Boost Your Brainpower with These 5 Tips from a Neurophysiologist & Elite Human Performance Coach

how do you get a jacked brain your first symptom of Alzheimer's disease May begin in your 60s but that has been starting in your late 20s early 30s so we can essentially prevent ourselves from getting Alzheimer's this is the only disease that robs you of who you are your brain doesn't know the difference between you getting hit by a car or you going through a divorce or you just getting a bad notification from an ex improving your V 2ax by 1 Point improves your lifespan by 45 days that is correct yeah welcome back to the

Reena Malik MD podcast I'm your host Dr Reena Malik urologist and pelvic surgeon today our guest is Louisa Nica neurophysiologist and Human Performance coach as well as director at neuro Athletics where she coaches the world's Elite athletes and high performing individuals on how to optimize their brain for Peak Performance not only is she brilliant about the brain but she also herself was an Olympic Athlete doing triathlons for Australia she is a true pleasure to have on today we talked about how improving the quality of your brain can improve the quality of your life what are

the five things that you can do to improve brain health that are free and easily accessible and how exercise can not only remodel your heart to work more effectively but can also increase the volume volume of your brain and how valuable that is in terms of improving your brain health how can you Stave off dementia and what exactly is dementia and we also talk about the importance of sleep how to deal with jet lag and what are some things you can do to optimize your nighttime routine so that you're getting to bed and sleeping at

the same time every single night and what are the two supplements that you should be taking for your brain Louisa thank you so much for joining us thank you so much I'm so excited to be here this is such an important topic and I often like think about this and I'm like you know everyone knows about heart health like they've got the best marketing team right like everyone knows what's good for your heart and you should exercise and eat right but no one ever really talks about brain health in the same way right like I

think it's an afterthought it's like oh you know my grandpa's losing their thoughts or they're they're having difficulty remembering things it's getting a little Troublesome but they don't think about it when they're younger I think that's a real issue and I've heard you say that you can improve the quality of your life by improving the quality of your brain correct so let's talk about why people should care about their brain yeah and that's a really you know you've touched on something so important most people do only care about you know cardiovascular disease the number one

killer in the world so of course we need to be caring about it I think this whole world of brain health is very elusive because even today we still we actually know more about space than we do about the brain which is quite scary right we hear the word dementia but still a lot of people are confused as to what it is they can't differentiate between dementia Alzheimer's disease fronto temporal dementia so we can you know we can talk about all of that but we really need to be caring about the health of our brains

because when you think about it the human brain okay it's about 2 lbs I would say it's got the consistency of hard jell but it is responsible for absolutely everything we do everything you are everything you think everything you produce from your muscle actions to the people that you talk to to the person you are married to is ultimately determined by the quality of your brain and when I think about brain health I think about quality of the function of the brain that's the neural networks and structures which is the gray matter and the white

matter of the brain so the structure structural components and the functional components and if we are not careful we can end up going down this road that 55 million people currently go down right now in the world and that is Alzheimer's disease and that is a very scary State and the one thing I do want to point out first and foremost is that my hypothesis well not if it's not even my hypothesis it is my what I believe what I believe to be true and that is that dementia is not a normal part of aging

so we need to really redefine what that is because a lot of people you just said it oh my grandmother's losing like it's not a normal part of aging but people think that it is and we have the ability to change that we have the ability to slow the progression of onset of dementia and Alzheimer's disease through lifestyle habits yeah and we're going to get into that but you've said so many important things here and I think one thing that people don't realize is that the quality of your life including the people you marry and

the people you surround yourself are related to your brain health let's talk a little bit about like does that mean how does that the brain change that for you we have these networks these specialized NW people hear about the prefrontal cortex okay it sits in the frontal lobe right at the frontal pole of the brain and it's where we house our executive functions think your information processing speed your thinking your decision making these are all governed by the prefrontal cortex we've also got other networks in our brain and they can be molded through actions that

we produce through the people that we talk to through this phenomenon called neural plasticity so literally everything is information that is what you are taking in information from your phone information from the people that you are talking to information from your spouse so when you get this information your brain creates a network around it and then it becomes stronger so that information becomes stronger becomes more familiar your brain likes familiarity right it loves to you know loves regularity and what's familiar it doesn't want to be shocked so once it sees certain behaviors you then mold

into that you start to think that this is normal that's why I'm really careful with the people that I talk to it's that old saying like you are the the product of the top five people that you hang around can your brain health affect your attraction to people so like if you have a healthier brain will you find yourself attracted to healthier people I mean I think yes I don't know the science behind that but you would definitely think so if you are on that part and that's also got to do with the the endocrine

system as well the hormones that are produced that are signaling different things to your brain but I really think it's a a result of who and what the information is that you're giving your brain it is very plastic it doesn't it has to be given the information so what is neuroplasticity it's the brain's ability to rewire itself through actions so we've all heard of you know we've got 87 billion neurons average in the human brain they are nerve cells they are our chief brain cell in the brain and they communicate with each other right and

they connect to one another each neuron has around 15 to 30,000 connections which if you do the math on that it's a lot of it's a lot of energy happening in the brain and it is thought that if you produce a certain action or you think a certain thought you create a new connection you rewire itself I always try and think of have you seen the you take a helicopter view you look down on the highway in in Dubai there's all these little networks these highways it's kind of like neuroplasticity and you keep going down

the one Highway if you keep going down it you create and strengthen those Pathways when you create and strengthen those Pathways it becomes easier like Habit to keep going down them without a thought so then it becomes more of an unconscious part of the default mode Network thing that's why you don't want to rely on motivation you want to rely on habit formation in terms of life-changing behaviors absolutely I mean because we know that you know there's several theories for the brain aging process and one of them is we lose efficacy to release dopamine so

you don't want to be relying on dopamine all the time and you don't want to be relying on motivation all the time you want to create these patterns that are just like so familiar to you that it just feels like second nature yeah that's that's sad that we are dopamine goes down because it makes things much more challenging as you age to find joy in the same things that you used to previously yeah it is and look apart from pathology we know we know certain disorders we can't produce the dopamine but it's it is scary

that we lose that as we get older in terms of making bad behaviors like say you are an alcoholic or say you are even just like eating poorly let's say something as simple that PE many Americans and and people around the world can relate to that also is developing a a neural pathway in your brain so how do you overcome that yeah I always say that your brain doesn't know the difference between right or wrong it just knows information if you feed it alcohol and it it gives you the response you got to remember it's

also B neuroplasticity is also based on how strong of an emotion it has this is why you know certain breakups are hard to get over it's like how emotionally attached are you how good did the alcohol make you feel if it made you feel really good and euphoric and you felt you're going to want to seek that pleasure again and if you do it again you just keep creating these bad habits and it takes a lot of strength mentally physiologically to overcome certain behaviors that's why it's scary right this is why drug addiction you know

is very hard to overcome from a physiological standpoint and a neurological standpoint so these habits it doesn't matter whether you think they're bad or good it is just information into your brain and it gets as as we get older we lose our cognitive reserves the builtup reserves that are there to help us fight off the negative thoughts or fight off the bad habits so it just keeps you become weaker in being able to say no to these things so how do you make yourself stronger how do you make your brain Stronger Yeah I actually call

it how do you get a jacked brain yeah it comes down to function which we'll talk about function it comes down to structural it comes down to living a healthy life and just delaying the the onset of these brainal Health Related Disorders before we get into that let's talk about these brain health disorders what is the difference right between somebody who's a bit forgetful maybe forgetting names forgetting where their keys are forgetting um simple things here and there versus fullon cognitive dementia Alzheimer's disease when does it become a concern I love that question because so

many people automatically think oh my gosh I've got Alzheimer's I've got dementia because I start to forget my keys and although some of the early signs of cognitive decline is short-term memory loss such as where are my keys and where do I live that can also occur under stress me I'm in my mid-30s uh I've have no signs of cognitive decline as I know you that I know but sometimes I do forget because I've got so much going on in my brain so we don't want to get too scared I'm sure you've come across people

who think that oh no I've got a bump on my head does that mean I have a tumor you know people just jump to WebMD and they jump to conclusions it's the same thing right but let's define globally what dementia is it's a set of cognitive decline symptoms and dementia is the umbrella term that is used to describe all these other neurodegenerative diseases neurodegenerative so it's a process that hope happens over time 20 30 years you know your first symptom of Alzheimer's disease May begin in your 60s but that has been starting in your late

20s early 30s which is why I'm really advocating for people to live a healthy life in their 30s where the that's when the the real damage occurs because that's when the brain begins to atrophy so you've got Alzheimer's disease you've got Parkinson's dementia you've got fronto temporal dementia you've got vascular dementia and so they they all sit underneath dementia now the reason why we know so much about Alzheimer's disease is because that's the most prevalent currently around 6 million people in America have Alzheimer's disease 55 million people worldwide that number is said to Triple by

the year 2050 staggering absolutely un because of these lifestyle things that people are doing well yes and no well let's first differentiate the difference between you've got many different risk factors right we've got genetic mutations and then we've got genetic risk factors and I think it's important to differentiate these so genetic mutations that's when you've got a mutation in your genetic code there's something that has happened there which will definitely cause you to get early onset Alzheimer's disease for example if you've got a mutation on chromosome 4 we know you're going to get Huntington's disease

it's just you know an error and currently we have three genetic errors in that and that is the a amalo precursor protein and You' got pralon one and pralon two so if we have the mutations there we know 100% penetrant you will get this disease sadly if you look at the cases that only represents 2 to 3% of the cases really worldwide so why what's happening with the rest of them MH why are people still getting Alzheimer's disease if they don't have the genetic G the genetic mutations then we look at genetic risk factors and

you know I really want to talk about this because I think we have overemphasized this Gene called the AO lipoprotein e APO E4 Gene and Chris Hemsworth is known to have two so you get one gene from Mom you know you get a gene one Alo from Mom one from Dad and we have the APO lipoprotein e Gene we've got Epsilon 2 which is actually quite protective so if you have an E2 E2 it's a very protective against the disease if you have E2 E3 it's protective a very average is an E3 E3 I have

I an E3 E3 it just means it's just it's nullified we don't increase the risk it doesn't decrease the risk if you have one L of E4 raises your risk if you have two raises your risk by 10 to 12 times so it's quite scary but I want everyone to know that if you test positive for the these genes I've just said it is a risk factor it does not mean that you will get Alzheimer's disease in fact 50% of people who go on through life with E4 E4 without even getting Alzheimer's disease arguably they

are probably living a very healthy lifestyle but then you've got this other subset of people who are getting the disease but they don't have the E4 E4 genes they don't have the genetic mutations so what could it be it turns out that it really does come down to the way you're living your life so we can essentially prevent ourselves from getting Alzheimer's you can prevent yourself from getting dementia and Alzheimer's disease these are diseases that are completely preventable but it's up to you and it's up to you to be empowered every single day it's an

individual effort that needs to be practiced and it needs to be done every day and so what is Alzheimer's dementia well Alzheimer's dementia is a is a form of neurodegenerative disease that is prod L made there's two theories currently we actually which is scary we've currently got something called the amalo hypothesis amalo Cascade hypothesis that's what we currently know of right now where we get the accumulation of this protein and I'm not even going to call it a toxic protein because we all have it in our brain and accumulation of these proteins that end up

aggregating outside of the neuron so remember you've got the neuron the cell body you've got the axon that comes off of it this is outside of the neuron I told you earlier that neurons communicate with each other 20 to 30,000 maybe 15,000 connections so if these amalo plaques and they Clump together if they are building up outside of the neuron they are interfering with the way the neurons connect and wire together when our neurons connect they fire something we we have something called a synapse and that's how they communicate with each other that's how we

think that's how we produce actions so this ends up getting disrupted So currently that is the the current hypothesis but then we've also got something else that happens within the neuron itself and that is the tow protein so we've got you know we've got these neurofibrillary Tangles and they go they basically if you think of the analogy I like to use is a roller coaster right so you've got these you've got these um neurop fiary I would say I can't even explain it but they're they end up what happening what happens is they end up

aggregating within the cell and they end up killing the neuron itself as well so these amalo plaques build up create these neurop fiary Tangles that basically prevent communication between the and potentially lead to death of the neuron itself and the very early signs of this happening is in within an area deep within the temporal loads called the hippocampus mhm and the temporal loes just sit here so so deep within that structure is this seahorse shaped structure called the hippocampus and that's where we have a lot of our memory formations a lot of our learning occurring

there and we get the breakdown and degradation of the neurons within there which is why the some of the earliest signs are memory loss forgetfulness and clinically I mean I've seen over my career many many patients with a variety of different dementias ultimately the symptoms tend to be overlapping in many of the conditions meaning memory loss some have like for Parkinson's there's a movement component it's really traumatic and I think people really need to understand like it's not just grandpa or Grandma's getting older and they're a little forgetful like it can be really tragic to

see your family go through that and to see them literally look at you and maybe not recognize you for a moment or a few hours or only recognize you for a few hours over the course of many weeks and so it is really a traumatic experience for people to go through and I think if people realize that it's in our power to hopefully stay that off or prevent that for the large majority of people I think that's extremely powerful yeah it's you know I think to myself you wake up with your brain and you wake

up with who you are every day you go to sleep with who you are this is the only disease that robs you of who you are and this became very apparent to me I've um I've seen a patient who has actually looked at me and said who am I mhm and it was really scary when you really forget who you are you forget who your kids are but then it can also be scary when you get your memory back for a moment and you remember what is happening and so it's it's actually a very big

burden an economic burden on and a very big burden on the caregiver itself but something we should also point out is what I'm also advocating for in terms of women's rights in science um and research is two out of three dementia cases are or Alzheimer's disease cases cases are women so we know that there is a hormonal component with that as well what do we think the hormonal component is although not not my my field um I am going to be interviewing Dr Lisa muscone who um you know she's researching this field but it does

have to do a lot with the estrogen yeah so we we're born with you know if you are born with a uterus and and ovaries we have many estrogen receptors in our brain and evidently after menopause we we lose that and that's one of the reasons another reason we believe is just the fact that we are living longer yeah I mean I think during the during menopause certainly there's there's changes because there's less estrogen to the brain but also the hot flashes have negative impacts because that's actually an error in temperature regulation in our brain

correct and that can also disrupt sleep as well which we know that sleep is a huge component of staving off these disease states are you sick of going to the doctor only to have them talk at you for 15 minutes and leave without knowing exactly why they're prescribing you this certain medication and what exactly the next step is to take to optimize your health wouldn't it be great to finally find a doctor who actually listens to you answer your questions and doesn't rush you out the door well at my practice Reena Malik MD I aim

to do just that I specialize in taking care of patients who have issues with their sex lives issues with their bladder with their Hormone Health or are having pain in their pelvic region or with sex my goal is to give you the time and attention you deserve so you can leave with a clear understanding of your condition as well as our treatment plan that's optimized for your goals during your visit I'm 100% present with you for an entire hour and after you leave you can reach me it is super easy to send me a message

through our secure portal and I'll get back to you within 24 to 48 hours no questions asked no hidden fees scheduling is easy just visit our website renam Malik md.com slappointment we see patients in both Irvine and Beverly Hills California and I see patients virtually in California Florida Illinois Maryland New York New Jersey and Virginia oh and don't forget Texas if you're outside these states consider seeing me for an educational visit I look forward to seeing you what are early signs so you said short-term memory loss what are some other early signs that people can

pick up maybe even younger that they may need to really be keeping an eye on this and amping up their prevention potentially changes in cognition so as as I mentioned earlier cognitive performance which we look at you've got decision-making information processing speed uh your ability to think faster these things can start to decline we have Global cognition and I will tell you that the degree to which your cognition lasts is how much that you want to to push it right you you go to the gym how do we make our muscles bigger we have to

place it under stress your brain is the same if you can place your brain under stress stressful situations whether albe it through learning learning a new task anything that is actually going to send hortic stress or good stress to your brain to push further in a specific area is going to be good for it remember our brain is it's highly adaptable and every area is accounted for every area in the brain is accounted for from hearing to to our visual cortex to seeing to balancing to posture so everything has a purpose in the brain it's

not just there and the Brain kind of takes the theory of use it or lose it so if you neglect to use a certain area of the brain and this is why a lot of cognitive decline actually occurs post um you know when somebody retires because they're not utilizing every aspect of their brain they're not learning they're not putting their they're not thinking as much they're not placing their brain under stress so your brain is like okay use it or lose it what are good stresses so say let's talk about someone who's like got a

lot of stress in their life how can they you know like that's a majority of people right people are working full-time they're taking care of kids they're taking care of Aging parents they're taking care of their spouse whatever right some people are multiple jobs so like how can you differentiate like obviously the day-to-day stressors which are not necessarily positive all the time to those that are good stressors that's an important one so when we talk about bad stress that is things such as putting yourself under chronic stressful situations that lasts a long time but also

I I must admit there's also nutrient deficiencies which could signal a chronic stress to your brain we don't want that good stresses are things like exercising thermal regulation such as getting into a sauna and releasing these heat shock proteins um that is a good stress that is something that signals to your brain okay I'm under stress like for example this morning I posted about um mitochondrial bi Genesis the creation of new and healthy mitochondria we need this we know that mitochondria is a Powerhouse of our cell where the the site of energy production ATP production

we can induce more mitochondria through getting into cold water because when we do we basically signal a stressful situation to our body and our brain and what happens is your body says oh my gosh she's freezing she's actually going to die hypothermic we have to warm her up how do we warm her up well we have to do that through mitochondria so the mitochondria get to work you start to produce this heat and then because it's so stressed it says guys we don't have enough mitochondria let's produce more so that is a that is a

positive stressful situation I've induced stress to create a positive outcome and so that's where I would say that is good stress this happens under heat stress as well if you go into the sauna we do the same we release these heat shock proteins which can be a really good beneficial thing and in fact they've actually done um there was a really great study that was done that showed that 4 days per week of infrared sauna can ameliorate some of the amalo beta depositions in a brain like looking at biopsies of the brain correct yeah and

what about with that's very early research what about with cold exposure are we seeing have they done that investigation no we know that one of the most robust um responses to cold exposure is the release of neopine which is a neurotransmitter neuromodulator it's involved in vigilance when released from the brain it can be released um from the body as well but it's involved in vigilance and focus and it's a really great neurotransmitter so we know that that occurs we also know that we can um activate a pathway called the rbm3 pathway they're now experimenting this

with postconcussive patients which putting you know putting these heads into after they've had a concussion like dumping dunking their heads into a bucket of ice to cool the brain down so we know that but that's very it's it's still so early yeah yeah so I mean interesting stuff I think ultimately probably also reducing your bad stressors would be beneficial as best as possible that's actually one of the risk factors so even looking at how can you minimize I wouldn't say mitigate because it is 2024 how can you minimize the amount of stress that you place

upon your system every day even deep breathing is a really great measure and you can actually measure your stress I wear an aura ring and right now it does things like now it picks up on daytime stress but we can also see through heart rate variability how well or even how well we've slept we can increase our heart rate variability with deep breathing and I'm trying to do everything I can to minimize my stress and it starts with giving yourself a head start start every morning if I'm up against a very stressful day I want

to know that at least I've slept well at least I've woken up with some cognitive reserve and I've slept well that's the first thing that I want to know if I exercise I'm armoring my my brain as well so that's another thing to kind of Shield me against some of the if I've if I'm hydrated and I'm eating well and I'm eating nutritious food plant-based diets are really great as well I'm an omnivore I eat everything but really you know giving your brain the best outcome it can so when it is about to go to

war because you never know things happen every day you want it to be protected and be strong enough that's why I call it how do you get a jacked brain so going to war meaning just dealing with stressors absolutely your brain doesn't know the difference between you getting hit by a car or you going through a divorce or you just getting a bad notification from an ex on your phone it is the degree to which you tell your brain that you are affected everyone can someone can get hit by a car and have the same

stress as someone who's just gotten a notification on their phone yeah or just read the news correct and what we actually see in schizophrenic patients in depress depressive patients we see that they actually have low levels of neuroplasticity so anything that's going to raise the the outcome of neuroplasticity as well is going to help you so these lifestyle factors that we speak about is really yeah yeah so you've sort of alluded to them but what are the five most important things let's say five things I think you've mentioned five already five most important things we

can do to help our brain health and maybe in order of importance if you had to pick oh okay well I'm biased because I'm currently I mentioned to you that I'm currently doing my Doctrine it's literally in exercise and Mild cognitive impairment so I'm looking at many different studies um interventions such as resistance training aerobic training and what these have on global cognition and on the structural components of the brain so I think at the bottom of the pyramid the best thing that you can be doing is exercising I know that the Sleep people and

the nutrition people probably have something else to say but um let's talk about exercise and what that's doing yeah so we've got aerobic training and that's generally your longdistance running that's generally when you're getting a lot of blood flow through the brain remember you mentioned earlier heart health and it's the same thing with the brain what's good for the heart is good for the brain and good for your genitals as you mentioned yes and good for your genitals why because the blood there's blood vessels to the genitals and they're usually smaller than those to the

heart or the brain so you're going to see problems in your genitals long before you see them elsewhere correct and your brain is the most vascular Rich organ in the entire body meaning it is infiltrated with blood vessels capillaries veins like these are important structural components of the brain so we let's just actually think about the heart for a moment okay you've got the aort and branching off the aort you've got the corroded arteries and then you've got the vertial arteries which is the posterior blood supply to the brain and everything else is just branching

off of these two arteries so every time your heart pumps you get a massive profusion big or small of blood to the brain the brain loves that because you're getting an influx of nutrients and oxygen and we need that and it turns out that even even the smallest one cell thick capillaries in your brain need to be utilized because they are essentially providing your brain with blood often times during cognitive decline they are the first things to go they go under stress so the first things to go during actually hypertension and elevated blood pressure is

your capillar so you every time you kill off a tiny little supply of blood to the brain what happens that means the neuron is not getting fed so it dies so we need to maintain our vasculature and how do we do that through adquate blood flow how do we do that through exercise so there's um you know aerobic exercise is the most widely studied when it comes to cognitive impairment and dementia because we started off with obviously mice studies and you can just get a m a mous to run on a wheel the best things

that it does is when you are exercising you get a rapid release of a neurotropic factor or a brain derived neurotropic factor bdnf and this is a growth factor for the brain so what scientists realized early on was that when you do as little as 20 minutes of exercise you release bdnf and bdnf when it acts as a growth factor in the brain it goes into the hippocampus and it is responsible for the growth and proliferation of new neurons so it can grow new neurons in the hippocampus there's also been twoyear follow-up studies that have

shown an increase in hippocampal volume so growing the hippocampus now whether that and and the the hipocampal sub regions as well whether that directly relates to um improvements in cognition is dependent on the person but we know that exercise is is great for that what else is aerobic activity doing actually there's a really wonderful study done out of Ben lavine's group he's a he's a cardiologist uh by training what he did Reena was he took 53 50-year-olds sedentary otherwise healthy 50-year-olds he subjected them to 4 hours of maximal exercise per week and when I say

maximal I'm talking it was around 75% of their maximum heart rate mhm for 4 hours a week so it's it was pretty a lot he did this um as an intervention for 2 years guess what he found he reversed the age related decline of your heart by 20 years so he was looking at the hearts of these 50y olds and they were presenting with the hearts of 30-year olds and he saw this through something called as we age we get stiffening of the ventricles specifically we get left ventri rric stiffness so that you know it

hypertrophy so it gets bigger so it constricts our blood so therefore we can't get a lot of blood through stroke volume per pump okay so that's scary because that means with every heartbeat we have less blood flow going to the brain he improved that over time and I think that that is absolutely incredible we called that cardiac remodeling so you can literally remodel your cardiac system your cardiac system is just like your muscular system system so through cardiac remodeling through putting your your body under these stressful situations you can rewire the your actual heart so

it can be pumping better and remember your aort these big blood vessels are actually made of muscle so the stronger they are the better equipped they are at delivering blood to the brain so remember blood flow then we'll move on and we can talk about um you know and we know this I know you've done um you've had Dr Andy Galpin on the podcast and he spoke tremendously about V2 Max which is a measure of your cardiorespiratory Fitness we know that even just an increase in your V2 Max can give you a life ex if

you go from below average to above average it can give you an increased life expectancy of 5 years so I think everyone in terms of protocols I think everyone should understand their Baseline where they sit for their Fitness I think everyone should get a V2 Max test because it is in the pursuit of a higher V2 Max that you get the real benefits it's not about the number it is about what do I have to do to increase my V2 Max and this doesn't happen you know you can't just you know you can go and

get blood work done let's just say you've got low vitamin vitamin D you can go and just take maybe 10,000 IUS of vitamin D per day for 2 3 months and you go back and get a blood test you'll see a dramatic increase it's not the same for v2 Max V2 Max like to increase your V2 Max you really need to be stressing your system on a daily basis so in the pursuit of that is where you'll get the benefits yeah and you posted something very recently I think it was on your stories maybe about

one point of V2 Max increase led to uh some really dramatic change what was that 45 day increase yeah increase in life expectancy so improving your V2 Max by 1 Point improves your lifespan by 45 days that is correct yeah that's really impressive it is and it is because of the the changes in the heart yeah so we know now based on what you've told me is that improving your aerobic exercise daily at a at a reasonable V2 Max around 75% it seems like you'll see improvements in cardiac remodeling you'll see Improvement in hippocampal volume

and in terms of sexual function you'll see Improvement in erections for men and similar improvements in arousal for women in terms of clitoral tum Essence really great reasons to incorporate aerobic exercise improvements in global cognition as well and glob well I would assume that that would be related to your hippocampo volume but yeah yes absolutely yeah and then we move on to resistance training which um again biased to it but I think that it offers a tremendous amount of positivity to the brain from a structureal perspective right and my area um of expertise is in

an EEG Electro andram where you actually measure the connectivity of the brain the functionality of the brain but then when we look at the structural components of the brain which you know you can see through an MRI for example we can see changes in the gray matter cortex there was one study that I came across and this was back in I think 2016 which showed that 80% of brain gray matter is modifiable by a exercise and for the audience what is gray matter so we've got both gray matter and white matter the gray matter sits

on the outer cortex of the brain it's generally made up of the neuron cell bodies that's why if you see it on appearance it can come darker and then the white matter is our aons it's the myelinated neurons and these are the things that you know are responsible for conduction and conduction speed and velocity this is what you'll test if you go and get a nerve conduction study or an EMG and someone is you know picking up on for example Ms multiple sclerosis you'll see um complete conduction block or slowing of conduction speed and so

that's the white matter of the brain and that's deep within the brain and the outside is your gray matter and that thins over time we get thinning of the gray matter cortex due to age as well however it doesn't have to be so we do get the loss of neurons as we get older arguably over the age of around 25 to 30 we start to see an atrophy in our brain and are those neurons like is that reversible it's so it's preventable but it's not so adult neurogenesis unfortun very controversial as well doesn't exist from

what I've seen in the literature outside of the hippocampus so I mean look if that was true we'd all be running around growing new brain cells which would be amazing yes angiogenesis so synaptogenesis exist so gen Genesis creation you can create new synapses and you connect we know that to be true through neuroplasticity and there's a great there's great research coming out now on Lion's man and um other adaptogens that can really help with that process but back to resistance training and there was a wonderful study that really signified my understanding and love for this

field and that was by Harold atal who basically did a systematic review of all of the literature on resistance training and Mild cognitive impairment and he found many things one thing was Benta Peterson is a wonderful researcher she coined this term called myokine and aoine is a muscle based protein coming from the P cyto kind family and what she found was that under contraction of a muscle fiber when you contract it and you squeeze it together you have the release of these proteins that are only released from the muscle fiber when they're released they go

into the bloodstream and they can go into they can cross the bloodb brain barrier and they can go through and connect in on different receptors in the brain and have positive effects of the brain so for example there is one called Iris MH iris is a myoc kind named after the Greek god of Iris and because it acts as a messenger molecule so when it's released from the muscle belly it goes up crosses the blood brain barrier and it improves the proliferation of bdnf so it actually helps bdnf Express itself more we've got um cathepsin

B so all of these wonderful myocin that are literally like fertilizer for the brain but not just that we know that these can go into other organs such as prostate we've got like receptors on the prostate on the ovaries we've got receptors on our on our liver and there's a really great study now in cell press that showed that exercise via lactate which lactate is another it's a byproduct of exercise but it's also another myokine can actually inhibit tumor cell growth really yeah doing resistance training is improving this myokine release which is then going to

our brains and having improvements in uh basically a multitude of ways multitude yeah uh which can be you know these one ful growth factors that help our brains function better and potentially have uh proliferation yes absolutely that's a really good sum yeah and just to just these myocin are not anywhere else they are literally released under tension you have to really be lifting high this is why you when you're going to the gym you should be lifting you know you have to be lifting hard not these tiny little weights because it's you want to put

your muscles under tension for them to release these growth factors but we've got circulating tumor cells that can actually be downregulated through aerobic physical activity and also through the myokine release yeah that's that's I mean I I love lifting and I think it's like addictive like once you like oh I can lift more like it's actually really sort of fun yeah and you've also seen the the studies of the age related loss in our strength and muscle so even just for the creation of like stronger muscles stronger you know more strength as we age because

one of the number one causes of death the CDC actually released this over the age of 80 is Falls mhm and that's really scary and then you think if you reverse engineer everything right well why do we fall okay sometimes cognition you know lack of cognition of where to actually know where you are in space and time can cause that we see balance the you know you can get atrophy in the cerebellum which is the mini mini brain if you will and which is that's responsible for our balance and coordination so that can also result

in it but then we also so know that strength obviously and and muscle loss psyopia can result in that yeah absolutely I mean Falls are some of the things I worry about very much so in my patients because a lot of them wake up at night to urinate and then that leads to Falls because they're getting up they're you know in the middle of the night where they're not fully uh alert yet it's dark like there's so many things that we talk about with our patients But ultimately you know I don't think people realize how

bad a fall is when you're in your 70s and 80s and how that can literally increase your mortality Risk by 20% you know just from having a fall within that first year so it is really um important so strength is going to help with that as well so okay we talked about aerobic exercise resistance exercise what's next the other one is a sub specialty so my company's actually called neuro Athletics and I founded this in 2014 and that was because there is a third part of exercise that we all neglect and that's neurocognitive training and

it is things using things such as your reaction training which is actually so beneficial for the brain many people say to me Louisa can I just do a puzzle or Sudoku if it places your brain Under Pressure then yes because your brain will adapt to it but a really great thing that you can do is just get two handballs and throw them to the wall and that's this part of this neurocognitive training reaction training hand eye coordination balance these these things are actually worthwhile to do as you age yeah so let's let's break that down

how often should you do this and how with what regularity in terms of like how long should you be spending doing something like that you only really need to do around 7 to 10 minutes a day there's been great studies that have done that shows that juggling can actually improve the gry matter cortex so sadoku is not enough sadoku is not enough okay good cuz my mom's obsessed but do you know what's actually good yeah like anything where you're learning learning new language and one thing that we do with um some of our clients too

is we we take into consideration the auditory cortex we know that hearing loss is another risk factor for dementia but um you know doing like hearing tests like maybe react to a sound that you can hear or we do eye patches at neuro Athletics we get all of you know some people to wear an eye patch which literally closes off half of your brain or closes off half of your visual cortex so it makes your brain work harder because it thinks oh my gosh I've only got 50% of my vision I have to work harder

and it places your brain under stress m yeah that's that's a compl blindfold yeah yeah but yeah I guess you can be Progressive about it right like you can do it with both eyes open you can do it with one eye patch on with a blindfold to to work your way through yeah exactly and it's fun anyone can do it it's cheap 7 minutes a day just get a handball and just throw it to the wall and just try and not drop it for a minute if you don't do that then go to 2 minutes

and then 3 minutes and it seems like it's something you could do with your kids like for me like my boys would love that yeah yeah absolutely um Okay so we've got neuro so we've got aerobic exercise resistance exercise neurocognitive training what else and then one really great study which I'd be remiss if I didn't speak about this which has nothing to do with exercise per se but it's got to do with the quality of the connections that you have so there was an 80-year study that was done out of Harvard which showed that the

number one thing for a healthy performing brain in your in your 80s '90s and Beyond is the quality of your relationships doesn't just mean the quality of your like romantic relationships it is do you have supportive people around you and creating a really great social network is going to be key to a healthy brain as well that is that is so uh important and I you know I see a lot of older patients and I often ask them like who what are you doing like cuz sometimes their their Partners have passed away or you know

the closest people them are getting older and the ones that thrive are the ones who get involved in their community in some way they may have they may go to bridge games they may do they may go golf with their buddies that they still have or make new friends and that is really or they'll volunteer even going to the library and volunteering or something and that's sort of how they maintain those social connections because I think even there's some day that even the the small connections like the the connections you have with people in passing

are also very important to Foster because they help us connect with people in a different way yeah and and then you think about well why is that it could be the release of different neurochemicals when you're with somebody else and your bonding and that could be really great it could be the fact that you could be learning from somebody else because your brain is like oh I'm learning from somebody else I'm learning new things more connections more growth but if you understand the just the structural components which I mentioned which is we need adequate blood

flow to feed the neurons what we don't want is neuron loss so how do we keep getting blood flow to the brain how do we keep strengthening the connections between the brain and then we'll talk now we can shift gears and talk about sleep because then that's also probably the next pillar of what you can be doing to health a healthy performing brain as well and so we've done Exercise we've done stress uh lower stress we've done positive social connections and now we'll do the fourth one which is sleep sleep is not just this nocturnal

thing that we we go through it is a it is a repair process that is absolutely imperative for your brain and sleep we can just categorize it as we've got REM sleep and we've got deep sleep and your brain needs both of them and there's now um the latest research is actually showing that regularity actually is more important than quantity and quality really I would argue it is all important but regularity the time that you go to sleep remember Reena what did I say to you at the start your brain loves regularity M familiar it

loves Pat it just wants to do the same thing every day don't shock it don't scare it right and so we've got a really wonderful process and this is stage three sleep so we've got stage one when we're falling asleep stage two we're in light sleep these are non rapid eye movement then we going to non Ram stage three sleep and on an EEG did you ever go into a PSG uh I've actually my son had one oh nice okay yeah so yeah well what you'd see is you'd see these big long waves and and

they they're called slow delta waves but but slow wave sleep which is also PSG is a polynom graph for a sleep study for those of you listening or watching yeah and you know when you go in there you've got a lot I want everyone to know like because everyone's like well what's the difference between that and maybe a weareable like there's a lot you know we're monitoring a lot of activity during that but you see what happens during this stage this this Delta wave pattern is we know that your brain does many things one thing

is this is where we get the release of testosterone mhm it was a 95% of um male testosterone is released during deep sleep not 95 but but a lot so what happens in testosterone is you release the highest amount is between 7 and 10: a.m. and then it sort of goes through a pulsatile but sort of slowly weaning throughout the day and then it starts releasing again around two to 4: am and goes back upwards but it starts in starts in the sleep yeah and that would be in deep it's probably most important for that

first first four hours of sleep so like going to sleep from 10: to 2 rather than like the 2 to 6 or or you know that that sort of time frame is more important and that's why timing matters right we also get the release of growth hormone during that stage which is responsible for the growth and repair of our muscles so this is why when we're in deep Sleep it is a repair process for our brain but we also know that we activate a system which is some similar to a washing machine if you will

it's called the glymphatic system now I mentioned neurons what sticks between the neurons are these other types of cells it's our chief immunity cell in the brain and they're called gal cells comes from the Greek word glue can you tell I'm Greek um and they stick you know they B bind together between the two neurons and they shrink in size during deep sleep and when they shrink it means that we can have the we can have our cerebral spinal fluid be able to wash away in this beautiful synchronous way and it gets excreted taking with

it toxins taking with it the whole marks of Alzheimer's disease which is amalo beta and it washes it through the brain washes it out through the system so you wake up you feel good normally if you wake up and you've got brain fog which is probably quite a big symptom of you know what maybe you just didn't get a uh get enough deep sleep and you didn't activate this system this system is blocked if you're having marijuana or alcohol MH I just want everyone to know that it can also be blocked under certain medications as

well yeah so that's you know the deep sleep thing I think people don't realize like what makes good quality sleep oh yeah I think really uh people like well yeah I'm sleeping 7 8 hours I'm you know I'm getting the right amount of sleep and I always you know for me I didn't even realize it either I am used to drink I mean I'm a physician so we drink coffee all the time so I used to drink coffee late in the day and I realized when I stopped that and I started I could fall asleep

fine I mean I was chronically asleep deprived as a resident I could fall asleep anywhere but I would fall asleep fine but I'd still feel tired and I realized once I limited my caffeine intake to prior to noon I actually and now I drink decaf a lot of the times um my sleep is way better well that's because caffeine obviously there's a halflife to it so it interrupts sleep and caffeine is an adenosine blocker which we know um adenosine builds up during the day which makes us tired yeah and so we want to try and

do everything we can you know I always say you're preparing for sleep the day before or the morning that you wake up you are setting your circadian rhythm from the first time you see sunlight around you know 12 hours after that when we're going to get tired we really want to be in deep sleep and then another thing that will kick you out of that stage as well is light and you think well I've got a dark room but even the smallest amount maybe a street light for my parents um you know street lights I

live in New York City I mean there's light everywhere but I I wear a mask every night so there's one more thing and this is new research in the last I would say 6 years we know that in order to fall asleep and stay asleep our core body temperature needs to drop 2° so keeping a cool environment can help you there's a difference between ambient temperature temperature of the room and your actual thermal temperature some people like to sleep on a um thermal mattress and then but if you don't have that you don't need it

you can obviously tamper with the temperature in your room or even sleep with your feet outside of the sheets because that's where we you know get rid of our isn't wearing socks actually reduce your core body temperature yeah it does so doing all these tiny little oh I hate the word hacks but these tiny little things can really make an improvement at lowering your core body temperature throughout the night and enabling you to have a deep sleep so sleep regularity though is number one so even on the weekends sleeping in on the weekends probably not

ideal no and remember a you can't your your sleep isn't like it's not like debt that you repay to the bank so it's not like I'll sleep 12 hours on the weekend I know right and one thing I want everyone to know is um the study that changed my life there's you know there's always there's either always a patient a client or a study that changes you and the one that changed me for the game was a study done on healthy adult men and it was um published in pnas where they subjected them to sleep

deprivation of just one week sleep deprivation by the way guess what how many hours it was six hours yeah you know which one I'm talking about it was the epigenetic change you've probably mentioned it but that changed the game for me where they found a um a change in 711 genes the ones that were upregulated were the ones responsible for tumor growth the ones that were down regulated were the ones responsible for immunity yeah it's so interesting I mean I think sleep I I love talking about sleep and I think that the one we're the

only species and Matt Walker says this we're the only species who intentionally sleep deprive ourselves our brains hurt us sometimes too right cuz we we let ourselves think oh I just want to do this one more thing before bed or I just want to like I want to Doom scroll or watch another episode of TV or whatever it is that when actually the restorative thing would be to go to sleep absolutely and unfortunately what happens even when you get the you know the buildup of these amalo plaques it has this cycle where if you don't

sleep you know you you raise your risk of developing these um this disorder but then when you have it it also prevents you from sleeping yeah it's really really tough I'm not going to go back into you know I know we are focusing on brain health but and we're focusing on sleep right now but I want everyone to know that there are only two real medications right now um that are attacking the amalo but it's very slow acting by the time you know they're administered through an IV by the time they actually get in and

you know ameliorate these plaes and Tangles it takes a very long time and the process of building up the amalo is taking place so really no drug really is curing we have no cure for Alzheimer's disease we have no reversal of Alzheimer's disease we don't even the the actual FDA approved drugs that we have and only having a very small amount of an effect so banking on the things that actually work from a preventative standpoint such as sleep is going to just do so many more wonders than any drug ever could are these things as

patients who have dementia maybe Alzheimer's a little more challenging to get patient Buy in but like to get them to sleep better or to get them to exercise are they going to see improvements in their symptoms at all yes and no so if you've already got MCI so mild cognitive impairment which is a pre-dementia state you can see the slowing of that so you can slow the progression of the MCI through all the mechanisms that we discussed earlier but you can never just halt it no yeah I mean I think it can it can help

their other health conditions too because very often because it's a very often a vascular issue they also have high blood pressure they also have U maybe have had a stroke they you know these other horrible things that have happened and so like they can help with those conditions as well yeah absolutely and improve their quality of life quick break from this episode to let you know I am so grateful that you're spending part of your day with me I started creating content online to empower people to learn more about their bodies without needing to go

see a doctor pay a co-pay wait in a waiting room or find parking and it has been one of the most rewarding experiences of my life if you want to help support our mission of providing free education please consider joining our premium membership there you will have access to adree episodes which are released early as well as free transcripts and the opportunity to ask me anything and these questions are answered in our monthly AMA episodes support the show and join today at renam malik. supercast docomo to see you there in terms of travel so you

said melatonin what do you do when you're traveling like how do you to because of course you're going to get jet lagged of course your time zones are off when I do a short trip I try to stay on the same time zone that I was when I go home um if possible but I think if you're on a longer trip you know what do you tend to do so I tend to try and set my so Rhythm based on where I'm going to land and I do this through a number of ways a one

of the biggest things for traveling is I try and minimize the amount of food that I'm eating on a plane that's the first thing the second thing is I do like to sleep as much as possible banking on sleep even though I mentioned earlier that it's not like a debt that you can repay to the bank but you can you can Bank on sleep so you can put as much sleep in your tank as humanly possible prior to going just to cater for the jet lag I'm also using light exposure I'm doing this through natural

sunlight light but also through a 10,000 Lux light box that I car carry around with me you can get these on Amazon for about 40 bucks so I'm doing that to help set my set my circadian rhythm to the time zone that I'm going into so like for example if you are going from New York to LA and LA's uh your normal Circ rhythm is to wake up at let's say 7:00 a.m. right but here 7:00 a.m. is 4:00 a.m. right so what are you doing to prepare for that and then when you're going back

let's like give some some concrete examples yeah so I would set I only do it for 72 hours I will put my body into a a state where I'm getting into waking up at 4:00 a.m. and hopefully going to sleep at 1 p.m. PST which will be 700 p.m. I will do this through the use of melatonin through the use of magnesium L3 and8 and through the use of Pharma Gaba and Gaba is our chief inhibitory neurotransmitter and this is just to help me calm my mind down and Rel relax me so I can induce

sleep better often times it won't work out that way I'll probably get to bed at maybe fall asleep at 8:00 p.m. but then wake up at 5: so it helps so you you'll like so you maybe for the 3 days before you'll wake up at so say you wake up at 7:00 you wake up at 600 and then you wake up at 5 you wake up at 4 and what time are you taking these supplements like how often before so say you want to sleep at 700 you're taking at 600 you're taking my five no

20 minutes prior to bedtime 20 minutes yeah that's when I I've seen the most effect for me me and you know from the and then when you're on vacation you reverse it to go back that's correct and it's all for me I don't have um jet lag when I go to Australia it's when I'm coming back that I'm it's a punish for me so I do everything I can even I even use caffeine to help stimulate me during um the the moment when I need to wake up as well and why don't you eat on

a plane because you've already got lowered digestion you're already up in the air you've got first of all the worst thing about being up in the air is you've got less oxygen mhm right and now um I was actually I went and bought I haven't used it yet I bought this drink bottle that can actually you know help with the oxygenation as well on flight I I mean I don't know if it's completely you know efficacious but I'm I'm going to try that but yeah but pretty much when it comes to food on the plane

you are not moving around you don't have aot lot of blood flow so digestion is just not going to be at its peak so you want to just be able to minimize the amount of food that you have to digest at such a high altitude got it got it so don't be snacking the whole FL because that's probably one of the reasons why you also feel horrible when you get off a plane yeah yeah or drinking or whatever oh my gosh people who drink on a plane um I don't understand well someone who used to

drink I don't drink anymore but I think um it used to be like part of the vacation experience right like I'm going to have a cocktail on the plane and I'm going to relax I'm going to maybe go to sleep and it'll help me relax and maybe should just take some melatonin before the plane do you ever do that like take just to like make the plane ride faster do you like try to sleep on a plane if it's an overnight so tomorrow night I fly out at like 10: p.m. so it'll be an overnight

flight so for me I will take melatonin just to try and like settle me down so I'm not up wired for 14 hours the entire trip got it got it we didn't touch on REM sleep and I will because that's the last stage of sleep that is also very crucial for the brain so rapid ey movement sleep we know that on a uh on a PSG you'll see these horizontal eye movements of the brain and what we know is that you are completely paralyzed from the neck down but your brain if you look at these

brain waves it mimics an awake patient so it's a lot of chaos is happening and this is generally where we get our memory formation vivid dreams occur which is why um and we get also the process of learning and the penetration of learning and skill acquisition you know if you've got kids and they're out there learning a skill it's also going to get penetrated during sleep you know skill takes the form of actual happening in real time learning of the skill but also the penetration of the skill yeah I think one I remember the first

time I learned that we're paralyzed in our sleep I was like how does that even work evolutionarily like what if you get you like you know sometimes you wake up and you're like you feel like you can't move for a second and um it doesn't happen often but like you know you wake up at the wrong moment or whatever and um it's it's sort of scary but two the the learning acquisition thing is is really um important and that's one thing I learned from Matt Walker when I was Lear reading his book and stuff was

like these these teenagers right their circu Rhythm is a bit later yeah and they're high school at least when I was I think they've gotten better when I was in high school you had to wake up at 7:00 a.m. to go to school and you're you're that's like 4 hours earlier than your circadian rhythm is really allowing and so they're losing all that skill acquisition correct they're losing the skill acquisition they're as well what about the amount of dopamine that gets released as well that you know that molecule that motivates us and drives us and

you know puts Forward Motion in place that's also getting that's not also getting released you know at the right time so that's scary as well yeah for people who wake up in the middle of the night uh and have trouble falling asleep what do you suggest for them do not look at light and I know many of your viewers are going to be like well that's great Louisa I'm going to trip going to the bathroom I would suggest getting Lighting on the floor yeah I tell them to get track lighting so like when you're walking

it just like it it activates to your footstep but it's motion censored and usually like just track lighting on the on the bottom like hallway floor yeah don't open the fridge that's going to be like a a lot of people think okay I'm hungry I'll go to the fridge I also say that leave the bed for sleeping if you're doing other things in there like you know watching TV maybe doing homework for young kids or whatever that may be you're you're also taking away from that sleep pressure so you really want to minimize the bedroom

and just leave it for sleep and that's it yeah I've always been so curious why people get these huge Master Suite bedrooms because I don't even go in my bedroom except to sleep like I don't spend time in there hanging out like reading a book in the in the um you know in a chair or something like that's in my living space and so I've always been like very curious as to why people uh develop these huge ginormous like bedrooms like they're going to be spending all this time like you know doing stuff in their

bedroom but maybe other things that's okay leave it for sex and sleep yes yeah absolutely um in terms of reading before bed so obviously want to avoid looking at a screen so try not to look at a phone or or something but what about using a Kindle versus reading a real book with some sort of light obviously you need some light to read what do you think about that it depends on whether it's actually going to keep you some people get EX so for me like I'm better off watching a TV show because that just

requires nothing from me mentally when I read I get stimulated and excited so that's going to stimulate me so I I choose not to read but in terms of lighting it look it's better than looking at a screen I know that you can like lower the lighting on the the Kindle so that's going to be great too but generally you really want to just get into bed I say so lights out at neuro Athletics is 10: p.m. if I want you in bed at 10:00 I want you asleep by 10:00 I want you to get

actually in bed by around 940 and give yourself the 20 minutes of you know just relax sleep latency and sleep onset yeah yeah okay so we got four things right five what's the fifth thing well the fifth thing is um I would say it it falls under the bandwagon of nutrition we know that one of the best things that you can have for your brain now I never get involved in nutrition on Instagram these wars are just absolutely insane I am an omnivore I maintain a really great lipid profile even though I have red meat

I really I really take that into consideration we know the brain loves antioxidants we know that it loves selenium okay we know that it loves vitamin A vitamin E so we want to be getting antioxidants from blackberries blueberries oranges we know that it loves vitamin C these can help protect you against free radicals these free radicals that occur in our environment in our just in our daily thoughts in our stress and in fact which recently um I've just done an episode dedicated to water and I just um I didn't even know I'm currently drinking um

essential no I'm drinking out of a I'm drinking smart water out of a a plastic bottle these bottles release these tiny microplastics and apparently um on average we're all having a credit card worth of microplastics per week yeah each bottle is like 15 microplastics and then just think of that over the I just did a video on this that's why oh so you've done the same thing okay great so yeah I mean I think it's fine I think like once in a while as long as you're not always drinking like you're a traveling you're not

home right but like I think if you're drinking from a water bottle once in a while that's cold and not in a hot environment it's fine and it's all about the dose right so if you are constantly drinking from plastic water Botts that stored in your hot garage that's probably not as safe or if you're warming up your food in plastic containers that's not as safe as using a glass and that's really pretty simple and easy to do but I don't like to stress people out and be like oh you know you got to get

rid of every plastic thing in your house and spend a ton of money to buy more because it's again it's the dose absolutely so so we know that that can help with free radical damage that is something that's really going to mitigate it and protect it against it so we want to increase our antioxidant profiles we sitting under that as well is really there's so much great research now on Creatine we used to think that creatine was just good for the body we know that it is really good for the brain from a neuroprotective standpoint

we've seen that postmenopausal women we've seen them um you know in a a 2-year really great study I think this was um done by Dr Darren kandal he dosed them with uh around 10 G of creatine per day they had improvements in muscle mass and bone density and I know people are going to say but Louisa doesn't this ruin your kidneys and it doesn't so creatine is absolutely fantastic for that we're now seeing the association of creatine and Parkinson's disease so I know that the Alzheimer's research is going to come I think it's going to

come from a neuroprotective standpoint so it helps with ATP generation so Cell Energy metabolism we need it we want it the next thing is our brain is made of fats and water and around 20% of our lipids in our brain is made from DHA and omega-3 fatty acids is another thing that I would definitely recommend anybody it doesn't matter outside of go and do your blood work but really having high dose omega-3 fatty acids EPA and DHA specifically Al is going to do wonders for your brain it's going to do wonders for actually downregulating inflammation

it's got a huge safety profile and it can really really help with these inflammatory biomarkers but it can also help with cell membrane fluidity yeah so there's pretty good evidence on Omega-3s and it's it's very difficult to get enough from our diet I think I mean I think you can do it but I think it's challenging unless you're eating fish every day or um but this even depends on the type of fish m MH yeah yeah so it's very tough um so yeah I think that's a good one are you feeling in a rut in

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diet you know I think Whole Foods generally speaking lots of plants and plant forward meaning lots of vegetables lots of fruits as antioxidant with with high antioxidants are very beneficial other things that you recommend the things that I don't it's it's like okay just we know that there is this you know people argue well saturated fat is bad because it clogs the AR arteries and it's like okay that's great as long as you maintain a good um lipid profile like I mentioned you keep your apob B down your um LDL down it's it's it's fine

and I want to reiterate like one of the I think one of the worst things that has ever happened in brain health is the fact that people think the brain is made of cholesterol and cholesterol past dietary cholesterol can pass through the blood brain barrier I want to make a note that dietary cholesterol cannot pass through to the brain unless you have a compromised bloodb brain barrier so don't even think about like oh avocados are good for your brain it's not doesn't work that way yeah the blood brain barrier does get weaker though as we

age yeah we do get permeability in the bloodb brain barrier and actually one of the best things um to do for that is exercise as well it really does help with the Integrity of the bloodb brain barrier via these little capillaries yeah yeah that's great um in terms of things that cross the bloodb brain barrier medications so I do a lot of overactive bladder management and one of the medications we use unfortunately for overactive bladder that often insurance covers because it's cheaper is anticholinergics yes and these have very you know challenging side effects including dry

mouth dry eyes constipation but there's more and more data suggesting that that there is a link there is an association between these medications and dementia and I can't tell you the number of patients I have who come to me and they're on 16 medications okay 16 yeah like 16 I mean like high blood pressure diabetes high cholesterol um they may be depressed they may have uh overactive bladder and so they're on all these medications and I'm always like wait wait are you even seeing a benefit let's let's peel it back cuz if you're not seeing

a benefit let's stop these medications because they're not doing any favors if they're not helping you so is there anything else that we should be doing to improve brain health that we haven't talked about you also should be hydrating and then look everything else is an accessory item when it comes to brain health as long as you're getting the like I always say the cake is exercise sleep proper nutrition and the two nutrients you know the two supplements that we discussed everything else is an accessory ice baths I have one in my living room because

I love it I think it's great for me it's an accessory your your saers that is an accessory red light therapy which is something that I'm really getting into now we know that like near infrared light and red light can penetrate uh the skin and go into the superficial organs we're seeing great efficacy for that actually being going going into the nose and shooting up to the brain we're seeing that for stroke patients helping with healing and trauma but again it's just an accessory it's not going to have the biggest bang for The Bu yeah

what are things that people people think are helping and you mentioned like avocados and things but what are things that people think help their brain but they don't oh you know there is a lot of research on like early research on medicinal mushrooms and I get asked often do you think that this is going to be good that people are taking Lion's man and it's like it's very it's very nuanced it's very in small doses it might help with synaptogenesis as I mentioned but there's just a lot of the supplements that you're taking should only

be taken if clinically relevant like if you get a low if you got like if you're vitamin D deficient vitamin is wonderful for the brain and if you're vitamin D deficient yes but if you're you know if you're over 60 that's fine like you're you're fine you don't need to be supplementing with absolutely everything yeah yeah I think that's important is there something that you used to think was important about for brain health that no longer is or something you've changed your mind on I did change my mind on plant diversity I would say that

I was never carnivore no but I'm now trying to do more because I'm seeing a lot of research in the way the gut communicates we've got you know it's a bir directional access between the the brain and the gut you've got this one fiber the you know you've got the vagus nerve which goes down to from the brain down into the gut but then you've got around 10 fibers that go from the gut to the brain which can help you know signal things such as depression anxiety schizophrenia so I'm changing my mind about how important

plant diversity is in maintaining a healthy gut to maintain a healthy brain and I'm sure you're aware of Dr Chris Palmer who is completely on the ketogenic side where he is you know advocating for a ketogenic Rich diet due to you know mitochondrial dysfunction which is a Hallmark of a lot of these um diseases in mental Mental Illness but I I I'm seeing just so much strong evidence cuz I'm in the Alzheimer's disease space on having plant rich foods for the brain so yeah I think there's a lot of data on fiber and which is

what you're getting from plant rich foods like the cruciferous vegetables and how that affects brain health right because you're affecting you're getting uh buic acid which is then affecting brain health so that's one thing I've changed my mind on and one thing that I've it's not changed my mind but something that I'm now really really pushing for is sex differences we know that there is a difference okay in our brains in terms of if you are born and I I want to be very careful with you know in terms of gender but if you are

born with ovaries and a UR you've got a different brain to that of a a male in terms of the neuroendocrine system so I think the way that we use Precision medicine when it comes to patient advocacy I think it's shouldn't be a onesize fits all approach it upsets me that even you know the first studies that were done on the the sex differences in brains was done in like 1850 and we still hold true those notion like we we're going to space okay and we still can't understand the difference between male and female brains

I think that that is something that I would love after I get this done maybe I'll go through and and start researching the sex differences in male and females because male and female are inherently different in that aspect so that's another thing I've changed my mind on yeah no I think that's really interesting I I do think that um there's a lot of work to be done in so many areas but absolutely there there are differences I think in genders and we'll see how that plays out over time I mean you'll interview Dr mcone and

I think that'll be really useful but there's a lot of data in terms of like how hormones affect our brains and obviously we have different levels of hormones but every hormone in terms of male and female but those hormones are very valuable for both so for men estrogen is important and for women testosterone is important and people don't really realize how valuable that is and people don't realize that everything is everything meaning that it's not just about these structural components these receptors in the brain of estrogen and testosterone it is what are they what is

estrogen doing or what is the lack of estrogen doing and what is it doing on your mood and your cognition and then what is that then doing on the choices that you make every day to either go to the gym or not go to the gym um you know for me you know during the menstrual cycle sometimes I I just can't go to the gym and so that then it's not just oh estrogen and and it is like what happens after that what very individual right like there's some people who don't notice a difference with

their cycle and there's some people who do and there's you know it's like how hormone sensitive are you we're not looking at The receptors right you're not looking at how many receptors are getting activated and how sensitive those receptors are I mean it goes down to a very deep level so I always tell my patients like it doesn't matter what your numbers are I mean we look at them we monitor them because they're important to see that we're headed in the right direction but what matters to me is how you feel because I can't test

receptors you have I can't test how sensitive they are to the amount of testosterone or the amount of hormones you're getting and so I think it's really important to realize that that every person is individual yeah and and and just as a closing out on that it's all also about when you advocate for women's rights it's advocating for women to come forward and be able to trust their physician and have a really good doctor patient relationship where they can can be completely honest with how they're feeling um I lost my my grandmother and my auntie

both in the matter of like two weeks from um from cancer and my mom and I talk about it often you two women who just never told us how they were feeling I'm so sorry yeah and that's it's it's devastating like you never you never knew and I I remember asking I said why didn't you tell me I didn't want to bother anyone MH that's a very yeah it's a very I would never hear a male well I haven't no sorry I shouldn't say that I haven't heard um any of my my grandfather ever say

that I think it's different I mean I think men tend to bottle up a lot of things I mean I work with a lot of male patients they don't share necessarily always but it's just I think it's it's in human nature to sometimes not want to burden others but certainly I think in terms of women we so busy taking care of others that we often don't take care of ourselves whereas for men I think it's that they feel like they need to be masculine and they don't share things and so it happens for different reasons

potentially that are cultural uh but uh I think it's still in both genders it does it does happen yeah I know your your company works with Elite athletes and high- Performing individuals so let's talk about either you want your kid to train to become an athlete or you yourself are a high performing maer Like a Surgeon like for me I need to go to work and I need to operate on people and I need to be at the top of my game so what are additional things that someone who is like really high performing or

you're trying to at a young age get your kids to sort of become High performing um what do you do set goals and routines if you have a goal that you're working towards it can and you really and you really pinpoint on that goal and you work towards it and you've reversed engineered it you need you you can put structure around that goal to achieve it that's what I see a lot of um a lot of these athletes doing they know exactly what they want and they get about doing it absolutely every single day so

that's that's one behavioral aspect to it the second one is physiological if you do want to be high performing you have to get your physiology in order physiology first I believe it's physiology before Behavior meaning you have to be sleeping you have to be eating well you have to be performing every single day so looking at behavioral characteristics of what makes a high performer it's the habits it's the rituals it's the structure and it's not veering off path from that as hot as that sounds in terms of goal setting I mean that's kind of part

of neuroplasticity too right you're setting a goal and you're setting out to achieve that goal and making a map with which to achieve that goal essentially correct and you're opening that dopamine Loop the circuit opens and if you set that goal and you achieve little Milestones towards that goal that dopamine is going to keep feeding you and you're going to keep going and going this is why I was a triathlete which fed into my entire career I raced you know internationally for Australia and I had a really good coach and he was the one that

set I didn't have the ability back then I was young I was a teenager I didn't have the ability to set my own goals so he set them for me and he benchmarked me and I used to want to be I I wanted to go faster and he said no he never spoke to me about dopamine he probably even didn't know what that was but if I had gone out and tried to achieve my own goals I probably would have just failed and not done it so it's about how do you goal set how do

you achieve those small Milestones how do you reward yourself with dopamine that keeps telling you to keep going and you just keep going on that path and try as hard as you can no matter what age you are but I'm speaking more so for adolescent teenagers try to limit the amount of social media you have I see it changing brains and they're their brains aren't developed yet yeah so that's yeah yeah so I think with kids set their goals help them set their goals their goals I think that's I mean I'm raising two kids so

I often think about you know how can I get them to find that ambition but also I think setting like smaller goals is really helpful because if you say hey I want you to get a scholarship let's say for example I me know parents want these things for their kids right I want you to get a scholarship that's like such a lofty goal and it's like 10 years away right so it's like how do you get there like what what is how do you got to as you mentioned reverse engineer like what do I need

to do right now to get there and that can be even again for your brain health what can I do right now to prevent Alzheimer's or to prevent dementia later on I'm reverse engineering the brain I want to have right yeah and and remember the best form of exercise is the one that you stick to so if you do love you know this is for for kids as well get them just what do you love first and foremost you can beat anything these days just due to social media so there's got to be a passion

in there because that passion is going to drive you every day to keep wanting to do it so once you find that passion even like with your exercise with your sleep gamify it if you have to and that's what's going to make you stick to it yeah I think finding the passion is key you can't force your kid to do something and I I've sort of let my children figure that out for themselves and when they start showing me signs that they are really into something we lean into that but we try not to like

put our own desires like you know I would love it if they were like you know professional North Indian dancers but like that's not going to happen so U that's okay you know yeah I wanted to talk just briefly before we uh close out is like happiness so in terms of how your brain and happiness are connected from a neurophysiologic perspective yeah that's such a that's such a good question because I was actually speaking about this yesterday in terms of sleep right there's really great studies that show that um you know people with even mild

depression have trouble sleeping and that's because generally when you think about sleep we know that serotonin helps us fall asleep and melatonin helps us stay asleep so there's a strong component there of um happiness but happiness really is if you think about you know when I think about food food is not food food is information right so if you feed your so I think about happiness not as like let's walk outside like happiness is what your brain is telling you and that's being projected in your physiology so what are you feeding your brain to help

it release certain neurochemicals to tell you that we are happy happy is just a word to describe a set of neurochemicals that are released so are we eating a Dietrich food that is you know full of tryptophan you know precursor to serotonin which ends up coming from a turkey for example are we do we have any stresses in our life from a micronutrient perspective that is signaling to the brain I am a bit under stress right now so I'm going to lower everything that doesn't need to be there such as happiness does does my brain

see a perceived threat I'm evidently not going to be happy about that so in a lower happiness so I see it that way and I also see that you know this is from Chris Palmer's book if you are in a an energy crisis in your brain low energy levels you cannot think in any way that you are going to just wake up and be happy happiness is something that is deliberate you cannot and this is s I've seen this in in studies but I've also this is also my opinion you cannot just wake up and

be happy you have to put the work in every day to make yourself happy because your brain is just there you are feeding your brain information and it is feeding it back to you and so you have to feed it information that is going to give you the happiness that you want yeah that's really powerful yeah it's in our control it's in our control so we end our uh podcast with a few questions and these can be about about you individually or about your work well the first question can't be about your work so the

first question is if tomorrow you lost all your abilities to coach or to do all your training and you couldn't be an athlete either cuz that was something you've done in the past what would you do o I always say that if I wasn't doing what I was doing I would actually go to space yeah yeah I don't Co I don't know why um I I had this very big fear of planes and I fly a lot so to overcome that I started to learn about Aviation um I was a math major by my M's

in mathematics so I do love math and Engineering um and then I thought imagine how amazing it would be to go to space and so I started like investigating I was like okay I would I I would go out of my way and do that I think that's cool yeah maybe someday you will we'll see what's a life hack or health hack that you haven't shared yet that you would share oh God gosh one thing that I'm trying to do now is Implement um a walk for 1 hour a day without any Electronics that's a

good one oh have you ever tried it I I not an hour I've done like 10 15 20 minutes 30 minutes maybe but not an hour yeah I leave my house now with nothing not even my I've got my watch I at home and I just I go I guess it's safe in New York to do that I know right there's a lot of people around I mean it's safe here too but I think if you live in like a small maybe depending what's a non-negotiable something like that you you do every day no matter

whether you're traveling whether you're um you know wherever you are in the world exercise I mentioned to you um today is so bad for me I've had a I've had minimal 4 hours I still went to the gym because I know that the sheer forcing of blood to my brain is going to actually outweigh the effects of sleep deprivation so when you're tired when you're sleep deprived what do you what do you focus on how do you like what do you do do you do both aerobic and um resistance or do you focus on something

in particular I go high intensity because I'm trying to get as much blood oxygen rich just to my brain as I can and I focus on breathing okay yeah and what's something you know now that you wish you knew earlier o that the power of the people that you get your advice from I used to take advice from anyone really anyone who was going to give it to me you know in your 20s and I was so hungry I always wanted to be you know amazing and really great at every so I just took advice

from anyone even relationship advice from you know my single friends we've all done that unfortunately um even to this day I've got friends who um who are not married or don't run a business who you know who give me advice and I I I think to myself huh I so I am so now I'm very Vigilant in who I ask advice from I think that comes with age and maturity right I think that's that's good L it was so wonderful to have you where can my audience find you you can follow me on Instagram Louisa

niola I also now have YouTube which is just Louisa niola and then you can check out the neuro Athletics website for everything else that's amazing thank you so much thank you so much for having me thank you guys so much for listening to today's episode of the Reena Malik MD podcast if you like this episode please do me a solid and share this podcast with your friends and family it would mean the world to me take a screenshot and share it on social media and tag me I love seeing it and of course this is

the best way that we can have our content Reach people around the world and as always I'm going to take care of yourself because you're worth it