June 8, 2025 • 43 mins
In this episode of ‘The Aging Well Podcast’, Dr. Dr. Armstrong’s guest is Dr. Pria Anand, author of ‘The Mind Electric.’ They discuss the intricate relationship between storytelling, aging, and the brain. Dr. Anand emphasizes that aging is not merely a decline but a complex transformation that involves both challenges and improvements in cognitive functions. The discussion explores neurodegenerative diseases, the impact of infections and autoimmune disorders on brain health, and the critical role of patient narratives in diagnosis and treatment. Dr. Anand advocates for better communication in healthcare and highlights the importance of patient advocacy in navigating the medical system and the challenges faced by women and underrepresented genders in navigating the healthcare system, emphasizing the importance of self-advocacy. She shares her journey of balancing a medical career with creative writing, highlighting how motherhood has shaped her priorities. The discussion considers the lessons learned from neurology that can be applied to everyday life, particularly the significance of storytelling in understanding our experiences and its impact on aging. The conversation concludes with a look at the future of neurology and the importance of continued research in sleep science for… aging well.
Learn more about Dr. Anand and the book at:https://www.priaanand.com/https://www.simonandschuster.com/books/The-Mind-Electric/Pria-Anand/9781668064016
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
Welcome to the Agingwell podcast, where we explore the
science, stories and strategies that help us live longer,
healthier, and more fulfilling lives.
Today. We explore the fascinating world
of neurology, storytelling, any intricate ways that our brains
shape our health. My guest is Doctor Priya Anon, a
neurologist at Boston Medical Center and assistant professor
at Boston University School of Medicine.
(00:26):
She is also the author of the upcoming book The Mind Electric
and exploration of the neurological underpinnings of
human experience, illness, and identity.
Doctor Anand's work investigatesthe power of storytelling in
medicine, the gendered history of healthcare, and the complex
cases she encounters. As a specialist in
neuroinfectious diseases and autoimmune disorders.
(00:47):
She also offers a deeply personal perspective on
balancing medical practice, writing, and motherhood.
Join us as we discuss the brain's profound role in aging,
the narratives that shape patient care, and what we can
all learn from the mysteries of the mind to Age Well.
Doctor Nod welcome to the Aging Well podcast.
Let's just begin by having you tell our listeners a little bit
(01:08):
about yourself and what led you to writing The Mind Electric.
So hi Jeff, let me just start bysaying thank you so much for
inviting me to join you and alsofor reading the book.
I am a neurologist. I care for patients with a
pretty wide range of neurologic illnesses and symptoms in the
course of my practice. But before I wanted to be a
doctor, I actually wanted to be a journalist.
(01:30):
I wanted to be able to tell people stories in a way that
felt powerful and true. And when I first started medical
school and kind of shifted gears, I thought that I left
storytelling behind. And the further that I went in
my training and my practice, themore I realized it was actually
a really essential part of my work still.
So I kind of, I think became interested in the kind of the
salience of stories and medicineand layers.
(01:52):
I, as a medical student, I was still really new to the language
of medicine and far more than learning about the jargon of
diseases, I really loved hearinghow my patients and their
families and their communities talk to their illness.
So people construct all of thesestories and fables and myths to
make sense of illness and they felt way more legible to me than
what I was reading in medical texts.
Great example of this example ofsleep paralysis.
(02:14):
I don't know if you have ever had the experience of sleep
paralysis maybe? You're not, thankfully.
Thankfully, it's it's it's shockingly common and maybe
listeners will be able to speak to this as you're falling asleep
or waking up just with this kindof like boundary between sleep
and consciousness. People will have this experience
a feeling frozen so their body is paralyzed as though they're
asleep and they can see or hear their dreams, but their brain is
(02:37):
fully, it's kind of this blurring of the boundary between
being asleep and being being awake.
It's really a profound and frightening experience.
But it's also common enough thatevery culture has a folklore
around the 6th. So people will describe a witch
or a sorcerer or cast a spell that freezes you, or a spirit or
a creature who sits on your chest.
And so you, before I grew kind of into some medicine, I was
really taken with the ways that people would tell stories to
(02:58):
make sense of the immensity of illness and of symptoms.
And after I finished medical school, I started my training in
neurology and I started to otherkind of storytelling.
I watched people's brains weave elaborate stories that they
weren't even aware of. A great example of this is the
symptom of confabulation, which is a part of so many neurologic,
the aging brain and other brains, which is essentially the
brain making up a story to fill in information that it's missing
(03:21):
about the world. I've had patients, a neurologic
disorder that caused amnesia, who could not remember from
day-to-day that they were in thehospital.
And I would say, oh, have we? Have we met before?
And they would say, of course, we saw each other at our high
school reunion and make up this really elaborate story of how we
knew each other even though we never met were at all.
And as I started to become a neurologist, I started to learn
also that there are ways that our bodies tell us, tell stories
(03:43):
about our past and our future and reveal something about our
own area. Because I've gone further in
medicine, I've realized that this way of telling stories
about illness, it's not just unique to patients.
Patients are not the only ones who tell stories to make sense
of what's scary and strange about illness and disease.
Doctors or stories are maybe themost powerful tool that our
brains, the human brain has, andthey're how our brains have
(04:04):
evolved to make a really chaoticworld.
And kind of watching all these layers of illness and story
unfold is really how I first started to think about story
that first inspired me. To the brain fascinates me and
it's kind of beyond my scope of understanding because I'm more
of a I'm an exercise physiologist.
So the the muscle, the cardiovascular system, all
that's easy understand, but diving deeper into kind of just
(04:26):
understanding the mind and how our, you know, our nutrition,
our lifestyles, our exercise, all that affects the brain.
And even though you just start scraping the surface.
And so your book, The Mind Electric explores our brains and
how our brains shape our experiences of illness and
healing. As you've been talking about,
how do you see this playing out in aging and neurodegenerative
(04:47):
diseases? I'll say first that I I feel
like I have very limited understanding of how my muscles
and my cardiovascular system arechanging as I I can subjectively
experience it, but that is a whole can of worms that I would
love to wish that I understood better.
I think what sometimes really scares people about the
experience of aging is fear the potential that aging is going to
disrupt their narrative or theirlife story or their identity in
(05:09):
a really profound way. Because so many diseases of
aging are disease of brain, neurogenerative diseases like
mentioned that really intersect with our stories and ourselves.
I think the most kind of common or like legible example is
probably Alzheimer's disease, which often effects memory, but
there are also dementias that affect language, that affect
people's ability to literally communicate their own stories,
(05:30):
that people's ability to visually perceive the world.
Other neurodegenerative disorders like Parkinson's
disease can leave memory and language intact but affect your
ability to physically move through the world.
All of these things that really kind of impact your story and
your and sense of self and identity.
I think there's this really likecomplex like a web of
relationships between neurodegenerative disorders like
(05:53):
Alzheimer's, person partners, disease, aging, and the stories
that that we tell about our cells and let our brain tell
that our brains tell us about our.
I had a colleague when I taught at Hope College before I moved
out here to Michigan, who was one of the Physiology professors
who had Parkinson's disease. And he had a tendency his body
would freeze up at times, which I I know is very common with
Parkinson's disease. But he found that when his wife
(06:15):
sang in his ear, it would loosenhim up.
And I always found that fascinating.
What? Why is that?
Such a lovely story and such a lovely there's there's like AI
think there's a physical explanation which is probably
doesn't capture the full like immensity of what you're saying.
Yeah, it's really interesting. This phenomenon of freezing can
have really particular trigger. So a very common one is passing
(06:37):
through thresholds, through a doorway or even crossing a piece
of tape on the ground. And somehow we these, you know,
even without a like a physical barrier that you have to to kind
of overcome. Our brains are so are so
efficient at translating sensoryinput about the world into kind
of modulation of our movement that even something as simple as
(06:57):
whether you're in a wide open space or in walking through a
doorway and in a tight order impact whether or not you are
able to to move or, or whether or not you're able to sort of
initiate movement is kind of thething that don't really start.
I I don't have a great explanation.
I haven't heard a story like that before about someone's
loved 1 singing to them, but I think it's a really beauty and
it's something I'm going to share with patients.
(07:18):
Well, the. Funny part, The funnier part of
that story is it's not quite as funny, but over a winter break,
I think it was like finals week in between semesters.
So it was winter time in WesternMichigan.
So it was very cold. But he lived close enough to the
Science Center that he just, he left without a jacket, walked
over to do some grading because the football game he was
watching was disappointing. And he froze on the stairs, you
(07:40):
know, just walking up the stairs, just mid step stop.
And fortunately, another colleague lived in a
neighborhood and saw him and knew that something was wrong.
So he goes over to him. He said, can I help you?
And he said, this is going to sound a little strange, but can
you try singing Did. It work with someone else
saying. Yeah, he had to kind of, I think
moderate his his singing a little bit to maybe match the
(08:01):
lives. But yeah, it, it ended up
working for him thankfully, because, you know, I don't know
what else he would have done Frozen.
He would have literally been frozen on those stairs.
So. So based on your experience,
what are some of the biggest misconceptions that we see about
aging in the brain? I think.
One of the big points I want to make here is that I think people
have this misconception that aging is all downhill when it
(08:23):
comes to the brain, and I don't think that's quite true.
Look, nothing in medicine, nothing about our brains and
bodies is simple or linear. There definitely are some things
that become more difficult or less efficient for our brains at
the age, but there are also somethings that become better.
So some of what happens in our brains as we age really
parallels what happens in the brains of infants and toddlers
as they grow into children and they learn about it's infants
(08:45):
grow into children. Something really important that
happens in their brains is that their brains go from being this
chaos of many, many different synapses and connections to some
of those connections being pruned away so that the brain
has a better sense of which onesare important, which ones to pay
attention to. And that that process of kind of
reduction is also part of how weacquire language as we grow into
children, how we acquire all sorts of skills and we prune
(09:08):
some of our synapses and sometimes form new ones as we
age as well. And what that means is that some
things get harder, but other things actually get better.
So some tasks that really rely on experience, accumulated
experience about the world, people actually do better as
they age. Their vocabulary can become more
robust, things like being able to judge distances, all of these
things that rely on your experience.
The world can become better and better as we age.
(09:30):
And I think being attuned to this nuance, that aging is
really, I think change rather than decline is, I imagine, a
big part of aging so. You kind of use the analogy of
pruning, and I think as we age, we just seem to accumulate more.
Well, we don't seem to accumulate more and more
knowledge. And so we have to be able to
figure out whether that knowledge is the most important.
So is some of this, you know, difficulty that we experience
(09:51):
with aging and just in terms of memory, really more of the
challenge of pruning and trying to just kind of pull up the
information that we need most efficiently?
Yeah. That's a great, I think that's a
great way to think about it. You know, that's a big part of
like why we need to go through that process as we've become
adult humans is because you're exactly right.
Like the information is only valuable you can access.
(10:11):
It's not yet I can just organize.
And if you can reach it easily, you know, there are kind of as
we age, there are other things that happen that make ourselves
a little bit less efficient at communicating with one another.
But we also, as you said, we accumulate all of this
experience and then part of whathappens is just our brains need
to make space for the things that we're they're acquiring age
that. There's something that tends to
scare us, I think, a little bit as we get older and we start
(10:32):
forgetting things. And it's not that we're our mind
is declining. It's just we have so much
information to deal with that, you know, we don't need to get
scared about. OK, Yeah.
I forgot that I forgot your name.
I mean, I teach and and you teach too, and you're a lot
younger than me. I can tell.
But for me, I've had so many students over the last 20-7
years that I'm finding it harderand harder to remember names.
(10:53):
And at times it's like, oh, you know, can't be, can't be the
aging brain. Yeah.
It's just that I have so much information I have to worry
about. So what role do them?
Oh, go ahead. I just was.
Going to say it's really interesting.
One of the one of the things that it does improve is we age
is actually one of the things that really doesn't wane in the
healthy aging brain is is our ability to to remember like
familiarity, familiar thesis. So you might struggle to love
(11:15):
the name, but the knowledge thatsomeone is familiar to you that
actually gets better and better as we get older.
So again, I change. I think rather mine, yeah.
Which is always, it's fun when Igo out somewhere and I, I run
into a student I haven't had forlike, a decade.
And, you know, they remember my name because, you know, it's a
lot easier to remember your professor's English means I know
this person, what's their name, you know, and, you know, it'll
(11:37):
bother me for hours, you know, go home and I'll try and figure
out who the heck this person is.I like when they actually come
up and introduce themselves. You might not Remember Me, but.
And then they have to pretend like, oh, yeah, yeah, I remember
you. Yeah.
So what role do infectious and autoimmune diseases play in
neurological aging? And are there preventative steps
(11:59):
that we can take I. Think this feels like
understanding the relationship between infections, our immune
systems and how our brains age. It's really an an emerging
science and I think there are probably more questions than
answers in terms of actionable advice that I can offer
listeners. I think, you know, we, we think
now that inflammation is a part of neurodegenerative diseases
(12:20):
like Alzheimer's disease, instance disease.
And some scientists have also speculated that chronic
infections, viruses like a herpes simplex virus, the
coupled sores or like the Epstein Barr virus, like this
mononucleosis, both those are pretty ubiquitous for most
people. They're often viruses in
childhood and can stay in our bodies our whole lives.
We think maybe those kinds of very, very chronic common
viruses can play a role in lammatory changes.
(12:41):
As we age, two different things happen to our immune system.
So the first is what some peoplehave called inflammation, which
is this idea that as we get older, our immune system has
this long memory for all of the infections that it's bought.
It becomes you can activated again and again and again, just
like learning all those names again and again and again year
after year. And it becomes more primed so
that even when we're not actively fighting an infection,
(13:01):
we have this sort of like constant low level state of
inflammation that we think somehow contributes to the aging
of neurons in our brain. The second thing that happens,
which is really counterintuitiveis what's called
immunosenescent, which is basically the phenomenon that as
this kind of general inflammation is happening, our
immune systems get less efficient in actually fighting
the infections that were that were coming up against than they
(13:23):
were when we were younger. So somehow, even though our
immune system is already primed by everything, it's already
experienced, it's not quite as good at activating when it's
truly needed for certain kinds. And so we become risk of certain
kinds of infections that our younger cells have much more
easily been able right off. And we think that these two
things really play a role in in brain aging.
Although this is really an emerging science and murky,
really murky how, how and why. I don't have great advice on
(13:46):
prevention, although I'll say that I think some of the studies
suggest that the factors that play a role in aging more
generally. So things like quitting smoking
if you're a smoker, getting enough sleep and exercise, all
of these things we think maybe have an effect on this
inflammation as well. So maybe you know, by addressing
1:00 we we kind of address some of the broader factors you.
Kind of touched on our what has now evolved in the six pillars
(14:07):
on this podcast where we talk about the role of exercise,
physical activity, healthy diet,getting good sleep hygiene, not
smoking, of course, maintaining healthy body composition and
purposeful social connections. But all those things seem to
have some positive effect terms of hurting the brain.
Yeah. Absolutely.
But we, you know, and I think itsounds really simple, but I
(14:27):
think there are like, there are still some mysteries on how
those, like how those pillars protect our brains.
And maybe a piece of it has to do with this picture.
Yeah. It's, I'm fascinated with the
inflammation part of it, part ofit because one of my professors
in Graduate School is really into exercise immunology.
And he actually, he and some colleagues coined the phrase
immuno inactivity, that they go kind of beyond the concept of
(14:50):
immuno inactive immuno aging. But our inflammation, I'm sorry,
and, and toward, you know, the fact that our inactivity tends
to have that contributory inflammatory response and that
that can lead to some of the degenerative stuff that we see
in aging. That's kind of fascinating.
The whole concept really is interesting to me.
It's so fascinating. There have been some studies
(15:11):
looking at in fact even infections like covet or
influenza and like the actively exercising body and how we
receive those events differentlydidn't have whether we're act
not it really. It's fascinating, gives you a
lot to chew on, I think, as you're thinking about how to
move through your day, you. Seem like somebody that is super
excited to just approach every day of work that, you know, the
lessons you're going to learn and the things that you're going
(15:32):
to experience. And you tend to specialize in
diagnostic mysteries. Can you share a particularly
fascinating case that shed some light on the complexity of the
aging brain? Yeah.
So I so after my residency ended, I did this a fellowship,
it's called the advanced generalneurology fellowship, which is a
very vague term and it was focused on what the Doctor Who
founded it, the fellowship called mysteriomas over the
(15:54):
areas. It's focused a little bit more
on autoimmune and infectious diseases in the nervous system,
which are often the ones that atfirst seem mysterious.
Medicine is increasingly becoming very self specialized.
But I really still love the ideaof being an old fashioned Doctor
Who cares for everyone who's on the door.
But I think the story that really comes to my mind when I
think about sort of the mysteries of how we how we age
(16:15):
and how our brains ages. Not someone I care for as a
doctor, but a personal story. So I before I knew I wanted to
be a neurologist when I was a medical student, I was in my
year, just starting my 4th year medical school.
And my grandfather who lived in India, he grew up in a very,
very rural village in North India and lived in India my
whole life. And he was, he was in his late
80s, maybe early 90s and he started to develop this really
(16:38):
strange illness. He started wasting away.
He lost one of his muscles. He started, he lost a lot of his
strength as his strength voice, he started to choke food.
And it was this really, it was areally, he was this really like
larger than life figure in my childhood.
He had all of these adventures. He traveled to the US when he
was younger. He had made films for the Indian
government and really had this incredible kind of larger than
(16:59):
life personality. And it was this real
transformation, watching him as he aged developed these
mysterious symptoms. And I can remember being a
worker medical student and goingto the neurologist and the
neurologist examining him in a cotton gown and showing me the
way that his muscles were twitching.
And what what turned out was happening was that he had grown
up in a very rural part of Indiaand had many, many infectious
(17:20):
illness, child malaria and seasonally, but he also polio is
a child. And as he grew older, he
developed all post poliosin, which is kind of this echo of a
childhood infection that our body stops being able to work.
And people with polio decades and decades and decades after
they were first ended will have what's called post polio
syndrome, which is a constellation of some of the
symptoms of polio that unfurl almost like a VHS tape rewinding
(17:41):
as they get older when they've been well for their whole adult
life. And because my first realization
of the way that our that the aging brain and the aging body
is really a record of all of ourexperiences, not just illnesses,
but you know, everything you're encountering and experiencing in
your life is becoming folded into your brain, in your body.
And I don't think I had quite, you know, it's something I'm
still kind of learning every day.
(18:02):
But I think that was my first like moment of realizing that
Oh, like this entire, you know, this my grandfather's whole
story, his childhood, his you know, his culture, like all of
these things were really wrappedup in his body as he as he grew
old or those things are not thing that ever leave you that.
Kind of leads to my next question about you write that
stories are hardwired into our brains and you know, you just
(18:23):
kind of give a little bit of theimpact of how that affects the
patient, but how does this impact the way doctors diagnose
and treat patients and really how they should diagnose and
treat patients I. Think so I'll say a couple
things. I think it just is a it is a
lesson to me that I think one essential lesson that I took for
my medical training is that no matter how strange a symptom
(18:43):
seems, you know, anything that can go awry with their brains
and bodies really reveals something universal about us.
So if something can go wrong, itoften tells us something about
how things are are working. And it's really fascinating to
watch. You know, the way that we know
that stories are hardwired into our brains is because someone
can have an injury that makes it, Someone can have a
neurological wound that makes sothat they lose their ability to
(19:05):
see or to move, but their brain is still often spinning stories
about their illness. And I think a lesson from seeing
this in people who have a neurologic disease is that
stories are a human universal. And what that means is that
doctors are telling stories justas much as their patients.
And sometimes we get the story right and sometimes, sometimes
we get it wrong, you know, and Ithink, and I think like a big
part of being a big, I think an essential part of being a Doctor
(19:28):
Who sometimes gets it right is having humility and realizing
that we're just, you know, trying to make us trying to find
the a coherent narrative and allthe deals we're seeing in exam
or history and that sometimes wedon't pay attention to the
right. Do we get it wrong?
So have. You seen cases where the way the
patient's story is framed by themselves or by the medical
professionals has affected theircare.
Absolutely. I think I see, I, I don't always
(19:49):
notice it, but I don't always realize that that's happening.
But I think if you look at play enough, it happens all the time
in hospitals. And I think anyone is in time in
the hospital has experienced this, whether or not they've
been a part of the morning rounds where they actually see
it happening. One example that always jumps to
my mind example of of autoimmuneencephalitis, which is an
inflammatory disease of the brain caused by an.
Overactive immune system and what's so particular is that it
(20:12):
often first presents with psychiatrics and so with mania
and psychosis and kind of behavior changes and like many
autoimmune disorders, it tends to be more common in young women
than in other groups. And that, you know, we could do
a whole episode on on that and why that's the case.
That is still something I think science is trying to come to it.
Maybe for that reason, maybe because the stories we sometimes
(20:33):
tell about young women and theirbrains because of this old idea
and medicine that are like hysterical women.
That's story of neurology and medicine.
Many of these young women are dismissed by doctors before
they're diagnosed or given the wrong diagnosis.
The journalist Susanna Cahillan,who suffered from an autoimmune
encephalitis, wrote this amazingbook experience Screen on Fire,
and she talks about all the misdiagnosis she was given
(20:55):
before, before doctors gave her the correct she was.
She was diagnosed as as a neurotic, as an alcoholic.
All of these things that really were not really were not
grounded in the reality of what was going on, but they were
based on the stories that doctors are telling and
inferring about who she was. And they really were it.
Matt I was so consequential because it determined how she
(21:16):
was treated or not treated it. Seems like that can be a pretty
big problem in our health care system if doctors don't dive
deeper into the story. We tend to just treat the
symptoms and we miss pages and pages of information to kind of
keep it in that storytelling scenario.
So how can patients and caregivers better advocate for
(21:36):
themselves or their loved ones in medical settings, Sister?
It's really tough. I think, I think that I, I hate
like it's, it's tough because I,I wish that the onus weren't on
patient and patients and caregivers.
I wish like the conversation we're having is like, how can
hospitals do better? But it really, you know, exactly
as you said, I think I think going into that.
So one, one thing I would say isyou're advocating for yourself
(21:57):
or your loved 1 is just going into the hospital setting.
Just be it's helpful to be aware, I think that doctors are
human and medicine is a very fallible science.
So we get things wrong and that's not necessarily because
of negligence and it's not because of malice because we are
operating in this imperfect system with incomplete
information. Doctors are not generally known
for being great at humility, I would say.
But I think having an awareness of the ways that medicine is
(22:19):
perfect and it's filled with ambiguity and uncertainty in
Gray areas. I think that's really helpful
going into a hostile setting, because I think it can help sort
of make set your expectations and help to and help to, you
know, to first of all, you know,know that that absolutely like
we're all fallible and and doctors getting wrong just as
anyone else. But also to, you know, to know
that like, you know, you might you're you might be in that you
(22:41):
might be in this kind of like ambiguous or Gray area space.
Your illness might fall into that space And there there might
be a a lot of discovery that's required for, you know, striking
on what works great. So I think that like sometimes
those contexts to keep in mind is approaching illness and.
Systematically, how can the hospitals themselves and the
medical systems, what can they do to change to maybe help allow
(23:03):
more time for doctors to be ableto get the full story?
My gosh. That's such an important
question and one that I spent a lot of time thinking about.
You know, in the American healthcare system, the way that
the way that, that that doctoring is reimbursed is with,
is through this system is using a metric, it's called revenue
value units, RV, and it's essentially a way of trying to
(23:26):
value the time that doctors spend with their patients in a
way that minimizes the amount oftime for the maximum amount of
benefit. And I just don't think there's
AI don't think that that's the right incentive for, you know,
for, for valuing the time that people spend with their
patients. So, you know, I, I don't have a
great, I mean, you know, not thehospital where I work.
I think a big one is, is I care for patients who speak many,
many, many different languages, like hundreds of languages are
(23:48):
spoken within the walls of my hospital and making sure that
making sure that we have medicalinterpreters who are readily.
And then I think that that, you know, extends even to context
where everyone is fluent in English.
I think the languages and can betotally separate language as
well. So, you know, so, you know, I
think like for doctors and health systems, like thinking
about how to remove the jargon and the insurance language from
(24:08):
from the conversation. I think that can really hold an
effective existing on this matter.
But, you know, I think it's justtough.
It's really tough. I think in Americans, I think
sometimes economic benefits and Wellness are aligned, but I
think often they don't and we still need a way to value well.
So what advice do you? Have for for women in particular
and people of underrepresented genders and navigating the
(24:29):
healthcare, yeah, so I think. You know, again, like I I wish
that I could be Sanger systems like we need to value people's
experiences equally and care forpeople equally.
Very exactly right that some people, I think, sometimes need
to advocate more for themselves than others and the onus really
falls on need for themselves in system.
I think one thing I would say isthat, you know, for all that we
don't know in medicine, in neurology, I think that's
(24:49):
doubled for women and people of underrepresented gender.
So we, I mean, doctors in medicine don't know a whole lot
about how illnesses and medications interact with
pregnancy, with all kinds of different hormonal shifts in our
bodies. And as a result, I think
medicine can't always offer kindof A1 size fits all solution.
So I think just being aware of of the degree to which there is
(25:10):
uncertainty in medicine and science and the degree to which
we are still learning about the pregnant body, the, you know,
the like hormonal shifts that wego through as we age.
Those are all things that that Ithink medicine has not carried
very deeply about for a long time and is just now something
that that we're starting these more deeply about South.
Just just being aware that therethere is still a lot left to
(25:32):
learn. It isn't for encountering the
health system. So how do you?
Find time for creative work while practicing medicine
because it sounds like you're really busy at the hospital and
yet you're able to write and I know you're a mother, a lot
going on. How are you able to find time to
just be creative? Well, again, practicing your
medicine and raising your familyand doing all the things that
(25:54):
you do to be totally candid. I'm still still figuring that
out, so I don't have an easy answer yet.
I wrote the first essay of what would become this book like six
weeks after I gave birth to my first child.
I was in this bizarre, sleeplessstate that really echoed my
experience in medical training, where I would often work like 28
hour shifts without leaping. And I wrote a chapter of the
(26:15):
book that went up being the chapter about sleep.
The book sold to Simon and Schuster 2 weeks before I gave
it to my second son. And I wrote the rest of the book
in this kind of like manic sleepless haze during my
maternity leave while I was still nursing my second son
every couple hours. I didn't leave my house for a
few months. I my kids are not toddlers.
The big kid is turning 3 this summer and the little one is 1
(26:36):
1/2. And I think something I've
realized after having kids, I don't know that I could have
written a book before I had kidsbecause I, I think I treated
having children as like, I made a bucket list while I was
pregnant. I was like, these are the things
I have to do before I have kids because once I have kids, it's
all over. And I think it's just that that
sort of it really threw things into sharp focus.
I think it really helped me to prioritize the projects and the
(26:56):
goals that felt truest to me, that which were being a mother,
being the kind of neurologist and teacher that I've always
admired, but also writing, like writing these stories felt like
something that were unique to meand that, you know, were stories
that only I could tell. And I think I had a much easier
time saying no to things that didn't feel as essential to
those like horror values and andgoals.
(27:16):
I think it turns out that makingtime for things means having to
not make time for other things is what I've learned.
So the key to being. Creative is to have kids, huh?
If. You're going to write.
More books, you're going to haveto have about 5 or 6 more kids.
I have a bunch more. Kids, right?
There's already two kids turns. It turns out two kids is a whole
lot of kids already. So.
(27:37):
Oh yeah. Don't know how.
People do it. Yeah, I have two.
We're just waiting to get them all out of the house.
My youngest is just turned 17, so she's anxious to get out of
the house. My oldest is going to be 20 in
July and I think he wants to getout of the house, but he's in
college, so it's kind of like it's not time yet.
You know? It's too expensive for you to
move out and you're going to school locally.
(27:59):
Just stay home and get the college stuff done.
That seems like a huge. Transformation and like identity
shift is it is having a 17 year old who's about to leave that
and she's she's. A character so it's fun that's
what you get to look forward to you know yours are young enjoy
them I mean I'm at all age we tell my heads when I.
Talk all the time. I'm like, when are we gonna?
When are we gonna be able to sleep again?
When our kids go to college, even Sure if you can.
(28:23):
Sleep in. If they go off to college,
that's going to affect your sleep too, because you're always
going to be worried about them. A little worried?
Right. Yeah, true.
So what? Lessons from neurology have you
applied in your own life? We've kind of been touching on
that a little bit, whether it's an aging, parenting or
self-care. Yeah, I mean.
Like I think again, I think it'sjust the way that the way that
science and medicine works is that every time that something
(28:44):
goes awry in our brains, we takelessons from that to understand
how things work when we're when we're well.
So may seem like some these neurologic symptoms are really
kind of esoteric and like, what does that have to do with me or
my brain? But it really reveals something
about how our brains were. So I think I, I really love, I,
I really love the idea that stories are how we make sense of
the world. That's something that I like
(29:05):
think a lot about in parenting and in, in being, you know, even
my toddlers, it's so interesting.
They, they are already starting to frame the world in terms of
stories and they're seeing themselves as character.
So that's I think a big one thatI have that I have taken to my
to my personal definitely learned again and again in my.
So I'm curious. When you put your kids to the
bed at night, are you a storyteller?
Do you make up stories to them or just read to them?
(29:27):
Or what do you do so for the longest?
Time we did they have a they love books and have a ton of
books. So for the longest time we would
we would books and my my toddlerlike really likes to imagine
himself as like so character andmajor in his book.
So blueberries for Sal is now blueberries for Emil, which is I
mean, that's like his favorite, favorite book.
(29:47):
But recently the the big kid hasstarted to ask for what he calls
Emil and Lomax adventure stories, which are stories that
we make up about him and his brother going on a big
adventure. And they all are very similar.
There's not a lot of variation. They, you know, they go one or
three places, the zoo, in the museum or at their grandparents
house. But it's really interesting,
like how much they love, love hearing stories about
(30:08):
themselves. They never want it to end.
So I'm just now entering the agewhere we're making up stories.
Yeah, you might have a. Career in writing children's
books too then it's so it's it's.
You know, I think you look at these books and you're like,
there are like 3 words in this book.
How hard can it? But the children's you can click
Once you have kids, you can tell.
Some children's books really work and stay in the test of
time, and some don't. And it really takes a lot of
(30:30):
skill, I think, to write a good children's book.
Do you have a favorite? That you like to read with kids,
we have a. We have a let me think we have a
ton of books that I really love 11 really good one that I never
seen before is that little fur family, which is by Margaret
Weiss Brown and she wrote, she wrote Goodnight Moon, which is
probably her most popular book. But she has this book called
Little Fur Family, which is about a a little a family family
(30:53):
of three that lives in a a wood and the the little fur baby goes
out on this big adventure and then come somewhere and it's an
old, but it's just incredible how resonant it feels for my
kids. I still love it.
Nice to see that lots of things stand the test of time and age.
Well, I think one of my favourites.
Was always pajama time and I forget the author's name and
then the other is, is that? Yeah.
(31:13):
Yeah, Sandra. Bolton yeah, Car bucks are
always fun. They read the kids and then the
other was Doctor Seuss's Fox andSocks because it is so hard to
read that. I actually used that when I
started teaching pathophysiologyand exercise.
Stumbling over all, especially in your field, how do you talk
about neurology with all these big words and stuff, blah, blah,
(31:34):
blah, blah. You know, I tried these long
words and my, you know, I would always end up teaching
pathophysiology when I was at Eastern Michigan, one of my
third classes or fourth classes of the day.
So it's at the end of the day, I've just been teaching in
anatomy. I just taught Physiology and now
I got to teach all these big words and I would start
stumbling over the words. And so I started.
I would read Fox and Socks just to kind of warm my tongue up.
(31:56):
And there were times when the students would be like, Doctor
Armstrong, I think you need to pull the book out.
So I'd pull it out. I'd read a few and it kind of
warmed me up to be able to speak.
So I always loved that book. I still love that book.
I love Yeah. It's like every possible, it's
like flax, socks, chicks, bricks, like every configuration
that your tongue and your mouth can go into.
That's amazing. I feel like it's just a reminder
(32:17):
that teaching is such a performance.
I feel like the teachers are really delivering.
Amazing. So how does this?
I mean, this is a little off topic, a little bit, but you
know, we consider aging to startbasically before conception.
You know, if you're aging well, it starts with your parents,
your grandparents and epigenetics and and all that.
But how does that storytelling, that starting to read early, all
(32:39):
that, how does that impact the the long term health of the
nervous system of, you know, neurology for a child and
someone that's wanting to age? Well, yeah, maybe we should.
Add a 7th pillar, which is around storytelling.
You know, I think, you know, youspoke about how it's really
interesting. You spoke about how you've
spoken on this platform about how one of the most essential
(33:00):
pillars of aging, of healthy aging is kind of social action.
And it's so interesting. Like, I think one of the lesser
from a lot of these disorders is, is, you know, I So what like
1 great example is if you lose your vision in a certain way, or
if you lose your ability to hearin a certain way and you're a
person who is isolated, your brain will actually construct
new visual input or new sounds to make up for the input that
(33:21):
it's, it's missing. It happens much more in elderly
people who are socially isolated.
And I think it just tells us like how like stories are, I
think are often a form of connection or a form of
understanding our are placed in a complex social structural
world. And so I think, I think stories
are probably a part of very mucha part of that pillar.
And again, exactly as you said, you know, aging the way that our
(33:43):
brains age has is such an echo of the way that our brains first
develop. There's this really, you know,
profound kind of mirror image between how our brains age and
how our brains first are tire uplanguage and first start to 1st
learn to read and 1st learn to make all of these movements.
You know that you wonder whetherwhether aging brains are more
able to to prune and keep the right synapses and and
(34:05):
understand what's salient if youhave as kind of if you have or
if you're able to, if you're officially able to kind of form
stories to to tell your brain ison right.
So all this kind of. Leads me to my next question is
the question I ask of all of my guests.
So you can't escape it. What are you doing personally to
age well? This is a.
Major work in progress for me. I don't know that I again, I
don't know that I have any kind of actionable advice.
(34:27):
I think one of the factors, one of the pillars that you
mentioned that I think a lot about as a parent of toddlers,
as a doctor, is sleep. You know, I writing the book, I
spent a lot of time reading these very old scientific papers
and medical reports that are often like much more vivid and
descriptive than temporary scientific papers.
For a long time, scientists basically ignored sleep
(34:47):
together. It was described in medical
texts as the cessation of the waking state.
So it's literally like when you're not awake, you're asleep,
but we don't care about it. And then this Russian
neuroscientist is one of the first female biochemists.
She did the series of experiments to try and
understand, published it in thispaper called Sleeping, Sleeping
1/3 of Human Life, which was about how profoundly important
(35:08):
was. And she writes really
evocatively about the physical traces that that sleep
deprivation leaves in our brains, the way that our
physical DNA of our neurons acted by prolonged sleeping.
Sleep can really feel like a luxury for people who have
little kids or who are working the 3rd shift or who don't have
a lot of control over their wordand lives.
So I don't want to be prescriptive about this.
And I know as a resident, I spent years of my life
(35:28):
essentially not sleeping at all.I'm not sure how that has aged
my brain, but now the big thing that I have been trying to focus
on recently is trying to priority when I can, but I'm not
on call the hospital. I sleep on a different floor of
my house from my phone and my laptop.
So they're on a completely different the house than I am.
I try and have as much of A separation between screens
asleep as I possibly can. And I also do my own bedtime
(35:51):
stories. So I my husband and I before we
would read books to each other so that we so that, you know, we
wouldn't have to be like lookingat light when we were falling
asleep and I couldn't be readingand bedroom rather than.
So this is like a something thatI have sleep is something that I
have always thought a lot about and and wished for.
And I'm not thinking about how it's going to be a part of how
I, yeah, I don't think I really.Started thinking about sleep
(36:14):
enough until really starting this podcast and over the last
year and a half, really kind of being introduced to how
important it is for sleep. It was not one of my pillars
initially when I was teaching pathophysiology and exercise.
And, you know, as I explored it more, it's like I'm starting to
look at my own sleep and tracking my own sleep.
And, you know, I pushed to have a sleep study done so that I can
(36:34):
determine whether I had sleep apnea.
After about a year, I finally got my CPAP.
And, you know, I've been doing that for about a week now and
I'm not sleeping. I'm getting these like, worse
sleep reports. It's like, wait a minute, I'm
supposed to be sleeping better. So what is going on here?
So I have a feeling, I hope it'sjust that I'm adjusting to, you
know, using the machine and thenhaving that, you know, something
(36:56):
to keep my mouth shut at night and trying to breathe through
this, you know, a little thing under my nose.
But sleep is just hugely important and I think we
underestimate it. And as an exercise physiologist,
you know, I'm humbling myself starting to say, you know, I,
I've always kind of put exerciseat the top in terms of for
aging. Well, you got to be exercising
and physically active, but sleepis starting to kind of get up
(37:18):
above that. And then so are social
connections that it's like the most important things you got to
be doing is have those social connections and you got to sleep
because you can't exercise well if you don't sleep and you're
not going to get the benefits ofthe exercise if you don't sleep.
And so I, I think maybe I becomea sleep physiologist or
something like that. I don't know.
But I'm glad as a physician you're pointing out that that is
(37:39):
one of the most important thingsthat we have to do to be able to
age. Well, it's interesting, you
know, it's. So crazy because I think
doctors, we still have this, youknow, medical training system
that really values the ability to not sleep.
And that's still, you know, it'schanged over the years, but it's
still a little bit of a part of our medical, but it's so
essential. And it's also, you know, when we
look at neurologic illnesses like neurodegenerative diseases
(38:01):
like Parkinson's disease, this is a great example.
So sometimes the very, very first clue that someone will go
on 10 years later or 20 years later to develop Rickinson's
disease is changes in their sleep.
So people will have really vividnightmares that they'll develop
what's called REM sleep behaviordisorder, where it's kind of the
opposite of sleep paralysis. They lose the paralysis of
dreams that are acting. And if you listen to someone's
(38:22):
story, sometimes you can, you know, the people will describe
that they've been sleeping, you know, side by side with their
wife for years, but now they're sleeping in the guest room
because they're punching and kicking in their sleep.
And it's so, it's so, so, so entwined with so many of the,
you know, illnesses of aging that I think it, it's shocking
that that medicine occurred so little about sleep for as long
as it did. It's only been pretty recent.
That they've kind of made the rules where you can't be on call
(38:45):
for, you know, several days at atime and, you know, you have to
be able to get some sleep and doing all that.
And, you know, it's just, it's fascinating how much we ignore
sleep. Sleeping 1/3 of human.
Life well, hopefully for some people.
It might not be 1/3 of life, It might be far less.
Some of my college students, I think it's a lot more, but
they're young. That's right.
(39:05):
That's my that's. Why I'm going to aspire to 3rd,
3rd a few third of my life and Ialways get fascinated.
Too with the the nature and the quality of my dreams depending
on how I sleep. And I'm starting to tie a lot
more of, you know, the more I'm dreaming and especially the more
wild the dreams are, the better my REM sleep appears to be.
Is there any real tie to that oris it just something that's kind
(39:27):
of coincidental and it's just kind of cool to think about, but
there's no real science to it? That's really interesting, I.
Don't that's a really great question.
This is like an entire this is Even so like it took science a
really long time to care about sleep at all.
And then it took a really long time for science to care at all
about dreams. So that was like an even more it
was like this kind of esoteric weird discovery where this this
(39:47):
this physiologist who was interested who had been studying
like infants was interested in how infants eyes were moving
when they slept. And then he was trying to figure
out how to use an EEG machine and he his 10 year old, 10 or 12
year old son was, was hanging out with him in a sleep lab and
he the kid up to try and figure.How to get all the electrodes
correct? And he all of a sudden realized
that as his son was sleeping, there was a moment during sleep
(40:07):
when his brain suddenly seemed awake.
And that was REM sleep. And his eyes were doing
something really funny at the same time.
And that was like the first moment, not like in recent
decades that science suddenly started to care about dreaming.
But I don't think there's, you know, I think, you know, we are
starting to understand a little bit about this architecture
sleep from medications that we can use to shift how much time
(40:27):
spent someone spends in slow agesleep versus REM sleep.
But I don't think there's any. I don't know that there's any
science on sort of the quality of your dreams and how that
reflects the quality of different phases of your sleep.
This is the next should be the next frontier for for medicine.
Also notice too that. Depending on which side of the
body I sleep on, because I'm a side sleeper most of the time,
if I sleep on my left side, I tend to have this far more kind
(40:50):
of vivid weird dreams that again, drive my REM sleep up.
And if I sleep on my right side,I tend to be processing a lot
more, you know, thinking about what I have to do, teaching the
next day or, you know, a podcastinterview that I'm doing, just
things that I need to be doing kind of more practical dreaming.
And it's like, again, it might just be my weird nature, but
(41:12):
it's kind of, you know, for somebody who is fascinated by
the human Physiology, I'm like, is there something to that?
That is, I sleep on one side versus the other.
My brain is functioning slightlydifferent, you know, and maybe
it's tied to my veggies. Yeah.
I was wondering like could the sleep?
Apnea be like, is there one sideon which this apnea is more
prominent than the other side? It could be, I don't know.
There's SO. Much science left to be done,
you know, and I can just be on my own human experiment, so.
(41:36):
Your book is is. Fascinating and it's one that we
we know you really kind of get the listeners to check out and
where can the listeners learn more about your work and to
pre-order because I think it's still in the pre-order stage,
right for the book to pre-order the the mind electric.
Yes, well, again. It's been thank you so much for
having me on this pod and it's such a joy.
I feel like I have learned a lotabout aging well.
(41:59):
So thank you again for having me.
People can learn more about me and the book at my website,
Priya on and.com, my first name,my last, or on the Simon and
Schuster website where they can find links to order a copy of
the Mind Electric anywhere booksare sold.
The book is going to be out on June 10th and I cannot wait to
share it with all of your listeners and we'll have links
to all that so that. They can just click on it and
(42:19):
get the book. But anything else to add as we
wrap up? No, this is.
This is such a. Joy, So thank you again for
having. Well, I enjoyed having you.
And as always, just keep, you know, doing what you're doing.
Keep being creative. Keep writing.
You don't have to have more kids.
You know, you can be creative without having more kids.
But if you want to have more kids, I'm sure that will be a
blessing on the world. So just keep doing what you're
(42:39):
doing and keep aging well. Thank you so much, chef you.
Too with such a joy thank you for.
Listening Hope you benefited from today's podcast and until
next time, keep aging well.
Welcome to the Agingwell podcast, where we explore the
science, stories and strategies that help us live longer,
healthier, and more fulfilling lives.
Today. We explore the fascinating world
of neurology, storytelling, any intricate ways that our brains
shape our health. My guest is Doctor Priya Anon, a
neurologist at Boston Medical Center and assistant professor
at Boston University School of Medicine.
(00:26):
She is also the author of the upcoming book The Mind Electric
and exploration of the neurological underpinnings of
human experience, illness, and identity.
Doctor Anand's work investigatesthe power of storytelling in
medicine, the gendered history of healthcare, and the complex
cases she encounters. As a specialist in
neuroinfectious diseases and autoimmune disorders.
(00:47):
She also offers a deeply personal perspective on
balancing medical practice, writing, and motherhood.
Join us as we discuss the brain's profound role in aging,
the narratives that shape patient care, and what we can
all learn from the mysteries of the mind to Age Well.
Doctor Nod welcome to the Aging Well podcast.
Let's just begin by having you tell our listeners a little bit
(01:08):
about yourself and what led you to writing The Mind Electric.
So hi Jeff, let me just start bysaying thank you so much for
inviting me to join you and alsofor reading the book.
I am a neurologist. I care for patients with a
pretty wide range of neurologic illnesses and symptoms in the
course of my practice. But before I wanted to be a
doctor, I actually wanted to be a journalist.
(01:30):
I wanted to be able to tell people stories in a way that
felt powerful and true. And when I first started medical
school and kind of shifted gears, I thought that I left
storytelling behind. And the further that I went in
my training and my practice, themore I realized it was actually
a really essential part of my work still.
So I kind of, I think became interested in the kind of the
salience of stories and medicineand layers.
(01:52):
I, as a medical student, I was still really new to the language
of medicine and far more than learning about the jargon of
diseases, I really loved hearinghow my patients and their
families and their communities talk to their illness.
So people construct all of thesestories and fables and myths to
make sense of illness and they felt way more legible to me than
what I was reading in medical texts.
Great example of this example ofsleep paralysis.
(02:14):
I don't know if you have ever had the experience of sleep
paralysis maybe? You're not, thankfully.
Thankfully, it's it's it's shockingly common and maybe
listeners will be able to speak to this as you're falling asleep
or waking up just with this kindof like boundary between sleep
and consciousness. People will have this experience
a feeling frozen so their body is paralyzed as though they're
asleep and they can see or hear their dreams, but their brain is
(02:37):
fully, it's kind of this blurring of the boundary between
being asleep and being being awake.
It's really a profound and frightening experience.
But it's also common enough thatevery culture has a folklore
around the 6th. So people will describe a witch
or a sorcerer or cast a spell that freezes you, or a spirit or
a creature who sits on your chest.
And so you, before I grew kind of into some medicine, I was
really taken with the ways that people would tell stories to
(02:58):
make sense of the immensity of illness and of symptoms.
And after I finished medical school, I started my training in
neurology and I started to otherkind of storytelling.
I watched people's brains weave elaborate stories that they
weren't even aware of. A great example of this is the
symptom of confabulation, which is a part of so many neurologic,
the aging brain and other brains, which is essentially the
brain making up a story to fill in information that it's missing
(03:21):
about the world. I've had patients, a neurologic
disorder that caused amnesia, who could not remember from
day-to-day that they were in thehospital.
And I would say, oh, have we? Have we met before?
And they would say, of course, we saw each other at our high
school reunion and make up this really elaborate story of how we
knew each other even though we never met were at all.
And as I started to become a neurologist, I started to learn
also that there are ways that our bodies tell us, tell stories
(03:43):
about our past and our future and reveal something about our
own area. Because I've gone further in
medicine, I've realized that this way of telling stories
about illness, it's not just unique to patients.
Patients are not the only ones who tell stories to make sense
of what's scary and strange about illness and disease.
Doctors or stories are maybe themost powerful tool that our
brains, the human brain has, andthey're how our brains have
(04:04):
evolved to make a really chaoticworld.
And kind of watching all these layers of illness and story
unfold is really how I first started to think about story
that first inspired me. To the brain fascinates me and
it's kind of beyond my scope of understanding because I'm more
of a I'm an exercise physiologist.
So the the muscle, the cardiovascular system, all
that's easy understand, but diving deeper into kind of just
(04:26):
understanding the mind and how our, you know, our nutrition,
our lifestyles, our exercise, all that affects the brain.
And even though you just start scraping the surface.
And so your book, The Mind Electric explores our brains and
how our brains shape our experiences of illness and
healing. As you've been talking about,
how do you see this playing out in aging and neurodegenerative
(04:47):
diseases? I'll say first that I I feel
like I have very limited understanding of how my muscles
and my cardiovascular system arechanging as I I can subjectively
experience it, but that is a whole can of worms that I would
love to wish that I understood better.
I think what sometimes really scares people about the
experience of aging is fear the potential that aging is going to
disrupt their narrative or theirlife story or their identity in
(05:09):
a really profound way. Because so many diseases of
aging are disease of brain, neurogenerative diseases like
mentioned that really intersect with our stories and ourselves.
I think the most kind of common or like legible example is
probably Alzheimer's disease, which often effects memory, but
there are also dementias that affect language, that affect
people's ability to literally communicate their own stories,
(05:30):
that people's ability to visually perceive the world.
Other neurodegenerative disorders like Parkinson's
disease can leave memory and language intact but affect your
ability to physically move through the world.
All of these things that really kind of impact your story and
your and sense of self and identity.
I think there's this really likecomplex like a web of
relationships between neurodegenerative disorders like
(05:53):
Alzheimer's, person partners, disease, aging, and the stories
that that we tell about our cells and let our brain tell
that our brains tell us about our.
I had a colleague when I taught at Hope College before I moved
out here to Michigan, who was one of the Physiology professors
who had Parkinson's disease. And he had a tendency his body
would freeze up at times, which I I know is very common with
Parkinson's disease. But he found that when his wife
(06:15):
sang in his ear, it would loosenhim up.
And I always found that fascinating.
What? Why is that?
Such a lovely story and such a lovely there's there's like AI
think there's a physical explanation which is probably
doesn't capture the full like immensity of what you're saying.
Yeah, it's really interesting. This phenomenon of freezing can
have really particular trigger. So a very common one is passing
(06:37):
through thresholds, through a doorway or even crossing a piece
of tape on the ground. And somehow we these, you know,
even without a like a physical barrier that you have to to kind
of overcome. Our brains are so are so
efficient at translating sensoryinput about the world into kind
of modulation of our movement that even something as simple as
(06:57):
whether you're in a wide open space or in walking through a
doorway and in a tight order impact whether or not you are
able to to move or, or whether or not you're able to sort of
initiate movement is kind of thething that don't really start.
I I don't have a great explanation.
I haven't heard a story like that before about someone's
loved 1 singing to them, but I think it's a really beauty and
it's something I'm going to share with patients.
(07:18):
Well, the. Funny part, The funnier part of
that story is it's not quite as funny, but over a winter break,
I think it was like finals week in between semesters.
So it was winter time in WesternMichigan.
So it was very cold. But he lived close enough to the
Science Center that he just, he left without a jacket, walked
over to do some grading because the football game he was
watching was disappointing. And he froze on the stairs, you
(07:40):
know, just walking up the stairs, just mid step stop.
And fortunately, another colleague lived in a
neighborhood and saw him and knew that something was wrong.
So he goes over to him. He said, can I help you?
And he said, this is going to sound a little strange, but can
you try singing Did. It work with someone else
saying. Yeah, he had to kind of, I think
moderate his his singing a little bit to maybe match the
(08:01):
lives. But yeah, it, it ended up
working for him thankfully, because, you know, I don't know
what else he would have done Frozen.
He would have literally been frozen on those stairs.
So. So based on your experience,
what are some of the biggest misconceptions that we see about
aging in the brain? I think.
One of the big points I want to make here is that I think people
have this misconception that aging is all downhill when it
(08:23):
comes to the brain, and I don't think that's quite true.
Look, nothing in medicine, nothing about our brains and
bodies is simple or linear. There definitely are some things
that become more difficult or less efficient for our brains at
the age, but there are also somethings that become better.
So some of what happens in our brains as we age really
parallels what happens in the brains of infants and toddlers
as they grow into children and they learn about it's infants
(08:45):
grow into children. Something really important that
happens in their brains is that their brains go from being this
chaos of many, many different synapses and connections to some
of those connections being pruned away so that the brain
has a better sense of which onesare important, which ones to pay
attention to. And that that process of kind of
reduction is also part of how weacquire language as we grow into
children, how we acquire all sorts of skills and we prune
(09:08):
some of our synapses and sometimes form new ones as we
age as well. And what that means is that some
things get harder, but other things actually get better.
So some tasks that really rely on experience, accumulated
experience about the world, people actually do better as
they age. Their vocabulary can become more
robust, things like being able to judge distances, all of these
things that rely on your experience.
The world can become better and better as we age.
(09:30):
And I think being attuned to this nuance, that aging is
really, I think change rather than decline is, I imagine, a
big part of aging so. You kind of use the analogy of
pruning, and I think as we age, we just seem to accumulate more.
Well, we don't seem to accumulate more and more
knowledge. And so we have to be able to
figure out whether that knowledge is the most important.
So is some of this, you know, difficulty that we experience
(09:51):
with aging and just in terms of memory, really more of the
challenge of pruning and trying to just kind of pull up the
information that we need most efficiently?
Yeah. That's a great, I think that's a
great way to think about it. You know, that's a big part of
like why we need to go through that process as we've become
adult humans is because you're exactly right.
Like the information is only valuable you can access.
(10:11):
It's not yet I can just organize.
And if you can reach it easily, you know, there are kind of as
we age, there are other things that happen that make ourselves
a little bit less efficient at communicating with one another.
But we also, as you said, we accumulate all of this
experience and then part of whathappens is just our brains need
to make space for the things that we're they're acquiring age
that. There's something that tends to
scare us, I think, a little bit as we get older and we start
(10:32):
forgetting things. And it's not that we're our mind
is declining. It's just we have so much
information to deal with that, you know, we don't need to get
scared about. OK, Yeah.
I forgot that I forgot your name.
I mean, I teach and and you teach too, and you're a lot
younger than me. I can tell.
But for me, I've had so many students over the last 20-7
years that I'm finding it harderand harder to remember names.
(10:53):
And at times it's like, oh, you know, can't be, can't be the
aging brain. Yeah.
It's just that I have so much information I have to worry
about. So what role do them?
Oh, go ahead. I just was.
Going to say it's really interesting.
One of the one of the things that it does improve is we age
is actually one of the things that really doesn't wane in the
healthy aging brain is is our ability to to remember like
familiarity, familiar thesis. So you might struggle to love
(11:15):
the name, but the knowledge thatsomeone is familiar to you that
actually gets better and better as we get older.
So again, I change. I think rather mine, yeah.
Which is always, it's fun when Igo out somewhere and I, I run
into a student I haven't had forlike, a decade.
And, you know, they remember my name because, you know, it's a
lot easier to remember your professor's English means I know
this person, what's their name, you know, and, you know, it'll
(11:37):
bother me for hours, you know, go home and I'll try and figure
out who the heck this person is.I like when they actually come
up and introduce themselves. You might not Remember Me, but.
And then they have to pretend like, oh, yeah, yeah, I remember
you. Yeah.
So what role do infectious and autoimmune diseases play in
neurological aging? And are there preventative steps
(11:59):
that we can take I. Think this feels like
understanding the relationship between infections, our immune
systems and how our brains age. It's really an an emerging
science and I think there are probably more questions than
answers in terms of actionable advice that I can offer
listeners. I think, you know, we, we think
now that inflammation is a part of neurodegenerative diseases
(12:20):
like Alzheimer's disease, instance disease.
And some scientists have also speculated that chronic
infections, viruses like a herpes simplex virus, the
coupled sores or like the Epstein Barr virus, like this
mononucleosis, both those are pretty ubiquitous for most
people. They're often viruses in
childhood and can stay in our bodies our whole lives.
We think maybe those kinds of very, very chronic common
viruses can play a role in lammatory changes.
(12:41):
As we age, two different things happen to our immune system.
So the first is what some peoplehave called inflammation, which
is this idea that as we get older, our immune system has
this long memory for all of the infections that it's bought.
It becomes you can activated again and again and again, just
like learning all those names again and again and again year
after year. And it becomes more primed so
that even when we're not actively fighting an infection,
(13:01):
we have this sort of like constant low level state of
inflammation that we think somehow contributes to the aging
of neurons in our brain. The second thing that happens,
which is really counterintuitiveis what's called
immunosenescent, which is basically the phenomenon that as
this kind of general inflammation is happening, our
immune systems get less efficient in actually fighting
the infections that were that were coming up against than they
(13:23):
were when we were younger. So somehow, even though our
immune system is already primed by everything, it's already
experienced, it's not quite as good at activating when it's
truly needed for certain kinds. And so we become risk of certain
kinds of infections that our younger cells have much more
easily been able right off. And we think that these two
things really play a role in in brain aging.
Although this is really an emerging science and murky,
really murky how, how and why. I don't have great advice on
(13:46):
prevention, although I'll say that I think some of the studies
suggest that the factors that play a role in aging more
generally. So things like quitting smoking
if you're a smoker, getting enough sleep and exercise, all
of these things we think maybe have an effect on this
inflammation as well. So maybe you know, by addressing
1:00 we we kind of address some of the broader factors you.
Kind of touched on our what has now evolved in the six pillars
(14:07):
on this podcast where we talk about the role of exercise,
physical activity, healthy diet,getting good sleep hygiene, not
smoking, of course, maintaining healthy body composition and
purposeful social connections. But all those things seem to
have some positive effect terms of hurting the brain.
Yeah. Absolutely.
But we, you know, and I think itsounds really simple, but I
(14:27):
think there are like, there are still some mysteries on how
those, like how those pillars protect our brains.
And maybe a piece of it has to do with this picture.
Yeah. It's, I'm fascinated with the
inflammation part of it, part ofit because one of my professors
in Graduate School is really into exercise immunology.
And he actually, he and some colleagues coined the phrase
immuno inactivity, that they go kind of beyond the concept of
(14:50):
immuno inactive immuno aging. But our inflammation, I'm sorry,
and, and toward, you know, the fact that our inactivity tends
to have that contributory inflammatory response and that
that can lead to some of the degenerative stuff that we see
in aging. That's kind of fascinating.
The whole concept really is interesting to me.
It's so fascinating. There have been some studies
(15:11):
looking at in fact even infections like covet or
influenza and like the actively exercising body and how we
receive those events differentlydidn't have whether we're act
not it really. It's fascinating, gives you a
lot to chew on, I think, as you're thinking about how to
move through your day, you. Seem like somebody that is super
excited to just approach every day of work that, you know, the
lessons you're going to learn and the things that you're going
(15:32):
to experience. And you tend to specialize in
diagnostic mysteries. Can you share a particularly
fascinating case that shed some light on the complexity of the
aging brain? Yeah.
So I so after my residency ended, I did this a fellowship,
it's called the advanced generalneurology fellowship, which is a
very vague term and it was focused on what the Doctor Who
founded it, the fellowship called mysteriomas over the
(15:54):
areas. It's focused a little bit more
on autoimmune and infectious diseases in the nervous system,
which are often the ones that atfirst seem mysterious.
Medicine is increasingly becoming very self specialized.
But I really still love the ideaof being an old fashioned Doctor
Who cares for everyone who's on the door.
But I think the story that really comes to my mind when I
think about sort of the mysteries of how we how we age
(16:15):
and how our brains ages. Not someone I care for as a
doctor, but a personal story. So I before I knew I wanted to
be a neurologist when I was a medical student, I was in my
year, just starting my 4th year medical school.
And my grandfather who lived in India, he grew up in a very,
very rural village in North India and lived in India my
whole life. And he was, he was in his late
80s, maybe early 90s and he started to develop this really
(16:38):
strange illness. He started wasting away.
He lost one of his muscles. He started, he lost a lot of his
strength as his strength voice, he started to choke food.
And it was this really, it was areally, he was this really like
larger than life figure in my childhood.
He had all of these adventures. He traveled to the US when he
was younger. He had made films for the Indian
government and really had this incredible kind of larger than
(16:59):
life personality. And it was this real
transformation, watching him as he aged developed these
mysterious symptoms. And I can remember being a
worker medical student and goingto the neurologist and the
neurologist examining him in a cotton gown and showing me the
way that his muscles were twitching.
And what what turned out was happening was that he had grown
up in a very rural part of Indiaand had many, many infectious
(17:20):
illness, child malaria and seasonally, but he also polio is
a child. And as he grew older, he
developed all post poliosin, which is kind of this echo of a
childhood infection that our body stops being able to work.
And people with polio decades and decades and decades after
they were first ended will have what's called post polio
syndrome, which is a constellation of some of the
symptoms of polio that unfurl almost like a VHS tape rewinding
(17:41):
as they get older when they've been well for their whole adult
life. And because my first realization
of the way that our that the aging brain and the aging body
is really a record of all of ourexperiences, not just illnesses,
but you know, everything you're encountering and experiencing in
your life is becoming folded into your brain, in your body.
And I don't think I had quite, you know, it's something I'm
still kind of learning every day.
(18:02):
But I think that was my first like moment of realizing that
Oh, like this entire, you know, this my grandfather's whole
story, his childhood, his you know, his culture, like all of
these things were really wrappedup in his body as he as he grew
old or those things are not thing that ever leave you that.
Kind of leads to my next question about you write that
stories are hardwired into our brains and you know, you just
(18:23):
kind of give a little bit of theimpact of how that affects the
patient, but how does this impact the way doctors diagnose
and treat patients and really how they should diagnose and
treat patients I. Think so I'll say a couple
things. I think it just is a it is a
lesson to me that I think one essential lesson that I took for
my medical training is that no matter how strange a symptom
(18:43):
seems, you know, anything that can go awry with their brains
and bodies really reveals something universal about us.
So if something can go wrong, itoften tells us something about
how things are are working. And it's really fascinating to
watch. You know, the way that we know
that stories are hardwired into our brains is because someone
can have an injury that makes it, Someone can have a
neurological wound that makes sothat they lose their ability to
(19:05):
see or to move, but their brain is still often spinning stories
about their illness. And I think a lesson from seeing
this in people who have a neurologic disease is that
stories are a human universal. And what that means is that
doctors are telling stories justas much as their patients.
And sometimes we get the story right and sometimes, sometimes
we get it wrong, you know, and Ithink, and I think like a big
part of being a big, I think an essential part of being a Doctor
(19:28):
Who sometimes gets it right is having humility and realizing
that we're just, you know, trying to make us trying to find
the a coherent narrative and allthe deals we're seeing in exam
or history and that sometimes wedon't pay attention to the
right. Do we get it wrong?
So have. You seen cases where the way the
patient's story is framed by themselves or by the medical
professionals has affected theircare.
Absolutely. I think I see, I, I don't always
(19:49):
notice it, but I don't always realize that that's happening.
But I think if you look at play enough, it happens all the time
in hospitals. And I think anyone is in time in
the hospital has experienced this, whether or not they've
been a part of the morning rounds where they actually see
it happening. One example that always jumps to
my mind example of of autoimmuneencephalitis, which is an
inflammatory disease of the brain caused by an.
Overactive immune system and what's so particular is that it
(20:12):
often first presents with psychiatrics and so with mania
and psychosis and kind of behavior changes and like many
autoimmune disorders, it tends to be more common in young women
than in other groups. And that, you know, we could do
a whole episode on on that and why that's the case.
That is still something I think science is trying to come to it.
Maybe for that reason, maybe because the stories we sometimes
(20:33):
tell about young women and theirbrains because of this old idea
and medicine that are like hysterical women.
That's story of neurology and medicine.
Many of these young women are dismissed by doctors before
they're diagnosed or given the wrong diagnosis.
The journalist Susanna Cahillan,who suffered from an autoimmune
encephalitis, wrote this amazingbook experience Screen on Fire,
and she talks about all the misdiagnosis she was given
(20:55):
before, before doctors gave her the correct she was.
She was diagnosed as as a neurotic, as an alcoholic.
All of these things that really were not really were not
grounded in the reality of what was going on, but they were
based on the stories that doctors are telling and
inferring about who she was. And they really were it.
Matt I was so consequential because it determined how she
(21:16):
was treated or not treated it. Seems like that can be a pretty
big problem in our health care system if doctors don't dive
deeper into the story. We tend to just treat the
symptoms and we miss pages and pages of information to kind of
keep it in that storytelling scenario.
So how can patients and caregivers better advocate for
(21:36):
themselves or their loved ones in medical settings, Sister?
It's really tough. I think, I think that I, I hate
like it's, it's tough because I,I wish that the onus weren't on
patient and patients and caregivers.
I wish like the conversation we're having is like, how can
hospitals do better? But it really, you know, exactly
as you said, I think I think going into that.
So one, one thing I would say isyou're advocating for yourself
(21:57):
or your loved 1 is just going into the hospital setting.
Just be it's helpful to be aware, I think that doctors are
human and medicine is a very fallible science.
So we get things wrong and that's not necessarily because
of negligence and it's not because of malice because we are
operating in this imperfect system with incomplete
information. Doctors are not generally known
for being great at humility, I would say.
But I think having an awareness of the ways that medicine is
(22:19):
perfect and it's filled with ambiguity and uncertainty in
Gray areas. I think that's really helpful
going into a hostile setting, because I think it can help sort
of make set your expectations and help to and help to, you
know, to first of all, you know,know that that absolutely like
we're all fallible and and doctors getting wrong just as
anyone else. But also to, you know, to know
that like, you know, you might you're you might be in that you
(22:41):
might be in this kind of like ambiguous or Gray area space.
Your illness might fall into that space And there there might
be a a lot of discovery that's required for, you know, striking
on what works great. So I think that like sometimes
those contexts to keep in mind is approaching illness and.
Systematically, how can the hospitals themselves and the
medical systems, what can they do to change to maybe help allow
(23:03):
more time for doctors to be ableto get the full story?
My gosh. That's such an important
question and one that I spent a lot of time thinking about.
You know, in the American healthcare system, the way that
the way that, that that doctoring is reimbursed is with,
is through this system is using a metric, it's called revenue
value units, RV, and it's essentially a way of trying to
(23:26):
value the time that doctors spend with their patients in a
way that minimizes the amount oftime for the maximum amount of
benefit. And I just don't think there's
AI don't think that that's the right incentive for, you know,
for, for valuing the time that people spend with their
patients. So, you know, I, I don't have a
great, I mean, you know, not thehospital where I work.
I think a big one is, is I care for patients who speak many,
many, many different languages, like hundreds of languages are
(23:48):
spoken within the walls of my hospital and making sure that
making sure that we have medicalinterpreters who are readily.
And then I think that that, you know, extends even to context
where everyone is fluent in English.
I think the languages and can betotally separate language as
well. So, you know, so, you know, I
think like for doctors and health systems, like thinking
about how to remove the jargon and the insurance language from
(24:08):
from the conversation. I think that can really hold an
effective existing on this matter.
But, you know, I think it's justtough.
It's really tough. I think in Americans, I think
sometimes economic benefits and Wellness are aligned, but I
think often they don't and we still need a way to value well.
So what advice do you? Have for for women in particular
and people of underrepresented genders and navigating the
(24:29):
healthcare, yeah, so I think. You know, again, like I I wish
that I could be Sanger systems like we need to value people's
experiences equally and care forpeople equally.
Very exactly right that some people, I think, sometimes need
to advocate more for themselves than others and the onus really
falls on need for themselves in system.
I think one thing I would say isthat, you know, for all that we
don't know in medicine, in neurology, I think that's
(24:49):
doubled for women and people of underrepresented gender.
So we, I mean, doctors in medicine don't know a whole lot
about how illnesses and medications interact with
pregnancy, with all kinds of different hormonal shifts in our
bodies. And as a result, I think
medicine can't always offer kindof A1 size fits all solution.
So I think just being aware of of the degree to which there is
(25:10):
uncertainty in medicine and science and the degree to which
we are still learning about the pregnant body, the, you know,
the like hormonal shifts that wego through as we age.
Those are all things that that Ithink medicine has not carried
very deeply about for a long time and is just now something
that that we're starting these more deeply about South.
Just just being aware that therethere is still a lot left to
(25:32):
learn. It isn't for encountering the
health system. So how do you?
Find time for creative work while practicing medicine
because it sounds like you're really busy at the hospital and
yet you're able to write and I know you're a mother, a lot
going on. How are you able to find time to
just be creative? Well, again, practicing your
medicine and raising your familyand doing all the things that
(25:54):
you do to be totally candid. I'm still still figuring that
out, so I don't have an easy answer yet.
I wrote the first essay of what would become this book like six
weeks after I gave birth to my first child.
I was in this bizarre, sleeplessstate that really echoed my
experience in medical training, where I would often work like 28
hour shifts without leaping. And I wrote a chapter of the
(26:15):
book that went up being the chapter about sleep.
The book sold to Simon and Schuster 2 weeks before I gave
it to my second son. And I wrote the rest of the book
in this kind of like manic sleepless haze during my
maternity leave while I was still nursing my second son
every couple hours. I didn't leave my house for a
few months. I my kids are not toddlers.
The big kid is turning 3 this summer and the little one is 1
(26:36):
1/2. And I think something I've
realized after having kids, I don't know that I could have
written a book before I had kidsbecause I, I think I treated
having children as like, I made a bucket list while I was
pregnant. I was like, these are the things
I have to do before I have kids because once I have kids, it's
all over. And I think it's just that that
sort of it really threw things into sharp focus.
I think it really helped me to prioritize the projects and the
(26:56):
goals that felt truest to me, that which were being a mother,
being the kind of neurologist and teacher that I've always
admired, but also writing, like writing these stories felt like
something that were unique to meand that, you know, were stories
that only I could tell. And I think I had a much easier
time saying no to things that didn't feel as essential to
those like horror values and andgoals.
(27:16):
I think it turns out that makingtime for things means having to
not make time for other things is what I've learned.
So the key to being. Creative is to have kids, huh?
If. You're going to write.
More books, you're going to haveto have about 5 or 6 more kids.
I have a bunch more. Kids, right?
There's already two kids turns. It turns out two kids is a whole
lot of kids already. So.
(27:37):
Oh yeah. Don't know how.
People do it. Yeah, I have two.
We're just waiting to get them all out of the house.
My youngest is just turned 17, so she's anxious to get out of
the house. My oldest is going to be 20 in
July and I think he wants to getout of the house, but he's in
college, so it's kind of like it's not time yet.
You know? It's too expensive for you to
move out and you're going to school locally.
(27:59):
Just stay home and get the college stuff done.
That seems like a huge. Transformation and like identity
shift is it is having a 17 year old who's about to leave that
and she's she's. A character so it's fun that's
what you get to look forward to you know yours are young enjoy
them I mean I'm at all age we tell my heads when I.
Talk all the time. I'm like, when are we gonna?
When are we gonna be able to sleep again?
When our kids go to college, even Sure if you can.
(28:23):
Sleep in. If they go off to college,
that's going to affect your sleep too, because you're always
going to be worried about them. A little worried?
Right. Yeah, true.
So what? Lessons from neurology have you
applied in your own life? We've kind of been touching on
that a little bit, whether it's an aging, parenting or
self-care. Yeah, I mean.
Like I think again, I think it'sjust the way that the way that
science and medicine works is that every time that something
(28:44):
goes awry in our brains, we takelessons from that to understand
how things work when we're when we're well.
So may seem like some these neurologic symptoms are really
kind of esoteric and like, what does that have to do with me or
my brain? But it really reveals something
about how our brains were. So I think I, I really love, I,
I really love the idea that stories are how we make sense of
the world. That's something that I like
(29:05):
think a lot about in parenting and in, in being, you know, even
my toddlers, it's so interesting.
They, they are already starting to frame the world in terms of
stories and they're seeing themselves as character.
So that's I think a big one thatI have that I have taken to my
to my personal definitely learned again and again in my.
So I'm curious. When you put your kids to the
bed at night, are you a storyteller?
Do you make up stories to them or just read to them?
(29:27):
Or what do you do so for the longest?
Time we did they have a they love books and have a ton of
books. So for the longest time we would
we would books and my my toddlerlike really likes to imagine
himself as like so character andmajor in his book.
So blueberries for Sal is now blueberries for Emil, which is I
mean, that's like his favorite, favorite book.
(29:47):
But recently the the big kid hasstarted to ask for what he calls
Emil and Lomax adventure stories, which are stories that
we make up about him and his brother going on a big
adventure. And they all are very similar.
There's not a lot of variation. They, you know, they go one or
three places, the zoo, in the museum or at their grandparents
house. But it's really interesting,
like how much they love, love hearing stories about
(30:08):
themselves. They never want it to end.
So I'm just now entering the agewhere we're making up stories.
Yeah, you might have a. Career in writing children's
books too then it's so it's it's.
You know, I think you look at these books and you're like,
there are like 3 words in this book.
How hard can it? But the children's you can click
Once you have kids, you can tell.
Some children's books really work and stay in the test of
time, and some don't. And it really takes a lot of
(30:30):
skill, I think, to write a good children's book.
Do you have a favorite? That you like to read with kids,
we have a. We have a let me think we have a
ton of books that I really love 11 really good one that I never
seen before is that little fur family, which is by Margaret
Weiss Brown and she wrote, she wrote Goodnight Moon, which is
probably her most popular book. But she has this book called
Little Fur Family, which is about a a little a family family
(30:53):
of three that lives in a a wood and the the little fur baby goes
out on this big adventure and then come somewhere and it's an
old, but it's just incredible how resonant it feels for my
kids. I still love it.
Nice to see that lots of things stand the test of time and age.
Well, I think one of my favourites.
Was always pajama time and I forget the author's name and
then the other is, is that? Yeah.
(31:13):
Yeah, Sandra. Bolton yeah, Car bucks are
always fun. They read the kids and then the
other was Doctor Seuss's Fox andSocks because it is so hard to
read that. I actually used that when I
started teaching pathophysiologyand exercise.
Stumbling over all, especially in your field, how do you talk
about neurology with all these big words and stuff, blah, blah,
(31:34):
blah, blah. You know, I tried these long
words and my, you know, I would always end up teaching
pathophysiology when I was at Eastern Michigan, one of my
third classes or fourth classes of the day.
So it's at the end of the day, I've just been teaching in
anatomy. I just taught Physiology and now
I got to teach all these big words and I would start
stumbling over the words. And so I started.
I would read Fox and Socks just to kind of warm my tongue up.
(31:56):
And there were times when the students would be like, Doctor
Armstrong, I think you need to pull the book out.
So I'd pull it out. I'd read a few and it kind of
warmed me up to be able to speak.
So I always loved that book. I still love that book.
I love Yeah. It's like every possible, it's
like flax, socks, chicks, bricks, like every configuration
that your tongue and your mouth can go into.
That's amazing. I feel like it's just a reminder
(32:17):
that teaching is such a performance.
I feel like the teachers are really delivering.
Amazing. So how does this?
I mean, this is a little off topic, a little bit, but you
know, we consider aging to startbasically before conception.
You know, if you're aging well, it starts with your parents,
your grandparents and epigenetics and and all that.
But how does that storytelling, that starting to read early, all
(32:39):
that, how does that impact the the long term health of the
nervous system of, you know, neurology for a child and
someone that's wanting to age? Well, yeah, maybe we should.
Add a 7th pillar, which is around storytelling.
You know, I think, you know, youspoke about how it's really
interesting. You spoke about how you've
spoken on this platform about how one of the most essential
(33:00):
pillars of aging, of healthy aging is kind of social action.
And it's so interesting. Like, I think one of the lesser
from a lot of these disorders is, is, you know, I So what like
1 great example is if you lose your vision in a certain way, or
if you lose your ability to hearin a certain way and you're a
person who is isolated, your brain will actually construct
new visual input or new sounds to make up for the input that
(33:21):
it's, it's missing. It happens much more in elderly
people who are socially isolated.
And I think it just tells us like how like stories are, I
think are often a form of connection or a form of
understanding our are placed in a complex social structural
world. And so I think, I think stories
are probably a part of very mucha part of that pillar.
And again, exactly as you said, you know, aging the way that our
(33:43):
brains age has is such an echo of the way that our brains first
develop. There's this really, you know,
profound kind of mirror image between how our brains age and
how our brains first are tire uplanguage and first start to 1st
learn to read and 1st learn to make all of these movements.
You know that you wonder whetherwhether aging brains are more
able to to prune and keep the right synapses and and
(34:05):
understand what's salient if youhave as kind of if you have or
if you're able to, if you're officially able to kind of form
stories to to tell your brain ison right.
So all this kind of. Leads me to my next question is
the question I ask of all of my guests.
So you can't escape it. What are you doing personally to
age well? This is a.
Major work in progress for me. I don't know that I again, I
don't know that I have any kind of actionable advice.
(34:27):
I think one of the factors, one of the pillars that you
mentioned that I think a lot about as a parent of toddlers,
as a doctor, is sleep. You know, I writing the book, I
spent a lot of time reading these very old scientific papers
and medical reports that are often like much more vivid and
descriptive than temporary scientific papers.
For a long time, scientists basically ignored sleep
(34:47):
together. It was described in medical
texts as the cessation of the waking state.
So it's literally like when you're not awake, you're asleep,
but we don't care about it. And then this Russian
neuroscientist is one of the first female biochemists.
She did the series of experiments to try and
understand, published it in thispaper called Sleeping, Sleeping
1/3 of Human Life, which was about how profoundly important
(35:08):
was. And she writes really
evocatively about the physical traces that that sleep
deprivation leaves in our brains, the way that our
physical DNA of our neurons acted by prolonged sleeping.
Sleep can really feel like a luxury for people who have
little kids or who are working the 3rd shift or who don't have
a lot of control over their wordand lives.
So I don't want to be prescriptive about this.
And I know as a resident, I spent years of my life
(35:28):
essentially not sleeping at all.I'm not sure how that has aged
my brain, but now the big thing that I have been trying to focus
on recently is trying to priority when I can, but I'm not
on call the hospital. I sleep on a different floor of
my house from my phone and my laptop.
So they're on a completely different the house than I am.
I try and have as much of A separation between screens
asleep as I possibly can. And I also do my own bedtime
(35:51):
stories. So I my husband and I before we
would read books to each other so that we so that, you know, we
wouldn't have to be like lookingat light when we were falling
asleep and I couldn't be readingand bedroom rather than.
So this is like a something thatI have sleep is something that I
have always thought a lot about and and wished for.
And I'm not thinking about how it's going to be a part of how
I, yeah, I don't think I really.Started thinking about sleep
(36:14):
enough until really starting this podcast and over the last
year and a half, really kind of being introduced to how
important it is for sleep. It was not one of my pillars
initially when I was teaching pathophysiology and exercise.
And, you know, as I explored it more, it's like I'm starting to
look at my own sleep and tracking my own sleep.
And, you know, I pushed to have a sleep study done so that I can
(36:34):
determine whether I had sleep apnea.
After about a year, I finally got my CPAP.
And, you know, I've been doing that for about a week now and
I'm not sleeping. I'm getting these like, worse
sleep reports. It's like, wait a minute, I'm
supposed to be sleeping better. So what is going on here?
So I have a feeling, I hope it'sjust that I'm adjusting to, you
know, using the machine and thenhaving that, you know, something
(36:56):
to keep my mouth shut at night and trying to breathe through
this, you know, a little thing under my nose.
But sleep is just hugely important and I think we
underestimate it. And as an exercise physiologist,
you know, I'm humbling myself starting to say, you know, I,
I've always kind of put exerciseat the top in terms of for
aging. Well, you got to be exercising
and physically active, but sleepis starting to kind of get up
(37:18):
above that. And then so are social
connections that it's like the most important things you got to
be doing is have those social connections and you got to sleep
because you can't exercise well if you don't sleep and you're
not going to get the benefits ofthe exercise if you don't sleep.
And so I, I think maybe I becomea sleep physiologist or
something like that. I don't know.
But I'm glad as a physician you're pointing out that that is
(37:39):
one of the most important thingsthat we have to do to be able to
age. Well, it's interesting, you
know, it's. So crazy because I think
doctors, we still have this, youknow, medical training system
that really values the ability to not sleep.
And that's still, you know, it'schanged over the years, but it's
still a little bit of a part of our medical, but it's so
essential. And it's also, you know, when we
look at neurologic illnesses like neurodegenerative diseases
(38:01):
like Parkinson's disease, this is a great example.
So sometimes the very, very first clue that someone will go
on 10 years later or 20 years later to develop Rickinson's
disease is changes in their sleep.
So people will have really vividnightmares that they'll develop
what's called REM sleep behaviordisorder, where it's kind of the
opposite of sleep paralysis. They lose the paralysis of
dreams that are acting. And if you listen to someone's
(38:22):
story, sometimes you can, you know, the people will describe
that they've been sleeping, you know, side by side with their
wife for years, but now they're sleeping in the guest room
because they're punching and kicking in their sleep.
And it's so, it's so, so, so entwined with so many of the,
you know, illnesses of aging that I think it, it's shocking
that that medicine occurred so little about sleep for as long
as it did. It's only been pretty recent.
That they've kind of made the rules where you can't be on call
(38:45):
for, you know, several days at atime and, you know, you have to
be able to get some sleep and doing all that.
And, you know, it's just, it's fascinating how much we ignore
sleep. Sleeping 1/3 of human.
Life well, hopefully for some people.
It might not be 1/3 of life, It might be far less.
Some of my college students, I think it's a lot more, but
they're young. That's right.
(39:05):
That's my that's. Why I'm going to aspire to 3rd,
3rd a few third of my life and Ialways get fascinated.
Too with the the nature and the quality of my dreams depending
on how I sleep. And I'm starting to tie a lot
more of, you know, the more I'm dreaming and especially the more
wild the dreams are, the better my REM sleep appears to be.
Is there any real tie to that oris it just something that's kind
(39:27):
of coincidental and it's just kind of cool to think about, but
there's no real science to it? That's really interesting, I.
Don't that's a really great question.
This is like an entire this is Even so like it took science a
really long time to care about sleep at all.
And then it took a really long time for science to care at all
about dreams. So that was like an even more it
was like this kind of esoteric weird discovery where this this
(39:47):
this physiologist who was interested who had been studying
like infants was interested in how infants eyes were moving
when they slept. And then he was trying to figure
out how to use an EEG machine and he his 10 year old, 10 or 12
year old son was, was hanging out with him in a sleep lab and
he the kid up to try and figure.How to get all the electrodes
correct? And he all of a sudden realized
that as his son was sleeping, there was a moment during sleep
(40:07):
when his brain suddenly seemed awake.
And that was REM sleep. And his eyes were doing
something really funny at the same time.
And that was like the first moment, not like in recent
decades that science suddenly started to care about dreaming.
But I don't think there's, you know, I think, you know, we are
starting to understand a little bit about this architecture
sleep from medications that we can use to shift how much time
(40:27):
spent someone spends in slow agesleep versus REM sleep.
But I don't think there's any. I don't know that there's any
science on sort of the quality of your dreams and how that
reflects the quality of different phases of your sleep.
This is the next should be the next frontier for for medicine.
Also notice too that. Depending on which side of the
body I sleep on, because I'm a side sleeper most of the time,
if I sleep on my left side, I tend to have this far more kind
(40:50):
of vivid weird dreams that again, drive my REM sleep up.
And if I sleep on my right side,I tend to be processing a lot
more, you know, thinking about what I have to do, teaching the
next day or, you know, a podcastinterview that I'm doing, just
things that I need to be doing kind of more practical dreaming.
And it's like, again, it might just be my weird nature, but
(41:12):
it's kind of, you know, for somebody who is fascinated by
the human Physiology, I'm like, is there something to that?
That is, I sleep on one side versus the other.
My brain is functioning slightlydifferent, you know, and maybe
it's tied to my veggies. Yeah.
I was wondering like could the sleep?
Apnea be like, is there one sideon which this apnea is more
prominent than the other side? It could be, I don't know.
There's SO. Much science left to be done,
you know, and I can just be on my own human experiment, so.
(41:36):
Your book is is. Fascinating and it's one that we
we know you really kind of get the listeners to check out and
where can the listeners learn more about your work and to
pre-order because I think it's still in the pre-order stage,
right for the book to pre-order the the mind electric.
Yes, well, again. It's been thank you so much for
having me on this pod and it's such a joy.
I feel like I have learned a lotabout aging well.
(41:59):
So thank you again for having me.
People can learn more about me and the book at my website,
Priya on and.com, my first name,my last, or on the Simon and
Schuster website where they can find links to order a copy of
the Mind Electric anywhere booksare sold.
The book is going to be out on June 10th and I cannot wait to
share it with all of your listeners and we'll have links
to all that so that. They can just click on it and
(42:19):
get the book. But anything else to add as we
wrap up? No, this is.
This is such a. Joy, So thank you again for
having. Well, I enjoyed having you.
And as always, just keep, you know, doing what you're doing.
Keep being creative. Keep writing.
You don't have to have more kids.
You know, you can be creative without having more kids.
But if you want to have more kids, I'm sure that will be a
blessing on the world. So just keep doing what you're
(42:39):
doing and keep aging well. Thank you so much, chef you.
Too with such a joy thank you for.
Listening Hope you benefited from today's podcast and until
next time, keep aging well.
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