Meet Wendy Pietri, BSN RN: Brain Health Coach

Wendy is a dedicated Brain Health Coach who combines her nursing background with a passion for cognitive well-being. Her journey into brain health was profoundly influenced by personal family experiences, particularly witnessing her mother's struggle with Alzheimer's disease. These experiences ignited her commitment to helping others achieve optimal brain health and sparked a career dedicated to making a positive impact on individuals and their families.

Wendy's professional journey began with her training as a Registered Nurse, where she earned bachelor's degrees in both Biology and Nursing from the University of Tennessee. She has pursued advanced certifications in brain health and wellness coaching. Her nursing background and personal experience with dementia equips her with a unique perspective, allowing her to integrate medical insights with holistic, personalized coaching strategies.

In her personal life, Wendy is a wife and proud mom to three grown children. She enjoys playing pickleball, weightlifting, sauna, nutrition, walking, and travel.

Wendy's Top Recommendations

Strength training for women: "What I see time and time again is how many women do not realize how important strength training is for both longevity and brain health. Women in their 30s can lose 2 to 3% muscle mass each decade, and during perimenopause and menopause, they can lose as much as 10% muscle mass every decade. If we are not actively growing and building muscles, we will not be doing any of the activities in our later decades that we can do now. People in that last decade of their life, if they experience an injury or a fall, approximately 50% do not recover.

Muscle strength is intricately tied to brain health. People in the top 20% of strength versus the bottom 20% see approximately a 5x difference in Alzheimer's risk.Muscles are glucose metabolizers, helping our bodies better regulate blood sugar, and blood sugar regulation is critical to long-term brain health. For all of these reasons, we should all be training our bodies for the life we want to live in the future."

Optimizing bloodwork: "One of the biggest payoffs for my clients has been optimizing nutrient and vitamin deficiencies, especially homocysteine. We know we should try to get most nutrients from food (vitamin D, iron, vitamin B12, folate), but sometimes that just isn't possible. Homocysteine is an amino acid that when elevated in the bloodstream can cause cardiovascular constriction and damage. A homocysteine level consistently above 13 doubles your rate of brain atrophy. By knowing your levels and optimizing your B vitamins, we can decrease the damage that an elevated level could be causing. This is a biomarker that is not typically tested, and we at BetterBrain feel it is an incredibly important one not to miss."

Sauna: "The most effective tool (outside of exercise) that I use at least 4 times a week is sauna. If you have access to a sauna whether at home or the gym, there is just no reason to not get in it. Sauna bathing has so many amazing benefits for the body and the brain. It is an excellent detoxification tool, a mild cardiovascular workout (your blood vessels are dilated, your heart rate is elevated), and it is also a fantastic brain healthy tool. Sauna heat stress increases BDNF ("miracle grow" for your brain), releases heat shock proteins (the clean-up crew), and improves oxygen and nutrient delivery to the brain. Sauna is also a wonderful stress reducer as it helps to lower cortisol and increases endorphins, dopamine, and serotonin. For me, sauna has also helped improve my sleep. For all of these reasons, this is one activity that I just cannot live without."

Sardines: "Call me crazy, but one of the foods I have recently started to incorporate in my weekly routine are sardines. I buy them packed in good extra virgin olive oil and eat them with Wasa crackers and Cholula hot sauce. Sardines pack a punch when it comes to protein (22 grams) and omega-3s (1600 mg). They are also loaded with vitamin D (200-400 IUs), calcium (15-20% of daily value), B12 (over 100% of daily value), and selenium (60-70% of daily value). I eat them for lunch at least 3 times a week, and it is one of the easiest lunches to put together. Try them! They are not as bad as you may think!"

Content Corner

Tim Ferriss: 4 Science-Backed Tools That Rewired Decades of Childhood Trauma & Depression

One of Wendy's favorite podcasts of 2025 was Tim Ferriss' appearance on The Diary of a CEO podcast with Steven Bartlett, titled "4 Science-Backed Tools That Rewired Decades of Childhood Trauma and Depression."

The episode: Tim Ferriss shares his personal journey through childhood trauma and depression, revealing four science-backed tools that helped him manage anxiety and rewire his nervous system: vagus nerve stimulation, HRV tracking, accelerated TMS brain stimulation, and metabolic psychiatry approaches.

1. Vagus nerve stimulation: Tim explains why stimulating the vagus nerve may hold the key to anxiety relief. The vagus nerve is a major component of your parasympathetic nervous system, which controls your body's rest and digest response.

2. Heart Rate Variability (HRV): HRV has become the number one biomarker Tim tracks. Higher HRV indicates better stress resilience and nervous system flexibility. He shares how to improve it through breath work, cold exposure, and other evidence-based interventions.

3. Accelerated Transcranial Magnetic Stimulation (TMS): This was particularly striking. Tim describes how accelerated TMS (10 sessions per day for 5 days) gave him 4 to 5 months of relief from anxiety, comparable to having meditated twice a day for a year. The before and after effects, he says, equal or surpass the amplitude and durability of psychedelic-assisted therapies.

4. Metabolic psychiatry: Tim explores emerging research on how ketogenic diets and metabolic approaches can benefit conditions like schizophrenia and Alzheimer's disease, connecting mental health treatment to metabolic health.

Why this matters for brain health:

Tim's conversation reinforces what we've talked about before: your mental health is not separate from your brain health. Chronic stress, anxiety, and depression create neuro-inflammation, elevate cortisol (which is neurotoxic at high levels), and can lead to measurable brain atrophy over time.

The tools Tim discusses, particularly around nervous system regulation and HRV, are accessible interventions that can reduce the chronic stress load on your brain. When we help clients optimize their mental health through stress management, we're not just improving their mood. We're protecting their brain structure and function for long term health.

If you're interested in learning more about the connection between stress, mental health, and cognitive function, we highly recommend giving this episode a listen. Tim's vulnerability and his commitment to finding evidence-based solutions make this an incredibly valuable conversation.

The Findings:

Prevention, Intervention, and Treatment

Background: Researchers from Stanford University analyzed data from more than 282,500 adults in Wales, taking advantage of a unique natural experiment. When Wales launched its shingles vaccination program, people who turned 80 just after the program started were eligible for the vaccine, while those who turned 80 just before the program started remained ineligible for life. This created two groups that were virtually identical in every measurable way (education, health behaviors, prevalence of chronic conditions) except for access to the vaccine.

The results were striking across three stages of the dementia disease course:

Prevention: Among older adults without cognitive impairment, those who received the shingles vaccine had a 20% lower risk of developing dementia over the next seven years compared to those who didn't receive it. That translates to a 3.5 percentage point reduction in dementia diagnoses.

Early intervention: Among those without prior cognitive impairment, vaccinated individuals saw a 3.1 percentage point reduction in mild cognitive impairment (MCI) diagnoses over nine years. MCI is often a precursor to dementia, so reducing MCI diagnoses is clinically significant.

Therapeutic benefit: Perhaps most surprising, among people already living with dementia at the start of the vaccination program, those who received the vaccine had a 29.5 percentage point reduction in deaths due to dementia over nine years. Nearly half of the unvaccinated group with dementia died from the disease during follow-up, compared to only about 30% of the vaccinated group.

The protective effect was significantly stronger in women than in men, though the reasons for this difference aren't yet fully understood.

The Science:

Why the Varicella-Zoster Virus Matters

The varicella-zoster virus causes chickenpox, typically in childhood. After the initial infection resolves, the virus doesn't leave your body. It stays dormant in nerve cells for life. In people who are older or have weakened immune systems, the virus can reactivate decades later to cause shingles, a painful rash characterized by blisters.

But the virus's impact may extend beyond the rash. Research has linked varicella-zoster to several mechanisms that contribute to Alzheimer's disease and other dementias:

Amyloid deposition and tau aggregation: The virus has been linked to the formation of amyloid plaques and tau tangles, the hallmark pathological features of Alzheimer's disease.

Cerebrovascular disease: Varicella-zoster is associated with patterns of blood vessel damage in the brain that resemble those seen in Alzheimer's disease, including small and large vessel disease, ischemia, infarction, and hemorrhage.

Neuroinflammation: Clinical and subclinical reactivations of the virus create chronic immune stress that drives inflammatory pathways in both the peripheral and central nervous systems, interfering with healthy brain aging.

HSV-1 reactivation: Some evidence suggests that varicella-zoster reactivations may trigger reactivations of herpes simplex virus (HSV-1) in the brain, which has also been linked to dementia development.

By preventing these viral reactivations, the shingles vaccine may interrupt multiple pathways that contribute to cognitive decline.

What This Means:

An Accessible Intervention

Bottom Line: What makes this research particularly exciting is how actionable it is. The shingles vaccine isn't an experimental treatment years away from approval. Shingrix, the recombinant shingles vaccine, is already widely available and recommended for all adults 50 and older. It's more than 90% effective at preventing shingles and has a strong safety record.

Most insurance plans, including Medicare, cover the vaccine. It's administered as two doses, typically given two to six months apart.

This study's natural experiment design provides some of the strongest evidence to date for a causal relationship between the vaccine and reduced dementia risk. Because the two comparison groups were so similar in every measurable way except for vaccine eligibility, bias is much less likely than in typical observational studies. The research team has now replicated these findings in health records from Australia, Canada, England, and New Zealand.

"We just keep seeing this strong protective signal for dementia in dataset after dataset," said Dr. Pascal Geldsetzer, senior author of the study.

The dual benefit (preventing a painful, debilitating condition while also reducing dementia risk) makes this one of the more interesting preventive interventions currently available.

If you're 50 or older and haven't received the Shingrix vaccine, talk to your doctor about whether it's appropriate for you. Check your vaccination status and confirm whether your insurance covers it (most plans do).

This is particularly relevant for women, who showed stronger protective effects in the research. Even if you have mild cognitive impairment or early-stage dementia, the study suggests potential benefits across the disease course, making it worth discussing with your healthcare provider.

The shingles vaccine illustrates a broader principle that's central to BetterBrain's approach: reducing systemic inflammation protects your brain. The pathways through which varicella-zoster contributes to dementia (chronic inflammation, vascular damage, protein aggregation) are some of the same pathways affected by the health domains we assess.

And if you haven't yet, join BetterBrain today and take the first step on your brain health journey.

Gut Health: Your Second Brain

The Bottom Line: Gut health is one of BetterBrain's 10 core systems because of the gut-brain axis, a bidirectional communication system where the bacteria in your gut directly influence brain function. Your gut produces roughly 90% of your body's serotonin and communicates with your brain via the vagus nerve, immune signaling, and bacterial metabolites. While the science around gut health and the brain is early, there is mounting research in the area.

Here's why inflammation from the gut matters: An imbalanced gut microbiome can create problems through multiple pathways. First, it can trigger systemic inflammation that crosses the blood-brain barrier, creating the neuroinflammation that is linked to Alzheimer's disease. Second, it can impair nutrient absorption. If your gut isn't properly absorbing omega-3 fatty acids or vitamin B12, your brain is starved of essential building blocks.

This means chronic digestive issues like bloating, constipation, or irregular bowel movements aren't just gut problems. They're early warning signs of processes that can potentially impact cognitive function over time.

Evidence informed solutions:The best way to address gut health is on an individualized basis. For people with chronic digestive issues or diagnosed gastrointestinal disorders, more intensive interventions might be needed, such as elimination protocols, comprehensive stool testing, or working with a gastroenterologist.But for people with slight disturbances or occasional issues, evidence-based dietary approaches can be helpful:

• Control sugar and refined carbohydrate intake, as these feed harmful bacteria and create inflammation.
• Increase prebiotics, which are essentially fiber from vegetables, whole grains, and legumes that feed beneficial bacteria.
• Add probiotics through fermented foods like yogurt, kimchi, sauerkraut, and other cultured foods.
• Follow a Mediterranean-style diet rich in diverse plant foods, which naturally supports a healthy, diverse microbiome.
• Minimize processed foods, which often contain additives that can disrupt gut bacteria.

The gut-brain connection illustrates perfectly just one way that whole-body health is brain health.

Oral Health and the Inflammation Pathway

Bottom Line: The health of your mouth can be a significant indicator for your overall well-being, including your brain health. Periodontal disease, a severe form of gum disease, sits within our inflammation domain because it's fundamentally a story about chronic systemic inflammation and how it creates pathways to neurodegeneration.

Here's how it works: Periodontal disease is associated with increased levels of systemic inflammation throughout your body. This isn't just localized gum inflammation. Research has found that the bacteria commonly involved in periodontal disease, particularly Porphyromonas gingivalis, can enter the bloodstream and potentially make its way to the brain. Once there, these bacteria can trigger inflammatory responses and potentially impact brain health.

A 2020 study published in the Journal of Alzheimer's Disease found that periodontal disease is closely associated with Alzheimer's risk in older adults. While a direct causative relationship between periodontal disease and Alzheimer's has not been definitively established, several studies have shown that people with periodontal disease are more likely to experience cognitive decline over time.

What makes this particularly relevant is how preventable it is. The bacteria don't just appear overnight. They build up over months and years of suboptimal oral hygiene. The inflammation compounds. The damage accumulates.

But the good news is that simple, evidence-based interventions are both straightforward and accessible, and make a meaningful difference.

1. Brush twice daily, ideally with an electric toothbrush, for 2 minutes each time.
2. Floss twice daily to remove bacteria from areas your toothbrush can't reach.
3. Get routine dental cleanings every 6 months, which removes tartar buildup and allows your dentist to catch early signs of periodontal disease.

These are all low effort, low cost, and supported by high-quality evidence.

Mental Health & The Bigger Picture

Why Whole-Body Health Matters

Why this matters: Mental health is one of our 10 core domains because disorders like depression and anxiety don't just affect mood, they have measurable impacts on brain structure and long-term cognitive outcomes.

The Science: Chronic stress from unmanaged mental health conditions elevates cortisol, which at high levels is neurotoxic and damages the hippocampus, your brain's memory center. This stress also drives systemic inflammation through the same pathways we've discussed with oral and gut health. Depression in midlife has been linked to nearly double the risk of dementia later in life.

The bottom line: It's important to emphasize that while we're only touching the surface of mental health's importance here, it is the perfect example of why holistic health matters. You could be doing everything else right: eating well, exercising regularly, taking your supplements, managing your physical health conditions. But if your mental health is suffering, the rest of your health will suffer too.

Chronic stress, anxiety, and depression create ripple effects across every system in your body: they disrupt your sleep, suppress your immune function, drive inflammation, impair your gut microbiome, reduce your motivation to exercise, and directly damage brain structures critical for memory.

The Bigger Picture: This is why BetterBrain assesses 10 health domains. Inflammation from your gums, neurotoxic compounds from your gut, stress hormones from chronic anxiety: these aren't isolated problems. They're all pathways that converge on your brain and shape its trajectory. Mental health, oral health, and gut health are just three examples of how every system in your body connects to cognitive function.

This is also why so many of our members report feeling better overall, not just cognitively sharper, as a result of their BetterBrain interventions. When you reduce inflammation, optimize your gut microbiome, manage stress effectively, improve your sleep, and move your body regularly, you're not just protecting your brain. You're improving your energy, mood, metabolic health, and overall well-being.

As you think about your goals for the new year, remember that taking care of your brain means taking care of your entire body, and taking care of your body means taking care of your brain. They're inseparable!

Understanding APOE4 Genetics

How APOE4 carriers benefit most from specific interventions

Bottom Line: APOE4 is a significant genetic risk factor for Alzheimer's, but it's not deterministic. We've talked before about how environmental and lifestyle factors play a vital role in whether you develop the disease, and certain interventions are particularly beneficial for APOE4 carriers, and today we'll dive in deeper.

How APOE genetics work: The APOE gene has three major variants: E2, E3, and E4. Each person inherits one copy from their mother and one from their father, creating six possible genotype combinations.

The risk breakdown:

• E2/E2 or E2/E3: Lower risk (protective effect)
• E3/E3: Normal risk (baseline, this is the most common genotype)
• E2/E4 or E3/E4: Increased risk
• E4/E4: Increased risk (highest risk, earlier potential onset)

What E4 does: The E4 variant is associated with several mechanisms that increase Alzheimer's risk:

• Impairs lipid cholesterol metabolism and transport
• Reduces amyloid-beta clearance, leading to plaque buildup
• Increases inflammation leading to neuronal damage
• Causes blood-brain barrier dysfunction and vascular inflammation

Why knowing matters: the prevention advantage: Recent groundbreaking research shows that APOE4 carriers benefit even more from specific interventions than non-carriers.

A 2025 study published in Nature followed over 5,700 people for 34 years and found that closely following the Mediterranean diet lowered dementia risk by at least 35% in people with two copies of the APOE4 gene, the highest risk group.

"Not only did following a baseline Mediterranean diet reduce the probability of developing dementia by 35% in people with two APOE4 genes, but higher adherence to the diet further reduced their risk," said lead author Yuxi Liu, a research fellow at Brigham and Women's Hospital and Harvard Medical School.

The building blocks matter more than the diet label. While this study focused on the Mediterranean diet, it's important to understand our approach at BetterBrain. Following a specific diet like Mediterranean, MIND, or Paleo is less critical than understanding the underlying building blocks.

The totality of research highlights these essential components: healthy fats (especially omega-3s), micronutrients, antioxidants, sufficient protein, and fiber. Diets like Mediterranean are selectively valuable because they're rich in these protective building blocks, but you don't need to follow one specific diet perfectly. What matters most is consistently incorporating these brain-protective nutrients in a way that fits your lifestyle.

Other interventions particularly beneficial for APOE4 carriers:

• Omega-3 supplementation: APOE4 carriers have impaired brain lipid transport and DHA uptake, making higher doses of omega-3s especially important (more on this below in Coach's Corner)
• Aerobic exercise: Particularly effective for APOE4 carriers in maintaining brain volume and cognitive function
• Sleep optimization: Critical for amyloid clearance, which is already impaired in APOE4 carriers
• Lipid management: Monitoring and optimizing ApoB, LDL, and inflammation markers is especially important
• Avoiding head trauma: APOE4 carriers have worse outcomes from traumatic brain injury
• Limiting alcohol: Alcohol is particularly harmful for APOE4 carriers

The empowering reality: As Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases, notes: "Genes do not have to be your destiny. If the risk of dementia in a person in the highest risk category can be cut by 35% just by following a specific diet, imagine what can be done when you work on dozens of modifiable risk factors such as exercise, sleep, stress and the like."

BetterBrain's APOE testing: APOE testing can be added on to all of our BetterBrain programs. It's a very personal choice, but many people find it very useful and empowering to know. Understanding your status allows us to tailor your prevention protocol with precision, emphasizing the interventions that will have the greatest impact for your specific genetic profile.

Coach's Corner

Omega-3 DHA, Brain-Healthy Salmon & Holiday Mindset

We're very excited to feature Erika Schwan, one of our newest additions to the BetterBrain coaching team, in our Coach's Corner this week!

About Erika: Erika Schwan, RDN, is a registered dietitian nutritionist, health coach, and trained chef with more than a decade of experience in clinical care, functional nutrition, and personalized wellness. Her work centers on individualized nutrition, mindful lifestyle practices, and evidence-informed approaches that support long-term brain health and overall well-being.

Erika's passion for optimizing brain health and advancing dementia prevention is deeply rooted in her personal experience caring for her mother, who lived with Alzheimer's disease.

Personal brain health technique: "For anyone wanting to improve their cognition, support their mental health, and reduce dementia risk, omega-3 polyunsaturated fats are crucial, especially the DHA form found in fatty fish like salmon."

Why DHA matters: DHA is an integral component of neuronal membrane structure. It increases membrane fluidity, supporting neuronal function, neuronal speed, and synaptic transmission. It also reduces neuroinflammation and protects against neurodegeneration.

The APOE4 connection: If you're an APOE4 carrier, getting this essential nutrient at higher than standard doses is even more important. Brain lipid transport and DHA uptake are impaired in APOE4 carriers, meaning you need more to achieve the same brain benefits.

Erika's omega-3 protocol: "I've taken a quality fish oil for years but recently switched to one with more concentrated DHA for increased neuroprotection. I also have a few go-to salmon recipes to ensure a steady intake of omega-3s about 2-3 times per week."

Air Fryer Salmon with Honey-Ginger Marinade

Below is one of my favorite recipes for cold weather. It's tasty, warming, and has additional anti-inflammatory support from fresh ginger. It pairs wonderfully with brown rice (or any whole grain), kimchi, and any vegetables really! I prefer roasted organic broccoli with extra virgin olive oil, a little kosher salt, fresh black pepper, and red pepper flakes for some heat.

If you haven't tried air frying salmon, I highly recommend it!

Ingredients:

• 2, 6-oz salmon filets (skin on or off, per preference)
• 1 Tbsp avocado oil
• 2 Tbsp soy sauce
• 1 Tbsp honey
• 1-inch piece of ginger, grated
• ½-1 tsp garlic, minced (to preference)

Instructions:

1. Select "Fish" setting on the air fryer (or select 370°F, 15 minutes); preheat the air fryer for 5 of those minutes
2. In a small bowl, whisk the avocado oil, soy sauce & honey together
3. Add the ginger & garlic, whisk again
4. Cut your salmon into ~1" cubes
5. Place salmon & marinade in a sealable container & shake to coat
6. Marinate the salmon for 20-60 minutes
7. For easier cleanup, place a piece of parchment paper in the bottom of the air fryer taking care not to have the paper exceed the height of the air fryer basket
8. Place your marinated salmon in the air fryer basket and cook for 10 minutes at 370°F; check for doneness
9. Enjoy!

Making Space for Mental Health

"As I've moved into the holiday season, I'm aware of both the joys and stresses that can arise at this time. As someone who's lost loved ones around the holidays, I'm learning the importance of making space for mental health.

Our mental and emotional health is intricately tied to brain health and impacts so many areas of our lives like stress, sleep, appetite and motivation.

Making space for mental and emotional health can take many forms. First and foremost, working with a licensed mental health professional can be incredibly supportive and transformative. Define your support system and lean upon them at this time.

I find using an app for gratitude practice trains my brain to continue to see the good things in my life and is an easy way to reflect on what I've logged. Finding ways to ground myself in breath and nature are healing measures: a simple home yoga practice, app-guided meditations, a walk at the park, or a hike in the woods and mountains.

And finally, practicing self-compassion as we navigate the nuance of this season can help us walk with a lighter step. Wishing you and yours all the best this holiday season!"

Member Testimonial

Nancy's Journey: Comprehensive Risk Reduction at 57

Background: Nancy (blinded name for privacy), a 57-year-old retiree, came to BetterBrain with concerning family history and multiple risk factors that were quietly undermining her brain health. Rather than accepting these as inevitable parts of aging, she decided to take proactive action.

The Discovery: Nancy's comprehensive testing revealed a complex picture: high homocysteine, low folate and B12, poor omega-3 ratio, elevated HbA1c (pre-diabetic), and chronic use of anticholinergic medications like Benadryl. 

Taking Action: Working with her BetterBrain coach, Nancy developed a systematic approach targeting each risk factor:

The Personalized Plan:

• Started fish oil and methylated B vitamin supplementation to address nutritional deficiencies
• Implemented targeted dietary changes with continuous glucose monitoring to minimize blood sugar spikes
• Began 1 HIIT session and 2 full-body strength training sessions per week
• Switched from Benadryl to Xyzal to reduce harmful anticholinergic exposure

3-Month Results:

• Metabolic: HbA1c reduced to pre-diabetic levels
• Biomarker optimization: Reduced homocysteine to optimal levels, improved omega-3 ratio
• Medication safety: Successfully eliminated anticholinergic burden
• Quality of life: Improved mood and energy levels
• Overall outcome: Significantly reduced dementia risk and improved day-to-day function

The Transformation

Nancy reflects that the comprehensive approach made all the difference. Instead of just focusing on one aspect of her health, we addressed multiple aspects to achieve a compounding effect. She now feels more energetic and sharper than she has in years, and her numbers prove it's working.

Featured Biomarker

HbA1c (Blood Sugar Control)

Nancy's success in reducing her HbA1c to pre-diabetic levels was a crucial part of her brain health transformation. This biomarker reflects how your body has handled glucose, and your brain depends heavily on stable glucose levels. It is strongly associated with long-term cognitive health.

What it is: A measure of your average blood sugar levels over the past 2-3 months. Unlike a fasting glucose test that captures just one moment, HbA1c shows the bigger picture of how well your body manages blood sugar over time.

Why it matters for brain health: Chronically elevated blood sugar damages blood vessels, impacts cognitive function, and increases dementia risk (particularly in the case of diabetes). Some researchers even call Alzheimer's "type 3 diabetes" because of this connection.

What affects HbA1c:

• Diet: Processed foods and refined carbs drive levels up
• Exercise: Both cardio and strength training improve insulin sensitivity
• Sleep: Poor sleep increases insulin resistance
• Stress: Chronic stress elevates blood sugar
• Body composition: More muscle mass improves glucose metabolism

Nancy's approach: She combined dietary changes with glucose monitoring, strength training, and HIIT workouts. This comprehensive strategy moved her from pre-diabetic to normal range, directly protecting her brain health.

You can read more about HbA1c optimization and metabolic health on our BetterBrain Portal.

Technique Spotlight

Anticholinergic Medication for Brain Health

One of Nancy's most important interventions was switching from Benadryl to Xyzal, reducing her anticholinergic burden. This lesser-known risk factor could be quietly affecting millions of people's cognitive function.

What are anticholinergic medications: Drugs that block acetylcholine, a neurotransmitter crucial for learning and memory. While these medications treat various conditions, they can impair cognitive function, especially with long-term use.

The brain connection: Acetylcholine is essential for attention, learning, and memory formation. When anticholinergic medications block this neurotransmitter, they can cause confusion, memory problems, and increase dementia risk with chronic use.

Common anticholinergic medications:

• Antihistamines: Benadryl, Dramamine, some sleep aids
• Bladder medications: Oxybutynin, tolterodine
• Antidepressants: Some tricyclics like amitriptyline
• Sleep aids: Many over-the-counter sleep medications
• Muscle relaxants: Cyclobenzaprine and others

Safer alternatives:

• For allergies: Claritin, Zyrtec, Xyzal instead of Benadryl
• For sleep: Melatonin, magnesium, or sleep hygiene instead of PM medications
• For bladder issues: Work with your doctor on newer, less anticholinergic options

How to assess your risk:

• Review your medications: Check labels for diphenhydramine, doxylamine, and other anticholinergics
• Consider cumulative effects: Multiple low-risk medications can add up
• Talk to your pharmacist: They can help identify anticholinergic burden
• Work with your doctor: Don't stop medications without medical guidance

BetterBrain insight: Nancy's anticholinergic reduction was a simple but powerful intervention. Many people don't realize that common medications like Benadryl can affect cognitive function over time. Small changes in medication choices can have significant impacts on brain health.

Content Corner

Peter Attia & Rhonda Patrick on Creatine Dosing

Bottom Line: While 5g of creatine monohydrate is the standard recommendation for athletic performance, emerging evidence suggests 10g daily may be necessary for optimal brain health benefits. The issue? Skeletal muscle absorbs most of a 5g dose, leaving minimal creatine available to cross the blood-brain barrier.

The episode: In episode #369 of The Peter Attia Drive, Dr. Rhonda Patrick joined Peter to discuss creatine's well-established effects on strength and endurance, but pivoted to its more overlooked benefits for cognition and brain health under stress conditions.

The dosing revelation: Rhonda explains that 5g daily saturates muscle creatine stores within about three weeks, which is why that dose became standard for athletic performance. However, muscles are voracious consumers of circulating creatine. By the time creatine reaches the blood-brain barrier, much of that 5g dose has already been absorbed by skeletal muscle tissue.

Why this matters for your brain: Your brain uses approximately 20% of your body's total energy despite representing only 2% of body weight. Unlike muscles, the brain can't store large amounts of energy reserves, making it heavily dependent on rapid energy regeneration during cognitively demanding tasks. (We'll dive deeper into the chemistry and mechanisms below.)

The case for 10g: Higher doses (10-20g) may be necessary to ensure adequate creatine reaches the brain after muscles take their share. This is particularly impactful during periods of high cognitive demand, sleep deprivation, or mental fatigue, which is exactly when your brain needs the most energy support.

Practical considerations: Peter and Rhonda discuss implementation strategies, including splitting doses to prevent GI upset and selecting third-party tested products with NSF certification to avoid heavy metal contamination common in lower-quality supplements.

Key timestamps:

• [1:09:00] How Rhonda became fascinated with creatine
• [1:16:30] Creatine for the brain: how higher doses may enhance cognition under stress and support resilience against aging
• [1:25:45] Optimal dosing for adults and teens, safe product selection, debunking kidney myths

BetterBrain takeaway: At BetterBrain, we currently recommend 5g daily of creatine monohydrate for cognitive and athletic performance. Based on this conversation and the emerging evidence, we're evaluating updating our recommendation to 10g daily split into two doses for those specifically targeting brain health benefits. The science is compelling that higher doses may be necessary to ensure adequate brain supply after muscle uptake.

Technique Spotlight

Creatine for Brain Health

The energy problem: Brain cells constantly perform energy-demanding tasks, such as neurotransmitter release, maintaining electrical signals, forming memories. Memory formation and retrieval are particularly energy-intensive. When your brain runs low on energy, cognitive performance suffers.

Creatine's role: After you take creatine monohydrate, it gets converted to phosphocreatine inside cells. Think of phosphocreatine as a battery backup system that rapidly regenerates ATP (your cells' energy currency) in milliseconds, far faster than your mitochondria can produce it through normal metabolism.

Why your brain needs more than your muscles get: Here's the critical issue: skeletal muscle contains about 95% of your body's total creatine stores. When you take 5g of creatine, your muscles absorb most of it. What remains must cross the blood-brain barrier, where transport is more limited. Higher doses increase the odds that enough creatine reaches your brain to make a difference.

How creatine enhances cognition beyond just energy:

Research suggests creatine works through multiple pathways:

• Increases neurotransmitter synthesis (like acetylcholine for learning and memory)
• Enhances communication between brain cells at synapses
• Provides antioxidant protection against cellular damage
• Supports mitochondrial function in memory-critical brain regions like the hippocampus
• Upregulates proteins involved in memory consolidation and learning

When it works best: Multiple studies show creatine's benefits are most pronounced under metabolic stress: sleep deprivation, mental fatigue, sustained cognitive demand, and aging. This makes sense because creatine helps most when your brain's energy system is challenged.

Implementation:

1. Start with 5g daily for 1-2 weeks to assess tolerance
2. If no GI issues, increase to 10g split into two doses
3. Take with meals to reduce stomach upset
   
4. No loading phase necessary, steady intake works fine
5. Expect noticeable effects within 2-4 weeks

Product quality matters:

Use creatine monohydrate (the form with the most research). Look for:

• Creapure certification (>99.99% pure)
• NSF Certified for Sport designation
• Third-party testing documentation

Lower-quality products contain contaminants that cause the GI distress people associate with creatine. High-purity products largely eliminate these issues.

Safety: Creatine has an excellent safety profile backed by decades of research. The kidney damage myth originated from a single 1998 case report and has been thoroughly debunked. However, people with pre-existing kidney disease should consult their physician.