Dr. Wood provides a rigorous scientific framework for cognitive longevity, proving that the most effective "brain hacks" are still rooted in physical grit and deliberate learning. It is a masterclass in transforming complex neurobiology into a practical, high-performance lifestyle.
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Accelerate Learning & Increase Cognitive Capacity | Dr. Tommy Wood
Added:There's a much more recent study that took again older adults and randomized them across three different groups. One was like a low-intensity group. Another group basically did kind of zone 2 type work on a treadmill three times a week.
And the third group did um a high-intensity interval training intervention which was the Norwegian 4x4 protocol. So 4 minutes at 85 to 95% of maximum heart rate. They had a 3minut rest in their protocol. They did that four times over.
>> That was three times a week.
>> Three times a week for 6 months. That's that's pretty intense. But what they showed was that that highintensity interval training group, they improved their fitness just as well as the zone 2 group, interestingly, but they had much better improvements in hypocample function and maintenance of hypocample structure and MRI scan. And they maintained that benefit for 5 years after the six-month intervention. So they worked really hard for 6 months, but that that benefit was maintained for for a really long period of time.
Welcome to the Huberman Lab podcast where we discuss science and science-based [music] tools for everyday life.
I'm Andrew Huberman and I'm a professor of neurobiology and opthalmology at Stanford School of Medicine. My guest today is Dr. Tommy Wood. Dr. Tommy Wood is a medical doctor and neuroscience researcher at the University of Washington in Seattle. He is also the chief science officer of BetterBrain, a company that provides free brain health coaching. Tommy is an expert in neuroplasticity and human performance and how science-based protocols can be used to improve your focus, ability to learn, and skill expression. His work applies to everyone from the novice to the elite expert, and for all kinds of skills, cognitive, language skills, athletic, and creative endeavors. Today, we discuss the brain states that favor learning and importantly, how to get yourself into those states. We also discuss how to get the most from a learning session. for instance, how long that session should last, how many sessions to do per day, and perhaps most importantly, how to tune your mind and body to get better at learning. That's something we don't often hear in the context of learning and neuroplasticity, that our brain circuits for focusing and learning are also capable of plasticity, meaning you can literally get better at getting better. Today, we discuss things like flow states and something called a clutch state, which is a seldom mentioned but critical brain state to accelerate learning and performance. In fact, a clutch state is the state that you want to seek to learn and perform at your best. We also discuss how different types of physical exercise from long slow cardio to brief high-intensity cardio and different forms of resistance training each open the window for distinct types of neuroplasticity and learning. So, this goes way beyond the general discussion about exercise improving your brain. We get really granular about exactly what types of things to do to improve your brain in specific ways. As a career neuroscientist who has worked on and taught neuroplasticity for decades now, it's rare that I encounter someone with as deep knowledge about the real science and application of learning and plasticity as Tommy has. He's also extremely unique because he has a ton of knowledge about new science-based protocols for plasticity. And he's also an athlete. We discuss that a little bit at the end as well. So today you will hear a lot of information that I am confident you have not heard on this podcast or anywhere else frankly about exercise, mental training, nutrition and supplementation and much more and how you can leverage each alone and in combination to learn new skills with accelerated speed, precision and durability over time. I should also mention that Tommy recently released a new book that he wrote entitled The Stimulated Mind: Futureproof Your Brain from Dementia and Stay Sharp at Any Age.
It's an excellent book if you're interested in following up on today's discussion and learning more about how you can make your brain better at any age. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, today's episode does include sponsors.
And now for my discussion with Dr. Tommy Wood. Dr. Tommy Wood, welcome.
>> So amazing to be here. Thanks so much for having me.
>> Man, this is my favorite topic in the entire world. What is more interesting than neuroplasticity, right? The brain is so interesting, but its most interesting feature in my opinion anyway, is that it can change itself.
>> Essentially, that's its core most important function. If it can't do that, literally none of the other functions matter. You could you could argue and it's something that we have to be able to do right until the end of our end of our lives.
You have an eclectic research tapestry, right? Today we're going to talk about neuroplasticity, what it is, what it isn't, how to access it for men, for women, different ages, and you also are a high performance coach. You're also a competing natural strongman.
>> Uhhuh.
>> Yeah. Yeah.
>> Uh does that mean lifetime no gear?
>> Lifetime. Well, it's tested. I Yeah.
Lifetime no gear for me personally, but it's a drug tested version of the strongman sport. So yeah, if you uh if you compete in natural strongman, then you you get tested.
>> Great. So we'll we'll talk about that.
I'll resist the temptation to talk about your two boxer [snorts] pups because I'm a dog lover. That's a different episode.
Neuroplasticity. I know what it means to me. How do you conceptualize it? How do you think people should think about it in terms of wanting to learn things and not forget things?
I essentially just think of it as the brain responding to inputs in order for us to then be able to better navigate and survive our environment. And that's why I think it's such a fundamental part of what the brain does. And essentially every time you learn something, interact with something, remember something, the principles of neuroplasticity are engaged, right? you are making new sinapses or strengthening sinapses, weakening other synapses. A lot of people don't realize that particularly brain development, but then also the refining of functions in the brain through neuroplasticity includes the pruning or removal of signapses. Often we think about it's all about growth and new connections, but actually it also involves the refining or removal of of other connections that aren't needed.
That's that's a massive part of of brain development in the first place. And this is a process that's essentially continuously on ongoing and you can think of it as it primary role is so that you can navigate survive the world around you and that's through learning skills through remembering people and things and facts. Um, and where I one of the one of the things that's most interesting to me about neuroplasticity and the way we think about our brains over time is that I think people have uh conflated neurogenesis and neuroplasticity. Mhm.
[snorts] >> So when we're thinking about brain development, we're thinking about um then also brain function over with with with age and either cognitive decline or maintaining cognitive function. We thought that the adult brain was was fixed, right? Um or or then it was fixed and then it lost function. And this goes all the way back to Kahal who said the adult brain is immutable, right? He told us that you got into adulthood, it finished developing and then it was kind of done. He then at other times also said that changes in the connections between neurons could explain learning.
And so there he's talking about neuroplasticity. But we we kind of got this idea that the brain was essentially fixed as an adult and then you know couldn't change anymore. But that can't be true because you still learn and remember things on a daily basis as as an adult. One of the things that I think we've gotten um confused about is the fact that the adult brain does not make new neurons in many places, right? maybe in the alactory bulbs in the dentus of the hippocampus, but tiny tiny number.
>> Yeah. But like compared to the rest of the brain, they're not you're not really making new cells. And so because of that, we thought, well, we can't then grow and adapt or change our brains as adults. But just because we have a fixed relatively fixed number of cells doesn't mean that we can't change the connections between those cells. And that's happening all the time. And that is, you know, the main principle of neuroplasticity.
>> Yeah, I like your definition. Um, in part [clears throat] because I agree with it. in part because it encapsulates a lot of uh things including u helping to clear up this misconception that you know we generate new neurons. I think >> the attractiveness of the new neuron idea is just uh it's so sticky.
>> Um and so we would all love to believe that.
>> Yeah.
>> But maybe there's good reason why we don't add new neurons. Maybe maybe it's uh not adaptive, right? Adding new elements to a circuit is >> maybe not the best way to change a brain circuit. I think people also like the idea that, you know, every organ in our body turns over its cells. That we're not the same person literally that we were. The brain is same cells you were born with, minus a bunch of them that die off, as you pointed out. And thank you for mentioning pruning and the and the removal of connections as a fundamental uh aspect of plasticity in terms of um motor skill learning. Um let's say I decide I'm going to um practice billiards.
>> Mhm. and I'm okay now. Hang in there.
But let's say I want to get really good as I learn and get better and better.
Can we reliably say that uh most of my improvement is the removal of inappropriate action and therefore synaptic connections.
>> I don't know whether it's the majority.
You might know whether it's the majority, but I think that there certainly you it requires both, right?
the either the development or strengthening of new connections and then the removal of other connections that decrease accuracy say or that don't allow you to do the exact motion that you were intending to do. This, like I said, kind of goes all the way back to the development of motor skills, say in childhood, right? The brain has kind of finished developing new neurons sometime around 2 or 3 years old, right? Beyond that point, you're actually primarily removing connections in order to refine [snorts] uh functions based on the exposures that you have, be they language, motor, social skills, which is what the brain is essentially developing during that time period. So then that continues throughout our entire lives.
And I think that uh something that happens later in life, one of the reasons why we may lose function is because we stop giving the brain inputs to maintain a given function. Therefore, that pruning continues, right? I don't need to learn know how to do this. So, I'm going to refine that away. That's kind of the developmental theory of aging or part of the developmental theory of aging. So in that you know when you're learning a skill as an adult or anytime a big part of refining that motor patterns that you're developing has to be the removal of connections that are or you know the down reggulation of connections that aren't allowing you to to do the skill that you want to do. If you were to tell people, look, you want to keep your brain as young as it can possibly be relative to your chronological age, >> you should what?
>> Like it it so this is a general brain health question, but really I'm specifically asking about plasticity [clears throat] >> and let's make it multiple choice and then you can add things to it. Okay, >> you should exercise. So it can be multiple things and then we'll talk about which types of exercise. you should continue to do the things that you already know how to do.
>> Yeah.
>> And then third option um not mutually exclusive with the others of course is uh you should try to do new things that you can't already do.
>> I I still toil with this when I look at the literature on neuroplasticity and aging, >> right? Like yes, use it or lose it is true, >> but we're also told that novelty and trying things that we're not good at is an essential component of building out brain circuits, continuing to make them function better as we get older. So, how do you how do you think about all of that? I'll partly answer your last question and then maybe give a framework for how I think about it. So when you look at a combination of epidemiological studies and intervention studies in older adults, everything about maintaining cognitive function later in life, you definitely see that those who continue to engage in hobbies and activities that are cognitively engaging or cognitively demanding and that can be lectures, that can be um volunteering, that can be you know reading crosswords, that kind of stuff. those individuals tend to either have slowed rates of decline or better maintenance of function over time and or lower rates of dementia. That's of course observational, right? But that's usually people continuing to engage in the things that you know they've already been doing, right?
>> So they're holding on to what they've got.
>> Holding on to what they've got by continuing to do that.
>> Okay. Now, of course, it could partly be reverse causation because if you're maintaining function, then you will you're more likely to continue to do the things that that you enjoy doing, right?
So, there's probably it probably goes in both both directions. However, there's an increasing body of literature that shows that by engaging older adults in novel cognitive activities, you see improvements in function. So that can be language learning. Uh that can be uh complex like coordinative movement or exercise. You see the same things with um like musical training like people learning a new musical instrument or learning um musical theory trying to identify different patterns in music.
And you see in randomized control trials improvements particularly in executive function that seems to be most common across those different interventions.
But you're seeing um improvements in cognitive function with novel cognitive stimuli. Uh there's a lot of uh recent trials that have also used types of brain training um things like the pointer trial that was here in the US maintain your brain which is a massive online study done in Australia recently and that's sort of broad cognitive training with like an online cognitive training platform. So again it's it's a new uh or novel um intervention or exposure that seems to provide a stimulus that improves function. So, I think both can be or do seem to be important.
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>> Can I ask what um for an example of maybe one or two of the things that were in that large-scale trial from Australia, like just at a at a very top contour level, um older adults, meaning 65 and older, um are doing what? The maintain your brain uh study was actually it was um sort of midlife kind of uh 50s and 50s and 60s mainly and they actually had interventions across four different domains based on risk factors within that given individual. So they had uh dietary a dietary intervention, they had physical activity, they had um cognitive behavioral therapy for those who had um you know some potentially some mental health um concerns and then they had uh online brain training. Uh there was something similar done in the pointer trial uh which was in older adults now 60s and 70s that was done here in the US that was a replication of an older trial called the finger trial that was done in Finland but what those guys did was something very similar. So it's uh diet, exercise, uh monitoring and and treating uh cardiovascular risk factors and then brain training. So what the brain training looks like um so the points trial is a good example. They did um they used a platform called Brain HQ >> which is an HQ >> Brain HQ um which was uh developed based on the work of Mike Mzinich um who's you know like one of the godfathers of learning and neuroplasticity right um and they do various tasks primarily focused on developing and maintaining processing speed. Um, some of that evidence goes all the way back to an older trial called active that was done in the US in the '90s. It was still the biggest ever trial of like pure cognitive brain training again in older adults. So 60s and 70s. They had three different um training groups. The uh and then a control group. Uh the training groups did memory training and kind of like you know pneumonics, memory palaces, that kind of stuff to help them remember.
There was reasoning training which is kind of like looking looking for patterns in numbers and letters. And then there was processing speed training where in this example it's visual processing speed. So things flash up on a screen in increasingly small uh increments. So could be hundreds of milliseconds. And as you get better at doing it, that time gets shorter and you have to remember what you saw and where you saw it on a screen. They just published a secondary analysis of the active trial that showed that um those who did processing speed training with uh booster sessions at one and three years had a significantly decreased risk of dementia 20 years later. Um and they've done some other studies showing that that kind of training improves co-allergic signaling in the forebrain um which we know is susceptible to um the processes of dementia. So in particular, it's this training uh to be able to improve either visual or auditory processing speed, which is not something that you know, as you get older, you tend to not do activities that require you to process information quickly. Like driving is probably the the main one, but you can do it in sports and music and and other scenarios, but if you're not doing those things, processing speed tends to drop off sometime around 60 years old. When you say uh well I say processing, you say processing [laughter] uh processing speed. Um are you talking about reaction time, improving reaction time or pushing people to um stay at the edge of of reaction time? And when I say stay at the edge, I should clarify for people some task where if you go too fast, you make errors. If you go too slow, there's also a penalty >> in this scenario. And there are, you know, studies that look at these different functions over time. Probably the biggest one looked at uh data that came from the implicit association test people might have heard of where you get um show these pictures of different things and depending on how quickly you respond it tells you something about like your implicit um you like your implicit thought processes. Um they took some of the data from that. Um this is published in one of the nature journals a few years ago. And what they showed was that um you can separate out reaction time versus processing speed because reaction time is just is a is a very um just the basic of response to a visual stimulus whereas processing requires you is is based on how quickly you can process and remember the information that you're seeing. You actually think Yeah. So [snorts] what they showed in this study was that reaction time kind of slowly decreases on average in a population of it was about 1.2 million people slowly decreases in sort of like from about our 30s and then and then maybe decreases even more once we get past about 60.
>> Processing speed on average tended to be more stable until about 60 years old and then tends to drop off. So in what you're doing in these um training modalities is you're being shown information for a very short period of time and then having to remember what it was you saw and where you saw it. Um so requires you to actually think and you know remember process the information rather than just like responding to a stimulus.
>> So for people that want to jump to the okay what do I do? Um, can we conclude? Okay, if you like crossword puzzles, keep doing them, but do really hard ones for you. If you like lifting weights, continue to challenge yourself with those. If you like to run, you know, push harder. Or should it be we shift domains? You like to lift and run, great. Start swimming again, Andrew. I'm telling myself, I used to I, you know, I just noticed over time, it's it's such a cliche of aging, right? um that you one does tend to become more narrow quote unquote set in their ways.
You like what you like, you don't want like what you don't. You get busier.
Probably don't actually get busier, but you convince yourself, well, do I'm doing these things and I do plenty of them, so but I'm not doing these other things. Or for those of us, I think this is everybody. If they really ask themselves an answer honestly, >> you'd love to hold on to your motor function and cognitive function as long as you can, >> maybe even improve it. Should we push ourselves to do something that's really far outside the box or maybe sort of current skill adjacent? So, I think of those three categories. What What do the data say? If you want the greatest effect for the minimum amount of time, assuming you're still going to do all the stuff you normally do, you're going to add something else.
>> Should it be something really different, slightly different, or just push harder in the thing you do?
>> I think it's going to depend a little bit on what it what it is the things that you currently do, right? So like crosswords are a good a good example.
Even if you're doing hard ones, if you look at the work of people like uh Gloria Mark, the things like crossword and sudoku, they're less of like a true cognitive challenge, right? It's it's almost has more of like a meditation meditative like effect, right? Which can be a good thing, right? So you're focused but not challenged really. uh whereas if we're trying to build capacity, you need to spend some time doing something where you are both focused and challenged um cognitively.
So that can come from um learning new skills be they motor, language, social um and ideally as broad as possible because you're going to get better like overall stimulus as well as kind of like broader potential for for transfer into other areas of of daily life. In reality, the narrowness of the response or the breadth of the response is proportional to the narrowness or the breadth of the stimulus, right? So, you could get really good at one very specific thing or you could try and learn a new skill that requires a that involves a wide variety of tasks. So, I'll give like like an example is learning a new ball sport, right? that is going to require multiple assets of motor skills, social skills. Um, it's going to include both visual and auditory processing that's going to get faster and faster and harder and harder the better you get. So, something like that uh creates a much broader stimulus um than you know if you get very good at one very specific brain training task on like one computer program, right? This is one of the main arguments against online or you know digital brain training is that you get very good at doing that one specific thing but it doesn't transfer over to other areas of your life. Whereas some of these broader more complex ultimately more human skills probably give us much broader transfer as well as you know you know because of the the multiple pathways or networks that are being activated.
>> If my interpretation of what you said is correct, pick something hard.
>> Yeah. Ideally, pick something that's a bit outside or really outside your current skill set. Uh that involves motor and cognitive aspects like maybe um and that's kind of tricky to to find, right? I mean, with sport stuff, it feels motor and cognitive because you have to learn the rules of the game. You have to in some cases interact with others. with cognitive stuff. Um the motor skills involved in writing or turning a page, they're not that significant, right? Um even with a video game, I know [clears throat] video games can improve reaction time and visual search and things like that, but basically your thumbs get real real good. I actually went to a video game competition. They have teams. A kid that used to work for me, I was like, "What do you want for kind of end of year gift?" and he's like, I really want to go to this video game championship. And the kids actually who compete warm up their hands.
>> The kids in the audience like have these styrofoam things so they clap so they don't make noise. So they and it was a whole thing.
>> Yeah.
>> So I don't want to take anything away from the the real sport. I I discovered that is playing video games, but >> mostly what was moving was thumbs and fingers, not a lot of large scale motor activity. Yeah. So, if you had to maybe [clears throat] throw out three or four things that are particularly potent plasticity inducers, what would those be?
>> This definitely doesn't have to be super complicated. So, like the things that you mentioned earlier, so because you mentioned exercise and then skills, right? And so, you could do those things separately, right? I would maybe we'll get into why aerobic and strength training do different things to different parts of the brain, right? So, ideally, you do a little bit of both. if you don't feel super compelled to go and start a new sport, but you're getting these inputs from elsewhere. Um, and so you you would rather say learn a new language, right, which we have which we have some good evidence for, then that combination is great. But if you're thinking about some of the things that we have very good evidence for that kind of hit multiple um networks at the same time, dancing is probably number one.
Lots >> learning a new dance.
>> Learning a new dance. solo or with someone else? I'm sure we're half joking, but some people dance on their own. Some people dance with someone else.
>> So, like dancing on your own in your living room, highly encouraged, right?
It's a great form, physical activity.
It's fun. You of course the um the best evidence is for ballroom and line dancing, which generally requires and so there are meta analyses of these interventions in older adults showing that ballroom and line dancing have the greatest effect on cognitive function.
And so both of those require other people as well as learning you know various sets of of movements. So you have a you have skill learning you have social interaction and you have a physical activity component. There's probably also the musical component right you have to listen for the timing of the music and those kinds of things that that is its own skill set. So dancing has a a large body of evidence behind it. But then I think you know in the exercise realm you've got all the sort of ball sports, board sports, team sports. Um, I think skateboarding would be a great example. As long as you wear a helmet and don't hit your head uh too often. You know, most martial arts, again, as long as somebody's not punching you in the face too much.
>> Something like Brazilian >> jiu-jitsu. Exactly. So, like you're um there's a physical component, there's a complex motor skill component. Usually, there's a social component, there's a there's a lot of uh responding, reacting to the environment or your opponent. Uh, right. So then talking about processing speed again but then beyond that there's some really interesting data on some other creative arts that do seem to have some effect on um you know network stability and function in the brain particularly the networks like the front of prioral network that we know is really important for like focus and attention and its function does tend to decrease with age. Um so uh things like like creative or or visual arts um some maybe some similar effects of learning a language um again um uh similar effects from learning to play video games. Yes of course there's no like big motor patterns involved but you're having to do um you know solve complex problems you know uh react quickly to to a changing environment that that kind of stuff. So that's, you know, eight or nine different things that that somebody could try. And like just one of those, I think, is going to be a new skill, a new stimulus, often happens in a social environment. Um, a number of different things happening at the same time.
>> Any particular uh instruments?
>> I don't think anybody's looked at instruments like the difference in different instruments. So I would say no. Pick pick one that you would that you feel motivated and interested to learn.
>> Yeah. dancing by oneself has a lower shame quotient.
>> Well, the shame quot I think might be might be important, right? the um you know there's the discomfort of making mistakes and we know how critical that is for learning and so like you're I think some of that can be important too but if you do it in a in a class everybody else is a beginner you're all doing it together maybe that adds a fun component because you can laugh at each other when you don't get it right you know so a few uh years ago I wrote a paper with my colleague Josh Tknet about this idea that um potentially one of the reasons why we lose lose cognitive function as we get older is because we stop giving our brain novel inputs or complex inputs that help maintain function, drive neuroplasticity. And I think one of the reasons that that happens is because adults hate being bad at things, right? You just like this thought like you you you just imagined it, right? I'm in a dance class and I'm going to suck at dancing, right? I imagine that I'm going to take my wife to to a tango class. It's something I've always wanted to do.
When I go in the first time, I imagine I'm going to be like Arnold Schwarzenegger and Jam Lee Curtis in True Lies. Do you ever see that movie?
But anyway, so right at the beginning, they're like they're spies and they're doing the tango at this, you know, like gangsters mansion or something. And it's like he leans her over, she grabs the rose from the table in her in her mouth.
Like I'm going to try that. I'm going to drop my wife and she's going to hit her.
She's going to be mad at me and lots of people are going to see and I'm going to feel stupid, right? And [snorts] so that's why we don't do those things. But it's so critical to driving those processes of learn of neuroplasticity that we make those mistakes that we have to kind of let go of some of that that we feel as adults like we we think that everybody expects us to be good at everything and the best at everything and you know we shouldn't fail we shouldn't make mistakes but as you have covered many times um it's so critical to to do that and so I think acknowledging that shame component exists and leaning into it is going to be a really important important part of trying to maintain this function over time.
>> Couple of quick anecdotes and then some encouragement to do the tango class. Um I'll start with tango. My grandparents on my Argentine side did tango until they're into their 80s.
>> So it can be done but they learned it rather young. Um >> and Tim Ferrris as I recall talked about this one of his books. Yeah, he learned tango. And um and that gets to the other point which is I want to talk about sex differences in uh results of experiments on in plasticity but when you dance the sorts of dances that we're talking about so salsa tango >> typically this is you know traditionally the male leads >> um years ago I had a girlfriend who was really into salsa so I went salsa dancing with her in the Bay Area one night and it's it's a tricky thing if you're not skil salsa dancer because basically you're taking your girlfriend to go dance with a bunch of other men, you know, and then you you until you learn. So the the it's it's there are conditions that make it harder, social conditions that make it harder for men to learn than women to learn particular types of dance, unless as Tim did, he got a dance coach, a female dance coach to teach him how to lead and then he learned how to lead and then he was able to dance tango competitively. I think I have that right, Tim. They'll correct me in the comments, but as as I recall, that's the story. So there's that. Um not that following is is trivial. It requires some skill. But there the if the person again traditionally the male can't lead the whole thing it it doesn't work >> right. So um I just made you more nervous about going to this class but you should do it because um I had a roommate when I was a posttock who was a neurology resident at UCSF and she would go do tango late at night and she would come back a different person. And so this is like the other piece here is you know it seems that when we are trying something truly new that involves interactions with other people and we go into that willingness to enter beginner's mind or whatever it is embrace the shame and as we start to get even just a little bit better at something. I mean it almost seems like there's this kind of halo around the rest of our life. We go to work the next day differently. We interact with people differently. like our nervous system is changed. What do you think that is? I mean, we can make up stories about chemicals and maybe we should because they're likely to be true. What do you think that is? That like general change in arousal like you're sleeping better, you're you're more excited for the other things in life when you're trying to learn tango and you get just a little bit better. What is that?
>> I don't think I would make up anything about about chemicals. I think you could boil a lot of it down to we like to be good at stuff and we like to overcome things, right? There's just like this this like core need to be challenged and then to overcome those challenges. And I think there's a lot of downstream effects of of not doing that and they could be um you know related to mental health. It could also be related to physical health, right? because we think about physical and and um cognitive or or um you know stressor psychological related challenges and and the process of overcoming them because that's what really drives you know a lot of physical or or mental psychological growth and I think that's something that you know fundamentally is part of what we need on a daily basis and so you did this thing that you were bad at and you got better at it and you proved to yourself hey I'm capable I'm able to overcome challenges is I'm able to you know engage and and and do difficult things and I think the psychological benefits of that you just that process of engaging with a challenge overcoming it uh working hard to do that um I think that's just you know almost like a core psychological need that we have and then that transfers to all these other things oh yeah I can do these hard things I'm going to do that other thing I'm excited to try something else that's difficult I'm excited to challenge myself again and it needs to be something that feels feels uh meaningful, feels difficult enough that you have the ability to overcome with some dedicated practice or you know focus time working on it. If it's too hard, right, you can have the opposite effect, right? Like making something so difficult somebody can't do it and they just fail again and again and again and again, right? That that can obviously have the opposite effect.
But something that you know you can get better at, you know, you can work on, you can see progress, right? I think all of that then has all these knock-on effects.
>> Maybe we could talk about flow for a second. you know, one of the most bastardized terms in uh neuroscience performance psychology and the rest.
When Cheeks Mahai talked about it initially, um when he really defined the term, it was about um being engaged in a process where you have a certain level of skill, but the thing you're trying to do is just beyond your skill level. So, really striving a bit and that kind of general sense of well-being that can come from that. Nowadays, I think people assume flow is when you are able to do something in the absence of kind of feeling of effort. It's like you just you you get the magic power kind of thing, which is not what flow was originally intended to to mean. I'd like to know how you think of this concept of flow and whether or not it's even a meaningful term. And I I you know I tip my hat to Stephen Cutotler and others who have written about it and and studied it and >> a great respect for Stephen and um what he's done uh with the concept and and uh and I think it's a meaningful concept but I don't think we really know how to define it. And I think this is important in the context of plasticity because I think what we see in Harry Potter movies and sci-fi and um you know fight club and everything else is that suddenly we're just going to be endowed with these powers just because we want them and need them and that is not how it works.
>> Yeah.
>> So is flow an expression of skill or is it the striving to attain a skill?
>> I think of flow as the maximal expression of a complex learned skill.
like you said, you're like right at the edge of your capabilities, but you're still managing to maintain um maintain function whatever whatever skill it is that you're you're performing at.
The thing that really frustrates me is that because of that or you know some version of their definition of flow, people like well I've always got to search for flow like everything happens in flow and like we need to be in flow all the time which doesn't make any sense to me whatsoever.
There's two different parts of this. So one is that people assume that for optimal performance you need to be in flow. That is not true. Um flow is one version of your of your of of being able to you know perform at the best of your abilities. If you think about this in terms of sports performance there might be broadly two states associated with top level performance. One is flow states the other is clutch states. And so a clutch state um you are still at the optimal level of arousal right if we think about the arousal curve and performance which we can come back to but so at the optimal level of arousal which is required for you know you to perform the skill that you're trying to perform but when you're in a clutch state it still feels like hard work right so like there are you you could talk to any athlete about a time that they um they performed well they won they you know they did at the best of their abilities but it was hard cognitive work it hard physical work. It was a slog, but they still managed to perform well. That's a that's a clutch state. And people can perform at the best of their abilities in clutch states. Um, and you know, even though they're not in flow, it's not all coming to them easily, right? It requires them to like really focus and work hard to get get the job done. And both of those are perfectly reasonable states in which to perform. And assuming that you have to be in flow to perform just isn't true if you look at like how you know athletes perform in the moment. The other side of it is that some people have intimated that flow is required for learning or like optimal learning happens in flow which doesn't make any sense. Right? If we if we talked about making mistakes and errors and friction required for learning that is not conducive to flow because it's uh it can be stressful, it could be frustrating and sort of the other side of that is if you know flow is expressing your skill.
If you want to get better at that skill, you have to work even further beyond your current capacities which which will move you out of flow, right? because of like the friction, the mistakes and the errors that come from that. So I think yeah, flow is super interesting and I I wouldn't pretend to be an expert in flow, but there are all these other states where learning happens, where performance happens that aren't flow and that's fine, too, right? But sometimes it's hard and that's okay.
>> I'm so glad you're here. I I've been looking for this conversation for well since I started the podcast because I completely agree about flow and the misunderstanding of the concept of of flow. I've never heard of a clutch state. Um is that a term that you coined or something?
>> No, no, it's in the sports psychology literature. They'll talk about >> that's why I haven't seen it. Yeah, cuz I'm very familiar with the neuroplasticity literature, but I've I've never heard of it. Maybe I'm just not up to date on my reading. But um thank you for introducing clutch state which is when one is performing well but it's it is involving and this is a term I did make up sort of some limbic friction like you have to push yourself you're feeling constrained it's that you're at that edge where it's there's real challenge you're not you're definitely not in flow.
>> Yeah. Uh, fantastic clutch state everyone. Um, learn it, know it, embrace it, um, live there for some period of time in your life across your lifespan.
Uh, and you'll be better off. I I I mean that. Maybe we could drill into this a little bit more because you know several times on this podcast or more we've talked about the anterior midsulate cortex the structure that you know maintains size and super aers who take on hard things and you know this area of the brain that seems associated with tenacity which when stimulated people feel like an impending challenge there's actually neurosurgery experiments done by Joe Parvey at Stanford people feel like oh there's an impending challenge I'm going to lean into it this is sounds more like the clutch state than certainly and flow state. So maybe the thing we need to embrace is the clutch state. It's pretty catchy. It's not quite as catchy as flow, but but I I like it because um it has an element of like friction kind of written into it. You heard it first from Tommywood folks uh not me. A good friend who uh comes from the special operations community. Uh we talked about >> performance uh years ago and he said, "Well, there's unskilled, skilled, mastery, and virtuosity." M okay cool and he said virtuosity is when someone who has mastery pushes out to an edge of effort where they're sort of inviting in the unknown. They don't quite know what they're going to do next. They they have some semblance of an idea like they're not being um haphazard >> but there's an inviting in of the unknown and they find themselves at a new level.
I've probably mentioned this documentary four times in the last four episodes, but when Andy Stumpf, former uh tier one SEAL operator, came on this podcast, former wings sutor, >> Red Bull High Performance team came on here, he suggested a podcast that I'm now suggest he suggested, excuse me, a documentary that I highly recommend, which is The Dark Wizard, which is about Dean Potter, who was a free climber, a free solo climber, turn wings, etc. And you see in that documentary how somebody who's pushing to their edge and a little bit beyond where the consequences the death consequence is able to access levels of skill that are like jaw-dropping I think even to him.
>> Mhm.
>> So does that make sense? Like is that sort of how you think about unskilled skilled mastery virtuosity? Do you think virtuosity is like where someone's like, "All right, I've mastered this thing.
Now put me in a situation or I'll put myself in a situation where I don't know what's going to happen and maybe it'll all go wrong, but when it doesn't, new levels of performance emerge >> as it's described that way." Um, because you people might talk about virtuosos in a skill just because like they're so much better than everybody else, right?
But like that that that definition requires a specific scenario and moment of performance, right?
>> So then that sounds a lot like how I would think about flow, >> right? And so like when you when you look at some of the classic descriptions from individuals who've been in that kind of level. So like um there's there's one from so I I do a lot of work in Formula 1. So there's one from Aton Center where he's >> from who? I'm sorry. and Senna. Um, >> the driver.
>> The driver.
>> Sra.
>> Yeah. Senna. Senna. Excuse me. Sra is David Senna. The great podcaster. He's the He's the virtuoso of of uh performance and business and finance podcasting.
>> Don't let any of your uh F1 loving friends hear that part of the podcast.
>> No, no, I like Sen. [laughter] Some people consider him to be the the the best Formula 1 driver of all time.
He died tragically in a in a crash. Um but there's this um famous quote from him where he's driving in the Monaco Grand Prix and basically what he describes is that he's like going faster and faster and faster. He's like this is beyond my capabilities. Like he doesn't feel like he's actually connected to doing the thing. It's just kind of like happening. It's exact it's exact like he's going seconds faster around the lap than anybody else. And so like that's kind of what like he is so good, right?
he achieved mastery and in that in that moment he's displaying virtuosity in that kind of um in that under that kind of definition and so like that that feels like there's a lot of overlap there.
>> Yeah. Ever since seeing this uh Dark Wizard uh documentary which I've watched twice all the way through because it has a mental health component. It's a it's a brilliant and beautifully shot documentary recently released. I um I think about this virtuosity thing like constantly. Uh, but I I love this notion of the clutch state because it sounds to me that that's the state that we want to seek.
And the assumption is that high performers are in this relaxed, mellow state, but I'm guessing they spend a significant amount of time there and drilling the really boring stuff to make sure they can get there. Yeah.
>> Um, Twilight Tharp, who's in her 80s, uh, worldass choreographer, sat in the chair that I'm in and described the daily routine of her worldass dancers. They go through the most basic drills >> every single day, but every iteration for hours upon hours upon hours before they begin quote unquote practice, right? Before before they try and embrace the the new performance piece.
>> Mh. but over and over and over often after multiple hours of morning exercise I think we we don't see all of that foundational work and that it needs to be maintained which raises a question do we always need to maintain uh practice the fundamentals >> before I answer your question I think there's there's another useful thing just kind of to remember that relates to all of this from you know in um you know athletes and sports particularly on the training side there's this general idea of thirds right? A third of your sessions, >> training, um, learning, whatever it is, are going to feel great. You're going to feel really good. You're just going to get stuff, you know, immediately. It's going to just come to you. Um, a third will just be average, right? And a third are just going to suck and you just have to show up and get it done.
>> But this is all in the same day or this week across across the week, across months, across years, right? This stuff undulates. And the the the main reason why I say that is because related to this sort of glorification of flow is this idea that these things should just like always come easily to us. But that's completely antithetical to the idea that we have to work hard and challenge ourselves in order to build capacity drive neuroplasticity. So there's kind of this weird tension between what people are seeking versus what is actually just the part of the the grind of getting better and you know o over time and sometimes it is a grind and that's you know again that's okay doesn't mean you're doing it wrong you maybe it means you're doing it right when you then think about maintaining the fundamentals I think yes but probably it's going to depend on the scenario that that you're that you're thinking about um because sometimes the skill that you're performing, the fundamentals are kind of baked into that in in some way. So, it kind kind of depends on what the what the fundamentals really are. Maybe, you know, if it's um so I'm thinking about one specific study that was done in in pianists. Um so this is kind it was kind of related to the Ericson studies in uh in violinists, right? But this time they were looking at uh pianists. And so they had four they had four groups uh older and younger. So the younger was like 20s and 30s, older were 50s and 60s, expert and amateur pianists. And so the experts came from um German like music conservatories. Um and then they they looked at um sort of basic skills related to um you know moving the fingers and other things that that you you would do playing the piano. And um so they were like very task specific skills related to piano playing. And what they [snorts] found was that the most important predictor of how well somebody performed at those piano specific skills was not their age, it was how much they practice. So it's just that getting those reps in helps you maintain those sort of like basic functions. And maybe right when you're playing very complex piano pieces, you're encompassing all those fundamentals anyway, right? You don't need to you don't need to like do your you don't need to do your scales every day because some of that stuff is kind of built in. But you will also see people as they warm up say you maybe they will do scales and things cuz that's part of just like you know the the warm up maybe part maybe that's routine right this is me getting in the mo in in the mode of you know playing a complex piece but then maybe some of it is just kind of helping to maintain those fundamental skills. I'd like to take a quick break and acknowledge our sponsor, AG1. AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens. I discovered AG1 way back in 2012, long before I ever had a podcast, and I've been taking it every day since. The reason I started taking AG1, and the reason I still take it every day, is because AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.
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>> So, now's your opportunity to kill the 10,000 hours. I mean, I know other people have attempted to, but what what does that really boil down to? Is it simply that about 8 hours a day of practice for a dedicated period of time is what leads to rapid plasticity and that's what was measured or is there really a a some sort of rule about time under uh seeking clutch state? The simple answer is what the study showed was that 10,000 hours was the average amount of time that an expert violinist had spent practicing by the time they reached 20 years old. That's what the study showed. They weren't even experts by that point. That was how much they'd practiced, you know, essentially in their youth. So that number of hours doesn't even translate over to true expertise in violinists in this one specific example. So I don't think there's some fixed number of hours uh required. It is interesting. Other parts of that study kind of looked at the the the practice routines of these expert violinists and what they found was that they tended to practice for about two sessions of 60 to 90 minutes a day. And I think that's a pretty good rule, right? If you're going to do something hard, you're pushing beyond your current skill level, focusing for 60 to 90 minutes, maybe with, you know, a couple of breaks in there, um, a couple of times a day, that's probably about as much as most people can do. And I think that also relates to how we perform on a day-to-day basis in other areas of life, right? We kind of expect that we can go to work and we can work really hard for eight hours straight during the day, but like the brain doesn't really work like that. If we're doing hard um, cognitive work, right? you're being you're focused and highly challenged as you might be if you're a um you know a future virtuoso on the violin. You're trying to you know really practice and push yourself. You can only really do that for you know chunks of 20 to 30 minutes maybe a couple of times of the break right? So like that's why Pomodoro, even though there's no like good studies on the Pomodoro technique, like for those time periods, you know, 25 minutes with a 5-minute break a few times, they do kind of fit into that kind of rhythm that translates over to multiple areas where we might want to use our brains. Um, and just remember that hard cognitive work and that process of learning can only really happen in those kinds of size of of chunks if you want to do them sustainably.
>> Yeah. Before I started writing my book, somebody uh who's published several uh very well-received books said, "You can only write for about four solid hours per day >> uh broken up into a couple of sessions."
>> I was like, "Come on." I mean, like I'm I'm not trying to boast, but I used to go into the lab and sit down and work on a grant for six hours or something like that. And I started thinking like, was it really six hours? Go in there, see my students and postocs, sit down. Okay, then there's lunch. I need to walk my dog. Yeah. you know, and there were some late nights, but then the next morning I'm kind of dragging because I was in, you know, in my office really late and you you get real honest with yourself real quick and you go, "Oh, okay." In the periods of time where I definitely pushed to the 6 8 10 12 hours of just non-stop work as a deadline approached, there was a compensatory drop in output after after you clicked send. And so I I think >> you're right. They're right. It's somewhere between maybe I mean you're saying 60 to 90 minutes and they're saying 4 hours, but not a whole lot more than that for real focused in clutch state work.
>> Yeah.
>> So really digging in and no distractions, no phone, no checking your text messages, just you know.
>> Yeah.
>> Do you ever give yourself uh forced constraints to get real work done?
>> Not to force it. I will say that um one of the best ways to like truly get deep focused work done is to eliminate distractions, right? That's one of the most important things that you can do.
So close the email. I like put my phone in a different room or something because like nowadays your own, you know, close Slack, I have Slack, Teams, my lab and I uh we uh interact on, you know, we message back and forth on WhatsApp. Like there's email. I've got like five or six different ways that people can like constantly try and get my attention, right? So, like eliminating distractions is really important. And again, I return to Gloria Mark's work. She wrote an an excellent book called Attention Span if anybody's like really interested in this. Um, but you get used to a pattern of distraction such that when you're um not actually being distracted, you will distract yourself, >> right?
>> Um, and but you can be trained out of that as well. But so you know that thing where you're trying to do work and you like reach for your phone for no reason.
It's because your brain is kind of used to this pattern of you around about now I'm somebody will text me or send me an email and I'll and I'll reach my my phone. So you you go looking for it >> even if it hasn't happened. But again you can train yourself out of that if you if you have periods where you're not getting constantly distracted. So I will eliminate notifications. Um, but at least for me, what I found is that if I if I have a ton of friction in terms of trying to get something done, I will usually step away from it. Um, because there's something in there that just like needs to click or come back before I can like really engage in it. Or >> if you're at a sticking point.
>> Yeah. Mhm.
>> So if if I'm at a sticking point or it's like if something feels like it's just not coming in the moment, uh I will usually switch over to to to something else, which is also kind of a normal it's a it's it's one of a a possible set of patterns of work, which is that you have two or three projects you're working on on any given time. If one just like isn't quite working, then you can switch over to the other one and come back to it. [snorts] And then like the alternative is that when the deadline is so close and uh you know this often happens with a with a grant deadline or you know when I was writing my book and there's a you know a book deadline and you I've got to get this to my editor in um how however many days or hours I I tend to just not need to to eliminate those things because I'll I'll just I'll just focus in like I I I don't feel that kind of draw to be distracted by other things. But that usually only happens for relatively short periods of time, right? It's going to be a day or two or hours during a day rather than, you know, extended periods of time.
>> Are you familiar with this recent study about phone on the table, phone in the bag? We would just remind people that if you're your phone has to be out of the room, even if it's in your bag beneath your chair turned off, >> you can still focus, but there's a a cost.
>> Your cognitive flexibility, etc. really suffer. So that means that the brain is unconsciously expecting a call. You're sort of waiting for it. And and the way you describe this attentional break expectation thing um that we get entrained to interruptions is uh really interesting. Um maybe this is why meditation is such a useful tool for improving focus is that it's just a forced no breaks >> yeah thing. Although it's pretty easy to drift in meditation if you are not used to doing 20 minutes of meditation. You sit down to do that you set the timer like your brain can end up way off the trail. there could be some benefit to that as well, right? Because there's, you know, without kind of building that in and I and I don't routinely meditate, but um unless you have some parts of your day where actually you're not either putting in information, distracting yourself, thinking about a specific thing, right? You don't necessarily get that time to integrate.
Um, you know, that's kind of, you know, the classic is you come up with your best ideas in the shower, right? because that's actually the time when you don't have your phone on you and you're not watching TV and you're not doing all these other things, you know, at the at the same time. So maybe yes, that's not what meditation is formally for, but it could potentially be beneficial if your if your mind's going to wander, you know, making new connections, um you know, coming up with new ideas, having that space and time to do it, you know, could potentially be beneficial, too.
>> In these studies, these large scale uh trials, what was the diet intervention?
Can we distill it down to some things that um everyone should do or ought to consider?
>> Most interventions in the sort of um cognitive and psychological space are focused on some version of the Mediterranean diet. Um there's uh the mind diet um Mediterranean intervention to prevent neurogenerative delay. It came out of the Rush U memory and aging project and it's basically just a version of the um Mediterranean diet kind of focused on um dementia prevention and and the way they initially created it was they looked at foods that people ate more or less of and created a score and those who had a higher score tends to you know had a lower risk of later de dementia. It wasn't an intervention when it was when it was first um developed but that was kind of the version. And it it's kind of combination of the Mediterranean diet and the DASH diet which is um like a a anti-hypertension blood pressure treatment type diet. So it's uh you know seafood, vegetables, berries, whole grains, that kind of stuff.
>> Not too much uh saturated fat or animal protein.
>> And so this is very similar to the diet they used in the Smiles trial which was the first randomized control trial in depression that showed significant improvements in in mood symptoms. I think the the principles are useful, but there's not necessarily a huge amount of evidence to say that like this is the way that you you should or you have to eat uh to maintain cognitive health.
There was actually um a big trial of the of the mind diet. It was published in the New England Journal of Medicine a couple of years ago and they compared uh the mind diet to standard caloric restriction. Um and actually they saw similar benefits in both in both groups.
There have been big observational studies that have looked at how much their diet looks like a Mediterranean diet. And those whose diets look more like Mediterranean diets, yes, they have a lower risk of dementia. Of course, right, this is observational data, right? So, it's not you can't say it's causal. But what's interesting in some of these studies, so a big one that came out of the UK bio bank was that they um took out individual uh foods or food components of the Mediterranean diet to see if that changed the relationship between the Mediterranean diet and dementia risk. And there was no food or you know olive oil or food group or you eating more or less meat that changed the relationship between the Mediterranean diet and dementia risk. So what that tells me is it's much more about whole foods. they're nutrientdense rather than avoiding any you have to eat you have to consume lots of olive oil right or you have to restrict meat because if those things are eaten in the context of all this other stuff it's really that bigger context of diet quality and nutrient density that really matters so the the parts of diet that I think about are the you know there's three so there's energy there's nutrients and then there's overall dietary pattern. So, one of the confounding things about that trial I told you about the mind diet versus caloric restriction is you're like, well, the mind diet should win out, right? How does caloric restriction do just as well? And [snorts] in the kind of average population, we tend to have some issues with metabolic health and have been in a state of chronic energy excess for some period of time. There's been some very nice studies that have looked at brain aging and brain volume or brain reserve um across different populations. There was um there was uh one group that looked at different um tribes in Bolivia, the Bolivian Chiman who are hunter gatherer group, the Metan who are kind of an intermediate group between sort of the Chiman and like a standard kind of industrialized group and then industrialized humans in the US and Europe. And what they found is there's kind of this um bell-shaped curve between energy availability and brain volume. And in general, brain volume, right, the more the better, right, we think. And so if you're chronically calorically restricted, your brain is smaller um because you just don't have the resources to invest in, you know, the structure um and to maintain it. At the other end, you see the same thing.
So if you're chronically in a chronic state of chloric excess, you also tend to have a smaller brain on average. And this is related to metabolic disease um you know and you know potentially and what comes with it um higher levels of inflammation high blood pressure things like that that we know can negatively impact the brain. So the most important thing and I think this is where some of the benefits of caloric restriction happened in that in that trial compared to the mind diet was that you know people's cognition improved just because they decreased their energy intake to a point that was you know more you know was essentially kind of what their brain kind of needed or you know kind of supported their overall physical health which then affects you know cognitive health and and brain volume and and brain function. So the first thing to do is to make sure that you're eating enough but not too much right and that's very simplistic but like energy is really critical energy availability not too low not too high then the next thing that you need is there is is nutrients we know there are several critical nutrients for uh related to cognitive function and risk of dementia. Um the ones that we have the best evidence for are vitamin D, iron, omega-3 fatty acids, uh the B vitamins uh involved and the B vitamins involved in methylation.
So particularly B12 and folate also potentially B6 and riboflavin although that might depend a little bit more on on the individual. Then there are some other nutrients that you know have some pretty good evidence for them. So many of the antioxidant uh polyphenols things that you get from berries, coffee, tea, chocolate, the carotenoids that make things orange, yellow and red. Um lutein, zeazanthin, aazanthin if it comes from seafood that's that's what makes shrimp and salmon pink. Um and then you know some other aspects like dietary fiber seems to have you know some some benefits as well.
>> Not magnesium.
>> So magnesium is absolutely absolutely in there in there too. Um and in general I think um and the so magnesium uh zinc um then there's some of the structural lipid components things like choline and ethanolamine that you might get from um nuts and seeds or eggs. They have some slightly less you like less evidence.
you really when you're looking at um brain changes over time and dementia risk, but they certainly do seem to be related to to cognitive function. So, there are some studies that show that those who have lower magnesium intakes tend on average to perform less well on some some cognitive function tests. So, all of those do seem to be important. I have two questions about nutrients and brain health in the short and [clears throat] long term. And they have to do with interactions between nutrients, >> which at least to my understanding are rarely explored. You know, you'll see studies of supplementing omega-3 or having people eat some fatty fish or or less and so on, but rarely in the presence or absence of some other vitamin that, you know, that can potentially impact the same pathways. So there's synergy. There's also, you know, necessity. So that could impact results.
The other piece is on what time scale are these nutrients needed and on what time scale are they metabolized? So maybe to just kind of drill into the second question first. So you know I'm not out here as like the defender of supplements, but I've been taking supplements in various forms and eating whole foods and eating as generally healthily. You know, less so when I was younger, but still pretty healthy and more so as I get older. But here's where my brain goes. Wait, whole food is great, but let's say dark leafy greens have a bunch of things in them that are fundamentally important for brain and bodily health. Great. And they have fiber, etc. How many times a week am I eating dark leafy greens? Let's say I do Monday, Tuesday, Wednesday. I'm great. But then I'm traveling on, you know, Thursday, Friday. Should I be just supplementing Thursday, Friday? Am I good until the next week? I think one of the reasons why eating really well, I think everyone knows what that means, not enough calories, not too many, mostly whole foods, etc., enough vegetables, fruits, and high quality protein and quality fats.
I think the reason why supplements still become enticing to me, maybe even necessary, is because you can take them every day very easily. So you can make sure that you're in range and maybe above range. So let's take one of these things. Okay, omega-3 fatty acids. I I believe that the data are pretty compelling. They can be helpful for health, maybe even brain health.
Certainly, I believe that. But let's say the early part of my week is omega-3 rich and the later part of my week is omega-3 poor.
Am I good? Versus, you know, spreading it out across the week. it just becomes difficult to eat in a truly healthy way if uh if it's the case that it has to be consistent every 24 hours. So what do we know?
>> So again, I think we're often tempted to over complicate this and try and think, oh, you know, I have to hit all these things at this interval and if I can't do that, then I have to supplement. And in reality, we probably have more buffer in the system than than we realize. So, um, omega-3 fats is a really good example. Your adapose tissue, your fat tissue is a depo. You know, it kind of stores excess omega-3s. I actually wrote a paper on this with a colleague of mine, Rory Heath, a few years ago. The longchain omega-3s that we have in our in our fat stores um may help to explain why supplementation does or doesn't work in some of these trials because >> some people just have more kind of hanging around. And if you eat more than you need on one day, um especially in a state of caloric excess, um that's going to be stored in your fat tissue. And then when uh you're sleeping or when you uh initiate uh lipolysis, the breakdown of fat. So particularly during periods like you're doing exercise, those then get released and they you know the the brain then has access to them. So there's some studies that um show that when you this relates to the form of the omega-3s as well. So many people will tell you that you have to take omega-3s in the phosphoipid form uh which is like a a special it's a special supplement. Um you can get it from krill. Um and the the form is where the the fat is attached to like a a phosphoipid head group just like it would be if it was sitting in in a cell membrane. And there's a specific pathway for those to get into the brain.
>> It's only krill or it's fish oil also.
>> Uh no. So fish tends to be the triglyceride form uh which is you know glycerol and then three fatty acids attached.
>> When you compare a single dose of phosphoipid versus triglyceride form then more of the phosphoipid form gets into the brain. Some of this, you know, most of this comes from rodent studies, but what's interesting is that if you supplement over several days, it all kind of comes out in the wash because the triglyceride form um cycles through the adapose tissue as a depo and then it gets released and the brain can then use it. So, if you're going to take just one day of supplement and you want to get as much of that omega-3 in your brain, yes, you should take the we think we should you should take the phosphoipid form.
But the form that comes in seafood, which is primarily the trig triglyceride form, is regulated through the body's fat stores. So, this is a really long way of me telling you if you eat some fish early in the week, you don't then have to supplement later in the week as long as you got kind of enough. And especially if you've consistently eaten seafood across your entire life because you probably have a bit of a depo. And so what you see in several trials where they've given omega-3s to decrease dementia risk or improve cognitive function. So many studies of like that have been done. There was actually a very recent one that just came out of of USC where they gave omega-3s for a long period of time. They measured omega-3 levels in the in the CSF, right, in the spinal fluid of these people to show that this the omega-3s were getting into the brain. they didn't see any changes in terms of cognitive function or um brain structure on an MRI scan. So, everybody's like, well, omega-3s don't work. But when you kind of squint at the data and and they didn't quite give me the data that I wanted, but when you look at it, those the people in the trial just didn't seem that omega-3 deficient in the first place. So, right, if this isn't something that you need more of to start with, giving a load more of it isn't going to make that much of a difference, right? And this is the case for all of these different supplements. So the best advice if you have access to it is to test your levels. Test your vitamin D levels. Test your hemoglobin and iron levels. Test your omega-3 levels. Test your homocyine levels which is as a marker of B vitamin status which we know is a a risk factor for cognitive decline dementia as well. So if um if you can test your levels and it shows that you need more and yes there are the the normal ranges that you have on a blood test are not necessarily the same as the risk ranges. So um homoyine is a good example. A normal range for homocyine which goes up if you need uh some of these methylation dependent B vitamins the normal range might go up to like 15 or 16. But we know that risk is definitely elevated above 13 and is probably elevated above sort of 10 to 11. So what your target range really might be is is probably lower than what the normal range might be. But we have very good evidence that if you then supplement when somebody is above that range and you bring that down, you see significant improvements in in cognitive function or slowed cognitive decline.
That is particularly the case for omega-3s and B vitamins that lower homocyine. And so this is the interactions that you were talking about earlier and this is the best one that we know of although I'm sure there are many more. Like I said, there are lots of trials that have given omega-3s or have given u B vitamins to lower homocyine and just haven't seen much of an effect.
And everybody goes, "Oh, well, they don't work." But there are now at least three randomized control trials that have shown that omega-3 status and B vitamin status interact and they're dependent on one another. So, if you give uh B vitamins to somebody who has elevated homocyine, you bring down their homocyine, but they have poor omega-3 levels, you don't see any benefit. And that's been shown in two trials. It was originally shown in the vittog trial that was run out of the University of Oxford. Um it was then uh replicated in the B proof uh trial. Then the other side has also been shown there was a in the omega AD trial they showed that supplements with omega-3s didn't result in any benefit if people had elevated homocyine. [snorts] So this that's just one example and you can imagine like you kind of said there are probably lots of these and if we're not you know going into a study actually looking like well what nutrients does this person need and then supplementing with them um you you you're not going to find any effect like you shouldn't be surprised when there's a when when the study doesn't show anything. potentially the one recent um example of kind of just giving a broadbased kind of set of nutrients with a multivitamin that seemed to work fairly well was the Cosmos study people may have heard of.
It was thousands of people of older adults um and they were given either a multivitamin or a a flavonoid supplement.
>> It's like a sententrum type vitamin.
Yeah, it was it was Centrum silver, right? The most basic multivitamin, just 100% of the recommended daily allowance, not like no mult no like massive doses of anything.
>> And in that study, those who got the mil got the multivitamin saw, you know, changes in cognitive function that suggested some like some some improvements. And but that was literally just covering the bases, right? No massive doses. The most basic multivitamin. So in the kind of general population, I think you could say that something like that is probably a reasonable strategy. But what they also showed was that um supplementing with this antioxidant cocoa flavonol was only beneficial in those who tended to have a poor quality diet to start with. Right?
So they just weren't getting many of these kind of compounds from their diet.
If you're drinking a lot of coffee, eating a lot of berries, seeing a lot of fruits and vegetables, you probably don't need it because you're already getting it.
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Thank you for that clarification. I I look forward to a day hopefully not long from now where people get their blood work done.
They are told and they decide, it's a collaboration after all, which supplements to take.
Ideally, those supplements are tailored to them. So, it's not gazillion tablets and capsules and then they can redo their blood work and see whether or not things come into range. And of course, that should be measured against subjective >> experience of well-being and sleep and all of that. That that's not hard to do in today's environment of technology and trackers and blood testing. It's just that uh we're a little bit in the um still in the '9s. uh even just the way that most people talk about supplements, certainly not you, but I think when people hear supplements, they go, "Oh, it's expensive urine." Okay, that's vitamin minerals. Maybe some of that is just getting urinated out, but then there's food replacement supplementation. And then there's supplements to get a specific desired effect like speed up the transition time to sleep, get more slowwave sleep, um more focus, etc. So it's unfortunate that we don't have good nomenclature like we do in science where where where words are very important so that people can communicate with accuracy.
>> And I also wonder whether okay if you know one gram of of uh omega-3 uh EPA per day is good um but maybe three is better even though I'm at you know upper range upper reference range. And this is something that like nobody really wants to address because then it sounds like quoteunquote biohacking, but ultimately I think people want to feel good. They want to live longer. No one wants to do anything dangerous. I feel like we're really like in the in like prehistoric times with with how we think how most people think about nutrition and supplementation. I feel like the last 40 years have been spent mostly focusing on what's bad for us. get trans fats, bad, fried foods, bad, eating too much, bad, right? Um, energy over energy toxicity, bad. Um, too much alcohol, bad. Zero is better than any, but you could probably drink a little bit and be fine. Okay, if you're going to take nicotine, don't smoke it or vapor dip it or like we sort of figured it out, right? Don't hit your head. If you do, don't hit it twice, you know? Like, like we've sort of been spending so much time on the don'ts that now I feel like we're in this exciting time of what can you do for one's health? And then there's this divide, right? Just eat whole foods, you'll be fine. And you've actually convinced me that we'll be fine. The question is, could I be that much better?
>> This is really interesting to me because there's there's there's two different parts to it potentially, although, you know, they may end up being the same thing. So one is if we're thinking about if we're thinking broadly about improving brain health, cognition at the population level, what's really important is kind of raising the floor. Like what is going to work for everybody and get most of us most of the way there. So like that really is improving food quality. Um and then you know access to those foods as well, right? because that's diff you know that can be very inequitable like can people afford it do they know how to cook it can you know can they access it and then within that I think we also know we have very good evidence for cut offs that predict risk and if you can't get those um nutrients from food I think we should supplement I think I I like to call nutrients like the great leveler of like there's no point in arguing about different diets because your body requires these nutrients and like I don't care where you get them from as long as you get them, right? So, if you need to get them from supplements, I think that's fine. That that that should be fine. When you then get kind of to the next level, like how much further can we push function? My answer is I genuinely don't know. Like when you say like, you know, if I put so if I if I test my omega-3 index, right, you said it was the kind of the higher level, maybe it's seven or eight or something like that. All right.
If you push it to 12, is that better? I genuinely I genuinely don't know. like some of these more complex um AI systems, data collection, kind of seeing how you then respond individually as long as you can perform your own sort of like personal experiments, right? As much as you can hold one variable constant, have some meaningful output that you can kind of track over time, see whether it works or not. Can we then aggregate those data to kind of better understand this? I'm excited to see where that goes. I will say that the best evidence we have just says in reality don't be deficient. If you can reach that threshold of not being deficient or insufficient, maybe that's enough. I'm hopeful that that's the case, right? Because then more people will get to that point more more easily, but you know, there's there's a lot that we have to learn there.
>> There was a time in the '9s and 2000s um where people would take stuff and do stuff. I'm not talking about anabolic steroids, although that was happening too. Um, and the whole idea was find things that work, perform really well in one's job or in one's sport, assuming you're not breaking any rules, right?
But not tell anyone you were doing them.
And then what changed, I think, were two things. One is there became a a market value for telling people what one does in order to make money. So people started doing that. And I do believe sharing is good, right? But also there's this problem that goes with that is that people who sit on the outside of kind of brain and and sports performance or just life just trying to maintain memory and do well in school and be be a busy person and still get sleep and all of that feel like, oh, you know, it's it we're being sold this one thing that's supposed to make all the difference.
>> And I think the thing that really came to came in and changed all of it are the GLPs. I've never taken a JLP, but I'm just struck by like Americans are now willing to inject themselves. So now it opens up this whole thing about peptides, which you know the major consumers of peptides are not the bro science guys like the gym bros, it's women >> who look I have female family members, right? Um who have and they'll tell you me and and there's a long history of people doing and taking things and doing things for their cosmetic appearance and not necessarily sharing it with the world.
So, these are the performance-enhancing uh um substances of of a whole different kind, right? And so, how is it that this peptide industry is so intriguing to so many people that Yeah. like jabbing yourself with something that is not FDA approved? Like people are doing it like crazy, even people who are kind of cautious about what they'll do and put into their body >> because of this bridge that the JLPs have made. It's so much easier now to just people aren't as needlehobic. So I think we're entering a time now where people are saying okay you know what the government uh the the the food pyramid the whatever the food quadrants like yeah that's just like if you don't want to die but I want to feel great and there's actually this potential that you and others are sort of offering like you can learn things into your older age you can be uh lean and have great posture into your 60s7s 80s 90s we see examples of this so I think that there's this pull we're getting kind of pulled forward towards this promise >> and I don't I think that promise is all about avoiding the the bad stuff. And people say, "Oh yeah, well my grandfather lived to be 102 and he was smoking every great like awesome." But a lot of people don't have those kinds of genetics in their family.
>> They really and genetics play a big role. So I'm kind of editorializing here. I'd love your thoughts on how you sort of sit back and you look at the landscape of things. Um eat right, exercise, get good sleep, socialize is awesome, >> but that is just that is difficult >> for people that puts people into a clutch state. just trying to do that while managing family and profession and cost of life it you know cost of living that's a lot so I think people do want something that gives them more energy gives them better sleep you know picks up their mood you know and I don't think there's anything wrong with thinking about those things as long as it feeds back to to better behaviors >> particularly when I think about this kind of this new part of the of the supplement industry and like you said the the you know peptides are just the next they're the next iteration of the pills and potions and things >> to supplements more than drugs because look there's no putting the genie back in the bottle. I don't care what the FDA does and they can mark my words people are going to find their way to get their peptides cuz they love them.
>> Mhm. [clears throat] >> And most people are not playing a drug tested sport.
>> Yeah. And there may be adverse events out there, and this isn't a plug for peptides, per se, but where are all these adverse events that are not from botched injections or from really bad black market sources. Where are all the roid rages of peptides? Where are all the like I think you can see way more plastic surgery like like whoa, that looks bad kind of things in it like okay, melanitan's kind of an issue because people can really mess themselves up um there. But where are all the adverse events? Until people start dropping dead from BPC injections, people are going to get and they're going to take their BPC.
>> I'll admit I'm more conservative when you're trying a new supplement or you peptide um I'm going to include peptides in into this, but of course you could it could be a pill or or whatever, right?
Some peptides come as pills. I [snorts] would want some reasonably good evidence of efficacy that this is going to work in humans like me. Um, that's probably not a bar that most of these things are going to hit anytime soon.
>> No, people don't care. I mean, people who who have no interest in walking into a gym are contacting me like crazy.
These are adults who have kids they love, spouses they love. They are not medicine phobic like traditional medicine phobic. And they're like, "Should I be taking low dose? Should I be micro doing or reatite?" I'm like, "Edite's not even released yet." They're like, "Where can I get it?" like, are you kidding me? You know, but it's like it's incredible what's happened in the last few years.
>> So, we think about what might what you might think about if if you're going to start to consider one of these.
First of all, I would want to see evidence that that it works. The majority of peptides don't have good quality evidence in humans except the GLP ones, right? They're on the market >> and the growth hormone secrets, but for reasons other than people are taking them.
>> Yeah. Yeah. psychopenia um you know other and and with with the most of those growth hormones secret dogs come with a risk of insulin resistance diabetes at high you particularly at higher doses >> yeah they're not the super popular ones I think the super popular ones are besides the GLPS and reat is a GLP and other things but are I would say micro doing of reat and trespatide one category for weight loss um fat loss I would say BPC57 people are taking it without even knowing what the desired effect is >> recovery is really broad I think it's >> injury repair that's the thesis no human evidence as far as no good human evidence and then there are these other kind of dot dot dot ones I would say um GHK copper for skin >> um appearance those are the three biggies >> um that seem and the last one in particular with women >> so I would want evidence that in humans it does what I want it to do most of those if not all of them except for the GOP ones don't don't have that evidence or for the thing or for the thing that you're you're you're trying to get right um but beyond that a question that that you have to ask and and I I like I like this reframing I heard it recently heard it recently from um Jeffrey Bland um which is that if you're going to consider injecting or taking something the first thing you should want to know is is this safe right if you have good safety data then trying it is low risk, right? Even if it doesn't work, right?
At least, you know, it's not dangerous.
And but we don't even have that for most of these.
>> No, we just have the absence of documented adverse effects.
>> Yeah. And >> in the time course that they've been used because we don't know about long-term use.
>> And so, everybody has their own risk tolerance. Everybody's welcome to do whatever whatever they want, of course.
But for me personally, first I would want documented evidence of safety and then you can say, well, I'm willing to try it because, you know, it may or may not do this thing. But you should also have a specific problem that you're trying to solve, right? Otherwise, why why would you bother taking it? But it's also the case for the vast majority of supplements that are out there and have been around for long periods of time is first of all, we don't have good evidence of long-term safety at whatever dose that you're taking. And then second of all, we don't know whether it works.
For some we do like creatine, omega-3s, magnesium.
>> Yeah. And creatine is actually the best.
So like omega-3s, we know that they're, you know, critical nutrient, creatine, I think, is the best example because we know it's very safe, right? So even though this this idea of creatine responders and non-responders, um, you know, maybe it's going to be useful uh to improve or support cognition for some people, not others, may improve physical performance for some people, not others.
At least we know that you can give high doses of creatine to frail old older individuals with essentially no side effects, right? We know it's very safe.
So then you can try it and see if it benefits you. So creatine is a great example, but there aren't that many others that kind of fit into that category.
>> Interesting times.
>> Mhm. Again, I go back to I love the idea of blood testing, tailor tailoring supplementation to the needs of the individual, retesting so people can be really objective about whether their levels are moving in the right or wrong direction. Subjective experience. Um the sleep supplementation thing is kind of interesting because either pe people feel it improves their sleep or it doesn't. Even if it's a placebo effect, which in some cases it could be. Um with sleep tracking people can see are they getting more REM, are they getting more slowwave sleep? um such a such a fascinating um area. [clears throat] I mean, as you and I both know, there's no plasticity pill, >> but arousal, alertness, focus seems to be a prerequisite of plasticity, >> which is why things like caffeine and stimulants and elyroine and all these things that you can find some evidence for them improving plasticity, but it it's very likely to be indirect, right?
It's not that they like make you learn.
They set the stage for learning. It seems to always get back to arousal. So, this is what I I want to get back to exercise as as a tool for opening the window for plasticity.
>> Could it be that it's simply a matter of moving your body to get enough adrenaline in your body, norepinephrine in the brain, and maybe some dopamine as well, so that the stage is set for plasticity? And it doesn't matter whether you jump rope, do jumping jacks, sprint, or do deadlifts. It's all about getting your brain into an altered admittedly indogenous chemical altered state of just more arousal and then boom you can go learn is it I mean could it just be that before we get into the exercise there's a an interesting part with the supplements that increase arousal right so the stimulants in particular and I am a big proponent of thinking about or um tracking how somebody feels right I think that how you feel is this kind of ultimate integration of all these inputs and outputs that the brain is kind of bring bringing together, right?
And we know that how you feel, so how an athlete feels is a much better predictor of their performance than their HRV or any of their blood test.
>> What are you asking them? Like you how good do you feel today on one to 10 >> some some version >> I feel like I can conquer the world one I feel like >> exactly on you know and you you can boil it down or I mean you can um spread it out to many more questions. So there's there's a question there called the rest cue which is all about like how you recovered how recovered you feel, how motivated you feel to train or perform that kind of stuff. But essentially it boils down to how feel how good you feel. If you feel good, you're more likely to perform well. And that works better than the vast majority of data that you like biological physiological data you can collect. There are papers that come out on this every year that essentially show the same thing.
>> That's kind of cool. Yeah, >> because mindset as my colleague Ali Crumb has focused on so much like mindset can be you can be honest with yourself and you can lie to yourself and tell yourself like okay you got a lousy sleep score but like I feel good.
>> Yeah.
>> Or I'm you know maybe sleep scores are like they mean something but today you know right I mean and it can work right I mean in terms of performance.
Yeah. And so absolutely right then that gets into like the noibo effect of of how we think about either our sleep data or these other things, right? That that can negatively impact our performance.
And we have good good studies um that that show that as well. So so I I think that like tracking how you feel is really important. [snorts] But when it comes to stimulants in particular, they they seem to dissociate how we feel versus how we perform. Right? So there there are studies that show that um uh giving people caffeine makes them [snorts] feel like they're performing better, but they're actually performing worse on certain cognitive tasks. So there's been studies done with like the the endback task. So like very complex uh you know working memory task particularly as you get like to like N3 you're like trying to remember did I see this letter three letters ago, right? In those kinds of complex cognitive tasks, people who take caffeine feel like they're performing better but they're actually performing worse. they're making more errors or they're kind of um you know they're reacting too quickly, they're not really thinking about it.
>> And [snorts] there are there's similar data from other stimulants too. So there was a paper that came out in science a couple of years ago with uh giving people um methylenadate some of the or some of the other like ADHD medications in people who don't have ADHD. These stimulant medications again show this dissociation between so they feel great.
>> It's like the the inverse of the cannabis thing where people think they've got all these great ideas and then the next day even they are like oh my goodness this is dreadful. Yeah. And that's again been like formalized in studies where where you can do these tests where then other people objectively see how creative were you people taking cannabis felt like they were more creative but actually they weren't. And so the reason why um I say this is that when we're talking about supplements all these other things we're like well I feel much better therefore it must be must be doing something good.
We know that with many of these supplements you can create this dissociation between how you how you feel and how you perform. whereas some of these endogenous things don't have that effect. So that's why that kind of like endogenous increase in arousal using things like exercise is a much more reliable way to improve performance because you don't kind of get this association between the two. So with exercise in particular, we we you know know very well that some period of exercise it can be resistance training, aerobic exercise, very brief sprints, increase arousal, improve cognitive function across multiple domains um improve learning um and retrieval, right? So so you're definitely augmenting some of these processes of neuroplasticity. Some of that's going to be related to the catakolamines and other things that get released as you know as you as arousal increases.
>> [snorts] >> But we also know that different types of exercise have different effects on different parts of the brain. So yes, I think some of just like the general process of moving your body um and exerting effort definitely increases arousal. Um definitely improves cognitive function, improves learning as long as it's not truly exhaustive exercise. Like anybody who's done some terrible CrossFit wad or, you know, I used to be a rower. We used to do a 2K test on the rowing machine, right? You do a 2K test on a rowing machine, your brain does not work afterwards. It's like a six-minute flat out like V2 max kind of level of exertion.
>> Yeah. Thanks. I'm going to interrupt briefly. Thank you for pointing that out because I think that people assume they have an infinite amount of energy and there's crossover and um I certainly have done, you know, extra sets to failure in a great morning workout and then the in the afternoon I'm dragging.
If I hold back just a little bit in terms of volume, >> I find I get a real boost out of training. But I do low low volume high intensity, you know, usually two sets per exercise to, you know, two or three exercises per per muscle, like quadriceps being one muscle or something like that. If I do three, it's a small addition, right? The rest of the day I'm kind of dragging. So leaving something in the tank, >> yeah, >> does seem worthwhile. not during the sets, but leaving something in the tank in terms of volume really seems to help.
>> Especially if you want your like to perform hard cognitive work directly afterwards. Sometimes if you're trying to really push >> sure >> performance or adaptation, right, is worth digging into that hole. But it really just depends on what you want to be able to do directly afterwards.
>> I think student athletes, especially in D1 schools, they really um come to appreciate this. I've had a few of them in my courses over the years and um they really understand when they're pushing very very being pushed very hard in their sport and um they know that they have to sit in the front of the classroom, sit upright, do ex take extra measures to make sure they're not >> dozing off, attention drifting, especially in the age of phones and iPads and and things like that. It's very very difficult. Um, yeah, thank you for for mentioning that because they're just an extreme case of the rest of us.
You know, we're told, we're all very busy like, "Oh, you need to exercise.
It'll help your brain." And people like, "Well, I exercise and I'm exhausted."
You know, that's not helping my brain.
Let's get practical here.
>> So, is there any way uh to it's got to be really subjective and uh depend dayto day. Is is there any way to kind of formalize that? like should you train let's say resistance training or running you know should you cap it at an hour should you pull back on the intensity if you have harder cognitive work to do in the afternoon we all want the maximum effect of exercise but we don't want it to undercut our efforts >> yeah I think that a lot of it's going to be based on what your current capacity is right as as with everything so if you're you you want to do some you got some you know learning to do you got an exam you want to do some hard cognitive work at, you know, whatever it is, writing a presentation, analyzing data, you uh reading you reading papers, writing your book, then doing some kind of workout that's that's probably below your kind of typical or below what what you would do when you're really sort of pushing pushing the envelope. We I think that when you look at meta analyses of exercise and then cognitive function immediately afterwards, the the protocol that has like the best evidence for it is like a 20 to 30 minute jog, right? So like that's the kind of um level of activity that that really seem to sort of like support all those general processes of plasticity and learning.
>> What do you think is going on? Because it can't be that much arousal. I mean that the amount of catakolamines released from again catakolamines folks being the you know adrenaline, norepinephrine and uh dopamine um generally increased levels of arousal, alertness, uh propensity to move. You just that's that I feel better. People often think about the runner's high and endorphins. The endorphins come from pretty long intense duration effort.
They're more of a you're floating kind of like uh you know I think the catakolamines are really the the cocktail of like all right I got a great workout in this morning showered got dressed I'm off to work let's go that's the so 20 or 30 minute jog I don't expect you'd get that much catakolamine release >> I mean you'll definitely get some right and like cortisol too right which obviously increases alertness and arousal and can can in the short term make you feel good >> it's a good thing >> um you you see similar effects of you know short resistance training workouts.
Um, I think of it, it's it's probably a little bit of like an area under the curve thing because you see some similar effects of like you go out and you do >> sixsecond really hard sprints like max effort sprints. You do that a few times with a long break in between, right?
That seems to have a similar effect, but you're only working for very short periods with very long rest periods.
>> So, it's some it's something in that in that sphere. And I think it's that's probably just it. It's just enough to you just kind of boost catakonamines a little bit, a little bit of cortisol.
That's enough to kind of move you up the arousal curve to the point where you're then able to focus and engage a little bit better. And I think yeah, you don't need a huge dump of that um in order to achieve that increase in arousal particularly as it pertains to like learning and then you know cognitive performance in like formal cognitive tests when which is where this is usually done. If you're then thinking about the type of exercise that changes cognitive function or brain structure long term, effort uh and intensity do seem to matter a lot more. But those studies have looked less of well how did that how do they feel directly afterwards?
Right now you're thinking about what's the kind of stimulus that drives change over time and then intensity matters a lot as well. So um the the best example um is with aerobic exercise on the kind of uh zone 2 up to kind of zone four five sprint spectrum. So most people who listen to your show are probably familiar with a study where in older adults they had them do uh brisk walking three times a week 40 minutes. Um and when you kind of read the study and and the heart rate uh levels they were trying to attain, it was basically zone 2 work, 40 minutes brisk walking three times a week for a year. And they saw significant increases in the volume of the hippocampus uh increases in V2 max fitness, increases in circulating BDNF levels, though circulating BDNF doesn't actually get into the brain, but it's kind of telling you something about probably BDNF that's being produced in the brain. um and improvements in memory. With all of that, [sighs] however, there's a much more recent study that took again older adults and randomized them across three different groups. One was like a low inensity group. Another group basically did kind of zone 2 type work on a treadmill three times a week, very sim similar to that previous study that I mentioned. And the third group did um a highintensity interval training intervention, which is the Norwegian 4x4 protocol. So 4 minutes 85 to 95% of maximum heart rate. They had a threeminute rest in their protocol. They did that four times over.
>> That's really hard. Anybody who's done the Norwegian 4x4, if I then say, well, hey, do that three times a week for 6 months. Like that's >> that was three times a week.
>> Three times a week for 6 months. That's that's pretty intense. But what they showed was that that high-intensity interval training group, they improved their fitness just as well as the zone 2 group, interestingly, but they had much better improvements in hippocample function and maintenance of hypocample structure on an MRI scan. And they maintained that benefit for 5 years after the six-month intervention. So they worked really hard um for 6 months, but that that benefit was maintained for for a really long period of time. And in several analyses within that study, they basically show that the harder people worked um and the more cortisol they released, the better the benefit. And so this is important because nowadays there's or you know there's several people out there saying, "Oh, don't do high intensity exercise. It releases cortisol. That's stressful. Your body can't handle it." Right? This study directly shows that working really hard, releasing a lot of cortisol in high-intensity interval training actually improves hippocample structure and function um over over time. So yes, I imagine after they did their workouts, their brain wasn't maybe working at its best cuz that's a hard workout. But over time, this was this really strong stimulus that then resulted in significant improvements.
>> Forgive me if you said it and I missed it. Uh what was the form of exercise?
Was it rowing or biking or >> It was on a treadmill.
>> Treadmill.
>> Yeah.
>> Uh really interesting. Um and you said it about 85% of max heart rate.
>> Yeah. So that's that's a typical Norwegian 4x4 protocol, but I don't think that's the protocol you have to do. I think it's just this process of highintensity exercise that it releases a whole bunch of myioines and lactate in particular. We know that lactate very easily gets into the brain, generate, you know, stimulates BDNF production as as kind of part of that support of neuroplasticity or augmenting recent neuroplastic processes. I think there's something about that just that highintensity work that drives some of those factors that then support structure and function.
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>> Yeah. Uh, two things. Super interesting, um, comparison between these studies.
Um, and as somebody who incorporates one day a week of 4x4 type >> exercise and one day of longer, slower cardio, maybe I should try maybe doing a bit more of the high intensity.
>> I think if you want it to be sustainable for long periods of time, like I would typically say one day of highintensity work is fine, right? Cuz you probably you want to be doing some resistance training. You >> I'm doing that three days a week. I do one long slow for me jog of about 60 minutes >> uh 45 to 60 minutes and then one kind of in moderate kind of maybe more like zone 3 4.
>> So thank you for putting in a a strong um word for cortisol not always being the bad guy.
>> Um people are so afraid of cortisol. You want your morning cortisol high. It's going to make you sleep better at night.
You'll have more energy during the day.
It's a It was interesting to me to dive into the literature on cortisol and find that a moderate and int a moderate intensity resistance training session or cardio session probably a little bit easier than the uh 4x4 will triple one's baseline levels of cortisol and like or quadruple it. It's transient, but nobody's freaking out about these workouts, but they're afraid to get in a cold shower, which doesn't have nearly the same impact on cortisol or um it's kind of wild how afraid of cortisol people are. People think they're going to get Cushing syndrome. It's been I don't know what the SCOP on cortisol was all about, but you know, you're going to get moon phase, you won't be able to lose abdominal fat. I mean there is a a real condition which is you and I know it's a Cushing syndrome where cortisol is is pathologically elevated but come on folks like cortisol goes up cortisol goes down you that but 20 30fold from the morning until night in a healthy individual. So what do you think it is that that people get you know like afraid of cortisol afraid of uh some stress? I mean like your hippocampus obviously in this case their hippocampus got better. It's not dissolving into a puddle of its own tears. [laughter] What What is this? What did What did our predecessors do wrong?
>> You know, let's blame it on the parents.
What? Because [clears throat] we weren't doing science communication then. What What What in the world was the incentive for like demonizing molecules? It's so crazy. So even though his uh frameworks are still potentially very helpful, some of it we can blame on Hans and his like general adaptation response like the the the original idea that if you were chronically stressed it would lead to like true exhaustion of all your physiological systems, right? Because that was the final phase of his general adaptation response.
>> People have conflated acute stresses versus chronic stresses. And yes, we know chronic stress be they psychological, physical, increase allatic load, increase metabolic disease, inflammation, blood sugar dysregulation, insulin resistance significantly associated with heart disease, dementia, all these kinds of things, right? So we so we know that these chronic stresses are can be really detrimental to our health. But we've kind of conflated that like any stress is bad because chronic stress is bad.
But the way that I think about it or I try and talk about it is that actually the stress response and this is as kind of Sier originally described it is stress drives adaptation. He called it general adaptation syndrome or the general adaptation response because what stress is is your body acknowledging that you need to respond to some external stimulus, right? And so stress diverts resources so that you can then adapt to that stimulus. Be they physical, cognitive, neurological, right? A stressor diverts glucose to the immune system, right, in in an infection so that it functions better. You can eliminate the infection. And so yeah, if you took somebody and you like look you measure their cortile levels after a workout, it actually looks very similar to how it would look if you just broken your arm or if you were like really sick, right? This is the body adapting to a stimulus and like everything we've talked about here you know physical training driving neuroplasticity that requires adaptation and so some of that core stress response is involved in that the release of cacodium as you talked about in the brain right those are stress related molecules that are driving adaptation so that your body can deal with the stressor better in the future and we also know actually that there's some where there's some evidence for the uh cross stressor adaptation particularly with exercise, right? So, if you exercise regularly, you are better at dealing with other stresses like psychological stresses. You won't you're more robust to stresses. Your your mood or your cognitive function doesn't dip as much when you're when you're then psychologically stressed.
So, stress is actually really important because it's the fundamental driver of adaptation. But because we've kind of, you know, we know that chronic stress is bad if if you never get a chance and that's because you never get a chance to adapt. You never get a chance to downregulate. you never get a chance to respond because it's just continuous.
But right intermittent exposure to these stressors is really important. And Selia also talked about the idea of hypo stress, right? Not having enough stress because then you can't you don't adapt, you don't build function and response.
So we just need to think about them very differently because that those acute stresses are incredibly important for driving adaptation.
>> Way I think of it is pick your stressor.
You can either be exercise or it can be psychological stress. If you take it in the form of exercise, you probably have less in the form of psychological stress. It's obvious not not completely true at a one for one, but I think uh as you pointed out, we and all organisms thrive on some degree of stress. I think if people are getting enough good sleep at night, >> yeah, sleep is the >> I don't want to say there's no limit to the amount of stress they can absorb, but when it starts to erode your sleep, that's perhaps when things need to be, you know, adjusted.
>> Resistance training. Um, is there a particular protocol for resistance training that opens the opportunity for plasticity better than others that is supported in the literature?
>> Again, two different windows say of of action. So, there's that that acute kind of arousal and this would be um, you know, you you go in the gym, you do a couple of sets, you're not maxing out.
Um, you know, it's it's probably going to be your fairly typical couple of sets of uh 8 to 12 reps, kind of 80% of of max, something like that. You do >> compound movements. So, most studies use machines, right?
>> Um, so maybe do a leg press and a chest press and a lat pull down, shoulder press, multi- joint movements, usually with machines.
>> [snorts] >> And again, if that takes 20 to 30 minutes, that kind of shows some similar effects to that like 20 to 30 minute jog that I talked about in terms of some some acute bumps in in in cognitive function probably through through arousal the mild activation of those arousal pathways actually quite similarly though I mean probably um slightly higher intensity will also be beneficial as long as you're able to uh recover over time like that that that recovery is is critical just like I was just saying in terms of any kind of adaptation. Um there are several studies of resistance training looking at cognitive function and uh brain structure over time. I say several, it's like three or four in older adults and they typically do two or three times a week, five to six exercises, three sets of 8 to 12 reps.
Very very similar. Um, so those multi- joint machines in in the gym that anybody can do and they're in any gym.
>> Presses, pull-ups, rowing, pull downs, leg press, leg press, >> hamstring curls. Exactly. Okay.
>> Yeah.
>> And what you tend to see is that if you do that for at least 6 months, so the studies go on for like 6 to 12 months, you see significant um changes in the structure of the white matter of the brain and with that improvements in executive function. You want to remind people what white matter is just for for the for the newbies.
>> Very broadly, you have white matter and gray matter in your brain. In the human brain, white matter makes up approximately 60% um more than um most other species, any other species. And so like the wrinkly outer part of your brain, the cortex, that's gray matter.
You also have more gray matter deep inside the brain. In between that is the white matter, which is where you have uh the myelin sheaths on your axons. That's what allows those uh nerves to conduct information really quickly. Whereas aerobic exercise on that kind of intensity spectrum we just talked about seems to particularly benefit the gray matter which includes the hippocampus.
Resistance training seems to particularly benefit the white matter.
Um and so you see improvements in a white matter structure which and and changes in white matter structure with age are one of the best predictors of cognitive decline with age.
Interestingly, like outside of other things you see in terms of neuropathology, amaloid tow etc. That loss of white matter structure and function is you know closely tied to cognitive decline over time. So you see improvements in structure and function of the white matter and potentially improvements in something that we call Y matter lesions which tend to happen um around areas of poor blood flow uh within the Y matter of the brain. Um and with that improvements in executive function. So um uh aerobic exercise is gray matter and memory and resistance training is um white matter and more sort of executive type decision-m processing speed type functions. You know we talked about uh lactate and some of these other things that might increase uh um uh BDNF with the aerobic training in resistance training. The I I think the primary mediator of that or one of them is IGF-1 which is in particularly increased with resistance training. We know that IGF-1 is really critical to the development of white matter uh you know right you know in the womb and then as a baby and it seems to be also really important for for white matter structure then throughout um the lifespan. So resistance training is a really great way to then create these boosts of of IGF-1. So that's probably that's that's probably part of of of why we see that difference. But that that's why you need to do both though they may have similar kind of acute effects in terms of cognitive function. they seem to be having very different effects in terms of the structure and function of the brain long term.
>> I so appreciate that you're basically telling us that different forms of exercise impact different critical aspects of brain structure and function.
So, resistance training, white matter, cardio, gray matter, broadly speaking, and many different molecules, IGF-1, BDNF, lactate, and on and on. Just for uh >> uh what how do you say in in Britain?
Well, it's not kicks, they use a different word, but for kicks and giggles, I'll just tell you there were sort of two running jokes in the field of neuroscience when I was coming up, which was if you desperately need a thesis, fortunately, this was not the position I found myself in. uh if you desperately need a thesis and like it's not going well, study the effect of pretty much any compound on REM sleep because it will reduce REM sleep. There are very few things that increase REM sleep. Very, very few except sleep deprivation and then REM rebound.
>> Likewise, there was a review published by a guy named Jeff Lickman and Josh Sains who were in a different field. So, they did a kind of cocky thing, but they back then they were like like they're good guys. Um I know them both. Um but they published this review about long-term potentiation >> where they said they did a review of the literature and they said basically you can throw any molecule on a couple of neurons and do the protocol for long-term potentiation and you get an enhancement of long-term potentiation.
Now that wasn't completely true. The reason I'm raising this is that there's this theme right like it's um there are certain processes like processes that are not that hard to disrupt like REM sleep. you just kind of tweak the system a little bit, you see a deficit, small or large deficit. And then things like long-term potentiation, which is thought to underly a lot of forms of learning and memory in a dish with some neurons or maybe even an animal, you can knock something out or overexpress something and whoop, you get more or less long-term potentiation. It's not that hard to tilt the scale on it. But in reality, the human body has tons of molecules that it deploys. And it now to me makes perfect sense why plasticity which of course is the the foundation of learning sort of one in the same uh in many ways is brought about by resistance training and by cardiovascular training because they're both motor.
>> Yeah.
>> Just like crossword puzzles certain plasticity effect >> maybe less than you know dance where there's a number of different things social inputs balance inputs and on and on. So whereas 2 3 years ago I would have said all right are we really talking about exercise opening plasticity that's always seemed like mice running on wheels and you get a few extra neurons you get a nature paper like I love that work don't get me wrong but it turns out to not be that meaningful >> in terms of new neuron production isn't that doesn't seem to be that meaningful for human uh memory and and offsetting cognitive decline. So, but now I have a completely different view of exercise based on your work, based on the studies that you're describing because it's like, yeah, these are the big guns in terms of deploying lots of molecules that >> without question are interacting with one another.
>> So, I no longer think about exercise as like okay well like it's just increasing vessel growth, you're getting more metabolic health, so then the brain gets better. Um I now think about resistance training and cardio and their various forms as you point out 4x4 etc as like the real plasticity uh triggers.
>> So that that was a long-winded way of saying thank you to you and your colleagues who've been doing this and thinking about things like clutch states and and molecules that shift plasticity because I love reductionist single molecule manipulations. I think they're very important in a certain context, but uh for a while it was like gosh, everything opens plasticity and everything disrupts REM sleep and like when are we going to get to this stuff?
>> Anyway, Alzheimer's, Parkinson's, nobody wants these neurodeenerative conditions.
What is the current thinking about the factors that make one susceptible to Alzheimer's? I'm beginning to think that it's not just one, but that there's a p genetic predisposition issue that maybe you could touch on. And what can we do besides the things that we're already talking about today um to best reduce the chance of um accelerated cognitive decline or full-blown Alzheimer's?
>> First, we talk about dementia um which is essentially the end stage of cognitive decline. there's some trajectory of decline that happens from your peak to that point um where ideally we'd intervene much sooner but right now you know we don't really do much until dementia is diagnosed. It's but it's it's very similar like we don't do very much until diabetes is diagnosed. you know, ideally we can we can act much earlier in that trajectory and that's increasingly being accepted in the neuroscience and neurology communities that actually we could potentially change that trajectory or at least decrease risk. And so within dementia there are as an umbrella term which is essentially the loss of cognitive function such that you can't look after yourself on a day-to-day basis. You can't do the day you sort of the the basic activities of daily living.
Alzheimer's disease is the most common.
It makes up about 60 to 80% of cases of dementia. Um the next most common is vascular dementia. Although vascular dementia and Alzheimer's disease overlap a ton like the vast majority of people who have Alzheimer's disease also have some element of pathology or changes in the blood vessels in the brain which is what you get with vascular dementia. And then there's also dementia with Louis bodies um uh front to temporal dementia and then uh dementia related to Parkinson's potentially although that overlaps a lot with um Louisibody dementia and and dementia and Parkinson's may just be may actually mostly be Louis body dementia but [gasps] we've gotten to a point now where it's generally accepted that potentially half of cases of dementia are preventable and I think the majority of that falls into those first two buckets Alzheimer's and vascular dementia although metabolic disease and other risk factors for Alzheimer's disease also increase the risk of Parkinson's disease and and those other dementias as well. When you then think about Alzheimer's disease specifically, there's there's one small slice of Alzheimer's which is like monogenic dominant mutations that you have in either most of them happen either in the precinylan genes pin one and two or the amaloid precursor protein gene. They make up at this point less than 5% maybe as little as 1% of Alzheimer's disease. So, we're kind of we set those to the side a little bit.
The vast majority of Alzheimer's disease is what we would call late onset Alzheimer's disease, although it's happening actually earlier and earlier in in some populations. Yes, there's a genetic component. Um, your APOE gene is your probably your most common uh risk gene. It's also associated there's also polygenic risk. So thousands of genes can give you a little bit more a little bit less risk of of of Alzheimer's disease, [gasps] but it's much more related to lifestyle and the environment than say that that kind of early onset monogenic Alzheimer's disease. And the the kind of the best accepted um review of all of this um is is run by the Lancet Comm Commission on Dementia Prevention uh overseen by professor Jill Livingston and their most the most recent version of this suggested there were 14 risk factors who between them accounted for about 45% of uh de dementia risk or dementia cases and that that are modifiable. So early life education, high blood pressure, diabetes, hearing loss, vision loss, brain trauma, um high uh high cholesterol, they recently recently added >> high LDL, >> high LDL cholesterol, low physical activity. So this is all related to the things we've already talked about, right? Maintaining good physical health, maintaining uh maintaining inputs, getting inputs in the first place, right? Education is is uh is critical.
Um >> and hearing loss, as I recall, was an important one, right? in reference to to inputs like you don't want sensory input degraded.
>> Absolutely. So hearing loss, vision loss, um social isolation. Um they didn't uh it was quite so two things they didn't include um that were fairly controversial and were sort of debated.
Letters were written to the editor and all that kind of stuff as happens in in academia uh related to so they didn't include sleep loss or sleep deprivation as a risk factor for dementia even though the evidence particularly if you're >> didn't look at it or didn't include it.
>> They didn't include it. So, like they talked about it, but they felt that the level of evidence wasn't high enough, though it was probably as high as some of the other things that they included.
>> It's a tricky one. I I don't want to take us on too much of a tangent, but having looked at these data a lot, I do think that people need to get enough sleep, but some people, like myself, do fine on 6 and 1 half or 7 hours, and other people can do fine on only seven or eight or nine.
>> Very few people are a-okay all the time on just four to five hours for prolonged periods of time. But what but when we say not a-ok okay what tends to happen with shift work or people that are chronically sleepd deprived is most of the other things you're talking about get worse LDL goes up stress levels goes up diabetes go so it's >> it's like uh I can understand why they might not have included it but it seems so foundational to me that it does seem kind of a shame >> part of it is related to how they analyze the data so we can we can we can get to that but I mean in reality when you look at the data on sleep loss and dementia risk The cut off is really around 6 hours. So if you're consistently sleeping fewer than 6 hours, that's where risk starts to increase. So that that kind of sounds Yeah, that sounds about right. Cuz it's the I think it's the LA it's the lack of those last two cycles where that are REM enriched.
>> Yeah.
>> You know, cuz in the beginning of the night, you get your growth hormone surge, you get a lot of deep sleep, assuming you're, you know, doing things right during the day and and then it's those last, you know, 290 minuteish cycles that you glean most of your REM.
>> Yeah. And if you're not getting those night in and night out and night in night out, like sooner or later, you're going to have issues.
>> Yeah. So, so sleep was one. Then the other one was was nutrient status. So, they didn't talk about omega-3s, B vitamins, which we do actually have some some quite high quality interventional and observational kind of epidemiological data for. So, there was kind of some discussion as whether those things should have been included. Other analyses that looked at those suggested that they potentially contribute a significant of the amount of the population attributable risk of dementia. So all that to say that their their 45% estimate could be quite conservative if we consider some of the other things there there are some other studies that suggest that the maybe as many as or as much as 70% of dementias may be preventable but then you have to start including things related to socioeconomic status and deprivation and other societal factors that we know have a massive impact as well. So that's less modifiable like on the individual level, right? It really would require mod like changes at the societal level which is kind of harder to do.
>> Could I ask you a question? It's going to be a very controversial one, but >> um >> there are people arguing there are very smart people I should say arguing that the shingles vaccine is lowering rates of dementia significantly. I haven't looked at those data closely yet. I plan to, but it certainly is intriguing given the data that herpes viruses of various sorts have been correlated with uh Alzheimer's. This comes off the back of three or four very large natural experiments that have been done in in various countries. And really how you interpret these data is going to depend a little bit on your kind of risk tolerance and like how you what you think should be done in terms of the le level of evidence required to to intervene. So, I'll describe the studies in a second, but some people are definitely saying, you know, if you want if you want to say that um the shingles vaccine decreases dementia risk, you have have to have a clinical trial that's adequately powered to show that.
And there is a trial like that being planned currently.
>> So, the the studies that have happened so far, uh there was one in the UK, in in Wales, uh one in Australia, uh and one in Canada. And in each of those countries, what happened was that on a single date, a huge trunch of people became eligible to get the shingles vaccine. Whereas if they were born one day earlier, they weren't eligible. So you get what you call like a natural experiment where from one day to the next, those people shouldn't be that different otherwise. and and they showed that, you know, rates of other diseases weren't that different. Rates of uptake of other, you know, health care and other vaccines weren't wasn't that different, but there different there was a big shift in the uptake of of the shingles vaccine. And so what they essentially consistently showed across all those different populations was that those who got the shingles vaccine um or were eligible to have the shingles vaccine, depending on whether they had access to the data on whether people got it or not, had a had decreased risk of dementia. And that was consistently seen across those three groups. All those three trials used an older version of the shingles vaccine called zostifax zostifax which was a live attenuated vaccine. There's now a newer version uh called Shingri which is a recombinant vaccine and there was a study done in the US that um compared people who switched from you know there was a similar switch from Zustvax to Shingri and and saw that Shingrix was associated with with a lower risk of dementia compared to Zustvax although both were associated with a lower risk than none.
When you look at some of these trials um or studies because they're not trials, people have made the a very fair comment which is that when you look at the trajectory of dementia over time, you look at something called a Kaplan Meyer curve. So it's like a survival curve. So like um every time somebody gets a case of dementia like the line goes up and you look at the trajectory of the two lines those who got you know got the uh vaccine or not they diverge very early which kind of says that oh it only takes a couple of months to kind of see this difference in dementia risk which you which you wouldn't really expect based on like the natural course of dementia takes years to happen. So um this is very common in these kinds of studies. Um and it it's it's due to residual confounding. So there's like something inherently different about the populations that may be driving some of this different. Right? They they were going to get less dementia anyway. And so maybe the shingles vaccine isn't having that big of an effect. But I would say that having looked at all those trials and all those data, I'm fairly, you know, I'm convinced enough that um there's there's a signal there.
there should be a randomized control trial. That's that's happening. But there's a number of reasons why this might be the case. One, uh it obviously we know reduces cases of shingles.
Shingles can be very painful. It can, you know, can uh change how people interact with the world. You stay at home. You don't feel good. You're in a lot of pain for a long period of time.
That can be that can go for you many months. It's rare for it to last many months, but it can can last a long time.
Um then you know there's they've hypothesized in some of those papers that the magnitude of the reduction of dementia risk didn't map perfectly onto the reduction in uh in cases of shingles.
Right? There had to be something else going on as well. They've suggested that it may be um due to like an imunom modulatory effect. It may be because you're also suppressing other viruses like herpes simplex virus that we know uh may also be associated with certain cases of dementia Alzheimer's. Um and the reason you one of the arguments for the imunom modulatory effect is because not in all the studies but in most of the studies there's a slightly bigger signal in women than there is in men. Um and it may be that that sort of um >> meaning it's more effective in >> more effective in women than it was in men. And we should mention that the shingles virus lives on neurons.
>> Yes.
>> Yeah. The herpes viruses tend to live on neurons that and they hang out on neurons which is why people who you know get herpes [clears throat] one infections will get a cold sore at a particular location that will come back because it's living on the trigeminal nerve. This just you know uh I think people don't often understand that viruses can you know harbor in in particular cell types.
>> Yeah. And uh so the logical link between herpes viruses and and uh dementia risk is you know it's not >> I mean that that alone is not a causal relationship but it but it makes sense mechanistically.
>> Yeah.
>> And a fundamental feature of herpes viruses is they generally don't kill the neuron. They can >> but that's why they stay alive. These viruses are very smart.
>> They know how to get infect their host but not kill their host which is what really smart viruses do.
>> Yeah. So what age are people getting the shingles vaccine?
>> The study is actually quite late. It's like people in their 807s and 80s.
>> Oh wow.
>> Yeah.
>> Okay.
>> So again, um it would be very fair to argue that getting it much earlier we don't have any evidence for because you know in reality in these particularly in these the studies um like the UK this is done in the national healthcare system.
it was you know for the the highest risk older you know older adults and so getting it in your like 50s or you know mid-50s which is u sort of the guidelines in the US that yes to reduce shingles absolutely but it doesn't map onto the dementia risk um age that was seen in seen in these studies a final piece of this that I think is important and kind of goes beyond just the shingles vaccine is that if you want to maintain function over long periods of time, one of the best things you can do is minimize your chances of getting really sick. There have been sever several studies, one was the adult changes in thought study done at the univers University of Washington in Seattle primarily. Um this a similar thing was shown in the Rush memory and aging project. But basically, when you when you look at the same individual over time and you measure their cognitive function every few years, which these studies did, cognitive function doesn't just decline sort of linearly or steadily with age.
It goes down, you know, a little bit on average, but the biggest decreases sort of happen stepwise after periods of significant illness. Um and so like in the adult changes in the thought study, those who'd been um you know sick in between, you know, had a major illness in between uh have be having their cognition retested, they had a step change down and those who were hospitalized that that step change down was even bigger. So you could talk about, you know, how people maybe could have changed things in order to recover some of that function afterwards. I think that would have been possible if you'd, you know, thought thought about how you might intervene. But a major I think it it's a it's a reason to say if I can do as much as I can to minimize the chance that I get really sick because what happens then is I'm I'm at home. I'm not receiving any stimuli any inputs. I'm not moving. I'm not eating well.
Obviously there's the all the downsides of the infection itself. um then you know if I can avoid that as much as possible then over time that that that could lead to you know greater benefits right change change change the overall trajectory so I think that's one reason why some of these vaccinations could be beneficial is just you're minimizing the time you spend really sick as you're older which we've seen is results in these sort of like step changes down in cognitive function >> fascinating I realized that we could and probably should do an entire podcast about traumatic brain brain injury and concussion.
>> But as a [clears throat] teaser for that, um, >> are there anything that people should do and or take in the immediate aftermath of a head hit? Now, I'm not talking about uh hopefully people are getting checked out for brain bleeds and things like that. So, I'm I'm talking about moderate concussion.
Someone got their quote unquote bell rung. uh they slipped and fell. Uh they got clipped in soccer practice. Um their kids a little dizzy. Not of course somebody young or old is vomiting or you know not able to sleep or real issues. I mean everyone should probably be checked out in in the first case but I get asked this question all the time. Is there anything that people can take to kind of get over mild concussion or moderate concussion? The evidence base on this is a little shaky, but I think for most things it kind of fits into this idea of positive asymmetry, right? Low risk, high potential for benefit. And there have been lots of you there have been randomized control trials to kind of look at some of these things. So we a couple years ago we published a paper looking at different nutritional supplements after concussion that you know we have some reasonably good evidence for. So, um, yes, you should be seen by a doctor. You should get whatever scans and, you know, immediate medical care that you need. Absolutely.
Right. That's we're assuming all of that is done or will be done.
>> Yeah.
>> Immediately, there are a couple of things that I think we know um from sort of um animal studies that translate fairly well onto onto humans, but also some you maybe some observational studies in humans. But, a couple of things are important. So one is temp temperature management temperature regulation. There have been this is what my PhD was actually in hypothermia after acute brain injury >> hyperothermia.
>> Hypothermia. Yeah. So cooling down.
>> Although I did do some studies where we you know heat it up and that makes things worse. So this kind of pertains to imagine brain doesn't like to get too hot.
>> That's essentially what I'm about to say. So there have been lots of studies where they've done cooling hypothermia in people after traumatic brain injuries and concussions hasn't really shown much of an effect. What seems to be important is preventing hyperothermia.
So um one of the effects of cooling somebody down is that they don't get hot. So that's probably something that's really important. So often concussions happen in a heat stressed environment.
You're on a football pitch. It's August in Alabama. It's 40°, right? Get inside, get cool as quickly as you can because there are there are studies that and that doesn't mean you have to get an ice bath. Just don't be really hot. If you get a fever, which you might might do after a more significant injury, you know, Tylenol or something like that to help maintain thermmorreulation will be really important. The next is uh blood sugar regulation. So, we know that after a significant brain injury, you have increases in in blood sugar that's associated with worse outcomes. Some of it's like what's caused, what's consequence, is the injury driving the blood sugar, is the blood sugar driving the injury. I think an easy thing to just say is I would avoid any super sugary refined carbohydrates that might just sort of you know uh kind of pile on for one of a better word, right? What about alcohol?
>> So alcohol um I would avoid as well mainly because it impairs sleep and we know that sleep is going to be critical to recovery. Some people would say something similar about caffeine acutely after injury because it's a it's a stimulant. Um, one thing that the reason why hyperothermia or getting too hot makes the injury worse is because it um, you know, simply speaking increases the gap between energy requirements and energy production. So like one of the hallmarks of these acute brain injuries is a deficit in energy production with you know mitochondrial failure or mitochondrial dysfunction. And so if you get too hot or you stimulate the brain, you're asking for more energy when the when the when your neurons can't produce it and that is a trigger that kind of deficit in energy production is a trigger for cell death and neuroinflammation and some of these other processes that then may happen. So avoid alcohol, avoid caffeine. Both of those potentially related to improving sleep. Then uh things that we have some you know reasonable evidence for um immediately after concussion are creatine.
>> At what dosage? The best trial was actually done um in a p like pediatric group although very broad. It was like one year old to 18 years old. Um but they gave point4 gram per kilo per day.
So >> wa.
>> Yeah. So it's it's a pretty it's it's like double a traditional loading dose if you're a 100 kilo person. But like if you're 7 if you're 70 kilos um you know 155 lbs or something like that then that's 28 g of creatine. So like it's a lot but not >> trips to the bathroom could be expected but you just spread it out across the day right.
>> Yes. So well one thing I'll say about that is um the most recent meta analyses show that you actually don't get is actually quite rare to get more GI side effects uh with creatine compared to placebo. Some of it is probably related to the quality of the supplement. So poor quality creatine supplements have more adulterance that may cause some of those GI side effects. Some of it is can be due to high um um you can saturate the creatine transporters. It doesn't get absorbed. Water gets drawn into the gut that can that can then write cause diarrhea or something. Um but some of the GI issues that people experience are probably due to poor quality products that they're taking. For the non uh head injured individual, is there any reason to go back to the old loading protocols of taking 20 grams per day, putting it in a little bit of grape juice or something else to spike blood sugar for this very reason that it could um augment the the passage of creatine into your cells as opposed to drawing water into the gut? In the '9s, we would take five grams of creatine four times a day in an ounce or two of pure grape juice.
Yeah. Um, and you draw a lot of water into your muscle cells. You put on, you know, it varies, but for me, anywhere from 5 to 8 pounds of, it's water weight, but it's mostly in the muscles.
It's not insignificant. Translates to big strength increases. I don't take nearly that much now. I just do the 10 grams per day. But is there any reason to go back to those traditional loading?
>> So, if you're just like long like long-term creatine supplementation, pro probably not. um in this kind of setting I think a a you know the the evidence is for a loading style protocol right so for most people it might be 20 to 30 grams of of creatine spread spread across the day you know for if anybody's just like taking creatine for other reasons you know this is a standard dosing protocol I think is fine >> I thought you were going to tell me I could get it to work that way >> so so like the the some of the studies that use traditional like creatine monohydrate and look at creatine levels in the brain they did use is a loading protocol for for a week and then you see significant increases in brain creatine.
But you creatine having other effects on the brain, you know, potentially improving mood, improving uh memory and in older adults. Um some of those benefits happen at just like a traditional creatine doses. So you don't need to take massive doses, you know, take load loading doses. You can actually see some benefits of like 5 to 10 grams. So that's a creatine. So magnesium, so 400 milligrams once or twice a day. There've been some trials that shown um >> what form >> those studies actually use magnesium oxide. surprisingly. Um, but I would probably use magnesium glycinate. Um, the it's very bioavailable. Um, athletes usually need a bit more glycine anyway, but any bioavailable form will will be fine than omega-3 fatty acids. Um the evidence is is is a little bit better for like um there are now several studies in like America in like collegiate American football players where they take a couple of grams of omega-3s every day and across a season you see um less accumulation of uh biomarkers of of injury like neuropilament light that are circulating in the blood. So that's something that I would just take long like longitudinally. you're somebody who's at risk of a concussion uh because of your sport or your job, I would just, you know, take a reasonable omega-3 supplement just long term because we have some reasonable evidence for that.
Then uh other things might become a little bit specific to uh the symptoms that you're experiencing. So if you have sleep issues, then uh there's studies that have used melatonin and that's that's shown improvements branch chain amino acids at high doses uh for sleep.
And that's interesting because outside of TBI, high doses of branch chain amino acids may actually impair sleep because they compete for tryptophan uptake into the brain, decreasing potentially decreasing serotonin, melatonin uh production. But in TBI, there are two studies that suggest improvements in sleep with high doses of branch chain amino acids.
>> If somebody's going to take branch chain amino acids, presumably they're going to look at how much leucine is there for a variety of reasons. Um, so do you recall how much leucine to get this effect post TBI?
>> So I I don't think they at least I don't remember the leucine dose, but they were taking up to 60 g of branches.
>> 6. Okay. Cuz a typical kind of suggested supplement bottle gym dose would be 3 to five grams. That's usually about six capsules. Yeah.
>> So Okay. So like one study they did in uh veterans they had um I think it was three doses of 20 grams AC spread across the day.
>> Are you curious about um these uh Ibeane studies that are looking at uh you know TBI and brain recovery? I mean Ibeane is a it's a a whole other thing because it's a the the most powerful long-lasting psychedelic at least that I'm aware of. But it seems like there's some interesting data coming out.
Absolutely. Um and then you know in people with a history of brain trauma and PTSD and I think some of these other psychedelics are going to be um very interesting um there as well potentially due to their neuroplastic um effects that tend to particularly happen in like macro doses right in in [clears throat] um in the psychedelic doses. I think that there's a lot more to come there, but certainly the trials that have been done so far are quite compelling, but that's obviously in in a very controlled kind of clinical setting, heart rate monitor. Again, it's not legal in the United States, although things are shifting. But >> choline is another thing, particularly acetyloline. So um uh best evidence is for 1 to two grams a day um >> of choline >> of choline, you know, in the form of CDP choline or citicoline, which is the which is the same thing. Um those are the main ones. Then there's some other like Nisha supplements that do have some evidence. The one that's probably has the most evidence for it is Boswellia.
>> Boswellia.
>> Yeah. Uh which is a frank Indian frankincense. But there's an extract of Boswellia that's been tested in I think three different clinical trials after TBI showed some benefit. Enzogenol which I think is a pine extract. Slightly less evidence than Boswellia. I typically would recommend people stick to the first group of kind of nutritional type supplements. um but in very specific um use cases based on specific symptoms some of those other things might be beneficial. Then beyond that we know that phys return to physical activity as soon as possible is really important after >> without getting another head injury >> without getting another head injury. And you know so so this really changed over the last few years. You know maybe 5 10 years ago people like you know rest is what you need to do. Go lie in a dark room. If you got a concussion in sports, you you would expect the team to have a rigorous return to play protocol that included lowle aerobic activity as soon as you're able to tolerate it u two or three times a week at a level just below what might make your symptoms worse. And then first you do sort of like non-specific aerobic exercise and then you start to bring back skill specific exercises, sports exercises, then go back into full training and then um go back into into playing kind of in that order and that should be quite systematized now. So I would expect sports teams to kind of have have that in place. So like the standard of care is generally phys physical therapy. if you have any ongoing cognitive or physical symptoms sort of a month plus after uh any kind of traumatic brain injury. Um there's some evidence that like virtual reality or augmented reality uh physical uh activity uh might improve cognitive symptoms uh vestibular therapy for balance and dizziness issues. And then increasingly uh you know there's um a focus on sort of ocular motor training for like convergence or other eye like um eye issues that are very common after concussions but aren't picked up as often as as people might like. But increasingly kind of eye tracking and these kinds of things are done particularly in professional sports or other arenas after brain injuries to kind of ideally you'd have a baseline you figure out what's changed and then you would track that over time and you can you can train that depending on the deficit.
>> Those recommendations are going to be extremely helpful for people athletes at all levels. I mean, I think for people that don't have access to the, you know, all the latest and greatest, uh, you know, technology and coaches and, uh, nurses and doctors that, um, you know, there's a lot of head hits out there that aren't nec, >> you know, fortunately aren't um full-blown brain bleeds and brain damage, but the the low-level trauma to the brain is obviously a consideration, especially kids like just falling off the monkey bars. Like parents want to know what they can do.
So, thank you very much for those recommendations.
>> You're doing a strongman competition.
>> Uh-huh.
>> All natural. This is not the enhanced games. No.
>> Um, just tell us what the format of that is. Well, first of all, how old are you?
>> 41.
>> Cool. Have you done one of these before?
>> Yeah, six or seven competitions at this point. I started during CO. I've done like a competition or two every year since then.
>> Mhm. You're a tall guy. You're like 6'2.
You weigh >> like 210 215 usually.
>> And is it So, it's height and weight class or just weight class? So, it's it's weight class. Um, I now so now that I'm older than 40, I compete uh in the mast's category. So, there's a >> this one of my favorite things about strongman is that if you weigh less than 200 lb, you're a lightweight. So, I'm uh I'm in the lightweight masters category.
It means that I usually have to like do a a water cut to like for a weighin cuz I don't normally I'm not I'm normally above 200 lb. Um but yeah, they so they have they have weight they have weight classes and age classes. Can you eat your way and hydrate your way back up to after?
>> Yeah. Like the usually you weigh in 20 hours 24 hours before. I'm I'm definitely back to my usual weight by by the next day.
>> Gotcha. Yeah. We don't want you trying to lift heavy things dehydrated. What are the big events? So, you're carrying stuff overhead. You're carrying stuff at your sides. You're What are you doing?
>> A standard kind of local regional competition is five is five events. Um I qualified for the natural like world's strongest man uh which is going to be seven events. But there's usually um some kind of deadlift, some kind of overhead pressing event, uh some kind of um medley where you're like carrying something, lifting stones, farmers walks. So in um truck pull, something like that. So like more dynamic. So there's like usually like a static max strength thing, but then also like more dynamic.
>> The teeth you do the teeth pull the >> Oh, no. No teeth. Uh no, no teeth pulling. Um the we didn't talk about oral health and cognitive function, but that's really important too. The events in the competition that I've got coming up, the the world's strongest, there's going to be a farmer's walk. So that's where you just like pick things up at the side and kind of >> So for a guy, let's say you you hydrate back to like 2 205 210 or something like that. What what what's a good distance and weight to carry?
>> I know the weight in the competition.
It's 120 kilos per hand. So that's 264 pounds per hand. Um and as far as you can as far as you can carry it. Um I can't remember if >> that's a big human in in each hand.
>> Yeah. Um so typically, you know, if you if you can get to where you've got like your body weight in each hand and you're able to pick it up and move with it, even if it's not very far, I think that's pretty good. Um but like, you know, some people might say half your body weight. In reality, >> if you pick something up heavy and move with it, that's great. Like, and then get better.
>> We're not talking about recommendations.
This is your time to shine, my friend.
People can work their way up. I I I watch uh Tom Havlin's um uh Instagram.
We'll put a link to it. Everyone should see that. His wife and his kid also work into the workouts. He's got a But man, he's strong. But yeah, carrying heavy weight. No, no, this is not your time to tell people how to tiptoe into it.
That's a different podcast. So, you're carrying 220 lbs in each hand.
>> 264 lbs per hand >> and walking how far?
>> It's maximum distance um in I can't remember if it's 60 or 90 seconds.
>> You can set it down. You can set it. You can set it down. So, it's as far as you can get in that period of time. And it'll be similar with a with a yoke walk. So, there's a a yoke where you know sort of like put it on your back.
It's 700 lb. How far can you how far can you walk in that period of time?
>> Love this. So primitive. Love it. Pure hypothalamic event. Yeah.
>> So, in that event in the in the yoke walk, if you get to the end, I think it's 30 I think it's 30 m 90ish feet. If you can carry that in that far in the time cap, then you do reps on a circus dumbbell. So like this this big massive dumbbell that you have to like shoulder to overhead. There's one at 110 lb and the next is at 135 lb. Then there's going to be a loading medley. So sandbags and kegs uh like over over a platform that's like I think 200 to 300 lb implements. They kind of increase over time. Um there's a maximum squat and you have a choice of two different um weights. Um, and so like if you choose the bigger weight and you get reps on the bigger weight that you get a better score than somebody >> standard back squat.
>> It's a standard back squat is with an axle bar. So like a thick bar.
>> Um, and then in strongman when you have squatting you usually have pads that you squat down to. So there's a specific height you squat down to.
>> Um, so like that could give you an advantage if you're shorter, right?
Because you have to go less distance to get the weight on the pads. But like >> but there's no geeking it and calling less than a one rep. Yeah, people have done that. It doesn't look good.
>> Yeah. No, no. Like it just has to hit the pads and come back up. And the weights are 170 kilos and 200 kilos. So that's >> what uh nearly 400 lb and 440 lb uh log press um for reps. And again, it's a similar style. And I I think it's 100 kilos. So 220 lb and then 120. So 264.
And then there's a sled like you uh I think you push a sled and then you load it with a 275 lb sandbag and then you drag it um in a in a time cap. I think that I think that's all the events.
>> Awesome. Uh you'll let us know when it is.
>> Yes. Uh it's at the end of August.
>> Cool. Will it be online?
>> Uh it won't be online, but I'm sure there'll be some stuff on Instagram.
>> Cool. I I love that you do this. Uh clearly um you got a lot of brains in that. uh skull of yours and you you're also super strong. Love hearing it.
That's that's great. And and uh you have no excuse not to carry the groceries at home, right? So you you lost that that ride. But there's no doubt you would.
Anyway, that's awesome. I I I'm very impressed by the by people who continue to take on athletic challenges in their uh in their adult life as which is very appropriate to context today. So Dr. Tommy Wood, thanks for coming out today.
I learned a ton from you and you know going into this I like I like to think I know a thing or two about plasticity having spent so much time in it and studying it over the years but I learned a lot from you today and I know everyone else did as well. You're an exceptionally clear communicator and um you're working on not just an important issue you're working on the issue uh this neuroplasticity thing and a whole lot more. So, let's definitely get you back to talk about recovery from brain injury and stroke and things of that sort because there's a lot of uh additional things I think we could dig into, >> but uh meanwhile, you've given us a lot of uh actionable tools and um >> yeah, I I love that uh you're doing the strongman competition and uh come back again. We appreciate you.
>> I will. Thank you so much.
>> Thank you. Thank you for joining me for today's discussion with Dr. Tommy Wood.
To learn more about his work and his book, please see the links in the show notes caption. If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zerocost way to support us.
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It's entitled Protocols, an operating manual for the human body. This is a book that I've been working on for more than 5 years, and that's based on more than 30 years of research and experience. And it covers protocols for everything from sleep to exercise to stress control protocols related to focus and motivation. And of course, I provide the scientific substantiation for the protocols that are included. The book is now available by pre-sale at protocolsbook.com.
There you can find links to various vendors. You can pick the one that you like best. Again, the book is called Protocols, an operating manual for the human body. And if you're not already following me on social media, I am Huberman Lab on all social media platforms. So that's Instagram, X, Threads, Facebook, and LinkedIn. And on all those platforms, I discuss science and science related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the information on the Hubberman Lab podcast. Again, it's Huberman Lab on all social media platforms. And if you haven't already subscribed to our neural network newsletter, the neural network newsletter is a zerocost monthly newsletter that includes podcast summaries as well as what we call protocols in the form of 1 to three-page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure. We have a foundational fitness protocol that covers cardiovascular training and resistance training. All of that is available completely zero cost. You simply go to hubmanlab.com, go to the menu tab in the top right corner, scroll down to newsletter, and enter your email. And I should emphasize that we do not share your email with anybody. Thank you once again for joining me for today's discussion with Dr. Tommy Wood.
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