Well Said Podcast | Jan. 27

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Heather Reisman:
Hi, I’m Heather Reisman, and this is Well Said, a podcast on the art and science of living well. This podcast is brought to you by Indigo. We’re delighted to be joined today by Dr. Sanjay Gupta.

Dr. Sanjay Gupta:
But to really understand those parts of your brain, use them regularly, that’s the key, that’s the reserve, the untapped potential.

Heather Reisman:
That’s Dr. Gupta, a neurosurgeon, the chief medical correspondent for CNN, and the author of the bestselling books Chasing Life, Chasing Death, and Monday Mornings. His latest book, Keep Sharp, fully demystifies that black box we all possess in our heads, and powerfully makes the case for prioritizing our brain health. Better still, in Keep Sharp, Dr. Gupta shares what we can do to enjoy the benefits of optimum brain health every day, and long into the future. Dr. Gupta, thank you for joining us today.

Dr. Sanjay Gupta:
What a pleasure. Heather, thanks so much for having me.

Heather Reisman:
Sanjay, I have to share, I am so revved about this book. It is just jammed with things we need to know about our brains. So let’s get started.

Heather Reisman:
As a neurosurgeon, you’ve spent your life opening up people’s skulls and peering into people’s brains. What does the brain look like? What does it look like, this thing we have between our ears?

Dr. Sanjay Gupta:
It’s magical. It really is. I’ve been doing this for 25 years. I mean, how many things do you do for 25 years and still call them magical? You scrub in as a medical student on brain operations, and it’s a great privilege—you stand there and you watch. And I remember the first time I saw the brain and that meant the skull was off and the outer layer of the brain is called the dura, and that was also removed. So I was looking at the surface of the brain and the first thing I remember thinking to myself is that it looks super vulnerable. It’s soft, it’s sort of gelatinous. And how could something that’s super vulnerable like that contain every experience, learning, pain, joy, everything that we ever had in our lives? How could that be in that three and a half pound bundle of tissue? But the other thing, when I was looking at it just from a macro level, we call it grey matter, but it’s actually more pinkish. It’s got these big blood vessels that sort of are on top of it. It looks very clean. It’s very segmented. You know, you have the frontal lobes, you have the temporal lobes. You have a right side of the brain, the left side of the brain. It’s all divided. It’s a really neatly segmented organ that does all these amazing things. So, I still find it quite mystical.

Heather Reisman:
You make clear in the book that brain diseases like dementia, Alzheimer’s, Parkinson’s actually begin long before we see the visible symptoms.

Dr. Sanjay Gupta:
It’s really interesting, Heather, because I think it reflects a greater sort of issue in how we’ve medicalized things. You know, we diagnose disease. We treat disease. That is what the medical system is sort of based on. But the idea that you can optimize, that there is a best way to do things, not just about diagnosing or treating disease, but there is a best way to live your life, take care of your brain. In this case, whatever it may be, is very true.

Heather Reisman:
You dispel some big myths in the book. Can you share one?

Dr. Sanjay Gupta:
The idea that you only use 10 to 20 per cent of your brain, that’s not really the case. What I would say is that we use 10 to 20 per cent of our brain, 80 to 90 per cent of the time. So most of our brain, we’re not using that much.

Heather Reisman:
Does that mean we’re leaving potential on the table or that other 80 per cent is not accessible?

Dr. Sanjay Gupta:
No, we’re leaving potential on the table.

Heather Reisman:
OK, that’s what I wanted to hear!

Dr. Sanjay Gupta:
That’s the key. OK, it’s like if I were to surface map the Earth and say, ‘OK, this is the metaphor for your brain, the surface map of the Earth. You live in Canada, I give you all of Canada.’ OK, that’s your brain and you know, Canada, you go everywhere, you know how to get around, but all the rest of the world is that untapped potential. Maybe you visited every now and then, but to really understand those parts of your brain, use them regularly. That’s the key. That’s the reserve, the untapped potential.

Heather Reisman:
So one of the things that I found most inspiring in the book and certainly would make the book of relevance to people of any age—everybody, I think, worries that at some point in their life they might get a form of dementia. But we just don’t pay attention to it. We think, ‘Well, we’ll worry about that when we get to be 65 or 70.’ But you’re saying, I think, that the causes and even the symptoms start way earlier. Could you amplify that a bit? I think everybody listening would like to understand when does what turns up as dementia actually start?

Dr. Sanjay Gupta:
Yes, absolutely. This will both frighten you and inspire you, at the same time. What we know, and this is based on really great, great research that came out of UCLA—there’s close to 50 million people roughly in the United States who have evidence, if you were to image their brains or do diagnostic testing, evidence of what would be considered Alzheimer’s, amyloid plaque in the brain, tangles that are neurofibrillary tangles, things like that—that you would look at the brain and say, ‘Hey, I wonder what the cognition of this person is.’ And yet, those close to 50 million people really have no symptoms. OK, so that’s an important note that you can have all the objective signs in the brain of Alzheimer’s, but not have symptoms. That is possible, and a really important thing to keep in mind. But also, there is this idea that for people who do develop Alzheimer’s at age whatever, as they get to some older age, those changes in the brain that they now see, when they now go get tested, started decades before. So the groundwork was getting set decades before, and the period in between where you see the objective changes in the brain in someone who has symptoms, that’s called the preclinical time.

Heather Reisman:
So those tangles or that plaque began slowly tangling or building up way earlier. Is that what you’re saying?

Dr. Sanjay Gupta:
Way earlier, 30s, 40s, even people that young could start to develop it, but they have no symptoms. And I just think that’s so fundamentally important because now it tells us that it is possible to have those things in the brain and no symptoms.

Heather Reisman:
Which is to say, I think, that we should start investing in our brains very early to stave off, or make that happen later. Is that the point?

Dr. Sanjay Gupta:
Absolutely. That’s the key.

Heather Reisman:
So that’s where I wanted to get to here. And that’s what I think is so, as you say, frightening, but mostly inspiring about the book, because now that we know something, we can start to address it. So in essence, you break it down, you say there are five areas that we can pay attention to that have a very meaningful impact on our ability to experience peak brain performance. Walk us through them.

Dr. Sanjay Gupta:
I’ll start with movement. I chose the language very specifically, movement, as opposed to exercise, and that’s something that I’ve said for a long time because it was a fundamental rule. I don’t think human beings were designed to sit or lie for 23 hours a day and then go to the gym for an hour. That would be exercise. The idea of movement is movement, that you’re just continuously moving. You’ve heard this, lots of people have talked about it, but this idea that there is a certain best way to be moving in terms of your brain health I think is very important.

Some of the best evidence around brain health really exists around this type of movement. What they have shown, and this is why I included it as a pillar, is that when you were doing moderate intensity movement, brisk walking, things like that, you are reliably releasing what are called neurotrophic factors. In fact, if you want to know the specifics, it’s called BDNF, brain derived neurotrophic factor. And neuroscientists describe it to me, and I loved it, as sort of Miracle-Gro for the brain. So, it’s the stuff that helps the brain grow. It helps this pattern of new brain cell development happen. You can’t take that as a pill. You can’t even inject it. That’s only something that is released from the body itself in response to movement. So movement is really critical, but moderate intensity—they found with very intense exercise or movement, people would also release a lot of stress hormones like cortisol, which could be counterproductive, could actually decrease the amount of these neurotrophic factors that are happening. So moderate movement.

We often think of activity as the cure to things. As I spent time in these communities around the world and talk to the scientists on the ground in these places, what I sort of arrived in, and I remember writing this in my journal one day: Activity is the cure. No, inactivity is the disease. Very simple way of thinking about things, but flipped. That means I’m not necessarily thinking about the gym as much as I’m thinking every time I’m about to sit. Do I really need to be sitting? How can I increase that movement in my life? You’re studying for a test or doing something like that. Going for a quick walk around the block and getting a bunch of neurotrophic factors into your brain is probably a pretty good thing to do.

Heather Reisman:
OK, so pillar number two: nourish.

Dr. Sanjay Gupta:
Nourishment of the brain is a different sort of thing than just food. Everything that we’re exposed to, all of our sensory inputs in a way, are nourishing the brain. And what you see, what you hear, what you smell, what you taste, everything is nourishing the brain in some way, in addition to food. So, with regard to nourishment, there’s a couple of basic things. What is good for the heart is good for the brain. That is true. Why? They’re both highly vascular organs. The brain is just two per cent of your body weight and yet takes about 20 per cent of your blood flow. So, you really do need to pay attention to what’s in that blood, too much sugar, too much lipids, all that sort of stuff.

But the brain is much more sensitive. I’ll give you an example. We were familiar with diabetes—Type 1 diabetes is when your pancreas isn’t making enough insulin, Type 2 is when you have too much body weight and your insulin doesn’t work as well. There is a term that a lot of neuroscientists are using now called Type 3 diabetes, and that is typically a type of diabetes associated with dementia. And more specifically, it’s what’s happened in the brain is that the brain can no longer absorb glucose from the blood. There’s just too much glucose and it’s become overwhelmed. So what happens is you’re eating and you’re getting a lot of energy into your body, but at the same time, your brain is still starving because it’s no longer absorbing the energy. You’ve overloaded the system essentially. So sugar, we’ve known sugar is toxic. We shouldn’t eat so much sugar. Everyone’s heard that. But the brain is particularly sensitive to this sort of thing. So cutting out sugar by three-quarters or at least a half to start with is probably a very good thing to do.

I talk about hydration because the brain is so, it’s 20 per cent of your blood flow, even two per cent dehydration can cause a lapse in memory, a decrease in cognitive decline. And the good news is, add a little bit of water into the mix and you can have a very rapid restoration of some of that cognitive decline. So those are some examples around nourishment. I have a whole chapter in there on that.

Heather Reisman:
One of my favourite parts in your chapter on Nourish is your acronym S-H-A-R-P. As a summary of how we need to think about the food we need to eat you say S, sugar, lower it, H, hydrate, all through the day, A, add omegas, R, reduce portions, and P, plan our meals with intention. And it has so stuck in my brain, so thank you for making a new brain connection for me.

Dr. Sanjay Gupta:
People get inspired to maybe change their behaviour. Everyone knows you shouldn’t eat too much sugar, but now that you know what’s happening in your brain, that you could be actually causing your brain to starve counterintuitively as a result of too much sugar, maybe it clicks a little bit more.

Heather Reisman:
Onto pillar number three.

Dr. Sanjay Gupta:
Pillar number three, I’ll tell you, I use the word rest and relaxation as opposed to sleep. I think it’s very important to recognize that when the brain is at, what you think the brain is at rest, there’s lots of important things happening. And when you do go into sleep, that’s the time period when you are consolidating your memories. I have three teenage daughters. I mean, I always tell them when they’re studying for exams, that they’re not sleeping if they’re cramming all night long for an exam. Part of the reason that’s not a very effective strategy is because they’re really not going to encode those memories into their hippocampus. I don’t say it quite like that to them because they would never listen to me, but they sort of get the idea of what I’m trying to get at. But we live these wonderful lives and you want to remember them. That’s the movie track of your life. You’ve got to sleep, and you’ve got to sleep at the time. That’s something you can really catch up on.

But there’s also this this rinse cycle that’s happening in the brain, when we sleep. We’re constantly creating waste. That’s part of cellular metabolic processes. You need to get rid of that waste or it can start to either increase your risk for disease or to give you symptoms right now in terms of cloudiness or fogginess.

Heather Reisman:
Pillar number four?

Dr. Sanjay Gupta:
Pillar number four: connection. Connection for protection. And I approached this a little bit opposite as well, in the sense that we know we are social creatures, human beings, and that’s really important for us. It’s causing the release of these various hormones, such as oxytocin. It increases our empathy for one another. That’s all true. But the way I really thought about this was I spent a lot of time with loneliness researchers and looked at the particular, to some degree, measurable toxicity of loneliness and understanding that all these neurotrophic factors that I’m talking about that are so good, what are the inhibitors of those things? If neurotrophic factors are naturally released, what’s inhibiting it from happening all the time? Loneliness is a big one. It’s a particularly toxic one, and we find that connections end up being really, really important, and not just connections, but a profoundness of connection.

So, for example, I’ll give you a couple of these pillars and give you what that would translate to in terms of a tangible activity. My mom asked me this the other day. I said to her, take a brisk walk with a close friend and talk about your problems. Now, that may sound like a very euphemistic sort of thing to say, but a brisk walk, I’ve explained, that’s probably one of your best bets for releasing the neurotrophic factors, doing it with a close friend. You want the connection. Why talk about your problems? Well, this came out of a lot of the research I did with these neuroscientists who are focused on isolation. And what they found is that we don’t have particularly profound connections with people often. How are you doing? I’m doing fine. How are you doing? I’m doing fine. Even with people we consider close friends sometimes.

So how do you get to a more profound connection? There’s all sorts of ways to do it. But one way that really kept coming up over and over again as I talked to people was the idea of vulnerability. What we’re really not showing is our vulnerability. And when we don’t show our vulnerability, we tend not to have as strong a connection, being vulnerable, asking for help. Talking about your problems, however you want to do it, makes a big difference. It can be uncomfortable. It can make you feel awkward, which is not bad because you’re probably harnessing new real estate in your brain when you’re doing this. But the idea that it forms a deeper connection with somebody is really important. So that’s an example of a tangible activity out of a few of these pillars.

Heather Reisman:
OK, we have move, nourish, rest, connect. And the last one your write about is the need to challenge our brains. I love this one. Can you expand on it a bit?

Dr. Sanjay Gupta:
What constitutes challenging your brain is really anything that you don’t normally do. I love this. And it took me a while to get to Heather, I’ll be honest with you. I spoke to a lot of scientists about this idea that in your brain, I’m just using the brain as your example, 80 to 90 per cent of your brain time is spent in 10 to 20 per cent of your brain. And if you were to make the metaphor your life, you’re living at home. You may drive to the grocery store, you may go to a couple of places during this COVID time and that’s it. And you’re really good at it. You can get to all these places very easily. That’s good. That’s great. That’s the practice makes perfect part of your life.

But if you’re wanting to go explore some new cities or build some new roads, you’re going to have to do different things. It’s that simple. It’s that simple in your life. And it’s kind of that simple in your brain as well. And we don’t do that. So, you know, a simple example, you go to dinner and you eat. I’m right-handed, so I eat with my right hand. If for a week I said, ‘OK, I’m gonna eat with my left hand.’ Now, it’s going to feel awkward and you’d be surprised how challenging it is actually to get the elbow position quite right and hold the fork at the right angle on everything and all these sorts of things that you take for granted. But all of a sudden now you’re recruiting all these new brain cells, building new ones as well to basically allow you to do that.

Heather Reisman:
So what brain activities do you consider good brain building, brain challenging activities? Learning a new language?

Dr. Sanjay Gupta:
That’s a great example. And it’s complicated. Well, people will say, ‘I don’t have time for that.’ But if you do, that would be a perfect example of something that could harness more real estate in your brain.

Heather Reisman:
Taking up a new hobby that you haven’t tried before, good or bad?

Dr. Sanjay Gupta:
Good idea. And if it can be with your hands, something that you’re actually creating, painting, pottery—something that’s actually using your hands, even better.

Heather Reisman:
So is something as simple as brushing our teeth with the opposite hand or brushing our hair with the opposite hand brain challenging?

Dr. Sanjay Gupta:
The reason it’s important is you build new roads in your brain and it’s kind of fun. It’s just fun. It’s fun to take a spin out on these roads. It makes you happy and you’re a big thinker, you’ll start to think and connect patterns that maybe you would have otherwise missed because you’ve got all these other cities and roads in your brain now that you’re drawing on.

But I think more to the point, going back to your original question, that road that you know so well, you could drive it with your eyes closed. What if that road is one of the roads that becomes obstructed with an amyloid plaque at some point later in life? And if you don’t have any other roads, cognitive decline, memory loss, all that. But if you’ve built dozens of other roads, then, yes, the amyloid plaque is still there, but it’s not affecting you. You built the extra roads, you have the extra reserve, you built the extra resiliency, all those sorts of things.

Heather Reisman:
So you’re building some kind of resilience, a store of stuff you can call on. It’s unbelievable. It’s fair to say that we’ve all been put into this very different state of mind since COVID over the last 10 and a half months. It’s nuts. What do you think that living through this pandemic is doing to our brains, if anything?

Dr. Sanjay Gupta:
I think it has turned what is a relatively less frequent occurrence of these high peaks of stress into something that is more relentless. People always talk about stress and they say, well, you know, I don’t want to have any stress in my life. And that’s not really a worthy goal. We need stress in our lives. I mean, it’s what gets you out of bed in the morning and makes sure you perform well for an exam, whatever it may be. But it is the unrelenting nature of stress that is so toxic. And much of the developed world is already dealing with an increased level of stress and an increased sort of pace of stress, meaning you don’t get as many breaks from it. What COVID has done is really taken away the breaks from stress. People are thinking about it all the time. They’re worried about it. They’re worried about their health, their loved ones’ health. I mean, it’s a terrible situation. It’s a storm that we’re going through. And we have all the anxiety and all the depression and all the behavioural things that are coming about as a result of that. Health care workers are leaving the profession in greater numbers than ever before. Ninety-three per cent report burnout now. So it’s had a significant effect overall on our on our psyche. It’s not to say that it’s permanent, but it’s certainly present now.

Heather Reisman:
OK, so that’s the question. Will it have a residual effect? What about the people who have had COVID and talk about something called brain fog? Does it last? Does it go away?

Dr. Sanjay Gupta:
First of all, I think brain fog is real. This haziness, even this lethargy, this inability to connect patterns that you otherwise could connect very easily, the slowness that people sometimes feel in terms of formulating thoughts. I think it’s very real. There are a percentage of patients who have these symptoms. It’s real. And we’re going to learn more about how long it’s likely to last. It seems like it’s months, not forever. There are patients who have had these symptoms for months and then resolved. But we are all learning about this together right now.

Heather Reisman:
Before we wrap up, a few fun questions. What have you read this year that you loved?

Dr. Sanjay Gupta:
And that’s funny. I just went through my bookshelf and I see you have so many books and I keep the books that I love, that I want to read again in one area. And I had just pulled out a tome like this. It’s a book called Cutting for Stone.

Heather Reisman:
Oh, my favourite, Verghese!

Dr. Sanjay Gupta:
Abraham Verghese.

Heather Reisman: I love that book. That was a Heather’s Pick. But you know, he hasn’t written another book since.

Dr. Sanjay Gupta:
No, but he’s working on one. He was in Calcutta last year and he’s like doing research for a book. But that was a book that even though it’s like this, I couldn’t, I didn’t want to finish. I was like, ‘Oh, it’s the last few drops. I want to savour it.’

Heather Reisman:
What brings you the most joy?

Dr. Sanjay Gupta:
It’s definitely my family. I am one of these people who recognizes that I’m like the blink of an eye on this whole journey of life that we human beings are having and you know, that I can have my family, you know, be with me and enjoy that journey. I think it’s fun and they will hopefully outlive me and continue the journey. I get great relevance out of that.

Heather Reisman:
Listen, it’s just a joy to speak to you, Sanjay. We are grateful that you’ve written the book. And I truly believe that the more we can bring science out of the lab and the heads of brilliant people like you and into those of us who need to benefit from it, the better. So thank you so, so much.

Dr. Sanjay Gupta:
What a pleasure. That was one of my favourite conversations I think I’ve ever had, so thank you.

Heather Reisman:
Thank you for tuning into our conversation with the inspiring Dr. Sanjay Gupta. For more ideas to help you live well, including the book featured in this episode, Keep Sharp, visit indigo.ca/podcast. If you enjoyed this podcast, please leave us a rating on Apple podcast. You can subscribe wherever you listen to your podcasts. Well Said was produced for Indigo Inc. by Vocal Fry Studios and is hosted by me, Heather Reisman.