561: How to Future-Proof Your Brain and Stay Sharp at Any Age | Tommy Wood, PhD

What's going on everybody? It's episode 561 of the Genius Life. Let's go. I say Genius Opplement. [Music] The Genius Life. [Music] What's going on everybody? Welcome back to the Genius Life. A show where we cut through the noise and focus on what actually works for your health. I'm your host Max Lugavir. If you caught last week's episode, number 558, you know that we went deep on brain health. Well, today is the perfect follow-up. We're zooming out, connecting more dots and getting even clearer on what actually moves the needle when it comes to protecting and upgrading your brain. If you've ever felt like cognitive decline is just part of getting older, like it's this slow, inevitable slide that starts earlier than we'd like to admit, well, this episode is going to challenge that in a big way. Today's guest is Dr. Tommy Wood. He's a neuroscientist and performance expert whose new book, The Simulated Mind, takes a radically empowering view of brain health. We're not just talking about preventing dementia. We're talking about building a brain that stays sharp, resilient, and adaptable for life. In this conversation, we get into what actually drives cognitive decline and what most people are completely missing from the surprising role of energy balance to why how you use your brain might matter more than what you feed it. So the forms of exercise that seem to literally reshape your brain, we cover the levers that actually move the needle. This one, as you know, hits close to home for me, and I think it will for you as well. Listen all the way through to the end, you're not going to want to miss a beat, and as always, don't forget to share this episode with friends and loved ones that you think may benefit from it. Now with all that out of the way, here's Dr. Tommy Wood. It's episode 561. Let's rock. Dr. Tommy Wood, what's going on? Hey man, so awesome to be back here. So good to see you. Yeah, it's been a while, but yeah, really, really happy to be back. Welcome back to SoCal. I know that you're based up in Seattle, and I'm so excited to celebrate your new book, man. There's a big deal. The Simulated Mind. Yeah. It's been a couple of years in the works. Took me six months to write it. It's a bit of an epic. It's like right at the upper limit of the number of pages they would let me have. But hopefully it's, you know, packed full information and super useful to people. That's the best. Well, I mean, I don't need to tell you, but you're the topic of your book, the subject is right on my alley. Yeah. Future proof your brain from dementia and stay sharp at any age. I'm super excited to get into it, man, because, you know, obviously this is a topic that hits home for me. I had a loved one with dementia. Many people are struggling with dementia. It's a rapidly growing brain disease. I mean, millions, tens of millions of people around the world are suffering from it. Numbers are set to triple in the coming decades. Yeah. So what can we do? What can we do to future proof of our brains? Yeah. This is essentially the premise of the whole book, right? And I think there's a few things that are important in terms of pieces of information because right now people often feel like there's nothing they can do about it. And that it's inevitable, right? There's this unstoppable decline in cognitive function. And maybe even starting in our 30s and just after that, right? It just continues. And maybe that the decline will be so sharp or steep that we end up with the diagnosis of dementia. And obviously people familiar with your work will know that that doesn't have to be the case, right? And I think that there's a huge amount of evidence that the exact numbers are maybe debated, but potentially the majority of cases of dementia are preventable, right? And we even see this actually in some of the recent data looking at dementia, age specific dementia incidents over the past few decades. Because something that doesn't necessarily get the sort of the highlights that it should, let me talk about the expansion of dementia burden, right? Doubling or tripling in the next few decades. But age specific incidents of dementia has been decreasing for the last 80 years or so. And what I mean by that is that today at 60 years old or 70 years old, you're significantly less likely to be diagnosed with dementia than you were several decades ago. And this is maybe like ticking up again as sort of overall population health declines because that's a critical component of dementia risk. But we've seen that dementia risk can decrease at the population level. And this is because we like people think there's a lot of things going on, but it could be because, right, smoking generally decreased over that period of time. Cardiovascular disease treatment generally proved in that period of time and that's something that is like tracks very closely with dementia risk. And then there was some other interesting things that have happened that I think may be contribute, but are harder to track. So we've seen an increase in women getting access to education, getting access to the workforce, which they didn't until really begin the 70s in the US. And we know that education and cognitive-estimulating work are also critical determinants of dementia risk. So there are many things that change, which actually have been beneficial. And I think that then gives us a way in to say this is something that is actually the we can continue if we then address critical risk factors. So when you think about all the different things that a brain might need, I have a sort of like a model of all these different components. So there's a lot called the 3S model. This is kind of what the book builds up to, right? There are multiple chapters that go through physical activity, how different types of exercise affect different parts of the brain and different functions in the brain talks about nutrition, sleep, stress, and cognitive stimulation. Obviously that's the name of the book. But the first S is stimulus, right? So how we use our brains seems to be a critical determinant of how our brains function. And then once you've stimulated a part of the brain or a network in the brain doing some kind of cognitive activity, then you need blood flow, oxygen, metabolic substrates and nutrients to kind of allow that part of the brain to do its job. So that's my supply bucket. And then once you've stimulated the brain as responded, you want it to adapt and improve right process of neuroplacicity, building and maintaining function. And that happens during adaptation periods like sleep. So there's a support bucket. That's my third S so sleep is critical. And it's interesting because studies that have estimated the proportion of dementia that might be preventable. So one one big example is the Lancet Commission dementia report and which people probably have heard of the estimated that 45% of dementia is a preventable. They didn't include loss of sleep or poor sleep as a as a potentially modified risk factor. So I think that's one reason why that's probably a conservative festival because we know sleep is critical. Then other things that go into that we want to support adaptive processes in the brain. So a trophic factors like brain derived, your trophic factor BDNF critical hormone status can be critical. And we also want to avoid things that impair that process like smoking alcohol chronic chronic stress, which can impair brain function in many ways. So those are the things that I think that we can do. The sort of the risk factors that we see at the population that will kind of map onto those. So one of the biggest risk factors in that Lancet report was education as a critical risk factor. So if we can improve access to education or just like thinking more broadly. If we can continue to challenge and learn challenge our brains and learn across the entire lifespan. We see that first that builds. Excuse me. First that builds cognitive function in the first place and then cognitive demanding work and engaging in cognitive, you stimulating activities slow the rate of decline and all could even improve cognitive function, you know, late late in life. So that's probably one of the most important factors and then there's things like maintaining metabolic health, avoiding things like obesity, type to diabetes, nutrient status, obviously critical. And that's also something that there were several letters written to the Lancet after that report came out because they didn't mention omega three's. They didn't mention homocysteine and B vitamins. We know these are critical determinants of dementia risk as part of like that bigger picture and then some other things like avoiding brain trauma and stuff like that is going to be important as well. And so that's the I kind of provide that framework because then hopefully some were in there. People might say, oh yeah, like that's one area that maybe I could I could attend to a little bit of rather than thinking here's 50 things that I have to do for my brain, which can be very overwhelming. And in the book, I also talk about how all those different mechanisms are interconnected right so when you change one thing, you change everything. So if you sleep better, then the next day you feel more social so you're more likely to be social connected, you're more likely to engage in cognitively challenging tasks, right? If we sleep deprived, we know people don't like to do things that are cognitively difficult, right? We just don't feel like it. But if we sleep better, we also, like, our blood pressure improves, and our blood sugar improves, and all these things kind of change at once. - Our appetites are better. - Exactly. - Exactly. - Yeah, but as our regulates it, maybe we even make better food choices. Similarly, if we exercise more, or if we do something cognitively stimulating, we sleep better the next night. There were some really interesting trials where they take older adults, and they give them a brain training program, and then they sleep better afterwards, like in a randomized control trial. So again, in multiple different ways in, but when you change one thing, kind of the whole network shifts in your favor. - It's so cool. There's so much to unpack there. I love, first of all, I love the 3S framework. So supply, nutrient supply, sleep and stimulation. - Yeah, so sleep kind of gets rolled into support, which is with all those other processes as well. - Yeah, I love it. And I also love that you touched on the fact that, 'cause I agree with you that that 2024 paper was very conservative. I mean, it positive that 45% of dementia cases are potentially preventable based on, the modifiable risk factors that it elucidated, but yeah, it completely missed the whole, like nutrient-repletion part of the conversation. It also something that I noticed that I think is really important is the overuse of anticholinergic drugs, which is a big problem. So toxic exposures and the like. But no, this is like, this is crucially important stuff. - If you had to devise a diet and lifestyle that acted in a way like a perfect storm, like if you were for whatever demonic reason, intent on developing dementia, like how would you live and what would your diet be like? - Yeah, I would, you know, at the risk of being hyperbolic, I would basically live like a modern American human and unfortunately, if we think about generally relatively sedentary, not necessarily getting either access to or engaging with cognitive-y-stimulating activities that really challenge our capabilities, right? We're often very busy, right? We feel very stressed, but we're never really pushing the boundaries of our capabilities and then resting and recovering, sleeping afterwards. And, you know, on top of that, in general, eating a high-parasable calorie-dense nutrient poor diet, we know that excess energy of ateability, metabolic disease, right? Those are significant risk factors for dementia. We know, we already touched on some of the nutrients that we know are no more critical. And if we're deficient in B vitamins, vitamin D, iron, omega-3s, all of those, and potentially even interact to increase dementia risk. So, right now often, I think we're seeing that perfect storm to an extent. There have been some attempts to improve this. So actually, the rate of individuals with very high levels of homocysteine actually decreased in the population when they started to fortify flour with a photoc acid, right? Because you improved some of that B vitamins status. But, in reality, everything else has really trended in the wrong direction. Hmm. Don't you wanna live a cozy life? I know I do. Well, one of the sponsors of today's episode of the show is Cozy Earth. Cozy Earth makes the kind of products that quietly upgrade your life in a way you immediately feel. 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And if you get a post-purchase survey, be sure to let them know that you heard about Cozy Earth right here on the Genius Life. Again, cozyearth.com to make your life a little more cozy and use my code Genius for up to 20% off. Cozyearth.com, use code Genius, 20% off, enjoy. - Yeah, it is crazy the way the standard American, just the degree to which the standard American diet and lifestyle is ravaging our bodies and the brain sits directly downstream of all of the consequences, all the myriad consequences of that. - Yeah, and a lot of this is driven by overall society, right? This isn't anybody's fault necessarily. This is just where we've ended up based on, well, some of it's basic human nature, right? It's a lot of energy and effort to move, to engage in challenging tasks. And so we've started to engineer those things out of the environment and we're still doing it, right? So with AI, right? And again, AI could be a fantastic cognitive or authentic. It could be a way for us to challenge ourselves and extend our capabilities. - What do you just call it a cognitive or authentic? - Yeah, so-- - That's a fascinating way to phrase it. - So, this is not my own phrase. I've stolen this from somebody else, but it's basically this idea that, if you think about orthoses for physical function, you might use it in an individual who has like cerebral palsy to help kind of restructural, hold the foot in a certain way so they can walk, right? So it's supporting them to do something they couldn't do otherwise. And this could be the same thing. So there's certain evidence that if you use, say, large language models to challenge your thinking or to extend your thinking, right, in conversation, right? What have I missed? What else could I do? What else should I be like? Here's my first try. How could I improve this? And that is essentially an orthotic, right? It's extending our current capabilities, but requires you to actually engage in that process. Whereas it could go the other way where we just let it do all the thinking for us. And we know that the functions we want to keep need to be continuously challenged in order for that function to be maintained. So any critical thinking, any complex skill, if we offload that to something else, that's a skill that's a function that we'll lose. And we do that to enough functions and overall function will decline. So we're at a tip, people have been, again, quite hyperbolic in terms of how bad it could be. And it could be very bad, but it could also be very good. It all just depends on how we end up using these tools. What do you say to people who are convinced that dementia Alzheimer's disease are genetic in origin? That it's something that they will inherit if, say, their parents or one of their parents or their grandparents had it. There's two parts to this that I think are important to think about. So one is the absolute genetic component. So yes, a small proportion of Alzheimer's disease, early onset for meal Alzheimer's disease, which is a single mutation in a single gene like amylopreca-suppoting or one of the presynilin genes, which does result in a fairly predictable early onset dementia. So I know some clinicians work with populations like that and do seem to see some benefit if they can put some lifestyle, things that in place, but that's sort of like a small sliver, maybe 1%. The rest certainly has a genetic component. You can develop polygenic risk scores for dementia, at least within certain populations. And then there's obviously your apoe genotype being the best known genetic risk factor. Recently, there was one paper that came out in nature a couple of years ago that argued that apoe for being homozygous for apoe for was as bad for dementia risk as having one of those other mutations that I just mentioned. They said it should behave like that. When you look at their data, that wasn't even true. You look to the paper and yes, obviously, if you have two copies of apoe before, you have a significant increase risk of dementia. We know that. But it didn't like the onset and the trajectory didn't map onto those other conditions. So there were a lot of people who were really scared of that based on that paper because they were just like, "Worth, I have two copies, but I'm doomed." But when you look at other data, there are several populations where being the heterozygous or homozygous, right, having one or two copies of apoe for doesn't increase your risk of dementia. And therefore, it seems like it must be context dependent. What's the environment that that gene is sitting in? Because there was one study that even looked at mortality risk because apoe for also increased the risk of cardiovascular disease, looking at Sicilian American populations compared to Sicilian populations in Sicily. So they had very similar genetic background. Apoe for was only increased risk in those who were in America. So there's this interaction with the environment. And there are several other studies that show that apoe for. is probably a risk multiplier. So if you drink excess of alcohol or if you have a poor quality diet or if you're sedentary, you have other cardiovascular disease risk factors, then Apple before kind of magnifies that effect on dementia risk. But by the same token, if you then remove those risk factors, you exercise more, you improve omega-3 status, you decrease alcohol intake, you will see an increased benefit such that some of that outsized risk is decreased or nullified. It's difficult to say whether it's completely nullified, but certainly because it's like interacting with those environmental factors, if you address those factors, you've probably removed the majority of excess risk. Beyond then Apple before, so you can still have dementia in your family if you have without having Apple before and people then might think, it's true, if you have family members who have dementia, you're more likely to get dementia, your risk is increased. But there are also studies that show, so say if it's polygenic across multiple genes, regardless of your genetics, you still benefit from lifestyle factors that are associated with dementia risk. So you can decrease your risk regardless of your genetics. And there's other evidence that one of one of the things that you don't isolate in those kinds of studies is shared lifestyle and environment. So you're likely to eat and sleep and exercise like your parents did. And so if you can change those shared risk factors, again, you can overcome some of that shared risk. So I think there's a huge amount, like across all the dates, there's a huge amount of hope that regardless of your family history and genetics, you still have a ton of agency and ability to modify your risk. I love that. So I mean, put simply genes are not destiny. Yeah. I've always found that to be incredibly empowering when looking at the epidemiology of of APOE 4 and how, you know, even just like location modifies risk, it's been, it's like incredible to see that, you know, if you're genetically at risk for Alzheimer's disease here in the United States, you might simply live to a, you know, a less industrialized part of the world, adopt a diet and a lifestyle that's less sedentary, less industrialized and see that risk, you know, significantly attenuated if not abolished completely. Yeah, incredible. And you could, right, you could move to the other side of the world, but I mean, it's possible to do it here. Of course, like different, different people have different resources on time to do it, but the the possibility is absolutely there for everybody. That's amazing. What are the big levers when it comes to diet? I know that nutrition is sort of like, you know, everybody loves to talk about nutrition and everybody has an opinion on, you know, how best to eat these days, but based on your read of the, of the literature, you know, the intersection of like nutrition science and brain health, neurology, neuroscience. What might a roadmap look like in terms of eating for better brain health? One thing that I noticed as I like dug even more into the into the literature as I was writing, as I was writing the book is that the the biggest signal in terms of brain reserve, which is essentially like how much brain you have in your skull, right, it's like a buffer. And, you know, the bigger your brain reserve, the bigger your brain, the lower your risk of dementia over time, you want to try and maintain as much brain volume as possible. So looking at brain reserve, but then also looking at dementia risk. The biggest lever, and it was kind of surprised, like more so than individual nutrients, is just energy availability. So there's this like bell shaped curve, if you look at energy availability and then brain reserve. And there was a nice study, there was in PNAS that looked across multiple populations, so included on together populations, sort of intermediate populations, and then westernized like US and European populations. And what you see is that is that at low energy availability, right, when calories are scarce, the brain volumes are smaller, the idea being that you just don't have the extra energy to kind of invest in that additional buffer. And we see something similar across the decades of the US, where from the 1940s to 1950s and then every decade after that, brains actually got bigger. Brain reserve got bigger, and I think part of it is because after the Second World War and the Great Depression, we just had access to more calories, like we weren't starving as we were previously. And so you can kind of see that signal over here as well as in other populations. When one other example of that is I do a lot of work with athletes, and it's very common for athletes to who don't eat enough calories to have something called low energy availability, right, or relatively and relative energy deficiency in sport, or reds or reds. And those individuals experience a number of symptoms including cognitive symptoms and mood changes. And I think some of that is just you don't have the additional calories to kind of run the system at optimal. Then, right, so things improve as energy availability improves, but then they start to decline on the other end as well. So as we see pre-diabetes and type 2 diabetes, high blood pressure, high cardiovascular disease risk, metabolic syndrome, then again, brain reserve, brain volumes decrease, dementia risk increases. One of the best examples, and most surprising examples to me of energy availability being this like primary lever, was a study of the mind diet. So people might have heard of the mind diet. This is like a Mediterranean diet version, specifically for the brain, developed as part of the rush memory. In aging projects, they sort of developed a scoring system for a Mediterranean style diet, and they saw that those who adhered most of that diet had had a lower risk of dementia. There was a big randomized control trials published in the New England Journal of Medicine a couple years ago, where they randomized individuals to the mind diet or to a calorie restriction diet. And what they saw was that cognitive function improved the same in both groups. I saw that. Yeah. And like for somebody, people like us who are obviously very focused on neutrals are like, this doesn't make any sense. How can I make sense of this? And what you see, first of all, the calorie restriction group actually improved their diet quality slightly, sort of spontaneously. But both groups lost the same amount of weight. And so when you're in a high risk group who have maybe some element of metabolic disease, they're sort of like on that spectrum somewhere, the most important lever to pull is the energy availability metabolic disease one. And that's just driven by total calorie intake. Now beyond that, I'm sure we see from separate studies that if you improve nutrient intake, you will also see additional benefits. And if you have markers of nutrient deficiency, you have increased risk. But it's just at that sort of population level, energy availability is obviously really key in people who are high risk of dementia. So then moving beyond energy availability, and I didn't write this in the book because it's hard to get the message across succinctly. And this is something that I've done, because I do a lot of work with athletes, this is something I've kind of communicated with them. I think you want to eat as many calories as you can without gaining weight and getting metabolities, which is kind of so that you have enough resources to kind of run the system properly. But what that is for you is going to be very different based on activity and other things. But I think that's an important message because the other one that we see a lot in the longevity sphere is you need to restrict less protein, less calories. And when it comes to the brain, I'm really not convinced that's going to be the best way. But then for most people, it's very easy to overeat if they're eating sort of like a standard type diet. So decreasing energy, density, increasing nutrient density, for most people, is going to be a massive win. It's just going to make it easier to do that. So that's why the other thing I think about is pattern. How do you approach your diet in a way that allows you to do that? Plus get all the nutrients that your brain needs. So the critical ones being vitamin D, omega-3s, B vitamins, getting enough iron, particular in women as they approach that sort of perimenopausal period. There are studies that suggest that a lot of the cognitive symptoms that they might experience might be related to iron status. And there are some other studies similarly showing that be like sort of suboptimal be a be vitamin status even within like the normal range might also be associated with cognitive changes. So enough iron, I've B12, zinc, magnesium, also critical as part of that sort of regulating that whole system. And then I'm really fascinated by the antioxidant polyphenols. I know you are as well. When anybody asks you about superfoods for the brain, I'm like, eat sardines and wild blueberries and you've ticked all the boxes at the same time. But they have really cool acute and chronic effects in terms of cognitive function. As do some of the other, so the things that make berries, blue and purple and red. Similar things, like luteensia, astasanthin, like the things that make salmon and shrimp, pink, we see in people who consume less of those, they have a higher risk of dementia. Some studies have even looked at the brains of individuals without signs of these versus those who didn't have it and see high, you know, in those who were protected or didn't get dementia have higher levels of those compounds. So again, like, really nice like observational and interventional studies. This is just benefit there. And so if you can sort of hit all those nutrients whilst sort of hitting your calorie needs through some kind of consistent dietary pattern that's sustainable and enjoyable to you, that's really my approach. And I talk a lot about nutrients specifically because I think they're like the great level. I don't mind where you get your B12 from as long as you get it, right? Same with your omega-3, same with your zinc. So that then hopefully gives people some flexibility in terms of how they approach it based on their own preferences. It's, I mean, yeah, perfectly, I think we're perfectly aligned there. I mean, so one thing I heard you kind of allude to is energy balance. Yeah. It's ultimately as simple as that. There is a long term consequence to being chronically in a calorie surplus, right? Because you're predisposing yourself to obesity, which is a modifiable risk factor, right? For the 2024 Lancet, you're predisposing yourself to type 2 diabetes, insulin resistance, hypertension, right? And then in a chronic calorie deficit, I mean, I'm not as well versed on the literature there, but I can speak from personal experience like when I'm in a cut. Yeah. And brain doesn't work. And metabolic adaptation kicks in. It's like, yeah, you feel like you're, you know, you're, you're, it's like a browser with too many open tabs. Yeah. Yeah, yeah, exactly. So I think it's a very, a very simple message, but hopefully one that people understand. Like that's, that's the place to start. Particularly if you, you know, you, you do have some elements of metabolic syndrome, like hypertension is probably the, the biggest risk factor for all of them, but predibities and types of diabetes and high blood pressure are consistently the two metabolic risk factors that increase the risk of dementia. And you know, if that's associated with energy excess or obesity and you can improve that. I think it would long term will probably see a lot of benefit at the population level from the new G.O.P.1 medications, right? Because yes, we have to consider our people getting enough total nutrients if they're no longer eating. And yes, you have to consider our people making sure they maintain muscle mass and getting adequate protein and that kind of stuff. But if at the population level, there's so much metabolic disease and we can decrease that and we know that it's a risk factor, I think we'll start to see improvements in overall dementia risk, just because people are improving their metabolic health. If, if that's the way that they, they end up addressing it. 100%. 2026, the year you stop kicking the can down the road. We all have ideas we think about late at night, things we're good at, things people tell us we should sell, but most of them never leave our head. And that's usually not because the idea isn't good, it's because we never take the first step. If you've been waiting for a sign, let this be it. that helps write product descriptions and polish photos and run email and social campaigns all from one place. And when your business grows, Shopify grows with you. More orders, new markets, same dashboard. In 2026, stop waiting and start selling with Shopify. Sign up for your $1 per month trial and start selling today at shopify.com/ginius. That's shopify.com/ginius. Again shopify.com/ginius to start selling with Shopify by your side. Yeah, I couldn't agree more. Did you see that study? There was a study that just came out that found that for obese people who lost weight, there was an improvement in you know, an improvement in metabolic health, which you would predict. But they also, there were changes to the brain. Like an image, it was a, there was like a robust imaging component to the study. It was actually two independent studies that found that brain, I believe like certain indicators of brain volume improved. But then there was also an improvement in cognitive function, which is to say that if you're obese, like if you are overweight or obese, can you improve your brain function by losing weight? Yeah, yeah, absolutely. And so I think that was part of the signal that was seen in that mind trial. And there were other studies, I mean going back decades now where if you take people with types diabetes and you improve their blood sugar control, even if it's with with the medication. So this was studies looking at dipeptidile peptidase for inhibitors, which sort of like the precursors to the GLP ones because they act in that same system. And the more blood sugar improved, the more cognitive function improved. Wow. So we know that improving these metabolic risk factors significantly improves cognitive function. Then there will be an expected downstream effect on domestic risk. Amazing. What are your thoughts on creatine? Everybody's now talking about creatine specifically. I don't even know if we covered this the last time. I'm not sure if the show. But yeah, everybody's now talking about creatine specifically in the context of brain health. Yeah, I think it's really cool that creatine has kind of come into the spotlight and you know, it's something I've taken for a long time. Clearly, you clearly look like you lift. And the creatine is this part of that. I've taken it every day for, I don't know, decades at this point. And I think that creating clearly has some interesting effects on the brain. There are some studies in athletes that show that acute creating use, like a creating loading protocol can improve some aspects of cognitive function. The first study, I think they looked at that was in rugby players. It was sleep deprived, and they looked at creating sort of saw that it helped in sleep deprivation to like maintain complex skills as an athlete. There's that more recent study where they did sleep deprivation, gay people creating and looked at brain energetics and saw maintain cognitive function. Randomised control trials show that particularly as people get older, so older individuals may benefit more from creatine and it seems to particularly benefit memory in terms of cognitive functions. And then there was this one trial in early Alzheimer's disease recently where they gave creatine and saw some improvements in cognitive function. But it wasn't a, like there wasn't a placebo control trial. It was just, they tracked people over time and often in that kind of study, even in people who already have some elements of dementia, you just get better at taking the test. So that could be that could be part of it. So I don't think creatine is magic by any stretch, but it seems to help the body and brain do work. That's why it was used in bodybuilders or is used in bodybuilders and strength athletes. It sort of helps you do an extra rep, helps you maybe have a slight higher level of strength than over time that results in better adaptations. And my guess is that it probably does something similar for the brain whereby if you're challenging the brain and actually using it requires, maximizing that sort of those energy systems and creating this a critical part of the energy system of every cell. And one reason why maybe it's more beneficial in older adults is, especially as people get, if they start to get frail into their sort of 70s or 80s, they eat less, consume less protein, they're probably consuming less creatine. So that might be why they're getting additional benefit. But I think that as, if it's something that people are interested in, we know it's very low risk. Very recent meta-analysis show no increase in side effects compared to placebo across dozens of trials. And they've used it in patients with neurodegenerative disease, so there was one trial that they gave it to Parkinson's patients, high doses for years and saw no side effects. It didn't show any benefit in this trial but didn't show any detriment. Excuse me. So we know that even in older and frailer populations, creatine is probably going to be very safe. So I don't think it's going to be magic, but if some people may benefit from it, especially if they're not getting enough from the diet. Is it fair to say that it is particularly effective in terms of scaffolding a brain under stress? That's what I've, my kind of take on it is that it might not have an acute, it's not like a new atropic, but it kind of supports the brain when it's either under slept or in a stressed state as it might be considered in aging or Alzheimer's disease. Yeah, I think that's probably a good way to think about it. Sleep deprivation is one way to very acutely stress the brain and the one thing that happens with sleep, the one of the main reasons why we lose cognitive function when we're sleep deprived is that we still have all these metabolites, like a denazine that accumulate and they actually actively suppress brain metabolism, brain metabolic rate. So creatine seems to overcome some of that metabolic suppression that you get in that setting, which might happen in other cognitively degraded states might call them. So there's some evidence for creatine improving recovery after traumatic brain injury. Similarly, you see some benefits in older adults in terms of memory function. So I think as the brain is under. stress or the some other kind of issue going on, those might well be states where the brain is more sort of primes the benefit from it. Love that, love that synthesis. What's your current read on like the ketogenic, like the keto literature? I mean, I'm not like a keto, you know, advocate per se, but you know, everybody was talking about the ketogenic diet a decade ago, medium chain triglycerides and the like as a means of kind of, you know, for lack of a better way of phrasing it, keeping the light on. Yeah. I think there's there's there's two parts of it, both of which are important. So in, so like some of the studies you're mentioning done by like Stephen Kenaing, right, took individuals with Alzheimer's disease. When you do a brain scan of individuals without simers, one of the things that sort of pathonomonic, which is a fancy word for saying like if we see this, then we know it's Alzheimer's, right? Or, you know, it's sort of like a signature of the disease. Is decreased glucose uptake into the brain? So one of the concerns is that if glucose isn't getting into the brain, then you don't have the energy to kind of run all the systems, right? So in this trial, when they gave MCTs, they didn't see increased glucose uptake, but they saw increased keto and uptake. So they did like an acetacetate PET scan rather than a glucose PET scan and saw significant, you know, some improvements in cognitive function with that. So kind of overcoming some kind of metabolic block where glucose isn't getting into the brain. So I think in that kind of situation, if we've already gotten to that point in terms of cognitive decline, then ketones become an interesting option. The problem being that there are a couple of small trials, but we're still kind of waiting for some like really good big ones. And it's the same with ketones in dramatic brain injury and other scenarios. You know, we've been talking about them for 20 years. Somebody needs to do these trials so that we can actually see whether it's whether it's a real signal or not. So certainly very interesting and very promising, but kind of I think the jury is still out a little bit. There have been a couple of studies done by Jonathan Mittle's lab at UBC in Canada, where they gave ketone esters one study in individuals with obesity, one study in individuals with targeted diabetes. And they looked at many things including how it affected cognitive function. And those exogenous ketones were like beneficial in one group, but not in the other. They may be improving some aspects of blood flow to the brain, which then could be associated with improvements in cognitive function. But it was quite inconsistent, right? You would expect if it was a really strong signal, both groups, obesity, types of diabetes, you'd see improvement in both, but they didn't. So there's probably some other stuff going on that we still need to figure out. And sort of like the bigger picture of that, when we think about glucose and energy getting into the brain, we often think about supply, right? So it's can the glucose that you have, can it get in or is it being taken up by the brain? But when you're measuring glucose uptake into the brain, you're not measuring whether it's the glucose can't get in or whether the brain isn't asking for it. So if that makes sense. So your like one of the reasons why exercise is so good for blood sugar control is when you move your muscles, right? They take up more glucose. But that's increased demand, right? You have to create the demand in the muscles. And up to a certain point, the brain seems to be the same. So there was a study now is like 20 years old or so, where they took individuals either with normal cognition or with differing stages of Alzheimer's disease. And they looked at glucose uptake into the brain. And then they gave them a cognitive stimulus. And they found that in individuals with even with in the early stages of Alzheimer's, they could increase glucose uptake into the brain so that they looked the same amount as healthy controls did. So you just need they just need to create the demand for that for that glucose in the first place. So I think some of what we see in terms of decreased energy uptake into the brain is that we're just not using those areas of the brain as much. Which is why I mentioned right at the beginning, like how we use our brains as a primary determinant of how our brains function. So some of that may be as we get older, we're just not really creating a stimulus for certain cognitive functions, certain areas of the brain. And as a result, they're not asking for glucose, they're not improving and maintaining their function. And of course, like metabolic health and all those things absolutely matter. We know that. But I think we have to think about both supply and demand to kind of really understand the full picture. I'm sure you've seen some of those studies utilizing intranasal insulin as an intervention. How familiar are you with those? A little bit. I think that in reality, I think those studies have largely been abandoned. I haven't seen any of that research recently. But there was some evidence that there was that you might improve some aspects of cognitive function with intranasal insulin, potentially because you're overcoming one part, you could be overcoming some of that inability of glucose to get into the brain, right? You're overcoming some of that block there. But equally, I think we have to remember that insulin has other properties in the body. It's like trophic, right? It's pro growth. Although, technically, it's more like anti-catabolism in many ways, but it ends up having it having the same effect. So we know that insulin growth factor one, IGF one, a really critical for brain structure, particularly the white matter of the brain. And IGF one production can be in part regulated or stimulated by insulin. So it could be that it's helping with energy metabolism in the brain. But it could also be that it's having a trophic effect through other things that get activated by insulin. But because we also know that over time, additional exogenous insulin can start to drive insulin resistance to an extent, potentially. I don't think that's a pathway that people are really exploring as much anymore, especially as things like GOP ones and other drugs that come up once in the market. Yeah, that makes a lot of sense. When it comes to exercise, there's this perennial, I guess, tug-a-war between the varying exercise factions, whether it's the endurance athletes or the cardio junkies or the the meatheads as it were. Is there in your view, in your read of the literature, does there seem to be one form of exercise that's better than others when it comes to long-term brain health? No. And I think both are important because when you look across, and then there's an additional category that I'll call co-ordinative exercise, which I think does do something particularly magic for the brain compared to the others. And I'll come to that in a sec. But when you look at the interventional literature, randomized control trials of particularly older adults having them do different types of exercise protocols, you see the different types of exercise have different benefits for the brain. So the classic paper with walking for 40 minutes, four times a week, we have risk walking significantly improving, a hippocampal function particularly as cardiovascular fitness improved. And you see this across multiple studies that the hippocampus and other areas of gray matter seem to be particularly benefited by aerobic type exercise with an intensity component. So the best study on this was published again a couple of years ago from an Australian group, you might have seen this study where they randomized people to three different groups. They're like a low intensity group, a moderate intensity group which is basically a jogging group and then a high intensity interval training group where they did the Norwegian 4x4 protocol. So four minutes at 85 to 95% maximum heart rate on a treadmill with three minute break and they did that four times round. And they each did that three times a week for six months. And they found that the high intensity interval training group gained as much fitness as the jogging group. So it didn't improve fitness more as a measure, like measured by VO2 max. But they saw much greater improvements in and maintenance over time of hippocampal structure and hippocampal function. And those benefits were retained five years after into the trial. Like amazing that a six month exercise intervention and those benefits were retained for five years. And it was just like in cumulatively just 16 minutes of exercise. I don't really know much about the 4x4. I came up recently on another episode of the show but it's four minutes repeated four times at 85 to 90% heart rate. So it's hard. And so four minutes, three minute break, four times through. It ends up being a total of 40 to 45 minutes once you've warmed up with the rest and all that kind of stuff. And so doing that three times a week, people who have experienced that pro school, you tell them, hey, do this three times a week, they're like, I'm not sure I want to do that because week, but they did it. And then they also tracked their activity after the study. Everybody went back to their previous activity. So it's not like the people who did the sprints were like, I love this so much. I'm just going to keep doing sprints every like three times a week, they didn't. But they still saw benefits five years later. Whoa. That's insane. The Norwegian 4x4 minus. Norwegian 4x4 minus. I can imagine - The average in sustaining 85%, 90% heart rate output for four minutes. - Yeah. So the idea is that you should be able to, it's an intensity that you can keep the same speed for all four rounds, right? So you may be like in the first few rounds, you're sort of like at that kind of 85% and then towards the end it gets harder as fatigue accumulates, you're sort of like nearer that 95%. I also don't think that you have to do it that way. I think that a lot of that benefit is driven by the production of lactate. And there's lots of ways to produce lactate. And lactate seems to be this like critical link between intense exercise, right? The interval training group didn't get any fitter than the jogging group, right? They both improved their fitness, but not one more than the other. So it's not driven by fitness. The main differentiator is gonna be the things that get released during more intense exercise. And there are lots, so there could be some of these other things as well, right? They release more cortisol, other things. But lactate gets into the brain very easily. There are transporters that take up lactate to the more lactating you're blood, the more lactating you're brain. And lactate switches on BDNAF production. So lactate seems to be this like messenger from intense exercise like to the brain that then produces this trophic factor that supports neuroplasticity and neuronal function. So, but that seems to be particularly beneficial for the gray matter, right? The cortex, hippocampus. Then we think about resistance training. The, you can actually, if you work hard doing, like cortisol squats or something, you can get your lactate up to a similar level, right? You can work that hard. But there are other things that are released with resistance training like IGF1 that seem to be particularly beneficial for the white matter of the brain. So the white, you know, when they measure this, it's executive function, the ability to make decisions, ability to suppress a response if when you need to, right? These are sort of like, aspect of sort of like prefrontal cortex, sort of quick decision making type functions. And when you have older adults again, do a really basic resistance training program. Two or three times a week, six to eight exercises to kind of work the whole body. Three sets of eight to 12, just like the most basic resistance training program. You do that for several months. You see significant improvements in the structure of the white matter of the brain and improvements in executive function. So you can't really pick one or the other because they do different things. So I think a bit of both is important. And so then that final piece is this coordinate of exercise piece. And again, a ton of like fascinating studies where they compare, some kind of co-ordinative complex exercise. So like a team sport or a ball sport, like dancing, I know we talked about dancing, that's not what it's here. And you compare that to some kind of physical activity that's the same level of physical intensity, but you see additional benefits for the brain with the sort of co-ordinative exercise, either a better improvement in brain structure or better improvements in cognitive function. And that's probably because you're layering on cognitive processes that you wouldn't have otherwise. And that are often missing as we get older, right? Responding to a ball being hit at you and pickle ball, you have to process that information really quickly and make a decision away, you're gonna hit the ball back, right? The strategy, you're always thinking about the score, right? So like, impicable, like the scoring system is really complicated. So that's like an additional cognitive stimulus. We're dancing, right? There's a music component, a social component. These things are more fun. So you consistently see, right, all exercise is great for the brain, but you see this slightly outsized benefit from these more complex sports. And I think it's because, especially on average, as people get older, they remove stimuli that require a constantly adapted environment, you're respond quickly, process information quickly. And so these sports are a really kind of safe nice way to maintain those functions. - That's amazing, yeah. I mean, I feel like that explains the line of research on like Tai Chi as an intervention. - Yeah, absolutely. And so Tai Chi is kind of lumped into those studies where coordination seems to have this additional benefit. So several studies show improvements in cognitive function with Tai Chi. So again, another really nice option. So you could broaden that all to all martial arts, right? You're constantly controlling your body. You might be like responding to this other person who's trying to rip your head off. Ideally, it's not a sport where you get punched in the face a lot, right? Because that's probably gonna be counterproductive. But those kinds of things where you're grappling, responding, reacting, and then also strategically planning at the same time, as you would do on a tennis court, or you would do like on a mat in Jiu Jitsu or something like that. I think they're having these very similar benefits for the brain. - Everybody in their mother is doing Jiu Jitsu these days. And I feel like, do you think there is a brain health benefit to doing Jiu Jitsu? - Yeah, I would put it in that sort of same category with those other things. And then layer on top. So actually, I will credit this thought to Tim Ferris 'cause he mentioned it when I was speaking to him about this. The Jiu Jitsu grappling is kind of high intensity of interval training plus complex motor skills and strategic planning, right? So you go in, grapple, maybe it's a few minutes, then you step back, take a break, you're producing a ton of lactate, you're working really hard, but you're also working your brain as you orientate yourself in 3D space, you're getting flipped around and that kind of stuff, right, these are additional stimuli that you're getting. So yeah, as long as you're not getting need in the head, I think the Jiu Jitsu is actually probably pretty cool in terms of brain health. That's so cool. My brother is a huge fan of, he's a fighter, he does it. I took a boxing during the pandemic and I thought it was insanely powerful for the stimulation, the brain health aspect of things, until I got hit in the head. And that was like, I'm out. - That's really come out. - The way that I do that, I really like, and I think that this is a brand new sphere for cognitive stimulation that I'm really excited about and sort of like doing some work in is an virtual reality. So I use supernatural on the Metacrest headsets, it's just like VR boxing. It's so much, honestly, it's a ton of fun. So like it's music that you recognize, the target's kind of come at you in time with the music, but they're like, often coming from multiple directions. And it's a really good workout. So I mean, I have no affiliation with them, but I really enjoy that. So like, if you enjoyed boxing, but you don't wanna get punched in the face, I would try it, I really enjoy it. - Is this the Oculus headset? - Yeah, I have one of those. And I was doing it back in the day and then I just kind of, now it's gathering dust somewhere. But yeah, I remember that. Great workout too. - Yeah. - Yeah, a ton of fun. And sort of like if we expand beyond that, I think that it offers us a really cool opportunity to create cognitive stimulus in ways that are much more similar to how the brain normally learns. Right? So you can have like complex visual stimuli, or a true stimuli, you can require fine and complex motor movements, you like respond to whatever's being sent at you. So whether it be boxing or there are some platforms where you kind of have to make these very distinct hand movements to kind of hit balls in certain directions or respond to certain things. And you can sort of like layer on physical, cognitive stimuli in a relatively sort of safe way and then increase challenges in that way. And we know there's a good literature on video games for helping being an option to support cognitive function. I think VR, if used in the right way, could like really expand that even further. What about the, there's long been the perception that doing like crossword puzzles and games like Sudoku and even switching, otherwise mundane tasks but like using your other hand to brush your teeth with do those have any benefit? So, up to an extent maybe, but probably not as much as been sold to us. When I think about the kind of stimuli that we know sort of support or maybe even improve cognitive function, regardless of where we are in life, like we're thinking about education and educational attainment like long term slowly improving, learning, showing that we've developed expertise by passing exams or whatever, cognitively stimulating work where there's complex social interactions and we're problem solving and we're always having to learn new things. And then languages, music, dancing, sports, these are multi-dimensional, multi-sensory, long term stimuli that really help to drive function. Whereas, I think that Sudoku and cross-wise things that that can be nice, but they're not really challenging the brain in the same way. And when you sort of, Gloria Mark has a nice framework. She's a psychologist who's looked at how we use our brains, particularly in the workplace, but she has sort of like a framework for how our brain is challenged or engaged by a specific thing. And it's sort of, it's based on, it's like a two by two table sort of based on the amount of focus it requires and the amount of cognitive challenge that we feel. And like Sudoku's and Crosswords fall into this bucket where we're focused, but we're not really challenged. Right? And this is what she calls, "rotate attention." So yeah, actually, it can be quite nice to do. It's a bit of a break. You can learn a bit of a new skill. You feel good when you've completed it. But what we really want is, at least intermittently, so that we can build capacity as things require a lot of focus and where we're challenged. And so that's all those other things that I mentioned earlier. And they probably have greater benefits in terms of long-term cognitive function. Well, this was so helpful, so interesting. And I'm so excited and grateful that you put this tone out into the world, this stimulated mind. I implore everybody to pick it up. I mean, this is the most important topic in my life. I mean, obviously I went through almost a decade of seeing a loved one descend down the neurodegenerative, just descend into the neurodegenerative abyss. And it was the most heartbreaking thing to witness. And if I could help anybody, forge a different path for themselves or their loved ones, I mean, I think that that's, yeah, that's my mission in life. And so I'm just so glad that you've put this out. And I know that, you know, this is a topic that has been many years in the making. I mean, when I first got started, you couldn't really talk about dementia as a potentially preventable condition. I mean, you would be considered like fringe or something. And now it's something that we just like take for granted. But it's due to people really pushing this issue forward and doing the hard work, doing the research. And so I applaud you for your work, for your efforts. And I'm just so pumped for people to get their hands on it. Thanks so much. I really appreciate this. I know that you've also been banging this drum for a long time. And I hope it's making a big difference because I think it can. Obviously, I hope nobody ever gets dementia. And anything that we can do to change the trajectory and the experiences of those individuals and their families, I think, is important. That doesn't necessarily mean that we can always prevent it, right? And I think that it's worth remembering that what we're trying to do is sort of stack the deck in our favor as much as possible. And/or improve our quality of life, should we experience some progress that's required and all of those things can happen through lifestyle and the environment. So no blame to anybody like nothing like that for people who have experienced it. But hopefully if the more information we have and the better we able to institute this at the individual and population level, I'm really hopeful that we can make a big difference there. Yeah, knowledge is power. And implementing that knowledge, I think. I mean, it's like what is knowledge if not implemented? Yeah, absolutely. Yeah, so thank you. Again, where can people pick up the book and where can they find you on social media? So it'll work. The book, you can go to the stimulatedmind.com, or my website, drtommywood.com, and all the information is there. Or, and then you can also follow me on Instagram @Dromiewood, all the links and various things, substalk and podcasts can all be found there. And I really appreciate anybody either reaching out or picking up a copy of the book. Love it, man. You're one of the greats. So thank you again for coming out and giving us a bit of your time, really appreciate it. And thank you guys for listening. Share this episode with friends and loved ones that may benefit from it is a crucially important topic. And we are all vulnerable as Dr. Wood alluded to, you don't necessarily have to have a genetic risk factor necessarily. If you have a brain, you are vulnerable to some degree. Wooden you say? Yeah. The, I guess, three main risk factors for dementia, unfortunately, are be human, be old and have a brain. So anybody who fits into those categories, I think, should know that they first, that, yeah, maybe there's some risk, but also that that risk is something that they maybe have some control over. Love it. Thank you guys. I'll catch you on the next episode. Peace. Hey guys, thanks so much for listening to this episode of the show. If you enjoyed it, hit subscribe and leave a rating and review. It really does help. And don't forget to grab my free weekly newsletter at maxlougavir.com/newsletter for science-backed insights, expert interviews, and exclusive discounts. No spam, just good stuff. Catch you next time. [MUSIC PLAYING]