Sanjay Gupta Returns

This could sound like the beginning of radio. Look, oh, yeah. Welcome, welcome, welcome to armchair expert, expert, expert. We love you, Radio Lab.

We do. We wish we were as good as you. We have our first 3P today. That's right.

Our Alec Baldwin. Our Alec Baldwin or our Steve Martin of SNL. I think Martin's up there in the teens. Interesting.

He doesn't get as much credit as Baldwin. He doesn't. He's under appreciated. Wow.

He's everybody anything on credit? What? That's true. Oh, Steve Martin's never bought anything on credit.

Yeah. That's one of his things. Yeah. It's cool.

I almost never bought anything. I'm really mad right now that I can't say I've never did. But I was a stickler for I didn't use a credit card forever and I didn't. It's actually good to use a credit card because you do need to have a good credit score.

Not if you don't have anything on credit. Then you don't have a good credit score. Well, you don't need one. No.

Isn't it cool? Yeah, it's more gangster than not need a good credit score. Anywho, our first 3P, Sanjay Gupta, he is an American neurosurgeon. And he's a medical reporter and writer.

You see him on CNN all the time. We've talked to him twice. Love him. We love him to death.

And he has a new book called Keep Sharp, Build a Better Brain at Any Age. I've already started implementing some of these tools. Well, he planted a seed for me to worry about you. Remember I said, are you moving enough?

This holiday break? I wanted to make sure you were moving. I wasn't. Because he says the number one thing for brain is moving.

Keep moving, Monica. In armsaries, you keep moving and enjoy Sanjay Gupta. We are supported by Airbnb. If you've ever traveled kids or with extended family, you know how much difference a little extra space can make.

Everyone's on different schedules. You want room to actually relax without disrupting anyone. That's where Airbnb really makes a difference. Giving you the space you actually need.

Having separate bedrooms, a real kitchen, a common area where everyone can spread out, it just takes the pressure off. We were up in Toronto and we opted for an Airbnb over a hotel. What I love about it is everyone can be on their own sleeping schedule. That is nice.

You're not required to wake up in the earliest riser get some. Not for me. I always start by checking out guest favorites. They're the most loved homes on the platform, consistently highly rated by guests.

Some trips really do feel better when you have the right space. He's in our church. You don't know that you have this distinction, but you're our first three peat. Yeah.

Is that true? Yes. You're not a priority. I was going to wear that badge with great honor.

That's fantastic. I was just saying this backdrop is just a picture for me. I'm in a window that's closet, actually, in my basement. But it got just so depressing to be there all the time.

I figure at least I could see that. It would make me happier, which actually really works, I think. Now what scares me about this image, your background, you've selected, is it appears to be on the second or presumably even higher floor. And there's a circular railing, but there's no inlet for a staircase.

So I'm a little confused how people are getting up and down. You know, it's so funny is that everyone asks me, like, where's the staircase and stuff? You're the only person who's actually come to the there is no inlet. You're absolutely right.

It's a rail all the way across. And it was purely decorative. You know, it was interesting. And it was my wife's idea.

And it was funny. We just wanted something that looked a little bit distinctive because it has no function. And it's a waste of space. I mean, clearly, but it was worth it.

Like, you know, typically you think of function over form, but this was clearly just form over function, which was like it. You got to applaud it. Yeah. Yeah.

But who knows, you know, maybe a bucket could be lowered down kind of like an exhibition style dumb waiter. Maybe that's its design in town. If someone had to quarantine, that's a great way to bring food up and down. Really, really would be nice.

I don't know. The aperture may be too large and the virus could still spread through the. Oh, you're right. Yeah.

I just ain't aperture. It's not a word that's used nearly enough, I think. Not outside of the shutter bug community. No.

And in the hospital. Yeah. Yeah, they're talking aperture a lot. So the last time we talked to you, it was like really new into the pandemic.

And you were so gracious to find time for us. And during that interview, I really thought, boy, I hope this Corona doesn't take up. Sunshine and not because he's going to get it, but because the stress and hourly demand of updating America seemed like it was too much for me. I couldn't have done it.

I don't think I had no idea it was going to last this long. I was reflecting on our conversation before. And I think this is my own sort of lack of anticipation, I guess. But if you think it's like a few weeks, I mean, you sprint, right?

You just go out there and you're sprinting and you're trying to just get it all in and make sure you educate people as much as possible. But I thought that, you know, there was a good chance it would be a couple of months, you know, I mean, the United States where the, you know, one of the wealthiest countries in the world got this public health system. We've been through SARS. We've been through H1N1.

Here we are. Yeah. 11 months. First of all, how's your hand?

Because I read about that. Oh, sure. I broke all the bones in my hand at one point in quarantine. And then I broke the clavicle into four separate pieces and four ribs at another point in quarantine.

So like you, the novel virus didn't almost get me. But by God, I almost got got during the whole thing. You're getting a little restless during quarantine. Is that what prompted all this?

Yeah, I felt like I needed more and more off-roading and hospital. Yeah. I want to get a first hand look at what was happening at the hospital. But in our first conversation, I was under the belief with no data.

I just was under the belief that I had had it already. And that several people in my circle had it earlier. And boy, I was convinced of that. And in fact, we all took antibody tests and I was so excited to be vindicated.

And they all found out like I took one that required three days turnaround. They took one that took like, I don't know, a day turnaround. So I walked into the house and they had all gotten the results. And it took like about two or three hours before our friend, Eric, said, I don't know if you heard, but we don't have the antibodies.

We were all very scared to tell him because he was so adamant about. Oh, so embarrassing that they would have been nervous to tell me this good news that no one had ever had Corona. You've learned so much. Do you know what I did today?

I would love to find out. It's very exciting. It's very exciting. I got the first Pfizer shot.

I did. It's this great news. Yeah. You know, so healthcare workers are in the first group of people.

So they've been vaccinating healthcare workers in my hospital. And you know, everyone sort of gets their call and says it's your turn. So I didn't hesitate at all. But you know, it's so amazing because I've been doing this sort of medical media, sort of blended life for close to 20 years now.

The world's came colliding together really today because I was getting vaccinated as a healthcare worker, but as a journalist, because of reporting on it, I, you know, I had watched the initial development of this vaccine. I talked to the scientists at the NIH and at Pfizer, as they're like, figuring out how exactly this vaccine is going to roll out to talk to the FDA. So I had all this knowledge about it that I think if I wasn't a journalist, I'd know that it was safe and effective. I know that part of it, but I have really granular knowledge about this vaccine.

Yeah. And then so it was able to really apply that knowledge towards making the decision. I would have gotten it regardless, but it was really like an informed decision because of reporting on it for a year. So it was kind of amazing.

OK, so I'm going to error again right now real time. I'm going to make the same mistake twice. And I'm going to guess I have to imagine people that have been in and out of the hospitals working for the last 10 months. The percentage of folks who have to have the antibodies is it's got to be high, right?

Well, you know, they've done some studies on this, you know, it was really interesting, the Northwell medical system in the Northeast during that, you know, big April sort of surge of cases. They took care of some 70,000 patients over there. So they had a lot of patients with COVID in the hospital inside and health care workers obviously taking care of them. And what they found at that point, because they did do antibody testing, surveillance testing, and they found that the incidence of COVID among their health care workers was lower than the general population at that time.

Despite the fact that they were indoors, taking care of COVID patients. I'll tell you why. I mean, I think it's just that you can protect yourself. That's one of the great ironies masks and they wash their hands every five minutes.

Yeah. It's really, really basically it. I mean, the masks work really well. It's hard to sometimes convince people.

I think we even talked about this before. It's hard to convince people that something so simple would be so effective. You know, I think we're used to expecting that in order for it to work, it's got to be really complicated. It's got to be really expensive, all these things.

And so I tell you masks and you know, you think I must be getting, you know, how could it be that simple? This is a pandemic, you know, but the health care workers have a lower incidence than the general population. Well, I'm going to add a layer. You know, you're having one conversation that's very logical and backed by so much evidence that just it works.

There's nothing really to talk about. It works, but that's not I don't believe what the real conversation is, right? It represents loss of liberty to people. It represents what they perceive as a fear base, snowflake left that wants to cripple our economy.

You're on the science side saying, come on, this thing works, but you're really not having the same conversation. I don't think with the people who don't want to wear a mask. Yeah. You know, I've talked to so many people this year and you know, it's hard to paint with a broad brush, why people have made certain decisions.

Sometimes I made the mistake of sort of shortcutting it saying this is clearly a political thing, right? Yeah. There are people like you say who say it's an individual liberty thing. There are people who say that they simply don't work.

And by the way, you told us not to wear masks in the beginning. And now you're saying wear a mask. So obviously you don't know what you're talking about. I kind of get that one, you know, people are a very, a very clear, consistent message, but you know, then there's other people who it did become sort of a divisive political tool.

And that one's the one that shocked me, I think, because in order to get the economy open, you know, wearing masks would have actually helped. Not hurt. I mean, we're not saying, not shut down. We're saying, stay open, just wear masks.

So the same people who very much did not want shutdowns, which was everybody. I don't think anybody wanted to shut down. But oftentimes they were the same people who said, I'm not going to lean into the basic sort of stuff, you know, wearing the mask. It's fascinating to me.

I've learned so much this year about this, just to behavior, how we assess risk, all this sort of stuff. Yeah, we're complex little animals, man. We got a little too much brainpower at times. That is what it boils down to, I think.

I remember when we did our first conversation and I think, okay, you may have brought this up, but I was talking about this trip that I had had with chasing life and I was really quite taken with this idea that someone had told me about reciprocal altruism, which is this idea that you do something nice for somebody without any sort of transactional quality to it. And it just feels good. It feels good to do good. And I think people sort of know that, but evolutionarily, like, why would we have selected for that trait?

Like, why would I sacrifice something of mine to make someone else feel good? How does that help me evolutionarily? Right? I don't know.

But it's true. Well, I know why, which is the odds of your survival being in a group are definitely higher than an individual. So if you have to make certain individual concessions to remain a part of that group, you're going to pass your genes on. Yes.

If you're an indignant piece of shit, guess what? The early hominids, they're kicking your ass right out into the savannah. And good luck. And do you think that's still like from an evolutionary standpoint, is that still happening?

I mean, people who do not want to be part of the group, are they slowly being selected out? I mean, obviously not next year, but I'm saying over time, over hundreds of years. Well, and I think your book is going to address this explicitly, but yes, so you're not relegated to the savannah where a large predator cat is going to take you down, but you are banished to isolation. And in isolation, you're going to have very predictable, statistically relevant declines and all kinds of health things.

So yeah, on the surface, it doesn't carry the risk of getting eaten, but we now see the rate of addiction, the rate of all these things through isolation and lack of community are as probably more people go down from that than ever got killed by lions. I think you're right. It took me 11 months to come to that conclusion. You guys should we call right?

So I don't know that I'm right on this. But really quick, can I pause you? You're free to be wrong here. You just got to own it.

So like I was wrong about my antibody thing and then we already had it. You just got to own it. Okay, sorry. Moeram.

By the way, when I read another article beside your hand, it said that your wife was complaining about you being a know it all. So the idea that you would admit that we're wrong anyway, he's pretty good at it. To know me is to know I'm a know it all. So I think anyone in my life could have made that statement.

No, but I just assumed that large groups of people ultimately based on, again, just the human species selection of reciprocal altruism would have been intent on wearing masks because it's actually a fairly simple thing, you know, just two ear loops. And then the messaging is, you know, you can be part of a movement that can save tens of thousands of people. You just put on two ear loops when you go outside and so many people said, you know what, I'll pass. I'm going to do it.

I don't even know what to make. I was surprised by that because I always felt like we would pivot towards reciprocal altruism in the face of some sort of, you know, universal threat, like a pandemic. I have an armchair theory. So I do think that, you know, we live in the least regulated capitalist experiment of all time and in this capitalist society that we live in through advertising, we learn that the individual is celebrated, the pioneer, the brave, explore.

These are the archetypes that this system really celebrates and loves. By the way, I'm a victim to it all the time. We just took this weird test to see what Hogwarts school you'd be in. And one of the things was like, what would you want people to say about you after you died?

And I chose bold. So like it's bold like me, right? I want to be seen as bold and fearless and all this shit. So I think that's got to play a role in like, well, when I don't put these two loops around my ear, when I'm telling the world is I'm not afraid.

And by the way, I have great compassion for a lot of people who want to send the message, I'm not afraid because I think a lot of those people were victimized in childhood. Please don't try to hurt me because I will hurt you back. That helps me sort of have a little bit of an understanding of why people might behave that way. But the idea of rugged individualism, right, which I think you're sort of talking about and how that was celebrated and even ads on television and all that.

Like, I guess I never thought that it was a total odds with the idea of still being altruistic. Like, can't you be individualistic and altruistic at the same time? Are they are the properties that cancel one each other out? And it's a contagious disease as well, right?

So I'm willing to take the risk. Well, you're not just taking the risk for you. You know, you're taking it for your spouse, your loved ones, your community, whatever. I mean, people fundamentally get that, right?

When they say I'm being brave, being brave by potentially carrying a contagious disease and spreading it to others. How do you justify that? I totally agree, but I saw people interviewed at Walter Reed standing outside to show support. And in this interview line, a person wasn't wearing a mask and they said this.

And then they said, do you have anyone in your life? And he said, yeah, my grandparents, who I love. And I got to tell you, I saw it real time click to that person. So I actually don't know that a lot of people have taken it beyond their bubble of their identity and realize, no, no, I'm being brave on the back of my grandpa or my grandma.

Right. Yeah. I think you're right. And I think it's not as binary.

You know, like, I think we want to like sort of have the easy way of framing it. But like, I think that there's a lot of people who, I mean, they totally believe this pandemic was real. It wasn't like they thought it was a hoax or anything, but statistically, they thought, you know what, I'll be okay. It's not going to hit me.

And it's more like that, which I think maybe it's just how we assess risk in general. We'll be okay. You know, myself, my grandparents, you know, whoever it may be. But that was the case with everybody who got sick.

Right. I talked to so many patients and I talked to family members of people who had died. And it was always like, they weren't deniers, not the ones that I talked to. Yeah.

But then, you know, somebody got a few symptoms one day and then the symptoms got worse. And then they needed to be hospitalized and then they embarked on the worst days of their life. And it just happened so quickly and they were shocked. And, you know, I don't know how that changes their behavior going forward, you know, who knows?

But I think it was a genuine surprise to people. And right now there's hundreds of thousands of people, maybe if you look at the models, who are just fine, they are totally fine right now. And they're looking at this in the rear view mirror because they're hearing about the vaccine and all that and they're like, we're done, you know, 2020 goodbye and we're done. And they're going to get up.

I mean, there's no question that there's going to be so many more people still affected. And I mean, I really, I've learned as much about the science here as I had the psychology. Let's talk about the brain because that's actually what you have dedicated your life to. And you've written a new book called Keep Sharp.

And I think I want to start with a kind of a misunderstanding I personally have, which is if I recall my biology class, I remember there being somatic cells and those cells go through mitosis, they can replicate, they can repair themselves, but that our brain cells are not somatic. So they can't go through cell reproduction or copying themselves. So the ones you're born with, that's what you get. And when they go away, that's that.

That was my understanding of it. That's flawed. Yeah. Is that right or wrong?

Well, as it turns out, it's wrong, but this is a relatively new discovery. So I don't want to say it's wrong in the sense that, you know, we've known this for a long time. The idea of neurogenesis or any kind of cell genesis and stuff like that, and how you think about it, I mean, it's still evolving. We used to study, you know, for the most part, in terms of why we thought about this incorrectly for so long, is that we studied diseased organs, you studied a diseased or traumatized spinal cord, for example, and you're looking for evidence of new neural development, new neural cells, neurogenesis, whatever it may be.

But oftentimes it wasn't happening because it was traumatized or same thing with the brain. When you started to look at healthy spinal cords and brain, because we had better techniques to actually study this, you realize that there are neural stem cells, just like there are stem cells in other parts of the body, and they can basically stimulate the production of new cells. Neurogenesis in areas of the brain that kind of need them or being recruited there because of the activity of the brain there. So it's a relatively new thing, and it's pretty clear it can happen throughout your life.

That is so comforting because I remember thinking, whoa, man, I blew a bunch out at many different times in my life. And fuck, I'm just taking money out of the principle, you know? I drained the cash of cells. That was sort of the thinking, right?

You know, you can have this negative impact on your brain through various things. There's no question about it. But the idea that it can heal and repair itself, or in someone who has a healthy brain, continue to be optimized, I find really exciting. I mean, that was probably the biggest sort of driver.

There was two things that really drove me around this. Well, really three things. One is that I've had a long standing love affair with the brain. I just love the brain.

I love the fact that you look at three and a half pounds of tissue and that memories live there and your pain lives there and your joy. And I don't want to sound reductionist, but this idea that those things that make you you are contained within this tissue still, consciousness is probably a locally contained phenomenon within the brain. Some would argue with that. But nevertheless, it's got a lot going on there, right?

It's the whole thing. All the other shits in support of it, really? I think so. And in order to improve anything else in your body or in your life, really, you've got to get the brain right.

That was another big thing. In order to best heal the body, you've got to heal the mind, which I thought was fascinating. That's what I was going to ask you. But first I just wanted to say that, yeah, you start with the notion that cognitive decline is not inevitable, and it's never too early or too late to start taking care of your brain, which is what we just talked about, which is it's not written in stone.

It can be nurtured. It can be pathologized. You have a role in this, which is very encouraging, I think. And then, yeah, next, I guess if I ask people to rank which organ they should prioritize for their health, I have to imagine the vast majority of people say heart.

That's where all of us would start, yeah? I think so, you know, and I think there's been a real medicalization of heart disease. It is an accessible organ. You can see it.

We show you the blockages that occur in the blood vessels. My father had that operation. I just had it. I just had the CT scan with the dye, and they give you a percentage in every artery of plaque.

Your calcium score. Yes, it's crazy. I was zero. I was zero.

I was shocked. I couldn't believe it. My only explanation is exercise. I don't know what else to say.

Is your diet good? Your diet's good, right? It's fair. I eat too much meat.

I'll tell you that. Really? It's a heart disease. Well, if you have a zero calcium score, that is a really, really good thing.

You know that already. But in terms of being predictive of the likelihood of having some sort of coronary event, Dr. Agatstin, South Beach diet, you've heard of that. He's a cardiologist, and he's big on these coronary CT scans.

Have a long conversation about it. He basically said if you have a zero percent calcium score, you're basically heart attack proof for at least four to five years. You'll be heart attack proof a lot longer than that, but you'll get another scan. It's kind of interesting to be able to look at a particular scan and say, your likelihood of now having a cardiac event is X.

In your case, it's basically zero. I can't tell you the peace of mind it gave me. I think anyone who's in a position to get one, I can't think of a better $1000 I've ever spent in my life. To your point, for the next four years, I'm like free of that concern.

I'm not going to go to Sizzler and put it to hand-tock there, but you know what I'm saying? It might be a fun experiment to see how unhealthy you can get quickly. You can prove it wrong. You can't prove it wrong.

It's a race to 40% blockage. But you know, it's interesting. So Monica, I had this test done too. I'm 51 now.

I think mid-40s. By the time this airs, I'll have just turned 46. Good for you. Yeah.

So fingers crossed. I hope I have given you a zero percent calcium channel. But you know, so I like to run and every now and then I would have some sort of pain in my chest. And it could have just been frankly reflux.

It could have just been that I was lifting some weights. So I was having some muscle pain there as a result. But my father had cardiac bypass surgery at 847. His father, my grandfather died at 50 of a heart attack.

So it's always like in the back of the mind. So I got a zero percent tube back when I was around mid-40s, 45 or so. We in a club. We in a club.

We in a club. We need a zero percent club. The outlaw bikers think they're cool because they're 1%ers. We'd be zero percenters.

That's what you got to aspire to. It did give me that peace of mind that I wasn't having a heart problem in the middle of a run. It was something else. It was interesting.

But I want to say something because this might actually get at what you're talking about with the heart versus the brain. We think of optimizing the heart you just said you wouldn't automatically think of the brain. And this is really interesting. This was the second thing that really inspired me on this book.

And that is that things that are measurable take on an added degree of importance because they are measurable. Right? So you did the Framingham study and you found cholesterol and lipids and all these sorts of things were associated with heart disease. And all of a sudden they became these huge things to aspire to.

And lower your cholesterol, lower your lipids, lower your blood pressure and all that. And all that's very important. But if I told you for example, stress was a bigger predictor of having a heart event. Now people are like, well that's kind of nebulous soft squishy around the edges.

What does that really mean? Yeah, how do you quantify stress? That's the problem. So that is the problem, but it makes it no less important.

Things that are measurable shouldn't be more important by virtue of the fact that they are measurable. It should be important because they are so associated with something like this. And that's why again with this book, it was all these things people think of the brain as this black box. Impenetrable, immutable, not changeable, as we were just saying, encased by this skull of heart bone.

And therefore you can't do anything to improve it. You can't prevent disease. It's all sort of preordained when it comes to things up there. And a lot of it's because it's hard to measure.

If I had a coronary CT scan of the brain, like we were just talking about for the heart, and I could tell you now your brain is optimized at this level or here are the things you need to do, that'd be pretty incredible. But we don't really have that. People do have that. They've been working on it.

Some of these scientists they interviewed for the book. And yet it's hard to get this stuff published because they don't have the cholesterol below 200. That's an easy paper to write. But if I tell you that you need to have three friends, you need to be hanging out with them for this long, and it's going to do this to your brain objectively.

It's a harder evidence to collect, but it makes it no less true or no less important. Yeah. I mean, our best diagnostic tool to my knowledge is the DSM in psychiatry, right? And so it's the best we can do.

And there's no numbers given. They might say you're bipolar, but at what level are you at 100? Is your cholesterol 300? Right.

And then the distinction between pathology and healthy and optimization. Like if I told you, you could be optimized. Like I'm not thinking you have any kind of, there's nothing medically wrong or there's nothing of diagnosis here. It's just that I'm going to increase the reserve in your brain so that when you encounter a problem, you're going to be able to tackle that problem in different ways.

Any otherwise would have that you're going to connect patterns that you would have otherwise missed. You're going to be resilient to something meaning like a muscle when I work it out, it gets stronger as opposed to getting crushed. Daily events right now are crushing so many people mentally. Yeah.

But if they have greater resiliency, then that actually can be turned into an attribute in the sense that it's almost becomes like a workout. I'm not saying that any of this is good that's happening to us. But what it does to us in the long run in terms of our brain health is very much dependent on how we treat it. Like a workout or are we treating it like a crushing event and some of that has to do with just how resilient you are in the first place.

And that is a buildable thing that is probably the core of it to build that resiliency. Well, also you point out, which is really plainly logical, which is if you have any hope of having a healthy heart, the best thing to start with is if you have a healthy brain and you have some of the things you just listed, you know, if you feel flexible and you feel not overwhelmed and you feel optimistic, all these little things, they actually will lead to you making the time to go get the heart CT scan. Maybe they help you make a better food choice. Like you can't be in abject depression and then make a great food choice in general.

You know, you're probably caught in a spiral of feeling terrible, trying to get a bump from something bad. And so yes, starting at the top and having like a trickle down approach to everything else makes a ton of sense to me. It all starts in my opinion. And I think I'm obviously unbiased on the brain surgeon, but everything starts with the brain.

The same activity that you do when you're not in a good headspace or whatever you want to call it is not going to have as much of an impact on you. But you know, one thing I want to say, because I, and again, I think you'll understand this is that when you create resiliency and redundancy or reserve in your brain, whatever you want to call it. And I can tell you how I think that can best be done. But when you do that, I find it to be a very joyous experience because what happens, even for you guys who live this very interesting life, because you do this podcast, you talk to interesting people, you have to learn your reading new things, which is fantastic.

Medical term is spoiled. Yeah. What a privilege, right? No, we're probably spoiled.

You can just say, and you would do this for, I mean, just to do it, right? Oh, for sure. We pay to do it. Yeah.

Yeah. Stay tuned for more if you dare. Okay. You guys go deep.

You know, I think for someone like me, you know, just why I love doing your podcast is because there's only so much you can really convey in the public discourse, I think. People's attention spans are short and they want the crisp headline, you know? Yeah. And sometimes everything lives in the nuance.

Everything lives there. I can give you a crisp headline, you know, and I can give you the five things you should do to improve your brain. And I will. Yeah.

But the why besides the what? You're exactly right. Because in what I love what you just said, which is I'm actually promising you not just maintenance of status quo. It's hard to motivate people to prevent their body from deteriorating.

That's not a very incentivized approach, but the notion of joy, the notion of optimism. Yeah. And that's a very, very, very, very, very, very, very, very, very hot response in the brain. And the amygdala, the emotional center of the brain, which is an immediate hot, you know, fiery response.

The problem is that it's not very coordinated response. It doesn't go through the frontal lobes. So you get somebody in response to being told they may have a heart attack who does a week of intense dieting and then stops because the amygdala now is not as fired up and they didn't really have a plan. They just reacted out of fear.

But when it comes to the brain, what is so interesting? So a headline would be, you know, you know, you're not going to be a little bit of a problem. And then you're going to be a little bit of a bad guy. But when it comes to the brain, what is so interesting?

So a headline would be, do something that scares you every day, get outside your comfort zone in some way, every day. And you say, well, why is that? Well, because I could show you your brain. I could surface map it and I could show you that you have a million roads in your brain and you're using a hundred thousand of them really, really well all the time.

And those hundred thousand roads are great. They're going from your thalamus over here to your occipital lobe and they're coming over here to your temporal lobe. So that's why you can remember songs and you can sing them, whatever it may be. But the other 900,000 roads are there.

They're not getting used as much. And when I start to get you outside your comfort zone, you automatically start recruiting new neurons and neurogenesis. You start using new roads. And that sort of reserve means when the roads that you use all the time start to get blocked or need construction, which happens, you already have all these other roads there.

That is sort of what reserve means. And I think that the idea that you can build it now, just by thinking about something you don't typically think about and being vulnerable about it is really fascinating in terms of how it serves you now, you'll think about things differently automatically. And I find that quite joyous, to find patterns that I, well, I just saw a pattern there that everyone else missed. And it can help buffer you as you get older from the medical things that people worry about, such as dementia.

Well, not to fear motivate, but it does atrophy in some sense, right? If you're not using the other 900,000 pathways, it kind of atrophy's. Use it or lose it, but practice makes perfect, which is true because the roads you are using will be really, really smooth running roads, but change builds resilience. And I think that that's sort of the key for me.

I got to tell you something, though, just real quick on atrophy. Quick story, it's about a year ago, I was in the operating room and I was on call. And what happens a lot of times is they say somebody is coming to the emergency room and here's a story and they'll show you the scans. And it was a 93 year old guy.

Okay, so they say 93 year old person who had a blood collection on his head. So right away, I think 93 year old person like this, is this somebody who we're going to operate on? I mean, is this a big deal? And if I want to be strategic and be thoughtful in terms of how I'm approaching this, they say, well, they say he's very high functioning guy and all this sort of stuff.

And so give me the story, it turns out he had been on his roof of his house with a leaf blower blowing the leaves off of his roof. Okay. And he fell and he got injured. He had a subdural hematoma.

He came in to the hospital and he was still with it at this point. The blood collection was growing, but he was with it. So I went to go talk to him. And when I went to go talk to him, I'll never forget, he was looking at his iPhone or whatever.

And just, it was interesting because he never reading glasses. I thought I need reading glasses. I looked at this thing and I said, Hey, so what's going on? He's like, Oh, you know, he fell off my roof.

You know, whatever. And I said, what do you read? And he's like, Oh, these elections are happening in East Africa. I'm just been following them.

Oh, wow. So he's obviously a high functioning guy like they said. So we take him to the operating room, he's got a subdural blood collection. So that's blood that's just underneath the outer layer of the brain called the dura.

Remove that, you stop whatever little bleeding there is. And for a little bit of time, you're looking at the brain because you've taken the blood off the brain. So 93 year old guy, this gets back to your point about actually, what do you think I saw in this 93 year old really high functioning guy's brain? What I saw was a very shriveled up brain that looked like it belonged to a 93 year old.

Oh, really? Yeah, it had aged just like you expected it would age, but it had almost no correlation to his function. That was the thing that really stuck with me. He was sharp.

In fact, I went to his room after the operation and he we're having this conversation and I thought, what, you know, this is quite an experience. I mean, you're you fell, you almost died. How you doing? And he said, well, he goes, I guess thing I've learned in all this is probably shouldn't be blowing leaves off the roof.

Just this just really comical, thoughtful, 93 year old guy whose brain was a 93 year old brain, but the function was remarkable. We think of our organs having this natural deterioration and they do, but it doesn't mean they can't function like they did when you know you're much younger. Well, it makes me think of two things that people like commonly know, right? It doesn't really even matter if the numbers are right, but they say, you know, like you only use 10% of brain or 20% of brain, but forget that.

The notion that you can have a stroke and they can actually take your motor control and move it to another area of your brain. Am I right? And that's how it works? Like they just basically force another area of your brain to do the job that another area was doing.

Yeah. I mean, you do it. You basically are recruiting other areas of your brain. They can through therapy and things like that, they can basically start creating these changes in your cortex, you know, where the motor areas are the brain and create new areas around that to actually help you move again.

But you're the one doing it. Your brain is capable of doing it, you know, it's not like they're going in and sticking new motor neurons in this area. It is accelerating a process that might happen anyway, right? Yeah.

You didn't, I didn't even know I had a stroke. But then you got to make you move and then eventually you start moving again. You know, if someone told you how to stroke you're like, I can't move. What that tells me, you can't take one of the four chambers of the heart and then just jettison, one of them and have one of the other ones to do the job of that, right?

Because it operates virtually at capacity. But what that tells me about the brain is that there's so much untapped potential just sitting there. There is so much untapped potential. And if you build that reserve, which I'm fascinated by this idea of cognitive reserve, then that potential is even greater and can come into play more easily if you start to develop any problems.

I don't know if you caught the HBO real sports story. They ran a couple weeks ago on CTE patients that have gone and done ayahuasca or psilocybin mushrooms or ecstasy. And the way the neurologists in that segment described it is that the guys with CTE, their brain is so unflexible and that the pathways are so, how do I say it? It's all they're using and it's part of the condition in that when they kind of explode their brain with these different drugs and they show them in whatever scan that is.

It's not MRI, but they show their brain and the activities off the charts, right? It's just an electrical storm on these drugs. And then when the brain is trying to reprocess and bring them back down to reality, in that they end up forging new highways. That's how I understood it.

And I was just curious if you knew about that research and could it be that promising and it's very exciting. I follow the psilocybin research pretty closely. I think that the idea, let's see, TTE, first of all, the idea that you develop similar sort of plaques and tangles that people see in Alzheimer's disease, which leads to interference with these pathways, I think is real. And there's very classic sort of symptoms as a result of that.

With the psilocybin, the thing that struck me the most was that they were giving people who, not a CTE, but had refractory depression or anxiety for a particular reason. In the case of the early trials, it was because these people had a terminal diagnosis. It wasn't just that they were old. People had incurable cancer, whatever it may be.

And they were super depressed about it understandably, but they also weren't responding to any kinds of therapies. And they would go through generations of these antidepressants and anti-anxiety meds. And they were incorrigible to the point where they were suicidal despite the fact that they only had months to live. I mean, it was really, I don't know if you've read any of these studies.

There was one out of NYU and then Hopkins. And now at UCLA, they've added another trial site. I only know it by way of the pollen book, which yeah, talks about the active psilocybin actually reduces your connection with your sense of identity, where you're formulating identity and that it allows you to feel connected in a way that you otherwise can't. And that connection to the rest of the world seemed to be very helpful to those people.

Pollen, you know, he had an article in the New Yorker before he wrote his book, How to Change Your Mind Called The Trip Treatment. And it was based on that exact thing. When you talk to those NYU researchers, I'll just tell you this really quickly because I think he's in what you're saying, they had remarkable results. As you know, that's why I got such attention.

These people who did not respond to existing therapies, they took a single dose of fluency. They were psilocybin in a cognitively controlled setting. So they were in a hospital and they had a cognitive therapist. Terrible place for a trip, I would imagine, but continue.

Well, you know, it was fascinating. They showed me the room. You put on this iPad, you had the headphones. Oh, oh.

And for a lot of people, it was, I've never done psilocybin. I've never done it. Oh, son, Jay, you have to. I forced Monica.

You know, I'm sober, but I used to do them 16 years ago. I did them all the time. I forced Monica. I was really against it for a long time.

What did that entail? I put together a beautiful group of people. I was in charge of administering it. I was there sober in case anyone got scared, which happened.

Yeah. And I was not prepared for that and also not to make it personal, but Dax was there to protect us and he went to the other room to watch TV. Because he said he wasn't feeling it. So they were all getting annoying.

Like they were evaluating whether they were high or not. I forgot how annoying that part of it is. Oh my God. Yeah.

Can you look at those wishes? Look at that. Are you feeling anything? Are you feeling like?

I bounced into the other room and hoping that when it came on, I would get involved. So, but I missed my window. I did. I did.

My hands turned to the ground. My hands and I started to panic because I was really scared to do it. I didn't want to do it forever. And he had been saying you should do it.

You know, make you more creative. And so I went and I out when I was serving, which I generally cannot be peer pressured, and I thought okay, I guess I'll try, but also we went there with the intention of microdosing, which is a waste of time. And we didn't do it. I had a full dose.

You guys did microdosing, everyone was like, why the fuck are we doing this? Nothing's happening. And then everyone decided to have a real trip. And I said, okay, well, then it's going to be this amount.

Okay. So anyway, it just really caught me off guard and I started panicking and having a real panic attack. And by then, Dax came out, also everyone looked like a cartoon, but then Dax came out and took a walk. I took it on a walk.

We slowed down, we talked, I said, look at that house. So what was really funny is she started getting convinced I was on them too because how on earth would I know it looks like a movie set? And I'm like I'm done this. Are you in my head?

Are you even real? But then he said a really wonderful thing which was you have the Capacity to decide whether this is enjoyable or not you can pick so then I turned to turn it around and it was really really life-changing Sunday, please don't leave planet earth without doing it. It would be a big mistake. You're not an addict, right?

You know, you're not But you know, it's interesting because I hear this story exactly Monica what you just said and I think I'm a bit of a control Yeah, you can't be more of a control freak than Monica Right, so that part worries me like to pay the price to get there by what you the grandma hands and all that and having the hallucinations I won't leave your side. I learned from this. Okay, so I will give it to you and then I'll just hang with you the whole time Okay, okay, also if you know going in yeah, oh, there's gonna be physical changes maybe or you know I just had no idea and I thought I was only doing a tiny amount So I thought colors were just gonna get a little brighter. It was so much more extreme than that So I think expectation right there I'll tell you when I read the article that the pollen book was ultimately based on and then went back and looked at the research It's people in that trial who had these you know refractory depression anxiety their scores improved and lasted for months I mean up to six months in certain cases So it was a really profound experience for them I mean people who are atheists were writing things about their experience like I I'm an atheist But the only way to describe this is I felt like I was bathed in God's love and that was quite interesting to me to sort of read People's first-hand perspectives on going through this and also from a medical standpoint, you know Like it so you give an antidepressant every day has all these side effects give a single dose of something like a psilocybin in a cognitively controlled setting Whatever it may be and it can have really long-lasting effects I mean it's a whole nother discussion But you know I did a whole bunch of reporting on cannabis a few years ago in this whole inflection point between overtins window They've made with overtins window.

Oh, I love no terms. Tell me that overtins when I'm pregnant wrong So I'll just be humble about this but overtins window fundamentally is a concept of a window through which everything that is acceptable Societally can pass through at any given time and as you might imagine it shrinks and it expands and it moves all the time and Cannabis like cannabis was not something that went through overtins window 15 20 years ago Yeah, it was not allowed to pass through and then now obviously it's changed tremendously But those inflection points between what is acceptable and what is actually helpful to people because it's not acceptable We say it's not helpful like cannabis can actually be helpful. I became convinced to that did these documentaries on people with refractory epilepsy and things like that kids You know again who weren't responding to conventional treatments? Not only did it work for them for some of them It was the only thing that worked yeah So it became as much of a moral issue as it did a medical issue and I do think things like psilocybin for depression MDMA for post-traumatic stress.

I'm not as familiar with the applications of ayahuasca Although, you know, I just haven't read as much about it But obviously it's gaining more and more they're doing more trials around this it have to be really effective because it's almost guaranteed You shoot your pants so for me. That's a big barrier of entry. I better have some real real positive outcome Is that a metaphor? No, no, no, no, no, no.

What you do it? There's a bucket at the front of your bed and there's a toilets everywhere. Yeah, it really messes up the system I'm never doing this just a little bit of a deal-breaker for me also I don't want to be your guide like I'll guide you through those rooms event, but not that not I don't want to deal with that You need a true shaman for that, huh? Okay So one thing I love about your book is that it reinforces something that I believe the most if I have any conviction It's you know if I had to give up things that helped me in order the very last thing I would ever give up I would leave a a before I would stop exercising so tell me about the power of exercise on your brain First of all, it's the only thing that we've actually been able to really gather the evidence around with regard to brain health And you know again, there's a lot of other things that are helpful and absence of evidence is not evidence of absence But the thing you're gonna hear from neuroscientists and stuff They're always going to talk about physical exercise a because it works B because it's measurable and C because we've been able to collect real evidence around it So people who are in motion and I'll just use that term for now And I can define that but people who are more active tend to have brains that are going to have a lot more of these same qualities That we're talking about more reserved more resiliency BDNF is something that people will often refer to which stands for brain derived neurotrophic factor BNF You want BDNF I can't give it to you in a shot or a pill or anything like that But your body can make it it's like miracle growth of the brain and it'll actually spray into the brain in response to movement Which is a really interesting thing and again It's the only predictable way to increase these neurotrophic factors which will enable the neurogenesis that we're talking about all these other things in a very predictable way So movement is really key when I started to think about this book I had been traveling around the world and looking at all these various cultures where you know dementia was very rare and A lot of these cultures they had a lot of healthy habits But one thing that you noticed was that there was a lot of movement in these cultures They hardly ever sat they were either lying when they slept or they were standing and walking usually walking frankly Not even running when they were upright and that was it and you know you start to talk to these evolutionary biologists about this And you say you know people human beings really only sat when they got old You know it was almost like it was teleological in the sense that you started to sit a lot when you got old and it signaled these things to your body Like hey, I hope and some of your body's self-defense mechanisms started to decrease your immune system started to taper a bit All these things have basically allowed you to come to a natural biological end which happens to all of us But it was almost like the sitting was triggering that as opposed to the other way around Now obviously you fast forward to now and you know we sit all the time So in some ways we're always sending these signals to our bodies that you go ahead shut down the perimeter defenses You know, I'm ready to go my body must think I'm 200 years old.

I mean it's a lazy boy half today Yeah, but you're an active guy as well, you know, I mean there is something we said for natural consistent movement throughout the day But you're an active person I think you know and I think it makes a huge difference But it's really the only proven evidence-based way to really improve brain health increase blood flow increase BDNF create that reserve that resiliency all that sort of stuff So for me, you know a body in motion stays in motion I think of activity not so much as the cure to things as inactivity is the disease I mean that whenever I'm about to sit I do ask myself if I could be standing instead Do I really need to sit, you know, whatever it may be however you incorporate that into your life can make a huge difference, you know Just overall in terms of brain health. I think much more so than crossword puzzles or particular brain training exercises It's like you're signaling to the body that I'm here signaling to the brain that I want to stay Yeah, I need to be in a condition to respond. Yeah, exactly I want to be engaged with this world so keep me as healthy as possible thinking as clearly as possible all those sorts of things You also bust some myths in this book. Here's one I wasn't shocked by supplements won't keep your brain sharp Supplements are a big topic and I will tell you that there are some really good supplement makers out there But the reason when I look at this talk to a lot of people who have done these trials around supplements a few things sort of jump out one is that it's hard to get the good stuff out of food and put it in a pill no lack of trying here I mean this isn't to malign some of these really good supplement makers It's just a hard thing mm-hmm.

There is this notion that you may have heard of called the entourage effect Which basically means that when you eat food you're getting your lycopene's Yes, you know whatever it may be but you're getting lots of other micronutrients that in conjunction with the biggest active ingredient are really important for letting that Active ingredient work in your body I open some receptors, you know They allow the lycopene's whatever the most active ingredient is to work best It's hard to do that when you put it in a pill form because you're losing the entourage of micronutrients around it So that's number one number two is that just a really unregulated business in this country You know it was just too bad because again, there's some really good supplement makers out there But because of lack of regulation you get a lot of bad actors as well They're not as diligent about what it is that they're putting into their pills either It's not what they say it is. It's too much of what they say it is and in some cases even harmful So we don't have a regulated industry and that's a problem And one thing I'll tell you is that there are supplement makers that have been around for a few decades And that's something that I immediately gravitate toward because there are these fly-by-night operations It's such a big business right billions of dollars are spent on this so these fly-by-night operations They come in with these grand promises and they sell a bunch of supplements for several months or a couple years And then they're gone and they're not in service to the customer They're in service to just making a lot of money on the other hand You do have and I'll send you some of these names that have been around a long time and you spend time with these supplement makers They still are at risk of having the same problem of not being able to create the entourage effect in pills But they do a pretty good job. They can help overcome deficiencies people have true deficiencies of a particular thing But overall for your brain eating it versus trying to take it in a pill I think makes the world a difference. Okay, and that brings me to another one which this is one I was kind of shocked by which is brain superfoods are a myth superfood is a Advertising sort of term that people can get easily behind just like we were saying they want the crisp headline This is a superfood There's almost nothing that is a true superfood and it should surprise no one that when you got seven billion people on the planet Everyone's brains and what they respond to or what they best respond to is gonna be a little bit different You know, yeah, I mean we want the sort of universal rules as part of this book One of the things I did someone kept telling me to do it I never done it but I decided for the book I would do it which was I was really diligent about keeping a food journal and you write down what you eat and then you Spend time, you know an hour later two hours.

I just writing down how you're doing And maybe you have your own sort of way of grading yourself Like I feel very creative right now or I feel like I need a nap right now or I couldn't possibly do a challenging task right now Or this is the best I've ever felt and you will find your quote unquote superfoods For me, you know, it was interesting I all of a sudden found that fermented foods like pickles were a secret weapon for me Oh, oh when I'm gonna sit down and write or do something that's you know, I think it's gonna be challenging It's gonna require different parts of my brain. I might have to do novel thinking I'm not just regurgitating things, but the novel thinking part of my day. That's the fun part, but it's a challenging part pickles You know, I got it that through food journaling and people may have different sort of superfoods for them And you can figure it out you can individualize your optimization here comes my crossfire journalism Isn't it true Sanjay that you have a large holding of pickle futures You come or futures I thought that was totally private Everyone go on by pickles If you dare And how about crossword puzzles we always hear that crossword puzzles are like doing sit-ups for your brain Yeah, cross-repuzzles are good for developing things like fluency of your brain word finding using words, you know More quickly and those are great, but maybe sit-ups is the right analogy If you just did sit-ups and nothing else I don't know how good that would be it wouldn't be bad But you know if I tell you I want to give you a whole body workout And I'm gonna focus on your diet and focus on all these other things it would look different than just crossword puzzles Crossword puzzles are great, but they become a substitute for everything else that you should be doing for your brain I love the one thing you wrote finishing a crossword puzzle on your own isn't nearly as impactful in boosting brain function as having a face-to-face Interaction with a friend study show that having a diverse social network can improve brain plasticity and help preserve cognitive ability So yeah, everyone would assume doing two hours of crossword puzzle would be better for your brain than shooting the shit with a buddy Right, I think most people would think that and what you find again And it won't surprise neuroscientists is that when you were shooting the shit with a buddy all the various things that are happening in your brain as a Resolve the friendship the content that you're talking about whatever it may be getting yourself outside your comfort zone challenging each other a little bit Whatever it may be those things end up being much better for harnessing and recruiting all these different areas of the brain If that is the goal to always be recruiting new areas of your brain then it starts to make sense Why certain activities are better than other activities? It's not that the other activities are bad But if I had to put it all together if you said, okay, what is the best thing to do for your brain?

Just give me a couple examples I would say take a brisk walk with a close friend and discuss your problems That kind of gets at all these things, you know the brisk walk obviously just in terms of the movement But having the real social connection with somebody, you know And how do you determine that it's a close connection because you feel like you can actually talk about your problems Can't do that with everybody so I found that really you know quite compelling and easy to digest and I started using it my own life I haven't been able to see my parents obviously in a long time because of this pandemic But when I call them I would typically say hey, how you doing and they would typically say hey, we're doing fine You know and it was very cursory when I started having a more purpose-driven conversation with them and this loneliness expert taught me this Asking them for help in some way could be something simple all of a sudden it completely changed the purpose and intent of our conversations So my parents both engineers as you know, you know Michigan background and one day my wife came home and her car had smoke coming out of the hood And you know she's like I take a look at my mom, okay So I thought the hood and it's all you know, I mean these engines nowadays I don't know where to begin and I FaceTime my parents and showed them the thing and you know dad I got this problem I got this problem and they were so into it the next morning My mom is sending me these diagrams of the engine and here did you look over here and it was a wonderful sort of interaction with my parents Yeah, it was revolving around something that was just so purposeful and I just I felt good first I learned something just about engines But you know like the number of like really meaningful conversations that I've had even with my family I do have meaningful conversations with them But you can get so procedural in your lane Yeah, and to say I'm going to create a purpose-driven conversation again You guys are privileged because you get to do this through this podcast and other things all the time So maybe this sounds so obvious to you. I don't think so Sanjay I think everyone's life is a broken record like once you go home from work It's like we got to get some food on the table. We got to get these little jerks to brush their teeth almost impossible You know the steps are so repetitive that of course then the dialogue ends up being informed by the action in a weird way You know look I'm guilty of that as well I mean I'm not preaching here But if you can be vulnerable to somebody and that means asking for help then it gets up so many of the concepts in this book Because it does harness the new areas of the brain it creates an emotional attachment that really fires up your amygdala The memories are stronger of those types of interactions because you have more of these neurotransmitters are actually impregnating these memories more strongly into your hippocampus There's a physiology behind all this. There's a why behind all this but the what which is what you should do is to me very simple And it makes sense to me this makes me want to tell you a two-second story Which is on a movie set or a TV set the people that have to most memorize names probably are the camera operators Because they're so often saying Jennifer will you step to your left or whatever?

You know they can't just say like hey guy in the red shirt So they more than anyone have to really learn everyone's names and there's this great guy on parenthood Skippy O africano perfect name for him his trick that he taught me was he hung out in the morning at the craft service area where people Get their coffee and their snack and when he would see a new actor that was just there for the day or a background player Or anyone he would have to talk to he would ask them to hand him something and he said that he had learned this trick That if you need something from somebody you will remember their name And I tried that trick in real life And I also just went through historically when I'm there as an actor I actually don't need anything from anybody but when I've been directing things. I need the costumers to do this I need the hair people do that. I'm so good I've memorized 120 people's names on my crew because I need something from all of them interesting But when I'm there as an actor I mean I don't know anyone's fucking name And I was like there's something to what he said here How do you create a purpose around that interaction because then it helps you remember yeah, you had an experience and asking for help There's a little bit of a vulnerability there which I think is maybe the key I mean, I'm not sure that that that's the key to be honest But whatever it is you tend to remember that maybe it's because you have this instinctive gratitude because they just helped you in some way Whatever it may be just asking someone's name and they tell you there's nothing to associate that with I mean, you know You're Dax your Monica. I would not have been able to guess your names just by looking at you sure sure it's very arbitrary Yeah, I mean if I got to know your mom your parents maybe it would make sense, you know, there'd be some story there But yeah, I think you're absolutely right how we remember by the way, you can remember too much You know going back to the MDMA, you know when you talk about post-traumatic stress One of the things that they were studying as part of these MDMA trials was to give people these beta blockers right after a traumatic experience You know basically bringing down the level of stress hormones because stress hormones Cause you to really impregnate these memories even stronger injury hippocampus So somebody's had a terrible accident or some terrible trauma in addition everything I was giving some beta blockers and they'll be less likely to have PTSD later on sort of fascinating But it's the same thing except in reverse Abolutionarily if you find that when you drink from this certain water hole a crocodile comes out at you This is very pertinent information to remember.

It's not hard to understand why we're so good at remembering life-threatening things Exactly exactly. Okay, so we hit move so it's such as five pillars of brain health We hit move and we just talked about connect but I would like to talk about discover relax and nourish Because again some of these are counterintuitive. Well with nourish, you know, I think that there are a couple of basic rules I do apply which is one of the things that what is good for the heart is good for the brain I do think that is true just fundamentally because these are both highly demanding vascular structures The brain is 2% of your body weight it takes 20% of your blood flow What you have in your blood in terms of nutrients and how you're feeding yourself is obviously going to make a difference But what I think is different about the brain versus the heart for example is that nourishing the brain comes not just in the form of food But in terms of every sensation you have every experience you have is nourishing your brain in some way every sensation you take in visual Any kind of sensory stimulation is nourishing your brain So how do you think about nourishing your brain from an experienced standpoint being out in nature? For example, you know when you're out in nature, you're breathing in these things called fight-on sides Which are nature's own stress relieving chemicals?

That's how nature sort of busts stress or wards off potential threats And we have receptors for these fight-on sides So that's a sensation or a nourishment that you can give to your brain as well So, you know, you really think about nourishment from a dietary standpoint Understand what is good for your heart is also good for your brain find your superfoods like I did and think about nourishing your brain in terms of all these various experiences Sleep and rest. They're both important I think with sleep, you know We think about just the body is shutting down and you think the brain is sort of sleeping as well and it's and it's not The brain is actually quite active during most parts of your sleep cycle And you are actually then consolidating a lot of memories during that time So if you get joy out of having these great experiences presumably you have joy out of remembering them if you are consolidating those memories well through good sleep It's a joyful thing, you know, that's the incentive It's not just to tell you that you will live longer It's that you will have a more joyous life now Why because you're consolidating wonderful memories that you had before and that's a good thing you want to remember your life But it also serves a pragmatic purpose of almost creating this rinse cycle in your brain at night There's various debris and waste that occurs just from natural cellular processes You want to be able to sort of flush that away and again This is relatively new science but almost like the lymphatic system that takes away Away in your body the brain has its own sort of lymphatic system, which is far more active during sleep So whatever it takes to convince people to do this, you know, it's super important. Did you read why we sleep? Yes?

Oh my god It's fantastic. Oh, it's mind blowing It's mind blowing and you know like I think the what and the why right like I can tell you what to do But I do think like in why we sleep understanding why you do it I think it's a really good way to learn and then people will follow it because oh that's why I'm doing this It makes sense to me now It sticks with you you're more likely to share it with your you know your friends your family And on a personal level while I was relapsing this year in a view Opius what I realized is I either wasn't dreaming or if I was I certainly didn't remember it and then I read that book and I thought oh I was probably robbing myself of all this time where I process my fears. I process my memories I store those here I get rid of that I don't need it It's like well that could be an unintended collateral effect of that that I would have never even considered right but I didn't know about the relapse Oh, well everyone listening knows so don't apologize I've been so head down and covet so I know you have no obligation to follow my Yes, I'm totally okay. I'm three months clean.

I had all those surgeries and then I decided I would Would write on those opiates well more complicated than that but that was certainly probably what got me to critical mass. Yeah I'm sorry. You're my friend. I feel like I should know these things No, no, I didn't say it to be a downer.

I just was putting that piece together while reading why we sleep I just thought oh this is something probably known even thinks about with different addictions alcohol people who are alcoholics We know it affects your sleep tremendously. We know that it robs you of RAM. We know it robs you of this So that's just again when you learn of the function of sleep and how important it is that then to has to be a factor You consider totally it's not just your liver. It's not just you know your marriage You know this is a lot of stuff You know going back to the brain You know to the extent that you think of the brain when you think of sleep the liver you measure your liver function tests And it's again this objective measure with your brain, you know, I'm telling you you're not thinking as well as you normally do You're not remembering as well as you normally do you've lost your energy You know there's all these sort of vague nebulous ways of describing it, but it makes it no less important And in fact, it's the most important stuff for how someone thinks about their life You know how they define their lives and yet because we don't have a precise measure of that It's been hard, you know That's again what I really wanted to get out in this book I'm very careful not to be too audacious in terms of high present this because I want it to be something that people are really gonna believe in I'm not out there sort of making these wild conclusions But there are several things we know to be true in terms of how we can best take care of the brain And I believe there is a best way to take care of the brain for everyone if you believe that there is a best way to do this for you If you start with that premise then I can help anybody can help really get you there Yeah, and I don't think these are big asks, you know It's not like Atkins diet where you can't eat more than 30 grams of carbohydrates in a day That is very hard to achieve but taking a walk every day is doable You know getting the right amount of sleep is doable connecting with people you love is doable None of these things are painful really asks and so I think it's very approachable in that way Yeah I mean I think the reason people don't do them is almost for the opposite reason you know in some ways they're too simple So they don't believe it could actually have an impact or two it's always the first thing to drop off your schedule You got a busy day So you know you're gonna get together and do that walk with your buddy and talk about your problems and that fell off the schedule quickly Because how important could that be so unlike other things which are actually hard to do and you're like I just I can't do it's too hard It's almost like with these things because they're too easy.

They don't seem like they have the same level of importance I've struggled with that even in this book Like how to convey that to people because I write a book like this as a brain surgeon as someone who has studied the brain for a quarter Century and people will say well are these books too soft are they too vague are they too nebulous and what I say is look I think that if it's objective measures that you want we'll catch up we'll figure that out We're gonna figure out how to test differently how to measure differently and all that and we'll have these paradigms You have to have a 95 score on X You know yeah But until then don't we still want to use common sense and understand societies around the world that have hardly any dementia and learn from them In some way don't we want to pay attention to things that we know must be true or we're gonna wait a hundred years for the evidence To do things that can help us now. It's a fundamental debate that's always happening in the scientific world And frankly part of the reason I got into journalism because sometimes things move too slow You're gonna wait for a new England Journal of Medicine article Which will take 10 years from some idea and some smart person's head to the time that it's published or you're gonna start doing things now That aren't that hard to do like you just said and can make a huge difference. That's really what it's about Yeah, we can't quantify pain actually we try with this one out of ten thing It's told what the fuck is Monica's nine versus my six, but I'm not gonna drop a brick on my foot every day until I have that number Right, you know and by the way measurements are a little bit, you know seven billion people on the planet just like with pain We're right with everything my cholesterol of whatever the number is may not have the same impact on my heart as your cholesterol of the same number We make shortcuts. Yeah, my favorite from anthropology was just in it's we're living on a generally a diet of like 5,000 calories a day of Well blubber.

That's virtually all they ate yet. They don't have coronary disease They're so you just look at the extreme Latitude of how humans have lived how they've thrived in yes, we're so very young you talk about a fatty diet right being a bad thing Everyone would say that yeah, and yet we know that I think we talked about this two conversations ago About sugar, you know and sugar became the substitute for fat because we were a low fat country and low fat food Tastes a terrible so you're placed it with sugar and that was actually considered health foods Yeah, I mean these were terrible decisions Cardiac disease became the number one killer of men and women alike We obviously have to countries either prediabetic or diabetic and we are a country that follows a low fat diet We don't really but my point is that that became the enemy sugar became the friend and where did it get us? So having measurables that way can actually be to our peril as well We know fundamentally what's right and that's what Keep Sharpe was really all about was in some ways Cottifying the things because it needs to be codified in some way. Maybe I'm a good person to do it I don't know We'll see but to be able to take this journey and say okay, you know what I believe this stuff I spend enough time with these neuroscientists I'll give you the what and the why to explain why these things work and then do with it what you will but if you do it right You're probably gonna have a better more joyous brainful of more resilience and reserve You'll have that life if you do these very simple things Yeah, cuz your body's gonna physically let you down like I too am gonna fall off a roof with a leaf blower 93 I guarantee that so you know Let's hope the one thing you want the most in those latter years is still high functioning I hope everybody buys Keep Sharpe so that we can buy Sunjay a staircase for this I'm definitely doing that now.

I'm telling Rebecca. We're putting a staircase in and listen You were a three-peat, but I think you should go for the Alec Oh, yeah, Martin SNL numbers on here I'd like to talk to you every a bi-annually. I'd say I agree. No semi-annually like every day.

I really love it I really do I don't get the connection so much especially nowadays we can dig deep, you know I mean sometimes I just feel like life gets a little cursory You know and sometimes I just want to lean in with some of my friends and have the deeper conversations And you know sometimes they don't and you gotta like get the bandwidth right because if you want to have a deep conversation They don't that's the worst right and that is the worst and yet guys you are such curious people and I just really enjoy it Well, we hope we're part of the antidote to the Twitter. Yes Mark Twain said what was it would have written your shorter letter, but I didn't have the time Yeah, I just heard the first time the other day. It's of quote from someone funny. Do you say who's it from?

I think you know Mark Twain gets credit for everything so I'm actually Yes, I heard that and fuck it was in reference to something else really funny What were you gonna say mother? I just never get a chance to talk to neurosurgeons often and I have you here So I'm going to so I think last time we recorded this was like days after I had a seizure So I then has been diagnosed with epilepsy and I don't know what it is Exactly like what is happening in my brain when that's happening? So, you know, I didn't know this is after the time that we just spoke in March you had just had a seizure I think yeah, I just haven't like probably Jesus. I'm on pills.

She's having seizures. Where are you goodness? I need to do any to be doing these more often free pizza not enough He's flopping around on the ground. I'm eating like But they were both at night.

I've had two only I think but they're both nocturnal You're apart the only reason we knew the second one was a seizure like I had a seizure and I didn't know it because it was at night I woke up and I had like disorientation I peed in the bed and my back was killing me and then I went to the doctor that day And they just did like a you know a urine test to check my kidney functioning and stuff and they're like your other famous moment I was wrong. I was like, oh sure. Look at just peed who cares people be the bad I don't think I don't think it's normal and then a year passed and I had one in February in New York And I was in a hotel room with three friends, so they saw it. So that's how we knew that one was witnessed.

Yes Thank God, so I mean I am always try to be very humble I don't want to diagnose from afar But I imagine you had to work up with scans and do you have an EEG as well? We didn't end up doing an EEG because minorologist who I love was just like I don't think we're gonna find especially because yours We're so far apart and it just doesn't seem I offered to do an amogram and she didn't think that Not the most Nothing else that can just as two points in time was there anything else that was similar about those two points in time and not that I can Say I mean it's hard because of the first one I didn't do very good documentation because it got written off very quickly, but I don't think so It's also tricky because they're happening there they happen tonight So I don't know if I'm on medication now. I've been on medication since February, but I don't know if they're still happening You know, I sleep by myself, so it's a weird thing. Well, I agree It's hard to pick these things up on EEG But if you are on medication, you know one thing you can do is you can do a EEG on and off to see if you're you know At some point I'm sure they're gonna think about we knew off the whatever it is the cat breast I went in the cat breast yeah, yeah and being able to compare it to see if you're even having anything micro subclinical at that point It's good that the scan was normal MRI scan you did that with contrast use to put an IV in and use contrast No, I don't think so we did all the tests that day like that next day went to the hospital They did all those tests and they said everything was they thought they were very comfortable with the scan sound yeah about a third of seizures Or you know their sort of video pathic they never really figure out what caused it You know it could be an electrolyte imbalance It could be some sort of sometimes of medicine that you've interacted with for some reason or whatever it is a substance All right, I've had friends that said they were on a birth control and they had them and they went off and they never had one again Is that erroneous I hadn't heard that you know specifically with progesterone, but you know who knows I mean, you know a third of these things are the psychopathic There's got to be some other drivers, but as a neurosurgeon You know we always worry that in an adult who has a new onset seizure that it's something organic in the brain You know something's right on the brain and if it's not that then it's good news obviously and two is that they're much more likely to resolve You know so you know I'm sure you're neurologist good But you know thinking about getting a egy while on and then off to see if it changes at all might be worth it Yeah, and I'm sure they check all your labs your sodium and all that at that they don't yeah I'm sure they're done.

I'm a gram of these doubles Yeah, sure That's a lot you know I listen to that That's not we talked to you was gonna land a plane or something I think it was myself as a primary care physician So pilot I think you're trying to convince me that you should land a plane that I was on I was fine it Oh that started that that debate has yet to end by the way And we've even had a pilot say that he thinks I'd be a good candidate just because I'm so arrogant Yeah, you really need to believe you can do it. That's probably the most important thing Alright, well great luck with the book everyone should really appreciate it by and read keep sharp and we will talk to you again shortly I guarantee it for Pete. All right. Thank you And now my favorite part of the show the fact check with my soul mate Monica Batman Oh, you have us now you have a second diary of facts.