May 15, 2024
Keeping your brain healthy with aging
Are you worried about your brain health as you get older? You're not alone. As we age, our brains naturally start to decline, but there are things we can do to help keep them healthy.
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award-winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now, here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Well, welcome everybody. Welcome to Docs in a Pod, I'm Ron Aaron. Docs in a Pod comes to you every week and we talk about a variety of medical issues involving folks who may be Medicare-eligible, and others and we're delighted to have you on board. We're available on the radio as well as via podcast and wherever you get your podcast, you can listen to the award-winning Docs in a Pod. Our co-host Dr. Tamika Perry is with us. Dr. Perry is an associate medical director and a physician at WellMed at Redbird Square in Dallas. She completed her master's degree at the University of North Texas Health Science Center in Fort Worth. Earned her medical degree at Philadelphia College of Osteopathic Medicine in, oddly enough, Philadelphia. She also earned her master's in public health from the University of North Texas. Dr. Perry's undergraduate degree is from Prairie View A&M University, and we're delighted to have Dr. Perry with us as always. Tamika, tell us about your brain because we're going to be talking about brain health and aging.
DR. TAMIKA PERRY
Well, think about your brain as the main frame and the main computer of your entire body. If you don't have a functioning brain, you may not have a functioning body. But I'm interested to hear what our guest says.
RON AARON
Well, let me introduce Dr. Kevin Shih. He's a physician at WellMed at McDermott in Plano, not far from you. He earned his medical degree from the University of Texas Southwestern Medical School in Dallas, completed his internship and residency at McGovern Medical School in Houston, and geriatric fellowship at Baylor College of Medicine, also in Houston. Dr. Shih specializes in internal medicine and geriatric specialties. Dr. Shih, it is great to have you on Docs in a Pod.
DR. KEVIN SHIH
Thank you very much, Ron, and thank you, Dr. Perry. Yes, today we'll be talking mostly about the brain and how to keep your brain healthy with aging. As you know, the brain is a very important organ of the body, controls a lot of functions, gives you emotions, gives you memories, gives you the ability to complete complex tasks and write checks and everything like that.
RON AARON
Actually, nobody writes checks anymore, Dr. Shih. I read a story the other day, the only one that's writing checks, and I don't mean to be sexist, but it turns out women write a lot more checks than men.
DR. KEVIN SHIH
Or if you're an online gamer, it lets you play online games. The brain lets you do many tasks and complex tasks.
RON AARON
Well, talk to us about what we ought to be doing as you think about brain health. Aging is something many of us assume our brains are just going to kind of become less and less functional, that we're going to slip into dementia, that that's an automatic going to happen, but that's probably not true.
DR. KEVIN SHIH
Yeah, so as you know, the brain is constantly developing while you're young, and until early adulthood. Once it gets to full size, it kind of stays that way. So, anything you may have learned thats probably going to be sticking with you in your brain after it's fully developed. But as you get older, you know middle age, geriatric age, multiple things can happen to the brain, just in regard to having a life and doing a lot of things, there can be injuries to the brain, like traumatic brain injuries that can cause damage to brain cells. People who drink a lot can have alcoholic brain damage. And then, of course, strokes and things like that as you get older, you worry about those causing damage. Poor blood flow to areas of the brain that caused the brain to die off. So, those are things that can impact the brain. But even if you avoid all those things as you get older, you're not immune to changes in the brain. The brain the neurons can start to malfunction. The most common cause of malfunction would be abnormal proteins of the brain come on the beta amyloid. This leads to what's commonly known as Alzheimer's disease.
RON AARON
I don't want to get too deep in the weeds. What are neurons?
DR. KEVIN SHIH
Neurons are basically the cells of the brain. They have connections that can connect to one or more different neurons. They send signals, electrical impulses to different neurons and depending on what part of the brain the neuron connects to it can send messages. It can send a message to your parietal lobe, frontal lobe a temporal lobe, and each one of those lobes does different things. Controls emotions, controls memories, controls processing step-by-step instructions, right and wrong, stuff like that.
RON AARON
All right, now hold on just a second. I want to let folks know who may have just joined us, you're listening to the award-winning Docs in a Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and our special guest today is Dr. Kevin Shih. He is an internist, a WellMed physician. We're talking about brain health and aging. Dr. Shih, are there foods that you recommend or suggest we eat as a way to keep our brain healthy? Are there exercises we ought to be doing in ways in which we can stimulate our brain? What should we do to keep our brains functioning at the top level that we all hope they do?
DR. KEVIN SHIH
Yes, yes. Keeping the brain healthy kind of depends on each individual person. Generally speaking, just having a good diet, nothing like too much cholesterol, that stuff can lead to cholesterol build up in the brain and lead to strokes. People with diabetes, if they kind of eat too much carbohydrates or sweets or cakes, their sugars can be high and that can also lead to brain dysfunction, maybe strokes. But in general, just having a good diet, a balanced diet with good portions, proteins, things like that, would help with the brain. You just mainly want to watch out for things that can hurt the brain. Alcohol is a big one. You don't want to drink a bunch of alcohol. That can lead to low B12. Low vitamin B12 can impair brain function as well. It is a component of neurons and alcohol itself is harmful to neurons, too. Having a low-salt diet would be beneficial. If you have high blood pressure, you want to control that blood pressure over time. Blood pressure can lead to damage to the brain, poor blood flow, areas of damage. Those few things I think are a good start for any patient who wants to see what things they can change in their diet to preserve brain health.
RON AARON
Dr. Perry, I know you've done a specialty in obesity when you hear Dr. Shih and I hear Dr. Shih talking about, well, eat a good diet. Give us some specifics on the kind of foods we ought to be eating and maybe foods we should try to either minimize or avoid.
DR. TAMIKA PERRY
Oh, absolutely. The brain is what's called a glucose conglomerate. Dr. Shih talked about those things called neurons before, those connections that send messages. Those neurons need good, healthy glucose, and you can get that from fresh fruits and vegetables. I think one of the things that's interesting, Ron, these blue zones in the world where people live over a hundred. One of the dietary commonalities that they have is they have a diet that's high in fresh fruits and vegetables and low in processed foods that are high in fat. So, I mean, Dr. Shih would probably agree, there's plenty of studies that directly correlate Alzheimer's, dementia, to these high in-fat, processed foods are related to a plethora of brain disorders and deterioration of the brain. If you have to get your food out of a window and they hand it to you in a paper bag, it's probably not what you want. You want to go into the store or the farmer's market. It should be colorful, you should be able to smell it, taste it, feel it and when you put it down it should not leave a greasy residue on your hands.
RON AARON
It's interesting, there's a drive thru that our kids like going to, and I'll pick food up for them, and now, because of changes in law, and it's a good thing, have to put calories for each of the items that you get in that paper bag through that window. I was absolutely shocked when I saw that, for example, a kid's meal, which you would think, well, how bad could that be? It's 1,200 calories. That's more than a lot of people ought to be eating in a day, for kids.
DR. KEVIN SHIH
Kids better be six feet tall and 200 pounds.
RON AARON
I'm never going to have a six-foot-tall kid, I'm 5'5. Dr. Perry, somebody once said to me and Dr. Shih that what you want to look for on that plate of food are colorful items. So red peppers, green peppers. Does that make sense?
DR. TAMIKA PERRY
It does make sense. We're talking about a direct correlation with nutrients that are good for your body, particularly good for your brain, so yes, you want a colorful plate. You want a plate that has some good fats in it, and you want a plate that has good proteins in it, too. Tofu, lean fish, like salmon.
RON AARON
I love tofu.
DR. TAMIKA PERRY
Since the last time you told me you love tofu, I actually tried it and some Asian takeout, and I loved it. Youre right, it takes on the flavor of whatever you eat, so you cant lose here.
DR. KEVIN SHIH
Sushi, too.
DR. TAMIKA PERRY
Yes, which is another one of my favorites. I'm becoming a sushi connoisseur. Not quite there yet, but I think I'm on my way.
RON AARON
Now, what about exercise, Dr. Shih? I've got a good friend, Dr. Chris Thompson, who's a cardiologist, who says folks who are on a bunch of meds, could probably get off a whole lot of them if they engage in regular exercise. What do you think, Dr. Shih, when it comes to brain health?
DR. KEVIN SHIH
Yes, yes. Obesity is probably the biggest cause of a lot of these comorbidities, diabetes, high blood pressure, cholesterol leading to strokes and heart disease and things like that. Obesity, I think, would be the main common denominator for people to tackle. If they can really work on the weight, get good cardiovascular exercise. Not just walking around the neighborhood, but really get your heart rate up. Try to get your heart rate close to your maximum, maybe 80 percent of your maximum, that's good cardiovascular exercise. That will help shed some weight and lead to improvement in a lot of those issues, the sugars, the cholesterols, the blood pressure. If it works, then some people may be able to get off. Not everybody, but I think at least reduce the dose. Cardiovascular exercise is also good for blood flow. You want to get good blood flow to the brain, helps with brain nutrition, delivers oxygen to the brain. That will help the neurons function better. Also, obesity can lead to sleep apnea. That basically reduces oxygen intake at night and leads to poor sleep as well as poor brain regeneration at night.
RON AARON
All right, stay with us a minute. Now, for those who don't know, sleep apnea is when folks who go to sleep wake up frequently during the night because their throat is closing. They don't have enough oxygen, and they wake up, often with a big snort and then go back to sleep, and it can be very dangerous to your health. We're going to come back to Dr. Shih and our co-host Dr. Tameka Perry, I'm Ron Aaron. You're listening to the award-winning Docs in a Pod.
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RON AARON
Well, thank you so much for staying with us right here on the award-winning Docs in a Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry. We're talking with our special guest today, Dr. Kevin Shih. Dr. Shih is an internist with WellMed at McDermott in Plano, and we're talking about brain health and aging. He mentioned just a couple of moments ago, sleep apnea. I've got a friend who had gone for a sleep study because his wife said, you're waking up awfully frequently during the night, we need to get you checked. It turns out Dr. Shih and Dr. Perry the sleep study showed he was waking up 60 times a night. Of course he had no idea. He then got on a CPAP machine. That's something that can reduce the frequency of sleep apnea symptoms, and he says he's doing great. Is that a story you hear often, Dr. Shih?
DR. KEVIN SHIH
Yes. People who are undiagnosed sleep apnea patients feel miserable, but once they start the CPAP, they feel like their sleep has completely done a 180. The reason is because, as you know, obesity leads to weight on the neck. The weight on the lungs, the weight basically forces the trachea and airways to be compressed. And really snoring is a method the body is trying to open those airways. So, people who snore very loud, most likely have significant compression and it's not just annoying to your spouse or anything, it is harmful to your body, harmful to your brain. If it closes too much at night, you do not get enough oxygen to the lungs. There's not enough oxygen circulating and then there's not enough oxygen circulating to the brain. The brain does a lot of processing. It processes the previous day's information; it helps form memories at night when you're sleeping. People have heard of REM sleep, and that's pretty much almost like your brain is awake, you're just not aware of it, and it's processing a lot of different things that happen. And, if you're not getting that REM sleep because of low oxygen, that can impair memories, you'll forget what happened the previous day. Harder to learn. People may be studying for a test, but then they forget what they read and do poorly on a test. Other things besides memory impairment are also, it raises blood pressure. When you're not getting oxygen, your body thinks you're choking. So, it increases adrenaline, tries to get the lungs pumping, gets a heart pumping. That adrenaline also will lead to higher blood pressure and can lead to worsening hypertension. So, people who have uncontrolled hypertension may also want to be checked for sleep apnea.
RON AARON
So, Dr. Perry, when you have a patient come in, maybe it's the first time you've seen them, and you start doing the intake, and you talk with them, and you ask questions. Do you try to probe, maybe they're a candidate for a sleep study?
DR. TAMIKA PERRY
We do. I think Dr. Shih and I both do, and one of the things we do, we look at the patients physical habit. Is there soft palate in the back of their mouth, low-lying? Do they have a thick neck? Are they obese or overweight? And then we look at their symptoms. Another thing that we pro for, if you come in for a specific complaint, like memory loss, or if you have a child and he's just not learning the way that you think he should learn. One of the things that we would do is to say, is this a patient who's a candidate for sleep apnea? So especially in the senior population, we want to attribute memory loss to the worst case scenario, but it could be something that is very, very fixable and treatable, like sleep apnea.
RON AARON
And Dr. Shih, you see the same thing with patients?
DR. KEVIN SHIH
Yes, patients who didn't have any energy, were lethargic, thought they were getting dementia. They were treated, and it just turned out that their brain was not getting a regenerative rest at night. And once they got treated, after a few weeks of treatment, they felt better. They didn't want to go traveling without their CPAP. They didn't want to sleep or take naps without their CPAP. It really became a constant companion and they felt way better. Of course, losing weight can help with that too.
DR. TAMIKA PERRY
The word apnea actually means stop breathing, lack of respiration. Ron, you mentioned snoring earlier. Snoring is the result of sound going through a small pipe and those small pipes being your airways. The louder the snore, the smaller the pipe, because of compression, most commonly from weight. Then when the pipe compresses, you snore to open up the airway because that adrenaline says, hey, hey, we're in distress. Take a big gulp, open the air where you snore it, and the cycle starts all over again. But during those apneic periods where you're not breathing, your brain gets no oxygen, your lungs get no oxygen, your heart has to work harder. So, it leads to the things that Dr. Shih was talking about. It leads to memory loss, congestive heart failure, worsening hypertension, et cetera, et cetera.
RON AARON
And as you think about that, it's not a given that as we age, our brains will become less and less functional, we'll begin to lose memory and life goes to what they would call hell in a handbasket. Is that foreshadowed for everybody, Dr. Shih, or are you suggesting that we can do a better job with brain health?
DR. KEVIN SHIH
Not everybody will develop dementia, but some of the figures and studies have shown that one in nine people over age 65 can develop Alzheimer's dementia. And right now, there's probably about 7 million Americans over 65 who have Alzheimer's dementia. So, from this statistic, not everybody will get Alzheimer's dementia or any other dementia. People will still probably have some sort of cognitive slowing trouble with short term memory or forgetting where they put the keys and things like that. Definitely not everybody will have dementia, but it can still have some memory slowing.
DR. TAMIKA PERRY
Yeah, the good doctor makes a great point. There are some normal processes for normal aging that come along with memory loss. Like right now, I need to dye my hair because we age on the outside, just like we age on the inside. So, if you were a person who never had to make a list before when you went to the store, and now you have to make a list. Or you were a person who never lost your keys before, and occasionally now you lose them. That's okay. But when we start to forget where you live. You forget that your 40-year-old son is not 18 and you're asking them to come into the house before the streetlights come on. If these are things that you forget, then we get most certainly more concerned.
RON AARON
A friend of mine who's a psychiatrist said to me that the way to understand if you've got a serious potential problem is if you lose your keys and then you find them, and you know what to do with them, you're probably okay.
DR. TAMIKA PERRY
Correct. I've had patients tell me they've gotten to a stop sign, didn't know where they were going or where they were at. And then, maybe a few minutes later, they remembered. Now that's a little bit more concerning to me than I lose my keys a lot now, but I found them and I'm fine. Dr. Shih, have you seen the same thing in your practice?
DR. KEVIN SHIH
Oh, yes, yes. I have some patients who will misplace things and they find it, or they go into a room and they forget for a second, but then recall the purpose. That's perfectly normal. I have some patients who put their meal in the microwave and walk away and forget about it, or they put something like their wallet in their fridge or something like that. That is a red flag of additional testing that needs to be done. Make sure it's not something reversible. And if it is constant, progressive, and worsening, then dementia and other types of dementia should be assessed and ruled out.
RON AARON
Dr. Perry and Dr. Shih, do you find it that patients are willing to tell you they're having these problems? Or does it turn out to be a caregiver or relative who says, hey, mom's not functioning the way she used to.
DR. TAMIKA PERRY
In my experience its probably 20 percent patient because a lot of times the patients will make excuses for it because they're scared of what they think is inevitable. The other 80 percent is the family or the caregiver saying, look, something is going on here. And I don't want to think this is a sad story that we're telling here. Just like we do exercises for our body, we can do mental exercises for our brain and help keep them young. Those neurons like to do things like play chess, play checkers, engage with other people socially. This helps keep the memory strong. It helps those neurons make connections where we have to think crossword puzzles, where we're thinking about things. It's like weightlifting for your brain, so I highly recommend this, not only for my seniors, but all populations.
RON AARON
And Dr. Shih, we got a little over a minute left. As you think about brain health and aging, what are the things you tell your patients when they come to see you about how to maintain a healthy brain?
DR. KEVIN SHIH
I tell them to stay active, try to learn something new, keep it engaged. One thing that has been shown to not really reverse, but at least slow symptoms would be having more knowledge. If you have more, that means those connections are better and it will take a little bit longer to lose those connections. So, engaging, not just watching TV. You want to think about things, do different tasks. Multitask, if safe. The brain does a lot of different things, so you want to make sure you hit different areas to get each area a workout. Then, of course, exercise is good for controlling blood pressure, getting blood flow to the brain. So, living an active lifestyle is good.
RON AARON
That's perfect. Dr. Perry, I'll give you the last word today. What do you share with your patients?
DR. TAMIKA PERRY
Very similar to the good doctor here. Healthy diet, exercise, and mental and physical exercise. Don't discount that crossword puzzle in the paper.
RON AARON
The New York Times crossword puzzle. You do it every Sunday?
DR. TAMIKA PERRY
You know what? Maybe I should go see Dr. Shih because I attempt, but apparently my vocabulary isn't that big.
RON AARON
All right. I got to stop you there, we are flat out of time. Our co-host, Dr. Tamika Perry, thank you so much. And Dr. Kevin Shih, loved chatting with you. We'll get you back right here on the award-winning Docs in a Pod.
OUTRO
Executive producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed.
We welcome your emails with suggestions and comments on this program at radio@WellMed.net. Be sure to listen next week to Docs in a Pod, presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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