#851: Dr. Tommy Wood — How to Future-Proof Your Brain from Dementia

Tim Ferriss introduces Dr. Tommy Wood, an associate professor researching brain health across the lifespan, including therapies for brain injury in newborns and prevention of cognitive decline. Dr. Wood emphasizes that cognitive decline is not an inevitable process and interventions are possible.

Dr. Tommy Wood's diverse background is highlighted, including degrees from Cambridge and Oxford, a PhD from the University of Oslo, and his role as head scientist for motorsport at INSA Performance, working with Formula One drivers. He has also competed in multiple sports, achieving high rankings in off-road Ironman and Strongest Man competitions.

Dr. Wood discusses two main types of brain injuries in newborns: preterm brain injury and hypoxic ischemic encephalopathy (HIE). For HIE, the state-of-the-art treatment involves cooling the baby down to 33.5 degrees Celsius for 72 hours to reduce death and disability. For preterm babies, caffeine is beneficial, not for neuroprotection, but to stimulate respiratory drive and improve cognitive function.

The biggest impact on later outcomes for babies with brain injuries is the home environment they return to. While neonatologists do amazing work in the intensive care unit, the home environment has the most significant influence on brain development. Parents can significantly help a child's brain develop as normally as possible, even after an imperfect start to life.

Dr. Wood outlines steps to take after suffering a severe concussion as an adult. Managing fevers is crucial, as hyperthermia worsens brain injury. Managing blood sugar by avoiding refined carbohydrates is also important. Supplements like creatine and omega-3 fatty acids can be beneficial. Exogenous ketones are also recommended.

DHA is important for brain structure and function, concentrating at neuron synapses and in mitochondria. It regulates neurotransmitter release and supports energy production. Omega-3s are important precursors for signaling molecules like resolvins and protectins, which regulate the immune response after brain injury.

A daily intake of one to two grams of DHA is recommended, achievable through two to three servings of seafood per week or supplementation. The body actively sequesters extra DHA, storing it in adipose tissue for later use. Exercise or fasting may help access this depot.

The conversation shifts to Alzheimer's disease, dementia, and extending health span. Cognition is viewed as a critical pillar of health span, and there is a desire to do anything possible with the right risk-benefit ratio to avoid cognitive decline. The discussion then turns to August Dieter, Alzheimer's index patient.

August Dieter was Alzheimer's index patient, studied by Alois Alzheimer in the early 20th century. Alzheimer studied unusual cases of pre-senile dementia in younger individuals. Over time, early and late-onset dementias were lumped together due to similar brain appearances under a microscope. However, it's now thought that August Dieter may not have had Alzheimer's disease at all.

It is estimated that 45 to 70% of dementia is preventable through lifestyle interventions. The Lancet Commission Report on Dementia Prevention estimates 45% is preventable by eliminating risk factors like smoking, low education, hypertension, hearing loss, obesity, and low physical activity. Societal factors also play a role, and lifestyle changes can significantly stack the deck in one's favor.

Tim Ferriss shares his personal regimen for cognitive health, including fasting, a ketogenic diet, exogenous ketones, avoiding glucose spikes, omega-3 intake, B vitamins, regular blood testing, zone three training, walking, and weight training. He has also undergone brain MRI and cognitive testing to establish a baseline for measuring the effects of these interventions.

While ketones show promise, they may not be necessary for dementia prevention. MCT oil seems to increase C2 acetate uptake into the brain, improving cognitive function in early Alzheimer's disease. This addresses an energetic deficit seen in Alzheimer's, where less glucose is taken up by the brain.

Different types of exercise affect the brain differently. Coordinate or open skill exercise, plus activities with a navigational component, seem particularly beneficial. These activities require constant response and adaptation to the environment. Examples include dancing, board sports, ball sports, and team sports.

The benefits of aerobic exercise on the brain seem to be intensity-dependent. A study involving the Norwegian 4x4 protocol (high-intensity intervals) showed significant improvements in hippocampal structure and function that were maintained for several years. This is likely driven by lactate, which gets into the brain and activates BDNF.

The conversation transitions to Dr. Tommy Wood's forthcoming book, The Stimulated Mind. The book goes through all the stuff they're talking about and a lot more. The book is for anybody with a brain.

The supplements with the best evidence are core nutrients like omega-3s, B vitamins, vitamin D, iron, and magnesium. Antioxidant polyphenols from berries, coffee, and tea are also beneficial. Choline is critical as a head group for fats in membranes, and CDP-choline has shown benefits in older adults with cognitive decline and after traumatic brain injury.

Dr. Wood supplements with 10 grams of creatine daily, finding it cognitively stimulating. He takes it in the morning to avoid sleep disruption. There is no need to do anything to increase brain uptake of endogenous lactate because the brain will generally just take up as much as you've got.

Dr. Wood uses B-Strong blood flow restricting cuffs, which come with a sphygmomanometer. When traveling, he takes a "gym in a bag" consisting of BFR cuffs and bands. He performs bodyweight exercises like lunges, squats, presses, and bicep curls, accumulating 75-100 reps in 10-15 minutes.

A recent study called "Creative Experiences and Brain Clocks" looked at the impact of tango dancing, language learning, musicianship, art, and video gaming on brain structure and function. As expertise increases in these complex arts, the structure and discreteness of critical brain networks improve.

Those who grew up bilingual perform better on tasks requiring executive function, such as response inhibition. This is likely due to the constant suppression of one language while activating another. Bilingualism is associated with a decreased risk of dementia or a later onset.

Both Tim Ferriss and Dr. Wood share their experiences with cognitive testing, noting that they perform averagely on most tests except for response inhibition tasks, where they excel. This may be related to their experiences growing up speaking multiple languages.

The discussion highlights the multifaceted benefits of activities like tango, which combines dancing, language learning, and music. The improvised nature of tango requires constant listening and adaptation to the music.

Sensory loss, particularly vision loss through cataracts and hearing loss, is associated with an increased risk of dementia. This risk is reversible with cataract surgery and hearing aids. The loss of engagement with the world due to sensory loss is a significant factor.

Dr. Wood's non-negotiable is sleep. Inadequate sleep is associated with increased risk of dementia. He prioritizes sleep over diet and exercise, recognizing its critical importance.

It's important to avoid becoming too orthorexic about sleep and freaking out over wearable data. In short periods of time, sleep deprivation primarily affects processing speed and mood, not accuracy. Knowing this can help manage the impact of occasional poor sleep.

Air quality and air pollution are significant risk factors for dementia. Air filters can help improve blood pressure, a key metabolic risk factor. Oral health, particularly treating gum disease, is also important due to systemic inflammation and the presence of bacteria in atherosclerotic and amyloid plaques.

Xylitol gum or mouthwash can improve the oral microbiota and decrease cavity-causing bacteria. Things that have an anti-inflammatory effect or decrease inflammatory burden seem to have an outsized benefit for those who are ApoE4 carriers.

Dr. Wood stops work before dinner, uses blue light blocking glasses, and reads fiction before bed. He uses an Eight Sleep to stay cool and wears an eye mask to block out light.

Dr. Wood supplements with a few micrograms of vitamin K2 daily, as it comes with his vitamin D supplement. He also consumes natto and other fermented foods that contain K2.

The conversation digresses to fermented shark, a traditional Icelandic dish, and surströmming, a Swedish fermented herring.

Dr. Wood explains the motivation behind writing "The Stimulated Mind," which aims to provide a practical and science-driven guide to preventing dementia and improving cognitive function. The book focuses on the big rocks and tactics for addressing risk factors.

The book provides practical and specific advice on diet, sleep, physical activity, social connections, and stress tolerance. It emphasizes a holistic approach, showing how improving one area can positively impact the entire network of factors affecting brain health.