87. The Neuroscience Behind Improving Performance | Louisa Nicola (Ep 45 Rebroadcast)

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Hey everyone, welcome back to Medicine Redefined. This episode is going to be a rebroadcast of episode 45 where we hosted Luisa Nicola. So if you don't know who Luisa is, she is a neurophysiologist, and she has so much knowledge when it comes to optimizing brain health and also just human performance. She is the founder of Neuroethletics, and she works with world-class athletes around the world, trying to help them improve their cognitive abilities on the field or on the court, as well as just athletic performance in general. She is also a scientific advisory member for companies such as Tonal, Fitflight, Chlora. She even has an exclusive partnership with the supplement company Momentus. She's also the host of her own podcast called The Neuro Experience. So in this episode, if you have already listened episode 45, I think this is going to be a great listen again. This is one of my favorite episodes that we've done on Medicine Redefined because there's just so much information. As you'll listen, Luisa is very energetic, and the way that she can convey information is very contagious. So you will learn a lot, but we're going to go through Luisa's background, we'll touch on sleep, we'll touch on brain health, we'll touch on supplementation. So there's a good amount to learn on this, so don't be afraid to hit that rewind so that you can absorb it all, okay? So enjoy this episode, and I'll see you at the end. All right, everyone. We're back here with another episode with a special guest, Dr. Luisa and Nicola. How are you? This has been a long time coming, and Ultramas and I are super excited to talk about this because all three of us are athletes here. You delve into the realm of neuroethletics. But first, it's crazy times right now. How are you doing? You're in Australia. What's going on? Hey, guys, I'm so excited to be here. Thanks for having me on. How am I? I'm actually fantastic. So I flew home, I live in New York City, I born and raised obviously in Australia, moved to New York in 2016, and every year I come home for Christmas break to see the parents. And this time I decided just because everybody's working from home now, back in New York, I didn't really have, I usually only come home for two weeks, and so I have come home for two months. I've got a month left. So look, I am fantastic. It's beautiful here. I'm surfing every morning. I'm running. I'm loving it. I've got a fantastic tan for those of you who are watching us on our video. Well, I'm totally jealous. I just took a winter trip to Austria, but being in the sun right now sounds amazing because it's freaking cold out here in the east coast at least. So you should not be missing New York City. So Louisa, let's just delve right into it. How did you, so I know you were a pro athlete in your teenage years doing travel on, and that journey had some ups and downs, but it led you into this world of neuroscience. Take us through that journey. Interesting. So I, you know, I don't know how much you know about Australians, but we are pretty much born in the water. And so I grew up as a swimmer, always loved swimming, always loved surfing. And so it's a very strong swimmer, and I loved being outdoors and being like, you know, athletic. And I remember we, this word triathlon, somebody mentioned it, okay? And I thought, what is triathlon? It wasn't in the Olympics at the time. At first came into the Olympics and think in 2008. So before then, I hadn't been in the Olympics. And there was a triathlon just occurring in my hometown. And I thought, you know what? I'm going to do it. I like doing all of this stuff. So I raced it and I ended up winning. I think it's just because I was a strong swimmer. So that's when I started my triathlon career. I thought this is incredible. And that was the pretty much the spark of everything when it relates, as it relates to high performance, physiology, neurology, neuroscience, athleticism. I really, I put everything down to triathlon. And endurance athlete, you have to learn how to, you know, just beat, you know, unbeatable things that happening in your mind and the environment. So, yeah, I was a triathlete. I raced for Australia. I went to Beijing. I went to London. And then I finished my career in Auckland. And that was, you know, I was, I was 20 to 23 at the time. You know, good question about that. I, I've talked to quite a few triathletes and, and I've often heard that if there is an event that allows people to get in the most separation, it's swimming because not a lot of people tend to be strong swimmers. Is that the case? Is that where, like, you know, you want to spend most of your energy on? If you are maybe not the best overall triathlete? Well, here's the thing. I was always the first, you know, we call it the lead pack. I was always the first out of the water. I was a very strong swimmer, but, you know, being a strong swimmer in, this is why I think Australians really excel when it comes to triathlon is because we learn how to swim in the ocean. That's where triathlons take place. So if you can learn how to navigate first and foremost the water, the environment, you have to wake up. You don't know what swell we're going to have. And then if you can go around the boy, which is, you know, a kilometre, two kilometres out, learn how to really maneuver around that and get back into the leading pack and then get out of the water and there's so much technique involved. If you can get out of the lead pack there, if you can be an intermediate cyclist, then you've pretty got a really good head start. The reason why I, you know, called it quits for a number of reasons, but first and foremost, I wasn't, I'm not a built, I'm not built for running. So that let me down, you know, I got some podium finishes, which is what got me on the Australian team. To be top three podium finisher, but look, when I, when I, when I stopped my career, I was 13th, I would never be able to get number one, just because my body isn't built for running, unfortunately. So in a fast forward, you mentioned 2016, you came to New York City, right? You've got new athletics. You're doing amazing things. You're working with high profile clients and both the athletic sector and the business sector. What was it that led you down the path of neuroscience? I mean, it's not the sexiest thing that people think about, right? I mean, no offense, you know, it's challenging. It's very, very complicated. But what was it? Was it a personal journey, like, you know, adversity that you've fell through? What was it? Yeah. There was a number of things. First of all, when I graduated high school, I was a bit, I wouldn't say loss, but I was heavy into triathlon, and you know what, it's like 17, I was 17 when I graduated. I just wanted to be world number one triathlete. I didn't think of anything else as you do at that age. And my parents said to me, you know, they were funding, you know, it's an expensive sport. I had to buy bikes and they were funding it. And they said, the only way that we're going to keep funding this is if you go to university. I thought, okay, that's fine. So I went and did exercise physiology and teaching. And I thought, you know, what, I'll just, I'll become a teacher so I can just go to work and then train in the morning and train in the afternoon. And when I was in, you know, when you do an exercise physiology degree, you learn, you're going to a lab and you go in and you play with cadavers. And that's where I learned, oh my God, I'm obsessed with this. I'm obsessed with human anatomy, human body, et cetera. So I loved that. I knew that about myself. And then what happened was in 2011, I so I had graduated and I ended up going on, you know, I know it's a weird pathway, but I ended up going on and doing a masters of mathematics. So I was, I was just very good at mathematics. I loved it. I've mathematicians in the family. So I went on to do mathematics and I applied my thesis to anatomy and neurology. But we'll pause right there and I'll tell you that in 2011, I was due to go overseas and race in Beijing. And two weeks prior to that, I was hit by a car. And it was very devastating. I had to forfeit my title. The next person up got my, got my seat on the team. And it was really tragic. It was a tragic moment for me. I snapped my legs, my collarbone, my arm. And it was, I was out of action for almost a year. So it was really traumatic for me. And I remember I still went to training and I just sat there because I had teammates. So I just sat there every day. And my coach said, we've got somebody flying here and his name was Bobby McGay at the time. He was Usain Bolt's running coach. So he flew from Colorado, California, wherever. And he said to me somewhere far west, somewhere, I hadn't been overseas. And I was like, he was in 2011. And he said, he goes, you can get back on the bike and you can be an even better athlete than you were before. And I said, how? And he said, it's not through rehabilitation and, you know, gaining strength and, you know, cardiovascular health. He said, I'm going to teach you something. It's all in your head. It's about your brain. And he introduced me to an EEG. And my, like, when I, he put, he put a cap on me for those of you who don't know an EEG and a lecture on cephalogram, we use it mainly back then. We were using it mainly in epilepsy wards and sleep analysis. So he put this on me and he took me through a triathlon in my mind. And he recorded my brain wave activity. And something happened to me right then and there. I didn't really know too much about the brain. We didn't hear anatomy in college and school. And that's when I became obsessed, I thought, oh my gosh. And so I applied his methods. I literally started training my brain. This is, in 2011, we're in 2020, 2022 right now. Wow. And people, and because of people like Andrew Huberman, people are starting to understand what the brain is. And this is back way back when, and I thought, I'm applying, I'm applying neurology into sport. And I fell in love. I said, that's it. I have to go to med school. I have to become something to do with the brain. That's all I knew. So that's how it started. But ultimately you decided not to go to medics school. No. No, I didn't decide that. That's it. That was the next step for me. Yeah, in Australia. Oh, I see. Yeah, we don't have, we don't have in Australia. We don't have, sorry, I cut you off. We don't have MDs. We have MBBS. Yeah. So instead of going through the pathway of becoming, you know, what you guys are, you know, going through and doing residency, I thought, no, I just want to get my studies done. I want to get my degree, I want to get my medical degree and then just apply that to sport. And that's what I did. I started in Australia and I, by chance, I flew to New York and I was picked up in 2016 by a very, very well known athlete and that kind of started my career. Interesting. That's really awesome. Yeah. Yeah. That's really cool. You know, I find this fascinating. I think a lot of people who are in the athletic sector and performance, right, such as you are, you know, we have an athletic background and that was the case for me as well. I was nowhere near the athlete. You were, right? But, you know, I had the passion for sports medicine at an early, early on in my life and I knew that, hey, you know, I really know what it is like to be injured and I can really empathize with the patient. And so for early on before I even went to medical school, I knew I was going to do sports medicine. I knew I'm a path that was going to get there. And as I've started to learn more and more, much like you exercise physiology, you know, initially introducing myself as a musculoskeletal expert because, you know, that, that was cool, you know, by mechanics, all the stuff. And then the more we learn in our primary specialty and PM and R, we do a lot of neurorehab as well. Yeah. And it's interesting because the musculoskeletal system doesn't operate until the neurological system asks it to, right? And so you're really need to understand one before you can understand the other. And so now I've started introducing myself as a neuromuscular, probably the expert still learning. But the next question is, you know, you've had this injury, you've got this passion. And now you've got this company of neuro athletics. So was it, is it something that you're saying, okay, like, hey, you know, I've got this passion and I want to help other people get recover. And now you've translated that into the business sector as well. How does that transition happen? Yeah. So that's a good question. So first of all, I love your, your theory of it starts with the brain. And I always say the brain's like the federal government. It starts there. And then we go down from there and vice versa in a bidirectional axis, which we'll talk about later. But so my, my theory was I want to apply, I wanted to have literally a business which was the intersection of the brain and athleticism. And I was working with a very well-known soccer player back then. And he said to me, because Louise, he's like, what's your business name? It literally was the night before I was to work with him because he had to bill me. I sent him an invoice and his manager said, we have to invoice you. So I literally, in that moment, I just said, OK, well, neuro and athletes literally went on in Australia and I found a business name and I just, that's how I started the creation of neuro athletics. But it was literally the intersection of neuroscience and athleticism. And basically what I wanted to do was I wanted to show athletes and teams that they can perform better, think faster and ultimately live longer, which is what we want for all athletes. They have an expiration date, live longer by understanding their nervous system. So and you know, everyone says to me, but Louise, can you work with me? Can you work with me? I say, well, if you have a brain, then that's yes. So at that time, I was working with all athletes, didn't matter, you know, I was working with a lot of boxes. We have a lot of fighters in Australia, a lot of soccer players. And it wasn't until I moved and it wasn't until I would say 2017, 2018 that I really honed in and said, I'm only going to work with NFL athletes because there was a lot of, you know, TBI concussions, I thought I can really make a dent in that space. I want to work with NBA players because I like the sport, OK, and I thought I really want to work on the cognitive aspect, you know, reaction time, visual acuity, et cetera. I really want to work with them. I think it'd be great to work with a ball sport. And then soccer, I grew up on soccer, I never played it, but I'm Greek and we are very big soccer fans. And I said, I just love the sport and I know the sport. So I just dedicated myself to those three sports. And then in the last two years, the company has expanded into the financial sector. We now work with portfolio managers, we work with day traders, we work with investors, and that's been really fun too because I think that they are just like athletes as well. That's amazing. Louisa, you know, you talk about, you guys have your stories, right? And exactly what you're talking about is optimization, you know, in every single aspect. And that's how I got interested in rehab medicine and, you know, becoming an athlete. For me, you know, I wasn't always the strongest growing up, you know, all I had was speed. I was really fast. But it always came down to looking at other people's weaknesses and seeing what I could do to gain strengths. So this is why this topic is so fascinating to me. You just mentioned cognitive, visual acuity, reflexes, all these things, which we will get into. I want to switch it to sleep for a little bit because I know you're very passionate about sleep. And I think sleep is probably the biggest driver that we're starting to understand. I mean, you mentioned Andrew Heberman and he's got a lot of episodes on it. Matthew Walker just came out with a podcast on it. So you call sleep the most or the highest performance drug. Why is that? Yeah, I love that. I call it the most underrated high performance tool that we have. And I think it really is for a number of different, different reasons. But I will preface this by saying in Australia, if you go and do any medical degree, it's got a very different medical system in Australia. I know it's like, it's like we're both dealing with the, but it's completely different. But in Australia, if you are, if you want to be a surgeon, for example, you go and do your medical degree, then you have to go back and do a master of surgery. Anything you have to go back and do a master of medicine in surgery and anything. So I knew that I loved neurophysiology, literally, which is what we're speaking about here. But it's when we talk about neurophysiology, it's about, we look at epilepsy, we look at how does the brain relate to the body, what to do, and how does other things, like the body, how does that, you know, affect the brains? When I mentioned this bi-directional axis. So I went back and I did master of medicine in neurophysiology. That's where I really understood, because we learn about we're going to surgery, we do intraoperative neurophysiology, where we learn how to drop electrodes into the brain. And a really big aspect of the learning curve in there is sleep medicine, because when you do a sleep study, you have to go into a lab within your physiologist. And that's where I really understood, wow, it's not until you're in a sleep lab that you understand what sleep really is. And it is so powerful, it can literally detect things such as Parkinson's disease, 20 years before it's diagnosis, which I think is during REM's behavior disorder. But when you're in these labs, you understand what the body goes through during sleep. And there are some amazing things that happen that I think, wow, we are all rushing out to get the latest new topic. Or we're all rushing out to get the latest cycling gear or the running shoes, but we haven't nailed our hydration, our nutrition, or our sleep. So let's talk about sleep, sorry. Yeah, no, do you think it's worth breaking down the stages of sleep and kind of just going in? Yeah, I'll do a break. I won't we, you know, I'll, I'll briefly outline, you know, some of the stages that we have during sleep. So the first three stages, stages one, two and three, we have a fourth stage as well. But the first three stages happen from the moment that we're starting to fall asleep, that stage one, we're going to stage two light sleep, then we're going to stage three. Now, these three stages are comprised of what we call non REM sleep. It stands for non rapid eye movement sleep. So they're the first three first three stages of sleep. Now, amazing things occur during during these three. And I'm only going to focus on stage three because it's what we know as deep sleep. For those of you who wear a whoop strap or an aura ring, for example, if you check your metrics the next day, you'll see REM sleep or deep sleep, you can see your score. And during deep sleep, we have so many things that occur. We have things such as the release of human growth hormone. And this is responsible for what protein synthesis, muscle repair and recovery. I think, wow, okay, so we don't really, you know, if we're optimizing our sleep, I thought if we're really optimizing, which is we're really getting into deep sleep, then we don't really need to be taking, you know, to an extent, you know, I say this is the caveat, we don't really need to be taking all the protein powders and all of these supplements and doing all of this stuff unless we've got deep sleep really, you know, optimized. So that was a first thing I was like, that's interesting. And there's another thing that also happens in these stages and also during REM sleep, too, which is this next stage stage four. When we go to sleep, we activate this system, I think it's a wonderful system. It's called the lymphatic system. And basically, so we, we all knew until 20 years ago, we all knew about this lymphatic system in our body. We went and got lymph, lymph node massages. That what they called lymphatic massages. We all knew about that. How can we clear out all the toxins in our body? Wasn't until about 20 or 30 years ago that neuroscientists saw that we have a lymphatic system in our brain. It's called the glimphatic system. The reason why it's called glimpses because we have these are, we have these amazing neurons in our brain called glial cells or these brain cells, I should say. And basically all of the CSF, the cerebral spinal fluid, it goes through and through your brain. If anybody's watching me, I've got a lot of hand movements right now. Basically, all of these glial cells, they move out of the way and we have these systems, these fluid systems that just go through the brain and clears out all of the toxins, all of the gunk that's occurred in your brain and in your nervous system throughout the day. And it gets cleared out. I thought, well, that's, that's interesting because imagine waking up in the morning and feeling, you know, so much clarity and not having a headache and not feeling that kind of gluggy feeling that you're feeling you don't sleep. That's because the glimphatic system has kicked in and it's cleared out. All of that thought, that's amazing. Wow. So we don't need, we really, if we have that optimized, we don't really need caffeine or performance enhancing drugs. So that was great. And then we move into that REM sleep stage, rapid eye movement. Just the reason why it's called rapid eye movement is because when you're in a sleep lab, and you've got your hooked up to the electrodes, you've got these also, these electrodes on your eyes, what happens is your, your body, you know, it's, your, your eyes are going through this thing and it comes up on EG as horizontal eye movements. You can get some vertical ones too, but 90% of them are horizontal eye movements, which is why they came up with rapid eye movement. And this is where we're getting a lot of our memory consolidation happening. So a lot of our learning takes place during this time. And they say that to, you know, a lot of sleep scientists say that you should be having 20% of your total sleep time in REM sleep. So I think wow, so much, so much is occurring during sleep that is just so fantastic for us as athletes and as individuals, especially in the finance space. Why are we not, why are we not talking about this more? So I think it's a, I think it's something that we need to be looking for. I think everything starts with sleep when it comes to athleticism. And if it can be optimizing for that, you'd see dividends in your, in your performance. Follow up on the REM sleep. So I've heard that statistic several times, right? But I imagine much like anything, there has to be a large amount of variability, right? Whether it's through different stages of our life, right? I mean, I think as we get older, like we know people in their 50s and 60s, my understanding is, obviously, you know, their overall sleep quantity tends to lessen, right? And so they're also going to curtail some of the REM sleep. So have you found in your practice that maybe ask people go through different phases of their life, they have different amounts of REM sleep? Because again, as what we're going to talk about later, you tend to track a lot of these metrics as well. Oh, look, everybody has, you know, you're right as, you know, as we get older, a lot of things decline. One of them is REM sleep. It's also deep sleep and total sleep time. But everybody is different. And REM sleep can be really modulated by a lot of activities. For example, we know that things such as bright light is going to block REM sleep and some deep sleep. There's certain medications, anti-psychotic drugs, a lot of other different medications that actually go in and block REM sleep. And then there's a really wonderful thing, which has only come to my attention. I would say in the last six months, I've put this out there in a podcast and on a news, I don't think you're athletics news, I don't. And that's around vitamin D and how having vitamin D deficiency can really go in and affect your sleep, especially your REM sleep. And so that's a really fascinating finding. So everybody's going to wake up, like for example, another big one is alcohol. I should mention alcohol really goes in and completely plummets your REM sleep. But I have been, you know, I've been having a glass of wine each night with my dad. He's a big whiny and you know, I don't spend that much time with him. So we've been having a glass and my REM sleep is 8%. It's usually 21, 22%. I feel like, wow, this is fascinating stuff. So yeah, no, I was just going to ask real quick. I think I saw an Instagram post of you are saying that that wine probably affects you more. So do you think that alcohol has, you know, a variable effect on different people? So for instance, by taking a glass of wine, I'm not going to see as much of a drop as you would. Yeah, well, it might be everybody's different. Obviously, it's like how you metabolize it. However, it really comes down to the active ingredient in alcohol, which is ethanol. That acts as a sedative and, you know, you've both done, I'm guessing you've both done anesthesiology rotations, I think. And we all know what, you know, propavold does. We all know what happens when you go in and you have an IV. It sedates you. So you're not getting into sleep. And this is, you know, this brings up another important question surrounding marijuana use. And, you know, almost all, you know, a lot of the athletes that we sign do say, well, the way is it to calm down, I smoke a joint every, you know, maybe two, three times a week. I go, no, no, no, please don't. Because you're not actually getting into sleep. It may be, it may be calming down your nervous system, but you're sedating you. That's what you're doing. When you have alcohol or another form of sedative, you are sedating yourself. This is why I lobby against prescription sleep pills or sleep medication. I really, you know, ambient, it's a, it's another form of sedative. So you're sedating yourself. You're not going into those deep sleep and REM sleep stages. I'm curious, would the wine example you gave, have you noticed if you curtailed that drink at a certain hour in the evening, that you tend not to have an effect? Well, yes, it's because there's a half life, just like caffeine. But that would mean I'd be day drinking at midday. And that would be a bit more of a problem. Because I'm not 21 anymore. So yeah, it's a, look, if I have it at 9 p.m. then yeah, completely different to having it maybe at 6.37. But look, it's a, yes, I, I give myself a lot of slack because of my culture. Yeah. That makes a question though, remember? So, you know, I, one of the people that Darshan I do listen to quite a bit, of course, Matthew Walker. I think we're all fans of him here, his book. And then, you know, he's been on Peter T's podcast quite a bit. And they've talked about the different interaction of very strong and sleep, I think at length. And I, I don't know if it was Peter who said this or not. I think that when we're having these discussions with patients, right? So let's just take alcohol, any type of these sedatives, right? There's something to be said about the fact that it calms down the nerve, right? And it overall, if it just lowers, maybe not actually clinically and objectively lowers cortisol. But it just gives somebody, it takes the edge off the anxiety. Because one of the things that people have challenges, you know, with their sleep latencies, they're embedded in their, their mind's just racing and stuff, not. And if just a little bit of alcohol or marijuana or whatever your medication drug might be, takes the edge off, is there something to be said about looking in the larger clinical context? Hey, in the grand scheme at this, this might be beneficial because you might not be struggling with chronic sleep deprivation. Well, are you saying that in the short term, if it does lower cortisol and it kind of sells down your nervous system, is there merit to having it? Yeah, I guess what I'm wondering is, in the over the last two years, you know, people have been maybe not everybody, but I think just the general state of anxiety has been at an all-time high. I think we can probably agree with that, right? For obviously reasons. And I think that perpetual stress has a role in, in being able to get good quality sleep, right? Absolutely. And I'm certainly not, you know, I'm not saying that anybody should be using these type of Saturdays and medications or whatnot. But I'm just wondering is, how do you take that into account? I mean, you do this on a day to day basis and I don't. And if somebody comes in and they look, Luis said, like, I understand. I understand what you're saying. I see the sleep metrics. I see my whooping or a ring. But here, it helps me. Are there instances where like, you know what, in your case, taking everything into account, taking the history that you're talking about? I think this is okay. Let's work with how we can bring it back to a glass or, you know, whatever, whatever might be. Well, depending on how much they're having, a, you know, you don't just want to go cold turkey on somebody who's having, you know, six because of, you know, stressful reasons. But no, with a lot of my athletes, they're only doing it really to decompress. And there are other forms of that. And we really help them with that, you know, stress relieving strategies. We can even look into certain types of new tropics. For example, you know, when you have a sleep complaint, a lot of patients have got two chief complaints. And that is I've trouble falling asleep. That's the first one. Or I've trouble staying asleep. And two of them offer two completely different forms of, you know, you're going to be dealing with them in two different ways. And then the, let's talk about the former. I have trouble falling asleep. Okay, well, why is that? Well, Louise, when I go to sleep, my mind is racing. And by the way, that's something that happens with me a lot. My mind races. And right now I'm on three different, I feel like I'm on three different time zones. So my mind is constantly, my phone blows up. Like, you know, when you guys are waking up, it's like 11 p.m. hear my phone's blowing up. So it's like, okay, okay, well, what do we know about that when the mind is racing? Well, we know that we have, you know, anywhere from 80 billion neurons in our brain, brain nerve cells. And in order for us to think a thought or to produce anything, these two nerve cells have to fire together. It's called a synapse. And, well, okay. So they're obviously going at a very rapid, you know, rapid rate, because we're thinking so much. How we really settle those down? We have a chief inhibitory neurotransmitter. And it's called GABA. Well, GABA, it stands for gamma amino buteric acid. And it's our chief inhibitory neurotransmitter. So what does it do? It's neurotransmitter that goes in. And it inhibits the action of all of these action potentials from firing. So this is a naturally occurring neurotransmitter in the brain and the body. So let's see what we can do. Let's supplement with this and see if it calms down our nervous system. That's just one healthy option that we can take. The second thing might be optimizing your environment around you so you can start to decompress and not have those racing thoughts prior to going to sleep. And I always say, I always give my athletes an out. I say, try all of my tools first. Try everything. And if all else fails after two months, have your glass of wine? I haven't had one yet over so many years and it hasn't worked yet. Let's go into optimizing sleep then. Yeah, because you work with athletes and you actually even go to their hotel rooms to kind of situate. Take us through that process. So you go through that door. What are you looking at? What are you doing? Well, first thing I'm looking at is I find out what mattress they're sleeping on. Okay, that's the first thing. One thing I make all of them do is I make them travel with their own pillow. The reason being is that we want them to be able to have an optimal sleep and something that you and you can obviously imagine this as well. When you go to a hotel room and you're sleeping on different pillows, you just know it's not your pillow. It's not your home. So I make them travel with their own pillows. But when I'm looking at optimizing the room, I'm looking at the temperature of the room. I'm looking at what type of mattress they're sleeping on. Sometimes I try and get them to sleep on an eight-sleep mattress. So my company has got a partnership with eight-sleep and they are, I believe, they are the leaders in the sleep fitness technology company. So their mattress cools down and it heats up according to your heart rate and sleeping rhythms and patterns. So I think that's incredible. I look at how dark can the room get? I really want to get blackout curtains. So these are some of the things I make sure that everybody's got their eye mask. A bath tub is a really big necessity in the hotel rooms. But I think if I did nail it down to something that everyone can do for an actionable tip to enhance the performance of their sleep, it would be looking at your temperature. So let's talk about that. So we have a homeostatic core body temperature. What is it in Fahrenheit? What's the 98 degrees? 98 degrees Fahrenheit. So that's what we need. That's what we're all out at baseline homeostasis. We call it. Now, what we know from the literature is that in order to fall asleep and in order to stay asleep, our core body temperature needs to drop at least two degrees. Two degrees below our Fahrenheit level. Now, how do we do this? It's very hard because we think, well, can we do this with the thermostat? And that's called ambient temperature. That's changing the temperature of the environment. We know that that doesn't really have an effect on our core body temperature. So unless you've got somebody waking up throughout the night and putting and cooling you down with ice packs, the only real way to do that after that is via a mattress or a cooling blanket, if you will. So this is why we partnered with eight sleeps. So we got them to give all my athletes a mattress and the guys just go in, they lay down, and the mattress just cools down with them. So it keeps them asleep. And it detects, you know, some people are hot sleepers. You know, I don't know if you guys are, but some, there are a lot of men, big men as well, who are hot sleepers. So the mattress picks up on the temperature and it's like, oh, no, he's getting too hot. We're gonna drop him down even more. So it keeps your body at a cool state. So I think that's a really important thing for everybody to know. Sorry, yes. No, what's with the bathtub? What's that about? So I, okay, well, bathtub is for other purposes, such as I like to, you know, in order to like, like really calm down your nervous system, sometimes I suggest a magnesium bath, okay? Which, if you've had a magnesium salt bath, I don't have a bathtub in my New York City apartment, but here I'm in Sydney, I have a bathtub. And when I have my bath and I, oh my God, it can just put me to sleep, it's incredible. That's the first thing. The second thing is there's a lot of science that shows that when you heat up your, your core body temperature, you get a dramatic drop after that. So I like to suggest this because it brings all the blood to the surface of the skin and makes you hot. And then your body has to push hard to bring it back down to that homeostasis level. But in doing so, it drops it down even further and then later through the night, it lifts it back up. So it's another way if you don't have a cooling mattress, that's another way of manipulating temperature. I like that. I mean, as opposed to just taking a shower, you can do two for one, right? Do the magnesium and take a hot. So a quick follow up for the Aidsley partnership that you guys have. I mean, you know, a lot of these NBA players, I mean, they'll be in the city for one night. I mean, I can't imagine they're taking a mattress with them. So are they getting multiple mattresses to different cities? Like, that's pretty amazing at that time. Yeah, no. So we have designated rooms around the city, especially in New York City, yeah. You have to come to Louise and a colota, yeah. But we do have, so we do have different hotel rooms that have got these mattresses in there and they're specifically designed for this purpose. So when somebody's flying in, they can stay in that specific room. And it also comes with a cover. Like, you don't just have to have the mattresses comes with a cover, which is what I did. I've just got the pot pro cover. I put it on my mattress. So that's one way. But back to that bathtub. Another great reason to have a bathtub is you can always turn it into an ice bath. So, yeah. No, I think to your point about, you know, the ambient temperature and sleep. And I've written about this before too. I mean, maybe five, six years ago, it probably a little bit longer than that, is when I really started learning and appreciating that, you know, I need to optimize my sleep quality. And I was like, okay, well, of course, where I'm gonna start, I'm gonna start at the mattress. And as I started learning more and more about sleep and, you know, going through medical school, you're pretty sleep deprived too. So, you know, you really want it more than anything else. I was like, just absolutely fascinated by it. And I showed this funny story because I just thought about the irony. You know, I'm one of those people, I think much like Darsen, probably much like yourself. And you know, as we start learning more, you get excited and you go down this rabbit hole, right? And this is shortly after I'd gotten married. And, I mean, I just was learning about different mattresses and sleep quality and temperature changes and whatnot. This is before, I think, eight sleep. I don't know how they'll live them around. But one morning, you know, it was like maybe two, 30 in the morning. And I'm still there studying about sleep. My wife just woke up and he goes, do you not see the irony of the situation that you are staying up in the middle of life, sacrificing sleep so you can learn about sleep quality and I was like, wow, that's most amazing and insightful and I'm a ridiculous person. Sorry, that was a little tangent. But I haven't used the pot pro cover. I recently heard your episode when Justin Mateiro is talking about it. I think that's going to be attending purchase. I personally use the uller by chili technology. I got to say honestly, that's been an absolute game changer for me. Once I can appreciate it and especially when you can control at what time the temperature changes throughout the night. I know you can do that with each sleep as well, right? Different stages in the night. You can have different temperatures. So yeah, that's been incredible. Yeah, it connects with your phone and you can set it to whatever. And the great thing is if you sleep with somebody, you can separate the bed into two. So if you want it to just go to zero and minus one, minus two, they are not the temperatures. It's just the gauge of the settings. And your panel wants to sleep at maybe one and it's completely different. So I think that's amazing too. Now I'm curious about the eat sleep. You wear an aurora ring, yeah? I do, yeah. So but the eat sleep has its own internal tracking system? It does, yeah. So the sleep adjustments are automated by that tracking system or do you do a manual inputs? No, no, they're automated by that tracking system. And then so every morning I wake up and I check both, you know, but so here's my theory and you would know this just like an EKG, you know, when people are wearing HRV, you can't really detect HRV as good as what an EKG can. But it's just like the aurora ring. It's like, well, this is amazing and the whip strap and the a sleep. But nothing's going to be an in-lab PSG. So you have to get the next best thing. And what do we know when it comes to science? We know that as many different data points can help us get there and give us the quantifiable measurement that we're looking for. So I look at everything, but so far I feel like the aurora ring is the most reliable out of all three. There's a lot of controversy around that, but there's also a lot of research around that. I found a great PubMed article that links this type of wearable. I think it says it's around 86% of a PSG. So that's the closest that we have to wearable. Yeah, well, I mean, it's pretty solid. I mean, 80% and again, I think we talked about this on previous episodes. We use these wearables to give us insight, right? In order for us to change behavior, not necessarily just give us data, not to do anything with it. But yeah, I've got the boob. And I mean, it's the same thing. I'm just kind of using it to gauge my behavior, which again, I have these blue blockers on right now because I'm a little jet lag. But you mentioned HRV, and I know you're a big fan of tracking it. Can you kind of break down what HRV is for the audience? And then how do you use it with your athletes? Yeah, so it's HRV, you've probably seen it on your work band or your Aura Ring. It's pretty much the, I would say people are scientists and like saying the average, but it's pretty much a measurement between the autonomic nervous system. And I feel like I'm going to file with this. I feel like I need to take a step back and introduce the nervous system. But we've got a sympathetic nervous system and we've got a parasympathetic nervous system. And basically we want one is about stress, okay, and one's about rest and digest. And we want to know, well, how many times during the day, am I getting into that stressful state? And we do this via, you know, when we're exercising, but when we're at rest and we're activating the parasympathetic, which is the rest and digest nervous system, we're in the parasympathetic where our heart rate is completely down. And maybe at 60 beats per minute, maybe at 54 depending on how fit you are, your age, et cetera. And we want to know, well, how long during the day did I spend in both? And a pretty much as the average of these two systems. And when we look at this, the reason why I love it so much is because with HRV, it gets manipulated through sleep. When we're looking at a wearable such as the auto ring, the auto ring goes through and actually track to HRV in the early stages of deep sleep. So that's when it gets to HRV tracking. The web strap does the same thing, it tracks it overnight. So this is why it's really important to wear your wearables at night. And tracks, and in the morning, it delivers your result. And what we've found is that the more recovered you are, the less stressed you are and the healthier your body is functioning, the higher your HRV. So we can use this measurement as a predictor of performance the following day. When we're jet lagged, we haven't slept well. Our body is constantly in that fight or flight, in that stressed mode, high inflammation, low cardiovascular health. Then our HRV heart rate variability is going to be lower. So we're looking at the variability of the different systems that we got into that day. And I think it's a great predictor. We didn't know HRV prior. We had to go in and get an EKG. We have a little lead that's strapped up here in a year at Clavicle. And it was also a great measurement of cardiovascular health. But now that we can do this at home, it's a great predictor of performance the following day. How well you've recovered or how well that you're going to be in a game, for example. How long of a period do you ask your athletes or for you personally to have the data for the HRV? For instance, is just one night of wearing or ring at night, time sufficient to predict performance? Or do you want 24 hours of data? Yeah, I'm tracking their daily metrics. Like I have a back end. So all of my athletes are wearing an or ring on the back end. So they can't lie to me. So I'm literally tracking them 24-7. And I'm seeing a lot of trends. I think, well, OK, how come your HRV was so low here? And then I look, oh, well, he just traveled. He was his jet lag. HRV has completely plummeted. Or he could tell me, I could look at his sleep times and think, wow, he slept great. But why is his HRV still low? It could be infection. It could be mental stress, emotional stress. This is the things we need to take into play or it could be COVID-19. So yeah, I'm looking at more than a 24 hour basis. And also, it takes time for your body to try you have to wear it for about two weeks for your body to really understand your systems. What's your highest recording HRV? Mine is like a 50, my highest. But it might be different in the loop, right, in terms of how they present it. Or is it the same? No, it's pretty much the same. I think the same. Yeah, I'm like a 50. And that's what I was actually just going to ask you is how much genetic variability do you think there is? Me and my brother are probably around like high is 55. But I kind of hang around that 40 to 50 range. Like, if I'm not, you're like, yeah. Right. Because you're at like 120, aren't you? Well, you know, yeah, I'm more than that. I thought, oh my gosh, well, I've got a history of A-Fib in the family. I thought I'm going to go get it better when I was like shit. No, because I did record. This is how I got the attention of Wubit. It was about a year ago. I recorded, I had a 210, for a week, 210, HRV. And I kept putting my stats up and they contacted me. Like, can we do a study on you? So now it's, I was like, oh my gosh, maybe I've got A-Fib but no, everything's fine. So I just had a, I was very healthy. But now it's sitting, I would say my greatest average is around 180. So if I'm down at like 48, then I know what have I done? I don't think it's ever been 48, but maybe if it's been around, you know, if it's been around 96, I think to myself, well, that's, I've done something wrong. That was really interesting, though. You know, I've talked about this before. I think that when I first got, so I don't use Wubit, I used to worry as well. And initially probably wore it consistently for about two and a half years and really dialed down the information that I needed to optimize my sleep regimens that worked for me and then I kind of put it away because I think I was in one of those camps where it was starting to become detrimental to run to check my sleep score in the morning for a while. I don't seem to have that problem now when I throw it on from time to time just to make sure everything is cool. But interestingly, you know, my wife and I welcomed a baby not too long ago and that first two weeks, where I was, thank you. But the first two weeks, I was sleeping like four hours a night and I had my highest that I've ever seen. Interestingly, I was like, one eighty eight, and I was like, well, this makes no sense. So I found that to be very curious. I'm not really sure what to make of that, but that was interesting. Were you exercising? Yes, but only like three times a week. I don't know if I did that day or not, to be honest with you, I don't remember. Maybe it was mistaking your activity, yeah, for exercising thinking, well, he's going great. But then yeah, lack of sleep is, it can be really, it can really plummet the HIV. Interesting. So on the note of HIV, I kind of want to take a somewhat of a short turn here. I remember you mentioning, I forget which podcast, maybe it was on like Matt Dawson or Wild Hell podcast about the correlation or the alterations in HIV post-TBI. And so I see a lot of sports related concussion. Actually, both of us see, in our training, we see moderate severe mild TBI, but the sake of this discussion, we'll keep it to mild TBI. You worked with a lot of NF athletes you said in the past, how is that affected? And like what does HRV tell you post traumatic brain injury, mild traumatic brain injury? Well, look, I think it's great when we can have these metrics, not a lot of my boys were wearing them at the time of concussions, but let's just step back a bit and talk about this. Because there's something that's been ever since the San Antonio Brown thing went insane. Like let's open everybody's eyes to the fact that concussion should be really looked at in more than just sports medicine fellowships. They've actually introduced now the American Academy of Neurology have now introduced a sports neurology fellowship because concussions are so under recognized. And the reason is that I think that even, we're getting mild concussive hits with every single time that we go out, even when my soccer player's a headbutting the ball, they're getting some form of collision to the head, okay? And what do we know? Well, we know that when you get hit to the head, the brain starts to go back and forth and hits the skull. So we've got all these metabolites, all these neurotransmitters just going wild. So it's gonna mess up the brain in some way, the fluid, everything's gonna get messed up in some way. So I was finding that the first 48 hours post concussion, whether it's mild, whether it was just light or severe, you see a massive, massive downturn in HRV. Now, in terms of like the why to that, my only suggestion can be the increase in neural, the increases in neural inflammation. We know that inflammation is another predictor of getting into that fight or flight, sympathetic, sympathetic nervous system state. So we know that that's going to have an effect on the, you know, for two or three days afterwards, it's gonna have an effect on the HRV. I haven't gone too much into the depths of understanding the complete correlation, but that would be my understanding. It would be the increase in neural inflammation. But that's the first thing. The second thing that I could suggest is it probably has something to do with temperature as well. We know that when we, if we heat the brain up to a certain amount, you can fry the brain. You literally can, and we've seen this in multiple studies. And what we know when we are a concussed, you can probably, you know, weigh in on this. Do you know anything about the temperature of the head post concussion? Is it, does it increase? I personally don't know. Well, so, okay, so two years ago I was approached and I was in, I was working, you know, a lot in New York and I got approached by the university that used to attend the university of, I attended the University of Sydney, but it was actually the University of New South Wales. They reached out to me, there was a lab there, and they were working on a cooling mechanism post-traumatic insult, pretty much like they were working on, you know, how can we get a neck cooling device for if someone gets hit on the field we can go through and just call them down immediately because you get a raise in your body temperature increases and the temperature of your head increases and that's what's going in and actually messing with the brain metabolites. So that's where, and I haven't really gone into it, but I thought that was really interesting. So I'm thinking that that also has another effect of how it plays into HIV. Yeah, I mean, I think that one of the proposed mechanisms in terms of, again, sportually concussion, but really any type of TBI is the alterations of metabolic activity, right? And that's where the PET scans and some of these advanced imaging modalities come into play as well. I know that, you know, staying on the note of TBI, but don't want to dive too far into supplementation, but you are passionate about EPA and DHA, in fact, after before we started, you had to get your daily dose in. Yes. And, you know, one of my journal club articles that I did this year for our sports related concussion was the efficacy of DHA as a protective agent for mild traumatic brain injury in elite football players. And it's actually started in boxers, again, coming back full circle, you talked about working with that. So what is your understanding of the evidence of using, I think both EPA and DHA, but as far as I understand it, DHA may be a little bit more so for, you know, neuroprotection, is that fair? Yeah, let's, to make it really simple because I do go into this a lot, but to make it really simple, first of all, I believe, and I get in so much trouble for saying this, if you're a boxer or you're an NFL athlete, you have a death wish. I've said that, I've actually said that to Roger Godel, the commissioner of the NFL in front of his face, didn't go down too well. So that's a first thing we know that. Second thing is, let's look at what's the, we know that the brain itself, it's like a hunk of fat. Most of the fat that it's made out of is DHA fat, you know? So we know that this is comprised of, we know that if we're going to fish oil, it's comprised of omega-3 fatty acids, which is EPA, DHA and ALA, correct? Okay, so ALA is more found in flaxseeds and it's more for the plant-based vegans out there. But then we've got EPA and DHA. These are the two things that I supplement with. So EPA does have more of an efficacy when it comes to neuroprotection, but where EPA comes in is, it has a really great effect on lowering inflammation. So before we got on this podcast, I remembered I had to have, I have two grams of EPA in the morning, EPA, DHA and two grams at night, because I try and get two grams of EPA and two grams of DHA all day. So four grams completely together. So why do I have this? I always have a circulating amount of omega-3s in my blood in order to bring down the, bring down the neural inflammation and bring down just the inflammation in my body. So it does have a major protective mechanism for athletes. Any type of fat diet, actually, there was a great study that was done, and it was in nature, nature journal, nature. Really, really in a high stringent, high quality journal. And I forget the title of it, but I've prefaced it so many times, and it was about post-traumatic insult within the first 72 hours of that insult, having a high fat diet and ketones actually aids and speeds the recovery of these TBIs. And I think it goes in by way of fat being, you know, the primary source and glucose being like, we're gonna have, do we wanna feed the brain with what it's made out of or do we wanna just wanna rush glucose to the brain when it needs it? So I think this whole realm of DHA and fat to help the brain and protect it is a really great thing. I think everyone should be having EPA DHA, like everybody. So taking that strong stance that you have on this matter, how do you work with your vegan athletes who maybe, you know, don't wanna do that? I don't have any vegan athletes, thank God. Yeah. If you did. If I did, it would be, you know, see, it would be more high dose ALA because you can't mimic the effects of EPA DHA just from ALA alone. And there's a lot of people, you know, there's a lot of veganist is out there who attack me about this, but it's just, you know, I just go by what the evidence suggests and then you just have to work around it, I guess. So interestingly, I think that this is a question that I've had a couple of times and, you know, come to learn that like sources, like algae sources are the source, right? I mean, do you know better, but do you wanna say something about this one? Or, sorry, they're... The where is it? Oh, yeah. No, Darsh. No, no, no, I was good to say. So I'm a vegetarian just being born one, grown up, not vegan. Oh, we're going to stop this podcast right now. But, so what they say right is that if you're taking the fish oil, the way the omega-3's are coming from the fish are from the algae. So the algae itself is the source of those omega-3's. Thoughts on that I guess is what but ultimately it's kind of leading here. Yeah. Yeah, I think one thing that we talked about is, we actually did a whole podcast on algae, actually. But obviously acquiring those algae-based food sources, at least here in the United States is much harder to do, maybe in the far Eastern cultures, is a bit easier to do. And the other thing I think worth noting about ALA, and Darshan, I talked about this offline before, is your body will convert it, right? ALA to EPA and DHA, but there's a rate limiting step, not everybody has the enzyme, and the activity of the enzyme is a little bit different too, because I think walnut is another great resource. Is that correct, right? That's another source for ALA as well. I think so. Can anybody check me on that? Yes, okay. Walnuts, chia seeds, yeah, flax seeds, those types of things, yeah. But what you said was really important, the fact that it has to go through this two-step process, right, it goes through first ALA, then it has to convert so it's just like, well, instead of going through that metabolic pathway, let's just take the EPA and DHA. And if you take a really high-quality supplement from a great brand, which is what I advocate for, you're not gonna be getting that fishy taste. If you feel comfortable disclosing, what brand do you like for your EPA DHA? I only use Thorn, yeah. Yeah, not partnered with them. I just, honestly, I've looked at their regulations, I've looked at the way that they manufacture it. I've also looked into all the multiple studies that have been done on the manufacturing process of some over-the-counter drugs, and you just don't know what they're lined with. So if it's a, if they haven't got a good reputation, I don't know why people just buy a ginseng over the internet on eBay and just take it, I'm like, what are you putting in your body? Yeah, yeah. I, of course, they're an of that. And it's certified, yeah, right? That's what is the, is it vitamin E that you're using in terms of to protect from oxidation? What is it that they use in their EPA DHA? Rosemary oil or? No, it's not. It's, you know, I, I don't even have the bottle in. We can look it up, that's not even important. No. So I wanna come back to sleep, right? Cause this is one of the things that you're an expert among many, and you know, one of the things that we're starting to learn is we maybe we don't have a causative evidence yet, but we do have correlations in for, you talked about sleep and, or lack of sleep and adversely affecting performance, right? Both cognitively and physically. But of course being a physician and a sports medicine provider, I see a lot of people who get injured. What do you know, or what do we know about the interplay between sleep and risk of injury? Oh gosh, well, like I mentioned earlier, okay? If we're not getting the proper secretion or release of these vital hormones such as human growth hormone, responsible for protein synthesis, we're not gonna be properly recovered the next day, okay? But not just that. Let's, let's, I always go, you know, as a good scientist, you always go in and dig a little deeper. Why? What else happens when it comes to injury? Now, I know a lot of people who have, you know, especially in the NFL, who have gotten an injury because maybe, just maybe in that split moment, they didn't see somebody coming on the right quadrant of their, why is that? Lack of sleep can do more than just not release certain hormones. Lack of sleep can go in and, you know, there's been studies that have been done where there's a, there was an ultra adventure runner. I don't know what you call them, but she had to run for like three days and what happened was the race was over three days. So you wanna try what they did was they're only sleeping for an hour each night, having a power nap. And she, on the third day, I think of the second or third day, she started hallucinating. This is what happens when we are sleep deprived. This is what happens with people who go out and they take drugs that keep them awake. They are keeping themselves up and they start to hallucinate. Then that plays merit into, if you're a bit sleep deprived, if you're having maybe four hours of sleep one night, you can induce a tiny bit of psychosis the next day. You can induce your cognitive capacity can go completely down. Then you might miss the ball or you might miss a catch or you might just be in the wrong way and someone can just charge at you and you can be paralyzed within a second. So I look to that as well. I don't just say that injury can be caused because lack of sleep because of, you know, not a sufficient amount of hormones, but it can also be because your body is just not fueled enough to be able to do the right movements that can cause an injury. Does that make sense? Yeah, absolutely. It's hard sometimes when I say something in my head, it's like to put it out there, but that's my thinking as well. No, it makes sense. I mean, sleep is that primary driver, but without it, there's a ripple effect that leads down to so many different things. And actually, I'm just gonna ask you that. I have so many questions right now, actually. So let me try to, forget what I wanna ask you here. So, all right, in regards to sleep and TBI, you just mentioned cognitive decline, right? So you're seeing your athletes, especially in football and boxing, I'm sure, going downhill after a certain time period, right? And the other sports as well, is there a certain age or a certain years of athletic experience that you're seeing where they start to fall off? Cause I think sports science is at all time high right now, right? I think, you know, a lot of people give Tom Brady credit, but I always step back and say, well, look at almost all the sports in tennis. You have federal. You have Joker, you have Ronaldo and Messi. I mean, in basketball, you have LeBron, you have Steph Curry. I mean, these people are well beyond the peak years, you know, you could say in quotes. So what are your thoughts on that in terms of the cognitive decline? Are you seeing it at a certain age or a certain amount of years after they have that athletic experience? Yeah, I always say that elite athletes come with an expiration date. You're getting a decline in performance. I can't believe you brought up Jocke of itch. Yeah, sorry, you're also in a hurry. Again, that's really upsetting that you brought his arm up. I'm a rough kid. I won't get into, yeah, I won't get into that. And I was in Melbourne. I just got back last night from Melbourne. So I won't talk about that. But let's look at, let's look at a beast of all a beast out there. And that's LeBron. What's his age now? Is he 30, 37, 36, at least 37, maybe 38. And he's at his prime. He is just absolutely incredible. If you saw him on the tonal advertisement, his body is unbelievable, it's like, OK, 37. So what time is he going to start to decline with single of these amazing young guns coming through? And it all depends on first and foremost, it depends on what you're doing every day, what your genetic makeup is, what you're ingesting, and how you're refueling. Because everybody's cognitive, everyone can decline. That's just what happens over time. We decline, depending on if you're declining at a rapid rate due to, if you've got an allele for Alzheimer's disease, or if you're just declining because of inflammation or age, you can slow the progression of this via lifestyle interventions. So I mean, at most athletes, what I'm seeing is that at around 34, that's when they're really starting to call it quits. They're just getting injured more. I've got an athlete who's been out a lot of this season because of a hemmy injury that is going back and forth from Chicago to New York seeing surgeons and everything. So things start to weigh in on you at around that 34 mark. So let me ask you this as well. I mean, athlete structures, I'm sure day to day, are pretty structured, right? I mean, there's not much wiggle room. So aside from sleep, what else are you doing during the day to optimize their recovery, or if they have a low HRV that day? I utilize ice a lot called immersion. It's something that I really believe in. And like I said, I got the attention of this, the study that was being done on post-traumatic insult and cooling that really got me excited. Because there's this pathway that gets activated nearly when you're getting cold, it's called the RBM3 pathway. But there's so many different things that occur during cold thermogenesis that I absolutely love. It can really help you mentally, feeling good, feeling vigilant, feeling focused, but it also does so much for you neurologically and physiologically. So one of the things I do outside of a window of three hours, pre and post-training is 12 minute ice bath. I think I really, really believe in that. I want to come to recovery, I believe in that. Sauners, obviously I believe in, there's a lot of merit, but I've had to choose between cold bath and sauna. I would choose a cold bath. So those two things and hydration are probably the three biggest things that I fall back on when it comes to recovery. Why is that the case? I've heard a lot of talk about heat shock proteins in terms of recovery. I think you might have been the first person that I heard about cold shock proteins from. But my just very rudimentary understanding is in terms of the evidence behind sauna for longevity is much more robust than it is for cold therapy. But you mentioned that you'd rather pick that. Why is it the case? Well, you asked me about recovery. I see. So from performance standpoint. Yeah, from a performance standpoint. But yes, my dream is for my parents to have their own sauna and get into the sauna every day, but they just will not, they hate the heat, okay? My parents, my dad just turned 70, my mom is 65. When it comes to longevity, I would love them to be doing that on a daily basis, rather than an ice bath for longevity purposes. But I'm looking at a 32-year-old athlete who's at their prime, they're at their peak. I would, if I had to choose something to take away from their time, it would be the ice bath. A follow-up question. You know, I just thought somebody mentioned Tom Brady maybe it was Darshan. I don't know if it was the man in the area that he was talking about 2017 or whenever there was this whole thing about his own personal trainer. It couldn't be in there. Do you guys remember that? Like his trainer couldn't work out with the, anyways, he's got his own guy, right? And who's been with him, done his, I'm sorry, sorry for all that kind of stuff, but there was a whole thing with the Patriot staffs training recovery philosophy differed than his. Yeah, yeah, yeah. So I'm curious, you know, you work with athletes primarily on an individual basis, is that fair? Correct. How often do you find that struggle? Where an athlete will follow Luisas protocol? How are the team training staff, team medical staff have different philosophies? And how do you handle that? Well, here's a thing. There is an MBA team now that because I was working with so many of their players, I now work with the actual medical staff of that team pretty much because they're, you know, they're, they're medical team just did not really understand any of the precision medicine things that we're doing your athletics. And this comes down to politics. And this is something that once I have a bit more time, I'm still finishing board certification and introoperative neurophysiology. Once I finish that, I, you know, I dare say that I'll be out there speaking about the public health system and the public policies when it comes to NFL, especially when it comes to the concussion protocol, but not just that, like, what are they doing? Like, what are the staff mandates? And you have to look at, you know, why is it like this? You have to look at, for an MBA team, they're all, they're all owned by individuals. It goes up the ranks. So if it's the medical staff, they've got to adhere to this person and then this person and then this person and then this person. So you've got to look at who's at the top and who's running the show. And so more often than not, you know, you would admit, when you go to, when you go to medical school, those four years, you know, pharmacology, you're getting the bare essentials to really go out and understand this. I talk to a lot of physicians, actually I talk to physicians every single day. You know, just here in Australia, I had to go to my doctor, she's been treating me for a very long time. She's 67, she's like, she goes, oh Louise, I follow you now on social media, she goes, I don't even know what you talk about. I go, well, you know, to be actively involved in these things, you know, to understand this, it takes a lot of time and between patient notes and seeing 30, 40 patients, how are you supposed to do that and have a family? So these people don't really know, you know, a lot of them, unless you're really actively involved in precision medicine and research, you're really just doing your job. So it's hard for them to get on board with mainstream medicine, which is getting into a cold bath, like my physician here, my GP would be, she'd be like, what are you talking about? Like, you know, so it's very hard, yeah, and that comes down to public health right, or yeah, politics. Yeah, absolutely. Yeah, and so touching on politics, touching on the culture of sports, right? And I know a lot of NBA players, for example, in the last three years have kind of come out about the schedule saying, hey, we need to space things out. And obviously, there is a division, right, between money that can be made by the fans watching more, right? So now we have an extra week in the NFL, versus player safety, where do you, who do you think is kind of on top right now? I mean, obviously by what we're seeing, it seems like it's the higher up saying, we're not, we're gonna sacrifice our player safety, maybe. But do you think we'll see the culture change somewhat? No. Moving forward now? No, because that means for it to change, you have to take a year. And it's a season's not a, you know, NBA playoffs isn't gonna go for that long. So we will always, for the health of the economy, unfortunately, be choosing money over player safety. Like I said earlier, and I stand by this, even if I had to get fired from working with all NFL athletes, I stand by the fact that you do have a death wish, because that's what it really is. So, is there anything, is there anything that the NFL can do to change that answer of yours? Or do you think, regardless, it's just the way this question plays? Get rid of how the game is played and not have tackles. So that would not be a sport, right? I see. All right, we got it. Yeah. Do you feel as strongly about rugby as well? So everyone asked me that because I'm in Australia. I do, yeah, I do. I'm actually going to see the head of the Australian Brain Bank next week. Michael Buckman, wonderful man. And he's very, you know, so it's the same thing. They're just, they don't have helmet. Oh, no, they don't have helmets like the NFL. So I do want to ask you, right? You mentioned the challenge of trying to stay up on top of the evidence, trying to be informed, but having difficulty, right? For somebody who's busy, I mean, you're that person. I know I've heard you talk about multiple times, how you don't compromise in your sleep, right? You need at least eight hours. I think I've heard you say, but at the same time, you are updated on the evidence, right? You are, you mentioned you're, you're setting for your, your boards again soon, but at the same time, you know, self care is extremely important to you and you seem to do a pretty good job with that. How do you do it? That you say that you say on the outside. No, look, I do. I do pride myself on look. I've never been a drinker. Evidently don't take any drugs or heavy alcohol. I'll have a one with my dad more culturally, but in New York, I hardly drink. And, you know, I don't have kids, which is great. I'm in a relationship and we do have to sacrifice a lot. You know, I say, no, we can't be going out, you know, three, four times a week. And so, you know, I do, every single moment is optimized. And unfortunately, you know, drink the, you know, try-out on the reason why I think it was very dear to my heart is because I did give up a lot. When you're a triathlete, you have, and going to university, I gave up a lot of weddings. I lost a lot of friends. I did, I had a relationship, I'd probably like three relationships breakdowns because, you know, they couldn't seem to understand that. I needed to ride on a Sunday morning. So you do have to choose your battles. When you're in your early 30s, I don't know how old you, you both are, but when you've gone through it, you know, all of your 20s, you've kind of find out, great, I've got, you know, five best friends. And most of my friends are now married with kids. So they've got their own thing going on. So you don't lose friendships anymore because you don't need to be with them 24-7. So I just, I just do what I have to do. I will never comprehend, you know, dedicating my life to medicine and the brain is my life. Like I, you know, I live and breathe it. And then everything else outside of that until I have kids really comes second. So, yeah. Yeah, I gotta ask this, Luis. I know you've recently had an Instagram post, and I'm sorry, I didn't get to actually check it out in death, but it was about how there's, I think, a new study showing that there's no such thing as having too much sleep. And I know sometimes you post, you post having like 10 and a half hours, and I'm like, damn, jealous. I think it's just very, I just think we need to talk about that a little bit because I know there's this thought out there saying that if you have too little or too much, it's not good. What did this study exactly say? The study said that yes, you actually can't mechanistically or you clinically, there is no such thing as too much sleep. But that means that no disease states can be really formed by too much sleep. However, little sleep, such as six hours or less a night, you can get a lot of different things being occurred during that time, up regulation, down regulation of certain genes. So that was, that's pretty much where the base of that is. But what I was saying with the Instagram reel was, while we know this, while this is not gonna cause drastically any type of disease, we do have to take caution because if you do spend too much time in bed, you are going to feel a bit lethargic, you may not feel motivated to get up. So I think there is a sweet spot. I believe dependent, like LeBron needs, I would say needs 11 to 12 hours of sleep, okay? Body mass plus what he's doing cognitively plus what he's doing physically. But somebody like me, I would definitely say that my average should be, I wish it was nine hours, I wish that was my average, I just won't get there yet, eventually maybe I will, unless I'm extremely strict. Yeah, and thank you for kind of elaborating on that. I think that just, I've heard Dr. Matthew Walker talk about this and you know, just people saying exactly for those reasons that in terms of the correlations that they had noted that folks who were sleeping, I think maybe the study that I'm thinking of was published in one of the cardiology journals that beyond 10, maybe 11 hours, increase mortality, they saw that. And his explanation for that was that essentially the body was trying to fight these illnesses, right? But ultimately had lost, despite the increased need for sleep for the reparative process, many of that you've mentioned from a neurological standpoint as well. So I think that's worth noting as well. I love that. Look, there's still so much to be discovered. I think that's the most exciting thing about medicine, the fact that it changes every day, the fact that there's new technologies being invented. So yeah. All right, so I think that we have to talk that length about the benefits of sleep, how it affects performance, you know, both positively and negatively. And I think that we've had, we've talked about it a couple of times before. So I think most people have really started appreciated. And, you know, as much as I would love to work with folks in an ideal environment, people don't come to see us in clinic, you know, when things are going great. That's just the culture of medicine in this world, right? We don't do a lot of preventative medicine, we don't do a lot of healthcare. But I've also first had now experience with a newborn that sometimes in reality it's hard to get seven, eight hours of sleep. So, you know, my question for you is how do you, how do you work with folks who have these barriers? I mean, of course you do this with folks who wear their jobs dictate that, right? High profile athletes. But then you have everyday life thing as well. Children, job stresses, right? That kind of stuff like that. What kind of things do you look at to optimize so you can buffer the negative effects of sleep loss? We have a jet lag protocol at your athletics. So, we manage a lot of that with, okay, you know, we've got, I wouldn't even say that the athletes are the crazy ones with this. I would say that my portfolio managers, you know, one day I'll have a meeting booked in, let's say Tuesday night and I've spoken to them on Monday, Tuesday night, I ring them and they're in Italy. I'm like, they're like, I had to get on here last minute fly, I had to get here. I'm just like, okay, investors, like that's a create, they're living a crazy crazy life. Some of them, I've got one who's on a, you know, if he makes the wrong movies, got like, I think it was like 50 billion in assets. If he makes the wrong movie, it could cost his family like 50 million dollars. I'm just like, really crazy things and I'm like, okay, okay, so that's a stressful moment. How do we buffer that? I do a lot of things where I put in protocols at like 1 p.m., where we see most of the slumps happen in performance. I get them to meditate for 10 minutes. Or I get them to do breath work or yoga, just get them to just be still, shut everything off, close your damn eyes, like even if I have to put tape on your eyes and just be still for 10 minutes. And that helps a lot, that helps to buffer. And I think there's a lot of studies that show that you can mimic four hours of sleep or close to that via like 20 minutes of meditation. So we try and, you know, hone that into them as a protective mechanism. Yeah, you know, we have some 40 to 60 year olds who also listen to this podcast. And I've been wanting to ask you this, in terms of the cognitive decline, are there any easy exercises that you can recommend? Whether it's through reflexes, visual acuity, that people can do on a daily basis. Too perfect. Oh, absolutely. Yeah, we're actually, you know, four years ago, when I got super excited, we brought out these things called NeuroBalls. I should probably change that. But we're going to, such a kid, but there will be, we will be doing that again. But literally, all you have to do is get a tennis ball, okay? And just throw it to the wall and see how many, you know, throws overhand. You know, it's like that neural reflexes, overhand throws, catching it with the ball just to the wall. And then change it up, just do left hand for a minute. Then do right hand for him and then do left, right, left, right. The amount of hand-eye coordination and reflexes and visual acuity that goes into just that small thing is amazing. And yes, I will bring, bringing out some NeuroBalls very soon. Very cool. I sell Peter Tiedu, actually, is there a certain distance you recommend staying away from the wall, or is it just, hey, just have a look at it? I always say a meter away. Meter away, okay? Yeah. It's so easy and so underappreciated, because you think, well, what's it? Try it. I tell, I beg everybody to go out there and try it. Watch it. Okay. All too much, any questions for you? I think, I mean, I'm wrong out here in my head, but this isn't awesome so far. No, this has been tremendous. I really want to thank you for not only coming here and educating us in our audience, but also just all the good work that you do. I mean, your podcast is incredible. We'll link that. We're, of course, going to ask you what else is going on in your world coming in with the exception of NeuroBalls. We'll talk about that. But, you know, I just want to thank you. I think for being a sleep champion as well, I mean, it's incredibly important, but also, you know, giving a lot more love to this, this noggin that we all share. I think something really profound that I, I don't know if you said it or somebody said it that you were a guest on is, the brain is the only organ that's aware of itself. Yes. And that one, I thought was pretty amazing for us to really appreciate, right? I mean, I don't know if it makes it more less important. I think you'll argue that it does, but, you know, I think that that was pretty cool, and I think it's really important for us to start appreciating it. Absolutely. Thank you guys. You guys are awesome. I love talking to you. It's so nice being interviewed by doctors, because we can have this great conversation. So thank you so much. Yeah, absolutely. No, thank you. And again, I think we first met on Clubhouse in those rooms, and it was just awesome to connect with you, Van, and then, you know, following you on Instagram at the Diamond Boss, is that correct? That is correct. We'll link it. We'll link it in there. It's been amazing, as Aldmer said, just seeing your journey and kind of seeing everything that you do. And I'm super excited and pumped to see what's next for you. But tell the listeners, is there anything that's coming up for you that you're excited about? Look, we do have a lot of, we're going to be doing a lot of tours. We're doing a tour in February. I've got a lot of athletes in Miami. We're going to go there and do some content with them. Sign up to our newsletter. We have a free newsletter that goes at each week, Neuralathletics.substac.com. I'm going to now also be doing a very short clip YouTube channel just to introduce some of the interviews that we do. Probably won't be long form, just some of the important things that we do, so stay tuned. And obviously, look, everyone heard about the launch of NeuroBalls. So that's going to be coming out soon, too. Yeah. And your podcast is called The Neuro Experience. Experience, and we'll definitely link that as well. All right, last question for you here. Last question, we have to ask all our guests. How do we put the health back in health care? And I know Australia might be a little different than the US, so you can take it globally or US, which are the way you want to take it. But how do we put the health back in health care? I think the best way to do that is via education. I think the only way out is via education. If we were in a perfect world, and we got a shortage of doctors in Australia, in a perfect world, doctors would be seeing two or three patients a day because they'll not only be attending to them, but they'll also be educating them and that takes a long time. So I think that's how we put the health back in health care. That's right. I mean, it's education and teaching. It's in the word, right? Yeah. That's all right. Awesome. Thanks, Lisa. Cheers. All right. I really hope you enjoyed that episode. If it was your first or maybe in the second or third time listening to it, Ganluisa is just full of information. She's a good friend and ally and someone that I frequently visit in terms of her social media pages just to get more information and keep up to date. She's got a newsletter, a podcast. She's always putting out good videos. So I'm going to make sure to link all of her socials, her websites, her podcasts, and everything else that she is a part of in our show notes. So that way you can click on it and get the same information that I do to make sure that I'm optimized in terms of my brain health, as well as athletic performance. I really want to thank our team, Ethan Zhu, Harita Yepuri, and Iman Bashiri. Without them, this podcast will not be possible. So thank you so much to them. And of course, our medical disclaimer. Everything in this podcast is for educational purposes only. It does not constitute the price of medicine and we are not providing medical advice. No physician, patient, relationship is formed, and anything discussed in this podcast does not represent the views of our employers. We recommend that you see the guidance of your personal physician regarding any specific health-related issues. And lastly, if you enjoyed this episode, please share it. Please share it to anyone you know that would also enjoy it, as that helps us get our reach out there to the entire world. All right, take care.