Overview of #851: Dr. Tommy Wood — How to Future‑Proof Your Brain from Dementia
Tim Ferriss interviews Dr. Tommy Wood — associate professor of pediatrics & neuroscience (Univ. of Washington), clinician‑researcher, and head scientist for motorsport at HINSA Performance — about practical, evidence‑based strategies to preserve and improve brain health across the lifespan. The episode covers acute brain injury (newborns, concussion), lifestyle drivers of dementia risk, nutrition and supplements, exercise modalities that best support the brain, cognitive stimulation (dance, language, music, games), sleep, air and oral health, and which interventions have solid vs. preliminary evidence. Dr. Wood’s book The Stimulated Mind is presented as a science‑driven, practical roadmap.
Key takeaways
- A large proportion of dementia cases appear preventable at the population level (Lancet Commission estimate ≈45%; other estimates up to ~70%) through addressing known risk factors (education, hearing loss, hypertension, obesity, inactivity, smoking, social isolation, etc.). This is probabilistic — not a guarantee for individuals.
- Brain health is multi‑factorial: nutrition, sleep, physical activity, cognitive stimulation, sensory health, social engagement, and environmental exposures interact. Benefits often require multiple complementary changes (the “orchestra” vs. a single “pill”).
- Early and timely intervention matters. Processes that lead to dementia begin decades before symptoms; building reserve and healthy habits earlier increases odds of maintaining cognition.
- Practical, low‑risk steps (hearing aids, treating periodontal disease, improving sleep, increasing physical and cognitive activity, fixing deficiencies) often have big population‑level effects and can be started now.
Clinical & acute brain injury highlights
Newborn brain injuries
- Two major neonatal injuries studied: preterm brain injury and hypoxic‑ischemic encephalopathy (HIE).
- HIE (insufficient oxygen/blood during birth): therapeutic hypothermia (cooling to ~33.5°C for 72 hours) reduces death/disability when initiated within hours.
- Cooling does not help — and can harm — in preterm infants. Caffeine (for apnea of prematurity) has shown durable cognitive benefits (improved outcomes followed into childhood).
- The home environment after NICU care has an outsized effect on long‑term outcomes.
Traumatic brain injury / concussion (adult/pediatric)
- Acute management priorities: prevent/treat fever (avoid hyperthermia), control large glucose spikes, maintain hemodynamics and oxygenation.
- Early, graded return to low‑level aerobic exercise (as tolerated, without symptom exacerbation) improves outcome — evidence best in pediatric sports concussion.
- Nutritional strategies with supportive evidence or promising signals:
- Creatine (prevention if on board; pediatric TBI trial shows benefit)
- Long‑chain omega‑3s (DHA/EPA)
- Exogenous ketones (promising; used by Dr. Wood for acute injuries but evidence still limited)
- B vitamins (riboflavin, methylation support), branched‑chain amino acids, melatonin (sleep).
- Avoid caffeine in the acute early window after concussion (may increase metabolic demand).
Nutrition & supplements — practical guidance and doses Dr. Wood mentions
- Omega‑3 (DHA/EPA): aim ~1–2 g/day DHA (or combined long‑chain omega‑3s) via seafood (2–3 servings/week) or supplement. Rationale: DHA concentrates in synapses & mitochondrial membranes and supports anti‑inflammatory/pro‑resolution lipid mediators (resolvins, protectins).
- Methylation B‑vitamins: B12, folate (L‑methylfolate when needed), B6, riboflavin — important especially if homocysteine elevated. Trials show B‑vitamin benefits on brain atrophy/cognition primarily when omega‑3 status is adequate.
- Choline (CDP‑choline / citicoline): 500–1,000 mg/day can help in some cognitive decline and after TBI; dietary sources = eggs, liver, some seafood, oats.
- Creatine monohydrate: Dr. Wood takes 10 g/day (single morning dose). Studies suggest cognitive and recovery benefits; many supplements use 5 g/day, with larger doses used in some protocols — GI tolerance varies.
- Vitamin D (with K2): supplement seasonally; K2 often co‑supplemented (Dr. Wood uses ~15–20 mcg K2 in winter with vitamin D).
- Iron & magnesium: check labs and correct deficiencies (particularly iron in menstruating women).
- MCT oil and ketogenic strategies: MCTs showed benefit in early AD (improve brain ketone uptake + cognition). Exogenous ketones have therapeutic promise but are not yet proven for dementia prevention.
- Safety notes: quality of supplement matters (e.g., Creapure for creatine), individualized dosing based on labs and tolerability.
Exercise — what to prioritize and why
- Mix of exercise types is optimal:
- Open‑skill/coordinative activities (dance, martial arts without repeated head impacts, many team sports, climbing) provide cognitive load + motor/cognitive integration and show strong associations with cognitive benefits. Dance often has the largest observed effect size (music + social + coordination + learning).
- Aerobic / high‑intensity training: intensity matters for hippocampal benefits. Studies (e.g., Norwegian 4x4 interval protocol) show durable hippocampal improvements even years after a months‑long intervention. Lactate production is an important mediator (lactate → brain BDNF signaling).
- Strength/resistance training: supports overall health, bone loading (osteocalcin), and cognition.
- Practical HIIT protocols that raise lactate:
- Norwegian 4×4: 4 × (4 minutes at ~85–95% HRmax with 4 min rest) — very taxing but evidence‑supported.
- Short all‑out efforts (20–45 seconds) with long rests repeated multiple times produce significant lactate without prolonged runs.
- Blood flow restriction (BFR): effective for maintaining/gaining strength with low loads; portable and travel‑friendly. Dr. Wood uses B‑Strong cuffs + Black Mountain resistance bands and does short sets (lots of reps/short rests) to accumulate work with low equipment needs.
Cognitive stimulation & learning
- Complex, multi‑sensory, mistake‑rich activities that require learning and adaptation provide durable brain benefits:
- Dance (tango example), learning musical instruments, language learning, and certain videogames show measurable changes in brain networks and “brain age” metrics.
- Bilingualism is associated with better executive control (response inhibition) and delayed dementia onset in observational work; training in a language in adulthood also shows benefits.
- Video games: structured training studies (including StarCraft and Super Mario 3D World) show cognitive benefits — not all games are equal.
- Principle: novelty + challenge + error feedback (making mistakes and learning from them) drive neuroplasticity. Repeated stimulation of particular networks preserves demand and metabolic uptake (e.g., glucose uptake when brain regions are regularly activated).
Sleep, sensory & oral health (high‑leverage areas)
- Sleep is foundational:
- Sleep quantity & quality predict amyloid accumulation and broader dementia risk. Prioritize sleep hygiene, cool bedroom, consistent schedule, treat sleep disorders (sleep apnea), and address insomnia (CBT‑I first-line).
- DORAs (dual orexin receptor antagonists) can help in refractory insomnia; improving sleep in people with sleep disorders probably reduces Alzheimer‑related pathology, but using DORAs prophylactically in otherwise good sleepers is not currently justified.
- Hearing & vision:
- Age‑related hearing loss and visual impairment increase dementia risk; restoring input (hearing aids, cataract surgery) is associated with reduced risk and better outcomes.
- Oral health:
- Periodontal disease (e.g., Porphyromonas gingivalis) associates with dementia risk; oral bacteria have been found in plaques and vascular lesions.
- Low‑risk measures: maintain dental care, consider xylitol gum/mouthwash to improve oral microbiota. Treat periodontitis when present.
Environmental health: air quality & pollution
- Air pollution (traffic pollution, wildfire smoke) is linked to higher dementia and cardiovascular risk.
- Practical mitigation: use HEPA‑capable air purifiers (Dr. Wood mentions HealthMate, Blueair models, Coway AirMega as options) tailored to room size; ventilate when safe; avoid prolonged exposure when pollution/wildfire smoke is present.
Where the science is solid vs. emerging
- Solid/evidence‑supported:
- Treat sleep disorders; hearing aids and cataract surgery reduce associated risk.
- Aerobic exercise, strength training, and cognitively engaging activities are protective.
- B‑vitamin correction when homocysteine elevated (in context of adequate omega‑3s) reduces brain atrophy in trials.
- DHA/EPA benefit brain structure/function; 1–2 g/day often cited.
- Emerging/promising:
- Exogenous ketones for acute brain injury and MCTs for early AD (therapeutic potential shown in some studies).
- Creatine for cognition & recovery (several supportive trials; not yet definitive for dementia prevention).
- CDP‑choline in specific settings (post‑TBI, mild decline) has RCT support but is not a universal cure.
- Breathable continuous lactate monitors / ketone monitors are developing but not widely standard.
- Caution: single‑supplement claims, off‑label drug use to “prevent AD” without clear indication, or expecting guarantees — many positive interventions are probabilistic and synergistic.
Practical, prioritized checklist (what to start today)
- Sleep: optimize bedtime routine and address insomnia/sleep apnea. Keep bedroom cool, dark; consider sleep tech if helpful.
- Hearing & dental: get hearing tested; treat hearing loss (hearing aids if indicated). Maintain dental hygiene; treat periodontal disease. Use xylitol gum as low‑risk adjunct.
- Diet & labs: ensure sufficient long‑chain omega‑3 (seafood or 1–2 g/day), correct vitamin D, iron if anemic, magnesium; check homocysteine and methylation status and correct B‑vitamin insufficiency (B12, folate, B6, riboflavin).
- Exercise routine:
- Weekly mix: aerobic (include some high‑intensity/lactate‑raising sessions), resistance training 2×/week, and one open‑skill/coordinative activity (dance, martial arts, climbing, racket sport).
- Short, high‑effort intervals or 4×4 sessions for hippocampal benefit.
- Use BFR + bands for travel/low‑time options.
- Cognitive challenge: pick a sustained learning project (language, music, dance, complex videogame) that provides novelty, error feedback and social engagement.
- Address modifiable vascular/metabolic risks: manage BP, blood sugar, lipids; avoid smoking; limit excessive alcohol.
- Environment: improve air quality at home if needed (HEPA air purifier) and avoid chronic exposures.
- Track biomarkers and imaging if you want personalized guidance (vitamins, omega‑3 index, homocysteine, ApoE genotype, MRI/hippocampal volume if useful for baseline & monitoring).
Notable practical specifics mentioned by Dr. Wood
- Omega‑3: 1–2 g/day DHA (or combined EPA+DHA).
- Creatine: Dr. Wood uses 10 g/day; many use 5 g/day — split larger doses if above ~10 g to improve absorption and reduce GI side effects.
- Choline (CDP‑choline/citicoline): 500–1,000 mg/day when used therapeutically.
- BFR gear: Dr. Wood uses B‑Strong cuffs and Black Mountain resistance bands for travel/training.
- Air purifiers he recommends testing/looking into: HealthMate, Blueair, Coway (AirMega).
- Ketone use: Dr. Wood keeps exogenous ketones for acute injury scenarios; MCT oil has RCT evidence for symptomatic improvement in early AD.
Notable quotes & insights
- “The home environment is where the biggest impact happens” (neonatal outcomes).
- “You need the orchestra — multiple legs of the stool” (nutrition + methylation + omega‑3s + lifestyle).
- “If you change one area, the whole network shifts in your favor” — small wins in sleep/fitness cascade into other gains.
- On neuroplasticity: “Error detection (making mistakes) triggers adaptation” — deliberate practice that includes mistakes drives learning and reserve.
Where to read/learn more
- Dr. Tommy Wood — website: drtommywood.com
- Instagram: @DrTommyWood; X account historically @DrRagnar (he notes he doesn’t post much on X)
- Book: The Stimulated Mind — subtitle: Future‑Proof Your Brain from Dementia and Stay Sharp at Any Age (science‑referenced, practical guide).
- Recommended background reading/studies mentioned: Lancet Commission on dementia prevention, VitaCog/B‑proof trials on B‑vitamins & omega‑3 interaction, studies of MCTs in early AD, Norwegian 4×4 interval studies on hippocampus, Matt Walker’s work on sleep & amyloid.
This summary highlights actionable, evidence‑oriented strategies emphasized by Dr. Wood. If you want the very high‑level starter plan: optimize sleep, treat hearing & oral issues, start a mixed exercise routine (including some high‑intensity and an open‑skill activity), ensure basic nutrient sufficiency (omega‑3s, B‑vitamins, vitamin D, iron), and commit to at least one cognitively demanding, mistake‑rich learning project.