How to Future-Proof Your Brain from Dementia — Dr. Tommy Wood
These notes were generated by AI and may contain inaccuracies.
45 to 70% of dementia is preventable through lifestyle. 45% comes from the most recent edition of the Lancet Commission report on dementia prevention looking at different risk factors that have a consistent relationship with dementia risk. One big study from the UK Biobank data by Professor Yintaiu estimated that up to 72% of dementias were preventable.
Human babies are the only mammalian species born fat, even compared to other primates. Primary reason: fat as a repository for things the brain needs to develop, particularly DHA (omega-3 fatty acid) and fats as a source of ketones for the brain. Ketones are the preferred synthetic precursor for brain structure like fats and cholesterol, which make up a significant chunk of the brain—especially in the developing brain and relevant to recovery from brain injuries. Humans born fat to generate ketones to support the very hungry developing brain for the first few weeks or even months. Newborns also have brown adipose tissue to keep those little hairless monkeys warm.
Two main brain injuries in babies: pre-term brain injury (born early; earlier birth = greater risk of neurodevelopmental impairment, cerebral palsy, other neurological disorders later in life) and hypoxic-ischemic encephalopathy (HIE) (full-term baby with insufficient oxygen/blood flow to brain, often during childbirth e.g., cord wrapped around neck, placental abruption, uterine rupture).
Cool babies to 33.5°C (92.3°F) for 72 hours if started within a few hours of birth—significantly reduces death and disability (studied in PhD; cooling machines often European-made, run on Celsius even in US).
Cooling doesn't help pre-term babies (can be detrimental). Caffeine given for apnea of prematurity (pre-term babies don't breathe as well, lack normal respiratory drive) led to significant, durable improvements in cognitive function (followed to 2-3 years old, into childhood). Renewed interest in caffeine for other baby brain injuries; trials starting.
Biggest impact on later outcomes is the home environment the baby returns to—even after neonatologists keep babies alive and brains in good shape in ICU.
After severe concussion (e.g., slipped on ice, hit head):
- Ideally, pre-injury: improve overall health to affect brain/body response.
- Manage fevers: Prevent hyperthermia (hypothermia trials in adults failed; fever from immune activation post-trauma increases metabolic demand while mitochondria damaged, widening energy supply gap; supported by animal models and human data). Use flu shots, Tylenol (acetaminophen/paracetamol), neck/head cooling devices, antibiotics.
- Manage blood sugar: Avoid large glucose spikes/refined carbohydrates (high glucose stressful post-injury; injury causes higher blood sugar; avoid e.g., chugging Powerade post-field removal in athletes).
- Creatine supplementation: Beneficial if pre-loaded; at least one pediatric TBI trial showed enhanced recovery.
- Omega-3 fatty acids (DHA/EPA).
- Exogenous ketones: Enough promise to take post-injury despite limited evidence.
- B vitamins (esp. riboflavin), branched-chain amino acids (improve sleep), melatonin (for sleep issues).
- Avoid caffeine early (increases brain metabolic rate like high temperature).
- Early return to physical activity: Low-level aerobic exercise as soon as tolerable (doesn't worsen symptoms), increase over time—most evidenced strategy.
Improves cerebral blood flow, myokines/exerkines with beneficial brain effects, sleep support (best evidence in pediatric sports-related concussions).
Came in second at Washington's Strongest Man 2024 (middleweight class; dieted down + water cut to under 198 lbs / 90 kg on day, normally 15 lbs higher). Top 20 in world's first fully off-road Ironman triathlon (XTR-24, originally X-Man, Marvel sued; ~2012; body weight low 80s kg / ~185 lbs).
Brain is a big pile of fat, much of it DHA. Concentrates in neuronal synapses (regulates neurotransmitter release, structural component), mitochondria (DHA content correlates with energy production capacity, possibly due to electron movement physics). Critical for brain development (mother sacrifices her DHA stores; women better at converting ALA to DHA/EPA for potential babies). Precursors for signaling molecules (resolvins, maresins, protectins; e.g., neuroprotectin D1 from DHA—regulates/turns off immune response post-injury; being tested exogenously).
Football player study: 1-2 g DHA/day reduced accumulation of blood marker neurofilament light (subconcussive impacts) over season.
Omega-3 deficiency raises dementia/cognitive decline risk (depends on methylation status). Aim 1-2 g/day (2-3 good seafood servings/week or supplement). Triglyceride form (common in seafood) stores in adipose, cycles out (aided by exercise/fasting/not constant eating). Phospholipid form also discussed but seafood/trig form builds depot.
Interaction between omega-3 status and B vitamins involved in methylation (affect homocysteine levels—testable via blood). Trials (VITACOG by David Smith at Oxford; B-PROOF; Omega trial) showed B vitamins reduce brain atrophy/cognitive decline only in adequate omega-3 status (and vice versa). DHA incorporation into brain cell membranes requires attachment to phospholipid head groups (choline/ethanolamine) via methylation-dependent processes.
Terrified of Alzheimer's, dementia, cognitive decline (loss of memory, identity, emotion—death before death). Interested in extending healthspan (cognition key pillar; local maximum better than prior generations).
Auguste Deter (Augusta Dita data) was Alois Alzheimer's index patient. Alois Alzheimer, a psychiatrist in the early 20th century, studied rare cases of presenile dementia in younger individuals (40s or 50s), not late-onset senile dementia after age 65. After patients died, he examined their brains under a microscope and first identified amyloid plaques and tangles, now pathognomonic for Alzheimer's disease.
What we now call Alzheimer's (late-onset) was lumped together with early-onset cases because brains looked similar microscopically. Early-onset Alzheimer's usually involves a single genetic mutation in genes like presenilin or amyloid precursor protein. Late-onset (95-99% of cases) has a genetic component but is more tied to lifestyle and environment.
Auguste Deter, age 50s (actually 33? conflicting), lacked early-onset genes or mutations and was not an ApoE4 carrier. Cause unknown; possibilities include neurosyphilis (syphilis in brain, causes amyloid accumulation mimicking Alzheimer's), psychiatric issues, nutrient deficiencies, or poor environment (downtrodden housewife with little stimulation or poor treatment). Likely did not have Alzheimer's as we define it today.
45-70% of dementia preventable through lifestyle is defensible. 45% from latest Lancet Commission report on dementia prevention (Prof. Gill Livingston), aggregating observational and interventional studies using population attributable risk (percentage of dementias eliminated if risk factor removed entirely):
- Smoking: couple percent
- Low early education: 7%
- Alcohol: ~1%
- Hypertension (high blood pressure)
- Hearing loss
- Obesity
- Low physical activity
Total adds to 45%. Excludes sleep loss/insomnia and late-life physical activity (good evidence but not included), suggesting >45% preventable. UK Biobank study (Prof. Yintau?) estimated up to 72% preventable, requiring societal overhaul (low socioeconomic status, education/work opportunities). Directly controllable factors (physical activity, smoking, drinking): ~15-20% or more.
Population-level probabilities, not guarantees. Stack the deck in your favor; family member did everything right but still got dementia is possible.
Host has family with rapid deterioration diagnosed as Alzheimer's (questionable; relatives ApoE3/3). Considers undiagnosed infection (e.g., STI). Process starts decades before symptoms (e.g., 70s onset means earlier pile-up).
Host's interventions:
- Fasting, ketogenic diet, exogenous ketones (sparingly; e.g., 11g ketone monoester ~51% 1,3-butanediol before talk; concerns chronic high-dose >30g/day; special occasions).
- Avoids crazy glucose spikes (occasional holidays fine); slow carb or Mediterranean diet; sufficient omega-3 (fish, supplements); poor methylator so B vitamins, L-methylfolate.
- Quarterly comprehensive bloodwork.
- Zone 3 training 2-3x/week (30-60 min, boring); daily walking (>4,000 steps reduces dementia risk 25%; optimal 10,000 steps; reverses hippocampal shrinkage: +2% vs. expected -1-2% loss).
- Weight training 2x/week.
- Brain MRI (predicted brain age 46 vs. chronological 48 based on hippocampal volume); cognitive battery (brain age 20, 28 years younger; reaction time 267ms vs. 406ms; some gamification/training effects); APOE3/4; proteomics pending; considering ibogaine (Nolan Williams data, not recommending).
Ketones promising therapeutically for Alzheimer's energetic deficit (overcome early). MCT oil (Steven Cunnane's lab): increases C8 (caprylic acid?) acetate uptake into brain, improves cognition.
FDG-PET shows less glucose uptake in Alzheimer's brain. Not necessarily insulin resistance (type 3 diabetes); PET can't distinguish supply issue vs. low demand. Studies show cognitively stimulated Alzheimer's brains uptake glucose normally (early stage; too late in advanced).
Brain glucose uptake demand-driven like muscles: stimulate brain to maintain uptake, energetics, metabolic machinery.
Host analogy: CGM shows post-meal glucose spike without walk = apparent muscle insulin resistance, but exercise (GLUT4) disposes glucose. Brain may be "offline" (car on blocks) early, not defective.
No direct data on glucose uptake by activity; decreased uptake signals low metabolic activity/use.
Protective activities enhance short-term cognition, long-term dementia prevention. Different exercises affect brain differently; need variety for global support.
Coordinative/open-skill exercise (plus navigational): respond/adapt to environment (vs. closed/unimodal like jogging/biking). Same physical challenge, more cognitive challenge = greater brain structure benefits, cognition.
Dance: highest effect size vs. other activities for cognition, mental health (depression), dementia risk (randomized trials). Components: learning steps, social, music. Other open-skill: ball sports, team sports, board sports (react to environment/people).
Bull sports and martial arts are beneficial if avoiding traumatic brain injury (TBI). Beyond physical strain, they require reaction speed, challenge processing speed, and involve learned complex motor skills, leading to outsized effects on cognitive function.
For aerobic or close-skill unimodal sports like running or cycling, benefits are intensity-dependent. Walking a certain number of steps daily decreases dementia risk if starting from inactivity. Higher intensity activities better improve hippocampus structure and function, visible on MRI scans.
Australian study used Norwegian 4x4 protocol three times a week for several months (6 or 12 months intervention): four sets of 4 minutes on a treadmill at 85-95% maximum heart rate with 4 minutes rest. Significant improvements in hippocampus structure and function maintained for 5 years post-trial.
Pretend like you're being chased by wolves through the snow for four minutes and then take a four-minute rest.
Driven by lactate: increases BDNF (brain-derived neurotrophic factor) locally in the brain as a histone deacetylase inhibitor. Muscle-derived BDNF in blood doesn't readily enter brain. Lactate, ketones, and osteocalcin (from bone loading) activate brain BDNF. Regularly producing lactate via high-intensity sports, combined with high-skill, high-reaction open-skill sports, benefits exercise standpoint.
Jiu-jitsu offers 3-5 minute intense rounds with breaks, avoiding frequent limb breaks or chokes if managed.
Threshold varies by individual lactate threshold. Regularly exceed lactate threshold (6-7+ mmol/L lactate) for benefits; no perfect talk test equivalent, but misery-related (10% from puking). Short sprints (30 seconds flat out on bike/rower with several minutes rest, 6-8-10 rounds) or 45 seconds max effort with 6 minutes recovery generate several mmol/L lactate.
No breath-based lactate monitor like ketone breathalyzers; continuous lactate monitors near commercial availability. No need to measure: do something really hard for short periods regularly (e.g., sled pushing/pulling). Exogenous lactate salts minimally increase blood lactate; brain takes up endogenous lactate readily like ketones. Blood flow restriction (BFR) with low-load high-rep (e.g., 20 leg presses) produces several mmol/L lactate.
Dr. Wood uses B Strong BFR cuffs (leg/arm, with sphygmomanometer; no affiliation, paid himself). Travel gym-in-a-bag: BFR cuffs + Black Mountain Products bands (lifetime warranty, $40, handles).
6'2", 220 lbs, ~12% body fat. 10-15 minutes: cuffs on legs/arms, bodyweight lunges, squats, presses, push-ups, bicep curls, tricep extensions. 3-4 minutes per exercise: 75-100 reps (e.g., 30-20-20 or 20-15) with 30s rest; one body part at a time or superset. Maintained/gained muscle with cheap BFR/bands previously.
BFR partially occludes venous return (not arteries), creating extreme pump/discomfort safely (used in rehab).
Dr. Wood's book: The Stimulated Mind.
Core nutrients if deficient:
- Omega-3s
- B vitamins (B12, folate/B9, riboflavin/B2, B6) for methylation
- Vitamin D
- Iron (check status, especially perimenopausal women; anemia symptoms)
- Magnesium
Antioxidant polyphenols from berries, coffee, tea, roasted nut/seed skins.
Choline (head group for membrane fats): increasing deficiency without eggs/liver. RCTs: 500-2000 mg/day CDP-choline (citicoline) improves cognition in older adults with decline and neuropsychological outcomes post-TBI (meta-analyses). Sources: eggs, liver, seafood (sardines), oats, quinoa. Dr. Wood gets from diet, no supplement.
Creatine: 10g daily (single morning dose for convenience/cognitive stimulation/sleep effect; noticeable for him, varies). Above 5g may saturate transporters; split higher doses (20-30g). Use Creapure monohydrate (meta-analysis: no extra GI effects vs. placebo in studies). GI issues from dose/quality/polypharmacy (coffee, MCT, sardines).
No ingestibles to boost lactate uptake; produce endogenously easily.
Activities maximizing brain activation/glucose uptake: dance, language learning, music.
Recent study: Creative Experiences and Brain Clocks. Estimates brain age via MRI/other tests. Creative experiences affect brain aging.
As the brain ages, structural changes occur: different parts get smaller and lose volume. Functionally, brain networks become less discrete and more distributed, leading to increased brain entropy—less tightly knit, function-specific networks and more of a mismatch with areas connecting loosely. Entropy decreases in end-stage dementia due to reduced activity.
Ways to quantify brain age include structure and connectivity of networks like the frontal parietal network, salience network, and attention network, critical for executive function, focus, and attention. These lose function with age. EEG (electroencephalogram) measures brain electroactivity effectively.
A study meta-analysis compared creative experiences: tango dancing, language learning, musicians, artists, video gamers (including interventional training with Starcraft; Super Mario 3D World has the best evidence). Amateurs vs. experts and training interventions showed that increased expertise in complex arts improves structure and discreteness of critical aging-susceptible networks. Effects similar across tango dancers, bilinguals, artists, video gamers.
Core effect from complex, multi-sensory stimuli requiring significant expertise and skill, training focus, learning, and engagement.
Colleagues Andrea Stockco and Shantel Pratt at University of Washington study bilinguals via brain activity, cognitive function, and modeling. Lifelong bilinguals perform better on executive function tasks like response inhibition (e.g., stopping impulsive actions, tested via go/no-go tasks or Stroop test—naming ink color of color words). Bilinguals suppress one language while activating another, improving suppression skills but reducing responsiveness to immediate surroundings.
Bilinguals have decreased dementia risk or later onset. Language training (e.g., Duolingo app in older adults, with actual progress) improves executive function. Similar benefits from music learning—complex human skills have carryover to core cognitive functions.
Host notes poor digit span memorization (flashed briefly, relies on hardware) but exceptional Stroop-like test performance (10 standard deviations above norm), possibly from multilingualism (started at 15-16, studied multiple languages). Guest similar: average on memory/other tests, excels at response inhibition/Stroop, grew up with Icelandic (mom's side), lived in Germany/France, PhD in Norway teaching medicine in Norwegian.
Host's tango chapter: 2004, 6-8 hours/day in Argentina, competing/world championships—combines physical, Spanish learning, music. Tango de Salon mostly improvised: respond to music, memorize songs.
Frequent music listening associated with lower dementia/cognitive decline risk (beyond sociology). Studies on musical theory training (listening, extracting components) show benefits similar to playing instruments. Attentive engagement as listener helps, plus producing music.
Dance requires careful music listening; tango improvisation demands responding/memorizing music.
Sensory loss (vision via cataracts, hearing via presbycusis) increases dementia risk, reversible with cataract surgery or hearing aids. RCTs for hearing aids show benefits mainly in high-risk groups (poor health, cardiovascular disease)—exacerbates other risks.
Reasons: lost input decreases brain area function (allostasis/adaptation); reduced world engagement (less outings, socializing, tango). Loss of prior senses matters, not congenital absence (adapt via other ways). Guest encouraged mom for hearing aids—dramatic quality-of-life improvement.
Error detection triggers adaptation for neuroplasticity (new connections, branches, supporting cells). Requires mismatch between capacity/expectation, best via mistakes/errors—like training to muscular failure. If always capable, no adaptation needed. Key in dancing, languages, music: opportunities to fail beyond current capabilities drive learning/plasticity.
Guest: weight lifting, occasional blood flow restriction. Rock climbing (kinesthetic puzzle; sees 60s-70s athletes in Colorado/Idaho/Utah gyms meeting 2x/week).
Sustainability key—prioritize adherence over long lists.
Sleep most important, consistently prioritized despite lapses in diet/gym. Inadequate sleep strongly associated with dementia risk, often missing from studies.
Avoided sleep anxiety (wearables/self-fulfilling prophecy); studies show telling people they slept poorly (via wearable) worsens perception despite good sleep. Short-term deprivation: slows processing speed but not accuracy (quality preserved, just slower); mood affected more than performance. Knowing this reduces grumpiness—now approaches poor nights positively, performs fine.
More sleep always better (e.g., 6 to 6.5 hours great); humans adapted to variability (travel, kids).
Avoid excessive alcohol, smoking.
Air quality/pollution: significant dementia risk (wildfire exposure, near roads); short-term raises cardiovascular risk/blood pressure. Air filters help. High blood sugar/pressure top metabolic risks (lipids secondary).
Oral health: gum disease (gingivitis to periodontitis) increases dementia risk via inflammation; bacteria in bloodstream, atherosclerotic plaques, amyloid plaques. Treat it. Xylitol gum/mouthwash improves oral microbiota, reduces Streptococcus mutans, Porphyromonas gingivalis. Anti-inflammatory interventions outsized benefit for APOE4 carriers.
Air purifiers: HealthMate, Jasper, most BlueAir models (room-sized); budget Coway Airmega.
High CO2 (hotels, airplanes, unventilated rooms) negatively impacts sleep—keep windows open.
Stop work before dinner (avoids rumination unless essential); cool temperature (65-70°F).
Dr. Tommy Wood follows a basic shutdown routine if working late: wears blue light blocking glasses (possibly placebo, but signals bedtime to his brain), reads fiction before sleep, uses an Eight Sleep mattress cover to stay cool as he gets hot when sleeping, and wears an eye mask to block light. Studies show eye masks improve cognitive function by preventing early morning light disruption; one study compared regular eye masks to Zorro masks (eyes cut out) in summer, with significant cognitive improvements in the regular mask group.
Vitamin K2 Supplementation
Dr. Wood supplements vitamin K2 (15-20 micrograms daily), mainly bundled with vitamin D in winter due to limited sun exposure in Seattle. In summer, he gets vitamin D from bare skin sun exposure. He also consumes natto or fermented foods for K2, describing natto as 'stinky spider webs' that Japanese people give foreigners to watch their reaction—some like it, and he can handle a little.
Dr. Wood grew up eating rotten shark (hákarl) in Iceland, describing it as terrible. He recounts a family trip to Hotel Ranga in mid-winter for northern lights (only twilight for a few hours), eating fermented Greenland shark at a gas station restaurant on a celebratory day. It's like eating something soaked in ammonia—pungent like smelling salts hitting the sinuses. Greenland sharks lack kidneys, accumulating urea that breaks down to ammonia for edibility; texture like tuna, taste like strong blue cheese peed on. Pair with brennivín (Icelandic aquavit): shark removes brennivín taste, brennivín removes shark taste, continue until hammered enough not to care. Watching his brother eat it was entertaining; he doesn't crave a return.
Worse than shark is surströmming (Swedish fermented herring in a can)—the worst thing he's eaten. YouTube videos show people opening the tin, smelling it, and vomiting; involves rotting herring bones on bread. Highly recommended sarcastically.
DORAs (e.g., for insomnia, sleep apnea) may help clear beta-amyloid and tau (p-tau?), potentially preventing accumulation linked to Alzheimer's—some human publications, but not definitive. Sleep quality/quantity affects amyloid accumulation short- and long-term (studies from Matt Walker's lab); improving sleep later in life lowers amyloid burden.
Amyloid is a marker for brain clearance failures during sleep, not the full Alzheimer's picture. DORAs improve sleep in insomnia/apnea. Beneficial for sleep issues preventing high-quality sleep. Previously, trazodone was the least-worst option (doesn't harm sleep architecture like other sedatives). If sleeping fine or maintaining quality sleep with age, no need for DORAs to prevent Alzheimer's—sleep already clears. Cognitive stimulation in older adults improves sleep; physical activity enhances sleep quality. Don't jump to DORAs; first try CBT-I (CBT for insomnia). If that fails and no sinister issues, DORAs are now the best option.
The Stimulated Mind: Future-Proof Your Brain from Dementia and Stay Sharp at Any Age. For anybody with a brain—covers cognitive function/performance (relevant for younger people) and dementia prevention. Addresses big rocks and tactics for preventable dementia risks discussed earlier (diet, sleep, physical activity, social connection, stress tolerance).
Wrote it because no such book existed: others focus narrowly or overwhelm with unsustainable blood tests/supplements/tables. Provides middle ground: practical, approachable, science-driven, heavily referenced (2,000 human papers, superscript citations in text, full reference list).
Dr. Wood explains a brain that improves with age results from controllable actions: diet, sleep, physical activity, social connection, stress tolerance—not expensive pills, far-off discoveries, or strict optimizations.
What Makes It Different
Practical/science-driven with references. After covering nutrition/sleep/exercise, integrates into a daily life model. Improving one area (e.g., sleep) cascades: more sociable, cognitively engaged, better blood sugar/blood pressure—whole network shifts positively. Starting with one thing moves the needle, compounds over time, increases likelihood of adherence.
Endorsements from Kelly Starrett and Juliet Starrett. Available at Amazon; check drtommywood.com, Instagram/ X (@DrTommyWood, though he doesn't post on X).
X account @DrRagnar from early blogging during PhD (listened to early Tim Ferriss podcasts with Dom D'Agostino). Middle name Ragnar (grandfather's name, passed down; should have been his first as firstborn grandson, but dad thought it'd lead to bullying—now cool from Vikings TV). Old Norse: 'wise counselor' (self-important 30-year-old blogger choice). Sometimes uses Ragnarok (final Valhalla battle) for gaming.
Dr. Wood invites complaints on book—every statement cited, read papers, disagree with interpretation? Tell him to help him learn. Plans BFR/bands for chest/arms. Tim took tons of notes.
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