Q & A Roundup, Plus This or That!


Welcome to Better Brain Fitness, hosted by doctors Josh Turknett and Tommy Wood. In this podcast, we will explore the frontiers of how to keep our brain fit and healthy so that we can perform at our best and do the things we love for as long as possible. Let’s go. Ok, Welcome again to the Better Brain Fitness podcast. I’m joined again today by my cohost, the serendipitous doctor tommy Wood. Hello, Tommy hello what makes me serendipitous? It’s just your play on adjectives. I just feel like it’s very fortunate that you happen to be here today, right when I’m wanting to do a podcast so yeah, it’s just like, that was pretty serendipitous of you yeah funny how that happens yeah so this episode, we’re going to do something just a little bit different we’ve had a few questions that have come in, questions and comments that are fairly short answers, maybe not needing an entire episode so we’re going to try to tackle a few of them all at once.

01:03 : And also to encourage those of you who might have little questions that pop up that might not warrant it full episode, but you’d like to know what we’d have to say. Encourage you to send those our way as well. And if you want to do that, if you have any questions for us, you can go to brain Joe dot Academy forward slash questions All right, so let’s tackle the first one. Comes from Gene in Toronto who said this is a question about the episode on doctor Tommy Woods Typical day. He mentioned high protein cereals and I wondered if he had any brands to recommend. I found it hard to find any that are really very high in protein.

01:42 : Thanks very much. Love the podcast. Ok, So yeah, this comes from Tommy’s the episode we did on Tommy’s Daily Routine you mentioned occasionally eating high protein cereal so you got any brand recommendations for us? Yes, and thanks for the question and I have no affiliation with this particular product, but it’s not yet. Not yet. Soon I’ll be the face of cereal school so cereal School is the is the company where I get my high protein cereals from.

02:17 : There are some other options like Magic Spoon is very similar. The reason why I prefer cereal school is that between the two the actual ingredients in them are very similar but for cereal school you get more protein per calorie and you know when I’m eating this kind of food, I just want to maximize my protein intake and minimize sort of processed food calories from other sources so that’s why I prefer that the cereals, the cereal school version, Do you know what else is in that besides protein? Yes it’s mainly casein is mainly casein protein and then whatever they use so like if I have a chocolate ones like a bit of cocoa powder in there and then they’ll usually use a little bit of a high or lay and they specify high oleic sunflower oil.

03:10 : So it’s a, it’s a seed oil but it has a low little acid content, which is another thing that makes me sort of feel a little bit better about having it as like a processed food, right. And little aleic acid potentially more inflammatory than other oils, right is that one of the reasons yeah and particularly in relations so there’s been a, oh, this is not going to be a quick answer question now you’ve started something I do, so I’ll get, I was looking for a simple yes yeah.

03:38 : So is linlaic acid in itself inflammatory no, that is the quick answer. There are some interesting studies maybe saying that there’s an interaction with genetics on whether it’s inflammatory or not. There’s been a big whole thing about seed oils recently and people talking about cardiovascular disease and diabetes and that kind of stuff. There’s very little evidence there, and I’ve had to change my mind on that i can’t really find anything that supports, you know, from human data that it’s negative in that respect however, there’s enough data to suggest that linlaic acid and its metabolites may interfere with DHA uptake into the brain specifically, and one very small study saw high little egg acid metabolites in individuals with Alzheimer’s disease compared to those compared to a control group.

04:26 : So it’s super tenuous at this point like, I’m not sort of sounding the alarm, but if I’m going to have something with that has vegetables in it, I would prefer one that has a lower little egg acid of content you know, just in case I’ll say one thing and then we’ll go to the next one but so yeah, I think this brings up an important 1 of the issues that arises sometimes where we talk about, you know, we have kind of mismatch as a, as a fundamental paradigm, you know, looking at our ancestral habitat and as a sort of the foundational starting point for, you know, a lifestyle that’s best for us to thrive.

05:01 : And then, you know, a diet that’s high and analeic acid could potentially be a area of mismatch, right, Just because we got we then you can put forth, oh, we found a potential mechanism for that, right and if that mechanism is wrong, still may not mean that the fundamental idea of the right that mismatch, but that’s a common thing that happens in this space is that somebody puts forth a potential mechanism as to why it might be problematic and then all the attention goes to the mechanism and you kind of lose sight of the fundamental reason why you’re worried to begin with.

05:34 : That’s fair and I will say just in response to that ancestral and hunt together diets probably contain around 2 to 3 % of calories from the linlaic acid on average. So some is certainly not bad and that would certainly be in line with the type of intakes that we’re used to. Hey there. So if you like this podcast, then I think you will enjoy the Brain Joe Connection newsletter. The Brain Joe Connection is a free newsletter sent out twice a month and is all about the science of how to keep our brain fit and healthy along with products, books, tools and resources for improving brain health and function that we use and recommend to subscribe.

06:14 : You can go to Brain Joe dot Academy forward slash connection or click the link in the podcast description. All right, now back to the show okay, here we go. Next question is from Howard in New York City. Following your suggestion, four five weeks ago I started taking 5 grams of creatine monohydrate powder in my 16 ounce cup of green tea in the morning I have felt fine, but when I had my annual physical exam last week, the kidney related chemistries came back as abnormal.

06:51 : I drink 64 ounces of water each day. I am a very fit 74 year old who exercises for cardio and also with weights for resistance and the specific issues were as elevated creatinine slightly which gave him the lower estimated GFR as well as some oxalate crystals in the urine so he’s he mentioned he’s going to cut out the creatine to see if the chemistry is returned to normal, but wanted to know your thoughts. Yes, this is a very normal thing that happens when you start supplementing with creatine when you phosphorylate and turn over creatine in cells, occasionally you get this byproduct, which is creatinine, and then that’s used as a as a marker of kidney function.

07:45 : In reality, creatinine is a terrible marker of kidney function, particularly for people in this kind of situation, because creatinine increases when you have more muscle mass, so actually low creatinine. Which then sort of means that with an equation, they estimate from your creatinine how well your kidneys are functioning and that’s where the EGFR comes from, It’s just calculated based on the creatinine. You can improve your kidney function with this marker by having less muscle mass, which of course makes no sense at all it’s complete nonsense. So and then also as you if you take creatine, your creatinine will go up. I was once almost not discharged from hospital after a snake bite because they’re worried about my creatinine levels which were normal for me but I take creatine and I have more than an average amount of muscle mass, so this is a problem that has impacted me personally.

08:42 : If you feel uncomfortable taking creatine, that’s fine it has not, and there is no evidence that it has not affected your kidney function and there is no evidence that creatine supplementation negative effects kidney function. There is an alternative marker that you could get called cystatin C That’s what I would ask for. So much more robust marker of kidney function it doesn’t. It’s not affected by creatine, it’s not affected by muscle mass or anything else.

09:08 : It actually is a is a better marker so that’s something that you could ask for related to the oxalate crystals. I can’t find anything to suggest that take supplementing with creatine would increase oxalate crystals in your urine. That’s probably related to something dietary or something else. You know for instance your the intake of oxalate containing foods we know that also interacts with gut health that can then affect how much oxalate you’re absorbing and excreting. I don’t think it was the creatine that did that however, if you stop taking it and the oxalate crystals go away, then maybe I’m wrong about that that’s also possible, but I think it’s unlikely that the creatine increased oxalate crystals in your urine, and I’m also fairly confident that it didn’t affect your kidney function it just affected a marker, but it’s not a very good marker and size statin C would be a more accurate way to test whether there’s anything going on there.

10:03 : Yeah, so and you briefly mentioned it on the previous podcast but it is worth remembering that if you are going to, if you’re going to be supplementing with creatine, that you may see a little bump in your creatinine, your chemistries and you can reassure your Doctor Who may not necessarily be aware that that’s a potential confounder. All right? And it’s not again, like you just described, it’s not anything concerning it’s not an abnormality it’s not it’s a false, false positive. Ok so the next question, Lyle, in Texas, since acetylcholine is necessary for learning, should older people do something to boost acetylcholine production? All right. You tell me.

10:48 : Oh, yeah. Did you have an answer no go for it. Ok, Yeah. This is a great question and related to something I think we’ve mentioned previously, which is choline intake codeine being very important for the brain in multiple respects one being the production of a style codeine, which as you mentioned is an important neurotransmitter for encoding memories. But then it’s also important for helping to build the membranes around the cells in the brain as a phospholipid. So then it’s just important to take in enough choline essentially so this could come from eggs, two or three eggs a day on average or some salmon i think we talked about this previously those are good sources of choline, fish and eggs.

11:35 : Liver is another great source of choline. There’s also possible to supplement. There are multiple types of choline that you can get. The one that I wouldn’t take is called choline by Tartrate has been shown to not be particularly useful. There’s a very fancy, more recent one called Alpha GPC, which a lot of people sell is like this precursor for astylcholine, and of the choline supplements, it is most readily taken up into the brain and it metabolizes into a astylcholine directly. However, I don’t think people need to take out for GPC i think the best studied and safest form of choline to take in is called cittycholine or CDP choline.

12:19 : This has this gets into the brain, it’s turned into a style codeine it can also support the production of phosphatidyl choline in cell membranes. And there’s also some nice evidence that supplementing with cittycholine can improves memory in those with mild cognitive impairment. And it’s also seems to be neuro protective in the setting of an acute brain injury, at least there’s some nice animal data and it’s also been used after dramatic brain injury in humans in randomized control trials and improves neural neuropsychological outcomes so for a whole bunch of reasons, if you’re going to supplement codeine, then cytocholine or CDB coline, which is cheap, needs to get.

13:01 : That’s the one I would take something like 500 milligrams a day. And is this something you can test your levels of? Not easily. But it is. It is an important part of the methylation cycle so one of the So if you measure your homocysteine, which we recommended people do before, and if your B12 and folate levels look good but your homocysteine is still high, then it could be signifying choline requirements and then supplementing with choline can help there another way. The something else that’s very common nowadays is non alcoholic fatty liver disease and there’s some animal and human data to suggest that this is related to a choline deficiency in multiple different animal models of fatty liver.

13:54 : Regardless of how you created it, you can actually reverse it with choline supplementation so if you have metabolic syndrome or any evidence of fatty liver or liver disease then choline could be that could be an indicator that choline supplementation could help great any like if you just want to edge on the side of caution and even if you’re getting feel like you’re getting plenty of choline in your diet, taking a little taking the supplement. Any reason to be concerned about excessive amounts? As far as you know, no, i don’t think so.

14:27 : If you really get into choline in a big way, then you’ll start to hear about some of its metabolites like TMAO. And some people are worried that may be associated with cardiovascular disease. The evidence actually really isn’t very good and that’s probably, it’s probably more related to your overall metabolic health in general and the health of your gut. So unless you have some significant concerns there, I don’t think, you know, taking a couple hundred milligrams of choline is going to be problematic and then, you know, there may be benefit from, you know, several randomized controlled trials with hard neurological outcomes in humans.

15:02 : All right, so we have a couple of audio ones to do. The first we’ll play here is from Zhao. Hi, Hello. Thank you very much for your podcasts. It’s really interesting. So I was listening to the podcasts where you were speaking about the role of Colleen as A and their potential brain health benefits. I was wonder also if there’s a role for the phosphor details three to be used as a phospholipid instead of Colleen and if there is better evidence for that use? Thank you.

15:38 : So another follow up here on the choline topic and right up your alley so I’ll let you take in phosphatidylserine. Yeah, another great question and follows nicely on from the phosphatidylcholine point, which is that phosphatidylcholine as sort of the top of a phospholipid that sits within the membranes of cells is only one type of phospholipid there is, there are several and phosphatidylserine is another very important one for making phospholipids in the brain. So yes, there is a role for phosphatidylserine and then the question becomes about supplementation.

16:19 : There was an interesting story related to phosphatidylserine because some people use it to as an adaptogen, which basically means that it helps to modulate stress responses, particularly those who are chronically very stressed. And there was some data, you know, going back into the into the nineties suggesting that if you took phosphatidylserine it would decrease cortisol production, particularly in those who were stressed. However, the way that they made those phosphatidylserine supplements back then was from brain extract, so they would particularly use cow brain as the source of phosphatidylserine.

16:56 : There was then a switch because of BSE or bovine spongiform encephalopathy this prion disease, the mad cow disease that was prevalent in the UK, you know 2025 years ago. Because of that you couldn’t then make supplements from brains, you had to get them from somewhere else so then they started to make phosphatidylserine similar to actually some choline supplements you can get them from lesser thin, which is this emulsifier that you can get from soy or sunflower.

17:27 : So then they’ve started to make some phosphatidylserine supplements from there were soy based and there was this question of whether they worked the same so for a while I thought and I saw some data to suggest that the more recent trials using a soy based or plant based phosphylserine were having less of a benefit. And you know, there’s still potentially some questions about this because some of the more sort of convincing or large effect sizes in the in the historical studies were using this brain derived supplement which obviously can’t get anymore.

18:06 : And then the question was, is there something else coming along for the ride with the phosphatidylserine and that’s where the benefits coming from, you know, but if you isolate it from soy is having less than an effect. However, there does actually still seem to be some benefit from these newer soy based phosphatidylserine supplements. So there’s definitely some benefit from that phosphatidylserine, 2 main things that pop up there was a recent meta analysis that looked at cognitive function in those with some degree of cognitive decline or dementia and there was a statistically significant benefit on memory from those who supplemented with phosphidylserine. One of the studies that in itself was positive use this soy based formulation.

18:48 : And then going back to that stress question, there’s a recent study that used again a soy based phosphidylserine supplement that looked at stress responses and response to a stressful situation, a simulated stressful situation in those who supplemented with Fosto serine and in those who were chronically stressed, there seemed to be this down regulation of these stress responses in a stressful situation so again, maybe having that adaptogenic benefit in those who have high levels of chronic stress. So there does still seem to be some benefit from fostoidal serine. You can get it from a soy based formulation it looks like 300 to 400 milligrams per day is where will you’ll see benefit and that’s from those memory trials as well as from that stressful that stress trial.

19:35 : Do you think that it would be at all redundant to be taking choline and serine or would they be complimentary in some way? I think they’re complimentary because they don’t have completely overlapping roles and there were some, there are some membranes that specifically enrich for fossyl choline versus Fosyl serine in their phospholipids in different areas of the brain. I haven’t seen a study that like compares them head to head in terms of supplementation that would be interesting. Usually if you if it’s a phosphylserine trial, it comes with phosphatidic acid which is just you know this sort of is part of that same formulation but I haven’t seen a comparison of choline versus serine.

20:24 : However, I would expect them to have. Different roles so I think there’s probably a potential role for both cool. All right. Thanks Y’all for that question. We have one more comment here that came in from Charlie i’ll play that now. This is more of a comment than a question i am Charlie, I’m an audiologist and I appreciated the way you discussed hearing aids. I enjoyed your comment about relying on hearing aids and the difference between under stimulation from using a device like using a powered wheelchair when you are able to walk and under stimulation from not using a device like using hearing aids with reduced sensory input, it becomes a lot harder for people to participate in conversation and in social situations.

21:13 : This then becomes a cost benefit analysis that everyone with hearing loss ends up doing. Is it worth it for me to go to a social event if I cannot participate? So folks with hearing loss are more likely to reduce social contact. And I don’t think I need to tell you that closing a social circle is also not good for your cognitive health. Ultimately, hearing aids are supposed to make these social situations easier and to promote interaction.

21:41 : Again, I appreciated the way that you discussed the topic and hearing aids and music or a whole other ball of wax, but I’d be happy to answer any questions about that if you have any. Ok thanks Charlie for that comment. I thought it was an important one to air we focused on in that prior episode on hearing aids and hearing loss primarily kind of from the demand coupling side of hearing aids and the fact that you know, giving the brain more finely grained input stimulus is a good thing. But in terms of you know what a hearing aid can do, but perhaps even bigger issue that can arise with hearing loss is kind of the social isolation that arises from it.

22:23 : People definitely tend to withdraw more, not surprisingly so. And you know that can have all sorts of negative consequences on cognition, on health. You know there’s the sort of the demand coupling side of things where the just having social contact, having social interactions is really good for the brain, but then there’s all the others good stuff that goes along with it so that’s an another definite pro for getting hearing aids and correcting any hearing issues so an important thing to add. Anything else on your end, Tommy? No, it was great. Really appreciate the comment from an expert in the field and the additional context is really important.

23:03 : All right those were the questions that we had. Since this was a rapid fire episode, I thought we might conclude with a quick game of this or that. Tommy, are you game? Yeah all right. So i’m going to give you the questions. Have you played this or that before? I have not. Ok, so this is a novel stimulus you’re totally novel stimulus all you have to do is choose one or the other things that I say. Just go with your first instinct.

23:32 : All right, We’re going for time. You’re ready. Ok Yeah. All right. Machines are free weights, free weights. Steak or chicken? steak. We’re starting easy. Sprinting or jogging sprinting darwin or einstein einstein. New York or london? london. Polarizing blue or green? blue. French fries or chips. They’re the same thing. The chips Mozart or def Leopard. Mozart coffee or creatine come on, I didn’t say it’ll be easy. Coffee garage or garage? Depends on whether you’re talking about the place you put your car or the genre of music. Ok, fair enough fair enough. So the place you put your car is the garage and the genre of music garage.

24:39 : Interesting oK, It would if I’m in the UK, will they say the same thing? Yeah, just everybody call you garage. And would they say I’ve had to switch to garage so people understand what I’m talking about, But the place that you put your car, if you’re in the UK, it’ll still be yeah, garage, right? yeah. Ok you did good. Seven out of nine correct. Oh, I didn’t realize there was the right answer. I’m just kidding there’s the right answer. It’s all your own.

25:07 : Your own personal instincts and opinion so you can’t get a wrong answer on this or that. Well done. All right thanks. We’ll have to do one for you next time yeah i think that we can bring back this or that. All right. Thanks everyone for your questions. If you have one of your own, you can head to brainjo.academy/questions and thanks for listening we’ll see you in the next episode.