw was that the majority of people, so like more than half of people maintained cognitive function into their 50s, 60s, and 70s. So yes, there were some people who lost function. They dragged down the average. But the norm, more than 50% of people, was to maintain function over time, even into your 70s and 80s. And those data were actually used to raise the retirement age in the US because. Because he showed actually that we can expect that most people will maintain function later into life. But if we don't understand that as individuals, then all those things we just talked about come into play because we stop doing the things that help to maintain function, because we expect function to decline as we get older.
- [17:14]
Dr. Rangan Chatterjee
I think about that through the lens of public health messaging and, you know, let's take what you do or what I do on this podcast, you're trying to share information that people can then absorb and then if they choose to take on in their life. Yeah, but there's a fine balance, isn't there? Because if you spend two hours talking about the problems of sleep deprivation. Yeah, right. On one hand, you're being honest. You, you're trying to educate people, but also you're also probably infusing this idea that it's really, really bad. And actually, as you beautifully write about in your book, we're pretty resilient. You can deal with a couple of nights where we don't sleep. But I've changed my messaging around sleep over the years. Let me put it, I've evolved it because I've realized actually that when you do these deep dives, it's great. And for many people it's like, wow, I better start taking my sleep seriously. Right? But then you, of course, get new parents who then send me messages saying, I'm really worried. After that last podcast, I haven't slept well for the last three months. Cause my young baby needs feeding throughout the night, et cetera, et cetera. And then the unintended consequence is you're trying to help and empower people. But sometimes that same message can be very disempowering and frankly, quite stressful.
- [18:40]
Dr. Tommy Wood
Yeah, there's. So that particular example, there's a study that I reference in the book that showed this is using UK Biobank data, again showed that the more children that parents had, both men and women, the lower their risk of dementia. And I thought this was fascinating because on the face of it, having kids should be devastating for your cognitive function, right? Stress, sleep, all these things that you don't get to do. You don't get to look after yourself anymore because you're so busy worrying about this new human that now has to navigate the world. But this is what happens when we focus on the downside. Downside of stress, downside of poor sleep, downside of, you know, what are the contaminants in seafood or is your food organic or not in general, so many of these things, the benefits massively outweigh the downside. So when you think about kids, right, they come with opportunities for joy, cognitive stimulation, social connection, pro social behavior, which is just such a critical component of humans and their evolution and what it takes to you make them healthy, looking after other people and building a community. And so those benefits seem to massively outweigh the potential downsides. And this is then, I think, the important thing for us to remember, A, we are incredibly resilient and Adaptable. And B, usually the things that we're doing want to try and get the most benefit out of them as possible. So when we're then worrying about those minutiaes for the potential downsides, we're actually offsetting some of the benefits that we're getting from all these amazing things that we're doing. And I think a study that maybe we've talked about previously, but is worth bringing up again is a study where they looked at physical activity, both actual physical activity and perceived amounts of physical activity. This was done by Alia Crump, who actually trained with Ellen Langer and now she's a professor at Stanford. And what they found was that people who felt like they were doing less exercise than people like them, similar demographically, they had a higher risk of mortality. And there was another study that found a similar thing for cognitive function. So if you thought you weren't doing as much exercise as people like you, they ended up having on average lower cognitive function. And this was after adjusting for how much exercise people were actually doing as well as a whole bunch of health related confounders. So what that says is if you spend all your time thinking, I'm not doing enough, I should be doing more, you are then essentially creating a situation where you're not getting benefit from the things that you are doing and creating this chronic stressor that's having negative health effects. So I am much more in favor of celebrating all the amazing things that we do do because those are probably offsetting any of the sort of like the minor things that we, we would otherwise worry about.
- [21:49]
Dr. Rangan Chatterjee
Yeah. And of course, in the modern age, now we'll maybe talk about modern technology and social media later. But one of the things, of course, that many of us have experienced is comparison. Right. And so, you know, maybe 100,000 years ago, you're kind of comparing yourself to your tribe. Yeah, maybe 150 people max, maybe less. Who knows? Now we can compare ourselves to the best in the world at anything. Right. So you go for your 30 minute walk around the block, but then you go on Instagram and someone's just done an ultra marathon.
- [22:27]
Dr. Tommy Wood
Right.
- [22:27]
Dr. Rangan Chatterjee
And so your 30 minutes round the block is fantastic for your mental well being, your physical well being, emotional well being, your stress levels, brilliant. But there is a risk that you think, oh gee, yeah, man, out of 30 minutes, they've just done 30 hours
- [22:43]
Dr. Tommy Wood
or whatever it might be. Yeah, there's a really nice paper or set of papers and essentially work done by George Slavic and Steve Cole. They're at UCLA and myself and Julian Abel, who's a retired palliative care physician, we recently curated and edited a set of scientific papers on the importance of community and social connection in health. And one paper was written by Steve Cole and George Slavage. And they talk about social stress and the effect that has on our physiology. And one thing that was, like, particularly impactful to me was reading it and you kind of. They talk about social rank, perceived social rank, right? How we see ourselves compared to others. And. And as you sort of like, read, as you know, I'm reading what they've written, I'm like, this is why social media is so bad for our health. Because what happens is that you spend all your time seeing people who are doing more than you, more successful than you, richer than you, better looking than you. However, you would perceive that compared to yourself. And what we do is then we rank ourselves, like, where are we in the world? And we demote ourselves internally because we see all these people who we think are better than us or doing more than us. And being demoted in your perceived social rank creates a social stress. And so it creates a physiological response similar to when we're socially isolated. And we know that when we're socially isolated, we see shifts in our physiology. It changes our immune function, it changes baseline levels of inflammation. This is a evolutionarily conserved response, right? So if you're isolated, then your immune system shifts away from being better at dealing with things like viruses, respiratory viruses, because you're not surrounded by anybody to give you a cold or a flu. And it shifts more towards an acute response that makes you better with, like, wound healing, for example, which is survival. That's important, right? There's nobody to look after you if you get injured. And these things are, you know, we can measure them in our physiology, however, that comes with a baseline lower level of inflammation because your body's ready to respond to an injury. If you continue that long term, you then see an increased risk of many chronic diseases, heart disease, dementia, because of this immune system shift. And that is driven by social isolation, but it's also driven by other social stressors, such as a lower perceived social rank.
- [25:18]
Dr. Rangan Chatterjee
Yeah, I remember reading that in. I think it was in the adapt chapter in the book, which is one of my favorite chapters. That whole idea that the immune system shifts, I think is really interesting. So I just wanna clarify something. Cause I think. I don't know if you said lower inflammation or higher inflammation when it shifts because you're lonely. The cost of that is a higher background level of inflammation so it makes us inflamed, basically being lonely.
- [25:48]
Dr. Tommy Wood
Yeah, exactly.
- [25:49]
Dr. Rangan Chatterjee
Yeah. And some of that being a perception is quite interesting. I once had a very successful author on the podcast, Will Stor. He's written some brilliant books. We chatted about status. And I remember chatting to Will, and it came up this idea that Will is more successful than most authors in the whole scheme of things, but he's not as successful as son. And let me define success in terms of book sales. Okay. There's many ways to define success. And so Will was quite honestly just saying, yeah, but all I see is all the authors who are selling more than me and who are doing better than me, and it just shows that it doesn't matter who you are, no matter how successful you perceive yourself to be. I agree with you. I think that may be one of the darkest things that happens to our subconscious when we're spending a lot of time on social media. And this is one thing I thought about a few years ago. We can talk about this stuff, right? People can know it and go, yeah, when I'm on social media, don't take it seriously. It's just their highlights reel. Right. I don't think it matters. I think your subconscious is constantly being fed that you're not enough, that everyone else is doing better than you. And I know in my own life, so I've recently taken all my social media apps off my phone so I can go on them on my laptop, but I can't easily get onto them on my phone. And I just feel better. Yeah, like, that's subjective. I can't give you a trial for that. I just feel better.
- [27:26]
Dr. Tommy Wood
There are. Well, there are actually trials that do. Look at that.
- [27:35]
Dr. Rangan Chatterjee
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- [31:09]
Dr. Tommy Wood
There are, well, there are actually trials that do look at that. It's interesting because the timeline matters, right? If you ask somebody how they feel about quitting social media after just a week or two, they might not feel that good about it. You still get, you know, FOMO and these other things because you're not interacting in that world. It's like asking how a smoker feels two days after they quit. They don't feel great. But if you go out long enough, four weeks plus, there seems to be an overall increase in well being. And this is also driven by what people do instead. Right? This is where a lot of the issue with social media comes from, I think, because it can be a way to increase social connection and social contacts that you wouldn't have had otherwise. And we see this in studies in older adults where they're using Facebook for the first time, they can communicate with family members that they wouldn't have done otherwise. You know, share photos, that kind of stuff. That is a net benefit. But if you're using social media to consume content instead of going and meeting people in real life, that's a net negative. And we see that very clearly in terms of well being. So, yes, there is maybe some benefit from at least decreasing our exposure to social media. But you can also curate the way that you use it such that it becomes a net positive. Plus, you need to think about what am I doing instead? And then there are multiple different ways to navigate that. But just appreciating that these are potential issues based on the fact that if you're constantly, you know, being exposed to content from people that makes you feel less than, either consciously or unconsciously, it might be having a net negative effect on your health.
- [32:53]
Dr. Rangan Chatterjee
Yeah, it's the tool. Right. And like all tools, it depends how you use it. I agree. And at the same time, I think something has happened recently which makes that even harder. So a few years ago, I thought, right, I'm going to cull everyone, when it was still called Twitter. I thought, I'm gonna unfollow everyone and just follow the people who I think really are giving me value. Right. So some of these, you know, there's a few endurance coaches who I really like following. They share research papers on exercise physiology and their experience coaches, you know, the things that I really enjoy looking at. And I did that, and for a while it worked. Okay. Cause whenever I go on, all I'm seeing is stuff from people. Actually, I want to see stuff from. But I think algorithms have changed where you don't only see stuff anymore from people you follow.
- [33:41]
Dr. Tommy Wood
Ye.
- [33:43]
Dr. Rangan Chatterjee
That's only a very small percentage of who you see. So I do think it's getting harder. And you do talk about this in the book. Right. You talk about the halcyon days of social media. And you were very early because I think your uni was like the third uni to get Facebook or something like that.
- [33:57]
Dr. Tommy Wood
Yeah. One of the first unis to get Facebook outside of the US in 2004. I think we got it.
- [34:04]
Dr. Rangan Chatterjee
Yeah. But I remember back sort of, I don't know, 2007, 2008. Facebook was great. Yeah. It was way of staying in touch with mates. You know, you'd share photos, you'd see what your mates are doing, you might follow a few people and see their content. And it was, I think, unless I'm looking at it through Rose Tinted glasses. It seemed to be connection, like social connection, I think for many reasons, which you don't necessarily have to go into on this show today. But you write about. Is it prime in the book? But just explain what prime is.
- [34:35]
Dr. Tommy Wood
Yeah, so this is information that we prioritize as humans. So the prime stands for prestigious in group, moral and emotional. And this is because we prioritize information that tells us something about our social environment, because that's going to help us survive. Right. And we are inherently social beings. And so this then is what's, I think, leveraged by the algorithms to have us stay engaged or, you know, continue scrolling. And so they know that information that you will respond to either positively or negatively in a large way is the kind of information that's going to keep you hooked in. Because your brain thinks this is important information about my social environment that I need to gather such that I will then survive better in my environment. And so that will include the things that you want to see. Right. But they might also include stuff that they know will elicit a negative emotional reaction because you get these large swings in dopamine that then drive learning. Right. That dopamine is largely responsible for learning what's important. And that's. That's done on. That's done on purpose. And so, like, I think that social media takes advantage of our need for social information whilst giving us social disconnection. But we keep going back. Cause we're like, well, next time I'll learn something that will really help me. And that's how you get sort of stuck in the loop.
- [36:07]
Dr. Rangan Chatterjee
Okay, Tommy, so far, we're basically up to the point where we're saying that a lot of dementia cases are preventable, which is a very empowering message. You've mentioned that the brain can adapt to any age. Again, very empowering. Doesn't matter how old you are. When you're listening to this. I don't know if we'll get to your owl story or not today, but you start the book with a beautiful story about owls, which really highlights this point. Right. That the brain can adapt at any age. We're talking a lot about social connection.
- [36:38]
Dr. Tommy Wood
And
- [36:40]
Dr. Rangan Chatterjee
I wanna really talk about the 3S model that you put forward in the stimulated mind. Okay. Because, well, firstly, I do have to tell you, I think this is one of the best health books I've ever read.
- [36:48]
Dr. Tommy Wood
Thank you.
- [36:49]
Dr. Rangan Chatterjee
It's absolutely fantastic. And it's so thorough. I'll tell you what I like about it the most. Not only is it grounded in a lot of scientific research. It's very clear that you've got a lot of practical knowledge about the application of it as well. And that's not always the case. There are sometimes books from researchers which are great and you see all the science, but as someone who's spent many years practicing, I'm like, yeah, but that doesn't. There is a different skill, I think, to application of these things for real life people who are busy. So it's a beautiful blend of that. You also. And I know this whenever I talk to you, you seem to know a study for app. Absolutely every. I can literally say anything. And you know a lot of studies, don't you?
- [37:40]
Dr. Tommy Wood
Yeah, that's part of. It's an occupational hazard at this point. I think the book has a reference list of. It'll be about 2,000 studies, 99.9% of which are in humans, that people can have access to if they're interested in digging in further.
- [37:55]
Dr. Rangan Chatterjee
Yeah, it's very rigorous, which I think is great. But I really love this 3S model that you put forward in the sort of the final third of the book, as it were. Stimulate supply and support. And I'll just. Before you sort of go, you know, outline it for us, something I read last night, which I've been thinking about ever since, is this idea that nutrition, of course, is important,
- [38:26]
Dr. Tommy Wood
but I think
- [38:27]
Dr. Rangan Chatterjee
it's only one of the assets.
- [38:28]
Dr. Tommy Wood
Yeah.
- [38:29]
Dr. Rangan Chatterjee
And I think that's quite novel because we think, well, what can I eat to support my brain? You're making this case throughout the book that actually stimulus to the brain is perhaps the most important thing. So it made me think, well, hold on a minute. If you think about physical health, right, we can talk about eating protein for your muscles, but if you're never stimulating your muscles with movement or with lifting weights, is that protein really going to translate to muscle growth? And then I thought about it through the lens of the brain. We can have the right diet, the right Omega 3s, and, you know, all the things you talk about. Right. We can have them in our diets, but that seems to be only one of the S's. If we're not also stimulating our brain, we're perhaps not getting the full benefit. So I said a lot there. I think it's interesting. Can you walk us through the model, then comment on anything I've just said that you feel is important?
- [39:29]
Dr. Tommy Wood
Yes. So what you say is exactly right. And where the model comes from is all the different pockets of neuroscience that I've worked in or coached in over the years. So I'M thinking about the developing brain, thinking about individuals who suffer some kind of brain injury during life, like a traumatic brain injury or concussion, or trying to help elite athletes perform at their absolute best. And then also thinking about, you know, what are the factors that contribute to long term cognitive decline and dementia. And you see the same things pop up again and again and again, which sort of makes me feel like there are these core foundational inputs that the brain requires in order to perform at its best, both on a day to day basis, but then also long term. So things that you can do right now to improve how your brain functions today or tomorrow, then translate into a longer term, lower likelihood of dementia. And you know, much, you're much more likely to maintain the function that you do have or maybe even improve it. Right. In your 60s, 70s, 80s and beyond. And there are a whole host of factors that we could talk about. We already talked about several of them. Right. But for me, they coalesce around these three common areas, which are the three S's. So stimulus, supply and support, like you said. And I think that stimulus is something that we inherently know is important. Everybody said use it or lose it at some point, right. But I don't think we've quite understood what that truly means in order to give our brains the stimulus that or the stimuli that they, that they benefit from the most. But I do relate it to this idea of physical performance and physical health, because people, we kind of inherently understand that, right. If I want to get, if I want to get bigger and stronger, right. I want bigger biceps. The most important thing to do is to do bicep curls. Right. I can improve my response to my training with a higher quality diet and making sure I attend to sleep and recovery. But I can't just drink protein shakes and nap and hope that my biceps get bigger.
- [41:37]
Dr. Rangan Chatterjee
Okay, this is great. So in that physical health example, right, you're making the case that the three S's are still important, but the stimulus is the most important.
- [41:53]
Dr. Tommy Wood
Yes.
- [41:53]
Dr. Rangan Chatterjee
Which I think makes intuitive sense if we step back and think about it.
- [41:57]
Dr. Tommy Wood
Exactly. And in reality, the function of any part of your body is driven by how you use it. Right. And you can think about your bones when you do your weightlifting, or you can think about your heart when you go running. Right. The way that we use our body is the primary determinant of how it functions, and the brain is exactly the same. So I'm making the case that how you use your brain is the primary driver of how it works.
- [42:25]
Dr. Rangan Chatterjee
Okay. So we have this 3S model. And I wonder if we could just go through the three of them and stimulate. How do we stimulate Supply. How do we supply support? How do we support. Yeah, give us a sort of top line on that.
- [42:40]
Dr. Tommy Wood
Sure. So the stimulus that I think that we need more of, and I will acknowledge that I quite like the title of the book the Stimulated Mind, because is provocative in a way, because right now we are at the same time understimulated and overstimulated. Everybody feels overstimulated. Right. So Tommy, how can you tell me that my brain isn't stimulated enough? Like I'm constantly feeling stimulated. And so it's the type of stimulus that really matters. And I think we can talk about social media is one of those things. We can talk about how you can decrease these other stimuli that make us feel overstimulated or stressed, because that's an important part of it that will end up in our support bucket. But the. The kind of stimuli that drive the development of the human brain are learning knowledge acquisition, skill acquisition, social interaction pro social behavior are, you know, languages, music, complex movements in sports, social connection. These things that require us to learn a skill and apply that skill in a way that involves processing information quickly, in a way that involves responding to the environment, responding to other people, and through multiple senses, our hearing and vision and touch, taste, smell, like all of these things actually can be important stimuli for maintaining cognitive function. And it's that kind of complex skill development and expression across all those domains, including arts, including computer games. Complex computer games can even improve cognitive function because it's the same thing, a multi sensory complex cognitive stimulus. These are the things that I think we need more of and we need to spend time really attending to them and focusing on them.
- [44:36]
Dr. Rangan Chatterjee
Is it the complexity of the stimulation you mentioned, this kind of the paradox of the time in which we live? The book is called the Stimulated Mind. As you say, many of us go, yeah, but most people are overstimulated. But is it that. It's almost like we've got too much of the wrong kind of stimulation. Like the unidimensional, perhaps like the scrolling. Cause, you know, let's say you wake up and you go onto your social media platform of choice for an hour whilst drinking coffee. Okay, you're getting stimulation, right? You might in the hour, see more information in the hour than maybe your ancestors would see in a year or maybe even longer. Right? Okay, let's just work this 3S model. Let's say for that one hour, you got all of this stimulus in, right? And Then we go to the supply and go, yeah, and let's say you've got an exceptional diet and you're moving your body regularly so you're getting supply and you're sleeping well that night to allow that learning. In theory, could that stimulation be beneficial for the brain?
- [45:45]
Dr. Tommy Wood
To an extent. So if you're using Instagram and you're consuming educational content such that you're learning important facts and thinking. And thinking. Yeah, absolutely. That can be an important stimulus. We know that educational attainment is the primary driver. Education and the environment are the primary drivers of brain development. And educational attainment is one of the best predictors of long term cognitive function and cognitive decline. So that's literally just every day your job is learning, you're learning and you're applying that knowledge. That's why attainment is important. You're actually remembering things, applying that knowledge in exams or however that knowledge is tested.
- [46:36]
Dr. Rangan Chatterjee
Okay, so attainment, so it's not just going to school and passively consuming stuff. You have to actively engage in some way. Yeah.
- [46:46]
Dr. Tommy Wood
So the, to kind of like really simplify that. It's, it's the difference between, you know, you spend 10 years at school and you, you know, pass your A levels or you, you spend another few years and you get an undergraduate degree. Right. That those levels of attainment versus you spend 10 years retaking the same year in school because you never pass an exam. Right. Those are two, you spent the same time in education, but those are two very different outcomes in terms of applying your brain and making sure that you're using the knowledge that you've, that you've gained.
- [47:18]
Dr. Rangan Chatterjee
And can the stimulation that we need, like the primary stimulus to the brain, we don't all need the same. Because when you've been on the podcast or you, you have spoken a lot about, you know, when do we have peak cognitive status? Is it after university or in your late twenties maybe in kind of the modern Western world in terms of how people who go through education and then they might go and study beyond that. But then it made me think about hunter gatherer communities and I thought, well, do we know in these traditional societies whether they have high rates of cognitive decline if they've not done the same type of education? But then I think, well, but they would be getting stimulated in other ways, maybe not in the conventional or the modern academic stimulus. You know, stimulus can come in a variety of different forms, can't it?
- [48:13]
Dr. Tommy Wood
Yeah, so I think that's an important clarification to make because these studies are done in a Typical west, you know, Western environment. We're doing specific tests of cognitive function, you know, related to a whole bunch of different functions of the brain that could involve memory, attention, decision making, processing speed, like how quickly you can process information. But these are just the data that we have access to. This is how we understand it. Right? And what those data show is that the cognitive function peaks around the time that you leave formal education. So the later you leave education, so the longer you spend at school or getting degrees, the higher and later your peak of cognitive function. Because I think you're just getting this stimulus on a day to day basis. But that doesn't mean that that's the way that you have to do it. Right? This could happen outside of a formal educational setting. In those traditional hunter gatherer groups, they will actually constantly be learning, and then at some point they'll transition from learning to teaching. Right? This is a big part of later life where we know that older adults in those Communities in their 60s, 70s and 80s are just as active as their younger community members. But they transition to being repositories of knowledge. And that's the expression of these complex skills and information that they've learned back to younger individuals who are now developing. So they're still constantly engaging their brains. It's just then using the information that they've gathered. So cognitive stimulus of this type of can come from anywhere. And you see very interesting studies looking at different types of skills that have the same core effects on the function of the brain. So there was this. One of my favorite papers of all time was published very recently. It's called Creative Experiences and Brain Clocks. And what they did is they looked across multiple creative experiences or skills. So they had tango dancers, they had musicians, they had visual artists like painters, and they actually also included a computer game group, gamers, including a randomized controlled trial where they had people game and looked at the effect on their brains. And across all those different. These are very different skill types, but across all of them, they had this. As you gained expertise in these complex skills, they saw the same effects on different networks and functions within the brain. So the brain has all these different regions and each region has a specific function. But what we're now learning is that really functions are distributed across the entire brain into these complex networks. And how well these networks are connected and how efficient they are is a primary determinant of how our brains function as we get older. So as we get older, these networks tend to become a little fuzzier and a little less efficient. That makes it Harder to, say, pay attention, or maybe slightly harder to remember something. But as people gained expertise in a complex skill, those networks strengthened, regardless of what that skill was. This is networks like the frontal priority network. It's really important for attention and memory. So what that says to me is that when we're doing these inherently human, creative, multisensory things, that requires us to pay attention, it requires us to focus, it requires us. It drives neuroplasticity through learning. And then this is what's important for maintaining brain function, the function of these networks for processing information and language and the social aspects of the things we want to do with our brains. And that also then means depending on what you find interesting to do, I just listed four or five things that are very different, but they all have similar effects on the brain. So that just means pick the one that you enjoy and start by not being good at it and get better. And it's in the getting better, it's in the learning and the failing. That's what drives the improvement of connections in the brain. That's what drives the improvement in the function of these networks. That then ultimately translates to improved cognitive function over long periods of time.
- [52:39]
Dr. Rangan Chatterjee
That whole interconnected nature of the brain, but also more widely the body, is also another theme that underpins the whole book, which I absolutely love. It's how I've always seen health and wellbeing. And I think when people think about, I guess, the typical inadverted commas, lifestyle factors like nutrition, exercise, sleep, stress management, whatever it might be. I love that section at the end when. And you quote quite a few people there about the interconnected nature of health. You change one thing, you change everything. And I think that's really empowering for people, especially when they get bogged down with what that expert said. These are the benefits of yoga. And that expert said that this is the benefit of running. And that expert said these are the benefits of meditation and. Yes, yes, yes. And you don't have to do them all. You do the stuff that you want to, and you'll probably find that that starts to change other things in the body. Yeah.
- [53:38]
Dr. Tommy Wood
So that's. And I think to fully unpack that, we can flesh out the model a bit more, because then you kind of understand how this works, which then gives us a lot more agency and it's a lot simpler in terms to start applying this stuff and benefiting from it. So we have stimulus. Right. You've stimulated your brain, doing something. Right. Starting to learn a new language. When the areas of the brain that are related to that skill that you're learning are activated, they ask for more blood flow. There's this thing called neurovascular coupling where the, the neurons and the astrocytes in that area stimulate the local blood vessels to bring in. They need more oxygen. Right. They need more glucose or whatever fuel you're fueling your brain with. And so those blood vessels dilate, they widen, they bring in more blood flow. This is then. So now we're in our supply bucket. And so that's where like cardiovascular health becomes important. We know that things like high blood pressure, high blood sugar are important risk factors for long term dementia. And that's at least partly because they affect the health of those blood vessels. If you want your brain to be able to react and adapt and do a whole range of different things that our blood vessels need to be healthy and respond accordingly.
- [54:53]
Dr. Rangan Chatterjee
So you've stimulated your brain and now we're going to the second S supply. When you have chronically high blood sugar or you have poor metabolic health, you are negatively affecting the supply. And the supply is important to get the most out of the stimulation that you just gave your brain.
- [55:12]
Dr. Tommy Wood
Exactly.
- [55:13]
Dr. Rangan Chatterjee
And is this why perhaps we read things where, let's say we've done a 90 minute bout of work and you know, cause my son's in his GCSE year, I'm talking a lot to him about how he revises and how important it is to move his body. And you know, so, you know, you do the stimulus. Let's say you've revised your whatever, whether it's a child or an adult. Let's say you work for 60 minutes on something quite cognitively challenging. Is it overly simplistic to say that if you then go for a walk or a run, you've done the stimulation with a one hour work, the run and the walk has basically got your blood flowing. So your, you know, your supply from nutrients, from oxygen, everything is increased. That's correct.
- [55:59]
Dr. Tommy Wood
Right, yeah. So one of the reasons why movement is so beneficial for the brain in the very short term is because it improves blood flow to the brain. So the supply, the second improves supply. Exactly. And then that also translates long term. Right. Long term. The more, if you're more physically active, active, you may maintain better physical fitness there and physical health, metabolic health, then you maintain good, good blood flow to the brain. Brain because your blood vessels are healthier. The other part of that is that, and we may get to this more later, is that you, if you increase arousal, which exercise does you increase some of the neurotransmitters that are related to learning and focus and attention and that then afterwards, once you've taken a chance to recover and adapt, you, you remember things better. So we know that if you do exercise before or after learning something, partly due to blood flow, partly due to arousal and neurotransmitter release, you will then remember those things better. So that's why movement around learning can be really important. Plus, if you've been learning because you've been, you've been sat in a chair the whole time, we know that if you, if you sit very still for long periods of time, blood flow to the brain start to decrease and that can decrease mood and attention a little bit. So it's another way to just kind of reactivate everything related to that learning process.
- [57:23]
Dr. Rangan Chatterjee
Okay, so let's go back to the three S's. We've stimulated the brain and now you're talking about supply. Today's episode is sponsored by Peloton. Now, we all know that moving our bodies more is good for us, but despite that knowledge, many of us find it hard to actually implement. And that's where the new Peloton Cross Training Bike plus, powered by Peloton IQ can really help. It's built for fitness breakthroughs with real time insights and endless ways to move. And you can go from cycling on the Bike plus to strength training off it with one smooth spin of the swivel screen which offers endless ways to train for a well rounded routine. While you lift, Peloton IQ counts reps, corrects your form and suggests new weights so you're always making progress towards your goals. And Peloton's Movement tracking camera provides real time feedback so that you can train safer, lift smarter and make every move count more. With over 15 types of workouts, expert instructors to keep you motivated, and a personalized plan tailored to your goals, the Cross Training Bike plus takes the guesswork out of working out so that you can move freely and let Peloton handle the rest. Let yourself ride, lift, stretch, move and go Explore the new peloton cross training bike plus@1peloton.co.uk that's o n e p e l o t o-n.co.uk and please note, peloton All Access membership is required to access all Peloton content and applicable features on your Peloton hardware.
- [59:25]
Dr. Tommy Wood
Foreign. So you stimulated an area of the brain or the networks in the brain. We're now bringing in more blood flow, right? So we've talked about why physical health becomes really important there to Maintain healthy blood vessels, maintain a good glucose supply to the brain. And we know that in individuals with Alzheimer's disease in particular, there's a, there's a decrease in glucose getting into the brain that may be, there's two parts of that. One may be due to decreased stimulus, right? If you're not using your brain in the same way, the brain is going to ask for less glucose, but it may be also an issue with the glucose getting in. If we have poor physical health, metabolic health. So then the final part of supply is nutrients. The critical nutrients that we know are important both for cognitive function on a day to day basis, but also in terms of long term dementia risk. So the ones that we have the best evidence for, vitamin D, iron, omega 3 fatty acids, B vitamins, especially the B vitamins related to methylation like B12, folate, B6 and riboflavin. Other things that we see are important for long term cognitive function are like the antioxidant vitamins like vitamin C and vitamin E. Antioxidant polyphenols. There's very cool things that you can get from that make berries purple and red or that make, you know, fruits and veggies, veggies orange and red. So like lutein, zeaxanthin, astaxanthin, that's what makes shrimp and salmon pink. These antioxidant polyphenols seem to have really interesting benefits for the brain both in the short term and the long term. And then some other minerals like magnesium and zinc, things like that become important too. So those are the critical nutrients that we're hopefully getting from the diet that then gets directed to the parts of the brain that are building new connections, building new synapses as it sort of cements the things that you're learning. Right. And so that's, that's, that's the final part of supply. And then you stimulated a part of the brain, you've brought in all the resources it needs to do the thing that you've asked it to do. Then we know that for a tissue, including the brain, to adapt to a stimulus, it needs a period of time to do that. And that's usually during rest, right? So it's the same if we, if we, if we're going training for something like a marathon, right? You don't get faster while you're running, you get faster while you recover after the training run that you did. And so the brain is the same. This is where sleep is really critical. So now we're in the support the 3rds. So sleep is A big part of support, that's when all those connections that we've made are cemented. That's when, you know, we're building that function in the brain based on the, based on the stimulus that we've applied. But we can also further support that adaptation through a variety of different things. So that's where hormonal status can become important. That's where other factors that get released by the body can support the neuroplasticity and development in the brain. Things like brain derived neurotrophic factor which is released during exercise. These can kind of help to support the direction and creation of new connections in the brain. And then sort of the other side of support is we want to avoid things that inhibit that process. So smoking, excessive alcohol, air pollution, other things that can cause chronic increases in inflammation. So we already talked about the social side, but that could include like dental health and oral health is a increasingly recognized risk factor for dementia because either because of the direct effect of the bacteria, but also maybe the inflammation that they create. And then chronic stress plays a role here too, because we know that if you never get a chance to fully switch off because you're chronically stressed, then that can sort of impair our ability to adapt. So then you realize that all these different buckets are interconnected. Right. So stimulus drives supply and stimulus also drives support. So when somebody does a cognitively challenging task, they then have a greater need for sleep that evening. So they actually, they may sleep better because they have a greater drive for it.
- [63:42]
Dr. Rangan Chatterjee
So just. Sorry to pause that, but that could mean if someone's listening to this and they sometimes struggle to sleep, and there's many reasons for that. One of the reasons might be that you're not stimulating your brain enough. Yes.
- [63:58]
Dr. Tommy Wood
So one of the ways that we know that, one of the ways we understand that the best is through exercise. We know that exercise improves sleep, can improve sleep onset as well as sleep quality. But there are really interesting studies in older adults where they have them do a brain training program for a few weeks. And what they see is that compared to a control group who are just doing much less cognitively stimulating stuff on a computer, they were using paint to just like, you know, make some things. But it's not the same as like really challenging your, your cognitive function. With some of these brain training programs, those who are cognitively stimulated, they ended up sleeping better because they're creating greater sleep drive. And so I often wonder if part of the reason why, as we get older, we sleep less is because we're not using our brains in the same way. We're not stimulating them, we're not asking as much of them, so we're not creating that, that pressure, that sleep pressure, that drive to sleep. And so because all these things are connected, that then means exactly what you said earlier, which is when you change one thing, you change everything. So we know that if you start to sleep a bit better, then your blood pressure improves and your blood sugar improves, and the next day you feel more sociable, so you're more likely to engage with other people in some kind of social interaction. We also know that if you're less fatigued because you've slept better, you're more likely to engage in a cognitively stimulating task, because we avoid cognitively challenging things when we're tired. And the same is true, right? If you stop smoking, blood pressure improves, inflammation improves, you're more likely to exercise, you're more likely to make a more nourishing meal choice. If you start to exercise, then you sleep better and all those other things come off that. So if we understand that these are not a long list of things that all these things we have to do, but instead, even just within one bucket, you would identify something where you're like, oh, yeah, I could start to make a small change there. We know that benefits tend to be linear, right? A little bit more is going to have some benefit, right? You don't have to do four hours of exercise in order to see benefit, right? Anything is going to start to be beneficial. But you pick the thing that you feel like you can make some change in you and you would enjoy doing or, you know, you're able to do. The whole network starts to shift in your favor, and then you can start to come in from other places as well. But understand that it's not a long to do list that's overwhelming. It's a network that allows you to come in pretty much anywhere and start
- [66:32]
Dr. Rangan Chatterjee
to see big benefits that has huge practical application. I think back to earlier on in my career, and I very quickly learned that if I was to tell a patient or give them loads of things that they could do, you know, say, hey, and I'd give them the research, say, hey, you know what? If you do this, it's gonna do that. If you do that, it's gonna do that. And they come back four weeks later, they haven't done anything, right? I was like, oh, I've actually just overwhelmed them. Have you found that to be true yourself in your own sort of coaching in your own life?
- [67:08]
Dr. Tommy Wood
Absolutely. I think that Right now it's very common on social media to see, here's a list of things to do for your brain health. And they can all be very evidence based, right? It could be all the things we've talked about today, but I've seen time and time again, you give somebody a list of 37 things they will do zero things, right? For those exact reasons. And my favorite personal experience is the first time I worked in Formula one, I, you know, I had sort of interacted with the team a little bit before. This is I do all of my Formula one work through a company called Hints of Performance. And I was invited to go to the, the US Grand Prix in Austin and I was going to be in the paddock, you know, meeting with coaches and drivers and team principals and all this, you know, all these amazing people. And like I was a big Formula one fan so this was like a, this was a big deal for me.
- [67:55]
Dr. Rangan Chatterjee
You nervous?
- [67:56]
Dr. Tommy Wood
I'm very nervous. And then I did what any good nerd would do and I massively over prepared. I was like, I went in armed with 100 things and 200 studies were like, I'm ready. I've got all these things that people could do, right, to improve performance and health and all this kind of stuff. And I remember having a conversation with a coach. And so the way that Hintsa works is the majority of the drivers that we work with, they have a hints of coach. This is usually somebody, they have like a master's degree in strength and conditioning or they're a physio or some of them have a psychology background just depending on what the driver needs. But they're there, inserted into the life and world of the driver. They're there every day. They hold the helmet next to the car, hold the umbrella, they're doing all the warm up drills, they're doing all the training and they're looking after diet, all this kind of stuff. They're sort of like organizing their lives. And these are the individuals that I spend most of my time interfacing with, like how can I help the coach do their job better? And so I'm meeting with his coach for the first time and I think I'll probably start throwing out all these different ideas. And he's like, we've got time for maybe one thing, maybe, right? What you don't realize or maybe don't think about is that first of all, drivers are essentially jet lagged nine months of the year because they're constantly flying from place to place. Plus you have to do all the, there's the races, but then there's all the preparation. In between, there's media days. You gotta go and schmooze the sponsors. Right. Cause everybody wants their peace. Plus, you've got a million people like me showing up and be like, hey, try this thing, do this thing. Hey. Right? And so then he's like, right, we've got time for one thing. What's the one thing that you think would have the biggest impact? And so, like, ever since then, that's the mindset that I've had to take in. We can start with a big net, but first of all, where's the biggest potential anchor or issue that's affecting this one individual? What's the highest return thing that that person could do with the time and resources and things that they have available? And that's where you start. And, yeah, sometimes you get it wrong. And that's true for all of us. Right.
- [70:09]
Dr. Rangan Chatterjee
But you need to experiment. Yeah.
- [70:10]
Dr. Tommy Wood
And of course, some of this requires some trial and error, but starting with the one thing that you think is most likely to have an effect is always going to be much more likely to actually start to move the needle, because you'll actually start to do it, rather than thinking about 100 things that I've suddenly thrown at you, like, well, I just don't know where to start, so I won't do any of it.
- [70:30]
Dr. Rangan Chatterjee
Yeah. You mentioned Formula one, and I know we've. I've always wanted to delve deep with you about your experience there, because it's super fascinating, as you were describing, the drivers there and the pressures on them, the pressures to compete, to perform at a high level, to deal with jet lag, sponsors, everyone wanting a piece of their time. I thought, wow, that must be quite stressful. And perhaps some of these extra commitments that they have potentially are going to get in the way of their ability to perform, which is ultimately what they're paid to do. But of course, they have to appease the sponsors and all that kind of stuff as well. From all your time in Formula one and having worked with several drivers, would you say there is something that's common to all of them, like a skill or an attribute that actually, you know what, they all seem to have that
- [71:28]
Dr. Tommy Wood
something that I see across, you know, all the successful athletes I've either worked with or interacted with is, in a way that's relevant to them focusing on process above results? Because. And I think this is. This is also relevant to everybody.
- [71:51]
Dr. Rangan Chatterjee
Yeah, for sure.
- [71:52]
Dr. Tommy Wood
Because you will never achieve the result and you can never guarantee the result, yeah, right. But you can enjoy the process and figure out what works best for me. How can I make this better, how can I continue engaging with that? How can I be more targeted in the things that I do and don't do so that I have better overall balance? I think it's people who love that process and really focus on improving the process itself, then end up consistently achieving high levels of anything. And this works in academia and sports and any kind of area that you might think about. The other thing that I see very consistently, and I don't just say, I like we as a team, the team that I am part of, I'm head scientist for motorsport for Hinsa, but we have doctors, we have coaches, we have a bunch of performance experts, psychologists, and we all work together. The thing that I see most consistently then is, is this need for downregulation and recovery. Right. So if we're thinking about our three S's, it's very unlikely that we can come in and somebody's already performing at that level and say, do you know what? You need more stimulus. Right, right, right. Because they've spent their entire lives learning how to drive those cars and dedicated to that craft. You're driving around the track at 200 miles an hour, you're getting plenty of stimulus. Right. And we spend a lot of time looking at blood work, looking at diets, tweaking those things, just to kind of make sure that they have all the bases in place. But really, recovery is where a lot of the benefit is going to be seen. Like, how can we allow these guys to rest, recover, downregulate, adapt, so that they can get the benefits from the stimuli they're receiving physical in their training, in the car, everything they have to do around engineering and working with the teams there.
- [73:55]
Dr. Rangan Chatterjee
So the third S support the third
- [73:56]
Dr. Tommy Wood
S becomes really critical for them. And that's probably where we spend a lot of our time focusing, because in driver development, and this is something we do a lot of now as a company, and we're. We're doing more and more over time and trying to improve these processes. You know, if you have a young driver wants to be in Formula One in five, 10 years time, yes, we might focus on stimulus. How can we build skills and fitness and performance, cognitive, physical? And so that's maybe where we focus. But once you get up to that tip, it's thinking about how can we make sure they're getting the most out of what they're doing so that they can sustain performance for long periods of time.
- [74:38]
Dr. Rangan Chatterjee
Yeah, it reminds me a little bit of, I think, a case you write about in your book when you first started coaching. Perhaps was it, was it a runner who was. Well, you can tell the story because it really now I'm looking at that fresh through the lens of the three S's going. You can stimulate all you want and supply all you want, but if you ain't got the capacity for the support, for the rest, the sleep, for you to absorb the stress and adapt to it, you ain't gonna get any faster.
- [75:11]
Dr. Tommy Wood
Yeah, and so this is something that's very common in amateur athletes. So like this, this, this individual was, they were, they were a high performer, they, they competed at a high level, but they were, they were an amateur as in, you know, they weren't paid to take part in their sport. And so this was a runner who came to us several years ago and did, felt like his performance was going backwards. So like he wasn't getting the race times that he wanted and was also sort of like slipping back in the field whenever, you know, compared to, compared to others.
- [75:43]
Dr. Rangan Chatterjee
But he was training, wasn't he?
- [75:45]
Dr. Tommy Wood
He was training, yeah. So he and was training very, very hard. Plus you layer on top of that a travel schedule that was, that was quite brutal because every two or three months you would travel internationally to compete. And so the reason why I tell this story in the book is because it was the first time that I as a coach previously I would focus on stimulus. Right. What's the training program like? How can we improve that? But it was the first time when I looked back, I looked across everything that I had from this individual and thought all these other pieces are the most important pieces. And so I think the first thing I said to him was, if you continue this, the only thing I can guarantee is that you'll get a divorce. And it was a bit tongue in cheek, but basically you're seeing somebody who's over trained, not able to eat enough calories or not able to have the, the cognitive bandwidth to focus on getting enough calories in because they're so focused on their training plus a brutal travel schedule. Plus. Right. They're, they're a husband, they're a father, right. They have a family to, they should spend time with that they're not, that they're not focusing on because they're just like so focused in on, on their training. And this then essentially made me realize that it's all these, all these other things are going to affect our capacity to a get the benefit of the stimulus that we're applying, but B, the overall picture of what it even means to be an athlete or be an individual in the world that we want to be. Right. He presumably, and I think this was the case, and he made changes to his training program and his race schedule to kind of take account for these things. Right? Having a family and being a husband and father was more important than racing. But, like, once you're so deep into this and you're so stressed and overworked, you become very focused on singular things like, what's the thing that I can control? And what he felt he could control was, I'll just train more, I'll just do more, right? That's the thing. That's the needle I can move. When actually that was the thing he needed to pull back on so that he could then benefit from that and actually think about who is actually. Who is the person who. Who's the person I want to be that, yes, is an athlete and performs well, but also does all these other things. And so then by focusing on the recovery aspects, by focusing on these other areas, maybe even training a little bit less, making sure that he was eating enough, right, enough supply to kind of support this, the adaptation, then he ended up doing less but performing better because he was taking care of these other areas.
- [78:30]
Dr. Rangan Chatterjee
I imagine a lot of people listening are probably thinking, well, yeah, I could probably get more stimulation. I could probably learn new things or get more social connection or whatever it might be, learn new skills, all that kind of stuff. Regular listeners to this podcast will of course know about the importance of regular movement, good nutrition, the stuff that you'd put in that second bucket of supply. But I think this third s of support is something that a lot of people need help with these days. So many people struggle to downregulate and switch off, and maybe they're not getting the right kind of stimulation in the day or when they're scrolling in the evening. But it is so common now for people to feel wired but tired, right? They are knackered, but they can't switch off and fall asleep. So I know you sort of. There's a whole chapter on this in the book, but have you got some sort of practical guidance for people who might be experiencing that at the moment?
- [79:31]
Dr. Tommy Wood
I think one of the things that ends up being very common is because of the way we structure our work day, we get to the end of the workday and we're still sort of stressed about what we have and haven't done. Plus, we're sort of desperate for some kind of Way to switch off that we end up spending a lot of time on screens, social media. Right. And those things can be beneficial, they don't have to be that detrimental if we craft our experience with them. But a lot of what happens when people can't sleep, this sort of tired and wild thing I think is downstream of our lack of structuring how we spend our days. So in one of the. One of the first people that I met when I was working, when I started working with Hincer is a guy called James Hewitt. He used to be a professional cyclist and now he's sort of a cognitive performance specialist. And he wrote a book with Aki Hintsa, who founded Hintsa called Exponential, where they, they outline this idea of cognitive gears and it sort of again relates to sort of like the physical side of physical training. And. But basically we have three gears in which we can use our brains. High gear is sort of really deep, focused work. Like this is when we're paying attention to one thing at a time. We're doing something complex, we're learning, we're problem solving these big tasks that we have to get done in our days. Low gear at the other end is when we're fully switched off, relaxed, our brains free associate. This is why we have moments of inspiration in the shower, because we're not constantly having to deal with other inputs. Or this is often happens when I'm in the gym. Like that's when I'm not thinking about anything else and sort of like ideas kind of appear same when you go for a walk, right? And ideally your brain spends a lot of time in this kind of mode because you need that mode to recover from this like complex cognitive work that you've been doing even during the day, in addition to sleep, where we spend most of our time, if not all of our time is in the middle gear. So think about high gear as like sprinting. Low gear is like walking and middle gear is kind of like jogging or running. And we basically spend our entire day running. And if you imagine like how exhausting is it to run all day, you couldn't do it right, but you just like keep trying to keep, keep going. And this is essentially what we're doing to our brains in the modern work environment. And it's the middle gear is meetings, emails, dealing with slack and teams and all these different inputs. Multitasking or task switching across multiple, like trying to deal with multiple things at the same. So like you're trying to do some work and then an email comes in or a message comes In. Or we get to the point where we're so used to distractions that we distract ourselves. There's some really nice work from, from Gloria Mark, fantastic book called Attention Span, if any, if anybody's interested in this. But basically, if we're distracted a lot, our brains get used to distractions. And then we go looking for distractions. You know, like when you go to pick up your phone even though it hasn't gone off and there's no, I mean, you, you, I mean, you have your, your framework, like, why now? Why am I doing this? What is it for? But we basically get to the point where our brain gets used to distraction and goes looking for it. And so we know that when we're forced to multitask or we're interrupted in our work, which is essentially everything we're doing in the modern work environment, it's inherently stressful. It creates this low level of stress. And then you layer on top the fact that you never get a chance to do the really high quality work that makes you feel useful. Right. This, this is what I'm good at. Like, this is, this is a job that I'm here to do. And it could be, right, researching or writing a book. It could be, you know, preparing presentations for a board. It could be, you know, luckily, you know, if you're like a surgeon, right, they get to remove all the distractions and actually do their, their work. But that's the kind of thing that we want to be doing, like, focused. This one thing that we're doing, this is the thing that we're good at, really applying ourselves.
- [84:00]
Dr. Rangan Chatterjee
But we'll do that with a surgeon because we know that someone's life depends.
- [84:04]
Dr. Tommy Wood
Yeah.
- [84:05]
Dr. Rangan Chatterjee
But without being flippant, you could kind of make the case that all of our lives depend on it. Right. Like if. Yes, we're not surgeons or many of us listening are not surgeons. I'm sure there are a few surgeons listening. But, you know, the quality of your life probably does depend a lot on how you're spending each day. Yeah, Right. So, yeah, a surgeon has a reason to do that, but we kind of need to give ourselves that reason as well, I think.
- [84:32]
Dr. Tommy Wood
Exactly. And so we want to feel, we want to feel useful and productive. Right. We're no longer, you know, as, as a species. Our history was largely, you know, our productivity was largely due to physical work. Right. Hunting, gathering, farming. But now the product of our work is due to our brains. Right. We're knowledge workers. I'd like to call us all cognitive athletes. Right. And so, like that's important because the best athletes, like I was saying earlier, they know they are very targeted training, they are very targeted stimulus. And then they focus on recovery, adaptation, how getting the most out of their training. Whereas we just spend all day jogging and never think about the recovery that our brains need in order to perform our best. So well, then what happens is at the end of the day you've felt very busy and very stressed because you're constantly bouncing around between all these different things. You know you're in, in zoom while you're also writing an email, but you're like not paying proper attention to either of them. And so that process is inherently stressful. And we know that people make more mistakes and errors and feel more stressed when they're interrupted or they have to multitask. And then you're stressed about the fact that you didn't actually do that really high quality, focused piece of work that you needed to do because you were so busy in meetings and multitasking. And so then when you get to the end of your day, you're like, you're stressed about the fact that you didn't do those things. And then you have to try and somehow wind down and go to sleep. So you then may rely on other things that could, that you feel like are allowing you to relax, but could compound that. So it could be social media or it could be a glass of wine, which then impairs your sleep and then, or two glasses of wine and then the next day the whole kind of cycle starts again. So I kind of start by thinking about how can I structure the work day so that even if it's just for 30 minutes, I can just get the thing that I need to get done today done. And you do that by, if you can, structuring your day so that whenever you feel best. And like each of us feels most focused, most alert, most attentive at one specific time of day. And it could be in the morning, it could be in the evening, right. Depending on chronotype and other things during that period of the day, like just get, just set aside half an hour to like do the thing that you need to do. And then you can also set aside time to do the, do the meetings and other things right. And the emails. We all have to do that. But in between those things, allow yourself time to get, to have a break. Can you go for a five minute walk? Right. Can you just like look outside at something green?
- [87:04]
Dr. Rangan Chatterjee
Right.
- [87:04]
Dr. Tommy Wood
There are studies that show that we can become reinvigorated and less cognitive fatigue Just by looking out a window at greenery for 90 seconds. Right. So it doesn't necessarily take that much. There are also some nice studies where people feel reinvigorated after five minutes of watching comedy clips on YouTube. Right. Just something to completely disengage from the work that you're doing. So can you build some structure in that allows you to do high quality, focused work? Can you build in breaks during the day so that you can recover just like in between bouts of sprinting? Right. You can't sprint forever. You have to take a break and then you go back and do it again. And then at the end of the day, if there's anything that's still on your mind that you need to get done, or your to do list, we know things like mental offloading can really help with sleep. So you write down your to do list, or you write down the things you're worried about, and then that helps people fall asleep.
- [87:58]
Dr. Rangan Chatterjee
It literally gets it out of your mind.
- [87:59]
Dr. Tommy Wood
Get it out of your brain. Yeah, exactly. And then maybe you can also think about those other things that you might be doing the evening that could impair your ability to sort of wind down and recover. But I kind of think about it in that way that you're sort of like tired and wired. Thing starts at the beginning of the day. And then there's also, like the cycle of alcohol and caffeine, which is very. Which is very common, that can then also impair that process. But just thinking about how we structure, how, again, how we use our brains, I think sets us up for the ability to wind down in the evening.
- [88:30]
Dr. Rangan Chatterjee
Yeah. I love the idea that if you're feeling tired and wide in the evening, think about how you started your day. It's not just about what's happening in the evening. Right. The whole day plays into that. One thing I've often spoken to patients about is this idea of a stress threshold and that you accumulate all these stress doses in the day. And when you get to your personal stress threshold and we all have one, and each one of us can be different depending on our resilience, depending on what we've got going on in our life. But it's when you hit that threshold that the problems often start. Or when you get close to it, your back goes, your neck goes, you react to an email, you said something about you shouldn't have done or whatever it might be. And I have seen over the years, once people understand that stress threshold concepts and go, yeah, so I've been working for a couple of hours. I'M getting closer to it. Can I take a five minute break? Just move myself away from it in the day? You just keep, you never let it accumulate to the point where you hit because once you've hit it, it's harder. You can down regulate with this breathing sections in your book that you different exercises people can do and there's all kinds of things. But if you can and if you do have a degree of autonomy over your day building in those regular sort of micro breaks, it has an outsized effect in my experience.
- [89:54]
Dr. Tommy Wood
Absolutely. Especially if you can. So like, like I said, any, any kind of hard cognitive work, right. You need a break from just like with just with physical work. And it doesn't have to be that long. It just has to be something that completely allows you to disconnect. And you know, even better if you can pair it with just like a very brief exercise, snack or period of movement. Because like I was mentioning earlier, if we, if we spend long periods of time sitting, mood starts to drop, right? Maybe that's what, you know, maybe like our stress threshold decreases, right? Blood flow to the brain decreases a little bit. You know, we don't have quite the same sort of level of cognitive function. So just like breaking up sitting by using that as a cognitive break. Right. If you can go outside or you can just like do anything, you can just like step back. There's multiple things that then happen at that moment in time that allow you to then go back into it just a few minutes later.
- [90:52]
Dr. Rangan Chatterjee
Let's talk about women's brain health. It's getting a lot more attention these days, very rightly so.
- [91:00]
Dr. Tommy Wood
Absolutely.
- [91:01]
Dr. Rangan Chatterjee
I know you've got some, some really quite thought provoking ideas relating to women's brain health through the lens of your 3S model in terms of stimulation. So can you speak to that as a topic?
- [91:12]
Dr. Tommy Wood
Yeah, absolutely. So another reason why I think we have this hopeful message for dementia prevention and decreasing population dementia burden in the future is because over the past hundred years we've seen a decrease in the age specific instance of dementia and that's measured in a very specific way. But what we hear all the time is dementia cases are going to triple in the next 10 or 20 years. You know, the, the risk of dementia is constantly increasing and those things are technically truer because the, the, the world is, you know, the population is living longer and if you live longer without dying of something else, then you're more likely to get dementia. We know that. But you are less likely to be diagnosed with dementia at the age of 70 like today than you ever have been in, in, in, in previous history. And people don't, people don't realize that. So what that means is over time, age specific incidence of dementia has decreased.
- [92:20]
Dr. Rangan Chatterjee
What does that mean, age specific incidence?
- [92:23]
Dr. Tommy Wood
So that's exactly, so that's exactly what I was saying is. So like if you pick up a specific age, 60 years old, 70 years old, you're now less likely to have dementia at 70 years old than you were 20 or 30 years ago.
- [92:34]
Dr. Rangan Chatterjee
And I just want to make sure everyone's got this. So why is there this apparent discrepancy then between, you know, rates going up? Yeah, but our individual risk at any
- [92:41]
Dr. Tommy Wood
given age going down, it's because we're living longer. So it is true that because now we're more likely to live to be 80 or 90, that yes, the, the, the risk of having dementia at 80 is lower than it was previously. But because more of us will live to 80, more of us will have to, will have dementia at some point in our lives, but it will just happen later in life, if that makes sense. So both of those things are happening at the same time, which is complicated. Like I understand it. But what's then interesting is you see that it is possible to move the needle on the incidence of dementia at any given age, which then means that it's probably also possible to move the needle on dementia overall. Right. Which just goes back to the fact that dementias are preventable or some proportion of dementias are preventable. But when you think about, well, why might this be? Because it, because it kind of goes against some of the narrative and one is an improvement in cardiovascular health. And this seems to be particularly been beneficial for men, decreasing the age specific incidence of dementia for men, because heart disease risk factors overlap very tightly with dementia risk factors. We've already talked about blood pressure, blood sugar, but smoking, blood lipids play a role here too. We've become much better at treating and preventing heart disease and that seems to have translated to a lower age specific instance of dementia, maybe more so in men, because men tend to have higher heart disease risks than women. But we do also see some of this shift happening in women as well. And there were these big meta analyses that have been done in studies using data from the us, from the uk, from multiple European countries. And I wonder if some of what we're seeing, particularly in women, is the changing role of women in society, which has been overwhelmingly beneficial. So if you think back to, I mentioned Warner Shy's Seattle Longitudinal Study, and one of the things that they looked at in the Seattle Longitudinal Study was environmental enrichment or an enriched environment, which basically meant how complex and cognitively stimulating is the world that you exist in, largely related to your work and your hobbies? And the more enriched or complex your environment, the lower your risk of dementia or cognitive decline. In the Seattle Longitudinal Study, but there were a group of individuals who had low environmental complexity and a higher risk of cognitive decline, dementia. And they were all overwhelmingly women, which was the housewife. And this in the 1950s was a very traditional thing. Right. And the way that they measured these things and the way they wrote about them, you know, is part partly of their time right now, 60, 70 years ago. But something that they saw in that study was that that environment was not necessarily as stimulating or complex as, you know, the work environment or that other people might have access to. But we've seen both within Westernized societies, but also globally, as education has become more accessible and equitable to women in particular, dementia rates and dementia risks have decreased. That's one of the reasons why education is actually the risk factor. In the Lancet Commission report, that is the biggest number, 7% of dementia is related to education. And then we think about the work environment. So women's presence in the workplace only really started to expand in the 1970s. This is based on US labor and statistics data. And so there's been this big shift from what was maybe the potential for a less cognitively stimulating environment. And I realized that that doesn't have to be the case. Right. People can be primarily at home, and most of their work and commitments are at home with their children or family or family members. Right. And that's what they do. And that can be incredibly stimulating and incredibly enriching and incredibly satisfying.
- [97:03]
Dr. Rangan Chatterjee
Of course.
- [97:04]
Dr. Tommy Wood
Right. So we're talking, like, averages and maybe how things looked 60 or 70 years ago. But as those things have shifted, right, women have been allowed access to more complex, higher powered jobs and more education. Again, both within Westernized countries and globally, we've seen age specific instances of dementia decrease. So I think as society becomes more equitable across the sexes, we may start to see some of those benefits pay off in terms of dementia rates. Because right now, right, about 2/3 of Alzheimer's disease burden is in women. Right? We know that. But those statistics come from women who are largely of that period. And so I think. So my hope is that, yes, we should do a whole bunch of additional research where women have been left out of neuroscience and neurology research for decades. And I'm so happy that that's changing. But I also wonder if, like, this shift in society will pay off in a beneficial way because of the stimulus that you can get from work and education that now more people have access to.
- [98:20]
Dr. Rangan Chatterjee
It's so fascinating to think about that. And it all feeds back to this idea that the stimulus to the brain is the most important thing. Going back to women's health again, and specifically women's brain health, how do you think about the menopause and the hormonal changes that occur in the menopause and risk of cognitive decline?
- [98:47]
Dr. Tommy Wood
This is an area that still right now is hotly debated. And this is probably the most challenging part of the book for me to write, mainly because I want it to be very evidence based, but equally like women should feel supported by men. I am absolutely a feminist and I. And I want, I want that, I want that to come across. And so, first of all, there's a whole bunch of studies that need to be done. Things like Lisa Moscone's care initiative, funded by the Wellcome Trust. Like, fantastic. Like, really excited. I'm really excited to see those things happen. But. Right, so right now we know that just like really simplify it, if you live long enough as a woman, all women will experience the menopause. Right. But only about 20% will experience dementia. So that means that that decrease in hormones is not going to automatically result in cognitive decline. Dementia.
- [99:53]
Dr. Rangan Chatterjee
Exactly.
- [99:53]
Dr. Tommy Wood
Right. Yeah, we know, we know that from the, from the. Now if somebody is experiencing symptoms related to perimenopause and menopause, particularly vasomotor symptoms, you know, night sweats, hot flushes, you know, problems with sleep, even, even, even cognitive changes, which, which do happen, then I think things like menopausal hormone therapy can be incredibly powerful by improving quality of life, by improving sleep, by improving your well being, sexual function, mental health, how likely people are to engage in other important aspects of lifestyle, you know, critically important. And that's what the current guidelines say, that to address symptoms and quality of life or. Menopausal hormone therapy is an incredibly powerful tool. And for other things, you know, bone health, cardiovascular health, when used, you know, in that way, in, in, you know, in collaboration with your physician. But the hormonal changes don't seem to be enough to explain cognitive changes. And actually the data seem to suggest a couple of things. One is that vasomotor symptoms are better predictors of cognitive changes than hormonal shifts are.
- [101:02]
Dr. Rangan Chatterjee
And for people who don't understand the term vasomotor.
- [101:04]
Dr. Tommy Wood
Yeah, so like I mentioned the hot flushes, night sweats, that kind of stuff, like those kind of symptoms that the women get during the menopausal transition. And there was so, like, one example is there was a very interesting study where they used nerve blocks to. So like, you. You sort of like, inject an anesthetic around nerves in the neck, which decreases some of these symptoms. And in those who, those who had significant symptoms and they, they saw that by blocking these nerves that affected vasomotor symptoms, they saw improvements in cognitive function. Nothing to do with hormones, right? And this is probably because changes in body temperature regulation and blood flow and, you know, you know, activation of stress hormones, these can then affect certain parts of the brain that might affect cognitive function. So we know that there are a whole host of lifestyle factors that relate to those symptoms, right? So we know that you can improve them by improving diet quality, you can improve them by improving physical activity, right? So, yes, hormones play a role, and that is part of that. But we know that other lifestyle factors are critically important as well. We also know that this is the period when the risk of Alzheimer's disease diverges between men and women, right? And so it seems like the menopausal transition is a risk amplification period. And what I mean by that is that other risk factors for dementia and cognitive decline, their effect seems to get larger in women as they enter that transitional period. So one example is there was a study done in the US where the largest cognitive changes seem to be in women who had evidence of metabolic disease. So that's again, we know the metabolic disease is a risk factor for dementia and cognitive decline during that transition. In those who had metabolic disease, they saw a bigger impact on their cognitive function. So I tend to think of it as a risk amplification period, such that if we think about all the things we've talked about today, any ongoing risk factors may have a larger effect as you enter menopause, but that also means that those are things that you have control over, because by the same token, we know that if you improve your diet quality or if you improve your movement, then you can help control those symptoms. And those symptoms are the things that correlate with changes in cognition. And the final piece that I think is important is that it is a transitional period. So there was, the Swan study in the US found that in women who did experience some cognitive changes during the menopausal transition, they actually went back to almost exactly where they were beforehand once the transition was completed. So if you do experience some cognitive changes during, you know, Perimenopause, menopause. It's not. It is, it is a transition you may like, they may well improve later. And of course, like in the meantime, if menopausal, Menopausal hormone therapy or other lifestyle or environmental interventions improve that, that's great and you should actually do that to focus on quality of life and a whole host of other things. But it's not, it's not guaranteed that any changes are going to be permanent. And there are several cognitive functions that continue to improve as we get into our 50s, 60s and 70s and well being as well in both men and women, where the components of crystallized intelligence, which is a fancy way for saying wisdom, elements of taking in a bigger picture, thinking about all the things that we know, putting them in context, they actually improve, as does well being.
- [104:46]
Dr. Rangan Chatterjee
So a different type of cognition.
- [104:48]
Dr. Tommy Wood
It's a different. Yeah, so cognition doesn't get worse as we get older, it just shifts. Right. So some things change. Right. And you can measure reaction time or something, maybe that decreases, but we get better at other things. So like all that to say that this is an incredibly important topic and I want everybody to feel amazing every day regardless of where they are in that period. But we've kind of boiled it down to two groups who are like, hormones are everything and we need menopausal hormone therapy because if we don't we're going to have cognitive changes and experience dementia. And the other group who are saying, well, there's no evidence for any of that. And the second group is actually more. Right. I will say based on the available data because there are studies where they give bioidentical hormones to women in the menopausal transition and they don't see any effect on cognitive function.
- [105:41]
Dr. Rangan Chatterjee
Right.
- [105:41]
Dr. Tommy Wood
Like the keep, like the KEEPS trial, keeps cog done in Canada. But they can have a massive impact on quality of life and all these other things that I mentioned. So it is incredibly nuanced.
- [105:52]
Dr. Rangan Chatterjee
Yeah.
- [105:53]
Dr. Tommy Wood
And I, the, the main thing that I've seen is that there have been two sort of very black and white pictures of it and the person who doesn't benefit is the woman in the middle who's just like, I just, I just want to feel better, I want my brain to work better. And that's the person that I, that I really feel for. And I hope that they understand that there are all these different parts and actually a whole bunch of things that they can potentially do, including related to hormonal therapy, if that makes sense for them. But also there's a Lot of power to improve physical health. Start resistance training, which we know can improve symptoms. Start to focus on sleep if you can, or maybe the hormones help you sleep and then you sleep better. So all these things should be kind of taken into account when we're having these complex conversations about menopause and cognitive function.
- [106:44]
Dr. Rangan Chatterjee
Yeah. Hence the importance of women having better access to well educated healthcare professionals who know the nuances. Right. Because that's something probably that hasn't been there. But what, as you said at the start, it's kind of like, well, if you live long enough as a woman, you're going to go through the menopause. So everyone has hormonal changes and a hormonal decline, but not everyone gets dementia. Right. So it can't just be that that is solely responsible. Could genetics play a role? Could other factors play a role? It is incredibly nuanced. So of course we want more data and more research. Let's talk about exercise. I know we've spoken before about the importance of exercise for our brains. Perhaps you can give us an overview of that. But today I thought it'd be interesting to specifically go into what do the different types of exercise do to our brain. And also, is it fair to say that exercise just fits in that second s supply? Cause I kind of feel some exercise could count as stimulation. And of course, like we've already said, and if you exercise enough, it's gonna help you with your support and recovering from it.
- [108:00]
Dr. Tommy Wood
Yes. Yeah.
- [108:01]
Dr. Rangan Chatterjee
So lots of yeses.
- [108:02]
Dr. Tommy Wood
Yeah, lots of yeses. So one of the, one of the potential downsides of thinking about, and, and I've experienced this when trying to explain the. The 3s model to some people is they, they expect that any given activity only fits in one bucket when of course, they don't. I think that there are types of exercise that could absolutely hit all three S's at the same time. Right. So if we're thinking about big leverage points, there are things that we can do that hit multiple buckets at the same time. Right. So, like, that's definitely something we could take into consideration. But when you think about exercise in the brain, it largely comes in three flavors. So like aerobic type exercise, resistance training or weightlifting, and then coordinative exercise. And in the research, they might call it open skill exercise. And I'll get to that kind of last. But the most important thing to say first is that any physical activity that you do will improve cognitive function if you're starting from a low level of initial physical activity. Right. So we know that the more steps you take per day, the lower your risk of dementia. Up to sort of somewhere around 8 to 12,000 steps per day. The first time we really saw that exercise could improve the structure and function of the brain, particularly the hippocampus, which is important for memory and is vulnerable in Alzheimer's disease, was with a brisk walking intervention. Brisk walking, 40 minutes, three times a week. So anywhere you start that just like starts, you moving your body regularly is great. But aerobic exercise across the scale of intensities, because at the top, the low end you might just have walking, at the top end you might have high intensity interval training where you do sprinting on a bike or a treadmill or a row machine for some period of time, and then you recover and you do a few rounds. Those types of exercise seems to be particularly beneficial for the gray matter of the brain, which is sort of like the wrinkly outside the cortex, as well as some stuff inside, like the hippocampus, and particularly beneficial for memory. So if you're looking at different cognitive functions and at the higher levels of intensity, we see greater benefit, probably because of the production of lactate, which has been sort of derided as a molecule that we want to avoid that's somehow bad for us for long periods of time. But what we're seeing increasingly is that it's a very powerful signaling molecule, particularly in the brain. So when you make lactate, you feel the burn. And lactate is part of the buffering system that we use when we're doing anaerobic type exercise or very high intensity exercise. And lactate goes into the brain and it switches on the production of bdnf, brain derived neurotrophic factor, which supports the function of recently activated neurons. So it supports the process of neuroplasticity, which is what underpins learning and improving function in the brain. And again, when you look at studies where they do high intensity interval training interventions for long periods of time, you see improvements in the structure and function of the hippocampus in particular. Um, so you can see that on a brain scan. Then you also see improvements in memory, specifically. So that's like the aerobic bucket. Then the next bucket is, is resistance training. So a lot of what's different across these different types of exercises is what gets released while we exercise. And so while we might think about something like lactate, brain derived neurotrophic factor, with aerobic type exercise, with resistance training, we release more things like IGF1, insulin, like growth factor one, which is really critical for white matter. So this is something that we see even in babies born preterm who are at risk of injury to their white matter. And then associated increased risk of things like cerebral palsy and IGF1 is really critical for the white matter. And one reason why babies born preterm have issues with white matter development is because the placenta normally provides the IGF one that they use to grow their white matter. But then we see the same thing later in life where if you do resistance training, you release IGF1 and the structure and function of the white matter improves. So it's critical, like, throughout the entire life, that this is a very important molecule for white matter. So the white matter kind of sits in the middle of our brains. It makes up about 60% of the human brain. And it's responsible for these fast connections between different parts of the brain and the brain and the body. And so when we do resistance training and we do the randomized controlled trials, you take older individuals, you have them do a resistance training program for a few months, you see improvements in the structure of the white matter and then improvements in sort of like overall cognitive function, but particularly things like executive function or rapid decision making. And that's because of the effects on white matter, we think. And actually, white matter changes. The changes in structure and function of white matter better predict cognitive decline and loss of cognitive function than some other things that we've tended to focus on more as a community, like amyloid protein in the brain, white matter changes seem to precede that and actually predict some of those cognitive changes better. So that's where resistance training becomes really important. And then sort of the final piece is this coordinative movement. So it's, you know, there are now a huge number of studies where you take two different types of exercise that have the same physical intensity. Right. They raise the heart rate the same amount, for example, but those that then have a complex movement component on top seem to have an additional benefit for the brain. So it's like comparing dancing to cycling, or, you know, they've done table tennis and badminton compared to cycling, and they've done running around an obstacle course compared to just running around a track.
- [114:22]
Dr. Rangan Chatterjee
And presumably the table tennis, the badminton, the dancing, these are these complex tasks where, as well as fitness, you're doing other things as well. So more complex stimuli to the brain.
- [114:37]
Dr. Tommy Wood
Exactly, yeah. So all activity is great for the brain. Right. But there seems to be an even greater benefit. And you can measure this in terms of cognitive function. You can measure this in terms of. Sometimes they've Looked, looked at brain scans, like changes on a brain scan that if you have a complex movement component on top of the physical component, there's additional benefits for the brain. So yeah, we're talking dancing, martial arts, ball sports, racket sports, any kind of team sport. And what all these things involve is learning complex motor skills, movement skills, but also often there's a social component. There's also a requirement to respond to the environment, respond to other people, react to the ball being hit at you, and strategize quickly and in real time. Right. So if you're playing tennis, I'm a terrible tennis player. So like not me playing tennis, but a good person playing tennis. Right. You're trying to not only respond to the ball being hit at you and moving your own way around the court, but you're trying to manipulate the positioning of your opponent so that you can hit the ball past them. Right. And you're doing this at high speed and so you're challenging multiple senses. And so it's these kinds of complex movements that seem to have an outsized benefit for the brain. So again, I've, you know, across the things I mentioned, there could be 12, 20 different things that you could do that challenge the brain in the same way. So like pick one that you enjoy. And if we were thinking about really high impact or activities that maybe hit all the different nodes of the 3S model, you might think of something like dancing or paddle or pickleball. In the US There's a social component, there's a complex movement. So you're getting physical activity, you're getting cognitive stimulus, you're going to sleep better afterwards, all of those things you're doing at the same time. So when people do inevitably ask me like, well, what's the one thing I should do? These kinds of activities are the one thing that I would. If you're gonna pick one thing, pick a new sport that requires you to use to learn a complex skill and do it in a social setting. You've hit all those things, everything in one.
- [116:54]
Dr. Rangan Chatterjee
God, I love that. So many thoughts came up for me. First thing is to reinforce this message that the brain can adapt to any age.
- [117:00]
Dr. Tommy Wood
Yeah.
- [117:02]
Dr. Rangan Chatterjee
Last summer, my son broke his wrist at the end of the summer holidays and had to wear a cast. And one of the things we like to do, particularly in the summer, we had this outdoor table tennis table and we basically decided with a bit of cajoling from me, that we were going to play left handed table tennis while his cast was healing. I'm a kidding. You like we started off the first time as, oh, man, this is. You know, we're decent players with our right hands.
- [117:32]
Dr. Tommy Wood
Yeah.
- [117:33]
Dr. Rangan Chatterjee
And it was a bit tricky with the left hand. Literally, within about two days, we're having good rallies. And after about 10 days, he was going and playing table 10 at school, and he was beating other people who were playing with their right hands. But he's a decent player. But I just thought, wow. And I think that speaks to this broader point, doesn't it, about how quickly our brain can adapt and respond. And I've also read some stuff that perhaps learning it with it with the weaker hand then improves your ability with the stronger hand because different regions of the brain are connected. So that was one thing I thought about. The second thing I thought about was in relation to this. I know we've not spoken today about headroom and cognitive reserve. I know we've spoken about that before. And obviously you write a lot about it in the new book. I thought about Novak Djokovic.
- [118:25]
Dr. Tommy Wood
Oh, yeah.
- [118:26]
Dr. Rangan Chatterjee
Okay. So he's still getting to Grand Slam finals. I think he's 38. He's in phenomenal shape. Arguably the greatest tennis player of all time. I'm wondering if, as a thought experiment, if he was to retire, let's say, at the age of 40. So for many, many years, he's been learning these skills. Right. So. And also he's. He pays attention to detail. Like, he. He leaves no stone unturned in his desire to get better. Whether that's eye training, you know, juggling before he might go out onto the core. You know, mindsets, nutrition, movement, recovery, all these things that you probably see when you. Formula One drivers. Right. So let's say at 40, he just stopped. Hypothetical scenario. So he's had all this incredible stimulus, supply and support for the first 40 years of his life. So he probably has a huge amount of cognitive reserve and headroom. If the day after he retired, he. I'm almost certain he wouldn't do this, but let's say the day after he retired. I use the word retire. Cause this is kind of what happens to people at 65. Right. He stopped doing anything. So he just sat at home in his nice house watching box sets on Netflix. They're not even called box sets anymore. Are they streaming? He was streaming series on Netflix. Is it fair to say that because he's worked that capacity for so much, it will take him longer to have a decline in function that is noticeable compared to someone who has not stimulated their brain as much, or do we not know?
- [120:21]
Dr. Tommy Wood
Well, so there's two competing parts to this that make me say maybe and I'll explain them both. So because you've built so much additional capacity with all this training, do you then have a longer trajectory before you've lost so much function?
- [120:41]
Dr. Rangan Chatterjee
Yeah.
- [120:42]
Dr. Tommy Wood
Right. And the, there's probably again, there's probably two areas of this. One could be like tennis specific skills. Right. Even if he doesn't play for 10 years and like when he's 50, he's still gonna be a better tennis player than me. Right. Even if he's, although we're, we're roughly the same age, so maybe that's about comparison. He's gonna be a bit, you'd still be a better tennis player than like some 20 year old off the street. Yeah, but he, the, the, the amount of skill that he's lost will be massive. Like the relative loss of skill will be huge because he had so much previously. But if we're thinking about this more broadly in terms of like broader cognitive decline and dementia, then I'll briefly go back to the, the example of education, educational attainment. So when we look at, and so his primary education has come on the tennis court, right. If that's his primary mode of stimulus. And so when we look at cognitive trajectories over a lifetime, those who have high levels of educational attainment, they have a higher peak of cognitive function, happens slightly later, they have a lower risk of dementia and they tend to get dementia later because they've started at the same peak. And, but the, the early stimulus doesn't change the rate of decline. Right. So if you remove, if you remove that stimulus, right, you're still, you're still gonna, you're still gonna decline. Right. It doesn't, doesn't prevent that. There are some studies that suggest that those who have the highest levels of educational attainment or the highest job complexity lose function. Relative function like relative to where they were, they lose it faster after retirement because their body was so used to, to performing at a high level and having high levels of stimulus that they actually have a higher drop off rate. So one could say that Novak Djokovic's tennis related skills are going to drop off faster than most other people's because he had so much and he was so used to getting so much. So the relative drop off rate is going to be faster. And so there's a few different things that you have to balance there. One is, yes, you build overall capacity, but the system may adapt such that it requires greater ongoing stimulus in order to maintain that capacity. If that makes sense, because that's what you. You have more to lose because of what you've built. So you do have some buffer. But it doesn't mean that you can rest on your laurels because you built all this capacity. Right. That ongoing stimulus is required. And then where you end up in terms of that final trajectory, it's probably going to depend on the whole kind of network. So it's actually quite a complicated answer to your question because you're going to have all these competing things going on.
- [123:34]
Dr. Rangan Chatterjee
Yeah, it's interesting to think about that. No matter what your job is, no matter where you are, you got to keep using it. Right. Basically, like you said at the start, use it or lose it. Maybe overly simplistic, but people get that you have to keep giving your brain a reason to adapt. And, you know, as it happens, I think he speaks maybe seven or eight different languages. I think he's a very, very rounded and intelligent individual. So I suspect, I can't imagine he's going to retire and then do nothing. But it's an interesting thought experiment just came out to those three types of exercise. I just want to, as you said, the practical take home is move. Right. And as you said, I think you said dementia risk goes down up to about 8 to 12,000 sets. Doesn't mean you can't do more than that. But you may not get the benefits in the same way.
- [124:26]
Dr. Tommy Wood
Or you just. You don't see additional benefits.
- [124:28]
Dr. Rangan Chatterjee
You don't see additional benefits.
- [124:29]
Dr. Tommy Wood
Yeah, yeah.
- [124:31]
Dr. Rangan Chatterjee
When it comes to lactate, and I think you spoke about in the context of high intensity movement, lactate has particular benefits for the brain. That doesn't mean that people shouldn't do low intensity training, because it's, you know, keeping your lactate low for an hour and a half walk also has benefits for mitochondria and, you know, your ability to burn fat and your metabolic health. Right. So, you know, how do you see that? I want to make sure that everyone listening understands that when it comes to brain health, how do they interpret those three buckets that you spoke about and introduce it into their lives?
- [125:08]
Dr. Tommy Wood
Yeah. So if I'm honest, I feel like people in the health sphere, podcasting sphere, spend way too much time talking about exercise strategies that are only relevant to elite athletes and people who spend all their time exercising. If you can only exercise in a formal way two or three times a week, which is the case for most people, then getting in a little bit of structured resistance training and maybe the occasional sprint session, that's where I would Focus. The rest of the time I'd just be like during the day, how much can I just move around as much as possible, like break up periods of sitting, take the stairs, walk for 20 or 30 minutes a day. I have in the book I have this movement funnel that I think people should work through. And the first level is snack which basically is just breakup periods of being sedentary during the day, however you do it, stand up, walk around, take the stairs, anything. Then the next level is propel, which is basically just do some low level movement or whatever you can. And so it can be cycling, it can be rowing, it can be walking, it could be propelling a wheelchair. Right, anything like that. Low level activity, that's what most of us should spend most of our time doing. But just because it's part of our day. Then on top of that I would layer in some, some kind of structured higher intensity stuff. So maybe it's right, you go for a walk and then you make it brisker and then towards the end maybe you just like sprint for a little bit or something. You sort of like layer on little bits of intensity because we know that that has additional benefit it. And then once or twice a week I'd go and lift, do some kind of resistance training. Um, and that's, that's what we think the like the minimum effective dose to build strength, muscle mass and then also improve brain health. At least, you know, once a week probably we have very basic six or eight exercises that cover the whole body. Three sets of eight to 12 reps. Like the, the basics, like maybe, maybe the best is twice a week if you can. But then in reality if you're going to try and tick multiple boxes in just like a normal person's schedule, I would make some of my aerobic type exercise something that's more coordinative. Right. So like rather than going for a jog, go and play football, go and play table tennis, go to a dance class. Right. So you're getting that aerobic training but you're also getting additional benefit and all the other things that we've talked about.
- [127:38]
Dr. Rangan Chatterjee
That's it super helpful. And that's one of the things, Tommy, I also, I've always liked about your approach. It's very, very pragmatic and practical. It's really trying to look at the big picture and see where most people are at and acknowledging that we have this healthcare crisis and actually if we make it too difficult and if people feel it's too difficult in the context of their everyday life, they're not gonna do anything. It's gonna be paralyzing. Right. And, yeah, I think sometimes. I think sometimes what happens is that researchers talk about optimal or what they've seen in the lab, which is great, and I love reading about all that stuff, but it also needs that conversion to the man or woman on the street who's just trying to get a little bit healthier. Right. Tommy, I could talk to you for hours. And there's just. Of course, because you've written such a thorough book, we've barely scratched the surface of what's in it. I want to reiterate, I think it's one of the best health books I've read. It's so good. I love the title. I love the subtitle. The Stimulating Minds Future. Proof your brain from dementia and stay sharp at any age. On a personal level, how has it been for you doing all these interviews about your book? You're traveling a lot. You're doing a lot of podcasts. That takes its toll.
- [129:02]
Dr. Tommy Wood
Yeah, it's. Well, maybe before I get to that part, I just wanted to say that this book exists because of you, and I wanted to say thank you for that. So. For two main reasons. The first being that you were the first person that I think I really spoke to about wanting to write a book. Several years ago, we talked about this, and I had various ideas, and those ideas have shifted over time, but you were the first person to kind of encourage me to do that, and I really appreciated that. And then one of the previous episodes that we did, I think it was the second time I was on the podcast. There was somebody. She used to work at Ebry, which is a Penguin imprint. She's called Anya Hayes. She now works for Hay House. But she sent me an email and was like, I listened to your episode with Rongan. I think you should write a book. And that was the first time that I actually took it seriously and started to work on a proposal and all the kind of stuff that kind of brought us to here today. So, like, thank you. Like, this exists largely because of you, and I wanted to, like, really Well,
- [130:13]
Dr. Rangan Chatterjee
I really appreciate it, and it's my absolute pleasure. And I say no credit for how great the book is, but thank you.
- [130:21]
Dr. Tommy Wood
So, yeah, then writing the book, I loved it. It's hard. It's a very different type of writing from how I normally write, which is very academic and dry and all that kind of stuff. So it took me a while to kind of find that voice, but it's still reading research, thinking about ideas, how to Bring them together, how to make them practical, which was really important to me. I loved it. But the hard part is then you have to go out and you have to tell people about it. And you obviously have done a lot more of this than I have, but, yeah, in general, I quite like being at home. I like working with the people that I have in my lab. I like spending time with my wife and my dogs. And it is also an incredible experience to come out, like, come and visit you and talk about these things and do some of the shows that I've done, be on podcasts that I've listened to for more than a decade is an incredible experience. But you're right, there's jet lag, travel, stress, not being able to do the things that you normally do to kind of look after your health. It's definitely been a bit of a roller coaster and whirlwind, and I'm incredibly grateful for all of it. But you're right, there's only so much of this that one person can do because it takes a lot of effort.
- [131:38]
Dr. Rangan Chatterjee
And if we look at that. I just had a thought there. If we look at that through your 3S model, which we can apply on a daily basis, a weekly basis, but I guess you could also apply it across a period of months. Right. So we could say, let's forget about the writing of the book just for a moment. Let's say all this travel and being asked questions about, you know, it's such a thorough book. People could ask you something from anywhere. And you've got to answer questions and have something to say. Right. You're getting a lot of stimulation. I know you. So you'll be, to the best of your ability, trying to make sure that supply is good. So you'll try and eat.
- [132:18]
Dr. Tommy Wood
Well.
- [132:19]
Dr. Rangan Chatterjee
We haven't spoken about blood flow restriction today, but we're gonna do that next time for sure. Right. So you'll be doing things about exercise and making sure that there's enough flow to the brain. But I guess when I think about support and how you can rest and sleep and integrate all of this into your brain and your life, I guess the thing that comes to me is once this is done or this initial batch, have you planned in a period of prolonged support so you can adapt, rest, sleep, get all the benefits? You know what I mean?
- [132:55]
Dr. Tommy Wood
Yeah, absolutely. And that is definitely in the plan. My wife and I, we've sort of sat down and there's been a big burden on her to, like, there's more that she has to do when I'm not at home. Right. So it's been a burden on both of us and then figure out, like, when's this hopefully going to wind down? What are we going to do to kind of take some time to ourselves and spend time together? So, like, that's a big part of it. But I think that your point is really, really important because all of these things integrate over incredibly long time periods. Right. We have decades over which, that we can influence our health, you know, both good and bad. But what it means is that you don't need to worry about it on as much on like a day to day basis. Yeah. If you, if you can then use it to say, oh, yeah, today I'm going to do a little bit of this, I'm going to do a little bit of this. That's great. But I certainly go into this knowing, hey, do you know what, there's going to be a few months where I'm not going to move as much as I would otherwise and I'm not going to sleep as well as I would otherwise. But actually, because I spend so much time creating that foundation and I know I'll go back to it, I know I'll be just fine. And I think that that's something we can give ourselves a little bit of grace on that as well, because it's not always going to be perfect. We're not going to be able to do everything and know that these things integrate over long periods of time.
- [134:18]
Dr. Rangan Chatterjee
For that person who has listened to us, Tommy, and is really, really scared that they're going to get dementia because a lot of people in their family have had it, and let's assume they don't have one of these predeterministic genes. Okay, what are your final words for that individual?
- [134:38]
Dr. Tommy Wood
I want them to know that
- [134:42]
Dr. Rangan Chatterjee
we
- [134:42]
Dr. Tommy Wood
each have huge power over our long term risk of dementia and our cognitive trajectory. And regardless of where a family history may come from, and sometimes it's genetic, it could be related to APOE genotype, which is a common risk factor for dementia. It could be related to. There's a whole host of genes that come together, thousands of genes. You get risk increases and decreases related to that. A lot of family history of dementia and risk comes from shared environments and shared behaviors. Across all of those, you can dramatically decrease your risk by starting to engage in some of the things that we've talked about today. And I think the two things, or maybe three things that I would want to say is one, know that this is possible. Right. Know that you have massive capacity to change cognitive function, that decline is not inevitable. Then know that just starting with very simple things can have a big impact for the reasons that we talked about. And know that even if you have some previous risk, you can mitigate the majority of that risk, regardless of where that risk comes from, by engaging in those behaviors. And maybe that's one way that you might look at it. So if you have a family member who had dementia, My grandfather died of dementia. I know that so far, knock on wood, I've avoided his major risk factor. He was an alcoholic, right? So the, if you think about, you know, my mother, my grandparent sibling had cognitive decline, dementia, what were the things that they did or didn't do that maybe map onto some of the stuff we've talked about today. Maybe that's the place to start, right? Because those shared risk factors are a lot of things that sort of come across in families. And then know that by changing that, by starting to move that needle. And it's just, you know, I say in the book, everything counts, right? Each little bit that you can do to work on that will have an impact. Know that you have control over that and focus on the things that you have the ability and resources and time to focus on. Because anywhere you start, right in the model, anywhere you start, the whole network starts to shift in your favor.
- [137:09]
Dr. Rangan Chatterjee
Tommy, I love it. It's a very hopeful message. It's a very empowering message. Guys. Get the book. It's really, really good. The stimulating mind. Tommy, thanks for coming back on the show and let's do another one very soon.
- [137:19]
Dr. Tommy Wood
Yeah, we'd love to. Thanks so much for having me. A blast as always.
- [137:27]
Dr. Rangan Chatterjee
Really hope you enjoyed that conversation. Do think about one thing that you can 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 Firebits, 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, you actively look forward to receiving. So 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 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 without 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.