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Brain Health Multipliers

Updated: Jun 1, 2023

Flourish and whimsy. Pen and ink on paper. Discovery Bay 2022.

When it comes to brain health and dementia prevention, there are no one-size- fits-all protocols. We each get to design our own brain care protocols to address our individual needs and preferences.

What’s a health multiplier?

The funny thing is that when I first learned that I could be responsible for my own brain care protocol, I felt overwhelmed. Instead of seeing this as a kind of freedom to choose, my brain immediately wanted to tell me how there was no way that I would get this “right,” and for sure I would fail at taking care of my own brain. After all, don’t we all just want to be told what to do?

It was kind of like when the nurse at the hospital handed me my newborn baby and told me I could go home. I was like, “Wait, you don’t understand! I’ve never done this before - I have no idea what I’m doing!” And when she only smiled and sent me on my way, I had no choice but to do what any doctor-still-in-training would do, I got busy reading everything I could about parenting an infant. This was back in the days before wikipedia, Youtube, or even the internet.

Health multipliers are choices we make that have huge and multiple impacts on our lives

I realize now that it was okay that I didn’t trust myself to know what to do, nor even to figure out how to do anything. I had no idea that I would stand adamantly against my mom’s well-intended admonishments to feed with baby formula. She firmly believed that formula was the modern scientific breakthrough that had allowed my brother and I to grow into a robust healthy adult.

Dr Em personal archives

And for the first time in 26 years, I found myself turning a deaf ear to a mother that I feared, even more than I loved. Despite an extremely rough first 3 months, when I wanted to quit every single day, my firstborn and I made it through his first year of life on breast milk. And today he is a robust and healthy adult, and I am forever grateful for all the lessons he has taught me along the way.

Health multipliers are choices we make that have huge and multiple impacts on our lives. Breastfeeding boosts our childrens’ immune systems, brain function, and promotes bonding - something that proved to be a lifesaver for me as I navigated my senior year of internal medicine residency with a newborn. Breastfeeding further protects mothers against breast and ovarian cancer, heart disease, and diabetes. Breast milk doesn’t always works out for new moms, but it’s a good example of a health multiplier when it does.

Physical brain multipliers

I like to group brain health multipliers into three categories: physical, mental and purpose. Our highest impact multipliers for physical brain health are also the three components of the Daily Essentials Matrix, i.e. Move, Sleep, and Eat.

Physical Brain Health MultipliersTM

Movement benefits our brains through many different mechanisms, whether we do it in the course of our daily lives (e.g. gardening), or as a specific activity (e.g. walking on a treadmill). Resistance training builds lean muscle mass and shifts our metabolism favorably, while aerobic exercise strengthens our cardiovascular system, which benefits the heart as well as the brain. When we are exercising, we improve our perfusion and efficiency of oxygen delivery to the brain, as well as boosting brain chemicals like endorphins and brain-derived neurotrophic factor (BDNF).

Exercise further improves brain health by regulating our circadian rhythms, thereby improving sleep. And here’s where our multipliers can overlap to achieve synergistic effects. Sleep is proving to be one of the hardest habits for most of us to shift, even though it’s absolutely crucial both for Alzheimer’s prevention and current cognitive function. I never used to think that sleep and nutrition were related, but there is growing evidence for the notion that our hunger cues and even glucose management are affected by sleep.

Mental health multipliers

When reading about brain health, I often see this term “stress management,” which I find vague and unhelpful at best. For example, we are taught to believe that spending time with friends and family reduces stress. But as an introvert who spends a lot of time with others most days, it’s actually more restful for me to spend some time alone when I want to destress.

Stress Performance Curve TM

I like to think of stress as being neither exclusively good nor bad, but rather as a kind of balance between excitement and fear. We are motivated by excitement, and we can often handle the healthy dose of anxiety that rides along. In fact, some of us pay good money for the hair-raising experience of those steep drops on a rollercoaster, while others prefer to get their dopamine/adrenaline thrills through playing action video games.

So a little stress in controlled settings is okay - I call that the optimum zone of stress. But when stress builds up day after day, we end up overtaxing our bodies’ stress response and marinating in a toxic cocktail of stress hormones.

I find the term “stress management” to be vague and unhelpful at best

As humans living in this modern age, it’s actually impossible to avoid stress, so we have ways to help us to cope with stress. The question is whether these stress coping tools actually help or hurt us over the longer term. For example, many of us use work as a way to escape relationship difficulties or other life stresses, and overwork can be considered to be a socially acceptable or even admirable trait these days. But over the longer term, neglecting relationships and self care can compound stress on the brain.

Healthier approaches to stress management can look like connecting with friends, or spending time alone meditating, depending on our personal proclivities. Some may enjoy spending time in nature, while others prefer to engage in mindful creative activities like music or art.

Stress Coping and Cleaning ToolsTM

We can further modify our experience of stressful events in our lives by proactively engaging in practices that proactively shift mindset and cultivate healthy emotional energy. I like to think of this approach as the mental health equivalent of dental hygiene, with cleaning tools that may comprise talking with loved ones, journaling or self-coaching.

The good news is that while our physical brains are fragile and prone to injury, we can harness the extraordinary power of our supercomputer minds to protect, rather than allowing our default thoughts and feelings to create more stress.


The third set of multipliers when it comes to brain health have to do with purpose in life, which has been proven to improve our cognitive reserve. Cognitive reserve is a term that describes efficiency and resiliency in neural connections despite physical disease. It turns out that our brains can accumulate signs of Alzheimer’s disease in the brain tissue (i.e amyloid beta or tau), without necessarily manifesting signs of cognitive decline. It’s not clear how this works, but neuroplasticity is believed to play a major role.

Purpose Brain Health MultipliersTM

So if we want to build neuroplasticity, how do we go about doing so? Purpose can further be subdivided in three components, namely Meaning, Connection and Challenge. Studies of elders in the Blue Zones have shown that those with healthy brains continue to find meaning and purpose to their lives, to challenge themselves to learn new things, and to connect with others regularly.

I used to play games like sudoku or use a game app to challenge my brains, but I’ve learned that it’s important to find meaning in these kinds of cognitively challenging activities. Like, maybe finding it meaningful to engage with others in playing mahjong. And it’s also a good idea to stimulate many parts of the brain at the same time, for example learning to play a musical instrument, or to speak a foreign language.

There is definitely considerable overlap between purpose and mental health, as we are clearly engaged in neuroplasticity when we engage in reprogramming our societal or even generational beliefs. I encourage you to continue to find ways to engage and stimulate your beautifully complex and diverse mind in all the ways that humans do, right up to your 100th birthday party and beyond.

Dr Em coaching tips

Take a few minutes to study the Brain Health Multipliers image, paying specific attention to the areas where the 3 big circles overlap: Habits, Action, Growth.

What are you noticing - is anything pulling your attention, that you may want to learn more about? Perhaps there is a segment that makes you feel a tiny bit curious or even excited, and others that feel like an energy drain.

Take a few moments to jot down what is coming up for you, good or bad. And then use this as a journal prompt, the next time you are writing or planning.


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