Feel Better, Live More with Dr Rangan Chatterjee - #167 The Truth About Fitness and Keeping Your Brain Healthy with Dr Tommy Wood
Episode Date: March 24, 2021This week's guest is someone who I really respect - Dr. Tommy Wood has a biochemistry degree from the University of Cambridge, a medical degree from the University of Oxford and a PhD in physiology an...d neuroscience from the University of Oslo. He's currently a research assistant professor at the University of Washington, and he conducts research focusing on ways to increase resilience and treat injury in the developing brain. What I love about Tommy is that not only is his knowledge and education second to none, he's also got an incredible range of experience across a variety of different disciplines, which gives him a really broad perspective and an ability to see the big picture. Alongside his career in medicine and research, Tommy has invested a lot of time in developing easily accessible methods with which to track human health, performance and longevity. He’s published multiple scientific papers and lectured all over the world about the root causes of multiple sclerosis and insulin resistance. Tommy's goal, much like my own is to cut through the mixed health messages that we’re given in the media, by healthcare professionals, and even from scientific studies. His objective is to shine a light on the best way for people to approach these conflicting issues, and to help find ways to practically implement them in our daily lives. In this conversation, we cover a variety of fascinating different topics. We start off talking about fitness and endurance sports and how being fit might not be as healthy as you think. Tommy shares his own health journey through low self-esteem and orthorexia and we discuss how the language we use when talking about health is so important. We also cover the value of failure and how vital it is to keep challenging our brains as adults. Tommy explains the latest thinking on the various factors that can influence our brain health, from sleep and stress to movement and food. Finally, we touch on the crucial role that emotional health and human connection plays in brain health and the powerful idea that your brain needs a reason to be alive. I think one of the most empowering things to come out of this conversation is that the changes you need to make to improve your health and well-being are much smaller than you'd think. I hope you find this conversation inspiring. Show notes available at https://drchatterjee.com/167 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.
Transcript
Discussion (0)
There's almost no example in medicine or health where the same thing helps everybody.
Subjective quality of life, subjective health is one of the best predictors of long-term health.
How do I feel, right? And so just asking yourself that question over time,
as you make changes, being mindful of, you know, how is my body responding,
I think is going to get you a good
chunk of the way. Hi, my name is Rangan Chatterjee. Welcome to Feel Better, Live More.
This week's guest is someone who I really, really respect. Dr. Tommy Wood has a biochemistry degree
from the University of Cambridge, biochemistry degree from the University of
Cambridge, a medical degree from the University of Oxford, and a PhD in physiology and neuroscience
from the University of Oslo. He's currently a research assistant professor at the University
of Washington, and he conducts ongoing research focusing on ways to increase resilience and treats injury in the
developing brain. And what I love about Tommy is that not only is his knowledge and education
second to none, he's also got an incredible range of experience across a variety of different
disciplines, which gives him a really broad perspective and an ability to see the big picture.
You see, alongside his career in medicine and research, Tommy has invested a lot of time in developing easily accessible methods with which to track human health, performance and longevity.
He's published multiple scientific papers and lectured all over the world about the root causes of multiple sclerosis and insulin resistance.
Now, Tommy's goal, much like my own, is to cut through the mixed health messages that were given
in the media by healthcare professionals and even from scientific studies. His objective
is to shine a light on the best way for people to approach these conflicting issues and to help find ways to
practically implement them in our daily lives. In our conversation, we cover a variety of different
topics that I think you are going to find really, really interesting. We start off talking about
fitness and endurance sports and how being fit might not be as healthy as you think.
We also touch upon Tommy's own health
journey through low self-esteem and orthorexia. We discuss how the language we use when talking
about health is so, so important. We also cover the value of failure, how vital it is to keep
challenging our brains as adults, and the latest thinking on the various factors that we can
influence in our lives that influence the health of our brains. We finish off touching on the
crucial role that emotional health and human connection plays in brain health and the
powerful idea that your brain needs a reason to be alive. It needs meaning and purpose. And we get that from interactions with
other people. I think one of the most empowering things to come out of this conversation is that
the changes you need to make to improve your health and wellbeing are much smaller than you
think. I really enjoyed having this conversation. I really hope you enjoyed listening.
And now my conversation with the incredibly knowledgeable,
but also inspirational Dr. Tommy Wood.
Often athletes, you know, we say that they're fit,
but they're not necessarily healthy. They've kind of often crushed themselves in this attritional training and eating model that is often used, particularly in endurance sports.
And then how do you unpick some of that and make it so that people can perform well,
long into later life, that was something that we're doing. So I so alongside my sort of formal
academic career, which is largely based in neonatal neuroscience. So I research ways to heal the injured newborn
brain. Well, it was my day job is what I spend most of my time doing. There's been this kind of
working with these other diverse populations and trying to really understand how their environment
contributes to health or any kind of disease that they might have.
Yeah. Thanks for sharing that, Tommy. And you mentioned something there that was really interesting. These people can be fit, but not healthy. Now, to most people listening, I would
imagine there's a bit of a clash there. What do you mean they can be fit and not healthy? Because
I think in society, the prevailing narrative is that the fitter you become,
the healthier you become.
So I wonder if you could elaborate on that.
Yes, I think from a general population standpoint, there's almost a linear relationship between how fit you are and how healthy you are.
And that means that anybody, regardless of their current fitness levels, can probably, again, in the average population, improve that somewhat and have some kind of overall health benefit. However, when
you're at the pointy edge of the spear, you have to start making sacrifices for your health in order
to get some kind of increase in performance. And that may be because you're targeting a very
specific adaptation. You know, if you took a Tour de France cyclist, I mean, they're essentially
this incredible cardiovascular system on little legs. But if you ask them to jump onto a high wall,
they wouldn't be able to do it. They don't have like the muscle fibers and the structure to be
able to do it. And when you think about what you might want to do long term to protect your health, as you get
older, one of the most important things is being able to stop yourself from falling over. And that
requires a certain type of what we call fast twitch muscle fibers, which you can lose with a
huge amount of endurance exercise.
So in the long term, while these people are incredibly fit, they may not have the best overall muscle structure and strengths to then be able to keep themselves from, say,
falling over in 40 years time.
And of course, there's plenty of time in between those two periods for that to change.
But there are lots of things that we need in order to be fit and healthy and just, you know, work well in our environment. And in
terms of strength, or cardiovascular fitness, it's not that much, we do need some absolutely,
but it's not necessarily as much, or we don't have to work as hard as some people tell us,
or you have made us believe that we have to write you to be fit, you don't have to go and run for
an hour a day, for instance, far from it. and but you you do need enough and if you have enough then there's a huge amount of
health benefit that comes from that but if you really try and chase a certain adaptation a
certain performance in a given sport um more likely than than not you're going to have to
sacrifice somewhere else uh which which may then be detrimental long term. Yeah. Really, really interesting. And it's something I've been thinking about, actually,
because I am currently on paper down to do the London Marathon in October of this year. Now,
long story how that started, it was a dare from Chris Evans on live radio last January,
which I said yes to. And at that point, there was, I think, 12 or 13 weeks to go.
Then the pandemic happens, things get postponed. And, you know, as things stand,
it's meant to happen in October. Now, I have an amazing running coach who,
frankly saying running coach is really underserving what she
does, but she's really big on recovery. And as you know, when I go into sort of intense weeks,
and I try and experiment with certain things, I'm really looking at my whole load in my life and
going, okay, if I'm going to do that, I can't just keep killing everything else as well. You know,
I've got to make sure that I'm balancing things. So I'm really, I think maybe this comes with age and maybe this is because I'm,
you know, a father now and I've got other responsibilities, but I really feel that
actually I've got to be very careful about how much I take on here and what I can actually
balance because recovery, rest, recuperation, my cognitive capacity for my job, all those things are sort of vying for that
same amount of energy, right? Yeah, I think there's a number of things that come out of that.
And it's important to remember that one of the most important things that I've really focused
on recently is that humans are far stronger and more resilient than sometimes we give ourselves credit for.
And often we talk about, we talk about things that affect our health or can affect our health
with this very negative language, which I think has a significant effect on our physiology because
of the way that our brains affect our bodies. And part of that, the reason why I bring this up now
is because some stress, and I mean stresses in anything that sort of like directly causes a
change in our physiology, is really important for us. It's how we adapt, it's how we get stronger,
it's how that we sort of create fitness to survive. But at some point, all of those things start to come together
and they can create too much of what some people might call an allostatic load,
like how much total stress is being put into the system.
And it can come from all these different places.
It can come from the amount that you're sleeping,
how well you're eating, the amount of exercise you're doing,
you know, psychological stresses, because,
you know, you've got to go to, you've got to go to work, and you've got to balance your patient
load, and then you've got to record your two hours for radio two. And then you've got to think about
getting up early to go to go and do your marathon training. And all of this has an effect. So,
so some small pieces of these of these stresses, as I would call them, are really important.
But, you know, overall, you do have to balance them and then give yourself time to recover.
And again, if we take the example of an athlete, you don't get stronger through training.
You get stronger through recovery.
And so continuously beating yourself down in any of those spheres without any ability to
adapt or consolidate or recover, then essentially just results in sort of a long-term detriment.
Yeah. Yeah, I love that. And Helen, who's sort of, I went to because I was, you know,
having some issues with my right hamstring. And she very holistically looks at
the whole body, biomechanics, but also, you know, emotional load and how you think about running.
And she, like you, I think also very much, we are strong. We are much more capable than we often
give ourselves credit for. And she has this sort of, she does these little three-week builds and
one-week rest weeks, but she doesn't call them rest. She says,
those one weeks where you're not actually running and you're walking, that is training. That is your body recovering and building and getting stronger. And she's really hammering that home to me. I
think to be fair, I sort of get that concept, but she says most of the athletes she works with
have real difficulty acknowledging that a week of maybe taking it lighter is also going to have a benefit.
Is that something you've seen as well?
Yeah, absolutely.
And it reminds me of when, so my first year as a junior doctor, I worked in orthopedics in foot and ankle.
I worked in orthopedics in foot and ankle.
And one of the consultants, I remember, said that – so runners, it's very common for runners to get stress fractures
in their metatarsals, in the bones in their feet.
And he made the comment that only amateurs get stress fractures
because they always want to push themselves.
They never want to recover.
They never auto-regulate.
They never listen to their body. They just think, I need to go out and I need to train really hard because
then I'm going to get really fit. And then that's going to give me my fast, you know, 5k time or 10k
time. Whereas most professional athletes, when your body is what pays the bills, you have to
really focus on recovery and making sure that you're getting stronger and you're not
overdoing it. Um, and I think, you know, the majority of the athletes that I've worked with
are just passionate amateurs. Um, even though I have worked with some, some, some professionals
in different sports. Um, but, but those, those people, um, they tend to always want, uh, to work
really hard. Um, and you you know we can go into various reasons
why why that might be but but eventually it starts it starts to sort of come apart and it can affect
all kinds of things like it can affect relationships and your work because you're constantly trying to
fit in 20 hours of training a week or racing an iron man every two or three two or three months and
the travel and time involved in that and so that's actually one of the most important things again i
remember seeing an intake form for an iron man triathlete for for this coaching service that i
was i was running and looking at the training load and looking at the racing load like the first thing
that i thought was all this is going to result in is divorce because like
it's just not sustainable from a relationship standpoint so so so all of your body can can
obviously suffer but but then so can all these other areas if if if you don't you know uh provide
time for sort of relaxation and recovery and all these other things that are also very important. Yeah, it's interesting how I'm thinking about this because last January, right at the start
of January in 2020, when Chris asked me, I said yes. And that was kind of like the old
wrongan from like uni, like you'll always say yes, you know, whatever challenge you
give me, I will do it.
And I was thinking, oh man, that's in 12 weeks. I'm not a runner. Like that's a long distance to do.
And, you know, I would have done it. I know I could have done it and I would have pushed myself to do it, but I think it would have come at a cost now because of circumstances that never happened.
And it really helped me though, because now I've really processed
what it is about that, that I liked. I like the thought of doing a marathon,
but now I've got really clear in my goals, Tommy. For me, it's about having fun, right? It's about
enjoying the process of training. It's about it not breaking me. So I have no desire for a particular time. My goal is to be able to
function in my life as a doctor, as a father, as a husband, as a health communicator,
to enjoy the process and not to break myself doing it. And I believe it's possible,
but I believe it's possible if you have clarity into what your goal is rather than trying to excel and get better at every
single component of your life because that may work in your 20s but maybe now that I'm in my
early 40s maybe that's not going to work so well yeah I mean I certainly appreciate the chat uh
the the need for a challenge um and I think again again, I think that's, it's important. It's,
it's a new skill. It's a new like process of bringing, of bringing things in. It's a new
exposure for the body, which, you know, has a huge amount of benefit. And I have done my fair share of ridiculous sporting events, essentially for the same reason.
And although when I was younger and probably mixed with a small amount of self-loathing in there.
now sort of looking back on all of that is how sort of the marathon has become the pinnacle of challenges for for humans and made me like the like the triathlon was kind of in there a little
bit but it's really the marathon um and now you know if i think about what is it that i want to
be good at um physically as i get older I would have much more right some
cardiovascular fitness is incredibly important like we talked about but I but I think physical
strength is is really undervalued and probably because you know we think about you know these
incredible feats of endurance performance like the marathon. But as soon as you think about
being strong, you imagine seeing people who are incredibly big and bulky, and maybe you think
about taking steroids to achieve that. And again, it doesn't require much, but there's a huge amount
of benefit in not just preventing you from falling and breaking your hip. Being able to do all your
daily activities
well into your 80s, 90s, 100 plus, it's going to require some kind of physical strength. So
that's where I focused my attention later in life. But I did, you know, I spent 15, 20 years
incredibly focused on endurance performance first, and then kind of just sort of switched
into something that I think is going to be more, I guess,
sort of all round beneficial longer term.
And I'm not built like a marathon runner.
And let's be honest, you're not really either.
And so I certainly appreciate the challenge.
But I think, yeah, longer term, I focused more on gentler
aerobic stuff and then strength because I think that's what's going to take me further
into the future.
Yeah, I think you've raised a great point there.
I'm doing it because it's trying something new.
I would like to have completed that.
I'm very lucky to have a place in the London Marathon.
So I think, you know, I'd love to do that.
It would just be a nice personal challenge.
But yeah, I'm under no
illusion that that's necessarily going to be helping me with my longevity. Now, there's quite
a few things going on there, Tommy. And it's a nice way to move into the main topic I really
want to talk to you today about, which is our brain health. You got a lot of experience. You're
doing a lot of research in neonatal brain health.
And there's a couple of things we've already touched on in terms of strength. You've touched
on a challenge and trying something new. And these are all things that can actually feed into
how healthy our brain is. So I thought we could start off with this line that I've heard you say on a
talk on YouTube, which is long-term brain health can be inexpensive and simple to achieve. And I
wonder if you could expand on what you mean by that. Yeah, I think that's absolutely true. And this forms essentially the, the foundation of my
current and, and hopefully future career. And when I think about, uh, building a healthy brain,
that's essentially what happens when, when you're, you're a baby, both, uh, in the womb and,
and then afterwards for, you know, two or three decades potentially.
in the womb and then afterwards for you know two or three decades potentially then i think well how you know so what is it what do you need to make a healthy brain in the first
place and then what do you need in order to keep it healthy and and those things are often very
similar they are essentially the the same thing and there's always going to be a huge amount of
interest in in terms of how do we maintain
cognitive function late into life? Because age-related dementia and age-related cognitive
decline are now the leading cause of death. Some people call it Alzheimer's disease, but
there's Alzheimer's disease, as it was originally described, as probably a genetic early onset
Alzheimer's disease, familial Alzheimer's disease. Whereas
what most people have is this late onset Alzheimer's disease, which may actually not be
the same thing. And in my mind, it's a continuous onslaught of the brain from the environment,
and then a lack of protective factors and a lack of protective inputs.
So if you think about things that are protective and beneficial for the brain, so we've talked
about exercise. I think the first time, so first in rodents and then in humans, the first time we
saw that we can actually increase the size of an important
area of the brain later in life was the hippocampus so the hippocampus is an area of the brain that's
very important in memory it's definitely uh significantly affected in people with dementia
or cognitive decline alzheimer's disease and in an uh an older, I think they were in their 60s, they had them just do brisk walking
three times a week for a year. I think it was 45 minutes. And there was a control group who did
some stretching for the same period of time. And in the brisk walking group, and again, when I talk
about cardiovascular exercise, aerobic exercise, that's what I mean. I mean, going for a brisk walk,
like it doesn't need to be more intense than that but that group saw an increase in the size of their
hippocampus which would normally decrease in size with age it was the first time that we ever saw
in humans in adult humans older adult humans that an area of the brain can increase in size
and so exercise is incredibly important um Again, resistance training has similar effects, but seems to affect more the white matter,
which is the part of the brain that's really there for fast connection, sort of connecting
all the different parts of the brain and sending signals.
And so both aspects, as we might separate them out, aerobic and strength, are important
for the brain.
as we might separate them out, aerobic and strength, are important for the brain.
And then the challenge aspects, which we talk about, I think this is one of the, probably the most, I guess, forgotten, important part of what it takes to make and keep a healthy
brain. And again, let's use an athlete analogy,
which is that if you stop training, or for some reason you become immobilized,
your muscles, and you have a good amount of muscle, you're an athlete, right? Or you say,
break your leg and it goes in a cast. When you take that cast off, you'll see the leg on that
size is smaller. You've lost muscle mass on that size.
So anytime you stop sort of giving an input, a stimulus to the muscles, they will reduce
in size because it's energetically expensive.
If you don't need them, your body isn't going to keep it around.
And everything, all the evidence that exists today suggests that the brain is the same,
right?
Use it or lose it.
And when we think about using the brain, again, I like to compare back to what it takes to
create and build a brain in the first place.
So as an infant, you are doing things like learning to talk, learning social interaction,
talk, learning social interaction, social cues, learning to control this fabulously complicated meat suit with incredible dexterity. And those things take a huge amount of neurological
stimulus, input, and effort. Then throughout life, you start to do things that you may think are hard, but compared to that,
really not that hard, like biochemistry as an undergrad or learning to drive a car
or the ins and outs of your job. They feel hard, but in terms of the stimulus and the effort
required from your nervous system, it's actually quite small compared to,
say, learning how to control your whole body. And as we get older, we just do the same things
again and again. They get easier for us. They just become habits. They become patterns which
don't require, again, any significant cognitive input. And because of that, you're essentially telling your brain, hey,
I don't need you to be as complex as you once were, because we're not doing anything difficult.
And you see multiple different strands that kind of come into this. So people have probably heard
about the knowledge, right? London cab drivers, you know, less so now if
Uber continues to be allowed to exist. But to be a black cab driver in London, you had to learn
the knowledge originally, which is all of the streets in a six mile radius of Charing Cross.
And they once looked at brain scans of people taking the knowledge or learning it before and
after and those who passed and again we don't know why they passed whether it was because they were
the ones who actually studied or you know they have some other some other skills that allowed
them to be able to gain the knowledge those who passed again saw an increase in size in certain
aspects of the brain on a brain scan and those who didn't pass the knowledge didn't become
caballeros didn't so you've you've created this incredibly difficult stimulus, which has then helped improve the
brain.
And you see something similar in terms of people who retire earlier tend to die earlier
as well.
And that's after you're adjusting for all the things that might cause you to retire
earlier, such as medical conditions.
So again, like telling the body, telling the brain that it's required, is incredibly powerful for brain health. And, you
know, we could go on. So if you look at the brain, if you look at the brain health or the brain age
of musicians, amateur musicians have a better brain age than professional musicians, because
amateur musicians, it's harder for them, them right they have to work harder to get
a nice result so so all of this is basically telling me that in order to keep your brain
healthy you need to tell tell your brain that it's needed that requires you to do difficult
things which is going to also require you to be bad at stuff as you learn new skills um and then
once you once you've acquired a new skill,
you then have to move on to something else.
I mean, still do the thing if you enjoy it.
But then as soon as something becomes habit,
becomes patterned, becomes easy,
it's no longer the same stimulus.
So this could be anything.
It could be dancing.
It could be some kind of movement or sport.
It could be singing, teaching others.
It seems to be protective as well,
knitting. I recently started to learn how to code on my computer because, you know,
that was something that's beneficial for my job, but also incredibly difficult. I'd never done
anything like it before. So there are all these things that you can do, but you need some kind of
ongoing stimulus to tell your brain that it's
still needed, it's still worth keeping around. And that's something that you'll essentially need for
as long as you want your brain to still be working. I mean, it's so fascinating what you
mentioned about the leg that goes in a cast. And six weeks later, muscle mass has declined this whole idea that our brain is
constantly responding to the inputs that we get. And if we think it's not required, it's like,
I'm not going to waste energy shoving it out. I'm going to focus on something else. But
it made me think about something Professor Laurie Santos said to me recently on the podcast. She's
from Yale. She's a psychology professor and has got this globally successful course called the science of wellbeing. And she talks a lot about
how our brains kid us often in terms of the things that are going to make us happy are not the sort
of things that our brain think is going to make us happy. So we actually behave in a way that
actually isn't moving us towards happiness. And as you were talking there, it made me think that it's interesting that society, the way we live now, where everything's front loaded as kids,
and then we sort of just gradually decline once we start working. We don't have time anymore to
try new things. It's just pay the mortgage, go to work, take the kids to their classes.
And then people are waiting for retirement to just chill out. And it sort of, it reminds me a little bit
of that where, you know, as we're older also, we get quite shy. We don't want to suck at something.
We don't want to fail at something. So we don't do it. But what you're saying, Tommy,
is actually that's exactly what we need to be doing. We need to be doing things that remind us that,
hey, you are needed. My brain is needed. You need to grow. You need to respond. So,
yeah. I mean, do you feel we're sort of fighting human nature or certainly the way society is set
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Yeah, absolutely.
The way society is set up is to sort of funnel you continuously in one direction
and then be very good at whatever it is that you do but it doesn't require
again it sort of becomes you know just part of the same thing again and again doesn't require the
same the same inputs and i think there's a huge amount of benefit from um you know being a bit
of a jack-of-all-trades trades, you know, having lots of interests,
like diversifying your interests and your expertise and your skills. And that creates some buffer in terms of, you know, hey, you may not always have that job, or you may not always
be able to do that job, you know, having some kind of broader, you know, base of skills or
things that you enjoy, again, create some kind of buffers in there.
But equally, as we get older, we're expected to get more serious.
Another thing that I didn't mention, which is incredibly important and very well
emphasized and advertised by our mutual friend, Daryl Edwards, is play.
Adults aren't supposed to play.
We're supposed to be serious.
We're not supposed to have
fun um and and again it's sort of it become you know our exercise our movement is supposed to be
very prescribed it's going to be on a treadmill or you're going to do x reps in the gym or whatever
and again that's just not how we're how we you know quote unquote designed to move like we're
supposed to be interacting with our environment it interacting with other people, animals, nature, you know, that's why our bodies are built and structured the way that they are.
But yeah, everything that is required of us in modern day society is sort of pulling us away
from those stimuli, those inputs that our body I think expects, and then is what creates a foundation for long-term health.
Yeah, and there's a brilliant talk that you did on brain health that's on YouTube,
and I'll definitely link to that in the show notes for this podcast. You put up a graph towards the
end, and I think it's something about the amount of cognitive capacity it requires to do certain things. And, you know, at one end was
learning to walk, I think, and the other end was, you know, retirement and doing Sudoku.
And it was, the contrast was really quite stark. Yeah. And, you know, I, so I borrowed that graph,
I remade it as made by a friend of mine, Dr. Josh Turkney, who's a neurologist
over here in the US. And it's a lot of those ideas about sort of this, the requirement of
long term stimulus to keep our brains healthy is certainly something that I've discussed a lot with
him and gotten from him. And yeah, I mean, it's very difficult to quantify these things, right?
How could you possibly quantify the amount of effort that it takes to learn how to control
the human body, except for if you think about people, you know, adults who have to relearn
how to walk, or if you're trying to build a robot that knows how to walk, right?
These are incredibly complex tasks that we haven't even necessarily been able to figure
out yet, right?
Because it's that difficult.
But most of the other things that we require of our brains can probably you know as adults can
probably be automated to some degree because it's actually not that difficult so so yeah if you think
about what's what you what you ask of your body and your brain it just it's just a steady decline throughout life um and that requires now some kind of um
significant effort on our part to to to prevent that so in practical terms for people that could
be anything right that could be what learning a language learning an instrument, I don't know, doing some balance work, you know,
anything, I guess, where you're being challenged is going to have a positive impact on your current
brain health, but also, I guess, make you more resilient for that sort of brain decline that we
might see as we get older. Yeah, absolutely absolutely and that's the thing is it can be
you know almost anything that you and i say you enjoy but it's probably if it's difficult you're
probably not going to enjoy it to begin with right this is what we talked about we don't like being
bad at things and we're you know and we're sort of taught to feel like it's not good to be good
at something whereas actually if you think about kids they
would just try stuff and they'll be bad at it and they'll fall over and they'll try it again and
again and they'll get better over time and that's again something that we need to um reacquaint
ourselves with um but then you know it you know it can and should be something that you enjoy doing
um and that you can use so you'd learn a language and then one day we'll be able to travel
again and you can go and put it into practice but it doesn't need to be a language could be anything
any of the things you mentioned um and it you know could be you know knitting or or whatever
literally anything that requires you to learn a new skill and that you enjoy but again as soon
as you get good at it you have to then start thinking you know what what can i do next that
sort of keeps the challenge going yeah there's this kind of conflict between mastery and and super specialism with that kind
of just general broad all-round knowledge as you say jack of all trades and uh you train as a medical
doctor um i i really do feel that of course specialism is important in medicine, but I think we really have
undervalued the role of the generalist for many years. And although not directly related to brain
health, I can't help but see some similarities in terms of what you're talking about and how
we kind of need that overview. I feel in medicine, Tommy, that
now we need generalism more than ever. We've got all these complex problems that are coming across
multiple systems in the body and we can't just be focused on one organ. We have to be able to put
everything together. Yeah, I agree. And when you think about people's health,
I agree. And when you think about people's health, I think the more that we learn, the more we realize how complex it is, how many different inputs, environmental factors are contributing to this disease or these symptoms in an individual patient and if you're very hyper focused on one system or one disease process you're going to miss out on all the the factors that are sort of coming together
in this individual so i think having a really you know broad base and open mind is really important
when you're when you're then trying to because when you're then trying to um because when you're then trying to improve the
health of a patient because like the people can come in with the same the same disease um the
same concern the same symptoms and there could be vastly different uh underlying uh reasons
environmental environmental sociological socioeconomic factors that could be contributing
and you really need to be able to appreciate all of those to get the best outcome. Well, I think that sort of approach applies to us looking after our own health as
well, doesn't it? Instead of a laser-like focus in just one area. And we've both been in the
nutrition space for quite a number of years, and there can be a real focus on nutrition and of course that's important but there was i think for a period of time a
neglect of uh the importance of stress management the importance of sleep when those things are
starting to change and if we if we sort of think about brain health and how you think about it with
your expertise you mentioned some of the components of movement that can be really important. And I mean, before we move on from movements, just to be really clear for people, you were saying in that trial, I think, that it was 40 minutes of walking, of brisk walking three times a week changed the size of your hippocampus, one of the memory centers in the brain.
That's not that much, is it?
No, no no absolutely not and again i think um it comes it comes from the the way i believe society has sort of created this image of exercise
where again the pinnacle is the marathon um and then to be fit requires this huge volume of running so that you could even
survive a marathon. But when we look at, you know, this is, you know, in terms of the brain,
but also in terms of just overall mortality risk, you know, how long you live a healthy life,
health span, you get to a point where you reach diminishing returns, you might call it. So if you
do a load more, you're not going to get that much more benefit. And that point is something like 30 to 45 minutes
of moderate to vigorous activity every day. And when I say moderate to vigorous, I mean
a brisk walk. 30 minutes of brisk walking a day is going to get you the vast majority of the way
in terms of exercise that's
required to see long-term health benefit. And if you do a load more, you're not going to see that
much more. So it's really not that much. Yeah. It's not that much. And I really think this is
a point that's worth hammering home. Yeah. If we move on to nutrition, Tommy, in terms of
what kind of things we should be eating to
build a healthy brain, I'd be interested in your view there. And also, I wonder if you could touch
upon why a healthy brain is important, because it's, yeah, we want to build a healthy brain. And
then often we think about the other extreme, which is when our brain doesn't work when we're 70,
or it doesn't work as well. But we forget that there's this long latent period where our brain function can start
to decline before we even get symptoms so just a couple of things there which I wonder if you
could just sort of expand upon yeah sure so so actually before we um get into that you mentioned
earlier about this hyper focus on on nutrition in terms of what's
essential for for long-term health and when i think about the things that a healthy body a
healthy brain requires long term right so nutrition is important um but so is sleep or circadian
rhythm right light when it's light dark when it's dark. Movement, some kind of stress
mitigation, and then social connection. Probably those are the things that I think are going to
underpin most of the stuff. Those are the biggest rocks that you can move to improve long-term
health. And I think that the more you neglect any one of those areas, the more you have to become
hyper-focused in another.
So when people are talking about restricting, restricting, restricting from a dietary sense,
and that could be total calories, it could be fat, it could be carbohydrates, it could be protein, all of them have been vilified by different groups for essentially the same reasons.
I think that the reason why we had to become so hyper focused and so restrictive
to a large degree um and actually any one of those approaches can have can have benefit depending on
the person in front of you um it's because we were neglecting the other things we're neglecting
movement we're neglecting sleep and and circadian rhythm we're neglecting social interaction social connection um and so so that's that's that's one reason it's also something that's very easy to
sort of like quantify whereas it's hard for me to say you know it's easy for me to say oh you should
stop eating carbohydrates it's much harder for me to say um oh you should go and make new friends
right that's much harder um and so i think that's one reason why we're hyper focused so the more you
neglect the others then you have to sort of like really sort of focus in on another one because those other
systems are not getting the attention that they should. In terms of building a healthy brain,
I mean, the easiest way to think of it in my mind is, well, what is a brain made up of?
in my mind is, well, what is a brain made up of? And it's mainly made up of fat and cholesterol.
And that, in our modern nutrition environment, sounds very scary. I'm not telling you that you need to eat a whole load of fat and cholesterol. Actually, your brain makes its own cholesterol.
And it makes it from precursors that could be glucose or could be ketone bodies. When you're a baby, ketone bodies are essentially the preferred precursor
for making new fats, making new cholesterol.
But one of the things that's very important is DHA,
the long-chain omega-3 fatty acid that you get in seafood.
And there's going to be some variation in terms of what
amount people need. And it's probably going to be based on their ancestral background.
So there's some evidence to suggest that people who are of a more northern ancestry,
northern ancestry, so people like me, we got most of our long chain of polyunsaturated fatty acids from food, from seafood. So I'm probably going to do better with more direct from the source.
Whereas people who live close to the equator may have gotten more sort of precursors,
like alpha-linolenic acid, which is the omega-3 that
you might get in nuts and seeds. And then we make our own DHA. And there's a whole host of other
things that can influence that. But there is going to be some sort of individual variation. It's just
the point that I'm trying to make. But DHA is incredibly important. And it's accumulated very actively in the brain in the last trimester of um of pregnancy so the last
three months or so and it's basically being actively uh depending on the amount in the mother
it's being actively regulated how much is passed on to the baby and then basically all of it is
ending up um in the brain and then some is put in the fat stores and humans are the only primate that has
significant fat stores when it's born and that's largely because it's a repository of these
important things to then support the brain and again because babies are born with an incredibly
demanding brain human babies and it's you know we need these fat stores to support it to support
it's one of the reasons that we have the brains that we do so dha is incredibly important um
lots of other things you know will come up so uh things like choline can be very important. Again, you might get that from eggs, liver, organ meats, potentially.
And then when I think long term, something that is probably having a negative effect on the brain
is really large swings in blood sugar. And there's a lot of data to support that, you know,
if you're eating foods that cause very, very big spikes in blood sugar, that's probably over time going to have a negative effect on your cognition and there are some studies that
suggest that people with diabetes if you improve their blood sugar control you improve their
cognitive function and this can happen over years you know and you and again we're normally told
that it's like this inexorable decline over time whereas actually we have plenty of evidence to
suggest that we can reverse that as long as we improve some of these factors so so it's just um i think it's very positive and
empowering to say you know wherever you are today there is potential for improvement if you're you
know sort of capable and able and and and and you know interested in doing that. There's a few different threads there.
So you mentioned DHA.
You mentioned that potentially your ancestry
may influence what you thrive best on.
So you were talking about yourself
and how your ancestors probably got a lot of seafood.
And then you mentioned people who might,
like my own ancestry
would have been, you know, from India, sort of near the equator. Potentially we can actually
make that DHA that typically you would get from seafoods. We might be able to make that from
non-animal sources. It's interesting that my ancestors potentially did that, but then my parents emigrated to the UK. I've been born
and brought up here. So my microbiome, I'm sure, has changed significantly to adapt to my new
environment. So there's a whole world of complexity here to try and unpick as to what someone like me
should potentially do then. Is it more to suit the local environment where I live?
Is it more to do with how my ancestors lived? But then I think the wider point for me is
there is this big sort of debate, isn't there? DHA, impulsive for the brain. So typically you
get that from seafood and animal products. And then people who prefer plant-based diets are
saying, well, yeah, you can take ALA or we can supplement
to make that. And I think the truth is that different people probably do well on different
approaches depending on all kinds of different factors. But how would you unpick your way through
that? I think where we are currently, it's very difficult for me to say because of your ancestry because of
what generation of immigrant you are to your new to your current place to then say
this is how you should or shouldn't eat I believe we'll get to a point where we can do that um i believe very strongly that you
can't use genetic testing to tell you what you should eat most of that is complete nonsense
um and so this is kind of in that box so so when i'm talking about so particularly polyunsaturated
fatty acids there have been studies where they look where they look at whether uh populations
based on their ancestry do better with plant or animal-based
sources of PUFAs, polyunsaturated fatty acids, omega-3s and omega-6s. And so in broad strokes,
I can tell you that people of your ancestry will probably do better or are more likely to thrive
using plant-based sources than mine. But that doesn't mean that you will do better
on plant-based sources than I will, or vice versa. So I think a lot of the confusion,
and this can come from pretty much any area in health, the confusion comes from
conflating what can we say on a population level versus what can I recommend
the individual. And they are very, very regularly not, you know, they are essentially mutually
exclusive. I can't take anything from a population level and say this will definitely help this
individual. Now, both are important because you may want to identify groups at risk for certain conditions
and then you know all of medicine is is applying statistics and hoping that you're going to improve
an outcome right so when you do a clinical trial you see you know you give half the group an active
drug you give half group placebo you generate something
called the number needed to treat how many people do you need to treat so that one will benefit
and often that number is quite high right so you're treating a lot of people so that one will
get benefit on average right so so there's almost no example in medicine or health where the same
thing helps everybody so so all we're doing is playing the
statistics. And this is just unfortunately how we have to work currently. And things will improve
over time. So for fats, I think it's very difficult. We'll get to a point where we can
measure some of these things. But if I measure the omega-3s and
omega-6s in your blood, it's a very, very poor indicator of what's in your brain, because there
are transporters, other mechanisms that are regulating that. So some people would say,
well, you just measure the omega-3s in the blood, that will tell you something about the brain.
Unfortunately, that's not the case. But again, these things will improve. However, one area where we have made some improvement is in blood sugar control.
And there have been some really interesting studies, first from the Weissman Institute in Israel.
Then Tim Spector's group in London have done some similar work.
and basically looking at based on an individual food a person you know when they're eating it what what the uh um sort of the context of that food is have they exercised recently is it breakfast
is it lunch is it dinner um their genetics their microbiota um all these you know their
their metabolic health in general uh you know what their fasting blood sugar is, then there's a huge amount of variability
in how different people respond to the same food.
So if I eat a banana,
I'll have a very different blood sugar response
to when you eat a banana.
And all of those factors are going to play a role there.
So I think we can, to a certain extent,
we're starting to get to a point
where we'd hope to be able to predict it, right? So maybe I can measure some things in you and then I'll say, well, this is how you're going to get to a point where we'd hope to be able to predict it, right? So
maybe I can measure some things in you and then I'll say, well, this is how you're going to respond
to banana, this is how you're going to respond to pasta, this is how you'll respond to a cookie.
But we can also do it ourselves to a certain extent. So we can, you know, there's increasing
interest in continuous blood sugar monitoring or just testing your blood sugar after meals, see how you respond. And again, this is not something that I'm not saying everybody
needs to do it. I'm just saying this is probably the area where we're the closest to being able to
understand inter-individual variability. And even then, it's quite an intensive process. And that's
just with blood sugar. So then when you think about all the different fats, all the different micronutrients, protein, carbohydrates,
you know, we're really miles away from being able to understand how one person should eat for their
individual health. So then it really comes down to personal preference, to a large extent and then some kind of iterative process whereby you know
maybe you measure maybe you do some blood tests or maybe you just like how do i feel
right subjective quality of life subjective health is one of the best predictors of long-term health
um and and so we at the moment we just have to be be guided by some of that because the rest
you know people are working on it but it's incredibly complex and we're not there yet.
Yeah. I mean, that question, how do I feel? So, so powerful, but just hardly ever spoken about.
It's about, you know, like I say on this podcast, this is about helping people become the architects of their own health, which is the place I want to put them into where they feel,
yeah, I can absorb this information from the experts or from people who've got experience
in a certain area, but then I can start to put it through my own filter and go, well,
does this work for me? Does it work in the way I live my life with my family, with my work patterns?
You know, and I think we've forgotten a bit of that, I don't know, that autonomy,
that sort of sovereignty that actually sometimes we know what's best for our bodies, not somebody
else. Yeah, absolutely. And I think there has to be more humility in people who talk about any given
approach to improve health because if you actually
go out in the real world and apply it you're going to see it fail yeah a lot um and again that's not
i don't think that's a depressing message i think it's just a reminder that humans are incredibly complex um and we we essentially are the species
that we are because we can thrive in almost any environment right there is no other um you know
multi-cellular organism that can thrive in the variety of environments and with the variety of
exposures that we can and so all of those things are going to change what is going to
be best for an individual. So when you see any given approach fail, you then have to step back
and say, well, hey, well, this is a useful tool. It's going to work for some people. Or, you know,
this is a useful tool for some people, but it didn't work for me. And that's fine, right? There's no arguments to be made there. And like you said, the question, how do I feel? How do I view my health?
Even 30 years ago, a question of somebody's subjective health, how do you rate your health,
was one of the best predictors of longevity and mortality, right? On a scale of
one to four, you know, very good, good, not very good or poor, something like that. And, you know,
and so just asking yourself that question over time, as you make changes, being mindful of,
you know, how is my body responding? Am I moodier? You know, do i feel less good when i go for my walk uh do i feel less able
to concentrate um you know these can can be really good indicators um but again becoming really
hyper focused on something does have its detriments but looking inwards and just you know you're
checking in on yourself how do i feel after i've made this change is it you know positive or
negative i think is going to get you a good chunk of the way.
Yeah.
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That's a brain health. We were touching on DHA, we were talking about ancestry.
And just to sort of complete that then, you're saying that DHA, the fat, is an important
component for brain health in the womb when you're growing, but also throughout life? And if so,
what are those sources? And how can we think about taking practical steps on that? that yes so particularly important um in the womb um or potentially if you're born prematurely which
is a a group that i frequently uh work with then you know making sure they're getting that um
during that during that lot during that period when they would have otherwise been in the womb
and then throughout life as well and so the your
fat tissue is incredibly important and one of the reasons why it's incredibly important is because
it acts as a store for dha so some people estimate that the average person has maybe 10 years worth
of dha for their brain stored in their adipose tissue so that means in their fat tissue so that means that you don't need to have it every day you don't
need to be overly worried about how much you're taking in uh because you have a buffer uh that's
one of the best ways to describe your fat tissue is an incredibly important buffer and but you know
if you were to take in no dha and you're somebody who isn't very good at converting it from plant-based sources or you're not getting plant-based sources because you eat a highly refined modern diet, then, you know, you're going to run out of that store eventually.
I'm a big fan of seafood, small fish.
If we think about there is a risk of mercury contamination, some other things, and larger tuna and swordfish and other things.
So sardines are particularly good, shellfish, oysters.
You can take – there are algal sources, krill sources you can take as a, you know, as a supplement, like, if, if you're taking as a supplement, you know, one or two grams a day is probably going to be enough for most people.
You know, if you're eating it from from seafood, you know, a portion once or twice a week is
probably is probably going to be enough. So it's not a huge amount. But longer term, I think it's definitely going to have an effect. The other side of that is vegetable oils. And if you exist in the nutrition space,
there is a huge amount of controversy around vegetable oils. Because some people will say,
if you replace saturated fat with vegetable oils, your cholesterol will be lower, and that's going
to lower your risk of heart disease. Other people will say that vegetable oils are incredibly
inflammatory, they're easily oxidized, and then that can then cause issues, including heart disease.
And so I think there's a varied amount of evidence in both directions for those,
and that's why it's complicated. for the brain particularly when we look at
both the the data that we have from humans and it mainly comes from uh autopsies in children
and from animal models including pigs which are very similar metabolically in terms of their gut
and their brain to humans you see that if you have a large amount of linoleic
acid which is an omega-6 largely found in vegetable oils in our diet if you have a large amount of
that in the diet it seems to out-compete dha getting into the brain so in you know if we're
just thinking about simple heuristics not eating a lot of fried foods is probably going to be number one
for a number of reasons, but that's going to be one because that makes up a significant portion
of the caloric intake or caloric content of fried foods and a lot of processed foods.
And then just making sure that you're eating some kind of whole food sources of some some
omega-3s at the same time so reducing reducing your intakes um you know just just if you're
eating whole foods and cooking them at home as much as you can and again there's a lot of privilege
that's involved in being able to do that there's not something we've talked we've talked about yet
but but you know that's that we have to remember that as well but if you're reducing the intake of those vegetable oils
um again just from sort of processed and fried foods then i think most of the problem goes away
so you don't need to be like overly um overly worried or um you know really hyper focused on
that you know just just removing that component there and then you know making sure you're getting
some um from from whole either seafood or plant-based sources that's probably going to be good enough right it doesn't
doesn't require anything harder than that so you're saying that the we've got these omega-3s
is dhas and we've got these omega-6s which we were talking about a lot of them come in the
vegetable oils and in highly processed foods and fried foods and they're sort of competing. So one option is to increase omega-3s
but you're saying actually a really good option that will have multiple benefits
is reduce how much processed food you're having, how many vegetable oils are in your diet and
actually automatically that's going to mean ratio-wise there's more omega-3 there and you're going to
get all the knock-on benefits as well uh beyond just vegetable oils uh and sort of oxidized
vegetable oils that you that you get from whole food diets is that is that effectively what you
what you're saying there tommy yeah exactly and and you know depending on the nutrition camp that
you're in uh people get very hyper focusedfocused on a specific intake, a specific ratio.
They start looking at the omega-6 and omega-3 contents of all their foods and trying to
decrease one and increase another to improve the ratio. I don't think that anybody really
needs to do that. I think if we just focus on reducing the most significant contributors, which have a number
of potential negative health effects, which are processed and fried foods, and then we are just
getting some whole food based sources, you know, if it's fish once a week, or, you know, chia seeds
in your morning porridge or something, which is a good plant source of ALA, which is a precursor to DHA, you know, just by doing that is probably going to get you most of the benefit.
When we do talk about vegetable oils, is it the vegetable oils per se, or is it how they're
cooked and if they're fried and if they're heated?
I think both is actually important. so the linoleic acid the
this main omega-6 in in vegetable oils in its native state seems to some and i don't think we
necessarily understand exactly how or why but it seems to compete with dha getting into the brain
um and so you know and if you have a huge amount of that as forming part
of this, the fat content of the diet, then you seem you seem to see less DHA in the brain.
And that's regardless of how that oil comes. But equally, there's also some, some increasing
on the breakdown products, where it's become oxidized, which happens with high heat,
repeated heating cycles. So if you think about the fryer at McDonald's, it goes through multiple
cycles on and off being heated and cooled, heated and cooled. And that's something that definitely
increases the oxidation of the oil. And that seems to have a negative effect on brain health
as well and there's some data in humans and then also in animal models so i think um i think it's
a bit i think it's a bit of both uh really um however i i don't think we should be demonizing
these things and just saying they're definitely bad they shouldn't be in the diet so you know
when we talk about vegetable oils what are we what are we talking about? So I'm talking, you know,
sunflower oil, refined rapeseed oil, which again is soybean oil. These are very, you know,
these are the ones used in commercial fryers in, you know, fast food restaurants.
Sunflower oil, not as bad, actually, because it has a lower linoleic acid content it's more
monounsaturated fats more like olive oil so again olive oil uh a very good option um coconut oil
avocado oil butter um tallow if you're a carnivore you can use the rendered fat from your cow um
so when you're cooking with these in normal amounts at home i don't really
think it's worth it's worth worrying about obviously if you're deep deep fat frying at
home the same applies but if it's just in a pan to saute some vegetables or you know cook a bit
of chicken or something i'm much less worried about that you know what you know i think again
if we think about the the big rocks that you want to move if you can if you're using a bit
of sunflower oil at home to cook yourself a stir fry um rather than getting a big portion of chips
um that was sort of you know the the the total exposure and the nature of it is very very
different um so so again if you can bring it back to cooking whole foods at home, you're able to do
that. You have the facilities and the resources to do that. Then I, then I, I think a lot of the
problem goes away. There's talk that these oxidized fats can stick around in our body for a
long period of time. Um, and is that something that we should be thinking about? So, you know, a lot of people
like some fries, for example, which of course is likely to have been cooked in, um, multiply
reheated vegetable oils, which presumably will be super oxidized and drive inflammation in the body.
I would imagine, um, crisps are a very common snack here in the UK. I think even people who like to follow whole food
diets find it really hard to resist, you know, fries and crisps. And those things, of course,
are highly processed. And just in terms of, you know, one thing I love about your approach,
and why I think I resonate with it so much is because there's real balance there.
It's not about extremes necessarily. It's about saying, look, here are the big levers to turn.
Don't worry about these small things if you're turning those big ones. And I just wonder when
it comes to things like fries and crisps, that oxidized fat can stick around i think in the body for quite some time so it's
not about demonizing it necessarily but just helping people understand why they may not be
the best choices certainly in high amounts i don't want to be too prescriptive but i think we need to
talk about these things yeah it's it's a very important question and i think the the natural tendency is for people
to basically say they're terrible for your health you should never eat them um and there's really no
evidence to support that idea although like mechanistically like you you say, biochemically, yes, these things can hang around for a long time.
But one of the most important aspects of all of this to me is to control the things that you can
control. And then the ones that you can't control, or you're not willing to control for whatever
reason, are things that you shouldn't worry about. Right? And because I think that the process of worrying about it is
worse than the process of doing the thing itself, right? So if you have a bag of chips once a month
because it's your treat on a Friday night, I would much rather you do that and enjoy it and it's,
you know, part of your overall, you you know health and well-being then worry about
what the fat that's on those chips is going to do in your body like i would really hope that you
never that you don't do that because the the effect of worrying is probably going to be more
significant than the effect of the fat on the chips so it's very much about just thinking about
you know what am i trying to achieve what can I meaningfully control that doesn't have a negative effect, right?
Because if you feel like you're being restricted because you can't have your monthly Friday
night chips, that's going to have a negative effect on your physiology.
And people who feel more restricted dietarily,
then have some knock-on effects
like they have higher stress hormone levels
and things like that.
Like it has an effect on your physiology.
So to the extent that you can
and are willing to change something, do that.
That's great.
It's gonna have, you know,
it's definitely gonna have an effect on your health.
But when you get to a point
where it feels restrictive long-term,
A, it's not gonna be sustainable and B, it's going to have a know it's definitely going to have an effect on your health but when you get to a point where it feels restrictive long term a it's not going to be sustainable and b it's going to have a negative effect on you so so yes i think that people should minimize their intake of
vegetable oils and fried and processed foods i still eat those things and it's a big part of
you know occasionally and it's a a big part where it's important to me to if i'm
going to do it i'm going to enjoy it and then not feel guilty about it because the guilt is going to
be worse than the food itself you know that guilt and feeling bad about something is is actually a
lot more toxic than people really think and there's actually really good research. Kristen Neff has done a
lot of research on self-compassion for 20 years, which I've only been coming across in the last
few months. And it's really, really fascinating. And it really echoes my own clinical experience,
which is deprivation and restriction works for a period of time. But if you still feel as though
you're being deprived and restricted, you can get all kinds of toxic knock-on
behaviours on the back of it. You feel bad. You know, as you say, if you're going to have those
chips with your friends, if you're going to do it, enjoy it and understand that, hey, you know what?
I'm doing this because I'm with my buddies and I'm hanging out and it reminds us of university
or whatever it is. Be in that because otherwise the next morning you wake up, you're like,
or whatever it is, be in that because otherwise the next morning you wake up, you're like,
man, I shouldn't have done that. I'm a failure. I can't stick to anything. You drink more wine that evening to compensate for that feeling. And it's a knock-on effect. And again, this doesn't
get spoken about enough, I don't think, in the health and wellness space. It's all very well
giving a prescription for healthy living living but how we deliver that prescription
how that prescription is communicated is so so important but i just don't think it's given enough
credit yeah this is uh and i particularly got interested in this when thinking about we talked
about genetics briefly the way we talk about our genetics and our health and we always talk about it from like using this negative language right either you're normal or
you have some kind of genetic risk factor or deficit or this gene isn't working properly
you know if you if you listen to people who talk about genetics and health that's the language that
they use and so automatically you're creating this negative association with something that's
inherent to you.
And it has a negative effect on your physiology.
So they've done experiments where they had people do a treadmill test, right?
How far can you run in 30 minutes?
Then they did a genetic test.
far can you run in 30 minutes? Then they did a genetic test and they told them, based on their genetics, we would expect you to be, you know, either you have a good aerobic performance gene
or you have a bad aerobic performance gene. Then they redid the test. Those who were told that they
had a good performance gene did exactly the same. Those who were told they had a bad performance gene did worse,
on average, right? They've been told they have a bad gene for aerobic performance,
and they actually got worse on a treadmill test. Now, the thing is, they randomized people to
whether what they told them was true or not. So the effect was not in the genes. The effect was
in being told whether you had the gene or not, which actually was not true.
So being told something negative about your physiology, about something that's inherent to you, has a negative effect on your health or your performance.
And this is how we talk about things.
This is how we talk about vegetable oils.
This is how we talk about genetics.
This is how we talk about carbohydrates or protein or meat.
carbohydrates or protein or meat and what it creates is that like everything becomes this well what's the negative effect this is going to have on me it's never what's the beneficial what like
what's the benefit like what are the great things that are happening to me right now because of this
um and we know you know ellen langer has done some incredible work on the effects of the mind on physiology,
blood sugar control, weight, like body weight.
And, you know, we just don't give that enough credit. So the way that health experts talk about these things, you're automatically creating
this sort of feeling of negativity around pretty much anything in the people who are
listening.
And that's having a bigger effect, I believe, on the physiology than actually whatever the advice is.
Yeah, it's such a good point, Tommy. There's so many aspects of that to think about. There's how
we communicate health messaging. So we always feel that we're slightly inadequate in some way that,
oh, I need to optimize. I need to, oh, I wasn't born with that gene. Oh, but my best mate,
oh man, I've got to do something to compensate for my inadequacy.
But that sort of mindset, it sort of goes beyond that as well, doesn't it? That not feeling good
enough in ourselves, that insecurity that many of us have. You know, I remember I didn't sort of
go down that route at the time. I remember you saying that in your earlier days,
you used to go on these quite brutal
endurance, you know, you'd really, really push yourself. And you sort of laughed it off at the
end of a sentence, there was a bit of self-loathing there. And I really noted that at the time,
because I know myself, one of the reasons I feel I can approach the marathon this year with
a real calm is because
I'm not trying to prove myself to anyone. I'm comfortable with who I am. I've done a ton of
therapy over the last seven, eight years. And I feel I like the person that looks back at me in
the mirror now, whether I run a marathon or not, whether I finish it or I fall after seven miles
and I'm injured, that doesn't change how I feel
about myself. My kids still love me. My wife still loves me. I still love me. And I know my own
behaviors in the past were driven from a place of not feeling good enough. So I would define myself.
My identity was made up around, oh, if you do that, you know, yeah, you're a success. You are
someone. And letting go of that has just given me
more freedom in my personal life, but also with my health, I feel. And I don't know, you know,
how would you think about that self-loathing you spoke about before? And how do you think that's
impacted your journey throughout health? Yeah, I think most of my health journey actually started with that. I was bullied a lot as a kid. I was a bit overweight, didn't really like sport, didn't really have very many friends. the nerd who wanted the extra tests was trying to do very well at school which doesn't often go well
damn well with your peers and when i was dumped just before my a levels
and i channeled all of that into into the gym um which is the first time i'd ever really done
any significant exercise um and you know like when you're 18 years old you're like well if i get a
six-pack maybe she'll love me again and she'll take me back right um and this is i think this is where you know where
a lot of teenage males may end up going and obviously not at all helped by um you know
men's health and men's fitness magazines which i read obsessively me too um and i remember
and i was also very hyper focused on on everything that went into my mouth.
It had to be very high quality.
It had to be completely unprocessed.
I had to have cooked it myself.
I had to know all the ingredients.
This is sort of, I guess, like 18, 19, mainly my gap year before university was when it was probably at its worst.
worst and i remember when i when i then got to university somebody as a joke posted underneath my uh my dorm room door uh a thing about orthorexia which i mean this is in 2000 and
2003 right i don't think anybody had heard of orthorexia then right and like that was really
when i was at my lowest like i was training 20 plus hours a week.
I wasn't really eating very much. I look at pictures back of me, like of me back then.
I'm just I'm gaunt. Actually, I went to see my grandmother one summer and she she she used that word.
It was Icelandic, but she basically told me that I was gaunt and I didn't see it.
didn't see it. But like slowly over time, as I became accepted by my peers, as I started to feel like I had worth in other areas, as I like started to be like loved more by others, and I started to
love myself and understand myself, a lot of this stuff disappeared. But it's in the background
all the time. Like I still think too in the background all the time like i still think
too much about what i eat and i still think too much about the exercise that i do but it's sort
of just like a little grumble that's in the back of my mind it's not negatively affecting my health
in the way that it used to um but it like that journey took 15 years maybe but because of that
it allows me to see it in others empathize with it in others
you know really understand why these things exist how common it is um and then also you know inform
some of my approach uh to how we might think about health and nutrition and stuff but it's so so
basically that that journey which has sort of underlied all of my education and and uh professional
experiences has kind of kind of been been ongoing and has really sort of
laid the foundation of it. Yeah, thanks for sharing that, Tommy. Super poignant to hear that
and certainly helps us understand some of your passion for health messaging and the way we can and should deliver that messaging.
Yeah, I mean, I think emotional health is so, so important, isn't it? I mean,
is there much research on emotional health and brain health? I certainly know there is
regard to overall health and well-being and our satisfaction, but with respect to our brains,
is there anything there that you're aware of?
Well, they're essentially, they're very intimately connected. And if you think about anxiety and depression, those who have diagnosed anxiety and depression have an increased risk of
dementia. Those who have certain types of stress, you know, emotional stress. So particularly, they've looked at this
in the workplace. If you have a job that has a high amount of stress, but you have very little
control over that, that's then also so, you know, that obviously has a negative effect on your
mental health at that time, but also increases your risk of cognitive decline. So, and these
things are intertwined, right? Is it simply the
psychological effect or is it, you know, the mind and the body are intimately connected and we know
that a lot of injury processes in the brain have a peripheral component, which could, you know,
be some kind of inflammation due to some other kind of disease process, which then negatively
affects the brain. And, you know, these things are in constant communication. So, so yeah, the things that affect our emotional well-being and our
subjective stress levels, absolutely, then, then have, can have an impact in terms of our long,
long-term brain health. Yeah. I mean, we're all on a journey, aren't we, in our, in our health,
whether it's as health communicators or just to improve our own well-being.
And, you know, I certainly think of the way I've evolved my thinking is, you know, yes, food, movement, sleep, stress, super important, of course.
But I really feel these days that how we feel about ourselves, self-worth, that emotional health,
how we feel about ourselves, self-worth, that emotional health, I'm starting to think that that's actually more of a root cause because when that's sorted, you often don't need to chase
around with food, movement, sleep, and stress because actually you don't actually compensate
for that lack of self-worth by engaging in those other behaviors so i mean that's currently where
my head is at at the moment um how do you think about that i i think i mean because of all the
the sort of the reasons we've gone over i'd you know i'd i'd completely agree with you and
the the modern environment you know social media how we interact with others now, I think feeds into this general negative self-worth.
And again, even those of us who are trying to help other people improve their health, we can absolutely make it worse.
And I'm sure we actively do that despite our best interests.
And I actually, and you know, I think most people are trying to help. They just don't realize the
potential, you know, negative effects of that. But again, I think these things are tightly
connected. So if you put yourself in an environment that is supportive of your self-worth and your mental health,
yes, that's going to hopefully reduce these sort of negative behaviors that can have a
negative effect.
But I think the nature of that environment can also support better habits or better processes
in those areas.
So, you know, if you're in a place that
you're actively supporting your self-worth you're probably gonna sleep better um and you're probably
you know getting better you know either making or you know sort of being exposed to better food
choices and better better social connection and you're less subjectively stressed and i think
if if the environment changes then many of these things are going to change and these things
compound over time so we know that you know people who start to exercise more are more likely to
change their diet they're more likely to stop smoking they're more likely to sleep better
and these things sort of they're intimately connected um so so yeah i mean the
the environment that we're creating currently is probably having a this huge effect on our on our
self-worth that is then negatively impacting all these other areas and then it might be from person
to person a different area is the root in you know maybe it's a focus on sleep which then improves
mental health and self-worth which improves you know that your diet or your movement yeah i think i think there
definitely is a different route in for different people you can enter that circle at any point and
it can start to feed all the all the other components to sort of close this off tommy
the two other areas i want to talk to you about in relation to brain health was sleep and connection.
Now, I'm super cautious, given what we've just said, that we don't stress anyone out as we talk about our lack of sleep and brain health and a lack of connection and brain health.
So let's keep that at the top of our minds if we can, which is always difficult.
But how did those two things
potentially impact our our overall brain health so i think i mean sleep has become thankfully
sleep has become sexy again which i think is, because it really did used to be sort of like
society said, sleep when you're dead, you know, get the work done. You know, it's something that
you can, you can, you know, reduce and, you know, you're just don't worry about it, pay for it later.
And you really do pay for it pretty much right from the start. So I'm really glad that people are starting to focus on sleep again.
And I also think, and this is something that I've learned from my friend, Dr. Greg Potter,
who's my own personal expert in circadian biology, and we've published together and
worked together on some projects. And he'll tell you that actually we don't sleep as badly as we're told we do.
And the majority of people probably sleep enough.
But, you know, if you're not spending seven hours in bed, you know, all things being equal,
you're probably going to be better off from a mental health standpoint, a long-term brain
health and physical health standpoint, if you do get to spend seven to eight hours in bed and then you get to spend most of
that asleep. And we look at both sleep quantity and sleep quality. Both of those are important
for long-term risk of cognitive decline. And though it's difficult to really unpick it,
we probably can't pharmaceuticalize our way into that.
So if you're taking sedatives in order to achieve that sleep, you're probably not going to be getting all of the benefits because the nature of that sleep isn't the same.
So I don't think our sleep is necessarily as bad as we're told it is.
But for the people who aren't sleeping well or long, you know, it doesn't, you know, again, like seven to nine hours is probably the average that you might want.
Then I think there's definitely going to be some benefit to improving that if you're able to spend that extra time in bed.
There was one paper I think I saw you present once, Tommy, where decreased sleep, yes, increases reactivity in the amygdala,
the emotional part of the brain. But also, I think you shared something where it decreases empathy, which I found really interesting. Yeah, so this was, those things were actually
from the same paper, looking at how we react to visual cues in other
people's faces when we're sleep deprived or not and when um when we're sleep deprived and acutely
it's going to happen in one night of sleep and again the the important thing that other studies
have shown that is that one night of bad sleep does not have any meaningful negative effect on your health right so you know overall we're talking about these things
compounding over time so if you if you sleep badly one night it's not something to worry about again
you know it's just it's fine and you'll you'll survive just just fine you'll have no long-term
negative effects but when people are sleep deprived you're less likely to be able to
recognize a positive emotion or change in somebody else's face, you're less likely to be able to
empathize with them, and you're more likely to see something as negative. And again, so when you
think about people sleep deprived, in meetings, on zoom calls, interacting with others, meeting new people,
when you're sleep deprived, it's more likely to be a negative experience. And again, I think this stuff compounds over time. So this is one of, you know, if you want to be a well-rounded,
socially connected, sociable human being, sleep is incredibly important um and you know that's you know in that
study that was one of the reasons why why that was found to be the case yeah i think we all know that
intuitively i mean going back to how do we feel um you know we can we can talk about sleep and
and ask yourself the question you know each morning you know how do i feel does that was
that enough do i feel refreshed do i need a little bit more tonight was that a little bit later than is best
for me um just finishing off there then Tommy on connection and you know I guess some of the
softer stuff or what we used to think was the softer stuff I don't think I learned anything
about the power of connection at medical school now, thinking about, thinking back.
Maybe I did.
Maybe I've forgotten about it.
But just how important is connecting with others for our brain health?
When you really boil it down, social connection, again, is essentially the sort of foundational aspect of us as a species, right?
We are a collectivist species.
We benefit from being part of a social group, from having a place in that social group, from having a purpose within that group, which gives us meaning.
And having meaning is something that tells our body that it's worth
being alive. Having meaning or not seems to have an effect on the immune system, has an effect on
our physiology. And so without social connection, you're essentially not giving that input, which
is that you have purpose, you have meaning, you belong. And that is one of the critical inputs for the the brain to to keep
working and one of the um one of sort of the the downstream or threads that comes out of
this demand-driven theory of cognitive decline which we talked about earlier
is the grandmother hypothesis um and so the grandmother hypothesis states that,
you know, rather than when you've procreated, you are essentially just a useless sack of meat,
which is what some people will tell you about the evolutionary forces on our bodies, right?
That you're just there to procreate. Once you've done that, there are no more evolutionary forces
that are creating fitness, right?
And so, like, most people will say that your genes are just there to make you live to 20 or 30 years old, procreate, and then what happens after that doesn't really matter.
if you are useful and healthy longer into life, then you are available to help support your progeny, their progeny, and to keep your tribe alive, right? So you are actually increasing
the likelihood that your genes will be passed further into the future by being alive to be
able to help the new parents or being able to look after the
grandchildren so actually there are evolutionary forces that exist to keep us long and healthy for
as long as possible however you get to a point where you are no longer of use to the group
and then that's probably going to be a trigger for some kind of decline because as soon as you're no
longer of benefit you know if we think about this from an evolutionary perspective we think about
um you know hunter gatherers you know early humans as soon as you're no longer of benefit
you are that you're a detriment to your tribe to your group you're going to take up resources
uh people are gonna have to care for you um which is which they can't really afford to do. So that could trigger this period of decline.
You know, you think about wolves or dogs leaving the pack when they're old, so they can go and
die peacefully in the wilderness. And humans used to do that in some groups as well. So we are
only giving ourselves the input that says, you know, you're worth being here, you're worth having
some kind of function because you're part of a group, and because you have purpose.
And without social connection, it's almost impossible to have any kind of significant
purpose, because you don't know that you have purpose because you're not contributing to a
to some kind of goal or group that's greater than yourself.
So I think that, you know, we've kind of bounced back from the philosophical to the physiological.
But, you know, at some level, for us to survive and be healthy and functional requires some kind of social input that says you have meaning, you belong, you have purpose.
And so that's going to be critical to physical health, mental health, cognitive function. And
that requires social connection, it requires other people to help you see and learn that.
And so without that social connection, I think that is probably a significant trigger for decline in health and
decline in cognitive function. Yeah, thanks for sharing that, Tommy. Super powerful. And,
you know, I was thinking about my elderly mother, as you were saying that, and the message keeps
was coming through to me that you've got to give your brain a reason to think that you need to be alive you have value
and uh i think we can all think about that for ourselves and for the people around us
tommy i've so enjoyed our conversation today we've gone into all kinds of different areas
there's a there's so much we didn't touch upon as well uh which no doubt we'll do at some point in the future. Tommy, I always love to
leave the listeners and the viewers on YouTube with some practical tips. So the podcast is called
Feel Better, Live More. When we feel better in ourselves, we get more out of life. You have
worked with neonates, you've worked with people trying to lose weight. You've worked with Formula One drivers, with athletes, with all that experience.
What are some of your top practical tips for people to improve the way that they feel?
I think when you go across all of those different groups, what I've seen again and again is that the things that are required for optimal performance
are the same as the things that are required for optimal physical health, the same of the
things that are required for optimal cognitive health and cognitive function. And those are
the things that we've talked about. So they are sleep, diet, nutrition, social connection.
about um so they are you know sleep diet nutrition social connection and what i think it you know there are two things that are really important um to remember from from like my perspective one
is that to improve any of those things requires much less um physical effort than we are often told, right? Or that we tell ourselves in terms of the amount
that we need to change our diet or restrict our diet or the amount that we need to exercise.
And even just small, you know, small changes, a brisk walk three times a week can have huge
knock-on effects on our brain and
on our bodies. And so that's one thing. It doesn't take much to have a really big effect.
And the other thing is to remember that we are incredibly strong and resilient as individuals,
but that does require a group. It does require a collective because that's where we
derive our meaning and purpose, which is where a lot of this comes from. So, you know, remember
that it doesn't take much to improve any of those areas, which will then have knock-on effects in
other areas. And then also remember that you are an incredibly strong, resilient human being with significant
purpose and meaning.
You are loved and you have a place.
And because of that, you have incredible strength.
And if you remember that, then all this negative messaging that could come from, a lot of it's
internal, but a lot of it comes from external social media, all that kind of stuff.
Then you can sort of leave some of that by the wayside and just like how little it takes to improve and how strong and resilient you really are.
Yeah, brilliant way to finish. Great advice there, Tommy. At the end, I just want to publicly
acknowledge you, Tommy. I think what you're doing is great. I love the information you put out. I
love the way you do it. You're someone who I regard as inspirational, very influential,
and thanks for joining me today.
Thank you so much for having me.
It's a real pleasure.
And yeah, you're one of very few people in this arena that I really respect and look up to as well.
And, you know, I really appreciate that.
Cheers, Tommy.
Really hope you enjoyed that conversation. As always,
do have a think about one thing that you can take away from the conversation and start applying
into your own life. Remember, small changes really do make a big difference. And of course,
please do consider sharing this episode with others who you feel may benefit.
If I want to take a pause right now and send this episode to a friend or a colleague with
a personal note, this is a really thoughtful thing to do for someone else. And honestly,
it's going to have benefits for you both. It serves as an act of kindness,
which we know benefits the giver as well as the receiver. And as I mentioned in the
introduction, Tommy is someone who I really, really respect. In fact, when I was writing my
latest book, Feel Great, Lose Weight, it was Tommy who I approached to proofread the manuscripts and
give feedback. He made some really insightful comments and made suggestions which really
helped to improve the final version. The book is about
how we can make simple, sustainable changes that can have a huge impact on our health and well-being.
And although the book's written around the topic of weight loss, the truth is that the themes in
the book are universal and will help any one of us understand why we have certain behaviors and
what we can do to change them. The book comes out this week in the USA and Canada as a paperback, as an e-book,
but also as an audio book, which I am narrating.
So if that appeals to you, you can check out all the links to this book,
as well as my previous ones, on the show notes page on my website.
Now, before we finish, I just want to let you know about Friday Five.
It's my brand new
weekly newsletter that contains five short doses of positivity. It could be a practical tip for
your health, a book, an article, or a video that I found inspiring, a quote that's caused me to stop
and reflect. Basically anything that I feel would be helpful and uplifting. I'm so glad I started
doing this. The feedback has
been simply wonderful. Many of you tell me it's a wonderful way to finish off your week and get
you set for the weekend. So if that sounds like something you would like to receive each Friday,
you can sign up at drchatterjee.com forward slash Friday five. A big thank you to my wife for
producing this week's podcast and to Richard Hughes for audio
engineering. Have a wonderful week and please do press follow on whichever podcast platform
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you are the architects of your own health. Making lifestyle changes always worth it because we're