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Dr Rangan ChatterjeeDr Rangan Chatterjee

The Daily Habits That Shape Your Brain Health | Louisa Nicola

Do you think that it’s inevitable that the function of your brain will decline as you get older? Or, do you believe that there are simple things you can do each day to preserve, protect and enhance it?

Dr. Rangan ChatterjeehostLouisa Nicolaguest
Feb 12, 20252h 2mWatch on YouTube

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Transcript

  1. 0:00 – 1:11

    Everyday habits that shape long-term brain health

    1. RC

      You've been studying the brain for many years, and I'd love to know at the top here, what are some of the common habits that people are doing or not doing that predict the function of our brains and things like Alzheimer's-

    2. LN

      Mm

    3. RC

      ... as we get older?

    4. LN

      Wow, that's a, that's a hefty, that's a hefty question because there are so many things to consider. If we are looking at long-term brain health outcomes, which is what we all are really looking for, if we're looking at these neurodegenerative diseases and we reverse engineer those, we know that they are driven through lifestyles. So the habits of not sleeping well, not exercising enough and adequately, I would have to say, the foods that we're eating, the stress that we are having, because inflammation, which we'll touch on, is a very big factor here. So if we look at these five things and we think, what are we doing each and every day to form good habits around those, we can set ourselves up for a, a healthy performing brain as we age. But unfortunately, we're just not doing that.

  2. 1:11 – 2:37

    Where brain health is heading: prevalence, projections, and lack of progress

    1. RC

      If we look across society, whether it's here in the UK or where you live at the moment in the US, in fact, in many other countries around the world, what's the state of our brain health? How does it compare to where we were a few years ago?

    2. LN

      Yeah.

    3. RC

      And what are the predictions for the future?

    4. LN

      The state of our actual global health, in my opinion, is horrific-

    5. RC

      Yeah

    6. LN

      ... to say the very least. Right now, Alzheimer's disease, 55 million people worldwide have this disease. That number is going to triple by the year 2050. In the UK, Alzheimer's disease is the second leading cause of death, and the first leading cause of death among women. Now, two out of three Alzheimer's disease cases globally are female, so that's something to consider. And you know, Rangan, I, I rack my head every day. I am deep in the weeds of Alzheimer's disease. I study it. I have been. I first authored a paper on it, and I'm going to be doing several others. So I'm, I'm, I'm critically analyzing the evidence, and if we date back to the early 1900s when Sir Alzheimer actually found this disease, w- we haven't really made much progress since then. So the state of our, of our global, I would even say our global health crisis is something that we need to, that we need to talk about.

  3. 2:37 – 5:26

    Alzheimer’s isn’t “normal aging”: defining dementia and reframing amyloid and tau

    1. RC

      I think there's a common belief in society that our brains are going to decline as we get older. I think many people believe that Alzheimer's is an inevitable consequence of the aging brain, but it's simply not the case, is it?

    2. LN

      Absolutely not, and I always tell people that. Dementia is not part of the natural brain aging process. So what, what... We can take a trip down what is about to happen to both you and I and everybody as we age, and I will clearly point that out. But we have to understand, first of all, what Alzheimer's disease is, what dementia is, and then what the brain really is. So dementia is the umbrella term used for Alzheimer's disease, Parkinson's dementia. So we've got de- we've got dementia, then we've got all these different sub-demensions underneath it, and Alzheimer's disease is the most prominent one, as I mentioned the statistics earlier. And Alzheimer's disease is a multi-proteinopathy, meaning that there are two proteins at stake here. We've got amyloid beta, which has been demonized. By the way, it, it first, this disease first started off with something called the acetylcholine hypothesis.

    3. RC

      Yeah.

    4. LN

      Now it's the amyloid cascade hypothesis, which is still what we used to think of back in the early 1900s. We're still, we're still calling it that, whereas we, you know, we're, we're demonizing this protein. We're demonizing amyloid, and amyloid isn't the demon here. Amyloid is actually a great antimicrobial pep- peptide. It is there to protect our brain against insults, against stress, against inflammation, so we need it.

    5. RC

      Yeah.

    6. LN

      So that's one protein at stake in Alzheimer's disease. The second protein is tau, and tau is phosphorylated within the axon of the actual brain cell. So we've got two cells. We've got two proteins here. We're really attacking one when we talk about these therapies, you know, these newly approved FDA therapies that, uh, that you can administer when you have Alzheimer's disease. We're just attacking it as a one-size-fits-all approach for one protein.

    7. RC

      Yeah. A few years ago, I was in America, um, doing some work with Professor Dale Bredesen.

    8. LN

      Oh, I love him.

    9. RC

      Yeah, Dale's great, and, um, I remember him talking to me about beta amyloid at the time and saying, "Look, we're, we're trying to target this and get rid of it, but it's there for a reason."

    10. LN

      Yeah.

    11. RC

      And I think that's, of course, one of the reasons potentially why all these treatments to get rid of beta amyloid aren't working so well, 'cause it's actually not perhaps addressing the underlying root causes.

    12. LN

      Yeah.

  4. 5:26 – 10:19

    Why pathology begins early: stress, inflammation, and amyloid buildup over decades

    1. RC

      So we follow that logic and say, okay, in Alzheimer's, a- and other conditions of course, there is beta amyloid protein in our brain. I've heard you say in previous interviews that beta amyloid is accumulating in our brains maybe from the age of 25 or 30.

    2. LN

      Yes.

    3. RC

      Right, so let's explore that, 'cause that's really interesting. If it's there to protect our brains-

    4. LN

      Mm-hmm

    5. RC

      ... what are we doing that means that it's having to do that job at such a young age, and therefore- And this is one of the things I love the most about your message. It's very empowering. The message you're putting out there to the world on podcasts, in your work in New York, on your Instagram, is very much about saying to people, "Look, this is not an inevitable consequence. There is so much that you can be doing right now, no matter how old you are, that's absolutely gonna make a difference in the future."

    6. LN

      100%. We think about Alzheimer's disease as this one point in our life, in our 70s, that we're diagnosed with, but Alzheimer's disease is comparable to end-stage cancer. When you get Alzheimer's disease, there is no reversal, there is no cure, there is no going back. There is Alzheimer's disease, and it is a very f- very, you know, a- another two, three years until death, okay? So that's what we need to be talking about. We need to be talking about that when you actually are diagnosed in your 70s or in your 80s, that disease has been accumulating since your 20s, your 30s, and your 40s. And like we mentioned, let's talk about beta amyloid, this, this toxic protein which it's not a toxic protein. It is a sticky protein. It actually lives outside of the neurons, and it accumulates over time, and it's actually part of our innate immune system. So when we are stressed, we can be stressed from anything, it's emotional stress, anytime we raise our inflammation, our brain says, "Okay, we're under attack." Now, remember, our brain is really responsible for two things, survival and reproduction. So it basically says, "She's under attack. Let's, let's raise the level of amyloid beta." So we, we activate our innate immune system. We raise amyloid beta in a way to protect the brain cells. It lives outside of the brain cells and it says, "Let's protect her brain cells against these various insults," that is inflammation. Now, if you have a healthy performing brain, you then activate your other immune system, and it kind of down regulates the innate immune system. We've all got that. But what happens is, when we don't take time to rest and we don't have time to clear out that amyloid, then it starts to build up-

    7. RC

      Hmm

    8. LN

      ... and it starts to stick together and end up, we end up with a f- a head full of maybe about 4.5 grams, actually, has been noted in some of-

    9. RC

      Wow

    10. LN

      ... the brains of Al- of Alzheimer's disease patients.

    11. RC

      There's a couple of principles I just wanna highlight because you've just brought them up, and they come up in different forms with regularity on this podcast. One is this idea that chronic disease, the diagnosis of any chronic disease does not happen overnight.

    12. LN

      Mm-hmm.

    13. RC

      So you just mentioned that the process in the body that ultimately leads to a diagnosis of Alzheimer's at some point, let's say when you're 70 years old, right? That starts at least we know 30 years before that, right? And you're saying it might even be, you know, 40, 50 years potentially, that process-

    14. LN

      Yeah

    15. RC

      ... right? We know that type 2 diabetes, when you get that, that doesn't just happen. You don't just go on a holiday, have too much alcohol, and have too many, uh, rich, um, calorie-dense meals and come back with a diagnosis of type 2 diabetes.

    16. LN

      Yeah.

    17. RC

      That has been building up for 10 years-

    18. LN

      Mm-hmm

    19. RC

      ... right? So I think that's a really important principle for people to think about, and it's also what you said about inflammation, this idea that, you know, if there's an insult to the body, if we're having a stressful time in our lives, that's okay if we rest and allow everything to recover.

    20. LN

      Yeah.

    21. RC

      But if it's chronic and we don't allow ourselves to switch off... So you can apply this principle to inflammation. Acute inflammation, helpful. Chronic inflammation, problematic. Acute stress, helpful. Chronic stress, problematic. Those two kind of core principles I think are absolutely at play when we're thinking about the brain.

    22. LN

      Yeah, absolutely. I also think there is miscommunication around what this disease is, how to treat it. And look, when you're in your 20s, you're not really thinking about Alzheimer's disease. You're not thinking about a nursing home. Why would you? I wasn't in my 20s-

  5. 10:19 – 13:57

    Alzheimer’s as a “network insufficiency”: neurons, dendrites, and lost connections

    1. RC

      Hmm

    2. LN

      ... to be honest. I wasn't thinking about that. I thought I was invincible. And then things evidently start to slow down as we age, just due to the brain aging process. But let's just actually also reflect on what Alzheimer's disease actually is. It's not just the accumulation of amyloid beta and phosphorylated tau proteins. It is a network insufficiency. What do I mean by that? Let's look at the brain. The brain is around two pounds. It's kind of got the consistency of hard Jell-O if you look at it.

    3. RC

      Hmm.

    4. LN

      It's got around 87 billion neurons. They're brain cells. These neurons each have around 5000 connections. So the way neurons communicate with each other is via these connections. We call them dendrites. These dendrites synapse together, and this is how we create our emotions, our feelings, our thoughts, all the actions we produce. So that's a network in and of itself.

    5. RC

      Mm-hmm.

    6. LN

      So 87 billion neurons, 5000 connections. So at any given point in our 24 hours, each day we- we're producing around 500 billion, if you do the math-

    7. RC

      Yeah

    8. LN

      ... connections. Alzheimer's disease is a breakdown of those connections. Dementia is a decline in our cognitive performance. Our cognition is things such as information processing speed, reaction time, memory. They decline because we have a, an interference within the connections of these neurons-

    9. RC

      Mm

    10. LN

      ... and that interference is amyloid, because amyloid lives outside of the neuron cell body, and it interferes with the connections. And what ends up happening is- The connections start to die. It's not the neuron itself per se. The connections start to die. So we have a network insufficiency.

    11. RC

      Yeah, that's super interesting. So it's not the brain cells that are dying necessarily, it's more that the connections between them-

    12. LN

      Yes

    13. RC

      ... are starting to go. So, so I don't know, would, would, would this analogy work, right? Let's say you have a field of trees, right? The trees representing the nerve cells. I guess the, the branches aren't connected to the other trees, so maybe it doesn't work. But it is one helpful way of looking at it that you really want as you get older, each of these brain cells that, to be rich with all these connections. And as we get older, if we don't do the things that you're gonna be talking about on this podcast today, then actually those connections start to go down, and at some point you pass a critical threshold, and then you start to get symptoms. Is, is that, is that a reasonable-

    14. LN

      Yes

    15. RC

      ... explanation, would you say?

    16. LN

      Correct. And I love the analogy of a tree because actually, if you do imagine an entire tree, the word dendrite actually comes from the Greek word tree.

    17. RC

      Mm.

    18. LN

      So it's, it's somewhat similar. And if you imagine the axon as the trunk, so within the axon, that's where the tau builds up, and it actually breaks down. You get the collapse of the axon within that.

    19. RC

      Mm.

    20. LN

      So it's a collapse of the, of the, the, the trunk. Then we move up the leaves. Okay? The leaves are the, let's just say the, the dendrites that connect with other leaves. If we get pruning away of those, then yes, we end up losing the, the, the ability for one neuron to connect to another.

    21. RC

      We've given a lot of technical terms-

    22. LN

      Yes

  6. 13:57 – 20:04

    What drives Louisa Nicola’s mission: seeing decline firsthand in clinical practice

    1. RC

      ... so far, uh, talking about amyloid, you know, beta amyloid protein and tau protein and all these things, and dendrites and connections. Before we go into those practical things that people can do, which you're so passionate about, let's humanize this condition a bit.

    2. LN

      Yeah.

    3. RC

      Okay? Because when I see you online talking about this, there's a real passion that comes across. This doesn't feel ... In some ways I, I can almost say it feels personal, like there's something that you are driven to communicate with the world about this condition. There, there's a really fiery passion, which I'm sure we're gonna see shortly. Where does that come from? Why does Alzheimer's mean so much to you?

    4. LN

      You know, it ... I don't have a personal story per se. My father in 2019, uh, did have a stroke of the right parietal lobe, and I've seen some cognitive decline since then. But my real passion comes from actually working in clinical practice. I'm a neurophysiologist by trade, and as part of that, we scan brains using an electroencephalogram. And I remember scanning brains and, and my main job was to look for dysfunction, dysfunction in different brain lobes. And I remember this one patient, let's call her Betty, and she was very young, and by young I'm talking 55. And I remember her coming in. She had three kids and her husband, and she ended up ... You know, I worked with her for a year, and I saw the decline. It ended up she couldn't even remember who I was, and I saw the look in her husband's face. He said, "Sometimes we wake up and she doesn't even know who I am, so why would she remember who you are, Louisa?" And this woman had done nothing wrong. She actually didn't even have the genetic risk factors that predisposes you to certain types of dementia. She didn't even have the risk genes. She wasn't even positive for APOE4. And when I looked at her, she was actually doing everything right, Rangan. She was doing what she thought was exercise, doing what she thought was good eating, trying to sleep and, you know, maintain her, you know, a full- being a full-time mother and also working full-time. And I thought, "Who has failed you?" Because she actually had no idea what Alzheimer's disease was. She didn't know what dementia was. She just thought this is something that occurs when you are 80. And it was at that moment that I thought, "Something has to change." And ever since then, that was, that was 2019. Ever since then, you know, it breaks my heart to think that we are spending millions or billions of dollars trying to get to space, literally trying to figure out how can we live on a different planet, and yet we haven't solved for a disease where you literally forget your husband's name and your children's name. You forget who you are. You know, the FDA will have you say that, uh, we're making progress through these various types of, uh, drugs, you know, uh, d- donanemab, uh, Leqembi, but we've seen that these drugs just treat the symptoms.

    5. RC

      Yeah.

    6. LN

      That's not progress. That is a systemic failure of our healthcare system.

    7. RC

      It's the same thing with frankly every chronic disease, um, is that most of the time the pharmaceutical drugs are treating the symptoms, which may have value in some conditions some of the time. But what really drives me, and I, I really feel it drives you, is to try and help people understand the root causes of what's going on. So you're saying that brain decline as you get older is not necessarily inevitable, at least not to the degrees that we're seeing, and you're saying Alzheimer's is not inevitable-

    8. LN

      Correct

    9. RC

      ... and it's not a normal part of aging. Yet you're also saying, you're sharing statistics, that rates are gonna triple by 2050.

    10. LN

      Yes.

    11. RC

      Right? And I love that analogy saying we're spending billions of trying to get to- ... space and live on a different planet, right? But let's figure out [laughs] how to live-

    12. LN

      Yeah

    13. RC

      ... well on this planet.

    14. LN

      But, but it's literally we- B- basically it's like the 1900s called, they want their medications back. That's like a dad joke, right? Because we, we are still not understanding that we are attacking the wrong thing. We are basically saying, "That's okay, guys, get Alzheimer's disease because we have therapies that are going to eliminate the symptoms." And by the way, I don't know if you read The New England Journal of Medicine where they did the study on donanemab, which is an intravenous drug that you get, and it's around... I'm telling you, it's around 50 or $60,000 in the US.

    15. RC

      And what does that drug do?

    16. LN

      That actually... Well, it's a monoclonal antibody.

    17. RC

      Yeah.

    18. LN

      That eliminates the amyloid. And what we've seen is that the risk factors associated with that is microhemor- hemorrhages. So you're... They're getting brain bleeds from these patients. Edema, so you're getting brain swelling from taking this drug, and some of them have caused death in some patients. So we're attacking the symptoms of this disease, where, by the way, even if you remove the amyloid, even if you remove the 4.5 grams of amyloid from somebody's brain, you are still not curing Alzheimer's disease-

    19. RC

      Mm

    20. LN

      ... because you're going to build that back up-

    21. RC

      Yeah

    22. LN

      ... if you don't address the root cause of why do you keep attacking your innate immune system for it to raise amyloid beta in the first place? And not just that. Let's look at it this way. There is a supply and demand issue here.

    23. RC

      Mm.

    24. LN

      If you do not supply the neurons, or if you do not supply your brain with the things that it needs to not only survive and thrive, but be able to meet the demands of everyday life, you will succumb to this disease. So you need to have more supply than demand.

  7. 20:04 – 27:31

    Genetics vs lifestyle: deterministic mutations, APOE variants, and whether to test

    1. RC

      Yeah. Okay. So in terms of getting into the root causes, and specifically the things that we can do today, whether we are 50 or 60, or whether we're 20 and 30 years old, so I think it's relevant for all of us, right, to start doing these things as soon as we can. Let's just set out a- and address a common misconception, genetics v lifestyle.

    2. LN

      Yeah.

    3. RC

      Right? Because there is still this perception out there that genes are a big thing for brain decline in things like Alzheimer's. People will still say, "Oh, you know, my grandma had Alzheimer's, so I think I'm probably gonna get it." Can you clear that up-

    4. LN

      Yeah

    5. RC

      ... for us before we get into the lifestyle factors?

    6. LN

      Absolutely. And almost everybody can say that they know somebody who had dementia. I-

    7. RC

      Yeah

    8. LN

      ... when people find out, you know, when they get a chance to speak to me, they're like, "Oh, Louisa, yeah, my grandmother had dementia." And I always ask, "Did she have dementia or did she have... Like, what did, what type of dementia?" Nobody ever knows. They just say dementia. When we talk about genetics, it's important to determine and differentiate between risk factor genes and genetic mutations. So genetic mutations, for example, if you have a genetic mutation on chromosome four, you will get Huntington's disease. So these genetic mutations that you are born with, unfortunately, if there is a disruption in your DNA somewhere which has been passed down from your parents, you will get the disease associated with that gene. When it comes to dementia, there are three involved in the mutation process. You've got presenilin one, presenilin two, and then a mutation on the amyloid precursor protein. That represents a mere 1% of the Alzheimer's disease population.

    9. RC

      Wow.

    10. LN

      Genetic risk factors, which is still a small percent of the population, are the very famous genes that most of us have heard about, APOE4. So we have, um, we have APOE2, apolipoprotein E2, which is protective against Alzheimer's disease. We have APOE3, which is basically a null. It doesn't protect you, but it also doesn't raise the risk. And then we have the APOE4. Now we get two genes. We get one from mom, one from dad. So you could be E3E4, which raises your risk slightly to get the disease. Raises your risk. Notice how I say raise your risk, not it means you'll get it.

    11. RC

      Yeah.

    12. LN

      Um, if you are a 3.3, you're part of the, the population, the average population. I'm a 3.3. If you are a 4.4, then you've raised your risk by 12 times of getting the disease.

    13. RC

      So significant increase in risk.

    14. LN

      It's a significant increase in risk. However, it's not a foregone conclusion that you will get it.

    15. RC

      Okay, so this is really interesting. So you mentioned there are some genes, uh, that are predictive.

    16. LN

      Yes.

    17. RC

      But that's only... That's under 1%-

    18. LN

      Oh, okay. Yep

    19. RC

      ... of this population, right? So we, we- let's assume that most people don't have those-

    20. LN

      Mm-hmm

    21. RC

      ... which I think is a pretty reasonable assumption given how low that number is. You mentioned APOE3 and APOE4. I think many people, uh, will have heard of those things. Now, first of all, I wanna know, would- do you recommend people get tested? So I think this is quite a tricky area for people, and I think we also have to acknowledge, aren't there studies in places like Nigeria where people with APOE4-

    22. LN

      Yeah

    23. RC

      ... double APOE4 don't end up getting Alzheimer's?

    24. LN

      Yeah.

    25. RC

      Right? So what, what can we learn from that?

    26. LN

      Well, that means then that these risk factor genes just raise our risk of getting it, just like going out into the sun.

    27. RC

      Yeah.

    28. LN

      You raise your risk of getting skin cancer. It doesn't mean you're going to get it, it just depends on what you do and how long you spend in the sun and how you protect yourself, et cetera. If you have... I think everyone should get it. It is a controversial topic. I understand that it's scary for some people. You know, if you want to go and get it done and you need genetic counseling, that is always offered to you.

    29. RC

      Well, why do you think people should get it?

    30. LN

      I think everyone should know, understand their risk

  8. 27:31 – 33:43

    Exercise as the top lever for brain health: clarifying intensity and fixing confusing guidelines

    1. RC

      Yeah, so let's then look at these five factors. Let's go through them and, and see what we can educate people with. I think exercise is your passion.

    2. LN

      Yes.

    3. RC

      So let's start there. What do you wish everyone knew about exercise and the brain?

    4. LN

      I wish everybody would exercise for their brain health and for health outcomes and longevity rather than aesthetics. In my world, people are, but that's a mere probably 10% of the population. The physical activity guidelines, uh, globally state that we should be exercising around 150 minutes to 300 minutes per week, and that's moderate to vi- vigorous physical activity.

    5. RC

      Which means what?

    6. LN

      Exercising at around 65% to 75% of our maximum heart rate.

    7. RC

      And for people who have never taken their heart rate-

    8. LN

      Yeah

    9. RC

      ... um, are you able to give some examples of activities that might fall into that category?

    10. LN

      Yeah, so imagine you are running up a flight of stairs and you are going full force, and the last step is when your heart rate, you feel like it's going to come out of your chest. You've reached most likely your maximum heart rate. Let's just say that's 200.

    11. RC

      Okay.

    12. LN

      Okay? You want to be working... I mean, that would be very high. That's a young, young person.

    13. RC

      Yeah.

    14. LN

      Let's just say 100 then, just for argument's sake. That means that we want you working out at 65% of that 100 beat. That is your maximum heart rate, so we want you to be working out for 150 minutes at 65% of your 100, so 65 beats per minute.

    15. RC

      Okay, so that's gonna depend on who we are and what our maximum heart rate-

    16. LN

      Yes

    17. RC

      ... is, but essentially we're talking about things like a, a pretty fast walk, uh-

    18. LN

      Fast walk, yep, fast-paced walk, a jog, an, an easy jog where you can, where, where you can hold a conversation but you are, you feel like you're working out at the same time.

    19. RC

      Okay. Do you agree with those physical activity guidelines, first of all-

    20. LN

      No

    21. RC

      ... or do you think they are conservative?

    22. LN

      They're conservative. I think that there's a nomenclature issue here. People think about physical activity... And by the way, I do all of these s- epidemiological experiments on my parents. Uh, for example, my mother, if you said physical activity, she will say, "But I took the clothes out today and put them on the line." That's not what we're talking about here. We need to change the word physical activity to exercise, so you should be ex... Physical activity is literally anything above sedentary behavior. So for you and I, when we walked in here, that's considered physical activity. That shouldn't be part of your 150 minutes to 300 minutes. That's the first thing. The second thing is I don't think many people really understand 65%-

    23. RC

      Yeah

    24. LN

      ... of maximum heart rate, like you just said.

    25. RC

      This is what we just explored, right?

    26. LN

      Yeah.

    27. RC

      The- these... I think that one of the problems with the way we as doctors and we in this healthcare profession often communicate- ... is that we use a different language that the lay public doesn't understand. So even moderate physical activity, I believe if you ask 10 people what that is, you're gonna get 10 different interpretations-

    28. LN

      Yeah

    29. RC

      ... which then creates confusion, and therefore inaction.

    30. LN

      Yeah.

  9. 33:43 – 1:09:39

    A practical brain exercise prescription: zone-two aerobic base + short intense work + VO2 max framing

    1. LN

      Yeah. That also... That t- t- 150 minutes to 300 minutes encompasses everything. People don't know, how many times am I going to be doing weight training? How many times am I meant to be doing aerobic training? So they're just compiling it all together. So let's break it apart. Your aerobic training should be made up of at minimum three hours a week. So aerobic training are things like your long distance running, cycling, anything where you're r- where you're able to move at around that 65% of maximum heart rate.

    2. RC

      So you don't feel as though you're crushing it or you're pushing hard.

    3. LN

      No.

    4. RC

      It's quite, you know-

    5. LN

      Aerobic. It's easy. It's your long slow distance running, I call it.

    6. RC

      So what about someone who doesn't run, right? And they're like, "Okay, like, I really wanna protect my brain. I'm, I'm hearing what you're saying."

    7. LN

      Mm-hmm. Yeah.

    8. RC

      "Exercise is one of the most important things to focus on." Like, I really want this to be accessible to people, and I don't want people to get put off because they're like, "Well, I, I don't run." What else counts for that aerobic activity in your view?

    9. LN

      I'm so happy you pointed that out, because your brain doesn't know the difference between you running, cycling, or swimming. It just knows heart rate. So get on a bike. Get on anything. The... There is an elliptical trainer at the gym. Anything that is that car- it's in the cardio zone of the gym, anything that's just going to get you into that steady state of 65% to 75%.

    10. RC

      And you don't have to push yourself hard here.

    11. LN

      Absolutely not.

    12. RC

      I think that's important, right? So you should be able to have a conversation whilst doing this?

    13. LN

      Yes. And at the end of every sentence, you should be like, you know, you have to take a breath.

    14. RC

      Okay. So you're, you're, you're lightly exerting yourself-

    15. LN

      Yes

    16. RC

      ... but your heart rate is certainly elevated compared to when you're just sitting down.

    17. LN

      Yes.

    18. RC

      And you would say what? Maybe 30 minutes a day is good for that?

    19. LN

      Well, I think that you should be doing at minimum 45 minutes per session.

    20. RC

      Okay.

    21. LN

      So if you're doing three hours a week, make it around a 45-minute session.

    22. RC

      And is that because if you've been doing that and your heart rate is elevated for 30 minutes, you could obviously do that every day. Seven times 30 is 210 minutes. Or you could do, you know, let's say five 45-minute sessions-

    23. LN

      Yes

    24. RC

      ... which is, you know, a bit more, like 225 minutes.

    25. LN

      Mm-hmm.

    26. RC

      Is there, do you think, a benefit from actually having it longer than 30 minutes, going up to 45 minutes?

    27. LN

      Yes. And the reason being is that it does take a while for your heart rate to elevate-

    28. RC

      Okay

    29. LN

      ... and then steady out. The second thing, let's talk about the benefits of aerobic training and what it does, because the benefits really come when you're, okay, you're in the zone. You and I right now, we're in our zone one, right? We've... When we talk about zones, we talk training zones. Zone one, we are sedentary. That zone two is that next level up, 65% of maximum heart rate. We've got zone three, and then when you're in that zone four, I call that the death zone. That's when you are working so hard running up those stairs to your maximum.

    30. RC

      The death zone.

  10. 1:09:39 – 1:12:07

    Strength training as a cornerstone: muscle as an endocrine organ and myokines as “medicine”

    1. RC

      How important is strength training?

    2. LN

      Oh my gosh. Well, now we're getting into it. Strength training, I believe, is probably f- fundamentally the most important part of exercise.

    3. RC

      Really?

    4. LN

      Many reasons. One, you're increasing your muscle mass. We know that at the age of 40 we get a decline exponentially in strength and mass. Think about muscle as your, y- your reserves, okay? Muscle is an endocrine organ. It stores a lot of our mitochondria where we produce all of our energy. It helps us and stabilizes us as we get older. But it's jou- it's the journey of building the muscle that is the most important because when we are strength training, we are releasing and expressing a whole host of myokines. Now, we mentioned BDNF. That's a myokine. But oh my gosh, strength training releases another 100 of them.

    5. RC

      And what do myokines do?

    6. LN

      Myokines are muscle-based proteins that when they go into different organs in the body, the brain, the liver, the pancreas, they have positive effects. F- so for the brain, they help preserve the synapses. So those dendrites-

    7. RC

      Mm

    8. LN

      ... that die off, they help preserve them. They help the other neurons survive. They help with the growth and proliferation of other neurons in the hippocampus. So they're doing the same thing as BDNF, but they're doing even more than that. Remember, BDNF just goes into the brain, but these myokines can actually go elsewhere. We know that this is the one responsible for inhibiting prostate cancer. There was a wonderful, um, there was a wonderful study that was produced in Cell Press journals that actually showed downregulation of tumor. Like, the, the tumor actually shrunk due to this myokine activity. We know that interleukin-6 can help us with immunity and with our mitochondrial function. Interleukin-6 has this dual effect. We know that it can be, it can be pro-inflammatory depending on which site it's released from.

    9. RC

      Yeah.

    10. LN

      But when it's released from the cells of the muscle, it's anti-inflammatory.

    11. RC

      And this is why you are calling our muscles our own internal pharmacy.

    12. LN

      Our muscles are our own internal pharmacy, and the myokines are the medications that you need to survive as we age.

  11. 1:12:07 – 1:23:40

    Adherence, motivations, and realistic resistance training targets

    1. RC

      Relating to something you said before, you said you wish that people would exercise because it's good for their brains, not necessarily because it's good for their physique.

    2. LN

      Yeah.

    3. RC

      I think certainly over the last few decades, and still today although I think it's changing, is that the number one reason most, certainly many people exercise, is to have a better physique.

    4. LN

      Yeah.

    5. RC

      Is to look better. Is that problematic, or are you okay with that because it gets them into the gym to get those brain benefits anyway?

    6. LN

      I'm okay with that to an extent, but I'm seeing a lot of people... Remember, what is the number one problem that you would come into contact with with a patient if you were to tell them to exercise more? Adherence.

    7. RC

      Adherence, yeah.

    8. LN

      Right? So out of exercise, sleep, and diet, diet's probably my, my worst one, right?

    9. RC

      In terms of your own behaviors.

    10. LN

      To adhere to, my own behaviors.

    11. RC

      Yeah.

    12. LN

      And now that is a behavioral trait. Adherence to a diet for me is way harder than adherence to a sleep protocol and an exercise protocol. That's just me.

    13. RC

      Okay.

    14. LN

      So if adherence is the hardest thing, then just going into the gym and getting anything done is great, but I would rather people know why they're doing what they're doing. Because what I'm seeing now is that people are just going for aesthetic purposes. They're not touching on the HIIT training. I hear people saying, it's, you know, "If I do aerobic training, it's gonna eat into my muscle gains." And then I just see people just pumping weights just purely for, uh, muscle mass and not even touching on strength, and they're two different things.

    15. RC

      Yeah. I guess the problem with doing it around aesthetics, and I understand the desire to do it around aesthetics. Who doesn't want to look-

    16. LN

      Yeah

    17. RC

      ... uh, good and lean and have a great physique, right? I, I totally get that. But I guess if you're dependent on that as the outcome, if you're not getting that outcome, and if that outcome is not coming as quick as you might want it to, you risk stopping doing it.

    18. LN

      Yes.

    19. RC

      Whereas if the motivation to go to the gym or move your body or pump weights or whatever it might be is, "This is one of the best things I can do for my brain to function well whilst I'm alive on Planet Earth," well, you've always got a reason to go, right?

    20. LN

      And you will adhere to this every single day throughout the lifespan instead of taking massive breaks just because, "Oh, I'm going on holidays, I'm just not gonna exercise for the next two weeks because I'm gonna have... I'm gonna binge eat, I'm gonna drink."

    21. RC

      Yeah. It also means for people who, let's say, naturally are leaner than others, and there are many people out there who can seemingly get away, at least from their external appearance, from not eating well. Obviously, there is a condition which colloquially is called skinny fat, where on the outside w- we look lean, but on the inside we've got, you know, visceral fat, the fat around our organs, which is incredibly dangerous and increases our risk of getting sick. The reason this conversation, this part of it, I think is really interesting is because if you look at yourself in the mirror and go, "Well, I'm, I'm okay. You know, I might have a little bit of a belly, but it's nothing to worry about at the moment," you're not then being driven into these behaviors because you're not connecting it with your brain, you're just connecting it with your physique. And if you think your physique is fine, you may not engage with the behavior.

    22. LN

      And you're basically doing this elimination, "Oh, I had two drinks today. I had three drinks today, but I'll just burn it off at the gym."

    23. RC

      Mm.

    24. LN

      And that's not the right attitude. Or, "I'm gonna have a cheat meal today, and then I'll just burn it off at the gym." I hate when... I hate when I hear that, because that just means that you're just going to the gym just to basically burn the calories that you ate.

    25. RC

      Yeah. Okay. So it was three hours of aerobic-

    26. LN

      Yeah

    27. RC

      ... 20 minutes of intense, so kind of gear four and gear five, or zone four and zone five, whatever you wanna... how- how- however you wanna think about it. Do you have a specific recommendation for resistance training?

    28. LN

      So in the paper that I authored alongside our, our friend, uh, Dr. Tommy Wood, we basically-

    29. RC

      I think Gabrielle Livremore's on that as well, right?

    30. LN

      Gab was on it, too.

  12. 1:23:40 – 1:32:23

    Neurocognitive training: combining movement with brain tasks, vision work, and coordination

    1. RC

      Yeah. I've heard you talk about the combination of resistance training with brain training.

    2. LN

      Yeah.

    3. RC

      And I found this absolutely fascinating. I don't think we've ever covered that on this show before. So can you explain what that is-

    4. LN

      Yeah

    5. RC

      ... and why you might even get some additional benefits-

    6. LN

      Oh

    7. RC

      ... by combining these two? 'Cause it's so interesting.

    8. LN

      That's where the name Neuro Athletics came from. So there's this whole part of-

    9. RC

      Why?

    10. LN

      ... of, of training called cognitive training where you're training your brain. We're training it to think faster, to react faster, to have better vision. Because remember, your eyes are two pieces of your brain, so you can literally work on your vision in many ways and strengthen your brain. And it's as easy as getting a tennis ball and throwing the ball to the wall. You're doing so many things when you do this. Remember the last time... You know, badminton, for example, is, is wonderful. It's probably one of the best brain training exercises you can do.

    11. RC

      Why?

    12. LN

      Because you're incorporating so many different cognitive abilities. You've got-

    13. RC

      Right

    14. LN

      ... reaction time.

    15. RC

      Mm-hmm.

    16. LN

      You have to think, you have to process when the ball's going to come. You're also in that aerobic zone. Sometimes you're dipping into zone four, and it just does wonders. You've got, you've got vision in place.

    17. RC

      I went on your Neuro Athletics website this morning-

    18. LN

      Oh, amazing

    19. RC

      ... and one of the reviews at the bottom was from someone who was saying that, "Louisa's really helped me with my peripheral vision."

    20. LN

      Oh, there you go.

    21. RC

      Yeah. And I found that fascinating. That's come up a little bit on the show over the last couple of years because since I started working with my own movement coach, Helen Hall, who's phenomenal, one of the things that we've been working on is eye movements.

    22. LN

      Really?

    23. RC

      And she's been tracking. She's got this very, very, um, sensitive device. There's under 10 around the world in terms of our spinal movements and what's happening when you're in gait. How is every vertebra moving? How's your pelvis? You know, it, it's phenomenal what... If you know how to interpret it, which Helen does, it can be incredibly helpful. And I've seen how just something as simple as walking or running on that treadmill with peripheral vision versus focused concentric vision changes the way you move, and she can measure that, and she can show you, and it's really, really interesting. And so without going into a deep rabbit hole there, which I'm sure you'd be really [laughs] interested in, actually, is, it's this idea that, well, well, first of all, I'm thinking a lot now with my kids about- What exercises are also helping them with their vision?

    24. LN

      Yeah.

    25. RC

      Right? So I've become a real fan, I always have been, but things like tennis-

    26. LN

      Yeah

    27. RC

      ... badminton, where you're, you're tracking something that's moving far and then near-

    28. LN

      Yes

    29. RC

      ... and then far and then near. So that's a, that's an incredible workout for your eyes.

    30. LN

      Yeah.

  13. 1:32:23 – 1:54:38

    Sleep and the brain: glymphatic clearance, deep sleep, and why regularity matters

    1. RC

      We've gone deep into exercise, which I think was really important. Um, let's go to sleep.

    2. LN

      Mm-hmm.

    3. RC

      What would you like everyone to know about the relationship between sleep and brain function?

    4. LN

      First of all, sleep is, uh, the, the best way for you to clear out these amyloid proteins that build up during the day.

    5. RC

      Wow.

    6. LN

      When we sleep, we dip into our, our deep sleep zone, which is stage three sleep, where generally when I talk about sleep, I really just talk about stage three sleep and stage four. Now stage three is non-rapid eye movement sleep. This is our deepest sleep possible. Two major things happen during this stage. This ... And this is towards the, you know, around 90 minutes after you fall-

    7. RC

      Mm

    8. LN

      ... asleep. We go into our deep sleep zone. You're activating something called the glymphatic system, and this is when all of the cerebral spinal fluid in our brain washes out all of the debris. So those, those toxins that built up that we mentioned earlier, the environmental toxins, the mycotoxins, and the amyloid beta, when that builds up in the brain, it has a chance at, at night during deep slow-wave sleep to be cleared out. And it does this because the certain are- the certain brain cells in our brain called glial cells, they, they shrink in size and they, they stick between neurons as well. They're our immunity, uh, our immunity cell. They shrink in size, and that's what allows the cerebral spinal fluid to act like a washing machine.

    9. RC

      So sleep's important to clear out-

    10. LN

      Yep

    11. RC

      ... toxins that may build up over the years.

    12. LN

      Yes.

    13. RC

      Just a reminder for people what we said right at the start, which is this idea that beta amyloid protein, which, yes, we do see in people's brains with Alzheimer's, is not really the root cause of what's going on, and beta amyloid p- perhaps is a response to inflammation and stress and all kinds of modern-day insults, and that accumulation may well be starting at the age of 30 or 25, okay?

    14. LN

      Yeah.

    15. RC

      So when we think about that, you're now connecting sleep, saying, listen, this stuff may start to appear in your brain because of the stressful toxic lives many of us now lead, especially we live in urban environments, right? But actually one of the best ways to insulate yourself from that potential damage and accumulation is to focus on your sleep.

    16. LN

      Yes. Remember also I mentioned that the amyloid gets, gets triggered due to the innate immune system.

    17. RC

      Yeah.

    18. LN

      It's the body's first line. Then we've got the adaptive immune system, which is meant to take over-

    19. RC

      Yeah

    20. LN

      ... and basically calm down the innate immune system. So this is your chance, all right, of when you're sleeping, you're also building up immunity. We've actually seen through a, a really well-documented study in pr- presented in PN- PNAS where they took a group of healthy men, and they subjected them to sleep deprivation for one week, which was around six hours per night just on one week, and what they found over just that seven-day period was that they had a epigenetic change of 3%. So they, they changed their genome. So we have around 20,000 genes in our human genome. They changed 3% of this genome, so they changed around, I think it was 711 genes.

    21. RC

      For the worse?

    22. LN

      For the worse.

    23. RC

      Hold on a minute. Did you say they were deprived ...

    24. LN

      Just for one week.

    25. RC

      But the sleep-deprived individuals were sleeping six hours a night?

    26. LN

      Yes.

    27. RC

      Right. Six hours a night is-

    28. LN

      I know, and that's the problem

    29. RC

      ... is actually what some people are, are happy if they're getting six hours a night. That's their, "Hey, I had a great night. I slept for six hours."

    30. LN

      Yeah.

  14. 1:54:38 – 1:57:33

    Stress, inflammation, and agency: managing load, testing inflammation, and building momentum

    1. RC

      ... as a supplement. And we haven't really touched on stress. Of course, meditation is a great way for some people at reducing stress. What would you like people to know about the impact that chronic stress has on our brain function?

    2. LN

      Chronic stress ends up leading to that chronic inflammation, right? That's something that we really need to take care of because remember, inflammation is one of the root causes of what is killing the network in our brain. It's killing the synapses. So we've got a network problem here, and if we want the growth and survival of this network, which preserves our cognitive functions as we age, which basically halts the, the onset of Alzheimer's disease, we need to get our inflammation underway. You can go and get this tested by getting something called a HS-CRP, high-sensitive C-reactive protein, which is a measure of inflammation in your blood. You want it to be below zero. But what do we do on a daily basis to manage this, okay? Because every time you get stressed, you activate that innate immune system. You impr- you increase the amount of amyloid in the brain.

    3. RC

      And for short periods of time, that stress is okay. It can help you perform better. It can help you-

    4. LN

      Yes

    5. RC

      ... function well.

    6. LN

      Yeah.

    7. RC

      It's that chronic-

    8. LN

      Chronic

    9. RC

      ... day after day, especially with no recovery-

    10. LN

      Yeah

    11. RC

      ... where this starts to become a problem, right?

    12. LN

      I see everything, Rangan, as, um, an allotment. You have a certain allotment, which you probably ha- have told your patients, of how much radiation you can have each year. You know, just getting an X-ray is not gonna be bad. If you're doing an X-ray every single day, it's probably going to be bad for you. I believe, this is just my own thinking, we have an allotment of stress. Let's say we stress our body by going to the gym because that's what we do.

    13. RC

      Mm.

    14. LN

      We, we, we micro-stress, but it's a good stress, right? If we stress our body at the gym, and we are sleep-deprived, and we are having the worst day, and we're, we're negative, and we're angry, and we're emotionally triggered, and we're having refined sugars and ultra-processed foods, you've, you've exceeded your allotment of stress.

    15. RC

      We're in the middle of London at the moment. You're basically talking about- I would say-

    16. LN

      Is that a normal thing? I d- I don't-

    17. RC

      I, I-

    18. LN

      That's, that's a make-believe thing to me

    19. RC

      ... I, I think it is pretty normal now for many people. I really do. I think having, you know, refined sugars, ultra-processed foods, being sleep-deprived, being chronically stressed, getting angry, emotionally reactive, um, and if you do get any time, you go and kill it at the gym and add to your stress load and maybe not have the proper sleep and recovery afterwards, I don't think it's as uncommon as you might think.

    20. LN

      And that's probably why Alzheimer's disease is as common as you think.

    21. RC

      And gonna triple by 2050-

    22. LN

      Yes

    23. RC

      ... because that is the lives

  15. 1:57:33 – 2:00:28

    Supplements discussed: sleep supports, creatine, and omega-3s (plus testing)

    1. RC

      that so many people are living these days, right?

    2. LN

      Yeah.

    3. RC

      And, and I get it that for some people, they are living tough lives. The world does feel out of control. There's all kinds of events going on that people don't like. Maybe they're struggling to have the money to do the things that they wanna do, right? So I think we have to acknowledge that, that that is real. But one thing I like about your message is that a lot of what you're talking about actually doesn't cost that much money. It really doesn't, right?

    4. LN

      Mm-hmm.

    5. RC

      What do you say for stress for some of your high performers? Write down everything in your minds.

    6. LN

      Yeah.

    7. RC

      Right? That really doesn't cost any money.

    8. LN

      No.

    9. RC

      Right? You're talking about, uh, walking, brisk walking. You know, maybe doing some squats while actually trying to do some calculations. In terms of practical advice for people, there's a lot one can do if they don't have the financial resource. Of course, they do need the time resource, and there's some people who are working two or three jobs to make ends meet, and they don't feel that they have the time. So, yeah, do you think that's a fair reflection? And do, do- is, is that fair for-

    10. LN

      Yeah

    11. RC

      ... what I said in terms of your work?

    12. LN

      And another thing I wanted to point out is what above all controls all of this? It is your outlook. It is your perspective. It is your mind. I believe we've got three different minds, and they all live in the brain. So a stronger brain, a stronger network, a stronger mind. You'll be able to talk yourself into creating the life that you can have to improve these brain health outcomes. You just, you said it yourself, it's free.

    13. RC

      Yeah. I think one of the most important decisions you can make in life that is at the root of your health outcomes and your happiness outcomes is whether you're a victim to life or you're in charge of life, and I say that with all the compassion that I have within me. Wherever you are in life, you have to take agency and go, "Okay, what one small five-minute action can I do today for my health, for my wellbeing, for my family's wellbeing?" Start there. But if you don't have that agency, I don't think it matters what else you try and do. I think you are gonna be a victim to life and a victim to external circumstances.

    14. LN

      Yeah. And I use the analogy of compound interest. Everything you do has an effect, for the positive or the negative, when it comes to your longevity, your mindset, and your brain health. One night of sleep deprivation probably won't do anything. If you exer- if you don't exercise and you're sedentary for maybe five, six days, that won't do anything. It is the compounding effects-

    15. RC

      Mm-hmm

    16. LN

      ... of that certain habit. So you want to be able to fix it. You wanna be able to build a stronger mind, which will build a stronger mindset, so you can have that ripple effect.

  16. 2:00:28 – 2:02:44

    Closing takeaways: preserving identity, accessible interventions, and where to follow Louisa

    1. RC

      Yeah. I love it. Louisa, honestly, I, I really love what you're doing out there in the world. You're publishing studies. You're looking at the research. And then certainly what I've seen on your Instagram, you're trying to put out this positive, inspiring message for people to say, "Look, brain decline is not inevitable. You can do something about it, so please start." If people wanna stay in touch with you, they wanna find out more about your work, where would you send them?

    2. LN

      Definitely come to Instagram. That's where I hang out a lot. Um, we actually, at Neuro Athletics, we have our flagship course, which is the Neuro Athletics Coaching Certificate, where we actually teach coaches our pillars of human performance.

    3. RC

      Wow.

    4. LN

      Yeah.

    5. RC

      Fantastic. And if there's one final message you could leave for people, right? Let's, let's imagine you're talking to that one person who has just stumbled across this podcast or this video on YouTube. They've never heard any of this before, and they thought, "Wow, I didn't know. I th- I didn't know that I had this much control over my brain function." But they're struggling with motivation to get started. Talk to that individual. What would you say to them?

    6. LN

      You know, we get one life, and the one thing that you don't want is to lose or forget who you are because we spend our entire lives in search of meaning of who we are. And to come to the end of your life and to think, "I could have just exercised. I could have just slept. I could have just not stressed out as much," the last thing you want is to look in front of the mirror and see your reflection and not recognize that and not recognize who your children are. So it is my, it is my dream that one day we have a cocktail of interventions where everybody, no matter what your location is, geographic location, or your socioeconomic status, that everybody is able to exercise.

    7. RC

      Louisa, you're doing incredible work. Thank you so much for coming on the show.

    8. LN

      Thank you so much for having me. [upbeat music]

    9. RC

      If you enjoyed that conversation, then I think you are really going to enjoy this one.

    10. SP

      If at 37 your limit is just being able to run that 30-minute park run, at 75 you're gonna have a very difficult time getting around.

Episode duration: 2:02:44

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