Next Question with Katie CouricWellness Check: Dr. Sanjay Gupta on how to build a better brain
This episode is presented by Midi Health, a virtual care clinic dedicated to providing expert menopause and perimenopause care to women in midlife.
Dr. Sanjay Gupta is a neuroscientist and in addition to his on-air work and a daily podcast (Coronavirus: Fact vs Fiction), Sanjay also found the time to write a book called “Keep Sharp: Building a Better Brain at Any Age,” which is out now. On this episode, Katie and Sanjay talk about how to keep the brain healthy with tips you can use right now to protect and improve your brain. But Katie starts the conversation by asking the COVID about the status of the pandemic and if we’re truly out of the woods.
Hi, it's Katie. Welcome to Wellness. Check our series of some of our favorite Next Question episodes focused on women's health and wellness. Enjoy. Hi everyone, I'm Katie Couric and this is Next Question. You know. I've known and admired doctor Sanje 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.
So 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 going to 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 doctor Sanje Gupta's chief medical correspondent, and this is coronavirus fact versus fiction.
Throughout this very long year, Sanche has really acted as our guide, helping us understand this 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 is 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 sanj 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 had the COVID expert of experts, I couldn't help but start our conversation there. You must feel like 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 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 sars, 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 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, grab 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 believe that respiratory viruses really only spread when you were sick, when you had symptoms that's when you spread. And you know, the guidance was well 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. Was that's never really happened before, as doctor Faucia said, never in the history of respiratory viruses has that happened before. That's novel. I mean, you know, you 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 residence 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 brand new disease, COVID. So it was quite extraordinary to sort of see see how that all played out.
Well, before we talk about 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 optimist, stick Sanjay, I then read something about variants or increase 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 tunnel is the end of the tunnels in sight. I mean the 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 talk about the vaccines, we talk 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 know that's not your question, Katie, but I just feel like I can never answer a question about 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 hundred thousand people died and some of them are my friends. And I've seen families, I talked 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 the vaccines will. I think they're really extraordinary and really effective. They seem to be pretty effective against the variant u B one one seven, the UK variant, because there's a lot of concern about that very but if you have been vaccinated, or if you had the infection in the past, the other you know, 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'll be great. I do think, you know, we'll probably get to herd immunity over the summer, but it's worth reminding that herd immunity isn't a sort of destination necessarily. You can pop in and out of herd immunity. So if not enough people get vaccinated over 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 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. 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's I guess now you say that in April of twenty twenty one and it's obvious, right, everyone knows that, but it starts starting off covering the story and now all the way now to the vaccines, even every single component has been politicized in some way. So it is disturbing the anti VAXX movement. And you may not even remember this, kiddie, but I actually did a segment on 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, Simmers, we saw measles outbreaks in Brooklyn and Disneyland and Minnesota.
This seems bigger, though, Sancha. You know, that was a particular group and it really dealt primarily with childhood vaccinations, and now this has expanded to 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 you know we're seeing some of this for or really seeing it come to light, I should say, you know, in a pretty dramatic way. Now. I think I was reading the statistics this morning Katie Kaiser Family Foundation, forty to fifty percent of those in rural areas who say they absolutely will not take the vaccine. It's not a 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 I said, what is the explanation.
That's the curious thing, Like you said, with some people who are vaccine hesitance, it is concerns about safety or mistrust or you know, my grandfather was experimented on as part of Tueski, 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 scamdemic sort of thing. So I don't know if that's the case. For it's a huge percentage of people we're talking about here, So maybe there's some heterogeneity, you know, some variety of opinions there, but bottom line, if the numbers stay that high, we're not going to get to herd immunity based on vaccinating adults.
Alone, which is really depressing.
It's so I mean, gosh, we wait for science to rescue us. We don't do the basic public health practice, and then 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 weighted, created this amazing medicine, and then you don't take the medicine. It just it doesn't make any sense.
It's a head scratcher for sure.
Yeah.
When do you think Sancha will be able to go about our daily lives without mass I.
Think it'll be the summer, Katie, 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 going to 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 virus 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 seeks around, you know, in Hong Kong after Hong Kong really wasn't a mask wearing country until after SARS, 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 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, 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 is past season, and that you know that that wasn't because of any increase 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 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 Aarbara 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, sort of that sort of concept is something that's more than one hundred years old. I just don't quite you know, I don't know. Maybe I'm just being naive. 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, a 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 purpose does 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 behalf of the American public, thank you for your coverage of this. I think you're so measured and so eloquent 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, Sancha Gufta.
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 are the standard obviously by whom we all measure ourselves. But also you know, we're 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. 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 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 anyone listen to me? I mean, if you're the medical reporter and presumably people 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 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 listened, 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.
Let's talk about 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, Sanjay, 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 our failing brain power that happens as we age. Tell me about that.
Well, when I was twelve or thirteen years old, my grandfather, my mother's dad, who I was very close to, developed, you know, signs of dementia. He had had a stroke earlier in his life that had recovered and was now developing. You know, just these these periods of time where he really wasn't aware of what was going on. He would sometimes make a joke that no one else was in on, you know, and it was all these things 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 write, 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? That? Is my mom going to develop those symptoms? Will I one day all of that? And then you know, fast forward, you know, thirty forty years later, and we're still worrying about the exact same things and haven't really made a lot of progress in terms of being able to deal with that. So that was a large part of what I think inspired me 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 lifestyle behavioral standpoint in terms of what we.
Know and how does that influence you to go into neurology?
No, you know, it's funny, it didn't. I Actually when I started medical school, I thought I was going to go into pediatrics, and then I did a neurosurgery rotation 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 forty seven million Americans have some of and so a pre clinical Alzheimer's disease, and by twenty sixty one new case of dementia will be diagnosed every four seconds. Sonjay, what the heck is going on here?
Well, this will become the most dominant neurodegenerative disease of our time. I think that part, I think 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 could 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, Okay, you're breaking me 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 able to retrospectively look at their lives and their skins in their brains, you find we now know 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 it, 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 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 got a block blood vessel. Now 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 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. 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 functional? You know, maybe some memory issues right that once in a while, 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.
Well, 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 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 due 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 our brains can get sharper and better as we age, and dementia is not necessarily an inevitable consequence of old age. So you know, I remember reading Sanjay, how your brain like by the time you're twenty three or twenty four, and then your pre 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 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 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 from shrink king.
It works well to some extent, but the uh, you know it, but that that part of it is not true, and 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 lay public yet. So it's about a ten year gap. In some ways, keep sharpest 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 and your brain was still forming, and maybe after an injury like a stroke or a traumatic brain injury, there may be a process of neurogenesis that occurs. But what these neuroscientists have really 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 just backtrack for one moment, just so I understand the difference between neuroplasticity and neurogenesis. Explain it like I'm a fifth grader, So.
You know, when you think of neuroplasticity, it's more like your brain 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 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 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.
Body 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. Neurogenesis is the growth of new brain cells. So this, this, this lies 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 mostly 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 you you're not traveling around the rest of the world. You're not even traveling around the to the state. Right now, that's kind of how our brains are. We use our whole brain, but ninety percent of the time we're using ten percent of 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 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 that's the whole concept of what neurogenesis can do for you.
When we come back Sanch's advice on how to keep our brains strong, especially as we age, well, take me on a trip, okay, and how can I visit these new places in my brain? Because this is really exciting And I know your book has a lot of recommendations for ways that we can encourage neurochemphasists.
So what do I do, Sanjay?
Yeah, well, 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, 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 kill and drill sort of teaching that a lot of schools focus on. It's important to understand 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 it with your eyes closed. Now you know, 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 and 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 metaphor you want to apply to it. 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 be the resilience 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, but should I learn how to play the guitar or the viol of the violin sounds just horrible if you're not good at it. But what I 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 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 is a key, but something that you can also use your hands with that you're actually activating your motor cortex as you're doing, seems to be even more benefit. So an instrument is great 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 in 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 may be even a little uncomfortable. So if you're painting, and I just bring up painting, because this is the one that came up several 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. Do it with your 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 going to do something different, and I'm going to actually now focus the left 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 blocked 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, 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 clacks entangles 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 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 were doing autopsy, they may be diagnosed with Alzheimer's 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 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 always found it so interesting, even when you talk about like antidepressants and you know, serotonin reuptake inhibitors or whatever they're called ss rise. Yeah, 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 Alzheimer's and preventative strategies that we could follow.
I think so. I mean, 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 dementia based on a scan. And as I say, I think we will.
You think we'll get to that point though.
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 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 maybe functionally cognitively normal. Right, And again, I look, do I I don't want to I don't want to have blackx entangles 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 trained to do. And yet I'm now becoming increasingly convinced that these types of changes that we talk about in this book really can can prevent you from developing the symptoms of dimasasion.
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 the steps, 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 react to things that you're now doing that are different or new. 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 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 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 sugar. You know, 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 one hundred and thirty a year on average of sugar. But 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 in the cells. I have a lot of energy, whatever it might be. These these are a lot of calories that are now providing me 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 is a situation that leads to 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 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 I spend a little bit of time talking through talking to the reader through how they define that, because it is different for different people. Robert Sapolski, 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 and you know ancient times because you are more likely to be protected by the group. But now it's this idea of what true connection does for protection of the brain. And and and now to your earlier point, measurable. You know, a lot of what we talk 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 topic really interesting. But there's this loneliness researcher named Stephanie Cacciopa. She's an Oregon.
I know, I know, she's in Chicago. Her husband was one of the preeminent scientists about memory, and then he died.
I died, I know. And now she's an organ and I talked to her from time to time. It's been tough, as you might imagine. And she's by herself an organ which you know, as a loneliness researcher 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 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 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 to 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 and all this stuff. Figure out the way to build the meaningful connection that is that is probably one of the most critical points, and there are 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 right amounts of the right hormones, not too much epinephrine, 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 were talking about in terms of that cognitive reserve, you know, actually 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 regimen for a while, adding in something totally unrelated. 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 going to 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 and greens. It's got to 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 Italy instead of staying in New York or going somewhere even different, Argentina, you know, totally different. If you can do something that involves 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 good if it makes you a little uncomfortable. 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, no, right, yes, definitely do the sugar thing I mentioned already, So, I mean that's just a I think you could accomplish seventy percent 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 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 overeating, and a lot of those metabolic by products 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 no?
I you know, I think superfood 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 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 the idea that for certain people who have deficiencies, then supplementing that part of their diet's 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 MacDonald even the food is largely fortified, you know, with all these different vitamins and micronutrients and things like that. That is a decision that our USDA 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 approach is more in terms of what you're not eating versus what you are eating, and 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 prevagen or should I be taking what is it like? Almost isn't it like jellyfish derivatives and stuff?
And I'm like, should I be doing that?
Well? You know, the privilege in one is interesting because you know, Eric Candell is very involved with this, and he's a very prominent neuroscientist. 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 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 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 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 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'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 is brain derived neurotrophic factor. That's kind of like the miracle grow for your brain. As was described, if you are intensely exercising, you also tend to release a lot of epinephrine. And epinephrine is actually a blocker, It's a cascade blocker of what BDNF, this neurotrophic factor does. I know, I'm throwing a lot of language at you, but that's okay.
I'm following.
Intense exercise may be great for your heart and you know, maybe even weight loss, whatever your goals may be. 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 going to go hard. That was my sort of approach, and sometimes I still feel the need to do that. But walking is great, brisk here's the best way to do it. If you want to just make it for your brain. Take a brisk walk with 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 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 hipocampus, you can correct me if i'm wrong, responsible 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 stimulus lie has on neurogenesis and keeping our brains healthy.
Yeah, okay, it's a great topic, and I approach it as a person who wrote this book frankly, also as a dad of three teenage girls, because and this is conversation topic number one on our household all the time. And and I'll tell you two things that actually came out of a dinner time conversation I recently had. And I try not to be too preachy 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 it might be. 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, when 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 differentficult 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 possible goal. But we don't get breaks from it. And that's what I worry about the most 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. The distraction, just the presence of it, whatever it may be, it takes you away from being in the moment. And again, I know some of this sounds so euphemistic and maybe you've heard it all before, but now the data is there. I mean, I mean smartphone has only really been around since two thousand and five, Katie. I mean, think about that teen 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 brain is producing too much cortisolve, right, I mean, the stress hormone, or is it doing a lot of other stuff.
Physiologically, I think I think the thing that that is becoming clearer is that the absolute amount may not be as important as how long your cells are are sort of exposed to the to the stress hormone, you can have these amazingly high spikes. And they saw this in people fighter pilots, people who are in these incredible situations for periods of time, really high spike, so high in fact, that the blood vessels in the back of their eyes would change. They would have to account for blurriness of vision because they're they're they're epinephrin spike so high. But the when they weren't, and that's a 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 bloodvessels aren't clamped down by all the stress hormones. They're the kind of loose and the variability is good. And so it wasn't the spikes in cortisol, epinephron other stress hormones as much as it was them staying plateauing at an at an unreasonably high level.
Interesting when it comes to stress and closing because I've kept you far too long, sign Jay, 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 pretty pretty good data on what these stress hormones in prolonged periods of time due to the brain we've you know, 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 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 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 we've seen it before, you know, with other even other pandemics.
A huge thank you to my friend doctor Sanche 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 Sharp, 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 Kirk is a production of iHeartMedia and Katie Kirk Media. The executive producers are Me, Katie Kirk, and Courtney Ltz. The supervising producer is Lauren Hanson. Associate producers Derek Clements, Hriana Fassio, and Emily Pinto. The show is edited and mixed by Derek Clements. For more information about today's episode, or to sign up for my morning newsletter, Wakeupcall, go to Katiecuric dot com. You can also find me at Katiekuric, on Instagram and all my social media channels. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple podcasts, or wherever you listen to your favorite shows.
