A (4:49)

When you describe cognitive decline, that sounds generalized enough. Is it possible for somebody even in their 40s, to start experiencing something like that?

B (4:58)

Yes, I think as you go to your 40s and 50s, you may have some difficulty remembering names or going to a garage and wondering why you went there, or forgetting an appointment or asking some question twice. So those are some things that can happen even in young people. It's not always concerning a mistake that people make. Is this just because somebody has cognitive issues, memory attention, concentration issues, it's, it doesn't mean that it's the beginning of the end. See, in my practice as a neurologist, I've seen thousands of patients with cognitive issues. And it's so interesting to me that they will come to me convinced they have Alzheimer's disease. And they often have other things. Too much work, poor sleep, vitamin deficiencies, anemia, hormonal changes. There are a lot of things that can cause cognitive issues, but they think they have Alzheimer's disease. I fix them. And they were happy because I fixed their Alzheimer's disease. I didn't fix their Alzheimer's disease. They didn't have it. And unfortunately, these days, Alzheimer's disease has become such a common concept that people talk about it and they just jump on that concept with every little thing.

A (6:11)

Right. I do think that if you've never had the experience of having, you know, a brain fart, reaching for a word that you used to know, but you just can't think of that word anymore, I think the first couple of times that that happens, it can be so scary that the brain does start to catastrophize, like, oh, no, that's a mistake.

B (6:31)

And I hope that by the end of our conversation, your listeners would forget that and look at cognitive decline as a symptom that has many different causes, most of which are treatable. See, I talk about brain health in general, and I think there are many things that people can do to improve their brain health, which would in turn improve their brain performance. In fact, I think of brain functions and brain in general as your biggest asset. Just like, you know, you have an asset that you manage over time, and there are things that may reduce your total asset, and there are things that compound and improve your performance, your portfolio performance. You can think of it the same way as, as your brain. Your brain is an asset that you can manage it. So it's about asset management. And, you know, you're all very good at asset management, right? What do you do when you want to manage someone asset? You look at what they are. Now, what's your baseline portfolio? What are the things that are draining your asset? What are the things that are hidden taxes? What are the things that are damaging your brain? And then what are the things that give you the highest return on investment? If you think of it that way, it's very simple.

A (7:45)

Wow. So excessive alcohol consumption, sedentary life, Those are taxes on your brain.

B (7:51)

Well, there are five hidden taxes. Number one is to have a sedentary lifestyle, just like you said. Number two is to have poor sleep, or if you have sleep apnea. Sleep apnea is a condition that's associated with snoring at night and then feeling tired and foggy during the day. Third is poor diet. Poor diet is really bad for Your brain, it increases inflammation, it reduces blood flow to the brain, it affects the cleaning processes that happen in the brain. It really drains your brain. It's a leakage that's really bad in terms of acids. And then you have stress. Stress is horrible for your brain because it levels up cortisol. Cortisol is a hormone that can circulate in your blood and can reach different parts of your brain. The part of your brain for memory is called hippocampus. Okay, Hippocampus. Not any campus hippocampus.

A (8:46)

All right? So just imagine a college campus full of hippopotamuses. Hippocampus.

B (8:50)

But each hippocampus is the size of your thumb. You have one on the right, one on the left. And so hippocampus is ground zero for learning and memory. And what happens is that when your cortisol levels are high, the cortisol goes everywhere. But hippocampus is particularly vulnerable to cortisol. For some reason, cortisol damages and kills neurons in hippocampus more so than other parts of the brain. We don't know why, but it is what it is. Several studies have shown that high cortisol levels shrink the hippocampus in a dose dependent manner. So if you have a little stress, occasional stress, your hippocampus is good. If you have stress only for two years or six months in the setting of some crisis, your brain recovers and everything is good. But if you have consistent chronic daily stress for 10 years, your hippocampus shrinks by a lot. And these are not just things that people talk about. We have absolute scientific evidence for it. So as we're going through the five things, we talk about sedentary lifestyle, we talk about poor sleep, we talk about nutrition. And the next one we just talked about is when you have too much stress. And the last one is mental laziness, where you just default to just, you know, just doing your day job and nothing that would challenge you, nothing that would affect your brain. So these five things are hidden taxes that compound over time, and they interact with each other. So, for example, when you have poor sleep, when you sleep, let's say, five hours a night, and you're tossing and turning, when you wake up in the morning, you're more likely to have high blood pressure, you're more likely to have stress, and you're more likely to have brain fog. These things affect your interactions with other people. You may snap at a coworker, you may snap at a family member, and these things actually compound over time. And then you're not enjoying yourself, you cause more trouble for yourself. So when you go at home, when you go home in the evening, you've had a horrible day and that affects your sleep again. And during sleep, your brain goes through a rinsing process. It's so beautiful how it works. When you go to sleep, with each pulse of the heart, the blood vessels in the brain pulse a little bit. And there's a little fluid around these blood vessels, like these tubes that are blood vessels around them like a sleeve, and has this clear fluid called csf. And with each pulse, this fluid, this CSF is pushed through the blood and it rinses the blood. And then the space around the veins, the perivascular space around the veins, collects this junk, dirty csf, and then takes it away and it goes away. So this rinsing process happens mostly during deep sleep. And when you don't get enough sleep, this junk accumulates. The byproducts of chemical reactions that need to be cleared stick around in your brain and they cause inflammation and your brain's work in a dirty space, basically. So all those five things I told you compound each other in a negative way.

A (11:53)

With regard to mental laziness, would things like excess scrolling on social media, excess television watching, would those things qualify as mental laziness?

B (12:03)

Yes. Oh, see, when you're strolling on your social media, you're passively just watching things. Yes, there are sometimes some useful pieces of information in thousand things that you look at, but for the most part is a passive experience. It actually tires you out. The same thing is when you're just passively watching some tv, you're not really activating your brain, you're not challenging your brain, you're not putting in effort. And that's the part that's bad for you. When you don't challenge your brain, your brain is not going to grow, your brain is not going to be healthier.

A (12:39)

Many people will often talk about how when they come home from a cognitively demanding day at work, because most of the people who are listening to this are knowledge workers, they come home and they're so mentally exhausted that they then begin scrolling. How does that all shake out? When you're doing something very cognitively demanding for a limited period of time, but then you counterbalance that with doing something very cognitively lazy for an alternate period of time.

B (13:08)

Yes, that's not a healthy thing to do. It's like saying, you know, I'm gonna go home, smoke a cigarette and relax. That's not a good way to relax. You know, for one thing, I think people do what other people do. You know, in the old days, people go home and smoke a cigarette or just watch tv. And these days, people go home and scroll through the social media, right? And unfortunately, it's becoming so common that everybody does it, but that's the wrong way to do it. And I'll tell you how to do it correctly. But in general, you want to use that time in a productive way. If you're tired, don't feel like anything, you can go for a walk, or you can call a friend and have an interesting conversation with a friend, or you can take a dance class. There's so many things you could do to enjoy yourself that makes yourself more tired and fatigued by just passively scrolling through the social media.

A (13:59)

One thing that I noticed was not on your list of taxes was anything related to dental health. That's something. In reading about this topic, something that actually surprised me was the link between oral health and oral hygiene and your brain. Is that tax number six, Is it? You know, where does that fit into this paradigm?

B (14:20)

Yes. Those five things I mentioned to you are the five most important things that can affect your brain. I go over a list of 40 things that can affect your brain. Oral health is one of them. You know, if you have gingivitis and you have some bacteria in your mouth when you floss, those bacteria can then go through your blood system and reach your brain and increase your risk of strokes and increase risk of Alzheimer's disease. However, that's low on the list of things that can harm your brain. The same thing applies to drinking alcohol. You know, in general, alcohol, we now know it's not really good for you. But if you've done everything right and you want to enjoy your glass of wine at night, I think it's fine. It's not as big a factor as the stress is. I really hope that your listeners appreciate that there are major things that affect your brain and there are minor things. And so if you want to have the best brain portfolio, you want to put your investment on the things that give you the highest yield. You want to focus on things that move the needle the most, and then the little things you can take care of later, of course you can take care of those. Again, as I mentioned, there are other things that can affect brain health, like hearing loss, vision loss, air pollution, concussions, childhood trauma, lack of education. There are a whole lot of other things that can affect your brain. It's not just five, but based on my 30 years of experience mostly at Hopkins and Harvard. I have decided to determine what are the most important things. Now I teach a course at Johns Hopkins called Advances in Neuroplasticity and its Applications in Neurology. Neuroplasticity means that our brain can change at any age. Our brain is not a fixed structure like our ears. Our brain is constantly changing every day, based on our habits, we. Our brain changes a little bit for the better or for the worse. So I give 26 hours of lectures, and I talk about at least a thousand studies that change the brain toward the negative and toward the positive. So, based on all my experiences, I've come to decide what are the most important thing for brain health. And those five things I told you are, in my opinion, the most important things.

A (16:40)

You mentioned brain plasticity. So I'd like to talk about that and lay some foundation here for the base question of what is the brain and how much plasticity do we have over the course of our lives? I know one of the things you've written about is the broca lobe, which is used in language formation. I first heard about it when I was learning about how, you know, children are really good at picking up foreign languages. And as you become an adult, you're less good at picking up foreign languages. And the brochalobe has something to do with that. Can you walk us through that? Because that, if I understand it correctly, is a section of the brain where you lose some plasticity or lose some ability, even just as you transition from childhood to adulthood.

B (17:31)

Well, I'm so impressed that you've learned those things in the past and actually can use that lingo. Good job. Blah, blah, blah. Let me talk about the cortex. Cortex is the outer layer of the brain. You can think of your brain being covered by a blanket. It's a layer of cells. This cortex is the ground zero for cognitive functions. So, for example, when you read, write, type, do your taxes, do anything cognitive. When you use your higher brain functions, you're using different areas of cortex. You can think of it as a mosaic of areas of little areas. And each of those little areas connect with other parts of the cortex and with hippocampus, which is deep inside, and they form networks. So, for example, you have a network for attention. When you sustain attention during our conversation, you're using that network. So that network is highly active. As we're talking, you're keeping track of what I'm telling you. There's also a network for language. So when you're understanding what I'm telling you, and when you're speaking, you're using a combination of different parts of the cortex and hippocampus to speak and to understand what I'm telling you. One of those nodes in the language network is called Broca's, and there's another part called Wernicke. And these parts of the brain are parts of the network for language. Now, cortex overall has plasticity, which means at any given time your brain can change with a lot of things. And we'll talk about the five pillars of brain health shortly. But the five pillars of brain health can literally grow the size of cortex. So for example, if you learn a new language, you actually increase parts of the network or language, including the little areas of the Broca's areas and the wet Nicki area. If you learn to play golf, you increase the parts of the cortex and hippocampus that are important for your eye hand coordination. Let's say you learn how to play the piano. Or if you learn to become a financial consultant, for example, or if you learn to play with numbers, the corresponding parts of the brain, which are parts of a network for those functions literally grow. Literally, they become larger by a few millimeters. So much so that we can see it on mris. For example, in Sweden, they were training a group of teenagers, young adults and college students to become interpreters and go to war, to battlefields in Iraq. So they gave them a three months intensive course of learning to speak Arabic. They did MRIs on these young fellows, college students before this, three months of intensive training and after three months of intensive training. And then they looked to see if there's a difference. And they could see clearly that the parts of the brain for language had increased in volume. So this is something that again, I can talk about an hour just on that topic alone. But what you said is true in that a younger brain has higher degree of plasticity than an older brain. But the mistake that people make is to think that when you get older, they can't do things. When you get older, you don't run as fast as when you're younger. First of all, you don't have to run much when you're older. But you can't also give up on running or exercising in general because you can't run as fast as you did when you were in your 20s. And that's the important thing. There's so many things people can do when they get older. And they should not look at aging as like a downhill course. Yes, there's a little bit of slowness in cognitive processes. Yes, there's a little loss of vision. Yes. There's a little bit of hearing loss. Bodies are minor. To enjoy life, to have peak performance in what you do, to improve your brain functions, to do all the things you want to do. That little decline really doesn't make that much of a difference, but it's important on your mindset. See, I'm 63, and I look forward to aging. I look Forward to my 70s and 80s. You know, I am retired now from my neurology practice. I'm mostly. And I'm a. A junk professor at Johns Hopkins. I spent most of my time teaching and giving lectures and doing academic work, which I love. And I look forward to my 70s and 80s because I have so much more time to enjoy life. I'm not gonna sit around, think, oh, I can't think as fast as I used to. Oh, my language areas are not as good as they were. In fact, I know multiple languages. And these days, I am improving my French again because I'll be going to France to give a book tour in French. And so I'm brushing up on my French. Yes, I'm not learning as fast as I did when I was, you know, 16 years old. But there's no rush. I have time, and I think that's the main point. Paula, people need to pay attention to how they view aging. They should not look at aging like a downward hill, that everything is falling apart. Recently, I was just hanging out with my friends. We were just going skiing, and a couple of my friends when they're 60s, and they said, you know, I can't ski as fast as I used to. Like, you know, oh, my joints hurt. I'm getting old. I said, listen, stop right there. Don't just look at the negative and complain about it. You're skiing. Be happy that you're skiing. Set aside all those negative thoughts about aging and look forward for the fact that, hey, you have such a financial freedom to be able to not be working on a weekday and you're skiing and improve on your skiing and improve your fitness.

A (23:06)

Are there certain skills that get better with age? We've. We've had Dr. Arthur Brooks on the podcast, and he talks about how when you're younger, you have this raw horsepower intelligence. But when you get older, in your 40s and 50s and beyond, you tend to have what he refers to as crystallized intelligence, which is a synthesis across domains, another form of wisdom.

B (23:32)

It is true that your learning slows down and that when you get older, you know, you have more. What's called crystallized intelligence, which basically means it's the knowledge that you accumulated. But this is exactly what I'm talking about. These experts really need to change the conversation. They shouldn't emphasize that you can't learn new things when you get older. Let me give you an example. Some of my friends I was not there were playing pickleball and one of the four persons were supposed to be that didn't show up. So they were stuck. They needed a fourth person and it was an older woman sitting there like 79 years old. They were like thinking like, should we invite her? I mean, she's gonna slow us down, but whatever, just invite her. So she came to play and they were in the 50s, 60s themselves, and she was 79 and so she started playing and she was slower than the other ones. And these three other players were looking at each other, oh, what a mistake we made, you know, in writing. So they played and then the following days the fourth person couldn't come. I think she, you know, that person had a knee surgery or something. So this fourth person, being this 79 year old woman, decided to keep joining them because they needed her anyway. But then she kept getting better as she played with them and she was a little clever. She actually went and practiced some more with others and didn't tell them. So after a few months she was actually getting better than the younger ones. So when she turned 80, they really needed her. They didn't want her to suture with somebody else because she was now the star of the game. This is the way we need to think about aging. We shouldn't always think, oh, I'm falling apart, oh, I can't learn. That is the wrong way to look at aging. You can learn new things any age. And I think there's something that people are missing out. When you're an older person and you learn something new and you get good at it, you get a feeling of accomplishment. It improves your self esteem. It improves as in contrast to feeling like, I'm falling apart, darn it, why am I so old? When I was in 20s, I used to do so many things. I can't do that. You tell yourself, look at me, I'm 72 years old and I just figured out how to figure out this app or I'm 75 years old and I just did that. And that gives you self esteem. See, I'm starting to do some more social media recording. So I have to do all this stuff with recording and play around with social media. It's not my thing. I haven't been doing those things throughout, you know, my academic work. But now that I'm doing more of public education, I'm getting to it. So figuring everything else and working with different apps, it really felt good that I'm learning these things. And I have different microphones and different lights and different apps that I can use for my recording and putting things in different social medias, cutting them, editing videos. And I felt great about myself to think like, hey, I just did that and I did that without the help of my two daughters who are in college because you know, I'm doing that myself. And that's what I mean. When you get older, you really need to learn new things and then feel great about yourself. You want to have those early wins. Those early wins are going to contribute to your self esteem and they're going to contribute to you investing in your brain. Foreign.

A (26:51)

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B (31:23)

Yes. So the five pillars of brain health, which I think are extremely important for producing a high performing brain portfolio, are fitness, optimal sleep, brain healthy nutrition, mindset, and brain training. These are five important brain health factors that can compound over time. The most important pillar of brain health, the one that gives you the most return on investment in a short period of time, is exercise. When you improve your fitness, you do so many good things for your brain and for your body in general, you get a tenfold return on your investment. Let me just give you some of the things that happens when you improve your fitness. You increase the number of mitochondria inside your brain cells. Mitochondria are small little organelles inside the cells that generate ATP, which is energy. So when you exercise, you multiply the number of mitochondria. You create your neurons with much more fuel than they would have had otherwise. Then you reduce the inflammation inside your brain. Like if you were to think of your brain as like a little neighborhood, when you exercise, you improve the health and environment of that neighborhood. You reduce inflammation in your brain. The third thing that happens, you increase the number of connections in your brain. And the fourth thing that happens, you generate new neurons in the hippocampus. We used to think that you die with as many neurons that you were born with, if not fewer. We now know that you can eat, increase the number of neurons, the number of brain cells in the hippocampus. So hippocampus is ground zero for learning and memory. As the hippocampus shrinks with all those five taxing things we talked about, there are things that can grow. Your hippocampus can literally reverse the effects of aging in your brain. And exercise does just that. We talk about mitochondria, increased number of connections, reducing inflammation, new neurons, and then you actually increase your cognitive functions. When you exercise, you improve your cognitive functions. And the more fit you are, the better you can perform on cognitive tests. The other benefit of the exercise is better sleep. People who exercise regularly sleep better now. The other things that exercise does is to improve your heart functions. When you exercise regularly, you're far less likely to develop heart attacks. It improves your skin. There's Nothing as good as exercise for your skin health. When you talk with dermatologists, they always talk about two things. Improve your exercise and reduce your stress for your skin health. And the other thing that improves is your sex life. Exercise increases blood flow everywhere and that's good for sexual function in general and also good for libido and it reduces risk of Alzheimer's disease or any form of dementia. So there's tenfold return on investment by just exercising. To me, that's a no brainer. I mean, if you were investor and you were looking to invest on something with low cost, which gives you tenfold return on investment, I mean, that's a no brainer. I mean, you can't not do it. You know, I can just see how financial people look at outsiders and say, like, why are not they making good decisions about their finances? There are so many simple things they can do to ensure financial freedom in retirement years. And why are not they doing it? I look at them the same way. I know about brain health, brain portfolio, and I look at some of my patients who are very successful in finance, but their brain functions are not optimal. Their brain portfolio is not as strong as their financial portfolio. So anyway, the five pillars of brain health, number one, and the most important one is exercise.

A (35:22)

Okay, before we move on from that, I have a follow up question. So in the realm of exercise, there's cardiovascular exercise and improving your VO2 max, there's strength training, and then there's stretching and mobility. To what extent do each of these three components contribute specifically to brain health?

B (35:44)

They contribute to brain health in the order that you mentioned them. Increasing VO2 max. Increasing your fitness is the number one determinant of your brain health. So many studies have shown that the more muscle you have, the healthier your brain is. Muscles produce a hormone called myokine. These myokines, such as B dnf, brain drive, neurotrophic factor, are excellent and you increase myokines when you do weight training. And finally, the balance is very important. Working on your core and maintaining your balance is very important. So you want to be fit, you want to have muscles, and you want to have balance. If you have only so much time in a week and you can't obviously spend, you know, every day in the gym for two, three hours, I recommend to work on your fitness more than anything else on your endurance, cardio, endurance, cardiovascular stamina. You should be able to go up 10 flights of stairs, you should be able to walk three to five miles. You should be fit. And if you really want to Know exactly how fit you are. You can do VO2 max testing. These days, many smartwatches have an option to actually check your VO2 max, which gives you an estimate and then in that order. The second thing is weight training, and the third one is balance. What I do is that about three times a week, I do one hour of exercise, cardiovascular exercise, on a bike, a stationary bike, like peloton, and I do 45 minutes of weight training, and that's it. And, you know, I walk around most of the days and I try to stay active. I think we have to keep it simple. We really don't need to make it too complicated. In the bucket of exercise. I think the most important thing is to be active. If you don't have time anything. If you don't have time for exercise and you walk three to 5,000 steps a day, that's good already.

A (37:30)

Mm.

B (37:31)

Walking three to 5,000 steps a Day reduces the footprints of Alzheimer's disease in the brain. Just three to 5,000 steps a day, which is not much. If you walk 10,000 steps a day, four or five miles, you reduce the risk of Alzheimer's disease by 50%. That's incredible considering how easy it is. So any exercise is better than no exercise. Walking is great. But if you have time to do extra things, I Recommend to do 3 hours of exercise and you can do like 45 minutes of cardiovascular and 15 minutes of weight training. If you have more time, then maybe we can do, you know, five hours a week.

A (38:09)

What I'm trying to understand, I understand, or at least I think I understand at the mechanical level, how cardiovascular exercise increases blood flow to the brain. That makes sense. Strength training increases that brain derived neurotropic factor. That makes sense. But how does stretching, mobility, balance? Like, how does that improve brain health?

B (38:30)

Yes. Stretch and mobility imbalance prevent falls as people grow older. Falls are a major cause of head trauma. And unfortunately, when an older person has a concussion, that's usually the beginning of the end. And you want to work on improving your balance as you go to your 40s, 50s, 60s, you don't want to start in your 70s to improve your balance, although you can. But if you have strong cores and a strong balance throughout life, then you're far less likely to have falls.

A (39:05)

All right, so the number one thing then is exercise, and that's one of the five pillars. What's number two?

B (39:12)

Number two is sleep. You really need seven to eight hours of sleep now. I hear this all the time, but I can't sleep now. I can exercise. I have Control over exercise. But I don't have control over sleep. I can't just turn off a switch and then I'm asleep. You know, I have difficulty falling asleep or I wake up in the middle of the night. I think that people need to make sleep a priority. As I mentioned earlier, during sleep, your brain goes through a rinsing process. And as a result of rinsing process, your brain then is fresh and vibrant. When you wake up in the morning, when you didn't get enough sleep, your brain is kind of dirty because all these metabolic byproducts have accumulated. And one of those things is amyloid, which is the core protein for Alzheimer's disease. One study showed that even if you don't sleep one night, even one night of not sleeping increases amyloid in the brain. So people need to figure out what's causing them not to fall asleep or what's causing them to wake up in the middle of the night. Most often it's stress. Most often it's worrying about finances, relationships, career challenges. People need to write things down for themselves and have a solution for individual problems so that the brain thinks, okay, we have a plan for things and allows them to sleep. Scrolling on social media is one of the worst it could do. I think if you want to do anything, you should read one of good old books. And there are breathing exercises before sleep that can help. In my book, I have a whole chapter about all the things that can cause sleep problems and all the things that people can do to improve sleep. But I think it's important to make sleep a priority. I have many patients who come to me with brain issues, and when I go to sleep, they say, doc, I can't sleep. What do you want me to do? I can't sleep. I don't fall asleep. I toss and turn the whole night. And of course everybody else is like that. So it's not just me. And that's a mistake. You can't just say because other people have difficulty sleeping that I'm just like everybody else. You need to be smart about it. You need to say, what's causing my sleep problems. Usually there are three or four things, not 50 things. And there are three or four common things. But for example, your bedroom needs to be quiet and dark. Your bed needs to be comfortable, your bed sheets need to be clean, and you have to wear comfortable pajamas. And you should not use your bedroom for other things. Your bedroom should be used for three things, sleeping, reading and sex. Nothing else. So don't bring your laptop to your bed. Don't put a TV in your bed, don't put an exercise machine in your bed, and don't use your bed like, you know, do other things. Your bed needs to be reserved for those three things only. So these simple interventions can really help. The other thing is that your body needs to be tired. If you haven't exercised all day and you've just been sitting all day, your body is not physically tired. These are simple interventions that can improve sleep.

A (42:23)

How does this apply? You know, there are some people who are listening to this who are frequent business travelers, for example, and, and they're constantly, A staying in different hotels and B, switching up time zones. What should they do that's more difficult?

B (42:37)

I give them that. You know, when you travel, you have the jet lag and that makes it difficult for the first three or four days that you're in a new time zone. And if you travel a lot, you're right. Going to different hotels makes things difficult. When I travel, and I do travel a lot, I make sure that when I go to a new city, I exercise for an hour or sometimes two hours. I need to be tired. I need to be physically tired. Now, just traveling alone can tire me out. But when I go to a new hotel, I first go check out the gym. And if there is no gym, I go for a walk for an hour, an hour and a half before I come back. So that's one short trick. The other thing is that if you can't sleep, it's okay. See, one of the things that happen is the person was not sleeping. In their mind. They're thinking, damn it, I'm not sleeping. It's one o', clock, I'm not sleeping. Two o', clock, I'm not. And that makes them more frustrated and more frustrated they are. They can't fall asleep. If I can't sleep, for some reason I say, fine, I'm not sleeping. I'm just sit up and read. I'm not going to think about, oh my God, I'm not sleeping. Obviously I'm not sleeping. The other thing I do is I do sudoku. I have some sudoku on my phone and I do a difficult sudoku and that really puts me to sleep. So find what works for you, but don't toss and turn in bed all the time. If you can't sleep, just sit up and do something else. Ideally reading, not social media reading or puzzle or something that gets your mind off of things. And if there are things that worry you, just pick up a paper and write down the five things that are on your mind and what you're gonna do about it. Own the problem. Don't blame things. Don't think about, oh, I should have not gotten married. I should not have taken this job. I should have not started the project. That doesn't help things. Now you are where you are. And so you list all the things that you will do and that gives your mind a piece that, okay, we have a plan of action. The other thing to keep in mind is that look back on all the problems you have in your life and everything worked out. So if you're in the middle of a crisis, things will work out. They will, because they have in the past. There are these little things that you could do to improve your sleep. But the thing is, you have to make sleep a priority because it's a negative interest that compounds over time. If you don't sleep well for a few nights for a few months, your brain recovers. If you sleep fewer than six hours a night for two years, your hippocampus starts to show some shrinkage. But if you have not had enough sleep for 25 years, your hippocampus will be almost half its original size. So don't say, I can't sleep. Tell yourself, I'm good at solving problems. I'm good at figuring out people's financial portfolios and figure out what's wrong with it and fix it. I'm going to figure out what's affecting my sleep and I'm going to fix it. See, mindset, which we'll talk about in a minute, is so important in so many things. Improving sleep. Sleep is critical for preservation of your brain. Think of it that way. Go out of your way to figure out what's preventing you from sleep and fix it. Because in my experience, 95% of things that affect sleep are fixable. There are people who have primary sleep disorders like narcolepsy or some primary neurological things that cause sleep problems, but that's such a minority. Most people's sleeping issues are bread and blood problems that can be fixed by improving sleep. Hygiene, listening to some sound, meditating, breathing exercises. There's so many things that can improve sleep. So don't be negative about sleep. Just be positive about how you're going to figure it out, do different things. You know, supplements are okay for.

A (46:37)

I was going to ask you about either magnesium or melatonin.

B (46:40)

What are your thoughts on this? I think a short period of taking supplements is okay. I haven't had great experience with melatonin. Some people swear by it. I think magnesium is Actually pretty good magnesium glycanate. It's a good supplement. It does help some people sleep, and many herbal teas can help with falling asleep. So if something has worked for you, you can take it for a short period of time. But while you're taking the supplements, work on figuring out the source of sleep issues and address them. One thing I don't recommend unless it's really emergency is sleeping pills. Ambien or benzodiazepines. They're really bad in the long term. I occasionally prescribe them. If somebody hasn't slept for a long time and they really are overwhelmed with poor sleep, I may give it to them for four or five nights just so that they get some sleep so they can function. In general, I totally avoid sleeping medications. I think supplements are good for a short period of time. But most important thing is have peace of mind, enjoy life and be physically tired and follow the same standard sleep hygiene. And those things really work 90% of the time.

A (47:52)

Sometimes the goal of getting more sleep conflicts with the goal of getting exercise. Because if you end up going to bed late, maybe you have evening work related responsibilities or family related responsibilities. So you go to bed late and let's say you go to bed at midnight and then your choice is wake up at 6am to exercise or wake up at 7.30am but then you don't get to exercise that day. In the battle between sleep versus exercise, which one wins?

B (48:25)

I think exercise is number one. However, I think that you need to be smart about your lifestyle choices. If somebody complains that they have too much work to do, I don't have too much sympathy for them, to be honest with you. To me, they're telling me they have failed to have a balanced life. There are different forms of intelligence. There's intelligence like being good in math and logic and physics. There's also a form of intelligence called metacognition where you have insight in the way you think. Like you realize that you're obsessed about cleanliness, or that you're obsessed about something else, or realize that you tend to make things into a drama. You know, everybody has a thinking style and so metacognition means that you have insight in the way you think. There's also emotional intelligence where you can connect with someone. I can see that you actually are very good with connecting with your host. I've seen and watched some of your podcasts. I can see how you connect with such variety of people. And that's great, that's great intelligence to have. But there's also a Lifestyle intelligence, which means you figured out how to have a lifestyle where you have a balance of taking care of yourself, taking care of your brain, taking care of your family, and just be balanced. And if you haven't done that, don't complain to me, because you can do this. You can sit down and write down what are the most important things and what are the things that would allow you to finish work on time. If somebody says, I work until 10 o' clock at night in the office, it doesn't impress me either. You shouldn't be working 10 hours in the office every time. I mean, sometimes there are deadlines and sometimes there are things that need to be done. But you need to have a balanced life. When it comes to planning for retirement, you need to think of your brain performance as the most important tool. Your cognitive wealth is more important than your financial wealth. So you need to refigure out that the things that you do in your 30s and 40s will have an impact in your retirement years. You shouldn't be focusing on financial aspect of your life. You need to think of your most important asset, the asset manager, which is your brain. And so figure it out. Figure it out. You have so many hours in a day, you need eight hours of sleep. If you have to wake up at 6, you need to go bed at 10. So figure out how you're going to challenge things and how you're going to organize things and manage your time. So you do have eight hours. When it comes to if you have one night that you have to pick up, you know, am I sleeping a bit more? Am I exercising? I think exercise has so much more benefits that you probably want to sleep six hours, but you want to make sure you do the exercise. A related concept is the importance of habit formation. See, I'm in a habit of exercising. Most days it's a habit. It's like brushing my teeth. I don't have to think, oh my God, am I going to exercise today or not? Most days I do get up and exercise. I don't think about it. It is what it is. I don't think about whether or not I'm going to brush my teeth today. It's not a choice. I do it routinely. So I think exercise needs to be a habit that you do. And sleep needs to be a habit that you make it a regular habit to, to go to bed at a certain time. So it allows you seven to eight hours of sleep. Finding great candidates to hire can be.

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A (53:05)

We've covered two of the five pillars. Before we move on to the other three, I want to take some time to unpack some of those other types of intelligence because you have a long list. There's athletic intelligence. There are so many different forms of intellect and I think that's revelatory for people who have learned broader social messaging that intelligence is book smarts only.

B (53:29)

Absolutely. I think the IQ tests have done a disservice to most people. See, the general assumption is that if you're smart, you do well on your IQ test. And that's a huge mistake. The IQ test measure only a small segment of all of our cognitive capacities. Remember I told you how you have the outer layer of the brain which is like a blanket and it's like a mosaic of different nodes which together with the hippocampus form networks and how different cognitive functions are manifestations of these networks working. So you have parts of your brain that are important for emotions, parts of your brain that are important for connecting to others. Parts of the brain are important for being funny. Imagine being a comedian standing in front of 10,000 or 2,000 people and to make them laugh for an hour. There are several thousand people with different backgrounds. Some are Democrats, some are Republican, some are religious, some are not religious. And you're making everybody laugh. That is intelligence. Or someone who makes a delicious meal. That's not easy. And so there are two forms of intelligence. Innate intelligence and acquired intelligence. There are many form of intelligence I just talked about could be emotional intelligence, you know, lifestyle intelligence, mega cognition, math, physics, Cooking, being good handyman. These are all the different forms of intelligence. But in general, there's either innate or acquired. Innate means that you're born with some forms of intelligence at a higher level. Like, you may be good with numbers. You didn't ever try to be good with numbers, but you just are, or you just are a funny person. You don't try to be funny, you're just funny. Or you're very good about planning things and, you know, getting things done on time. Or you may be good about playing the piano. You don't try hard, you're just good at it. But then acquired intelligence means we can develop different parts of the cortex in the campus with practice, and we can make it as good as anybody who has an innate form of intelligence. So you may have good innate intelligence for playing the piano. Be good with music in general. I don't have that. But then I'm going to play the piano for 10,000 hours. After a few years, my performance will be better than yours. Even though you have that innate intelligence, my acquired intelligence in that particular area will be better than yours. The same applies to memory. A lot of people say, oh, such and such has a photographic memory. They're so lucky. They're so intelligent. You can have photographic memory. If you work five hours on improving your memory, after two years, you'll be a memory champion. See, this is what people don't appreciate. So in general, intelligence comes in many different flavors. And I think you need to appreciate that you're smart in your own ways. And one of the things that people often say is, oh, my God, why don't these people do their job right? It's so obvious. Why aren't they doing it? And I think it's important to realize that you have strengths and weaknesses. So you're looking at your point of strength and looking others and how they don't have that part of the brain and as good as you have it. But you don't realize that you have weaknesses. Don't forget that. I think that's important, humbling experience to appreciate that. You may be good with numbers, you may be good with figuring out complicated financial portfolios, but how good is your emotional intelligence? How good is your cooking intelligence? How good is your lifestyle intelligence? How well are you managing your time? If a secretary who works for an executive, has a balanced life, goes to church, has good relationships, enjoying her life, isn't she not intelligent compared to an executive who's running around all the time, his family's mad at him because he's never Home. His employees are mad at him because he's rough on them and he's mad at himself to make everybody else unhappy. That executive may be rich, but the secretary has many forms of intelligence which are, you know, maybe better than what he has. And that's humbling. And it's good to know that people have different forms of intelligence. And you need to be proud of yourself. You feel great about the forms of intelligence that you have innately. And more importantly, you have to appreciate you can be good at anything. See, one of the things I've done for myself is that I feel like I can do anything. I'm not good with numbers, for example, like, I really don't enjoy doing my taxes, but I know that if I wanted to, it won't be that hard. I can do it, or, you know, I'm not quite a handyman around the house, but I've decided, you know what, I'm going to fix more things around the house. And, you know, we were talking about how small wins contribute to continued investment. So I fixed a few things around the house and I felt, oh, my God, this wasn't as hard as I used to think that. I used to think it was so bad, but it's not that hard after all. So people need to feel good about the forms of intelligence they have. And more importantly, they need to be open to learn new skills and form new forms of intelligence.

A (58:46)

Right. That goes back to fixed mindset versus growth mindset.

B (58:49)

Exactly. You want to have a growth mindset, which means I can be good at anything I want to. I mean, we're talking about athletic intelligence. You know, when you watch Olympics and these people who do ski or gymnastic and they do all the things with their body, well, that's intelligence. I mean, you try to do that.

A (59:06)

Right.

B (59:07)

And the point is that these people who do these amazing things during Olympics, they were not born with it. Some of them may have some innate intelligence with, let's say, move their body, but most of them acquired the skills through hours and hours and hours, hours of practice. And this is what you want to think. Like, I don't think I can be at the level of reaching Olympics. Neither do I have to. But I could be better at skateboarding, I can be better at skiing, I can be better at any sports.

A (59:36)

Right. And there's research that backs this. There's MRI scans of taxi drivers. Those scans have demonstrated that their spatial intelligence actually grows over time because they get better and better at mapping the road, mentally mapping the roads of a city.

B (59:54)

Yes. When you learn new things, you grow the corresponding parts of the brain. For example, if you're a cab driver and you learn all the complicated map of the roads in London, the parts of brain for navigation, your spatial orientation improves. There was a very interesting study in London related to cab drivers. Researchers looked at people who apply to become a cab driver in London. Even though there is a GPS everywhere, there's still a test for cab drivers to memorize all the streets in London. There are 10,000 streets and tourist attractions in London. And some streets are one way, this way and the other way. And so there's a four year course to pass this test that's called the knowledge. And usually half the applicants pass and half the applicants fail. Researchers darker Margaret did MRIs on all the applicants at baseline. They were all in their 30s and they did MRIs after the four years of training. And they saw that those who had passed the test had increased the volume of hippocampus. And those who failed had not increased the volume of hippocampus. In other words, those who had practiced and learned the roads and were able to pass had actually grown that part of hippocampus. And those who had not studied as much and failed the test. We can see on their MRI that they had not expanded the growth in the hippocampus.

A (61:25)

Wow. You talked about how chronic stress can actually reduce the size of the hippocampus. Let's say a person who is listening to this is 45 years old and for the last 20 years they have lived in conditions of chronic stress. They would like to make a change and they would like to start developing brain healthy habits. But they also recognize that, let's say for the last 20 years they've lived in conditions of extreme stress. They've been eating junk food, they've been sedentary, they've been drinking too much alcohol, they've been doing everything, quote, unquote wrong. Is there a certain point at which it's too late? You're hippocampus has shrunk too much, you're too far gone?

B (62:13)

No, absolutely not. In my practice we saw patients of all ages. Many of my patients were in their 70s and they had a lot of risk factors. You know, they had diabetes, they had smoking for many years, they have obesity, they had centered lifestyle, they had depression, they had a lot of negative risk factors. And through our 12 week program, we really reduced their negative risk factors and help them expand on their asset and improve their protective factors. And we did some brain training with them. We also helped them meditate we helped them exercise more, we worked on the five pillars of brain health with them, and we also treat their depression, treat their diabetes, manage the other medical issues as a holistic approach. 84% of my patients improved cognitive functions. 84%. These are people 60s, 70s, and early 80s who had a whole lot of problems. And within 12 weeks, they had remarkable improvement in cognitive functions. We published that study in the journal Prevention of Alzheimer's Disease. Now, what was interesting is that half of the patients increased the volume of hippocampus within 12 weeks to such a high degree, we could see on the MRIs, MRI at baseline, MRI 12 weeks before and after program, and it was noticeable improvement in and the size of the hippocampus just in 12 weeks. So people in their 40s and 50s can definitely reverse years of things that have gone wrong with their brain. In general, our body is very forgiving. If you had smoked for 20 years, your lungs are going to be dark and dirty. With all the junk that have accumulated in your lungs and you can't probably breathe as well, you may have COPD. If you stop smoking for three years, not 10 years, for three years, your lungs clean up, your lungs become almost as good as if you never smoked. Because our body has a healing mechanism. Whether it's our brain or heart or our lungs, there's an intrinsic healing mechanism that we have in our bodies. And when you stop harmful things to our body, our body regenerates. And that's the beauty of our body, which applies to our brain, which as much as it applies to our heart and our lungs.

A (64:33)

In that case, and this is a serious question, although it's going to sound tongue in cheek, given that the body is so forgiving, why wouldn't a person just say, I'll start being healthy when I turn 50 or 55, but until then, I'll trash my body?

B (64:51)

You can create a lot of damage to your body and take a risk. It's like saying, you know what? I'm just gonna invest in the stock. It's high risk stock, but I'm gonna invest in it anyway. Deep inside, I'm gonna be fine. And usually stocks are fine in general. And so you could be impulsive and do things thinking that the future will be fine. And of course, you may be fine, you may not be fine. I think one thing that can happen is that if you have a whole bunch of negative risk factors, let's say you're drinking, you're not sleeping, you're spending much time, most of your time watching tv, then you Develop obesity and you may have heart attacks and strokes. See, people who come with a stroke in the hospital, they're always surprised. I've seen thousands of patients in the stroke units. They always say, well, why do you have a stroke? Well, stroke is a result of negative risk factors. Stroke just doesn't happen out of thin air. Stroke happens to people who have many of the risk factors. We talked about high cholesterol, obesity, diabetes, high blood pressure, stressful lives. Those are the risk factors for stroke. So you could just say, look, you know, you may end up having a stroke and not be able to move half your body. People who have a stroke, again, they just don't get stroke out of nowhere. It's the negative risk factors. Same thing with heart attacks. You know, I've seen many patients who come to the hospital with heart attacks. Most people think heart attacks and strokes happen to other people. Somehow they think, like, moi, I'm not going to have heart attack. I mean, I go to work, I come like I remember a bank manager was a bank manager gentleman. He was like £270 and he was like a frustrated man. And he had come to a hospital because he had a stroke and he couldn't speak. He had lost actually his broca. Sorry. There was a part of brain for speaking was stroke. He couldn't speak and he was so frustrated. And his frustration, even though he couldn't speak, he said, aqua God. Aqua God. You know, he would smack things. He clearly was a stressed out bank manager who had a stressful lifestyle. He was angry at everyone and he was maybe 48 or 50. You could take a risk and be like him. And he was frustrated because he couldn't speak and he was frustrated because he was in the hospital, because he had things to do. But, you know, if you want to take a risk and do it that way, you could, but I wouldn't recommend it. Yeah.

A (67:14)

So it'd be the equivalent of buying an extremely risky asset.

B (67:18)

Yes. I think with brain health, patience, persistence pays off. Just like with stocks, you need to be patient and steady. There may be fluctuations, stock market, but you want to be steady with lifestyle choices, you want to be steady. There are periods where there are more stress than usual. There are periods that you don't have time to exercise. There are periods you can't sleep, but that's okay. If you're steady and you get back to your five pillars of brain health, then you will have excellent outcomes. You will have excellent performance on your brain portfolio. Speaking of the pillars, we talk about exercise and we talk about sleep. The third one is nutrition. When it comes to nutrition and brain health, you want to stop eating junk food. Junk food, things that are like highly processed food, high trans fats, and sugary food, increase inflammation in the brain. And the more of junk food you consume, the more inflammation you'll have in your brain, which means your neurons gradually will get smaller and die over time. Several studies have shown that people eat a typical western diet, it's called sad, Standard American diet, are more likely to have smaller brains than people who don't have this kind of diet. Every day you have a choice of, you know, having a big hamburger and some french fries and some sugary soda, or you can have some salad. Every day you have a choice of, you know, eating a lot of cookies and donuts and chips or reaching out for some grapes and some fresh fruits that you enjoy. Nutrition is important for the brain in that you need to avoid junk food.

A (69:07)

And this is the part where I'm certainly confused as to. Even if the intention is to eat, quote, unquote, healthy, there's so much conflicting advice about what constitutes healthy. We used to have a food pyramid, and now we have an inverted pyramid. We used to be told that grains should be a foundation of what we eat, and now we're told to minimize that. We used to be told that meat should be only sporadic, and now we're told that meat and protein should be a major staple of our diet. We used to be told saturated fat is bad, but now it's good, unless it's maybe bad again, like, it's very thoroughly confusing.

B (69:50)

I agree with you. However, I don't think anybody has ever told you that donuts are good for you.

A (69:56)

Correct.

B (69:57)

And I don't think anybody has ever told you that drinking a large cup of sugary soda is good for you.

A (70:03)

Right?

B (70:04)

Neither anyone has told you that cookies are good for you or a bag of chips are good for you. So I think you need to use common sense. The dietary recommendations have changed over time based on the cumulative science and there's also some politics involved. I'm aware of that. However, I think never has anyone told you to eat junk food. And I think the principle of diet, which is very straightforward and nobody argues with, is don't eat junk food. If you like keto diet, you can try keto diet. If you wanted to be a vegetarian or vegan, do it. If you like vegetarian diet, do it. Just don't eat junk food. That is the principle I follow, and it works for me. I actually know that, you know, I Eat fruits and vegetable. Most days I usually eat twice a day. Like, I eat the breakfast and I eat dinner and for lunch I should have some yogurt and it's working for me. And if you feel like you have a keto diet and it's working for you, great. And if you're a vegetarian and you're enjoying it, great. I think an important element of nutrition is that you need to enjoy it. You can't say, I enjoy soda and hamburger and I'm going to enjoy it if you do it. Just keep in mind that stroke is the number one cause of disability in the United States, is the second leading cause of death in the world. There are risk factors for who gets stroke, who doesn't. Poor diet, diabetes, insulin resistance are major risk factors for stroke and heart attacks. So be prepared to show up in the hospital. When I saw my patients who had risk factors would come to see me, they say, doc, I love my hamburger. I can't not have the food. And it's cheaper. It's a lot cheaper to have a hamburger and french fries and soda than it is to have, you know, salad. Anyway, I would say, listen, you can go ahead and eat the food you want and you can go ahead and continue to smoke. But don't tell me I didn't tell you that you are at risk for stroke. And I don't want to get a call from hospital. Dr. Fatouhi, we have your patient here. Mr. Such and Such can't move the right side of his body and he can't. Difficult speaking. I don't want to hear that. I don't want to get that call from the emergency room. Don't tell me I didn't tell you. And a stroke doesn't give you advanced notice. It's not like you get advanced notice, you know. Mr. Such and such, we are here to inform you that in three months you're going to lose the ability to walk and that you have a major stroke. Please be advised. No. You wake up or you're doing something in the middle of the day and suddenly you lose vision on one side of the body. You can't move half the body, you can't walk. And the strokes that can happen are as a result of accumulation of risk factors and poor nutrition as a mystery risk factor.

A (72:59)

On the subject of stroke, how does. Mechanically, how does stroke lead to death?

B (73:07)

Unfortunately, my father had a major stroke and he died. So it's unfortunate. He was 87 and he did have risk factors. I mean, he had smoked when he was younger and he unfortunately had a huge stroke which caused swelling in the brain, which then pushes on the base of the brain where the breathing happens and the breathing stops and the person dies. Most strokes are not that big. Usually stroke that's the size of a bean or the size of a ping pong ball, it wouldn't cause death, it causes disability. But if a stroke is large enough, it can cause swelling, can cause edema in the brain. And that edema pushes at the base of the brain, the bottom part of the brain, where the breathing is controlled, and that part of brain literally gets choked and a person stops breathing.

A (73:53)

Wow. Is there a loss of consciousness prior to that?

B (73:57)

Yes. If a person has large stroke, they especially as the swelling increases, they will not be able to appreciate what goes on around them.

A (74:07)

Thank you for sharing that. Did that influence your choice of career or did that happen?

B (74:13)

No, this happened last year. You know, I became interested in brain and neurology as a kid. Actually, my father talked to me about how there is no limit to what our brain can do. You know, when I was a kid, my father used to talk to me about you can do anything in the world. I was seven years old, he said, Thomas Edison, Mahatma Gandhi, John F. Kennedy, well known scientists in the world, they were all once regular kids like you. And so you can learn seven languages, you can become a doctor, you can become a researcher, you can become an author, you can change the world, you really can, if you wanted to. And so ever since I was a kid, I always thought, you know, I can't do anything, so why not learn more languages? So I ended up learning many languages. And when I was 14, I wrote a book on how to become successful in life. As a 14 year old, you know, about importance of persistence, having passion about what you do, working hard, consistency, being kind to people and so forth. So I think there's no limit in what our brain can do. Our brain is such a beautiful organization. I think of a brain as a beautiful organ. And I think there are many things that we can do to make our brain a more beautiful organ. There's no Botox for the brain, but when I look at people's brain, when I look at people, when it comes to seeing me as a patient, I can envision the brain is their brain, fresh, vibrant and healthy. And it's pulsing and it's looking beautiful, or brain is dusty, dried up, shriveled up. When I talk with someone who's complaining about everything, they can't do things, their sleep is poor and they're obviously not in tip top brain shape. I can just envision their brain as I look at their eyes, what kind of brain I'm looking with. And I love it when a 75 year old comes to see me and they're happy and healthy and they're still sharp and they're doing things and they're learning new skills. I can envision how the brain has remained vibrant and healthy and clean, like a pinkish clean, vibrant color. So I think we need to work on brain beauty. And I wish there was a way we could take pictures of people's brains and show them. See, people don't realize the brain is an organ. Just like your skin can have a lot of wrinkles, it could be healthy, your brain can have different shapes. It could be healthy and strong or, or shriveled and dried and dusty and dirty.

A (76:49)

You know, with the brain being an organ, as a layperson, the part that can sometimes be confusing is that you think about working out your muscles. And when you exercise your muscles, the muscles get stronger. You don't think about exercising your organs. But it does seem like the brain is the organ that you exercise.

B (77:07)

Exactly. Your brain is very much like a muscle. It's use it or lose it. And the more you use it, the stronger it gets.

A (77:17)

Right? Right. And that's because it's an organ and not a muscle. I think that's often something that you just don't like. I don't exercise my kidneys.

B (77:25)

Yes. But you know, one thing is that your kidney also changes with life. And your heart definitely changes with your heart. If you have chronic hypertension, if you have a high blood pressure for many years, the muscles of your heart thicken, not in a good way. You get what's called hypertrophy and you get fibrosis in your heart muscles and you get calcifications in the arteries that cover your heart. So your lifestyle changes very much affect the anatomy of your heart. Your heart versus heart of someone who smokes and has diabetes and has obesity and has a centered lifestyle are very different. If you put it on a plate side by side, you could see which one is which. When I was in medical school at Harvard, I never forget the day that they showed us hearts from different conditions. It was a large classroom. They had put tables around the classroom, and on each table was a tray with a heart on it. And these hearts looked very different from each other. And our job was to learn what caused the problem. So, for example, one heart would be very thickened ventricular muscles, they had hypertrophy. Another Heart looked larger. The size of the heart was very larger. Sometimes a virus or drinking alcohol can cause that. And then some hearts had open arteries. They were like straws that covered the heart, but the straws look open. Other hearts had arteries, which are all filled with plaques and they were crunchy. So our job was to say what caused the problem, to make the heart look the way it does. But clearly these hearts look very different. And the same thing happens to your liver. See, when you're healthy, your liver looks fresh and it has red color in it. But if you have diabetes, if you have obesity, if you have poor diet, you get fat inside your liver cells. So you get what you develop what's called non alcoholic fatty liver disease. And so inside your liver there are pockets of fat. And the more fat you accumulate in your liver, the worse it functions. I mean, your liver doesn't function well, it doesn't detoxify things as well. And as a result, your brain is affected. Same goes with your muscles. If you have an active lifestyle and you walk three to 5,000 steps a day, your muscles are healthy, that there are muscle cells and there are nice blood flow in them and they look healthy. But if you have a sedentary lifestyle, if you have poor diet, if you don't exercise, if you smoke, you get small fats inside and between the muscle cells, you develop fat, intrinsic fat inside your muscles, and you don't function well. It causes inflammation and you can't function well. You were talking about why not just to take a chance and not take care of yourself over many decades. And then when you're 70, then start. Just keep in mind that if you take that route, it's a high risk choice because your muscles, your liver, your kidney, your heart, your skin, your brain are all going downhill. And hopefully at that age, you'll be able to get it all together and do it. Because one of the things that happens is that you lose your energy as you do all those things. You have fewer mitochondria. Mitochondria, remember, there are organelles that generate energy. And when you have all those lifestyle choices I mentioned, you have fewer mitochondria, so you have less energy. So at 70, you may feel frail, you may feel like you don't have the cognitive performance that you would like to have. And you say, you know what, it's time to just turn things around and do it. But you don't have the energy. You could have someone like me who take care of you, who will put you on a program and work with you, but These days when you go see doctors, they spend have 15 minutes with you and they sort of figure out what's the problem. You have high blood pressure, here's a prescription. You have diabetes, here's a prescription. And you know, they may give you a pamphlet about lifestyle and you go home. So I think it's best to have a lifestyle that has those five pillars of brain health which really guarantee that you will have an excellent brain portfolio when you get to retirement age. Only 5 to 7% of people have a genetic reason either to develop Alzheimer's disease or different forms of dementia or be unusually sharp. There are people who seem to smoke and drink and do everything wrong, and yet they're 90 and they're still functioning. And there are very small percentage of people who seem to have done things right and they get older and they're not functioning well. Those are the exceptions. Those like 5% of people maybe fall in that category. For most people, your lifestyle choices, those five pillars of brain health determine how well you function now and how well you function decades later. Foreign.

A (82:39)

This message may be shocking to many millennials. If you are one, you might want to sit down right now. Loads of people are searching the following on Depop.

B (82:47)

Low rise jeans, halter top, velour, tracksuit.

A (82:52)

Puka shell necklace, disc belt. You likely placed these in the dark of your closet in 2004. No. Never to be seen again. But if you can find it in yourself to dust them off, there are a lot of people who will give you money for them. Sell on Depop where taste recognizes taste. Going back to those five pillars, we've talked about three out of five, exercise, sleep and nutrition. What are the other two? What's number four?

B (83:25)

Number four on the list is mindset, which relates to sleep because stress, as we talked about earlier, is a major negative interest. It's a major drainage. It's a major leak of cognitive abilities and you really need to hold it and manage it. You can think about risk management. You know, stress is stress management. You really want to reduce as much as possible. There are many ways to do it. And that's why I don't call it just stress management. I call MIT mindset number one. Mindset. To have low stress, in my opinion, is have a purpose in life. Be clear as to where you're heading. Once you establish what your goal for your future is, what gives you passion in doing things, what gets you excited in doing things, that's your passion. That's your purpose in life. Then pursue that and eliminate things that are not in line with your purpose in life. See, these days, many people do too many things and in order to free your time, you have to eliminate some things. And so you need to look at everything you do and decide what are the important things that are in line with your purpose in life. So for example, your purpose in life may be to be good grandparents, that you want to be able to provide for your family and your grandchildren. So that's your purpose in life. So then if that's what you're doing, then everything else should be aligned with that. Your purpose in life is I want to be a brain superager, which means I want to reach the age of 90 and be sharp and independent. If that's your purpose in life, then you have to sort of make sure that most things you do are in line with what you want to do and not to do the things that are not primarily and directly involved in that. So that's one mindset. Establish your purpose in life and then align your activities in every day toward that goal. The second important thing is to own your problems. Many people feel stressed and frustrated because other people are not doing the things they're supposed to be doing. If you are frustrated with your spouse and coworker and boss and children, you realize that you only can work on yourself. You can't change other people and also realize that you have your issues. We tend to think that we're fine. Other people are not doing what they're supposed to do. So second thing you want to do is own your problems and set specific goals that you're going to achieve to address your problems. And don't blame other people. Don't blame the economy, don't blame the administration, don't blame the spouse, the children. Work on yourself. And the third thing is the growth mindset we talked about earlier. Realize that you can have a tip top brain, that you can learn anything, that you can be better at anything. And so those three things, those three mindsets, the mindset as to what it is I'm trying to get in life, where is my long term goal? The second thing is that you own your problem, you work on yourself and you minimize expectations for people around you. You become humble as to, I'm not perfect and I can't expect other people to be perfect and I can't expect other people to be the way I want them to be. Each person, they have their own life story, they have their own problems, they have their own brain portfolio, they have their own issues and you have yours. So don't push your agenda Your criteria for excellence on other people, just work on yourself. And the third one is a growth mindset that I can do things, you know, I can do things. So those are in terms of mindset, there are simple things people can do on a daily basis to reduce the stress. Let's say you work in a busy financial office. Everybody's running around. The screens always show the stock market crashing. There's a lot of chaos going on around you. You can't help to feel the stress that people are looking at you like, why did you pick this stock? This was a horrible mistake you did. You can do breathing exercises for two to five minutes, not two hours, two to five minutes. And if you want, we can do it together. Do you want me to do it?

A (87:50)

Yeah, let's do it.

B (87:51)

Okay, so we're going to do this. Okay, so you're going to sit up upright and we're going to breathe in with a count of three. We count of six, going to hold for a count of three, and we're going to breathe out and we're going to do this three times.

A (88:01)

All right?

B (88:02)

So you watch my hand as you breathe in. You hold and you breathe out. Ready? Okay, go. One, two, three, four, five, six. Hold. One, two, three. Now we're going to breathe out. One, two, three, 4, 5, 6. Breathe in. One, two, three, Four, five, six.

A (88:37)

Hold.

B (88:38)

1, 2, 3. Breathe out. 1, 2, 3, 4, 5, 6. Breathe in. Two, three, four, five, Six. Hold. 1, 2, three. And breathe out. 1, 2, 3,. 4, 5, 6. So it's amazing. I mean, I just did that myself and I feel like one chill, a little calmer just doing it for three cycles.

A (89:16)

Right.

B (89:17)

And if you just do it for set a timer, two minutes, just two minutes, it really breaks the rush, rush, rush, rush. You always have to. Ideally when I do five minutes, you can set a timer. There's an app called Calm. It has these breathing choices that you can just. It's free app. You just go there or just set something else. These days, a lot of apps for these things. What we just did is called heart rate variability. Biofeedback. HRV is a measure of your cardiac health. Heart rate variability means that there's a variation in your heartbeat from beat to beat. Let's say your heart goes 60 per minute and there's a short variations between beat to beat. So it's one's one second, there's 1.9 second. The other one's 1.1 second. As you breathe in and you breathe out, the heart rate goes up and down. Just A little bit. And that small variation with breathing in, breathing out is reflective of having a healthy sympathetic, parasympathetic balance. The sympathetic nervous system is your stress response. It's when you get excited, you run, your heart goes fast, and that's how people are when they're stressed out. The sympathetic overdrive and parasympathetic is when you're calm, you're chilled, you smile, you laugh, you enjoy yourself. And so when you have a good balance between the two, your heart rate variability is higher. But when you're stressed out, then your heart is rigid, it goes one per second, or, you know, if it goes 100, it's worse. When you do these breathing exercises, you increase your heart rate variability. Now, here's the interesting thing. Heart rate variability training has been shown to reduce the amount of Alzheimer's footprint in your brain. I was, oh my God. What does breathing have to do with Alzheimer's in my brain? Several studies have shown in a randomized controlled trials that slow breathing has many benefits. Improves brain health, improves memory, improves mood, reduces depression, but reduces the amount of Alzheimer's amyloid plaques that you have in your brain. We don't know exactly why, but it's incredible that this slow breathing has such a powerful effect on the brain. We think that one reason is that when you do this breathing exercise, you increase activity in the vagus nerve, which is a nerve from your heart to your brain, and it becomes rhythmic at a slow rhythm. It sets the rhythm of the brain to slow down. That reduces cortisol. And remember earlier we talked about how cortisol is toxic to the brain, so reduces cortisol, but it also increases blood flow, which helps with clearing any inflammation in the brain. Talking about hacks, you know, this is a real effective intervention which is so simple and it's so powerful, I find it surprising, frankly. They did a study, a randomized controlled trial in patients with depression. Half of them received this HRV biofeedback. We just did. They did, I think 30 minutes for three months. And a control group that just sat there and listened to music, calm environment. And then after three months, the group that had received HRV biofeedback had lower depression scores. Their mood improved in that three months. And then they said, okay, nobody does any more hrv. And we're going to check both groups in three months. The group that had done HRV biofeedback had better mood scores even though they had not done HRV for three months afterwards. So there's some long term benefits of this simple breathing exercise so in summary, if you want to reduce your stress, you need to have the right mindset, you need to set priorities of what's important to you. You need to sort of manage your own stress, have a plan of action for doing things. You need to have a positive outlook. And then you want to do these breathing exercises. You can also do Tai chi, you can do yoga, you can do meditation. There's so many things you could do. So there are so many things that you can do to reduce your stress and you can do what you enjoy doing. Now we talk about the four pillars of brain health. We talk about exercise, we talk about sleep, we talk about nutrition, we talk about stress. And the last one is brain training.

A (93:50)

Brain training. Before we get to that, I have a follow up question on the breathing exercises you mentioned, Tai Chi and yoga, that actually ties in with what I was about to ask, which is when I think about gentle exercise, there's gentle exercise, so yoga is one example. But there's also swimming at a very gentle pace or even walking. There are forms of gentle exercise that could lead to rhythmic or slow breathing. Would that constitute this pillar number four? Would that be sufficient for these types of breathing exercises? Or should a person set time aside to sit and breathe and focus exclusively on breath?

B (94:35)

No, you can combine. In fact, that's what I do sometimes when I go for a walk. I do rhythmic walking and I set the rhythm of my walking with my breathing. You could do interventions that combine the different pillars of brain health. For example, if you go hiking with your friends, you're hiking, so it's exercise, you're talking with your friends, learning hopefully new things, which is you're doing brain training and you feel less stress. So one intervention, one activity gives you multiple benefits. And I think the other thing is you could get together with your friends to have dinner, or you can have lunch, or you can get together and go for a hike, or go for running, or go for cycling as a group. So by doing those things, you achieve goals on separate buckets. You have those five buckets and sometimes one exercise, one activity fulfills multiple pillars of brain health. And so breathing could be combined with walking. There's something called meditative walking where you walk in a quiet area like in a wood, and you just enjoy the walking. You listen for the birds, you listen for any sounds in your environment. You don't think about work, you don't think about taxes or interest rate or stock market. You just think about how beautiful it is to just breathe this fresh air, feel the air, go to your nostrils or listen to your steps like that. With each step, listen to your steps. This is something that fulfills multiple things. You're in nature, you're doing stress reduction, you're walking and you're meditating.

A (96:27)

Perfect. Oh, and one other thing. You mentioned purpose and how important purpose is. Can you talk about. I know there have been many studies that have shown that having a sense of purpose actually has measurable quantifiable longevity benefits and brain health benefits that have been proved out in research.

B (96:48)

Yes. These days we have a questionnaire that can determine any person's level of sense of purpose by asking you six or seven questions from for example, when you wake up in the morning, do you feel purpose in your life? Or are there things that you feel passionate about? Or do you think your life has meaning? Yes or no? So there are a series of questions that determines level of sense of purpose in an individual. So let's say put that from 1 to 10 and then you can measure it and you can monitor it over time. Many studies have shown that people who have a higher sense of purpose in life are less likely to get Alzheimer's disease. They're less likely to have stroke, they're less likely to have heart attacks, they live longer. And these are specific numbers. For example, people with a higher sense of purpose are 50% less likely to get strokes. They're 19% less likely to have a heart attack. On average, their life expectancy is much higher than people who don't have a sense of purpose in life. And even if they have Alzheimer's disease in the brain, they're more likely to function well despite having Alzheimer's disease in their brain. And even when they get Alzheimer's disease symptoms, if they do develop it, they're usually calmer and more pleasant. So sense of purpose has a huge benefit for all aspects of our life. I give a whole one hour lecture, including the report of maybe 20 studies that have shown the wide range of having a sense of purpose in life. And it's easy to obtain. Let's say you don't have a sense of purpose in life. You just think about how I'm going to pay my mortgage, how I'm going to survive my day, and that's what I'm doing. I don't have time to figure out what I want to be in general in the future. I have a series of seven questions to help you identify what your sense of purpose is. And here I'll give you some of the questions. What kind of job would you do if nobody paid you and why? What would you want people to say after you die? Let's say there's eulogy. What do you want people to say about you? Another thing is, what kind of books do you like to read and why? By answering these questions, you realize, what are the things that excite you? People assume that everybody wants money, that money is a universal goal. That's not the case. Money is very important part of life. True, but this is not what excites every person. And money should be, you know, helping you get to what you really want in life, not be the goal itself. Of course, you may want to say, you know what, my purpose in life to be extremely rich. And that's a valuable purpose in life. In which case you do everything to reach that goal. For many people, faith is important. They want to be a good Christian, a Muslim or a Jew person. And their purpose in life to be closer to God. That's a very valuable purpose. And in fact, they're into something, you know, they enjoy life more. People who have a sense of purpose in life, they enjoy day to day life more. They don't get stressed as much. Stressful things happen to them, but they don't get stressed as much because they have that view of the big picture.

A (100:13)

So let's go to number five.

B (100:15)

We did actually cover number five throughout our conversation. Brain training is an important factor to grow the size of your cortex and hippocampus. We mentioned how, for example, when you learn to play golf, the parts of your cortex hippocampus that are important for hand eye coordination literally grow in size. If you learn to become a taxi driver in London, the parts of your brain for navigation and three dimensional spatial orientation grow. If you're a Swedish college student and you learn Arabic in three months, parts of your brain that are important for language grow in size. If you're an athlete and you practicing how to become a better basketball player and you improve your shooting and the parts of your brain for balance and hand eye coordination improve. If you learn how to play the piano, the corresponding parts of the brain for moving your fingers and for music grow. So practice makes cortex. The more you practice something, the more that part of the brain, specifically cortex and hippocampus, grow. So then the question becomes, well, I have all these cortical areas that I can improve on. Which one should I focus on? And the answer is, focus on the one that you care about. See, a lot of people care about memory. Many people worry that as they get older, the memory fades. Well, work on your memory. Memory is A form of intelligence and memory, just like any other skill, can be improved on with practice. So you can improve your memory by learning how to memorize numbers, memorize names, memorize lists of 20 things. Again, in my book, I showed you how to memorize lists of 20 things.

A (102:04)

Lots of lists. Yeah. And you mentioned there was a guy, his grandmother died of dementia, and he then became a little bit paranoid about one day getting dementia. And so he decided to study memory. And within four or five years, he became a memory champion.

B (102:19)

Yes. My friend Nelson Dellis is a person who did that. He was in his 20s, he was a computer science major in Miami, and his grandmother passed away due to Alzheimer's disease. And he became concerned that, you know, he's going to develop Alzheimer's disease one day. So he decided to do memory exercises, and he actually enjoyed it. And instead of doing one hour exercise, he did two hours, sometimes three hours, sometimes four hours. He became really interested because he was improving and he was becoming more interested. And it was a local competition in Miami, and for fun of it, he decided to just join and he won. And then there was a state competition and he won. And then there was a national competition, and he did like, you know, five, six hours of training every day. And then he went to the memory championship, actually in New York, and he won. He could memorize a deck of cards in 45 seconds. He can memorize 20 decks of cards. He can memorize 10,000 digits. His cognitive capacity has really exploded in size, in capacity. Anybody can do that. Like, I can. Probably not the same level as he is. But if I spend 10 hours a day of memorizing things and practicing anything, including memory, I'll be much better than I am. And of course, when I teach at Hopkins or at TW or at Harvard, I always memorize the names of my students, even if it's one lecture. Like, if I go to Harvard to give one lecture and there are 20 students, when I walk in, I walk in looking 15, 20 minutes early, and I make a point of memorizing their names. Sometimes I have 50 students and I memorize their names in two classes. So the first session and the second session, and I memorize credit card numbers, and I memorize whatever comes near me, because practicing my memory, I'm boosting the size of my hippocampus. I usually memorize whoever I meet. Part of it because it's polite and I enjoy it. Part of it is because I'm actually doing memory workout for my hippocampus. I'm doing push up for my hippocampus. And I think that a lot of people think, you know what, I'm not good with names. And frankly, I hate it when people say that because it's a self fulfilling prophecy. You say you're not good with names. You meet someone, they tell you their names, you really didn't work hard to memorize their names and you forgot it. And you tell yourself, see, I'm not good with names. Now I give lectures a lot. I give lectures around the world. I've been to like 40 countries. And I usually ask people, how many of you have Difficulty remembering names? 90% of people raise their arms or ask how many people you have memory problems. Again, 90% of people raise their hands. It's not possible that 90% of populations all around the world has a disease. I think the problem is that most people feel their memory for name fades with aging without making effort. It's true if you don't make any effort, if you just live life, have a sedentary life, don't challenge your brain, don't eat right, stress a lot, you, brain will shrink. The hippocampus on average shrinks by about 1% per year after age 50. That's on average. That's not for someone who follows the five pillars of brain health. For someone who follows brain health, the five pillars of brain health, it may be 0.1%. For someone who does everything wrong, it may be 1.5 to 2%. So the 1% is average. So if you tell yourself that I have a growth mindset, that I can have a good memory and you learn memory skills, There are skills to improve your memory, Just like there are skills and way of doing things for being better in playing golf.

A (106:02)

Right.

B (106:03)

So you can improve those things and be better with memorizing names.

A (106:06)

Can we talk through some of those skills?

B (106:08)

Yes.

A (106:08)

So earlier at the very beginning of this interview, I said hippocampus, I said, I'm visualizing a hippopotamus on a college campus. And it was sort of a visual mnemonic that helped me remember the term hippocampus. Would you recommend things like that in order to develop memory? Is that how you memorize credit card numbers, for example?

B (106:30)

Yes, I think that visualizing things is a very effective way of doing things. Usually you want to make a funny story. If you have to memorize a long list. If you have to memorize a list of 20 things, you can put in groups of four, and then you make a little funny story with four things.

A (106:47)

Let'S say baked beans, lettuce you know that grocery list.

B (106:51)

If you want to make a micro. Let's say lettuce, tomato. Give another one baked beans.

A (106:56)

Lettuce, tomato, banana.

B (106:57)

Okay, beans. Say it again.

A (106:59)

Beans, Lettuce, tomato, banana.

B (107:01)

Okay, so beans. Just think of walking to this grocery store, and there's a huge can of beans. And then this is such a huge can. You have to walk around it. And then as you walk around it, you see behind it there's a tail of lettuce. And then you just picture that this lettuce is going a long way. And then the important thing, as you just said, is to visualize it as clearly as possible. That, like, visualize. See the big can of bean that's there, and then see the lettuce? And then let's say the banana is the next word. So then you decide that as you walk to the end, there's a large banana at the end. And again, you visualize the component of the list that you have in mind and then repeat it to yourself.

A (107:46)

Yeah, I'm actually almost imagining, like, a dinosaur. So I'm seeing, like, in my head, I have this image that's a little bit like a Tyrannosaurus rex, except the body is a can of baked beans, the tail is like a long string of lettuce, and then it's got, like, spiky bananas sticking up from it as spikes.

B (108:05)

Yes. And then you go to the next aisle. And so before going to the supermarket, you visualize those things for the fun of it. And then when you picture that, you go to the next aisle, then you have four other things. Make a funny story with those four things. And then go to the next aisle before going to the supermarket. Just visualize that. So when you approach the supermarket, then you go over with the story you made in your mind, and then you can go through the whole thing. Right. But when it comes to names, I think that's one thing that people often complain about. There's a simple way. The way is this. When you meet someone, you first decide, I'm going to memorize that person's name. See, most people start by saying, I'm not going to be able to remember this person's name. This is like a fixed mindset. You're already starting by saying, I know I'm not going to remember the name. See, that's a wrong way to approach that. Approach it with, I'm going to definitely memorize Paula's name. This is going to be Paula. And I'm gonna. I don't know you yet, but I'm gonna memorize the name. So I'm gonna envision that when I leave this place, somebody give me $10,000 if I remember the name of this person I'm gonna talk to. And then when you meet them, you look at their eyes. Because when you do eye to eye connection, it's emotional connection. And it's very important to make something emotional. And so as you look at them, you ask their name and they say, I'm Paula. And then when they say it, you wanna say it back because you want to make sure you say it right, like your name is EZ Paula. But my name is Majeed Fatouhi and that's not a common name. And a lot of people will hear their name. They say, oh my God, it's impossible, I'm not going to remember it, but I like it. But some people say, majeet, how do you spell that? And I say, M A, J, I, T, O, Majid. I get it, okay, Majeet, how are you? They spell it so they can visualize it and they actually pronounce it so their muscles and the jaw feels comfortable saying it. Many people feel unsure because they're not. The name is Jean, John, Joanna, Jenny, Jane. So they're not sure what it is. But once you say it, it confirms that you said it correctly and you're going to memorize it. So let's say that five minutes in the conversation, I don't know what your name is. As much as I repeated it, as much as I made eye to eye contact with you, as much as I was excited about $10,000, I forgot it. Then I just say, can you tell me your name again? I don't apologize. I usually say, do you remember my name? Most people don't remember my name. So we laugh about it. I say, oh, my name is Majeet. Tell me your name again. And we all laugh about it because most people are not gonna remember my name, right? And I ask them a second time and when they say it, and I say something like, paula, how long you been here? Or Paula, how do you know the host? Or Paula, I actually say the word because by saying it, you consolidate it in your memory. And here's a key point. At the end of the conversation, you need to be able to say their name again. Now, when you're a beginner, you may have forgotten even though it was told, you know, you were told the name twice, you may still forget it, in which case you ask them a third time. Don't be embarrassed. You're in training, it's like, you know, Paula in training. That's okay. Tell them, do not remember my name. They probably don't. So you laugh about it. You ask the name, because you want to catch that price. You're not going to let go of them until you know their name 100%. You can't memorize someone's name. 90%. You have to know their name 110%. And that's how you remember it later. You need to consolidate. You don't need to just acquire it. You need to consolidate it in your brain. So by repeating the name, you remember it. And of course, if I don't see you ever again, if I see you, like, three months later, I may not remember your name, and that's fine. But if you see somebody multiple times, chances are you will remember their name. And so practice that every time you see somebody new, have the mindset that I will definitely remember this person's name. Memorizing a name is not rocket science. It's not that difficult. I can do this. I can memorize someone's name. It's not that difficult. You know, it is possible. Then introduce yourself. Listen to the name, repeat it as they're talking. Mention their name when you talk back to them. If you forget it the second time, ask a second time. If you're in training and you still don't remember it, do it third time. And keep in mind, the more you practice, the better you'll be at it. So sometimes I give a lecture to, like, 70 people, and I memorize all 70 names. Most people say, oh, my God, wow. But it's not that hard because I've done it so many times. It has become something that I'm getting good at it. And you can be better at anything. You can be better at playing the piano. You can be better cook, you can be better anything. And if you do something over and over again, you get good at it. Your brain has plasticity. Your cortex and hippocampus can grow. And the more you challenge them, the better they get, the stronger they get. So brain training is very important. And if you have to choose something to be good at, you may want to choose memory and memorizing names or memorizing lists, because it's a good skill to have in the long term.

A (113:07)

Right. How do you memorize credit card numbers? Do you have a trick for that or long strings of numbers?

B (113:12)

Yeah. So for credit card numbers, you put the numbers in a series. I'm not going to give you my credit card number. But let's assume, hypothetically, is like 3711-5046-3021. And then expiration date is 4-30th. And I don't give a security code. The way I just did it for you is that I have memorized the sequence of numbers, as in groups of four. And I put it in our backyard. So right as you walk to the backyard, I put 3711. And so I put 3711 and that. And I visualize it just like you do. I. I visualize the 3711 standing where I usually plant my tomatoes. So that's. I see 3711 is where I plant my tomatoes. And as I walk, there's a little back part of the corner that I have bushes that are bushes, bed there. And I remember 3021 on the ground. So I look down and I see 3021 written on the ground. And then next to it is actually a place I just planted some watermelons last year. And that's where I put the zeros. And then next to it is, we have a little storage area in the other corner of the backyard. And that's where I put the code 5046. I envisioned 5046. And then on the way out next to the pool is where I have the expression date, which is April 30th. So I just walk through my backyard and I see the numbers that are there. So when I have to remember the credit card number, I just envision the areas that there are, and I remember it. If we visualize something with a story, just like in the supermarket, our brain is good at remembering things that are visual. And so we remember things that we can see clearly. And like everything else, you get good at it with practice, right?

A (115:08)

Baked beans, lettuce, banana, tomatoes. Yeah. When it comes to this type of mental training, let's say that you're a person who you're quote, unquote, book smart. And in your day job, you deal with the book smart elements of life. But there's really nothing that you ever do that relates to maybe kinetic or athletic activity like dance, for example. With dance, you have to memorize feelings, memorizing choreography, right? You have to memorize a series, a sequence of physical moves, you know, like 1, 2, 3, 4, 5, 6, 7, 8, over and over and over and over. And it's a completely different form of memorization and a different type of brain usage than what you do in your normal life. Does it make sense for the purpose of brain health to focus on doing something like that, Doing something that's just different than what you typically do.

B (116:07)

Yes. I think you want to challenge yourself by doing something different. Because if you're in finances and you're looking at stock market fluctuations and you know everything about each company, the growth period, and you know the areas time they did not do well, this is your thing. This is your niche. You're not challenging your brain. This is your comfort zone. But like you said, learning the sequence of steps is outside your comfort zone. So you want to get outside your comfort zone and you want to take on brain training exercises that are a little challenging, not so challenging that you're discouraged, but just a little challenging.

A (116:49)

I also wanted to ask you about nootropics. This is something that's gotten really popular lately. What is your feeling on that? Is there validity to it? Is it something that people should be looking into? Is there benefit?

B (117:02)

The only supplement I recommend and I take myself is omega 3 fatty acids DHA and EPA at a dose of 1000 milligrams per day. I know that there are at least a thousand different supplements that have been advertised for being beneficial for brain and I'm sure some of them may have some benefits like curcumin is good, CoQ10 is good, resveratrol is good. There are so many things that are potentially good, but in my opinion, the one supplement with the strongest data is omega 3 fatty acids. I really don't think that people need to focus too much on taking too many supplements. Again, I think it's best to focus on the five pillars of brain health. These five pillars of brain health compound over time and provide you the best possibility of having excellent brain health and brain performance in the future. And the benefits of those compound with each other. So for example, when you exercise, you sleep better. When you sleep better, you're less likely to be stressed out. And if you're not stressed out, you may feel better when you get home and you will be in a better mood and you probably go for exercise or you may go for a walk with a family member and so forth. So you really need to focus and put your money on those five pillars of brain health. You want to diversify and put something in each bucket every day. So you want to move your body every day. You want to make sure you have a routine sleep time every night. You want to make sure you don't eat junk food. Any food other than junk food is good. Fruits, vegetables, natural food. And don't worry too much about the grain versus red meat. Just Be reasonable, enjoy what you're eating and then work on your mindset. Don't stress too much. Laugh, smile, take it easy. Don't put pressure on the people. Don't put pressure on yourself and challenge yourself. So these are five buckets and every day you put something in each of those five buckets and you take a supplement. It's fine if you don't take it, it's fine. But the supplement is not going to change your life. Don't think that you take omega 3 fatty acid or creatine or CoQ10 and all of a sudden you'll be a genius. Or all of a sudden you will get the best insurance against developing Alzheimer's disease decades later. Those are small in comparison to the five pillars of brain health.

A (119:17)

Excellent. Well, thank you. Is there anything that I haven't asked about that you'd like to emphasize?

B (119:22)

No. Thank you very much for reading my book so carefully. I really appreciate it.

A (119:25)

Of course, where can people find you if they'd like to learn more?

B (119:29)

I have a website, drfutui.com, that's-r f O-T-U-H-I.com. i'm also on Instagram and several other social platforms, as well as on YouTube and LinkedIn.

A (119:43)

Thank you to Dr. Fatuhi. What are three key takeaways that we got from today's episode? Key takeaway number one. Your brain is your most important asset. Dr. Fatuhi says your cognitive wealth matters more than your financial wealth because your brain, it's like an investment portfolio. There are hidden taxes that are draining it. And there are also smart investments that compound over time. So the five hidden taxes are a sedentary lifestyle, poor sleep, junk food, chronic stress, and mental laziness. The smart investments that compound over time, those include exercise that delivers a tenfold return on investment. It multiplies mitochondria in your brain cells, it reduces inflammation, and it improves your overall health.

B (120:30)

I look at them the same way I know about brain health brain portfolio and I look at some of my patients who are very successful and in finance, but their brain functions are not optimal. Their brain portfolio is not as strong as their financial portfolio. So anyway, the five pillars of brain health, number one, and the most important one is exercise.

A (120:51)

Key takeaway number two. Chronic stress physically shrinks your memory center. So your hippocampus, which is the memory center in your brain, is where you learn. And it's ground zero for learning. And high cortisol levels from chronic stress kill neurons in the hippocampus more than in other brain regions. So a little bit of stress is fine. If it's a short term crisis, your brain will recover. But daily chronic stress for years and years and years actually shrinks your hippocampus significantly. And you can see that damage on MRI scans.

B (121:29)

Each hippocampus is the size of your thumb. You have one on the right, one on the left. And so hippocampus is ground zero for learning and memory. And what happens is that when your cortisol levels are high, the cortisol goes everywhere. But hippocampus is particularly vulnerable to cortisol. For some reason, cortisol damages and kills neurons in hippocampus more so than other parts of the brain.

A (121:55)

Finally, key takeaway number three, your brain will forgive decades of bad habits. Dr. Fatouhi has studied patients who are in their 60s, 70s and early 80s who had diabetes, obesity, depression, years of poor lifestyle choices, and within 12 weeks of working on the five pillars of brain health, he found that 84% improved their cognitive function. Half of them increased the the volume in their hippocampus so much that it showed up on MRI scans.

B (122:27)

And we did some brain training with them. We also helped them meditate, we helped them exercise more. We worked on the five pillars of brain health with them. And we also treat their depression, treat their diabetes, manage the other medical issues as a holistic approach. 84% of my patients improved cognitive functions. 84%. These are people 60s, 70s and early 80s who had a whole lot of problems.

A (122:53)

Effy those are three key takeaways from this conversation with Dr. Majeed Fatouhi, the author of the Invincible Brain. Thank you so much for being part of the Afford Anything community. If you enjoyed today's episode, please share this with the people in your life. Share it with your friends, your loved ones, your liked ones, your tolerated ones. Share this with all of the people that you know and love or like or put up with. Because that is how you spread good information in a world full of bad or mediocre information. Good information is worth sharing. It's worth spreading. It's a service that you can do that impacts the people around you. So share this with the people around you so that they can learn, they can benefit, and they can improve their own lives. That is the most important thing that you can do. Not just to help support the show, but also to help support your community at large. Also, make sure that you're following this podcast in your favorite podcast player. And while you're opening up that favorite podcast app, please leave us a Review up to 5 stars. We would appreciate it so much. Also, subscribe to our newsletter, affordanything.com newsletter where we send out updates that you won't find anywhere else. It's totally free and you can find that again@affordanything.com newsletter. Thanks again for tuning in. This is the Afford Anything podcast. I'm Paula Pant and I'll meet you in the next episode.