Optimizing Brain Health in a Modern World with Austin Perlmutter, MD

[00:00:00] Dr. Austin Perlmutter: The reality of it is that just like every other part of our bodies, our exposures to these different environmental inputs are changing our brains in real time. The outcomes of those exposures, usually people do not care about or even pay attention to in the least until they're so significant that it necessitates a doctor's visit.

[00:00:19] Dr. Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level  Welcome to Next Level Health. I'm Dr. Melinda Ring. Today we're exploring how to protect our brain and body in a world that's not always built for it. My guest is Dr. Austin Perlmutter, board certified internal medicine physician. Bestselling author and a passionate advocate for brain health. In the face of modern challenges. From air pollution to digital overwhelm, austin's been unpacking the forces that inflame and impair our brains and offering tools to protect, nourish, and even rewire them. We'll talk about surprising links between muscle and cognition, and what it means to truly take care of your brain in today's world. Austin, I'm so glad to have you here.

[00:01:32] Dr. Austin Perlmutter: I'm excited to be.

[00:01:34] Dr. Melinda Ring: so let's start big picture. I've heard you talk about how today's world is mismatched with the brain that we evolve to have, so. From your perspective and the digging into the research that you've done, what are the biggest threats that you see right now to our brain health, and why is that more important than just talking about mental health?

[00:01:57] Dr. Austin Perlmutter: So my perspective is that we have made incredible advances in modern medicine. We are living longer. We have done incredible things, especially with infectious disease, but. All of this pales in contrast to the significance of brain health. The way that I look at medicine, the way I look at health is what is the primary outcome we're trying to optimize towards? It's really easy to chase other things surrogates. We could say blood pressure's the most important thing, but if you really chase it and say, why do we care so much about blood pressure? It's because, well, people who have high blood pressure at higher risk of having a heart attack or higher risk of having a stroke, and then we say, well, why does that matter? Bottom line is the reason all of this matters is because it funnels into the ability to enjoy our lives, the years that we have on this planet, and that is a direct manifestation of brain health. So there is a bit of a mismatch between a world that has been set up to be optimized towards other variables and the thing that matters most, which is brain health. When we look at the actual metrics around how we're doing right now, roughly 300 million people around the world have depression, roughly the same amount, have anxiety disorders. About a third of Americans report overwhelming stress most days. and when you look at. Cognitive health. We've got about 57 million people with dementia right now. A number that is expected to increase to 153 million people by 2050. we see that there are still these very pronounced drop-offs in brain function that occur over our lifespan, but also we're seeing, especially in the context of mental health, that brain health is not good. Even in our youngest generations, we're seeing a drop off in mental health in adolescents, in children, especially in young females. And so I think. If we're going to be honest about saying how are we doing with the things that matter most? In this case, I'm saying brain health, mental health, the answer is not that well and certainly not that well relative to the amount of money and science that we've invested in other things. So while it's great to chase things like gross domestic product, I think that we need to be more concerned about how we're pursuing brain health across the planet.

[00:04:06] Dr. Melinda Ring: Are you talking about. Really the world, our environment, things like air pollution and endocrine disruptors and things like that. When, we're talking about what we can do about brain health while still living in this world.

[00:04:19] Dr. Austin Perlmutter: Yeah. and that's it. I, mean, I love that you brought this up because sometimes what happens in these conversations is you get to this point where people will say, it sounds like what I need to do is move out into the middle of nowhere, grow. Everything organically on my farm have my stream where somehow I'm able to get salmon and fresh water and not really participate in the things that we know are bad for us. And I think that's not at all what I think is relevant for most people. We're still going to be participant. You're probably not going to get rid of your smartphone, get off the internet and go off grid. The goal here is to say, this is the world we live in. How can we best optimize so that we are protecting and improving our brain health as we participate in this modern day reality. So then you look at what are the things that we kind of need and what are the things that maybe we don't need at all? And you can look at various aspects of what is programming our brains for our worst mental and cognitive health. Certain of those things are kind of built into the ecosystem. For example, processed food in the United States constitutes the majority of our calories. 70 plus percent of our foods and beverages contain added sweetener. So. Unless you actively do something to depart from eating and drinking what most people eat and drink, you're gonna be taking in data that programs your brain for worse health, we know the correlation between ultra processed food consumption and worse brain health is pretty strong. So that's a scenario where we say, well, look, this is actually the way things are set up. You're gonna have to depart from that pretty dramatically. If you want a shot at Good Brain Health, other things are all around us, but they're not necessary and, but that, what I mean is you have to eat food. So then you get the question of how do I do it in a healthier way? But we don't have to be spending 11 hours of our day consuming media yet. That is what the average American is consuming 11 hours a day, of which it's about two and a half to three hours on our phones, and especially social media. It's about four plus hours watching tv. So these are things that we've kind of taken on as, okay, this is normal, but it really isn't, and it isn't something that is necessary in any way for us to be healthy, happy people. So in some ways you could say, look, this is a, this is a scenario with the digital consumption that we could make some pretty dramatic changes and there's no reason why we have to be doing those things. And then. Some variables are kind of more of a, a, a macro policy level reflection of what's happening. Air pollution, something you mentioned. So we know that air pollution exposure and in particular exposure to particulate matter correlates with much higher rates of Alzheimer's disease. And so a lancet consistently lists air pollution as one of the top drivers of dementia, and in particular, Alzheimer's disease. We know air pollution also correlates with violent behavior, with depression, with A DHD type symptoms, with a whole lot of brain related problems. And so we could say that if we were optimizing a society for brain health, we would do a whole lot more to decrease exposure to air pollution. That is a true statement, but again, the trade offs that we make here are saying. We're going to be pursuing other things that are more important than brain health. And the last thing I'll just say here, because I think it is part and parcel of this conversation is. We are in some ways optimizing for brain chemistry. That is actually how most of what we do in the modern day is set up, but we're optimizing towards short-term gratification towards getting rid of, for a moment or two, the existential distress, the anxiety. With things that by and large make our brains less healthy over time. So whether you're pulling out your phone to scroll on social media because you're feeling stressed about work or eating an unhealthy meal because you're basically feeling like something in the world isn't going super well or coming home from uh, a rough day and plopping down on the couch and just kind of veg out on the tv, we are actually replacing the healthy habits with things that. For a short amount of time, take our mind off the issue and maybe reduce stress in the immediacy, but over time are either because of the opportunity cost of what we're not doing, or because they're actually toxic to the brain, are wiring our brains for worse overall health. So some of this stuff is very unique to the modern age where there are just so many things that we can do in the place of the stuff that is necessary for good brain health.

[00:08:36] Dr. Melinda Ring: I think about these air alerts that I get on my phone with, you know, wildfires and things and, I've always thought of those as like, okay, maybe that's why my allergies seem a little worse. Or, oh, I, you know, somebody who has asthma or something like that needs to be more. Concerned, you're bringing up that it's really the brain health that's also being affected by this air pollution and these air alerts.

[00:09:02] Dr. Austin Perlmutter: let, me play off that for just a second because I think there is this massive gap between what we think changes our brains and what actually changes our brains. If you ask a person, why is it that? You make the decisions that you make, why did you decide to eat that, uh, unhealthy junk food as opposed to eating that healthy food? why did you say something that was mean to that other person? They will probably say, oh, well, you know, that wasn't me, or, or, you know, I didn't have the willpower or something like that. That despite the fact that we know so much more about the brain than at any other point in history, we still tend to dilute all of that science and instead say the issue is a willpower deficit or it's a character issue . And the reality of it is that just like every other part of our bodies, our exposures to these different environmental inputs are changing our brains in real time. The outcomes of those exposures, usually people do not care about or even pay attention to in the least until they're so significant that it necessitates a doctor's visit. And so just to use a couple of examples here. We would say, okay, if person had a stroke, then that is a reflection of some sort of a vascular problem. But they wouldn't necessarily be thinking about, oh, my brain vascular system is having issues until that issue goes wrong. Whereas with the heart, people tend to look at it over time and gauge it's relative health. When we look at something like depression, uh. This is maybe the best example, depression and dementia, where most people don't worry about it until they're at the point of getting the diagnosis and they walk into the doctor's office and they say, wow, you know, I've been fielding really low, or My husband, for example, or my wife has been losing their keys, has not been remembering names. What's going on here? And so we're several standard deviations in to the extreme ends of this pathology or or changes in our neurobiology that's been occurring over decades, but we somehow have this idea that if you have depression, it's something that happened with your neurochemistry overnight. All of these systems in the body operate in the same way, which is that they are a reflection of the programming that comes in from the outside world. The problem with the brain is because the output. Look so much like what we would call our identity, our personality traits. We're really not willing to look at them as dynamic until they get so severe that we have a medication or an algorithm for them. So depression by and large doesn't happen overnight. And I've seen patients as I'm sure you can resonate with who say, okay, well I lost my wife, uh, especially for example, in the va. I lost my wife and I've been down in the dumps for the last month since she died. I can tether that to a specific event. I can say you are feeling low, whereas previously you were feeling great because this thing happened in your life. But what you often see is that depression isn't tethered to one specific event. It is a change in the way that people perceive their world. That can be maybe related to their autoimmunity, that can be maybe related to, uh, metabolic dysfunction. And that's why you see, for example, that people with inflammatory diseases are at higher risk for developing depression. That inflammation in the body predicts a higher rate, not only of getting depression, but of having treatment resistant depression. And similarly, you can see that there is a correlation between type two diet. PDs and the development of depression because there is a metabolic and an immune component that speaks to the brain. And so my, my primary goal here is not to just overwhelm people by saying, oh my God, look at all this science and what do I do about this? But rather to say that as we look at brain health. We need to be approaching it the way we do biology as a a, a general topic, which is to say that our brain is a three pound organ made up of mostly fat that is highly responsive to environmental data, and we've gotta pay attention to that longitudinally, not just at the time where things get so bad that we're ready to prescribe a drug or put somebody in a treatment algorithm.

[00:12:59] Dr. Melinda Ring: You mentioned the heart. Okay. Well, we we're a little more tuned into the heart. Uh, people are now getting these coronary calcium scans, getting their scores, trying to see things before they, uh, actually have a heart attack. They're now into the guidelines. Some of these tests that we've done in integrative functional medicine, like a POB lipoprotein, a inflammation markers, you know, now those are starting to make their way into conventional biomedicine, more as a preventive, from a brain perspective, are there similar measures that we can take that, or measures that we, we can look at that are pretty readily available? That, you know, somebody who is like, well, you know, my heart, my coronary calcium score was x. I really would like to see the equivalent for my brain. You know, what, what would you, what? What do you say there?

[00:13:55] Dr. Austin Perlmutter: So what I would say is we're getting better metrics for Alzheimer's disease. We're starting to see peripheral MA markers that we can look at that predict risks. So APO E four, the best known of these, if you have double uh, or homozygous apo, E four, maybe a 15 fold increased risk for developing Alzheimer's. So we say that tells us you're at a higher risk. And so now there are additional, uh, markers like PTA that can give you additional data as to your risk for developing Alzheimer's disease. But. That's still just looking at what is your biological propensity or risk for developing a condition. It's not telling you, uh, how are you doing on the spectrum, right? In terms of saying, is my lifestyle working or am I increasing my risk for developing brain disease? So I. What I would say is there are cognitive tests that you can take to give you a sense as to how your brain is functioning in a given day, and that can be helpful for people. I definitely recommend, if you're concerned about your risk for mild cognitive impairment for dementia, that's a great opportunity to go and see a doctor and get a conventional screen because at least then you have somebody who can give you a semi objective sense as to how your brain is doing. So you're not just kind of sitting there saying, oh, well I forgot my keys last Thursday, but then I remembered them today. So go in and seek that actual professional analysis, however. As we're saying about with the heart, brain issues start decades before you get to a diagnosis, and so I think we all need to be thinking about what are the correlations with readily available data that can tell us something about what we're doing to our brains. So I mentioned the immune and the metabolic components. We know, for example, that people with diabetes, as I said, are at higher risk for developing brain issues, and that's not just depression, it's also dementia, maybe two to threefold higher risk depending on the study you look at. So does that mean that working on your, uh, not getting diabetes or even reversing your diabetes is a good plan for brain health? Yes it does. But when does that type of stuff start? Well, if you look at metrics for metabolic disease in the United States right now, it used to be the case that type two diabetes was relatively rare. Now it's about 10% of people who have type two diabetes, a number that increases with age. But when you add in people with pre-diabetes, which is around 40% of Americans, you realize that roughly half of Americans have either. Pre or legitimate type two diabetes, and both of those translate into higher risk for brain issues. So we should be making this connection, which is looking at a person's glycemic control, their metabolic function. And saying, based on this, we are going to need to make some changes to help you to prevent or decrease your risk of developing brain problems like Alzheimer's disease. So all of that is a long way of saying that looking at a person's hemoglobin, A1C is a brain metric because we know that. A1C helps to predict not only who has diabetes, but who is pre-diabetic and who is more likely to shift from pre-diabetes into diabetes, looking at insulin resistance, looking at models of insulin resistance, also helpful, triglycerides, a metabolic marker. All of these things are actually going to tell us something about a person's brain risk. So that's kind of on the metabolic side. I mean, waist to hip ratio. All of these things actually do correlate with brain health as it relates to their metabolic state, but they also relate to the. Inflammation component, and so I've spent probably much more time relative to the metabolic health, looking at how the immune system biases brain function in the immediacy and in the long term. And just to really drive this home, you know, we think about inflammation as a risk factor for heart disease or inflammation as, uh, a skin issue. Inflammation may be the single most significant risk factor that we can modify as it relates to brain health, because inflammation, as I mentioned, strongly correlates with mental health.

It strongly correlates with cognitive health, and inflammation is largely driven when we're talking about chronic inflammation by lifestyle choices. So there's this amazing circuit here where we say most people are being exposed to chronic inflammatory stimuli through their lifestyle that predisposes people to having higher rate of brain issues, but there's something we can do about it. So how would you know if you are at high risk for having brain inflammation or risk for brain inflammatory diseases? Well, most people are at high risk, I think is is the bottom line. really interesting tests that we've been looking at that can actually help you to determine whether your inflammatory state is activated is, is basically these second order labs around a complete blood count. So I don't know how many people who are listening to this will be clinicians versus the general public, but. One of the basic labs that you would get when you go into a a clinic would be a complete blood count. So it tells you about your white blood cell count. It tells you about the different white blood cells that you have. It tells you about your platelet count, and there's a lab called the systemic immune inflammation index, or SII. And what you do is you basically multiply your neutrophil by your platelet count and divided by your lymphocyte count. And what's super interesting about this test, which is it's basically as cheap as it could be because it's just a, a second order derivation off a CBC is that higher SII scores predict dementia severity. Predict, uh, small vessel disease in the brain predict white matter hyperintensities, predict risk of stroke and predict postoperative delirium. So all of these different brain states this immune metric. And what's super interesting about the SII is it's also influenced by metabolic function and it's dynamic, meaning it changes if you get sick, it comes down after you get sick, and it is responsive to, uh, things that you can do to decrease your total inflammatory burden.

[00:19:34] Dr. Melinda Ring: So, Austin, shifting from things that we can easily look at in terms of the markers for metabolic health and for underlying inflammation. Maybe we can shift now to those things that we. Can actually do to improve those factors and build healthy brains.

I know that you were involved in a pilot study about polyphenols and how those can affect immune aging at the epigenetic level. So can you share a little more about polyphenols might, what they were, why you studied them, and why they're so important to our brains?

[00:20:09] Dr. Austin Perlmutter: Absolutely. So two things here. The first one is trying to get a handle on what is the next best thing a person can do for their brain health. And that's going to be different depending on who you are, where you are, what you have access to. And then the second piece, talking a little bit about polyphenols, which. Are really a fascinating subgroup of, uh, these molecules found in our food. So let's start with the first piece, which is you're listening to this podcast, you're watching. You're saying to yourself, either for me, for my patient, for my family member, I want to do something either to improve brain health right now, or protect brain health in the future. What is that next best thing? And we live in a time right now where usually what you're seeing, if you turn on the TV, open a magazine, go on social media. Is that the next best thing is, is, some amazing hack. It's some sort of a, a fad diet. It's some sort of a supplement. It's a, a peptide. Uh, it's flying to this other country and getting some sort of an injection. And while I think there's a lot of value in looking into what longevity and brain related research is telling us, I am fully focused on trying to understand what the next best thing is for a person where you get the majority of your benefit. What we know right now about brain health is that the best studied tools to improve brain function and protect our brains into the future are going to be to do the basics well. So before you go and try to find some new supplement, ask, how is your sleep quality and what can you do to improve your sleep quality? Before you go and do some sort of a custom drip at a longevity clinic, ask yourself, are you eating healthy food most of the time before you sign up for some sort of very fancy program, that's going to cost a lot of money. Are you moving your body regularly? Are you getting some steps in each day? And if you're not doing those basics first, I would always recommend optimizing those first. The reason is, number one, they're far better studied in terms of their value proposition for brain health. And number two, they're almost certainly cheaper and more sustainable than these fancy interventions. So. The next best step is your next best step, and looking at the basics in terms of are you engaging in some mindfulness practice? Are you getting out into some nature? Are you eating some real food? Are you exercising? Are you spending time with people that you care about? Uh, these are the things I would always prioritize ahead of anything fancy or really anything that you have to spend additional money on. Now, shifting a little bit into this domain of the research that we're doing. One of the things that seems quite clear is that we know that food is a principle lever of what influences our brain health. The food that we eat has a major effect on our brains. It's not always an overnight effect. And as much as we live in this era where people want the quick fixes, the reality is that if you were to eat, you know, uh, an unhealthy meal. It may not have any significant effect on your brain. Now, you might feel a little bit guilty, so that's a psychological effect, but even if you went to the worst restaurant in the world and got the most fried hamburger with all the fries and you ate it all. You know, you might feel a little sick to your stomach, but it's not going to reprogram your brain overnight. What winds up happening is over time, the data that we consume from our food does play a significant role by changing the microbiome, changing the immune system, changing our metabolic state within our brains. And it's not just about are you getting the right calories, the right fats, the right carbs, uh, and the right proteins. But also all the other data that is in real food. What we know from looking at all of the existing data on nutrition and brain health is as much as we have a tendency to focus on specific nutrients when it comes to the best interventions to protect and enhance brain function, it is eating a good diet most of the time. And what I mean by that is really eating a Mediterranean or a mind diet, which is a variant of the Mediterranean diet. Most of the time it's absolutely the case that for certain people that's not going to work. It is absolutely the case that for certain people, a tailored diet, uh, may be much better. And in a perfect world, everybody is working with a nutritionist or a dietician to tailor their diet to their needs. That's not the world that most of us live in, and that's why I always would recommend take the next best step to eat less processed food, eat more of a Mediterranean style diet if you don't have another option that allows you to do more comprehensive lab work and more comprehensive intervention with somebody who really knows their stuff. But as we look at why certain diets have more of a beneficial effect on brain function. Again, going beyond the basics. So not just macronutrients and not even micronutrients, vitamins and minerals, but this group of nutrients called phytochemicals or phytonutrients, they don't really contribute anything in terms of calories, but we know that they have an impact on our brain health to, to give an example here, if we think about these phytochemicals, these molecules that are in our food, of which there are thousands and thousands, um. You can look at anything from caffeine, which obviously not caloric, but still has a significant and rapid effect on our brain Health to molecules called polyphenols. And polyphenols are so named because of their chemical structure. They have multiple phenols, which for those who took organic chemistry, number one, good for you. Number two, uh, these are basically just carbon rings. If you haven't taken organic chemistry. Why they have historically been seen as significant is because their chemical structure allows them to be antioxidant. So they are able to participate in these reactions, these oxidative reduction reactions. And we've thought historically that you want more antioxidant, so you want to quell these oxidative stress molecules, and that's a good thing for our health. But the research shows that when you give a person high doses of antioxidants, not only do they not. Get better, but they may actually have other health effects. So negative health effects. So polyphenols, which are naturally found in plants, actually correlate with better brain health, correlate with lower risk for Alzheimer's disease, correlate with longevity, and it doesn't quite make sense that it would just be an antioxidant effect. It's not that they're all in this one pool of antioxidants and you dump more into the body and we do better. What seems to be the case is that these molecules, which exists in our food program, our bodies and our brains, using pathways related to immunity, metabolism, epigenetics, and the microbiome. And we studied this in the context of a plant called Himalayan tarry buckwheat. The the reason we did this is because. We see that certain foods that have historically been consumed across cultures in places like Blue Zones, which Dan Butner popularized these domains around the world where people tend to live longer, tend to be very rich in these polyphenol molecules. And it's been pretty much unknown as to why polyphenols are associated with longevity. So we started to look at how. These polyphenols. So things like quercetin and rootin lutein translate into effects in humans, and what we started to find is a number of different pathways related to the immune system, to metabolism and to longevity. This was our, our first study, which was in 50 people. We're now expanding that out. Do a study in, uh, over 800 people to see how this food basically changes a person's overall makeup when you look at these epigenetic markers, brain related markers. So that's a lot of science. Let me now translate all of that down. We know that certain diets translate into better overall and brain health. The question is why, and we can break it down and say, well, you're getting more omega threes. That's true. You're getting more fiber. Also beneficial, but is there some sort of a signaling cascade that translates data from soil to plants to people that helps us to program our bodies and our brains towards a better state of resilience and health? The answer seems to be yes. And the driver of this signal seems to be polyphenols. So eating foods rich in polyphenols and not just saying, I'm gonna take a gram of courses in a day, but eating foods that have a diversity of polyphenols, you're getting the data from soil. Really even from soil microbes, because the reason plants produce polyphenols impart is to signal to the soil microbiome. But you're translating that into your health and your epigenetic expression. So if you heard all that and you say, well, what do I do about this information? It all comes back to many of the basics, but the most polyphenol rich foods. I mean, interesting little bit of trivia here. The number one source of polyphenols in the American diet is going to be something that is bitter because polyphenols are bitter and it's coffee. I'm not saying you have to drink coffee, but thinking about consuming more bitter foods is actually a great way to get more polyphenols. So coffee and tea, dark chocolate. Uh, also this tarry buckwheat is actually pretty bitter again because of the polyphenols. The most concentrated sources of polyphenols that you can get are going to be herbs and spices. So cloves, for example, incredibly rich in polyphenols, but. Polyphenols are actually a big reason why you should try to optimize towards a colorful diet. Uh, one of my friends Diana Minick talks about this rainbow diet. The idea being you want to get all these different colors on your plate, and it's not just because it looks nice and you can take the photo for Instagram with all the colorful foods on your plate. It's because now you're getting access to all of those colorful nutrients, which are polyphenols that can help to enrich your health by programming your systems towards. Balance. Balance.

[00:29:54] Dr. Melinda Ring: just to note, we did have Deanna a minute on the podcast, and so I encourage people to go back and listen to that and to check her stuff out too. So so that's the diet side of things.

Now, another thing that I saw, on your, your Instagram is in the connection between Muscle and our health, our brain health, which I think is something that most people don't associate. You know, they think about strength training either to look good or to protect your bones, or maybe for, you know, other things. But I, I see that you've been leaning into this link. So what does the science say about that?

[00:30:33] Dr. Austin Perlmutter: I'm a big proponent of aerobic and cardiovascular conditioning. But if you were to ask this question about is that the most important activity for brain health, we've only recently started to see that yes, it matters, and also it's not the only thing. So if you have aerobic conditioning on one hand, the other side would be anaerobic or resistance training. And so we think about this as any sort of activity where you are, you know, pushing against resistance, but also these are activities that kind of exhaust your, your muscles oxygen supply, because they're intense and usually shorter in duration.what you're doing is you're. You're exerting a force on your muscles that leads to the release of molecules called myokines. And myokines are a form of signaling molecule produced by muscle that go throughout the body and influence the brain. And they have names like Irisin. People are probably more familiar with one called Brain Drive Neurotrophic Factor, or BDNF. But the main point here is that when you engage in resistance training. You actually produce these molecules that seem to benefit the brain. And a number of studies have come out just in the last decade showing correlations between muscle Health and brain health. And you can look at a very simple metric that tells you about your muscle Health, which is going to be your grip strength. And you can get a a pretty cheap grip strength meter. You can order it off of the internet and it will tell you about. Your muscles Health. Most people, and especially women, deprioritize muscle Health because they think that it's not the more important thing for overall wellness. For women in particular, starting some resistance training is absolutely key to promoting longevity and giving your brain the necessary molecules that it needs, uh, to promote good health. And by the way, it helps with balance, it helps with functional strength. So we are starting to see this movement towards the promotion of weight training as a, a cornerstone of, of overall health. I'm really trying to focus on why it's so valuable to brain health.

 you and I are a hundred percent on the same page, like lifestyle, first diet, exercise, stress management, sleep, joy, all of those things. And people are looking for a quick fix. And they're reading about these nootropics, they're reading about peptides. I have patients who are going to these longevity clinics and brain clinics and getting all these scans and put on tons of supplements , So I'm curious in terms of how you see some of these targeted supplements or, more anti-aging, more experimental approaches fitting into somebody's brain health strategy.

sure. So. What I love is that it feels like more and more people care about their health and you know, the Kardashians are, are doing an episode where they're talking about epigenetics for all these, these things that you would've never guessed that would enter the mainstream conversation. So I love that people are focusing on their health, on longevity and increasingly on brain health. One of the things that people need to understand is that the wellness industry, like the pharmaceutical industry, and really anything in the United States is based on an energy of incentive and capitalist structure, which means that at the end of the day, the drivers of any of these companies are making profit and maximizing shareholder value. Now, that doesn't intrinsically mean that the things that a company sells are bad or don't work? Not at all. But it is important to understand that because wellness has been. Turned into a commodity and because there's so much funding of wellness, that there is going to be a, a far higher need for consumers to be able to be discerning about the things that they purchase. If you were to go through my Instagram right now and just see the ads and purchase everything, the ad said you would have 8,000 supplements, probably about 15 different saunas. Um. 84 plunge pools for cold temperature, and you would wind up spending every cent that you have on these interventions. Now, it doesn't mean that these interventions don't work, but you need to understand that there's no marketing spend behind general exercise or eating generally healthy food or engaging in 10 minutes of mindfulness each day. There's no company that benefits financially. From your doing those things or is going to spend money to educate you on those things. So you're out there, you're saying, I wanna do something good for my brain. I've heard about a nootropic. Should I be taking the nootropic? By and large, most supplements don't have enough data to where I would recommend their use. It's just the case you should ask for. Show me the research, show me the research demonstrating that this does something in a person like me. It doesn't exist for most supplements. It does for some, and for. The ideal scenario, you would actually be looking at the labs to determine why it is that you're using any sort of an intervention. So yes, I think many people are not getting enough omega threes, but you're far better served to actually measure and find out if that's the case before you go taking two or three grams of omega threes a day. Similarly, some people need vitamin B12, but that doesn't mean the average person on the street is going to get a cognitive boost from taking a, an incredibly concentrated B12 supplement because they heard about the ad for it on tv. So that's what I would say in terms of my take on the general industry. And I do think, you know, the, the issue is then you say, well, what should I do next? And. There's, there's two things that you should do next. One is if you have concern for your cognition, the cognition of your relative or friend, if you have concern for your mental health. If you can, the next best step is not to take advice from a podcast social media magazine. It is to see somebody with expertise in that subject, and that especially becomes true when things get more significant. If you're worried that you or your family member has Alzheimer's, the next best step really shouldn't be to find some sort of a new tropic. It should be to go get a conversation with a qualified healthcare practitioner. If you're concerned that you or a friend or family member is experiencing a significant mental health issue, the next best step is not to go find a supplement. It is to go seek qualified help. Now, that is the maybe more intense, more extreme version, and I do so understand that not everybody has access to those things. And some people have a general trepidation towards engaging with healthcare practitioners. I think historically healthcare practitioners have not done the best job of actually listening to people and providing them with, uh, with reasonable sounding boards, but. I, I, I will say, even though there's a lot of pushback against the medical industry right now, every single physician that I know is trying their best to make that happen. So I think there's a bit of a myth there that doctors don't care when they absolutely do. But then when it comes to taking agency over your own decision making, I would say look at these core domains that we've established, and if you don't exercise, if you don't move. Find a way to put a little bit more movement into your day that will compound and give you so much benefit. If you wind up eating a whole bunch of junk food, try to make one positive change in your food. So we talked about, you know, food earlier, but cutting back on sugary beverages is an amazing first step for anybody. And some people would say, no, you have to replace it with a green juice. And I'd say, sounds great. Show me the study. That shows that that's the next best step. It doesn't exist, which is why I would say the next best step is to cut back on the sugar sweetened beverage because we know that that helps. The power of connection and the significance of mindfulness. So connection to other people is the single biggest predictor of quality of life. And if you're spending all your time on social media chasing these solutions, you're not spending time connecting with other people. So sometimes the best thing is just to turn it all off and go spend time with people you care about. And then the last one here is the mindfulness piece. Companies prefer you to be mindless because then you're more likely to make the next purchase. The more you can reclaim your mental real estate, the better suited you are going to be to be able to make healthy decisions for your brain. So for different people, this means different things. I'm not saying you need to do a 10 day silent retreat. But if you're not already engaging in some sort of a mindfulness practice, what I do is I sit on the couch each morning, I set an alarm for 10 minutes, and I close my eyes and I pay attention to my breaths and watch what comes up in my brain. And you'll be shocked if you don't regularly engage in meditation, just how crazy things can feel. And it is that. Level of intense, you know, spastic thinking and the worries that come up that drives us to purchase things we don't need and drives us to make unhealthy decisions. So the more awareness we have over that, the better our chances are of at least taking a little bit of a step back, taking a breath, and then being conscious about our decision making in a way that most benefits us and doesn't just benefit the companies that are trying to take our money.

[00:39:45] Dr. Melinda Ring: I, I think we can put those two together, the connection and the mindfulness, because. I know there are times when, you know, my husband will be talking to me, but I'm looking at my phone or commute or computer, and then we're, you know, we're in the same space. Maybe we're sort of having a conversation, but it's not a mindful conversation. So I think those really have to go together, that you can actually be physically in the same space with somebody, but that doesn't mean you are present. So being present with people that we love is so important too. Well, thank you, uh, Dr. Austin promo for connecting with me today, for letting me pick your brain about how we can protect our brains. And you've reminded us that brain health isn't just about how we feel, it's about how we function and we think, and we eat, and we move and we reconnect and we adapt. So for those listening, we will link Austin's work in the show notes. And if this conversation sparked something for you, please share it with a friend. Let us know what resonated most by tagging us on Instagram at NM Osher Center, or you can tag me at at Dr. Melinda Ring. And until next time, keep taking your health to the next level.

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