Dr. Gary Steinberg: How to Improve Brain Health & Offset Neurodegeneration | Huberman Lab • Podcast Notes (2024)

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Key Takeaways

• Stroke is like a heart attack for the brain that usually results from a clot
  • Lifestyle factors can increase your risk of clotting: Smoking, excessive alcohol consumption, drug use (cocaine, meth), uncontrolled high lipids (high LDL), hypertension (high blood pressure)
• Maybe controversial, but potential benefits of statins for people with normal cholesterol: Improved blood vessel integrity, protective benefits against cognitive decline
• It appears that one of the main benefits of stem cells is that they modulate the immune system which helps with plasticity in the brain
• Don’t panic if you hit your head once; there is usually not long term damage or concern after a hard head it, so long as it’s a one-off event and not repeated
• Cooling the body a few degrees may have a protective effect on the brain; this mild hypothermia does help recovery and restoration of function following cardiac arrest and global ischemia
• Stem cells seem to work by modulating the immune system which facilitates neuroplasticity by resurrecting circuits or inducing plasticity in circuits
  • Be weary of any stem cell treatments that seem to good to be true; go somewhere reputable with a regulatory body if seeking stem cell treatment

Introduction

Dr. Gary Steinberg MD, PhD, a neurosurgeon and a professor of neurosciences, neurosurgery, and neurology at Stanford University School of Medicine.

In this episode, Andrew Huberman and Gary Steinberg discuss brain health and brain injuries, key factors for brain health, novel mechanisms to improve recovery after concussions, advances in neurosurgery and more!

Host: Andrew Huberman (@hubermanlab)

6:45 – Understanding Brain Pathologies

• A stroke is like a heart attack for the brain; it involves disruption of blood flow to the brain, most often as a result of a clot or rarely as a result of hemorrhage
  • In many cases you don’t know you have a clot until it’s too late
  • “In general, the things that are good for the heart are good for the brain.” – Gary Steinberg
• Clots can occur on the venous (vein) side or arterial (arty) side
  • The arterial clots are generally what causes a stroke
  • The venous clots cause things like deep vein thrombosis which can travel to the lung; venous clots don’t commonly travel to the brain
• Different drugs thin the blood which can lead to larger hemorrhage if something is bleeding but won’t cause excess on their own
  • Aspirin is an anti-platelet agent which thins the blood; this is useful if you have a predisposition for clots
  • Anticoagulants thin the blood
  • Oral contraceptives (estrogen dominant) can increase the risk of developing clots, especially among smokers
    • IUDs are safer for those prone to clots
• Lifestyle risk factors for clotting: Smoking, excessive alcohol consumption, drug use (cocaine, meth), high lipids (high LDL) uncontrolled by diet, hypertension (high blood pressure)
  • Statins are beneficial for blood vessel integrity even if you don’t have high LDL
• The incidence of stroke is decreasing, partly because of lower rates of smoking and better controlled lipids
• The brain represents just 2% of total bodyweight but draws in 15% of total blood flow and consumes 20% of body’s oxygen

23:27 – Current Technology& Techniques In Neurosurgery

• Neurosurgeons can now operate in the brain stem which is something that used to be too risky
• Neurosurgery is becoming less invasive
  • Minimally invasive techniques include: Operating through vessels (this method can be used to take out clots), radiation beams (don’t have to open skull), incisions are often just 2-3mm, focused ultrasound (used for essential tremor and Parkinson’s), deep brain stimulation (implanting electrode)
• The future of neurosurgery is minimally invasive surgeries and procedures; these techniques will also play a role in psychiatric conditions

28:13 – Transient Ischemic Attacks (TIAs) & Other Types Of Strokes

• A transient ischemic attack (TIA) is a reversible stroke that results in a temporary loss of function (such as inability to move, vision problems, slurred speech, cognitive problems)
  • Neurologic deficit due to lack of blood flow which lasts minutes up to 24 hours but passes
• Spinal strokes are much less common than strokes of the brain; an interruption in arterial blood flow can cause death of tissue in spinal cord, resulting in neurologic deficit depending on location
  • If the loss of blood flow is on front/stomach side of the spinal cord, it would cause paralysis of both legs and partial sensory deficit
  • If the loss of blood flow is on the back side of the spinal cord, it would cause a problem with sensation in legs and problems with proprioception

36:00 – Alcohol

• Latest studies suggest there is no level of alcohol that is safe or good – but the nuance is that responsible alcohol use can help people reduce stress, which has its benefits
• “Moderation is the key to life, happiness also promotes longevity.” – Gary Steinberg
• Vessels of drug users lack integrity and jack up blood pressure which can cause hemorrhage

39:55 – Traumatic Brain Injury (TBI)

• You can examine someone and get a good sense of how they’re recovering from a concussion
• Repeat concussion causes chronic traumatic encephalopathy (CTE)
• Usually there are not long term sequelae after concussion, so long as they’re not repeated
• MRIs do not show molecular abnormalities that occur with concussion; the best way to identify severity is with more sophisticated neurologic tracking including eye tracking
  • Football and hockey are including pre-season eye tracking exams to get a baseline
  • The visual system tests the brain from the retina all the way to the occipital lobe in the back so it’s the whole brain being tested
• Nerve cells in the brain may take days to die off; in the moment, it’s hard to know the damage done by TBI
• In general, it’s good not to overstress the brain when recovering from concussion

47:30 – Statins & Other Drugs For TBI

• There’s a growing case to be made for the use of statins even if you don’t have cholesterol issues
• Some newer studies are even suggesting benefits of statins against cognitive decline
• Do not take aspirin for TBI or concussion (as opposed to stroke or TIA where you want to take an aspirin)

48:31 – Exploratory MRI: Benefits & Risks

• Total body scans have benefits and risks
• Benefits: You might pick up something you might not otherwise treat until it’s too late (i.e., cancer or aneurysm)
• Risks: You might come across something that might send you down a rabbit hole and lead to more invasive treatments and iatrogenic injuries (injury caused by physician)
• First and foremost, speak with a specialist and make sure you have resources in place to interpret and follow up properly

52:00 – Lifestyle Factors To Protect Brain Health

• Guidelines are everchanging; it is important to understand healthy ranges for your body
• If someone has naturally low blood pressure: Measure blood pressure regularly and correlate with symptoms; stay hydrated
• Strokes occur more commonly during sleep – it’s possible there’s a link between sleep deprivation and stroke
• Be weary of chiropractors! Avoid neck manipulations – it is possible to dissect an artery (either vertebral or carotid) with neck adjustment; it’s rare but worth avoiding
• Inversion tables: There’s no evidence hanging upside down is bad or harmful

1:05:15 – Kids & Sports

• Good skills are learned through team sports but there is great risk in tackle football and contact sports
  • Even kids in high school are showing up with brain damage
• Soccer: There is evidence that repeated headings can cause injury
• It’s difficult when you’re getting paid but worth finding a different sport to participate in when you’re young
• In general, you don’t need to worry about those one-off hard hits to head that might happen, it’s the repeated hits that are cause for concern

1:10:49 – Nerve Regeneration, Stem Cells For Healing

• It used to be that there was no hope to restore function in patients who had TBI, stroke, neurological disorders, etc. – but now, we know that stem cells do form in the adult brain
• 90% of recovery from stroke occurs within the first six months; implanting stem cells and/or vagal nerve stimulation can improve limb and motor function years later
• “The old notion that these circuits are dead simply isn’t true. They can be resurrected.” – Gary Steinberg
• Youth is always on your side, but recovery can happen at any age
• Stem cells can promote mechanisms that turn the adult brain into a younger brain and promote neuroplasticity and healing
  • Stem cells from bone marrow & fetal neural tissue secrete powerful growth factors that promote native recovery and modulate immune system; by modulating the immune system they can promote neuroplasticity and healing
• Physical activity is beneficial for stimulating endogenous stem cells in the brain and recruiting circuits
• Study: Intriguing data suggests you may have to restrain use of healthy limb after stroke to force use of affected side – but there is an important temporal factor, you can’t do this oo soon

1:23:50 – Neuroprotection After Injury

• When you deprive the brain and neurons of oxygen and glucose they don’t die immediately
• After a stroke when there’s a deprivation of oxygen and glucose, there’s a release of excitatory amino acids which causes an influx of calcium into neurons which ultimately leads to death
• Mild hypothermia (reducing the brain and body temperature a few degrees) shows protection, even after stroke because it blocks many detrimental pathways (release of excitatory amino acids, blocks calcium influx, blocks inflammation)
  • Mild hypothermia works so well, it’s become the standard of care; some neurosurgeons even cool patients post-surgery for augmented recovery
  • Pharmaceuticals have been tried and seemed beneficial in the lab but that didn’t translate into clinical benefit
• Two types of stroke benefit most from mild hypothermia: (1) Cardiac arrest; (2) Neonatal hypoxic ischemic injury (newborns with blood flow cutoff to brain)
• TBI studies have been done with mild hypothermia and have suggested benefit though more research needs to be done

1:34:59 – Platelet-Rich Plasma (PRP) & Novel Therapies

• If you leave the country, you don’t know what you’re getting – there are cases of patients going elsewhere and getting harmed more than their original illness
• There is a clinic in Florida that was injecting stem cells into people’s eyes, suggesting it could cure macular degeneration, and many of the patients went irreversibly blind
• There’s a lot of hope for stem cell therapy but it’s critical to go somewhere reputable
• The FDA is cautious with novel treatments and technologies
• Greater collaboration with other industries would help move the needle on new technologies – government agencies do not provide enough money to get to FDA approval
  • There are good therapies that go bankrupt because their studies show efficacy but funding dries up
  • It costs $10s of millions to get from study to FDA approval
• Vagal stimulation can be about calming or alerting the brain depending on the location of stimulation; the brain stimulation seems to resurrect circuits or induce plasticity in circuits
  • Vagal stimulation coupled with physical therapy was the first FDA approved treatment for chronic stroke patients (approved 2021)

Articles

• The fasciola cinereum of the hippocampal tail as an interventional target in epilepsy(Nature)
• Transplanted Stem Cell-Secreted Vascular Endothelial Growth Factor Effects Poststroke Recovery, Inflammation, and Vascular Repair(Stem Cells)
• Human neural stem cells enhance structural plasticity and axonal transport in the ischaemic brain(Brain)
• Revisiting Stem Cell-Based Clinical Trials for Ischemic Stroke(Frontiers in Aging Neuroscience)
• Two-year safety and clinical outcomes in chronic ischemic stroke patients after implantation of modified bone marrow–derived mesenchymal stem cells (SB623): a phase 1/2a study(Journal of Neurosurgery)
• Mild Hypothermia Reduces Apoptosis of Mouse Neurons In vitro Early in the Cascade(Journal of Cerebral Blood Flow &Metabolism)
• Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest(The New England Journal of Medicine)
• Childhood Outcomes after Hypothermia for Neonatal Encephalopathy(The New England Journal of Medicine)
• Slow rewarming improved the neurological outcomes of prolonged mild therapeutic hypothermia in patients with severe traumatic brain injury and an evacuated hematoma(Scientific Reports)
• Vision Loss after Intravitreal Injection of Autologous “Stem Cells” for AMD(The New England Journal of Medicine)

Huberman Lab Episodes Mentioned

• Dr. Craig Heller: Using Temperature for Performance, Brain & Body Health (Podcast Notes here!)

People Mentioned

• Timothy Schallert: professor of psychology, University of Texas at Austin
• Theresa Jones: professor of psychology, University of Texas at Austin
• Norman Shumway: father of heart transplantation, Stanford University
• Henry Kaplan: discovered radiation exposure to treat leukemia, Stanford University

Huberman Lab :brain health, health, life, neurobiology, popular, traumatic brain injury
Notes By Maryann