Dr. Gary Steinberg: How to Improve Brain Health & Offset Neurodegeneration

Dr. Gary Steinberg (00:00:00)

• Dr. Gary Steinberg is a medical doctor, professor of neurosurgery, neurosciences, and neurology at Stanford University School of Medicine.
• He is a world expert in cerebrovascular architecture, which explains how blood flow to the brain supplies oxygen and nutrients to neurons and removes waste products.
• Blood flow to the brain is critical for brain function.
• Disruptions in blood flow, such as in stroke and aneurysm, can impact brain functioning.
• Concussions and traumatic brain injuries (TBI) are common and can have lasting effects on brain function.
• Dr. Steinberg's research focuses on using stem cells to recover function in the brain and spinal cord after concussion, TBI, stroke, and other disruptions to the cerebrovascular architecture.
• Dr. Steinberg shares science-supported tools and protocols that anyone can use to improve brain health and function.
• These tools and protocols can benefit those who have experienced brain injuries, as well as those who want to maintain or improve their brain health.

Sponsors: Eight Sleep, ROKA & AeroPress; Subscribe on YouTube, Spotify & Apple (00:01:44)

• Dr. Andrew Huberman's podcast, the Huberman Lab, provides free science-related information to the public and is separate from his teaching and research roles at Stanford.
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• Roa eyeglasses and sunglasses are designed for clarity and comfort, suitable for various activities and settings.
• The AeroPress coffee maker brews a perfect cup of coffee quickly, without bitterness, and is highly portable.
• Dr. Gary Steinberg emphasizes the importance of brain health, learning, and enjoyment for preventing neurodegeneration.
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Stroke, Hemorrhage & Blood Clot (00:06:16)

• A stroke is a disruption of blood flow to the brain, either due to a blocked vessel or a hemorrhage.
• About 87% of strokes are caused by a clot forming in the brain artery or dislodging from the heart or carotid artery.
• About 13% of strokes are caused by a hemorrhage, which is the bursting of a blood vessel.
• Lack of oxygen and glucose delivery to brain cells due to a stroke causes tissue death and disruption of neurological functions.
• Some people may have a genetic predisposition to clotting, such as heterozygosity for Factor V Leiden.
• Lifestyle factors can exacerbate clotting, such as being homozygous for Factor V Leiden.
• Deep vein thrombosis (DVT) is a Venus-side issue that can occur when not moving legs during activities like flying, but it usually doesn't travel to the brain.
• Venus-type strokes are less common and occur due to a clot in an important vein, causing blood to back up and swell in the brain.
• Strokes are generally arterial in nature, involving either blockage or bursting of a blood vessel.

Blood Clots & Risk Factors, Medications, Smoking, Cholesterol (00:10:25)

• Different types of drugs that thin the blood can predispose someone to having a larger hemorrhage.
• Aspirin is a type of antiplatelet agent that thins the blood.
• Anticoagulants are another type of drug that thins the blood.
• Oral contraceptives, especially first-generation ones, can increase the risk of developing clots.
• Modifiable risk factors for developing clots include smoking, high lipids, and hypertension.
• Smoking increases the risk of stroke due to nicotine and other chemicals produced by smoking.
• The incidence of stroke is decreasing, possibly due to decreased smoking and better management of other risk factors.
• High blood pressure is a significant risk factor for stroke.
• The higher the blood pressure, the greater the risk of stroke.
• Hypertension can damage the blood vessels in the brain, making them more susceptible to rupture and causing a stroke.
• Hypertension can also lead to the formation of blood clots, which can block blood flow to the brain and cause a stroke.
• It is essential to control blood pressure to reduce the risk of stroke.

Heart & Brain Health; Neurosurgery & Brain Function (00:16:19)

• The brain, despite its small size, is a vital organ that consumes a significant amount of the body's oxygen and blood flow.
• Neurosurgeons, like astronauts of neuroscience, gain valuable insights from each patient they operate on.
• Functional MRI scans aid in mapping the speech area before surgery, but the most precise method involves operating on awake patients using a stimulator to assess speech and language impairment.
• Surprises arise during surgeries, such as discovering small areas in the brainstem responsible for connecting signals to the face, arms, and legs.
• Dr. Gary Steinberg, a renowned neurosurgeon, discusses advancements in brain surgery, particularly in the brainstem area.
• Modern technology, including computer technology, imaging, and anesthesia, has made brainstem surgeries safer.
• Dr. Steinberg marvels at the precision and success of recent procedures, such as the removal of vascular malformations in the brainstem without major complications.
• Neurosurgery has been revolutionized by the ability to visualize the brain and target specific locations.

Current Technology & Neurosurgery, Minimally Invasive Techniques (00:23:27)

• Neurosurgery is becoming less invasive.
• Minimally invasive techniques include operating through the vessels, using focused radiation (radiosurgery), focused ultrasound, and brain stimulation.
• Radiosurgery can treat aneurysms, tumors, and pain conditions.
• Focused ultrasound is used to treat essential tremor, Parkinson's disease, and tumors.
• Brain stimulation is effective for treating Parkinson's disease, chronic pain, and epilepsy.
• Minimally invasive techniques are also being used to treat psychiatric disorders.

Transient Ischemic Attacks (TIA); Spinal Cord Strokes (00:28:13)

• A transient ischemic attack (TIA) is a temporary loss of brain function due to a lack of blood flow.
• Symptoms of a TIA can include:
  • Inability to move or partial/complete paralysis
  • Inability to speak
  • Visual problems (double vision, blurred vision, loss of vision)
  • Slurred speech or difficulty understanding language
  • Imbalance or problems walking
  • Cognitive problems
• TIAs were previously defined as lasting less than 24 hours, but with advanced imaging, some TIAs lasting minutes or up to 24 hours may be considered strokes if they show a new abnormality on an MRI scan.
• Spinal cord strokes are less common than brain strokes due to less tissue involved.
• The spinal cord is supplied by the anterior spinal artery on the front side and two posterior spinal arteries on the back side.
• Interruption of blood flow in these arteries can cause death of tissue in the spinal cord, resulting in a neurological deficit.
• Symptoms of a spinal cord stroke depend on the location of the stroke.
• Vascular problems in the spinal cord can also include abnormal connections between arteries and veins, causing venous congestion and symptoms such as problems walking or sensory problems.

Stroke Risk: Alcohol, Cocaine & Other Drugs (00:33:23)

• Excessive alcohol intake increases the risk of stroke and hemorrhage.
• Cocaine, methamphetamine, and other drugs damage blood vessels and increase the risk of aneurysms and hemorrhage.
• Smoking also contributes to poor vessel integrity and increases the risk of stroke.
• The relationship between alcohol consumption and brain health is complex and still debated.
• Moderate alcohol consumption (0-2 drinks per week) seems to be safe for non-alcoholic adults.
• Excessive alcohol consumption (more than 4-5 servings per week) is associated with negative health effects.
• Alcohol can relieve stress, but it can also disrupt sleep patterns and affect the microbiome.

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• AG1 supports gut health, which in turn supports immune system health, brain health, and various cellular and organ processes.
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Traumatic Brain Injury (TBI), Concussion: Sports, Testing & Recovery (00:39:55)

• Concussions are common in various activities and can result from accidents like car crashes or construction work.
• After a concussion, it's crucial to avoid excessive sleep, alcohol, and further head injuries.
• Eye tracking tests are sensitive in detecting subtle brain problems after a concussion and are used in sports for pre-season testing.
• Concussions were not known to cause CTE (chronic traumatic encephalopathy) in football players until the 1990s, and it was previously only known in boxers.
• MR scans may not show abnormalities associated with concussions, so more sophisticated neurological testing is needed to assess severity and recovery.
• Neurons in the brain can be injured or die after a head injury, and the dying off of the tissue can take several minutes, hours, or even days.
• Putting someone back into a situation where they could get hit more after a head injury is risky due to the potential for further brain damage.
• There are better methods of testing for concussions on the sidelines of sporting events, including involving neurosurgeons.
• Total sensory deprivation is not good for brain recovery, but neither is overstressing the brain. It's important to find a balance between providing input and avoiding overstimulation during concussion recovery.

Statins; TBI & Aspirin; Caffeine & Stroke Risk (00:46:45)

• Statins might be vascular protective even in the absence of high cholesterol.
• Some people report experiencing brain fog as a side effect of taking statins.
• Aspirin is not recommended for traumatic brain injuries, but it is recommended for strokes or TIAs.
• There is no evidence that moderate caffeine consumption increases the risk of stroke.
• Caffeine has many health benefits.

Exploratory MRI: Benefits & Risks (00:48:31)

• People are getting exploratory MRIs for preventative purposes.
• Benefits:
  • Can detect early cancer or large brain aneurysms.
• Risks:
  • Can cause undue concern about small, non-consequential findings.
  • Can lead to unnecessary invasive biopsies and tests, causing iatrogenic injuries.
  • Need for specialist interpretation and follow-up scans.

Blood Pressure, Lifestyle Factors; Tool: Feeling Faint, Hydration; Sleep (00:51:53)

• Eating well, avoiding smoking, excessive alcohol, hard drugs, and getting regular exercise are important for brain health.
• Blood pressure and cholesterol levels for stroke prevention should be individualized, as some people may experience negative effects from blood pressure that is too low.
• Overdoing it, such as excessive exercise or overworking, can lead to health problems.
• Prioritizing sleep, meditation, non-sleep deep rest, and journaling can help slow down the pace of life and improve overall health.
• Reducing caffeine intake and prioritizing sleep are key for brain health.
• Hydration is crucial for brain clarity, overall health, blood pressure, and kidney function.
• Strokes occur more commonly during sleep, possibly due to circadian rhythms, but the relationship between sleep deprivation and stroke risk is unclear.

Sponsor: LMNT (00:59:52)

• LMNT is an electrolyte drink with sodium, magnesium, and potassium in the correct amounts and ratios, and no sugar.
• Hydration and adequate electrolytes are crucial for proper brain and body functioning.
• Electrolytes are essential for the functioning of all cells, especially neurons.
• LMNT dissolved in water ensures adequate hydration and electrolytes.
• The speaker dissolves one packet of LMNT in 16 to 32 ounces of water first thing in the morning and during physical exercise.
• LMNT has various great-tasting flavors, and the speaker's favorites are watermelon, raspberry, and citrus.
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Chiropractic Neck Adjustment & Arterial Obstruction; Inversion Tables (01:01:27)

• Chiropractors can be beneficial, but there is a range of talent among practitioners.
• A story is shared about a patient who experienced hemi-paralysis of the face after a neck adjustment, resulting in a stroke.
• Neck manipulation by a chiropractor can cause dissection of the vertebral or carotid artery, leading to obstruction of blood flow and potential clot formation.
• There is no way to know if this will happen, so it's recommended to avoid neck manipulation by a chiropractor.
• Inversion tables are not harmful, but it's important not to stay in the inverted position for too long.

Kids, Tackle Football, Soccer, Boxing; Mild Concussion (01:05:16)

• Dr. Steinberg warns against children playing tackle football due to the risk of chronic traumatic encephalopathy (CTE) and other long-term injuries.
• Repeated heading of the ball in soccer and participating in high-risk sports like boxing can also cause concussions and long-term injuries.
• Mild concussions with symptoms resolving within a day or two generally do not require medical attention or scans.
• The thick skull protects the brain.

Nerve Regeneration, Stem Cells, Stroke Recovery (01:10:49)

• Contrary to previous beliefs, nerve cells in the adult brain can regenerate, and new stem cells can form.
• Circuits previously thought to be dead can be revived, restoring function in patients with chronic stroke, traumatic brain injury, spinal cord injury, ALS, and Parkinson's disease.
• Stem cell therapy, vagus nerve stimulation, and intensive physical therapy have shown promise in improving arm function in chronic stroke patients.
• The brain's plasticity allows for tissue and circuit regeneration, with infants displaying exceptional recovery abilities due to their high level of brain plasticity.
• The Kenard principle suggests that brain injuries sustained early in life heal faster than those sustained in adulthood.
• Researchers are exploring methods to enhance plasticity in the adult brain, including stem cell injections, brain stimulation, and vagus nerve stimulation.
• The aim of these methods is to induce a state of plasticity in the adult brain similar to that observed in the infant brain.

Stem Cells, Immune System, Activity (01:17:36)

• Stem cells used in experiments can come from various sources, such as bone marrow donors or fetal neural tissue.
• Stem cells secrete powerful proteins and growth factors that promote native recovery, angiogenesis, neurogenesis, gliogenesis, and synaptogenesis.
• The main benefit of stem cells may be their ability to modulate the immune system in the brain, inducing plasticity and recovering function.
• There are dormant stem cell populations in certain brain compartments that can be released through hyper oxygenation or increased blood flow, such as through exercise or learning tasks.
• Physical activity, including physical therapy and forced activity, is beneficial for stroke patients as it stimulates endogenous stem cells, recruits circuits not involved before, and contributes to recovery.
• Exercise can increase blood flow to the brain, promoting the release of stem cells and stimulating neurogenesis.
• Physical activity improves cognitive function and reduces the risk of neurodegenerative diseases such as Alzheimer's and Parkinson's.
• Exercise can also improve mood, reduce stress, and enhance overall brain health.

Injury & Recovery, Restraint Therapy (01:21:27)

• Timothy Scher and Teresa Jones' work on animal models showed that restraining the uninjured limb after brain damage can promote recovery in the injured limb.
• This approach, called constraint therapy, has also shown promise in clinical studies of stroke patients.
• However, animal studies suggest that forcing use of the injured limb too soon after the injury can be detrimental to recovery.
• Neurogenesis, the birth of new neurons, occurs in the hippocampus and olfactory bulb in adult mammals.
• New neurons are important for learning and memory.
• Exercise, environmental enrichment, and certain drugs can increase neurogenesis.

Neuroprotection After Injury; Mild Hypothermia (01:23:46)

• Mild hypothermia, achieved by cooling the body by a few degrees, has been shown to protect the brain after stroke and cardiac arrest.
• Cooling reduces metabolic activity, blocks the release of harmful substances, and decreases inflammation in the brain.
• Mild hypothermia is now standard care for cardiac arrest patients and has shown promise in improving outcomes after traumatic brain injury, although more research is needed.
• Cooling methods include cooling blankets, catheters, and external devices.
• Cooling too much can have adverse effects, so careful monitoring is necessary.

Platelet-Rich Plasma (PRP), Stem Cell Therapy (01:34:59)

• Stem cell therapy for brain injuries or diseases should be approached with caution, especially when considering clinics outside the US due to a lack of regulation and oversight.
• There are risks associated with stem cell therapy, including tumor development or other problems.
• Intravenous or intra-arterial delivery of stem cells for brain treatment may be more effective than direct injection into the brain.
• Stem cells can modulate the immune system and enhance brain plasticity.
• Early data from clinical trials using stem cells for stroke therapy shows promising results, with some patients experiencing significant improvements in mobility and speech.
• A prospective randomized blinded controlled study is necessary to confirm the efficacy of stem cell therapy for stroke.

Scientific Advancements & Clinical Translation, FDA & Industry (01:42:27)

• Lack of funding is a major obstacle in the process of scientific advancements and clinical translation.
• The FDA is appropriately cautious, but other countries' equivalent agencies may move things along more quickly, especially for therapies with no other treatment options.
• Greater collaboration with industry and promoting more academic-industry relationships would be beneficial.
• Government agencies do not provide enough funding to complete the final stages of research, leading to the "Valley of Death" where promising therapies fail due to lack of funding.
• The speaker's own research team received a $12 million grant from the California Institute for Regenerative Medicine, but the next trial will require an estimated $45 million.
• The speaker is considering forming a company to secure funding for future trials.
• The speaker's podcast generates some revenue, and they also receive donations for philanthropy to laboratories at Stanford, Salk Institute, and Columbia University.
• Stanford University has improved in translating basic research discoveries into clinical therapies and is now doing some of that work at Stanford instead of farming it out to other places.
• The proximity to big tech companies in the Bay Area facilitates the flow between basic science discovery and implementation.

Vagal Stimulation (01:47:40)

• Vagal nerve stimulation (VNS) can have both calming and alerting effects on the brain, depending on the stimulation method and the branch of the vagus nerve targeted.
• VNS, combined with intensive physical therapy, has been FDA-approved as a treatment for chronic stroke patients, showing improvements in brain function at 90 days and up to a year.
• The mechanism of action for VNS in stroke recovery and depression is believed to be through brain stimulation, inducing plasticity in circuits and resurrecting damaged neural pathways.
• VNS for medical purposes requires an invasive procedure with an implanted stimulator, which can be controlled using an external magnet device.
• Dr. Gary Steinberg expresses gratitude for the opportunity to share his knowledge and expertise, acknowledges challenges in clinical trials, and extends appreciation on behalf of himself, the listeners, and viewers. He also expresses his willingness to return and provide updates on the progress of the clinical trials in the future.

Zero-Cost Support, Spotify & Apple Reviews, YouTube Feedback, Social Media, Neural Network Newsletter (01:53:17)

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• Dr. Gary Steinberg is a professor of neurosurgery at Stanford University and the director of the Steinberg Laboratory and Clinic.
• His research focuses on understanding the mechanisms of neurodegeneration and developing therapies to prevent or slow the progression of neurodegenerative diseases.
• Neurodegeneration refers to the progressive loss of structure or function of neurons, leading to cognitive and motor decline.
• Common neurodegenerative diseases include Alzheimer's, Parkinson's, Huntington's, and multiple sclerosis.
• Risk factors for neurodegeneration include genetics, aging, head trauma, chronic stress, and certain environmental toxins.
• Neurodegeneration can be prevented or slowed by adopting a healthy lifestyle, including regular exercise, a balanced diet, adequate sleep, stress management, and cognitive stimulation.
• Certain supplements, such as omega-3 fatty acids, curcumin, and resveratrol, have also been shown to have neuroprotective effects.