The Human Upgrade with Dave Asprey – How to Stop Brain Fog After Anesthesia | Biohacker Tips (Ep. 1370, Nov 27, 2025)

Episode Overview

Dave Asprey welcomes Dr. Cameron Chestnut—internationally recognized facial plastic surgeon and expert in regenerative medicine and brain-safe anesthesia protocols—to explore how surgeries and anesthesia cause postoperative brain fog and how to minimize it. The discussion is a masterclass in biohacking surgical outcomes: pre- and post-op optimization, state-of-the-art anesthetics, pain management, and regenerative strategies for healing. Rich in actionable tips, this episode guides listeners on advocating for better anesthesia, healing faster, and protecting brain health during surgery.

Key Discussion Points & Insights

1. The Often-Ignored Risks of Anesthesia

• General Anesthesia & Cognitive Dysfunction
  • General anesthesia’s purpose is safety, but standard protocols (especially benzodiazepines, opioids, and propofol) contribute to postoperative cognitive dysfunction (POCD)—persistent brain fog or worse.
  • POCD disproportionately affects the elderly but can happen to anyone.
  • “It blows my mind. It’s talked about mostly in elderly populations… but it’s not isolated there. It happens to everybody.” (Dr. Chestnut, 14:10)
  • Microemboli, disrupted sleep architecture, neuroinflammation, and residual drug effects are implicated.

2. Best Practices: Pre- and Post-Op Optimization

• Pre-Surgery ‘Athlete’ Mindset & Protocols (04:34)

  • Treat surgery like an athletic event: arrive metabolically optimized, rested, with inflammation controlled and excellent sleep.
  • Functional-medicine-style labs and even genetic data guide supplementation, nutrition, and circadian prep.
  • For international patients, prepare for jetlag with melatonin and circadian syncing.
  • Preoperative hyperbaric oxygen therapy is used for oxygenation and to push patients toward parasympathetic calm.

• Nutritional Strategies

  • Patients tend to do better if they’re already mindful of diet, sleep, fasting, and anti-inflammatory practices (06:52).
  • Creatine supplementation and metabolic optimization are increasingly common.

• Post-Op Recovery Stacking (37:29)

  • Aggressive post-op care—hyperbaric oxygen, red light therapy, PEMF, tailored IVs—compresses healing time (“for every one day of that, it’s worth about three days of normal recovery in the first week” – Dr. Chestnut, 39:10).
  • Commitment is required—patients often spend 4-6 hours per day on healing activities in curated recovery homes.

3. Safer, Brain-Friendly Anesthesia Protocols

• Avoiding Traditional “Twilight” Agents

  • “Most common is a benzodiazepine and an opioid mixed together—that’s what you don’t want.” (15:45)
  • Chestnut avoids all opioids and benzodiazepines pre, during, and post-op and minimizes propofol.

• Preferred Agents: Dexmedetomidine & Ketamine (15:59)

  • Dexmedetomidine: Central alpha-2 agonist; promotes a deep sleep-like, parasympathetic state, preserves sleep architecture, avoids respiratory depression, and is non-neuroinflammatory.
  • Ketamine (low dose): Disassociative, neuroprotective, anti-inflammatory, analgesic.
  • “I supplement that with some other agents. Ketamine… is really, really neuroprotective at low dose.” (Dr. Chestnut, 16:04)

• Blocking Peripheral Pain at its Source

  • Local anesthesia at incision sites blocks pain pathways, reducing post-op pain and central sensitization.

• Music & State Management

  • Uses binaural beats (delta/theta) with noise-canceling headphones during surgery. “It’s a very calming state... and I need less anesthetic to do what I’m doing.” (Dr. Chestnut, 19:25)

4. How to Advocate for Better Anesthesia

• Practical Guidance for Patients

  • In hospitals, anesthesiologists often just aim to “keep you alive”—brain fog is rarely addressed (25:24–27:10).
  • “Let your anesthesiologist or surgeon know you’re interested in these things and ask: ‘Can I do this under light sedation or a nerve block?’” (Dr. Chestnut, 28:29)
  • Scripts: “No benzos, no opiates, no propofol if possible. Use as little as you can. I like ketamine—it’s generally good for my brain.” (Asprey, 28:29)

• Handling Pushback/Resistance

  • If doctors shame or ignore you for these requests: “There’s really two powerful words that always work: ‘You’re fired.’” (Dave, 32:02)
  • Build a relationship—angry energy reduces surgical success; bring calm, curiosity, and awareness.

• Emerging Pharma for Pain:

  • Suzetragine (2025 FDA Approval): Oral peripheral sodium channel blocker for post-op pain, safer and more targeted than opioids (31:38).

5. Regenerative Techniques & Enhancers

• Autologous (Own) Fat Transfer

  • Facial fat transfer (with stem cell-rich tissue) not only restores volume and structure but promotes regenerative healing (11:25–12:25, 75:17).

• Peptides & Hormones

  • BPC-157, thymosin beta-4, GHK-Cu, growth hormone analogs—augment healing when used mindfully (50:07–51:41).
  • Pre-op optimization of testosterone, growth hormone status (via peptides or direct) accelerates healing. “My patients that are on those things heal wonderfully.” (Dr. Chestnut, 49:57)

• IV Stacks Post-Op (46:03)

  • Glutathione, magnesium, NAD+, amino acids, and custom nutrient blends based on genetics/labs.
  • “IV glutathione, wildly beneficial when somebody is post-anesthesia. Same with NAD.” (Dr. Chestnut, 46:09)

• Ketones for Neuroprotection

  • Fasting, ketogenic diet, or exogenous ketones pre- and post-op (“neurostabilizing” and “remarkably beneficial for neuronal protection”—47:11, 47:56).
  • Used at Asprey’s 40 Years of Zen neurofeedback program for brain resilience (49:13).

• Havening, Tapping, EMDR, Mindfulness for Surgery Anxiety (35:08)

  • “Breathwork, mindfulness, havening, tapping—these are all part of our process.” (Dr. Chestnut)
  • Demonstration of havening and its trauma-soothing effects (35:24–36:36).

• Light, Environment, and Sensory Factors

  • Natural daylight used in Dr. Chestnut’s OR; soft warm lighting and environmental controls support better outcomes and sleep architecture (65:01).

6. Innovations and Rare Biohacks

• Xenon Gas Anesthesia: (40:00–41:48)

  • “It’s the lowest harm of all anesthesia agents I’ve found… all the research is from Russia.” (Asprey)
  • Super safe, zero neuroinflammation, not used in the U.S. due to cost.

• Nootropic Racetams to Protect the Brain (aniracetam, piracetam, etc.)

  • Used off-label as neuroprotectant before/after surgery; “normalize” glutamate transmission.
  • Dave: “If I was gonna get a micro blood clot, I’d rather have no neuroinflammation from it because then the damage would be exceptionally small.” (45:03)

• Nicotine (Non-Smoking) for Angiogenesis

  • “I kind of like oral nicotine because it increases angiogenesis, which is growth of new blood vessels.” (Asprey, 62:43)
  • No benefit from smoking/vaping due to vasoconstriction; patches/lozenges under 10mg/day may be net positive for recovery (63:54).
  • “Anything that increases angiogenesis is wildly beneficial.” (Dr. Chestnut, 64:25)

• Avoiding Overuse of Steroids

  • Corticosteroids post-surgery can superficially reduce swelling/inflammation but impede true tissue healing by shutting down natural repair phases—a dangerous tradeoff (67:30–69:31).
  • “Comfort is a slow death—you’re killing the results by making things more comfortable.” (Dr. Chestnut, 69:31)
  • Use adrenal support if genetically necessary (Asprey: “I take an extra 20mg cortef daily post-procedure, just to let my body have plenty.” 70:10)

• Diet & Healing

  • Carnivore over vegan for surgical recovery due to density/bioavailability of protein, essential fats, micronutrients (58:21–59:41).
  • Post-op: “I eat three pounds of ribeye every day for the first week. I have oysters, I have some liver—the body sucks it up as long as you can digest it.” (Asprey, 59:41)
  • Carbs can reduce adrenaline and cortisol post-surgery, so strict keto not always indicated during recovery.

7. Fillers and Regenerative Medicine in Facial Surgery

• Downsides of Traditional HA Fillers
  • Move unpredictably in facial tissue, lead to “puffy face,” migrate away from intended location, accumulate over years.
  • “I am removing massive amounts of hyaluronic acid filler almost every procedure I do. It’s rare that I’m not managing it.” (Dr. Chestnut, 73:38)
• Preferred Approach: Autologous Fat + Stem Cells (75:17)
  • Stays in place, boosts paracrine cell signaling, enhances local skin quality, and supports full facial recovery.

Notable Quotes & Memorable Moments

• “If you’re listening to this episode going ‘my eyes are crossing,’ play it back—there’s so much powerful information.” —Dave Asprey (31:39)
• “There’s really two powerful words that always work: ‘You’re fired.’” —Dave Asprey (32:02)
• “The reality is, you talk to your anesthesiologist and tell them that you’re calm, you’re peaceful… everyone wants you to be safe.” —Dr. Chestnut (32:16)
• “I want to be anywhere but near the wall when I go in, and when I come out. Ketones are a part of what I do there.” —Dave Asprey (49:13)
• “Comfort’s a slow death. You’re killing the results by making things more comfortable.”—Dr. Chestnut (69:31)
• “It is a curiosity… It’s the antidote to most things in life, including ignorance and boredom—just staying curious.” —Dr. Chestnut (52:52)
• “If you look at your skin after a fat transfer, you’re also going to get improvements, just from your fat pad being full of young, stem cell-rich fat.” —Dr. Chestnut (76:34)
• “If you look angry, we can fix that surgically, guys.” —Dave Asprey (80:06)

Timestamps for Critical Segments

• 04:34 – What to do before surgery: the “athlete mindset”
• 06:52 – Pre-op sleep, circadian timing, and labs
• 08:45 – Hyperbaric oxygen pre-op
• 11:25 – Fat pads and facial stem cell transfer
• 14:09 – Postoperative cognitive dysfunction explained
• 15:27/15:59 – Safer anesthesia protocols (Dexmedetomidine, Ketamine)
• 19:24 – Role of sound, binaural beats in the OR
• 28:29 – Scripting advocacy for better anesthesia
• 31:38 – Suzetragine: new peripheral painkiller (2025)
• 35:08 – Mindset, calm, and trauma hacks for anxiety and pain
• 39:10 – Post-op protocol multiplies recovery 3x faster
• 40:00 – Xenon gas anesthesia, Russia’s research
• 45:03 – Nootropic racetams for POCD
• 46:03 – IV glutathione, NAD+, custom stacks post-op
• 47:11 – Ketones for neuroprotection and fasting
• 50:07 – Testosterone, growth hormone, peptides impact on healing
• 58:21 – Carnivore vs. vegan for surgery recovery
• 65:01 – Medical lighting and environmental controls for healing
• 67:30–69:31 – Risks of “healing too fast” and overusing steroids
• 75:17 – Fat transfer vs. fillers for facial volume
• 77:15 – Laser, pharma, and the quest for non-surgical skin tightening

Conclusion: Action Steps for Listeners

If you have upcoming surgery:

• Prioritize sleep, circadian rhythm, and nutrition beforehand—prep like an athlete!
• Ask for functional labs/genetic info and optimize deficiencies.
• Use pre- and post-op biohacks (hyperbaric, red light, IVs, ketones, peptides) where possible.
• Discuss anesthesia with your doctor: request avoidance of benzos, opiates, and propofol when possible. Advocate for IV sedation with Dexmedetomidine and ketamine.
• Consider discussing nootropics (aniracetam, piracetam) with your care team for neuroprotection.
• Practice breathwork, havening, or tapping pre-surgery to mitigate anxiety and trauma encoding.
• Post-op, invest energy in recovery protocols—don’t “heal on accident.”
• Nutrition: not the time for a poor diet! Focus on high-quality protein, healthy fats, and a mindful balance of carbs for fastest healing.
• If facial rejuvenation is on your mind, autologous fat transfer with stem cell focus is superior to fillers for both look and regenerative benefits.

For More

• Connect with Dr. Cameron Chestnut: clinic5c.com | Instagram: @chestnutmd
• Explore Asprey’s deep dives on ketones, nicotine, anesthesia, and surgery prep at daveasprey.com.

This summary delivers practical takeaways and advocacy tools to ensure the healthiest—and mentally sharpest—surgical experience. The message? Demand more from your care and biohack your healing every step of the way.