Hi everyone. I'm Katie Kuric, and this is next question. You know, I've known and admire Dr Sanjay Gupta for years. He's such a great guy. He's also a neuroscientist and the chief medical correspondent for CNN, which, as you can imagine, when COVID hit put him at the center of the pandemic storm. This may be a new pathogen that circulates around the world. You're running into a situation where you just don't have beds. If those numbers don't budge, it's gonna be very hard to get to hurt immunity. I think this has added a lot more urgency to an already very urgent situation. There has been so much to cover. In fact, Sanjay also launched a daily podcast on the subject. I'm Dr Sanjay Gupta, CNN's chief medical correspondent, and this is coronavirus fact versus fiction. Throughout this very long year, Sanja has really acted as our guide, helping us understand the thorny virus and what it means for our health, our communities, and our country. And he admits it's been as all consuming as you might think. All I think about, Katie has been COVID. You know, I viral transmission, how people evaluate risk social behavior. But there is some joy in getting so head down in something. I feel like we live such distracted lives. You get a little bit about a lot of things, like I really know so much about this virus. I also wanted to talk to Sanjay because he's got a new book out. Yeah, believe it or not, he found time to write a book during this crazy year. It's called Keep Sharp, Building a Better Brain at any Age, and it's fascinating. It's also a practical guide for better brain health, something I'm extremely interested in. And don't worry, we do get into that, but since I have the COVID expert of experts, I couldn't help but start our conversation there. You must feel like you you have a PhD in virology at this point, right, Yeah, I mean totally and and and the the irony is, Katie, is that this is a novel virus, right, So I mean novel actually means something, which which that didn't really strike me until a few months into this either, Like I think because you said the PhD in virology. The the irony is that that I think people who had a lot of knowledge about this. In some ways it got in their way because it's very hard to think about something as novel. You immediately want to put it into a box. It's the box of stars, it's the box of H one, N one, whatever you come up with. But this was novel, which means that if you try to put it in a box, you probably got it wrong. So they had to cast aside their preconceived notions completely, and that's hard to do, right for a scientist, it's really hard to do, and and it goes against sort of how you think about things. Let's get the best experts. And by the way, I think there's really really value, great value and expertise. Don't get me wrong, But what you would do is grab the coronavirus experts, grabbed the pandemic experts, and that was all important. But this virus was just behaving in a totally novel way. I mean. One of the best examples, as you well know, was everybody believed that respiratory virus is really only spread when you were sick. When you were when you had symptoms, that's when you spread. And you know, the guidance was, will screen people at airports, will tell people to stay home if they're sick, which people should do anyway, regardless of whether in a pandemic, and we should be able to quell this thing. No one really believed initially that this thing would spread most efficiently when people didn't have symptoms. That that was that's never really happened before, is it. As Dr Fauci has said, never in the history of respiratory viruses has that happened before. That's novel. I mean, you know, remember the story of typhoid Mary. She was a silent carrier of typhoid. It was so dramatic because she infected all these people in this single residents in this community and all that, and people couldn't figure it out. This is like millions of typhoid Mary's in a way of a of a brand new disease, COVID, So it is it was quite extraordinary to sort of see that, uh, see see how that all played out. Well, before we talk about your your new book, keep sharp, because I'm really interested, as someone who's sixty four, in maintaining my mental acuity as i age. I just want to ask you one last question about COVID, and that is, are we seeing the light at the end of the tunnel. Every time I feel optimistic, sang, I then read something about variance or increased cases, and it's quite nerve racking, I think for the average person who doesn't have a medical degree or hasn't been deeply, deeply entrenched in the science of this, I mean, are we screwed? Are we at the tail end of this pandemic? I do feel the light on my face, in your face. I mean, I do think that the the tunnel is is the end of the tunnels in sight? I mean, the then can I just can I just remind people, and I think this is such an important reminder that they were having rave parties in Wuhan at the end of last summer. And I bring that up only to say that we talked about the vaccines. We talked about the fact that science is now rescuing us, which is great, fantastic, but so much of this didn't need to happen. And I and I and I know that's not your question, Katie, but I just feel like I can never answer a question about um, about the sort of future or being optimistic about this pandemic because I'm so it's just so, it's so, I'm so angry in so many ways. I mean, you know, six people died and some of them are my friends. And I've seen families, I talk to families still, I just it just this may not have even been the Black Swan event, right, we think of this black Swan event, this really contagious virus, which this was, but something that has a two to three percent mortality that would be awful, that would be the Black Swan event. This wasn't even that. There were countries around the world that immediately quelled this and measure their debts in the hundreds instead of the hundreds of thousands. Having said that, we are a society. Because we are we focus on touchdowns and home runs and knockouts. We don't care much for singles and doubles. Because we're that society. We waited for science to rescue us. And and the vaccines will. I think they're really extraordinary and really effective. They seem to be pretty effective against the variant B one one seven, the UK variant, because there's a lot of concern about that variant. But if you have been vaccinated, or if you had the infection in the past, the other you know, the the circulating coronavirus that should also protect you. So it's really I think it's really good. And I think with the warmer, warmer weather in the summer, viral transmission rates will go down. That would be great. I do think, you know, um, we'll probably get to hurt immunity over the summer, but but it's worth reminding that her immunity isn't a sort of destination. Necessarily. You can pop in and out of her immunity. So if not enough people get vaccinated over you know, the next few months, then going into the colder weather again in the fall, we could see resurgences. It's quite disturbing when you hear about the people who are refusing to get vaccinated. Many of them are white men, Uh, in this country. I think you see the impact of politics on that number, not only in terms of the response to the pandemic, but now to the response to the vaccines. Uh. That must be quite disturbing for you too, it is for me. Yeah. I mean there's been no not a single part of this entire pandemic that hasn't been politicized in some way. I mean that I guess now you say that's in in April of two one, and it's obvious, right, everyone knows that, but started starting off covering the story, um and now all the way now to the vaccines, even every single component has been politicized in some way. So it is it is disturbing the anti vax movement. And you may not even remember this, Katie, but I actually did a segment on your your show years ago about anti vaccination movement at that time around h one and one. But it's been around for a long time, the anti vaccination movement, and it's sort of you know, it simmers it. We saw measles outbreaks in Brooklyn and and Disneyland and Minnesota. This seems bigger though you know that was a particular group, uh, and it really dealt primarily with childhood vaccinations and now this has expanded to um, you know, these adults who I don't know for one reason or another. I think you can understand people of color and the terrible history of Tuskegee and some of the ways that people of color have been abused in scientific research in the past, and this kind of deeply ingrained mistrust of the medical community. So I think you can appreciate that. But this is, you know, this is a whole other ball of wax, isn't it? Yes, it really is. And and you know we're we're seeing some of this for or really seeing it come to light, I should say, you know, in a in a pretty dramatic way. Now. I think I think I was reading the statistics this morning, Katie Kaiser Family Foundation, forty of those in rural areas who say they absolutely will not take the vaccine. It's not any question of hey, I want more information, I want to see how this plays out. They're just saying, out of the gate they absolutely not take it. And what said, what is the explanation? That's the curious thing, Like you said, with some people who are vaccine hesitants, it is concerns about safety or mistrust or you know, uh my my grandfather was experimented on as part of Tuskegee, you know, things like that. With this, I think it's almost an extension of this pandemic. Isn't even real. It's not a hoax. Why would I take a vaccine for something that's a hoax. I'm not scared for safety of it. I just don't. I think the whole thing is sort of you know, the scam demic sort of thing. So I don't know if that's the case. For it's a huge percentage of people were talking about here, so maybe there's a some heterogeneity, you know, some variety of opinions there. But bottom line, if if, if the numbers stay that high, we're not going to get to hurt immunity based on vaccinating adults alone, which is it's it's it's so. I mean, gosh, we wait for science to rescue us. We don't do the basic public health practices, and then when when this truly extraordinary scientific achievement occurs in the form of this vaccine, people don't take it. You know, if you are a Martian coming to planet Earth and saying, so, let me get this straight. So you didn't do anything about the virus. You waited, created this amazing medicine, and then you don't take the medicine to it. Just it doesn't make any sense. It's a head scratcher for sure. When do you think Sanjay will be able to go about our daily lives without mass I think it'll be this summer, Katie, I I really do. I mean, I know that there's people who are painting a more dire prediction around that, but you know, we for no other reason alone with the warmer weather, and then you're gonna really see the blunting despite the vaccine hesitancy that we're talking about. You are going to see a significant blunting of people who are getting very sick, people who are dying. And we know that the the vaccine does seem to have good evidence that it stops or decreases transmission. So I think we're really going to get to a pretty good point. I think you'll still see masks around, you know, in in Hong Kong after Hong Kong really wasn't a mask wearing country until after Stars and then there was this huge psychological impact. That's why they went to mass so early in Hong Kong, but they became a mask wearing culture. I think you will see people who are just frightened still want to wear masks in public places. I think in flu season, you know, the colder months, I think you'll see more masks. I think that may become a a larger part of our culture. Not a dominant, but I think a larger part of our culture. That's interesting because I remember being in Tokyo maybe gosh, gosh, maybe ten ten or twelve years ago and going on the train to Kyoto and seeing everyone wearing masks and thinking this is so weird. Why are they wearing masks? And now, of course I understand, and you're right. I think when people are on places like public transportation, if they're in a closed spaces with lots of strangers, Um, it actually makes sense, doesn't it. I mean, you know, one thing we saw, as you may remember, is that the flu numbers were way down this past season, and that you know that that wasn't because of any increase in in vaccination or anything. That was because of just public health behavior. It's always worked, you know. I don't know there's a metaphor for this, Katie, right, I mean we I don't know. I guess it's true in our lives, like we'd rather just take a pill for weight loss rather than go exercise, and we always want the convenience. And and this is this is another example of that. We I I was struck. And again, we can talk about COVID all day long, but the but the I'll never forget these these mask researchers from Harvard, a guy named Abera Kuran. He basically was doing all this modeling all along. We were talking to him. He told me that if for four weeks, and this is back, you know, October November of last year, if for four weeks everybody just wore a high filtration mask when they went out in public, that's it. For four weeks, if everybody did that, it would have ended the pandemic. Are you kidding? That's incredible. The virus would have nowhere to go. It couldn't find a willing host. I mean, you know that that that sort of that sort of concept is something that's more than a hundred years old. I just I just don't quite you know, I don't know. Maybe I'm just being naive, But but you hear that and you think it's amazing, right, I think it's amazing. And yet we also know both of us that in the United States that couldn't happen. It just wouldn't happen. I mean, human being survived and thrived as a species because we're reciprocally altruistic. There's a reason that it feels good to do good. Why should it feel good when I do something nice for you? I mean, what purposes that serve my evolutionary tree? I don't know, But the reality is that it does feel good to do good. We encoded that in some way in our DNA and then people can't be bothered to wear a mask to save tens of thousands of lives. I just I'll that may be one of the greatest mysteries of all out of this whole thing. Well, I just want to say, on on behalf of the American public, thank you for your coverage of this UM. I think you're so measured and uh so eloquent and and honestly calming in a way, and I just really appreciate all the fantastic reporting you've done throughout this pandemic. So on behalf of a grateful America, I would like to say thank you, Sancho Gupta, Well, Katie, thank you, thank you, And that obviously means a great deal in particular coming from you, So I appreciate that you know, you get it. You know, I mean, you're you are the standard obviously by whom we all measure ourselves. But also you know you were all in these black holes, right I mean, I don't know where you are right now. As I said, I'm in this tiny little closet. I don't you don't get any feedback. Sometimes it's been really dispiriting because you think, Okay, I'm a medical reporter in the middle of a pandemic, that that is my you know, that's a job. And at the same time, the country in which I'm reporting arguably did the worst in the world. I mean, I know I keep taking this in that direction, but it's just so dispiriting. Did I did anyone listen to me? I mean, if if, if you're the medical reporter and presumably people are are counting on you to provide knowledge hopefully that will inform how they behave and then we do the worst in the world. That's that's you know, I'm going to need to reflect on that. I think, you know, in the years to come, like what is the real impact here? One could argue that maybe it would have been worse, who knows, you know, but it's pretty bad. Well, don't get too dispirited, because I think a lot of people listen, relied on you, and actually acted. So even though the track record was bad, your information was good and important. So thank you. I appreciate that. When we come back Sanja and I find some optimism and believe it or not, brain health, that's right after this, let's talk about keep sharp because moving forward, I think many people like me really are interested in how to keep our cognitive and mental health at the top. And I think you know, certainly, one big change in medicine is that we as patients are not passive. It turns out, Sang, that there is a lot of things that we can do to keep our brains in shape, just like we can do to keep our bodies and our organs and other things in shape. And that's why you broke keep Sharp. But you have a very very personal connection to this, I guess, well, obviously because of your specialty, but particularly about Alzheimer's dementia and are failing brain power that happens as we age. Tell me about that. Well, when I was when I was twelve thirteen years old, my grandfather, my my mother's dad, who I was very close to, um developed, you know, signs of dementia. He had had a a stroke earlier in his life that had recovered and was now developing. You know, just these these um periods of time where he he really wasn't aware of what was going on. He would sometimes, uh make a joke that no one else was in on, you know, and it was all these things that that I remember really being struck by as a kid, because you look at adults and you're not used to seeing brain power start to diminish. And it was the first time I saw really specific things like he could he could still um right, but he couldn't really read. It was it was all these things that became really fascinating in a way for me in terms of just how does the brain work like that? But also to see it in a loved one to wonder, is that how genetic is that? Is? That? Is my mom going to develop those symptoms? While I one day all of that and then you know, fast forward, you know, thirty forty years later, and and we're still worrying about the exact same things, and and I haven't really made a lot of progress in terms of being able to deal with that. So that was that was a large part of what I think inspired me to to to write the book What has Happened over the last forty years? Both from a, you know, a pharmaceutical standpoint, but also more importantly, I think from a from a lifestyle behavioral standpoint in terms of what we know and how did that influence you to go into neurology? No, you know it's funny, Um, it didn't. I actually when I started medical medical school, I thought I was going to go into pediatrics, and then I did a neurosurgery rotation, uh during my third year of med school, and I just sort of fell in love. So I came to it quite late. But I was always interested in the brain because of my grandfather, and so it felt like a very natural fit. Let's talk about the numbers. Because seven million Americans have some evidence of pre clinical Alzheimer's disease, and by two sixty one new case of dementia will be diagnosed every four seconds. SANJ, what the heck is going on here? Well, this is this will become the most dominant neurodegenerative disease of our time. I think that that part, I think is is pretty well established at this point. But there was two things about the statement that you just made that I thought were really important in terms of what we can potentially do about it. As you point out, there's probably about forty seven million people who if you were to look at their brains, they would have objective evidence of plaques and tangles and things like that, but also have no symptoms. That's the pre clinical time, right, so out a little well, it's you know, but I think this is ultimately good news, and I'll tell you why. If you look at patients with Alzheimer's disease and and and able to retrospectively look at their lives and their scans and their brains, you find we now know that that Alzheimer's starts in the brain decades before people develop symptoms. Decades so you're starting to see the kindling and then even plaques and tangles. But the fundamental point that neuroscientists really started to focus on was almost the the the analog of that, meaning, Okay, so now you've established that you can have a brain that has plaques and tangles but still functions normally. So why don't we focus on that side of things instead of saying, hey, look, let's get rid of the plaques and tangles, and we have spent billions of dollars testing drugs to do that that haven't really worked. What if we say, instead, we have established that a brain with plaques and tangles can function normally. Let's figure out why and see if we can basically make that an aspiration. Do you still have objective evidence of Alzheimer's in your brain. Yes? Is it consequential? No, because you know you you are able to still have normal cognitive function, memory, judgment, all the things that you associate with a healthy functioning brain. The metaphor, in some ways, Katie would kind of be like a heart bypass surgery. You've got a block blood vessel. Now you you go in there and you bypass that area of the blockage with a new blood vessel. Do you still have heart disease? Yes? Is it? Is it? Is it causing you some dysfunction? No, because you're getting enough blood flow now to the heart. If you can think about that same metaphor for the brain, Yes, you have plaques, but there's so many ways to build all these new pathways in the brain to your destination, that little blockages due to the plaques becoming consequential. So is there a tipping point? You know you talk about these tangles and plaques in your brain. Um, is it just a slow growth of plaque or slow accumulation of plaque and increase kind of tangles that then lead you from being perfectly functioning? You know, maybe some memory issues right that once in a while, you you know you're not quite as sharp as you were as you when you were younger. But where you kind of fall off or it's just gradual build up of this gunk in your brain, it's it's it does seem to be a pretty gradual build up, and you can tolerate a significant amount of build up before you I guess as you as you say, fall off. You know, so what exactly then pushes people over? It's not all of a sudden you have an exponentially more plaque, and that leads to the problem. Maybe for different people it's a different inflection point. But the brain is actually quite resilient. I mean, that's the thing that came out of this. Even with a lot of plaque and tangle, you could actually be doing fairly well. I mean the occasional memory lapse, like you say, which is probably do more to inattention than even anything organic in the brain, but other than that doing pretty well. And you see societies around the world where arguably brain function not only is it good, it may be improving as you get older, which is so incredible, and that I think is one of the hopeful things about this book, that that our brains can get sharper and better as we age and dementia is not necessarily an inevitable, you know, consequence of old age. So um, you know, I remember reading Sanjay how your brain like by the time you're twenty three or twenty four and then your prefrontal frontal lobe and all this thing that has to stuff that has to do with judgment, Like after that, your brain really stops absorbing and growing and changing. I mean that was sort of what I always thought, and then it was downhill from there. But but this book is really cause for celebration in some ways, right, right, absolutely, you know I was told the same thing. Right, You've got a certain number of neurons in your brain, and then you're going to drain the cash as you go through life. Certain things is like drinking alcohol and things like that are gonna kill more brain cells. You're never going to get them back. I think that's what our parents told us to keep us front drink. It works well to some extent, but the the you know it, but that that part of it is not true, and that that may be one of the most fundamental new things that we learned. And by the way, you'll appreciate this, Katie, I'm in some ways this book, I'm acting as translator. I go to these neuroscience meetings because that you know, I live this bifurcated life between medicine and media. But I'm still going to these neuroscience meetings and they're talking about these fascinating developments, and yet that hasn't really gotten to the to the lay public yet. So it's about a ten year gap in some ways. Keep Sharp is to just accelerate that that knowledge tree. But one of the things that they've been talking about is exactly what you mentioned, which is neurogenesis. Everyone's heard of neuroplasticity, which basically means you can recruit neurons, brain cells from other areas of the brain to do new functions. This is actually growing new brain cells, and we were told throughout our lives that it basically happened twice. You know, when you were a baby in your brain was still forming, and maybe after an injury like a stroke or traumatic brain injury, there may be a process of neurogenesis that occurs. But what these these neuroscientists have have really I've been writing about and focused on for some time is that at any age, a healthy brain can continue to grow new brain cells. You really can't say that about any other organ in the body. So it's quite incredible. The stem cell surges, the various growth factors, all these things that converge to allow you to grow new brain cells at any age. That to me was deeply inspiring. It's super exciting. But let me dis backtrack for one moment, just so I understand the difference between neuroplasticity and neurogenesis. Um, explain it like I'm a fifth grade Okay, So you know, when you think of neuroplasticity, it's more like your brain is is like plastic it's it's can be molded. So let's say there's been an area of your brain where someone had an injury or a stroke or something. You could sort of mold another part of the brain to to fill the game, compensate, compensate, Yeah, exactly. You know. Take so if it was motor strength, for example, on the right side of your body that was affected, cells, brain cells that normally don't do motor function, they're not responsible for motor function, could be recruited to do that sort of work. Or a sense. You know, even if you lose a sense, other senses can start to become heightened or even create, right. You hear that with blind people, you know, in terms of a heightened uh sense of I guess all kinds of senses, right, that compensate for the fact that you can't see exactly and that and that is a that is a It's an amazing concept. It's what sort of gives real birth to physical therapy, to cognitive therapy. We're using these therapies to basically recruit neurons from other parts of your brain to do something. The human is so amazing, isn't it. It continues to wonder and delight me every day. And I've been thinking about this for forty years, you know, I love it. Um Neurogenesis is the growth of new brain cells. So this this, this, this flies in the face of what we were all told when we were young, that you only have a certain number of brain cells and that's it. This is basically saying you can create new brain cells at any age. The metaphor I think that may make it more more accessible, is right now, our COVID life is kind of like how our brain operates. And what I mean is that you probably are at home. You may drive to the grocery store. Maybe you drive to a couple of different places and you but you're not You're you're mostly in in just a small, small square sort of area of place. You know how to get to all those places really well. You could drive there with your eyes closed, no problem. But but you you're not traveling around the rest of the world. You're not even traveling around the rest of the state right now. That's kind of how our brains are. We use our whole brain, but the time we're using our brains. That's the thing. If you start to actually do things to inspire neurogenesis in your brain, it's kind of like building new cities and visiting those new cities in your brain. It's it's it's a it's a little bit of a simplistic metaphor, but it makes me really happy to think about because visiting other places in your brain is an incredibly joyous thing. You start to see patterns that you would have otherwise missed. You connect dots, you're thinking is clearer, and and and that's the whole concept of of of what neurogenesis can do for you. When we come back Sanche's advice on how to keep our brains strong, especially as we age. We'll take me on a trip, do and how can I visit these new places in my brain? Because this is really exciting And um, I know your book has a lot of recommendations for ways that we can encourage neurochantesis. So what do I do? Son J? Yeah, so you know. The way I'll tell you the way that I wrote the book was I took all these these neuroscience concepts and try to make them accessible and also help you set up a substrate for your brain in terms of, you know, how you nourish yourself, how you rest your brain, things like that. So the basics are there, but your question is more about taking the trip and building the new brain cells. So after you sort of you know, make sure and it's not challenging to get to the right sort of place in terms of your diet, you know, uh, and and the amount of rest that you need. That's important. But the biggest I think difference with growing new brain cells versus how we typically think about strengthening our brain is that you don't necessarily want to just keep doing the same things over and over again. The whole practice makes perfect sort of teaching the killing drill sort of teaching that a lot of schools focus on. It's important to to understand and and be able to learn concepts. But that's kind of like those roads I was talking about that you travel so well, that's like getting even better at traveling those same roads. Now you can really do with your eyes closed. Now you know it's it's it's totally second nature to you. But if you were to do different things, totally different things, things that get you out of your comfort zone a little bit, a totally different sort of hobby, that's when you're starting to actually build some of these new brain cells, create some of these new cities, create some of the new roads, whatever, whatever metaphor you want to apply to it. That's that's a much better way to sort of do that versus the practice makes perfect. So if practice makes perfect, change is what's going to build the neurogenesis. It's going to build the resili and redundancy in your brain. So I played the piano. Should I not focus as much on the piano because I thought about taking lessons even though I took for ten years and I played by ear, But I enjoyed the piano, And we actually have a beautiful piano that Jay and I bought each other for our birthdays back in the day. Yeah, and but but should I learn how to play the guitar or the viol The violence sounds just horrible if you're not good at it. But what do you mean, should I try a new instrument? Yeah? You know, so I asked a lot of neuroscientists about this, because one thing about writing a book like this is that it affects everybody, right, So even the guys and gals who are who are doing all this research, they're thinking about what to incorporate into their own lives. And there are a couple of things that sort of jumped out at me. One is that something new is I think really important. That's that's that that is a key, But something that you can also use your hands with that you're actually activating your motor motor cortex as you're doing, seems to be even more beneficial. So so an instrument is great, um painting, Try a new one because a new one? Yes, I mean I mean the piano again. I want to be careful here. I did this Bill Clinton. I was talking to him about brain health the other day and he got on my case because he said he loves crossword puzzles, and he's like, so you tell me crossword puzzles are not good for No, No, I'm not saying don't do those things. But understand what you're accomplishing. You are you are. You're paving those roads really really well on your brain, and that is great, there's great value in that. But if it is true that you can build all these new roads, and the question you're asking me is how to do that, then it would be it would mean doing something different. So I'm not saying stop playing the piano, keep driving those roads, but if you want to start going on these trips around your brain, doing something different, and preferably doing it in a way that maybe even a little uncomfortable. So if you're painting, and I just bring up painting, because this is the one that came up set all times among these neuroscientists. Learn how to paint. I'm a terrible artist. Learn how to paint, do whatever you can, and do it with your non dominant hand. Yes, this was another. In fact, they went so far as to say that tonight at dinner, when you're eating your dinner, try eating your meal with your non dominant hand. And just see what happens. And it's really interesting, Katie, because we think of building the brain means reading books and gaining new knowledge, and that's true, but in terms of actually creating neurogenesis, it's more like you think about a physical workout. I'm gonna do something different and I'm going to actually now focus the less side of my brain, which normally isn't doing motor function. That's delicate or fine. On actually doing that sort of stuff, it has real relevance because again, you're you're actually building these roads in these cities in your brain, and that's fun. Try it. It's fun. But on a more practical level. To your original question, Let's say one day the road that you drive so well becomes locked by one of these amyloid plaques that we're talking about, some of these tangles. Right now, you know that road really well, but you know what, you don't really have other roads to get from point A to point B. If you've been building all these roads by painting with your left hand and spilling your food, but by eating with your non dominant hand, whatever it might be, you're actually building roads. This gets back to the bypass analogy. Do you still have flacks and tangles in your brain. Yes, So are these the cognitive reserves that you're talking about, Yes, the cognitive reserves, the cognitive resiliency, which is often they often use these terms interchangeably, but that's exactly it. We have the capacity to to have significant cognitive reserve. We're barely tapping into that. If you look at societies around the world where people are living into their nineties and hundreds and have hardly any dementia. The presumption now is that if you were to image their brains, they might have plaques and tangles. If you're doing autopsy, they may be diagnosed with all Heimers, because that's how Alzheimer's was diagnosed, was that autopsy. But the truth of the matter is that during their lives they had perfectly normal cognitive function. Before we talk about your twelve week program, I'm just curious in terms of diagnostic advances and and therapeutic advances. I mean, will we get to a point where someone can have a brain scan and say, Okay, here's the status of your tangles and plaques, and here's what you need to do. Because brain imagery, you know, I've ways found it so interesting even when you talk about like antidepressants and you know, serotonin reuptake inhibitors or whatever they're called ss is. Yeah, that that you know, there was never a way until recently to kind of measure how the brain was reacting. They would just kind of it would be very anecdotal, you kind of throw it against the wall to see what sticks. And now we have so much better brain imagery. So will that translate into dimension all time person and preventative strategies that we could follow. I think, I think so. I mean, we're we're making a lot of progress on brain imaging, and you're absolutely right. I mean, the brain has long been sort of considered this black box only measured by its inputs and its outputs. You really couldn't get a good idea of its internal machinery. But now we can. I mean, I don't know that we're at the point yet where we can determine degree of severity of of dementia based on a scan, and as I think we will. We think we'll get to that point. I think we'll get to the point where we can very quantifiably measure the burden of plaques and tangles and other things in the brain. But well, but Again, what I think is so extraordinary, Katie, is that you could have two people with the exact same scan essentially and very different clinical pictures. One person may be completely debilitated, obviously having dementia, and the other person may be functionally cognitively normal. And again, I look, do I don't want to I don't want to have flax and tangles in my brain. But mostly what I don't want to have is the cognitive dysfunction that comes with that. It's a different way of thinking. It really is, like I think, again, we focus so much on making someone's images look better or whatever, and what the person really wants is them to be better, and there are ways to do that, you know, with lifestyle changes. I mean, I'm a neurosurgeon saying this, by the way, just remember that because I'm a specialist. That's that's what I was trying to do. And yet I'm now becoming increasingly convinced that these types of changes that we talked about in this book really can can prevent you from developing the symptoms I was going to say. So you're saying that brain scans are just part of the story. It's sort of like it's half of the story because even with them, you could have these cognitive reserves developed and be very asymptomatic. Well, let's talk about this twelve week program. Sharp take us through this deeps because I'm all ears. It's it's twelve weeks where I basically based on how I think your brain is going to change and and react to things that you're now doing that are different or new. Um, it all sort of builds on itself. I start off by really making sure you get the basics right, and I'll tell you it's it's not that complicated. There are a few big messages in terms of the overall getting it the substrate right, and as you might guess, diet nourishment is one of them. But but the big the big takeaway here is I think generally people know what a healthy diet is, and for those who don't, there's some information in there about what's specifically healthy for the brain. There are some distinctions between the brain and the body in this regard. One is one is sugar. Um. You know, we we we talk a lot about sugar, and people know that they shouldn't need too much sugar. We used to get sugar, you know, twice a year when fruit fell from the trees. Even honey was protected by the bees. And now we're eating a hundred and thirty pounds a year on average of sugar. But what was what was a learning point for me was that the brain is exquisitely sensitive to sugar. So typically you eat a lot of sugar and you think, well, that's being absorbed into cells. I have a lot of energy, whatever it might be. These these are these are a lot of calories that are now providing the energy the brain. As soon as sugar levels get beyond a certain point, and it's a pretty narrow range, the receptors basically shut down. So you could run into a situation where you're taking in a lot of calories, a lot of energy, and starving your brain at the same time. And that that is a situation that leads to a whole a whole cascade of events that you can pretty easily avoid. So that's you know, as much as I talk about in the first few weeks of what to do, there are several things that you're told not to do just to avoid and that's that's more than half the battle, and they're not that hard to do. I also try to make the case for things like sleep, which you've read a lot about I've read a lot about, but reminding people just how metabolically active the brain is during sleep, and this wonderful conversation that I'm having with you right now will be encoded into my hippocampus if I get good sleep tonight, so that twenty years from now I can recall this and remember it. A lot of times people say that they can't remember something. It's not that they can't remember that, it's not that they forgot it, it's that they never actually stored it in their memory centers in the first place. So these are strategies to help that. But then, you know, sort of the midpoint of the book is really about and the the evidence based things that we know improve brain health. Starts off by asking you to define what you think a healthy brain is. What is a healthy brain? We know what a healthy heart is, it pumps a certain amount of blood out with each beat. What is a healthy brain? You know? And and I spend a little bit of time talking through talking the reader through how they define that, because it is different for different people. Robert Zapolski, who is this evolutionary biologist, I was interviewing him, and he and her forget. He said to me that a healthy brain is a is a is a brain that has a bigger circle of you, is what he said, which basically means you let more people into your circle. Now why is that relevant. Well, it's relevant in you know, ancient times because you were more likely to be protected by the group. But now it's this idea of what true connection does for for protection of the brain. And and and now to your earlier point, measurable. You know, a lot of what we talked about is based on objective data that we couldn't collect some time ago. But I will tell you something fascinating because I find this this topic really interesting. But there's this loneliness researcher named Stephanie Cacciope. She's an oregan. I know. I at the in Chicago. Her husband was one of the pre eminent scientists about memory, and then he died, died, I know. And now she's an oregan. And I talked to her from time to time. It's been tough, as you might imagine. And she's by herself an Oregon, which you know, has a loneliness. Researchers through this pandemic has been such a significant thing for her. But she said this thing to me that I'll never forget, and and and I talk a little bit about it in the book, which is we talk about connection, like right now, you and I get to zoom and have this call about you know this, this conversation that's very interesting to me. Most connections that we have with friends, maybe even family to some extent, are pretty cursory. How you doing, I'm doing fine. How you doing, I'm doing fine. You know. It's it's how do you get to a level of more profound connection, because it wasn't. As you've well heard, it's not about the number of connections you have. It's about the quality. But what does that mean quality? And one thing Stephanie said to me was a sort of shortcut to building the quality and the high intensity connection is to be vulnerable, to ask for help, to share your problems, which is totally counterintuitive to how I think about things. I would rather not burden somebody with things. But I took it to heart. And I was talking my parents, who are in their late seventies in Florida through this pandemic, and we were having those conversations how you do and how the girls. That was the conversation for months, and I said to them, I asked them a question about a problem I was having one of my cars that my wife's car had some smoke coming from the hood. They're both engineers, and for days, Katie, we started to have these really interesting conversations about cars, about their history of being interested in engineering, in all this stuff, figure out the way to build the meaningful connection um that that is. That is probably one of the most critical points, and and they're there pretty easy ways to do it. I think the point is connection, deep connection is good for your brain, yes, and good for you, and I think you know it's good for you in general. So the last part of the twelve week program, I'll just tell you quickly, is more about what we started talking about initially, which is, then, how do you create Now that I've primed your brain for neurogenesis, giving you all the right amounts of the right hormones, not too much epinephrin, but enough oxytocin, and all that sort of is happening by going through the first few weeks of the program, Now how do you build the new brain cells? And that gets to a lot of what we're talking about in terms of that cognitive reserve. You know, actually, um uh, doing these different types of activities, doing similar activities in a totally different way, doing things with different people, doing them in at different times, eliminating certain things completely from your regiment for a while, adding in something totally unrelated. It's it was fascinating to me. I tried it. I based this entire thing on my conversations with these neuroscientists who all tried it and written about it and published it in journals. It's fun, It's a fun ride. I was gonna say, so, give me some ideas real quickly before we go about things I could do. Should I take a pottery class, Should I learn Italian? Should I pick up the guitar? What should I do? I think that, you know, I think the two big ingredients are it's would be something you really haven't done before. This isn't about trying to again build a two lane highway where you're used to driving one. This is about getting to you know, to Italy instead of staying in New York or or going somewhere even different in Argentina, you know, totally different. If you can do something that involves your your your hands, like pottery or painting. Even better, that was something that came up over and over again. And then the second ingredient, I guess, and this is a little bit more vague, is that it's it's good if it makes you a little uncomfortable. I And I know that sounds almost euphemistic or too easy or too simple, but the whole point is that when you start to release certain hormones in the body, like some stress hormone, stress can be good. It really helps that process of neurogenesis. So a little bit of discomfort with something totally new, preferably using your hands, that's a pretty good prescription. Before we go, can you tell me about foods that are healthy brain foods? I know that you hear about fish, you hear about nuts, you hear about extra virgin olive oil. Are all those things sort of good brain food? And what else should I be eating other than staying away from the cupcakes? Yeah? Nor Yes, definitely the sugar thing I mentioned already, So I mean that's just that's just a I think you could accomplish sev of all the other things by basically just eliminating added sugar from your diet. But I think the adage what is good for the heart is good for the brain remains true. But I think with the brain there are a few a few distinctions. One is, if an apple a day keeps a doctor away, then berries are what's good for the brain. Berries really good data around berries. Really start to add berries into your diet. I think that's one of the big ones. And while most of the neuroscientists did not advocate a caloric restriction diet, necessarily a calorie reduced diet overall to the extent that you can do it. We create a lot of metabolic byproducts from from overeating, and a lot of those metabolic byproducts get accumulated in the brain. So if you can cut down on the amount of energy that has to be metabolized in that way, you can make a lot of progress. Even though berries may be good for your brain. You don't believe in this whole idea of supplements or superfoods, do you, now? I you know. I think super food first of all, is a really vaguely defined term. As part of this book, I asked a lot of people, and I even talked to your friend Mark Hyman about this as well. It's it doesn't it doesn't have a really objective meaning. There are some foods that are maybe better than others. But I think the thing about supplements that struck me was was the idea that for certain people who have deficiencies, then supplementing that part of their diets important. But you know, Katie, in this country, and I'm not advocating this, but in this country, even the standard American diet, like if you go to a McDonald's, even the food is largely fortified, you know, with all these different vitamins and micronutrients and things like that. That that is a decision that our US d A made decades ago to fortify food so that people wouldn't develop basic nutritional deficiencies. So oftentimes we're supplementing something that doesn't need to be supplemented. A lot of a lot of the approaches more in terms of what you're not eating versus what you are eating, and that that you know that holds up to be true. So berries I single out because they are one of these foods whose active ingredients are particularly good at crossing the blood brain barrier, particularly good at creating these scaffoldings, you know, for the neurogenesis that we talked about earlier, So I put that high on the list. But what about you know, I see this stuff in the drug store and I'm like, Oh, should I be taking like privig in or should I be taking what is it like? Almost isn't it like jellyfish to run derivatives and stuff? And I'm like, should I be doing that? Well? You know, I the privileged one is interesting because you know, Eric Kendell is very involved with this, and he's a very prominent neuroscientists did a lot of the original jellyfish research basically trying to figure out where the memory stores were in jellyfish, how jellyfish remembered, and isolating those stores and basically creating a supplement. It's a fascinating idea. I don't know that it really works. I mean, it's very hard to study this sort of thing. You know, it takes decades long studies to prove that something like that's improving memory. What we do have is is decades long data on societies around the world where dementia is essentially so rare that it's reportable. You know, if somebody developed dementia, you'd report that in the medical journal. But my my point is though that with these we don't need to have the supplements. We know it's possible to be done because we see it having already transpired real time and large societies across the world, and in those societies, you know, I took the neuroscientific data that we had and tried to see, are are they in some ways applying that unwittingly? I mean they didn't read these papers obviously, but were they sort of just by default essentially following that that right diet, following that right amount of movement, following the right amount of rest. So movement, for example, I'll just tell you this was an interesting one. If you look at movement, it's probably the only thing that has has the longest amount of evidence behind it in terms of actually creating neurogenesis. All of this is new research, but that that's sort of the oldest new research. But what was fascinating to me was that what does movement mean to people? Right? I use the word movement instead of exercise, because what they found was that moderate movement, brisk walking that tended to be a lot better for neurogenesis than intense exercise. Now, why would that be Well, it turns out that when you briskly exercise, you're releasing a lot of what is known as brain derived neurotrophic factor. That's kind of like the miracle grow for for your brain. As was described, if you are intensely exercising, you also tend to release a lot of epinephrin and epinefrin is actually a blocker. It's a it's a cascade blocker of what b d NF, this neurotrophic factor does. I know, I'm throwing a lot of language at you, but I'm FOLLI. Intense exercise may be great for your heart and you know, maybe even weight loss, whatever your goals. Maybe, but for your brain, intense exercise actually is not good and you find that can actually be a little bit destructive by releasing these stress hormones that block the beneficial effects that exercise should have on your brain. I never knew that, and it so like I think. I go for a walk as often as I can with Rebecca. Now, that wasn't something I did. I was out there thinking, I got forty minutes, I'm gonna go hard. That was my sort of approach, and sometimes I still feel the need to do that. But walking is great. Brisk here here, here's the best way to do it. If you want to just make it for your brain. Take a brisk walk would a close friend or family member and talk about your problems, and that sort of brings all these things together in some ways that we've been talking about. Take your take your you're very smoothie with you, and you've pretty much nailed it. I'm curious about social media and the way we live our lives. You know, we're constantly distracted, we have constant incoming information, our attention spans have shortened. I read a fascinating study a while ago that said the part of your brain I think it's a hypocampus you can correct me if i'm wrong, responsible for for creativity. It only fires up when you're bored. And that's why you have so many great ideas when you're in this shower, when you're not distracted, or when you're taking a long walk and you don't have your phone with you. And I'm curious the impact of all this mental stimulus or stimuli has on nerroa genesis and keeping our brains healthy. You know, yeah, okay, that that that's a It's a great topic and I approach it as a person who wrote this book frankly, also as a dad three teenage girls, because and this is conversation topic number one in our household all the time. And I'll tell and I'll tell you two things that actually came out of a dinner time conversation I recently had. Um And I try not to be too preachy with with my girls, although sometimes I can say I don't use this line often, but I can say I did write a book about that. The girls hate it when I do that, but it's true, and I can use that as a wild card to actually get them to listen to what I'm saying about the fact that when you are distracted like that and you think maybe even you are multitasking, the brain is actually not that good at multitasking. It actually requires a lot of energy to shift back and forth between things, between scrolling through your social media feed, trying to have a conversation, trying to look your dad in the eye when he's talking to you, whatever might be. It's a it's hard to transition back and forth between all these things. We think we're being efficient, and we're not, because the amount of energy it takes to actually make the switch is a lot higher than we realized. That's kind of novel thinking because you know, it's always been about multitasking. How many things can I do at the same time. But the second thing, which I think is, you know I worry about the most, and I think is what you're saying as well. Is that leaving aside just the content on social media for a second, and just the fact that it's so incessant, Like you're saying, we talk about stress and on the brain and on the body. Stress in and of itself is not the enemy. I mean, in fact, we need stress. I was a little nervous to do this podcast with you today because I have so much respect for you. But it makes me a little stressed because I have that nervousness. But it's good. I need that because I prepared for this. But the problem is that we can't get a break from the stress. Social media screens, the incessant nature of it make it very difficult for us to ever turn the stress off. We don't want to turn it off completely or never have it. That would not be a worthy or or possible goal. But we don't get breaks from it. And that's what I worry about the most. With with my girls, myself to some extent, although I'm much more aware of it. But that's what I worry about, Katie. So you're saying that it's really important to put the phones down, put them away, even studies that show if it's on a table, it's distracting by its very presence, because you can't have a deep, focused conversation with that thing in your line of sight, right that that that the distraction, just the presence of it, whatever it may be, it takes you away from from being in the moment. And again, I know some of this sounds so euphemistic, but and maybe you've heard it all before, but now the data is there. I mean, I mean, the smartphone has only really been around since two thousand five, Katie. I mean you think about that fifteen years, and it's not that long, and we've had some of the biggest behavioral shifts ever recorded in human history during that time. You talk about kind of constant stress, and you need stress in them recovery. I guess that's because your your brain is producing too much cortisolve, right, I mean, the stress hormone or is it doing a lot of other stuff of physiologically. I think I think the thing that that is becoming clear is that the absolute amount may not be as important as how long your selves are are sort of exposed to the to the stress hormone, you can have these amazingly high spikes. And they saw this, uh in people fighter pilots, people who are in these incredible situations for periods of time, really high spikes, so high in fact, that the blood vessels in the back of their eyes would change. They would have to account for blurinus of vision because they're they're they're a benefference spikes so high. But when they weren't in that situation, they had incredibly low levels of stress, really high heart rate variability. Heart rate variability is a really interesting measure of this because if you have high heart rate variability, that's good. That means that means your your your blood vesseles aren't clamped down by all the stress hormones. They're they're kind of loose and can the variability is good. And so it wasn't the spikes in in cortisol, epineffer and other stress hormones as much as it was them staying plateaung at an at an unreasonably high level. Interesting when it comes to stress. In closing, because I've kept you far too long Sunday, but I could talk to you all day. Is what is the impact of this year plus of really for many people, this constant stress, And how is that going to, in your view, affect us in terms of collective trauma? You know, we we have we have pretty pretty good data on what these stress hormones in prolonged periods of time due to the brain um we've you know, we're, we're. That's been documented now in all sorts of different studies. Nothing quite like this, obviously, because this is so unique, and that's why I still preface by saying I don't know for sure. With great humility, I try and answer some of these questions, but I think there will be an impact. But I think that we've also learned that we can grow new brain cells, though we can recover from that. We can create situations where it doesn't become such a incessant memory that that it basically leads to post traumatic stress, which is a real concern as well. There will be people that have significant amounts of post traumatic stress, but our ability to treat that, to recognize it is better than before, and our ability to to build new brain cells to help compensate. Is better than before, so impact significant, but solutions you know emerging as well. So it is possible to heal. I hear you say it is possible to heal, and and we we we've seen it before, you know, with other even other pandemics. A huge thank you to my friend Dr Sanjay Gupta, who you can watch on CNN or listen to on his daily podcast Coronavirus Fact or Fiction. His new book, by the way, is called Keep Sharpe, How to Build a Better Brain at any age. And I want you all to know I just ate breakfast using my left hand. Next Question with Katie Kurik is a production of My Heart Media and Katie Kurk Media. The executive producers Army, Katie Curic, and Courtney Litz. The supervising producer is Lauren Hansen. Associate producers Derek Clements, Adriana Fassio, and m Lee Pinto. The show is edited and mixed by Derrick Clements. For more information about today's episode, or to sign up for my morning newsletter wake Up Call, go to Katie Currect dot com. You can also find me at Katie Currect on Instagram. And on my social media channels. For more podcasts from I heart Radio, visit the I heart Radio app, Apple podcast, or wherever you listen to your favorite shows.