Dr Rupy: According to Alzheimer's Research UK, over 50% of everyone listening to this podcast will be affected by dementia in some way, either by contracting the disease, caring for somebody with the disease, or both. Dementia is due to impact over 130 million people globally by 2050 and today, it's the biggest killer in the UK. But we have no effective treatments. It's diagnosed late in the disease process and prevention is hardly mentioned. Well, today, I'm joined by Dr. Louise Nicola, who has been studying this disease throughout her career and is currently completing her doctorate with the University of Washington focused on Alzheimer's. She also runs a human performance clinic, Neuro Athletics, where the goal is to prevent and delay dementia, as well as advise on what activities we can do today to keep our brains sharp. Today, we're going to talk through brain-boosting exercises and the reasons why certain exercises are good, plus the nutrients we need to feed ourselves to support our neurological needs. You'll get an idea of the routines, habits and practices that are not only necessary for elite athletes to optimize performance, but also for us if we want to do our best to avoid dementia. I'll also get Dr. Louise's thoughts on protein, as well as omega-3, electrolytes and creatine supplements. This is going to be a great episode and I think if you want to support the Doctor's Kitchen podcast and what we do and the research and everything that we present to you on YouTube and the audio versions, do us a favor and just follow the podcast on Spotify or Apple or wherever you get your podcast. It is the free way of supporting the show. And you can watch along on YouTube and subscribe whilst you're there as well. I also think this is going to be one of those episodes that you want to share with a loved one. If you get benefit from anything that Dr. Louise and I are talking about, the easiest way to spread this message of prevention that I don't think gets enough airtime is just to share this podcast and just share it with someone who you think could benefit from one or two hacks and strategies that we discuss today. You can also watch this on YouTube, like I mentioned, where you get loads of recipes. We're doing a lot more stuff on YouTube. And if you're struggling to think of recipes for how to put into action what we're talking about with Dr. Louisa, the types of omega-3 fats, the plant-forward approach to healthy eating, the greens, the different nutrient-rich ingredients that we want to be having every single day, go to thedoctorskitchen.com, go to the recipes, check out what we have there, and you can filter them according to brain health. We've done all the hard work for you. We've done all the research, we've put all our references there, and we've formulated recipes that are specifically designed with those ingredients and dietary patterns that align with good brain health. For now, onto the podcast with Dr. Louisa Nicola.
Dr Rupy: Louisa, thank you so much for coming in. We are privileged to have you here. I know you've flown in from New York. Um, I want to get right into this. Uh, how do we prevent Alzheimer's and dementia using food and lifestyle?
Dr Louisa Nicola: That is a loaded question. Because if we really, if we really, you know, knew the answer to that, then I don't think 55 million people worldwide would have the disease. I think in order to tackle that question, we need to first understand what dementia is, what Alzheimer's disease is, and what are the reasons why we're getting it. I love to reverse engineer everything. Because I don't know if you know some of the stats, um, it is the second leading cause of death in the United Kingdom.
Dr Rupy: Gosh.
Dr Louisa Nicola: Yeah. I live in the United States, so if I, you know, if I, if I muddle some things up, please bear with me. However, it's, um, it's scary. You've got around a million people in the UK who have Alzheimer's disease, around six to seven in the US. The scary thing is that number is said to triple by the year 2050. Yeah. And look, it's coming mainly from lifestyle. We know that this is a lifestyle-driven disease. And something that's very controversial that I've been stating, I think only in the past four, five months. It is Alzheimer's disease, as of 2024, in my opinion, Alzheimer's disease is now an optional disease.
Dr Rupy: Ah, okay.
Dr Louisa Nicola: So you have the option. And I always say that if you are, you know, a teenager going into adulthood, you are at the best stage of life to be preventing this disease. And now, gratefully, you've got so much education from the free market available to you to prevent this disease.
Dr Rupy: Yeah, absolutely. I mean, I think it's a really important point and I just want to double click on that actually, that everyone should be thinking about dementia given the fact that it is so high up on the list of, uh, causes of death in the UK, but also in the US as well. Um, but also the fact that it is preventable. I think when I was at med school, I didn't really think about it through the lens of prevention. And I still think doctors today don't think of it about it as a preventable disease. So I'm really interested to dive into some of these lifestyle factors.
Dr Louisa Nicola: Yeah. So when we look at dementia, dementia is usually the umbrella term that is used to define, you know, somebody who starts to have some cognitive complaints, whether it's, uh, a network insufficiency such as, I can't think properly, uh, information processing speed is declining, I'm forgetting people's names. But then you've got these categories that sit underneath that. We've got frontotemporal dementia, we've got dementia with Lewy bodies, we've got Parkinson's dementia. Then we've got Alzheimer's disease. And the reason why we know that is because, the reason why we know that one most prominently is because that's the one that affects most people. And that's the one that, which I hate to say, is literally driven, like 98% of these cases are driven through lifestyle factors.
Dr Rupy: 98%?
Dr Louisa Nicola: Yeah. So what it is, let's just have a bit of a neuroanatomy course, go back to neuroscience 101 in, in med school. We've got the brain, which is around two pounds, and it's kind of like hard jello. Around 87 billion neurons that we have. They're, they're brain cells. We all have them, okay? And per neuron, these neurons communicate with each other, and there's around 5,000 connections per neuron. So if you do the math, that's around 500 trillion connections happening in your brain. These connections are responsible for how we think, how we move, how we process information. Now, Alzheimer's disease, and we call that a neural network, the network, right, of how they're all communicating. Alzheimer's disease is a network insufficiency. So you're getting a decline in the brain's ability to communicate, in the neuron's ability to communicate with one another. The way they communicate is via these, these little spikes that come off of the, the nucleus, of the cell body, I should say. And they're called dendrites. And they're the ones that tend to die off. So instead of having 5,000 connections per cell, you may have 3,000, 2,000, zero.
Dr Rupy: Okay.
Dr Louisa Nicola: And that's what's responsible for brain volume, by the way. I think, I don't know if you've, um, ever seen some statistics around exercise, for example, you'll see that around 85% of brain gray matter is modifiable by physical activity.
Dr Rupy: 85%?
Dr Louisa Nicola: Correct. But we, you know, a lot of people think, well, does that mean we just get bigger brains or we grow new brain cells? No. Unfortunately, adult neurogenesis doesn't exist. Basically, what that means is we just get more connections. And who doesn't want more connections?
Dr Rupy: Okay. So just to define that, so adult neurogenesis is you can't grow new brain cells, but you can grow new connections. Have I got that right?
Dr Louisa Nicola: That's correct. We can, however, grow new brain cells in a specific structure of the brain called the hippocampus.
Dr Rupy: Okay.
Dr Louisa Nicola: And we've seen that. We've seen that through the earliest studies by Marion Diamond back in 1960 who showed first in mouse studies that we can grow new neurons, especially in the hippocampus through aerobic activity. We now know that humans can, however, it is, it is definitely just in that region and the hippocampal subregions. And for everybody listening as well, that's the area, it's this seahorse-shaped structure deep in the temporal lobes. And that's the area that the, that is the first one to go during Alzheimer's disease. It shrinks. But that's where we hold our memories, memory formation, learning, episodic memory as well. So if that is the first thing to go during Alzheimer's disease, but we know we can slow the progression of that deficit through exercise, then why are we not exercising? I don't know the stats in the UK, but in America, we've still got 75% of the adult population who don't meet the physical activity guidelines.
Dr Rupy: Yeah, I can imagine something similar in the UK for sure. You mentioned one thing that I just want to go back to just for the listeners, gray matter. Yes. What do we mean by gray matter and and white matter?
Dr Louisa Nicola: So our brain, like I said, is made of neurons. They are the brain cells. And when you look at neuroimaging, and this is pretty much how it came about, when you look at an MRI, it slices your brain, you know, coronal, different types of images we see. And when the first studies were done of the brain, they saw that the outer portion, the cortex, we call it, looked gray or darker, and the inside looked whiter. So that's where it came from. But basically what that means is the gray matter is our neuron cell bodies, and the white matter is the myelinated part of the neurons. So myelin sheath, people probably heard of that. That's where all of our conduction velocity takes place.
Dr Rupy: Okay. Yeah. So it's where speed of thought, speed of action takes place. And this is what tends to degenerate in diseases such as multiple sclerosis.
Dr Rupy: Okay. So you mentioned the myelination. So I've got this idea of like a, you know, a cable with a plastic wire around it and that conduction improves the velocity and the speed of of these connections. Um, and you mentioned, uh, delaying the, the sort of Alzheimer's disease. What about prevention? Is that, is that something that we can also do with the same input?
Dr Louisa Nicola: Yes, so we can delay it, we can prevent it. We cannot reverse it and there is no cure. And we're going to go into what the current, I guess, cures are, if you will, which I, I hate using that term because all of the medications right now, which are, you know, they're, we've got some FDA approved IVs. If you have Alzheimer's disease, you go in, you take this IV, it is just treating the symptoms. Now, what is classified as Alzheimer's disease? It is pretty much if you go and get a an MRI, we call MRI with volumetrics or you get a spinal tap where you take some of your cerebral spinal fluid out, you're generally going to find a buildup of this protein called amyloid beta. So if we have a certain amount of buildup in there and we see some maybe white matter lesions, okay, some, some deterioration in the, in the white matter tracks that I just mentioned, we're going to see, maybe you'll see some, some brain atrophy as well. You may be classified as having Alzheimer's disease.
Dr Rupy: Okay.
Dr Louisa Nicola: So it's, it's, there's two hallmarks to it. There is the buildup of amyloid beta. But you've also got another protein involved. And that is called tau. So you could say now that Alzheimer's disease is a multi-proteinopathy.
Dr Rupy: Okay. Multi-proteinopathy. So you've got different types of proteins that are in excess, would you say, or?
Dr Louisa Nicola: In excess, yes. And what happens is they end up building up and they basically take over your brain. But here, Rupy, here's the, the most fascinating part of this. Amyloid beta has long been held as the demon. 20 years ago, even, even five, 10 years ago, Alzheimer's disease was known as the amyloid cascade hypothesis, meaning that it's just a cascade of amyloid in the brain and amyloid's the demon, but amyloid is not the demon. Amyloid is necessary. So what we've, uh, what I found, I don't know, um, I should have sent it to you. I, I, I first authored a paper that was published probably about six months ago now. However, and this is what I do. I'm constantly researching and analyzing. But what we know now about amyloid is that amyloid is an antimicrobial peptide.
Dr Rupy: Ah.
Dr Louisa Nicola: You've got it. I have it. Mine's probably getting built up right now in my brain because I am a bit under the weather. But antimicrobial, what does that mean? That means that this comes up when our innate immune system is activated. When we are stressed or in the presence of inflammation, your brain is there for two things, survival and reproduction. So it's going to protect it at all costs. If you are inflamed, and we can talk about that because that's a buzzword right now. Inflammation, it's bad. When you are inflamed, you activate your innate immune system. It's the first, the body's first line of defense. And so your brain is like, oh, she's inflamed, we're going to raise amyloid to protect the brain.
Dr Rupy: Okay. Uh-huh.
Dr Louisa Nicola: Now what happens is, that's fine. You know, I, I'm young, I take, I take good care of myself. So what happens is, I then, I can get rid of that amyloid through exercise and through sleep, mainly through sleep and through the foods that I eat. So I'm supporting my brain. So that's okay. What happens is, if we keep building it up and building it up and we don't clear it, then you've got a problem. So the amyloid is now starting to take over and what I call Alzheimer's disease is basically your brain has said, all right, I give in. I give in. You have not, we've got too much amyloid now, Louisa. I'm going to rest. And that's when you go into the nursing home.
Dr Rupy: Gosh, okay. Do, this might be an early question, but do you think different people have different thresholds of, uh, the amount of amyloid that they can tolerate that actually leads to the symptoms of, of Alzheimer's that are actually displayed through, you know, working memory tests and all the rest of it?
Dr Louisa Nicola: Yeah, you've, you know, that's a, a really good question. So the amyloid builds up outside of the neuron. I think we need to just cover that first. It builds up outside in the blood vessels. And so when it builds up outside, it then blocks the connections. We've seen people who have, who don't have dementia or Alzheimer's disease, but they have a head full of amyloid. So that could, you know, plausibly, we could say yes. However, it's a very, probably touch and go basis.
Dr Rupy: Sure.
Dr Louisa Nicola: Yeah, very minor, a minor amount of people who can tolerate that.
Dr Rupy: Okay. Um, so there's amyloid. Does tau appear to have any protective effects? I love thinking about sort of the body through this lens of, um, evolution. You know, clearly amyloid has served a purpose and very much in the same vein, we used to think of all microbes as bad and we know actually 99% of the microbes in and around the body are actually doing us good. It's interesting to see that sort of reframing of amyloid. Is there a same, the same thing going on with, with tau?
Dr Louisa Nicola: So tau is a completely different ball game, right? So tau actually builds up inside the microtubules of the axon.
Dr Rupy: Uh-huh. Okay.
Dr Louisa Nicola: And so what happens is, I've got this analogy. I, if we're in America, I would probably have brought my, there's these little, um, plastic things that you tie on maybe suitcases and you can lock them. I don't know what they're called, but that's what basically your microtubules look like. So they're in the axon, right? And these microtubules are responsible, you just think of, think of a roller coaster, you know, the two tracks. They're responsible for just keeping that axon nice so like information can pass down it freely. This tau ends up building up around those microtubules and it collapses the microtubules.
Dr Rupy: Okay.
Dr Louisa Nicola: So you get the collapse within the neuron. So that's why we start to get slowed thinking.
Dr Rupy: Okay, okay.
Dr Louisa Nicola: Yeah.
Dr Rupy: So from, at this point, we don't really know of a protective mechanism behind tau.
Dr Louisa Nicola: That one, no. That one's not the protective mechanism.
Dr Rupy: You mentioned brain inflammation or inflammation in general. Um, you know, we only recently found out about the ability of the blood-brain barrier to be permeated. So inflammation can move from your body into your brain. What do we know about inflammation and what causes inflammation and the relationship with dementia and Alzheimer's more specifically here?
Dr Louisa Nicola: Yeah, so you're referring to neural inflammation, inflammation of the brain and spinal cord. And I, I love to just tell everybody that this is like a Goldilocks, like scenario here. Too much of it is bad. That's chronic inflammation. But we need it. So not enough of it is also bad. We, we are inflamed and we need inflammation when we exercise. It's a normal thing. So too much of it is bad and evidently if it does get into the brain and causes neural inflammation via the, via the blood-brain barrier, then it can cause a cascade of issues. So this is why I actually love turmeric. I don't know if you've ever talked about that with your...
Dr Rupy: But, but please, let's talk about turmeric. I love talking about turmeric.
Dr Louisa Nicola: So what, look, first of all, what causes inflammation? Look, toxic exposure, uh, lack of sleep, quality sleep, both quantity and quality, lack of physical activity, sedentary behaviors, the food, evidently, you know, ultra-processed foods, the food that we eat. I think we are demonizing it though. I don't want to, you know, the dose makes the poison. I'm not even in the bandwagon of, uh, seed oils are completely detrimental. I think there's many more things that are detrimental. Again, unless you're going to go and have a barrel of seed oils, I think we have to be a bit lenient there. But just know that if you are doing the, you know, at neuro athletics, my company, we teach everybody about this pyramid of human performance. The pyramid is just three steps. It is exercise at the bottom, then sleep, then nutrition. Then you've got these accessory items that sit on top of the pyramid, which is kind of like icing on a cake. The accessory items are ice baths, saunas. Unless you are absolutely proficient in these three things, there is no point in doing any of the above, supplements. So if you can meet these three things, you are basically setting your body up. Yeah. For, in the way that it should be, basically setting it up for war.
Dr Rupy: Yeah, yeah. I think we've established A, this is a really important topic and I think people have an idea of what we're talking about with Alzheimer's and dementia. Let's start at that base. I want to start at that sort of that foundational base of building aerobic strength or or just cardiovascular strength, let's say. How do you, uh, communicate the importance of exercise through the lens of brain health and where would you start in terms of the types of exercise and then we can get into the dose of exercise as well.
Dr Louisa Nicola: Exercise is the elixir to brain health. Now my advisor, I'm doing a body of work right now and my advisor, Dr. Tommy Wood keeps telling me, stop saying that. I'm like, I won't. And at the end of probably every post I put on social media, it is exercise is medicine. This is fundamentally the most important thing you can do for your overall longevity and your brain health. If we cut exercise up into three categories, we've got aerobic, we've got resistance training, and then we've got neurocognitive training. All serve a benefit. So, aerobic training, what is it? And this is the first ever studies that we had and that it was because when you put mice, you know, we, we first experiment with mice before humans, when you put them on a wheel, it's just much easier than to have them push weights. 1960s, that's when we first realized, and Marion Diamond did this. She got two groups of mice, split them up. One group was just the sham control, which she did was she put them in a, in a box, in a shoe box where they didn't have what she called an enriched environment. Dark, didn't have many, the mice didn't have many friends, many things to do. Then the other ones, she put them in an enriched environment. They had wheels, they had little steps, they had friends, sunlight, exciting times, right? And over the course of six months, that's when she found that the mice in an enriched environment improved cognitive scores, they improved gray matter, white matter. And that then birthed what we know now as aerobic activity is good for your brain. So what does it do for your brain? So I'm talking about long distance running, right? In your zone two. Okay. Zone two is typically classified loosely as around 65% of your maximum heart rate.
Dr Rupy: Okay.
Dr Louisa Nicola: When you can sustain it for around 90 minutes, or maybe 60 minutes, right? What are we doing? Well, when we're running, we are releasing these hormones, right? One of them is called BDNF.
Dr Rupy: Okay.
Dr Louisa Nicola: Sure you've heard about it because the 90s were all about BDNF. Brain-derived neurotrophic factor. What that is is it is a growth factor for the brain.
Dr Rupy: Okay.
Dr Louisa Nicola: And that's what Marion Diamond found. She found that when we produce a lot of this, it acts as fertilizer, if you would, for the brain cells. Basically, it goes into the brain, it goes into the hippocampus specifically, and it helps with the growth and proliferation of new brain cells in the hippocampus. That's what it's responsible for. So we get a big boost of that. It's really great for also depressive-like symptoms.
Dr Rupy: Okay.
Dr Louisa Nicola: So this is why you feel great when you exercise because you're getting a release of these neurotrophic factors.
Dr Rupy: That runner's high.
Dr Louisa Nicola: That runner's high.
Dr Rupy: Okay.
Dr Louisa Nicola: You're also doing another thing which I think is is not spoken about enough and this is getting into more of the exercise physiology. You're getting something called cardiac remodeling.
Dr Rupy: Cardiac remodeling.
Dr Louisa Nicola: Yeah.
Dr Rupy: Okay.
Dr Louisa Nicola: So think back to med school, right? You've got, you've got your cardiac system, you've got your, your heart, you've got these chambers that come out of, you know, you've got this massive artery, it's called the aorta. You've got so many other things happening. What's your heart, what type of muscle is it? It's just like the muscle in your actual legs, right? So when you train it, it remodels itself. And we have a study actually from Dr. Ben Levine, he's a cardiologist, turned sports cardiologist. Wonderful study, right? What he did was he took a group of, he took 50, 53 year olds, or 53, 50 year olds, right? He subjected them to two years of maximal aerobic exercise. So this is when you're going into your VO2 max. So around 80 to 95% of your maximum heart rate.
Dr Rupy: So super strenuous.
Dr Louisa Nicola: Super strenuous.
Dr Rupy: Like Tabata type style, like hit training.
Dr Louisa Nicola: Like running.
Dr Rupy: Oh, right. Okay.
Dr Louisa Nicola: Okay. I wasn't, I'm not aware of the exact protocol, but they were reaching that strenuous state.
Dr Rupy: Gotcha.
Dr Louisa Nicola: What he found, and he took 3D models of the heart, he did echocardiograms, he did everything to, to really look at the heart, right, of these 50 year olds. After two years, and he subjected them to four hours a week of maximal exercise, which is a lot.
Dr Rupy: That is a lot.
Dr Louisa Nicola: That is a lot. And I don't actually suggest that, but this is just, this is what happened. Over the course of two years, he reversed the age-related decline in the heart by 20 years.
Dr Rupy: 20 years.
Dr Louisa Nicola: So these 50 year olds now had a 30 year old heart.
Dr Rupy: Gosh. Wow.
Dr Louisa Nicola: So what does that mean? Well, that means that as we age, many things happen to our cardiac system. One thing is we get stiffening of the arteries. Unfortunately, and this is probably why you advocate, I guess, for, um, lowering cholesterol. We, we don't, we want those arteries nice and we want blood to be able to flow through them. That's the first thing. So we get stiffening of that. With your heart, you've got a left and a right chamber. And the right chamber gets all of our deoxygenated blood. And the left chamber actually, it, it expels blood to your, your organs and your muscles when you're exercising. We get something called left ventricular hypertrophy. So the, the left ventricle becomes a bit smaller and stiffer. And so he actually reversed that part of it. So therefore more blood was able to pump through the heart.
Dr Rupy: So the actual chamber of the heart is smaller and the actual the thickness of those chambers is bigger.
Dr Louisa Nicola: Yes, more efficient.
Dr Rupy: Ah.
Dr Louisa Nicola: So more efficient blood flow. What do we know about more efficient blood flow? What's good for the heart is good for the brain. If you can be pumping out the right amount of blood with less beats per minute, this is why resting heart rate comes into it. So the fitter you are, the lower your resting heart rate. That means that we are efficiently pumping blood to the heart, to, to the brain while we sleep, while we're awake, while we're exercising. So it's better for the brain because what does blood do? It delivers oxygen, nutrients. It's a, it's a delivery truck, if you will, for all of these myokines, muscle-based proteins, all of these hormones.
Dr Rupy: Mm.
Dr Louisa Nicola: So,
Dr Rupy: Yeah.
Dr Louisa Nicola: that's one reason why we should all be exercising.
Dr Rupy: This is, it's phenomenal for me because if we've been sitting on this research from the 1960s about how exercise can literally impact the volume of the hippocampus, and I, I'm just thinking back like 25 years ago when I first went to med school and we learned about brain health, we learned about dementia, I never really was given the importance or told of the magnitude of effect of exercise. And I've, I've, I've been, unfortunately, in many scenarios where we've had older patients who are on the wards being told to take donepezil and all the other medications that we know aren't as effective as we'd like them to be. But if we're sitting on an intervention like exercise that has all these other benefits, surely this is something that should be on the prescription pad of of every patient with Alzheimer's.
Dr Louisa Nicola: Surely, yes. However, what would happen if we didn't have Alzheimer's disease? What would that do to the healthcare industry? People wouldn't make money. Um, pharmaceutical industry wouldn't make money. I mean, I'm not sure if you're aware of the cost that if you have Alzheimer's disease, you're up before you pass away, the statistic is you're going to spend 350,000 on your medication.
Dr Rupy: 350,000?
Dr Louisa Nicola: Yes. So it's around 80,000 per year and between,
Dr Rupy: I imagine this is in the States.
Dr Louisa Nicola: Well, sorry, I am talking in the US. Yes.
Dr Rupy: But it would still cost the NHS a similar amount. It's just that the individual doesn't see that cost. It's sort of passed off to the state, which we...
Dr Louisa Nicola: Which is going to be the collapse of the healthcare system. Correct. And this is, just so everyone knows, there has been, um, some breakthroughs in the FDA approved drugs right now. We've got Donanemab, we've got Leqembi. When I say breakthroughs, they have become approved. So if you have Alzheimer's, you can get this. But here's the issue. They are reducing the amyloid in the brain. But that's not the problem, right? We can reduce it, but you know what's happening? And the New, New England Journal of Medicine actually showed this. You're increasing, you're getting these microhemorrhages from taking these drugs. So you go in, you take an IV, they are causing hemorrhages. So you're getting brain bleeds. You are getting brain atrophy. They are going in and they're doing the scans of people who have been on, you know, Leqembi, Aducanumab even. And they're seeing these brains and they're like, this brain is around 4.5 grams lighter than what it was. You could equate that to, well, that's 4.5 grams of amyloid, but that's, that's really scary, right? So you're getting brain atrophy, you're getting these brain bleeds. So there's, it's a very risky, risky procedure to be doing. And not just that, you're only reducing the symptoms. It doesn't build the connections. You still have to then go and build the connections through exercise.
Dr Rupy: Yeah, yeah. I, I think there's this sort of like binary approach, unfortunately, that is rife within medicine beyond neurology, actually. And this plays out even more so in Alzheimer's disease. You know, if amyloid's the problem, we're going to do everything to attack amyloid without really thinking about the other elements or the risk of of other conditions as well. I'm sure it has a knock-on effect on a number of other issues.
Dr Louisa Nicola: 100%.
Dr Rupy: So we'll go back to exercise. Okay, so we know we should be doing aerobic physical activity.
Dr Rupy: What kind of dose are we talking?
Dr Louisa Nicola: So my recommendations, well, the, the physical activity guidelines in the United States, but I do believe I've looked across the board and they're all, um, general. They say that you should be doing around 150 to 300 minutes of moderate to vigorous physical activity. Uh, just because this is what I do for a living, I like to categorize that. I think you should be doing at minimum three hours a week of steady state zone two.
Dr Rupy: Okay. Yeah, you mentioned zone two. So give, give folks an idea of how you might calculate zone two, perhaps in the, in a lab using some of the equipment that you're used to. And if they can't afford that, or how do you, how do you know that you're in your zone two? How, how can you sort of guesstimate?
Dr Louisa Nicola: This is what I want to just be really easy. Like for the aficionados, I think everyone should go and get a VO2 max test. I'm actually pushing for that to be part of the, you know, screening at your doctor. Like, you know, exercise should be a vital sign. You can get a VO2 max at your local university or I know that there are just plenty now opening up. So just look up VO2 max. It's a measure of your peak cardio-respiratory fitness.
Dr Rupy: Okay. I don't know, have you ever had one done?
Dr Rupy: I've had one done. I had one last year.
Dr Louisa Nicola: Okay, great.
Dr Rupy: And it's, uh, it's not pleasant. It is, it is.
Dr Rupy: It's not, it's not a ride in the park. That's for sure.
Dr Louisa Nicola: But here's the thing. Here's my issue with it. Okay? You should have, like, you should, did you gas out to the point where you thought you were going to...
Dr Rupy: Yeah, yeah.
Dr Louisa Nicola: There are a lot of people who are doing VO2 max tests now that are going to people who may not be doing it the right way. Like, you should have a crash cart next to that, you know, next to that treadmill. I want everyone to know, make sure there is a, not that you're going into cardiac arrest, but like, you should go to the point of, we have some, what we do is we actually have you harnessed.
Dr Rupy: Ah.
Dr Louisa Nicola: Yeah. So to the point where you go until you collapse and we catch you.
Dr Rupy: Wow. That's, yeah, yeah. No, I didn't go that far. I didn't gas out that much. No, no, no. But I did it to the point where I just couldn't push anymore. And I was on the bike as well because I don't, I like to run, but running's not my, my favorite sort of aerobic exercise. So I did it on the bike and I didn't do as well as I thought I was going to do. I got like a 43, 43 mils.
Dr Louisa Nicola: Well, without, um, being too intrusive because I, I don't know your age group, but it, you what happens?
Dr Rupy: I'm 39.
Dr Louisa Nicola: Okay, great. Uh, yeah, I'm, you can look up if that is, uh,
Dr Rupy: I think I was like the higher end of good.
Dr Louisa Nicola: Okay, great. Yeah, it goes, you know, you can go average and then fit and then elite. And I, we strive to get all of our clients into the elite category of the decade below.
Dr Rupy: Okay, right. So I've got a long way to go. I want to go into elite for my age group at least, but...
Dr Louisa Nicola: But I think everyone should get that VO2 max because within that, you can determine your zone two. But for everybody out there who is just like, you know, like my, my parents refuse to get one, by the way.
Dr Rupy: Oh, neither my parents would not do that. Absolutely not. Because it is quite scary. It's quite a lot of, you know, I mean, it's not particularly costly. I wouldn't say it's that expensive, maybe like 150 pounds. And I think for the benefit that that's going to give you, it's phenomenal value for money. But the actual process for someone perhaps who is quite sedentary is very uncomfortable. So I don't imagine a lot of people would be queuing up for one.
Dr Louisa Nicola: Exactly. So the way that you would work this out is you can just get on a treadmill and when you're ex, or wherever you're exercising, basically do a talk test. You want to be able to hold a conversation with somebody next to you. Okay. But to the point where like every time you, you know, stop the sentence, it's like, you know, it's hard to breathe. So you're not walking, depending on how fit you are. Probably a light jog.
Dr Rupy: Okay.
Dr Louisa Nicola: Yeah. So you're at that state and you want to be, and you can keep this. So many things happen in that state, by the way. We can keep going. Like it is just, it is literally medicine. You're also inducing mitochondrial biogenesis.
Dr Rupy: Let's talk about that.
Dr Louisa Nicola: That's just a fancy word for you're creating and growing new mitochondria.
Dr Rupy: What, what, what's so important about mitochondria? Like, because if people haven't heard of mitochondria for the first time, like what, what is it and why is everyone going on about it?
Dr Louisa Nicola: It's because within the cell, we have these little things, organelles, they're called mitochondria. That is the site of energy production. So you eat food and it gets turned into energy and we can use that energy. If I eat a banana versus if I eat some potato chips out of a bag, my, I'm going to end up getting more energy from the banana. So what happens is the banana goes into your body and it actually gets filtered through the mitochondria. Mitochondria breaks it down and it produces energy called in the form of something called ATP. That is our, our, our currency.
Dr Rupy: Gotcha.
Dr Louisa Nicola: And the ATP is what we use for energy. So we need mitochondria for better health because we need energy for everything, for fighting off disease, for fighting off, uh, age-related diseases, even for our immunity. And they did, you know, I think two, three years ago, I was talking about this, the famous study done on centenarians where one of the predictors of getting to age 100 is these people had more mitochondria.
Dr Rupy: Ah, and did they do that through muscle biopsies or something? Is that how they...
Dr Louisa Nicola: I believe that. There was about, I think there was about 20 different things that they came up with. But here's the problem. Mitochondria can be healthy or it can be dysfunctional. So we have to ensure, and they're like little factories. Imagine these little factories that go to work and, you know, just chugging out. Exactly. If it's, if the factory's broken down, that means when the banana goes in, I don't know why I thought about a banana. It just, it doesn't actually give us the energy we want. So we want healthy mitochondria. When you are training in that zone two, right? You are training within the mitochondria. Okay? Not outside. We're not using lactate. So we're, we're, we've got our lactate below two millimoles, which is getting too fancy, so we'll stop there. But basically, when we're training in there, we produce more. You know, basically the mitochondria is like, hey guys, she hasn't got much mitochondria. We need more energy. Can we, can we just grow new ones to give her more energy?
Dr Rupy: Gotcha. So aerobic exercise, you want to get into your zone two. Is there a, like a, a particular dose that you think is optimal? I know the guidelines are 150 minutes per, per week, but is there a, is there a sweet spot where for people who are like, like looking to optimize it even further, like that you would recommend on a, on a daily basis?
Dr Louisa Nicola: You're building your base in zone two. If you can, look, if you can run at in zone two for five hours a week,
Dr Rupy: Really? Okay.
Dr Louisa Nicola: Beautiful.
Dr Rupy: Okay.
Dr Louisa Nicola: Because you're building your base.
Dr Rupy: Okay.
Dr Louisa Nicola: So, but look, general, like minimum three hours a week. And here's the, here's the catch. You can't just go out. It's not made up of 10 minute intervals. You have to do at least, at least 45 minutes all in one go.
Dr Rupy: Gotcha. So it's, it's a bit about the, uh, extent to which you're in zone two, as in the time that you spend in zone two, as well as the frequency that you, you pepper your week with it. Is that right?
Dr Louisa Nicola: Correct, yeah.
Dr Rupy: Okay, great. Because a lot of people might be listening to this and be like, oh, okay, fine, I'll do my three hours zone two on a Saturday. Yeah. Is that, so you want to sort of space it out as well?
Dr Louisa Nicola: Space it out, yeah.
Dr Rupy: Okay, great.
Dr Louisa Nicola: And then on that, you want to be doing at least 20 minutes a week of VO2 max.
Dr Rupy: Okay.
Dr Louisa Nicola: Okay, of that hard, feel like I'm going to die zone.
Dr Rupy: Right.
Dr Louisa Nicola: Yeah. I call them sting sessions.
Dr Rupy: Okay. How many of them a week?
Dr Louisa Nicola: Just 20 minutes a week.
Dr Rupy: Just 20 minutes a week. Okay, fine. That can be done in one session or?
Dr Louisa Nicola: Yeah, I do that in one session. I do a 4x4x4 principle.
Dr Rupy: What's a 4x4x4?
Dr Louisa Nicola: Four minutes on.
Dr Rupy: Uh-huh.
Dr Louisa Nicola: Four minutes off.
Dr Rupy: Four minutes on? Gosh, that's a lot.
Dr Louisa Nicola: Yeah. So here's, here's the thing. You know, now that we're Instagram friends, you'll see this every Monday is VO2 max day, but I do it on the step machine. Okay. And so you start your timer on, okay? And by the time you get to your max, it's going to take you two minutes. So you're probably in your maximum for about a minute and a half.
Dr Rupy: Okay, okay.
Dr Louisa Nicola: But it does feel like the death zone.
Dr Rupy: Mm, yeah.
Dr Louisa Nicola: You have a four minute break completely off. Repeat that four times. So that's more than 20 minutes, okay? So you'll do that just one day a week can, you can, you can go from your above average to elite zone.
Dr Rupy: Okay.
Dr Louisa Nicola: In your VO2.
Dr Rupy: So again, BDNF benefits, cardiac remodeling benefits, myokine benefits as well. That's all.
Dr Louisa Nicola: We're going to get into that in resistance training.
Dr Rupy: Okay. Okay, great. Um, I'm, I'm definitely going to do that. And I'm working on my hit training as well, but I'm nowhere near four minutes on at the moment. I'm doing two minutes on the bike with a two minute rest and then repeating for about 20 odd minutes once a week.
Dr Louisa Nicola: So yeah, so that interval training shows some benefits of around, I think a 6.7 percent increase as whereas the 4x4, which is the most, um, I guess the gold standard for improving that is probably you're seeing a benefit of around 10%.
Dr Rupy: 10% on VO2 max?
Dr Louisa Nicola: Yeah, so you're going, like that, I know you're like, oh, but six to eight, it's like that's huge, especially if you are in that, you know, I, every Monday, I'm like, I look at that step machine, I'm like, it's war. Yeah.
Dr Rupy: That's good to know. I'm going to start, uh, making sure I'm, I'm, uh, paying attention on Mondays to see whether you're, you're keeping up with it. How long have you been doing that for?
Dr Louisa Nicola: Look, I was a, I was a, an elite triathlete back in my day.
Dr Rupy: Okay.
Dr Louisa Nicola: So I've been doing it for quite a while.
Dr Rupy: Okay. Yeah, yeah. So it's like second nature to you.
Dr Louisa Nicola: Yeah.
Dr Rupy: Yeah, yeah. Let's talk about resistance training. Um, yes. I love it. I love it. I'm so excited. Uh, what, what are some of the benefits of, uh, of resistance training to the brain and, and then we can talk about dosing and how, how one might start with it.
Dr Louisa Nicola: So, I'm going to send you my paper.
Dr Rupy: Okay.
Dr Louisa Nicola: All right, which was all about how does resistance training in older adults in with mild cognitive impairment, like what happens, right? And it basically was a narrative review and we found many things. So first of all, I'll go through and I had to write these down. Okay, yeah. You know, I've got around 1500 references in there, but I want to make, I just really want to point out two studies because I think this is going to be really great, especially for the women listening. The first study I'll point out was one called the SMART study. They took 100 men and women, around 55 to 87 years old, who had mild cognitive impairment. Now that's important to note. So they subjected them into four groups. They did a two by two trial. They did resistance training, um, they did cognitive training, and then they did one with both and then they did a sham, people who didn't do anything. After six months, what they found was that they all just maintained their cognitive scores.
Dr Rupy: Okay.
Dr Louisa Nicola: So they did various cognitive tests, Stroop tests, other basic cognitive tests. So they didn't decline because mild cognitive impairment is a pre-dementia state. You have got normal individual, normal person goes into subjective cognitive impairment. That one goes into MCI and then MCI turns into dementia.
Dr Rupy: Got it.
Dr Louisa Nicola: I hate the word MCI, by the way.
Dr Rupy: Why is that?
Dr Louisa Nicola: Mild cognitive impairment. There is nothing mild about it. I don't know if you've seen patients, but I certainly have. And there is nothing mild about it. It's basically saying that you have mild metastatic cancer.
Dr Rupy: Yeah, I get you.
Dr Louisa Nicola: You know, I think everyone should understand that Alzheimer's disease is comparable to end-stage cancer.
Dr Rupy: Yeah.
Dr Louisa Nicola: So, that's another discussion. So they didn't decline. So that was great. Then there was another study done, which was even better. It was called the Mind Power study. You know, some caveats in that because what happened was they took 155 women, only women, 65 to 75, and they randomized them. They didn't have MCI, they were healthy. This is great. They subjected them to once weekly or twice weekly.
Dr Rupy: Okay.
Dr Louisa Nicola: So, two people were doing, uh, twice, uh, resistance training or one day a week resistance training. This was over two, 52 weeks. So, a year. What they found was they found significant improvements in attention, cognitive scores, information processing speed, and memory.
Dr Rupy: Wow.
Dr Louisa Nicola: They also found that the resistance training group decreased their brain volume.
Dr Rupy: Decreased their brain volume?
Dr Louisa Nicola: Decreased. I know. What does that mean? They removed the existing plaque that was in their brain.
Dr Rupy: Wow.
Dr Louisa Nicola: Yes. And they improved the networks.
Dr Rupy: Wow.
Dr Louisa Nicola: Yeah. So that was monumental.
Dr Rupy: Yeah.
Dr Louisa Nicola: So how does it happen? What is it? So resistance training is, what did I call, I called exercise the elixir. Resistance training is the panacea for brain. I'm running out of words, right? I looked them up in a dictionary, but like what is it?
Dr Rupy: Your mentor is cringing right now. He's like, no, stop saying that.
Dr Louisa Nicola: What is it? Basically, so what happens when we're resistance training, we are contracting a muscle, right? Let's think of a bicep curl. We contract our muscle. Under tension, what happens is the muscle fibers, they release myokines. Myokines are muscle-based proteins. They're hormones. They only live in the, the cells of the muscles. They don't live anywhere else. And they do absolutely incredible things. And we're finding out more and more. My dream is to discover one.
Dr Rupy: Okay.
Dr Louisa Nicola: And there's a lot of work done out of Denmark by a wonderful physician, scientist, her name is Bente Pedersen. I'm going there to find her and interview her.
Dr Rupy: Oh, nice.
Dr Louisa Nicola: Because she refuses to do an interview with me. So I'll fly to her. But she coined this term myokine.
Dr Rupy: Okay.
Dr Louisa Nicola: Okay. So these hormones, they, they, they come out of the muscle cells, they go into the bloodstream. And then when they're in the bloodstream, they go everywhere. So we know that they go up, they cross that blood-brain barrier, and they have effects on the brain. They can help us grow new brain cells in the hippocampus. They help with BDNF. So they help express BDNF more. They go into the frontal lobe. The frontal lobe of the brain houses our prefrontal cortex, which houses our executive functions. So all of our cognitive performance takes place, it enhances that. It helps with the delivery of neurotransmitters, which is why we probably feel better when we exercise. It helps with dopamine release. Amazing other things that happen, which is just now coming out, which is exciting me, is it can actually inhibit tumor cell growth.
Dr Rupy: Wow.
Dr Louisa Nicola: Yeah. So, uh, there's great studies that have been done to show that it goes in and actually inhibits prostate cancer, prostate tumors from forming. There is another reason to be doing this. Another thing that happens is it, interleukin-6 is one of the myokines. What do we know about IL-6 and the, the interleukin family? We know that they're pro-inflammatory. You know, we don't want interleukin-6, it's, you know, that's bad. Yes, okay, depending on what site it is released from. When it's released from the muscle as a myokine, it becomes anti-inflammatory.
Dr Rupy: Okay.
Dr Louisa Nicola: So, during interleukin-6, when it actually is released, it's also getting into tumor cells and shrinking them.
Dr Rupy: Okay.
Dr Louisa Nicola: Yeah.
Dr Rupy: Uh-huh.
Dr Louisa Nicola: It's absolutely monumental. And not just that, we are also seeing that it is going through and so what happens, I'll just give a quick breakdown. When you're at stage one cancer, right, you've got a tumor that has gone into a certain organ, right, where it's stage one, right, so that's the time where we can, you know, intervene and and odds are great. What ends up happening is this tumor releases these things called circulating tumor cells and it goes through and they bind together and they have their own, you know, these tumors have their own blood vessels. So they're, they're mighty. It's like a little army and they go and lodge somewhere and then it becomes metastatic cancer. So when these circulated tumor cells are circulating through the bloodstream, myokines can actually go through and ameliorate those circulating tumor cells.
Dr Rupy: Wow. Yeah.
Dr Louisa Nicola: So it can be used and not just that, we're now seeing that through these myokines, you can actually have a better prognosis when you are going through cancer therapies such as chemotherapy.
Dr Rupy: Yeah. We've had a number of oncologists on the show talking about how exercise needs to be encouraged as much as possible. I mean, obviously, you know, titrating against someone's experience, particularly peri-treatment as well. Um, but as much as someone can move and do resistance training to, I mean, now understanding the mechanisms behind the myokine connection and the IL-6 connection, which in my mind, I immediately go to like, oh, pro-inflammatory, that's bad for your heart health, etc, etc. And just reframing it from that perspective and looking at it through the lens of how that can sort of bolster your innate immune response to removing foreign, uh, cells or tumor cells. Um, it's fascinating.
Dr Louisa Nicola: It's absolutely unbelievable. Um, the cancer research is really, uh, exciting me right now. Um, and it's just, I think that there, you know, we've made, the, the, it's just, it's, it hurts me. I've seen, um, a lot of people close to me who have sadly passed away and they didn't know about this. I didn't even know about this when this happened. Something that is free, something that everyone can do, that you don't need money for. That is the beautiful thing about running because anybody in any country, even without shoes, it doesn't discriminate. And that's the beautiful thing about exercise. So I, I, um, you, you were in healthcare. I don't know if you're still a clinician, maybe you're, you're not, but it...
Dr Rupy: I've been practicing for 15 years, but now I've left the NHS.
Dr Louisa Nicola: You've left. Exactly. And you think to yourself, why are these therapies not pushed for more?
Dr Rupy: I know. That was kind of one of my frustrations behind actually leaving because you just don't see this as, as the standard of care when it's actually very easy to prescribe, very easy to talk to, and actually a lot of people are willing to do it as well. And hence the communication tool now that we have with a couple of microphones and just getting out to hundreds of thousands, if not millions of people and actually encouraging them to take the medicine in their own hands. It's, it's that's what I'm, I'm so passionate about now.
Dr Louisa Nicola: So I look at my mother, um, who is in her late 60s, and she didn't grow up exercising. So I know how hard it is to, you know, we've, we have literal fights, like where I, I say, I'm not coming back to Australia if you don't exercise. But we, you know, I can see how, um, how scary it might be for someone who, who is at that age and who hasn't done exercise. But it's, if you can just start with walking, and that's how we get people, you know, just start 15 minutes a day, just walk, turn that into 30 minutes, and then before you know it, it'll be a speed walk. Then it might be an exercise bike. I encourage everyone to get a personal trainer if you can afford it, or get a group. One thing that I'm going to start doing is walking tours. Um, in every state that I, I visit because I visit so many states and I've got a lot of people following me. So I think, you know, even doing a walking tour where we're all getting together and, and climbing mountains.
Dr Rupy: I'll give you a map to do a little walking tour around West London. Because I know you're going to be here for another week. So if you want to start, you can start around here. In terms of the dose of resistance training, because I'm just thinking of, you know, a listener, we have a lot of, of folks listening on, on YouTube who are over the age of 55. We have all ages, you know, across the board. Um, but for someone who thinks of the word resistance training, you think that gym section that you're scared to go to because everyone kind of knows what they're doing and they're throwing on these big heavy weights and stuff. When we talk about that kind of person, how would you encourage someone to do like the bare minimum of resistance training specifically?
Dr Louisa Nicola: Start first at home. If you, you know, you can get massive benefits in, um, in your strength and your muscle mass by doing a wall sit, depending on how untrained you are.
Dr Rupy: Okay, so body, body...
Dr Louisa Nicola: Start, yeah, if you are completely untrained, start with body weights and find a YouTube clip. During COVID, that's what I was doing. So start there and then, um, and then work your way up. The unfortunate thing is, and for you and I, you have to get these effects, the myokine release, you do have to be pushing heavy. And when I say heavy, I'm referring to around 75 to 80% of your one repetition max.
Dr Rupy: Okay.
Dr Louisa Nicola: Now your one RM, everybody listening, is basically how much can you squat in one rep until you gas out, really. So if that is 100 kilos, you should be looking at doing around six reps of 80 kilos.
Dr Rupy: Six reps of 80. Wow. Okay.
Dr Louisa Nicola: That would be 80% of your one RM.
Dr Rupy: Okay.
Dr Louisa Nicola: For a squat.
Dr Rupy: For a squat. Okay. And are there particular resistance exercises that have more bang for your buck, like a squat?
Dr Louisa Nicola: Well, yes, because if we look at our, our legs, they've got larger vector sizes, really. We're actually, I don't know if you know this, but, um, they've just found an extra quad muscle. So it may not be a, I know, it may not be a quadricep anymore, it may be a quintecept, if that's a word. Uh, we won't even have to go there. We won't go there. Basically what I mean is, you know, you've got, you've got more muscle fibers in your legs than what you do in your arms. But everywhere, you know, these, um, a lot of the, a lot of, you know, what I spoke about in the, um, in the study was looking at around two days a week at minimum. You can get benefits from two days a week. I'm not that person who's going to harp on and tell you every day.
Dr Rupy: Yeah. Yeah.
Dr Louisa Nicola: I personally, I do more than two days.
Dr Rupy: Yeah.
Dr Louisa Nicola: For maybe aesthetic purposes, but you just need two days full body compound.
Dr Rupy: Okay.
Dr Louisa Nicola: Just get in there and just lift.
Dr Rupy: Okay.
Dr Louisa Nicola: Lift things, not just designer, like lift sandbags, lift, like just get bigger muscles. And for the ladies listening, this is so imperative as you age because we know that two out of three Alzheimer's patients are female.
Dr Rupy: Yeah.
Dr Louisa Nicola: And actually, um, it's in the UK, the number one cause of death in females is Alzheimer's disease.
Dr Rupy: I did, I did want to get to that actually, women and Alzheimer's disease. But as we've touched on there, why don't we just...
Dr Louisa Nicola: Because we've closed out exercise anyway.
Dr Rupy: Yeah. Oh no, we're going to go to the neurocognitive exercises. I haven't forgot about that. But, um, women and Alzheimer's, uh, because I, I think people see dementia, uh, as they do heart disease as a predominantly male condition. And I don't know why. It's something that I've, you know, come across in my clinical career. A lot of women just think of it as something that, you know, is more of a men's problem, but it's, it's absolutely not.
Dr Louisa Nicola: No. It's not. I wonder why they think that.
Dr Rupy: Yeah, I think it's because there's a lot of, um, there's a lack of awareness of the impact of the menopause on dementia and cardiovascular risk. So perhaps it stems from that. And I'm sure that's what we'll touch on now.
Dr Louisa Nicola: And so what we see, you know, why does this affect more men than women? We now have actual, a randomized control trial, many, but, uh, one now to very much state that we have men's and women's brains are different. And that's mainly because of our dominant hormone, which is estrogen, that tends to die off during menopause. When we hit that official menopausal state, generally, uh, women are aged around 52. It can be longer depending on who you are, but that's the average age. That is, you know, the complete stop of you producing estrogen. Now, why, why is estrogen good for the brain? Through this study that I mentioned, uh, Dr. Lisa Mosconi, uh, she was wonderful at pioneering this. She found that we have these receptors in our brain cells, these estrogen receptors. So when we get a release of estrogen, which is, by the way, it's, it fluctuates throughout the month, uh, from our menstrual cycle, when we get those, these, the estrogen goes up, which is a hormone, by the way, it goes up and it lodges into these receptors. And it basically feeds your brain. And it helps with network sufficiency. It helps with growing the connections, but not just that, stabilizing the connections. It helps with, um, many things. Basically, the way I describe, uh, Alzheimer's disease is, is you've just like business, supply and demand. Okay? When your demand exceeds the supply, we have a problem. And we get a lot of what we call trophic support. That is our neurotrophins, which is testosterone, estrogen, that help the supply, okay, give the neuron and the brain supply to meet the demands. And when we don't have that support anymore, that's when we're in trouble. The six supports I've got them here are energetics, inflammation, um, well, actually the six things that that decrease the the networks is energetics, inflammation, toxicity, neurotrophins, neurotransmitters, and stress. So the number, the number four neurotrophins, that's where your estrogen would sit. So when women don't choose to take hormone replacement therapy, which is a very controversial topic that we don't need to get into, then they miss that window of opportunity to basically get on estrogen and replace that.
Dr Rupy: Yeah.
Dr Louisa Nicola: So not giving the brain the support it needs.
Dr Rupy: Totally. Yeah. We've discussed, uh, HRT with a number of different menopause specialists before and I think, um, it's now becoming a lot more well known about the flaws of the WHI study and how it scared off a lot of, yeah, it scared off a lot of women for many years. It still does. I think there's still lasting effects of that. And obviously I want to be, um, sensitive to the fact that not all women can take HRT for whatever medical reasons. But, um, but yeah, that window of opportunity is very, very important as well to, to be cognizant of in terms of when you can take, uh, HRT and, and what lasting effect that might have on protecting your brain. Um, but that, I think we're going to come back to this in a sec. I, I want to round off exercise with, uh, neurocognitive exercises. So what, what do we mean by neurocognitive exercises?
Dr Louisa Nicola: That's where my company's got its name from, Neuro Athletics.
Dr Rupy: Okay. Um, I started that in, in 2015.
Dr Rupy: Uh-huh.
Dr Louisa Nicola: Neurocognitive training represents the training modality that's used for your cognitive functions, such as, uh, reaction time, processing speed. So you'd think of badminton as neurocognitive because you have to think, you have to follow the ball with your eyes. So that's vision is also part of your cognitive functions. You've got vision, you've got hand-eye coordination, you've got reaction time. You couple that with also your aerobic training, but basically neurocognitive training is anything that involves like hand-eye coordination, reaction time, and vision. And anyone can do this. And the way that you should start is you just get a tennis ball, you just start on a, throw the ball to the wall.
Dr Rupy: Right.
Dr Louisa Nicola: I always say, you know, I did this with, um, a number of different people in, in the US whenever I'm on a podcast, we do it. Uh, you just get a, a ball and throw overhand grip to the wall.
Dr Rupy: Okay.
Dr Louisa Nicola: Go for a minute, change your hand, do the other side. Do right hand, left hand, like, you know, it's, it's, it sounds ridiculous because it's like we did this when we were young, but we lose that as we get older. Like when was the last time you played handball or just engaged in, in hand-eye coordination?
Dr Rupy: Yeah, yeah.
Dr Louisa Nicola: Yeah. So your brain, remember, it, it represents a map. Okay, we've got all these Brodmann's areas, right? And basically it says, whatever, you know, use it or lose it, whatever the analogy is. Basically, if you don't use every area of your brain, if it's not needed, there's no blood supply that goes there because it's not needed. And what happens then? Well, we start to atrophy the brain cells like, okay, well you don't need me anymore.
Dr Rupy: Yeah.
Dr Louisa Nicola: That's why we should be doing as many different things as possible.
Dr Rupy: Okay. Badminton, tennis. I play a bit of tennis. Does that count?
Dr Louisa Nicola: Fantastic. Yes.
Dr Rupy: Okay, great. Um, anything else other than those sort of activities? Is there one that really stands out?
Dr Louisa Nicola: Table tennis.
Dr Rupy: Table tennis is great.
Dr Louisa Nicola: I think badminton. Uh, but, you know, for, for us, what we do, you know, go to CVS or your local pharmacy and buy this $5 eye patch that you use for like eye infections, like a pirate patch.
Dr Rupy: Oh, right.
Dr Louisa Nicola: Okay, block off 50% of your vision.
Dr Rupy: Yeah.
Dr Louisa Nicola: Right? Because that's basically your brain is like, okay, 50% has shut off. So the other side gets stronger.
Dr Rupy: Ah.
Dr Louisa Nicola: Right? Because, yeah, we've got two lobes of the brain and it basically says, oh my god, guys, like we are, we're shut down 50% of the brain, so we need to get to work. Okay? And then take the eye patch off and do the other side. It's really fascinating. And then try that with, um, with your ball drills.
Dr Rupy: I'm 100% trying that. That makes sense because you're stressing that side of the...
Dr Louisa Nicola: You're stressing that side. Yeah, we go, we go in the extreme version and, uh, some of our elite athletes, we've got these strobe goggles. So we like black out like, like three quadrants of the eye and just show the upper eye. Yeah, and we're like, run.
Dr Rupy: What? That sounds great. And are there, are there research studies that look at, at that being, that, that kind of stressor having more of an effect on, on the brain and the connections?
Dr Louisa Nicola: Absolutely. But look, you're, you're talking about like pushing 1%. So I've got like professional MLB players who maybe their eyesight is like worth like millions of dollars.
Dr Rupy: Yeah, yeah, yeah. Yeah, no, it's not for the general population.
Dr Louisa Nicola: Yeah.
Dr Rupy: Okay, great. All right. So in terms of those extra things, bit of sauna, like 20 minutes a week, something like that, or?
Dr Louisa Nicola: 20 minutes times four times a week.
Dr Rupy: Times four times a week. Okay, fine. I'm going to spend a lot of time doing these brain healthy activities. So is there a dose effect? Like, can I get some benefits if I squeeze like, you know, 15 minutes of sauna once, once a week or?
Dr Louisa Nicola: Yeah, you can. Here's something that, um, you should be aware of. When we, when we go into the sauna and we're sweating, it's important to, because you're, you're releasing all of these toxins. You don't want them to seep back into the skin. As soon as you get out of the sauna, run to the shower and, and use soap.
Dr Rupy: Okay.
Dr Louisa Nicola: Yeah.
Dr Rupy: All right. So just to get rid of those toxins that you're...
Dr Louisa Nicola: Get rid of that.
Dr Rupy: And I'm assuming like heavy metals, that kind of stuff comes out.
Dr Louisa Nicola: All of that, yeah.
Dr Rupy: You can do a heavy metals test as well.
Dr Louisa Nicola: Okay.
Dr Louisa Nicola: Um, I am doing it for all of the benefits that I just spoke about. By the way, it does dilate the blood vessels a lot. You get hot, it dilates the blood vessels in the sauna. So you're getting a massive perfusion of blood to the brain.
Dr Rupy: Ah, okay.
Dr Louisa Nicola: Right? So it's wonderful. It's wonderful for everybody who wants to mimic the effects of cardiovascular training.
Dr Rupy: Gotcha.
Dr Louisa Nicola: So you're doing that as well. But you are, I'm doing it because I am at the, I'm in the heart of Manhattan. I also have a, my, my job isn't just a walk in the park either, right? So it's, I'm, I've got so many attacks. I call them insults as well. So I'm doing everything I can to like eliminate that. And I'm also at the mercy of BPA. It is just seems like no matter how many glass items I have. So I, you do get release of BPA in there.
Dr Rupy: Yeah, yeah. I think there's, there's things that are in our control and things that are outside of our control. And whatever you can do to put the ball more so in your corner, particularly when it comes to environmental toxins, I'm a big fan of because equally like you, it's a, it's a scary topic to talk about, but it definitely needs to be addressed because, you know, as a neurophysiologist, you know the impact this could potentially be having on our brains and that may explain the sort of like doubling of dementia over, you know, every 20 years up to this like ridiculous number of a, I think it was 130 million diagnoses in 2050. If I got that right.
Dr Louisa Nicola: It, the number will triple by the year 2050. So yeah, 55...
Dr Rupy: 150 million.
Dr Louisa Nicola: Yeah.
Dr Rupy: So it's, it's, uh, it's super important. So we, we definitely need to be talking about it. Let's talk about electrolytes. So you mentioned sauna, um, and now I see a lot of, you know, electrolyte brands, a lot of people are talking about sodium chloride, magnesium, and like how to hydrate yourself properly. It all seems to have sort of come in the last couple of years. Um, and I remember electrolytes as being something that you would have if you're really into sports and you want to hydrate. So do they have benefits to our brain? Should everyone be thinking about taking an electrolyte supplement?
Dr Louisa Nicola: Well, your brain actually needs electrolytes. Right? So remember when you sweat, you're not just sweating out water, you're sweating out sodium, potassium, selenium, magnesium. Your brain, the two brain cells, okay, remember how we spoke about brain cells and the connections? When they connect with each other, they form a chemical reaction known as a synapse. In order for that to happen, it uses a sodium potassium pump.
Dr Rupy: Okay.
Dr Louisa Nicola: So your brain literally, your brain cells need electrolytes to function.
Dr Rupy: Okay.
Dr Louisa Nicola: So, uh, I mentioned earlier, there was a wild, uh, New York, New York Post article that came out and it said a woman died from drinking too much water. Why would that happen? Because she literally diluted all of her electrolytes. And it's a real thing. And you know, it actually happens more than you know. People drinking too much water and just getting rid of all of the minerals and electrolytes that are needed for our body to actually function. How do you mitigate this? Well, that's an extreme sense, by the way. Like, I, I didn't read how many liters she drank, but you've got to have quite a bit.
Dr Rupy: Yeah.
Dr Louisa Nicola: I drink these little sachets, okay, they're called Element, L-M-N-T, and basically it's like 1,000 milligrams of sodium, 200 milligrams of magnesium, I think, and potassium. So it's dosed essentially, and I have one of those a day. And just because you aren't sweating, it doesn't mean you shouldn't be replacing your electrolytes.
Dr Rupy: Okay.
Dr Louisa Nicola: Yeah. If you have, uh, just a mere dehydration status of 2%, that's like a 30% decline in your cognitive performance. And dehydration isn't just water, just pure H2O. It's also minerals as well.
Dr Rupy: Sure. Okay. So even if I'm sedentary and I'm not sweating, I should be thinking about electrolytes and I can't just get those from food?
Dr Louisa Nicola: No, you can't just get those from food. And by the way, if you are not sweating and you are sedentary, we've got more problems than you ingesting electrolytes.
Dr Rupy: Sure, yeah, okay.
Dr Louisa Nicola: So basically what I mean is, even if you've got a desk job and you're like, Louisa, all I did was walk today. It's like, but, but your brain was using electrolytes. Your body uses electrolytes. You don't have to go crazy. I'm not saying have a brick of salt per day. Maybe just, you know, and you can do, you don't even have to buy a Gatorade. By the way, you shouldn't be having the drinks that actually, you know, a lot of these sports drinks also come with a lot of sugar in them. You really just want a clean, like sugar-free electrolyte replacement. Um, and just be having one of those a day. You can even have a bit of, uh, sea salt in your morning water.
Dr Rupy: Yeah, yeah. I remember there was this drink that my dad used to, still gives me actually during the summertime where it's just, they call it nimbu pani, it's like an Indian drink. It's basically lemon juice that's freshly squeezed, some salt, I don't think it's pink Himalayan salt, I think it's just like regular sea salt, which is good quality. Um, and, uh, I mean, they put like pepper and a few other spices in it just to sort of like give a bit more flavor. Um, but that's like known as the rehydrating drink where he's from, like he grew up on a farm and stuff. So I imagine like these kind of drinks were passed down, you know, through families as sort of like little medicinal, um, habits to, you know, potentially improve their, uh, their health, uh, you know, when they're out there in the sun and all the rest of it.
Dr Louisa Nicola: That would be great. I haven't had that, but having that first thing in the morning.
Dr Rupy: Yeah, yeah.
Dr Louisa Nicola: But yeah, so electrolytes, the, the point of this is electrolytes are definitely needed. And it's not just something that we get in a drink and that we sweat out.
Dr Rupy: Sure. Okay. Um, you mentioned turmeric as well earlier. And we didn't come back to that.
Dr Louisa Nicola: I'm currently obsessed with turmeric. And that's because of the, uh, inflammatory pathway. So there is this inflammatory pathway that gets activated during the innate response, the, the innate immune system response. And it's called the NF-kappaB pathway. And you've probably heard of it. But the NF-kappaB pathway is literally blocked via this, um, this active ingredient. It's not curcumin. It's, uh, it's something else. I forget what it's called, but it's found in curcumin, which is found in turmeric. So we know that we can actually block the inflammatory pathway by having turmeric. So I've been having, I've been having a dose a day, found in a really top quality supplement.
Dr Rupy: Nice.
Dr Louisa Nicola: Yeah, I'm not going to walk around with a stick of turmeric in my pocket. But it's something that I'm like extremely, like, I'm very vigilant on having every single day. Now my, um, my inflammation, as represented by C-reactive protein on a, on a blood test is less than one.
Dr Rupy: Okay.
Dr Louisa Nicola: Which is desirable.
Dr Rupy: Great. Okay.
Dr Louisa Nicola: That's what mine is. Uh, is it the same? I don't know if it's...
Dr Rupy: Yeah, we have like HSCRP and...
Dr Louisa Nicola: Oh, it's the same thing.
Dr Rupy: Yeah, yeah, yeah.
Dr Louisa Nicola: But is it measured as less than, do you...
Dr Rupy: Yeah, less than one is usually what we, um, uh, we look for, for sure.
Dr Louisa Nicola: So that's what I would hope that, you know, if and this is a very standard, uh, test that everybody, it's a very standard biomarker found on almost every test that you get from your physician. So just get that, make sure you're looking for, uh, less than zero.
Dr Rupy: Okay. Brilliant. Um, I want to talk about two things. This might require a part two. Um, but I noticed that these were on your, uh, Instagram, I think it's where I, I got them from. Is there a connection between vitamin D and dementia and, uh, vitamin D and ADHD?
Dr Louisa Nicola: Yes, lovely that, that you we brought that up. Well, it does require a part two, but it turns out that we, you know, being low on vitamin D is also a risk factor for dementia and Alzheimer's disease. So we want to be getting our vitamin D really up, up well and truly above 50 nanograms per deciliter, right? So I'm trying to get to 60 and it's a hard thing to do, by the way. I actually, I remember I did a blood test in September last year. So now it's been a year. It was at 29. That was the result of living in New York City. It's now sitting at around, I would say 42. So it takes a long time even in the summertime. So, um, I, I do that with 5,000 IUs of vitamin D per day. We have these specialized cells on our brainstem and that's where our vitamin D receptors are. And arguably, this is also the, the interaction that takes place during sleep. So if you are vitamin D deficient, you're going to be disrupting your sleep-wake cycles as well. And we see the areas of the brainstem that release certain, um, hormones and certain trophins that are regulated during, um, Alzheimer's disease as well. So yes, it is a risk factor. But it's also a risk factor for many other things. It's also a risk factor for all-cause mortality, right? It's vitamin D is not just a vitamin, it's a hormone. It's a precursor to many things. We need it. Like, but here's the thing. I don't know if you know this, but let's just say you do a blood test on a patient, it comes back with a very low vitamin D. What is the natural process after that? It would be communicating why it might be. Well, what I would hope is that you would communicate to the patient why their vitamin D might be low. And vitamin D can be low in the presence of heavy metal. Did you know that?
Dr Rupy: No, I didn't know that.
Dr Louisa Nicola: So what happens is it actually binds to metal, heavy metal. So if you've got heavy metal in your system, right, it basically says, hey guys, we need to lower vitamin D. So it might not be a response from lack of sunlight. It may be, hey, we need to lower vitamin D because we have the presence of heavy metal and we don't want heavy metal in her system. So what happens if you're not told that or not informed about that? What happens is you get told you've got a low vitamin D, then you go and take like a bolus of the sun. You know, people go crazy. They're like, I'm going to take 10,000 IUs of vitamin D. What you're doing is you're raising your vitamin D exogenously and therefore you're, you're raising your, your heavy metal as well. So what you want to do is in the presence, if you do have vitamin D deficiency, also do a, a heavy metals test. Again, super easy. It tests for many different metals. I think about 10 or 12.
Dr Rupy: Is that a blood spot as well? Is that a...
Dr Louisa Nicola: Oh, right. I think it is. I'm not sure.
Dr Rupy: Okay.
Dr Louisa Nicola: Every time I get a blood test, there's like 15 vials of blood taking place.
Dr Rupy: Sure.
Dr Louisa Nicola: Um, but I've had one and it's, um, so if that does happen, then you need to take a different procedure and protocol.
Dr Rupy: I'll enjoy this. I, um, I did a little experiment on myself because, uh, I, I tend to have low vitamin D. I take 3,000 IU every single day. That pushes me into the 55, 60 plus, maybe even a little bit more, but under 90. And I thought, I'm going to Australia for a month. Let me see what I'm like off my, during the summertime. So I went in December, which is in the middle of, um, Australian summer. I knew I was going to be on Balmoral Beach, getting a lot of sunlight, you know, walking around my, uh, t-shirts and shorts. Let me just see what I'm like in pretty much full sun without taking my vitamin D. I was out there for 30 days, retested as soon as I got into the UK, and my, uh, vitamin D level fell quite a bit. It went to the, uh, high 20s. So clearly I need that vitamin D and I can't get enough from the sun. Potentially from the, you know, color of my skin. I'm darker than than most people. So...
Dr Louisa Nicola: That's what, how I feel as well. Um, and surprisingly, they've done studies on raising vitamin D and it really takes two, what you've just, you know, this is new to me, but like, um, you can raise it with just two minutes of sunlight, but it can probably get dramatically decreased on a day-to-day basis.
Dr Rupy: Yeah, especially if I'm used to having exogenous, uh, amounts as well, 3,000 IU. Um, and should I nap? Are naps good for my brain?
Dr Louisa Nicola: So napping is, you know, I think that you, I think everyone should be taking at least 20 minutes a day to just quiet their mind.
Dr Rupy: Okay.
Dr Louisa Nicola: Okay. So I don't think that you should nap depending on how tired you are. So napping takes away from what we call sleep pressure. You want a lot of sleep pressure. You know, as we, you know, during the day, we build up this molecule called adenosine. We build it up, build it up, and it makes us feel sleepy. And that when it's all built up, it's like we feel sleepy and that's what, when we go to sleep, we replenish it and it's empty in the morning, right? Caffeine is an adenosine blocker. And so a nap will also kind of down-regulate that adenosine and take away from the sleep pressure at night, depending on how tired you are.
Dr Rupy: Okay.
Dr Louisa Nicola: But for me, I don't nap. Probably not good. But I do do, I don't even know what you would call it. It's not a meditation. It's just I sit there and it's like just cancel out. I try and cancel out all the noise in my head. I put a sleep mask on on my eyes even if I'm just sitting there.
Dr Rupy: Yeah. Yeah. Okay. I'm going to, I mean, I, I have a meditation regime. I do that in the mornings.
Dr Louisa Nicola: Okay, great.
Dr Rupy: But I'm, I'm constantly juggling a million things, as I'm sure you are as well with your, your businesses, socials, etc, your podcast. Um, I find it quite hard to quiet my mind. That's probably the, one of the biggest things up there along with sleep that I, I struggle with. Um, I feel like we definitely need to do a part two. There's probably so many different things, different elements on those six, uh...
Dr Louisa Nicola: Oh, yes. Um, my next paper that, um, I'm writing is actually based on, uh, processing speed and the number of biomarkers that can interfere with processing speed. And you probably think about processing speed and think, oh no, like what, uh, stress, you know, there's over probably like 150.
Dr Rupy: What?
Dr Louisa Nicola: It's taking me a long time to write.
Dr Rupy: Wow. Yeah. Okay.
Dr Louisa Nicola: So, yeah, we can definitely get into that next round.
Dr Rupy: That would be brilliant. Yeah, because, um, there's just so much more I want to talk to, but I know you, you've got a sore throat, you're not feeling your best at the moment. I'm not going to make you talk anymore.
Dr Louisa Nicola: The amyloid's building up.
Dr Rupy: Yeah. Um, but really appreciate you sharing your knowledge with the community on YouTube and, and the podcast. Um, your work's phenomenal and anything I can do to try and promote what you're doing, love to. And like I said, we probably have to do a part two if you're willing to.
Dr Louisa Nicola: We're going to do it because I'm coming back here.
Dr Rupy: Oh, you are? When?
Dr Louisa Nicola: I don't know.
Dr Rupy: Okay.
Dr Louisa Nicola: I love it here so far. I love it.
Dr Rupy: We'll cook next time. We'll cook like a, a brain healthy meal or something like that using your, your berries and the fiber and the omega-3.
Dr Louisa Nicola: And the creatine icing.
Dr Rupy: And the creatine icing. Yeah, we'll have to add that as well.
Dr Rupy: Thanks so much for listening to this episode of the Doctor's Kitchen podcast. Remember, you can support the pod by rating on Apple, following along by hitting the subscribe button on Spotify, and you can catch all of our podcasts on YouTube if you enjoy seeing our smiley faces. Review show notes on thedoctorskitchen.com website and sign up to our free weekly newsletters where we do deep dives into ingredients, the latest nutrition news, and of course, lots of recipes by subscribing to the Eat, Listen, Read newsletter by going to thedoctorskitchen.com/newsletter. And if you're looking to take your health further, why not download the Doctor's Kitchen app for free from the App Store? I will see you here next time.
