Ep. 289: Unlocking the Age-Proof Brain: Enhance Memory and Defy Dementia with Dr. Marc Milstein

About Dr. Marc Milstein

Dr. Marc Milstein specializes in taking the leading scientific research on health and happiness and presents it in a way that entertains, educates, and empowers his audience to live better. 

His presentations provide science-based solutions to keep the brain healthy, lower the risk of dementia, boost productivity, and maximize longevity. He earned his Ph.D. in Biological Chemistry and his Bachelor of Science in Molecular, Cellular, and Developmental Biology from UCLA. 

Dr. Milstein has conducted research on topics including cancer biology and neuroscience, and his work has been published in multiple scientific journals. Dr. Milstein has been quoted breaking down and analyzing the latest research in popular press such as USA Today, Huffington Post, and Weight Watchers Magazine. Dr. Milstein has also been featured on television explaining the latest scientific breakthroughs that improve our lives. Dr. Milstein’s upcoming book “The Age-Proof Brain” will be published on October 25th, 2022.

Connect with Cynthia Thurlow

Follow on Twitter, Instagram & LinkedIn

Check out Cynthia’s website

Connect with Dr. Marc Milstein

On his website

On Instagram 

On social media: @drmarcmilstein.com

Dr. Milstein’s book, The Age-Proof Brain: New Strategies to Improve Memory, Protect Immunity, and Fight Off Dementia 

Transcript:

Cynthia Thurlow: Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week, and impact over a million lives.

Today, I connected with Dr. Marc Milstein. He’s a researcher with a PhD in Biological Chemistry and a degree from UCLA in Molecular, Cellular and Developmental Biology. He specializes in taking the leading scientific research on health and happiness and presenting in a way that entertains, educates, and empowers his audience to live better. Today, we discussed his background, age-related brain changes, the anatomy and physiology of our brains, the role of neuroplasticity, the concept of plaques and tangles, the buildup of waste, which leads to decreased focus, productivity, and energy, factors that impact brain health including a robust immune system, leaky gut leading to leaky brain, memory issues, the role of mild cognitive impairment versus dementia versus Alzheimer’s, the impact of insulin resistance, the role of trauma, and ways to age proof our brains. I hope you will enjoy our conversation as much as I did recording it.

Well, welcome Dr. Milstein. It’s so nice to have you on today. I really enjoyed reading your book and I’ve been looking forward to this discussion.

Dr. Marc Milstein: Thank you. Thanks for having me on. I appreciate it.

Cynthia Thurlow: I would love for you to share with listeners a bit about your background and I love that a lot of your focus, at least in your introduction, is helping people understand. You want to make science and brain health actionable and understandable, and kind of take away this in many levels. The lay public may not have as much familiarity with anatomy and physiology, but you make it in a really nice approachable way.

Dr. Marc Milstein: Oh, thanks. I appreciate that. Well, I started out actually in cancer research at UCLA and I was part of a group of researchers that was also looking at how something involved with breast cancer was also involved in learning and memory in the brain. And that was at a time where that was an interesting insight that something involved in one part of the body was also involved in a completely different part of the body. And brain science at that point was really exploding in terms of our understanding of how this information could be usable for sleep or for gut-brain connection, or for just all aspects of stress and stress management, etc., etc. So, I was actually at UCLA and somebody asked me if I would give a talk there and I was not somebody I thought would give a talk, but I just thought I’ll try it. And it was to a group of people who weren’t scientists or weren’t physicians or in the medical field. And people enjoyed it and they said, “Would you like to give another one? And that turned into another one.” And I realized there was this real need to just get this information out in a way that was accurate but also interesting and entertaining. And that was really kind of the start of all this and just really enjoy, just getting these breakthroughs and this interesting information out to people.

Cynthia Thurlow: Well, I think it’s so important. One of the things that I think on a lot of levels, why, as an example, advanced practice nurses have done so well in the medical field is that we take complicated information, we make the information accessible. And a lot of what I saw in your work was making information accessible and then patients or the lay public can then take actionable results accordingly. So, let’s really start the conversation talking about changes that are happening in our brains as we are getting older. Some of it is normal, like a normal kind of physiologic evolution. A lot of it is lifestyle and I know we’ll dive into that, but let’s start the conversation there and then dive into some of the anatomical and physiologic things about the brain that really impact the trajectory of our brain health and cognitive health throughout our lifetime.

Dr. Marc Milstein: Yeah, definitely. So actually, starting even at the age of 40, the brain can start shrinking about 5% every 10 years. And so, we can understand how that shrinking can really devastate memory, focus, productivity, attention. But we’re clearly seeing, as you just mentioned, that this doesn’t have to happen, that we can slow this process down. And so, I just like to think of it like you want to have a full plump brain, [laughs] we don’t want it to shrink. And then if we also think about our brain as 80 billion individual brain cells and they need to talk and communicate with each other, that there are things that can get in the way of that communication. So, every time we learn something new, we make that connection between those brain cells. But things can build up in the brain and especially as we get older, this buildup of different types of waste and trash and toxins, and kind of leftover chemical reactions, we’re better at removing it. And if you think of just like an apartment or a house that fills up with waste or garbage, it’s hard to find things, it’s hard to be productive. Same thing with our brain. And this inability to remove this waste or this garbage, or these toxins not only interferes with the brain cells’ ability to communicate with each other, but over time, it can cause these brain cells to die or to be damaged and that can really impact brain function. So really the two big things to think about are just keeping the brain full and plump and also keeping those brain cells talking to each other and communicating.

Cynthia Thurlow: It’s interesting because I think when my evolution in medicine started in the 1990s, we just thought it was normal like your grandmother, your grandfather, they start having cognitive decline. This is just a normal function of aging. This is what’s going to happen to us. And I think as I’m getting older, the recognition that so much about our day-to-day lifestyle has such a profound net impact. And I think these overhurried existences is kind of western, you know civilization, first world nation, not just unique to the United States, but for so many people. We live lifestyles that are really not sustainable and certainly not sustainable for brain health. So, let’s talk about some of the things that make our brain the anatomical structures that are actively involved in, as you mentioned, thinking, decision making, processing information, memory. And then we can kind of dive into the role of remodeling and neuroplasticity and all these terms that might sound a little ambiguous but when we talk about them, people will understand this is why it’s so important to be proactive about brain health.

Dr. Marc Milstein: Yes, definitely. So just one key structure to think about is the hippocampus [chuckles] and it’s a part of the brain that’s just basically anytime you’re learning new information this part of the brain, it looks kind of like a seahorse if you can picture it. But this part of the brain, when you learn something new or you hear something, it takes that information in and it decides with other parts of the brain where it’s going to go. And part of the decision is are you going to remember this information or are you going to throw it away? Because the brain is actually filtering out information quite a bit. It doesn’t want to fill up with useless information but we want to make sure that information, if it’s necessary, is transferred on to other parts of the brain like long-term memory where we’re actually going to remember it.

And so just if you think of this part of the brain like a waiting room, and we want to keep this part of the brain strong and functioning, there are certain things that keep this part of the brain strong and certain things that make this part of the brain shrink, essentially make it weaker. And one of the things that we see if we talk about lifestyle factors is just simply walking like 30 minutes a day. We see that people; their hippocampus gets bigger and stronger. It’s better able to manage new information, transfer it on to long-term memory. We also know that stress in a moment, in a burst is actually good for our brain. It actually keeps our brain healthy and youthful. It’s just the stress that never ends, that we never take a break from. Cortisol we want to get things done, we want to have challenges, things we want to tackle, things we want to do. But if it’s too much cortisol that part of the brain shrinks and it can be difficult to remember what we have to do.
So that’s just some examples of where we see a specific part of the brain where if we can take care of it through lifestyle factors, through really simple things, we can help its functioning. But as you mentioned, in a world where we’re oftentimes not walking as much as we used to, we’re more sedentary or we’re filled with a lot of stress nonstop based upon our constant multitasking or not taking breaks or not managing stress, we see how these lifestyle factors can really have an impact on our brain health long-term and short-term. And that’s why we want to do these little things that can be really helpful, especially if we accumulate them and kind of add them up together.

Cynthia Thurlow: Well, and I think it’s really interesting, as I was reading the book, the one thing that stood out to me about the hippocampus that perhaps I had learned, but perhaps I’d forgotten, [Marc laughs] was that when we’re talking about short-term memory, it’s 7 to 20 seconds. I mean, that’s short-term memory. So, I’m thinking to myself, I think my perspective on short-term memory was someone tells you something 15 minutes ago, and then you’re trying to recall it. But that’s not actually the way that the hippocampus is remembering the information. And I love that you brought up chronic stress, the influence of cortisol. I think there’s a term in the nonmedical vernacular about adrenal fatigue. And really what it’s speaking to is the hippocampus has been significantly altered, deranged, is less optimized, maybe dysregulated in response to chronic unrelenting stress. I’m so glad that you brought that up, but let’s kind of talk about, you mentioned we have these 80 billion cells our brain weighs 3 pounds. It’s one of those things that just stuck with me. It was like, you think about the brain itself, you assume it’s kind of heavy, but if you’re holding it up all day long, it can actually be heavy.

Dr. Marc Milstein: Right.

Cynthia Thurlow: What is the role of remodeling and neuroplasticity, the value of learning new things and how that contributes to brain health and cognition?

Dr. Marc Milstein: Yes, definitely. And it’s such an important point that we have more control over our brain and its structure than we really ever thought. I mean, there’re parts of our brain that are less easily changeable, and there’re some things that are fixed. But when we learn new things, we take some of those 80 billion brain cells and we force them to reach out and make new connections and that is remodeling. That’s basically changing the structure of our brain. And if we make connections for things that are overall positive information that is beneficial or just basically things that make us feel good, happy, basically things that are involved with purpose, we’re making those connections stronger because we’re prioritizing them. And then connections that are tied to things like anxiety or stress or negative thought patterns. If we don’t spend time on those things or less time, those connections get weaker.

It’s kind of like playing the piano. If you practice a certain song, what’s actually happening in the brain is the connections for that song, the memory for that song gets stronger. Those connections get stronger. We get better at playing that song. If we don’t practice that song, those connections get weaker. They essentially move apart. And so, we realize that our emotional state, in part definitely complicated. Not just this isn’t the only piece of the puzzle, but part of what’s happening. And that’s why we have more control over our emotions in general than we used to think, is that by taking time during the day to think about positive thoughts or feelings of gratitude or purpose, we’re prioritizing those connections and we’re letting connections that might be tied to more stressful or negative thinking patterns get weaker. And this used to be thought of as just kind of like frou-frou ideas are not really rooted in science. But now we know there’s real brain science here, that there is a mind brain connection and thus a mind body connection because these connections also impact our immune system, our stress response. So, there’s much more power and control than we thought here in this area.

Cynthia Thurlow: Yeah. And it’s interesting, I guess what I was always taught was, “What wires together, fires together.”

Dr. Marc Milstein: Right, right.

Cynthia Thurlow: And so, reinforcing what you just said. And I was reflecting on my grandparents. I had one grandmother who was volunteering until she was 90 years old. She was a former nurse and an administrator. And she used to explain to me that she needed to have a sense of purpose, even in retirement, that she was never going to be and no judgment if you do this, the type of person who’s just going to kind of sit at home and do nothing. And so, for her, I think it was very, very important for the social aspects, but I also think it was really intricately important for her brain health, helping others, because it gave her this tremendous sense of purpose and always learning. I look at her as an example of someone that was always reading, doing crossword puzzles, learning new things. I look at my mother-in-law who loves sudoku, and up until she had some visual deficits in an eye, she was doing bridge and she was like this wicked bridge player, like vicious, wicked bridge player.

Yes, the Thurlow family that I’m married into are vicious game players. Like, they are serious about their games. But for anyone that’s listening, the understanding that irrespective of where we are in age and stage, it’s important that we continue to learn in different ways. Like, obviously there might be hobbies that one of us embraces that someone else does not, but we don’t want to ever stop learning. I think that’s a really important lesson to understand.

Dr. Marc Milstein: Yeah, definitely. And I like to think of it very much like how you’re saying is cross train your brain. If you think if you’re weak and you think if you were going to go to the gym and work out physically, you would probably not just do bicep curls all day every day or that wouldn’t be the only exercise you would do. Same thing with the brain, a couple of times a week, new information, it could be painting, learning to paint, learning a foreign language, learning a musical instrument, learning a little bit about brain science, doesn’t matter what it is, something new. And then another day of the week thinking about doing something physical in terms of like yoga or dance or just a new sport, anything that involves brain balance. Those things are so important. And then what you said is exactly so important is social. Just being around people, talking to people. When we’re around people, we’re learning. That’s a really important reason why social is so important for our brain because we’re engaged, we’re hearing, we’re learning new things from people and that’s just making it part of our week. So, it’s like some of these things are just fun [laughs] that are good for brain health too.

Cynthia Thurlow: I think we really emphasizing that this is not like task oriented. You sit down and you’re taking an exam, this is actually finding hobbies or things that bring you pleasure. Now you kind of touched on junk in the brain and things that can build up in the brain. So, let’s talk about plaques and tangles and how they differentiate, how they impact brain health and cognition and why they’re so important to understand.

Dr. Marc Milstein: Yeah. And it’s also important to start with the caveat that it’s not the whole picture. It’s a piece of a complex puzzle of what’s happening in brain health. There’re many different types of waste and trash and garbage that build up in the brain. But in Alzheimer’s disease specifically, two types of trash that are what we call hallmarks of the disease are inside the brain cells these tangles build up. And if we think of it like inside of a brain cell, there’s basically like a roadway system that transports important nutrients and all these different things that need to get to different places in the cell. Your cells are like a little bustling city and there’s like train tracks in there and those train tracks can basically get into a tangled mess and you can imagine that tangled mess inside of a city cause all sorts of problems. Same thing in the brain cells.

So that’s what we’re concerned about is that buildup of that tangled, basically railway system that happens in our brain cells and then outside of the brain cells, we call those the plaques, specifically in Alzheimer’s disease. And there’re a couple of reasons why this happens and some reasons we’re still learning. But there’s a stickiness to a certain type of a protein that breaks down and it clumps together and it forms this sticky plaque. And if you think about those brain cells need to talk to each other and communicate. And those synapses, those connections between the brain cells where our memories are when we learn new things, these plaques get in between those brain cells and they disrupt. They don’t allow those connections to be made or they don’t allow the connections to be strong.

And so again, it’s not the only thing that’s happening in Alzheimer’s. We realize there’re multiple factors, but it’s a piece of the puzzle of what’s happening. And that’s why it’s so important that we want to do things. And we now know we can do things to lessen the incidence of this buildup of this waste. And just to kind of tie this to the last point is that one of the things we realize actually helps clear away some waste and garbage in the brain, different types of waste is learning new things. It actually causes a release of a chemical in the brain called norepinephrine. It’s kind of like a spray and it sprays away waste and trash and garbage, different types of it. And that’s why just another really kind of take-home message of why that’s so important is if you think about washing your brain or power washing it with a spray, you’re doing that when you’re learning new things.

Cynthia Thurlow: That’s really interesting because I hadn’t put that together. And I think for so many people that are listening, they’re saying, “Okay, well, some of these things are markers for Alzheimer’s, which is obviously significant.” But it’s also understanding that when our brain isn’t properly getting rid of diseased disordered cells and trash as you appropriately called it, that can impact focus, that can impact productivity, that can impact energy. And I think for a lot of individuals and I speak as a middle-aged person myself, I think there’s this assumption that after a certain age, whether it’s 40, 50, etc., that you’re supposed to be tired, that you’re supposed to not feel as mentally sharp. And I’m here to remind people that your work and certainly work of many others that I’ve interviewed on the podcast is to suggest otherwise, to kind of challenge that limiting belief that after a certain age that you’re just not going to be as sharp that doesn’t have to be the case.

Dr. Marc Milstein: Yeah, absolutely. That is like the big take-home message is that this whole idea that, “Oh, that’s just part of the aging process or that’s just what happens when you get older.” We want to really challenge that and say that losing significant memory is not normal, it should not be happening. And we clearly see that there’re things that we can do to slow it down, reverse it in some cases and really get the best of our brain each day and protect it years from now.

Cynthia Thurlow: Well, and something that was interesting to me when I was reviewing the work and thinking thoughtfully about what direction to take the podcast in. You do a really nice job about talking about factors that impact brain health. And obviously, a lot of the work that I do now is helping people talk about brain health and metabolic health. And I know that we’ll dive into these things, but let’s talk about the interrelationship between our immune system and brain health because I don’t per se think that everyone necessarily makes those connections, but it makes a great deal of sense. And it’s why especially as we’re kind of hopefully, fingers crossed coming off the back end of this pandemic and people maybe perhaps now are thinking more about having healthy robust immune systems. But what is the interplay between the brain and our immune system?

Dr. Marc Milstein: Yeah, definitely. And so, a key message is that it’s not just our brain in isolation, it’s these other parts of the body that are so important. And the good news is we have really good lifestyle changes or things we can do or in some cases medication if that’s necessary, that we can utilize to optimize these other parts of our body and our health to really impact our brain. And right at the top of the list is the immune system. And so just to think about this, going back to the idea of the waste that builds up in the brain, we have this human cell. It’s part of our immune system called microglia. And it swims around your brain, basically, and it eats up garbage, just like the bottom feeder that swims at the bottom of a fish tank. You see that little bottom feeder gobbling up garbage. Imagine something like that in your brain gobbling up the trash and the waste and it’s keeping your brain basically keeping it healthy and keeping it clean. That’s one way to think about it. But the problem is that these microglia can get confused and instead of gobbling up the garbage it makes the mistake to actually attack or gobble up healthy brain cells.

And that’s when we see devastation to memory or we see increased risk of depression or anxiety when our own immune system is making this mistake. And instead of doing its job of gobbling up garbage and waste, it’s attacking healthy brain. And you can imagine the immune system so powerful attacking healthy brain cells, the devastation that can do to the ability of these brain cells to function and how it can impact cognitive function and abilities. And so, we realize is that we want to essentially have our immune system balanced, as you said, working properly, functioning properly, so that the immune system is essentially in check, so it’s not overreacting to things. And part of that is we realize our stress response plays a role in our immune system, our gut health plays a role in our immune system, what we’re eating, how we’re sleeping. And so all of these things keep coming back to these key factors that are so important that all sort of work together. So even though it’s complicated, it boils down to some things that really just keep coming up over and over again as, “Oh, if we just do these simple things that allows our immune system to be more balanced, it allows it to not make these mistakes.” And we realize that’s a really hopeful, empowering message in all of this.

Cynthia Thurlow: Absolutely. Because I think on a lot of levels, maybe pre-pandemic, the average person probably wasn’t thinking about immune function very much at all. And I think maybe one of many gifts or blessings that we have received is that people are probably thinking more thoughtfully about vitamin D levels and the impact of sleep on the immune function and metabolic health and things that allow people to have some sense of control over what is going on, as opposed to feeling very powerless. Because that was certainly across social media and a lot of the input we’re getting from listeners was that people just felt disempowered, unempowered, and they really desperately wanted and needed good information.

Now, you kind of touched on this, but when we talk about brain health, we’re also talking about gut health and this complex interrelationship between the gut-brain axis and the role of mood and metabolism. And one of my favorite things to talk about is the blood-brain barrier because if you’ve got a leaky gut, you’ve got a leaky brain. And understanding this complex communication that goes on between two entirely very different systems in the body, but two that are very very important for our health.

Dr. Marc Milstein: Yeah, absolutely. It’s so fascinating, we’re learning so much about it. But just thinking about how your brain impacts your gut and your gut impacts your brain. And if we tie it into what we’re just talking about in terms of those microglia getting confused, one of the messages that confuses them is information coming from the gut. So, if we think about it, essentially the gut, as you said, can leak and it can leak out inflammation. And so, we have good bacteria, we have bad bacteria, but if there’s too much of this bad bacteria, it can release factors that leak into the gut that send basically signals or inflammatory signals, almost like a fire that’s in the gut. And that fire has instead of releasing smoke, it releases these factors or these chemicals that spread into the bloodstream make their way to the brain. And the microglia see these signals and they get confused and they start attacking healthy brain cells. And that’s really a connecting point of these two concepts of wait, now we realize, “Oh, wait a second, what I’m eating which impacts my gut health and which types of bacteria are growing,” is actually sending signals to my brain to impact how my immune system is going to be either protecting or attacking my brain. And so, we realize how important food is. And I know that you’ve done such wonderful work in your field and everything you’ve done to communicate that to people, that this is an important piece of what we’re doing and how we can optimize our brain health and overall health.

Cynthia Thurlow: Well, and it’s interesting because when I was still in clinical cardiology and talking to my patients about food, their eyes would glaze over. They were like, “Oh, food isn’t important, nutrition isn’t important.” And maybe this is a time to kind of talk about some aspects of food that are important for not only brain health, but overall wellness. You do a really nice job in the book talking about this, but things like sulforaphane and how that complex interplay is so important. And for anyone that’s listening, we will unpack what this is and how you can get this into your diet. But from my perspective, it’s this understanding that it is not just a– and this is the way that I was taught was that the cardiovascular system is outside of every other system. It’s like everything is compartmentalized.

Dr. Marc Milstein: Yeah.

Cynthia Thurlow: But what I’ve now evolved to understand is that everything interacts with everything. So, if you think that your stubbed toe is not communicating valuable information to your brain and also the inflammatory response, I mean, there’s a lot of complex interplay that goes on that in many ways we haven’t been making those connections because we haven’t been helping our patients make those connections and now, we know better.

Dr. Marc Milstein: Yeah, absolutely. And so, it’s about how it really is hopeful because it gives us more opportunities. Just like you said, if somebody’s having an issue with brain health, we say, “Oh, part of what we can do here is think about what you’re eating or how you’re sleeping or what’s going on with your immune system.” We can check some levels here and so because it can be really hard to treat the brain directly. The reality is that can be a challenge. And what we realize is that if it’s connected to all these other things in the body, that gives us avenues for treatment and for hopeful treatments and for interventions. And then also realizing you mentioned the sulforaphane in the broccoli. My editor said, “I think you just call the book Broccoli and the Brain [laughs] because it just kept coming up over and over again.”

I go in depth, but there’s food that I talk about in the book that there’re just things our brain needs at its essence that doesn’t make on its own everything from the omega-3s to certain factors that we just– our brain needs these things. And if we’re not giving it to it in quality amounts, then we’re basically not giving our brain what it needs. We’re just not fueling it properly. So, we realize that that’s just such an important avenue. Also, certain foods feed good bacteria and some foods feed bad bacteria. And so, the bad bacteria, if we go back to what we’re just talking about, they release those factors that get into the bloodstream, impact the brain or impact the joints. So, some of this inflammation doesn’t just come from the gut. It can come from, as you said, an injury or joint pain, and it can spread to the brain. So other avenues of hopeful interventions there too.

Cynthia Thurlow: Well, and it’s interesting. We had salmon last night and I remember explaining to my husband that most Americans undereat omega-3 fatty acids and overeat omega-6 fatty acids because seed oils are rampant in our diets. They’re in everything. You go to a restaurant, a lot of processed foods, and so we have this imbalance. So, we have more inflammatory foods than anti-inflammatory foods. So big takeaway for me was a piece of healthy, good-sized salmon. If you cut up your broccoli, let it sit for 20 minutes, because that will kind of upregulate these sulforaphane compounds that you talk about. A lot of questions that came in for our conversation were centered around memory, memory loss, and dementia.

I think this is a huge concern, especially for a lot of the population that I interact with. I was trained right as the Women’s Health Initiative came through, and so many many women were taken off of hormone replacement therapy. And we understand the changes that occur in a woman’s body and a man’s body as well, but probably more so for women, these changes in perimenopause and menopause, and that directly impacts brain health. So, when we’re talking about memory, we had spoken about the hippocampus a little earlier. I was curious for you to share with listeners, what is the dopamine squirt as it pertains to memory?

Dr. Marc Milstein: Yeah. So essentially, one way to think about this is that your brain likes newness. And so, we tend to think of dopamine as this feel-good chemical, and it plays a role in feeling good. Or people say, “Oh, dopamine is not related to loves or things like that.” But really dopamine is a big part of it, is feelings of newness. And what happens is that if you just think about your ancestors a long, long time ago, if they were walking around in the wilderness or [chuckles] in the forest, and it was just sort of the same old situation, then they didn’t really have to pay attention. But if there was any newness that happened, they had to focus on it. They had to pay attention. Their survival depended upon it and so this has just carried over. And now we realize that our brain really responds to newness.

And especially over the last couple of years, especially during the pandemic, there was a lot of the sameness going on. And so just a moment a day or a couple of moments a day of saying, “I’m going to walk on a new street, I’m going to maybe go to a new coffee shop, try new type of music, cook a new meal, a little bit of newness each day is something that’s really powerful. It causes that dopamine squirt in the brain. It helps us focus, it helps us pay attention, helps with memory.” And you don’t have to go halfway around the world. That doesn’t have to be what happens. You can take a trip. That can be great. But there’re just little things we can do to give our brain this dose of newness this dopamine, which is very helpful for the brain, especially in times where it can be easy to fall into ruts of the sameness.

Cynthia Thurlow: Well, I think the concept of novelty is certainly important, and that could come from something really benign, as you mentioned. Maybe you take a walk on a different street, maybe you start reading a new book, maybe you start reading a new magazine, interacting with a new hobby can all be super helpful. Now, you differentiate in your book talking about the role of mild cognitive impairment is differentiated from other types of more progressive dementias, and then obviously the most significant of which is Alzheimer’s. What I found really interesting is that you mentioned 12% to 18% of those that are greater than 60 years old have a type of memory loss and impaired mental function. Now, that sounds like a lot of people to me. [laughs] That was surprising. And this is mild cognitive impairment. This is not the more significant other types of dementia that you discuss in the book.

Dr. Marc Milstein: Yeah. So, what we were talking about earlier with this idea of it’s not normal to have, I should say, significant memory loss. And in the past, these were things that we would have said, “Oh, that’s just part of the aging process.” And so, some examples of this are it’s normal to miss an appointment from here or there or forget to pay a bill. But if it’s happening with increasing frequency and it’s starting to interfere with one’s ability to get through the day, there’re changes to what we call executive functioning, or how’s somebody managing their day, or we’re just noticing some changes either in ourselves or somebody that we’re close to. These are the signs of this mild cognitive impairment that we want to say, we need to dig deeper. We need to figure out what’s going on here. We don’t want to just say this is part of aging, because there are so many things that can be causing this that are treatable hormone imbalances, vitamin deficiencies, side effects to medications, injuries, and many other things that could be exacerbating these conditions.

As you mentioned, heart health, gut health, not sleeping properly, or not getting effective sleep. So, we want to dig deeper and figure out what is the root cause, what’s happening here. Is it just it’s okay to forget where you put your keys or parked your car from time to time? That could just be some distraction or multitasking that’s going on? Or is it something that is really deeper and we need to address? And that really, we want to get some help to determine where that line is and not be afraid to seek help because it’s understandable to be scared. But we want to say, just like pretty much every other condition, early detection, getting on top of things early is where we see really great benefits.

Cynthia Thurlow: Well, and I think there needs to be the discussion so that people don’t feel stigmatized. And I’ll use an example, obviously, working in cardiology, a lot of people with hearing aids, a lot of people that had ocular issues, vision changes, sometimes after a stroke, where they had catastrophic changes in their vision. What is the research demonstrating about the significant decline in a particular sense, whether it’s hearing, whether it’s vision? What is the net impact on our brain health and then also memory related to this specifically? Because it’s interesting to me that, it was my clinical experience that patients who had hearing loss, who weren’t getting hearing aids were just getting more and more withdrawn because they felt like they couldn’t participate in the conversations. And then on the other hand, individuals that had some type of catastrophic event, I’m thinking about retinal hemorrhages, strokes where they suddenly couldn’t read anymore or they couldn’t drive anymore. The net impact on not just their mental but also their cognitive health was pretty significant.

Dr. Marc Milstein: Yeah, absolutely. I’m really glad you brought this up because this is an area where we see not enough conversation, but big helpful impacts when changes are made. So, for example, hearing loss, if hearing loss is just mild, it doubles the risk of memory loss. If it’s moderate, it triples the risk. If it’s severe hearing loss, it’s five times the risk of dementia or memory loss. But if you simply treat the hearing loss as something like a hearing aid, and that’s effective for the hearing loss, pretty much all those risks go all the way back down. Like they pretty much disappear. And what we believe is happening is if we’re not hearing, we’re not engaged, we’re not learning, we’re not part of the conversation. And essentially our brain is very much use it or lose it in many ways. And our hearing is the same way in the terms of if we’re not stimulating those parts of the brain because a hearing aid is not being used, then those parts of the brain that are involved with the nerve stimulation and sending signals to other parts of the brain, they atrophy. And so, what we want to do is we really want to get the word out that this is an area where, of course, there can be stigmas and people can be embarrassed about a hearing aid.

But the technology has gotten so much better, they’re much easier to use. And I know people, even in my family who in the last year have made that step, and they say to me all the time, “I’m so thankful you told me that information because I feel so much more engaged. I feel better. I feel like my memory is working better.” And I am so happy that I took this step because at any age, if somebody needs help with any aspects of their senses, we want to be on top of it. It’s an area that we can treat. And you mentioned vision, studies show that cataract surgery if it’s needed, it can slow down memory loss decade later. So, we want to keep our senses active and engaged because they’re direct routes to the brain and we don’t want to cut off any of that stimulation because if we can keep that stimulation moving and we keep it active, we can keep our brain active.

Cynthia Thurlow: And I think it’s really important to state it is not just patients of mine that were in their 60s, 70s and 80s.

Dr. Marc Milstein: Yeah.

Cynthia Thurlow: I think given the fact that we have earbuds in, we have really loud music. I know having teenagers myself, oftentimes they’ve got noise canceling headphones on when they’re at the gym. And I’m wondering if younger generations are going to start demonstrating signs of, as an example, hearing loss a whole lot earlier than my parents’ generation, given the fact that all this technology that they’re involved in on a daily basis. And let me be clear, I’m a total realist. I’m not ever going to tell my teenagers who get really good grades, “Oh, I don’t want you wearing earbuds 24/7.” And they do kind of keep that in check. But I do suspect that this generation may start experiencing changes in auditory health earlier than even our generation did.

Dr. Marc Milstein: Yeah, it’s a concern. And so, at any age, having the conversation of not too loud, being careful with our hearing, I was giving a talk about a week ago and somebody in their early 40s was talking about his experience in the military and how that impacted his hearing. And so just being aware that our environment– things, different careers, different aspects of life can impact our senses, just doing everything we can to make sure that we know that it’s not only important because we want to keep our senses, but it impacts our brain health too.

Cynthia Thurlow: Yeah. And it’s interesting when I was going through the book also understanding that women in particular seem to be at greater risk for being undiagnosed or misdiagnosed with things like sleep apnea that can impact brain health and cognition. And the statistic that was mentioned in the book is that with sleep apnea you lose memory 10 years before the rest of the population, and then 80% of women are undiagnosed. I mean, that was startling to me and I don’t know if that’s because women are the caretakers. We’re usually the ones encouraging our spouse or significant other to get tested. What has been your experience with women and the role and changes that occur with perimenopause into menopause? Unless they’re on hormone replacement therapy, the role of estrogen and how that impacts brain health and cognition.

Dr. Marc Milstein: Yeah. That’s really difficult important question. Unfortunately, the research is a bit mixed. And so, one hand, we know that this is important. We know that the age of onset makes a difference, other factors, pregnancies make a difference. And although we would hope that we’d have a simple answer for this complex question, I think what I talk about in the book is this is an area where we want people to be highly encouraged to have the conversation with either nurse practitioner, their doctor and talk about “Okay, based on my family history, what I’ve gone through in my life, everything you know about me, what is the right route for me?” Because there isn’t a one size fits all here but it’s important. And that’s really the take-home message, is that this really does matter, but it doesn’t impact two people the same way. And it’s an area where if we can be on top of it and we can make it part of a treatment plan, whether that’s lifestyle, whether that’s medication, whether that’s hormone replacement for the right person at the right time. It’s an area where we see it is critically important for brain health and it’s not being utilized or talked about enough.

Cynthia Thurlow: Well, I think you bring up such a good point. The bio-individuality rules and having those discussions and have them early before you even need to even consider hormone replacement therapy. And this goes for men as well, to have those conversations so that you’ve got a plan in place and you have a sense of whether or not this is something that would be a benefit to you. A lot of my work is talking about metabolic health and of course that leans into insulin resistance, diabetes, inflammation. Let’s talk about how these factors impact the brain on such a substantial level. And I think that people need to understand that our brains in our 60s,70s and 80s are really made in our 40s and 50s. And so, if you think you can take your foot off the gas and cruise, [laughs] you can’t. At this stage, I think it’s even more important to make sure that you are finding lifestyle choices that are going to be able to be sustainable and don’t feel like they’re punitive. But understanding the role in all of these things, specifically in relation to metabolic health, given the fact we have such a largely unhealthy population.

Dr. Marc Milstein: Yes, definitely. The way I like to think about it, and I talk about in the book, is that if you look out and you see the waves rolling in, those waves are like the symptoms of memory loss. You can see them when they’re there, but if you look past the waves, it looks calm. But if you go beneath the surface, even where its calm, waves are there. In fact, many waves travel hundreds of miles before we see them. And memory loss, dementia, Alzheimer’s, these things are taking root in our brain and our body 10, 20, 30,40 years before we’d ever see a symptom. And I know that sounds scary, but in almost all cases, memory loss isn’t something that happens overnight. It really does take, in almost all cases, decades to develop. And that’s why exactly what you’re saying is we want to do these things now. And it doesn’t have to be punitive. It really can be fun things.

I mean, if we’ve talked about being social, learning new things, being active, finding purpose, all these things are really positive, beneficial, additive aspects to life. And then in terms of thinking about metabolic health, just thinking about sugar, if we think about sugar is something that if it’s added to our food and it’s left over in our blood after we’re eating, it’s toxic to the brain. And also thinking about if we get back to that idea of waste in the brain, basically there’s some overlap in some systems, and part of our body deals with a system involved in basically clearing out waste. And that same system is involved in insulin, which helps regulate the amount of sugar in our blood. And if this system has to focus too much on insulin because it’s being overwhelmed by sugar, it gets distracted and it doesn’t do its job of cleaning. And so, I like to think of it like your desk. It gets messy or cluttered, at least mine does when I’m busy with other things, when I’m distracted.

And if these mechanisms in our body that are involved with cleanup, cleanup of waste in the brain, if they’re overwhelmed by other systems that they also have to play a role in, then they don’t do their job properly. And that’s why, just at its essence, we just want to be thinking about metabolic health, insulin sensitivity, prediabetes, diabetes. 50% of our population either has prediabetes or diabetes and it’s a major driving force for brain health. I mean, not to throw too many stats out, but besides age, our single greatest risk factor for Alzheimer’s and dementia is untreated diabetes. It raises the risk by about 60%. But if the diabetes is effectively treated, that risk comes all the way down. It’s just kind of a model for what we see over and over again that these things bring the risk way up if we don’t treat them, if we treat them, the risk comes back down. And nothing is more true than metabolic health when it comes to brain health.

Cynthia Thurlow: Absolutely. And I feel like the past year there’s just been an explosion. Many guests coming on and talking about trauma, the role of adverse childhood events, how that impacts brain health. You talk about it as well. Let’s talk about the impact of adverse childhood events on our brain health and cognition.

Dr. Marc Milstein: Yeah, definitely. So, it’s important to realize that the brain is precious, and especially in the early years of life, it’s undergoing a lot of development. And that developmental process is something that can be impacted by the environment that child is growing up in. And what can happen is that essentially our ability to manage stress, to regulate our emotions, fight or flight response, all those things are things that we develop. They grow as we grow. We’re not born with a brain that’s able to manage emotions. So just completely– we see this in newborn babies. So, the idea is that the brain learns through the first decades of life how to manage an emotion, how to manage anger, how to manage stress. And a lot of that is coming from the prefrontal cortex. It’s the part of the brain, it’s like the brakes. It turns off these emotional responses and takes a break from them when necessary or subdues our emotional feelings. But in episodes or situations of trauma, this part of the brain essentially doesn’t do its job as well. It doesn’t turn off the emotion as well. And we think about it evolutionarily, it’s possibly because the brain is thinking, “Well, this person needs to flee, it needs to run, it needs to get out of this situation.” And so, it’s causing a brain development that is not allowing the brain to essentially manage emotions effectively.

Now, it’s important to talk about this. It’s also important to highlight that at any age we can do things to optimize our brain and change our brain. It can be so beneficial, different types of therapy because it can help the brain develop essentially at any age, the ability to become more adept or stronger at turning these emotions off or taking a break from them, I should say. So, if we think about the brain is precious, it’s delicate as it’s developing in certain ways and that trauma can impact that development. But the hopeful insight in this is that at any age we can do things to help the brain recover. It’s not necessarily an easy process, but there’re lots of evidence the brain can recover and regain its abilities to improve managing stress and emotions.

Cynthia Thurlow: I think it’s such a good point that reframe that trauma is not your destiny. I know Gabor Mate, when I spoke with him, he described trauma as a wound. And if you think about it that way, if it hasn’t healed, then it’s going to continue to kind of provoke uncomfortable feelings. Things for an individual may not allow them to function at their optimal level. Now, let’s focus a little bit on age proofing our brain. What are some of your high-level recommendations? I love that your book is really providing strategies. It’s very hopeful, it’s very positive. It’s not a Doom & Gloom book. But what are some of the things that you think are most important? And I love that you started with sleep because that is something that’s foundational to our health. Let’s start there and kind of hit some of the high points.

Dr. Marc Milstein: Well, sleep is one of the things we can really take control over and it’s one of the most powerful. I like to say it’s like the secret weapon for brain health because at its essence, just two of the things that we’re talking about that are so important among many is that when you’re sleeping at night, at certain points during the night, your brain finds every new connection you made that day, and it makes it stronger. It runs electrical stimulation over those connections, and it makes those memories or those connections or those memories stick. So, if we don’t get a good night’s sleep, we just don’t remember the things we learned that day nearly as well because we missed out on making that connection stronger. That’s why sleep apnea is such a concern for brain health, is because it’s so disruptive to sleep. But sleep in general is critical to talk about optimizing and making more efficient and effective.

Then the second thing that is so important when it comes to sleep is if we want to talk about that waste or that trash in the brain. Essentially, while you’re sleeping at certain points during the night, your brain shrinks down and it squeezes out all the trash and the waste that builds up throughout the day, which is just a normal part of living. And then fluid comes up from your spinal cord and washes all this trash away. So, every single night, you give your brain basically a squeeze and a wash. [chuckles] We call this like the brainwash. And if you think about– if you don’t get the best night’s sleep, if you’ve ever had that kind of foggy, fuzzy feeling at its essence, that’s too much of this waste left in the brain and that can interfere with your ability to think properly and concentrate. And over time, the buildup of that waste cumulatively can have a really devastating impact and raise the risk of memory loss and dementia. And so that’s why we know for so many reasons, but just two really powerful reasons why sleep is so important for brain health.

Cynthia Thurlow: Yeah, and it’s interesting, the glymphatic system is certainly something I like to talk about. I can certainly appreciate it serendipitously. We are talking on the first day after daylight savings [Marc laughs] and I think most of us are feeling even if we’ve gotten a decent amount of sleep, we feel like we’re a little bit off. And it’s because we’ve had the sleep disruption that is impacting not per se my mental health, but definitely I don’t feel as energetic as I would normally. Talk about exercise, what role does exercise play in brain health? I think the statistics are really interesting.

Dr. Marc Milstein: Yeah. I mean, exercise is another one right at the top of the list of something we can do. It doesn’t have to be a marathon or a triathlon. Intense exercise can be good for some people in certain situations. But what’s really hopeful about exercise is that it’s not nearly as much as we thought in terms of where we get a lot of benefit. So, for example, we talked in the beginning about that 30 minutes of walking a day lowers the risk of memory loss by about 60%. We know that a study came out a few weeks ago that found that 6 to 10 minutes of some intense movement like brisk walking, getting on an exercise bike, maybe jumping up and down, getting the heart rate up for 6 to 10 minutes, had a significant impact on people’s memory, on their ability to remember things. And so, if we just think about as a starting point, I’m going to park a little bit farther from the grocery store, I’m going to walk around my house or my apartment a little bit more, I’m going to get up every 30 minutes or so and try to take about a five-minute walk. And those things add up throughout the day and then throughout the week.

And then thinking about, “Okay, within that 30 minutes maybe 5 to 10 minutes of it, if I’m outside for a walk a little bit faster walk between street signs, a little bit faster pace. We have all these studies that show that we’re calling it faster gait and it’s just like walking speed. And if you look at people who tend to have the ability to walk faster, their brain looks more youthful and you don’t have to powerwalk everywhere you go. [chuckles] It’s not about that, but just as a really good starting point, like going to get some more walking and about 10 minutes of it, I’m going to make it a bit of a brisk power walk. Beyond that, of course, aerobics and strength training, and all those things are great, but just getting the message out that the amount that we’re just talking about gives a lot of benefit and it’s a great place to start, double down, or just embrace and then build from there.

Cynthia Thurlow: So important. And lastly, what are your thoughts on alcohol?

Dr. Marc Milstein: Controversial. [chuckles] Controversial and conflicting studies. So, whenever we see these conflicting studies, we go, “Okay, what does all this mean?” And we can essentially break it down like this. There’s the MIND diet, Mediterranean like diet, heart-healthy DASH diet, one glass of wine a day was included in that diet. And that diet has been shown to be effective for lowering risk for Alzheimer’s dementia. There are other studies that suggest that no alcohol is better for brain health. What we clearly see is that too much alcohol past a moderate amount we’re concerned about for brain health, so we don’t want to go past moderate. So, when it comes to what’s right for the individual, this is another area where we want to say, okay, we want to go one step further and say once or twice a year when your doctor, your nurse practitioner, just say, “What’s my family history? Let’s talk about do I have any underlying conditions? Anything you know about me where alcohol is something that could raise the risk of another condition that’s going to negatively impact my brain.” And people really deserve that level of care for these types of issues.

A lot of things we talked about today is general, applies to almost everybody. But these types of things when it comes to alcohol, we want to say people deserve that next level of communication and guidance and get away from just the headlines or the blog posts and say that the data we know is that yes, alcohol is included in a moderate amount in a brain healthy diet. There’s significant amount of evidence there. But there’re conflicting studies too that suggest that alcohol might not have benefit. And when we see those conflicting studies, we think it’s probably more individualized based upon underlying conditions, genetics, and thus we want to have people go one step further.
Cynthia Thurlow: Well, and I think that’s certainly very reasonable and feasible. And what’s interesting to me is as women and men are getting closer to middle age 40s, 50s, sometimes their relationships with things like alcohol change dramatically. And so, for everyone that’s listening, have that conversation, bring it up with your healthcare practitioner, figure out if this is the right choice for you. And I think that bio-individuality absolutely rules here. Well, I’ve loved our discussion. Please let my listeners know how to connect with you, how to preorder your book, how to connect with you on social media.

Dr. Marc Milstein: Well, thank you. It was so great talking to you and I appreciate you having me on. In terms of social media, I’ve been starting to do more on Instagram, so @drmarcmilstein and then some of the other social platforms too. Same handle @drmarcmilstein my website drmarcmilstein.com and then the book is available in Amazon, Barnes & Noble, local bookstores, anywhere, I think anywhere books are sold. [laughs] So I appreciate that and thanks again.

Cynthia Thurlow: It’s been so great connecting with you.

Dr. Marc Milstein: Thank you.

If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.