Cognitive Decline Expert: The Disease That Starts in Your 30s but Kills You in Your 70s

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Save $80 with code space80 at Talkspace.com. We have this white powder in front of me. You've got to be small in your face. I do because I don't care who you are, you should definitely be having this. So let's talk about creatine. Phenomenal research shows you can creatine your way out of sleep deprivation. It can protect your brain against a concussion stroke from stress and there was a study done on Alzheimer's disease patients and they found that patients not only preserved their cognitive functions but they had more energy and they were able to exercise more. And I know this because I'm a clinician and over the last decade I've been surrounded by the greatest neurosurgeons in the world studying the brain. And so I'm here to tackle one disease and that is Alzheimer's because it generally starts in our 30s and 60 million people worldwide have Alzheimer's. 70% being women and I get angry and I get passionate because women have been lied to. They've been underrepresented. They downplay their symptoms or they're too scared to ask their doctor for advice and what people don't really know is that it is a preventable disease but it's like an end-stage cancer. Once you get the diagnosis there is no cure and the fact that so many people are at the mercy of a disease that is preventable is not okay with me and I don't think people understand these things like people don't really know that we're becoming more sedentary which is a disease. And there was a study that was done on this that showed that if you do 10 air squats every hour this can compensate for your sedentary lifestyle and then we have several lifestyle factors that can lower your risk of getting Alzheimer's disease. As well as showing you what five minutes a day can do for your brain performance just using a tennis ball and an eye patch. Guys I've got a favour to ask before this episode begins. 69% of you that listen to the show frequently haven't yet hit the follow button and that follow button is very smart because it means you won't miss the best episodes. The algorithm if you follow a show will deliver you the best episodes from that show very prominently in your feed. So when we have our best episodes on this show the most shared episodes the most rated episodes I would love you to know and the simple way for you to know that is to hit that follow button but also the fact that I think what 41% of you have chosen to follow this show that listen to it regularly is the reason why we've been able to improve everything. It's the simple easy free thing that you can do to help us make this show better. I would be hugely grateful if you could take a minute on the app you're listening to this on right now and hit that follow button. Thank you so so so much. Louisa what is it you do in simple times and I guess most importantly why is it that you do it and why now? Over the last decade I've been studying the brain. I'm both a clinician and an academic so I get to see the brain and I also get to research it and I'm really here to tackle one disease and that is Alzheimer's disease. Why is this so important now? Right now because 60 million people worldwide have Alzheimer's disease. That number is going to triple by the year 2050. 110 million women will have Alzheimer's disease by the year 2050. This is a disease that robs you of who you are, your complete identity. So we're going to get really into this straight away because I brought Henry with me. I'm bringing in that concy. Henry is a model brain that she's holding in her hands. This is around two pounds and if you actually feel it and you know if you actually feel a real human brain it feels like tofu but this is everything you are and the fact that so many people are at the mercy of a disease that is preventable is not okay with me. It doesn't sit well with me. We used to think that women were disproportionately affected by Alzheimer's disease because we lived longer because age played a role in it but we now have substantial evidence to show that it's not the fact that women live longer or people in general because dementia and Alzheimer's disease are not part of the natural brain aging process. For women and they differ from men and we can separate the sexes and talk about it. For women it is purely because being a woman is a risk factor for getting this disease. Now if we go through and we have a look at all of the people that currently have Alzheimer's disease 95% of them could have been prevented because this is not a disease of genetics it's a disease of lifestyle. 95% it could have been prevented. Correct. We're we're born with our with our genetic makeup meaning that for example if you have a genetic mutation on chromosome 4 you will get Huntington's disease there is nothing we can do about that that's how you were born but when it comes to Alzheimer's disease there's around 20 to 30 genes involved in the disease only around 3% of the disease cases right now were driven through those genetic mutations. The genetic mutations that you are born with you get them from mum and dad are presinole 1, presinole 2 and the amyloid precursor protein. So if you have a genetic mutation in one of these genes you will get some form of dementia. What is the age range where people will start to experience Alzheimer's? Let's just actually take a broad overview of what Alzheimer's disease is okay so you've probably heard of dementia. So dementia is the umbrella term so Alzheimer's disease is sits under the umbrella it's a form of dementia there's frontotemporal dementia which is what Bruce Willis has. There's dementia with Louis bodies there's Parkinson's dementia there's vascular dementia this disease dementia or Alzheimer's disease is a disease of midlife and so it generally starts in our 30s it starts in our 30s but the first symptoms show up in our late 60s 70s and beyond when you say starts yeah our brain fully develops at around 25 years old 25 to 30 and after that that's when we if we don't take care of our brain we start getting a decline in these functions. Now let's go back to the brain the brain is 87 billion neurons around 5 to 10,000 connections per neuron the my favorite area of the brain is a cerebellum and the pecans yourselves inside the cerebellum have upwards of 50,000 connections per cell so so tightly dense and there is so much happening it takes 20% of the total calories that you consume every day to power this thing and it's the most vascular rich organ in the entire body over time through things such as sleep deprivation poor diet lack of physical activity environmental toxins this slowly erodes at the functioning of the brain and over time this starts to compound because that's what biology is everything is compounding one night of sleep deprivation raises your risk of amyloid beta which is one of the hallmarks of Alzheimer's disease pathology by 4% that's just one night of sleep deprivation imagine a new mother or a shift worker or a physician in their residency getting countless nights of sleep deprivation day in and day out imagine all of that compounding and what happens well we end up with either neuronal loss which is like the complete atrophy of certain parts of the brain and that's what is mild cognitive impairment mild cognitive impairment is a pre-dimension state so what is this that I have here this photo um so you've got the sagittal view right now of the brain and we're looking at a healthy brain on here as you can see I'm going to show it up here on the left hand side you can see that the brain is thick we can see that the integrity of the gray matter which sits out here is thick it's volumous okay we can see that the ventricles are smaller we go over here and we see thinning of the cortex you can see these big spaces between the gyri these are thick because the gray matter has atrophied it's shrunk you can see that the space between the cortex itself and the skull there's a bigger space you can see these ventricles here these butterfly shaped ventricles this is thicker this is thinner we can see atrophy down here so essentially the brain is getting smaller and smaller at the age of 30 if I do everything right and we were to sort of plot this on a graph of where I land at 70 what is the variance of where I'll end up at 70 you know my brain is quite important to me and I do worry I think fuck it like I think I worry in part because I I sit and interview a lot of people at a lot of different ages and one thing you notice as an interviewer is some people at 60 have a razor sharp and some people at 60 are not as razor sharp yeah there are ability to articulate their words the memory recall their ability to understand stats and stories one of this and I sit here and go I wonder what the difference is yeah and that's actually beautiful because it brings up this important concept in neuroscience called cognitive reserve and that's your brain's ability to withhold capacity to overcome stresses okay so you've probably heard for example let's use the analogy of physical performance your VO2 max which is a measure of your peak respiratory fitness you know how well you can utilize oxygen when you are at a high intensity state how well does your body utilize oxygen the the fitter you are the more reserve you have to overcome stress stress such as an infection everyday stresses sleep deprivation surgery the more reserve you have in your band to overcome that the same is with your brain the more cognitive reserve that you have the more cognitive capacity that you have been training year on and year out will save you at 60 from harmful insults such as you can get a woman at the age of 18 with a head full of amyloid beta amyloid beta being the one of the hallmarks of Alzheimer's disease you can get somebody with a head full of amyloid which is like a plaque on the brain yeah it's a protein that's actually it's a it's a protein that lives inside the neuron itself and we can explain what that is which I will in a second but let me just tell you can have a head full of amyloid in this person and they have retained their cognitive functions then you can have somebody else with hardly any amyloid but they've lost their cognitive functions and this all comes down to cognitive reserve and cognitive reserve lives where in the head you've got around five to ten thousand connections person over time those connections fail now those connections are responsible for your thinking your processing speed every time you have a thought you building your connection the more connections that you have the more things that you see the more novelty that you give your brain the richer it gets the more stable it gets so the ends of these of the neurons we have dendrites and coming off the dendrites of these little trees imagine a branch that's the dendrite and all of the leaves that come offered all these little dendritic trees if you will and they connect to nearby cells ten ten thousand cells over time those are the connections that fall those are the connections that fail they fail because you don't utilize them so the way that one would build reserve at the age of 30 is to is by exercising we can build reserve in a number of different ways in fact there was a really wonderful study that just came out that I just wrote about and they found that those who preserved cognitive capacity at 75 years old were handwriting and reading so handwriting and reading preserves cognitive functions exercise is one of the most potent stimulus for brain health and Alzheimer's disease prevention and cognitive reserve the more you exercise the bigger your brain what about scrolling on social media does it improve my reserve if I'm watching videos it's in the opposite why would that be because I'm still learning stuff yeah when I'm on the internet because what you're doing then is you are relying on short dopamine hits every time you scroll you're sending signals to your brain that you're getting a dopamine hit and your brain gets used to it remember your brain is only there for two things survival and reproduction so every time that you stress your brain in the smallest amount of times you're giving it dopamine hits it doesn't allow us to do other things for a sustained period of time like focus read have a conversation so writing and reading are good for building up my neurological reserves yeah neurological reserves it doesn't compare to what exercise can do for the brain and it's so sad because around 80% of the US population don't exercise for at least 30 30 minutes a week which is actually quite scary the physical activity guidelines are 150 minutes to 300 minutes of moderate to rigorous physical activity per week what's the most compelling study you've ever encountered that proves the exercises central to Alzheimer's prevention and brain health when we look at all of the data we can see that the biggest amount of return on investment is from resistance training resistance training being strength training one of the most compelling studies was probably the the smart trial where they took a group of people with mild cognitive impairment and gave them two to three times per week of resistance training and they not only preserved their cognitive functions they enhanced their processing speed they enhanced their fluid intelligence and they had slowing of the gray matter the gray matter yeah so your brain consists of both gray and white matter so gray matter of the cell bodies it lives on the outer side out of portions of your brain and the white matter is deep within the brain and that's where all of our myelinated neurons live and over time we see that we can have little lesions in the white matter of the brain so a lot of the times people ask me Stephen I'm scared my mother had Alzheimer's disease I'm scared I'm going to get it and we were talking about genetics before and there's another genetic risk factor that we didn't talk about the APOE4 gene is one of the the strongest risk factors of getting Alzheimer's disease but it is not a foregone conclusion that you're going to get it so Chris Hemsworth was tested and he has two copies of this gene so you get two copies one from one from dad it's the APO lipoprotein e gene and it comes in three main variants so you've got APOE2 APOE3 and APOE4 so I'm a three three carrier I've been tested and that's the general population they're three three so it doesn't raise my risk of getting the disease but it also doesn't protect me if you've got a copy of the APOE2 gene it protects you against the disease but when you have a copy of the APOE4 gene it raises your risk by two to three times if you have two copies of the gene it raises your risk by ten times if you are a male he's the devastating thing if you are a female with one copy of the gene you are at doubled the risk than your male counterpart so one copy of the gene of APOE4 gene for a female raises your risk by about sixfold whereas two copies raises your risk by 15fold and how would one go and get checked you can get the APOE4 gene checked out with your doctor it's a simple blood test on this point of resistance training I've heard you talk about how the legs are so important having strong legs having strong legs is by far the most important tool in your toolbox for the prevention of Alzheimer's disease and this was made certain to me when I read a study done on identical twins exact same genetic profile and they tracked them and they did cognitive tests and MRIs and they tracked them over a 10 year period and what they found was that the twin who possessed the greatest strength and the most leg power had a bigger brain larger gray matter volume they preserved their cognitive functions they did better on different cognitive tests why is resistance training increasing the size of my brain resistance training does so much feel brain the first thing is we have to think about the journey that we're going on right so when you look at all of the studies I want to make it really clear all of the studies show that in order to produce the neural effects of resistance training you need to be lifting at around 80% of your one repetition max so 80% of one rms that's quite heavy there is so much controversy on social media right now should I lift heavy should I lift light and when it comes to hypertrophy alone so increase in muscles muscle mass muscle cell size you can get there men can get there women can get there by lifting light high reps or you can get there by lifting heavy and low reps it just depends on who you are and how much time you have but when it comes to the brain specifically you want to be lifting heavy for several reasons the first one is when we lift heavy when we literally when we contract our muscle like this we are releasing a whole set of chemicals they're called myocions and when they're released from the muscle they go up to the brain and they do beneficial things for our cognitive performance our cognition and they help with the growth and proliferation of new neurons in the hippocampus and it's the first thing to go during our sinus disease it actually shrinks this holds our memory this is where a lot of our memory consolidation and learning takes place which is why short term memories the first thing to go during this disease okay and as we get older and what we found is that you can grow new neurons in the hippocampus from structured exercise and consistent exercise the biggest growth is going to occur because of BDNF brain derived neurotropic factor so this is a growth factor for the brain and it gets released when we exercise it gets released abundantly when we are doing aerobic training when we're running when we're cycling for long distances but it also gets released when we do resistance training now he is the beautiful thing about it when we do resistance training and we're releasing all of these myocions these myocions are signaling molecules they work together so we've got one called irison okay and that's a messenger molecule so what it does is it actually helps BDNF express itself so when we release this myocaine it goes into the brain crosses the blood brain barrier and it tells BDNF to express itself so then BDNF goes in and it helps grow new neurons in the hippocampus but then we've got another myocaine let's just take aisle six interleukin six that comes from the interleukin family what is that sorry the interleukin family is a a class of pro-inflammatory cytokines so these get released when we are under stress or you've got an infection or a virus for example but when we exercise it depends on where the site is interleukin six instead of acting as a pro-inflammatory cytokine instead of creating inflammation it acts as an anti-inflammatory cytokine so it goes into the brain and it lowers inflammation in fact this is one of this was one of the first ever myocions to be studied and they showed that interleukin six is also responsible for the down regulation of tumor cell growth so exercise is a potent anti-cancer intervention as well by way of myocions how much exercise does one need to do to avoid the cancer related side effects but also the Alzheimer's problem well just 30 minutes a day of aerobic physical activity can down regulate 13 types of cancers and the most prominent ones being breast cancer colon cancer and prostate cancer so these three have been studied most and you get your anti-cancer effects from the myocaine release so quite specifically when we exercise we're getting a robust release of something called natural killer cells and when we get these natural killer cells into the plasma and into the blood stream they go into the tumor site and they do what they were born to do they kill so they go into the tumor site and they start to kill the tumor and this is where you get your anti-cancer effects of it but you can also get it from the anti-inflammatory effects of resistance training anti-inflammatory effects of aerobic training so these myocions are really powerful in fact pharmaceuticals are spending billions of dollars trying to replicate these myocions in a bottle and they can't do it I want both men and women lifting heavy because you've got areas in your brain right across here lives your motor cortex think of your brain as real estate there's real estate in your brain reserved for lifting heavy so every time you lift a heavy weight as opposed to a lightweight it takes more neural real estate to lift that heavy weight so the heavier you lift the greater the neural drive the greater the neural drive the better it is for your brain if you have to do just one exercise for the rest of your life to protect your brain and you can only pick one what would it be deadlift why if done correctly the deadlift can use almost every muscle in your body erect a spinae you've got the glutes you've got the quads you've even got serratus anterior you've got the you've got your calf muscles there is so much compounding in that one lift would probably be comparable to a barbell squat as well according to the World Health Organization we're getting increasingly more sedentary I am we're moving less and less in part because of technology but also there was this really interesting study done by the Cleveland Clinic where they talk about people who are active sedentary and this this felt a little bit personal if I'm honest it says a major finding in 2025 found a danger of being active sedentary which is people who exercise for like 30 to 60 minutes but sit for the remaining 10 hours a day if you sit for more than 10 hours a day your risk of cardiovascular disease increases even if you meet weekly exercise goals because prolonged sitting shuts down lipoprotein lipays and enzyme essential for burning fat and cleaning glucose from the blood that wasn't that's annoying to read because I feel like that's me yeah and being sedentary is a disease you can change the trajectory of your life by doing 10 air squats every hour on the hour and there was a study that was done on this that showed that if you do 10 air squats every hour this can compensate for your sedentary lifestyle because unfortunately this is the life we're living in we are becoming more sedentary in our day-to-day lives we're sitting more we're not going out as much there is younger kids on video games they're scrolling there's so much happening that is involving our sedentary lifestyle which is obviously like you said increasing our risk of type 2 diabetes cardiovascular disease etc yep you can do it like this there you go 10 of those if you do 10 of those you can outweigh the benefits of a 30 minute power walk every hour yeah for how many hours eight okay so I could set an alarm on my phone every hour just get up or every 45 minutes get up and do an air squat and this is primarily because if you heard that when you eat you get a massive spike of glucose and the best way to bring that glucose spike back down is by doing any form of exercise you can albeit go out and go for a fast run do an air squat bring that bring that glucose level back to baseline and do you think much about aerobic training as a preventative measure for Alzheimer's I love aerobic training women are facing a dilemma on social media because they're being given so much information there is this huge rapport of should I do zone to exercise or should I not do zone to exercise what is zone to exercise so we can think of physiology in zones zone one is what you and I are in right now right zone two is that next level up and that's generally when we're looking at exercising at around 60 percent of our maximum heart rate and it's where you can where you're jogging but you can have a conversation but where you're huffing and puffing when we're exercising we need to produce energy and that energy firstly starts in the mitochondria so we need all of our energy it gets created we create ATP and that's how we are able to perform the given task and soon as we get out of that zone and we go into zone three zone four and zone five we're producing energy outside of the mitochondria in the cytoplasm and when we're doing that in order to do that we're breaking down glucose so fast via a pathway called glycolysis the byproduct of that is lactate and then we produce lactate and that's actually a fuel source for the brain it's also a myokine right so that's when we're in zone three zone four zone five so a lot of women have been doing zone two they've been going to the gym they've been doing zone two and I'm trying to push women to get out of zone two for several reasons not because it's not good for you I think all forms of exercise are good for you the more you move they're better right but let's be really honest a lot of people in midlife are busy their time poor men actually get a greater return on investment by doing zone two women don't get the same return on investment from doing zone two so I'm trying to push women to first work on zone five zone three zone four zone five if they can just do zone five then do two to three sessions of resistance training a week and if you have time leftover that's right there I've just described around four hours of exercise if you have time leftover then you can work in zone two now zone two is great if you're going to go out and go for a long run you're doing many things you are secreting a lot of BD and F which we need it's a growth factor for the brain you're getting a massive amount of blood that's going into the brain which is great as well it's sustained blood delivers oxygen and nutrients to the brain you're doing a lot of things right but what you're not doing is having a complete effect on the chambers of your heart is it better for me to do five kilometers on a treadmill or outside I would say it's better for you for the brain to do a smaller amount of exercise and a higher threshold because I was I think I've read somewhere one time that running outside is better for the brain because it stimulates the brain well you're outside so you've got so many things around you imagine your brain I told you it's got prime real estate every part of the brain is responsible for a different function from what you see to what you hear you go outside and you can see so many things you've got forward emulation so that's going to help you with drive motivation dopamine but then you're also taking in the sounds the senses it down regulates inflammation so you get so many other things from doing that yes but five kilometers outside compared to 20 minutes of high aerobic physical activity what is better for the brain I would say that the zone five is better for the brain the zone five training does a lot for the chambers of your heart as well now I'm gonna grab this we've got a little model here and we can see that we have a left chamber we have a right chamber we have actually four chambers of the heart but we have something in the heart called a ventricle we've got a left ventricle and we've got a right ventricle now the left ventricle delivers oxygenated blood to the entire body it's really interesting because the chamber of the left ventricle is like a is like a muscle right it's responsible for pumping blood to your entire body it first gives blood to the brain which means it's the most important part of your body after it's done giving blood to the brain it goes through to the rest of the body as we get older we get stiffening of these arteries okay stiffening of all of the arteries in the heart and we get we get something called left ventricular hypertrophy so that's when the ventricle the left ventricle it starts to get thicker and when it gets thicker that means that we can't it's not as strong it can't pump a lot of blood as much as it could when it was younger to the rest of the body Ben Levine Dr. Ben Levine he's a sports cardiologist and he did this landmark study which changed how I thought about zone 5 training he took a group of sedentary males average age I think it was around 47 to 55 so around 50 years old and he scanned their hearts he did you know he looked he did echocardiograms he took photos of the heart he did everything good to see when they were first on the protocol what does their heart look like he then subjected them to around four hours of exercise per week and that was stratified against he did one resistance training session away one was high intensity physical activity at around 90% of the maximum heart rate the VO2 max heart rate and then in between he did some long sessions as well right but it was all moderate to rigorous exercise and that was done over two years at the end of those two years what he found was that he remodeled the heart by 20 years so he reversed the age-related effects and defects of the heart by 20 years essentially turning the 50 year old hearts into 30 year old hearts just from physical activity alone 4 hours a week for two years 4 hours a week for two years and what kind of exercise was it so he got them to do like let's say for example one of the one of the protocols was exercising at 90% of your maximum heart rate so when we do this we're generally looking at increasing our VO2 max so you've probably heard that VO2 max along with strength but VO2 max is the strongest predictor of all cause mortality right so if you want to improve your VO2 max and if you want to get the heart related changes that he did what you want to do is you want to do 20 minutes of VO2 max per week just to keep your VO2 max because it does decline you're on and you're out starting at the age of around 35 we start to see a declining VO2 max so if we want to work on our VO2 max we want to be doing a what we call the Norwegian 4x4 it's the gold standard of increasing your VO2 max so you want to get your heart rate elevated to 90 to 95% for four minutes on four minutes off repeat four times so how do I do this well I actually do this twice a week because the more you do the better I do this on a stepper I do this at the gym and I put my stepper onto I think I'm at like a level 14 and I'm working my way up and I'm staying on there for four minutes and then I'm having a complete stop and a complete rest for four minutes and I'm repeating that four times so what I'm doing in that moment I'm not just getting a massive shunting of blood to the brain okay which is good I'm not just getting a massive release of myocytes at exocytes to the brain I'm also remodeling the heart I'm down regulating tumour cell growth I'm improving my cognitive performance I'm doing so much more than just exercising alone so that's once once a week in Levine study that reversed these guys hearts by 20 years yeah that you do that once a week you only have to do that once a week but he also did um he did around 70% of maximum heart rate for around two hours a week and he also threw in one resistance training session so consistency is key I'm just looking at some of the findings of that study and one of the surprising things is it showed that there is a biological exploration date per se for the reversal of the heart yeah and then the heart retains its plasticity the ability to remodel itself until the age of 65 if this intervention had started after the age of 65 the heart was too stiff to be physically remodeled to get that 20 year reversal yeah you have to start in late middle age exactly so midlife is the window of opportunity for brain health and for longevity I didn't realize you could sort of remodel the heart yourself that's interesting yeah you can remodel the heart and the heart is amazing okay because what you see with the aorta right so the aorta goes up and we've got we've got to we've got the main blood supply for the brain exists in the vertebral arteries okay so there's branching off of the aorta comes from the heart vertebral arteries which supply the posterior part of the brain and the cerebellum with blood and then you've got the corroded arteries so one on each side branching off the aorta which supply the frontal and middle part of your brain with blood the brain is the most vascular which organ in the entire body in times of stress such as hypertension okay that is elevated blood pressure we see that we can actually kill off the tiniest parts of the blood vessels which are called the capillaries you can see the capillaries up here they supply even the blood brain barrier so they supply mainly the outer cortex of the brain with blood when we have elevated blood pressure we are starting to kill off those tiny little capillaries of the brain those capillaries are feeding different neurons in the brain and also feeding the blood brain barrier so when we get breaking off of these we lose the blood supply we lose the oxygenation we get a breakdown of the blood brain barrier itself which is scary and we see that in patients who have got mild cognitive impairment you can call it you've heard of leaky gut we can call it leaky brain if you have a leaky brain what happens eventually is so your blood brain barrier sits like this okay and there are cells and we call them parasites for example and they're bound together by tight junctions that's what the blood brain barrier is it's like a you think of the blood brain barrier as the bouncer of a nightclub they are all standing there like this responsible for who can come in and who can't and they don't allow some molecules to get in but over time when this starts to degrade and become leaky they start to spread apart and when they do you can have the passive diffusion of all these molecules coming in and that's really bad for your brain so we want to maintain the integrity of the blood brain barrier by maintaining the capillary health we don't want the capillaries to die they're one cell thick any type of damage can damage them and kill them hypertension there was a really great study it was core it was actually the sprint child and it was it's now the gold standard for the recommendation of 120 over 80 so when you have your blood pressure taken we get the systolic over diastolic and you've probably I don't know if you take your blood pressure but doing your blood pressure every day is a really great inexpensive and effective tool for maintaining good brain health so you measure your blood pressure and if you are high intensive this is anywhere over 135 okay systolic over 135 that's when things start to break down that's when we start to get the breakdown of those small one cell thick capillaries so in this trial in the sprint trial what they found was that when they aggressively manage these patients and they bring their blood pressure down they did it pharmacologically through something called an ACE inhibitor it's a medication to drive down blood pressure when they bring it down pharmacologically these patients preserved their brain gray matter and their cognitive functions so we now have a gold standard and this is what I would recommend anybody on amazon it costs about 25 dollars for a blood an automatic blood pressure monitor do it every single morning and watch your blood pressure and then if it's high what would I do about it well outside of pharmacology if we don't want to take a medication we want to get stronger and we want to do this via exercise stress is one of the biggest things driving high blood pressure manage stress manage cortisol manage chronic inflammation by a way of exercise sleep all of the things that mother nature gave us I was just looking at the the study that reversed the heart by 20 years and trying to figure out what exercises they did and as you said the first one was a high intensity workout the four by four then they did a long aerobic exercise again this is all once a week so 60 minutes once a week doing a longer exercise like it could be hiking or tennis recycling a moderate intensity workout 30 minutes where they did the talk test you should be able to break a sweat but still be able to speak so that was once a week and then lastly strength training once a week so it's really a variety of exercises that caused such a profound impact on the heart and I think cardiovascular diseases are the single biggest killer yeah cardiovascular disease dementia is the number one killer of women in the UK the number one really it's the number one cause of death in Australia for both men and women how does it kill you because we all think about memory loss and stuff like that yeah and so this is the actual devastating part we don't die of Alzheimer's disease specifically over time what happens is in these patients you have to remember Alzheimer's disease is like end-stage cancer once you get the diagnosis there is no cure there is no going back there is no reversal you have the disease and that's the scariest part mild cognitive impairment you can slow the progression of that like I said to you it goes for 20 years mild cognitive impairment you can slow the progression of mild cognitive impairment but as soon as you get diagnosed on that awful day that your mother or your friend gets diagnosed with Alzheimer's disease it's a sad day and what ends up happening with these patients is you can die of asphyxiation you can die of you your brain loses the signal to swallow it loses the signal to maybe you fall because you've lost balance it's really it's a really scary moment but it's not like you die of Alzheimer's disease specifically if you were diagnosed with Alzheimer's disease it's an interesting reaction because I would have no hope I think a better question is you'd have no hope if I was diagnosed with Alzheimer's disease there is nothing I could do how would that change your life and the decisions you make or would it at all I would aggressively aggressively exercise I would monitor my diet I would aggressively monitor my diet and I would potentially have a ketogenic diet because what we've found is that during this metabolic crisis that happens in your brain okay where you lose the ability to use glucose as your primary fuel source so the brain doesn't know how to use glucose as a primary fuel source so it's under attack during Alzheimer's during Alzheimer's but also during this window in for women as well in the perimenopause state so the brain so when it's under attack and it can't utilize glucose effectively and it doesn't have any energy it starts to think about survival it starts to think what can I do I'm under attack so it starts to break down the myelin sheath and in that moment it's actually the astrocytes they're the supporters of the brain so of the brain so so they start to think okay let's break down the myelin sheath from that the astrocytes produce ketone bodies and then the ketone bodies get shuttled into the brain and that's how we use energy in the brain so in that state of metabolic crisis I would make sure that I am having a ketone rich diet or I may be getting our exogenous ketones I would aggressively exercise I would aggressively manage my my lipids I'd have a high intake of omega-3 fatty acids and I would preserve if I could any form of cognitive function by way of talking to people by going outside socializing having hard conversations if I was intact and I could do so I would throw tennis balls to the wall so on that point of the ketogenic diet the reason is because ketones are an alternative fuel source to glucose and the brain likes ketones the brain loves ketones and actually utilizes them more effectively than glucose but glucose is the primary fuel source for the brain and here's what's really interesting and devastating if you will for females during the onset of perimenopause right when we see a decline in estrogen right we see a decline in estrogen what happens is a 30% reduction in brain glucose metabolism so when these receptors start to die because we don't have we don't have a lot of estrogen circulating in the bloodstream anymore what happens well we can't utilize glucose as effectively so during that state that's when we start to get the breakdown of the myelin sheath to use that as as ketone bodies as an alternative brain fuel source so do you think women going through menopause should be considering a ketogenic diet yes I do think that I think that women who are going through perimenopause and who are at the mercy of this brain energetic crisis should be adopting if they can a ketogenic diet is one of the best diets for the brain I didn't really understand this idea that during menopause there was a glucose deficiency or metabolism problem in the 30% reduction in brain glucose metabolism is this why women report having brain fog and all these kinds of things yeah absolutely because when the brain can't utilize it's fuel source effectively what happens well metabolites start to shift we don't sleep probably around 60 to 65% of women in menopause report having a hot flash or night sweats it wakes them up at night that's also causing cognitive decline and brain fog so I mean this graph's pretty shocking can you explain what it shows oh this is showing the estrogen levels at birth going through all of the life cycles that a woman will go through puberty perimenopause and then eventually menopause there is one thing that is certain after age I mentioned earlier being a woman is the next strongest risk factor for getting this disease for getting Alzheimer's and that largely lies in our in our menopausal shift that occurs the downsizing of estrogen however we do have forms of estrogen that we can supplement with so I just need to keep the estrogen up because then the brain health is going to be up and normal this is where the controversy lies yes and no so I want everyone to understand I am seeing right now so my entire doctoral thesis is focused on women and Alzheimer's disease and I'm Switzerland right now when it comes to hormone replacement therapy that is replacing your hormones your Switzerland I'm Switzerland meaning that there is no evidence to suggest right now we don't have large scale randomized control trials to show that hormone replacement therapy prevents dementia so what I will tell you is this it is a signal it is a supporter it will help you do the things that can lower your risk of dementia we've seen multiple times that having hormone replacement therapy can reduce your risk of getting Alzheimer's disease by up to 30% we know that but it's not because estrogen alone is minimizing your risk it's because when you have estrogen it helps get rid of the hot flashes it helps with the night sweats because during menopause when we actually have a dysregulation of the of estrogen in our brain what happens in the hypothalamus which is an area in the brain that controls our temperature regulation when we lose the ability to monitor our temperature for a woman what will happen is when she feels the slightest bit hot her temperature you know is rising a little bit the hypothalamus doesn't know what to do so it signals I'm super hot so it'll raise your temperature right up and that's a hot flash and then it'll be right down and as a result this is keeping women up at night and we know that sleep deprivation is a risk factor for Alzheimer's disease of course it is compounding sleep deprivation will accumulate amyloid beater in your brain so if we can replace if we can use hormone replacement therapy as a signal and as a support to help us sleep at night then that's a good thing another thing estrogen is anabolic to muscle what does that mean it means that it helps with muscle protein synthesis so it helps me make muscle yeah we've got estrogen receptors on our bone we've got estrogen receptors on our muscle so if estrogen is anabolic to muscle if estrogen helps with muscle protein synthesis if estrogen helps with bone mineral density then replacing estrogen during that menopause state is going to help us with all of the risk factors of Alzheimer's disease so when does estrogen I mean really in this image drops off a cliff yeah and it varies so it tends to generally happen at around 45 years old as an average and that that perimenopause stage lasts around 10 years but it starts going down on this graph about 30 it starts to go down and everyone's different okay you can have a woman in her late 30s going to perimenopause or the general age is around 42 to 45 most OBGYNs that I've spoken to say that you need to start checking in with your doctor at around 40 years old to check for this so do you think thinking about my fiance now do you think that someone like her should go on hormone replacement therapy at like 40 well so that's the that's the big question that's the elephant in the room should you go on hormone replacement therapy or should you not and that's definitely a conversation between you and your physician however we've got large scale studies right now to show that we don't have to be afraid of hormone replacement therapy and without going too deep into the weeds there was a massive study that was done the women's health initiative that scared women out of taking hormone replacement therapy in fear of getting breast cancer correct we went from having 40% of women on hormone replacement therapy to just 4% of women on hormone replacement therapy we know that even at the onset of menopause a woman's risk of having a heart related event triples a woman's risk of getting Alzheimer's disease increases so there is something to pause it here about the benefits of hormone replacement therapy that we still haven't yet studied will you do hormone replacement therapy I definitely will and look so this is really interesting so this was given to me by a friend and this is the this is the capsule so this is estradiol and progesterone okay so progesterone is that one that's going to help you sleep at night this one here is vaginal estrogen so this is a claim that actually gets you know depending on how it is it can get inserted and the vaginal estrogen apparently if you put it on your face it's probably the best form of skincare that you could ever have yeah we have estrogen receptors all over our tissues including our skin these are estradiol inserts so that's not the cream itself but if you get vaginal estrogen in the form of a cream you can put it on your face and it can help with skin elasticity collagen dermal thickness this is why I'm actually most excited about it so I mean is this are these the only ways that one can do hormone replacement? no there's also a patch and that's what most women are opting in for the trans dermal patch when the time comes I will probably do the the patch why because it's the the easiest that's the one that I've researched the most I'm not afraid of hormone replacement therapy in the slightest we do have to you know everyone has to check with their doctor but I definitely think that this is going to be one thing that is going to help with the Alzheimer's disease crisis that is occurring go ahead I mentioned earlier plaques right so a lot of people ask well what distinguishes Alzheimer's disease from the rest of the dementias and it comes down to two proteins amyloid beta and tau protein and here's where it gets really interesting and actually dates back to 1901 the first ever Alzheimer's disease patient Augusta DT she was 52 years old and she went to the hospital her and her husband went complaining of difficulties of word finding word fluency and she couldn't remember where she put her keys and her husband said she is delirious and Augusta told the doctor onboard he was a psychiatrist his name was aloeas Alzheimer she said to him and I quote I don't know who I am anymore as I mentioned this disease robs you of who you are in 1906 it oh six Augusta DT died and that was the first ever patient to be recorded of having Alzheimer's disease and so post-mortem they cut her brain open and they found that she had these plaques in her brain and they didn't really know they didn't really understand what it was but that was the first ever induction of this disease in society and ever since then ever since then we are still trying to tackle this disease in the 2000s we had this notion that Alzheimer's disease was the amyloid cascade hypothesis meaning that great at Alzheimer's disease means when you get a head full of amyloid this toxic protein that builds up so we were demonizing this protein we were demonizing this peptide protein that builds up in the head and so then came the medications okay in the form of IV drugs so you go to the hospital you get an IV in the promise that it will clear out amyloid great we've got a cure but what they found was that when they were taking out the amyloid in these brains they were taking with them brain tissue and causing micro hemorrhages and in some patients it was resulting in death so we now know that the problem here isn't amyloid in fact amyloid is a antimicrobial peptide so amyloid is actually a good thing amyloid beta is a good thing because it protects the brain cells now here's what happens we have this beautiful process during sleep that occurs when we get into deep sleep we activate the glimphatic system okay so the glimphatic system comes from the word glials glial cells we have glial cells in the brain they sit outside of the neurons and this is what is responsible for immunity there are chief immune response cell during deep sleep they shrink and when they shrink all of this amyloid beta that's floating around in the cerebral spinal fluid gets washed out so it's like a washing machine that occurs in your brain right but what tends to happen in Alzheimer's patients is they don't get a chance to wash out the amyloid what happens in perimenopause and menopause due to the hot flashes you don't get to get into deep sleep because you're having a fragment and sleep because you're waking up due to hot flashes and night sweats so that is what's do that is what's causing the buildup of amyloid now stick with me we've got another protein that is a hallmark of Alzheimer's disease it's tal protein and tal lives in the axon of the cell the one that I said is covered in the myelin sheath and what happens under times of stress what happens is this tal protein phosphorylates so it breaks off and basically tal protein stabilizes the microtubules okay imagine these railroad tracks in the axon okay just going up and down the axon the axon's in the in the cell or in the brain so the the the brain cell itself the neuron is the neuron cell body and the axon is like the trunk of the tree okay right yep so holding up the tree are microtubules and those microtubules are bound by tal proteins that the tal proteins keep the microtubules intact so the trunk of the tree is stabilized and it sits there why does it need to be stabilized because that's how speed of thought travels information processing speed travels up there when the tal protein phosphorylates it starts to form tangles they're called neurofibulary tangles so that happens in the axon and when all these tangles clump together we get the collapse of this axon the collapse of these microtubules so we're not just having a cascade of environmental disaster inside the cerebral spinal fluid of the brain and inside the brain outside the cells we've also got this cascade happening inside the cell body itself so the brain is under attack inside the cell and outside the cell why why exactly why why does this happen because of how we treat our brains because of how we treat our brains yes the reason why your brain is hyper phosphorylated and the reason why these tal proteins are hyper phosphorylated is because of many things one is we have seen time and time again that we have estrogen receptors that are on in the brain so themselves in the axon so when we don't have adequate estrogen estrogen actually is so smart what it is doing it's blocking an enzyme that is responsible for phosphorylating the Tao so if we don't have the estrogen there then the Tao the enzyme is there to phosphorylate the Tao and break it down and cause these neurofibulary tangles but let's just say you're a man and you don't have you don't need the testosterone you don't need the estrogen there although testosterone is neuroprotective testosterone actually aromatisers into estrogen which is why you actually have an extra added protection in your life what else causes this well stress so sleep is I think by far the most underrated Alzheimer's disease prevention tool that we have is underrated because we have been doing it all our lives and we think that we can just go to sleep and the magic happens but I think now in 2026 we actually need to train for sleep so during deep sleep we activate the lymphatic system and sadly a large proportion of us are getting into deep sleep so sleep is one of the reasons how do you sleep yeah I sleep I make sure I sleep seven and a half hours a night this message is brought to you by apple card it's a great time to apply for apple card you'll love earning unlimited daily cash back on every purchase that includes 3% daily cash when you buy the latest iphone air pods and apple watch at apple through this special referral offer when you get a new apple card you can earn bonus daily cash to qualify you must apply at apple.co/get-daily-cash apple card issued by Goldman Sachs Bank USA Salt Lake City branch offer may not be available everywhere terms and limitations apply all I had to do was brain dump imagine if you had someone with you all times that could take the ideas you have in your head synthesize them with AI to make them sound better and more grammatically correct and write them down for you this is exactly what whisper flow is in my life it is this thought partner that helps me explain what I want to say and it now means that on the go when I'm alone in my office when I'm out in a bar out I can respond to emails and slack messages and whatsapps and everything across all of my devices just by speaking I love this tool and I started talking about this from my behind the scenes channel a couple of months back and then the founder reached out to me and said we're seeing a lot of people come to our tool because of you so we'd love to be a sponsor we'd love you to be an investor in the company and so I signed up for both of those offers and I'm now an investor and a huge partner in a company called whisper flow you have to check it out whisper flow is four times faster than typing so if you want to give it a try head over to whisperflow.ai/doac to get started for free and you can find that link to whisper flow in the description below a lot of people struggle with sleep and they've just kind of gotten used to it I hear this from friends of mine that'll say you know I'm a bad sleeper I'll sleep for five hours and they kind of have just gotten used to it do you think that's okay? No and they will pay for this in their 60s and 70s. How do you know? Because I know that just one night of sleep deprivation is raising your risk of amyloid beta by at least four to five percent. Just one night. Just one night so you can imagine the accumulation of this not only that we know that you're interrupting with the hormones that are responsible for hunger and society we know for hunger and satiety we know that you're increasing your risk of type two diabetes with sleep deprivation but not just that we also see that this compound effect can't be reversed meaning that a lot of people think I'll just sleep for six hours a night and then just bank on it on the weekend but sadly that's not how our brain works it's not like dead that we can repay to the bank. I heard from Matthew Walker the other day though that we can save it up. He said um he said you can't make up for lost sleep. Exactly. But if on Monday I've got something worrying now I'm going to be deprived. He says on the weekends like saturday and sunday if I got a huge amount of sleep it's kind of like I can use that. Yeah it's kind of like yeah it's kind of like the reserve yeah actually I do this I do long haul flights I'll be at like six hours between L.A. in New York but also to Australia and so if I know I'm going on a long haul flight I'll bank on my sleep for about a week leading up to that because I know I'm going to be sleep deprived on the plane. So if you were one of those people that struggles with sleep that's listing right now and they're slightly concerned that you know you talked about this lymphatic system which sort of comes out not it cleans up the brain and they're hearing you know shit my lymphatic system isn't going to be up to when I'm not sleeping. If that was you and for whatever reason you start sleeping poorly. What would you do about it? I would get really serious about examining my lifestyle the day before. So this generally involves two things you have to ask yourself are you having trouble falling asleep or are you having trouble staying asleep? A lot of women report trouble falling asleep meaning they've got a racing mind men too they've got this racing mind they can't you know just stop that default mode network and the the racing thoughts that happen that's one thing and then there's the I can't stay asleep meaning that I'm waking up due to heat I'm waking up because I'm stressed and I'm having bad dreams there's all different reasons as to why you wake up so for the person who is having trouble falling asleep at night I would strongly recommend introducing a supplement called GABA which is gamma amino butaric acid it's our chief inhibitory neurotransmitter and when you have this it really helps stabilize all those thoughts it helps with a racing mind and it can help calm you down at night. The next thing I'll do is I will think about what I'm eating actually it turns out that eating starchy vegetables something that's going to make you like you know sweet potatoes for example it's going to have a better benefit backloading your carbs at night for helping you sleep. If you start training for sleep as if sleep is your marathon and start preparing for that at eight p.m. at night getting off you know don't email don't have any hard conversations don't watch anything crazy at night you'll settle your mind down you'll settle your nervous system down but where I think most of the optimization occurs is when you're actually in sleep. I would also work on sleep regulation so what we know is that in order to fall asleep and stay asleep our core body temperature needs to drop at least two degrees and I'm doing this with a temperature controlled mattress because it's working on thermal regulation a lot of people who don't have that can do several things like sleeping with their feet outside of the sheets or turning the air conditioning on the thermostat onto calling the room to calling down your body temperature core body temperature. One thing that you can supplement with is glycine and I think it's amazing because it helps with sleep by way of temperature regulation it can bring down your core body temperature and in fact and I don't know too much about the mechanism behind this glycine itself has one of the greatest longevity benefits for improving lifespan so taking glycine can also help with that. Now in terms of the person who is having trouble staying asleep. What about this one? You don't talk about the old Ashwagandha. Oh yeah Ashwagandha is great. Ashwagandha is going to help you with stress and you've got here Ashwagandha rodeola so what they both are they are adaptogens and basically an adaptogen is great because it goes in and it adapts to what is happening in your body so let's just say you have elevated cortisol and this tends to happen during different cycles during they mainly during the daytime when we wake up where cortisol levels are at its peak but it could also happen at night having this can actually stabilize that cortisol because it can go in and combine to cortisol and bring it down likely if something is not elevated and it's low it can bring it up so it's really good it's an adaptogen and studies show that you can actually take this three times a day and you won't feel fatigued it doesn't disrupt anything and it pairs really well with caffeine for example sodas theanine so this is actually a really great adjunct to your supplement stack and you really talk about how you need to sort of warm up to warm down warm up to go to sleep. Oh yeah starting at like 7 p.m. Yeah starting at like 8 p.m. and that's in line with circadian rhythm and circadian biology you want to try and when it comes to sleep and your circadian rhythm you kind of want to mimic the sun and mother nature and when does the sun start to go down it starts to go down at around 8 p.m. depending on where you are in the world and when this happens we also get the natural release of I love that you're taking that by the way you must be stressed right now you get the natural release of melatonin so melatonin is that sleepy hormone that gets released in response to darkness this may also be another reason why somebody somebody is having trouble falling asleep and staying asleep so we want to get the natural release of that so these bio hacks that occur right now sleeping with our red light mask on dimming the lights look dimming the lights is great I've actually replaced all of my light bulbs at home with in my bedroom as well with red light bulbs so I'm getting I'm getting rid of the blue light the junk light I'm replacing it with red light to help down regulate the nervous system yes I do wear blue light blocking goggles or glasses I should say do I think that they're providing an immediate and huge benefit I don't know but they could have a minor benefit there so warming down involves doing these things that are going to help you down regulate your nervous system so you can fall asleep faster sticking on supplements for a second omega-3 yes I've got some omega-3 here I've got two of them here but when I brought both of them out you said that I've got to be quite careful about what brand I buy but also something about temperature so by far out of all of the supplements omega-3 is probably the only one that you have to make sure that you look at the supplement label for and there there was this study that was done that showed that around 95% of their most popular omega-3 supplements in the US and there was about 85 of them that were tested exceeded the normal oxidation level meaning that these pills because they're omega-3 fatty acids they come from fish oil they're oil they can become rancid and oxidized and they usually do this when they're in a heated environment there are the here are the rules of thumbs one you want to look for a manufacturer that is highly credible and that is certified certified yeah so NSF certified so it's an external governing board that certifies them on you know everything heavy metals they make sure that the oxidation levels are met and they make sure that you know what's in the capsule is actually in the capsule that's another thing that is scary the supplement industry is highly unregulated and I treat my omega-3 is the same way I treat my olive oil you want to get oil that is sourced in the area that you are wearing california right now so you might want to find an omega-3 that is sourced in california do I want to put it in the fridge you want to put it in the fridge the moment that you get it really yeah why doesn't nobody talk about that I'm not sure but it's just the same as olive oil you don't want the olive oil to become rancid so you don't leave it near the near the stove you want to put it in a cupboard away from the stove and he's good for the brain omega-3 is by far one of the most potent stimulus that you could have for the brain they help with cell membrane fluidity so where your cells meet neuron to neuron they create something called a synapse and in order for that to occur we have a massive influx of all of these neurotransmitters dopamine serotonin we've also got calcium and potassium and these help our brain cells communicate okay we want to make sure that our membranes the cell membranes are fluid and they glide in order to help with that synaptic transmission another thing that they do is they are comparable to an NSAID an anti-inflammatory medication these have massive anti-inflammatory effects in fact I think that these have the safety profile of an FDA-approved drug and there's only benefits from it there's no side effects from it not just that 60% of our brain is made of fat 70% of that is made of DHA and DHA comes from omega-3 fatty acids so why do I not want to replace my brain or the fat in my brain with what it's made of and that's what you do when you have omega-3 fatty acids in fact there's been several trials to show that omega-3 fatty acids are most beneficial and most effective for mild cognitive impairment patients people who have the APOE for gene and people who have got Alzheimer's disease because when I told you that our we get the breakdown of the blood brain barrier those parasites on the blood brain barrier require DHA in fact there's a transporter on the outside of our brain that allows the that allows the DHA to come in and get into the brain and I know you're a big fan of vitamin D as well because there's been some very encouraging studies done that vitamin D is phenomenal we have vitamin D receptors all over our brain brainstem and and they're abundantly found in the hippocampus and the memory centers of our brain and there was this act there was actually a study done on centenarians in China so yeah those who lived to a hundred but it was done in women and they showed that the women who preserved their cognitive functions and who didn't get Alzheimer's disease had high levels of vitamin D so they weren't vitamin D deficient in fact being vitamin D deficient can increase your risk of all cause dementia by 40 percent likely being having a high level of vitamin D which is around 60 nanograms per deciliter can lower your risk of getting Alzheimer's disease by around 80 percent and then we have this white powder in front of me you've got a big smile on your face I do because there is just so much benefit to this depending on which brand you've bought of course but I can't say enough about creatine I have my parents on creatine they're 70 one years old I've got my dad on high-dose creatine I've got my mother on low-dose creatine it's the most widely studied supplement on the market and I'm so excited because I think that this is a really cheap and effective way to get everything you want from both your physiology and upgrade on your physiology and your neuro physiology so let's actually talk about creatine because I know it gets a lot of airtime but women and men are still scared of it and they're scared of it for two reasons one they're scared it's going to cause kidney damage and two it's this scared the hair is going to fall out and I'm going to address both of those fears but first let's talk about what it is so creatine is a naturally occurring molecule we it's we get we produce around two to three grams of creatine per day gets so created from a bit from the brain but a lot from the liver and two to three grams a day is great but it's not enough so we have to supplement with it and all through the 90s and all through the 2000s people were supplementing with five grams a day that is this scoop here five grams of creatine per day now that we're getting more rigorous with our brain health studies we have found that creatine has enormous benefits for the brain but here's the problem when you have five grams of creatine you're saturating the muscles okay remember the muscles are so hungry so they get first dibs and they take up all of that creatine so then there's none left for the brain we also lose a bit of the bioavailability when the creatine goes into the brain it crosses the blood brain barrier but when it goes into the brain we lose some of it so we have to supplement with more than five grams and one of the studies that changed my thinking came out last year it was the first ever pilot study done on Alzheimer's disease patients you're talking about patients whose brains are under attack they're in an energetic crisis they cannot produce energy effectively ATP is all skewed brain glucose metabolism is skewed they don't remember left from right cognitive functions are declined they put them on 20 grams of creatine per day which is how much I mean that well actually that is four of this so you want to go one and I don't know if they did this all at once that's two or if they did it like me over four separate intervals throughout the day there we go that's a lot that's a lot which is why you probably want to have this skewed throughout the day which is what I did I had 20 grams today I had five grams in the morning five mid-morning and then I think I had 10 all at once before I got here so that is a lot for all at once and what they found was that these patients not only preserved their cognitive functions but they had more energy and they were able to exercise more and it blew my mind that it does not matter how old you are it doesn't discriminate based on gender creatine doesn't discriminate based on age it doesn't discriminate based on weight it doesn't discriminate based on pathology or disease states or ethnicity it is just there it is there to support you it's the most widely studied supplement on the market and it's all risk it's all reward there is no risk it's helping with cell energy metabolism so basically it's helping ATP create energy so if you're someone that is low energy you should definitely be having creatine I don't care who you are you should definitely be having creatine people with brain fog and yeah people with brain fog you know I think one of the greatest benefits are men who are in football football players you can actually it's actually a protective molecule so what studies has shown is that at high doses of creatine around 30 grams a day it can protect you against insults insults meaning you take a hit to the head like a concussion it can protect your brain against a concussion it can protect your brain against a stroke it can protect your brain from stress the best thing about creatine is that it works in the background of stress I think that's where most that's where you'll get most of the benefits from after hearing so much about creatine on this podcast I start recommending it to all the people in my life there's one particular person actually that's probably out out out there in my house at the moment who had gone through cancer treatments and had survived cancer treatments and in their words wasn't the same on the other side of the cancer treatments and I talked to her about um creatine and she said to me the other day she I think the exact quote was I feel like I've got my life back because it's she's been taking creatine every single day for the last I'd say five months or so it's funny you said that because just recently in the last two weeks this study was done to show the anti-cancer effects of creatine and if my memory serves clear they they dosed it at they dosed it at 0.36 grams per kilogram of body weight so if you are a 70 kilo person if my mathematics is correct you're looking at around 25 grams of creatine per day that can have the effects the anti-cancer effects so the the study you're referring to I'll put up on the screen as well for anyone that wants to see it it's um the man's 2025 study which was a major study involving over 25,000 adults found a linear negative association between dietary creatine and cancer prevalence for every standard deviation increase in dietary creatine intake the risk of having cancer decreased by roughly 5% to 80% depending on the demographic that is wild this protective association was strongest in adults over the age of 50 suggesting that as we age maintaining higher creatine levels might be more critical for cellular health and immune surveillance. Well if you think about life and think about energy we need energy to survive we need energy to fight off infections we need energy to fight off stress preserve our normal normal bodily functions so when we are at the mercy of a low energy crisis we can't fight off tumour cells we we can't fight off these debilitating diseases so it actually makes sense that with more energy and with more functional energy meaning like if ourselves can function better it makes sense that you can see a reduction in cancer incidents likely you can see a reduction in Alzheimer's disease incidents when I said that creatine works in the background of stress also there was there's been phenomenal research to show that you can basically creatine your way out of sleep deprivation so if you've had a if you've had a long night and you you sleep deprived maybe you slept four five six hours you sleep deprived you can take you can take high dose creatine in the form of around 15 to 20 grams a day and you can reverse the negative effects associated with that sleep deprivation does it matter what time you take the creatine it doesn't matter what time you take the creatine it doesn't degrade in hot water it you can take it anytime throughout the day and it doesn't matter whether you're taking it right before exercise during exercise after exercise it works phenomenally some people are researchers are now wondering if taking it at night before bed helps with sleep performance and I think that that's a really exciting area but the one thing that I want to tell everybody because a lot of people are scared of this biomarker called creatine meaning that there's yeah so meaning that you've got a high creatine level and this is a marker of it's one marker of kidney function but this is where I find it really invaluable and this is where a lot of the nonsense comes around on Instagram and social media a lot of people say well I had so much creatine that my doctor told me to get off it because my creatine levels were high but creatine levels are high during times of stress during times of intense physical activity and also people who have a lot of muscle mass the higher muscle mass that's you have higher creatine levels what you want to test a greater marker of kidney function and GFR is cystatin C so all you have to ask it's really easy ask your doctor could I please get cystatin C in my blood work and if that is elevated and without we're not within normal range then maybe get off creatine but right now I cannot see any reason as to not have creatine every single day I think every single person no matter what age you are everybody should be supplementing with creatine now there was this recent study that came out on menopausal women and it was a really small study it was a randomized control trial and they split women into four groups and these were paramedic causal women they split them into low dose creatine where I think they were having 750 milligrams a day medium dose which was around 1.5 grams a day then they had them supplement with a range of both creatine monohydrate and creatine hydrochloride this was a hydrochloride creatine study and then there was a placebo group what they found was a very small study very small group what they found was that those in the medium range having the 1.5 had substantial increases in their mood and their cognitive functions so creatine is now being explored in females across the lifespan as it relates to paramanopause pregnancy menopause and dementia so there's just there it's phenomenal the only thing I want to point out what you want to look for when it comes to creatine are two things when it comes to manufacturing standards you want to look a has it been NSF certified and b you want to look for is it pure and that's the gold standard of creatine and it comes from Germany and a lot so the one that you've got there I can tell it's not career pure excuse me I know my creatine how can you tell what it is by looking at it I can just tell I can I I bet you a million dollars that it is the brand that I think it is because it's got this powdered icing sugar substance if it was pure gold standard career pure it would be gritty the reason why it's like this is because a lot of manufacturers want to add these different agents in there in order for it to mix well this probably mixes mixes really well a lot of people also complain of feeling GI distress when they take it and all I have to say is that's not a reason to stop taking it maybe take two grams at a time maybe take three grams at a time but don't stop taking it what you test for with your own health and health frequently do you test I test every three to four months what you test oh I do everything oh I've I just did lab work December 15th the day before my birthday I do it you know around that age but every year funnily enough I test my biological age what is your biological age it came back as 22 what's the most important test they don't typically do that you think everybody should be doing lipoprotein little A raises your risk of having a heart related event or raises your risk of getting cardiovascular disease but it's hereditary and then for for dementia this is a really exciting part at least in the US we now have a predictable way of picking up on mild cognitive impairment and picking up on these Alzheimer's hallmarks towel protein p towel 217 it's called on blood work and amyloid beta so we can now pick up on this with 90% accuracy of a PET scan what are these cards over there these are here to test your processing speed pink so it says pink on it yeah so this is actually a great measure of brain function your brain processes visual information 15 times faster than written words and so this is going to test your brain function okay so what I want you to do is you're going to see the color yeah I want you to actually say the color of the card not the word okay let me just program my brain say the color not to the word okay are you ready green orange yellow green orange green orange yellow pink orange green now let's do the reverse I want you to say the words okay yellow blue green black purple brown okay so you're good thank you let's do it to Jack Jack you come sit in the chair you call him off God and he hasn't got pretty it's an unfair advantage okay you ready wait so what am I doing and just say the color of the card okay just the color of the card yeah okay green orange pink yellow yellow yeah orange pink now let's roll reverse I want you to say what's on the card itself so just okay brown purple pink green black yellow okay so now we're going to test it even more that was the starting right not too bad that was not too bad so I want you this in actually involves us standing up and using a tennis ball so we're going to train your visual cortex which sits at the back here in the occipital lobe we're going to train your processing speed your reaction time your handout coordination is one of the best exercises that you can do physical exercises is actually handout coordination jaws tennis racket sports but I'm going to show you what five minutes a day can do for your cognitive reserve and your brain performance just using a tennis ball and an eye patch okay so first things first I'm going to give you this tennis ball yeah and for the whole time I want you to throw the ball with an overhand grip oh like this yep okay so I want you to just throw it with the right arm and catch with the right arm over I mean what's this okay I'm just checking the wall okay okay so like see you might want to move back where the chair is okay no you would cut that cut the half good so now throw with the right and catch with the left and alternate yep okay you've got it so what we're doing we're engaging almost all the executive functions now you've got and you should be able to do this for a minute okay okay now we're going to make it even harder it's like placing weight well I'm not going to do the one with the eye patch I'll do the next one okay so basically what you want to do and if you do it with a black ball it's actually even better so now we're going to make it a bit hard and a bit nearly demanding we're going to put an eye patch on you which is really going to block out like 50% of the vision okay which eye any eye let's see the left one now let's see how many you can do you I think we counted around eight before a pirate what wait this is not flattering okay let's go oh that's so different yep wow this feels significantly harder I know let's go this feels like really hard let me just double check fucking out that's really that's so hard there you go you've got it okay let's alternate now left hand right hand yeah you're training your visual system to work under load and under stress so when you do this I'm interrupting you no it's okay you got it you got it you got it good good good and then to even make it even harder okay stand on your right foot yeah put the other foot there you go on one leg yeah standing on one leg is now engaging the cerebellum okay we're getting spatial awareness let's go posture yeah right left right yeah oh my gosh you got it I want to see you do it but the eye patch on yeah wow I mean I can bit great my eyelashes have gone now it's okay we can AI that out this actually looks great okay we're ready well I blame my nails I blame my nails let's do it okay it's hard it's so hard and so what is this doing is this is engaging executive functions processing speed hand eye coordination and you did this with NBA players I did this with NBA players to improve their executive functions decrease their reaction time and this will this will change my brain if I do this frequently not just that but you're also improving cognitive reserve you're building new connections between the brain cells you're strengthening neural networks and you're doing something incredible you know every once in a while you come across a product that has such a huge impact on your life that you'd probably describe it as a game changer and I would say for about 35 to 40% of my team they would currently describe this product that I have in front of me called ketone IQ which you can get at ketone.com as a game changer but the reason I became a coach of this company and the reason why they now are a sponsor of this podcast is because one day when I came to work there was a box of this stuff sat on my desk I had no idea what it was Lily in my team says that this company have been in touch so I went upstairs tried it and quite frankly the rest is history in terms of my focus my energy levels how I feel how I work how productive I am game changer so if you want to give it a try visit ketone.com/diven for 30% off you'll also get a free gift with your second shipment and now you can find ketone IQ at target stores across the United States where your first shot is completely free of charge. If there's anything we need it is connection especially in the world we're living in today and that is exactly why we created these conversation cards because on this show when I sit here with my guest and have those deep intimate conversations this remarkable thing happens time and time again we feel deeply connected to each other at the end of every episode the guest I'm interviewing leaves a question for the next guest and we've turned them into these conversation cards and we've added these twist cards to make your conversations even more interesting and there are so many more twists along the way with the conversation cards this is the brand new addition and for the first time ever I've added to the pack this gold card which is an exclusive question from me but I'm only putting the gold cards in the first run of conversation cards so get yours now before the limited edition gold cards are all gone head to the link in the description below. So doing hard things is what is going to improve brain function over the lifespan. Doing hard things tells your brain that you can do hard things meaning have you ever heard of this brain area, a little area in the brain called the anterior mid-singular cortex? Yes I have. What do you know about it? I'll let you say. Well it's shown that it's larger in what we call super ages and people who age really well and who can withhold a lot of cognitive capacity and it's really profound in people who can die at well. It gets bigger when we do hard things so when we do really hard things this area in the brain gets bigger and basically what that is it's reserved for when life gets hard it means it basically tells your brain that no matter what happens no matter what event comes my way I have the ability to go in, welcome it and push through it no matter how hard it's going to be. When you give up or when you don't do hard things this little area doesn't grow it doesn't get bigger. So doing these neural activating drills that we just did going to the gym and pushing well above your threshold and pushing really hard is going to help grow this little area of the brain. And they call this the willpower. The willpower this is why I think that when people go out to set their goals during the year and they say I'm going to lose 20 pounds I'm going to do this I'm just going to increase my willpower I think it's not willpower it's neurobiology. I think it's really important to just spend a little bit of moment talking about this part of the brain because when I discovered it I found it absolutely fascinating and I think it was Andrew Huberman who said either to me or he said publicly that he thinks it's one of the most fascinating and important discoveries of the last century. Of course will you think about how we're living our lives where we're punishing ourselves for not being able to read a book for not being able to pay attention how many people are now diagnosing self-diagnosing themselves with ADHD low attention spans and they're blaming it on environment they're blaming it on circumstances when they should be blaming it on neurobiology and they should be blaming it on their brain state. This area of the brain if you can push and this is why these super majors seem to have what's a superager? A superager is somebody who is aging well so they're going through life low cardiovascular disease state they've maintained their cognitive functions they're at the age of 1890 with a VO2 max profile of maybe a 50 or 60 year old so they're aging quite well biologically so these you know super ages have many many different facets to them and one of them isn't a larger mid-secular cortex. Conversely the AMCC anterior mid-secular cortex shrinks in people who live sedentary lives or avoid challenges it literally atrophies if you play it safe in life too often. Growth only occurs during resistance if you love taking nice baths and you take one your AMCC doesn't change if you hate the cold but force yourself to do it anyway the AMCC grows. Scientists now view the AMCC as the seat of the will to live its size and activity level are strong predictors of how long an individual will survive after a major setback in their life whether it's a health setback or a surgery. There's something really philosophical about that as well you know if you I don't know if you read Stoicism or anything but it it really dates back to how the Stoics lived their life especially Marcus Orrelius with being able to push through hard times little did they know that it was this little area in the brain. Yeah I think I was telling the story of the day of Roosevelt and what happened in his life as a young man when he came home one day on Valentine's day and found that his mother and his wife who had just had his newborn baby had both died one upstairs, one downstairs and he went off to the Badlands for two. I think it was two to four years. The Badlands in America were just this like horrific natural place where he'd get up at 4am ride these like horses in the freezing cold where like the horses would literally die standing still because it was so horrific. He did that to two years to like deal with the grief but when he came back to New York City after this two years in the Badlands all of his friends and he was just a completely different man. And what they now know from a neuroscience perspective is that he didn't just build his muscles, he literally like rewired his brain. He went on to become the youngest US president of all time, he got shot during a speech and carried on doing the speech. He led the charge in various walks, he's just unbelievable. I think he won the Nobel Prize and they pointed those two years in the Badlands and say actually that forged not just the man but his his brain, his AMCC. The studies also show that athletes consistently show much larger AMCC volume and study show that individual struggling with obesity often have smaller AMCCs but it begins but it begins to grow the moment they start a successful challenging dietary or exercise intervention. It's that word challenging because when you place stimulus upon a system it adapts and grows and that is neurobiology at its most infinite source. And this is why we get the breakdown of these synapses. This is why we get into a place of going from 5,000 to 10,000 connections to 2,000 or no connections. These dandroid expires end up breaking down because we don't do the hard thing. And also think being deep rooted in neurobiology you can see that everything is cause and effect and it's a cycle. If you don't do the hard thing you don't grow the AMCC. You don't grow the AMCC. You don't do the hard thing again and it's just this loop and it's this cycle which is why so many resolutions, new years resolutions and by February 1st it's why we have the obesity epidemic. It's largely why I think we've got a crisis of people not being able to meet their goals. I'm just fascinated from an evolution perspective as to why we needed one and why it wasn't just always big. In the pursuit of evolutionarily, in the pursuit of hunting and going out and hunting for food sources and being motivated to do that in a near starvation state when times were tough. And so when times got easier we didn't need it as much so we could conserve I guess our energy so we could scale down our world power when times were good. Well it's interesting that you say that because this brings up the whole brain rot and AI era just like with you know in 2024 Oxford Dictionary I think named brain rot the word of the year. And it's interesting because it plays into evolution and what's happening with this AMCC meaning like we're just there scrolling at mindless information every day, training our brain to get these small dopamine hits, these small rewards from doing absolutely nothing. What do you think of these chat bots that everybody's using at the moment to write for them and think for them etc? Oh my god I think it's on the spectrum of being so incredible but being so detrimentally harmful. I know this with myself so I was a mathematician I did my masters of mathematics and I was able, Stephen, to the trigonometry and pure calculus that I could do back then with just my head and a pen was fascinating now. I'm going to I'm going out and I'm calculating on chat GPT the bill the 20% tip on top of this bill how much does it cost? And I think how dumb am I actually getting? So I think it's both good and bad. I think the rate of decline we're seeing in people reading books and exercising their brain is declining and our ability to think and and use our cognition is declining. Louise I've been waiting a long time to ask you one particular question which is I think is very important which is you're clearly very passionate about this stuff. One might say you're pretty obsessed with it you come across as pretty obsessed. Do I? You do, yeah. Why? We are living in a society that doesn't allow women to ask for what they want. We're living in a society that doesn't allow women to ask for what they need and when this happens it results in 70% of all Alzheimer's disease cases being women it results in 80% of all autoimmune diseases being female and these are largely preventable diseases and when I ask why and I hear that women are wildly misrepresented in academic literature. When I when I see women who downplay their symptoms or they're too scared to ask their doctor for advice or they too scared to ask somebody else for advice because of what they're going through or they're ashamed of some of their symptoms I get angry and I get passionate and it reminds me of my grandmother who she was my best friend her name was Louise and you named after I was named after her yes and we spent every day together and I'm getting emotional now because I remember her and she sadly died of pancreatic cancer. It was ovarian cancer that went to pancreatic cancer and she never asked for what she wanted and she never asked for what she needed which was help she didn't understand her symptoms she didn't go to the doctor when she needed to because she was just more inclined to look after the family and look after the household and when the time came that she was given her diagnosis I was sitting there with her it was it was at home and the doctor came she did a house call and my grandmother looked at her she hardly spoke that much English and she said please is there something I can do I don't want to die and the doctor said there's I'm sorry there's nothing you can do and I spent every day with her in the hospital and I think about that it's been almost 20 years now but I think about that moment and I kick myself thinking why didn't we why didn't we get her a scan she told us several times that her stomach was hurting she told her several times that she felt pain she never she hid her symptoms she hardly ever ate one point and we never stopped to think about why and she never stopped to think about why so I think about her every day and then I think about my mother too and these women you know first generation they came we migrated to Australia from a country called Cyprus and they've just been so they put themselves second and they they just look after the family and I can't stand that and when I see women coming in as patients or caregivers I think to myself do you not know that there is something for you to do and most women don't and I I can't believe the amount of money that we are spending that is going towards putting us on rockets to go to Mars but we haven't yet found a cure for this disease that is largely preventable it's just not okay with me and I would hate to see women go through this the emotion is still very present in your face even though it was so long ago it was so long ago I mean I was very close to her I'm very close with my mother I check in with her twice three times a day and I just don't think it's fair I think women deserve the truth they've been lied to they've been underrepresented and we need to change that with Louisa your grandmother what what are those range of emotions that have turned into this incredible fire you have anger anger is one of the emotions anger at society that places women to be everything to be a a mother a caregiver to go to work to represent the family women represent 51% of the total population and then it becomes I feel political if that's an emotion because you think about health care you think health care should be accessible to everybody but it seems as though especially in this country that health care is only really accessible by those with a high socioeconomic status and that I'm not okay with so it does become political even though health care I guess health care is political because policies have been set but a woman in need is a political and my grandmother was a political and her needs just were not met anger frustration at the system frustration at the fact that we still have only 4% of women taking home and replacement therapy in fear that they're going to get this disease that they're going to get breast cancer utterly frustrated at the cycles of administration who vouch to help you you look to your you know your government and your administration to look up to to guide you when you have secretary Kennedy in 2014 go on national television and say vaccines are totally safer had all my kids vaccinated they've eradicated some of the most deadliest diseases that have plagued this world vaccines are so safe to fast forward to 2025 saying vaccines are so unsafe do not trust your medical doctor you need to take your health into your own hands you start to lose trust and it's not that we're uninformed it's the fact that we are confused because we hear vaccines are bad oh vaccines are good vaccines are a really good take them don't get your kid vaccine you've got women here who don't even know they're they don't even know how to get on the internet or order a blood testing you're expecting them to take their health into their own hands so it upsets me that you see women who are so vulnerable being sold a vaccine lie which could potentially save them from a disease which could potentially save them or their child from getting the flu hepatitis P meningitis which was just eradicated from the vaccine schedule I'm not this is not meant to be political I am I'm a scientist I am not this is not propaganda this is not ideology this is just women who deserve to be treated better you're 36 Louisa passed away when you were how old oh I was probably 18 at the time you were 18 when you around that 1819 when you got the diagnosis yeah it was very fast it was within a two-month time frame not even and had she not got that diagnosis and had you not sat there and watched her ask that doctor if there's something that she could do do you think your career would have taken this course I became utterly obsessed with disease management but when I first saw a human brain I was 21 I was in a lab and we had to go into a cadaver lab and I saw a brain being harvested from a body that was donated and I stayed back that day I remember and I helped in the pathology lab and when I saw that brain I knew that I wanted to dedicate my life to it so ever since then I've been in OAS and it's where I feel most alive why why did you want to get your life to it because when you know what the brain is that it is responsible for the life that we have and you can use it for your advantage to overcome any obstacle that comes your way you become obsessed with understanding it metacognition is thinking about your thoughts and every day if you can think about why you think about the things you think about you can challenge yourself to overcome any adversity is there a cost to your obsession in your passion yes what's the cost I moved away from my family to be surrounded by the greatest neurosurgeons in the world which I am and I'm very thankful for that I moved away from a population of 22 million to come to the hardest city in the world New York New York City are you still paying a cost I'm still paying a cost my health pays a cost I've missed family events traveling for my career but I wouldn't have it any other way because the people that I've met have forged the way for me to live the life that I want I'm surrounded by incredible thought leaders in health and medicine and so what is success to you then at the deepest possible level what is success you we meet again in 10 years time you say my life has been a success or I feel successful I'm a sick Louisa says I am a successful woman what does that mean what happened being able to control my brain states being able to control your brain states I think that the ultimate form of success and high performance or being able to perform at your peak is being able to go from brain state to brain state and then be able to recover what do you mean by brain state meaning like being able to get switched on when you need to be switched on and inviting your transmitters involved in that nor a pernephrine adrenaline dopamine but not having that in constant overdrive and being able to know when to switch off and I think that that is what high performance is the book that changed my mind on that was flow by me hi chick simnii which actually speaks about the flow states so being able to know how to separate yourself in these states any goals outside of your professional kids family life yeah definitely it's tough isn't it it's tough I was saying earlier to my friend that you know kind of just thought the minute I wanted to have kids they would just appear it's not sister that's what I thought too until I realized oh but I'm the woman I actually have to bear the the children as well which is a big sacrifice I'm a sacrifice it's an honor and a privilege and a sacrifice that I think everybody yeah I I mean I think I I definitely want are you hopeful for one of your professional endeavors yes you are hopeful I'm in control you think we're going to move in a good direction as a society as it relates to Alzheimer's and yes I I'm hopeful for that I'm hopeful for the message that I'm getting across I think social media is providing the platform for free education and for people to understand they have agency over their brains I'm not hopeful for anybody saving us or coming in and giving us a easy way forward do you ever have days where you wish you were less obsessed with your craft has there ever been a day where you're like you know I wish I was just a little bit less captivated by this sometimes I do yeah I think if I didn't well I'd be probably back home in Australia living an average person's life I'm not saying that that's it I'm just saying you know maybe I would have done it done my life differently I have days like that where I think if obviously because the obsessed brain is the one making this decision so it's quite difficult to detach but like if you put a knob in front of me and I could just turn it down just a little bit would I now my obsessed brain is is the one making this decision so my obsessed brain is not like fuck it turn it up but I think I do wonder sometimes I am the way that I am right but I do wonder sometimes if I would be happier overall if I could just turn it down a little bit but isn't the whole point of life to know thyself and in pursuit of something bigger and better yeah it is but I just sometimes worry about what I'm sacrificing and whether at some point I don't know when I'm on my death better 80 years old I'm going to look back and say actually I made a bad trade well exactly and but we're never going to know that I think about that often yeah you think about that often and you think well if the world came to a collapse tomorrow what would you regret today not having done I think it would be like making more memories with people I love I think that's one of the big ones I think did you hear what you just said yeah making more memories and imagine losing those imagine yeah a life full of like thinkable you know creating these experiences and these memories to have them being taken away from you yeah to not being able to recognize your wife your kids and looking in the mirror and not being able to recognize yourself that's why Alzheimer's is just such a disgusting sinister like horrific thing because yeah it's just it's the most heartbreaking thing to lose someone while they're still alive and to lose yourself we've got this one woman who looks in the mirror and she says who's that really yeah and you know it's it's sad because two years ago she knew who I was and now she asks are you my daughter and when you're confronted with that every single day it gets you thinking you don't live a normal life you don't live an average life because you do think about every facet of medicine you think about history you think about diseases and then you think about life and the people that you spend the most time with we have a closing tradition where their last guess leaves the question for the next not knowing who they're leaving it for and the question left for you is what is God to you God is that power that you feel and have faith in that you cannot see the power that basically makes you feel like there is somebody there that has you and that is guiding you that always has a path for you knowing you're you believe in God yes I'm Christian I'm Greek Orthodox when you see the brain deteriorating in such a way and you think about this concept of prayer like asking God to help me with something doesn't it feel pretty I mean it's the definition of like hopelessness is watching your brain deteriorate and I think some part of my struggles with religion since I was 18 year old and I came from a very religious family was seeing injustice in the world and this doesn't seem to be much greater injustice than watching someone's brain just deteriorate in front of their family yeah or somebody going through losing their child and you start to think about God people pray for I can't find my keys or want my football team to win and I get there's no point if people praying for an Alzheimer's cure having no luck then maybe I should stop praying for lunches tonight to win yeah if you understood the intricacies of how we were actually brought into this world from the point of conception from the point of conception to the point of mural development how a baby is formed and how precise everything has to be for you to come out the way you did it is so beautiful and so miraculous and so rare even though there are billions of people in this world that you cannot just turn to biology anymore you have to turn to something bigger and I used to trust me even as a as a great as a Christian who's read the Bible I even in my early 20s when I was getting into medicine and science I was so gung-ho about we're born in a body we're dying a body but then when you get so deep into the literature of science and medicine and biology it's hard to ignore God and it's hard to ignore that there is a higher power out there and why is it that there are chapels in hospitals because people want to go to heaven because people want an alternative method of getting through whatever it is that they can get through something that science and medicine cannot offer and believing in something that is not there or something that hasn't occurred yet is having faith. I work in neurosurgery and some of the cases you think this person's not coming out of here alive and the fact that they do and they preserve their cognitive functions and they look next to normal after they've had a massive tumour resected which is a true story from here the tumour was going all along this one woman's face who was 78 years old who traveled here from France to have the tumour resected how is it that she's walking and she's cognitively normal and she's not even on any medication the next day how is that possible is it God is it just miraculous neurosurgeons there's just some things that medicine can't answer. I agree with that I am I don't think I'm arrogant enough to say that I know and I'm curious and I think I'll never know yeah so I guess that's where we need to have faith Louise thank you so much it's very important that you do the work that you do because it's people like yourself that are so passionate so obsessed and so good at communicating that help average people who are who don't have access to the wisdom and the research and studies and information that you have understand all of these things and it's through this understanding that we can make better choices and preserve our life preserve our brains and if we preserve our brains we preserve everything that matters correct thank you for doing what you do and I appreciate your passion and dedication to it because it's very very important and I know it comes across so I feel obliged to tell you that as a normal person who isn't involved in your field we're grateful thank you so much Stephen thank you (gentle music)