Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today we're discussing dementia. Many believe that dementia is inevitable, something solely determined by our DNA. But this isn't the case. In fact, lifestyle choices play the most significant role in determining if we develop this disease. So what changes can you make today to reduce your chance of getting dementia tomorrow?

Dr. Claire Sties joins us to share simple steps that will protect your brain for years to come. Dementia is something whereby our functions are interfering with daily life. And obviously, if we start off with really high functioning,

then we get to that point much later in any disease process. So you can put off significantly the time at which you fall below that threshold of being able to function in daily life. It's about cognitive reserve. So that's the kind of maximum cognitive ability that we might have, not just in terms of sort of intellectual ability, but also psychological state as well. So, you know, I'm someone in my late 40s. I really want to make sure that I don't have dementia. Give me the advice if I was walking into your clinic

Tell me what you would be saying that I should be doing in order to try and make sure I never had to come back to your clinic in 20 years. So actually what I realistically say to patients is, it's about getting as many different colors of fruit and vegetables into your diet as possible and making sure that you're getting good plant-based fats into the diet. Because the brain is hugely metabolically active. It needs a lot of nutrients. And we know that a wide variety of plant-based

nutrients is really important for brain health. And I talk about colors because actually there's evidence that flavonoids are really key phytonutrients for brain development. It may be because you're changing the microbiome because there's such a thing as a gut-brain axis. So we think that there's a very strong relationship between what's going on in our gut. Lots of plants with lots of fiber, lots of different colors. And then you said

lots of healthy fats, which means a lot of plant-based fats. And so I think you were mentioning nuts. We often talk about things like avocados, right? Zoe, these are the sorts of things that you're talking about. Yeah. And I think... Olive oil, I guess. That's right. And, you know, there's

quite a number of studies now showing Mediterranean diet helps to improve cognitive health. So that there is real evidence that the Mediterranean, like changing this, this isn't just like something, because doctors always say you should eat more healthily, right? And everyone's like, yeah, yeah, yeah. There's real scientific studies that show that switching to this Mediterranean diet, which is high in the things you're describing and low in the more traditional Western diet of

meats and white bread and all the rest of it, that actually has an effect on dementia? Yeah. And then you just mentioned the other thing, which is meats and white bread. So we know that there's a relationship between vascular health

and brain health. And vascular health means? The blood vessels within your body and your heart. That's because one of the other types of dementia we haven't really talked about is a vascular dementia. And often there's a combination actually of vascular factors that then bring on those other processes like Alzheimer's. So if you're eating a diet that's good for your heart, basically, and that's also going to be good for your brain.

Yeah, it's going to be good for your brain and it's going to put backwards the balance of things that are going on in your brain that might relate to Alzheimer's. There is real scientific evidence that this shift in diet really can reduce your risk of dementia? So, for example, in the Mediterranean diet, there have been really large randomized controlled trials that were conducted over a year period in five different countries in Europe.

And when they compared the group that were randomized to the Mediterranean diet against the control group,

They didn't find very significant differences. If you manage to change your diet in a sustainable way, it really can reduce your risk of dementia, but you have to stick at it. You have to stick at it. You can't just do it for a few months. And the trouble is that's difficult. What else would you tell? So the second thing is about physical activity. So, you know, I do tell all my patients to make sure they're physically active at least three times a week.

and they're going out every day. These are really important things to do. And that can help preserve your physical function as well, and your cardiovascular function. It's probably the biggest thing that you can do to help your overall fitness. And when you say physical activity, when you think about dementia, what's really required? Because we talked

to a very wide range of people who vary between, if you even get up from your chair for two minutes, you've done everything amazing to, if you're not doing a massive workout four times a week, then you're sort of dooming yourself. But what should people be thinking? Like, this is what I really need to make sure that I'm building into my life. So to improve your cognitive health, you need to do more exercise than you're doing now. Okay.

Okay. Okay. Up to a point, unless you're like an Olympic athlete. I'm not an Olympic athlete. And that's the key thing. Okay. And this is again about the difference between scientific proof and practical advice. So the reason why there's this debate between scientists about what is the dose required of exercise is because to show a change over a short period of

you have to have a big enough dose to be able to detect that effect. Whereas if we look at really big population studies, we can see effects even with minimal levels of exercise and it's fairly linear. So even being more up and about less sedentary time makes a difference, but then you can still make more difference by putting every egg on. So whatever you're doing, if you go up by a third, you'll be improving yourself. And is there any particular sorts of exercises you're thinking about this year?

So probably the most evidence is around resistance training exercise for overall frailty and so on. Then, you know, for cardiovascular fitness, there's aerobic exercise. I'm one of your patients. I'm not very physically active. What would you be telling me that I should do that can really make a difference?

Walking. Walking. I think you need to get out and do walking 45 minutes, at least three times a week. And that will really make a difference. If I'm not doing that, that will really make a difference. So that, I think, again, is amazing. I think you're like, well, it seems sort of obvious. But again, I think many people listening to this grew up with the assumption there is nothing you can do about it. It's just literally a consequence of getting older. And you're saying, actually, if you went

for a walk three times a week, compared to just not doing that, you're going to make a really significant reduction in risk is rather extraordinary.

and does suggest that our current way we live our life is not very well optimized for avoiding this, if that is almost like your starting advice to people. One thing I haven't really talked about ever before with you is teeth, the importance of teeth. In the UK population, about 35% of older adults have periodontal disease, inflammation of their gums. We know there's quite a strong tight relationship between periodontal disease and cognitive disease. You believe this is true?

Because we had somebody on, just if anyone's interested, a few weeks ago, we'll put a link, who was a dental researcher saying this.

But I was curious because obviously if you're a dentist, you're going to be convinced that the teeth are important. Oh, no, no. I really think it's really true. You're not a dentist. I'm not a dentist. You're unbiased on this. This is really true, isn't it? It's really true. There is a vicious cycle though, obviously, because as you start to get dementia, it's more difficult to look after your teeth. And also, we know that looking after teeth, actually diet is really important in looking after teeth.

So teeth are much more healthy if you have a good varied diet that we've been describing and less sugar and so on and so forth. But actually, this is a very common inflammatory load, which is tickling. The

Which is amazing. I just heard this literally a few weeks ago. I was shocked to hear this. Yeah. And actually, when I see my patients in clinic, okay, the thing that sort of, you know, just eyeballing, the thing that's related to that cognitive reserve we were talking about, i.e. the difference between what's in their brain and how they're actually living, you know, how they actually present, right?

The people that have the bad teeth will be doing badly. The people that have the good teeth will be doing well. You would be saying if someone is having problems with their teeth, like absolutely go and get it fixed right away because that really could be a big risk factor. What else could...

people do. And I feel like you mentioned a little bit about intellectual stimulation and social stimulation. Is there anything you can do with your, is this all fake or that you, that, you know, doing things with the brain can help prevent dementia or is there something real about this? Well, no, I think the thing is it's about that cognitive reserve as well. I, again, okay. So I don't think we, we mustn't be getting the idea that if you have

I've got a managerial high paid job, whatever, you're doing lots of intellectual activity that you're immune to dementia. Everybody can get dementia. It's just that you will present later. So I'm in my late forties. I'm thinking about this right now. Is there anything that I could be doing with my brain over the next 20 years that will change my risk factor? Is there anything I can do there that is actually going to

shift it. Probably one of the most complicated things that we do in our brain is to really interact socially. And so that's a brain workout. So that is better than a crossword puzzle? It's better than a crossword puzzle. I think much more fun as well. So it's good news. I know not everybody feels that way. Some people who are more introverted feel this is hard work, but it's really good for your brain. It doesn't necessarily mean that some of these brain games aren't helpful. I think the thing is that what brain games tend to do is they tend to make you better at that brain game.

They don't necessarily... You'd have lots of different brain games. You'd have to have lots of different brain games. Okay, so it's not that bad, but actually you're saying social interaction is so complicated for our brain. That's really exciting, which also I guess ties into why loneliness is another reason why loneliness is not good for us. Yeah.

And then physical activity, certain physical activities are really taxing for the brain, aren't they, in terms of activity? So if you're like cycling in London, that's for sure quite taxing. Yes, I always think that it might be lowering your life expectancy for other reasons. Yes. Yeah. But there are other sort of forms of physical activity like dancing or whatever, which is quite a good cognitive task. Because your brain is having to think quite a lot as well. So basically what you're saying is using your brain, making it have to do something that is actually going to

build what you're calling this reserve, which is basically meaning you're less likely to- Your tank. What's in the tank. Yeah.

That's it for this week's recap. If you're hearing this, you're already on your way to making smarter food choices with world-leading science. Speaking of making smarter food choices, Zoe membership helps you do just that with scientific solutions that let you listen to your gut. Listening to your gut starts with an at-home test kit that helps you understand your body's responses to food and the good and bad microbes in your gut. Then Zoe's app helps you build life-changing nutrition habits step by step.

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