How to Rewire Your Brain For Sleep with Dr. Andrew Huberman

Coming up on this episode of the Doctor's Pharmacy. Getting quality, sufficient sleep on a regular basis is without question the foundation of mental and probably physical health as well.

Hey everyone, it's Dr. Mark. My main goal with diet is to use food as medicine. But even when we eat super well, most of us are missing out on certain essential nutrients. Our soils have become depleted and our digestive tracts just aren't working so great. They're compromised by stress and toxins and they just can't absorb as efficiently as they should. And that's why I always use, and I recommend to my patients, a multivitamin mineral as nutritional insurance. It covers the basics for all our day-to-day body functions, all the things that we need that our food might be missing. But there are so many products out there I wouldn't go near because they contain artificial fillers or inactive ingredients, and you have to be pretty picky. The one I trust and take myself is Athletic Greens. They use high-quality, highly absorbable forms of vitamins and nutrients from real whole foods. Athletic Greens comes in a powder that tastes great and mixes easily with water or smoothies, and specifically supports my gut health, immunity, energy, and recovery. And it's not just vitamins and minerals. It has phytonutrient-rich superfoods and adaptogens and pre- and probiotics and even digestive enzymes. I love that they add the digestive support in their powder since so much of our immune strength and overall wellness starts in the gut. It's really one supplement that covers so many bases, and you'd be hard-pressed to find something else in this comprehensive form in any single other product. I use Athletic Greens in the morning as part of my daily routine, and I love having it with me whenever I travel. I also love that it's diet-friendly, whether you're vegan, paleo, keto, dairy-free, or gluten-free. Right now, Athletic Greens is offering my audience a full-year supply of their Vitamin D3K2 liquid formula free with your first purchase. Now, these two nutrients are also so vital for a strong immune system and strong bones, and many of us are not getting enough of them. I use the Athletic Greens powder and their D3K2 formula to make sure I get extra nutrients that complement my diet. They're also going to give you five free travel packs as well. Just go to athleticgreens.com/hymen to get your free year's supply of vitamin D3 and K2 and five free travel packs with your first purchase. you'll get it delivered straight to your door and I promise you'll feel the difference Athletic Greens can make in your daily wellness routine. Again, that's athleticgreens.com/hymen. I'm all about using food first when it comes to nutrition, but there are certain nutrients I recommend everyone supplement with because it's simply impossible to get adequate amounts from your diet alone. One example is magnesium, which our soils, well, they're not too healthy and because because there's no organic matter, they can't extract the magnesium from the soil, from industrial farming, which is a drag. And that leads to 50% less of these minerals in our food than there was 50 years ago. And then of course we're doing things that cause us to lose magnesium like sugar, caffeine, fluoride, even stress, which none of us have, right? 80% of Americans are actually deficient in magnesium. And that may mean insufficient, not necessarily true deficiency, but just not enough for optimal functioning because magnesium is so important. a huge problem for our health. Considering the pandemic of stress, along with the pandemic of COVID that we're facing, we should all really be conscious about our magnesium intake because it activates the parasympathetic nervous system, which keeps us calmer and more relaxed. Magnesium is crucial for more than 300 other chemical reactions in the body and impacts everything from metabolism to sleep, to neurologic health, energy, pain, muscle function, and lots more. My favorite new magnesium is from a company called Bio-Optimizers. Their magnesium breakthrough formula contains seven different all of which have different functions in the body. There is truly nothing like it on the market. I really noticed a difference when I started taking it and I've tried a lot of different magnesium products out there. I also love that all their products are soy free, gluten free, lactose free, non-GMO free of chemicals, fillers and made with natural ingredients. Plus they give back to their community. For every 10 bottles sold, they donate one to someone in need and there's a lot of those. Right now you can try Bio-Optimizers Magnesium Breakthrough for 10% off. Just go to magbreakthrough.com that's M-A-G-B-R-E-A-K-T-H-R-O-U-G-H.com .com slash Hyman and use the code Hyman 10 and you'll get 10% off this really great formula. I think you're gonna like it as much as I do. And now let's get back to this week's episode of the Doctor's Pharmacy. Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacist and F-A-R-M-A-C-Y, a place for conversations that matter. And if you care about your brain, if you care about making it better, if you care about figuring out how to hack the one organ that we pretty much ignored for most of my medical training, other than saying it's not connected to the rest of your body, then you should listen closely to this podcast, because we've got an incredible guest, Dr. Andrew Huberman, who I've known for a number of years. He's a neuroscientist and tenured professor in the Department of Neurobiology at Stanford University School of Medicine. And he's made a lot of really important contributions in the field of brain development, brain function, neuroplasticity. We're going to get deep into that, what that means, which basically is the ability of our nervous system to rewire and learn new things like skills, behaviors, and even cognitive function. He is the McKnight Foundation and Pew Foundation fellow and was awarded the Kogan Award in 2017, given to the scientist making the largest discoveries in the field of vision. Pretty good. His most recent work in his lab focused on the influence of vision and respiration on human performance and brain states such as fear and courage. He's also focused on sleep and many, many, many other topics that relate to brain. He works from Huberman Laboratory at Stanford University, School of Medicine, and his work's been published in major journals like Nature, Science, Cell, featured in Time Magazine, BBC, and has now an amazing new podcast called Huberman Lab, which I would encourage you to listen to because it's basically.

Like boot camp for understanding your body. Welcome, Andrew. Well, great to be here.

Thanks so much for having me and great to see you again. Great to see you again, too. Yeah, it's been a while. We met five years ago in Mykonos at a conference, what a place to meet, in Greece. And it was a really mind opening expansion. Then listening you talk about your work, and I'm sure in the last five years it's grown quite a bit, and you've been focused on really, I think, a topic that most of us aren't really focused on too much, which is how do we take care of our brains, how do we optimize our brains? What are the ways in which we harm our brains? And how do we stop doing that? And how do we actually think about not only our brains, but our minds? Because our minds control the quality of our life. And the quality of our brain function also determines the quality of our life. And it drives all our behaviors, which are the things that we struggle most with, whether it's relationships, or money, or work, or body, or food, or whatever. We're always struggling with those challenges. So how did you come first to understand that the brain was such an important thing and be a neuroscientist. Because, I mean, honestly, I remember reading the neuroscience book by Candell, who was incredible.

He's still alive.

He's still alive. I've met him. He won the Nobel Prize, amazing dude. And I love the book, but I'm like, man, this really is a lot of stuff. I think I'm gonna pick another field. I really have deep respect for neurologists and neuroscientists. And now, you know, 40 years later, after I read that book, it's just gone so far into the, you know, the brain territory and understanding and mapping what it does, how it works, our states, how to change it, how to work with it. So tell us how you sort of got into all this.

Yeah, I was a sophomore in college. I took an abnormal psychology class, and that's the interesting stuff.

Is there something like normal psychology? Because I don't know anybody who has that.

I don't know if they still call it that, but it was called abnormal psychology and you know, it's the discussion of schizophrenia, depression, OCD, and there were very few lectures focused on anything biological, but there were a few. Talked about serotonin. This was right when Prozac first came out. The book Listening to Prozac came out, so this is the late 80s, early 90s. There was one brain imaging study where they showed a picture of a brain lighting up, or OCD, I'll never forget that image, Judith Rapoport at NIH was one of the first people to identify areas of the brain that were involved in OCD. And I loved the idea that there were chemicals and real physical entities to these complicated brain and mind states. It felt to me like something that I could have made sense that it just made sense. It was sort of mechanical. I got the idea in mind that you could actually physically see and maybe even hold on to these things. And so that's what drew me to it. And I eventually shifted over to, there was no neuroscience then. There was actually no neuroscience degree. they called it biopsychology. Really? Yeah. And other places called it psychobiology, which is even weirder. But now we just call it neuroscience, of course. So I eventually joined a laboratory as an undergraduate, and I was working on physiology. I was studying metabolism and thermal regulation, which is it's interesting now that's kind of getting a resurgence with brown fat, interest in brown fat. These incredible studies that were being done at the time of fidgeters, people that.

Fidget a lot burn.

Burn about 2500 calories more per day.

They call that NEAT, right? Non-exercise activity thermogenesis. Yeah, I wrote about that in my first books. I definitely have that. I think that's why I'm thin. I'm a constant fidgeter. And if you were the person sitting.

In front of me in medical school class, you would not be happy. It's amazing, 800 to 2500 calories burn more per day. We now understand, it's interesting, there's some data that show that neurons actually connect to fat tissue. and release epinephrine, adrenaline into the adipose tissue and can convert white fat into brown fat locally. And that's part of the thermogenic effect. It was always thought that the effect of fidgeting was adrenaline release from the adrenals, but it's actually a local effect of neuron. So anyway, I joined a lab where we worked on metabolism. We actually were studying the effects of MDMA ecstasy at that time. My schedule, you know, probably still now an illegal drug, but it's slowly making the migration into clinical trials and treatment on thermal regulation. So I really liked physiology. And to this day, you know, I love talking about the mind and decision making and memory and consciousness and those things, but I was really drawn to it from the mind-body relationship. You know, how we perceive if we are too hot or too cold, involves receptors in our body, neurons in our body, and the hypothalamus, something up in the brain. And so I was drawn to that. And then I went off to graduate school and studied neural development and neural plasticity. And that eventually took me into neural regeneration. I wanted to understand how we could repair the visual system and brain after injury. And over the years, things have kind of drifted back toward psychology, how human beings can modify their experience and their behavior through what I would call self-directed intervention. But it was really that seed of wanting to attach something really physical to what was otherwise a kind of a psychological discussion.

But does the mind really exist in the brain?

So, I don't know. But what I do know, that's a good question.

In Chinese, and I studied Chinese in college, and the language is even different. The word for the mind is heart.

Interesting.

So when you say, you talk about your heart, your shin shin, which is your mind, it's like your heart mind. It's almost like your heart mind as opposed to your brain mind, which is what we talk about in Western culture.

Interesting. I didn't know that. Well, I do know one thing, which is that, and you of course know this, but that the brain and the body are intimately connected in both directions. Yeah. Right. The brain and the spinal cord, our central nervous system, send connections out to our muscles, but also our spleen, our gallbladder, our lungs, our diaphragm, and all those organs of the body, the stomach, of course, are also sending a rich set of connections back to the brain. And so it's that reciprocal connection that is undeniable, that what happens in the body impacts the brain and what happens in the brain impacts the body. And I think that one of the great Triumphs of neuroscience and health and psychology and medicine in the last five years really is that people are starting to really internalize that fact. Yeah, absolutely. As opposed to thinking, oh, you know, if it's mind-body, brain-body stuff that it's somehow fluffy. No, there are neurons in our gut that fire in response to sugar and trigger dopamine release in the brain. And there's no question about it. We have genetic markers for those cells.

We know- It's bidirectional communication.

Absolutely. And so I think that that's the thing that's most exciting to me lately is that the whole world now, I think because, frankly, because of COVID and the fact that people had to become aware of the immune system and the lungs and the brain and the questions, you know, are there effects on the brain? Because of all the questions that are being asked about one's own health, people are aware that their body is a system that includes the brain.

Yeah, incredible. Actually, you know, the last five years, well, you can seem like you came at this by understanding the mind affecting the body, but seeing then the other part was happening. I came at it by working on the body and noticing all these effects on the mind and the brain. And it was sort of shocking to me as a functional medicine doctor back, you know, 20 years ago when I started treating people's physical issues, inflammation in their body. their psychiatric problems in go bay, their PTSD would get better, their anxiety, depression, bipolar disease, schizophrenia, autism, I mean Alzheimer's, their brains would totally change. And I'm like, what's going on here? And I really began to dig into literature and it was really just beginning at that time. But this was like probably started working on it 15 years ago. It was a book called the Ultra Mind Solution, which is about how the body affects the mind. And the subtitle of the book is how to fix your broken brain by fixing your body first.

I love it.

And I think it's not necessarily first or second, but you have to master the physiology of your brain through working on the physiology of your body as an ecosystem. And that's what functional medicine is really all about. And it's that thinking that really is starting to catch hold in the traditional scientific community, which is kind of exciting.

It is exciting. I mean, I love this idea of using the body to adjust the mind in one direction or the other. because you know, the brain is housed in this cranial vault, this thick thing, right? So we don't have access to it. You can't just drop electrodes in there. It's not trivial. We do it, but you have to drill through the skull. You can take a drug- I'll pass on that one. Yeah, so you can go into the gut, but then of course has to pass through the gut brain, you know, the blood-brain barrier. But the ingest, what we ingest and how we move has a direct relationship because of these these neurons that connect the body and brain. And so I think that in the very near future, we are going to see a tremendous tide change about this mind-body thing. And I think we can look to the gut-brain interaction as one of the major reasons for that, that people now understand that there's stuff goes on in their stomach that impacts their mood.

It's body mind.

Yeah, 10 years ago, yeah, it should be body mind. or body brain. But I think 10 years ago, if you said that, oh, you know, eating probiotics is going to shift the way you feel psychologically, people would have thought that was complete, you know, fluffy, meaningless, you know, whatever pseudoscience. But, you know, I've got an upstairs colleague at Stanford, Justin Sonnenberg, who's done the work showing that people that regularly ingest fermented foods that inflammatory markers go down, but all these incredible positive psychological effects too. So, there's now a lot of science to support it, but I'm telling you what you already knew.

No, I mean, I know. This is so huge. This is such a huge idea because most of us are pretty well aware that we want to lose weight or keep our bodies healthy, we have to eat well, we want to exercise, we understand we need to sort of condition our bodies and get healthy. if you ask most people, what are the things that your brain needs to thrive? They're gonna be a pretty clue. Yeah. Like, they're gonna.

Right.

You say, doctor, how do I improve my brain function? You know? Well, you know, do sudoku puzzles. You know, like that. Yeah.

Or the whole nuns don't get Alzheimer's. Right. You know, this whole thing, like. Like the example of, like, blue zones and nuns and things like that. And they're. They provide insights, but they. They're. It's unclear what the directives are.

Yeah, for sure. And you've spent a lot of your time studying the way in which we can access our brain through our biology and then change our brain states to enhance its function. Can you talk about that work?

Sure. So the brain has different states, and states are a little bit like emotions, but they're easier to talk about because emotions are very subjective. Your sense of happiness and my sense of happiness, could be similar, but we don't really know how to scale them. States are best thought of first by thinking about a state that we all go into, and we can all agree on it, which is sleep. So sleep is divided into multiple stages, but it's a state of inaction. No surprise there. We're not walking around unless we're sleepwalkers. And it's divided mainly into two general states. One is the early part of the night, when we are mostly in slow wave sleep and our body is repairing itself, that's mainly growth hormone is released, that's a state in which our dreams tend to have very little emotional load, and it's mostly about motor learning, physical repair of the body, etc. And then the second half of the night, where we are in so-called REM sleep, rapid eye movement sleep, is the other major state where the dream content tends to have a lot of emotional richness, the dreams are very intense. And we know that we don't release the molecule epinephrine, adrenaline during REM sleep. And it's sort of like a built-in every night therapy, exposure therapy. The argument we got into with somebody a few days ago, the challenge that we're going through in a relationship, an old thing wound or shameful thing gets worked out slowly over time in sleep. And we are confront, we're basically confronted with stuff in sleep. in this REM sleep, and we don't release the molecules that allow us to act on that. If you ever wake up from one of these dreams, you immediately get a surge of adrenaline.

It's very intense. Right.

So it's kind of like built in exposure. It's not happening when you're awake. That's right. And then we wake up and we don't have a language for waking states the same way we do for sleeping states. So then we wake up and we don't have a language to explain the states that we go through in waking the same way we do for sleep. But there are two general features of states that I think are really powerful as an anchor point for thinking about states of mind and emotions, et cetera. And those are the ones that are regulated by the so-called autonomic nervous system. And the name is a real misnomer because it's the system in our body. It's sort of like a seesaw that takes us between different levels of alertness and calmness. Some people talk about these in terms of the sympathetic and parasympathetic nervous system, but we can just discard with the nomenclature for now. Sympathetic means more alertness, parasympathetic means more calmness essentially. And it's sort of like a seesaw. And so the way to imagine this is that throughout your day, you have varying levels of alertness and calmness. Now, if you are very alert, extremely alert, we call that panic or anxiety. But with that also comes something beneficial, which is focus. So we know that without alertness, there's no focus. And then there are states of deep calmness. Sometimes we think of that as fatigue. It could be fatigue at its extreme, but it could also be a nice feeling of tranquility. And in states of calmness, the mind and the way that thoughts are organized and feelings are organized is that there tends to be less linear structure. Actually, there's more creativity in calm states than there is in hyper-focused states. Hyper-focused alert states are great for implementing a strategy you already understand.

Like running from a tiger, like running.

From a tiger or performing surgery or your kid comes to you and has a problem and to them you can see that it's huge but you know how to navigate this problem because you have the perspective of having been a 14 year old before. So you say, okay, here's what we're gonna do, who talked to who, who said this, you know. So there's nothing really creative about that situation. It's just kind of an implementation what you already know. So this We don't, again, we don't have a language to talk about what creativity really is at a neuroscience level. We can start to approach it or what focus is or what stress is. But if we all could understand that there's an undeniable truth about our nervous system, which is that our states of alertness and calmness set us up to be better or worse for certain kinds of events. So, for instance, if you want to sit down and do focused work, if you're too calm, too sleepy, that's not good. Your mind will drift. Similarly, if you want to relax and have a meal, if you're too stressed, if you're too alert, that's not good for all sorts of reasons as we know as well. So, one of the things my lab has really been focused on is to try and figure out what are the levers, what are the entry points for people to be able to deliberately adjust their level of alertness and calmness in this kind of seesaw-like fashion, and then to just elaborate on the seesaw analogy a little bit. Try and imagine oneself not as the seesaw, but you're a person on the seesaw. So you're right all day long, basically you're moving back and forth. You're kind of surfing this seesaw between alertness and calmness. And one of the places where we see pathology, acute stress turns to chronic stress, or acute stress turns to chronic fatigue, is when the hinge on the seesaw gets too tight and the thing gets locked at one side. Yeah. Okay. And a lot of people are locked.

In the stress state.

Locked in the stress state or locked in the stress state.

I don't think there's too many people.

I see walking around too calm and relaxed.

Right.

Because the hardest thing to do is an active process to be in the mid to surf the seesaw.

Yeah.

This is what we, you know, the reason just a simple seesaw doesn't work as an analogy is because it's an active process. You're literally making adjustments all the time. Like surfing. Exactly. And what happens in sleep is it's as if we get to climb off the seesaw and relax for the night and then get back on there and we're able to surf the seesaw again. So we know there are a couple sort of foundational truths that can emerge from this model of how the brain works and how the mind works, which is that if we don't sleep, the hinge gets very loose on the seesaw. like stress, stress, stress, stress, exhaustion, stress, stress, stress, exhaustion. It kind of bangs back and forth. And it gets harder to surf this seesaw. And so sleep is sort of the foundational element of all waking states. We often think about sleep as its kind of own thing, but sleep is the thing that allows you to deliberately access waking states in a really directed way.

We're gonna get really deep into stuff.

So that's the way I think about it. All of this serves as an entry point to discussions about plasticity, et cetera. But one thing to emphasize is that the seesaw and surfing the seesaw is not a brain thing, it's not a body thing, it's a brain-body thing, or more appropriately, as you said, a body-brain thing. It's a loop. So we can't say that our states of alertness are because of what's going on in our head because we've also got adrenal glands that are releasing adrenaline. malignant. We can't say that states of calmness are just about relaxing the mind because it also involves turning off a number of systems in the body. And the nervous system is really what is responsible for that. And so what's exciting is that there are now entry points where one can adjust the level of alertness or calmness. Yeah. That one can get better at surfing the seesaw, as, as I'm referring to.

Well, I've never really described like that, but I think that's very the description of something I've learned to do to actually manage my brain and my physical states. And I developed all sorts of techniques over the years that work for me, and they're different for different people. But, you know, for example, if I'm, like, working on a project, I'm just foggy and stuck. I'll, like, take a steam and I'll jump on an ice bath. That'll change my state. Right. Well, the adrenaline from the ice bath.

Will definitely put you in a more alert state.

Yeah, I meditate. or I'll do yoga, or I'll get a massage, or I'll go sit by a river. There are mechanisms that I've learned that are ways to change my state. And then even using food to change your brain states and using supplements and using all kinds of hacks essentially to regulate the thing that we feel like we can't regulate. Because a lot of us feel powerless at the effect of our minds. and the effects of our cognitive states. And we don't realize that there are all sorts of doorways that we can use to actually enter different brain and mind states by certain techniques, whether it's breathing or, you know, hot and cold therapy or all the things that I mentioned. So from your experience, you know, how do people start to learn those things? And what are the, what are the most important things you come across that are important for helping people to regulate the that process, that seesaw, they're surfing instead of getting stuck.

Yeah, so there are approaches that are going to work very quickly and there are approaches that are going to be slower. And you might say, well, I just want the fast ones, but the sort of health of the seesaw, if you will, the integrity of the seesaw and the ability to surf it relies mainly on a couple of foundational elements. And these are going to be slow, acting systems in the body that I don't want to bring in too many analogies, but the way I think about it is like if your well-being, if you will, is sort of like a boat on the shore and the tide has to be in for the boat to get off the shore. And so there are things that you can do on a regular basis that establish a basic ability to operate the seesaw, to surf the seesaw. And certainly sleep is going to be the number one variable. Getting quality sufficient sleep on a regular basis is without question the foundation of mental and probably physical health as well.

It's amazing. Many people don't understand that.

Yeah, it's a non-negotiable thing. I think that many people are afraid to acknowledge it because people have now, once you really appreciate how vital sleep is and how great life can be if you're getting good sleep and how terrible it is for our health, both immediate and long term, if you're not. I think then it creates its own sleep anxiety. And so one of the things that I've been very active at for sure. Yeah, where you think, to be fair, the body and brain are resilient. If you don't get a good night's sleep every once in a while, it's fine. You can manage that. Certainly new parents do just fine over time, although it's challenging. But there are a few things that really help with sleep. So in terms of and there are a lot of causes of insomnia and things. So they're the basics like avoiding caffeine in the afternoon if you're caffeine sensitive, et cetera. But one of them is to start to understand that this state of sleep is not something that you should be able to drop into unless you do a couple of other things properly. And based on the research done in part by my lab, but mainly a guy out at the National Institutes of Mental Health named Samer Hattar, he's the director of their chronobiology unit, he's done these beautiful beautiful studies showing that light exposure early in the day, getting bright light exposure, ideally from sunlight within an hour, ideally within 30 minutes of waking up, is vitally important for getting sleep later that night. And the reason is, is it basically once every 24 hours, you're going to have a spike in cortisol. It's non-negotiable it's built in your genome. It's going to happen.

So do people in like Arizona sleep better than people in Seattle?

Well, they do actually, and a lot a lot of people in Seattle need light boxes because if you live in an area where you can't get sunlight first thing in the day, feel free to flip on artificial lights. But you want basically the rule is you want as much bright, ideally natural, but if you can't get natural, artificial light would be fine early in the day. And what that does is it basically times this cortisol spike to wake you up. That spike in cortisol isn't to stress you out, it's to wake you up. and then it sets a timer on your melatonin release. So 14 to 16 hours after your bright light exposure, you're going to get a pulse of melatonin, which is the hormone, of course, that promotes sleepiness and puts you to sleep independent of any supplementation of melatonin. Light inhibits melatonin through a direct pathway through the eyes to the brain stem and then up to the pineal. It's a well-established pathway. So the number one thing is get bright light exposure to your eyes. So, no sunglasses, eyeglasses or contacts are fine early in the day. How long? Well, it depends on how bright. So, anywhere from two minutes to 10 minutes. Ideally, you're not looking at your phone during that time. Ideally, it's sunlight, but if you wake up before, you know, flip on a.

Bunch of artificial lights and then get.

Outside once the sunlight is out. Just outside taking a walk. You're not looking at the sun, right? You're not looking directly into the sun. You don't want to burn your retinas out. Indirect exposure is fine, but there's a class of neurons called the melanopsin ganglion cells that reset your circadian clock and time things nicely. They time the cortisol, the time the melatonin. So, that's the number one thing for, I wouldn't just say for sleep, but also for optimizing levels of alertness throughout the day. The other thing is that you really want to avoid bright light between the hours of 11:00 PM to 4:00 AM if you're on a standard schedule. Shift workers is totally different. The reason is Sammer's lab and a guy named David Berson at Brown University have shown that bright artificial light of any color, blue blockers or no, if there's bright artificial light, it activates a pathway in the brain involving this brain structure called the habenula. When I was an undergraduate, actually someone asked in neuroanatomy, what's the habenula do? No one knew. The habenula is involved actually in generating our feelings of disappointment it suppresses dopamine release for several days afterward. Now, if you have to go to the bathroom or you have to pull an emergency trip to the supermarket or something in the middle of the night, you don't have to worry about crushing your dopamine long term. It's a chronic thing, but you really want to dim the lights in the evening starting at about 10:00 p.m. and- so you're saying those blue blocker things, that doesn't work? Well, the blue blockers will work, but if the lights are bright enough, it doesn't matter what wavelength. they are. And this is because these melanopsin cells, these neurons in the eye, they do respond best to blue light, but they're very broad spectrum, the wavelengths that they will respond to. You can shine bright red light on one of these cells and it will signal to the brain time to wake up. Amazing. So it's really key to just dim things down. And I always say blue blockers are terrific, but you don't want to wear them during the morning and early part of the day because blue light is the optimal stimulus for this wake up signal. So, we took, the blue blocker thing is great in principle, but people kind of took it too far. So, bright light when you want to be awake, and alert, and dim light when you want to be asleep.

So, how many hours before bed? Because people are up on their TVs and their screens, computers and phones.

Yeah, so the subtle things that people can do are to start dimming the lights in the evening right about the time the sun goes down is when you want to say, oh, the sun is going down outside, and if it's overcast, It's getting dark, well that's the time to dim the lights in your home. The other thing is because of the where these neurons are situated in the eye, overhead lights will activate this wake up signal much more readily than lights down low. So the Scandinavians have it right. In the evening, you want desk lamps, most people aren't going to have floor lighting in their house. Desk lamps in early in the day and throughout the day, that's when you would want overhead lights. Those two things are going to be very beneficial. A lot of bright light, overhead light throughout the day, ideally from sunlight. And then in the evening, avoid bright lights of any color, any kind between 11 p.m. and 4 a.m. Don't get neurotic about it, but many people find that just making these changes.

So you don't have to be off from like 6 o'clock at night.

No, no, no, no. And there's actually the third tool, which is also grounded in really nice work. paper published in Scientific Report shows that if you get some sunlight in your eyes in the evening, right about the time of sunset, if you can't get it from the actual sunset, just go outside. You don't have to see the sun setting. You just need the light, the ambient light, the outdoor light in the morning is sufficient. There's so many photons out there, even on a cloudy day, you'd be amazed. In the evening, if you see or get outside and get some sunlight or you get some light in your eyes, that has an effect of lowering the sensitivity of the retina, of the neural part of the eye and provides you a kind of insurance. It offsets a little bit of the late night bright light exposure. I call it sort of your Netflix inoculation. It kind of protects you against some of the ill effects. Now, if someone's schedule is really messed up, I mean, they're not sleeping, they're really screwed up. There's a study out of the University of Colorado that showed that this is a little extreme, but going camping for two days, reset these melatonin and cortisol rhythms for two weeks.

It's pretty incredible.

It's really incredible.

I noticed when I go camping or I go out in the wilderness or far away from technology, I just sleep way better. We had a storm my house last summer and we got power out for four or five days and we just had candles at night. and it was unbelievable. I loved it and it felt so good to not have all that bright light at night and to go to sleep and sleep better and deeper. Yeah, you really reset.

Hey everyone, it's Dr. Mark.

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Episode of the Doctor's Pharmacy. I'm glad you mentioned candlelight. Candlelight in the evening is fine. Actually, not to turn people into geeky scientists, but there's a great app. I have no relationship to it, but it's completely free. It's called a light meter. And, you can run this experiment. You can download the app. You go outside on an overcast day in Boston in January and press the little button on light meter in the morning and it'll show you that even though you don't see the sun, it looks like cloud cover, there'll be something like 5,000 lux of light. You'll go inside, you'll point the thing at a really bright artificial light, and it'll say 300 lux. Close the window to the outside, and it reduces it by about 50 fold. So you don't want to do this through a window or a car window. And then you say, well, wait, you just said that there's very little light intensity coming from artificial lights. Why is it so bad at night? I should be able to turn on every light in the house, and it won't reset. But the clock and your eye get more sensitive as the day progresses. So you have to control it at both ends. And candlelight is fine, dim light in the evening is fine. But throughout the day, you really want to try and get some bright light exposure. And for many people whose schedules are just really screwed up, anchoring to these two or three things of bright light exposure and avoiding bright light in the evening hours between 11:00 p.m. and 4:00 a.m. often, not always, can really reset people's ability. And once you're sleeping well, everything else gets better. So that was kind of the first question you had. The other one is that I'd be remiss if I didn't mention that there are things that people can take. I'm sure you're familiar with several of these as well. Obviously, well, we have a doctor right here. So talk to a doctor. Obviously, I'm not a physician. I'm a professor. so I don't prescribe anything. But the three things that have, have made a tremendous difference. You profess. You don't. I profess. I don't prescribe. That's right. That's how I usually say. Profess lots of things. The three things that I've certainly benefited from, and I know a number of other people have, and for which there's really good research, are apigenin, A-P-I-G-E-N-I-N, which is, it's very inexpensive. It's chemomile extract and it basically turns on a chloride channel mechanism in the brain. It turns off thinking. It's kind of the equivalent of an alcoholic drink. It just turns off thinking. You could still drive on the stuff.

But it makes people drowsy.

So drink chamomile tea or you have to take a concentrated. Some people get that benefit from chamomile tea. Other people like the apigenin. And the other ones are the magnesium, magnesium and magnesium threonate and by glycinate in particular. threonate spelled T-H-R-E-O-N-A-T-E and by glycinate, I won't spell out, but sort of just as it sounds. Those cross the blood-brain barrier more readily because you're ingesting this obviously into the gut and then that magnesium needs to get into the brain and basically the magnesium seems to act as a precursor to GABA, the inhibitory neurotransmitter. And so for people who have a hard time turning off their thoughts, that can be very beneficial. so there's the kind of light, which is a kind of ancient mechanism by regulating alertness and getting into sleep. And then there's the modern thing, which is supplements. And there's something sort of in between worth mentioning, which is there's a great tool that was developed by my colleague who's our associate chair of psychiatry at Stanford. His name is David Spiegel. He's actually a clinical hypnotist, has done a lot of work on pain management and even breast cancer outcomes from hypnosis. and he's developed a free app that's on Apple and on Android called Reverie R-E-V-E-R-I. It's a 15-minute hypnosis that you do in waking which trains the brain to sleep better. And I think that a lot of people hear hypnosis and get a little bit freaked out, but there are a lot of clinical data showing that this can help people to learn to turn off their thoughts and to relax and go to sleep. And there's some other nice hypnosis scripts in there as well. It's David's voice and he kind of walks you through it. So those are, aside from the supplements, the light and the hypnosis are free resources that I think most everyone could benefit from. If I wake up in the middle of the night, oftentimes I will do one of these hypnosis scripts. And just one other thing about sleep. A lot of people wake up at 3 or 4 a.m. and can't fall back asleep. Okay. I never understood why that was. And then I talked to the folks in the sleep lab at Stanford and I talked to the Here's probably the reason. There's an asymmetry in this seesaw that we all equipped with internally, which is that we can all push on and stay awake more easily than we can just force ourselves to sleep.

That's true, right?

At some point we fall asleep. But if you're waking up at 3:00 or 4:00 a.m., unless you're drinking too many fluids, and that's the reason why, chances are you are running out of melatonin, at that point, the levels of melatonin in your blood are dropping. And what it means is you stayed up too late and you probably are one of these people that should be going to bed at 8:30 and waking up about 3:30 or 4:00 a.m. And people don't like that answer because they think, no, but I want to be the person that goes to bed at 11. And there are ways to shift your circadian rhythm that we could talk about, but try and go to bed one hour earlier and chances are you will wake feeling better at 3 or 4 a.m. Now, it's not exactly a solution, but if you're in an argument with your spouse or something about going to bed at one hour or the next, you can leverage biology or cite this discussion.

Wow. So, we really have this sleep epidemic problem and people are struggling with figuring out how to deal with it. And, your lab and you have worked really a lot on how do we navigate the landscape sleep of sleep because as we're having this conversation, whatever I ask you, you keep coming back to sleep, which is fascinating to me as a foundation. And we always think diet's the foundation, exercise, foundation, meditation, but sleep is sort of that neglected fourth leg of the table.

Well, and it's the thing that we've been encouraged to push through. And I mean, there are some elements, I mean, that we could get down into the fine science of it. You know, we sleep in 90-minute cycles. ultradian cycles. Better to wake up after six hours than seven, right? For most people, for sake of alertness. So waking up at the end of one of these 90-minute cycles, you're going to feel more alert than you would say if you slept into seven hours would mean you were about, you weren't complete through your last ultradian cycle. But sleeping at 7:30 would be even better if you can. So getting the right amount of sleep, it's a process that you want to master on average, right? The one occasional all-nighter, you'll be okay. You drink coffee too late, you'll be fine. But on average, you want to be sleeping. Most people, it's going to be anywhere from five to eight hours a night. Naps in the afternoon seem to be okay. The hypnosis script and the other things will really help people get centered around this. I think that the idea of breaking up one's sleep, there were these crazy sleep cycles that were promoted. Not to be confused with Huberman, they called it the Uberman schedule. I just want to be very clear, not Huberman schedule. There was a study that came out recently that showed that it's incredibly detrimental to all sorts of inflammatory cytokine markers. Did you see that study? Oh, no, to try and sleep two hours, wake up, sleep two hours, wake up, sleep to around the clock. There are people that they found they could compress their total sleep time. This was kind of a Silicon Valley thing. trying to master one, you know, you just have to have these human bodies.

You've got to actually.

Yeah, you can't conquer that. But I think sleep is vitally important. Then I think, I do think that foundational diet and supplementation and from the literature I've seen, I'd love your thoughts on this, that the literature that impresses me the most in terms of diet and the brain and brain states are the studies that look at EPA, essential fatty acids, and the gut microbiome. Those are the two things that to me, it's undeniable. I don't understand how anyone nowadays could even question the idea that getting proper lipid intake, you know, essentially- Dr. What your brain is fat, yeah. Dr. Yeah, these Omega-3s are so important. I mean, in several double-blind placebo-controlled studies that I've read, it appears that getting a thousand milligrams or more per day of EPA. So not just taking a thousand milligrams of fish oil, but making sure that you're getting above that threshold of a thousand milligrams of EPA from quality sources compares just with similar effect as SSRIs, prescription antidepressants, but without the side effects, which is incredible. And that if you are taking SSRIs, it allows you to take a much lower dose to still be effective. To me, incredible data. And then the other one is that getting fermented, ingesting fermented foods, one or two servings a day. Sauerkraut for the brain. Yeah, sauerkraut for the brain or whatever given culture. Because what I learned, and this is very new and emerging data, there's a guy at Duke, he's incredible. He was a nutritionist, but then he has PhD in nutrition, excuse me, and now he's a neuroscientist. his name is Diego Borges, not to be confused with the Argentine writer Borges. He's Ecuadorian, and he found that there are neurons in our gut of the vagus nerve. So these are neurons that live in the gut and to endothelium, and they sense three things. They fire electrical signals to the dopamine centers of the brain in response to fatty acids, right? When fats are, you know, meats and things are broken down in the fatty acids, amino acids of other kinds, so from protein, and sugar. And so these neurons can easily be tricked into signaling the brain to release more dopamine, because dopamine is really the molecule of craving, into craving more of whatever activated those neurons. And so if you give these neurons enough EPA or enough amino acids, so protein and essential fatty acids, the dopamine centers of the brain are just firing like clockwork, which is going to enhance mood, motivation, energy. I mean, dopamine in proper amounts is a beautiful thing.

Too high, obviously, you don't want, but you're not going to get it too high.

People don't get addicted to chicken breast, but they get addicted to sugar. Right. And I actually think that's because these neurons seem to be responding best to particular amino acids. They seem to want glutamine, of all things. They seem to want the omega-3s. and what's interesting is that even if they numb the taste so that people can't taste sugar, if people ingest sugar.

These neural receptors in your gut, right?

And they crave more sugar even if they can't taste the sugar. So I always thought that the dopamine release to sweet things was because it tastes so good. But the Borges lab results and some other work on dopamine more generally from my colleague Anna Lemke at Stanford shows that dopamine isn't so much about pleasure. We all, including myself, were taught it's about pleasure. Dopamine is about craving more of whatever it is triggered dopamine release.

Yeah. Whether it's heroin, cocaine, or sugar. Right.

Or sugar. And so these neurons that trigger dopamine release, they are powerfully affected by these quality omega-3s and by amino acids. And then what's really interesting is that they trigger the release of dopamine. But then you say, well, okay, that should be pretty simple. We should, like you said, people don't get addicted to chicken breasts. And I wonder whether or not that's either because omega-3s are too low. So these neurons are not. The full concert of these neurons is inactive. Or it could be that for some reason that the other things that people are ingesting has messed up these neurons. And so the whole brain-body relationship is disrupted, and it's. I guess Robert Lustig is his name at UCSF.

Yeah, yeah.

And others are now showing that some of the emulsifiers in foods and other things like that, what they do to the gut endothelium, I never really understood how the gut brain thing works. But what I realize is that these microbiota, they don't care about us. What they do is they're trying to find conditions in the gut where the mucus is, pH of the mucus is just right. And that if people ingest emulsifiers and sugars, what happens is these neurons and Boris Slava has shown this that these neurons that are in the gut endothelium and can sense amino acids and can sense essential fatty acids, they actually start to retract their processes into the deeper layers of the gut. In other words, if you ingest the wrong things, pretty soon the neurons in the gut remodel the bad kind of neuroplasticity and you lose your gut brain sensing system. And so it's not just a matter of giving it the things. It's really about, for many people, it's going to be about repairing this system and, and allowing that this portion of our nervous system to, to grow back. Now, the nice thing about peripheral neurons is that they grow back. So.

By the way, I just got, I gotta unpack that because what you said was just so profound right there. Basically, you're talking about uncoupling the, the natural ability of our body to sense its environment. and to self-regulate in the right way to create health, when we eat processed food that contains ingredients that screw up the gut microbiome or the lining, and all of a sudden that the brain in the gut, or whatever you want to call it, the neurons in the gut, start to change as a result of the crappy food we're eating and make us less able to seek out and want the foods that are good for us. and tend to make us seek out and want the foods that are bad for us.

Exactly.

That is a massive brain state shift for me because I never really understood the mechanics of how that happens. But it's clearly true when people are eating bad foods, they want more bad foods and they keep eating more and more of them. And there are many reasons for that, but the gut story is just fascinating.

Yeah, these neurons and really, you know, I tipped my hat to the Borges lab. It's cool, you know, science, as you know, can get really entrenched and then someone comes from a completely different perspective of, you know, his background in nutrition. And he described it actually, it's a relevant story here. He had a friend who was, she was very overweight and she ended up having a gastric bypass surgery and she lost a lot of weight and her diabetes went away. but she also started craving runny eggs, you know, easy over runny eggs. But previously, just the thought of runny eggs made her nauseous, made her want to vomit. And he heard that story and he realized that cravings themselves are modified by the conditions of the gut. How could this be? So he started exploring, what are these neurons in the gut? Who are they? What brain areas are they talking to? It's very clear that these neurons, they innervate the gut, they're part of the vagus nerve. connect to the brain areas that release dopamine and create craving. And so the health of these neurons in your gut is strongly going to impact what you want. And so what I love about the literature, and I haven't had anything to do with the research I'm describing, but I've spent a lot of time with that work. What I love about the work that he's doing and others are doing is that it really points to A, the brain-body connection. is mediated by neurons. B, that what we crave and what we seek really can change. I think that a lot of people that are having a hard time shifting towards healthier eating or healthier relationship to light, so we talked about a few moments ago, it starts becoming reflexive, not just because it's better for us, but because our nervous system actually remodels itself in ways where the good stimulus starts to evoke dopamine release.

Yeah, I find that for so true. If I go off track, I just want more of the bad stuff. stuff. If I stay on track, I want more of the good stuff. Like I naturally will crave the things that are good for me. But I think what's happened through, through our radical dietary changes is we've gotten so far away from our natural sort of ability to seek out things that nourish us. And, and we've lost that animals have that they're not going to be running around eating things that are going to make them sick and gain weight and cause damage to their gut microbiome or whatever. But they're not thinking about it. Their body naturally will seek out, oh, I want this plant because it's got this nutrition in it or this one has this phytochemical. They're not thinking that, but their body is telling them where to go, where to look and what to eat. We've sort of really decoupled our ability to be in touch with our natural healthy cravings and have been hijacked by the food industry to desire all these foods that are driving us into worse and worse states of dysfunction poor health and poor brain states and poor brain function.

Yeah, it's interesting because the discussion about light and the discussion about food are remarkably similar from the perspective of these neurons in our eye, they don't think. They'll respond to light at 1:00 a.m. when you're watching Netflix just as well as they'll respond to sunlight because of their sensitivity at that time of night. They don't care. They'll work for you or they'll work against you. They don't have a mind of their own. cells. These cells in your gut are the same. And so I think that what's exciting as more and more of the neuroscience and emerges in these other fields like nutrition start to really infiltrate neuroscience in a positive way, we're starting to realize that giving the brain and the body the proper stimulus and there is a proper stimulus, there is a right time of day to get sunlight and light in your eyes and there's a wrong time. of day. There's a right set of nutrients, amino acids and fatty acids, are what your body really craves, but we've been giving it decoys, right? Sugar is a decoy. It really is a decoy. These neurons, unfortunately, respond to sugar, connect to the dopamine centers of the brain. And as I mentioned before, even if we don't taste the sugars, they're triggering these mechanisms. So I think that neurons are both beautiful and remarkable, but they're also dumb. They'll send these signals to your brain to a variety of things that you give it. So you want to know what is the proper input? Like, what do I need to give these neurons? When do I need to give it sunlight or amino acids, essential fatty acids? Because that's really what we crave. There's no essential carbohydrate. And I'm not an anti-carbohydrate person. I eat starches. I actually find them very useful for falling asleep at night.

They really help. Well, it's not only what to eat, it's what to eat when, right? Right. We are totally flipped in this country. We eat all of our sugar and starch and carbs in the morning, not.

So much at night. Yeah, I tend to do it the opposite. I'll fast in the early part of the day and then I eat meat and vegetables throughout the day and then starches at night. That's just what works from a neurotransmitter perspective to be alert and then asleep. The other thing I realized the other day is that it's weird because really healthy clean proteins taste better than dirty proteins. But really healthy clean carbohydrates, it takes They don't taste, they're not as intuitively tasty as like chips and things like that. Like what? Well, I feel like a really good, I eat meat, so a really good steak tastes delicious. A lousy steak or like beef jerky is never as good as a steak. Whereas a bowl of white rice is like, maybe it's just the way I cook it, is not as tasty as.

A bag of potato chips, right? For me, I'd much rather eat a.

Sweet potato than a bag of potato chips.

Yeah, I probably need to up my culinary game.

Like, I mean, you know, I. Yeah.

I mean, it's interesting, you know, we, we think, you know, we sort of willfully want this or that food. I know, I'm, I'm wanting this, but it's actually our brains are sort of taken over because we've not been treating them properly and we're craving all the wrong things and we're not craving the right things. Yeah, absolutely. And I've said this before, like, when I walk by, for example, like a Starbucks display and I see all the muffins and, or anywhere, you know, like, and a croissant, it just doesn't look like food to me. Yeah. Like, why would I eat that rock?

That stuff has lost its appeal to me as well. One thing that's relevant here that I think actually is useful knowledge, and my colleague Anna Lembke, who's a psychiatrist, studies dopamine and craving. She explains something to me that it makes sense when you hear it, but it's not intuitive before that, which if you've ever tasted like a delicious piece of chocolate or you've had a delicious experience, I'll let people use their own mind to that. Or something really, really wonderful that you love. The sensation in your mind is not one of pleasure, believe it or not.

-What is it?

-It'S a sensation of craving more. And you can do this if you're a chocolate lover. I don't want to send people on a chocolate.

I can eat too much chocolate.

There's a point where I'm like, I'm all for this. Sure, but absolutely. There's a point where you hit a threshold, but dopamine, we know this from animal studies and human studies, and this is one of the reasons it can create addictions in its extreme form, is that pleasure and pain have this reciprocal relationship. And when you eat something that tastes really delicious, if you just insert your mind into the process for a second, unless you're being very mindful and really kind of doing the Buddhist thing of really just tasting it, Yeah. The way dopamine release works is it makes you think about the next bite. And this is true. Imagine any experience. Oftentimes, it's not just about the presence of the thing you're in, unless you've done a lot of conscious work around experiencing pleasure and all its like immediate container. Right. And this is what, I mean, this is why people gamble. This is why people eat more sugar. This is why people get addicted to anything. And so I mention it because when the first time I heard it, I thought, no, that's not true. I really love this experience or this thing. But then I started to pay attention, start to realize that oftentimes our mind goes to yes and more please. Yes and more please as opposed to just, and that's dopamine release in full form. And so dopamine release is a little bit of like a jet pack that gets attached to us that puts us toward a destination. And dopamine isn't bad, but I think once people understand the nature of craving, they can be in a position to to maneuver around it better.

So you're speaking really about, you know, how do we play with our brains in a different way than we thought about? And you talk about this idea of neuroplasticity, which I'd like to sort of jump into a little bit. You know, the brain, what I learned in medical school was that you were born with a certain number of brain cells, and that's all you get. And if you used up too many in college by staying up all night or doing drugs or partying too hard. Well, tough, you know, that's all you got. But it turns out that's just not true.

That's not true.

That we have tremendous ability to restore brain function, to bring back, you know, all sorts of things at any age that we just didn't think possible. I mean, I just, I had a patient who, you know, was 70-ish year old guy who had a stroke and was paralyzed on one side. And, you know, traditional care is like, you know, just do rehab and. take your blood thinners and cross your fingers and, you know, hope for the best. And I'm like, hell no. We know a lot about how to optimize brain function. So I put them on a ketogenic diet, which helps the brain repair and heal. I had him do hyperbaric oxygen therapy. I had him do IV nutritional therapies like NAD, which helps the tissues and cells in the brain repair. It helps the energy cycle. I had him take a number of supplements that help with inflammation. My mitochondria and I had him do exercise, the whole cocktail of things, because it's not any one thing that's going.

To make a difference.

Even had him do sort of derivatives of stem cells and things like exosomes. And it's unbelievable to see how much he's been able to recover and repair from what we would have thought in medical school when I was going to medical school was a permanent disability. And now he's not disabled. He's walking, he's using his body, he's doing things come back. It's not 100% yet, but it just compared to what we imagined was possible, we're seeing things we never thought possible. Like whether it's reversing Alzheimer's or autism, strokes, trauma, brain trauma, even things like depression, anxiety, PTSD, we're seeing all sorts of doorways into repairing that. The psychedelic therapies that are being used now or MDMA therapies for trauma and for PTSD. are changing the way we think about accessing the brain. It's like, how does that even make sense that you take one therapy of psilocybin and all of a sudden lifelong symptoms are gone of depression? It's wild, right? It's pretty wild. We just like, oh, you need 30 years of therapy and psychoanalysis five times a week and nope, just go on this seven-hour journey with a therapist and.

A guided experience and something shifts in your brain. Yeah, the data coming out of Hopkins is in that are really impressive. I think we're going to look back the work of Matthew Johnson and some of the other groups in the UK and the MAPS groups. And I know less about the MAPS groups, and I think we're going to realize that, yeah, they are true pioneers. And it's a topic for another discussion perhaps, but what they've had to go through in order to bring credibility to this area has been really, really incredible. Yeah, so neuroplasticity is real. The brain's ability to change itself in response to experience for better or for worse. I think that most of the discussion about plasticity is going to be what I call adapt, we don't have to get too much lingo, but adaptive plasticity is the stuff we want. And plasticity after a head injury or from chronic illness is the kind of plasticity we don't want. But if we say plasticity, it's almost always neuroplasticity of the type we want. I think the way to think about neuroplasticity is that early in life, our brain is extremely plastic. Our brain is basically designed to wire itself up from about birth until age 25, which is not to say we don't need guidance from parents and peers, etc., but that the brain is trying to create a map of its experienced so that it can move forward from that point. There are areas of the brain that are not very plastic, and we should all be grateful for that. Areas like the areas of the brain that control your heartbeat, your respiration, to make sure your gut continues to churn food along. Like, you know, all the kind of basic stuff, the housekeeping stuff. But the rest of it we're discovering is extremely plastic. from age zero until age 25, just mere passive experience, exposure to things, your brain will change. Creates a map for better or for worse. Now, if people have traumas in that time, conditioning, you know, conditioning, you know, there are ways to undo that. And that all starts usually around age 25, people, you know, maybe earlier, but, you know, the skills you learn, how to walk, Etc. All that's laid down early in But from 25 on, you know, I want to draw a distinction because from 25 on or so, 25 or so until the end of life, the brain is still very plastic, but the requirements for changing the brain shift radically.

Yeah, talk about that.

Yeah, so the way to think about this is that the brain, the adult brain has no reason to change unless it has a shift internally that says what you're about to experience or what you just experienced is meaningful enough that you got to do something, you got to change. Okay? Now, the negative stuff is always provides the most salient examples of like a car crash. You'll never forget that. Where I was when 9/11, when I first learned about 9/11, when the shuttle exploded, you know, one trial learning immediate brain change. is always going to happen for negative events more readily than it is for positive events. I'm sorry, that's just the way we're wired. There's an asymmetry there. It's designed to keep us safe. Keep us out of danger. And we should be grateful for that. So, but adding new skills, changing our emotionality, even changing personality, it seems to some degree, can be accomplished if certain chemicals are liberated into the brain and or body. And the chemicals that cue the nervous system, aha, I need to change something, basically fall into two categories. And they are adrenaline, epinephrine, and acetylcholine. So acetylcholine, we could start with that. Acetylcholine is released from multiple sites within the brain. It's actually the neurotransmitter that allows us to, it's responsible for nerve muscle communication.

Memory.

Memory. There are two main sites in the brain that release acetylcholine. One is in the back of the brain, in the brain stem, and it triggers alertness. And it also acts as sort of a spotlight on certain areas of the brain saying, Ah, whatever's active right now, I'm gonna mark that for change later. I'm gonna make those connections stronger. That's just the nature of the sort of like a sprinkler system. It's more general. But it's kind of in the vicinity of, you know, I want to learn, you mentioned that you learn Chinese. So let's say I don't speak any second language really. So let's say I wanted to learn Mandarin. So if I were to go in and try and learn Mandarin, it'd be very, very challenging for me. So I need to focus. We know that early in life you can assimilate new knowledge without having to focus too much. Yeah, which is amazing.

Which is amazing.

But that's because the whole brain is basically basically bathing in acetylcholine. It's, you know, it's like, I see little kids. Youth has lost a little bit.

Yeah, yeah, yeah. Three or four year old kids speaking three languages.

I'm like, what the heck? Exactly. So, younger people always ask me, what should I do if I'm not 25 or older? Here's what you should do. Don't even check with your parents. Learn a second or third language. You'll thank me later. Learn a musical instrument. You'll thank me later for many reasons. I didn't do either of these two things, by the way. and develop good habits around health and nutrition and learning. And you are basically, you're pretty much home free. Okay. You know, so those are the things that you're good and you have this gift of plasticity. It's just, et cetera. So as an adult, you need acetylcholine released also from this area of the forebrain called nucleus basalis. There's a connection, a collection, excuse me, of neurons in the basal forebrain that when those become activated, essentially anything that you experience in the time window around that can be rewired. And these are incredible experiments that were done by Mike Merzenich at UCSF and colleagues where they would stimulate nucleus basalis and then provide some sensory experience and the brain would just remap within seconds. Now, the problem is getting basalis to release acetylcholine is challenging.

How do we do that?

Yeah, so it comes from powers of focus. You have to be able to contract your visual window or your auditory window, whatever your attentional window is. You have to be able to bring a lot of focus to that learning event or life event. And now if you think about negative life events, you can realize why we learn them so readily because they bring about our entire focus, right? I'll never forget seeing those planes hit the towers in New York. So I wasn't focused on anything else. I can see it in my mind's eye now still. And I probably don't have all the details, right? But that's the level of focus you need to bring to something that you want to learn as an adult. Now, there are things that can facilitate, as we call it, cholinergic transmission. First of all, there needs to be a baseline level of alertness, and that level of alertness is going to come from epinephrine, from adrenaline. So there is no learning without a sense of agitation and focus. I think most people think, oh, I'm just gonna calmly go into this and I'm going to learn Mandarin or whatever. No, it actually requires us a little bit of that leaning forward in the chair. So now your agitation and your knee bumping Mark makes sense because you were that guy and you're rich with knowledge, you know?

So that's why it's so well medical school.

That's epinephrine. That's epinephrine. That's epinephrine. And so you set the stage for that by getting good sleep and by being excited and motivated. You know the phenomena of meeting someone and then you forget their name a second later. You were focused on something else. We all do it. I'm terrible about that too. But when you meet somebody that you're very interested in, let's be honest, you don't forget their name. It just locks in and you never forget. You never forget the details. And so focus and agitation and alertness, they work together because when acetylcholine and epinephrine are liberated in the brain and body together, it basically signals to the nervous system, okay, I need to rewire things so that I don't have to deploy all these resources in the future.

So if we want to improve our brain function, improve our learning, our memory, alertness, attention, that's what people care about. and we want to enhance the neuroplasticity. What are the top things that we should be doing?

Okay, so get the foundational stuff right. Sleep, sleep, sleep. Sleep, get your nutrition right. And for there are many things and you speak to this in much more detail and sophistication than I ever could. But I think the Omega, the what, what do you say? Follow the Pegan diet.

I jokingly said Pegan, not vegan. I'm not Pegan.

Yeah, not Pegan. Yeah, so get sleep right, get your nutrition right, get your relationship to stress right, we can talk about that maybe at the end. But basically you need cholinergic transmission and the thing, you need sufficient choline available. And we know that choline is going to come from meat sources, nut sources, eggs, certain fish, Sardines. Sardines. So, you need choline available. Now, you can't just ingest those things and expect to get smarter. People always say, Tell me what to eat to get smarter.

Sardines are going to get a long way.

You have to engage in those focused learning.

You might have friends who have bad breath, but otherwise.

You have to engage in those focused learning bouts. You have to decide what it is that you want to learn, what you want to change and do that. Now, for some people, they'd say, well, I don't want to learn another language. I just want to feel happier. But that's actually, as we know, a process as well. That's going to be a process of leaning into some gratitude practice or some, maybe if what makes you happy is a physical activity, it's going to be bringing the greatest amount of attention and alertness to that practice as you possibly can. And there's a lot of literature now pointing the fact that what we sometimes call flow or flow states or getting lost in the beauty of some experience or often involves a bit of challenge. It involves a sense of focus and your focus will drift and continually bringing that back. Now, from a supplementation side, the data on alpha-GPC are pretty impressive to my mind.

That's glycerophosphocholine, which is a derivative of choline for people listening. Yeah.

You know, people, I mean, again, I'm not a physician, so I can't prescribe anything. the data on anywhere from 300 to 900 milligrams of alpha GPC before a learning bout, it's clear that cognitive function goes up. It's clear that people remember more. It's clear that people retain more of that information. So there's the encoding part, which is the part in which you're packing in the new knowledge, and that requires high levels of alertness and focus. And if it's that's gonna be supported by this nutritional, perhaps supplementation background. And then there's a second step. And the second step is the one that in recent years we've learned the most about, which is that just having this heightened level of focus and attention to what you're trying to learn or change is just the first step. The second thing is to actually turn off focus and put the brain into a state where it can rewire more rapidly. And there's a beautiful study that was published in Cell Reports. There's a fine journal last year showing that if people go into a kind of a pseudo nap or they intentionally move away from any kind of focus for 20 minutes or so after an intense learning bout, that the brain rewires more quickly and their heightened levels of retention, the brain just rewires in these states of relaxation. So it's just sort of like physical fitness. You don't actually get better during the effort. You get better during the recovery.

That must be why I did so good in neuroscience, I was reading that Candell book and I remember being in the library in medical school and I would like read it and I would like go, Exactly. Exactly.

And then wake up and keep reading. Oh, okay. That book is a beast. No disrespect to Eric because I think that's a beautiful book. But there's now a shorter one called Principles of Neurobiology by somebody else that is a little bit, but it's still pretty intense. I love that book.

It's a favorite book in medical school.

Yeah, it's a beautiful book too. It's a big it's a can hold the door open. It's so big. But so you need these bouts of relaxation afterwards. Those can come from naps. And now for people that want to kind of accelerate the process, they, they're like, wait, I don't want to do the stimulus and then the relaxation. I want to accelerate. There is a way that you can learn more quickly. And that brings us back to hypnosis. Hypnosis is a very odd state of mind because it's a state of mind where you both have heightened states of focus and relaxation at the same time. It's what I call an atypical state. Normally we're either very alert or very calm. A nap is very calm. Focus learning is very alert. Stress is very alert, obviously. Sleep is very calm. But in hypnosis, the whole purpose is to bring the brain and body into a state of deep relaxation while maintaining awareness. I think deep forms of meditation do this also. And if you can leverage those states as a way to accelerate plasticity.

So meditation.

So meditation, the Reverie app for hypnosis is great. Some people, including myself, have trouble with meditation because the mind tends to drift. Sometimes hearing a script or something that can keep you oriented towards something, a metronome or a hypnosis script can be useful.

Yeah.

And this all might sound like a ton of hard work, but actually the best learning bouts are going to be anywhere from about 30 minutes to 90 minutes. You don't really want to hammer on some things five, six hours a day. Medical school. Medical. I teach medical students. Medical school is like the worst form of learning. Too late.

Too late.

And I.

And.

But it's interesting because I look the way medical students who have phenomenal minds, obviously, have so much respect for physicians. The way that you guys learn was essentially to come in there and say, I'm going to extract the critical knowledge. So it's like these spotlights that come on when something's really important. It's not 90 minutes of content blitz. It's like you guys learn how to really extract the right information.

I not intentionally, but I think I kind of biohacked my way through medical school because I lived four miles away from the campus and I didn't have a car. And so I would run to school every morning, it was four miles and any weather.

Where was this?

And in Ottawa, which by the way, I ran to my nutritional bio, no, my biochemistry exam my first year was 37 degrees below zero without the windshield vector. I literally had Canadians face racked up. I got there, my eyelids were crusted shut. so I was kind of alert when.

I got to school. Yeah.

And then I would kind of stretch and do a little yoga in the back, and then I would run home and I would really hyper focus all day in class. And I made sure I was sitting in the front. I was fidgeting all the time, so I was probably stimulating my whatever. And then I. Yeah, you're dragging. And I did not leave that classroom till I understood everything. And then I would run four miles back home. I'd do an hour of yoga, make myself a healthy dinner, and then I would sit in the chair for four hours until 11. and just go to bed. And I do that day after day after day.

So, you just described the perfect neuroplasticity regimen.

I majored in Buddhism and I graduated like the top of my class and I just, you know, it was kind of a joke because I really wasn't into science at all when I was in college.

Toggling back and forth between these highly alert states and these deeply relaxed states.

Is.

The secret sauce, if you will, of neuroplasticity as an adult.

But what you're talking about is, I would call it inner size, right? Like we know how to exercise, but we don't know how to access these different techniques that help our brain function better. And it's just of a shame because most of us are not connecting what we eat to how we feel, our sleep to how we feel, whether we're exercising or not how we feel. My daughter came to visit me and she was really going crazy just studying for medical school, she was in pre-med and she's sort of an older student and COVID was very isolating with, you know, she didn't have a lot of social contact and she didn't, oh she was sleeping and all she did was study and she got into medical school.

That's great.

Oh, she's gonna become a physician. Yeah. Oh, wonderful. But she really neglected the self-care and got super physiologically depressed. Yeah. And it was sort of amazing, we sort of identified what was going on with her and she didn't even make make the connection. And then within a few days of just changing her diet, exercising, she literally transformed her, her whole mood and well-being and the depression just went away.

Yeah, we, we reward performance and productivity, and there will always be people that are willing to burn their themselves, including their health on the altar of whatever it is they're trying to do. And it, it shifts the culture. I mean, it's I don't follow tennis, but we saw this recent thing, a woman who is top tennis player. Forgive me for not remembering her name. Yeah, she stepped away from the tournament, citing that she needed to take care of herself. I think it's great. I think that self-care, of course, can be taken too far in the other direction, too. We have to appreciate and understand that any learning, any competition, anything like that is going to involve some adrenaline release in our body. But I think if we could all become better at surfing the seesaw, so to speak, then it becomes an issue of, okay, there's a 30-minute break between classes. Are you talking about the exam with your friends or are you relaxing under a tree and resetting your mind? That's a key question. Are you the person who shows up to the conference and is at every talk, feeling like you need to be at every talk, and you're going out for dinner and drinks and then expected to be in the front row the next morning performing. You know, when you start looking at things from a optimal, when you start looking at your life, whatever that life happens to be from an, what's going to optimize my performance in, which includes relationships, of course, as well, then the whole game changes because it really becomes an issue of how good are any one of us, each of us at regulating the seesaw and if you are spending too much time at one end of the seesaw, you're headed for trouble. That's just the way it is. Now, sleep, most of us probably don't get enough sleep, but I think that can be overdone too. I think that many people feel exhausted because these systems for engagement of the mind and engagement of the body are also a bit atrophied.

Yeah, and that's the thing. We don't learn those skills and tools. So how do people start to begin to learn those tools to enhance their neuroplasticity? plasticity to do the things. We talked a few of the practical suggestions about sleep, but is there a way? Because, you know, one of the things that terrifies me is the effect of technology on the brain.

Yeah.

And I just came back from a week, a vacation in Mexico, and we were off grid, like phone, cell phone, computer, nothing works. And we were in nature. Didn't even know what time it was, didn't watch. and my sense of well-being, my happiness, my focus was so different. And you talk about this, this phenomena of a digital concussion from phones, computers, social media. And I felt that, like, you literally, your brain hurts.

ADD, like we, the incidence of diagnosable eight ADD, ADD, she is going up in adults and in kids. I think, well, there's ideal and then there's there's reasonable and practical, right? I mean, I do think vacations and resets are great. I think just like going camping can reset your circadian clocks and melatonin and cortisol. I think from a very practical low or no cost perspective, one of the things that one can do is ask, okay, if attention and focus are required for neuroplasticity throughout the lifespan, what can I do to increase my levels of attention and focus? And there's some interesting data on this. First of all, Learn to read one chapter of a book without your phone in the room. Just a physical book, not an audiobook necessarily. Learn to read one chapter of a book per day.

Can it be a Kindle book or an audiobook?

It could be a Kindle book, sure. The ability, you know, written word and handwriting and reading are baked into our DNA. It just, there's no question. I mean, sure, we were drawing on cave walls a long time ago, but we were drawing on cave of walls. And when we evolved language, there are areas of the brain responsible for speech and language and for digesting speech and language and producing speech and language, of course. So this is something I struggle with and as much as anybody, but if you're not a reader, still do it. Learning to read one chapter of a book and your mind will drift. People will go, wait, this isn't engaging or my mind drifted or something, and that's revealing to you your powers of attention, of deliberate attention. It's revealing your ability to engage nucleus basalis. So if you want to take a test of how well or poorly you can pay attention, well, read one chapter of a book per day. So that's a wonderful practice that will improve the circuits for attention. So this is one of the cool things about neuroplasticity is it's not just about learning the information, it's about learning and teaching the circuits for attention. to get better at attention. So you can get better at attention as an action step and that will allow you to learn more things. So it's a- you- want to let's.

Wait, you have to start a little bit and keep going. So you want to read one chapter.

Then you can read a book. That's right. And pretty soon what's really interesting about the relationship between acetylcholine and an epinephrine is pretty soon it starts to recruit the dopamine system. It starts feeling good to move through that agitation. You start realizing, okay, I'm doing this, I'm doing this. And then your mind will flip off.

And you'll go back to reading and.

This sort of thing.

It really works for me is when I have a deadline.

Deadlines are great.

I can write a book in three weeks.

Right, and the reason deadlines are so effective is because they deploy epinephrine. When it's baked into your psyche that there are some social pressures of being, you want to perform well, you want to know the material, you don't want to make mistakes, et cetera. So, adrenaline is released. And once adrenaline is released, then acetylcholine naturally will follow. You tighten your focus. So reading one chapter of a book, whatever that happens to be per day, is absolutely critical to maintaining one's ability to focus and therefore one's ability to engage neuroplasticity.

You'll also read a chapter.

Read a chapter. We talked about all the foundational stuff of sleep and microbiome and all that earlier. Yeah, the other one is to really respect these 90-minute learning cycles. Don't try and throw yourself into a deep immersion of four hours of learning of something. Ratchet up to being able to do 90 minutes of focused work. So an ideal goal would be two 90-minute blocks of learning per day, but that's a lot. So if you're somebody who wants to keep your brain sharp, read a chapter a day and then decide what it is that you want to learn. Curiosity, what's that old saying? I think it was, Is it Dorothy Parker? The anecdote for boredom is curiosity. There's no anecdote for curiosity or something like that. Right, right. The best way to engage the mind is to actually be curious about something. So simply saying, I want to keep my brain young, that's a terrific mindset. But then the question is, what is it that you really want to know? So if it's about fitness or it's about health or it's about language or... Learning something new. If it's murder mysteries even, something that engages your mind. I would hope that wouldn't be, something, you know, morbid or something like that, but something that engages your mind that's going to be important to do for 90 minutes and ideally two 90 minute learning cycles per day. And you might say, well, I don't have time for that. That's actually you people are wasting far more time than. Now in terms of the so those are some dos. And then of course, if you really want to move things into the optimization realm, it is true. I don't want people just relying on pharmacology, but it is true. that if you take 300 milligrams or 600 milligrams, which is a lot actually of the alpha-GPC, you will be like a laser for those 90 minutes. You'll feel really focused. Now, a lot of people nowadays are taking Adderall, Modafinil, things like that. I personally, I mean that you're the physician, but I personally find that relying on what are essentially amphetamines in order to tighten the focus of the mind is a very slippery slope because what it does is it tightens up that hinge on that seesaw on the alertness side, and then there's a crash to the other side. And, you know, there are clinical uses, obviously, but I don't think those are the best way to go in terms of nootropics, drugs that make us smarter. The only thing that really speaks to improved brain function for learning that I've seen besides the foundational stuff are Alpha GPC and creatine. Creatine has a gives the brain a boost, it seems, because it increases the availability of lactate, which the brain can use as fuel. Some people, of course, like the Ketone thing or ketogenic diet for focus. The other thing is that fasting and ketosis will increase focus. If you're somebody who's falling asleep while trying to learn and you're sleeping enough at night, chances are you're not releasing enough acetylcholine and epinephrine into your system and fasted states promote that. And ketogenic states promote that. Carbohydrates flip on the other switch, which is for serotonin and for sleepiness. So if you're falling asleep, we were all taught that you have to eat a good breakfast and you need food for energy. You actually, I realize you don't really need food for energy. No, you need food for food. You need neurotransmitters for focus and energy. Right, right. And so eating to supplement to support those. There are other things that if it's a physical skill that you're trying to learn, as opposed to just a mental skill, then there's a whole kingdom of things that are fun. For instance, if it's a physical skill, you want to generate as many repetitions as you safely can per unit time. So if you say, I'm going to.

Learn dance, you want- It's a ball.

Machine if you're playing tennis. Exactly. You literally want to generate repetitions, and in particular you want to generate failures. Every time you give a bad serve playing tennis. Oh, yeah. that activates the circuits for focus and alertness for the next attempt.

Yeah, it's true.

That's right.

Especially when you're losing.

That's right. So, and a lot of people don't like failures and so they back away from it. So, remember the nervous system will only change if you give it a reason to do that. And the other one that's kind of an interesting twist on this is the way the nervous system is wired is it wants to pass off all of its work to circuits that are reflexive. as much as it can. You don't think about walking anymore because you learned how to walk, but when you were learning, you were very focused on it. Sure. One of the things that can set the stage for more plasticity overall is when you disrupt the vestibular or the balance system. It does appear that whenever we are physically off balance, the brain is primed to pay attention and the chemical milieu is such that it can actually rewire itself faster. And whereas I think the 90s and 2000s brought out a lot of important work on saying, Hey, exercise of aerobic type or maybe even weight training can create neuroplasticity. That was great, but it wasn't directed enough. It didn't say, well, what kind of exercise? And what will get me even more plasticity? And so there are some basal things about heart rate and blood flow, et cetera. But anything that involves balance or coordination, it's incredible how fast the brain can learn. So things like dance, martial arts, a real sport, not just exercising, and I'm no disrespect to the, I'm more of a just an exerciser than a sport guy. But if you're 40, 50, 60, 80, whatever, learning a new physical skill, we know is tremendously powerful for opening up neuroplasticity, broadly. So, some people will even leverage this where after they finish some physical skill learning or something, they might take a 20-minute nap and then they might read or they might try something. So, when we see these people-- I've been learning surfing.

I'm like 60 years old.

Perfect.

Surfing. And I'm like, yeah.

Exactly. Exactly.

I learned, started learning tennis when I was 45. And it's really a challenge because it's not automatic and I have to really.

Focus and repress Well, these individual cases are not necessarily the place to hang our hat completely, but for instance, the great physicist Richard Feynman, he was well known for learning bongo drums in the 60s when he was in, well, it was in the 60s, but in his 60s, then he became a quite accomplished painter later in life. And his whole thing was approach all of these things from a standpoint of play with intense focus. And I think the play element is key because the play element keeps the agitation in check so that when you're stepping on your partner's feet, trying to learn how to dance, or you're failing miserably, it can, frustration is a real thing. And so I think that the element of playfulness, some people call it beginner's mind, but I think that should be the anchor point to return to. And people that maintain curiosity, or I should say that cultivate curiosity and that cultivate a sense play and willingness to take on new vestibular experiences of all things. They show very, they show remarkable plasticity into their late life. And I think that it all comes back to this thing that the brain won't change unless something changes in the weather of the brain. The overall milieu has to say, oh wait, everything that's about to happen is different. Otherwise, why would it change?

This whole conversation is so great because it really is pointing out the fact that we have the ability to change our brains at any time in any age.

Absolutely.

And that there are pathways and doorways and techniques and tools that help us do that. And if we do that, we're going to be happier, healthier, enjoy life more, be able to do whatever we want, and actually be able to actually maybe even live longer.

Absolutely. And the system around emotionality also has neuroplasticity. again, unless it's these very deep structures controlling really what we call vegetative functions, like how much saliva we make or something. And even those, right, the Pavlovian thing can change. But for instance, people who are depressed, right, they need various forms of help. But the self-directed help that can be useful is when people pay more attention, even if it's just a subtle or tiny shard of their experience, when they pay more attention to something that brings them a sense of happiness or gratitude or well-being. Those circuits can rewire. The circuits for emotionality can shift and change. And the studies of personality across the lifespan have shown that we are not necessarily the same people we were in our 20s as we are in our 30s. The old version of it was that we're all basically the same person just kind of aging out and then fading out. But it's very clear that we've been endowed with this amazing capacity for self-reflection and if we can leverage the right tools, so meaning focus and alertness and attention followed by rest on a repeated basis, these neural circuits rewire. And that's true for the neural circuits in our head and it's true for.

The neural circuits in our body. This seems like just the beginning of the conversation. We're coming to the end. This is such an inspiring conversation because it's empowering and empowering us with the knowledge that we can actually change our brains and we don't have to be victim to the psychological, emotional or cognitive states that we have. and your work is just such a leading light in all this. I encourage everybody to check out Andrew's work at hubermanlab.com. It's his podcast website. Check out his podcast. It's really good. If you want to really dive deep into these topics, get an understanding of it, check out some of his work at Stanford. You can go to hubermanlab.stanford.edu and learn more about the work he's doing there. And I'm just so excited by this potential for us to really deeply dive into the new frontier of the brain in ways that we haven't before and understand the way the body affects the brain and people can really change your life because the quality of your brain determines the quality of your life, right? I mean, you can be a little overweight or whatever, maybe have a knee replacement or stroke, but if your brain isn't working in the way you want.

You'Re not going to be able to have a great life. Yeah, the mindset, whatever the mind happens to be, is definitely the major Believer.

That's true. Well, thank you so much for being on the doctor's Pharmacy, everybody. If you love this podcast, please share with your friends and family on social media. Leave a comment. Have you fix your brain? And maybe what did you do to your body to fix your brain?

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And we'll see you next time on the doctor's Pharmacy. Thanks for having me on. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly weekly newsletter, I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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