356 – AMA #73: Preserving brain health, optimizing exercise programming, improving body composition, and more

We discuss:

• Overview of episode topics on brain health, cardiovascular training strategies, and body composition [2:15];
• Understanding dementia risk: modifiable vs. non-modifiable contributors to cognitive decline [5:00];
• The causality between metabolic health and dementia [9:45];
• How diet and exercise influence brain health: energy balance and exercise as key preventative tools [13:30];
• Why combining aerobic, resistance, and cognitively engaging activities offers the most comprehensive benefits for preventing cognitive decline [17:00];
• Additional lifestyle factors that influence dementia risk: smoking, head trauma, alcohol, and sleep [19:45];
• The link between hearing loss and dementia: dose-dependent risk and the case for correction [25:15];
• How poor oral hygiene may contribute to neuroinflammation and dementia risk [23:30];
• Supplements for brain health: which ones matter and when they’re worth considering [28:45];
• Low LDL cholesterol and brain health: debunking the myth of cognitive risk [33:45];
• How to approach zone 2 training: the importance of staying in zone 2 and tailoring intensity based on your time and goals [38:00];
• Lactate testing for zone 2: clinical protocols and at-home approaches [43:00];
• Combining modalities in zone 2 training: balancing enjoyment and efficiency [47:00];
• Zone 2 training for women: addressing the misconception that zone 2 training is unnecessary or ineffective for postmenopausal women [49:30];
• Effective strategies for VO₂ max training: short vs. long intervals [51:45];
• The benefits of post-meal walking for glucose management, and why spikes in glucose during exercise aren’t harmful [56:45];
• The role of stability training in supporting resistance work and healthy aging [1:00:15];
• Adapting strength training to manage chronic back injuries and train for longevity [1:02:00];
• The role of aerobic exercise (like zone 2) in fat loss, metabolic health, and weight maintenance [1:06:30];
• Debunking the “fast vs. slow metabolism” myth: why energy balance and protein matter most for fat loss [1:09:45];
• Lean mass vs. body fat: why both matter for health and longevity [1:12:15];
• How protein intake impacts muscle mass and why pairing it with resistance training is significantly more effective [1:15:15]; and
• More.

Show Notes

Overview of episode topics on brain health, cardiovascular training strategies, and body composition [2:15]

• Today’s AMA will be covering a variety of topics gathered from questions on social media, through the website, through the AMA portal, and more
• The main topics include brain health, exercise, and body composition
  • Peter will answer questions around all the different variables and interventions people can do in order to prevent cognitive and neurological decline. 
  • He will dive into the most common exercise questions, which are a lot around zone 2, including questions around if females should be doing zone 2 training, as well as some VO2 max training questions. 
  • Additionally, Peter will address questions related to body composition and diet, touching on exercise, fat loss, lean mass development, and the role of protein

Understanding dementia risk: modifiable vs. non-modifiable contributors to cognitive decline [5:00]

For more check out: #251 – AMA #46: Optimizing brain health: Alzheimer’s disease risk factors, APOE, prevention strategies, and more

***

Categories of Risk Factors

Non-Modifiable Risk Factors

• Definition: Factors you cannot change, but they are important to acknowledge.
• Examples:
  • Age: Risk of cognitive decline increases monotonically with age (i.e., steadily, without plateau).
  • Sex:
    • Women have 2x the risk of Alzheimer’s compared to men.
    • Not fully explained by longer life expectancy.
    • Peter suspects sudden estrogen withdrawal during menopause may play a major role.
    • Possible link between HRT (Hormone Replacement Therapy) and reduced risk, but more data is needed.
  • Genetics:
    • Most notably, the APOE e4 genotype significantly increases Alzheimer’s risk.
    • Other genetic contributors exist as well.

Modifiable Risk Factors

• Definition: These are areas individuals can influence through lifestyle and health management.
• Key Modifiable Risks:
  • Obesity:
    • Associated with a 60% increase in relative risk for dementia.
    • Risk becomes more meaningful with age due to increasing baseline risk.
  • Type 2 Diabetes:
    • Raises dementia risk by ~50%.
    • Risk increases with disease duration: every 5 years adds ~25% more risk.
  • Hypertension:
    • Also raises dementia risk by ~60%.
  • Dyslipidemia (High LDL cholesterol):
    • Each 1 mmol/L (≈40 mg/dL) increase in LDL is linked to an 8–10% increase in all-cause dementia risk.

Genetic Susceptibility & Interaction with Modifiable Risks

• APOE e4 carriers are more vulnerable to the above modifiable risks.
• For example, a person with diabetes and APOE e4 has a 5.5x greater risk of dementia compared to a diabetic without the APOE e4 variant.
• This shows gene-environment interaction—modifiable risks carry greater impact in genetically susceptible individuals.

Summary of Prevention Strategy

• Target metabolic health aggressively by optimizing:
  • Blood pressure → Target: ≤ 120/80 mmHg.
  • Lipid levels → Keep LDL and other harmful lipids as low as reasonably possible (with diminishing returns at very low levels).
  • Insulin sensitivity → Reduce insulin resistance through diet, exercise, and lifestyle interventions.

{end of show notes preview}