Longevity Neuroscientist: Fix These 5 Things After 40 To Preserve Muscle Strength & Stay Young!

for people who I guess have a bit more time or already active let's say they're already able to go for a 30 minute walk seven days a week they're like Tommy look I can do that there's no problem my my life and my work allows me to do that what else should I be doing as I get older to you know look after my health body brain mind everything where would you go next resistance training of some kind you some kind of of weightlifting or something where you're applying resistance to to the muscles I you

know there's lots of different ways that you can think about this uh in general um I think there's a I have a pyram a movement pyramid it's my own movement pyramid and I think at the at the bottom is just spending less time sitting right so there's even there's even benefits to um you getting a standing desk if you can or so say say you're you're in a job where you're sitting all day is there some way to make it so that you're just sitting less and that could even be this idea of movement snacks

where you know once an hour you go for a quick walk or you go up and down some stairs or whatever you can do near you so just less time sitting um and then the next would be spend more time walking and there's a whole bunch of studies again suggesting that risk walking um particularly in those who are who are otherwise sedentary can dramatically improve um your health and there's this linear benefit of number of steps you can get per day in terms of mortality risk and and various disease risk up to maybe somewhere between

8 and 14,000 steps per day or something but the more you can do in that zero to 10 or 12,000 the better really and a lot of that if particularly if you're doing quite brisk walking so say you're doing your 30 minutes and it's quite brisk um then that for many people maybe getting them up into that area that you mentioned briefly mentioned earlier that zone two so you're getting some of those cardiovascular benefits and that's probably where a lot that benefit comes from so then the next level I think is is resistance training um

and particularly as you get older we know there's a decrease in muscle mass but more importantly and probably faster and earlier there's a decrease in strength and as you get older you lose in particular type two muscle fibers these are fast switch muscle fibers and those are important for a number of reasons because they're they're an important glucose snc so they're important for metabolic Health right so if you we talked earlier about all these things that affect your blood sugar having healthy active muscles and having a lot of these types of fibers is really important

for our blood sugar control and a whole host of other things um and it's also really important for our stability and mobility and function so if you lose those fast twitch fibers those are the ones that are important for like reactions and like if you uh if you like going to fall like grabbing onto a handrail or stopping yourself from falling and you know particularly as you get older you know FS risks and broken hips and all that kind of stuff you're going to be protected against that if you have more of those types of

muscle fibers and those are the ones that you get through resistance training the ones you develop in particular you know it affects all the all of your muscle tissue but those are the ones that you protect when you do that kind of resistance training I wonder if we could just spend a bit of time trying to Define resistance training and and the reason I'm asking this question is some people don't want to go to the gym and you know given that gyms are a relatively modern phenomenon and that humans have lived to pretty decent ages

for a long period of time I think when we say resistance training or strength training we have to broaden it out Beyond lifting weights in a gym because for the people who love that they love hearing it and go yeah I knew I was on it was strength training right but for people who don't like it it can be bit confusing so indoor climbing running up hills right yeah you know that's resistance Against Gravity in your view what counts as resistance training so it can be it's literally any movement where you're you you're moving your

body in space against so against something that makes it harder than it normally would be for that movement if that makes sense right so so carrying your shopping bags to your car or even to your home or is that resistance training instead of walking you're carrying right yeah and we've talked previously about so you mentioned the blue zones and in the Nyan P Peninsula they're not all down the gym all day right um but they are doing physical activity every day that includes things like carrying and lifting um and so and you can translate that

to your own activities of daily living as we call it right so if you want to be able to carry your shopping um then heavy shopping bags are resistance training um and anytime that you're moving your body and so it could be squats just with your body weight that's resistance training or you you could do push-ups and it can be against the wall rather than against the floor you know that that's resistance training um and and it can just be these daily activities like lifting things into cupboards and carrying things around like all of that

counts and particularly as you get older you want to maintain those you want to maintain those functions so anywhere you can find an opportunity to move your body against some kind of resistance that counts the the problem you know does become at some point you need to progress things so in order for it to create again anything is better than nothing but to create an ongoing stimulus it has to be a I think it has to be a little bit challenging M so you know if you're just going to so so maybe uh you do

a few uh car phrases squats push-ups against the wall few bicep curls in the kitchen like all of that stuff is great um but at some point you have to make sure that you're you you would like to progress it would like to be you would like to get stronger such that that is no longer enough and then you have to find some way to make it a little bit harder so I think there has to be a challenge component to it so the push-up against the wall then has to be the push-up against the

table and then the push up against the chair and then a few months later maybe push up on the actual floor exactly um and also I think I just want to highlight let's say yoga and pilates for example because sometimes I feel that gets left out of strength training and I think uh participants uh and teachers of those disciplines will often say hold on a lot of what we do is is hard on the muscles you know and there are plenty of yoga moves for example or poates moves which I think do count as resist

I think they absolutely should be included particularly for for for this kind of discussion um that I mean there's a lot of yoga stuff I'm relatively strong there's a lot of yoga poses and things I can't I can't do it's a different different it's different but it definitely counts as as as resistance absolutely is there a next rung on your pyramids yes so then the the next rung um is high is sort of high is high intensity interval training or hit and the reason why it's next is because I think that and again this is

for um this is not for Elite Sports Performance this is just for average people who want to try and figure out how to uh separate out their time in terms of movement and so you will get some cardiovascular benefit from your risk walking and or it could be it could be cycling or or something right it doesn't it doesn't have to be walking but I I like walking because anybody or most people can do it um but then you do get some slightly you know if if you then want to get into the physiological biochemical

nitty-gritty you do get different adaptations to high intensity training versus lower intensity training right I think in general that idea of intensity times time is what's most important but of course different things happen at the cellular level when you do one versus the other and so you can you know that that's that's a beneficial add-on uh on top of say resistance training if you're already doing some some lowlevel uh intensity movement and then on top of that um you if you if you really enjoy it I think you can do very long periods of of

endurance training but but I don't think most people need that if they're just trying to move as much as they as they can in order to improve their health so that's kind of the that's the progression that I use yeah so so I really like that um if someone's hearing that and says okay Tommy look I don't move much I like that pyramid but do I have to sequentially go up it or for example if someone goes you know what I used to do some strength training when I was at school but I haven't done

it in ages and I quite fancy that there's no reason why they can't start there right on your pyramid they don't have to progress up yeah and um what's what's quite good about say say if you're going to the gym is there's there's a lot of you start doing the other stuff as well so when when you're at the gym you're usually not like sitting like you would in in in in a chair at a desk or on the couch or on the sofa and you're probably walking around quite a bit right you're getting some

of that you know additional movement and um there are some some nice papers that talk about how particularly if you do weight training to what they call voluntary muscular failure right so you do a number of repetitions to the point where you can't do anym with good form even that has some cardiovascular benefits right you know similar to maybe some some low lower intensity aerobic training so yeah I think you know anywhere in that that's that's a um that's a good entry point for you I think is is great and that's always where I would

want people to start the reason why I have like very long hard endurance exercise at the top is because that's often where people start because that's where they assume they need to be in order to improve their health right if I'm going to I need to go for a run I need to be hard and I to do it for an hour or else there's no point in doing it but actually that's that's quite taxing on the body and you don't necessarily get all the the other benefits that you would from those other different types

of types of training so that's why I put it at the top but there's other there's there's lots of other places that people can enter and again anything that you can do that you enjoy and is sustainable that's the place to start and the only thing I I guess I'd want to add there is we forget sometimes that exercise and high intensity exercise can be a stressor on the body and what I've I've often seen with certain patients is they have very high stress lives go go go and then the workout is also you know

high intensity at 8 fast 1 hour run that is very hard on the body and I've I think again this is a much broader conversation so we we have to save this for another time but I do think we also need to think about how much is this exercise now taxing us and I certainly have found over the last couple of years I've really been leaning more into a lot of low intensity you know walks or bikes or swimming where you know it's just nice and relaxed but I'm going for 30 40 minutes maybe an

hour I'm like wow I I feel like I need no recovery it doesn't stress me out and I kind of measure it sometimes with HRV and heart rate variability and things like that and I'm like wow I do feel that we sometimes forget about the stress components so that's if people really want to dive into it but but I agree with the message which is anything's better than nothing and it's probably not that much for most people right that's going to give them some benefits yeah the main thing that I try and get across is

the the dose needed or the amount you do needed to to see some benefit again for for most people is really quite low and that the because because often what you see and that's that's kind of all what I alluded to earlier is that people assume that they need some vast amount several hours a week in order to see benefit and if and if they can't do that then they just don't bother doing anything so the the most important thing is to do more than you're currently doing again if you're relatively sedentary or you're you

know trying to improve your health through physical activity um and then you know once once you get beyond that point you have several hours a week to train of course there's lots of different protocols and different things that you can follow but up until that point you know anything that you can do and is sustainable and you enjoy is going to be great you've touched on muscle mass uh through the lens of resistance training and how important that is as we get older we have spoken about it before one thing I wanted to cover though

is look if I look at you you're a musly guy you know you like to you know you you compete I think don't you in in strong man in strong man right so that's a passion for you and you you you eat a certain way you work out a certain way so you can compete in this sport one thing I've been thinking a lot about over the last few months is what's the cost of muscle because I don't feel that we see often in the longevity hotpots really muscly people right I haven't gone out there

and studied this in debt so I you know I can't say I know that for everyone or you know we often don't hear about them being really musly in their 40s and 50s and I often think about a place I've spent a lot of time in which is shamany in France where it's in the mountains in the French Alps and many people there if not most people are active they are but very functionally active so a lot of the time you'll see that people have got uh quite lean um they're strong physiques but not necessarily

bodybuilding strong uh you see this with mountain guides and and I think a lot about okay there's a big movement now to say guys you got to work on your muscle mass as you get older because you're going to lose muscle mass as you get older and it's very important for longevity it's important for brain health as you you've covered uh before on the podcast but we're not necessarily talking about big muscles I don't think I'd love you to expand on that and also you know I guess broad broadly you know what is the cost

of muscle mass because the more muscle you have I guess the more protein and calories you need to feed that muscle so how do how do you think about that there's several moving parts that that I'll try I'll try and cover the first is is an important one um which you didn't ask about but I will mention which is that whenever I talk about muscle everybody's like I don't want to look like you I don't want to eat like you I don't want to train like you and that is not what I'm saying absolutely not

um and when I say that the people should build muscle mass and strength I'm absolutely not talking about what I do or other you know other people do in terms of bodybuilding or or strength training um that's completely separate I don't think that that's detrimental to health and we'll cover that as well but that's not what I'm recommending to people um and it's funny because I actually mentioned Gabrielle lion and and um I Heard uh like an anecdote which is that somebody uh somebody was telling me that they've been telling their or suggesting to their

wife that they should um May maybe do some strength training you know for all the reasons that we talked about and it was sort of like in one ear and out the other um but as soon as she heard another woman like her talk about the importance of strength training immediately that that that message went in so it's so the message is important but the messenger is important as well so sometimes it's not good for me to talk about muscle because people are like well I don't want you know that I don't want to look

like that and that's that's definitely not what I'm suggesting um when you look at again so at the population level we're going to use that word again so we do these large large studies of people who sort of represent the population and they've done it in the UK with the UK bio bank they do it with in the in the US with nanes and other I mentioned earlier how terrible the enhan dietry data is the other data they collect enes is actually very good um and what you see is that those who are in the

top 50% of muscle mass so you know just above average they tend to live longer um and have you know overall lower risk of most diseases and mortality but there's not like a dose response it's not like more is better it's just don't so so really the the what you see from those studies is that low muscle mass being and you know we might use the phrase sarcopenia that's the technical term for just having low muscle mass um dynapenia is related to low strength um or loss of strength so low muscle masses is problematic um

rather than more muscle being better if that makes sense so you really just don't want to have not very much muscle like that's where the real um signal of benefit comes from again at the population level when you know studies that I've done either and there's one we published just recently and there's some other stuff that were working on um what we've found is that more muscle is not better um above a you know above that low level but if you do have more muscle it needs to be functional so you need to have strength

proportional to that amount of muscle mass um and that's the kind of muscle mass that you generate through resistance training so if I have more muscle but I'm stronger with it I think that that is is just fine right that but there's another scenario where you can gain a lot of muscle and that's this is muscle measured on a on a like a dexa scan which is a type of X-Ray Scan you look at how much muscle people have and when they do that at the population level those who have the most muscle particularly in

men there's a a a study that came out um from the UK bio Bank recently those who had the the men who had the most muscle the top it was either 20 or 25% they had a higher risk of mortality and a higher risk of cardiovascular disease but the men who were the strongest had the lowest risk so there's this dissociation that's another fancy word like the separation of like strength and muscle so strength is what's important relative to muscle mass and when I've looked at some of these data myself those you know muscle does

not correlate with physical activity so these people are not gaining muscle because they they're in the gym all the time they're gaining muscle because they're eating beyond their caloric needs and gaining more total mass and some and and with that they they tend to have worse metabolic Health um more you know high blood pressure worse blood sugar um so they they're not it's not muscle that's gained through lifting weights right it's muscle gain just through gaining more mass and some of that is muscle tissue so as people put on excess weight there's an assumption that

will always be fat no some of it is muscle so you still put on extra muscle as well W and actually that relationship between strength and muscle reminds me of conversation I used to have with a really good mate of mine who I was at Uni with who was a um a very keen indoor climber and he used to talk about the perfect you know they measured the perfect ratio between strength and muscle for climbers because you don't want too much cuz you're too heavy yeah particularly in the legs exactly and I was like so

it reminds me of those conversations and I I think the so there are there are two parts to this one is that there are there are these studies and you talked about the cost of muscle there are these studies that suggest that more muscle is is detrimental but that's because muscle you know muscle is coming along for the ride with um you know gaining excess weight and worse metabolic health and all that stuff that comes with it that muscle has not been gained with a proportional Improvement in strength or function but if you look at

having a high level of strength or function relative to your muscle mass that's incredibly predicted of cognitive function and and mortality risk so you want enough muscle you just you don't want to have very little and you want that muscle to be strong and functional that's the most important thing and that's that's what you're talking about in terms of those those individuals that you see um in the French Alps and in terms of the the individuals you see in in Longevity Centers or you know you know placees around the world where people live a long

time it's functional it's functional um so whatever muscle that you have has to be functional I think that's the main that's the main takeaway now related to that Tommy again whenever we talk about anything we have to think about in what population are we talking about it for and sometimes when I think about some of the protein research and the encouragement to high protein diet I know we've covered that there's no real detrimental effects and you you believe in as I do that many people are undereating protein and we think about it in terms of

our muscle mass like if you're not eating enough protein let's say you let's say you should be eating 30 gram for your for your size at a meal now let's say you get really with active and do loads of strength training if you do that yes I know you need protein to support the muscle growth but is there a case to say and I I kind of think that maybe this happens in some longevity hotspots that they are really really active maybe not eating high protein but because they're so active and they're so functionally active

they're still maintaining muscle yeah when you I the best way to understand it in terms of the so the research that we have is if you have individuals who are um calorie restricted um and when you restrict calories one of the thing right you lose weight and that comes from fat and muscle and you know other tissue as well but in that scenario if you add in physical activity you preferentially keep that muscle tissue and you you preferentially get your your energy elsewhere so even if you know you have a a period of time where

you're e either dramatically undereating or you have a a high energy expenditure um then you will preferentially keep your muscle mass and strength as long as you maintain activity levels so that becomes important if people decide to do long periods of fasting maintaining activity is important so that you preferentially keep you don't use your muscle tissue for energy um and so that's that's partly what part of what comes in there but I think there's there's also been a big debate in terms of so again we go back go back to the the blue the blue

zones there's there's been some some pretty reasoned debate in terms of how much protein those those um groups are actually eating and it is it is probably more than the typical uh Western diet you know they're they're not eating low protein diets uh but then they're also physically active and all these other things that are important as well I do remember um a conversation a few years ago I was I was speaking at a longevity conference and Michelle pulan was there who was one of the original researchers who went to study in the blue zones

and he shared with me that essentially that in some blue zones they're eating more animal products than Maybe than we've been led to believe yeah I love a lot of the stuff on Blue zones for sure I think they're really really interesting but what their diet is I I'm not sure we're fully sure yet well certainly I've heard conflicting things let's put it like that and when you step outside of those um you know small pockets and you look at you more say uh higher income or you know you know westernized for one of better

word societies there are lots of populations around the world that eat a very high protein intake relatively and have some of the the the longest live people on average so like Hong Kong and Iceland eat a lot of animal products a lot of meat a lot of protein and they are some of the longest lived Nations on Earth um so so I think that using you know the blue zones are informative but if you try and look at an overall population that's closer to to ours in terms of overall technological you know development or you

know an access to Foods then those I think are worth considering as well um and in general you know they there there are several that that have a high protein diet and and you live a long time yeah I think also the nature of science often is to be reductive so we can measure one thing yeah but our Human Experience isn't that reductive right we have all different kinds of inputs into our lives and so I often feel that it it gets hard because you know science is very useful to inform us but then and

I'm I guess I'm biased from my experiences with patients where I kind of feel yeah that's one factor but it kind of depends what are the other factors that are going on as well that influences how much that factor is important so thinking about food intake without also thinking about physical activity and stress and sleep yes can be usedful but potentially limited as well so I feel I feel like we over focus on diet most of the time that's that's where everybody wants to go when all the other things that you mentioned probably for the

vast majority of people are going to be at least if not more important yeah I totally agree I mean You' covered quite a lot Tommy I mean maybe just one more topic um supplements um you're a fan of cine aren't you yeah why um because it does everything no it's it's probably the one supplement that I would routinely recommend to pretty much everybody um there was a there was a recent study that came out in postmenopausal women where they took creatine um for two years and it it was associated with some improvements in in uh

bone strength you know obviously that's U that's that's that's important for for postmenopausal women um I I'm I'm a big fan of it because of its effect on the brain so um there are several studies showing that creatine supplementation acutely improves cognitive performance uh that's in like in athletes and young healthy people and there have been large meta analyses looking at creatine supplementation on cogntive function and the benefits are greater as you get older so in those who are older um they they have they seem to have a great they have a greater benefit um

there are studies where they've used creatine as an add-on to anti-depressant therapy and those with major depressive disorder and seen a significant Improvement above uh what what they got in terms of the response from from the anti-depressant and there are some some studies suggesting that you know the population level epidemiology the amount of creatine that people get from their diets is associated with their um with their mood or risk of um mood disorders um then there's the effect on strength that you know that in the majority of people creatin intake is associated with improved strength

and and and muscle function um so a wide variety of um uh systems and organs in the body seem to benefit from from adequate uh creatin intake and not um the the the amount that you would take is is maybe around something like 5 to 10 grams per day and that's not um that's not a heroic dose we'll go back to that term relative to what you could get from the diet so a tin of sardines um is somewhere around 3 to five grams of creatine so and five grams of creatine is probably you know

it's like a kilo or two of salmon or or beef and like not a lot of people eat that much salmon or beef but it's it's possible to to eat that much from the diet but just most people don't um what is it so it's uh um is it's made out of three amino acids and it's essentially well it does does a number of things but its main uh role is as uh an energy buffer so earlier we talked about ATP adenosine triphosphate and when you move energy around the cell and you use it to

do different functions with with proteins and things like that um you do this in with what we call high energy phosphates so you break bond with with this phosphate molecule and then that provides the energy for the process when you um take ATP and you use up a phosphate you create energy ADP adenosine die phosphate so it's gone from try which means three to die which means two and then that needs to be recycled and that's essentially what your mitochondria do they're they're recycling ATP or generating ATP uh creatine creates a buffer for that system

so creatine you put a phospho a phosphate onto it's called phosphocreatine and it's used to recycle uh ATP um so it's kind of like the shortterm energy buffer sorry to interrupt if you're enjoying this video and want to dive deeper into the topic of nutrition I have created a free special guide which contains the five most important changes I think we all need to make when it comes to our diet if you want to get a hold of the free guid all you have to do is click on the link in the description box below

um and that's why it improves um physical performance but some of the things that it improves in terms of cognitive performance we're probably less sure about it seems to have some effect on uh mitochondrial function and and some other things um it uh it integrates with the methylation system because uh producing creatine and we make our own um is one of the most methylation intensive processes the body you know by some accounts the majority of methylation is used in order to generate and regenerate creatine in the body so you know and then when you do

that you you if you supplement with it so you don't need to make it yourself then you're offsetting the need for B vitamins and all these other these other nutrient requirements as part of the system so there's a number of different ways that it and to be honest we don't really know all of them we we know it has these beneficial effects that we've tested in randomized control trials but the exact mechan mechanism by which that happens is still kind of Up For Debate quite cheap and accessible for people is it uh very cheap um

you you know if people are going to are going to buy it they should buy something called creatine monohydrate that's the that's the cheap form that's been um well studied in all kinds of populations for decades and decades it's very safe um most of it is made in Germany it's a product called Crea pure and then the do what they call White labeling so a sport supplement company just like buy buys it in bulk and then puts their own label on it it's the same thing so just like a a scoop of one of those

and it can also be um useful if you're going to buy supplements in general there's some due diligence that I would always recommend that people do so um there are third-party testing companies or or groups that test for impurities and that can be important if you're a a drug tester athlete but also for other things that you don't necessarily want to be in your supplements so things like informed sport you can see that as a stamp uh on your supplements um and then often companies will say that they're batch tested or third party tested that

means that they're making sure they're not full of heavy metals and these other things um because you know some supplements you know particularly cheaper ones or you don't know where they where they came from they're made in some Anonymous Factory somewhere and who knows what's in them and you know wouldn't recommend that people take those so you can you can often ask for certificates of analysis so you know where people have tested for impurities and stuff like that and I I think that if people are going to take supplements it's worth doing that little bit

of due diligence but in general if you see informed sport or something else and like you can go to Hollander Barrett and you can buy an informed sport certified creating monohydrate uh is very cheap you know anybody can do that you don't need to spend a whole bunch of time doing research on it and I think that brings up a wider point on supplements and I think one of the reasons why the medical profession for many years has been quite anti- supplements is because of the lack of Regulation so there are poor quality supps out

there for sure but there were also high quality ones yeah and I kind of feel the whole thing supplements good or bad is a is a ridiculous question in and of itself it's like a pharmaceutical drug is good or bad well kind of depends for who in what dose uh for how long for and I personally have seen the right supplements be very beneficial for patients over a number of years um so I have a slight I don't really share that view that's been there in medicine for a number of years which is you know

you know stay away from supplements because we routinely give them like B12 is a supplement or vitamin D is a supplement and you know so I I don't kind of yeah that but there's a bit of nuance there and as you say if you're going to get one get a high quality one yeah and in terms of other other supplements in general um the the V vitamins like come very like in those who need them come very high on a list of things that I would recommend so um vitamin D uh very important some of

the B vitamins very important some um I think we measured I talked previously about measuring something like a homocystine if you can particularly if you're thinking about uh both brain health but then also cardiovascular health and B vitamins that are relevant for that are rb12 folate B6 B2 which is rior flaven and you can you can get these from a right if you're eating uh some green leafy vegetables and um some eggs and meat you'll get a lot of those um but equally we know that being deficient in those is associated with a whole host

of chronic health conditions so you know I think we should you know the in terms of within the NHS we should probably be doing a little bit more testing for those things so that they can be they can be supplemented if Hine I still think isn't routinely available on the NHS it's still a serum B12 and um you know this whole thing about promoting diet and lifestyle first yes of course but we' also acknowledge in this conversation how tricky it can be for people to eat well yeah and that's why yeah I'm all for a

food first approach but at the same time I recognize that many stroke most people are finding it hard to get the nutrition they need there's I don't know if you've seen this research on soil quality and how that's poorer now and so are we getting the same level of nut nutrients that we were getting 50 years ago from the same Foods that's really interesting also I've tested um B12 a number of ways over a period of years and I've been really quite surprised by how many people have suboptimal B12 levels even animal food eaters and

I think a lot of that may also come down to the chronic stress in society because we need good stomach acid to absorb B12 if it's going through our gut and into our stomach and one of the things that chronic stress will do was alter levels of stomach acid alter how your digestive function is I've got a friend who has tried everything she used to be paleo she was vegan she was raw food she's very educated on health she's a practitioner and about 5 years ago she pretty much moved to close to carnivore and I

don't know many people she's in her 50s she is thriving she looks great she can run ultramarathons um I've done stuff with her I've seen her work she can work for 14 hours straight cognitive function completely just as good at 9:00 p.m. as it was at 7 a.m. it's phenomenal to see but I'm thinking if we take a step back for a minute there are so many reports of people thriving on these animal heavy diets autoimmune symptoms going joint pain going like we can either put our head in the sand as a profession and go

no you've got to do this you got to eat more fiber or go wait a minute what's going on here why are people not following the dietary advice and are thriving and she's also done all her blood tests her triglycerides HDL ratio is fantastic her hba1c is amazing what's your perspective Tommy so I completely you know on the gut front and again I I know people who are much smarter I know much more about this than I do so I've I've learned a lot from them one of them is uh Dr Lucy Ming who I

wrote this this paper with um and I think the gut has really been this thing where the more we know the more we realize we don't know um and again the the the paper we wrote tried to come at this from like a a first principal idea which is that so if we think about the wide variety of of environments and diets that humans thrived in and thrived on how common is it how common would it have been for you to have 30 different plant Foods in your diet in a week right you're in Greece

two things are in season tomatoes and oines you talked about that right what are the other 28 that you're supposed to find in the environment like it's just not something that our guts ever you know are used quote unquote used to seeing that doesn't mean it's bad right I'm not saying that it's bad I'm just saying like what are the things that you know our guts have helped us through in the past and if you think about it that way then you have to think about scenarios when like there were no plants right so so

you know we've come at from this idea that uh for the gut plants are essential fiber is fiber is essential and that's pretty much because in large population studies um we've told people that that's the case so people who are more health conscious do that but they also don't smoke and they sleep more and they exercise more right the healthy user bias um and if we think about our guts and you know the rest of the body is the same but in a healthy individual it's it's adaptable to many different types of fuel right um

is it blood glucose or is it fat or is it ketones right these these different um sources of energy that you can use that you need to run your heart or your muscles or your brain your gut is the same and the traditional story is that you need fiber your gut bugs turn to something we call short chain fatty acids like berate that provides the fuel for your um ocytes the cells in your gut but what you see quite clearly is that your gut can use a wide range of fuels so yes it can use

those if uh if you eat predominantly plant Foods you'll make sure ter fatty acids like berate that will that will be the source of fuel but if you eat more protein then you'll make what we call isos short chain fatty acids and those essentially have the same function so you can support your gut health just fine with the metabolites from meat rather than plants the gut the gut cells will still use it uh you can also use aseltines which are metabolites of fats um or if you're on a ketogenic diet the the it doesn't come

from inside the gut like those other things do from the gut bugs it can come from the blood so you can take the the cells in the gut can take ketones from the blood if you're fasting or um you know fasted because there's no food available right if there's no food available your gut still has to be able to survive it can't just like give up and stop working right because as soon as you get food it needs to function so then if you for whatever reason don't have access to food your body makes a

bunch of Ketone bodies and the gut can use those for energy as well so the gut is incredibly metabolically flexible based on the systemic health of the body physiology of the body so what I think we've seen in a lot of studies around the gut is that something that affects systemic physiology affects the gut and then that affects the types of microbes that get selected for within the gut let's just back up systemic physiology well how would you say that in layman's yeah so so basically your General Health right you do something affecting your general

overall health yes that's then affecting the health of your guts and then you're measuring bugs in there and we're make we're drawing conclusions from that exactly and it's uh it goes in both ways so we know that the bugs in your gut can affect your body but it really seems like what's happening in your body elsewhere and that can happen with changes in sleep or diet or physical activity right so when you exercise that affects your General Health it affects what happens in your heart and your blood vessels and your muscles they you know creete

a bunch of um chemicals and hormones and things like that that can that affects your health it also affects your gut and then what happens is your gut is affected by that like just by your health changing that then changes the kind of bugs that survive in that gut so you'll see things change within the gut right you'll see different bugs but it's because of what's Happening elsewhere in the body so I think we've ascribed too much to the bugs that we measure and it's also the bugs we can measure there's a whole bunch of

stuff that we're just not able to measure and this has been another problem with um studying the gut microbiome is that historically we've used um a a cheaper measure called um looking at something called 16s RNA um and when I've talked about this um previously it the level of information it gives you is it's like if you think about the lineage of dogs right they're in animals and then Kines and then the the sort of that the house dog the dog that we have dogs that we have at home so a 16s RNA can tell

you this is a dog rather than a cat but it can't tell you whether it's a French Bulldog or a doberman right which are vastly different dogs and it's the same thing with gut bugs so it might tell you yes I think I have an idea what this bug is but it tells you nothing about its specific functions um and a lot more about what's happening in the gut is based on the function of the bug rather than what the bug is and so vastly different bugs can have the same function but you might just

focus on one that has a specific function and think we need this when actually something else entirely could take that function so it's do the information that we have is incomplete um I think we've ascribed too much um you know too much to its to its activity doesn't mean it's not important I think it's very important no for sure but I I think we've given it too much credit and and taken away what's maybe happening elsewhere in the body also maybe it's not even giving it too much credit but it could also be you know

we're overly focusing on lifestyle change influencing the gut microbiome influencing our overall health maybe it's just the lifestyle change is influencing our overall health as you say which is then influencing the gut microbiome ex exactly and this is one of the key things I think I've evolved my view on uh over the past few years is is this Maxim that we need fiber for Optimal Health I I I don't know the answer to that I've just I'm very open-minded and I I just I can't um make that work in my head cognitively and also see

many many people thriving literally thriving in every way that I can see on low fiber diets yeah I think it doesn't add up like we've got to do better like there that's do you know what I mean yeah and and and again um I think when we when we've looked at so I'm not going to say that fiber isn't important because I think in the in the setting of The the modern mixed diet where most foods are ultr processed and we think about the things that we talked about earlier that may be able to you

know help support gut function you're probably not getting any of those and in that setting fiber may be beneficial it's also uh fiber in the diet when we ask people about their diet it's like a marker of a bunch of other things like usually if you're using more fiber you're eating high quality foods um and fiber may affect things like satiety right so if you're eating more fiber then maybe you eat total fewer calories in an environment that encourages us to eat more calories than we need so there are these signals that maybe it's beneficial

but that doesn't mean that it's essential yeah and and just to just to clarify my own view I'm also not saying fiber is not important there is plenty of research which is suggesting that more fiber is associated with Better Health outcomes I've written about this before right so I'm I'm just I think we always need to remain open-minded and go just because we believe this to be true just because everyone said it was true maybe it's a partial truth yeah maybe maybe it's true for a lot of people and also the other thing think with

diet Tommy is that when we look at these ancestral populations these hunter gatherer tribes and we look at what they're eating and you know the hadsa tribe in Tanzania are reported to eat a ton of fiber maybe 100 150 grams a day I've seen in some reports compared to you know an urban population a western population that may be struggling to get 15 20 25 grams a day right so I get that on the face of it it seems like a huge difference and hey we want their health outcome so let's do that let's increase

the fiber but it also depends doesn't it that diet on top of what yeah so if you've grown up there with low stress eating naturally in sync with the seasons you know without the the urban Western societal pressures that you know affect all aspects of our physiology well maybe that diet works really well but maybe maybe in the you know the world in which we we live you live in America now I live in the UK but so many people have got poor metabolic Health already they're already um got suboptimal health so maybe they need

a corrective diet do you know what I mean it's kind of like and I I sort of hypothesized in my first but why a low carb diet seems to work so well for so many people in the western environment might be because we're overly stressed we're underslept we're under moved where we've had too many calories of the wrong types of calories we we are insulin resistant and therefore maybe in that setting there's a there's a kind of unique role for it yeah I don't know I mean I'm not saying I've got the answers or I

don't think you were saying you've got the answers either but it's worthy of discussion yeah um in my mind uh Do's this you know every every everything that we use to describe human health everything we use in biology is some kind of model right um and because we can't we we're unable to completely explain everything right it's not physics and even in physics they can't do that um but there's this fam George box is a statistician of this famous quote which is called which says all models are wrong but some models are useful and I

think that's that's really and I think that's really important to think about cuz everything with we're talking about here is some kind of model to to describe human health and if your model doesn't allow for the individual that is doing amazingly well eating nothing but beef then your model is wrong right then it's more wrong than any kind of model you can build that that bu that that encompasses that so I always think like the outliers are important because they force you to change the parameters of your model and if you don't I think that's

incredibly unscientific so yes you can say that's interesting I want to learn more about that but at some point you then have to try and incorporate it into whatever model it is that you're building that says you know well why is it that we seeing the you know if humans can thrive in a scenario where they're not eating any fiber then that has to be incorporated into the model somehow yeah I love that I love that muscles right we've we've drawn an analogy you've drawn an analogy earlier on about muscle health and brain health yeah

and I'm really interested as to practically what advice would you give to people who want to optimize their brain health in terms of yes physical activity but but I guess specifically I'm interested in in muscle um I know you know you lecture on this you you're going to give a talk I think this weekend on muscle mass and longevity in the UK okay wish you're here we had Dr Gabrielle Ling on recently she was talking um about protein intake uh the importance of resistance training I would love your perspective on these things so I obviously

haven't heard your interview with uh with Dr Gabrielle but I imagine that I will have agreed with pretty much everything she said so you can hear what I say and then you because in general I think she's she's she's fabulous and she she focuses on on really important things such as muscle tissue and protein intake um and the re I mean there are multiple reasons why muscles are important there are biggest glucose snc so you talk about blood sugar you talk about you know that being important for diabetes risk but also cardiovascular disease risk dementia

risk 75% of your blood sugar is taken up into your muscles and the more muscle you have and the more you move it the more glucose blood sugar that they take up so if you're trying to regulate your blood sugar which is relevant to the vast majority of of adults because they probably you know again the average individual at least has pre-diabetes average adult in in the US and the UK and and similar Studies have been show shown that in Europe that's pretty alarming yeah and so so I think the the projected number in the

US is 60% um have at least pre-diabetes or obviously if you progress then that includes pre-diabetes and Frank type 2 diabetes 60% of us adults currently currently and do you know what that figure is in the UK um I believe it's 40 or 50% yeah so muscles are your most important glucose snc if you want if you want to regulate your blood sugar you need to create somewhere for that blood sugar to go right um and muscles are the thing that 75% of blood sugar goes up into into your muscles so the more muscle you

have yes the easier it is to regulate your blood sugar absolutely and the more you move it so and so both are important right so the to mass and then how much movement you the amount that you move it um and there are there are several studies that have shown that but you can in you know again in type two diabetics you can put on continuous blood sugar monitors or look at their you know blood sugar and the more they move they better the blood sugar is controlled um and if you have more muscle and

you move it more you can control that even better so that's one reason why muscle is important it's also um it's it's an organ like it's sec treats factors and hormones and things that we're still learning about right um every month there's a another paper in a fancy Journal that says we just learned this thing that happens when you exercise and it makes this molecule and then we inject that molecule into mice and they live longer that's sweet to what you just said about the gut right how long have we been studying muscles compared to

how long have we've been studying the gut years decades on muscles and we're still learning new stuff that we're like oh we didn't realize yeah so it's kind of naive on the gut is think after 10 years of study we kind of know all this stuff yeah exactly and so one of the reasons why I like to use exercise as an example is because everybody re right diet we can argue about some other things we can argue about nobody argues about physical activity right yeah everybody recommends it every Health body every governmental or organization every

non-governmental organization says you should you should move more right physical activity is good for your health but we don't know how it works yet I mean we know lots of things but we don't know all the things that happens happens when you exercise and so what you know it's a um when you when you exercise you release a whole bunch of factors that you know directly support the brain things like brain derived neurotrophic Factor you secrete things that decrease asemic inflammation um a whole wide range of things so it's this it's a secretory organ you

know just like um just like the the the pancreas or the thyroid um but when you move it um and then sort of more practically as you get older we you know that you lose muscle masses as you age and it particularly starts to decline from about 60 muscle muscle mass so it starts slowly in your 30s and then it really accelerates when you hit about 60 on average but strength declines pretty much continuously from your 30s so you lose strength more than more more quickly than you lose muscle tissue and strength is really the

thing like functional um functional capacity of muscle is is is really important it's like saying you don't want a bigger brain you want a brain that works better right right that's that the function is the important thing and uh strength is a really important predictor of mortality and cognitive decline and there are simple things like if you have enough muscle mass and enough strength then you're not going to fall over you and break a hip and right if you get into your you get into your 70s or 80s you fall and break a hip you

have a very high chance of dying within the next well even days then also weeks and months afterwards so like your muscle tissue supports pretty much you know all the all all these important like it supports every other organ in the body um and what's interesting to me about exercise when we think about longevity and aging um there was a uh about 10 years ago there's a paper that came out called the Hallmarks of Aging which are all these things that you can measure biochemically in cells that happen as the as the body or the

cell ages physical activity and exercise is the only thing that reverses all of those components right it's the only thing that can actively anti-age you in everything that happens as you age um so it it basically affects everything and then I know it's important to give practical advice right how how like what's how much is enough and um you know whenever I talk about muscles I have to you know I have a Phil philosophical conflict which is like I really like lifting weights right so everybody you know the first thing that happens when I talk

about muscle mass is people like well I don't want to look like don't want to look like you and like that's fine that's great you don't have to um and you basically just have to be in the top 50% of the population right so if you go out and you find 10 people like you if you have if you're in the top half in terms of the amount of muscle mass then you're good that's enough so that's the challenge to the listeners at the moment find 10 people who look like you and have a press

up competition yeah exactly and if you're if you're if you're in the top half in terms of number of press UPS you can do then you're fine um you don't have to do that but so what does it take to achieve that kind of um some something like that and it's it's really not very much um if if you've never done any kind of resistance training and resistance training I mean uh it could just be uh body weight stuffs so some of the things from your books uh like your kitchen workout uh it can you

can use bands yes you can use weights and go to the gym but you don't need to uh this morning I watched a talk by Professor Su gray um who who was talking about um the healthiest thing to do with bags of sugar is to use them as weights and I was like great yeah you could so you could use bags of sugar you could use cans of beans um that provides resistance and if you do um two to three sets per muscle group right so maybe you have to do bicep curls and squats and

a press to like cover all your your your your muscle groups two to three sets per week is probably enough two to three sets per week per week so the minimum effective dose to to increase strength is somewhere between two and four sets per muscle group per week and when you say sets is that 10 bicep kills is that five is it 15 what how do we Define a set so that's a great question and the again what's really great is the answer is it it doesn't matter as long as you go to something approaching

what we call voluntary muscular failure which is basically this is really hard I can't do anymore right so if you pick if if whatever you're doing you can do five and you're like I can't do six then that's enough but if whatever you're doing you can do 30 but you can't do 31 then that's enough so you just has to get to a point where it gets hard enough that you say I probably can't do anymore um and you don't need to like really push it and like get to the point where you're like you

know your form looks terrible cuz you're sort of like trying to muscle this thing up you don't need to do that it's the same Principle as doing something new isn't it you just saying maybe 20 to 30 minutes on something that you find challenging but then it's probably enough after 20 minutes or so yeah it's a similar kind of principle with the muscle yeah exactly and so 20 minutes two or three times a week and even if it's just one set each time where in that Cho in whatever you're doing so say you're doing uh

some squats and and if you can't do squats then you could just do like sit getting up and down from a chair right if that's the limit and if you get up and down from a chair sorry to interrupt if you're enjoying this video and want to learn more you can download my free special guide containing six simple breathing practices that will help you calm your mind lower stress and improve your energy to get a hold of this guide all you have to do is click on the link in the description box below 15 times

you're like o I probably couldn't do a 16 then that's great that you've I think the important message there is for people because people tend to get hung up on numbers a lot of the time is it 10 is it 15 is it 5 it's like no it's voluntary muscular failure so and that's going to change as you get stronger yeah right so maybe it's you can do only two press UPS now but as you get strong it'll be you know five is what you need to do and as you get stronger it's going to

be 10 yeah yeah so that's the minimum effective dose okay so the premise is we're trying maintain our brain health as we get older uh above the age of 30 we start to lose muscle mass you're making case that lean muscle mass is very important for our cognitive health and many other aspects of our health yeah so you're saying the minimum effective dose is two to three sets on most muscle groups a week so that's going to do something that you're going to get benefit from that you've given us the minimum effective dose but presumably

more up to to a point I guess can be better yes and so what I think is the B like the best balance of like the amount of response you get versus what's practical for most people is probably something more like 8 to 12 sets per muscle group per week split over two to three sessions and so it's very common in the exercise literature to see three times per week three sets per muscle group and then you know they usually do like something like 8 to 12 reps and and and uh change the weight to

to get it so that by you know 10 or 11 you're at that point of failure like whatever that is for you yeah so that's and that's very common and so there was um they they've done studies where they've compared individuals in their 70s versus individuals in their 20s and with that kind of training protocol so three times a week three sets per muscle group maybe so maybe six to eight different exercis each time even individuals in their 70s you know are gaining significant muscle mass significant strength right so again it's it's not the thing

you can't do it right the body still responds it still adapts once you've achieved whatever level you want to achieve you need much less to maintain it right you can maintain it with those levels we were talking about before two or three times per week whatever you've built up um so that's important too right maybe you get to a certain point and you're like well I only just want to maintain my strength you need much less to maintain that you need that you need to actively build so that's important too um there's there was a

very nice study uh called the smart the smart trial where they did gave people either resistance training or cognitive training or both and they looked at sort of function and and um and things uh like structure of the brain they were looking particularly at the brain and these again individuals in their 70s and the resistance training protocol which significantly improved function and structure in some areas of the brain because we were talking about the brain was just that it was three times per week uh three sets of six different machines in the gym so you

could go to your local you know local gym you just do like some kind of row some kind of press a leg press right five or six different machines three times a week three sets of 8 to 12 for each and then that showed significant benefits in the brain each session was close to half an hour so it's 90 minutes a week very doable yeah is there any benefits for our health when we drink alcohol no um but as with everything and I imagine most of the topics we'll talk about today they are always caveats

so if you look at hard Health outcomes there's some mixed results and mixed research and what previously we thought was that moderate alcohol consumption So within say the alcohol guide lines um was associated with with Better Health outcomes overall so not drinking alcohol is less good for your health than drinking some um when you then sort of break out the diff the different health conditions um you might see that a small amount of alcohol intake or regular alcohol intake is associated with lower risk of cardiovascular disease but then that's balanced by a slightly higher risk

of certain cancers so overall if your main out come is say how long do you live there doesn't really seem to be any any effect of alcohol either either beneficial or or negative in terms of moderate consumption if you try and then figure out well what's a safe amount to consume uh there are several studies and you know me I'm particularly interested in the brain so there was a recent study that looked at brain volume so the size of people's brains which is which decreases over time that's associated with risk of cognitive decline and Dem

and a drink once a week seem to be just fine but beyond that you maybe start to see some some detrimental effects are you saying there Tommy that our brain volume will decrease over time as we get older but that more than one drink a week potentially one alcoholic drink a week increases that so when you look at these kinds of data they're generally not longitudinal as in they don't look at the same person over time what they do is they look at people across ages and across levels of drinking and at one snapshot in

time they say how much do you drink and what does your brain look like oh so it's not the same person it's not the same person so we kind of so we cannot say that um alcohol is the driver here uh when you do this kind of epidemiological research we call it an association right this amount of alcohol is associated with these changes in the brain but we don't know if it's truly causal um we can adjust but that's what we do with Statistics we adjust for other things that may be accounting for that and

then we we think whatever's left is a signal so so I think that there are a few studies that basically suggest that drinking one or two drinks one or two times a week is probably fine but anything above that there's certainly no benefit and then it may be detrimental to our brain health and our other health the other side of that though is that um often people drink alcohol in social situations and and that if it's helping to facilitate social connection and it means you know you're going down the pub with your mates you get

spend time and and talk with them that probably offsets some of th some of those effects so it's not always black and white good or bad um but higher levels of drinking than that don't seem to be associated with improved health and maybe associated with wor worse Health um but there you know drinking some amount is probably just fine uh but then context and other things are going to be important as well yeah I think you've bring up some really interesting points and it's kind of one of the reasons I wanted to have this conversation

with you is to try and bring that context a Nuance that I think is often lost in the conversation around Health these days you know everything's either good or bad which diet is best you know is alcohol all good or all bad it's like well hold on a minute it kind of depends and I agree that it's pretty hard to make a case that there's a physiological benefit to consuming alcohol but I think we also have to acknowledge that many cultures have managed to drink small amounts of alcohol now and again in community absolutely and

they seem to have high rates of longevity and minimal disease so it's like everything that's balanced right you can look at the blue zones for example which are front and center of everyone's mind at the moment because if you know the Netflix show and I know there can be some debates on various things in the blue zones but I think one thing we can say is that many of these populations they do drink alcohol but they're also doing a lot of other things very well that may counterbalance that like low stress nutritious Foods strong sense

of community and all these things so yeah if we say though what are the negatives we if we really trying to address okay for someone who does drink let's say more than that one drink a week and goes well I feel okay right you know I think I'm eating well I'm moving my body well um you know but you're saying more than one drink a week maybe problematic how would you have them think about that you know are there some key things for example you say well just watch out for these three things because this

is what alcohol consumption can do if you're not careful it's really difficult to tease that out at those very moderate levels you know within say government alcohol guidelines right because it's going to be very subtle and you may not there may not even be something that you can you know put your finger on and say that's definitely something that you you need to watch out for um when you talk about the blue zones they may you know some of them they may drink red wine every day but in general portion sizes are much smaller than

we would consider a a glass of wine say uh in the UK um so it's probably even more moderate than we might think and of course all the other things that you mentioned uh come into play so one one thing that I see very frequently is people really don't want to give up alcohol and and and I'm not here sitting saying that you should of course you know I I do I do drink uh occasionally and socially but you might think about you know what is it that alcohol is is facilitating for you like why

has it become a habit if it is a habit and so if it's the social social aspect then actually now it's much easier to get non-alcoholic cocktails non-alcoholic beers you can still go out and you can have that that same kind of ritual with your friends or or with yourself that gives you that feeling of relaxation even though there's no alcohol involved so you can get all of those benefits you can still feel like you're getting that de-stressing at the end of the day with like a beer in front of the TV or something like

that um all of that is still is still possible um and so you can think about maybe replacing those things in um occasionally and then it's also worth thinking about often when people sort of fight against the idea that may maybe they may be drinking too much often we we hear about that it's like they're bargaining oh but I do all these other things so isn't it okay that I drink alcohol and I'm not here to to judge one way or the other but it's just worth thinking about like are you trying to find ways

to justify it um and if you are then that maybe signifies that that's worth thinking about even deeper and and and maybe considering some Alternatives yeah I really like that approach one thing I think about with my patients who are in this conundrum is I I always talk to about their sleep because I think alcohol for many people disrupts their sleep and often they're not aware of it yeah you know if they get this sleep fragmentation they're waking up multiple times in the night they don't always know that they just know they feel tired the

next day and I found that some people don't always put put that together with alcohol the night before so I know with certain patients I've said why don't we try a week without just see how you feel and sometimes I go wow I've got so much energy and I'm sleeping better and then that's empowerment because I'm very much like you Tommy I don't really want to tell people what to do with our lives I don't think it's my place to and I think alcohol now is becoming again a big thing that we're talking about in

the Public Health Arena for good reason because many people do have a problematic relationship with alcohol but I think we be very careful it doesn't go to nobody should be drinking ever I personally don't really drink much anymore I don't think I've had an alcohol that drinking maybe four or five years now and I have no ethical or moral problem with people who do at all it's just in my own life I found I got to a point where I just don't need this anymore like it's not doing anything for me and I prefer the

way I feel without it so yeah I don't know anything else you want to add on alcohol perhaps from my own personal experience I notice that it affect negatively affects my sleep that's one of the reasons why I don't drink very regularly you know maybe once a month or something because I certainly feel less well rested the next day it it um affects your temperature regulation so you like like hot during the night or other things you just don't feel as as as rested so that that's certainly that's a nice in because I think that's

something that the people will will appreciate that that's going to be important and notice the difference and may I ask given that you know it affects you negative L because this is the funny thing about alcohol I think we we all know I know when I was drinking that you're going to not feel good the next day or you're not going to be your best self the next day yet we still do it so I guess it's a bit of a personal question but given that you know all that and I kind of I'm asking

this just for the purpose of asking it rather than you know trying to highlight anything because you know we're all human given that you know it's going to negatively affect your next day what goes through your mind before you actually consume it so I've historically I I've struggled with a lot of these things around alcohol I had what some people might have considered disordered eating a long time ago and being very hyperfocused about the quality of the food that I ate and and what I ate and so it's taken me a long time to work

on some of those things and in reality I've gotten to a point where I'm where if I have decided to do it then I lean into enjoying it so if I'm going to eat this cake I'm going to enjoy this cake like this is you know I'm all and all the reasons why why I'm eating it just like if I'm going to have a nice cocktail I'm going to make sure it's a it's a nice cocktail I'm really going to enjoy it and with my friends I'm having a nice dinner so I really lean into

um the enjoyment Factor because the the alternative is spending hours then worrying about the thing that I ate or the thing that I drank and how that's going to affect my health and that worrying is probably worse than the eating and drinking itself so so I embrace the the positive sides of it because you know it's usually a social aspect or some other thing and then and I think that's that's how I approach it yeah love it Tommy thank you for sharing that okay let's move on to caffeine okay there's plenty more I could do

on alcohol but I think we're going to try and discipline myself to keep moving through topics today caffeine good or bad for our health uh yes um as as everone I think this is going to happen several times the answer is uh it depends um there's certainly if we go back to the epidemiological observational evidence where you ask people how much coffee they drink and then you look at their health outcomes it seems like drinking up to you know three or four maybe more small cups of coffee so so probably like one or two of

my cups of coffee um per day is associated with um improved Health outcomes and that's uh liver disease outs disease um and then um there certainly no no signal of harm right so it doesn't seem to be harmful up up to those levels and and and maybe some benefit of course there's no randomized control Trials of coffee drinking that that show that definitively um but there does seem to be some potential benefit there and there's there's a lots of um polyphenols and other things in in say coffee for instance or te could you just explain

what a polyphenol is for someone who doesn't know yeah so these are the compounds often they're color that make up these beans or berries and it's the same they're in the same class of compounds that make like blueberries blue but they have um coffee has its own um compounds like that that seem to affect our gut microbiome uh they affect our vascular health and there are randomized control trials actually on some of that they extract those polyphenols out and they give them to people and look at their cardiovascular function or that you know their the

health of their blood vessels or their cognitive function and they seem to be beneficial so so um those are the kinds of things that are coming along for the ride uh with caffeine but sometimes when you look at the research like decaf coffee for instance doesn't has some of the benefits but maybe not all of the benefits of of caffeinated coffee but again you have to think about what kind of person drinks decaf versus regular coffee and it's probably the differences in those people that's driving that rather than the caffeine itself so I think there's

definitely a signal that some caffeinated beverages uh you may be associated with improved Health outcomes and that's probably because some of the compounds that come along for the ride in those both tea and coffee separately but then you have to think about the other side so what are the things that caffeine can potentially negatively affect the most obvious one is is sleep and different people have different uh abilities to metabolize caffeine so there's a gene uh that that affects how fast you metabolize caffeine and anybody who's done a genetic test will have probably gotten that

on there and know if they're a fast or slow metabolizer and there's some early evidence that suggests that people who are slow metabolizers that drink a bunch of caffeine may be getting some negative effects of that just because it's hanging around in their system for for much longer um but you probably know that a little bit about yourself anyway or a lot of people do so I you know I know some people who are very sensitive to caffeine right they have any at all and they're awake for 24 hours they can't sleep whereas um others

and then again it becomes you know you don't know what's habit versus real but some people who say you I can drink late at night and it doesn't affect my sleep at all we don't really know if that's necessarily true but it's certainly there's there's some good evidence from uh randomized control trials there was a met analysis that came out um in the last year or two that the looked at caffeine intake and it can affect sleep architecture and how much sleep you're getting negatively negatively yes so then it's just a case of making sure

that you're timing your caffeine relative to your sleep so it doesn't negatively affect your sleep um so so for me I try not to drink caffeine after midday because there was this period of time where I was having coffee you know every night and you know we're in the lab or and everybody's drinking coffee in the late afternoon this is very I did my did my PhD in uh in Norway and it's very normal to have a cup of coffee at 4:00 in the afternoon or something I couldn't figure out why I couldn't sleep um

and then then it sort of tinkering with caffeine timing that that that that made a really big difference but that's going to be very personal from from person to person like how much how much it affects them the other thing that I think is very interesting about caffeine is how it affects cognitive function and if you're doing very simple tasks or you're very sleep deprived caffeine does seem to be beneficial but if you consume a lot of caffeine it can actually negatively affect your cognitive function particularly on complex tasks so it might improve your action

time but if you had to think through some complex task and they they do this in the lab with like complex executive function like how how how fast can you interpret this diagram or how fast can you uh like reel off these different things having a bunch of caffeine in your system can actually make you perform worse and it's interesting because people think they're performing better but they're actually performing worse so caffeine like improves your mood which we know it does but it doesn't necessarily improve your performance yeah it's so interesting I there's quite a

few things to pick up on there first of all genetic testing I like the theory behind the genetic testing of fast metabolizers and slow metabolizers but what I've seen with certain people and experience myself I think I am a fast metabolizer genetically but I'm exquisitly sensitive so I'm like wait a minute the genes are saying this but I can be I've got to be very careful with my caffeine intake both in terms of dose and timing for many years I won't touch caffeine after 12:00 midday unless there's some you know I'm I'm tired and I'm

I'm driving right yeah or I really need to get through knowing there may be a consequence that evening as well but for whatever reason I need to get through something so that was the first thing to comment on so and I just quickly respond to that by saying that whenever you think about any part of a biological system it's not just one thing that's important right so um your caffeine metabolism will tell you how far like we should tell you on average how fast you'll clear it but caffeine attaches to a receptor it's so it's

an adenosine receptor antagonist so there's going to be polymorphisms in The receptors there's going to be differences in in how you then respond to that to caffeine binding to that receptor and what happens in the cell and that's going to be different from person to person as well so yeah you're right just that one thing isn't going to be enough to tell you exactly how you're going to respond to caffeine yeah and I think also something I'm quite passionate about whether it be alcohol or caffeine is I've noticed with patients and myself that the kind

of stress load in your life also can play a role here for example I remember when I did used to drink not to excess but if I'd have a glass of red wine or a beer in midweek let's say after work sometimes won't sleep so well and you'd feel it the next day you know maybe one or two units of alcohol but the same amount when I was on holiday I wouldn't feel a thing yeah now it could be you know different alcohol but you know it was kind of similar and I really thought about

this I thought well my stress load is right down I feel I've got a lot of head room psychologically and mentally as well and I think you know I really think about this idea that I don't think we can completely separate biology and psychology like I do feel there's something about that so if you're really really stressed and you're using caffeine to get you through I don't know I I I really sort of believe there'll be a different impact if you're very relaxed and drinking yeah and caffeine partly activates the sympathetic nervous system which you

know the stress fight or flight side of your nervous system so if you're adding if you're pouring that on top of a whole bunch of other psychological stress of course there's the potential for a greater negative effect like the context is is important as well absolutely did you ever see the study uh I think it was in 2011 from the University of Bristol where they looked at caffeine Drinkers and they try to with answer the question from recollection does caffeine really enhance performance and enhance our cognition and the conclusion of that study was if you

are a habitual caffeine Drinker then yes consuming your caffeine in the morning does raise your mood and cognition but only to the level of where non-caffeinated drinkers are all the time and I find that really interesting because it kind of makes sense to me that for a lot of us that would be the case if if we cuz in the past I have quit and I haven't had it for a few months and I'm like I feel great all the time even I don't need a morning cup of tea or coffee but I do enjoy

it so what was your perspective on that and then how does that fit alongside the fact that athletes for example or I know you work in Formula 1 for example so I don't know if you encourage your drivers to maybe have caffeine or not so that's a a very well cited study the one that you mentioned I think that's probably right is that a lot of that first caffeine boost is just making up the the caffeine deficiency that you've you've generated because you're so habituated to it and that takes you up to sort of like

your normal Baseline um and then you can you can wean yourself off within a couple of weeks and that that effect goes away um the I think the the Formula One driv is is very different from from driver to driver but something that I've noticed over the years actually fits very well with what I was saying earlier so there are multiple components to performing well in that environment but if you think about uh the beginning of a Formula 1 race there are two things you want to do you want to get off the line as

fast as you can and you want to navigate the first corner while 19 other cars are trying to do the same thing so caffeine and this is based on the work of yeres and Dodson uh which looks at how um at your arousal level and your performance of of tasks and there's this this this classic arousal curve which is BAS which basically says that the more aroused you are the better you perform up to a point where greater arousal is basically more anxiety and more stress and then your performance Goes Down And every sport has

its own sweet spot for arousal so if you're a sprinter in the blocks your your optimal arousal level is very different from a snooker player right or or an Archer even in the even in the Olympics right the so that's why um they banned beta blockers which sort of calm down your nervous system in those Sports where you want to be like very calm like like archery say or or some kind of shooting or snooker um whereas in the 80s I think even they drink whilst playing sneaker because it would calm them down exactly EXA

yeah um for that reason so they're adjusting their arousal curve um but something like caffeine will improve your performance um in a simple cognitive task or a simple task so particularly what the thing that they meas measure is reaction time it's often called a psychomotor vigilance task so if you want to get F if you want to get off the line fast in a Formula 1 car caffeine is great um but what happens is that you can get to a point where your caffeine dose is so high it will then affect your ability to navigate

the first Corner because all of a which is a much more complex cognitive task because you're trying to figure out the direction you're going plus where all the other cars are um and so you can you can caffeinate you want to caffeinate yourself to the point and not all drivers use caffeine this is that like some find some benefit from small doses at the right time but you want to improve your reaction time off the line but you don't want to negatively affect your ability to then navigate the first few corners of the race there's

a really fine line in terms of that arousal cover and I've seen that in action in Formula 1 driv that think is really interesting yeah absolutely fascinating even that idea that different sports have got different times where you want to Peak yeah and I guess then taking it back to a nons sportsman well we've all got different things in our lives that are important to us and different times in the day when we want to Peak right so you know again what's the right dose for you what's the right time for it which I guess

comes with experimentation and just trying to bring alcohol and caffeine together and sort of close them off I guess what you're saying and I would agree Tommy is that there's pros and cons and we need to figure out what works for us and if for example you really enjoy your caffeine and it has no seemingly negative effects on your mood your anxiety levels or your sleep and even if you accept that drinking it might just bring you back up to the level that if you didn't drink it but you get so much enjoyment out of

it you know I love a good cup of black coffee in the morning for sure then it's probably worth it yeah but if you enjoy it and love it and it's giving you palpitations and anxiety and it's trashing your sleep and you're Moody and reactive with the people around you you know you might want to rethink about your relationship with it basically so it's not black or white when you sort of bring them together I think if you think about uh our Collective modern Lifestyles that's a phrase that you use um what what often happens

is that you'll drink at the end of the day then you'll need to you won't sleep very well you'll have to drink coffee all day because you're sleep deprived and then to wind down you're going to need alcohol at the end of the night so they they often reinforce one another and so again it's just worth thinking about how is it affecting you is is there is it possible that there's this this sort of perpetu perpetuating a cycle of one another that you can somehow try try and break and if it's not NE negatively affecting

you you're still performing well you feel good great you know we neither of us would recommend that you change anything but it's it's possible that they they can go hand in hand in that way as well well I think about uh building a healthy brain that's essentially what happens when when you're you're a baby both uh in the womb and and and then afterwards for you know two or three decades potentially then I think well how you know so what is it what do you need to make a healthy brain in the first place and

then what do you need in order to keep it healthy and and those things are often very similar they are essentially the the the same thing and there's always going to be a huge amount of interest in in terms of how do we maintain cognitive function late into life because sorry to interrupt if you're enjoying this video and you want to learn more then do check out my free special guide which contains the six crucial steps you need to take in your life to not only build healthy habits but also to make them stick if

you want to get hold of this threee guides all you have to do is click on the link in the description box below age related dementia and age related cognitive decline are now the leading cause of death some people call it Alzheimer's disease but there's uh Alzheimer's diseas is as it was originally described as probably a genetic early onset Alzheimer's disease you might a familial Alzheimer's disease whereas what most people have is this late onset Alzheimer's disease which may actually not be the same thing and and in my mind it's a continuous um Onslaught um

of the of the brain from the environment um and then a lack of protective factors and a lack of protective inputs so if you think about things that are protective and beneficial for for the brain so so we we've talked about exercise um I think the first time so first in in rodents and then in humans the first time we saw that we can actually increase the size of an important area of the brain later in life uh was the hippocampus so the hippocampus is an area of the brain that's very important in memory it's

definitely uh affect significantly affected in people with dementia uh or cognitive decline Alzheimer's disease and in an an uh an older population they were in their 60s they had them just brisk do brisk walking three times a week for a year I think it was 45 minutes and there was a control group who did some stretching for the same period of time and in the brisk walking group and again when when I talk about cardiovascular excise aerobic excise that's what I mean I mean going for a brisk walk like it doesn't need to be more

intense than that but that group saw an increase in the size of their hippocampus which would normally decrease in size with age this was the first time that we ever saw in humans in adult humans older adult humans that an area of the brain could increase in size and so exercise is incredibly important um again resistance training has similar effects but seems to affect more um the white the white matter which is the part of the brain that's really um there for fast connection sort of connecting all the different parts of the brain and sending

signals and and so so both aspects as we might separate them out aerobic and strength um are are important for the brain and then the the the challenge aspects which we talk about I think this is one of the probably the uh most um I guess forgotten important part of what it takes to make and keep a healthy brain um and again let's let's use uh an athlete analogy which is that if you stop training or for some reason you become immobilized um your muscles and and you have a good amount of muscle you're an

athlete right or you say break your leg and it goes in a cast when you take that cast off you'll see the leg on that size is smaller you've lost muscle mass on that size so anytime you stop um sort of giving an input a stimulus to the muscles they will reduce in size because it's energetically expensive if you don't need them your body isn't going to keep it isn't going to keep it around and everything all the evidence that exists today suggests that your the brain is the same right use it or lose it

and when we think about using the brain um again I like to compare back to what it takes to create and build a brain in the first place so as an infant you are doing things like learning to talk learning social interaction social cues um learning to control this fabulously complicated meat suit with Incredible dexterity and those things take a huge amount of of neurological uh stimulus input and effort then throughout life um you may you start to do things that you may think are hard but compared to that really not that hard like bu

chemistry as an undergrad or learning to drive a car um or you know the the the ins and outs of your job right they feel hard but in terms of the stimulus and the the the effort required from your nervous system it's actually quite small compared to say how learning how to control your whole body and as we get older we just do the same things again and again they get easier for us they just become habits they become patterns which don't require again any significant cognitive input and because of that you're essentially telling your

brain hey I don't need you to be as complex as you once were because we're not doing anything difficult um and you see multiple different strands that that that kind of um come into this so uh people have probably heard about the right London cab drivers you know less so now if if if if Ubers continues to be allowed to exist but uh to be a a a black cab driver in London you had to learn the knowledge originally which is um all of the streets in a six mile radius of Ching cross and they

once looked at brain scans of people taking the knowledge or learning it before and after and those who passed and and again we don't know why they passed whether it was because they were the ones who actually studied or you know they have some other some other skills that allowed them to be able to gain the knowledge those who passed again saw an increase in size and certain aspects of the brain on a brain scan and those who didn't pass the knowledge didn't become cers didn't so you've you've created this incredibly difficult stimulus which has

then you know helped uh improve the brain um and you see something similar in terms of people who retire earlier tend to die earlier as well and that's after you adjusting for all the things that might cause you to Tire earlier such as medical conditions so again like telling the body telling the brain that it's required um is incredibly powerful for brain health and you we could go on so if you look at the brain if you look at the brain health or the brain age of musicians amateur musicians have a better Brain Age than

professional musicians because amateur musicians it's harder for them right they have to work harder to get um a nice result so so all of this is basically telling me that in order to keep your brain healthy you need to tell tell your brain that it's needed that requires you to do difficult things which is going to also require you to be bad at stuff as you learn new skills um and then once you once you've acquired a new skill you then have to move on to something else I mean you still do the thing if

you enjoy it but then if as soon as something becomes habit becomes patterned becomes easy it's no longer the same stimulus so this could be anything it could be dancing it could be some kind of movement or sport it could be singing um teaching others uh seems to be uh protective as well uh knitting um I recently started to learn how to code on on my computer because you know that was something that beneficially for my job but also incredibly difficult I've never done anything like it before so there are all these things that you

can do uh but you need some kind of ongoing stimulus uh to to tell your brain that that's still needed it's still worth keeping around um and and that's something that that you'll you'll essentially for for as long as you want your brain to to still be working I it's so fascinating what you mentioned about the the leg that goes in a cast and six weeks later muscle mass has has declined this whole idea that our brain is constantly responding to the inputs that we get and if you know if we think it's not required

it's like I'm not going to waste energy shoving it that I'm going to I'm going to focus on something else but maybe think about something Professor lorri Santos said to me recently on the podcast she's from baale she's a psychology professor and has got this globally successful course called the science of well-being and she talks a lot about how our brains kid us often in terms of the things that are going to make us happy are not the sort of things that our brain think is going to make us happy so we actually behave in

a way that actually isn't moving us towards happiness and and as you were talking there it made me think that it's interesting that Society um you know the way we live now you know where you know everything's front loaded as kids and then we sort of just gradually decline once we start working we don't have time anymore to try new things it's just pay the mortgage go to work take the kids to their classes and then you just you know people are waiting for retirement to just chill outx and it and it sort of it

reminds me a little bit of that where you know as we older also we get we get quite shy we don't we don't want to suck at something we don't want to fail at something so we don't do it but what you're saying Tommy is that actually that's EX exactly what we need to be doing we need to be doing things that remind us that hey you are needed my brain is needed you need to grow you need to respond so yeah I mean do you feel we we're sort of fighting human nature or certainly

the way Society is set up in an effort to improve our brain health yeah AB absolutely the the way um Society is is set up is is to sort of funnel you continuously in One Direction and then you know be be very good at whatever it is that you do but it doesn't require again it sort of becomes you know just part of the same thing again and again doesn't require the same the same inputs and I think there's a huge amount of benefit from um you know being a bit of a jack of all

trades you know having lots of having lots of interests like diversifying your interests and your expertise and your skills and that creates some buffer in terms terms of you know hey you may not always have that job or you may not always be able to do that job you know you know having some kind of broader you know base of of skills or things that you enjoy again create some some kind of buffers in there um but equally as as we get older we're expected to get more serious uh another thing that I didn't mention

which is incredibly important and uh very well um emphasized and advertised by our mutual friend Daryl Edwards is play adults aren't supposed to play We're supposed to be serious we're not supposed to have fun um and and again it it sort of it become you know our our exercise our movement is supposed to be very prescribed it's going to be on a treadmill or you're going to do X reps in the gym or whatever and again that's just not how we're how we you know quote unquote designed to move like we're supposed to be interacting

with our environment interacting with other people animals nature you know that's why our bodies are are built and structured the way that they are um but yeah everything that that is required of us in in modern day Society is sort of pulling us away from those those stimuli those inputs that that our body I think expects um and then is what creates a foundation for for long-term Health yeah in that um there's a brilliant talk that you did on brain health that's on YouTube and I'll definitely link to that in the uh the show notes

for this podcast you put up a graph towards the end and I think you it's something about the amount of cognitive of capacity it requires to do certain things and and you know at one end was learning to walk I think at the other end was you know retirement and and doing sodoku and it was the contrast was really quite Stark yeah and you know I I uh so I borrowed that graph I remade it as made by a friend of mine Dr Josh Turk who's a neurologist over here in the US and you know

a a lot of those ideas about sort of this the requirement of a long-term stimulus to to keep our brains healthy is certainly something that I've discussed a lot with him and gotten from him and yeah I mean you it's very difficult to quantify these things right like how could you possibly quantify the amount of effort that it takes to learn how to control the human body except for if you you know think about people you know adults who have to relearn how to walk or if you're trying to build a robot that's that's that

knows how to walk right these are incredibly complex tasks that we haven't even necessarily been able to figure out yet right because it's that difficult but most of the other things that we require of our brains can proba you know as adults can probably be automated um to to some degree because it's actually not that difficult so so yeah if if if you think about what's what you what you ask of your body and your brain it it just it's just a steady decline throughout life um and that requires now some kind of um significant

effort on our part to to to prevent that so in Practical terms to people that could be anything right that could be what learning a language learning an instrument um I don't know doing some balance work you know anything I guess where you're being challenged is going to have a positive impact on your current brain health but also I guess make you more resilient for that sort of brain decline that we might see as we get older yeah absolutely and and that's the thing is it can be you know almost anything that you I say

you enjoy but it's probably if it's difficult you're probably not going to enjoy it to begin with right this is what we talked about we don't like being bad at things and we T you know and we're sort of taught to feel like it's not good to be good at something whereas actually if you think about kids they would just try stuff and they'll be bad at it and they'll fall over and they'll try it again and again and they'll get better over time and that's the something that we need to um reacquaint ourselves with

um but then you know you know it can and should be something that you enjoy doing um and that you can use so you learn a language and then one day we'll be able to travel again and you can go and put it into practice but it doesn't need to be a language it could be any any of the things you mentioned um and it you know could be you know knitting or or whatever L literally anything that requires you to learn a new skill and that you enjoy but again as soon as you get

good at it you have to then start thinking you know what what can I do next that that sort of keeps the challenge going yeah there's there's kind of conflict between Mastery and and super specialism with that kind of just general broad all around knowledge as you say Jack of all trades and uh you know you train as a medical doctor um I I I really do feel that of course specialism is important in medicine but I think we really have undervalued the role of the generalist for many years and although not directly related to

brain health I can't help but see some similarities in terms of what you're talking about and how we kind of need that overview you know I I feel in medicine Tommy that now we need generalism more than ever we've got all these complex problems that are are coming across multiple systems in the body and we can't just be focused on one organ we have to be able to put everything together yeah I agree and when you think about People's Health I think the more that we learn the more we realize how complex it is how

many different uh inputs environmental factors are contributing to this disease or these symptoms in individual patient and if you're very hyperfocused on one system or one disease process you're going to miss out um on all the the factors that are you sort of coming together um in this individual so so I think having a really you know broad-based and open mind is really important when you're when you're then trying to um because when you're then trying to improve the health of a patient because like the people can come in with the same the same disease

um the same concern the same symptoms and there could be vastly different uh underlying uh reasons environmental environmental so sociological socioeconomic factors that could be contributing uh and you really need to be able to appreciate all of those to get the best outcome I think that sort of approach applies to us looking after our own health as well doesn't it instead of a laser like focus on just one area and you know we've both been in the nutrition space for quite a number of years and there can be a real focus on nutrition and of

course that's important but there was I think for a period of time a neglect of uh the importance of Stress Management the importance of sleep when those things are starting has changed and if we if we sort of think about brain health and how you think about it with your expertise you mentioned some of the components of movement that can be really important and and I mean before we move on from movements just to just to be really clear for people you were saying in that trial I think that it was 40 minutes of walking

of brisk walking three times a week Chang the size of your hippocampus you know one of the memory centers in the brain mean that's not that that much is it no no absolutely not and again I think um it comes it comes from the the way I believe Society has sort of created this image of exercise where again the Pinnacle is the marathon um and then to be fit requires this huge volume of running so that you could even survive a marathon um but when we look at you know this is you know in terms

of the brain but also in terms of just uh overall mortality risk you know how long you live a healthy life Health span you you get to a point where you you reach diminishing returns we might call it so if you do a load more you're not going to get that much more benefit and that point is something like 30 to 45 minutes of moderate to vigorous activity every day um and when I say moderate to vigorous I mean a brisk walk 30 minutes of brisk walking a day is going to get you the vast

majority of the way um um in terms of exercise that's required to see long-term health benefit and if you do a load more you're not going to see that much more so it's really not that much it's not that much and I I really think this is a this is a point that's worth hammering home and yeah if we move on to nutrition Tommy in terms of what kind of things we should be eating to build a healthy brain be be interesed in your view there and also I wonder if you could touch upon why

healthy brains important because it's yeah we want to build a healthy brain and then often we think about the other extreme which is when our brain doesn't work when we're 70 or it doesn't work as well but we forget that there's this long latent period where our brain function can start to decline before we even get symptoms so just a couple of things there which I wonder if you could just sort of expand upon yeah sure so so actually before we um get into that you mentioned earlier about this hyperfocus on on nutrition in terms

of what's essential for for long-term Health um and when I think about the things that a healthy body a healthy brain requires long-term right so nutrition is important um but so is sleep or Cadian Rhythm Right light when it's light dark when it's dark movement um some kind of stress mitigation and then social connection probably those are the things that I think are going to underpin most of the stuff you know those are the biggest rocks that you know that you can move to improve long-term health and I think that the more you neglect any

one of those areas the more you have to become hyperfocused in another so when people are talking about restricting restricting restricting from a dietary sense and that could be total calories it could be fat it could be carbohydrates could be protein all of them have been vilified um by different groups for for essentially the same reasons um I think that the reason why we had to become so hyperfocused and so restrictive to a large degree um and actually any one of those approaches can have can have benefit depending on the person in front of you

um it's because we are neglecting the other things we're neglecting movement we're neglecting sleep and and cing Rhythm neglecting social interaction social connection um and so so that's that's that's one reason it's also something that's very easy to sort of like quantify whereas it's hard for me to say you know it's easy for me to say oh you should stop eating carbohydrates it's much harder for me to say um oh you should go and make new friends right that's much harder um and so I think that's one reason why we're hyperfocused so the more you

neglect the others then you have to sort of like really sort of focus in on other one because those other systems are being are not getting the attention um that that they should um in terms of building a healthy brain um I mean the easiest way to to think of it in my mind is well what is a brain made up of um and it's mainly made up of fat and cholesterol um and the you know that in our modern nutrition environment sounds very scary I'm not telling you that you should that you need to

eat a whole load of fat and cholesterol actually your brain makes its own cholesterol uh the the and it makes it from from precursors that could be glucose or could be Ketone bodies when you're a baby Ketone bodies are essentially the preferred precursor for making new fats making new cholesterol um and but one of the one of the things that's very important um is DHA the longchain omega-3 fatty acid that you get in seafood and there's going to be some variation in terms of what amount people need um and it's probably going to be based

on um their ancestral background so there's some evidence that suggest that people who are over more uh Northern um ancestry um so people like me uh we got most of our most of our longchain polyunsaturated fatty acids from food from Seafood so I'm probably going to do better uh with more you know direct from The Source whereas people who live close to the equator may have gotten more sort of precursors like alphal linolenic acid which is the omega-3 that you might get in nuts and seeds and then we make our own DHA and there's a

whole whole host of other things um that can influence that but there is going to be some sort of individual Vari it's just the point that I'm trying to trying to make but DHA is incredibly important and it's um accumulated very actively in the brain in the last trimester of um of pregnancy so the last three months or so and it's basically being actively uh depending on the amount in the mother it's being actively regulated how much is passed on to the baby and then basically all of it is ending up um in the brain

and then some is put in the fat Stores um and hum humans are the only primate that has significant fat sores when it's born uh and that's largely because it's a repository of these important things to then support the brain um and again because babies are born with an incredibly demanding brain human babies um and it's you know we need these fat stores to support to support it it's one of the reasons that we have the brains that we do so DHA is incredibly important um lots of other things you know will come up so

things like Coline can be very important again you might get that from eggs liver organ Meats potentially um and then when I think longterm something that is probably having a negative effect on the brain is really large swings in blood sugar and there's there's a lot of data to support that you know if you're eating foods that cause very very big spikes in blood sugar that's probably over time going to have a negative effect on your cognition and there are some studies that suggest that people with diabetes if you improve their blood sugar control you

improve their cognitive function and this can happen over years you know and you and again we're normally told that there like this inexorable decline over time whereas actually we have plenty of evidence that suggest that we can reverse that as long as we improve some of these factors so so it's just um I think it's very positive and empowering to say you know wherever you are today there is potential for improvement if you're you know sort of capable and able and and and and and you know interested in doing that but I think we do

need to acknowledge maybe in this Wellness Community more than often does get acknowledged that there are huge psychosocial stresses cultural stresses for different communities Financial stresses racial stresses these things hugely impacts our biology and our physiology and for some of us it's easier to make those changes than for others isn't it yeah and I think it's a it's been something that's sort of aimed at uh whether you you know the lifestyle medicine or uh functional medicine or Integrative Medicine uh ancestral Health communities you know there's people who focus on these lifestyle factors that we've talked

about and it's a worthy criticism criticism to say not everybody can do that right not everybody has the financial ability to remove themselves from the environment that they're in if it's you know um they have to live close to Road or they have to live close to uh refinery right so in the in the United States um you know near you know large petrochemical plants that's where you've had redlined housing areas where people from low socieconomic status usually more likely to be black have been put around these areas and then it's you know it's baked

into the environment and you can't afford to move out um and or it may be you know we talked about food but you know what food do you have access to um do you even have a kitchen you know do you have are you working two jobs you have time to cook um you know we need to be very mindful that the social determinance of Health play a big role here yeah I mean I totally agree with that I think it's I think there's a lot of nuance to that because sometimes that criticism gets leveled

and say we shouldn't be giving any information out because it's not relevant to that Community yeah I don't agree with that it's like we should definitely be giving out information but we also need to be aware that that information may not be relevant or as relevant and so we shouldn't look down when people can't take that advice for example yeah you know and I've always fought for that uh Wellness for one of a better term is for everyone I think every single human being has the right to good quality health information that they can try

and apply in their own life and my bias comes from my clinical practice so um I I've worked in lots of different practice throughout my career but there was a particular period of time where I worked in a practice in alum in North Manchester and it was a very low socioeconomic status area lots of immigrants lots of people on benefits people working two jobs lots of single parents a lot of in adverse commers struggle for day-to-day life compared to other areas I've work where it's um you know more affluent there's struggle there as well in

a different way and you know what I learned Tommy in that is it because I think it's easy and I see this in the media a lot we it's either we can Empower people with their lifestyle choices or we say that there's huge social determinance F it's kind of like well why does it have to be that black or white I think all these things are nuance and I'm I I do passionately believe that this information is relevant for everyone and we should be giving it to everyone but with the acknowledgment that for some people

it's harder yeah and I completely agree and I in that line I think it's very both patronizing and disempowering to say that oh you shouldn't be talking about lifestyle or Diet because it's you know these people you know may may or may not have an ability to change it's very condescending it's incredibly condescending so but we just need to acknowledge that all of these things are important um but again there have been the there was a a recently published study came out and L at Public Health a few years ago that looked at using UK

biobank data looked at like mortality risk um and they stratified individuals by some lifestyle factors So based on quality of diet whether they smoke you know physical ity and then also stratified them by social deprivation and you see that yes as your um like socioeconomic status decreases overall risk increases but when you look at the effects of Lifestyle movement diet there's still great benefit there so so yes the overall risk is greater but you can like those there are individuals there you know reducing it through those through those activities so to say that we we

shouldn't be talking about it I think is incredibly and also you know what I found tell me is that if I change the advice I give them because I make that assumption I'm depriving them of good quality advice and what I learned there is actually sometimes in the poorest communities they would actually literally follow my advice to the letter more than in more middle class athl communities like I remember I thought you know there wasn't much money in the family and you know at the time I don't think we were allowed to give vitamin D

this lady had really bad pains and I was convinced it was related and um you know she went and bought from the local health food shop supplements for her and her family and got huge Improvement and like it's unfair to to think that we know what they will prioritize with their money it's not up to us yeah I think this is this is complex but I think it's important that we talk about it actually yeah absolutely um all of the all of these pieces are you different parts are are important for different people in in

different amounts and um there's you know part of it is just getting information out there and and so again empowering people to to know what may or may not be important uh for them for and it could be whether they're worried about their risk of Dementia or heart disease or you know they just want to be able to play with their grandkids uh you know you often people's goals are much more practical than a doctor might think you know you're you're worried about some diagnosis or something but people you know want to be able to

just interact with their family or something like that and different things are going to be different relative importance for different people but they should be allowed to to make those decisions you know yes we should I think that um we need greater support for Behavior change for individuals who want it um we don't necessarily do a good job of that and doing something new that's stimulating and challenging there are a lot of lowc cost ways to do that if not free ways to do that you know absolutely balancing hopping around your you know I don't

know we can make up all kinds of things that would actually provide a stimulus yeah and so I think that's a great piece of practic advice okay so that was in the first bucket the second bucket was about important nutrients not getting to the brain whether that be because we're not taking them in or because we're taking them in or we might be taking them in but they're not able to get to where they need to get because let's say our our blood vessels are in poor health for whatever reason so you've been on a

bit of a journey Tommy since I've known you and from what I've seen in public um as we have this conversation in 2022 uh what is your current viewpoint on nutrition for human health uh I guess specifically we're talking around brain health preventing cognitive decline as we get older which I think everyone wants what kind of advice would you give to people regarding Foods I think the starting point is that you should eat something that is accessible to you that you enjoy and is sustainable like that has to be a starting point because I could

give you a whole bunch of recommendations but if it's none of those things then you're not going to do it or not going to stick to it and one thing that constantly fascinates me about the human body is how adaptable it is um and the wide variety of diets that people um evolved while eating or you know ancestrally you know the the different diets that you know my ancestors ate a very different diet to your ancestors just because of where they are on the planet and they both thrived and I find that fascinating and so

it's the same thing now like what somebody enjoys and is sustainable to them is very different from the person next to them and they may sustain their health in in an identical manner with you know objective objective measures that you could take so I don't have any particular one way that I would recommend that people eat but it should support your health and we can certainly talk about things that you might measure and want to to track um over time specifically for the brain uh because we have Interventional studies that that show it's the case

um B vitamins are incredibly important so we're talking um B12 which generally you can only get from meat and animal Foods um if you are vegetarian or plant-based I think the best people who to uh promote or work with individuals of those diets would recommend you take a B12 supplement um then uh folate uh B2 which is riboflavin and uh B B6 those are probably the most important U nutrients for for for for brain health and again you know any diet that has a a reasonable number of Whole Foods plants vegetables eggs meat fish will

have enough of those probably um then the other important thing specifically uh for the brain is uh the Omega-3s longchain Omega-3s and in this in these studies that I mentioned earlier by David Smith they showed that the greatest benefit from the B vitamin supplement came from those who had what they called adequate omega-3 status and again this is longchain um omega-3 fatty acids like EPA and DHA which in the diet are generally only available from Seafood uh but there is a there is a slight genetic component based on people who can take shorter ones that

you might get in cheia seeds or walnuts and then convert them to to longer chain ones um but so again there's there's a slight genetic component there but some seafood is probably important as well yeah okay this this is super interesting so you first mentioned B12 and as you say if people are eating animal products in their diet they're likely to be at least taking in enough B12 what I found when I used to measure this quite a lot is that even people who were taking in reasonable amounts of B12 had suboptimal B12 levels on

their bloods yeah there's a whole variety of reasons why that might be uh I have my view I I feel I certainly feel stress as a huge part of it because to be able to actually absorb that B12 what needs to happen can be impaired I think by too much stress because I was thinking why is it that they're eating enough B12 from what I can tell yet that's not being shown up and there's all kinds of reasons for it that's just one of my views I mean what what's your perspective on that is that

something you've seen and do you have any opinions as to the reasons why that might be yeah um absolutely and I I remember even um you know 10 years ago uh is now 10 years since I worked as a doctor pretty much uh as a junior junior doctor at St Thomas is in London I was working on the elderly care Ward and when people got a a first diagnosis of dementia even then one of the first things we did was something called a d screen which we looked at iron status uh vitamin D and some

B vitamins B12 and folate at least and then if um B12 was low there was a second test they called meth malonic acid which is produced uh when you're B12 deficient and so even then we were doing it in an NHS Hospital 10 years ago right just these basic nutrient status checks and I think uh stress you know stress um certainly may affect um acid production which is really important for B12 and also iron absorption um but then some medications can do it so metformin can can affect B12 absorption proton pump inhibitors which people might

take for um you know reflux that can affect B12 absorption these are very common drugs to prescribe so uh you know there's probably some some lifestyle factors but then you know it may also be a result of some something else that somebody's taking yeah remember Professor breson when I spoke to him about this a few years ago he he will work with patients do all the tests the home assisting the the MMA that you mentioned and the serum B12 and at the time I remember thinking I I can't get this stuff from my NHS patients

back then and he said he likes to see for cognitive function a serum B12 right so that's your regular cheap uh B12 test um and you know I'm going to say it depends on your lab but you know the normal value that would be reported would typically be something like 200 250 to 7 800 maybe 900 depending on the lab right so huge huge range of normal yeah and he said in his experience if it's under 600 he would treat it and I remember I came back because I I was Chan in America and I

I tried that with a few patients actually and again this is just anecdotal it's not a scientific study but people would come back say yeah they feel sharper their cognitive function has got better when I'd treat their ser and b12 from let's say a normal level of 250 what you think to that I think that's um I mean I'm not necessarily surprised uh again it probably depends what's interesting about um the difference between the US and the UK is that in the US you can't get an active B12 test what we would call Holo trans

cabalan is very common to do in the UK you can't do it in the US so you in on the US test you probably need to be at the at the upper end of normal because um there are lots of other things that can crossreact with the test and they look like B12 but they don't have the function of B12 and that's the case with some like plant-based B12 analoges uh so that so for him I imagine that's probably one reason why that may be the case but equally more broadly I spent a lot of

time uh looking looking at and thinking about blood tests and if we think back to what we said right at the beginning which is that the average popula the average adult has at least one chronic condition takes at least one um medication has at least one if not two of the components of metabolic syndrome of which there are five if that's the average person and the normal range is just the way you define the normal range is you test a whole bunch of people and you take the middle 95% and whatever the bottom the lowest

person of that middle 95% whatever the top person is that's nor noral range and if the average person is sick to some degree then what's normal is not necessarily normal um and I think that's part of and you see this again and again um the they've changed the ranges over time that's been uh it's been the case for certain sex hormones you know like and people have talked about this a lot you know they they're decreasing the normal range for testosterone in men because they think that testosterone is decreasing um on at the population level

whether it's actually true or not is Up For Debate but there's something that's happened that's you know they've changed the ranges if they see that you know overall the population level changes I saw something similar when they were trying to develop normal ranges for grip strength um and what they saw over you know Generations you know from you know like uh Generation X uh Generation Y Millennials like uh coming through to what in America we call gen z um grip strength was declining particularly in males so there was a publication that said that and said

we need to change the normal range for grip strength rather than saying we're getting weaker why aren't we working on that and so you know it's it's like um the the frog that sits in water from when it's cold and then if you if you boil it it will slowly heat up it will never jump out because it never realizes because it's so incremental and slow and so that's that's one of the problems is that we're look you know some normal ranges are constructed around a population that's sick so the normal is isn't necessarily isn't

necessarily normal and that's that may be playing part of the role there too yeah it it's it's super interesting hopefully we'll get time to go into some blood test that people can do you mentioned Seafood why do you think Seafood is so important for our brain health and then for people who are vegan or you know choosing not to have animal products can they still have good brain health and get those nutrients that you would get from Seafood in other ways so there are a few strands um that that of information that lead me to

think that that seafood or I say Seafood because it's the the most common dietry um component that gives us longchain Omega-3s what I'm really interested is longchain Omega-3s particularly DHA in the brain and again if I go back to what does it take to build a healthy brain in the first place DHA is preferentially sucked up into the brain while you're making it as much that the mother will sacrifice her own DHA stat so that the baby gets enough because it's one of the most critical fats that makes up the brain for a number of

reasons um it and it go it goes directly into the the cell membrane so people may or may not know that most of your brain which isn't water is fat almost all of it right so because fat makes up all the insulation around the nerves it makes up all the the membranes around the cells and DHA is incredibly important both for the function of the synapses how they talk to each other because of its because of because of its structure has this you know very important um role in terms of like how the copses work

how neurons talk to each other but then it's also accumulated into the mitochondria which people might know as the PowerHouse of the cell it it's inside the cell generates most of the energy and some of it is really cool physics that basically how electrons travel through DHA is really interesting um but equally you know sort of like a more basic way you can see that the more D that's in a mitochondria the greater energetic capacity it has the more energy it can produce um and that's the reason why and and there are some evolutionary theories

that say that you know maybe the human brain as it currently exists developed in a SE in like a group of hominids that had either direct access to lots of seafood or to the brains of other animals uh because brains are an incredibly rich source of DHA because your your body preferentially shuttles it to the brain during development so it has this really important functional role um and when you um don't have it that's associated with neurodevelopmental disorders or developmental delay um risk of other neuro like neurodevelopmental issues um and then you can also see

things like um there have been some interesting studies done in the the UK and in the SE shells where uh you look at the the amount of seafood that a mother or her her children eat and then you look at long-term your development and you you asked about heavy metals earlier particularly Mercury is important for seafood but it seems that even if you have a higher Mercury burden because you eat a lot of seafood you get you get greater benefit uh because of the Omega-3s in the diet um so that kind of you know that

sort of first principles approach says what does a brain really want when it's the veloping and it really wants DHA it's you know it's it's essentially that's where all your DHA goes is your brain and and again one of the things that um is interesting about humans is that we're the only mammal that has fat babies no other animal has fat babies and one of the reasons why um uh human babies are fat is because they have adapost tissue as a store of DHA for the brain as it grows well when you say fat you

don't mean un healthily fats no I mean like healthy chubby plump little babies right so if you look at any other mammal um when they're born they're very lean even other primates they don't have large adapost stores and what you know it's it's an and so it's an energetic store right we know that adapost tissue fat tissue is a is a store for energy but what but it also stores fats that are then particularly used for the brain and D DHA is one of them so a developing brain needs it yes can we therefore say

that a developed brain also needs it so this is an exceptionally nuanced topic even more so than any of the other topics that that we've talked about a colleague of mine Dr Rory Heath and I wrote a paper recently about DHA and Alzheimer's disease and some people have said that the DHA in in patients with Alzheimer's disease in their brain is low others haven't quite found the the same thing uh part of it is probably that again you ad post tissue is is essentially a very nice buffer of DHA that you can use across your

lifetime so it's it's it's quite if somebody is unless somebody has never eaten seafood or has never eaten really any longchain Omega-3s it's very unlikely that you're going to be deficient um in for the brain for cardiovascular function um and and other things that that that may not necessarily be the case um and that's why the omega-3 index or you know how you know your Omega-3s in your blood is a increasingly used um risk predictor of cardiovascular disease and things like that um so it's so it's very nuanced um but if you're going to be

maintaining cell membranes and cell function you're definitely going to need some and then the much better line of evidence comes from systemic measures of Omega-3 it's impossible for me to measure how much DHA is in your brain right but I can measure how much is in your blood right and when these studies were done at Oxford they showed that you needed both adequate B vitamins and enough Omega-3s in in order for to get this slowing in in brain atrophy and cognitive decline so if you measure omega-3 levels in people and they're low they have a

a faster rate of cognitive decline which tells me that that's important if you fix it then you can you can change that yeah it's super nuanced um but it's super important because you know tell me one of the things that I've noticed is I have seen patients thrive on radically different diets yeah so I'm like there is no one true human diet that's for everyone in my view it's just based upon 21 years now of clinical experience it's like I I I I've seen nothing to back that up there are some principles Whole Foods uh

as much as you can minimally processed you know decent amounts of healthy fats there are some basic principles but you can twist it in many different ways culturally ethically you know taste preference wise using those principles to seemingly be in good health I so I I completely agree with with everything that that you've said and I've also seen people thrive on an incredibly wide range of diets like I said earlier I think that's one of the most fascinating things about humans and we have to take individual health into consideration and so lots of things are

done at the population level that are very important but if two different individuals can thrive on very different diets and it supports their health in objective ways and they feel good we have to be able to support them and and in doing that um and to go back to omega3 is like I don't if you don't want to eat seafood there are algal um sources of longchain Omega-3s right so you can do plant-based versions absolutely and you would recommend that to people um I would recommend so I don't want to show up and just say

people should take all these supplements ideally you'd test right it's not difficult I mean an idea you know in in my perfect world you would have access to this test through your doctor it shouldn't be something you have to pay for uh because it's much cheaper than you getting a whole bunch of cardiovascular and cognitive diseases because you just didn't know that what you needed was a bit more omega-3 so you would just you would you would do one of those what blood spot tests that blood spot for an omega3 index um and if you're

in a good range then don't worry about it um if so that's I think that's really empowering it's like look if you're choosing to eat predominantly plants you're choosing not to eat animal products and you're maybe thinking about what Tommy just said and other guests have said in the past thinking okay well why don't I just go and measure my levels that seems like a pretty practical approach to take yeah and there are there are some studies that have been done that have looked at the omega-3 levels the DHA levels of um omnivores versus vegans

and sometimes vegans have lower levels but there have been studies that showed no difference right so you can eat a plant-based diet and maybe you don't have any issues whatsoever one one thing that's interesting is that there may you know I don't at this point believe in neutr genomics where you can measure your you can you know get a genetic test that will tell you the foods that you should eat I don't think we're at a point where we can do that but one of the things that we know the most about is how our

body metabolizes specific types of fats um and there have been there have been some studies that showed that if your ancestors agriculturalists longer ago right so they were usually closer to the Equator usually became Farmers um further away in the in your in our ancestral history like more thousands of years ago then the body has adapted to being able to take shorter Omega-3s like um ala which you can find in nuts and seeds and some grains and then turning into these longer chain ones by comparison um say half you know half of my family is

from Iceland right you can't grow grains in Iceland um there's not a starchy carbohydrate to be seen anywhere right they ate seafood and they still do and you know that was where they got their omega3 so their body's never had to adapt to it yeah so there may be some people and one of the reasons why they thrive on a completely U plant-based diet is because they're really good at converting some of these precursors to the longer chain Omega-3s and that's partly based on their ancestry and some other genetic components so that's why I don't

think that everybody who eats a plant-based diet should take an omega-3 supplement I think they should test and then if they need to change something they should but if they don't then great yeah if you enjoyed that I think you are really going to enjoy this conversation about the most important things that you can do right now for your Health and Longevity if at 37 your limit is just being able to run that 30 minute park run at 75 you're going to have a very difficult time getting around