The aim of this paper is to discuss how to implement a brain-health checkup in any anti-aging practice, and to discuss the role of anti-aging hormones on this fundamentally important organ.
All diseases, as we get older, are basically accelerated aging, and every doctor is already an anti-aging specialist in part. The most important thing is not to be smart, but to be in the right paradigm. We were flying at mach one 50 years ago. Today, we can fly at mach 10. It is not a case of “if” the aging barrier will be broken – it will be broken.
There are four core principles of anti-aging medicine. The first principle is that healthcare should be delivered headfirst: all medical conditions should be interpreted with respect to the brain. It does matter how old a person is, or how much we can extend the lifespan by, the same principles of healthcare will apply. And at any age, the most important organ is the brain.
The second principle is that there are many menopauses of the body. Every single part of the body is going into one form of menopause or another. Menopauses have two forms: total and partial. A total menopause of the ovary means that your ovary passed away, and you can hold funeral services all you want, but it will not resurrect. The thyroid menopause, or thyropause, represents partial death. Approximately 25% of the thyroid dies as we age.
The third principle, which is a cornerstone, is providing a non-drug alternative, and combining conventional medicine and drug alternatives. All great healthcare should be multi-modal. If someone says that they are only going to use conventional medicine, well it’s great that they want to dominate healthcare with drugs, but it will not work to produce health. Multi-modal care will always include drugs, bio-identical hormones, nutrients, and lifestyle. Thus, effective healthcare will be multi-modal.
And finally, the fourth principle, the new paradigm of anti-aging medicine is the use of early, non-invasive, high-tech diagnostics for the assessment of early breakdown of health. It is crucial that we scan people from head to toe because you can have a young brain and a young heart, but you can still have old bones, and die – prematurely. Thus, the only way that you can take care of a patient properly is to find out exactly what the problem is, and that is why scanning technology is so important.
DELIVERING HEALTHCARE HEAD-FIRST
The brain is obviously involved in conditions such as anxiety, depression, personality disorder, Alzheimer’s disease, and Parkinson’s disease. However, conditions like stroke, myocardial infarction, arrhythmia, coronary heart disease, and asthma don’t obviously appear to be affected by the brain, but they are. Studies have shown that whether or not a person has a stroke is not just dependent on homocysteine and C-reactive protein (CRP) levels, depression can significantly increase the risk of stoke and heart attack.
There is no medical condition in which neuropsychiatric factors do not come into play. Half of the people that die of a heart attack do not have any coronary artery disease; instead they have anxiety disorders and psychiatric disorders. And they die because neurology, psychiatry, and internal medicine were never integrated according to anti-aging principles, and their brain was never taken care of. Asthma is at epidemic levels in New York City, and much of it is triggered by a cascade of events – a nervous mind, insomnia, addictive behavior, and smoking.
The cornerstones of brain disease are: low brain voltage, obesity, a slow brain or cognitive failure, and addictive behavior and insomnia, which is when the brain is out of synch. The diseases caused by these problems are costing the American economy in excess of $100 billion each year, and the conventional attitude to medicine explain why 15% of the American budget has not been able to have a significant impact on our wellbeing. You cannot separate the head from every medical condition. And the miracles that I’ve seen in my life as a doctor have occurred because we consider the brain/mind component in every medical condition, and that includes gastrointestinal diseases and cancer. I have seen cancer patients that I never expected to survive do just that because we treated their depression, just because we treated their anxiety, just because we treated their cognitive decline. The same thing is true with hormone treatment; sometimes you get surprising results in conditions that are totally unrelated. And that is because the human body is a total system, in which the brain is the most complicated and important organ. If you put the brain on the one side and the body on the other, the brain outweighs all the other organs put together in terms of complexity and importance.
THE PAUSES OF LIFE
We react to light in 50 milliseconds, sound at 100 milliseconds, and we think at 3/10ths of a second (300 milliseconds). If the brain slows down by just 100 milliseconds we become senile – just a 100 millisecond difference in brain speed results in us dropping the balls of memory.
All the other pauses of life that occur are relatively easy to fix. The pineal pause can be treated with melatonin. The thyropause can be treated with T-4 and T-3 Armour thyroid. The parathyropause can be treated with a parathyroid hormone injection. We know a lot about adrenal decline, and we know the dosages of DHEA that are needed to rectify it. We know about nephropause, and we know that erythropoietin is a new injectable that can deal with nephropause of the kidneys. We know about somatopause, and that one shot per month of depo growth hormone (GH), or a daily injection of GH, will solve that problem. So, these are relatively simple pauses to repair. We have come a long way.
Different pauses happen at different ages in different people. In some people the kidneys will go young, and that is why we put diabetics on ACE inhibitors. While other people the adrenal gland will age prematurely, and they will get gray young. And in women in particular, somatopause occurs young when there is a significant conversion of muscle to fat – by menopause most women have gone from 22% to 40% body fat. Somatopause is antecedent to menopause. When women says that they are going into the menopause, what they don’t realize is that they are already in multiple pauses. And all of those pauses have accelerated the aging process.
NUTRIENT AND NON-DRUG APPROACHES
Anytime that someone who tells you that they can heal a person just from nutrients, they are kidding themselves. You cannot heal everybody naturally. The best situation is one that uses natural therapies in combination with conventional drug treatment. Niacin plus Zocor is better than niacin without Zocor. Calcium channel blockers, and other cardiac treatments work better with magnesium. A trip to the Caribbean is almost as good in the winter as any antidepressant. It is not possible to be a great healer without using a combination of treatments, diet, and lifestyle changes. Any healing that is not multi-modal like that is missing the full armamentarium available to being a doctor in the 21st century. Doctors who don’t believe in anything natural should remember that N-acetylcysteine is in every emergency room in the United States for Tylenol overdose, every cardiologist uses the digoxin, every malarial doctor or infectious disease doctor uses quinine sulfates, and every neurologists should know that GABA Pentin is nothing more than GABA pentose, a modified amino acid. There is no such thing as being a pure drug doctor.
DIAGNOSING THE PATIENT FROM HEAD TO TOE
It is vital that we do the correct diagnostic tests, and you have to deal with the fact that no one diagnostic system covers everything. To cover absolutely everything you need an EKG and a brain map for the brain, an ultrasound for the body, a DEXA scan for bone and muscle, a backup Ultrafast CT for positive stress thalliums, a PET scan for cancer patients, an MRI for MS patients, and blood analysis. The important thing is knowing when and how to use it.
By using all these techniques together, you can get real miracles in medicine, because you have dealt with the brain and the total person and you generate a total age print. Ultrasound is by far the best and safest technique to do a new physical exam. Any physical exam that does not include a head to toe ultrasound is missing a lot, including: thyroid nodules, ejection fraction changes, bowel changes, carotid artery disease, aneurisms, gallstones, kidney stones, kidney cysts, pre-cancers, scrotal cancers, and breast cysts. There is nothing like a head to toe ultrasound. Right now, we have to depend on a lot of different instruments, and it is important to know these instruments and what organs they test.
TESTING THE BRAIN
Brain function is important in every single condition. As we age the creative and alert brain starts to decline. Beta and alpha waves diminish, and theta and delta waves increase. As a result the mind starts to present symptoms of stress, anxiety, and depression.
A cardiologist wants to know all there is to know about a person’s coronary arteries, their cardiac rhythm, their total cholesterol level, their HDL-cholesterol level, their LDL cholesterol level, their fibrinogen level, and other laboratory values. They will use a Holter monitor to determine whether their patient has any serious arrhythmias, and an increasing number want to know a patient’s coronary calcium score. Those cornerstones help a doctor to manage cardiac disease, but what must we know to manage any person, at any level, and that means children with ADD, adults who can’t remember, middle-aged people living on Prozac, and old people that are getting senile. It is important to understand that dementia is a 20-year-long gradual disease that people start to develop in their 50s and 60s. All of these things are why a brain checkup is vital.
A variety of instruments and tests are needed to assess the health of the brain: a Milan – which can determine whether or not a patient is absolutely out of his mind, or too anxious, or too blue, or too hysterical to benefit from you, a Myers-Briggs Test can tell you whether the patient the type that can handle 49 supplements six times a day and a GH injection daily, or if they would be better suited to taking three vitamins – a brain energy supplement, antioxidant, and a multivitamin – and having a GH injection and a testosterone injection once a month. Some people are not going to be organized enough to take large numbers of supplements, but some are. Thus, a quick assessment of your patient will help you to determine what sort of regime they can cope with.
Without a core memory test, a doctor is blind. The Mini Mental Status Examination (MMSE) is basically a dementia scale. It offers the physician a quick way to determine cognitive function and to monitor changes or disease progress. Another important test is the Wechsler Memory Scale-III (WMS-III). This test can be done in approximately half-an-hour, and anyone can be trained as a technician to do it. What you may find is that most people who complain of a memory problem actually have an anxiety problem. They are getting irritated, they are getting worried, and they are getting stressed out. That does not mean that they are not going to develop a memory problem in the future, but the brain has to slow down.
Fifty percent of my patients flunk an attention test. They are the ones that you screaming at when they drive. They miss the stop signs, they jump the lights, and they slam on their brakes. They are slow drivers with psychomotor retardation. There are four forms of attention. They all deserve more discussion, but there are forms of attention that relate to acetycholine, GABA, serotonin, and dopamine. There are forms of memory that relate to those core neurotransmitters. And finally, there are even four IQs. There is the abstract IQ, which is the last to go, the common sense IQ, the emotional IQ, and the creative IQ.
The Brain Electrical Activity Map (BEAM)
The failing brain follows this pattern. First, it loses speed. Then it loses memory or attention. It deteriorates simultaneously, dynamically, psychiatrically, and emotionally. The last thing to go is the IQ and mini mental status. Brain waves are the key to life. They are what distinguish the living from the dead. When we measure brain waves we are measuring consciousness, memory speed, brain chemical depression, and brain chemical rhythm. As a doctor, what you are really measuring is whether your treatment worked or not. If brain electricity is the sum result of all of your treatments, the proof that you are successful is the patient saying that their memory feels much sharper. The final end point marker of successful treatment of a patient is a juiced-up, stable, energized, sharp brain. This is why you need to measure the brain with a Brain Electrical Activity Map (BEAM).
The components of a brain map include:
– Spectral analysis, which includes an analysis of changes in frequency of the alpha wave
– A thinking test called P-300, which is a positive brain wave at 3/10ths of a second. This test tells you about the voltage (strength) and latency (delay in the wave echo).
– Evoked potentials using visual and auditory provocations. This is ultimately a stress test. We give insulin as a pancreas stress test. We do a stress thalium for a cardiac stress test. We stress the brain by bombarding it with visual and auditory information. If you can handle a lot of visual and auditory information, you are a stable person with less GABA dysrhythmias in your life.
– Electroencephalography (EEG). Many people are shocked that the EEG is last in the list of things to do when evaluating the brain. They shouldn’t be. Conventional doctors used to say that EEG was the cornerstone of electrical evaluation of the brain. However, the truth is that EEG is the least valuable thing you could possibly do in terms of gathering information about the brain.
The brain is not a blood flow organ. The brain is not a metabolic organ. The brain is an electrical organ in which the difference between life and death is your charge. An MRI scan before and after you die is the same. The CAT scan before and after you die is the same. Brain electricity is the marker of life and consciousness. We don’t always know what the electrical signals mean. We know that they are related to neurotransmitters. We know that GH raises acetycholine, dopamine, and serotonin levels in the brain. We know that testosterone is more of a catecholamine stimulant and estrogen more of an acetylcholine stimulant. We know that parathyroid is an acetylcholine stimulant. We know that hormones are constantly affecting the brain, and that is why they are called neurosteroids. We know that electromagnetic fields are changing the brain. We know that nutrients and electrolytes change the brain. We know that the target reality of brain health is electricity, just like we know the target reality of bone density is the bone’s density. We also know that there are dozens of factors affect the bone, and dozens of factors that affect the brain.
The P300 Wave
There is only one way to tell if everything you have done has made a patient’s brain sharper, quicker, and healthier. Measure it. The P300 wave has become the recognition of what a brain code really is. The voltage of the brain is basically your level of intensity, a general signal of your brain’s overall electrical power and energy. It falls with age, but you can raise it with tyrosine, GH, Wellbutrin, Provigil, ecstasy, and temporarily with alcohol. There are many pharmacological approaches and electrical approaches for raising the falling brain voltage of an aging person. Brain speed is important too. We are constantly losing quickness as we age, and there are many things, from exercise to drugs, that can help to increase brain speed. A quick brain is a powerful brain. As well as having an intense brain and a fast brain, you need a stable and a serene brain. You need right and left hemispheres working together, and you need the entire brain to be level. However, the core brain age marker is speed.
The fastest part of the brain are beta waves, they beat 16 times faster than the heart or 16 cycles per second. Alpha waves beat at 8 to 10 cycles per second. They sag down to 7 cycles per second as we age. You lose juice as you get older and you get sleepier and sleepier. We get sleepier as we get older because the drowsy waves of theta and delta increase and the brain loses a little bit of its right-left integration, and that’s the story of the sagging brain and it is similar to that of other organs.
The BEAM was developed originally as a million dollar machine at Harvard Medical School. Now, it is available in a laptop version for $50,000, and eventually, we hope, as a $5,000 EKG. When you have a burst at 3/10ths of a second of P300, the brain wave starts in the right frontal lobe, moves across to the left frontal lobe, and bursts into the parietal and occipital lobes. It covers the entire brain. It represents how you think. And it’s a nice, beautiful burst of electrical activity. The computer reads and analyzes the wave by itself.
Biological Markers of Brain Aging
Biological markers of brain aging include: a decline in amplitude and speed, a decline in beta waves, a decline in alpha waves, an increase in theta waves, an increase in delta waves, a decrease in coherence, and a decrease in the voltage and an increase in the latency of the P300 wave. The brain voltage marker can be used to understand obesity. Obesity is a brain metabolism disorder more than any other disease. Obesity is caused by dopamine-damaged receptors and a loss of metabolic activity in the brain. The same is true for addictions, schizophrenia, and the daily blues. Brain speed is also altered by disease and age. Whether it’s Parkinson’s, dementia, or the developmental disorder of an ADD child, brain processing speed drops. Memory is basically a wave and a particle. If the neurons slow down, they keep dropping the biochemical balls of memory. As the brain slows down, we all get senior moments and they increase in frequency with age.
There are many well worked out scales of the loss of brain energy. Any number of medical conditions will wear you down. And that is why you cannot practice internal medicine without neuropsychiatry, because illness of the body means illness of the brain. Illness of the brain means illness of the body. With regards to brain speed, being faster is not necessarily desirable. The normal person thinks at 3/10ths of a second, and if he uses cocaine he’ll think at 270 milliseconds, and his judgment will be impaired, and he’ll be on his way to a permanent psychiatric disorder. However, being chronically anxious may make your brain faster, but you will pay a price with stability, and you will pay a price, as we all do, with focus. There are many other medical conditions that slow the brain down, or speed it up. Even substance abuse disorder gives people temporary speedy brains. The addictives have faster brains but it isn’t going to make them healthier people, because you are only as healthy as your sickest part, and you are only as young as your oldest part. Any disease can slow the brain down and accelerate you towards dementia. And most people over 60 have partial dementias; they are getting cognitive impairment and progressing towards dementia. Menopause is a dementing disorder. So is diabetes. So is hypertension. So is chronic pulmonary disease. These are all dementing disorders that are slowing down brain function.
At 40 years old, you should process thoughts at 340 milliseconds. If you following the normal course of aging you will lose 7 to 10 milliseconds of your speed, and all of us will essentially be demented by 100. Obviously, that is unacceptable and that is why I developed these techniques to identify dementia. And I have seen this dementia completely reverse in patients. Senile people have taken a MMSE and got a score of zero, and with treatment that score has risen to 15 and they have spoken again. And yet drugs for Alzheimer’s will change a MMSE score by one point. It is ridiculous. These drugs are a con; they have no impact at all without hormones, nutrients, diet, sugar control, and anti-aging techniques.
ANTI-AGING HORMONES AND THE BRAIN
As we get older and acetylcholine levels fall, the brain loses water, and it loses conductivity. You lose voltage and your brain cells die. Brain speed peaks at 317 milliseconds somewhere between the age of 20 and 30, and from there onwards you start to slow down. And exactly the same is true for memory – it peaks between the age of 20 and 30, and then begins to plummet. Therefore, as we age brain voltage drops and brain cells die. This is what we must stop and we can stop with all our methods of neurovascular endocrine repair. However, once these processes start, there is a tendency to go back to set point, even though we managed to reverse 90 years off brain speed and 80 years off of brain voltage. What we are up against is a continuous deterioration of verbal memory.
At the same time that brain speed and voltage are dropping, insulin-like growth factor-1 (IGF-1) levels are falling too. We conducted a study of 1500 patients to see if there was a relationship between IGF-1 levels and brain speed. We wanted to know if GH actually is the anti-dementia pill or anti-dementia shot that we thought it was. What we did was we charted IGF-1 levels in both men and women of every age and every hormonal group. And what we found was statistically significant between the age of 30 and 50. The results showed that 55% of patients aged between 30 and 50 with the lowest IGF-1 levels had a slow brain, compared to just 15% of those with the highest IGF-1 levels. The P300 difference was 10 milliseconds. That is akin to having a brain that is effectively a decade younger. Basically, when you raise GH levels of 125 or 150 to 300, you also speed up the brain. It is not unbelievable, but it is good, and when you add up all of the anti-aging modalities, such as estrogen, progesterone, testosterone, erythropoietin, parathyroid, calcitonin, vitamin D, nutrient treatment, exercise, and lifestyle, you have a cascade or edge effect of getting people sharper and sharper, the reverse of the domino effect of obesity, aging, and death.
When you change from an infant to an adolescent, you lose your melatonin levels. As an adolescent, you lose your immune system. Between 20 and 30, you lose your GH. Between 30 and 40 you lose your steroids. Between 40 and 50, you lose your DHEA. Between 50 and 60, you lose your erythropoietin, calcitonin, and parathyroid. By the time you reach 70, you are most definitely dying, but you actually stagger on for another 10 to 15 years. The good news is that we are breaking the aging barrier now. DHEA exerts its greatest impact upon brain speed between the age of 50 and 70. That doesn’t mean that you shouldn’t treat someone with a DHEA deficiency at 35 or 25. It just means that in general, the largest impact of DHEA short-circuiting the nervous system and killing you in this age group. Remember, everyone has an age print or a pause print, and you have an age of your bones, an age of your heart, an age of your coronary vessels, an age of acetycholine system, an age of your dopamine system, and an age of your GABA system. The age print can be subtly analyzed in even more depth at every section, including, of course, the brain. But the ballpark age print of DHEA is between 50 and 70. And the ballpark age print of progesterone is 60. That doesn’t mean you shouldn’t use it at 30, but the loss of progesterone is an anxiety disorder, more than it is a brain speed disorder so it doesn’t have an impact. Remember, progesterone is every woman’s Valium. Progesterone is what we use for treatment-resistant seizure disorders. Progesterone is a serotonergic hormone and a GABAnergic hormone, but it does eventually border on the impact on brain processing speed.
We are now all bombarded by electromagnetic fields increasing the dementia rate to 50% at age 80, and we are becoming demented at a faster rate. Brain speed is antecedent to dementia as cholesterol and high blood pressure are antecedent to heart disease. The brain is the most important organ, and a brain-health checkup is critical to saving our economy.
Eric R. Braverman, M.D.
Dr. Braverman is a Summa Cum Laude and Phi Beta Kappa graduate of Brandeis University and NYU Medical School, did brain research at Harvard Medical School, and trained at an affiliate of Yale Medical School. He is acknowledged worldwide as an expert in brain-based diagnosis and treatment, and he lectures to and trains doctors in anti-aging medicine.