Accelerate Learning & Increase Cognitive Capacity | Dr. Tommy Wood

Transcript

[00:00:00] There's a much more recent study that took again older adults and randomized them across [00:00:05] three different groups. One was like a low intensity group. Another group basically did [00:00:10] kind of zone two type work on a treadmill three times a week. And the third group did [00:00:14] a high intensity interval training intervention, which was the Norwegian four by four protocol. [00:00:19] So four minutes, 85 to 95% of maximum heart rate. They had a three minute rest in their protocol.

[00:00:24] They did that four times over. [00:00:25] That was three times a week. [00:00:26] Three times a week for six months. That's pretty intense. [00:00:29] But what they showed was that that high intensity interval training group, [00:00:33] they improved their fitness just as well as the zone two group, interestingly,

[00:00:36] but they had much better improvements in hippocampal function and maintenance [00:00:41] of hippocampal structure on an MRI scan. [00:00:43] And they maintained that benefit for five years after the six month intervention. [00:00:48] So they worked really hard for six months, [00:00:51] but that that benefit was maintained for a really long period of time.

[00:00:56] Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for [00:01:00] everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology [00:01:09] at Stanford School of Medicine. My guest today is Dr. Tommy Wood. Dr. Tommy Wood is a medical [00:01:15] doctor and neuroscience researcher at the University of Washington in Seattle. He is [00:01:19] also the chief science officer of Better Brain, a company that provides free brain health coaching.

[00:01:25] Tommy is an expert in neuroplasticity and human performance and how science-based protocols [00:01:30] can be used to improve your focus, ability to learn, and skill expression. His work applies [00:01:35] to everyone, from the novice to the elite expert, and for all kinds of skills, cognitive, language [00:01:41] skills, athletic, and creative endeavors. Today we discuss the brain states that favor learning [00:01:47] and, importantly, how to get yourself into those states. We also discuss how to get the most from

[00:01:52] a learning session. For instance, how long that session should last, how many sessions to do per [00:01:57] day, and perhaps most importantly, how to tune your mind and body to get better at learning. [00:02:02] That's something we don't often hear in the context of learning and neuroplasticity, [00:02:06] that our brain circuits for focusing and learning are also capable of plasticity, [00:02:10] meaning you can literally get better at getting better. Today we discuss things like flow states

[00:02:16] and something called a clutch state, which is a seldom mentioned but critical brain state [00:02:20] to accelerate learning and performance. In fact, a clutch state is the state that you want to seek [00:02:25] to learn and perform at your best. We also discuss how different types of physical exercise [00:02:30] from long slow cardio to brief high intensity cardio and different forms of resistance training [00:02:35] each open the window for distinct types of neuroplasticity and learning. So this goes

[00:02:40] way beyond the general discussion about exercise improving your brain. We get really granular [00:02:45] about exactly what types of things to do to improve your brain in specific ways. [00:02:49] As a career neuroscientist who has worked on and taught neuroplasticity for decades now, [00:02:54] it's rare that I encounter someone with as deep knowledge about the real science and application [00:02:58] of learning and plasticity as Tommy has. He's also extremely unique because he has a ton of

[00:03:03] knowledge about new science-based protocols for plasticity. And he's also an athlete. We [00:03:09] discussed that a little bit at the end as well. So today you will hear a lot of information that [00:03:13] I am confident you have not heard on this podcast or anywhere else, frankly, about exercise, mental [00:03:18] training, nutrition and supplementation, and much more, and how you can leverage each alone [00:03:23] and in combination to learn new skills with accelerated speed, precision, and durability

[00:03:28] over time. [00:03:29] I should also mention that Tommy recently released a new book that he wrote entitled [00:03:33] The Stimulated Mind, Future-Proof Your Brain from Dementia and Stay Sharp at Any Age. [00:03:38] It's an excellent book if you're interested in following up on today's discussion and [00:03:42] learning more about how you can make your brain better at any age.

[00:03:46] Before we begin, I'd like to emphasize that this podcast is separate from my teaching [00:03:49] and research roles at Stanford. [00:03:51] It is, however, part of my desire and effort to bring zero cost to consumer information [00:03:54] about science and science-related tools to the general public. [00:03:58] In keeping with that theme, today's episode does include sponsors.

[00:04:02] And now for my discussion with Dr. Tommy Wood. [00:04:04] Dr. Tommy Wood, welcome. [00:04:06] So amazing to be here. [00:04:07] Thanks so much for having me. [00:04:08] This is my favorite topic in the entire world.

[00:04:11] What is more interesting than neuroplasticity, right? [00:04:14] The brain is so interesting, but it's most interesting feature, in my opinion anyway, [00:04:18] is that it can change itself. [00:04:20] Essentially, that's its core most important function. [00:04:23] If it can't do that, literally none of the other functions matter, you could argue.

[00:04:28] It's something that we have to be able to do right until the end of our lives. [00:04:35] You have an eclectic research tapestry, right? [00:04:40] we're going to talk about neuroplasticity, what it is, what it isn't, how to access it [00:04:44] for men, for women, different ages. And you also are a high-performance coach. You're also [00:04:51] a competing natural strongman. Does that mean lifetime, no gear?

[00:04:56] Lifetime, well, it's tested. Lifetime, no gear for me personally, but it's a drug-tested [00:05:02] version of the strongman sport. So yeah, if you compete in natural strongman, then you get tested. [00:05:08] Great. So we'll talk about that. I'll resist the temptation to talk about your two boxer [00:05:12] pups because I'm a dog lover. That's a different episode. Neuroplasticity. I know what it means to [00:05:18] me. How do you conceptualize it? How do you think people should think about it in terms of wanting

[00:05:23] to learn things and not forget things? I essentially just think of it as the brain [00:05:30] responding to inputs in order for us to then be able to better navigate and survive our environment. [00:05:38] And that's why I think it's such a fundamental part of what the brain does. [00:05:43] And essentially, every time you learn something, interact with something, remember something, [00:05:49] the principles of neuroplasticity are engaged, right? You are making new synapses or strengthening

[00:05:54] synapses, weakening other synapses. A lot of people don't realize that particularly brain [00:05:58] development, but then also the refining of functions in the brain through neuroplasticity [00:06:03] includes the pruning or removal of synapses. Often we think about it's all about growth [00:06:08] and new connections, but actually it also involves the refining or removal of other [00:06:13] connections that aren't needed. That's a massive part of brain development in the first place.

[00:06:18] And this is a process that's essentially continuously ongoing. And you can think of [00:06:25] it as its primary role is so that you can navigate, survive the world around you. And that's through [00:06:31] learning skills through remembering people and things and facts. And where I, one of the things [00:06:41] that's most interesting to me about neuroplasticity, and the way we think about our brains over time, [00:06:48] is that I think people have conflated neurogenesis and neuroplasticity.

[00:06:54] So, when we're thinking about brain development, we're thinking about then also brain function [00:07:03] over with age and either cognitive decline or maintaining cognitive function. [00:07:08] We thought that the adult brain was fixed, right? [00:07:13] Or then it was fixed and then it lost function. [00:07:15] And this goes all the way back to Kahal who said the adult brain is immutable, right?

[00:07:19] He told us that you got into adulthood, it finished developing, and then it was kind [00:07:22] of done. [00:07:23] He then, at other times, also said that changes in the connections between neurons could explain [00:07:28] learning. [00:07:29] And so there he's talking about neuroplasticity, but we kind of got this idea that the brain

[00:07:33] was essentially fixed as an adult and then, you know, couldn't change anymore. [00:07:37] But that can't be true because you still learn and remember things on a daily basis as an [00:07:43] adult. [00:07:44] One of the things that I think we've gotten confused about is the fact that the adult [00:07:49] brain does not make new neurons in many places where I may be in the olfactory bulbs in the

[00:07:52] dentate gyrus at the hippocampus, but like compared to the rest of the brain, [00:07:57] they're not, you're not really making new cells. [00:07:59] And so because of that, we thought, well, we can't then grow and adapt or [00:08:03] change our brains as adults, but just because we have a fixed, relatively [00:08:07] fixed number of cells, doesn't mean that we can't change the connections

[00:08:11] between those cells. [00:08:11] And that's happening all the time. [00:08:12] And that is the main principle of neuroplasticity. [00:08:16] Yeah. [00:08:16] I like your definition.

[00:08:18] Um, in part because I agree with it in part because it encapsulates a lot [00:08:22] of things, including helping to clear up this misconception [00:08:26] that, you know, we generate new neurons. [00:08:28] I think the attractiveness of the new neuron idea is just, [00:08:32] it's so sticky.

[00:08:34] And so we would all love to believe that. [00:08:37] But maybe there's a good reason why we don't add new neurons. [00:08:39] Maybe it's not adaptive, right? [00:08:41] Adding new elements to a circuit is maybe not the best way [00:08:45] to change a brain circuit.

[00:08:47] I think people also like the idea that, you know, [00:08:49] every organ in our body turns over at cells [00:08:52] that we're not the same person literally that we were. [00:08:54] The brain is same cells you were born with, [00:08:57] minus a bunch of them that die off as you pointed out.

[00:08:59] And thank you for mentioning pruning [00:09:01] and the removal of connections [00:09:03] as a fundamental aspect of plasticity. [00:09:06] In terms of motor skill learning, [00:09:10] let's say I decide I'm going to practice billiards

[00:09:16] and I'm okay now, hang in there, [00:09:19] but let's say I wanna get really good. [00:09:21] As I learn and get better and better, [00:09:25] can we reliably say that most of my improvement [00:09:28] is the removal of inappropriate action

[00:09:32] and therefore synaptic connections? [00:09:36] I don't know whether it's the majority, [00:09:38] you might know whether it's the majority, [00:09:39] but I think that this certainly, it requires both, right? [00:09:43] So you're the development or strengthening

[00:09:45] of new connections and then the removal of other connections [00:09:48] that decrease accuracy, say, [00:09:51] or that don't allow you to do the exact motion [00:09:54] that you were intending to do. [00:09:55] This, like I said, kind of goes all the way back

[00:09:58] to the development of motor skills, say, in childhood, right? [00:10:05] The brain has kind of finished developing new neurons [00:10:08] sometime around two or three years old, right? [00:10:11] Beyond that point, [00:10:13] you're actually primarily removing connections

[00:10:16] in order to refine functions based on the exposures [00:10:21] that you have, be they language, motor, social skills, [00:10:24] which is what the brain is essentially developing [00:10:26] during that time period. [00:10:27] So then that continues throughout our entire lives.

[00:10:33] And I think that something that happens later in life, [00:10:35] one of the reasons why we may lose function [00:10:37] is because we stop giving the brain inputs [00:10:40] to maintain a given function. [00:10:42] Therefore, that pruning continues, right?

[00:10:44] I don't need to know how to do this. [00:10:46] So I'm going to refine that away. [00:10:48] That's kind of the developmental theory of aging [00:10:51] or part of the developmental theory of aging. [00:10:53] So in that, when you're learning a skill as an adult

[00:10:57] or anytime, a big part of refining that motor patterns [00:11:02] that you're developing has to be the removal of connections [00:11:05] that are, or the downregulation of connections [00:11:08] that aren't allowing you to do the skill that you want to do. [00:11:11] If you were to tell people, look,

[00:11:15] you wanna keep your brain as young as it can possibly be [00:11:19] relative to your chronological age, you should what? [00:11:23] Like it, so this is a general brain health question, [00:11:26] but really I'm specifically asking about plasticity [00:11:30] and let's make it multiple choice

[00:11:31] and then you can add things to it. [00:11:33] You should exercise so it can be multiple things. [00:11:35] And then we'll talk about which types of exercise. [00:11:37] You should continue to do the things [00:11:40] that you already know how to do.

[00:11:42] And then third option, [00:11:44] not mutually exclusive with the others, of course, [00:11:46] is that you should try to do new things [00:11:49] that you can't already do. [00:11:50] I still toil with this,

[00:11:52] when I look at the literature on neuroplasticity and aging, [00:11:55] right, like, yes, user to lose it is true, [00:11:59] but we're also told that novelty and trying things [00:12:02] that we're not good at is an essential component [00:12:04] of building out brain circuits,

[00:12:07] continuing to make them function better as we get older. [00:12:09] So how do you think about all of that? [00:12:12] I'll partly answer your last question [00:12:15] and then maybe give a framework for how I think about it. [00:12:19] So when you look at a combination

[00:12:24] of epidemiological studies and intervention studies [00:12:26] in older adults, so everything about maintaining [00:12:29] cognitive function later in life, [00:12:31] you definitely see that those who continue to engage [00:12:34] in hobbies and activities that are cognitively engaged

[00:12:38] or cognitively demanding, and that can be lectures, [00:12:41] that can be volunteering, that can be reading crosswords, [00:12:46] that kind of stuff. [00:12:47] Those individuals tend to either have slowed rates [00:12:50] of decline or better maintenance of function over time

[00:12:53] and or lower rates of dementia. [00:12:55] That's of course observational, right? [00:12:57] But that's usually people continuing to engage [00:13:00] in the things that they've already been doing, right? [00:13:04] So they're holding on to what they've got.

[00:13:05] Holding on to what they've got by continuing to do that. [00:13:07] Now, of course, it could partly be reverse causation because if you're maintaining function, [00:13:13] then you will, you're more likely to continue to do the things that you enjoy doing, right? [00:13:17] So this probably goes in both directions. [00:13:20] However, there's an increasing body of literature that shows that by engaging older adults in

[00:13:27] novel cognitive activities, you see improvements in function. [00:13:31] So that can be language learning. [00:13:34] That can be complex, like, co-ordinative movement or exercise. [00:13:38] You see the same things with, like, musical training, like, people learning a new musical [00:13:42] instrument or learning musical theory, trying to identify different patterns in music.

[00:13:47] And you see, in randomized control trials, improvements, particularly in executive function, [00:13:52] that seems to be most common across those different interventions. [00:13:54] But you're seeing improvements in cognitive function with novel cognitive stimuli. [00:14:00] a lot of recent trials that have also used types of brain training, things like the pointer trial [00:14:07] that was here in the US, maintain your brain, which was a massive online study done in Australia

[00:14:12] recently. And that's sort of broad, cognitive training with like an online cognitive training [00:14:18] platform. So again, it's, it's a new or novel intervention or exposure that seems to provide [00:14:26] stimulus that improves function. So I think both can be or do seem to be important. [00:14:32] I'm excited to share with you that my book protocols and operating manual for the human body [00:14:37] is now available for pre-order and will be coming out in less than two months. It's my first book

[00:14:42] and it's a reflection of decades of research, hundreds of conversations with leading scientists [00:14:47] and medical doctors, and my own exploration of health, fitness, and performance. Protocols is a [00:14:52] straightforward to use manual for overcoming any number of different pain points you might have [00:14:56] in terms of mental health, physical health, and performance. And if you're already doing well [00:15:00] with mental health, physical health, and performance, it can make you that much better

[00:15:04] at any and all of those things. It's meant for anyone interested in achieving better health and [00:15:08] vitality. It provides a deep dive into and clear explanation of tools to improve your sleep, [00:15:14] nutrition, exercise, focus, stress management, neuroplasticity, and motivation, and much more. [00:15:20] I'm truly thrilled to share protocols with all of you. The launch date is September 15th. [00:15:25] You can learn more about it by going to protocolsbook.com. That's protocolsbook.com.

[00:15:30] I'd like to take a quick break to acknowledge one of our sponsors, David. David makes protein bars [00:15:36] unlike any other. Their newest bar, the bronze bar, has 20 grams of protein, only 150 calories, [00:15:42] and zero grams of sugar. I have to say, these are the best tasting protein bars I've ever had, [00:15:48] And I've tried a lot of protein bars over the years. [00:15:51] These new David bars have a marshmallow base and they're covered in chocolate

[00:15:55] coating and they're absolutely incredible. [00:15:58] I, of course, eat regular whole foods. [00:15:59] I eat meat, chicken, fish, eggs, fruits, vegetables, et cetera. [00:16:03] But I also make it a point to eat one or two David bars per day as a snack, which [00:16:07] makes it easy to hit my protein goal of one gram of protein per pound of body

[00:16:11] weight. And that allows me to take in the protein I need without consuming excess [00:16:15] calories. [00:16:16] I love all the David Bronze bar flavors, including cookie dough, caramel chocolate, double chocolate, [00:16:21] peanut butter chocolate. [00:16:22] They all actually taste like candy bars.

[00:16:24] Again, they're amazing. [00:16:25] But again, they have no sugar and they have 20 grams of protein with just 150 calories. [00:16:30] If you'd like to try David, you can go to DavidProtein.com slash Huberman. [00:16:35] Right now, David is offering a deal where if you buy four cartons, you get the fifth [00:16:38] carton for free.

[00:16:40] You can also find David on Amazon or in stores such as Target, Walmart and Kroger. [00:16:44] Again, to get the fifth carton for free, go to DavidProtein.com slash Huberman. [00:16:49] Can I ask what, for an example of maybe one or two of the things that were in that large [00:16:55] scale trial from Australia, like just at a very top contour level, older adults, meaning [00:17:00] 65 and older, are doing what?

[00:17:03] The Maintain Your Brain study was actually, it was sort of midlife, kind of 50s and 60s [00:17:11] mainly. And they actually had interventions across four different domains based on risk [00:17:16] factors within that given individual. So they had a dietary intervention, they had physical [00:17:22] activity, they had, um, cognitive behavioral therapy for those who had, um, some potentially [00:17:29] some mental health, um, concerns. And then they had, uh, online brain training. Uh, there

[00:17:34] was something similar done in the pointer trial, uh, which was in older adults now, [00:17:39] 60s and 70s that was done here in the US. [00:17:42] That was a replication of an older trial [00:17:43] called the finger trial that was done in Finland. [00:17:46] But what those guys did was something very similar.

[00:17:48] So it's a diet, exercise, monitoring and treating [00:17:52] cardiovascular risk factors, and then brain training. [00:17:55] So what the brain training looks like, [00:17:58] so the points trial is a good example. [00:18:00] They did.

[00:18:01] They used a platform called Brain HQ, which is Brain HQ, [00:18:07] which was developed based on the work of Mike Mersinich, [00:18:11] like one of the godfathers of learning and neuroplasticity. [00:18:15] And they do various tasks primarily [00:18:20] focused on developing and maintaining processing speed.

[00:18:25] Some of that evidence goes all the way back [00:18:27] to an older trial called ACTIV that [00:18:30] was done in the US in the 90s. [00:18:32] It was still the biggest ever trial [00:18:34] of like pure, cognitive brain training.

[00:18:37] Again, in older adults, so sixties and seventies, [00:18:40] they had three different training groups, [00:18:44] and then a control group. [00:18:46] The training groups did memory training [00:18:48] and kind of like, you know,

[00:18:49] mnemonics, memory palaces, [00:18:51] that kind of stuff to help them remember. [00:18:53] There was reasoning training, [00:18:54] which is kind of like looking for patterns [00:18:56] in numbers and letters.

[00:18:57] And then there was processing speed training, [00:18:59] where in this example, it's a visual processing speed. [00:19:02] So things flash up on a screen in increasingly small increments. [00:19:07] So it could be hundreds of milliseconds. [00:19:09] And as you get better at doing it, that time gets shorter.

[00:19:13] And you have to remember what you saw and where you saw it on a screen. [00:19:16] They just published a secondary analysis of the active trial that showed that those who [00:19:21] did processing speed training with booster sessions at one in three years had a significantly [00:19:26] decreased risk of dementia 20 years later. [00:19:28] And they've done some other studies showing that that kind of training improves code allergic

[00:19:31] signaling in the full brain, which we know is susceptible to the processes of dementia. [00:19:38] So in particular, it's this training to be able to improve either visual or auditory [00:19:45] processing speed, which is not something that, you know, as you get older, you tend to not [00:19:50] do activities that require you to process information quickly, like driving is probably [00:19:55] the main one. But you can do it in sports and music and other scenarios. But if you're

[00:20:00] not doing those things, processing speed tends to drop off some time around 60 years old. [00:20:06] When you say, well, I say processing, you say processing, processing speed, are you [00:20:12] talking about reaction time, improving reaction time or pushing people to stay at the edge [00:20:17] of reaction time? And when I say stay at the edge, I should clarify for people some task [00:20:21] where if you go too fast, you make errors. If you go too slow, there's also a penalty.

[00:20:26] In this scenario, and there are studies that look at these different functions over time, [00:20:33] the biggest one looked at data that came from the implicit association test, people might [00:20:37] have heard of where you get, show these pictures of different things and depending on how quickly [00:20:41] you respond, it tells you something about like your implicit thought processes. [00:20:48] They took some of the data from that.

[00:20:50] This was published in one of the nature journals a few years ago and what they showed was that [00:20:55] you can separate out reaction time versus processing speed. [00:20:59] Because reaction time is just a very, [00:21:02] just the basic of response to a visual stimulus, [00:21:04] whereas processing requires you,

[00:21:06] is based on how quickly you can process [00:21:09] and remember the information that you'll see. [00:21:11] Actually think. [00:21:12] You actually think, yeah. [00:21:13] So what they showed in this study was that

[00:21:15] reaction time kind of slowly decreases, [00:21:17] on average in a population of, [00:21:19] it was about 1.2 million people, [00:21:21] slowly decreases in sort of like from about our 30s [00:21:26] and then maybe decreases even more

[00:21:28] once we get past about 60. [00:21:30] Processing speed on average tended to be more stable [00:21:33] until about 60 years old and then tends to drop off. [00:21:35] So in what you're doing in these training modalities [00:21:40] is you're being shown information

[00:21:43] for a very short period of time [00:21:46] and then having to remember what it was you saw [00:21:48] and where you saw it. [00:21:49] So it requires you to actually think and remember, [00:21:52] process the information rather than just responding

[00:21:55] to a stimulus. [00:21:56] So for people that want to jump to the, [00:21:58] okay, what do I do? [00:22:01] Can we conclude, okay, if you like crossword puzzles, [00:22:05] keep doing them, but do really hard ones for you.

[00:22:08] If you like lifting weights, [00:22:11] continue to challenge yourself with those. [00:22:12] If you like to run, push harder, [00:22:15] or should it be we shift domains? [00:22:18] you like to lift and run, great.

[00:22:20] Start swimming again. [00:22:21] Andrew, I'm telling myself, I used to, [00:22:24] I just noticed over time, [00:22:25] it's such a cliche of aging, right? [00:22:28] That one does tend to become more narrow,

[00:22:31] quote unquote, set in their ways. [00:22:33] You like what you like, you don't want, [00:22:34] like you don't know, you get busier, [00:22:36] you probably don't actually get busier, [00:22:37] but you convince yourself, well,

[00:22:39] I'm doing these things and I do plenty of them so, [00:22:42] but I'm not doing these other things. [00:22:44] Or for those of us, and I think this is everybody, [00:22:47] if they really ask themselves an answer, honestly, [00:22:51] you'd love to hold onto your motor function

[00:22:53] and cognitive function as long as you can, [00:22:55] maybe even improve it. [00:22:57] Should we push ourselves to do something [00:22:58] that's really far outside the box [00:23:00] or maybe sort of current skill adjacent?

[00:23:03] So I think of those three categories, [00:23:06] what do the data say? [00:23:07] If you want the greatest effect [00:23:09] for the minimum amount of time, [00:23:11] assuming you're still gonna do all the stuff you normally do,

[00:23:13] you're gonna add something else, [00:23:15] should it be something really different, [00:23:16] slightly different, or just push harder in the thing you do? [00:23:20] I think it's going to depend a little bit on what it is, [00:23:23] the things that you currently do.

[00:23:24] So crosswords are a good example. [00:23:27] Even if you're doing hard ones, if you [00:23:30] look at the work of people like Gloria Mark, [00:23:33] things like crossword and Sudoku, [00:23:35] they're less of a true, cognitive challenge.

[00:23:39] It almost has more of a meditation, meditative effect, [00:23:43] which can be a good thing. [00:23:44] So you're focused, but not challenged really. [00:23:48] Whereas if we're trying to build capacity, [00:23:52] you need to spend some time doing something

[00:23:54] where you are both focused and challenged cognitively. [00:23:58] So that can come from learning new skills, [00:24:03] be they motor, language, social, [00:24:08] and ideally as broad as possible [00:24:10] because you're going to get better, like overall stimulus, as well as kind of like broader

[00:24:18] potential for transfer into other areas of daily life. [00:24:22] In reality, the narrowness of the response or the breadth of the response is proportional [00:24:27] to the narrowness or the breadth of the stimulus, right? [00:24:31] So you could get really good at one very specific thing, or you could try and learn a new skill [00:24:39] that requires, that involves a wide variety of tasks. So I'll give like an example is learning

[00:24:45] a new ball sport, right? That is going to require multiple assets of motor skills, social skills, [00:24:52] it's going to include both visual and auditory processing that's going to get faster and faster [00:24:58] and harder and harder the better you get. So something like that creates a much broader [00:25:04] a stimulus than, you know, if you get very good at one very specific brain training task [00:25:11] on like one computer program, right?

[00:25:13] This is one of the main arguments against online or, you know, digital brain training [00:25:19] is that you get very good at doing that one specific thing, but it doesn't transfer over [00:25:23] to other areas of your life. [00:25:24] Whereas some of these broader, more complex, ultimately more human skills probably give [00:25:30] us much broader transfer as well as, you know, because of the multiple pathways or networks

[00:25:36] that are being activated. [00:25:38] If my interpretation of what you said is correct, pick something hard, ideally pick something [00:25:43] that's a bit outside or really outside your current skill set that involves motor and [00:25:50] cognitive aspects, like maybe, and that's kind of tricky to find, right? [00:25:55] I mean, with sports stuff, it feels motor and cognitive because you have to learn the

[00:25:59] the rules of the game, you have to, in some cases, [00:26:01] interact with others. [00:26:02] With cognitive stuff, the motor skills involved [00:26:06] in writing or turning a page, [00:26:10] they're not that significant, right?

[00:26:13] Even with a video game, I know video games [00:26:15] can improve reaction time and visual search [00:26:17] and things like that, but basically your thumbs [00:26:19] get real, real good. [00:26:21] I actually went to a video game competition.

[00:26:24] They have teams, a kid that used to work for me, [00:26:26] I was like, what do you want for kind of end of year gift? [00:26:29] And he was like, I really want to go to this [00:26:31] video game championship. [00:26:33] And the kids actually who compete warm up their hands,

[00:26:36] the kids in the audience like have these styrofoam things [00:26:38] that they clap so they don't make noise. [00:26:40] So they, it was a whole thing. [00:26:43] So I don't want to take anything away from the real sport. [00:26:46] I discovered that is playing video games,

[00:26:48] but mostly what was moving was thumbs and fingers. [00:26:53] Not a lot of large scale motor activity. [00:26:56] So if you had to maybe throw out three or four things [00:26:59] that are particularly potent plasticity inducers, [00:27:03] what would those be?

[00:27:05] This definitely doesn't have to be super complicated. [00:27:07] So like the things that you mentioned earlier, [00:27:09] so you could, you mentioned exercise and then skills, right? [00:27:12] And so you could do those things separately, right? [00:27:15] I would maybe we'll get into why aerobic

[00:27:18] and strength training do different things [00:27:20] to different parts of the brain, right? [00:27:21] So ideally you do a little bit of both. [00:27:24] If you don't feel super compelled to go and start a new sport, but you're getting these [00:27:29] inputs from elsewhere, and so you would rather say learn a new language, which we have some

[00:27:35] good evidence for, then that combination is great. [00:27:39] But if you're thinking about some of the things that we have very good evidence for that kind [00:27:43] of hit multiple networks at the same time, dancing is probably number one. [00:27:51] Learning a new dance? [00:27:52] Learning a new dance.

[00:27:53] solo or with someone else? I'm sort of half jokey, but some people dance on their own. [00:27:57] Some people dance with someone else. [00:27:58] So like dancing on your own in your living room, highly encouraged, right? It's a great [00:28:02] form of physical activity. It's fun. Of course, the best evidence is for ballroom and line [00:28:09] dancing, which generally requires, and so there are meta-analyses of these interventions

[00:28:13] in older adults showing that ballroom and line dancing have the greatest effect on cognitive [00:28:17] function. And so both of those require other people, as well as learning, you know, various [00:28:23] sets of movement. So you have a you have skill learning, you have social interaction, any other [00:28:27] physical activity component, there's probably also the musical component where you have to listen for [00:28:31] the timing of the music and those kinds of things that is its own skill set. So dancing has a large

[00:28:38] body of evidence behind it. But then I think, you know, in the exercise realm, you've got all the [00:28:43] sort of ball sports, board sports, team sports, I think skateboarding would be a great example, [00:28:48] as long as you wear a helmet and don't hit your head too often, most martial arts again, [00:28:52] as long as somebody's not punching you in the face too much. [00:28:54] Something like Brazilian Jiu-Jitsu.

[00:28:55] Yeah, exactly. So like there's a physical component, there's a complex motor skill [00:29:01] component. Usually there's a social component. There's a lot of responding react into the [00:29:06] environment or your opponent, right? So then talking about processing speed again. [00:29:11] But then beyond that, there's some really interesting data on some other creative arts [00:29:16] that do seem to have some effect on network stability and function in the brain,

[00:29:21] particularly the networks at the front of prior to network that we know is really important for [00:29:24] like focus and attention and its function does tend to decrease with age. So things like creative [00:29:32] or visual arts, some maybe some similar effects of learning a language. Again, similar effects [00:29:41] from learning to play video games. Yes, of course, there's no like big motor patterns involved, but [00:29:46] you're having to solve complex problems, react quickly to a changing environment,

[00:29:53] that kind of stuff. So that's eight or nine different things that somebody could try. [00:29:59] And just one of those, I think, is going to be a new skill, a new stimulus, [00:30:04] often happens in a social environment, a number of different things happening at the same time. [00:30:09] Any particular instruments? [00:30:12] I don't think anybody's looked at instruments, like the difference in different instruments.

[00:30:17] So I would say, no, pick one that you would, that you feel motivated and interested to learn. [00:30:22] Yeah, dancing by oneself has a lower shame quotient. [00:30:25] Well, the shame quotient I think might be, might be important, right? [00:30:28] There's the, you know, there's the discomfort of making mistakes and we know how critical [00:30:34] that is for learning. And so like, you're, I think some of that can be important too. But

[00:30:39] if you do it in a class, everybody else is a beginner, you're all doing it together, [00:30:42] maybe that adds a fun component because you can laugh at each other when you don't get it right. [00:30:47] So a few years ago, I wrote a paper with my colleague, Josh Turknet about this idea that [00:30:55] potentially one of the reasons why we lose cognitive function as we get older is because [00:31:00] we stop giving our brain novel inputs or complex inputs that help maintain function,

[00:31:04] drive neuroplasticity. And I think one of the reasons that that happens is because adults hate [00:31:11] being bad at things, right? You just like this thought, like you just imagined it, right? I'm [00:31:16] in a dance class and I'm going to suck at dancing, right? I imagine that I'm going to take my wife [00:31:23] to a tango class. It's something I've always wanted to do. But when I go in the first time, [00:31:27] I imagine I'm going to be like Arnold Schwarzenegger and Jamie Lee Curtis in True Lies.

[00:31:32] video, do you ever see that movie? But anyway, so right at the beginning, they're like, [00:31:35] they're spies, and they're doing the tango at this, you know, like gangsters mansion or something. [00:31:40] And it's like, he leans over, she grabs the rose from the table in her in her mouth, [00:31:45] like, I'm going to try that, I'm going to drop my wife, and she's going to hit her, [00:31:48] she's gonna be mad at me, and lots of people are going to see and I'm going to feel stupid, right?

[00:31:52] And so that's why we don't do those things. But it's so critical to driving those processes of [00:31:58] of neuroplasticity, that we make those mistakes, [00:32:01] that we have to kind of let go of some of that [00:32:04] that we feel as adults. [00:32:06] We think that everybody expects us to be good at everything

[00:32:09] and the best at everything. [00:32:10] And we shouldn't fail, we shouldn't make mistakes. [00:32:12] But as you have covered many times, [00:32:15] it's so critical to do that. [00:32:18] And so I think acknowledging that shame component exists

[00:32:22] and leaning into it is gonna be a really important part [00:32:25] of trying to maintain this function over time. [00:32:27] a couple of quick anecdotes and then some encouragement [00:32:29] to do the tango class. [00:32:31] I'll start with tango.

[00:32:32] My grandparents on my Argentine side did tango [00:32:35] until they're into their 80s. [00:32:37] So it can be done, but they learned it rather young. [00:32:40] And Tim Ferriss, as I recall, [00:32:42] talked about this in one of his books.

[00:32:44] Yeah, he learned tango and that gets to the other point, [00:32:48] which is I wanna talk about sex differences [00:32:52] and results of experiments in plasticity. [00:32:55] but when you dance, [00:32:57] the sorts of dances that we're talking about,

[00:32:59] so salsa, tango, typically, this is, you know, [00:33:04] traditionally the male leads. [00:33:07] Years ago, I had a girlfriend who was really into salsa. [00:33:10] So I went salsa dancing with her [00:33:12] in the Bay Area one night.

[00:33:13] And it's a tricky thing if you're not skilled salsa dancer, [00:33:17] because basically you're taking your girlfriend [00:33:18] to go dance with a bunch of other men, you know? [00:33:21] And then you, until you learn. [00:33:23] so that there are conditions that make it harder,

[00:33:27] social conditions that make it harder for men to learn [00:33:29] than women to learn particular types of dance, [00:33:32] unless as Tim did, he got a dance coach, [00:33:35] a female dance coach to teach him how to lead, [00:33:38] and then he learned how to lead,

[00:33:39] and then he was able to dance tango competitively. [00:33:41] I think I have that right, Tim. [00:33:42] They'll correct me in the comments, [00:33:43] but as I recall, that's the story. [00:33:45] So there's that.

[00:33:47] Not that following is trivial, it requires some skill, [00:33:50] but if the person, and traditionally the male can't lead, [00:33:56] the whole thing, it doesn't work, right? [00:34:00] So I just made you more nervous about going to this class, [00:34:03] but you should do it because I had a roommate

[00:34:05] when I was a postdoc who was a neurology resident at UCSF [00:34:08] and she would go do Tango late at night [00:34:11] and she would come back a different person. [00:34:13] And so this is like the other piece here is, [00:34:15] it seems that when we are trying something truly new

[00:34:19] that involves interactions with other people. [00:34:21] And we go into that willingness to enter beginner's mind [00:34:25] or whatever it is, embrace the shame. [00:34:28] And as we start to get even just a little bit better [00:34:30] at something, I mean, it almost seems like

[00:34:33] there's this kind of halo around the rest of our life. [00:34:36] We go to work the next day differently. [00:34:38] We interact with people differently. [00:34:40] Like our nervous system is changed. [00:34:42] What do you think that is?

[00:34:44] I mean, we can make up stories about chemicals [00:34:45] and maybe we should because they're likely to be true. [00:34:48] What do you think that is? [00:34:49] That like general change in arousal, [00:34:51] like you're sleeping better.

[00:34:52] You're more excited for the other things in life [00:34:55] when you're trying to learn Tango [00:34:57] and you get just a little bit better. [00:34:59] What is that? [00:35:00] I don't think I would make up anything about chemicals.

[00:35:03] I think you could boil a lot of it down to, [00:35:06] we like to be good at stuff [00:35:08] and we like to overcome things, right? [00:35:10] This is like core needs to be challenged [00:35:13] and then to overcome those challenges.

[00:35:16] And I think there's a lot of downstream effects [00:35:19] of not doing that. [00:35:20] And they could be related to mental health. [00:35:22] They could also be related to physical health, right? [00:35:24] Because we could think about physical and cognitive

[00:35:27] or stressor, psychological-related challenges [00:35:31] and the process of overcoming them, [00:35:33] because that's what really drives [00:35:35] a lot of physical or mental psychological growth. [00:35:39] And I think that's something that fundamentally

[00:35:42] is part of what we need on a daily basis. [00:35:45] And so you did this thing that you were bad at [00:35:48] and you got better at it, and you proved to yourself, [00:35:51] hey, I'm capable, I'm able to overcome challenges, [00:35:54] I'm able to engage and do difficult things.

[00:35:58] And I think the psychological benefits of that, [00:36:02] you're just that process of engaging with a challenge, [00:36:05] overcoming it, working hard to do that. [00:36:08] I think that's just almost like a core psychological need [00:36:12] that we have.

[00:36:13] And then that transfers to all these other things. [00:36:14] I can do these hard things. I'm going to do that other thing. I'm excited to try something else [00:36:18] that's difficult. I'm excited to challenge myself again. And it needs to be something that feels [00:36:24] meaningful, feels difficult enough that you have the ability to overcome with some dedicated [00:36:29] practice or, you know, focus time working on it. If it's too hard, you can have the opposite effect,

[00:36:35] right? Like making something so difficult, somebody can't do it, and they just fail again, [00:36:38] and again, and again, and again, right? That can obviously have the opposite effect. But something [00:36:42] that you know you can get better at, you know you can work on, you can see progress. I think all of [00:36:47] that then has all these knock-on effects. Maybe we could talk about flow for a second. You know, [00:36:52] one of the most bastardized terms in neuroscience, performance, psychology, and the rest. When

[00:36:58] Cheeksumai talked about it initially, when he really defined the term, it was about [00:37:04] being engaged in a process where you have a certain level of skill. But the thing you're [00:37:09] you're trying to do is just beyond your skill level. [00:37:11] So really striving a bit and that kind of general sense [00:37:15] of wellbeing that can come from that.

[00:37:17] Nowadays, I think people assume flow is when you are able [00:37:20] to do something in the absence of kind of feeling of effort. [00:37:25] It's like you just, you get the magic power kind of thing, [00:37:29] which is not what flow was originally intended to mean. [00:37:32] I like to know how you think of this concept of flow

[00:37:35] and whether or not it's even a meaningful term. [00:37:37] And I, you know, I tip my hat to Stephen Kotler [00:37:40] and others who have written about it and studied it [00:37:43] and a great respect for Stephen [00:37:45] and what he's done with the concept

[00:37:49] and I think it's a meaningful concept [00:37:52] but I don't think we really know how to define it. [00:37:56] And I think this is important in the context of plasticity [00:37:58] because I think what we see in Harry Potter movies [00:38:02] and sci-fi and, you know, Fight Club

[00:38:06] and everything else is that suddenly we're just going to be endowed with these powers [00:38:09] just because we want them and need them. [00:38:11] And that is not how it works. [00:38:14] So is flow an expression of skill or is it the striving to attain a skill? [00:38:18] I think of flow as the maximal expression of a complex learned skill.

[00:38:24] Like you said, you're like right at the edge of your capabilities, but you're still managing [00:38:27] to maintain, maintain function, whatever skill it is that you're performing at. [00:38:33] The thing that really frustrates me is that because of that, or some version of their [00:38:40] definition of flow, people are like, well, I've always got to search for flow. [00:38:44] Everything happens in flow, and we need to be in flow all the time, which doesn't make

[00:38:47] any sense to me whatsoever. [00:38:49] There's two different parts of this. [00:38:51] One is that people assume that for optimal performance, you need to be in flow. [00:38:56] That is not true. [00:38:58] Flow is one version of being able to perform at the best of your abilities.

[00:39:04] If we think about this in terms of sports performance, there might be broadly two states [00:39:10] associated with top level performance. [00:39:13] One is flow states, the other is clutch states. [00:39:17] And so a clutch state, you are still at the optimal level of arousal, right, if we think [00:39:22] about the arousal curve and performance, which we can come back to.

[00:39:25] So at the optimal level of arousal, which is required for you to perform the skill that [00:39:30] you're trying to perform, but when you're in a clutch state, it still feels like hard [00:39:35] work, right? [00:39:36] So like there are, you could talk to any athlete about a time that they, they performed well, [00:39:42] they won, they did the best of their abilities, but it was hard cognitive work, it was hard

[00:39:47] physical work, it was a slog, but they still managed to perform well, that's a clutch state. [00:39:52] And people can perform at the best of their abilities in clutch states. [00:39:56] And you know, even though they're not in flow, it's not all coming to them easily, right? [00:40:00] It requires them to like, really focus and work hard to get get the job done. [00:40:04] And both of those are perfectly reasonable states in which to perform.

[00:40:08] And assuming that you have to be in flow to perform just isn't true if you look at like [00:40:12] how you know, athletes perform in the moment. [00:40:14] The other side of it is that some people have intimated that flow is required for learning, [00:40:22] or like optimal learning happens in flow, [00:40:23] which doesn't make any sense, right?

[00:40:25] If we talked about making mistakes and errors [00:40:28] and friction required for learning, [00:40:30] that is not conducive to flow because it can be stressful, [00:40:34] it can be frustrating. [00:40:36] And so the other side of that is

[00:40:38] if flow is expressing your skill, [00:40:44] if you want to get better at that skill, [00:40:46] you have to work even further beyond your current capacities, [00:40:49] which will move you out of flow, right? [00:40:51] because of the friction, the mistakes, and the errors that come from that.

[00:40:55] I think flow is super interesting, and I wouldn't pretend to be an expert in flow, but there [00:40:59] are all these other states where learning happens, where performance happens, that aren't [00:41:04] flow. [00:41:05] That's fine too, but sometimes it's hard, and that's okay. [00:41:09] I'm so glad you're here.

[00:41:10] I've been looking for this conversation since I started the podcast, because I completely [00:41:17] agree about flow and the misunderstanding of the concept of flow. I've never heard [00:41:23] of a clutch state. Is that a term that you coined or something? [00:41:27] No, no. In the sports psychology literature, they'll talk about it. [00:41:30] So that's why I haven't seen it. Yeah. Because I'm very familiar with the neuroplasticity

[00:41:33] literature, but I've never heard of it. Maybe I'm just not up to date on my reading, but [00:41:38] thank you for introducing clutch state, which is when one is performing well, but it's involving [00:41:43] and this is a term I did make up, [00:41:46] sort of some limbic friction, [00:41:47] like you have to push yourself,

[00:41:48] you're feeling constrained, [00:41:50] it's that you're at that edge [00:41:51] where there's real challenge, [00:41:52] you're definitely not in the flow, fantastic, [00:41:56] clutch state, everyone, learn it, know it, embrace it,

[00:42:02] live there for some period of time in your life, [00:42:04] across your lifespan, and you'll be better off, I mean that. [00:42:09] Maybe we could drill into this a little bit more [00:42:11] because several times on this podcast [00:42:13] more and more, we've talked about the anterior mid-singulate cortex, the structure that,

[00:42:17] you know, maintain size in super-agers who take on hard things and, you know, this area [00:42:22] of the brain that seems associated with tenacity, which when stimulated, people feel like an [00:42:26] impending challenge is actually neurosurgery experiments done by Joe Parvizi at Stanford. [00:42:32] People feel like, oh, there's an impending challenge. [00:42:33] I'm going to lean into it.

[00:42:35] This is sounds more like the clutch state than certainly than flow state. [00:42:40] So maybe the thing we need to embrace is the clutch state. [00:42:42] It's pretty catchy. [00:42:44] It's not quite as catchy as flow, but I like it because it has an element of like friction [00:42:52] kind of written into it.

[00:42:53] You heard it first from Tommy Wood, folks, not me. [00:42:57] A good friend who comes from the special operations community, we talked about performance years [00:43:04] ago and he said, well, there's unskilled, skilled mastery and virtuosity. [00:43:08] Okay, cool. [00:43:10] And he said, virtuosity is when someone who has mastery

[00:43:14] pushes out to an edge of effort [00:43:19] where they're sort of inviting in the unknown. [00:43:21] They don't quite know what they're gonna do. [00:43:23] Next, they have some semblance of an idea, [00:43:25] like they're not being haphazard,

[00:43:28] but there's an inviting in of the unknown [00:43:30] and they find themselves at a new level. [00:43:35] I've probably mentioned this documentary four times [00:43:37] in the last four episodes, [00:43:39] but when Andy Stumpf, former tier one seal operator

[00:43:45] came on this podcast, former wingsuiter, [00:43:47] Red Bull High Performance team came on here, [00:43:48] he suggested a podcast that I'm now suggest, [00:43:50] he suggested, excuse me, a documentary [00:43:53] that I highly recommend, which is The Dark Wizard,

[00:43:55] which is about Dean Potter, who was a free climber, [00:43:57] a free solo climber turned wingsuiter, et cetera. [00:44:00] And you see in that documentary [00:44:03] how somebody who's pushing to their edge [00:44:06] and a little bit beyond where the consequences,

[00:44:10] the death consequence is able to access levels of skill [00:44:14] that are like jaw dropping, I think even to him. [00:44:18] So does that make sense? [00:44:20] Like, is that sort of how you think about unskilled, [00:44:23] skilled mastery, virtuosity?

[00:44:24] Do you think virtuosity is like, [00:44:26] where someone's like, all right, I've mastered this thing. [00:44:28] Now, put me in a situation [00:44:30] or I'll put myself in a situation where, [00:44:33] I don't know what's gonna happen.

[00:44:35] and maybe it'll all go wrong, [00:44:37] but when it doesn't, new levels of performance emerge. [00:44:41] As it's described that way, [00:44:44] because people might talk about virtuosos in a skill, [00:44:47] just because there's so much better than everybody else.

[00:44:50] But that definition requires a specific scenario [00:44:57] and moment of performance. [00:45:00] So then that sounds a lot like how I would think about flow. [00:45:04] And so when you look at some of the classic descriptions [00:45:07] from individuals who've been in that kind of level,

[00:45:09] so like there's this one from, [00:45:12] so I do a lot of working for me the ones. [00:45:14] So there's one from Ayrton Senna, where he's- [00:45:16] From who, I'm sorry? [00:45:17] Ayrton Senna.

[00:45:18] The driver? [00:45:19] The driver. [00:45:20] Senna. [00:45:21] Senna, S-E-A. [00:45:22] Senna, excuse me.

[00:45:22] Ayrton Senna, yeah. [00:45:23] Senna is David Senna, the great podcaster. [00:45:25] He's the virtuoso of performance and business [00:45:29] and finance podcasting. [00:45:30] Don't let any of your F1 loving friends

[00:45:34] that part of the podcast. I like Senna, some people consider him to be the best Formula [00:45:41] One driver of all time. He died tragically in a crash. But there's this famous quote from him [00:45:50] where he's driving in the Monaco Grand Prix. And basically what he describes is that [00:45:57] he's like going faster and faster and faster. He's like, this is beyond my capabilities. [00:46:00] he doesn't feel like he's actually connected

[00:46:03] to doing the thing. [00:46:03] It's just kind of like happening. [00:46:05] It's exactly like he's going seconds fast [00:46:07] around the lap than anybody else. [00:46:09] And so like, that's kind of what like,

[00:46:10] he is so good, right? [00:46:11] He achieved mastery. [00:46:12] And in that moment, he's displaying virtuosity [00:46:15] in that kind of, under that kind of definition. [00:46:18] And so like that,

[00:46:19] that feels like there's a lot of overlap there. [00:46:21] Yeah. [00:46:22] Ever since seeing this dark wizard documentary, [00:46:25] which I've watched twice all the way through, [00:46:26] because it has a mental health component,

[00:46:28] It's a brilliant and beautifully shot documentary [00:46:31] recently released. [00:46:34] I think about this virtuosity thing constantly. [00:46:37] But I love this notion of the clutch state [00:46:39] because it sounds to me that that's the state

[00:46:45] that we want to seek. [00:46:46] And the assumption is that high performers [00:46:49] are in this relaxed, mellow state. [00:46:52] But I'm guessing they spend a significant amount [00:46:54] of time there and drilling the really boring stuff

[00:46:56] to make sure they can get there. [00:46:58] Twyla Tharp, who's in her 80s, a world-class choreographer, [00:47:04] sat in the chair that I'm in and described [00:47:06] the daily routine of her world-class dancers. [00:47:09] They go through the most basic drills every single day,

[00:47:14] but every iteration for hours upon hours upon hours [00:47:17] before they begin, quote unquote, practice, right? [00:47:21] Before they try and embrace the new performance piece, [00:47:26] But over and over and over, often after multiple hours of morning exercise, I think we don't [00:47:33] see all of that foundational work and that it needs to be maintained.

[00:47:36] Which raises a question, do we always need to practice the fundamentals? [00:47:43] Before I answer your question, I think there's another useful thing, just kind of to remember [00:47:47] that relates to all of this, from in athletes and sports, particularly on the training side, [00:47:54] is this general idea of thirds, right? [00:47:57] A third of your sessions, training,

[00:48:01] learning, whatever it is, are gonna feel great. [00:48:04] You're gonna feel really good, [00:48:05] you're just gonna get stuff immediately, [00:48:07] it's gonna just come to you. [00:48:10] A third will just be average, right?

[00:48:12] And a third are just gonna suck [00:48:14] and you just have to show up and get it done. [00:48:16] But this is all in the same day, [00:48:17] or this year across the week? [00:48:19] Across the week, across months, across years,

[00:48:21] right, this stuff undulates. [00:48:22] But the main reason why I say that is because related to this sort of glorification of flow [00:48:30] is this idea that these things should just like always come easily to us. [00:48:34] But that's completely antithetical to the idea that we have to work hard and challenge [00:48:37] ourselves in order to build capacity, drive neuroplasticity.

[00:48:41] So there's kind of this weird tension between what people are seeking versus what is actually [00:48:45] just the part of the grind of getting better and, you know, over time, and sometimes it [00:48:51] is a grind. [00:48:52] you know, again, that's okay. It doesn't mean you're doing it wrong. Maybe it means you're [00:48:56] doing it right. When you then think about maintaining the fundamentals, I think yes,

[00:49:01] but probably it's going to depend on the scenario that you're thinking about. Because sometimes [00:49:09] the skill that you're performing, the fundamentals are kind of baked into that in some way. So [00:49:16] it kind of depends on what the fundamentals really are. Maybe, you know, if it's, so I'm [00:49:21] about one specific study that was done in pianists. So this is kind of [00:49:29] related to the Ericsson studies in violinists, but this time they were

[00:49:33] looking at pianists. And so they had four groups, older and younger, [00:49:38] so the younger was like 20s and 30s, older were 50s and 60s, expert and [00:49:42] amateur pianists. And so the experts came from German music conservatories. And [00:49:48] And then they looked at sort of basic skills related to, you know, moving the fingers and [00:49:56] other things that you would do playing the piano.

[00:49:59] And so they were like very task specific skills related to piano playing. [00:50:04] And what they found was that the most important predictor of how well somebody performed at [00:50:11] those piano specific skills was not their age, it was how much they practice. [00:50:16] So it's just that getting those reps in helps you maintain those sort of like basic functions. [00:50:21] And maybe, right, when you're playing very complex piano pieces, you're encompassing

[00:50:26] all those fundamentals anyway, right, you don't need to, you don't need to like, do [00:50:30] your, you don't need to do your scales every day, because some of that stuff is kind of [00:50:34] built in. [00:50:35] But you will also see people as they warm up, say, maybe they will do scales and things [00:50:40] because that's part of just like, you know, the warm up, maybe part, maybe that's routine,

[00:50:45] right? [00:50:46] This is me getting in the, in the mode of, you know, playing complex piece, but then [00:50:50] maybe some of it is just kind of helping to maintain those fundamental skills. [00:50:55] I'd like to take a quick break and acknowledge our sponsor, AG1. [00:50:58] AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens.

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[00:52:17] I know other people have attempted to, [00:52:19] but what does that really boil down to? [00:52:21] Is it simply that about eight hours a day of practice [00:52:24] for a dedicated period of time [00:52:26] is what leads to rapid plasticity

[00:52:28] and that's what was measured? [00:52:30] Or is there really some sort of rule about time [00:52:34] under seeking clutch state? [00:52:37] The simple answer is what the study showed was that 10,000 hours was the average amount of time [00:52:43] that an expert violinist had spent practicing by the time they reached 20 years old.

[00:52:47] That's what the study showed. They weren't even experts by that point. That was how much they'd [00:52:50] practiced essentially in their youth. So that number of hours doesn't even translate over to [00:52:56] true expertise in violinists in this one specific example. So I don't think there's some fixed [00:53:03] number of hours required. It is interesting, other parts of that study kind of looked at the [00:53:10] practice routines of these expert violinists. And what they found was that they tended to practice

[00:53:17] for about two sessions of 60 to 90 minutes a day. And I think that's a pretty good rule, [00:53:26] right? If you're going to do something hard, you're pushing beyond your current skill level, [00:53:30] focusing for 60 to 90 minutes, maybe with, you know, a couple of breaks in there, a couple [00:53:37] of times a day, that's probably about as much as most people can do. And I think that also [00:53:41] relates to how we perform on a day to day basis in other areas of life, right? We kind

[00:53:45] of expect that we can go to work and we can work really hard for eight hours straight [00:53:48] during the day. But like, the brain doesn't really work like that. If we're doing hard, [00:53:54] cognitive work, right, you're being, you're focused and highly challenged, as you might [00:53:59] be if you're a, you know, a future virtuoso on the violin, you're trying to really practice [00:54:06] and push yourself, you can only really do that for, you know, chunks of 20 to 30 minutes,

[00:54:11] maybe a couple of times of the break, right? So that's why Pomodoro, even though there's [00:54:14] no like good studies on the Pomodoro technique, like those time periods, you know, 25 minutes [00:54:18] to the five minute break a few times, [00:54:20] they do kind of fit into that kind of rhythm. [00:54:24] That translates over to multiple areas

[00:54:26] where we might want to use our brains. [00:54:28] And just remember that hard cognitive work [00:54:31] and that process of learning can only really happen [00:54:34] in those kinds of size of chunks [00:54:36] if you want to do them sustainably.

[00:54:37] Yeah, before I started writing my book, [00:54:39] somebody who's published several very well-received books [00:54:44] said you can only write for about four solid hours per day [00:54:48] broken up into a couple of sessions. [00:54:51] I was like, come on.

[00:54:53] I mean, like I'm not trying to post, [00:54:54] but I used to go into the lab and sit down [00:54:56] and work on a grant for six hours or something like that. [00:54:59] And I started thinking, like, was it really six hours? [00:55:02] Go in there, see my students in postdocs, sit down.

[00:55:04] Okay, then there was lunch and he walked my dog, you know? [00:55:07] And there were some late nights, [00:55:09] but then the next morning I'm kind of dragging [00:55:10] because I was in, you know, in my office really late. [00:55:13] And you get real honest with yourself real quick

[00:55:16] And you go, ooh, okay. [00:55:19] In the periods of time where I definitely pushed [00:55:21] to the six, eight, 10, 12 hours of just nonstop work [00:55:24] as a deadline approached, [00:55:26] there was a compensatory drop in output

[00:55:28] after you click send. [00:55:30] And so I think you're right, they're right. [00:55:33] It's somewhere between maybe, I mean, [00:55:36] you're saying 60 to 90 minutes [00:55:37] and they're saying four hours,

[00:55:38] but not a whole lot more than that [00:55:40] for real focused in clutch state work. [00:55:44] So really digging in and no distractions, no phone, [00:55:47] no checking your text messages. [00:55:49] Just, you know, do you ever give yourself

[00:55:52] forced constraints to get real work done? [00:55:55] Not to force it. [00:55:56] I will say that one of the best ways [00:55:59] to like truly get deep focused work done [00:56:04] is to eliminate distractions, right?

[00:56:06] That's one of the most important things that you can do. [00:56:08] So close the email. [00:56:09] I would like put my phone in a different room or something [00:56:11] Because nowadays, your own closed Slack, [00:56:16] I have Slack teams, my lab and I,

[00:56:19] we interact on, we mess it back and forth on WhatsApp, [00:56:22] like there's email. [00:56:23] I've got like five or six different ways [00:56:25] that people can constantly try and get my attention, right? [00:56:29] So eliminating distractions is really important.

[00:56:31] And again, I've returned to Gloria Mark's work. [00:56:34] She wrote an excellent book called Attention Span [00:56:36] if anybody's really interested in this. [00:56:38] but you get used to a pattern of distraction [00:56:41] such that when you're not actually being distracted,

[00:56:45] you will distract yourself. [00:56:47] Right? [00:56:48] And you can be trained out of that as well. [00:56:50] But so you know that thing where you're trying to do work [00:56:53] and you like reach for your phone for no reason.

[00:56:56] It's because your brain is kind of used to this pattern [00:56:58] of around about now, somebody would text me [00:57:02] or send me an email and I'll reach my phone. [00:57:04] So you go looking for it, even if it hasn't happened. [00:57:07] But again, you can train yourself out of that

[00:57:09] if you have periods where you're not getting [00:57:11] constantly distracted. [00:57:12] So I will eliminate notifications. [00:57:15] But at least for me, what I found [00:57:17] is that if I have a ton of friction

[00:57:21] in terms of trying to get something done, [00:57:24] I will usually step away from it. [00:57:27] Because there's something in there [00:57:29] that just needs to click or come back [00:57:31] before I can really engage in it.

[00:57:33] Or if you're at a sticking point. [00:57:35] Yeah. [00:57:36] So if I'm at a sticking point, [00:57:37] it's like if something feels like [00:57:40] it's just not coming in the moment,

[00:57:42] I will usually switch over to something else, [00:57:45] which is also kind of a normal, [00:57:47] it's one of a possible set of patterns of work, [00:57:50] which is that you have two or three projects [00:57:52] you're working on at any given time.

[00:57:54] If one just like isn't quite working, [00:57:56] then you can switch over to the other one [00:57:57] and come back to it. [00:57:58] And then like the alternative is that [00:58:01] when the deadline is so close,

[00:58:03] And this often happens with a grant deadline [00:58:06] or when I was writing my book. [00:58:08] And there's a book deadline. [00:58:09] And I've got to get this to my editor [00:58:11] in how many days or hours.

[00:58:15] I tend to just not need to eliminate those things [00:58:20] because I'll just focus in. [00:58:23] I don't feel that kind of draw to be [00:58:26] distracted by other things. [00:58:27] But that usually only happens for relatively short periods

[00:58:30] of time. [00:58:30] It's going to be a day or two or hours during a day [00:58:32] rather than extended periods of time. [00:58:34] Are you familiar with this recent study [00:58:36] about phone on the table, phone in the bag?

[00:58:38] We just remind people that your phone [00:58:41] has to be out of the room. [00:58:42] Even if it's in your bag beneath your chair turned off, [00:58:44] you can still focus, but there's a cost. [00:58:48] Your cognitive flexibility, et cetera, really suffers.

[00:58:51] So that means that the brain is unconsciously expecting [00:58:54] a call, instead of waiting for it. [00:58:56] And the way you describe this attentional break expectation [00:58:59] thing, that we get entrained to interruptions is really [00:59:04] interesting.

[00:59:06] Maybe this is why meditation is such a useful tool [00:59:08] for improving focus, is that it's just a forced no breaks [00:59:13] thing, although it's pretty easy to drift in meditation. [00:59:16] If you are not used to doing 20 minutes of meditation, [00:59:18] you sit down to do that.

[00:59:19] You set the timer. [00:59:20] Your brain can end up way off the trail. [00:59:24] There could be some benefit to that as well, right? [00:59:26] there's, you know, without kind of building that in, and I don't routinely meditate, but [00:59:33] unless you have some part of your day where actually you're not either putting in information,

[00:59:43] distracting yourself, thinking about a specific thing, right, you don't necessarily get that [00:59:46] time to integrate, you know, that's kind of, you know, the classic is you can't with your [00:59:52] best ideas in the shower, right, because it's actually the time when you don't have your [00:59:55] phone on you and you're not watching TV and you're not doing all those other things at [00:59:59] the same time. So maybe, yes, that's not what meditation is formerly for, but it could potentially

[01:00:07] be beneficial. If your mind's going to wander, making new connections, coming up with new [01:00:13] ideas, having that space and time to do it could potentially be beneficial too. [01:00:17] In these studies, these large scale trials, what was the diet intervention? Can we distill [01:00:23] it down to some things that everyone should do or ought to consider. [01:00:28] Most interventions in the sort of cognitive and psychological space are focused on some

[01:00:35] version of the Mediterranean diet. There's the mind diet Mediterranean intervention [01:00:42] to prevent neurodegenerative delay that came out of the Rush memory and aging project. [01:00:47] And it was basically just a version of the Mediterranean diet kind of focused on dementia [01:00:54] prevention and the way they initially created it was they looked at foods that people ate [01:00:59] more or less of and created a score and those who had a higher score had a lower risk of

[01:01:04] later dementia. [01:01:05] It wasn't an intervention when it was when it was first developed, but that was kind [01:01:09] of diversion. [01:01:10] It was kind of a combination of the Mediterranean diet and the DASH diet, which is like an anti-hypertension [01:01:16] and blood pressure treatment type diet.

[01:01:18] So it's seafood, vegetables, berries, whole grains, [01:01:24] that kind of stuff. [01:01:25] Not too much saturated fat or animal protein. [01:01:27] Yeah, and so this is very similar [01:01:29] to the diet they used in the SMILES trial,

[01:01:31] which was the first randomized controlled trial [01:01:32] in depression that showed significant improvements [01:01:35] in mood symptoms. [01:01:37] I think the principles are useful, [01:01:39] but there's not necessarily a huge amount of evidence

[01:01:41] to say that this is the way that you should [01:01:44] or you have to eat to maintain cognitive health. [01:01:47] There was actually a big trial of the MIND diet. [01:01:51] It was published in the New England Journal of Medicine [01:01:54] a couple of years ago.

[01:01:55] And they compared the MIND diet to standard caloric [01:01:59] restriction. [01:02:00] And actually, they saw similar benefits in both groups. [01:02:03] There have been big observational studies [01:02:05] that have looked at how much their diet looks

[01:02:07] like a Mediterranean diet. [01:02:09] And those whose diets look more like Mediterranean diets, [01:02:11] yes, they have a lower risk of dementia. [01:02:13] course, right, this is observational data, right, so it's not, you can't say it's causal. [01:02:18] But what's interesting in some of these studies, there's a big one that came out of the UK Biobank

[01:02:21] was that they took out individual foods or food components of the Mediterranean diet to see if [01:02:29] that changed the relationship between the Mediterranean diet and dementia risk. And [01:02:33] there was no food or, you know, olive oil, or food group, or you're eating more or less meat [01:02:39] that changed the relationship between the Mediterranean diet and dementia risk. [01:02:42] So what that tells me is it's much more about whole foods, they're nutrient dense, rather than

[01:02:49] avoiding any, you know, you have to eat, you have to consume lots of olive oil, right? Or you have to [01:02:55] restrict meat. Because if those things are eaten in the context of all this other stuff, it's really [01:03:01] that bigger context of diet quality and nutrient density that really matters. So the parts of [01:03:08] of diet that I think about are the, you know, there's three, so there's energy, there's [01:03:15] nutrients, and then there's overall dietary pattern. So one of the confounding things

[01:03:20] about that trial I told you about the mind diet versus caloric restriction is you're [01:03:23] like, well, the mind diet should win out, right? How does caloric restriction do just [01:03:27] as well. And in the kind of average population, we tend to have some issues with metabolic [01:03:36] health and have been in a state of chronic energy excess for some period of time. [01:03:41] There's been some very nice studies that have looked at brain aging and brain volume or

[01:03:45] brain reserve across different populations. [01:03:50] There was one group that looked at different tribes in Bolivia, the Bolivian Chamane, the [01:03:55] Ruhan Togada group, the Musetan, who are kind of an intermediate group between the Chamane [01:04:01] and like a standard kind of industrialized group, and then industrialized humans in the [01:04:05] US and Europe. And what they found is this kind of this bell-shaped curve between energy

[01:04:10] availability and brain volume. And in general, brain volume, the more the better, we think. [01:04:17] And so if you're chronically calorically restricted, your brain is smaller. Because you just don't [01:04:22] have the resources to invest in the structure and to maintain it. [01:04:28] At the other end, you see the same thing. So if you're chronically in a chronic state [01:04:32] of Chloric excess, you also tend to have a smaller brain on average. And this is related

[01:04:36] to metabolic disease, you know, and you know, potentially, what comes with it, higher levels [01:04:43] of inflammation, high blood pressure, things like that, that we know can negatively impact [01:04:46] the brain. So the most important thing, and I think this is where some of the benefits [01:04:50] of Chloric restriction happened in that in that trial compared to the mind diet, was [01:04:54] that, you know, people's cognition improved just because they decrease their energy intake

[01:04:59] to a point that was, you know, more, you know, was essentially kind of what their brain kind [01:05:05] of needed, you know, kind of support their overall physical health, which then affects, [01:05:09] you know, cognitive health and brain volume and brain function. So the first thing to [01:05:14] do is to make sure that you're eating enough, but not too much, right? And that's very simplistic, [01:05:19] but like energy is really critical energy availability, not too low, not too high. Then

[01:05:24] Then the next thing that you need is nutrients. [01:05:27] We know there are several critical nutrients related to cognitive function and risk of [01:05:32] dementia. [01:05:33] The ones that we have the best evidence for are vitamin D, iron, omega-3 fatty acids, [01:05:39] the B vitamins involved, and the B vitamins involved in methylation.

[01:05:42] So particularly B12 and folate, also potentially B6 and riboflavin, although that might depend [01:05:47] a little bit more on the individual. [01:05:49] Then there are some other nutrients that have some pretty good evidence for them. [01:05:53] many of the antioxidant polyphenols, things that you get from berries, coffee, tea, chocolate, [01:05:59] the carotenoids that make things orange, yellow, and red, lutein, zeaxanthin, astaxanthin,

[01:06:04] if it comes from seafood, that's what makes shrimp and salmon pink. And then, [01:06:10] some other aspects like dietary fiber seems to have some benefits as well. [01:06:14] Not magnesium. [01:06:15] So magnesium is absolutely, absolutely in there, in there too. And in general, I think, and so [01:06:22] magnesium, zinc, then there's some of the structural lipid components, things like choline

[01:06:28] and ethanolamine that you might get from nuts and seeds or eggs. They have some slightly less, [01:06:36] like less evidence, really, when you're looking at brain changes over time and dementia risk, [01:06:42] but they certainly do seem too related to cognitive function. So there are some studies that show [01:06:46] that those who have lower magnesium intakes tend, on average, to perform less well on some [01:06:52] cognitive function tests. So all of those do seem to be important.

[01:06:56] I have two questions about nutrients and brain health in the short and long term, [01:07:01] and they have to do with interactions between nutrients, which, at least to my understanding, [01:07:06] are rarely explored. You'll see studies of supplementing Omega-3 or having people eat [01:07:11] eat some fatty fish or less and so on, [01:07:13] but rarely in the presence or absence

[01:07:15] of some other vitamin that, you know, [01:07:18] that can potentially impact the same pathways. [01:07:21] So there's synergy, there's also, you know, necessity. [01:07:25] So that could impact results. [01:07:27] The other piece is,

[01:07:29] on what time scale are these nutrients needed [01:07:32] and on what time scale are they metabolized? [01:07:34] So maybe to just kind of drill [01:07:36] into the second question first. [01:07:37] So, you know, I'm not out here

[01:07:39] is like the defender of supplements, [01:07:41] but I've been taking supplements in various forms [01:07:43] and eating whole foods and eating generally healthily, [01:07:48] you know, less so when I was younger, [01:07:49] but still pretty healthy and more so as I get older.

[01:07:52] But here's where my brain goes, [01:07:55] wait, whole food is great, [01:07:58] but let's say dark leafy greens [01:08:01] have a bunch of things in them [01:08:03] that are fundamentally important

[01:08:05] for brain and bodily health. [01:08:06] Great, and they have fiber, et cetera. [01:08:10] How many times a week am I eating dark leafy greens? [01:08:12] Let's say I do Monday, Tuesday, Wednesday, I'm great, [01:08:14] but then I'm traveling on Thursday, Friday.

[01:08:16] Should I be just supplementing Thursday, Friday? [01:08:18] Am I good until the next week? [01:08:20] I think one of the reasons why eating really well, [01:08:25] I think everyone that knows what that means, [01:08:26] enough calories, not too many, mostly whole foods, et cetera,

[01:08:30] enough vegetables, fruits and high quality protein [01:08:34] and quality fats. [01:08:35] I think the reason why supplements still become enticing [01:08:40] to me, maybe even necessary, [01:08:42] is because you can take them every day very easily.

[01:08:45] So you can make sure that you're in range [01:08:48] and maybe above range. [01:08:50] So let's take one of these things. [01:08:53] Okay, omega-3 fatty acids. [01:08:55] I believe that the data are pretty compelling.

[01:08:57] They can be helpful for health, maybe even brain health. [01:09:01] Certainly, I believe that. [01:09:03] But let's say the early part of my week [01:09:05] omega-3 rich, and the later part of my week is omega-3 poor, am I good? Versus, you know, [01:09:13] spreading it out across the week. It just becomes difficult to eat in a truly healthy way if it's

[01:09:19] the case that it has to be consistent every 24 hours. So what do we know? [01:09:24] So again, I think we're often tempted to overcomplicate this and try and think, oh, [01:09:31] you know, I have to hit all these things at this interval. And if I can't do that, [01:09:35] then I have to supplement. And in reality, we probably have more buffer in the system [01:09:41] than than we realize. So omega three fats is a really good example. Your adipose tissue,

[01:09:49] your fat tissue is a depot. You know, it kind of stores excess omega threes. Actually, I wrote a [01:09:55] paper on this with a colleague of mine, Rory Heath, a few years ago, the long chain omega threes that [01:10:00] we have in our fat stores may help to explain why supplementation does or doesn't work in [01:10:08] some of these trials, because some people just have more kind of hanging around. And if you eat [01:10:13] more than you need on one day, especially in a state of caloric excess, that's going to be

[01:10:19] stored in your fat tissue. And then when you're sleeping or when you initiate lipolysis, the [01:10:25] breakdown of fat, so particularly during periods like you're doing exercise, those then get released [01:10:30] and the brain then has access to them. So, there's some studies that show that when you... [01:10:36] This relates to the form of the omega-3s as well. So, many people will tell you that you have to [01:10:40] take omega-3s in the phospholipid form, which is a special supplement. You can get it from krill,

[01:10:49] and the form is that the fat is attached to a phospholipid head group, just like it would be [01:10:55] if it was sitting in a cell membrane. And there's a specific pathway for those to get [01:11:00] into the brain. [01:11:01] It's only krill or it's fish oil also? [01:11:03] No, so fish tends to be the triglyceride form, which is glycerol and then three fatty acids

[01:11:08] attached. When you compare a single dose of phospholipid versus triglyceride form, then [01:11:15] more of the phospholipid form gets into the brain. Some of this, most of this comes from [01:11:19] rodent studies. But what's interesting is that if you supplement over several days, [01:11:24] all kind of comes out in the wash because the triglyceride form cycles through the adipose [01:11:29] tissue as a depot and then it gets released and the brain can then use it.

[01:11:33] So if you're going to take just one day of supplement and you want to get as much of [01:11:38] that omega-3 in your brain, yes, we think you should take the phospholipid form. [01:11:42] But the form that comes in seafood, which is primarily the triglyceride form, is regulated [01:11:48] through the body's fat stores. [01:11:50] So this is a really long way of me telling you, if you eat some fish early in the week,

[01:11:54] you don't then have to supplement later in the week, as long as you've got enough. [01:11:58] And especially if you've consistently eaten seafood across your entire life, because you [01:12:02] probably have a bit of a depot. [01:12:04] And so what you see in several trials where they've given omega-3s to decrease dementia [01:12:12] risk or improve cognitive function, so many studies like that have been done.

[01:12:17] there was actually a very recent one that just came out of USC where they gave omega-3s for a long [01:12:22] period of time. They measured omega-3 levels in the in the CSF right in the spinal fluid. These [01:12:27] people to show that this the omega-3s were getting into the brain they didn't see any changes in [01:12:31] terms of cognitive function or brain structure or an MRI scan so that everybody's like well [01:12:36] omega-3s don't work but when you kind of squint at the data and and they didn't quite give me

[01:12:42] the data that I wanted but when you look at it those the people in the trial just didn't seem [01:12:46] that omega-3 deficient in the first place. So if this isn't something that you need more of to [01:12:52] start with, giving a load more of it isn't going to make that much of a difference. And this is [01:12:57] the case for all of these different supplements. So the best advice, if you have access to it, [01:13:03] is to test your levels, test your vitamin D levels, test your hemoglobin and iron levels,

[01:13:07] test your omega-3 levels, test your homocysteine levels, which is a marker of B-vitamin status, [01:13:12] which we know is a risk factor for cognitive decline dementia as well. So if you can test [01:13:19] your levels and it shows that you need more, and yes, the normal ranges that you have on a blood [01:13:26] test are not necessarily the same as the risk ranges. So homocysteine is a good example. [01:13:32] A normal range for homocysteine, which goes up if you need some of these methylation-dependent

[01:13:37] be vitamins, the normal range might go up to like 15 or 16. But we know that risk is definitely [01:13:43] elevated above 13, and is probably elevated above sort of 10 to 11. So what your target range really [01:13:51] might be is probably lower than what the normal range might be. But we have very good evidence [01:13:56] that if you then supplement, when somebody is above that range, and you bring that down, [01:14:01] you see significant improvements in cognitive function or slowed cognitive decline.

[01:14:05] That is particularly the case for omega threes and B vitamins that lower homocysteine. [01:14:12] And so this is the interactions that you were talking about earlier, and this is the best [01:14:15] one that we know of, although I'm sure there are many more. [01:14:18] Like I said, there are lots of trials that have given omega threes or have given B vitamins [01:14:24] to lower homocysteine and just haven't seen much of an effect.

[01:14:26] And everybody goes, oh, well, they don't work. [01:14:28] But there are now at least three randomized control trials that have shown that omega [01:14:32] omega-3 status and B vitamin status interact, and they're dependent on one another. [01:14:36] So if you give B vitamins to somebody who has elevated homocysteine, you bring down [01:14:41] their homocysteine, but they have poor omega-3 levels, you don't see any benefit.

[01:14:46] And that's been shown in two trials. [01:14:47] It was originally shown in the Vitacog trial that was run out of the University of Oxford. [01:14:51] It was then replicated in the B-proof trial. [01:14:55] Then the other side has also been shown. [01:14:57] was in the Omega-AD trial, they showed that supplements with Omega-3s didn't result in

[01:15:03] any benefit if people had elevated homocysteine. [01:15:06] So that's just one example. [01:15:08] And you can imagine, like you kind of said, there are probably lots of these. [01:15:10] And if we're not going into a study actually looking like, well, what nutrients does this [01:15:16] person need?

[01:15:18] And then supplementing with them, you're not going to find any effect. [01:15:22] You shouldn't be surprised when the study doesn't show anything. [01:15:27] the one recent example of kind of just giving a broad based kind of set of nutrients with [01:15:39] the multivitamin that seemed to work fairly well was the Cosmos study people may have [01:15:43] heard of. It was thousands of people of older adults and they were given either a multivitamin

[01:15:49] or a flavonoid supplements like a centrum type vitamin. Yeah, it was it was Centrum [01:15:53] silver, like the most basic multivitamin, just 100% of the recommended daily allowance, [01:16:00] no massive doses of anything. And in that study, those who got the multivitamins saw [01:16:06] changes in cognitive function that suggested some improvements. But that was literally just [01:16:11] covering the bases, right? No massive doses, the most basic multivitamins. So in the kind of

[01:16:17] general population, I think you could say that something like that is probably a reasonable [01:16:21] strategy. But what they also showed was that supplementing with this antioxidant coco flavonol [01:16:27] was only beneficial in those who tended to have a poor quality diet to start with, right? So they [01:16:32] just weren't getting many of these kinds of compounds for their diet. If you're drinking a [01:16:35] lot of coffee, eating a lot of berries, seeing a lot of fruits and vegetables, you probably don't

[01:16:39] need it because you're already getting it. I'd like to take a quick break and acknowledge our [01:16:43] sponsor, Function. Function provides over 160 advanced lab tests to give you a clear snapshot [01:16:50] of your bodily health. This snapshot gives you insights into your heart health, your hormone [01:16:54] health, autoimmune function, nutrient levels, and much more. They've also recently added access [01:16:59] to advanced MRI and CT scans. Function not only provides testing of over 160 biomarkers key to

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[01:17:30] exactly where I want them. Comprehensive lab testing of the sort that function offers is just [01:17:35] so important for health. I mean, how else are you going to know what's going on under the hood? [01:17:39] And while I've been doing blood work for years, it used to be time-consuming, [01:17:42] complicated and expensive. [01:17:44] In fact, I used to spend thousands of dollars per year

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[01:18:20] I look forward to a day, hopefully not long from now [01:18:23] where people get their blood work done. [01:18:28] They are told and they decide, [01:18:31] it's a collaboration after all, [01:18:34] which supplements to take.

[01:18:36] Ideally those supplements are tailored to them. [01:18:39] So it's not gazillion tablets and capsules. [01:18:42] And then they can redo their blood work [01:18:44] and see whether or not things come into range. [01:18:46] And of course that should be measured

[01:18:47] against subjective experience of wellbeing [01:18:51] and sleep and all of that. [01:18:53] That's not hard to do in today's environment [01:18:55] of technology and trackers and blood testing. [01:18:58] It's just that we're a little bit in the,

[01:19:01] still in the nineties, [01:19:03] even just the way that most people talk about supplements, [01:19:06] certainly not you, but I think when people hear supplements [01:19:08] they go, oh, it's expensive urine. [01:19:09] Okay, that's vitamin minerals.

[01:19:11] Maybe some of that is just getting a urinated out, [01:19:13] but then there's food replacement supplementation. [01:19:16] And then there's supplements [01:19:17] to get a specific desired effect, [01:19:19] like speed up the transition time to sleep,

[01:19:21] get more slow wave sleep, more focus, et cetera. [01:19:24] So it's unfortunate that we don't have good nomenclature [01:19:28] like we do in science where words are very important [01:19:31] so that people can communicate with accuracy. [01:19:34] And I also wonder whether,

[01:19:37] okay, if, you know, one gram of omega-3 EPA per day is good, [01:19:44] but maybe three is better, [01:19:46] even though I'm at, you know, upper range, [01:19:49] upper reference range. [01:19:51] And this is something that, like,

[01:19:53] nobody really wants to address, [01:19:57] because then it sounds like, quote unquote, biohacking. [01:20:00] But ultimately, I think people want to feel good. [01:20:02] They want to live longer. [01:20:03] No one wants to do anything dangerous.

[01:20:05] I feel like we're really like in the, [01:20:07] in like prehistoric times with how we think, [01:20:10] how most people think about nutrition and supplementation. [01:20:13] I feel like the last 40 years have been spent [01:20:15] mostly focusing on what's bad for us.

[01:20:16] I'll get trans fats, bad, fried foods, bad, [01:20:18] eating too much, bad, right? [01:20:21] Energy over energy, toxicity, bad. [01:20:25] Too much alcohol, bad. [01:20:26] Zero is better than any,

[01:20:27] but you could probably drink a little bit and be fine. [01:20:29] Okay, if you're gonna take nicotine, [01:20:30] don't smoke it or vapor, like we sort of figured it out. [01:20:34] right? Don't hit your head. If you do, don't hit it twice. We've sort of been spending [01:20:39] so much time on the don'ts that now I feel like we're in this exciting time of what can

[01:20:45] you do for one's health. And then there's this divide, right? Just eat all foods. You'll [01:20:49] be fine. And you've actually convinced me that we'll be fine. The question is, could [01:20:53] I be that much better? [01:20:55] This is really interesting to me because there's two different parts to it, potentially, although [01:21:01] may end up being the same thing. So one is, if we're thinking about, if we're thinking broadly

[01:21:07] about improving brain health, cognition, and the population level, what's really important is kind [01:21:15] of raising the floor, like, what is going to work for everybody and get most of us most of the way [01:21:21] there. So like, that really is improving food quality. And then, you know, access to those foods [01:21:28] as well, right? Because that's different, you know, that can be very inequitable. Like, [01:21:33] can people afford it? Do they know how to cook it? Can you know, can they access it?

[01:21:37] And then within that, I think we also know we have very good evidence for cutoffs that [01:21:42] predicts risk. And if you can't get those nutrients from food, I think we should supplement [01:21:48] I think I like to call nutrients like the great leveler of like, there's no point in [01:21:53] arguing about different diets, because your body requires these nutrients. And like, I [01:21:57] care where you get them from as long as you get them. So if you need to get them from supplements,

[01:22:00] I think that's fine. That should be fine. When you then get kind of to the next level, [01:22:06] like how much further can we push function? My answer is I genuinely don't know. Like when you [01:22:12] say like, if I test my Omega 3 and your Omega 3 index, right, you said it was kind of the higher [01:22:18] level, maybe it's seven or eight or something like that. All right. If you push it to 12, [01:22:22] is that better? I genuinely, genuinely don't know. But some of these more complex AI systems,

[01:22:29] data collection, kind of seeing how you then respond individually, as long as you can perform [01:22:34] your own sort of like, personal experiments, right, as much as you can hold one variable constant, [01:22:40] have some meaningful output that you can kind of track over time, see whether it works or not, [01:22:46] can we then aggregate those data to kind of better understand this? I'm excited to see where that goes. [01:22:50] is, I will say that the best evidence we have just says, in

[01:22:55] reality, don't be deficient. If you can reach that threshold of [01:22:58] not being deficient or insufficient, maybe that's [01:23:00] enough. I'm hopeful that that's the case, right? Because then [01:23:03] more people will get to that point more more easily. But you [01:23:07] know, there's there's a lot that we have to learn there.

[01:23:10] There was a time in the 90s and 2000s, where people would take [01:23:16] stuff and do stuff. I'm not talking about anabolic [01:23:18] steroids, although that was happening too. [01:23:21] And the whole idea was find things that work, [01:23:26] perform really well in one's job or in one's sport,

[01:23:30] assuming you're not breaking any rules, right? [01:23:33] But not tell anyone you were doing that. [01:23:35] And what changed, I think were two things. [01:23:38] One is there became a market value [01:23:41] for telling people what one does in order to make money.

[01:23:44] So people started doing that. [01:23:46] and I do believe sharing is good, right? [01:23:48] But also there's this problem that goes with that [01:23:52] is that people who sit on the outside [01:23:54] of kind of brain and sports performance

[01:23:57] or just life, just trying to maintain memory [01:23:59] and do well in school and be a busy person [01:24:02] and still get sleep and all of that, [01:24:04] feel like, oh, you know, we're being sold [01:24:06] this one thing that's supposed to make all the difference.

[01:24:09] And I think the thing that really came in [01:24:11] and changed all of it are the GLPs. [01:24:14] I've never taken a GLP, but I'm just struck [01:24:15] by like Americans are now willing to inject themselves. [01:24:18] So now it opens up this whole thing about peptides,

[01:24:20] which, you know, the major consumers of peptides [01:24:23] are not the bro science guys, like the gym bros, [01:24:26] it's women who, look, I have female family members, right? [01:24:31] Who have, and they'll tell me, [01:24:34] and there's a long history of people doing

[01:24:37] and taking things and doing things [01:24:38] for their cosmetic appearance [01:24:40] and not necessarily sharing it with the world. [01:24:42] So these are the performance enhancing substances [01:24:47] of a whole different kind, right?

[01:24:49] And so how is it that this peptide industry [01:24:52] is so intriguing to so many people that yeah, [01:24:54] like jabbing yourself with something [01:24:55] that is not FDA approved, [01:24:57] like people are doing it like crazy,

[01:24:59] even people who are kind of cautious [01:25:02] about what they'll do and put into their body [01:25:04] because of this bridge that the GLPs have made. [01:25:06] It's so much easier now to just, [01:25:08] people aren't as needle phobic.

[01:25:10] So I think we're entering a time now [01:25:11] where people are saying, okay, you know what? [01:25:14] The government, the food pyramid, whatever, [01:25:18] the food quadrants, like, yeah, [01:25:20] that's just like if you don't wanna die,

[01:25:22] but I wanna feel great. [01:25:23] And there's actually this potential [01:25:25] that you and others are sort of offering, [01:25:26] like you can learn things into your older age. [01:25:28] You can be a lean and have great posture

[01:25:31] into your 60s, 70s, 80s, 90s, we see examples of this. [01:25:34] So I think that there's this pull, [01:25:36] we're getting kind of pulled forward towards this promise. [01:25:39] And I don't think that promise is all about avoiding [01:25:41] the bad stuff and people will say,

[01:25:43] oh yeah, well my grandfather lived to be 102 [01:25:45] and he was smoking every, great, like awesome. [01:25:49] But a lot of people don't have those kinds of genetics [01:25:51] in their family. [01:25:52] They really, and genetics play a big role.

[01:25:54] So I'm just kind of editorializing here. [01:25:55] I'd love your thoughts on how you sort of sit back [01:25:57] and you look at the landscape of things. [01:26:00] Eat right, exercise, get good sleep, socialize is awesome. [01:26:04] But that is just, that is difficult for people.

[01:26:07] That puts people into a clutch state. [01:26:09] just trying to do that while managing family and profession and cost of life, cost of living, [01:26:15] that's a lot. So I think people do want something that gives them more energy, [01:26:19] gives them better sleep, picks up their mood. And I don't think there's anything wrong with [01:26:24] thinking about those things as long as it feeds back to better behaviors.

[01:26:28] Particularly when I think about this new part of the supplement industry. And like you said, [01:26:35] the peptides are just the next iteration of the pills and potions and things that people have been- [01:26:43] They're linked to supplements more than drugs because look, there's no putting the genie back [01:26:47] in the bottle. I don't care what the FDA does and they can mark my words, people are going to find [01:26:52] their way to get their peptides because they love them. And most people are not playing a drug

[01:26:57] tested sport. And there may be adverse events out there and this isn't a plug for peptides per se, [01:27:03] But where are all these adverse events that are not from botched injections or from really [01:27:08] bad black market sources? [01:27:10] Where are all the roid rages of peptides? [01:27:14] Where all that you like, I think you can see way more plastic surgery, like, whoa, that

[01:27:20] looks bad kind of things in it, like, okay, melanotans kind of an issue because people [01:27:24] can really mess themselves up there. [01:27:26] But where are all the adverse events until people start dropping dead from BPC injections [01:27:32] people are gonna get and they're gonna take their BPC. [01:27:35] I'll admit I'm more conservative.

[01:27:37] When you're trying a new supplement or peptide, [01:27:41] I'm gonna include peptides into this, [01:27:44] but of course it could be a pill or whatever, right? [01:27:46] Some peptides come as pills. [01:27:47] I would want some reasonably good evidence of efficacy,

[01:27:52] that this is gonna work in humans like me. [01:27:56] That's probably not a bar [01:27:58] that most of these things are gonna hit anytime soon. [01:28:01] No, people don't care. [01:28:01] I mean, people who have no interest in walking into a gym

[01:28:07] are contacting me like crazy. [01:28:09] These are adults who have kids they love, spouses they love. [01:28:12] They are not medicine-phobic, like traditional medicine-phobic. [01:28:16] And they're like, should I be taking low-dose, [01:28:18] should I be micro-dosing terzepatide or radiotrutide?

[01:28:21] I'm like, radiotrutide is not even released yet. [01:28:22] They're like, where can I get it? [01:28:24] Are you kidding me? [01:28:25] You know, but it's incredible [01:28:27] what's happened in the last few years.

[01:28:29] So think about what you might think about [01:28:33] if you're gonna start to consider one of these. [01:28:39] First of all, I would wanna see evidence that it works. [01:28:42] The majority of peptides don't have good quality evidence [01:28:45] in humans except the GLP ones that are on the market.

[01:28:48] And the growth hormone secretagogues, [01:28:50] but for reasons other than people are taking. [01:28:52] Yeah, sarcopenia, you know, other, [01:28:56] And with most of those growth hormone scretagogues come with a risk of insulin resistance, diabetes [01:29:02] at high, particularly at higher doses.

[01:29:04] Yeah, they're not the super popular ones. [01:29:06] I think the super popular ones are besides the GLPs and the red atrutide as a GLP and [01:29:10] other things, but I would say microdosing of red atrutide and interzepatide, one category [01:29:16] for weight loss, fat loss, I would say BPC157, people are taking it without even knowing [01:29:22] what the desired effect is.

[01:29:24] Yeah. [01:29:25] injury, is it going to be really broad? I think it's injury repair, that's the thesis, [01:29:30] no human evidence as far as no good human evidence. And then there are these other kind [01:29:34] of dot, dot, dot ones, I would say, CHK, copper or skin appearance. Those are the three biggies [01:29:44] that seem, and the last one in particular with women.

[01:29:47] So I would want evidence that in humans, it does what I want it to do. Most of those, [01:29:52] if not all of them, except for the GOP ones, [01:29:54] don't have that evidence, [01:29:57] or for the thing that you're trying to get, right? [01:30:01] But beyond that, a question that you have to ask,

[01:30:05] and I like this reframing, I heard it recently [01:30:09] from Jeffrey Bland, which is that if you're gonna [01:30:12] consider injecting or taking something, [01:30:14] the first thing you should want to know is, is this safe? [01:30:17] Right?

[01:30:18] If you have good safety data, [01:30:20] then trying it is low risk, right? [01:30:23] Even if it doesn't work, right? [01:30:25] At least you know it's not dangerous. [01:30:27] But we don't even have that for most of these peptides.

[01:30:29] No, we just have the absence of documented adverse effects. [01:30:32] Yeah, and- [01:30:33] In the time course that they've been used, [01:30:35] because we don't know about long-term use. [01:30:37] And so everybody has their own risk tolerance.

[01:30:40] Everybody is welcome to do whatever they want, of course. [01:30:43] But for me personally, [01:30:45] first I would want documented evidence of safety. [01:30:49] And then you can say, well, I'm willing to try it [01:30:53] because it may or may not do this thing.

[01:30:55] But you should also have a specific problem [01:30:57] that you're trying to solve, right? [01:30:58] Otherwise, why would you be able to taking it? [01:30:59] But it's also the case for the vast majority [01:31:01] of supplements that are out there

[01:31:02] and have been around for long periods of time is, [01:31:04] first of all, we don't have good evidence [01:31:05] of long-term safety at whatever dose that you're taking. [01:31:08] And then second of all, we don't know whether it works. [01:31:11] For some we do, like creatine, omega-3s, magnesium.

[01:31:15] And creatine is actually the best. [01:31:16] So like omega-3s, we know that they're a critical nutrient. [01:31:20] Creatine, I think is the best example [01:31:22] because we know it's very safe, right? [01:31:24] So even though there's this idea of creatine responders

[01:31:27] and non-responders, maybe it's gonna be useful [01:31:31] to improve or support cognition for some people [01:31:34] or not others, may improve physical performance [01:31:36] for some people or not others. [01:31:37] At least we know that you can give high doses of creatine

[01:31:41] to frail older individuals with essentially no side effects. [01:31:45] Right, we know it's very safe. [01:31:46] So then you can try it and see if it benefits you. [01:31:48] So creatine is a great example, [01:31:50] but there aren't that many others

[01:31:51] that kind of fit into that category. [01:31:53] Interesting times. [01:31:55] Again, I go back to, I love the idea of blood testing, [01:31:58] tailoring supplementation to the needs [01:32:01] of the individual retesting,

[01:32:02] so people can be really objective about [01:32:04] whether their levels are moving in the right [01:32:06] or wrong direction, subjective experience. [01:32:09] The sleep supplementation thing is kind of interesting [01:32:11] because either people feel it improves their sleep

[01:32:13] or it doesn't, even if it's a placebo effect, [01:32:16] which in some cases it could be, [01:32:19] with sleep tracking people can see, [01:32:20] are they getting more REM? [01:32:21] Are they getting more slow wave sleep?

[01:32:23] Such a fascinating area. [01:32:26] I mean, as you and I both know, there's no plasticity pill, [01:32:30] but arousal, alertness, focus, [01:32:35] seems to be a prerequisite of plasticity, [01:32:38] which is why things like caffeine and stimulants

[01:32:40] and L-tyrosine and all these things [01:32:42] that you can find some evidence [01:32:44] for them improving plasticity, [01:32:46] but it's very likely to be indirect, right? [01:32:49] It's not that they like make you learn,

[01:32:51] they set the stage for learning. [01:32:53] It seems to always get back to arousal. [01:32:55] So this is what I want to get back to exercise [01:32:58] as a tool for opening the window for plasticity. [01:33:02] Could it be that it's simply a matter of moving your body

[01:33:06] to get enough adrenaline in your body, [01:33:09] norepinephrine in the brain, [01:33:10] and maybe some dopamine as well, [01:33:12] so that the stage is set for plasticity. [01:33:14] And it doesn't matter whether you jump rope,

[01:33:17] do jumping jacks, sprint, or do deadlifts. [01:33:21] It's all about getting your brain into an altered, [01:33:24] admittedly endogenous chemical altered state [01:33:28] of just more arousal. [01:33:29] And then boom, you can go learn.

[01:33:31] I mean, could it just be that? [01:33:33] Before we get into the exercise, [01:33:35] there's an interesting part with the supplements [01:33:38] that increase arousal, right? [01:33:39] So the stimulants in particular.

[01:33:41] And I am a big proponent of thinking about [01:33:46] or tracking how somebody feels, right? [01:33:50] I think that how you feel is this kind of ultimate [01:33:53] integration of all these inputs and outputs [01:33:55] that the brain is kind of bringing together, right?

[01:33:57] And we know that how you feel, [01:33:59] so how an athlete feels is a much better predictor [01:34:02] of their performance than their HRV [01:34:04] or any of their blood tests. [01:34:05] What are you asking them?

[01:34:06] Like, how good do you feel today? [01:34:08] Yeah, on one to 10. [01:34:09] Some version. [01:34:09] And I feel like I can conquer the world one, I feel like. [01:34:12] Exactly.

[01:34:13] And you can boil it down or I mean, you can spread it out to many more questions. [01:34:19] So there's a question there called the rest queue, which is all about like how you recovered, [01:34:23] how recovered you feel, how motivated you feel to train or perform, that kind of stuff. [01:34:27] But essentially it boils down to how good you feel. [01:34:30] If you feel good, you're more likely to perform well.

[01:34:32] And that works better than the vast majority of data that you, biological, physiological [01:34:38] data you can collect. [01:34:39] papers that come out on this every year that essentially show the same thing. [01:34:42] That's kind of cool. [01:34:43] Yeah.

[01:34:44] Because mindset, as my colleague Ali Krum has focused on so much, like mindset can be, [01:34:50] you can be honest with yourself and you can lie to yourself and tell yourself like, okay, [01:34:55] you got a lousy sleep score, but like I feel good. [01:34:59] Or maybe sleep scores are like, they mean something, but today, you know, right? [01:35:06] And it can work, right?

[01:35:07] I mean, in terms of performance. [01:35:09] Yeah, and so absolutely right. [01:35:11] Then that gets into the like the no SIBO effect [01:35:14] of how we think about either our sleep data [01:35:16] or these other things, right?

[01:35:17] That can negatively impact our performance. [01:35:19] And we have good studies that show that as well. [01:35:23] So I think that like tracking how you feel [01:35:25] is really important. [01:35:26] But when it comes to stimulants in particular,

[01:35:30] they seem to dissociate how we feel versus how we perform. [01:35:35] Right, so there are studies that show [01:35:37] that giving people caffeine makes them feel [01:35:42] like they're performing better, [01:35:43] but they're actually performing worse

[01:35:44] on certain cognitive tasks. [01:35:45] So there's been studies done with like the end back tasks. [01:35:48] So like very complex working memory tasks, [01:35:50] particularly as you get like to like N3, [01:35:52] you're like trying to remember,

[01:35:53] did I see this letter three letters ago, right? [01:35:57] In those kinds of complex cognitive tasks, [01:35:59] people who take caffeine feel like they're performing better, [01:36:03] but they're actually performing worse. [01:36:04] They're making more errors or they're kind of,

[01:36:06] they're reacting too quickly, they're not really thinking about it. And there are similar data [01:36:11] from other stimulants too. So there was a paper that came out in Science a couple of years ago [01:36:15] giving people a methylphenidate or some of the other like ADHD medications in people who don't [01:36:20] have ADHD. These stimulant medications, again, show this dissociation between, so they feel great. [01:36:26] No, it's like the inverse of the cannabis thing where people think they've got all these great

[01:36:29] ideas. And then the next day, even they are like, oh my goodness, this is dreadful. [01:36:33] Yeah. And that's, again, been like formalized in studies where you can do these tests where [01:36:38] then other people objectively see how creative were you. People taking cannabis felt like they [01:36:43] were more creative, but actually they weren't. And so the reason why I say this is that when [01:36:50] we're talking about supplements, all these other things were like, well, I feel much better,

[01:36:53] therefore it must be, must be doing something good. We know that with many of these supplements, [01:36:58] you can create this dissociation between how you feel and how you perform. [01:37:02] whereas some of these endogenous things don't have that effect. So that's why that kind of like [01:37:08] endogenous increase in arousal using things like exercise is a much more reliable way to improve [01:37:14] performance, because you don't kind of get this dissociation between the two. So with exercise in

[01:37:19] particular, we know very well that some period of exercise can be resistance training, aerobic [01:37:26] exercise, very brief sprints, increase arousal, improve cognitive function across multiple [01:37:31] domains, improve learning and retrieval. So you're definitely augmenting some of these [01:37:38] processes of neuroplasticity. Some of that can be related to the catecholamines and other things [01:37:42] that get released as arousal increases. But we also know that different types of

[01:37:50] exercise have different effects on different parts of the brain. So yes, I think some of [01:37:54] just like the general process of moving your body and exerting efforts definitely increases [01:38:01] arousal, definitely improves cognitive function, improves learning, as long as it's not truly [01:38:08] exhaustive exercise, like anybody who's done some terrible CrossFit wad or you know, I used to be a [01:38:14] rower, we used to do a 2k test on the rowing machine, right? You do a 2k test on a rowing machine,

[01:38:18] your brain does not work afterwards. It's like a six minute flat out like VO2 max kind of level [01:38:25] of exertion. Yeah, thanks. I'm going to interrupt briefly. Thank you for pointing that out because [01:38:28] I think that people assume they have an infinite amount of energy and there's crossover. And [01:38:34] I certainly have done, you know, extra sets to failure in a great morning workout. And then in [01:38:41] the afternoon, I'm dragging. If I hold back just a little bit in terms of volume, I find I get a

[01:38:47] real boost out of training, but I do low, low volume, [01:38:51] high intensity, you know, usually two sets per exercise, [01:38:55] you know, two or three exercise per muscle, [01:38:58] like quadriceps being one muscle or something like that. [01:39:00] If I do three, it's a small addition, right?

[01:39:05] The rest of the day, I'm kind of dragging. [01:39:06] So leaving something in the tank does seem worthwhile, [01:39:09] not during the sets, but leaving something in the tank [01:39:12] in terms of volume really seems to help. [01:39:14] Especially if you want to perform hard,

[01:39:17] cognitive work directly afterwards. [01:39:18] Sometimes if you're trying to really push performance [01:39:23] or adaptation, right? [01:39:24] It's worth digging into that hole, [01:39:26] but it really just depends on what you want to be able

[01:39:28] to do directly afterwards. [01:39:29] I think student athletes, especially in D1 schools, [01:39:32] they really come to appreciate this. [01:39:35] I've had a few of them in my courses over the years [01:39:37] and they really understand when they're pushing very, very,

[01:39:41] being pushed very hard in their sport. [01:39:44] and they know that they have to sit in the front [01:39:48] of the classroom, sit upright, take extra measures [01:39:52] to make sure they're not dozing off, attention drifting, [01:39:55] especially in the age of phones and iPads and things like that.

[01:39:59] It's very, very difficult. [01:40:01] Yeah, thank you for mentioning that, [01:40:03] because they're just an extreme case of the rest of us. [01:40:05] You know, we're told, and we're all very busy, [01:40:07] like, oh, you need to exercise, it'll help your brain,

[01:40:08] and be like, well, I exercise, and I'm exhausted. [01:40:10] You know, that's not helping my brain. [01:40:12] Let's get practical here. So is there any way to [01:40:17] it's got to be really subjective and depend day to day? [01:40:21] Is there any way to kind of formalize that?

[01:40:23] Like, should you train, let's say, resistance training or running? [01:40:28] You know, should you cap it at an hour? [01:40:31] Should you pull back on the intensity if you have harder cognitive work to do [01:40:34] in the afternoon? We all want the maximum effective exercise, [01:40:37] but we don't want it to undercut our efforts.

[01:40:39] Yeah, I think that a lot of it's going to be based on [01:40:42] what your current capacity is, right, as with everything. So if you're, you know, you want to [01:40:48] do some, you've got some, you know, learning to do, you've got an exam, you want to do some hard [01:40:52] cognitive work, you know, whatever it is, writing a presentation, analyzing data, you know, reading, [01:40:57] reading papers, writing your book, then doing some kind of workout that's probably below

[01:41:04] your kind of typical or below what you would do when you're really sort of pushing, pushing the [01:41:10] the envelope. I think that when you look at meta-analyses of exercise and then cognitive [01:41:17] function immediately afterwards, the protocol that has the best evidence for it is like [01:41:22] a 20 to 30 minute jog, right? So that's the kind of level of activity that really seems [01:41:30] to support all those general processes of plasticity and learning.

[01:41:34] What do you think is going on? Because it can't be that much arousal. I mean, the amount [01:41:37] of catecholamines released from, again, catecholamines, [01:41:40] folks being the adrenaline, norepinephrine, and dopamine, [01:41:45] generally increased levels of arousal, [01:41:47] alertness, propensity to move.

[01:41:49] You just, that's that. [01:41:50] I feel better. [01:41:51] People often think about the runner's high endorphins. [01:41:54] Endorphins come from pretty long intense duration effort. [01:41:57] They're more of a, you're floating kind of like, ugh.

[01:42:00] I think the catecholamines are really the cocktail [01:42:02] of like, all right, I got a great workout in this morning, [01:42:05] showered, got dressed, I'm off to work. [01:42:07] Let's go. That's the so 20 or 30 minute jog. [01:42:11] I don't expect you'd get that much catecholamine release.

[01:42:14] I mean, you'll definitely get some, right? [01:42:16] And like cortisol, too, right, which obviously increases alertness and arousal [01:42:20] and can can in the short term make you feel good. [01:42:22] It's a good thing. [01:42:23] You see similar effects of, you know, short resistance training workouts.

[01:42:28] I think of it is probably a little bit of like an area under the curve thing [01:42:32] because you see some similar effects of like you go out and you do [01:42:35] six second really hard sprints, like max effort sprints, [01:42:39] you do that a few times with a long break in between, right? [01:42:42] That seems to have a similar effect,

[01:42:43] but you're only working for very short periods [01:42:45] with very long rest periods. [01:42:47] So it's something in that sphere. [01:42:51] And I think that's probably just it. [01:42:53] It's just enough to just kind of boost catacombs

[01:42:56] a little bit, a little bit of cortisol. [01:42:59] That's enough to kind of move you up the arousal curve [01:43:01] to the point where you're then able to focus [01:43:03] and engage a little bit better. [01:43:04] And I think, yeah, you don't need a huge dump of that in order to achieve that increase

[01:43:09] in arousal, particularly as it pertains to like learning and then, you know, cognitive [01:43:13] performance in like formal cognitive tests, which is where this is usually done. [01:43:18] If you're then thinking about the type of exercise that changes cognitive function or [01:43:23] brain structure long term, effort and intensity do seem to matter a lot more, but those studies [01:43:31] have looked less at how did that how do they feel directly afterwards right now

[01:43:35] you're thinking about what's the kind of stimulus that drives change over time [01:43:39] and then intensity matters a lot as well so that the best example is with [01:43:47] aerobic exercise on the kind of zone two up to kind of zone four five sprint [01:43:53] spectrum so most people who listen to your show are probably familiar with a [01:43:58] study where in older adults, they had them do brisk walking three times a week, 40 minutes.

[01:44:06] And when you kind of read the study and the heart rate levels they were trying to attain, [01:44:10] it was basically zone two work, 40 minutes, brisk walking three times a week for a year. [01:44:14] And they saw significant increases in the volume of the hippocampus, [01:44:18] increases in VO2 max fitness, increases in circulating BDNF levels, [01:44:23] though circulating BDNF doesn't actually get into the brain, but it's kind of telling you

[01:44:28] something about probably BDNF that's being produced in the brain and improvements in [01:44:34] memory with all of that. [01:44:37] However, there's a much more recent study that took again older adults and randomised [01:44:44] across three different groups. One was like a low intensity group. Another group basically [01:44:48] did kind of zone two type work on the treadmill three times a week, very similar to that previous

[01:44:53] study that I mentioned. And the third group did a high intensity interval training intervention, [01:44:58] which is the Norwegian four by four protocol. So four minutes, 85 to 95% of maximum heart [01:45:03] rate. They had a three minute rest in their protocol. They did that four times over. That's [01:45:08] really hard. Anybody who's done the Norwegian four by four, if you then say, well, Hey, [01:45:13] do that three times a week for six months, like that's three times a week, three times

[01:45:18] a week for six months. That's, that's pretty intense. But what they showed was that that [01:45:22] high intensity interval training group, they improved their fitness just as well as the [01:45:27] zone two group, interestingly, but they had much better improvements in hippocampal function [01:45:32] and maintenance of hippocampal structure on an MRI scan. And they maintain that benefit [01:45:38] for five years after the six month intervention. So they worked really hard for six months,

[01:45:46] but that that benefit was maintained for a really long period of time. And in several [01:45:51] analyses within that study, they basically show that the harder people worked, and the [01:45:56] more cortisol they released, the better the benefit. And so this is important, because [01:46:00] nowadays, there's, you know, there's several people out there saying, well, don't do high [01:46:04] intensity exercise, it releases cortisol, that's stressful, your body can't handle it,

[01:46:07] right. This study directly shows that working really hard, releasing a lot of cortisol in [01:46:12] high intensity interval training, actually improves hippocampal structure and function [01:46:16] over time. So yes, I imagine after they did their workouts, their brain wasn't maybe working at its [01:46:23] best because that's a hard workout. But over time, this is this really strong stimulus that then [01:46:28] resulted in significant improvements. Forgive me if you said it and I missed it.

[01:46:33] What was the form of exercise? Was it rowing or biking? It was on a treadmill. [01:46:37] Treadmill. Yeah. Really interesting. And you said it about 85% of max heart rate. [01:46:43] Yeah, so that's, that's a typical Norwegian four by four protocol. But I don't think that's [01:46:47] the protocol you have to do. I think it's just this process of high intensity exercise, that [01:46:54] it releases a whole bunch of myokines and lactate in particular, we know that lactate

[01:46:58] very easily gets into the brain, generate, you know, stimulates BDNF production as kind of [01:47:03] part of that support of neuroplasticity or augmenting recent neuroplastic processes. [01:47:09] I think there's something about just that high intensity work that drives some of those [01:47:14] factors that then support structure and function. [01:47:17] It's an unfortunate reality, but tap water often contains contaminants that negatively

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[01:48:22] you can go to rora.com slash Huberman [01:48:24] and get an exclusive discount. [01:48:26] Again, that's rora, rora.com slash Huberman. [01:48:31] Yeah, two things. [01:48:32] Super interesting comparison between these studies.

[01:48:36] And as somebody who incorporates one day a week [01:48:38] of four by four type exercise [01:48:41] and one day of longer, slower cardio, [01:48:42] maybe I should try maybe doing a bit more [01:48:45] of the high intensity.

[01:48:46] Well, I think if you wanted to be sustainable [01:48:47] for long periods of time, [01:48:48] like I would typically say one day [01:48:50] of high intensity work is fine, right? [01:48:52] Because you probably want to be doing

[01:48:53] some resistance training. [01:48:54] You probably- [01:48:55] I'm doing that three days a week. [01:48:56] I do one long slow, for me, jog of about 60 minutes, [01:49:00] 45 to 60 minutes and then one kind of moderate,

[01:49:04] maybe more like zone three, four. [01:49:06] So thank you for putting in a strong word for cortisol [01:49:12] not always being the bad guy. [01:49:14] People are so afraid of cortisol. [01:49:16] You want your morning cortisol high,

[01:49:18] it's gonna make you sleep better at night, [01:49:20] more energy during the day. [01:49:21] It's interesting to me to dive into the literature [01:49:23] on cortisol and find that a moderate intensity [01:49:28] resistance training session or cardio session,

[01:49:32] probably a little bit easier than the four by four, [01:49:37] will triple one's baseline levels of cortisol [01:49:40] and like, or quadruple it. [01:49:42] It's transient, but nobody's freaking out [01:49:45] about these workouts, but they're afraid to get

[01:49:46] in a cold shower, which doesn't have nearly [01:49:49] the same impact on cortisol or it's kind of wild [01:49:52] how afraid of cortisol people are. [01:49:54] People think they're gonna get Cushing syndrome. [01:49:56] It's been, I don't know what the PSYOP on cortisol

[01:49:58] was all about, but you're gonna get moon face, [01:50:00] you won't be able to lose abdominal fat. [01:50:03] I mean, there is a real condition, [01:50:05] which is you and I know it's a Cushing syndrome [01:50:08] where cortisol is pathologically elevated,

[01:50:10] but come on folks, like cortisol goes up, [01:50:14] cortisol goes down, you have that 20, 30 fold [01:50:17] from the morning until night in a healthy individual. [01:50:19] So what do you think it is that people get, [01:50:22] like afraid of cortisol, afraid of some stress?

[01:50:27] And like your hippocampus, obviously, in this case, our hippocampus got better. [01:50:32] It's not dissolving into a puddle of its own tears. [01:50:35] What is this? [01:50:36] What did our predecessors do wrong? [01:50:40] You know, let's blame it on the parents, because we weren't doing science communication.

[01:50:45] What in the world was the incentive for like demonizing molecules? [01:50:48] It's so crazy. [01:50:49] So even though his frameworks are still potentially very helpful, some of it we can blame on Hans [01:50:55] and his like general adaptation response, like the original idea that if you were chronically [01:51:01] stressed, it would lead to like true exhaustion of all your physiological systems, right?

[01:51:05] Because that was the final phase of his general adaptation response. [01:51:08] People have conflated acute stresses versus chronic stresses. [01:51:12] And yes, we know chronic stress, be they psychological, physical, increased allostatic load, increased [01:51:18] metabolic disease, inflammation, blood sugar dysregulation, insulin resistance, significantly [01:51:23] associated with heart disease, dementia, all these kinds of

[01:51:26] things, right? So we know that these chronic stresses can be [01:51:29] really detrimental to our health. But we've kind of [01:51:33] conflated that like any stress is bad because chronic stress is [01:51:36] bad. But the way that I think about it, or I try and talk [01:51:39] about it is that actually, the stress response, and this is as

[01:51:44] kind of Celia originally described it, is stress drives [01:51:49] adaptation, he called it general adaptation syndrome, the general [01:51:53] adaptation response, because what stress is, is your body [01:51:57] acknowledging that you need to respond to some external [01:52:02] stimulus, right? And so stress diverts resources so that you

[01:52:07] can then adapt to that stimulus, be they physical, [01:52:10] cognitive, neurological, right? A stressor diverts glucose to [01:52:15] the immune system, right? In an infection so that it functions [01:52:18] better, you can eliminate the infection. And so, yeah, if you [01:52:22] took somebody and you measure their cortisol levels after a workout. It actually looks very

[01:52:28] similar to how it would look if you just broken your arm or if you're like really sick, right, [01:52:31] but this is the body adapting to a stimulus. And like everything we've talked about here, [01:52:36] you know, physical training, driving neuroplasticity, that requires adaptation. And so some of that [01:52:43] core stress response is involved in that the release of catacombs you talked about in the [01:52:47] brain, right? Those are stress-related molecules that are driving adaptation so that your body

[01:52:53] can deal with the stressor better in the future. And we also know, actually, that there's some [01:52:58] evidence for the cross-stressor adaptation, particularly with exercise, right? So, [01:53:03] if you exercise regularly, you are better at dealing with other stresses, like psychological [01:53:07] stresses. You're more robust to stressors. Your mood or your cognitive function doesn't [01:53:13] dip as much when you're when you're then psychologically stressed. So stress is actually

[01:53:18] really important, because it's the fundamental driver of adaptation. But because we've kind of, [01:53:23] you know, we know that chronic stress is bad, if you never get a chance, and that's because you [01:53:28] never get a chance to adapt, you never get a chance to down regulate, you never get a chance [01:53:31] to respond, because it's just continuous. But right, intermittent exposure to these stresses is [01:53:37] really important. And so he also talked about the idea of hypostress, right, not having enough

[01:53:41] stress because then you can't, you don't adapt, you don't build function and response. [01:53:44] So we just need to think about them very differently because that, those acute stresses are incredibly [01:53:49] important for driving adaptation. [01:53:51] The way I think of it is pick your stress or you can either be exercise or it can be [01:53:56] psychological stress.

[01:53:57] If you take it in the form of exercise, you probably have less in the form of psychological [01:54:01] stress. [01:54:02] It's obviously not completely true at a one for one, but I think as you pointed out, we [01:54:08] and all organisms thrive on some degree of stress. [01:54:11] I think if people are getting enough good sleep at night.

[01:54:14] Yeah, sleep is the common limit to the amount of stress they can absorb. [01:54:18] But when it starts to erode your sleep, that's perhaps when things need to be, you [01:54:22] know, adjusted. [01:54:24] Resistance training. [01:54:26] Is there a particular protocol for resistance training that opens the opportunity for

[01:54:31] plasticity better than others that is supported in the literature? [01:54:35] Again, two different windows, say, of action. [01:54:40] So there's that, that acute kind of arousal and this would be, you know, you, you go in the gym, [01:54:48] you do a couple of sets, you're not maxing out. You know, it's, it's probably going to be your [01:54:54] fairly typical couple of sets of eight to 12 reps, kind of 80% of, of max, something like that.

[01:55:02] You do compound movements. So most studies use machines, right? So maybe do a leg press and a [01:55:08] chest press and a lap pull down. Okay. Multi-joint movements, usually with machines. And again, [01:55:15] if that takes 20 to 30 minutes, that kind of shows some similar effects to that, like [01:55:19] 20 to 30 minute jog that I talked about in terms of some of the cute bumps in cognitive [01:55:23] function, probably through arousal, the mild activation of those arousal pathways. Actually

[01:55:30] quite similarly, though, I mean, probably slightly higher intensity will also be beneficial [01:55:37] long as you're able to recover over time. That recovery is critical, just like I was just saying [01:55:43] in terms of any kind of adaptation. There were several studies of resistance training looking at [01:55:49] cognitive function and brain structure over time. I say several, it's like three or four. In older [01:55:55] adults, and they typically do two or three times a week, five to six exercises, three sets of eight

[01:56:02] to 12 reps. You're very similar. So there's multi-joint machines in the gym that anybody [01:56:09] can do. And they're in any gym. [01:56:11] Presses, pull-ups, rowing, pull-downs, leg press, hamstring curls. [01:56:15] Exactly. [01:56:16] Okay.

[01:56:17] And what you tend to see is that if you do that for at least six months, so the studies [01:56:23] go on for like six to 12 months, you see significant changes in the structure of the white matter [01:56:30] of the brain, and with that improvements in executive function in particular. [01:56:34] You want to remind people what white matter is just for the newbies? [01:56:39] Very broadly, you have white matter and gray matter in your brain. In the human brain,

[01:56:43] white matter makes up approximately 60% more than most other species, any other species. [01:56:49] And so the wrinkly outer part of your brain, the cortex, that's gray matter. You also have [01:56:53] more gray matter deep inside the brain. In between that is the white matter, which is [01:56:57] you have the myelin sheaths on your axons, that's what allows those nerves to conduct information [01:57:03] really quickly. Whereas aerobic exercise on that kind of intensity spectrum we just talked about

[01:57:08] seems to particularly benefit the gray matter, which includes the hippocampus resistance training [01:57:14] seems to particularly benefit the white matter. And so you see improvements in a white matter [01:57:19] structure, which and changes in white matter structure with age are one of the best predictors [01:57:24] of cognitive decline with age. Interestingly, like outside of other things you see in terms [01:57:28] of neuropathology, amyloid, tau, et cetera, that loss of white matter structure and function is

[01:57:33] closely tied to cognitive decline over time. So you see improvements in structure and function [01:57:37] of the white matter and potentially improvements in something that we call white matter lesions, [01:57:43] which tend to happen around areas of poor blood flow within the white matter of the brain. [01:57:48] and with that improvements in executive function. [01:57:51] So aerobic exercise is gray matter and memory

[01:57:56] and resistance training is Y-matter [01:57:59] and more sort of executive type decision-making [01:58:01] processing speed type functions. [01:58:03] You know, we talked about lactate [01:58:05] and some of these other things that might increase

[01:58:07] BDNF with the aerobic training. [01:58:10] In resistance training, I think the primary mediator [01:58:15] of that or one of them is IGF-1, [01:58:17] which has particularly increased with resistance training. [01:58:20] We know that IGF-1 is really critical

[01:58:22] to the development of white matter, [01:58:24] right in the womb and then as a baby. [01:58:27] And it seems to be also really important [01:58:30] for white matter structure then throughout the lifespan. [01:58:33] So resistance training is a really great way

[01:58:35] to then create these boosts of IGF-1. [01:58:37] So that's probably part of why we see that difference. [01:58:40] But that's why you need to do both. [01:58:43] Though they may have similar kind of acute effects [01:58:45] in terms of cognitive function,

[01:58:46] seems to be having very different effects in terms [01:58:48] of the structure and function of the brain long term. [01:58:51] I so appreciate that you're basically telling us [01:58:54] that different forms of exercise impact [01:58:56] different critical aspects of brain structure and function.

[01:58:59] So resistance training, white matter, cardio, [01:59:01] gray matter, broadly speaking, and many different molecules. [01:59:04] IGF-1, BDNF, lactate, and on and on. [01:59:08] Just for, how do you say, in Britain, it's not kicks. [01:59:13] They use a different word, but for kicks and giggles,

[01:59:15] I'll just tell you, there was sort of two running jokes [01:59:17] in the field of neuroscience when I was coming up, [01:59:20] which was if you desperately need a thesis, [01:59:25] fortunately this was not a position I found myself in, [01:59:27] if you desperately need a thesis and like it's not going well,

[01:59:31] study the effect of pretty much any compound on REM sleep [01:59:35] because it will reduce REM sleep. [01:59:36] There are very few things that increase REM sleep, [01:59:39] very, very few, except sleep deprivation [01:59:41] and then REM rebound.

[01:59:43] Likewise, there was a review published [01:59:44] by a guy named Jeff Lichtman and Josh Sainz [01:59:47] who were in a different field. [01:59:48] So they did a kind of cocky thing, [01:59:49] but back then they were like,

[01:59:52] they're good guys, I know them both. [01:59:55] But they published this review about long-term potentiation [01:59:59] where they said they did a review of the literature [02:00:01] and they said basically you can throw any molecule [02:00:04] on a couple of neurons and do the protocol

[02:00:06] for long-term potentiation [02:00:07] and you get an enhancement of long-term potentiation. [02:00:09] Now that wasn't completely true. [02:00:10] The reason I'm raising this is there's this theme, right? [02:00:13] Like there's certain processes like processes

[02:00:17] that are not that hard to disrupt like REM sleep. [02:00:20] Just kind of tweak the system a little bit. [02:00:22] You see a deficit, smaller, large deficit. [02:00:24] And then things like long-term potentiation, [02:00:26] which is thought to underlie a lot of forms

[02:00:28] of learning and memory. [02:00:30] In a dish with some neurons or maybe even an animal, [02:00:33] you can knock something out or overexpress something [02:00:36] and whoop, you get more or less long-term potentiation. [02:00:38] It's not that hard to tilt the scale on it.

[02:00:40] But in reality, the human body has tons of molecules [02:00:44] that it deploys. [02:00:45] And it now to me makes perfect sense why plasticity, [02:00:50] which of course is the foundation of learning, [02:00:53] sort of one in the same in many ways,

[02:00:56] is brought about by resistance training [02:01:00] and by cardiovascular training because they're both motor. [02:01:03] Just like crossword puzzles, certain plasticity effect, [02:01:07] maybe less than, you know, dance, [02:01:09] where there's a number of different things

[02:01:11] that social inputs, balance inputs, and on and on. [02:01:14] So, whereas two, three years ago, [02:01:17] I would have said, all right, [02:01:19] are we really talking about exercise opening plasticity? [02:01:23] It's always seemed like mice running on wheels

[02:01:25] and you get a few extra neurons, [02:01:26] you get a nature paper, like, I love that work, [02:01:28] don't get me wrong. [02:01:29] It turns out to not be that meaningful [02:01:31] in terms of new neuron production

[02:01:34] doesn't seem to be that meaningful [02:01:35] for human memory and offsetting cognitive decline. [02:01:39] But now I have a completely different view of exercise [02:01:42] based on your work, [02:01:43] based on the studies that you're describing,

[02:01:45] because it's like, yeah, these are the big guns [02:01:48] in terms of deploying lots of molecules [02:01:52] that without question are interacting with one another. [02:01:55] So I no longer think about exercise as like, [02:01:58] okay, well, it's just increasing vessel growth,

[02:02:00] you're getting more metabolic health, [02:02:02] so then the brain gets better. [02:02:04] I now think about resistance training and cardio [02:02:06] and their various forms, as you point out, [02:02:08] four by four, et cetera,

[02:02:09] as like the real plasticity triggers. [02:02:14] So that was a long-winded way of saying thank you [02:02:17] to you and your colleagues who've been doing this [02:02:19] and thinking about things like clutch states [02:02:22] and molecules that shift plasticity

[02:02:24] because I love reduction of single molecule manipulations. [02:02:28] I think they're very important in a certain context, [02:02:30] but for a while it was like, [02:02:32] gosh, everything opens plasticity [02:02:34] and everything disrupts around the sleep.

[02:02:35] It's like, when are we going to get to this stuff? [02:02:37] Anyway, Alzheimer's, Parkinson's, [02:02:40] nobody wants these neurodegenerative conditions. [02:02:44] What is the current thinking about the factors [02:02:48] that make one susceptible to Alzheimer's?

[02:02:51] I'm beginning to think that it's not just one, [02:02:54] but then there's a genetic predisposition issue [02:02:57] that maybe you could touch on. [02:02:59] And what can we do besides the things that we're already [02:03:04] talking about today to best reduce

[02:03:08] the chance of accelerated cognitive decline [02:03:12] or full-blown Alzheimer's? [02:03:14] First, we talk about dementia, which is essentially [02:03:18] the end stage of cognitive decline. [02:03:20] There's some trajectory of decline

[02:03:22] that happens from your peak to that point, where ideally, [02:03:26] we'd intervene much sooner. [02:03:28] But right now, you know, we don't really do much until [02:03:31] dementia is diagnosed. But it's very similar, like we don't do [02:03:34] very much until diabetes is diagnosed. You know, ideally, we

[02:03:37] can we can act much earlier in that trajectory. And that's [02:03:40] increasingly being accepted in the neuroscience and neurology [02:03:44] communities that actually we could potentially change that [02:03:47] trajectory, or at least decrease risk. And so within dementia, [02:03:52] there are as an umbrella term, which is essentially the loss of

[02:03:55] cognitive function, such that you can't look after yourself on [02:03:58] day-to-day basis. You can't do the basic activities of day living. [02:04:04] Alzheimer's disease is the most common. It makes up about 60 to 80% of cases of dementia. [02:04:10] The next most common is vascular dementia, although vascular dementia and Alzheimer's [02:04:15] disease overlap a ton. The vast majority of people who have Alzheimer's disease also have

[02:04:19] some element of pathology or changes in the blood vessels in their brain, which is what [02:04:23] you get with vascular dementia. [02:04:25] And then there's also dementia with Lewy bodies, frontotemporal dementia, and then dementia [02:04:30] related to Parkinson's potential, although that overlaps a lot with Lewy body dementia. [02:04:36] And dementia and Parkinson's may just be, may actually mostly be Lewy body dementia.

[02:04:40] But we've gone to a point now where it's generally accepted that potentially half of cases of [02:04:47] dementia are preventable. [02:04:49] And I think the majority of that falls into those first two buckets Alzheimer's and vascular [02:04:53] dementia, although metabolic disease and other risk factors for Alzheimer's disease also [02:04:58] increase the risk of Parkinson's disease and those other dimensions as well.

[02:05:02] When you then think about Alzheimer's disease specifically, there's this one small slice [02:05:06] of Alzheimer's, which is like monogenic, dominant mutations that you have in either, most of [02:05:12] them happen either in the presenilin genes, presenilin 1 and 2, or the amyloid precursor [02:05:16] protein gene. [02:05:18] They make up at this point, less than 5%, maybe as little as 1% of Alzheimer's disease.

[02:05:22] So we kind of, we set those to the side a little bit. [02:05:25] The vast majority of Alzheimer's disease is what we would call late on to Alzheimer's [02:05:29] disease, although it's happening actually earlier and earlier in some populations. [02:05:33] Yes, the genetic component, your APOE gene is probably your most common risk gene. [02:05:41] It's also associated, there's also polygenic risk, so thousands of genes can give you a

[02:05:45] little bit more, a little bit less risk of Alzheimer's disease. [02:05:49] But it's much more related to lifestyle and the environment than, say, that kind of early [02:05:55] onset monogenic Alzheimer's disease. [02:05:59] And the kind of the best accepted review of all of this is run by the Lancet Commission [02:06:09] on Dementia Prevention, overseen by Professor Jill Livingston.

[02:06:13] And the most recent version of this suggests that there were 14 risk factors who between [02:06:18] them accounted for about 45% of dementia risk or dementia cases, and that are modifiable. [02:06:26] So early life education, high blood pressure, diabetes, hearing loss, vision loss, brain [02:06:31] trauma, high cholesterol, they recently added. [02:06:36] High LDL.

[02:06:37] High LDL cholesterol, low physical activity. [02:06:39] So this is all related to the things we've already talked about, right? [02:06:42] Maintaining good physical health, maintaining inputs, getting inputs in the first place [02:06:46] where education is critical. [02:06:49] And hearing loss, as I recall, was an important one in reference to inputs.

[02:06:54] Like you don't want sensory input degraded. [02:06:56] Absolutely. [02:06:57] So hearing loss, vision loss, social isolation. [02:07:01] They didn't, it was quite, so two things they didn't include that were fairly controversial [02:07:07] and were sort of debated, letters were written to the editor and all that kind of stuff as

[02:07:10] happens in academia related to, so they didn't include sleep loss or sleep deprivation as [02:07:15] as a risk factor for dementia, even though the evidence, [02:07:18] particularly if you're- [02:07:18] Didn't look at it or didn't include it? [02:07:20] They didn't include it.

[02:07:21] So like they talked about it, [02:07:22] but they felt that the level of evidence wasn't high enough, [02:07:24] though it was probably as high [02:07:26] as some of the other things that they included. [02:07:28] It's a tricky one.

[02:07:28] I don't wanna take us on too much of a tangent, [02:07:30] but having looked at these data a lot, [02:07:32] I do think that people need to get enough sleep, [02:07:34] but some people like myself do fine [02:07:36] on six and a half or seven hours,

[02:07:37] and other people can do fine on only seven or eight or nine. [02:07:41] Very few people are A-OK all the time [02:07:44] on just four to five hours for prolonged periods of time. But when we say not AOK, what tends [02:07:49] to happen with shift work or people that are chronically sleep deprived is most of the [02:07:53] other things you're talking about get worse. LDL goes up, stress level goes up. So it's

[02:07:59] like I can understand why they might not have included it, but it seems so foundational [02:08:05] to me that it does seem kind of a shame. [02:08:07] Part of it is related to how they analyze the data. So we can get to that. But I mean, [02:08:13] reality when you look at the data on sleep loss and dementia risk, the cutoff is really around [02:08:17] six hours. So if you're consistently sleeping fewer than six hours, that's where risk starts

[02:08:22] to increase. So that kind of fits. Yeah, that sounds about right. Because I think it's the [02:08:27] lack of those last two cycles that are REM enriched. Yeah. Because in the beginning of [02:08:32] the night, you get your growth hormone surge, you get a lot of deep sleep, assuming you're [02:08:36] doing things right during the day. And then it's those last two 90 minute-ish cycles [02:08:42] that you glean most of your REM. And if you're not getting those night in and night out,

[02:08:47] and night in and night out, sooner or later, you're going to have issues. [02:08:52] So sleep was one, then the other one was nutrient status. So they didn't talk about omega-3s, [02:08:56] B vitamins, which we do actually have some quite high-quality interventional and observational [02:09:01] kind of epidemiological data for. So there was kind of some discussion as whether those things [02:09:05] should have been included. Other analyses that looked at those suggested that they potentially

[02:09:09] contribute a significant amount of the population attributable risk of dementia. So all that to say [02:09:16] that their 45% estimate could be quite conservative. If we consider some of the other things, [02:09:23] there are some other studies that suggest that maybe as many as, or as much as 70% of [02:09:28] dementias may be preventable, but then you have to start including things related to [02:09:33] socioeconomic status and deprivation and other societal factors that we know have a massive

[02:09:38] impact as well. So that's less modifiable like on the individual level. I really would require [02:09:44] changes at the societal level, which is kind of harder to do. [02:09:47] Can I ask you a question? It's going to be a very controversial one, but [02:09:52] there are people arguing, they're very smart people, I should say, arguing that the shingles [02:09:58] vaccine is lowering rates of dementia significantly. I haven't looked at those data closely yet.

[02:10:04] I plan to. But it certainly is intriguing given the data that herpes viruses of various sorts have [02:10:10] been correlated with Alzheimer's. This comes off the back of three or four very large natural [02:10:19] experiments that have been done in various countries. And really how you interpret these [02:10:25] data is going to depend a little bit on your kind of risk tolerance and like what you think should [02:10:31] be done in terms of the level of evidence required to intervene. So I'll describe the

[02:10:36] studies in a second, but some people are definitely saying, you know, if you want, [02:10:39] if you want to say that the shingles vaccine decreases dementia risk, you have to have a [02:10:44] clinical trial that's adequately powered to show that. And there is a trial like that being planned [02:10:50] currently. So the studies that have happened so far, there was one in the UK in Wales, [02:10:58] one in Australia, and one in Canada. And in each of those countries, what happened was that on

[02:11:06] a single date, a huge tranche of people became eligible to get the shingles vaccine, whereas [02:11:14] if they were born one day earlier, they weren't eligible. So you get what you call like a natural [02:11:20] experiment, where from one day to the next, those people shouldn't be that different otherwise, [02:11:25] And they showed that rates of other diseases weren't that different, [02:11:28] rates of uptake of other healthcare and other vaccines wasn't that different,

[02:11:33] but there was a big shift in the uptake of the Shingles vaccine. [02:11:37] And so what they essentially consistently showed across all those different populations [02:11:41] was that those who got the Shingles vaccine or were eligible to have the Shingles vaccine [02:11:45] depending on whether they had access to the data on whether people got it or not [02:11:49] had a decreased risk of dementia.

[02:11:51] And that was consistently seen across those three groups. [02:11:55] All those three trials used an older version of the Shingles vaccine called Zostavax, which was [02:12:01] a live attenuated vaccine. There's now a newer version called Shingrix, which is a recombinant [02:12:08] vaccine. And there was a study done in the US that compared people who switched from... [02:12:15] There was a similar switch from Zostavax to Shingrix and saw that Shingrix was associated

[02:12:19] with a lower risk of dementia compared to Zostavax, although both were associated with a lower risk [02:12:24] than none. When you look at some of these trials, or studies, because they're not trials, [02:12:31] people have made a very fair comment, which is that when you look at the trajectory of dementia [02:12:35] over time, you look at something called a Kaplan-Meier curve. So it's like a survival curve. So like, [02:12:40] every time somebody gets cases of dementia, like the line goes up,

[02:12:43] and you look at the trajectory of the two lines, those who've got, you know, got the vaccine or [02:12:48] not. They diverge very early, which kind of says that, oh, it only takes a couple of months [02:12:54] to kind of see this difference in dementia risk, which you wouldn't really expect based on like [02:12:58] the natural course of dementia takes years to happen. So this is very common in these kinds [02:13:05] of studies. And it's due to residual confounding. So there's like something inherently different

[02:13:11] about the populations that may be driving some of this different, right? They were going to get [02:13:15] less dementia anyway. And so maybe the shingles vaccine isn't having that big of an effect. But [02:13:20] I would say that having looked at all those trials and all those data, I'm fairly, you know, [02:13:26] I'm convinced enough that there's a signal there, there should be a randomized control trial that's [02:13:33] that's happening. But there's a number of reasons why this might be the case. One,

[02:13:37] it, obviously, we know reduces cases of shingles. shingles can be very painful, they can, you know, [02:13:46] can change how people interact with the world, you stay at home, you don't feel good, [02:13:50] you're not paying for a long period of time, that can be that can go for many months, [02:13:54] it's rare for it to last many months, but it can kind of last a long time. [02:13:59] Then, you know, there's, they've hypothesized in some of those papers, that the magnitude of the

[02:14:06] reduction of dementia risk didn't map perfectly onto the reduction in cases of shingles. There [02:14:12] had to be something else going on as well. They've suggested that it may be due to an [02:14:17] immunomodulatory effect. It may be because you're also suppressing other viruses like [02:14:23] herpes simplex virus that we know may also be associated with certain cases of dementia or [02:14:28] Alzheimer's. One of the arguments for the immunomodulatory effect is because

[02:14:36] Not in all the studies, but in most of the studies there's a slightly bigger signal in women than there is in men [02:14:42] and it may be that that sort of [02:14:44] Meaning it's more effective more effective in women than it was in men and we should mention [02:14:49] That the shingles virus lives on neurons. Yes [02:14:52] Yeah

[02:14:53] The herpes viruses tend to live on neurons that and they hang out on neurons [02:14:58] Which is why people who you know get herpes 1 infections will get a cold sore at a particular location that will come back [02:15:04] because it's living on the trigeminal nerve. [02:15:06] It's just, you know, I think people don't often understand [02:15:10] that viruses can, you know,

[02:15:11] harbor in particular cell types. [02:15:14] And so the logical link between herpes viruses [02:15:18] and dementia risk is, you know, it's not, [02:15:22] I mean, that alone is not a causal relationship, [02:15:25] but it makes sense mechanistically.

[02:15:28] And a fundamental feature of herpes viruses [02:15:30] is they generally don't kill the neuron. [02:15:32] They can, but that's why they stay alive. [02:15:34] These viruses are very smart. [02:15:36] They know how to infect their host, but not kill their host, which is what really smart

[02:15:40] viruses do. [02:15:42] So what age are people getting the shingles vaccine? [02:15:44] The study is actually quite late. [02:15:46] It's like people in their 70s and 80s. [02:15:49] Oh, wow.

[02:15:50] Yeah. [02:15:51] Okay. [02:15:52] So again, it would be very fair to argue that getting it much earlier, we don't have any [02:15:58] evidence for, because in reality, in these, particularly in these, the studies like the [02:16:03] UK, this is done in the national healthcare system, it was for the highest risk older

[02:16:09] adults. [02:16:10] And so getting it in your like fifties or mid fifties, which is sort of the guidelines [02:16:15] in the US, that yes, to reduce shingles, absolutely, but it doesn't map on to the dementia risk [02:16:21] age that was seen in these studies. [02:16:24] A final piece of this that I think is important and kind of goes beyond just the shingles

[02:16:30] vaccine is that if you want to maintain function over long periods of time, one of the best [02:16:38] things you can do is minimize your chances of getting really sick. [02:16:41] There have been several studies. [02:16:44] One was the adult changes and thought study done at the University of Washington in Seattle [02:16:47] primarily.

[02:16:48] This is a similar thing was shown in the Rush Memory and Aging Project. [02:16:51] basically, when you look at the same individual over time, and [02:16:56] you measure their cognitive function every few years, which [02:16:58] these studies did, cognitive function doesn't just decline [02:17:02] sort of linearly or steadily with age. It goes down, you know,

[02:17:06] a little bit on average, but the biggest decreases sort of [02:17:10] happens stepwise after periods of significant illness. And so [02:17:14] like in the adult changes of the thought study, those who'd been, [02:17:17] you know, sick in between, you know, had a major illness in [02:17:20] between having their cognition retested,

[02:17:24] they had a step change down, [02:17:25] and those who were hospitalized, [02:17:26] that step change down was even bigger. [02:17:29] So you could talk about how people maybe [02:17:33] could have changed things in order to recover

[02:17:35] some of that function afterwards. [02:17:36] I think that would have been possible [02:17:37] if you thought about how you might intervene. [02:17:41] But a major, I think it's a reason to say, [02:17:45] if I can do as much as I can to minimize the chance

[02:17:49] that I get really sick, [02:17:50] because what happens then is I'm at home, [02:17:52] I'm not receiving any stimuli, any inputs, [02:17:55] I'm not moving, I'm not eating well, [02:17:57] obviously there's all the downsides of the infection itself,

[02:18:02] then if I can avoid that as much as possible, [02:18:06] then over time, that could be to greater benefits, right? [02:18:11] Trainings change the overall trajectory. [02:18:12] So I think that's one reason why some of these vaccinations [02:18:16] could be beneficial, is just you're minimizing the time

[02:18:19] you spend really sick as you're older, which we've seen as [02:18:23] resulting in sort of like step changes down in cognitive [02:18:25] function. [02:18:27] Fascinating. I realized that we could and probably should do an [02:18:32] entire podcast about traumatic brain, brain injury and

[02:18:35] concussion. But as a teaser for that, are there anything that [02:18:44] people should do and or take in the immediate aftermath of a [02:18:48] a head hit. [02:18:49] Now I'm not talking about, [02:18:51] well, hopefully people are getting checked out

[02:18:52] for brain bleeds and things like that. [02:18:54] So I'm talking about moderate concussions. [02:18:56] Someone got their quote unquote bell rung. [02:18:59] They slipped and fell. [02:19:01] They got clipped in soccer practice.

[02:19:05] Their kid's a little dizzy. [02:19:06] Now, of course, somebody young or old is vomiting [02:19:10] or not able to sleep or real issues. [02:19:12] I mean, everyone should probably be checked out [02:19:14] in the first case,

[02:19:15] but I get asked this question all the time. [02:19:17] Is there anything that people can take [02:19:18] kind of get over mild concussion or moderate concussion. [02:19:22] The evidence based on this is a little shaky, but I think for most things, it kind of fits [02:19:30] into this idea of positive asymmetry, low risk, high potential for benefit.

[02:19:35] And there have been lots of, there have been randomized controlled trials to kind of look [02:19:37] at some of these things. [02:19:38] So a couple of years ago, we published a paper looking at different nutritional supplements [02:19:42] after concussion that we have some reasonably good evidence for. [02:19:47] So yes, you should be seen by a doctor, you should get whatever scans and, you know, immediate

[02:19:53] medical care that you need. [02:19:55] Absolutely. [02:19:56] Right. [02:19:57] That's, we're assuming all of that is done or will be done. [02:19:59] Yeah.

[02:20:00] Immediately. [02:20:01] There are a couple of things that I think we know from sort of animal studies that translate [02:20:07] fairly well onto, onto humans, but also some, you know, maybe some observational studies [02:20:11] in humans, but a couple of things are important. [02:20:13] So one is temperature management, temperature regulation.

[02:20:18] There have been, this is what, my PhD was actually in hypothermia after acute brain [02:20:22] injury. [02:20:23] Hyperthermia. [02:20:24] Hyperthermia. [02:20:25] Yeah.

[02:20:26] So cooling down. [02:20:27] Although I did do some studies where we heated up and that makes things worse. [02:20:30] So this kind of pertains to what I'm about to do. [02:20:32] I can imagine. [02:20:33] The brain doesn't like to get too hot.

[02:20:34] Yeah. [02:20:35] That's essentially what I'm about to say. [02:20:36] So there have been lots of studies where they've done cooling hypothermia in people after traumatic [02:20:40] brain injuries and concussions hasn't really shown much of an effect. [02:20:44] What seems to be important is preventing hyperthermia.

[02:20:49] So one of the effects of cooling somebody down is that they don't get hot. [02:20:54] So that's probably something that's really important. [02:20:56] So often concussions happen in a heat-stressed environment. [02:21:00] You're on a football pitch, it's August in Alabama, it's 40 degrees, right? [02:21:05] Get inside, get cool as quickly as you can, because there are studies that, and that doesn't

[02:21:09] you have to get an ice bath, just don't be really hot. If you get a fever, which you might do after [02:21:14] a more significant injury, you know, Tylenol or something like that to help maintain thermal [02:21:19] regulation will be really important. The next is blood sugar regulation. So we know that after a [02:21:26] significant brain injury, you have increases in blood sugar, that's associated with worse outcomes, [02:21:30] some of it's like, what's cause, what's consequences, the injury driving the blood sugar is the blood

[02:21:34] sugar driving injury. I think an easy thing to just say is, I would avoid any super sugary [02:21:41] refined carbohydrates that might just sort of, you know, kind of pile on for one of a better word, [02:21:47] right? So alcohol, I would avoid as well, mainly because it impairs sleep. And we know that sleep [02:21:53] is going to be critical to recovery. Some people would say something similar about caffeine acutely [02:21:58] after injury, because it's a it's a stimulant. One thing that with the reason why hypertherm,

[02:22:03] you're getting too hot makes the injury worse is because it, you know, simply speaking, increases [02:22:10] the gap between energy requirements and energy production. So like one of the hallmarks of these [02:22:16] acute brain injuries is a deficit in energy production with, you know, mitochondrial failure [02:22:20] or mitochondrial dysfunction. And so if you get too hot, or you stimulate the brain, you're asking [02:22:26] for more energy when the when the when your neurons can't produce it. And that is a trigger

[02:22:32] that kind of deficit in energy production is a trigger for cell death and neuroinflammation and [02:22:36] some of these other processes that may happen. So avoid alcohol, avoid caffeine, both of those [02:22:41] potentially related to improving sleep. Then things that we have some reasonable evidence for [02:22:48] immediately after concussion are creatine. At what dosage? [02:22:51] The best trial was actually done in a pediatric group, although very broad. It was like one

[02:22:58] year old to 18 years old, but they gave 0.4 grams per kilo per day. So it's like double [02:23:07] a traditional loading dose if you're a 100 kilo person. But if you're 70 kilos, 155 pounds [02:23:14] or something like that, then that's 28 grams of creatine. So it's a lot, but not a ton. [02:23:19] A few extra trips to the bathroom could be expected, but you could just spread it out [02:23:22] across the day, right?

[02:23:23] Yes. [02:23:24] So, well, one thing I'll say about that is the most recent meta-analysis show that you [02:23:30] actually don't get, it's actually quite rare to get more GI side effects with creatine [02:23:35] compared to placebo. [02:23:37] Some of it is probably related to the quality of the supplements, so poor quality creatine

[02:23:40] supplements have more adulterants that may cause some of those GI side effects. [02:23:44] Some of it is, can be due to high, you can saturate the creatine transporters, it doesn't [02:23:50] get absorbed, water gets drawn into the gut that can then cause diarrhea or something. [02:23:58] But some of the GI issues that people experience are probably due to poor quality products [02:24:03] that they're taking.

[02:24:04] For the non head injured individual, is there any reason to go back to the old loading protocols [02:24:10] of taking 20 grams per day, putting it in a little bit of grape juice or something else [02:24:14] to spike blood sugar for this very reason that it could argument the passage of creatine [02:24:21] into your cells as opposed to drawing water into the gut. [02:24:24] In the 90s, we would take five grams of creatine four times a day in an ounce or two of pure

[02:24:31] grape juice and you draw a lot of water into your muscle cells. [02:24:36] You put on, it varies, but for me, anywhere from five to eight pounds of it's water weight, [02:24:42] it's mostly in the muscles. It's not insignificant. It translates to big strength increases. I [02:24:48] don't take nearly that much now. I just do the 10 grams per day. But is there any reason [02:24:51] to go back to those traditional loading?

[02:24:54] So if you're just like long-term creating supplementation, probably not. In this kind [02:25:01] of setting, I think the evidence is for a loading style protocol, right? So for most [02:25:07] people, it might be 20 to 30 grams of creatine spread across the day. If anybody's just taking [02:25:14] creatine for other reasons, there's a standard dosing protocol that I think is fine. [02:25:20] I thought you were going to tell me I could get it to work that way.

[02:25:24] Some of the studies that use traditional creatine monohydrate end up with creatine levels in [02:25:27] the brain. They did use a loading protocol for a week, and then you see significant increases [02:25:31] in brain creatine. But creatine having other effects on the brain, potentially improving [02:25:36] mood, improving memory in older adults. Some of those benefits happen at just like a traditional [02:25:43] creatine doses. So you don't take massive dose, you know, think load loading doses,

[02:25:47] you can actually see some benefits are like five to 10 grams. So that's creatine. So magnesium, [02:25:51] so 400 milligrams, once or twice a day, there have been some trials that shouldn't form [02:25:56] those studies actually use magnesium oxide surprisingly. But I would probably use magnesium [02:26:02] glycinate. It's very bioavailable. Athletes usually need a bit more glycine anyway, [02:26:10] but any bioavailable form will be fine. Then omega-3 fatty acids. The evidence is a little

[02:26:18] bit better for like, there are now several studies in like collegiate American football players, [02:26:24] where they take a couple of grams of omega-3s every day. And across a season, you see [02:26:29] see less accumulation of biomarkers of injury like neurofilament light that are circulating [02:26:35] in the blood. [02:26:36] So that's something that I would just take long longitudinally if you're somebody who's

[02:26:40] at risk of a concussion because of your sport or your job, I would just, you know, take [02:26:46] a reasonable omega three supplement just long term because we have some reasonable evidence [02:26:49] for that. [02:26:51] Then other things might become a little bit specific to the symptoms that you're experiencing. [02:26:58] So if you have sleep issues, then there are studies that have used a melatonin, and that's

[02:27:03] shown improvements of branched-chain amino acids at high doses for sleep. [02:27:07] And that's interesting because outside of TBI, high doses of branched-chain amino acids [02:27:12] may actually impair sleep because they compete for tryptophan uptake into the brain, decreasing, [02:27:17] potentially decreasing serotonin and melatonin production, but in TBI, there are two studies [02:27:22] that suggest improvements in sleep with high doses of branched-chain amino acids.

[02:27:26] If somebody is going to take branched-chain amino acids, presumably they're going to look [02:27:30] at how much leucine is there for a variety of reasons. [02:27:34] So do you recall how much leucine to get this effect post TBI? [02:27:38] So I don't think they, at least I don't remember the leucine dose, but they were taking up [02:27:43] to 60 grams of branched-chain mouses.

[02:27:46] Six zero. [02:27:47] Six zero. [02:27:48] OK, because a typical kind of suggested supplement bottle gym dose would be three to five grams. [02:27:55] usually about six capsules. [02:27:57] Yeah. So, OK.

[02:27:58] So like one study they did [02:28:00] in veterans, they had [02:28:02] I think it was three doses [02:28:05] of 20 grams spread across the day. [02:28:08] Are you curious about

[02:28:10] these Ibogaine studies [02:28:12] that are looking at, you know, TBI [02:28:14] and brain recovery? [02:28:15] I mean, Ibogaine is a. [02:28:18] It's a whole other thing because

[02:28:19] it's the most powerful, long-lasting [02:28:22] psychedelic, at least that I'm aware of. [02:28:23] But it seems like there's some interesting data coming out. [02:28:27] Absolutely. [02:28:28] And then in people with a history of brain trauma and PTSD, and I think some of these

[02:28:34] other psychedelics are going to be very interesting there as well, potentially due to their neuroplastic [02:28:42] effects that tend to particularly happen in like macro doses, right, in the psychedelic [02:28:48] doses. [02:28:49] I think that there's a lot more to come there, but certainly the trials that have been done [02:28:52] so far are quite compelling. But that's obviously in a very controlled kind of clinical setting.

[02:28:57] Yeah, you have to be heart rate monitored. Again, it's not legal in the United States, [02:29:00] although things are shifting. But choline is another thing, particularly our citi-choline. [02:29:05] So best evidences for one to two grams a day. [02:29:09] Of choline. [02:29:10] Of choline. In the form of CDP choline or citi-choline, which is the same thing.

[02:29:17] Those are the main ones. Then there's some other like [02:29:19] Nisha supplements that do have some evidence, the one that's probably has the most evidence for it [02:29:22] is Boswellia. [02:29:23] Boswellia? [02:29:24] Yeah, which is Indian frankincense, but there's an extract of Boswellia that's been tested in,

[02:29:29] I think, three different clinical trials after TBI showed some benefit, [02:29:33] Enzogenol, which I think is a pine extract, slightly less evidence than Boswellia. [02:29:37] I typically would recommend people stick to the first group of kind of nutritional type supplements, [02:29:42] but in very specific use cases based on specific symptoms, some of those other things might be [02:29:48] beneficial then beyond that we know that physical returns physical activity as soon as possible

[02:29:53] is really important without getting another head injury and you know so this really changed over [02:29:59] the last few years you know maybe five ten years ago people like you know rest is what you need [02:30:03] to do go lie in a dark room if you've got a concussion in sports you you would expect the [02:30:10] team to have a rigorous return to play protocol that included low level aerobic activity as soon [02:30:17] as you're able to tolerate it two or three times a week at a level just below what might

[02:30:23] make your symptoms worse. And then first you do sort of like non-specific aerobic exercise, [02:30:28] and then you start to bring back skill specific exercises, sports exercises, then go back into [02:30:32] full training and then go back into into playing kind of in that order. And that should be quite [02:30:38] systematized now. So I would expect sports teams to kind of have that in place. So like the standard [02:30:43] of care is generally physical physical therapy. If you have any ongoing cognitive or physical

[02:30:48] symptoms, sort of a month plus after any kind of traumatic brain injury. There's some evidence that [02:30:55] like virtual reality or augmented reality, physical activity might improve cognitive symptoms, [02:31:03] vestibular therapy for balance and dizziness issues. And then increasingly, you know, [02:31:10] there's a focus on sort of oculomotor training for like convergence or other eye issues that [02:31:19] are very common after concussions but aren't picked up as often as people might like. But

[02:31:25] increasingly kind of eye tracking and these kinds of things are done particularly in professional [02:31:30] sports or other arenas after brain injuries to kind of ideally you'd have a baseline you figure [02:31:35] out what's changed and then you would track that over time and you can train that depending on [02:31:39] on the deficit. [02:31:40] Those recommendations are going to be extremely helpful for people, athletes at all levels.

[02:31:44] I mean, I think for people that don't have access to the, you know, all the latest and [02:31:48] greatest, you know, technology and coaches and nurses and doctors that, you know, there's [02:31:55] a lot of head hits out there that aren't, you know, fortunately aren't full blown brain [02:32:01] bleeds and brain damage. [02:32:03] But the low level trauma to the brain is obviously a consideration, especially kids, like just

[02:32:10] falling off the monkey bars, like parents want to know what they can do. [02:32:13] So thank you very much for those recommendations. [02:32:16] You're doing a strong man competition. [02:32:18] All natural. [02:32:19] This is not the enhanced games.

[02:32:22] Just tell us what the format of that is. [02:32:24] Well, first of all, how old are you? [02:32:25] 41. [02:32:26] Cool. [02:32:27] Have you done one of these before?

[02:32:28] Yeah, I've six or seven competitions at this point. [02:32:30] I started during COVID. [02:32:31] I've done like a competition or two every year since then. [02:32:34] You're a tall guy, you're like 6'2", you weigh... [02:32:37] Like 210, 215 usually.

[02:32:38] And is it, so it's height and weight class [02:32:40] or just weight class? [02:32:41] So it's weight class. [02:32:43] I now, so now that I'm older than 40, [02:32:45] I compete in the master's category.

[02:32:48] So there's a, this one of my favorite things [02:32:50] about Strongman is that if you weigh less than 200 pounds, [02:32:52] you're a lightweight. [02:32:53] So I'm in the lightweight master's category. [02:32:56] It means that I usually have to like do a water cut

[02:32:59] to like for a weigh in because I don't normally, I'm not, I'm normally above 200 [02:33:03] pounds. Um, but yeah, they, so they have, they have weight, they have weight classes [02:33:09] and age classes. [02:33:10] Can you eat your way and hydrate your way back up to after? [02:33:13] Yeah. Like the, usually weigh in 20 hours, 24 hours before I'm, I'm definitely back

[02:33:20] to my usual weight by the, by the next day. [02:33:22] Gotcha. Yeah. We don't want you trying to lift heavy things, dehydrated. [02:33:25] What are the big events? So you're carrying stuff overhead. [02:33:28] you're carrying stuff at your sides, what are you doing? [02:33:31] A standard kind of local regional competition is five events.

[02:33:34] I qualified for the natural world's strongest man, [02:33:38] which is going to be seven events. [02:33:39] But there's usually some kind of deadlift, some kind [02:33:43] of overhead pressing event, some kind of medley [02:33:48] where you're carrying something, lifting stones, farmer's walks.

[02:33:52] So in a truck pull, something like that, more dynamic. [02:33:57] So there's like usually like a static max strength thing, [02:33:59] but then also like more dynamic. [02:34:01] Like the teeth? [02:34:02] Yeah.

[02:34:03] You do the teeth pull? [02:34:03] No teeth, no, no teeth pulling. [02:34:06] Cool. [02:34:08] We didn't talk about oral health and cognitive function, [02:34:10] but that's really important too.

[02:34:12] The events in the competition that I've got coming up [02:34:13] the world's strongest, there's going to be a farmer's walk. [02:34:16] So that's where you just like pick things up at the side [02:34:18] and kind of. [02:34:19] And so for a guy, let's say you hydrate back to like 205,

[02:34:23] 210 or something like that. [02:34:24] What's a good distance and weight to carry? [02:34:27] I know the weight in the competition. [02:34:29] It's 120 kilos per hand. [02:34:30] So that's 264 pounds per hand.

[02:34:33] And as far as you can carry it, I can't remember this. [02:34:37] That's a big human in each hand. [02:34:39] Yeah. [02:34:40] So typically, if you can get to where you've [02:34:44] got your body weight in each hand

[02:34:46] and you're able to pick it up and move with it, [02:34:47] even if it's not very far, I think that's pretty good. [02:34:51] Some people might say half your body weight. [02:34:53] In reality, if you pick something up, [02:34:55] heavier, you move with it, that's great.

[02:34:56] Like, and then get better. [02:34:58] We're not talking about commendations. [02:34:59] This is your time to shine, my friend. [02:35:01] People can work their way up. [02:35:02] I watch Tom Haviland's Instagram.

[02:35:06] We'll put a link to it, everyone should see that. [02:35:08] His wife and his kid also work into the workouts. [02:35:11] He's got a, man, he's strong. [02:35:12] But yeah, carrying heavy weight. [02:35:14] No, no, this is not your time to tell people

[02:35:15] how to tiptoe into it. [02:35:16] That's a different podcast. [02:35:18] So you're carrying 220 pounds in each hand. [02:35:21] 264 pounds per hand. [02:35:22] walking how far? It's maximum distance in, I can't remember if it's 60 or 90 seconds.

[02:35:29] You can't set it down. You can set it down. So as far as you can get in that period of time, [02:35:34] and it'll be similar with a yoke walk. So there's a yoke where, you know, sort of like put it on [02:35:39] your back, it's 700 pounds. How far can you walk in that period of time? Love this, so primitive, [02:35:44] love it. Pure Hypothalamic event, yeah. So in that event, in the yoke walk, if you get to the end, [02:35:49] I think it's 30 meters, 90-ish feet. If you can carry that far in the time cap,

[02:35:55] then you do reps on a circus dumbbell. So this big, massive dumbbell that you have to [02:36:00] shoulder to overhead. There's one at 110 pounds and the next is 135 pounds. [02:36:05] Then there's going to be a loading medley, so sandbags and kegs over a platform that's [02:36:12] like, I think, 200 to 300 pound implements that kind of increase over time. [02:36:17] there's a maximum squat and you have a choice of two different weights and so

[02:36:24] like if you choose the bigger weight and you get reps on the bigger weight that [02:36:27] you get a better score than somebody you did. It's a standard back squat. It's a standard back squat [02:36:31] is with an axle bar, it's like a thick bar and then in Strongman when you have [02:36:36] squatting you usually have pads that you squat down to so this is a specific [02:36:40] height you squat down to so like that could give you an advantage if you're

[02:36:44] shorter right because you have to go less distance to get the weight on the pads [02:36:47] but like there's no geeking it and calling it less than a one rep. People have done that it [02:36:52] doesn't look good. Yeah no like it just has to hit the pads and come back up and the weights are 170 [02:36:57] kilos and 200 kilos so that's what nearly 400 pounds and 440 pounds. Log press for reps and [02:37:06] again it's a similar style and I think it's 100 kilos so 220 pounds and then 120 so 264

[02:37:11] And then there's a sled, you push a sled and then you load it with a 275 pound sandbag and then you drag it in a time cap. [02:37:23] I think that's all the events. [02:37:25] Awesome. You'll let us know when it is? [02:37:29] Yes, it's at the end of August. [02:37:31] Cool. Will it be online?

[02:37:33] I won't be online, but I'm sure there'll be some stuff on Instagram. [02:37:36] Cool, I love that you do this. [02:37:38] Clearly, you got a lot of brains in that skull of yours [02:37:43] and you're also super strong. [02:37:45] Love hearing it, that's great.

[02:37:46] And you have no excuse not to carry the groceries at home, [02:37:50] right, so you lost that right, [02:37:52] but there's no doubt you would anyway. [02:37:54] That's awesome, I'm very impressed by the, [02:37:57] by people who continue to take on athletic challenges

[02:38:00] in their adult life, [02:38:03] which is very appropriate to context today. [02:38:05] So Dr. Tommy Wood, thanks for coming out today. [02:38:09] I learned a ton from you. [02:38:10] And going into this, I like to think,

[02:38:13] I know a thing or two about plasticity, [02:38:14] having spent so much time in it [02:38:16] and studying it over the years, [02:38:17] but I learned a lot from you today. [02:38:18] And I know everyone else did as well.

[02:38:20] You're an exceptionally clear communicator [02:38:22] and you're working on not just an important issue, [02:38:25] you're working on the issue, [02:38:28] this neuroplasticity thing and a whole lot more. [02:38:30] So let's definitely get you back to talk about recovery

[02:38:32] from brain injury and stroke and things of that sort, [02:38:34] because there's a lot of additional things [02:38:36] I think we could dig into. [02:38:38] But meanwhile, you've given us a lot of actionable tools [02:38:42] and yeah, I love that you're doing the strong man

[02:38:46] competition and come back again. [02:38:49] We appreciate you. [02:38:50] I will, thank you so much. [02:38:51] Thank you. [02:38:51] Thank you for joining me for today's discussion

[02:38:53] with Dr. Tommy Wood. [02:38:54] To learn more about his work and his book, [02:38:57] please see the links in the show note caption. [02:38:59] If you're learning from and or enjoying this podcast, [02:39:01] please subscribe to our YouTube channel.

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[02:39:34] For those of you that haven't heard, [02:39:35] I have a new book coming out. [02:39:36] It's my very first book. [02:39:38] It's entitled, Protocols, [02:39:39] An Operating Manual for the Human Body.

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