Josh: [00:00:00] Okay, well welcome to another episode of the Better Brain Fitness podcast. Once again, I’m joined by my co-host, Dr. Tommy Wood. Hello, Tommy. Hello. So, as I mentioned in the introductory episode, the main format of the show will be us trying our best to answer questions from you. So that said, if you have a question for us or if something pops into your mind as you’re listening to this or any episode, please feel free to send it our way.
There is a link in the show description where you can do that or you can also go directly to brainjo.academy/question and you’ll see an option to send it there as well. . We’ve already gotten a lot of excellent questions from you folks, and the one that we have chosen for today’s episode, which seems appropriate one to start with comes from Margie, who sent hers by audio message, and here it is.[00:01:00]
Okay, so excellent question, Margie, and I am going to attempt to do my best to answer it. Um, this question of what is health in this case, what is brain health is something that people have wrestled with since the dawn of time. Um, and, uh, and my answer here will benefit from many of those efforts. So, um, wish me luck, Tommy
Tommy: I’m glad that you are taking this one. .
Josh: You know, it’s one of those words. I mean, some of, some of the most common things that we talk about are words we use are often the hardest to define. You know, it’s almost, it’s like what is love? Or, you know, something like that. So I think that many of us, whether we realize it or not, are inclined to think about health as the absence of disease.
And our ideas about it I think have been influenced a lot by our healthcare. , which has the word health in it. Um, but as our good friend, Dan Pardi likes to point [00:02:00] out the more accurate name for it is a sick care system. And that’s not intended to be derogatory in any way. It’s just meant to be an accurate term for what it is.
It’s a place where we go to get help when we’re sick. It’s not a place to go to get healthier. Um, though I think many might conceive of it that way. It’s really a system designed to diagnose and treat disease or illness. But I think that, our, , association with health and the healthcare system has really shaped how many people think about it.
And I think it also may be part of the reason why we aren’t healthier as a population, because on some level, We’ve outsourced promoting health to that system when it’s not really what it does. So as we’re trying to define this concept, I think it’s actually helpful to think about what happens when you go see a doctor.
So if we’re talking about the brain, in this case, that would be a neurologist, and I happen to have a little bit of experience with such things. So, [00:03:00] When I’m performing a neurological examination, what I’m primarily trying to do is to detect signs of a disease, and I’m doing so by assessing how well the brain is performing in that moment.
Meaning is the brain doing all of the things that it’s supposed to be doing? . So what is, what are the sorts of things that our brain is responsible for? Well, it’s, it’s regulates homeostasis, meaning maintaining stable conditions inside the body. It does that by controlling the sympathetic nervous system, the endocrine system, our behavior.
It’s responsible for controlling all of our movements, all of our reflexes. It’s responsible for our simple perceptual abilities, like vision, hearing, taste, touch, et cetera. And then, of course, it’s responsible for all of cognition, which in neurology we refer to as your higher cortical functions. So things like language, your complex perceptual abilities, your complex motor skills.
So the typical neurological exam is designed [00:04:00] to test all of those things and to see if the brain is performing normally in that moment. But the important thing to note is that we’re assessing performance when the brain is not under any kind of stress. . So, because what we’re doing, as I mentioned, is we’re looking for signs of disease and really the hallmark of a disease process is an organ system or organ not being able to perform as it’s supposed to under ordinary conditions.
Now, would we think that, would we equate that with being healthy again? We might be inclined to think that being told by a doctor that everything is normal means that you’re. . But I think for most people, that conception of health would fall short. And I think th that is the critical point to understand for this conversation about what health is, what brain health is, and that is that our overall health isn’t reflected by whether [00:05:00] we perform well in ordinary, everyday conditions.
But rather it’s the range of conditions under which we can still perform well. So if we think about our cardiovascular system, like our heart and lungs, in the absence of any disease, we should all be able to perform well under the demands of ordinary life. Which really just requires walking and moving around to do our normal daily activities.
Yet one person who could do all that may also be only able to walk a mile without having to rest, whereas another person might be able to jog for 30 miles before they have to rest. So the latter person’s cardiovascular system can continue to perform well under a much wider range of conditions. And I think anyone would agree that we’d view that person’s cardiovascular system as being.
Yet neither of those individuals has a disease of any kind. So in this definition, health is a continuum. The greater the range of conditions under which you can maintain [00:06:00] performance, the healthier you are. And this applies to physical and cognitive health, or body and brain health. So you have one end of the spectrum, which is full.
And as we move down the spectrum, we can ultimately reach the point of what we’d call frailty. And frailty is really a narrowing of the conditions under which we can still perform normally. So in that situation, even very minor stressors will lead to that particular system breaking down to the point where that can be life life-threatening.
So, for example, in someone who is physically frail, things like a hip fracture or pneumonia can be life threatening because there’s no extra capacity in the system. Those stressors are enough to tip things over the edge so the body can no longer perform its basic life sustaining functions. Whereas someone who is in good health, you know, far from the frail end of the spectrum, they can easily recover and those things aren’t going to be life-threatening [00:07:00] because again, there’s a much wider range of conditions under which they can perform.
And the exact same thing is true, I think, of someone who is cognitive, cognitively frail, which is a term we used in the, in the paper we discussed in the lapse episode. So someone who is cognitively frail or who has poor brain health, and again, we’re not talking about someone with dementia because in that situation, they’ve reached a clinical diagnosis, meaning they can no longer maintain function in the course of ordinary life.
In the cognitively frail a minor stress, just like in the physically frail causes a breakdown in the brain’s ability to perform its function. And we see this in the form of delirium. So for example, the stress of a relatively simple infection in someone who is cognitively frail can cause brain for performance to completely break down.
And the classic example, is the urinary tract infection. So that, and medications are the most [00:08:00] common cause of delirium in an older person. Since older people are more likely to be cognitively frail. So, In the case of an infection in the bladder, in a cognitively frail person, you see complete breakdown in brain performance.
So conceptual abilities, breakdown. They can’t organize thoughts, they can’t keep track of time, they can’t communicate coherently. There’s breakdown of perceptual abilities. They hallucinate, see things that aren’t there, hear things that aren’t there, they feel things crawling in their skins that aren’t there.
They have illusions and distortions and. They, there’s a breakdown in complex motor skills. Yeah. Dressing themselves, feeding themselves, et cetera. So all of these sort of higher cortical functions breakdown, which is just a sign of the brain no longer being able to perform its primary functions and it is usually very dramatic and alarming, but it’s just from the brain being put in conditions where it can no longer maintain performance. And the less healthy you are the more conditions [00:09:00] under which that’s going to happen. This also happens just from being in the hospital itself, and that’s likely, largely because of disruption in circadian rhythms that happens in that setting, but that alone can cause complete breakdown in someone who is cognitively frail. And I think most of us wouldn’t even think of that as being a stressor of any kind.
But this scenario reveals that it is a kind of brain stressor, but it’s something that for someone in good health would not compromise brain performance in any way. But for someone who is in poor health, it will. And as just a PSA here, one tragedy is that it can be very hard to convince family members.
that being in the hospital is a problem in and of itself, but it’s one of the worst places for someone who is cognitively or physically frail and each day you’re there makes it harder and harder to recover from that, but people naturally, and, and, and [00:10:00] expectedly have a really hard time wrapping their minds around this idea because when brain performance completely breaks down, when you see delirium, it seems like something has catastrophically gone wrong inside the.
It’s hard to conceive that it could just be from the stress of being in the hospital, but it’s just from the brain being unable to cope with that particular stress. And oftentimes people don’t ever recover from that process. And the longer it goes, the less likely that is to happen.
This was a conversation that I would have at least once a week when I was in the hospital regularly and, uh, very, very frustrating and discouraging and, um, If you have a loved one who is frail, you only want them to be in a hospital if absolutely necessary, and for as short period of time as possible.
And hopefully this conception of health will maybe give you a better way of understanding why that’s important. So back to the topic at hand. Health is the range of conditions under which we can perform well. And so brain health [00:11:00] is the range of conditions under which the brain can still perform well.
So if our goal, if we want to be healthy in both the physical and cognitive domains, should be to maintain full health or to be as far away from frailty as we. and the way we think. The best way to do that is to build excess capacity in the system or move towards the healthier side of the continuum by improving the fitness of our body and brain.
And last point, improving health is not just important for increasing the odds of living a long life, even though it will do that, it also directly affects our quality of life. So where we are on this spectrum directly influences how we feel and how we perform each and every day. So the health of our brain is directly tied to how well we perform cognitively and our overall sense of wellbeing.
So our brain, only our brain is what generates how we feel. [00:12:00] So naturally those things are one and the same, and that’s why in my view, improving and maintaining brain health is the single best route to performing and feeling at our best to do the things we love for as long as possible, and to feel at our best for as long as possible.
So there’s my stab at Brain Health, Tommy, um, , what do you think? Anything to add there?
Tommy: I think that’s, that’s great and very much, you know, sort of encompasses the things that we talked about from the paper in the in in the last podcast. That sort of idea of trying to be, as you know, have capacity as much as possible above what you need to be able to do from, from day to day.
And so I completely agree with all of that. The only thing that I would add is that a lot of this is very individual and rather subjective, right? So it’s the capacity of your brain to operate on a, under a whole bunch of conditions that you are exposed to, that you need it to function within, in the functions that [00:13:00] you need it to function.
And so to make that a little bit clearer, we, you know, we have all these standardized tests. You may, you know, sort of try and assess how your brain functions and then you want to. to somebody else? Well, maybe that isn’t actually that useful, cuz you know, for, for sort of more concrete examples, say Josh and I sit down.
and, uh, the, the test of cognitive or brain function is how well can you play the banjo? I’m gonna have very low performance on that indicator compared to Josh. Just like if he comes and joins me in the gym and we deadlift, he’s not gonna try and compare himself to me. So we have different aspects of our performance that are important to us that, that we want to be able to function within.
So that’s the only thing that I’d want to, to sort of add to that is that it, it’s based on what do you need your brain to be able to do or want your brain to do and in what areas. And that’s, I think the sort of like the final sort of personalized aspect of, of brain health that, that you should consider rather than just [00:14:00] saying, you know, nobody’s gonna be the best at everything.
Physically impossible. So, what are the areas that are important to you and they’re all linked to like core functions in health of the brain, but you know, where you assess or test or stress, your brain is gonna be different based on where you want to perform.
Josh: That’s a really good point. So really, you know, once we’re getting into the realm of all of our cognitive capabilities, they are all individual. They are all a product of our life history. We happen to share many because we all have, we all lead very similar lives as humans, right? We have certain core capabilities, like we all speak to each other, so we all have language networks, right? So that’s one kind of universal. But then we each have our own specific sort of capabilities we’ve built up over the course of a lifetime that are, are going to be unique.
So any assessment, as you say, any assessment of an individual brain has to be individualized in some way because those capabilities, any, any set of capabilities is going to be unique to that person. And, how we assess and [00:15:00] evaluate brain performance is how are those capabilities doing.
Yeah. Um, so yeah. . Great point. You know, another thing that from this view that, that I think that emerges as I was thinking about is that you realize that health is be best measured in what we can do or how we perform. But I think we’re often inclined to think that how our tissues look on a scan or under a microscope might be the best indication right. People often think that, you know, oh, I get a brain mri, then I’ll really know how my brain’s doing. You know what I mean? . Um-huh. And really, pathology is only useful, or, you know, structural changes are only useful insofar as it’s compromising a tissue’s ability to perform its job.
Right. So if, if I have some dirt on my car’s bumper, it’s not going to impact its performance right, it’s gonna perform just fine. Yeah. Likewise, it’s ultimately about is this organ system performing well? So it’s not really about what it looks like, but what it’s capable of, which again, in this view is the, I think the truest reflection of health, those things may be correlated, may not [00:16:00] always be.
And those changes in how they look are only useful insofar as how it impacts function or performance. And I, I mentioned in the last episode, maybe one of the reasons we’ve been led so far astray with the amyloid hypothesis with Alzheimer’s is because that hypothesis, that was a hypothesis led entirely by pathology, which may or may not be material or linked to performance or performance decline in any given tissue. You can’t just assume that’s the case. One other thing I wanted to say is that again, back to the idea of the healthcare system being really a sick care system, um, designed to diagnose and treat disease, that whole period on this continuum where health is declining but you haven’t reached the point of disease, that whole period is almost entirely opaque to the system. So by and large, the tools that we have are not designed to tell you where you fall on that spectrum, but rather, whether you’ve reached the end stage of that process.
And I think part of the goal of filling [00:17:00] things like functional medicine and the set of tools there was to try to find some ways of finding out where people are on that spec spectrum. You know, at least in theory, that’s the goal of, of doing so and, and developing a toolkit for that.
But that’s largely not what the conventional medicine toolkit is about. All right, well thanks again, Margie for your question. Again, if you have any questions, uh, for us, we would love to hear from. And, uh, there is the option to send us a message through audio format if you’d like, as Margie did, and we would love for you to do that, because it’s great to hear your voice.
Again, there’s a link to where you can submit your questions in the podcast description or you can go to brain jo.academy/question. Okay. Thanks so much for listening and we will see you in the next episode. Thanks everybody.