The Choice to Have a Healthy Brain

Tami Simon: You’re listening to Insights at the Edge. Today, my guest is Dr. Daniel Amen. Dr. Amen is a double-board-certified psychiatrist and the founder and medical director of the Amen Clinics. He’s the author of ten New York Times bestsellers including Change Your Brain, Change Your Life and Unleash the Power of the Female Brain.

With Sounds True, Dr. Amen is making available for the first time several audio programs, including Unchain Your Brain: An Audio Program for Breaking the Addictions that Steal Your Life [and] also Dr. Amen’s Change Your Brain Workshop, Supercharging the Female Brain, and a program on Relaxation, Focus, and Memory Training. Dr. Amen will also be participating in Sounds True’s Neuroscience Summit, which is a free gathering of over 20 leading researchers, teachers, neuroscientists, and neuropsychologists on ways we can change our brain to increase well-being. The Neuroscience Summit begins at on May 10.

In this episode of Insights at the Edge, Dr. Amen and I spoke about how he sees brain imaging technology as being at the root of a social revolution. We also talked about his thoughts on competitive contact sports and traumatic brain injury, and how people need to understand the risks before partaking in such sports. We also talked about Dr. Amen’s view of spirituality and the brain, [as well as] finally, a strong statement of his that brain aging is optional, and he talked about a power that we all have—one of our most important powers, the power of choice. Here’s my conversation with Dr. Daniel Amen:

Dr. Amen, welcome to Insights at the Edge.

Daniel Amen: Thank you so much.

TS: You’re a pioneer in the clinical application of brain imaging technology. And to begin our program, I’d love to know if you could share with our listeners how you first became introduced to brain imaging technology. Take us back.

DA: So, I’d been a psychiatrist for a decade, and psychiatrists are the only medical doctors who virtually never look at the organ they treat—and it handicapped me. I was actually an X-ray technician in my younger life, when I was in the Army. Our professors used to always say, “How do you know unless you look?” [So] I fell in love with psychiatry, but I always felt handicapped.

In 1991 I went to an all-day lecture on brain SPECT imaging—SPECT is the study we do at Amen Clinics. The physician told us this was a study that could give you more information to help your patients. And out of the first ten cases where I ordered scans, it changed what I did in eight of them. I was completely hooked.

From that time—25 years ago to now—we’ve done 118,000 scans on people from 111 countries. It has literally changed everything I do. It changes what I eat, it changed the supplements I take, it changed my weight, it changed my decision-making on letting children or influencing grandchildren to play contact sports. Ultimately, it gave me brain envy—I [began to] care about my brain because I could see it, and it wasn’t as healthy as I wanted it to be. Although, 20 years later, it’s younger, fatter, healthier—so I’m grateful for that. It even changed my relationship with my children, in the fact that if you date[d] my daughters for more than four months, I scanned you.

TS: Aha!

DA: Because I want to know how your brain looked if you were going to be part of my family.

I got divorced about 15 years ago, and I told myself if I ever got married again, I would scan the woman—that would be the most important part of her I’d want to see before I gave away my heart. And so, about 10 years ago, I scanned Tana, and her brain was great, so I married her. And it’s worked out much better for me this time around.

TS: Now, there’s a couple things you said that I want to tease out for a moment. In the practice of psychiatry today, do most psychiatrists use brain imaging technology? I mean, I’m not that familiar with psychiatrists in general using it.

DA: They don’t. No. In fact, it’s been a little bit of a war trying to get my colleagues to see the world differently. If you think about it, psychiatrists make diagnoses today pretty much exactly like they did in the 1840s, when Lincoln was depressed. They talk to you, look at you, look for symptom clusters, then diagnose and treat you. And that’s how they did Lincoln in 1840 when he was suicidal and his friends took his knives away from him.

I have a problem with that, because when you don’t look at the brain of someone who’s depressed, someone who’s angry, someone who’s suicidal or homicidal, how do you know if they have an infection, or if they had a head injury, or if their brain works too hard or not hard enough? And you don’t know.

So, I have experience on both sides of the fence—for a decade I was a psychiatrist and I never looked at my patients’ brains. For the last two and a half decades, I’ve been looking every day, and it just changed everything.

TS: So I don’t quite understand. Why would a psychiatrist not want to look at brain images? Why has this not taken over the whole field? I don’t get it.

DA: Yes, me neither. I still struggle with, “So why—what’s the problem?” I’ve come to a couple of conclusions. One, it’s not what they’re trained to do, and doctors don’t do what they’re not trained to do. Two, it doesn’t match the diagnostic Bible. So the [Diagnostic and Statistical Manual of Mental Disorders]—whatever version you want to think about, III, IV, or V—is based on symptom clusters, and when you look at someone’s brain, all depressed people are not the same. All ADD people are not the same. All demented patients are not the same. And because it doesn’t fit the preconceived paradigm, people said it wasn’t useful.

It was then I said, “Well, that’s exactly why you do it, because not everybody responds to Prozac or Wellbutrin or Effexor or Lamictal or whatever. You need a map to guide you.” It’s been a little bit of a food fight.

Now, I’m not the only one that does it. I mean, there are dozens of us who use imaging. But it’s clearly not the standard of care, and trying to shift a big profession of 40,000 people is sort of like trying— it’s not trying to move a speedboat, where you can just turn it around. It’s where you’re trying to move the big ocean liner, where it takes a long time.

TS: Mhm. Well, I know in becoming familiar with your work—somewhat familiar—in preparation for this conversation, one of the things that came up for me is I would love to see what my brain looks like. I mean, you mentioned wanting to see the brains of potential suitors for your daughter, and this idea of “brain envy”—getting excited about what your brain might look like and making it healthier and more beautiful. You said “Younger, fatter, and healthier,” and I thought, “Hmm, do I want my brain to be fatter? That’s interesting. Might be the only part of my body I want to be fatter.” I’d love it if you could explain that, but that’s a little bit of an aside. My question is: how do I get to see what my brain looks like? I want to do that.

DA: Well, if you could come to one of our six clinics, we’d be happy to scan you and see what your vulnerabilities are, and give you a very clear program to make it better. There are other people that do it—and there are different kinds of studies. At Amen Clinics, we do SPECT, which is a nuclear medicine study that looks at blood flow and activity. We also do another study called quantitative EEG, that looks at the electrical activity in your brain. There are many more people that do quantitative EEG because it’s a much easier procedure to learn and much less expensive for a practitioner to put in their office. So, those would be some of the options you’d have available to you.

The part I love about imaging is when you look, you then get connected to your brain and you then start to treat it better. You then start down this path of brain envy, and by making it fatter—60 percent of the solid weight of your brain is fat, so if someone calls you a “fathead,” say thank you! One of the big things we’ve learned in neuroscience in the last 20 years is you can grow your brain. Your behavior shrinks it—smoking, alcohol, much marijuana, being in a mold-filled home. Or you can make it bigger—the right diet, exercise, new learning, some simple supplements can just make a radical positive difference for it.

TS: You know, the access to brain imaging technology—I brought that up because I am genuinely curious and I think anyone who gets deep into your books would probably also feel curious about what their brain looks like. But also, because when you talk about this revolution and how we’re dealing with a barge when it comes to the field of psychiatry, it seems to me that access—easy, affordable access—to brain imaging studies would be part of the kind of revolution in health care that you’re talking about.

So what I’m curious about is if you could paint a picture for me—not just in terms of psychiatry, but the whole entire revolution that you can see happening as a result of brain imaging technology—what that would look like to you. I see you as a real visionary, and so I’d love for you to paint the vision for me.

DA: So, when I first started doing imaging, I loved football. I played in high school, and it’s just like a crazy fad. And then I started looking at the brains of people who played—high school, college, and then later on professional—and I became horrified by it.

But if you never look, you never know. In 2009, Amen Clinics did the world’s first and largest study of active and retired NFL players, showing high levels of damage—actually, [that was] the time when the NFL was in denial [that] they had a problem. So it is through the lens of imaging that has changed the conversation [completely] in our society that contact sports can cause long-term brain damage for children.

So, the vision is to use imaging to uncover what makes us better, what makes us worse, and shift the conversation away from, “Oh, he’s bad,” to, “Perhaps he’s sick.”

The same thing is true with the death penalty. So if we take some really huge societal issues, from traumatic brain injury in sports to the death penalty—I actually had no opinion before 1991 on the death penalty. I just really hadn’t thought about it. But if people heard about my imaging work, they would send me people who did bad things. So, we’d scan 90 murderers [and] about 500 convicted felons. And then I would end up in a courtroom on the witness stand explaining to juries the damage in the defendant’s brain.

I read a quote from Dostoyevsky [about how] you can tell about the soul of a society not by how they treat their wealthy citizens, but by how they treat their criminals. And it was just like a light went on in my head—“Oh, maybe we shouldn’t be killing sick people.” Because when you look at their brains as a group, they’re very disturbed, very damaged.

Now of course, that doesn’t mean you send everybody home because you have to protect the brains of the people in the general public. But, shouldn’t we be rehabilitating their brains so that when they got out, if they did—most people go to jail and get out—they’d be able to actually hold a job, support their family, pay taxes? But that was really the conservative idea—investing in people so that you get a return. I’d have never had that thought without imaging.

The other huge thought imaging caused me to look into the future is I published these studies that say as your weight goes up, the actual physical size and function of your brain goes down. Think about that. As your weight goes up—two thirds of us are overweight. One third of us are obese. As your weight goes up, the size and function of your brain goes down. It’s the biggest brain drain in the history of the United States, and it’s directly tied to the terrible diets we eat.

So, from sports to jail to nutrition, imaging really changes everything because it’s the moment-by-moment function of your brain that determines the quality of your decisions—that ultimately determines the quality of your life.

TS: Dr. Amen, you’ve said some big things here. So, I want to follow up. Let’s starts with sports. Do you think that it should just be illegal to play sports that create traumatic brain injury?

DA: You know, I’m not sure about illegal, but I think people should know the risks. I mean, you can’t make everything illegal, otherwise you’d be making racecar driving illegal; you’d be making skiing illegal; you’d be making football, hockey, soccer illegal. But I don’t think people are aware, [and] now it’s happening. And I think actually, five years from now—only five years from now—if you allow your child to play football, it’ll be like you’re allowing your child to smoke. The damage from football is worse than smoking. So, the level of consciousness is going to go way up and ultimately, even though the NFL won’t go away, the thoughtful parents are not going to let their children play.

TS: What do you think—I mean, this is venturing a little bit outside of your work looking at brain imaging scans, but I’m curious because I know you’ve thought about this—what do you think about the casual spectator who says, “Yes, I know it creates traumatic brain injury and that’s problematic, but I love watching football on Sunday. I just love it.”

DA: Well, it’s sort of like you know boxing causes brain damage. I mean, we’ve known that since the 1930s. But who didn’t watch Muhammad Ali in his prime? It was an event. But it also shows that there’s something off with our society, and maybe with our species, because watching people become mauled is not a new sport. It’s an old, old, old sport.

TS: Now, you mentioned soccer as well, and before I read your book, Change Your Brain, Change Your Life, I hadn’t really thought about hitting the ball with your head as being risky. But it sounds like it is.

DA: So, your brain is really soft. It’s about the consistency of soft butter, tofu, custard—somewhere between egg whites and Jell-O. Your skull is really hard. If you looked at the inside of the skull, you would see that the skull has sharp, bony ridges. Your brain and your skull were not made or evolved to play football, hockey, or hit soccer balls with your head. It damages it.

So, when you understand the physics, you cannot make a helmet to make football safe. It’s impossible, because the brain will rattle whenever the head is stopped quickly. And when you hit a soccer ball with your head, it causes your soft, Jell-O-like brain to slam up against the ridges in your frontal lobes and around your temporal lobes, and it can rip blood vessels, scar brain tissue, cause axons to break, and there’s just no way to get around that. And if you love yourself, if you love your child, it’s not a rational thing to allow them or yourself to do.

TS: I hear what you’re saying, and I’m imagining a certain group of people who might be having the thought, “Dr. Amen is taking all the joy out of watching certain competitive sports for me. You’re not my favorite person, Dr. Amen.”

DA: Right, I get that. So, we actually have a high school course. It’s in 42 states and 7 countries and I’m so proud of it. And we teach ninth, tenth, eleventh, twelfth graders to love their brains. I think it’s in week four [that] we talk about all the things that can hurt your brain, and traumatic brain injury is one of them .And invariably, a smart-alecky teenage boy will raise his hand and say, “Well, how can you have any fun?” And so we do this exercise called “Who Has More Fun”—the kid with the good brain, or the kid with the bad brain? Who gets the girl and gets to keep her because he doesn’t act like a jerk—the kid with the good brain or the kid with the bad brain? The kid with the good brain. Who gets into the college they want to get into? Who gets the best jobs, makes the most money, takes the coolest vacations, has the most meaningful, consistent, productive, happy lives—the kids with the good brains or the kids with the bad brains?

And I would argue based on my experience with over 100,000 scans that when your brain works right, you work right. And when your brain is troubled for whatever reason, you’re sadder, sicker, poorer, less successful in everything you do. If we could globally create brain envy, our society would be better. It is the organ that runs our souls—our intelligence, our personality, our character, and most importantly, every single decision that we make. So, do I feel bad that Pop Warner’s gone down nearly 50 percent in the last five years? Absolutely not!

I have this great story: one of my clinic directors in Atlanta—[we have] six clinics around the country—her son was playing football, and he had a concussion. He came in, we scanned him, and his brain looked awful! So she said, “It’s not my choice, it’s your choice whether you continue to play.” And he stopped—and what he said is, “I love football, but I am going to love my future family more than I love football. I want to be a good husband and a good dad.” So that’s really the choice that we have, is—the superficial thing is, “Well, how can I have any fun?” But I think the real question is, what do you want your life to look like? Who do you want to be? And does it require healthy brain function to get you to where you want to go?

TS: OK. So, when we talked about the social revolution that brain imaging technology might really catalyze, you started by talking about sports, then you talked about people on death row and people in jail, and you said, “Let’s rehabilitate their brains.” And I’m sure you’ve gotten this question from people: how expensive would that be? How complicated is that? Do we really want to start by rehabilitating the brains of prisoners?

DA: Well, that would be the cost-effective thing to do. And it’s so funny, because cost always comes up. Nobody asks the other question, “What does it cost not to do that?” It costs $35,000 to house somebody in prison for a year. So, what if we could cut their expenditures in half by spending less than $10,000? Would that be a good financial trade-off?

I funded my NFL study. We scanned and treated 178 players, and these are people who had serious brain damage—many of whom hadn’t been to prison, many of whom who were suicidal. A very high percentage were depressed. They’re expensive people.

By using scan-guided treatment—and the treatment we use, because we were paying for it so we wanted to use the most cost-effective treatment we could find [laughs]—we taught them how to eat right. We taught them how to exercise. We taught them how to not believe every stupid thing they thought. We ran an NFL weight loss group, because you heard me say as your weight goes up the size and function of your brain goes down. Then we put them on a very sophisticated but simple group of supplements.

Then we re-scanned them again, at about an average of six months later. Eighty percent of our players showed improvement in things like memory, mood, sleep, motivation. We were like little kids, so excited. We ended up publishing that study—you’re not stuck with the brain you have, you can make it better. And it’s not terribly expensive.

It’s more expensive—you know, if you don’t have that mindset, you think the couple of thousand dollars you spend for the scan, [gasps] “Oh my God, that’s so expensive, I don’t have access to care.” Then you’re like, “But what does it cost to not do that?” It’s really how you think about it. It ends up to be a very cost-effective tool.

TS: Now, how tailored to an individual is your advice when you’re talking about things like nutrition and exercise and working with negative thoughts? It seems like we all need to do that—we know we need to change the way we eat, get regular exercise, et cetera. How does the brain scan help you tailor what you’re saying to an individual?

DA: I think generally the diet recommendations, the exercise recommendations, and not believing every stupid thing you think—that really works for everybody. Where it becomes tailored is, “Well, what’s my brain like?”

So for example, I’ve written whole books on seven types of ADD, seven types of anxiety and depression, six types of addicts, five types of overeaters. If you don’t have the scan, you end up putting people on the same treatment for categories like ADD, anxiety, depression, addiction, [or] obesity when they’re wildly different.

So, let’s just take two people who are overweight. One is what we would call an impulsive overeater. They have low function in their frontal lobes, so the brake in their brain doesn’t work right. And another one would be a compulsive overeater—their frontal lobes actually work too hard and they can’t get away from the repetitive thoughts about food. So, one brain doesn’t work hard enough, one brain works too hard. One brain they need to stimulate, another brain they need to calm down. If I gave everybody a stimulant—which is what they often do for people who are overweight, give them something like phentermine to knock off their appetite—it would help the impulsive person, but it would make the compulsive person more compulsive. Am I making sense?

TS: You are! You’re making a lot of sense, yes.

DA: OK. So let’s take the compulsive person. Let’s just assume—take depression. And one person’s frontal lobe is low, the other person’s frontal lobe is high. Now, let’s put everybody on Prozac.

So Prozac is an SSRI—it raises serotonin. And what serotonin does is it calms your frontal lobes. So, if your frontal lobes are busy and we calm them, so now you’re not thinking about food all the time and you’re not thinking about all the negative thoughts. So, it can help that person.

But what if we gave that to the impulsive overeater or the person who’s depressed that has low frontal lobes? If I relax that person’s frontal lobes, I’m going to actually not—they won’t just have a weak brake, they may have no brake, and I can disinhibit them. All of the sudden they’re eating everything in sight, they can’t control their behavior, their temper becomes out of control.

My favorite patient to explain this is the wife of a pastor who went to her doctor and said she was depressed and the doctor put her on Prozac, and she felt better in a few days. And then two weeks later, she’s like, “Oh, I feel so great, I’m so happy,” and she’s at a stoplight. This is the wife of a pastor. A guy pulls up in a pickup truck, and he winks at her—which is not unusual because she is a pretty woman. But what happened next is really unusual—she unbuttoned her blouse and showed the man her breasts! And then finally her frontal lobes kicked in like, “What the hell are you doing?” And she sped off as this poor man tries to follow her!

She ended up seeing us, and when we scanned her, she had low frontal lobes, and the last thing you want to give to someone who has low frontal lobes is an SSRI which will lower them further and disinhibit them. There’s a reason that medications—almost all psychiatric medications—have black-box warnings. It’s not that they’re bad, it’s just that they’re not right for everyone. And how would you know if this is right for this person or that person if you didn’t have a map?

TS: Yes. I mean, I think this kind of goes back to where our conversation started, because here I’m new to your work, Dr. Amen, but I did immerse myself a bit in preparing to speak to you, and what I got was: why would any health care professional go forward without looking at a brain scan? And here you’ve written 10 bestselling books, so obviously you’re having a big influence on the culture, but yet it seems like the uptake here is slow compared to what you’re offering and the promise in your work. So, what is this force moving against you? I don’t get it.

DA: It’s funny, it’s been one of the most confusing, frustrating parts of my life over the last 25 years. Why wouldn’t we want to do this? And they’ll go, “Well, the cost.” And I’m going, “Well, OK, so what’s the cost of not doing it?” There was a study published in 1993 that it cut hospital stays by more than half if you scan someone.

OK. So it’s not really the cost. [Maybe] it is the radiation—there is some radiation. But you know, it’s the same as a CT scan that they order hundreds of thousands of times every day across the US. OK, so it’s really not the radiation.

It’s the mindset. It’s, “I have to learn something new and completely change what I do,” and it’s sort of a big learning curve. It’s, “Not only do I have to understand what the scans mean, I have to treat my patients completely differently. When I became a psychiatrist—so, in 1982, I began my psychiatric residency. Psychiatrists have an hour with patients. We could sit and talk to them and get inside their heads and their lives. In the early ’90s, when managed care came out, it really took the legs off of high technology in medicine. Psychiatrists all of the sudden became med-check doctors.

So, “Oh, [we have] 15 minutes. Try this, try that,” and you’re throwing darts in the dark at people. It completely changed the financial incentive of my profession, and getting to know people really changed to psychologists, marriage and family counselors. So there was really no incentive for them to begin to change the paradigm.

Unless I’m crazy and a charlatan, my work completely changes the paradigm of mental health treatment. In fact I often say, “Nobody really wants to see a psychiatrist. No one wants to be labelled as crazy, abnormal, or defective. But everybody wants a better brain.” What if mental health was really brain health? That’s the revolution that my work leads us to. We’ve been wrong, and it’s sort of a fraud to think we can diagnose people based on symptom clusters.

By the way, there’s this new article out today that Alzheimer’s disease may actually be caused by a virus. What I would say about Alzheimer’s disease is it’s not one thing. We’ve just completely missed the boat because we don’t look. Is it the result of multiple head injuries, as with CTE and NFL players? Is it an infection? Is it mold exposure? Is it anoxia from sleep apnea? And when you look, you just get all these amazing ideas and trails to follow to help people. We actually do a formal outcome study on everybody we see, and we have the highest outcomes of anybody who publishes them. The reason is we look.

I don’t know if you saw the piece on me—I mean, there’s certainly plenty of hate pieces on me—but Discover Magazine in January published the top 100 stories in science for 2015. And number 18 was the Tesla’s new battery that everybody’s really excited about. Number 20 was the discovery of a new dinosaur species, the Chilesaurus, which is a vegan dinosaur. And number 19 was my work, where we published a study showing we could distinguish post-traumatic stress disorder from traumatic brain injury in 94 percent of cases. We got that wonderful honor, and yet still most psychiatrists will go, “Oh, you had a brain injury, so do this,” or, “Oh, you have PTSD, so do that,” without any biological information. And it’s crazy.

TS: Now, we’ve been talking about how once you have this image of someone’s brain that they can go through a rehabilitation—a change process—and of course that brings up how malleable really is this soft butter, tofu-like substance of our brain? How malleable is it, really? The word “neuroplasticity” has entered the culture. I think people now have this idea, “Yes, we can change our brain, but how much can we change our brain?”

DA: Well, I think the easiest way to understand it is: can you make your brain worse? We know, for example, if you start on benzodiazepine, Xanax, Ativan, Klonopin, Valium, it increases your risk for dementia. That alcoholic dementia is probably the second most common cause of dementia. We know this now—repetitively hitting your head can increase your risk for CTE, psychosis, aggression, incarceration, dementia. So we know, without a shadow of a doubt, we can make our brains worse.

[With] my imaging work, without a shadow of a doubt, I can make your brain better. If I get you to eat better, your brain’s going to start working better. If I get you to stop smoking and stop drinking and stop smoking pot or thinking of marijuana as good medicine, your brain’s going to start functioning better. If I get you to exercise—I get you to do mental exercise, if I give you omega-3 fatty acids and multiple-mechanism supplements, your brain’s going to function better. And sometimes it can function better the next day.

Now, nobody stays better if they just do one thing, one day. But if you do the right things over a year, your brain can be significantly healthier in that period of time. I’m so excited about that. That’s really what has kept me motivated. I don’t own any patents on imaging, right? So imaging will never make me rich. I was a busy psychiatrist before I ever did imaging. I actually wanted to be a writer—that was my goal when I graduated from medical school—to be a good psychiatrist and a writer. The imaging was never about money. It was about, “Well, how do I do this if I don’t look?” My goal is always to improve the outcomes of the people I serve.

TS: OK, Dr. Amen, before we end our conversation, there’s a couple of other things I really want to touch on. One is the whole area of spirituality, and what I mean by that is connecting to something mysterious that gives us a sense of infinity or eternity or timelessness. I’m curious: in your understanding of the brain, is there a certain part of the brain that’s responsible for this spiritual connection? Can we reduce our spiritual connection to an aspect of brain function, in your view?

DA: Probably not. People who believe in God actually have a larger right temporal lobe. I always thought that was interesting, because many scientists would think they’d have a smaller right temporal lobe. I’ve done studies on people who channel, including the Long Island Medium, which was pretty interesting.

Whenever I do an evaluation with somebody, I always look at their lives in four circles. I look at the biological part of their life—how does your brain function, what’s your family history, how is your diet/exercise, [whether you have] had a brain injury or infection, exposure to some sort of environmental toxin. So I look at the biology.

I also look at the psychology, or how you think and your development. And I look at the social circle—who you hang out with, because that really does matter; your habits become like the people you hang out with. The fourth circle is the spiritual circle. It’s why are you here, why do you think you’re here? Why do you care? What’s your deepest sense of meaning and purpose? When people tap into that, they get better faster.

It’s often associated with the right temporal lobe. When we stimulate that part of the brain, people have a sensed presence—they feel the presence of God in their lives in the room. So, from a neurological standpoint, people talk about the right hemisphere—non-dominant hemisphere—especially the temporal lobe area. But it’s so much more than that.

I wrote a book once called Healing the Hardware of the Soul, and argued that if you believe your decisions get you to heaven or take you to hell, you really want to take care of your brain because the front part of your brain is all about decision-making: forethought, judgment, impulse control, organization, planning. If you can’t see the future and then make decisions that are consistent to what you want or where you think you should be going, it puts you literally in hell on earth. You’re trapped in a potential that’s less than what you want or hope for, or feel like you’re destined for. And I can see how your frontal lobes function [and] can we make them better?

Another one of the many things that hooked me was when I could see it and I could show it to my patients, the concept of forgiveness just skyrocketed. I had one boy from China who came to see me, and he was very resistant to treatment and was struggling in school and with his temper. And he had birth trauma, and I could see it. When he looked at the scan and at his mother, he started to cry and he said, “It’s not me. It’s what happened to me.” And that was just such a precious moment, because it allowed him to be free of the condemnation that he had brought upon himself.

TS: Now, you mentioned something interesting where you tied spirituality to our sense of purpose. I’m curious how you made that link—how that links up for you.

DA: People who have a sense of purpose live longer. There are a bunch of studies that correlate that. For me, spirituality is not just, “Do I believe in God?” but it’s, “Why am I here, and am I living a meaningful, purposeful life?” When I can get my patients into that—what I call “spiritual circle”—they do so much better. But without that, there is a sense of hopelessness, of selfishness. You know? It’s all about the moment.

It’s funny, I saw your website—Eckhart Tolle’s work. And I love his work. I love The Power of Now, except I hate the title, because it’s the power of now that kills people. They’re not thinking about five years from now, ten years from now, if I eat this, [does it] serve me or hurt me? I want us to have the power of all the moments so that it’s not just about now. I mean, I understand his work and love his work and it was actually very helpful to me at one point. But I need to be thinking about—I’m 61. I need to be thinking about what my life’s going to be like at 90, and make appropriate decisions so that it’s not like every other 90-year-old who has a 50-percent risk of being diagnosed with Alzheimer’s disease. But if I make good decisions now, my life is going to be better then. If I make bad decisions now, I’m going to be dependent on somebody I don’t want to be dependent on if I’m not dead.

TS: Which brings me to a statement that you made in your Change Your Brain, Change Your Life book—“Brain aging is optional.” I thought, “Wow, most people probably don’t believe that,”—that brain aging is optional. They think that, “As I get older, I will have memory loss, et cetera. There will be a cognitive decline. It happens, I saw it happen to my parents, grandparents, et cetera.”

DA: And I believe it is definitely related to the quality of your habits. We’re doing work with Dale Bredesen at UCLA. We actually published a study showing you could reverse Alzheimer’s disease in a significant percentage of patients. How did he do it? He did it by eating all the right things! It was habit-driven. So your habits today can accelerate the aging process or they decelerate it. Just look all around and you see what people are doing.

I have a new book coming out in November with my wife, Tana called The Brain Warrior’s Way, and it’s because—through the imaging work and then I see all the things that hurt our brains—we’re in a war. Everywhere you go, someone’s trying to shove bad food down your throat, put a toxic thought in your head, give you a gadget that steals your attention. The human attention span is now eight seconds. A goldfish is nine. I mean, this is truly evolution going the wrong way! But if you’re armed and prepared, you have a choice in how fast your brain ages.

Did you know that 50 percent of the US population is diabetic or pre-diabetic? It’s a disaster when you think of what diabetes does to the brain. It prematurely ages your brain and triples the risk for Alzheimer’s disease. Is that a choice? Type I diabetes is not a choice—it’s an autoimmune reaction. Type II is totally a choice! It’s related to obesity, to high-sugar diets, to inflammation that we can control. That’s what I want to teach people in Change Your Brain, Change Your Life and the other things I do is—if you love your life, if you have a reason to live, you need the energy and brain health to take you there. Love and care for it. And it’s not hard.

I have this great story I tell in the new book. I was at a conference a couple of years ago, and I guess maybe I’m just not that much fun. [Laughs.] I mean, I think of myself as fun, but I’m at dinner with one of my close friends who has diabetes, and he’s injecting himself with insulin at the table. When I watch what he ordered for dinner, it just irritated me. So I said, “Mark, how tall are you?” He said, “I’m six feet.” I said, “How much do you weigh?” “245.” And so I took out my phone and I calculated his BMI or body mass index, which was 33. I’m like, “Dude, you’re obese.” And he’s like, “Daniel, you’re so cold!” And I’m like, “Buddy, not nearly as cold as you’re going to be when you’re buried six feet under the ground prematurely and you abandon your wife and your grandbabies!” [Laughs.] So we had a very interesting conversation.

And it was this past September—we’re at the same conference two years later—he just looked fabulous. And I’m like, “Mark, what happened?” He said, “I’m so grateful to you, because you loved me enough to have a hard conversation with me.” And he was down 53 pounds. I said, “So, was it hard?” And he said, “Not at all.” He said, “Being sick is hard. Having pain, having a lack of focus, having decreased energy, having no libido—” and his wife was there, and I was almost getting embarrassed, and they were telling me about their sex life! I felt so joyful for him.

There’s a verse in the New Testament, John 8:32, “Know the truth and the truth will set you free.” And that’s what imaging has done for me. It has given me the truth about brain health that I’m blessed enough to share. I never want to hurt anybody’s feelings, but I want you to know the truth. If your habits are bad, it’s hurting you, and it doesn’t just hurt you. What we didn’t talk about is epigenetics, which is your habits turn on or off certain genes that make illness more or less likely in you if it’s true, but also in your children and your grandchildren.

So, your habits are passed along by the etchings in your genes, so that if a mom and dad eat badly even before they’re pregnant, it changes the genes in her eggs or his sperm and passes illness on to the next generation. So if you think that 50 percent of us are diabetic or pre-diabetic, two-thirds of us are overweight, a third of us are obese, 60 percent of us are hypertensive or pre-hypertensive, this is a freaking epigenetic disaster that our children will never be able to afford.

TS: Let me ask you one question though, [Dr. Amen]. In your own life, in seeing habits that you needed to change, did you ever find yourself struggling? Like, “Gosh, I know the brain scans are showing this, but I’m not actually making the habit change I know I should be making.” Has that ever come up for you?

DA: So, the big “aha” for me—because I was not sleeping because I had so much to do. And then I’d read a study that said that if you get less than seven hours of sleep at night, you have lower overall blood flow to your brain. Then I got serious about that. I don’t think I’m actually really all that intelligent, but I think I’m really practical—I would never purposely do something to hurt myself.

But I always carried like 20, 30 extra pounds. I’d try this and try that but really wouldn’t stick with it until I read a study from the University of Pittsburgh that said as your weight goes up, the size and function of your brain goes down. And then I looked at my own brain scan data, and we looked at our healthy group—overweight versus healthy weight—and they had less brain function, the overweight people. That’s when I got really, dead serious. I’ve been pretty much at my high school weight ever since.

And I’m plenty vain—I like being in the same size jeans I was in high school, I like that. But what I really like more is I’m not purposely doing things that damage myself. Am I perfect? No. Am I really good? Yes. And I like that.

Maybe just one more story if you’ll allow me?

TS: Yes.

DA: It’s my Christmas story from last year. So, about a year ago, my dad—who was difficult for me. I love him to death—he’s a highly accomplished, amazing person, but he was always sort of irritating for me. In 1980 I told him I was going to be a psychiatrist, and he asked me why I didn’t want to be a real doctor. So he’s not terribly psychologically minded.

Then when I started to get really healthy after the imaging work, he’s now making fun of me and calling me a health nut. But I would nudge him because I love him. “You need to get healthy, come on, let’s do better.” And he would just [say], “I could never give up the bread, I could never give up the sugar.” Then he got sick and he had heart disease—which was quite ironic because he used to always say, “I’m not going to get a heart attack, I give heart attacks.” [Laughs.] So you sort of begin to get my Dad.

TS: Yes.

DA: Then he had heart failure and he got sick. He was still working at 86, but he had to stop going to work. He couldn’t drive anymore. He was literally in a chair for five months, tired and depressed. And he looked at me one day and he said, “Danny, I’m sick of being sick. What do you want me to do?”

And he just did everything I asked him to do. He ate right, took the supplements, we scanned him, and he fell in love with his brain. And his stubbornness—he just did everything right. He’s texting me labels, and within about three months his energy came back, and then he started to drive, and now he’s fully back to work. I go over to his house and we lift weights twice a week. He’s lost 40 pounds, his energy is way up, and my promise to him—he’s 87—is, “Pop, you will be better at 90 than you were at 60. You just have to make good decisions.”

TS: Dr. Amen, you inspire me. Thank you. Thank you so much. Thank you for your work and for your courage to be a pioneer and also to commit to your own health and the health of all of us—to each other, to all of us who are having an opportunity to change and be inspired. So thank you. Thank you so much.

DA: Thank you for the opportunity to share my work with you and the people who depend on you.

TS: I’ve been speaking with Dr. Daniel Amen. With Sounds True, Dr. Amen has created a series of audio learning programs, including Dr. Amen’s Change Your Brain Workshop; Relaxation, Focus, and Memory Training with Dr. Amen; Supercharging the Female Brain; and a program called Unchain Your Brain: An Audio Program for Breaking the Addictions That Steal Your Life. Dr. Amen will also be participating in Sounds True’s Neuroscience Summit, a gathering of 20 leading researchers, teachers, neuroscientists, and neuropsychologists on the ways we can change our brain to increase well-being. The Neuroscience Summit begins on May 10. Many voices, one journey. Thanks for listening.

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