The Psychology of Fighting Dementia | Dr Tommy Wood

Right now, I think in the U.S., somewhere between seven and eight million people are living with dementia. Worldwide, seven to eight times that. And the burden of dementia is expected to double or triple in the next two decades. That's alarming. How much of dementia risk is actually within our control? They estimate that potentially 45% of cases of dementia could be completely prevented. There are other analyses that think it could be even higher than that. They include things like. Welcome back. Or welcome, too, the Finding Mastery podcast, where we dive into the minds of the world's greatest thinkers and doers. I'm your host, Dr. Michael Jervet. Today's guest is Dr. Tommy Wood, physician, neuroscientist, associate professor of pediatrics and neuroscience at the University of Washington, and author of the stimulated mind. Future proof your brain from dementia and stay sharp at any age. What we think or expect to happen to our brains doesn't necessarily have to be true. Regardless of our family history or our genetics, and hopefully that means that we can put ourselves in a position to decrease the likelihood of decline and potentially dementia towards the end of our lives. In this conversation, we explore what dementia actually is. Who may be most at risk and why some of the factors that shape long-term brain health are more modifiable than many of us realize? If a parent has dementia, can you speak to the listener here about how they should be thinking about themselves? If you had a parent who had dementia, a great place to start is. With that, let's jump into this week's conversation with Dr. Tommy Wood. - Tommy. - Hey. Hey, that's a good way to start. You know, I've been looking forward to having you back on. One, because we're running in similar circles, which is fun. We'll get into some of our cross-pollinations in a minute. More than anything, though, you've got a rich understanding of the brain from high performance into health, that kind of wide chasm there. So, can we just start first with what do you hope the listener will get from this conversation, from somebody who has been a student of the brain for a long time? The main thing I hope people get out of this conversation is an understanding of how much power they have over their own cognitive health now and then for decades into the future. And an appreciation of the fact that what we think or expect to happen to our brains doesn't necessarily have to be true, regardless of our family history or our genetics. There's still a lot that we can do and we have a lot of power over our brain health and our cognition. And hopefully that means that we can put ourselves in a position to decrease the likelihood of decline and potentially dementia towards the end of our lives. My understanding, I don't know, from most of my training, was you reach a certain age and your brain is on a decline. And that I would imagine is the prevailing wisdom and in your book stimulated mind, you've highlighted a different way of thinking about it. So, can you just address that prevailing idea that your brain hits 65? I think it starts at 40 is where I learned and then there's a decline and then there's a bit of a shelf after a certain age. Can you just beat that up a little bit? Sure, so there's two parts of that and a lot of it I think goes back all the way to the beginnings of neuroscience. And I love being a student of the history of the fields that I work in, right? So, the father of modern neuroscience is Kahal, remote Santiago de Kahal. He got the Nobel Prize in Physiology and Medicine in 1906, which he's shared with Camilo Golgi. And they actually disagreed so much about the nature of the nervous system that they refused to give their acceptance speeches on the same day, which I thought was fascinating. But Kahal was the person who essentially described that the brain was made of individual cells, which we now called neurons. He didn't call them neurons, they were somebody else did later on. And he also told us or had this idea it's written down that the adult brain is immutable as it is words. And so, this is something that we've thought ever since that the adult brain becomes fixed at some point and then it starts to decline. And that decline part I think comes from other aspects of what we've kind of baked into society since the beginning of the 20th century. So, I think some of this comes from the work of, or the teachings of people like Sir William Osler. So Sir William Osler is a legendary physician. I went to Oxford Medical School. He was Regis Professor of Medicine at Oxford at the beginning of the 20th century. Everything is named after Osler in Oxford. He was a Canadian physician. He was one of four physicians that founded Johns Hopkins Hospital. And one of the things he did is he popularized the idea of retirement, which before the beginning of the 20th century wasn't really a thing. People worked until they died, essentially, because they had to. And he told people, by the time you're 60, you're essentially useless. And I think he would use the word useless and you should be put out to pasture. He did use the word, yeah. And this is something that we've kind of internalized as a society. And I'll be fair to him that in 1904, the average lifespan in the US was 57, I think. So, the average 60-year-old was probably not in great health. But we've advanced medicine and health care a lot since then. And now we shouldn't think the same way about either our bodies or our brains. And there's even evidence going back to the middle of the 20th century. One of the first studies that looked at people over time and measured their cognitive function in the same person over decades, I was actually done in Seattle. The Seattle Longitudinal Study, run at the University of Washington by Warner Shai. And what their data show is that the average, you know, more than 50%, maintain cognitive function from their 50s and into their 70s and beyond. And that's not what people expect. Those data are actually used to raise the retirement age in the US in the 1980s. But we've known for 70 years that the average trajectory is that you shouldn't see significant decline in those sort of years from your 50s into your 80s. But we never really kind of updated our thinking about that. And so people still expect that they'll reach some age, decline is just going to happen. And then because of that, I think that nowadays it almost becomes self-fulfilling when people do experience it. Because we tell ourselves, oh, I'm too old to do that. I'm too old to do these things that actually are the same things that would help you to maintain function. For example, so physical activity, I'm too old to lift that, that's too heavy. Or new skill learning, or I'm too old to learn. I can't learn like I used to when I was a kid. And we also have data that show that that's not true, that older adults can learn almost as fast as kids, as long as you give them the environment to do that, which is less common. For example, so I've got it to work. Yeah, I mean, it's essentially a process of challenging yourself in some kind of complex skill and dedicating focus and time to doing that. And there are dozens of randomized control trials where older adults learn new skills, languages, sports, musical instruments. And you see significant improvements in cognitive function. You see changes in the brain when they do MRI scans. But one of the reasons why we don't do that when we're older is we have this expectation that we can't. And so there's this idea of stereotype embodiment theory, like we embody an aging personality because we think that's what we expect to happen. And it almost becomes self-fulfilling. It's pretty radical. Aliyah Krum, Dr. Krum, had a Stanford, did a bunch of work on belief sets. And one of the really interesting findings is that if you believe something is going to be fattening, tasty, and delicious, and indulgent was the word that she used that had lots of calories, it was metabolized differently than the same shake that was labeled sensible. Yeah. So Aliyah Krum worked with Ellen Langer, and Ellen Langer, who's from Harvard and Ellen Langer is the person I took that word stereotype and that phrase stereotype embodiment theory from. Because that comes from her original studies and nursing homes of telling people about how much agency they have over their lives and that then affecting their disease and mortality risk. So it's all part of this incredible string of work done by people like them. Yeah. And for fun, Ellen did something remarkable as well. I would call it her hallmark study is that she manipulated the environment and had a bunch of people that were older, right? I can't remember the exact age. Let's say 65, 70, somewhere in that range, maybe it was older. And then manipulated for X number of days, the environment that they grew up in when they were younger. So the radio looked like the radio they had when they were 1920 in that age. And then she measured a bunch of variables on aging and functioning and whatever. And there was a noticeable impact on the way people felt and expressed their capabilities based on just manipulating the environment. So if there's this two pronged approach, which is the environment matters, your belief set, which is the internal system that you work from matters. And you're saying, right, if you just believe that you're going to get old and your brain is going to get feeble, then such happens. Now you and I can travel between high performance and kind of the one of the more compromising cognitive structures called dementia. I want to spend time on dementia. Can you first describe what dementia is, walk us into why you wanted to study dementia, and where the hope and the path is from your research? Dementia is an umbrella term for a group of conditions where you get a clinical diagnosis due to the fact that you've lost enough cognitive function that you're no longer able to look after yourself on a day to day basis, and sometimes you have to rule out some other things like psychiatric conditions or things like that, and you would hopefully try and get some idea of the subset of the type of dementia. So the most common is Alzheimer's disease, which most people will have heard of. That makes up something like 60% to 80% of cases of dementia. The next probably most common is vascular dementia, so affecting blood vessels in the brain primarily, although increasingly, the field is appreciating that it's very hard to get very distinct separations between all these different types of dementia, and actually the pathology, which is generally proteins accumulating in the brain can overlap across a lot of these, but vascular dementia and Alzheimer's disease often occur together. So together they make something like 70% to 90% of cases of dementia. Then you have things like frontal temporal dementia, dementia with Louis bodies, those are the most common ones. Those first two that I was talking about, Alzheimer's disease, and vascular dementia, there's an increasing appreciation for the fact that they are quite closely linked to lifestyle and the environment in terms of their risk. There are genetic components and other things as well, of course, but it's increasingly appreciated that particularly those dementias are potentially at least partly preventable, and by preventable, I mean, at a population level. So they've done these big statistical analyses where they say, if we eliminate, if we could somehow eliminate these risk factors, this proportion of dementias we would expect to never occur in the first place. And it's important to make that distinction because often when you talk about dementia being preventable, understandably, people who've your family members or loved ones who experienced dementia, you could interpret that as saying, I was somebody who got dementia, it was their fault, because they didn't do these things, which is absolutely not the case. We can decrease our individual of risk, but you couldn't say I could completely prevent one person from getting dementia, but we know that if we changed lots of things in the population level, we can significantly change population risk like we've done with heart disease, for example, that's from heart disease, which tend to be coming down. Between these two, can you just describe the nuances between the two? And I think our community is, there's probably two things for us. One is, I don't want dementia, and the second is, my parents are kind of right in the middle of it, so can you help me on both fronts? Yeah, there's a confluence of factors that come down to determining somebody's risk of dementia. And I think we can talk about dementia fairly broadly here, because sometimes the separation of type is a little artificial, that's what I was kind of saying. And what you tend to see is an accumulation of proteins in the brain, so particularly for Alzheimer's disease, we're talking amyloid plucks and towel tangles, so the abnormal accumulation of proteins in the brain. We also see changes in blood vessels, so impaired blood flow to the brain. We know that blood flow, as it delivers oxygen and energy and nutrients, is a really critical for the brain to function as normal. This is one reason why heart disease risk and dementia risk are quite closely tied together, because what's happening in the blood vessels in your heart, that might cause a heart attack, very similar processes are happening to blood vessels, either on the way to the brain or in the brain, which can affect brain function. And with these, when we're then talking about which factors may be modifiable in terms of dementia risk, probably the best accepted list is a list of 14 factors published by the Lancet Commission on Dementia Prevention, which is overseen by Professor Jill Livingston. Between these 14 factors, they estimate that potentially 45% of cases of dementia could be completely prevented. There are other analyses that think it could be even higher than that, but the 45% is probably the most accepted number. They include things like education, cardiovascular disease risk, so high LDL cholesterol, diabetes, obesity, physical and activity, smoking, excessive alcohol, brain trauma, loss of vision or hearing, and social isolation. And many of these things are probably factors that people have heard again and again, when we're talking about what does it take to have a healthy life? And it really seems that if we can address these factors, we can significantly reduce our dementia risk. And I think there are other factors that we can and should build in as well, but even just those core ones, maybe enough to dramatically change the trajectory of brain health at the population level. Did you use social economic status or did one of those come forward? Because it's really hard to do some of these things if you are deeply struggling. Absolutely. And this is one of the core potential criticisms of this kind of approach, which is that socioeconomic status determines so much of whether these risk factors are modifiable in the first place. Does this person have access to education? Can they finish high school? Can they get a college degree? Can they get a graduate degree? I think we have to accept that for some of this to change, we need full-scale societal change rather than just saying, hey, you person, you need to fix all these things, because that's obviously not possible for most people. And so some studies, so I mentioned that other studies have suggested that maybe even a greater proportion of dementia is preferentable. One study was done in the UK Biobank. They estimated potentially up to 70% of cases of dementia were preventable, but a big chunk of that was if we could change aspects of socioeconomic status and socioeconomic deprivation. Got it. Finding Mastery is brought to by granola. Here's something that I think most of us miss without even really realizing it. Every conversation that we have has two layers happening at once. There's the conversation, the obvious conversation with the words themselves. And then there's everything else underneath. That's the emotional language, the subtle tones of voice, micro expressions, the brief pauses before someone answers. That second layer is really rich with information. And in meetings, it's easy to miss it when our heads are down and we're taking notes. That is why I use granola. Granola is an AI-powered notepad that makes your meeting notes useful. It captures what happens in your meetings and then turns them into clean, structured notes with decision and action items pulled out and made it easy to find. And the best part, it works right through your devices audio, which means that it integrates seamlessly into the video conferencing tools that you are to use. No big setup, no awkward bots. I use it every day when my meetings are done. There's a clean recap and a clear set of next steps that are just waiting for me. Nothing slips away. This isn't about doing less. It's about being more present. I think you're really going to like what granola is doing. Once you try it on a first meeting, it's hard to go without. You can try it totally free. Head to granola.ai/mastery. That's granola.ai/mastery to get your time back. Go to granola.ai/mastery and try it on your next call. Finding masters brought to you by LinkedIn Hiring Pro. When you're building a small business, every new hire has the potential to make a real impact. The right person, they can bring fresh energy and new ideas and really help the whole company move forward. It's awesome to watch when you get it right. So finding that right person, finding that great hire, it takes clarity. You have to know what you're looking for. You have to recognize it when you see it and then make the call with confidence that this is the right hire. That's where LinkedIn Hiring Pro can help. It's really like having a hiring partner throughout the entire process. You can chat with it just like you would a recruiter. Tell it what matters most for you for the role, compare candidate side-by-side, you give it feedback and then hiring pro-lissons that adjust. It helps surface the people who actually might fit what you need. They're trying to help us optimize. We're still the ones making the decision. LinkedIn Hiring Pro is just a smarter way to find the right people to build the team of your dreams. Now, if you haven't already checked them out, LinkedIn Hiring Pro can really help your business. Yet started by posting your job for free at LinkedIn.com/mastery. Terms and conditions apply. Again, that's LinkedIn.com/mastery. Okay, so from my lens professionally as a high-performance psychologist, is that when somebody asked me like, "Okay, how does somebody have a high-performing mind?" I'm like, "Oh, geez." You know, it's a bit like the Panama Canal. There's a handful of things that need to take place for the whole thing to work well. And there's a few things that are maybe first movers that do kind of get the other things on a path of development and execution. So when you think about the first movers here, which ones are you most interested in? When I think about the list of potential risk factors or modifiable factors that affect cognitive function and dementia risk. When we normally interact with these, and we might see them in scientific papers, those scientific papers might get turned into Instagram posts that you'll see, which are very evidence-based. But you might have 20 or 30 things as a list. And the most truthful answer is, well, the most important ones are the ones that you're not doing, because that's going to be different from person to person, and I think the way that different. This fact is interact in different people over time then creates the fact or the output is that their cognitive trajectory is different over time and that is different for everybody. We don't all experience one trajectory or one kind of rate of decline. Even individuals with dementia all look very different. So I think that tells us that it's this, the way that all these different factors interact within an individual that kind of gives that output. So to kind of understand that, the way I think about it is I have this model in my head that I call the 3S model and I think the majority of risk factors that have strong evidence for their relationship with cognitive decline and dementia fit into these sort of three core mechanistic buckets that interact with each other. So it's not a list, it's kind of like this interacting network. So the first S is stimulus and in that list I talked about earlier, I talked about education. We know that educational attainment is an important risk factor for dementia. So is late life, cognitive engagement, the type of work you do, the hobbies you do, the skills you learn, the activities you engage in, the people you engage with. And I think that the majority of tissues in the body, even outside of the brain but including the brain, their function is determined by the stimulus that we apply to them. So there's a huge amount of parallels between physical function and cognitive function. You can't quite see the output the same with the brain, but everybody knows that if you want to get stronger and fitter, you have to train, right? You have to lift weights, you have to sprint, you have to go running, whatever it is that you're trying to get better at. The stimulus is the primary driver and yes, we can get the most out of that training by having adequate nutrition, optimizing recovery strategies, all those kinds of things. Very important. But unfortunately you can't drink protein shakes and nap and get bigger biceps, right? I wish it were so, but it's not. You have to go to the gym. Oh, that's stimulus. Yeah, yeah. The stimulus. Well done. And I think that all the evidence that we have suggests the brain is the same and actually some of the biochemical processes are even identical. So this, I think, is the primary driver of how our brains function is how we use them, how we engage in how we engage in the world. And so that's important. Early in life and it's important as we navigate adult life and then go into retirement and old age. Meaning putting your brain under some sort of proper levels of stress. Some of you want to hear the word stress or like, no, I don't want more. I don't need more. You and I would say, no, stress is required for adaptation. Being looking for the right levels of acute stress and the right levels of recovery over and over and over and over and over again, in stimulating complex ways is actually the broth for an amazing cognitive performance, if you will. So you're saying just the way our bodies grow, our brains do the same. We can't see a bigger brain, like a bigger bicep, but we do see what in the brain. So if we could do scans of your brain which is done in research, you can see that when people are exposed to a new stimulus and that could be a physical one. So we've seen in older adults, if you start them on a new training program, depending on the type of training, you can see physical changes in brain structure. The brains can actually get bigger, even in those 60s and 70s, which we never thought was possible previously. And you can see some similar things. If people learn a new complex skill, there are some great studies in London taxi drivers where they memorize this huge map of London and their hippocampai or parts of the hippocampai which are really important for memory, they get bigger, even in adulthood. So we can see the brain get bigger. It's just that not everybody's getting an MRI scan. Yeah, it's more of the idea that neurons are fired together, wired together. And that study was a groundbreaking study for so many of us because we're like, oh, wait, if you do something over and over and over again for an extended period of time and you're really good at it, there's a structural change that takes place. Oxygenation as well would be a really important factor that you just mentioned. And when you're stressing the system, just like your physiological system for muscles or whatever, there would be an oxygen exchange that would be favorable both to from the heart to the muscles to the brain as well. Yeah, so do you find the same when you're doing complex, solving complex or doing complex things that there's also an equal oxygenation? One kind of core aspect of healthy brain function is this idea of neurovascular coupling which is when you stimulate a network in the brain, a group of neurons to do a specific task. Those neurons in the astrocytes, which are another type of cell in the brain, neurons only make up about half of the cells in the brain. We don't realize there's a bunch more that's going on in there. That was actually the primary argument between Golgi and Kahal was neurons versus other cells in the brain, like which were most important and to they're all important. But neurons in astrocytes, they stimulate the local blood vessels to expand, to dilate. So the blood flow to those areas of the brain are very tightly linked to activity in those areas of the brain. So this is another reason why it's so important to have healthy blood vessels or healthy vascular. But yes, that's exactly it, those areas become activated, they need the greatest supply of oxygen and energy and they ask for it in those vessels to dilate, just like what happens in the muscles when you start to exercise them. It's amazing how important it is. This is why smoking is such a problem, sitting is such a problem. Both of those alike is that we are starving our bodies for something it really wants, which is oxygen. All right, let's ground the conversation in numbers. So what are the most recent numbers internationally and nationally that you're working from for people that do have dementia? Right now, I think in the US, somewhere between seven and eight million people living with dementia, worldwide, seven to eight times that, something like that. This number is increasing and the burden of dementia is expected to double or triple in the next two decades, depending on who you ask, it might be by 24 to go by 2050. That's alarming. It is alarming. And there are even news articles where they're saying Alzheimer's disease is going to bankrupt Medicare because of the huge burden that it's going to create on the healthcare system. And I think it's important to think about why this is. And also, there are other ways to look at the data that are not necessarily quite as alarming and that give us some hope. So one reason why the burden of dementia is expected to increase is because we're living longer and we're living longer because we've become better at treating other diseases. And so hard disease has been the number one cause of death in the US for a long time. It's probably going to stay that way, but the numbers are decreasing. And so Alzheimer's disease is kind of making its way up the list. We're actually in many high income countries is expected to be the number one cause of death in the next couple of decades. I didn't think that Alzheimer's killed people or the dementia killed people. So it's often kind of the primary driving factor than those complications, right? Because you become bed bound, you fall, pneumonia is like those kinds of things. It's a first domino or it's an important domino, not first. Yeah, okay. Like kind of like the underlying. Yeah, okay. And of course, there could be things like sometimes people could get seizures or other things that that's kind of like the trigger, but it's sort of that fundamental change in that individual then drives their risk of the thing that might be the final cause of death. So we need to stimulate ourselves, including our brains, right? Okay, so that's the first S of your model. Yeah. Second S. So the second S actually ties in very nicely with why I think we don't need to be so worried about the numbers. But why they don't need to be as concerning as why they might on first blush. So when you look at one way of sort of slicing the data on dementia, we might look at something called age specific incidents, which is at a given at a certain age, how likely are you to be diagnosed with dementia? So at 70 or 80 as old, how likely are you to be diagnosed with dementia? An age specific incidence has been decreasing for the past several decades. At 70 or old now, you are less likely to be diagnosed with dementia than any other time in history. One of the reasons why it's thought that age specific incidents is decreasing is because we've done quite a good job at the population level of treating and preventing heart disease. And so the heart is doing better. Yeah. We've got medication. We've got behavioral and psychological remedies. And so there's more oxygenation taking place. So the brain is a little bit better. So we've pushed down the road, this kind of set of complications. Yeah. And so on top of that, of course, we are living longer. And so if we do get dementia, we may just get it later. But it gives us this. It shows us that if we do these large scale interventions, we change things at the population level. We improve healthcare on these related to these risk factors. We could actually start to move the numbers on this. So that's why I think that gives us some hope. And so why this ties into the 3S model is because the second S is supply. So we already talked about blood supply. Why it's important. Another supply that's really important is energy supply. So the brain primarily runs on glucose. It can run on some other things, lactate and ketones and depending on what state you're in. We need healthy energy, right? regulation essentially. So metabolic health is critical. This is why diabetes or metabolic diseases or metabolic syndrome is a risk factor for dementia is because it impairs energy metabolism. We also need a supply of nutrients that make neurotransmitters that help create the actual physical structure if we're rebuilding that or building that. And there are some nutrients that have quite good evidence for their relationship with cognitive function later in life and dementia risks. So omega-3 fatty acids, vitamin D, iron and B vitamins are probably the ones with the best evidence. There are some others, certainly zinc, magnesium, flavonoids and polyphenols, fiber. So like all these things that you might get from a. Let's just pick those apart. Those are really important. People throw them around like I did not know how to create a intelligent intervention until I started to measure them. So I could very easily go find a high grade omega and take 2,000 milligrams on average. And I was doing that for a long time. I do it twice a year. Just take a look at my nutritional panel on it. And yeah, I'm kind of wasting money. So I'll go on and off now because I'm tuning to it. Same with vitamin D and whatever. So can you just kind of go down your best practice for either measurement and/or just kind of a general guidance on how to go about being better on those supply functions? Yeah. Ideally, these are things that we would get measured and assessed. And that's getting easier and easier to do. So get your cardiovascular disease checked, you know, at least probably starting in your 40s. Yeah, that's the number I have in my head as well. And then I'm starting to see people talk about why not get one 18, 20 in that range as a baseline. Would you have any concerns about a young baseline? I'd have no concerns about a young baseline. What it comes down to really is access and then how you interpret it and how you act on it. So one of the hardest things for doctors to do is not do anything in response to a test result. It's mainly avoiding being over results in just like suddenly spraying everybody with supplements and medications that they might not need. But we know that the primary time at which risk starts to diverge in terms of dementia is midlife. So really late 30s into the 50s, early 60s, that's when the risk really starts to increase. So that's the critical period when you want to make sure as much as possible that you're addressing these things. The two cardiovascular metabolic risk factors that are most closely tied to dementia risk are blood pressure and blood sugar. So having high blood pressure or being pre-diabetic or having typed diabetes. And there are data from randomized control trials that show that if you have high blood pressure and you treat it, you significantly decrease dementia risk. So that's one that we have some pretty good evidence for. So say it again in the converse. If you have type 2 diabetes or you have an issue with the metabolic structure of glucose, what is the likelihood that you would have dementia? The best answer is I can't give you an exact number. It's something like a 2-3-fold increase in the risk of dementia. But like when we talk about changes in risk, that's assuming everything else is the same. You only change, like these are kind of like statistical things that come out of a specific model. So one thing that I try and avoid as much as possible is put an exact number on something for that reason. We know that it's a meaningful increase in risk and you will meaningfully decrease your risk if you address it. But like whether it's two and a half times or three and a half times, we have this thing, we're like precision bias. Like it sounds smarter because I can give you a number. But in reality, there's also an error band around that and you'd have to talk about the exact model that gives you the numbers. What you're pointing to is a meaningful trend that if this is the case, then there's an increased chance. The number is not as interesting. However, for all host of factors, pre-diabetic type 2, you know, type 1, getting that under belt is a really important investment in overall health to mention it otherwise. And then let's just stay here for a moment that folks that might be on that arc. Finding Mastery is brought to you by Athena. The psychological skill of control is something we talk about regularly here at Finding Mastery. And part of that skill is being honest about what's actually yours to carry and being clear about what is not. Not every task deserves your time. Even when it really needs to get done. If you're leaving a company or a team, there is so much competing for your attention every day. You know that. You feel that. The inbox, the calendar, travel, hiring, glisco's on and on and on. And just because something needs to get done doesn't mean it needs to get done by you. That's the shift that Athena is making possible. They match you with a dedicated full-time remote executive assistant. It's a real person who takes on the inbox, calendar, travel, the details that fill up your day. They're EAs. They come from the top 1% of more than 60,000 applicants, the best of the best. And they're fluent in AI tools. They make great support. They support you even better than you can imagine over time. Clients, on average, get back 15 hours a week. How about that? Take control of what's in your control and learn to delegate the rest. Check out what Athena is doing. I think you're really going to appreciate it. Go to Athena.com/mastery right now and get matched with your EA. Give yourself a few hours back this week and go to Athena.com/mastery and see who they pair you with. Finding Mastery is brought to you by our partners at Lisa. Most of you know that I have a morning mindset routine. It's what I do every morning before. I check into the world around me. I check into the world inside of me. And it's just a few quiet moments to set my intention for the day. Make sure I answer to the things that I'm grateful for. And I want to focus my attention on what matters most. And what that does is it wakes up the mindset to help me bring the best of myself in the day head. Generally speaking, I wake up feeling pretty good. No aches, no stiffness. Nothing pulling my focus, you know, the minute that my eyes open up. So when your body gets the recovery it needs, it is so much easier to set your mind up to help you be your very best. So that's why we turned to Lisa for some support. We've worked with Lisa for a long time now because they build quality crafted mattresses that are tailored to how you actually sleep, your position, your feel, all of it. Premium materials, premium mattresses, real full body support, the intention they put into their products is real. I love what they're doing. Go to Lisa.com for up to 30% of mattresses plus get an extra $50 off with the promo code mastery. Exclusive for our listeners. That's L-E-E-S-A.com promo code mastery for up to 30% of mattresses plus an extra $50 off. And let them know we sent you in the survey after check out. Do you have any best practices that are of interest to you? With metabolic disease broadly now. So Safia have types of diabetes. We have some pretty good medications like Metform and has some good evidence for it. And then there's also, obviously, lots of evidence around diet to change physical activity. Lifestyle plays a huge role here. Lifestyle is the primary driver of these diseases in the first place. If lifestyle changes aren't enough, which for some people that they aren't, and that's fine. Right now, the GOP1 agonists are doing them. I mean, they're doing an incredible job, decreasing metabolic disease risk and hard disease risk. We don't have the evidence for dementia yet. Those trials are being done. But I think that in terms of the big shift we're seeing in terms of obesity, metabolic syndrome, dramatic improvements in blood sugar, blood pressure, I expect that we're going to see that really pay off in terms of dementia risk if people are addressing it that way. What about folks that are, you know, we're in the land of Los Angeles here where folks are three pounds overweight. You know, that is some ridiculous number. And they're using GLPs to really shape their body. But it's an awful label use. Let's call it to be generous. What are some of the risks for that population of folks? Because at the finding mastery community level, I do not want us to fall into the trap of needing to look a certain way to be okay. Yeah. And I do want you to use every lever that you possibly can to be your very best psychological behavioral, physiological medicine like all of them. And so, but what is the dark side of folks that are trying to look a certain way when they actually don't need it? Two parts to it. One, maybe you can speak to as well, which is the psychological side. From the health intervention and the lifestyle habit, literature, there's actually quite a lot of evidence that says that if you're constantly saying that you're not doing enough, right, I think I should be sleeping more. I think I should be exercising more. Regardless of how much you are actually sleeping or exercising, you tend to have worse health and worse health outcomes. And I think that that's because of the effects that our mindset and our psychology has on our physiology that we can physically measure. You see changes in autonomic function. The other side is, well, there's I guess two, then we could bring it apart two ways as well. When we're then looking at, say, the evidence or the potential downsides of taking, say, medications to look a certain way, the best evidence that we have when it comes to metabolic health, body composition, things like that. And as they relate to most chronic disease, dementia risk is that you mainly just want to avoid the disease state, right? So if you don't have pre diabetes, if you don't have high blood pressure, like you're good, like more isn't more as far as we can tell. And so constantly trying to optimize for a certain number below those thresholds. We don't actually have evidence that that's any better for your health. All interventions have side effects, right? There's been a lot of talk about geography ones and muscle loss. I think what we've started to see more of -- and this is particularly in the setting of obesity or metabolic disease -- is that yes, some lean mass is lost, but a lot of it is probably fat being lost from the liver, which counts as lean tissue, and also fat being lost from the muscle, which is actually a good thing, because that improves muscle function, and often strength is maintained. So I think some of the concerns about muscle loss have been oversold, but equally, you can get to the point where you're not eating enough to maintain nutrient status, get adequate protein, to then have your body get everything that it needs. Most of the data we have so far on muscle loss comes from individuals who were potentially at a beast to start with, or they had a beast to start with. So there's actually far less data on people who are a normal body weight than to geography ones, because they're not -- the people in the studies, because this is the off-label you. So I would still have concerns about muscle loss at that lower end, particularly if they're not eating enough to not fuel enough, and they're not doing resistance training, which is the primary way that you would then build on maintain that muscle mass. How important is it to get glucose slash prediabetes, like how important is this when we're going after optimization? Again, there's two parts to that. One is the avoiding prediabetes or diabetes, because you do see significantly increased risk of dementia, but also several other conditions, heart disease, depression. There's a whole host of conditions that come with disregulated blood sugar, or increased risk of them at least, and so avoiding that or reversing that is important. But beyond that cutoff, I don't think we have great evidence that there is some truly optimal range. So often what you'll see is people will say, "Oh, I don't have prediabetes, but my fasting blood sugar is 90, but it will be better if it was 80." For most conditions, we don't actually have evidence that that's true. So I think that we can get into a trap of constantly chasing these numbers. We don't have that much evidence that more would be better, and there are opportunity costs as well as side effects of things we might be taking off label, or things that we don't get to do or enjoy, because we're so worried about these numbers when we're not necessarily doing something that has a lot of evidence behind it. Okay, so stimulus supply, and now we get to support, what is the third S really about for you? Before we get to support, because we didn't touch on nutrient blood tests, we could just quickly cover those. So again, we have some pretty good cutoffs for things we might try and achieve or avoid. So a vitamin D level, at least of 30, because below that risk of dementia increases particularly below 20. Just for you, do not talk about general advice for people because we're both going to say, go get your levels measured. How much D are you taking? How many I use? In the winter, I take 3,000 per day, and that keeps me above 40, which is kind of like my target. So we have some other evidence from the sports performance literature that maybe a 40 to 60 range is sort of like the best spot to be in. Especially in the Northwest. When we would measure second or third year athletes that were with the Seahawks, we'd see a decline in D because of the sun, the lack of sun. So it's a pretty massive competitive advantage to get D right as a high functioning and even just well functioning person. Yeah. Okay. Then the Vitamin status, again, has some of the best evidence for it is homocysteine. Homocysteine goes up when you don't have enough of one of the methylation supporting B vitamins. And why is homocysteine important? Homocysteine seems to do a few things. It can affect blood vessel function, so it's related to heart disease risk as well. When you look at animal studies, so it's impossible to test this in humans, but it seems that homocysteine may accelerate the phosphorylation or hyperphosphorylation of Tau that creates Tau tangles. The tangles. Yeah. So it may contribute in that way too. People who have an elevated homocysteine have a high risk of dementia. There have been multiple randomized control trials that have shown that if you decrease homocysteine with B vitamins, you decrease the rate of chromatic decline and decrease the rate of brain atrophy. And so the target would be at least below 13, ideally below sort of 10 to 11. So single digits if possible. That effect of homocysteine lowering seems to be dependent on omega-3 status. So now there are several trials that show that if you improve omega-3 status but you don't look at homocysteine, you don't see any benefit. If you improve homocysteine but you don't look at omega-3 status, you don't see any benefit, you need both to benefit. And there are probably a whole bunch of other dependencies when it comes to nutrition as well. This is just the one that's been best studied. But people will hear all the time, oh hey, we did this trial, we gave people B vitamins, nothing happened. B vitamins don't work. Right? They weren't looking at the combination. Because they weren't looking at all the things that they were looking at. That's the Panama Canal thing that I was mentioning earlier. Like you do need a handful of things to work together to do it. So then you've measured your omega-3 status and probably the best evidence test is an omega-3 index. Real risk is when it's like two to three percent. And so the omega-3 index is the percentage of the fatty acids in your red blood cells that's made up of EPA and DHA, which are the two sort of long chain omega-3 fatty acids. Risk really starts to come down once you're about 5 percent. Ideal is probably at least six to eight percent. But you just want to avoid being two to three percent, like if possible. You get it, get it above there. And then the final one that we have some good evidence for is iron status. So anemia, in particular, increases the risk of dementia. Probably about 10 percent of perimenopausal and postmenopausal women in the US are iron deficient. And iron deficiency, particularly in that period, sort of like the perimenopausal transition early menopause, increases the risk of cognitive changes during that time. So like getting iron status right is really important. If you're going to measure your hemoglobin, which is one way that you would assess that. So you measure hemoglobin level, you want it at least above sort of 12.5 in women, 13.5 in men. And if it's below that, you have an increased risk of dementia. But if it's very high, too, that's something that you should check out as well. Okay. Shift gears. I want to stay here one more time before we get to your third S, which is support. Can you speak to folks that are not eating red meat? Concerns that you have. Or are you like bullish on that? And then can you speak to people that are not eating meat at all vegan vegetarians? Are you in support bullish on that? The way that I think about it is that nutrients are the great leveler, I call them. So those nutrients we talked about, some of the other things I mentioned briefly earlier, it's important that you get enough of them. I care much less where you get them from. So depending on the study that you look at, you know, a small amount of red meat is sometimes associated with an increased risk of dementia, sometimes actually associated with a decreased risk of dementia. I think some of that probably comes from the nutrients in it, right, it has B12, iron, zinc, some other things that we know that we know are important. I don't think we have good evidence to say that a normal amount of red meat increases the risk of dementia. And for some people, it may be an important source of nutrients. I also don't think that it's something everybody has to eat, right, as long as they're getting those other nutrients, those nutrients from other foods. So people that are eating a plant-based diet in particular, we know there are an increased risk of B12 deficiency. I think anybody in that world now appreciates that. And they should take a bit of an supplement and maybe measure those things. Iron also potentially, too. Maybe red meat is a good source of iron for some people, but not everybody needs it. So again, I would just like tailor this to your personal needs. If you have dietary preferences, that's fine. This is where sort of the testing or eating more of certain foods that fit within your dietary pattern that have those nutrients to kind of make up that gap is great. We do also now have some evidence that, especially, well, this isn't an older adult, so this comes from the Cosmos trial, which is a massive trial done recently in the US that gave half of the participants a multivitamin. And it was sent to himself, like, the most basic multivitamin, just 100% of the recommend data allowance. They consider it a vitamin. Yeah, still. Yeah. Okay. So I think this is potentially important because there's no like mega doses of anything that could, you know, which if you take for long periods of time, some of this stuff can get a little out of kilter. Like, when I work with my athletes, every sports supplement has B6 in it, right? And so like, when you take three or four different things, we get their blood test back and they're just like stuffed full of B6 because it's everywhere. And we know that if you take very high levels, very high amounts of B6 for long periods of time, it can cause like some neurological symptoms and stuff. So like with that kind of really basic multivitamin, you're making sure you're getting at least the basics, but you're not kind of at risk of overdoing anything. And in the Cosmos study, those who took the multivitamin, you know, had some improvements in cognitive function. So I think that especially if you have some concerns about your diet, like a base, like a basic multivitamin, we now have some good evidence for from a cognitive standpoint. But as long as you're getting those core nutrients, like I said, I think it masses much less where they come from. And there was double-blind placebo of that, so they beat that beat of placebo. Yes. The Cosmos trial was a two by two study they called it. So there were actually four groups. One group got only placebo's. One group got a cocoa flavonal, another group got a multivitamin, and then the fourth group got both the cocoa flavonal and the multivitamin. And they looked at a whole bunch of outcomes, like cardiovascular outcomes and things like that. And the multivitamin seemed to be beneficial from a cognitive standpoint across both the groups that got it. The cocoa flavonal only seemed to be beneficial in those who were eating a low-quality diet and therefore weren't really getting other antioxidants from the diet because the cocoa flavonal acts as an antioxidant. So if you're not eating fruits, vegetables, berries, maybe not drinking a lot of coffee or tea, which is where some of these compounds come from, then that kind of supplement seemed too beneficial. But if you were eating a diet that contained them, they didn't really seem to be any benefit. While we're on the supply here, one more turn is that are there any supplements that you're really interested in right now, like alpha-GPC or phosphatital serine or are there other things that are not really on the base of the omegas and the B and the D? The only thing that we might consider more broadly, not necessarily because we have the most amazing evidence for it, but because the evidence is increasing and we know it's incredibly safe is creating. So creating seems to be the potentials and benefits after setting a brain trauma individual with depression. Multiple studies now in the setting of steep deprivation seems to improve sports-specific skills and athletes, some aspects of decreases fatigue, under sleep deprivation. One pilot study in Alzheimer's disease, but there wasn't a placebo control, so we don't really know whether a creator team was what actually drove some of the improvements in cognitive function they saw. But in older adults, a creator team may particularly be beneficial for memory function, and there were some meta-analyses that showed that. 2011-12 was my first year with the Seattle Seahawks, and I brought in a colleague, and do you remember Professor Greenhoff? He did some of the first original studies on creating, and so I brought my colleague in and Professor Greenhoff and my colleague, Paul Winsburne, and I sit, we were on a board together, and Paul came in and he says, "Why is there no creating here?" This is 2012, 2011, and I said, "Ah, it's league policy." He said, "This is criminal." You're asking these guys to do A, B, and C, and you don't have the most basic fundamental, it was Cretein. I want to say it's amino acids. It's like a peptide from three amino acids. Yeah, and he said, "This is criminal." And so he harped and harped and harped. Now, you can't go in an NFL, probably, any sport organization, and not find creating. One of our partners that is a great supporter of this podcast, Momentus, they just moved to their own. First ever Cretein, I'll get you some of it. It's called Signature Spec. They developed it. It's really good. It's totally different as a form function with all of the right kind of quality. So, they've been great. They've done a nice job of educating people on it, and so you're into it as well. Yeah, I take creating every day. I have for a long time. What about the risk? Older people start, I interrupted you. I'm more interested in what I'm about to ask though. What about for you? Because I was going back to the older folks, is that Cretein to creatinine. I would love for you to dispel the connection between creatinine and liver. So, I'm thinking about older people. Maybe the liver is a little bit weaker. I don't know if that's fair to say or not, and see where we are pumping Cretein. I've read the research, and I'm still kind of confused. Can you open that up a little bit for us? Sure. The first thing I'll say is they've actually done studies where in frail older adults, they're giving them very high doses of creatinine for long periods of time. So, there's one randomized controlled trial in Parkinson's disease. 10 milligrams. 20 grams a day initially. 20 grams. And then I think it was 10 grams a day for several months afterwards for two years. This is a potential treatment in Parkinson's disease. It was a small trial. It didn't show any benefit, but it also didn't show any negative side effects. So, that's an important context. Is that even in frail older adults, we still haven't seen like negative side effects of Cretein. The thing that does potentially happen is that creatinine goes up. So, creatinine is used as a marker of kidney function. Creatinine is actually not a good marker of kidney function. It's actually a very dirty marker of kidney function. The primary driver of your creatinine level is your muscle mass. They're always asking, are you working out? Yes. Are you taking Cretein? Yes. Well, it's probably not a big deal. Yeah. Is what I get. And then I look at the research and they're saying the same thing, but I don't want to high marker of Crete, and they're knowing that I've got a potential compromised kidney function. So, your creatinine level, it's used because creatinine is constantly filtered out by the kidneys. So, if it goes up, it suggests that your kidney is on working as well. So, you have to look at GFR, EGFR? No. So, EGFR is just calculated from creatinine based based on body weight and things. So, if it's adjusted for your weight or body surface area, if your EGFR is adjusted for body weight or body surface area, that is more useful. You're using that creatinine number, but you're taking into account the size of the person, which is important because muscle mass is the primary source of creatinine in the blood. And if you increase creatinine intake, creatinine is just a byproduct of creatine being phosphorylated and used for energy processes in the muscle, primarily. And sometimes it creates creatinine and it gets sent into the blood and then the kidneys filter out. So, there are studies that suggest that if you take creatinine creatinine levels go up. But there are also studies that have used a more accurate marker of kidney function called sci-statin C. And sci-statin C does not change when you take creatinine. So, creatinine goes up because it's kind of like a it's a dirty marker, but sci-statin C doesn't change. So, there's no evidence that creativity negatively impacts kidney function. Like the actual function of the kidneys, it's just the nature of the marker they're using. I can tell you a personal anecdote. I was once hospitalized for a snake bite in Costa Rica. I spent nearly two weeks in the hospital. And yeah, I, so I got bitten by a pit viper, the tertiopelibol fed reliance in the Costa Rican jungle. And I needed obviously the antivenom and then I got a severe abscess. They had to drain from my leg. I had like bad cellulitis, so skin infection went all the way up my leg. Funny Master is brought to you by Magic Mind. A question that I often come back to, and I hear from people I work with, isn't, how do I perform well today? It's how do I protect my capacity to perform well over my entire career? That's a different question. And it changes what you invest in. At some point, I started applying that same thinking to my own brain. Not just what helps me get through it every week, but what am I actually building over time? Because there is a difference between burning through your cognitive resources to meet the demands of the day and investing in the long-term health of your brain. That's one of the reasons I enjoy using Magic Mind. It's a daily two ounce mental performance shot with clinically-backed ingredients like ashwagandha, turmeric, and limesmaid. When I drink it, I know that I'm investing in better focus sustained energy. And what I value just as much is what's happening underneath. These ingredients support stress adaptation and long-term brain health in ways that seem to compound over time. That's the long-gain. The formula is based on over 10 years of research, and Nano encapsulated for five times better absorption than traditional pills and powders. Go to MagicMind.com and get 50% off your first order. The best performers I know make investments today that their future self-thanks them for. This is one of them. Finding Mastery is brought to you by Fatty 15. Okay, let's talk about longevity. Longevity is much more than simply adding years. It's about maintaining health and a zest and a vitality and enhanced performance as you age. And that's why I'm excited about Fatty 15. It's an award-winning supplement. It's powered by C-15, which is the first essential fatty acid discovered in over 90 years. Okay, so C-15, it's a geroprotector. What that means is it helps to slow biological aging by strengthening your cells, basically protecting them from damage. You can think of it like kind of like a 401k for your health where you're investing in cellular quote-unquote resilience. And I dug into the research on the relationship between C-15 and heart health. I love what I saw. Fatty 15 is on a mission to optimize your C-15 levels to help you live healthier, longer. Get 15% off your 90-day subscription starter kit by heading to fatty15.com/findingmastery and use the code "Finding Mastery" at checkout. That's Fatty F-A-T-T-Y 15.com/findingmastery. Start investing in your long-term health today. These are his words. They nearly didn't let me go home because of my crass knee. It was slightly elevated. And it's the combination of my higher muscle mass and my take creatine supplements, but they were terrified that my kidneys were failing because of everything they actually did. All the things that were going on. But I had to be like, "No, no, it's fine. This is just normal." Trust me, I actually do know. That's great. This is just worth bearing in mind, because if you're older or maybe you get a test for kidney function, you get your creatinine measured. It's a very normal part of a typical blood test. Just let your doctor know that this is something you're supplementing with, but so far, there's no evidence that it's actually negatively impacting kidney function. So the connection I'm glad we're talking about this. The connection between creatine and brain health, creatine and dementia. Can you just, can you wrap that up for us? - So no evidence that creatine decreases the risk of dementia, like we couldn't say that. But particularly under a group of conditions where maybe your cognitive function has been affected in some way. So brain trauma, sleep deprivation, maybe with some cognitive decline later in life, because creatine seems to be most beneficial. In quote, unquote healthy people, creatine is maybe most beneficial in older adults. So maybe they've already experienced a bit of decline. In those states, we do like across all the evidence we have, that does seem to potentially be some benefit. Like we're not going to pretend it's magic, but there are trials in all of those areas that say they could be some benefit there. - You would say it would be foundational as a first mover supplement for brain health is to take creatine or eat enough red meat, God help us. I don't know how you would to get that level of creatine into the body right now. - If you are thinking about supplements for cognitive function, particularly if one of the things that I mentioned applies to you, then creatine would potentially be the place to start. And the reason why I'm more bullish on creatine than other supplements, broadly, is because we know it's incredibly safe. - Are you at 5 milligrams, 10 milligrams? What are you taking? - I'm going to take usually 10 grams a day. - Yeah. - And is there a difference that you're aware of between genders? - No. A recent study that gave 10 grams of creatine a day to menopause of women in concert with a resistance training program. So like the resistance training or resistance training with creatine. And there was potentially some additional benefit on bone health. It was minor though in the creatine group in addition to the resistance training. But again, so in that kind of age group of women taking 10 grams a day, certainly no issues in terms of side effects. So like the dosing seems to be similar. - Yeah, from a side effect standpoint. - Yeah, and also in terms of like efficacy. - Okay, this is great. Let's get us to a third S, okay? So we're on support. - Yeah. If you think about right, you've simulated the brain. You're doing some like new complex challenge, learning a new scale or something. You've activated this increase in supply to those areas, right? More blood flow is brought in, brings in the nutrients and oxygen and all that kind of stuff. And then you need a period of adaptation so the brain can like respond to the stimulus that you apply to it, right? So if we go back to the athlete and physical function example, right? No athlete gets stronger in the gym, they get stronger when they recover afterwards, right? And the brain is essentially exactly the same. So we apply a stimulus, we give everything we need to respond to that stimulus and then we need a period of adaptation. Most of this happens during sleep. So this is the support S sleep is a critical component of that. That's when you know new synapses are cemented. This is where neuroplacicity happens. This is where memories are kind of integrated into the bigger picture of what we know about the world as well as our emotions of process. You know, all this kind of critical stuff happens during sleep. We can also support adaptation with other aspects of physical health, so hormonal status. Concerny play a role here. Trophic factors produced during exercise like brain-derived neurotrophic factor. That helps the support sort of neuroplacicity and skill learning or development. And then we want to avoid things that impair adaptation. So that kind of fits into the support bucket too. So things we've already talked about smoking, excessive alcohol, air pollution is increasingly appreciated as a risk factor for dementia because it's dramatically increases sort of inflammatory processes that we know can impair cognition. Oral health, so dental disease, gum disease is another increasingly appreciated risk factor for dementia. And then sort of like a broad bucket that we might just call chronic stress, right? So we've already touched upon like acute stress being really critical to function. Like that's what drives adaptation. But if you never switch that off, like chronic stress essentially causes like an overtraining picture in the brain. It never switches off. It can never recover. It can never adapt. It may even like be impairing sleep and some of these other things. So that group of things kind of comes into the support bucket kind of balancing what allows the brain to actually adapt to the stimulus that you've applied to it. - I really appreciate your model. And I appreciate that you didn't name it like S for sleep, right? You did support. You know, there's a whole bunch of things sleeping a really important one, yeah. Another level of support is, you know, the social engagement with other people. And I would even add probably underneath support when you are in service is something greater than you and you are the support mechanism for others. - Yeah. - And you are a cause greater than you, which is probably not how you've organized the support, but just flipping it, being in support as a massive protective factor. - So what I like about thinking about it like this, it kind of helps us appreciate why certain things are so foundational to brain health. And like just like one area you can make improvements, you can see improvements across the entire network. So yes, we know that prosocial behavior has huge effects on physiology, well-being, like people who volunteer more have a lower risk of dementia, people who care or look after others have a lower risk of dementia. And it's it's fitting stimulus, it's fitting that kind of effect on autonomic balance and how that affects inflammation and immune function, right? So it's coming in that kind of prosocial in acting in something greater than yourself is actually hitting multiple nodes of the network at the same time. - What are most people get wrong about dementia? - I think maybe two things. One is that it's inevitable, which we talked about a lot already. - Meaning it's not inevitable. - Meaning that I don't think it's inevitable. That doesn't mean that you could guarantee one person couldn't experience dementia, if that makes sense. But you could, I think that we have evidence that you could change that trajectory, but there are still aspects of dementia that we don't understand. There are still cases of dementia that we wouldn't consider preventable, right? So I'm kind of talking big picture population level, but I don't think we should consider it to be inevitable. And genetics and other things come into play here, but even in the setting of genetic risk, you can decrease that risk with all the kind of stuff that we've talked about already. The other thing that I think we get wrong that is improving now is that each of those dimensions that I've talked about, historically, we have focused, and by we, I mean, a neuroscience, neurology community have focused purely on the proteins that we see accumulate in the brain affiliated with that type of dementia. So like amyloid and towel in Alzheimer's disease. And those are absolutely part of the disease process. But we also know that people can experience Alzheimer's disease with not that much amyloid and towel in the brain. There are people who can have brains stuffed full of amyloid and towel and their brains work just fine, right? So they are absolutely part of the picture, but now we're appreciating other things like inflammation and changes in blood vessels and the factors that affect those. So historically, I think we kind of painted ourselves a bit into a corner by just focusing just on what the brain looks like under a microscope after you've died. We're actually, that gives you a very incomplete picture of all the things that that person was and that affected their condition. - If a parent has dementia, can you speak to the listener here about how they should be thinking about themselves? - There are a couple of pieces to this. One is the genetic piece, right? So for example, the most common genetic risk factor for Alzheimer's disease in the population is your apoe genotype, apoe protein E. - Which you can measure. - Apoe 4, if you have one copy that increases your risk by maybe two to six times, two copies, six to 20 times, something like that. - From all the data we have so far, it does seem that apoe 4 primarily acts as a risk multiplier rather than being like this really big baseline risk that you can't change. So those who have one or two copies of apoe 4, they get an even bigger increase in risk if they drink a lot, or if they have a poor quality diet, or if they have a sedentary lifestyle, or if they have cardiovascular disease. By the same token, they may get larger benefit if they address those risk factors, if that makes sense. And there are actually several population studies and several populations where apoe 4 doesn't increase the risk of dementia. And I think that's largely because of like a gene environment interaction. So that suggests that the risk associated with apoe 4 is also modifiable. And there are studies that show that say treatment of high blood pressure and high cholesterol, so taking a blood pressure medication on a statin is particularly beneficial in those who have apoe 4 in terms of their dementia risk. - Who do we ask? And what are we asking for? I don't know how it happened for me, but my doc was like, "Hey, you wanna get this measured?" It was, I can't remember what blood test I did it with. I cannot remember, but. And he's like, "Yeah, I think you should do it." And I was like, "Yeah, let's do it." But what would somebody ask for? - You would just ask for your apoe genotype, which is short for apoe 4 protein E. And it's spelled APOE if people are looking it up. - Yeah. - But equally, it is worth thinking about like what will you do with this information? Because in reality, the answer for what you should do to decrease your dementia risk is gonna be the same regardless of your apoe 4 genetics. Right, you might take it more seriously if you have a copy of apoe 4. But if you don't have a copy of apoe 4 and you smoke and drink and don't exercise, I'm still gonna tell you to do those things. - There you go, that's right. So whether you have it or not, the behaviorally and psychological lead, there's still a whole bunch of things that you can do to decrease your chances or. dementia and/or increased your chances of vitality through the end of your life. So then more broadly, we also know that if you have a first degree relative who had dementia, you have an increased risk of dementia. So some of that is genetic, but there are also studies that show that, and unsurprisingly, lifestyle-related risk factors also transmitted across families, right? You're more likely to move and eat and sleep and live your life like your parents did. So if you had a parent who had dementia, a great place to start is think about what are the risk factors that I have that I share with them? Because that's going to be at least part of that picture of risk. That's maybe the place that you would begin to make some changes. I love your framing. Is this you doing some gymnastics with the data or is this like the way that you see data? A genuinely don't think it's gymnastics with the data. When I see all of this, I see hope because so much of this is modifiable. Yes, what each individual can do, the resources they have, the time they have is different. But you have to first know that it's possible, and that's what you consistently see across all these pieces of data. Something that I learned a little bit about when I was in medical school, actually not in medical school, but I was just like doing this at the time, was learning to think about sort of systems theory, systems dynamics, which is basically this way of, it's used in engineering a lot. My wife is a chemical engineer, and chemical engineers do this all the time. So she's much better at this than I am, because she's actually trained to do it. I know just enough to be dangerous. But it's this idea of building up a sort of a model of a system based on all the different ways that things interact within that system. And this sounds obvious, but it's not something we really do in medicine and biology that much. We do it a lot more now, like people have heard of systems biology and this kind of stuff. But when you're talking about the way we analyze data related to dementia risk, whatever, we do these very basic statistical models where we just kind of adjust for stuff and we assume that everything is linear, just kind of like stacks on top of each other. But that's not how biology works, like things interact and then they inhibit each other and then they feed back and all this kind of stuff. And so when I try and approach a problem, like often my wife will catch me drawing these things called causal loop diagrams. So it's like all these different arrows and feedback loops and all this kind of stuff. And then it just kind of helps you picture how all these pieces interact. Is the Krebs cycle just that? Yeah, partially yes. And one of the things that I most enjoyed when I was an undergrad student was biochemistry and physiology, which is just full of feedback loops and chemical reactions. And so it kind of that fits how I think about things. If none of this, then likely that. Yeah. If lots of this, then likely that. If lots of this and none of that and a little bit of this likely. Yeah. So if somebody wanted to see a causal feedback loop, they could look up Dr. Krebs cycle. Yeah. And or what else would you point them to as a classic? If they wanted to use their intelligence for systems thinking for something they're trying to solve. Some like very common examples, which are interesting, though not always that useful. There's one. If you like Google metabolism, have you ever seen that? And just like this, there's this one diagram, which is like this, this mess of arrows and biochemical names. And like somewhere in the corner is the Krebs cycle. And then there's everything else. And it's usually used to say we're like, hey, if you think you take this one suppleman and you throw it in here, are you going to like fix everything like you're not because it's way more complicated than that. And then there's also one a famous one around the causes of obesity, which people could easily Google. And then right, of course, there's all the like how you eat and how you move. But then like you go several layers out and it's like society and socioeconomic status and like all these other things and you can like go down to biochemistry and you can go up to the environment and like all of it's kind of in there. What I find most useful, which is one way that you can use this idea is you sort of you draw out some version of your model. And then you look for what are what are common themes? Where are there nodes in the network that lots of things sort of coalesce? Where are their potential intervention points that affect lots of aspects of the network? And so some version of doing that is what resulted in the 3s model, right? And it's not going to capture everything. But it gives us enough to kind of understand, oh yeah, these pieces interact with each other. And like this is how things are acting. So like the alternative is you can make one big very complex computer model and try and sort of like model all this stuff and make changes and see what happens. But for me, as like a thought experiment, I quite like sort of like distill it down like can I find some really basic core themes that kind of emerge from this complex system? It's cool. You are systems thinker that they can drill all the way down into the nuances of lots of singular properties, which is fun. I want to take a second here to tell you about a morning routine that I've been using for years. For me, it's a great way to switch on my mind to ready myself to take on the day. So before I check my phone, my emails, market updates, or text threads, I choose how to start my morning. That's always in my control. That's always in your control too. This is the same morning mindset routine that some of the world's top performers across sport, business, and the arts are using. The best part, it only takes about 90 seconds to do. So just head over to findingmastery.com/morning to download the audio guide for free. Again, head to findingmastery.com/morning to get your morning mindset routine. Can you speak to the listener directly that is noticing that they are on a cognitive decline? They can feel it. They sense it. Maybe others don't quite understand or can observe, or it's just starting to happen. I'll tell you, my grandfather had vascular dementia, and he was so smart and so socially tuned and so clever, we didn't know for a long time, because he could fit in a conversation still because of his social intelligence was incredible. I'm asking you to just speak to the person that is noticing it themselves. What your grandfather experiences is actually very common, particularly individuals with high levels of cognition and intelligence to start with. They're very good at hiding it. The brain adapts and they don't even necessarily know they're doing it. They're filling the gaps and they can play along for a long time. Sometimes the individual doesn't even notice. Sometimes there's other people that notice it. But if a loved one says something about changing you or your noticing changes, previously, this was never considered part of the framework of cognitive decline. You would get a diagnosis of something called mild cognitive impairment, and then if that trajectory continued, you'd get a diagnosis of dementia based on the amount of function. Now there's an appreciation for this period that they call subjective cognitive decline, and different people will argue about how you can measure that. Because if you have subjective cognitive decline, but you did some of the standard cognitive tests that they do for diagnosing dementia, you would do just fine. Because they're very basic. And so one thing that has been a problem that will hopefully improve over time is like we talked about measuring your blood pressure and your blood sugar when you're 18, measuring your lipids in midlife. We don't routinely measure people's cognition until we think they have a problem. So we don't know what that trajectory was because the tests are too coarse to do that. We need much more nuanced things and have everybody have access to them, and there is some companies kind of one that I work with, there's sort of like working on that. Just like make it that everybody does cognitive function tests, and the goal isn't necessarily to get in the top 1%, right? The goal is just to maintain whatever it is for decades. Is there a place that we can go to? Yes, there's a company that I'm chief science officer of called Better Brain. They have a free brain health platform that has a few different flavors. So one is like an AI self-guided process, free to anybody. It's trained on thousands of papers that I help them curate a lot, you know, basically like that one chunk of them was just like they took the 2000 references from my book and just kind of like that. And so you can put all the things about your lifestyle, your environment, your preferences, your diet, you can even upload some blood tests. It could help build you like a, here's a one thing that you should work on, right? Then there's also brain health coaching, all the brain, all the coaches are audience, and that's available for most people that's covered by health insurance. Registered diet. Registered diet. Dietitian nutritionists. Yeah, thank you. Highly qualified people. And even if you don't have any cognitive issues, that coaching is still covered by insurance. Cool. So the one thing you might need to do is you could pay for some blood tests if you want them, but they're sort of like provided at cost, if you want to do it. And as part of that company, or if you do the coaching, you get access to cognitive tests, like validated cognitive function tests, we're now building or they are, I didn't do it, I sort of gave input. I've built a suite of more complex cognitive tests that will then, which will soon be launched and be available free to everybody. So you can just like track your own cognitive function over time. So this will then need to validate them against other things, right? So there's a lot to be done, but I think we're getting to the point where people can just track this much better. And you want to know what it was when you were 30, and then you hope that it's the same when you're 80, rather than some stuff happens for five decades, and then all of a sudden you have a diagnosis of dementia, right? That's what we want to try to, try to avoid. What a great resource. And I'll say it again, better brain probably.com. Yeah. Yeah. I'm going to go check it out for sure. Thank you for introducing that to me. For folks that are on the decline and they notice it. Yeah. Should we think about slowing it down? Should we think about increasing other behavioral choices? What can we do? Yeah. So the important part of subjective cognitive decline now being an accepted part of this path is now that people are recognizing it, so they're willing to talk about addressing it. And it's generally accepted that if you're in the period of subjective cognitive decline, that is largely reversible. There aren't a ton of really large randomized control trials for that specific group. But we do have trials in older adults 60s, 70s where you make changes in exercise, diet, address cardiovascular risk, brain training or cognitive training to some kind of new cognitive stimulus. In some of the studies, they might do CBT if there are some issues around depression or anxiety. And you see significant improvements in cognitive function, even later in life. So we know that this is modifiable. And so the easiest way to start thinking about this is, well, first, can you get some of the stuff assessed? Can you measure your home assisted and get your blood pressure checked all that kind of stuff? And then think about-- all the things I talked about in the 3S model. And think about, to start with, what's one thing that you could start to move the needle on? And so-- You're being kind. Invest in your sleep. Start moving and stressing your body. Put the sugary foods down. So this is, of course, great conversations with people that are stimulating. Like, get in service of something that matters to you and see if you can support others. Get out of your own self-interest in that respect and suggesting. So I obviously completely agree with you. But with the huge spectrum of people that I've worked with, some will be exactly-- I'll be like, I've noticed something. I'm going to fix everything. Let's go. Great. But some people even think about that as overwhelming. So the things that you have to take away are you can change this trajectory. There is still scope to do that. And in many respects, we know the things that you should focus on. And that then means that you can change and engage something. And you know that even if you just start to work on one thing, you can start to see improvements. So in the studies where they've identified, these are the risk factors in this person. We address these risk factors. They see significant improvements in cognitive function. So the maintain your brain study in Australia. Thousands of people all done remotely. Identified individual risk factors address them, source significant improvements in cognitive function. So we know you can just start on one thing that you know is affects you and work there. So if you want to do 10 things, great. This is why people love working with you. You take them right where they are. Hold it. Yeah, that's great. What a fun conversation. We need part two, part three, part four, because we didn't even touch the high-performing brain, which obviously you have a deep understanding about as well. And so Tommy, it's always fun to speak to you. At a later time, I would like to talk to you about your worldview. I would like to talk about how you make decisions. I would like to talk about how you work with high stress, acute stress, and recover from it. And I'd also like to understand like, how did you ready yourself to go to the most meaningful institutions on the planet, Oxford and Cambridge? And then you get your PhD, just for whatever reasons, after your MD at University of Oslo. Like, I would love to talk to you about how you shape your life. And today was a great service to the application of solid science. And at the same time, I got to feel that you are optimistic. You are highly conscientious. You are not agreeable for the sake of being agreeable, but you want to be kind of in a slipstream with trying to find the commonality between people. I think you're obviously highly motivated, probably more internally than externally. You're not driven by money, fame, attention, you'll take them. But it's an internal driver. And no one has a shoulder tap you to go to work. You are the exact teammate that I think the world is wanting to work with. And for that reason, I want to celebrate not only your work, but how you show up with the 30,000 hours before this conversation. And we saw each other at the grid one day, at Formula One grid. You were supporting a handful of teams, and I was with one of them. And after you left, you don't know this. But after you left, one of the drivers said, oh, you know Tommy? I said, yeah, and he goes, isn't he great? So you've earned that. Those are the things that are said behind your back. And so I want to promote your work. Stimulated mind is a great read. You took complicated science, made it simple, digestible. I ripped right through it. I hope people will pick that book up for both healthy brain and for a look at dementia. And more than anything else, what we can do to be better. So Tommy, thank you for showing us what high agency, high efficacy, generosity, and discernment to make a difference in the world. Thank you for what you've provided us. Thank you so much. I mean, your words mean a huge answer. I mean, we really, really appreciate it. And this has been so much fun. Awesome. Next time on Finding Mastery, half the population will experience menopause. Yet for many of us, it's still something we rarely talk about. And often don't understand. In this conversation, Dr. Michael Dreves sits down with award-winning journalist and menopause advocate, Tamsen Fidel, to explore why so many women are misdiagnosed, why symptoms are often mistaken for anxiety or burnout, and how better conversations can transform our homes, workplaces, and relationships. Whether you're a woman navigating this transition or someone who loves, works with, or cares about one, this is a conversation that matters. So join us Wednesday, September 2nd at 9 a.m. Pacific, only on Finding Mastery. (bell dings) - All right, thank you so much for diving into another episode of Finding Mastery with us. Our team loves creating this podcast and sharing these conversations with you. We really appreciate you being part of this community. And if you're enjoying the show, the easiest, no-cost way to support is to hit the subscribe or follow button wherever you're listening. Also, if you haven't already, please consider dropping us a review on Apple or Spotify. We are incredibly grateful for the support and feedback. If you're looking for even more insights, we have a newsletter we send out every Wednesday, punch over to findingmastery.com/newsletter to sign up. The show wouldn't be possible without our sponsors, and we take our recommendations seriously, and the team is very thoughtful about making sure we love and endorse every product you hear on the show. If you want to check out any of our sponsor offers you heard about in this episode, you can find those deals at findingmastery.com/newsletter, slash sponsors. And remember, no one does it alone. The door here at Findingmastery is always open to those looking to explore the edges and the reaches of their potential, so that they can help others do the same. So join our community, share your favorite episode with a friend, and let us know how we can continue to show up for you. Lastly, as a quick reminder, information in this podcast, and from any material on the Findingmastery website and social channels, is for information purposes only. If you're looking for meaningful support, which we all need, one of the best things you can do is to talk to a licensed professional. So seek assistance from your healthcare providers. Again, a sincere thank you for listening. Until next episode, be well. Think well, heat exploring.