Episode 16: How Exercise, Stress, and Sleep Impact Your Cognitive Health with Dr. Ayesha Sherzai

Michelle MacDonald: Welcome to The Wonder Women Podcast, where we discuss a variety of subjects all pertaining to optimizing your physique, building strength, developing a strong mindset, and tools to help you win at life.

I'm Michelle MacDonald and I'm the founder of The Wonder Women Coaching Team. We are a community of results-driven coaches and clients who believe that we can age like never before.

Welcome back to episode two with Dr. Ayesha Sherzai. Last week, we covered how nutrition plays an important role in fostering brain health, and this week, we're going to cover why you shouldn't skip leg day, the importance of regulating stress, and why you need to keep expanding your mind. Let's get to it.

Okay, I'm going to dive now into exercise. You know I love exercise.

Ayesha Sherzai: Of course, you do.

Michelle MacDonald: You have a really interesting point, and I've heard this before in my readings, but I would love to hear from you this statement that lower limb, lower body strength training in particular is associated with better cognitive health. Can you tell us a little bit about that? Don't skip leg day, everybody.

Ayesha Sherzai: No, no, no, definitely not. I'm so happy that you emphasize that in your community as well and I've seen it in your beautiful videos. This comes from several pieces of data that show that when people do resistance training in general, they tend to do better for several reasons.

Resistance training, as you know, increases the level of specific growth hormones in our body, specifically when it comes to the brain, it's BDNF, brain-derived neurotrophic factor, which plays a major role in neuroplasticity. Neuroplasticity is essentially the connections between brain cells.

We're all born with a finite number of brain cells, 87 billion neurons. Over our life, there is some programmed cell death and modulation of our brain. As we grow older, we may lose some brain cells, but our brain capacity has nothing to do with the number of brain cells we have. It has to do more with the connections between these brain cells.

Each of our brain cells can make as little as two or three connections, dendritic arborization, or as many as 30,000 connections. Whether you're 9 years old or 99 years old, these connections are made and broken on a regular basis, and exercise and cognitive activity—but we're talking about exercise right now—seems to be the main driver of creation of these connections.

Resistance training seems to be a very important element of it. Multiple studies have shown that when people combine resistance training along with cardio exercises, they tend to do better in neuropsychological testing or memory testing. They tend to retrieve information faster. They tend to process information faster. They tend to have better short-term and long-term working memory, etc, and other cognitive domain as well, visual-spatial and so on and so forth.

In a couple of studies, the one that was very, very interesting was a twin study, where they exposed twins to resistance training and it seemed that based on all the different muscle groups that they exercise, when they exercise their leg muscles, and they measured the volume of the leg muscles, their neuropsychological test scores were better.

Then there was another study that looked at the comparison of resistance training, which mostly was squats, lunges, and lower leg exercises, versus just stretching and some very light exercises that essentially activate some muscle groups, but not in a way resistance training does and the cases and the controls were exposed to these activities for six months. They exercised for about 30 to 45 minutes, about three to four times a week.

After six months, by the way, both of these groups had the beginnings of Alzheimer's disease. They had the beginnings of what we call mild cognitive impairment, which is that limbo stage where you can do something about it. They have memory problems, but they can continue to do all their activities of daily living.

These patients with MCI, when they were exposed to resistance training versus stretching, the group that did resistance training, and especially lower leg exercises, were able to reverse their mild cognitive impairment. Forty-seven percent of them reversed their mild cognitive impairment and their score became normal.

They stayed normal for 18 months, despite not even engaging with the same level of resistance training, which is fascinating. It's so empowering to know that. So based on the data on resistance training and the specific studies on leg exercises, the statement was, “Do not skip leg day and make sure that you exercise on a regular basis.”

Michelle MacDonald: Wow, do you remember when that study was done?

Ayesha Sherzai: Yes, I'd be happy to share the study with you and the reference with you so that your audience can actually read about it more.

Michelle MacDonald: Wonderful. Yeah, it gives more ammunition too to our programming.

Ayesha Sherzai: Most definitely.

Michelle MacDonald: So we've got food, we have exercise. What about the unwind strategy?

Ayesha Sherzai: U is in the middle of NEURO for a good reason. I think it's the connective tissue that combines everything together. If people are living a stressful life, forget about fixing your nutrition, your exercise, your sleep, and optimizing your cognitive activity.

It literally and figuratively is at the center of brain health and it's quite unfortunate because the more advanced we get as a society, I don't know about that, but the more gadgets we have, the more resources we have, the higher our stress levels are.

It's a very extensive topic and I'd love to speak with you about that. We could probably just dedicate an entire hour talking about the impact of stress on brain health. But we know that when people are exposed to chronic stress, they literally have shrunken brains.

There's a part of the brain called the hippocampus, which is responsible for encoding memory. The hippocampus basically stops working properly when people are experiencing stress. Stress, it comes in different forms, but even something like just being worried on a regular basis, just worrying about random things. We're not used to it. And that worrying will stop you from accumulating information, from retrieving information.

Stress management techniques are critically important, and that could be different for different people. But at its core is perception, figuring out what bad stress is and differentiating it from good stress, which is very important too. Sometimes we feel that just negating stress is important, and that's the most important thing. No. Having some level of cognitive activities that is good for you, where you get engaged, where you're challenged on a regular basis, that keeps your brain alive.

We've actually seen people when they are employed, and when they retire and they don't do anything, they don't challenge themselves, they have the steepest decline in their cognition. So it's important for people to be able to differentiate between good stress and bad stress.

Michelle MacDonald: I actually really wanted to ask you about that, how do people differentiate between those two kinds of stress? Dean had mentioned on that same interview with Kimberley, and I love that battle between the limbic brain and the frontal lobe.

When people are tripped, I call it being tripped or triggered, when they're triggered into their limbic brain and their heart rate's going up and they go into their behaviors, how can they stop? How can they get that awareness and be able to auto-regulate themselves out of it? How do you tell somebody who's having those palpitations, "Hey, do some deep breathing?"

Ayesha Sherzai: Yeah. At those moments where it's quite overwhelming and people fall into this immediate environment where they are completely overwhelmed with the massive influx of neurotransmitters and your hormonal system going awry, it's very difficult for people to be cognizant and put organization ahead of everything else.

In those circumstances, it's very, very important for us to quickly just throw that system off and things like deep breathing, for example, just taking in a deep breath, closing your eyes, getting yourself out of that situation, going out on a walk, listening to music, something that is rather quick and completely changes your physiology and your chemistry, immediately is important.

I find that deep breathing and making sure that you actually get some feedback by putting your finger on your pulse and thinking about something that gives you joy and grounds you is very helpful in those situations.

I have a tendency when I'm in those situations, which I've managed a lot, I've lived with chronic anxiety all my life, so I've been getting used to techniques to get rid of that feeling, especially when I'm faced with it, going out on a walk, getting out of that zone, out of that environment is very important.

But long-term, having a plan of addressing and identifying sources of chronic stress and sources of bad stress is very important. That's essentially just organizing and it's almost like a business plan where you create a table and you write down your good stresses and your bad stresses.

What makes you go towards those bad stresses? What are those small little moments where you not being aware of it puts you in that bad stress? Then just eliminating, delegating it, and getting rid of it, getting some help, changing your environment, long-term, I think it's very important for us to make those kinds of plans.

Otherwise, we keep falling into the same loop over and over again, and every time we expect that the outcome is going to be different, it's not, and years go by and we just live with these chronic stresses and it really takes a toll on our brain health.

Michelle MacDonald: Beautiful, beautiful. I talk a lot to my clients about, as they're going through the transformation process, and a lot of it is about self-awareness, keeping some kind of a book, whether it's a digital or a real tangible book, writing down their aha moments, those moments when they have clarity and awareness, maybe it's a winning strategy or just an awareness of a behavior or their emotional state, then also keeping a list of things that they don't want to repeat, and having a way to refer back to it, then slowly slowly but surely, evolving changes to your processes so that you end up with more wins and losses and then your identity changes.

Ayesha Sherzai: Absolutely.

Michelle MacDonald: These habits really drive your identity.

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Gosh, I'd love to just quickly tap on two last things. One is sleep and one is this idea of cognitive reserve and what can we do about it. With sleep in particular, because a lot of the audience that is listening to this is going to be either pre-menopause period or post and sleep is an issue.

I just want to underline to people listening, please understand that these things are so multifaceted. If you just start chipping away at all the things, your nutrition, your sleep, your unwind strategies, your exercise, and your cognitive reserve, your base, your foundation of health will improve and things will get easier. So please don't get overwhelmed and think you have to do all of these things at once. So sleep and menopause.

Ayesha Sherzai: Yeah. No, sleep and menopause, I mean, that's such an extensive subject. As you mentioned, as we all grow older, especially for women being in that very, very interesting and very important stage of their life where their hormone systems change, it can definitely affect their sleep as well.

Sleep is cleansing. We have an elegant system like the glymphatic system that is dedicated to getting rid of byproducts from the brain when we go through the deeper stages of sleep and when we don't, there's an accumulation of these products and the second thing that happens is our memory consolidation.

Our short-term memory gets converted to long-term memory during deeper stages of sleep. Sleep does change as our bodies change during pre, peri, and post-menopause. There are multiple different reasons for it. For some people, it could be overthinking and that would require some cognitive behavioral therapy. For others, it could be sensitivity to certain types of food, including caffeine, or having too many calories later during the day. For other people, it could be chronic pain.

Sometimes when we exercise later during the day, as you know, as estrogen and progesterone changes in our bodies, it affects our ligaments, our bones, our musculoskeletal structures as well.

Without even acknowledging it, because a lot of women are pretty tough and they don't want to say it, but we actually have minor aches and pains that keep us up at night, so identifying specifically what the issue is with you, what are you sensitive to the most, is it more of cognitive issues? Is it diet? Is it exercise? Is it because of hormonal states? Is it because of your internal temperature? Is it because of your environment? The therapy and the treatment depend on your risk factors.

Knowing yourself really well and identifying your risk factors for sleep is incredibly important for finding the right kind of sleep hygiene techniques to help you develop sleep habits that will help you throughout the rest of your life.

Michelle MacDonald: Thank you so much. That was a lot of information. You mentioned CBT, cognitive behavioral therapy. I think maybe you alluded to modifying the room temperature if it's your body temperature that's an issue. If it's aches and pains, thinking about things like, "When are you training?" or, "Are you skipping your foam rolling, myofascial release, and all that stuff? Are there other things that you can be doing?"

Well, cognitive behavioral therapy would manage if you're overthinking things or having too many anxious thoughts. Then, of course, hormonal disruption for some people, that's really a major factor that has to get investigated.

Last piece is this idea of cognitive reserves. I want to end with this last little takeaway because I think this is so important. One of the reasons people ask me, “Why did you get your mother into Instagram?” The two main reasons were one, because I knew I needed a village to help keep Mom supported. I thought, “Well, if she finds just a few friends, just a few really on Instagram, it'll keep her going and it won't just follow me to bolster her up.”

It worked tremendously well. She loves her community. Then the other reason was because I knew that neuroplasticity has to be continually worked. I thought, “Let's get around this app. It's like learning a language at her age.” We know where the things are, we know what the three lines at the top right-hand corner mean or the four dots mean swipe left or swipe right.

But for my mom, being in her 70s, it's literally like learning a new language. That's why I got her into it. I'd love to hear more from you on this idea of cognitive reserve and how we can tap into that. What we can do, a practical strategy we can do.

Ayesha Sherzai: Right, no, your mom is lovely, by the way, I love her and the fact that she's on Instagram is so empowering for other women. Yeah, I think cognitive activity or optimizing cognitive activity is such an important aspect of brain health.

If I had to say it, there was a time when I would argue with Dean and say, "Oh, nutrition is more important," and he would say, “No, cognitive activity is way more important.” Just two neurologists bantering and talking to each other. But I am of the belief that cognitive activity is probably as important as any of the other elements and sometimes it's the most important thing and it's also one of the most ignored ones for women.

One of the hypotheses that we have, especially given that two-thirds of cases of Alzheimer's disease are women, is probably because the era that women lived in and now say, for example, they're in their 70s and 80s and they have a higher risk of Alzheimer's disease, at that particular time, women were not allowed to be exposed to challenging cognitive activities as much as they are now.

I mean, now women run their own businesses, they go to school and they're more empowered and they have lives, very complex lives and challenging lives to take care of. I think that really gives them the opportunity to build resilient brains and it has been ignored profoundly.

We now know that men and women, when people actually engage in complex and challenging activities, they literally have bigger brains, and that translates to better neuropsychological test scores, better memory, better attention, better focus, and lower risk of cognitive impairment later on in life as well.

There are so many different studies, whether it's the London taxi driver studies, which showed that taxi drivers that were in their 50s, so not very, very young, they were in their mid-50s and 60s, and they took a very extensive and a very difficult test called the Knowledge, for those of you who will live in London, you guys know that there's really no system in London, and they had to memorize each street and home and everything else, when they went through that extensive testing, compared to bus drivers who had a specific route, they literally grew their brain, their hippocampus and their frontal lobe actually grew in size.

They had a lower risk of having bad scores in their memory testing. That's just one example. I think it's very important for us to talk about that on a regular basis. What does that mean to us on our daily basis? It means that women should not resort to just engaging with the same thing over and over again, challenging yourselves, learning a new musical instrument, creating a community, joining a group, volunteering, playing games with friends, anything that is done in a social setting is actually much better, but then there are introverts that don't want to be a part of a society, that's okay.

Anything that is challenging, that is complex, and is connected to your purpose, your meaning in life can create resilient and stronger brains. I think if that's not there, and if we've taken care of everything else, I think that should be an easy way to add on to it because even at this age of being connected virtually, there are so many different elements that we could enter our lives for better and more resilient brains.

Michelle MacDonald: Beautiful. Thank you so much. Thank you so much. I know I picked your brain and I literally, especially because you said, “No hacks, we got to go deep here,” and I feel like we just scratched the surface. But I hope people listening have felt like they've got a lot of very practical take-home from somebody who is truly an expert in the field of neurology and hopefully, I'll be able to get you back on the show. Thank you so much, Ayesha, for sitting down with us and sharing your incredible vast knowledge. Thank you.

Ayesha Sherzai: That's very kind of you. Thank you so much, Michelle, for having me and for creating this platform where you're sharing all this amazing information with your community. I appreciate you.

Michelle MacDonald: Thank you so much. Another great show covering practical tips based on science for improving your health, this time focusing on the brain. Make sure to check out the show notes. We've put links to all the information covered in the show, including how to follow Ayesha and join her NEURO Academy.

Please share this episode on your socials and send it to friends who need to hear some positive information on aging well. Don't forget, we're accepting applications for our signature 24-week transformation program. You don't want to miss out.