WHOOP Podcast - Dr. Richard Isaacson, Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, discusses a study that used WHOOP sleep data to search for signs of early Alzheimer's detection, plus background on the disease and how to combat it.

Episode Date: November 19, 2019

Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College Dr. Richard Isaacson talks about why he began studying Alzheimer's (4:07), how it starts 20-30 years before symptoms appear (4:38), how many people have it and the early signs of it (6:06), the three stages of the disease (8:27), ABC's of Alzheimer's prevention management (10:51), the reason for the study (17:21) and why they wanted to look at sleep (18:19), the value of cost-effective, non-invasive monitoring (19:49), the study's hypothesis and methodology (23:10), conclusions based on the WHOOP data (29:56), implications for future research (34:29), his own personal learnings from wearing WHOOP (38:52), and tips for what we can all do to prevent Alzheimer's (43:05).  Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

We discovered that there were secrets that your body was trying to tell you that could really help you optimize performance, but no one could monitor those things. And that's when we set out to build the technology that we thought could really change the world. Welcome to the WOOP podcast. I'm your host, Will Ahmed, founder and CEO of Woop, where we are on a mission to unlock human performance. Our clients range from the best professional athletes in the world, to Navy SEALs, to fitness enthusiasts, to Fortune 500 CEOs and executives. The common thread among whoop members is a passion to improve.

What does it take to optimize performance for athletes, for humans, really anyone? And now that we've just launched all-new whoop strap 3.0 featuring Whoop Live, which takes real-time training and recovery analysis to the next level, you're going to hear how many of these users are optimizing their body with whoop and with other things in their life. On this podcast, we dig deeper. We interview experts. We interview industry leaders across sports, data, technology, physiology, athletic achievement, you name it. How can you use data to improve your body? What should you change about your life? My hope is that you'll leave these conversations with some new ideas and a greater passion for performance. With that in mind, I welcome you to the

WOOP podcast. Using the Woop collected measures, we were able to predict whether or not a person was going to fall into two buckets, and that one bucket would be someone with excellent or above average executive function, higher order processing.

And the other bucket meant that, you know, the Woop measures said, I'm a little worried about this person. Their cognitive function was below expected. Hello, listeners. My guest today is the brilliant and talented Dr. Richard Isaacson, director of the Alzheimer's Prevention Clinic at Wild Cornell Medical College

and head of the Wild Cornell Memory Disorders Program and Neurology Residence Training Program. Dr. Isaacson has written multiple near-times bestselling books on Alzheimer's disease and also makes regular appearances on the Dr. Oz Show. Richard joins me today to talk. about a recent study from Wild Cornell in which patients with a family history of Alzheimer's disease wore whoop straps to evaluate for possible relationships between their sleep patterns and cognitive performance. We discussed the results of the study, the role whoop played, and what it means for future research when it comes to detecting and preventing Alzheimer's

disease. With November being Alzheimer's Awareness Month, we also explore how the disease disease works, who's affected by it, and the number of people who have it, as well as what we can do to prevent it in the future. I'm someone who's had Alzheimer's in my family history, and overall, I think this is just an incredibly important work that Dr. Isaacson is doing. Couldn't be prouder that WOOP supported this study. Without further ado, here's Richard. Well, I'm here with Richard. Thank you so much for coming on the Woop Podcast. I've been a big fan of your work for quite some time and and all the research that you've done in all timers to date. Cool. Well, thanks so much, Will, for having me. And I've been a big fan of Woop for a while.

I was an early adopter. I got my Woop out three, three months or so after it came out. And thanks to Woop, and I'm not doing a shameless plug here, but like thanks to Woop, I got my resting pulse down from 56 to 43. And so I think that means you're making me live longer. So, Alzheimer's Awareness Month is no. November, and I'm really proud of the work that we've gotten to do together. I think before we jump into talking about the study that we've conducted, why don't we just first talk about how you got into Alzheimer's? So why Alzheimer's, Richard? Sure. So Alzheimer's, for me, is personal. And my Uncle Bob was diagnosed when I was in high school, and back in Long Island. And basically, as I've

kind of gone throughout my career, several other family members were also diagnosed with Alzheimer's. So I've seen the disease develop in people really when I was young. And now it's something that is a disease where we now know it starts 20 to 30 years before the first symptom of memory loss begins. So I've really been interested in the prevention of Alzheimer's. I'm seeing people kind of like me, asymptomatic, no problems with memory function, but people that have a risk of Alzheimer's and their family, and trying to figure out what can we do an evidence-based and safe way to reduce that person's risk. You know, exercise is by far the number one thing a person can do to reduce their risk,

hence our interest in lifestyle and other aspects. Well, I devoured your book, The Alzheimer's Prevention and Treatment Diet over the past few days. It's pretty phenomenal. I recommend anyone reading it. And we also share the personal connection to Alzheimer's because my grandmother, died with Alzheimer's and you know I remember vividly in the sort of the last 10 years of her life like having those conversations with her where she would just completely forget what we'd

been talking about and you know it's it's really hard especially for a young person I think to understand like I was between the ages of eight and like 15 when I was sort of experiencing this with Missy and so when the opportunity came up to do more research on Alzheimer's with whoop but it was just overall really excited, and I'd been such a big fan of your work and everything that you've done in the space that, you know, we felt like we had to leap at the opportunity. Now, let's talk about Alzheimer's for a second and a little bit more. So I think what would be helpful for probably people listening is just like, how big of a problem is in Alzheimer's, how many people have it, you know, things like that?

Sure. So Alzheimer's is by far the most common neurodegenerative disease, or what that means is the most common brain disease of people as we age. And I think a lot of people, you know, think of Alzheimer's disease and older person's disease, but we now know that that's really not true. Alzheimer's begins in the earlier, even middle age. So while over probably 5.8 or so million Americans currently have Alzheimer's disease dementia, meaning someone has Alzheimer's in their brain, but they can no longer care for themselves, believe it or not, over 46 million Americans have Alzheimer's disease, their brain right now, but have no symptoms. And that's called pre-clinical or pre-symptomatic Alzheimer's.

And yeah, those numbers are shocking. This is not just a public health urgency. It's a public health emergency, not just in the United States, but really also globally. Yeah, I mean, I think the numbers are pretty staggering when you actually look at it. And the thing I found so interesting in reading your book is how early some of the, you know, the symptoms or how early you can actually track against this before, you know, the obvious symptoms of forgetting things and things of that nature actually persist. Yeah, you know, Alzheimer's is characterized by, you know, someone losing their keys and, you know, forgetting words and missing appointments.

That's what most people understand about Alzheimer's, but it's really much different. You know, people's sleep patterns change, their mood changes. And this happens, honestly, years or decades before symptoms, you know. And what we do in the Alzheimer's Prevention Clinic is try to look for tools and signs way earlier before symptoms. You know, you can do a brain scan and find if there's amyloid that's the bad, called the pathologic protein that gets gunked up in the brain of an Alzheimer's patient. You can see that on a brain image on a pet scan, you know, a decade or more before. But what we're doing is we're trying to develop new and innovative tests, cognitive tests, technology-based assessments where we can detect maybe something's wrong before that first symptom. And if we can do that and then intervene accordingly, that's when we can have, you know, the most benefit.

And there's, it seems to be there's three levels or stages of Alzheimer's disease. Talk a little bit about each one of those stages. Sure. So in the past, we used to call patients that they have Alzheimer's disease or Alzheimer's dementia, meaning they had problems with their memory and they couldn't take care for themselves any longer. Now, we know that is Alzheimer's dementia, but we now know that's actually the, end stage of Alzheimer's called stage three, Alzheimer's disease dementia. And that's the, that's the most progressed level. And basically what we now know is that Alzheimer's occurs over

decade. So stage one, Alzheimer's disease is pre-clinical or pre-symptomatic. That means that the disease is starting to develop silently in the brain, but there are no symptoms. Now, stage two is different. It's called mild cognitive impairment due to Alzheimer's disease. And what that means, is that someone may be having those, what we used to call in the past senior moments. So I forget something here and there, but it's not affecting my activities of daily living. I can still take care of oneself. So with that, it's really the earliest symptomatic phase of Alzheimer's. So stage one, no symptoms.

Alzheimer's has begun in the brain. Stage two, mild symptoms, but the person can still care for themselves. And stage three is Alzheimer's disease dementia, where the problems with memory and cognitive function and everything else really impair the person's ability to, you know, live independently. There's also, you know, before all this happens, really I call it stage zero. And stage zero means there's no symptoms and there's no Alzheimer's yet in the brain. And that's really an important phase. And that's an area of prevention called primary prevention. So we're trying to prevent the disease from happening in the

first place. And I think that's a really important phase. So I think whether you are pre-Alzheimer's in the brain or during the earliest stages, that's when we can do a lot to reduce a person's risk. Explain, I mean, in that earliest stage where there isn't, you know, there aren't necessarily any symptoms, right? It's pre-clinical. How do you actually know that someone's experiencing the early stages of Alzheimer's? Sure. So I usually just kind of take my magic hands and wave them over the person's, no, so there's no magic, perfect way to do this. But I think what we're doing as researchers and as clinicians, we're trying to do something and we're trying to figure it out. So the way that we've kind of characterized this is we call it the ABCs of Alzheimer's Prevention

Management. And ABC, we came up with that because we wanted to try to keep it simple. Alzheimer's is complicated. Neuroscience and the brain is complicated, but we try to keep it simple. So A stands for anthropometrics. Anthropometrics is just a big, big word that really talks about body composition. What is a person percent body fat? What is a person's muscle mass? These are things that, you know, a lot of people just don't think of these in Alzheimer's in the same sentence, but honestly, they're really, really related. As the belly size gets larger, the memory center in the brain gets smaller. It's, it's very interesting, and it really underscores that Alzheimer's disease is really a medical disease that then affects the brain later. So we look at the A's, we look at the B's, Bs that include

blood-based biomarkers. So what do I mean by that? I mean cholesterol markers, inflammation, metabolism, things like blood sugar, nutritional markers, as well as genetic. So we do several genetic tests in the clinic. And this is something called personalized medicine or precision medicine is what we've called it before. And then finally, the C is cognitive tests. So when we're trying to assess what is happening in the brain of an Alzheimer's patient, we know that that things start changing in the brain and they don't have symptoms, but you can actually detect changes in cognitive function using very sophisticated cognitive test using a computer. So we've created some tests that we can administer online in front of a computer, and we take

all of these ABCs together, and we look for a signature of what is the pathology potentially, is this person on the metabolic road, diabetes, for example, is this person on the cholesterol road. So again, they don't have symptoms, but their cholesterol is all out of whack in specific aspects of their cholesterol say, I bet this person's at high risk. So we take all this together. We use the genetics. And of course, you know, with our study, we're using even passively collected data. We're using, you know, cardiovascular metrics. We're using sleep patterns to, you know, wouldn't it be amazing? So right now, most doctors have to order really expensive, fancy pet scans that cost $5,000 and are not covered by insurance. What we're trying to do in the clinic,

because we're trying to do computer-based tests and that's quicker and cheaper and easier and we're trying to do blood tests. But wouldn't it be better to not even like stick someone with a needle, not stick someone in an expensive MRI or pet scanning machine, just have someone wear a ring or a whoop device or whatever it is, you know, implant something that can actually detect whether or not a person may be having cognitive changes by using a peripheral biosensor? Well, I love how you highlighted just the fact that it's so hard to actually diagnose this in its earliest stages, right?

The facts that you have to go through this ABC steps. And, you know, ultimately there's this opportunity, whether it's with, you know, random testing or whether it's with looking at your body or blood markers, to then introduce other invasive or, excuse me, non-invasive measurements like with whoop, to be able to measure things like sleep and cardiovascular activity and then try to pin down those other items,

or identify people earlier in the process that may be at risk. So if you think about, we talked earlier about the 47 million people, right? Where do they fall across those three different stages? So actually the 47 million people are people at stage one, meaning they have Alzheimer's in their brain but no symptoms. Stage two, meaning the mildest symptoms, but Alzheimer's in the brain, we don't actually have the best statistics on that. So I'd probably be guessing, but I would say at least 10 million people or so. But again, this is a guess. And then in terms of the dementia, stage three, the best estimates are approximately

5.8 million Americans. So if you take these numbers, you know, and you add them all up together, I mean, we're talking over easily 60 million people in America. You know, that's, you know, that's a lot of people at all the various stages of Alzheimer's disease. So it's an enormous number of people. Let's talk more about you had a pretty personal incident with Alzheimer's when you were young with Uncle Bob. Let's talk about Uncle Bob for a second and how you inspired your work.

So if you look somewhere in my office, up there we go, above on the top of the bookcase, Uncle Bob was not just, who's actually my great uncle, but he's not just a relative of mine. He, number one, introduced my parents, so like that's important. I wouldn't be here if it wasn't for him. And then number two, after I was born, I also wouldn't be here if it wasn't for him because at the age of three, I jumped into the pool at my Aunt Carol's house on Long Island and sunk to the bottom and everyone was inside except my Uncle Bob kind of said, hey, where's little Ricky at? And he basically ran out, jumped into the pool and saved me. And to this day, I don't go near water. I hate water. It freaks me out. So yeah, Uncle Bob was really,

really important for me. And, you know, there was always like a connection with me and him. And I don't maybe understand why or maybe it's maybe there's a reason obviously because I ended up later dedicating my career to it but you know just just to see someone like him you know he used to say what a party uh he's always the life of the party at all the family events and and gatherings he would always be the one who really brought the life to the party and you know to see someone like that of all people to basically just become a shell of himself really become nothing um not even be able to have a conversation and barely be able to look. My cousin Cynthia, you know, she would have to take care of him. And like that's, that, that's just heartbreaking. So, and this happens to, you know,

millions of people. And Alzheimer's doesn't just affect the patient. It affects the entire family. So it really has kind of given me the motivation to keep pushing forward to, to do something against this disease. Well, I love what you just said about, about your uncle, because I, I remember vividly the same experience with my grandmother who was just such an energetic woman and someone who was constantly surrounded by other people, someone who people looked at as an inspiration, and then over time you just saw that slow deterioration and it was so sad. So I think with that in mind, let's talk about this unbelievable study that you conducted and helped lead. Why don't you explain it for our audience? In the never-ending quest to try to detect

Alzheimer's disease as early as possible, because if we can do that, then we can intervene as early as possible. I had this, I guess, idea or my gut told me. I guess, honestly, it was my gut that said that there's something about the cardiovascular system and something about sleep that are intimately related to Alzheimer's. So, you know, having cardiovascular disease basically fast-forward a person to Alzheimer's, and it really fast-forwards a person through the dementia process and in Alzheimer's we don't want to do that we don't want to fast forward we want to slam on the break so having cardiovascular disease there's just something that made sense with with monitoring someone's cardiovascular state the other part about sleep is sleep is just

so important when it comes to brain health and as we sleep there's different phases of sleep and basically when someone is having deep sleep that is really the the garbage disposal time of the brain. So I talked earlier about amyloid, the bad protein that gets gunked up, built up in a person brain with Alzheimer's. And during deep sleep, that's when the trash gets taken out and the amyloid gets removed. So, you know, when people are, you know, not having sufficient deep sleep, they're basically repair mechanisms just aren't working. And when it comes to REM sleep, that's the part of sleep, rapid eye movement sleep, which basically is when the person is dreaming, REM sleep is when a person takes those short-term memories that happen during the day and it gets translated into long-term memories.

So to me, REM sleep, if that's doing well, then maybe your memory's function is better the next day. When REM sleep is low, maybe your memory function isn't as good the next day. And I would see time and time again patients, they were sleep deprived, they're smart, they're normal, they're CEOs of companies, whatever it is, and they come in and their memory isn't really working that great. and their processing speed isn't working that great, and their executive function isn't working that great. And all these different parts of the brain function and cognitive function are related to these sleep patterns subjectively that a person told me. So when I think about, well, if someone's telling me something subjectively,

I think, well, what the heck else can we do to objectively track this? Because if we can do this, first of all, in a cost-effective way, in a non-invasive way, in a way that patients don't mind, I'm interested in that. So I was wearing a whoop, and I've been involved in, you know, a tech-based research for a while now, and we build websites and we do all this stuff. So I've always had, I guess, an interest in tech, but I got rejected from MIT, so I had to, you know, be the schlub that went to medical school.

So I went to medical school and things come full circle, and we have a tech-based research program. We create apps and this and that and everything. So I bought a whoop for myself to use personally. and honestly within time frame so I bought the whoop February of I believe 2017 probably three months after it came out yeah so that would have been early that would have been early on in the consumer launch yeah exactly so I read about it on a blog or something like that and I waited a month or two to see some feedback and I pulled the trigger I got it in a few weeks and literally within a week I said ah I mean this this is this is what I needed you know tracking heart rate variability is well used to be cumbersome now it's not thankfully In the past, like, you know, there were other devices that I wore. I won't name any names, but like, I'm sorry, but step counting, just like, irrelevant. Like, come on.

Like, I mean, I respect the person that kind of came up with the step counting thing, and I've read that literature. But, I mean, that is like decades old stuff. And to me, just having a passive device, you know, I, I sleep in bed every night with a former Division I college athlete who ran track and field at USC. She's a couple years younger than me, so I got to keep up. So in order to like, you know, stay in best physical health and cardiovascular and also mental health, I'm looking for every edge I possibly can take. So, you know, using for me personally, within honestly a week, I learned a lot.

And after a month, probably March of that of 2017, I said, I got to contact these people. And I said, wait a minute, the American Academy Neurology meeting is in Boston next month. I'm going to contact these people and say, can I, can I, can I, can I, swing by. So I basically kind of came by the office. You were busy. You were too busy for me back then. It's cool. It's not true. That's not sure. I was not too busy. I was probably on a plane. So whatever it was, I met with some folks and I was blown away by the science team, all Harvard, you know, folks. Yeah, we've got a great research. Yeah. I mean, like, really smart people that just blew me away. The science was there. The tech was there. You know, the evidence was there, which is like really important. And basically, um,

I said, we got to do something with this. And next thing we know, like a couple months later, we got a donation, you know, one of our patients was a grateful patient that gave us some money. And I said, what should we do with it? And he said, do whatever you want with it. And I said, I know what I'm doing. So I bought a bunch of whoops and you guys were great. We worked with you guys and we bought a bunch. And then actually later on, we had a fundraiser called Aces for Alzheimer's.

These two girls from high school in upstate New York actually put together a fundraiser on a tennis. tournament and I said, what do you want to do with the money? And they said, well, what about something athletic and sport related? And I said, great, let's, let's buy some more whoops. So we bought the more whoops. We hired someone part time to help with the study. And that's really how the study was born. And the goal was to basically, we had all these patients really doing all this stuff already, doing the cognitive test, doing the brain imaging, doing everything. We just decided to slap whoops on people and track something to see if there are anything that we could detect in the data to figure out maybe if their brain is working well or not. And again, this idea

was a little crazy, but I honestly thought that we could detect a person's cognitive function by looking at a person's cardiovascular function plus or minus sleep function. That was my hypothesis. That's what my gut told me. And I actually kind of can't believe it, but you're fast forward the clock two years and we actually now have proof that that actually is the case that's like a little crazy for me to say it's pretty amazing so uh the overall the the goals to evaluate for possible relationships are reading this here from the study between cognitive performance and sleep patterns in patients with a family history of Alzheimer's disease and determine the feasibility of using a wrist-worn biosensor device whoop in patients at risk for AD dementia and

To your point, I mean, previous research had indicated that a decrease in REM could be associated with an increased risk of Alzheimer's. There wasn't a ton of studies that been done on this. And in fact, you were kind of working against the grain here. I mean, in your book, I love this quote from the National Institute of Health in 2010, which says that firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline or AD. I mean, how lame is that? Oh, man, like, this is what I've been up against for, like, my entire career. And, you know, it's 10 years later. I, you know, we have a study that just came out.

I'm really excited about it. We can talk about that in a separate podcast. That's a long thing. But, you know, our work on the clinical side, and a lot of these, actually, a lot of these patients wear whoop, so, you know, help to motivate people, I think, too. But we're just turning that statement on its head. You know, our new research study in Alzheimer's and dementia. it just says that that statement is categorically incorrect. So, you know, we've made a lot of progress, which is great.

But to make more progress, we need to really be able to track brain and body health in a passive, cost-effective way. And I think the promise with using a risk biosensor like WOOP is really, you know, exponential in terms of that. Let's talk for a second about the actual method for this study. So I understand we had 40 people, ultimately 33 subjects with a family history of AD, wore whoop straps throughout the entire study. And, I mean, it was really fascinating for me to read about this because there's all sorts of testing that's going on throughout the whole thing. I often talk to, you know, sports teams or executive clients.

They're trying to figure out how to map whoop data to other things in their lives. And here, you guys have really clear data sets to map whoop data, too. So talk about the methodology. Sure. So I'm just a simple brain doctor, but we had really smart people that helped us with this. We had this guy, Dr. Peter Yan, he's actually now back in Boston. He went to BU for med school, and now he's at Harvard for work. Really smart guy.

Oh, he's a smart. He's no way I could have possibly done this without him. And he's the co-first author on the paper. So Peter was a bioinformatics fellow. He's also a neurologist. He's also an epileptologist, meaning seizures and that kind of thing. And he understands brain metrics and physiology and sleep and all the stuff that's way over my head. And basically got together a team to take the rich data set that Woop gave us.

Now, you know, when I look at the app and I track my own performance and I look at my performance every morning and I basically say, okay, now I know how I'm doing. This is, I better plan my day in terms of what I should do for exercise or what I should do for sleep or whatever else. Well, we had to take the back end of that data that you guys provided us in, you know, Excel spreadsheets. And we had a lot of data. Let me just put it that way. The whoop data that you see in the app is, is just a pretty looking snapshot of it. But we actually, you know, got down and deep into the engine and saw, holy cow, like, what do we do with all this data?

So long story short, we basically had Peter and his team do, sorry, really fancy things that I don't understand using bioinformatic type whatever and K means clustering. And I honestly just can't even explain it all. It's all in the paper. But figured out the different metrics that were most correlated with the cognitive measures that we were collecting in the clinic. Yeah. I mean, it looks like the team really used some sophisticated machine learning to all. ultimately divide these, you know, the subjects into two different groups. And then they were able to look at how WOOP biometric data compared to some of these tests that are, you know,

typically used to help stage the severity of Alzheimer's disease. So I think two of the key tests, and you're going to explain this better than I am, Richard, were around blood tests and then also around cognitive tests. So what types of tests were we're using in the study? Great. So you explained that actually way better than I could have, so thank you. This stuff's complicated for me. But yeah, the cognitive tests that we do look at different areas of brain functions.

So we look at not just memory function, but also learning. Can someone learn new material? Then when we talk about memory, we don't just say, oh, you know, remember three words, remember whatever. we look at verbal memory, we look at logical memory, we look at associative memory, we look at other things, we look at executive function or higher order processing. We look at processing speed and attention. Then we do this interference stuff, so we make it even harder for people to do it. Then we do tests that kind of combine a little bit of executive function, a little bit of processing speed, and we basically try to assess all the different parts of the brain. And we also look at blood-based biomarkers, So cholesterol measures, you know, inflammation, things like that. So the goal of the study was to try to correlate with whether whoop collected metrics could really predict whether or not someone did well or not as well in some of the cognitive tests. And you can probably explain the results better than me.

But the long story short, what I got out of it was, you know, and this is, again, you have to read the papers in the journal of the prevention of Alzheimer's disease. and it gets into a fair amount of granularity in the paper. But what I got out of it was is that using the Woop Collected measures, we were able to predict whether or not a person was going to fall into two buckets. And that one bucket would be someone with excellent or above average executive function, higher order processing, which is kind of a predictive measure for someone with cardiovascular disease as well as Alzheimer's disease. otherwise the person would drop in the other bucket, and the other bucket meant that, you know, the

whoop measures said, huh, I'm a little worried about this person. Their cognitive function was below expected, below average, and that there was a difference between the two groups. So that's one way that I guess I would explain the results. Yeah, I mean, it's pretty amazing. The punchline is that this is the first study ever to show that slow wave sleep identified by a wrist-worn wearable device, which is whoop, can actually correlate with performance on cognitive tests, right?

And if you're trying to figure out ultimately how someone's mind is functioning and what stage they are for Alzheimer's. And we can talk about the potential for all sorts of different cognitive functions and the correlations with sleep because I think there's a lot of different ways to think about where this study goes. But the bottom line is that we were able to show that slow wave sleep correlated with performance on cognitive tests. And what's exciting for me just in obviously building technology is 89% of the participants who participated in the six-month study said they wanted to keep

wearing whoop. So if you get back to this idea of non-invasive technology and being able to conveniently use technology to better understand your body, better understand your body, but I mean, here we've got a clear use case where people who aren't necessarily the most obvious target population for whoop, right, from day one at least, they're willing and able to use it. And so that goes to a lot of the hard work that our design team and our engineering team has gone through to build this. Yeah, totally. You know, we planned this study as a six-month study and then we were going to, like, you know, give it to other people and, you know, give us the device back. Yeah, that didn't work. Like when people were given this device, they weren't wanting to give it back.

And I mean, I agree. These are people of all ages, you know, of mid-20s up to, I think the oldest whipware in our study was, oh, I'm going to get this wrong, but 72 maybe. I don't even remember anymore. He's a really nice guy. He's, you know, I know these people, like the back of my hand. He's actually a psychiatrist. He's a really cool dude. We go to spin class at the same place over on 67th Street.

You know, I'm looking at the app now. I mean, you know, we, we completed this study, like, I don't even, like, over a year ago, it just takes so long for research to get published and all that kind of stuff. But, you know, like, this guy, APC, 108, man, this guy's a trip. He, he texts me at, like, at 1159 p.m. He's like, hey, you had a rough day today. I'm beating you again. So, you know, having the leader.

I'm looking at a whoop leaderboard with Richard here in the office. Yeah, so actually the person in second place today, she's great. She did some weightlifting today. She's actually another doctor, an orthopedic. surgeon, retired orthopedic surgeon. She's really great. The person in third place today is a guy from Utah, Tall Paul. I can say that because it's not identifying information. Tall Paul is a cool dude. He's a cyclist, long-distance cyclist. I'm in seventh place today with my, that's my picture. Do you know what that is? I'm trying to see the photo now. That's Rick Ross. That's my nickname.

I'm in seventh place today. I haven't done much today, but I will do something later. And APC. 10, he's a ninth place. He's a cool dude. He's a physical therapist. former division uh he played a football at delaware i'm not sure what division that is but um yeah he's he's a good dude and uh so he's obviously a former collegiate athlete we have all sorts of people in the study from all walks of life and um literally the study ended i like over a year ago and this this the whole leaderboard is still still active well you know for for us in in uh in building technology i mean that's music to our ears because you you hope that you can build something that's simple enough to use and provides enough valuable data that, you know, people ultimately want to keep

wearing it, keep using it. So if I'm reading here the conclusion of this study, it says our findings suggest that individuals with a family history of AD more time spent in deep sleep may predict improved executive function. I mean, it's amazing, Richard, what you and your team have been able to show with this study. We're definitely proud, very proud of it at Woop. where do we go from here? What are the next steps and how can you see this evolving? Sure. So, you know, we published this study and, you know,

we had specific outcome measures that we kind of chose right at the beginning. And that's how studies are designed. So you design a study and you say at the beginning exactly what you want to study. And so that's the data that we presented. Now, there is so much more data. I mean, you kept talking about the deep sleep and executive function. And like, I kept having to hold my tongue because I know so much more about what these metrics can do. But, you know, we we did an a priori or like before the study started set those out as endpoints.

So that's going to inform what I want to do in the future. So what I want to do in the future and what we've done is applied for grant funding for additional support for 100 patients this time. Now, we purchased, I believe it was 40 whoops back in the day. We offered 34 whoops to patients. One of them lost it within a week, pain in the butt. And you guys all know this person. He's on television. So every time I see him on TV, I'm still upset that he lost his darn whoop and didn't even like buy another one.

But the other six are the other six people that are not, that didn't get in the study were people on our team. So our team really enjoyed wearing it and learned from it. So with all of this massive amount of data that we haven't published on, we actually use this to inform the next phase of our work. So the next phase of our work is an application. So Bill Gates threw his hat into the ring, thankfully with Alzheimer's research, with something called digital biomarkers or really looking for Alzheimer's biomarkers. Well, digital biomarkers, what music to our ears, because when we started this study, there was zero, nothing, not even one grant application on the planet. where someone could apply for money in the space. So, you know, we did this kind of by the seat of our pants and through grateful patients.

And what we did now is we applied for half a million dollars through the Gates allotment, that money was given through the Alzheimer's Drug Discovery Foundation. We'll hear about that in probably another three or four or five months with grants. We submitted it and then basically it takes six months for all the decisions. But what we're going to really try to do next is really expand the cohort, do more measures. and what I'd like to do is to try to detect, and I have a feeling of what the answer is here, but I believe, or sorry, my hypothesis is that whoop collected measures may predict whether or not a person has amyloid in their brain.

Wow, that would be epic. Yeah, and I think, you know, I'm going with my gut here because I always go with my gut. I don't have exact proof on this, but when I look at the patients in the study, I know who had amyloid in their brain, and I know what their measures looked like. and I'll just leave it at that. I just think that this type of research can not only detect whether there's a problem, but detect it in a more cost-effective and honestly safer way. A PET scan, aside from being $5,000, you get like some radiation.

You can't even have more than two or three PET scans a year because it increases potentially risk for cancer. So, you know, I think passive monitoring can do something like this. And I also think passive monitoring can detect, you know, in millions of people, as opposed to PET scans. You know, there's only been, you know, maybe 100,000 PET scans done ever for amyloid or maybe less. And with a biosensor, I mean, millions of people can be assessed. And if they're at high risk, those are the people we need to do something in. Well, you know, our mission at Woop is really to unlock human performance. And what we're finding over the past six, 12 months and working with people like yourself, Richard, is, you know,

you know, cognitive performance is a huge component of that, and it's pretty critical to any form of performance, broadly speaking. Now, you've been on WOOP for quite some time. What are some things you've learned about yourself just from monitoring your body? Oh, boy, this is fun. And this is really a treat for me, so I appreciate you coming down all the way from Boston. And, you know, I ran my first marathon at age 13, Long Island Marathon. That was my first only marathon. That's kind of amazing. I don't know how many people who've run a marathon age 13. Thank you. That was my first and last. I now do half marathons, but that's about it. I've never excelled as a athlete in the ways of other people are. So I'm glad I could get in the back door

and get on the locker whoop podcast, you know, somewhere or another. So I'm glad those six years of medical school turned it to something. But I've learned a ridiculous amount from wearing Roop. I'll just, I'll just be honest with you. Um, I, what did I learn about myself? Well, I learned about myself that I'm not just going to schedule classes. I'm not going to schedule, you know, I, you know, Alison is my spin instructor and she's terrific. Um, but I'm, you know, yes, she teaches Monday, Tuesday and Sunday, but sometimes that weekend warrior, 1130 a.m. class, um, that's 60 minutes. Um, I shouldn't be taking that class because I'm not ready. Um, and I'm not recovered. So I learned a lot about myself in terms of recovery. Um,

you know, I learned what, what does it to me and what doesn't. So I don't drink much alcohol because my head, I get headaches. But, you know, if I would even have, and I don't know, this sounds crazy to me back then, and now I know it's true with my patients too, I mean, a half a beer to a beer completely destroy me. My heart rate variability is just, just like to the floor. I mean, it's just, it's crazy. You know, when it comes to sleep, I had to really do a better job at getting myself ready for sleep. You know, melatonin for me helps, and that helps in a way that when I'm jet lagged and I'm traveling all over the place, a tiny little dose of melatonin really kind of righted the ship a lot of times. And I just had no idea. Now I have, again, objective data to

tell me that for myself. You know, I've learned a lot not just wearing the whoop, but kind of from there's a whoop community. I'm sure you're aware of on Facebook. I'm like never on heard of them. Yeah, yeah, I'm rarely on Facebook because social media freaks me out. But, I mean, I've learned a lot from them about what could potentially help with heart rate variability, help with deep sleep. That's been, that's been a learning experience. You know, I got my pulse down from resting pulse of 56, which I thought was healthy. I mean, I thought I was like in good shape. And I thought a resting pulse of 56 is pretty good. I was wrong. My pulse now is between 43 and 45, you know, and how did I do that?

well, I learned, I learned a lot about interval training versus weights and, you know, all the measures that I need to track for myself. And, you know, I've read, and I don't know if this is correct, but for every one beat of heart rate that a person comes down, that increases longevity by about three months. So to me, like, I'm wondering, like, wow, I can not only improve potentially my longevity, but also my brain health. So this is something that, you know, I need to pay attention to. So I think the other thing I've learned about is, is the motivation aspect. The team, you know, I was there in the days before teams and before all the fancy settings on the app. And I've been using the app for a while. But when you guys enabled the team setting, that was cool.

Yeah, that's a breakthrough. Yeah, I mean, the fact that like my, you know, my patient is texting me at night laughing because, you know, like he's beating me on the leaderboard, well, I'm going to then go walk my dog or do 50 pushups so that I can then beat him. Um, the fact that, you know, we've been able to use Woop to motivate, um, people and each other, um, I think is, is, is a really important breakthrough. You know, um, Alzheimer's terrible. It's like the worst possible disease. Like, I mean, there's a lot of bad diseases out there. But anything that can motivate people to sleep better, um, exercise more.

Exercise more efficiently. Um, I think, I think is a win-win for, for everyone. It's a public health, um, you know, value ad. And, and I think, um, the competitive tracking. part of it has been a lot of fun too. For whoop users listening to this or otherwise, what are your couple quick hits on just generally speaking how to, you know, prevent Alzheimer's or just, you know, be in a position where over the course of the rest of your life, you're not going to have, you're less likely

to have to worry about it. Sure. So for whoop listeners out there, you are already schooled about exercise and sleep. And exercise and sleep are easily two of the five most important things. exercise on a regular basis, whether it's cardiovascular three times a week or it waits twice a week or, you know, it depends on what you are and what your muscle mass is and what your body fat is. So exercise on a regular basis that's targeted for you is really, really important. You know, sleep, you got to pay attention to sleep.

It's really important. So for the non-whoop metrics tract, well, actually in some ways, oh, you know what I learned about whoop? when I eat bad when I eat lots of sugar like that's I was at a Yankee game recently and I went crazy on the junior mints and skittles and eminent I may have gone crazy it was like all you can eat so I went a little too crazy I didn't have any beer I didn't do anything else wrong and just sugar really messes up my heart rate so nutrition is key um eating a Mediterranean style diet um I really also believe in intermittent fasting or time restricted eating I don't eat um uh breakfast. For the most part, I wait 12 to 14, even to 16 hours for probably at least five days a week between dinner and breakfast. I think that helps with brain longevity. I think the other key here is that know your numbers. Everyone out there should know, just like you know your weight. And in the past, we used to get fooled by saying, oh, I'm going to my BMI, my body mass index. I'm going to get my height and my weight and that's going to be a picture of my health. Well, no,

not at all. Just like your resting pulse is one part of the metric. And, uh, it's a You know, what about heart rate variability? What is your recovery? Knowing your numbers, know your blood pressure, know your resting pulse, know your heart rate variability, know your cholesterol, know your blood sugar, know every single thing about you. You know, there was a study recently. It was called the Sprint Mind Study. And it looked at people and they randomized people to regular blood pressure control

versus more aggressive or more comprehensive. And the regular target was 140 over 80. And most people out there listening, if they have a blood pressure of 140 over 80, they're not going to be sounding any alarms, and even their doctors won't either. But when you looked at the arm, the intervention randomized arm, where the target blood pressure control was 120 over 70, controlling blood pressure from 140 over 80 to 120 over 70, reducing it for just three years, reduce the likelihood of the stage 2, mild cognitive impairment due to Alzheimer's disease or early dementia, by 19%.

So the fact that, you know, 19% risk reduction in Alzheimer's disease dementia from just just modifying blood pressure, you add that to the exercise, the sleep, the nutrition, the meditation, the, you know, eating more berries, eating more fatty fish, you know, blah, blah, blah, blah, blah, controlling everything else. I mean, I really think we can make a dent in this disease. Now, if someone is out there and wants to learn more, all of this is free. I thank you for plugging the book. I appreciate that. I'm going to make 37 cents. The book will be in the show notes. Yeah.

Thank you. I get 37 cents every time you buy a book, so thanks. But no, you don't have to buy the book. You can, thanks for you actually did read it because you quoted it. But if anyone wants free education online, again, totally free, it's at Alzheimer's Universe is the name of the site. It's A-L-Z-U, the letter U.org, al-ZU.org. And Alzheimer's Universe has courses for high school students, college students, medical students, doctors, as well as the general public.

And we've had over 1.5 million people on the site. We've actually partnered with Seth Rogen, who's been really great. He donned my lab coat and kind of taught several courses for us. So whether you want to learn about Alzheimer's, learn about whatever, or see Seth Rogen make some funny jokes, definitely check out the course. And all that will be in the show notes. And if people are interested in giving to Alzheimer's research

or giving to some of the work that you're doing, where can they find that? Oh, and honestly, thank you for bringing that up. We honestly are just two steps ahead of the curve with research, and there were no grants for what we did with Woop until like a few months ago. So two and a half years early, we had to generate the money. And for most of the preventative work we do,

I know this sounds crazy, but there are no research grants. We can't even apply for grants if we wanted to. I've been in contact with the National Institutes of Health and this and that. Like, they just don't even have work to apply for. So philanthropy is amazing. We really, really, really appreciate it. Every single dollar goes to immediate good use, you know, including fun, innovative projects like this. You can even dedicate, if you want us to do a whoop study.

We'll pay, we'll pay for it. Please, let's do it. So actually on ALZU.org, there's a donate button and you can give through Wild Cornell Medicine or New York Presbyterian. And if you're thinking about a larger gift or you really have capacity and you want to really fast forward and move the needle, just reach out to me. I'm findable on the Internet pretty easily, maybe too easily, at my email address. All right. Well, we'll include all of that in the show notes.

Richard, this has been an absolute pleasure. And thank you for all the work that you do to advance Alzheimer's research. Cool. And Will, thank you. It's not common where I meet someone who invented a device that I wear frequently, meaning every day. For the last three and a half, yeah, 24-7, it's always on. See, I got the motto down. But thanks for being a trailblazer.

I can tell you that when you're ahead of the curve, you have to endure some pain. So I'm sure you've endured pain. I've endured it. But thanks for pushing forward. No, thank you, man. It's been a real pleasure. Thanks again to Dr. Isaacson for coming on the podcast. We are thrilled to explore how Woop can further his research.

search to prevent Alzheimer's disease. If you're not already a WOOP member, you can join our community for as low as $30 to begin. We provide you with 24-7 access to your biometric data, as well as analytics across strain, sleep, recovery, heart rate variability, and more. The membership comes with a free Woopstrap 3.0. We offer 6, 12, and 18-month memberships. The more you sign up for, the more you save. if you enter the code Will Ahmed at checkout, that's W-I-L-L-A-H-M-E-D, will give you $30 off a membership, just for listening to this podcast.

For our European customers, the code is Will Ahmed E-U, and that'll give you 30 euros off when you join. For our listeners in Australia, the code Will Ahmed A-U will get you 35 Australian dollars off your membership. and for our current members, you can upgrade to the Woop strap 3.0 and get access to all the new Woop Live features by following the link in your Woop app. If you're out of contract, you'll literally get the 3.0 for free when you commit to another six months. Check out Woop.com slash The Locker for show notes and more, including links to relevant topics from this conversation and others. Make sure to subscribe, rate, and review the Woop podcast on iTunes, Google, Spotify, or wherever. you like to listen. We'd love to hear your feedback. You can find me online at Will Ahmed.

I try to respond to everyone who reaches out. And you can also follow at Whoop on Instagram, Twitter, and Facebook. You can email The Locker at Whoop.com with any thoughts, ideas, or suggestions you may have. Thank you again to all our listeners, to all our Whoop members. We love you.