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Unpacking Brain Health

What is Brain Health?



Clouds I. Watercolor on paper. Discovery Bay, Hong Kong. April 2020.

My definition of Brain Health encompasses our current experience of how well our brains are working, as well as protection against brain aging diseases like dementia. And the Brain Health movement is about promoting more dialogue around how to reduce brain damage, including both physical and emotional kinds of injuries.


We don’t really have a home for Brain Health in our healthcare systems. We have memory care centers to help diagnose and manage patients suspected of having dementia. But the waitlists for such specialty clinics range from months to even years, because there are relatively few neurologists, geriatricians, and/or psychiatrists who practice in this space. And so more and more patients end up seeing their primary care providers, who may or may not feel comfortable handling such care. The reality is that existing resources are woefully inadequate to meet the growing demand for such care, as our populations age in developing countries.


My friend and former colleague Dr Barak Gaster has been championing an effort to arm primary care providers with tools for diagnosing and addressing the needs of patients and families who are faced with questions of what is normal aging when it comes to cognition. His Cognition in Primary Care program is one of many grassroots efforts to provide education for both professionals and the public dealing with brain aging conditions.


Turns out that we still have very limited therapeutic options, but the good news is that there is strong evidence in favour of lifestyle measures when it comes to improving and protecting the brain. The paradox is that both physicians and the public consistently underrate lifestyle interventions while simultaneously overrating pharmaceutical and technological options, when it comes to treatment.


Brain Health encompasses our experience of how well our brains are working, as well as protection against dementia

Our modern society has come to discount the examples of lifestyle change that we see in friends or family, like when someone quits smoking or loses weight on their own. We minimize that individual’s effort and perhaps even the impact that they have had on their health, preferring instead to glamourize pills or surgery. After all, it is human nature to desire the quick and easy fix.


Luckily, when it comes to Brain Health, it all helps. Lifestyle interventions like sleep and exercise are the most impactful behaviors to target, but weight loss and tobacco cessation can also be very helpful. We don’t yet have an effective medicine for treating dementia, but there are many actions that we can take to protect and nurture our brain health.


Our miraculous brains


Our brains house the everyday miracle of our human minds, which comprise our memories, our stories, our experiences, our connections, and our very identities. And yet our brains are incredibly fragile. Knowing this, Nature has intentionally designed multiple layers of protection for our brains, including the strong bony skull, the bath of shock-absorbing cerebrospinal fluid, and even the blood-brain-barrier layer to keep out harmful molecules.


And while all of these defensive mechanisms are important, it turns out that our minds are our most powerful weapon when it comes to defending against brain aging diseases. The problem is that our minds can be a double-edged sword. What I mean is that we rely on our minds to make decisions about wearing bicycle helmets, and when to go to bed. Which means that we can also decide that we are too lazy to wear a helmet today, or that we feel like staying up late, just as easily as we can choose to practice brain-healthy behaviours.


When I was in medical school in the 1980s, neuroscientists didn’t believe that our brains were capable of regenerating or healing after injury. But we have realized in recent years that brains not only have the capacity to remodel and heal, but that they have the remarkable ability to adapt and even to grow. For example, we have seen that patients who lose their vision will develop improved hearing and tactile sensitivity. The body compensates for injuries or disabilities by forming new neural pathways to provide more sensory input, in a process called neuroplasticity.



Quantum Body. Pen and ink on paper. Discovery Bay, Hong Kong. March 2020.

As a doctor, I have been consistently amazed by our bodies’ self-healing powers. Medicines can alleviate symptoms and sometimes help to combat infection or inflammation, but most of the time the body does an amazing job of healing itself. Of course healing processes aren’t always perfect, and bodily injuries do leave scars and/or deformities. Dementia and other brain aging processes appear to result from cumulative injuries to the brain over the lifespan, and/or abnormal healing responses.


Physical injuries


We didn’t used to think much of minor head injuries or concussions in sports, but then neither did we have to wear seatbelts in the car. Nowadays we have come to see that any head trauma must be treated carefully, both in healing brain contusion or damage, but also to avoid compounding the injury. Emerging research is also showing us mechanisms whereby neurodegenerative diseases like Alzheimer’s and Parkinson’s are triggered by repeated traumatic brain injury.



Photo by Johann Walter Bantz on Unsplash


Stroke is perhaps the next most damaging or physical injuries. Strokes are also known as “brain attacks,” because they are caused by the same mechanism as heart attacks, where an artery gets completely blocked off by a blood clot and brain tissue dies off because it is starved of oxygen. We tend to think of atherosclerotic plaques as forming in the heart or coronary arteries, but the exact same clogging process is going on in our brain arteries as well.


Major strokes can be devastating, causing paralysis and speechlessness, but minor strokes and microscopic brain injury can accumulate over years, eventually causing vascular dementia. We will often hear from brain experts that what’s good for the heart is good for the brain, meaning that we benefit that brain through heart healthy practices like controlling blood pressure, cholesterol and blood sugar, as well as exercise and nutrition.



Photo by Gijs Coolen on Unsplash


Exposure to toxins like tobacco and alcohol also cause cumulative physical injury to our brains over time. Even certain foods and excess sugar cause inflammation and oxidative stress at the molecular level, leading to microscopic injury in many bodily tissues including the brain. So dementia prevention recommendations will typically also list tobacco cessation, moderation of alcohol intake, and avoidance of excess sugar.

Emotional injuries


Our brains also sustain cumulative emotional injuries over our lifetimes. Examples of major emotional injuries include: loss of a loved one, divorce, losing a job, abuse or assault. But minor or “little T” emotional traumas begin in infancy with the stress of birth and accrue even in those of us with the happiest of upbringings.


We are taught right from wrong by our parents, teachers, and other adults in our lives, based on their values and often with the best of intentions. And then we learn from our peers (siblings and other children) what’s actually cool or not cool. These are just a few of the sources of societal conditioning that we are exposed to as children. So what we learn in terms of how to behave tends to be based on how our immature childhood brains have assimilated these often conflicting bits of information.



Milly the gremlin. Adobe Draw, Discovery Bay 2021


Before we have even finished grade school, most of us will have developed a strong inner critic, or even drill sargeant, that tends to be pretty harsh. Mine is called Milly, and she has been responsible for a huge amount of stress in my life. She can also take a lot of credit for getting me through college, medical school and residency, so there was a time in my life when I really did rely on her to crack the whip.


Our brains sustain cumulative injuries in the form of emotional trauma

But I’m realizing now that she has probably caused me quite a lot of unnecessary stress, or emotional brain injury, as well. Milly used to make me think that I needed her to beat up on me, or I would just be a lazy slug, but I’ve been pleasantly surprised to learn that practicing self compassion engenders much higher levels of creativity and productivity than I could have imagined. I’ve learned through self-coaching that I am more sustainably motivated to consistently do my best when Milly is helping me to “mom my brain” with kindness.


Healing our brains


So I do what I can to protect my brain against further injuries, and try to help it to heal as much as possible on a daily basis. I know that there is definitely nothing in my doctor’s toolkit that can help my brain to heal itself as well as daily exercise, good nutrition and excellent sleep. And what’s interesting is that even though I preach these fundamentals to anyone who will listen, my own mind will find all kinds of obstacles to me personally putting my own advice into practice.


My brain is my most valuable and powerful asset

My most common excuse has to do with time scarcity - there is simply too much to do and not enough hours in the day to do it all. One of the tricks that seems to work best is when I reframe self-care as being brain care. For some reason, the term self-care tends to conjure up the image of bubble baths and scented candles in my mind. But when I tell myself that I’m taking care of my brain, I’m reminded of the fact that it’s important not only to me, but also to my kids, that I am healthy of mind and body at my 100th birthday party. So of course I will take care of myself and my brain, so I can stay independent and thus avoid the possibility of becoming a burden for them in my old age.


I’ve come to see that taking care of my brain comes down to making healthy choices through mind mastery. This means:

  • Designing and creating consistency in my daily health habits

  • Maintaining mindset dexterity to manage the obstacles that my mind will inevitably come up with

  • Cultivating the emotional energy needed to keep me motivated and on track..


My brain is my most valuable and powerful asset, and so caring for it deserves my mind’s best effort. No excuses.









 


Resources:


Website



Well-researched and informative site with pragmatic tips for families and caregivers who may be dealing with issues related to memory loss.




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