168. Rewiring the Brain: Unlocking the Secrets to Neurodegenerative Disease Prevention | Leonaura Rhodes, MBChB

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamashiraja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in healthcare. Our guest today is Dr. Leonardo R. Rhodes, a distinguished physician, public health expert, neurosurapist, and certified brain health coach. With over three decades of experience, Dr. Rhodes has dedicated her career to helping individuals optimize her brain function, manage stress, and design fulfilling, high performing lives. Dr. Rhodes obtained her medical degree from the University of Manchester, and later pursued a Master's in Public Health at the University of London, where she trained in biostatistics, epidemiology, health economics, health promotion, and medical writing. She further expanded her expertise by obtaining numerous certifications in counseling and neurotherapy. Additionally, she completed intensive coaching training at the Tony Robbins Coaches Academy, equipping her with a broad skill set to help individuals improve cognitive health and resilience. Throughout her career, Dr. Rhodes worked as a general practitioner, public health physician, and neurodevelopmental pediatrician, gaining extensive experience in neurological and cognitive health. She has since transitioned into coaching, corporate training, and medical writing, focusing on stress resilience, neuroplasticity, and brain health optimization. In this episode, we are going to explore neurodegenerative diseases, the lifestyle factors that influence brain health, and practical steps to protect cognitive function as we age. Throughout this episode, you're going to learn about how we can understand what neurodegenerative diseases are and their causes, the progression, and similar common types such as Alzheimer's, Parkinson's, and Vascular dementia. We'll then go into the role of genetics versus lifestyle and how we can prevent cognitive decline. You'll also learn about the power of exercise, sleep, and diet when it comes to maintaining long-term brain health, we'll also talk about how stress, inflammation, and gut health can contribute to neurodegeneration, and lastly, we'll also talk about insights on supplements such as creatine and their impact on brain performance. This is a wonderful episode. I can tell you from firsthand experience in the rehabilitation setting. I'm seeing more and more patients with neurodegenerative diseases, so I know this is something that is going to hit home for all of us. Let's dive in. Welcome, Dr. Lianora Roath. I'm so glad to be here. Thank you for inviting me. Yeah. It's always a pleasure to have guests that I've spoken to you prior, but it's always fun to have a friendly, familiar face back on the podcast here. Let's get right into it. We're going to be talking about neurodegenerative diseases as well as the life-self actors. This has been a hot topic on social media lately. There's been a lot about brain health that has been coming out. For listeners, why don't we just start with the basics? What is a neurodegenerative disease and can you provide some examples for us? Totally. Yes. So, neurodegenerative diseases, which is hard to say, is a group of diseases that is marked by an abnormal or escalated death in brain cells, which sounds dramatic. But basically, the brain is aging faster than normal. And it inevitably leads to a significant reduction in brain function, cognitive decline, and loss of normal function, and ultimately, the ability to be independent. Interestingly, neurodegenerative diseases usually don't cause early deaths themselves, but they do cause early mortality through the side effects of the disease themselves. Some examples you'll all have heard of. We have Alzheimer's diseases the most common. Not many people have heard, lay people have heard of vascular dementia. This is the second most common of the neurodegenerative diseases, Parkinson's disease, which is more well known than we have multiple sclerosis. Another one that not many people have heard of is Lewy body dementia, frontotemporal dementia, ALS, and Huntington's disease. They're the top eight of the neurodegenerative diseases. And they all cause slightly different symptom profiles. Some of them are associated with more musculoskeletal symptoms, you know, difficulty walking and things like that. And others have more of a prominent cognitive or thinking memory, if I mention to them. So you mentioned, yeah, how these diseases are not only just isolated to the brain. There is the cell death that we see there, but it is pretty much systemic and everything that you mentioned, man, this is bringing PTSD probably for all of us when we're studying for boards. It's CAG repeats and Huntington, the Lewy body and the vascular dementia, the stepwise decline that you see. These are all things that we had to learn. Not much that I see them at least in the clinic. I definitely see a lot of Parkinson's, I've seen ALS dementia just as a whole we see. But what are those early symptoms and signs that we see in these disease processes? I think herein lies one of the problems. They're often pretty vague early on. And we have three phases with all of the neurodegenerative diseases. We have a preclinical phase where people might have some really subtle symptoms, maybe a bit of memory decline, which it's funny, I'm in my mid fifties and I've spent time with we went for a weekend with four people in the late fifties a couple of weekends ago. We spent the whole weekend saying, remember that guy who was in that movie that played that role, not being able to remember names, those kind of memory lapses that people have and in these diseases they are at a higher level than they are in the normal aging process. But it can be very hard to discern what's normal aging and what is more significant. Also things like mood change, personality change and then of course with say Parkinson's, Huntington's and Lewy body. We also have some physical symptoms as well with problems walking or tremors, things like that. So early on it can be very difficult to in the preclinical phase to know what's going on in it. It can be hard to discern from what's just normal. And then we have a phase that is certainly an Alzheimer's is called mild cognitive decline where you're starting to see more significant symptoms. And in these first two stages, this is where we do have a window of opportunity to actually slow the progression of disease through lifestyle change, which will come on to talk about in a minute. Sadly, by the time most people are diagnosed, the disease process is at such a significant level that current treatments are not able to halt the progression of the disease and then we are relying on symptom relief. That delay in diagnosis, what do you attribute that to? Is it the vagueness of the symptoms and there's overlap with so many other things? Is it access? At least, you know, I'm sure the answer varies in terms of the access answer depends what part of the world you're in. But considering we're all practicing in the states at least, we're also there is some disparity. But what would you think here? The reason for that is. I think it is a combination. It is going to be largely down to people not seeking medical care, you know, being, it's very frightening when you think you, you know, you have early, early symptoms of these diseases and, you know, especially, I'm of a generation where we did go to the doctor more, but my parents' generation were very stoical and would, you know, would delay going to the doctor. You know, I frequently hear from that generation, I didn't want to bother the doctor. And so often, you know, they'll be ignoring symptoms for months or years before they'll seek medical care. And you know, if they do see their doctor for, you know, for their routine medical, they may forget to bring these things up. You know, years can go by of symptoms being missed. You then have people at the other end of the spectrum who are a bit neurotic and who, know, who go to the doctor very early, but then you have the problem with, you know, sometimes doctors not taking things seriously being, you know, bob doff, saying to people, you know, don't worry about it. It's normal. You seem fine to me type of, and then, of course, access to, you know, access to seeing specialists. This is a specialist diagnosis. This is not something that's made by a primary care doctor. It's usually made by a neurologist or a neuropsychiatrist or neuropsychological evaluator. And the testing, the in-depth testing that needs to be done in order to make an accurate diagnosis is very expensive as well. Well, you know, we're talking about thousands of dollars in treatment. And for some people, that is prohibitive. Right. Yeah. Yeah. So I was just bringing up the story about parents' generations and bothering the doctor actually had an interaction with the patient today where she was looking forward to meeting my residents and sharing her story, but I didn't have any training. So it was just me today, and she kept saying, you know, I'm sorry, I know your time is really valuable. And I want to try to get it all out for a moment. I felt so bad. And I was like, is it, you know, what is about this interaction that I don't feel like I've ever given off this vibe that, you know, I'm pressed for time. I feel like I can do a pretty good job, hopefully sitting down and listening all that kind of stuff. But I think it's just that generational gap that you have talked about where you feel like you are a bother with your symptoms, with your quote unquote issues that you might be bringing on. And so that's really interesting. What about, I think one of the things that we talk about often in medicine to be able to recognize these things is, you know, different disease patterns will present in different stages of life. Age of onset could be an important thing that we always consider. So if we were just to take some of those top ones that you talked about, so you said all slammers, vascular dementia, I think you said Parkinson's might have been a third or fourth. I think Parkinson's in my experience may be a little bit easier in the sense that when you have the physical manifestations, the tremors and rigidity and that kind of stuff, ALS, another devastating one, speaking of, especially I had a case of an individual who we were suspecting ALS with, but like nobody was comfortable giving that information to the patient over the phone. Even the electric diagnostic studies had shown that and we were all able to read between the lines. Even the EMG person, we wanted a person who specialized in motor disorders and neurologists to be able to make that, right, and could feel the lot of the follow up questions for that. So talk a little bit about that age distribution in terms of being able to pick that up. Yeah, with the exception of multiple sclerosis, all of these conditions increase in incidents with age. You know, Alzheimer's were usually talking about 65 and above, similar with Parkinson's. Of course there are all those exceptions. Michael J. Fox is a really good example of somebody who is, I think he was late 30s or something when he was diagnosed with Parkinson's, which is extremely rare, but all the others, it's increasing incidents with age, except MS, MS usually occurs, we usually get onset of symptoms between 20 and 40 years of age. And you know, that is the kind of outlier with those. We have some kind of gender differences as well. Alzheimer's diseases, twice as common in women, Parkinson's is more common in men. And of course, you know, we have the, the role of genetics and family history, which play a role in most of these conditions as well, ALS is one of the ones actually where there isn't much of a genetic or family history link. They do, does seem to be something that pops up randomly. For someone who's a question, yeah, we are for someone listening to this podcast who is an optimizer, let's say, right? They want to know whether they have a risk factor for this is, so for instance, a cardiac history, they can get L.P. Little A, they think they're APOB, they know they have a family history, maybe a part of tax and high counseling scores or whatever it might be on one father and mother side. When it comes to maybe running down a checklist as they're listening to this podcast, what are the things that they should be looking for? Is it a genetics, is there a specific genetic testing? Is it the fact that just they're getting older or just looking at family history? What would you say? Yeah, you know, we're all getting older. I think it's really important to know, especially with the, you know, the top three of these, the disease process is a, is beginning decades before diagnosis, which is a good thing in a lot of ways because it does give us a big wind of opportunity to, to make the lifestyle changes that we're going to come on and talk about. The difference is, and interestingly with neurodegenerative diseases, the research is still probably in its infancy as to, you know, in exactly what is going on with a lot of these diseases. Alzheimer's being a really good example. You know, we have, we know about how protein and amyloid, but every intervention that's been tried to reduce these things does not reduce Alzheimer's. So it's, you know, we have these kind of markers, but we don't, they seem to not make a difference when we, when we make changes with them, when we have drugs that are reducing them. There are some genetic tests that can be done. There's one, for example, with Alzheimer's disease, that's called apoe4, or apoe, you have the test done and then it tells you what your profile is. And this does give, you know, the, if your, your homozygous for apoe4, then you have a dramatically increased risk of developing Alzheimer's. But the problem with the testing is that it tends to just make people really anxious without being helpful. And I actually think it's more helpful to come from the perspective of saying that we're all at risk of these diseases and therefore we should be doing everything we can from as young as we can to have a healthy brain and therefore reduce our risk going forward. Does that make sense? Yeah, I think maybe a lot of our listeners, I know we've referenced that series limitless with Chris Hemsworth. Yeah. Are you familiar with that? Yeah. About a year ago, and maybe towards some time fall, 23, really good stuff. But one of the things that came from that is, you know, he had this million dollar work up because the whole idea is about longevity and, you know, brain health is very important. I think Peter T is in there too. And it turns out that he has, he's, someone's like, so he's got the two peers of apoe4 if I remember correctly. A lot of people wanted to social media, a lot of well-known physicians and just completely destroyed the whole approach about, hey, why would you add this? This is a guy. I think at the time, people might have been 38 years old in the prime of his career. And you know, at least behind the camera, it looked like he was really taking it hard as shipping. I think his, maybe his father also has Alzheimer's and it really changes your perspective and how you start looking at life and re-valuating. You know, to make matters worse, of course, he's very popular, this store and Marvel's Avengers. That's my favorite superhero there. Yeah. And he's talking about, oh, I'm going to take a break from acting for a little while to be able to spend this all seemingly because of based up this testing. And so I think that really adds to your point in terms of these tests aren't without harm. Putting aside the cost. No idea how much they put you for gene testing costs, probably not that much. The anxiety and then the further, you know, downstream testing that comes from that and that can have profound effects not only on the individual, their families, the system and cause just burden in general. And so that's something really important for us to consider. You know, Darshan and I were physiatrists, we're musculoskeletal docs, we're also maybe neurodox in some sense, but we look at the whole picture. And so this is certainly something that we're going to be ordering when appropriate, looking at. But nowadays, actually, because of this consumer-driven healthcare system we're in, everybody has access to this. Because I think if you get your 23 and me or any of those genetic stuff, you'll have access to that data. You'll be able to see if you have at ApoE, I think it's ApoE4, if I'm not correct. Yeah, that's correct, yeah. So I think that's something really important for us to be mindful of. Yeah. And I think, you know, like I mentioned earlier, I think the potential risk of harm, it's you know, there's debate about having all of this genetic testing done. What do you do with it? You know, does it just make you terrified and, you know, become very obsessed and end up not, you know, not living a normal life? And there's been examples of people who have, you know, for example, who have bilateral mastectomies because they find that they are at risk of breast cancer when they don't have breast cancer. To me, that seems to be going too far and there is a high risk of causing harm. And I think with, you know, if somebody already has symptoms or they have a very strong family history, then I think you could make an argument for doing some of the genetic testing, there's genetic testing for Parkinson's as well. But even if your test comes back negative with most of, especially with the common ones, it doesn't mean you're not going to get them because they're multifactorial, you know, all of these things are multifactorial. I'd love to share with you Daniel A. Men who I am trained as a brain health coach and trainer. He's done some really fascinating. He does specs, scans and he's found that there are 11 things that are frequently associated with increased risk. Is it okay for you to share them? Please. So number one is blood flow. And even, you know, often we think with Alzheimer's, this isn't, you know, a disease of reduced blood flow, but it turns out that it is. And people who have, you know, who have cardiovascular disease, they are at dramatically at the increased risk of Alzheimer's. The brain is a really greedy organ. It is only 2% of our bodies, so it's pretty tiny. I meant to get, I have a brain model, I meant to get it out, I won't get it out now. But it's pretty tiny, you know, you can hold, you could hold it in the palm of your hand. And it uses 25% to 30% of all of your resources. So if it's not getting enough blood, it is going to harm the neurons and it is going to affect the functions. Blood flow is often, you know, really underestimated. You want to, you know, take control of your cholesterol, you want to, you know, have your blood pressure checked regularly, that type of thing. The next thing which is really interesting is cognitive stimulation. And this is, you know, this is particularly a problem when people retire that they suddenly the stimulation that they're getting to the brain drops off a cliff. And it is really important to stay mentally stimulated to be learning new things, to be experiencing new situations. And there is a massive increase in all of these diseases when, you know, if people retire and stop doing anything, you know, people, so many people just, you know, stop working and watch TV all day long. It's really bad for you. The next thing is inflammation. And we all know that, you know, inflammation is at the root cause of most chronic illness. Inflammation, it particularly hits the brain hard. And it's, you know, you have heard the term neuroinflammation. So that is, you know, that is, that is really important. And probably is underlying most of these conditions also. Then we have the genes which we've just talked about. And, you know, here's the thing, your genes are not your destiny. And also not having bad genes doesn't mean you're not at risk like we just talked about, but it's worth reiterating. The next thing is head trauma. The brain is really sensitive to traumas as you, you may recall, we've got these kind of spiky bones in the temporal region. And if you have head trauma, it can cause sharing of neurons and it dramatically increases your risk of dementia as you get older. Next we have toxins, excessive alcohol. And, you know, there's been a lot of debate in the last couple of years about, you know, is it okay to have, you know, a couple of drinks a week? I don't know the answer to that, but, you know, it alcohol is a neurotoxin, especially if it's in excess and your body, you know, as you're older, your body can cope less well with alcohol. And then drugs, environmental toxins, yeah. Sorry, yeah, I was just going to ask you about drugs. Do we know if marijuana is included in that? And is there any associated risk for dementia with marijuana use? It is, it is absolutely. And Daniel Aiman has some, you know, there's some brain scans that show after chronic use, meaning like four years of marijuana use, you end up with large, large areas of holes in the brain. They're not physical holes in the brain, but they're low perfusion to parts of the brain after it's been, you know, shown at four years of chronic marijuana use. The odd, you know, the odd joint is not going to make any difference, but chronic marijuana use is not good for the brain at all. So it's a really good question. And, you know, it's just become legal in many states when the last kind of three years or so. And I think it is not without risk. For sure. So that's a great question. And the next thing in kind of the toxins bucket is environmental toxins. And I was actually listening to a Peter Atier podcast today. I forget the name of the woman that he was interviewing. And she was describing there's an area of the states that they call the Parkinson's belt. And it's basically a region in the Midwest where there's a lot of agriculture. And Parkinson's is double the rate of anywhere else. And it is, you know, it is believed that this is because of the pesticides being sprayed on the fields in that area. And so that's extremely worrying for people, you know, people who live near spraying that they have no control over at all. The next is mental health, you know, depression, anxiety, ADHD. Unfortunately, these all harm the cognitive function in the brain. And, you know, with anxiety and depression, if you have them for a short period of time, it's, you know, it's probably not going to cause much harm. But if you have it for a long period of time, you are at increased risk. And ADHD, and sadly, this worries me because I have ADHD. It doubles your risk of Alzheimer's disease, which just seems so unfair. You know, other mental health conditions have, and, and with ADHD, it's not been diagnosed for that long. So I'm sure there'll be, you know, emerging information that comes out is also, it also brings up questions for me. I used to be a neuro, neurodevelopmental pediatrician, you know, what about autism and other things like that? We do know that Down syndrome, if people with Down syndrome live long enough, they will all end up with an Alzheimer's-like disease. And that's thought to be because I think it's the apoE gene is on the 21st chromosome. And of course, they have three of them. And then our, for, for ADHD specifically, is that, do we know if that's untreated ADHD or does it not matter? I don't know the answer to that. And I, and as far as I know from my brief bit of research on it, I don't think it's known. Yeah. And of course, you know, with, I, I have a lot of experience with ADHD. I used to diagnose them and prescribe it when I was in the UK. You know, if you have untreated ADHD, you're at increased risk of alcoholism, drug addiction, risky behaviors, head injuries. You know, it could be that it is untreated ADHD because it increases a lot of the risk factors that I've, I've just been talking about. But it could also be that, you know, it's something to do with brain function ADHD. In ADHD, there is, you know, the brain has trouble making enough dopamine. I don't know if it's related to that. But I think, you know, the research on that as, you know, there's always been, we've always been, there's always been people that were like, you know, in retrospect, oh, they probably had ADHD. I have a family member and like my grandmother's generations. He probably had ADHD, but it hadn't been invented back then. So, you know, that you, you can't do longitudinal studies to say these people who were just a bit wild had ADHD and they went on to develop dementia. So I think, you know, that will be something that, you know, pretty much my generation was the first generation to be diagnosed with it. So this is, you know, we're going to find this out in probably 20 years time. That's a really good question. That's exactly what I was thinking, right? Because we know in Parkinson's, specifically, right? So in some sense, you know, you lose those neurons. And so we know that dopamine seems to be a very important player. And so balance of dopamine is critical. You know, we got Dr. Heberman who will talk about his favorite with that respect, right? So yeah, I'm really curious what the research will show out to that. Because the other part that gets interesting about that is if it does turn out to be all right, the leading cause, or at least one of those, you know, for dementia is, hey, down the road, these people are going to be suffering with these things. Okay, well, maybe we should be treating it earlier on. And if you're going to do that, you have some non-stimulate medication, but stimulants seem to work the best. We already seem to have a problem in this country, at least in the United States, over prescription, a lot of these medications. And just actually non-prescription use of these medications. And so that seems to be a real problem. So that becomes a really interesting conundrum for us 10 years on the road. Completely. And I was really shocked when I moved to the States. So when I moved to the States, I couldn't practice medicine because of it takes four years to retrain. And I had two kids who needed me to be at home. But I started doing a therapeutic neurofeedback. And there was many kids on the autism spectrum and with ADHD. And I could not believe how drugged up some of these kids were. There were kids, you know, seven years old, coming in on five different medications. And the last four would be to treat the side effects of the first one. And in the UK, we just wouldn't have done that. Partially because of ration, you know, one of the good things that comes out of rationing of services is that you're very careful about what you prescribe. And you very rarely stack, you know, multiple medications. You will try something and then you'll try something else. But I was horrified when I moved here by how overly medicated children were. And also that some kids who, you know, I really felt probably didn't have ADHD who would maybe just, you know, a bit rambunctious and, you know, had a lot of energy were because teachers were complaining about the child were being diagnosed. And I think, you know, that makes me sad. And I think it's really inappropriate and needs to be watched very carefully. But, you know, the medications for, I used to see this all the time. For people who truly do have ADHD, the medication can be magical. It really can turn a child world around. Yeah. Yeah. So great questions. Thank you. Thank you. So sorry, we'll catch up. I think you keep going. I think you. Yeah, indeed. Yeah. So next is immunity and infections, you know, autoimmune disease. As you probably all remember from medical school, MS is one of the ones where, you know, it's believed that there might be an autoimmune component to it. And it is more common in people with other illnesses, like Hashimoto's thyroiditis often goes alongside MS. And then, of course, we have infections. And things like chronic Lyme disease, we used to have syphilis, not so common anymore. And sadly, this worries me also, personally, COVID. And we, you know, we don't know what the impact is going to be. We have a lot of people, you know, who have long COVID, who are, you know, two, two, three years on, still not recovering their brain function back to normal. And so we are not going to know for years to come. The, you know, the impact on neurodegenerative diseases of the brain inflammation that came alongside COVID for some people. And so just, you know, interesting. Yeah. Just to add to that, ultimately, I did an episode actually along COVID, kind of the leading theories. And they want to be mostly in the theory was that there was low serotonin in the gut from the vector of the virus. And so when we think of the gut brain access, you know, I wonder how much of that the gut played a role, you know, with serotonin and the brain. But yeah, like you said, I think we're going to, we're going to find out more. Yeah. And we know that, you know, COVID was causing neuroinflammation from the loss of sense and smell. And interestingly, one of the things that is done in neurocognitive testing is testing the sense of smell because it is one of the earlier signs, certainly of Alzheimer's disease. And, you know, I personally, I lost my sense of smell and taste for at least five months. And I'm not sure that it's fully recovered. I did, I don't actually drink alcohol anymore, but I did a wine tasting and just, just sipped and spat. And, and I could not really tell the difference. I'm like, I know it's red wine, but I, you know, and, you know, and there are some people I have a friend who three years on really does not have much of a sense of taste and smell. And that is something happening in the brain. That's not in the nose. It's not in the mouth. That's in the brain. Wow. So would you relate that as well to the second point of calm stimulation? Because we know those who start to lose their hearing also are at an increased risk of dementia. So is it? Yes. Just any type of sensory input that we see? It totally is. And actually, this pokosal I was listening to with Peter Atia, the neuro psychiatrist he was interviewing said that what the theory is that when, you know, when you are losing your hearing or your sight or your smell or your taste, the part of the brain that, you know, that those senses go to becomes undistimulated and therefore, you know, the neuron start to die just because they're not being used. Fascinating stuff. Yeah, yeah. So the next thing is neurohormones and, you know, hormonal imbalances. And we all know, you know, I think the most famous one that we learn about in medical school and everybody is obsessed about paying attention to a thyroid. You know, we know that thyroid hormone, both low and high effects, you know, brain function affects your energy levels, how you feel, et cetera. But of course, then, you know, we have, we have other hormones as well. And there is a very strong association with particularly Alzheimer's disease incident, dramatically increasing after menopause. And, you know, clearly we've got, you know, that all the female hormones are dropping. And we also know that treatment of menopause with hormone replacement therapy slows the progression. So that's really interesting too. And again, something that I think is in its infancy in the research, but I'm going to know more on that going forward. The next thing is what Daniel Aiman and I think Mark Hyman call diobicity. And this is the combination of obesity, insulin sense, insensitivity and diabetes. And this has all been reduced, you know, associated with brain size and function. And I heard something the other day they found that if they give a spray of insulin up the nose, so that it goes straight into the brain, it can improve cognitive function in the short term. So there's definitely something going on with insulin that is dramatically impacting brain function. And, you know, the bad news for people who are overweight and believe me, I completely understand this. Two years ago, I lost 53 pounds. I was really struggling to get my weight under control. It's not easy and I really feel for anybody who is struggling with their weight. It sadly has a really big impact on your brain. And it, Daniel Aiman has found that it leads to an overall shrinking of brain size if you are in the obese range or higher. And, you know, that is definitely something that's worth getting under control. People with type one diabetes have a much higher risk of Alzheimer's disease. And then the final one, which is actually one of my favorites, is sleep. Sleep is when our brain is restoring, regenerating. And the glimphatic system was discovered. I can't remember how long ago, but really fascinating when it was. And I tell, you know, people when I work with them, it's like a cleaning crew comes into your brain at night and puts everything, you know, their tidy and crew as well. They put everything back where it's meant to go. They, it cleans away the waste so that, you know, when you wake up in the morning, your brain is fresh and ready to go. And so sleep, if you're not getting adequate, REM and deep sleep, your brain may not be getting that proper cleaning going on. And that is likely to lead to neuro-information and other risk factors as well. So poor sleep is, and it's not an easy thing to, to deal with it's something that I struggle with, but sleep is incredibly important for brainhouse. And I think it's a, go ahead, I'll, no, sorry, just to build up on that. And, you know, the risk of making this an entire podcast about sleep, I think what's even more fascinating as we continue to learn about the different stages of sleep, right? So people are familiar with non-rem, REM sleep, but even within the non-rem sleep, you have multiple stages. And we know that deep sleep, you know, let's say is three sleep is critical when we're talking about physical recovery. We're talking about growth hormone releases is going to be quite high. So if you're training and exerting yourself at a high level from a physical recovery standpoint, that is very important. And that tends to be earlier in the night, right? When, you know, first couple of hours that you're going to get into. What's interesting, I remember coming across a study, and I'll have to find it so we can put it in the show notes, is, you know, individuals that are deprived, specifically of REM sleep, tend to have worse mental health, right? We're talking. And so that suggests that, you know, different stages, as we know are responsible for different parts of recovery and health in general, and just to kind of your overall brain health. And so it's just fascinating. It really is. Yeah, one mentioned that. Sleep science is amazing. And anybody who's is into sleep, Matthew Walker's book, a huberman has had Matthew Walker on several times. He has an amazing book called Why We Sleep. And it goes really deep and nerdy into the science of sleep. But again, it's a relatively new field with, you know, new research coming out all the time. And it's absolutely fascinating. You know, I've mentioned that I'm 56. When I was a young doctor, you know, we did not know that sleep was important. It sounds crazy. And, you know, and certainly amongst medical professionals, it was like, I'll sleep when I'm dead type of thing. And, you know, everybody used to make a joke and be proud. You know, I've only had four hours sleep in the last week type of thing. And I look back and I'm like horrified by it, because goodness knows what damage it is. So, fascinating. Yeah, and it's not, I know you're talking like that was a long time ago. That was happening. I think that book came out in 2021 maybe. And I really put the importance of sleep made it more mainstream for people. Yeah. And so he should definitely be accredited for making a conversation among people more often, particularly healthcare practitioners. But I think that hustle culture and just sleep being the first thing to go, it's highly prevalent even today. Yeah. Yeah. You know, I know he has his biases and he'll talk about and this is a quote. He's going to sleep at the elixir of life, as he says. Yeah. For certain people, absolutely. But for others, you know, they have other lower hanging fruit that's going to have, you know, as Charles Duex his Keystone habits. And if you change those, they're going to have more ripple effects. Yeah. And so, but it goes about saying sleep is absolutely critical. Josh, did you have something? Because I wanted to follow up on something specific about this list and recap for the listeners. Go ahead. I was going to say exactly what you said about the stages. So, yeah. Awesome. So, let me just recap for you because I wrote this down. This is awesome. So, you talked about blood flow, right? Number one, we talked about cognitive stimulation, sensory input coming from different places and continue to challenge that. We talked about inflammation and neuroinflammation in general. We talked about genetics, head trauma. That's the part that concerns me with all the football and stuff. Excessive substance use, oxygen substance, alcohol in particular, but even marijuana and environmental toxins. Mental health, depression, anxiety, ADHD in particular, are immune diseases and infections, which we're trying to learn more about the neuroendocrine system, which is fascinating as well. Neurotransmitters end their effect down into other hormones. Diabeticity or just metabolic syndrome. I would take it even broader to that and talk about that. And then last one, at least, sleep. Did we get all of it? Yes, absolutely. Absolutely. And this just popped into my mind when you were talking about it. I think another really emerging field right now is gut health and the microbiome. And, you know, talking about neuro hormones, we now know that I can't remember the percentage, but it's really high of serotonin is produced in the gut. By the microbiome and you know, we need just another reason why we need to be focusing on having a healthy diet. But again, I think the research on that is just emerging and it's going to be fascinating to find what comes out from that research. Yeah, so a little while back before we started the list, we were talking about the role of genetics, particularly. I think Darshan brought up what we think the role might be for people who are very much into being active participants in their care and they want to optimize per se or just consider preventative measures, right? Early, we talked about the disease starts decades before we even diagnosed. And so what can I do as an individual to mitigate the risks of this happening, particularly if you know there's some family history there. Yeah. And so that building in what I had mentioned earlier about the role of looking at some of this genetic testing, you know, what do we end up doing for this? And I'm curious what your specific thoughts are about that. I know you were practicing for a long time and like, how do you look at that problem? And is that something that you would advise your closest family members loved ones to get that done? Or do you think it does cause more harm than good? I think on balance, for me, it causes more harm than good. I think I'm less, you know, you have a lot of risk factors and you want to be certain, but I would say even if you have a lot of risk factors, you should be taking this really seriously. Anyway, even if all you have is risk factors and you don't know your genetic profile, I think there's just so much uncertainty around that. I think it could definitely do more harm than good. But it's a personal decision. You know, if you want to know all of your genetic risks, then go for it. But you must make sure that you get proper counseling about that because you're likely to find that you're at risk of several of the chronic illnesses because we all are. And when I trained as a doctor, we were told your genes were your destiny. And we now know that not to be true. Many disease promoting genes have an on and off switch. And what can switch them on and off is lifestyle change. And when I, you know, I work mainly as a coach now and I, you know, I do trainings on brain health and stuff like that. And what I like to tell people is think of health as being a balancing act. You know, it's a balance. You have health liabilities. So these are the things that these are your risk factors. These are the things that are bad for your health and the things that you might be doing in your lifestyle that you know are potentially bad for your health. And then we have health assets. Now, you probably can't be doing everything to mean that your health assets are, you know, right up here and you have no health liabilities. But I think the sensible approach is to say, what can, what simple things can you do to tip the balance in your favor? I think we all know people. I had a friend who died at a 24 of our friendship group. And she died of adult, like adult sudden death syndrome. Like they couldn't find anything wrong with her. She just died in her sleep. It was devastating. She was the healthiest of all of our friendship group. She wasn't athlete. She ate well. I think she was vegetarian, maybe even vegan. And she ate a bet on somebody to, you know, to live to be a 105, it would have been her. And, you know, health is unpredictable. And what you should focus on is tipping the balance in your favor. Does that make sense? I personally, I believe that to be a sensible approach because I think you can become very stressed and obsessive about it. When, and as we all know, stress is really bad for you. Stress increases inflammation. And, you know, don't get stressed about this. But take actions every day to tip the balance in your favor. And I also recommend that people start with the basics. Do the things that are easy to do and where there's the most research. And so, the top thing, especially when it comes to neurodegenerative disease, is exercise. Atia, Peter Atia calls exercise the most potent longevity drug. He says there is no other intervention that does nearly as much to prolong our lifespan and preserve our cognitive health. As strong as words from a medical expert can get. So, exercise is key. And he says, you know, we want to be a decathlete when it comes to exercise. You want to be doing lots of different things. Don't just be, you know, a long distance runner. Don't just be, you know, a cyclist. You want to do a little bit of all of the different types of exercise. We, you know, aerobic is really important. Strengths training and, you know, in the last couple of years, the research on strength training and muscle mass as we get older. It's really important to optimize your muscle mass as you get older. So many reasons. But then we also need to do the balance exercises as well. Because you could be, you could be a body builder and have big muscles. But you have very poor balance. You fall and you break something. And then you can't work out anymore. And that is, you know, that's going to be a big problem. So exercise is the, you know, if you only change one thing, try and get more exercise every day. Does that make sense? Yeah, absolutely. And I think it's a great point that you make about the reverse in your exercise sets. Because a lot of people might hear, oh, well, the number one causes blood flow. And that means I have to double down on cardio. Yeah, that's all that's all I have to do. But wait, let's not forget that weightlifting can help hormones help the obesity issues. You know, go hand in hand with a lot of the other exercises you talk about. Stimulation from doing balance, maybe hand eye coordination. We know I could sports tennis, take a ball, those sports typically have the highest correlation longevity. And you know, having fun and being able to be diverse, I think is critical. It really is absolutely. One of my favorite reasons for exercising is brain derived neurotropic factor, which I'm sure many of you listeners will have heard of. But it's a, it's a school neurochemical. And basically when you exercise, it produces brain derived neurotropic factor. I think your muscles produce it. And it stimulates the hippocampus and primes it for learning. A really great combination if you, you know, if you want to optimize brain health, is to exercise, then meditate. So you calm your nervous system down and then learn new things. That's a brilliant combination for kind of optimizing new learning. So that's one of my favorite tidbits. So yeah, anything else that we want to discuss about exercise, because it's, and you guys are experts in this, it's a huge field and it's super important. No, I think maybe if you do counsel somebody and you sounds like that's a good place to start, if we were just making blanket statement, which is the best that we could do, not having a person in front of us in their individual situation. What dose, right? So we talked about different movements, but the dose also matters just like any medication. Completely. The kind of, Atia says, you know, 90 minutes a week or more, as much as you can get while, you know, while still doing all of the other things that you need to do. And you're like, 90 minutes a day, I think reduces your risk of, if you go from zero to 90 minutes a week, it decreases your risk of Alzheimer's by 14% just from doing that, that one thing. And of course, people when they're exercising also tend to, it's like a keystone, how about like you mentioned earlier, they also tend to then improve other things as well. It's, you know, because they're exercising, they might notice that, you know, food is affecting them more or they might decide that, you know, they want to eat a healthier diet. So it can, it's a really great place to start. And I think, you know, you guys work in, in kind of the rehab setting, you have to start where you are and very gradually work up. You know, the last thing you want to do is go from zero to, you know, doing a 90 minute intensive Zoom, Zimbabwe class and having a heart attack or injuring yourself. You want to do it slowly. My favorite tool that I've discovered recently, I have, I have Ella's Dinosynthere and so I have very lax hip joints and I've been told that I mustn't run. And so I have started walking with a weighted vest and I've now got, I'm now up to 16 pounds of weighted vest and I have a hill behind my house. So I do 30 minutes every day of walking up and down this hill. My husband thinks it's the most boring thing on the planet. What are you doing? You do not get bored and I'm like, I don't care. I'm walking up and down hills with a weighted vest on. But for some people, even that would be too much. You know, start where you're at. If you have existing health problems, you have to, you know, you have to check them with your doctor before you start any exercise. Otherwise, there's a high chance that you're going to do more harm than good. Is that your mode for aerobic or so into training? Yeah, that's for me. Yeah, absolutely. And I do a bit of peloton as well, but I don't like it. But I love walking outside and, you know, the other benefit of walking outside, even in the winter, is sunlight, which, you know, increases your natural vitamin D. And it also helps regulate your melatonin levels. So it increases your chances of getting a good night's sleep. A human and very obsessed about that. And I become obsessed about it too. Even, you know, I'll try and even get outside if it's raining. Because there's still some daylight to be got and getting that into the back of your eyes in the morning is really important. Yeah, and I think that's the key point right there at the time of that is critical. So getting early sunlight is very important in terms of regulating your circadian biology. And, you know, coming back to that point about exercise you're talking about and how it has ripple effects, I think. Another key point we talked about sleep, right? That's one of the eleven that you have is we know that you need to have adequate buildup of a denocene in your body. The prime way is to increase that a denocene in your body is how much activity you've done throughout the day. So by exercise getting steps being just more mobile throughout the day, you build up an effidena scene and then you're going to have a better quality sleep throughout the night. As long as you're not consuming a lot of caffeine, which is an antagonist for that and other drugs and what that might you have. And again, that's probably the two most important things when I will counsel my patients. You know, I will do a lot of coaching and we'll do this lifestyle medicine approach. We talked about the pillars that multiple guests have talked about. The most recent guests also talked about those and we'll typically look at one of those. Sleep or exercise, you talked about stress, management and inflammation as well. Again, to amazing medicines, exercise and sleep to help with stress as well. And you know, all these things are just intertwined so tightly and they're coupled that when you tend to focus on one, which might be different for a different individual of what's going to have the biggest bang for buck. And the greatest ROI, it tends to work out pretty well. Yeah. And one last thing to say about exercise, you have to see it as an investment. Yes, it is time consuming to do exercise. But you will get that time back multiple times over with increased health span, with, you know, with being fitter and healthier and reducing your risk of falls and dementia. All these things that we've been talking about, I would, if you're struggling with exercise, I would recommend that people start to see it as an investment and that can change things around. Yeah, that's the buzz word, the word that we love, health span, right? We're very good at extending life span and dragging people through the finish line. I use that. Whatever that means. The last couple of years of your life, and Darshan, I, Darshan Moore, so now, then sees people in the rehab setting and yeah, and they're not very mobile. And so last 10, 20 years of, what does that look like? And so I think being, you know, my guest told recently talked about this on Chris Williams's podcast about you have the mortality piece of it, which modern medicine, phenomena, the morbidity piece, not so good. And so again, things like exercise, giving you options, his life, the action they valuable, something my colleague here is phenomenal at, you know, particularly we talked about, you know, all the places that he likes to visit and how important that is to be able to enjoy those vacations when you have to do, I don't know, when you had to do like a thousand steps, Darshan was at Portugal or wherever you went, like where you have a bunch of steps and if you're not fit and you don't have the requisite muscle mass, you're not getting the most out of that vacation. Totally. I had an incident a couple of years back getting on a plane, and there was a lady probably in her 60s who was in the seat next to me. And she couldn't even manage any of her baggage. Like, she had a wheelie at, you know, suitcase and a backpack. She couldn't, she could barely drag them and she certainly couldn't lift them into the overhead, you know, compartment. And I remember thinking, I want to be able to lift my own bag. So there's a funny thing to get obsessed about. It led me to start doing more arm exercises. It's really important. You want to be able to keep up with your friends and family. Yeah, for me to run through the airport when you have a short layover. Exactly. Yeah. Just to bring back Tia, because I know we mentioned his name a lot. He talks about this when he had a recent trip to Italy with the family for wedding. And, you know, they had a run to the train on cobblestone. Yeah. If you take your training and you think about what is it going to take the dream vacation? A lot of you want Italy, a lot of you want countries. Well, how do you have the train to do that? Is it steps? Is it the strength training? Is it the fallids? It's lifting overhead. So those are the types of things that I even talked to my patients about, you know, when it comes to rehab. It's, yes, you're going to the gym and you might not be motivated. I guess what's going to motivate you thinking about how these exercises translate to your everyday living, to your, you know, occupation, et cetera. Yeah. And I think they're in nice, you know, one of the big problems with prevention is complacency when you're healthy. You know, it's hard to, we call it in coaching, to it's hard to future pace to a time when you're not going to be healthy when you are healthy. And I think that's, you know, that's why, you know, we're especially as physicians, we all know the things that we should be doing. So why is it that most people are not doing it? And that largely comes down to complacency. And that is a hard thing to, to overcome if you feel fit and healthy right now and, you know, so that is definitely a challenge. Yeah. Awesome. So we've stressed the importance of sleep. We've talked about exercise. And I think these are pillars that we've addressed, you know, addressed multiple times before. I'd like to just have to talk about just your nutrition and diet, right? Yeah. I think when I look at this list that you created for us or you give to us today, you know, I look at inflammation and I look at diabetes and I put them together. Just because metabolic syndrome and metabolic health is turning out to be such an interesting thing in terms of how it affects, you know, for our field, specifically when we talk about musculoskeletal health and pain, we're now starting to learn that individuals who have poor metabolic health not only are they more predisposed to tendon-related injuries and just pain in general, but they also don't respond as well when we're offering some of those treatments that we've talked about on this show quite a bit is something called PRP, orthobiologics, regenerative medicines and people might recognize it. I'll tell you anecdotally from my own experience, like you're drawing somebody's blood who has poor metabolic health and then spitting that and injecting it back in versus healthy individuals, it's visible to the naked eye in terms of how the quality of that product looks, right? And we even have evidence on this. I think it came across a study which looked at adipus-derived, quote unquote, stem cells and individuals who were obese by a quadrat by BMI versus people who were not tended to do a lot worse with these treatment modalities, right, for musculoskeletal conditions. And you know, I'm digressing a little bit, but I think it does stress the importance of how important it is to dial that in. And so with that said, how do you look at just metabolic health and controlling that in terms of withdrawal and brain health? Yeah, back to the old, I'm forgetting who it came from, but it's an ancient philosopher, food is medicine. And you know, what we eat fuels every cell in your body and going back to talking about neurodegenerative disease, like I mentioned earlier, the brain is a really greedy organ. So what you, and it's even more sensitive than most of the rest of the body to what you eat, but it's all sensitive to it. I think, you know, thinking about diet, I am a big believer in personalizing diet. I think there isn't one size fits all, but I think there are some basic rules that, you know, are backed up by, you know, pretty strong science that tells us, you know, for example, limit processed food and sugar. These, you know, cause inflammation all sorts of other things and they are ultimately bad for you. I think that's, give me a nod if you think there's a consensus on that. I think it's also important to, you know, eat lots of fruits and vegetables. I did this weight loss program a couple of years ago and a rule that I found really useful is to eat at least 10 ounces of fruits and vegetables with every meal. And and I've always thought of myself as a pretty healthy eater, but that's quite a lot of volume. I remember my husband saying, you're eating so much now and it was just, you know, these huge mountains are vegetables, but, you know, they give if fruits and vegetables give you slow-release carbohydrates, they are giving you fiber, which is important for gut health and the microbiome, like we talked about earlier. And if you eat from the rainbows or eating lots of different colors, you're getting all the micronutrients that are necessary for healthy cell function. Fruits and vegetables are super important. Eating clean, lean protein, you know, to become very popular. Still most people are not doing that. Healthy fats, you know, fish oil, avocados, olive oil, and drinking plenty of water. And those are my basic rules. We could go much deeper, but I think, you know, I like to keep it simple. If you go online, you can get so confused about nutrition and if you just create some simple rules that you can stick to, I believe it's so much easier to follow. I find it so funny that you talk about 10 ounces. You know, we've had multiple time guests here at E.C. Sinkowski. I think you're really finding her work really awesome. Who talks about the 800 gram challenge in consuming, you know, fruits and vegetables and 800 grams a day. Can you guess what 10 ounces, if we say three times a day, what that equates to in grams? I'm going to have to go with 800. It's about 850, yeah. So I find that really, really interesting about that dose, you know, that that is. And again, this comes back from show studies and E.C.s talked about this. I should add to that. I remember sending her there was an updated study that actually came out that 90% of that benefit you can actually even get from 400 grams a day. And I'll put that in the show notes. Obviously, we don't always like to say more is better, but probably 800 grams from a volume standpoint. Just by, you know, subtraction by addition, we have talked about. So if you end up putting that much volume of fruits and vegetables, we have a little bit less space in your stomach for the crap, right? This ultra-process food and stuff that tends to increasingly inflammation. So, you know, I still think that's probably a better strategy for majority of the people, not everybody, but for a lot of people. That is good to know that is just because it's sometimes pretty hard to eat and you have to get creative getting that that much. And I'll encourage people to again follow her on social media because she does a phenomenal job actually sharing the meals and showing that in comparison to what a plate of 200 grams looks like, right? There are ounces however you want to look at that. And so, I think that's just really interesting too. Amazing. Yeah. What about something that we're interested in, right? Because we like exercise and stuff. And, you know, there's a lot of interesting stuff coming about in terms of different supplementation, particularly in creating as being this panacea almost when it comes to brain health. The benefits on muscle and strength are well-prepared. The most research supplement probably with the exception of caffeine, but maybe even more so just athletes and sports and just health in general. But we've seen a lot of interesting stuff with mental health and brain health with creatine. What can you tell us about that? Yeah. So, I knew you were going to ask me about this, so I had to go and research it because I didn't really know if there was a link between it, but it's emerging, you know, in the scientific literature, but it does seem that creatine probably has neuroprotective benefits in Alzheimer's Parkinson's and Huntington's. And they think that it's because of its role in improving cellular energy homeostasis, you know, the balance of energy production in the individual cells. And it is also theorized that it improves mitochondrial function, reduces oxidative stress and inhibits apoptosis. You know, I think that the exact mechanism, it's probably going to be multifactorial, like most things are, but it's really interesting. And I think in the next few years we're going to start to see, you know, more compelling that the research right now, I think, you know, it is in that emerging stage. And with regard to neuro health is, you know, it's in the balance right now, but it's looking really hopeful. Do you know what dosages were used in the research? Because from my understanding, for exercise, we pretty much saved five grams a day, man, women. And then I was looking at Luis and Nicole as Instagram. She's a neurophysiologist, but she's really been promoting creatine. Believe she was saying about 10 to 15 maybe to get the brain health benefits. Is that on par with what you're doing? I don't know. I don't know about the dosage. I'd have to have to have to look deeper into that. Yeah. Fascinating. Yeah. All these wonderful things coming out that, you know, it's an easy supplement to take. I take it every morning myself in a shake. Don't know that I particularly see, you know, much changing it, but I'm willing to trust the research on it. And especially with muscle, you know, going back to what we're saying about muscle mass being highly protective as we age. If that's the only reason to take it, then that's a very good one too. Yeah, just to actually follow up, I just pulled up a study here. And in it, they're looking at, actually, it's even higher. So here at, you know, the 11 studies, three of them showed that about 20 grams a day for anywhere from seven to 28 days seem to have positive effect. A lot of heterogeneity between these studies, but all in all, that's the doses that they're looking at. And this, again, we'll put this in the show notes. This is a paper from Brain Science published in 2023. So a great recent, actually, first author is Moriarty. So interesting, much higher than I would have entered. That's a lot. Yeah. You got to work up to that, though, from like the gut perspective, too. I'm sure a lot of people got intolerance at that. I have a dose. Yeah, not everybody, not a, yeah, gut or just kind of retention, water retention, not everybody seems to have that stuff. But yes, at the higher doses, you do. So interesting. Fascinating. Watch the space. Yeah. Yeah. Lena, what do you think, what do you think it makes sense to go next from here in terms of putting a framework? I know there's a lot of areas we can go and we're probably with this full seminar. Yeah. In terms of practical things, one of the things that we love to do is give people something that they can take away from this and implement relatively quickly in their lives just to improve. And we stress the importance of exercise. We talked about sleep. We've talked about just being mindful. And you know, you give the number of eating sufficient amount of fruits and vegetables. What do you think it makes sense to go next in terms of things that it carries a lot of bang for bucks, so to speak? I think for me, the other really important piece of the puzzle is stress management. And this kind of overlaps with mindfulness practice. I think, you know, many people, and I particularly worry for people in the medical profession where stress is very high. My own podcast, we, you know, we, the aim of it is to reduce burnout because burnout is extremely high, you know, in medicine and in other professions like law. And, you know, I think, I think learning to manage stress to, you know, to become more emotionally aware and to be able to regulate your emotions is hugely important and a little bit underestimated. So happy to go there if you guys are interested. Yeah, please. Yeah, that's something I'm very bad at. So I'm all absolutely, absolutely. And I think, you know, mindfulness practice does fall into this umbrella. I once had it, I once had a coaching client and I was talking to him about mindfulness practice. And he said to me, the only thing that relaxes me is getting on my motorbike and driving on country lanes. Is that okay? And I'm like, if that does it for you, then go for it. And I think, you know, for a lot of bright people who have a busy brain, the thought of coming to sit and meditate for, you know, 30 minutes and empty your mind as like, it's very daunting. And I think, you know, we need to get away from that image of mindfulness practice. For me, mindfulness practices is any practice that teaches a person to become more aware of the state of their mind and their emotions and to learn to consciously control it. And the result, if you can find a practice that works for you is better emotional regulation, less stress. And also, there's a brilliant book called Peak Mind that came out a couple of years ago, a really wonderful neuroscientist and she found that the only reliable tool for improving focus and productivity was mindfulness practice. And which was really, she didn't want that to be the answer to her question of what improves focus and attention and productivity she wanted to do to be something else but turned out to be mindfulness practice. And you know, it has no side effects. It is extremely portable. You can do it anywhere. And I personally believe that there is a mindfulness practice out there for everybody. And there are some wonderful tactile mindfulness practices that when I'm teaching it for my high performing busy-minded clients, I always get them to start with the tactile one. And you know, you can do it. I get really grumpy when I'm driving and people cut me up or there's a red light when I'm in a hurry or whatever. And I do this tactile mindfulness practice and immediately calms me down. You know, if you've tried mindfulness practice and you've not had any success with it, I would highly recommend you continue looking. There are, you know, there's a million different things that you can try on on YouTube or, you know, many other platforms these days. But it is such a powerful tool that, like I say, has no side effects really that I think everybody should have a mindfulness practice in their lives. I got to ask you this. So mindfulness has this connotation of a solo practice where you can build social intelligence, emotional intelligence, like you said. Ultimately, I think what was it yesterday? He sent me an Instagram post about 11, you know, different statements that somebody with high emotional intelligence can, and you know, some of those things were just really understanding the topic and then responding in a very pragmatic but also allowing the other person to maybe expand on their thoughts. So saying something like, oh, that's a very interesting take. What do you think about X? So I guess my question is, does a mindfulness practice have to be solo or can it also be practiced by communication and also in a social setting, initially, which can then help regulate emotionality or build on these skills? I do think it's a solo practice. I think you can learn it in community, like you could go to a mindfulness class or you could do it, but it is about going inward and learning to, you know, to listen to what is going on inside. The true test of mindfulness practice is being able to use it in everyday life for people when you're in a stressful situation, you know, for the medical professions who are listening, you know, when you're in clinic and patients, you know, being very difficult and you're able to use your mindfulness practice in that moment. That's a true test of it. It's not meant to be just for the practice, but to get good at it, I would say you have to practice this sort of thing. Yeah. You only need 12 minutes a day. I mean, she has research showed 12 minutes a day as a sweet spot, and you can split it up into two minute blocks. So you don't have to do it all along go. You could, don't maybe four minutes when you get up in the morning and four minutes after your breakfast and to do it during, you know, split up during the day works just as well. Yeah, super excited. We're going to have Dr. Robin Tiger come back, you know, she goes as the stress-free MD. You're probably feeling her work. Yeah. And she's going to be back here for around two. She had a great book. They came out recently and we want to talk to more about that. Darshan, that question that you asked, I'm really interesting. And I think, you know, I probably agree with you. I think initially, much like anything else, you have to practice and go inward like you talked about. I think though, the purpose of that probably is so in your day to day encounters, right? You can, like for instance, in that post that you're talking about, Darshan, it's okay, if somebody says something to you that might create some type of an emotional response and you might tend to react, you want to be able to create space between what you took in and what you're about to put back out. And mindfulness empowers you to be able to do that, right? I think though, again, as you mentioned, you want to be able to apply it to your day-to-day life. And when you do apply it on a constant basis being mindful in those interactions, you do reinforce and you strengthen that mindfulness practice. So in a sense, it's like, you know, if somebody practices for a sport and executing a play, and then they execute a play perfectly during a game, well, they've reinforced that pattern. And you know, that in itself is practice, right? So Vince LaBarty said, you know, practice doesn't make perfect, practice make perfect. Can do perfect practice in those interactions like Darshan is talking about. So, yeah, I think that's how I think about that. And I think the last thing to say about mindfulness practice is there is no perfect mindfulness practice. It is, you know, I think even, you know, regular meditators will have some, sometimes that they practice where, you know, 90% of the time they're distracted and thinking about the things, you know, they're like, you know, they're being distracted by squirrels. But then, but the more you do it, the more you'll have more time, you know, actually in a mindful present healing state. Yeah. Awesome. Love that. I want to ask you, learner, out of some of these things that we've talked about, what do you struggle with the most, personally? Hmm. Do you know for me, it is sleep and it's really frustrating because, you know, I've tried everything that I can think of. And as in you have trouble going to sleep or staying asleep? I have trouble staying asleep. And yeah, and it worries me from a brain health perspective that I have trouble staying asleep. And I think, you know, it's my age and I have some problems with, I have some problems with reflux that's not caused by bad diet. And I, you know, it frustrates me because I've night, I feel like I'm doing most other things right. And I, you know, no matter what I do, it doesn't seem to improve my sleep. What's, what comes the easiest to you? Now diet. I, for many years, that was not a case. I really struggled. I was a food addict for many years. And I, I'm now in control of that. And then I have a very healthy relationship with food. And, you know, I'm very comfortably able to, I, you know, unhealthy food. I look at it now and I, it's not food to me. If you offered me a kind of dog food, I would say, I don't eat dog food. And I'm able to look at, you know, highly processed, sugary food and say, I do not eat that. And that's been really profoundly helpful for me. Okay. The last of the trio of questions there, what do you spend most of your energy working on? What do you, I know you said sleep frustrates you the most, but what are, is that where you're working on the most? From my own health perspective, my other struggle is exercise. I struggle to make time for it. I love working and I love, you know, I love coaching and I love creating content and like educating people. And so I often deprioritize exercise. I do at least 30 minutes a day, but I know that I need to be doing more. And, you know, I, I struggle with that a bit. So yeah, I'm thinking about actually the parallels to, again, coming back to that, the question I asked you about ordering some of these genetic markers and what that means, right? So, and more, a different example in the realm of cardiovascular disease. So we've talked about LP little A quite a bit with multiple clinicians who've come on the past. And we know that there is a, a strong relationship with elevated levels of LP and Lulae and adverse cardiovascular health. Yes. But the problem is that thus far, at least in the primary prevention, there's really not much you can do. There's nothing you can do, right? Down the should have these things called the SOs that might be available at this point. There's stage three for just people who are tertiary prevention or secondary prevention. But the argument that I make with individuals is that if you do know that you have certain risk factors, so either LP little A elevated or two alleles of APOE4, there's not to do about those specific things. And sure, it might cause a little bit of anxiety. But what you can do is you can double and triple down on everything else that you can control, right? So for instance, in the cardiovascular stuff, maybe you can get your APOB and LDL and better, maybe you can manage blood pressure and you can really take those things seriously. Same thing with respect to brain health, right? And maybe now you can really, it can almost quote unquote, light a fire under someone's ass to really take their sleep seriously, to really focus on exercise, really with all the other things and not freak out. But I think that's really important, right? That's where you have to sit down and in front of the patient and you have to figure out, is this the person who is going to actually be empowered to know, oh my god, I need to seriously. And that could be a really powerful coaching tactic. Or is this the person who is going to the overwhelming that knowledge is going to be so burdensome that they will actually crumble and get more stressed out? I think that part is really important. And so when I personally had this conversation with some clinicians about ordering these things or doing that stuff or actually even ordering it in my practice, they're like, well, there's no role for that because you can't do anything about it. Well, yeah, maybe not directly, but you can use that to do things for other things, right? And I bring that back to the conversation you're having. And I was thinking about that as, okay, if you say that you struggle with sleep, is this something that you double down on your strengths, which is diet? And again, my friend here likes to talk about this. He likes to take the contrary point of view is like doubling down your strengths rather than focusing on your weaknesses. And I find that to be interesting. Yeah, absolutely. Yeah, it's a difficult one. And I think, you know, it's so dependent on the person and the stage of life there are the, you know, there's been times that if I'd been told I was a genetic risk that I would have totally freaked out and it would have made me ill. And there's other times when I would have been totally empowered by that and become really determined and being like you said, that'd be like, okay, now I'm going to do everything within my power to, you know, to reduce my other risks. And I think it all comes down to helping people find their own leverage. I think you, this is a kind of a coaching term finding what is it that motivates them? And sometimes talking about the future life that people want to be living, you know, what do you want your life to look like in five years time? You know, do you want to be able to travel? Do you want to be able to spend time with your children or your grandchildren? Do, you know, and get people to envision that powerful future. That can be really helpful sometimes. And for some people threatening them with bad outcomes can be helpful as well. It's, it depends on the individual so much. It's a very hot question to answer. 100%. It comes out of the perspective and what the patient sees through their eyes, right? You look at Chris Hemsworth, he's got his bucket list has probably changed, right? He's probably checked off a few more things knowing that, hey, he's got that almost, I guess, eight, but we four. But again, he has, he's in that social economic bracket where he can go ahead and do those things, right? So I think there's so many factors like he said that really the clinician has to use to determine whether those tests are used for or not. Absolutely. And bringing up the point about money, you know, with everything that's coming out and in the longevity field, I'm trying to think of the name that I follow. He bends something. His whole thing is don't die. You guys come across him. Yeah. That's it. And he has this ad and it says at one point, I was taking over 100 supplements. Dude, which was that costing. And, you know, back to what I was saying about, do the basics first, like, and then if you have money left over, sure, take some supplements and, you know, buys up a sauna or whatever, but make sure, you know, no number of saunas is going to help you overcome the fact that you never exercise or that you eat junk food all day long. Focus on the basics first. If you have resources left over, then you can go and explore some other things. Yeah. That sounds like a common sense approach. Absolutely. That's something we always try to preach on this podcast, for sure, is, you know, double down on the basics and those in line first. And then, yeah. And then go for the small things. Awesome. Well, we definitely need to hear about your background and, you know, coming from the UK to here and how you even got interested in brain health. I'm sure you have a lot of, you probably have a fascinating timeline as well, stories in regards to how you got interested this field. Yeah. So I began my career. I was training to be a general practitioner, sort of three years of hospital medicine. And so, you know, which included two medical rotations. So I was working a lot and I worked on an elderly care unit for three months, where dealing with a lot of patients with these kind of neurodegenerative diseases. I have to say they were the thing that scared me the most of all of the kind of medical conditions. So that kind of got me interested in it. And then I became a public health doctor, which back then in the UK was about prevention and improving the health of populations rather than of individuals. And it really struck me when I was working in primary, I would did a year in primary care that when we just did not have time to talk about prevention at all, we had five minutes per patient. You barely had time to open the door and let them sit down and you had to ask them out. So there was no prevention going on. And, you know, so many times we were seeing people who just were taking no personal responsibility for their health. And that really bothered me. So I did, you know, I got my masters in public health, really enjoyed that. And then I had to take a career break. Both my kids nearly died as infants. And they were both really sick and I took a career break. And during that time, I trained to be a counsellor and then a coach. And when I returned to medicine, I went into neurodevelopmental pediatrics and not to go into it too much, but I by then I'd had a family member who'd been diagnosed with a condition. And it got me really interested in it. I also have ADHD myself. So I was always interested in what's going on with that. And when I was a neurodevelopmental pediatrician, I got really fascinated by how differently people's brains could work. It's like how very interesting. And it occurred to me, you could, you know, brain research was totally just in its impency then. And I would say it probably is still today. And I love learning. So a field where the learning is almost infinite, really appeals to me. And then when I moved to the US, rather, I trained to do a therapy call neurofeedback. Then I trained with Daniel A. Men as a brain health coach and trainer, which is all about education and preventing these illnesses and helping people have a healthy brain. And so that's what I currently do. I do coaching, help people reduce stress, become peak performers, and, you know, get their brain and body as healthiest can be. And the neuroscience, my family all, you know, laugh about me. I'm such a neuroscience nerd. I just constantly listening to books and podcasts about neuroscience. It just totally fascinates me. And I love it. And one other thing to mention that I had COVID pneumonia and severe brain fog in 2020. I was actually almost blind for a week, which was the most terrifying thing. I had, it was like having a veil across my eyes. And I had profound memory loss afterwards. I couldn't remember anybody's names. It was incredibly scary. And, you know, I got even more obsessed with brain health. And I started using some of the tools that I learned on myself. I'm like, I do not want this to be my life going forward. And I became very obsessive about doing everything that I can. And, you know, I've been experimenting myself as well. And I, you know, we can prevent many of this, these illnesses, if we, you know, if we fall in love with our brain and take it seriously as early as possible. And that begins today. Absolutely. Tell us a little bit about your website, your podcast, your courses you had as well. And maybe what's upcoming for you. Yes. Wonderful. So my website is Dr. Leonora Rhodes.com. I have a funny spellings. Please read, please read this spelling of that. And I have a couple of courses. And I have a plan to develop 12 in total on my website, my website, my coaching platform is called Peak Life Design. And I have a program that is to help people design a life that they will love and get out of the drudgery of everyday life. I also have a course that I'm about to launch in stress management as well, which is one of my, one of my favorite topics. And earlier on in 2020, I got approached by a podcast company to do a podcast that was about preventing burnout in physicians and healthcare workers. And I had profoundly burnt out when I was working in hospitals when I was in my mid-20s. And it was a terrible time. And so when they approached me, I just leapt on the chance of what a brilliant, you know, brilliant way to reach people. And on that podcast, I interview medical practitioners about, you know, to hear about their story and about the strategies that they use to balance their lives and to reduce stress and prevent burnout. And I absolutely love it. I love podcasting. It's really fun, isn't it? It is fun. It is definitely fun to get together with like-minded individuals, share stories, and share expertise. And, you know, everyone comes out with a win. As, including the audience, definitely good time. Yeah. We'll definitely link your social media, your podcasts, website, all in the show notes. So there'll be access for the listeners there. And then we end every episode with a question for our guests. And that is how do we put the health in healthcare? Absolutely. So I think it begins with from the individual perspective, taking responsibility for your own health. You have been gifted one body. You need to look after it, and you need to take that extremely seriously. And, you know, for healthcare professionals, the World Health Organization defines health as not just the absence of disease, but being about, you know, holistic health, body, mind, and spirit. And I think, you know, there is a sea change in the medical profession. More people are learning about holistic medicine, alternative medicine, integrative medicine, whatever you want to call it. We have to, as medical professionals, we start, have to start seeing the whole person rather than just a bunch of organs and systems that happen to be housed in the same body. That is my view on that. I love it. We are Nora, Dr. Rhodes. Appreciate you taking the time out to join us. Thank you. It's been really fun. Thank you for having me on the show. 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