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The 1000 Hours Outside Podcast
1KHO 808: Taking Brain Health More Seriously | Dr. Steven Storage, Amen Clinics
00:52:29
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- [00:01]
A
Summer gets busy fast. One minute you're easing into warmer weather and the next you're juggling sports schedules, swim days, camping trips, road trips, late nights around the fire, and trying to keep the house from completely falling apart in the middle of all of it. And if you're a cat family too, there's still the everyday stuff waiting for you at home, including the litter box. That's why Whiskers Litter Robot is such a game changer. During busy seasons, it automatically cycles after every use, so you're not constantly scooping or dealing with litter cleanup every single day. It just handles the dirty work for you. And the Whisker app notifies you about your unit, like when a clean cycle is complete, when drawer levels are getting full, or if the unit needs attention. You can always track things like your cat's weight and bathroom usage over time, which makes it easy to stay aware of changes without having to constantly check in. Honestly, during a packed summer, having one last daily chore to think about makes a huge difference. Maintain your cat's litter while focusing on your growing family. Learn more about Whisker Litter robot models and starter kits today to get set up before the summer craziness arrives. Take an additional $50 off bundles with code 1000 when you shop whisker.com 1000hours that's an additional $50 off bundles with Code 1000hours@whisker.com 1000hours welcome to the 1000hours Outside podcast. My name is Jenny Arich. I'm the founder of 1000 Hours Outside and I have the honor today of sitting across from Dr. Steven Storage. You may know him from Instagram or Tik Tok. He's also works at the Eamon Clinic, so you may know him through there as well. Welcome.
- [01:28]
B
Thank you so much for having me. Super excited to talk to you.
- [01:31]
A
So we have a lot to talk about today. We're going to be talking about a lot of what you're seeing through patients that are coming through. And also a special thing about the Amen clinics is they do all these brain scans so you can see like what's going on with kids that are on screens excessively and things like that. Substance abuse. But I would love if you could start off with your backstory. There's a video on the website that gives a little bit of it, but you were like a tinkerer growing up, a hands on kid. You're in Scouts, you're doing Pinewood Derby and you're always like, oh, how can I get it even up to I'm like, how can I get this better? How can I tweak? And that has kind of translated into your world of work.
- [02:06]
B
Yeah, that's exactly right. I. I can get obsessive sometimes about trying to think really, really hard about how to optimize the health of people's brains. And one of the reasons I joined Amen clinics about it's been five years now, was that when I entered the world of psychiatry, I entered it with a lot of hopes that I could enact, like, change in people. Right. And. And the human brain is the most interesting thing in the world to me. Like, the number of connections in the human brain exceed the number of stars in the universe. I mean, we're talking about the sun being one star of 100 billion in our galaxy, and our galaxy being one of 2 trillion galaxies. So this machine that is so incredibly complex, that drives every decision, every emotion, every ambition, that's what psychiatry is about. But when I started actually practicing psychiatry in a traditional setting, it became so much more about, okay, well, we talk to people, which is fantastic. I want to get to know people. But ultimately were just asking questions to get at symptoms. And then depending on the number of symptoms someone has, they get a diagnostic label and then there's a medication that might be prescribed. And that didn't satisfy that tinkering, you know, to the same degree that I hoped it would. And so the model that we follow at Amen clinics is really looking at mental health as brain health and actually taking a look at the brain and realizing that what our brain does dictates everything. And with that kind of approach, the amount of creative interventions that we can come up with to help optimize someone's brain outside of just traditional things like medication, it increases exponentially. And that has been so satisfying because that's sort of what I entered the field. That was the ambition that I. That I had entering the field to begin with. So. So I'm always trying to think about how to take awesome people and make them feel even more awesome.
- [04:24]
A
Just like the Pinewood Derby Cars.
- [04:26]
B
Just like the Pinewood Derby Cars. Turns out brains are a little bit more complicated than Pinewood Derby Cars, but it's cool. It's. It's, you know, same principles.
- [04:36]
A
I love that connection to childhood. That's really hands on and just about making things as good as they can possibly be. So one of the uni aspects here is that you spend more time. I'm not sure exactly how much more time, but you'll. You get more time with these patients, a Lot more. Yeah, a lot more time.
- [04:53]
B
By the. So by the time I see someone for their initial evaluation, they've already completed pages and pages of intake paperwork. They've already met with a patient outcome manager who's compiling all of that data into a narrative summary of their whole life that I get to read ahead of time. They've already done computerized testing, they've already done, most of the time, brain scans, and I get to see all that information before I even meet the person, and then I have two hours with the person. So if you compare that to the traditional model, which is sometimes like 15 minutes, you can't possibly begin to understand what someone's brain is doing in 15 minutes. So time is, is of the essence. Yeah.
- [05:41]
A
What would you say that in the, in the other model that's so much quicker? 15 minutes, 10 minutes? What kinds of things are they missing? That might be too broad of a question.
- [05:52]
B
Root cause? No, no root cause. You know, like, like, for example, let's take something really common like adhd. You can have two people sitting in front of you who both have symptoms of adhd, and each one of them could have completely different ways that their brain fires. Right? We, in our work, we talk about seven different subtypes of ADHD that you can identify based on imaging and what,
- [06:24]
A
based off of the brain scans, this brain scans will look different. Seven different types of seven different subtypes.
- [06:31]
B
And we can talk about those types if you like. And, but really, the big picture point there is you can have on the surface what looks like ADHD in both cases, but underneath the surface, it's a totally different pattern of brain firing that's leading to the symptoms, which means the interventions that are going to work are different for those two people. This is why a lot of people with adhd, they'll go in for a quick assessment, maybe they'll get prescribed a stimulant like Ritalin or Adderall, and many will see improvement, but many won't, right? Many will feel worse on the medication, and then they get caught into this cycle of, well, let's try a different stimulant, let's try a different. Let's try a different one. And it just doesn't go anywhere. And the reason is all along, the wrong thing is being treated. And so that's an example of why spending more time pays off. Because if you're just going off a quick and dirty assessment just off of symptoms you miss so much. And that's not just adhd, that's depression. You can look at two brains that are depressed, and one might be associated with, you know, an overactive thalamus, a part of the brain that tends to fire really, really hot when someone's depressed. And then someone else, you might look at their brain scan and their brain just looks completely toxic, like, so unhealthy. And maybe there's some underlying reason for that that's contributing to the depression. And so throwing an antidepressant at that person is probably not going to be the solution.
- [08:08]
A
Isn't that interesting? So you spend this extra time at the front end, and then you're able to really help them. So in the long term, I would imagine, probably it saves time. It certainly saves quality of life. So let's stick with this example of ADHD, because you say there's these seven subtypes. Subtypes. And I've read a bunch of Dr. Amen's books where he'll show. I never thought about it before. You know, you never think about, like, what does my brain actually look like? But when you see the pictures of the scans and in his, you know, some of his books will have, like, his mom, his grandma, and, you know, some of these people are older, and you can really tell, like, even if you have no basis, no history, no education, you can tell, like, that one looks more supple, it's more full, you know, that one's grayer. It looks like it's decaying. It looks brittle. So you can actually see a difference in the scans. So if a child comes in and they have these ADHD symptoms, what, just an example or two, not all seven subtypes, but, like, what might you see in a brain that shows it's one side subtype versus a different one?
- [09:08]
B
Absolutely. Well, I'll give you an example of, like, two different extremes of within the seven different subtypes. So the classic pattern with ADHD is reduced activity in the prefrontal cortex, which is. Here's. Here's my little brain model. The very front of the brain, right behind the forehead, that's the prefrontal cortex. And that is the part of the brain that is responsible for things like focus, decision making, planning, organization, impulse control. And that part of the brain runs on dopamine. And so in a classic ADHD scan, what you might see would be reduced activity in this part of the brain. And on a brain scan that we do, that will show up as what looks like potentially even holes that are there. Those aren't real holes. Right. So the type of scan we used is called a SPECT scan. And it's looking at blood flow in the brain. And blood flow tells you about activity level. So when you see low blood flow, that's low activity. So that type of adhd, where you see low activity in the prefrontal cortex, might respond really, really well to interventions that boost blood flow to the prefrontal cortex, that boost dopamine. And there's all sorts of things that help with that, from certain supplements to lifestyle changes to neurofeedback, to even medication options if needed. So that's one type. Another type of ADHD that we see not uncommonly in kids is called Ring of Fire adhd. Very dramatic name. And in that scan, the surface scan, the prefrontal cortex actually looks good. You know, you look at that prefrontal cortex and it looks, as you said earlier, supple, right? You don't see holes there. But when you look at blood flow and activity much deeper in the brain, in that person, what you see is a wildfire of activity. You see, you see basically multiple areas where blood flow is significantly higher than you would anticipate, which you can conceptually think of as background noise. So for that individual, their prefrontal cortex by itself looks okay, but their prefrontal cortex is trying to operate next to rush hour freeway traffic, okay? And so effectively, it drowns out the prefrontal cortex's ability to do its thing, and you'll see ADHD symptoms. But now what happens if you put that kid on a stimulant? It usually doesn't go well, right? It usually doesn't go well. Usually that's the kid who is having even more behavioral issues, or they're feeling jittery, they're not eating, they're not sleeping, or sometimes the other extreme, they look almost like they've become a zombie, and it's because it's the wrong fit. And so those are two of the seven types, the classic type. And then Ring of Fire. And again, on the surface, the person can look similar. Underneath the surface, totally different root cause.
- [12:22]
A
Whoa, that's life changing. It's life changing. Do you find that the parents are so relieved to. I mean, that would be such helpful information as a parent to understand which subtype is it?
- [12:34]
B
100%. And the average person that we see at Amen Clinics has seen anywhere from three to four psychiatrists in the past and has been on anywhere from four to five medication trials in the past. And usually they're sick and tired of things not working. And when you actually know what you're treating, the number of times I've had parents or patients cry when they see their brain or their child's brain and finally understand, wow, this is where it's coming from. It's, it's so, it's so powerful. And, and then, and then the outcomes really speak for themselves, right? And that's what it's all about. It's about helping people tap into their best self.
- [13:26]
A
I can imagine, I can imagine the parent that would be so overwhelmed in a good way, because normally, you know, they're feeling rushed, they're feeling dismissed, they're feeling like nobody hears them, it's not working. And then what a different experience they come and they have and they, and they, and they can find out what exactly is going on and so that they can really help their child. So often you've got parents like you talked about, this might be their fourth provider that they've come to their fifth. So you're finding people often in really hard spots, like this is a low spot in their life, one of maybe the hardest moments of their life. They're trying to help their child. Can you talk about what you found over the past amount of time that you've been in your practice, like about what kids are carrying today? Does it feel like it's more, you know, they're having to hold more than maybe they used to?
- [14:12]
B
Oh, so much more. So much more. And really, I think that that has to do with the fact, you know, in part, that technology is evolving much faster than the human brain is. And so if you think about what kids nowadays are up against compared to when you and I were kids, we've got the advent of social media. And, you know, there can be good things about social media. It can promote connection, but it can also promote a very, very false impression of how our life stacks up compared to others. Because when people are posting on social media, as we all know, they're usually posting the highlights. And when we go to social media to consume content, it's usually when we're bored or maybe not in a particularly exciting moment in our life. And this constant comparison is so much even for an adult brain to manage, much less a kid. The other thing is, screens are really, if you think about it, they are dopamine dumping grounds. Okay. And what I mean by that is when someone is engaging with technology like a video game or social media or short form content, the brain is releasing so much dopamine. And by design, right, like people who create these programs and these apps are wanting people to be glued to them, right? There's lawsuits that are out in the open right now about this very topic. And we only have so much dopamine in our brain at any given time. And when we dump it all, it means that we don't have any left for other things. And so what does that look like? It looks like a kid who's engaging with a screen, they dump all their dopamine, and now it's time to do homework, let's say. But they don't have any dopamine left. And so it's that much harder to be able to walk in and focus. And also, there's an emptiness that comes with that, because dopamine, it's not just the focus chemical. It's. It's a happiness chemical. Right. And so at the end of a session of being on your phone for two hours, how does a person typically feel?
- [16:31]
A
You feel totally empty. Any of it. Netflix binge, you know, like video games.
- [16:39]
B
Wow. And when you're in it, it feels really hard to pull yourself out of it because of how addicting it is. And we can talk about how that shows up in a brain, but then when you're done with it, it's like, what did I. What did I just do? And, and, and I don't, you know, I don't feel happier. I feel unfulfilled.
- [16:57]
A
Right.
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B
And. And kids are having to deal with that much more commonly than they were, you know, 20, 30 years ago.
- [17:07]
A
Absolutely. Because all there was was Saturday morning cartoons.
- [17:11]
B
Exactly.
- [17:12]
A
There wasn't much else. So this. This is an opportunity to feel this empty void, but you're still drawn to it. And you can't pull yourself out every single day, all day.
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B
Saturday morning cartoons that were only on at a certain time. Right.
- [17:25]
A
That.
- [17:26]
B
That you couldn't stream on demand. Right. That you couldn't log into a Netflix account and catch up on, you know, it was like, that's the time. And really what I advise my patients to do and parents to do is technology is not going anywhere. Right. Like, I mean, it's here, but how we consume it is what matters. And I think we have to sort of go back to that concept of Saturday morning cartoons where there's a defined period where we consume content, and then outside of that, we're doing other things. Right. Like, yeah.
- [18:04]
A
Being outside Pinewood Derby Cars.
- [18:06]
B
Like Pinewood Derby cars. Exactly. And I mentioned that this, you know, technology, video game, social media really hijacks brain circuitry, and you can actually see it in a brain scan. I. If I'm looking at two scans and you tell me that one of them is addicted to video games, and the other is addicted to. To methamphetamine. I wouldn't easily be able to tell you which one was which. And the reason is that it's the same reward circuitry that gets hijacked with both. So if you want to go into the nitty gritty, there's a part of the brain called the basal ganglia, and it's deep inside the brain, and within the basal ganglia, there's this little part of it called. The name doesn't matter, but it's the nucleus accumbens, and its job is to release dopamine whenever we do something that feels good. So we do that thing. Dopamine gets released. The rest of our brain says, ooh, that felt nice. Let's do it again. And so we do it again and again and again and again, but each time we do it less and less and less. Dopamine gets released because our brain's getting used to it. But when we're not doing it, our dopamine level drops lower than it was before. And so pretty soon, we feel like, the only thing that makes me happy is to do the thing right, play the video game, use the substance. And when we're not doing it, we feel even worse than ever before. And so the way that shows up on the scan is those basal ganglia end up looking really, really hyperactive because they are now craving dopamine stimulation. And things that normally would bring joy, that would normally bring up our dopamine a little bit, don't stand a chance because they just pale in comparison to what has hijacked it in the first place.
- [20:05]
A
What a horrendous cycle. Oh, my goodness. We have to have empathy about this for our kids.
- [20:12]
B
It's a cycle that is inescapable and inescapable when you're in it. The only. And I should clarify what I mean by that. Any activity that we engage in that gives us easy dopamine without having to work hard for it inevitably will follow the pattern that I just described, where gradually the dopamine response lessens, lessens, lessens, and we get more and more into a relative dopamine deficit. And things that used to bring us joy don't bring us joy. Anything that gives us dopamine without having to work hard for it. And the only way out of that is essentially sobriety off of the thing, you know, and. And that might be a screen that might be a drug that might be, you know, whatever, depending on the person.
- [21:04]
A
And then in time, there'll be at least some sort of a reset.
- [21:08]
B
Absolutely. Yeah. You can. You can recalibrate your dopamine systems as long as that artificial pressure of, you know, whether it's a screen or something else, has been removed and regulated. And. And then we are feeding our brain with healthy sources of dopamine, like exercise, connecting with people, eating right, sleeping well, taking on projects that require us to put in sustained effort, and then there's a payout at the end, you know, like. Like these sorts of things. Yeah.
- [21:46]
A
This is just such critical information. And I think that the brain scans. Who would have known. Who would have known whenever they started doing the brain scans? Because it was a while ago. I don't remember the exact date that I read in Dr. Amen's books, but it's not like they're new in the. He's been doing it for.
- [22:02]
B
No, no. He's been doing it for decades. Yeah.
- [22:04]
A
Yeah, for decades. Right. So I remember, I read this book. It's one of my favorite books. It's called glow kids by Dr. Nicholas Carderis, and it's about the screen hijack. I can't remember quite when it came out, but when. When it came out, he was like, lambast. People were like, these screens are not that big of a deal. You're overreacting. And he is an addiction specialist. So he was like, no, actually. And in fact, he changed his whole business model where he was helping people who are addicted to drugs and alcohol to. His whole business model is now helping people who are addicted to screens. Because there's so many realms, too. It could be pornography, it could be gambling, it could be video games, it could be social media, it could be the Internet in general. And so he comes out with this book and he gets unbased it for it. But the brain scans do not lie.
- [22:48]
B
No, you can't fake a scan. Right. And you really do. You can conceptualize screen addiction in the same way that you conceptualize any addiction. Right. There's. There's tolerance that builds up. Right. The more I do it, the more I need. There's withdrawal symptoms. I think most parents have probably had the experience where they take a screen away and their kid looks like they're in active physiologic withdrawal. They're grumpy, they're irritable. That. And it's because they are in an active state of physiologic withdrawal. And it's. It. Like I said earlier, it's the same circuitry.
- [23:29]
A
Yeah. Violent, even. That's what this Dr. Nicholas Carter would say violent even when, when the parents take away the screens. Talk about age here. So this is another thing that's different. I read a statistic recently that said the average child never watched a screen, never saw a screen. I think in this, maybe up through the 70s until age 4, and you're, you're kind of like, whoa, you know, what a revolutionary time. No screens until age 4. And now the average age that a child sees the screen is four months. So this is a, this is a massive societal change from age 4 to 4 months. And then obviously now this. There's just so much ubiquity in it. They're everywhere. You can get attachments for the stroller and that sort of thing. And similar to substance abuse, I've talked to different authors that were exposed to alcohol around age 12 or 13, and it just took them for a ride, you know, into their 30s before they really could kind of get a hold of it. How does age affect, like, the potency of some of these things, whether it's substance abuse for, you know, preteen teens, and then screens for children and teens.
- [24:40]
B
The human brain is constantly undergoing changes, and that is most active up until mid 20s, mid to late 20s for, for most people. So for the female brain development is, is very rapid until the mid-20s. For the male brain, it takes us a little bit longer. You know, it's maybe late 20s. And the prefrontal cortex, right the front of the brain, the part of the brain that we talked about that's responsible for decision making and focus, that is one of the last areas to fully develop. And so if we're introducing an artificial pressure that is affecting how the prefrontal cortex fires at a very early age, when the brain is supposed to be undergoing all sorts of changes that will affect brain development. And it worries me when, when screens are introduced that young, there's data, I mean, there's really good studies to show that if a screen, or specifically in this case social media, is introduced before the age of 12, it's associated with major, major emotional challenges in kids. And we're talking about depression, we're talking about suicidality, we're talking about externalizing behaviors, we're talking about addiction. All of these things correlate with earlier introduction of screens in general, but also specifically social media. And you know, and all that being said, I have a seven year old, I have a four year old. Have they ever seen a screen? Yes, they have. But at the same time, I'm very, very intentional about what that looks like. So first off. We avoid short form content. We try to make sure that if a screen does show up, it's educational. We try to co watch, we try to bring whatever it is that's on the screen to real life, interact about it, connect it to reality and not have it be some sort of escape. And we're also very, very diligent about limiting that amount of time and not having it be kind of like a standard, but rather something that happens every now and then.
- [27:10]
A
This is what everybody needs to know, right? Which is like what does the psychiatrist do about screens for his own kids? The one who can see the brain scans. And those are the answers. Avoid short form content because you're seeing and people can look at the books and things, but you're seeing it on a continuous basis. Like there. Oh, you can see that there's the brain, that's the kid. You know how people say sometimes like a teacher can tell, like a preschool can, teacher can tell who are the kids that have been read to a lot. You know, they can tell because they said or they like the stories and it's like, well, you could tell just by looking at someone's scan. I would imagine there's a kid that is watching a lot of short form content. There's a kid that they're not co watching, not educational. It's kind of bombarding the brain. And there are these actual changes that you can see through these brain scans. If this became really mainstream, do you think that parents would this, this is a critical component I think of parents actually making the changes that they need besides the screens. Substance abuse, is there too? Are there anything else we would change? Are there educational things we would change? You know, like the kids, they don't get much recess time. Would we change that? Would we go back textbooks and pencil and paper in schools?
- [28:27]
B
Well, I think if people were really, really dialed in to seeing how kids brains are firing nowadays, I think there'd be a few changes that we'd see. Number one, people would feel a whole lot more pressure to get kids off screens and to have kids engaging in other healthy forms of recreation like sports, being outside, other hobbies. I think the food that we serve our kids and sometimes I'll say especially at school would dramatically change. It's something that even in our own life we've worked hard with our kids schools to try to help optimize the types of foods that are offered. Because many times if you walk into a school cafe, cafeteria, the stuff that's being served is highly processed artificial ingredients, refined sugars, Lots of gluten. And that has a huge impact on brain health. There was a study that came out just last year of about 200 kids with ADHD. And the only intervention in that study was to really optimize nutrition. And by that I mean get rid of refined sugar, get rid of processed foods, ingredients you can't pronounce, and lean into a Mediterranean style diet that leans paleo. So a lot of protein, a lot of healthy fat, fruits, vegetables, whole foods, color. 70% of participants in that study had significant improvements in their ADHD symptoms. And that was the only intervention. That was the only intervention. And you can see a difference between a kid who has a really well balanced diet versus a kid who's eating mostly processed foods on their brain scan. There's a finding that we see pretty commonly called scalloping, where if you're looking at blood flow and activity along the surface of the brain, scalloping is where it almost looks like there's, there's denting everywhere. Right? Like it doesn't look supple. And the way a person with scalloping feels is they'll feel like it's hard to focus. They'll feel brain fog, they'll feel sometimes mild depression. They'll feel sort of blah overall. And one of the most common reasons I see scalping in a kid is inflammation from food.
- [30:54]
A
Oh, you know, so much goodness. It's like this is the information that everyone needs. I talked to this farmer named Joel Salatin, who I really like. He's my favorite farmer. And he grew up, I guess he was born in the 50s and so he grew up in the 60s and early 70s, and he would take his eggs. He was a farmer even back then. He take his eggs from his chickens to the school. So he'd go to elementary, middle school, whatever, and he would take his eggs and the lunch ladies would prepare them as part of the school meals. Well, I learned about, and I can't remember who I learned about it from, but it was like some sort of bill that got passed where the school could no longer subsidize the food and the food had to kind of stand alone in terms of like not, not losing profit, I guess. And so what they did was they cut the lunch ladies because that was the thing that cost the most money. And so they cut the lunch ladies and then that was like the ushering in of ultra processed foods. Because then all of a sudden it's like, well, all we need are these ovens or we'll just bring in these frozen things and so then obviously all of these huge corporations, they've got the solution. And so what I learned was that they don't even have kitchens anymore. Like, they don't even have lunch ladies as they were before, who were actually cooking food. And so a lot of times this is the only option. And I read this book recently called the Indoor the Indoor Epidemic. And he used the phrase, I was like, oh my goodness, this is so accurate. Ultra processed time. And I was like, oh my goodness. Childhood has become this mix of ultra processed food and ultra processed time. It is very processed. Like the video game has been processed through however many other people who have created it. You're not creating it out. You know, you're not taking your block of wood for your pinewood derby car and creating your own thing. You've stepped into something that someone else has processed. Wow. So you just are really seeing a 70% increase just through changing the diet. So if imaging became more mainstream, I think there would be a bigger alarm.
- [32:51]
B
I think people, people would start taking brain health more seriously. And, and again, it goes back to this idea that mental health is brain health and you can't separate the two. And a problem in psychiatry is we're not routinely looking at the brain. And so it leads us as a society to think that, well, things like ADHD or depression or addiction, well, those aren't biological conditions. Right. Like, that's something else in a different category. But in reality, all of those things are driven by the health of an organization, and that's our brain. Just like if I went to a doctor and I said I had chest pain, if the doctor didn't look at my heart, I would be very, very concerned.
- [33:44]
A
Absolutely.
- [33:45]
B
And I think when we start thinking about mental health in that manner, we start wanting to take care of the organ that controls everything. And that's optimizing brain health. And really, it's getting back to basics. It's making sure nutrition looks good. Like we talked about, it's making sure that people are getting exercise. I mean, exercise is not just about the health of our muscles. You know, it's also the health of our brain. When we're engaging in cardio, let's say our heart is pumping the freshest blood directly to our brain. Right. Like, the first branch off the aorta goes up to our brain. So that means our brain is getting really, really good oxygenated blood, which is fantastic for brain health. Also, when we're engaging in cardio, we're naturally increasing serotonin levels. Serotonin has a calming effect for parts of the brain that are overactive and we're sweating and so we're sweating out toxins. Right. That hands down one of the best ways that a person can optimize the health of their brain, it doesn't take a ton. You know, it could be as little as 20 minutes of good higher intensity cardio even every other day for an adult and for a kid you probably want it every day. That can have substantial effects on someone's focus, someone's mood, etc and then sleep. You know, I mean I think sometimes we view sleep as something that is almost like something you have to fit in, you know, to, to your day. But we, we, I think if we were focused on brain health we'd be treating sleep more like, like a prescription, you know, more like a prescription, more like something that is just a non negotiable one. The statistic on this blows my mind. One night of bad sleep drops executive functioning the next day. So focus planet all that by 30% right. So that's a huge effect and that's a more powerful effect than medications have on boosting executive function.
- [35:49]
A
So I felt it. We were coming home from a trip recently and we got, I mean our plane got delayed or it was a whole thing. We ended up being up for about 24 hours and I was like, I can't even finish a conversation. You know, like we ended up at a kid's sports banquet because they wanted to go really bad. And I was like I haven't slept for a really long time and people are trying to talk to you and you're like I can't remember what you said six seconds ago. I mean I felt it, I felt it. And so it's all interwoven, right? The screens, kids are staying up later. School starts really early. A lot of the schoolwork is on screens in during the school day. Then they've got the ultra processed lunch. They don't have much time to run around because they've cut recess to really short periods of time. By the time you get out there, I mean you might have 18 minutes or something like that and you're probably not going to be running the whole time. So you can just see how when you're talking about these scans like in a lot of ways we're not setting up children to be super successful and, and we want them to have these habits because you brought up this is, is pliable. And I know people say like you can always change your brain your whole life but like really pliable through the 20s. So if you can set your children up with good habits in their younger years, then this is gonna really help them as they're out of your home when they graduate and go off into their own life. So this is incredibly important information. Let's talk. Can you talk about the moms? There's a lot of anxiety you had there. There was a story I found online in the Amen Clinics website where it was like. Like, you know, the mom, there's just like so much worry, and then there's a panic attack. And then, you know, this wasn't about a mom, but it was like she fought it with her fiance and what's gonna happen. And even all of that, like the digital communication where you can miscommunicate and misunderstand, and there's dating apps. And I mean, like, I didn't. I didn't have to deal with that. You know, everything was pretty much in person, but now you're like, well, what. What did they mean by that? Did they. And they liked that person's photo, but in that was the ex girlfriend. I mean, there's just so much. It's such a swirl. So a lot of times the anxiety, it's so physical, feels so physical. It can spiral really quickly. What's happening in the brain? What's happening in the body, and what are you suggesting for people to. To help that?
- [37:57]
B
Yeah, so we see a lot of anxiety. And as far as what actually changes in the brain when a person is anxious, interestingly, it's the same part of the brain we were talking about earlier with addiction, which. There's a relationship there. It's the basal ganglia. The basal ganglia, those are the addiction centers of the brain, but they're also the anxiety centers of the brain, which is why when the basal ganglia ramp up in a state of addiction, people are feeling really, really anxious when they're not doing the thing that they're addicted to. When the basal ganglia are very, very active, we feel like our nervous system is tied up in knots and it's going to look like restlessness, sometimes irritability, overwhelm, anxiety, stress. And that can be experienced emotionally and mentally, but it can also be experienced physically. Anxiety comes out in the body too. So stomach aches, headaches, feeling sweaty, clammy heart rate, elevated diarrhea, all of these are physical manifestations of anxiety. And I think some of the things that. That contribute to anxiety are people feeling a lack of control over their life and feeling like there. There is too much unknown. So the difference between fear and anxiety. Fear is, you know, A fear of something tangible that's in front of you. Right. Like, oh, I have a fear of clowns. I have a fear of height. Like, that's a thing that's right there in front of you. Anxiety is really a fear of the unknown, a fear of the. Of the intangible. And as you were alluding to earlier, there's so much more unknown in, in the day and age that we live in.
- [39:58]
A
Because, yeah, if.
- [39:59]
B
If you're cruising through social media and you see that someone liked something but then didn't like your. Or how something is communicated on a text message and you lose the nuance, what did the person mean by that? There's all of these little micro hits over the course of the day of feeling just not quite perfectly grounded and certain in what's happening lead to this buildup of anxiety. And it doesn't help when we're making constant comparisons to the highlight reel of other people's lives.
- [40:32]
A
Yeah. Yes, yes. Is. Is it a thing where you can get, this might be worded, poorly addicted to anxiety?
- [40:41]
B
Well, I think some. It's an interesting question. I. I do think that some people use anxiety unconsciously as a way to cope with underlying depression. And so here's what I mean by that. Anxiety and depression almost always go hand in hand. You know, most people who experience depression have experienced anxiety and vice versa. And the way I think of it is, let's just as a metaphor, imagine that someone is in the deep end of a pool and they're treading water. The treading of water would sort of be like anxiety, Right. That's keeping you afloat. Right. You're staying busy, you're doing things, things. And if you stop treading water, you sink into the depression. So some people will use anxiety as a way to keep going. But then the flip side of that is there are people who run so anxious for a long time that that chronic stress burns them out and they enter into a depression. So. So that. That's how I understand the kind of, on a high level, the relationship between anxiety and depression.
- [41:49]
A
Yeah, it was interesting because you talked about how they come out of the same part of the brain. And you would. You could. It makes sense that if you're in that sort of cycle of dopamine drop and you know, you need that next hit of whatever that is that. That feels like that would be anxiety producing. And that a lot of times people deal with their anxieties using addiction, and then addiction can produce more anxiety. So it just is. It becomes like this, really, this Thing that spirals. And so obviously people can get a lot of help and long term healing through what you offer at Amen clinics. And people can follow you if they're an adult on Instagram and tik tok at Dr. Steven Storage for more information that's constantly coming out. And that reminder, I think in a day and age like this, it's like we need that reminder, you know, bound in your screen time. Make sure that your kid is old enough for such and such. Think about short form content. What is this doing to their brain? Think about what you're feeding them like it actually is showing up on these scans. I'd love to talk about one last thing. I'm pretty sure you brought it up earlier, but we didn't dive deep into it. I've never talked about this and haven't read about it too much, but there's a part of the brain called the thalamus.
- [43:01]
B
Yes.
- [43:01]
A
And this is related to motivation and mood, which seem to be very important because there's a lot of failure to launch.
- [43:09]
B
Yep, that's right. So the thalamus you can think of as sort of as the emotional gatekeeper to the brain. And so on scans we'll sometimes see people who have a hyperactive thalamus. Right. A thalamus that is, that is extremely active. And the types of traits that'll tend to correlate with that will include things like a person who might be deeply feeling, a person who might be sensitive, perceptive, intuitive, all good things. And also a person who might read into things more than are actually present, a person who might have a harder time shaking off a negative emotion. And the number one symptom that correlates with an overactive thalamus is depression. And failure to launch is, is a topic that comes up frequently in our work for so many reasons. You know, one is the pace at which people are expected to develop versus whether or not that's economically possible in this day and age. And people having a harder time making a decision about what it is that they truly want to do with their life and not being able to connect what their, what their purpose and vision is to what they're actually doing. And there's, there's a lot of reasons for that. But what I find is when people are living a life where they've spent some time really thinking about what it is that they care about and aligning with that, usually that's a recipe for at least a reduction in depression and hopefully happiness and joy. We have this activity that I, that I Often have patients do called the one page miracle. And it asks people to do a deep dive into thinking about four different aspects of life. One is financial goals, and that might be more applicable to, you know, teenager and adult. Another is relationships, and that's romantic relationships, friendships, family. Another would be personal health. Right. So my physical health, my mental health, my spiritual health. And then the final thing would be work slash school. Right. And I have the person spend at least an hour thinking in as much detail as they possibly can about what they actually want in all of those different areas. And we don't often like sit down and do this. So you go into as much detail as you can thinking about what you actually want, not what you don't want. Right. You frame it as what you want and you write it all down. And then you've generated this document and that becomes your compass. Because you check in with it each day or each week and think, is my behavior and are my decisions fitting with this vision that I have for myself? If yes, you feel really good about that. And if no, it's not about beating yourself up or, you know, getting down on yourself, but it's about recalibrating. Because a big problem is we become so susceptible to the whims of the day that we lose focus on what it is that we really, really want and care about. And this is, this is a simple exercise that can help offset that.
- [46:48]
A
Yeah. And you could see that will really help with motivation. Obviously, drugs and alcohol are out. What is so interesting to me is I've got a daughter that at 16, she's playing volleyball with this like club team. It's just a bunch of kids from around the area and we homeschool. So we're in a little bit of a bubble. And she's like, mom, the kids say that every party they go to, there's drugs and alcohol. And I'm like, huh? Like there's no way. Because didn't we all go through DARE? And they were like, this is your brain on drugs. And it was like they would drop an egg into a pan. And I don't know, I read actually that DARE didn't really work, but I remember that. So now in this day and age, when you can actually see a stage scan of like what this does to the brain, and especially if you got like a 15 year old, a 16 year old. And I was like, there's no way that's true. And she said they are absolutely like positively saying that every single party they go to. So then I'm like, where Are the parents, like, not only the. And I. I'm. Where. I'm just. I don't even know. I'm kind of just like, jaw dropped. Where are the parents who own the home? Where are the drugs coming from to begin with? I have so many questions. And also, what about the parents who are sending their kids there? Like, they need to know. This is not good. I read this book, It's a lady, she talks about the Japanese way of parenting, and she was like, the top goal is that these kids have the best brain possible. I'm like, if you want to have the best brain possible, probably they shouldn't be going to parties with drugs and alcohol when they're teens.
- [48:14]
B
Yeah, well, and. And. And a big part of it, too, is the types, like the three most common substances that tend to get abused by teens. Nicotine, alcohol, cannabis. Those are ubiquitous, right? They're everywhere. It's not that hard to get. And also the method in which or the. The. The route in which people are consuming these things are, like, more convenient than ever. And specifically, I'm talking about nicotine and cannabis, which. With vapes, right? So. So with a. With a vape, you're not generating a lot of smells. You're not having to, you know, peel off and. And. And go. Go to a corner and roll something up and light something. Like, it could be done anywhere at any time, which means your brain is going to see likely more and more hits of that thing, which means that addiction cycle gets triggered that much more easily. And then I also think a lot of teens and even adults don't necessarily appreciate just how toxic these things are. We've done studies on nicotine, alcohol, and cannabis and how they affect blood flow to the brain. All three significantly drop blood flow to the brain, which means a person who's using any one of those is aging their brain faster than someone who isn't. And of the three, nicotine, alcohol, cannabis, it's actually cannabis that lowers blood flow to the brain five times faster than the other two. Whoa, that's legal?
- [49:56]
A
It's legal in Michigan, where we live, it's only been legal.
- [49:59]
B
Same in California, where I live.
- [50:01]
A
A period of time, I don't know how long, but it's everywhere, Stephen. Like, there are so many of these. You like, they have, like, these normal names, but that's what they are. So they. I'm like, obviously there's a market for it, and they have these huge buildings. I'm like, how much money are they making in there? You know, wow. Five times.
- [50:22]
B
Five times. Faster. Yeah. And, and that's not something that is mainstream knowledge. I think a lot of people think of cannabis as being sort of in a different category because it's a plant. But, but this is not, this is not a benign substance. And, and it definitely is having an impact on brain health.
- [50:43]
A
I hope that everybody listening has just increased their resolve to pay attention not only to your own brain health, but really for your children. Are we engaging in practices that if we came in and put them on a scan and that, you know, someone would say, yeah, you're doing a good job here with your kids and their brain health. And I really appreciate the time that you spent to explain all of this and to talk about how serious it is and that it's just very apparent. And also that this is a better model too, if you are struggling to make sure that you're getting some good quality care, if you can, so that there's a little bit more in depth looking into what's going on. Because maybe there's different invention interventions than the ones you've been told and they could help more. So they. So I'm so honored to get a chance to talk with you. Your work is exceptional. I'll make sure. I'll put the links in the show notes so people can find you online. You, they can find you at Amen clinics. I'll put the link there. And then also on TikTok and on Instagram, we always end our show with the same question. What's a favorite memory from your childhood that was outside.
- [51:42]
B
Oh, favorite memory, childhood outside. Okay. There's a few that come to mind. I'm going to go with climbing up some of the. The stones of the pyramids in. In Giza. I actually, I actually was born in Egypt. I'm half Egyptian. And we'd go to the pyramids from time to time. And now I think it's probably much harder to actually be able to get onto one of those stones. But climbing up a couple and just appreciating just how vast that pyramid was in front of me and just feeling very small, small in comparison. That just for some reason stands out right now as the first thing that came to mind. I haven't thought about that one in a while.
- [52:25]
A
Incredible. No one else has given that answer. That is you and you alone, Dr. Steven Storage. Thank you so much for being here.
- [52:31]
B
It was so good talking with you. You're such a great interviewer and I love your energy. Thanks, Jenny. Nice to meet you.