Protect Your Brain, Extend Your Life: 7 Mistakes to Avoid for Better Cognitive Health with Dr Tommy Wood #681

Why would you want to live longer, if not to spend more time with the people you love? That question sits at the heart of this conversation with brain health expert Dr Tommy Wood. And today, we tackle the biggest mistakes people make when it comes to protecting their brain and longevity. Tommy is Assistant Professor of Paediatrics and Neuroscience at the University of Washington, where his research spans brain development, cognitive decline and dementia prevention. He’s also worked with elite athletes and Formula One drivers as a performance coach. And in his must-read book The Stimulated Mind, he combines that breadth and specialism to make understanding brain health easier – and more fun – than you might think. We start with mindset, and the surprising research findings that how you feel about ageing can shape how you go on to age. As someone in his 40s, I was delighted to hear Tommy cite a paper called Humans Peak in Midlife, showing that increasing wisdom, emotional intelligence and moral reasoning could make age 55 to 65 my best brain decade yet! We talk about the risk of becoming so focused on optimising your own health that you neglect what matters most, your relationships with other people. And Tommy points out why chasing longevity without that connection is missing the entire point. From there we get practical. We discuss mistakes like ignoring your blood pressure (and the implications for dementia) and what testing markers like homocysteine early, rather than waiting until something goes wrong, means for your long-term brain health. I also ask Tommy which supplements are worth considering, including the latest evidence on creatine and basic multivitamins. And he reveals the surprisingly strong link between your oral health and your brain. Finally, we consider the toxic load of modern life, from microplastics to air pollution, and whether you should filter your water. Tommy’s balanced, evidence-based perspective avoids scaremongering while still taking these issues seriously. Whether you’ve listened to every one of Tommy's previous appearances or you’re new to the podcast, this conversation is packed with practical ideas you can act on today, whatever your stage of life. As Tommy reminds us, it is never too late to start. The Thrive Tour: Transform Your Health and Happiness, a live show: Book Your Tickets https://drchatterjee.com/live Thanks to our sponsors: https://drinkag1.com/livemore https://thewayapp.com/livemore https://exhalecoffee.com/livemore https://dohealth.co/livemore Show notes https://drchatterjee.com/681 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

  It's never too late to start thinking about dementia prevention. Studies in individuals in their 60s, 70s, 80s, they start an exercise programme. They start with some dietary change. They do some cognitive training. You know, they start language or dance classes or they start to improve their sleep. You start to see benefits. So start wherever you are and even just starting with one thing can have significant benefits.

• 0:28Rangan Chatterjee?

  Hey guys, how you doing? Hope you're having a good week so far. My name is Dr Rangan Chatterjee and this is my podcast, Feel Better Live More.

• 0:41Rangan Chatterjee?

  For many of you listening, today's guest needs no introduction. Dr Tommy Wood has been on this podcast more times than almost anyone else. This is his fifth appearance and every time we speak, he gives us something new to think about when it comes to brain health and meaningful longevity. Now, if you're new to Tommy, he originally trained as a medical doctor and now he's a world-leading neuroscientist and performance coach, whose research spans brain development, traumatic brain injury and dementia. His very first book, The Stimulated Minds, came out earlier this year and is honestly

• 1:23Rangan Chatterjee?

  a fantastic read for anyone who's interested in brain health, focus and longevity.

• 1:31Rangan Chatterjee?

  In this conversation, Tommy and I explore seven common mistakes that many people are making when it comes to protecting their brains. Now, some of them may surprise you, but honestly, there's no need to worry because, as ever, Tommy is full of practical ways to address them. We talk about mindset and while your beliefs about aging shape how you go on to age. We get into blood pressure, blood testing, supplements, oral health, microplastics, and whether or not you should be filtering your water. And perhaps most importantly of all, we debate the risk of becoming so focused on

• 2:13Rangan Chatterjee?

  optimising your own health that you forget about other people. As Tommy says, social connection does not just make life feel richer, it helps protect our brains and extend our lives as well. So if we chase longevity but lose our connection to others along the way, well, maybe we've missed the entire point. This is a really empowering and practical conversation that at its core has the message that it's never too late to make the simple changes that can improve the health of your brain.

• 2:56Rangan Chatterjee?

  You are back. This is number five.

• 2:59Speaker 00

  Wow.

• 2:59Rangan Chatterjee?

  I think that's a record.

• 3:01Speaker 00

  Yes.

• 3:02Rangan Chatterjee?

  Thank you. You've just, just gone ahead of Gabor Maté with number five.

• 3:07Speaker 00

  Well, hopefully it's not a competition we have to keep having because I'm sure he'll win out, but while I'm ahead, I will enjoy it.

• 3:17Rangan Chatterjee?

  When I was thinking about how to go about our fifth conversation, I was trying to think of a different framing and the framing I thought would be quite fun and useful for people is basically around the common mistakes people make when it comes to brain health and longevity and health span. So are you up for this?

• 3:38Speaker 00

  Sounds great.

• 3:38Rangan Chatterjee?

  Different kind of format?

• 3:39Speaker 00

  Yeah, let's do it.

• 3:40Rangan Chatterjee?

  Mistake number one, I think relates to mindset. We neglect how much our perception of aging impacts how well we age. And in your latest book, which I love, you quote the Ohio Longitudinal Study of Aging and you write that those with a more positive perception of aging were found to live on average seven and a half years longer. What's going on?

• 4:10Speaker 00

  There's several things going on and it's difficult to tease them all apart in a study like this, but essentially what they did is they asked people how they felt about the process of aging. So they asked them to rate on a scale of, you know, one to five, how do you feel about questions like when I get older or when people get older, they become less useful? Things, you know, things like that. And those who had a higher level of the positive perception of aging tended to live longer, like I said, seven and a half years longer on average. And then you have to adjust for other things like age and health status and some other things. And some of it could be what we call reverse causality, right? So if you're already feeling like you're experiencing the process of aging, you're,

• 4:53Speaker 00

  you've lost some of your health, then you might feel more negative about aging and it's the health that's really driving it rather than your perception. So some of that is certainly playing a role. But I do think that having a positive outlook on the processes of aging will then allow you to continue to engage in the world in a positive manner that then drives a whole host of benefits. And we know that mindset and how we feel about our own health and our wellbeing are important drivers of our physiology and important predictors of our long-term health. So some of that reverse causality is possible there too, but we do know that how you feel

• 5:34Speaker 00

  about the future and how you feel about your health and then aging as part of that is going to change both how you interact with the world and change your physiology. And I think that that's what we're seeing some of in that particular study. And where this then becomes really interesting to me is when we think about this idea of chasing longevity in particular, then inherent in that is some idea that aging is bad, right? Because in order to fight against aging, you have to think that aging is inherently detrimental.

• 6:15Speaker 00

  And yes, we, we know that with aging, you will lose some function. It just, it is what it is. We can't prevent it entirely. But if you have a negative perception of that, then when you start to see aging happen regardless of your efforts, I think that could then have an even worse effect on your psychology and mindset because you've kind of internalised this idea that aging is bad, when with aging could come a whole bunch of changes in, say, cognitive function and other aspects of personality that may be beneficial. But we might miss out on that if our primary focus is on preventing it entirely because we think that it's bad.

• 6:57Rangan Chatterjee?

  When we think about changes that we can make to help increase our health span, we can think about individual changes that we can make, but we also need to think about, I guess, collective changes and the influence that culture and society has on us. So if we're constantly being surrounded by a message that aging is bad, how can you fight the aging process? Stop the aging process?

• 7:29Rangan Chatterjee?

  It kind of undermines like a central truth, which is you're actually aging from the minute you're born, right? It is just a truth of life. And we see this, I think I mentioned to this in maybe one of your previous appearances, that there's quite a bit of research showing that cultures where women aging is seen as a good thing, report less menopausal symptoms.

• 7:55Speaker 00

  I think that a lot of what we experience, we know, is based on how our culture sees these processes of aging. And I really enjoy, there was actually a very recent paper that came out called Humans' Peak in Midlife. And actually talking about the fact that when you look at just individual factors, and we're talking about, you know, cognition and personality here primarily, then you might look at something like how quickly can you process complex information and maybe do some kind of non-verbal reasoning, something like that?

• 8:29Speaker 00

  Yes, that peaks early in life, 20s and 30s, and then on average tends to decline. But that's one very narrow idea of cognitive function, right? So when you look across a whole different range of things that the brain does, and they sort of had various scales and ways to integrate all these different things, you think about the fact that other things increase over time and maybe even into our 60s and 70s, things like crystallised intelligence, which is a fancy word for wisdom, but also emotional intelligence and moral reasoning, right? On average, a 20-year-old probably isn't as good at sort of like thinking about the moral big picture as a 40, 50, 60-year-old because they have more experience, they've kind of integrated all these different things.

• 9:11Speaker 00

  So when you look across all those different factors, then on average, people sort of tend to peak somewhere between 55 and 65, sort of like you have, you still have a good cognitive function, plus you've built other aspects of wisdom and emotional intelligence and sort of integrate. And like, that's actually when people tend to peak. And so that's after the menopausal transition in women and obviously it's, you know, similar ages seen in men. So we can continue to grow cognitively, emotionally and see benefits from that, you know, much later maybe than, than people might otherwise think.

• 9:49Rangan Chatterjee?

  Yeah.

• 9:51Rangan Chatterjee?

  What's the practical take on then for an individual? Is it a bit like gratitude where if you focus on what you lack, you lose what you have?

• 10:01Speaker 00

  Yeah, I think maybe it's worth just talking for a minute on the process of aging and what aging is. And there are lots of different theories of what aging is. And so like one is actually the developmental theory of aging, which is that aging is the continuation of developmental processes that caused growth earlier in life. And then as they sort of continue decades later, they actually drive a functional decline. Although what I would argue, and this is right, the major point of my book as well, is that it might be that we stop giving the body inputs that maintain function and then that's why function declines. And that would make sense with development because development is all about building

• 10:44Speaker 00

  function relative to inputs. So if you stop giving those inputs, then function declines because the body is trying to match function to whatever it is that you're doing. So that would fit with the developmental theory of aging. But there are other theories like the information theory where, you know, damage accumulates and, you know, DNA doesn't replicate as well. And then that kind of drives these aging processes. But regardless of, you know, what aging actually is, which people don't actually agree on what aging is, the one thing that most people do agree on is that we may not be able to slow aging down, but we can accelerate aging, right? And that's by not sleeping and eating a poor quality diet and not moving and, you know, not being socially connected.

• 11:26Speaker 00

  So when we're thinking about aging in general, know that the best place to start is just do those things that I just mentioned, the things that you talk about all the time. Because by not doing those things, you could accelerate the process of aging. You probably can't slow aging down, or at least at this point, we're not sure how much we can slow aging down. So then if you tick those kind of boxes, those big boxes that I think each of us can do in our own way and can have a big impact even with relatively minimal effort, then the rest is just acknowledging and understanding that, yeah, things will change over time. But you also see, you know, with this kind of idea that humans peak in midlife, you

• 12:08Speaker 00

  actually tend to see an increase in satisfaction with life and happiness as you get older. And that's probably a downstream effect of all these things kind of integrating and coming together. So maybe the main takeaway is in that kind of middle portion, as you transition into sort of mid and later life, just don't, maybe don't fight it as much. Because then it's just, it increases distress without, you know, any kind of major benefit of it. And so it's just acknowledging that it's happening, acknowledging that actually there is some benefit to it. And at the same time, you're doing, you know, you're kind of covering your bases so that you're not kind of accelerating any kind of biological process associated with aging.

• 12:52Speaker 00

  But I think just knowing that it happens and knowing that actually there's some net benefit to it is probably a starting point because then you're not constantly fighting your biology, which is going to win out at some point.

• 13:03Rangan Chatterjee?

  Yeah, it's interesting. It makes me think of the stress response. And I guess the more spiritual or philosophical explanation of stress is to do with resistance, right? If you resist what is happening, that is what is creating the stress.

• 13:21Speaker 00

  Yeah.

• 13:21Rangan Chatterjee?

  The more you can accept and not resist, the less stress you are going to experience. And I guess we could bring that argument in here and go, if you try and resist the aging process to a degree, we're not saying don't do the things that are going to help you age well.

• 13:36Speaker 00

  Yeah.

• 13:37Rangan Chatterjee?

  But the more you resist the fact that your hair is going grey and that you're not going to run probably your 5K PB at 70.

• 13:47Speaker 00

  Yeah.

• 13:48Rangan Chatterjee?

  And that's okay.

• 13:49Speaker 00

  Yeah.

• 13:49Rangan Chatterjee?

  Yeah.

• 13:50Speaker 00

  Just not essentially wasting mental and physical energy in resisting something that will happen to all of us, because then you may be more likely to see the benefits of the things that will happen as we change over time.

• 14:04Rangan Chatterjee?

  Before we move to mistake number two, I've heard you talk before, Tommy, about how we perceive stress changes the physiological stress response.

• 14:16Speaker 00

  Yeah.

• 14:16Rangan Chatterjee?

  And I think, you know, we're broadly talking about mindset here and how the right mindset as we age can potentially help us live longer, improve our brain health and improve the quality of our lives, right? So talk to me a little bit about stress, maybe from a less philosophical lens and a more scientific lens.

• 14:34Speaker 00

  Yeah.

• 14:34Rangan Chatterjee?

  What it is and how reframing that stress in particular ways can change the way that our bodies respond.

• 14:43Speaker 00

  Yeah. So where we've gotten to right now, and there's actually been a lot of it in the last couple of years where people are talking about, right, stress is inherently bad in all situations, regardless of what's happening. And fundamentally, that just is not true. The stress response is incredibly important. And it's also a general response to the outside environment changing and your body realizing, I need to do something in response to this thing that's outside of me. That's essentially all the stress response is.

• 15:24Speaker 00

  And that might be psychological, it might be physical. But the initial response, you release adrenaline, cortisol, heart rate goes up, blood sugar goes up. Your body is diverting resources to allow you to respond to this change in the environment. And it's why historically, sort of like the kind of the father of the modern stress response, right, is Hans Selye.

• 15:54Rangan Chatterjee?

  Yeah.

• 15:55Speaker 00

  Right? And he called it general adaptation syndrome initially. And I quite like that because it's like, this is your body signaling that adaptation is required. So when you're focused and learning and maybe failing, and we talked about the importance of failure before for building cognitive function and building skills, it's stressful. Your heart rate goes up, you release stress hormones like noradrenaline in the brain. But it's your brain diverting resources to say, hey, I need to change my structure and my functioning so that I can adapt to this thing that I'm being exposed to. And my exercise is the same. If you did somebody's, you know, blood pressure and measured their heart rate and measured their glucose and cortisol, right, measured that in you after a paddle game, you'd be

• 16:39Speaker 00

  like, God, paddle is terrible, right? Just look how stressful it is for your body. But as a result, your body adapts, right? Resting heart rate improves, inflammation improves, strength and speed and power improve, VO2 max improves. And that's driven by this stress response. So the first thing that I hope that people realize is that stress is useful. It's your body's signal to adapt to some change. Yes, chronic stress where it then starts to impact sleep and it impairs your ability to adapt, which can, which can happen if you're a stressor, isn't, you're removed or relieved or you're unable to process that stress.

• 17:24Speaker 00

  Yes, it can be maladaptive or problematic, but in the moment, stress is actually incredibly beneficial. And then we know, kind of to get to your question, we know that how we think about stress affects how we respond to it. So most of this work is done, has been done by Alia Crum. She's at Stanford. She, as a PhD student, she worked with Adam Langer, who I know we both love.

• 17:51Rangan Chatterjee?

  Love, love.

• 17:51Speaker 00

  Love her work. And so it's very much in a, like, Alia's work is very much in a similar vein, but has obviously taken it and built an amazing career in her own right. And what she researches, or one of the things she researches, is this idea that stress is enhancing. And they've done randomized controlled trials where you take a group of people and one group, you say, just think about how terrible stress is, right? It's sort of, it breaks you down, it impairs your decision making, right? It's just, you know, just really, really bad for you. Stress is debilitating, right? It prevents you from being able to perform your best. And in another group, they sort of show them videos and they prime them with this idea

• 18:36Speaker 00

  that stress is enhancing. Think about all the amazing people who've performed under incredible stress. So you might talk about Winston Churchill or Abraham Lincoln or Sully Sullenberger, who landed the plane in the Hudson famously. Think about all the times that you've performed under stress, like, think about how amazing you can be even when you're stressed. And then you put them in a stressful situation, and there are experimental ways to do this. One is called the trial social stress test, where there are different versions of it. But essentially, you go into a room and there's a panel of people in front of you and they're like, you have to speak for five minutes on this topic that you haven't prepared at all. And while you do that, the audience just sits there completely impassively, just like staring at you, which is like very stressful.

• 19:19Speaker 00

  And what you see is that those, you know, both groups, they get stressed, right? Cortisol goes up, the same in both. But you see a few other things that happen in those who are told that stress is enhancing. So you see other hormones increasing at the same time. So one of them is DHEA, which is a steroid hormone. And that, like, DHEA is part of that adaptation process. It's kind of helps to facilitate growth and the, you know, the building and the adaptation of tissues. And that goes up in the stress enhancing group, whereas it doesn't in the stress debilitating group. There have been other studies by other groups that looked at hormonal responses to stressful situations.

• 20:04Speaker 00

  And they found that those who release more DHEA when stressed tend to make better decisions under stress. It may not be the DHEA, it may be this sort of like whole physiological kind of setup of thinking that stress is enhancing, that you can then, or, you know, being that, in that kind of situation where you don't necessarily think stress is debilitating, that allows you to make better decisions under stress. But this is very interesting that not only does your mindset change your physiology and response to stress, but it may also then change your ability to perform under stress. So I think some of this just requires us to acknowledge, hey, stress is actually good. It's a good thing. And first of all, it's for survival, but it's also for growth and adaptation and, you know, making us bigger and stronger and smarter.

• 20:51Speaker 00

  And then acknowledging and thinking about the fact that, yeah, well, actually, I probably can perform under stress. And then in doing that, you will perform better under stress.

• 21:01Rangan Chatterjee?

  Yeah. Okay, let's get to point two. Okay, so mistake number one about having the wrong mindset. Mistake number two, and again, I've started with these on purpose because I don't think they're spoken about enough, focusing on solo health habits at the expense of social connection. And I guess the point I'm trying to make here is if we consume all the health podcasts and hear the list of things that we could be doing and perhaps should be doing to optimize our health and longevity, you could end up living quite an isolated life. If you were going to get your five hours of zone two and do your Norwegian four by four and never eat out late and all this kind of stuff, you could find yourself spending

• 21:45Rangan Chatterjee?

  a lot of time by yourself. Yes, you've optimized certain metrics, but potentially at the expense of social connection.

• 21:54Speaker 00

  Yeah, I think that this is

• 21:59Speaker 00

  in particular, a risk for those who are very hyper focused on this area. And I don't think any of us needs to go very far to see examples of this in popular media, social media, where people who are trying to push, say, the edges of longevity essentially live indoors by themselves with a very perfected sleep schedule, food schedule, supplement schedule. And it's very possible that they'll live a little longer. I don't think they're going to live 20 years longer. But I think that it's possible they could undo or even go in the other direction

• 22:39Speaker 00

  because by being so hyper focused on optimizing everything, which I think is a misnomer in the first place, you miss out on this core part of human biology, physiology, which is the connection to others. And we know that is health promoting and health driving, as well as just being a part of how humans evolved. So one of my favorite stories around this goes back to Charles Darwin. Because when we think about Darwin, we think about evolution, we think about survival of the fittest, although survival of the fittest was not his term, it was coined by somebody else later. But this idea that like it's

• 23:24Speaker 00

  every species or individual for themselves. And it's just like this battle to survive and reproduce. And right, that's, that's, that's how you, that's how you win. But 12 years after he wrote on the origin of species, which is like the, you know, the, the set of essays that kind of came, that founded this theory of evolution, supposedly Darwin thought, well, actually, survival of the fittest is an idea doesn't explain human evolution. And so he wrote another set of texts called the descent of man and essentially came up with this idea instead that the group that was the most, he called them sympathetic,

• 24:06Speaker 00

  the like, the, the group of humans that were most sympathetic, we would, we would call it empathy now, that looked after each other the most, that cared for each other the most. Actually, they would be the ones that would, that would survive. And that, that kind of better explained human evolution. And then Dacher Keltner, sort of much later, ended up calling this survival of the kindest.

• 24:26Rangan Chatterjee?

  Yeah.

• 24:28Speaker 00

  And there's now a huge amount of science to show that when we act pro socially, like we connect with others, particularly when we're helping others. And this is where some of those ideas of why like purpose and meaning can have such a big effect on our health. You can see again physiological responses. So you see activation of the vagal nerve and like heart rate variability improves and, you know, stress responses decrease and all these things that we know are again tied to long term health. And so I think that there's this, we know there's this core requirement of our biology to be connected with others, and especially to act in the benefit of others or the benefit of things outside of ourselves.

• 25:11Speaker 00

  And I think we miss out on that when we're so hyper focused on optimizing everything for ourselves individually. And I've seen this a ton with, you know, clients that I've worked with over the years where they, you know, they stopped going out, they stopped seeing friends, they stopped having meals in restaurants because they're so worried about the food that they'll eat, or whether they won't get to bed in time. You know, everything else will kind of fall out of kilter because then they're not at home to kind of get their, their perfect routine. And I think that the health suffers because of it. And like, there's, there's almost, I imagine everybody who works in our fields, or I don't see patients clinically, I haven't for a long time. But, you know, when you've

• 25:56Speaker 00

  worked with people as a health coach, everybody has a story of the person who essentially gave up their diet and gave up their exercise and just started hanging out with their mates again, and all of their health problems improved. And yeah, you know, there's maybe exceptions to the rule because, you know, those aspects of lifestyle still do matter a lot. But I think there's this critical importance of social connection that we lose out on when we're so hyper focused on, you know, getting everything else perfect.

• 26:22Rangan Chatterjee?

  Yeah.

• 26:25Rangan Chatterjee?

  Your book, Tommy, The Stimulated Mind, which you know how much I love it, you know how much I want people to get it. So I think it's one of the books of the year. It's absolutely fantastic. There's two studies in that book that I wrote, I sort of wrote down to discuss with you, which relates to this topic, right? A Japanese study of 9,000 adults greater than 65 years old, more frequent social contact was associated with higher brain volumes and less age related white matter injury. And then you also spoke about the 2025 World Happiness Report, showing that one of the strongest predictors of well being across 142 countries was the number of meals per week people share with others. I mean, this

• 27:09Rangan Chatterjee?

  is huge, right? Because as we're talking about here, you can solo optimize, but you miss out on all of the social inputs. And if we go back to your three S model, which I'd love you to just briefly summarize for people who've, you know, come into you for the first time. Well, when we think about stimulating the brain, yeah, it can be learning new things for sure. But you can also argue that having conversations with other human beings, being around other human beings, well, that's also an important stimulus for the brain, isn't it?

• 27:45Speaker 00

  Yeah. So I think it's maybe worth first thinking about.

• 27:56Rangan Chatterjee?

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• 29:17Rangan Chatterjee?

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• 30:00Rangan Chatterjee?

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• 31:00Speaker 00

  What's the point of living longer and maintaining cognitive function for long periods of time, right? Because I don't think it's to stay at home by yourself for more time, right?

• 31:12Rangan Chatterjee?

  More Netflix watching by yourself?

• 31:14Speaker 00

  You don't think that's why we evolved? I mean, you know, I absolutely love a good Netflix binge, of course. But for the vast majority of people, and actually, yes, the sort of the extreme optimizers and biohackers, I think it's almost like theatre. It's interesting. I'm glad people are doing it because, you know, maybe I'm sure we'll find out some useful stuff. But the vast majority of people don't want to just live longer. They want to get to 80 something and be in good health for the majority of that time. And why do they want to do that? Because they want to spend time with family and friends.

• 31:58Speaker 00

  That's like, that's what it boils down to. So it's the spending time with people that is the primary motivator for all of this in the first place, right? So you don't want to miss out on that in the pursuit of it because you'll never actually get the thing that you're trying to live longer for in the first place. So I think that for most of us, that should have kind of like framed why are we even doing this in the first place? To kind of, to go to the three S model. So this is kind of my idea of how we bring together all these different aspects of lifestyle and the environment that affect cognitive function. But it's actually, this is the same, the same principles work for physical function and, you know, many other aspects of our health. And so the three S is a stimulus, supply and support.

• 32:42Speaker 00

  So stimulus being how, essentially how we're using our brains. The idea is that how we use our brains is the primary determinant of how our brains function, just like how we use our bodies is the primary determinant of how our bodies function. And that could be, you know, learning, skill building, languages, music, but of course, like social interaction. And there are many examples where there's an outsized benefit from something that includes doing it with other people, be that volunteering or sports, you know, dancing and like similarly, languages, music often happen with other people, right? That's why, that's why you do it, is to play with other people or perform in front of

• 33:27Speaker 00

  other people or to kind of do something communally. And so that kind of is the driver of adaptation, building structure and function in the brain. And then you kind of activate networks in the brain in order for those networks to do what you're asking them to do, you need a supply of various things. So that's our second S. So it's blood supply, energy supply, and then nutrient supply. So these things come from physical health, cardiovascular health, diet quality. And then, like we were kind of talking about earlier, right? We know that stimulus drives some version of a stress response. This drives adaptation. So that brings us to our third S, support. And most adaptation happens during sleep, but essentially during periods of rest.

• 34:11Speaker 00

  So that's the kind of major part of support. But then we can support adaptation in other ways. Hormonal status is important as well as avoiding, you know, and other kind of aspects of physical health that sort of support adaptation. And then avoiding things that impair that process. So alcohol, smoking, the certain environmental exposures that can kind of increase inflammation or oxidative stress, which some of which I think we'll get to today. So that's kind of, that's kind of the three S's. But so many of like, the overall goal of thinking about the three S model and then many of the primary inputs in the stimulus bucket come from things that either we learn

• 34:52Speaker 00

  and do with other people or where we can, we want to express them and use those skills and abilities with other people or cognitive functions, be able to, you know, play with our grandkids or, you know, do any kind of sort of sport or other activity with them. And that's why we're trying to maintain function in the first place. So I really think that that part of human connection is critical to all of this. And I will say that I wrote a paper on this with my colleague, Josh Turkner, a few, a few years ago, talking about how the sort of potentially the primary driver of loss of function with age, and this was focusing on cognitive function, was stopping doing

• 35:36Speaker 00

  the things that maintain function, right? Stopping stimulating the brain. And then when I spoke to my friend, Julian Abel, who is, you know, famous for his work in compassionate communities and, you know, the importance of social connection on health, his response was like, was yes, this is great, but of course it's all driven by the human need for social connection because so much of this happens through our connections with other people. And, you know, he's absolutely right. That is sort of like fundamental to so much of this.

• 36:04Rangan Chatterjee?

  Yeah. Can we say that social isolation is a form of stress?

• 36:09Speaker 00

  So, yes, on multiple levels, we, we see in controlled studies that being socially isolated increases stress responses, which you can, you know, measure through things like heart rate variability and cortisol levels. And there are studies where they've done this, for instance, NASA and other space agencies around the world have wondered, how will people do if we, if we send them to Mars, right? So there've been some Mars simulation projects where you put people either on their own or a very small group in a tight confined space for extended period of time. And even that, for just weeks, significantly increases stress responses.

• 36:53Speaker 00

  We know it's inherently stressful, even if there are other people there, you're relatively isolated because there's only one or two other people. And we also know that when you look at, when you look sort of across a big population, those who are more socialized, particularly those who feel lonely, they have other markers of, of a heightened stress response. So you can measure these stress responses in people who are isolated in a variety of different ways, either experimentally or just as part of their, you know, unfortunately where, where they are in the world right now. On the other side, you can also see a response or changes in the brain with social isolation that look like the removal of stimulus and accelerated brain aging.

• 37:38Speaker 00

  So when you look at the areas of the brain that are, the human brain that are most driven by the environment and are most driven by experience and sort of interaction with the world around you, that they're also responsible for some of our most complex cognitive functions, areas like the prefrontal cortex, the lateral parietal lobe, the lateral temporal lobe, so kind of like the front and sides of the brain essentially, which are responsible for things like decision making, focus and attention, memory, language, you know, vision or visual processing, social cognition, things like that. These areas of the brain are essentially completely undeveloped at birth.

• 38:21Speaker 00

  They are, their development is driven by the environment and how you engage with it during childhood and then early adulthood. But these are also the areas of the brain that are most susceptible to the processes of aging, particularly the removal of stimuli, right? I mentioned earlier that part of the reason why I think our brains age is because we stopped doing the things that help build these functions in the first place, interacting with other people, learning skills, focusing on stuff, you know, kind of doing complex activities. And those areas of the brain that I just mentioned, when you look at people who are socially isolated, those areas of the brain are the areas of the brain that tend to either get smaller or tend to lose function.

• 39:02Speaker 00

  And they've done studies where you look at, yeah, so people from those like sort of simulated Mars trip studies or people who were polar explorers, right? On their own, off, you know, on some snowy glacier for months on end or in prisoners who are placed in solitary confinement. Those same areas of the brain that I mentioned tend to lose structure and function as a result of that loss of social input. So not only is social isolation and loneliness, not only are they inherently stressful, you're also removing a critical input that maintains these really important structures in our brains.

• 39:42Rangan Chatterjee?

  Even if you're a polar explorer, right? And you're getting stimulated by all kinds of things in your environment and, you know, you have to be vigilant and all, all kinds of stuff, right? Even with that kind of stimulation, you're missing out on a very important part of stimulation or stimulation for the human brain. And it made me think, the brain needs stimulation, and this, I guess, fits in with the second mistake of focusing on solo health habits at the expense of social connection. Let's say you're an 80 year old and you live by yourself, okay? And you've heard Tommy Ward or you've read your book and you go, yeah, I need to stimulate my brain. So you are learning new skills on your computer, you're competing at chess online with other

• 40:27Rangan Chatterjee?

  people, but you're doing it all in isolation. So you're giving it a lot of stimulus, but it's individual stimulus as opposed to social stimulus. Can we say then, or do you, can we hypothesize that even with all of that stimulus, you are still missing a significant primary stimulus that the brain needs, which is social connection?

• 40:54Speaker 00

  The way that I would answer it is that if that person feels lonely or feels that beyond what they're currently doing, they lack some kind of purpose or meaning, then yes, I think there's more to be gained. If that life is incredibly fulfilling to them, which for some people it will be, then no, I couldn't say, well, you have to go out and make friends, right? So I think some of it is going to come down to like fundamentally, how do you feel about the kind of setup and your current connection to other people? Because often when you talk about social connection,

• 41:35Speaker 00

  and rightly so, some people will say this is directed at extroverts who like to spend time with other people.

• 41:42Rangan Chatterjee?

  I was literally going to bring that up, exactly.

• 41:44Speaker 00

  And you can be connected to a lot of people and still feel lonely. And some people only need a very small amount of human connection to feel like, you know, they're getting everything they need. My friend, Dr. Ben Ryan, who wrote an excellent book called Why Brains Need Friends, you know, talks about, you know, a flower in a pot. And like some people, the soil in the pot needs a lot of watering, right? It needs a lot of social connection for them to feel kind of fulfilled. But like, some people are a succulent or a cactus, right? They only need a little bit and they feel just fine. And like wherever you are on that spectrum is absolutely fine, as long as you're getting what you need to feel like you're connected, to feel like you're supported, to not feel lonely, to feel like you have,

• 42:29Speaker 00

  you know, some kind of, you know, your life has some meaning, you know, outside of just yourself. So I want to make that very clear, that it will come down to how you feel about the situation.

• 42:39Rangan Chatterjee?

  Yeah, that's a really important point. And I think for those people who were pushing back when they heard social connection, I think that hopefully appeases people and helps clarify things. Okay, we've done two of these mistakes so far. Mindset and this solo health habit focus at the expense of social connection. I'm going to go to some areas that I think we haven't spoken about before. One is blood pressure. So I would say mistake number three that I think gets made a lot is ignoring high blood pressure. Do you agree with that statement, Dr. Wood?

• 43:13Speaker 00

  Yeah, yes. And I didn't necessarily realise it until I was doing the research for my book, but the evidence for blood pressure management and dementia risk is actually incredibly strong. It's one of the few interventions where we have multiple randomized controlled trials that have been put into meta-analyses to show that if you address this risk factor, you see a significant reduction in dementia. Most of the other things we talk about come from big population studies, observational studies. Yes, we're pretty sure that that connection is there. And if you modify this risk factor, you'll see benefit. But blood pressure actually has really high quality evidence.

• 43:56Speaker 00

  So when we talk about blood pressure normally, we're usually thinking about heart health, right? And, you know, heart disease risk, and it's obviously important there too. But if I've learned one thing over the past few years is that even when people are taking cardiovascular disease risk fairly seriously, it's not as much of a motivator for behaviour change as we might hope. Whereas when we think about this in terms of our brains, often that's the right, somebody wouldn't maybe worry about their blood pressure, oh, it's a little bit high, it's probably fine. When you then realise that this is a, you know, a critical risk factor

• 44:41Speaker 00

  for the majority of dementias, both Alzheimer's disease and vascular dementia, which have a lot of overlap and they, between them, they make up 70 to 90% of dementias. Often that's the key maybe to, for people to think about it. But we don't really think about the brain when we think about blood pressure. But we know that once your blood pressure goes much above sort of 120 over 80, and you're really, once you get into the sort of the metabolic syndrome, criteria level of blood pressure, which is usually one over 130 over 85, you see a significant increase in the risk of dementia. And if you can reduce it, you see a significantly reduced risk of dementia. And the sort of the average benefit is if you can get your systolic blood pressure down by about 10 points,

• 45:26Speaker 00

  you see a significant benefit in terms of your dementia risk. So there are multiple ways to do that, right? We know we can do it through physical activity. We can do it through other, you know, other lifestyle changes to improve metabolic health. But these studies are with blood pressure medications and you see significant benefit in terms of dementia risk. So if you need a blood pressure medication or your blood pressure is high and is not fully controlled, you know, I think that is something that we really should take seriously.

• 45:50Rangan Chatterjee?

  Yeah. I guess one of the problems with, or potential problems with blood pressure is that people often don't feel anything wrong.

• 46:04Speaker 00

  Yeah.

• 46:05Rangan Chatterjee?

  They used to call it the silent killer, right? I think certainly in medical school, I'm pretty sure that's what we used to get taught, that it's just going on in the background. I'm literally at the moment trialling the Hilo bands. I think it's the, to my knowledge, it's one of the only FDA approved continuous blood pressure monitors. The goal is that that is telling you more accurately whilst you're going about your everyday life, what actually is my blood pressure doing?

• 46:32Speaker 00

  Yeah.

• 46:34Rangan Chatterjee?

  But of course, you know, there are 24 hour monitors that you can get on the NHS. So there's all kinds of ways. But I guess the message you're sort of, I guess, trying to give people around brain health is get your blood pressure checked.

• 46:46Speaker 00

  Yeah, and we've now gotten to a point where you could go to Boots and a blood pressure monitor, was it 20 or 30 quid?

• 46:54Rangan Chatterjee?

  Yeah.

• 46:55Speaker 00

  Probably not that much.

• 46:55Rangan Chatterjee?

  Probably not anymore.

• 46:56Speaker 00

  And if you do it two or three times a day at home, or you could even get it, you know, your GP could prescribe it for you on the NHS, right? So you might not even have to pay for it yourself. But just like, like you said, having some idea, you know, what's in the morning, what's in the afternoon, take it two or three times a day. That's going to give you a much better picture. Plus you get used to having your blood pressure taken. So you have less of that kind of anxiety of, you know, it feels kind of weird and, you know, getting stressed about what it might be. And I think now it's gotten to a point where blood, you know, relatively regular blood pressure monitoring is something that's easy for all of us to do and, you know, we should be doing.

• 47:33Rangan Chatterjee?

  Yeah, I think that's a good segue to get into the fourth mistake, which is not doing any form of blood testing until, maybe until you get sick, right? Before we just jump there though, I guess this is related to blood pressure. I mentioned earlier on in this conversation that over the last 12 months, I have taken up paddle. One thing I've noticed since I started playing, and you've got to bear in mind, it wasn't as if I was sedentary beforehand. I was already, I would say, pretty healthy before I started playing paddle. My resting heart rate has gone down by about four beats, right? That is significant. We've never covered resting heart rate before.

• 48:18Rangan Chatterjee?

  There is a linkage here with blood pressure, of course, but, you know, as well as being a brain health expert, you're a performance coach for Formula One drivers and a lot of high level athletes. What is the benefit of a resting heart rate going down in this context?

• 48:31Speaker 00

  Yeah, the, there are several metrics that you can sort of track physiologically that do seem to correlate with longevity, chronic disease risk, you know, heart disease risk in particular. And resting heart rate is one of them. Heart rate variability is another. And I imagine if your resting heart rate has dropped, your heart rate variability has also gone up.

• 48:56Rangan Chatterjee?

  Yeah.

• 48:57Speaker 00

  And then resting respiratory rate is another one that maybe we don't appreciate as much, which is basically, you know, how many breaths you take a minute. And that also seems to be a good predictor of, you know, stress burden and other things, as well as being, you know, related to some aspects of long-term health. And when your resting heart rate is lower, your heart is essentially more efficient, right? To get blood around the body. And we know that those who have a low resting heart rate tend to be fitter. They tend to live longer. They tend to, you know, have fewer chronic diseases, less heart disease. And that's probably a combination of, yeah, improved fitness, decreased stress responses and, you know, all those kinds of things related to that.

• 49:42Speaker 00

  So having lower resting heart rate is absolutely like a measure of better sort of like overall health and fitness. Like you said, in this context, there are times when low resting heart rate can be a bad thing. You have later risk of things like heart disease, heart failure. And so by improving efficiency and improving heart function, you're decreasing the risk of that happening long term.

• 50:09Rangan Chatterjee?

  Yeah, and almost certainly, had I been tracking my blood pressure, which I was not, I might also see that come down as a consequence, right? Because these things, of course, don't work in isolation. Let's get to that mistake number four, you know, this idea of not doing any form of blood testing until you get sick. And I guess underpinning this as a mistake is an idea that I don't think is widely known with the public. And, you know, I very much appreciate your take on this, which is this idea that the bulk of our medical education, and I would say certainly here in the UK,

• 50:47Rangan Chatterjee?

  the way the NHS is broadly speaking set up is to diagnose disease and treat it. Okay, and I think it can do that exceptionally well.

• 51:00Rangan Chatterjee?

  The creation of health is a little bit different from the diagnosis and treatment of disease. And one of my frustrations over the last couple of decades or so has been that we in medicine, and maybe we could argue there's no resource for that within medicine, but for whatever reason, I feel that people are allowed to deteriorate somewhat, not quite get into a disease category, but deteriorate and say everything's fine until actually something happens. Oh, you've got type 2 diabetes. Let's talk about metformin and insulin and sulfonylureas and all that kind of stuff, right?

• 51:45Rangan Chatterjee?

  So this idea that HbA1C, for example, your average blood sugar marker, here in the UK, at 6.0 in old money, it becomes prediabetes. At 6.5, you're called a type 2 diabetic, but that does not mean that 5.7 and 5.8 and 5.9 is fine. And many people in the UK, if you go and get an HbA1C test from your doctor, you're told that's normal. Now, there's a resource issue within the NHS, I accept.

• 52:25Rangan Chatterjee?

  At the same time, I think our approach to prevention is a little prehistoric. It's kind of a 20th century approach, even though we're now at 2026, we're in the 21st century. And so I believe it's much better if we were able to track certain metrics and start to see when things start to go wrong. So we can say, hey, listen, you're not prediabetic, but you're not where you were a year ago. You're on the way. Would you like some help in making some changes which will perhaps stop this process? Right? So do you have any sort of thoughts on that initially at least?

• 53:06Speaker 00

  I completely agree with you. This is relevant to pretty much any chronic disease. It's relevant to, we've talked about blood pressure, it's relevant to blood tests. I mentioned cognitive tests previously, like just in passing earlier, because nowadays you can't get cognitive tests from a neurologist or an old age psychiatrist or whoever would be doing it until somebody suspects you have cognitive impairment. There had to be some trajectory of decline, but we know, no idea where you started, no idea how long that took, no idea how long you've, or like how much function you've lost in order to get to the point where somebody diagnoses you with, say, mild cognitive impairment from a cognitive function test. Because we don't track these things over time.

• 53:50Speaker 00

  A charity that I work with, Food for the Brain, that has an online cognitive function test, that people can do for free if they're interested, but more importantly, they just got a big Invent UK grant to try and develop it so that it can be used in the NHS. Hopefully so that people will do it more regularly and then they can track their own function over time. But this relates, this relates to everything.

• 54:12Rangan Chatterjee?

  Why I think it's so important, right, is because if you were doing an annual cognitive test, you may realise that 48, hey, listen, at 45 I was scoring here, at 48 I've just gone down a bit. Jesus, hey, doc, what can I do here? So it might motivate people to start these changes earlier.

• 54:34Speaker 00

  Yeah, absolutely. I think that's the case for many, you know, very basic blood tests, just like it was, just like it is for blood pressure. We have to have diagnostic cutoffs, like the ones you mentioned for prediabetes and type 2 diabetes when it comes to blood sugar. You have to have some decision-making point where you then say, right, this is the, this is, right now it's time to treat with the medication. I completely understand why we have those, that's very important. But blood sugar is a good example, so HbA1C, because two people can have the same HbA1C but have very different blood glucose or blood sugar trajectories or experiences over the day. Because HbA1C is affected by many other things, including the life of your red blood cells

• 55:18Speaker 00

  and there's some genetic components as well. So what they do is they say your HbA1C is this, your average blood glucose was this. But actually, there's a huge amount of error in that. Like, two people with the same HbA1C can have very different average glucose levels. And one may be problematic, but the other may not be. And so where HbA1C is most useful is tracking your own changes over time. So, but again, you can't do that unless you have a baseline. What was my HbA1C when I was young, healthy? Everything was good, right? Because for some people, that might be close, might be not that far from a prediabetic cutoff, but from other people, for other people it may be much lower. And then it's watching that change over time.

• 56:01Speaker 00

  And when it does start to change, realising, oh, maybe, maybe now's the time, or, you know, I should be doing something to intervene.

• 56:06Rangan Chatterjee?

  Yeah. This is one of the reasons that I have created something called Do Health here in the UK initially. And the truth is, I never had any aspirations to do something like this, a health app, a preventative health app to help people get on top of their health early. But what I realised, Tommy, is that I've been talking about this stuff with the public now for maybe 12 or 13 years. And people were saying, yeah, Dr. J, I get all this, but I'm going to my doctor and I can't get this, right? And some of the tests that you talk about, like fasting insulin or homocysteine, I just can't get, I might be able to get an A1C, but I can't get it regularly, I can't track it.

• 56:49Speaker 00

  Yeah.

• 56:50Rangan Chatterjee?

  And I've been wanting the NHS to do this in the UK for years. I mean, my honest hope with Do Health is that within a few years, we'll have proved the case that the NHS take it and go, actually, we want to roll this out, let's see what actually happens. But this idea that if you can empower people early, you can see certain things early, you can actually do something about it, and there's, you know, there's coaching built in and all this kind of stuff, which, so it's not just do it, it's like, let's find out where your current state of health is, let's help you make changes, and then let's recheck to see if those changes actually made a difference. I don't want to go through all the tests that we're doing, but two, I'd love your

• 57:32Rangan Chatterjee?

  take on, and I really pushed hard for these two, because you can't really get these easily on the NHS, is fasting insulin and homocysteine.

• 57:42Speaker 00

  Both are very important. Homocysteine, we'll start with. So homocysteine is a, is a marker related to methylation in the, in the body, particularly related to the status of B vitamins related to methylation. So B12, folate, B6 and riboflavin for, for most people, you know, and there may be a genetic component there as well. So the two most, the two most important are B12 and folate. And we know that having elevated homocysteine is associated with a higher risk of cardiovascular

• 58:26Speaker 00

  disease, but also in particular dementia. So it also influences the trajectory of cognitive decline. So those who have elevated homocysteine have a more rapid rate of brain atrophy, right? Their brain shrinks faster and they lose cognitive function faster, or their cognitive function declines more rapidly. The sort of, the threshold based on the randomised control trials that have been done is probably somewhere around 10 or 11. So ideally, you'd get your homocysteine below 10, you definitely want it below 13 because that's, that's considered elevated and you'd see a more rapid cognitive decline associated with that.

• 59:08Speaker 00

  And then the, the intervention that you would do is, you know, supplement with B vitamins or make sure that you get enough B vitamins in your diet. The proportion of people who have very high homocysteine has come down a bit in countries that have started to fortify white flour with folic acid. So in the, there's a big population study is done in the US where they started to fortify flour with folic acid in 1998. The proportion, the number of people who had elevated homocysteine did decrease after that. So just, we know that getting more of this in the diet definitely brings homocysteine down. Randomised control trials have used folate and B12 and then plus or minus B6 as well.

• 59:53Speaker 00

  And we also know people, in particular people who have MTHFR polymorphisms, they have elevated homocysteine if they don't get enough riboflavin. But by enough, I just mean the recommended daily allowance.

• 1:00:04Rangan Chatterjee?

  Tommy, I know what you mean when you say that, but a lot of people will hear MTHFR polymorphism and go, say, come again? So could you, could you just try and explain?

• 1:00:13Speaker 00

  Absolutely.

• 1:00:14Rangan Chatterjee?

  In layman's terms, what that means?

• 1:00:21Rangan Chatterjee?

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• 1:03:27Speaker 00

  Yeah, so unfortunately, you'll actually, I imagine, a lot of people who've listened to this podcast will have heard about MTHFR. It's a gene, methylene tetrahydrofolate reductase. There'll be a test later. That is involved in this sort of methylation pathway, which is essentially, what methylation is, maybe let's talk about that. Methylation is this process of moving carbons with some hydrogens attached, there's one carbon with three hydrogens as a methyl group, moving them around the body. And when you move methyl groups, you turn on genes, you activate proteins, it's like

• 1:04:10Speaker 00

  this really important signalling molecule that we use to kind of control biological processes. And the B vitamins are involved in kind of providing the methyl groups for our body to do that, just to kind of move these signals around, to turn things on and off. And so, one of the enzymes in that pathway, MTHFR, it's very common, most of us have a polymorphism, which is just a slightly different genetic code that makes this enzyme, that just changes how that enzyme functions a little bit. And we're often, if you go out into the world and you look up MTHFR, it's usually like

• 1:04:53Speaker 00

  sold as this disastrous thing, like your body can't do these methylation processes, and you need all these fancy supplements to overcome it. None of that is true. And so, if you go out and see a bunch of doom and gloom around MTHFR, I would ignore the vast majority of it. Because most of us, actually, the majority of people have one of these polymorphisms that changes activity a little bit. But what these polymorphisms do, and they absolutely have some kind of benefit, right? Because most of us have at least one, is that changes how that enzyme binds to a cofactor, a cofactor being the thing that just allows that enzyme to run. And that cofactor is made from riboflavin, which is vitamin B2. And there are studies, there are randomised controlled trials that show that if you just

• 1:05:38Speaker 00

  get enough riboflavin, which you can find in whole grains and liver and things like that, then it's not an issue. So, for most people, if you go out and you kind of see what's on the internet, you'll be told that things like homocysteine and methylation are driven by your genetics. They're not. They are largely determined by nutrient status, just getting enough B vitamins. So, if you just get the recommended daily allowance, you've ticked that box. But if you do measure homocysteine and it's elevated, then the other B vitamins are a great place to start. There are some other things that you can think about as well, but those core B vitamins

• 1:06:22Speaker 00

  are really the main drivers.

• 1:06:25Rangan Chatterjee?

  This just highlights something that has happened in the last 24 hours. So, one of my really good mates has just done their do health blood tests. And he texts me yesterday, saying, mate, I've got my results, and I'm loving it, loving the whole thing, and the app and the explanations. And so, mate, if you're open to sharing, send me them and I can give you some advice if you want. Now, he gets advice on the app anyway, but his homocysteine was 15.

• 1:06:53Speaker 00

  Hmm.

• 1:06:54Rangan Chatterjee?

  Okay. Now, why I'm so passionate about this, Tommy, is that you've already mentioned, and I don't know if we've covered before or not, but this idea that elevated homocysteine can increase your risk of cognitive decline as you get older. He has a family member who has got dementia.

• 1:07:13Speaker 00

  Hmm.

• 1:07:15Rangan Chatterjee?

  Now, it could well be for this individual that this elevated homocysteine is increasing his risk of cognitive decline, like some family members of his. I'm being very careful, so it's not possible to identify who this person is I'm talking about, okay? So, what's really interesting is if you don't have your homocysteine checked, which is the norm at the moment, I would say in the NHS, then you don't know a critical piece of information that is actually quite easy to address.

• 1:07:51Speaker 00

  Yeah.

• 1:07:52Rangan Chatterjee?

  I said to him, listen, mate, you can try it with diet. If that doesn't work, it's quite easy with relatively simple supplementation of B vitamins and folates to bring that down. I said, at the same time, mate, you've got to be, you've got to understand that your omega-3 status is also important here. But the point is, is that that piece of information will directly impact his behaviour. And when he rechecks the bloods in four months, we will know, has that made a difference? If it has, great, have we brought it down under 13, but ideally under 11, under 10? And that is a meaningful piece of the picture in terms of his risk of getting dementia in the future.

• 1:08:36Rangan Chatterjee?

  So, when I think about prevention, one of the things that led to me doing all the work to try and create this is to go, well, there is another model out there for prevention that doesn't currently exist. But any comments at all on what I just said about homocysteine and sort of my friend and how he can meaningfully reduce his risk of getting sick in the future?

• 1:08:54Speaker 00

  Yeah.

• 1:08:57Speaker 00

  So, one of the reasons why homocysteine isn't routinely measured is because homocysteine had a moment 20 years ago in cardiovascular disease and neurological disease, or neurodegenerative disease prevention. And then, there were some trials where they gave people B vitamins and they didn't really see much of an effect. And so, everybody, like, if you speak to neurologists now, most of them will say, oh, well, we looked at homocysteine and we tried it, and the supplements don't work. Now, the critical part of that then is what you mentioned about omega-3s. And this has now been replicated in multiple clinical trials.

• 1:09:37Speaker 00

  And it actually makes perfect sense that if you take a person and they have insufficient levels of one B vitamin, they're, or one vitamin, one nutrient, they're probably going to be insufficient in others, right? Not everybody, but in general, these things don't come one at a time. And when we've done clinical trials in the past, we haven't looked at a full picture of somebody's nutrient status and kind of addressed multiple things at the same time. We just like, we've done the same thing with omega-3s, actually. This person's at high risk of dementia, we give them omega-3s, does it decrease their dementia risk? Nah, it doesn't seem to have a big effect in most clinical trials because we didn't check whether this person needed more omega-3s in the first place or not.

• 1:10:22Speaker 00

  Plus, nutrients don't act one at a time.

• 1:10:26Rangan Chatterjee?

  Yeah.

• 1:10:27Speaker 00

  Right? In order to send a signal in the brain, you need B vitamins, right, for mitochondrial functions, right, for your brain to make the energy to send the signal in the first place. And then, you need to send that signal down a long kind of arm of the neuron, we call an axon, and it's got this sort of wrapping of fat around it to kind of allow that signal to be transmitted faster, called myelin. And it's like, iron status is really critical for myelin. And then, you get to the end, and you're trying to send the signal, if it's like a serotonin neuron, right, then we need vitamin D in order to make that serotonin in the first place, and we need omega-3s to kind of sit at the end of that neuron at the synapse

• 1:11:12Speaker 00

  that sends the signal to the next neuron. We need, like, DHA, which is a long chain omega-3, kind of concentrates there, because it's really important to kind of make the little sort of envelopes or vesicles of neurotransmitters to send them, right? So- You need all of those things for that to happen at its kind of best. And so for this reason, when you look at sort of multi-component interventions, or you look at the status of multiple nutrients, you see that they interact. So the first time this was found, this was the Vitacog study run by David Smith at the University of Oxford.

• 1:11:50Rangan Chatterjee?

  Yeah.

• 1:11:50Speaker 00

  And this was the first study to show that if you have people with high homocysteine and you give them B vitamins, you slow their rate of brain atrophy and cognitive decline. But only if they have adequate omega three status. That's now been replicated in multiple clinical trials. You can't just address one or the other. You need B vitamins and you need omega threes. So this is one of, you're thinking about this as like a single variable nutrient problem is one of the reasons why it's hard to get a homocysteine test today. Because those previous trials didn't kind of address this full, this, this full picture.

• 1:12:24Rangan Chatterjee?

  But that's the kind of hangover of

• 1:12:28Rangan Chatterjee?

  the kind of reductionist approach to health that we've taken, right? Which is obviously how we test pharmaceutical interventions. You know, you 100 people, 50 get the drug, 50 don't. Is there a difference?

• 1:12:40Speaker 00

  Yeah.

• 1:12:41Rangan Chatterjee?

  But of course, as you're saying, you know, and I love the Vaisco trial, this idea that, yeah, lower the homocysteine and it will lower your risk of cognitive decline if you have sufficient omega three. If you don't, it won't.

• 1:12:56Speaker 00

  Yeah.

• 1:12:56Rangan Chatterjee?

  I think is very, very empowering, which is why I told my buddy, I said, omega three needs to be there as well, right? So of course, testing omega three is a little bit harder.

• 1:13:06Speaker 00

  Yeah.

• 1:13:06Rangan Chatterjee?

  Do you think people need that? Or if they're, I guess, if you're, if you're eating fatty fish two to three times a week, do you really need an omega three test?

• 1:13:15Speaker 00

  Yeah.

• 1:13:15Rangan Chatterjee?

  Maybe if you're vegan, it's a good idea, you know? How do you think about this?

• 1:13:18Speaker 00

  Yeah, it's an important question because very quickly we can accumulate a large, you know, bill of tests, right? A large costs for all of these tests. But I will say that, so Food for the Brain, the charity that I mentioned, does have an at-home blood test called the DRIFT test that includes Hb1c, vitamin D, homocysteine and omega three status. You have to, you have to, you have to pay for it. It's somewhere between one and 200 pounds. So it's not cheap.

• 1:13:49Speaker 00

  And I'm not saying that everybody needs to do that test, but if somebody wants to test the omega threes, right, that, that is an option. The, when you then think about testing omega three status, dementia risk, if you're regularly eating fatty fish, cold water fish, sardines, mackerel, salmon, two or three times a week, you probably don't need, you probably don't need to test. Equally, if you're not doing those things and you'd rather just, you know, take a high quality fish oil or omega three supplement, I think that's fine too. And often, you know, when I talk about this, yes, those who are vegetarian or vegan, they certainly have questions.

• 1:14:30Speaker 00

  I would recommend like an algal, you know, an algae-based omega three supplement. So it's, it's not an animal-based supplement, but you, you can still get those fats in your diet. And then, you know, you take, you know, one to two grams of omega threes a day. That's probably going to cover your bases. That's going to, you know, that's, I think that's going to be enough for most people.

• 1:14:51Rangan Chatterjee?

  Yeah, we, on DoH, we don't actually test omega three. Maybe it's something we'll bring in at some point. In fact, one thing I was very clear on is that over-testing is a massive problem.

• 1:15:02Speaker 00

  Yeah.

• 1:15:03Rangan Chatterjee?

  You know, one thing I've, I know in America, there's loads of companies now who are doing, you know, we're going to do 200 biomarkers, we're going to do 400, we're going to do 600, right? And I get that. One thing clinical practice has taught me is that too much data and too much information becomes very, very confusing. So our focus really is on what I call the 11 core biomarkers, which are, I think 11 biomarkers, which have a really good amount of evidence and science behind them, which are all to do essentially with metabolic health.

• 1:15:34Speaker 00

  Yeah.

• 1:15:34Rangan Chatterjee?

  And interestingly enough, and I can't remember the exact statistic, just on homocysteine, Tommy, I think so far, the few thousand people who've gone through, I think over 25, might even be over 30% of people have got elevated homocysteine, which is quite interesting.

• 1:15:50Speaker 00

  Yeah. There's been some recent discussion about where these blood tests fit in dementia prevention in particular. So I think last time we talked about the Lancet Commission Report on Dementia Prevention, run by Professor Jill Livingston. They identified 14 modifiable risk factors for dementia, estimated that 45% of dementias may be preventable.

• 1:16:12Rangan Chatterjee?

  But diet wasn't in that, was it? And those 14, I don't think.

• 1:16:14Speaker 00

  No, it wasn't. And so there were actually letters written to the Lancet where it was published. And then there was, this was actually discussed in the sort of popular media as well, that B vitamins and omega three status weren't discussed, you know, even though we have some fairly good evidence for those. I absolutely don't want to put like words in people's mouths, but there was some discussion as to whether insufficiencies in B vitamins and omega threes were common enough that it was worth kind of, you know, building an evidence base around them. But like, I think you're right, that particularly as people get older, 10 to 20% of individuals at least may have elevated homocysteine. So that's like a significant chunk.

• 1:16:56Speaker 00

  Your previous analysis done by other groups suggested that potentially up to 20% of cases of dementia were related to elevated homocysteine and low levels of omega threes. So that's, you know, even if, even if it's not 20%, it's still a meaningful.

• 1:17:13Rangan Chatterjee?

  Significant, yeah.

• 1:17:13Speaker 00

  It's a meaningful contribution to, to future risks. So, yeah, I think to kind of go to your original point about like, what's it worth testing? I also agree that just like more testing isn't, isn't always the answer. And I do agree with this idea that if you're doing a test, you should be answering a specific question, like, why am I doing this test? So rather than just like doing a scattergun, test everything. And right in, in medicine, we have this idea of a pre-test probability, like how likely is it that you're going to find something that you, and that you can address it?

• 1:17:48Rangan Chatterjee?

  Yeah.

• 1:17:48Speaker 00

  And I think that's really important. So we focus on metabolic health. We know that the vast majority of adults have at least one risk factor for metabolic disease, right? So it's very likely that you're going to find some kind of modifiable metabolic health.

• 1:18:06Rangan Chatterjee?

  That's why we focus on metabolic health. And I had a criteria when choosing the 11, that there's got to be a good evidence base behind them. And we've got to be able to do something with the results.

• 1:18:16Speaker 00

  Yeah.

• 1:18:17Rangan Chatterjee?

  And I guess in answering some of the stuff around homocysteine and omega threes, we, we've slipped into mistake number five, which is thinking all supplements are a waste of money. Okay. So again, the framing here is that Tommy's been on this show four times in the past. So this is appearance number five. If you haven't heard the first four, please go and listen to him. There are a wealth of information. The whole point of today is to go through common mistakes that people often make when it comes to brain health and longevity. We've done four so far. We've covered mindset, social connection, high blood pressure and sort of testing. The fifth one, which I think relates to what we've just been talking about, is this idea

• 1:19:01Rangan Chatterjee?

  about, you know, supplements, thinking all of them are a waste of money, I think is a common mistake. You've already mentioned the potential benefits of B vitamins and omega threes. I want to go through some other supplements with you to get your take on them. But I wonder if it's worth talking about the Cosmos trial?

• 1:19:17Speaker 00

  Yeah.

• 1:19:17Rangan Chatterjee?

  And what your take is on that trial? Cause I thought it was really quite illuminating.

• 1:19:22Speaker 00

  Yeah. So the Cosmos trial was a recent trial run in the United States. Thousands of people, it was a massive trial. Older adults, randomized to four different groups. So they had a control group and then they had a group that took a basic multivitamin. Centrum Silver was the multivitamin. It, Centrum Silver essentially just has 100% of your RDA of like the basic vitamins. Another group got cocoa flavanol supplements. So cocoa flavanols are like the polyphenol, the antioxidant polyphenols that are in cocoa. You know, you, you have similar compounds in coffee, tea, chocolate, berries, for example, like the things that make berries sort of purple and red.

• 1:20:07Speaker 00

  And then one group got both, right? So we call it like a two by two design. And what they found was that in the two groups that got the multivitamin, there was a significant reduction in estimations of brain age and cognitive function, such that, you know, on average, people's brains acted as if they were two years younger. So you kind of saw this slowed slowing of brain aging by taking a multivitamin. And this is the most basic multivitamin, like you go to Boots and you get an over 50s multivitamin, and that's essentially what it is. And I'll also say this about the Vitacog study. The Vitacog, you know, often when we're sold supplements and vitamins, we're like,

• 1:20:49Speaker 00

  you have to have this fancy version and this bioavailable version is going to cost, you know, X amount of money. The best evidence that we have for multivitamins, for B vitamins is the most basic version, you know, the essentials version, you know, some folic acid and cyanocabalamin. If anybody's like, this is a form of B12, it's like the cheap, the cheap version of B12. That's what showed benefit in Vitacog, just like the most basic low, essentially low dose multivitamin showed showed benefit in Cosmos. And there may actually be a thing where your massive doses could potentially be detrimental. Whereas, you know, Cosmos just gave you, you hit a hundred percent of your RDA, you've got your bases covered, that's it. And that showed benefit.

• 1:21:33Speaker 00

  In the, the sort of the cocoa flavanol supplement was a little bit more nuanced, where benefits were largely seen in groups that had low diet quality. So if you're getting few, like plant polyphenol antioxidants, because you don't eat many fruits and vegetables, or drink much coffee or tea, because actually, actually coffee is the most, for most people, is the primary source of antioxidants in their, in their diet. If you had a low quality diet, lots of processed foods, just like processed fats and carbohydrates and few nutrients, a nutrient poor diet, then taking the cocoa flavanol supplement was beneficial. If you already, if you have a high quality nutrient dense, varied diet, it didn't seem

• 1:22:16Speaker 00

  to have as much of an, as much of an effect, which I, which I think makes sense.

• 1:22:19Rangan Chatterjee?

  Yeah. There's often been a negative view with doctors around supplements, possibly because the industry has been unregulated, right? Which, which I, which I get. But the truth is, is that I have seen so many patients over the years where the right supplement can be game changing. But I think the Cosmos trial just showed us that actually for across a broad population, there can be a benefit with the brain for a multivitamin and mineral. Okay, so we're thinking is a really good take home. We've covered B vitamins and omega three. The supplement of the moment is of course creatine. Okay. You take creatine every day.

• 1:23:02Rangan Chatterjee?

  Should the listener also take creatine every day?

• 1:23:09Speaker 00

  I recently heard this nice idea for how to think about supplements that I hadn't really heard before, this is from, I was actually, I was on a panel with Jeff Bland, who many people call it, you know, the father of functional medicine. And the first thing that he said we should think about, not is will, could this work for me, is, is it safe? Because if it, if it's safe, then you can try it with very little risk, right? If we don't have good safety data, then the will it work for me becomes much, much riskier, right? And so.

• 1:23:48Rangan Chatterjee?

  So chemotherapy, right? It's like, you want really good evidence that this is going to help you before you expose yourself to the downsides.

• 1:23:57Speaker 00

  Because we, because there are a lot of downsides, right? And so I think that for most people, you know, a very basic level of B vitamin supplement, right? We know it's going to be safe. If you're not taking your massive, massive doses, you're just going to pee out any extra, like worth potentially trying, especially if you've got some markers to kind of suggest that you could take it. Vitamin D, trickier, because again, in very high doses of fat soluble vitamin, you don't want to overdose on vitamin D, there's some, some downsides there. But we know in people who are vitamin D deficient, absolutely, but you said it's prescribed on the NHS for people who are deficient. We know it's important, brain health, bone health, et cetera. Then you come to things like creatine.

• 1:24:40Speaker 00

  One of the reasons why I think it's actually okay that creatine is the supplement of the moment is because we know it is incredibly safe. It's been tested in probably thousands of clinical trials at this point, randomized controlled trials for various people in various conditions, low doses, high doses, years at a time. Recent meta analysis found essentially no side effects with creatine compared to placebo on, on average. And that's probably because it's something that we can get from the diet, maybe not quite at the doses that some people might take, but you're close. So we know, you know, assuming that you're getting a high quality source, it's not contaminated, contaminated, that kind of stuff, all right? So you would, you want a reputable supplement maker, hopefully they've done something we

• 1:25:25Speaker 00

  call third party testing, it's been tested for impurities, they can send you a certificate to show that they've done that, every, every good supplement, some company would be able to do that. But we know that creatine is incredibly safe, even in sort of like frail older populations. So then we might say, well, is there a possibility that it might benefit me? So creatine has been used for decades as a supplement in like sports performance, particularly, particularly strength and power. It helps you do an extra rep or two in the gym. And then if you do that over time, you can build more muscle, you can build more strength. The effect isn't huge, but it is statistically significant and meaningful, right? It's not, it's not magic, but it helps you do a little bit more work in the gym and that compounds over time.

• 1:26:10Speaker 00

  It's become of particular interest in the brain world recently, because there have been some studies to show that, actually several different studies to show that it might help particularly in what we could call, or what I might call cognitively degraded states. So something has happened that's affected cognition or mood, and then creatine may, may be of some benefit there. So for the average person who thinks that their brain is working really well, there might not be that much of an effect. And so when you look at meta analyses, studies of many studies of creatine, it tends to benefit older people, and particularly is beneficial for memory. That's, that's kind of where it's been shown to, to have some benefit.

• 1:26:51Speaker 00

  In other populations, there's some evidence, there's actually better evidence in like kids with concussions, but there's some evidence that taking creatine after like a traumatic brain injury may help with some elements of recovery. In the, the, the kind of the, the really flashy study that got a lot of press recently was in individuals who were sleep deprived, and they took a high dose of creatine. It was kind of the equivalent of sort of 20 to 30 grams of creatine, when maybe a standard dose is like five to 10 grams. And they saw, saw that the people maintained brain energetics, you can do a brain scan, you can measure energy, sort of the production of a certain energy metabolites in the brain.

• 1:27:33Speaker 00

  And that was, and cognitive function was retained better when sleep deprived, when taking creatine. This was just like a single night of sleep deprivation. And there was an older study in rugby players, actually, that showed that when they were sleep deprived, taking creatine, actually a, a lower dose, sort of five to 10 grams, helped to maintain rugby specific skills when they were sleep deprived, similar to caffeine, actually, because they also did use caffeine in that study as a comparison. So in those kind of settings, when sleep deprived, maybe creatine can help to maintain some elements of cognitive function. And then there were a few randomized controlled trials now, although some people have suggested that, you know, that were done in countries where maybe the quality of the science isn't

• 1:28:18Speaker 00

  as good as in the UK or the US. So some people have kind of questioned the quality of these trials, but it's been shown two or three times that in individuals with depression, supplement, you know, adding creatine to say a medication regimen, if they've, if they haven't had full, you know, remission of symptoms, may, may improve like symptoms of mood and wellbeing, or, or depression symptoms. And again, sort of a five gram kind of dose. So lots of different pockets of things suggesting that creatine may be beneficial for the brain across a wide range of doses. A lot of people are now saying that you take a very high dose for it to benefit the brain, but I don't think we've seen that from the studies. I think we've seen benefit even at sort of a standard lower dose.

• 1:29:03Rangan Chatterjee?

  Which is five to 10 grams.

• 1:29:04Speaker 00

  Which is five to 10 grams. And the reason why they say that is because when you look at studies of creatine, like increasing creatine levels in the brain, that takes longer and higher doses. But you may actually see benefits of creatine before you're seeing increases of, of like creatine levels in the brain, if that makes sense, right? You don't need to be saturating the brain with creatine to see benefit for the brain, because it could be having other, other effects. There was one study in individuals with Alzheimer's disease, where they gave them creatine and saw some improvements in cognitive function. However, there wasn't a control group. And we know that when you enroll people with, even with cognitive decline, in a study,

• 1:29:49Speaker 00

  they tend to do better. They get better at the test, they, they, even though, you know, they're, some of their cognitive function may be impaired, they do better at the test the second time, they start to feel a bit, feel a bit better. There's a placebo effect of being part of a trial, connecting with other people is kind of stimulating in its own way. So I tend to not include that trial when I, when I say there may be some benefits for creatine for the brain, just because it was, you know, no control group. We know in cognitive, in, in studies that look at cognitive function, it's really, it's really hard to, to look at the effect of an intervention without having a control group, because you get better at the test, there's significant placebo effects, things like that.

• 1:30:31Speaker 00

  So, but if you're somebody who identifies with any of those things that I mentioned, right? Sleep deprivation, maybe some issues with memory when you're older, you know, maybe you're, you have been diagnosed with depression and you, you have had some benefit from a medication, but you might consider adding creatine on, which is what some of these studies have done, then I think it's worth trying. We know it's safe, it's cheap. It's not, again, it's not going to be a panacea, it's not going to be magic. But, you know, I think we're starting to see more and more evidence that it may have some benefits for the brain.

• 1:31:07Rangan Chatterjee?

  Are you happy to share why you specifically choose to take it?

• 1:31:10Speaker 00

  Yeah, I mainly take it from a performance standpoint. So I train for and compete in Strongman. And so I, I definitely can tell that I'm just a little bit, little bit stronger, you know, a little bit faster in the gym when I'm, when I'm taking it. I find creatine to be mildly stimulating for me. And that is the case for some people, like, like I kind of mentioned, that rugby player study, right? Seeing similar benefits with creatine versus caffeine in the setting of sleep deprivation. And so I definitely noticed that if I take it later at night, I don't, I don't sleep as well. And so for the same reason, I do feel like I get a bit of a cognitive boost from it when I take it in the morning. But some of it might be placebo, right?

• 1:31:54Speaker 00

  I kind of maybe expect some of that. But it could be that if you do get a mild stimulating effect from it, whereas caffeine can often like over stimulate people where so say if you, if you had several espressos before you played paddle, you might be sweaty, anxious, you like, you don't, you don't quite have the accuracy because right, you're, you're sort of over stimulated. Creatine could give us like a mild stimulating effect and it doesn't happen to everybody, but those who experience it, you know, if you're one of those people, maybe it's useful then. But in terms of sort of the, the strength and the power effects and the fact that, you know, paddle is more of a sort of aerobic cardio type sport.

• 1:32:37Speaker 00

  It's less likely to give you that kind of performance benefit. But there's a possibility that in some people, there may be some kind of cognitive effect.

• 1:32:43Rangan Chatterjee?

  But then bringing it back to the start, if you bring up mindset, right? And so there's good science on creatine, but if you also believe that taking it is helping you and making you sharper. It's hard not to hit the case that that is going to do something as well, which is, I guess, the kind of hidden glue with all this. If you believe something's helping you, it probably will.

• 1:33:05Speaker 00

  It probably will, yeah.

• 1:33:06Rangan Chatterjee?

  Okay, we've got to find mistakes so far. We're not going to get to 11, but I think the two I would like to get to, because we haven't talked about them before. It's number one, neglecting oral health and number two, ignoring the toxic load of the modern world. Okay, slightly inflammatory, but I'm talking about things like microplastics and should we filter our water and that kind of stuff. So perhaps we can sort of zoom through oral health, you know, point number six. What's the relationship between oral health and brain health and oral health and longevity?

• 1:33:39Speaker 00

  It's been known for maybe 10 or 20 years at this point, that there is a connection between oral health and cardiovascular health. That was, I think that was probably found first. In fact, there are some of the bacteria that you get when you have gum disease or what we would call. So, so gum disease has two stages. The first is gingivitis and then if it starts to affect kind of the underlying bone, then it would be called periodontitis. But I think we can call it just gum disease more broadly. And some of the bacteria that tend to overgrow in the setting of, of gum disease, things like pseudomonas gingivalis and streptococcus mutans.

• 1:34:24Speaker 00

  You can find those bacteria in atherosclerotic plaques in, in the heart, which we know sort of trigger, trigger heart disease. And some of the thought is that because you sort of like have all this inflammation around the gum disease and, you know, you know, bleeding and things like that, that actually those bacteria can get from the mouth into the bloodstream and then can trigger systemic inflammation. Might, might trigger the, the formation of some of these plaques in, in, in heart disease. And they've actually been found in amyloid plaques in the brain of, of certain individuals. And some people argue that one of the reasons why we accumulate amyloid is, you know, one of the parts of kind of the process of developing Alzheimer's disease is because it has antimicrobial effects.

• 1:35:09Speaker 00

  So it's accumulating around, say, bacteria that, that might have gotten into the brain. And one way that that happens or, and does seem to happen is through, through gum disease. This doesn't mean that if you have gum disease, you're definitely going to get dementia, right? We're all, we're all talking about what increases and decreases risk. So there are several studies that show that having gum disease is associated with increased risk of dementia. In, you know, multiple sort of perspective, as in sort of like you follow people over time, studies. And then in at least one study, they also found that in people who have gum disease, those who get treatment for that gum disease, something like scaling and root planing, which your dentist would do.

• 1:35:52Speaker 00

  They then decrease their risk of dementia over the next several years compared to those who don't get treatment. There have been other studies that show that the amount of antibodies you have circulating in your blood against those bacteria that tend to sort of accumulate because of, of gum disease. The more antibodies you have, kind of suggesting that you have had a higher exposure. They, those people tend to have a higher risk of dementia as well. So like from multiple different directions, it seems that gum disease is associated with increased risk of dementia. And then there's also some evidence that if we treat that gum disease, that risk of dementia is decreased.

• 1:36:27Rangan Chatterjee?

  Yeah, basically don't ignore going to the dentist.

• 1:36:30Speaker 00

  Don't ignore your oral health.

• 1:36:32Rangan Chatterjee?

  Yeah. And in terms of xylitol gum, are you a fan?

• 1:36:35Speaker 00

  So, uh, yes, and um, the, my favorite story about xylitol is actually a colleague of mine, Greg Valentine, who I work with at the University of Washington. He's run several clinical trials, he's still running clinical trials, looking at this. But his work is looking at ways to decrease preterm birth. So this is nothing to do with dementia, although people who were born preterm do actually have an increased risk of dementia. So it could sort of have this full kind of life, lifespan effect. But we know that having gum disease is a risk factor for preterm birth

• 1:37:16Speaker 00

  because it creates this inflammatory effect that, and we know that chronic inflammation is a potential trigger for preterm birth. So babies being born too soon and the more preterm you're born, the higher your risk of both death, but also neurodevelopmental impairment, multiple long-term health issues. Obviously not everybody born preterm experiences those, but it's just on average. So he's run multiple clinical trials, he's running them in the US right now, but the, the clinical trials he ran already are in Malawi.

• 1:37:47Speaker 00

  In Africa, Malawi has the highest rate of preterm birth in the world. And the majority of pregnant women in Malawi have gum disease. And so one trial they did was this large cluster randomized trial where they had different villages in Malawi. And they sort of, they gave them, they gave them some of the villages xylitol gum to chew like three times a day throughout the, the last chunk of pregnancy. And they saw significant improvements in gum disease and a statistically significant reduction in preterm birth rates, which to me is just like mind boggling.

• 1:38:23Rangan Chatterjee?

  Amazing.

• 1:38:24Speaker 00

  And right, the, the, the design of the trial wasn't perfect. They didn't have a placebo gum and that kind of stuff. Those are the trials he's running right now. But like, even that you would see that kind of effect is just incredible to me. And so we know that chewing xylitol gum or using xylitol mouthwashes can address the oral microbiome. And it's really the microbiome that kind of, and an imbalance in the microbiome that drives a lot of gum disease. Without having negative effects. So other types of mouthwashes, for example, like a alcohol based or a chlorhexidine based mouthwash, they can actually get rid of good bacteria that you want in your mouth. Whereas xylitol seems to particularly kind of decrease the ones that maybe we would like a little bit less of.

• 1:39:07Speaker 00

  So if you do have gum disease, I absolutely go to your dentist, have it addressed, whatever they suggest. But, you know, xylitol, xylitol gum is, is one thing that you could try at the same time.

• 1:39:19Rangan Chatterjee?

  Yeah. Okay, very, very important message. Okay, the final mistake for this conversation, right, is saying number seven, ignoring the toxic load in the modern world. Now, I don't want to scare people, okay, because I think one of the problems with health these days is people get quite scared. And I think we've got to be careful not to do that. But I think a few things that people often talk about and worry about are microplastics. Should people be filtering their water or not in your view? And air pollution inside and outside. So I wonder if we can just sort of talk about these themes and how they relate to people's lives.

• 1:39:58Speaker 00

  Yes, so the, the issue with all of these is that there's

• 1:40:06Speaker 00

  absolutely some important signal and as it relates to these exposures and, and our health. But there's also a huge amount of kind of hyperbole and it's overblown and there's a ton of scaremongering. But there is sort of like, but, but in the middle of those, I think there is a, a way for us to navigate it fairly reasonably without sort of being overly stressed about what it might mean or, you know, overselling the effects of these things on our health. So I think we can go through them one by one. Microplastics have certainly gotten a lot of press recently.

• 1:40:48Speaker 00

  And these are essentially the breakdown products of plastics that, you know, we use for packaging for food or, you know, utensils or other things. So our primary, our primary exposure is from the food that we eat. You can get some from like skincare products and things like that. But there, there have been some recent studies that suggest that maybe our primary exposure is through food, food and drink. And a couple of years ago, there was this study that said, you know, the average human consumes a credit card's worth of plastics a week or something. And then everybody lost their minds.

• 1:41:31Speaker 00

  The, the, then some, some more recent studies, they got a lot less press. Went back and they redid the calculations and they were like, we estimate that this is out by like several orders of magnitude. It's like not, it's like a fraction of 1% of the amount that they said previously. So like, yeah.

• 1:41:49Rangan Chatterjee?

  The decimal place went in the wrong.

• 1:41:50Speaker 00

  The decimal place was like miles out, like several, like, I can't remember exactly how, how many. It was like six or seven places in the wrong place. Like it was, it was, it was, it was huge, the, the difference. And so that's one part is yes, we do consume these things, but the amount that we've been told we're, that we're consuming is probably a lot less than, than, than we've been told. Then the next part is there have been studies that have looked at microplastics in the body. In like tissues of people who've, who are deceased and like looked at them in, say, artery plaques, looked at them in the brain.

• 1:42:31Speaker 00

  And, and, you know, they've, they've looked at them in like testicles and other organs. And, and basically suggested that in those who have a higher disease burden, say higher heart disease burden or higher dementia burden, they have higher, so like people who have a higher dementia burden or people with dementia have more microplastics in their brain.

• 1:42:52Speaker 00

  This is certainly possible, but there's a few reasons why I'm not yet certain it's like the thing that we have to worry about. So the first is that we know that vascular disease, so issues with blood vessels are present in most people with dementia. If you have issues with blood vessels in the brain, blood flow is going to be slower. You're more likely to accumulate microplastics that that might be in your bloodstream. So the dementia is probably driven, at least partly by the blood flow issue, the, you know,

• 1:43:32Speaker 00

  vascular disease. And then microplastics just kind of accumulate, you know, they come along for the ride. We also have a big issue in terms of how microplastics are measured in these studies. So when you, when you take tissues and then you try and measure the amount of microplastics in them, the typical way you do that is through something called pyrolysis, which is essentially just a fancy word for heating something up a lot. And so what they do is they, they essentially vaporize the plastics and then measure it in something called a mass spectrometer.

• 1:44:13Speaker 00

  The problem is that that doesn't work very well in tissues that have a high fat content, like the brain in particular, because when you vaporize fat tissue, it looks like plastic. It breaks down into the same compounds as plastics do. So there have been some papers that say that particularly in tissues that have a high fat content like the brain, pyrolysis is not a valid way to measure microplastics. So it could be that when we're seeing high microplastics in some of these studies, it's actually just an error in the measurement, right? Because of the method that's being used. So I think that some of that is overblown too. So some of the exposure is overblown. Maybe some of like what we're measuring in tissues

• 1:44:57Speaker 00

  is overblown. However, we do know that some of the compounds that come in plastic, some of the plasticizers, phthalates, bisphenols, right? People have heard of BPA, right? The lining of cans. And there are many other breakdown products of plastics, right? They are certainly linked to some changes in cognitive function, issues with neurodevelopment in kids, higher risks, higher rates of heart disease. So these things aren't, you know, completely benign. And so like, I think we can end up down this middle road where we're like, yes, some of it's probably overblown, or at least we don't have the data to be, you know, really say that it's this primary driver. But we also know that then that they're not benign and we should try and

• 1:45:42Speaker 00

  minimize our exposure where we can. There was a recent trial where they randomized individuals to multiple different groups where they changed different plastic exposures and then tracked their sort of levels, it was levels in the urine of these different, of different plastic breakdown compounds. And the biggest driver seemed to be the food. So they, so they gave people that, so they, they stopped them using canned or reduced their canned foods, reduced a storage of foods in plastic, yeah, reduced plastic utensil use. So, you know, if you're, if you're kind of like stirring a pot and you've got a, a plastic spoon, right? Swapping it for a metal spoon

• 1:46:24Speaker 00

  or a wooden spoon. And then they reduced the number of foods that were just stored in plastic, right? So they actually controlled a lot of the food production process so that at no point were, were foods kind of stored in plastic for long periods of time. So you go to the supermarket and you're getting your, your veggies kind of loose and you're just throwing them in your basket rather than kind of packaging them up and stuff, or, you know, and getting things that are, that you can buy loose rather than things that were sort of like pre-chops and stored in plastic, that kind of stuff. I would say that if you're going to avoid foods and then not replace them with other similar healthy foods that aren't stored in plastic, I would rather you eat those

• 1:47:05Speaker 00

  foods, right? So if you're, if the reason why you get, you can eat vegetables is because you get them frozen and they come in a plastic bag, but they're already pre-prepared and it's really easy to prepare them and you're going to just throw them in a pot and then make, make dinner quickly, do that, right? That is, has a much bigger signal in terms of benefit. But if you can, you know, don't, you don't store your leftovers in plastic, get a wooden spoon, minimize the amount of foods that you get that, that are kind of stored in plastic or, right? Wherever that's possible, drink fewer drinks out of plastic bottles or cans, then do that. So wherever

• 1:47:47Speaker 00

  you can start to move that needle a little bit, just decrease your exposure. I think that's going to be beneficial. But you know what? If, if the reason you eat beans is because beans come in cans, I would still eat those beans, right? Because we know that they have a lot of, a lot of health benefits. So it's all about just reducing your exposure where you can, rather than being really, really concerned about all the different ways that you might be exposed.

• 1:48:10Rangan Chatterjee?

  Yeah, I think that's a reassuring message. I guess, importantly, I guess, we can probably make the case, I think that a thousand years ago, humans probably weren't being exposed to plastics in this way. So it's, it's a new thing. So of course, we have to see how the research plays out and if we're going to learn more things. Remember when Dale Bredesen came on recently to talk about dementia risk and, you know, brain health? You know, he was, you know, at some point, we spoke about microplastics. And I think, to be fair to Dale, he said, look, we, we don't know the full story yet. I said to him, have you seen enough to make you at least

• 1:48:50Rangan Chatterjee?

  reduce how many microplastics you're exposed to? He goes, yeah. So wherever possible, I try not to. And I guess that's the approach I've taken for a couple of years. I'm, you know, I try, you know, it's very rare for me to drink out of a plastic water bottle now unless I'm on a plane for eight hours and actually have, you know, I'm thirsty, right? I personally, no longer, I haven't done this for a while, will get a takeout coffee in a, in one of those containers, you know, because the heat and that, how that interacts with the cost. Again, for me and my life, that's not that difficult to do. You know, and, you know, certainly at home, we, we don't store in

• 1:49:32Rangan Chatterjee?

  plastic anymore. We store in, in glass containers when we overcook food and that kind of stuff. So I think there's a lot of practical things people can do without necessarily worrying. But I guess time will tell with the science, how much of an impact this is having on health. Okay. And I'm sure we could talk for an hour on plastics, but let's leave it there on plastics. What's your take on filtering, drinking water?

• 1:49:55Speaker 00

  Yeah. So I'd start by saying that, you know, luckily for, I imagine everybody listening to this podcast are, are like, water supply is very safe, right? And so the

• 1:50:07Rangan Chatterjee?

  In many countries.

• 1:50:08Speaker 00

  Yeah. In, in the, in the vast majority of countries, not, not, not all, but right. I, I would expect that wherever you're listening to this, your, your water supply is, is, is safe. And it's, it's not, it shouldn't be a primary concern. However, we do know that, for example, you know, several pipes in the UK and the US still contain lead, right? And so there are several places where you drink the, the tap water and there's a significant amount of, of lead in it. We also know that there are other things ending up in the water that are very hard to remove, like the PFAs and the, you know, the forever chemicals.

• 1:50:43Rangan Chatterjee?

  And plastics.

• 1:50:44Speaker 00

  And, and, and plastics. So phthalates and things like that can, can end up in the, in the water as well. And we know that these have, we know that these have some potentially negative health, health effects. So the way that I've approached this is that I do, I do filter my water. I have an in-fridge filter. You can get a jug filter, although the main thing with the jug filter is just remember to replace it because I know there are people who have a jug filter and then it's in there for a year and then it starts to grow stuff and right? You've probably undone the good work of filtering, of filtering your water, right?

• 1:51:22Rangan Chatterjee?

  You're probably adding your own contaminants.

• 1:51:23Speaker 00

  Exactly. And right. And then you can scale that up to under, you know, some people have, you know, you can get under sink filters and stuff like that. But the, I, I think about it very similarly to how I think about microplastics. And actually, this is how I think about this, like, whole topic in general, is that wherever, whatever you're able to do, do that and you're almost certainly decreasing your exposure over time, right? So most jug filters will do a decent job of decreasing things like lead, if there is lead in your water, or they'll do a decent job of decreasing phthalates and other things if they are, if they are in your water. And all of this stuff integrates over time, right? So if you just continuously do that, you'll be decreasing

• 1:52:05Speaker 00

  your exposure over time. And it's sort of like a, other than, you know, remembering to change your filter, it's kind of like a set it and forget it thing. It's low, low risk, high potential for benefit, not particularly cost intensive, depending on which filtration system you go for. So I, that's, that's generally how, how, how I approach it. There's probably a level of water filter that each of us could do. I, I don't think you have to do it, but if we're trying to think about something that might give us benefit over long periods of time, it's low risk, relatively low cost, I think, I think it's worth considering.

• 1:52:39Rangan Chatterjee?

  Yeah, I think all these things, you know, it just depends. Some people get very triggered over water filtration, go, the tap water is completely safe. And it's like, yeah, compared to, you know, many countries around the world, it, it probably is, certainly here in the UK, you know. And I think that's fine. And if you are looking to just do a little bit extra, as I certainly am, you know, it's one of those things I didn't do till about three years ago, I don't think, you know. So I lived most of my life drinking tap water. And I think I'm doing fine. And as I learn more, I think, hey, you know what? It's not that much of

• 1:53:20Rangan Chatterjee?

  A heavy lift to have a water filter at home.

• 1:53:23Speaker 00

  Yeah.

• 1:53:23Rangan Chatterjee?

  So I've got something, I think, I think it's called Aquatrue. It's a reverse osmosis filter. Bought it about two, three years ago. It reminds you when your filter needs changing. You know, it's just, we have a habit now in the house. So we fill it up and you pop it on and it, you know. But yeah, it is, you could call it hassle if you want, because it takes out lots of good stuff as well.

• 1:53:46Speaker 00

  Takes out minerals.

• 1:53:47Rangan Chatterjee?

  Takes all the minerals. So we have to put some drops to remineralize it. Now, someone might call that a faff. It possibly was a faff three years ago when I first started doing it. Now it's just the new norm, which is what we do. And so I think that's one thing I always like about you, Tommy. It's a very practical nuanced approach, which is, you know, really at its heart, trying not to scare people and go, yes, things are changing in the world. It is harder to eat nutrient dense food. It is, we are being exposed to all kinds of new things now, which weren't in our evolutionary history. At the same time, going back to point number one about mindset, worrying about this stuff ain't going to help you that much. It's, you know, what can you feel that you have an element of control over?

• 1:54:29Rangan Chatterjee?

  What's your take on sauna use filtering out microplastics? Cause I think there's quite a lot of noise emerging now that that could be a good way of removing it from our system.

• 1:54:40Speaker 00

  Yeah, so you do definitely sweat out some of these compounds that you get.

• 1:54:47Rangan Chatterjee?

  So exercise, of course, would do that as well.

• 1:54:49Speaker 00

  Yeah, so, so I think that sweating is important. It is a detoxification pathway in the most important sense, right? It's one of the ways, right? Just like with our liver and our kidneys, it's one of the ways that we excrete things that our body doesn't want inside.

• 1:55:06Rangan Chatterjee?

  Urine, feces, skin, right?

• 1:55:08Speaker 00

  Yeah, exactly. Yeah. So I do think sweating is probably beneficial. We know that some of these compounds can be excreted in sweat.

• 1:55:18Speaker 00

  Exercise that causes you to sweat is free, right? So I don't, and actually many of the benefits of sauna, particularly dry, you know, dry sauna, sort of like a Finnish hot sauna. Many of the benefits of sauna actually overlap very significantly with aerobic exercise. The pathways that get activated, right? The sweating. So yes, I think sauna is a possible intervention, but I don't think everybody needs to sauna. If you've got one and you enjoy it, great. But equally, you could go, you could go for a jog, go play paddle and you're probably, you know,

• 1:55:53Speaker 00

  sweating out in a similar way. So yes, I would think about sweating. But however you achieve that sweating, I think matters a lot less.

• 1:56:03Rangan Chatterjee?

  That's a great message. However you achieve your sweating, it's up to you. You know, you choose the activity you want.

• 1:56:08Speaker 00

  Absolutely, yeah.

• 1:56:09Rangan Chatterjee?

  Okay. And because I mention it, let's just touch on pollution in the air. Because when I think about it, I think about controllables and uncontrollables. Okay. So we know that air pollution from planes and cars and diesel and stuff can negatively impact human health and increase risk of dementia. But there's also the pollution inside our home. Again, I don't think we've covered this before, Tommy. So I think we have covered the big levers a lot. So yeah, external air pollution, I know there's a link to B vitamins and how we can attenuate our risk. So what's your sort of top level take on pollutants in the air?

• 1:56:49Speaker 00

  Yeah, so it's very similar to the others. Yeah, I guess we can touch upon that, that the B vitamin study, this was done actually at the University of Washington where I work. And they looked at air pollution exposure. So it's particularly, people might have heard of PM 2.5. It's like the two, like two and a half micron, that's the size particles that are released from, you know, cars and roads and things like that. That seemed to be, there were other aspects of air pollution as well that are linked to human health. But they're, they're kind of the most frequently studied and, you know, associated with increased risk of heart attacks and dementia. So this study looked at dementia and they found that those who had good B vitamin status,

• 1:57:34Speaker 00

  if they were exposed to high levels of air pollution, they had, that sort of mitigated the risk of dementia. Of course, this is not a randomized controlled trial, but it's thought that exposure to air pollution increases homocysteine, which we were talking about earlier. And so if you measure your homocysteine level and it's high and then you supplement with B vitamins and it comes down, if it was the air pollution that's driving that, you may be offset a lot of the risk from the air pollution by supplementing with B vitamins. So I think that that makes sense. So it's just another reason to maybe consider getting enough B vitamins in your diet.

• 1:58:09Speaker 00

  Then the, you know, a lot of the sort of inside air, well, it's obviously connected to the outside air. But because where you've got closed windows, things sort of like accumulate over time. And so often the, if you, if you look at things like the Environmental Protection Agency in the US, they sort of have this big part on their website about how indoor air quality is often worse than outdoor air quality for that reason. And so I think that, again, if you, especially if you live somewhere, you live near a main road or, so I live in Washington state in Seattle in the summer. We have lots of wildfires, like often the, the air outside is filled with smoke.

• 1:58:54Speaker 00

  The house smells of smoke. And we know that's linked to poor health, you know, effects in the local population, like several studies have shown that. So I think in those kinds of settings, if you do have high exposure to air pollution, then I would consider getting an air purifier in the rooms that you spend a lot of time.

• 1:59:13Speaker 00

  And there was one recent study where they actually did a randomized controlled trial of air purifiers in people who have high exposure to air pollution. And they, they saw that having an air purifier on significantly reduced blood pressure. So again, a meaningful intervention that's kind of like a set it and forget it thing in people who have high exposure or high risk, you know, definitely something worth considering. But again, right, we can't, you know, it's often very, there aren't many people who can just move because they have a lot of air pollution. Right? So I think that if you can address that by just, you know, if you're spending, if there are rooms you spend a lot of time in, say the bedroom, get an air purifier.

• 1:59:58Speaker 00

  Again, over time, you're dramatically decreasing your exposure with a relatively simple intervention.

• 2:00:06Rangan Chatterjee?

  Yeah. And of course, something we have covered before is the socioeconomic sort of

• 2:00:12Rangan Chatterjee?

  input here in the sense that, you know, in, in many places in the world, your socioeconomic status hugely influences how polluted your environment is, right? So, you know, the, the, the middle classes and the wealthy people can live out in the suburbs and have less busy roads around them, et cetera, et cetera. So I think we always acknowledge that. I think it's always important to acknowledge that, that everyone has a different ability to make changes. Tommy, I love chatting to you. You know, as you know, you're, you're one of the doctors and the health commentators who I respect the most. I love your, your balanced, nuanced, but also open minded approach to health.

• 2:00:57Rangan Chatterjee?

  I think the book, The Stimulant Ammon is fantastic. And I really would encourage people to pick it up and take a look at it. I know we haven't covered some of the interventions we've covered before in today's show. But I guess just to finish off,

• 2:01:14Rangan Chatterjee?

  for that person who has been listening to us talk and throughout the conversation has realized that they've neglected their brain health for a number of years, maybe decades, and is wondering, well, you know, maybe it's too late, maybe there's nothing I can do.

• 2:01:33Rangan Chatterjee?

  What would your final words for that individual be?

• 2:01:37Speaker 00

  I would say that it's never too late to start. And we actually have really good evidence for that.

• 2:01:45Speaker 00

  I talked to the, you know, I mentioned the Lancet Commission report again. The first time they published that report in 2020, they even said that on the front page of the Lancet, like the, one of the world's premier medical journals. It's never too late to start thinking about dementia prevention. That's because they were focusing on dementia. But then your brain health more broadly. Studies in individuals in their 60s, 70s, 80s, they start an exercise program. They start with some dietary change. They start to improve. They do some cognitive training, some, or like some kind of, you know, they start language or dance classes or, you know, musical instrument, or, you know, they start to improve their sleep. You, you start to see benefits, you know, even at those later ages. So know that, start wherever you are and.

• 2:02:35Speaker 00

  Even just starting with one thing can have significant benefits. Is it taking more steps a day or getting an extra 15 minutes of sleep? Or volunteering for something like, because you, because you sort of connected to the stuff that we talked about in terms of, in terms of social connection. Is it just like getting an air filter and a water filter? And those are just, that's, that's all you can do right now, but you set it and forget it. Or, you know, you start a B vitamins supplement. These things we know have significant impacts with, through very high quality trials, regardless of the age that you're at. And by starting one thing, sort of like the whole system, we talked about the three S model, that whole system shifts in your favor.

• 2:03:18Speaker 00

  And yes, maybe you have to, you would ideally make multiple changes over time. But these things, you know, just, just one, one thing is the place to start and then build from there.

• 2:03:27Rangan Chatterjee?

  Yeah, very, very empowering message. I just want to highlight your key message from the last couple of appearances on my show about learning a new thing. Give your brain a reason to grow and adapt. And I think since our last conversation, which was only a few months ago, Tommy, these are some of the comments that came in on the back of that. Artie has told us she started playing netball and paddle.

• 2:03:51Speaker 00

  Cool.

• 2:03:51Rangan Chatterjee?

  Laura started figure skating. Lynn started reformer Pilates. Dorothy started tap dancing classes. So she started a heels dancing class. Heather started playing pickleball. Louise started ballet after a recent Parkinson's diagnosis. And Daryl started playing table tennis and badminton. And honestly, that's all because of the information you shared on my show. So I think you're doing wonderful work, Tommy. Thank you for sharing your research so generously with us all. And I look forward to number six at some point in the future.

• 2:04:27Speaker 00

  Thanks so much for sharing those with me. That's, that's so, so cool. I'm so glad that people are just finding, like you said right at the beginning, you find something that you enjoy, right? You do it because, do it because it's fun, right? And then, oh yeah, it just happens to have all these other sort of health benefits on the side. So like, pick something that, you know, any of those things are fantastic. I'm so, I'm so happy people are doing it. I really appreciate your time as always, and thank you for having me on.

• 2:04:56Rangan Chatterjee?

  Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been

• 2:05:39Rangan Chatterjee?

  consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatge.com/fridayfive. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change and movement, weight loss, and so much more. So please do take a moment to check them out.

• 2:06:21Rangan Chatterjee?

  They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family, or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health.

• 2:07:02Rangan Chatterjee?

  Making lifestyle changes always worth it, because when you feel better, you live more.