Below you can find the full tran­script of our engag­ing Q&A ses­sion yes­ter­day on holis­tic brain health with clin­i­cal neu­ropsy­chol­o­gist Dr. Paul Nuss­baum, author of Save Your Brain. You can learn more about the full Brain Fit­ness Q&A Series Here.

Per­haps one of the best exchanges was:

2:08
AlvaroF: Stress man­age­ment sounds dif­fer­ent from spir­i­tu­al­ity. Med­i­ta­tion too. Can you please describe what spe­cific practices/ out­comes fall under spirituality?

2:10
Dr. Nuss­baum: Sure. I refer to spir­i­tu­al­ity in a broad sense to try and cap­ture the impact of a brain that is at peace or with­out neg­a­tive impact of stress, par­tic­u­larly chronic stress. On the behav­ioral front, I note humans have par­tic­u­lar ways to gen­er­ate reduc­tion in stress. This is impor­tant as we know from ani­mal research that too much stim­u­la­tion can cause the brain to stop devel­op­ing. As such, behav­iors such as med­i­ta­tion, prayer, inter­ac­tion with nature, breath­ing, yoga, etc all help the organ­ism and brain to slow and to inte­grate inside and outside.

Full Tran­script of Live Q&A held on Novem­ber 22nd, 2-3pm ET

2:00
AlvaroF: Hello everyone

2:01
AlvaroF: We are start­ing the third Brain Fit­ness Q&A ses­sion with authors of books named Best Books on Brain Fit­ness by AARP.

2:01
AlvaroF: And today we have the plea­sure to have Dr. Paul Nuss­baum, author of Save Your Brain, with us.

2:02
AlvaroF: You can all start writ­ing your questions.

2:02
Com­ment From Nas­rin Lakhani
Hello Alvaro and Dr. Nussbaum

2:02
Com­ment From Mark Wald­man
Good morn­ing Alvaro and Paul

2:02
Dr. Nuss­baum: Hello every­one and thank you Alvaro

2:03
AlvaroF: Thank you very much for being with us. Let me first explain that this is a web chat — there is no audio or video.

2:03
AlvaroF: Let’s go ahead!

2:03
Com­ment From Mark Wald­man
What do you feel are the 5 best ways to main­tain a healthy brain?

2:04
Dr. Nuss­baum: Hello Mark. My major focus has been on lifestyle with brain health. My belief and work cen­ters on five major areas to include phys­i­cal activ­ity, men­tal stim­u­la­tion, nutri­tion, social­iza­tion, and spir­i­tu­al­ity. Research has been con­ducted on spe­cific behav­iors within each of these five major domains to indi­cate a rela­tion­ship between the activ­ity and reduc­tion in risk of demen­tia or what I call brain health.

2:05
AlvaroF: Which one of those 5 ele­ments do you believe is under­ap­pre­ci­ated by the pub­lic at large, and the media?

2:06
Dr. Nuss­baum: My opin­ion is the area of spir­i­tu­al­ity although it is gain­ing momen­tum as we learn more from the research on neu­rothe­ol­ogy. The impact of med­i­ta­tion, prayer, relax­ation, breath­ing, etc on stress reduc­tion and enhanced brain func­tion is quite inter­est­ing. This will only increase with more advanced and sen­si­tive mea­sures of the brain.

2:08
AlvaroF: Stress man­age­ment sounds dif­fer­ent from spir­i­tu­al­ity. Med­i­ta­tion too. Can you please describe what spe­cific practices/ out­comes fall under spirituality?

2:10
Com­ment From Pas­cale
So it is not clear which spe­cific aspects of spir­i­tu­al­ity have an impact on brain health? Any spe­cific study show­ing that prayer itself has any effect?

2:10
Dr. Nuss­baum: Sure. I refer to spir­i­tu­al­ity in a broad sense to try and cap­ture the impact of a brain that is at peace or with­out neg­a­tive impact of stress, par­tic­u­larly chronic stress. On the behav­ioral front, I note humans have par­tic­u­lar ways to gen­er­ate reduc­tion in stress. This is impor­tant as we know from ani­mal research that too much stim­u­la­tion can cause the brain to stop devel­op­ing. As such, behav­iors such as med­i­ta­tion, prayer, inter­ac­tion with nature, breath­ing, yoga, etc all help the organ­ism and brain to slow and to inte­grate inside and outside.

2:11
Com­ment From Mark Wald­man
In the brainscan/meditation research I do with Andy New­berg, we came to the con­clu­sion that opti­mism was the #1 best way to exer­cise the brain, based on 2 lon­gi­tu­di­nal stud­ies from Mayo and Duke U. Adds 2 years to life. We listed med­i­ta­tion as #4.

2:12
Dr. Nuss­baum: Prayer has been stud­ied by some folks at Duke and there has been some rela­tion­ship between prayer on a daily basis and enhanced immune func­tion, prayer and sense of hap­pi­ness, and prayer and stress reduc­tion. I have not seen a spe­cific study on prayer and cog­ni­tive func­tion. On the other side, I con­tinue to be amazed with my patients with late stage AD and their main­tained abil­ity and respect for reli­gious prac­tice includ­ing prayer.

2:13
AlvaroF: So per­haps spir­i­tu­al­ity is a poten­tial avenue towards stress man­age­ment and opti­mism. Would other tech­niques from cog­ni­tive ther­apy to biofeed­back be com­ple­men­tary? How do peo­ple nav­i­gate dif­fer­ent options?

2:13
Dr. Nuss­baum: Thanks Mark and inter­est­ing. I believe the whole area of pos­i­tive think­ing with stim­u­la­tion of the left frontal lobe is excit­ing and may soon be applied for many peo­ple in the near future.

2:15
Dr. Nuss­baum: I do view prayer as an option sim­i­lar to oth­ers Alvaro. We may find that this whole area has some gen­eral abil­ity with humans, and that there may be a cus­tomized approach by per­son. The impor­tant mes­sage is that envi­ron­men­tal input is crit­i­cal to the brain and will have some impact on the brain. My hope is to iden­tify and then apply those that are found to be brain healthy.

2:15
Com­ment From Dr Dia­mond
In our Indian cul­ture — we are taught at early age –4 –5yrs — to med­i­tate –10 mins to 15 mins — early morn­ing and before going to sleep — and the only ‘media’ was say­ing our reli­gious names, poems etc. so for us med­i­ta­tion was very much con­nected to spir­i­tu­al­ity — this also gave us ‘relax­ation’ time so as to speak

2:16
Com­ment From Nas­rin Lakhani
Is there any con­crete research on relax­ation enhanc­ing brain func­tion? I prac­tice Biofeed­back — it would be inter­est­ing. Mark is your study available?

2:16
Dr. Nuss­baum: Very good Dr. Dia­mond. I speak to teach­ers across the USA and I believe med­i­ta­tion and relax­ation pro­ce­dures can enhance learn­ing and should be con­sid­ered within the edu­ca­tion system.

2:18
Dr. Nuss­baum: Nas­rin. I would encour­age you to review the work of Dr. Sapol­sky at Stan­ford. Stress increases the activ­ity of the Amyg­dala which sup­presses the hip­pocam­pus. As the hip­pocam­pus is nec­es­sary for learn­ing we can begin to under­stand the import of a relaxed brain on max­i­mal learn­ing poten­tial. Biofeed­back is a method to gain some con­trol over the body and brain.

2:19
Com­ment From Pas­cale
Can you say more about the study of pos­i­tive think­ing with stim­u­la­tion of the left frontal lobe? Sounds intriguing!

2:20
AlvaroF: Nas­rin, I also encour­age you to look for “heart rate vari­abil­ity” and cog­ni­tion in PubMed, there’s quite a bit.

2:21
Dr. Nuss­baum: Sure. There is some inter­est­ing work from Dr. Han­son who wrote Buddha’s Brain on the left frontal lobe and eeg cor­re­lates with pos­i­tive think­ing. We also know that the left frontal lobe that incurs stroke or other dam­age can result in depres­sion, often called post-stroke depres­sion. These areas we are dis­cussing are rel­a­tively new and offer tremen­dous promise not just from a clin­i­cal per­spec­tive, but from a health pro­mo­tion perspective.

2:22
AlvaroF: That is a crit­i­cal point — would you say we have a more sig­nif­i­cant oppor­tu­nity today either in terms of clin­i­cal appli­ca­tions or pub­lic health pro­mo­tion (or both)?

2:23
Dr. Nuss­baum: As the med­ical field is so promi­nent in the USA and con­tin­ues to be dis­ease dri­ven we will likely view the world from such a per­spec­tive. My hope is that this changes to a health pro­mo­tion per­spec­tive with well stud­ied proac­tive approaches to health across the lifes­pan. This includes the brain. I think this is start­ing to take some hold.

2:24
Com­ment From Guest
Yes we are think­ing of adding to our activ­i­ties in The Inter gen­er­a­tional School here in Cleveland.

2:24
Com­ment From Mark Wald­man
There is new evi­dence that intense, long term med­i­ta­tion thick­ens the neo­cor­tex and shrinks the amyg­dala. Less stress, increased cog­ni­tion. Lot’s of stud­ies show­ing small but sig­nif­i­cant cog­ni­tive improve­ment for stu­dents tak­ing tests.

2:24
Com­ment From Mark Wald­man
Herb Ben­son at Har­vard has shown that the relax­ation response (20 min­utes of focus­ing on a pos­i­tive mean­ing­ful word) turns on genes involved in the reduc­tion of stress.

2:25
Dr. Nuss­baum: Great. I think as we learn and accept more the idea and power of neural plas­tic­ity and that envi­ron­ment mat­ters, we will con­tinue to focus more on how the brain inter­faces and responds to par­tic­u­lar stim­uli and how health is promoted.

2:26
AlvaroF: Couldn’t agree more that we need a lifes­pan approach to health, includ­ing brain health. Where do you see that start­ing to hap­pen in the US?

2:26
Dr. Nuss­baum: Mark. I believe we are learn­ing more about the trig­gers of the genes. We have iden­ti­fied every gene in the human body. We now need to under­stand what trig­gers or silences the man­i­fes­ta­tion of genes. It is my view that there is an entire world of stim­uli such as thought that might be impor­tant here.

2:28
AlvaroF: Given all we’re dis­cussing here, what do you make of last year’s NIH state­ment on the pre­ven­tion of Alzheimer’s/ cog­ni­tive decline, which was basi­cally reported as “noth­ing works”.

2:29
Dr. Nuss­baum: Alvaro. My own expe­ri­ence over the past 15 years when there were not many of us inter­ested in brain health is that it is actu­ally hap­pen­ing in the com­mu­nity rather than the aca­d­e­mics or med­ical field. By this I mean the con­sumer has become more edu­cated and more inter­ested in health. I do believe busi­ness, schools, libraries, media, and the reli­gious sec­tor have been very inter­ested for some time. I do see that tra­di­tional med­i­cine and acad­e­mia are now becom­ing more inter­ested. In this sense, it has been con­sumer driven.

2:29
Com­ment From Pas­cale
Do you think there is still a lot of edu­ca­tion to be done before brain fit­ness become an obvi­ous thing to care about, as much as phys­i­cal fitness?

2:30
Com­ment From Nas­rin Lakhani
There is so lit­tle pub­lic aware­ness about brain fit­ness, biofeed­back — any ideas on nav­i­gat­ing the issue?

2:32
Dr. Nuss­baum: I get that ques­tion a lot Alvaro. My read of the NIH state­ment is that the med­ical field is tak­ing a seri­ous look at this grow­ing field of study and prac­tice. My take home mes­sage from NIH is that we need to con­duct more prospec­tive research that helps us draw more cause and effect con­clu­sions rather than the robust cor­re­la­tional work that has been done. I agree. How­ever, it is impor­tant to under­stand that our med­ical work is based in large part on stud­ies that are cor­re­la­tional and indeed our prac­tice is often based on advice that is cor­re­la­tional in nature. Finally, the NIH takes a med­ical approach and views brain health as an ill­ness that needs to be cured. Brain health is not AD, but rather a prac­tice towards health. Health pro­mo­tion is not the same as dis­ease treat­ment or even dis­ease prevention.

2:34
Dr. Nuss­baum: Nas­rin. For­tu­nately there is much more infor­ma­tion on Brain Health which I dif­fer­en­ti­ate from brain fit­ness. You might want to take a look at the recent issue of Gen­er­a­tions ded­i­cated to brain health, pub­lished by the Amer­i­can Soci­ety on Aging (www.asaging.org).

2:34
AlvaroF: Yes — the NIH panel didn’t review many of the maintenance/ enhance­ment out­comes most of us care about.

You were involved with the ASA brain health poll a few years ago, which iden­ti­fied a very pos­i­tive response to the idea of an annual “men­tal checkup”, Any progress?

2:35
Com­ment From Peter White­house
I think some times more research is not the answer frankly.

2:35
Dr. Nuss­baum: We have not fol­lowed with an empir­i­cal approach on that spe­cific issue. How­ever, I am aware of peo­ple and com­pa­nies not adopt­ing brain health prac­tice as part of their over­all well­ness pro­gram. I do believe the ASA work I helped with years ago helped to con­tinue the aware­ness and edu­ca­tion of the issue that is needed.

2:36
Com­ment From Mark Wald­man
Andy New­berg would say that noth­ing works yet, and we’re just begin­ning the jour­ney. He has hope and faith that we will find ways to improve our neural functioning.

2:36
Dr. Nuss­baum: Hello Peter. I would tend to agree, but I think research can help pro­vided we are clear what we are look­ing for.

2:36
Com­ment From Guest
Unless your busi­ness is research.

2:36
Com­ment From Jeanette
I have read that the num­ber 1 dis­ease Baby Boomers fear is Alzheimer’s. Do you think that brain fit­ness aware­ness is being dri­ven by Boomers more than any other older or younger generation?

2:38
Dr. Nuss­baum: Mark. Andy does great work. My thought would be what is meant that “noth­ing works.” Brain Health prac­tice does not mean pre­ven­tion of dis­ease. I believe you cited your own work on opti­mism and its util­ity. These are the things that can help us under­stand the effects of par­tic­u­lar behav­ior on the brain. My hope is learn more about what pro­motes health.

2:39
Dr. Nuss­baum: Hello Jeanette: I think that is fair and may have some truth. Boomers like me tend to be a bit more focused on health than our par­ents and grand­par­ents. The energy from the boomers helps to cre­ate momen­tum and demand. Boomers are very inter­ested in the brain and brain health because they are care­givers for par­ents who may have demen­tia and boomers will learn what is known about delay­ing onset of such diseases.

2:40
Com­ment From Guest
Do you think it will take insur­ance reimbursement/co-pay before our soci­ety includes brain health as a part of any sub­stan­tive well­ness pro­gram (either per­sonal or corporate)?

2:41
Dr. Nuss­baum: I think a sys­tem can change if the con­sumer demands it. Insur­ance com­pa­nies do not want to be left out of a ser­vice or prod­uct, etc. that con­sumers want and demand. I think as we learn more about the brain and as our research pro­vides more sup­port for brain health we will see move­ment at the pol­icy, govt, pri­vate insur­ance, etc. level.

2:41
Com­ment From EB
If bet­ter brain health can pre­vent or delay the risk for long-term impair­ment, then what is the nuance that makes it “not pre­ven­tion of disease.”

2:44
Dr. Nuss­baum: My per­sonal approach is that pre­ven­tion is not a good descrip­tion because we really do not have con­vinc­ing evi­dence for pre­ven­tion of a dis­ease. This is true of most dis­eases inside and out­side the brain. How­ever, my study of the area indi­cates we have tremen­dous amounts of research in the area of brain reserve that indi­cates an abil­ity to not pre­vent, but delay onset. It is fair to point out that some brains diag­nosed at autopsy with AD never man­i­fested the dis­ease in life and there­fore one can argue for pre­ven­tion. I per­son­ally am more com­fort­able with delay­ing onset and not using prevention.

2:46
AlvaroF: In the Gen­er­a­tions spe­cial issue you write that “neu­ropsy­chol­ogy can become a larger player in the area of brain health”. How will this hap­pen? PS: we see a lot of inter­est among neu­ropsy­chol­o­gists, speech and occu­pa­tional therapists…

2:46
Com­ment From Nas­rin Lakhani
Very help­ful dis­tinc­tion — thank you

2:47
Com­ment From EB
Dr. Nuss­baum, thank you for the thought­ful descrip­tion dif­fer­ence of pre­ven­tion and delay.

2:49
Dr. Nuss­baum: Yes. As a neu­ropsy­chol­o­gist I believe it is fair to point out my field has taken the med­ical approach to clin­i­cal prac­tice. I am very proud of my pro­fes­sion, but we are in a good posi­tion to really lead on brain health because we study neu­roanatomy and we also have a keen inter­est in behav­ior. We should appre­ci­ate the rela­tion­ship between envi­ron­ment and brain struc­ture and func­tion. The field has not moved towards brain health at the lead­er­ship posi­tion yet, though I am try­ing to make some inroads. I think there is great promise here.

2:50
AlvaroF: I agree. Elkhonon Gold­berg (co-author of The Sharp­Brains Guide to Brain Fit­ness) is a neu­ropsy­chol­o­gist and we view many oppor­tu­ni­ties through neu­ropsych lens. Chal­lenge is how to scale things.

2:50
Com­ment From EB
We need to orga­nize some form of the Occupy move­ment (cleaner, clearer in mes­sage) for brain health so that we can spur the changes in pol­icy, insur­ance, etc. Is there any­thing grass roots going on in any form for this?

2:51
AlvaroF: We only have a few min­utes left so I am look­ing for ques­tions on top­ics we haven’t dis­cussed so far.

2:52
Dr. Nuss­baum: Yes. I think there are some large issues with eco­log­i­cal valid­ity and mea­sure­ment. HOw­ever, there is also a huge growth area for health prac­tices, edu­ca­tion on brain basics, inte­gra­tion of brain health into soci­ety, and pro­vid­ing a dynamic and research-based proac­tive approach for all of us to live brain healthy lives.

2:52
Com­ment From Pas­cale
Do you think com­put­er­ized cog­ni­tive train­ing pro­grams are a good answer to main­tain­ing brain health? How do they com­pare to med­i­ta­tion, etc.?

2:54
Dr. Nuss­baum: Pascale:

I do not know the answer to the sec­ond ques­tion as I am not famil­iar with any study on the spe­cific ques­tion. Recall, I have five major com­po­nents to my brain health lifestyle. I view com­put­er­ized train­ing pro­grams as one activ­ity within one slice (maybe two) of the approach, men­tal stim­u­la­tion and social­iza­tion. I believe such train­ing pro­grams may be help­ful with health pro­mo­tion and I do not view them from a clin­i­cal inter­ven­tion per se.

2:54
Com­ment From Dr Dia­mond
It is impor­tant that we first accept that we now live in an ‘unbal­anced world’ — very stress­ful and demand­ing times — this means boomers are most affected — and really they have to take steps any step to reduce stress or learn to man­age stress — to man­age some equi­lib­rium — or else they’re head­ing to some unpre­dictable men­tal health prob­lems. So any step towards stress man­age­ment, med­i­ta­tion — spir­i­tu­al­ity should help. I appre­ci­ate Dr Nussbaum’s efforts in pro­mot­ing meditation(relaxation) and spirituality.

2:55
Com­ment From Guest
Where do you see the role of cre­ativ­ity in main­tain­ing brain health?

2:55
Dr. Nuss­baum: I agree Dr. Dia­mond. I also like your state­ment for it indi­cates we have power and con­trol within us to mod­ify and even change to a health­ier existence.

2:56
Com­ment From Joanne
I firmly believe that laugh­ter is really good for the brain. Do you know of any research that proves this?

2:56
Dr. Nuss­baum: Cre­ativ­ity is pow­er­ful as it stim­u­lates in large part the frontal lobe and can be well within the men­tal stim­u­la­tion part of my lifestyle. Improv is a great exam­ple of a brain health men­tal stimulating/creative behavior.

2:57
Com­ment From Joanne
I also want to com­ment on Pascale’s ques­tion about com­put­er­ized train­ing pro­grams which we use in our prac­tice. We have also devel­oped a brain fit­ness train­ing pro­gram which uses some of the same types of exer­cises– but is done in groups — this seems to work at least as well as the com­put­er­ized pro­grams– and peo­ple really ben­e­fit from socializing

2:58
Dr. Nuss­baum: There is research on humor though I can­not cite the specifics at this time. We used humor for our patients with can­cer in the past. Humor is unique to humans and is another exam­ple of pro­duc­ing hap­pi­ness and stress reduction.

2:58
AlvaroF: Paul and every­one, thank you very much for a won­der­ful conversation!

2:58
Dr. Nuss­baum: Social­iza­tion is very impor­tant and is one of the five areas of my lifestyle approach.

2:59
Dr. Nuss­baum: Thanks Alvaro and thanks to everyone.

2:59
AlvaroF: Any spe­cific tip on how to live Thanks­giv­ing in the most brain-enhancing way

2:59
Dr. Nuss­baum: Use the time to give and to for­give. Fam­i­lies are a won­der­ful social group, but we prob­a­bly all have a chance to for­give and to apol­o­gize. Good for the brain.

Happy TG everyone.

3:00
AlvaroF: We need to wrap up now. Thank you again to every­one for your inter­est and par­tic­i­pa­tion. The full tran­script will be avail­able via sharpbrains.com by end of tomor­row. Bye and Happy TG!

3:01
Com­ment From Dr Dia­mond
Thank You Alvaro and Dr. Nussbaum

Tran­scripts of pre­vi­ous Q&A Sessions:

• Dr. Gary Small on Enhanc­ing Mem­ory and the Brain
• Alvaro Fer­nan­dez on “Men­tal Cap­i­tal­ism” and Cog­ni­tive Fitness

Be Socia­ble, Share!

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