Elephants and Brain Health
- Dr Em Wong
- 2 days ago
- 8 min read
If you’ve been following iHeal Mag for a while, you’ll know that I have a special affinity for elephants, because my childhood nickname was “little elephant” or xiao xiang 小象. And when it comes to brain health, elephants serve as a powerful mascot, because we all know that elephants never forget. As it turns out I’ve discovered a few other elephant metaphors when it comes to brain health.
Alzheimer’s research is like an elephant
When I was a medical student in the ’80s, we were taught that dementia was simply an inevitable part of aging. Some people were destined to have it worse than others, but there was nothing that could be done about it. Today, we know that that narrative is outdated and inaccurate, but the “nothing can be done” idea somehow remains stubbornly persistent in our collective thinking.
The truth is that we now know that dementia is neither normal nor inevitable. Scientists are continuing to refine techniques to develop and study potential treatments. And they have also gathered a considerable body of evidence supporting numerous strategies for protecting brain health.
The past 3 decades of intensive research has yielded considerable insights into various biological mechanisms that play important roles in potentially causing or repairing injury to our delicate neurons. More than 130 drugs are currently undergoing the US FDA drug approval process to determine which may be safe and promising enough for use in treating Alzheimer’s disease (AD).
Apart from the amyloid cascade theory, researchers have also identified a host of other mechanisms that seem to act in highly complex and interconnected ways to cause brain injury in AD. These pathways represent potential targets for treatment—for example with drugs that address neurofibrillary tau tangles, immune function, inflammation, neurotransmitter receptors, or synaptic plasticity.
Prevention trumps cure
It reminds me a bit of the Indian parable about the blind men and the elephant that goes back more than 2,ooo years. The story tells of a group of blind men who can each only touch one part of an elephant, but none can see the whole animal. The one feeling the tusk describes a sharp curved spear, another feels the trunk and believes it must be a mighty snake, yet another blind man feels the leg to be a sturdy tree trunk. The elephant serves as a metaphor for AD research in that scientists must continue to work together to figure out how to resolve the complexity and fully characterize the whole beast.
The good news is that we don’t have to sit around waiting passively for scientists to develop our future arsenal of targeted immunologic, hormonal and biological AD agents. Scientific evidence already supports many ways for us to build our brain health or resilience. That is, our brain's ability to adapt, recover, and maintain optimal function under stress, adversity, or pathology. In other words: In the world of dementia research, prevention definitely trumps cure at this particular moment in time.
Eating the brain resilience elephant
Research has shown that 45% of dementia cases are preventable by addressing modifiable risk factors. The “nothing can be done” message is not only deeply disempowering, but it actually discourages us from having conversations about brain health. After all, what’s the point of talking about something that you believe to be scary and probably inevitable?
The reality is the opposite! There’s so much that we can do to prevent dementia.
When people ask me what they can do to improve their brain health, I’m reminded of the trope about “how to eat an elephant.” (Not that anyone would want to eat one, right?) The thing is that elephants are actually so huge that you don’t even know how to begin. In this case, the elephant metaphor represents the catalog of options for what can be done to boost cognitive function, and the answer is that we eat that elephant “one bite at a time.” :)
Beginner’s awkwardness acts like Miracle-Gro for neuroplasticity
I think of that catalog of options as being like an opportunity to design our own Back-to-School curriculum. I remember that (way back when I was choosing classes in college): I was bound by certain constraints as dictated by my major and pre-med requirements. So I wasn’t allowed to take those art, music, or language classes that looked so fun.
The first 20+ years of our lives are all about going to school to acquire skills and knowledge, as well as learning how to make friends and take care of ourselves. But the later decades of our lives can be about choosing what feels the most fun, appealing, practical, and sustainable, for us personally. We are each unique in our individual preferences. Perhaps you want to take care of your grandkids, or love bonsai trees or dog shelters. Maybe travel is your thing, or you’ve secretly been too scared to try dancing—well, now is the time!
The beginner’s awkwardness that comes with learning new things acts like Miracle-Gro for neuroplasticity, supercharging our neurons to form new connections.
And it’s a bonus if you can laugh at yourself, because that boosts endorphins, as well as lowering stress hormones—like cortisol and adrenaline. So it’s up to us to keep challenging ourselves by staying curious, making and maintaining relationships, and taking care of our bodies and brains.
Modern technology is changing so quickly now that we need to constantly be jogging to keep up with the latest developments. Ours is not the first generation to be learning as much from the youth as they can from us, so our communities are well served by promoting activities that advance intergenerational interactions.
Most people either didn’t know or hadn’t been convinced that it was okay to be hopeful about brain health. They may even have intentionally tuned out dementia- related news, because it felt triggering or scary.
But it turns out that the only way to change our personal disease trajectory is by replacing the old narrative with one grounded in current science. This is what will empower us to stay abreast of new developments and fully engage in preventive practices.
In the 5 years that I’ve been writing this online magazine, brain health has begun to shift from being a total social taboo to being more mainstream. This may be in part due to the advocacy work of celebrities like Bruce Willis who bravely shared his story of early Alzheimer’s, and Chris Hemsworth who is a double-ApoE4 carrier. Other authors, actors, and artists have also been working to shift our collective consciousness to the fact that there is more dimension and nuance to ageing in general and to brain health in particular.
Ageist beliefs are the elephant in the room
Most of us don’t love the idea of getting older, because our modern societies tend to glorify youth. Ageing is associated with the progressive loss of beauty, strength, mobility, independence, and cognitive function. But what if these beliefs were just stereotypes or a societal mindset?
There is a vast range of variability in how people age. We all know elders who conform to the stereotype, and others who refute them by being exceptional.
For example, I felt such a mix of admiration and gratitude for Dr. Gladys McGarey when she attended my integrative medicine fellowship bookclub in 2023. Dr. McGarey spoke about her book The Well-Lived Life: A 102-Year-Old Doctor’s Six Secrets to Health and Happiness at Every Age, teaching us how important it was for each of us to find our own “juice.” She defined “juice” as being whatever it is that makes life worth living for us individually. For herself, it was teaching the concept of living medicine, which has to do with listening to “our physician within” for guidance on how to become physically, mentally, emotionally, and spiritually whole.
Ageism is the prejudice that we all practice against our future selves
I never used to think of myself as being ageist, but as I began to educate myself more about brain health in the context of ageing, I realized that I had internalized a lot of ageist beliefs and practices myself.
For example, I had always dismissed my birthdays and avoided telling people my age. I would laugh off my “senior moments” or technical ineptitude in handling my phone or apps. And I had even appreciated being able to use self-deprecating humour to handle such embarrassing moments.
Now, I realize I was being casually ageist against myself and other elders. By dismissing birthdays and avoiding telling people my age, I was sending a message that I was embarrassed by my age, or that I was afraid of being judged for being “too old.”
I’ve come to see that I was inadvertently reinforcing the stereotype of forgetful older folks, when I blamed lapses in memory on “senior moments” by implying that only old people forget things. And I was assuming that all elders are technically incompetent, rather than just me.
Ageism has often been called the last socially acceptable form of prejudice, and the only one that we all practice against our future selves. But I’ve learned that ageism isn’t just about unintentional microaggressions, everyday ageism has been found to affect health outcomes.
For example, older adults with self-directed ageist beliefs (e.g. thinking decline is inevitable) are less likely to engage in healthy behaviors like exercise. They tend to experience higher levels of stress as measured by cortisol and inflammatory markers, and even show faster cognitive and physical decline.
On a broader scale, structural ageism contributes to social isolation and reduced economic opportunities, both of which are linked to poorer mental and physical health. So, ageism is not just a matter of attitude—it’s a measurable public health issue that shortens lives and diminishes quality of life. This is why the World Health Organization (WHO) developed a global campaign to raise awareness about ageism and to combat ageism.
So ageist beliefs are the proverbial elephant in the room, whenever we talk or think about brain health. It’s always uncomfortably crowding the space, even when we don’t acknowledge how heavy a burden it’s become for our modern societies. There’s a lot that can be learned from traditional cultural practices that esteem ageing, as in Japan where elders are recognized each year on September 21st, “Respect for the Aged” Day. We all have a role to play in promoting intergenerational dialogue and reframing the narrative around ageing.
I don’t get to choose how long I’ll live, but I definitely don’t want to be cutting myself short by not planning proactively to be in excellent shape right up to the end. And I certainly don’t want to be living the rest of my life vaguely hoping for a cure or passively distancing myself from a feeling of dread about getting dementia.
Instead, I get to learn how to let go of ageist beliefs that are bad for my brain and to keep challenging myself to learn new things and trust myself to handle whatever comes my way.
Dr Em coaching tips
(Adapted from Dr. Becca Levy’s Breaking the Age Code)
Building awareness of your personal ageing beliefs:
- Write down the first five words or phrases that come to mind when you think of the word “ageing.” Try to do this as quickly as possible and without judgment. There are no right or wrong answers.
- Now, think of someone that you know who is over the age of 70 (this can be a celebrity or family/friend). Write down five words or phrases again with this person in mind.
- Were your responses different or the same both times? How many of your responses are negative and how many positive? Don’t worry if you had a lot of negative responses. Remember: our beliefs are malleable. Developing awareness is the first step in deciding which beliefs you choose to keep or change.
Choosing positive role models:
- Who do you want to be “when you grow up?” List at least five older people whom you admire. You may choose people you know personally or others from the world or historical figures.
- For each model, write down 1-2 qualities that you admire or find inspirational.
- Seek out stories or images of older people that you admire. Doing this can serve to balance out our collective diet of media and advertising images that feed us a constant barrage of images featuring young, slender, beautiful models.
- Tweak your media feeds or “following” content that celebrates ageing, rather than being myopically focused on youth.
Resources
1. McGarey, G. (2024). The Well-lived Life: A 102-Year-Old Doctor's Six Secrets to Health and Happiness at Every Age. New York: Atria Paperback.
2. Levy, B. (2022). Breaking the age code: how your beliefs about aging determine how long & well you live. New York: First edition. William Morrow, an imprint of HarperCollins Publishers.
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