Dr Rupy: Dementia is a disease of lifestyle. That's what my guest, Dr Louisa, believes and it's her mission to get everyone up to speed on the science so we can delay the onset or entirely prevent dementia around the globe.
Dr Rupy: Today we are diving into supplements like creatine, omega-3 and vitamin D as they relate to brain health optimisation and the prevention of one of the biggest killers in the UK and globally, dementia. Now, I personally take these supplements regularly as part of my daily routine and while I don't necessarily feel the immediate benefits, with the exception of creatine, the research is solid enough for me to make this decision. I've spoken to many people on the podcast about this and that's why I'm a big fan of what we're going to be discussing today. Dr Louisa, if you don't know, specialises in neurophysiology and Alzheimer's disease prevention and the science of brain optimisation. And it's her mission to live in a world where Alzheimer's no longer exists. It's a real moonshot and I love her for that. Louisa, if you didn't know, graduated from the University of Sydney Medical School where her doctoral focus in neurophysiology spotlighted lifestyle interventions and neurodegeneration. And after relocating to New York, she advanced her research career by working alongside some world-class neurosurgeons and contributing to clinical investigations in cranioplasty and post-surgical outcomes with a particular emphasis on the role of exercise and nutrition in recovery and brain health. She is also a trusted adviser to high-performing athletes, many of whom I can't mention for confidentiality reasons, but you will 100% know exactly the athletes that she works with. And she also works with healthcare professionals as well. And what I love about Louisa's work is her ability to translate complex neuroscience into actionable strategies for longevity, brain health and performance that we can all benefit from, myself included.
Dr Rupy: On to my podcast with the wonderful Louisa Nicola.
Dr Rupy: Louisa, this is great that we get to do this in LA, closer to home for you, further away for me. Let's dive into some of the research that's evolved around Alzheimer's and dementia since the last time you were on the podcast with me.
Dr Louisa Nicola: Well Rupy, the long and short answer is a lot has evolved, not a lot has changed. Okay, so we are still under the assumption that Alzheimer's disease is a lifestyle-driven disease, meaning that regardless of your genetic predispositions and having the APOE4 gene, which we can go into later, it still raises your risk of getting the disease, but it also doesn't mean it's a foregone conclusion that you're going to get it. The second thing is, we now have even more substantial evidence to show that there is no reversal of the disease and there is no cure. Even in the last year, we've seen the damaging effects of the latest FDA-approved drugs, which is lecanemab, donanemab, and we've seen that people who undergo these IVs, these therapies, actually experience brain atrophy, microhaemorrhages in the brain. So we still know that, and that was because of a New England Journal of study that came out that showed this. So that is all still into in effect. We still also know that amyloid isn't the demon. We used to think that 10, 20 years ago. Amyloid is the hallmark of Alzheimer's disease along with another one, tau protein. They are not to be demonised. Some of the new and latest evidence that has come out in the last year, which we'll go into, is in the US specifically, we now have availability of getting this, it's a blood test which can pick up on markers of amyloid, tau and neurofilament light, which is so exciting, right? So we now have a blood test that can mimic what we used to get, which was a PET scan and a spinal tap.
Dr Rupy: Wow.
Dr Louisa Nicola: Right? So if you went to a neurologist and you did a cognitive assessment or a brain check and they suspected you to have Alzheimer's disease, you would go and get a spinal tap and that would measure the amount of circulating amyloid. It's a protein that builds up in the brain in these patients and they'd measure how much is in that fluid. We don't have to, and that's invasive. Getting a spinal tap, it's really invasive. Extremely safe, but still invasive, right?
Dr Rupy: Yeah, yeah.
Dr Louisa Nicola: We can now do that with a simple blood test. Caveat, it's only available in the US.
Dr Rupy: Oh, really? Oh, gosh.
Dr Louisa Nicola: Yes. So that's one exciting thing that's changed. The second, I guess, exciting thing is we're now getting even more robust evidence around these so-called lifestyle interventions that we can now say that if you do these things, and we'll talk about them specifically, including supplementation, there's been some great observational studies and randomised control trials that show certain supplements can help stave off the onset of these diseases. We've got supplementation, we've got nutritional interventions, and we've got exercise interventions. So they're the things we're going to talk about today. What can you do to reduce your risk of getting mild cognitive impairment and Alzheimer's disease? But also what can you do if you're in that stage of cognitive impairment?
Dr Rupy: Amazing. Before we get into that, I just want to double tap on the blood test that's not available in the UK.
Dr Louisa Nicola: I know, or in Australia.
Dr Rupy: Yeah. What what is that blood test?
Dr Louisa Nicola: Well, it's just a, it's that's it's just the Alzheimer's blood test.
Dr Rupy: Okay. Is there a cost consideration? Is it quite expensive? Is it
Dr Louisa Nicola: In the US, it's depending on who you go to, but it is, there is no insurance and it's around $800.
Dr Rupy: Oh wow, okay.
Dr Louisa Nicola: But it does literally mimic almost to complete 100% accuracy of a PET scan.
Dr Rupy: Wow, okay. And is there is there like a reference range for it? Are you like you can tell how far along you are with the disease in terms of getting that that sort of like degree of severity or?
Dr Louisa Nicola: That's interesting, right? Because the disease is not just pathological, meaning that you can, you have to get so many parts to see where along the spectrum you are. But if you do have even mild amounts, then that's still a cause for concern because we know that Alzheimer's disease is around a 30-year progression, right? Alzheimer's is end stage, but before that, you've got subjective cognitive impairment and then mild cognitive impairment. So you've got like this 30 degree, 30-year time frame there. So it's not about just looking at this one blood test. That's just one part of it. But we also know that from patients already that you can have a head full of amyloid but not experience any cognitive deficits. So that's not the only thing. You have to combine that with an MRI of volumetrics, which, you know, looks at the measurement and volume of different lobes of the brain. And then you also have to look at a cognitive assessment, which is testing processing speed, reaction time, memory.
Dr Rupy: Yeah. Yeah. Are there any other ways to determine cognitive speed other than seeing a neuroscientist or a neurologist who knows how to formally do that test? Are there any other programs or any other one that you can any any other practitioner?
Dr Louisa Nicola: Look, there's there's widely available assessments online that is free to everyone, but whether that's actually getting global cognition, which is the scores that we really look at, you probably would want to go and get one registered, but the most easiest thing that you can do is the MOCA test, the Montreal cognitive assessment. And it's a really simple and accurate test that if you score between 0 and 30, you can be put at risk for Alzheimer's disease. So that's when I think everyone can go through it. It's a free test. You can go and do this and just go and check and then go and see somebody after that. You don't have to go and get the full blood test.
Dr Rupy: Yeah. The reason why I ask is because I was chatting with Darshan earlier this week actually, who you know, in LA, and I've just turned 40 this year and he's definitely put me on the route of being a lot more pragmatic and thinking about preventative testing. Yeah, across all different areas of my of my health. So cardiovascular disease, of course, skin disease and absolutely brain health. His sort of suggestion, you know, alongside regular colonoscopies, depending on like whether there's a family history, CT angios, making sure that my cholesterol levels are in check, which is obviously going to help my brain as well. Cognoscopes, or you know, being
Dr Louisa Nicola: Cognoscopy.
Dr Rupy: Yeah, yeah. So this is certainly interesting because I I sort of want to take people on the journey and obviously if we we can't all have invasive imaging or these expensive blood tests, but we can all do some sort of test that gives us a baseline of where we're at, like the MOCA.
Dr Louisa Nicola: And then let's, so what I feel like you're asking me is when should people start to be worried or concerned and what are the best things to do? Let's let's categorise this and I hate playing this game of battle of the sexes right now. Okay, but let's talk about why, and this is also another recent thing. Why are two out of three cases of Alzheimer's disease female? So what I love now is that menopause is now in the spotlight and I love that due to the damaging effects that we're still experiencing from the Women's Health Initiative 23 years ago. So we're still seeing, you know, damaging effects, meaning that there's still a huge population of females who are under the impression that hormone replacement therapy increases your risk of breast cancer. Why am I bringing this up? Because how does it even relate to Alzheimer's disease? Well, it turns out that the reason why two out of three cases of Alzheimer's disease is women is because of the loss of estrogen that starts to occur and decline during the perimenopause and obviously the menopause state. And the estrogen is a neuroendocrine hormone that is absolutely substantially important for women's brains. We have estrogen receptors all over our brain, including one of the areas that tends to first go during Alzheimer's disease, which is the hippocampus. So the hippocampus and the subregions is infiltrated with these receptors ready for to be taken up by estrogen. And if there's no longer estrogen there, well, you get atrophy of this area of the brain. And so if you are a female, my I believe, and this is all driven by evidence, is that women need to start really taking inventory of things that happen in their late 40s and early 50s. It starts with, you know, and it's also often hard to differentiate between what is just stress and what is perimenopause, right? Because if it is short-term memory loss, like that happens, happens to me all the time, right? But I'm not at that stage yet. So it's about being able to really monitor your symptoms. And I would I always recommend women especially, but men too, to carry around a journal when things start to happen that you're that you're like, that never happens to me. Like walking into a room and forgetting why you're there when you're not stressed, right? Or getting into the car and forgetting where you're going. Just like start to keep a journal and start to log this. But I'll tell you that the the earliest signs of symptoms aren't just cognitive deficits. It could come in the form of a motor deficit. It could come in the form of vision deficits. We've got we know that hearing loss is one of the another risk factor now of Alzheimer's disease. And that's because your ears are sitting right next to the temporal lobe. Okay, that's where auditory processing takes place. And the temporal lobes houses the hippocampus. And they're, you know, so if that starts to atrophy, then everything starts to atrophy after that. So just keeping a log book of that over time. And then if you experience that, then then maybe go through and and see. And and we also see that during the menopause stage, did you know that in menopause, women have a three times higher risk of having a cardio-related event, like a heart attack?
Dr Rupy: I only know this because of the number of different specialists who treat women and also who research women that have told me about this research because of this podcast, but I don't believe I appreciated that when I was in full-time practice in primary care. So I think a lot of people listening to this who are either in the profession or outside it or are just common listeners probably don't fully appreciate that they haven't listened to those episodes because it's not widely known.
Dr Louisa Nicola: Yeah, exactly. And so that relates to Alzheimer's disease in many ways because we know that increasing your lipids, whether it's the LDL or apoB, this has a direct correlation to the arteries of your brain. So that's another thing to look out for. So Alzheimer's disease is so multi-domain and multi-faceted that we can't just base it off a single snapshot, which is I have a reduction in my memory. Is that due to Alzheimer's or is that due to just the stress or natural brain aging or did an event occur in your life that was pretty traumatic?
Dr Rupy: Yeah, yeah, absolutely. Okay, so we've established not much is going on in the pharmaceutical realm. We know that this is lifestyle driven. Let's talk about some of these interventions that you're most excited about, you want people to know about so they can take control of their brain health before and potentially even slow down the progression if they have a diagnosis or they know someone with a diagnosis.
Dr Louisa Nicola: Okay, so we can split these up if you like and we can talk about, since nutrition is your domain, but I'm not going to talk solely on nutrition. I'll talk more about some of the latest research in supplements because I know that people get excited about supplements, right?
Dr Rupy: Yeah.
Dr Louisa Nicola: I know they do because it's like a cheat code. But it turns out that there is probably two supplements that I recommend that are not just a cheat code and these two supplements will go a long way. We spoke last time on creatine, but there is so much more to be said now.
Dr Rupy: Okay.
Dr Louisa Nicola: So back when I spoke to you, I was under the assumption that 5 grams of creatine per day would suffice for brain health and I put that out there. I have put a statement out two months ago telling everybody that I am sorry and that we were wrong because the latest evidence out of Germany actually shows that in order to saturate the brain, we actually need 15 to 20 grams of creatine.
Dr Rupy: Oh my gosh.
Dr Louisa Nicola: So put down the 5 gram scoop or just you know, redo it at least five times because
Dr Rupy: Four times I should say.
Dr Louisa Nicola: because we now need to up the dose. And that's because creatine is already naturally occurring, right? We already we already release a little bit from the liver. Not that much. And when it's released, 95% of it is stored in the muscle and 5% of it is stored in the brain. But that's still not enough, right? So in order to get the cognitive benefits, which is how do we have more brain cell energy, we need to be upping the dose because if you have 5 grams, that goes directly to the muscles. So there's none left for the brain. In order for it to go up to the brain and cross the blood-brain barrier and saturate the brain, you need to have at least 10 grams as a starting. And then if you have 15 grams, it's just going to even do even better. But the reason why we're going from 15 to 20 is because people who have undergone a type of insult, and by insult, I'm referring to if you've had a stroke or maybe you've already have early onset Alzheimer's disease or mild cognitive impairment, your brain is already under attack. So it needs an even greater amount of energy to sustain name normal daily activities of living. So that's when you'd probably be needing 20 grams a day. And who is that? That's my father who's 72 years old. He had a stroke in 2019. So he's had some decline in his cognitive performance. We've seen it. We we see it. Even motor symptoms have occurred from that. And he gets tired a lot because when you lose brain cells, which um, by the way, for you know, every hour after a stroke matters and you lose a million brain cells every hour after that stroke if you don't go straight to the hospital. So due to the loss of those millions and millions of neurons, his brain now needs to work even harder just to sustain what he used to sustain, right? So he needs greater amounts of creatine.
Dr Rupy: Got you. So what I'm hearing is we need a higher dose because we need to saturate the muscles' hungriness, their their sort of they're not satiated unless, you know, you hit a certain amount such that there's some left over for the brain to uh to to grab and and and utilize. Um, is the the cutoff of 15 and 20 a general number for everyone or is there a conversion that you can use depending on your weight or whether you're male or female or is that the the sort of suggested target?
Dr Louisa Nicola: It's it's the suggested target and I would recommend females sticking to around 12 to 15 grams. And if that is too much on your stomach and you get GI distress from that, you can split that up and have like, you know, 7 grams in the morning and 7 grams at night. But for men, if you are, you know, 6 foot tall and uh and you work out and you're healthy, maybe sticking to around 18 to 20 grams a day.
Dr Rupy: Okay. And is this for both preventative action as well as for someone like your dad, for example?
Dr Louisa Nicola: Yeah, and you don't see 20 grams a day, you can do that for the study showed that if you do this and load it, then you can go back down. And that's around 10 days of loading. You can go back down to 15 grams a day.
Dr Rupy: Okay.
Dr Louisa Nicola: But we want to be hitting the higher amounts.
Dr Rupy: And because this is quite well tolerated, it's, you know, it doesn't appear to be much downside unless you do have GI side effects. Can we just rewind a little bit for the listeners because I know you've explained this in a previous podcast, but perhaps we should just talk a bit about creatine monohydrate itself. Like
Dr Louisa Nicola: Monohydrate.
Dr Rupy: Monohydrate, sorry. Yeah. Creatine monohydrate itself and figure out or just just sort of remind us as to why it's working. What is it actually doing and if we fully understand it at all.
Dr Louisa Nicola: Yeah, so within the cells of our brain and our our body, we have these little energy powerhouses called the mitochondria. The mitochondria is at the seat of our energy production. And they go through a chemical process which requires ATP as the energy fuel. And ATP actually uses creatine. So creatine helps with cell energy metabolism. So it helps you generate more energy within the mitochondria of the cell. So if your mitochondria, by the way, people have different amounts of mitochondria within their cells. You could have 10,000, you could have 50,000, right? But they go to work and they are what produce energy within your cell, which comes out in the form of me speaking, me running, me fighting off diseases. In fact, it's said that the three biggest diseases that are killing us, cardiovascular disease, cancer, neurodegenerative diseases, at the seat of it is mitochondrial dysfunction, which at the seat of that is probably inflammation, right? So mitochondrial dysfunction, that's when the mitochondria are not working well. If they're like factories, they're going to work. Imagine the factory breaking down. These mitochondria end up dying. And when they die, then we don't have enough energy in the cell. We don't have enough energy in the cell, then we don't have enough energy to do normal things every day, but not just that, we barely wouldn't have any energy to fight off diseases. So by providing the cell with more energy through creatine, you're going to be better off at fighting these diseases. You're going to be better off at having just fighting headaches and and anything that you deal with.
Dr Rupy: So creatine monohydrate, really cheap, easily accessible supplement, widely studied, really, really safe. Um, there's various forms you can find online, but we're just talking about creatine monohydrate, standard stuff, not the fancy options. There's I think it's called ionized creatine monohydrate. I think it's still creatine monohydrate, but it's like a little bit thinner and less chalky. Is that okay?
Dr Louisa Nicola: That's okay too. Yeah.
Dr Rupy: Okay, fine. Um, and in terms of like whether the message is getting out to neurologists around the world, because if this has got some evidence base for it being used for stroke patients and rehab, I mean, I I haven't come across many medics using this in clinical practice alongside other other drugs.
Dr Louisa Nicola: No, so I'm working on, so I'm I'm I work in a hospital setting in neurosurgery and we're working on looking at all of our post-surgical cranioplasty patients. We're looking at how can we improve their wound healing and, you know, when I say cranioplasty, I'm talking we reconstruct skulls and that's a that's a very harsh invasive process and you can imagine going through that afterwards and we're trying to speed up the healing process. And we are actually giving them creatine to speed that up along with a number of other different supplements to speed up skin wound healing, but also a lot of these patients are experiencing just after a surgery, once you've undergone anesthesia and invasive brain surgery, you've got brain fog, mental clarity, all of this stuff that we need to eliminate as soon as possible so we can help the brain heal. So we're giving them creatine.
Dr Rupy: I'm a new dad. I've got a nine-month old who's consistently disrupting my sleep. Is there any role for creatine helping me when I'm groggy in the morning after he's woken me up at like 4:00?
Dr Louisa Nicola: Hugely. Uh some of the studies are showing that you can offset the negative impacts of sleep deprivation with creatine.
Dr Rupy: Oh gosh, with the high doses?
Dr Louisa Nicola: With the high dose, the 20 grams a day. In fact, I did grand rounds at the hospital like three weeks in a row.
Dr Rupy: You just for the listener, grand rounds is sort of like when you do case presentations and it's usually from uh involving multiple different disciplines from the hospital. So you've got the cardiologist sitting next to the radiologist, etc, etc. So it's it's it's quite a big thing. Yeah.
Dr Louisa Nicola: The yeah, it was a big thing. The the first one I did uh in for neurosurgery was very well received and for some reason I got asked to speak at the OBGYN grand rounds. I'm not sure why and that was a huge debate and everybody was late to work that day. But um, so that was interesting. But um, so it's yeah, so I that day I got in there I'm like, oh my god, I was I was sleep deprived because I was trying to do it the night before and so I took 20 grams of creatine that day. So it can offset the negative signs of sleep deprivation as well.
Dr Rupy: Interesting. So I'm on 10 grams of creatine at the moment and I thought I was being a great A student, but now you're saying I'm I'm like middle of the class back again.
Dr Louisa Nicola: Middle, yeah.
Dr Rupy: Okay. All right. Okay, fine. So creatine, I've got to increase that. Are there any extra benefits that you you're aware of like looking at the maybe even beyond the brain?
Dr Louisa Nicola: Yeah, look, we're seeing great benefits for improving bone mineral density in menopausal women and that's because the estrogen receptors, as we spoke about earlier in the brain, are also present on the bone and this is why a lot of women experience osteopenia and then which is the precursor to osteoporosis or I would say it's an osteoporotic pre-state. So um, and we're seeing like really great like going from osteopenia to normal bone mineral density with having creatine monohydrate. And that's even at a lower amount of around 12.5 grams a day.
Dr Rupy: Really? Yeah.
Dr Louisa Nicola: And I'm assuming that's in combination with resistance training, exercise, diet, protein.
Dr Rupy: Resistance training and believe it or not, jumping.
Dr Louisa Nicola: Yeah, I know. One of the exercises that we were taught not to recommend to osteoporotic women, but now it's completely turned on its head.
Dr Rupy: Yeah. Okay, great. So I think we've done creatine, great for prevention, great for a number of different things if you can tolerate it, and even within the stages of dementia itself, so MCI, mild cognitive impairment, and even, you know, from a rehab point of view with with stroke patients.
Dr Louisa Nicola: Correct, yeah.
Dr Rupy: Great. All right, let's go let's go for another one.
Dr Louisa Nicola: So what else does creatine help with?
Dr Rupy: No, no, I think we've done creatine. I'm convinced. Unless you want to carry on.
Dr Louisa Nicola: Creatine is king. Um, but I will say that there's great evidence for creatine and depression, almost mimicking the effects or actually mimicking the effects of Prozac, which is an SSRI, an antidepressant, um, and there's, look, I mean, we can go on with creatine. So we can definitely move on now.
Dr Rupy: Okay, cool. Let's uh let's go for another, you want another supplement, right?
Dr Louisa Nicola: Well, one of my other favourite ones, um, probably spoke about it last time, which is uh we spoke about omega-3 fatty acids, but I think we should go more in depth with that because I'm still seeing a lot of people either not taking it and or afraid to take it for some reason. So let's talk about the brain. The brain is around 2% of your entire body weight, it's around two to three pounds and it consumes 20% of the total calories that you consume a day, which tells you it's a hungry organ, right? And your brain is made of around 60% fat, right? And the rest of it is protein and water. That fat, the out of that 60% fat, around 10 to 15% of that is comprised of omega-3s. Now, omega-3s, which we know of are fatty fish, I'm sure you've spoken about it a lot, they're comprised of EPA, DHA and ALA. ALA is a precursor to DHA. So I'm not going to really speak about ALA now. The 10 to 15% of that 60% fat is actually DHA. So what happens when we have high levels of DHA in the brain? So the one thing that it does is it helps with cell membrane fluidity. So the outer layer of the cell membrane, if it is coated and it's full and rich in DHA, that's where you get the most bang for your buck and the benefits that arise. So one thing that it does, if it helps with cell membrane fluidity, what does that mean? Well, at the the neuron cell body, you've got dendrites and these dendrites connect with itself. So you've got around 100 billion neurons with around 10 to 15,000 connections per neuron. And when these neurons fire together through the synaptic transmission, they release a whole host of chemicals. These chemicals are known as neurotransmitters, dopamine, serotonin, norepinephrine, GABA, which are all responsible for different things, happiness, vigilance, excitedness, all of this, right? Um, it helps when you have a more fluid cell membrane, you're able to release these at a faster rate, at a more smoother rate. So it allows for that to happen. One thing that it also does is once it is extracted from the cell membrane, it undergoes a process that is able to downregulate the amount of inflammation in the brain. We all know what inflammation is. It can either be a good thing or a bad thing. Chronic inflammation exists systemically, but we have inflammation in the brain, which is called neuroinflammation. Neuroinflammation is, in my opinion, at the seat of Alzheimer's disease because when your brain is chronically inflamed, and by the way, this can show up as a headache, right? Or it can show up as brain fog. Don't forget that symptoms are just messages from your body. That's what symptoms are. What do we do when we have a headache? We take a Tylenol or a Panadol, wherever you are in the world.
Dr Rupy: Do the UK have Panadol?
Dr Louisa Nicola: Yeah, we've got Panadol, paracetamol, generic one.
Dr Rupy: Yeah, yeah. Aspirin.
Dr Louisa Nicola: Yes, aspirin. Okay, let's talk about aspirin. This goes in and blocks prostaglandins. Guess what? DHA does that too. So DHA is a powerful anti-inflammatory or and it's it really serves as the same type of anti-inflammatory that you would take in a pharmacological way. So we're seeing that effect. And I think that that is really interesting because omega-3's sister, which is omega-6, that when that's in the brain, that produces prostaglandins. Isn't that interesting? So if you have a higher amount of omega-3s, it can kind of offset the amount of omega-6s in the brain. We're now seeing that with extra cell membrane fluidity, you're able to ameliorate or get rid of these hallmarks of Alzheimer's disease such as amyloid beta, which is within the cerebrospinal fluid, which is outside of the neuron. So you can have the ability to clear out the hallmarks of amyloid beta. So of Alzheimer's disease, sorry. So that's interesting, but also omega-3 fatty acids, we're now seeing with Dr. Bill Harris out of his group, he's the one that formulated the omega-3 index. When he did his studies, he saw that people with a high omega-3 index, which is around 8% or more, reduced their risk of cardiac death, sudden cardiac death, reduced their risk of all-cause mortality, reduced their risk of Alzheimer's disease. So there is just so much that you can achieve from having a high omega-3 index.
Dr Rupy: Yeah. So the omega-3 index, which I I completely get on board with. I mean, I test mine. I want to make sure that I'm between
Dr Louisa Nicola: What are you at?
Dr Rupy: I'm like 8.5, 9% the last couple.
Dr Louisa Nicola: Oh, I'm 11.8.
Dr Rupy: Oh gosh. Okay, well you're beating me in everything. You're taking more creatine, you're taking more omega-3. Um, I remember coming across Bill Bill's work around that. Um, and I think it's one of those tests that I think is worth paying out of pocket for because I don't believe we do test that on the NHS.
Dr Louisa Nicola: I think it's around probably 60.
Dr Rupy: It's like 40 pounds or something like that. Yeah, it's relatively cheap. And you can buy it in many different places now. And it just gives you a bit more of a guide um as to how much omega-3 you need to be consuming because I think I was consuming a relatively low amount and now I'm at like 1.5 grams now of EPA and DHA.
Dr Louisa Nicola: So is that as a whole or 1.5 grams?
Dr Rupy: So it's 3 grams all up.
Dr Louisa Nicola: Yeah, yeah. That's fantastic. Yeah. Because all you need to actually climb that scale from 10% to 11% is 2 grams.
Dr Rupy: Oh, really? 2 grams of each?
Dr Louisa Nicola: Or 2 grams total.
Dr Rupy: Total. Ah, so I'm I'm having more than that and I'm still not at the at your level.
Dr Louisa Nicola: So the um, yeah, so the um the studies that I'm referring to for dementia and um and brain atrophy, the people who experienced greater improvements in brain gray matter volume and global cognition were only supplementing with just 1 gram.
Dr Rupy: Okay.
Dr Louisa Nicola: Yeah, so that's a a really low dose. So I think like from what I've read, it's 2 grams of each per day.
Dr Rupy: For this is really good information for folks because um most of the omega-3 supplements that you find in stores is low dose, including not just the algae ones that are like, you know, 400 milligrams, but most of the fish oil ones as well are under that amount that we are seeing is actually having the effect on the omega-3 index and pushing that blood level higher. So I think that's a really important note to to make to either increase the number of capsules you're consuming or I take a purified fish oil, um an algae based one as well now because I wanted to move for purity reasons. But that that's yeah, that's something that I think most people need to be aware of.
Dr Louisa Nicola: And um there was a study that was done in the US and what they did was they actually took 73 um EPA DHA omega-3 supplements that are sold in the US and they found that every single one of them exceeded the oxidation level.
Dr Rupy: Oh, really?
Dr Louisa Nicola: So meaning that most of these fish oils were rancid. So you also have to be mindful of who you're buying your fish oil from because you're probably just buying rancid fish oil. And then the way that you store your fish oil and you should be stored in a cool. I usually put mine in the fridge so they don't become oxidized and rancid. And just really looking at the quality of the fish oil itself.
Dr Rupy: Well, most of the fish oil that you buy in stores is stored outside of the fridge, right? So there's a telltale sign that they're not taking care of the fish oil even at the, you know, the the marketplace level.
Dr Louisa Nicola: Exactly. And you also want to be mindful of how did they even get to the store to begin with? Were they driven there on a truck sitting out in the sun? When were they bottled? Where's the source?
Dr Rupy: Yeah. Yeah. It's no wonder so many of them are rancid, unfortunately. Um, okay, I just want to double click on neuroinflammation here and we can go beyond nutrition. What are the the biggest drivers of neuroinflammation that you you've come across?
Dr Louisa Nicola: Uh, ultra-processed foods, obviously, at the seat of it. Uh, I hate the seed oil debate. I'm not in the nutrition field. I'm not going to harp on about it, but there is something to be said of the omega-6s and um and look, first and foremost, it is obviously what we're told not to eat. It's the ultra-processed foods that is causing the cascade of neuroinflammation. Then we've got the lack of exercise because exercise truly is foundational for downregulating inflammation and improving brain health outcomes. Sleep. Sleep is fundamentally important for lowering inflammation. So if you're not getting into deep sleep specifically and also REM sleep and sticking to sleep regularity, then that's also going to cause an increased risk of neuroinflammation. But then look, then you've got other things that have just become apparent to me, which is exposure to particles in the air, such as PM 2.5 and PM 10. And I just um I put up a a real uh talking about over 300,000 people were tracked in China where the air quality isn't too good. And they found increased risk of Alzheimer's disease, um cancer, and the reason why it stood out to me, this study specifically, because it showed that out of those 300,000, they also took a cohort of pregnant women. And it seemed to have uh women were giving birth prematurely and it was affecting the neurodevelopment of their unborn child through the umbilical cord.
Dr Rupy: Wow.
Dr Louisa Nicola: So that's also because this, you know, these toxic particles in the air are now infiltrating our system, getting into our brain tissues and causing inflammation at the at the lining of the arteries, at the endothelial level. Then we're exposed to BPA, right? We're exposed to these microplastics that are now being found to be lodged in brain tissue. Actually, the lab in Australia in Sydney, which I'm so proud of because I know them, were the first ones to show ever that um that BPA that microplastics were found in human brain tissue.
Dr Rupy: Oh my gosh.
Dr Louisa Nicola: So don't even, you know, and we haven't even spoken about, you know, maybe going through a divorce, all right? Or um maybe just being upset, maybe getting fired, maybe going through something hurtful. That's causing a lot of uh a lot of neuroinflammation. Some of the um, you know, people are on different types of uh medications that's causing levels of neuroinflammation.
Dr Rupy: Yeah. So I mean, it just seems like we have the burden of disease that is piling on top of each other. And you're right to to mention all these other emotional triggers that can compound neuroinflammation. And it's, you know, we can control the controllables and just do our best. And I I want to give people hope, which is why I want to move swiftly on to some other things that we can actually be proactive about. Yeah. But just to to to um press for a moment on omega-3, what about for pre-existing patients with dementia? Is there any evidence that this is actually helping or is that, you know
Dr Louisa Nicola: Of course it's helping.
Dr Rupy: Okay.
Dr Louisa Nicola: Okay. It's everything I just described, the mechanism of action of omega-3 fatty acids is helping them incredibly, especially the pre-clinical studies that are showing the amelioration of the amyloid beta from high doses of omega-3 fatty acids.
Dr Rupy: Is there any evidence that like pushing it really high, we're talking like, you know, proper pharmaceutical levels of omega-3.
Dr Louisa Nicola: Like Vascepa?
Dr Rupy: Yeah, like Vascepa in the states, I think it's called. Yeah.
Dr Louisa Nicola: Um, yes and no, but I I don't know the dosages of that, but I mean
Dr Rupy: They're like 4 grams, I think. 4 grams plus.
Dr Louisa Nicola: And that's but that is that is the dose that, you know, is generally I mentioned 2 grams of each per day.
Dr Rupy: Okay, fine, fine. Okay. Um, great. Anything else to say about omega-3?
Dr Louisa Nicola: Um, you know, the EPA content is great for your heart and it also helps with um atrial fibrillation. And I know there was a huge study that was actually debunked that showed that the EPA content of the omega-3s is causing atrial fibrillation or it can be a an indication of, yeah, but it's it's not.
Dr Rupy: Yeah, yeah.
Dr Louisa Nicola: It's not. That's been that's been properly debunked. I think across the board, if you are not supplementing with these two, then you're doing your brain a massive disservice.
Dr Rupy: The other side of it is um compliance as well, because, you know, we talk a lot about food and nutrition and, you know, supplements, but even with the knowledge and the education, people still don't take the supplements. And I'm guilty of this as well, to be honest. I mean, throughout my patient journey, I knew what supplements I was meant to be taking and I I didn't take them all the time. Now I'm a lot more fastidious, but perhaps that's just the factor of my age and the fact that I've got a little boy now that I'm just trying to be around for as long as I can, but but yeah, I think that's another issue that people can take them and with all the best intentions, buy them online or in store, but just not actually maintain the consistency of taking it every single day.
Dr Louisa Nicola: Yeah. Of course.
Dr Rupy: Epic. Um, all right, omega-3, go get your omega-3. What do you have a preference between algae and fish oil as long as you get the EPA and DHA?
Dr Louisa Nicola: Just get EPA and DHA.
Dr Rupy: Okay, sweet. Awesome.
Dr Rupy: Next on the list.
Dr Louisa Nicola: Next on the list. Yeah. Are we are we moving on from
Dr Rupy: Oh, okay. We're still on supplements.
Dr Louisa Nicola: We're still on supplements because a phenomenal study that was just released, uh which tracked over 10,000 people showed that those with a high vitamin D level exhibited a 40% reduction in dementia.
Dr Rupy: Oh, interesting.
Dr Louisa Nicola: Yes, as opposed to those who had a low level, which was described as 20 nanograms per decilitre or less, had a 68%
Dr Rupy: That's super low.
Dr Louisa Nicola: Well, actually, that's the national average in the US.
Dr Rupy: I know, I know, but like it's so low. I mean, I was literally just talking about how I'm no longer surprised when I see numbers around the 20, 30 mark.
Dr Louisa Nicola: I know, right?
Dr Rupy: But, you know, anything under 25 or 25 or under, like is way too low for in my book. Like I'm really trying to push people to 50 as a minimum.
Dr Louisa Nicola: Yeah, and that was a look, this was a I I will admit this was a correlation study, but vitamin D, ultimately, we have vitamin D receptors on our brain just like we do with estrogen that um are responsible for many different things, including brain global brain atrophy, which is what the uh mainly the study showed. So increasing gray matter volume is probably the best thing that we can garner from this study. But vitamin D is so beneficial for many other things such as women who experience osteopenia because we have vitamin D receptors on the bones. We've got vitamin D receptors on our brain stem, which is responsible for how we go into sleep. So so many benefits from that and I think that that was really powerful to point out. And I think it's precursor as well, which is magnesium, which sits at the middle of the chlorophyll molecule. So where does that come from? Green leafy vegetables. So got to make sure you get your greens in.
Dr Rupy: Yeah, I know that you you do that on the cover of your book.
Dr Louisa Nicola: Yeah, I know, yeah. I'm a big fan of getting greens at every meal time. Um, in terms of the vitamin D um levels or the dose that you recommend, what what do you tend to
Dr Louisa Nicola: It depends on where you're at on the spectrum, but globally, it it would be 5,000 international units per day. And if you pair that with vitamin K2 for greater absorption, then what you want to do with this as well, because it's a hormone, right? Hormones are and the receptors is like key and locks. You want to track this over time. So if the worst thing you can do is keep supplementing with vitamin D and not get anywhere because it does say something. That means that if you are supplementing every day with 5,000 IUs of vitamin D over the course of, let's say, six months and you go and retest and you haven't climbed the ladder, you haven't gone from 30 nanograms to at least 40 or even 50, then something's wrong. Maybe it's an absorption issue. Maybe you've got lead presence in your blood because vitamin D binds to lead in the blood. So that's something to be cautious of.
Dr Rupy: Yeah. I I currently take 3,000 IU. That's getting me to a good level. Um, so I think whatever, I think you're right in terms of titrating it to your blood levels, making sure you're aware of your blood levels, getting your blood levels checked. You can actually get this done by your GP. Um, but you can also buy them pretty cheaply as well. And I think, you know, this is all part of being uh like the architect of your own health, like being your real health manager. Um, so that's why I think it's really useful to have um these numbers at the tip of your fingers. Um, cool. Okay, so we've done vitamin D.
Dr Louisa Nicola: We're done.
Dr Rupy: Yeah. Any other supplements before we move on?
Dr Louisa Nicola: Okay. I might ask you about some others a little bit later. What else is in the lifestyle bundle that you're excited about?
Dr Louisa Nicola: So, um, there's a really wonderful study that came to my attention um out of King's College in London where they tracked over 300 sets of female twins. So twins, genetic profiles are the same. And they were testing their leg strength and leg power. And what they found over the course of 10 years, and these were 65-year-old females. And what they found was that the twin who had or exhibited greater leg power had better scores on global cognition and had greater brain volume metrics. So they had greater brain volume. So I thought that that was so interesting. They tested them using a leg extension machine and they did this through MRI, fMRI studies as well. And they underwent after that 10 years, they then spent 12 years, one twin underwent um like rigorous like leg training and they still saw the same thing. So basically this means that the greater the leg muscle, the bigger the brain.
Dr Rupy: That's amazing. And so from my understanding, like leg muscle is a really good proxy for general muscle around the body. And if you've got better muscles or you've got better quality muscles, you've got bigger mass, good strength, what is going on? Why is there an improvement in your brain health and volumetrics? Like what are the some of the mechanisms that you've come across that explain that?
Dr Louisa Nicola: Well, A, muscle is a huge storage sink for glucose. So we know that type two diabetes is a risk factor for Alzheimer's dementia. But instead of talking about the end product, which is increased muscle mass, let's talk about the journey that it takes to get to that increase in muscle mass. During the time of you going and strengthening your leg muscles, you are doing a number of things. One thing you're doing is you're getting greater amounts of blood flowing to the brain. The brain is the most vascular rich organ in the entire body. It needs blood flow to operate, to survive and to thrive. So that's one thing it's doing. The next thing it's doing, every time you contract your muscles and the bigger the muscle, this this works better, you release myokines, which are muscle-based proteins. These myokines are like pharmaceuticals that live in the cells of your muscles. And when they go in and they lodge onto their receptors in the brain, they do phenomenal things like grow new brain cells in the hippocampus or improve global cognition. So that is extremely, extremely important. But then we're also seeing the effects of that on cancer reduction and cancer metastasis. This was actually a really great study out of nature that showed that these myokines can inhibit prostate cancer. So
Dr Rupy: global benefits of just exercise and making sure that your muscles are strong.
Dr Louisa Nicola: Just from those myokines alone. So it's not just about the end result, which is increased muscle mass. It's about what's the journey that it takes to get to increased muscle mass. But look, greater leg strength can also mean you can walk further and you can keep walking, you can um have better grip from not falling in your 80s and succumbing to a hip break. Um, and then you've got also, you know that by vector size, obviously they're your you've got four muscles on the quads and they're quite big. Every time you squeeze your muscles together, you've got veins, okay, that's part of the vascular system and they they are just one-directional pumps. So we need to be squeezing those veins together to actually get the flow of blood to go through them.
Dr Rupy: So if anyone's listening to this, you just like feel your thigh at the moment, just as long as you're not driving or anything like that, and you just squeeze or you can just like squeeze the glute or something. What's what what describe again what you just said. So you you're compressing the muscle or you're contracting the muscle.
Dr Louisa Nicola: Every time you contract the muscle, which is shortening the muscle, you are squeezing them together and during that process of contraction, you are releasing these myokines. That's the first one. But also you have veins that run through your muscles as well. So every time you squeeze your muscles and it pushes the veins together, veins are a one-directional pump. So you have to they don't flow by themselves. They're not like arteries. So you have to push them together to get that blood flowing.
Dr Rupy: Yeah, yeah. That's brilliant. Okay. So in terms of exercise, I I definitely get it from a preventative perspective, right? Ensuring that you are regularly moving, um, you are doing resistance training. What about for those who again have a an established diagnosis of MCI and dementia? Is there any research that putting these folks with all the sort of challenges that it would pose, um, putting these folks on an exercise program can can actually help?
Dr Louisa Nicola: Yeah, there was a great study by Louisa Nicola et al, actually, that looked at this. Um, so her and her team went out and did a uh did a review on all of the available evidence on exercise, specifically resistance training and what it does for mild cognitive impairment. And to cut a 30,000 story down short, 30,000 word story down short, basically what it showed was that just two days a week of strength training on mild cognitive impairment patients can slow the progression and the onset of Alzheimer's disease. So let's just say that you were set to get if you had been newly diagnosed with MCI and you were going to get Alzheimer's disease in 20 years, then maybe you will get it in 30 years. It will not halt the disease at all. You will not reverse the disease at all. This is why prevention is so key. It's like a wildfire, right? You light something on fire and it is so hard once it gets attached and it just keeps going and going and going, it's very hard to put out. That's what Alzheimer's disease is.
Dr Rupy: Yeah, yeah. It's just such an unfortunate scenario that we have right now where we can um we don't have a cure and this is why we need to really lean heavily into prevention and lifestyle. Um, in terms of the resistance training that you just referred to, give folks an idea of like what types of exercises, the amount of time, how much they were spaced out in the week, if that is even important.
Dr Louisa Nicola: I'm a realist, okay? I'm a I'm I'm a realist and I'm looking at life and I'm not going to go and say to you go and work out five days a week. A, probably not going to be beneficial. B, we know that just two to three days a week in the gym is going to yield great results if you're doing the correct things. So, starting first of all with how do we get the biggest bang for our buck? It is doing the compound movements, your squats, your deadlifts, right? And your bench presses, etc. But even before you do any of that, the best thing that everyone could do, because not everyone, I I've now come to the conclusion that not everyone has grown up in a gym or exercising. In fact, in the US, only 20, around 15 to 20% of US adults meet their physical activity guidelines.
Dr Rupy: That's 15, really?
Dr Louisa Nicola: Yes, I don't know what it is in the UK.
Dr Rupy: Probably not far off.
Dr Louisa Nicola: Probably not far off at all. So that tells me that, okay, there's a problem there. So therefore, a lot of people probably don't even have the correct technique. And if you don't have the correct technique when it comes to squatting, then you are going to succumb to an injury. And bed rest is the new smoking. So you don't want to be in that stage. So going to the gym, get the technique down, right? From that, then you can build your way up. Unfortunately, we are in the game of heavy. You do need to lift heavy to get the benefits and to get the global benefits on your bones, on your brain, and on longevity and all cause mortality. Because we know that strength is another strong predictor of all cause mortality and longevity, right? So you want to be going in there, you want to be getting the right technique, you want to be lifting heavy. And then let's just say you've gotten there and you're like, okay, Louisa, like give me the real stuff. I truly believe you need to be working on a five sets of five reps. Because when you're at, let's just say you're at five or six reps, right? That's when you're at the stage, if you can leave it with two reps in reserve, that's the sweet spot.
Dr Rupy: Explain to folks what that is because we're probably speaking to some people that don't understand what a set or a rep is.
Dr Louisa Nicola: Okay, so basically, let's just say we're going to go in and do barbell squats. That's when you've got the squat, you've got the barbell across your shoulders and you're going to squat down and that means that if you, if I go in and I do six squats, that is one set. And then I load the bar back up again. I put it to rest. I go back, I do another set of six reps. So I want to be doing that at least four or five times. And when I say reps in reserve, I mean, when you get to the sixth rep, that means you want to stop there, but if you had to for gun was to your head, you would be able to push out another two. But on those other two, once you get to eight, you would drop dead.
Dr Rupy: Got you. Yeah. Got you. And and the types of exercises that, I mean, it sounds like what you're alluding to, are these compound exercises? Is this giving you more bang for your buck?
Dr Louisa Nicola: Deadlifts, squats. Yeah, because you've got more, I mean, I and I actually do this sometimes, you know, I am guilty of going and doing accessory muscles, dumbbell flies. It's like, why? Uh, if you are in a if you are competitive or you have you do it for a living, you're a fitness influencer and you have time to do that, then do that. But for the regular everyday person, especially if you're a mother or a father like you, you can attest to this. It's really hard to go to the gym seven days a week.
Dr Rupy: I have such little time now. Like I used to be that person doing the accessory muscles and stuff and now I'm just all I do is whatever I can.
Dr Louisa Nicola: Chin ups, deadlifts, not deadlifts because my technique isn't great. Bulgarian squats and um uh what is it? Press ups and other variations and pull ups really. That's basically it.
Dr Rupy: Yeah. And that's that's if that's what you all you can do, then that's all you can do. And that's that's a pretty great thing. Actually, one thing I'm trying to optimize for in my 40s, which I'm not there yet, got a while to go, but what I'm optimizing for is I need a home gym because it's becoming so difficult for me just like with uh with my career to get to the gym. That's becoming like such a chore. And I think to myself, if only I had a home gym.
Dr Rupy: Yeah, yeah.
Dr Louisa Nicola: But I don't want a crappy one. Like I want a real gym.
Dr Rupy: Honestly, it's on my vision board. I was telling uh Tara Swart about this the other day actually. Um, about what I'm action boarding right now and I don't want a fancy car. I don't want like a fancy house. I don't need like any of the sort of like designer bags or anything like that. I just want a home gym.
Dr Louisa Nicola: Yeah.
Dr Rupy: I want a home gym because I know that gives me extra years in my life. It gives me extra energy. As I'm learning from you, it gives me uh better brain health, better cognition, and it just gives me time back as well. That time traveling to the gym and back and I it sounds like a privilege, but like, you know, it just gives me so much more. So yeah, home gym all the way.
Dr Louisa Nicola: Like traveling to the gym. So I live between New York and LA, but now with my career, it's like I live actually just on Delta Airways. I like it's it's insane. But um going to the gym is now even more of an issue. Uh but thankfully where I live in New York, I live right in Manhattan and Equinox is one block away. So that's that's I can do that.
Dr Rupy: Yeah, yeah, got you. All right. So exercise, omega-3, vitamin D, creatine, um, if uh if there was anything else, what would you what would you add that perhaps has maybe less evidence, maybe something that you're less confident on, but you might be there's a twinkle in the sort of distance that gives it a bit of hope.
Dr Louisa Nicola: I love uh as it relates to brain health and Alzheimer's disease. Look, um I do love hyperbaric oxygen therapy.
Dr Rupy: Okay. Yeah, talk to me about that.
Dr Louisa Nicola: But there's so many caveats for that. A, the best way to include hyperbaric is just after you've undergone surgery or just after you've had a stroke or you've had a TBI. That's really not not us, right? So does it affect the everyday person? Well, look, it's amazing to get 100% oxygen delivered straight to your brain and tissues. I see the biggest benefits of that when I've just come off a plane. So I did it on Monday because I just flew from Sydney. So it was like a 15-hour flight and I just felt horrible. So I went and did it. Would I include that in my everyday routine? No, I wouldn't because strapped for time and the benefits are probably very much like if I like I I live a healthy lifestyle already. So it wouldn't give it probably give me like a 1% benefit and that's not big enough for me to spend an hour and you actually get locked in there for an hour. It closes and you can't you can only escape if you're if it's a medical emergency.
Dr Rupy: It's definitely not for the claustrophobic.
Dr Louisa Nicola: No, but one thing I do love are the infrared light beds.
Dr Rupy: Okay.
Dr Louisa Nicola: So I'm becoming really bullish lately on light, whether it's sunlight or whether it's infrared light or whether it's mitigating blue light at night. And that's because we've seen pre-clinical studies of shining infrared through the nasal through through your nose, which shines up to a piece of your brain where we've actually where people have had a stroke and they've healed it with red light. So that was a yeah, that was really interesting to me. Now we're seeing that red light can actually penetrate the skin and really go into the superficial organs of the body, having an effect on immunity, having an effect on mitochondria.
Dr Rupy: Really?
Dr Louisa Nicola: Yeah, so induce mitochondrial biogenesis. And this is not, by the way, I'm skeptical of everything. I'm a scientist. I need hardcore evidence. And this has the evidence. So I've now started to include whenever I can, uh red light beds. It comes at a cost, obviously. That's why it's but I do have red light panels set up at home.
Dr Rupy: So you know those panels because my wife's got one of these and she's been using it when she meditates and I don't know if you know the brand or whatever, but like she puts it in front of her and I'm always like, I don't know what you're doing, but I don't think it's working.
Dr Louisa Nicola: Well, it actually depends on the wavelength. And I've spoken about this. I have a newsletter and I I put out all of the probably in the last month I put out the all of the robust evidence that shows that red light therapy can stimulate collagen production, which is great if you are looking for some beauty tips.
Dr Rupy: I think that's what she's doing it for.
Dr Louisa Nicola: But it can also um speed up wound healing. Right? If you've got a cut or a graze somewhere, but yeah, it can also help with um at the mitochondrial level. So that's something I love.
Dr Rupy: That's so interesting. So this study you were mentioning earlier where they shone red light, I'm assuming it was of a specific wavelength. You talked about it in your is it a substack?
Dr Louisa Nicola: Yeah, neuroathletics.substack.com.
Dr Rupy: Okay, great. We'll definitely link to that. But um, so they shone they shined it up the nose where it goes to the
Dr Louisa Nicola: It goes to the brain. Yeah. And they can heal the brain with red light.
Dr Rupy: Wow.
Dr Louisa Nicola: So what we so the caveat to that is now there's a lot of um red light helmets um that they've got for TBI patients who have undergone maybe a concussion or brain injury from something. But even stroke patients as well. The only thing is, um I think to penetrate through the skull, it has to be a really like specific wavelength, but they'll get there.
Dr Rupy: Wow. I wonder if NFL athletes and rugby players are doing this preventively.
Dr Louisa Nicola: They're using there's definitely, oh, they can be doing a lot of things to prevent. If if NFL players were dosing with at least 20 to 30 grams of creatine prior to going out onto the field, I tell you, they will be in a much better position to overcome the trauma such as a concussion than if they weren't. And that's because creatine is neuroprotective.
Dr Rupy: Wow, that's so interesting. I wonder what else they could be doing with this stuff. I mean, if they're not on high dose omega-3, they're not uh taking creatine at a high level. I mean, they're probably all on like 5 to 10 grams to be fair because of the uh the exercise benefits, but you know, this this new sort of 20 grams plus idea, I think is is relatively novel. It probably hasn't filtered down yet.
Dr Louisa Nicola: Yeah. Um, and they can also get really great benefits with that we won't go too much into it from cooling their brain because concussions and even strokes, um we we can see that there is and they're doing this in Australia where they're working on putting cool uh pads on the back of their necks to cool them down as well, to cool down their entire core body temperature.
Dr Rupy: Wow. Wow. That's amazing. Okay. So red light therapy, I should be
Dr Louisa Nicola: Well, looking into it. It's not a it's not a necessity. The necessities are
Dr Rupy: Or taking the mick out of my wife less about the red light therapy.
Dr Louisa Nicola: The necessities really are exercise. We only touched on and we don't have to go deep into it. We only touched on the effects of resistance training, but I got to tell you for the women out there listening, um they're doing really great studies in New Zealand where they're taking a cohort of women in the menopausal stage who have got osteopenia and they're getting them to jump for 10 minutes, three times a week. And over the course of 10 weeks, they're taking women from osteopenia to normal bone density.
Dr Rupy: Amazing.
Dr Louisa Nicola: So just jumping on the spot stimulates the bone to produce more bone tissue.
Dr Rupy: Yeah, yeah, yeah. So they're stimulating the osteoblasts and then they're building more. Wow.
Dr Louisa Nicola: Because at that stage, osteoclasts is taking over.
Dr Rupy: Yeah. Yeah. Incredible. That's amazing.
Dr Louisa Nicola: Yeah. So if you can imagine, if you combine that with high dose creatine and you're hitting the gym and you're doing minimum 8 and a half thousand steps a day, I got to tell you, you are on the track to be living a beautiful brain healthy life.
Dr Rupy: Have you looked at the, I mean, this is extra work for you, Louisa, on top of your already very busy schedule.
Dr Louisa Nicola: I've got time on the plane.
Dr Rupy: Uh, I imagine it would be a really interesting study or review paper that sort of estimated uh how we could bend the curve of dementia if you compounded all these different interventions and added up essentially their effect if people were actually given this advice at a primary care level or a public health level, right? Getting enough of these different
Dr Louisa Nicola: Do you mean educating the GPs and and doctors?
Dr Rupy: Educating the GPs, but let's just imagine that every population, every every person in the population above a certain age was actually doing these interventions, what would actually happen to the cost of uh neurodegenerative disease, you know, at a country level. It would be pretty interesting, right?
Dr Louisa Nicola: Yeah, well, because the global burden economic burden of Alzheimer's disease will be the collapse of the US healthcare system. However, intervening within that could disrupt and upset the pharmaceutical industry.
Dr Rupy: Oh, do you reckon? Do you reckon that's what it's not going out there? We're going to conspiracy corner now.
Dr Louisa Nicola: Let's not go down there, please.
Dr Rupy: All right. Louisa, this has been great. Honestly, my audience absolutely love you. I love you. I think you're doing incredible work. I think you're really banging the drum as well in so many different ways. So I'm going to be I'm going to be upping my creatine. I'm going to be showing you, I'm telling you about it. And if I get GI effects, I'm going to be texting you. So
Dr Louisa Nicola: You've got a beautiful head of hair right there. So it doesn't really matter. Okay. And look, this is evidence that creatine doesn't increase. No. That hair, yeah.
Dr Rupy: Thank you, Louisa. This has been great. Appreciate you.
Dr Louisa Nicola: Thank you so much, Rupy.
